Sulphuricum acidum

Volume I — Main text

ACIDUM SULPHURICUM.

Sulphuric acid. H^SO^. A product of the oxidation of sulphur, UMially obtained by its combu!»tion and subsequent treatment by nitrous vapours.

1. Provlngs. — I. Hahnemann, Chronic Diseases^ Part 5 of original, vol. of English translation. Contains 513 symptoms from self and 5 fellow-observers, and 8 from authors. Of these 5 belong to a typhoid fever from which the patients taking it were suffering. The others — "salivation," "aphthae in mouth," and "hiccup — seem genuine effects of acid, and last repeatedly recurred after administration of clysters containing it.

2. Dr. D. Cowley (now of Pittsburgh, Pa.), act. 24, sanguinenervous temp. July 17th, 1855, being a very warm day^ he had a

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craving for something acid, and put 3 or 4 drops of dilute sulphuric acid into half a tumbler of water, and drank it down. Immediately after had slightly cutting pain in 1. arm, extending whole length of it, and lasting a few seconds, perhaps I m. In a (tw m, slightly cutting pain from stomach into hypochondria. In ^ h. slight cutting pain in region of cascum, lasting 2 or 3 m. In 1 h* slight pain in L thigh near knee, feeh'ng as though it would soon become cutting \ also slight feeling of tension in scalp and ear of I, side, more in front of ear, lasting a few m, {Cammunicated)

1. Po'tsoningi, — I * a. The local effects of the acid on the alimentary canal are chemical. That it is absorbed into the blood is shown by increased elimination of sulphates in urine ; but it is not found there in a free state during life.

b. In the urine, passed naturally or by artificial aid, very large amounts of albumen and casts have recently been detected (Wyss, Mannkopf, Munk and Leyden, and others). Still, albuminuria has not as yet been recognised by all observers as a constant symptom of acute sulphuric actd poisoning (Smoler found it but once In fourteen cases), , , . Recently Mannkopf has observed, in several cases of poisoning, neuralgic affections of the abdominal and intercostal nerves; also, in isolated cases, extended and severe hyperesthesia over the whole trunk, symptoms regarding whose pathogenesis we are as yet entirely in the dark. In the different cases they developed at diff^erent times, between the 8th and the 22nd d. after the poisoning. After death, the liver has been found in a state of fatty degeneration, the kidneys in that of parenchymatous nephritis, (Boi:HM| ZUmsscn*$ CycUt^dia^ xvii.)

Volume I — Appendix

Acidtun Btilphuricuni* — The lollowlng are some of the cases of poisoning referred to in IL t. b.

1. a. A shoemaker's apprentice, aet, 16, swallowed inm. some sulph, ac. ; he was at once taken into hospital and died collapsed at 6 p.m. Urine pasi^ed at z p.m. w'a» of bloody brownish.red colour, turbid, acid reaction, sp. gr. toiS, contained much albumen* In urine very few blood*corpuscles, but a large amorphous mass of ycllowish-rcd colour. P.M. — Abdominal walls much distended. A large quantity of clear blood 'Coloured fluid In both pleural sacs and pericardium. In heart much dark greasy coagulated blood, which had but few intact blood. corpuscles. Ve5>ical m,m. pale, turbid blackish.brown urine with numerous flakes. Kidneys showed nothing to the

*cye, were not examined microscopically. Great swelling of follicles of root of tongue and m.m. of fauces. M.m. of orsophagus rather dry, of brownish colour. Stomach much distended. Contents viscid greasy mass. In fundus m.m. quite destroyed, the muscular coat laid bare. In pylorus m.m. pretty well preserved. In duodenum m.m. black coloured, very friable — jejunum more normal.

