Poisonous Hemlock vs. My Hemlock Fence

So I’m building a fence. Like any reasonably savvy consumer, I did a little Google-fu magic and figured out exactly what I wanted, then called around town and scheduled a half-dozen people to come out from different companies to give me quotes. As with any industry, in the fence business you get the occasional idiot.

The Lowes guy had already rang several of my alarm bells by the time we got around to this gem (allow me to paraphrase):

“You don’t want to use hemlock rails if you’ve got dogs in the house. Dogs can chew on the fence and hemlock is poisonous. Go with chemically treated  pine.”

Now, for a lay person who has no medical knowledge and who isn’t supposed to be a knowledgeable lumber sales professional, this might be an understandable mistake. Poisonous hemlock (Conium maculatum) is a flowering plant with parsnip-like roots that is poisonous to humans and animals when ingested because of a powerful paralytic agent. This plant was reportedly used in the execution of Socrates by progressive paralysis that eventually stopped his ability to breath. It looks like this:

 

Another group of plants from the parsley family go by the name water hemlock, and these are commonly considered the most poisonous plants in North America. These plants produce a much higher rate of fatality than Conium, but deaths occur due to unrelenting seizures rather than paralysis.

Hemlock lumber is harvested from the Tsuga tree, a Japanese evergreen variety which has a similar odor to that of the poisonous hemlock, and thus the name. The two are about as related as a rattle snake is to a lemur, though. Hemlock wood is not poisonous. (Chemically treated pine, on the other hand, often contains formaldehyde and arsenic to prevent rot and insect damage, and use with animals that chew wood is discouraged.)

While the mix up is perfectly understandable for someone without specialized knowledge, a lumber salesman ought to have known better, and so should a writer who works with the poisonous plants named hemlock as part of a story.

Just in case you were thinking about using that age-old poison Conium (which has also been used by physicians and apothecaries for treatment seizures and as a sedative, but the potential for overdose is very high), here’s a quick list of symptoms of poisonous hemlock toxicity:

  • nausea or vomiting
  • rapid (early) or very slow(late) heart beat
  • belly pain
  • trembling
  • progressive paralysis (starts in the feet and moves upwards)
  • respiratory paralysis
  • coma
  • death

Water hemlock produces a different set of symptoms:

  • Nausea and vomiting
  • belly pain
  • production of excess saliva (drooling, frequent swallowing)
  • change in heart rate (fast or slow)
  • change in blood pressure (high or low)
  • arrhythmia (irregular heart beat)
  • heart failure
  • extreme hyperextension (as with tetanus, see picture below)
  • convulsions
  • seizures (progressing to status epilepticus or seizures that do not stop, which lead to death)
  • violent movements of the arms and legs

painting of a man suffering from tetanus toxicity

On an administrative note:

Hello readers! It’s been about nine months since my last round of sporadic postings, but I’m hoping to get back on track with this blog, because I love to do it. The contact information in the Ask Your Questions page is still valid.

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This blog is written for the purpose of informing writers for realism in fiction. It is not intended to diagnose, treat, advise, or assist real people who have real problems. If you have a problem not related to fiction, please see a physician!

Posted in Poison | Tagged , | 1 Comment

The Scars of the Past

One of the matters you may wish to consider in any world-building you do are scars, both physical and psychological, and both on a personal level and on the level of your society.

You can milk a scar or a collection of scars for a lot of characterization. Did the person have a disfiguring childhood disease? Were they beaten or flogged as punishment for something? Did that very sedate, almost passive character have a violent youth?

Keep in mind that how the scars were gotten and how the character *says* they were gotten aren’t always the same thing. That wound from the great battle might really have been obtained from falling off his dad’s horse when he was 5. Even more interesting from the point of a reader are the mysterious scars – the ones your point of view character notices and wonders about but doesn’t ask about.

Scars can form anytime there’s a break in the skin – from a paper cut to major damage. For the first 4-6 weeks after the injury, the scar will probably appear red and raised. The scar can then turn a sort of bluish-purple color, particularly if the scar is on a body surface that is prone to decreased blood flow or that is over a joint or flexible area of the body (like the knee). It can take up to a year (sometimes longer, depending on the individual) for a scar to look “old” or have its final appearance. Most old scars are white-silver and either flat or containing keloids.

Keloids are abnormal “lumps” that form during scar formation and are more likely to form on people of African descent or with dark skin tone. Keloids can grow massively large, taking over entire structures of the body and rendering them useless, particularly if formed on the hands, feet, or ears. Keloids can be painful, itchy, and continue to grow for months or years. Unlike normal scars, keloids do not get smaller or lighter with age.

Diseases like measles, chicken pox, and smallpox can leave survivors covered in patchy, white scars. Leprosy, despite being curable with modern treatment, can be horribly disfiguring to individuals who do not have access to treatment, culminating in gangrene and loss of limbs, blindness, and more. In a pre-modern society that is often struck by diseases and plagues, at least some of the people your characters interact with (if not your characters themselves) will likely show evidence of those same diseases.

Another type of scar to consider are the scars left on your society by plagues and diseases. Particularly in a world that lacks modern medical practices, plagues and diseases can cut a swath through a culture, changing the behaviors of the people within it.

Military camps were also prone to certain outbreaks and soldiers more often suffered and died from bacteria than from the enemy’s weapons. Typhus, particularly decimated more than one army in the field. Typhus is a disease that struck armies because hygiene was often poor. The deadlier form is more common in cold weather and is caused by a bacteria called Rickettsia typhi. It causes headaches, joint pain, light sensitivity, high fever, rash, cough, delirium, and stupor. Without modern treatment, 10-60% of those infected with typhus died, and the disease spread like wildfire through close camps, including armies, crowded transport ships, and jails. It was historically called “gaol fever” because of its rapid spread through prisons.

