Aids To Forensic Medicine And Toxicology Part 10

19, and 51 and 52 Vict., c. 19), any habitual drunkard may voluntarily place himself under restraint. He must make an application to the owner of a licensed retreat, stating the time during which he undertakes to remain. His application must be accompanied by a statutory declaration of two persons stating that they knew the applicant to be a confirmed drunkard. Without this testimony as to moral character his application cannot be entertained. His signature must also be attested by two justices, who must state that he understands the effect of his application, and that it has been explained to him. The limit to the term of restraint is twelve months, after which he must resume his former habits if he wishes to qualify for another period. The Act works automatically, and, when it has been set for a certain time, the patient cannot release himself until the period has expired. The Inebriates'

Retreat must be duly licensed, and the licensee incurs distinct obligation in return for the powers entrusted to him. It is an offence against the Act to a.s.sist any habitual drunkard to escape from his retreat, and should he succeed in effecting his escape he may be arrested on a warrant. A drunkard who does not obey orders and conform to the rules of the establishment may be sent to prison for seven days.

It may be as well to mention that it is an offence to supply any drunkard under the Act with any intoxicating drink or sedative or stimulant drug without authority, and that the penalty is a fine of 20 or three months' imprisonment. The Act is a good one, but might be carried farther with advantage. It has been ruled that a crime committed during drunkenness is as much a crime as if committed during sobriety. A person is supposed to know the effect of drink, and if he takes away his senses by drink it is no excuse. He is held answerable both for being under the influence of alcohol or of any other drug, and for the acts such influence induces.

=Inebriates Act= (1898-1900).--If an habitual drunkard be sentenced to imprisonment or penal servitude for an offence committed during drunkenness, or if he has been convicted four times in one year, the court may order him to be detained for a term not exceeding three years in an inebriate reformatory.

PART II

TOXICOLOGY

I.--DEFINITION OF A POISON

Though the law does not define in definite terms what a poison really is, it lays stress on the _malicious intention_ in giving a drug or other substance to an individual. It is a _felony_ to administer, or cause to be administered, any poison or other destructive thing with intent to murder, or with the intention of stupefying or overpowering an individual so that any indictable offence may be committed. It is a _misdemeanour_ to administer any poison, or destructive or noxious thing, merely to aggrieve, injure, or annoy an individual. For a working _definition_ we may state that a poison is a substance which, when introduced into or applied to the body, is capable of injuring health or destroying life. A poison may therefore be swallowed, applied to the skin, injected into the tissues, or introduced into any orifice of the body.

II.--SALE OF POISONS; SCHEDULED POISONS

The sale of poisons is regulated by various Acts, but chiefly by the Pharmacy Act, 1868, and by the Poisons and Pharmacy Act, 1908. Only registered medical pract.i.tioners and legally qualified druggists are permitted to dispense and sell scheduled poisons. They are responsible for any errors which may be committed in the sale of poisons. If a druggist knows that a drug in a prescription is to be used for an improper purpose, he may refuse to dispense it. The pract.i.tioner who carelessly prescribes a drug in a poisonous dose is not held responsible, but the dispenser would be if he dispensed it and harmful or fatal consequences followed on its being swallowed. When a dispenser finds an error in a prescription, it is his duty to communicate with the prescriber privately pointing out the mistake.

A great responsibility rests on the medical man who does his own dispensing, as there is no one to check his work.

If a doctor prescribes a drug with the intention of curing or preventing a disease, but that, contrary to expectation and general experience, it causes illness or even death, no responsibility can rest with the prescriber. It has to be proved that actual injury has been sustained by the complainant before an action for damages can be commenced, and that the plaintiff was free from all contributory negligence.

=Scheduled Poisons.=--By the Pharmacy Act of 1868 two groups of poisons are scheduled. Part I. contains a list of those which are considered very active poisons--_e.g._, a.r.s.enic, alkaloids, belladonna, cantharides, coca (if containing more than 1 per cent. alkaloids), corrosive sublimate, diachylon, cyanides, tartar emetic, ergot, nux vomica, laudanum, opium, savin, picrotoxin, veronal and all poisonous urethanes, prussic acid, vermin killers, etc. Such poisons must not be sold to strangers, but only to persons known to or introduced by someone known to the druggist. If sold, the latter must enter into the 'Poison Register' the name of the poison, the name of the person to whom it is sold, the quant.i.ty and purpose for which it is to be used, and date of sale. The entry must be signed by the purchaser and by the introducer.

