It plainly appears, then, that most of the fallacies alleged against the validity of the evidence derived from the discovery of arsenic within the human body in cases of poisoning have no real existence; and that those which are real can easily be provided against by simple and obvious precautions.
The arsenite of copper [Scheele’s-green, Mineral-green] deserves notice, because it is in use as a pigment, and has actually been used as a poison. Dr. Duncan once detected it in pills, given to a pregnant female with the view of procuring abortion; in Paris it has been detected in sweetmeats, having been used to give them a fine green colour;[556] and Mr. Ainley of Bingley in Yorkshire informs me he found it to constitute a pigment sold by London pastry-cooks under the name of emerald-green for colouring preserves, and which in his practice had proved poisonous to children who had eaten apple-tarts coloured with it.
It is a compound of arsenious acid and deutoxide of copper, is sold in powder or pulverulent cakes, and has a pale grass-green colour. Its nature may be ascertained by heating it in a glass tube. Crystals of oxide of arsenic sublime, and oxide of copper remains, which, on being dissolved in nitric acid, yields a fine violet-blue solution with ammonia.
The mineral-green of the shops, however, is seldom arsenite of copper. The substance sold in Edinburgh under that name, although believed by colourmen to be a preparation of arsenic, is not the arsenite of copper, but a mixture of hydrated oxide of copper and carbonate of lime; which will be mentioned more particularly under the head of the poisons of copper.
Process for Organic Mixtures.—The suspected mixture is to be heated with a little hydrochloric acid and well stirred. The arsenite being thus dissolved, the solution is to be allowed to cool and then filtered. A stream of hydrosulphuric-acid gas will now cause a dark-brown or yellowish-brown muddiness or precipitate, which is a mixture of sulphuret of copper and sulphuret of arsenic. The precipitate being separated after boiling, and properly cleansed by the process of subsidence and affusion, or if it is large, by washing on a filter, the two sulphurets are to be separated by ammonia, which dissolves sulphuret of arsenic but leaves the sulphuret of copper; and the sulphuret of arsenic may be recovered from the filtered fluid by expelling the ammonia with heat. The sulphuret of arsenic is next to be reduced as directed at page 211; and the sulphuret of copper examined as recommended under the head of copper.
This salt is an object of some importance to the medical jurist, as it forms the basis of a common medicine, Fowler’s Solution, or the Tasteless Ague Drop. This preparation contains in every ounce four grains of arsenious acid. It has a brownish-red colour, and an odour of lavender. It is strongly alkaline to litmus. When acidulated with hydrochloric acid, hydrosulphuric-acid gas causes in it a dirty brownish-yellow precipitate; and Reinsch’s process will detach arsenic from it upon copper in a state capable of being subjected to the usual tests [see p. 214].
This substance is so rarely met with as to be an object of little consequence to the medical jurist: nevertheless I have found in the course of reading two instances of poisoning with it. A very dangerous and tedious case has been related by Professor Bernt, which arose from too great a quantity having been given medicinally by an ignorant druggist;[557] and a case of accidental poisoning with it has been related in the London Medical Repository.[558] A singular account too has been published of the accidental poisoning of seven horses with it at Paris. They all died, most of them with the symptoms and morbid appearances of well-marked inflammation of the alimentary canal.[559]
When solid it forms tetraedral prismatic crystals, acuminated by four planes. It is very soluble in water, fuses at a red heat, and on cooling concretes into a crumbly, foliaceous mass, having a pearly lustre. It is easily known by the effect of the process of reduction—of the nitrate of silver, the salts of copper, and sulphuretted-hydrogen. Heated with charcoal in a tube it gives off metallic arsenic in the usual manner; but a stronger heat is required than for the reduction of the arsenious acid. Dissolved in water and treated with nitrate of silver it yields a brick-red precipitate, the arseniate of silver. With the salts of copper its solution gives a pale bluish-white precipitate, the arseniate of copper. With sulphuretted-hydrogen gas, preceded by acidulation with muriatic acid, and transmitted for a considerable length of time, it yields the yellow sulphuret of arsenic. When in solution it yields arsenic both by Reinsch’s process and the method of Marsh.
In the arts various substances are known which contain a compound of sulphur and arsenic. In the first place, two pure sulphurets are known in chemistry and in painting, the one of a fine orange colour, and known by the name of realgar, the other of a rich sulphur-yellow, and termed orpiment. Secondly, the name of orpiment is familiarly given to a pigment in more general use than either of the former, which has a less lively colour, and consists of pure orpiment with a large admixture of arsenious acid. Lastly, orpiment also forms a great proportion of another common pigment, King’s yellow.
The orange-red sulphuret (realgar, risigallum, Σανδαραχη, sandaracha), is chiefly a natural production. It is solid, of a bright orange-red colour, and composed of small shining scales, so soft as to be scratched with the nail. It is composed of one equivalent of metal and one of sulphur. Its best chemical characters are the disengagement of metallic arsenic when it is heated in a tube with potass or the black flux; and its undergoing sublimation unchanged when heated alone in a tube.
The yellow sulphuret (orpiment, auripigmentum, αρσενικον), is both a natural production, and the result of many chemical operations. The sulphuret thrown down from solutions of arsenic by sulphuretted-hydrogen is quite conformable in physical and chemical characters with the natural orpiment. Natural orpiment, when in mass, consists of broad scales of much brilliancy and of a rich yellow colour. It is composed of two equivalents of metal and three of sulphur. Its most striking chemical characters are the same with those of realgar, from which it is distinguished chiefly by its colour.
It has been stated by Hahnemann in his elaborate work on Arsenic, that the pure sulphurets are somewhat soluble in water,—that native orpiment is soluble in 5000 parts of water with the aid of ebullition, and that artificial orpiment by precipitation is soluble in 600 parts.[560] Hahnemann, however, was mistaken in supposing that the water dissolved these sulphurets. It does not dissolve, but decomposes them. Very lately M. Decourdemanche has found that, by slow action in cold water, and much more quickly with the aid of heat, the arsenical sulphuret is decomposed by virtue of a simultaneous decomposition of the water, hydrosulphuric acid being evolved and an oxide of arsenic remaining in solution. And he has farther remarked, that this change is promoted by the presence of animal and vegetable principles dissolved in water.[561] These facts are interesting, as they explain certain apparent anomalies to be noticed presently in the physiological properties of the sulphurets.
