Ammonium Causticum (Ammonia)

, NH3

Common name , Hartshorn spirits.

Preparation , Solution of the gas in water.

Authorities.

Toxicological ( 1 , Wibmer, proving, Buchner's Repertorium; 2 , Vetter, Hufeland's Journal, 78; 3 , Chrestien, Gaz. d. Santé; 4 , Schlegel, Material, etc., 1801; 5 , Mankiewicz, Virch. Archiv., 45; 6 , Winter, Med. Chir. Cent. Bl., took 3 drachms; 7 , Hiff, Lancet, 49; 8 , Br. J. of Hom., 21; 9 , Souchard, in N. A. J. of H., 17; 10 , Imbert-Gourbeyre, J. d. Chim. Med., 1854; 11 , Gaz. d. Hôp., in N. Z. f. H. K., 17; 12 , Watson, Times, 1845, "Guano Fumes;" 13 , Wibmer, Effects of Inhalation; 14 , Cattel, in B. J. of Hom., 11).

MIND

• The patient, perfectly comprehending his condition, resigns himself to despair, 3.
• Remarkable timidity, 2.
• His intellect was clear, 6.
• Unconscious, 10.

HEAD

• Slight confusion in the head, with rumbling in the abdomen (in six minutes), 1.
• Slight confusion in the head, with pressure in the temples, ceasing almost entirely in ten minutes (in a quarter of an hour), 1.
• Sensation as if the brain protruded at the centre, forward, and on both sides, and the skull was quartered, but without pain and without confusion of the head, 1.
• The forehead, where the bloodvessels are full of blood, feels hot to the touch, 9.
• Pressure in the frontal region, with feeling as if the head would split, but without pain, which lasts a few minutes (in seven minutes), 1. [10.]
• Slight pressure at the occiput, lasting ten minutes (in half an hour), 1.

EYES

• Eyes red, shining, 9.
• The eyes sunken; the pupil widely dilated, 6.
• Lachrymation, 12.

EARS

• Deafness, 12.

NOSE

• Peculiar redness of skin over nose and frontal sinuses, 12.
• Coryza, 12.
• A watery fluid runs at intervals from the nasal cavities, and the air is completely excluded from them, 3.

FACE

• The face is altered, 3.
• The expression was anxious, 6. [20.]
• The whole expression of his face showed the greatest anguish, 9.
• Extremely pale face , expressive of the greatest suffering, 2.
• Face always very red during the febrile exacerbations, 2.
• His distorted features had red spots, 9.
• His lips were rather swollen, 7.
• Lower lip swollen to three times its normal size, 5.
• Small black coating on the middle of the lower lip, 3.
• The mucous membrane of the lips and nose was destroyed, 9.

MOUTH

• Teeth clenched, 5, 10.
• The surface of the tongue is white, 3. [30.]
• The tongue appeared deprived of its epithelium; only on solitary places could some white membrane still be seen, and nearly the whole fauces showed the same state, 9.
• Curled pieces of white skin are detached from the tongue and throat, and those parts appear red, 3.
• The tongue, the palate, and the entire œsophagus, as far as visible, are whitish and partly covered with blisters, 2.
• Burning and scraping at the root of the tongue and posterior portion of the œsophagus (while swallowing the medicine), 1.
• Small black coating on the tip of the tongue, 3.
• The entire buccal cavity, the mouth, the tongue, and probably a great part of the œsophagus and stomach, are raw, denuded of epithelium, 4.
• The mucous membrane of the mouth, and all the visible parts of the throat, were dark-red, swollen, and tender; the epithelium was detached in different places, 6.
• The penetrating smell of Ammonia was still clearly perceptible in his breath, although he had taken so much vinegar, 6.
• From mouth and nose flowed a large quantity of bloody fluid, 9.
• Profuse bloody salivation, 11. [40.]
• Foaming from mouth, 10.

THROAT

• Throat externally red, and the soft parts swollen, 5.
• Burning pain in throat, 9.
• Burning pain from the mouth to the region of the stomach, 3, 13.
• Burning heat at the throat, 3.
• Burning pain at throat and stomach, 2.
• Lancinating and scraping sensation at the throat (immediately after taking the medicine), 1.
• Scraping at the throat (when swallowing the medicine, 1.
• Deep redness of the velum, its pillars, the tonsils, and the posterior wall of the pharynx, 3.
• The uvula is contracted and covered with white mucus, 3. [50.]
• The tonsils appear scarcely at all enlarged, 3.
• The posterior wall of the pharynx and the epiglottis, were deeply reddened, and like the mouth, with most intense pain in the throat, 6.
• Dryness in œsophagus, 11.
• Great difficulty in swallowing, 3.
• Could scarcely swallow, 13.
• He swallowed with difficulty some vinegar and water, but it seemed to relieve him, 9.
• After two hours of great anxiety, the patient complained mostly of his throat, as swallowing was still nearly impossible, 9.