The word 'Poison' must be affixed to the bottle or package, and also the name and address of the seller.

Part II. contains a list of poisons supposed to be less active. These may only be sold if on the bottle, box, or package there is affixed a label with the name of the article, the word 'Poison,' and the name and address of the seller. It is not necessary to enter the transaction in a register.

Chemists are required to keep poisons in specially distinguishable bottles, and these in a special room or locked cupboard.

=Dangerous Drugs Act, 1920.=--The regulations restrict the manufacture and sale of opium, morphine, cocaine, and heroin so as to prevent their abuse. Preparations containing less than 1/5 per cent. of the first two or less than 1/10 per cent. of the last two are excluded. Prescriptions containing the above drugs must be dated and signed with the full name and address of the prescriber, and must have also those of the patient.

The total amount of the drug to be supplied must be stated, and it must not be dispensed more than once; the dispenser retains the prescription.

Special books must be kept recording the purchase and sale of these drugs.

=Proprietary Medicines Bill= (introduced in 1920, and likely soon to become law).--The sale of any unregistered proprietary medicine purporting to cure certain diseases or produce abortion is made an offence. A register of proprietary medicines, etc., is established. The object is to protect the public against quack remedies.

=Notification of Poisoning.=--Every case of poisoning which occurs in any industry (lead, a.r.s.enic, anthrax, etc.) must be notified by the medical attendant to the Chief Inspector of Factories (Factory and Workshops Act, 1895).

III.--ACTION OF POISONS; CLa.s.sIFICATION OF POISONS

=Action of Poisons.=--They may act either locally or only after absorption into the system.

1. _Local Action_, as seen in (a) corrosive poisons; (b) irritant poisons, causing congestion and inflammation of the mucous membranes--_e.g._, metallic and vegetable irritants; (c) stimulants or sedatives to the nerve endings, as aconite, conium, cocaine.

2. _Remote Action._--This may be of reflex character, as seen in the shock produced by the pain caused by corrosive poisons, or the poison may exert a special action on certain structures, as belladonna on the cells of the brain, strychnine on the motor nerve cells of the spinal cord.

3. _In Both Ways._--Certain poisons, as carbolic or oxalic acids, act in this way.

Age, idiosyncrasy, tolerance, and disease, all exert modifying influences on the action of a poison. The form in which the poison is swallowed and the quant.i.ty also determine its action. In the gaseous form, poisons act most rapidly and fatally. When in solution and injected hypodermically, they also act very rapidly. In the solid form they act as a rule slowly, and may even set up vomiting, and so may be entirely ejected by vomiting. Poisons act most energetically when the stomach is empty. If taken when the stomach already contains food, solution and absorption may be greatly delayed.

Some poisons are c.u.mulative in their action, and thus, even if infinitesimal doses be swallowed each day, there is a certain amount of storage in the tissues (though a certain percentage of the poison is being constantly eliminated), and at last symptoms of poisoning show themselves.

=Cla.s.sification of Poisons.=--As an aid to memory, the following cla.s.sification is perhaps the best:

I. _Inorganic._

1. Corrosive acids and alkalies, and caustic salts (carbolic and oxalic acids also).

2. Irritant--practically all the metals and the metalloids (I. Cl.

Br. P.).

II. _Organic._

{ Animal--venomous bites, food poisoning, cantharides.

1. Irritant { Vegetable--all strong purgatives, h.e.l.lebores, savin, { yew, ergot, hemlock, laburnum, bryony, etc.

2. Neuronic.

(a) Somniferous--opium and its alkaloids.

(b) Deliriant--belladonna, hyoscyamus, stramonium, cannabis, cocaine, cocculus, camphor, fungi.

(c) Inebriants--alcohol, ether, chloral, carbolic acid (weak), benzol, aniline, nitro-glycerine.

3. Sedative or depressant.

(a) Neural--conium, lobelia, tobacco, physostigma.

(b) Cerebral--hydrocyanic acid.

(c) Cardiac--aconite, digitalis, colchic.u.m, veratrum.

4. Excito-motory or convulsives--nux vomica, strychnine.

5. Vulnerants--powdered gla.s.s.

III. _Asphyxiants._

Poisonous and irrespirable gases.