The common orpiment of the shops is not a pure sulphuret like the natural orpiment, but a much more active substance, a mixture of orpiment and arsenious acid. It is made by subliming in close vessels a mixture of sulphur and oxide of arsenic. It is met with in the shops in two forms, in that of a fine powder possessing a yellow colour with a faint tint of orange, and in that of concave masses composed of layers of various tints of white, yellow and orange, commonly also lined internally with tetraedral white pyramidal crystals. Till lately it was accounted a variety of sulphuret, and some ingenious conjectures were made as to the cause of its superior energy over the other sulphurets as a poison. But M. Guibourt has proved that it always contains oxide of arsenic, and is commonly impregnated with it to a very large amount, some parcels containing so much as 96 per cent.[562] The inner surface I have often seen lined with large crystals of pure oxide. In a very interesting account by Dr. Symonds of Bristol, describing the case of Mrs. Smith, for whose murder a woman Burdock was executed in that city a few years ago, it is stated that artificial orpiment was the poison given, that death took place in a very few hours, and that a sample from the druggist’s shop where the poison was bought contained on an average 79 per cent. of oxide of arsenic.[563]
Another impure sulphuret, a good deal used in painting, and a favourite poison in this country for killing flies, is King’s yellow. It is sold in the form of a light powder or in loose conical cakes. It has an intense sulphur-yellow colour. This substance is soluble, though not entirely, in water, both cold and warm, and forms a colourless solution, from which, on cooling, or by evaporation, a yellow powder separates. In this respect it differs essentially from the pure sulphurets. The solution is not acted on by reagents in the same way as the solution of arsenious acid. Lime-water and hydrosulphuric acid have no effect on it, the ammoniacal nitrate of silver causes a copious dirty brown, and the ammoniacal sulphate of copper a scanty, dirty lemon-yellow precipitate. I have not seen any account of the mode of preparing it or an analysis of its composition. But according to my own experiments it contains a large proportion of sulphuret of arsenic, a considerable proportion of lime, and about 16 per cent. of sulphur. Its nature is best shown by the following method of analysis. Let the powder be agitated in diluted ammonia till the colour becomes white. The filtered fluid contains the sulphuret of arsenic, which, on addition of an acid, falls down, and may be separated and reduced in a tube with the black flux. The remaining white powder, well freed from adhering sulphuret by washing, is next to be agitated in diluted acetate or hydrochloric acid and again filtered. The solution on being neutralized precipitates abundantly with oxalate of ammonia and the alkaline carbonates, showing that lime was taken up by the acid: and, as the acid operates without effervescence, the lime must have been in the caustic state. The powder which remains after the action of the acid will be found to fuse with a gentle heat and to burn almost entirely away with a blue flame, emitting sulphureous vapours. These experiments make it obvious that King’s yellow contains sulphuret of arsenic, caustic lime, and free sulphur; and in all probability the lime exists in the form of a triple sulphuret of lime and arsenic.
All the preparations containing the sulphuret of arsenic are interesting to the medical jurist, but particularly the two impure sulphurets last mentioned. The King’s yellow above all should be carefully studied, because on account of its frequent employment as a fly-poison it has been the source of fatal accidents. It was likewise taken intentionally a few years ago in this city, and proved fatal in thirty-six hours. Dr. Duncan also, while he was Professor of Medical Jurisprudence, met with an instance of an attempt to poison by mixing King’s yellow with tea; and at the Glasgow Spring Circuit of 1822 a woman was tried for poisoning her child with it.
Process for Organic Mixtures.—If sulphuret of arsenic be present in such mixtures in appreciable quantity, the particles, owing to their intense yellow colour, will be visible in any mass which has not the same tint. From this state of admixture they may be removed by adding caustic ammonia which dissolves sulphuret of arsenic; and the solution, on being acidulated with muriatic acid, will deposit the sulphuret sufficiently pure for undergoing the process of reduction.
Sulphuret of arsenic sometimes exists in small quantity in the stomach, although the poison was given in the form of oxide; for a portion of the oxide is subject to be converted into the sulphuret by hydrosulphuric acid gas evolved in the stomach after death.[564] In every instance of the kind yet carefully examined a large proportion of the oxide has remained unacted on, although the intense colour of the mixed sulphuret makes it appear as if that were the only compound present.
This compound presents the form of a colourless gas, possessing a fetid garlicky odour, a density of nearly 2·7, and great virulence as a poison. It is mentioned here, because accidental poisoning with it has happened occasionally within a few years, chiefly owing to the occasional adulteration of sulphuric acid with arsenic, and the liability of the arsenic to form arseniuretted-hydrogen when such sulphuric acid is used to prepare hydrogen gas. Dr. O’Reilly has mentioned a melancholy instance of a young chemist losing his life in this way.[565] Dr. Schlinder of Greifenberg has related another, which did not prove fatal.[566] And it is well known that the German chemist Gehlen lost his life by accidentally breathing arseniuretted-hydrogen while engaged in examining its chemical properties.[567] It is an inflammable body; and its presence in any other gas is easily detected by burning it according to the method of Marsh.
It is now generally admitted that arsenic produces in the living body two classes of phenomena,—or that, like the narcotico-acrids, it has a twofold action. One action is purely irritant, by virtue of which it induces inflammation in the alimentary canal and elsewhere. The other, although it seldom occasions symptoms of narcotism properly so called, yet obviously consists in a disorder of parts or organs remote from the seat of its application.
It is also the general opinion of toxicologists, that arsenic occasions death more frequently through means of its remote effects than in consequence of the local inflammation it excites. In some cases indeed no symptoms of inflammation occur at all; and in many, although inflammation is obviously produced, death takes place long before it has had time to cause material organic injury. Nevertheless in some, though certainly in comparatively few instances, the local action, it must be admitted, predominates so much, that the morbid changes of the part primarily acted on are alone adequate to account for death.
