A crystallizable acid. C15H18O3. Santoninic acid. Obtained from different species of Russian and Levantine Artemisia, especially from “Semen cinae.” See Cina. Preparation: Triturations.
Delirium. Consciousness clear when awake, but during its restless sleep light delirium showed itself (second day). Felt very;much excited, and inclined to dance and laugh (soon). Hysterical laughter. Restless, irritable (first day); wanted everything; was satisfied with nothing (second day). The best marked symptom was a feeling of profound and most unusual depression, accompanied by so much irresolution and want of confidence in my own powers as to render me quite unfit for work of any kind; this invariably followed even a single 5 grain dose, and beginning with dulness and heaviness, ran on into very much that sort of melancholia which I imagine sometimes produces. Unconscious. Comatose.
Vertigo. Dizzy feelings (in nine cases). Giddiness. Head turning and twisting, restless (first day). Dulness of the head.
Headache. In almost all cases of cured acute choroiditis, with the exudation more or less colored, it generally caused headache.
Pain in the forehead; (after 5 grains). Fullness about the temples.
Blue rings around the eyes. Eyes rolled convulsively. Distortion of the eyes. Pressure in the supraorbital region. Pressure in the eyes. Pupil. Dilated pupils. Pupils insensible. Pupils dilated for several days. Pupils enormously dilated and insensible.
Pupils enormously dilated. Vision. Visions (in eight cases).
Flickering before the eyes. Objects seemed to totter and dance, and the child seemed to see various figures, cherries, animals, etc. Photophobia and lachrymation (second day). When the narcotism seemed to have disappeared (i. e., when he had got used to it), he went to dine at a restaurant; the experiment was over and forgotten; during lively conversation in a friendly circle, in comes the waiter with yellow egg soup; it smelt peculiar to him, and also looked quite red; perfectly shocked, he sent the soup back as entirely spoilt; to the amusement of his friends, he persisted obstinately in asseverations which to them were inexplicable; they came to words, and my hot-headed colleague left the “good-for-nothing eating-house” in a pet. The conversation turned causally upon a gentleman’s coat, and led to a dispute; one said it was yellow, the other a fine violet color; the gentleman, whose coat was gray, and was not aware that one had made herself violet-sighted, the other violet-blind (or yellow-sighted), was astounded; they, too, in their discussion, had forgotten the cause, and could not, without the help of a third person, shake off the illusions. The blue sky in the evening twilight looked green, not so during the day. Objects seemed green, as if beheld through green glass. All objects became green and wavering. Vision green. Everything looked green.
Between five and six o’clock he thought he perceived a very faint greenish tint upon white window curtains, but ascribed it at first to his imagination. At six o’clock the gas flame, chandeliers, the fire in the stove, and all white object strongly illuminated, assumed a very intense yellowish tinge; other objects retained their ordinary colors. This effect continued without intermission during the whole evening, and did not diminish until half-past ten o’clock, and was still appreciable at midnight and until two o’clock in the morning, when the doctor went to bed. If the dose exceed 5 grains in the adult, a curious effect upon the retina is produced, the patient, for an hour or more, occasionally seeing all objects tinted green or yellow, as though he were looking through colored spectacles. Yellow sight (in thirty cases); violet sight (in nineteen cases). Very sudden yellow vision; all objects seem enveloped in a yellow mist (four hours after 2 grains). Sees things yellow (second day). Intense yellow and green vision, lasting an hour (three-quarters of an hour after 3 grains). Yellow vision. A yellow tinge imparted to surrounding objects, similar to that assumed by the salt itself when exposed to the light for any time. He became conscious, while reading, of a yellowish tint on the paper and of a yellow haze in the air; his own hands, and the complexion of others, appeared of a sallow unhealthy color, and the evening sky, which was really of a pale-yellow color, seemed to be light-green (after three hours); vision was not perfectly distinct for some hours, and was accompanied by a certain vagueness of definition.
