SPLENECTOMY FOR SPLENIC ANEMIA
Journal of the American Medical Association
Since death occurs from narcotic action, with subse¬ quent paralysis of the respiratory and circulatory cen¬ ters, in this as well as in poisoning with other coal-taranilin preparations, a prompt emetic should be given or the stomach tube used. The stomach tube should be used, since, as in the case of morphin, the possibility of the drug being excreted into the stomach and bowels should be borne in mind. An effort should be made to ward off the impending coma; constant exercise, flaggellation
... se, flaggellation with wet towels and rubbing being employed. Hypodermically, atropin 1/100 to 1/60 gr. and cocain 1/4 to 1/2 gr. might be used for their stimulative ac¬ tion on the respiratory and cardiac centers. Evidently the process of elimination is attempted by the kidneys (as in the present case) and possibly also by the bowels. Large quantities of hot normal salt solution per rectum or intravenously would undoubtedly assist in this process. The depressant action of and clanger attending the use of pilocarpin to assist elimination by the skin, in cases of already depressed circulatory activity, would seem to be contraindicated because of the danger of pulmonary edema. CONCLUSIONS. This case reiterates the danger of the promiscuous use of nitrobenzol by manufacturers. Ho\v the}are able to prevent poisoning among the workers in their factories is somewhat of a mystery. Its use should be still more strenuously prohibited as entering into the composition of liquid shoe blacking, cheap soaps, confections and similar articles of widespread usage. The conditions present in this recorded case were unfortunately such as to permit of absorption by the skin. The shoes were put on before the blacking was dry, and shortly afterward the exercise incident to the dancing party probably aided its absorption. Nitrobenzol is probably used as a solvent, for the anilin dyes in many liquid shoe-blackings on the market. The reason that the small boy shoeblack is not more frequently poisoned lies in the fact that but a very small quantity of the liquid comes in contact with his fingers, brushes being used instead, while the fingers are usually used for the application of the "polish." The "polish" is probably an anilin-black in most cases and probably contains nitrobenzol as a solvent. Why fatal poisoning is comparatively so rare among shoe-blacks is not quite clear. Perhaps but extremely small quantities are absorbed and that this absorption extends over a con¬ siderable time.