The importance of the fact established by these cases will appear from the following medico-legal inquiries. A Prussian medical college was consulted in the case of a new-born child, in which the stomach and intestines were healthy, and did not contain poison, but in which the cuticle of the lips was easily scraped off, the gums, tongue, and mouth yellowish-green, as if burnt, the velum and uvula in the same state, the rima glottidis contracted, and the epiglottis, larynx, and fauces violently inflamed. The College declared, that a concentrated acid had been given, and that death had been occasioned by suffocation. Sulphuric acid was found in the house; and the mother subsequently confessed the crime.[270] A case was formerly quoted (p. 75), where MM. Ollivier and Chevallier found traces of the action of nitric acid on the lips, mouth, throat and upper fourth of the gullet, but not lower. In this instance the reporters came to the opinion from the absence of injury in the more important parts of the alimentary canal, as well as from the marks of nail scratches on the neck, and the gorged state of the lungs, that death had been produced by strangling, after an unsuccessful attempt by the forcible administration of nitric acid. It is quite possible, however, that death might quickly ensue from the effects of the poison on the throat and gullet. In the course of the judicial inquiries M. Alibert stated that he had known repeated instances of death from swallowing nitric acid, although none of it reached lower down than the pharynx. Ollivier in his paper doubts the accuracy of this statement; but the cases quoted above show clearly that such injury may be done to the glottis as will be adequate of itself to occasion death.[271]
It seems farther not improbable that, among the terminations of poisoning with the strong mineral acids, scirrhous pylorus must also be enumerated. This is a very rare effect of the action of corrosive poisons. But M. Bouillaud has related an instance of death from scirrhous pylorus in its most aggravated shape, which supervened on the chronic form of the effects of nitric acid, and which proved fatal in three months.[272]
In some circumstances the stomach seems to acquire a degree of insensibility to the action of the strong acids. Tartra, in alluding to what is said of certain whisky-drinkers acquiring the power of swallowing with impunity small quantities of the concentrated acids, has related the case of a woman at Paris, who, after passing successively from wine to brandy and from that to alcohol, at last found nothing could titillate her stomach except aqua-fortis, of which she was seen to partake by several druggists of veracity.[273] The fire-eating mountebanks too are said to acquire the same power of endurance; but much of their apparent capability is really legerdemain. On the other hand, a very extraordinary sensibility to the action of the diluted mineral acids has been supposed to exist in the case of infants at the breast,—so great a sensibility, that serious symptoms and even death itself have been ascribed to the nurse’s milk becoming impregnated with sulphuric acid, in consequence of her having taken it in medicinal doses. By two writers in the London Medical Repository griping pains, tremors and spasms have been imputed to this cause;[274] and a writer in the Medical Gazette says he has seen continued griping, green diarrhœa and fatal marasmus ensue,—apparently, he thinks, from ulceration of the gastro-intestinal mucous membrane.[275] Without questioning the great delicacy and tenderness of that membrane in infants, I must nevertheless express my doubts whether so small a quantity taken by a nurse, amounting in the cases in question only to four or six drops a day, could really produce fatal or even severe effects on her child.
Sulphuric acid is not less deadly when admitted into the body through other channels besides the mouth. Thus, it may prove fatal when introduced into the rectum. A woman at Bruges in Belgium had an injection administered, in which, being prepared hastily in the middle of the night, sulphuric acid had been substituted by mistake for linseed-oil. The patient immediately uttered piercing cries, and passed the remainder of the night in excessive torture. In the morning the bed-clothes were found corroded, and a portion of intestine had apparently come away; and she expired not long afterwards.[276]
Death may also be occasioned by the introduction of this acid into the ear. Dr. Morrison relates a case of the kind, where nitric acid, which is analogous in action, was poured by a man into his wife’s ear, while she lay insensible from intoxication. She awoke in great pain, which continued for two or three days. In six days an eschar detached itself from the external passage of the ear; and this was followed by profuse hemorrhage, which recurred daily more or less for a month. On the day after the eschar came away, and without any precursory symptom referrible to the head, she was attacked with complete palsy of the right arm, and in eight days more with tremors and incomplete palsy of the rest of that side of the body. These symptoms subsequently abated; but they again increased after an imprudent exertion, and she died in a state of exhaustion seven weeks after the injury. The whole petrous portion of the temporal bone was found carious, but without any distinct disease of the brain or its membranes.[277]
Sulphuric acid and the other mineral acids are equally poisonous when inhaled in the form of gas or vapour; and they then act chiefly by irritating or inflaming the mucous membrane of the air-passages and lungs. For some observations on their effects in this form both on plants and animals the reader may refer to the Chapter on Poisonous Gases.
Sulphuric acid belongs to the poisons alluded to under the head of General Poisoning,—of whose operation satisfactory evidence may be occasionally drawn from symptoms only. If immediately after swallowing a liquid which causes a sense of burning in the throat, gullet, and stomach, violent vomiting ensues, particularly if the vomited matter is mixed with blood; if the mouth becomes white, and stripped of its lining membrane, and the cheeks, neck, or neighbouring parts show vesications, or white, and subsequently brown excoriated spots;—if the clothes show red spots and are moist and disintegrated there,—I cannot see any objection to the inference, that either sulphuric or muriatic acid has been taken. In this opinion I am supported by a good authority, Dr. Mertzdorff, late medical inspector at Berlin.[278]
The outward appearance of the body in cases of Tartra’s first variety in the action of the acids is remarkably healthy; every limb is round, firm, and fresh-looking.
