Another form perhaps equally common with that just described, and not less certainly fatal, commences like the rest with violent symptoms of irritation in the mouth, gullet, and stomach; but the bowels are not affected, and by and by it becomes apparent that the stomach is little injured; dysphagia or even complete inability to swallow, burning pain and constriction in the gullet, hawking and coughing of tough, leathery flakes, are then the leading symptoms; at length the case becomes one of stricture of the œsophagus with or without ulceration; the bougie gives only temporary relief, and the patient eventually expires either of mere starvation, or of that combined with an exhausting fever. Mr. Dewar has related a very striking example of this form of poisoning with the alkalis.[442] His patient, after the first violent symptoms had exhausted themselves, which took place in sixteen or eighteen hours, suffered little for four or five days till the sloughs began to separate from the lining membrane of the mouth, throat, and gullet. The affection of the gullet then became gradually predominant, and terminated in stricture, of which she appears to have been several times so much relieved as to have been thought in a fair way of recovery. After repeatedly disappointing Mr. Dewar’s hopes of a successful issue by her intemperance in the use of spirituous liquors, she died of starvation about four months after swallowing the poison. Sir Charles Bell has noticed three parallel cases, and has given delineations of the appearance in the gullet of two of them.[443] One of his patients did not die till twenty years after swallowing the poison, which in this instance was soap-less; yet he does not hesitate to ascribe the stricture to that cause, and says death arose purely from starvation. 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.