Extracted from the American Journal of the Medical Sciences for October, 1881. 
CONTRIBUTIONS TO THE STUDY 
OF THE TOXICOLOGY OF CARDIAC DEPRESSANTS. 
I. CARBOLIC ACID; 
A SUMMARY OF FIFTY-SIX CASES OF POISONING, WITH A 
STUDY OF ITS PHYSIOLOGICAL ACTION. 
BY 
EDWARD T. REICHERT, M. D., 
FORMERLY DEMONSTRATOR OF EXPERIMENTAL THERAPEUTICS AND INSTRUCTOR 
IN EXPERIMENTAL PHYSIOLOGY IN THE POST-GRADUATE COURSE IN 
MEDICINE, IN THE UNIVERSITY OF PENNSYLVANIA. [Extracted from tlie American Journal of the Medical Sciences for October, 1881.] 
CONTRIBUTIONS TO THE STUDY OF THE TOXICOLOGY 
OF CARDIAC DEPRESSANTS. 
I. CARBOLIC ACID; 
A SUMMARY OF FIFTY-SIX CASES OF POISONING, WITH A STUDY OF ITS 
PHYSIOLOGICAL ACTION. 
By EDWARD T. REICHERT, M.D., 
FORMERLY DEMONSTRATOR OF EXPERIMENTAL THERAPEUTICS AND INSTRUCTOR IN 
EXPERIMENTAL PHYSIOLOGY IN THE POST-GRADUATE COURSE IN 
MEDICINE, IN THE UNIVERSITY OF PENNSYLVANIA. 
Last June, while pursuing a series of experiments in connection with 
a paper on the dangerous properties of chlorinated, brominated, and 
iodated anaesthetics,1 it occurred to the writer that all decided cardiac 
depressants were capable at times, like chloroform, of acting wholly out of 
proportion to the dose used, even under apparently similar circumstances, 
and several instances were cited of poisoning by aconite, apomorphine, 
and tartar emetic, in connection with the cases due to the above classes of 
anaesthetics, to illustrate this belief. Not feeling satisfied to allow so 
interesting a question, and one of such momentous importance to the thera- 
peutist, to remain unsettled, a survey of the articles on the toxicological 
effects of cardiac depressants was made. But the absence of statistical 
papers was so noticeable, and the details given so inadequate, and often- 
times so inaccurate, that the urgent need was felt for a series of papers 
which would faithfully depict the poisonous phenomena and such other 
features as would seem to be of interest and value to the therapeutist and 
toxicologist. 
I have selected carbolic acid as the earliest to be discussed, because the 
knowledge of its physiological action among the profession seems to be so 
very limited, and as no study of any large number of cases has yet been 
made—the deductions appearing in the several essays already published 
evidently being based on a consideration of but few cases. 
1 See page 50 of the preceding number of this Journal. 2 
The following are the records of the cases, which have been very con- 
siderably condensed:— 
Cask I. Female, aged 43.—Dose and -preparation taken. Amount (?) ; crude. 
—Symptoms. Insensibility; retching; breathing stertorous ; pupils contracted; 
pulse intermittent.—Treatment. Chalk; 7 ounces of olive oil injected into the 
stomach by stomach pump, and subsequently an emetic was given.—Result. 
Death in six hours. 
Autopsy and Remarks. Strong smell of carbolic acid detected ; oesophagus 
dark gray colour, harsh to the touch, and the inner part friable and tearing 
readily. The mucous membrane of the stomach was in a similar condition. The 
intestines presented the appearance from a dark gray above to a bright red and 
congested appearance in the jejunum. Brain congested. Blood incoagulable, 
and remained fluid up to time of writing, which was five days. Brain con- 
tained 3jij serous fluid. (Harrison, Lancet, 1868, ii. p. 133.) 
Case II. Male, aged 64.—Dose and preparation taken. Rather over gj in 
of oil.—Symptoms. In ten minutes : the patient looked ill; flushed, perspiring, 
ineffectual attempt to vomit; eyes rolling wildly as if bewildered ; mouth, tongue, 
and fauces whitened. (Mustard given, but stomach ineffectually evacuated ; 
pump used and albumen given; castor oil injected into stomach.) In an hour: 
mental equilibrium restored ; skin hot and perspiring; face flushed ; pupils strongly 
contracted ; pulse, rapid and soft; breathing somewhat laborious ; voice harsh ; 
deglutition difficult; thirst; retching; burning pain and tenderness at epigas- 
trium. Acute gastritis supervened ; features occasionally distorted by convulsive 
twitchings ; hot, dry skin ; temp. 102.5°, cold extremities ; respiration shallow ; 
pulse 140, small and hard; pupils contracted; intelligence perfect. Collapse 
ensued; imperceptible pulse; and cadaverous features.— Treatment. Emetics, 
albumen, castor oil, and stomach pump.—Result. Death in twelve hours from a 
failure of heart. 
Autopsy and Remarks. The man had a compound comminuted fracture of the 
thigh, and in the above toxic condition bore manipulation with perfect equanimity, 
as if he was almost anaesthetized. (Anderson, Lancet, 1869, i. p. 179.) 
Case III. Female, aged 44.—Dose and preparation taken. Nearly 3j impure 
carbolic acid.—Symptoms. Dyspnoea; epigastric pain; restlessness; mouth and 
lips whitened ; brown stain on the chin ; pulse 140, feeble ; difficulty in swallow- 
ing ; stupor ; breathing slow and stertorous ; pulse exceedingly feeble; comatose. 
— Treatment. Zinc sulphate, olive oil; no vomiting ensued; stomach pump 
used, and warm water injected.—Result. Death in 50 minutes. 
Autopsy and Remarks. Left lung greatly congested; right emphysematous ; 
mucous membrane of both lungs congested ; left ventricle of heart strongly con- 
tracted, right partially so; mucous membrane of mouth, oesophagus, and stomach 
converted into a soft white material; blood fluid, became light red on exposure. 
(Brabant, Lancet, 1873, i. p. 302; also in Guy's Hasp. Riep., 1879.) 
Case IY. Female, aged 7.—Dose and preparation taken. 3ss diluted with §j 
glycerine and water.—Symptoms. Ten minutes—insensible; pulse almost im- 
perceptible; pupils contracted ; conjunctival reflex gone ; temperature lowered ; 
respiration catching and slowed; died comatose.—Treatment. Stomach pump, 
gruel and oil, enema of brandy; heat of body maintained.—Result. Death in 
1 hour and 25 minutes. 
Autopsy and Remarks. Right side of heart full of blood, which was dark and 
fluid ; also larger vessels full of similar blood. Left ventricle contracted, and con- 
tained only two drachms of blood. No abnormality in lungs or abdominal viscera, 
except alimentary canal. The tongue, mouth, fauces, oesophagus, and stomach 
and upper part of duodenum unaffected by poison, but small intestine for three 
feet was whitened. Blood fluid ; brain contained much venous blood; no effu- 
sion into the ventricles, which were quite dry ; odour of carbolic acid detected in 
brain. (Rickards, Lancet, 1873, i. p. 876.) 
Case Y. Female, aged 20.—Dose and preparation taken. 3iss impure undi- 
luted acid.—Symptoms. Mouth and tongue whitened ; pain in oesophagus and 
stomach ; swallowed readily ; hesitancy in speech in four or five minutes ; stum- 3 
mers ; totters in walk ; insensibility in eight minutes; unable to swallow; breathing 
stertorous; pupils unaffected ; pulse frequent, small and intermittent; extremities 
warm up to the time of death.—Treatment. Six eggs given through stomach 
tube; water and magnesia ; the contents of stomach drawn off; artificial respi- 
ration for half an hour witb some benefit.—Result. Died in little more than an 
hour after taking the poison-. 
Autopsy and Remarks. Lips and nose blistered ; sinus of dura mater gorged 
with dark tarry blood ; bloodvessels on surface of brain full; lungs and heart 
healthy, the latter empty; mucous membrane of mouth whitened, and of oeso- 
phagus and stomach congested and peeled off with the slightest touch ; mucous 
membrane of intestinal canal did not appear much changed; smell of carbolic acid 
in all the organs ; green stains in the stomach. (Swain, Lancet, 1869, i. p. 395.) 
Case VI. Male, adult.—Dose and preparation taken. Probably a mouthful 
of impure acid.—Symptoms. Probably ten minutes elapsed, then vomiting ; 
comatose ; contracted pupils ; intermittent pulse ; stertorous breathing ; frothing 
at the mouth; livid appearance of eyelids, lips, and ears.—Treatment. Emetic 
by means of stomach-pump, but without success.—Result. Died in three-quarters 
of an hour. 
Autopsy and Remarks. Tongue and fauces corroded. (Gerrard, Lancet, 1871. 
i. p. 672.) 
Case VII. Female, aged 37.—Dose and preparation taken. f$j of—acid 1-10 
linseed oil—(nearly 50 grains).—Symptoms. Twelve minutes or more, sufficiently 
conscious to reply when spoken to sharply ; skin moist; face dusky ; pulse weak ; 
pupils slightly dilated ; unconsciousness ; duskiness deepened ; moisture of skin in- 
creased ; pupils dilated; pulse quick, irregular, and scarcely perceptible ; breathing 
regular and noisy. In three-quarters of an hour, coma complete; face livid; 
pupils dilated ; body and extremities warm and moist; pulse imperceptible ; soft 
palate and tongue relaxed ; breathing slow and regular ; reflex sensibility of con- 
junctiva was now altogether lost.—treatment. Stomach washed with tepid 
water ; the oil which came out did not smell of the acid ; aqua ammonise (2 gtts. 
FFF.) injected into vein of forearm, and in a few seconds the radial pulse became 
perceptible. Repeated injection in one-quarter of an hour with benefit.—Result. 
Recovery. (Shaw, Lancet, 1875, ii. p. 451.) 
Case VIII. Female, aged 29.—Dose and preparation taken, ifss (crude).— 
Symptoms. 5 minutes: collapse; cold; clammy; pulse 112, almost impercep- 
tible ; conjunctiva insensible; pupils dilated and immovable ; respiratory move- 
ments almost imperceptible, and were 56 in a minute; froth from the nostrils ; 
breathing stertorous; cardiac movements weaker and intermittent; pupils con- 
tracted somewhat; face livid.—Treatment. Olive oil given first with a spoon 
and then with pump; solution of sodium carbonate given; stomach emptied; 
brandy per rectum, and mixed with milk ; sinapisms to legs.—Result. Died in 
forty-five minutes. 
Autopsy and Remarks. Rigors strongly marked; dependent parts congested ; 
skin corroded at angles of mouth ; froth from inflamed nostrils ; blood fluid, and 
smelt of carbolic acid ; brain smelt of acid ; ventricles of brain full of serous fluid, 
odour of carbolic acid detected; vessels full of fluid blood; trachea in a state of acute 
inflammatory congestion ; lungs and bronchial tubes congested; heart pale and 
flabby, and contained fluid blood in all cavities ; mouth and tongue blanched; 
mucous membrane of oesophagus white and rough, and the epithelium appeared 
replaced by false membrane which could be stripped off, leaving a red congested 
surface ; cardiac end of stomach reddened, and in a state of acute inflammatory 
congestion, mucous membrane soft and smooth ; bladder contained four ounces of 
urine, smelt of carbolic acid, but otherwise normal. (Packer, Lancet, 1878, ii. 
p. 511.) 
