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Full text of "Medical Jurisprudence And Toxicology"

ANTIFEBRIN,   ANTIPYRIN   AND   PHENACETEST                               657

"be a fatal dose for a healthy adult.   On the other hand, recovery has followed the inges-
lion of 120 or more grains of antifebrin.

A dose of five to ten grains of exalgin has produced toxic symptoms. Recovery has
followed much larger doses.

Five to fifteen grains of antipyrin have produced severe toxic symptoms in suscep-
tible persons. Fifteen grains have also caused death. Recovery has, however, occurred
from very large doses.

Five to ten grains of phenacetin have produced poisonous symptoms. Fifteen grains
have caused death, but recovery has taken place after much larger doses.

Fatal Period.—Uncertain. Death may occur in a few hours or may be delayed for
days.

Treatment.—Eliminate the poison by washing out the stomach with water or potas-
sium permanganate solution 1: 5,000, and freely administer stimulants such as digitalis,
strychnine, camphor, caffeine and sodium benzoate, etc. For saook 5 per cent glucose
may be given intravenously. For methemoglobinemia slow intravenous injection of 50
cc. of 1 per cent methylene blue in a 1.8 per cent sodium sulphate solution is useful.

Post-mortem Appearances.—Not characteristic.

Chemical Analysis.—Antifebrin.—This may be extracted with ether or chloroform
from the aqueous solution in the Stas-Otto process. On evaporating the solvent, the
residue may be tested for antifebrin as follows: —

1.    Indophenol Test.—A portion of the residue is boiled with 4 cc. of hydrochloric
acid in a test tube until it is reduced to 1 cc-   After cooling, 2 to 4 cc. of a saturated
aqueous solution of phenol are added.   A freshly prepared aqueous solution of calcium
hypochlorite is added drop by drop when a dirty red colour is produced which deepens
,on shaking.    Then ammonium hydroxide solution is carefully added to float over the
surface of the mixture.   An indigo-blue colour occurs in the upper layer of ammonium
liydroxide,

2.    Phenyl-lsocy&nide Test.—If another portion of the residue is boiled "with a few
cubic centimetres of alcoholic or aqueous sodium or potassium hydroxide solution, the
odour of aniline is noticed.    If a few drops of chloroform are added after cooling, and
the solution warmed, the offensive smell of phenyl-isocyanide is perceived.

3.    Potassium bichromate dissolved in strong sulphuric acid produces a red colour
which changes to blue and blue-green, and then disappears.

Antipyrin.—This may be xecovered by extracting the tissues with chloroform from
alkaline solution, The residue is diluted with distilled water and filtered. The filtrate
contains antipyrin which may be identified by the following tests : —

1.   A few drops of ferric chloride solution added to an aqueous solution of the
residue produce a deep red colour which becomes pale yellow on the addition of dilute
sulphuric acid.

2.   If strong sulphuric acid is added to a little potassium nitrite dissolved in water,
. nitrous acid is evolved, which gives a green colour with antipyrin.

3.   Heated with a solution of calcium hypochlorite, antipyrin  gives a brick-red
precipitate.

Phenacetin.—Like antifebrin, phenacetin may be separated from the aqueous acid
solution and the residue may be detected by applying the following tests ;—

1.   Oxidation Test.—A portion of the residue is boiled with 3 cc. of concentrated
hydrochloric acid for three or more minutes, diluted with water to about 10 cc., cooled
and filtered.   If a few drops of 3 per cent chromic acid solution, 8 per cent potassium
bichromate solution or strong chlorine water are added to the filtrate, a violet colour
changing rapidly to ruby red develops.

2.   Another portion of the residue is heated to boiling with a few cubic centimetres
of 10 per cent nitric acid.   A yellow or orange-red coloured solution is formed.   If the
solution is sufficiently concentrated, long, yellow needle-like crystals of nitrophenacetin
will separate out on cooling.

Medico-Legal Points,—Most of the poisonous cases have been accidental from over-
doses or even from medicinal doses, especially if the heart happens to be diseased,

Antifebrin has produced fatal symptoms from its application as an antiseptic dressing
to raw surfaces.

It is reported that four drachms of antipyrin were used subcutaneously as a last
resort by Clark of Agra to murder Fulham, after he had been unsuccessfully drugged
with arsenic, gelsemine and probably cocaine and belladonna,

Amidopyrine (Pyramidon or Aminopyrine).—This occurs in small colourless crystals
or as a white, crystalline powder and is soluble in 18 parts of water and readily 'soluble
in alcohol or solvent ether.   It is largely used as an analgesic and antipyretic, the dose
42