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ST085334I POISONING PLAINTIFF'S EXHIBIT DOW-1656 A GUIDE TO CLINICAL DIAGNOSIS AND TREATMENT by W. F. von OETTINGEN, M.D., PhD. National Institutes of Health U.S. Public Health Service Federal Security Agency Bethesda, Md. PAUL B. HOEBJSR, INC. medical book department OF HARPER Ic brothers ST08533U2 POISONING Copyright, 195*, by Paul fi. Hoeber, Inc Medical Book Department of Harper k Brothers Printed in the United States of America A-D Reprinted with corrections 1954 All rights reserved. For information address Paul B. Hoeber, Inc., Medical Book Department of Harper & Brothers, 49 East 33rd Street, New York 16. Library of Congress catalog card number: 52-8491 ST0853343 Dedicated to the many physicians whose observations and reports have enriched our knowledge of poisonings. ST 085334U CONTENTS PREFACE PART ONE: INTRODUCTION 1. Classification and Diagnosis of Poisoning 2. Medico-Legal Responsibilities 3. Emergency Measures and Equipment ix i 3 6 11 PART TWO: DIAGNOSIS 4. Taking the Patient's History 5. Structural and Functional Pathology Changes noticeable upon inspection The respiratory apparatus The circulatory apparatus The gastrointestinal tract Glandular structures of the digestive and urinary tracts Glands of internal secretion The nervous system and sense organs The blood and blood-forming apparatus 6. Biochemical Changes The blood The urine 7. Laboratory Tests 15 17 22 23 46 65 75 96 106 109 154 161 161 168 178 PART THREE: MANAGEMENT* 8. The Rationale of Treatment 9. Removal of the Toxic Agent 10. Elimination of the Toxic Agent vii 209 211 213 219 ST 0853345 riii CONTENTS ii. Detoxification of the Absorbed Poison 222 is. Symptomatic Treatment 223 13. General Measures; Treatment of After-Effects 235 PART FOUR: SYMPTOMS AND TREATMENT OF 461 TYPES OF POISONING INDEX *37 59 *. ST0853346 PREFACE While death is the most dramatic manifestation of poisoning, subacute and chronic poisonings are far more common and often offer serious problems for diagnosis, which in turn determines the treatment of the patient and the prognosis of his condition. The incidence of poisoning, both acute and chronic, is constantly in creasing as new chemicals for'the most diversified purposes are placed on the market and are used in homes and industry. There are also many plant poisons which are of concern in rural districts, and finally there are many drugs on the market which may produce side reactions of varying severity. There are literally hundreds of substances in use or to which one may be exposed today which may give rise to poisoning. Some of these toxic syndromes closely simulate infectious or functional diseases, and it is therefore of paramount importance that they be recognized. It is the purpose of this book to organize today's knowledge of the sub ject in a fashion which will most readily aid the general practitioner and the internist in diagnosis and treatment of poisoning. It is earnestly hoped that the material has been so arranged that it will save time for the busy physician in tracking down the toxic agent and instituting ef fective treatment when poisoning is suspected. The book is divided into four parts. The first discusses the classification of poisons, the medico-legal aspects and responsibilities of the physician and the emergency measures and equipment necessary for the treatment of poisoning. Part two takes up the clinical diagnosis of poisoning. Here it is shown how diagnosis is based on the patient's history and the structural and functional pathology observed in the course of a medical examination. The signs and symptoms are classified by body systems for ease of refer ence, and are discussed one by one ay they present themselves in the course of a clinical examination. Under each is an alphabetical list of toxicants which may be responsible for such a change. The physician will first turn to this section when confronted with suspected poisoning, find- IX * l ST0853347 PREFACE ing under the symptoms he has observed a list of toxic substances which may give rise to them. In this section of the book there are also chapters on blood and urine changes in poisoning and on laboratory tests which are within the com pass of the private practitioner or small hospital facilities. In part three each step in the management of poisoning is taken up separately. Emphasis is placed on the technics available for removal of toxic agents and on the symptomatic treatment which must often be em ployed at the same time or even preceding removal of the poison. The final and largest section of the book is an alphabetical listing of 461 poisons. Under each poison is a short synopsis of the clinical picture and the treatment required. This arrangement is made with an eye to convenient reference by the practitioner. The section is based on the analysis of several thousand case reports. The book aims to supply in a single source the information needed by the clinician for the accurate detection and successful treatment of poison ing. Therefore, it does not cover the mechanism of action of various poisons, nor does it cover the animal experimental studies which were undertaken to study those mechanisms. For more detailed study of toxic agents the reader is referred to the various review articles mentioned in the text and to the larger text books of pharmacology. If this book helps the harried practitioner to detect poisonings more quickly and to take effective measures it will have achieved the author's aim. The author is indebted to Mrs. Florence B. Hall and Mr. A. F. Collins and other members of the staff of the library of the National Institutes of Health for their untiring help in furnishing the many journals and texts required for the preparation of this book. Finally thanks should be given to the publisher for encouraging the writing of this book. Bethesda, Md. W. F. von Oettincen i; I: i I ST 0853348 PART ONE INTRODUCTION ST0853349 1. Glassification and Diagnosis of Poisoning The correct diagnosis of poisonings or of toxic conditions has become increasingly more important. It is not only essential for the prompt and effective treatment of the patient, but in addition it may have other farreaching consequences. It may be of forensic importance and lead to the detection of a crime, or it may be instrumental in improving inadequate sanitary conditions and thus prevent later cases of a similar nature. The prompt recognition of a toxic condition which is due to the occupational environment may be of considerable economic importance for the patient in that in these cases the treatment of his illness and the resulting loss of gainful activity may be paid for through compensation by state and private insurance agencies. The number of toxic substances to which modem man may be exposed is constantly increasing. The importance of some poisons as causative agents for suicide and for accidental poisonings has varied, especially as new chemicals have become readily available, while others like carbon monoxide and certain plant poisons have caused havoc for thousands of years. At one time poisonous antiseptics, such as phenol and lysol, were the prevalent cause of poisonings. With the introduction of essence of vinegar for domestic use this has caused numerous fatal and nonfatal accidents. With the advent of illuminating gas and more recently with the widespread use of the automobile, carbon monoxide poisoning has become much more prevalent than in the past. The unrestricted sale of sedatives and soporifics such as the barbiturates has caused an appalling number of fatalities from the intentional or accidental ingestion of these drugs. Similarly industrial poisons have varied considerably in their importance as causative agents. Sometimes their dangers are recognized and controlled in certain trades and operations, but they may be used in new processes under different conditions where their danger is not so apparent or even not suspected. The