Outlines of medical jurisprudence for India / by J.D.B. Gribble and Patrick Hehir.

  • Gribble, J. D. B. (James Dunning Baker), -1906.
Date:
1898
    him. Native drug-sellers are in the habit of keeping their medicines without any labels or distinguishing marks ; and when we find that, in spite of all the precautions which the law in England and in Europe lays down, mistakes are of by no means of rare occurrence, it would seem high time that some legislative enactment should be introduced. It has been found possible to check the sale of saltpetre and opium, and the books of the traders contain a full record of all sales. Various writers in India have frequently urged that a similar restriction should be put upon the sales of poisons, and espe- cially of arsenic, which is so readily obtainable. The public press has advocated the same thing over and over again, but up to the present time nothing has been done. A law, similar to that in England, is required, under which all sales can be traced, and when arsenic is sold iu large quantities for purposes of trade, it should be mixed either with soot or with indigo. It may be mentioned that in this matter the Government of Hyderabad has set a laudable example to the rest of India, for in 1890 an order was passed by the Judicial Secretary regulating the sale of poisons. No report is as yet available regarding the way these rules have worked. 660. The quantity of arsenic required for a fatal dose is j»atal dose, estimated by Taylor, at from two to three grains. The smallest quantity proved to have been taken was two grains. Guy says that recoveries have taken place from doses of half an ounce. It will largely depend upon the condition of fulness or emptiness of the stomach at the time the poison is taken, and also upon the vehicle in which the poison is administered. As mentioned before, it must always be remembered that the amount found in the body is no test of the dose taken. It is only a proof of what remains in the body. When the dose is large, vomiting and purging come on early and get rid of much of the arsenic before its fatal action is produced. The fatal period varies from 20 minutes to 2 or 3 weeks and even later from the secondary effects of the poison. Any thick vehicle will delay the action of the poison.
    Statistics of 661. The following table shows the statistics of cases of ^fa Ma£w." affseuicaJ poisoning in Madras for the five years 1885-1889:— Number of Number oi' n v> v cases in which cases in which i™?^ poison was death result- cat is detected. ed. reported. 1885 ... ... 35 17 20 1886 ... ... 46 19 W 1887 ... ... 37 18 18 1888 ... - 28 17 18 1889 ... ... 06 18 20 Total... 179 89 96 For arsenic poisoning consult cases of:— Madeline Smith, Lattsome Browne ; Trial* for m wrder hy poisoning, p. 295.
    CHAPTER III. ANTIMONY AND OTHER METALLIC POISONS. ANTIMONY is a poison which appears to be seldom used Antimony, in this country, though occasionally cases occur in which the poison has been taken in the form of tartar-emetic. This occurs in the form of a white powder, sometimes having a tin ere of yellow. The antimonial wine of the British Pharma- copceia contains two grains of tartar emetic to the ounce. Cheveks only mentions three cases, all of which appear to have been accidental. 662. Antimonial poisoning occurs in both the acute and Symptoms of chronic forms. The clinical history of the acute variety is as nial poi80ning. follows :—Tartar-emetic is an irritant poison, but possesses light corrosive properties. When taken in large doses of two or three drachms, it gives rise to a metallic taste in the mouth, which is not easily removed. In most cases, violent vomiting follows immediately after the poison is swallowed, the vomiting continuing even after the stomach is emptied, of its contents. Burning pain is felt at the pit of the stomach, accompauied with cramps in the belly, and purging. There is considerable difficulty in swallowing, and the patient complains of tightness and constriction in the throat. The mouth and throat in some cases are excoriated or covered with whitish aphthous-looking spots, which ultimately become brown or black. In some cases, the thirst is intense ; in others, absent or nearly so. Cramps in the lower extremities, almost amounting in some cases to tetanic spasms, followed by extreme depression, are generally the precursor of a fatal termination. The urine is not sup- pressed, as is the case in arsenical poisoning; in some cases it has even been increased. On this point, however, the statements of observers differ. Trousseau says that the urine is suppressed ; Hussmann that it never is suppressed.
