In acute poisoning with the mineral acids renal changes are constant. K. N. Vinogradoff (Trans. Third Gen. Meeting Russian Med. Men at St. Petersburg. No. 2, p. 3S, '89).
Conclusions based on observations on cases of poisoning with hydrochloric acid: (1) it produces severe gastritis, with embryonic proliferation and exten sive cellular necrobiosis; (2) there is great danger of penetration of the caus tic liquid into the respiratory passages during efforts at vomiting; and (3) such efforts, therefore, should be prevented, it possible, by washing out the stomach. Letulle and Vaqnez (Archives de Phys., Nos. 1, 2, '89).
Fatal case of poisoning by hydrochloric acid observed. Patient took about an ounce of the drug by mistake, and the usual corrosive symptoms followed. Death ensued on the ninety-fourth day. P. ,T. Duncan (Lancet. Apr. 12, '90).
Case of poisoning by hydrochloric acid in a woman, who drank I tablespoonful of pure muriatie acid. Besides burning and pain in the stomach, vomiting. 'lima, and cramps in the lower extremi ties, there were observed: (a) Absolute loss of tendinous reflexes on the first day of poisoning; this symptom disappeared on the second day; consciousness was complete. (in Entire absence of injury of mucous membrane of the mouth. (c) the sediments of the urine containing numerous hyaline and granu lar casts and purulent corpuscles. (d) One day's fever 102° F. on the sixth day of the disease, without any apparent cause. Lamle (N. V. Med. Jour., June. '97).
Treatment of Poisoning by Hydrochlo ric Acid.—In these cases the use of the stomach-pump or stomach-tube is con tra-indicated. The chemical antidotes are the alkalies and their carbonates, magnesia, lime (wall-scrapings, if noth ing better), and soap-suds. The admin istration of albumin, eggs, milk, oils, etc., will act mechanically to protect and soothe the corroded tissues. Opium by mouth or by hypodermic injection is use ful to relieve the pain and irritation. To counteract the great depression which these cases present, intravenous injec tions of ammonia may be made and nu trient and stimulant enemata given. If
undiluted acid has been swallowed there is but little hope that the above reme dies, or any other, will save the patient.
Therapeutics.—Hydrochloric acid is seldom used as a caustic, though its serv ices may be marked for that purpose in sloughing gums of mercurial stomatitis, mucous patches, etc., if nothing better is at hand.
For cauterizing enlarged tonsils hydro chloric acid applied by a long capillary tube to the excretory ducts of the ton sils, three in each gland, at a sitting twice a week recommended. This is painless and produces no inflammation or swelling. Five or six applications are sufficient for moderately-enlarged tonsils. Kendal (Ann. of Ophtha]. and Otol., '96).
Eight cases of sinuses leading to ne crosed bone treated by the local use of hydrochloric acid. The acid employed was in the concentrated form, employed twice a week, the number of minims depending upon the individual case and the amount of bone exposed. The con clusions were as follow: 1. No evil ef fects have resulted from its use. 2. The use of the acid in its concentrated form is preferable. 3. When the area of necrosis is extensive operative methods are advised. 4. Its action is limited to the ncerosed area, whereas curetting may remove both diseased and healthy bone. 5. By the disintegration of the dead bone the newly-formed tissue has a better opportunity for its more rapid develop ment. Waterman (N. V. Med. Jour., Aug. 8, '96).
. The pure acid is never used internally, ex cept when largely diluted. It is not stable, but must be kept in dark bottles, well stopped and in a cool place. The dilute acid may be given in beef-juice, in lemonade, or in syrup of lemon. When combined with the bitters, its efficiency is increased as a stomachic. In appro priate cases it may be combined with pepsin to increase the efficiency of the latter. It is most useful in gastric dis orders and diseases consequent upon impaired digestion and assimilation.