Case IX. Male, aged 32.—Dose and preparation taken. 10 A. M., swal- 
lowed a quantity of a solution.—Symptoms. Immediately: nausea; cold sweats ; 
stupor; unconsciousness (12.30, magnesia given) ; profound insensibility; noisy, 
tracheal rales in breathing ; death apparently imminent. (Mustard poultices ap- 
plied to the whole surface.) 5 P. M. : temperature risen nearly to normal; 
coma ; complete relaxation of the limbs persisted; anajsthesia of skin and mucous 4 
membrane of month, nose, pharynx, and bladder; complete loss of reflex excita- 
bility ; cornea and conjunctiva insensible; pupils contracted ; respiration (48) 
stertorous, with tracheal rales ; pulse (128) small. He had passed no urine, but 
some which was drawn off was yellow, with a violet tint by reflected light, and 
which smelt of carbolic acid. On its surface were some oily drops. Some drawn 
blood was of a singular brown colour, and possessed the odour of the acid. The 
clot formed was soft and diffluent, and did not contract.—Result. Death in nine 
and a half hours. 
Autopsy and Remarks. All parts smelt strongly of carbolic acid. No distinct 
lesions of the mucous membrane were found above the stomach. The membrane 
of the stomach wras thickened, marked with black cauterized spots, and elsewhere 
deeply congested, and in one or two places were submucous hemorrhages; it Avas 
not ulcerated ; kidneys deeply congested ; some spots of effused blood under the 
capsule and in cortex ; the tubidi were perfect; epithelium fatty and completely 
degenerated. Albumen and acid found in the urine. (Rendu and Patrouillard, 
Jour, de Pharui. et de Chem., Dec. 1871 ; New Remedies, April, 1872, p. 341.) 
Case X. Male, aged 60.—Dose and preparation taken. Not more than (?) 
—Symptoms. Frothing at mouth; countenance turgid; quite speechless.— 
Result. Died in a few minutes of shock and depression. 
Autopsy and Remarks. Body discoloured ; superficial veins engorged ; mouth 
and throat whitened; faint odour of carbolic acid ; veins of scalp gorged with 
dark blood ; brain free from any sign of congestion ; but little fluid in cerebral 
ventricles, merely moisture; lungs full of dark blood, but normal; heart pale, 
fatty, quite empty; stomach contracted and coats thickened ; contained about 
an ounce of turbid, pinkish fluid, smelling strongly of carbolic acid and giving 
a strong reaction ; mucous membrane whitened on tops of furrows but reddish 
in furrows; oesophagus slightly affected ; no trace of severe local effects in in- 
testines, which were reddened along superficial surface. The appearance of the 
mucous membrane extraordinary and characteristic ; cardiac end of stomach prin- 
cipally affected. (Barlow, Lancet, 1869, ii. p. 404.) 
Case XI. Female, aged 60.—Dose and preparation taken. )$vj (?) Calvert’s 
used in XI., XII., and XIII.; applied acid to surface of body; had itch.—Symp- 
toms. In a few moments smarting pain and headache ; giddiness, approaching 
insensibility. Twenty-five minutes: prostration; spasmodic breathing; total 
insensibility ; surface of body hard and dry ; occasional spasm of diaphragm ; 
pupils unaffected and responded to light. Continued unconscious for four hours, 
the breathing was laboured and slow.— Treatment. Acid washed from skin by 
tepid water and soft soap; brandy with ammonia and ether, some was swallowed. 
—Result. Died in four (?) hours. 
Autopsy and Remarks. Small patches of sloughy skin about the body. (Ma- 
chin, British Med. Journ., 1868, i. p. 220.) 
Case XII. Female, aged 23.—Dose and preparation taken. (See Case XI.) 
Applied acid to surface of body.—Symptoms. (See, also, Case XI.) Unconscious 
for five hours ; consciousness gradually returned ; attempts at vomiting; mustard 
given; but little of stomach contents were evacuated ; retching considerable ; strong 
odour of carbolic acid in expiration; respiration lost spasmodic character, quick 
and irregular; continued pain in head and throat. In the morning epileptiform 
convulsions came on; pain in head better, but throat unrelieved; symptoms of 
congestion of lungs; gradually sank; conscious until the last. Patient said 
to be an epileptic, and to have had convulsions when application was made.— 
Treatment. Emetic of mustard given with but little effect; strong coffee given 
with benefit; leeches to temples in course of morning; alkaline mixture of 
potassium chlorate and chlorine given, but symptoms of congestion of lungs 
came on and patient collapsed.—Result. Died in about forty hours. 
Autopsy and Remarks. Small patches of sloughy skin about the body. (Ma- 
ch in, British Med. Journ., 1868, i. p. 220.) 
Case XIII. Female, aged 68.—Dose and preparation taken. (See Case XI.) ; 
applied the acid to surface of body ; had itch.—Symptoms. (See, also, Case XI.) 
Rallied in about four hours; states that as soon as dressing was used, she felt giddy- 
drunk ; head felt constricted by band ; unconsciousness ; no vomiting in this case ; 5 
pulse (80) regular and feeble; skin harsh, dry, puckered; no vesication in any 
of the three cases (XI., XII., XIII). Skin thrown off often in scaly patches.— 
Treatment. (As in Case XI.)—Result. Recovered in twenty-one days. (Ma- 
chin, British Med. Journ., 1868, i. p. 223.) 
Case XIV. Female, aged 51.—Dose and preparation taken. A case of exci- 
sion of elbow-joint. Dressed with lotion, one part to fifty.—Symptoms, etc. Dec. 
2, seventy-two hours: “shivering fit;” tongue rapidly fouled ; pulse 100-120, 
weak and irregular ; skin cold and clammy ; very uncontrollable vomiting; face 
pinched and anxious ; spirits depressed. Fifth day, rapidly sinking ; pulse 130- 
140, and thr.eady ; tongue has a brown coat; cerebration clear ; urine scanty and 
loaded with lithates, but not dark or carbonaceous. The carbolic lotion was the 
same day changed and flaxseed used instead, and in the course of forty hours pus 
was present in poultices, and the constitutional irritability removed. Improving 
up to Dec. 15, when lotion was again employed (same strength). Thirty-six 
hours: vomiting, and same symptoms as before. The discharge, which was puru- 
lent on the 15th, became scanty and rusty on the 17th; poultices again substi- 
tuted on the 18th.—Poultices used up to the 27th, when lotion was applied with 
a similar result as above ; wound was now nearly healed. The lotion was dis- 
continued and warm water used.—Result. Recovered. 
Remarks. Nothing was found in this case to be able to check the vomiting 
caused by the carbolic acid. (Lightfoot, British Med Journ., 1870, i. p. 331.) 
Case XV. Dose and preparation taken. One part to five of linseed oil, used 
as a dressing for bedsores in typhus fever.—Symptoms. Two days dressed with 
lint soaked with the carbolic acid and oil. After the second dressing severe vomit- 
ing ; urine became very dark. On discontinuing carbolized oil, the symptoms 
ceased, and urine became natural. No signs of blood corpuscles in the urine 
could be detected with the microscope, only carbonaceous particles.—Result. 
Recovered. (Wilks, quoted by Lightfoot, Brit. Med. Journ., i., 1870, p. 332; 
also Guy's Hasp. Reports.) 
Case XVI. Male, adult.—Dose and preparation taken. Carbolic enema.— 
Symptoms. During administration fit occurred ; stertorous breathing.—Result. 
Death in twenty minutes. (Worcester Infirmary, quoted by Lightfoot; Ibid.) 
Case XVII. Female, aged 1 year.—Had extensive ulceration of gluteal region 
and labia, following from sitting on block on which some of the disinfectant, |jj 
to Oj of water, had been thrown two days before.—Symptoms, etc. The next 
morning after sitting on the block the blistering had commenced and ulceration 
rapidly followed. Used fullers’ earth and French chalk with comforting effect. 
On fifth day used lotion of lead-water with glycerine, several sloughs formed 
and separated ; child became weaker from exhaustion and shock ; some signs of 
internal inflammation ; usual remedies used.—Result. Died on tenth day. 
Autopsy and Remarks. Rectum inflamed ; patches of inflammation in intes- 
tine ; right pleura much inflamed. Child had been perfectly healthy before. 
(Sandwell. British Med. .Journ., ii., 1870, p. 382.) 
Case XVIII. Male, aged 47.—Dose and preparation taken. (?) 
(crude, black and oily).—Symptoms. Shortly afterward found insensible ; smelt of 
carbolic acid; speechless; cannot walk; unconscious; stertorous breathing; puff- 
ing of lips at expiration ; heat of body natural; pulse disturbed (84-106) and inter- 
mitting; emetic had no effect; lips, gums, and tongue whitened; no muscular 
movements in three or four hours ; eyelids closed; pupils contracted to a pin’s 
point; at six and one-half hours opened eyes and moved the extremities; after 
tin’s pupils expanded; began to speak ; asked for cold water, but never regained 
complete consciousness. Then laborious breathing occurred; difficult muco-puru- 
lent expectoration ; breathing easier and coma lessened; severe pain in back; 
respiration 46-48. Eight and one-half hours : passed a quantity of very dark- 
coloured urine, which smelt of carbolic acid. Afternoon, attempted to pass water, 
but unsuccessfully ; brow, face, and hands covered with a clammy perspiration ; 
collapse.—Treatment. Castor oil, olive oil, and emetic; stomach-pump (would not 
work) ; ammonium carbonate and brandy, but to no purpose.—Result. Died in 
thirteen and one-half hours. 
Autopsy and Remarks. Lividity of back and front of neck and chest; face 
sallow ; pupils natural; watery froth and yellowish fluid at mouth and nostrils, 6 
which smelt of carbolic acid; clot in longitudinal sinus; dura mater and arach- 
noid congested ; blood smells of carbolic acid ; serum found in ventricles and sub- 
arachnoid ; gray matter of brain of pink hue; intense congestion of vessels on 
under surface of pons and medulla. Mucous membrane of mouth, throat, and 
gullet whitened, sodden, soft, and easily detached; §ij thick brownish pulp in 
stomach ; great curvature covered with hard, reddish, and elevated points the 
size of shot, without any marked congestion ; similar points on other portions of 
stomach, tending to follow the course of the vessels; stomach otherwise normal, 
perhaps more vascular. Portions of intestine of slate colour ; containing brown- 
ish pulpy substance ; heart full of dark firmly clotted blood on both sides, right 
side §iv, left 3ij ; whitish urine in bladder; universal smell of carbolic 
acid ; blood everywhere firmly clotted. (Ogston, Brit. Med. Journ., 1871, i., 
p. 116.) 
Case XIX. Male, adult. Dose and preparation taken. Exposed for three 
hours to fumes of strong carbolic acid.—Symptoms. Violent convulsions with 
trismus ; quite comatose ; lividity of face ; stertorous breathing ; extremities and 
surface cold ; pulse scarcely perceptible ; warm bath was given ; in forty minutes 
convulsions ceased ; sensibility partly restored ; face and neck assume a natural 
hue; symptoms improved. Six hours later, passed urine, which was more acid 
than normal, but no odour of carbolic acid ; complained of giddiness ; no pain in 
head, but pain in face and eyes, with taste of carbolic acid in mouth and throat, 
and gastric irritation.—Treatment. Wrapped in blankets; hot water to feet; 
cold applications to head, and mustard to nucha; aperient mixture, bismuth sub- 
nitrate, dilute hydrocyanic acid (P. L.), a gargle of potassium chlorate and 
myrrh, and a liniment of belladonna with soap liniment to neck and face; warm 
baths.—Result. Recovered. (Nuthank, Brit. Med. Journ., 1872, ii., p. 579.) 
