Poisoning

POISONING. By poisoning is meant "disorders of the functions of the animal organism, caused by exogenous or endogenous, chemically or physico-chemically acting substances, which in terms of quality, quantity or concentration are foreign to the organism or organs" (Starkenstein). This definition of poisoning, although it is the most successful of all attempts of this kind, is still valid only in a general biological sense, since there is no fundamental difference between poisoning by some medicine and intoxication of the organism in infectious diseases and diseases of metabolism. From a practical medical point of view, the definition should be narrowed, since in this case poisoning is conventionally understood to mean only such disorders of functions and violations of the structure of the organism that are caused by exogenous substances called poisons. From the point of view of origin, poisoning can be divided into the following types: 1) Intentional, which include: a) suicides by means of poisons and b) poisoning (murder) of another person (or several people), including combat poisoning. 2) Accidental poisoning, which in turn are divided into: a) professional, b) domestic and c) medical. Intentional poisoning are also considered below from a forensic medical point of view. Of accidental poisoning, professional ones occupy a special position due to their social significance (see below). Domestic poisoning include: 1) Poisoning by food products {see Food infections, poisoning}, prepared from inferior materials (spoiled fish, meat, poisonous mushrooms, etc.) or spoiled due to improper preparation (poorly smoked sausage, fruits and vegetables boiled in un-tinned copper vessels, cheese kept too long, etc.). 2) Poisoning by beverages containing poisons (beer containing arsenic, drinking water with lead, etc.). 3) Poisoning due to the presence in the living environment of objects containing poisonous substances (wallpaper, furniture, animal specimens containing arsenic, wearing stockings containing antimony, sleeping in freshly painted rooms, skin irritation from some house plants, e.g. primrose, etc.). 4) Poisoning associated with improper heating or lighting of premises (carbon monoxide, illuminating gas). 5) Poisoning by means for cleaning and cleaning premises due to careless handling of them or erroneous application instead of other substances (alkalis, acids, ammonia, gasoline, spot removers, many means for cleaning and washing dishes, etc.). 6) Poisoning by cosmetic means (hair water, rouge, white paint, hair coloring agents, etc.). 7) Poisoning caused by bites of poisonous insects, snakes and other animals, and many others. Medical poisoning includes all those where poisons acted as medicinal substances due to errors in prescriptions, incorrect dosage, insufficient knowledge of the properties of drugs (this especially applies to new, little-studied medications), their improper preparation or method of application, erroneous prescription or taking one remedy instead of another, or due to an unexpected special reaction of a given organism (cases of so-called idiosyncrasy; see Medicines). This category also includes cases of poisoning from the use of home remedies (enemas from tobacco, decoctions from poppy heads, etc.) and folk remedies (strong laxatives, abortifacients), various contraceptives, so-called "love potions" (Spanish fly, etc.) and poisons used due to various superstitions and recommendations from folk healers and similar persons. Poisoning of this group are mostly accidental in nature, but in individual cases they may represent intentional self-poisoning to achieve a state of euphoria (alcoholism, morphinism, cocaineism, opium smoking and tobacco smoking, etc.). All the types listed above can occur in acute or chronic form. Chronic poisoning can occur and manifest in various ways. They can be the result of prolonged penetration into the organism and accumulation in it (cumulation) of such (sub-threshold) doses of poison, each of which does not yet cause any symptoms of poisoning, or of such doses (small) which each individually cause acute poisoning, but not pronounced; finally, chronic poisoning can follow acute poisoning if the poison is slowly eliminated from the organism. An intermediate position is occupied by so-called subacute poisoning, which are longer in duration than acute ones, but still shorter than chronic ones; in these cases, slow elimination and therefore the continuing action of the poison, once it has entered the organism, often takes place. The clinical picture in the vast majority of cases does not give any pathognomonic signs for one or another poisoning, and only their combination can give an idea of the nature of the poisoning agent or the group of substances to which it belongs. Therefore, a number of symptoms are common to many poisonings, although the diagnostic value of these symptoms is different for different cases. Among the most pronounced subjective symptoms, pain can be mentioned, Table 1. Pre-symptoms characteristic of poisoning by certain poisons (compiled according to Starkenstein and other authors).

Affected organs | Symptoms | Poisons to be considered Sudden (i.e., after several seconds or minutes) death Hydrocyanic acid, potassium cyanide, carbolic acid, chloroform and other inhalation anesthetics, hydrogen sulfide, 'cloacal gas Central nervous system Loss of consciousness, coma Collapse, loss of consciousness with heart weakness and falling temperature Shock, strong excitement of the central nervous system, consciousness preserved; extreme pallor, small pulse Headache Maniacal state, hallucinations, acute delirium, strong excitement Various mental disorders Convulsions: 1) tonic 2) clonic or tonic-clonic Alcohol, veronal, sulfonal, chloral hydrate, luminal, chloroform, ether, carbon monoxide, opium, morphine, codeine, heroin, dionin, pantopon, benzene, kerosene, carbon dioxide (in large quantities), aniline, late stages of P. with phosphorus and fungi, ammonia vapors, arsine, phosphine, carbon disulfide, nitrobenzene, gasoline, carbon tetrachloride, nitrotoluene, sulfuric acid, hydrogen sulfide, hydrocyanic acid, carbolic acid, acetylene, chlorobenzene, nitrous oxide Chloroform and other anesthetics, chloral hydrate, veronal and other hypnotics, nicotine, arsenic, antimony salts, colchicine, phosphorus, nitrobenzene, aniline, after-effects of caustic alkalis and acids Consequence of extensive damage from caustic acids and alkalis, mostly as a reflex from severe pain Hydrogen sulfide, lead (chronic), benzene, nitrotoluene, phenols, nitroglycerin, carbon monoxide, amyl nitrite, alcohol, opium, morphine Alcohol (chronic), atropine, laughing gas, Indian hemp, camphor, late stages of chronic lead and mercury poisoning, cocaine, gasoline, acetylene, tetrachloromethane, nitroglycerin Alcoholism, etheromania, morphinism, cocaineism, ergotism, lead, mercury, bromides, iodoform, carbon disulfide, carbon tetrachloride, nitroglycerin, benzene, nitrotoluene, acetylene, carbon monoxide Strychnine, tetanotoxin, arsine, ergot Santonin, brucine, aconitine, cocaine, atropine, veratrine, nicotine, lobelia, physostigmine, hydrocyanic acid, carbon monoxide, nitrated benzenes, ergot Peripheral nervous system Paresthesia of limbs Anesthesia Paralysis of facial and other nerves Polyneuritis Ergot, aconitine, veratrine, antimony, arsenic, alcohol Cobra bite, veratrine, aconitine Gasoline, kerosene, carbon disulfide, chloromethyl Lead, mercury, arsenic, antimony, nitrotoluene, trinitrophenol Musculature Paralysis: 1) general (mostly ascending) 2) of individual muscle groups 3) cramps in calves Atrophy of individual muscles Coniine, colchicine Lead (chronic), arsenic (chronic), carbon disulfide, ergot Arsenic Lead (chronic), arsenic (chronic), ergot (chronic) Eye Conjunctivitis Changes in pupil: 1) dilation 2) constriction 3) immobility Nystagmus Visual disturbances: 1) amblyopia (often with central scotoma) 2) diplopia and paralysis of upper eyelid 3) color vision 4) amaurosis (in severe cases progressing to atrophy of optic nerve) Irritating gases and vapors: chlorine, bromine, iodine, blister chemical warfare agents, ammonia; acids-sulfurous, hydrochloric, nitric, osmium, hydrofluoric, nitrogen oxides; mustard oil, croton oil, ipecacuanha, quillaia and other saponins; chrysarobin, superphosphates, salts of chromic and picric acids, arsenic (chronic) Atropine, hyoscyamine, scopolamine, atropine substitutes: homatropine, eumydrin, etc.; cocaine, gelsemine, sausage poison, aconitine, coniine, benzene, aniline Morphine, opium, heroin, dionin, codeine, pilocarpine, physostigmine, arecoline, nicotine, muscarine Carbon disulfide, benzene, aniline Gasoline, kerosene Nicotine (chronic), alcohol (chronic), Hyoscyamus, Stramonium, Atropa belladonna, carbon disulfide (chronic), lead (chronic), santonin, arsenic (chronic), mercury (chronic) Sausage and fish poisons Santonin, amyl nitrite, alcohol (chronic), arsenic (chronic), lead (chronic) Quinine, optochin, rivanol, salicylates, fern extract, atoxyl, methyl alcohol, arsenic, carbon disulfide, nitrated benzenes, chlorobenzene, belladonna Nose Runny nose, usually starting with violent sneezing Perforation of nasal septum All those poisons that cause conjunctivitis (see above), if they come into contact with nasal mucosa Entry into the nose of powder from chromic acid salts, cocaine, cement Hair Loss of hair Green coating on head hair Softening of hair Throat and mouth Moist skin Extremely dry skin and mucous membranes Dry gangrene of peripheral parts Erythema (mostly scarlet-like), urticaria Eczematous skin rashes Redness of face and peripheral parts Blisters on skin, sometimes in mouth Multiple skin ecchymoses Acne Dark skin discoloration (without cyanosis) Cyanosis without respiratory disorders Yellowish discoloration of skin and conjunctiva Green discoloration of sweat | Lungs and breathing Irritation and swelling of lips and corners of mouth Abnormal coloration of tongue and oral mucosa: yellow-red yellow-brown blue green whitish blackish Stomatitis Dark border on gums Specific smell of exhaled air Salivation: 1) increased 2) decreased (with aphonia, thirst) Teeth, necrosis Edema of vocal slit Edema of lungs: 1) after inhaling poison 2) after parenteral administration Respiratory disorders Quinine, salicylic preparations, nitrobenzene, antipyrine, antimony, 01.

Chenopodii, methyl alcohol Arsenic (chron.), thallium Copper dust (chron.) Bromine vapors Opium, morphine, aconitine, muscarine, pilocarpine, nicotine, physostigmine, lobelia, antimony and other poisons causing collapse (see above) Atropine, hyoscyamine, scopolamine, Belladonna, Stramonium, Hyoscyamus, sausage and fish poisons Carbolic acid (externally), ergot (chron.), phosphorus (very rarely), arsenic Atropine, hyoscyamine, antipyrine, pyramidon, quinine, copaiba balsam, cubeb, iodine, opium, pantopon, morphine When externally applied-croton oil, quinine bark dust, ipecacuanha, quillaia powder, emetic tartar, carbolic acid, tar, phenylhydrazine Amyl nitrite, sodium nitrite, nitroglycerin Cantharides preparations Snake bites, carbon monoxide, benzene, phosphorus Bromides, iodine, chlorine, arsenic, antimony compounds, ipecacuanha, tar Silver (chron.), lead (chron.), arsenic (chron.), mercury (chron.) Poisons forming methemoglobin, Berthollet's salt, nitrobenzene, aniline, toluidine, antifebrin, pyridine, pyrogallic acid, naphthol, tolylene diamine, also-iodine, bromine, carbon disulfide Berthollet's salt, nitroglycerin, sodium nitrite, amyl nitrite, trinitrophenol (picric acid), trinitrotoluene, pyrogallic acid, arsine, phosphorus Copper Caustic acids and alkalis, free halogens (chlorine, bromine, iodine), caustic salts (sublimate, antimony chloride, potassium bichromate, etc.), carbolic acid Chromic and bichromic salts, manganese dioxide Nitric acid, picric acid Free iodine and bromine Copper salts (copper sulfate, copper acetate) Schweinfurt green, basic copper carbonate Caustic alkalis and acids, caustic metal salts, especially sal ammoniac, sugar of lead, lead acetate Sulfuric acid, hydrochloric acid, oxalic acid Mercury salts, bismuth salts, arsenic, vapors of hydrochloric, sulfuric, sulfurous and nitric acids Lead, bismuth, mercury, silver in chronic or subcutaneous administration Opium, Indian hemp, alcohol, wood alcohol, amylene hydrate, paraldehyde, chloroform, ether, ethyl bromide, creosote, iodine, iodoform, bromine, bromoform, phosphorus, nitrobenzene, hydrocyanic acid, essential oils (camphor, etc.), tellurium and selenium salts, cacodyl compounds, amyl nitrite, ammonia, carbolic acid, lysol, acetic acid, kerosene, hydrogen sulfide When taken per os-ammonia, saponin substances, essential oils, cantharidin, caustic agents; parenterally- pilocarpine, physostigmine, muscarine, arecoline, nicotine, choline, mercury salts Atropine, hyoscyamine, scopolamine, sausage and fish poisons Inorganic acids and acids of fermentation, creosote All caustic poisons Concentrated nitric and hydrochloric acids, sublimate and other caustic poisons, suffocating, chemical warfare agents, especially phosgene, chloropicrin, dichloroethyl sulfide, chlorosulfonic acid, pyridine Muscarine, pilocarpine, physostigmine See above poisons causing excitation and paralysis of the respiratory center Affected organs Symptoms Poisons to be considered Stomach Vomiting without diarrhea Vomiting and diarrhea Glowing of vomit Fat droplets in vomit or lavage water Intestine Liver Stool Colic with constipation* Colic with diarrhea Diarrhea without vomiting Stool dark to black contains hematoporphyrin, almost black or bloody Enlargement of liver Acute yellow atrophy of liver Heart and circulation Pulse: 1) very slow and soft 2) slow and hard 3) first slow, then irregular and accelerated 4) very accelerated Uterus Abortion, resp. premature delivery Alcohol, apomorphine, emetine, lobelia, cytisine, small doses of soluble copper and zinc salts, saponins, carbon disulfide, benzene and a number of indifferent drugs Arsenic, antimony salts, sublimate, astringents (in large doses), salicylic acid, pilocarpine, physostigmine, nicotine, colchicine, aconitine, veratrine, copper and zinc salts, some irritating plants, substances of the digitalis group, colocynth, emetine, croton oil Phosphorus (in the first period after taking the poison) Phosphorus oil, croton oil, hogwash oil, nitrobenzene, kerosene Lead salts Barium salts and all caustic agents Jalapa, podophyllin, croton oil, colocynth, calomel and other drastics Iron, lead, silver, mercury, bismuth All caustic agents, if they have reached the intestines, all drastics in large doses, all emetic-cathartic agents, then phosphorus, Sabina, Thuja Alcohol (chron.), phosphorus, poison from Agaricus, seu Amanita phalloides Phosphorus, aromatic nitro compounds, trichloroethylene Opium, morphine, physostigmine, muscarine, quinine, arecoline, narcotic fats Lead (in the stage of colic), soluble barium compounds Digitalis, marsh marigold, lily of the valley, Helleborus, sea onion, strophanthus, pilocarpine, nicotine, soluble barium compounds Atropine, belladonna, Hyoscyamus, Stramonium, scopolamine Phosphorus, ergot, lead, Sabina, Thuja, Ruta, pilocarpine, physostigmine, large doses of salicylic acid and quinine which often leads to shock. Pain localized by the patient along the gastrointestinal tract or in areas of visible mucous membranes and skin almost always indicates a strong local irritating (or necrotizing) effect of the poison on these areas. Headache and pain from other internal organs indicates the resorptive effect of the poison. In the latter case, pain is almost always accompanied by objective signs of dysfunction of individual organs or systems (disorders of circulation, respiration, state of the nervous system, metabolism, thermoregulation, etc.). Along with complaints of pain, complaints of various sensory disorders (anesthesia, paresthesia, hyperesthesia, burning, itching, etc.) appear, indicating impaired function of the nervous system. Less pronounced are indications of sensations from the heart (palpitations, feeling of precordial anxiety, stopping, etc.); here objective signs give the physician much more material for judging the damage to the organ. Objective symptoms may manifest simultaneously from a number of organs and create great difficulties for the diagnosis of poisoning due to the similarity of the symptom complex with the picture of a number of general diseases. Suspicion of poisoning is sharply strengthened if such phenomena occur under the same external conditions in many people and proceed without an increase in temperature. Objective research almost always allows the physician, along with the diagnosis of poisoning, to establish the path of penetration of the poison into the body (through the gastrointestinal tract, lungs, skin) and to some extent trace its excretion (examination of urine, stool). Knowledge of the pharmacotherapeutic action of individual medicinal substances can significantly help the diagnosis, but it is often insufficient, since the toxic effect of large doses can differ significantly from the therapeutic one, because in poisoning the characteristic selective or predominant action of a given drug on individual organs and tissues is often erased, and phenomena from the most vital organs, such as the central nervous system and heart, or from organs subjected to strong local irritating effect (gastrointestinal tract, skin, excretory organs) begin to dominate. Symptoms characteristic of some poisonings are collected in tables 1, 2 and 3, with the first two tables aiming to allow, based on the presence of one or another symptom, to arrive at a presumptive diagnosis of poisoning by a specific agent; the characteristic action of the latter, indicated in table 3, can then be compared with the phenomena observed in this case. Course of poisoning. The first local effects of poisoning occur immediately after taking the poison only with caustic and irritating poisons, causing irritation and necrosis at their sites of application and strong reflexes to distant organs (changes in cardiac activity, respiration, etc.). The interval between taking the poison and the manifestations of poisoning depends on the nature of the poison, the size of the dose and the conditions that enhance or limit its absorption and action (see Medications). In fatal poisonings, the phenomena as a rule increase until death. In acute non-fatal cases, the increase usually goes up to a certain limit (absorption of the poison) and then the symptoms weaken (excretion or destruction of the poison). In some cases (mineral, narcotic poisons), it happens that after the decrease of the phenomena they increase again due to secondary absorption of the poison from depots or due to successive changes in the body itself, which can lead to a fatal outcome. The rate of excretion is very high for gaseous poisons, alkaloids and easily soluble mineral poisons, so that many of them appear in the urine in the first hours. Slower to be excreted are poisons that form strong compounds in the body (e.g. heavy metals). Prognosis. For recovery, it is necessary to excrete or remove the poison from the body and eliminate the changes in organs caused by the poison; the sooner this happens, the more favorable the prognosis, all other conditions being equal. More favorable conditions in poisoning per os than in subcutaneous administration of the poison, since medical removal of the poison is impossible in the latter case. All other conditions being equal, the prognosis is worse in children, old people and in persons weakened by diseases.

Among individual symptoms, the most alarming are facies hippocratica and pulmonary edema, but even in such cases, it is often possible to save the poisoned person. A very unfavorable symptom is cold sweat, whereas muscle twitching and convulsions are often not as threatening symptoms. Coma, even lasting for hours, can end favorably. The absence of a pulse in the presence of at least weak breathing, or the absence of breathing in the presence of a pulse, is not absolutely a bad omen, as cases of recovery have been described where breathing ceased for 1-2 hours (artificially maintained) or the pulse was barely perceptible for 1/2-1 hour. Restitutio ad integram can usually (but not always) occur after poisoning by alkaloids, volatile and gaseous poisons. Poisoning by mineral poisons more often gives a prolonged course. In poisoning by metallic poisons, long-term nutritional disorders (due to fatty degeneration of individual organs and tissues) or disorders of the nervous system function (often after lead salts, after arsenic) may remain. Treatment of acute poisonings. Due to the rapid course of acute poisoning, the doctor often has no time to make an accurate diagnosis and must use the general principles of treating acute poisonings. Experience shows that this kind of therapy gives a favorable result in the vast majority of cases. The main tasks in treating acute poisonings are as follows. 1. If possible, prevent or at least hinder the absorption of the poison that has entered the body. For this purpose, attempts are made to remove the poison mechanically or inactivate it by chemical or physicochemical means. 1) External mucous membranes, skin, wounds. The poison is removed by washing with large amounts of water (with physiological solution for wounds) or with chemically neutralizing agents, namely: in poisoning by acids, diluted alkalis, lime water, soapy water, etc. are used; with alkalis-diluted vinegar or weak acids (Ac. tartaricum, Ac. citricum), lemon juice; with organic poisons soluble in lipids-benzene, carbon tetrachloride, alcohol, ether; with organic bases (for example aniline)-washing with very diluted hydrochloric acid (to form a poorly absorbed salt); with oxidizing organic poisons and irritants-oxidizing agents (Calcium chloratum, Calcium hypochlorosum, seu Calcaria chlorata, Kalium hypermanganicum, Chloraminum, Dichloraminum.T, Dakin's solution). In addition to the above, sometimes squeezing or cauterizing the wound, bandaging and immobilizing the affected limb are performed. Suction of the poison (in snake bites) from the wound may be dangerous for the person providing assistance if the integrity of their oral mucous membrane is damaged (scratches, ulcers, etc.), so it is more rational to use leeches. In case of acid burns of the conjunctiva or cornea of the eye, it is advisable to wash with large amounts of highly diluted sodium bicarbonate; dusting or placing behind the eyelid for the same purpose magnesium oxide or calcium carbonate powder is dangerous due to the corrosive action of the salts formed in strong concentrations. 2) Stomach. Complete removal of the poison even immediately after swallowing is impossible due to the uneven surface of the stomach (folds) and the presence of mucus, colloids, etc. in its contents, but still it is often possible to remove a larger part of the poison even after 1-2 hours or later. a) The best way to empty the stomach is by washing it through a tube. The tube is inserted into the stomach, the funnel is filled with lukewarm water (7₂-1 liter), and when almost all the water has flowed into the stomach, the funnel is lowered below the level of the stomach, whereupon (by siphon) the stomach contents flow into a specially placed vessel; then the funnel is filled again and the procedure is repeated; such washing is performed several times. To prevent the tube from being compressed or bitten off, a plug can be placed between the teeth. Occasionally, washing is done through a thin tube inserted into the stomach through the nose. Adding a small amount of 3% hydrogen peroxide to the washing water facilitates the washing of the poison from the stomach. Due to the fact that a large influx of water can accelerate the dissolution of some poisons, it is rational to combine washing with adsorption therapy (animal charcoal, tannin, etc.). Instead of water, solutions and suspensions that are recommended as specific antidotes (chemical antidotes, tea, coffee, milk, animal charcoal in pure water, etc.) are also used. Instead of stomach washing, emetics can be used, but they achieve less complete emptying of the stomach and are ineffective in case of paralysis of the vomiting center (poisoning by narcotic fats, morphine, etc., when unconscious) or may be dangerous (possibility of aspiration and suffocation). The best emetic is apomorphine (under the skin), directly stimulating the vomiting center. Among reflex emetics, copper sulfate, zinc sulfate are used, rarely ipecacuanha and antimony tartar. Vomiting can be induced by tickling the pharynx or root of the tongue with a goose feather, inserting fingers into the throat, pressing on the abdomen, massaging the stomach area with the body bent forward, introducing a large amount of warm water, to which fat, oil, soap, mustard flour and mustard (dessert spoon per glass of water) or table salt (tablespoon per glass of water) can be added.

