Poisoning and Its Treatment

A poison is a substance which, by its direct action on body tissues or its action after absorption into the circulation, injuriously affects health or destroys life. It has no rigid legal definition, and is accordingly referred to in law as 'a poison or other destructive or noxious thing'.

Many substances in common use in the house and garden, as well as in factories, workshops, and farms, are extremely dangerous if not properly handled. When to such substances are added the contents of a domestic medicine chest, including medicinal substances prescribed for a member of the family, it will be seen that some knowledge of the properties of the commoner poisons and the methods of first aid used in treating people who suffer from their effects is of value to a householder. This is true particularly when there are young children in the house.

Routes of Entry

A poison can enter the body by a variety of routes. The commonest are by ingestion (swallowing), as with aspirin, and by in-halation, as with poisonous gases. Absorption through the skin after a poison has been spilled on clothing is now not uncommon. Absorption through the delicate membranes which line the rectum and vagina is a rare occurrence, though one which may have rapid effects. Finally, injection of a poison under the skin, usually by means of a syringe and needle, may rapidly produce poisoning in rare instances.

Successful treatment of poisoning depends not only upon knowing what type of poison has been taken or absorbed, but also upon knowing how much has been taken and by what route. Hence any external evidence such as a partly used bottle of tablets or pieces of plant material which a child has eaten should be carefully kept for the doctor to examine.

Individual Variation

Great individual variation occurs in the effects of any individual poison on different people. Persons who have an allergy or an idiosyncrasy to a chemical compound react violently to even small doses of it or slight contact with it. Those who, because of liver or kidney disease, are unable to get rid of absorbed substances from the body in the same way as normal people, may suffer aggravated poisonous effects.

To many substances people may acquire a tolerance which makes them relatively immune to the effects of doses which would kill an ordinary person. People who become dependent on narcotic drugs such as opium develop high tolerance; so do people who have taken small and increasing doses of arsenic, for instance, for long periods. Certain habits, such as regular high alcohol consumption, make a person more susceptible than usual to the poisonous effects of some organic solvents such as carbon tetrachloride and benzene.

All these variations in sensitivity make it impossible to judge with certainty what the reaction of any individual to a poison may be.

Acute v. Chronic Poisoning

A distinction must be made between acute and chronic poisoning.

Acute Poisoning. Accidental swallowing of a poison is an acute emergency, produces alarming symptoms without warning, and is followed as a rule by fairly rapid recovery if treatment is prompt and adequate.

Chronic poisoning produces vague illness which cannot be traced to any particular cause (such as a cold or other infection), and which is often extremely difficult for a doctor to diagnose. Exposure to lead and mercury compounds in the surroundings and in food is an example of how chronic poisoning may arise. An observant parent may find that several children show similar symptoms at certain times, or that a child becomes more out of sorts when he is doing something particular or playing with a certain toy.

Treatment of chronic poisoning is not as a rule very urgent; but the sooner it is under-taken the better since, if it goes on, permanent damage to body organs may result.

General Emergency Treatment

If a person becomes unwell soon after eating a meal, or in circumstances connecting him with a possible poison (for example if he is found unconscious with a bottle of sleeping tablets beside him), or if a child becomes unusually sleepy or is repeatedly sick without obvious cause, poisoning should be suspected, and quick action may then save suffering and sometimes even life.

1. Send for a doctor and let him know what sort of poisoning you suspect, so that he may bring suitable remedies.

Alternatively, take the patient as soon as possible to the casualty department of the nearest hospital.

2. Relieve respiratory depression if it is evident. First remove the patient from any poisonous atmosphere (carbon monoxide from car exhaust fumes, for instance) into the open air and loosen clothing around the neck. If you have to enter a poisonous atmosphere to rescue a patient, it is usually sound policy to stoop low, where the air is likely to be less contaminated. A rescuer should if possible be roped to a second rescuer outside, in case he is overcome by fumes or gas, when he can be dragged out quickly.

If the patient is not breathing and does not start doing so within about thirty seconds, apply artificial respiration. When breathing starts again, give oxygen by means of a face mask if it is available.

