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Full text of "Medical Jurisprudence And Toxicology"

556                                              MEDICAL JURISPRUDENCE

Symptoms.—An inky, metallic taste in the mouth; violent pain in the stomach and
abdomen; vomiting; purging with black motions ; suppression of urine ; collapse and
death. Sometimes, there are convulsions and paralysis of the extremities.

Fatal Dose and Fatal Period.—The fatal dose of ferrous sulphate for children is
usually 36 grains, but it is not known for adults. Recovery has occurred after ingestion
of an ounce of ferrous sulphate. One ounce and a half of the tincture of ferric chloride
has caused death in five weeks, and recovery has followed a dose of three ounces of
the tincture.

Death from ferrous sulphate poisoning has occurred in children in thirty hours or
more.

Treatment—Wash out the stomach with the stomach tube, or administer emetics.
Give sodium carbonate or bicarbonate dissolved in a large amount of water or milk,
demulcent drinks, opium and stimulants, if necessary. Inject intravenously saline with
5 per cent glucose.

Post-mortem Appearances.—The mucous membrane of the stomach is red and
inflamed with small haemorrhages. The duodenum shows similar appearances. The
liver and kidneys show degenerative changes.

Chemical Tests.—1. Ammonium sulphide gives a black precipitate, soluble in dilute
hydrochloric acid with both ferrous and ferric salts.

2.   Potassium ferrocyanide with ferrous salts produces a white precipitate, which
turns immediately blue and with ferric salts a blue precipitate  (Prussian blue),

3.    Potassium ferricyanide gives a blue precipitate   (Turnbull's blue)   with ferrous
salts and a brown colouration with ferric salts.

4.    Potassium sulpho cyanide produces no change with ferrous salts and a blood red
colouration with ferric salts.

Medico-Legal Points.—1. Iron is a normal constituent of the body, it being present
in the colouring matter of the blood. It is also present in food and is often a constituent
of tonic medicines.

2.    Ferrous sulphate seems rarely to have proved fatal to adults, but it has pro-
duced fatal poisoning in children under the age of four years who took proprietary fer-
rous sulphate tablets mistaking them for sweets.   Each tablet contains three grains of
ferrous sulphate, l/25th grain of copper sulphate and l/25th grain of manganese sulphate.

' Forbes49 describes two such fatal cases. In one case a child 31 years old, died in 53
hours after taking 50 tablets and in the other case a child, aged 1 year, died in 30 hours
after swallowing 30 to 35 tablets.

Perchloride of iron has been given for homicidal purposes to persons in an intoxi-
cated condition. Poisonous, irritant symptoms have followed the use of iron chloride as
an injection into the uterus. Both the sulphate and the chloride have been used in
poisonous, doses to procure abortion.

Intravenous injections of an iron preparation, such as saccharatcd iron oxide (ferri-^
venin), neoferrum, etc. produce toxic reaction especially in persons suffering from
severe liver disease and severe infections. Injections of 60 to 80 nig. produce mild
symptoms and 100 mg. or more produce severe toxic symptoms. The chief symptoms
are a burning sensation at the site of the injection spreading to the head and neck,
which are flushed, wheeziness, tightness of the chest, dyspnoea, sweating, cyanosis, faint-
ing fits, imperceptible pulse, collapse and rarely death. Barritt and Swainno report
the case of a man, aged 69 years, who died in 30 minutes after the intravenous injec-
tion of 100 mg. of ferrivenm. To avoid toxic reaction it is recommended that the injec-
tion should be started with the initial dose of 25 mg. and gradually raised to 50 mg.

3.    Iron is eliminated in the faeces and urine.

MANGANESE

Of the compounds of manganese, potassium permanganate and manganese dioxide
are of toxicological interest.

Potassium Permanganate, KMnO^This is prepared by heating potassium hydroxide
with manganese dioxide and potassium chlorate. It occurs as dark purple, slender, iri-
clescent prisms and has a sweet astringent taste. It dissolves in 20 parts of water,
forming a purple-coloured solution. It is a pharmacopoeial preparation, known as potassii
permanganas, the dose being 1 to 3 grains.

' p- 367; see also T^mson, J, Ibid, p. 640; Annotation,