Part 2 — CHAPTER XIII. OF POISONING WITH ARSENIC. (continued 2)

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 231to 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 232an 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 233alluded 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 234been 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 235irritation 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 236has 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 237made 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, 238with 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 239bed 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; 240Pyl 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 241deficiency 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.

242This 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 243for 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 244length 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.

3. The third variety of poisoning with arsenic places in a clear point of view its occasional action on the nervous system. This occurs chiefly in persons who, from having taken but a small quantity, or from having vomited soon after, are eventually rescued from destruction; but it has also been met with in some cases where death ensued after a protracted illness.

In such cases the progress of the poisoning may be divided into two stages. The first train of symptoms is exactly that of the first or inflammatory variety, and is commonly developed in a very perfect and violent form. In the second stage the symptoms are referrible to nervous irritation.

These generally come on when the former begin to recede; yet sometimes they make their appearance earlier, while the signs of inflammation 245in the alimentary canal continue violent; and more rarely both classes of symptoms begin about the same period. The nervous affection varies in different individuals. The most formidable is coma; the slightest, a peculiar, imperfect palsy of the arms or legs, resembling what is occasioned by the poison of lead; and between these extremes have been observed epileptic fits, or tetanus, or an affection resembling hysteria, or mania. As these affections are of much interest, in respect to the evidence of poisoning from symptoms, it may be well to relate in abstract a few characteristic examples of each.

A good example of epilepsy supervening on the ordinary symptoms of inflammation has been minutely related by Dr. Roget. A girl swallowed a drachm of arsenic, and was in consequence attacked violently with the usual symptoms of irritation in the whole alimentary canal. After being ill about twenty-four hours, she experienced several distinct remissions and had some repose, attended with fainting. In twelve hours more she began to improve rapidly; the pain subsided, her strength and spirits returned, and the stomach became capable of retaining liquids. So far this patient laboured under the common effects of arsenic. But a new train of symptoms then gradually approached. Towards the close of the second day she was harassed with frightful dreams, starting from sleep, and tendency to faint; next morning with coldness along the spine, giddiness, and intolerance of light; and on the fourth day with aching of the extremities and tingling of the whole skin. These symptoms continued till the close of the sixth day, when she was suddenly seized with convulsions of the left side, foaming at the mouth, and total insensibility. The convulsions endured two hours, the insensibility throughout the whole night. Next evening she had another and a similar fit. A third, but slighter fit occurred on the morning of the tenth; another next day at noon; and they continued to return occasionally till the nineteenth day. For some time longer she was affected with tightness across the chest and stomach complaints; but she was eventually restored to perfect health.^[659]

A characteristic set of similar cases, which occurred in London in 1815, has been related in a treatise on arsenic by Mr. Marshall.^[660] They were the subject of investigation on the trial of Eliza Fenning, a maid-servant, who attempted to poison the whole of her master’s family by mixing arsenic with a dumpling, and whose condemnation excited an extraordinary sensation at the time, as many persons believed her to be innocent. Five individuals partook of the poisoned dish, and they were all violently seized with the usual inflammatory symptoms. But farther, one had an epileptic fit on the first day, which returned on the second, and he had besides frequent twitches of the muscles of the trunk, a feeling of numbness in one side, and heat and tingling of the feet and hands. Another had tremors of the right arm and leg on the first day, and several epileptic fits in the 246course of the night. During the next fifteen days he had a paroxysm every evening about the same hour; which returned after an intermission of eight days, and frequently for several months afterwards.

In the following set of cases the nervous symptoms exhibited a singular combination of delirium, convulsions, tetanus, and coma, such as is frequently met with in paroxysms of hysteria; but the cases are probably not pure examples of poisoning with arsenic, for liver of sulphur was administered as a remedy to a considerable amount. Three servant girls in one of the Hebrides ate a mixture of lard, sugar, and arsenic, which had been laid for destroying rats. The ordinary signs of irritation in the stomach ensued, but on the following morning were greatly mitigated. They were then ordered twelve grains of liver of sulphur every other hour. Soon afterwards the inflammatory symptoms became more severe, the root of the tongue swelled and inflamed, and in the afternoon two of them lost the power of speech and swallowing, and were attacked with locked-jaw and general convulsions. The third had not locked-jaw, but was otherwise similarly, affected. On the morning of the third day one of the two former was found comatose, with continuance of the locked-jaw and occasional return of convulsions; and on being roused by venesection and the cold affusion, she complained of headache and heat in the throat. The sulphuret of potass, which had been discontinued on account of the locked-jaw, was then resumed. On the evening of the fourth day the headache increased, and the patient became delirious and unmanageable. The cold affusion, however, soon restored her again to her senses, and from that time her recovery was progressive. In the other patients the symptoms were similar, but less violent. In these instances the evidence of an injury of the nervous system was decisive; but it may be doubted whether the symptoms were not, in part at least, owing to the sulphuret of potass, which has been already described as an active poison, capable of inducing convulsions and tetanus. Its properties were not generally known in this country at the time the cases in question happened.^[661]

