Oxalicum Acidum

[oxalic acid.]

This acid was first discovered byScheele, in 1783, by decomposing sugar and strong nitric acid. It is found in wood-sorrel. It is another irritant poison which may destroy life in ten minutes to one or more hours.

In one case of poisoning, half an ounce of the acid, which was swallowed by mistake for Cheltenham salt, caused the following symptoms : Burning pain in the stomach ; swelling of the tongue which was thickly lined with a white coating ; difficult respiration \ feeling of icy coldness throughout the body ; clammy sweat over the whole body ; the pulse at the wrist and temples was scarcely per- ceptible ; cold extremities ; the nails look brown ; hgematemesis ;. shaking of the whole body ; increasing prostration as if the end were approaching ; feverish condition with profuse perspiration ; itching of the fingers, with remarkable keenness of the understanding; faint- ing and vomiting of a pint of fluid. ; violent eructations, spasms and extraordinary hiccough ; pulse one hundred, feeble ; numbness of the right arm, with shiverings of the feet ; swelling of the face ; hoarseness ; dryness of the throat and tongue which was covered with spots and looked reddish-brown ; emaciation, increase of debility and anxiety, restless sleep ; delirium ; wart-shaped, itching eruption, followed by the breaking out of a general redness ; death.

I have enumerated the symptoms in the order in which they developed themselves in this case. A post-mortem examination revealed symptoms of inflammation on the inner surface of the stomach and in a small portion of the intestinal canal ; the stomach contained a small quantity of a dark fluid ; the villous coat was com- pletely destroyed, even high up in the oesophagus. In some parts it seemed intact, but might easily be detached with the ringer or with a sponge. The muscular coat of the stomach and of the oesophagus very much thickened, injected, of a dark, gangrenous app3arance ; the circular and longitudinal fibres very distinct and readily de- tached ; the cardiac portion was more inflamed than the pyloric portion.

The small intestines presented a similar appearance, but much less marked.

In another case of poisoning, where the patient, a girl of twelve years, recovered, the pains in the stomach and bowels were speedily counteracted by antidotal treatment ; next morning the patient felt

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well, except an intense feeling of debility in the lower extremities.

A number of other cases of poisoning by this acid, which had been taken for magnesia, are reported in English periodicals. A girl of fourteen years swallowed an ounce of the acid and died soon after in convulsions. The stomach contained a substance resembling coffee grounds ; the vessels were distended with black blood, but the coats were intact.

In a case related by Johnson, where death took place a quarter of an hour after the poison had been swallowed, the mucous coat was detached, the blood vessels were filled with black blood, the stomach was perforated in several places, friable, pultaceous ; the spleen dis- organized.

In another case, the bowels were found inflamed and distended with gas ; the stomach was inflamed externally, shrunk, the inner coat flocculent, destroyed and filled with tenacious masses.

These are the effects of large, corrosive doses of the poison. The dilute acid, when acting by absorption, not by its local corrosive effects, causes the following symptoms in animals : Rigidity of the hind legs, sadness, general debility, drowsiness without loss of sensi- bility, without spasms; from these effects the animal soon recovers. If larger doses are introduced into the stomach, the breathing becomes embarrassed, with paroxysms of tetanic convulsions which arrest the respiratory process entirely for the time being.

The heart and respiratory organs act more and more feebly, and the animal finally dies convulsed. If death does not take place too suddenly, the lungs are found marked with red spots, without any signs of effusion. If death takes place previous to the stage of insensibility, the right ventricle is filled with dark, and the left with a more bright colored, blood ; if death takes place during a tetanic convulsion, the heart continues to beat for a time, although the breathing may have ceased ; the blood in both ventricles looks black.

Dr. John Mollan, in a case of poisoning related by him in the Dublin Hospital Reports, says, "one circumstance deserves notice from its infrequency, namely, the discovery of air in the right cavities of the heart. I am not aware that anything similar has been observed in cases of sudden death, produced by any deleterious substance, and I am at a loss to account for its production."

This acid has undoubtedly a powerful action upon the brain and spinal cord. This is its constitutional effect which it produces by absorption. It then annihilates the functional power of the cerebro- spinal axis, and sometimes destroys life with extraordinary sudden- ness.

We have as yet very little clinical experience with this agent, and for the present I shall content myself with suggesting its use in the following affections where it is indicated by its toxical as well as by its physiological effects.

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CEREBROSPINAL GROUP.

TREMOR OF THE LIMBS, more particularly when symptom- atic of irritation of the motor portion of the spinal system.

PARALYTIC NUMBNESS throughout the limbs, with coldness and a feeling of rigidity as if the blood would become congealed, the pulse being small, rapid, tremulous and intermittent.

