§ 87. Symptoms.—The symptoms and course of nitric acid poisoning differ in a few details only from those of sulphuric acid. There is the same instant pain and frequent vomiting, destruction of the mucous membranes, and, in the less severe cases, after-contraction of the gullet, &c.
One of the differences in the action of nitric and sulphuric acids is the constant development of gas with the former. This, without doubt, adds to the suffering. Tartra made several experiments on dead bodies, and showed that very considerable distension of the intestinal canal, by gaseous products, was the constant result; the tissues were corroded and almost dissolved, being transformed, ultimately, into a sort of greasy paste. The vomited matters are of a yellow colour, unless mixed with blood, when they are of a dirty-brown hue, with shreds of yellow mucus, and have the strong acid reaction and smell of nitric acid. The teeth may be partially attacked from the solvent action of the acid on the enamel. The fauces and tongue, at first blanched, soon acquire a citron-yellow, or even a brown colour; the whole cavity may swell and inflame, rendering the swallowing of liquids difficult, painful, and sometimes impossible. The air passages may also become affected, and in one case tracheotomy was performed for the relief of the breathing.[111] The stomach rejects all remedies; there are symptoms of collapse; quick, weak pulse, frequent shivering, obstinate constipation, and death (often preceded by a kind of stupor) in from eighteen to twenty-four hours. The intellectual faculties remain clear, save in a few rare instances.
[111] Arnott, Med. Gaz., vol. xii. p. 220.
C. A. Wunderlich has recorded an unusual case, in which the symptoms were those of dysentery, and the large intestine was found acutely inflamed, while the small one was little affected. The kidneys had the same appearance as in Bright’s disease.[112] The smallest fatal dose given by Taylor is from 2 drachms, which killed a child aged 13 years. Should the dose of nitric acid be insufficient to kill at once, or, what amounts to the same thing, should the acid be immediately diluted with water, or in some way be neutralised, the patient, as in the case of sulphuric acid, may yet die at a variable future time from stenosis of the gullet, impaired digestion, &c. For example, in an interesting case related by Tartra,[113] a woman, who had swallowed 42 grms. (1·5 oz.) of nitric acid, feeling acute pain, took immediately a quantity of water, and three hours afterwards was admitted into hospital, where she received appropriate treatment. At the end of a month she left, believing herself cured; but in a little while returned, and was re-admitted, suffering from marasmus, extreme weakness, and constant vomiting; ultimately she died. The post-mortem examination revealed extreme contraction of the intestinal canal throughout. The lumen would hardly admit a penholder. The stomach was no larger than an ordinary intestine, and adherent to adjacent organs; on its internal surface there were spots, probably cicatrices; there were also changes in the gullet, but not so marked. A somewhat similar case is related by the same author in his thirteenth observation. In the Middlesex Hospital there is preserved the stomach (No. 1363) of a man who died forty days after swallowing 2 ozs. of nitric acid diluted in a tumbler of water. The stomach is contracted, the mucous membrane of the lower part of the gullet, the lesser curvature, and the pyloric end of the stomach is extensively corroded, showing ulcerated patches commencing to cicatrize.
[112] De Actionibus quibusdam Acidi Nitrici Caustico in Corpus Humanum immissi. Programma Academ., Lipsiæ, 1857, 4.
[113] Op. cit.