of the cheeks are white, and as it were polished, like ivory.[1] There is almost always great difficulty, and sometimes complete impossibility, of swallowing. In the case of a child related by Dr. Sinclair, of Manchester, fluids taken by the mouth were returned by the nose; and the reason was obvious after death; for even then the pharynx was so much contracted as to admit a probe with difficulty.[2] On the same account substances taken by the mouth have been discharged by an opening in the larynx which had been made to relieve impending suffocation. The matter vomited, if no fluids be swallowed, is generally brownish or black, and at first causes effervescence, if it falls on a pavement containing any lime. Afterwards this matter is mixed with shreds of membrane, which resemble the coats of the stomach, and sometimes actually consists of the disorganised coats, but are generally nothing more than coagulated mucus. The bowels are obstinately costive, the urine scanty or suppressed; and the patient is frequently harassed by distressing tenesmus and desire to pass water. The pulse all along is very weak, sometimes intermitting, and towards the close imperceptible. It is not always frequent; on the contrary, it has been observed of natural frequency, small and feeble in a patient who survived fifteen days.[3] The countenance becomes at an early period glazed and ghastly, and the extremities cold and clammy. The breathing is often laborious, owing to the movements of the chest increasing the pain in the stomach,—or because pulmonary inflammation is also at times present,—or because the admission of air into the lungs is impeded by the injury done to the epiglottis and entrance of the larynx. To these symptoms are added occasional fits of suffocation from shreds of thick mucus sticking in the throat, and sometimes croupy respiration, with sense of impending choking.
Such is the ordinary train of symptoms in cases of the first variety. But sometimes, especially when a large dose has been swallowed, instead of these excruciating tortures, there is a deceitful tranquillity and absence of all uneasiness. Thus, in the case of a woman who was poisoned by her companions making her swallow while intoxicated aqua fortis mixed with wine, although she had at first a good deal of pain and vomiting, there were subsequently none of the usual violent symptoms; and she died within twenty hours, complaining chiefly of tenesmus and excessive debility.[4] Occasionally eruptions break out over the body:[5] but their nature has not been described.
Death is seldom owing to the mere local mischief, more generally to sympathy of the circulation and nervous system with that injury. According to Bouchardat death arises from the acid entering the blood in sufficient quantity to cause coagulation.[6] But
- ↑ Correa de Serra in Journal de Chimie Médicale, ii. 209, on the third day.
- ↑ Edinburgh Med. and Surg. Journal, xxxvi. 103.
- ↑ Archives Générales de Médecine, xiii. 367.
- ↑ Tartra, iii. 87.
- ↑ Desgranges, Recueil Périodique de la Société de Médecine, vi. 22. Tulpius, Observationes Medicinales, iii. 43.
- ↑ Annales d'Hygiène Publique, xvii. 362.