SPINAL NEURALGIA, with acute pain in the back, extending down to the thighs, numbness, tingling and pricking in the lower portion of the spine.

ANGINA PECTORIS— Dr. J. C. Guernsey gives the following indications : Violent irritation of the alimentary canal ; costiveness.

Difficulty of breathing ; jerking inspiration, as though the patient made a sudden effort to relieve himself of intense pain by expelling the air from the lungs. Oppression of the chest, especially toward the right side. Pain on expiration ; sharp, darting or lancinating pains in the heart and left lung, also in the arms ; jerking pains like short stitches, confined to a small space, lasting for a few seconds. Numbness and weakness in the back and limbs ; peculiar numbness of the whole body, approaching to palsy ; coldness and complete loss of power of motion in the limbs.

Movement excites and aggravates pain. Periodical remission for some hours or days. (Halin. Monthly, J anuary, 1878.)

Dr. Pemberton Dudly relates the following case in the Hahn. Monthly, Septem- ber, 1870 : December 5, 1862 Mr.

J. T., aged forty-five years; carpenter; slightly built ; nervo-bilious temperament ; usually in good health ; temperate. Pains com- mencing in the precordial region, extending up the sternum, and darting out across the chest, particularly toward the left side. Sharp stitches or lancinating pains through the chest, compelling him to keep perfectly quiet in one position.

The arms folded across the chest ; the face haggard ; the trunk sitting upright in a chair, and the whole manner and appearance indicative of intense suffering. Cramps in the muscles of the extremities ; short, sharp, cutting pains in the extremities, especially in the arms and the deltoid portion of the shoulders ; sense of suffocation ; dyspnoea, manifested in short, jerking inspirations ; the quantity of air inspired being less and less at each successive effort, until at the greatest intensity of the paroxysm the function seemed to be entirely suspended.

The paroxysms lasted about one minute, with intervals of about two minutes, during which there was almost perfect relief from the pain. Pulse accelerated and somewhat irregular in its rhythm. A strong conviction that he would " die in the next paroxysm," seemed to be a prominent feature of the case. * * * Prescribed arsenicum album. * * * December 6th Return of the paroxysms, attended with coldness of the surface and clammy perspiration ; pain more violent on the right side, especially in the arm, " as though a knife were plunged into the shoulder joint and then drawn down the arm to the end of the little finger." Prescribed second attenuation of digitalis, every hour in alter- nation.

December 7th Patient much worse, the attacks come on more frequently and last longer. Delirium during the paroxysms, (but not during the intervals); makes a feeble effort to rise from the chair and says, " Now I must go," the expression being repeated twice or thrice during each paroxysm. Tells me he has been troubled with ascarides nearly all his life, and recently more than usual.

Spigelia* every hour. * * * Dec. 8th Paroxysms occurring more frequently

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■during the day, and a violent one this morning lasting four hours. Paralysis of the inferior extremities, lasting throughout the attack. Sharp, stitching pain in the deltoid muscle, confined to a small space ; costiveness ; great prostration ; pains now mostly on the right side. Spigelia and mix alternately every hour.

This afternoon I con- sulted Dr. N. May in reference to the case. He at once suggested oxalic acid as being the remedy.

Commenced its use about 4 P. M., third dilution, eveiy hour. Dec. loth Visited the patient at 10 A.

M. in company with Dr. May, and found -very decided improvement. Light paroxysm last evening and a still lighter one this morning. Dr.

May examined the case with care and could detect no cardiac disorder. * ■* * There was no return of the paroxysm except a very slight one on the ■evening of the 9th. Heard from the patient about four years later, and there had been no recurrence of the complaint.

INFLAMMATORY GROUP.

CHRONIC SORE THROAT, with burning dryness and aching pain, lias been relieved by means of this acid.

GASTRO-ENTERITIS.— It may prove useful in chronic gastro- enteritis, with burning pain in the epigastric region, and sensitive- ness to pressure ; thirst, dryness, redness and swelling of the tongue.

PYROSIS, with rising of a sour and burning fluid every evening or otherwise periodically. In

GASTRALGIA, with extreme sensitiveness of the stomach to the touch, pains, disposition to costiveness, the acid may prove useful. Likewise in

COLICA UMBILICALIS AND COLICODYNIA, with distress- ing feeling in the abdomen and umbilical region, frequent inclina- tion to stool.

ANTIDOTAL TREATMENT In cases of poisoning, chalk or

lime should be administered at once. These form the insoluble oxalate of calcium. Potash and soda are not available, since their oxalates are exceedingly poisonous.