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Full text of "Medical Jurisprudence And Toxicology"

CARBON TETRACHLORIDE                                                   645"*

Russian prisoners during the First Great War by drinking chloroform as a
substitute for alcohol. In his letter dated the 26th September 1946 addressed
to the author, the Chemical Analyser, Bombay, describes two cases, where
two Hindu males died after taking chloroform in place of alcohol.

Elimination.—Chloroform is eliminated mainly by the lungs, and may
be detected there some days after death. A small quantity may be excreted
in the urine, perspiration and milk. Chloroform may be re-secreted in the
stomach, even if introduced hypodermically into the system.

AVERTIN  (BROMETHOL OR SOLUTION OF TRIBROMOETHYL ALCOHOL)      r

This contains two parts of tribromoethyl alcohol dissolved in one part of amylene,
hydrate, the dose being J to 2/3 minim per pound of body weight by rectal injection.
It is readily soluble in water, and the aqueous solution, when heated to above 40*0. and
exposed to air and light, decomposes into dibromoacetaldehyde and hydrobromic acid,
which are quite irritant to the rectal mucous membrane. It is also inflammable and
volatile and must not, therefore, be used near a flame. It is generally administered in
a 2.5 per cent' solution in distilled water as an anaesthetic for surgical operations or as
a basal hypnotic prior to general anaesthesia.

, In large doses avertin produces toxic symptoms, the chief being headache, nausea,
cyanosis, fall in blood pressure and death from respiratory paralysis. It causes Tatty
degeneration or acute yellow atrophy of the liver and degenerative changes in the kid-
neys.

The treatment consists in the high rectal irrigation with a warm solution of sodium
thiosulphate and administration of coramine intramuscularly or ephedrine hydrochloride
intramuscularly or intravenously. Oxygen and artificial respiration, if necessary.

CARBON TETRACHLORIDE (TETRACHLOR-METHANE), CClt"

This is a heavy, colourless, volatile, non-inflammable liquid with a chloroform-like
odour and a burning taste. It is sparingly soluble in water, but dissolves freely in
alcohol and ether. It is extensively used as a solvent for rubber, resins, sulphur and
fats, and as a fire extinguisher. It is used as 'a dry-cleaning agent in the household. It
can be used as a'general anaesthetic-like chloroform, but has twice its toxicity. It is a
pharmacopoeial preparation, called Carbonei tetrachloridum, and is largely used as an
anthelmintic in ankylostomiasis in 30 to 60-minim doses. Poisoning has resulted from
the inhalation and the internal administration of this drug. It is a hepatotoxic and
nephrotoxic agent.

Symptoms.—When inhaled, it causes burning pain in the eyes and throat, head-
ache, nausea, sometimes vomiting, mental confusion, loss of consciousness and convul-
sions. Death occurs from failure of the circulatory and respiratory centres.

Persons employed in rubber works, where carbon tetrachloride is used as a solvent
for.rubber may suffer from chronic poisoning, which is characterized by irritation of the
eyes, nose and throat, dermatitis, nausea and' loss of appetite and weight. They also
suffer from jaundice, acute nephritis and ansemia.

When taken by the mouth, it causes headache, nausea, vomiting, abdominal min,
fine tremors, convulsions, coma and death. Gastric or intestinal haemorrhages frequently
occur:

The symptoms of poisoning are usually delayed for twenty to thirty-six hours after
the ingestion of this drug, but Mitra-"14 reports a case in which a prisoner, aged 30 years,
and of good health, felt nausea one hour after the administration of a medicinal dose of
45 minims, and commenced vomiting in a few minutes. He was seized soon afterwards
with colicky pains in the abdomen and was restless. The perspiration started on the
forehead, the pulse was soft and slow and the respiration was laboured. An urticarial
rash which soon became confluent appeared on the body. Recovery followed a nypoder^
mic injection of 0.5 cc. of pituitrin.

Fatal Dose and Fatal Period.—Uncertain. The concentration of carbon tetrachloride
fumes in air should never exceed one part per ten thousand for continued exposure.
The concentration of one part per thousand is dangerous if inhaled for more than, fifteen
minutes. A young woman who used it as a hair wash collapsed and died in a' few
minutes as a result of inhalation of its fumes.3 r»

The fatal dose of carbon tetrachloride liquid may be 3 cc. to 4 cc. for adults and
about 1 cc. for children. On the contrary, a dose of 40 cc. did not produce any toxic
symptoms in an adult,86 Death usually occurs in a day or two.

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34.    Ind. Med. Gaz., Nov, 1928, p. 637.     '                                        -                             , • V,

35.    Veley, Lancet, 1939, Vol. II, p. 1162.                                      ,;.    •'*

36.    Larnson, Minot and Robbins, Jour.. Amer. Med. Assoc,, Feb. }4, t.1928,. p. 345, -   ,/<