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which occurred soon after ingestion.1 Half an ounce to one ounce of crude
tobacco taken by the mouth has proved fatal. An infusxon of thirty grains
of dry tobacco leaves given as an enema has resulted in death.

Fatal Period.—Nicotine, when swallowed, may cause death almost imme-
diately or within five to fifteen minutes. In rare cases death may be delayed
for several hours.

Treatment.—Elimination by washing put the stomach with warm water
containing finely powdered charcoal, tannin, or a solution of iodine in potas-
sium iodide. These drugs render the alkaloid insoluble. Gastric lavage
with a 1 : 10,000 solution of potassium permanganate is also recommended.
Keep the patient in a recumbent posture, apply warmth to the body and
cold affusions to the head. Administer hypodermically atropine, strychnine
and diffusible stimulants, such as brandy, ether, etc. Oxygen inhalation,
artificial respiration and galvanism must be resorted to, when necessary.
Vasodilators, e.g. nitrites and methacholine are useful for amblyopia.

Post-mortem Appearances.—The odour of tobacco is usually noticed on
opening the stomach, which may contain fragments of the leaves. The
mucous membrane of the stomach and intestines is congested and inflamed,
if death has not ensued rapidly. The brain, lungs and liver are usually con-
gested. The blood is dark and fluid.

Chemical Analysis.—Nicotine is separated from the organic mixture by
making it distinctly alkaline with sodium hydroxide solution and distilling
It with steam, the distillate being collected in 5 to 10 cc. per cent hydrochloric
acid. The distillate is made alkaline, and shaken out with ether. The ether
extract is evaporated to dryness, and the residue is tested for nicotine.

Tests.—1. Schindelmeiser's Test.—The residue gives a rose~red colour,
with a drop of 30 per cent chemically pure formaldehyde solution and a drop
of concentrated nitric or sulphuric acid, if nicotine is present, If formal-
dehyde solution is used in excess, a green colour is formed. Coniine or ani-
line does not give this reaction.

2.    Roussin's Test.—A solution of iodine in ether mixed with an ethereal
solution of nicotine yields an amorphous, brownish-red precipitate which
after standing for some hours crystallizes into long needles of a ruby-red
colour.   These are called " Roussdn's crystals ".

3.    Biological Test.—One cubic centimetre of a dilute aqueous solution
of nicotine (1 : 1,000) injected into the dorsal lymph sac of a frog produces
fibrillary twitchings in the muscles of the hind legs within a few minutes.

Medico-Legal Points.—Poisoning by tobacco has occurred accidentally
from ingestion, from excessive smoking, from the infusion given as an enema,
or from the application of the leaves or their juice to a wound, an abraded
surface or even to the unbroken skin. A small girl2 suffered from symp~
toms of tobacco poisoning following a vigorous rubbing of her trunk and
limbs with a mixture of writing ink and scrapings from an old tobacco pipe
as a remedy for a very diffuse attack of ringworm. A convict admitted to
Liverpool prison, who secreted an ounce of cut Cavendish tobacco in his
rectum in order to convey it past searchers, suffered from very severe symp-
toms four hours later.3 Children have sometimes been poisoned accidentally
by sucking the juice of a tobacco pipe, or by drinking hookah water.

Accidental cases of poisoning have sometimes occurred from nicotine,
which, diluted with soft soap and water, is used largely as a germicide and

1.   Ars. Medici, Jan. 1932, p. 14.

2.   Jones and IVCorris, Brit. Med. Jour., April 24, 1926, p, 739.

3.   Gill, Brit Med. Jour., Vol. I, 1901, p. 1544.