Twenty minutes after swallowing 5 grains I observed flames to assume a decidedly yellow color, as though spirits were being burnt; ordinary white glass globes became deeply tinted with yellowish-green, and writing-paper presented the same phenomena in somewhat less marked degree; during three hours the tints gradually increased, after which they faded by slow stages, until vision was restored to its normal standard. At first light- colored objects seemed yellow, dark-colored of their natural hue; afterwards both light and dark became yellow-green, and red seemed violet. Red and blue always seen in their complementary colors green and orange. Carmine red looked fallow, brick-red bronze; Berlin blue, greenish. Saw everything that she looked at through a yellow light. All objects seem yellowish-green. Visual aberration, green and yellow being the prevailing colors. The symptoms were more or less present until the Santonin was expelled from he stomach and bowels by a full dose of castor oil.
All objects seem intensely yellowish-green (second day). The patients see objects yellow after the second dose; in those patients affected with atrophy of the arteries of the retina, as well as in those suffering from subacute choroiditis, with absorption of pigment, the yellow coloration of vision in not observed; in certain of the latter cases objects, on the contrary, appear whitish. The phenomena of visual illusion in persons poisoned by it are reducible to distinct classes. Every one, however small the quantity taken, could not recognize violet light; saw the spectrum as if curtailed at the violet end; overlooked everything of a pure violet color; whilst in all mixtures containing violet and yellow, the complementary yellow appeared to predominate; this has been called yellow-sight. Quite different is the next higher degree of intoxication; the subject of it is then unable to distinguish colors which on the healthy make a different, even an opposite impression, such as lilac and dark-gray, or violet and black; he not only confounds these colors with one another, but a great many dissimilar seem all alike to him; the colors which are mistaken for each other had always a different degree of purity and strength, which, however, continues unalterably the same for each other, so that when one had exactly thus mistaken, one can with perfect certainty and precision determine a priori by calculation with which two of all the other colors these two will be confounded; there is hardly a single color which can with certainty be distinguished from the rest; each one resembles an endless number of others, and thus the infinite host of colors which a healthy person can appreciate is reduced to an extremely small number; this stage manifests itself in the fact that all colors, the darker they really are, the more they resemble a tint between violet and ultramarine; with the determination of these, all other changes of color are determined.
Hallucinations of smell (in six cases).
Convulsive movements of the muscles of the face, especially of the lips and lids. Slight twitching of facial muscles set in (second day). Face pinched; drawing in of lips over the teeth, with pinched expression of mouth and nose (next morning). Face pale. Pale around the mouth, worse in the afternoon (first day).
One cheek white, the other red, resembling a hectic flush (first day); red color of one cheek for several days.
Grating of the teeth during sleep. Teeth clenched. Tongue deep red (second day). Dryness of the tongue. Frothing from the mouth.
Burning pains apparently torment her, as she forces everything in her mouth (second night). Hallucinations of taste (in five cases).
The glands of the neck, parotid, and submaxillary commenced swelling in about five days, and continued to increase until the throat was so filled as nearly to prevent swallowing.
Deficient appetite (after 5 grains). Intense thirst. Continual thirst for ice-water, which she swallowed greedily (next morning). Frequent eructations. Eructations. Nausea (soon).
Nausea and vomiting; (fourteen cases). Vomiting. Vomiting (after first dose); violent (after second dose). Vomiting and purging, with severe abdominal pains. Vomiting of yellowish slimy mucus set in at 11 P.M. and continued till forenoon. Excessively vomiting, accompanied by severe pain in the stomach and belly (after half an hour). One night, after taking a spoonful of nourishment, he choked and threw up half a teacupful of blood and pus, and died without any struggle. Dull pain in the pit of the stomach (second day).
Abdomen somewhat tumid, but soft (second day). Abdomen hot, full.
Rumbling in the abdomen. Abdomen very sensitive (second day).
