Medical Jurisprudence And Toxicology

476 MEDICAL JURISPRUDENCE

Picric acid is sometimes used by malingerers to simulate jaundice and to escape
military service.

Picric acid is eliminated in the urine, though the elimination is slow. In one case
its presence was detected in the urine for six days after the administration of a single
dose of one gramme of picric acid.39 It is also eliminated in the fasces.

In his annual report for the year 1938, the Chemical Examiner, Punjab, mentions
that an attempt was made by the tribesmen to poison the water supply of the troops at
Razani Camp on the North-West Frontier by introducing picric acid into the water sup-
ply tanks. Owing to its yellow colour and intensely bitter taste the acid was detected
in time before any mischief could be made.

SALICYLIC ACID, CoH, (OH) .COOH

This is prepared by the interaction of sodium phenoxide and carbon dioxide. It
may also be obtained from natural salicylates contained in gaultheria and sweet birch.
It is an odourless, crystalline solid, sweetish and acrid in taste, sparingly soluble in cold
water (1 in 500), but readily in hot water, alcohol, ether and chloroform. It is anti-
fermentative and antiputrefactive. It causes irritation of the gastric mucous membrane
and is rarely used alone for therapeutic use. The non-official dose is 5 to 10 grains.

Sodium salicylate is prepared by neutralizing salicylic acid with sodium carbonate.
It occurs in odourless, white scales or shining tabular crystals, having a sweetish, un-
pleasant, saline taste. It is soluble in water, alcohol and glycerin, but insoluble in ether.
It is antipyretic and antirheumatic, and is mostly used in the treatment of acute rheu-
matic fever. The dose is 10 to 30 grains.

Symptoms.—These are burning pain in the throat and stomach, difficulty of swal-
lowing, thirst, nausea, vomiting, diarrhoea, headache, noises in the ears, giddiness, flushing
of the face, profuse perspiration, cold, moist skin, slow, weak, and irregular pulse,
confused mind, delirium, insensibility and coma. Hemorrhages occur from the mucous
membranes, e.g. epistaxis, bleeding from the gums, retinal haemorrhages causing
amblyopia, and bleeding from the kidneys giving rise to haematuria. There may be
bleeding from the uterus, leading to abortion. Death occurs from the stoppage of the
heart or respiration.

Chronic Poisoning.—This is known as salicylism and occurs when salicylic acid and
its salts are administered for a prolonged period. The chief symptoms are loss of appe-
tite, impaired digestion, diarrhoea alternating with constipation, eczematous eruptions on
the skin and mental depression. The urine may be albuminous. Death may take place
from cardiac or respiratory failure.

Fatal Dose and Fatal Period.—Sixty to one hundred and fifty grains of salicylic acid
have caused death. One ounce of salicylic acid has caused death after four days.40 A
little more than one ounce of sodium salicylate proved fatal to an adult in thirty-one
hours. Recoveries have occurred from larger doses.

Treatment.—Emetics, lavage, sodium bicarbonate, magnesium oxide, raw eggs, milk,
warmth and stimulants.

Post-mortem Appearances.—The mucous membrane of the stomach is inflamed with
submucous haemorrhages. The same appearances are observed in the duodenum. The
spleen and liver are congested. The kidneys show the signs of inflammation. The lungs
are generally osdematous. The brain is congested.

Tests.—Ferric chloride gives a violet colour, which disappears on the addition of
mineral acids, but not on the addition of alcohol or acetic acid. Bromine water produces
a yellowish-white precipitate of tribromosalicylic acid, which dissolves in alcohol.

Medico-Legal Points.—Accidental cases of poisoning by salicylic acid and sodium
salicylate occur from overdoses administered internally. Salicylic acid is also absorbed
from the skin and produces toxic symptoms when applied in the form of an ointment
to the raw, surface or even to the intact skin. A child, 7 years old, who was suffering
from psoriasis, died forty hours after the application of 5 per cent salicylic acid ointment
to the psoriatic areas.41 Some individuals are susceptible to these drugs and suffer
from poisonous symptoms even from a small dose, while others can tolerate large doses
without ill effects.

Salicylic acid is eliminated chiefly by the kidneys as salicyluric acid. Its elimina-
tion in the urine begins within fifteen minutes of its administration by the mouth and
ends, as a rule, within forty-eight hours. It is also excreted in perspiration, bile and milk.

39. Warren, Autenrieth's Detection of Poisons, Ed. VI, p. 120.

40. Holland, Med. Chem. and Toxic., Ed. IV. p. 473.

41. Jour. Amer. Med, Assoc., 1937,. Vol. H, p. 1160; Martindale, Extra Pharmacopoeia,
Ed. XXn, p. 95.