same holds true for toxic substances sold for domestic use such as solvents, spot removers, insecticides, de- 3 PI ST0853350 4 POISONING odorants, and antiseptics. It is therefore apparent that the physician may be confronted with a great variety of toxic agents. Very often the medical examiner is unaware that a poisoning is the underlying cause for the condition of his patient and even more frequently he is not familiar with the toxic agent and its toxicologic properties. The clinical picture of parkinsonism may be the outcome of chronic manga nese poisoning or of exposure of carbon disulfide. A Korsakow syndrome may be due to alcoholism, but may also be the consequence of carbon monoxide poisoning. Hepatitis may be of infective character or it may result from exposure to hepatotoxic agents such as carbon tetrachloride. On the other hand, the physician should not be misled in his diagnosis by impressive and widely publicized reports on the toxidty of certain chemicals. For it is just as dangerous to interpret erroneously a clinical picture as the result of exposure to certain compounds. For instance DDT, which* has been publicized as being responsible for a great variety of pathologic conditions, has in most instances actually no relation to the condition of the patient. It is obvious that such mistakes may have farreaching consequences in that the true cause may require a different therapeutic approach. It has been customary to classify toxic substances according to their most characteristic action, such as nerve, liver, or blood poisons. Such arrangement may have certain advantages in that it affiliates specific toxic substances with specific pathologic conditions. But on the other hand, there is no poison which affects one organ only. Sooner or later, primarily or secondarily, other organs will be affected and in some instances these injuries may predominate, so that a liver poison like carbon tetrachloride may cause an obvious injury of the kidney or may be responsible for disfunctioning of the heart muscle. In other instances the sequelae of acute exposure may refer to one organ, and those of continued exposure to another. The inhalation of high concentrations of benzene vapors results predominantly in disturbances of the central nervous system causing headache, inebriation, somnolence, loss of con sciousness, and occasionally convulsions. Chronic exposure to the same agent will cause a more or less severe injury of the blood-forming organs and will lead to leukopenia and anemia. It is therefore obvious that such classification is not strictly justified. Others have arranged toxic substances according to their chemical characteristics such as aliphatic and aromatic hydrocarbons, chlorinated hydrocarbons, alcohols, phenols, alkaloids, glucosides, etc. Such classifica tion may enhance the understanding of the mechanism of their action and may allow the appraisal of the toxicity of chemicals with known chemical structure. However, it does not lend itself for the clinical CLASSIFICATION AND DIAGNOSIS ST085335 U diagnosis of poisonings unless one is familiar with the toxic phenomena of a great many different toxic substances. It appears impossible that a physician can keep in mind all signs and symptoms of toxic substances. For this reason in the following pages an attempt is made to give a pathologic physiology of poisonings by describing the observable path ologic changes in different organs and organ functions as produced by various poisons. A similar approach has been successfully used by H. H. Meyer and R. Gottlieb in their Experimentelle Pharmakologie and by L. Krehl in his Pathologische Physiologie. It is hoped that the comparison of abnormal findings as they present themselves in the course of a systematic clinical examination of a patient, and their classification by toxic causative agent or group of agents, will allow the elaboration of the toxicologic picture and thus lead to the diagnosis of the poisoning in question. In accordance with this plah the actions of toxic agents are discussed with reference to their effect on organs and organ functions which are noticeable upon inspection, or which refer to the respiratory apparatus, the circulatory system, the gastrointestinal tract, its glandular structures, the urinary apparatus, glands of internal secretion, the central and pe ripheral nervous system, the sensory functions, and the blood-forming organs. This is followed by a discussion of changes in the blood chemistry and in the composition of the urine as produced by various poisons, and by a number of tests for the detection of toxic substances or their me tabolites in blood and urine. In the last part a short synopsis of the clinical pictures of various poisonings is given, in order to summarize the various organ findings. In these descriptions the symptomatology is discussed somewhat summarily because the signs and symptoms produced by certain organ changes may vary in their frequency and intensity from case to case. It is felt that too detailed a description would run the danger of becoming a case history, and that a broader picture would emphasize certain definite characteristics whereas details may vary from case to case. Similarly the management of poisonings is discussed from the point of view of organ functions rather than of individual poisons. In those instances where specific measures have been found of value they are discussed in the last part under the particular poison. It is hoped that such an approach will facilitate the diagnosis of poisonings and allow an effective treatment even in those cases where the underlying cause has not been established. ST 0853352 2. Medico-Legal Responsibilities As in any disease, it is the duty of a physician attending a case of poisoning to save the life of the patient, to make him comfortable, and to protect-tiim against further injury. Beyond this he has additional responsibilities. In certain cases the poisoning may indicate a danger to the general public, as in the con tamination of drinking water or the pollution of the air by toxic gases or fumes. In such instances the public health authorities have to be notified at once so that steps may be taken to remedy the situation and to prevent further accidents. The occurrence of other poisonings, such as cadmium poisoning, may point to the appearance of cooking utensils and other food containers on the market which are plated with cadmium and it is obvious that the public should be warned against their use. The poison ing may result from the ingestion of food or food products contaminated with toxic materials used as preservatives, food dyes, and other agents added to make the food more appealing. Poisonings may result from the domestic use of insecticidal mixtures, dry cleaning agents, floor waxes, and similar materials which contain toxic substances. In all such cases it becomes the duty of the physician to notify the proper authorities so that appropriate action may be taken. Similarly poisonings of an occupational character have to be reported in order to avoid accidents of similar nature and to secure for the patient the benefits provided by law. The laws and regulations regarding the reporting of occupational poisonings and diseases vary with different states of the Union. The most recent compilation on this subject is that of V. M. Trasko (Industrial Health Regulations: A compilation of state laws and regulations. Division of Industrial Hygiene, Federal Security Agency, Public Health Service, Washington, D. C., July, 1950). According to this source industrial dis eases including poisonings are reportable in 28 states as listed in Table 1. It will be noted that these have to be reported to different agencies in 6 MEDICO-LEGAL RESPONSIBILITIES ST0853353 7 different states. It is, therefore, advisable to familiarize oneself with the local state laws and regulations regarding this question. Table i. STATE AGENCIES TO WHICH OCCUPATIONAL POISONINGS