December 1, 1873.] A MIRROR OF HOSPITAL PRACTICE. 323

POONA STAFF HOSPITAL. \ /

A CASE OF CARBOLIC ACID POISONING.

Reported by Surgeon C. T. Peters, M.B., Bombay Army.

Doolie bearer. Bhowanee Sungappa. was employed in the Commissariat Stores on the 23rd July 1873 in his usual state of health. In the morning he had been twice out with messages before 9^ o'clock. At 10^ he was found frothing from the mouth and faint. At 11? he was quite insensible, in which state he was sent to hospital, where he expired a few minutes after his admission. His respiration was very much laboured before death. It was rumoured that deceased had swallowed some fluid which he obtained from the stores, mistaking it for some

spirituous drink. No vomiting or-purging. At the post-mortem examination, held five hours after death,

the following observations were made :?

23rd July, 4-55. p.m.? Weather, cloudy and moist. Body of an adult, man about 36, well nourished. Jaws firmly closed. Slight rigidity in the knee joints, none in the elbows. Whitish froth escaping freely through the left nostril and slightly from the mouth. Superficial veins of the body turgid; dark venous looking liquid blood flowed out, as some of them were cut while opening the chest.

Thoracic Viscera.?Lun<rs extremely congested, and the anterior lobes completely hiding the pericardium from view. Inferior lobes almost in a state of hepatization. On opening the sac of the pericardium, about an ounce of serum was found in it. Heart contracted, full; on opening the cavities in either side, they were found gorged with dark liquid blood ; no coagula present, valves healthy ; no alcoholic odour, or odour of any kind present either in the blood, heart, or lungs.

Abdominal Viscera ?General congestion of all the viscera. Liver very much enlarged, and reaching to about three inches below the margin of the ribs. Gall bladder distended with bile. Mesenteric vessels turgid with blood, Spleen also enlarged, and containing a large quantity of blood. The stomach on being cut open from without, a hard resisting feeling was communicated to the scalpel as it cut through the mucous membrane, which on being laid open appeared extremely corrugated and of a

dirty white colour, hard but easily torn from the subjacent structures. This corrosion of the mucous membrane extended as high as the pharynx, being less severe in the upper part of

the alimentary canal. The stomach contained about 6 ounces

of a chalky looking fluid, having a very strong smell of carbolic acid, which, when mixed with the white of an egg, completely solidified it, and a piece of deal wood on being dipped in that

fluid and worked with strong hydrochloric acid, assumed a green- ish blue tint on exposure to the air, but less intense than the

colour similarly obtained from the strong crystalized acid.

The stomach, a mouth later, when it was packed up for trans- mission to the Grant Medical College Museum, Bombay, ap- peared almost as fresh as when it was first removed from the body. Remarks.?No case of poisoning has as yet been recorded

arising from carbolic acid;* but from the close resemblance that it bears to creasote, both in its physical properties and physio- logical action, one would naturally conclude that in a case of death it would give rise to similar effects and pathological changes as the latter. In the present instance, death ensued within 2? hours, or perhaps less, as the unfortunate man must have taken the fatal draught between 9? and 10J o'clock. He was seen

perfectly well at 9?, and in a state of great agony at 10^. The

intensity of the poison must have so completely paralysed tlie nervous system, that no vomiting or purging ensued ; efforts which are almost invariably made to expel an irritant poison from the system, and as such the carbolic acid did certainly act

iu this instance, are demonstrated by the inflammatory congestion found after death. Besides the irritant effect, the poison also pro- duced insensibility and coma; the deceased was found insensible at 11^. in which state he died about an hour later. So that in its narcotico-irritant effects, carbolic acid in this instance at least resembled creasote. Waring, in his Manual of Practical Thera- peutics, pp. 239, gives the following as the post-mortem appearances of animals killed with creasote:?"All the tissues of the body, except the liver, exhaled a strong odour of creasote ; the mucous intestinal membrane was inflamed throughout. In the heart and great vessels the blood was coagulated; the lungs greatly congest- ed ; the brain natural;" and states that" death is probably caused mechanically, the creasote coagulating the albumen of the blood

* [7 Eds., I.M.G']

and preventing its circulation through the arterial system." In the present instance, no smell of any kind was detected in the blood, heart or lungs, or anywhere, until the stomach was opened. This may, perhaps, be explained by the fact that creasote has a

stronger smell than carbolic acid, and consequently pervades the neighbouring tissues with greater facility. But the chief point of difference appears to be in the condition of the blood, which was found liquid in the heart, as well as the blood vessels, five hours after death?the same as in inflammatory affections, and death must have resulted not from the coagulation, but from want of aeration of the blood. Might it not be the same case in poisoning by creasote, and the clots observed in such cases

were only post-mortem, clots ? Sholapoke, '2<ith September 1873.