Document 5kVZeDzQemZ8B8NpXYnb0e8B5

'! ST0853242 Copyright, 1937, BY William D. McNally, M.D. i ?! 1 FOREWORD F 735/1 i OCRATES, were he permitted to return to life today, might be amazed to learn that his "juice of the hemlock" was not poison" but a galaxy of poisons. With endless fecundity the ly "hemlocks" of an ancient day have yielded a profusion toxic entities serving and harming mankind in proportion the propriety of their application. In some measure it may fe maintained that the number of toxic agents surrounding a )eople constitutes an indej^ ,of its cultural development. In escapably intelligent man in his desire to make the best use of [materials about him will uncover and produce limitless com1 binations of elemental substances, some of which will prove to possess dangerous properties. No guilt may be attached to that chemist who, because of a laudable curiosity to learn of [what a lump of coal consists, first produced benzene. This I plentiful substance, like a myriad of others, is at the same time one of man's helpful servants and one of his treacherous enemies. While the number of "poisons" knowingly or fortuitously isolated by the technologists of a race may mark its milestones of racial advancement, the "poisonings" of human beings in proportion to their number serve as an index of a people's de gradation. Whether by vicious design, accident, carelessness, unconcern, ignorance or superstition, poisonings among a people tangibly represent deficiencies in the plans for human living. It may be conceived that, in a remote day, those human brains best equipped with information as to poisons were en gaged in the preparation of better poisons--agents that acted with dispatch, leaving the fewest tell-tale marks and the least gore. Today, in a world still far removed from human perfec tion, toxicologists foremostly serve in just the opposite ca pacity. Theirs is the duty to detect the nature and mechanism of poisonings with such exactness that the guilty may be pun ished as a deterrent to others who might elect similar activi ties; to guide therapeutists as to the thresholds demarking safe and beneficent actions of man's natural and synthetic agents torn those direful actions associated with use in larger amounts; to plan with industry and commerce for the con trolled use of baneful substances and machines, lest the hu- ffc ST0853244 ii FOREWORD man elements of industry and commerce be damaged in the performance of their obligations. Thus the toxicologist takes a place alongside the lawmaker, the educator, the healer, the minister, the engineer, as a unit in the orderly organization of mankind--all participating in the conservation of the public well being. Since the mighty among the toxicologists may not with their own voices and hands directly touch all the agencies re quiring their services, they are obligated to record their experi ence, to appraise and compile the observations of others, and to disseminate their learning to the end that knowledge may not disappear from the earth; that remote man may enjoy the benefits of learning gathered in centers of technical activity; that succeeding generations of technologists may escape the necessity of oft repeated elemental investigations and instead may devote their capacities to needed new endeavors. In this present book one widely experienced and highly skilled toxi cologist meets, but does not necessarily finally discharge, his obligations to those about him and to coming generations. Medicine, in its slow growth toward complete control of its problems, must always progress both as an art and a sci ence. Toxicology is one of those branches of medicine which, more than most others, holds the promise of becoming an al most exact science. In present day America, with its un precedented complexity of industrial and scientific pursuits, numberless and intricate situations demand a full measure of exactness in toxicologic guidance. In this country there are outstanding toxicologists, many meritorious toxicologic achievements, numerous praiseworthy isolated journal pub lications, but conversely all too few comprehensive toxicologic books. The advent at this period of this book is no chance happening. Inevitably its arrival hinges on the operation of unvoiced, unseen and unmeasured scientific needs. It is a refreshing characteristic of this new publication that it treats the outmoded observations of bygone periods only on their historical merits. This book is singularly liberated from the ancient thralldom of the occult in toxicology, and its dis tinguished author, in breaking with the past save for historical reference, may be marked as the man who replaced many of toxicology's threadbare garments with a raiment suited to a rapidly expanding science. PREFACE THIS volume has been compiled so that the medical and legal professions may have a modern toxicological text that con tains the results of recent research in the field of toxicology as well as the fundamental facts and basic principles. The subject matter has been the basis of a course of lectures given students of the Rush Medical College of the University of Chicago, and is considered detailed in description. Sources for the compilation of the subject matter include standard text books, raerence books, and original literature. Among the textbooks used in this work are: Legal Medicine and Toxi cology, Peterson, Haines, and Webster; Noxious Gases, Hen derson and Haggard; Lehrbuck der Intoxikationen, Dr. Rudolf Robert; Lehrbuck der Chemischen Toxikology und Anleetung zur Ausmtttelung der Gefte, J. Gadamer; the United States Pharmacopeia, Eleventh Decennial Revision; Die Gewerblichen Vergiftungen und Ihre Bekamfung, E. Brezina; Clinical Toxicology, Erich Leschke; and Industrial Toxicology, Alice Hamilton. Credit is given to all authorities in instances where experiments are noted and definite results have been obtained. The author has endeavored to produce a text that will be valuable both as a classroom adjunct and as a source for evi dence in the courtroom, based upon the analysis of organs from many thousands of human bodies. Considerable space is de voted to carbon monoxide, lead, and arsenic, as these subjects are more frequently encountered in court and in industrial work. Chicago, Illinois. October 1,1937. William D. McNally, M.D. "TO 3 53247 PAGES 1-58 59-83 84-307 308-453 454-609 610-709 710-877 878-897 898-901 902-959 960-967 968-973 974-983 984-997 998-1000 1001-1005 1007-1022 ST 0 853248 vi CONTENTS GENERAL CONSIDERATIONS Poisons Classified............................... Absorption of Poisons........................ Absorption by the Respiratory Tract Oral Administration .......................... Alimentary Tract............................... Diagnosis of Poisoning ...................... Prognosis of Poisoning ......................................................... Circumstantial Evidence ................................................................. General Treatment .......................................................................... Antidote^-........................................................................................ Detection of Poisons......................................................................... Chemical Examination ..................................................................... Routine Methods of Examination..................................................... Volatile Poisons ........................... ...................................._............. Examination for Mineral Poisons ........................................... Method of Fresenius and von Babo............................................ Process of Ogier............................................................................ The Reinsch Test .......................................................................... Volatile Poisons ........................................ Alkaloidal Poisons............................................................................ The Author's Method ................................................................... Separation of Ptomaines ................................................................. Forensic Questions............................................................................ I. Was Death or Illness Caused by Poison?......................... II. What Poison Produced the Illness or Death?................. III. Could the Substance Administered Cause Illness or Death? ................................................................................ IV. Was the Substance Found by the Chemist the Poison which Caused Death? ........................................................ V. Is a Substance Given in a Minute Quantity, a Poison?..... VI. Was the Poisoning Suicidal or Accidental?..................... VII. Could the Substance Found have been Administered as a Medicine? ........................................................................ VIII. When and How was the Poison Taken?............................. IX. May a Poisoning have Occurred and the Poison Either Be or have Become Undetectable? .................................. X. Could the Poison have been Simulated?........................... Postmortem Appearances Evidence of Poisoning from the Dead Body................................ The Autopsy .................................................................................. External Examination............................................................... Internal Examination ............................................................... The Pericardium .................................................................. Stomach ..................................................................................... Cranial Cavity .......................................................................... 11 11 11 13 14 lfl 18 19 21 22 24 28 29 30 30 34 37 38 39 40 41 41 41 42 42 44 44 45 48 49 50 51 55 57 CONTENTS INORGANIC POISONING * Corrosive Acids ............ Salphnric Add .............. Nitric Add........-............ Hydrochloric Add......... Oxalic Add................... Corrosive Alkalis............ Ammonium Hydroxide ... METALS AND NON-METALS /Phosphorus ....................... /Potaadum Chlorate....... .. Potassium Permanganate Boric Acid and Borax...... Fluorine ............................ Iodine ..... Bromine .. Chlorine .. Tellurium Thallium Sliver ..... Vanadium Chromium Cadmium Nickel ...... Manganese Barium .... Lead ........................................ Chronic Lead Poisoning........ Mercury .................................. Corrosive Sublimate .......... Chronic Mercury Poisoning Calomel .................................. Arsenic .................................... Arsenic Trloxide ............. Chronic Arsenical Poisoning Organic Arsenicals ............. Carbarsone .......................... Tryparsamide ....................... Arsphenamin ....................... Neo-Arsphenamln ............... Sodium Arsphenamin ......... Silver Arsphenamin ........... Sulpharsphenamin ............... Copper .................................. Bismuth ................................ Antimony ............................ Antimony Chloride .......... Tartar Emetic................... Tin ......................................... vii 59 60 66 69 74 79 81 84 88 89 89 91 108 110 111 115 116 124 125 126 129 132 134 140 147 154 199 202 211 219 219 227 236 267 269 269 270 275 277 277 278 280 284 285 286 286 290 viii CONTENTS Iron ................................................................................................... 293 Zinc ....................-.......................................................-.................. 294 Industrial Zinc Poisoning.............................................................. 299 Metal Fume Fever.....................................................................~ 301 Magnesium Sulphate........................................................................ 306 Thorium ............................................................................................ 307 GASEOUS POISONS Carbon Monoxide ......................................... -.............................. 311 Chronic Carbon Monoxide Poisoning....................i................... 337 Detection of Carbon Monoxide in Blood...................................... 381 Sequelae of Carbon Monoxide..................................... Saturated Hydrocarbons: Methane ............................................................................................ 379 UnsattMrted Hydrocarbons: Acetylene .......................................................................................... 382 Ethylene .......................................................................................... 