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Much has been said recently about the use of alcohol as an "antidote" to carbolic acid. Dr. Phelps stated in 1899 that Dr. Powell had observed that the escharotic action of carbolic acid in wounds, on the hands, and on mucous membranes could be prevented by the use of alcohol. It has also been shown that the danger of absorption of carbolic acid from wounds and other surfaces is much less if the acid is washed off with alcohol. According to Honsell,3 the explanation of this action is that the carbolic acid is very soluble in alcohol, and so much of it is removed. These observations have led to the use of alcohol as a remedy in cases in which carbolic acid has been taken internally; some extraordinary results have been claimed for this method of treatment. From the present state of our knowledge it seems very probable that the best method of treating a case of carbolic acid poisoning would be to administer alcohol, provided the stomach could be washed out immediately afterward. To administer a large dose of alcohol and to leave it in the stomach, as has been done, would seem to be an extremely dangerous practice. It is true a number of cases have been reported in which this was done and the patients have recovered, but there is no reason to suppose that the alcohol acts in any sense as an "antidote."5

Postmortem Appearances.-When the poison has been taken by the stomach, there may be brownish, shrunken patches on the skin about the mouth. The mucous membrane of the mouth, esophagus, and stomach may be white, corrugated, and partly detached, and the edges of the affected parts are often hyperemic; if the case is one of long duration, these patches are red. In many cases the mucous membrane of the stomach and intestines is reddened and inflamed (see Plates 9 and 10). The urine is usually of a dark or dark-greenish color. The odor of the poison may be noticed in the body and in the urine. The blood is usually dark and fluid; the brain, the meninges, the lungs, the liver, and the spleen are often congested.

CASES OF CARBOLIC ACID POISONING.

CASE 1.-Woman, aged sixty, took 2 ounces (60 c.c.) of pure carbolic acid. Was found, shortly afterward, unconscious; pulse thready and scarcely perceptible; extreme dyspnea; lips cyanotic; conjunctival and pupillary reflexes absent. Rectal temperature, 96° F. A stomach-tube was introduced into the pharynx and 4 ounces (120 e.c.) of alcohol were poured in. After two or three minutes the tube was introduced into the stomach and the organ washed out with warm water; the washing was repeated with diluted alcohol. Signs of improvement quickly appeared. Strychnin and other cardiac stimulants were administered. In an hour and a half the patient was cheerful and felt little discomfort. The urine, which had to be drawn off with a catheter, was brownish black, but contained no albumin. Recovery was complete in three days.

CASE 2.-Adult male took 1 ounce (30 c.c.) of pure carbolic acid. Patient seen

1 New York Med. Jour., 1899, vol. 1xix., p. 62; see also Frazer, Medical Record, 1895, vol. xlviii., p. 741.

2 Adams, New York Med. Jour., vol. 1xx., p. 780.

3 Beit. z. klin. Chir., 1901, vol. xxx., p. 328.

* See Case 1.

5

e Wallace, N. Y. Unir. Bull. Med. Sci., vol. ii., p. 58.

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in a few minutes. There was a strong odor of phenol on breath; the lips were stained white. One-tenth of a grain (0.0065 gm.) of apomorphin injected. No emesis having occurred, the dose was repeated in five minutes, but vomiting did not take place. Patient soon had difficulty in swallowing; the face, which was at first flushed, soon became pale and slightly cyanotic. Within a few, perhaps seven or eight, minutes after the poison was taken there were tonic spasms of the voluntary muscles with muttering delirium; patient seemed unconscious of his surroundings. A quart of milk was pumped into the stomach. Pallor increased and the body became cold to the touch. Respiration labored, pulse weak and intermittent, pupils contracted. Patient did not at any time complain of pain. He was placed in bed and various stimulants were given. Respiration ceased about fifty minutes after the poison was taken. Heart was found to be beating feebly. Artificial respiration was resorted to. In about a minute patient began to breathe again and continued to do so for thirty minutes, when both respiration and heart ceased. No autopsy.1

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Isolation. In most cases of poisoning by carbolic acid the odor is distinctly noticeable. The tendency of the poison to combine with sulphuric acid is such that the sulphates present in the system may be completely used up in the formation of phenol sulphuric acid, and the urine under such conditions will fail to yield a precipitate when treated with barium chlorid.

For the isolation of the poison, the material under examination is thoroughly macerated with 5 per cent. sulphuric acid and submitted to distillation with steam (see Fig. 24, p. 321) until the liquid that passes over fails to respond to Millon's test. As carbolic acid is not appreciably soluble in petrolic ether, the distillate may be shaken with this solvent for the removal of various impurities and the carbolic acid finally extracted with ether or benzene. As salicylic acid responds to many of the tests for carbolic acid, it may be well to exclude this substance by making the distillate alkaline in the cold with sodium carbonate and extracting repeatedly with ether. Under these conditions carbolic acid is taken up by the ether, while sodium salicylate remains in the aqueous fluid.

It should be noted that combined carbolic acid is a normal constituent of the body, and that its amount is materially increased under certain pathologic conditions. It is, therefore, always necessary to supplement the extremely sensitive 3 tests given below by a quantitative determination. This is best accomplished by the method of Kossler and Penny, but as the limits of this book do not admit an adequate description of the method, the reader is referred to the original article and to an excellent abstract by Huppert."

Although the analyst may reasonably expect to find the greater part of carbolic acid in the combined form, it may, nevertheless, happen, and especially after the ingestion of large quantities, that the presence of the poison in the free condition may be demonstrated. It is, therefore, advisable to make a preliminary distillation of the material after faintly acidifying with acetic acid. Any carbolic acid that can be shown in the

1 King, Medical Record, 1897, vol. li., p. 158.

2 Jacobsen, Zeitschr. f. anal. Chem., vol. xxv., p. 607.

3 Almén, ibid., vol. xvii., p. 170.

Kossler and Penny, ibid., vol. xvii., p. 117.

5 Neubauer and Vogel, Analyse des Harns, Wiesbaden, 1898, p. 785.

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