SALICYLIC ACID 477 Methyl Salicylate.—This is also known as artificial oil of wintergreen, and is obtained by the interaction of methyl alcohol and salicylic acid. It is a colourless liquid, having a characteristic, aromatic odour and a sweetish, warm, aromatic taste. It is slightly soluble in water, and freely soluble in alcohol, ether, chloroform, glacial acetic acid or carbon bisulphide. Methyl salicylate is taken accidentally, suicidally or to procure abortion, and causes symptoms of acute gastro-intestinal irritation resembling those of poisoning by salicylic acid, followed occasionally by death. About an ounce of methyl salicylate proved fatal to an adult woman in 15 hours42 and a dose of 50 ml. of methyl salicylate caused the death of a middle aged woman hi about 11 hours.43 Doses of 10 cc. to 12 cc. of methyl salicylate have killed children.44 On the other hand, a child, aged 2 years, recovered after swallowing an ounce.45 The treatment consists in the washing out of the stomach and administration of olive oil and sodium bicarbonate mixed freely with water. Dextrose, saline and lactate solutions may be administered intravenously, and artificial respiration may be per- formed, if necessary. The post-mortem appearances are inflammation of the mucous membrane of the stomach and intestine and congestion of the viscera. There may be submucous haemor- rhages in the pelves of the kidneys and petechial haemorrhages in the renal cortex. Acetylsalicylic Acid (Aspirin).—This is obtained by the action of acetic anhydride or acetyl chloride on salicylic acid. It occurs as a white, inodorous, crystalline powder, having a slightly acid taste. It is sparingly soluble in water, but dissolves in 5 parts of alcohol and freely in ether. It is a pharmacopoeial preparation, the dose being 5 to 15 grains. Its action is antipyretic and analgesic. Symptoms.—These are headache, dizziness, buzzing in the ears, thirst, gastric pain, nausea, vomiting, red and swollen face, weak and rapid pulse, quick breathing, profuse perspiration, prostration, drowsiness and coma. The temperature is usually subnormal, but is sometimes raised. In some cases there may be cutaneous eruptions of various kinds, delirium and abortion in pregnancy. In severe cases the alkali reserve of the blood is diminished and clinical signs of acidosis with Cheyne-Stokes respiration are found. Death occurs from cardiac or respiratory failure, Fatal Dose and Fatal Period.—Small doses of five to ten grains of aspirin may pro- duce in susceptible individuals alarming symptoms, such as enormous swelling of the face, especially the eyelids, lips, nose and tongue, congestion of the fauces, oedema of the glottis, difficulty in speaking, dyspnoea, etc. and may even cause death. In his annual report for the year 1940 the Chemical Analyser, Bombay, mentions the case of a person, 18 years old, who died after swallowing 2 five-grain tablets of aspirin. Seventy-five to one hundred grains of aspirin is the minimum, fatal dose, while four hundred and fifty to six hundred grains is the average fatal dose, since suicides usually take large doses to ensure success in their attempt. On the other hand, recoveries have followed much larger doses of twelve hundred and fifty,46 fifteen hundred47 and two thousand48 grains of aspirin. The fatal period varies from a few minutes to several hours. A woman, aged 45 years, died in five minutes after ingesting five grains of aspirin.49 A male child, 5 months' old, died in ten hours after he was given thirty grains of aspirin.50 A man, aged 72 years, and a man, aged 50 years, died in about 12 hours after swallowing 150 five-grain tablets and one thousand grains respectively.5^ Treatment.—This consists in the washing out of the stomach with a weak solution of sodium bicarbonate and the administration of saline purgatives. Intravenous injec- tion of a 4 per cent solution of sodium bicarbonate is very beneficial. This may also be administered by mouth or by rectum after vomiting has stopped. Large quantities of water may be given to hasten the elimination of the poison. Saline infusion with dextrose may be given intravenously. Cardiac stimulants may be administered, if neces- sary. Lumbar puncture in serious cases may have a beneficial effect Post-mortem Appearances.—The gastric mucous membrane is eroded at places with blood vessels inflamed in patches. There may be haemorrhages in the other viscera. 42. Pinkham, Boston Med. and Surg. Jour., Vol. 117, p. 548. 43. P. Mouren, Semaine des Hopitaux de Paris, June 22, 1949, p. 1969; Abst. of World Med., Feb. 1950, p. 133. 44. Meyerhoff, Jour. Amer, Med. Assoc., May 31, 1930, p. 1751, 45. Myers, Jour. Amer. Med. Assoc., Dec. 25, 1920, p. 1783. 46. P. Hopkins, Lancet, Feb. 3, 1945, p. 145. 47. Evans, Brit Med. Jour., Vol. n, 1938, p. 386. 48. Ivan Leveson, Brit. Med, Jour., Sep. 17, 1949, p. €28. 49. Dysart, Jour. Amer. Med. Ass.» Aug. 5, 1933, p. 446, 50. J. B. Gillespie and R. K Dukes, Amer. J. Dis. Child., Vol. 74, 1947, p. 334 51. Neals, Brit. Med. J^ Jan. 18, 1936, p. 110.