384 Ethylene Dichloride........................................................................ 386 Ethylene Chlorhydrine ................................................................... 388 nhuninating Gaa........................................................................... 388 Hydrogen Sulphide ........................................................................ 390 Sewer Gaa ...................................................................................... 400 Nitrogen ............. ............................................................................ 403 Nitrons Oxide ................................................................................. 403 Nitrogen Dioxide ............................................................................ 405 Nitric Oxide .................................................................................. 412 Mustard Gas................................ ................................................... 413 Phosgene ......................................................... Tear Gas .......................................................................................... 421 Arsine ............................................................................................... 423 Refrigerants: Methyl Chloride............................................................................... 429 Sulphur Dioxide............................................................................... 439 Carbon Dioxide ............................................................................... 444 Ammonia ......................................................................................... 449 Dlcfaiormethane ............................................................................. 451 Dlchlorodifluoromethane ............................................................... 451 Acrolein ........................................................................................... 453 ALKALOIDAL POISONS Aconitum .......................................................................................... 465 Atropine ....................................................... Hyoscamine .................................................. Scopolamine .................................................................................... 473 Brucine ........................................................................................... 487 Cocaine ........................................................................................... 489 Codeine ........................................................................................... 493 Dionine ......................................................................................... 496 Pennine .......................................................................................... 497 Apomorphire ................................................................................ 497 375 418 472 473 Nicotine Opium .. Morphine Phyiootlpmfaie PQoc&rp' Quinine Cinchona Bcoporlns I Strychnine and Nnx Vomica Veratnim Yohimbine Tremetoi White Snake Boot, or Richweed Snlphaailamide ST 0B53252 x CONTENTS VOLATILES, DISTILLATES AND SOLVENTS Petroleum Distillates ----- ----------- ----------------- ----- --------------- Methyl Alcohol ......... -.....----------- ------- ---- ---------------------------- Ethyl Alcohol ......... ..............-.... -............... ........ ....................... Butyl Alcohol --------------- ---------- ------------------------------------------ Amyl Alcohol ------ ------- ---------- ---------- ---- --------------------------- Diacetone Alcohol ......... ....................................... .................... Butyl Acetate .......... ..... ...... .....................-......................... ....... Acetone .................. ...................... -.....--.......--...............-...... Furfural ________________ __ __ ____ ______ __ -__ ________ Dioxin _______________ ____ ------ ------- ---- ----- ------------------ Triortho-Creayl Phosphate -------- ----------------------- ----- ------------ Formaldehyde ------------- ------ ------- ---- ------------------------ ---- -- Paraldehyde ____ ___ ___ _____________________ __ ________ Acetaldehyde _____ ___ ___ ________ __ ________ ___ _____ __ Choral Hydrate _____ _____ __ ______ _______ __ ___________ Chloroform _____ ________ __ _______ ___ ___ 679 Brotnoform ......... Methyl Bromide..... ........ ................... .................................... Dimethyl Sulphate ................................... .............................. Carbon Tetrachloride ...... Tetrachlorethane ___ 610 613 632 662 863 663 664 664 664 884 665 686 871 672 874 691 692 692 693 707 DRUGS AND MISCELLANEOUS Iodoform _____ _____ Sulphonmethane___________ Trlonal and TetronaL...____ 712 Barhital___ ___________________________ Phenobarbital __ Dial________ Cinehopben andNeodnchophen. 724 Acetic Add______________________________________________ Formic Add __ Tartaric Add ____________________________________________ Ether _________ Amyl Nitrite............ ;___ __ ___________________________ ___ Ethyl Bromide __ Ethyl Chloride ____________ 735 Ethylene Pichloride____________________ Dimethyl Aoetony] Carbonyl.___ ___________ Dimethyl-paraphenyieudiamhie ____ Ethylene Chlorhydrin----------Ethylene Glycol ....-L--- ------------------------------------------------------Sulphur Monoehloride ---ToluylendJamlne ----------- Nitroglycerine __________________________________________ Carbon Disulphide ---------- Cyanides --------------Hydrocyanic Add ---------------------------------- Blttei Almonds................. ...... .....................---- ---------------------Oil of Bitter Almonds-------- 710 711 712 721 722 727 729 730 731 734 735 736 736 736 736 736 736 736 737 738 740 748 757 759 CONTENTS xi CyinuiMa---------------------------------------------------------------------------- 700 ii IHninnn (Benzol) Benzine 760 Phenylhydrasine785 Itiehloretbylene __ 786 Chloroprene___ _______________________________________________ 797 ' Tetraethyl Lead 797 . Naphthalene ___________ 801 Acridine __________ 802 Dihydroxybenzenes _________________________________________ 804 Creosote------------- 805 Pyrogallol -------------- ---------------- --------------------------------- ---------805 - Thymol __________________ ____________________ _____________ 807 Naphtbol----------------------------------------------------------------------------- 808 Carbolic Add--Phenol ---------------------------------------------------- ---- 809 Salicylic Add 817 Acetylsallcylic Add--------------------------------------------------------------- 819 jTrinltrophenol--Picric Add --------------- ---------- ------------------------ 821 jBenzaldebyde ______________ _______________________-..... -...... 822 'Nitrobenzene---------------------------- ---- --------------------------------------- 823 XHnltrobenxene _______________ __ ____________________ __ -...... 826 Trinitrotoluene______________ ___________-.... ............................. 820 Aniline __________________ _____________________________ ____ 828 boal Tar Dyee ................ --.................... --...... ..........-.... ...... ._... 829 AoetaniUd ................................. .............. .......................... ...... ........ 830 Dinltrophenol ............. ............ ..... ...... ..................... .............. ........ 831 Aoetopbenetidin ___ ________________________--.............. ......... 834 Antipyrine ......... ...... -..... ...... ...... ...... -..... ...... -....... ...... ...... --. 835 I Aminopyrine --------- ---- -------- --- ----------- ----- ------- ---- -------------- 838 Cantharide* ______ _________________________________________ 839 Cantfaaridin ................. ...... ............. ............................................... 840 Digitalis ........................ ...... ............. ...... ...... ...... ...... ................. 841 Dlgitoxin ......... ............. ............. ............. ...... ................. ........ 842 Digitalln ....................... ........................................................... . 842 Digitonin ......................................._.............................................. 843 8trophanthw ................. _..... .......................................................... 844 Oleander ................................................. ...... ...... ........................ 845 Cotton-Root Bark ................ ....................................................... 845 Tansy .................. .................. ..................................................... . 845 Oil of Pennyroyal ............................................................................ 848 Nutmeg ................................................................. ................. ....... 848 Apkrt .......................... ............ ............. ...... ....... ............. .............. 846 Oil of Savin .... ..... ..................... ...... .................................. ........... 847 Oil of Turpentine............ ....................................................... ....... 847 Oil of Cedar ........... ............................... ........................................ 848 Camphor ......... .................... ............................................. ........... 850 Male Fern ......... ...... ..... ....... ...... ............... .............. ...... ........... 851 Santonin ........................ ............................ ...... ...... ...... ............... 852 Vegetable Purgatives ___ __ _____ 854 Purgative Oils: Croton Oil ....... .. ............. ......................... ....................................... 854 xii CONTENTS Anthracene Purgatives: Aloes .............................................................. -.................... ----- ------- 855 Jalspln and Elaterin Purgatives ...................................................... 855 Colocynth ............................................................................................ 856 Gamboge ................................................................................ -.......... 856 Elaterin .... ..................... 857 Podophyllum .......... 857 Ivy and Sumac Poisoning ................................................................. 857 Picrotoxin ........................................................................................... 858 Water Hemlock .................................................................................. 860 Laurel ........... .................................................................................. -- 861 Local Anesthetics .............................................................................. 861 Alypin .... ...... 861 Apothesine ..................................................................................... 861 AnestResin ................ 882 Butesin Plcrate .............................................................................. 862 Butyn ............................................................................................... 862 Orthoform ....................................................................................... 864 Metycaine ....................................................................................... 865 Pbenacaine ..................................................................................... 865 Procaine Borate ............................................................................. 865 Procaine Nitrate...................................................... ...................... 865 Betaencaine Hydrochloridum ................................ 867 Tutocaine .......... 867 Procaine Hydrochloridum ................................................. 868 Nupercaine ...................................................................... 888 Pantocaine ....................................................................................... 870 Epinephrine ....................................................................................... 874 Ephedrine ........................................................................................... 876 'food poisoning and food-borne infections Metallic or Organic Poisons ............................................................. Poisons Present in Normal Animal orPlant Tissue ..................... Pathogenic Bacteria and Other Organisms ..................................... Poisonous Products of Bacteria andOther Organisms.................... Mushroom Poisoning.............................................................. Amanita PhalloJdes ............................................................................ Amanita Muscaria Linnaeus............................................................. Helvetia, or Gyromytra Esculents ................................................... 878 879 879 880 890 890 894 897 DEATH FROM POWDERED GLASS Mode of Action................................................................................... Symptoms ........................................................................................... Fatal Dose and Fatal Period ............................................................. Treatment ........................................................................................... Postmortem Appearances ................................................................. Chemical Examination ...................................................................... 899 899 899 900 goo goo BLOOD Blood-Stains 903 ST0853256 xiv CONTENTS ILLUSTRATIONS FIG. NO. PAQt 1. Steam Distillation Apparatus for Volatile Poisons (McNally) -- 19 2. Operation of Apparatus Diagrammed in Fig. 1----------------------- 20 3. Apparatus for Phosphorus Distillation (McNally) .--............... 21 4. McNally Reinsch Tube -------- --------------------------- -------- ----------- 27 5. Globules of Mercury as Seen in Reinsch Tube Under Low Mag nification __________________________________________________ 27 6. Condensers Used in Alkaloidal Extraction----------------------------- 31 7. Manner of Sealing Glass Jars Containing Organs................._... 48 8. Illustrating Technique of Removal of the Heart......................... 52 9. Opening the Right Ventricle____________ ______ _____________ 54 10. Chroftilum Chloride Test_________________ ______ __________ 73 11. Apparatus for Fresenius-Neubauer Method............. .. ...... ..........87 12. Apparatus for Fluorine Determination........................................ 107 13. Arsenic Trioxide (Reinsch Test) ............................. ..................247 14. Marsh Apparatus ___ _____________ _______ ____________ ____ 259 15. Lachele Apparatus for Arsenic............... 262 16. Mai and Hurt Electrolytic Apparatus for Arsenic..................... 268 17. Diagrammatic Cross-Section of Gas Mask................._........ ...... 349 18. The Microspectroscope for the Detection of Small Amounts of CO in Blood ............... ..... ...... ............................ .......................... 362 19. Carbon Monoxide Detector ............ .............. ............................. 365 20. Apparatus for Alcohol Determination................................. 649 21. The Direction of Blood Impingement_______________________ 906 - 22. Appearance of Bands Produced by Solutions of Oxyhemoglo bin, and by Hemoglobin, Hematin, etc......................... ............... 920 23. Blood Groups ......_..... ................................................................... 957 24. Crystals Obtained from a Single Thread......................... ...... . 962 25. Human Spermatozoa ............................................ ........ ............... 964 26. Animal Hairs ....................................................... .......... ............. 970 27. Wool, Fibers, and Human Hairs ................_........................ .....97? 28. A Silicotic Nodule ______ _____________________ _____________ 989 29. The Impinger........... ....... .... .... ....... ............ ....................______ -.. 993 ST0S53257 S': CONTENTS xv PAOE 11 2109 1I[ 2271 11' 27 31 48 52 54 73 87 107 '47 159 82 60 49 1I1 K I I ft V I ft I I I I 02 1 05 I ' table xo. TABLES PACE L Symptoms Caused by Poisons and Diseases...................... 9 n. Urine Changes In Poisoning...... ...... -......... -..................... 10 m. Poisons and Antidotes...........................--.............--...... 13 ' IV. Evidence of Poisoning from Postmortem Appearances.... 46 v. Cases of Sulphuric Add Poisoning.------------ ---- ------------- 60 VL Fluorine Content of Organs, Excretions, etc------------------- 94 VII. Presence of Sodium Fluoride in Four Cases....... --......... 101 . vul Detection of Fluorine by Distillation Method..... -............ 107 EX Physiological Response to Various Concentrations of Fluorine............................................................................ 112 X Barium Calculated ifr'Barium Sulphide............................. 141 XL Barium Chloride in Viscera........ ....................................... 142 xn. Signs and Symptoms Observed in 400 Cases of Chronic Plumbism________________________ ________ 161 xm. Blood Pressures of 438 Men Industrially Employed....... 162 XIV. Blood Pressures of 114 Persons Employed in Offices....... 163 XV. Blood Pressures of 280 Men Engaged in the Manufacture of Lead Products............. .............................. 163 XVI. Blood Pressures of Men Engaged in the Manufacture of Lead Products for 15 Years or Over......... 164 XVH. Blood Pressures of 93 Applicants for Insurance Not Working in Lead.__________________________ _____ 165 XVTIL Blood Pressures of 293 Men Industrially Employed......... 106 XIX. Blood Pressures of 120 Men Engaged in the Manufacture of Lead Products................. .......................... 169 XX. Solubility of Arsenic Trioxide............... ........................... 227 XXL Arsenic Found in Exhumed Bodies Calculated as A&O,.... 244 XX1L Arsenic Trioxide in Organs of Exhumed Body.... .............. 252 XXIII. Human Body Postmortems made within 24 Hours after Death; Arsenic Found per 100 Grams of Tissue Calculated as AsiOs..-............................................... 254 Distribution of Arsenic in Organs in Death Attributed to Arsphenamin and Neo-Arsphenamin.......... 274 Deaths Due to Carbon Monoxide Poisoning in Cook County, Illinois, 1917-1930........................................ 312 XXVI. Asphyxiation in Cook County........................................... 319 XXVII. Total Gas Asphyxiation Cases dor the Seventeen Years from 1904 to 1921, inclusive...................................... 320 XXVIII. Causes for the Inhalation of the Gas................................... 320 XXIX Where Gas Cases Occurred......................... .............. _...... 321 XXX Percentage Saturation of the Blood with Carbon Monoxide and Corresponding Physiological Effects......... 346 XXXI. Factors Used to Reduce to Standard Conditions CO in 100 cc. of Blood......................................................... 371 XXXII. Toxicity of Various Gases.................................................... 375 ST0853258 xvi CONTENTS XXXIII. Physiological Response of Man to Common Gases............ 380 XXXTV. The Toxic Concentrations of Hydrogen Sulphide.............. 397 XXXV. Poisons and Explosive Gases Found in Manholes.-......... 400 XXXVI. Composition of Gases from Manholes (Boston).............. 401 XXXVII. Composition and Inflammable Limits of Gases from Sewage Sludge Digestion Tanks............................... 402 XXXVIII. Physiological Response to Various Concentrations of Nitric Acid............................. .............-...........-..... -...... 410 XXXIX Physiological Response of Human Beings to Nitric Add.. 411 XL. Toxicity of Various Gases and Vapors.--.......................... 415 XLI. Physiological Response to Various Concentrations of Phosgene....................................................... --............. 420 XLII. Physical and Chemical Properties of Methyl Chloride Compared with Gasoline and Ammonia........................... 431 XLIII. Minimum and Maximum Blood Changes in Methyl Chloride Poisoning................................................. 435 XLTV. Summary of Inspections Made in 1929...................... ........ 437 XLV. Physiological Response to Various Concentrations of SO> 440 XLVI. Physiological Response to Various Concentrations of Ammonia............. -........................................................... 450 XLVII. Physiological Response to Various Concentrations of Some Common Gases and Vapors in Air....................... 452 XLVIII. Nicotine in Milligrams........................................................ 548 XLIX. Simultaneous Determination of Methanol and Ethanol.... 630 L. Deaths Due to Alcohol........................................................ 634 LI. Relation Between Clinical Indications of Alcoholic Intoxication and Concentration of Alcohol of the Blood and Urine............ ..................................................... 656 LII. Chloroform Content of Brain............................................. 680 LIH. Amount of Chloroform in Dogs' Brain......... -................... 681 LIV. Per cent of Inorganic of Total Sulphates in the Urine of Controls and Plant Employees........................................ 782 LV. Relative Lethal Concentrations by Volume in Air, if Toxidty of CCL=1.......................................................... 795 LVI. Toxicity of Common Solvents........................................... 796 LVII. Lead Found in Organs....................................................... 801 LVIII. Average Size of the Red Blood Cells.................................. 930 LIX Wormley's Measurements. Examination of Old Blood-Stains..................... ............ ...... ...................... 930 LX. Specificity of Precipitin in Serum of Rabbit Injected with Human Blood............................................................. 944 LXI. Precipitin Tests for Blood......................................... 945 LXII. Scheme for Precipitin Test.--........................................... 948 LXIII. Measurements of Various Spermatozoa................... 966 LXTV. Analyses of Lungs............................ ............................ . 987 LXV. Analyses of Lungs, Various Occupations......................... 988 ST 0853259 SILICOSIS AND ASBESTOSIS SILICOSIS may be appropriately termed a "depression dis ease," because in America prior to 1930 little was heard of silicosis, while now hundreds of alleged cases have come to the attention of the medical and legal fraternities. Hippocrates, in his "Epidemics"18" was the first to mention the symptoms which we recognize today as signs of silicosis. George Bow er11887978mentioned asthma due to inhalation of dust in the blood and lungs. Lohneiss,1880 referring to miners, described the ef fects on them: "The dust and stone fall upon the lungs, the men have lung disease, breathe with difficulty, and at last take consumption." Very little was written on the subject until 1717, when Ramazzini wrote a book on "Diseases of Trades men,"1881 incorporating his views from a personal investigation of mines and industry. The description he has portrayed of silicosis has changed but little up to the present time. The literature was sporadic in nature. Every thirty or forty years someone would write about disease of the lungs. The first report with microscopic demonstration of silica was made by Peacock.1882 Greenhow was the first to find the crys talline and small angular bodies, and to identify positively the presence of silicon dioxide by means of hydrofluoric acid. The first time the term "silicosis" was used appears to have been by Rovida,1883 1i8n841871. After 1930 the literature contained numerous references to the etiology, symptomatol ogy. pathology, chemistry of dust, and quantitative determina tions of silica in postmortem material. Following the Confer ence at Johannesburg, South Africa, in August, 1930, the lit erature was greatly augmented by contributions from every country. The Committee on Pneumonokoniosis of the Industrial Hy giene Section of the American Public Health Association1881 defined silicosis as "a disease due to breathing air containing 1878. Hippocrates: 4-Epid., M. 13, Trans, by Farr, 120, 1780. 1879. Coixis, Edgar L.: Milroy Lectures: Industrial Pneumonoconiosis, Georgii Agricolae, 1557; translated by Herbert Hooves. 1880. Lohheiss, G. E.: Bericht von Bergwercken, 50, 1080. 1881. Ramazzini: De morbus arta flcium diatribe, 1717. 1882. Peacock: Brit. & Foreign Af. Ret., 11:203, 1800. 1883. Rovida: Un caso di silicosis del polmini con analisi chemica, 1871. 