Or take the case of Richard Overfield, who was condemned at Shrewsbury Assizes in 1824 for murdering his own child, a babe three months old, by pouring sulphuric acid down its throat. In the dead body the following appearances were found: The lips were blistered internally and of a dark colour externally; the gullet was contracted and its inner coat corroded; the lining membrane of the mouth and tongue of a dull white colour; the great curvature of the stomach corroded and converted into a substance like wet brown paper; the stomach perforated and a bloody-coloured fluid in the sac of the peritonæum.[[297]] If to these appearances be added the fact that the child’s dress was reddened, what is there to prevent the medical jurist from declaring, without reference to chemical evidence, that this case must have been one of poisoning by sulphuric acid or some other mineral acids?
In like manner in the case of Mrs. Humphrey, who was condemned at Aberdeen in 1830 for murdering her husband by pouring sulphuric acid down his throat while he was asleep, there was found, on examining the dead body, two brown spots on the outside of the lips,—whiteness of the inside of the lips and of the gums,—glazing of the palate,—redness, with here and there ash-coloured discoloration, of the uvula, posterior part of the throat, pharynx and epiglottis,—abrasion of most of the inner coat of the gullet,—erosion and dark-red ulceration of the inner coat of the stomach in winding furrows. When to these appearances it is added, that the man was in good health only forty-seven hours before death, and was taken ill instantaneously and violently with burning pain in the throat and stomach,[[298]] it is not easy to see what other opinion could be formed of the case, unless that he died of poisoning with a mineral acid, and probably with sulphuric acid.
Among the appearances justifying an opinion where chemical evidence happens to be wanting, not the least important seems to me to be the peculiar turgescence and induration of vessels under the peritonæum of the stomach and neighbouring organs, occasioned by the chemical coagulation of blood in them. It is an appearance, which, when once seen, cannot be confounded with any natural morbid phenomenon I have ever witnessed.
I am far from desiring to encourage rashness of decision, or to revive the loose criterions of poisoning relied on in former times. But there cannot, in my opinion, be a rational doubt that in the instance of sulphuric acid there may often be distinct exceptions to the general law regarding the feebleness of the evidence from morbid appearances; and that a witness would certainly be guilty of thwarting the administration of justice, if, relying on general rules, he refused to admit such exceptions. What natural disease could produce appearances like those described above? Assuredly no form of spontaneous perforation bears any resemblance to that caused in most cases of death from sulphuric acid; nor is it easy to mention any combination of natural diseases which could produce the peculiar conjunction of appearances remarked in the case of the man Humphrey.
Section IV.—Of the Treatment of Poisoning with Sulphuric Acid.
Since this acid and the other mineral acids act entirely as local irritants, it may be inferred that their poisonous action will be prevented by neutralizing them. But in applying that principle to the treatment it is necessary to bear in mind their extremely rapid operation; for if much time is lost in seeking for an antidote, irreparable mischief may be caused before the remedy is taken. Should it be possible then to administer chalk or magnesia without delay, these are the antidotes which ought to be preferred; but it may be well for the physician to remember, that in the absence of both he may at once procure a substitute in the plaster of the apartment beat down and made into thin paste with water. M. Chevallier, in a paper on the antidotes for the mineral acids, quotes five cases of poisoning with sulphuric acid and two with nitric acid, where life seems to have been saved by the speedy and free administration of magnesia, although in some cases so large a quantity as two ounces of the poison had been swallowed.[[299]]—A solution of soap is another antidote of no small value. While the antidote is in preparation, the acid should be diluted by the free use of any mild fluid, such as milk or oleaginous matters.—The alkaline bicarbonates are also excellent antidotes; but their carbonates are ineligible, being themselves possessed of corrosive properties. In a paper on poisoning with the mineral acids by Dr. Lunding of Copenhagen, the author is disposed to ascribe the large proportion of deaths in his practice to the system pursued in the Copenhagen hospital of administering carbonate of potass as an antidote daily for weeks together.[[300]] On the other hand however it may be mentioned, that in a late memoir, on this description of poisoning Dr. Ebers of Breslau endeavours to show, that there is no reason to dread the administration of the alkaline carbonates, even the carbonate of potash, provided they be given with mucilaginous fluids and syrup in a rather concentrated form; and he gives three cases illustrative of the good effects of this mode of treatment, which he maintains to be free of all danger, and preferable to every other antidotal method, because the remedy may be administered in small volume,—an advantage possessed by it especially over chalk or magnesia.[[301]]
After the proper antidote has been given to a sufficient extent, the use of diluents ought to be continued, as they render the vomiting more easy.—Some have recommended the stomach-pump for administering antidotes and diluents; but this is unnecessary. When it is wished to evacuate the stomach, there is an advantage in allowing it to do so by its own efforts, if possible; because the evacuation is accomplished in this way more completely than by the stomach-pump. Besides, if the patient cannot swallow fluids, still less can he suffer the tube of the stomach-pump to be introduced. On several occasions, indeed, it has been found impracticable to introduce it.[[302]]
The treatment of the surpervening inflammation does not differ from that of inflammation of the stomach. Where there is great difficulty of breathing, evidently from obstruction of the larynx, and where the absence of abdominal pain, tension or vomiting affords a presumption that little injury has been done to the stomach, laryngotomy appears an advisable remedy, and has been known to give very great relief.[[303]] But the patient may nevertheless die soon of the sympathetic disorder of the circulation.
II.—Of Poisoning with Nitric Acid.
Nitric acid is more frequently used as a poison abroad than in this country. But even in Britain it is not an uncommon cause of severe accidents and death.