§ 88. Post-mortem Appearances.—The pathological changes in the tongue, gullet, and stomach can be readily studied from the preparations in the different museums. The staining by the nitric acid appears unchanged to the naked eye for many years; hence, most of the nitric acid preparations are in an excellent state of preservation. A very good example of the pathological changes is to be found in Nos. 1049 and 1050, University College museum.
No. 1049 presents the tongue, pharynx, and larynx of a man who had swallowed a tea-cupful of nitric acid. The epithelium of the œsophagus is for the most part wanting, and hangs in shreds; the dorsum of the tongue, in front of the circumvallate papillæ, is excavated, and over its central part superficially ulcerated; in other places the tongue is encrusted with a thick, loose, fawn-coloured layer, formed probably of desquamated epithelium. The whole of the mucous surface is stained of a dirty yellow.
No. 1050 is a preparation showing the tongue, gullet, and stomach of a person who died from the effects of nitric acid. The tongue in places is smooth and glazed; in others, slightly depressed and excavated. On the anterior wall and lower portion of the gullet two large sloughs exist.
Although perforation of the stomach is not so common with nitric as with sulphuric acid, such an accident may occur, as shown in a preparation at Guy’s Hospital, in which there is a perforation at the cardiac end. All the mucous membrane has disappeared, and the inner surface is for the most part covered with flocculent shreds. Three ounces of nitric acid are said to have been swallowed, and the patient lived seventeen hours. There is the usual staining. There is also in the Middlesex Hospital (No. 1364) the œsophagus and stomach of a woman aged 30, who died six hours after swallowing 2 to 3 ozs. of strong nitric acid. The inner coats of the mucous membrane of the gullet and stomach are in part converted into opaque yellow and black eschars, and in part to a shreddy pulpy condition. At the most depending part of the stomach is a large ragged perforation, with pulpy margins, which allowed the contents of the stomach to escape into the peritoneal cavity.
In St. Bartholomew’s museum, there is a very good specimen (No. 1870) of the appearances in the gullet and stomach after poisoning by nitric acid. The case is detailed in St. Bartholomew’s Hospital Reports, vol. v. p. 247. A male died in fifteen hours after swallowing 1 oz. of nitric acid. The whole mucous membrane is wrinkled, or rather ploughed, into longitudinal furrows, the yellow discoloration stops abruptly, with an irregular border, at the commencement of the stomach, the epithelial and mucous coats of which are wanting—its surface being rough and of a brownish-red colour.
The following preparations are to be found in the museum of the London Hospital:—A. b. 1. and A. b. 8.—A. b. 1. shows the pharynx, œsophagus, larynx, and stomach of a young woman, who, after taking half an ounce of nitric acid, died in eight hours. The staining is very intense; as an unusual feature, it may be noted that the larynx is almost as yellow as the œsophagus. The abrasion or solution of the epithelium on the dorsum of the tongue has dissected out the circumvallate and fungiform papillæ, so that they project with unusual distinctness. The lining membrane of the gullet throughout is divided into minute squares by longitudinal and transverse furrows. The mucous membrane of the stomach appears wholly destroyed, and presents a woolly appearance.
A. b. 8. shows a very perfect cast of the œsophagus. The case was that of a woman, aged 35, who swallowed half an ounce of nitric acid. The symptoms for the first four days were the usual pain in the throat and stomach, which might be expected; the bowels were freely open, and the stools dark and offensive. On the sixth day, there was constant vomiting with offensive breath; on the ninth, the appearance of the patient was critical, and she threw up the cast preserved. She died on the tenth day after the taking of the acid. The gullet, stomach, trachea, and larynx were found after death much inflamed.
The following preparations are in St. Thomas’ Hospital:—P. 5.—a stomach with gullet attached. The stomach is covered with yellowish-green patches of false membrane and deposit; the gullet has the usual longitudinal furrows so characteristic of corrosive fluids.
P. 6. is also from a case of nitric acid poisoning. It shows the lining membrane of the stomach partly destroyed and shreddy, yet but little discoloured, the hue being a sort of delicate fawn.
To these may be added a case described and figured by Lesser; to a baby, a few days old, an unknown quantity of fuming nitric acid was given; the child made a gurgling, choking sound, and died in a few minutes. The corpse, nine days after death, showed no signs of decomposition. The tongue and gums were yellow, the gullet less so, the stomach still less, and the small intestine had no yellow tint; the whole of the mouth, gullet, and stomach showed the corrosive action of the acid. The graduation of tint, Lesser remarks, is what is not seen when the yellow colour is due to poisoning by chromic acid or by strong solution of ferric perchloride; in such cases, wherever the liquid has gone, there is a yellowness.[114]