Sulphuricum Acidum

[sulphuric acid.]

Mr. Tartra, in his treatise on poisoning by nitric acid has given the first systematic description of the poisonous effects of sulphuric acid. We transfer the following summary of these effects from Christison's work on Poisons to our pages :

"M. Tartra considers that four varieties may be observed in the effects of the mineral acids: 1. Speedy death from violent corrosion and inflammation ; 2. Slow death from a peculiar organic disease of the stomach and intestines ; 3. Imperfect recovery, the person re- maining liable ever after to irritability of the stomach ; 4. Perfect recovery.

"1. The most ordinary symptoms are those of the first variety — ■ namely, all the symptoms that characterize the most violent gastritis, accompanied likewise with burning in the throat, which is increased by pressure, swallowing or coughing ; eructations proceeding from the gases evolved in the stomach by its chemical decomposition ; and an excruciating pain in the stomach, such as no natural inflam- mation can excite. The lips are commonly shriveled, at first whitish, but afterward brownish in the case of sulphuric acid.

Occasionally there are also excoriations, more rarely little blisters. Similar marks appear on other parts of the skin with which the acid may have come in contact, such as the cheeks, neck, breast or fingers ; and these marks undergo the same change of color as the marks on the lips. I had an opportunity of witnessing this in the case of the man who was disfigured by the Macmillans with sulphuric acid. He was cruelly burnt in the face, as well as on the hands, which he had raised to protect his face ; and the marks were at first white, but in sixteen hours became brownish.

The inside of the mouth is also generally shrivelled, white, and often more or less corroded ; and as the poisoning advances, the teeth become loose and yellowish- brown about the coronse. The teeth sometimes become brown in so short a time as three hours. Occasionally the tongue, gums, and inside of the cheeks are white, and as it were polished, like ivory. There is almost always great difficulty, and sometimes complete im- possibility, of swallowing.

In the case of a child, related by Dr. Sinclair, fluids taken by the mouth were returned by the nose ; and the reason was obvious after death ; for even then the pharynx was so much contracted as to admit a probe with difficulty. On the same account, substances taken by the mouth have been discharged

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oy an opening in the larynx which had been made to relieve impend- ing suffocation. The matter vomited, if no fluids be swallowed, is generally brownish or black, and at first causes effervescence, if it falls on a pavement containing any lime. Afterward this matter is mixed with shreds of membrane, which resemble the coats of the stomach, and sometimes actually consists of the disorganized coats, but are generally nothing more than coagulated mucus. The bowels are obstinately costive, the urine scanty or suppressed ; and the patient is frequently harassed by distressing tenesmus and desire to pass water.

The pulse all along is very weak, sometimes intermit- ting, and toward the close imperceptible. It is not always frequent ; on *the contrary, it has been observed of natural frequency, small and feeble, in a patient who survived fifteen days. The countenance be- comes at an early period glazed and gastly, and the extremities cold and clammy. The breathing is often laborious, owing to the move- ments of the chest increasing the pain in the stomach, or because pul- monary inflammation is also at times present, or because the admission of air into the lungs is impeded by the injury done to the epiglottis and entrance of the larynx.

To these symptoms are added occasional fits of suffocation from shreds of thick mucus sticking in the throat, and sometimes croupy respiration, with sense of impending choking.

"Such is the ordinary train of symptoms in cases of the first variety. But sometimes, especially when a large dose has been swallowed, instead of these excruciating tortures, there is a deceitful tranquility and absence of all uneasiness. Thus in the case of a woman who was poisoned by her companions making her swallow, while intoxicated, aqua fortis mixed with wine, although she had at first a good deal of pain and vomiting, there was subsequently none of the usual violent symptoms ; and she died within twenty hours, complaining chiefly of tenesmus and excessive debility. Occasion- ally eruptions break out over the body; but their nature has not been described.

" Death is seldom owing to the mere local mischief, more generally to sympathy of the circulation and nervous system with that injury. According to Bouchardat, death arises from the acid entering the blood in sufficient quantity to cause coagulation. But although this certainly happens sometimes to the blood in the vessels of the stomach and adjacent organs, as will be proved under the head of the morbid appearances, there is no evidence that the same takes place throughout the blood-vessels generally, or in the great veins and heart in particular. Bouchardat's proofs of the detection of sulphuric acid in the blood are not satisfactory.

"The duration of this variety of poisoning with the acids is com- monly between twelve hours and three days. But sometimes life is prolonged for a week or a fortnight ; and sometimes, too, death takes place in a very few hours. Tiie shortest duration among the numer- ous cases of adults mentioned by Tartra is six hours ; but Dr. Sin- clair has related a case which lasted only four hours and a half ; a

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man lately died in the Edinburgh Infirmary within four hours ; and Professor Remer once met with a case fatal in two hours.