Case XX. Male, aged 7.—Dose and preparation taken. Probably a mouth- 
ful of the impure carbolic acid.—Symptoms. Stertorous breathing; complete 
stupor; total muscular relaxation; anaesthesia; pulse feeble and rapid (160); 
temperature lowered; pupils contracted; salivation; power of swallowing lost; 
failure of respii’ation and pulse; collapse.—Result. Died in about seven hours 
after symptoms were first observed. 
Autopsy and Remarks. Post-mortem in twenty-four hours : rigor mortis pre- 
sent, but not to any marked degree; cerebral sinuses distended by dark fluid 
blood and some soft coagula ; cerebral vessels in a similar condition; little fluid 
in subarachnoid space and ventricles ; faint odour of acid detected, also in thorax, 
but intensified ; venous congestion of thorax and abdomen ; blood dark and fluid ; 
lungs congested, oedematous, and emphysematous; heart empty, left ventricle 
contracted, right one flaccid, also empty ; no coagula in great vessels ; mucous 
membrane of mouth, throat, and oesophagus white, sodden, congested, but not 
detached; stomach same character; contained some injection, but no capillary 
hemorrhage; liver, spleen, and kidneys hyperaemic ; bladder contained eight 
ounces urine of an olive-green tint, peculiar mixed odour, contained no albumen ; 
carbolic acid detected in urine with chemical tests, and also in viscera. (Perrier, 
Brit. Med. Journ , 1873, i. p. 167.) 
Case XXI. Male, aged 36. Dose and preparation taken. Probably of 
undiluted acid.—Symptoms. Five minutes : mortal agony ; lividity; protrusion 
of eyeballs ; continued subdued cry of “ wild and fear-inspiring tone,” which was 
broken by gasping respiration and inefficient attempts to vomit; condition fol- 
lowed almost immediately by profound insensibility. From the first the pulse was 
very rapid and feeble ; respiration short and infrequent; pupils unaffected.— 
Treatment. Olive oil poured in the mouth ; warm water was injected in stomach 
and withdrawn, impregnated with carbolic acid ; second injection of olive oil ; 
difficulty of introducing pump experienced.—Result. Died in thirty minutes, 
apparently asphyxiated. 
Autopsy and Remarks. Superficial veins, especially, extremely distended with 
blood ; lips and chin excoriated ; dura mater congested with dark venous blood ; 
arachnoid at vertex thickened with gelatinous matter ; brain healthy ; lungs em- 
physematous in front, passive congestion posteriorly ; pericardium contained jjj 
serum ; heart healthy, ail cavities full of blood, which was dark and perfectly fluid, 7 
with no coagula ; mucous membrane of larynx, trachea, and subdivisions highly 
congested, granular, and softened ; and air-tubes contained small quantities of olive 
oil and carbolic acid; tongue shrunken, pale, indurated ; mucous membrane of 
oesophagus white, glistening, softened, peeling off as if scaled ; mucous membrane 
of stomach softened and eroded, and with muscular coats reduced to a state of 
pulp, parts above orifices sustained most injury, and were of a dull, deep slate 
colour; small intestines similarly affected. (Hearder, Brit. Med. Journ., 
1878, i. p. 584.) 
Case XXII. Male, adult.—Dose and preparation taken. Two or three 
drachms in a mixture.—Symptoms. Immediately fell insensible and convulsed, 
and in eighteen minutes extremities were cold ; pulse scarcely perceptible and 
irregular; breathing stertorous ; consciousness lost; trismus.—Treatment. Stom- 
ach evacuated; bled to Oj—Result. Recovered on eleventh day. (Ilearder, 
loc. cit.) 
Case XXIII. Male, aged 72.—The patient was suffering with a suppurating 
stump.—Dose and preparation taken. Sucked carbolic acid from a sponge which 
had been placed under the bed as a disinfectant.—Symptoms. Semi-comatose ; 
pulse (98) feeble; respiration 48 ; olive oil and castor oil given, which was swal- 
lowed very slowly, also zinc sulphate and tartar emetic ; no vomiting ; pulse and 
respiration better; coma.—'Treatment. Olive and castor oil; 7)j zinc sulphate; 
two grains tartar emetic.—Result. Death in about four hours. 
A utopsy and Remarks. Lips, chin, right side of face, right breast and hand col- 
oured brown, and a strong odour of carbolic acid ; dura mater and arachnoid very 
much congested ; brain substance healthy. Mucous membrane of mouth and 
tongue white and softened, and of larynx thickened; of pharynx and oesophagus 
pale, thickened, soft, and corroded ; of stomach soft, corroded, congested, and 
also white. Intestines softened, and part corroded; odour of carbolic acid detected 
in the caecum. (Biddle, Brit. Med. Journ., 1873, i. p. 611.) 
Case XXIY. Female, aged 43.—Dose and preparation taken, impure 
carbolic acid.—Symptoms. Five minutes: insensible ; face blanched and perspir- 
ing ; pupils contracted; pulse 100, feeble and irregular; respiration stertorous, 
breath smelt of carbolic acid ; slight lividity of lips and tips of fingers. Rapidly 
grew worse, and became much swollen before death.—'Treatment. Emetic and 
stomach-pump ; the patient could not swallow the emetic, and the pump only 
brought out a small quantity of contents which smelt strongly of carbolic acid; 
difficulty of introducing pump experienced.—Result. Died in one and a half 
hours. 
Autopsy and Remarks. Angles of mouth and skin discoloured and shrivelled ; 
interior of moutli whitened ; tongue dry and chippy ; mucous membrane of oeso- 
phagus dry, shrivelled, and brownish ; heart feeble, both ventricles were empty ; 
mucous membrane of stomach readily peeled from walls, white patches over it, and 
whole slightly inflamed; mucous membrane of duodenum similarly affected, but 
less so; dura mater natural; arachnoid thickened and opaque; brain apparently 
healthy. (Sutton, Med. Times and Gaz., 1868, i. p. 456.) 
Case XXY. Male, aged 19. The patient was suffering with enteric fever, and 
the acid given by mistake.—Dose and preparation taken, jjss impure carbolic acid. 
—Symptoms. Unable to swallow ; almost pulseless ; difficult respiration ; lividity 
and a mottled appearance ; stools black-brown ; urine dark brown or blackish ; 
collapse.— 'Treatment. Brandy given; nutrient enemata of beef-tea and brandy, 
and iced milk by mouth.— Result. Died in two days. (Wiltshire, Meet. Times 
and Gaz., 1870, ii. p. 474.) 
Case XXVI. Male, aged 65.—Dose and preparation taken. 3ss-fj (?) 
impure acid.—Symptoms. Insensible; stertorous breathing; mouth and throat 
filled with mucus; stains of acid on chin ; pupil contracted ; pulse 40-50, and 
laboured; life nearly extinct; respiration irregular; heart-beats inaudible.— 
Result. Died in fifty minutes. 
Autopsy and Remarks. General aspect as if dead by asphyxia ; brownish lines 
from angles of mouth. Blood dark, fluid. No coagula, except in lungs. Mucous 
membrane of mouth and oesophagus whitened, firm, congested, hard, and tough. 
Stomach contained 5iv of thick, turbid fluid; smells of carbolic acid. Mucous 8 
membrane white, shrivelled, in granular masses, and easily scraped off; ruga? 
hard. Larynx, trachea, and bronchi filled with transparent mucus, streaked 
with blood. Heart flabby, and slightly fatty ; left side contained little blood ; right 
empty. Viscera congested. Arachnoid cavity contained gx fluid. (Jeffreys 
and Hainsworth, Med. Times and Gaz., 1871, i. p. 423.) 
Case XXVII. Female, aged 7.—Dose and preparation taken. Probably a 
mouthful, drunk from a demijohn of it used for disinfectant purposes.—Symptoms. 
Lips white, shining, and puckered ; odour of carbolic acid detected; face of a 
leaden hue ; cold sweat; eyes fixed ; pupils slightly dilated; extremities cold ; 
complete insensibility. Inability to induce emesis. Some improvement after use of 
stomach pump. Consciousness returned one and half hours after poisoning ; heart 
feeble ; pulse at wrist not countable. Pain in epigastrium. In three and three- 
quarter hours, respiration 40 ; pulse small and could not be counted. Pupils 
contracted; extremities cold. Three and three-quarter hours later, pulse 144; 
respiration 3G ; temperature 98°; less jactitation; drinks milk; “feels sick;’’ 
pupils widely dilated; relaxation of bowels. Twenty-third hour, face pale; 
respirations somewhat stertorous ; slight convulsions ; eyelids partly closed ; semi- 
conscious ; asks for milk constantly; lividity less; pupils dilated; extremities 
cold ; respirations 50 ; relaxation of bowels. In fifteen minutes, unconsciousness ; 
increased stertor; died five minutes later.—Treatment. Egg beaten up and poured 
down throat with a pump, three minutes after poison was taken, and shortly 
after albumen was given in same way. Later, a mixture of olive and castor 
oils, and afterwards wine of ipecac, were given. Stomach pump brought out 
albuminous coagula, which smelt of carbolic acid.—Result. Hied in twenty-four 
hours. 
Remarks. This patient was suffering with ascites. (Woodman, Med. Times 
and Gaz., 1875, i. p. 421.) 
Case XXVIII. Female, aged 40.—Dose and preparation taken. sjiv crude 
carbolic acid, which was taken at 9 o’clock in the evening.—Symptoms. In 
twenty minutes, uneasiness ; collapsed ; blanched ; no vomiting or convulsions ; 
respiration stertorous; pupils contracted; pulse hardly perceptible, not rapid. 
Washed out the stomach. Two hours later, condition better, but remained un- 
conscious. Midnight, semi-conscious ; pupils contracted ; pulse quick and feeble ; 
surface cold; convulsive twitchings; vomited bloody and oily matter. Some 
return of consciousness; able to swallow brandy and milk, but vomited. Late 
that day the evacuations of the bowels were black, and afterwards dark brown. 
Urine smoky colour and aromatic odour; no albumen. Epigastric tenderness. 
Dark-brown stain on upper lip, mouth, and chin. For a couple of days later she 
remained in a dangerous condition, and the urine remained smoky; she then im- 
proved slowly.—Treatment. Stomach pump ; mustard to calves of legs and 
heart; stomach thoroughly washed ; Oj olive oil injected. First day, milk and 
brandy, barley water, milk and lime-water, and ice.—Result. Recovery; left 
the hospital on the 17th, having taken poison before midnight on the 15th. 
(Davidson, Med. Times and Gaz., 1875, ii. p. 597.) 
Case XXIX. Male, aged 57.—Dose and preparation taken. Amount (?) 
eighty per cent. acid.—Symptoms. Carried into hospital insensible, and emetics 
given. Vomited freely. Tongue and mouth were quite white ; large white patch 
from mouth to chin ; sore throat during the night, but well otherwise. Olive oil 
applied locally, and a mixture of mucilage given, §j, every four hours, internally. 