b. A smith, st. 15, dirank some sulph. ac. about 11 a.m. and was soon after taken to hospital. Complained of violent pams in stomach. Constant retchin? and vomit, in^ of black bloody masses. When he swallowed ma^esia he always coughed. He got opium and slept some h. He had stridor of respiration increased by pressure on larynx. 1 he pains increased, collapse came on and he died on the e. of the next d. The urine soon after he came in was clear yellow, acid, and contained no albumen. That passed in the e. of the first d. was reddish yellow, turbid, had a great reddish sediment, acid, sp. gr. 1 02 c, contained much albumen and hyaline and granular cylinders, and a large quantity of cellular elements and blood -corpuscles. The urine drawn off at noon next d. was clear yellow, had less albumen. P,M, — Bloody serum in pericardium. Blood in heart coagulated. Nothing ob^rvable in lungs. In buccal cavity and palate the epithelium was covered with a thin black layer and was readily detached. In fauces, m.m. partially destroyed, epiglottis and ligam. aryepiglottica much swelled, brittle, cedematous, epithelium readily detached. (Esophagus very contracted, its m.m. brownish, with here and there erey epithelial streaks. Larynx contracted, m.m. very swollen, red, its m.m. on posterior wall readily detached. In abdominal cavity some bloody fluid. Intestines much distended with gas; partly grey, partly red. Spleen moderately larfi;e, soft. Kidneys pale, the incision shows a slight yellow colour. In stomach brownish -black fluid, the like in duodenum and jejunum. The walls of these parts very hard, the fundus ventriculi soft. The inside of stomach in its whole extent occupied by broad, high, black swellings, greatest in big curvature. The black colour extends deep into m.m. Its serous membrane injected. M.m. of duodenum and beginning of jejunum very soft, blackish, swollen. Bladder empty. Some of the uriniferous tubules are distended and filled with cellular contents. Some of them show ^tty degeneration. The glomeruli are large, full of nuclei. The interstices between the tubules are abnormally wide and contain more granules than nonnal. Fat globules among the nuclei. (Leyden and Munk, Firchonjij's Archi'v^ xxii, 137.)

1. «. A servant-girl, act. 16, drank on Oct. 20th, at 11.30 a.m., a good mouthful of dilute sulph. ac. (i to 5) on an empty stomach. Immediately a constant violent burning in mouth and along oesophagus to stomach. On drinking water she vomited at first dark vellow, then black stuff. Four K. after swallowing the acid she was admitted to tne hospital. Countenance red and distorted with pain. Tongue-tip deprived of epithelium, is bright red, with partial thick white fur. The m.m. of palate and pharynx swollen, very red, with white spots and stripes and some small flat ulcers. Dysphagia, which is attended by great pain. Epigastric pains on pressure. Magnesia, leeches to larynx, and almond emulsions were emplojred. On 13rd the pain and difficulty of swallowing had so much increased that nothing but ice-cold water could be taken, which was grateful owing to the burning thirst. Everything else as soon as it passed the pharynx was immediately rejected. Profuse secretion of saliva often mixed with blood. The inflammation of the m.m. extended to larynx, which was tender to touch. On the 16th some food got into stomach, but was immediately vomited along with some blood. Acute pains came on in the region of the r. lower ribs. They came in paroxysms, especially at n., and were excited by deep inspiration. The painful points of Valleix below the 6th and loth ribs were very well marked. These symptoms recurred repeatedly on the following d. They declined with the amelioration of the pains in pharynx. Obstinate constipation during the whole time. (Frerichs, Witm. Med. Wochituch.y 1861, No. 35.)

2. A servant.girl, aet. 14, May 31st, at noon, swallowed a mouthful of sulph. ac. Inunediately fainted. On coming to in 10 m. she vomited black stuff several times. Brought to nospital at 1.30 p.m. She got soap-water, magnesia and ice pills. At 5 p.m. cheeks red, slightly moist, expression anxious, and features distorted. From r. commissure of lips downwards is a parchment-like strip where the epidermis is coloured brown, lips swollen and painful when touched. All buccal cavity and tongue covered with white layer. Swallowing difficult and very painful, pain from mouth down to itomach. Speech difficult, pain in larynx increased by speaking and pressure. Much

