This is, perhaps, the most extreme case of destruction on record; the cause of the unusually violent action is referable to the acid acting on an empty stomach. It is important to note that even with this extensive destruction of the stomach, life was prolonged for two hours.
The case I have selected to serve as a type of a chronic but fatal illness produced from poisoning by sulphuric acid is one related by Oscar Wyss. A cook, thirty-four years of age, who had suffered many ailments, drank, on the 6th of November 1867, by mistake, at eight o’clock in the morning, two mouthfuls of a mixture of 1 part of sulphuric acid and 4 of water. Pain in the stomach and neck, and vomiting of black masses, were the immediate symptoms, and two hours later he was admitted into the hospital in a state of collapse, with cold extremities, cyanosis of the face, &c. Copious draughts of milk were given, and the patient vomited much, the vomit still consisting of black pultaceous matters, in which, on a microscopical examination, could be readily detected columnar epithelium of the stomach and mucous tissue elements. The urine was of specific gravity 1·033, non-albuminous; on analysis it contained 3·388 grms. of combined sulphuric acid.
On the second day there was some improvement in the symptoms; the urine contained 1·276 grm. of combined sulphuric acid; on the third day 2·665 grms. of combined sulphuric acid; and on the tenth day the patient vomited up a complete cast of the mucous membrane of the gullet. The patient remained in the hospital, and became gradually weaker from stricture of the gullet and impairment of the digestive powers, and died, two months after taking the poison, on the 5th of January 1868.
The stomach was found small, contracted, with many adhesions to the pancreas and liver; it was about 12 centimetres long (4·7 inches), and from 2 to 2·5 centimetres (·7 to ·9 inch) broad, contracted to somewhat the form of a cat’s intestine; there were several transverse rugæ; the walls were thickened at the small curvature, measurements giving 5 mm. (·19 inch) in the middle, and beyond about 2·75 mm. (·11 inch); in the upper two-thirds the lumen was so contracted as scarcely to admit the point of the little finger. The inner surface was covered with a layer of pus, with no trace of mucous tissue, and was everywhere pale red, uneven, and crossed by cicatricial bands. In two parts, at the greater curvature, the mucous surface was strongly injected in a ring-like form, and in the middle of the ring was a deep funnel-shaped ulcer; a part of the rest of the stomach was strongly injected and scattered over with numerous punctiform, small, transparent bladders. The gullet was contracted at the upper part (just below the epiglottis) from 20 to 22 mm. (·78 to ·86 inch) in diameter; it then gradually widened to measure about 12 mm. (·47 inch) at the diaphragm; in the neighbourhood of the last contraction the tissue was scarred, injected, and ulcerated; there were also small abscesses opening into this portion of the gullet.
E. Fraenkel and F. Reiche[74] have studied the effects of sulphuric acid on the kidney. In rapid cases they find a wide-spread coagulation of the epithelium in the convoluted and straight urinary canaliculi, with destruction of the kidney parenchyma, but no inflammation.
[74] Virchow’s Archiv, Bd. 131, f. 130.
§ 62. The museums of the different London hospitals afford excellent material for the study of the effects of sulphuric acid on the pharynx, gullet, and stomach; and it may be a matter of convenience to students if the more typical examples at these different museums be noticed in detail, so that the preparations themselves may be referred to.
In St. Bartholomew’s Museum, No. 1942, is an example of excessive destruction of the stomach by sulphuric acid. The stomach is much contracted, and has a large aperture with ragged edges; the mucous membrane is thickened, charred, and blackened.