Sulphuric acid (oil of vitriol) Poisoning

 

Sulphuric acid (oil of vitriol)

It is colourless with no fumes and it chars and blackens the skin.

Sign and symptoms: Pharyngeal pain is the most common presenting symptom. There will be intense burning pain in mouth, throat, oesophagus and up to the stomach. Dribbling of acid mixed with saliva on the angles of mouth and chin causing corrosion and brownish discolouration of skin over angles of mouth, chin and over the chest. Frothy eructation, retching and vomiting; vomited matter is acid, contains blood, mucous and shreds of mucous membrane

Oral cavity: Mucosa of mouth and lips are softened, excoriated, corru­gated and cove­red with dirty white necrotic mem­brane that assumes brownish black discolouration.

Tongue is swollen, excoriated and dis­coloured with white coating that becomes dark later. It may get disorganized in to a shapeless, pulpy mass. Teeth are dead chalky white deprived of polish; Breathing is difficult and noisy due to swollen and inflamed fauces and tender abdomen.

Fatal dose: 10-15 ml

Fatal Period: 12-24 hours

Treatment: Neutralization of acid with milk, milk of magnesia, aluminium hydroxide gel. Demulcents like olive oil, egg white should be given. Skin burns, eyes and face should be washed with large amount of water and paste of magnesium oxide should be applied. Tracheostomy for respiratory support if there is edema of glottis.

Autopsy Findings:

 (i) Changes produced from corrosive poisoning are limited to the upper diges­tive tract and respiratory system

 (ii) Mucous membrane of stomach is inflamed, oedema­tous, blackened with peppery feel

(iii) Greater part of the stomach is con­ver­ted in to soft, boggy, black mass that readily disintegrates on touching. The mucosal rid­ges are more damaged than inter­vening fur­rows.

Magenstrasse (street of the stomach): It refers to a portion of the stomach adjacent to the lesser curvature of the stomach and it is a route taken by food, fluids, acid, and alkali etc. as they flow from the fundus to the gastric outlet. The pathway of acids and alkalis in food filled stomach starts along the lesser curvature of the stomach and leads to the pylorus. This explains the location of greatest damage in food filled stomach. Stomach without food have significant injury in the lower half of two thirds and may have sparing of fundus.

 Medico legal aspects:

(i) Accidental poisoning occurs as it is mistaken for glycerin or castor oil

(ii) Mostly it is employed for suicidal pur­poses due to its easy availability

(iii) It is not used for homicidal purposes

(iv) Employed for the purposes of vitriolage causing grievous hurt

 

Vitriolage

Vitriolage is throwing of strong sulphuric acid, concentrated mineral acid, corrosive alkalis, car­bolic acid, or the juice of marking nut over the face or body of the victim for the purpose of disfi­guring the face, destroying the vision for causing injury on the body or even destroying the clothing of the victim.

There is severe burning pain and corrosion of the tissues with formation of brownish black burned areas that later leave a permanent scar. Blindness may result if eyes are involved. Extensive disfiguring inju­ries are caused on the face. Death may occur from shock, toxaemia, or infection from severe chemi­cal burns inflicted on the skin.

Section 326 A: Voluntarily causing grievous hurt by use of acid, etc.

Whoever causes permanent or partial damage or deformity to, or burns or maims or disfigures or disables, any part or parts of the body of a person or causes grievous hurt by throwing acid on or by administering acid to that person, or by using any other means with the intention of causing or with the knowledge that he is likely to cause such injury or hurt, shall be punished with imprisonment of either description for a term which shall not be less than ten years but which may extend to imprisonment for life, and with fine.

Section 326 B: Voluntarily throwing or attempting to throw acid, etc.

Whoever throws or attempts to throw acid on any person or attempts to administer acid to any person, or attempts to use any other means, with the intention of causing permanent or partial damage or deformity or bums or maiming or disfigurement or disability or grievous hurt to that person, shall be punished with imprisonment of either description for a term which shall not be less than five years but which may extend to seven years, and shall also be liable to fine.

Medico legal aspects:

(i) Blindness amounts to grievous injury

(ii) Scar tissue formation also amounts to grievous injury

(iii) Vitriolage amounts to dangerous injury either due to severe extensive burn or subsequent infection.

 

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