When poisoning has resulted in shallow breathing, the airway in nose and throat (see Fig. 1) requires prompt clearing. Dentures and mucus should be removed with the fingers and the patient placed in the recovery position (three-quarters prone) (see Fig. 2) so that he cannot inhale any vomit or mucus from the stomach and oesophagus. This is particularly important in the case of a child who has swallowed irritants such as fuel paraffin.

3. Treat Shock. The disturbances of circulation that many poisons cause must be treated by conserving warmth with blankets (not hot-water bottles). Severe pain increases shock, and the doctor may decide to give the patient an injection of an analgesic drug.

No drugs should be given in first aid, apart from those given by a doctor, but fluids appropriate to the particular type of poisoning are useful. As a rule moderate quantities of fluid, preferably water, given to a patient who has swallowed an irritant poison, will help vomiting. Meanwhile keep the patient with feet raised and head lowered to conserve circulation to the brain.

4. Removing Poisons from the System. A few poisons such as cyanides and hydrogen sulphide (sewer gas) act so rapidly that the only effective treatment can be carried out in hospital. After having so far as possible ensured that breathing and shock are cared for, the first aider should rush the patient to the nearest hospital casualty department, where specific treatment can be given.

No attempt should be made at home to wash out swallowed fuel paraffin (kero-sene), white spirit, or furniture polishes containing these solvents. Vomiting should not be encouraged with such substances, since inhalation of stomach contents into the lungs is dangerous. Soothing liquids such as milk or liquid paraffin emulsion may be given.

No attempt should be made to wash out corrosive or caustic substances, but they should be diluted as quickly as possible by giving the patient plenty of water to drink. For corrosive acids, magnesium hydroxide suspension (Milk of Magnesia) may be given, but antacids such as sodium bicar245678-= onate which effervesce with acids must be avoided. For caustic alkalis, immediate dilution with water, followed by vinegar or fruit juice diluted with its own volume of water, is appropriate.

Other substances may require removal of the poison from the stomach by emesis (vomiting) or lavage (washout). The proper place for a stomach washout is in hospital but a simple procedure is described below.

Emetics. Making the patient vomit to rid his stomach of a swallowed poison is not so effective as washing it out, but is sometimes useful when a child has chewed and swallowed plant poisons in lumps which would block a stomach tube. The safest method of inducing vomiting is to tickle the back of the tongue and throat firmly with a finger. It is important to ensure a full stomach before this is done, by giving the patient a tumblerful of water or milk.

If mechanical emesis is not effective, give half a teaspoonful of mustard in a tumblerful of warm water or up to a level tablespoon of table salt in 500 ml (two tumblerfuls; about 1 pint) of tepid water. Never give emetics to a patient who is unconscious, is suffering from convulsions, or who is thought to have taken a corrosive poison.

Stomach Washout. For this a stomach pump, a rubber or soft plastic tube 5 feet (1.5 metres) long and about ½ inch (12.5 mm) in diameter is used. A smaller tube is necessary for small children, but the largest that can comfortably be passed through the oesophagus is necessary.

A mark is made about 18 inches (45 cm) from the bottom of the tube; when this is level with the teeth the tube is usually fully inserted. Before insertion the end of the tube is lubricated with glycerin or butter or margarine. Check whether the tube is correctly placed by immersing the free end in a bowl of water; bubbles will regularly emerge if the tube has been passed by mistake into the trachea.

Raise the end of the tube, insert a funnel, and pour about half a pint of water into it. Before the water has all entered, pinch the tube and lower it into a bowl, when the stomach contents will syphon out. The first washing should be kept separately for examination. Repeat the process using a quarter to half a pint of water or of diltue sodium bicarbonate solution (one teaspoonful to a pint of warm water) for each washing until the washings are clear.

Stomach washout must be carried out with the patient lying on his side and his head lower than his waist (hanging over the side of a table, for instance).

Summary. For the first aider the aims of emergency treatment are to keep the patient's airway clear for breathing, treat him for shock, remove as much poison promptly as is possible, and hasten him to the doctor for specific treatment. If no trained person is available, then carry on treatment as detailed under each poison in the following pages.

