A Study of Oxalic Acid Poisoning. 



205 



Symptoms. — Although more than 1,000 cases of oxalic-acid 

 poisoning have occurred since Christison wrote his treatise, his 

 description still holds good. "If a person immediately after 

 swallowing a solution of a crystalline salt, which tasted strongly 

 acid, is attacked with burning in the throat, then with a burning 

 in the stomach, vomiting, particularly of bloody matter, imper- 

 ceptible pulse, and excessive languor, and dies in half an hour, or 

 still more, in twenty, fifteen, or ten minutes, I do not know of 

 any fallacy which can interfere with the conclusion that oxalic 

 acid was the cause of death. No parallel disease begins so ab- 

 ruptly, and terminates so soon; and no other crystalline poison 

 has the same effect." There may also occur headache, cold 

 extremities, numbness and tingling, loss of voice, cramps, con- 

 vulsions, delirium, coma, etc. 



Prognosis. — Out of 242 reported cases, there were 132 deaths, 

 a mortality of 54.5 per cent. This ratio, of course, depends 

 upon the manner and speed of treatment. Nor is the outlook for 

 complete recovery favorable if the initial degree of poisoning was 

 severe. There have been a few cases reported in which patients 

 returned after some months suffering from gastric irritability, 

 dyspepsia and symptoms of constriction of the esophagus, the 

 latter due apparently to destruction and subsequent repair of the 

 mucous membrane. 



Postmortem. — Aside from the local corrosive action, there are 

 no typical pathological lesions with one exception, namely, in 

 the kidneys, where the cortical substance may present a definite 

 whitish appearance due to the presence in the tissues of crystals 

 of calcium oxalate. None is deposited in the glomeruli. Calcium- 

 oxalate crystals have also been found in the blood, bile, aqueous 

 humor, and pleural and pericardial fluids. 



Elimination. — Is mainly through the urine. The reported 

 analyses show that from 80 to 90 per cent, is excreted through this 

 channel. The urine also contains albumin, a reducing substance 

 and hyaline casts. 



Treatment. — The oxalic acid should be neutralized and pre- 

 cipitated as quickly as possible, by giving plenty of syrup of lime 

 or a suspension of calcium carbonate. After a few minutes the 

 stomach should be washed out with lime water and, lastly, with 