Next day, sore throat; urine dark, clear, faintly acid, no albumen, sp. gr. 1044. 
Carbolic acid found in urine. Second day, sore throat; fauces covered with white 
patches ; tongue corrugated ; bowels open ; appetite good ; left hospital in the 
afternoon—Treatment. 25 grains zinc sulphate effectual; olive oil externally ; 
mist, mucil. ,§j every four hours.—Result. Recovered ; discharged second day. 
(Forster, Guy’s Hosp., Med. Press and Circular, 1878, ii. p. 42.) 
Case XXX. Male, adult.—Dose and preparation taken. About £ss Cal- 
vert’s No. 5.—Symptoms. “ Sudden and fatal sedation of nervous centres.” 
Probably died without suffering.—Treatment. Emetics given, but produced no 
effect.—Result. Hied in ten or fifteen minutes. (Hill, Rich, and Louis. Med. 
Jo urn.; quoted in N. Y. Med. Record, 1873, viii. p. 383.) 9 
Case XXXI. Male, adult.—Dose and preparation taken, jfss impure.— 
Symptoms. Suffered no uneasiness, except burning pain in throat for a few days. 
He had been an opium eater, and took some olive oil as soon as he found out his 
mistake.—Treatment. Olive oil.—Result. Recovered. (Outerbridge, N. Y. 
Med. Record, 1873, viii. p. 517.) 
Case XXXII. Male, aged 2£.—Dose and preparation taken, gj pure; equal 
to Calvert Xo. 2.—Symptoms. Immediately child ran about the room crying; 
then instantly became unconscious ; lividity ; eyes staring ; respiration stertorous ; 
foaming at the mouth and nose ; pupils dilated, but responding to light; twitching 
of muscles of the extremities ; capillary circulation slow. Vomiting excited to a 
slight degree by titillating the fauces ; quantity of tenacious, partially coagulated 
mucus expelled at each attempt at vomiting. Vomited mucus mixed with blood. 
Temperature raised ; cough croupy. Throat whitened and shrivelled. Urine 
dark olive-green colour, with odour of the acid. Stools greenish, thin ; became 
dark and smoky after standing some days.—Treatment. Olive oil; white of egg ; 
vomited ; milk and lime-water; bismuth and chalk every three hours.—Result. 
Recovered (Dusau, N. Y. Med. Record, 1878, xiii. p. 289.) 
Case XXXII1. Male, aged 5.—Dose and preparation taken. Cavity of open 
abscess injected with diluted acid, according to Callender, of London.—Symptoms. 
Radial pulse absent; skin pale, cold, and damp; respiration short, hurried, and 
over 100. (Brandy given hypodermically); pupils contracted. Belladonna given 
and repeated, pupils then became dilated; pulse perceptible; respiration 100, 
reduced to 70.—Treatment. Hypodermic injections of brandy ; belladonna.— 
Result. Recovered. (Post, N. Y. Med. Record, 1879, xv. p. 378.) 
Case XXXIV. Aged 2.—Dose-andpreparation taken, gj of mixture of equal 
parts carbolic acid and olive oil taken at eight o’clock.—Symptoms. Five minutes, 
pain in bowels ; soon became insensible. Ten minutes, partially comatose; pulse 
120; difficult breathing; congestion of lungs; paralysis of muscles of pharynx. 
8.30, insensible ; left pupil slightly dilated, but sensitive ; extremities cold. 8.45, 
left iris more dilated, less sensitive; breathing apparently improving under 
ammonia. 9, paralysis more marked; breathing becoming difficult, artificial 
respiration necessary. 9.20, pupils more sensitive to light; congestion of lungs 
becoming less. 9.30, pulse 140; breathing about normal; extremities warm. 
10, improving. 12.30, vomiting some ; oil given. Next day better; complains 
of pain in head.—Treatment. Carbonate of ammonia ; castor oil.—Result. 
Recovered in a few days. (Ghent, Canada Lancet, 1875, i. p. 67.) 
Case XXXV. Female, aged 50.—Dose and preparation taken, gij ; woman 
indelicate health.—Symptoms. Did not complain of much burning sensation; 
gave sodium bicarbonate and olive oil, followed by extract of ipecac. General 
debility ; violent burning sensation from fauees to stomach ; pulse slow, full, regu- 
lar ; semi-comatose ; can scarcely move her limbs ; relaxed ; with difficulty swal- 
lowed oil. Pulse unchanged. Forty minutes after taking poison, apomorphia 
given, followed by emesis ; vomit smelt of carbolic acid. Violent efforts at emesis 
every twenty minutes for one and a half hours. No sinking or flagging of pulse ; 
no cold extremities. Urine copious, smoky colour, smells strougly of carbolic 
acid; continued copious for twelve hours longer, and gradually improved ; bowels 
relaxed. Five and a half hours after poisoning, pulse 96, full and regular; tem- 
perature 101°. Lay in a critical condition for two days ; then greatly improved. 
—Treatment. Sodium bicarbonate, olive oil, enema of oil, apomorphia (about 
half a grain) hypodermically, mucilage, milk, and water.—Result. Recovered. 
(Semple, Virginia Med. Monthly, May, 1877, iv. p. 138.) 
Case XXXVI. Female, aged 39. Suffering with carcinoma uteri; the neck 
being nearly destroyed, leaving the body of uterus open.—Dose and preparation 
taken. Applied, locally, cotton-wool pessaries saturated with carbolic acid, gly- 
cerine, and oil, the carbolic being in the proportion of one part to eight of liquid. 
—Symptoms. This treatment was continued from Nov. 17th to Jan. 7th, when 
she suddenly became insensible ; convulsions ; inability to void urine. Suppres- 
sion of urine continued until the lltli, when some water was discovered in the 
bed. 17th, another convulsion; fatal collapse. For several days before 
death, anasarca.—Treatment. Dry-cupped loins, hot fomentations, salines, ten- 10 
minim doses tr. digitalis.—Result. Died. (Edwards, Practitioner, 1869, iii. 
p. 324.) 
Case XXXYIT. Female, aged 41. Suffering with cancer.—Dose and prepa- 
ration taken. Injection ordered of “one part of carbolic acid, glycerine 3 j, and 
3xx water.” This was used ter in die for some days; then “applied daily a cotton- 
wool pessary saturated with carbolic acid, tannin, and glycerine, the strength being 
one of acid to sixteen parts of water.”—Symptoms. Commenced treatment Sept. 
6th. Sept. 27th, hiccough; sickness; prussic acid and salines given, with a blister 
to epigastrium. Oct. 2d, rigors; extremities cold. 3d, partially unconscious; 
face cedematous ; legs much swollen ; no water passed. 4th, no better ; delirium 
at night; no water passed, and bladder emptied by passing a catheter. 5th, 
hemorrhage (uterine); anasarca; and at times, insensibility. 10 P. M. drew off 
§ij bloody urine. Oct. 8th, decidedly worse. 10th, little more urine passed. 
11th, died comatose.—Result. Died. (Edwards, Practitioner, 1869, iii. p. 324.) 
Case XXXYIII. Male, aged 40.—Dose and preparation taken. Probably a 
whiskeyglassful of the impure acid.—Symptoms. Pallor; coldness of surface ; in- 
sensibility, and coma ; respiration slow and laboured ; pupils fixed and insensible 
to light; no erosion or mark on face or lips. Stomach pump brought up a quan- 
tity of dark fluid. Next day passed dark, almost black, urine ; no carbolic acid or 
albumen in secretion. Pulse frequent and weak.— Treatment. Turpentine enema, 
sinapisms, stomach pump, ammonia to nostrils, opium, and morphia.—Result. 
Recovered. (Warren, Irish Hasp. Gaz., 1875, iii. p. 17.) 
Case XXXIX. Female, aged 33.—Dose and preparation taken, s;ss liquefied 
carbolic acid.—Symptoms. Immediately “ felt mad ;” “ fought the air.” Fif- 
teen minutes, uneasiness. 4 o’clock, uneasiness ; extremities somewhat flexed 
and rigid ; trismus; pupils contracted ; pulse feeble; respiration attended with 
“rattles.” 7 A. M. pulse extremely wreak ; surface cold. 12.30, severe burn- 
ing in stomach; sore throat; painful deglutition ; headache ; no thirst; tem- 
perature 98°; pulse 90 and weak. 7 P. M. delirious at times; nausea, but no 
vomiting; hurried respiration.—Treatment. Morphia, brandy, beef-tea, milk, 
eggs, etc.—Result. Recovered. (Walker, Boston Med. and Sury. Journ., 
1879, p. 797.) 
Case XL. Female, aged 35.—Dose and preparation taken. Scarcely less 
than %viij.—Result. Died very soon. 
Autopsy and Remarks. Mucous membrane of oesophagus, stomach, and small 
intestine thickened and corrugated, and of a bluish-white colour. Action of 
poison ceased abruptly fifty inches from pylorus. (Esophagus at point of stomach 
so much contracted that the point of a probe was passed with difficulty. Blood 
fluid, very dark; cavity of heart moderately full. Viscera and urine exhaled 
the odour of the acid. Mode of dying seems to be syncope or shock. (Way, 
Trans. Path. Soc., 1873, xxiv. p. 93.) 
Case XLI. Aged 21 months. — Dose and preparation taken, gj crude car- 
bolic acid.—Symptoms. Ten minutes, motionless; insensible, but recovered in 
a little time. Pupils contracted, insensible to light; conjunctiva insensible; 
pulse 120 and very weak; cold and clammy; lividity of lips; respiration im- 
peded; strong tarry odour of breath ; vomited frothy liquid. Unable to swallow 
emetic. Breathing grew worse; (artificial respiration used) ; lividity worse; 
(tracheotomy, which enabled the child to breathe easier). Four hours, respira- 
tion 80; anesthesia; contraction of pupil. Child vomited later.—Treatment. 
Unable to introduce emetic into the stomach, as oesophageal walls seemed 
spasmodically contracted; artificial respiration; tracheotomy performed.—Re- 
sult. Died in ten hours. 
Autopsy. Twelve hours after death. Brown discoloration of skin about 
mouth, which is dry and shrunken. Bronchi contained a brown-red liquid, which 
choked tubes and smelt of acid. Mouth whitened; dense epithelium loosely 
connected; oesophagus the same. White line terminated abruptly at stomach. 
Stomach, at anterior part, lower curvature, and in isolated patches on anterior 
and posterior surfaces, greatly changed. Change consisted of red-based patches 
with red borders, mostly limited to ruga?. Surface diphtheritic; walls of the 
jejunum natural. (Taylor, Guy's Ilosp. Rep., 1868, xiii. p. 233.) 11 
Case XLII. Male, aged 50.—Dose and preparation taken. Injection into 
piles (internal) of a “liquid composed partly of carbolic acid.” Had used on two 
occasions before with success, five weeks before the present one.—Symptoms. 
11 A. M. Felt at once “uncomfortable.” 4 o’clock, had a chill, with nervous 
distress. Passed a bad night ; sleeplessness; nervous distress; insupportable 
giddiness and strange feeling about the head. 6 A. M. treatment for carbolic- 
acid poisoning commenced. Afternoon, “ nervous chill, although warm ;” weak, 
irregular pulse ; giddiness, and impending convulsions. Giddiness continued for 
three days.—Treatment. “Eliminative character, with the bromides in addi- 
tion.”—Result. Recovered. (Wright, Cinn. Lan. and Clin., Aug. 1878, p. 
