The symptoms it occasions in man are very like those produced by sulphuric acid. As few cases however of poisoning with this substance have yet been published, its effects are not so well known as those of the other powerful acids; and it may therefore be right to mention the leading particulars of some of the cases which are met with in authors.—Mr. Quekett has related the case of a man, who, on arriving at home one day, told the woman he lodged with that he had poisoned himself with spirit of salt, but presented at the moment so little sign of uneasiness, that she at first scarcely believed him. In a short time however he suddenly became faint and fell down. On being removed to the London Hospital, magnesia and milk were given, about three hours after the acid had been taken; but no relief was experienced. He suffered intense thirst, complained of excessive pain in the stomach and throat, and expired in about fifteen hours.[[315]]—Mr. J. F. Crawfurd of Newcastle has related a still more rapid case which was occasioned by two ounces of an equal mixture of hydrochloric acid and “tincture of steel,” probably the tincture of chloride of iron. Vomiting occurred soon afterwards, but subsequently ceased; there was no complaint made either of pain or heat anywhere, or of thirst; and questions were answered intelligently. But the pulse was imperceptible, and the muscles of the extremities contracted; and death took place in five hours and a half.[[316]]—Orfila mentions that an hospital patient, affected with inflammation of the brain after a fall on the head, having got by mistake from his nurse 45 grammes, or two fluid ounces, of hydrochloric acid, was attacked with acute pain in the stomach, efforts to vomit, hiccup, extreme restlessness, a small pulse, a fiery red tongue, blackness of the lips, and a burning skin; and next day he died in a state of constant delirium, and covered with a cold clammy sweat.[[317]]
These cases present nearly the same violence and variety of action with that which results from the two other acids.
Section III.—Of the Morbid Appearances caused by Hydrochloric Acid.
The morbid appearances are on the whole similar to what are caused by sulphuric acid. In Mr. Quekett’s case the stomach outwardly was leaden-coloured and its vessels gorged with black blood; the intestinal peritonæum injected and speckled with fibrinous effusion; the villous coat of the stomach lined with yellow, curdled milk, and itself irregularly black here and there, as if charred, and in some places softened and corroded, so that a rent was made in handling it; the inner membrane of the duodenum similarly affected, and also even the jejunum, though more irregularly. The contents of the stomach were not acid, and did not contain any chloride.—In Mr. Crawfurd’s case the villous coat presented black elevated ridges, as if charred, and the furrows between were scarlet-red; black granular extravasation had taken place at many points into the submucous tissue; similar appearances were seen in the duodenum and jejunum; and the lower part of the gullet looked as if it had been cauterized.—In the case related by Orfila the gullet and pharynx were red, and at one or two places excoriated; the stomach inflamed externally, and its inner membrane spotted with gangrenous (?) patches, and very brittle; the duodenum thickened, and the jejunum perforated by a round worm.
CHAPTER IV.
ON POISONING WITH PHOSPHORUS AND THE OTHER BASES OF THE MINERAL ACIDS.
