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VERONAL                                                             655

Chronic Poisoning.—The symptoms of chronic poisoning are foul breath, ataxia,
tremors, thick and difficult speech, skin rashes, loss of memory, mental deterioration,
delusions, visual _ hallucinations and delirium. Sometimes, there may be symptoms of
gastro-intestinal irritation, anaemia and albuminuria.

Medina! (Veronal Sodium, Barbitonum Solubile, Soluble Barbitone, Barbital Sodium
or Sodium Barbitone).—This is a mono-sodium salt of diethyl-barbituric acid. It is a
white, crystalline powder, soluble in 6 parts of water slightly soluble in alcohol (90 per
cent), insoluble in chloroform or solvent ether, and possessing a bitter taste. The dose
is 5 to 10 grains. It is similar in action to veronal, and produces fatal poisoning in the
same way as veronal. The cumulative toxic effects of medinal are the same as those
of veronal. The medinal habit (chronic medinal poisoning or medinalism) has the same
toxic action and produces the same after-effects on the physical health and mental con-
dition of the patients as chronic veronal poisoning. In his annual report for the year
1933, the Chemical Examiner of Bengal reports the case of a medical practitioner, who
took medinal with intent to commit suicide and died on the third day. E. Stolkind73
describes the case of a man who died, thirty hours after taking medinal. The symptoms
were smaller pupils not reacting to light, absence of corneal reflex, cyanosed lips, large
amount of mucus in the mouth, and moist skin, but the extremities were not cold.
Breathing was stertorous, and the respirations were at first 24 per minute, and then
became 45 per minute. The pulse was weak and regular but became frequent, the
number being 150 per minute. The temperature was normal. The patient was in a
comatose condition. At the post-mortem examination the lower lobes of the lungs were
deeply congested and oedematous, and the spleen was soft.

Charters 7* reports a case in which a woman, aged 46 years, tried to commit suicide
by taking 30 grains of medinal and 750 grains of aspirin on the next day, but she re-
covered under prompt treatment.

Luminal (Gardenal, Phenobarbitonum, Phenyl-ethyl-barbituric acid or Pheno-
barbital).—This differs from veronal in that an ethyl group has been replaced by a
phenyl radicle, It is a white, crystalline, odourless powder with a slightly bitter taste
and almost insoluble in cold water, but soluble in alcohol (90 per cent), in solvent ether
and in chloroform, and readily in aqueous alkaline solutions. It is a more active hyp-
notic than veronal, and is given in & to 2~grain doses, but according to Phillips ?5 there
is little difference between the therapeutic and the fatal dose, hence it should not be
prescribed in single doses of 14 grains and not more than 3 grains should be taken
in twenty-four hours. Small doses of luminal continued for a prolonged period show a
cumulative effect'. Luminal forms with sodium hydroxide a soluble salt, luminal-sodium
(phenobarbitonum soluble, soluble phenobarbital or luminal soluble). It is an inodorous,
white, hygroscopic powder, the dose being J to 2 grains.

A single dose of 4J grains of luminal has produced toxic symptoms,70 while 3 tablets
of luminal have caused the death of a woman, 25 years old.77 A dose of 15 grains of
luminal has also proved fatal to a woman, 67 years old, in 29 hours.78 Recovery has
occurred after a much larger dose of about 450 grains of luminal.™

A woman8() is reported to have administered an overdose of luminal to her son,
5J years old, with a view to murdering him.

Luminal is excreted by the kidneys, but a portion is oxidized in, the body. A case 81
is recorded in which a woman took 0.1 gramme of luminal for a few days, and her
breast-fed child suffered from the symptoms of poisoning owing to the secretion of
luminal in her milk.

Dial (Diallyl-barbituric acid or diallyl-malonyl«urea) and Didial, a combination of
dial and ethyl-morphine (dionin), are other derivatives of the veronal group. Dial is a
powerful hypnotic, the ordinary dose being 1J to 3 grains. It is about five times as
strong as veronal, but it is more rapidly oxidized in the body, and is, therefore, less
likely to produce a cumulative effect. Didial is used to induce twilight sleep.

73.    Lancet, Feb. 20, 1926, p. 391.

74.    Brit. Med. Jour., Jan. 1, 1944, p. 10.

75.    Jour. Awer. Med, Assoc., April 22, 1922, p, 1201.

76.    Stein, Therap. Halbmontashft, Vol. 34, 1920, p. 387.

77.    Bengal Chem. Examiner's Annual Rep., 1942,

78.    Weig, Deutsche Medizinische Wochenschrtft, Berlin, Feb. 13, 1925, p. 272; Jour.
Amer. Med. Assoc., April 11, 1925, p. 1159.

79.    Boenheim, Medizinisch Klinik, Berlin,  Oct. 10, 1921, p. 1263;  Jour. Amer. Med.
Assoc., Jan, 7, 1922, p. 76.

80.    Yorkshire Post and Leeds Mercury, Dec. 6, 1944; Medico-Leg, and Criminal. Rev.,
Vol. XIII, Part I, 1945, p. 47.                                                                                               ;

81.    Frenedorf, Munchener Medizinische Wochenschrift, Munich, Feb, 19, 1926, D. 322;
Jour. Amer. Med. Assoc., May 15, 1926, p. 1591,