§ 59. Symptoms.—The symptoms may be classed in two divisions, viz.:—1. External effects of the acid. 2. Internal effects and symptoms arising from its interior administration.
1. External Effects.—Of late years several instances have occurred in which the acid has been used criminally to cause disfiguring burns of the face. The offence has in all these cases been committed by women, who, from motives of revengeful jealousy, have suddenly dashed a quantity of the acid into the face of the object of their resentment. In such cases, the phenomena observed are not widely different from those attending scalds or burns from hot neutral fluids. There is destruction of tissue, not necessarily deep, for the acid is almost immediately wiped off; but if any should reach the eye, inflammation, so acute as to lead to blindness, is the probable consequence. The skin is coloured at first white, at a later period brown, and part of it may be, as it were, dissolved. If the tract or skin touched by the acid is extensive, death may result. The inflammatory processes in the skin are similar to those noticed by Falck and Vietor in their experiments, already detailed ([p. 79]).
Internal Effects of Acids generally.—It may not be out of place, before speaking of the internal effects of sulphuric acid, to make a few remarks upon the action of acids generally. This action differs according to the kind of animal; at all events, there is a great difference between the action of acids on the herb-eating animals and the carnivora; the latter bear large doses of acids well, the former ill. For instance, the rabbit, if given a dose of any acid not sufficient to produce local effects but sufficient to affect its functions, will soon become paralysed and lie in a state of stupor, as if dead; the same dose per kilo. will not affect the dog. The reason for this is that the blood of the dog is able to neutralise the acid by ammonia, and that the blood of the rabbit is destitute of this property. Man is, in this respect, nearer to the dog than to the plant-eaters. Stadelmann has shown that a man is able to ingest large relative doses of oxybutyric acid, to neutralise the acid by ammonia, and to excrete it by means of the kidneys as ammonium butyrate.
Acids, however, if given in doses too great to be neutralised, alike affect plant- and flesh-eaters; death follows in all cases before the blood becomes acid. Salkowsky[71] has, indeed, shown that the effect of lessening the alkalinity of the blood by giving a rabbit food from which it can extract no alkali produces a similar effect to the actual dosing with an acid.
[71] Virchow’s Archiv, Bd. 58, 1.
2. Internal Effects of Sulphuric Acid.—When sulphuric acid is taken internally, the acute and immediate symptom is pain. This, however, is not constant, since, in a few recorded cases, no complaint of pain has been made; but these cases are exceptional; as a rule, there will be immediate and great suffering. The tongue swells, the throat is also swollen and inflamed, swallowing of saliva even may be impossible. If the acid has been in contact with the epiglottis and vocal apparatus, there may be spasmodic croup and even fatal spasm of the glottis.
The acid, in its passage down the gullet, attacks energetically the mucous membrane and also the lining of the stomach; but the action does not stop there, for Lesser found in eighteen out of twenty-six cases (69 per cent.) that the corrosive action extended as far as the duodenum. There is excessive vomiting and retching; the matters vomited are acid, bloody, and slimy; great pieces of mucous membrane may be in this way expelled, and the whole of the lining membrane of the gullet may be thrown up entire. The bowels are, as a rule, constipated, but exceptionally there has been diarrhœa; the urine is sometimes retained; it invariably contains an excess of sulphates and often albumen, with hyaline casts of the uriniferous tubes. The pulse is small and frequent, the breathing slow, the skin very cold and covered with sweat; the countenance expresses great anxiety, and the extremities may be affected with cramps or convulsions. Death may take place within from twenty-four to thirty-six hours, and be either preceded by dyspnœa or by convulsions; consciousness is, as a rule, maintained to the end.
There are also more rapid cases than the above; a large dose of sulphuric acid taken on an empty stomach may absolutely dissolve it, and pass into the peritoneum; in such a case there is really no difference in the symptoms between sudden perforation of the stomach from disease, a penetrating wound of the abdomen, and any other sudden fatal lesion of the organs in the abdominal cavity (for in all these instances the symptoms are those of pure collapse); the patient is ashen pale, with pulse quick and weak, and body bathed in cold sweat, and he rapidly dies, it may be without much complaint of local pain.