The latter is contraindicated in cases where it causes accelerated dissolution of the poison (sublimate) or irritates the burned mucous membrane (alkalis, acids). Existing vomiting is maintained by administering large amounts of milk, beaten egg white, etc. Emetics, as well as gastric lavage, are contraindicated (danger of rupture of the esophageal and gastric walls) in poisonings by poisons that act by corroding the walls of the esophagus and stomach (strong mineral acids, caustic alkalis, salts of some heavy metals, etc.). In these cases, emetics and lavage can only be used immediately after the poison has been taken. b) To slow down the absorption of the remaining poison in the stomach, adsorbent, precipitating, and coating agents are used. These include charcoal (Carbo medicinalis), both animal and vegetable, but freshly calcined (activated), less effective are white clay (Bolus alba), aluminum preparations (Argilla pura), Magnesia usta. They bind many poisons, bacterial toxins, animal poisons, alkaloids, glycosides. In poisoning with arsenic or potassium cyanide, freshly precipitated colloidal iron hydrate is used. In poisoning with salts of heavy metals, acids, alkalis, halogens, and other caustic poisons, colloids are given internally, namely milk, egg white (raw, beaten in water at the rate of 2 whites per bottle of water), vegetable protein, gelatin, mucilaginous soups, flour, starch decoction, Mucilago Gummi-arabici, Mucil. Salep, vegetable glue, decoction of flaxseed, in extreme cases - fruit jelly. For poisons soluble in fats (phosphorus, aniline, nitrobenzene), the administration of milk, fat, and oil is contraindicated. Astringents (coffee, tea, red wine, large amounts of tannin, bilberries, decoctions of various roots, wood, bark, etc.) with many metal salts, some alkaloids, and glycosides form difficultly soluble and therefore almost non-absorbable compounds. For most alkaloids, astringents are unsuitable, because soluble compounds of tannin with alkaloids are formed in excess. The simultaneous administration of protein and astringents is meaningless; charcoal is also better given alone, since protein and other colloids reduce its effect. Similarly, it is irrational to give charcoal in coffee, tea, wine, etc.; it should be taken only with pure water. All products resulting from precipitation, formation of complex compounds, and adsorption should be removed from the digestive canal as soon as possible, since digestive processes, the action of bacteria, etc. can gradually release the inactivated poisons. Therefore, for example, it is advisable to administer charcoal simultaneously with Magnesium sulfuricum or Natrium sulfuricum as laxatives. In this way, the formation of charcoal stones in the intestine is prevented. Since spasms in the pylorus and small intestine often occur when adsorbents are administered, antispasmodic agents (papaverine, atropine, 20-40 drops of Spiritus camphoratus) can be given simultaneously. c) Chemical neutralization of the not yet absorbed poison does not always give certain success. In acid poisoning, Magnesia usta and so-called sugar lime (Calcaria saccharata) are given, less often chalk (Calcium carbonicum), soapy or lime water. Since such neutralization of acids forms salts that are not indifferent to the irritated mucous membrane at such concentrations, alkalis should be introduced highly diluted with water or washed down with large amounts of water. Carbonates are contraindicated in acid poisoning due to the development of carbonic acid and bloating of the stomach. Even in diluted solutions, alkaline hydroxides and ammonia are completely unnecessary. In alkali poisoning, very diluted vinegar, lemon juice, sour wine, weak solutions of organic acids (Ac. tartaricum, Ac. citricum, Ac. benzoicum) are given. Neutralization of the poison (e.g., alkaloids) by its oxidation (administration of hydrogen peroxide, potassium permanganate, old ozonized turpentine, etc.) is of little practical use (exception - KMnO₄ in the appropriate solution in morphine poisoning). Some salts can possibly be converted by the administration of other salts into insoluble and therefore harmless ones: e.g., in silver nitrate poisoning, NaCl is given to form AgCl; in oxalic acid poisoning and its alkaline salts - calcium salts to form insoluble calcium oxalate; in soluble barium salts - sulfate salts to form insoluble barium sulfate; in copper salts - potassium ferrocyanide solution; in lead salts - sodium sulfate, etc. 3) Intestine. The poison is removed with laxatives, of which Magnesium sulfuricum and Natrium sulfuricum are especially recommended; due to their saline effect, they also reduce the absorption of the poison from the intestine. Oil of Ricini is used less often; it is unsuitable in poisoning by oil-soluble poisons (phosphorus, cantharidin, camphor). The administration of laxatives is usefully combined with the use of high enemas. II. The poison absorbed into the blood must be removed from the body as soon as possible or at least significantly reduce its concentration in the blood by introducing large amounts of fluid and enhancing the activity of excretory organs (kidneys, sweat glands, and lungs). For these purposes, the following are used: 1. Intensive introduction of fluids: orally, hot tea of all kinds, and where this is not possible (due to cauterization or ulceration of the digestive tract) - drip enemas of water or physiological NaCl solution, subcutaneous or intravenous (especially after bloodletting) administration of large amounts (up to 1 liter or more) of sterile physiological NaCl solution, Ringer's solution, 10-20% glucose solution, etc. Table 3. First aid in poisonings. No. Name of poison ! Symptoms of acute poisoning Help in poisoning Adamsite (diphenylamine-chlorarsine) See Combat Q.V., irritating 1 Adonis vernalis See Foxglove Adrenaline Restlessness, nervousness, muscle tremor, palpitations, precordial anxiety, increasing pulse and respiratory rate, increase in blood pressure and temperature, sometimes hyperglycemia and glycosuria. In severe cases - then vomiting, acute heart dilation, threadlike pulse, pulmonary edema, death from paralysis of the heart or respiratory center Inhalation of amyl nitrite, chloral hydrate in enema, artificial respiration; otherwise - symptomatic treatment Infernal stone See Silver nitrite Nitrous acid After inhalation of vapors - cough, catarrh of the larynx and bronchi, shortness of breath, abundant bloody or yellowish sputum; in poisoning per os - gastrointestinal disorders, slowing of pulse and respiration, cyanosis, coma In poisoning by inhalation - fresh air, inhalation of water vapor with ammonia; in poisoning per os - abundant drinking, diuretics, coating agents, coffee, stimulants (caffeine, camphor) Sodium nitrite See Nitroglycerin Nitric acid (Ac. nitricum) Pain and burns in the mouth, pharynx, and stomach, yellow discoloration of the tongue and oral mucosa, vomiting mostly yellowish, often mixed with blood masses, difficulty swallowing, painful abdominal distension, constipation, less often diarrhea, decreased urination, usually albuminuria, often cylinders and blood in urine, collapse, often also laryngeal edema, loss of consciousness, drop in temperature; after inhalation of concentrated acid vapors, pulmonary edema may develop Abundant drinking, first of all water, water with ice and alkalis, in extreme cases (until other means are obtained) internally - chalk, ash, eggshell, fats and oils, milk, egg white, 1% solution of caustic soda, or even better, calcined magnesia with water (Rp. Magnes. hydrooxydateae 30,0 recente paratae in Aqua 200,0, DS. take 1/2 at once, then every 10 minutes a tablespoon); if the previous preparation is not available, give lime water (a tablespoon every 5 minutes), Calcaria saccharata (a tablespoon every 5 minutes); further - coating agents (Decoetum Salep, Muc. Gummiarabici, Decoct, sem.

(in tablespoons every 5 minutes), oat broth, milk (by the glass), fats and oils, raw eggs (6-12 pieces), egg white; symptomatically: for thirst - ice pills, cold drinks, enemas; with severe difficulty swallowing - feeding via enemas; for anuria - diuretics (diuretin, theocin); for pain - morphine, pantopon; for swallowing disorders - lubrication of the oral and pharyngeal mucosa with a 2% solution of novocaine hydrochloride; for collapse - subcutaneous stimulants (camphor, caffeine), cold douches; for laryngeal edema - tracheotomy; avoid emetics, alkali carbonates, and gastric tube insertion (danger of stomach wall rupture!). Silver nitrate (lapis, hellstone) Oral mucosa is white or gray, pain in the stomach and intestines, vomiting of white masses that blacken in light, dark diarrhea, peritoneal symptoms; then - dizziness, convulsions, paralysis; with subcutaneous administration of silver salts - dark border on the gums Wash the stomach with a 2% NaCl solution; orally, 0.5% NaCl solution in tablespoons repeatedly, solution of potassium or sodium iodide (5.0-10.0: 500.0); milk, albumin water, mucilage broths; ice in pieces, castor oil in emulsion; oil enemas or enemas with milk and salt; cold to the epigastric region; for collapse - subcutaneous caffeine, camphor, ether № Name of poison ! Symptoms of acute poisoning Help in poisoning Yellow acacia (Cytisus laburnum L., ракитник, golden rain, cytisine) Nausea, prolonged vomiting (even with blood), pain in the stomach and intestines, sometimes diarrhea, flatulence, headache, dizziness, feeling of fear; breathing is slowed, cyanosis, skin is cold, cold sweat, pulse initially rapid and weak, then slow and irregular; pupils dilated, sometimes dry, muscle twitching and general convulsions, delirium, hallucinations, respiratory paralysis Quickly and thoroughly wash the stomach; orally - laxative, animal charcoal, wine, cognac; subcutaneously - ether, camphor, caffeine; wrapping in heated blankets, artificial respiration, for convulsions - chloral hydrate Aconite See Monkshood Alcohol See Alcohol Aloe Inflammation of the intestines, colic, tenesmus, diarrhea, sometimes with blood and discharge of membranes, sometimes hemorrhagic nephritis; during pregnancy, abortion is possible Mucilage broths, opium orally and in enema Aluminum (potassium alum) Vomiting, gastro-intestinal pain, weakness Soapy water, milk, chalk, alkalis, otherwise symptomatic measures Amygdalin See Hydrocyanic acid Amylene hydrate

Specific smell of exhaled air, heavy drowsy state, small, soft and slow pulse. See Sleeping drugs. Amyl nitrite. Strong beating of carotid arteries, headache, redness of face, skin of head and neck, sometimes jaundice, feeling of heat, cough, dizziness, tightness in chest, dilation of pupils, palpitations, fainting; specific smell of exhaled air, sometimes xanthopsia. Fresh air, cold washes and douches, stimulants (caffeine, camphor under the skin), artificial respiration; bloodletting followed by administration of physiological NaCl solution. Ammonia. See Spirit of ammonia. Aniline (chemical dyes, pencils, etc.), nitrobenzene (mirban oil), toluidine, etc. Vomiting (with nitrobenzene - with characteristic smell of bitter almonds), fat droplets in vomit or lavage waters, dizziness, weakening of hearing and noise in ears, drowsiness, cyanosis of skin, lips and nails, shortness of breath, dilation of pupils, collapse, weak pulse, drop in temperature, depression of consciousness to a state of sopor, in severe cases - clonic or tonic-clonic convulsions, coma and death. For oral poisoning, stomach lavage or emetics (better apomorphine), then saline laxatives (Glauber's salt or Epsom salt, but not castor oil); orally - egg white, hot black coffee; do not give (as they increase absorption when dissolved) fat, oil, castor oil, alcohol, ether; warming the body; stimulants - under the skin camphor, caffeine or ether; rubbing the skin, warm baths with cold douches to the head; in severe cases - bloodletting followed by blood transfusion or administration of physiological NaCl solution, Ringer's solution, etc. For poisoning by aniline vapors - fresh air, artificial respiration, inhalation of oxygen; under the skin - caffeine, camphor; warming the body. Antimony. See Arsenic. Antipyrine, antifebrin (acetanilide), pyramidon, phenacetin, citrovanillin. Dilation of pupils, weakening of hearing, diplopia, noise in ears, nausea, vomiting, sweat; with antifebrin and phenacetin - cyanosis of skin and mucous membranes, headache, small pulse, decrease in body temperature, drowsiness, delirium, convulsions in calves, severe shortness of breath, coma; in urine - products of blood decomposition, acetone; sometimes skin rashes. Stomach lavage with cold water (avoid prescribing alcohol and warm water as they increase the solubility of the poison) or emetics; warming the body, stimulants - under the skin caffeine, camphor, strychnine, atropine; inhalation of spirit of ammonia; irritation of the skin (mustard plasters, rubbings, etc.); orally - diuretics, water, milk, sugar solutions; for convulsions orally chloral hydrate, sodium bromide. Name of poison Symptoms of acute poisoning Help in poisoning Antifebrin. See Antipyrine. Apomorphine. Nausea, vomiting, intermittent stertorous breathing, weak, irregular pulse, collapse. Maintain vomiting by giving orally warm milk, mucilage decoctions; mustard plasters, subcutaneously - camphor, caffeine, ether, strychnine, orally - 2% tannin solution, strong coffee or tea. Arecoline. Salivation, pupil constriction, scratching in the throat, dizziness, diarrhea, very slow and soft pulse, depression of consciousness. Stimulants, under the skin atropine, if taken orally - stomach lavage with tannin solution; otherwise treatment - purely symptomatic. Arrenal. See Arsenic. Atoxil. See Arsenic. Atropine (deadly nightshade, or belladonna, Atropa belladonna), hyoscyamine (henbane, Hyoscyamus niger), datura, scopolamine, homatropine. Severe dryness and burning in the mouth and pharynx, hoarseness, intense thirst, difficult swallowing; sharp dilation and immobility of pupils, amaurosis, red face, dry skin; sometimes skin rashes, very frequent pulse, headache and dizziness, strong excitement up to delirium and violent state, hallucinations, attacks of clonic or tonic-clonic convulsions; after belladonna often nausea and vomiting, after datura - bloody diarrhea; in late stage of poisoning - sharp depression of the central nervous system. Removal of poison from the stomach - vigorous stomach lavage, preferably with the addition of animal charcoal or tannin (for adsorption of poison), emetics (apomorphine subcutaneously or copper sulfate orally); for poisoning with plant material (as it remains in the intestines for several days) - castor oil, high enemas or enemas with oil or glycerin; to calm the cerebral cortex morphine (1% solution, 2 cm³ subcutaneously, repeated after 1 hour until calm), chloral hydrate (orally or in enema), inhalation of chloroform (until sleep occurs); against rush of blood to the head - compresses with ice water, enemas with vinegar; as physiological antagonists to iron and heart, cautious use of 1% solution of pilocarpine hydrochloride subcutaneously (1 cm³ every 15 minutes until the painful dryness in the mouth disappears), solution of 1:1000 physostigmine salicylate (1/2-1 cm³ subcutaneously); against sharp dilation of pupils and visual disturbances - instillation of 1/2-1% solution of physostigmine salicylate into the eyes; with depression of the central nervous system and weak heart - caffeine, strong coffee and tea; if necessary - artificial respiration. Acetylene. Loss of consciousness, immobility of pupils, cyanosis, coma or manic state, hallucinations, acute delirium ending in coma. Fresh air, with depression of the central nervous system - stimulants, with excitement - depressants (e.g. chloral hydrate, etc.), otherwise symptomatic treatment. Barium and its compounds (caustic barium, barium chloride), use in radiography of barium sulfate contaminated with barium carbonate. Vomiting, headache, dizziness, profuse diarrhea, colic, profuse sweat, rare and hard, then irregular and accelerated pulse, double vision, convulsions, oliguria. Stomach lavage with water or 1% solution of sodium sulfate, then - orally alkali sulfates in strong dilution (Glauber's salt or Epsom salt 20.0 in 150.0 water, a tablespoon every 5 minutes); after this emetics to remove the formed barium sulfate; then - mucilage drinks, milk, stimulants (subcutaneously camphor, caffeine), into the vein 3% solution of sodium sulfate (Starkenstein). Colchicum autumnale, colchicine. 2-6 hours after oral intake - burning in the pharynx and throat, pain in the stomach and throughout the abdomen, thirst, suffocation, vomiting, profuse diarrhea rice-like, often also bloody. Stomach lavage with 0.2% tannin solution; orally mucilage drinks, warm milk, strong tea, white clay or tannin solution; with excessive vomiting - ice; against diarrhea - opium; against fluid loss - water administration; diuretics; against collapse - stimulants, warm baths. Henbane. See Atropine. Whitewash. See Chlorine. Belladonna. See Atropine. Gasoline. See Benzene. Benzene (coal tar benzene), kerosene. When inhaling vapors - excitement similar to intoxication, headache, then - depression of consciousness, narcosis, dilation and immobility of pupils, nystagmus, respiratory disorders, coma; sometimes - nosebleeds, skin bruises; when swallowed in addition to the above, also symptoms from the stomach and intestines (burning, pain, vomiting, etc.), paralysis of the facial and other nerves; with kerosene poisoning - fat droplets in vomit or lavage waters. Fresh clean air, artificial respiration, electrification of the chest in the heart area; stimulants - subcutaneously caffeine, camphor, atropine, orally - black coffee; inhale spirit of ammonia; alternating hot and cold showers, mainly on the chest; ice on the head. For oral poisoning - stomach lavage or emetic, orally - hot milk, provence oil, castor oil; mustard plasters on the abdomen; in addition - measures mentioned above. Berthollet's salt (Potassium chlorate). Nausea, vomiting with black-green (or black-yellow) masses, pain in the stomach, diarrhea, jaundice, green-violet spots on the skin, red-brown or black urine (methemoglobin); very little urine; headache, severe shortness of breath, cyanosis, enlargement of liver and spleen, delirium, coma, weakness of heart, convulsions, collapse. Repeated stomach lavages or emetics, abundant hot drinking (avoid acids, acidic lemonades, carbonated drinks), sodium carbonate (a teaspoon in a large amount of water), diuretics, laxatives (Glauber's salt, Epsom salt or castor oil); high enemas with soda; bloodletting followed by administration of physiological solution into the vein, also alkaline solution of sodium chloride (0.3% sodium carbonate + 0.6% sodium chloride), sodium bicarbonate or sodium acetate into the vein; if no collapse - subcutaneously pilocarpine; with collapse - stimulants, warm baths with cold douches; as causal treatment - sodium hyposulfite into the vein (Lipschitz). Combat poisonings.