"The quantity required to produce these effects has not been as- certained, and must be liable to the same uncertainty here as in other kinds of poisoning. The smallest fatal dose of sulphuric acid I have hitherto found recorded was one drachm. It was taken with sugar by mistake for stomachic drops by a stout young man, and killed him in seven days. An infant of twelve months has been killed in twenty-four hours by half a teaspoonful, or about thirty minims. A man has recovered after taking six drachms.

" 2. The second variety of symptoms belong to a peculiar modifica- tion of disease, which is described by Tartra in rather strong language. It begins with the symptoms already noticed ; but these gradually abate. The patient then becomes affected with general •fever, dry skin, spasms and pains of the limbs, difficult breathing, tension of the belly, salivation, and occasional vomiting, particularly of food and drink.

Afterward membranous flakes are discharged by vomiting, and the salivation is accompanied with fetor. These flakes are often very like the mucous membrane of the stomach and in- testines ; and such they have often been described to be. More probably, however, they are of adventitious formation ; for the mere mucous coat of the alimentary canal cannot supply the vast quantity that is evacuated. There is no doubt, however, that the lining membrane of the alimentary canal is occasionally discharged.

Dr. Wilson has mentioned an instance of the ejection by coughing of about nine inches of the cylindrical lining of the pharynx and gullet, six days after sulphuric acid was taken. Sometimes worms are discharged dead, and evidently corroded by the poison. Digestion is at the same time deranged, the whole functions of the body are languid, and the patient falls into a state of marasmus, which reduces him to a mere skeleton, and in the end brings him to the grave.

Death may take place in a fortnight, or not for months. In one of Tartra' s cases the patient lived eight months. The vom- iting of membranous flakes continues to the last.

"3. The third variety includes cases of imperfect recovery. These are characterized by nothing but the greater mildness of the primary symptoms, and by the patient continuing for life liable to attacks of pain in the stomach, vomiting of food, and general disorder of the digestive function.

"4. The last variety comprehends cases of perfect recovery, which are sufficiently numerous, even under unpromising appearances. From the average of fifty-five cases recorded by Tartra, it appears that the chances of death and recovery are nearly equal. Twenty- six died, nineteen of the primary, seven of the secondary disorder, twenty-nine recovered, and of these twenty-one perfectly. Suicidal are for obvious reasons more frequently fatal than accidental cases.

" Tartra has not taken notice in his treatise of another form of poisining with the strong acids, in which the injury is confined to

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the gullet and neighboring parts. In Corvisarfs Journal there is the case of a man, who began to drink sulphuric acid for water while intoxicated, but suddenly found out his error before he had swal- lowed above a few drops ; and consequently the chief symptoms were confined to the throat. After his physician saw him he was able to take one dose of a chalk mixture ; but from that time he was unable to swallow at all for a fortnight. Martini likewise met with a similar instance of complete dysphagia from stricture in the gullet caused by sulphuric acid.

His patient recovered.

"It also appears exceedingly probable, that the strong acids may cause death without reaching the stomach or even the gullet, by exciting inflammation and spasm of the glottis and larynx. Such an effect may very well be anticipated from an attempt to commit murder with these poisons ; as the person, if he retains conscious- ness at the time, may become aware of their nature before he has swallowed enough to injure the stomach.

"Thus, Dr. A. T. Thompson says, in 1837, that he once met with the case of a child, who, while attempting to swallow strong sul- phuric acid by mistake for water, died almost immediately, to all appearance from suffocation caused by contraction of the glottis ; and it was ascertained after death that none of the poison had reached the stomach.

Professor Quain describes a similar case, occurring also in a child, where impending death was prevented by artificial respiration, and acute bronchitis ensued, which proved fatal in three days. In this instance, thickening of the epiglottis and great contraction of the upper opening of the larynx showed the violent local injury inflicted there, inflammation could be traced down the trachea into the bronchial tubes, but no trace of injury could be detected in the gullet and stomach.

In a very interesting and carefully detailed case by Mr. Arnott, where the poison taken was the nitric acid, the injury was confined in a great measure to the gullet and larynx, the stomach which was distended with food at the time, being very little affected. The chief symptoms at first, besides great general depression, were croupy respiration and much dyspnoea, which became so urgent, that laryngotomy was performed, and with complete relief to the breathing. But the patient nevertheless rap- idly sunk under the symptoms of general exhaustion, and died in thirty-six hours, without presenting any particular signs of the oper- ation of the poison on the stomach ; and the traces of action found there after death were trifling.

