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CHLORAL  HYDRATE                                                       649


lodoform occurs as an amorphous powder or as small, lustrous, lemon-coloured
hexagonal crystals, having a very penetrating, persistent and disagreeable odour and
taste. It is insoluble in water, but dissolves in alcohol, ether, chloroform, and fixed and
volatile oils. lodoform is a constituent of a pharmacopceial preparation, Suppo$iton&

Symptoms.—These are giddiness, nausea, vomiting, abdominal pain, skin eruptions,
elevation of temperature, dilated pupils, unconsciousness, quick pulse, stertorous breath-
ing, coma and death. In some cases there may be convulsions, hallucinations, delirium
and melancholia.

Fatal Dose.—Thirty grains taken internally have proved fatal, though recovery has
ensued from larger doses. More than one drachm should not be applied to a wound at
a time.

Fatal Period.—Death may occur in one day or after several days. In one case
death occurred on the 9th day after the injection of an ethereal solution containing 45
grains of iodoform.51

Treatment.—Wash out the wound. Treat the symptoms. Intravenous or subcuta-
neous injections of normal saline are regarded as beneficial.

If iodoform is taken internally, the stomach should be washed out and large doses
of sodium bicarbonate should be administered. Brandy and other stimulants should be
given. Bromides should be given if delirium, is present.

Post-mortem Appearances.—(Edema of the lungs and acute nephritis. Occasionally
fatty degeneration of the heart, liver and kidneys.

Chemical Test.—Warmed with an alcoholic solution of caustic potash, iodoform
yields free iodine after it is acidified with nitric acid.

Medico-Legal Points.—lodoform is used largely as an antiseptic and disinfectant in
surgical dressings. Accidental poisoning has occurred from its use as a dressing for
large, raw, ulcerated surfaces or from injection of its ethereal solution in chronic abscess
cavities, and also from its internal administration. The powdered form is absorbed
more easily than the crystalline form. After absorption iodoform is decomposed into
iodine, and iodides, which are excreted slowly in the saliva, sweat and urine.

,     CCl8.CH(OH)3

This is a colourless, crystalline substance, having a peculiar, pungent
odour and a pungent, bitter taste and melting at 57°C. It is freely soluble
in water, alcohol, chloroform or ether, and forms a liquid when rubbed up
with an equal weight of camphor. The pharmacopceial dose is 5 to 20 grains.
Syrupus Chloral is a non-official preparation made from it, the dose being
30 to 120 minims. It contains 10.9 grains of chloral hydrate in one drachm.

Acute Poisoning.—This occurs from swallowing a large dose all at once.

Symptoms.—The patient complains of a burning pain in the mouth,
throat and stomach immediately after swallowing a poisonous dose, but it is
not marked if the drug is administered in a mucilaginous mixture. This is
followed by drowsiness, unconsciousness, loss of reflexes, and deep sleep
passing into coma. The face is cyanosed, the pulse is slow, feeble and
irregular, the breathing is stertorous, the skin is cold with sub-normal tem-
perature and the pupils are contracted. Sometimes, a scarlatinal or
urticarial rash may be seen on the skin. Death usually occurs from para-
lysis of the respiratory centre. In a few cases death may occur from failure
of the heart soon after swallowing the drug,

Chronic Poisoning.—This occurs among persons habituated to the use
of the drug in medicinal doses for a long, continued period.

Symptoms.—These are those of gastro-intestinal irritation with erythe-
rnatous and urticarial eruptions on the skin, general weakness, sleeplessness,

51.   Arch, de Med. et de Pharm., 1890 ; Collis Barry, Leg. Med,, Vol. II, p, 472.