1) Asphyxiating agents (chlorine, phosgene, diphosgene, etc.). Conjunctivitis, burning in the nose and throat, feeling of tightness in the chest, spasm of the vocal cords, cough, dizziness, sometimes ringing in the ears, palpitations, some general weakness, slight blueness of the lips, nose, and ears; in severe poisonings - severe cough with copious frothy sputum (often with blood), extreme shortness of breath, rapid heartbeat, headache, general weakness, cyanosis, cooling of the extremities, pulmonary edema. Removal from the poisoned atmosphere, removal of contaminated clothing, cutting of hair, washing of the body with water heated to 30-35° with green soap; complete rest, warming of the body (warm room, hot water bottles, hot drinks, etc.); for cardiac weakness - subcutaneous injection of camphor, caffeine, ether, intravenous injection of strophanthin (0.25 mg in solution); administration of oxygen every 1/4 hour for 3-4 minutes (4-6 liters per minute) until cyanosis disappears; it is desirable to humidify the oxygen; artificial respiration is contraindicated (danger of rupture of lung tissue); bloodletting (not less than 400-700 grams of blood) in the first hours after injury, if pulmonary edema increases, bloodletting can be repeated after several hours; it cannot be performed in anoxia complicated by collapse; to combat the appearance of pulmonary edema, intravenous infusion of a 10% solution of calcium chloride (5-10 ml, can be repeated after 12-24 hours) at a rate of 10 ml per 3 minutes; for the same purpose, a 25% solution of glucose (Saccharum) is administered intravenously, 30-50 ml repeatedly; symptomatic remedies: for spasm of the vocal cords - heat, rhythmic pulling of the tongue according to Labord, insertion of a Nelatonsky catheter into the trachea, in severe cases - intubation and tracheotomy in combination with artificial respiration; for spasmodic cough - codeine, diionin; for weakened respiration - stimulants (caffeine, camphor, lobelia); for eye irritation - washing with 3% boric acid or 2% soda solution, instillation of 1% zinc sulfate solution, application of alkaline ointment (2% sodium bicarbonate or Wessely's ointment: Borax 1.0, Sodium bicarbonate 2.0, Distilled water, Lanolin anhydrous ana 10.0, Vaseline ad 100.0); for photophobia and spasm of accommodation - instillation of atropine solution; for thirst - hot milk, tea, coffee; food - liquid. See Carbon monoxide and Hydrocyanic acid

Bromoform. State of intoxication, loss of consciousness, deep narcosis, anesthesia, paleness, cyanosis, shallow breathing, weak pulse, pulmonary edema, iodoform odor from the mouth. Gastric lavage, artificial respiration, cold douches in a warm bath, stimulants under the skin (camphor, caffeine). Veratrin (protoveratrine, white hellebore, sabadilla seeds). Scratching and burning in the mouth, throat, and esophagus, salivation, thirst, vomiting, abdominal pain, severe diarrhea, slowed respiration and pulse, paresthesia of the extremities, dizziness, headache, paleness and darkening of the face, trembling, rigidity and weakness of muscles, clonic or tonic-clonic convulsions and collapse. Gastric lavage with tannin solution; internally - tannin, iodine water; against vomiting - morphine, ice; for collapse - stimulants (caffeine, strong wine, ether, camphor); for colic - opium, morphine; artificial respiration. Name of poison. Symptoms of acute poisoning. Assistance in poisoning. Veronal. See Hypnotics. Hellebore. See Ranunculaceae plants. Bismuth and its salts. Soreness of the gums, black border on the teeth, stomatitis, loss of appetite, ecchymoses on the mucous membranes of the lips, difficult swallowing, salivation, digestive tract disorders, black stools, skin phenomena (pruritus), exanthema, purpura and other rashes. It is possible to remove bismuth from a wound more quickly; when taken internally - gastric lavage, emetics, castor oil, diaphoretics, diuretics; for skin phenomena - intravenous injections of sodium hyposulfite; otherwise - symptomatic treatment. Wolf's bane, wolf's pepper (Daphne mezereum). Burning and redness in the throat, salivation, stomach pains, bloody-mucous vomiting, diarrhea, colic, blood in the urine, weakness, cerebral phenomena, blisters on the skin. Gastric lavage, emetics (apomorphine), internally - ice cubes, opiates, oily and mucous drinks. Laughing gas. See Nitrous oxide. Carbon monoxide. See Carbon monoxide gas. War gases. See War gases. Harmful gases (carbon dioxide, marsh gas, illuminating gas). Headache, noise in the ears, dizziness, nausea, sometimes vomiting, loss of consciousness, sharp weakening of respiration, coma. Pure air, artificial respiration, inhalation of oxygen, inhalation of ammonium spirit; internally - diluted (40°) alcohol, cognac, coffee; under the skin - caffeine, camphor; on extremities - mustard plasters; put to bed, rest. Hashish. See Indian hemp. Guaiacol. See Carbolic acid. Helleborein. See Black hellebore. Gelsemine, gelseminin (yellow jasmine). Dizziness, dilation of pupils, paralysis of the eyelids, yawning, drowsiness, dryness in the throat, weakness in the legs, nausea, vomiting, trembling of hands, shortness of breath. Gastric lavage or emetic, artificial respiration, stimulants (caffeine, camphor under the skin). Heroin. See Morphine. Hydroquinone, pyrocatechol, resorcinol. State of intoxication, delirium, severe decrease in temperature, cyanosis, collapse, convulsions, at the end paralysis. Gastric lavage or emetic (apomorphine, zinc sulfate), stimulants (caffeine, camphor under the skin). Hyoscyamine. See Atropine. Cowslip. See Foxglove. Mustard oil, mustard (Brassica nigra, Brassica juncea, Sinapis alba). With prolonged irritation of the skin - intense rose-like inflammation with blister formation and scabs; when it gets in the eye - conjunctivitis; when large quantities are introduced into the stomach - stomach pains, salivation, vomiting, diarrhea, trembling, weakness, slowed pulse, shortness of breath, drop in temperature and collapse, irritation of the kidneys (protein and hemoglobin in urine); may cause abortion (often taken for this purpose). Gastric lavage with tannin solution; internally - tannin, animal charcoal, mucous drinks; saline laxatives (Glauber's salt, Epsom salt); for collapse - stimulants; food in the first days consists of tea and mucous soups; for skin irritation - indifferent liquid ointments, ointment compresses. Bitter almond. See Hydrocyanic acid. Poisonous mushrooms (morels, fly agarics, etc.). Nausea, repeated vomiting, abdominal pain (colic), persistent diarrhea (often bloody), severe thirst, headache, dizziness, salivation, slow and small pulse, decreased temperature, narrowing (and with cyanosis - dilation) of pupils, visual disturbances, shortness of breath, general weakness, moist skin, delirium, convulsions ending in paralysis; in the last stage - loss of consciousness, coma; with fly agaric poisoning - enlargement of the liver, very sensitive to pressure. Energetic and repeated gastric lavage with water or water with tannin or emetic; then castor oil, high enemas (can with 0.2% tannin solution), animal charcoal per os; with fly agaric poisoning when pulse is slowed - under the skin 1 cm of 1:1000 sulfate of atropine (but not in the stage of excitement); for vomiting - internally ice pills or cocaine; for general weakness and collapse - warm baths with cold head douches, internally - strong black coffee or tea, on the skin - mustard plasters, under the skin - caffeine, camphor; for severe asphyxiation - injection into a vein of physiological solution or grape sugar solution in Ringer's fluid; in the stage of excitement - cold compresses on the head, internally opium or under the skin morphine, enemas of chloral hydrate; food in the first days consists of tea and mucous soups; do not give acids and vinegar! Gummi-gutt (Gummi-gutta). Severe diarrhea without meteorism symptoms, sometimes vomiting, headache, abdominal pain, collapse. Emetic (ipecacuanha), oil, milk, protein-containing drinks, mucous drinks, mucous enemas, ice cubes, opium, under the skin - morphine, camphor; warm bath. Dermatol. See Bismuth. Digitalis. See Foxglove. Dinitrocresol (saffron surrogate). Yellow coloring of the mouth and throat; formation of methemoglobin, jaundice, cyanosis, methemoglobinuria. Gastric lavage or emetic, high cleansing enemas, diuretics, alkaline drinks, inhalation of oxygen. Dionin. See Morphine. Diuretin, theobromine. Headache, loss of appetite, nausea, vomiting, intestinal spasm, with very large doses - muscle trembling, increased reflexes, hemorrhages in the stomach, protein in urine; erythema, convulsions. Gastric lavage with water or tannin solution, laxatives (saline or castor oil), injection into a vein of physiological solution. Diphenylchloroarsine. See War gases, irritants. Diphenylcyanarsine. See War gases, irritants. Diphosgene. See War gases, suffocating gases. Dichloroethylene. See Tetrachloroethane. Dichloroethylsulfide. See War gases, vesicants. Wood alcohol. See Methyl alcohol. Broom. See Sparteine. Datura. See Atropin. Javelle water. See Chlorine. Yellow jasmine. See Gelsemine. Iron sulfate. Vomiting, black stools, abdominal pain, prostration. Repeated gastric lavage, internally - milk, protein, mucous drinks, laxatives, then Magnesium hydroxydatum no 1.0-2.0 per dose in water, Magnesium carbonicum no 0.5-2.0 several times a day, soda, lime sugar. Ferric chloride. See Iron sulfate. Zigunets. See Ranunculaceae plants. Nitrous oxide (Nitrogenium oxydulatum), laughing gas. Noise in the ears, manic state, acute delirium, excitement phenomena, loss of consciousness, cyanosis, narcosis, then - asphyxia and death from paralysis of respiration (without convulsions, as the centers are paralyzed). Artificial respiration, inhalation of oxygen (periodically for 10-15 minutes); into a vein - 20% grape sugar, otherwise - symptomatic treatment. French green. See Arsenic. Snake venom. See Snake bites. Lime. See Alkalis. Indian hemp. See Indian hemp. Insulin. Feeling of strong hunger and fatigue, restlessness, fearfulness, loss of proper assessment of one's sensations, feeling of trembling (but muscle tremor is rare), mild coordination disorders for fine movements, often paleness or redness of the face, feeling of cold or heat, profuse sweating. In more severe cases - all kinds of mental disorders, delirium and coma; in individual cases convulsions and even fatal outcome were observed. With initial phenomena, it is sufficient to give 2-3 pieces of sugar (if needed several times) or an orange, orange juice (from 2 oranges), lemonade with the addition of 10 g of glucose or 20 g of white bread.

In severe cases - subcutaneous glucose (30-40 cm³ of a 10-20% solution) or, even better, into a vein (100-200 cm³ of a 5-10% solution); in the latter case, symptoms disappear almost instantly; less effective are subcutaneous administrations of adrenaline (*/g-1 ^cm3 of a 1:1,000 solution), pituitrin (1 cm³) or a mixture of both. Iodine (tincture of iodine, iodoform) Lassitude, loss of appetite, headache, conjunctivitis, skin rashes, insomnia, sometimes vomiting and diarrhea, small and rapid pulse, cyanosis without respiratory disorders; often psychoses (maniacal attacks, persecution mania, refusal of food); in severe cases - convulsions, deep comatose state, very small, rapid pulse, sometimes death with feverish phenomena; when free iodine is swallowed - brown discoloration of the tongue and oral mucosa, specific odor of exhaled air. Removal of iodoform from the wound; in O. per os - repeated washing of the stomach with a 1/2% solution of sodium hyposulfite, and then with water; internally - liquid starch paste, flour decoction, milk, albumin water, mucilaginous drinks, alkaline waters, calcined magnesia, potassium acetate (20.0-40.0 in 200.0 water, by tablespoonfuls), solution (1:12) of sodium bicarbonate; in O. by iodine vapors - inhale warm water vapor with a small addition of ammonia; repeatedly rinse the mouth, throat and nose with a 2% solution of sodium bicarbonate. Ipecacuanha. See Ipecacuanha root. Mustard gas (dichloroethyl sulfide). See War gases, blistering. Calabar bean, physostigmine (eserine) Restlessness, dizziness, vomiting, diarrhea, weakness and muscle rigidity, visual disturbances, salivation, lacrimation, profuse sweating, weakness, slowing and irregularity of the pulse, shortness of breath, collapse, pulmonary edema, muscle twitching, rarely clonic or tonic-clonic convulsions; pupil dilation rarely with internal use; during pregnancy - miscarriage. Stomach lavage (with tannin solution or potassium permanganate salt), emetic (apomorphine); internally - calomel as a laxative, subcutaneous injections of atropine sulfate, camphor, ether; artificial respiration; in convulsions - inhalation of chloroform. № | Name of poison Symptoms of acute poisoning Help in poisoning Caustic potash. See Alkalis 95

Potassium nitrate Vomiting, diarrhea, severe abdominal pain, collapse, painful muscle contractions; in severe cases - convulsions and comatose state Narcotic (opium), stimulant (camphor), ether, pieces of ice. Calomel. See Mercury. Camphora Headache, dizziness, visual and auditory disturbances, gastrointestinal disorders, excitement, delirium, convulsions. Stomach lavage, emetics; internally - laxatives (calomel, Glauber's salt or Epsom salt); avoid oily and alcoholic substances; in convulsions - chloral hydrate; subcutaneously in coma - caffeine, on the extremities mustard plasters, rubbing the body, alternating hot and cold showers on the chest. 95 Cantharidin. See Spanish fly. 95 Carbolic acid (phenol, lysol, creolin, creosote, etc.) When it gets on the skin - burning, eczematous rashes, whitening, profuse serous secretion, formation of blisters and ulcers, deep gangrene; when swallowed - burns of the mouth and pharynx, swelling of the lips and corners of the mouth, characteristic odor of phenol, headache, pain in the stomach area, nausea, vomiting, severe weakness, pallor of the face, irregular breathing, small and weak pulse; in severe cases - profuse sweating, pupil constriction, heart weakness, stertorous breathing, decrease in body temperature, weakening of cardiac activity, sometimes muscle twitching or convulsions; further - unconscious state, coma and death; urine, freshly excreted or left standing in the air, of olive or black-olive color (characteristic!), contains protein, cylinders and sometimes free hemoglobin; in O. of pure carbolic acid - rapid death (after 10-12 min.) from paralysis of the central nervous system, without the development of local phenomena. When the skin is affected, it is important to quickly wash it with lime water or water with alcohol, then apply an oil compress; alcohol, fats, glycerin, turpentine and ether, dissolving phenol, prevent its absorption or extract it from the tissues where it has penetrated; when the poison is swallowed, it is necessary to perform as soon as possible very careful (danger of stomach rupture), but abundant (until the smell of phenol disappears) stomach lavage with warm water or with the addition of calcined magnesia or Glauber's salt (30.0 per 1 liter of water) with 10% alcohol; if it is impossible to insert a tube, then after drinking large amounts of water, give emetics (apomorphin subcutaneously); internally - Saccharate of lime or lime water (by tablespoonful every 5 min.), Glauber's salt or Epsom salt (10.0 in 200.0 water by tablespoonful every 2 hours), calcined magnesia, ice, potassium acetate, albumin water, egg white, oily and mucilaginous substances, charcoal; avoid internally - alcohol, oil and other fats; enemas with Glauber's salt; calcium gives insoluble compounds; it is believed that sulfate salts convert phenol into non-toxic paired sulfur acids; subcutaneously - stimulants (camphor, caffeine, ether); on the abdomen - mustard plasters; warming the body; into a vein - saline infusions; if necessary - artificial respiration; against lowering of body temperature - wrapping in a warm blanket, hot water bottles, etc.; in case of laryngeal edema - intubation, tracheotomy. Alum. See Aluminum. Quillaja (soap bark). See Saponins. Kerosene. See Benzene. Cinnabar. See Mercury. 104 ! Castor oil plant (Ricinus communis, its seeds, oil cakes) When swallowed - burning in the pharynx, throat, esophagus, symptoms of gastroenteritis, vomiting of bile, headache, small and rapid pulse, jaundice, convulsions, anuria. Repeatedly wash the stomach and intestines, emetic; internally - pieces of ice, mucilaginous drinks with opium; subcutaneously - caffeine; on the abdomen - warming compress. № Name of poison '

Symptoms of acute poisoning. Assistance in poisoning. Cloacal gas. See Hydrogen sulfide. Codeine. See Morphine. Cocaine. Motor agitation, tremor, sharp pallor of the skin, cold sweat, dizziness, dilation of pupils, frequent and small pulse, vomiting, pain in the abdomen; subsequently-delirium, hallucinations, disturbance of respiration, respiration of Cheyne-Stokes type, attacks of short clonic or tonic-clonic convulsions, unconscious state; death from collapse and asphyxia. Limit the entry of poison into the body; with subcutaneous introduction of cocaine-tie the limb above the injection site, with introduction in the form of snuff powder-wash the nasal cavity, with per os introduction-stomach washing with water or with the addition of animal charcoal or a solution of potassium permanganate; internally-tannin; against spasm of cerebral vessels-horizontal position of the body, inhalation of amyl nitrite (3-4 drops on a handkerchief) or internally a solution 1:1,000 of nitroglycerin (1/2 cm³ up to 3 times); with signs of strong agitation-chloroform anesthesia (carefully!) or chloral hydrate in an enema, internally-sodium bromide (1.0-2.0); with collapse-black hot coffee or tea, cognac, 70% alcohol (by teaspoon), mustard plasters on the heart area, warm baths with cold douches, subcutaneously-camphor, caffeine; rubbing of hands and feet, wrapping them in warm sheets; bloodletting (400 cm³), infusion of physiological solution; morphine is contraindicated; some authors warmly recommend 5-10 cm³ of 10% calcium chloride into the vein (no more than 1 cm³ per minute); with severe disturbance of respiration-artificial respiration. 108 109 Sausage poison. See Ptomaines. Colocynth (Colocynthis). Inflammation of the stomach and intestines, bloody diarrhea, vomiting, convulsions of the calf muscles, peritonitis, weakness. Stomach washing, subcutaneously-apomorphine; oily and mucous fluids with opiates, white clay, warming compresses on the abdomen, infusions of salt solutions. Colchicine. See Autumn crocus. Coniine. See Hemlock. Indian hemp (Cannabis indica, hashish). Maniacal state, hallucinations, acute delirium with signs of agitation, increased pulse rate, dilation of pupils, stupor, specific smell of exhaled air. Wash the stomach with a solution of potassium permanganate or a warm NaCl solution; chloral hydrate internally or in an enema; subcutaneously-caffeine, camphor; on the head-cold compresses; warm baths, artificial respiration. Caffeine (coffee, tea). Restlessness, feeling of fear, palpitations, frequent pulse, unpleasant sensations in the stomach, dizziness, sweat; trembling and rigidity of muscles, subsequently-mental disorders, hallucinations; consciousness is preserved; death from paralysis of the heart. Remove all kinds of irritants, wash the stomach; internally-chloral hydrate or paraldehyde, veronal (or in the form of enemas); artificial respiration. Belladonna. See Atropine. Creosote. See Carbolic acid. Creolin. See Carbolic acid. Strong vodka. See Sulfuric acid. № Name of poison. Symptoms of acute poisoning. Assistance in poisoning. Croton oil and seed (Ol. et Semen Crotonis). Burning in the mouth and throat, vomiting, severe bloody diarrhea with pain in the abdomen, heaviness of the head, dizziness, cold sweat, cyanosis, collapse, asphyxia; fat droplets in vomit or wash waters; externally-dermatitis, eczematous skin rashes, when getting into the eye-conjunctivitis. Internally-ice cubes, milk, almond milk, mucous drink, opium in small doses; warm baths; avoid ammonia preparations; with collapse-cognac, ether, camphor; externally-cooling agents; to remove oil from the skin-

Wash with ether 113 Cubeba, black pepper Pain in the abdomen, fever, dizziness, skin rashes Gastric lavage or emetic (apomorphin under the skin) Cockle (darnel) Headaches, dizziness, stupor, diarrhea, vomiting Emetic (ipecac), castor oil, iodine solution in potassium iodide Cocculus fruit (Fructus Cocculi, picrotoxin) Severe pain and burning in the esophagus and stomach, vomiting, diarrhea, then shortness of breath, slow pulse, convulsions, death from paralysis of respiration Gastric lavage or emetic (copper sulfate or zinc sulfate); internally-chloral hydrate; it is convenient to administer it in an enema; in coma-caffeine, camphor, artificial respiration Lily of the valley See Digitalis Lysol See Carbolic acid Lobelia Symptoms are similar to symptoms in poisoning with tobacco; vomiting without diarrhea Gastric lavage. pieces of ice, opiates, in coma-stimulants Lewisite See War gases, blistering Luminal See Hypnotics Buttercup plants (anemone, clematis, buttercup, meadow saffron) Severe pain in the abdomen, inflammation of the digestive tract and kidneys, blisters on the skin, convulsions of the limbs, depression of the central nervous system Removal of the poison, swallowing pieces of ice, cocaine, opiates, demulcents Lunar caustic See Silver nitrate Potassium permanganate When taken internally-severe inflammation of the stomach-intestinal canal, phlegmon of the stomach, parenchymal degeneration of the heart, liver and kidneys; when gargling or douching with an overly strong solution-burn of the mucous membranes, their edema with subsequent inflammatory phenomena When taken internally-gastric lavage or emetics, oily laxatives (castor oil), then administration of charcoal, tannin, egg white, milk; weaker acting are mucous infusions (flax seeds, Gummiarabicum, starch). Kobert recommends internally yellow blood salt (formation of an insoluble precipitate); then-diuretics, stimulants; when the mucous membranes are affected-washing with a solution of Berthollet's salt, gargling with solutions containing menthol and alcohol Ergot (ergot, Secale cornu-tum) and its preparations Salivation, nausea, vomiting, headache, pain in the stomach, diarrhea, dizziness, feeling of crawling and tingling in the limbs, chills, visual disturbances, pupils dilated (sometimes narrowed), anesthesia; during pregnancy-often abortion, uterine bleeding; further-epileptiform convulsions, shortness of breath, fall in temperature, weak pulse, oliguria or anuria, delirium, coma Gastric lavage with water or a tannin solution, emetics (apomorphin); laxatives (Glauber's salt or Epsom salt, castor oil); then drinking infusions containing tannin; rubbing the limbs with aromatic alcoholic liquids, warm baths; for convulsions-warm baths, chloroform anesthesia, inhalation of amyl nitrite (2-3 drops on a handkerchief); in coma-stimulants (caffeine, camphor)