"The importance of the fact established by these cases will appear from the following medico-legal inquiries : A Prussian medical col- lege was consulted in the case of a new-born child, in which the stomach and intestines were healthy, and did not contain poison, but in which the cuticle of the lips was easily scraped off, the gums, tongue and mouth yellowish-green, as if burnt, the velum and uvula in the same state, the rima glottidis contracted, and the epiglottis, larynx and fauces violently inflamed. The college declared that a

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concentrated acid had been given, and that death had been occasioned by suffocation. Sulphuric acid was found in the house ; and the mother subsequently confessed the crime. A case was formerly quoted, where MM. Ollivier and Ohevallier found traces of the action of nitric acid on the lips, mouth, throat, and upper fourth of the gullet, but not lower.

In this instance, the reporters came to the opinion from the absence of injury in the more important parts of the alimentary canal, as well as from the marks of nail-scratches on the neck, and the gorged state of the lungs, that death had been produced by strangling, after an unsuccessful attempt by the forci- ble administration of nitric acid. It is quite possible, however, that death might quickly ensue from the effects of the poison on the throat and gullet. In the course of the judicial inquiries, M.

Alibert stated that he had known repeated instances of death from swallow- ing nitric acid, although none of it reached lower down than the pharynx. Ollivier, in his paper, doubts the accuracy of this state- ment ; but the cases quoted above show clearly that such injury may be done to the glottis as will be adequate of itself to occasion death.

"It seems farther not improbable, that among the terminations of poisoning with the strong mineral acids, scirrhous pylorus must also be enumerated. This is a very rare effect of the action of corrosive poisons. But M. Bouillaud has related an instance of death from scirrhous pylorus in its most aggravated shape, which supervened on the chronic form of the effects of nitric acid, and which proved fatal in three months.

" In some circumstances, the stomach seems to acquire a degree of insensibility to the action of strong acids. Tartra, in alluding to what is said of certain whisky-drinkers acquiring the power of swal- lowing with impunity small quantities of the concentrated acids, has related the case of a woman at Paris, who, after passing successively from wine to brandy and from that to alcohol, at last found nothing- could titillate her stomach except aqua fortis, of which she was seen to partake by several druggists of veracity.

The fire-eating mounte- banks, too, are said to acquire the same power of endurance ; but much of their apparent capability is really legerdemain. On the other hand, a very extraordinary sensibility to the action of the diluted mineral acids has been supposed to exist in the case of infants at the breast — so great a sensibility, that serious symptoms and even death itself have been ascribed to the nurse's milk becoming im- pregnateel with sulphuric acid, in consequence of her having taken it in medicinal doses.

By two writers in the London Medical Bepositori/, griping pains, tremors and spasms have been imputed to this cause ; and a writer in the Medical Gazette says he has seen continued griping, green diarrhoea and fatal marasmus ensue, apparently, he thinks, from ulceration of the gastro-intestinal mucous membrane. Without questioning the great delicacy and tenderness of that mem- brane in infants, I must nevertheless express my doubts whether so small a quantity taken by a nurse, amounting in the case in question

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to only four or six drops a day. could really produce fatal or even severe effects on her child.

" Sulphuric acid is not less deadly when admitted into the body through other channels beside the mouth. Thus, it may prove fatal when introduced into the rectum. A woman at Bruges, in Belgium, had an injection administered, in which, being prepared hastily in the middle of the night, sulphuric acid had been substituted by mis- take for linseed-oil. The patient immediately uttered piercing cries, and passed the remainder of the night in excessive torture.

In the morning the bed-clothes were found corroded, and a portion of in- testine had apparently come away ; she expired not long afterward.

"Death may also be occasioned by the introduction of this acid into the ear. Dr. Morrison relates a case of the kind, where nitric acid, which is analogous in action, was poured by a man into his wife's ear, while she lay insensible from intoxication. She awoke in great pain, which continued for two or three days.

In six days an eschar detached itself from the external passage of the ear ; and this was followed by profuse haemorrhage, which recurred daily more or less for a month. On the day after the eschar came away, and without any precursory symptom referable to the head, she was attacked with complete palsy of the right arm, and in eight days more with tremors and incomjnete palsy of the rest of that side of the body. These symptoms subsequently abated ; but they again increased after an imprudent exertion, and she died in a state of exhaustion seven weeks after the injury.

The whole petrous portion of the temporal bone was found carious, but without any distinct disease of the brain or its membranes.