Danger of Delay

The best place for treating any but the mildest poisoning is in hospital, where the delayed effects of poisoning can be anticipated and dealt with as they arise. It is often not appreciated that delay in dealing with a poison which does not produce alarming symptoms soon after it has been taken can be dangeeous. If the patient is taken to hospital, together with any evidence which may help the doctor to identify the poison and to assess how much has probably been taken, late ill-effects can often be averted and much suffering avoided.

Corrosive Poisons

ACIDS, which are sometimes accidently swallowed, include sulphuric acid (oil of vitriol); hydrochloric acid (spirits of salts); nitric acid (aqua fortis); formic acid (in kettle descalers); and acetic acid (in corn solvents). Strongly acid salts are used as metal and porcelain cleaners and include potassium oxalate (salts of lemon, salts of sorrel) and potassium bisulphate. These have effects similar to those of strong acids. Phenol (carbolic acid) and cresols (lysol) are also highly corrosive.

Alkalis, which act as caustic poisons, include sodium hydroxide (caustic soda); potassium hydroxide (caustic potash); strong ammonia solution; lye; washing soda; and quicklime. These are present in drainpipe cleaners and oven cleaners.

Signs and Symptoms

General Effects. Corrosive poisons cause obvious burning and tissue injury wherever they come into contact with the body. In the mouth, throat, and stomach they produce immediate severe pain, swelling, discoloration and tissue erosion. Breathing and speech become difficult and laboured, and the intense pain and thirst bring about early shock and collapse. If the throat tissues swell, mechanical suffocation may occur.

As a rule the patient's mind and consciousness remain unclouded. He may retch repeatedly and vomit brown or black material containing altered blood.

In shock the skin grows pale and clammy, the pulse fast and feeble, and body temperature falls. Interference with breathing results in cyanosis (blueness) of the face and extremities, followed sometimes by convulsions.

Characteristic Discolouration and Odour

SULPHURIC ACID arid HYDROCHLORIC ACID cause grey staining and later blackening on contact, due to altered blood.

OXALATES (POTASSIUM OXALATE arid OxALtc ACID) produce white or brown stains. NITRIC ACID produces yellow or brown stains which are intensified if attempts to neutralise it with alkalis are made.

ACETIC ACID, PHENOL, CRESOL arid AM-MONIA all have characteristic odours.

Treatment, General

Note. An emetic must never be given in corrosive poisoning, nor may a stomach tube be introduced. The first rule is to dilute the substance as quickly as possible with cold water or milk. After this has been done Milk of Magnesia can be given to neutralise some of the acid. Sodium bicarbonate and other antacids which effervesce vigorously with acids must never be given, since they increase the risk of stomach damage.

Treatment, Special

Certain corrosive poisons require special treatment.

PHENOL (carbolic acid) and CRESOL (lysol) are quickly absorbed into the bloodstream and cause brief excitement followed by stupor, coma, and convulsions. They cause the usual signs of corrosion but can be distinguished by the odour they impart to the breath.

Immediately they are swallowed they cause severe abdominal pain and abdominal muscle tension which later pass off. Blood-stained vomit may be produced. Apparent recovery from the first stage of poisoning is sometimes followed by relapse into shock several hours later. If the skin is heavily contaminated with phenol there will be local burning and blanching, and absorption through the skin leads later to shock. It is therefore important to remove contaminated clothing and wash the skin with soap and water.

Treatment.
Alkalis only speed the absorption of these poisons and must not be given. Half a pint of bland vegetable oil (peanut or maize cooking oil) should be given, followed by half a pint of milk or water in which one tablespoonful of sodium sulphate (Glauber's salt) has been dissolved. Magnesium sulphate (Epsom salts) should be avoided since it may add to later depression of the central nervous system. Spirits must not be given as stimulants, since they increase the absorption of the poison.

It may be possible to introduce a stomach tube with great care and wash out the stomach with sodium sulphate solution (as above) until the washings have only a faint carbolic odour. After this, milk or eggs beaten up in milk are given. The patient should be kept warm and given artificial respiration if necessary.