Sometimes the convulsions caused by arsenic assume the form of pure tetanus. At least a case of this affection is noticed by Portal.^[662] He has given only a mere announcement of it; and I have not hitherto met with a parallel instance in authors.

A common nervous affection in the advanced stage of the more tedious cases of poisoning with arsenic is partial palsy. Palsy in the form of incomplete paraplegia is a very common symptom even of the early stage in animals, and has been also sometimes observed during that stage in man. The paralytic affection, however, is more frequent in the advanced stage; and in those persons who recover, an incomplete paralysis of one or more of the extremities, resembling lead palsy, is often the last symptom which continues.

247Dehaen relates a distinct example of this disorder occurring in a female who took a small quantity of arsenic by mistake. The ordinary signs of inflammation were soon subdued, and for three days she did well; but on the fourth she was attacked with cramps, tenderness, and weakness of the feet, legs and arms, increasing gradually till the whole extremities became at length almost completely palsied. At the same time the cuticle desquamated. But the other functions continued entire. The power of motion returned first in the hands, then in the arms, and she eventually recovered; but eleven months passed before she could quit the hospital where Dehaen treated her.^[663]

An excellent account of a set of similar cases has been given by Dr. Murray of Aberdeen. They became the subject of judicial inquiry on the trial of George Thom, who was condemned in 1821 at the Aberdeen autumn circuit for poisoning his brother-in-law. Four persons were simultaneously affected about an hour after breakfast with the primary symptoms of poisoning with arsenic, and some in a very violent degree. But besides these symptoms, in all of them the muscular debility was great; and in two it amounted to true partial palsy. One of them lost altogether the power of the left arm, and six months after, when the account of the cases was published, he was unable to bend the arm at the elbow-joint. The other had also great general debility and long-continued numbness and pains of the legs.^[664]

An interesting case of the same nature with these was lately submitted to me on the part of the crown. A man after taking arsenic was attacked with vomiting, purging, and other symptoms of abdominal irritation, which were mistaken for dysentery. Five days afterwards he began to suffer also from feebleness of the limbs; amounting almost to palsy. Subsequently an improvement slowly took place; but he continued to suffer under irritative fever, diarrhœa, and faintness. Several weeks later the diarrhœa abated, but he had great stiffness, numbness, and loss of power in the joints of the hands and feet. Two months after he first took ill, and while he was slowly recovering from this paralytic affection, arsenic was again administered and proved fatal in eighteen hours.

Another, somewhat similar to the preceding, has been related by M. Lachèse of Angers. Two people took about half a grain in soup twice a day for two days, and were attacked with the usual primary symptoms. One of them died in ten weeks, gradually worn out, but without any particular nervous affection. The other was seized with convulsions, and afterwards with almost complete palsy of the limbs.^[665]—A well-marked case of the same nature has been noticed by Professor Bernt. It was the case formerly alluded to as arising from an over-dose of the arseniate of potass. The paralytic affection consisted in the loss of sensation and of the power of motion in the hands, and of the loss of motion in the feet, with contraction of the 248knee-joints. The issue of the case is not mentioned.^[666]—Dr. Falconer observes in his essay on Palsy, that he had repeatedly witnessed local palsy after poisoning with arsenic, and alludes to one instance in which the hands only were paralysed, and to two others in which the palsy spread gradually from the fingers upwards till the whole arms were affected.^[667]—On the whole, then, local palsy is the most frequent of the secondary effects of arsenic.