STOMACH

• Very urgent thirst, 2.
• Thirst, 13.
• Very urgent thirst, with difficult deglutition, 3. [60.]
• He is consumed with thirst, and yet is unable to get down a drop of liquid, 3.
• Thirst very strong, without the power to swallow, 9.
• Eructations which do not smell of Ammonia (soon after taking the medicine, 1.
• Constant mucous vomiting, 2.
• He passes an immense quantity of mucus from the mouth, 3.
• He throws up by the mouth and nostrils quantities of a whitish fluid burns wherever it touches, and smells like sal volatile liniment, 2.
• He immediately screamed and was very sick, bringing up at first stringy mucus of a light color, and then some more dark, 7.
• Vomiting blood, 11.
• The right hand automatically pointed in the stomach region, 5.
• He was allowed to get up on the fifteenth, but the next day a hearty meal gave him very great pain, 6. [70.]
• Heartburn, 14.
• There was burning pain in the track of the œsophagus, none in the stomach itself, but its region was tender on pressure, 6.
• Epigastrium swollen and tender, 5.
• Great sensitiveness of the epigastric region; very small pulse, with shiverings (at 4 P.M.), 2.

ABDOMEN

• Great pain and tenderness in left hypochondrium and at epigastrium, 14.
• There was no abdominal distension, 6.
• The abdomen was soft, 6.
• Rumbling in abdomen, 2.
• Inexpressible pains in the upper part of the intestinal tube, 4.
• Pains in lower abdomen, back, and sacral region, 3.

STOOL AND ANUS. [80.]

• Spasmodic contraction of the rectum; an injection spouted forcibly from the rectum as soon as throw up, 3.
• The vomiting is followed by several stools, which cause a violent burning at the anus, 2.
• Solid stool (he has already had the usual morning evacuation), with cessation of the confusion of the head (in six minutes), 1.
• Copious hæmorrhagic stools, 8.
• Bloody stools, very frequent, 11.
• Evacuation of some pints of clear blood, with excessive tenesmus, 11.
• The poison was taken March 7th, but his bowels did not act till the 12th, and then only after a purgative, 6.
• Suppression of a chronic looseness of the bowels, [°], 3.

URINARY ORGANS

• Scanty, red urine, 3.
• The urine was alkaline and dark-yellow, 6. [90.]
• Urine smelling of ammonia, 1.
• Next day, the urine contained a good deal of sediment, consisting of urates, 6.

SEXUAL ORGANS

• The menses, hitherto always regular, are fifteen days too early, and very profuse, 2.

RESPIRATORY APPARATUS

• Slight, rather coarse mucous râles were heard in the larynx and trachea, 6.
• He had a constant tickling in larynx, with pain in epigastrium, 6.
• For several days, he suffered from a bronchitis, with profuse expectoration , but it took nearly a week till his voice returned, and he regained his strength only by slow degrees, 9.
• Speech fatiguing, interrupted, 13.
• The voice was low and weak, speech fatiguing and interrupted, on account of the condition of the respiratory function, 3.
• She could hardly speak, because the effort to do so fatigued her exceedingly, and caused pain in the chest, 2.
• The voice was rough, weak, and hoarse, 6. [100.]
• Dull, hoarse voice, 4.
• Weak and indistinct voice, 9.
• Voice deep, weak, 13.
• Speech wanting, 5.
• Obstinate cough, 12.
• Cough, with copious mucous expectoration, 3.
• Cough and much expectoration, especially after drinking, 13.
• When he tries to drink, severe cough, with expectoration of slimy masses, 9.
• The cough and expectoration are especially excited by the contact of liquids with the back of the mouth; only a very little passes into the œsophagus, 3. [110.]
• Spasmodic cough, lasting an hour, during which he expectorates a great quantity of membrane, 4.
• He hawked and expectorated continually, although doing so gave him great pain, 6.
• Bloody expectoration, 12.
• Respiration heavy and rattling, 13.
• Every respiration produces a kind of rattling noise, 3.
• The breathing harsh, hurried, and somewhat obstructed, 7.
• Respiration difficult, 3.
• Very great difficulty in breathing, 3.*
• Great difficulty in breathing, 13.
• Difficult, quick, stertorous breathing, 3. [120.]
• Was aroused from sleep by a suffocative feeling, .