SHOULD BE REPORTED Slat* Aftncy Rmarkt Alabama Arkansas California Colorado Connecticut Georgia Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana New Hampshire New Jersey New Mexico New York Ohio Pennsylvania. Rhode Island South Carolina Washington Wisconsin State board of health State health officer Division of labor statistics within 7 days Local health officer immediately State department of health within 46 hours State board of health Department of health State board of health Board of health Department of health Bureau of health within to days State board of health Labor department State department of health Industrial commission State board of health, div. of industrial hygiene State board of health within 24 hours State board of health, div. of industrial hygiene State ooard of health State department of health, and department of labor within 48 hours (lead) Bureau of public health Commissioner, dept, of labor Commissioner of health and industrial commission Locstl health officer or State department of health Dept, of public health State board of health Department of health Industrial commission Some states publish lists of those occupational poisonings which have to be reported by the examining physician and may add to and change such lists as the necessity arises. Table 2 is compiled from the publication of W. Fowler (The Reportable Diseases. Pub. Health Rep. 59:317, 1944) and shows which occupational poisonings were reportable in certain states at that time. It should be pointedout that in some states the term "benzene poisoning" may also cover poisonings by nitro, hydroxy, and amino derivatives of benzene, and that in addition to poisonings from carbon tetrachloride, those by other organic halides or solvents are reportable in others. 8 S T 0 853354 POISONING uiruo3t}M uofhtnftVjft tnttjojDQ tpnog pmpjtptyy muoaj&mtj + +++ + + + + +++ + + + + + + ++ ++ ++ ++ + + + ++ + ++ rvo ++ + + + + ++ COfl HX <TMAf g 2 anxtyf aujf VCOJ mm 2 + ++++ + + + ++ + ++ ++++ + tjpfxjuwH wy $ 0 5 LOWXXt^Y a. u DJQffVVIjy u 0 puvj&vfy whJ 5 xutvjy H Pm 0 ft. - rvxuDjf + ++ + + + + ++ + + + +++ ++ + + + + + ++ ++ ++ ++ ++ ++ + +++ +++ + ++ w 3 vmoj + 4- + + + ++++ + + + t<A. H putpneuQQ + ++ opviojoj Dwvqvjy + ++++ ++ + ++ ++ + +++ ++ a? t a medico-legal responsibilities ST0853355 9 ++ + + + 4- 4- + + + +++ + + + + ++ + ++ ++ + ++ + + + + ++ + ++ ++ + .+ 4- 4- + ++ + ++ + + + 4* 4- ++ + 4- 4- 4- +++ +++ 4-4- + + + + ++ + + 4- ++ + ++ 4-4-4-4- 4-4- + ++ + ++ + ++ ++ + + 4-4-4+ 10 ST 0853356 POISONING Other states, as, for instance, Massachusetts, may require every physician treating a patient whom he believes to be suffering from an ailment or disease contracted as a result of the nature, circumstances, or conditions of the patient's employment, to report such information. The department may issue a list of such diseases which shall be regularly reported on by physicians and may also add to and change such lists at any time. Some states require the reporting of all cases of dermatitis from occu pational exposure and others that of certain diseases connected with certain trades. So, for instance, Kentucky requires physicians to report petroleum workers' diseases, such as respiratory, gastrointestinal, nerve, and eye disorders. South Carolina requires reporting of poisonings from refrigerants such as methyl chloride, ethyl chloride, dichloroethylene, methyl bromide, ethyl bromide, methylene chloride, methylformate, dichlorodifluoromethane, dichloroethane, and sulfur dioxide. Poisonings of suicidal or homicidal character and accidental poisonings should be reported to the county coroner or medical examiner in every jurisdiction of the United States. It is obvious that these different responsibilities require considerable precaution and extreme thoroughness on the part of the physician in order to safeguard the interests of his patient and, in many instances, also of the community at large. PATHOLOGY: RESPIRATORY APPARATUS $T0853357 63 Pulmonary hemorrhages may be caused by severe cough as produced by irritant gases, especially in the presence of vascular injury, hypermia or stasis in the lungs. They may result in blood extravasations of different size or in typical hemorrhagic infarctions. Pulmonary hemorrhages may also be the sequelae of vascular injury, as produced by carbon monoxide and benzene, and of such changes of the blood and blood vessels which may result in thrombus formation in the pulmonary vessels as observed in poisonings from: arsenic trioxide chlorate gasoline quinidine snake venom Gangrene of the lungs is usually of rapid onset and frequently the sequela of pneumonia and pulmonary infarctions. Although it may be difficult to differentiate between pulmonary gangrene and bronchiectasis, the former may be characterized by its characteristic foul odor. Pulmonary abscesses and gangrene have been observed in poisonings from poisons causing vascular injury, such as: arsenicals carbon monoxide and from pulmonary irritants such as: ergot phosphorus chlorine hydrogen sulfide phosgene mustard gas nitrogen oxide and after the aspiration of lye and other caustic agents. To what extent cancer of the lungs may be caused by toxic agents is at present still questionable, but it appears beyond doubt that this can be produced by the inhalation of: chromates nickel carbonyl radioactive substances tar products Granulomatous changes may be produced by inhalation of certain beryllium compounds. Pneumoconiosis is a chronic fibrous reaction in the lungs caused by prolonged exposure to excessive quantities of inorganic dust. Many of these pneumoconioses can hardly be considered as diseases since they may not cause impairment of the physical efficiency of the patient. This holds true for such pneumoconiotic processes as produced by the inhalation of coal dust (anthracosis), chalk dust (chalicosis), and iron dust (siderosis). 64 ST 0853358 poisoning However, the type of exposure associated with silica, which results in the picture of silicosis, is a chronic condition of the lungs, characterized by the development of fibrous nodules in the lung tissue. In advanced cases silicosis will cause dyspnea upon exertion, although it is not asso ciated with orthopnea unless aggravated by attacks of asthma. Only occasionally it is associated with dry or little-productive cough in the morning. A predominant cough is usually indicative of an existing tuber culous infection for which silicosis is a predisposing factor. In the initial stage the condition is difficult to diagnose without the aid of x-ray. Advanced cases may be complicated by hypertrophy of the right heart and dilatation of the pulmonary cone. Other pneumoconioses are asbestosis and cryolithosis; their prognosis is somewhat better than that of silicosis. ASBESTOS ST 0853359 267 phate, with bile thrombi and cholangitis in the liver, the late type shows marked alterations of the liver cells ranging from swelling to necrosis. Severe damage of the kidney is a rare complication; nephrosis with pur pura may be due to hypersensitivity; and in exceptional cases there may be nephritis with fatty degeneration. Occasionally the administration of arsphenamine may be followed by visual disturbances. These may be characterized by neuroretinitis with changes of the vitreous humor which are preceded by blurred vision, floating spots, flashes of light before the eyes, and some time later by such objective signs as haziness of the vitreous humor, alterations of the papilla, and in rare cases by optic neuritis, iritis, and paralysis of the oculomotor apparatus. In very rare cases the intravenous injection of arsphenamine has resulted in gangrene of extremities. This is preceded by shooting pain, swelling, and impair ment of sensation and motor functions. Hemorrhagic encephalitis, one of the rarest complications of~arsphenamine therapy, is relatively fre quently seen in women during pregnancy, and it sets in 48 hours after the second or the third injection. The first symptoms are headache, malaise, dizziness, generalized pain, and later restlessness, moderate leuko cytosis, coma, and convulsions. The disease usually takes a very rapid course, ending fatally as early as 24 hours after manifestation of the first symptoms. Treatment: This has to be symptomatic. The nitritoid reactions can be promptly alleviated by epinephrine or antihistaminic drugs. For the treatment of agranulocytosis, pentnucleotide (10 cc. every 6 hours intra venously), liver extract (2 cc. daily intramuscularly) and dimercaptopropanol, or BAL (1.5 cc. every 6 hours, for 48 hours and then 2 cc. daily for 6 doses intramuscularly) have been suggested. This medication should be combined with general supportive therapy such as the intravenous ad ministration of 5 per cent dextrose to maintain the water balance, vita min therapy, and oral hygiene. Arsphenamine encephalitis appears to respond promptly to therapy with BAL. Beattie, J., and Marshall, J.: Brit, M. J. 1:547, 1944. Fisher, S,, Holley, H. L,, and Fein, G.: Arch. Dermat. & Syphil. 