Читать книгу Treatise on Poisons - Robert Sir Christison - Страница 27

4. The last variety comprehends cases of perfect recovery, which are sufficiently numerous even under unpromising appearances. From the average of 55 cases recorded by Tartra it appears that the chances of death and recovery are nearly equal. Twenty-six died, 19 of the primary, 7 of the secondary disorder. Twenty-nine recovered, and of these twenty-one perfectly. Suicidal are for obvious reasons more frequently fatal than accidental cases.

Tartra has not taken notice in his treatise of another form of poisoning with the strong acids,—in which the injury is confined to the gullet and neighbouring parts. In Corvisart’s Journal there is the case of a man, who began to drink sulphuric acid for water while intoxicated, but suddenly found out his error before he had swallowed above a few drops; and consequently the chief symptoms were confined to the throat. After his physician saw him he was able to take one dose of a chalk mixture; but from that time he was unable to swallow at all for a fortnight.^[265] Martini likewise met with a similar instance of complete dysphagia from stricture in the gullet caused by sulphuric acid.^[266] His patient recovered.

It also appears exceedingly probable, that the strong acids may cause death, without reaching the stomach or even the gullet, by exciting inflammation and spasm of the glottis and larynx. Such an effect may very well be anticipated from an attempt to commit murder with these poisons; as the person, if he retains consciousness at the time, may become aware of their nature before he has swallowed enough to injure the stomach.

Thus, Dr. A. T. Thomson says in 1837, that he once met with the case of a child, who, while attempting to swallow strong sulphuric acid by mistake for water, died almost immediately, to all appearance from suffocation caused by contraction of the glottis; and it was ascertained after death that none of the poison had reached the stomach.^[267] Professor Quain describes a similar case, occurring also in a child, where impending death was prevented by artificial respiration, and acute bronchitis ensued, which proved fatal in three days. In this instance thickening of the epiglottis and great contraction of the upper opening of the larynx showed the violent local injury inflicted there, inflammation could be traced down the trachea into the bronchial tubes, but no trace of injury could be detected in the gullet and stomach.^[268] In a very interesting and carefully detailed case by Mr. Arnott, where the poison taken was the nitric acid, the injury was confined in a great measure to the gullet and larynx,—the stomach, which was distended with food at the time, being very little affected. The chief symptoms at first, besides great general depression, were croupy respiration and much dyspnœa, which became so urgent, that laryngotomy was performed, and with complete relief to the breathing. But the patient nevertheless rapidly sunk under the symptoms of general exhaustion, and died in thirty-six hours without presenting any particular signs of the operation of the poison on the stomach; and the traces of action found there after death were trifling.^[269]

The importance of the fact established by these cases will appear from the following medico-legal inquiries. A Prussian medical college was consulted in the case of a new-born child, in which the stomach and intestines were healthy, and did not contain poison, but in which the cuticle of the lips was easily scraped off, the gums, tongue, and mouth yellowish-green, as if burnt, the velum and uvula in the same state, the rima glottidis contracted, and the epiglottis, larynx, and fauces violently inflamed. The College declared, that a concentrated acid had been given, and that death had been occasioned by suffocation. Sulphuric acid was found in the house; and the mother subsequently confessed the crime.^[270] A case was formerly quoted (p. 75), where MM. Ollivier and Chevallier found traces of the action of nitric acid on the lips, mouth, throat and upper fourth of the gullet, but not lower. In this instance the reporters came to the opinion from the absence of injury in the more important parts of the alimentary canal, as well as from the marks of nail scratches on the neck, and the gorged state of the lungs, that death had been produced by strangling, after an unsuccessful attempt by the forcible administration of nitric acid. It is quite possible, however, that death might quickly ensue from the effects of the poison on the throat and gullet. In the course of the judicial inquiries M. Alibert stated that he had known repeated instances of death from swallowing nitric acid, although none of it reached lower down than the pharynx. Ollivier in his paper doubts the accuracy of this statement; but the cases quoted above show clearly that such injury may be done to the glottis as will be adequate of itself to occasion death.^[271]