Its chief operation being on organs remote from the part to which it is applied, a natural object of inquiry is, whether this action results from the poison entering the blood, and so passing to the remote organs acted on, or simply arises from the organ remotely affected sympathizing through the medium of the nerves with the impression made on the organ which is affected primarily. On this question precise experiments are still wanted. The general opinion has for some time been that it acts through the blood. And this view has of late been strengthened by indisputable evidence, that the poison does enter the blood, and is diffused by it throughout the body.
For a long period chemists sought in vain for arsenic in the animal tissues and secretions at a distance from the alimentary canal. Such was the position of matters at the date of the last edition of this work; in which the failure was ascribed to the methods of analysis then known not being delicate enough to discover the small quantity of arsenic which disappears by absorption in cases of poisoning.[568] That statement is now referred to, because in a late controversy in France an attempt was made, by an erroneous quotation of this work, to deprive Professor Orfila of the honour, which is due to him alone, of having recently been the first to demonstrate the possibility of detecting arsenic throughout the organs and secretions generally of the bodies of men and animals poisoned with it.
This most important discovery, pregnant alike with interesting physiological deductions and valuable medico-legal applications, was first announced by him to the Parisian Academy of Medicine in January, 1839; when he stated that arsenic is absorbed in such quantity in cases of poisoning as to admit of being discovered by an improved process of analysis in various organs and fluids of the body, such as the liver, spleen, kidneys, muscles, blood, and urine.[569] In November, 1840, he proved these facts to the satisfaction of a committee of the academy.[570] And since then they have been confirmed by others, not merely in express experiments, but likewise in the familiar experience of medico-legal practice. The situations where arsenic is met with in largest quantity are the liver, the spleen, and the urine, but above all the liver. The precise circumstances in which it may be found in one or another of these quarters have not yet been determined. But in most cases of acute arsenical poisoning where the search has been made at all, it has proved successful in the liver. In two late instances I have readily found arsenic by the process of Marsh or Reinsch in the liver after four months’ interment.
Since arsenic then is clearly absorbed into the blood, it becomes an interesting question whether the organization of the blood is thereby changed. This question cannot be answered with confidence. But in all probability the blood does undergo some change in its crasis; for in most cases of acute poisoning that fluid is found after death in a remarkable state of fluidity [see Section on the Morbid Appearances]; and Mr. James observed that if venous or arterial blood be received into a solution of arsenic, instead of coagulating in the usual way, a viscous jelly first forms, and lumpy clots separate afterwards.[571]
Our knowledge of the affection induced by the remote action of arsenic is in some respects vague. Toxicologists have for the most part been satisfied with calling it a disorder of the general nervous system. When employed to designate the state of collapse which accompanies or forms the chief feature of acute cases of poisoning with arsenic, this term is misapplied. The whole train of symptoms is that not of a general nervous disorder, but simply of depressed action of the heart. That this is the chief organ remotely acted on in such cases farther appears probable from certain physiological experiments, in which it has been remarked, that immediately after rapid death from arsenic the irritability of the heart was exhausted or nearly so, while that of the intestines, gullet, and voluntary muscles continued as usual.[572] As to the singular symptoms which often arise in the advanced stage of lingering cases, the term, disorder of the general nervous system, is more appropriately applied to them. They clearly indicate a deranged state sometimes of the brain, sometimes of particular nerves.
Arsenic belongs to those poisons which act with nearly the same energy whatever be the organ or texture to which they are applied. The experiments of Sproegel,[573] repeated by Jaeger,[574] and by Sir Benjamin Brodie,[575] leave no doubt, that when applied to a fresh wound it acts with at least equal rapidity as when swallowed. Although in such circumstances the signs of irritation are often distinct, yet the symptoms are on the other hand sometimes more purely narcotic than by any other mode of administering it,—Sir B. Brodie in particular having observed loss of sense and motion to be induced, along with occasional convulsions. Arsenic likewise acts with energy when applied to the conjunctiva of the eye, as was proved by Dr. Campbell. It acts too with great energy when inhaled in the state of vapour into the lungs, or in the form of arseniuretted-hydrogen. It farther acts with violence through the mucous membrane of the vagina, producing local inflammation, and the usual constitutional collapse. These facts were determined experimentally by the Medical Inspectors of Copenhagen on the occasion of a singular trial which will be noticed afterwards. Arsenic also acts, as may easily be conceived, when injected into the rectum. And farther, it acts as a poison, when it is applied to the surface of ulcers, yet certainly not under all circumstances. Its power of acting through the unbroken skin has been questioned. Jaeger found that, when it was merely applied and not rubbed on the skin of animals, it had no effect.[576] But some cases will be afterwards mentioned which tend to show that the reverse probably holds in regard to man. According to the last-mentioned author, who is the only experimentalist that has hitherto examined the subject consecutively, arsenic is most active when injected into a vein, or applied to a fresh wound, or introduced into the sac of the peritonæum; it is less powerful when taken into the stomach; it is still less energetic when introduced into the rectum; and it is quite inert when applied to the nerves.
It is a striking fact in the action of that poison that, whatever be the texture in the body to which it is applied, provided death do not ensue quickly, it almost always produces symptoms of inflammation in the stomach; and on inspection after death traces of inflammation are found in that organ. In some instances of death caused by its outward application, the inflamed appearance of the stomach has been greater than in many cases where it had been swallowed. Sproegel met with a good example of this in a dog killed by a drachm applied to wounds. The whole stomach and intestines, outwardly and inwardly, were of a deep-red colour, blood was extravasated between the membranes, and clots were even found in the stomach.[577]
Of the different preparations of arsenic, it may be said in general terms, that those are most active which are most soluble. In conformity with what appears to be a general law in toxicology, the metal itself is inert. It is difficult to put this fairly to the test, because it is not easy to pulverize the metal without a sufficient quantity being oxidated to cause poisonous effects. Bayen and Deyeux, however, found that a drachm carefully prepared might be given in fragments to dogs without injuring them; and they once gave a cat half an ounce without any other consequence than temporary loss of flesh.[578] Its alloys are also inert. The same experimentalists found it inactive when combined with tin; and Renault likewise found it inactive when united with sulphur and iron in the ore mispickel, or arsenical pyrites.[579]
It is probable that all the other preparations of arsenic are more or less deleterious.