CHEST

• Continuous mucous rattling in chest, 9.
• The chest-sounds were normal, 6.
• Pain in the whole chest, with suffocative anguish, 9.
• Inclination to draw a long breath, which is prevented by a violent pain in the chest towards the back, evidently in the œsophageal region, 2.
• Great oppression and want of air, 2.
• Extreme oppression of the chest, with increased rattling and threatened suffocation, 3.
• Lung-catarrh, 12.
• The præcordial region is distended and painful, 2. [130.]
• Extremely violent anguish at the præcordia, with great oppression of the chest, 2.

HEART AND PULSE

• Pulse small, weak, rapid, 13.
• Small, frequent, and weak pulse, 3.
• Very small and moderately frequent pulse, but it increases in frequency from hour to hour, 2.
• The pulse was quickened five beats per minute (usual rate 70); it was also somewhat hard, 1.
• Pulse so slow and intermittent that it was difficult to count it, as were also the beats of the heart, 5.
• Pulse 60, small and hard, 6.
• Pulse weak, irregular, 9.
• Small, depressed, scarcely perceptible pulse, 3.

UPPER EXTREMITIES

• Convulsive twitches of right arm, 14.

GENERALITIES. [140.]

• State of irritation and of extraordinary suffering, 3.
• In the evening, the patient was greatly excited; pulse quite small and very quick, with increased oppression, 2.
• After a venesection, the patient got more quiet, and the bloody expectoration ceased, 9.
• Motorial power intact, 6.
• He had perfect sensibility, and not much distress of countenance, 7.
• Great weakness, 13.
• Great debility, 3.
• Great prostration, 11.
• Remarkable exhaustion; his no muscular strength is diminished to a degree not proportioned to the duration of the disease, 2.
• On trying for the first time to get out of bed, he was unable to stand on his legs, and at the least effort, he trembled violently, 2. [150.]
• Bleedings from the mouth, nose, eyes, ears, which cause faintness, 13.

SKIN

• The skin was pale, cold, and had lost its elasticity, 6.
• The application of a blister plaster takes off the skin, but does not excite the secretion of serum, 3.
• Erysipelas, 8.
• Skin hot, not dry, 9.
• Hot, dry skin, 3, 13.
• Dry skin, 2.
• Cutaneous sensibility intact, 6.

FEVER

• Heat in chest and at stomach, 3.

SLEEP AND DREAMS

• Sleepless night, 3.
• Very restless night, 2.

CONDITIONS

• Aggravation.
• ( Evening ), Great excitement, etc.
• ( After drinking ), Cough, etc.
• ( After hearty meal ), Great pain in stomach.
• Amelioration.
• ( Solid stool ), Confusion of the head.
• ( After venesection ), More quiet, etc.
• ( Vinegar and water ), Seemed to relieved him.

SUPPLEMENT: AMMONIUM CAUSTICUM. Authorities.

15 , E. P. Wilkins, Lancet, 1846 (1), p. 385, a woman, æt. twenty-four years, took a quantity of liquid Ammonia; 16 , J. W. Trotter, Lancet, 1852 (1), p. 261, P. W., æt. thirty-six years, took 1 ounce harts-horn in milk, afterwards he took copious draughts of warm water; 17 , Dr. Barclay, Med. Times and Gaz., 1853 (2), p. 554, a girl, aged nineteen years, when faint from fright had some hartshorn given her; 18 , H. W. Reed, M.D., ibid., 1855, p. 59, a man, æt. thirty-five years, swallowed at one draught 3 drachms each of strong Ammonia and Ammonia sesquicarb.; 19 , A. Patterson, M.D., Edinb. Med. Journ., vol. iii, 1857-8, p. 236, a man took 1 ounce into his mouth, but probably none of it reached his stomach; 20 , John E. Bean, M.D., Pacific Med. and Surg. Journ., June, 1867, p. 13, Dr. John H. Pike swallowed some "Liq. Ammon. fort.," death after twenty-one hours; ( 21 to 27 , from Tardieu); 21 , Dr. Pellarin, Union Méd. 1857, effects of a large dose; 22 , Prof. Foussagrives, ibid., poisoning by 30 grams; 23 , Dr. Chapplain, Archives du Méd., 1845, p. 84; 24 , Gaz. Méd. du Santé, 21 Mai, 1816; 25 , M. Potain, Union Méd., 1862, t. 12, p. 119; 26 , M. Geneuil; 27 , M. Albert Robin, Journ. de Thérap. 1re ann., No 5, p. 194; 28 , Dr. F. R. Quinton, Lancet, 1876 (1), p. 280, a man, æt. forty-four years, swallowed about 5 or 6 drachms liquor Ammon., death in thirty-two hours; 29 , Dr. W. Dyson, Med. Times and Gaz., 1878 (1), p. 35, a child, æt. twenty months, swallowed a quantity of strong Ammonia, death; 30 , Mr. Gillam, ibid. (2), p. 706, T. B., æt. sixty-four years, swallowed half a pint of liquor Ammonia.

