TETRACHLORETHANE 647 Post-mortem Appearances.—Acute yellow atrophy of the liver is often seen in death from inhalation of the vapours. There may also be fatty degenerative changes in the kidneys. Medico-Legal Points.—Tetrachlorethane is a powerful poison and causes acute and chronic poisoning. Acute poisoning occurs from swallowing large quantities of liquid tetrachlorethane, which has a narcotic action. Chronic poisoning is caused by the inhalation of the vapours of tetrachlorethane and occurs mostly among workers in fac- tories, where it is used. In this type of poisoning, tetrachlorethane acts chiefly on the liver causing death from necrosis of the liver. Acute poisoning by tetrachlorethane is generally suicidal and rarely accidental. This drug is not known to have been used as a homicidal poison. Gilbert Forbes41 records the case of a labourer, aged 33 years, who died about six hours after drinking the liquid. Keish Mant 42 also reports two suicidal cases of acute poisoning by this drug. In one case a gardener, 57 years old, died rapidly within a few hours after the ingestion of a large quantity of tetrachlorethane taken on an empty stomach. In the second case a carpenter, 20 years old, died in about fifteen hours after he had ingested about 1 to 2 ounces of the poison. Trichlorethylene (Chlorylen or Trilene), CJICla.—This is a colourless, volatile liquid, having a pleasant, sweetish odour and boiling at 87 °C. It is used as a solvent for fat, tar, rubber and in the extraction of oils and fats, degreasing metals, painting, enamelling, dry cleaning, and cleaning photographic plates. It is used as a general ansesthetic, and is also employed in the treatment of trigeminal neuralgia and migraine in doses of 10 to 20 minims to be inhaled from cotton wool. Locally applied, trichlorethylene causes blisters of the skin after an interval of about twenty-four hours. Prolonged exposure to the fumes has an acute narcotic effect, and causes headache, giddiness, confusion, fainting, jaundice, paralysis of the sensory fibres of the fifth nerve, retrobulbar neuritis, optic atrophy, cardialgia, albuminuria, coma and death. The treatment consists in the administration of oxygen and 5 to 7 per cent of carbon dioxide by inhalation. Oxygen may also be administered if pulmonary cedema is present. The post-mortem appearances are congestion of the liver and fatty degenerative changes in the kidneys with haemorrhages. There may be congestion and acute cedema of the lungs with subpleural petechial haemorrhages. The brain and its membranes are congested. Trichlorethylene is likely to give rise to addiction, and may sometimes induce a state of drunkenness with complete loss of control. A man, 26 years old, had been addicted to the drug by soaking his handkerchief in it and sniffing it regularly. One night he murdered his mother to whom, he was devoted very much. The prosecution, finding no evidence of motive, accepted the accused's plea of not guilty of murder but guilty of manslaughter. He was sentenced to five years' imprisonment.43 The drug is likely to be decomposed into dichloracetylene, a toxic product, which can probably cause nerve palsies, when mixed with soda lime. Jensenius44 reports the case of a widow, 72 years old, who took 15 cc. of trichlo- rethylene in mistake for castor oil. She spat a little of the trichlorethylene, but most of it was retained. She drank two glasses of milk, but ate nothing. A few hours later, she became giddy, with cardialgia, drowsiness and coma. The temperature was sub- normal, with pulse 92 per minute, rigidity of the muscles of the extremities and increased tendon reflexes. She became conscious, but paraesthesia of the limbs set in, which gradually passed off. D.D.T. OR DICOPHANE [DICHLORO-DIPHENYL-TRICHLOROBTHANE, l-TRICHLORO-2, 2-BIS (P-CHLOROPHENYL) ETHANE, P, P-D. D. T.] Pure D.D.T. is a white, crystalline, solid substance, insoluble in water, but soluble in hot alcohol, ethyl acetate, chloroform, benzene, kerosene and many other organic solvents. It is used for destroying flies, mosquitoes, lice, fleas, bed-bugs, etc. A 5 per cent solution of this substance in kerosene oil is used as a spray for destroying bed- bugs and lice. A 2 per cent solution may act as a poison to human beings and its solu- tion in fatty acids is stated to increase its toxicity. D.D.T. is taken accidentally and suicidally. When swallowed, an oily solution of D.D.T, acts locally as an irritant and remotely as a nerve poison. In pure solid form 41. Brit. Med. Journal, March 20, 1943, p. 348. 42. Brit. Med. Journal, March 21, 1953, p. 655. 43. Lancet, Dec. 24, 1949, p. 1205. 44. Med.-Leg. and Crim. Rev., Vol. VII, Part II, 1938, p. 202; vide also Stephens, Brit. Med. Jour., Aug. 18, 1945, p. 218.