646 MEDICAL JURISPRUDENCE Treatment.— If carbon tetrachloride has been inhaled, the patient must be removed at once into the open air, and artificial respiration must be started. Oxygen should be administered by inhalation. Later, hot tea or coffee may be given as a stimulant. In cases where the drug has been swallowed, the stomach should be washed out, and a saline purgative should be given immediately. Alcohol, fats or oils should be avoided, but calcium salts should be administered. A high protein, high carbohydrate diet, with 2 grammes of methionine three times a day is also recommended. A case is recorded in which a man who took 30 to 40 cc. of carbon tetrachloride was successfully treated by casein digest and dl-methionine, administered partly orally and partly intravenously .37 Post-mortem Appearances. — On opening the body the smell of carbon tetrachloride may be perceptible in the thorax and abdomen. There may be small hsemorrhagic patches in the kidneys and in the gastro-intestinal tract. There may also be inflam- mation of the small bronchial tubes and necrosis of the liver. Chemical Analysis. — Like chloroform, carbon tetrachloride is separated from organic mixtures by distillation. It responds to the phenylisocyanide test, but not to the g- naphthol test. It is heated with an alcoholic solution of potassium hydroxide, it forms potassium chloride and potassium carbonate. If chloroform is similarly treated, it forms potassium chloride and potassium formate. Medico-Legal Points. — Cases of poisoning by carbon, tetrachloride are mostly acci- dental. A case38 of mass poisoning by carbon tetrachloride occurred among 66 persons followed by 20 deaths after consuming various quantities of a proprietary spirit hair lotion which contained 1.4 per cent of carbon tetrachloride. When fire extinguishers of carbon tetrachloride are used in a closed room with a high temperature, highly poisonous phosgene gas is formed. It is, therefore, dangerous to use such fire extinguishers in closed rooms. Khalil39 has demonstrated that the toxicity of the drug is due to impurities, pro- bably sulphur compounds, which can be got rid of by fractioning the carbon tetrachloride and throwing away the first portion of the distillate (about 1 per cent of the total quantity) . Lamson and his co-workers 40 have shown that alcohol and fatty substances should not be given before or soon after the administration of this drug either by mouth or by inhalation, as they greatly increase the rapidity of its absorption and its toxicity. They have also proved experimentally that calcium deficiency in the organism causes its increased toxicity. TETRACHLORETHANE (ACETYLENE TETRACHLORIDE), C&Ch This substance is a colourless, non-inflammable, volatile oily liquid, having a sweetish odour and taste suggestive of chloroform and boiling at 146° -147 °C. It is used as a solvent for varnishes, especially cellulose acetate, as a constituent of the varnish or "dope" applied to the canvas wings of aeroplanes and in the manufacture of arti- ficial silk, artificial pearls and non-inflammable cinema films. It is also used as an insecticide for weevils and for white fly on tomato plants, Acute Poisonmg.— Symptoms.— When liquid tetrachlorethane is taken internally, the chief symptoms are a sweetish smell like that of chloroform from the breath, frothy fluid at the mouth and nostrils, cyanosis, shallow respiration loss of consciousness, coma and death. Treatment— -Eliminate the poison by washing out the stomach and treat coma and other symptoms as they arise. Post-mortem Appearances.— -Hyperaemia of the mucous membrane of the lower end of the oesophagus and the stomach with small, superficial erosions at its cardiac and pyloric ends ; cloudy swelling and congestion of the liver and congestion of the kidneys and lungs, the brain is congested and cedematous. Chronic Poisoning.—Symptoms.— When the vapours of tetrachlorethane are inhaled, the symptoms are malaise, loss of appetite, nausea, headache, drowsiness and constipa- tion. After a few days vomiting and jaundice develop. These are followed by stupor, convulsions, delirium, coma and death. Occasionally there may be emaciation, anaemia, heemoglobinuria and haemolysis. Treatment— Remove the patient from the source of danger and give complete rest. Administer oxygen by inhalation and give internally sodium * carbonate and sodium citrate in water and also saline purgatives. ) Herbert> Wechtel and Steele, Brit. Med. Jour., Feb. 12, 1944, p. 209. *' 39j 1951' PP' 1"32 ; 39." Lancet, March 13, 1926,' p. 547. 40. Jour, Amer. Med. Assoc., Feb. 4, 1928, p. 345.