№ Name of poison Symptoms of acute poisoning Help in poisoning Copper and its compounds (especially copper sulfate, verdigris, copper paints, etc.) Prolonged metallic taste* profuse salivation, repeated vomiting of green or blue-green masses, green discoloration of sweat, headache, dizziness, pain in the abdomen, severe thirst, bloody diarrhea with tenesmus, difficult breathing, small and irregular pulse, fall in temperature, jaundice, collapse, delirium, convulsions, paralysis; scanty urine completely black in color, rich in protein; when swallowing copper sulfate and acetate-blue discoloration of the tongue and oral mucosa, with verdigris-green color Prolonged gastric lavage with a 0.1% solution of yellow blood salt, which forms an insoluble compound with copper; then internally the same (0.1% Kalium ferro-cyanatum by the tablespoon every 15 minutes) or calcined magnesia (30.0) to destroy copper sulfate or to adsorb copper compounds: animal charcoal (Carbo animalis 10.0 in 100.0 water), abundant amount of protein; fats (oil, fat, castor oil, milk) and acids cannot be given; as laxatives-Epsom salt or Glauber's salt; on the abdomen-hot compresses; under the skin-morphine 132 Mentha pulegium (pennyroyal or pennyroyal) When using tea from this plant or oil, the symptoms are the same as in phosphorus poisoning Clean the stomach-intestinal canal; diuretics, diaphoretics Methyl alcohol Often only after a latent period (up to 4 days)-loss of consciousness, deep coma, cyanosis, visual and respiratory disorders, rattling in the trachea, cold skin; death can occur already within 1/2 hour from the onset of symptoms; in other cases-restlessness, visual and auditory disorders, noise in the ears, severe pain in the abdomen, severe shortness of breath, convulsive attacks with immobile pupils, collapse Stimulants, diuretics, bloodletting followed by infusion of Ringer's solution or physiological solution, warming the body, morphine for pain, lumbar puncture to reduce pressure, under the skin adrenaline, repeated administration of alkalis internally or into a vein (for example 30.0 - 40.0 sodium bicarbonate in 500-1,000 cm3 of physiological solution) Bitter almond (Amygdalus communis amara), bitter almond oil and liqueurs (cherry, peach, maraschino), infusions from plum pits, cherry vodka Dizziness, headache, darkening of vision, rush of blood to the head, nausea, tightness in the chest, palpitations; then-deep and short breathing, loss of consciousness, general convulsions, paralysis of respiration and death; with rapid course of poisoning-sudden loss of consciousness, falling with a sharp cry, dilation of the pupils, a few convulsive sighs, cyanosis, death Gastric lavage with water or a solution of potassium permanganate; into a vein-physiological solution or Ringer's solution; also-Natrium hyposulfurosum (0.1 - 0.2 pro dosi); artificial respiration, inhalation of oxygen; cold dousing of the head and spine in a warm bath, stimulants and skin irritations Mirbane oil See Aniline Donets juniper, savin (Juniperus sabina) Burning in the throat and stomach, vomiting with the smell of juniper, diarrhea (sometimes bloody) with tenesmus, frequent urination, protein and blood in the urine, uterine bleeding; in pregnant women-miscarriage; signs of peritonitis, unconscious state, convulsions, coma Rapid gastric lavage possible, high enemas; then calomel as a laxative, mucous drinks with ice (fats not to be given), diuretics, diaphoretics; in fainting (collapse)-under the skin caffeine, camphor, ether 137 Milkweed Inflammation of the mucous membranes and skin, attacks of suffocation Cleansing of the stomach, ice, mucous substances, stimulants Sea onion When getting under the skin-burning, redness, formation of blisters. When taken internally-nausea, increased salivation and mucus secretion, vomiting, diarrhea, extremely slow pulse, protein in the urine Externally-removal from the skin, indifferent ointments; when poisoning by ingestion-see help for poisoning with digitalis Morphine (its salts, opium, pantopon, heroin, diionin, codeine) Sharp constriction of the pupils, flashing sparks, noise in the ears, dizziness, very slow and weak pulse, redness of the skin, sometimes skin rashes, dryness in the mouth, profuse sweating, slow or intermittent, Cheyne-Stokes type breathing, dry and cold skin; gradually increasing drowsiness to deep coma, difficulty urinating, cyanosis of the face and extremities, complete loss of sensitivity, immobility; sometimes (especially in children) attacks of tetanic Removal of the poison-gastric lavage (and with subcutaneous poisoning) repeated (within an hour after poisoning) with warm water, a solution of potassium permanganate or a tannin solution or water with the addition of animal charcoal; emetics not to be given, especially if reflexes have disappeared; to destroy or bind the poison: internally 0.4% solution of potassium permanganate (by the teaspoon repeatedly every 10-15 minutes) or tannin; fight against convulsions; in opium poisoning-specific smell of exhaled air depression of the respiratory center: inhalation of CO2 (5-7% mixture with air or oxygen), under the skin atropin (carefully!), lobelia, strychnine, caffeine, camphora; in milder cases of poisoning-hot black coffee or strong tea internally; inhalation or internally smelling salts; in very severe cases-inhalation of oxygen, artificial respiration as long as the heart is beating (10-16 hours in a row, sometimes through a tracheotomy cannula), inhalation of amyl nitrite (3-4 drops on a handkerchief) or per os solution 1:1,000 nitroglycerin (up to 1/2 cm3 3 times); enhancement of normal irritations to stimulate the central nervous system: hot baths with cold dousing of the head or ice on the head, and arms and legs in hot water, enemas with vinegar (1 part to 3 parts water), mustard plasters on the calves, rubbing the skin with canvas (burlap) etc.; sometimes careful conduct of the so-called ambulatory treatment, i.e. to shake the patient to prevent sleep; upon regaining consciousness, it is useful to give a saline laxative (Glauber's salt or Epsom salt); catheterization of the bladder due to spasm of its sphincter; to lay the patient in bed in a warm room Muscarin, "i Salivation, vomiting, thirst, colic, (fly agarics)"

diarrhea, sometimes bloody, pupil constriction, vision disturbance or complete loss of vision, coldness of extremities, very slow and soft pulse, clouding of consciousness, hallucinations, difficulty breathing, pulmonary edema, cyanosis, convulsions, coma. Gastric lavage with tannin or potassium permanganate solution or emetics; then internally-tannin (3.0 in 30.0 water, a teaspoonful every 10 minutes), animal charcoal, protein water, mucilage decoctions; for slow pulse-atropin subcutaneously; stimulants internally-black coffee, strong tea, caffeine, Hoffman's drops; subcutaneously-caffeine, strychnine, camphor; on the skin-mustard plasters, rubbings, etc.; for severe vomiting-swallow pieces of ice. Soap bark. See Saponins. Arsenic (arsenic and arsenious acids, Liquor arsenicalis Fowleri, Natrium kakodylicum, Arrhenal, Schweinfurt green, Scheele's green, French green, Atoxyl, Arsacetin, Osarsol, Salvarsan, Neosalvarsan). Sharp, burning or scratching pain in the pharynx, esophagus and then in the stomach, nausea, persistent vomiting of mucus, later even of blood-stained masses, unbearable thirst, cholera-like (but with pain) diarrhea, cold, sweaty skin, first pale, then bluish on the face and extremities; small and frequent pulse, rapid breathing; vision disturbances; oliguria; pulling in the sacrum, paresthesias and convulsive pains in the extremities; sometimes convulsions (tonic); collapse, drop in temperature, cyanosis, general paralysis; loss of consciousness, coma; with arsine-blood in urine, yellowish discoloration of skin and conjunctiva; with poisoning from Schweinfurt green-green discoloration of the tongue and oral mucosa; with poisoning from cacodyl compounds-garlic odor of exhaled air. Repeated lavage (even with vomiting) of the stomach with warm water or solution of calcined magnesia (20.0 in 1 liter of water) or emetics, similar enemas (Tartarus stibiatus should not be given); maintain vomiting with warm milk and a mixture of milk with beaten egg white, avoid acidic drinks, carbonated alkalis and ammonia spirits, internally ex tempore prepared official Antidotum Arsenici (pre-shaken) 1 tablespoonful every 15 minutes until vomiting stops or calcined magnesia-first 50.0 per dose, then every 5 minutes 1 tablespoonful of solution from 70.0 calcined magnesia in 500.0 water; further-internally large amounts of oil, fat, milk; laxatives (Glauber's salt or Epsom salt), diuretics (diuretin, agurin, theocin); for collapse-hot water bottles on the abdomen, subcutaneously caffeine, camphor, adrenalin, intravenously digalen or gitalen (up to 3 cm³); for convulsions of extremities-rubbing them, warm baths; for complications after salvarsan injection-intravenously: adrenalin, Natrium hyposulfitum (0.6-2.0 in 10 cm³ water), 20% Sol. Sacchari uvici (up to 500 cm³), 10% Sol. Calcii chlorati (10-20 cm³). Name of poison Symptoms of acute poisoning Help in poisoning Foxglove (Digitalis), strophanthus, adonis (Adonis vernalis), lily of the valley (Convallaria majalis, sea onion (Bulbus Scillae), Helleborus and their preparations. Sharply slowed, irregular pulse, severe weakness, coldness of extremities, stomach pains, hiccups, vomiting, diarrhea, pupil dilation, decreased urination, delirium; further-acceleration of pulse, temporary cardiac arrest, extreme weakness, coma, convulsions. Do not give emetics, avoid muscle movements, rest, bed rest; gastric lavage with tannin solution; for slow pulse-subcutaneously camphor, ether, atropin, internally-nitroglycerin (1% alcoholic solution 2-3 drops on a piece of sugar), strong black coffee-with cognac, on the skin-mustard plasters; for persistent vomiting-swallow pieces of ice, subcutaneously morphine; intravenous infusion of physiological solution; warm baths, rest, bed rest. Caustic soda. See Alkalis. 145 146 Sodium cacodylate. See Arsenic. Naphthalene. Headache, shaking chill, belching, nausea, loss of appetite, thirst, urge to vomit, excited state. In severe cases-drowsiness, small pulse, vomiting, diarrhea, colicky pains in the abdomen, strangury, jaundice, protein, blood and methemoglobin in urine, pains in the kidney and bladder area; urine on standing becomes black-brown and remains sterile for weeks; then-cyanosis, involuntary passage of urine and feces, collapse, death from paralysis of respiration and heart. Repeated energetic lavage of the stomach with water or potassium permanganate solution; internally mucilage decoctions, animal charcoal, white clay, laxatives (saline, but not castor oil). Do not give fats in food. Diuretics, diaphoretics and other symptomatic treatment measures. Naphthol, beta-naphthol. Irritation of the stomach (nausea, vomiting) and intestines (diarrhea with pain), hemorrhagic nephritis, sometimes changes in the retina and clouding of the lens, jaundice, enlargement of the spleen, liver and gallbladder, cyanosis without respiratory disturbances. Rapid gastric lavage or emetic (apomorphine, copper sulfate), then internally animal charcoal, oils, Saccharated lime; otherwise-symptomatic treatment 148

Ammonia spirit | (Liq. Ammonii caustici), ammonia. When it gets on the skin - severe pain, redness, formation of erythema and blisters; when it gets in the eye - conjunctivitis and deep lesions, danger of secondary infection; when inhaling concentrated vapors - cough, smell of ammonia from the mouth, burning in the throat, salivation, loss of voice, coughing up fibrinous membranes, development of pneumonia and edema of the throat, attacks of suffocation, dizziness, weak pulse, fainting, cooling of the extremities and the whole body, convulsions, loss of consciousness, coma; when taken internally - burning and pain in the mouth, throat, esophagus and stomach, profuse salivation, vomiting, often with blood; in severe cases - weakening of cardiac activity, collapse. When the skin is affected - compresses with a 5% solution of acids (citric, tartaric, acetic or hydrochloric), possibly sooner; when the eyes are affected - washing with physiological solution, in severe pain - instillation of a 2% solution of novocaine with adrenaline; in case of poisoning by inhaling vapors - inhale warm water or vinegar vapors or vapors of atomized physiological solution; artificial respiration; into the vein - physiological solution, bloodletting; in case of poisoning per os - drink vinegar with water or a 1% solution of citric or tartaric acid, mucilaginous drinks; otherwise symptomatic treatment. Neoarsphenamine See Arsenic Nicotine See Tobacco Nitrobenzene See Aniline Nitroglycerin, sodium nitrate Burning in the throat, severe headache, dizziness, redness of the face and peripheral parts, sometimes - jaundice, sweating, nausea, vomiting, diarrhea, weakness or paralysis of muscles, accelerated, and subsequently slowed, wheezing breathing, slowing of the pulse; cyanosis, manic state, hallucinations, acute delirium with signs of excitement, then - loss of consciousness, paralysis. Repeated washing of the stomach, internally - decoction of flaxseed, abundant drinking of water, saline (not oily) laxatives, stimulants (under the skin caffeine, camphor, ether), especially strong black coffee, artificial respiration, rubbing in mustard spirit, on the head - cold, if necessary - bloodletting. 3.U № Name of poison | Symptoms of acute poisoning Help in poisoning Nitrotoluol Headache, jaundice, gastrointestinal manifestations, pallor of the face, protein and blood in the urine, various mental disorders, polyneuritis, bleeding from the mouth and nose, petechiae on the face, neck and hands, loss of consciousness, coma Internally alkalis (calcined magnesia, sodium bicarbonate, etc.), bloodletting followed by infusion of physiological solution; inhaling oxygen; otherwise - symptomatic treatment 154 . Ozone Cough, headache, respiratory disorders, drowsiness. In severe cases - depressed state, coma, pulmonary edema, death from paralysis of respiration Fresh air, artificial respiration, under the skin caffeine or camphor j Nitric oxide Conjunctivitis, cough, chest pain, vomiting, headache; then (several hours) a latent period, after which: increased cough, feeling of fear and suffocation, bronchitis, shortness of breath, tachycardia, small pulse, increased temperature, sputum first lemon-yellow, then brown-red; development of pulmonary edema Treatment purely symptomatic; it is important to relieve pain, give oxygen to inhale, perform bloodletting 156 j Carbon monoxide See Carbon monoxide i 157 Osmium and its compounds Severe headache, abdominal pain, thirst, dryness in the throat, diarrhea, often bloody, tenesmus, weak pulse, coma Stomach lavage or emetics, then internally - milk, calcined magnesia with milk, ice, milk-opium enemas i 1 158 Hemlock spotted See Poison hemlock 15Э Opium See Morphine Optochin (ethyhydrocuprein) Vomiting, small and slowed, then rapid pulse, fall in blood pressure, amauroses, in severe cases progressing to atrophy of the optic nerves Purely symptomatic treatment 161 ; Osarsol ^; See Arsenic 162 ! Osmic acid (Ac. i hyperosmicum) j Inhaling vapors - disgusting taste in the mouth, redness of the conjunctiva, tearing, visual disturbances, dermatitis and deeper skin lesions (up to gangrene), headache, cough, pneumonia, intestinal disorders, nephritis; the skin ! may turn dark brown when locally exposed to ¹ the acid See Nitric acid, but since osmic acid is very quickly destroyed, often such vigorous treatment is not required 163 Pantopon See Morphine 164 I Fern (Filix mas, Rvota, pains in the stomach, bloody po- ¹ its extract) nos, increased pulse, shortness of breath, rise ; j in temperature, pupil constriction, visual ; disturbances, clouding of consciousness; ! later jaundice, severe tetanic ¹ convulsions, delirium, syncope, coma 1 : Stomach lavage, laxatives (calomel, but not castor oil), mucilaginous decoctions (but not milk and not fats); placement in a dark room (due to the danger of visual disturbances), with clouded consciousness - stimulants (caffeine, especially camphor repeatedly), bloodletting followed by infusion of physiological solution, warm baths; for convulsions - inhalation of chloroform (with caution!) ) 165 Bittersweet nightshade (Solatium dulcamara) When poisoned with unripe berries or other parts of the plant - scratching in the throat, dizziness, trembling of extremities, difficult breathing, irregular pulse, nausea, vomiting, diarrhea, abdominal pain, weakness, drowsiness Stomach lavage, internally - tannin, bismuth nitrate, opium preparations; stimulants (black coffee, wine) J\r» ! Name of poison Symptoms of acute poisoning Help in poisoning i 1 i 166 White bryony 1 Vomiting, diarrhea, severe clonic (Bryonia alba) i (sometimes also tetanic) convulsions 1 1 Removal of the poison, mucilaginous decoctions with opium, black coffee, warm bath | 167 Picric acid (trinitrophenol) Yellow coloring of the tongue and oral mucosa, abdominal pain, vomiting of yellow masses, diarrhea, yellowish coloring of the sclera and skin (keep in mind the use of the poison for the purpose of simulating jaundice), little urine, protein and blood in it; when it gets in the eye - conjunctivitis Stomach lavage, then - laxatives (castor oil); internally - egg white, milk sugar, Kalium bicarbonicum (0.5-1.0 in powders or in solution 6.0-8.0 in 180.0 water, by tablespoons); diuretics (diuretin, theocin, etc.) 168 Picrotoxin See Poison hemlock ^{1 ;} -1 169 Pilocarpine Profuse salivation, profuse sweating, nausea, diarrhea with vomiting, drying of the pupils, visual disturbances, irregular and sharply slowed, then Stimulants, under the skin atropine, j increased pulse, collapse, pulmonary edema; j when taken per os - washing the stomach with a solution of tannin; in the rest - symptomatic treatment j i sometimes significant depression of the psyche; in j pregnancy - miscarriage 170 Pyramidon 1 See Antipyrin 1 ! 171 Pyridine j After inhalation - irritation of the respiratory tract, shortness of breath, superficial j breathing, vomiting, headache, tremor j of extremities, cyanosis, development of j pulmonary edema, loss of consciousness \ Pyrogallol, pyrogal-lic acid Headache, vomiting, diarrhea, muscle tremors, weak pulse, jaundice, prostration; urine is dark, contains protein, blood, hemoglobin breakdown products, sometimes sugar, in rapidly progressing cases - cyanosis, shortness of breath, convulsions, collapse; at the end of poisoning - anuria, picture of uremia, coma, followed by rapid death from paralysis of the central nervous system; these j phenomena are also possible with external use of the poison j With external use - ointment from pyrogallol should be quickly removed with alcohol and ether; when taken internally - as soon as possible stomach lavage, then internally animal charcoal (20-30 g every 2 hours in aqueous suspension) or 100-200 g of oil (olive, almond, sunflower, etc.) or . Calcaria saccharata (1 tablespoon every 5 minutes); they also recommend internally Natrium hyposulfu-rosum (10.0 in 200.0 water, by tablespoon every 2 hours), but not Natrium sulfuricum (no effect from it) 173 ! Pyrocatechol i See Hydroquinone i 174 Pituitrin j Sharp pallor of the skin, enhanced intestinal peristalsis (there may also be diarrhea), spasms of the abdominal press, nausea, vomiting; during pregnancy there may be miscarriage j Chloral-hydrate in an enema or internally; warmth on the abdomen; otherwise symptomatic remedies j I 175 , Darnel j See Poison hemlock i Meadow cowslip See