A difference of opinion prevails as to the power of the sulphurets. Various statements have been published on the subject. But it may be sufficient to observe, that in consequence of the poisonous properties of the sulphurets having been imputed to the oxide, with which they are often adulterated,—Professor Orfila made some experiments with native orpiment and realgar, and with the sulphuret procured by sulphuretted-hydrogen gas (which are all pure sulphurets); and he found that in doses varying from 40 to 70 grains they all caused death in two, three, or six days, whether they were applied to a wound, or introduced into the stomach.[580] It may appear at first view singular that the sulphurets, being insoluble, should be poisonous; but the apparent anomaly vanishes on considering the experiments of M. Decourdemanche formerly noticed; which prove that in animal fluids the sulphurets are rapidly changed into the oxide (see p. 225). The sulphurets, however, are much less active than the preparations in which the metal exists already oxidated. Yet in sufficient doses they will prove rapidly fatal. In the Acta Germanica there is the case of a woman who was killed in a few hours by realgar, mixed by her step-daughter in red cabbage soup.[581] The common artificial orpiment procured by sublimation is very active, in consequence of the oxide mixed with it. Renault found three grains killed a dog in nine hours.[582]
Among the less active preparations of arsenic may also be enumerated such of the arsenites and arseniates as are not soluble in water. They have not indeed been actually tried. But there can be little doubt that they will prove poisonous; because, though insoluble in water, they are probably somewhat soluble in the animal juices. We may infer from their sparing solubility, even in these menstrua, that they will be less active than the preparations now to be mentioned, which are more soluble.
These are the alkaline arsenites and arseniates, arsenic acid, arsenious acid, the black oxide or fly-powder, and arseniuretted-hydrogen. With regard to arsenic acid, and the alkaline arseniates and arsenites, it is probable, from their effects in medicinal doses, that they are as active as the white oxide, if not more so. But they have not been particularly examined, as they are not objects of great interest to the medical jurist.
The fly-powder or black oxide is very active. Renault found that four grains killed a middle-sized dog in ten hours.[583] It has been likewise known to prove quickly fatal to man. In a French journal there is a case related which ended fatally in sixteen hours;[584] and in the Acta Germanica is an account of four persons, who died in consequence of eating a dish of stewed pears poisoned with it, and of whom three died within eighteen hours.[585] The dose is not mentioned; but it is probable from the collateral circumstances that it was not considerable.
Arseniuretted-hydrogen is probably the most active of all arsenical compounds. The celebrated German chemist Gehlen, having accidentally inhaled a small portion of it, died in nine days with the usual symptoms of arsenical poisoning. In Dr. O’Reilly’s case, which proved fatal in seven days, it was computed that the equivalent of twelve grains of oxide had been inhaled. And Dr. Schlinder’s patient had inhaled a quantity of gas corresponding with only an eighth of a grain of sesquioxide; yet he appears to have made a narrow escape.[586]
It is of some consequence to settle with precision the power of the white oxide. Witnesses are often asked on trials how small a quantity will occasion death? It is obvious that this question admits only of a vague answer: It can be answered at all only in reference to concomitant circumstances, and even then but presumptively. Nevertheless, it is right to be aware what facts are known on the subject.
It has been stated by various systematic authors that the white oxide will prove fatal to man in the dose of two grains. Hahnemann says in more special terms, that in circumstances favourable to its action four grains may cause death within twenty-four hours, and one or two grains in a few days.[587] But neither he nor any of the other authors alluded to have referred to actual cases. Foderé knew half a grain cause colic pains in the stomach and dysenteric flux, which continued obstinately for eight days;[588] and I have related an instance where six persons, after taking each a grain in wine during dinner, were seriously and violently affected for twelve hours.[589] Mr. Alfred Taylor mentions three similar cases occasioned by arsenic accidentally taken in port wine after dinner,—one, an infant of sixteen months who got about a third of a grain, another, a lady who took a grain and a half, and the third, a gentleman, who had two grains and a half,—in all of whom violent vomiting, and prostration, without pain, occurred for three or four hours; and the gentleman of the party did not recover for several days.[590] M. Lachèse mentions his having met with a number of cases of poisoning from small doses taken in bread or soup; whence he concludes, that an eighth of a grain taken in food may cause vomiting;—that a quarter of a grain or twice as much taken once only causes vomiting, colic, and prostration,—that the same quantity repeated next day renews these symptoms in such force as to render the individual unfit for work till three or four days afterwards,—and that four such doses, taken at intervals during two days, that is between one and a half and two grains in all, excite acute gastro-enteritis and may prove fatal, since two individuals who had taken this much died, one in seven weeks, the other three weeks later.[591] The smallest fatal dose I have found recorded elsewhere is four grains and a half; and death ensued in six hours only.[592] But the subject was a child, four years old, and the poison was taken in solution. Alberti mentions the case of a man who died from taking six grains; but I am unacquainted with the particulars, not having seen the original account.[593] Two children, whose cases are alluded to in the Proceedings of the Academy of Medicine of Paris, died, the one in two days, the other a day later, after taking rather less than sixteen grains. The former was four years and a half old, the latter seven years.[594] Valentini alludes to a case where thirty grains of the oxide in powder killed an adult in six days.[595] The effects of medicinal doses, which seldom exceed a quarter of a grain without causing irritation of the stomach, and the fatal effects of somewhat larger doses on animals, Renault having found that a single grain in solution killed a large dog in four hours,[596] must convince every one that the general statement of Hahnemann cannot be very wide of the truth. Mr. Taylor thinks his own cases mentioned above throw doubt over this inference. But it must be remembered, that his patients had dined just before taking the poison.