Skin injured by phenol or cresol should be thoroughly washed with cold water and then treated with vegetable oil, margarine or butter. If the eyes have been splashed they must be washed out with copious amounts of water and the patient taken to hospital for expert attention.

OXALATES (POTASSIUM OXALATE and OXALIC ACID). For these poisons chalk stirred into water, or lime-water, is the only safe and effective first-aid treatment. Milk, which contains calcium salts, should be given if no alternative is at hand. Other alkalis must never be given since they increase the absorption of the poison.

Irritant Poisons

The irritant poisons which are to be found in substances in common use are:

Metallic Compounds. The salts and other compounds of arsenic, antimony, lead, cadmium, mercury, copper, zinc and tin. Iron salts in tablets given for anaemia are an important addition to these.

Bleaches. Sodium hypochlorite solutions for the disinfection of food utensils and swimming baths.

Iodine solutions used as skin antiseptics.

Paraffin (Kerosene) and PETROL (Gasoline).

Phosphorus in vermin-killers and matches.

Poisonous Berries, Fungi, and Plants which contain various organic irritant principles.

Signs and Symptoms

Irritant poisons chiefly cause inflammation, either fairly prompt or often delayed, of mucous membranes with which they come into contact. Retching and vomiting commonly result, and the vomit may contain blood if the irritation is severe. Severe colicky pain and diarrhoea follow, and shock may develop. If the patient survives this, other symptoms following absorption of the poison into the bloodstream may follow.

General Treatment (except for Iodine)

An emetic should be given promptly. After vomiting has occurred a saline purgative (one tablespoonful of sodium sulphate in a tumblerful of warm water) is given to speed the poison from the alimentary canal and reduce its absorption to a minimum. Demulcent drinks (milk, eggs, and vegetable oils) and general treatment for shock may be required.

Metallic Irritant Poisons

Antimony Compounds. These are employed in industry in alloys, foils, platings, safety matches, and fireworks. Some antimonial drugs (e.g. tartar emetic) are used to treat schistosomiasis.

Symptoms.
Acute poisoning is followed by burning pain, a choking sensation and difficulty in swallowing, which usually develop within one hour. There is nausea, continual vomiting, and diarrhoea, with severe abdominal pain. Cramps in the legs and sometimes urinary suppression occur, with delirium, paralysis, or coma. Collapse is marked by coldness and clamminess of the skin and a rapid and feeble pulse.

Treatment.
Vomiting should be encouraged in the early stages and eased by giving plenty of tepid water. If it does not occur an emetic should be given. When vomiting has diminished, white of egg beaten up in milk should be given. Shock should be treated by general methods.

Arsenic now rarely occurs except in sheep dips.

Symptoms. As for Antimony above.

Treatment. An emetic or stomach washout should be given as soon as poisoning by arsenic is suspected. The patient should be given plenty of fluids and kept warm. Special treatment with dimercaprol is given to over-come the poisonous effects of absorbed arsenic, and body fluids are restored by intravenous glucose treatment.

Bleaches.
Household bleaches usually contain 3 per cent to 6 per cent of sodium hypochlorite, which in contact with stomach acid evolves chlorine, a strong irritant. Poisoning by chlorine gas has been caused by mixing bleach solution with acid toilet cleaners. Never mix bleach with anything else.

Symptoms. Swallowed bleach irritates the mucous lining of the stomach and the chlorine gas evolved when stomach acid acts on it irritates the lungs and causes coughing and choking. The effects are rarely very serious once the initial irritation has been overcome,

Treatment. Never give any acid antidote, which will make matters worse. Dilute sodium thiosulphate (one teaspoonful in a tumblerful of warm water) should be given to neutralise the bleach, followed by one tablespoonful of sodium sulphate in a tumblerful of warm water as a saline purgative.

Copper Salts. Some fungicides contain copper compounds. Worn copper boilers used for brewing tea have produced acute copper poisoning. which have a similar action.

