Treatise on Poisons by Sir Robert Christison

all the symptoms that characterise the most violent gastritis, accompanied likewise with burning in the throat, which is increased by pressure, swallowing, or coughing;[247]—eructations proceeding from the gases evolved in the stomach by its chemical decomposition;—and an excruciating pain in the stomach, such as no natural inflammation can excite. The lips are commonly shrivelled, at first whitish, but afterwards brownish in the case of sulphuric acid. Occasionally there are also excoriations, more rarely little blisters. Similar marks appear on other parts of the skin with which the acid may have come in contact, such as the cheeks, neck, breast, or fingers; and these marks undergo the same change of colour as the marks on the lips. I had an opportunity of witnessing this in the case of the man who was disfigured by the Macmillans (p. 122) with sulphuric acid. He was cruelly burnt on the face as well as on the hands, which he had raised to protect his face; and the marks were at first white, but in sixteen hours became brownish. The inside of the mouth is also generally shrivelled, white, and often more or less corroded; and as the poisoning advances, the teeth become loose and yellowish-brown about the coronæ. The teeth sometimes become brown in so short a time as three hours.[248] Occasionally the tongue, gums, and inside of the cheeks are white, and as it were polished, like ivory.[249] There is almost always great difficulty, and sometimes complete impossibility, of swallowing. In the case of a child related by Dr. Sinclair, of Manchester, fluids taken by the mouth were returned by the nose; and the reason was obvious after death; for even then the pharynx was so much contracted as to admit a probe with difficulty.[250] On the same account substances taken by the mouth have been discharged by an opening in the larynx which had been made to relieve impending suffocation. The matter vomited, if no fluids be swallowed, is generally brownish or black, and at first causes effervescence, if it falls on a pavement containing any lime. Afterwards this matter is mixed with shreds of membrane, which resemble the coats of the stomach, and sometimes actually consists of the disorganised coats, but are generally nothing more than coagulated mucus. The bowels are obstinately costive, the urine scanty or suppressed; and the patient is frequently harassed by distressing tenesmus and desire to pass water. The pulse all along is very weak, sometimes intermitting, and towards the close imperceptible. It is not always frequent; on the contrary, it has been observed of natural frequency, small and feeble in a patient who survived fifteen days.[251] The countenance becomes at an early period glazed and ghastly, and the extremities cold and clammy. The breathing is often laborious, owing to the movements of the chest increasing the pain in the stomach,—or because pulmonary inflammation is also at times present,—or because the admission of air into the lungs is impeded by the injury done to the epiglottis and entrance of the larynx. To these symptoms are added occasional fits of suffocation from shreds of thick mucus sticking in the throat, and sometimes croupy respiration, with sense of impending choking. Such is the ordinary train of symptoms in cases of the first variety. But sometimes, especially when a large dose has been swallowed, instead of these excruciating tortures, there is a deceitful tranquillity and absence of all uneasiness. Thus, in the case of a woman who was poisoned by her companions making her swallow while intoxicated aqua-fortis mixed with wine, although she had at first a good deal of pain and vomiting, there were subsequently none of the usual violent symptoms; and she died within twenty hours, complaining chiefly of tenesmus and excessive debility.[252] Occasionally eruptions break out over the body:[253] but their nature has not been described. Death is seldom owing to the mere local mischief, more generally to sympathy of the circulation and nervous system with that injury. According to Bouchardat death arises from the acid entering the blood in sufficient quantity to cause coagulation.[254] But although this certainly happens sometimes to the blood in the vessels of the stomach and adjacent organs, as will be proved under the head of the morbid appearances, there is no evidence that the same takes place throughout the blood-vessels generally, or in the great veins and heart in particular. Bouchardat’s proofs of the detection of sulphuric acid in the blood are not satisfactory. The duration of this variety of poisoning with the acids is commonly between twelve hours and three days. But sometimes life is prolonged for a week[255] or a fortnight;[256] and sometimes too death takes place in a very few hours. The shortest duration among the numerous cases of adults mentioned by Tartra is six hours;[257] but Dr. Sinclair, of Manchester, has related a case which lasted only four hours and a half;[258] a man lately died in the Edinburgh Infirmary within four hours; and Professor Remer of Breslau once met with a case fatal in two hours.[259] The quantity required to produce these effects has not been ascertained, and must be liable to the same uncertainty here as in other kinds of poisoning. The smallest fatal dose of sulphuric acid I have hitherto found recorded was one drachm. It was taken with sugar by mistake for stomachic drops by a stout young man, and killed him in seven days.[260] An infant of twelve months has been killed in twenty-four hours by half a tea-spoonful, or about thirty minims.[261] A man has recovered after taking six drachms.[262]