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' Ge°rge B* R°th and W" A' Ry°n' J°Ur' Amer' Med' Assoc'> June 25' 63. Brit. Med. Jour., Nov. 6, 1954, p. 1114.