Iodine and Iodides

Symptoms. Acute poisoning with iodine causes pain, vomiting, purging, a metallic taste in the mouth, and thirst. Strong iodine preparations are mildly corrosive. The vomit is yellow or, after a starchy meal, blue. The mouth and tongue look brown and swollen. Later effects of iodine are fever, delirium, and stupor.

Treatment of Acute Poisoning. Give a thin gruel of starch or cornflour in water, then a solution of two teaspoonfuls of sodium bicarbonate in a tumblerful of water. Demulcents (thin cornflour or arrowroot gruel, milk, or eggs beaten up in milk) relieve the irritation.

Chronic iodide poisoning (iodism) is associated with frontal headache, watering of eyes and nose, salivation, and inflammation of throat and gums. Acne or reddening of the skin may appear. The drug must be discontinued if these symptoms occur.

Iron Salts. Ferrous sulphate, which is prescribed for adults for anaemia, is in brightly coloured sugar-coated tablets, usually green, which resemble certain kinds of sweets. These are very dangerous if swallowed by small children.

Symptoms.
Pallor, drowsiness, and vomiting of blue-green material and sometimes of small quantities of blood. Pain in the stomach may be severe, the pulse is fast and weak, and coma may occur within one hour. The stools are black and tarry in appearance. Apparent recovery from the first phase of poisoning is often followed by serious deterioration and shock. For this reason a child suspected of iron poisoning must always be taken promptly to hospital, for observation and treatment.

Treatment. If the child has not vomited and is conscious, give an emetic. Give two teaspoonfuls of sodium bicarbonate dissolved in a tumblerful of water to precipitate a less irritant form of iron, then induce vomiting again. In hospital the child will probably receive a stomach washout and be given a specific antidote, desferrioxamine.

Lead and Its Compounds. These occur in certain paints and artists' colours, in storage accumulators, and in petroleum additives.

Symptoms. Acute lead poisoning causes dryness and a metallic taste in the mouth, with intense thirst. Colic, constipation and vomiting may occur, and the stools are dark to black. In severe lead poisoning stupor and convulsions develop.

Chronic lead poisoning occurs occasionally in painters using lead pigments, although paints for interior decorating and for toys and nursery furniture are now required by law to have a negligible lead content. Many recent cases of chronic poisoning have come from the use of lead-glazed pottery jars in home brewing. Pallor, tiredness, colic, and constipation occur. Muscular weakness ('wrist-drop'), kidney disorders, and mental disturbances are serious indications of poisoning. The patient's gums may show a blue line.

Treatment for Acute Poisoning.
Give an emetic and follow it with one table-spoonful of sodium sulphate in half a pint of water or milk. This precipitates the lead in insoluble form and also speeds its elimination. Afterwards give demulcents (milk or eggs beaten up in milk, or vegetable oil.) Hot water bottles will relieve abdominal pain.

For chronic poisoning, which is very difficult to diagnose, the source of lead must be removed before treatment takes place. A calcium-rich diet (plenty of milk) will help. Medical treatment will include injections of calcium gluconate and removal of the body store of lead by injections of sodium calcium edetate or of penicillamine.

Mercury and its Salts (Corrosive sublimate, perchloride of mercury, white precipitate, red precipitate, vermilion).

Symptoms.
In acute poisoning there is a metallic taste in the mouth, continuous sali-vation, abdominal colicky pain, vomiting, and purging. Shock may occur, with cold, clammy skin and a fast and feeble pulse. Muscular twitching, convulsions, and coma may follow. Later on, urine may be suppressed.

In chronic poisoning, anaemia and tiredness are prominent, with salivation, diarrhoea, and vomiting. The mouth is inflamed and the gums may show a blue line.

Treatment.
For acute poisoning give white of egg whisked up in milk or water, followed by an emetic. Then give more egg white and milk. Keep the patient warm and his airway clear. Medical treatment involves the injection of dimercaprol.

Phosphorus (in a few vermin-killers, matches, and fireworks).