Severe abdominal pains, with vomiting and purging. Severe pain in the belly and stomach, with the excessive vomiting (after half an hour); it was not till the second day that the bowels and stomach seemed free from irritation. Every night, before the child had a movement form the bowels, he gave manifest evidence of pain in the bowels. Pain in the abdomen.
Well-marked tenesmus was experience both by myself and by a friend who shared the experiment (after 10 grains).
Purging of watery, flaky, foul-smelling stools followed the vomiting in a few hours; passages came every ten to fifteen minutes; at 10 A.M. the stools diminished; she had only three till afternoon, but they were copious, grayish, with smell like putrefaction taking place. Purging with vomiting, and severe abdominal pains. Profuse diarrhoea, with the vomiting (in one case). Had movement every night while the child lived.
Frequent efforts to urinate, ability to pass only a few drops each time. Micturition painful on account of burning in the urethra, with constant desire to urinate, evacuation of only a few drops, that color the linen intensely yellow (after 10 grains). Five grains were taken at bedtime, and next morning an irresistible and almost uncontrollable desire to micturate was felt, the act being attended with some irritation and smarting; the urine was of a deep saffron-yellow, staining the pot and linen precisely as bile; it was of specific gravity 1028; the quantity was decidedly increased, and the urea was somewhat in excess; the diuretic action continued during the day, and it was not until 8 P.M. that the secretion was quite free from foreign pigment. Urine thick, sulphur-yellow; after standing an hour it deposited a sulphur-yellow sediment, the urine above which was slightly greenish. Urine increased in quantity, of the color of saturated saffron-water, continuing three days (after one hour).
Urine increased threefold. After four days the color disappeared from the urine. Urine pale yellow, alkaline; in other respects the child was well. Very copious and involuntary discharge of urine towards early morning. As a general rule the urine becomes colored; in some it continued colored even after the derangement of vision had passed away. The urine became light-green, and stained the linen so deeply that it could not be washed out.
Urine of the peculiar greenish color which has been noticed after the exhibition of this drug. Urine greenish. In two persons, the urine was very much colored for a few hours. Urine yellowish- green. Intensely yellow color of the urine. Urine orange-colored (second day). Urine scanty, dark lemon-yellow, acid, depositing dark-yellow crystals of uric acid; nitric acid caused a transient brownish-red color; alkalies caused an amaranth-red color. Next morning the urine, which had been kept in a tall glass vessel, was of a bright pinkish-red (second day). The urine passed soon after the second dose was of a greenish-yellow color; a few drops of liq. ammonia immediately produced a clear red tint. It gives to urine the property of turning cherry-red when boiled with caustic potass, or even when caustic potass is added to it in the cold; this reaction might easily lead to the conclusion that sugar is present in the urine; no result is obtained with the copper test, and, therefore, the application of this test will at once prevent any mistake in a doubtful case. The urine if not increased in quantity (which generally is the case), is voided with greater frequency, and is changed in color. It puts off its ordinary amber color and takes on a deep saffron; it resembles in hue a saturated solution of pure yellow precipitate of potash; it imparts this color to clean white cotton clothes dipped in it, and these clothes retain the color after they become dry. The color is the same as that acquired by Santonin after prolonged exposure to sunlight. The urine become turbid, turbid even when first voided, and symptoms of vesical and nephritic irritation become quite clear. There is frequent and painful desire to void urine, and the discharges are scanty. There is regular dysuria.
