The carbonate of soda, though a salt in very common use, has not hitherto been the cause of accident, which has found its way into print. It is plainly much less actively corrosive than carbonate of potass, and is therefore probably in every sense less energetic.
SECTION III.—_Of the Morbid Appearances caused by the fixed Alkalis._
The morbid appearances caused by potass, soda, and their carbonates differ with the nature of the case.
In the boy who died in twelve hours Mr. Dewar found the inner membrane of the throat and gullet almost entirely disorganized and reduced to a pulp, with blood extravasated between it and the muscular coat. The inner coat of the stomach was red, in two round patches destroyed, and the patches covered with a clot of blood;—its outer coat, as well as all the other abdominal viscera, was sound.
In the two chronic cases mentioned in the Medical Repository the mischief was much more general, the whole peritonæum being condensed, the omentum dark and turgid, the intestines glued together by lymph, the external coats of the stomach thick, the villous coat almost all destroyed, what remained of it red and near the pylorus ulcerated, and the pyloric orifice of the stomach plugged up with lymph so as barely to admit a small probe.
In Mr. Dewar’s patient who died of stricture of the gullet the intestines were sound, the inner surface of the stomach red especially towards the cardia, the inner and muscular coats of the gullet thickened and firmly incorporated together by effused lymph, the inner coat here and there wanting, the passage of the gullet every where contracted, and to such a degree about two inches above the cardia as hardly to pass a common probe. In Sir C. Bell’s cases the appearances were similar.
Orfila says he is led to conclude from a great number of facts that of all corrosive poisons potass is the one which most frequently perforates the stomach.[444] This appearance, however, has not been mentioned in any case of poisoning in the human subject.
SECTION IV.—_Of the Treatment of Poisoning with the fixed Alkalis._
In the treatment of poisoning with the alkalis the first object is evidently to neutralize the poison. This may be done either with a weak acid, or with oil. Of the acids the acetic in the form of vinegar is most generally recommended, as it is not itself injurious. A successful case in very unpromising circumstances, where two ounces and a half of carbonate of potash had been taken by mistake for cream of tartar, and where the antidote was not administered for half an hour, has been related by M. Liégard of Caen. Great relief was experienced to the burning in the throat and stomach, the chilliness, difficult breathing, and frequent efforts to vomit, which were the first symptoms; and after repeated alternations of collapse and reaction, convalescence was established in eight days.[445]—M. Chereau thinks that for the mineral alkalis and their carbonates fixed oil is a preferable antidote to vinegar; and he has given the heads of two cases of poisoning with large doses of carbonate of potass, in which the free employment of almond oil prevented the usual fatal consequences. It appears to act partly by rendering the vomiting free and easy, partly by converting the alkali into a soap. It must be given in large quantity, several pounds being commonly required.[446] For the subsequent treatment the reader may consult the paper of Mr. Dewar, which contains many useful hints on the management of the most complex description of cases.