1884. Am. Pub. Health Ass'n. Year Book, 1932-1933. ST 0853260 SILICOSIS 985 ca (Si02), characterized anatomically by generalized flbrochanges and the development of miliary nodulation in both gs, and clinically by shortness of breath, decreased chest ex ion, lessened capacity for work, absence of fever; increased eptibility to tuberculosis, (some or all of which symptoms lay be present), and by characteristic x-ray findings." In case of death, diagnosis must rest upon two findings: e characteristic fibrotic changes seen in section of the lung microscopic examination, and by chemical examination owing an excess of silicon dioxide, 1.13 mg. or more per gm. dried tissue. The normal lungs contain 1.13 mg. of silicon oxide per gm. of dried tissue.1885 AsrlPflica is a normal constiluent'of all the food we eat and the water we drink, it is natural at we should find it in all tissues of the body. It is a normal nstituent of connective tissue, skin, blood, bone, urine, feces, rand saliva of men. The silica in the lung in case of silicosis is erived chiefly by inhalation. Men engaged as grinders, stone 'cutters, or in occupations where the dust contains silica, are rone to develop silicosis in a concentration of 10 million parts r cubic foot of air, if the dust is 35% silica. The most harmful are those of 3 micra or under. Cement and coal dust fa vorably modify silicosis. The author advanced the theory that the fibrosis in the lungs in silicosis is caused by the chemical action of fluorides in the blood upon the silicon dioxide. The presence of fluor ides with silica causes silicosis to appear at an earlier date in experimental animals than in animals dusted with pure silica. To make a diagnosis it is absolutely necessary to have a history of the occupation and exposure of each workman in the silica-containing dust; to have a complete physical examination, and to have x-ray pictures. Detection in the sputum of particles of dust known to be associated with the pneumonokoniosis may assist in diagnosing the occupational sign of the attack. How ever, knowing the occupation of the man, one would expect to find in his sputum the particular type of dust he fiad been inhal ing. Policard and Magnin188* conclude ``that the microscopic and chemical examination of the sputum is no aid in the diag nosis of silicosis." They only confirm etiological data much more easily obtained in some other way. 1885. McNally, W. D.: J.A.M.A., 101:584, 1933. 1888. Presse mdd., 38:875, 1930. 261 986 SILICOSIS The inhalation of silica causes an inflammation with the development of fibrous tissue in small, well defined nodules. These nodules are more dense than the lung tissue, and are seen in the x-ray pictures. Three stages of silicosis are recognize^. The most usual symptoms are slight shortness of breath on exertion, non-pro ductive cough, and recurrent colds. There may be less ability to expand the chest than usual, and the elasticity of the chest may be impaired. Usually the normal breath sounds may be somewhat harsh, roughened, and shortened. The cough is usu ally the first symptoms. At first it is both paroxysmal and non productive and later is accompanied by scanty expectoration. Later on, the outstanding symptom is dyspnea. The second stage is often manifested by continuation of the shortness of breath on exertion and frequently pains in the chest; as the fibrosis increases and reduces the lung ventilation the symp toms become more marked. A patient may not lose weight, and may appear robust, but shortness of breath, may in terfere with his working efficiency. The chest expansion is notably decreased, and chest movements apparently are smaller. In the third stage there is pain in the side, which is probably due to early pleuritis. There is an absence of fever; night sweats are common. The patient, as a rule, is pale; his chest is flattened anteriorly; the expansion of the chest is more limited than in the other two stages; there are local areas of dullness, and the inspiratory breath sounds are shortened, roughened, or more harsh. In the third stage, hem optysis, loss of strength, and gastro-intestinal symptoms are pronounced. The symptoms increase in severity as the dis ease progresses. Tuberculosis may intervene at any time. It may be twenty years before the patient is incapacitated. In some instances, however, death has occurred within one and a half years from the time of exposure to silicon dioxide. Both silicosis and tuberculosis may be present at the same time, and the term "tuberculosilicosis" has been applied to this condition. When there are no cavities, one of the outstanding clinical findings would be a reduced vital capacity, i.e., the vol ume of air that can be expelled from the lungs after a full in spiration would show a reduction from the normal. When the individual dies and material is removed at the autopsy, the pathological and chemical examination is the final SILICOSIS , as to whether or not the case is one of silicosis. The histhe x-ray and clinical findings are subordinate to these igs. In Industrial Medicine, February, 1935,mT the author sted that no lump sum settlement should be made in silii cases, but that monthly payments be made with the proviso ; at the time of death an autopsy be performed and the lungs led for chemical and microscopical evidence of disease sed by inhaling dust. The following tables, LXIV and LXV, re an analysis of normal lungs and lungs from persons havig had various degrees of silicosis. Table LXV is of interest as : gives the occupation of the individual, and reports of investiators from various parts of the world.. TABLE LXIV Analyses of Lungs fCase per Gram Mg. of SIO, Age Ash % of Dried Tissue >57# .8 Mos. Fetus ... ...... 1.05........ ........... 11 f-MO ___2 Days Old........ ...... 5.32........ ........... 50 590 ...J3 Yrs. Old.......... ...... 5.21........ ........... 21 006_......... ..._5 Days Old........ ..... 3.20........ ........... 12 590....... ..... Tull Term........ ..... 5.38........ ........... 077 Jll*______ . .81 Years............ ..... 8.71......... ....-...1.86 31r______ 63 Years .......... ..... 5.81......... ........... 92 441'______ 40 Years .......... ..... 8.17........ ........ 1.21 15'______ 51 Years .......... ..... 9.85........ ........... 72' IT______ 43 Years .......... ..... 5.53........ ........ 1.90 18' _ ..... __28 Years .......... ..... 3.50......... ........... 80 8'______ --23 Years ........... ..... 4.77......... ....... 1.10 ir______ . 72 Years ........... ..... 4.40......... ....... 1.10 91**______ __ Normal ............ ....... 1.40 (Colorimetric) 1. McNally, W. D.: 101:584, 1933. 2. Gust, Willy: Beitrage Zur Pathologischen Anatomie und Zur Allgemeinen Pathologie, 1932-33. 3. Hydrochloric Acid insoluble which is nearly all silica. 4. Cummins, S. L., Sladden, A. F.: J. Path. & Bact., 33:11, 1930. 5. Kmc, E. J., Stantial, H., and Dolan, M.: Biochem. J., 27: 1004-1005. The prognosis in silicosis is unfavorable! The silica once llodged in the lung remains there forever, and the lung tissue lis never restored to normal. Susceptibility to pneumonia and [tuberculosis is increased in all stages of silicosis, especially in [the last. When an autopsy is performed, upon opening the thoracic 1887. "Silicosis--An Old Disease Revived." ST 0853263 988 SILICOSIS cavity there are usually dense adhesions, and it is with difficul ty that the thoracic organs can be removed. The adhesions are usually adherent on the lateral, mediastinal and posterior sur faces, with more extensive adhesions from the latter surface. The lungs are not collapsed, but stand out as if a cast had been TABLE LXV Analyses or Luncs, Various Occupations Case' Author % SlOi in Deled Lung Remarks 1.Z-..... -...Glese1_____ __________________ .2.24 Stone cutter Miner 5~<E*fe-. " J..3.50 Foundryman 8_______ Hackman*_____________________2.35 Miner 14__________ " ^3.12 Stone cutter 30__________ " 3.33 Miner, stone c. 1________ McCrea*.1.39 African gold m. 4_________ " 4.47 African gold m. 6----------- " ______________________ 2.81 African gold m. 503---------- .McNally*_____________________ .1.40 Mill stone sharp. 300............... " .2.60 Granite cutter 446...----------- " ____ ,____ h1.09 Zinc miner 1------------ Pancoast and Pendergrass* ___.1.81 Sand blaster 4________ " " ___ l2.45 Sand blaster 40 ............. Gladden*................... Hl.72 Coal miner 41 --------------- * ,.1.78 Potter 42 ............. " .1.80 Coal miner 1.............. Smith and WlkofT___ _______ JZ. 16 Driller 4------------ " " 8_____ __ u - ............. ...... 13.69 Driller u ____________ 1.98 Laborer 3----------- jttng, Stantial and Dolan*___ .13.64 4 . _ *4 m it ti j 70 5......!!!_..! " " .si 1. Goss, Willy: Beitrage Zur Fathologischen Anatomie und Zur Allgemeinen Phthologie, 1932-33. (Figures are for Hydro chloric Add insoluble.) 2. Hackman, C.: Beitrage Zur Pathologischen Anatomie und Zur Allmeinen Pathologie, 90, 1932-33. 3. McCrea, John: The Ash of Silicotic Lungs, South African Inst for Med. Research, Pub. 3, p. 122, 1933. 4. McNally, W. D.: J.AM.A., 101:564, 1933. 5. Pancoast and Pendergrass: Am. J. Roentgenol., 26:556, 1931. 6. Sladden, A. F.: Lancet, 225:123, 1933. 7. Smith and Wikoff: Am. J. Pub. Health, 23:12, 1252, 1933. 8. King, Stantial and Dolan: Biochem. J., 27:1004-1005. made. The lungs are not much increased in size, but show an increase in weight. On section, the lung of a typical case of silicosis will show a dull slate gray, the surface uniformly studded with discrete firm black nodules. The air spaces are emphysematous. The large bronchi are thickened by fibrosis. SILICOSIS e peribronchial lymph glands along the bifurcations of the ge bronchi are enlarged and black in color, and, upon section, t with difficulty and give a gritty feeling. The cut sections gray, with areas of black scattered throughout. The lung ts with difficulty and may show irregular spherical masses dense fibrous tissue scattered over the surface. The pathology of silicosis is well summarized in the statet on the Medical Aspects of Silicosis made at the Intemaional Conference on Silicosis in Johannesburg, South Africa, no. 28 A Silicotic Nodule I August 13 to 27,1930. It was agreed that the microscopic patho logical changes that may be produced by the prolonged inhalaEtion of silica dust are: 1. The development of a condition designated in South ; Africa as a dry bronchiolitis characterized \>y an accumula! tion of dust-filled phagocytes in or in relation to the termijnal bronchioles, with possibly some desquamation of their ' epithelium. 2. Ilie accumulation of dust-containing phagocytes about | and in the intrapulmonary lymphoid tissue and their transpor tation through the lymphatics into the tracheobronchial lymph S T 0853265 990 SILICOSIS nodes. (The conditions described above under (1) and (2) do not constitute the disease silicosis.) 3. The gradual development of fibrous tissue within such accumulations of phagocytes and the formation of characteris tic nodules of hyaline fibrous tissue. 4. Degenerative changes in these foci. 5. The hyaline nodules increase in size by extension at their periphery. Coalescence of adjacent nodules takes place and brings about involvement of further areas of the lungs. (The conditions described under (3), (4) and (5) constitute the dis ease silicosis.) (See Fig. 28.) Th%'ij^e'ura are nearly always thickened, and contain de posits of dust. The interlobular septa are thickened and contain dust. The primary lesion of silicosis is located in the tracheo bronchial lymph nodes, and a chemical analysis of a large num ber of lymph nodes shows increased amounts of silicon dioxide as the disease advances in the lung. The nodule is characteris tic and pathognomonic for silicosis, consisting of a discrete mass of hyaline connective tissue surrounded by layers of fibrous tis sue. In some nodules the hyaline material will contain dust, in other sections there will be no dust. (See method of microincineration under Methods of Collecting Dust, page 994.) The dust count should not exceed 10,000,000 particles per - cubic foot when collected by the Greenburg Impinger method, and counted with about 110 diameters magnification. This is equivalent to 300 particles per cubic centimeter (referring to silica dust exposure). This is the standard used in South Af rica, Ontario, Wisconsin, and Oklahoma. In South Africa the degree with which an individual is affected with silicosis has been divided into various stages:1888 "First, rather more fibrosis than usual; second, more fibrosis than usual; third, ante-primary; fourth, primary; fifth, secon dary." In the United States, the stages are called first, second, and third. "The first stage means that definite physical damage to the lungs has been found, and that such damage has resulted from exposure to dust. The second stage means that definite and specific physical signs of silicosis are or have been present, and that capacity for work has been impaired by the disease, though not seriously. The third stage means that specific pbysi- 1888. Rvssxll, A. .: J. Lancet, 22:605, 1933. ST0853266 SILICOSIS 991 cal signs of silicosis are or have been present, and that capacity for work has been seriously and permanently impaired by the diseases."188* (For the complete literature on the various phases of pneumonokoniosis, refer to The Pneumonokoniosis Series by Davis, Salmonsen and Earlywine.)1880 Sweany1891 states that tuberculosis with silicosis renders a roentgenographic examination difficult or impossible in the majority of patients affected with silicosis, because of atypical characteristics or the location of the lesions. Denny, Robson and Irwin* found in animal experiments that rabbits dusted with quartz, to which less than 1% of metallic aluminum dust had been aticfed, showed practically no fibrosis at the end of treatment. McCord, Kasper and Fredrick** state that ethyl silicate is used as a vehicle and solvent in paints and lacquers, as a stone preservative, in heat resistant coatings, as a cement bonding agent for refractories and other materials, and as a strengthen ing or hardening agent in sand molds, brick textile products and the like. Small quantities of ethyl silicate are used in dentistry for sealing of dental surfaces. Tetraethyl-ortho-silicate, SiCOQsH*)^ is a limpid waterwhite liquid, boiling at 165.5C. Its density is 0.933 20/20 and its vapor pressure is relatively low. Air saturated with ethyJ silicate vapor at room temperatures (25C.) will contain ap proximately 17 mg. per liter of the vapor. Regardless of the method of administration, but with re gard to dosage and time element, the administration of ethyl silicate invariably leads to a characteristic response to which most other manifestations apparently are related. This basic injury is at the location of marked hemorrhage into the air sacs, with some rupturing of alveolar tissues. This change may appear well within ten minutes following intraperitoneal in- 1880. Sayers, R. R., et al.: U. S. Bureau of Mln^f Tech. Paper, 545. 