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Full text of "Medical Jurisprudence And Toxicology"

628                                                 MEDICAL JURISPRUDENCE

account of partial recovery, but a relapse occurs and the patient dies sud-
denly in a state of coma. He may also die later of pneumonia or oedema of
±he lungs.

A case1 is recorded in which a boy, 8 years old, suffered from acute alcoholic
poisoning due to the application of surgical spirit to the legs. His legs were shaved and
washed with ether soap from the groin to the ankle. They were then covered from the
groin to the ankle with a towel wrung out in surgical spirit, over which a dry towel was
' placed and kept in position by three rubber bands. The first dressing was applied at
12 noon on January 8, 1931, and it was repeated at 4 p.m. and 8 p.m. At 12-30 a.m. on
January 9, 1931, he brought up food, but did not speak at all, and his mother thought
that he was still asleep. He continued vomiting and retching on and of! t during the
night, but did not wake up. When seen by the nurse first time in the morning, he was
unconscious, the pulse rate being 160. The respirations were regular, 24 per minute,
and the temperature was normal. At 10-30 a.m. the vomiti was found to emit the smell
of alcohol. The boy was unconscious, pale and warm, the pupils were small, reacted
to strong light, and there was slight internal strabismus of the right eye. The corneal
reflex was absent. The limbs were flaccid. There was no sweating. At 1 'p,m. the
patient was beginning to recover consciousness, but still vomited up small quantities of
turbid brown liquid. He could move all the limbs, and complained of frontal headache.
The pupils were of medium size and reacted to light. The pulse rate was now 142, the
respirations 20 and the temperature 98 °F. His bowels had opened involuntarily once in
the morning. The vomit and the urine were found to contain alcohol on analysis.

Fatal Dose.—This is modified according to the habit and age of the

patient, and the nature and strength of the liquor taken. Death occurs
usually from a large quantity taken in a short space of time. Five fluid
ounces of absolute alcohol are considered fatal for an adult. Two ounces
of absolute alcohol are probably fatal to a child under 12, though very large
doses may be tolerated by habit. Herter2 reports a case where a child, 3|
years old, accustomed to small drinks of whisky, recovered after taking 12
ounces of pure'whisky. Robertson-Milne reports the case of a strong Hindu
male, 30 years old, who,drank a pint bottle of French brandy* and shortly
afterwards became unconscious, but recovered completely the next day,s

Fatal Period.—The usual fatal period is 12 to 24 hours, though death may
occur in a few minutes or may be prolonged for 5 or 6 days-
Treatment.—Eliminate the poison by emetics or by the stomach tube.
Apply cold affusions to the head. Maintain the body-temperature by cover-
ing the patient with warm blankets. Administer strong coffee with glucose
either by the mouth or by the rectum. If necessary give 1,000 ec» of 10 per
cent glucose with normal saline intravenously, to which 15 units of Insulin*
200 nag/ of Vitamin B1? 200 mg. of Niacinamide and 1,060 ing. of Vitamin C
should be added. Wash out the colon with normal saline, Use hypodermic
injections of strychnine and camphor. Resort to galvanism, artificial respi-
ration, and oxygen inhalation at high tension.

Post-mortem Appearances.—Rigor mortis may last unusually long* De-
composition is also said to be retarded in cases where a very large quantity
has been taken, but this is not always the case. The alcoholic odour is
perceptible in the stomach, lungs and brain, unless putrefaction has set in.
The mucous membrane of the stomach may be red, intensely congested and
inflamed, or it may be only pale. The liver, lungs and brain are usually
congested.. The blood is generally fluid arid darE         "~~"" """"'"

"""The necessary viscera should be preserved in a saturated solution of
common salt for chemical analysis.

Chrome Poisoning.—Habitual drunkards, who have been taking alcohol
in one form or another for a long and continued period, suffer from many
organic diseases.

1.   Vincent C. James, Brit Med> Jour., March 28, 1931, t>. 539,
*         2.   New York Med. Jour., 1896, LXIV, p. 608.
3.   Jnd. Med. Gaz.t June 1902, p. 208.