68; vol. i., New Series.) 
Case XLJII. Female, aged 22.—Dose and preparation taken. l§ss Calvert 
(No. 4). Patient just recovering from a second attack of relapsing fever. Took 
poison at 4.15 A. M. on September 17th.—Symptoms. 5 minutes, complete uncon- 
sciousness ; conjunctival retlex gone ; pupils normal and insensitive to light; sur- 
face livid, clammy ; perspiration, copious ; extremities cold; respiration husky, 
with considerable mucous rattle ; occasional moaning. Pulse shaky, feeble ; no 
whiteness or unusual appearance about the lips. Power of deglutition gone. 
5.30, pulse improved. 7.30, able to swallow. 8.30, greatly improved; pulse 
108, soft and feeble; lividity gone; body warm, but clammy. 12.30, passed 
green-black urine; vomiting; stools light-coloured and offensive; looseness of 
bowels. 18th, urine more clear and light. 19th, symptoms double basic pneu- 
monia. Pulse ranged between 108 and 130 until Oct. 13th, when she suddenly 
became worse and died at 9 A. M.—Treatment, £j brandy and milk enema; 
with stomach tube, gave in course of half hour Oj and §iss brandy. Fomenta- 
tions to abdomen ; hot bottles to feet.—Result. Died. 
Autopsy and Remarks. Autopsy : The woman had double pneumonia, which 
the author attributes to the effects of the acid. (Tennent, Glasgow Med. Journ., 
1870-1, p. 74-78.) 
Case XLIY. Male, adult. Acute eczema.—Dose and preparation taken. 
One part of carbolic acid to four of lard applied on lint to arms and thighs, and 
covered with oiled silk.—Symptoms. In an hour and a half “ profound coma ; 
pupils firmly contracted ; breathing stertorous ; pulse weak, quick, flickering; in- 
ability to swallow.—Result. (?) (Canada Med. Journ., 1871, vii. p. 8 ; quoted 
by Tennent.) 
Case XLV. Male, aged 32.—Dose and preparation taken. §ss in the oily 
state.—Symptoms. Five minutes, insensible; face livid ; bathed in profuse, clam- 
my perspiration ; eyes open and turned up ; pupils contracted and do not respond 
to light; mouth open, filled with frothy mucus; respiration stertorous; pulse 
imperceptible ; heart sounds scarcely audible; forced to swallow raw eggs and % vj 
mustard water—vomited ; could not pass tube on account of stricture of oesopha- 
gus.— Treatment. Raw eggs, mustard water, galvanic current, and artificial res- 
piration ; by stomach tube large quantities of soap, lime-water, olive oil, flaxseed 
mucilage, and fluids were given ; also counter-irritation.—Result. Died in one 
and a quarter hours. 
Autopsy and Remarks. Eighteen hours after death: Rigor well marked; 
blood dark and fluid, smelt strongly of carbolic acid ; venous system greatly con- 
gested ; membranes of brain congested ; sinuses all filled with dark blood ; mouth, 
pharynx, and oesophagus whitened ; stomach contained about i$viij chocolate- 
coloured fluid, mucous membrane chocolate coloured, roughened, and charred, 
and in some places completely destroyed, exposing the muscular layer, and every- 
where readily detached; destruction mostly near cardiac pouch ; the pylorus 
thickened, and velvety to the touch ; discoloration and destruction continued 
through the duodenum, fading along small intestines ; whole alimentary tract 
highly congested; heart flabby and empty ; lungs highly congested ; bronchi 
contained frothy mucus; kidneys and liver congested. (Houston, Med. and 
Sury. Rep., 1870, xxii. p. 32.) 
Case XLVI. Male, aged 23.— Dose and preparation taken. Probably a good 
swallow of the impure—“not likely more than an ounce.”—Symptoms. Two 
minutes: insensible, pulseless; pupils dilated; face pallid and pinched; respira- 12 
tion gasping; involuntary discharge of urine; respiratory interval prolonged ; 
heart ceased ; then the respirations.—Result. Died in about three minutes, not 
more. 
Autopsy and Remarks. Stomach moderately distended, intensely congested ; 
externally being of a dark venous hue; contained Oj of whitish-coloured liquid, 
smelling strongly of carbolic acid ; mucous membrane has a white film, and be- 
neath tins was congestion and a chocolate coloration ; the membrane was strongly 
corrugated, thick, higher and more rigid than normal, especially marked at car- 
diac extremity, and along the greater curvature, and in lower end of oesophagus. 
Scalp and meninges congested, and vessels filled with dark fluid blood. (Taylor, 
Phil. Med. Times, 1873, ii. p. 284.) 
CaseXLVII. Male, aged 48.—Dose and preparation taken. Gr. v of crystals in 
gij water.—Symptoms. Immediately experienced burning in the throat and stom- 
ach ; vertigo ; nausea, with retching, but could not vomit; paleness ; hyperaemia 
of fauces; pulse 90; cold and nervous (gave lime-water, tartar emetic, and 
ipecac) ; no vomiting; nausea and vertigo ; giddiness continued for eight hours, 
when emesis occurred, which relieved his nausea ; but the vertigo trouble per- 
sisted until the following day. — Treatment. Lime-water, tartar emetic, and ipe- 
cac.—Result. Recovered. (Winslow, Phil. Med. limes, 1874, iv. p. 817.) 
Case XLYIII. Aged two years.—Dose and preparation taken, Calvert, No. 
4.—Symptoms. Immediately screamed; drank §iv lime-water, §j olive oil, then 
insensibility supervened; ten minutes, profound coma ; tactile sensibility totally 
abolished ; surface pallid ; copious perspiration ; limbs flaccid ; eyelids closed, 
bluish; pinched expression; frothy saliva. Pulse (ICO) soft, feeble, irregular; 
respiration (70) laboured, irregular, jerking, stertorous, and hissing; mucous 
membrane of tongue and fauces white, with patches of marginal streaks of capil- 
lary injection. Pupils widely dilated, and do not respond to light. Oil placed in 
pharynx immediately rejected, attended with suffocative symptoms. Apomor- 
phine given occasionally; shudder, followed by slight clonic convulsions; pro- 
longed spasm of glottis causing deep cyanosis. Any attempt to clear the mouth, 
or to give anything, excited dangerous spasm of glottis and general convulsions. 
A prick of a pin would cause the same thing. In the course of a couple of hours 
consciousness returned, and he took considerable powdered chalk and sugar, white 
of egg, iced port wine, and milk. Died with meningitic symptoms.—Treatment. 
Lime-water and olive oil; apomorphine. — Result. Died in twenty hours. 
(Winslow, Ibid.) 
Case XLIX. Female, aged 20.—Dose and preparation taken. A hundred 
and forty-five grains in glycerine as an enema for ascarides.—Symptoms. She 
rapidly became convulsed, delirious, and finally nearly or quite insensible; sur- 
face cold and moist; pulse weak and flickering; pupils contracted ; breathing 
stertorous. — Treatment. Injection of milk, and rectum thoroughly washed; 
ammonia, camphor, and diffusible stimulants given by the stomach.—Result. Re- 
covered. (Pinkham, Med. and Surg. Rep., xix. 1868, p. 492.) 
Case L. Female, aged 29.—Dose and preparation taken. Half teacupful of 
carbolic lotion.—Symptoms. Vomiting soon began, accompanied with drowsiness; 
pupils natural. No drugs given. Free from symptoms next day. Urine a deep 
brown colour.—Result. Recovered. (St. George's Hasp. Reports, 1879, p. 25.) 
Case LI. Male, adult —Dose and preparation taken. Drank from a jug in 
mistake for whiskey.—Symptoms. In three minutes unconsciousness; no notice- 
able symptoms outside of the feeble, fluttering pulse, and frothing at the mouth. 
—Residt. Died. 
Autopsy and Remarks. (Esophagus contracted, and shows well-marked lon- 
gitudinal folds ; surface smooth, and of a peculiar bright, slightly yellowish-white 
colour, “closely approaching that of freshly-pulled molasses candy;” stomach 
strongly contracted, and summits of rug* marked with white lines, and in inter- 
stices were found granular detritus. (Harris, Boston Med. and Sura Journ., 
1880, i. p. 494.) 
Case LII. Female, aged 40 —Dose and preparation taken. “One or more 
swallows, ninety-five per cent, acid”—“at least 3ij entered stomach.”—Symp- 
toms. Five minutes: comatose; respiration stertorous; pupils contracted and 
insensible; profuse perspiration. (Tartar emetic failed to produce emesis.)— 13 
Treatment. Tartar emetic, lime-water, and olive oil freely.—Result. Died in 
three hours. (Park, Chicago Med. Gaz., 1880, i. p. 228.) 
Case LIII. Male, adult.—Dose and preparation taken. Lotion to necrosed 
tibia.—Symptoms. Pulse very feeble and flickering; respiration difficult; pale 
and anxious ; feet and hands cold. (Wineglassful of brandy.) In three or four 
hours patient felt better, but a little nervous. (Opiate.) Urine next day smelt 
strongly of carbolic acid.—Result. Recovered. (White, N. Y. Med. Gaz., 
1871, p. 274.) 
Case LIV. Male, aged 20.—Dose and preparation taken. gj pure fluid car- 
bolic acid.—Symptoms. First swallowed milk, raw eggs, glycerine, and mustard ; 
then inability to swallow. Half hour after poisoning, comatose condition ; un- 
easiness, except when aroused ; short, laborious, somewhat stertorous respiration; 
coolness, lividity, perspiration; feeble, almost imperceptible pulse.—Treatment. 
Forced down milk through tube. Pumped out the contents of stomach, and forced 
in milk and sweet oil, and pumped out again, and repeated.—Result. Recovered. 
Remarks. Vomited when recovered from coma. Felt as well as usual next 
morning, except a slight burning in the stomach. (Glisan, Amer. Journal of 
Med. Sciences, 1880, lxxx. p. 452.) 
Case LV. Female, aged 13.—Dose and preparation taken. 3ij pure carbolic 
acid. Water immediately given ; then emetic, with no effect.—Symptoms. In 
three minutes unconsciousness ; seven minutes “radial pulsation gave way eight 
to twelve minutes tonic spasms, mainly of flexors; breathing slightly stertorous. 
—Treatment. Enema of brandy and milk, and stimulating applications.—Result. 
Died in nineteen minutes. 
Autopsy and Remarks. Considerable corrosion of mouth and throat. (Sigler, 
Louisville Med. News, 1880, ix.-x. p. 294.) 
Case LV1. Male, aged 24. Had herpes on right side, extending from nipple 
to axilla, about five inches square.—Dose and preparation taken. Painted the 
herpetic part with a saturated solution of the acid.—Symptoms. Twenty minutes, 
faint, dizziness, weakness in legs, and symptoms of collapse. Symptoms lasted 
for half an hour.—Result. Recovered. (Paul, Phil. Med. Times, 1880, x. p. 
404.) 
Besides these cases, there have been reported seven others in English journals 
to which I have not had access: Cleaver (Liverpool Med. Sury. Rep., 1871, v. 