Buttercup plants 177 | Ptomaines (from sausage, meat, fish, cheese poisons) ! 1' i After a short incubation period, vomiting, diarrhea, pains in the stomach and intestines (colic), headache, dizziness, chills, severe general weakness, shortness of breath, dilated pupils, very often ptosis, diplopia; in severe cases - disorders of swallowing, severe dryness in the mouth, hoarseness, barking cough, dry skin, collapse of cardiac function. Energetic repeated washings of the stomach (with water or a solution of potassium permanganate) or emetics; to bind the remaining poison - internally animal charcoal, white clay, tannin, mucilaginous drinks, decoctions, oily mixtures; to remove the remaining poison - calomel; if there is no tendency to vomit - castor oil; with frequent vomiting, severe colic and restlessness - under the skin morphine or pantopon, enemas from a decoction of flax seed, warm compresses on the abdomen; with general weakness - under the skin camphor, caffeine, digenal; internally - grape wine, strong tea, strong black coffee, ammonia spirits 3-5 drops with water Name of the poison Symptoms of acute poisoning Help in poisoning Si again after 20-30 min., warm wraps and baths; in moderate and severe cases - infusion of physiol. solution into a vein or under the skin or per rectum in the form of drop enemas, repeatedly and in large quantities; food in the first days - only tea and mucilaginous souths Broom See. Yellow acacia Vomiting stone See. Antimony Vomiting root (ipecacuanha), emetine Irritation of the mucous membranes, severe vomiting, there may be bloody diarrhea, collapse; in sensitive people inhalation causes asthma attacks; when it gets on the skin - eczematous rashes, on the eyes - conjunctivitis With O. per os - wash the stomach, internally - adsorbent agents (animal charcoal, protein, mucilaginous soups, etc.), tannin; ice pieces, soda or Seltzer water, opium, symptomatic treatment of collapse; inhalations of a 2% tannin solution recommended for inhalation of ipecacuanha have no "effect Vomiting nut See. Strychnine Realgar See. Arsenic Resorcinol See. Hydroquinone Mercury (sublimate, cinnabar, calomel and other salts) Metallic taste in the mouth, swelling of the lips, whitish-gray coating on the oral mucosa and tongue, pains along the digestive tract, burning and compression of the throat, salivation, severe vomiting, abundant mucous-bloody stools with tenesmus, oliguria or anuria, protein, blood in the urine; slowing of the pulse, cold sweat, fainting, loss of sensitivity, convulsions; after 1-2 days (if death has not occurred) - severe stomatitis with fever, ulceration of the gums, glossitis, often swelling of the larynx In the first hours after O. - washing the stomach with water with calcined magnesia or animal charcoal; after a few hours the stomach can no longer be washed (danger of rupture of its walls), then - raw eggs in milk, protein water, warm milk in large quantities, animal charcoal, mucilaginous decoctions, calcined magnesia (1:20 water, 1 tablespoon every 5 minutes), Natrium hyposulfurosum internally (1.0 per dose) or in a vein (0.6 in 10 oz water) or Natr. sulfurosum (1% solution internally or in enemas), or iron sulfide mixture (Rp. Ferri pulverati 20.0, Sulfur, pulver. 15.0, Sir. simpl., Aquae font, aa 50.0 MDS., tablespoons); while the poison is in the stomach, do not give table salt, as it increases the solubility of sublimate; abundant drinking of fluids (milk, protein water, etc.), gentle laxatives (castor oil); against tenesmus enemas of water, compresses of ice water, suppositories with opium, morphine under the skin; for collapse - stimulants (caffeine; camphor); for treatment of stomatitis - mouthwash with a solution of Berthollet's salt (1 tablespoon per glass of water) or hydrogen peroxide, brushing teeth with a soft brush; subsequent treatment after the cessation of acute phenomena: hot baths, milk diet, abundant drinking, washing of the intestine (2-3 times a day), bed rest, potassium iodide (0.2 per dose) to enhance the excretion of mercury Ruta graveolens When it gets on the skin - irritation and inflammation, when taken internally - salivation, swelling of the tongue, vomiting and diarrhea, sometimes bloody, difficulty breathing, slowed pulse, decreased t°; in pregnant women - miscarriage; convulsions, loss of consciousness and death Washing the stomach, against vomiting - internally cocaine with emollients, stimulants and diaphoretics Name of the poison Symptoms of acute poisoning Help in poisoning Fish poison See. Ptomaines ! 1 i187 | Sabadilla See. Veratrum Sabina See. Don juniper Salicylic acid, aspirin, salipyrin, salol and other derivatives and its salts Irritation of the mucous membranes, there may be vomiting, sweat, inflammation of the stomach and intestines, sometimes with hemorrhages, diarrhea, shortness of breath, delirium, hallucinations; weakening of hearing and vision; during pregnancy - miscarriage, urine when adding ferric chloride takes on a characteristic purple color Wash the stomach, emetic (better apomorphine), internally - soda, enemas with soda, alkaline enemas; under the skin - caffeine, camphor; warming the body, diaphoretics; discontinuation of salicylate administration 190 Salol See. Salicylic acid 1:1 Salvarsan See. Arsenic Santonin (wormseed, Flosculi Cinae) Vision of the surroundings in yellow, green or purple colors, flickering in the eyes, dilated pupils, nystagmus, olfactory and taste hallucinations, headache, dizziness, vomiting, diarrhea, colic, salivation, shortness of breath, clonic and tetanic convulsions; urine is greenish-yellow in color, when free alkalis are added to it, it becomes crimson-red Washing the stomach, emetics, laxatives (e.g. calomel 0.3, repeated after an hour), diuretics (diuretin, Liq. Kalii acetici, etc.), enemas with table salt (5.0 per glass of water); avoid oil laxatives and milk, with convulsions - careful inhalations of chloroform or in an enema chloral hydrate (care in dosing); with collapse - cold douches of the head in a warm bath, artificial respiration, stimulants (caffeine, camphor), warm baths; castor oil and other fats are contraindicated Saponins (for example from soap root, soap nuts, etc.) Headache, dizziness, nausea, vomiting, there may be diarrhea, increased pulse, feverish condition, drowsiness, fainting, pallor of the face, salivation, strabismus; local irritation of all mucous membranes that come into contact with saponins; on the skin - eczematous rashes Washing the stomach or emetic, internally - animal charcoal, milk, protein solutions, mucilage; when the eyes are affected - washing with a large amount of water or physiol. solution Saccharin With very large doses (8-10 g) Repeated washings of the stomach, noted: belching, vomiting, loss of appetite, high enemas, laxatives, ^! diarrhea, abdominal pain, convulsions, symptomatic means loss of consciousness and death (in one case after 40 hours) Illuminating gas See. Harmful gases Lead and its compounds (lead sugar, lead acetate, white lead, etc.) Metallic taste and dryness in the mouth, whitish discoloration of the tongue and oral mucosa, dark border on the gums, headache, pain under the xiphoid process, nausea, vomiting with grayish-white masses, colic, first liquid black or bloody stool, later - constipation; subsequently - slowed and hard pulse, delirium, convulsions, paralysis and death in a coma i 1 Washing the stomach with a 1/2-1% solution of Glauber's salt or Epsom salt* (to convert soluble lead compounds into insoluble PO4) or emetics (apomorphine); then internally - Glauber's salt or Epsom salt (60.0 in §W.0 WATER per dose) or Sal. Carlsbad (tea spoons), egg white, protein water, mucilaginous drink, milk, diuretics; for colic - warm baths, belladonna, atropine, morphine; after the cessation of acute phenomena to accelerate excretion - potassium iodide (2.0-3.0 per day) or Natrium hyposulfurosum (up to 1.0 per day) Selenium and its salts 1 See. Tellurium and its salts 1 1 198 ! Silver salts 1 See. Silver nitrate I 1 12 № Name of the poison Symptoms of acute poisoning Help in poisoning Sulfuric acid (Ac. sulfuricum) Burns of the digestive tract, dark discoloration of the lips and corners of the mouth, white- discoloration of the oral mucosa; vomiting of chocolate or black masses, often mixed with fragments ' of the mucous membrane; swallowing disorders, severe pain, starting from the mouth and ending with the stomach, often hoarseness and shortness of breath, prostration, blunting of sensitivity, hematuria and albuminuria, fever with a weak pulse See. Nitric acid.

Fear of washing sulfuric acid with water due to the development of a large amount of heat (which is observed in vitro) and the danger of secondary skin lesions is unfounded, since a large amount of wash water leads to dilution of the acid with significant cooling (Starkenstein). Sulfurous acid (Ac. sulfurosum). When inhaling vapors - conjunctivitis, severe irritation of the respiratory tract, cough with abundant bloody or yellowish sputum, shortness of breath; sometimes also severe nervous phenomena and collapse; death from paralysis of respiration. Treatment is only symptomatic: mustard plasters on the chest, expectorants, inhalations of an alcohol solution of NaCl, codeine; with excitation of the central nervous system - sedatives; with depression of respiration - stimulants (lobelia, atropine, caffeine, camphora). Hydrogen sulfide (cloacal gas). Headache, dizziness, nausea, vomiting, fainting, general weakness, shortness of breath, specific smell of exhaled air, unconscious state, cyanosis, paralysis of respiration, convulsions, coma, there may be sudden (after several seconds or minutes) death. Immediate removal of the poisoned person from the room containing hydrogen sulfide, fresh air, artificial respiration, inhalation of oxygen; cautious inhalation of chlorine using cloths soaked in chlorinated water or bleaching powder is recommended; stimulants - irritation of the skin (mustard plasters, rubbings, cold douches, etc.), subcutaneous caffeine, camphora or ether; internally sometimes hydrogen peroxide (20.0 in 100.0 water, by teaspoonfuls), alkalis, solution of iodine; abundant (up to 600 cm³) bloodletting with subsequent injection of physiological solution; if hydrogen sulfide has entered the digestive tract, then emetics (ipecac, apomorphine, but not metallic emetics) are prescribed; for preventive purposes, it is recommended to fill cesspools with iron vitriol before entering them. Carbon disulfide

After inhalation - excitement resembling intoxication, immobility of pupils, visual disturbances; in severe cases - vomiting, respiratory disorders, ataxia and anesthesia of the limbs, speech and vision disorders, insomnia, psychotic state, disturbance of consciousness, coma; after internal administration - headache, dizziness, vomiting, cyanosis, weakness of the heart, convulsions; paralysis of the facial and other nerves. Fresh air, artificial respiration, inhalation of oxygen; stimulants - cold douches, irritation of the skin, subcutaneous caffeine, camphora or ether; if the poison was taken internally - in addition to the above, stomach lavage or emetics (apomorphine). Fusel oil. See Alcohol 204. Hydrocyanic acid, potassium cyanide, cyanide compounds, Semen Amygdal. amar., Aqua Amygdalarum amarum, Aqua Laurocerasi and others. Severely difficult slowed breathing, weak and rare pulse, dilation of pupils, smell of hydrocyanic acid in exhaled air, clonic and tonic convulsions, loss of consciousness and sensitivity, coma, bright red color of visible mucous membranes; there may be sudden (after several seconds or minutes) death. When swallowing the poison - vigorous stomach lavage with a 0.04% solution of potassium permanganate (oxidizes hydrocyanic acid to non-toxic cyanic acid) or a 1-3% solution of hydrogen peroxide (form non-toxic oxamide); emetics are less reliable (apomorphine is better); with O. bitter almonds - internally diluted hydrochloric acid (2.0 in 100.0 water, by dessert spoons); as a chemical antidote, Natrium hyposulfurosum (forms non-toxic sodium thiocyanate) is given subcutaneously in a 3-5% solution 100-200 cm³, in a vein 1-5% solution in 0.6% sodium chloride solution FROM 100 TO 500 cm³; if swallowing is possible, internally a 2% solution of hydrogen peroxide, 1/2-1% solution of potassium permanganate (by teaspoonfuls) or a solution of Natrii carbonici in 15.0 water, followed immediately by a solution of 12.0 water, one and a half chloride of iron 2.0 and crystalline iron sulfate 1.5; a 1% solution of iron sulfate with calcined magnesia is also recommended; to stimulate the respiratory center - subcutaneous caffeine, lobelia, atropine, camphora, cold douches in a warm bath, cold on the head, on the spine, rubbing the body with ice, smelling or taking internally ammonia (3-5 drops); to remove the poison - artificial respiration in fresh air; intravenously a solution of grape sugar, bloodletting with subsequent injection into a vein of physiological solution 205

Turpentine (terpentine). Stomach pain, dizziness, vomiting, pupil constriction, increased pulse, weakness, increased urination, urine with a violet smell, protein and blood in the urine; in severe cases - asphyxia symptoms, weakness, epileptic seizures. Wash the stomach or give an emetic (better - apomorphine); internally - charcoal powder, mucilaginous drinks, ice pieces; in case of fainting (collapse) - subcutaneous caffeine, camphora. Scopolamine. See Atropine. Fats of the fatty series (chloral hydrate, veronal, sulfonal, luminal, etc.). Deep depression of the central nervous system, deep sleep lasting several days, narcosis, shallow and rare breathing, rare and weak pulse, sharp drop in temperature, cyanosis, coma 208 Solanine (containing solanine sprouted potato). Vomiting, diarrhea, pain in the stomach area, dizziness, feeling of fear, visual disturbances, stupor, sometimes phenomena as in atropine poisoning. Hydrochloric acid (Ac. hydrochloricum, seu muriaticum). Dark coloration of the tongue and oral mucosa, gastroenteritis, as in nitric acid poisoning, vomiting is usually bloody, sometimes yellowish-green, the oral mucosa is often burned, disturbances in urination or retention of urine, often nephritis, albuminuria, hematuria, small and frequent pulse, collapse; after inhaling acid vapors, pulmonary edema may develop. Sparteine (broom, Sarothamnus scoparius). Vomiting, lethargy, weakness, increased pulse and respiration. Stomach lavage (emetics are ineffective), laxatives (Glauber's salt, Epsom salt); to stimulate the respiratory center - inhalation of ammonia, subcutaneous atropine, lobelia, caffeine, camphora, strychnine, artificial respiration; irritation of the skin, warm wrapping of the whole body, hot water bottles, diuretics. Removal of poisonous food from the stomach and intestines, internally milk, mucilaginous soups, tannin, opiates, bismuth nitrate, stimulants. With acid poisoning per os, see Nitric acid; with chlorine vapor poisoning: fresh air, inhalation of water vapor with ammonia

I Alcohol or spirits (wine, amyl, wood, fusel oil, etc.) Loss of consciousness and sensitivity, often vomiting, hyperemia of the conjunctiva, usually strong redness of the face, sometimes paleness, smell of alcohol, foam from the mouth, immobility, narrowing or (with strong cyanosis, asphyxia) dilation of the pupils; deep coma, cold, moist, and sticky skin, slow and small pulse, low body temperature, slowed stertorous breathing, involuntary discharge of feces and urine, sometimes convulsions, manic state, hallucinations, acute delirium, phenomena of excitement Stomach washing, internally animal charcoal and demulcents; artificial respiration, stimulants internally and under the skin Removal of the poison-pumping out stomach contents (through a tube) with stomach washing with warm water; less reliably-emetic (apomorphin under the skin); combating body cooling-fresh warm air of the room, warming with blankets, hot-water bottles, warm bottles; stimulation of the respiratory and vasomotor centers and heart-cautious inhalation of aromatic spirits of ammonia, ice bag on the head, cold showers in a warm bath, high position of the head, vinegar enemas (1 part to 3 parts water) or from table salt (a tablespoon to 2 cups of water); introduction into the stomach of strong hot coffee or tea, caffeine, strychnine, atropine or camphor; without undressing the patient, irritation of the skin, for example, mustard plasters, rubbing the limbs with warm towels, etc.; into the stomach 3-5 drops of aromatic spirits of ammonia with water repeatedly; in strong individuals in a serious condition sometimes bloodletting (200-400 g); if necessary-artificial respiration, inhalation of oxygen, faradization of the phrenic nerve Ergot Strychnine (Cinchona, vomiting nut, Nux vomica) See. Ergot Significant increase in cutaneous and tendon reflexes; further-attacks of strong tonic reflexive convulsions, trismus, opisthotonos, small, very frequent pulse, consciousness usually preserved throughout Absolute rest, elimination of all external irritations (any noise, drafts, light, etc.); if there are no convulsions yet-energetic repeated stomach washing and at the same time in an enema chloral hydrate (2.0-5.0); with convulsions first inhalation of chloroform until narcosis, after which energetic stomach washing; after stomach cleansing internally chemical antidote: potassium permanganate (1:1,000 by tablespoons) to destroy the poison, tannin (2%, by tablespoons) to form an insoluble compound, iodine (tincture of iodine 15 drops in 1/2 glass of water or Rp. Iodi puri 0.1, Kalii iodati 0.5, Aquae dest. 200.0. MDS. every 5 minutes by tablespoon) for the same purpose; more reliable than the last means animal charcoal of good quality (for the purpose of adsorbing the poison); further-abundant drinking of hot water or alcoholic beverages (avoid tea and coffee, cannot be given), diuretics (diuretin, agurin, theocin or intravenously 2% sodium sulfate), laxatives (castor oil, Glauber's salt, Epsom salt), bloodletting with subsequent infusion of physiological solution, inhalation of oxygen (weakens convulsive seizures), warming the body

Strophanthus See. Digitalis Mercuric chloride See. Mercury See. Hypnotics Antimony, tartar emetic (stibium, Tartarus stibiatus) Metallic taste in the mouth, salivation, weakening of hearing, noise in the ears, burning pain in the mouth, throat, stomach and lower abdomen, severe vomiting and thirst, severe expectoration, frequent abundant watery stools, paresthesia of the limbs, small frequent pulse, cold sticky sweat, loss of consciousness, convulsions, collapse, drop in temperature, upon contact with skin-eczematous rashes Repeated stomach washings with tannin solution (forms an insoluble antimony tartrate); with sufficient vomiting-abundant drinking of milk, 2% tannin internally, mucilaginous drinks, barley broth, albumin water, black coffee or tea, Decoct. Corticis Quercus (20.0 to 1,000.0 water), preferably followed by stomach washing; enemas from a decoction of flaxseed with 10 drops of tincture of opium; with excessive vomiting-pieces of ice internally, lemonade, morphine under the skin; with collapse-stimulants (caffeine, camphor, ether) Tobacco (Nicotiana, nicotine) Nausea, salivation, vomiting, diarrhea, trembling of limbs, dizziness, general weakness, palpitations, small and slow pulse; collapse, drop in temperature; in severe cases-frequent and irregular pulse, "ho- When poisoning with parts of the plant-stomach washing or [vomiting (better apomorphin); then internally a laxative (calomel), 0.5% tannin solution, tincture of iodine (5-10 drops) or iodine in potassium iodide 36b № ! I Name of poison Symptoms of acute poisoning. Help in poisoning s o f a. boat-like sweat, delirium, loss of consciousness, respiratory disorders, clonic or clonic-tonic convulsions, coma (Jodi puri 0.5, Kali jodati 1.0 to 500.0 water, every hour by tablespoon) to form a precipitate; diluted (1:3) chlorinated water with a decoction of flaxseed, a mixture (2:100) of hydrogen peroxide with water; against diarrhea-opium, enemas of 1/2% tannin solution; with severe poisoning-stimulants (caffeine, camphor, atropine under the skin), cold head douches, skin irritations, artificial respiration; with nicotine poisoning during smoking-clean air, stimulants 219 220 Thallium and its salts In mild cases-dryness of the skin, loss of hair (characteristic), neuralgic pains, irritation of the kidneys; in more severe-disorders of hearing, headache, fainting, constipation (or diarrhea) with colic, neuralgia, muscle pains, swelling of the legs, frequent pulse, symptoms of uremia, absence of sweating, conjunctivitis, blepharitis, dermatitis of the face Symptomatic means-cardiac, diaphoretics, etc.; light diet, bed rest Tellurium and its salts, selenium and its salts Inhalation of tellurium oxide and tellurium hydride causes nausea, metallic taste, garlic smell of exhaled air, dryness of the oral and nasal mucosa, loss of appetite, trembling of limbs, respiratory disorders, drowsiness, depressed state, constipation Clean air, stimulants; if necessary-artificial respiration, inhalation of oxygen Turpentine See. Pine tetrachloride See. Carbon tetrachloride 223 ! Tetrachloroethane, dichloro-ethylene, trichloroethylene, ; Vitran, Trelin and others. Burning in the eyes and hands, loss of sensitivity of the face and tongue, depression of consciousness, loss of corneal and other reflexes, convulsions, narcosis, acute yellow atrophy of the liver 224 ! Thyroidin, preparations of the thyroid gland, "thyroxine Toluidine Increased pulse, palpitations, shortness of breath, complaints of weakness, nervous irritability, headache; tremor of muscles, insomnia, restlessness, feeling of fear, nausea, vomiting, loss of appetite, elevated temperature, sharp emaciation. In severe cases then-severe cardiac phenomena (up to attacks similar to angina pectoris), soporous state; there are known cases of death with myocarditis and endocarditis

Treatment is purely symptomatic, as in poisoning with chloroform; it is necessary to remove the patient from the atmosphere containing the poison to fresh air as quickly as possible. Discontinue administration of thyroid gland preparation for 8-14 days. Increased administration of carbohydrates and proteins. Orally, arsenic (Sol. arsenicalis Powleri no 3-6 drops per day); otherwise, symptomatic treatment. See Aniline. Trinitrotoluol. Irritation of the eyes and nasal mucosa, cough, bitter taste, pain in the stomach region, belching, colic, nausea, vomiting; initially persistent constipation, then diarrhea with tenesmus; jaundice, depression of consciousness, scotomas, temporary peripheral neuritis; in the end-delirious state, coma and convulsions. Removal of the poison from the atmosphere, symptomatic remedies. Trinitrophenol. See Picric acid. Trichloroethylene. See Tetrachloroethane. 229! Thuja (Thuja occidentalis). Local irritant effect; upon absorption-severe headache, bronchial catarrh, sometimes eczema of the hands, vomiting, diarrhea (stool contains hematin, almost black or bloody), severe nephritis; in pregnancy-abortion. Gastric lavage with water or tannin solution; then orally saline laxatives (Glauber's salt, English salt), astringent tannin, nitro-bismuth salt), mucilaginous drinks, animal charcoal; bloodletting followed by administration of physiological solution; stimulants.

Name of the poison. Carbon monoxide, carbon monoxide poisoning, carbon oxide, water gas, illuminating gas. Symptoms of acute poisoning. Assistance in poisoning. In mild cases-dizziness, headache, ringing in the ears, shortness of breath, palpitations, general weakness, feeling of depression, nausea, sometimes vomiting; in severe cases-clonic or clonic-tonic convulsions, loss of consciousness (fainting), coma, cessation or severe weakening of respiration, multiple skin ecchymoses. Fresh air, artificial respiration, inhalation of pure oxygen (it is useful to add up to 5% carbon dioxide to it); stimulants: subcutaneously-lobelia (0.3-0.5 cm³ of 1% solution repeatedly), camphor, caffeine, ether; orally-strong black coffee; on the skin-mustard plasters, cold douches, rubbings, warm compresses on the extremities; per rectum-vinegar enemas; in cases of significant poisoning, bloodletting (250-300 cm³) is recommended, followed by administration of physiological solution (up to 600-1000 cm³) or followed by blood transfusion; phenomena of excitement that sometimes occur are controlled by administration of scopolamine (1/2 mg subcutaneously). Carbon dioxide. See Harmful gases. Carbon tetrachloride (tetrachloromethane). After inhalation-headache, trembling of the extremities, motor and sensory paralyses, weak and rare pulse, depression of consciousness, sleep; after oral administration-persistent headache (for several days), vomiting, jaundice, drowsiness, loss of consciousness, coma; after several days-mental disorders of various kinds, manic state, hallucinosis, acute delirium. Symptomatic treatment-stimulants, diuretics; in excitement-depressants of the central nervous system; intravenous administration of grape sugar solution (Sol. 20% Sacchari uvici up to 500 cm³) is recommended.