It is not improbable that the activity of oxide of arsenic is impaired by admixture with other insoluble powders. M. Bertrand, conceiving from some experiments on animals that he had found an antidote for arsenic in charcoal powder, took no less than five grains of the oxide mixed with that substance, and he did not suffer any injury, although his stomach was empty at the time, and he did not vomit.[597] But Orfila afterwards showed, that other insoluble powders, such as clay, have the same effect; that no such powder can be of any use if not introduced into the stomach till after the arsenic is swallowed; and that they appear to act solely by enveloping the arsenical powder and preventing it from touching the membrane of the alimentary canal.[598] Although M. Bertrand’s discovery will not supply the physician with an antidote, the medical jurist will not lose sight of the interesting fact, that, by certain mechanical admixtures, arsenic in moderate doses may be entirely deprived of its poisonous quality. A singular case of recovery from no less a dose than sixty grains, which happened in the case of an American physician, probably comes under the same head with the experiments of Bertrand,—a large quantity of powder of cinchona-bark having been swallowed along with the arsenic. In this case, however, the symptoms were severe for three days.[599]
The tendency of habit to modify the action of arsenic is questionable. So far as authentic facts go, habit has no power of familiarizing the constitution to its use. One no doubt may hear now and then of mountebanks who swallow without injury entire scruples or drachms of arsenic, and vague accounts have reached me of patients who took unusually large doses for medicinal purposes. But as to facts of the former kind, it is clear that no importance can be attached to them; for it is impossible to know how much of the feat is genuine, and how much legerdemain. With respect to the latter facts, I have never been able to ascertain any precise instance of the kind; and so far as my own experience goes, the habit of taking arsenic in medicinal doses has quite an opposite effect from familiarizing the stomach to it.
Oxide of arsenic being sparingly soluble, its operation is often much influenced by the condition of the stomach as to food at the time it is swallowed. If the stomach be empty, it adheres with tenacity to the villous coat and acts with energy. If the stomach be full at the time, the first portions that come in contact with the inner membrane may cause vomiting before it can be diffused, so that the whole or greater part is discharged. One remarkable case of this nature has been quoted in page 29. In another, where severe symptoms did supervene, and recovery was ascribed to the use of magnesia as an antidote, the favourable result seems to have been really owing to the circumstance, that the patient had supped heartily not long before taking the arsenic.[600] An extraordinary case related by Mr. Kerr, in which nearly three-quarters of an ounce were retained for two hours without causing any serious mischief, probably comes under the same category; for the arsenic was taken immediately after a meal, and the stomach was cleared out by emetics.[601]
In the following detail of the symptoms caused by arsenic in man, its effects when swallowed will be first noticed; and then some remarks will be added on the phenomena observed when it is introduced through other channels.
The symptoms of poisoning with arsenic may be advantageously considered under three heads. In one set of cases there are signs of violent irritation of the alimentary canal and sometimes of the other mucous membranes also, accompanied with excessive general depression, but not with distinct disorder of the nervous system. When such cases prove fatal, which they generally do, they terminate for the most part in from twenty-four hours to three days. In a second and very singular set of cases there is little sign of irritation in any part of the alimentary canal; perhaps trivial vomiting or slight pain in the stomach, but sometimes neither; the patient is chiefly or solely affected with excessive prostration of strength and frequent fainting; and death is seldom delayed beyond the fifth or sixth hour. In a third set of cases life is commonly prolonged at least six days, sometimes much longer, or recovery may even take place after a tedious illness; and the signs of inflammation in the alimentary canal are succeeded or become accompanied, about the second or fourth day or later, by symptoms of irritation in the other mucous passages, and more particularly by symptoms indicating a derangement of the nervous system, such as palsy or epilepsy. The distinctions now laid down will be found in practice to be well defined, and useful for estimating in criminal cases the weight of the evidence from symptoms.
1. In one order of cases, then, arsenic produces symptoms of irritation or inflammation along the course of the alimentary canal. Such cases are the most frequent of all. The person commonly survives twenty-four hours, seldom more than three days; but instances of the kind have sometimes proved fatal in a few hours, and others have lasted for weeks. On the whole, however, if the case is much shorter than twenty-four hours, or longer than three days, its complexion is apt to be altered. In the mildest examples of the present variety recovery takes place after a few attacks of vomiting, and slight general indisposition for a day or two.
In regard to the ordinary progress of the symptoms, the first of a decisive character are sickness and faintness. It is generally thought indeed that the first symptom is an acrid taste; but this notion has been already shown to be erroneous. For some account of the sensations felt in the act of swallowing the poison, the reader may refer to what has been stated in p. 200. There is no doubt, that in the way in which arsenic is usually given with a criminal intent, namely, mixed with articles of food, it seldom makes any impression at all upon the senses during the act of swallowing.
In some instances the sickness and faintness, particularly when the poison was taken in solution, have begun a few minutes after it was swallowed. Thus in a case mentioned by Bernt, in which a solution of arseniate of potass was taken, the symptoms began violently in fifteen minutes;[602] in one related by Wildberg, where the oxide was given in coffee, the person was affected immediately on taking the second cup;[603] in one related by Mr. Edwards, the patient was taken ill in eight minutes,[604] in one mentioned by M. Lachèse of Angers, violent symptoms commenced within ten minutes after the poison was swallowed with prunes;[605] in a case communicated to me by Mr. J. H. Stallard of Leicester, the symptoms set in with violence ten minutes after it was taken dissolved in tea; nay, in a case of poisoning with orpiment in soup, mentioned by Valentini, the man felt unwell before he had finished his soup, and set it aside as disagreeable.[606] It is a mistake therefore to suppose, as I have known some do, that arsenic never begins to operate for at least half an hour. Nevertheless it must be admitted, that in general arsenic does not act for half an hour after it is swallowed.—On the other hand, its operation is seldom delayed beyond an hour. The following, however, are exceptions to this rule. Lachèse in the paper quoted above mentions an instance where the interval was two hours, and where the issue was eventually fatal. The arsenic had been in very coarse powder. Mr. Macaulay of Leicester has communicated to me a case where the individual took the poison at eight in the evening, went to bed at half-past nine, and slept till eleven, when he awoke with slight pain in the stomach, vomiting, and cold sweats. In this instance the dose was seven drachms, and death took place in nine hours. M. Devergie has related a similar case of poisoning with the sulphuret, where the symptoms did not begin for three hours; and here too the patient fell asleep immediately after swallowing the poison.