By W.R.M.TURTLE, M.B.,, B.S. LOND.,
DEPUTY MEDICAL SUPERINTENDENT, WHIPPS CROSS HOSPITAL;
AND
T.DOLAN,L.R.C.P.& S.IREL.,
Assistant Medical Officer to the Hospital.
The following unusual accident occurred on Oct.20th, 1921. hen a man, aged 30, in robust health and sober habits, was taking home a bottle of crude carbolic acid as a disinfectant for the house. He travelled home by train a journey of about 20 minutes.
From what the coroner ascertained at the inquest it would seem that the man was only just in time for his train, which was crowded, and in hurrying to get into a carriage he probably broke the bottle of carbolic acid in his pocket. On arriving at his destination he appears to have made an attempt to leave the carriage, but fell back again into his seat and was thought by the other occupants of the carriage to be intoxicated. At the next station he was helped out of the carriage,but fell. the stationmaster, who had received first-aid instruction,gave the following information:
About 6 P.M. on Oct. 20th he was called by his staff to the man, whom he found lying on the platform unconscious,as if he had fainted; his breathing,quiet at first became noisy like snoring the pulse seemed steady,the eyes did no respond,the was no burning of the mouth,m the bath did not smell of alcohol. He noticed some twitches , but there was no irritability; the man nut seemed “dead to the world.” He observed that his trustees were dampened that he had broken a bottle of carbolic in his pocket. He called a doctor, who thought the man had had a stroke and fallen and ordered his immediate removal to hospital.
Condition on Admission-The patient arrived at Whipps Cross Hospital at 7.5 P.M. and has was seen by one of us. He presented the following conditions:
Extensive carbolic acid staining and burning of the left hip, left thigh,and scrotum, unconsciousness with starters breathing; lungs filled with loud mucous rales; pulse regular and of good volume heart normal; abdomen normal;l pupils contracted. there were no signs of burning about the mouth or throat.
Course of Case-Later that evening be became irritable and vomited. The next day he had regained consciousness; he was very vague as to what had occurred,the last thing he remembered was sitting in a train quite comfortable with the carbolic in his pocket. He was now not at all irritable but complained of severe abdominal pain,and there was rigidity, especially in the upper half of the abdomen. He vomited a green fluid; the urine passed contained blood; cough troublesome. ?The burning of the left thigh and buttock was extensive and in places resembled was still rigid in the epigastrium. Pulse normal;tongue clean and most. On the 22nd the abdominal rigidity and passed off; there was no distention,but there was slight tenderness in the renal areas. He appeared better,but did not pass urine.
On the 23rd it was recognized that there was complete suppression of urine. He had severe pain in the loins. Pulse slow but of good volume. On the 24th there was no further vomiting;the skin acted in response to hot packs, but in spite of taking diuretics, large quantities of fluid,and having his renal areas poulticed,he did not pass urine. On the 25th he passed a few drops of bloodstained urine.
On the26th each renal area was tender. the left kidney was palpable and enlarged; no urine passed. On the 27th, still no urine. He vomited and the cough persisted. From the 21st to the28th the had remained mentally clear. His tongue was now dry; he retched, but did not vomit. The stool was green, as it had been on previous days. The pulse was good,74; he had not slept well. At 6.20 P.M., there was a sudden change; he felt cold and collapsed. The pulse went and the extremities became cold and clammy. Died at 6.25 P.M.
Autopsy-The conditions revealed were: Burns of the third degree of the left buttock, left buttock, penis,and scrotum. Lungs, congested. Heart,right side, dilated and flabby; left side, firm and contracted., Liver (5lb. 42 oz), spleen (92 oz), kidneys (together I lb.4 oz) were all hard,firm , and congested. Stomach,m summits of rugae slightly granular; no erosion of mucous membrane.
Bladder, I ox. of bloodstained urine, hemorrhages in the bladder wall. Abdominal cavity, transparent coagulated lymph and clear fluid in the pelvis. Brain, normal.
The Clinical Research Association reported on the following sections cut for us:
“Stomach”: The tissues are entirely neurotic,and show no normal nuclear staining. This might be post-mortem effect. the autolysis of the tissues is said to proceed more rapidly in some served; this we do not always see in a decomposed stomach.
“Liver There is less change in the liver than in the other parts examined. the section shows a large number of normal liver examined. The section shows a large number of normal liver cells, but there is a great distention of the inter cellular vessels and spaces which are filled with blood and a corresponding compression of the parenchyma.
“Kidney: The section shows an acute haemorrhage infuriates. Many of the tubules contain masses of desquamated epithelium and blood cells”.
Remarks.
We have come across no reported case quite like this. He find in Major Collis Barrys “Legal Medicine (in India) and Toxicology” (Illustrative Cases, vol.ii., Case 3396), pure carbolic applied to the skin of the back, causing coma, followed by death in 20minutes. Two cases, 3385 and 3386, in which 3o per cent. and 35 per cent carbolic acid taken by the mouth, developing symptoms similar to those exhibited in our case- namely, onset in 10-20 minutes, coma, starters breathing,contracted pupils,. then a partial recovery,followed by death in 10 days from nephritis and endocarditis. We also find two cases of carbolic acid coma induced by the application of carbolic compresses to the skin (R.Clement Lucas and W.Arbuthnot Lane). Here compresses were 5 per cent. carbolic. The early symptoms were stertorous breathing, low temperature,rapid feeble pulse, collapse,.vomiting, and small pupils (in one case).
Compared with these cases ours is in closest agreement as regards symptoms and course with those cases of carbolic acid poisoning by the mouth.
But what is so peculiar in our case is that apparently at no time until the end did the pulse fail or was there any evidence of collapse.
We have to thank Dr.J.C.Muir, medical superintendent, for permission to publish these notes.
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