brownhh mucus ejected from mouth* resp. rapid and rattling^ Abdomen distended, epigastrium tense and painful to touch. Spleen somewhat enlarged. Urine acid, sp. gr. 10381 contains a little albumen. — ist June. Vomited once. Every attempt to swallow anything resulted in its regurgitation. Got glycerine and bitter almond emulftion. When the slough came away there occurred bloody mucvis and saliva. Difficult rei^piration caused by ^welling of m.ni, of larynx. Coughing caused great pain in larynx, threatening of suffocation. — 3rd. Paroxysmal stitches in lowest ribs on both sides, painful neuralgia of intercostal nerves, spreading next d. to iumbar nerves^ Hyper. »sthcs»a of skin* which was always present at the seat of the neuralgia even when no paroxysm was on, extended ftrst to extremities, then over whole body and even race ; the slightest touch caused loud complaints, no ease could be had in any position. Morphia was injected hypodermically ; this brought refreshing sleep. Next d, complained of pain in the organs touched by the acid and of ncrvou?* symptoms. On the 4th d. the swallowing was improved. Patient could eat and drink very little. At beginning of ind week appetite returned, though the pains in stomach continued. Patient much emaciated. Food caused bilious vomiting* No vomiting at end of 3rd week, but appetite still worse. M,m. of mouth quite healed, palate and pharynx still red and painful to touch, hoarseness continued. At beginning of 4th week patient seemed to be recovering, but on md d, of week the most violent pains in stomach came on with copious vomiting, the vomited matter mixed with coagulated black blood. This lasted a d., and the Atools also were coloured black with blood. When the vomiting declined the patient felt nausea and had acid eructation. She had also fir^ of cardialgia of t m, duration, and dyspncjea causing anxiety. Then came on photophobia, roaring in ears, vertigo, once syncope. Emaciation went on, the skm was dry and scaly, the face quite colourless, speech hoarse and hollow, almost incomprehensible. PuUe thread-like, abdomen retracted. The patient could not retain any kind of food. Nutritious clysters were given, but did not seem to be absorbed. The urine contained no chlorides, the stools, which occurred every 2 or 3 d*, were large and devoid of bile, they also contained a little blood. There was great tenesmus. After several attacks of syncope the patient died on July lyih, 57 d, after taking the poison. The urine on the 9th d. contained albumen and some casts. The quantity of urine gradually diminished, but its sp. gr. increased j every trace of chlorides disappeared during the last days.^ — F,M. Heart small, contracted, but little blood in it ; muscular structure of heart pale, partial tatty degeneration. CEsophagus somewhat contracted behind cricoid cartilage and just above stomach, the m.m. there replaced by cicatricial tissue. Stomach and intestines very contracted, some blackish fluid in stomach. In the cardia some cicatrices, which extend in stripes along reddened m.m, of posterior wall of stomach. In the small curvature a continuous cicatrix to pylorus, which IS so contracted that it will scarcely admit a blade of the scissors, the walls of stomach very hypcrtrophicd j a portion of the duodenum is involved in the cicatrix. The remainder of duodenum is much congested. Close to valve of ileum a large Peyerian plaque with swollen follicles. Sigmoid flexure congested. Spleen hard, dark blue, small. In posterior wall of larvnx cicatricial streaks. Kidneys large, rather congested, its canaliculi contain granules and fat corpuscles. (IHd,^ No. 36.)

4* A cobbler's apprentice, Kt. 16, on June yd^ at 5 a.m., drank a mouthful of strong sulph. ac* He drank milk to allay the pain, and vomited at first black, later bloody stun. He was brought to the hospital, and magnesia and ice pills given, which relieved him somewhat. Skin moist, temp. 385'^ C, face red, pulse 116, resp. 14. The pains behind sternum to stomach are burning, aching, and cause anxiety j they arc much increased by swallowing, which is effected with great difficulty and only of fluids. Pressure on and behind larynx very painful. Epigastrium distended and very tender. Tongue covered with greyish fur, portion of its epithelium detachea. Vomiting ceased, but eructations commenced, and each time brought up a small quantity of reddish^brown fluid. — 4th. All symptoms increased, voice hoarse. The pain in abdomen severe, extending from stomach to meso- and hypo.gajstrtum Burning throat, swallowing very difficult, and fluid swallowed immediately vomited tinged with blood. — 5th. Better, tongue clean and niim, of mouth free from sloughs^ but still red and swollen. Vomiting ceased on 8th, At end of ist week voice was quite right, swallowing easy. The irritability of the stomach continued and in and week he still vomited after all food. He had acid eructations after drinking water, and the burning thirst conrinucd. In 3rd week he had tenderness on pressure over