On the lips, fingers, or other parts of the skin, spots and streaks are found where sulphuric acid has disorganized the cuticle. These marks are brownish or yellowish-brown, and present after death the appearance of old parchment or of a burn; sometimes there are little blisters.[279]
The lining membrane of the mouth is more or less disorganized, generally hardened, and whitish or slightly yellowish. The pharynx is either in the same state, or very red or even swelled. The rima glottidis, as in the case described by Dr. Sinclair and in that of Mr. Arnott, is sometimes contracted, the epiglottis swelled, or on the contrary shrivelled, and the commencement of the larynx inflamed.[280] The gullet is often lined with a dense membrane, adhering firmly, resembling the inner coat, but probably in general a morbid formation; and the subjacent tissue is brown or red. Sometimes, however, the inner coat or epithelian of the gullet loses its vitality, and is detached in part or altogether. In Mr. Arnott’s case the pharynx and upper gullet were lined by a pale lemon-coloured membrane, which in the lower two-thirds of the canal was completely detached and was plainly the œsophageal membrane; in the case related by Mertzdorff, the whole inner coat of the gullet, as well as that of the throat, epiglottis, and mouth, was stripped from the muscular coat;[281] and in Dr. Wilson’s case (p. 131), which proved fatal in ten months, the upper third of the gullet shone like an old cicatrix, and the lower two-thirds were narrowed, vascular, and softened on the surface.[282] In a few rare cases of chronic poisoning with the mineral acids the gullet is found perforated by an ulcerative process;[283] but it is never perforated by their corrosive action in quickly fatal cases. Occasionally the gullet is not affected at all, though both the mouth and the stomach are severely injured; and an instance has even been published where the acid, in this instance the nitric, left no trace of its passage downwards till near the pylorus.[284]
The outer surface of the abdominal viscera is commonly either very vascular or livid, or bears even more unequivocal signs of inflammation, namely, effusion of fibrin and adhesions among the different turns of intestine; and these appearances may take place although the stomach is not perforated.[285] The cause of this appearance, which is seldom observed in poisoning with other irritants, more especially with the metallic irritants, is that the acid passes through the membranes of the stomach by transudation during life,—as will be proved immediately. It must be observed, that the peritonæum is sometimes quite natural after death from sulphuric acid, even although the stomach was perforated. I have seen this in a case which proved fatal in twelve hours. An important appearance in the abdomen, to which less attention has been hitherto paid than it deserves, is gorging of the vessels beneath the peritonæal membrane of the stomach and adjoining organs with dark, firmly coagulated blood, arising from the acid having transuded through the membranes and acted on the blood chemically. My attention was first turned to this appearance by an interesting case, which I saw in 1840 in the Royal Infirmary of this city, and of which an able account has been published by Dr. Craigie.[286] The whole vessels of the stomach were seen externally to be most minutely injected and gorged, and the blood in them was coagulated into firmly-cohering cylindrical masses, as if the vessels had been successfully filled with the matter of an anatomical injection. This appearance was also observed in the superior mesenteric arteries, in the omental vessels, and over the greater part of the mesentery. It was occasioned by the chemical action of the acid coagulating the colouring matter and albumen; for the clotted blood was strongly acid to litmus-paper. So too was the peritoneal surface of the stomach, omentum and intestines. And the acid had transuded through the stomach and into the omentum and tissues of the intestines during life; for in the first place, there was no perforation of the stomach, and secondly, I ascertained that there was no free acid either in the matter discharged from the stomach before death after the free administration of antacids, or in the contents of the stomach obtained at the examination of the dead body.
The stomach, if not perforated, is commonly distended with gases. It contains a quantity of yellowish-brown or black matter, and is sometimes lined with a thick paste composed of disorganized tissue, blood and mucus. The pylorus is contracted.
The mucous membrane is not always corroded. If the acid was taken diluted, the coats may escape corrosion; but there is excessive injection, gorging, and blackness of the vessels, general blackness of the membrane, sometimes even without softening, as in a case related by Pyl of a woman who first took aqua-fortis and then stabbed herself.[287] More commonly, however, along with the blackness there is softening of the rugæ or actual removal of the villous coat, and occasionally regular granulated ulceration with puriform matter on it.[288] The stomach is not always perforated. But if it is, the holes are commonly roundish, and the coats thin at the margin, coloured, disintegrated, and surrounded by vascularity and black extravasation. In some rare cases there is no mark of vital reaction except in the neighbourhood of the aperture. A case of this kind is related by Mertzdorff: The margin of the hole was surrounded to the distance of half an inch with apparent charring of the coats, and this areola was surrounded by redness; but the rest of the stomach was grayish-white.[289] I examined with the late Dr. Latta of Leith a similar case, where the limitation of the injury was evidently owing to the stomach having been at the time filled with porridge. The patient, a child two years old, died in twelve hours; and on the posterior surface of the fundus of the stomach, towards the pylorus, there was a hole as big as a half-crown, which was surrounded to the distance of an inch with a black mass formed of the disorganized coats, and of incorporated charred blood. But the rest of the stomach was quite healthy. The most remarkable instance of chemical destruction of the coats yet known to me is a case mentioned by Mr. Watson of this city, where suicide was effected by cutting the throat about half an hour after two ounces of sulphuric acid had been swallowed. The individual was at first thought to have died simply of the wound of the throat. But on dissection the usual signs of acid poisoning were found; and among other effects, it was observed that nearly three-fourths of the stomach had been entirely destroyed.[290] The perforation, if the patient lives long enough, is generally accompanied with a copious effusion into the belly of the usual muddy liquor of peritonitis; and the outer surface of the viscera feels unctuous, as if from a slight chemical action of the acid on them. The acid has actually been found in the contents poured out from the stomach into the sac of the peritonæum.[291]
One would expect to find the acid always in the stomach when it is perforated. Nevertheless it is sometimes almost all discharged. In Mertzdorff’s case, that of an infant who was killed in twelve hours, a hole was found in the stomach ¾ths of an inch in diameter, and the contents of the stomach were effused into the belly: yet by a careful analysis the whole acid he could procure from the contents and tissues together was only 4½ grains. Sometimes of course the disappearance of the acid may be owing, as in Dr. Craigie’s case, to the effectual administration of antacids during life.
The inner coat of the duodenum often presents appearances closely resembling those of the stomach. Sometimes, however, as in the case just related from Mertzdorff, and in the infant I examined, the inner coat of the small intestines is not affected at all, probably because in such rapid cases the pylorus retains a state of spasmodic contraction till death or even after it.
The urinary bladder is commonly empty. The thoracic surface of the diaphragm is sometimes lined with lymph, indicating inflammation of the chest. In the case which was fatal in two hours [p. 131], Professor Remer found the surface of the lungs, as well as that of the liver and spleen, brown and of a leathern consistence, and the tissue beneath scarlet;—appearances which he thinks arose from the acid penetrating in vapour and acting chemically. I have not found this appearance mentioned by any other writer; but I have seen it in animals poisoned with oxalic acid. The blood in the heart and great vessels has been several times seen forming a firm black clot. Kerkring[292] relates an instance of the kind; in Dr. Latta’s case the appearance was very distinct; and it is dwelt on strongly in a recent paper by M. Bouchardat.[293] Bouchardat thinks this state of the blood is simply the effect of the absorbed acid; but coagulation of the blood in the heart and great vessels,—a striking appearance in contradiction to what is observed after death from most other poisons,—is more probably the healthy state of the blood, and not the effect of the particular poison.
The general appearance of the body of those who have died of the second or chronic variety of poisoning with the acids, is that of extreme emaciation. The stomach and intestines are excessively contracted: The former has been found so small as to measure only two inches and a half from the cardia to the pylorus, and two inches from the lesser to the greater curvature.[294] Tartra says the intestines are sometimes no thicker than a writing quill. They are in other respects sound outwardly, except that they sometimes adhere together.
