and a remarkable appearance sometimes observed, and not excited, so far as I know, by arsenic, is shrivelling of the tongue, with great enlargement of the papillæ at its root.[1]
The disorder of the alimentary canal is also usually more general, and reaches a greater height before death takes place. Sometimes the irritation and organic injury are confined to the stomach;[2] but more commonly the throat, stomach, gullet, rectum, nay, even also the colon, are affected. The black or melanotic extravasation into the mucous membrane of the stomach, which has been already several times described as a common effect of the more violent irritants, is also produced by corrosive sublimate. In Devergie's case and in that of Dr. Venables it was present in a very great degree.[3]
The coats of the stomach, and also those of the intestines, more particularly the colon and rectum, have frequently been found destroyed. So far as I have been able to ascertain, two kinds of destruction of the coats may be met with,—corrosion and ulceration.
The first is the result of chemical decomposition of the tissues. This kind is evidently to be looked for only when the quantity has been considerable and the dose concentrated. Nay even then it is rare. For on account of the solubility of corrosive sublimate, the facility with which it is decomposed by the secretions or accidental contents of the stomach, and the violence and frequency of the vomiting, this poison is peculiarly liable to be prevented from exerting its corrosive action on the membranes. Hence it is that proper chemical corrosion of the coats of the stomach is seldom witnessed in man.
The appearance of this corrosion differs according to the rapidity of the poisoning. In very rapid cases, for example in animals which have survived only twenty-five minutes, the villous coat has a dark-gray appearance, without any sign of vital reaction.[4] But this variety has never been witnessed in man, in whom the action has been hitherto much less rapid. In the most rapid cases, such as that of Dr. Bigsby, which terminated in two hours and a half [314], or those related by Mr. Valentine, of which one ended fatally in eleven and another in twenty-four hours, the corrosion was black, like the charring of "leather with a red-hot coal, and the rest of the stomach scarlet-red or deep rose-red;—showing that inflammation had set in." In the former of these two cases the corrosion was as big as a half-crown, in the latter three inches in diameter. In a third case, where the patient lived thirty-one hours, the stomach was perforated.[5] In the case described by Dr. Venables, and formerly alluded to, where life was prolonged for eight days, there was a patch on the under surface of the stomach as large as two crown-pieces, hard, elevated, and of a very dark olive or almost black colour, besides very general erosion of the villous coat.[6] In all these cases the disintegrated spot was probably situated where the poison first chiefly lodged.
