§ 60. =Treatment of Acute Poisoning by the Mineral Acids.=--The immediate indication is the dilution and neutralisation of the acid. For this purpose, finely-divided chalk, magnesia, or sodic carbonate may be used, dissolved or suspended in much water. The use of the stomach-pump is inadvisable, for the mucous membrane of the gullet may be so corroded by the acid that the passage of the tube down will do injury; unless the neutralisation is _immediate_, but little good is effected; hence it will often occur that the bystanders, if at all conversant with the matter, will have to use the first thing which comes to hand, such as the plaster of a wall, &c.; and lastly, if even these rough antidotes are not to be had, the best treatment is enormous doses of water, which will dilute the acid and promote vomiting. The treatment of the after-effects belongs to the province of ordinary medicine, and is based upon general principles. § 61. =Post-mortem Appearances.=[72]--The general pathological appearances to be found in the stomach and internal organs differ according as the death is rapid or slow; if the death takes place within twenty-four hours, the effects are fairly uniform, the differences being only in degree; while, on the other hand, in those cases which terminate fatally from the more remote effects of the acid, there is some variety. It may be well to select two actual cases as types, the one patient dying from acute poisoning, the other surviving for a time, and then dying from ulceration and contraction of the digestive tract. [72] It has been observed that putrefaction in cases of death from sulphuric acid is slow. Casper suggests this may be due to the neutralisation of ammonia; more probably it is owing to the antiseptic properties all mineral acids possess. A hatter, early in the morning, swallowed a large mouthful of strong sulphuric acid, a preparation which he used in his work--(whether the draught was taken accidentally or suicidally was never known). He died within two hours. The whole tongue was sphacelated, parts of the mucous membrane being dissolved; the inner surface of the gullet, as well as the whole throat, was of a grey-black colour; the mucous membrane of the stomach was coal-black, and so softened that it gave way like blotting-paper under the forceps, the contents escaping into the cavity of the abdomen. The peritoneum was also blackened as if burnt; probably there had been perforation of the stomach during life; the mucous membrane of the duodenum was swollen, hardened, and looked as if it had been boiled; while the blood was of a cherry-red colour, and of the consistence of a thin syrup. The rest of the organs were healthy; a chemical research on the fluid which had been collected from the stomach, gullet, and duodenum showed that it contained 87·25 grains of free sulphuric acid.[73] [73] Casper, vol. ii. case 194.