Symptoms. These usually develop in three stages. Within a few hours a garlic taste, irritation of the stomach and intestines, pain, thirst, vomiting of blood-stained fluid, and diarrhoea occur and sometimes lead on to shock. Some patients then make an apparent recovery for a few days, and some may in fact recover without further complications. Others show a third stage in which jaundice, liver enlargement, and kidney damage leading to suppression of urine occur. The liver and kidney damage if not treated successfully in hospital may bring coma and death.

Treatment. Give an emetic or thorough stomach washout with water containing enough potassium permanganate to make it pale purple. Avoid any kind of oil or fat, in which phosphorus is soluble and which increases its absorption. Contact with the vomitus or stomach washings must be avoided, since phosphorus will burn the skin and eyes if it makes contact with them. Prolonged bed rest and supervision will be necessary.

Zinc Salts (White Vitriol, soldering fluids)

Symptoms. The lips and mouth may be burnt. There is pain in the throat and abdomen, and difficulty in swallowing. Vomiting of blood-stained fluid, and diarrhoea may occur. If a large dose of zinc has been taken coma may follow, with convulsions.

Treatment. Zinc salts usually promote vomiting, but an emetic should be given if this does not occur. Cautious stomach washout may be performed. Give white of egg beaten up in milk, followed by half a pint of warm water in which one teaspoonful of sodium bicarbonate has been dissolved. Demulcent drinks (milk and eggs beaten up in milk, or vegetable oil) should then be given.

Organic Poisons

Aconite. The root of aconite is the most poisonous part of the plant.

Symptoms. Numbness and tingling of the mouth and tongue. Nausea and vomiting. Difficulty in breathing, and slow, irregular, weak pulse. The skin becomes cold and clammy. The patient walks unsteadily and complains of giddiness, but remains lucid. Death may occur suddenly by cardiac arrest.

Treatment. Give an emetic or stomach washout, and then if possible give a heaped tablespoonful of activated charcoal stirred into water to make a thin slurry. The patient should be kept warm and lying down, and should be given artificial respiration if necessary. Atropine is injected to counteract slowing of the heart and, if convulsions occur, diazepam injections are given.

Alcohol (acute poisoning)

Symptoms. The breath smells of alcohol. The patient is at first excited, violent, or stupid, with flushed face and pupils often dilated and fixed. Perspiration, giddiness, and confusion are later followed by convulsions, stupor, or coma. Sometimes apparent recovery is followed by sudden death from respiratory failure.

Treatment.
Alcohol is rapidly oxidised by the body, and the object of treatment is to speed this up and tide the patient over the emergency. Stomach washout or an emetic will prevent the absorption of alcohol which is still in the stomach. Half a pint of water containing one teaspoonful of sodium bicarbonate can be given in small portions over several hours, but too much fluid must be avoided. If coma develops, artificial respiration and warmth may be needed.

Antidepressants (Imipramine and similar tricyclic drugs).
These tricyclic antidepressants are now in many homes, and overdosage with them is becoming common and may be serious.

Symptoms.
Coma and convulsions, depres-sion of breathing, and disturbances of heart rhythm. It is these last disturbances which are dangerous, since they may bring death after apparent recovery from the effects of poisoning.

Treatment.
Stomach washout or an emetic should be combined with a saline purgative (sodium sulphate one tablespoonful in half a pint of water). Artificial respiration if necessary. Medical treatment involves overcoming convulsions with diazepam injections and injecting drugs to protect the heart's action.

Antihistamines

Symptoms. Lethargy and drowsiness with later amnesia and confusion. After large doses convulsions may occur. Symptoms are very varied from patient to patient, however.

Treatment. If the patient is conscious and not convulsing, induce vomiting by inserting the finger into the throat. Heavy doses of antihistamines reduce the vomiting reflex, and chemical emetics may then be retained in the stomach, so they should be avoided. If there are no convulsions the stomach may be washed out with sodium bicarbonate one teaspoonful in a pint of water. Treatment should be carried out in a darkened room to avoid stimulation of the patient, and if con-vulsions occur they may be controlled by injections of diazepam.