MIND

• Mental despondency, 18.
• Extreme anguish, 26.
• Anguish, with suffocation and constriction of the throat, 25.
• Insensibility, 18.
• Comatose, 20.

EYE

• Yellowish chemosis of the eyes, 25.
• Intense yellow discoloration of the conjunctiva, 25.
• Eyes spasmodically turned up, and eyelids closed, 18.
• Pupils dilated, 26. [170.]
• Pupils dilated and eyes inverted, 20.
• Pupils contracted, 23.

NOSE

• Profuse accumulation of serous liquid from the nasal fossæ, 24.

FACE

• Face pale, 23.
• Face pale, eyes haggard, injected, and lids swollen, 21.
• Face Flushed, 18, 19.
• Upper part of the face of a violet-red color, lower part blanched, 26.
• Aspect anxious (in two hours), 19.
• Lips and tongue red and denuded, 18.
• Lips cyanotic, 26. [180.]
• Lips livid, 18, 19.

MOUTH

• Tongue dry, 26.
• Mouth open, 18.
• Profuse albuminous, viscid, bloody secretion pouring from mouth and nares, 18.
• Inside of his upper lip, tongue, roof of mouth, and fauces were white, and other parts excoriated, 16.
• Inside of mouth, tongue, and fauces, as far as visible, red, raw, and fiery looking. When asked where pain was seated, he pointed to pomum Adami, under the left ear (in two hours), 1.
• Intense and excruciating burning in the mouth, œsophagus, and stomach, 18.
• Salivation profuse, 27, 28.
• Profuse salivation, 28.
• Enormous secretion of limpid mucus from the salivary glands and mucous membrane of the pharynx, etc., not less than three liters of liquid a day (wonderfully controlled by Chlorate of potassium), 23. [190.]
• Loss of speech, 18.

THROAT

• Hawking of frothy mucus (in four hours), 19.
• Horrible pains in the throat, and especially in the epigastric region, 21.
• Intense burning pain and feeling of suffocation (immediately), 19.
• Deglutition painful, 20.
• Great difficulty in swallowing, 16.
• Deglutition impossible, 26.

STOMACH

• Great thirst, 20, 23.
• Ineffectual efforts at vomiting, 18.
• Vomiting, 26. [200.]
• Persistent vomiting, 25.
• Vomited some blood, 20.
• Vomiting of bloody matter, 23.
• He vomited a quantity of matter like soapsuds, 16.
• Severe pain in stomach. 20.
• Horrible pain in the stomach, 25.
• Severe pain over the epigastric region, increased by pressure (second day). 16.
• Epigastrium excessively painful on pressure, 25.
• He felt as if he were on fire from his stomach to his mouth, 16.

ABDOMEN

• Excessive pain in the abdomen, 24.

STOOL. [210.]

• Involuntary stools, 23, 26.
• Voided large quantities of blood per anum, 20.
• Stools profuse, liquid, red, extremely fetid, evidently consisting of a large amount of disorganized blood, 25.

URINARY ORGANS

• Incontinence of urine. 26.
• Urine suppressed, 24.
• (Albuminuria); the urine contained up to two grams of Albumen daily, 27.
• Urine high-colored and thick, with an abundant heavy lateritious elimination, 18.

RESPIRATORY APPARATUS

• Trachea spasmodically rising and falling, 18.
• Œdema of the glottis, 23.
• Voice very feeble, 24, 25. [220.]
• Voice husky, 16.
• Complete loss of voice, 21.
• Sonorous, moist cough, resembling a suffocative catarrh, with tracheal râles, 23.
• Cough and expectoration provoked by anything getting into the throat, so that it was almost impossible to get liquid into the œsophagus, 25.
• Profuse expectoration of mucus, 24.
• Respiration rapid, 23.
• Hoarse croaking respiration, 18.
• Respiration stertorous, 24.
• Breathing stertorous, with strong odor of Ammonia, 20.
• Breathing stridulous (in two hours), 19. [230.]
• Gasping for breath, 18.
• Suffocation, 26.
• Insupportable suffocation, 21, 24.