It is sometimes very obstinate, as the cases related by Dehaen and Murray will show. But it even appears to be sometimes incurable. For in the German Ephemerides there is related the case of a cook, who after suffering from the usual inflammatory symptoms, was attacked with perfect palsy of the limbs, and had not any use of them during the rest of her life, which was not a short one.^[668]

Occasionally, instead of being palsied, the limbs are rigidly bent and cannot be extended.^[669] They were contracted, as well as palsied in the case noticed by Bernt.

The last nervous affection to be mentioned is mania. The only instance I have hitherto found of that disease arising from arsenic is related by Amatus Lusitanus. He has not recorded the particulars of the case, but merely observes that the individual became so outrageously mad as to burst his fetters and jump out of the window of his apartment.^[670] According to Zacchias, Amatus was not very scrupulous in his adherence to fact in recording cases.

The preceding remarks contain all that is known with certainty of the effect of arsenic on man when it is swallowed. Independently of the obvious nervous disorders which succeed the acute symptoms, other morbid affections of a more obscure character and chronic in their nature have been sometimes observed or supposed to arise from this poison.—Among these the most unequivocal is dyspepsia. Irritability of the stomach, attended with constant vomiting of food, has been occasionally noticed for a long time after. Wepfer has described two cases in which the primary symptoms were followed, in one by dyspepsia of three years’ standing, in the other by emaciation and an anomalous fever, which ended fatally in three years.^[671]—Hahnemann farther adds, that in the advanced stage the hair sometimes drops out, and the cuticle desquamates, accompanied occasionally with great tenderness of the skin;^[672] and Wibmer mentions a case of the kind, where not the cuticle and hair only, but likewise even the nails, fell off.^[673] Desquamation of the cuticle and dropping of the nails are at times produced by the continued use of arsenic in medicinal doses.—Other effects have likewise been ascribed to its employment medicinally. Thus passing over what was stated by its 249opponents at the time when its introduction into the materia medica was made the subject of controversy over Europe, Broussais maintained that it causes chronic inflammation of the stomach or intestines;^[674] and Dr. Astbury inferred, from an instance which fell under his notice, that it may bring on dropsy.^[675] Neither of these ideas is supported by the general experience of the profession; and although some persons even of late have alleged that those, who take it medicinally to any material amount, invariably die soon after of some chronic disease,^[676] there cannot be a doubt, that, under proper restriction, it is both an effectual and a safe remedy.—A case where salivation, with fetor and superficial ulceration of the gums, seemed to have been produced by arsenic, was lately published in an English Journal.^[677]

In the present place may also be considered the supposed effects of the celebrated Aqua Toffana or Acquetta di Napoli, a slow poison, which in the sixteenth century, was believed to possess the property of causing death at any determinate period, after months for example, or even years, of ill health, according to the will of the poisoner.

The most authentic description of the aqua Toffana ascribes its properties to arsenic. According to a letter addressed to Hoffman by Garelli, physician to Charles the Sixth of Austria, that Emperor told Garelli, that, being governor of Naples at the time the aqua Toffana was the dread of every noble family in the city, and when the subject was investigated legally, he had an opportunity of examining all the documents,—and that he found the poison was a solution of arsenic in aqua cymbalariæ.^[678] The dose was said to be from four to six drops. It was colourless, transparent, and tasteless, like water.

Its alleged effects are thus eloquently described by Behrends, a writer in Uden and Pyl’s Magazin. “A certain indescribable change is felt in the whole body, which leads the person to complain to his physician. The physician examines and reflects, but finds no symptom, either external or internal,—no constipation, no vomiting, no inflammation, no fever. In short, he can advise only patience, strict regimen, and laxatives. The malady, however, creeps on; and the physician is again sent for. Still he cannot detect any symptom of note. He infers that there is some stagnation or corruption of the humours, and again advises laxatives. Meanwhile the poison takes firmer hold of the system; languor, wearisomeness and loathing of food continue; the nobler organs gradually become torpid, and the lungs in particular at length begin to suffer. In a word, the malady is from the first incurable; the unhappy victim pines away insensibly, even in the hands of his physician; and thus is he brought to a miserable end through months or years, according to his enemy’s desire.”^[679] An equally vigorous and somewhat clearer account of the 250symptoms is given by Hahnemann. “They are,” says he, “a gradual sinking of the powers of life, without any violent symptom,—a nameless feeling of illness, failure of the strength, slight feverishness, want of sleep, lividity of the countenance, and an aversion to food and drink and all the other enjoyments of life. Dropsy closes the scene, along with black miliary eruptions, and convulsions, or colliquative perspiration and purging.”^[680]