45) ; Wood (Jhid., p. 110) ; Maloney (Australia Med. and Surg. Journ., 1872, 
xvii. p. 73-77); Allen (Ibid., 1880, ii. p. 116); Peters, (Indian Med. Gaz., 
1863, viii. p. 423); Sheddon (Glasgow Med. Journ., 1872, v. p. 266) ; Wood- 
ham (Virginia Clin. Record, 1871-2, i. p. 272). There are also to be found 
a number in journals of other languages. 
Superficially reviewing the general symptoms of carbolic acid poison- 
ing presented by the above cases, we find that the poison is absorbed 
with great rapidity, and the evidences of its toxic properties are soon 
manifested. In the course of a few minutes they become so rapidly ag- 
gravated that the system is profoundly affected ; and, indeed, at least two 
cases offer good illustrations of its acting with the same deadliness and fright- 
ful rapidity as have been noted in cases of poisoning from the more viru- 
lent hydrocyanic acid. In cases which have been under observation 
from the time of the ingestion of the poison, symptoms have been observed 
to appear almost immediately, which indicate that the acid finds its way 
into the circulation as soon as it comes in contact with an absorbent sur- 
face, whether it be the skin, stomach, rectum, pulmonary acini, or wounds. 
The first symptom generally appreciated isa burning pain in the parts of the 
body with which the acid has come in contact, provided the acid has been of 
sufficient concentration ; in some cases, however, no pain is experienced and 14 
even a diminution of sensibility may be present. Disorders of cerebration 
are then likely to follow, as evinced by a confused condition of thought, 
difficulty of speech, depression, restlessness and bewilderment, vertigo, 
delirium. Insensibility is one of the most frequent, earliest, and constant 
of the phenomena, but occasionally it does not make its appearance until 
late. Nausea and vomiting may be present, but this does not occur in 
more than about twenty per cent, of the cases. Uncontrollable vomiting 
occurred in one case, while in another it was very severe, and in a third was 
moderate. Even drugs seem to have but little power to bring about emesis, 
for in about twenty per cent, of the cases in which the different emetics 
were given, vomiting occurred only in about one-half of them. The pulse 
and respiration, like the nervous system, are seriously affected. The for- 
mer in a large percentage of the cases becomes feeble, frequent, and in- 
termittent, but in very exceptional instances was slow and weak. The 
respiration was soon affected, and in more than half of the cases, where it 
was particularly noted, was stertorous to a greater or less degree, but gen- 
erally well marked ; and in rare instances is described as being dyspnoeic, 
slow, husky, or hurried. Occasionally the face is flushed, but more often 
a paleness is present. The skin is exceptionally hot and dry, and in a 
larger portion of cases is cold and clammy—especially noticeable in the 
extremities; and in a single case a hot skin was followed by coldness. 
Lividity, moi’e or less marked, is a frequently noted symptom ; salivation 
was also observed. The temperature was stated to have risen above the 
normal in three cases, while in two it was lowered, and in a sixth case 
was natural. Frothing at the mouth and nose occurred in about ten per 
cent, of the cases, and deglutition was difficult in five and impossible in ten. 
In four the odour of the acid was detected in the exhalations. In ten 
cases the urine was noted as being coloured greenish, blackish, or brown- 
ish. Relaxation of the bowels was also occasionally noticed, and the 
stools in several instances were described as being brownish, blackish, or 
greenish. The pupils were variously affected, but in over half of the 
cases in which they were specially examined were found to be contracted; 
in less than a fifth they were dilated ; in four were unaffected ; in two dila- 
tation was followed by contraction ; and in another, there was first dilata- 
tion, then contraction, and ultimately dilatation. Convulsive movements 
occurred in fourteen cases; in one they were violent; in three were mere 
twitchings, and in a similar number trismus was present. In one case 
epileptiform convulsions were present, but this patient was stated to have 
been an epileptic, and in another case impending convulsions were recorded; 
sometimes they are only facial. Anesthesia was also recorded in about 
fifteen per cent, of the cases, but was undoubtedly present in the vast ma- 
jority where insensibility was recorded to signify this condition together 
with a loss of consciousness. Protrusion of the eyeballs, pain in the 
head or back, hiccough, muscular weakness, tremors, thirst, harshness of 15 
voice, and involuntary micturition were also exceptionally noted. Symp- 
toms of pneumonia, pulmonary congestion, or of meningitis, or muco- 
purulent expectoration, were observed in six cases. 
Pain in the mouth, oesophagus, and stomach, frothing at the mouth or 
nose, insensibility, difficult or impossible deglutition, a cold and clammy 
skin, stertorous respiration, a frequent, small, and intermittent pulse, con- 
tracted pupils, anaesthesia, and a brownish, blackish, or greenish urine are 
the most constant and characteristic symptoms, and the latter is probably 
pathognomonic. 
Experiments made on the lower animals yield results in accordance with 
the symptoms produced in man. According to Lemaire (De I’Acide 
Phenique, Paris, 1865), Neumann (Archiv f. Derm. u. Syph., i. 1869, p. 
425), Labbee (Archiv. Gen. de Med., 1871, p. 45), Stone (Phila. Med. 
Times,ix., 1878-9, p. 616),and Salkowski (Pfliiyer’s Archiv, Bd. v., 1872), 
toxic doses in frogs produce paralysis of the posterior extremities followed 
by paralysis anteriority, and of the whole muscular system. Lemaire 
states, however, that when frogs are placed in aqueous solution the ante- 
rior extremities are first affected. On the mouse and rat, Kempster 
(Amer. Jour, of Med. Sciences, July, 1868, p. 37) found that when they 
were confined to a jar and a sponge suspended a short distance from the 
bottom impregnated with the acid and the animal compelled to inhale the 
vapour, well-marked symptoms of poisoning rapidly occurred. The 
mouse in five minutes staggered as if intoxicated and then grew better. 
These paroxysms recurred several times during an hour and a half, when 
the animal became convulsed and died. A rat, in less than a minute, ap- 
peared sleepy, and as if intoxicated, muscular weakness was also appa- 
rent. In three-quarters of an hour it failed to notice sounds, and shortly 
after, to all appearances, was in a state of profound anaesthesia. Tremors, 
convulsions, and death followed. Two other experiments on rats confirm 
these results. In pigeons, according to Husemann (Schmidt’s Jahr., Bd. 
civ. p. 274), the same characteristic results occur as in mammals. Sal- 
kowski (loc. cit.), Neumann (Joe. cit.), Lemaire (Joe. cit.), and Husemann 
(Joe. cit.) found in rabbits and dogs, tremors, muscular weakness, slowing 
of the respiration, dyspnoea, salivation, dilated pupils, diminished sensi- 
bility, convulsions, and death. Before convulsions rabbits lie on their 
sides kicking in mid-air. Temperature is diminished, and, according to 
Husemann, haematuria and albuminuria are occasional phenomena. A very 
curious fact was also noticed in frogs that, after awhile, violent convulsions 
were induced by very slight irritation ; and at times when the posterior 
extremities were paralyzed, the anterior remained in a state of exalted 
reflex excitability (Stone, and Bert and Jolyet). 
The nervous system is profoundly affected, and the train of symptoms 
following the action of the acid on this portion of the economy is decidedly 
well marked. Convulsions in the lower animals are more prominent phe- 16 
nomena than in man, and are almost constant symptoms. Husemann 
states them to be one of the characteristic phenomena ; but in man in less 
than about one-third only of the above cases were such movements present, 
and in only one were they at all violent. The convulsions are generally 
clonic, but may assume a decidedly tetanic character. That they are not 
peripheral seems proven by the experiments of Salkowski, Labbee, and 
Stone, for these observers found that they did not occur in the extremities 
which had been deprived of their central nervous connections by severing 
the nerves going to them ; although they did occur when the limb was pro- 
tected from the poison by ligaturing the bloodvessels. It is, therefore, 
certain that they must be central in their origin. Salkowski, Bert and 
Jolyet ( Gaz. Med. de Paris, 1872, xxvii. p. 188, etc.), and Stone (loc. 
cit.) found them occur in animals with cut cords, and hence they concluded 
that the convulsions were of spinal origin. These results, however, are 
not in accord with those of Labbee and Haynes (Phila. Med. Times, 1874, 
iv. p. 407), who state that convulsions did not occur in animals thus ope- 
rated upon. From the disparity in these records it would seem that these 
phenomena are both spinal and cerebral in their origin, or else the former 
investigators did not completely sever the cord in the animals operated 
upon. Labbee removed the optic lobes and cerebri of animals, and found the 
convulsions still occurred when the basal ganglia were irritated, so that if 
the convulsions are exclusively cerebral they must, undoubtedly, if these 
results are accurate, be due to an action on the centres at the base of the 
brain ; and the presumption that they are probably cerebral seems to be 
strengthened by the fact of their clonic character, yet the occurrence of a 
tetanoid-paralysant condition in frogs after they are profoundly under the 
influence of the poison suggests that these convulsions are dependent upon 
a similar action to that which produces like phenomena in the poisoning 
by atropine, apomorphine, and strychnia,1 and hence, must be of spinal 
origin. Labbee does not give the details of his experiments; and Haynes 
used such large doses that it seems readily explainable why he observed 
convulsions anteriorly only; for, as above noted, the anterior extremities 
may be in a state of exalted reflex excitability while the posterior are 
paralyzed ; and, moreover, when paralysis occurs it attacks the posterior 
extremities first—indeed, large doses may immediately cause general pa- 
ralysis. When we consider the excessive doses used by Haynes (sij-o'ij 
liquefied acid), it seems clear that the reason why he did not get convul- 
sions posteriorly was because these large doses brought about an immediate 
condition of paralysis in the posterior extremities, with an attendant con- 
dition of hyper-excitability anteriorly. If, as before noted, we have a 
coexistent condition of paralysis and convulsions as has been described by 
several observers, it must be clear that if convulsions did not occur in the 
1 Reichert, Phila. Med. Times, 1881, p. 711. 17 
posterior extremities, after section of the cord, unless the section was made 
during the convulsive stage, a negative result would be of little value as 
proof that convulsions were cerebral; while a positive result, such as ob- 
tained by at least three experimenters, would be very weighty in proving 
their spinal origin, and especially so, since the experiment was performed 
many times by a single investigator with the same result. It is extremely 
improbable that in every one of these experiments in which section of the 
cord was made it was incomplete. 
Iiejlex action, according to Labbee (loc. cit.), is not lost, but he gives no 
details of experiments. Stone, in a very careful investigation of this func- 
tion, obtained very decided results, and found that reflex action in frogs 
was primarily diminished and secondarily increased,1 and that large doses 
may cause a decided exaltation. He also found that after section of the 
cord in the dorsal region hyperexcitability in the posterior extremities was 
not induced, nor was the diminished reflex activity present in the early 
part of the experiment as before ; he therefore concludes that the di- 
minished reflex irritability, as well as the increase, was due to a stimu- 
lation and ultimately to a depression of Setschenow’s inhibitory centres in 
the base of the brain. This, however, appears to be inaccurate because 
after section of the cord convulsions occurred which were induced by 
slight stimuli, and consequently there must be some other reason for this 
condition of reflex excitability besides a depression of these centres, and 
it is probable that this exaltation is due, in part at least, to a depression of 
spinal reflex inhibitory centres which are similar in their function to Sets- 
chenow’s. Late in the experiment, when the sensory function appeared to 
be highly exalted, the motor function was decidedly diminished, and Stone 
thinks that these phenomena wrere, like those of strychnia poisoning, due, 
as Kolliker suggested, to the excessive strain on the motor nerves ; yet, 
this can scarcely be true if his own statement, as well as those of Salkow- 
ski {loc. cit.) and Hoppe-Seyler {Pjluger’s Archiv, 1872, Bd. v.) be correct: 
that the motor and sensory nerves and muscles are not materially affected ; 
and then again it is exceedingly improbable that the depression of the 
motor nerves in strychnia poisoning is due only to excessive strain, as wre 
have much proof to show. 
