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Full text of "Medical Jurisprudence And Toxicology"

MEDICAL JURISPRUDENCE

and 240 grains « of quinine bisulphate have proved fatal to adults. On the other
^fl^e? doses have been recovered from. In one case one ounce of quinine
produced only confusion and noises in the ears.10

Fatal Period.—Death may supervene from in a few minutes to four or seventeen
hours, or may be delayed several days.

Treatment.—Administer emetics or wash out the stomach arid leave hypertonic
sodium suShate solution in for rapid elimination of the poison, and give hypodermic
SiSnl of st^chnine, digitalin and camphor. Give hot infusions of coffee and apply
warmth to the body. Resort to artificial respiration, if necessary.

Post-mortem Appearances.-There may be congestion of the organs. There is
usually haemolysis of the red blood corpuscles. In a case where the three soldiers died
^r swa™ng a solution of 16 grammes of quinine hydrochlonde, the post-mortem
^^ItionTtiie bodies showed that the gastric mucous membrane was macerated, both
kidneys were hypersemic and the bases of the lungs were congested.

Chemical Analysis.—Quinine may be extracted from aqueous alkaline solutions with
ether, benzene or chloroform. Upon evaporation, a resinous, amorphous residue as lett in
which quinine may be recognized by the following tests: —

1    When the residue is dissolved in a little dilute acetic acid and 5 to 11 drops of
saturated chlorine water are added, a green colour due to thalleioqum is obtained on the
addition of ammonia in excess if quinine is present.

2    If a few cubic centimetres of dilute sulphuric acid are added to a solution of a
quinine salt, a distinct blue fluorescence is formed.   This is a delicate test, which shows
reaction in dilutions as high as 1 in 100,000.

Medico-Legal Points.—Cases of poisoning by quinine are mostly accidental from
overdoses Owing to idiosyncrasy, even medicinal doses have sometimes produced
poisonous symptoms. Thus, Bamierjii? reports the case of his younger brother whom used
to complain of toxic symptoms even after the administration of ft gram of quinine.
Krishnarnurty is records the case of a male, 30 years old, whose face became swollen and
flushed and who complained of inordinate itching all over the body within ten minutes
after he had taken 5 grains of quinine. Cruikshank W also quotes the case of a woman,
63 years old, who nearly collapsed after an injection of 1 cc. solution containing 0.3
gramme quinine and 0.065 gramme urethane. He suggests the following test to be per-
formed where there is reason to suspect idiosyncrasy to quinine: —

If a drop of a 1 per cent solution of quinine hydrochloride is placed on the forearm
and the skin under it is scarified, a definite wheal surrounded by erythema appears ten
minutes later in individuals susceptible to quinine. A control of sterile water shows only
slight redness.

Quinine has been taken for suicidal purposes, but does not seem to have been used
homicidally.

Quinine excites the pregnant uterus and occasionally causes abortion; hence it is
often used as an abortifacient, and has sometimes produced poisonous symptoms. A
married woman,20 34 years old, swallowed 16 pills containing 6.08 grammes of quinine
sulphate or 5.04 grammes (76 grains) of the pure alkaloid with a view to procuring abor-
tion. Within a few hours she was taken ill with headache, vomiting, pyroxia and in-
creased pulse rate. The conjunctiva? showed an icteric tinge, and the, urine was almost
black. There was abdominal pain with bleeding from the vagina and scarlet rash all over
the body. The patient became restless, drowsy and later developed hiccup before she
died on the tenth, day. Abortion had occurred before death.

Quinine is eliminated for the most part unchanged in the urine. It may be detected
in the urine within fifteen to thirty minutes after its administration by the mouth, and
excretion may continue for forty-eight to seventy-two hours. Traces may also be found
in the saliva, sweat and milk.

NERIUM ODORUM  (WHITE OR SWEET-SCENTED OLEANDER, *0
KARAN OR KANER)

This plant belongs to N.O. Apocynaceae, and is grown in gardens in India
for its beautiful white or pink flowers, which are given as offerings to gods

15.   Raven, Brit. Med. Jour., July 9, 1927, p. 50.

16.    Cushny, Pharmacology and Therapeutics, Ed. XIII, p. 702.

17.   Ind. Med. Gaz., Sep. 1928, p. 533.

18.    Ind. Med. Gaz., March 1927, p. 142.

19.   Brit. Med. Jour., Jan. 19, 1929, p. 104.

20.    C. K. Vartan and G. Discombe, Brit Med. Jour,, March 30, 1940, p. 525,