582 IMPORTANT POISONS AND THEIR TREATMENT 



only when it is possible to demonstrate oxalic acid or its salts in the excre- 

 tions, above all, in the vomited material. In cases of poisoning, in which we 

 have the relatively slight corrosive effects which oxalic acid produces, energetic 

 gastric lavage, best of all with lime water, which changes oxalic acid and its 

 soluble salts into insoluble calcium oxalate, may be resorted to; lime water 

 may also be given internally. The use of sucrate of lime has been especially 

 praised. 



As with oxalic acid toxicosis, a special position has been assigned to poi- 

 ■ soning with peussic acid. In concentrated solution it is one of the most vio- 

 lent poisons known, and in the course of a few minutes causes death. With 

 a loud cry, the person poisoned collapses, the respiratory frequency rises enor- 

 mously, convulsions occur, and in a few minutes death results ; so rapid is the 

 course that the physician rarely has an opportunity of attempting relief. If 

 there is time, immediate washing out of the stomach, with the addition of 

 hydrogen peroxid, is, at all events, in place; subcutaneous injections of atro- 

 pin, etc., have been advised, but, in the main, we are compelled to say that in 

 severe cases of poisoning therapy is ineffectual, and only in the mild cases may 

 we count upon success. 



We now turn to the second group of poisons, that of the alkalies, salts of 

 alkaline metals, and metalloids. We shall describe only three forms of poi- 

 soning, namely : 1, Lye toxicosis ; 2, poisoning with potassium chlorate ; 3, poi- 

 soning with salts of barium. 



Next to poisoning with sulphuric acid, unquestionably poisoning with lye 

 is undoubtedly most often observed by the physician. We never get poisoning 

 by pure caustic soda, or pure caustic potash, but with mixtures which contain, 

 besides these bodies, potassium carbonate and other salts, i. e., with fluids which 

 are called in commerce soda solution and caustic soda. 



What symptoms follow the introduction of these substances by the mouth ? 



In a short time vomiting of glassy, smeary, soap-like masses occurs and 

 may continue for hours, or even days ; the vomited material has an intensely 

 alkaline reaction, and later often assumes a brown to brownish-red color due 

 to decomposed hemoglobin. The patient is tortured by great pain, particu- 

 larly upon deglutition, the areas of the mucous membrane which have come in 

 contact with the caustic substance appear softened, oozing, swollen, and cov- 

 ered with pseudo-membranes which desquamate in a few days, and then cause 

 the dreaded formation of strictures, particularly in the esophagus. Peritonitis, 

 due to perforation of the stomach by the corrosive action of the alkali upon 

 its walls, may also appear. The result of poisoning of this kind is always 

 serious, and in apparently mild cases the possible sequel of stricture of the 

 esophagus renders the prognosis unfavorable. I may add that alkalies, ceteris 

 paribus, give rise to stricture in decidedly slighter concentration than acids. 



The treatment consists in the immediate neutralization of the alkali, which 

 IS best accomplished by a lemonade containing tartaric acid. Prompt gastric 

 lavage is contraindicated on account of the danger of perforation of the 

 stomach ; on the other hand, on account of the severe pain, the use of mor- 

 phin and other opiates will be necessary. Cocain has here been as ineffective 

 as in the treatment of acid toxicosis. 



