case by Mr. Arnott, where the poison taken was the nitric acid, the injury was confined in a great measure to the gullet and larynx,—the stomach, which was distended with food at the time, being very little affected. The chief symptoms at first, besides great general depression, were croupy respiration and much dyspnœa, which became so urgent, that laryngotomy was performed, and with complete relief to the breathing. But the patient nevertheless rapidly sunk under the symptoms of general exhaustion, and died in thirty-six hours without presenting any particular signs of the operation of the poison on the stomach; and the traces of action found there after death were trifling.[1]
The importance of the fact established by these cases will appear from the following medico-legal inquiries. A Prussian medical college was consulted in the case of a new-born child, in which the stomach and intestines were healthy, and did not contain poison, but in which the cuticle of the lips was easily scraped off, the gums, tongue, and mouth yellowish-green, as if burnt, the velum and uvula in the same state, the rima glottidis contracted, and the epiglottis, larynx, and fauces violently inflamed. The College declared, that a concentrated acid had been given, and that death had been occasioned by suffocation. Sulphuric acid was found in the house; and the mother subsequently confessed the crime.[2] A case was formerly quoted (p. 75), where MM. Ollivier and Chevallier found traces of the action of nitric acid on the lips, mouth, throat and upper fourth of the gullet, but not lower. In this instance the reporters came to the opinion from the absence of injury in the more important parts of the alimentary canal, as well as from the marks of nail-scratches on the neck, and the gorged state of the lungs, that death had been produced by strangling, after an unsuccessful attempt by the forcible administration of nitric acid. It is quite possible, however, that death might quickly ensue from the effects of the poison on the throat and gullet. In the course of the judicial inquiries M. Alibert stated that he had known repeated instances of death from swallowing nitric acid, although none of it reached lower down than the pharynx. Ollivier in his paper doubts the accuracy of this statement; but the cases quoted above show clearly that such injury may be done to the glottis as will be adequate of itself to occasion death.[3]
It seems farther not improbable that, among the terminations of poisoning with the strong mineral acids, scirrhous pylorus must also be enumerated. This is a very rare effect of the action of corrosive poisons. But M. Bouillaud has related an instance of death from scirrhous pylorus in its most aggravated shape, which supervened on the chronic form of the effects of nitric acid, and which proved fatal in three months.[4]
In some circumstances the stomach seems to acquire a degree of insensibility to the action of the strong acids. Tartra, in alluding to what is said of certain whisky-drinkers acquiring the power of swal-*