Internally the pylorus is contracted. In a case of slow poisoning, fatal in three months, which has been described by Dr. Braun of Fürth, the chief appearance besides excessive emaciation was a thickening of the coats round and behind the pylorus to such a degree that the opening of the pylorus was formed of an almost cartilaginous ring several lines broad, and only wide enough to pass a quill.[295] There are spots over the stomach apparently of regenerated villous tissue, smoother and redder than the natural membrane. At the points where the stomach adheres to the neighbouring organs, its coats are sometimes wanting altogether, so that when its connections are torn away, perforations are produced. The other parts of the body are natural.
It may in some circumstances be necessary to determine from the appearances in the dead body whether sulphuric acid has been the occasion of death or has been introduced into the body after death. This may always be easily done. If a few drachms of sulphuric acid be injected into the anus immediately after death, and the parts be examined in twenty-four hours, it will be found, that wherever the acid touches the gut, its mucous coat is yellowish and brittle, its muscular and peritonæal coats white, as if blanched, and the blood in the vessels charred; the injury is confined strictly to the parts actually touched, is surrounded by an abrupt line of demarcation, and shows no sign of inflammatory redness. Nitric acid produces nearly the same effects. The whole tunics are yellow, and the disorganization is greater. For these facts we are indebted to Orfila.[296]
In closing this account of the morbid appearances, some observations will be required on the force of evidence derived from them; because circumstances may exclude all other branches of medical proof. In many instances both of acute and of chronic poisoning with the strong acids, I conceive, contrary to the general statements of most systematic writers on modern medical jurisprudence, that distinct evidence might be derived from morbid appearances only. Thus, what fallacy can intervene to render the following opinion doubtful? In a case several times alluded to as described by Mertzdorff, there were vesicles and brown streaks on the lips, neck, and shoulders, similar to the effects of burning,—almost total separation of the lining membrane of the mouth, throat, epiglottis, and gullet,—perforation of the stomach, with a margin half an inch wide, which was extensively charred, and surrounded by a red areola. From the appearances alone Mertzdorff declared that the child must have been poisoned with sulphuric acid. Perhaps he should have said sulphuric or muriatic acid.
Or take the case of Richard Overfield, who was condemned at Shrewsbury Assizes in 1824 for murdering his own child, a babe three months old, by pouring sulphuric acid down its throat. In the dead body the following appearances were found: The lips were blistered internally and of a dark colour externally; the gullet was contracted and its inner coat corroded; the lining membrane of the mouth and tongue of a dull white colour; the great curvature of the stomach corroded and converted into a substance like wet brown paper; the stomach perforated and a bloody-coloured fluid in the sac of the peritonæum.[297] If to these appearances be added the fact that the child’s dress was reddened, what is there to prevent the medical jurist from declaring, without reference to chemical evidence, that this case must have been one of poisoning by sulphuric acid or some other mineral acids?
In like manner in the case of Mrs. Humphrey, who was condemned at Aberdeen in 1830 for murdering her husband by pouring sulphuric acid down his throat while he was asleep, there was found, on examining the dead body, two brown spots on the outside of the lips,—whiteness of the inside of the lips and of the gums,—glazing of the palate,—redness, with here and there ash-coloured discoloration, of the uvula, posterior part of the throat, pharynx and epiglottis,—abrasion of most of the inner coat of the gullet,—erosion and dark-red ulceration of the inner coat of the stomach in winding furrows. When to these appearances it is added, that the man was in good health only forty-seven hours before death, and was taken ill instantaneously and violently with burning pain in the throat and stomach,[298] it is not easy to see what other opinion could be formed of the case, unless that he died of poisoning with a mineral acid, and probably with sulphuric acid.
Among the appearances justifying an opinion where chemical evidence happens to be wanting, not the least important seems to me to be the peculiar turgescence and induration of vessels under the peritonæum of the stomach and neighbouring organs, occasioned by the chemical coagulation of blood in them. It is an appearance, which, when once seen, cannot be confounded with any natural morbid phenomenon I have ever witnessed.
I am far from desiring to encourage rashness of decision, or to revive the loose criterions of poisoning relied on in former times. But there cannot, in my opinion, be a rational doubt that in the instance of sulphuric acid there may often be distinct exceptions to the general law regarding the feebleness of the evidence from morbid appearances; and that a witness would certainly be guilty of thwarting the administration of justice, if, relying on general rules, he refused to admit such exceptions. What natural disease could produce appearances like those described above? Assuredly no form of spontaneous perforation bears any resemblance to that caused in most cases of death from sulphuric acid; nor is it easy to mention any combination of natural diseases which could produce the peculiar conjunction of appearances remarked in the case of the man Humphrey.
Since this acid and the other mineral acids act entirely as local irritants, it may be inferred that their poisonous action will be prevented by neutralizing them. But in applying that principle to the treatment it is necessary to bear in mind their extremely rapid operation; for if much time is lost in seeking for an antidote, irreparable mischief may be caused before the remedy is taken. Should it be possible then to administer chalk or magnesia without delay, these are the antidotes which ought to be preferred; but it may be well for the physician to remember, that in the absence of both he may at once procure a substitute in the plaster of the apartment beat down and made into thin paste with water. M. Chevallier, in a paper on the antidotes for the mineral acids, quotes five cases of poisoning with sulphuric acid and two with nitric acid, where life seems to have been saved by the speedy and free administration of magnesia, although in some cases so large a quantity as two ounces of the poison had been swallowed.[299]—A solution of soap is another antidote of no small value. While the antidote is in preparation, the acid should be diluted by the free use of any mild fluid, such as milk or oleaginous matters.—The alkaline bicarbonates are also excellent antidotes; but their carbonates are ineligible, being themselves possessed of corrosive properties. In a paper on poisoning with the mineral acids by Dr. Lunding of Copenhagen, the author is disposed to ascribe the large proportion of deaths in his practice to the system pursued in the Copenhagen hospital of administering carbonate of potass as an antidote daily for weeks together.[300] On the other hand however it may be mentioned, that in a late memoir, on this description of poisoning Dr. Ebers of Breslau endeavours to show, that there is no reason to dread the administration of the alkaline carbonates, even the carbonate of potash, provided they be given with mucilaginous fluids and syrup in a rather concentrated form; and he gives three cases illustrative of the good effects of this mode of treatment, which he maintains to be free of all danger, and preferable to every other antidotal method, because the remedy may be administered in small volume,—an advantage possessed by it especially over chalk or magnesia.[301]
After the proper antidote has been given to a sufficient extent, the use of diluents ought to be continued, as they render the vomiting more easy.—Some have recommended the stomach-pump for administering antidotes and diluents; but this is unnecessary. When it is wished to evacuate the stomach, there is an advantage in allowing it to do so by its own efforts, if possible; because the evacuation is accomplished in this way more completely than by the stomach-pump. Besides, if the patient cannot swallow fluids, still less can he suffer the tube of the stomach-pump to be introduced. On several occasions, indeed, it has been found impracticable to introduce it.[302]
The treatment of the surpervening inflammation does not differ from that of inflammation of the stomach. Where there is great difficulty of breathing, evidently from obstruction of the larynx, and where the absence of abdominal pain, tension or vomiting affords a presumption that little injury has been done to the stomach, laryngotomy appears an advisable remedy, and has been known to give very great relief.[303] But the patient may nevertheless die soon of the sympathetic disorder of the circulation.
