Medical Jurisprudence And Toxicology

506 MEDICAL JURISPRUDENCE

The extensor muscles of the extremities atrophy; hence the patient is unable
to use his limbs, and becomes bed-ridden; but the sphincters are rarely
affected. Tremors are noticed in the muscles which become markedly para-
lysed. The interosseous and intercostal muscles are more often affected.
These are followed by general emaciation, dysuria, mental hebetude or
delusions and death occurs from failure of the heart muscle.

Treatment.—Remove the patient from the source of the poison, adminis-
ter potassium iodide in 5-grain doses and treat the symptoms as they arise.
Inject sodium thiosulphate intravenously every day. Administer five per
cent B.A.L. and 20 per cent benzyl benzoate in arachis oil intramuscularly
into the thigh or gluteal region. Give tonics, such as iron and strychnine to
improve the general health of the patient.

Post-mortem Appearances.—The stomach and intestines present a chro-
nic inflammatory condition but, more often, there may not be any
characteristic changes. The liver shows the signs of fatty degeneration, and
the kidneys show parenchymatous nephritis. The muscles are greasy and
atrophied.

ORGANIC COMPOUNDS OF ARSENIC

Organic compounds of arsenic are used in the treatment of syphilis,
yaws, sleeping sickness and other protozoal diseases. They contain arsenic
either in trivalent combination or in pentavalent combination. The trivalent
compounds, such as salvarsan, neosalvarsan, etc. are more potent upon
protozoa than the pentavalent compounds, such as atoxyl, arsacetin, etc.
The organic compounds have arsenic in chemical combination with a carbon
atom and are, therefore, less poisonous than the inorganic compounds of
arsenic.

Salvarsan and its derivatives are generally administered intravenously
and occasionally intramuscularly. Arsenic is found in the blood soon after
an intravenous injection of one of these preparations and is rapidly eliminated
by the kidneys and bowels, but may be retained in the tissues for a longer
time after an intramuscular injection. Thus, arsenic was not detected in the
viscera of a female patient who died fourteen days after the intravenous
injection, "but a large quantity was found in the gluteus muscle when post-
mortem examination was held on the body of a woman who died thirty-six
days after the intramuscular injection.13

Symptoms.—The symptoms of an anaphylactic nature may occur during
or soon after the intravenous injection of a medicinal dose of salvarsan or
its derivatives. They, are malaise, flushed face, oedema of the tongue or
eyelids, nausea, giddiness, headache, rigors with a slight rise of temperature,
pain in the chest and joints, dyspnoea, cough, urticarial rash and slight
diarrhoea. These symptoms usually last from half an hour to a day or two.
More severe poisoning ending in death may sometimes ensue after the first
injection or after two or three injections repeated at short intervals. The
symptoms in such cases are stomatitis, abdominal pain, vomiting, profuse
diarrhoea with bloody stools, severe headache, exfoliative dermatitis,
jaundice, hyperpyrexia, dilated pupils, anuria, cramps, convulsions, coma,
collapse and death. Extensive sloughing, abscesses and necrosis of the
surrounding, tissues .may occur at the site of the intramuscular injection.
Optic atrophy which is so common in poisoning by atoxyl and other penta-
valent compounds is not produced in poisoning. T^y . ssilvarsan and other
trivalent compounds. Death occurs among those suffering from visceral and
degenerative lesions. It may also occur from a faulty technique Mor from
auto-intoxication.

13, W. Wec£selinann; Treat, of Syphilis'witK SaZtrarsau'/Eng. TS&n&U'g. 86.