The signs of depressed circulation are always very striking. In general the pulse fails altogether, it is always very feeble, and the skin is cold and clammy. Contrary to the general fact, however, I once remarked in a dog the pulsation of the heart so strong as to be audible at a distance of several yards.
In some cases nervous symptoms have occurred, but in none so distinctly as in animals that have taken the diluted acid. It should be remarked, however, that few published cases contain good histories of the symptoms; since they commonly come to an end before being seen by the physician. Convulsions appear to have occurred in some instances either at the time of death or soon before it. In the slower cases various nervous affections have been observed. A girl, who swallowed by mistake about two drachms, and did not vomit till emetics were given, complained much at first of pain, but afterwards chiefly of great lassitude and weakness of the limbs, and next morning of numbness and weakness there as well as in the back. This affection was at first so severe that she could hardly walk up stairs; but in a few days she recovered entirely.[[412]] Analogous effects took place in Mr. Hebb’s patient and in Dr. Arrowsmith’s case. The first thing the former complained of was acute pain in the back, gradually extending down the thighs, occasioning ere long great torture, and continuing almost till the moment of death. Dr. Arrowsmith’s patient had the same symptoms, complained more of the pain shooting down from the loins to the limbs than of the pain in the belly, and was constantly seeking relief in a fresh change of posture. Mr. Frazer’s patient had from an early period a peculiar general numbness, approaching to palsy. Dr. Babington’s patient, who took two scruples by mistake for tartaric acid in an effervescing draught, suffered, after the first twenty-four hours, chiefly from headache, extreme feebleness of the pulse, and a sense of numbness and tingling or pricking in the back and thighs. In a recent case described by Mr. Tapson, which occurred in London, and where it was supposed, but on insufficient grounds,[[413]] that so much as two ounces had been taken, violent symptoms of irritation in the alimentary canal came on as usual, but soon afterwards a sense as if the hands were dead, loss of consciousness for eight hours, and then lividity, coldness, and almost complete loss of the power of motion in the legs; which symptoms were not entirely removed for fifteen days. In a case related by Mr. Alfred Taylor, where death was caused by seven drachms in fifteen or twenty minutes, there was first violent vomiting, then severe pain in the stomach, and finally clammy perspiration and convulsions, with two or three deep inspirations before death.[[414]] The effects in this case came very near those generally observed in animals.
In Dr. Arrowsmith’s case two symptoms occurred, which I have not seen mentioned in any other. The first was an eruption or mottled appearance of the skin in circular patches, not unlike the roundish red marks on the arms of stout healthy children, but of a deeper tint. The second was the poisoning and death of leeches applied to the stomach. “They were healthy,” says Dr. Arrowsmith in the notes with which he obligingly furnished me, “small, and fastened immediately. On looking at them in a few minutes I remarked that they did not seem to fill, and on touching one it felt hard and immediately fell off, motionless and dead. The others were all in the same state. They had all bitten and the marks were conspicuous; but they had drawn scarcely any blood. They were applied about six hours after the acid was taken.” This curious fact illustrates the observations formerly quoted from Vernière’s experiments [p. [67]]. It will be observed that the leeches were applied several hours after the poison was swallowed, and in a case in which the acid was largely diluted in the stomach;—so that it might have entered the blood and been diffused throughout the body before the observation was made.
Section III.—Of the Morbid Appearances caused by Oxalic Acid.
The external appearance of the body is commonly natural. In one instance the cellular tissue was distended with gases ten hours after death.[[415]] Violent marks of irritation have been commonly found in the stomach; and sometimes that organ has been even perforated.[[416]] It is probable that the extensive destruction of the coats noticed by some authors has taken place in part after death from the action of the acid on the dead tissues.—The usual conjunction of morbid appearances is well described by Mr. Hebb. The mucous coat of the throat and gullet looked as if it had been scalded, and that of the gullet could be easily scratched off. The stomach contained a pint of thick fluid. This is commonly dark, like coffee-grounds, as it contains a good deal of blood. The inner coat of the stomach was pulpy, in many points black, in others red. The inner membrane of the intestines was similarly but less violently affected. The outer coat of both stomach and intestines was inflamed. The lining membrane of the windpipe was also very red.—The appearances have also been excellently described in the case published by Mr. Alfred Taylor. The inside of the gullet was pale, as if boiled, strongly corrugated and brittle, and covering a ramification of vessels filled with consolidated blood. The stomach presented externally numerous vessels in the same state; and its villous coat was pale, soft, brittle, but here and there injected with vessels. The duodenum and part of the jejunum were red, the other intestines natural, the liver, spleen, and kidneys congested. The stomach contained a brownish jelly, in which gelatin was detected, as well as oxalic acid. The blood was fluid every where except in the vessels of the gullet and stomach.[[417]] The consolidated condition of the blood there was evidently owing to the local action of a strong acid, and is the same with what has been observed in poisoning with the mineral acids.—In Mr. Frazer’s patient the whole villous coat of the stomach was either softened or removed, as well as the inner membrane of the gullet, so that the muscular coat was exposed; and this coat presented a dark gangrenous-like appearance, being much thickened and highly injected.
Although these signs of violent irritation are commonly present, it must at the same time be observed, that some cases have occurred where the stomach and intestines were quite healthy. In a girl who died about thirty minutes after swallowing an ounce of the acid, no morbid appearance whatsoever was to be seen in any part of the alimentary canal.[[418]] In the case of a girl, described by Mr. Anderson, where death took place in twenty minutes, there was no appearance but contraction of the rugæ of the gullet and stomach, one spot of extravasation in the latter and doubtful softening of its villous coat.[[419]]
The state of the other organs of the body has not been taken notice of in published cases. In several instances, as in Mr. Taylor’s case, the blood in the veins of the stomach is described as having been black and as it were charred; probably by the chemical action of the acid after death.
Section IV.—Of the Treatment of Poisoning with Oxalic Acid.
The chief part of the treatment of this kind of poisoning is obvious. On account of its dreadful rapidity, remedies cannot be of material use unless they are resorted to immediately after the acid has been swallowed. Emetics may be given, if vomiting is not already free; but time should never be lost in administering them if an antidote is at hand. In particular it is necessary to avoid giving warm water with a view to accelerate vomiting, unless it is given very largely; for moderate dilution will promote the entrance of the poison into the blood, if it has not the effect of immediately expelling it.
The principal object of the practitioner should be to administer as speedily as possible large doses of magnesia or chalk suspended in water. Chalk has been given with great advantage in several cases,[[420]] and magnesia has also been of service.[[421]] As no time should be lost, the plaster of the apartment may be resorted to, when chalk or magnesia is not at hand. These substances not only neutralize the acid so as to take away its corrosive power, but likewise render it insoluble, so as to prevent it from entering the blood. There appears no particular reason for using the stomach-pump when antidotes are at hand. But fashion seems to have authorised the employment of this instrument for every kind of poison.[[422]] Alkalis are inadmissible. As might be inferred from the general statements formerly made on the effect of chemical changes on poisons [p. [28]], the alkalis, as they form only soluble salts, will not deprive oxalic acid of its remote or indirect action; and instances are not wanting of their inutility in actual practice.