Nitric acid is more frequently used as a poison abroad than in this country. But even in Britain it is not an uncommon cause of severe accidents and death.
1. When concentrated, nitric acid is easily known by the odour of its vapour, which is peculiar. When pure, the acid as well as its vapour is colourless; when mixed with nitrous acid it is of various tints, and generally yellow. The acid of commerce is at times rendered impure by sulphuric acid, a circumstance which must be attended to in applying the subsequent tests.—The simplest test for nitric or nitrous acid is the action of copper, lead, or tin. If any of these metals in small fragments, or powder, be thrown into either acid previously diluted with an equal volume of water, an effervescence takes place, which in the case of lead or copper is much accelerated by heat; nitric oxide gas is disengaged; and ruddy fumes of nitrous acid gas are formed when the gas comes in contact with the oxygen of the air. Another characteristic test, which has the advantage of being applicable on an extremely small scale, is morphia, the alkaloid of opium. This substance is turned in a few seconds to a beautiful orange-red colour by nitric acid, and after longer contact forms with it a bright yellow solution. No other acid has this effect. Muriatic acid, as Dr. O’Shaughnessey has remarked,[304] does not act at all on morphia, and sulphuric acid chars and blackens it. When nitric acid is added to a solution of narcotin in sulphuric acid, the colour of the solution is changed from yellow to blood-red.[305] When it is added to a solution of proto-sulphate of iron, the solution becomes brown, and the addition of sulphuric acid then alters the colour to violet.[306] When it is added even in the most minute proportion to sulphuric acid, the addition of a few particles of the alkaloid brucia will render the whole fluid red, passing gradually to yellow.[307]—Many other characteristic tests might be mentioned; but those now specified are more than enough.
2. In a diluted state this acid is not so easily recognised as the other mineral acids, for it does not form any insoluble salt or precipitate with bases.
The most convenient process consists in first ascertaining the acidity of the fluid, then neutralizing it with potass, evaporating to dryness, and heating the residue in a tube with sulphuric acid. The vapour disengaged, if abundant, may be known by its orange colour in the tube and its odour. But if small in quantity it is best to distil over the vapour in a proper apparatus, and to subject the condensed product to the tests of morphia, narcotin dissolved in sulphuric acid, and proto-sulphate of iron dissolved in water. A convenient tube for the purpose is that represented in Fig. 3; into which the materials are introduced by the funnel, Fig. 4. The wide part of the tube may then be drawn out in the spirit-lamp flame to any length or fineness that may be necessary, so as to conduct the vapour into another tube as a condenser, or directly into the substances to be used as tests.
3. When in a state of compound mixture, nitric acid, like sulphuric acid in similar circumstances, may be after a time partly decomposed and partly neutralized; and when the matter with which it is mixed belongs to either of the organic kingdoms, more particularly to the animal world, its decomposition is more rapid than that of sulphuric acid. Still it is an important fact, that some of the acid may be discovered after a considerable interval. M. Ollivier detected it in various stains on the skin at least a day after it had been applied;[308] Dr. O’Shaughnessey detected it in a stain on cloth sent to him from Ireland to Edinburgh;[309] and I have found it in stains made on broad-cloth with detached drops seven weeks before.
Process for Stains. Nitric acid produces on the skin a yellow stain, which gradually becomes dirty orange, and finally of a dirty yellowish-brown; but in all of these states it is at once rendered for a time lively yellow by the action of ammonia. I am not aware that any other yellow stain is similarly affected. Stains on cloth are generally yellow, reddish-yellow, or brownish-yellow, and are attended with more or less disintegration of the texture of the cloth. The method of analyzing all these stains is as follows:—The stained parts is to be boiled in a few drachms of pure water several times in succession; and the liquid is then filtered, and may be subjected to litmus-paper for the purpose of ascertaining its acidity. It is then to be rendered neutral, or for the sake of greater facility, feebly alkaline, by adding a few drops of a diluted solution of caustic potass, after which the whole is evaporated to dryness, and in a vapour-bath, if practicable. The residuum is then to be decomposed by sulphuric acid in the same way as recommended above for the simple diluted acid.—Orfila thinks it advantageous to let the stains macerate for some hours in a solution of bicarbonate of soda rather than to boil them in water. In that case, however, it is necessary to ascertain the acidity of the stains with litmus-paper before proceeding to macerate them.
Process for Mixtures. The detection of nitric acid in compound mixtures, such as the contents of the stomach, is not so easy a matter as its detection in stains; and indeed a sure and delicate process is still a desideratum in medico-legal chemistry. The process varies, as in the case of sulphuric acid, according as the subject of analysis is acid or neutral.
a. If the mixture be acid, and the proportion of the acid considerable, it maybe detected without difficulty. It is merely necessary to ascertain the acidity of the mixture by litmus-paper, to neutralize with potass, water being added if necessary, and then to filter and evaporate to a convenient degree of concentration. Crystals will form on cooling, which may be decomposed by sulphuric acid in the usual way. But the medical jurist ought not to flatter himself with the expectation of meeting often with a proportion large enough to admit of being discovered by so coarse a method of analysis. In general the crystallization of the nitrate of potass is prevented by co-existing animal or vegetable matter. When the proportion appears inconsiderable, therefore, a different process must be pursued. In preparing the former edition of this work, the present topic was investigated with some care, and a method suggested which appeared to me at that time more effectual, delicate, and conclusive than any previously made public. Since then Professor Orfila has also investigated the subject attentively, and after trying various methods, has ended in adopting one which is substantially the same as that now referred to, but without a precaution, which seems to me essential for success in certain probable enough circumstances.[310] I am therefore disposed to retain my former process, with some variations and additions in the details.