[607] Professor Orfila has noticed an instance, to be quoted afterwards, where there appears to have been scarcely any symptom at all for five hours[608] (p. 243). I suspect we must also consider as an instance of the same kind the case which gave occasion to the trial of Mrs. Smith here in 1827. A white draught was administered in a suspicious manner at ten in the evening; the girl immediately went to bed; and no symptoms appeared till six next morning, from which time her illness went on uninterruptedly.[609] In three of the preceding cases it will be remarked that sleep intervened between the taking of the poison and the invasion of the symptoms; and it is therefore not improbable that the reason of the retardation is the comparative inactivity of the animal system during sleep.—In voluntary poisoning, as in a case related by Dr. Roget, a slight attack of sickness or vomiting occasionally ensues immediately after solid arsenic is swallowed, and some time before the symptoms commence regularly.[610]
The observations now made will often prove important for deciding accusations of poisoning; for pointed evidence may be derived from the commencement of the symptoms, after a suspected meal, corresponding or not corresponding with the interval which is known to elapse in ascertained cases. The reader will see the effect of such evidence in attaching guilt to the prisoner in the case of Margaret Wishart, which I have detailed elsewhere.[611] In the trial of Mrs. Smith, the want of the correspondence just mentioned contributed greatly to her acquittal; for the symptoms of poisoning did not begin till more than eight hours after the only occasion on which the prisoner was proved to have administered any thing in a suspicious manner. As I was not at the time acquainted with any parallel case except that recorded by Orfila, I hesitated to ascribe the symptoms to the draught; and consequently, as the other medical witnesses felt the same hesitation on the same account, the proof of administration was considered to have failed. I am not sure that I should have now felt the same difficulty. The intervening state of sleep probably affords an explanation of the long interval; and the cases noticed by Mr. Macaulay and M. Devergie are parallel, though the interval in them was certainly not so great.—There is a limit, however, to the possible interval in such cases. It seems impossible that the action of the poison shall be suspended for three entire days. Yet death has been ascribed to arsenic in such circumstances. A child 3½ years old having swallowed eight grains with bread and butter, but being soon made to vomit forcibly by emetics, presented no decided symptom at the time, or for three days more; but on the fourth day difficult breathing ensued, with anxiety of expression, frequency of the pulse, and heat of the skin; and next day death took place. There was no morbid appearance found in the body.[612] I do not know of any parallel instance of death from arsenic, and cannot admit that the poison was the cause of the symptoms and fatal event.
Soon after the sickness begins, or about the same time, the region of the stomach feels painful, the pain being commonly of a burning kind, and much aggravated by pressure. Violent fits of vomiting and retching then speedily ensue, especially when drink is taken. There is often also a sense of dryness, heat, and tightness in the throat, creating an incessant desire for drink; and this affection often precedes the vomiting. Occasionally it is wanting, at other times so severe as to be attended with suffocation and convulsive vomiting at the sight of fluids.[613] Hoarseness and difficulty of speech are commonly combined with it. The matter vomited is greenish or yellowish; but sometimes streaked or mixed with blood, particularly when the case lasts longer than a day.
In no long time after the first illness diarrhœa generally makes its appearance, but not always. In some cases, instead of it, the patient is tormented by frequent, ineffectual calls: in others the great intestines are scarcely affected. About this time the pain in the stomach is excruciating, and is often likened by the sufferer to a fire burning within him. It likewise extends more or less downwards, particularly when the diarrhœa or tenesmus is severe; and the belly is commonly tense and tender, sometimes also swollen, though not frequently,—sometimes even on the contrary drawn in at the navel.[614] When the diarrhœa is severe, the anus is commonly excoriated and affected with burning pain.[615] In such cases the burning pain may extend along the whole course of the alimentary canal from the throat to the anus. Nay at times the mouth and lips are also inflamed, presenting dark specks or blisters.[616]
Sometimes there are likewise present signs of irritation of the lungs and air-passages,—almost always shortness of breath (which, however, is chiefly owing to the tenderness of the belly),—often a sense of tightness across the bottom of the chest, and more rarely decided pain in the same quarter, darting also through the upper part of the chest. Sometimes pneumonia has appeared a prominent affection during life, and been distinctly traced in the dead body.[617]
In many instances, too, the urinary passages are affected, the patient being harassed with frequent, painful and difficult micturition, swelling of the penis, and pain in the region of the bladder, or, if a female, with burning pain of the vagina and excoriation of the labia.[618] Sometimes the irritation of the urinary organs is so great as to be attended with total suppression of urine, as in a case related by Guilbert of Montpellier, in which this symptom continued several days.[619] During the late contentions among chemists, physiologists, and physicians, occasioned by the case of Madame Lafarge, it was alleged by Flandin and Danger that in animals the urine is always suppressed, by Orfila that it is always secreted, by Professor Delafond of the Alfort Veterinary School, that it is never suppressed, but always diminished, and sometimes even to a sixth of the natural quantity.[620] There is, however, no invariable rule in the matter. And in fact, urinary symptoms are seldom present unless the lower bowels are likewise strongly irritated; but are then seldom altogether wanting. They are rarely well marked in cases of the present variety, unless life is prolonged three days or more.
When symptoms of irritation of the alimentary canal have subsisted a few hours, convulsive motions often occur. They commence on the trunk, afterwards extend over the whole body, are seldom violent, and generally consist of nothing else than tremors and twitches. Cramps of the legs and arms, a possible concomitant of every kind of diarrhœa, is peculiarly severe and frequent in that caused by arsenic.
The general system always sympathizes acutely with the local derangement. The pulse commonly becomes very small, feeble and rapid soon after the vomiting sets in; and in no long time it is often imperceptible. This state is naturally attended with great coldness, clammy sweats, and lividity of the feet and hands. Another symptom referrible to the circulation which has been observed, though, very rarely, is palpitation.[621]
The countenance is commonly collapsed from an early period, and almost always expressive of great torture and extreme anxiety or despair; the eyes are red and sparkling; the conjunctiva often so injected as to seem inflamed; the tongue and mouth parched; and the velum and palate sometimes covered with little white ulcers.
