[200] R. Köhler, Würtem. Med. Corr. Bl., xlii., No. 6, April 1872; H. Abelin, Schmidt’s Jahrbücher, 1877, Bd. 173, S. 163.
In another case, a child died from the outward use of a 2 per cent. solution of carbolic acid. It is described as follows:—An infant of seven weeks old suffered from varicella, and one of the pustules became the centre of an erysipelatous inflammation. To this place a 2 per cent. solution of carbolic acid was applied by means of a compress steeped in the acid; the following morning the temperature rose from 36·5° (97·7° F.) to 37° (98·6° F.), and poisonous symptoms appeared. The urine was coloured dark. There were sweats, vomitings, and contracted pupils, spasmodic twitchings of the eyelids and eyes, with strabismus, slow respiration, and, lastly, inability to swallow. Under the influence of stimulating remedies the condition temporarily improved, but the child died twenty-three and a half hours after the first application. An examination showed that the vessels of the brain and the tissue of the lungs were abnormally full of blood. The liver was softer than natural, and exhibited a notable yellowishness in the centre of the acini. Somewhat similar appearances were noticed in the kidneys, the microscopic examination of which showed the tubuli contorti enlarged and filled with fatty globules. In several places the epithelium was denuded, in other places swollen, and with the nuclei very visible.
In an American case,[201] death followed the application of carbolic acid to a wound. A boy had been bitten by a dog, and to the wound, at one o’clock in the afternoon, a lotion, consisting of nine parts of carbolic acid and one of glycerin, was applied. At seven o’clock in the evening the child was unconscious, and died at one o’clock the following day.
[201] American Journal of Pharmacy, vol. li., 4th Ser.; vol. ix., 1879, p. 57.
§ 224. Internal Administration.—Carbolic acid may be taken into the system, not alone by the mouth, but by the lungs, as in breathing carbolic acid spray or carbolic acid vapour. It is also absorbed by the skin when outwardly applied, or in the dressing or the spraying of wounds with carbolic acid. Lastly, the ordinary poisonous effects have been produced by absorption from the bowel, when administered as an enema. When swallowed undiluted, and in a concentrated form, the symptoms may be those of early collapse, and speedy death. Hence, the course is very similar to that witnessed in poisoning by the mineral acids.
If lethal, but not excessive doses of the diluted acid are taken, the symptoms are—a burning in the mouth and throat, a peculiarly unpleasant persistent taste, and vomiting. There is faintness with pallor of the face, which is covered by a clammy sweat, and the patient soon becomes unconscious, the pulse small and thready, and the pupils sluggish to light. The respiration is profoundly affected; there is dyspnœa, and the breathing becomes shallow. Death occurs from paralysis of the respiratory apparatus, and the heart is observed to beat for a little after the respiration has ceased. All these symptoms may occur from the application of the acid to the skin or to mucous membranes, and have been noticed when solutions of but moderate strength have been used—e.g., there are cases in gynæcological practice in which the mucous membrane (perhaps eroded) of the uterus has been irrigated with carbolic acid injections. Thus, Küster[202] relates a case in which, four days after confinement, the uterus was washed out with a 2 per cent. solution of carbolic acid without evil result. Afterwards a 5 per cent. solution was used, but it at once caused violent symptoms of poisoning, the face became livid, clonic convulsions came on, and at first loss of consciousness, which after an hour returned. The patient died on the ninth day. There was intense diphtheria of the uterus and vagina. Several other similar cases (although not attended with such marked or fatal effects) are on record.[203]