example of this form of poisoning with the alkalis.[1] His patient, after the first violent symptoms had exhausted themselves, which took place in sixteen or eighteen hours, suffered little for four or five days till the sloughs began to separate from the lining membrane of the mouth, throat, and gullet. The affection of the gullet then became gradually predominant, and terminated in stricture, of which she appears to have been several times so much relieved as to have been thought in a fair way of recovery. After repeatedly disappointing Mr. Dewar's hopes of a successful issue by her intemperance in the use of spirituous liquors, she died of starvation about four months after swallowing the poison. Sir Charles Bell has noticed three parallel cases, and has given delineations of the appearance in the gullet of two of them.[2] One of his patients did not die till twenty years after swallowing the poison, which in this instance was soap-lees; yet he does not hesitate to ascribe the stricture to that cause, and says death arose purely from starvation.
The carbonate of soda, though a salt in very common use, has not hitherto been the cause of accident, which has found its way into print. It is plainly much less actively corrosive than carbonate of potass, and is therefore probably in every sense less energetic.
Section III.—Of the Morbid Appearances caused by the fixed Alkalis.
The morbid appearances caused by potass, soda, and their carbonates differ with the nature of the case.
In the boy who died in twelve hours Mr. Dewar found the inner membrane of the throat and gullet almost entirely disorganized and reduced to a pulp, with blood extravasated between it and the muscular coat. The inner coat of the stomach was red, in two round patches destroyed, and the patches covered with a clot of blood;—its outer coat, as well as all the other abdominal viscera, was sound.
In the two chronic cases mentioned in the Medical Repository the mischief was much more general, the whole peritonæum being condensed, the omentum dark and turgid, the intestines glued together by lymph, the external coats of the stomach thick, the villous coat almost all destroyed, what remained of it red and near the pylorus ulcerated, and the pyloric orifice of the stomach plugged up with lymph so as barely to admit a small probe.
In Mr. Dewar's patient who died of stricture of the gullet the intestines were sound, the inner surface of the stomach red especially towards the cardia, the inner and muscular coats of the gullet thickened and firmly incorporated together by effused lymph, the inner coat here and there wanting, the passage of the gullet every where contracted, and to such a degree about two inches above the cardia as hardly to pass a common probe. In Sir C. Bell's cases the appearances were similar.
Orfila says he is led to conclude from a great number of facts that