    Symptoms of chronic anti- monial poison- ing. 414: OUTLINES OF MEDICAL JURISPRUDENCE. [SEC. V. The skin is in some cases covered by a pustular eruption, not unlike that of small-pox. Even in the most desperate cases of antimonial poisoning, there is always greater hope of recovery than in arsenical poisoning. 663. The clinical history of the chronic variety is as follows :—The symptoms which mark the chronic form of poisoning differ chiefly in being less intense and less rapid than in the acute. Chronic poisoning by small doses is that form of poisoning which appears most in vogue of late years in England but is rarely met with in India. The unfortunate victim complains of constant nausea and retching, with great depression. Food is objected to, as it only increases the vomiting. The matters vomited are at first merely mucus, but after a time they become mixed with bile. Each time the poison is repeated the symptoms become aggravated. Emaciation gradually sets in, and the persons dies from complete exhaustion or from the effects of a larger dose than usual. In all doubtful cases the urine should be examined.* 664. The antidotes are—any infusion containing tannin, antimonial poi- such as decoctions of tea, oak-bark, etc., for the salt which soning. ^ keen eXpeilecl by vomiting may in this way be decom- posed and rendered harmless (Blyth). The treatment of acute poisoning, which has proved most successful, has been encouraging vomiting by tickling the fauces, giving strong green tea and stimulants. If the stomach has not been emptied by vomiting, use the stomach-pump, or give a hypodermic injection of one-fifth of a grain of apomorphine. Follow this with large quantities of strong tea, or give half a drachm of tannin or gallic acid in warm water. Give also demulcent drinks and stimulants in small doses, frequently repeated. Keep the patient warm by hot blankets and wraps. The interrupted galvanic current to the heart may be useful (Blyth). Give a hypodermic injection of one-third of a grain of morphine when the acute symptoms have subsided. Antidotes for Husband's Forensic Medicine.
    OFIAP. III.] ANTIMONY AND OTHER METALLIC POTRONS. 665. Antimony is used in large doses in veterinary prac- tice, as much as 90 grains of tartar-emetic being often administered to a horse in his gruel three times a day. It is supposed to be fattening. Medicinally, it is employed as a vascular depressant, diaphoretic, and expectorant. Tartar- emetic is given in doses varying from one-sixteenth to one- eighth of a grain, and as an emetic from one to two or three grains. It should never be used as an emetic in suspected poisoning, as its presence would confuse the investigation. Therefore, in a trial for poisoning by antimony, care should be taken to find out whether tartar-emetic had not possibly been given medicinally. 666. The leading English cases for poisoning by anti- English cases r. n ,i j rpi of antimomal raony are those of Dr. Pritchard, Dr. Smethurst, and 1 nomas poiSOning. Winslow ; a small portion of antimony was also found in the body of Cook in the famous Palmer case, but in this case the jury found the prisoner, Palmer, guilty of having caused death by administering strychnine. The Bravo case, with its appalling miscarriage of justice, is still fresh in our memory. 667. During 1883 " mercurial compounds were detected Mercury, in the forms of corrosive sublimate, calomel, and cinnabar" (Madras Chemical Examiner's Report for 1883). There were four cases of mercuric salt and one of calomel. Mercury is also occasionally mixed with other poisons. Chevers says, that cases of poisoning " by those medicinal preparations of mercury which are common in India—as by red sulphuret (factitious cinnabar), Ivngool (vermilion), shemjerf-darshikna, similar to corrosive sublimate, and by rasmpur, a mixture of calomel and corrosive sublimate, are not likely to call very frequently for the opinion of the medical witness." The last named preparation of mercury is frequently administered by the kobaraj* in large and small poisonous doses to the unfor- tunate sufferer who consults him. It is no uncommon thing; to find a considerable portion of the lower jaw necrosed,t the * Native empirics, t Deac|,