Much the same state of things exist as happens in irritation from cantharides or from spirits of turpentine, and haematuria often ensues. He found the presence of Santonin in the urine might he detected by the alkali test, in periods varying from ten to fifty minutes after it had been taken, and that it was eliminated in form thirty to fifty hours. The color of the urine was in all cases greenish-yellow, sometimes approaching a light-saffron tint, the greenish hue best seen by looking obliquely across the surface of the fluid; it resembled the urine of a person slightly jaundiced, and like it, stained linen of a persistent light- yellow; in two other respects also it curiously conformed to bilious urine; when nitric acid was dropped on small quantity, a distinct purplish color was brought out, which, however, was evanescent; again, when sulphuric acid was added drop by drop, it developed a reddish-brown color, changing to a deeper brown; no such effect was produced upon the urine when not under the influence of Santonin; the sulphuric acid reaction was less ambiguous than the nitric acid, which might affect the coloring matter of normal urine somewhat similarly. On the addition of an alkali to the urine, a fine cherry-red or crimson color will immediately be developed, according to the amount of Santonin present; the urine will respond to potash, soda, or ammonia, and also to lime or baryta; water; if a globule of potassium be dropped on the urine, a bright-red track is left wherever the burning metal skims along the surface; at first ammonia was employed, and the color is well brought out by pouring a few drops of liquor;ammonia down the side of the test-tube, so as to float on the urine, when a red zone will appear sharply marked at the line of junction of the two liquids; but potash was afterwards found to be a more delicate reagent, and is better suited to general uses; the red alkaline fluid is not bleached or altered by boiling, but the color is at once destroyed by any acid, even carbonic acid gas; the subsequent addition of alkali restores the color as before; hence it may be inferred that the coloring substance is not impaired or broken up by acids.
Bicarbonate of sodium produced no immediate change, but on boiling for some time, the reddish tint was gradually developed, and was discharged by continued boiling; carbonate of sodium afforded similar results, except that it required longer boiling before the color was discharged; phosphate of sodium gave no results. The red-colored stratum soon subsides to the lower part of the test-tube carried down by the precipitated phosphates; prolonged exposure to light in contact with excess of alkali, bleaches out the color and chlorine at once dissipates it.
Considering the sparing solubility of Santonin, one part requiring 5000 parts; of water, at 17.5 C., the delicacy of the test will be apparent when it is stated that Santonin was detected in the urine within ten minutes after 4 grains were taken, and within an hour after but 1 grain was taken; in one experiment; the urine voided twenty-four hours after the dose gave a decoded red color with liq. potass, even when diluted with three parts of water. For ordinary doses of 3 to 6 grains, about two days are required for elimination, and it is to be remarked that the urinary coloration and reaction to the alkali test are more persistent than the phenomena connected with vision. When the red liquid is examined with the spectroscope, the red, orange, and yellow rays are transmitted, while the blue end of the spectrum is absorbed; in a more dilute state, the red and blue rays are transmitted, and the center of the spectrum is stopped; no characteristic absorption-bands are produced. In order to determine the nature of the coloring material found in the urine, and to ascertain its behavior with reagents as an aid towards its isolation, the following process was adopted at the suggestion of Dr. Emerson Reynolds: About a pint of urine, passed after taking 4 grains of Santonin the preceding evening, was treated with neutral acetate of lead, avoiding excess, and then filtered; to the filtrate, neutralized with potash, basic acetate of lead was added so long as any precipitate was formed, and until the fluid became colorless; neutralized, filtered, and washed; the yellow precipitate was transferred to a beaker, and decomposed by the cautious addition of dilute sulphuric acid; spirit of wine was added, and the beaker set aside for twenty- four hours; filtered; removed excess of sulphuric acid by barytic water, and filtered; the clear fluid now gave the pink reaction distinctly with potash, but ammonia had no longer and effect; the coloring matter, therefore, was evidently set free, but the quantity at command was too small to admit of a more minute examination; the red alkaline filtrate gave a bulky precipitate with alum, and when this precipitate was filtered off, neither the precipitate nor the filtrate any longer afforded a trace of color with potash. The liberated coloring substance does not seem to enter into combination with nitrate of silver, nor is it visibly affected by corrosive sublimate, sulphocyanide of potassium, chloride of gold, or bichromate of potassium. With per salts of iron it gives a permanent rich brown color.
Coughed incessantly the whole night from tickling in the larynx and windpipe (first night). Respiration rapid sighing. Breathing quick and catching (second day). Rattling respiration.
Symptoms of paralysis of the lungs, so that artificial respiration had to be resorted to in order to save the life of the patient.
