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Full text of "Medical Jurisprudence And Toxicology"

680                                                MEDICAL JURISPRUDENCE

3.   Lamelloe Atropiuce.— Each disc contains 1/5,000 grain of atropine sulphate.

4.   Oculentum Atropince.— It contains 0.25 per cent of atropine sulphate.

5.   Oculentum AtropTiince   cum Hydrargyri  Oxido.—-lt  contains   0.125  per  cent  of
atropine sulphate and 1 per cent of yellow mercuric oxide.

6 Tabellce Atropinos Sulphatis.—Dose, 1/240 to 1/60 grain. If the quantity is not
mentioned, each tablet must contain at least 1/100 grain of atropine sulphate.

Symptoms.— These closely resemble those of poisoning by datura.

Diagnosis.— In doubtful cases of belladonna alkaloid poisoning 10 to 30
mgm. of methacholine chloride subcutaneously injected confirms the diag-
nosis if the characteristic flush, sweating, lacrimation, rhinorrhea, saliva-
tion and enhanced peristalsis does not appear. This diagnostic application
of the parasympathomimetic actions of methacholine has been suggested by
Dameshek and Feinsilver.9

Fatal Dose. — This is variable. A decoction of 80 grains of belladonna
root used as an enema caused the death of an adult woman. Three berries
proved fatal to a child, 9 months old, and 14 berries caused the death of an
old man. On the other hand, recovery has occurred after eating 50 berries.
A teaspoonful of belladonna liniment, a drachm of the tincture and the same
quantity of the extract have respectively caused death. Recoveries have,
however, followed the ingestion of larger doses of these pharmacopoeial pre-
parations. I saw a case where a man recovered under the treatment of
prostigmrn after he had taken by mistake one and a half ounces of the
tincture of belladonna. One and a half to two grains of atropine taken
; internally may be considered a fatal dose, although half a grain of atropine
has proved fatal, but recoveries have taken place after the administration
of much larger doses, even as much as 7.5 grains of atropine sulphate.10
One-twentieth grain of atropine injected hypodermically has killed an adult.
Three grains of an ointment containing 1.6 mg. of atropine applied to the
eyes twice a day for two consecutive days killed a boy, aged 2 years and
9 months, on the third day.11 An ointment containing three grains of atro-
pine applied to the abraded skin has caused death.12

Fatal Period. — In rapidly fatal cases death occurs in 3 to 6 hours. Usually
death occurs within 24 hours, although it may be delayed for days.

Treatment. — The same as for datura poisoning.

Post-mortem Appearances.— Berries, seeds or fragments of leaves may
be found in the alimentary canaL The other appearances are similar to
those found in poisoning by datura.

Chemical Analysis. — Atropine may be extracted by the Stas-Otto process
from organic mixtures, which are slightly acidified by tartaric acid or ren-
dered alkaline by a small quantity of sodium carbonate. Atropine is very
prone to undergo hydrolysis. The extraction should, therefore, be conducted
at a low temperature to prevent this action. Chloroform is the best solvent
for the final extraction of atropine.

Tests.— 1. Vitati's Test.— The extracted residue is treated with a few
drops of fuming nitric acid, heated to boiling, and evaporated to dryness on
a water bath. After cooling, the residue is moistened with a few drops of
freshly prepared alcoholic potassium hydroxide solution, when a violet colour
is produced which soon changes to red and finally disappears. The colour

™9nQU(2£? bry ^°Fdl^an ^Oilman in The Pharmacological basis of therapeutics,
Ed. II, p. 473 ; Jour, of Am. Med. Assoc., 1937, pp. 561-64.

10.   Comroe, Jour. Amer. Med. Assoc., Aug. 5, 1933, p   446

1L   Morton, J., Pediatrics, 14, 1939, p. 755; W. E. Heath, Brit Med. Jour., Sep. 9, 1950,

p. oUo»

12.   Glaister, Med. Juris, and Toxic., Ed. IX, p. 651.