130 POISONS : THEIR EFFECTS AND DETECTION. [§ II 9 . 
weak, and loss of consciousness and convulsions are not uncommon. If 
the collapse and after-inflammation are recovered from, then, as in the 
case of the mineral acids, there is all the horrid sequence of symptoms 
pointing to contractions and strictures of the gullet or pylorus, and 
the subsequent dyspepsia, difficulty of swallowing, and not infrequently 
actual starvation. 
§ 119. Post-mortem Appearances. —In cases of recent poisoning, 
spots on the cheeks, lips, clothing, etc., giving evidence of the contact 
of the alkali, should be looked for ; but this evidence in the case of 
persons who have lived a few days may be wanting. The mucous 
membrane of the mouth, throat, gullet, and stomach is generally more 
or less white—here and there denuded, and will be found in various 
stages of inflammation and erosion, according to the amount taken, and 
the concentration of the alkali. Where there is erosion, the base of the 
eroded parts is not brown-yellow, but, as a rule, pale red. The gullet 
is most affected at its lower part, and it is this part which is mostly 
subject to stricture. Thus Bohm 1 found that in 18 cases of contraction 
of the gullet, collected by him, 10 of the 18 showed the contraction at 
the lower third. 
The changes which the stomach may present if the patient has lived 
some time are well illustrated by a preparation in St George’s museum 
(43 a. 264, ser. ix.). It is the stomach of a woman aged 44, who had 
swallowed a concentrated solution of carbonate of potash. She vomited 
immediately after taking it, and lived about two months, during the 
latter part of which she had to be nourished by injections. She died 
mainly from starvation. The gullet in its lower part is seen to be much 
contracted, its lining membrane destroyed, and the muscular coats ex¬ 
posed. The coats of the stomach are thickened, but what chiefly arrests 
the attention is a dense cicatrix at the pylorus, with an aperture so 
small as only to admit a probe. 
The colour of the stomach is generally bright red, but in that of a child, 
preserved in Guy’s Hospital museum (No. 1798 24 ), the mucous membrane 
is obliterated, the rugae destroyed, and a dark brown stain is a noticeable 
feature. The stomach is not, however, necessarily affected. In a pre¬ 
paration in the same museum (No. 1798 20 ) the mucous membrane of the 
stomach of a child who swallowed soap-lees is seen to be almost healthy, 
but the gullet is much discoloured. The action on the blood is to 
change it into a gelatinous mass ; the blood corpuscles are destroyed, 
and the whole colour becomes a dirty blackish-red ; the spectroscojuc 
appearances are identical with those already described (see p. 66). 
The question as to the effects of chronic poisoning by the alkalies 
or their carbonates may arise. Little or nothing is, however, known 
of the action of considerable quantities of alkalies taken daily. In 
1 Centralblatt fur die med. Wiss. 1874. 