Macerate the subject of analysis for a few hours in distilled water, if it be not already liquid enough; and then boil for a few minutes, and filter it. Ascertain now whether the fluid be acid to litmus; and if it be so, neutralize it with solution of potash, or as Orfila suggests, with a solution of the purer salt, the bicarbonate of soda. Evaporate gently, to obtain crystals if possible; and if these do not tend to the cubical form, distil them with sulphuric acid, and proceed as directed for nitric acid simply diluted. If crystals do not appear, or their form tend to the cube,—in which case chloride of sodium is present,—redissolve the whole residue of evaporation in distilled water; add a slight excess of a warm solution of acetate of silver, to throw down organic matter and the chlorine of any chlorides that may be present; filter and evaporate to dryness, and distil the residuum with sulphuric acid, applying as usual to the vapour the tests of litmus-paper and morphia,—also, as Orfila proposes, the solution of narcotin in sulphuric acid, and proto-sulphate of iron in water,—and if the quantity of vapour be great enough, the sense of smell and the action of copper with the condensed vapour.
b. If the mixture be neutral, proceed exactly as above, except that it becomes unnecessary to neutralize the liquid with potash or bicarbonate of soda. This variety in the process will be principally required, where earths or alkalis have been administered as antidotes.
The process now detailed requires a word or two of commentary.—Organic matter is inconvenient because it prevents the nitrate of potash or soda in the mixture from crystallizing. But it will not prevent the evolution of nitric acid vapour by distillation with sulphuric acid, even although the material be a simple extract without crystals. At the same time it is better to get rid of as much organic matter as possible, if distinct crystals be not obtained by evaporation. A more serious difficulty, however, to which Orfila does not advert, arises from the co-existence of a chloride. For, in that case, distillation with sulphuric acid may disengage not nitric acid, but chlorine, in consequence of the reaction which takes place between the nitric and hydrochloric acids in the act of being liberated. This is a more important reason for purifying the liquid by acetate of silver before subjecting it to concentration; but in addition, by removing organic matter, this precaution increases the chance of crystals of nitrate of potash or soda being obtained. Its necessity, where a chloride co-exists, will appear from the following experiment. Four drops of nitric acid neutralized with potass were mixed with six ounces of strong barley-broth; from which half an ounce of limpid fluid was procured by filtration. One-half of this evaporated to dryness gave a crystalline residue, which, heated with sulphuric acid in a tube, emitted a strong odour of chlorine; and the moisture which bedewed the tube scarcely affected morphia. The residuum of the other half of the filtered fluid was redissolved, treated with acetate of silver, again filtered, and evaporated to dryness; and the residue was gently heated in a tube with sulphuric acid. An odour of nitric acid was now disengaged, and the moisture on the tube close to the mixture turned a fragment of morphia to bright orange-red.
Acetate of silver is prepared by mixing strong solutions of acetate of potass and nitrate of silver, draining and compressing between folds of bibulous paper the crystalline precipitate which forms, dissolving this precipitate by agitating it in boiling water, and finally crystallizing the salt again by refrigeration. The crystals, which are sparingly soluble in cold water, should be then separated, slightly washed with a little water, and again dried by compression. When put to use, a solution should be made by agitating the salt in boiling water, because at low temperatures water retains very little of the salt; but actual ebullition should be avoided, because acetate of silver is thus quickly decomposed.
In all medico-legal analyses for nitric acid, care must be taken that the different reagents used are free of this acid, and also of nitrates. Sulphuric acid often contains a little nitric, or rather nitrous acid; which may be discovered by the sulphuric acid becoming brown or dark-red when a solution of proto-sulphate of iron is gently poured over it in a test-tube; and which may be removed either by boiling the acid with a few grains of sugar, according to the formula of the Edinburgh Pharmacopœia, or, as Orfila directs, by boiling it with sulphate of ammonia.
All the observations made on these topics under the head of sulphuric acid apply, with few exceptions, to the nitric acid also. A few statements therefore on the peculiarities ascertained to exist in the latter case are all that will be required in the present sections.
Nitric acid is not less powerful as a corrosive and irritant than sulphuric acid. It will act with energy as an irritant even when considerably diluted, for example with six or eight parts of water or even more.—The lips which are rendered at first whitish by all the acids, and eventually brownish by sulphuric acid, becomes soon yellow with nitric acid. The tongue too sometimes acquires a yellow colour instead of a white glazed appearance; but this character is not invariable.—All spots caused by it on the skin become speedily yellow, and long retain this hue; or if the tint become dull, which generally happens in a few days, it is enlivened and the yellow colour restored for a time, by ammonia, potash, soda, or soap.—An important fact, for which toxicology is indebted to Professor Orfila, is that the acid may be often found in the urine, both when it had been swallowed, and when it had been introduced through the medium of the cellular tissue.[311] It is to be discovered by the process for compound mixtures. Orfila adds that he has hitherto been unable to find it in the liver or spleen.
A difference of tint in the lining membrane of the mouth and gullet is the only difference observed in the morbid appearances caused by nitric and sulphuric acid. The former sometimes renders these parts yellow; but this appearance is far from being invariable.
The treatment in both instances is the same in every respect.
This acid occurs more rarely than any of the other mineral acids in medico-legal cases; a fact which appears singular enough on considering, that it is a powerful corrosive, and more perhaps in the hands of the working-classes than any other.
Like the other acids, hydrochloric acid occurs in the concentrated shape, in a state of simple dilution, and mixed with various matters, especially from organic kingdoms.
1. Hydrochloric acid, in its concentrated state, is colourless, if pure, but yellowish as usually sold; and it is easily known by the peculiar appearance and odour of its fumes. A convenient additional test, which, however, is not absolutely distinctive, is the formation of white vapour when a rod dipped in it is brought near another dipped in ammonia. If any farther evidence be desired, the strong acid must be diluted with water, and examined by the tests for it in a diluted state.
2. When diluted, it is recognised with facility, first by litmus-paper, and then by the nitrate of silver, which forms with it a dense, white precipitate, the chloride of silver. This is soluble in ammonia, reappears on neutralizing the ammonia by nitric acid, and is not redissolved by a large excess of nitric acid, even aided by heat. Its permanence under an excess of nitric acid distinguishes it from every other silver salt, but the cyanide; which again is known by disappearing when boiled with a large excess of the acid.