Acetic acid (Ac. aceticum) and acetic essence. Severe reddening of the skin, sharp pain, formation of dirty-white scabs; upon oral administration-phenomena of irritation of the stomach and intestines, weakness, suffocation, edema of the vocal cords; smell of acetic acid in the exhaled air. See Nitric acid. Snake bites. Local phenomena depending on the type of snake, sometimes only 2 puncture wounds, in other cases-pain, swelling and redness, multiple skin ecchymoses, lymphangitis, lymphadenitis, formation of blisters, phlegmon; general phenomena-restlessness, trembling, fainting, then-headache, dizziness, nausea, vomiting, thirst, disorders of swallowing, diarrhea, shortness of breath, collapse with small frequent pulse, cold sweat, prostration; in particularly unfavorable cases-frequent bleeding from natural body openings, petechiae, convulsions. To remove the poison and prevent its absorption-strong tourniquet (not longer than 1/2 hour) on the limb above, i.e., more centrally from the site of the bite; suction of the wound is beneficial for the bitten person but dangerous for the one sucking if their oral mucosa is damaged; therefore, leeches are better (it is useful to preliminarily expand the wound with a knife and create slight bleeding); excision of the wound or cauterization of it with the following substances: heated iron (e.g. a nail, or a key, or a Pakenen), chromic acid, carbolic acid, ammonia spirit, caustic alkalis, silver nitrate, tincture of iodine; in the immediate vicinity of the wound-under the skin 1-2% solution of potassium permanganate (several cm³), 2% solution of calcium chloride (20-30 cm³), 3-6% solution of ammonium carbonate, 2% Calcii hypochlorosi or Javelle water; to slow absorption-under the skin around the wound a 1:1000 solution of hydrochloric acid adrenaline (to counteract pain, add hydrochloric acid cocaine or novocaine up to 1/2-1% solution); then-cold compress from lead water, vinegar, alkaline baths; to accelerate the removal of the poison from the body-abundant drinking of warm tea or coffee, subcutaneous or intravenous physiological solution, drip (prolonged) enema of the same solution, pilocarpin can also be administered subcutaneously; against internal bleeding as well as local inflammatory phenomena-intravenously 3% solution of calcium chloride 20 cm³ per day for 6-10 consecutive days; against depression of respiration and blood circulation-subcutaneous camphor, lobelia, adrenaline, orally ammonia spirit, 70% alcohol, cognac, warm baths; in severe cases-prolonged use of artificial respiration.

Name of the poison. Symptoms of acute poisoning. Assistance in poisoning. Insect bites (bees, etc.). Pain, swelling and heat at the site of the bite. Removal of the stinger if it remains in the wound, application of a wet dressing of ammonia spirit with water (1:5) or of alcohol (70°) to the site of the bite; later a blister with ice or cold compress, compress with lead water, orally-70% alcohol, Hoffman's drops; camphor subcutaneously. Uranium salts (Uranum nitricum, Uranum aceticum, etc.). Sharp spasm of the larynx, edema of the lung; in mild cases-bronchitis with bronchopneumonia, sharp filling of the small circle of blood circulation. Fresh air, cautious inhalation of alcohol vapors or water vapor, inhalation of alkalis, such as sodium bicarbonate, borax; against bronchospasm-atropine subcutaneously, morphine to relieve shortness of breath. 237. Urotropin. Frequent urination, protein, blood in the urine, painful tenesmus in the bladder area. Discontinue administration-phenomena disappear after several days. 238 239. Phenacetin. See Antipyrine. Phenylhydrazine. With external application-irritation of the skin, eczematous rashes, erythema nodosum and papulosum; with oral administration-nausea, vomiting, diarrhea (frequent), shortness of breath, convulsions, general weakness, paresthesias, cyanosis, convulsions, mental disorders. With oral administration-gastric lavage or emetics (better apomorphine), then saline laxatives (Glauber's salt or English salt, but not castor oil); orally-egg white, hot black coffee; do not give fat, oil, castor oil, alcohol, ether (as they, by dissolving, increase absorption); warming the body; stimulants-subcutaneous camphor, caffeine or ether; rubbing of the skin, warm baths with cold douches of the head; in severe cases bloodletting followed by blood transfusion or infusion of physiological solution NaCl, Ringer's solution, etc.; upon contact with the skin-washing with alcohol.

tom (70°), ether Phenol See Carbolic acid Physostigmine See Calabar bean Formaldehyde Upon inhalation—conjunctivitis, cough, feeling of tightness in the chest, heaviness in the head, depression of consciousness, fainting; upon ingestion—burning, pains in the stomach, vomiting of bloody masses, cough, disturbance of breathing, cyanosis, excited state, rapid pulse, disturbance of consciousness up to coma, anuria Remove formaldehyde from the atmosphere, provide fresh air; when consciousness is depressed—stimulants under the skin (caffeine, camphor, ether); when the poison enters the stomach—wash the stomach with very diluted ammonium alcohol or easily soluble ammonium salts to form non-toxic urotropine; after this—ammonium acetate (15% solution by tablespoons) or ammonium-anise drops; further—protein water, raw eggs, urea in large doses (1.0-2.0 every 2 hours, up to 15.0 per day), laxatives (Glauber's salt or Epsom salt), high enemas Phosgene See Combat P., suffocating № Name of poison Symptoms of acute poisoning Help in poisoning Phosphorus, phosphorus oil Pains and pressure in the stomach area, severe vomiting; vomit smells of garlic and glows in the dark; severe thirst, diarrhea often bloody and often with masses that glow in the dark; specific smell of exhaled air; rapid pulse; enlargement of the liver, increased temperature, delirium, may lead to abortion, later—collapse, weak pulse, oliguria, albuminuria, jaundice, drop in temperature, drowsiness, restlessness, coma, multiple skin ecchymoses, yellowish discoloration of the skin and conjunctiva, acute yellow atrophy of the liver; when poisoned with phosphorus oil—fat droplets in vomit or wash waters Frequent repeated (until the smell of phosphorus disappears in the wash waters) energetic stomach washings with water or with the addition of copper sulfate (up to 1%), which partly oxidizes and partly converts phosphorus into insoluble compounds, or washing with 0.04% solution of potassium permanganate; copper sulfate is also used as an emetic; further—chemical antidotes, namely: copper sulfate (2% aqueous solution, by tablespoons every 16 minutes), potassium permanganate (1:1000, by tablespoons), old ozonized turpentine, 5 drops on sugar several times a day or in the form of an emulsion, e.g.: Rp. Olei Terebinthinae non rectificati 10.0, Muc. Gummi-arabici 360.0, Sir. Corticis Aurant. 60.0. MDS. every 15 minutes by tablespoon; feed large amounts of mucilaginous soups; fats (oils, milk, egg yolks, non-ozonized turpentine oil, castor oil, etc.) are contraindicated, as phosphorus dissolves well in them; to remove from the intestine—salt laxatives (Glauber's salt or Epsom salt); to counteract decreased alkalinity of the blood, a 3-4% solution of sodium bicarbonate is recommended intravenously, and alkalis and liquid paraffin orally; when P. is fully developed, help is almost powerless; blood transfusion and intravenous saline solution are recommended.—Phosphorus burns on the skin are treated with a 10% solution of silver nitrate and alkaline solutions Phosphine Inhalation of weak concentrations causes irritation of the respiratory tract, cough with sputum; at high concentrations—dilated pupils, unsteady gait, trembling of limbs, depression and loss of consciousness, coma Fresh air, stimulants—under the skin caffeine, camphor; inhalation of oxygen Phosphorus oil See Phosphorus French green See Arsenic Hydrofluoric acid, its salts Upon inhalation of vapors—conjunctivitis, irritation of the nasal and respiratory mucosa, persistent cough; upon ingestion—vomiting (may be bloody), diarrhea. Excited state, disturbance of eye movement, muscle paresis, involuntary urination and defecation, death from respiratory arrest; before it—convulsions Purely symptomatic treatment: fresh air, codeine, etc., upon ingestion—stomach washing with tannin, first salt laxatives, then coating, astringent agents; under the skin—stimulants or sedatives for the central nervous system (depending on its condition) Chaulmoogra oil (Ol. Chaulmoogri, s. Ol. Gynocardiae) Upon ingestion—nausea, persistent vomiting (fat droplets in vomit), dizziness, ringing in the ears, hearing disturbances, strabismus, loss of appetite, diarrhea, protein in urine, increased temperature, ataxia, clonic and tetanic convulsions, respiratory disturbances, coma; upon subcutaneous injection—locally very painful abscesses, systemically—the same phenomena as with ingestion, except gastrointestinal Stomach washing, high enemas, salt laxatives, mucilaginous decoctions and drinks, animal charcoal; bloodletting; stimulants for the central nervous system and heart (caffeine, camphor, etc.) Chenopodium oil (Ol. Chenopodii) Nausea, vomiting, sometimes bloody, trembling of hands and feet, temporary (from a week to several months) hearing disturbances and ringing in the ears, general depression; in severe cases—coma, rapid and weak pulse, convulsions; death 2-3 hours after the onset of coma Stomach washing, laxatives (preferably salt), stimulants, saline infusions intravenously № Name of poison Symptoms of acute poisoning Help in poisoning Quinine and cinchona bark Headache, stomach pains, diarrhea, very slow and soft pulse, ringing in the ears, hearing impairment, visual disturbances, drowsiness, sometimes skin rashes, cyanosis, protein and hemoglobin in urine; in pregnant women, miscarriage may occur; excitement, sometimes convulsions, coma; when cinchona bark dust gets on the skin—eczematous rashes. With idiosyncrasy—rashes, vomiting, increased temperature Stomach washing with water or tannin or emetics; then laxatives (castor oil); with cyanosis and collapse—warm baths (40°), cold douches, hot coffee, stimulants under the skin (caffeine, camphor); with convulsions—enema with chloral hydrate Chlor See Combat P., suffocating Chloral hydrate See Hypnotics Chloroacetophenone See Combat P., tear gas 255 Chloromethyl Inhalation causes headache, drowsiness, nausea, dizziness, disturbances of sensitivity; then—prolonged abnormal drowsiness, weakness in the legs, unsteady swaying gait, paresis of facial and other nerves, auditory hallucinations, visual disturbances; before death—clonic convulsions, coma Fresh air, stimulants; with convulsions—chloral hydrate in enema 1256 Chlorine water, bleaching lime, Javelle water i1 Upon ingestion—vomiting and stomach pains, tightness in the chest, severe convulsive cough, shortness of breath, bloody sputum, spasm of the vocal cords With P. from internal use—stomach washing with 0.5% solution of Natr. hyposulfurosi and then with water * orally 5-15 drops of ammonium alcohol with water, protein water, milk, aqueous solutions of Natrii hyposulfurosi, magnesia (10 : 300), soda ! i257 Hydrochloric acid See Hydrochloric acid Chloroform, ether and other inhalation anesthetics Narrowing, and in asphyxia—dilation of pupils, small and rare pulse, pallor of the face, intermittent, weakened breathing, specific smell of exhaled air, deep anesthesia, decreased body temperature; sudden death (after several seconds or minutes) may occur Stop narcotization, artificial respiration in fresh air (prolonged), inhalation of oxygen; skin irritation—spraying the face and chest with cold water, rubbing the limbs with a brush, cold compress on the abdomen, mustard plasters on the heart area; pulling the lower jaw forward, mechanical irritation of the nasal mucosa, inhalation of ammonium alcohol, cold douches of the head, wrapping the body, hot water bottles; orally—coffee, ammonium alcohol (3-5 drops in water); under the skin—atropine, caffeine, camphor, strychnine; with vomiting, be careful due to the possibility of aspiration of vomit; with P. per os—stomach washing, laxatives, stimulants, artificial respiration 259 { Chloropicrin i See Combat P. "

V., lachrymatory 1; Chrysarobin (in ointment) Upon contact with the eye—conjunctivitis; on the skin—brown-red discoloration and swelling of lymph nodes, sometimes with elevated temperature; upon internal intake—pain in the intestines, diarrhea, difficulty breathing, asphyxia, yellow-colored urine, turns red from alkalis, oliguria, hematuria Remove the ointment, washing it off with ether; on the eyes—compress with ice water; inhalation of oxygen, bloodletting followed by intravenous administration of physiological solution; skin discoloration is washed off with lemon juice 37 6 № Name of poison Symptoms of acute poisoning Help in poisoning 261 | Chromic acid and its 1. salts | Painfulness and strong irritation of the digestive tract, red-yellow discoloration and inflammatory swelling of the lips, mouth, and pharynx, vomiting yellow (and bloody) or (from contact with organic substances) blue or green masses, dizziness, shortness of breath, protein and blood in the urine; unconscious state, sometimes convulsions; dust particles of salts locally cause abscess formation, conjunctivitis Rapid stomach lavage, after which give internally carbonated magnesia (10.0 in 300.0 water, take 3 times within 15 min.) or calcined magnesia (carbonated alkalis cannot be given with O. chromic acid) followed by secondary stomach lavage (to remove the precipitate); if necessary, instead of magnesia, chalk or lime (from the wall) can be given; then swallow pieces of ice, mucilaginous drinks, milk, alkaline waters, castor oil, potassium acetate Cyanide of potassium See. Hydrocyanic acid Water hemlock See. Poison hemlock Zinc (chloride of zinc, zinc or white vitriol, zinc white) Frequent persistent vomiting, irritation of the throat, headache, nausea, symptoms of severe gastroenteritis (pain in the abdomen, diarrhea, etc.), convulsions of the calf muscles Stomach lavage with the addition of animal charcoal 1% solution of table salt, 1% solution of soda or 0.2% tannin, or maintain vomiting with lukewarm water with milk and protein water; then internally mucilaginous drinks, milk, egg white, tannin, alkaline waters, bicarbonate of soda (to convert zinc into insoluble compounds), later—opium Santonin seed See. Santonin Citrovanillin See. Antipyrin Tea See. Caffeine White hellebore See. Veratrum Black hellebore (Helleborus niger) Salivation, nausea, dizziness, cholera-like attacks, pain in the abdomen, slowing of pulse and respiration, dilation of pupils, lowering of temperature; then—strong excitement, delirium, convulsions, collapse and death Stomach lavage or subcutaneous apomorphin, infusion of salt solutions, otherwise—symptomatic treatment, as in poisoning by digitalis Yellow gentian See. Digitalis Carbon tetrachloride See. Carbon tetrachloride Strychnine nut See. Strychnine Chickling (Lathyrus sativus) Pain in the lower back, pain and paralysis of the lower extremities, trembling of the legs, increased reflexes, anuria or dysuria, sexual impotence Greater celandine (Chelidonium majus) Counter-irritants, thermocautery, iodine, potassium bromide, warm baths, galvanization of the head and bladder, faradization of muscles and nerves; stomach lavage or subcutaneous apomorphin, internally—mucilaginous, astringent, enveloping agents Burning in the mouth, blisters on the mucous membrane of the mouth, acute inflammation of the intestines, bloody stools and urine, nosebleed Stomach lavage or emetics (apomorphin), otherwise—symptomatic treatment № Name of poison j Symptoms of acute poisoning Help in poisoning Spanish green See. Arsenic Schweinfurt green See. Arsenic Spanish flies (Lytta vesicatoria, cantharidin) Upon ingestion—burning pain and blister formation in the mouth and on the tongue, salivation, intense thirst, difficulty swallowing, vomiting movements, pain in the kidney area, painful and frequent urination, little urine, it contains blood; irritation of the genital parts (priapism); later—drowsiness, delirium, clonic and tonic convulsions; with external application—the same symptoms except for damage to the digestive tract Stomach lavage or emetic (apomorphin), then a laxative (but not castor oil), then give plenty of water to drink, protein water, mucilaginous drinks with ice (e.g., barley water, flaxseed infusion, Mixlura gummosa 150.0 with the addition of tincture of opium 2.0 by tablespoon every hour); contraindicated are internal administration of spirits, oily substances, ether and acids, as they, increasing solubility, facilitate absorption of the poison; for pain—pieces of ice internally, opium, mustard plasters or cups on the stomach area; for difficult urination—washing of the bladder with warm water, warm sitz or general baths, abundant drinking of warm tea Oxalic acid (Ac. oxalicum), oxalate of potassium Burning in the mouth and pharynx, dark discoloration of the tongue and oral mucosa, swallowing disorders, redness and in some places whitish discoloration of the oral and pharyngeal mucosa, suffocation, vomiting, often with bloody masses, pain in the abdomen; anuria or oliguria, protein and sometimes sugar in the urine; tingling and numbness in the extremities, later—paralysis of them; slowing of pulse and respiration, as well as lowering of body temperature, dilation of pupils, collapse, trismus, tetanus Avoid ammonium and potassium salts; internally preparations of lime (Aqua Calcis, Saccharated lime, chalk, eggshells) to form insoluble calcium oxalate; under the skin or in a vein—physiological solution with the addition of 2.0-4.0 calcium chloride per 1 liter; otherwise—symptomatic treatment Caustic alkalis (caustic potash and soda, quicklime, carbonated alkalis) Burns (whitish discoloration) of the oral and lingual mucosa, severe pain in the mouth, pharynx, throat, and esophagus, swallowing disorders; severe prolonged vomiting strongly alkaline, later bloody (brown black-brown) masses, intense thirst; severe colic, then diarrhea, often bloody; scanty urine, alkaline reaction, contains hematine; cold skin, general prostration; death in 2-3 days from collapse Vomiting and stomach lavage are contraindicated (danger of rupture of the walls); abundant drinking of milk, mucilaginous fluids, oil emulsions (Emuls. oleosa), protein water with the addition of acids, lemon or orange juice, diluted vinegar, 1% solution of citric acid or acetic acid, 2% tartaric acid; ice pills; mustard plasters on the abdomen, cold douches of the back; for bloody diarrhea, repeated enemas with ice water; for collapse—stimulants (subcutaneous camphor, caffeine, ether); for alkali burns externally—compresses with 5% solution of citric, tartaric, acetic or acid baths of acidulated water 280 | Ezerin ! See. Calabar bean 281 Emetine See. Ipecacuanha root ! ; 282 Ergotin See. Ergot 283 Ether See. Chloroform 379

Poisoning

380 Table 4. Medicinal substances most frequently used in the treatment of acute Poisoning. Purpose of application i i Name Form of administration and dosage Stomach lavage Tanninum 0.2-0.5% solution Carbo animalis (animal charcoal) Suspension 1 tablespoon in 500 cc of water Kalium hypermanganicum (potassium permanganate) 0.04% solution Magnesia usta (calcined magnesium) Solution 20.0 in 1,000 cc of water Inducing vomiting Apomorphinum hydrochloricum Cupri sulfuricum (copper sulfate) Zincum sulfuricum (zinc sulfate) Pulv. rad. Ipecacuanhas Tartarus stibiatus, seu Stibio-Kalium tartaricum 1/2% solution, 1 cc under the skin, after 15 minutes can be repeated In powders 0.2-0.5 every 5-10 minutes, until effect In powders 0.5-1.0 every 5-10 minutes, until effect In powders 0.5-1.0 every 15 minutes, until effect In powders 0.1 every 10 minutes up to three times Adsorption of poison Carbo animalis, or activated charcoal I Tanninum | Bolus, seu Argilla alba (white clay) Suspension 20.0-30.0 in 1/2 glass of water internally, after 2 hours repeat 1-3% solution internally by tablespoon every 5 minutes or 0.1-0.2 in water every 15 minutes Suspension 30.0-50.0 in 1/2 glass of water, repeatedly up to 200.0 Chemical neutralization of poison Calcaria saccharata (Calcii oxydati hydr. 5.0, Sacchari 15.0, Aq. dest. 5.0) Kalium hypermanganicum Aqua Calcis Magnesia usta Natrium hyposulfurosum ! 1 tablespoon every 5 minutes 0.4% solution, 1 teaspoon every 10-15 minutes By tablespoons or glasses 30.0-50.0 per dose or 1 tablespoon every 5 minutes, solution 75.0 in 500 cc water Intravenously 1-5% solution in 0.6% solution of Natrii chlorati up to 500 cc, under skin-3-5% solution-100-200 cc, per os-1.0 per dose Reduction of poison concentration in blood and stimulation of cardiac activity and increased urine secretion Sol. Natrii chlorati physiologica Ringer's solution (Natrii chlorati 8.0, Kalii chlorati 0.075, Calcii chlorati crystall. 0.2, Aq. dest. ad 1,000.0. Sterilisa! Adde Natrii bicarbonici 0.1) Intravenously or under skin 1/4-1/2 liter (intravenously within 12-30 minutes); if necessary this infusion can be repeated up to 3-4 times a day. Intravenously 1-2 liters within 15-30 minutes; if necessary this infusion can be repeated up to 3-4 times a day. Components of Ringer's solution must be chemically pure Laxatives Natrium sulfuricum (Glauber's salt) Magnesium sulfuricum (Epsom salt; Calomel or Ricini 30.0 in water 30.0 in water 0.3 per dose, after an hour can be repeated 30.0-40.0 per dose Diuretics Diuretinum | 0.5-1.0 repeatedly Theocinum Ho 0.3 2-3 times Kalium aceticum | Solution 30.0 in 180 cc water, 1 tablespoon every 2-3 hours Diaphoretics Pilocarpinum hydrochloricum | 1% solution 1 cc under skin, after 15-16 min., until effect Raspberry | \ Infusions and decoctions in hot form, 1/4-1 glass Linden blossom | For stimulation of the central nervous system Coffeinum natrio-benzoicum or natrio-salicylicum or camphoratum Aether sulfuricus Spiritus aethereus, seu Liquor anodynus Hoffmann! Liq. Ammonii caustici (ammonia spirit) i 10% solution 1-2 cc under skin repeatedly or in powder 0.2-0.5 internally 10-20% solution 2-3 cc under skin 1 1 For stimulation of the respiratory center Carbon dioxide | 5-7% mixture with air or oxygen for inhalation Lobelinum hydrochloricum | 1% solution under skin 0.3-0.5 cc repeatedly | 1 Purpose of application Name form of administration and dosage For stimulation of the respiratory center Atropinum sulfuricum Strychninum nitricum (see also above-Coffeinum natrio-benzoicum, or camphoratum_: Aether sulfuricus) Solution 1:1000 1/1 cc under skin every 15-30 min. up to three times Solution 1:1,000 under skin 1/1%-X cc For strengthening cardiac activity Digalen Strophanthinum (see also above-Coffeinum natrio-benzoicum, or camphoratum, Aether sulfuricus) T-ra Strophanthi Adrenalinum hydrochloricum Saccharum uvicum (grape sugar) For calming the excited central nervous system