From the above results it seems evident that the toxic influence of 
carbolic acid in the production of convulsions and on reflex phenomena, 
is entirely centric. Stone {loc. cit.) found that when he could induce no 
reflex movements by irritating a sensory nerve, irritation of the cord 
produced marked movement in the posterior extremities; and he there- 
fore concludes that the spinal action is probably confined to the motor 
columns. If this is so, the phenomenon of a consentaneous existence 
of exalted sensibility and motor depression is readily explainable in the 
1 See Case XLVIII. for similar symptoms in man. 18 
fact that both conditions are due to paralysis ; the exalted sensibility 
to a paralysis of reflex inhibitory centres,1 and the motor depression to a 
paresis of the motor columns of the cord. 
The cerebral functions are early and. seriously affected, the first symp- 
toms, as at times observed, being restlessness, bewilderment, hesitancy of 
speech, depression of spirits, and delirium, stupor, insensibility, and coma. 
The action of the acid on the circulation has not been thoroughly 
studied. Hoppe-Seyler (loc. cit.) found that the arterial tension was not 
materially affected until convulsions were present, when it was decidedly 
increased, remaining in this condition for a prolonged period, and then 
gradually falling and continuing in a decline until it reached a point far 
below the normal. Salkowski and others found that the heart after death 
was arrested in diastole, and that this condition existed whether by slow 
or rapid poisoning. In man the heart generally presents strong evidence 
of the result of a decided and direct poison, and is to be found in a pale, 
flabby, and distended condition; although in several instances the left side 
especially was found to contain but little blood, and in at least one case 
this viscus was described as being healthy and empty. The increase of 
arterial pressure as observed by Hoppe-Seyler would seem at first sight 
to be dependent upon the convulsions, but Lemaire’s and Salskowski’s 
experiments seem indicative that there are other features present, for the 
former observer states that the systoles in the early part of the poisoning 
are increased in their power, and that the arterioles can be seen to con- 
tract ; Salkowski declares that the rapidity of the blood-current in the 
capillaries is primarily increased and afterwards diminished. While there 
can be no doubt that carbolic acid acts ultimately as a direct and decided 
cardiac depressant and causes death very frequently, if not in the large 
majority of cases, in this way, yet the results of the above experiments 
are such as to preclude any decisive opinion until a further research is 
made. The frequent, feeble, and intermittent pulse, so frequently noticed 
in man, is strong evidence of a decided depressant action on the heart, as 
is also the slow and feeble pulse, which, at times, has been noted.2 
The respirations in the earlier stages of the poisoning are decidedly 
increased in frequency, but later they are deep, slow, and laborious, and 
possess a marked stertorous character. According to Salkowski, the fre- 
quent respirations are very shallow and are almost entirely costal in their 
character, the diaphragm taking but little part. It was also found that 
respirations were accelerated in animals with cut pneumogastric nerves; 
and, furthermore, in normal animals, when the vagi nerves were cut dur- 
1 Fora discussion of “Convulsions due to Depression of Spinal Reflex-Inhibitory 
Centres,” etc., see my paper in Phila. Med. Times, Aug. 13,1881, p. 711. 
3 Several experiments which I recently performed in connection with the blood- 
pressure, indicate that large doses of the acid, intravenously injected, cause an imme- 
diate cardiac paralysis. 19 
ing the existence of frequent respiration, the movements became decidedly 
slowed, and were deep and regular. These results indicate both acentric 
and peripheral action, and that the altered respirations are due to a stimu- 
lation of both the pneumogastric peripheries and centres, while it is proba- 
ble that the diminished respiratory movements, which occur later in the 
poisoning, are due to a paralysis of the same. 
The pupils in the above case were more often contracted, but no ex- 
periments have been made on animals to determine how this action was 
brought about. 
The temperature change in man is variable, as we have already seen, 
and in animals it has been stated to be diminished ; according to Erls 
(Schmidt's Jahr. Bd. clxiv. p. 148), the acid diminishes the heat in ani- 
mals in which fever was produced by injecting putrid substances. Latrobe 
and others found that carbolic acid causes changes in the blood-corpuscles 
out of the body; although no change was found to occur in the blood in 
the economy. 
The local action of the poison is that of a decided irritant and caustic, 
for when applied to the living tissues it induces swelling, redness, and, gen- 
erally, severe burning pain, which is followed by a white eschar and a loss 
of sensibility in the part. When applied to the skin the eschar becomes 
dried and translucent, presenting the appearance of being cornified. The 
same change has been observed by Taylor (Guy’s Hospital Rep. 1868, 
xiii. p. 233) to occur in the mucous membrane of the stomach. This 
gentleman states that the superficial layer of the stomach mucous mem- 
brane was destroyed, and the dead part showed all the structures perfect, 
and they were rendered sharp in outline by a sort of cornification which 
had taken place, and that no inflammatory process existed. The loss of 
sensibility is not confined to the circumscribed tissue directly destroyed by 
the acid, but extends to at least an appreciable depth. 
When swallowed, the mouth, throat, and oesophagus are whitened and 
present the appearance of being covered with a whitish, grayish, or brown- 
ish pseudo-membranous substance, which is soft or pulpy or diphtheritic, 
and easily detached from the underlying structures, which are then found 
to be in various stages of congestion, and frequently described as having a 
chocolate colour. The oesophageal mucous membrane is sometimes spoken 
of as being thickened, hardened, rigid, and corrugated. 
The gastric mucous membrane is seldom affected throughout, and as 
might be expected the most formidable lesions are to be found in those 
portions which the acid would reach in its most concentrated condition; 
consequently, the cardiac end and the greater curvature are the most to 
suffer. 
The stomach walls may so far be disorganized, that portions of the 
muscular coats are reduced with the mucous membrane to a pulp. The 
latter is generally found to be corrugated, Congested, and corroded, and 20 
covered with a pulpy or diphtheritic substance which may be of a whitish, 
grayish, or chocolate colour. The membrane is sometimes described as 
being thickened, tougher, more rigid, blackened, sodden, or chocolate- 
coloured. The summits of the ruga; have been observed to be whitened, 
while the interstices were red, and contained granular detritus; by another 
writer, elevated points about the size of shot, without any very marked 
congestion, were reported; and by still another, red-based patches, with 
well-defined borders, limited more particularly to the ruga;, were noted. 
The microscopical appearances of the mucous membrane have already been 
quoted from Taylor’s paper (loc. cit.). 
The stomach may be contracted or dilated, or be found in an interme- 
diary condition. The amount of fluid it contains is “variable, as is also its 
nature, for it may be of a whitish colour, or pinkish, brownish, or chocolate- 
coloured ; may vary greatly in its consistency ; and may possess in a greater 
or less degree the odour of the acid. 
The occurrence of nausea, retching, and emesis, or the utter impossibility 
of inducing these phenomena by giving emetics by the stomach, seems 
readily and satisfactorily explained when we consider the irritant and corro- 
sive properties of the acid ; and at the same time that emesis may follow a 
local application of the acid to an absorbent surface. When the acid first 
reaches the gastric mucous membrane it at once irritates the peripheries of 
the vagi nerves, and, vdiether we have vomiting following the irritation, or 
wdiether the irritation is too quickly superseded by a physiological destruc- 
tion of the nerve peripheries, is obviously determined by the relation existing 
between the rapidity with which the irritant effects are followed by those of a 
caustic character. That the peripheries of the pneumogastric nerves are soon 
seriously affected and functionally destroyed, is corroborated by the fact of 
the great difficulty or even impossibility of inducing emesis by drugs which 
effect this phenomenon by a direct local irritant action. Yet emesis, or 
the failure of the drug to induce it, cannot always be due to a local action 
only, unless it is dependent upon an effort of the system to eliminate the 
poison through the gastro-intestinal tract, for vomiting supervened in some 
of the above cases after a local application of the acid to absorbent sur- 
faces such as the skin, wounds, rectum, etc. It is, therefore, probable that 
the emesis is, in part at least, centric, the drug acting in small quantity as 
a stimulant to the vomiting centres and in larger ones as a depressant. 
What becomes of carbolic acid in the system, and the condition in 
which it is absorbed, are interesting questions which we are unable to 
answrer. It has been suggested, since it possesses the property of coagu- 
lating albumen, that it is absorbed in some combination. Its presence in 
the blood can be a matter of but little doubt, since in autopsies the odour 
of the acid was frequently very strong and distinctly perceptible in the 
different viscera. Lemaire (loc. cit.) believes that it is eliminated to a 
considerable extent by the lungs, for he found the odour on the breath of 21 
dogs and rabbits very perceptible ; and we have instances of the elimina- 
tion of the drug by this channel in at least four of the cases of poisoning 
in man. The lungs are certainly not the only channel by which elimina- 
tion takes place, for Iloppe-Seyler (loc. cit.) found it in the saliva, and 
Salkowski {loc. cit.) and numerous other observers have found it in the 
urine, but in what form it is eliminated is a matter of much doubt. Pa- 
trouillard {Jour, de Pharm. et de Chem. 1871, p. 459) states that he ob- 
tained an oily liquid by means of ether which reacted to the characteristic 
tests, and which he thought to be pure acid; yet Salkowski believes that 
it exists as an alkaline carbolate. 
The urine in over 20 per cent, of the cases was noticed to be coloured, 
and in eight of them was described as being smoky or brownish; in one it 
was a green-black, another had a violet tint by reflected light, and 
another was at first an olive-green, but became black and smoky on stand- 
ing. Albumen was noted as occurring in a single instance.1 The urine 
may or may not smell of the acid, or have a peculiar mixed or aromatic 
odour, and has been noted in exceptional instances to be bloody, copious, 
scanty, more acid, loaded with lithates, or to present a normal appearance. 
The coloration may make its appearance within a couple of hours and last 
for several days, and at times it can only be distinctly perceived when 
the urine is held up to the light. 
The cause of the coloration appears to be still invested in much doubt, 
and it has been suggested that it is the result of the destruction of a part 
of the carbolic acid in the system and the consequent formation of an 
oxidative product—for it will be remembered that when the acid and 
potassium permanganate are brought in contact the former is oxidized and 
oxalic acid results—which is eliminated by the kidneys, and this fact seems 
to be strengthened by the researches of Salkowski, who found, as already 
stated, that oxalic acid appears in the urine of animals poisoned with car- 
bolic acid. Ilusemann at first believed that the lnemoglobin was the cause 
of the colour, but he afterwards abandoned this theory because of the urine 
fully clearing up, after acidifying, and then heating, and especially because 
the odour of the acid was given off during the former process. Ilusemann, 
besides other observers, could detect no corpuscular elements of the blood 
in the urine; nor was there an excess of iron present. Waldenstrom and 
Almen {Zeitschrift Allgem. Apoth. Verei?i, Jan. 1872), in a later series 
of experiments with similar urine, obtained, by adding sulphuric acid and 
then distilling, a product smelling strongly of carbolic acid, and which re- 
sponded to the calcium chloride with a blue colour; and, moreover, when 
the product was shaken with ether, the latter left, on evaporation, drops of 
the acid. Similar results were obtained by Stadeler {Ann. d. Chem. und 
Pharm. Bd. lxxvii. p. 17) with the normal urine of the cow by a similar 
1 Albumen is reported as being found in a case reported by Waldenstrom and 
AlmtSn. 22 
process ; and these results have been corroborated by Buliginsky (Med. 
