POISONING After the accidental swallowing of any strong poison life may some times be saved by the patient immediately drinking a great draught of water or milk to dilute the poison and retard its absorption, whilst measures are being taken for evacuating the contents of the stomach. At the earliest possible moment the stomach should be emptied. This may be accomplished by emetics or by the stomach-pump, or by tickling the fauces when these agents are not at hand. In poisoning by the strong mineral acids and all corrosive substances the stomach-pump is contra indicated, but in the case of mild corrosives like carbolic acid this may be used cautiously if a soft tube be employed. Indeed, the soft india-rubber tube of the stomach-pump can scarcely do any harm except in the most destructive instances of poisoning by concentrated sulphuric or nitric acid, and the pump should always be fitted with such a tube in at least two sizes. When at hand the pump, or a soft rubber tube with funnel attached, should he preferred to every other means of emptying the stomach, and except in the limited number of cases just mentioned, it may be used even when there is room for considerable doubt in the diagnosis of poisoning in patients found in insensible or comatose con ditions. The coroner's court will justly censure the practitioner who has been in attendance upon a patient picked up in an insensible condition if the evidence afterwards produced proves that a narcotic poison had been swallowed, though when seen by the physician no such evidence had been forthcoming and the symptoms pointed to head injury, uremia, or apoplexy. The cautious use of the pump with the rubber tube or the siphon apparatus, when scientifically carried out, can in no way injure the patient's chances of recovery should the case ultimately turn out not to be one of poisoning; and as every minute's delay may be serious for the patient, and as there is thus short time for counsel and debate, he should be prepared to act accordingly and make his error upon the safe side. The first time of using the stomach-pump or lavage tube is sure to be a bungling affair if the operator feels timorous or hurried.
The tongue being depressed by the left index-finger as the patient is seated in a chair, with the head well steadied by an assistant. and the gag in position, the tube is to be pushed steadily and rapidly through the mouth, pharynx and msophagus till the stomach is reached. Though it is more difficult to pass the soft rubber tube, the confidence in its perfect harm lessness will he of great importance to the novice. Tie should not be deterred by the sound which may be produced by air passing through the tube as its extremity glides past the epiglottis; this ceases as the rubber is passed home into the stomach. An intelligent patient can assist the oper ator by a \ tan. effort at swallowing, and he should not be rushed unless in cases of desperate emergency. During the pumping, by reversing the action of the levers, a little water may from time to time be sent into the stomach to clear the tube of any solid obstruction, and before with drawing it finally, tepid water, well coloured with Permanganate solution, should he injected into the organ, and this should be pumped out again, the operation being continued till the washings return clear. The antidote may be mixed with the water, and in many instances a quantity of this should be left in the stomach. In pumping opium or alcohol cases, after the washings return clear and free from odour the stomach may be partially filled with strong infusion of tea or coffee.
All these manoeuvres can be equally achieved by using the soft rubber tube with its attached funnel, such as is employed in ordinary lavage of the stomach.
As it is now known that most of the alkaloids are eliminated by the mucous membrane of the stomach, in poisoning by these substances the washing out of the organ repeatedly during treatment is necessary. If the patient remains conscious he may be able to wash the stomach out himself by drinking copiously of tepid water. The writer has frequently pumped and washed out the stomach of young infants by using an ordinary soft rubber catheter attached to the nozzle of a metal or glass syringe.