55:57. 1947. Shirbal, J. J., and Thurmen, F. M.: Am. J. Syph. Neurol. 19:17, 1935Hanger, F. M., and Gutman, A. B.: Tr. As. Am. Physicians 55:179, 1940. Asbestos Asbestos (magnesium-calcium-silicate) forms fine, slender, flaxy fibers and is used as an insulating material. The inhalation of asbestos dust causes asbestosis, which differs from silicosis by its slower development and a certain type of pulmonary fibrosis. The earliest symptom is dyspnea upon physical exertion, later accompanied by a harsh, nonproductive S T 0 8 53360 268 POISONING cough and fleeting pain in the chest. In more advanced cases anorexia and cyanosis may develop and there may also be emaciation and finger clubbing. Many asbestos workers show asbestos corns on their skin, caused by hyperkeratosis around asbestos fibers which have entered the skin. Asbestosis is characterized by a diffuse interstitial fibrosis of the lungs with areas of catarrhal changes and the appearance of asbestos bodies in the sputum. It is a progressive disease with a bad prognosis for which there is only symptomatic treatment. 11man, P.: J. Indiut. Hyg. & Toxicol. 15:165, 1933. Aspidium Aspidium (male fern, Filix Mas) is used as anthelmintic against tape worms. Toxic effects may be observed even with moderate doses and are characterized by irritation of the gastrointestinal tract or symptoms from the central necyous system. In light cases there is vomiting, colic, and diarrhea, followed by headache, dizziness, more or less marked dyspnea, yellow vision, and amblyopia. In severe poisonings the pulse is rapid and the patient may suffer from fainting spells and may pass into collapse. He may become delirious, suffer from muscle cramps, trismus, clonic and tonic convulsions, become comatose, and in many instances develop visual disturbances such as nystagmus, hemianopsia, amblyopia, and amaurosis. Psychosis may be observed occasionally. The liver may be affected, as in dicated by the presence of jaundice, and there may be some irritation of the kidney as indicated by the presence of albumin, casts, and sugar in the urine. Treatment: This consists of gastric lavage, saline cathartics, and enema. The* irritation of the intestinal tract may be alleviated by demulcents. Otherwise the treatment has to be symptomatic. Schlier: Therap. Monatschr. 4:465, 1890. Westphal, A.: Samml. Vergiftungsfalien 1:71, 1930. Aspirin Aspirin (acetylsalicylic acid) forms white odorless crystals or a crystal line powder which decomposes readily into salicylic and acetic add. It is used very extensively as an antipyretic and analgesic agent. The ingestion of large doses will cause toxic symptoms similar to those seen in salicylate poisoning (q.v.). The patients suffer from tinnitus and impaired hearing, nausea, vomiting and diarrhea, profuse perspiration, severe thirst and de hydration. Later there is dizziness, anxiety, and great fatigue, passing into somnolence: in severe cases this may be followed by delirium, hallucina tions, convulsions, and coma. The vision may be impaired and there may be flickering before the eyes, and in severe cases the pupils are dilated SHELLAC ST085336 I 459 Smith, M. I., Franke. K. W., and Westfall, B. B.: Pub. Health Rep. 51:1496, 1936. Lemley, R. ., and Merryman, M. P.: Journal Lancet 61:435, ,94IMiddleton, J. M.: Arch. Ophth. 38:806, 1947. Manville, I. A.: Am. J. Pub. Health *9:709, 1939. Shellac Shellac (lacca) is a resinous exudate of the bark of various resiniferous species of Schleicheria, Butea, Ficus, and others, caused through punc ture by the insect Coccus lacca. It is one constituent of lacquers and varnishes. The prolonged inhalation of the mist of such lacquers may lead to chronic exudative pneumonia with induration. Hirtch, E. F., and Russell, H. B.: Arch. Path. 39:181, 1945. Silica Silica (silicon dioxide) occurs in,quartz, sand, Sint, chalcedony, opal, agate, and Kieselguhr. It forms colorless, transparent, and tasteless crystals or a white amorphous powder. It is used in the ceramics industry, and it is one of the hazards in stone cutting, sand blasting, mining, casting, and other trades. Inhalation of silica will result in silicosis which is essentially a fibrosis of the lungs. Its onset is slow and insidious. In the beginning of the disease symptoms may be absent except for changes revealed by x-ray examination. After the process has fully developed, shortness of breath upon exertion, cough, and pain in the chest are the most common subjective signs. The dyspnea is not affected by the patient's position. The objective signs are shortness of breath, cough, prolonged expiration, altered breath sounds, and rales, impaired resonance and the characteristic roentgenographic appearance of the lung fields; however, there is usually neither cyanosis nor clubbing of the fingertips. The blood pressure shows no appreciable rise, but there may be a hypertrophy of the right heart. The silicotic process may arise and continue after discontinuance of the exposure to silica, and there is no therapy to stop the process. Persons suffering from silicosis are prone to contract tuberculosis. Dreesen, W. E.: J. Indust. Hyg. ir Toxicol. 15:66, 1933. Seevers, M. H., Enzer, N., and Becker, T. J.: J. Indust. Hyg. & Toxicol. *0:593, 1936. Sayers. R. R., and Jones. R. R.: Pub. Health Rep. 53:1453, 1938. Giering, J. T., and Chair, R.: J.AM^i. 113:574, 1939. Farrell, J. T., Jr., Sokoloff, M. J., and Charr, R.: Am. J. Roentgen. 44:709, 1940. Silver Silver is a white, malleable, and ductile metal and the most important of its salts from the toxicologic point of view is silver nitrate, which forms colorless, odorless, large, transparent crystals or white small crystals which darken upon contact with organic matter and melt at si2 C. ST 0853362 INDE.I Abortion, 107 Absinthe, >39 Absinthium, 239 Acceleraton, 239 Accommodation, loss of, 142 Acetaldehyde, 240 detection of, 178 p-Acetaldehyde, 423 Acetanilid, 240 detection of, 179 Acetic add, 241 Acetoacetic add, detection of, 173 Acetone, 242 detection of, 179 Acetonuria, 173 Acetphenetidin, detection of, 179 Acetylaniline, 240 Acetylene, 242 Acethylene tetrachloride, 479 Acetylsalicylic acid, 268 Acidosis, 163 Acid red, 339 Acne, 38 Aconitine, 243 Aconitum napellus, 243 Acridine, 244 detection of, 180 Acridine red, 339 Acrodynia, 39 Acrolein, 244 Acrylaldehyde, 244 Acrylonitrile, 501 Addiction, 123 Adrenaline, 341 Adrenals, 108 Aethusia cynapium, 338 Agate, 439 Agotan, 312 Agranulocytosis, 160 treatment of, 233 Agrostemma githago, 455 Albuminuria, 169 Alcohol, 343 Aldehyde ammonia, 240 Alkali violet, 255 Alkyl mercury, 244 Alluritis cordata, 497 Aloe, 245 Aloe ferox, 245 Aloe Perryi, 245 Aloe vera, 245 Alopecia, 43 Alpha-dinitrophenol, 335 Alpha-naphthol, 405 Alpha-3-phenylnaphthylamine, 240 Alum, 245 Aluminum acetate, 245 Aluminum ammonium sulfate, 245 Aluminum chloride, 246 Amanita muscaria, 246 Amanita pantherina, 246 Amanita