Heart and Pulse
Pulse quick and feeble (first day); rapid (second day). Lowering of the pulse (in two cases). At 9 P.M., the pulse on the left side was gone, thready and soft in right radial artery (second day).
Spasm of the extremities. Twitching of the hands and feet.
Convulsive jerking of the upper extremities.
Gait unsteady and tottering. Staggered, when walking.
Most violent convulsions, with loss of consciousness; head hot, face flushed, purplish. Violent convulsions (after a quarter of an hour). Violent spasm, beginning in the face and extending to the extremities, affecting respiration; apparently the third to the seventh nerves were the seat of the irritation; pupils dilated. Convulsions (after eight hours). General convulsions, with loss of consciousness, with staring eyes, with red, hot face, dilated pupils (the right more dilated than the left), insensible to light; pulse rapid, weak, and irregular; extremities in constant convulsive movements, so also the muscles of the face. After midnight;severe convulsions set in, more like tetanus, throwing the head back, eyes rolling about, countenance distorted, body sometimes nearly curved, with legs turned back; in the interval grasping at everything; gnawing of fingers; she thus had four convulsive attacks, and died about 2 A.M. (second night). Without any previous warning sudden clonic convulsive spasms set in, commencing at the left angle of the mouth, and thence spreading over the left side of the face; these were succeeded by similar spasms in the right arm, beginning in the fingers (after ten hours); a quarter of an hour after, a tonic spasm invaded the left side of the face and left arm, then rapidly disappeared, leaving a fibrillary twitching of the muscles of the left angle of the mouth and left eyelid, which soon afterwards ceased quite suddenly; two more convulsive attacks occurred on the same evening, and in one the respiratory movements threatened to come to a standstill, although the heart was beating quite strongly, and the pulse was normal. Two or three similar fits occurred daily at intervals for the next four or five days, after which the child was as well as before.
Convulsive movements of the limbs and of the muscles of the face.
In about five days the child was partially paralyzed on one side, the hand assuming the appearance of induration of the cellular tissue of the head of an infant; the whole side presenting a blue appearance, which increased till death closed the scene.
Collapsed state (next morning). As soon as she lay down, the child got restless (first night); threw herself about with her whole body from one side to the other (second day). Great restlessness. Great prostration. Lassitude, prostration (in nine cases). Great weakness. Weakness (second day). Weariness.
Abnormal feeling and pains in the head (in eight cases).
Skin blue. Urticaria (like that produced by Bals. copaiva) with oedema of the skin of the nose, lips, and eyelids. Severe rash, described as urticaria, covering the greater parts of the body, accompanied the vomiting (after one dose); almost directly after the second dose, a white wheal appeared on the nose, surrounded by a red erythematous blush, and a similar eruption rapidly covered the body; the swelling attained such a height that within a quarter of an hour the child’s face was disfigured to such an extent as to make her almost unrecognizable; the lips from which some viscid saliva was still issuing, were swollen to an enormous size, glistening form the oedematous distension; the nose, at other times delicate feature in a sweet little face, was enlarged to the size of a Negro’s and the eyes were almost closed by the some condition of the lids. I at once placed the child in a warm bath, which soothed her; and within an hour the oedema and rash had for the most part disappeared.
Sleepy, tired. Sleep restless. Sleep was generally disturbed, and I usually woke unrefreshed, with sickness, frontal headache, and deficient appetite (after 5 grains).
Chilliness. Whole body icy cold. The whole body became cold, the lips and ears blue, the face as white as snow. Extremities rather cold (next morning); in spite of assiduous hot applications the icy-clammy coldness crept steadily upwards (second day). Cold feet. Heat. Violent fever, with very rapid pulse, burning heat of the skin, face puffy, eyes red, brilliant, fixed. Fever, all the afternoon (first day). Hot head. Heat about the head, increased every afternoon and evening. Sweat. Cold sweats. Hot perspiration on the occiput, more clammy in front (second day).