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Full text of "Medical Jurisprudence And Toxicology"

528                                                  MEDICAL JURISPRUDENCE

phate in doses of i to 1 gramme in a ten per cent solution has been
recommended, but administration by mouth of 10 ml. of a ten per cent
solution of sodium hypophosphite with 5 ml. of hydrogen peroxide m a glass
of water and gastric lavage with the same solution are regarded more
effective. Intramuscular injections of a solution containing ten per cent
B.A.L. and 20 per cent benzyl benzoate in arachis oil are suggested as a
useful remedy in acute mercurial poisoning, provided it is administered as
early as possible. An initial injection of 300 mgm. of the solution is to be
administered at once, and is to be followed within the first twelve hours by
two or even three further injections of 50 mgm. each.

Sodium formaldehyde sulphoxylate is also used as a chemical antidote,
as it reduces the perchloride to metallic mercury. A freshly prepared solu-
tion of 5 to 10 per cent of the sulphoxylate with 5 per cent of sodium
bicarbonate should be used for washing out the stomach, and 200 cc. of the
solution should be left in the stomach. This should be followed immediately
by a slow intravenous injection of 10 Gm. of sulphoxylate dissolved in 100 to
200 cc. of distilled water. The injection may be repeated after 4 to 6 hours.
High colonic lavage with 1 in 1,000 solution of sulphoxylate should be carried
out twice daily in case colitis should develop. It must be remembered that
this treatment is beneficial only if tried within the first half hour.

Intravenous injections of 20 to 40 cc. of a 25 per cent solution of glucose
have been recommended. The solution of glucose in the form of a drop by
drop enema has also a beneficial effect. Later, the symptoms should be
treated as they arise. It is said that sodium chloride is to be avoided, as it
favours the absorption of mercury, but Professor Michaud °° recommends the
liberal supply of sodium chloride (about 15 grammes daily) with the food in
order to combat the dangerous acidosis and, in addition, a 0.9 per cent solu-
tion of sodium chloride and a 40 per cent solution of sodium bicarbonate
hypodermically and intravenously. Since the introduction of this method
he has saved two cases of serious poisoning by corrosive sublimate.

Post-mortem Appearances.—The appearances of corrosive poisoning will
be present if the poison is taken in a concentrated form. Otherwise the signs
of irritant poisoning will be observed.

The mucous membrane of the lips, mouth and pharynx presents a diffuse
greyish-white escharotic appearance. The same appearance is noticeable in
the oesophagus; its mucous membrane appears also corrugated and eroded.
The stomach contents are masses of coagulated albumen mixed with mucus
and liquid blood. Its mucous membrane is corroded, inflamed, and covered
with a greyish deposit of mercury, or a black deposit of its sulphide.

During the post-mortem examination great care should be taken in
removing the stomach from the abdominal cavity, lest it might be ruptured
owing to the gre^^tenmg of its walls. Perforation of the stomach is very
rare.

The intestines, chiefly the caecum, colon and rectum, are found inflamed,
ulcerated and gangrenous, if the patient has lived for some days. The liver
is congested and shows cloudy swelling. The spleen is congested, The
kidneys are usually swollen with necrosis of the tubules. The heart may
show fatty degeneration.

It must be remembered that the post-mortem lesions are found in the
alimentary canal even if death has occurred from absorption of corrosive
sublimate as a result of the external application to the skin or irrigation of
wounds or abscess cavities, or of the uterus and vagina,

60.   Fortschrittee der Therapie, No. IS, 1930; Ars, Medici, Nov. m0, p. 502.