3. In the last edition of this work I proposed for the detection of hydrochloric acid in compound organic mixtures a process, to which Professor Orfila has since made an important addition,[312] and which the investigations of that toxicologist, as well as my own, lead me to suppose superior to any other yet suggested, although it is not entirely free from objection. This process divides itself into two, according as the subject of analysis is acid or neutral; but in the latter case its indications are of dubious import.
a. If the matter to be examined be acid, boil it with water if necessary, filter, and distil it with a gentle heat till the residue acquire the consistence of a very thin syrup. Subject the distilled liquor to the tests for diluted hydrochloric acid. It will seldom be found there, however, because it is apt to be retained by the co-existence of organic matter. If it be not found, add to the thin extract in the retort a slight excess of a strong solution of tannin, filter, and distil the filtered liquid by means of a hot bath of solution of hydrochlorate of lime (consisting of two parts of crystallized salt and one of water,)—taking care that the temperature of the bath never exceeds 240°; and stop the distillation just before the residuum becomes dry. Examine now the distilled liquor with the tests for diluted hydrochloric acid.
Hydrochloric acid has a tendency to adhere with obstinacy to organic matters, especially when these are abundant; and therefore Orfila properly proposes to remove organic principles as far as possible by precipitating them with solution of tannin. I have found, as he did, that the acid may be obtained by distillation after this measure, when it could not be obtained previously.—Orfila objects to the process however that hydrochlorate of ammonia will pass over in the distillation. But I have not found this to be the fact, when the temperature did not rise above 240°; which in his experiments seem to have been considerably exceeded.—A more important fallacy is, that hydrochloric acid will be indicated by the process in a mixture which contains both a neutral chloride, such as common salt, and sulphuric acid. This fallacy can only be obviated by ascertaining that sulphuric acid is not present.—But the most important fallacy of all is, that free hydrochloric acid constitutes an essential part of the gastric juice, and an ingredient of the secretions of the stomach in various states of disordered digestion.[313] It is not easy to see how this fallacy can be obviated, unless the acid be obtained in large quantity; nor am I prepared to say what quantity would justify the conclusion, that the acid had been derived from an external source. Dr. Prout once found between four and five grains of pure acid in sixteen ounces of the fluid of water-brash.[314] The quantity of hydrochloric acid is to be known by drying, heating and weighing the chloride of silver thrown down in the distilled fluid by nitrate of silver, and allowing 100 parts of concentrated commercial acid for 145 of chloride.
b. When the mixture is neutral, hydrochloric acid can be no longer detected in it without the aid of sulphuric acid to decompose the chloride that has been formed. This should be added to the filtered fluid obtained after organic matter has been separated by solution of tannin. Hydrochloric acid will then distil over.—It is seldom however that the discovery of the acid in this way will warrant the conclusion, that it had ever existed free in the mixture whence it is obtained. For it may have proceeded from chlorides contained in the subject of analysis from the first, more especially chloride of sodium, which exists in small quantity in all animal fluids and solids, and more largely in many articles of food and drink. The only circumstance indeed in which the detection of hydrochloric acid by decomposition with sulphuric acid will yield any evidence,—and even then the evidence will only be presumptive,—is when it is known that an earth or alkali was given as an antidote, and when the alkali or earth which was used is found in the suspected substance.
Hydrochloric acid has been found by Professor Orfila to exert the same action as sulphuric and nitric acids; but it is a less powerful corrosive and irritant.—In the gaseous state, it is a most destructive poison to vegetables, as will be shown in the article on the Poisonous Gases.
The symptoms it occasions in man are very like those produced by sulphuric acid. As few cases however of poisoning with this substance have yet been published, its effects are not so well known as those of the other powerful acids; and it may therefore be right to mention the leading particulars of some of the cases which are met with in authors.—Mr. Quekett has related the case of a man, who, on arriving at home one day, told the woman he lodged with that he had poisoned himself with spirit of salt, but presented at the moment so little sign of uneasiness, that she at first scarcely believed him. In a short time however he suddenly became faint and fell down. On being removed to the London Hospital, magnesia and milk were given, about three hours after the acid had been taken; but no relief was experienced. He suffered intense thirst, complained of excessive pain in the stomach and throat, and expired in about fifteen hours.[315]—Mr. J. F. Crawfurd of Newcastle has related a still more rapid case which was occasioned by two ounces of an equal mixture of hydrochloric acid and “tincture of steel,” probably the tincture of chloride of iron. Vomiting occurred soon afterwards, but subsequently ceased; there was no complaint made either of pain or heat anywhere, or of thirst; and questions were answered intelligently. But the pulse was imperceptible, and the muscles of the extremities contracted; and death took place in five hours and a half.[316]—Orfila mentions that an hospital patient, affected with inflammation of the brain after a fall on the head, having got by mistake from his nurse 45 grammes, or two fluid ounces, of hydrochloric acid, was attacked with acute pain in the stomach, efforts to vomit, hiccup, extreme restlessness, a small pulse, a fiery red tongue, blackness of the lips, and a burning skin; and next day he died in a state of constant delirium, and covered with a cold clammy sweat.[317]
These cases present nearly the same violence and variety of action with that which results from the two other acids.
The morbid appearances are on the whole similar to what are caused by sulphuric acid. In Mr. Quekett’s case the stomach outwardly was leaden-coloured and its vessels gorged with black blood; the intestinal peritonæum injected and speckled with fibrinous effusion; the villous coat of the stomach lined with yellow, curdled milk, and itself irregularly black here and there, as if charred, and in some places softened and corroded, so that a rent was made in handling it; the inner membrane of the duodenum similarly affected, and also even the jejunum, though more irregularly. The contents of the stomach were not acid, and did not contain any chloride.—In Mr. Crawfurd’s case the villous coat presented black elevated ridges, as if charred, and the furrows between were scarlet-red; black granular extravasation had taken place at many points into the submucous tissue; similar appearances were seen in the duodenum and jejunum; and the lower part of the gullet looked as if it had been cauterized.—In the case related by Orfila the gullet and pharynx were red, and at one or two places excoriated; the stomach inflamed externally, and its inner membrane spotted with gangrenous (?) patches, and very brittle; the duodenum thickened, and the jejunum perforated by a round worm.