phalloides, 247 Amaurobius ferox, 463 Amblyopia, 147 Amenorrhea, 107 Aminoanisole, 358 Aminoazobenzene, 339 Aminoazotoluene, 247 Aminobenzene, 253 p-Aminodimethylaniline, 358 p-Aminodiphenylamine, 358 Aminonitrophenol, detection of, 180 Aminophylline, 248 Aminopterin, 248 Aminopyrine, 248 detection of, 180 Aminophenetol, 358 2-Aminopyridine, 249 p-Aminosalicylic acid, 249 detection of, 181 Aminothiazol, 249 Ammonia, 250 Ammonium picrate, 251 Amnesia, 118 Amphetamine, 279 Amygdalin, 251 Amyl acetate, 251 Amyl alcohol, 252 Amylene hydrate, 252 Amyl mercury, 244 Amyl nitrite, 253 Anamirta cocculus, 439 509 510 Anemia, 154 treatment of, *33 aplastic, 156 hemolytic, 156 pernicious, 156 Anesthesias, 133 Aneurine, 486 Anhalonium lewinii, 391 Aniline, <40, 153 detection of, 181 Aniline black, 155 Aniline dyes, 155 Anisocytosis, 157 Anorexia, 75 Anosmia, 57 Anthraconiosis, 63 Antidotes, chemical, S15 Antifebrin, 140 Antihistantinics, *47 Antimony, 256 detection of, 182 Antimony oxide, 256 Antimony sulfide, 256 Antipyrine, 258 detection of, 182 Anuria, 102 Anxiety, 114 Aphasia, 123 Aphonia, 59 Apiol, 258 detection of, 182 Aplastic anemia, 156 Apomorphine, 259 therapeutic use of, 214 Apolopappus heterophyllus, 450 Arbor vitae, 490 Areca catechu, 259 Arecoline, 259 Argyria, 28 Arnica montana, 259 Arsacetin, 260 Arsanilic acid, 184 Arsenic, 260 detection of, 183 Arsenical pigments, 263 Arsenic trichloride, 263 Arsenic trioxide, 260 Arsenic trisulfide, 264 Arsenous chloride, 263 Arsenobenzene, 265 Arsenuretted hydrogen, 264 Arsine, 264 Arsphenamine, 265 detection of, 183 Artemisia absynthium, 239 Artemisia maritima, 454 Arteriosclerosis, 73 ST0853363 INDEX Arthralgia, 132 Artificial respiration, 225 Arysanthum cinerariaefolium, 445 Asagraea officinalis, 500 Asbestos, 267 Asbestosis, 64 Ascaridol, 301 Aspidium, 268 Aspirin, 268 Asthenia, 23 Asthma, 51 Atabrine, 269 detection of, 184 Ataxia, 129 Atophan, 312 Atoxyl, 271 detection of, 184 Atropa belladonna, 271 Atropine, 271 Auditory, disturbances, 150 acuity, decreased, 151 increased, 151 Auramine, 255, 273 Aurantia, 273, 339 Aureomycin, 273 Auricular fibrillation, 71 Auripigment, 264 Auroddin, 356 Aurothioglucose, 356 Avantine, 371 Avertin, 274 Azoimide, 361 Azo-triphenylmethane dyes, 339 BAL, 274 Banana oil, 251 Barbiturates, 275 detection of, 185 Barium, 277 Barium carbonate, 277 Barium chloride, 277 Barium sulfate. 277 Bee venom, 278 Beech nut, 278 Beech nut oil, 278 Benadryl, 257, 279 Benzedrine, 279 Benzene, 280 detection of, 186 Benzidine, 281 Benzine, 354 Benzol, 280 Benzoyl-pseudococaine, 496 Berberine, 361 Beryllium, 281 Beryllium chloride, 281 Beryllium fluoride, 281 INDEX Beryllium nitrate, 281 Beryllium oxide, t8i Beryllium oxyfluoride, s8i Beryllium sulfate, t8i Betabion, 486 Beta-methylacrolein, 319 Beta-naphthol, >40, 405 Beta-napbthylamine, *8s, 406 Betatoxin, 486 Betel nut, 259 Betula oil, 399 Bichloride of mercury, 388 Bile pigments in blood, 164 Biot's breathing, 51 Bismarck brown, 339 Bismuth, 28* detection of, 186 Bismuth subnitrate, 283 Bitter ash, 350 Bitter sweet, 462 Black color of skin, 30 Black widow spider, 463 Bladan, 360 Bladder, inflammation of, 103 spasms of, 103 tumors of, 103 Blepharitis, 137 Blepharospasm, 138 Blindness, 148 Blood, 154 bile pigments, 164 coagulation time, 163 color, 162 hypercalcemia, 167 hyperglycemia, 165 hypocalcemia, 167 hypoglycemia, i65 uric acid level, 166 Blood cells, fragility, 162 nucleated, 157 sedimentation rate, 163 Blood pressure, 73 Blue halos around light, 150 Bone changes, 44 Boric acid, 283 Borneol, 479 Bomyl acetate, 479 Botulism, 284 Bradycardia, 70 Brain, 110 Breath, odor of, 47 shortness of, 49 Brilliant violet, 255 British-anti-Lewisite, 274 Broad bean, 350 Bromates, 284 detection of, 187 ST0853364 Bromides, 285 detection of, 187 Bromine, 286 Bromoacetic acid-methyl ester, 287 p-Bromoaniline, 287 Bromoform, 287 Broachial spasm, treatment of, 223 Bronchial stenosis, 60 Bronchitis, 60 Bronchiectasis, 60 Brucine, 288 Buphane disticha, 288 Buphanine, 288 Burning bush, 350 Burning in mouth, 82 Bums of skin, 41 Burnt lime, 377 Butadiene, 288 Butanol, 289 Butea, 459 Butesin picrate, 289 Butter of arsenic, 263 Butyl alcohol, 28g Butyn, 289 B wood, 503 511 Cacao beans, 486 Cachexia, 23 Cadmium, 289 Cadmium oxide, 289 Caffeine, 291 Cajeputol, 349 Calabar beans, 437 Caldum chloride, 291 Calcium oxide, 377 Calomel, 292 Camomile, 479 Camphene, 479 Camphor, 292, 479 Canadine, 361 Cancer, of lungs, 63 of urinary bladder, 103 Cannabis sativa, 384 Cantharidin, 293 Cape aloe, 245 Carbarsone, 293 Carbolic acid, 427 Carbolineum, 380 Carbon dioxide, 294 Carbon disulfide, 294 Carbonic acid anhydride, 294 Carbon monoxide, 296 detection of, 188 Carbon tetrachloride, 298 detection of, 189 Carbonyl chloride, 432 Cardiac dilatation, acute, 72 CardUrol, 400 Carvone, 479 Castor beans, 300 Casa, 169 Cataract, 145 Catechu brown, 155 Centruroides sculptortus, 456 Cephaelis ipecacuanha, 370 Cevadilla seeds, 500 Cevadine, 500 Cevine, 500 Chalcedony, 459 Chalicosis, 63 Cheilitis, 81 Chelidonine, 300 Chelidonium majus, 300 Chemical antidotes, 215 Chemosis, 136 Chenopodium, 301 Cheyne-Stokcs respiration, 51 Chili salpeter, 409 Chinacrin, 269 China wood oil, 497 Chinese tea, 291 Chloral, 301 Chloral hydrate, 301 detection of, 189 Chloramine T, 302 Chlorates, 303 detection of, 189 Chlorinated lime, 304 Chlorine, 304 Chlorine dioxide, 305 Chlorine oxide, 305 Chloroacetophenone, 305 Chloroaminophenol, 358 Chloro-ahiline, 306 Chlorobenzene, 306 Chlorodiamines, 358 Chloro-dinitrobenzene, 306 Chloroethanol, 347 Chloroform, 307 Chloronaphthalene, 308 p-Chloronitrobenzene, 309 Chloropicrin, 309 Chlorosulfonic add, 310 5-Chloro-t-toluidine, 310 Choke cherry, 310 Choreiform movements, 126 Chromates, 310 Chromium trioxide, 311 Chrysiasis, 28 Chrysanthemum coccineum, 445 Chrysarobin, 312 Chrysoidine, 339 Cicuta vjrosa, 502 Cicutoxin, 502 ST0853365 INDEX Cinchonine, 312 Cincbophen, 312 detection of, 190 Cineol, 349 Cinnamene, 467 Cinnamol, 467 Circulatory collapse, 67 treatment of, 226, 228 Citral, 377, 479 Citrophen, 427 CitTullus colocynthis, 316 Claviceps purpura, 342 Coagulation time, 163 Coal oil, 372 Cobalt, 313 Cobalt acetate, 313 Cobaltine, 313 Cocaine, 313 detection of, 190 Cocculine, 439 Cocculus indicus, 439 Cocco bolo wood, 502 Codeine, 315 Coffee beans, 291 Cola nuts, 486 Colchicine, 316 Colichicum autumnale, 316 Colic, 93 Collapse, 67 Colocynth, 316 Color vision, disturbances of, 150 Coma, 117 treatment of, 232 Confusion, 118 Congo hardwood, 503 Coniine, 317 Conium maculatum, 317 Constipation, 94 Conjunctiva, corrosion of, 137 hemorrhages of, 137 Conjunctivitis, 135 Conquinine, 447 Convulsions, 124 treatment of, 231 Copper, 317 Copper acetoarsenite, 263 Copperhead snake, 461 Copper sulfate, 318 as emitic, 214 Coral snake, 460 Corn cockle, 455 Cornea, discoloration of, 138 inflammation of, 139 turbidity of, 139 ulceration of, 140 Coronary thrombosis, 72 INDEX Corrosion, of conjunctiva, 137 of akin, 41 of stomach, 8g of uterus, 107 of vagina, 108 Corrosive sublimate, 388 Cortisone, 318 Coryza, 54 Cough, 53 treatment of, **5 Creolin, 319, 380 Cresol, 319, 380 Crisalbene, 356 Crocus sativus, 45a Croton aldehyde, 319 Croton oil, 319 Croton tiglium, 319 Crow eyes, 466 Cyrolithosis, 64 Crystalluria, 175 Crystal violet, 255 Cubeb, 320 Cubeba officinalis, 320 Curasao aloe, 245 Curare, 320 Cyanides, 321 Cyanogen chloride, 322 Cyanosis, 26, 82 Cydohexylamine, 322 Cyclopropane, 323 d-Cymene, 301 Cystine, detection of, 176 Cytisus laburnum, 323 Cytrullus colocynthis, 316 Dalmatian insect powder, 445 Daphne metereum, 324 Darybatis sayi, 464 Datura stramonii, 271, 366, 455 Daturine, 366 DDT. 324 Deadly amanita, 247 Decubitus, 42 Deer wort, 450 Dehydration, 93 Delirium, 119 Delphinium staphisagria, 323 Dementia, 122 Dermatitis, medicamentosa, 34 venenata, 32 Dermopolyneuritis, 39 Derrid, 326 Derris eliptica, 326 Diacetylmorphine, 360 Dialkylphosphate, 326 Diaminophenol, 358 ST08533SS 513 44'-Diaminodiphenylsulfone, 326 24-Diamino-l-toIuene, 492 Diaphoretics, therapeutic use of, 221 Diarrhea, go treatment of, 229 Diazomethane, 327 Dichlorobenzene, 327 Dichlorodinitrobenzene, 328 Dichloroethane, 328 Dichlorohydrin, 328 Dichloro-iaopropyl alcohol, 328 Dichloromethane, 329 Dichlorophenylarsine, 430 Dicodid, 329 Dicumarin, 329 Dicumarol, 329 Diethylene ether, 330 Diethylene glycol, 330 Diethyelene oxide, 338 Diethyl-(p-nitrophenyI)-thiophosphate, 424 Diethyl phosphate, 326 Diethylsulfone-dimethyl-methane. 