1890. Book I: The Pneumonokonioses (Silicosis^-- Bibliography and Laws; Book II: The Pneumonokonioses (Silicosis)--Literature and Laws of 1934; Book III: The Pneumonokonioses (Silicosis)--Literature and Laws, Chicago Medical Press, Chicago. 1891. Sweany, H. C.: Pathologic Interpretations of Roentgenologic Shadows in Pneumonoconiosis, J-AMJL., 106:1965,1936. * Canad. M. A. J., 37, 1937. * McCord, Carey P., Kasper, Joseph A., and Fredrick, William G.: The Toxicity of Organic Silicon Compounds 1. Tetraethyl-OrthoSilicate. Manuscript from the Detroit Department of Health, 1937. ST 0853267 992 SILICOSIS troduction of minute quantities of ethyl silicate and without occurrence of the demonstrable local injury within the ab dominal cavity. To a limited extent, the capillaries of the heart and heart muscle are likewise injured by ethyl silicate. If death be not immediate, hemolysis may take place leading to hema turia and anomalies in blood counts. Also, in those animals surviving for a few days, an acute nephritis regularly may be demonstrated. From their animal experiments the authors found that ethyl silicate possesses highly injurious properties. The minimal lethal dose, when introduced intravenously into rabbtfiT-ls- approximately 0.2 mL per kilo of body weight; death usually takes place within one hour. The minimal lethal dose for rats, when administered intraperitoneally, is approxi mately 0.06 ml. per 100 gm. of body weight; with rare exception, death takes place within four days. DETERMINATION OF SILICON DIOXIDE THE whole lung is cut into small pieces and dried. After drying it is ground to sixty-mesh. Some fibrous material may have to be cut with scissors and ground in a mortar. Ten to twenty gm. of this well mixed powder are weighed into a platinum dish and the moisture determined, so as to be able to calculate all the silicon dioxide and other minerals to the dry basis. The sample is then ashed in the electric muffle, using about 5 gm. of the sample at a time, as the material may foam over if a larger sample is used. After the organic matter is all destroyed, a gray to reddish colored ash is obtained. Cool, weigh, and report as ash. If ashed over a flame the destruction of organic matter may be hastened by the addition of ammon ium nitrate, or pure hydrogen peroxide. (The loss in weight is due to water of crystallization, carbon dioxide, and the de struction of the organic matter in the tissues.) The ash at this stage may be examined by petrographic or chemical methods, or a combination of the two, but the examination is best made on the original lungs, as ashing causes a change in the appear ance of the mineral present. The ash is now digested with di lute hydrochloric acid, evaporated to dryness, and this process repeated three times. The residue is heated on the electric plate with strong hydrochloric acid for one hour. Warm water is added and the residue washed, dried upon an ashless filter s uo3268 SILICOSIS 993 paper, and ignited in a platinum crucible. It is then cooled, and weighed as "hydrochloric acid insoluble." A slight loss of silica may occur at this stage of the analysis, owing to the pres ence of fluorides, which the author found to be present in all tissues in the body. The ash still contains some iron and alum inum. The residue is treated with cold hydrofluosilicic acid for twenty-four to forty-eight hours, which separates silicates, leaving the free silica. The residue is washed with warm wa ter upon a small ashless filter paper, dried, and ignited in a platinum crucible. The residue is weighed as silicon dioxide. As a further check the residue ^ the platinum crucible is treat ed with hydrofluoric acid, warmecf slowly under a hood, ignited, cooled in a desiccator, and weighed, the loss in weight being calculated as silicon dioxide. Lematte and Kohane1892 1h8a9v3e advised the use of perchloric acid and 1% boric acid to prevent the loss of silica due to fluor ides. Where it is desired to obtain the total silica, both free and combined, the ash as obtained above is fused with about four parts of a mixture of potassium and sodium carbonates, digested upon the hot plate with warm water, filtered, and evaporated to dryness with an excess of hydrochloric acid. The dry residue is treated three times in the same manner with hydrochloric acid, pulverizing the white residue each time. The final residue is taken up with dilute hydrochloric acid, and washed with warm water upon a small ashless filter paper until tests for chlorides are negative. The paper is dried, ignited, cooled, weighed, and calculated as silicon dioxide, which can be checked by adding hydrofluoric acid as above. The filtrate after treating with hydrochloric acid can be examined for the pres ence of other minerals. The filtrate in the fusion method can not be used for the quantitive analysis of sodium or potassium, as these have been added. For the colorimetric determination of silica1898 as the silicomolydate, reference should be made to .the papers published by King. A micro-method has been devised where histological sec tions mounted on a slide can be ignited in the muffle and ex- 1892. Lematte; Kohane: Compt. rend. Acad. d. sc., 196:575, 1933. 1893. King, E. J.: J. Biol. Chem., 80:25, 1928; see also Chem. Abit., J. Am. Chem. Soc., 50:2395, 1928. Schwartz, M. C.: Indiut. & Eng. Chem., Anal. Ed.., 6: No. 5, 364, 1934. ST035326S 994 SILICOSIS amined for the presence of silica. Examining these under the polarized light will show the presence of free silica. METHODS OF COLLECTING DUST VARIOUS methods have been used in collecting samples. We formerly used the sugar-tube method, supplanting it by the Palmer water spray apparatus. The Bureau of Mines at the Pittsburgh Station1894 made comparative tests of the FIG. 29 The Imptnger various methods in use and a new instrument, the Impinger, was evolved (Fig. 29). "In this instrument, the air to be sam pled is drawn through a glass tube and impinged at a high velocity into a graduated tube containing water. The dust is momentarily arrested, wetted by the collecting fluid, and in this manner trapped. The apparatus possesses an efficiency of 94% to 97.5% when sampling finely divided silica dust suspen sion at the rate of one cubic foot per minute." A portion of the 1894. U. S. Pub. Health Reports, 47:654, March 18, 1932. STD 8 3270 ASBESTOSIS 995 collecting fluid is removed to a Sedgwick Rafter Counting Cell for microscopic count to determine the number of particles present. An eyepiece micrometer known as a "Whipple Disk" is placed in the eyepiece of the microscope in making the counts. The great objection to this form of apparatus is the weight, as one person cannot carry both parts of the apparatus and tripod. Collecting the dust in this manner gives the chemist an oppor tunity to weigh the amount of dust collected to determine the amount of organic matter, inorganic matter, how much dust is is in the form of silicates, and how much is free silica or other minerals, all of which can be de^rpiined quantitatively. The nature of the organic matter in the air can also be determined chemically and microscopically. Irwin1896 states that the micro-incineration method is an aid in the diagnosis of silicosis. Micro-incineration should be regularly included in the microscopic examination of any lung where siliceous fibrosis is suspected, not with any dogmatic predictions in mind but rather as a means towards a more cer tain diagnosis and a better understanding of the pathogenesis of siliceous fibrosis.189* ASBESTOSIS ASBESTOSIS is a pneumonOkopioses exposed by the inhalaA tion of asbestos dust. Although the exact differences be tween silicosis and asbestosis are not wdl defined, anatomic and radiologic observations ha' re shown that the appearance of asbestos fibrosis seems to be wfficiently distinctive to avoid confusion, asbestos causing a softer, mor$ delicate, and more diffuse type of fibrotic changes. A full medical and industrial history is emphasized as an aid to differential diagnosis. Asbestos exists in two chief forms, amphibole, and ser pentine. The minerals of amphibole and serpentine are known commercially as asbestos, and are used extensively in the manufacture of incombustible boards, paper, cloth, covering for oil and steam pipes, yarn and rope, and for packing valves. 1895. Irwin, D. A.: Canad. M. A. J., 31:140, 1934. 1896. Durt References: Sahtoriub, F., and Jottin, K. W.: Zentralbl. f. Gewerbehyg., 21:65, 1934; Tillson, B. F.: Eng. & Mining J., 135:306, 1934; Mbter, E. G.: Nat Safety New, 29:34, 1934; Met.t.ct, H. B.: J. Franklin Inst., 217:709, 1934; McNally, W. D., and Sandm, O. A.: J. Am. Insurance, 11:21, 1934; McNally, W. D., and Swzknxy, H., Nat. Underwriters, 31:38, 40, 1934. 996 ASBESTOSIS Most of the asbestos comes from Canada, and is the serpentine N Chrystole. The Canadian asbestos is a hydrated magnesium silicate containing no free silica, but about 44% of combined silica, 43% magnesium, nearly 13% of water, and traces of iron and nickel. The silica is combined chiefly with calcium, mag nesium, sodium, iron, aluminum, and potassium. At the present time it is estimated that there are nearly 12,000 individuals employed in the chief asbestos plants in the United States, of whom 10,000 might be exposed to asbestos dust.1897 18G9a8rd18n9e9r and Cummings,1,M and Gloyne,1** state that the nodular forma tion foun^JJp distinctive of silicosis is not found in asbestosis. While silicosis is predominantly parenchymatous, asbestosis is mainly interstitial. The clinical picture of asbestosis is milder than that of silicosis.1900 The individual with marked asbest osis will greatly resemble the individual with silicosis. There is the same dyspnea on exertion, the same dry cough, and the more or less indefinite physical signs elicited by the stetho scope. The asbestosis patient is apt to be pasty looking, while the silicotic patient is apt to be very robust in appearance. Lanza states that x-ray appearances are not as clear cut or dis tinctive as in silicosis and do not lend themselves to ready grouping into progressive stages. "There are less evident pathologic changes in these films and the shadows are finer, more granular and softer than in silicosis. The asbestos film gives the impression of ground glass, and there is no nodulation with the consequent tendency of the nodules to coalesce and give dense opaque somewhat different shadows, occupying the lower third of the lung, except in far advanced cases, when the shadows may occupy the major portion of the lung." As under silicosis, one must obtain a very careful occupa tional history. "Associated with exposure to asbestos dust is the occurrence in the sputum and pulmonary tissues of a peculiar formation known as asbestos bodies. These asbestos bodies have been described by a number of observers, and are due apparently to the action of the tissues on the asbestos fiber. It is commonly agreed they are not diagnostic and indicate 1897. Lanza, A. J.: J.A.M.A., 108:368, 1936. 1898. Gardnih, L. U., and Cummings, D. E.: /. Indust. Hya., 13:65, 1931. 1899. Glotnz, S. R.: Tubercle, 14:445, 1933. 