XXXIV Alcohol, Ether, and Chloroform
Alcohol, ether, and chloroform, induce general anæsthesia, often preceded by delirious excitement, and followed by nausea and vomiting. When they cause death, it is by inducing a state like apoplexy or by paralyzing the heart.
Alcohol.—Absolute alcohol is ethyl hydroxide (C2H5OH) with not more than 1 per cent. by weight of water. Rectified spirit (spiritus rectificatus) contains 90 per cent. of alcohol. Methylated spirit consists of rectified spirit with 10 per cent. of wood spirit. Proof spirit contains a little over 49 per cent. of absolute alcohol; brandy or whisky, 53 per cent.; port wine, 20 to 25 per cent.; ales and stout, 4 to 6 per cent.
Symptoms.—Acute poisoning; confusion, giddiness, staggering gait, headache, passing into stupor, with subnormal temperature, and coma. Vomiting may occur and recovery ensue, otherwise collapse sets in. Pupils usually dilated.
Dipsomaniacs suffer from indigestion, vomiting and purging, jaundice, albuminuria, diabetes, cirrhosis of liver, degeneration of kidneys, congestion of brain, peripheral neuritis, alcoholic insanity, and various forms of paralysis. In the acute form delirium tremens is the most common manifestation.
Post-Mortem Appearances.—Deep red colour of lining membranes of stomach. Sometimes congestion of cerebral vessels and meninges. Lungs congested, blood fluid. Rigor mortis persistent.
Fatal Dose.—Death from 1/2 pint of gin and from two bottles of port, but recovery from larger quantities.
Fatal Period.—Average about twenty-four hours.
Treatment.—Stomach-tube, cold affusion, electricity, injection of a pint of hot coffee into the rectum. Give chloride of ammonium in 30 grain doses to prevent delirium; strychnine or digitalin hypodermically.
Method of Extraction from the Stomach.—Neutralize the contents of the stomach, if acid, with sodium carbonate; place them in a retort and carefully distil. Collect the distillate, mix with chloride of calcium or anhydrous sulphate of copper, and again distil. Agitate distillate with dry potassium carbonate, and draw off some of the supernatant fluid for testing.
Tests.—Odour. Dissolves camphor. With dilute sulphuric acid and bichromate of potassium turns green, and evolves aldehyde. Product of combustion makes lime-water white and turbid.
Methyl Alcohol: Wood Naphtha.—Used to produce intoxication by painters, furniture-polishers, etc.
Symptoms are those of alcoholic poisoning, but vomiting and delirium are more persistent. Total or partial blindness may follow as a sequel of optic atrophy. A fatal result not infrequently follows.
The following table gives the points of distinction between concussion of brain, alcoholic poisoning, and opium poisoning:
| Concussion of Brain. | Alcohol. | Opium. |
| 1. Marks of violence on head | 1. No marks of violence, unless person has fallen. History will be of use. | 1. As alcohol. |
| 2. Stupor, sudden. | 2. Excitement precedes sudden stupor. | 2. Symptoms slow. Drowsiness, stupor, lethargy. |
| 3. Face pale, cold; pupils sluggish, sometimes dilated. | 3. Face flushed; pupils generally dilated. | 3. Face pale; pupils contracted. |
| 4. Remission rare. Patient recovers slowly. | 4. Partial recovery may occur, followed by death. | 4. Remission rare. |
| 5. No odour of alcohol in breath. | 5. Odour of alcohol in breath. | 5. Odour of opium in breath. |
Ether is a volatile liquid prepared from ethylic alcohol by interaction with sulphuric acid. It contains 92 per cent. of ethyl oxide (C2H5)O. It was formerly called ‘sulphuric ether.’ It is a colourless, inflammable liquid, having a strong and characteristic odour, specific gravity 0.735. Purified ether from which the ethylic alcohol has been removed by washing with distilled water, and most of the water by subsequent distillation in the presence of calcium chloride and lime. It is this preparation which is used for the production of general anæsthesia. It has a specific gravity of 0.722 to 0.720, and its vapour is very inflammable.
Symptoms.—When taken as a liquid, same as alcohol. When inhaled as vapour, causes slow, prolonged, and stertorous breathing; face becomes pale, lips bluish, surface of body cold. Pulse first quickens, then slows. Pupils dilated, eyes glassy and fixed, muscles become flabby and relaxed, profound anæsthesia. Then pulse sinks and coma ensues, sensation being entirely suspended. Nausea and vomiting not uncommon.
Post-Mortem Appearances.—Brain and lungs congested. Cavities of heart full of dark, liquid blood. Vessels at upper part of spinal cord congested.
Treatment.—Exposure to pure air, cold affusion, artificial respiration, galvanism.
Method of Extraction from the Contents of the Stomach.—Same as for alcohol. During distillation pass some of the vapour into concentrated solution of bichromate of potash, nitric and sulphuric acids, and note reaction as for alcohol.
Tests.—Vapour burns with smoky flame, depositing carbon. Sparingly soluble in water. With bichromate of potash and sulphuric acid same as alcohol.
Chloroform.—A colourless liquid, specific gravity 1.490 to 1.495, very volatile, giving off dense vapour. Sweet taste and pleasant odour.
Symptoms.—When swallowed, characteristic smell in breath, anxious countenance, burning pain in the throat, stomach, and region of the abdomen, staggering gait, coldness of the extremities, vomiting, insensibility, deepening into coma, with stertorous breathing, dilated pupils, and imperceptible pulse. When inhaled, much the same as ether, but produces insensibility and muscular relaxation more rapidly. It would be impossible to instantly render a person insensible by holding a pocket-handkerchief saturated with chloroform over the face. Statements such as this, which are often made in cases of robbery from the person and in cases of rape, are incredible.
Delayed Chloroform-Poisoning.—Death may take place in from four to seven days after chloroform has been administered, especially in the case of children. The internal organs are found to be fattily degenerated, and death is thought to be due to acetonuria.
Post-Mortem Appearances.—Cerebral and pulmonary congestion. Heart empty, or right side distended with dark blood.
Treatment.—Stomach-tube and free lavage; cold affusion; drawing forward tongue; artificial respiration; galvanism and suspension with head downward. Inhalation of nitrite of amyl; strychnine hypodermically.
Fatal Dose.—When swallowed, from 1 to 2 ounces.
Method of Extraction from the Stomach.—By distillation at 120° F. The vapour, as it passes along a glass tube, may be decomposed by heat into chlorine, hydrochloric acid, and carbon—the first shown by setting free iodine in iodide of starch, the second by reddening blue litmus-paper, and the last by its deposit.
Tests.—Taste, colour, weight; burns with a green flame; dissolves camphor, guttapercha, and caoutchouc.
Iodoform.—Poisoning may result from its use in surgery. It produces delirium, sleepiness, and coma. It may lead to mental weakness or optic neuritis.