Whatever were its real effects, there appears no doubt it was long used secretly in Italy to a fearful extent, the monster who has given her name to it having confessed that she was instrumental in the death of no less than six hundred persons. It has been already stated, however [p. 40], that she owed her success rather to the ignorance of the age than to her own dexterity. At all events, the art of secret poisoning cannot now be easily practised. Indeed even the vulgar dread of it is almost extinct. Partly on account of the improvement in general knowledge and chiefly in consequence of the subtility and precision, which the refinement of modern physic and chemistry have introduced into medico-legal inquiries, it is rare that the suspicious scrutiny of the world now “recognizes in the accounts of the last illness of popes and princes the effects of poison insidiously introduced into the body.”^[681]

I may add in conclusion, that I was consulted a few years ago on the part of the crown in a case which considerably resembled the effects ascribed in former times to the aqua Toffana, except that it was more acute in its character and swifter in its progress. As this case will probably be found to represent pretty nearly the usual effects of moderate doses frequently repeated, it is here given in some detail.

A woman of indifferent character married a young man in circumstances which led to a breach between him and his relatives; but the pair appeared to live on good terms with one another. Eighteen months after the marriage she was attacked with sickness and faintness; and on the fourth day of this illness, while she was recovering, the symptoms unexpectedly increased, and she seemed very unwell. On the fifth day she became extremely weak, and suffered much from yellow vomiting. On the seventh, when she was first visited by a medical man, she had frequent vomiting, burning in the stomach, a yellow tongue, flushed countenance, hot skin, and hurried pulse. On the ninth the throat was sore and red, and the expression anxious; and next day the soreness was greater, affected the nose and mouth also, and was attended with excoriation of the lips and nostrils, swelling of the glands of the throat, dimness of sight, and great exhaustion. On the eleventh day, while previously again getting better, she became much worse, and suffered greatly from excessive vomiting, pain in the stomach, and an increase of the other symptoms. On the thirteenth she was very hoarse, and despaired of 251recovery. Next day she was occasionally incoherent, and had twitches of the facial muscles; the hands and face were swelled, the eyelids dingy, the conjunctivæ injected, and the nails blue. On the morning of the fifteenth there was for two hours violent delirium and fierce maniacal excitement, which were succeeded by coma, and this by death in the course of the evening. There was no diarrhœa, or urinary complaint, and no paralysis or eruption on the skin. A variety of circumstances of a general nature, which it would be out of place to enumerate here,—the detection of arsenic in various articles of which the woman had partaken, and in which the arsenic had been dissolved sometimes simply, sometimes with the aid of an alkali,—together with the fact, that the body five months after death was found preserved from decay, as it is now well known to be in most cases of arsenical poisoning,—left little doubt that the woman died of the effects of arsenic taken in several small doses at distant intervals, although none could be detected in the stomach or intestines. The case did not go to trial, owing to the death of an essential witness.

The effects of arsenic on man, when introduced into the living body through other channels besides the stomach, will now require some observations. It is necessary for the medical jurist to be well acquainted with them, because there is hardly an accessible part of the human body to which this poison has not been applied either accidentally or by design. When some account was given of its comparative action on the different tissues of animals, it was observed that arsenic acts when applied to a wound or ulcer, to the peritonæal membrane, to the eye, and to the vagina. On man it has been known to act through an ulcer or wound, the inner membrane of the rectum, the membrane of the vagina, the membrane of the air-tubes, the membrane of the nose, and even the sound skin.