1900. Lanza, A. J., McConnzll, W. J., and Fehnzl, J. W.: U. S. Pub. Health Report, 50:1, 1935. ASBESTOSIS merely that the individual has been exposed to asbestos dust.101 Many of the workers in asbestos have a terminal death of tuberculosis. Such was the case of L. P., aged forty, who died on January 13,1935, and who had a history of working for four teen years in an asbestos factory. The postmortem showed that the lung on the right and left sides was bound down by dense adhesions. The left lung contained many small tuber culous cavities. One large cavity was found in the upper lobe. On section the lung showed, in addition to the small cavities, areas of anthracosis, and the peribronchial lymph nodes were moderately enlarged. The tricuspid valves were negative. The aortic valves were slightly calcifid<v>The mitral valve would not admit the small finger, and there were areas of calcification. The myocardium was pale, but firm. Grossly there was no pathology in any of the other organs. Microscopical examina tion showed a chronic fibrous and caseous tuberculosis of lung and peribronchial lymph node. There were many giant cells, also areas of caseous pneumonia, and fibrous tissue with brown ish-black granular pigment, fibrous myocarditis, chronic inter stitial changes in the kidney, chronic tuberculosis of the spleen. Anatomic diagnosis showed asbestosis, anthracosis, and silic osis. On chemical examination, the right lung contained 3.72 mg. of silicon dioxide per gm. of dried tissue, and the left lung contained 3.98 mg. per gm. of dried tissue.1903 1801. Mereweathxr, Wood, W. B., and Gloynx, S. R.: Lancet, 2: 1383, 1934. 1902. Asbestosis References: Amendola, O.: Morgagni, 76:16, 1934, Indust. Bull., 13:95, 1934; Safety Eng., 68:74, 1934; Becer, P. J.: Deutsche med. Wchnschr., 60: 231, 1934; Beceh, P. J.: Med. Klin., 30: 1222, 1258, 1934; Ellman, P.: Brit. J. Radiol., 7:281, 1934; Mereweather, E. R. A.: Tubercle, 15:69, 1933; 109, 1933; 152, 1934; Stewart, M. J.: J. Tech. Methods, 13:70, 1934; Wood, W. B., and Gloyne, S. R.: Lancet, 2:1383, 1934. ST0853273 INDEX Absorption, of gases, 310 McNally's method of of poisons, 4 detection, 30 by respiratory tract, S Alkaloidal precipitant*, 458 Acetaldehyde, 672 Alkaloids, 454 estimation, 672 color reactions, 456 symptoms of poisoning from, 672 identification, 455 Acetanilid, 830 of opium, 553 fatal dose, 831 precipitation reagents, 458 isolation of, 831 quantitative determination, 464 symptoms of poisoning from, 830 gravimetric method, 464 treatment, 831 stability of, 462 Acetic acid, 727 Allergens, not poisons, 2 fatal dose, 728 Almonds, bitter, 758 isolation, 729 oil of, 759 symptoms of poisoning from, 728 Aloes, 855 treatment, 728 'Alypin, 861, 864 Acetone, 664 tests for, 864 Acetophenetidln, 834 Amanita muscaria linnaeua, 894 tests for, 834 poisoning from, postmortem ap Acetylene, 382 pearances, 896 tests for, 383 symptoms, 894 toxicity of, In air, 375, 415 treatment, 896 Wlllstatter and Maschmann's Amanita phalloides, 890 test for, 384 poisoning from, postmortem ap Acetylsalicylic acid, 819 pearances, 891 Acids, as corrosives, 2 symptoms, 891 corrosive, 59 Amines, 886 Aconitin, 466 Amifiopyrine, 836 Aconitum, 465 Ammonia biological tests, 467 physic mouses cases, 469 to, 4. chemical tests, 466 tests for, 4uv. dosage, 468 toxicity in air, 375, 415 identification, 466 Ammonium hydroxide, 81 pathology, 467 fatal dose, 82 Acridine, 802 fatal period, 82 Acrolein, 453 pharmaceutic preparations, 82 Acute poisoning, 4 poisoning from, 82 Alcohol, as neurotic poison, 2 amyl, 663 postmortem appearances, 82 symptoms, 82 butyl, 662 treatment, 82 diacetone, 662 properties, 81 ethyl, 632 tests for, 82 methyl, 613 Amyl acetate, 663 Alimentary tract, absorption of Amyl alcohol, 663 poisons in, 6 vapors in air, 665 Alkalis, as corrosives, 2 Amyl nitrite, 734 corrosive, 79 detection, 734 detection, 81 isolation, 734 fatal dose, 80 Anesthesin, 862 fatal period, 80 Aniline, 828 postmortem appearances, 80 Animals, hair of, 970 properties, 79 Anodynes, 14 symptoms, 80 Anthracene purgatives, 855 tests, 81 Antidote, general, 12 treatment, 80 universal, 13 AlkaloidaL poisons, 3, 454 1 Antidotes in treatment of poison examination, for, 30 ing,. 12, .13 Kippenberger's method of ' mechanical. 14 detection, 30 Antimony, 285 . ... ST 0853274 1008 INDEX chloride, 286 detection, 290 fatal dose, 287 fatal period, 287 poisoning from, 287 postmortem appearances, 287 symptoms, 287 treatment, 287 tests for, 288 trichloride, 288 Antipyrine, 83S poisoning by, treatment, 836 symptoms, 835 tests for, 836 Apiol, 846 Apomorphine, 497 Apothecary system, 17 Apothesine,J8fr Argon, 308 Arsenic, 219 as irritant poison, 2 determination, 263 distribution of, in system, 240 eating, 239 fatal dose, 233 fatal period, 234 in beer, 222 in curtains, 224 in drugs, 226 in excretions, 224 in exhumed bodies, 244, 245, 248, 252 in flypaper, 221 in food in hair, 247 -in industry, 220 in Insecticides, 222, 224 in orpiment, 249 in Paris green, 248, 249 in postmortem examinations, 254, 255 in preservatives, 220 in realgar, 249 in Scheele's green, 249 in sheep dip, 221 in urine, 246 in viscera, 242 in wallpaper, 220 medicinal uses, 225 normal, 250 pentoxide, 240 poisoning from, 219, 228 acute, 228 chronic, 236 postmortem analyses, 254, 255 postmortem appearances, 235 subacute, 229 symptoms, 228, 237 treatment, 234, 239 quantitative estimation, 259 solubility, 227 tests for, 253 Bettendorf test, 256 electrolytic methods, 265 Fresenius and von Babo's method, 256 Gosio's arsenic fungus test, 263 Gutzeit test, 263 Lachele's method, 260 Mai and Hurt method, 265 Marsh test. 257 reduction test, 256 Reinsch test, 257 trioxide, 224, 226 Arsenical applications, 239 Arsenical*, organic, 267 estimation, 267 method of Vital!, 267 Reinsch test, 268 Arsine, toxicity in air, 375 poisoning from, 423 postmortem appearances, 427 symptoms, 425 Arsphenamin, distribution of, 274 dose, 274 elimination, 274 fatal dose, 271 neo-arsphenamin, 275 poisoning from, postmortem ap pearances, 275 properties, 270 silver, 277 sodium, 277 symptoms, 272 toxic reactions, 272 toxicity, 271 Asphyxiation, carbon monoxide, 319, 320, 321 Aspirin, 819 Atropine, 472 chemical tests for, 485 deposition in body, 484 fatal dose, 470 fatal period, 482 pharmacology, 474 poisoning by, cases, 479 symptoms, 475 treatment. 482 properties, 473 separation from tissues, 484 sulphate, 479, 481 tests, 482 Autopsy, 48 Bacillus, botulinus, food poisoning from, 884 enteridis, food poisoning from, 880 paratyphosus, food poisoning from, 880 Bacteria, pathogenic, in food, poi soning from, 879 poisonous products of, in food poisoning, 880 1 5T0853275 INDEX 1009 Barbital, 712 fatal dose, 717 fatal period, 718 isolation of, 719 poisoning by, postmortem ap pearances, 718 symptoms, 714 treatment, 714 toxic effects, 718 Barium, 140 carbonate, 140, 143 chloride, 141 in viscera, 142 detection of, 146 fatal dose, 142 fatal period, 144 poisoning from, cases, 144 postmortem appearances, l44-r symptoms, 141 treatment, 141 sulphate, 4, 5, 140 sulphide, 4, 5, 141, 144 tests for, 146 therapeutics, 141 Basophilic stippling, 177 Belladonna, 479, 480 Benzaldehyde, 822 detection, 822 estimation, 823 Benzene (benzol, benzine), 760 isolation of, 780 poisoning by, postmortem ap pearances, 778 symptoms, 761 treatment, 778 toxicity in air, 375, 452 tests for, 780 urine sulphate test, 781 Benzine (benzol, benzene), 760 poisoning from, symptoms, 761 Benzol (benzene, benzine), 760 poisoning from, symptoms, 761 Berberine, 529 isolation from tissues, 530 poisoning from, symptoms, 530 tests for, 529 Betaeucaine hydrochloride, 867 assay, 867 tests for, 867 Bettendorf's test for arsenic, 256 Biologic tests for aconite, 467 physostigmine, 577 strychnine, 593 tellurium, 116 veratrum alkaloids, 603 Bismuth, 284 elimination of, 284 fatal dose, 285 poisoning from, postmortem ap pearances, 284 symptoms, 284 subcarbonate, 284 subnitrate, 284 torts for, 285 Bitter almonds, 757 oil of, 759 Blood, 902 benzidine test for, 918 changes, methyl chloride poison ing, 435 drying of, 907 guaiacum test for, 915 iso-agglutination tests of, 953 of closely related animals, meth ods of differentiation, 951 phenolphthalin test for, 917 actual test and controls, 948 factors interfering with, 950 preparation of material for, 946 production of precipitin serum, 939 tests of precipitin serum, 942 for specificity of precipitin serum, 944 for strength of precipitin serum, 942 protein test for, 919 sodium tungstate test for, 914 spectroscopic test for, 919 tests for, chemical, 912 Teichmann's test, 912 Blood cells, red, influence of dis ease on, 936 size of, 930 Blood-stains, 903 color of, 908 identification of, 910 medicolegal examination of, 924 menstrual, 937 nasal, 937 solubility of, 908 Borax, 89 detection, 90 poisoning from, symptoms, 90 Boric acid, 89 detection, 90 poisoning from, symptoms, 90 Botulism, 884 symptoms, 884 treatment, 885 Bromine, 110 as irritant poison, 2 detection, 111 fatal dose, 110 fatal period, 110 physiological responses to, 452 poisoning from, postmortem ap pearances, 111 symptoms, 110 treatment, 110 Bromism, 111 Bromoform, 691 Brucine, 487 ST 0853276 1010 INDEX chemical testa for, 488 fatal amount, 489 isolation of, 488 symptoms of poisoning from, 488 Butanim, 867 Butesin picrate, 862 Butyl acetate, 664 Butyl alcohol, 662 Butyn, 862 tests for, 863 Cadmium, 129 in zinc ores, 294 poisoning from, postmortem ap pearances, 131 symptoms, 130 tests for, 131 Calomel, 219*s> Camphor, 850 fatal dose, 851 fatal period, 851 isolation of, 851 poisoning from, symptoms, 851 treatment, 851 tests for, 851 Cantharadin, 840 Cantharides, 839 as irritant poison, 2 fatal dose, 839 fatal period, 840 poisoning by, postmortem ap pearances, 840 symptoms, 839 treatment, 840 Carbarsone, 269 Carbolic acid (see Phenol), 809 as neurotic poison, 2 Carbon dioxide, 444 action on body, 445 physiological responses to, 380 poisoning by, postmortem ap pearances, 447 symptoms, 447 treatment. 447 tests for, 447 toxicity in air, 375 Carbon disulphide, 738 toxicity in air, 375, 452 Carbon monoxide, 311 action, 322, 343 an neurotic poison, 2 asphyxiation, 319, 320, 31 calculation, 370 cases, 324 deaths from, 312 experiments in re, 315 motor vehicles in operation, 316 hemoglobin, spectrum of, 922 in atmosphere, 313 in blood, detection, 361 in crank case gas, 317 in exhaust gases, 314 in exhumed bodies, 364 lethal dose, 325 poisoning, chronic, 337 duration, 327 pathology, 353 physiological effects, 346 physiological responses to, 380, 452 postmortem appearances, 351 psychosis following, 376 sequelae of, 375 symptoms, 329 treatment, 348 quantitative estimation, 366 Nicloux's method, 367 Fodor's method, 367 tests for, 358 toxicity in air, 375 Carbon tetrachloride, 693 poisoning by, symptoms, 704 treatment, 704 toxicity of, 375, 694 Cedar, oU of, 848 Cephaeline, 533 Chapins' classification, 3 Chemical analysis for poisons, 16 Chloracetophenone (tear gas), 421 Chloral hydrate, 674 estimation, 678 fatal dose, 676 fatal period, 676 isolation, 676 poisoning from, postmortem ap pearances, 676 symptoms, 675 treatment, 676 tests for, 678 Chlorine, 111 detection, 115 fatal dose, 113 physiological responses to vari ous concentrations of, 121, 452 poisoning from, postmortem ap pearances, 114 symptoms, 113 treatment, 115 tests for, 115 toxicity in air, 375 uses and properties, 112 Chloroform, 679 estimation, 688 fatal dose, 684 fatal period, 685 isolation, 686 physiologic action, 681 poisoning from, postmortem ap pearances, 885 symptoms, 682 treatment, 685 tests for, 687 toxicity in air, 375 ST 0853277 INDEX 1011 Chloroprene, 797 Chromium, 126 detection, 128 fatal dote, 127 fatal period, 127 poisoning from, postmortem ap pearances, 128 symptoms, 127 treatment, 128 tests tor, 128 Chronic poisoning, 4 Cinchona, 584 symptoms of poisoning by, 585 tests for, 585 Circumstantial evidence, 11 Classification, of Chapuis, 3 Clinical signs, lead poisoning, 183 Cinchophen, 724 Coal-tar dyes, 829 Cocaine, 489 fatal dose, 490 fatal period, 491 hydrochloride, 861 in nasal mucous membrane, 5 poisoning by, postmortem ap pearances, 491 symptoms, 489 treatment, 491 separation- of, from animal tis sues, 493 tests for, 491 Codamine, 507, 554 Codeine, 493, 554 fatal dose, 495 treatment, 495 poisoning by, symptoms, 494 separation from tissues, 496 tests for, 495 Colchicine, 509 biologic tests for, 509 chemical tests for, 508 Colchicum, 509 biologic tests for, 509 extraction from tissues, 511 fatal dose, 512 fatal period, 513 poisoning by, postmortem ap pearances, 513 symptoms, 511 treatment, 513 Colocynth, 856 Conhydrine, 515 Coniine, 513 Conium, 513 chemical tests for, 515 fatal dose, 517 poisoning by, postmortem ap pearances, 518 symptoms, 517 treatment, 517 Convulsions, 2 Copper, 280 poisoning from, symptoms, 280 tests for, 281 Corrosion, chief effect of poisons, 2 Corrosive alkalis, 79 Corrosive adds, 89 Corrosive sublimate, 202 Corrosives. 