NITROBENZENE 663 Fatal Period.—The fatal period varies from a few minutes to two or three days. Treatment.—If the vapour is inhaled, the patient should at once be removed into the open air, and artificial respiration should be performed. Oxygen inhalation and restoratives should be used, if necessary. If benzene is swallowed as a liquid, the stomach should be washed out, and stimu- lants, such as ether, strychnine and atropine should be injected hypodermically. Gal- vanism, artificial respiration and oxygen inhalation should be used, if necessary. Post-mortem Appearances.—An odour like that of coal gas emanates from the body cavities. Haemorrhages in the mucous membranes, hypersemia of the stomach and other organs. CEdema of the lungs may be present. Chronic Poisoning.—This may occur among workers who are directly or indirectly exposed to the fumes of benzene in factories. The symptoms are headache, excessive fatigue, dizziness, nausea, loss of appetite, weakness, nervousness, disturbances of sen- sation, such as numbness and tingling in the extremities, bleeding from the gums and nose, disturbed sleep, menstrual irregularities among women, indigestion, frequent uri- nation, leucopenia, and a tendency towards a diminution in the polymorphonuclear leucocytes.00 Aplasia of the granulocytes of the osseum medulla is a frequent and constant symptom. Post-mortem examination will show submucous haemorrhages, aplasia of the bone marrow and fatty degeneration of the heart and liver. A case1 is recorded where fifty cases of poisoning by benzene occurred among young women within a few weeks of their employment in a rubber goods factory. Of these seven died. The treatment consisted of blood transfusion, ingestion of fresh liver or liver extract and large quantities of fresh air. In severe cases extirpation of the spleen was tried with success. Heliotherapy, natural or artificial, is often effective. Detection.—Benzene is separated from organic mixtures by distillation and may be recognized from its odour and from its boiling point, which is 80.5°C. Medico-Legal Points.—Poisoning by this drug is mostly accidental and occurs when it is absorbed from the alimentary canal or from- the skin, and when the vapour is inhaled by the lungs. A few cases are recorded, when it was taken with a view to committing suicide. Benzene is oxidized in the body to phenol and dihydroxybenzenes, and is excreted partly by the kidneys in combination with sulphuric and glyeuronic acids and partly unchanged by the lungs. Taken internally, it causes a marked fall in the number of the leucocytes of the blood, and iSj therefore, recommended in the treatment of some forms of leukaemia. NITROBENZENE (NITROBENZOL), CoH5NOa This substance is formed by the action of strong nitric acid on benzene. It is a yellow, oily liquid, having a pleasant odour like that of oil of bitter almonds. It is insoluble in water, but freely soluble in alcohol. It is commercially known as artificial oil of bitter almonds, or oil or essence of mirbane. It is largely used in the manufac- ture of aniline and explosives, in the preparation of perfumery, and for making boot polish, scenting soaps and flavouring confectionery. Th6 liquid as well as its vapour are poisonous. When applied to the skin, nitrobenzene is absorbed rapidly and produces toxic symptoms. Symptoms.—The symptoms are usually delayed from one to three hours or even longer after swallowing the poison. These are a burning taste in the mouth, numbness of the tongue, salivation, nausea, vomiting, giddiness, headache, cyanosis, cold and moist skin, weak and rapid pulse, hurried breathing, drowsiness and coma. The pupils are contracted first and then dilated. The urine is dark coloured. Convulsions may occur before death. The symptoms produced by inhalation of its vapours are almost precisely the same as those produced when swallowed. Fatal Dose.—Twenty drops have proved fatal, On the other hand, recovery has occurred, under prompt and efficient treatment, from much larger doses. A married woman, aged 24 years, recovered after swallowing one ounce of a bee mixture containing 200 minims of nitrobenzene with intent to commit suicide.2 Fatal Period.—-Death usually occurs within six to seven hours, but may be delayed for two or three days. Treatment.—Use emetics or the stomach tube. Give stimulants, such as strychnine or digitalis, but avoid alcohol, oils and milk. Inject intravenously 10 per cent methy- 99. H. R. Smith, Jour, of Industrial Hygiene, March 1928, p. 73. 1, Correspondent of Vienna, Jour. Amer. Med. Assoc., July 19, 1930, p. 215. 2. W. E. Parkes and D. W. Neill, Brit. Med. Jour., March 21, 1953, p. 653.