Many persons have been poisoned by the application of arsenic to surfaces deprived of the cuticle, such as blistered surfaces, eruptions, ulcers, or wounds. When applied in this manner it commonly induces both local inflammation and constitutional symptoms. Amatus Lusitanus relates the case of a young man, who, against the advice of his physician, anointed an itchy eruption of the skin with an arsenical ointment, and next day was found dead in bed.^[682] A similar case, not so rapidly fatal, has been recorded by Wepfer. A girl, affected with psoriasis of the scalp, had it rubbed with a liniment of butter and arsenic. In a short time she was seized with acute pain and swelling of the whole head, fainting-fits, restlessness, fever, delirium, and she died in six days.^[683] Zitmann has noticed the cases of two children, eight and ten years of age, who were killed by the application of an arsenical solution to a similar eruption of the head.^[684] And Belloc relates the case of a woman who, trying to cure an inveterate itch with an arsenical lotion, was attacked in consequence with severe erysipelas of the whole body, succeeded by tremors and 252gradual exhaustion of the vital powers, ending fatally in two years.^[685] M. Errard of Injurieux in France lately met with two cases, where, in consequence of a freshly blistered surface being dressed with a cerate made with the stearine of arsenicated candles (see p. 256), local pain, nausea, pain in the stomach, urgent thirst, redness of the tongue, involuntary contractions of the muscles of the extremities, and weakness and irregularity of the pulse came on; and one person died within twenty-four hours, while the other recovered, chiefly because the dressing caused so much pain that the patient could not keep it on long.^[686]

Next as to ulcers; M. Roux has noticed the case of a girl, who was killed by the application of the arsenical paste to an ulcer of the breast, and in whom the constitutional symptoms were strongly marked, although the quantity of the poison must have been very small. The preparation used, which contains only a twenty-fourth of its weight of arsenic, was applied for a single night on a surface not exceeding an inch and a half in diameter. Yet she complained next day of violent colic and vomited frequently, the countenance soon became collapsed, and she died two days afterwards in great anguish.^[687] Another instance of the like kind is related in the Annales d’Hygiène, where death arose from an arsenical ointment ignorantly applied for scirrhous breast over a large surface of the skin stripped of the cuticle by a blister. The particular symptoms and their duration are not stated; but there was violent irritation of the stomach.^[688] Another fatal case, related by Dr. Küchler, arose from the application of Frêre Cosme’s powder to a soft fungoid tumour on the temple, which discharged serum usually and blood upon slight pressure. About a drachm and a half of arsenic mixed with fifteen grains of other powders was applied. Severe inflammation spread round the tumour next day; and soon afterwards, the patient was attacked with great difficulty of breathing, thirst, pains in the belly, and purging, then with difficulty in swallowing from swelling of the base of the tongue, delirium, cold sweating, and extreme debility; and death ensued in four days.^[689]

There is a singular uncertainty in the effects of arsenic when applied to ulcerated surfaces. Some persons, like Roux’s patient, are obviously affected by a single application; while others have had it applied for a long time without experiencing any other consequences than the formation of an eschar at the part. Two causes have been assigned for these differences, and probably both are founded on fact. One, which has been assigned by Mr. Blackadder, is the relative quantity of arsenic applied. He says he never witnessed but one instance of its acting constitutionally, although he often applied it to sores; and he imputes this success to his having always used a large quantity. For he considers that by so doing the organization of the 253part is quickly destroyed, and absorption prevented,—but that if the quantity be small, as in the mode practised by Roux, it will cause little local injury and readily enter the absorbing vessels.^[690] Another unequivocal cause is pointed out by Harles in his treatise on arsenic. While treating of its therapeutic properties, and noticing the controversy that prevailed last century throughout Europe respecting the propriety of its outward application, he remarks that it may be applied with safety to the abraded skin, to common ulcers, to wounded surfaces, and to malignant glandular ulcers, even when highly irritable, provided the part be not recently wounded, so as to pour out blood.^[691] The reason of this is obvious; the application of the poison to open-mouthed vessels is the next thing to its direct introduction into a vein. It is some confirmation of Harles’s opinion, that Roux, whose patient was so easily affected, recommends that before arsenic is applied to an ulcer, a fresh surface be made by paring away the granulations; and that Küchler’s patient had an ulcer which did not discharge pus, but serum, and was easily made to bleed.