It seems farther not improbable that, among the terminations of poisoning with the strong mineral acids, scirrhous pylorus must also be enumerated. This is a very rare effect of the action of corrosive poisons. But M. Bouillaud has related an instance of death from scirrhous pylorus in its most aggravated shape, which supervened on the chronic form of the effects of nitric acid, and which proved fatal in three months.^[272]

In some circumstances the stomach seems to acquire a degree of insensibility to the action of the strong acids. Tartra, in alluding to what is said of certain whisky-drinkers acquiring the power of swallowing with impunity small quantities of the concentrated acids, has related the case of a woman at Paris, who, after passing successively from wine to brandy and from that to alcohol, at last found nothing could titillate her stomach except aqua-fortis, of which she was seen to partake by several druggists of veracity.^[273] The fire-eating mountebanks too are said to acquire the same power of endurance; but much of their apparent capability is really legerdemain. On the other hand, a very extraordinary sensibility to the action of the diluted mineral acids has been supposed to exist in the case of infants at the breast,—so great a sensibility, that serious symptoms and even death itself have been ascribed to the nurse’s milk becoming impregnated with sulphuric acid, in consequence of her having taken it in medicinal doses. By two writers in the London Medical Repository griping pains, tremors and spasms have been imputed to this cause;^[274] and a writer in the Medical Gazette says he has seen continued griping, green diarrhœa and fatal marasmus ensue,—apparently, he thinks, from ulceration of the gastro-intestinal mucous membrane.^[275] Without questioning the great delicacy and tenderness of that membrane in infants, I must nevertheless express my doubts whether so small a quantity taken by a nurse, amounting in the cases in question only to four or six drops a day, could really produce fatal or even severe effects on her child.

Sulphuric acid is not less deadly when admitted into the body through other channels besides the mouth. Thus, it may prove fatal when introduced into the rectum. A woman at Bruges in Belgium had an injection administered, in which, being prepared hastily in the middle of the night, sulphuric acid had been substituted by mistake for linseed-oil. The patient immediately uttered piercing cries, and passed the remainder of the night in excessive torture. In the morning the bed-clothes were found corroded, and a portion of intestine had apparently come away; and she expired not long afterwards.^[276]

Death may also be occasioned by the introduction of this acid into the ear. Dr. Morrison relates a case of the kind, where nitric acid, which is analogous in action, was poured by a man into his wife’s ear, while she lay insensible from intoxication. She awoke in great pain, which continued for two or three days. In six days an eschar detached itself from the external passage of the ear; and this was followed by profuse hemorrhage, which recurred daily more or less for a month. On the day after the eschar came away, and without any precursory symptom referrible to the head, she was attacked with complete palsy of the right arm, and in eight days more with tremors and incomplete palsy of the rest of that side of the body. These symptoms subsequently abated; but they again increased after an imprudent exertion, and she died in a state of exhaustion seven weeks after the injury. The whole petrous portion of the temporal bone was found carious, but without any distinct disease of the brain or its membranes.^[277]

Sulphuric acid and the other mineral acids are equally poisonous when inhaled in the form of gas or vapour; and they then act chiefly by irritating or inflaming the mucous membrane of the air-passages and lungs. For some observations on their effects in this form both on plants and animals the reader may refer to the Chapter on Poisonous Gases.

Sulphuric acid belongs to the poisons alluded to under the head of General Poisoning,—of whose operation satisfactory evidence may be occasionally drawn from symptoms only. If immediately after swallowing a liquid which causes a sense of burning in the throat, gullet, and stomach, violent vomiting ensues, particularly if the vomited matter is mixed with blood; if the mouth becomes white, and stripped of its lining membrane, and the cheeks, neck, or neighbouring parts show vesications, or white, and subsequently brown excoriated spots;—if the clothes show red spots and are moist and disintegrated there,—I cannot see any objection to the inference, that either sulphuric or muriatic acid has been taken. In this opinion I am supported by a good authority, Dr. Mertzdorff, late medical inspector at Berlin.^[278]