2 Cotton-root berk, 845 Crank case gas, analysis, 317 Creosote, 805 Cresol, 665, 806 Crippen case, 481 Croton oil, 854 as irritant poison, 2 Cryptopine, 554 Cyanides, 740 Cyanamide, 760 Delirium, in poisoning, 2 Destruction of tissues, effect of poisons, 2 Detection, of poisons, 14 Diacetone alcohol, 663 Diacetyl morphine, 498 Diagnosis, of poisoning, 6 Dial, 722 Diamines, 887 Dichlormethane, 451 Dichlorodifluoromethane, 451 Digitalin, 842 Digitalis, 841 fatal dose, 842 physiologic action, 843 Digitonin, 843 Dlgitoxin, 842 Dihydroxybenzenes, 804 Dilaudid, 507 Dimethyl Acetonyl Carbonyl, 736 Dlmethyl-paraphenylendiamine, 736 Dimethyl sulphate, 692 Dinitrobenzene, 826 Dinitrophenol, 831 Dionine, 496 Dioxan, 664 Diseases causing symptoms similar to poisons, 8, 9 Divination, 1 Dust count, 990 Dust, methods of collecting, 994 Elaterin, 857 purgatives, 855 Emetine, 532 hydrochloride, 533 Ephedrine, 876 tests for, 876 Epinephrine, 874 fatal dose, 875 tests for, 875 Ergot, 518 alkaloids of, 519 ST0853278 1012 INDEX chemical teats for, 922 fatal dose, 522 fatal period, 522 poisoning, acute, 520 postmortem appearances, 522 symptoms, 521 treatment, 522 Ergotinine, 519 Ergotoxine, 519 Ethane, 314 Ethanol, 628 Ether, 731 detection of, 733 apparatus for, 733 fatal dose, 732 fatal period, 732 poisoning by, postmortem ap- pearaiwatT733 symptoms, 731 treatment 732 Ethyl alcohol, 632 analysis of distillates, 653 deaths from, 634 fatal cases, 660 fatal dose, 643 fatal period, 644 isolation of, 652 non-fatal cases, 655 normal alcohol, 641 pharmacologic action, 636 poisoning by, acute, symptoms, 642 postmortem appearances, 644 symptoms, 642 treatment, 643 properties, 635 quantitative determination, 647 tests for, 644 tolerance, 640 Ethyl bromide, 735 toxicity in air, 452 Ethyl chloride, 735 toxicity in air, 452 Ethylene, 384 toxicity in air, 375 Ethylene chlorhydrlne, 388, 736 Ethylene dichloride, 386, 736 poisoning from, postmortem ap pearances, 387 symptoms, 386 Ethylene glycol, 736 Ethyl morphine, 496 Ethyl silicate, 991 Evidence, circumstantial, 11 of poisoning, from dead body, 45, 46 Examination, routine methods of, 18 for alkaloidal poisons, 30 for mineral poisons, 21 for volatile poisons, 19, 29 Exhaust gases, 314 poisoning from, 317 Experiments, re carbon monoxide, 316 Fever, metal fume, 301 Fibers, 972 Fish, 1003 Florence test for seminal stains, 900 Fluorides, action on silicon dioxide, 985 Fluorine, 91 content of organs, excretions, etc., 94 detection of, 103 by distillation, 107 elimination of, 99 fatal dose, 100 poisoning from, cases, 100 postmortem appearances, 103 symptoms, 97 treatment, 103 Fluoroscopy, medicolegal relations, 976 Flypapers, arsenic in, 221 Food-borne infections, 878 Food poisoning, 878 symptoms, 884 treatment, 885 Forensic questions, 37 Formaldehyde, 666 estimation, 669 tests for, 668 Formic acid, 729 isolation and detection, 729 tests for, 730 Fresenius and von Babo's method of chemical analysis of poi sons, 22 Fresenius test for arsenic, 256 Furfural, 664 Gamboge, 856 Gas, crank case, analysis, 317 illuminating, 388 mustard, 413 marsh, 379 sewer, 400 Gases, composition of, from man holes, 401 composition from sewage sludge digestion, 402 poisonous and explosive found in manholes, 400 Gaseous poisons, 308 Gasoline, toxicity in air, 452 poisoning from, 611 Gastro-intestinal irritation, effect of poison, 2 Gautier's method of analysis, 25 McNally's modification, 25 Gelsemicine, 526 ST0853279 INDEX 1013 Gelsemidine, 526 Gelseminine, 525 Gelsemium, 523 of, 525 poisoning from, postmortem ap pearances, 527 symptoms, 525, 527 treatment, 527 sempervirine, 525 tests for, 523, 526 toxicity, 523 General considerations, 1 Glass, powdered, death from, 898 chemical examination, 900 fatal dose and period, 899 mode of action, 899 postmortem appearances, 900*^ symptoms, 899 treatment, 900 Glyoxalin, 455 Guaiacum test for blood, 915 Hair (and other fibers), 968 from various parts of body, 969 of animals, 970 Halowax, 1005 Heart, postmortem examination, 52 Helvetia, poisoning from, 897 Hematin, 923 Hematoporphyrin, 923 Hemlock, water, 860 Hemochromogen, 923 Hemoglobin, and decomposition products, 910 Heroin, 498 chemical tests for,*499 fatal dose, 500 isolation from tissues, 501 poisoning by, cases, 500 symptoms, 499 treatment, 500 Homatropine, 474 Homicidal poisoning, 3 Hurt and Mai's electrolyte estima tion of arsenic, 266 Hydrastis, 528 Hydrastinine hydrocloride, 528 tests, 528, 529 Hydrocarbons, saturated, 379 unsaturated, 382 Hydrochloric acid, 69 detection, 74 fatal dose, 72 fatal period, 72 poisoning from, 69 postmortem appearances, 72 symptoms, 70 treatment, 70 properties, 70 tests for, chromium chloride test, 73 silver nitrate test, 73 toxicity in air, 375 Hydrocyanic add, 746 estimation, 759 fatal doee, 749, 752 fatal period, 749 physiologic action, 747 physiologic response to, 452 poisoning, diagnosis, 749 postmortem appearances, 752 symptoms, 748 treatment, 750 tests for, 753 Hydrofluoric add, 95 Hydrogen chloride, physiological responses to, 452 Hydrogen cyanide, 744 Hydrogen sulphide, poisoning from, 390 postmortem appearances, 399 symptoms, 395 tests for, 398 toxic concentrations of, 397 toxicity in air, 375, 415, 452 treatment, 398 Hyoscamine, 473 Hyosdne, 481 Hypertension, not diagnostic in lead poisoning, 162, 170, 184 Idiosyncrasy, to foods, 2 Illuminating gas, 388 poisoning from, symptoms, 390 Impinger, 994 Inorganic poisoning, 59 Inorganic poisons, 3 Iodine, as irritant poison, 2 detection, 109 fatal dose, 108 fatal period, 108 postmortem appearances in poi soning by, 109 symptoms of poisoning, 108 treatment, 109 Iodism, 109 Iodoform, 710 detection, 710 symptoms of poisoning by, 710 Ipecac, 531 estimation of, in tissues, 534 symptoms of poisoning by, 535 tests for, and alkaloids, 533 Ipecacuanha, 530 Iron, 293 fatal dose, 293 normal, 293 poisoning from, postmortem ap pearances, 293 treatment, 293 tests for, 293 Irritant poisons, 2 Iso-agglutination tests for blood, 953 ST0853280 1014 INDEX Isoquinoline, 489 Ivy, poisoning, 897 treatment, 898 Jalapin purgatives, 895 Kerosene, 612 Kippenberger's method of detec tion of alkaloids, 33 Knock-out drops, 674 Krypton, 308 Laudanidine, 507 Laudanine, 506 Laudanosine, 507 Laurel, 861 Lead, 147. absorptfonr!57 acetate, 152 distribution, 159 in urine, 195 in zinc ores, 294 normal, 160, 171, 193 oxides, 152 sulphate, 152 teats for, 191 Lead poisoning, 148 acute, 153 fatal dose, 153 fatal period, 154 postmortem appearances in, 154 symptoms of, 153 treatment, 154 chronic, 149, 154 - blood pressure, in relation to, 162-170 clinical signs, 183 basophilic stippling, 177 diagnosis, 170, 174 factors predisposing to, 151 hypertension in, 162-170 not diagnostic, 184 industrial hygiene, chart, 197 normal lead, 160, 171, 193 postmortem appearances, 188 symptoms, 160, 173, 175 treatment. 186 Liquors, see Ethyl Alcohol Local anesthetics, 881 Lungs, analyses, 987, 988 Magnesium sulphate, 306 poisoning from, postmortem ap pearances, 307 symptoms, 308 Male fern, 851 fatal dose and period, 852 isolation and detection, 852 poisoning from, postmortem ap pearances, 852. treatment, 852 Manganese, 134 poisoning by, postmortem ap pearances, 138 symptoms, 135 treatment, 138 tests for, 139 McNally, method lor determina tion of alkaloidal poisons, 30 -Reinsch tube, 27 Meconine, 486 Mercurous chloride, 219 Mercury, 199 as irritant poison, 2 bichloride, 202 poisoning from, 200 fatal period, 207 fatal dose, 206 postmortem appearances, 210 symptoms, 203 treatment, 207 poisoning from, chronic, 211 diagnosis, 216 industrial, 211 symptoms, 212 properties, 199 tests for, 213 electrolytic method, 215 sublimate test, 213 hydrogen sulphide test, 213 micro-method, 218 Reinsch test, 214 Metallic poisons, 3, 84 in foods, 878 Metal fume fever, 310 Methane, 314, 379 physiological responses to, 380 tests for, 381 Methanol, 628 Methemoglobin, spectrum of, 922 Methods, of Fresenius and von Babo, 22 of Meillers, 25 of Orflla, 25 of Pouchet, 25 Methyl alcohol, 613 action of, 615 detection, 624 fatal dose, 622 fatal period, 622 isolation, 624 poisoning by, 614, 619 postmortem appearances, 623 symptoms, 617 treatment, 622 properties of, 613 quantitative determination, 626 removal of formaldehyde, 627 simultaneous determination of, and ethanol, 628 toxicity, 620 Methyl bromide, 692 I ST085328 INDEX 1019 Methyl chloride, 429 blood change*, 4SS phyaical and chemical proper- tie*, 431 poisoning from, symptoms, 434 treatment, 430 tests for, 438 Metric system, 17 Metycaine, 865 tests for, 865 Mineral poisons, examination for, 21 classification of, 59 Morphine, 554 chemical tests for, 557 chronic poisoning, 569 treatment, 571 deposition in body, 568 extraction and isolation, 565 fatal dose, 573 poisoning by, postmortem ap pearances, 568 symptoms, 556 of acute poisoning, 567 treatment, of acute poisoning, 569 Mushrooms, poisoning by, 890 Mustard gas, 413 poisoning from, pathology, 416 sequels, 418 symptoms, 434 treatment, 436 tests for, 438 toxicity in air, 375, 415 Naphthalene, 801 Naphthol 808 isolation, 809 poisoning from, postmortem ap pearances, 809 treatment, 809 tests, 809 Narceine, 505 Narcotine, 505 Nasal blood-stains, 937 Natural gas, 314 Neo-arsphenamin, 275 delayed symptoms of poisoning, 276 elimination of, 277 fatal dose, 276 poisoning from, postmortem ap pearances, 277 Neo-cinchophen, 724 Neon, 308 Neosalvarsan, 275 Nickel 132 detection, 133 poisoning from, postmortem ap pearances, 133 symptoms, 132 treatment, 133 tests far, 133 Nicotine, 535 chemical tests for, 547 fatal dose, 540 fatal period, 539 poisoning from, postmortem ap- peeranees, 547 symptoms, 587 trseenant, 541 separation from tissues, 550 statistics, 541 Nitric add, 66 detection, 68 fatal dose, 67 fatal period, 67 physiological responses to vari ous concentrations of, 410 poisoning by, postmortem ap pearances, 67 symptoms, 66 properties of, 66 tests for, 67 Nitric oxide, 412 Nitrobenzene, 823 isolation, 822 poisoning from, postmortem ap pearances, 825 symptoms, 823 treatment, 825 tests for, 825 Nitrogen, 380, 403 in natural gas, 314 Nitrogen dioxide, 405 physiological responses to, 410, 411 poisoning from, postmortem ap pearances, 408 treatment, 409 Nitroglycerine, 737 fatal dose and period, 737 isolation of, 738 poisoning from, postmortem ap pearances, 738 symptoms, 737 treatment, 737 tests for, 738 Nitrous oxide, 311, 403 fumes, toxicity in air, 375 poisoning from, symptoms of, 404 Nupercaine, 868 Nutmeg, 846 Nux vomica, 588 Oil croton, 854 of bitter almonds, 759 of cedar, 848 poisoning by, postmortem ap pearances in, 849 of pennyroyal 846 of savin, 847 of turpentine, 847 t ,4 ST0853282 1016 INDEX OU, purgative, 854 Oleander, 845 Opium, 551 aa neurotic poison, 2 alkaloids of, 552 chemical tests for, 557 poisoning by, symptoms, 556 Oral administration, of poisons, 6 Organic acids, of fatty acid series, 727 arsenical*, 287 poisons, food poisoning from, 878 Orpiment, 249 Orthoform, 864 tests for, 864 Oxalic add, 74 detection,. 76k.>fatal dose, 76 fatal period, 77 poisoning from, 74 postmortem appearances, 77 symptoms, 76 treatment, 77 properties, 76 teats for, 77 Oxygen, 308 physiological responses to, 380 Oxyhemoglobin, spectrum of, 921 Ozone, 308 Pantocaine, 870 Papaverine, 502 action, 504 preparations of, 504 tests for, 504 Paraldehyde, 671 fatal dose, 671 poisoning from, postmortem ap pearances, 672 symptoms, 671 treatment, 672 Paris green, 248, 249 Pathogenic bacteria in food, poi soning from, 879 Pennyroyal, oil of, 846 Pericardium, postmortem examina tion of, 51 Peronine, 497 Peroxide, 405 Petrol, toxicity in air, 375 Petroleum distillates, 610 symptoms of poisoning fr&m, 611 Phalloides, 890 Phenacaine, 865 tests for, 865 Phenobarbital, 721 fatal dose, 811 fatal period, 811 isolation of, 812 poisoning by, postmortem ap pearances, 812 symptoms, 810 tests for, 813 Phenol, 809 Phenolphthalin test for blood, 91T Phenylhydrazine, 785 Phosgene, 418 physiological responses to, 420 poisoning from, postmortem ap pearances, 419 treatment, 419 tests for, 420 toxidty in air, 375, 415, 452 Phosphorus, 84 detection of, 86 distillation of, 21 fatal dose, 85 fatal period, 85 poisoning from, postmortem ap pearances, 86 treatment, 86 properties, 84 quantitative estimation, 88 red, 84 tests for, 86 Physostigmine, 574 chemical tests, 577 biological tests, 577 poisoning from, postmortem ap pearances, 576 fatal quantity, 576 isolation from tissues, 578 salicylate, 574 Picric acid, 821 fatal dose, 821 isolation, 822 poisoning by, postmortem, 821 treatment, 821 tests for, 822 Picrotoxin, 858 fatal dose, 859 fatal period, 859 isolation of, 859 poisoning by, postmortem ap pearances, 859 symptoms, 859 tests for, 859 Pilocarpus, 578 isolation from tissues, 579 poisoning by, symptoms, 579 treatment, 580 Piperidine, 455, 513 Podophyllum, 857 Poison, definition, 1 Poisons, alkaloidal, 30 mineral, 21 volatile, 29 Poisoning, in connection with acetaldehyde, 672 acetanilid, 830 acetic acid, 727 acetone, 664 acetophenetidin, 834 acetylene, 382 ST0853283 INDEX t 1017 Poisoning, in connection with acetylsalicylic add, 819 aconitum, 466 acridine, 802 acrolein, 493 alcohol, amyl, 663 butyl, 662 methyl, 613 diacetone, 662 ethyl, 632 alkalis, corrosive, 79 almonds, bitter, oil of, 759 aloes, 855 alypin, 861 amanita, muscaria linnaeus, 894 phalloides, 890 . amines, 886 ' aminopyrine, 836 ammonia, 449 ammonium hydroxide, 81 amylacetate, 663 amyl nitrite, 734 anestbeisin, 862 aniline, 828 anthracene purgatives, 855 antimony, 285 antipyrin, 835 apoil, 846 apomorphine, 497 apothesine, 861 arsenic, 219 arsine, 375 arsphenamin, 274 aspirin, 819 atropine, 472 bacillus, botulinus, 884 enteridis. 