Certain pathologic conditions, as fatty degeneration of the liver,
cloudy swelling of the kidney, nephritis, malignant jaundice,
acute yellow atrophy of the liver, dysentery, and others may be
caused by such poisons as phosphorus, arsenic, mercuric chloride,
potassium chlorate, chloroform, etc. When such changes are found at
autopsy the pathologist must always carefully differentiate between
disease and poisoning. He must decide as to the actual occurrence
of poisoning, the source and nature of the poison, how and when
administered, amount of poison, number of poisons, primary and
secondary effects, attendant circumstances, accidental, suicidal
or criminal administration, motive, etc. Some poisons produce
no characteristic gross or microscopic changes in the organs or
tissues. In such cases no pathologic conditions sufficient to cause
death may be found, and when there is doubt a chemical examination
should be made. Other poisons produce more or less characteristic
changes, either by their local action, by selective action upon
certain organs, by excretion, or by acting upon the blood. The
effects will vary according to the amount of the poison, its
concentration, length of action, condition of gastro-intestinal
tract, rapidity of excretion, etc. The most important and common
poisons producing recognizable autopsy conditions are as follows:—
=Acids.= In _carbolic-acid_ poisoning there may be dry, brown,
leathery spots on the face about the lips; grayish-white eschars
on mucosa of lips, mouth, tongue, pharynx and œsophagus; œdema of
the glottis and pharyngeal submucosa; white or gray longitudinal
eschars in stomach and duodenum; leathery appearance of stomach
wall; cloudy swelling of kidneys, odor of phenol in urine, which
is dark in color; general passive hyperæmia. In _sulphuric-acid_
poisoning there may be brown, leathery and dry eschars on lips and
skin, grayish-white to black eschars in mucosa of mouth, stomach
and œsophagus; black, dry and brittle clots in the blood-vessels;
perforation of stomach; sloughing of mucosa; parenchymatous
nephritis. _Hydrochloric acid_ has little or no action on the skin;
on mucous membranes the action is similar to that of sulphuric
acid except that the drying of the eschars and blood-clots is less
marked. In _nitric-acid_ poisoning the eschars are yellowish;
hæmatin is not separated and dissolved, so that the brown black
eschars seen in sulphuric- and hydrochloric-acid poisoning are
not formed. _Oxalic acid_ causes a white or grayish escharotic
condition of the mouth, œsophagus and stomach; crystals of calcium
oxalate may be found in the blood-clots and in the kidney-tubules.
_Glacial acetic acid_ may produce a grayish-white escharotic
condition of the mucosa of the upper respiratory tract, and
pneumonia, when inhaled.
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