VI.—Caustic Potash and Soda.

§ 102. There is so little difference in the local effects produced by potash and soda respectively, that it will be convenient to treat them together.

Potash (potassa caustica).—Hydrate of potassium (KHO), atomic weight 56, specific gravity 2·1.

Properties.—Pure hydrate of potassium is a compact, white solid, usually met with in the form of sticks. When heated to a temperature a little under redness, it melts to a nearly colourless liquid; in this state it is intensely corrosive. It rapidly absorbs moisture from the air, and moist potash also absorbs with great avidity carbon dioxide; it is powerfully alkaline, changing red litmus to blue. It is soluble in half its weight of cold water, great heat being evolved during solution; it forms two definite hydrates—one, KHO + H₂O; the other, KHO + 2H₂O. It is sparingly soluble in ether, but is dissolved by alcohol, wood-spirit, fusel oil, and glycerin.

§ 103. Pharmaceutical Preparations.—Potassium hydrate, as well as the solution of potash, is officinal in all pharmacopœias. The liquor potassæ, or solution of potash, of the British Pharmacopœia, is a strongly alkaline, caustic liquid, of 1·058 specific gravity, and containing 5·84 per cent. by weight of KHO. It should, theoretically, not effervesce, when treated with an acid, but its affinity for CO₂ is so great that all solutions of potash, which have been in any way exposed to air, contain a little carbonate. Caustic sticks of potash and lime used to be officinal in the British Pharmacopœia. Filho’s caustic is still in commerce, and is made by melting together two parts of potassium hydrate and one part of lime in an iron ladle or vessel; the melted mass is now moulded by pouring it into leaden moulds. Vienna paste is composed of equal weights of potash and lime made into a paste with rectified spirit or glycerin.

§ 104. Carbonate of Potash (K₂CO₃ + 1¹⁄₂H₂O), when pure, is in the form of small white crystalline grains, alkaline in taste and reaction, and rapidly deliquescing when exposed to moist air; it gives all the chemical reactions of potassium oxide, and carbon dioxide. Carbonate of potash, under the name of salt of tartar, or potashes, is sold by oilmen for cleansing purposes. They supply it either in a fairly pure state, or as a darkish moist mass containing many impurities.

§ 105. Bicarbonate of Potash (KHCO₃) is in the form of large transparent rhombic prisms, and is not deliquescent. The effervescing solution of potash (liquor potassæ effervescens) consists of 30 grains of KHCO₃ in a pint of water (3·45 grms. per litre), and as much CO₂ as the water will take up under a pressure of seven atmospheres.

§ 106. Caustic Soda—Sodium Hydrate (NaHO).—This substance is a white solid, very similar in appearance to potassium hydrate; it absorbs moisture from the air, and afterwards carbon dioxide, becoming solid again, for the carbonate is not deliquescent. In this respect, then, there is a great difference between potash and soda, for the former is deliquescent both as hydrate and carbonate; a stick of potash in a semi-liquid state, by exposure to the air, continues liquid, although saturated with carbon dioxide. Pure sodium hydrate has a specific gravity of 2·0; it dissolves in water with evolution of heat, and the solution gives all the reactions of sodium hydrate, and absorbs carbon dioxide as readily as the corresponding solution of potash. The liquor sodæ of the B.P. should contain 4·1 per cent. of NaHO.

§ 107. Sodæ Carbonas—Carbonate of Soda—(Na₂CO₃10H₂O).—The pure carbonate of soda for medicinal use is in colourless and transparent rhombic octahedrons; when exposed to air, the crystals effloresce and crumble. The sodæ carbonas exsiccata, or dried carbonate of soda, is simply the ordinary carbonate, deprived of its water of crystallisation, which amounts to 62·93 per cent.

§ 108. Bicarbonate of Soda (NaHCO₃) occurs in the form of minute crystals, or, more commonly, as a white powder. The liquor sodæ effervescens of the B.P. is a solution of the bicarbonate, 30 grains of the salt in 20 ozs. of water (3·45 grms. per litre), the water being charged with as much carbonic acid as it will hold under a pressure of seven atmospheres. The bicarbonate of soda lozenges (trochisci sodæ bicarbonatis) contain in each lozenge 5 grains (327 mgrms.) of the bicarbonate. The carbonate of soda sold for household purposes is of two kinds—the one, “seconds,” of a dirty white colour and somewhat impure; the other, “best,” is a white mass of much greater purity. Javelle water (Eau de Javelle) is a solution of hypochlorite of soda; its action is poisonous, more from the caustic alkali than from the chlorine, and may, therefore, be here included.