CHEST

• Mucous râles in chest, 20.
• Intense cutting pain opposite fifth and sixth cervical vertebræ, at the bottom of the pharynx (in twelve hours), 19.

HEART AND PULSE

• Tumultuous action of the heart, 26.
• Carotids beating violently, 18.
• Pulse very rapid and feeble, 26.
• Pulse small, 112, 16.
• Pulse 100 (in two hours), 19. [240.]
• Pulse small, rapid, 23, 25.
• Pulse small, 21.
• Pulse feeble, 20.
• Pulse slow, very irregular, 22.

EXTREMITIES

• Nails violet, 27.

GENERALITIES

• As soon as she had drank it, she fell back insensible, apparently (to those with her) as if choked. In four hours she had revived somewhat, but complained of severe burning pain down her throat, in the epigastrium, and left hypochondrium, each of which parts were tender on pressure; pulse 53, small; voice a feeble whisper; great debility; countenance anxious; choking sensation on swallowing; pupils widely dilated; breathing difficult; tongue coated with white fur, painful and tender; two or three patches of its mucous membrane pulled off; three convulsive twitches of the right arm at different times during my visit, 15.
• Almost immediately became conscious of severe pain in the stomach. In an hour or two became sick and vomited some blood; hæmatemesis to a greater or less extent continued for three days. In eight weeks she became much emaciated complained of constant vomiting, with a weak and frequent pulse, a sort of hectic flush on the cheeks, and great prostration. Latterly the vomiting became more constant and severe, her pulse was sensibly feebler, and she became more emaciated from day to day; the eyes sunken, the tongue foul; she complained of headache, and was so weak that she was scarcely able to turn in bed. The bowels were confined throughout. She ultimately died of starvation, 17.
• Face pale, anxious, and covered with clammy sweat, extremities cold, pulse 140, and very feeble; mouth and throat very red and inflamed-looking. He complained of burning pain in his throat, with difficulty of swallowing, and a feeling of impending suffocation; his voice was reduced to a whisper, and his breathing noisy, frequent, and laborious; all the voluntary muscles of respiration seemed to be exerted to get air into the chest; occasionally he vomited mucus slightly tinged with blood (after one hour). Quantities of tenacious mucus collected in the throat and induced fits of coughing and sickness (first night), 28.
• Three white patches on the tongue, and one or two on the inner side of the cheeks; none visible on the tonsils or pharynx, but considerable congestion of the mucous membrane of these parts. Deglutition exceedingly difficult. Frequent occurrence of vomiting; respiration rapid and shallow, accompanied by laryngeal and tracheal râles; free passage of air into the chest; cyanosis slight (after one hour). Signs of interference with the entrance of air into the lungs more marked, but not considerable. Râles distinctly heard all over the back and chest (after eleven hours). Unconscious; eyes half open; pupils moderately contracted and equal. Convulsions came on during the night, and were now frequently recurring (after twenty-three hours), 29.
• Semiconscious; pupils widely dilated, and his breathing noisy and hurried; pulse very rapid; sweating profusely. He complained of great pain in the abdomen, and vomited a quantity of blood, mucus, and shreds of mucous membrane (in five hours); hoarse and in a heavy drowsy condition; face dusky and skin dry; temperature 100.8°; pulse 130; again vomited blood and mucus (in ten hours). His lips are much swollen, the tongue very dry, and the mucous membrane of the mouth is partly eroded. The fauces are extremely congested and almost meet in the middle line; the mucous membrane looks œdematous, softened, and inflamed. There is great pain and tenderness of the abdomen on the slightest pressure. Tympanitis is marked. Has twice vomited blood since the night, and complains of burning pain in the throat and at the pit of the stomach. 11 P.M., much worse and is becoming comatose. There is great dyspnœa; respiration about 66 in the minute; pulse 180. Incessant retching till death (second day), . [250.]

SKIN

• Erythematous spots in different parts of the body, especially along the lymphatics; the spots are red, bordered by a yellowish zone, 25.
• Scarlatina-like redness of the lips and mucous membrane of the mouth and tongue, as though the epithelium were peeled off, 23.
• Several rosaceous spots on the internal and anterior surface of the forearms; these red spots increased in number on the next day, and covered the whole inner surface of the arm, generally following the course of the lymphatics, 25.

FEVER

• General coldness, 25.
• Surface rather cold, 16. [260.]
• Coldness of the surface and extremities, 18.
• Cold skin, especially in the extremities, 22.
• Extremities cold (in two hours), 19, 20 , etc.
• Profuse perspiration, 18.
• Cold sweats, 18.