[120] Christison, 167.
If death does not occur rapidly, there may be other symptoms—dependent not upon its merely local action, but upon its more remote effects. These mainly consist in an excitation of the brain and spinal cord, and, later, convulsive movements deepening into loss of consciousness. It has been noticed that, with great relaxation of the muscular system, the patients complain of every movement causing pain. With these general symptoms added to the local injury, death may follow many days after the swallowing of the fatal dose.
Death may also occur simply from the local injury done to the throat and larynx, and the patient may linger some time. Thus, in a case quoted by Taylor,[121] in which none of the poison appears actually to have been swallowed, the man died nineteen days after taking the poison from inflammation of the throat and larynx. As with the strong acids, so with ammonia and the alkalies generally, death may also be caused many weeks and even months afterwards from the effects of contraction of the gullet, or from the impaired nutrition consequent upon the destruction, more or less, of portions of the stomach or intestinal canal.
[121] Principles of Jurisprudence, i. p. 235.
§ 99. Post-mortem Appearances.—In recent cases there is an intense redness of the intestinal canal, from the mouth to the stomach, and even beyond, with here and there destruction of the mucous membrane, and even perforation. A wax preparation in the museum of University College (No. 2378) shows the effects on the stomach produced by swallowing strong ammonia; it is ashen-gray in colour, and most of the mucous membrane is, as it were, dissolved away; the cardiac end is much congested.
The contents of the stomach are usually coloured with blood; the bronchial tubes and glottis are almost constantly found inflamed—even a croup-like (or diphtheritic) condition has been seen. Œdema of the glottis should also be looked for: in one case this alone seems to have accounted for death. The blood is of a clear-red colour, and fluid. A smell of ammonia may be present.
If a sufficient time has elapsed for secondary effects to take place, then there may be other appearances. Thus, in the case of a girl who, falling into a fainting fit, was treated with a draught of undiluted spirits of ammonia, and lived four weeks afterwards, the stomach (preserved in St. George’s Hospital museum, 43 b, ser. ix.) is seen to be much dilated and covered with cicatrices, and the pylorus is so contracted as hardly to admit a small bougie. It has also been noticed that there is generally a fatty degeneration of both the kidneys and liver.