Delirium sometimes accompanies the advanced stage, and stupor also is not unfrequent. Coma occasionally precedes death, as in Mr. Stallard’s case (p. 235), in which the symptoms of irritation, at first very violent, gradually gave place in two hours to complete insensibility, proving fatal in two hours more. Very often, however, the patient remains quite sensible to the last. Death in general comes on calmly, but is sometimes preceded by a paroxysm of convulsions.[622] In some cases it takes place quite unexpectedly, as if from sudden deliquium, as in a case mentioned by Dr. Dymock of this city. The patient, a girl who had taken two ounces intentionally, rose from her bed without help two hours and a half afterwards, went to a chair at the fireside, and had scarce sat down when she expired.[623]
Various eruptions have at times been observed, especially in those who survive several days; but they are more frequent in the kind of cases to be considered afterwards, in which life is prolonged for a week or more. The eruptions have been variously described as resembling petechiæ, or measles, or red miliaria, or small-pox. In the case already quoted from Guilbert a copious eruption of miliary vesicles appeared on the fifth day, and for fifteen days afterwards. They were attended with perspiration and abatement of the other symptoms, and followed with desquamation of the cuticle. Another external affection which may be noticed is general swelling of the body. Several cases of this nature have been described by Dr. Schlegel of Meiningen; and in one of them the swelling, particularly round the eyes, appears to have been considerable.[624]
In some cases of the kind now under consideration a short remission or even a total intermission of all the distressing symptoms has been witnessed, particularly when death is retarded till the close of the second or third day.[625] This remission, which is accompanied with dozing stupor, is most generally observed about the beginning of the second day. It is merely temporary, the symptoms speedily returning with equal or increased violence. Sometimes the remission occurs oftener than once, as in a case related in the London Medical and Physical Journal. The patient, a child seven years old, lived thirty-six hours in a state of alternate calm and excitement; and during the state of calm no pulse was to be felt at the wrists.[626]—So far as at present appears a long intermission is impossible.
In cases such as those now described death often occurs about twenty-four hours after the poison is swallowed, and generally before the close of the third day. But on the one hand life has been sometimes prolonged, without the supervention of the symptoms belonging to a different variety of cases, for five or six days,[627] nay perhaps even for several weeks. And, on the other hand, the symptoms of irritation of the alimentary canal are sometimes distinct, although death takes place in a much shorter period than twenty-four hours. Metzger has related a striking case, fatal in six hours, in which the symptoms were acute colic pain, violent vomiting, and profuse diarrhœa;[628] and Wildberg has related a similar case fatal in the same time.[629] Hohnbaum describes another fatal in five hours;[630] and I met with as brief a case in this city in 1843, where all the usual symptoms of irritation in the stomach and bowels were violent. These symptoms were also present at first in Mr. Stallard’s case, which was fatal in four hours; Pyl has recorded one, where all the signs of irritation in the stomach and intestines were present, except vomiting, and which proved fatal in three hours;[631] and Dr. Dymock met here with a similar instance which lasted only two hours and a half.[632] This is one of the shortest undoubted cases of poisoning from arsenic I have hitherto found in authentic records. Dr. Male mentions one, which was fatal in four hours;[633] Wepfer another equally short;[634] Johnston another fatal in three hours and a half;[635] and I shall presently mention others without symptoms of irritation which ended fatally in two, five, or six hours [p. 242].[636] Wibmer has even quoted a case fatal in half an hour; but there seems to have been some doubt whether the poison taken was arsenic.[637]
Such is an account of the symptoms of poisoning by arsenic in their most frequent form. It will of course be understood, that they are liable to a great variety as to violence, as well as their mode of combination in actual cases;—and that they are by no means all present in every instance. The most remarkable and least variable of them all, pain and vomiting, are sometimes wanting. A case, in which pain was not felt in the stomach, even on pressure, although the other symptoms of inflammation were present, has been briefly described in the Medical Repository.[638] A similar case fatal in fourteen hours and a half, where there was much vomiting and some heat in the stomach, but no pain or tenderness, has been related by Dr. E. Gairdner.[639] Another very striking example of this anomalous deficiency has been detailed by Dr. Yellowly. A lad sixteen years old died twenty-one hours after swallowing half an ounce of the white oxide; and the presence of inflammation was denoted all along by sickness, vomiting, purging, and heat in the tongue; yet he never complained of pain, neither did he ever seem to his friends to suffer any. Another anomaly in the case was, that the pulse, contrary to what is usual, was very slow: twelve hours after he took the poison, the pulse was 40, and two hours before death it was so slow as 30.[640] These deviations from the ordinary course of the symptoms are taken notice of merely to put the practitioner on his guard, and prevent the medical jurist from drawing hasty conclusions. Upon the whole, they are rare; and the symptoms of poisoning by arsenic are in general very uniform.
2. The second variety of poisoning with arsenic includes a few cases in which the signs of inflammation are far from violent or even altogether wanting, and in which death ensues in five or six hours or a little more,—at a period too early for inflammation to be always properly developed. The symptoms are then generally obscure, and are referrible chiefly to the mode of action, which is probably the cause of death in most cases,—a powerful debilitating influence on the circulation, or on the nervous system.
These symptoms occasionally amount to absolute narcotism, as in some of the animals on which Sir B. Brodie experimented. Thus, when he injected a solution of the oxide into the stomach of a dog, the pulse was rendered slow and intermitting; the animal became palsied in the hind-legs, lethargic, and in no long time insensible, with dilated pupils; and soon afterwards it was seized with convulsions, amidst which it died, fifty minutes after the poison was administered.[641] In man the symptoms very seldom resembled so closely those of the narcotic poisons. In Mr. Stallard’s case, however, formerly mentioned, the symptoms of irritation which appeared at first speedily gave place to complete insensibility for two hours before death (pp. 235, 238), a similar instance has been related in Henke’s Journal. A young man who got an arsenical solution from an old woman to cure ague, was attacked after taking it with vomiting and loud cries, afterwards with incoherent talking, then fell into a deep sleep, and finally perished in convulsions in five hours.[642]
In some cases of the kind now under consideration, one or two attacks of vomiting occur at the usual interval after the taking of the poison; but it seldom continues. The most uniform and remarkable affection is extreme faintness, amounting at times to deliquium. Occasionally there is some stupor, or rather oppression, and often slight convulsions. Pain in the stomach is generally present; but it is slight, and seldom accompanied with other signs of internal inflammation. Death commonly takes place in a few hours. Yet, even when it is retarded till the beginning of the second day, the faintness and stupor are sometimes more striking features in the case than the symptoms of inflammation in the stomach.