§ 109. Statistics.—Poisoning by the fixed alkalies is not so frequent as poisoning by ammonia. Falck has collected, from medical literature, 27 cases, 2 of which were the criminal administering of Eau de Javelle, and 5 were suicidal; 22, or 81·5 per cent., died—in 1 of the cases after twenty-four hours; in the others, life was prolonged for days, weeks, or months—in 1 case for twenty-seven months. In the ten years 1883-1892, in England and Wales, there were 27 deaths from poisoning by the fixed alkalies; 2 were suicidal (1 from potash, the other from soda); the remaining 25 were due to accident; of these, 7 (3 males and 4 females) were from caustic soda, and 18 (8 males and 10 females) from caustic potash.

§ 110. Effects on Animal and Vegetable Life.—The fixed alkalies destroy all vegetable life, if applied in strong solution or in substance, by dehydrating and dissolving the tissues. The effects on animal tissues are, in part, due also to the affinity of the alkalies for water. They extract water from the tissues with which they come in contact, and also attack the albuminous constituents, forming alkali-albuminate, which swells on the addition of water, and, in a large quantity, even dissolves. Cartilaginous and horny tissues are also acted upon, and strong alkalies will dissolve hair, silk, &c. The action of the alkali is by no means restricted to the part first touched, but has a remarkable faculty of spreading in all directions.

§ 111. Local Effects.—The effects of strong alkali applied to the epidermis are similar to, but not identical with, those produced by strong acids. S. Samuel [122] has studied this experimentally on the ear of the rabbit; a drop of a strong solution of caustic alkali, placed on the ear of a white rabbit, caused stasis in the arteries and veins, with first a greenish, then a black colour of the blood; the epidermis was bleached, the hair loosened, and there quickly followed a greenish coloration on the back of the ear, opposite to the place of application. Around the burned spot appeared a circle of anastomising vessels, a blister rose, and a slough separated in a few days. The whole thickness of the ear was coloured yellowish-green, and, later, the spot became of a rusty brown.

[122] Virchow’s Archiv. f. path. Anat., Bd. 51, Hft. 1 u. 2, 1870.

§ 112. Symptoms.—The symptoms observed when a person has swallowed a dangerous dose of caustic (fixed) alkali are very similar to those noticed with ammonia, with the important exception that there is no respiratory trouble, unless the liquid has come into contact with the glottis; nor has there been hitherto remarked the rapid death which has taken place in a few ammonia poisonings, the shortest time hitherto recorded being three hours, as related by Taylor, in a case in which a boy had swallowed 3 ozs. of a strong solution of carbonate of potash.

There is instant pain, extending from the mouth to the stomach, and a persistent and unpleasant taste; if the individual is not a determined suicide, and the poison (as is mostly the case) has been taken accidentally, the liquid is immediately ejected as much as possible, and water, or other liquid at hand, drunk freely. Shock may at once occur, and the patient die from collapse; but this, even with frightful destruction of tissue, appears to be rare. Vomiting supervenes; what is ejected is strongly alkaline, and streaked with blood, and has a soapy, frothy appearance. There may be diarrhœa, great tenderness of the abdomen, and quick pulse and fever. With caustic potash, there may be also noticed its toxic effects (apart from local action) on the heart; the pulse, in that case, is slow and weak, and loss of consciousness and convulsions are not uncommon. If the collapse and after-inflammation are recovered from, then, as in the case of the mineral acids, there is all the horrid sequence of symptoms pointing to contractions and strictures of the gullet or pylorus, and the subsequent dyspepsia, difficulty of swallowing, and not unfrequently actual starvation.

§ 113. Post-mortem Appearances.—In cases of recent poisoning, spots on the cheeks, lips, clothing, &c., giving evidence of the contact of the alkali, should be looked for; but this evidence, in the case of persons who have lived a few days, may be wanting. The mucous membrane of the mouth, throat, gullet, and stomach is generally more or less white—here and there denuded, and will be found in various stages of inflammation and erosion, according to the amount taken, and the concentration of the alkali. Where there is erosion, the base of the eroded parts is not brown-yellow, but, as a rule, pale red. The gullet is most affected at its lower part, and it is this part which is mostly subject to stricture. Thus Böhm [123] found that in 18 cases of contraction of the gullet, collected by him, 10 of the 18 showed the contraction at the lower third.

[123] Centralblatt für die Med. Wiss., 1874.