symph. pubis, frequent call to urinate, and the urine passed with cutting pains. The prostate gland Felt through rectum was swollen and very tender. This went off in about nine d. But patient emaciated and grew very weak, the pulse got small and quick (loo — ii6), temp. 36*8° C. On June 25th, in the r. lower part of chest, he had paroxysms of violent stitches, especially when he breathed deeply. Nothing abnormal on auscultation. An acute pain on pressure to r. of 4th — loth vertebra in the axillary aspect of 5th — loth intercostal space^at the point of junction of the corresponding ribs to the cartilages. The skin between axilla and mamma is very sensitive. Vomiting recurred after this to a great extent, the vomited stuff was acid and mixed with bile. He became collapsed and seemed as though about die, but he rallied, the vomiting in the 6th week became less, his strength increased. At end of 6th week he got a great swelling of 1. parotid gland ; in 7th week this opened and discharged pus by the meatus auditorius. During all his illness bowels very constipated. The urine showed albumen and cylinders, and free uric acid for 5 or 6 weeks. (Ibid,)

1. A cook, set. 34, who had been in hospital for cough, palpitation of heart, swelling of legs, and emaciation. On her dismissal, not quite cured, drank in despair on Nov. 6th, at 8 a.m., 2 mouthfiils of sulph. ac. (i strong acid to 4 water). Immediately violent pains, burning in throat, great pain in stomach, followed soon after by vomiting of black stuff. Brought to hospital at 10 a.m.; skin cool, great cyanosis of face, extremities, fingers and toes, which felt very cold. Pulse very small, scarcely to be felt, regular, 72 ; respiration calm ; temp. 345° C. She had violent pains in throat, especially on swallowing ; pain in ^tric region. Epigastrium rather tense, very sensitive to touch and pressure. Milk is immediately vomited along with blackishbrown fluid. The microscope shows these brown parts are epithelium and blood acted on by the acid. P.m., milk and ice, magn., morph. subcut. In e., pulse 76, temp. 356° C, no vomiting since noon. Violent pain when swallowing, tenderness of epigastrium, cyanosis continues. Urine deposits a flaky sediment of red colour, acid reaction, the sediment consists of pavement epithelia and many cylinders, granular, sp. gr. 1033, ^^ albumen or sugar. — 7th. Pulse regular, small, 104, temp. 35'3®, Skin warmer. Pain on swallowing less, more pain in umbilical region, whicn is very painful to touch. No stool. Urine as yesterday. £., pulse 104, fuller, temp. 37°. Less pain, no vomiting. A firm brown stool, cyanosis gone, abdomen moderately tense. Urine contains many pus-corpsucles. — 9th. Pulse 100, resp. 24, temp. 384 . Slept well, cheeks red, warm skin. Epigastrium more distended and very painful to touch. More pain when swallowing. Lips, palate, fauces, and tonsils show circumscribed white spots. Urine, sp. gr. 1026, as yesterday. E., pulse 88, temp. 38'5°, large shreds come away from mouth, pain in swallowing great. — 9th. Pulse 112, resp. 40, temp, 379**, urine as before. E., pulse 100, resp. 32, temp. 391°. The shreds of membrane continue to come away from mouth. — loth. Urine contains much uric acid. E., pulse 112, temp. 382°, pains less. — nth. Little sleep, continues to eject shreds. — 13th. More pains on swallowing. Vomited with great retching a long blackish-brown firm tube, rough on outside, smooth internally, the m.m. and part of mascular coat of the oesophagus 34 centimetres long. Patient went on apparently improving. — Dec. 2nd. I'hroat uneasy, something seems always to rise up in it, vomiting for the last few d. repeatedly. Swallowing became so difficult that on Dec. 4th she could not swallow at all. — T3th. Can swallow liquid food without difficulty* Emaciation increasing. She gradually* wasted away and died on Jan. 5th. — P.Af. Stomach attached by fibrinous bands to pancreas. Its walls are moderately thickened and its size is small. The small curvature is so contracted it will only admit the little finger, pylorus very contracted, will only allow a crowquill to pass. Internal surface covered with coat of pus, pale red-white cicatricial streaks with intervening pale tissues. No m.m. apparent. Fundus of the size of a thimble, smooth intemsuly, partly strongly injected. Corresponding to pylorus, the outside of stomach is fast attached to liver and omentum. (Esophagus very much contracted, its walls very thin, cicatrised. [The report of the F,M, is very long, but the above are the principal things observed.] (Wyss, JrcA. d, Hiilk,^ x, 1869.)