Diagnosis and Treatment of Poisoning

DIAGNOSIS AND TREATMENT OF POISONING Evidence of Poisoning.—It must be remembered that the symptoms of poisoning may be closely simulated by the symptoms of natural disease and the greatest care must be taken before a diagnosis of "poisoning is arrived at. For example, the symptoms of acute arsenical poisoning closely resemble those of cholera or acute bacterial food poisoning. The only certain differentiation is the finding of arsenic in the excreta or of the bacteriological evi dence of a cholera or food poisoning infection.

The evidences of poisoning are—( ) The symptoms are usually sudden in onset and they occur after the taking of food or drink or after exposure to poisonous gases or vapours. (2) If several persons are similarly exposed all are affected more or less with similar symptoms. An exception may occur in the case of bacterial food poisoning (so called ptomaine poisoning) where certain per sons may be immune, or some be specially susceptible. (3) The analysis which should always be carried out in suspected cases may reveal the presence of the poison in the vomit and urine and faeces and possibly also in some articles of food or medicine.

Post-mortem Evidence.

If death occurs a post-mortem examination should only be made following instructions from the coroner. The post-mortem signs found should be consistent with those occurring from poisoning by the suspected poison. The analysis of the viscera should yield results consistent with that of poisoning by the suspected poison having regard to the circum stances attaching to the date of administration and death.

Treatment.

The mode of treatment to be adopted varies according to the nature of the poison.

The first measure to be adopted without delay, is the removal of the unabsorbed poison. If the case is seen within six hours of the taking of the poison by mouth the stomach should be emptied and washed out as soon as possible. Emetics are a poor substitute for the emptying and washing out of the stomach by means of the funnel and stomach tube, but they may be employed if the more effective treatment is impossible. Safe emetics are mustard and water, salt and water, ammonium carbonate (3o grains) in a tum blerful of water, or apomorphine gr.-A- hypodermically.

The only contra-indication to the emptying and washing out of the stomach by means of the stomach tube and funnel are where poisoning occurs from the corrosive mineral acids or alkalies. In such cases there might be danger of perforation. After the stomach has been emptied and washed out suitable antidotes should be given, such as chalk and lime water to neutralize oxalic acid and the mineral acids, lime water for carbolic acid. Atropine may be given hypodermically in the case of morphine poisoning. Where morphia and cocaine are taken the stomach should be washed out with diluted permanganate of potash solution.

Elimination by the bowel is facilitated by colon washes with warm normal saline solution and by free bowel evacuations. The symptoms of poisoning are subdued by the administration of appropriate remedies, thus, pain may be relieved by hypodermic injection of morphine, and the convulsions from strychnine by chloroform inhalation.