This variety of poisoning has been hitherto observed only under the three following circumstances,—when the dose of poison was large,—when it was in little masses,—or when it was in a state of solution. The mode in which the first and last circumstances operate is evident; they facilitate the absorption of a large quantity of arsenic in a short space of time, so that its remote action begins before local inflammation is fully developed. But it is not easy to see how any such effect can flow from the arsenic being in little masses. It is also to be observed that none of the circumstances here mentioned is invariable in its operation. An instance is related in Rust’s Magazine, of the customary signs of irritation having been produced even by the solution.[643]
On the whole, the present variety of poisoning is rather uncommon, and indeed, although the attention of the profession was pointedly called to it even in the first edition of the present work, its existence does not seem to be so generally known as it ought to be.[644] It may be right therefore to specify the cases which have been published.
In the Medical and Philosophical Journal of New York,[645] is related the case of a druggist, who swallowed an ounce of powdered arsenic at once, and died in eight hours, after two or three fits of vomiting, with slight pain and heat in the stomach.—A similar case has been related by Metzger. A young woman died in a few hours, after suffering from trivial diarrhœa, pain in the stomach and strangury; her death was immediately preceded by slight convulsions and fits of suffocation; and on dissection the stomach and intestines were found quite healthy. Half an ounce of arsenic was found in the stomach.[646]—A third case similar in its particulars to the two preceding was submitted to me for investigation by the sheriff of this county in 1825. The subject, a girl fourteen years of age, took about ninety grains, and died in five hours, having vomited once or twice, complained of some little pain in the belly, and been affected towards the close with great faintness and weakness. The stomach and intestines were healthy.[647]—A fourth case allied to these is succinctly told in the Medical and Physical Journal. The person expired in five hours; and vomiting never occurred, even though emetics were given.[648]—A fifth has been related by M. Gérard of Beauvais. The subject was a man so addicted to drinking, that his daily allowance was a pint of brandy. When first seen, there was so much tranquillity, that doubts were entertained whether arsenic had really been swallowed; but at length he was discovered actually chewing it. This state continued for nearly five hours, when some vomiting ensued: coldness of the extremities and spasmodic flexion of the legs soon followed; and in a few minutes more he expired.[649]—A sixth and very singular case of the same kind has been described by Orfila. The individual having swallowed three drachms at eight in the morning, went about for two hours bidding adieu to his friends and telling what he had done. He was then prevailed on to take emetics and diluents, which caused free, easy vomiting. He suffered very little till one, when he became affected with constricting pain and burning in the stomach, feeble pulse, cold sweats, and cadaverous expression, under which symptoms he died four hours later.[650] Orfila justly designates this case as the most extraordinary instance of poisoning with arsenic that has come under his notice.—A seventh is related by Mr. Holland of Manchester where death took place in the course of eight or nine hours, and the symptoms were at first some vomiting, afterwards little else but faintness, sickness, a sullen expression, and a general appearance which led those around to suppose the individual intoxicated.[651]—Professor Chaussier has described a still more striking case than any yet mentioned. A stout middle-aged man swallowed a large quantity of arsenic in fragments and died in a few hours. He experienced nothing but great feebleness and frequent tendency to fainting. The stomach and intestines were not in the slightest degree affected during life; and no morbid appearance could be discovered in them after death,[652]—A similar instance not less remarkable has been communicated to me by Mr. Macauley of Leicester, where the individual died with narcotic symptoms only within two hours after taking nearly a quarter of a pound of arsenic.—Another fatal in four hours has been described by Mr. Wright, where the symptoms were vomiting under the use of emetics, great exhaustion, feeble hurried pulse, cold sweating, drowsiness and finally stupor. In this case the quantity of arsenic taken was about an ounce.[653]—Another of the same nature is recorded by Morgagni. An old woman stole and ate a cake, which had been poisoned with arsenic for rats. She died in twelve hours, suffering, says Morgagni, rather from excessive prostration of strength than from pain or convulsions.[654]—The following case related by M. Laborde is most remarkable in its circumstances. A young woman was caught in the act of swallowing little fragments of arsenic, and it afterwards appeared that she had been employed most of the day in literally cracking and chewing lumps of it. When the physician first saw her the countenance expressed chagrin and melancholy, but not suffering. After being forced to drink she vomited a good deal, but without uneasiness. Two hours afterwards her countenance was anxious; but she did not make any complaint, and very soon resumed her tranquillity. Five hours after the last portions of the poison were taken she became drowsy, then remained perfectly calm for four hours more, and at length on trying to sit up in bed, complained of slight pain in the stomach, and expired without agony. A clot of blood was found in the stomach.[655]—Dr. Platner of Pavia describes a case, fatal probably in five hours, where the symptoms were a tranquil, melancholic expression, great coldness, paleness of the features, slow languid pulse, retarded respiration, and suppression of urine, but no pain or swelling of the belly, and no diarrhœa till near death, when there was one copious fluid evacuation.[656]—Lastly, Dr. Choulant has related the case of an elderly female who got a thimbleful of arsenic in soup, and died in eleven hours, affected with occasional, easy vomiting, uneasiness, thirst, and undefinable uneasiness in the chest, but without pain of any kind, or any other complaint.[657]
The cases of which an abstract has here been given, will, it is apprehended, be sufficient to correct the erroneous impression of many,—that arsenic, when it proves fatal, always produces violent and well-marked symptoms. It will of course be understood that cases of the present kind pass by insensible shades into those of the first class,—the following, for example, being intermediate between the two. A young man had frequent vomiting and diarrhœa, which were supposed to depend on indigestion merely, as the countenance was calm, without any appearance of suffering, the appetite tolerable, and the abdomen quite free of tenderness. The pulse, however, quickly sunk, the voice failed, and death took place in eleven hours; and on dissection about twenty grains of arsenic were found in the stomach with strong signs of inflammation.[658]—In a case communicated to me by a former pupil, Mr. Adams of Glasgow, that of a woman who died five hours after taking six drachms of arsenic, there was some vomiting not long after she swallowed it; but subsequently she presented no prominent symptoms except a ghastly expression, redness of the eyes, a fluttering pulse and extreme prostration, until within half an hour before death, when the action of an emetic and the stomach-pump was followed by severe burning pain.