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502*                                              MEDICAL JURISPRUDENCE

Treatment.  It should be remembered that when taken in a finely
powdered state on an empty stomach, arsenic sticks to the mucous membrane
of the stomach, excites violent inflammation and forms tenacious mucus,
which glues it to the surface, and protects it from the action of both emetics
and antidotes.

The first step in the treatment is to remove the poison as promptly as

possible from the stomach.   If the stomach is full, i.e. if no vomiting has

occurred, empty it by giving emetics, but do not use tartar emetic, or copper

sulphate.   If not, wash out the stomach by passing the stomach tube, pre-

ferably with large draughts of warm milk and water, and then administer

freshly prepared hydrate^lferric oxide, which will convert arsenious acid

into ferric arsenite, a harmless and insoluble salt.   It is prepared by adding

an alkali  (half-an-ounce of strong ammonia or potassium or sodium carbo-

nate dissolved in about half-a-tumblerful of water) to ferric chloride tincture

(one and-a-half ounces of the tincture mixed with a wineglassful of water) .

The precipitate should be separated from the excess of the alkali by strain-

ing through a muslin cloth, and should be given suspended in water in

tablespoonful  doses   at  short   intervals,   or  4   ounces  of   arsenic   antidote

(antidotum   arsenum   B.P.C.   or   ferri   hydroxidum-cum-magnessi   oxido)

should be administered, and the dose repeated, if necessary.   To prepare

this antidote two solutions should be stored ready for use namely,   (1)  two

hundred and eighty-eight minims  of a strong solution of ferric  chloride

mixed with two and a half ounces of water, and^eighty-seven and a half

grains of light magnesium oxide triturated to a smooth paste with water and

diluted to fifteen ounces.   Before being used, 3| ounces of the magnesium

oxide suspension should be shaken well and added to 400 minims of the ferric

chloride solution.6.  Ounce doses of dialysed iron in water may be employed

as a substitute, but it is not so efficacious as hydrated ferric oxide or arsenic

antidote.   If none of these is available calcined magnesia mixed with an

equal quantity of animal charcoal may be administered.

Intravenous injection of 7J grains of sodium thiosulphate in a ten per
cent solution has been recommended and is saicTto have beneficial effects.
Intramuscular injections of a solution containing 10 per cent B,A.L.
(British-Anti-Lewisite, 2, 3-Dimercaptopropanol pr Dimercaprol) and 20
per cent benzyl benzoate in arachis oil into the thigh or gluteal region should
be tried to counteract the effects of arsenic poisoning. Later, denjujpents,
such as ghee (clarified butter), albumen water, barley water, linseed tea,
etc. should be administered to allay irritation and pieces of ice to relieve
thirst. Castor oil or magnesium sulphate may be given to diminish intestinal
absorption of arsenic. Hypodermic injections of morphine may be required
to relieve pain. Subcutaneous or intravenous injections of normal saline or
a five to ten per cent solution of glucose should be administered ' in cases of
severe diarrhoea. Massage should be used to, relieve cramps, and heart
stimulants should be administered by hypodermically to combat collapse. The
body heat should be maintained by the application of hot-water bottles.

The treatment of arseniuretted hydrogen consists in the supply of fresh
air, oxygen inhalation, blood transfusion, infusion of salt solution and admi-
nistration of alkaline drinks to' aid its elimination from the blood and tissues.

Post-mortem Appearances.  External Appearances.- Rigor mortis lasts
longer than us.ual.   The body sometimes presents a * shrHn
The^yeballs are" sunken, and the skin, chiefly of the fran
cyanosed, but not so much as in death from A&iatife cholera,
be found jaundiced as happened in a case dpfpribed by

6.   Martindale, Extra Pharmac'opc&w, M, ^itj <9*L i f ^