ACIDS 581 



membrane looks as though it had been scalded, hydrochloric acid should be 

 thought of; deeply invading, leather-like eschars are peculiar to sulphuric acid 

 toxicosis, white eschars are peculiar to tartaric acid, etc. The presence of the 

 special acids must, however, be proven by chemical analysis, the consideration 

 of which is not permissible within the scope of this article. Examinations of 

 this kind should, if possible, be made by each physician for himself. But we 

 cannot demand that the practising physician make these tests for himself be- 

 cause complicated chemical apparatus is necessary, and therefore I limit myself 

 in this article to a few general indications. Certain inorganic acids, such as sul- 

 phuric acid and nitric acid, may be very readily determined ; the proof of the 

 presence of hydrochloric acid is more difficult, since it is normally present in 

 aU stomach contents. But in most cases it is sufficient to demonstrate by 

 titration with an alkali a large amount of free acid in the vomited material. 



Regarding the therapy, our sovereign remedy is milk, which possesses in a 

 high degree the power of acid neutralization; if this is not immediately at 

 hand (for rapidity of action is the most important and first requisite in the 

 treatment of acid toxicosis) then soap suds is to be administered; solutions 

 of albumin are also advisable; of drugs as antidotes, magnesia usta in water 

 is advisable, also lime water. The severe pain which these poisonings cause 

 justifies the use of opiates, morphin and cocain. Unfortunately, painting the 

 mucous membranes with the last-named remedies has repeatedly proved disap- 

 pointing to me. 



Lavage of the stomach in such cases necessitates great care ; lavage of the 

 stomach in poisoning from sulphuric acid, particularly, involves certain dan- 

 ger to the patient, for it cannot be denied that by such a process a gastric 

 perforation may be produced. It must also be remembered that even the act 

 of washing out the stomach in such patients produces severe pain, and other 

 forms of distress. 



I must briefly describe those acid intoxications which, on account of their 

 not infrequent occurrence and their clinical picture, occupy a special position, 

 and, therefore, have certain interest for the physician. These are poisoning 

 by oxalic and prussic acids. 



We shall first describe oxalic acid toxicosis. Oxalic acid itself, above 

 all its salts, which are used for polishing metal ware, and to remove ink spots 

 from the skin, is in common use, and is a frequent cause of this toxicosis. 



Oxalic acid and its salts produce like. mineral acids a corrosive effect upon 

 the mucous membranes which is shortly followed by a considerable reaction 

 and subsequent inflammation in the surrounding area ; there results a picture 

 which more closely resembles poison by alkalies than by acids (see below). 



The nervous symptoms which invariably appear in the course of poisoning 

 from this acid, such as convulsions, trismus, and tetanic attacks, are quite 

 noteworthy. In other cases, however, very threatening symptoms, oliguria and 

 anuria, become prominent as signs of severe acute toxic renal insufficiency 

 due to infarction of the kidney with calcium oxalate. 



The prognosis in this form of poisoning is always serious ; and in all cases 

 a threatening clinical picture results. The diagnosis may be made from the 

 symptoms sketched above, and is usually easy. It becomes certain, however, 



