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CHLOROFORM                                                         643

The treatment of delayed chloroform poisoning consists in the adminis-
tration of subcutaneous or intravenous injections ot normal saline. Glucose
may be administered by the mouth or per rectum to combat the acidosis. A
light nutritious diet consisting of sugar and carbohydrates should be given as
a prophylactic measure four or five hours before chloroform inhalation.

Post-mortem Appearances.—Not characteristic. The brain is usually
congested. The lungs are congested and emit the smell of chloroform. Gas
bubbles may be found in the blood which is, as a rule, dark and fluid. The
heart is often dilated. The liver, spleen and kidneys are sometimes

Symptoms when swallowed as a liquid.—First of all the symptoms of
irritation appear and then coma supervenes. The patient complains of a
burning pain in the mouth, throat and stomach; this is followed by vomiting
and purging. The vomited matter gives the smell of chloroform, and may
contain blood. These symptoms are followed within ten minutes or so by
unconsciousness and coma. The pupils are dilated. The surface is cyanosed.
The skin is cold and bathed in perspiration. The pulse is feeble, frequent
and irregular. The respirations are slow and stertorous. Death occurs from
paralysis of the heart's action or respiration. It may sometimes occur from,
pulmonary oedema or gastritis. Cases that recover may show jaundice and
enlargement of the liver.

Fatal Dose.—Uncertain. The fatal dose is usually about 1 ounce, but
recovery has occurred after much larger doses.

Fatal Period.—The usual fatal period is 5 or 6 hours. Death may some-
times take place within a few minutes or may be delayed for some days.

Treatment.—Empty the stomach and wash it out with warm water and
milk. Give demulcent drinks, and administer hypodermic injections of
strychnine, digitalis, caffeine, atropine, brandy or ether. Give an enema
containing whisky. Keep up the body heat by warmth and mustard plaster.
Resort to artificial respiration and galvanism.

Post-mortem Appearances.—The mucous membrane of the pharynx and
gullet is congested and inflamed. The stomach contents may give off the
odour of chloroform. The gastric mucous membrane is red, softened and
inflamed, and may show patches of erosion. The lungs are intensely con-
gested. The heart, liver and kidneys may show fatty degeneration,

It must be remembered that in cases of suspected chloroform poisoning
the brain and lungs in addition to the stomach and liver should be preserved
for chemical analysis.

Chemical Analysis,—Chloroform is easily separated from organic mix-
tures by distillation with steam, In fatal cases of chloroform poisoning an
examination of the blood is very necessary, as chloroform, passes rapidly into
the circulation.

Tests,—1, The vapour of chloroform, when passed through, a red hot
exit tube, is split up into chlorine and hydrochloric acid. Chlorine is known
by its turning blue a piece of blotting paper moistened with starch and iodide
of potassium. Hydrochloric acid gives a white precipitate to a solution of
silver nitrate.

2.    If (3-naphthol dissolved in a small quantity of strong sodium hydro-
xide solution be added to a solution containing chloroform and heated, a blue
colour is produced, which becomes green and finally brown,                  ,  *

3.    Add 1 or 2 cc. of an alcoholic solution of caustic potash and a d#op
of aniline to 1 to 3 cc. of a mixture containing chloroform and heat.   A
disagreeable odour is given off due to the formation of phenylisocyanide or