" Sulphuric acid and the other mineral acids are equally poisonous when inhaled in the form of gas or vapor ; and they then act chiefly by irritating or inflaming the mucous membrane of the air-passages and lungs."

The post-mortem appearances, in cases of poisoning by sulphuric acid, are contained in the following resume from a number of cases reported in Frank's Magazine and Wibmer's Toxicology. We avail ourselves of the translation contained in the Am. Jour, of Horn. :

Brain". — Softening of the cortical substance of the brain. Dura mater, sinuses and pia mater distended with blood. Pia mater cov- ered with lymph ; cerebrum covered with red blood-spots. Lateral ventricles contained about a drachm of liquid. Choroid plexus very dark. Under the tentorium and in the vertebral canal were found about three onnces of watery exudation. Membranes of the brain very much thickened and opaque ; and here and there firmly adher- ing to the brain. Sinuses filled with black blood.

Mouth, Pharynx, (Esophagus. — Tongue very much swollen. Membrane of the mouth uncommonly white and indurated, and in some places corroded. Tunica villosa of the oesophagus and stomach

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detached. Tonsils and soft palate of a yellowish-white color and shrivelled. The whole mncons membrane of the oesophagus cor- roded. Behind the larynx a stricture, so that the oesophagus pre- sented an opening not larger than a feather-quill. Pharynx very much constricted, and denuded of epithelium.

The chemical effects of sulphuric acid have been regarded by a few homoeopathic practitioners as therapeutic indications upon which the selection of a homoeopathic remedial agent may be made to de- pend. Let me caution you against the fallacious analogies suggested by this species of materialism. Years ago it was recommended in the North American Journal, "as one of the most homoeopathic remedies for true membranous croup ; also ulceration and stricture of the larynx." This pretended homoeopathicity was inferred from the fact that sulphuric acid, when coming in contact with the mucous lining of the larynx, inflames it ; but would any man in his

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senses undertake to assert that, if this mucous lining has become in- flamed or corroded, and the physiological life of the organism sets up a formative process for the purpose of restoring the integrity of the disorganized membrane : this physiological product is similar, in a therapeutic view, to the pathological product formed in mem- branous croup ? One of the most effectual methods of utterly per- verting and destroying the truths of homoeopathy, is the application of chemico-physiological doctrines to the law "similia similibus." We can comprehend that a burn, which is a purely external injury as it were, should be successfully treated by the application of some corrosive acid which is capable of producing a similar injury ; but we are utterly unable to see any similarity between gangrene as the final termination of inflammation, and gangrene resulting from the destructive action of a corrosive poison.

Sulphuric acid has been successfully used in the following affections:

CEREBROSPINAL GROUP.

Dr. Marcy says that "the sixth attenuation of this acid has several times afforded permanent relief in obstinate constitutional head- aches, occurring in cachectic individuals." It has proved particularly useful in those cases which have been accompanied by profuse and debilitating leucorrhoeal discharges.

CONVULSIONS. — A boy who had become subject to attacks of convulsions, probably in consequence of self-abuse, was likewise cured.

EPILEPSY, in the case of a woman who had tried every known remedy in vain, was speedily relieved, and, at the end of three weeks, completely cured by nothiug but sulphuric acid ; she took from two drachms to half an ounce of the acid, much diluted, every day.

PHARYNGEAL GROUP.

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STOMATITIS MATERNA the acids, as a class, are of great

value, and among them the sulphuric acid is prominent.

Dr. Peters and others recommend it for

CROUPOUS INFLAMMATION of the pharynx, larynx, trachea and oesophagus ; also for gangrenous or putrid inflammation or ulceration of the throat ; in syphilitic angina ; in the malignant angina of scarlet fever ; stricture of the oesophagus. In

MERCURIAL PTYALISM, Mr. Pearson found great benefit from this acid. ,

CHYLO-POIETIC GROUP.

HzEMATEMESIS. — A case of haematemesis, where the vomiting returned about a dozen times within eight days, causing complete exhaustion and death-like pallor, was completely arrested by means of large doses of sulphuric acid.

Individuals who have weakened their digestive powers by excessive drinking, mental exertions, excessive sexual intercourse, etc., fre- quently complain of an acrid, foul, almost stercoraceous taste in the mouth, accompanied with a burning and smarting sensation in the throat, and an offensive odor from the mouth, particularly early in

144 ACIDUM SULPHURICUM.

I mention this upon the authority of HufelanoVs Journal; sul- phuric acid may not always act as a curative in such cases ; it certainly palliates these symptoms.

ACIDITY OF THE STOMACH.— In acidity of the stomach sulphuric acid has effected permanent cures.