473 Diethylstilbestxol, 330 Diethyldithiocarbonate, 240 Digitalis, 331 Digitalis purpurea, 331 Dihydrocodeinone, 329 Dihydromorphinone hydrochloride, 333 m-Dihydroxybenzene, 450 p-Dihydroxybenzene, 365 Dihydroxysuccinic acid, 478 Di-isopropyl&uorophosphate, 332 Di-isopropylphosphate, 326 Dilantin, 332 Dilaudid, 333 2,3-Dimercaptopropanol, 274 4-Dimethylaminoantipyrine, 248 Dimethylaminoazobenzene, 339 Dimethylaniline, 333 Dimethylbenzene, 503 Dimethyl carbinol, 371 Dimethyldithiocarbonate, 240 Dimethylketone, 242 Dimethylphosphate, 326 Dimethylphthalate, 333 Dimethylsulfate, 333 3,7-Dimethylxanthine, 486 Dinitrobenzene, 334 detection of, igi Difiitrocresol, 335 Dinitrophenol, 335 detection of, igi Dinitrotoluene, 336 Diodrast, 337 Dionine, 337 Dioxane, 338 Diphenyl black base, 339 514 Diphenylthiourea, <40 Diplopia, 149 Direct blue, <55 Disodium succinate, 467 Dliorienution, 118 Dithiopxopanol, 174 Di-o-tolyl-ethylene-dlamine, 140 Di-o-tolyl-thiourea, <40 Diuretics, therapeutic use of, ato Diuretin, 486 Divinyl ether, 338 Dog paisley, 338 Dulcin, 338 Dwarf bay, 384 Dya, 339 Dysmenorrhea, 107 Dyspnea, 49, 65 Eau d'Arquebus^.459 Ear, ringing of, 150 Ecchymoses, 40 Edema, pulmonary, 61 Egg white as antidote, st6 Electrolyte balance, asfl Emetics, therapeutic use of, 914 Emergency measures, it Emetine, ssg Emotional status, 95 Encephalitis, taa Eosin, 340 Eosinophilia, 159 Epanutin, 339 Ephedrine, 340 Epinephrine, 341 Epsom salt, 389 Erections, 106 Erethism, 113 Ergot, 34s Eructions, 90 Erythema, 35 Erythema nodosum, 36 Erythrityl tetrinitrate, 343 Erythrosin, 339 Erythroxylon coca, 313 Eserine, 437 Esophagus, irritation of, 87 paralysis of, 88 Estimex, 496 Etamon, 480 M-Ethanediol, 347 ' Ethanol, 343 detection of, 199 Ethene, 346 Ether, 344 Ethereal sulfates in urine, 175 Ethine, 941 Ethyl acetate, 345 ST 0853367 INDEX Ethyl alcohol, 343 Ethyl bromide, 346 Ethyl carbamate, 499 Ethyl chloride, 348 Ethylene, 346 Ethylene chlorhydrin, 347 Ethylene chloride, 398 Ethylene glycol, 347 Ethyleneglycol dinitrate, 348 Ethylene oxide, 348 Ethylene tetrachloride, 480 Ethylene trichloride, 499 Ethyl ether, 344 Ethylhydrocupreine, 419 Ethylmercury chloride, 944 Ethylmercury phosphate, 944 Ethylmorphine hydrochloride, 337 Ethyl nitrite, 348 Ethylurethane, 499 Eucaine, 349 Eucalyptol, 349, 479 Eucalyptus globus, 349 Eucodal, 399 Euonymin, 350 Euonymus europaeus, 350 Eupatorium urticaefolium, 450 Euphoria, 199 Euscorpius europaeus, 456 Excitement, 119 Exfoliative dermatitis, 39 Exophthalmos, 144 Extrasystoles, 70 Eye balk, abnormal position of, 143 destruction of, 147 Eye ground, congestion of, 145 Faba bean, 350 Facial expression, 95 Fagus silwtlica, 978 Fainting spelk, 66 False morel, 359 False white cedar, 4go Fatigue, 115 Fear, 114 Feer's disease, 39 Fenchone, 479, 490 Fennel, 479 Ferric chloride, 350 Ferrous sulfate, 371 Fetus, injury to, 107 Fever, 30 Ficus, 459 Filix mas, 968 Finger cherry, 351 Finger nails, discoloration of, 49 inflammation of, 43 malformation of, 43 INDEX Flickering, 147 Flowen o line, 505 Fluorides, 351 Fluoroacetate, 353 Flushing, 14 Fly agaric, 146 Formaldehyde, 353 detection of, 191 Formalin, 353 Formic acid, 354 Formic add methyl ester, 398 Formonitrile, 361 Foxglove, 331 Fragility, of red blood cells, 163 French chalk, 477 Friar's cowl, 143 Fuadine, 356 Fuchiin add, 339 Fuller's earth as adsorbent, 117 Gallotannin, 477 Gamboge, 357 Gangrene, 41 Garantose, 451 Garcinia morella, 357 Garget, 437 Gasoline, 354 Gastric lavage, 216 Gastritis, 88 hemorrhagic, 90 Gelsemine, 356 Gelsemium sempervirens, 356 Geraniol, 479 Gesarol, 3x4 Gingivitis, 83 Glaucoma, 147 Glottis, corrosion of, 58 edema of, 38 treatment of, 123 Glucide, 451 Glycosuria, 172 Glycol, 347 Goa powder, 312 Gold, 356 Gold sodium thiosulfate, 356 Golden celandine, 300 Golden seal, 361 Granuloma, 42 Green hellebore, 500 Green vitriol, 371 Guaiacol, 357 Guanidine, 240 Gum gut'tae, 357 Gynecomastia, 107 Gyromytra esculenta, 359 ST 0853368 515 Habu snake, 461 Hair, discoloration of, 43 dyes for. 358 loss of, 43 Halazone, 473 Hallucinations, 120 Halow wax, 308 Headache, 110 frontal, 57 Hearing, impaired, 151 Heart musde, hypertrophy of, 72 injury to, 71 Hedeoma pulegioides, 426 Heinz' bodies, 158 Helleborein, 358 Helleborin, 358 Helleborus niger, 358 Helleborus viridis, 358 Helvetia esculenta, 359 Hematuria, 171 Hemlock, 317 Hemoglobinuria, 171 Hemorrhages, 41 conjunctival, 137 retinal. 145 Henna, 358 Heparin, 359 Hepatitis, toxic, 97 treatment of, 229 Heroin, 360 Herpes zoster, 40 Hexachloro-naphthalene, 308 Hexaethyl-tetraphosphate, 360, 481 Hexagen, 494 Hexahydrothymol, 384 Hexamethylenetetramine, 395 Hexamine, 395 Hexanitrodiphenylamine, 360 Hexylresorcinol, 360 Histadyl, 257 Histamine, 360 Hoarseness, 59 Homatropine, 361 Hunger, 76 Hydrastine, 361 Hydrastinine, 361 Hydrastis canadensis, 361 Hydrazoic add, 361 Hydrochloric add, 362 Hydrocyanic add, 321, 362 Hydrofluoric add, 363 Hydrogen phosphide, 433 Hydrogen selenide, 364 Hydrogen sulfide, 364 Hydroquinone, 365 detection of, 193 Hydroquinone monobenzyl ether, 365 516 ST0853369 INDEX Hydroxybenzene, 4x7 Hyostine, 455 Hyoscyamine, 366 Hyoscyamus niger, 271, 366, 455 Hypercalcemia, 167 Hyperglycemia, 165 Hyperosmia, 58 Hypertension, 74 Hyperthermia, 30 treatment of, 231 Hypocalcemia, 167 Hypodermodysis, sig Hypoglycemia, 166 Hypotension, 74 Hypothermia, 31 treatment of, 227 Hypothyroidism, 108 Hypoxia, 48 Icterus, sg Indian arrow wood, 350 Indigo, 366 Inebriation, 114 Inkberry, 437 Insomnia, 113 Insulin, 367 Intocostrin, 320 Intraocular pressure, 146 Intravenous infusion, 2ig Iodeikon, 482 Iodides, 367 detection of, igs Iodine, 368 compounds, $6g Iodine solution as antidote, 215 Iodoform, 370 Iodophen, 482 Iodophthalein, 482 Ipecac, 339, 370 as emetic, 214 Ipe wood, 502 Iris florentina, 419 Iritis, 145 Iron, 371 Iron trichloride, 350 Iron vitriol, 371 Irritability, 113 Isoamyl acetate, 251 Isopropyl alcohol, 371 Japanese laquer tree, 441 Java coca leaves, 496 Jaundice, 29, 97 Jute, 372 Katatonia, 121 Keratitis, 139 Keratoses, 39 Kerosene, 372 Ketonuria, 173 Kidney, congregations, 101 inflammation of, gg KUselgukr, 459 Korsakow syndrome, 121 Kussmaul respiration, 51 Lacca, 459 Lacrimation, 136 Lactic add, 373 Laryngitis. 58 Laryngospasm, 59 Larynx, edema of, 59 Latrodectus mactans, 463 Lauron, 356 Lead, 374 acetate, 374 arsenate, 376 anenite, 376 detection of, 193 in hair dyes, 358 Lemon juice, as antidote, 216 Lemon grass oil, 377 Lethane, 377 Leucine, in urine, 176 Leukocytosis, 158 Leukopenia, 160 treatment of, 233 Libido, 106 Limbs, abnormal position of, 44 Lime, 377 Lime water, as antidote, 216 Limonene, 301, 479 Ltnaleol, 479 Lithium chloride, 378 Liver, fatty degeneration of, 98 injury to, 97 yellow atrophy of, 99 Lividity, 26 Lixivium, 379 Lobelia inflata, 379 Lobeline, 379 Lophophera williamsii, 391 Lorchel, 359 Lungs, cancer of, 63 gangrene of, 63 Lye. 379 Lymphocytosis, 159 Lysol, 380 Lytta vesica ta, 293 Maculopapular eruptions, 37 Magnesium, 382 as antidote, 216 calcium-silicate, 267 INDEX Magnesium--Continued oxide, 38a silicate, 477 sulfate, 382 Ma Huang, 340 Malachite green, 255, 339 Male fem, 268 Mandelic acid, 383 Mandrake root, 441 Manganese, 383 dioxide, 383 Mapharsan, 383 Marihuana, 384 Martius yellow, 339 Mate tea, 291 May apple, 441 Meadow safbone, 316 Memory, loss of, 118 Menorrhages, >07 Mental deterioration, 122 Menthol, 384, 479 Mepacrine, 269 Mercaptan, 385 Mercaptoacetic acid, 488 Mercaptobenzthiazole, 240 Mercuprin, 387 