1 cm³ under skin repeatedly Solution 1:1000 1/4-1/2 ^cm3 slowly intravenously, can be repeated after 48 hours

7-10 drops per dose internally Solution 1:1,000 1/2-1 cm³ under skin or 5-10 drops of solution 1:1,000 in 1 liter physiol. solution intravenously, very slowly, total not more than 1 mg adrenaline 20% solution intravenously Up to 500 cc 2.0-3.0 in 30.0 water with addition of 20.0 Mi-cil. Gummi-arabici, 1 tablespoon every 1/2-1 hour or immediately in enema For reduction of severe pain Pantoponum Morphium hydrochloricum 2% solution 1-2 cc under skin 1% solution 1 cm³ under skin For reduction of pain in intestines Extr. Belladonnae T-ra Opii Opium pulveratum Against spasm of smooth Papaverinum hydrochloricus musculature of intestines

Atropine sulfate 0.015-0.02 with sugar orally or with cocoa butter in the form of suppositories into the rectum. 3-5 times orally, if necessary repeated. 0.01-0.02 with sugar orally. 1% solution 1-2 subcutaneously. Solution 1:1000 1/2-1 subcutaneously. 2. Bloodletting from the elbow vein - from 300 to 600 cm³ of blood. Through bloodletting, a large amount of poison that has entered the body is removed (theoretically - up to 1/5 of it) and there is an intensified flow of fluid from the tissues into the vascular system, as a result of which the concentration of poison in the blood decreases; at the same time, enhanced formation of new blood is observed. 3. To enhance the work of excretory organs, the following are used: diuretics - primarily of the purine series (Diuretin, Theocin, Agurin, etc.), as well as others (solution of potassium acetate), diaphoretics - injections of pilocarpine hydrochloride, laxatives, especially saline (magnesium sulfate, sodium sulfate); in poisoning with carbon monoxide to enhance the breakdown of carboxyhemoglobin and the elimination of CO by the lungs - inhalation of oxygen, preferably (to stimulate the respiratory center) with the addition of carbon dioxide (5-7% by volume), artificial respiration; in poisoning with bromine compounds - solutions of sodium chloride or mineral water; in poisoning with heavy metals (especially lead and mercury) - potassium iodide, as well as sodium hyposulfite. Since many poisons, especially alkaloids (e.g., morphine) and heavy metals, after being absorbed into the blood, are again excreted into the gastrointestinal tract, it is advisable in later stages of poisoning to again perform stomach lavage and emptying of the intestines. III. Attempts to convert already absorbed blood poison into harmless compounds for the body with the help of chemical agents have not yielded significant results and only in individual cases deserve attention. For example, for this purpose, in recent years in cases of poisoning with hydrocyanic acid, lead, mercury, arsenic, etc., a 5% solution of sodium hyposulfite is given subcutaneously and intravenously or orally (see doses in table 4). IV. The functions of organs disrupted by poison entering the body are sought to be corrected by applying symptomatic means. Symptomatic treatment is primarily directed at life-sustaining functions, which include breathing, cardiac activity, blood circulation, body temperature, and further - life-threatening conditions of general depression, high degrees of excitement, sometimes - pain and convulsions. BREATHING. To stimulate the depressed respiratory center, reflex skin irritations are used (cold douches in a warm bath, alternating application of pieces of ice and hot compresses to the chest or rubbing the chest skin with them); centrally acting agents (inhalation of carbon dioxide with oxygen, subcutaneous atropine, lobelia, caffeine, camphor), orally hot strong tea or hot coffee. In paralysis of breathing, artificial respiration (various methods) is used, making 8-10-14 inhalations per minute, faradization of the phrenic nerve. Inhalation of oxygen (possibly pure) is used rhythmically or continuously in all cases where there is a danger to life due to suffocation (prolonged difficulty in breathing, decreased excitability of the respiratory center, especially in many poisonings by gases, depressing alkaloids, fatty series hypnotics). Swelling of the entrance to the larynx often requires the use of intubation or tracheotomy. CARDIAC WEAKNESS AND CIRCULATORY DISORDERS. Excitants of a physical or chemical nature or their combinations are used. These include warm baths with cold douches, especially of the head, rubbing the skin with brushes and hands, mustard plasters, enemas with vinegar (1 part to 3 parts water), rhythmic slapping of the cardiac area with the palm; orally - strong coffee or tea with cognac or strong wine, ammonium salts, Hoffman's drops, strophanthus; subcutaneously - caffeine, camphor, ether, digalen, adrenaline; intravenously - adrenaline, strophanthin, physiological solution, grape sugar solution, calcium chloride solution. To stimulate the vasomotor center, in addition to caffeine and camphor, strychnine is also given subcutaneously, in paralysis of capillaries (arsenic poisoning) - adrenaline. LOWERING OF BODY TEMPERATURE. Wrapping in warm blankets, hot water bottles, heating pads, heated bricks, sandbags, electric heaters, etc., warm baths, heating the room. In severe excitement of the central nervous system, chloral hydrate is given in an enema, in convulsions - chloroform anesthesia. Against pain (colic) in the stomach and intestines - orally belladonna, cocaine, opium, subcutaneously - atropine, papaverine, pantopon, morphine, camphor. The use of morphine must be very cautious due to the danger of paralysis of the respiratory center. Less severe pain can be alleviated even by local application of heat, administration of analgesics orally (phenacetin, pyramidon or aspirin). In excessive vomiting, ice pills are given, orally - cocaine. When a doctor is called for poisoning, he should take the following means with him: litmus paper (for examining the reaction of secretions and cauterized mucous membrane of the throat with acid or alkali), soft probe, funnel for lavage, laxative, syringe for injection, anesthesia kit. The most important devices and medicines for emergency aid in poisoning are: oxygen apparatus, stomach tube, set for tracheotomy and intravenous infusion, sterile physiological solution of sodium chloride, charcoal (medicinal carbon), calcined magnesia, sodium sulfate, apomorphine hydrochloride, several cardiac and stimulant preparations (camphor oil, caffeine, etc.), syringes.

M. Nikolaev. Professional poisonings - poisonings that occur in a worker of one or another production in connection with his professional work due to the effect on his body of a poison that is used, systematically formed or accidentally arising in the production process, i.e., an industrial poison. Since there is almost no branch of industry in which some poisonous substance is not used in one form or another, the number of workers exposed to the danger of poisoning is very large. One of the most important industrial poisons - lead - finds application in more than 120 productions; in one Leningrad (according to 1926 data), the number of workers in contact with lead was ~14,048 (5.7% of the total number of workers in Leningrad). A huge number of workers also work with other poisonous substances, for example, workers in rubber factories (gasoline), workers in aniline and organic dye factories (in one Germany, about 200,000 people work in this industry), etc.

To give even an approximate list of industrial poisons is quite unthinkable, given their enormous number. In almost all countries, lead causes the largest number of poisonings, followed by carbon monoxide and aromatic compounds (benzene and especially its nitro- and amino-derivatives); then come zinc, mercury, arsenic and arsine, sulfur compounds (hydrogen sulfide, carbon disulfide, sulfur dioxide), chlorine, nitrogen oxides and many others. Some poisons, which in the past represented an extremely great threat to workers and caused a large number of severe poisonings, have lost their significance almost completely (e.g. phosphorus) or partially (mercury, arsenic) thanks to their elimination from production; others, on the contrary, have moved to the forefront thanks to the intensified development of new types of industry (e.g. aromatic compounds). (For the degree of danger of individual industries, the number of poisonings by various poisons in them, see Lead, Arsenic, Mercury, Phosphorus and others, as well as Industrial Poisons.) As for the absolute number of poisonings that have occurred in the industries of different countries, the materials on the mandatory registration of professional poisonings, introduced in recent years in most Western European countries, provide an idea; in previous years (before 1910-1910) these data were accumulated accidentally and therefore suffered from great inaccuracy; for the present time, the materials are also usually far from complete—only cases accompanied by loss of working capacity are included. In Germany, for example, in 1926, 3,485 cases of professional poisonings were reported, in 1927—3,798; the largest number, as in other countries, was caused by lead: in 1927—3,329 cases, followed by benzene and its derivatives—113, mercury—90, carbon disulfide—86, arsenic and its derivatives—51, etc. In the USSR, where mandatory registration was introduced in 1924, material has been accumulated and processed for 5 years until October 1929. During these years, 18,242 poisonings were registered throughout the USSR, distributed by years as follows: 1924/25—3,022, 1925/26—2,931, 1926/27—2,897, 1927/28—4,697, 1928/29—4,694. These data cannot be compared with Western European ones mainly due to unequal registration: in the USSR, absolutely all cases, even the mildest ones, are subject to registration. Consequently, both in quantity and in form (course and outcome), our data differ qualitatively and quantitatively from Western European ones in a better direction. This also explains the discrepancy in the distribution of poisoning cases by individual poisons and industries: in the USSR, carbon monoxide ranks first in the number of poisonings, causing 9,857 cases of poisoning in the indicated 5 years (90% of them occurred in the metallurgical industry of Ukraine and the Urals, and about 70% were not accompanied by loss of working capacity). Next come lead—1,572, zinc oxide—2,201 (almost all cases are mild poisonings), gasoline, kerosene and others—639, chlorine—537, aniline—506, sulfur dioxide—472, nitro-compounds of benzene—315, hydrogen sulfide—242, mercury and its compounds—112, nitrogen oxides—144, etc. The increase in the number of cases, especially in the last two years, is explained, on the one hand, by improved registration, but mainly by the rapid growth of industry that began in 1927/28. For a number of poisons and industries, despite the significant increase in production volumes, a decrease in the number of poisoning cases can be noted due to a radical improvement in working conditions; this applies, for example, to cases of foundry fever (movement over 5 years according to the years mentioned above: 1,664, 325, 127, 56, 29), poisoning by aniline (171, 115, 117, 75, 28), sulfur dioxide (313, 35, 40, 75, 9) and others. (For more details—see the corresponding words.) From a clinical point of view, professional poisonings are divided into acute and chronic. Acute ones arise suddenly, manifest with more or less intense clinical symptoms, and are caused by the penetration into the body in a relatively short time of large amounts of poison or a more concentrated one, which usually occurs in unforeseen circumstances: damage to equipment, accidents, introduction of new unstudied or uncleaned substances, etc. Often in such cases, not one, but several or many people are affected. Chronic professional poisonings, developing gradually, are caused by small amounts of poison entering the body imperceptibly, day after day. To chronic professional poisonings are sometimes also attributed those pathological phenomena that remain for a long time as a result of acute professional poisoning, e.g. phenomena of parkinsonism and various mental disorders developing after carbon monoxide intoxication. Poisonings developing on the basis of depots of lead, mercury, arsenic, phosphorus, etc., present in the body, can more rightly be called chronic. On the other hand, on the basis of chronic professional poisoning, acute phenomena can episodically arise, e.g. lead colic in chronically lead-poisoned persons; this is more often observed in connection with the penetration of additional large amounts of poison. The question of habituation to industrial poisons is not sufficiently illuminated. According to some authors, it sometimes apparently occurs [e.g. to zinc vapors after a certain period of work accompanied by attacks of foundry fever (see); to gases irritating the respiratory tract: SO₂, Cl, NH₃]. In most cases, a single acute poisoning does not guarantee against a recurrence. On the other hand, in a number of cases, increased sensitivity to the poison is observed—phenomena of the order of idiosyncrasy, anaphylaxis.—In relation to the occurrence and course of acute or chronic poisoning, besides the biological factor, social factors have great, and sometimes predominant, importance. The somatic and mental state of the body exposed to the poison can both promote or counteract susceptibility to the poison and influence the form of the course of the poisoning. Hence also a number of social factors that are important, such as: the individual's attitude towards the collective, towards production, participation in communist forms of labor (moments that in the past were not taken into account by the mechanistic group of Obukh). Under the conditions of socialist construction, factors are accumulating, R M O m YYTTT, besides sanitary-technical rationalization, that prevent the occurrence of poisoning, increase the body's resistance, e.g. in relation to poisons acting on the neuropsychic sphere (disappearance of mass panic reactions to poisoning, which previously occurred repeatedly in our rubber factories, etc.). Symptomatology. The clinical picture of professional poisonings varies depending both on the poison, its quantity, concentration, routes of penetration, and on a combination of other factors, depending both on the state of the body itself (constitution of the body, state of its neuropsychic sphere, diseases and intoxications it has suffered), and on socio-domestic and production factors (unfavorable meteorological conditions, combined action of poisons, etc.). As for the question of which organs are predominantly or primarily affected in professional poisonings, in this regard, on the one hand, the properties of the poison, its selective action, and on the other hand, the special sensitivity and vulnerability of one or another organ or system in the victim are of importance. Thus, in a number of professional poisonings, the nervous system is mainly affected (acute poisonings by benzene, hydrogen sulfide, carbon monoxide, lead polyneuritis and encephalopathies, tremor and erethism of mercury, etc.). In another series of professional poisonings, symptoms from the blood and blood-forming organs are primarily present, such as: hemolysis, changes in blood pigment, lesions of the bone marrow, etc. (e.g. poisoning by arsine, aniline, chronic poisoning by benzene, etc.). The third group of professional poisonings proceeds with predominant lesions of the respiratory organs (nitrogen oxides, sulfur dioxide), the vascular system (lead), etc. In most cases, however, we are dealing with lesions not of one, but of several organ systems, resp. tissues. Course and outcome. In some rare cases, when a large amount of poison quickly enters the body, instant death may occur (during explosions, when working at great depth repairing sewer and gas pipes from CO or H_aS, when cleaning vats containing poisonous substances, etc.). In most cases, the following periods can be noted in the course of the disease: 1) latent, prodromal, 2) period of toxic action, 3) period of recovery and 4) period of sequential action. With the combined action of poisons, one often has to reckon with the 'potentiating' action of one poison on another (e.g. CO and H_aS). In chronic professional poisonings, the duration also depends on the presence of depots, periodic exacerbations, development of persistent changes in organs, etc. When making a diagnosis, special attention should be paid to the professional anamnesis, conditions of the production environment and execution of the production process, nature and place of the accident, composition of substances with which the victim comes into contact.

The patient's habitus is of great importance, as well as the color of the face and mucous membranes (blueness with aniline, jaundice with methemoglobin, etc.), the odor of the exhaled breath, and analysis of secretions for the presence of poison or its breakdown products (Pb, Hg, paramidophenol, etc. in urine). In some cases, when the poison is the main causative factor and other etiological factors recede into the background, professional poisoning is the primary diagnosis, as for example in most acute poisonings and some chronic ones. In other cases, when the poison is a secondary etiological factor among other causes, professional poisoning as a diagnosis will be secondary, as for example arteriosclerosis on the basis of alcoholism and lead poisoning, etc. Principles of treatment for professional poisonings. Removal from the given working environment is a conditio sine qua non for acutely occurring professional poisonings. In chronic forms of these, or with special functional insufficiency of organs particularly susceptible to poisoning by this poison, or with repeated acute poisonings, removal from this production is indicated, either temporarily or permanently. In acute poisonings, when indicated, artificial respiration, administration of oxygen, measures to remove the poison from the body, antidotes, venesection followed by administration of physiological solution, symptomatic remedies, etc. are used. In chronic professional poisonings, the main measures should follow two paths: 1) removal of the poison from the body (heat procedures, baths, spa treatment, some medications), 2) general strengthening or symptomatic treatment of persistent changes in organs by conventional methods. In appropriate cases with chronic professional poisoning, the question of utilizing residual work capacity in another profession should be considered. Preventive measures. The issue of combating professional poisonings is most radically resolved in cases where it is possible to completely eliminate the poisonous substance from production. One can cite a number of examples where removal of the poison by replacing it with another substance has immediately and fundamentally improved working conditions: replacement of mercury in mirror production with silver nitrate, elimination of it from the gilding and silvering process by switching to galvanostegia, exclusion of mercury from electric lamp production by switching from mercury to oil pumps; replacement of the poisonous white (or yellow) phosphorus with red, almost non-poisonous phosphorus in match production; switching to brass linings instead of lead in file production; gradual displacement of carbon disulfide from rubber production, etc. Nevertheless, these are isolated examples; in the overwhelming majority of productions, switching to a non-poisonous (or at least less poisonous) substance appears impossible, and it is absolutely impossible to eliminate the poison from production where it is a by-product or waste, evaporating in the form of dust, vapors, and gases (carbon monoxide, hydrogen sulfide, nitrogen oxides, and many others). Moreover, over the last few decades, in connection with the giant development of the chemical industry, in particular the aniline dye industry, the number of new poisons introduced into production processes has enormously increased, and this number continues to grow to the present day; the same can be said regarding solvents: their number has immeasurably increased in the post-war years, and their use in industry has multiplied many times over. Consequently, improving working conditions by complete (or at least partial) removal of poisons from production represents a relatively small area in the fight against professional poisonings; but since such removal immediately gives an exceptionally good effect, it should be pursued to the maximum extent everywhere where there is even the slightest possibility. Here one must note that a complete victory in this sector of the front under capitalist conditions is unattainable: poisons are introduced into production without any state or social control, in most cases without prior investigation of their toxicity, and only subsequent poisonings occurring in production force attention to be paid to these substances. Routinely, knowingly poisonous substances are released for industrial needs (for example, paints, varnishes) under fantastic names that hide their actual composition, or with labels 'slightly poisonous,' 'practically non-poisonous' (as recently occurred in Germany with sulfobeleils, which turned out to be no less poisonous than white lead carbonate), and so on. There are many known examples where poisons introduced into production, which caused a huge number of serious poisonings, nevertheless (despite the complete possibility) were not removed from production, because this was not profitable for entrepreneurs (the need to develop a new production method, invest in new equipment, etc.); as examples one can cite match production, where replacement of white phosphorus with red in Western European countries occurred only after the longest and most stubborn struggle; the production of felt hats, where despite the enormous danger to workers from mercury poisoning and the complete possibility of eliminating it by using other mordants (which was proven more than thirty years ago), mercury is still used in Western European countries and the USA to this day; the production and use of white lead and other lead-containing paints—despite decisions of special international conferences, resolutions of the International Labor Bureau, etc., it has not been possible to achieve complete elimination of lead from paints, etc. (for more details see Industrial Poisons, Lead, Mercury, Phosphorus, etc.). The same can be said about solvents: in recent years in the USA, Germany, and other countries, extremely strong poisons have been introduced, for example methyl alcohol ('methanol'), chlorinated hydrocarbons, etc., despite the possibility of replacing them with others, less poisonous, etc. In the USSR, the question is of course resolved much more radically: everywhere where there is even the slightest possibility of eliminating a poison, the question is raised, worked out, and at the first opportunity finds resolution in practice; one can point to such major achievements of recent years as the almost complete cessation of production and use of white lead, replacement of lead linings in file production with zinc ones, the almost completely implemented in hat production transition to working with caustic potash (instead of a mordant containing mercury), etc. Where a switch to working with non-poisonous substances is impossible, the fundamental question is raised that 1) workers must be absolutely