The changes which the stomach may present if the patient has lived some time, are well illustrated by a preparation in St. George’s museum (43 a. 264, ser. ix.). It is the stomach of a woman, aged 44, who had swallowed a concentrated solution of carbonate of potash. She vomited immediately after taking it, and lived about two months, during the latter part of which she had to be nourished by injections. She died mainly from starvation. The gullet in its lower part is seen to be much contracted, its lining membrane destroyed, and the muscular coats exposed. The coats of the stomach are thickened, but what chiefly arrests the attention is a dense cicatrix at the pylorus, with an aperture so small as only to admit a probe.

The colour of the stomach is generally bright red, but in that of a child, preserved in Guy’s Hospital museum (No. 1798²⁴), the mucous membrane is obliterated, the rugæ destroyed, and a dark-brown stain is a noticeable feature. The stomach is not, however, necessarily affected. In a preparation in the same museum (No. 1798²⁰) the mucous membrane of the stomach of a child who swallowed soap-lees is seen to be almost healthy, but the gullet is much discoloured. The action on the blood is to change it into a gelatinous mass; the blood corpuscles are destroyed, and the whole colour becomes of a dirty blackish-red; the spectroscopic appearances are identical with those already described (see [p. 114]).

The question as to the effects of chronic poisoning by the alkalies or their carbonates may arise. Little or nothing is, however, known of the action of considerable quantities of alkalies taken daily. In a case related by Dr. Tunstall,[124] a man for eighteen years had taken daily 2 ozs. of bicarbonate of soda for the purpose of relieving indigestion. He died suddenly, and the stomach was found extensively diseased; but since the man, before taking the alkali, had complained of pain, &c., it is hardly well, from this one case, to draw any conclusion.

[124] Med. Times, Nov. 30, 1850, p. 564.

It is important to observe that the contents of the stomach may be acid, although the death has been produced by caustic alkali. A child, aged 4, drank from a cup some 14 per cent. soda lye. He vomited frequently, and died in fifteen hours. The stomach contained 80 c.c. of sour-smelling turbid fluid, the reaction of which was acid. There were hæmorrhagic patches in the stomach, and signs of catarrhal inflammation; there was also a similarly inflamed condition of the duodenum.[125]

[125] Lesser, Atlas d. gericht. Med., Tafel ii.

§ 114. Chemical Analysis.—The tests for potassium or sodium are too well known to need more than enumeration. The intense yellow flame produced when a sodium salt is submitted to a Bunsen flame, and the bright sodium-line at D when viewed by the spectroscope, is a delicate test; while potassium gives a dull red band in the red, and a faint but very distinct line in the violet. Potassium salts are precipitated by tartaric acid, while sodium salts do not yield this precipitate; potassium salts also give a precipitate with platinic chloride insoluble in strong alcohol, while the compound salt with sodium is rapidly dissolved by alcohol or water. This fact is utilised in the separation and estimation of the two alkalies.

§ 115. Estimation of the Fixed Alkalies.—To detect a fixed alkali in the contents of the stomach, a convenient process is to proceed by dialysis, and after twenty-four hours, to concentrate the outer liquid by boiling, and then, if it is not too much coloured, to titrate directly with a decinormal sulphuric acid. After exact neutralisation, the liquid is evaporated to dryness, carbonised, the alkaline salts lixiviated out with water, the sulphuric acid exactly precipitated by baric chloride, and then, after separation of the sulphate, the liquid treated with milk of lime. The filtrate is treated with a current of CO₂ gas, boiled, and any precipitate filtered off; the final filtrate will contain only alkalies. The liquid may now be evaporated to dryness with either hydrochloric or sulphuric acids, and the total alkalies weighed as sulphates or chlorides. Should it be desirable to know exactly the proportion of potassium to sodium, it is best to convert the alkalies into chlorides—dry gently, ignite, and weigh; then dissolve in the least possible quantity of water, and precipitate by platinic chloride, which should be added so as to be a little in excess, but not much. The liquid thus treated is evaporated nearly to dryness, and then extracted with alcohol of 80 per cent., which dissolves out any of the double chloride of platinum and sodium. Finally, the precipitate is collected on a tared filter and weighed, after drying at 100°. In this way the analyst both distinguishes between the salts of sodium and potassium, and estimates the relative quantities of each. It is hardly necessary to observe that, if the double chloride is wholly soluble in water or alcohol, sodium alone is present. This, however, will never occur in operating on organic tissues and fluids, for both alkalies are invariably present. A correction must be made when complex organic fluids are in this way treated for alkalies which may be naturally in the fluid. Here the analyst will be guided by his preliminary titration, which gives the total free alkalinity. In cases where the alkali has been neutralised by acids, of course no free alkali will be found, but the corresponding salt.