PART OF STOMACH AFTER POISONING WITH CARBOLIC ACID (VON HOFMANN). A man of twenty years was found dead, having committed suicide by taking an unknown quantity of carbolic acid. At the postmortem examination the lips were found brownish-red and dry. The mouth and pharynx were white throughout and slightly cauterized. The mucous membrane of the esophagus was whitish, cloudy, and arranged in longitudinal folds. The stomach was contracted and contained about 100 c.c. (about 3 fluidounces) of a bright red, turbid fluid which had a strong odor of carbolic acid. Externally the organ was partly pale, partly violet in color, with bright-red, injected vessels. Within, the mucous membrane was arranged in rigid folds and appeared as though cooked. It was pure white in color except in the recesses of the rug, which were of a red color, and this color was transmitted through the markedly cauterized areas. In certain situations, especially at the crest of the rugæ, the milky white cauterized epithelium had desquamated and exposed the bright red, hemorrhagically infiltrated mucous membrane. There were no alterations in the intestines or in any of the other organs. distillate under these conditions must have been present in the uncombined state and will have greater toxicologic significance than that obtained by the distillation of a fluid that is highly acid with sulphuric acid. Tests.-1. Solutions of carbolic acid are colored red when boiled with Millon's reagent." The test serves to detect 1 part of carbolic acid in 2,000,000 parts of water, but the red color is produced also by all monophenols and by proteids. 2. Solutions of carbolic acid are colored intensely bluish-violet by a trace of ferric chlorid. The presence of mineral acid, ammonia, or an excess of the reagent is prejudicial to the production of the blue color, and the reaction fails entirely in the presence of alcohol. 3. On warming carbolic acid in substance with caustic potash and chloroform a product is formed which dissolves in alcohol with a carmin-red color. The color is removed by acids and restored by alkalis. The test is given equally weli by resorcin.* 4. To a dilute aqueous solution of carbolic acid that contains a trace of an alcoholic solution of ethyl nitrite is carefully added some concentrated sulphuric acid in such a manner that the liquids do not mix. A rose-colored ring will form at the surface of contact. The reaction will show the presence of 1 part of carbolic acid in 2,000,000 parts of water.5 5. From extremely dilute solutions of carbolic acid, bromin water precipitates white crystalline tribromphenol." 6. On warming a solution of carbolic acid with one-fourth of its volume of ammonia and a few drops of calcium hypochlorite solution, a transient blue color is produced that returns upon the addition of more hypochlorite or by shaking with air. Instead of hypochlorite solution, vapors of bromin may be employed. 7. To 50 c.c. of water add 3 drops of anilin and dilute from 5 to 10 drops of the mixture with 10 c.c. of water. Add as much sodium hypochlorite solution as will serve to change the blue color that is first formed into a brown, allow to stand a few minutes, and add the solution supposed to contain phenol and previously treated with a few drops of ammonia. In the presence of phenol a permanent blue color will be produced. This is Dragendorff's modification of Jacquemin's wellknown reaction." Jacobsen 10 claims that the greater part of the poison will be found in the blood and the liver, and Jacquemin " proposes the following short 1 Reale, Maly's Jahresbericht d. Thierchemie, 1891, p. 404. 2 Millon, Comptes rendus, vol. xxviii., p. 40. Dissolve mercury in an equal weight of 63 per cent. nitric acid, warming gently to start the reaction, and dilute the product with twice its volume of water. After standing overnight decant the clear reagent. 3 Guareschi, Ber. d. d. chem. Ges., vol. v., p. 1055. Lustgarten, Monatsh. f. Chem., vol. iii., p. 719. 1005. Eijkman, Zeitschr. f. anal. Chem., vol. xxii., p. 576. Landolt, Ber. d. d. chem. Ges., vol. iv., p. 770; Benedickt, ibid., vol. xii., p. 10 Loc. cit. 11 Loc. cit. method of preparing an alcoholic extract to which his test may be applied. One hundred grams of blood or finely cut liver are digested for an hour with 2 per cent. sulphuric acid; the liquid is strained through a cloth, treated with an equal volume of 30 per cent. alcohol, and filtered. Thirty c.c. of the clear fluid are used for the test given above. The dihydroxybenzenes (pyrocatechin, resorcin, and hydroquinon) have been used to a limited extent in medicine and have caused a few cases of poisoning. The symptoms are very similar to those of carbolic acid poisoning. The stimulating effect of these bodies upon the nervous system, however, is more marked than with phenol, for convulsions have occurred in some cases. In one case 2 drams (7.76 gm.) of resorcin, taken internally, caused cold sweats, stupor deepening very rapidly into collapse, with complete abolition of reflex movement. The temperature fell to 94° F.; the urine was of an olive-green color. Recovery was rapid.' Guaiacol (methyl-pyrocatechin) has caused a few deaths. Most cases of poisoning have resulted from its extensive use, both internally and externally, in the treatment of tuberculosis. The symptoms are irritation of the alimentary tract, loss of consciousness, fall of temperature, and collapse. The urine shows the same changes as after carbolic acid. In one case death occurred in a tuberculous patient eighteen hours after the external application of 30 grains (1.95 gm.).3 A number of preparations containing guaiacol, or derivatives of guaiacol, have been used in medicine; their effects are similar to those of guaiacol. Creasote consists largely of guaiacol and creosol. Its effects upon man are very similar to those caused by guaiacol. It is used extensively as an application in toothache, and its easy accessibility has led to a few cases of accidental as well as to criminal poisoning. About 2 drams (7.4 c.c.) caused the death of an adult woman in thirty-six hours, while another patient recovered after drinking 6 drams (22.2 c.c.). Pyrogallol (pyrogallic acid, trihydroxybenzene, CH(OH),) is used, in the form of an ointment, in the treatment of skin diseases, especially of psoriasis. It is readily absorbed by the skin, especially from the diseased skin, and has caused a few cases of poisoning in this manner.7 It has also been used for suicidal purposes, and solutions intended for photographic purposes have been mistaken for alcoholic liquors, with fatal results. The chief symptoms in poisoning by pyrogallo result from the effect of the poison upon the red blood-corpuscles; the latter become 1 Murrell, Med. Times and Gaz., 1881, vol. ii., p. 486. 2 Wyss, Deutsch, med. Wochenschr., 1894, vol. xx., pp. 296, 321; this paper is abstracted by Friedenwald, Maryland Med. Jour., vol. xxxi., p. 71. 3 Lewin, Lehrb. der Toxikol., 1897, p. 216. 4 Mosetig-Moorhof, Deutsch. med. Wochenschr., 1894, vol. xx., p. 168. 5 Manouvriez, Ann. d'hyg., 3 s., 1882, vol. vii., p. 175; Pürckhauer, Friedreich's Blätter, Nuremburg, 1883, vol. xxxiv., p. 430 (murder of infants by creasote). 6 Schulze, Munch. med. Wochenschr., 1894, p. 219; see Freudenthal, Medical Record, 1892, vol. xli., p. 456. Neisser, Zeitschr. f. klin. Med., 1880, vol. i., p. 88. |