Medical Jurisprudence And Toxicology

620' MEDICAL JURISPRUDENCE

Carbolic Acid Poisoning.— The most characteristic signs are white
patches on the lips and mouth, characteristic odour of the breath and green
coloured urine.

Compression of the Brain.— History of an accident, probably fracture of
the skull bones. The pupils are unequal or dilated with subconjunctival
haemorrhages.

Fatal Dose. — The smallest dose that has proved fatal to an adult is 4
grains of crude opium. The lethal dose for a healthy adult, not addicted to
opium, usually varies from 15 to 30 grains, though recovery has taken place
after much larger doses. The smallest fatal dose of the tincture of opium is
20 minims in a female adult,9 but large doses even upto 8 ounces have been
recovered from under prompt treatment. The usual fatal dose of morphine
or its salt for a healthy non-addict is 1 to 3 grains, but recovery has followed
much larger quantities. One-sixth of a grain of morphine hydrochloride
injected subcutaneously has produced alarming symptoms in an old man,
while half a grain of morphine hydrochloride .administered hypodermicaUy
has caused the death of a man. On the other hand, recovery has taken place
after the hypodermic injection of about 12 grains of morphine. Medicinal
doses of heroin have produced toxic symptoms, and 6.9 grains I0 have proved
fatal, while 9 grains11 have been recovered from. Four grains of codeine
have caused dangerous symptoms, but codeine rarely causes death,

Much smaller quantities of opium and its alkaloids have proved fatal to
children. For example, 1 grain of Dover's powder equivalent to 1/10 grain
of opium, 1 to 2 minims of the tincture of opium and 1/12 grain of morphine
hydrochloride have each killed children. Recoveries have, however,
occurred from very large doses, e.g. 7$ grains of opium, 2 drachms of the
tincture of opium and 3 grains of morphine sulphate, I have successfully
treated several infants and children who had been accidentally poisoned by
overdoses of opium or its preparations.

Fatal Period,— The shortest fatal period on record is 45 minutes. The
usual fatal period is 8 to 12 hours. Recovery is probable, if a patient sur-
vives 24 hours. In rare cases, however, death has been delayed for 2 to 8
days.

Treatment.— Wash out the stomach first with warm water preserving the
washing for chemical analysis, and then with a solution of potassium per-
manganate of the strength of 10 to 15 grains to the pint of water. This
washing should not be preserved for transmission to the Chemical Examiner,
as potassium permanganate oxidizes opium and its alkaloids and renders
them unidentifiable. It also converts morphine , into oxydimorphine, which
does not satisfy any of the tests for morphine,12 The oxidizing action is
increased by the addition of dilute sulgiu.jric acid. To continue this action
it is advisable to allow about half-a-pSrcof the solution to remain in the
stomach. The practical test to stop the lavage of the stomach is to find the
return water of a ]pink colour. ' '

If potassium permanganate is not available the stomach may be washed
out with an infusion of tea or tannic acid or a mixture of finely powdered
animar charcoal and water. Mustard or zinc sulphate may be given as an
emetic. A pirompt emetic is the hypodermic injection of apomjspkdne hydro-
chloride, but it should be administered cautiously, as it may increase
asthenia.

9. Bombay Chemical Analyser's Annual Report, 1$fot tn 7,
10. McNaIlyf Jour,. Amer. Med. Awoc,, 1&17, Vol. B, p, $

f ,. . . ,, , . , ,

11. Martindale and Westeott J&etai .PlWrncuspjiogfo ^crfL'I, Ed. XXU, p.

12, Henry, Plant Alkaloid, fed, H, p. ?62. , ' /v'^: -, 4,