Of Poisoning with Phosphorus.—The only other mineral acid that deserves mention is the phosphoric. It possesses properties nearly analogous, and hardly inferior to those of the three acids already mentioned. On its own account, however, it does not merit any notice here, since it is much too rare to be within reach of a person who intends to give or take poison. But it must be attended to, because it is formed in the course of the action of a more common poison, phosphorus. An attempt has actually been made to perpetrate murder by means of this substance. A woman at Mengshausen tried to poison her husband by putting into his soup a mixture of phosphorus, flour, and sugar, used for poisoning rats. But the soup having been kept warm on the stove, the man’s suspicions were excited by its phosphorescence, and phosphorus was detected in it.[318]
Orfila found that two drachms of phosphorus given to dogs in fragments caused death in twenty-one hours, that the whole stomach and intestines were more or less inflamed, and that the phosphorus had lost much of its weight, though vomiting had been prevented by a ligature on the gullet; in fact the poison was partly oxidated. In a state of minute division, as when dissolved in oil, twenty-four grains caused death in less than five hours with all the symptoms of the most acute irritant poisoning; and after death the stomach was found extensively corroded, and perforated by two holes.[319] Other experimentalists have found that half a grain melted in hot water could kill a dog;[320] and that water, in which phosphorus had been simply received in the process for preparing it, proved in small quantities fatal to poultry.[321]
There is no doubt, therefore, that phosphorus is a dangerous poison to animals. Its effects on man have not been often witnessed; but the observations hitherto made will show that it is not less injurious to him than to the lower animals. A grain and a half have actually proved fatal to man, as appears from a case mentioned by M. Worbe.[322] The subject of the case was a stout young man who took a grain and a half in hot water, after having previously taken half a grain without sustaining injury. In seven hours, and not till then, he was attacked with pain in the stomach and bowels, then with incessant vomiting and diarrhœa, excessive tenderness and tension of the belly,—all the symptoms in short of irritant poisoning; and he died exhausted in twelve days. Another fatal case somewhat similar in its circumstances has been related by M. Julia-Fontenelle.[323] An apothecary, after taking in one day first a single grain and then two grains of phosphorus without experiencing any particular effects, swallowed next day three grains at once in syrup. In the evening he felt generally uneasy, from a sense of pressure in the belly, which continued for three days; and then he was also seized with violent, continual vomiting of a matter which had an alliaceous odour. On the seventh day he had also spasms, delirium, and palsy of the left hand; and death speedily ensued.—Dr. Maier of Ulm relates a singular case occasioned by a portion of lucifer-match composition having been swallowed intentionally. Vomiting and pain in the belly ensued, then anxiety, restlessness, and excessive thirst, and death in about fifteen hours.[324]—M. Martin-Solon relates the case of a patient, affected with lead palsy, who having taken considerably less than a grain in the form of emulsion, was attacked with burning along the gullet and in the stomach, mucous vomiting, tenderness of the belly, general coldness and feebleness of the pulse. Afterwards the pulse became imperceptible, the limbs neuralgic, the intellect clouded, and the breathing stertorous; and he died in little more than two days.[325]—In the only other case I have hitherto found recorded death took place in forty hours, and the symptoms were violent pain in the stomach and continual vomiting, together with the discharge by clysters of small fragments of phosphorus, which were discovered by their shining in the dark, and subsequently by the appearance of burnt spots on the bed-linen. In this case, which is described by Dr. Flachsland of Carlsruhe,[326] the quantity of the poison taken was not ascertained. The patient, a young man, took it on bread and butter at the recommendation of a quack, to cure constipation, general debility, and impotence.
At one time it was the custom to give small doses of phosphorus in medical practice; but the uncertainty and occasional severity of its operation have perhaps properly expelled it from most modern pharmacopœias. Among other properties ascribed to it in medicinal doses, it is said to be a powerful aphrodisiac: No such symptom occurred in the first of the fatal cases just related, or is mentioned in any of the others; but there is no doubt that medicinal doses sometimes produce it.
As to the morbid appearances, the same changes of structure may be expected as in the instance of the mineral acids generally. In Worbe’s case quoted above, the skin was generally yellow, and here and there livid; the lungs gorged with blood; the muscular coat of the stomach inflamed, but the other coats not, except near the two extremities of the organ, where they were black. In Flachsland’s case much fluid blood was discharged from the first incisions through the skin of the belly; the omentum and outside of the stomach and intestines were red; the villous coat of the stomach presented an appearance of gangrenous inflammation (probably black extravasation only); the inner membrane of the duodenum was similarly affected; the great intestines were contracted to the size of the little finger; the mesenteric glands enlarged; and the kidneys and spleen inflamed. In Maier’s case the peritonæum and omentum were dry and vascular, the stomach and small intestines pale, the great intestines contracted, almost empty, brownish-red, and here and there inflamed, the liver large, and the blood everywhere liquid. The contents of the caput cœcum had an odour of phosphorus, and here were found two yellowish lumps weighing eight grains, which shone when rubbed, exhaled a phosphoric odour, and contained 0·6 of a grain of phosphorus. In Martin-Solon’s case the gullet was cherry-red and its epithelian brittle, the villous coat of the stomach grayish and brittle, the solid viscera in the abdomen soft, and the cerebral membranes congested.
Phosphorous acid, the effects of which have been examined experimentally by Professor Hünefeld of Greifswalde, differs in its operation from phosphoric acid. Twenty-five grains had no effect on a rabbit; but a drachm caused difficult breathing, restlessness, bloody vomiting, slight convulsions, and death in twelve hours; and the stomach was found not much injured. The urine contained phosphoric acid.[327]
Of Poisoning with Sulphur.—It does not appear that sulphur, which resembles phosphorus in many particulars, bears any resemblance to it in physiological properties;—which may be ascribed to its not being susceptible of spontaneous acidification. It certainly possesses, however, slight irritating properties. It is often given as a purgative, which is sufficient to prove that it is not altogether inert; and the veterinary school at Lyons found that a pound killed horses by producing violent inflammation, recognizable during life by the symptoms, and after death by the morbid appearances.[328]
Of Poisoning with Chlorine.—Chlorine in its gaseous state acts powerfully as an irritant on the windpipe and lungs, and on that account will be noticed under the head of the poisonous gases. But even in solution it retains to a certain degree its poisonous qualities. Orfila says that five ounces of a strong solution of chlorine will kill a dog in twenty-four hours, if it is kept in the stomach by a ligature, and that two ounces diluted with twice its volume of water will prove fatal in four days;—that the symptoms are those of irritation of the stomach;—and that in the former case he found general redness and blackness—in the latter ulceration of its villous coat.[329]
Iodine is a poison of more consequence than chlorine, both because it is becoming a more common article, and because it is more violent in its effects on the animal economy.
Tests of Iodine.—Iodine when pure is a solid substance easily known by its scaly form, its resemblance in colour and resplendence to polished iron, its peculiar odour, the violet fumes it forms when heated, and the fine blue colour it produces with a solution of starch. It is very sparingly soluble in water, but readily so in rectified spirit and in aqueous solutions of certain salts, more especially the iodide of potassium. Its ordinary forms in the shops are iodine itself, the tincture, and the compound solution, where the solvent is a solution of iodide of potassium in water. It stains the skin brownish-yellow; but the stain is not permanent. Its fumes are intensely irritating to the nostrils, throat, and lungs.
