§ 228. Carbolic acid is separated from the body in the forms already mentioned, a small portion is also excreted by the skin. Salkowsky considers that, with rabbits, he has also found oxalic acid in the urine as an oxidation product. According to the researches of Binnendijk,[209] the separation of carbolic acid by the urine commences very quickly after its ingestion; and, under favourable circumstances, it may be completely excreted within from twelve to sixteen hours. It must be remembered that normally a small amount of phenol may be present in the animal body, as the result of the digestion of albuminous substances or of their putrefaction. The amount excreted by healthy men when feeding on mixed diet, Engel,[210] by experiment, estimates to be in the twenty-four hours 15 mgrms.
[209] Journal de Pharmacie et de Chimie.
[210] Annal. de Chimie et de Physique, 5 Sér. T. 20, p. 230, 1880.
§ 229. Post-mortem Appearances.—No fact is better ascertained from experiments on animals than the following:—That with lethal doses of carbolic acid, administered by subcutaneous injection, or introduced by the veins, no appearances may be found after death which can be called at all characteristic. Further, in the cases in which death has occurred from the outward application of the acid for the cure of scabies, &c., no lesion was ascertained after death which could—apart from the history of the case and chemical evidence—with any confidence be ascribed to a poison.
On the other hand, when somewhat large doses of the acid are taken by the mouth, very coarse and appreciable changes are produced in the upper portion of the alimentary tract. There may be brownish, wrinkled spots on the cheek or lips; the mucous membrane of the mouth, throat, and gullet is often white, and if the acid was concentrated, eroded. The stomach is sometimes thickened, contracted, and blanched, a condition well shown in a pathological preparation (ix. 206, 43 f) in St. George’s Hospital. The mucous membrane, indeed, may be quite as much destroyed as if a mineral acid had been taken. Thus, in Guy’s Hospital museum (179940), there is preserved the stomach of a child who died from taking accidentally carbolic acid. It looks like a piece of paper, and is very white, with fawn-coloured spots; the rugæ are absent, and the mucous membrane seems to have entirely vanished. Not unfrequently the stomach exhibits white spots with roundish edges. The duodenum is often affected, and the action is not always limited to the first part of the intestine.
The respiratory passages are often inflamed, and the lungs infiltrated and congested. As death takes place from an asphyxiated condition, the veins of the head and brain, and the blood-vessels of the liver, kidney and spleen, are gorged with blood, and the right side of the heart distended, while the left is empty. On the other hand, a person may die of sudden nervous shock from the ingestion of a large quantity of the acid, and in such a case the post-mortem appearances will not then exhibit precisely the characters just detailed. Putrefaction is retarded according to the dose, and there is often a smell of carbolic acid.[211] If any urine is contained in the bladder, it will probably be dark, and present the characters of carbolic urine, detailed at [p. 174].