Mercuric chloride, 388 Mercurochrome, 387 Mercurous chloride, 292 Mercury, 385 detection of, 194 Mercury antiseptics, 387 Mercury diuretics, 387 Mercury fulminate, 390 oxycyanide, 390 Mersal, 387 Merthiolate, 387 Mesantoin, 391 Mescal buttons, 391 Mescaline, sg 1 Meta fuel, 392 Metaldehyde, sga Metal line, 81 Metanil yellow, 339 Metaphen, 387 Meteorism, 94 Methanal, 353 Methane, 392 Methanol, 393 Methapyrilene, 485 Methemoglobinemia, 162 Methemoglobinuria, 172 Methenamine, 395 Methoxyphenol, 357 Methyl acetate, 395 Methyl alcohol, 393 ST0853370 Methyl acrolein, 319 Methyl-allene, 288 o-Methylamino-phenol, 395 Methylamphetamine, 426 Methylaniline, 240, 491 Methylbenzene, 491 Methyl bromide, 395 Methyl chloride, 397 Methylene blue, 255, 398 Methylene chloride, 329 Methylene-dianiline, 240 Methyl formate, 398 Methyl Iodide, 399 Methyl-isopropylphenol, 490 Methyl mercury, 244 Methyl mercury iodide, 244 Methyl-morphine, 315 Methyl-phenol, 380 Methyl-p-phenylenediamine, 240 Methyl picrate, 494 Methyl salicylate, 399 Methyl selenide, 458 Methyl toluidine, 240 Methyl violet, 339, 400 Metol, 400 Metrazol, 400 detection of, 195 Mezereinic acid anhydride, 324 Milk, as antidote, 216 Milk sickness, 451 Milkman's syndrome, 45 Mint, 479 Miosis, 141 Mitral valve, injury to, 72 Moccasin snake, 461 Monkshood, 243 Monobromoethane, 346 Monobromomcthane, 395 Monochlorobenzene, 401 Monochloromethane, 397 Monoiodomethane, 399 Morbilliform eruptions, 36 Morel, 359 Morphine, 401 detection of, 195 Mouse bane, 243 Mouth, dryness of, 86 Muscarine, 246 Muscle, atrophy of, 44 contractures of, tag spisms of, 128 weakness of, 134 Musquash root, 502 Mustard gas, 403 Mustard water as emetic, 214 Myalgia, 132 517 ST085337I 518 INDEX Mydriasis, 140 Myochrysinc, 356 Myristidn, 404 Natl, malformation of, 43 Nailbed, inflammation of, 43 Naphazoline hydrochloride, 444 Naphthalene, 405 detection of, 196 Naphthol, 405 detection of, 197 Naphthol yellow, 339 detection of, 197 Naphthylamine, 140, 406 Narcylene, 24s Nasal septum, perforation of, 57 Nausea, 76 Neoantergan, 257 Neoarsphenamine_265, 406 detection of, ig8 Neodd, 324 Neohetrazine, 257 Neosalvarsan, 406 Neostigmine, 444 Nephritis, toxic, 99 treatment of, 230 Nephrosis, 99 Neptal, 387 Nerium oleander, 418 Nervousness, 113 Neuraltin, 427 Neuritis, 131 optic, 146 retrobulbar, 146 Nickel, 407 Nickel carbonyl, 407 Nicotiana tabacum, 407 Nicotine, 407 Night blue, 255 Night shade, 462 Nitrates, 409 Nitric acid, 409 Nitrite, 410 detection of, ig8 p-Nitroaniline, 411 p-Nitroaniline red, 339 Nitrobenzene, 411 detection of, 199 Nitrochlorobenzene, 412 Nitroerythrite, 343 Nitrogen, 413 Nitrogen dioxide, 415 Nitrogen monoxide, 417 Nitrogen tetroxide, 415 Nitrogycerol, 413 Nitronaphthalene, 414 Nitroprusside, 415 p-Nitrosodimethylaniline, 415 2-Nitrosodimethylaniline, 240 Nitrosomethylurethane, 415 Nitrous fumes, 415 Nitrous oxide, 417 Nose, bleeding from, 56 decreased secretion from, 56 hypertrophy of mucous membranes of, 56 increased secretion from, 56 ulceration of, 54 Nosophen, 482 Novaldin, 417 Novocaine, 444 Nucleated red blood cells, 157 Nupercaine, 417 Nutmeg, 404 Nux vomica, 466 Nystagmus, 144 Occupational history, 19 Occupational poisoning, 6 Oculomotor cramps, 143 Oculomotor impairment, 143 Odor of breath, 47 Oil of mirbane, 411 Oil of turpentine, 498 Oil of vitriol, 475 Oleander, 418 Oleum, 475 Oliguria, 102 Opal, 459 Opisthotonus, 126 Opium, 418 Oppression, in chest, 65 Optic atrophy, 146 neuritis, 146 Optoquine, 419 Oral cavity, discoloration of, 82 irritation of, 82 Orange II, 339 Orris, 419 Osmic acid, 419 Osmium trioxide, 419 Osteosarcoma, 44 Osteosclerosis, 45 Ouabaine, 465 Oxalates, 420 crystals of, in urine, 175 Oxalyl chloride, 421 Oxymethylene, 353 Ozone, 421 Pain, abdominal, 79 in chest, 54, 66 in neck, 66 relief of, 230 i' INDEX Pallor, 15 Palpebral edema, 137 Palpitation, 65 Pantocaine, 412 Papaver album, 418 Papaver somniferum, 418 Paraffin, 411 Paraldehyde, 413 detection of, 199 Paralysis, 130 Parathion, 414 Paresthesias, 133 Paris green, 163 Parkinsonism, 1x1 Parotitis, 96 Pear oil, 151 Pelletierine, 414 Penicillin, 415 Pennyroyal, 426 PentachLoronaphthalene, 308 Penta-(n-galloyl)-glucose, 477 Pentamethylene-tetraiole, 400 Perborate, 426 Percaine, 417 Perchlorethylene, 480 Perforation peritonitis, 89 Peribronchitis, So Pema disease, 308 Pernicious anemia, 156 Persian insect powder, 445 Personal history, 18 Perspiration, 31 Pervitin, 426 Petechia, 40 Peyote, 391 Phaseolus coccineus, 426 Phasin, 426 Phellandrene, 479 Phenacetin, 427 detection of, 199 Phenacylchloride, 305 p-Phenetidin, 427 detection of, 199 Phenotol, 358 Phenol, 427 detection of, 200 Phenolphthalein, 429 detection of, 200 Phenoquin, 358 Phenothiazine. 430 detection of, 200 Phenurone, 430 Phenylacetylurea, 430 j-Phenyl-a-aminophenol, 340 Phenyldnchoninic acid, 312 Phenyldichloroarsine, 430 Phenyldlmethylpyrazolone. 258 ST 0853372 p-Pheaylenediamine, 240, 431 Phenylethylene, 467 Phenylethylenediamine, 240 Phenylhydrazine, 431 Phenylhydroxylamine, 431 Phenylmercuric acetate, 387 borate, 387 nitrate, 387 oleate, 387 salts, 391 Phloxin, 339 Phosgene, 43s Phosphine, 433 Phosphoretted hydrogen, 433 Phosphorus, 433 oxychloride, 436 pentachloride, 438 trichloride, 436 Photophobia, 142 Photosensitization, 39 Phthalein, 429 Phthalic acid anhydride, 437 Phthalylsulfathiazole, 471 Physostygma venenosum, 437 Physostigmine, 437 Phytolacca decandra, 437 Picramic acid, detection of, 201 Picric acid, 339, 438 detection of, 201 Picrotoxin, 439 Pigeon berry, 437 Pilocarpine, 439 Pilocarpus jaborandi, 439 Pinene, 479 Pinene hydrochloride, 479 Pinipicrin, 490 Piper cubeba, 320 Piperidine derivatives, 240 Pink color of skin, 29 Pinus pallustris, 498 Pitayine, 447 Pituitary, 108 Pitch, 440 Planocaine, 444 Plasmoquine, 440 detection of, 201 Platinum, 440 Pneumoconiosis, 63 Pneumonia, 61 Pneumonitis, 61 Po3ophyllotoxin, 441 Podophyllum peltatum, 441 Poikilocytosis, 157 Poison ivy, 441 oak, 441 Poison sumac, 441 Poke root, 437 519 520 ST 0853373 INDEX Poke weed, 437 Polychromatophylia, 156 Polycythemia, 154 Polyuria, 101 Pomegranate, 414 Pool root, 450 Pool wort, 450 Porphyrinuria, 172 Potassium antimony tartrate, 256 as emetic, 214 Potassium bromate, 284 chlorate, 303 hydroxide, 379 iodide, 369 nitrate, 409 oxalate, 420 permanganate, 442 as antidote, 217 tellurite, 478 Potato, 462 Precordial distress, 66 Primrose, 443 Primula, 443 Privine, 444 Procaine, 444 Propanone, 242 Propenal, 244 Propylmercury, 244 Prostigmine bromide, 444 Prostigmine methylsulfate, 445 Protamine insulin, 367 Protovera trine, 500 Prunus melanocarpa, 310 Pruritus, 40 Psoriasis, 39 Psychoses, 120 Pterocarpus angolensis, 503 Ptosis, of the eyelids, 138 Pulmonary, edema, 61 treatment of, 223 emphysema, 62 hemorrhages, 63 Punica granatum, 424 Punicine, 424 Pupils, constriction of, 141 dilatation of, 140 rigidity of, 141 Puran, 401 Purpura, 40 treatment of, 233 Pustular eruptions, 38 Pyoctaninum aureum, 273 Pyramidon, 248 Pyrethrum flowers, 445 Pyribenzamine, 257, 445 Pyridine, 446 pyrocatechol, detection of, 202 Pyrogallic acid, 446 Pyrogallol, 446 Pyroludte, 383 Quartz, 459 Quillaja saponica, 455 Quinidine, 447 Quinine, 447 detection of, 202 Quinophen, 312 Quinosol, 449 Radium, 449 Rattle snake, 461 Rayless golden rod, 450 RDX, 494 Rectum, ulceration of, 95 Reflex excitability, 130 Regurgitation, 90 Renal congregations, 101 Renal excretion, decreased, 102 increased, 101 Resorcin green, 339 Resorcinol, 450 detection of, 203 Respiratory arrest, 52 rate, 47 stimulants, 223, 225 volume, 47 Restlessness, 112 Retching, 90 Reticulocytosis, 157 Retinal hemorrhages, 145 Retrobulbar neuritis, 146 Rhinitis, 54 Rhodamine B, 255 Rhodanides, 487 Rhodomyrtus macrocarpa, 351 Rhus radicans, 441 toxicodendron, 441 vemificera, 441 vemix, 441 Rich weed, 450 Ricin, 300 Ricinine, 300 Ricinus communis, 300 Risus sardonicus, 126 Rosemary, 451, 479 Rosemary oil, 451 Rosmarinus officinalis, 451 Rotenone, 326 Sabadine, 500 Sabinol, 479 Saccharin, 451 Saccharinase, 451 Saccharol. 