Medical Jurisprudence And Toxicology

520 MEDICAL JURISPRUDENCE

nausea, vomiting, diarrhoea and pains in the joints. A metallic taste is
frequently observed. The pulse is feeble, rapid and irregular. Collapse
occasionally sets in. In rare cases, unconsciousness and cyanosis occur,
followed by death. Fakhry43 reports the case of a woman who suffered
from asphyxia after an intravenous injection of one grain of tartar emetic
solution (6 per cent) as a treatment of schistosomiasis. She was_ uncon-
scious and cyanosed with slow, laboured and superficial respirations,
insensitive cornea and open eyes. The pulse could not be felt either in the
radial or temporal artery, and the extremities were cold. Intracardiac and
intravenous injections of 0.2 cc. of adrenaline solution (1 in 1,000) restored
her to life.

When antimony salts are applied externally, pustular eruptions are
produced on the skin. In some cases such eruptions are produced even
when these salts are administered internally or intravenously.

Acute poisoning by antimony is similar to that by arsenic, but there are
no remissions of the symptoms as in arsenical poisoning.

Fatal Dose.—The fatal dose for an adult is probably ten to fifteen grains
of tartar emetic, although two grains have killed an adult, and three quarters
of a grain have killed a child. On the other hand, recoveries have occurred
from much larger doses of tartar emetic owing to the immediate vomiting.

Two to three drachms of antimony trichloride would probably prove
fatal to an adult. Recoveries from large doses upto one ounce have been
recorded.

Fatal Period.—Death usually occurs within twenty-four hours. It occur-
red in six hours in one case, and in ten hours in another. It may be pro-
longed for several days or weeks. It should be remembered that death
occurs much more rapidly in young children who are very susceptible to-
antimony salts. The shortest recorded period in cases of poisoning by
antimony trichloride is less than two hours and the longest is twenty-four
hours.

Treatment.—Promote vomiting by administering musjtard and water
or wash out the stomach with the stomach tube except in tHe case of poison-
ing by antimony trichloride. Give a drachm of tannic acid as an antidote to
form an insoluble salt of antimony tannate, or give liquids containing tannirr
or tannic acid, such as strong and hot tea, coffee, or infusion of gallnuts-
Demulcent drinks, such as milk, oils, mucilage, albumen, water, linseed tear
etc. should then be given. Morphine may be given to relieve pain, and ice
to control vomiting. Stimulants, such as caffeine, strychnine, camphor,
alcohol and ether, may be given to combat heart failure.

Post-mortem Appearances.—The mucous membrane of the pharynx and
oesophagus is congested, and may sometimes present pustular ejoidatjons and
aphthous spots. The mucous membrane of the stomach is red and inHameo!
with patches of submucous haemorrhages. The contents of the stomach are
dark "brown in colour, slightly acid in reaction, and consist chiefly of a
grumous bloody fluid mixed with white or yellowish thick mucus which
adheres to its inner wall. In a decomposed body the colour may be orange-
due to the formation of antimony sulphide by the evolution of hydrogen
sulphide. The mucous membrane of the stomach may sometimes be eroded
and ulcerated. The mucous membrane of the duodenum presents similar
appearances. Small ulcers and haemorrhagic extravasations are occasionally
found in the caecum and rectum. The liver, spleen and kidneys are con-
gested. The brain is congested with effusion into the ventricles. The lungs
are usually congested and dark in colour.

43. Lancet, Dec. 12, 1931, p. 1325.