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Full text of "Medical Jurisprudence And Toxicology"

450

MEDICAL JURISPRUDENCE

funnel is almost empty the tube below it should be compressed between the
finger and thumb and lowered below the level of the stomach. On removing
the pressure the contents of the stomach which will run out of the funnel
owing to the tube acting as a syphon should be received in a perfectly clean
bowl or bucket. This process should be repeated until a clear, odourless
fluid comes out. A part or all of the material ejected by the first washing
of the stomach must always be preserved for chemical analysis. Instead of
warm water, it is preferable to use a solution of a suitable antidote, such as
a solution of potassium permanganate in poisoning by opium, dhatura and
other oxidizable substances. If the stomach contains large pieces of food
or poison, it may be necessary to produce vomiting by an emetic before using
the tube in order to prevent the blocking of the narrow opening at its blunt
end. In such an event it is also advisable to enlarge the opening with a pair
of scissors.

It is advisable to remove dentures and to use a mouth gag in those cases
where it is difficult to keep the mouth open for the passage of the tube.

A stomach wash out on a comatose or unconscious patient, whose cough
reflex is absent, may be fraught with danger, as the stomach contents which
are regurgitated around the tube may flow into the trachea and cause either
immediate suffocation or later broncho-pneumonia. As a safeguard against
such an accident it is necessary that the mouth and pharynx should be lower
than the larynx. This is usually achieved by placing the patient on a bed in
the prone position with the head projecting over its end and supported by
an assistant. In hospital the patient should be taken to the operating theatre
and placed in the high Trendelenburg position. In this position the gravita-
tion of fluid from the mouth into the trachea is impossible.16

1 The stomach tube should never be used in cases1 of poisoning by corro-
sives except carbolic acid, as there is danger of causing perforation of the
oesophagus or stomach owing to the -Softening and ulceration produced by
them. In cases of irritant poisoning the stomach tube should be passed with
caution.

When the stomach tube is not available, or when a patient is conscious,
and does not wish to have it passed into tn€ stomach, "free emesis should be
produced by tickling the fauces with a fihgerra feather, or a leafjr twig of a
tree. The vomited matter must be preserved for chemical analysis. The
following emetics may also be administered:—                                             ;

1.    Copious draughts of warm water.                                     *    *   >.         f

2.    A table-spooirful of ground mustard or two tabtftsjjQonfeb rf com-
mon salt in half a pant of warm water.

3.    Half a drachm of sulphate of zinc in a tumblerful of warm Water;
to be repeated in a quarter of an hour, if necessary.

4   Twenty  to thirty  grains of ipeeacq^pfea gowder,  or:, two io  six *
drachms of ipecacu^nJia wine.   la tt^@ case of a ^hiQ sjrurp of "ij^c
from half a tea-spoopful to ^wo                                                ''

preferred, as itis

5.   Fifteen to &8&yt grains of aijpnoniu*a

6.
not be used

7,
Ifiis acts