Читать книгу Treatise on Poisons - Robert Sir Christison - Страница 29

Since this acid and the other mineral acids act entirely as local irritants, it may be inferred that their poisonous action will be prevented by neutralizing them. But in applying that principle to the treatment it is necessary to bear in mind their extremely rapid operation; for if much time is lost in seeking for an antidote, irreparable mischief may be caused before the remedy is taken. Should it be possible then to administer chalk or magnesia without delay, these are the antidotes which ought to be preferred; but it may be well for the physician to remember, that in the absence of both he may at once procure a substitute in the plaster of the apartment beat down and made into thin paste with water. M. Chevallier, in a paper on the antidotes for the mineral acids, quotes five cases of poisoning with sulphuric acid and two with nitric acid, where life seems to have been saved by the speedy and free administration of magnesia, although in some cases so large a quantity as two ounces of the poison had been swallowed.^[299]—A solution of soap is another antidote of no small value. While the antidote is in preparation, the acid should be diluted by the free use of any mild fluid, such as milk or oleaginous matters.—The alkaline bicarbonates are also excellent antidotes; but their carbonates are ineligible, being themselves possessed of corrosive properties. In a paper on poisoning with the mineral acids by Dr. Lunding of Copenhagen, the author is disposed to ascribe the large proportion of deaths in his practice to the system pursued in the Copenhagen hospital of administering carbonate of potass as an antidote daily for weeks together.^[300] On the other hand however it may be mentioned, that in a late memoir, on this description of poisoning Dr. Ebers of Breslau endeavours to show, that there is no reason to dread the administration of the alkaline carbonates, even the carbonate of potash, provided they be given with mucilaginous fluids and syrup in a rather concentrated form; and he gives three cases illustrative of the good effects of this mode of treatment, which he maintains to be free of all danger, and preferable to every other antidotal method, because the remedy may be administered in small volume,—an advantage possessed by it especially over chalk or magnesia.^[301]

After the proper antidote has been given to a sufficient extent, the use of diluents ought to be continued, as they render the vomiting more easy.—Some have recommended the stomach-pump for administering antidotes and diluents; but this is unnecessary. When it is wished to evacuate the stomach, there is an advantage in allowing it to do so by its own efforts, if possible; because the evacuation is accomplished in this way more completely than by the stomach-pump. Besides, if the patient cannot swallow fluids, still less can he suffer the tube of the stomach-pump to be introduced. On several occasions, indeed, it has been found impracticable to introduce it.^[302]

The treatment of the surpervening inflammation does not differ from that of inflammation of the stomach. Where there is great difficulty of breathing, evidently from obstruction of the larynx, and where the absence of abdominal pain, tension or vomiting affords a presumption that little injury has been done to the stomach, laryngotomy appears an advisable remedy, and has been known to give very great relief.^[303] But the patient may nevertheless die soon of the sympathetic disorder of the circulation.