all cases; but in their subsequent course several varieties may be noticed.
In the worst form of poisoning death ensues at an early period, for example within twenty-four hours, nay even before time enough has elapsed for diarrhœa to begin. A case of this kind, which has been very well described by Mr. Dewar of Dunfermline, and which arose from the patient, a boy, having accidentally swallowed about three ounces of a strong solution of carbonate of potass, proved fatal in twelve hours only.[1] Here death was owing to the general system or some vital organ being affected through sympathy by the injury sustained by the alimentary canal.
In the mildest form, as in a case related by Plenck[2] of a man who swallowed an ounce of the carbonate of potass, the symptoms represent pretty nearly an attack of acute gastritis when followed by recovery,—the effects on man being then analogous to those observed by Bretonneau in animals, when the poison was introduced into the stomach without touching the gullet.
But a more common form than either of the preceding is one, similar to the chronic form of poisoning with the mineral acids, in which constant vomiting of food and drink, incessant discharge of fluid, sanguinolent stools, difficulty of swallowing, burning pain from the mouth to the anus, and rapid emaciation, continue for weeks or even months before the patient's strength is exhausted; and where death is evidently owing to starvation, the alimentary canal being no longer capable of assimilating food. Two characteristic examples of this singular affection have been recorded in the Medical Repository,[3] and a third, of which the event has not been mentioned, but which would in all likelihood end fatally, has been communicated by M. Jules Cloquet to Orfila.[4] Of the two first cases, which were caused by half an ounce of carbonate of potass having been taken in solution by mistake for a laxative salt, one proved fatal in little more than a month, the other three weeks afterwards. In Cloquet's case, at the end of the sixth week the membrane of the mouth was regenerated; but the gullet continued to discharge pus, and the stools were purulent and bloody.
Another form perhaps equally common with that just described, and not less certainly fatal, commences like the rest with violent symptoms of irritation in the mouth, gullet, and stomach; but the bowels are not affected, and by and by it becomes apparent that the stomach is little injured; dysphagia or even complete inability to swallow, burning pain and constriction in the gullet, hawking and coughing of tough, leathery flakes, are then the leading symptoms; at length the case becomes one of stricture of the œsophagus with or without ulceration; the bougie gives only temporary relief, and the patient eventually expires either of mere starvation, or of that combined with an exhausting fever. Mr. Dewar has related a very striking