Cultural practices and superstitions may spring up around particularly deadly plagues. Songs and legends may develop, not unlike the children’s songs that are thought to be about the Black Death. Historically the special treatment and blessing of food in religious rituals was part observance and part an attempt to ward off illness. Common superstitions, religious practices, and unconscious cultural behaviors often arise as a response to disease events.

Cultures may also react strongly to anyone who shows signs of illness. Historically, lepers have been ostracized or even killed, along with their families. Those afflicted with leprosy were considered cursed, and superstition played a large role in the cultural treatment of these individuals. Leper colonies were common  during the Middle Ages in Europe and India. Slave ships carrying “cargo” known to be ill with plague-like symptoms have been sunk rather than allowing their passengers to infect the port towns on the other side, and the corpses of infected people have even been catapulted over the walls of besieged towns as a primitive form of germ warfare.

Diseases have shaped the face of our world. They can add a lot of depth if you remember them when shaping yours.

Posted in Plague, Rare Diseases | Leave a comment

Birth Complications – Shoulder Dystocia

Maternal and fetal complications during the birth of a baby are some of the most feared problems in medicine, for a lot of reasons. The truth is, most complications that are severely detrimental to mother and/or baby are rare. You can see my post Special Topic: Death in Childbirth for more information.

Perhaps one of the most feared by modern obstetric practitioners is the complication called shoulder dystocia.

Shoulder dystocia occurs in about 1% of all modern human births. It happens because one (or rarely, both) of baby’s shoulders gets stuck behind the bones of mom’s pelvis.

This is a dangerous situation for mother and baby, as umbilical cord may be compressed if it is wrapped around the neck, preventing baby from getting adequate oxygen. Further, both mom and baby may experience exhaustion, trauma (including uterine rupture), and death if this situation is unresolved.

During a normal, vaginal birth, whomever is helping mom birth the baby should apply a gentle downward pressure on the baby’s head to help deliver the shoulders during a contraction – either immediately after the head is born or on the next contraction if baby’s nose and mouth can be suctioned while the body is still in the birth canal. This gentle downward pressure should be sufficient to help baby’s shoulder disengage from the pelvis and baby should slide out quickly (catch!). If baby stays stuck despite gentle downward pressure on the head, shoulder dystocia may be the problem.

Fortunately, shoulder dystocia is not a death sentence. There are a number of “maneuvers” that can help get that kiddo out. Whoever is helping with this dramatic type of delivery has a few options. The best option and least invasive option is just to get the mom up on hands and knees. This changes the angle that baby is approaching the pelvic outlet a bit and also creates more room for baby to turn. Unfortunately, in modern births this is often unable to be performed due to the use of epidural anesthesia. Further, a lot of modern doctors are simply “uncomfortable” attempting to delivery baby in an unfamiliar position (poor them, right?) so a number of other, physician-guided maneuvers have been invented.

Another option, particularly for women who are unable to go into the hands and knees position, is called the McRoberts Maneuver (see comments), and involves pressing the legs up toward the chest while the mother is in a semi-flat position on her back. This also widens the pelvic outlet. At the same time or separately, an assistant can use the heel of his or her hand to press down firmly on the baby’s stuck shoulder, just above the mother’s pubis – the ridge of cartilage that connects the pelvic bones in the front – using the same sort of position someone might use to perform CPR compressions on the chest (generally with only one hand though).

If that doesn’t work, your doc or cabby gets to go where at least one man has gone before. Inserting at least two fingers behind the baby’s stuck shoulder and applying firm, gentle pressure to rotate the shoulder away from the pubic bone can allow passage of the baby. Be careful here not to put rotational force on the baby’s head, though. This maneuver may require pressing the baby back up into the birth canal a little bit (between contractions) to give enough room to move the shoulder.

If there isn’t enough room for fingers in the canal, an episiotomy can be performed – this involves cutting the perineum (the skin and muscle between the vagina and the rectum). The cut generally extends about halfway between the two, although larger cuts and tears sometimes occur. Episiotomy will not help the shoulder dystocia itself, but it will allow doc more room to play, so to speak. If at all possible, this should be done using sterile instruments only – the risk of post-partum infection to mom otherwise is enormous.

If all else fails, a trained physician may attempt to utilize some last-ditch efforts, like intentionally breaking the baby’s shoulder or arm or using a Cesarean cut to give him or herself a chance to reach into the womb, rotate the baby, and allow the birth. The most risky maneuver involves attempting to push the baby’s head back into the birth canal to delivery via C-section. In developing countries, physicians who have very limited resources sometimes cut the mother’s pubic cartilage under local anesthesia rather than performing a Cesarean cut. The first few options on the page should take care of ~90% of shoulder dystocias, though. Keep in mind that this is a pretty rare occurrence to start with, and the last ditch efforts should be fairly rare.

That said, modern births do occur outside the statistical norms in a lot of ways. Almost 30% of births in the United States are performed by surgical removal of the fetus, but shoulder dystocias still occur at about the same rate in vaginal births because they are difficult to predict, despite a number of decades of measuring pelvises and guessing baby-weights. Women considered to be more at risk for shoulder dystocias include those of short stature and who have gestational or other forms of diabetes. Large babies >9lb are also at increased risk, but it is practically impossible to predict which women and which babies will be affected. Even given the risk factors for this condition, vaginal birth results in a much lower rate of complications for both mom and baby than routine surgical delivery.

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Remember, information at Muse Medicine is for fiction writers ONLY and should not be construed as medical advice or applied to real people. Please seek a licensed physician for questions regarding your personal, real-life situation.

Posted in Pregnancy/Birth | Tagged , | 2 Comments