When dissolved in water or in solutions of neutral salts, it communicates to the fluid a yellowish-brown or reddish-brown colour, which is destroyed by sulphuretted hydrogen, because the iodine is converted into hydriodic acid. In the colourless fluid thus formed, if treated with chlorine,—or in the original brown fluid without chlorine,—a solution of starch, obtained by ebullition and subsequently cooled, produces a fine blue colour and precipitate; and these, if the solution be sufficiently diluted, disappear on boiling, reappear on sudden cooling, and are removed permanently by a stream of sulphuretted hydrogen. This is a very delicate and characteristic system of tests. The best mode of using chlorine for decomposing hydriodic acid is to let it descend in the gaseous form from the mouth of a bottle of nitro-hydrochloric acid upon the fluid to be examined; In this way an excess is easily avoided, which bleaches out the blue colour. Sulphuric acid, though often recommended for the purpose, does not act unless it contains nitrous acid,—from which however the sulphuric acid of commerce is seldom quite free.
When mingled with organic substances, the discovery of it is a matter of some nicety; because many substances of this nature, especially in the living body, quickly convert it into hydriodic acid.[330] Hence few cases can occur in medico-legal practice, where iodine will be discoverable in its free state. The following method of analysis will meet all possible cases.
Process for Compound Mixtures.—Add water if necessary, and filter. If either the fluid or solid part is little or not at all coloured, test it with cold solution of starch, assisting the action of the test on the solid part by trituration in a mortar. If a blue colour be struck, which disappears under ebullition, and reappears under refrigeration alone, or on subsequently allowing chlorine gas to descend on the surface of the fluid, there can be no doubt of the existence of iodine.—If the colour of the suspected mixture after filtration is so deep that the action of the starch cannot be expected to yield characteristic appearances, then both the solid and fluid parts should be agitated with a third of their volume of ether; and after the ethereal solution has arisen to the surface, it is to be removed and tested with solution of starch. The blue colour will be now perhaps struck, because the ether, in carrying off the iodine from the mixture, leaves many coloured organic principles behind.
Should free iodine not be thus detected, strong presumptive evidence may still be procured of its actual presence, or of its having been at one time present, by continuing the examination with the view to detect hydriodic acid. This is described in p. 159.
By following this method of analysis, I have found that one grain of iodine of potassium, which is equivalent to three-quarters of a grain of iodine, may be easily discovered in six ounces of urine,—a fluid as complicated as can well be conceived.
The process adopted by Professor Orfila is so nearly the same with this, as scarcely to require being detailed. He uses nitric acid instead of chlorine for decomposing the hydriodic acid. Chlorine, however, is the most delicate reagent for the purpose, if it be used in the way described above.
Action of Iodine and Symptoms in Man.—Iodide has a twofold action, one local and irritating, the other general, and produced only when it has been administered long in frequent small doses.
Orfila remarked that in doses of two drachms it excited in dogs symptoms of irritation in the stomach; that death slowly ensued in seven days, without the symptoms having ever become very violent; and that the villous coat of the stomach was here and there yellow, had also patches of yellow mucus lining it, and exhibited numerous little ulcers of a yellow colour. He could not observe much injury from iodine introduced into the cellular tissue; and more lately, Dr. Cogswell remarked that in this way it merely induces phlegmonous inflammation and the usual consequences.[331]
An important circumstance in regard to the physiology and medical jurisprudence of this poison and its compounds is, that it may undoubtedly be detected in the blood, both when a single large dose has been taken, and in those persons who have used it for some time medicinally. Cantu, an Italian experimentalist, discovered iodine in such circumstances in the blood, sweat, urine, saliva and milk;[332] and Bennerscheidt, a German chemist, also found it in the blood, when it had been employed outwardly.[333] In the latter instance it could not be detected in the serum, but it was detected in the crassamentum by means of starch. Some interesting facts of the same nature have also been ascertained by Dr. O’Shaughnessey, from which it appears that even in acute poisoning with this substance, satisfactory proof of its administration may be procured several days afterwards by analysing certain secretions. In a dog poisoned with iodine, he detected the poison in forty minutes in the urine, and occasionally in the same secretion so late as the fifth day, when it died. It is singular, however, that he could not find it in the same quarter on the third day, although it existed at that time abundantly in the saliva.[334] In these experiments the iodine was always found in the form of hydriodic acid, having been converted into that compound in the alimentary canal. This change takes place with such rapidity, that on one occasion, in the vomited matter discharged by a dog fifteen minutes only after the administration of iodine, Dr. O’Shaughnessey could find no iodine, but a large quantity of hydriodic acid.[335] Orfila has found it not only in the urine, but likewise in the liver of animals.[336]
Considerable uncertainty prevails as to the circumstances in which we may expect iodine to be detected in the organs or secretions of persons who have taken it. Thus it has been stated by an Italian physician, Dr. Cristin, that in many individuals affected with dropsy, struma, epilepsy, and other diseases, he had sought for iodine to no purpose in the urine, bronchial mucus, and other excretory fluids.[337]
With regard to its operation on man, Orfila says, he has tried the effects of four or six grains on himself, and that he found this dose produce a sense of constriction in the throat, sickness, pain in the stomach, and at length vomiting and colic. There is no doubt, therefore, that in larger doses it will prove a dangerous irritant to man as well as to dogs. Accordingly, Dr. Gairdner has noticed the case of a child four years old, who died in a few hours after taking about a scruple in the form of tincture;[338] but he has not mentioned the symptoms. Dr. Jahn of Meiningen mentions a case where an over-dose produced violent pain in the belly, vomiting, profuse bloody diarrhœa, coldness and blanching of the skin, rigors, quivering of the sight and rapid pulse.[339] Two similar cases are related in a recent French journal; in one, which was produced by a drachm and a half of the ioduretted solution of hydriodate of potass, nausea, with acute pain and sense of burning in the pit of the stomach, followed immediately; in an hour there was vomiting of a yellowish matter which had the taste of iodine; excessive restlessness ensued, with headache, giddiness and paleness of the countenance; and these symptoms were not entirely dissipated for five days.[340] In the other case two drachms and a half of iodine were swallowed for the purpose of self-destruction. A sense of dryness and burning from the throat down to the stomach was immediately produced; lacerating pain in the stomach and fruitless efforts to vomit succeeded; and in an hour, when the relater of the case first saw the patient, there was suffusion of the eyes, excessive pain and tenderness of the epigastrium, and sinking of the pulse. Vomiting, however, was then brought on by warm water; copious yellow discharges, possessing the smell and taste of iodine, took place; and in nine hours the patient was well.[341]