451 INDEX Saffron. 45a Safranine, 155, 339 Sage. 45a Saline, therapeutic me of, a 19 Salicylic add, 43a detection of, 203 Salivary glands, 96 Salivation, 85 Salvia officinalis, 45a Salyigan, 387 Sand, 459 Sanocrysine, 356 Santonin, 454 detection of, ao4 Sapindus saponaria. 455 Saponaria officinalis, 455 Saponins, 455 Saprol, 380 Scarlauniform eruptions, 36 Scheelium, 498 Schlcicheria, 459 Schweinfurt green, 263 Scilla maritima, 463 Scopolamine, 455 Scorpion, 456 Sea onion, 463 Secalc comutum, 34a Sedimentation rate, 163 Sedormid, 457 Selenium, 458 detection of, ao4 Selenium oxide, 458 Selenium oxychloride, 458 Shellac, 459 Shock, 67 Siderosis, 63 Silica, 459 Silicium dioxide, 459 Silicosis, 64, 459 Silver, 459 Silver nitrate, 459 Sinus, irritation of, 57 Skin, blackened, 30 cyanotic, 26 dry, 32 greenish, 30 livid, 26 pallid, 25 pink, 29 yellow, 29 Smaltine, 313 Snake root, 450 Snake venom, 460 Soap root, 455 Soap, as antidote, 216 Socotrine aloe, 245 Sodium acetylarsanilate, 260 ST 0853374 521 Sodium arsanilate, 271 Sodium aurothiomalate, 356 Sodium bicarbonate, as antidote, a 16 Solium bromate, 384 Sodium bromide, 285 Sodium diphenylhydantoin, 33a Sodium fluoride, 351 Sodium hydroxide, 379 Sodium iodide, 369 Sodium nitrate, 4og Sodium nitrite, 410 Sodium nitroferricyanide, 415 Sodium nitropruaside, 415 Sodium perborate, 436 Sodium silicofluoride, 351 Sodium sulfite, 476 Sodium sulfpcyanate, 487 Sodium tellurite, 478 Solanidin, 46a Solanin, 46a detection of, 205 Solanum dulcamara, 46a nigrum, 46a tuberosum, 46a Somnifen, 46a Somnolence, 115 Speech, impaired, 1x3 Spider bite, 463 Spinal cord, 110 Spinal pressure, 123 Spindle tree, 350 Spleen, retrogressive changes in, 105 Splenomegaly, 105 Spotted cowbane, 50a Sprit blue, 255, 339 Spurge flax, 324 Spurred rye, 34a Squaw mint, 426 Squaw weed, 450 Squill, 463 Squint, 144 Staggering, 129 Staphisagria, 325 Stenosis, bronchial, 60 gastric, 8g Stilbestrol, 330 Stingaree, 464 Stingray, 464 Stomach, corrosion of, 89 perforation of, 89 strictures of, 89 ulcerations of, 89 Stomatitis, 83 Stools, bloody, 92 Strabismus, 114 Stranguria, 104 Strawberry tree, 350 ST0853375 522 INDEX Streptomycet aerojaciens, 173 Streptomycin, 464 Stippled cell*, 157 Strophanthin. 465 Strophanthus, 465 Strychnine, 466 detection of, >05 Strychnos nux vomica, 288 Stupor, 117 Styrene, 467 Styrol, 467 Succinate, 467 Sucbarinol, 451 Sudan IV, 339 Sulfadiazine, 467 crystal* of, in urine, 176 Sulfaguanidine, 468 detection of, 176 Sulfanilamide, 469. crystals of, in urine, 176 detection of, 105 Sulfanilamidopyridine, 470 Sulfanilamidopyrimidine, 467 Sulfapyridine, 470 crystals of, in urine, 177 Sulfathalidine, 471 Sulfathiazole, 472 crystals of, in urine, 177 Sulfhemoglobincmia, 28 Sulfocyanate, 487 Sulfonal, 473 Sulfonamide, crystals of, in urine, 176 detection of, 205 s-Sulfonamidothiazole, 472 p-Sulfone-dichloramido-benzoic acid, 473 Sulfomnetbane, 473 Sulfur, 473 Sulfur dioxide, 474 Sulfuric add, 475 Sulfuric chlorhydrin, 310 Sulfurous add, 476 Sulfurous anhydride, 474 Sulfurous oxide, 474 Sulfuryl chloride, 476 Sulpharsphenamine, 471 Swallowing, difficulties in, 87 Sweet birch oil, 399 Swift's disease, 39 Sykose, 451 Syncope, 66 treatment of, 228 Tachycardia, 69 Talcum, 477 Tannic add, 477 as antidote, 215 detection of, 206 Tannin, 490 Tar, 477 Tar camphor, 405 Tartar emetic, as emetic, 214 Tartaric add, 478 as chemical antidote, 216 Taste, impaired acuity of, 84 increased acuity of, 85 Teaberry oil, 399 Teeth, corrosion of, 44 deposits upon, 81 discoloration of, 44 impregnation of, 81 Tellurium, 478 Tellurium oxide, 478 Tellurous acid, 478 Tenesmus, 94 Terpens, 479 Terpineol, 479 Testes, atrophy of, 106 Tetrabromofluorescein, 340 Tetrachloroethane, 479 Tetrachloroethylene, 480 Tetrachloromethane, 298 Tetraethylammonium chloride, 480 Tetraethyl lead, 480 Tetraethyl pyrophosphate, 481 ac-Tetrahydro-beta-naphthylamine, 482 Tetrahydronaphthalene, 483 Tetraiodophenolphthalein, 482 Tetraiodophthalein, 482 Tetralin, 483 detection of, 206 Tetramethyltetramine, 240 Tetramethylthionine chloride, 398 Tetramethyl-thiuram disulfide, 240 Tetranitromethane, 483 Tetryl, 483 Thallium, 484 Thallium, acetate, 484 sulfate, 484 Thenyiene hydrochloride, 485 Theobromine, 486 sodium salicylate, 486 Theophylline ethylenediamine, 248 Thiamine hydrochloride, 486 Tbiocarbamide, 488 Thiocyanate, 487 detection of, 206 Thiodiphenylamine, 430 Thioglycolic acid, 488 Thiophos, 424 Thiosulfate, detection of, 206 Thiouracil, 488 Thiourea, 488 Thirst, 86 Thomas slag, 489 INDEX Thorium, 4&g Thorium oxide, 489 Thorotrait, 490 Thrombocytopenia, 157 treatment of, 133 Thuja, occidentalis, 490 plicata, 503 Thujone, 479, 490 Thymol, 490 Thyroid, 108 Tin, 491 Tinnitui, 150 Tityus serulatus, 457 TNT, 495 Toluazotoluidine, 147 Toluene, 491 Toluencdiamine. 140 p-Toluldine, 140, 491 Toluylene diamine, 358, 49a Tongue, inflammation of, 84 Toxicodendrol, 441 Tracheitis, 59 Treatment, rationale of, 111 Tree of life, 490 Tremetol, 451 Tremors, >17 Triazotin, 350 Tribromoethanol, 274 Tribromomethane, 187 Trichloroacetaldehyde, 301 hydrate, 301 Trichloroethylene, 491 Trichloromethane, 307 Tridione, 493 14,3-Trihydroxybenzene, 446 Triiodomethane, 370 Trimethadione, 493 Trimethylene, 323 Trimethylenetrinitramine, 494 Trinitroaniiole, 494 Trinitrobenzene, 494 Trinitroglycerol, 413 24,6-Trinitrophenol, 438 Trinitrophenylmethylnitramine, 483 Trinitrotoluene, 495 detection of, 207 Trinitrotrichloio-methane, 309 Triorthocresyl phosphate, 496 Tripellenamide hydrochloride, 445 Tropacocaine, 496 Trismus, 126 Trypanamide, 497 Tung nuts, 497 I, 497 Tungsten, 498 Turpentine, 479, 498 Turpin hydrate, 479 ST0853376 Twitching! of the musculature, ta6 TY, 494 Tympanites, 94 Tyrosin crystals in urine, 176 Udolac, 326 Ulceration, of the rectum, 95 of the skin, 41 of the stomach, 89 of the urethra, 104 of the urinary bladder, 103 of the uterus, 107 Unconsciousness, 117 treatment of, 232 Undecylenic add, 499 Uremia, 103, 165 Urethane, 499 detection of, 207 Urethra, irritation of, 104 ulceration of, 104 Urginea maritima, 463 Uric acid level in blood, 166 Urinary bladder, cancer of, 103 inflammation of, 103 spasm of, 103 ulceration of, 103 Urinary incontinence, 104 Urine, acetoacetic acid in, 173 acetone in, 173 bilirubin in, 175 blood in, 171 color of, 168 crystals in, 175 cystine in, 176 ethereal sulfates in, 175 hemoglobin in, 171 leucine in, 176 methemoglobin in, 172 porphyrin in, 172 oxalate in, 175 sulfonamides in, 176 tyrosine in, 176 urobilin in, 173 urobilinogen in, 174 Urticaria, 37 Uterus, corrosion of, 107 Vagina, corrosion of, 108 Valerian, 479 Valzin, 338 Vanadium, 499 pentoxide, 499 Vascular degeneration, 73 Vascular spasm, 42 Vasoconstriction, 72 Vasodilatation, 73 Ventricular fibrillation, 71 * 524 ST0853377 Veratiidine, 500 Veratrine, 500 Veratram, 500 Vesication, 41 Vesicular eruptions, 37 Vestibular disturbances, 15a Victoria blue, 255 Victoria yellow, 339 Vinegar, a 16 Vinethene, 338 Vinyl cyanide, 501 Vinyl ether, 338 Violet B, *55 Violet RB, *55 Viosterol, 501 Vision, impaired, 147 Visual field, restriction of, 149 widening of, 150 Vitamin Ri, 486 Vitamin D, 501 Vocal cords, paresis of, sg Vomiting. 76 agents for production of, *14 treatment of, **9 Vomitus, 76 Warts, 4* Wasp sting, *78 Water blue, 339 Water-hemlock, 50* Wernicke's syndrome, 121 Western red cedar, 503 White amanita, 247 White flag, 419 White sanicle, 450 White vitriol, 506 Wild pepper, 3*4 Windsor bean, 350 Wintergreen oil, 399 Wolfram, 498 Wolfsbane, 243 Wood, 50* Wood alcohol, 393 Wonnseed, 301 Wormweed, 239 Wrightta tinctoria, 366 Xanthates, 140 Xanthopia, 150 X-rays, 503 Xylene, 503 Yellow cedar, 490 Yellow vision, 150 Zinc, 504 chloride, 504 cyanide, 505 dichromate, 505 oxide, 505 phosphide, 505 stearate, 506 sulfate, 506 as emetic, 214 vitriol, 506 white, 505 INDEX i i i * \ > HECEIVED I i -i n a d Y j95S fflfi i><i viiCiU^iii i& ST0853318 BIOCHEMICAL RESEARCH <1 .< ST08533U0 1211 -V6 copy 2 U i CCII`<11CAL