Two cases which were actually fatal have been described in the Journal de Médecine for 1787, the one caused by one ounce, the other by an ounce and a half. In the latter the symptoms were those of the most violent cholera, and the patient died in two days and a half;[[456]] in the former death took place in three hours only, and in addition to the symptoms remarked in the other there were convulsions and twisting of the mouth.[[457]] In both the pulse failed at the wrist, and a great tendency to fainting prevailed for some time before death. Dr. Geoghegan has communicated to Mr. Taylor a case where an ounce and a half taken by mistake caused severe pain in the stomach, vomiting, and death in two hours.[[458]]
Similar effects have been remarked in several cases which have been followed by recovery. A woman in the second month of pregnancy, immediately after taking a handful of nitre in solution, was attacked with pain in the stomach, swelling of the whole body and general pains; she then miscarried, and afterwards had the usual symptoms of gastritis and dysentery, united with great giddiness, ringing in the ears, general tremors and excessive chilliness. She seems to have made a narrow escape, as for three days the discharges by stool were profuse, and composed chiefly of blood and membranous flakes.[[459]] Dr. Falconer has related another instance, where also the patient’s life seems to have been in great danger. The quantity taken was two ounces, and it was swallowed in half a pint of warm water by mistake instead of a laxative salt. Violent pain in the belly was immediately produced, in half an hour frequent vomiting, and in three hours a discharge of about a quart of blood from the stomach. After the administration of gruel and butter the symptoms began to subside; but they receded slowly; and even six months afterwards the man, though otherwise in good health, had frequent pain in the stomach and flatulence.[[460]] In the case of a female in the second month of pregnancy, described by Dr. Butter, miscarriage did not take place, although the symptoms were very violent and lasting. The quantity taken was two ounces. The symptoms were first bloody vomiting, afterwards dysentery, which continued seven days; and on the tenth day a nervous affection supervened exactly like chorea, and of two months’ duration.[[461]] The effects of the poison in the latter period of this woman’s illness tend to establish the existence of a secondary operation on the nervous system. But this kind of action is more strongly pointed out by the following cases. Three puerperal women in the Obstetric Hospital of Pavia got each an ounce of nitre by mistake for sulphate of magnesia. Two, who vomited immediately, did not suffer. The third, who retained the salt fifteen minutes, had pain in the stomach and vomiting, followed by paleness of the countenance, stiffness of the jaw, some stupor, and convulsive movements of the limbs; which symptoms continued till next day, when she gradually recovered.[[462]] A German physician, Dr. Geiseler, met with an instance, in which the only disorder produced appeared to depend on derangement of the cerebral functions. A woman, after swallowing an ounce of nitre instead of Glauber’s salt, lost the use of speech and the power of voluntary motion, then became insensible, and was attacked with tetanic spasms. This state lasted till next day, when some amelioration was brought about by copious sweating. It was not, however, till eight days after, that she recovered her speech, or the entire use of her mental faculties; and the palsy of the limbs continued two months.[[463]] Her case resembles the account given by Orfila of the effects of nitre on animals.
Section III.—Of the Morbid Appearances caused by Nitrate of Potass.
The morbid appearances observed in man are solely those of violent inflammation of the stomach and intestines. In Laflize’s case, which proved fatal in three hours, the stomach was distended, and the contents deeply tinged with blood; its peritonæal coat of a dark-red colour mottled with black spots; its villous coat very much inflamed and detached in several places. The liquid contents gave satisfactory evidence of nitre having been swallowed; for a portion evaporated to dryness deflagrated with burning charcoal. In Souville’s patient, who lived sixty hours, the stomach was every where red, in many places checkered with black spots, and at the centre of one of these spots the stomach was perforated by a small aperture. The whole intestinal canal was also red. In Dr. Geoghegan’s case, the stomach contained bloody mucus, and its villous coat was brownish-red, and here and there detached. He could not detect any nitre in it.
CHAPTER IX.
OF POISONING WITH THE ALKALINE AND EARTHY CHLORIDES.
There can be little doubt that the chlorides of soda, potass, and lime are active poisons; but the first two have alone been hitherto carefully investigated by physiological experiments.
The two alkaline chlorides are usually seen in the form of colourless solutions. That of potass is little known in this country; but that of soda is familiar to all in the shape of Fincham’s chloride of soda or bleaching liquid. The chloride of lime, which is best known of them all, is usually in the form of a dry powder, deliquescent, and acrid, commonly termed bleaching powder. All these substances are easily known by their peculiar odour of chlorine, and the copious disengagement of that gas on the addition of sulphuric acid.
The action of chloride of soda on the animal body has been examined by Segalas, who infers that it is an irritant poison, which, however, at times occasions symptoms of an affection of the nervous system. He remarked that three ounces of the solution, commonly sold in Paris under the name of Labarraque’s disinfecting liquid, caused immediate death by coagulating the blood in the heart, when injected into a vein in a dog. Two ounces introduced into the peritonæum excited palpitation, oppressed breathing, constant restlessness, and death in ten minutes; and three drachms did not prove fatal for some hours, tetanic spasms being produced in the first instance, and peritonæal inflammation being found after death. One ounce introduced into the stomach of a dog excited immediate vomiting, and no farther inconvenience; and two ounces retained by a ligature on the gullet brought on violent efforts to vomit, from which the animal was gradually recovering, when it was killed in twenty-four hours for the sake of observing the appearances. The stomach was found generally inflamed and interspersed with dark, gangrenous-like spots.[[464]]
I am not acquainted with any case of poisoning with these substances in the human subject. But it is probable that symptoms of pure irritation and inflammation will occur, and that moderate doses may prove fatal.