568 MEDICAL JUBISPRUDENCE Symptoms.—The lips, tongue, teeth, and the inside of the cheeks are purple-coloured, followed by tenderness of the epigastrium, salivation, persistent vomiting, diarrhoea, fever, albuminuria, and collapse. When given in an initial large dose or too frequently, sanocrysin may produce poisoning, the symptoms being skin rashes, unpleasant taste, stomatitis, nausea, vomiting, abdominal pain, diarrhoea, albuminuria, h^moglobinuria, jaundice, anaemia with agra- nulocytosis, myocardial failure and pulmonary oedema. Exposure of the face or neck to bright sunlight after a course of sanocrysin may cause a permanent purple discoloura- tion of the skin due to the gold being deposited in the skin.88 A case*9 is recorded where a patient suffering from tuberculosis was treated by gold salts without any ill-effects, but during the -second course the blood picture of severe ansemia with marked decrease of the granular white corpuscles (agranulocytosis) occurred and the patient died. Fatzer^o aiso reports two cases. In the first case a patient, 65 years old, who was treated with allochrysine for chronic deforming rheuma- tism, died of agranulocytosis with secondary necrotic angina. In the second case a 60-year-old patient suffering from the same disease developed agranulocytosis after one month's treatment with 3 grammes of solganal. This condition disappeared after treat- ment with liver extract, irradiation and nucleotide, but the patient died a month later from an abscess of the'lung. Fatal Dose and Fatal Period.—Not certain. An intramuscular iniection of 0.05 G. of sanocrysin proved fatal to a male phthisical patient, 37 years old, after 8 days. A man was treated with sanocrysin in April 1934. The first injection of 0.05 G. was followed by urticaria of the trunk and arms, so that the doses were decreased to 0.025 G. 'and given once a week. The last injection which was given on November 2, was followed by a papular eruption over the right shoulder and upper arm, as well as by diffuse polyneuritis which increased until complete paraplegia was developed. Death occurred on November 17, with symptoms of asphyxia of bulbar origin. The total quantity of sanocrysin in- jected was in all 5.4 G.91 Treatment—Administer at first 10 cc. of a 10 per cent solution of calcium gluconate and then give eggs and other albuminous substances. Sodium thiosulphate may be given orally or intravenously, B.A.L. has been recommended as an effective form of treatment in poisoning by gold. Post-mortem Appearances.—Irritation of the alimentary canal. Capillary haemor- rhages in the brain and other organs. Fatty degeneration of the liver. Chemical Tests.—1. Hydrogen sulphide produces a black precipitate, soluble in ammonium sulphide. 2. Ammonia yields a reddish-yellow precipitate. 3. Stannous chloride gives a purple precipitate. PLATINUM The soluble salts of platinum are poisonous and act as irritant poisons, the chief symptoms being burning pain in the mouth, salivation, nausea, vomiting, pain in the abdomen, diarrhoea with bloody motions, headache and slight jaundice. Erythema and urticarial rashes are often observed. A double chloride salt of platinum and potassium is used in photography. Hence it is liable to cause poisonous symptoms from its accidental internal use. Chemical Tests.—Hydrogen sulphide gives a dark brown precipitate, insoluble in hydrochloric acid. A concentrated solution of potassium or ammonium salts in presence of hydrochloric acid gives a yellow crystalline precipitate of the double chloride. NICKEL AND COBALT Poisoning by the salts of these metals is exceedingly rare. The chief salts that are likely to produce poisonous symptoms are carbonyl of nickel and cobalt. Nickel carbonyl, Ni(CO)4, which is a colourless, mobile, highly refractive liquid, has produced fatal symptoms among workmen employed in nickel work. Toxic symptoms "are also pro- duced by the inhalation of air charred with the vapours of nickel carbonyl, which is converted into a gaseous condition at 104 °F. In 1903, two of the men employed at Mond's Chemical Works, Clydach, who had been exposed to the vapours of nickel carbonyl, died and their deaths were found to be due to the inhalation of this substance. Dr. Jones reported that there had been twenty- six cases of slight poisoning under his care last summer in chemical workers. Post- mortem examination of both the bodies showed that the lungs were cedamatous and 88. Beaumont, Brit Med. Jour., 1928, Vol. II, p. 815. 89. Jacquettn and Allenie, Bull Soc. Med. Hop. Par., 1932, S, 3, XLVIII, pp. 539-47 ; Med.-Leg. and Crimmol. Rev., 1934, Part I, Vol. II, p 92 I^bS^Ss^ ™2l' WS°hr" 1936' Ij P' 12(>; Med~Leg' and Ofr»fo°l- Bw,, Vol. IV, Part 91. Jour. Amer. Med. Assoc., April 13, 1935, p. 1350.