§ 687. German Sausage Poisoning.—A series of cases may be picked out from the accounts of sausage poisoning in Germany, all of which evidently depend upon a poison producing the same symptoms, and the essentially distinctive mark of which is extreme dryness of the skin and mucous membranes, dilatation of the pupil, and paralysis of the upper eyelids (ptosis). In an uncertain time after eating sausages or some form of meat, from one to twenty-four hours, there is a general feeling of uneasiness, a sense of weight about the stomach, nausea, and soon afterwards vomiting, and very often diarrhœa. The diarrhœa is not severe, never assumes a choleraic form, and is unaccompanied by cramps in the muscles. After a considerable interval there is marked dryness of the mucous membrane (a symptom which never fails), the tongue, pharynx, and the mouth generally seem actually destitute of secretion; there is also an absence of perspiration, the nasal mucous membrane participates in this unnatural want of secretion, the very tears are dried up. In a case related by Kraatzer,[678] the patient, losing a son, was much troubled, but wept no tear. This dryness leads to changes in the mucous membrane, it shrivels, and partly desquamates, aphthous swellings may occur, and a diffuse redness and diphtheritic-like patches have been noticed. There is obstinate constipation, probably from a dryness of the mucous lining of the intestines. The breath has an unpleasant odour, there is often a croupy cough, the urinary secretion alone is not decreased but rather augmented. Swallowing may be so difficult as to rise to the grade of aphagia, and the tongue cannot be manipulated properly, so that the speech may be almost unintelligible. At the same time, marked symptoms of the motor nerves of the face are present, the patient’s sight is disturbed, he sees colours or sparks before his eyes; in a few cases there has been transitory blindness, in others diplopia. The pupil in nearly all the cases has been dilated, also in exceptional instances it has been contracted. The levator palpebrae superioris is paralysed, and the resulting ptosis completes the picture. Consciousness remains intact almost to death, there is excessive weakness of the muscles, perhaps from a general paresis. If the patient lives long enough, he gets wretchedly thin, and dies from marasmus. In more rapidly fatal cases, death follows from respiratory paralysis, with or without convulsions.
[678] Quoted by Husemann, Vergiftung durch Wurstgift (Maschka’s Handbook).
The post-mortem appearances which have been observed are—the mucous membranes of the mouth, gullet, and throat are white, hard, and parchment-like; that of the stomach is more or less injected with numerous hæmorrhages: the kidneys are somewhat congested, with some effusion of blood in the tubuli; the spleen is large and very full of blood, and the lungs are often œdematous, pneumonic, or bronchitic.
PART VIII.—THE OXALIC ACID GROUP OF POISONS.
§ 688. Oxalic acid is widely distributed both in the free state and in combination with bases throughout the vegetable kingdom, and it also occurs in the animal kingdom. In combination with potash it is found in the Geranium acetosum (L.), Spinacia oleracea (L.), Phytolacca decandra (L.), Rheum palmatum (L.), Rumex acetosa, Atropa belladonna, and several others; in combination with soda in different species of Salsola and Salicornia; and in combination with lime in most plants, especially in the roots and bark. Many lichens contain half their weight of calcic oxalate, and oxalic acid, either free or combined, is (according to the observations of Hamlet and Plowright[679]) present in all mature non-microscopic fungi. Crystals of oxalate of lime may be frequently seen by the aid of the microscope in the cells of plants. According to Schmidt,[680] this crystallisation only takes place in the fully mature cell, for in actively growing cells the oxalate of lime is entirely dissolved by the albumen of the plant.