DIAKRHCEA In diarrhoea, this acid has been successfully used by both alloeopathic and homoeopathic physicians. It is particularly in the choleraic forms that it has been found useful, when, according to Dr. North, as reported in the Am.

Jour, of Homoeopathy, "the symptoms are severe, with a tendency to lapse into low fever ; when the attack arises without any error in diet, the diarrhoea being pro- fuse, soon becoming like dirty water, with nausea and vomiting of a large quantity of fluid, severe spasmodic pains in the stomach and bowels, cramps in the limbs, often violent ; pulse small and frequent, skin cold and clammy, countenance anxious ; these symptoms being followed by a continued fever for a few days or a week or two."

URINARY AND SEXUAL GROUP.

Dr. Marcy has prescribed the* higher dilutions, for the most part, with benefit in those derangements of the system which give rise to alkaline conditions of the urine, provided the totality of the symptoms corresponded with the pathogenetic symptoms of sulphuric or some other acid. Under these circumstances, it is generally pre- scribed in large doses by practitioners who adhere to the chemico- physiological view of diseases, more particularly if the alkaline state of the urine is attended with the formation of phosphatic caleuli.

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Frank reports several cases of

Permit me to add that great debility, utter prostration of the nervous system, and a sensation of trembling (the trembling not being apparent to anyone but the patient) are strongly characteristic of this acid, and are to be considered very valuable and pointed in- dications for its use, not only in uterine haemorrhage, but in all serious disorders- in which the acid may be used.

Sulphuric acid has proved an excellent remedy for the hot flashes with which women at the climacteric period are at times troubled. We have usually employed the lower attenuations.

FEVER AND EXTERNAL GROUP.

PURPURA HEMORRHAGICA WERLHOFIL— Sulphuric acid has been found useful in this disease ; likewise in

PETECHIAL TYPHUS, where it was used by Rademacher, the chief of the empirical school in Germany, with great success, but in very large doses, which speedily arrested the dangerous hemorrhagic tendency.

A man, thirty-six years old, was taken with gastro-rheumatic symptoms. He was taken to the hospital within a few hours. Symptoms : Small red spots appeared on the lower leg, near the ankles, spreading with great rapidity and soon covering a large part of the entire surface ; they appeared in clusters, became confluent and often formed suggillations as large as the palm of the hand, which were at first intensely red, then assumed a bluish violet, and finally a greenish-yellow color; there were also suggillations on the mucous membrane of the mouth and nostrils, from which haemorrhage took place.

Prescribed acid, sulphuricum ["in large doses"?] with surprisingly prompt effect. (Schnappauf in Hirschel's Zeitschrift, v., page 144.)

NIGHT-SWEATS which so frequently drain the strength of con- sumptive patients, are either arrested or modified by means of water

VOL. I. — 9.

146 ACIDUM SULPHUROSUM.

acidulated with sulphuric acid, more speedily, perhaps, than by any other palliative.

BURNS. — Dilute sulphuric acid is an excellent application to burns, and common

BED-SORES OR FLESH-WOUNDS which threaten to become gangrenous ; they assume a more healthy ajDpearance and are often made to heal under the use of compresses moistened with a solution of this acid.

Sulphuric acid has been recommended as a specific remedy for the

The commercial acid is generally sold under the name of oil of vitriol ; it should be purified by distillation before it is used as a medicinal agent. The antidotal treatment, in a case of poisoning, is the same as that which has been indicated for phosphoric acid.

AOIDTTM SULPHUEOSUM.

[sulphurous acid, so2.]

This acid is formed by burning sulphur in pure oxygen or by heating together equal proportions of mercury or copper turnings and sulphuric acid. It has been utilized for bleaching purposes for some length of time, and has proven itself a cheap and valuable dis- infectant ; cheap, because the supply of sulphur is almost unlimited

ACIDUM SULPIIUROSUM. 147

and the manufacture of this acid involves but little expense. Eggs kept in sulphurous acid for three months (after first coating them with sawdust) were as fresh and palatable as if newly laid ; and the two legs of a pigeon preserved in the same way appeared perfectly fresh. Tainted meat is at once restored to purity upon having the acid sprinkled over it, and sewers, closets, etc., are readily made in- offensive by the prompt use of the same agent. One great advan- tage which the sulphurous acid has over other disinfectants lies in its perfect solubility in cold water.

HERPES CIRCINATUS.—

148 ACIDUM SULPHUKOSUM.

spinning mills are proverbially tedious in their progress, but they mend quickly under this application ; proud flesh being almost un- known, and cicatrization taking place with unusual facility."

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