Barbiturates

Symptoms. Mild poisoning is shown by drowsiness and mild confusion. Large over-doses produce delirium or coma, with slow stertorous breathing and blueness of the skin. This leads on to respiratory depression and a shock state, with body temperature lower than normal. In barbiturate poisoning, especially with phenobarbitone, red rashes resembling burns may appear.

Treatment. If the patient is conscious an emetic may be given or a stomach washout performed, and strong coffee given afterwards and allowed to remain in the stomach. The patient must be kept warm, and an adequate airway maintained while he is transferred to hospital.

Belladonna; Atropine (Deadly nightshade, eyedrops and liniments sometimes contain atropine)

Symptoms. Dryness of the throat and skin, gushing of the skin, and fever with a rapid pulse. The pupils of the eyes are widely dilated. The patient may be excited and hallucinated. Later the delirium gives way to depression and coma.

Treatment. Induce vomiting or carry out stomach washout with water containing enough potassium permanganate to render it pale pink. If possible give a tablespoonful of activated charcoal made into a slurry with water and leave it in the stomach; alternatively give strong black tea or coffee. If excitement is pronounced, an injection of diazepam may be necessary; other drugs tend to increase the later depression of respiration.

Berries of Poisonous Plants

Black. The most dangerous is the berry of DEADLY NIGHTSHADE (Atropa belladonna) which ripens in late summer and may remain on the plant during autumn. Belladonna berries are temptingly juicy and black but contain atropine (see above). Other parts of the plant, especially the root, are poisonous also.

Privet (Ligustrum vulgare) and its cultivated forms bear clusters of black berries which when eaten cause severe irritation of the stomach and intestines.

Baneberry (Actaea spicata) is rare except in woods on limestone areas of northern England. Its small, shiny, black berries growing within two feet of the ground cause irritation of the stomach and intestines, dizziness, and quickening of the heart rate.

Buckthorn (Rhamnus cathartica) and Alder Buckthorn (Frangula alnus) are tall shrubs both bearing small berries which turn black and shiny in late summer and autumn. These are violently purgative.

Cherry Laurel (Prunus laurocerasus) which is commonly grown in garden hedges bears black fruit exactly resembling cherries in shape and size. They are not so poisonous as many other black berries provided the kernel is not consumed, but contain compounds which liberate cyanide and therefore should be avoided.

Ivy (Hedera helix) has pea-sized berries which ripen in spring, an unusual phenomenon. If eaten they are irritant and cause vomiting and diarrhoea, with some depression of the central nervous system. The leaves of ivy also have irritant properties.

Red. The scarlet berries of the Woody Nightshade (Solanum dulcamara), which resemble redcurrants, are common in late summer and autumn. They are irritant and may cause vomiting and diarrhoea if swallowed in any quantity, with later apathy and paralysis.

The two climbers White Bryony (Bryonia dioica) and Black Bryony (Tamus communis) although belonging to different botanical families have similar scarlet berries in the hedges in autumn. Both are extremely irritant and should not be freely handled or eaten.

The Arum or Cuckoo-Pint (Arum maculatum) is a common hedgerow plant which produces attractive red berries in a spike on its naked stalk in late summer. These are acrid and irritant and may cause skin inflammation if the juice is allowed to dry on it. If eaten they produce severe stomach and intestinal irritation with consequent vomiting and purging.

The Yew (Taxus baccata) produces abundant red berries in late summer. These drop to the ground and are attractive to children. Although the outer red sticky covering of the fruit is harmless, it contains a small green seed which, like yew leaves, is highly irritant and if eaten causes vomiting, diarrhoea, delirium, convulsions, and heart failure. Yew must therefore be left alone, and no part of it should be eaten.

The Mezereon (Daphne mezereum) is popular in gardens, and is unusual in bearing its beautiful red berries in late winter. All parts of the plant are extremely poisonous. If eaten the berries cause burning of the mouth and swelling of the tongue and lips, and only a few are needed to produce delirium and collapse.

Treatment of Berry Poisoning

In cases where it is known that poisonous berries have been eaten, the child should be made to vomit by thrusting a finger down the throat, and repeating this after a drink of warm water.

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