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VERONAL                                                            653

Chronic poisoning is characterized by pain in the stomach region, vomiting, consti-
pation, erythematous rashes, headache, muscular weakness, ataxia, confusion of thought
and hallucinations. The urine is reddish-brown or port-wine coloured, and contains
haematoporphyrin, unchanged sulphonal and albumin.

Fatal Dose.—Uncertain. Seventy-five grains may be considered to be fatal to adults.
Thirty grains is the smallest quantity that has caused death. On the other hand, recovery
has followed a dose of 3 ounces.

Fatal Period.—Uncertain.   Death may take place after several hours or days.

Treatment.—Elimination and washing out of the stomach ; administration of sodium
bicarbonate in dilute solution and stimulants; infusion of normal saline, or transfusion
of blood.

Post-mortem Appearances.—Reddening and ecchymosis of the stomach and duo-
denum. Congestion of the liver and other internal organs. .Fatty degeneration of the
heart, liver and kidneys.

Chemical Tests.—1. Hydrogen sulphide is liberated if sulphonal be heated after
adding iron powder and hydrochloric acid.

2. Sulphonal gives off a garlicky odour of mercaptan, if it is heated with charcoal
in a test tube,

Medico-Legal Points.—Accidental cases of poisoning by sulphonal have occurred
from large doses or from the injudicious use of the drug by patients themselves without
consulting their physician. A few suicidal cases have also occurred,

Trional (Methylethyl-methane-diethyl sulphone or Methyl sulphonal).—It occurs
as a white, crystalline powder or as colourless, lustrous seales, with a slightly bitter
taste. It is soluble in 320 parts of water and more soluble in dilute alcohol. It melts
at 76°C, It is a BP.C. preparation and is given as a hypnotic in 5 to 20-grain doses. It
is similar in action to sulphonal, but acts more rapidly and induces sleep in from thirty
to sixty minutes. It has a cumulative action and produces toxic sympoms when taken
for a long time. The symptoms and treatment are similar to those of sulphonal poisoning,

Tetronal (Diethylmethane-diethylsulphone or Ethyl sulphonal).— It occurs in powder
or in white crystals, having a camphoraceous bitter taste.    It dissolves in 550 parts of
water and 12 parts of alcohol.   It melts at 85°C.   It is used as a hypnotic in 10 to 20-
gram doses.   It is a dangerous drug and produces poisonous symptoms like sulphonal.

CaH5 \         ^- CO.NH\.

MALONYLUREA, DIETHYL-BARBITURIC ACID),           ^V C <~                    J^ c°

C2HB -"^       ^- CO .NH -^^

This is a white crystalline powder having no odour, but a faintly bitter taste. It is
slightly soluble in cold water, more soluble in hot water and in 90 per cent alcohol,
chloroform and solvent ether and freely in aqueous alkaline solutions. The official dose
is 5 to 10 grains.

Symptoms,—Nausea, vomiting, headache, drowsiness, ataxic gait, stupor deepening
into coma, stertorous breathing and rise of temperature. In a case of fatal poisoning
recorded by Russell and Parker the temperature rose to 107.2 °F. and was brought down
to 104.5°F. by cold packs.04 Death occurs from respiratory failure. The lungs may
exhibit signs of acute congestion, oedema or broncho-pneumonia. Frequently a severe
erythematous rash appears on the skin and the face is cyanosed. The urine may be
suppressed or scanty, showing the presence of albumin and hsematoporphyrin. The
pupils are usually contracted and insensible to light, but may be dilated. Sometimes,
the pupils may be found contracted and dilating alternately at brief intervals.05 In coma,
the deep reflexes are suppressed and there is general muscular flaccidity, extensor plantar
response may be present. If recovery occurs, headache, dizziness, somnolence, diplopia,
ptosis, ataxia and low blood-pressure may be observed for several days.

Fatal Dose.—The smallest quantity that has caused death is 15 grains which proved
fatal to a barrister in 15 hours.06 The usual faiial dose is 50 to 60 grains for an adult,
but recovery has occurred after the doses of 125,67 200,^8 and 360 ^ grains.

64.    Brit. Med. Jour., April 18, 1904, p. 853.

65.    Boenheim, Medizinische Klinik, Berlin, Oct. 16, 1921, p. 1263; Jour, Amer, Med.
Assoc., Jan. 7, 1922, p. 76.

66.    Brit. Med. Jour., Nov. 6, 1909, p. 1387,

67.    Chitty, Lancet, Mar. 29, 1913, p. 917; C. J. France, M. Barnett and F. F. Yonkman,
Jour. Amer. Med. Assoc., May 15, 1943, Vol. 122, p. 173.

68.    Wells, Brit. Med. Jour., Nov. 5, 1927, p. 826; Sanderson, California and Western
Med., S. Francisco, Dec. 1930, p. 887.

69.    Tardieu and Camps, Bull. Soc., de TTier., Feb. 13, 1924, p. 63; Brit. Med. /our.,
Epitome, June 21, 1924, p. 89.