Treatise on Poisons: In relation to medical jurisprudence, physiology, and the practice of physicChristison, Robert, Sir
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Treatise on Poisons: In relation to medical jurisprudence, physiology, and the practice of physic
Christison, Robert, Sir
Medical jurisprudence; Toxicology
The following case from Laisné’s treatise shows that the gullet may be
also dissolved in the same way. A woman three days after delivery was
attacked with puerperal peritonitis, and died in four days. In the belly
were found the usual morbid appearances of peritonitis: but in addition
there was in the lower part of the gullet a large oval aperture two
inches long, which penetrated through the posterior mediastinum into the
lungs.[221] Another singular instance of the same kind has already been
mentioned under the head of the symptoms (see p. 107). Another has been
described by Dr. Marshall Hall. In a child who died of bronchitis, an
opening was found in the gullet about the size of a pea, so that the
canal of the gullet communicated with the sac of the pleura; and several
veins appeared also to have been opened.[222] The stomach was likewise
perforated.
It is not difficult to draw the distinction between these perforations
and the effects of poison. The throat and gullet may be partially
disorganized or corroded by the strong corrosives; but they are very
rarely penetrated, since the greater part of the poison must pass into
the stomach or be rejected by vomiting. Destruction of the mucous coat
is a common consequence, and stricture occasionally follows; but I have
hitherto met with only one instance among the innumerable published
cases of poisoning with the mineral acids, alkalis, and other
corrosives, where the gullet was perforated. In that case the
perforation was the result of slow ulceration from poisoning with
sulphuric acid, where life was prolonged for two months.[223]
Perforation from simple corrosion never occurs. The intestines are never
perforated by chemical corrosion from within, for either the poison is
in a great measure expelled from the stomach by vomiting, or the pylorus
contracts and prevents the passage of every poison that is sufficiently
concentrated to corrode. Both the small and great intestines might be
corroded from without, in consequence of the poison escaping through a
hole in the stomach. I am not acquainted, however, with any case of the
kind where, intestinal perforation has occurred.
When the intestines are pierced by true ulceration, it is impossible to
tell whether it arose from natural disease or an irritant poison.
The mode of forming a diagnosis between the symptoms and appearances of
irritant poisoning and those of natural disease being thus explained,
the different species of poisons which have been arranged in the class
of irritants will now be considered in their order.
The irritant class of poisons may be divided into five orders: the acids
and their bases; the alkalies and their salts; the metallic compounds;
the vegetable and animal irritants; the mechanical irritants. In a short
appendix some substances will be mentioned which are not usually
considered poisonous, but are capable of causing violent symptoms when
taken in large doses.
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