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Full text of "Medical Jurisprudence And Toxicology"

652                                            MEDICAL JURISPRUDENCE

the dose of which is SO to 120 minims by mouth and 1 to 1 fluid ounce by rectal injection
as a basal anaesthetic.

This drug acts chiefly on the cerebrum, inducing light and natural sleep within ten
to fifteen minutes, and is used as a hypnotic in insomnia of cardiac and respiratory
diseases and also in mental diseases. It is also administered per rectum or intravenously
as a basal anaesthetic about one hour and a half before an operation. When administered
in excess, it may produce acute poisoning.

Symptoms. These are nausea, vomiting, headache, giddiness, contracted _pupils,
rapid pulse, unconsciousness, deepening into coma and death from respiratory failure.

Fatal Dose and Fatal Period. Uncertain. About a drachm of paraldehyde has
produced toxic symptoms. About two to three ounces would probably prove fatal to an
adult. Death may occur in a few hours. A case - is recorded where a man, aged 41,
who was in the habit of taking one to two teaspoonfuls of the drug, took between 2J to,
3 ounces and went to bed at 11 p.m., and was found dead at 8 a.m. On the other hand,
recoveries have followed the ingestion of much larger doses. Nine ounces of paraldehyde'
given per rectum in mistake for nine drachms for a dental operation caused death in five
hours.so

Treatment.  Give emetics or wash out the stomach with a solution of sodium bicar-
bonate and then give purgatives. Administer stimulants, such as caffeine, strychnine,,
digitalis and coramine. Administer intravenously calcium gluconate and dextrose. Resort
to artificial respiration and oxygen inhalation at high tension, if necessary. Employ
liigh rectal or colonic lavage with sodium bicarbonate solution, if paraldehyde has beeri
administered by the rectum.

Post-mortem Appearances. The mucous membrane of the stomach is hyperamic
and may be slightly inflamed. The other viscera are usually congested. There is gene-
rally a characteristic odour of paraldehyde when the cavities are opened.

Medico -Legal Points. Accidental and suicidal cases of acute poisoning by paral-
dehyde, though rare, have been recorded. A case G1 is recorded where a rectal injection
of half-an-ounce of paraldehyde with three or four times its volume of water caused
considerable sloughing of the rectal mucous membrane. A case is also recorded in
which a woman who was given a dose'62 of 31 cc. of paraldehyde per rectum died in 8
hours and 20 minutes. It appears that the woman had idiosyncrasy for the drug, A
man, aged 32, died at Doncaster63 after taking 2 drachms of five years-old paraldehyd.e
diluted with equal amount of water. On analysis it was found to contain 40 per cent of
acetic acid. Paraldehyde is a polymer of three molecules of Acetaldehyde and can be
oxidised by atmospheric oxygen to acetic acid, which acts as a corrosive poison, hence
very old samples can become so toxic as to be fatal.

Persons, who take paraldehyde for a prolonged period, become addicted to its use
and suffer from the symptoms of chronic poisoning similar to those seen in chronic1
alcoholism. These _are digestive" disturbances, muscular Weakness, tremors, disturbance*
of speech, insomnia, emaciation,, anasmia, hallucinations, delusions and delirium.

Paraldehyde is mostly oxidized in the body, and about 5 per cent of it is eliminated
in the breath to which it imparts its unpleasant, ethereal odour.

.   SULPHONAL  (DIETHYL-SULPHONE-.DIMETHYL-METHANE OH SULPHONE-
METHANE),  (CK,)S C

This occurs in tasteless, odourless, colourless, prismatic crystals or powder, soluble
in 450 parts of cold water, in 15 parts of hot water, in 80 parts of 90 per cent alcohol, in
90 parts of ether and in 3 parts of chloroform. It is used in medicine as a hypnotic in
5 to -20-grain doses.

Symptoms. The symptoms of acute poisoning caused by excessive doses are giddi-
ness, headache, mental confusion with ataxic gait and thick speech, stupor, insensibility,
sometimes convulsions, feeble pulse, irregular and stertorous breathing, subnormal or
elevated temperature, marked cyanosis and coma. Broncho-pneumonia may develop in
case coma is prolonged. Death may occur from failure of respiration, or the urine is
sometimes suppressed and death may result from anuria. Eruptions may be noticed on
the skin after a single large dose.

Sulphonal is excreted slowly in the urine as sulphonal and ethylsulphonic acid. It
may produce chronic poisoning by cumulative effects, even if administered in small
quantities for a prolonged period.

59.   X E. W. Mac Fall, Brit. Med. Jour., Aug. 8, 1925, p. 255

60.   Lancet, Vol. I, 1929, p. 247.

61.   Robert Hutchison, Brit. Med. Jour., April 12, 1930, p. 718.

l" p  2145 KOtZ' Gerge B* Rth and W" A' Ryn' JUr' Amer' Med' Assoc'> June 25'
63.   Brit. Med. Jour., Nov. 6, 1954, p. 1114.