Of Poisoning with Phosphorus.—The only other mineral acid that deserves mention is the phosphoric. It possesses properties nearly analogous, and hardly inferior to those of the three acids already mentioned. On its own account, however, it does not merit any notice here, since it is much too rare to be within reach of a person who intends to give or take poison. But it must be attended to, because it is formed in the course of the action of a more common poison, phosphorus. An attempt has actually been made to perpetrate murder by means of this substance. A woman at Mengshausen tried to poison her husband by putting into his soup a mixture of phosphorus, flour, and sugar, used for poisoning rats. But the soup having been kept warm on the stove, the man’s suspicions were excited by its phosphorescence, and phosphorus was detected in it.[[318]]
Orfila found that two drachms of phosphorus given to dogs in fragments caused death in twenty-one hours, that the whole stomach and intestines were more or less inflamed, and that the phosphorus had lost much of its weight, though vomiting had been prevented by a ligature on the gullet; in fact the poison was partly oxidated. In a state of minute division, as when dissolved in oil, twenty-four grains caused death in less than five hours with all the symptoms of the most acute irritant poisoning; and after death the stomach was found extensively corroded, and perforated by two holes.[[319]] Other experimentalists have found that half a grain melted in hot water could kill a dog;[[320]] and that water, in which phosphorus had been simply received in the process for preparing it, proved in small quantities fatal to poultry.[[321]]
There is no doubt, therefore, that phosphorus is a dangerous poison to animals. Its effects on man have not been often witnessed; but the observations hitherto made will show that it is not less injurious to him than to the lower animals. A grain and a half have actually proved fatal to man, as appears from a case mentioned by M. Worbe.[[322]] The subject of the case was a stout young man who took a grain and a half in hot water, after having previously taken half a grain without sustaining injury. In seven hours, and not till then, he was attacked with pain in the stomach and bowels, then with incessant vomiting and diarrhœa, excessive tenderness and tension of the belly,—all the symptoms in short of irritant poisoning; and he died exhausted in twelve days. Another fatal case somewhat similar in its circumstances has been related by M. Julia-Fontenelle.[[323]] An apothecary, after taking in one day first a single grain and then two grains of phosphorus without experiencing any particular effects, swallowed next day three grains at once in syrup. In the evening he felt generally uneasy, from a sense of pressure in the belly, which continued for three days; and then he was also seized with violent, continual vomiting of a matter which had an alliaceous odour. On the seventh day he had also spasms, delirium, and palsy of the left hand; and death speedily ensued.—Dr. Maier of Ulm relates a singular case occasioned by a portion of lucifer-match composition having been swallowed intentionally. Vomiting and pain in the belly ensued, then anxiety, restlessness, and excessive thirst, and death in about fifteen hours.[[324]]—M. Martin-Solon relates the case of a patient, affected with lead palsy, who having taken considerably less than a grain in the form of emulsion, was attacked with burning along the gullet and in the stomach, mucous vomiting, tenderness of the belly, general coldness and feebleness of the pulse. Afterwards the pulse became imperceptible, the limbs neuralgic, the intellect clouded, and the breathing stertorous; and he died in little more than two days.[[325]]—In the only other case I have hitherto found recorded death took place in forty hours, and the symptoms were violent pain in the stomach and continual vomiting, together with the discharge by clysters of small fragments of phosphorus, which were discovered by their shining in the dark, and subsequently by the appearance of burnt spots on the bed-linen. In this case, which is described by Dr. Flachsland of Carlsruhe,[[326]] the quantity of the poison taken was not ascertained. The patient, a young man, took it on bread and butter at the recommendation of a quack, to cure constipation, general debility, and impotence.
At one time it was the custom to give small doses of phosphorus in medical practice; but the uncertainty and occasional severity of its operation have perhaps properly expelled it from most modern pharmacopœias. Among other properties ascribed to it in medicinal doses, it is said to be a powerful aphrodisiac: No such symptom occurred in the first of the fatal cases just related, or is mentioned in any of the others; but there is no doubt that medicinal doses sometimes produce it.
As to the morbid appearances, the same changes of structure may be expected as in the instance of the mineral acids generally. In Worbe’s case quoted above, the skin was generally yellow, and here and there livid; the lungs gorged with blood; the muscular coat of the stomach inflamed, but the other coats not, except near the two extremities of the organ, where they were black. In Flachsland’s case much fluid blood was discharged from the first incisions through the skin of the belly; the omentum and outside of the stomach and intestines were red; the villous coat of the stomach presented an appearance of gangrenous inflammation (probably black extravasation only); the inner membrane of the duodenum was similarly affected; the great intestines were contracted to the size of the little finger; the mesenteric glands enlarged; and the kidneys and spleen inflamed. In Maier’s case the peritonæum and omentum were dry and vascular, the stomach and small intestines pale, the great intestines contracted, almost empty, brownish-red, and here and there inflamed, the liver large, and the blood everywhere liquid. The contents of the caput cœcum had an odour of phosphorus, and here were found two yellowish lumps weighing eight grains, which shone when rubbed, exhaled a phosphoric odour, and contained 0·6 of a grain of phosphorus. In Martin-Solon’s case the gullet was cherry-red and its epithelian brittle, the villous coat of the stomach grayish and brittle, the solid viscera in the abdomen soft, and the cerebral membranes congested.