POISONING

Workers absolutely did not come into contact with poisonous substances, 2) the release of poisons into the air in the form of dust, vapors, and gases was completely absent; i.e., complete mechanization of production processes and hermetic sealing of equipment (operating under vacuum) are necessary, which is achievable in many cases and completely or significantly improves working conditions. (For details on successes in this field in the USSR, see the relevant entries.) Examples include the mechanization of blast furnace loading, which immediately eliminated the great danger of carbon monoxide poisoning; the transition to improved methods of brass casting, which sharply reduced the number of cases of foundry fever; the mechanization of a number of production processes in aniline plants; the fundamental reorganization of the production process in tobacco and makhorka factories and many others. Where complete hermetic sealing of equipment is impossible, measures such as covering apparatus with casings, sleeves, hoods, etc., connected with exhaust ventilation, and the installation of local or general exhaust (combined with supply) ventilation are introduced, the effect of which should be such as to reduce the content of poisonous impurities in the air to negligible amounts that do not pose a danger of acute or chronic poisoning (such 'maximum permissible' concentrations for a number of more thoroughly studied major poisons have been developed by the State Scientific Institute for Labor Protection and published by the NKT USSR as legislative norms). If, despite all measures, the conditions of the production process are such that poisonous dust, vapors, and gases are still released into the air in significant quantities, work must be done with gas masks or masks with a supply of fresh air. Next come measures of 'personal' hygiene: wearing rational special clothing and frequent changing of the latter, lockers for clothes (with compartments for work and personal clothing), washbasins with soap and towels, showers, baths, teeth and mouth cleaning, etc. The measures mentioned, implemented in various forms and combinations in different industries, can give—and indeed give—a large positive effect; thanks to their introduction in the majority of industries, the number of poisonings has decreased relatively significantly in the last decade, both abroad and the extremely severe cases of poisoning by such poisons as lead, mercury, carbon disulfide are now encountered much less frequently. But the real fight against the effects of industrial poisons still requires, in addition to production measures, a number of radical socio-public measures, which under the capitalist system cannot possibly be implemented, only in the USSR, a country building socialism, where the workers themselves are interested in creating completely healthy working conditions, only here was the question of combating occupational poisoning properly raised from the start, and as general conditions improve and corresponding industries develop, this struggle is expanding on an ever broader front. Despite the excellent equipment of enterprises, the most perfect apparatus, very good ventilation installations, etc., in a very large number (if not the majority) of 'poisonous' industries, with the current state of technical knowledge, it is not possible to achieve complete, i.e., 100%, improvement of working conditions; a certain, albeit sometimes negligible, amount of poisonous emissions enters the air; many operations involving cleaning, repairs, etc. remain where the worker inevitably comes into contact with the poison or inhales its emissions in increased amounts compared to normal. And these small amounts, the effects of which cannot be detected in a short time, still, with prolonged action on the body, are capable of causing (and do cause) certain disturbances. And here, in the effort to completely neutralize poisons, measures that should be aimed at increasing the body's resistance come to the forefront, i.e., striving to ensure that the worker's body is able to cope with this exposure without any harm to itself. This group of measures includes everything that directly or indirectly contributes to improving the well-being of the working class and improving general working conditions, to which the USSR pays such serious attention. This is, first of all, preliminary supervision over newly opened enterprises, not allowing them to start without special permission from preliminary supervision authorities, constant observation of working conditions, which must comply with the rules contained in both the 'general rules for the installation and maintenance of industrial enterprises' and special rules issued specifically for this type of 'poisonous' production (in the USSR, mandatory regulations have been issued for the production of mineral salts and acids, chromium salts, arsenic, production and use of lead paints, tobacco production, aniline plants and some others). Secondly (which is of particular importance) improvement of housing and nutrition conditions, creation of conditions for proper use of non-working time (cultural services, physical education), a 7-hour, and in some especially harmful industries a 6-hour, working day with a mandatory lunch break, prohibition of overtime work, additional vacations with the possibility of spending them in sanatoriums and other resorts; the provision of additional nutrition (in the form of milk or butter), which, while not playing the role of an antidote, apparently still increases the body's resistance; priority provision of workers in poisonous industries with places in sanatoriums and resorts; prohibition of the employment of adolescents; all this is consistently implemented in the USSR. Also of great importance is the preliminary medical examination conducted in the USSR (with the aim of not allowing persons who, due to their health condition, are under the greatest threat of poisoning to work in production) and periodic medical supervision, conducted in different industries—according to a special resolution—at different intervals (from two weeks to six months). For the purpose of identifying the most dangerous processes and workplaces and for preventing the recurrence of poisonings, all cases of poisoning that have occurred in production—even the mildest, without loss of working capacity—are subject to mandatory registration (for subsequent study and elimination of defects); and finally, one of the most important measures, which is particularly vigorously implemented in the USSR, is raising the cultural level of the working class, without which any health-improving measure is doomed to complete failure; in particular, workers in poisonous industries are given detailed information about the hazards and dangers of production and about the measures they must take to avoid poisoning; this is achieved through periodic lectures, conversations, visits to museums, and the distribution of mass popular literature in the form of leaflets, posters, etc. Only in this way, despite the widespread development of the chemical industry, which involves tens of thousands of new workers, can the question of the complete neutralization of 'poisonous' industries be resolved (and will be resolved in the USSR) radically; under capitalist conditions, however, radical struggle against occupational poisoning, as well as against other occupational hazards, represents an insoluble problem.

S. Gonkin, N. Rosenbaum. Poisoning - intentional injury to health as a result of introducing a poison (see) into the body for the purpose of murder or suicide. Poisoning as a form of murder was observed in ancient times. The history of the Middle Ages, and in particular the period of prosperity of the Italian republics, is especially rich in crimes of this kind. In modern times, murders by means of poisoning have been observed significantly less frequently. Thus, according to Vibert, for France for the period 1831-60, the number of accused annually fluctuated within the range of 27-41 people, and from 1871 to 1894 - between 7 and 17. At the present time, cases of poisoning, which are quite numerous, have taken on a different character. On the one hand, murder by this method is becoming an increasingly rare phenomenon, and on the other hand, along with the increase in the number of poisonous and potent substances used for treatment, suicides (see) and accidental poisonings occur more frequently. In particular, in the RSFSR for 1924-26, according to incomplete reports from court-medical experts, there were 7,328 cases of fatal poisonings, including: 450 murders, 1,884 suicides, 92 infanticides. Criminal legislation has always considered poisoning a serious crime. Roman law saw in poisoning (veneficium) murder and treason. The Criminal Code of Charles V (1532) provided for the death penalty (breaking on the wheel - for men, drowning - for women) for murder by means of poisoning. According to pre-revolutionary Russian law, poisoning was considered an aggravating circumstance for punishment for murder (hard labor for a term of 15-20 years or without term) only if there was intent. Impairment of health resulting from poisoning is classified by the Criminal Code of the RSFSR as bodily injury (see "Rules for drawing up a conclusion on the severity of injuries"), and one should be extremely cautious in predicting the outcome of poisoning, as subsequent diseases may be discovered relatively late. Murder by means of poisoning, if premeditated, under Soviet legislation entails the application of strict measures of social protection. For the purpose of preventing and limiting accidental and intentional poisonings in the RSFSR, rules have been established regulating the trade in poisonous and potent substances. Their careless storage is punishable by law (see "Rules for dispensing medicines from pharmacies", circular of the People's Commissariat of Health, No. 28 of 4/III 1926, published in the Bulletin of the People's Commissariat of Health for 1926, No. 5; "Regulations on the trade in poisonous and potent substances", circular of the People's Commissariat of Health, the Supreme Economic Council of the RSFSR and the People's Commissariat of Internal Trade, No. 298, of 30/XII 1925, published in the Bulletin of the People's Commissariat of Health for 1926, No. 1). In court-medical practice, one has to deal with acute, subacute poisonings and rarely with chronic ones, which in the vast majority of cases fall under the jurisdiction of social hygiene (occupational poisonings). Sometimes a remitting form is also observed (narcotic poisons, extremely rarely mineral): the symptoms of poisoning weaken for a time, and the patient apparently recovers, and then the phenomena of poisoning resume with even greater force, which can sometimes be attributed to the introduction of a new portion of poison - a circumstance that has occurred more than once in intentional poisoning. An expert is usually invited by the court-investigative authority to establish the fact of poisoning, and at his disposal are the following types of evidence: 1) analysis of the phenomena of life attributed to poisoning (clinical picture); 2) autopsy of the corpse in cases ending in death; 3) chemical examination of excretions from a living person (vomit, feces, urine) or parts of the corpse, remnants of poison, as well as other objects related to the alleged poisoning, such as medicines, food substances (see Food Poisonings), etc.; 4) microscopic examination of the same objects; 5) physiological experiments on animals; 6) spectral analysis (of blood); 7) study of the circumstances of the case. 1. The clinical picture of poisoning can be extremely diverse, and the symptoms observed during life are not in themselves absolutely characteristic of poisoning. Therefore, it is not surprising that sometimes cases of poisoning were not recognized and passed off as natural diseases, and conversely, cases of poisoning arose more often by chance regarding accidental diseases. In general, this type of evidence for poisoning is not very reliable, although in a certain number of cases it is possible not only to establish the fact of poisoning but also the nature of the poison based on the phenomena of life. For the expert analyzing the clinical picture of alleged poisoning, the following data are important: condition of the gastrointestinal tract (condition of the oral cavity, vomiting, diarrhea, abdominal pain), nervous system (excitation or depression of the psyche, convulsions, paralysis), phenomena from the sense organs, especially vision (hallucinations, condition of the pupils), respiratory disorders (shortness of breath, change in the type of breathing, wheezing, etc.), urination (amount of urine, abnormal components), body temperature and skin properties. It is essentially important to determine the time of appearance and the order of development of individual symptoms. - 2. In cases of poisoning ending in death, it is necessary to perform an autopsy of the corpse, observing the procedure prescribed by the existing "Rules for court-medical examination of corpses", §§ 83, 84, 85, 86 (journal "Court-Medical Expertise", book 11). If the corpse to be examined has already been buried, then the investigator usually does not proceed to its exhumation until the arrival of the expert, who can give valuable indications for the case and sometimes takes certain objects from the grave for further examination. It is also important to note that the person performing the autopsy should use as little water as possible, and of course, it is completely impermissible to wash hands and instruments with antiseptic solutions (sublimate, etc.), since the substances contained in them can easily penetrate into the corpse and, being discovered during subsequent chemical examination of the organs, can lead to erroneous conclusions. The routes of poison introduction are different (per os, per anum et vaginam, subcutaneously); therefore, all natural openings must be carefully examined, in which it is often possible to note pathological changes and sometimes remnants of poison; on the skin, traces from injections with a syringe may be present. After the external examination, the cavities are examined - abdominal, pleural, pericardial. Of the internal organs, the heart is first examined and opened, then the stomach and intestinal canal, followed by the organs of the neck and oral cavity, the other thoracic and abdominal organs, and finally the cranial cavity. The stomach and intestines require special attention at this time. In particular, two ligatures are applied at the entrance and exit of the stomach; it is cut between the ligatures at both ends, the stomach is removed and placed in a clean cup; it is opened along the anterior wall, the contents are poured into a graduated vessel, and the stomach is carefully examined. In the same way, the small and large intestines are ligated separately, opened over a clean cup, and the contents are collected in separate graduated flasks. Next, the quantity, degree of viscosity, color and general appearance, smell, reaction (acid or alkaline) are noted. The properties of suspicious solid particles are determined by the naked eye or with a magnifying glass, and where possible with a microscope; simple preliminary chemical tests are also performed (depending on the circumstances of the case). The data from the autopsy are the most important type of evidence of past poisoning. Thus, for example, during the examination of the corpse, the following can be discovered: 1) characteristic local changes, especially of the gastrointestinal tract (corrosive poisons); 2) one or another coloring characteristic of the poisonous substance: yellow - from poisoning with nitric acid, green - from arsenic green, blue - from copper sulfate, etc.; one should only remember that the coloring may also depend on the nutritional and taste substances taken; 3) characteristic smell of bitter almonds (poisoning by cyanide compounds), chloroform, alcohol, etc. when opening the body cavities, stomach; it is recommended to transfer the contents of the stomach to some vessel, close it, and after some time smell it, then the smell becomes more clearly distinguishable; sometimes the poison itself can be discovered in the form of particles of mineral, plant origin, oily droplets, etc. In other cases, the results of the general action of the poison are revealed - protein degeneration, degenerative fatty degeneration of internal organs, hemorrhages, changes in urine (blood admixture, etc.). The autopsy can establish the cause of natural, sudden death. Finally, a "negative result" of the corpse examination, namely the absence of macroscopic changes in organs that could have caused death, can be considered a valuable indication of the possibility of poisoning by certain poisons with general action (alkaloids, volatile substances). 3. If necessary for chemical examination of parts of the corpse, they must be taken by the expert in the quantity and manner specified in §§ 87 and 88 of the "Rules". In particular, placed in separate jars are: 1) the stomach (opened) and all its contents; 2) about 1 m of small intestine from the most changed part and all its contents; 3) approximately 2/3 of the liver with the gallbladder; 4) one kidney and all urine; depending on the nature of the alleged poisoning, the following can also be taken: 5) about 1 m of large intestine and its contents; 6) a part of the most blood-rich lung tissue, the entire spleen, heart and the blood contained in it; 7) a part of the brain and spinal cord.

Similarly, other parts not named here are taken, such as: skin, connective tissue and muscles from the site where the poison is presumed to have been introduced, then hair, pieces of bone, etc. When exhuming a buried corpse, the following may be taken: about 1 kg of earth from the grave, from under the coffin, pieces of clothing, coffin lining, jewelry, etc. The advisability of requiring objects intended for chemical examination to be placed in separate containers for each is based on the following considerations: 1) with a higher concentration of poison in one organ or another (liver, kidney, etc.), quantitative determination of the substance is easier; 2) for comparison of the results of chemical analysis of organs, e.g., when determining whether the poison has penetrated from the stomach into neighboring organs postmortem by diffusion; 3) in many cases it is necessary to establish the ratio between the amount of poison remaining in the gastrointestinal tract and that which has been absorbed and can be excreted from other organs. It is believed that in acute poisonings, the amount of unabsorbed poison predominates, while in chronic cases, the opposite is true. Wide-mouth glass jars, in which parts of the corpse are usually placed without the addition of preservative fluid, must be perfectly clean. The jars are tightly closed with ground glass stoppers or simple, unused ones. The top of the jar is wrapped in clean paper, tied with string, the ends of which are sealed with the seal of the investigator (investigation). The jars are numbered in sequence, labeled with information indicating: 1) which part of the corpse is in the jar, 2) in what quantity, 3) from which corpse, 4) when the autopsy was performed. The jars are handed over by the expert to the investigator (investigation) against receipt for immediate forwarding (many poisons decompose quickly) to the laboratory with an accompanying document and a copy of the act of forensic examination of the corpse. If for any reason prompt forwarding of the corpse parts to the laboratory is not possible, they are poured with pure rectified alcohol (formerly formalin was used for preservation, but it proved less suitable as it alters and does not preserve certain poisons), and at the same time a sample of the alcohol taken for preservation, in an amount of not less than 200.0, is also sent to determine its purity. 39G Objects subject to chemical examination are sent to the corresponding provincial or departmental health department, where there is a forensic chemist (forensic laboratory). The chemist performs the analysis, draws up an act with a detailed description of the course of the investigation and a conclusion - whether poison was found or not; if found, in what quantity. The remaining organs and tissues are stored for one year and then destroyed (see the 'Rules for the storage and destruction of objects of forensic chemical and microscopic research' of July 10, 1920). Chemical research as evidence of former poisoning has significant, but by no means unconditional, importance for the case. Data obtained by this method must be subjected to comprehensive critical evaluation, as it is possible to find poison even though there was no poisoning, and conversely, in cases of certain poisoning, poisons are often not discovered. With a positive result of chemical examination, the following must be kept in mind: the substance found could have entered the body without poisoning, both during life and after death. In particular, Devergie and Orfila assert that a small amount of arsenic normally exists in the human body (bones). It is not so rare to find traces of copper, zinc, lead, especially in elderly individuals, and this is not surprising given the widespread occurrence of these metals (canned goods, utensils). The poisonous substance could have been taken as medicine (mercury treatment for syphilis, arsenic used as Fowler's solution, as well as contained in considerable amounts in some mineral waters, etc.) or even as an antidote. It is not always a matter of small amounts of poison, as medicines are often taken for quite a long time, and with some of them the single dose gradually increases. It is also possible for certain substances to enter the body as components of beverages (e.g., hydrocyanic acid in liqueurs or acetic acid as a food seasoning). Moreover, in a living person and even more so in a dead body, particularly due to the decay of food masses in the intestine of a living person and the decomposition of organs of the corpse, ptomaines (see) are formed, which can give reactions characteristic of some organic poisons (strychnine, atropine, etc.). Accidental contamination of the corpse with poisonous substances is also possible, e.g., during autopsy, or they can penetrate the corpse from the coffin (ornaments, metal parts of clothing), and in rare cases, when the coffin decomposes, even from the soil. Thus, it has been repeatedly confirmed that the soil of some cemeteries contains arsenic. It is also important that the vessels, reagents, and filter paper used by the chemist do not contain foreign impurities. A negative result of chemical examination in cases of certain poisoning is observed quite often. Many poisons cannot be determined by chemical analysis at all (snake venom, etc.). In addition, the chemical reagents used to detect poison have a limit of sensitivity, and on the other hand, there are poisonous substances that kill in very small amounts, and in the portion of organs sent for examination, undetectable traces of poison may be present. The poison may have been expelled from the body by vomiting, diarrhea, urine to such an extent that only difficult-to-determine amounts remain. Some poisonous substances, namely organic ones, are undoubtedly destroyed in the living organism or converted into compounds whose discovery does not prove former poisoning. Volatile poisons easily disappear, especially if the examination is performed after a considerable period of time. Organic compounds undergo decay or transformation into more complex substances; this is even more possible if they are in the decaying mass of organs of the corpse. Moreover, under the influence of burial conditions, poisons can leave the corpse along with its fluids, seeping into the soil, or be 'leached out', i.e., washed out of the dead body by cemetery water. 4. Microscopic examination serves as a supplement to the autopsy and its continuation; with the help of a microscope, the properties of suspicious small particles are established, as well as changes in tissues and organs that are important for the diagnosis of poisoning. Microscopic examination gives particularly valuable results in non-fatal cases when there are only the excretions of the patient - vomit, feces, urine, etc. Organs taken from the corpse for further anatomical or pathological-pathological examination are preserved in 10% formalin or strong alcohol, and pieces of organs intended for microscopic examination, not more than 0.5-0.75 cm thick, are poured with the aforementioned preserving and fixing fluids and sent in sealed jars for examination (see § 90 of the 'Rules'). 5. In cases where the chemist has found a very small amount of poison (mainly plant-based, strongly acting), giving not quite definite reactions, its physiological effect can be tested on small animals (for experiments, frogs, guinea pigs, white mice are used, but if there is a sufficient amount of poison, also dogs, cats, and rabbits). Strychnine kills frogs and mice with symptoms of tetanus; atropin causes dilation of the pupils in animals, etc. The substance to be tested, obtained in as pure a form as possible (in a solution of neutral reaction), is administered intravenously or subcutaneously, into the conjunctival sac, etc. Auxiliary research must be carried out by specialist physicians, as the reactions obtained are distinguished by particular subtlety, and sometimes uniqueness. One should not forget that the animal organism does not always react to poisons similarly to the human one. When evaluating the results of physiological experiments on animals, the utmost caution must be exercised. In general, this type of evidence can have sufficient persuasiveness only in rare cases. It should be kept in mind that extracts from fresh, and even more so from putrefied corpses, obtained by extraction with water, ethyl and amyl alcohol (but not ether), are themselves poisonous and can kill animals. 6. If necessary for spectral analysis (see § 90 of the 'Rules'), the liquids intended for this purpose must be taken pure, e.g., blood directly from the heart. They are poured into vials with a capacity of 10-30 cm³, filled to the stopper to avoid contact of the liquids (e.g., blood) with air; the examination is of course best performed during the autopsy itself; if the circumstances do not allow, the liquids in the mentioned vials with appropriate labels are sent to the nearest laboratory with an accompanying document. A positive result of spectral analysis on fresh material has significant importance as one of the proofs of former poisoning, e.g., by blood poisons (carbon monoxide, potassium chlorate); a negative result does not exclude poisoning. 7. Circumstances of the case.

All data that in a specific case led to suspicion of Poisoning and provided grounds for the investigation should be included, and the expert must carefully consider and discuss them. Suspicion of Poisoning may arise when a seemingly healthy person, after consuming any food, drink, or medicine, begins to suffer from dangerous seizures. It also happens that sometimes several people suddenly fall ill after consuming food or drink. Various objects that may be related to the suspected Poisoning are often presented to the expert, such as: various suspicious substances in jars, boxes, paper, found during a search. Sometimes the victim or other parties involved in the case point out special properties of the food after which the illness developed - a peculiar taste, smell, presence of mineral granules, plant particles, or it is noted that the pathological phenomena repeated at certain intervals in connection with the intake of food, drink, or medicine. The established fact in some cases that animals that ate the vomit of the sick person or discarded food remains also became ill or died is also important. The lifestyle of the sick person, the nature of their occupation, behavior in the days before the suspected Poisoning, attitude towards others, etc., are not indifferent to the case. The analysis of written documents, which in some cases reveals long-term mental disorder or severe affective state (possibility of suicide), also has some significance. Regarding the question of murder, suicide, or accident, it is necessary to clarify the following: what is the nature of the poisonous substance, does it have such a sharp taste, smell, or color that it is difficult to mask, what is the amount of poison taken. If it is large and the poison had physical properties difficult to conceal, suicide is more likely. Accidental Poisonings are usually explained by the similarity of the poison to food substances and beverages or the similarity of packaging, containers. It should not be overlooked that Poisoning can be simulated. Generally speaking, the circumstances of the case as evidence of Poisoning have secondary importance; however, there may be cases where Poisoning is confirmed only in this way. Moreover, knowledge of all the circumstances of the case and their comparison with the data from the autopsy allow for a more precise opinion. Establishing the fact of past Poisoning is a responsible task for the forensic medical expert. A definite conclusion in the case often encounters significant difficulties; only a careful critical evaluation of all the available data in the specific case can prevent erroneous, irreparable conclusions when the body is cremated. In the examination of fatal Poisonings, the following questions are most often proposed by the investigative authorities: 1) was death caused by poison; 2) is there Poisoning, although the poison is not identified; 3) is the substance found by the chemist the cause of Poisoning; 4) could the substance taken cause death; 5) could the found poison be used as medicine; 6) was the substance found by the chemist administered to the deceased during their lifetime. In the examination of non-fatal Poisonings, it is necessary to determine: 1) what temporary and permanent consequences are caused by Poisoning; 2) what changes are due to Poisoning and 3) what can be attributed to previously existing diseases.