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Veronal Poisoning


Veronal Poisoning

Veronal was an over-the-counter sleeping potion that was occasionally misused for suicide.

This from JAMA, 1925, an abstract of a longer article.
The use of barbital (Veronal), or diethylbarbituric acid, as a hypnotic has constantly increased since its discovery in 1903. It is an effective drug with a considerable margin of safety, may be obtained in most localities without a physician’s prescription, and the possibility of its producing a habit is not generally appreciated. These reasons have been partly responsible for its popularity with both the laity and the profession. Medical literature, however, particularly in Germany and England, contains many reports of severe poisoning and fatal results from its use in excessive doses or in long continued administration. Its action is quite rapid, ordinarily producing sleep in from one-half to one hour, and in moderate doses is seldom followed by distressing after-effects. From 70 to 90 per cent, of the ingested drug is eventually eliminated in the urine; but its excretion is slow and is often extended over a period of from

This from the British Medical Journal of March 28, 1925.
SIR, As surmised in an annotation in the BRITISH MEDICAL JOURNAL of March 21st (p. 570), it is likely that death from Veronal poisoning is more common than statistics indicate. May I suggest a probable cause for the mortality, and a possible remedy? We have four salient facts-at least, judging from my own experience, they seem facts to me. 
  1. The drug is so potent that, given properly and in ordinary insomnia, it is rarely necessary to prescribe more than 5 grains, and usually 21 grains is sufficient. 
  1. There is no clear evidence of habituation; its victims merely desire drowsiness, not other sensations as well (as in the case of alcohol, opium, and cocaine); given natural sleep it is not desired; no more, and no less, than procures sleep is desired; as time passes there is no augmented craving, and the same dose continues to produce the same effect. 
  1. The action is delayed-four, five, or six hours. 
  1. Apart from deliberate suicide, in every case of death the victim has tried to procure immediate sleep. 
The case of a London clubman is instructive and typical. During an attack of insomnia he took 10 grains at bedtime, which in his case was late. He was wakeful that night, but ”deadly drowsy” next day, a circumstance which he attributed to lack of sleep. The following niight he took 15 grains. Again he was wakeful; but in the after noon slumbered so profoundly at his club that the attendants had difficulty in rousing him. Manifestly heavy and stupid, he went home, and subsequently had difficulty in clearing himself from a charge of drunikenness before the club committee. ”Veronal is no good; it has not the smallest effect on me,” he declared. On a later occasion, when ignorant of the remedy applied, he was given 5 grains in the early evening. He described himself as, getting ”a heavenly night,” but as being too sleepy in the morning. Thereupon he was given 21 grains, also in the evening. Now he had perfectly natural sleep ” with no apparent drowsiness till he went to bed, and none after he rose. He was then told the facts and informied that the fit of insomnia was probably broken, which proved to be the case. He still takes Veronal, but rarely, and never in more than 21-grain doses. I could quote many similar instances. But doubtless individuals vary. It seems evident that, apart from deliberate suicide, excessive doses are taken only because the victim, ignorant of the delayed action, makes more and more strenuous efforts to procure immediate sleep. I suggest that patients shall always be informed of the delay, anid that a label shall be affixed to every packet affirming the uselessness of Veronal as a quick remedy for wakefulness. I am, etc.,
Soutlisea, March 23rd. G. ARCHDALL REID.

This from the California State Journal of Medicine, March 1914:
By EDWARD SWIFT, M. D., Los Angeles.
Read before the Los Angeles County Medical Society. January 15, 1914.
The patient was a woman of 42 years. She had always been in good health, but was of a highly neurotic temperament. At 11 a. m. I was called to see her, though I had seen her the night before when she was apparently in perfect health but somewhat worried over some domestic troubles. I received the telephone call from her brother, who informed me that though his sister had gone to bed the previous night at 10 o’clock, she had as yet shown no evidence of awakening. On examination I found the patient in coma from which it was impossible to awaken her; no response from pressure over supraorbital nerve. There was no cyanosis; pulse 60 and of good quality; temperature normal; respirations 22. I immediately washed out her stomach with warm water, after which six ounces of black coffee and one egg was administered through the tube. Normal salt was given per rectum by the drop method (two quarts at this time). When I saw her a few hours later she was in the same condition, though her respirations were slightly deeper.  
About 4 a. m. the following morning she became cyanotic, her breathing, which had gradually been getting deeper, became stertorous, her pulse weak and irregular, being intermittent at times. Her temperature still remained normal. Caffeine sodium benzoate in doses of gr. i and camphor and ether in doses of m. x were given for cardiac stimulation. This treatment only improved the pulse temporarily. Her respirations gradually be came more and more stertorous, and by three in the afternoon she developed signs of pulmonary congestion. This gradually increased until there were signs of well marked edema of the lungs. Her cyanosis gradually increased in spite of oxygen inhalations and hypodermic injections of atropine. Adrenalin was given without benefit. At 4-p. m. her stomach was washed out and the return consisted of brown fluid with a decided fecal odor,. and containing some particles of fecal matter.
There seemed to be a loss of tone of the intestinal tract, for enemas given were not expelled. 
The patient died at 5 p. m. Just before death her temperature gradually increased to 105°, respirations developed into the Cheyne-Stokes type. Her pulse became weaker and weaker until it was imperceptible at the wrist. The function of the kidneys was lessened and in the last twenty-four hours of her life only two ounces of urine were to be obtained by catheter. Altogether she received one gallon of normal salt by the drop method, but this seemed to have no effect upon the secretion of urine. Hot packs and dry cups over the lungs were used, but nothing seemed to be of any avail. On investigation it was found that she had taken one hundred (100) grains of Veronal just prior to retiring for the night.

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