880 bacteria, 879 barbital, 712 barium,. 140 belladonna, 479 benzaldehyde, 822 benzene (benzol, benzine), 760 berberine, 529 betaeucaine hydrochloride, 867 bismuth, 284 bitter almonds, 757 oil of, 759 borax, 89 boric acid, 89 botulism, 884 bromine, 110 bromoform, 691 brucine, 487 butamin, 867 butesin pictrate, 862 butyl acetate, 664 butyl alcohol, 662 butyn, 862 cadmium, 129 calomen, 219 camphor, 850 cantharides, 839 cantharidin, 840 carbarsone, 269 carbolic add, 809 carbon dioxide, 444 carbon disulphide, 736 carbon monoxide, 311 carbon tetrachloride, 693 cedar, oil of, 848 cephaeline, 533 cbloracetophenone, 421 chloral hydrate, 674 chlorine. 111 chloroform, 679 chloroprene, 797 chromium, 126 cinchona, 584 cinchophen, 724 coal tar dyes, 829 cocaine, 489 codamine, 507 codeine, 493 colchicine, 508 colchicum, 508 colocynth, 856 conhydrine, 515 coniine, 513 conium, 513 copper, 280 corrosive acids, 59 corrosive alkalis, 79 corrosive sublimate, 202 cotton-root bark, 845 creosote, 805 cresol, 665, 806 croton oil, 854 cyanides, 740 cyanamide, 760 diacetone alcohol, 662 diacetyl morphine, 498 diamines, 887 dichlormethane, 451 dichlorodifluoromethane, 451 digitalin, 842 digitalis, 841 digitonin, 843 digitoxin, 842 dihydroxybenzenes, 804 dilaudid, 507 dimethyl acetonyl carbonyl, 736 dimethyl-paraphenylendiamine, 736 dimethyl sulphate, 692 dinitrobenzene, 826 dinitrophenol, 831 dionine, 496 dioxan, 664 elaterin, 857 emetine, 532 ephedrine, 876 epinephrine, 874 ergot, 518 ST 0853284 1018 INDEX Poisoning, in connection with ergotiniine, S19 ergctoxine, 519 ethanol, 628 ethane, 314 ether, 731 ethyl alcohol, 632 ethyl bromide, 725 ethyl chloride, 735 ethylene, 384 ethylene chlorhydrine, 388 ethylene glycol, 736 ethylene dichloride, 386, 736 ethyl morphine, 496 ethyl silicate, 991 exhaust gases, 314 fish, 10O-> fluorine, 91 f&ud-borne infections, 878 formaldehyde, 666 formic add, 729 furfural, 664 gambage, 856 gas, illuminating, 388 mustard, 413 marsh, 379 sewer, 400 gaseous poisons, gasoline, 611 gelsemldne, 526 gelsemidine, 526 gelseminine, 525 gelsemium, 523 alkaloids, 523 glyoxalin, 455 halowax, 1005 helvella, 897 hemlock, water, 860 heroin, 498 homatropine, 474 hydrastinine hydrochloride, 528 hydrocarbons, saturated, 379 unsaturated, 382 hydrochloric acid, 69 hydrocyanic add, 746 hydrofluoric add, 95 hydrogen chloride, 452 hydrogen cyanide, 744 hydrogen sulphide, 390 hyoscamine, 473 hyoscine, 481 . , illuminating gas, 388 iodine, 108 iodoform, 710 ipecac, 531 iron, 293 isoquinoline, 455 ivy, 857 jalapin purgatives, 855 kerosene, 612 laudinidine, 507 laudanine, 506 laudanostne, 507 laurel, 861 lead, 147 local anesthetics, 861 magnesium sulphate, 306 male fern, 851 manganese, 134 meconine, 488 mercurous chloride, 219 mercury, 199 methane, 314, 379 methanol, 628 methyl alcohol, 613 methyl bromide, 692 methyl chloride, 429 metycaine, 865 morphine, 554 mushrooms, 890 mustard gas, 413 naphthalene, 801 naphthol, 808 narceine, 505 narcotine, 505 natural gas, 314 neo-arsphenamin, 275 neo-cinchophen, 724 neosalvarsan, 275 nickel, 132 nicotine, 535 nitric acid. 66 nitric oxide, 412 nitrobenzene, 823 nitrogen dioxide, 405 nitroglycerine, 737 nitrous oxide, 311, 403 nupercaine, 868 nutmeg, 846 nux vomica, 588 oil, croton, 854 of bitter almonds, 7.59 of cedar, 848 of pennyroyal, 846 of savin, 847 of turpentine, 847 oils, purgative, 854 oleander, 845 opium, 551 alkaloids of, 553 organic acids, 727 organic arsenicals, 727 orthoform, 864 oxalic acid, 74 pantocaine, 870 papaverine, 502 paraldehyde, 671 Paris green, 248 pennyroyal, oil of, 846 peronine, 497 peroxide, 405 petrol, 375 petroleum distillates, 610 phalloides, 890 ST0853285 Poisoning, in connection with phenacaine, 865 phenobarbital, 721 phenol, 809 phenylhydrazine, 785 phosgene, 418 phosphorus, 84 physostigmlne, 574 picric add, 821 picrotoxin, 858 pilocarpus, 578 piperidine, 455, 513 podophyllum, 857 potash, caustic, 79 potassium chlorate, 88 potassium permanganate, 89 procaine borate, 865 procaine nitrate, 865 procaine hydrochloride, 868 prussic add. 375 pseudoconhydrine, 515 pseudomorphine, 502 psychotrine, 533 purgative oils, 854 j>urgatives, anthracene, 855 Jalapin and elaterin, 855 pyridine, 455, 513 pyrogallol, 805 quinine, 580 alkaloids of, 583 quinoline, 455 refrigerants, 428 richweed, 806 salicylic acid. 817 salvarson, 270 . santonin, 85" saturated hydrocarbons, 379 savin, oil of, 847 Scheele's green, 249 scoparius, 587 scopolamine. 472 scopoletine, 526 scorpion bites, 1002 sempervirine. 525 sewer gas, 400 silver, 124 sheep dip, 221 silver arsphenamin, 277 snake root, 606 snake venoms, 1001 soda, caustic, 79 sodium arsphenamin, 277 sodium cyanide, 740 sodium fluoride, 1001 sodium fluorosillcate, 97 sparteine, 587 strophanthus. 844 strychnine, 588 sulphanilamide, 606 sulpharsphenamin, 278 sulphonmethane, 711 sulphur dioxide, 439 sulphur monochloride, 736 sulphuric add, 60 sumac, 857 tansy, 845 tartar emetic, 286 tartaric add, 730 tear gas, 421 tellurium, 115 tetrachlorethane, 707 tetraethyl lead, 797 tetronal, 712 thallium, 116 thorium, 307 thymol, 807 tin, 290 tobacco, 536 toluylendiamine, 736 tremetol, 609 trichlorethylene, 786 trlnitrophenol, 821 trinitrotoluene, 826 trional, 712 triortho-cresyl phosphate, 665 tritopine, 507 tryparsamide, 269 turpentine, oil of, 847 tutocaine, 867 tyramine, 520 unsaturated hydrocarbons, 382 vanadium, 125 vegetable purgatives, 854 venoms, snake, 1001 veratrum, 602 wood alcohol, 614 yohimbine, 604 zinc, 294 Postmortem, appearances, 45 and see substance, and poison ing, conduct of, 48 data, 48 internal, 50 of abdomen, 55 of adrenals, 57 of brain, 58 of chest, 51 of cranial cavity, 57 of gall-bladder, 56 of heart, 51 of intestines, 56 of kidneys, 56, 57 of lungs, 51 of neck, 55 of pelvic viscera, 50 of pericardium, 51 of stomach, 55 of surroundings of body, 47 of thorax, 55 of unknown bodies, 50 of urinary bladder, 57 records of, 49 Postmortems, arsenic cases, 254. ST0853286 1020 INDEX Potaxh, cauatic, 79 Potaaaium chlorate, 88 Potassium permanganate, 89 Powder-stains, teat for, 413 Powdered glass, death from, 898 chemical examination, 900 fatal dose and period, 899 mode of action, 899 postmortem appearances, 900 symptoms, 899 treatment, 900 Precipitin, test for blood, 938 Procaine borate, 865 Procaine nitrate, 865 Procaine hydrochloride, 868 tests for, 868 Prognosis, of *gisoning, 11 Prussic add, toxidty in air, 375 Pseudoconhydrine, 515 Pseudomorphine, 502 Psychosis, following carbon mon oxide poisoning, 376 Psychotrine, 538 Ptomaines, separation of, 34 Purgative oils, 854 Purgatives, anthracene, 855 jalapin and elaterin, 855 Pyridine, 455, 513 Pyrogallol, 805 Pyrrol, 455 Quinine, 580 alkaloids of, 583 Quinoline, 455 Radium, medicolegal relations, 998 Rate, of absorption of poisons, 4 Realgar, 249 Refrigerants, 428 acrolein, 453 ammonia, 449 carbon dioxide, 444 dichlormethane, 451 dichlorodifluoromethane, 451 methal chloride, 429 sulphur dioxide, 439 Reinsch test, 26 for arsenic, 257 for mercury, 214 tube, McNally, 27 Respiration, 308 Respiratory tract, absorption of poisons by, 5 Rlchweed, 606 Roentgen rays, see X-Rays Salicylic acid, 817 estimation, 818 fatal dose, 818 isolation, 818 poisoning from, postmortem ap pearances, 818 tests for, 818 Salvarsan, 270 Santonin, 852 fatal dose, 853 fatal period, 853 isolation of, 853 poisoning from, treatment, 853 tests for, 853 Saturated hydrocarbons, 379 Savin, oil of, 847 Scheele's green, 249 Scoparius, 587 isolation from tissues, 588 poisoning from symptoms, 588 Scopolamine, 473 poisoning by, cases, 477 properties, 473 Scopoletine, 526 Scorpion bites, 1002 Seminal stains, medicolegal ex amination, 960 Sempervirine, 525 Sequelae, of carbon monoxide poi soning, 375 onset of, 376 Sewer gas. 400 composition, 402 Sheep dip, arsenic in, 221 Silicon dioxide, determination of, 992 Silicosis, 984 definitions, 984 diagnosis. 985 stages, 986 prognosis. 987 Silicotic nodule, 989 Silver, 124 arsphenamin. 277 fatal dose, 125 fatal period, 125 poisoning from, 125 postmortem appearances, 125 symptoms, 125 treatment, 125 tests for, 125 Smoke, composition of, 343 Snake root, 606 Snake venoms, 1001 treatment, 1001 Soda, caustic, 79 Sodium arsphenamin, 277 Sodium cyanide, 740 Sodium fluoride. 101 Sodium fluorosilicate, 97 Sparteine, 587 Spectrographic, analysis, 982 Spectroscopic, examination for car bon monoxide in blood, 361 test for blood, 919 Spermatozoa, detection of, 963 measurements, 966 on cloth, 966 ST0853287 INDEX 1021 tains, blood, see Blood-stains tramonium, 479 trophanthus, 844 tests for, 844 trychnine, S88 as neurotic poison, 2 biologic tests for, 893 chemical tests for, 590 deposition of, in body, .600 detection of in body, after pro longed periods, or burning, 601 failure to detect, 601 fatal dose, 595r fatal period, 595 nitrate, 589 poisoning by, cases, 598 postmortem appearances, 598 symptoms, 594 treatment, 595 separation from tissues, 599 sulphate, 589 Subacute poisoning, 4 Sulphanilamide. 606 toxic effects, 607 Sulpharsphenamin, 278 determination of, 278 estimation, 279 Sulphonmethane, 71J fatal dose, 711 fatal period, 712 isolation of, 712 poisoning by, symptoms, 711 Sulphur dioxide, 439 physiological responses to, 440 poisoning from, postmortem ap pearances. 443 symptoms, 441 treatment, 443 tests for, 443 toxicity of, in air, 375 Sulphur monochloride, 736 Sulphuric acid, 60 detection, 65 fatal dose, 62 fatal period, 62 poisoning from, postmortem ap pearances, 63 symptoms, 61 treatment, 82 properties of, 61 tests for, 64 treatment of, 858 Sumac poisoning, 857 Symptoms, poisoning and dis eases, 9 Tansy, 845 Tartar, emetic, 286 Tartaric acid, 730 Taste of strychnine, 590 Tear gas, 421 Tellurium, 115 detection, 116 poisoning from, postmortem ap pearances, 116 symptoms, 115 treatment, 115 Tests, for powder stains, 413 Tetrachlorethane, 707 poisoning from, postmortem ap pearances, 709 symptoms, 708 treatment, 709 Tetraethyl lead, 797 poisoning from, postmortem ap pearances, 800 symptoms, 799 treatment, 801 tests for, 800 Tetronal, 712 Thallium, 116 poisoning from, postmortem ap pearances, 123 symptoms, 119 treatment, 122 properties and uses, 116, 119 tests, 124 Thorium, 307 poisoning from, postmortem ap pearances, 307 poisoning from, symptoms, 291 symptoms, 307 Thymol, 807 Tin, 290 treatment, 291 quantitative estimation, 291 tests for, 291 T.N.T., see Trinitrotoluene Tobacco, 539. See also Nicotine Toluylendiamine, 736 Toxicology, definitions, 1 Treatment, of poisoning, 11 Trembles, 605 Tremetol, 605 Trichlorethylene, 786 fatal dose, 794 poisoning from, postmortem ap pearances, 795 treatment, 796 tests for, 796 Trinitrophenol, 821 Trinitrotoluene, 826 detection, 827 poisoning by, symptoms, 827 treatment, 827 Trional, 712 Triortho-cresyl phosphate, 665 Tritopine, 507 Tropine, 474 Tryparsamide, 269 Turpentine, oil of, 847 Tutocaine, 867 tests for, 867 ST0853288 1022 INDEX Tyraxnine, 520 Unsaturated hydrocarbons, 382 Urine, changes, in poisoning, 8 method of analysis of specimens, 782 sulphate test as measure of ben zene exposure, 781 Vanadium, 128 Vegetable purgatives, 854 Venoms, snake, 1001 Veratrum, 802 chemical tests for, 602 fatal quantity, 604 poisoning from, postmortem ap pearances, 604 symptoms, 60S treatment, 604 separation of from tissues, 603 Volatile poisons, 3 examination for, 19, 29 Volatiles, distillates, and solvents, 610 Vomiting, in poisoning, 2 Wallpaper, arsenic in, 220 War gases, 413, 418, 421 Water hemlock, 860 White snake root, 606 Wood alcohol, 614 Wool, 972 Xenon, 308 X-rays, medicolegal aspects, 974 Yohimbine, 604 Zinc, 294 distribution, 296 industrial zinc poisoning. 294 299 elimination, 296 normal, 295 chloride, 297 fatal dose, 298 fatal period, stearate, 295 sulphate, 297 poisoning from, postmortem ap pearances, 299 symptoms, 297 treatment, 299 in urine, 300 metal fume fever, 301 tests for, 301 titration method, 303 turbidity method, 303 micro-method, 304 toxicity, 300