Ghem. Untersuch. 1872, p. 234), and Hoppe-Seyler (loc. cit.). The lat- 
ter observer has, however, shown that the acid does not exist in the nor- 
mal urine, but that the substance thus obtained is probably a product of 
the decomposition of indican ; a fact which seems to be strengthened by 
the researches of Salkowski (Centralb. f. Med. Wissensch. 1876, p. 820), 
who found in cases of ileus an increase of the substance from which the acid 
is formed pari passu with the onset of the trouble; consequently, experi- 
ments of Waldenstrom and Almen do not, therefore, prove that the acid 
they found w’as eliminated by the kidneys. There can be no doubt, however, 
but that carbolic acid does exist in the urine in cases of poisoning, as the 
odour as well as the reaction to characteristic tests signify ; yet there must 
also be some new products formed, because the carbolic acid urine when 
subjected to nitric acid, and afterwards potassium hydrate, and then con- 
centrated, gives a blood-red followed by a pea-green and violet colour. 
Carbolic acid added to the urine outside of the body will not yield this 
play of colours (Schmidt’s Jahr. Bd. clxiv. p. 144). Microscopical ex- 
aminations reveal carbonaceous particles, and it is difficult to determine 
whether the particles have anything to do with the characteristic test as 
given above or not, although it seems that they are the probable cause of 
the coloration, and possibly the factor upon which the reaction depends. 
Bauman and Herte have found that the sulphates disappear from the urine 
very early in the poisoning. 
The kidneys in animals, according to Neumann, are found to be in a 
state of fatty degeneration. This is contradicted by the results of Sal- 
kowski’s researches; but Rendu and Patrouillard’s case (Case IX.) adds 
confirmatory proof to Neumann’s assertion. 
The venous system seems to be in a state of general dilatation, and 
as a consequence the different viscera and glands have been found in 
various degrees of congestion. The membranes of the brain are more 
frequently spoken of as being congested and full of dark fluid blood, and as 
an exception have been found natural. The brain is generally described 
as appearing healthy. The arachnoidean fluid has been found increased 
in some cases, and the odour of the acid has been detected in the cranial 
cavity. 
The lungs are often described as being congested, and especially so in 
the most dependent portions. The bronchi have been noted to contain 
mucus, which may appear bloody or as a dark-red fluid; oedema and 
emphysema are exceptionally recorded. In at least three instances the 
lungs have been found healthy; and in one, the left lung was congested 
and the right emphysematous. A double-pneumonia was developed in 
Tennent’s case (Case XLIII.), which he attributes to the effects of the 
acid. This is in accord with the statements of Lemaire, who found pneu- 
monia occur in animals thus poisoned. 23 
The blood in a vast majority of the eases is found to be dark and fluid, 
and in exceptional instances to contain soft coagula, and in one was every- 
where firmly coagulated. In one case it remained fluid for five days, and 
in another it became bright red on exposure to the air. The odour of the 
acid has not unfrequently been detected in the fluid. 
The asphyxiated condition, as can be surmised from the results of experi- 
mentation on animals, must be due to a paralysis of the pneumogastric 
apparatus; for it can scarcely be dependent, to any extent, upon changes 
in the blood disks, because no alterations are revealed by microscopical 
examination, and besides the blood possesses the power of becoming arte- 
rialized when exposed to the air after death (Brabant), which shows that 
the haemoglobin was not destroyed, nor its ozonizing power paralyzed. 
The venous condition of the blood must then be due to a failure of the 
pneumogastric nerves and centres to properly carry on the respiratory 
function, and probably in part to the congested condition of the lungs and 
the depression of the circulation. 
There are many difficulties in the way of satisfactorily accounting for 
the fluid condition of' the blood on mere theoretical grounds, because 
excessive carbonization of this tissue seriously affects its coagulating 
property ; yet, since we are aware of the power of the acid to coagulate 
albumen, it may be that it exerts some destructive influence on the fibrin- 
forming proteids. 
The smallest dose which proved fatal in any of the above cases was one 
drachm, in a man of 64, and who died in twelve hours; yet two children, 
one of two and the other of two and a half years, who had each taken the 
same quantity, recovered. The largest dose taken was by a woman of 35, 
who drank something less than eight ounces ; a half an ounce is almost 
invariably fatal, yet a case has recovered after the ingestion of four ounces, 
and another after taking an ounce. The most frequent dose was from a 
half an ounce to an ounce. Death occurred in nine cases in less than an 
hour; in one within three minutes, and in four others in less than twenty 
minutes. Life may be prolonged for twenty-four to forty-eight hours, 
or longer; but death usually occurs within the first four hours. Death 
ensued in one case in twenty minutes, from the effects of an enema for 
ascarides. Davidson {loc. cit.) cites a case wdiere seven drops caused 
alarming symptoms ; and in another case, above quoted, five grains elicited 
well-marked symptoms of poisoning. 
The number of fatal cases which have followed the external use of the 
acid in cutaneous affections, shows that its use, to any considerable extent, 
in these diseases is not altogether unattended with great danger. Deaths 
have occurred following its application in cancer of the cervix, and most 
alarming symptoms have supervened from its use as a lotion in necrosis, or 
as an injection in abscesses or piles ; and we have at least one authenticated 
case in which death nearly occurred from the inhalation of its fumes. 24 
The experiments of Kempster {loc. cit.) on animals, well illustrate the 
facility with which the pulmonary mucous membrane can absorb this 
vapour. About one-half of the cases proved fatal when the acid was 
drunk or used as an enema, while a large percentage recovered in which 
the poisoning ensued from its local or other use. Cerria (Phil. Med. Times, 
1879, p. 592) found the minimum fatal dose in rabbits to be fourteen and 
one-eighth minims per pound, and in dogs eight and four-sevenths minims 
per pound ; certainly a much higher ratio than in man. 
The frightful rapidity with which death occurs in some cases suggests that 
it must have been due to shock, such as occurs after the ingestion of sul- 
phuric acid and similar corrosive poisons; but in the other cases where dis- 
solution does not take place for some time it is undoubtedly dependent upon 
a progressive paralysis of the vital centres. Taylor (Phila. Med. Times, 
loc. cit.) believes that his case probably died from the effects of a paralysis 
of the pneumogastric and sympathetic nerves which brought about a ces- 
sation of function of all the important organs; while others suggest that 
it may be due to a failure of the heart, asphyxia, or shock. Judging from 
the symptoms during the poisoning and results of autopsies, there can 
scarcely be a doubt but that death is usually and directly due to asphyxia 
or an arrest of the heart or both. In animals the heart is not arrested 
until the cessation of the respiration, unless the acid be injected into the 
veins or given in very large quantities ; still, there can be no doubt, when 
the condition of the pulse during life is considered, as well as the strong 
evidence in the appearance of this organ after death, of the powerful para- 
lyzing action. 
The diagnosis of carbolic-acid poisoning in most cases should not be 
attended with difficulty, for the characteristic odour of the drug can gener- 
ally be detected; and in conjunction with the white or brownish stains 
about the mouth, and with the most characteristic symptoms as already 
noted, would almost be conclusive evidence; and, especially so, if the 
peculiar discoloration of the urine be present. After death the lesions are 
pretty well defined, and the odour of the acid can generally be distinctly 
detected in the blood and viscera. The danger of confounding these cases 
with apoplexy, urcemic coma, and similar conditions must be borne in mind. 
The treatment pursued was generally such as would be indicated in 
cases of poisoning by corrosive substances of this nature: emetics, the 
i!se of the stomach-pump, olive-oil, milk, eggs, sodium bicarbonate, mag- 
nesia, lime-water or chalk, stimulants, counter-irritants, warmth, etc. 
Bleeding was practised in one case, and as curious and interesting as it 
may be, the patient recovered. The emetics used were of but little avail, 
both on account of the inability or difficulty of the patient to swallow, 
and the disorganized condition of the gastric mucous membrane. 
Considering the difficulty of introducing emetics into the stomach, and 
the disorganization which has taken place in its mucous membrane, it must 25 
be certain that where we have a choice of emetics one should be selected 
whose action is on the vomiting centres, and which can be used hypo- 
dermically—not one which induces emesis by a local irritant action. We 
cannot hope for much in these cases by using zinc sulphate, mustard, or 
similar substances, for even if they are gotten into the stomach, the proba- 
bility is that the mucous coat is so far benumbed or destroyed that it will 
not respond ; while on the other hand, if a centric emetic, such as apo- 
morphine, is injected hypodermically, it will be rapidly absorbed, and 
the chances of its causing vomiting are infinitely greater than those with 
the former class. 
The administration of the alkalies, especially lime in the form of a 
saccharate, seems to be founded upon good grounds, for according to 
Husemann (loc. cit.) they possess some antidotal properties. He also 
found that the oil is probably of no value; yet Lemaire declares when the 
acid was given with it that its poisonous effects wrere materially modified. 
As it is not at all probable that there is any chemical combination what- 
soever between the acid and oil, it is likely that the latter merely acts 
mechanically by preventing a rapid absorption of the acid. On these 
grounds the oil may be administered quite freely with benefit. 
Up to the time of the researches of Baumann and Herte (Zeitschrift 
Phys. Chem. I.) nothing was discovered of any special value as a chemical 
antidote for carbolic acid, but if the researches of these gentlemen prove 
to be of the value they seem invested, we have invaluable antidotes in 
the soluble alkaline sulphates. Baumann believes that Avhen a soluble sul- 
phate is given a sulpho-carbolate is formed that is innocuous. My 
friend, Cerna, found in ten experiments on animals (Philadelphia Med. 
Times, 1879, i. p. 592-597) decided evidences of the efficacy of these 
salts in this form of poisoning. He first decided the minimum fatal dose 
in rabbits and dogs, and after determining this point, gave what was 
deemed a toxic amount of the acid in conjunction with the sodium or 
magnesium sulphate, and in every instance where they were thus given 
together the animals recovered; yet, in repeating the experiments in the 
same animals, after due time had elapsed for recovery, with the same 
amount of acid, but without the soluble sulphate, fatal results followed; 
thus clearly proving the antidotal properties. It was then sought to 
determine if a sulpho-carbolate were formed in the economy, as be- 
lieved by Baumann; consequently, the acid and solutions of the sulphates 
wTere mixed together in different proportions and different strengths, but 
he could obtain no chemical combination, and therefore doubted if such 
really takes place in the economy. Yet, until we have more conclusive 
proof than this, the question must still remain sub judice ; the fact, more- 
over, of the disappearance of the sulphates from the urine very strongly 
intimates that the sulphuric acid is gotten rid of in this way. 
106 Halsey Street, Newark, N. J. THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES. 
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