In the cases related above it will be remarked that the symptoms vary in their nature. Sometimes the chief disorder is inflammation, spreading over and around the eruption or ulcer, sometimes inflammation of the alimentary canal, sometimes an affection of the nervous system. In general the sufferings of the patient both from the local inflammation and constitutional symptoms are very severe. But this rule has its exceptions. In Pyl’s Memoirs there is the history of a child who died four days after an itchy eruption of the whole body had been washed with an arsenical solution, and signs of vivid inflammation were found after death in many parts; yet she appears to have complained only of headache.^[692] Occasionally too, without exciting either inflammation of the part, or disorder of the stomach, or a general injury of the nervous system, it seems to give rise to partial palsy of the muscles adjoining the seat of its application. An extraordinary case is noticed in an American Journal, in which the prolonged use of an arsenical preparation for destroying a tumour on the right side of the neck, was followed by complete palsy of the muscles of the neck and arm of that side.

In the next place, poisoning has been perpetrated by introducing arsenic into the fundament with an injection.^[693] Foderé has noticed a case of this kind, which happened in France, and was communicated to him by a physician of Thoulouse. A lady under medical treatment for some trifling illness, died unexpectedly under symptoms of poisoning; and it was discovered that her servant, after unsuccessfully attempting to despatch her by dissolving arsenic in her soup, had ultimately succeeded by administering it repeatedly in injections.^[694] There is no doubt that by this mode all the usual effects of arsenic may be induced; and on account of the facility 254with which the colon and rectum may be evacuated, it is not likely that the poison will be found in the gut after death, if the individual did not die in a few hours after its administration.

In the third place, women have also died of poisoning by arsenic introduced into the vagina. Two examples of this revolting crime are on record. One of them occurred in 1799, in the Department of the Ourthe in France. A middle-aged female was seized with vomiting, diarrhœa, swelling of the genitals and uterine discharge; and she expired not long after. Before her death she told two of her neighbours, that her husband had some time before tried to poison her by putting arsenic in her coffee, and had at length succeeded by introducing a powder into her vagina while in the act of enjoying his nuptial rights. The vulva and vagina were gangrenous, the belly distended with gases, and the intestines inflamed.^[695]

The other case, which happened in Finland in 1786, gave rise to an excellent dissertation on the subject by Dr. Mangor, at that time medical inspector for Copenhagen. A farmer near Copenhagen lost his wife suddenly under suspicious circumstances, and six weeks afterwards married his maid-servant. In a few years he transferred his affections to another maid-servant, with whose aid he endeavoured to poison his second wife. For some time his attempts proved abortive; till at last one morning, after coïtion, he introduced a mixture of arsenic and flour on the point of his finger into the vagina. She took ill at mid-day and expired next morning; and the murderer soon after married his guilty paramour. But a few years had not elapsed before he got tired of her also; and one morning, after the conjugal embrace, he administered arsenic to her in the same way as to her predecessor. About three in the afternoon, while enjoying good health, she was suddenly seized with shivering and heat in the vagina. The remembrance of her former wickedness soon awoke the suspicions of the unhappy woman, and she wrung from her husband a confession of his crime. Means were resorted to for saving her life, but in vain: She was attacked with acute pain in her stomach and incessant vomiting, then became delirious, and died in twenty-one hours. After death grains of arsenic were found in the vagina, although frequent lotions had been used in the treatment. The labia were swollen and red, the vagina gaping and flaccid, the os uteri gangrenous, the duodenum inflamed, the stomach natural. In the course of the judicial proceedings which arose out of these two cases, Dr. Mangor made experiments on mares, with the view of settling the doubts which were entertained as to the likelihood of arsenic proving fatal in the manner alleged; and the results clearly showed that, when applied to the vagina of these animals, it produces violent local inflammation and fatal constitutional derangement.^[696]

In the fourth place, poisoning by arsenic through the bronchial 255membrane or membrane of the air-passages is a comparatively rare accident, which can take place only in consequence of arsenical gases or vapours being incautiously breathed. The effects of oxide of arsenic when introduced in this way are described from personal experience by Otto Tachenius, a chemist of the sixteenth century.

“Once,” said he, “when I happened to breathe incautiously the fumes of arsenic, I was surprised to find my palate impressed with a sweet, mild, grateful taste, such as I never experienced before. But in half an hour I was attacked with pain and tightness in the stomach, then with general convulsions, difficult breathing, an unspeakable sense of heat, bloody and painful micturition, and finally with such an acute colic as contracted my whole body for half an hour.” By the use of oleaginous drinks he recovered from these alarming symptoms; but during all the succeeding winter he had a low hectic fever.^[697]

Balthazar Timæus relates a similar case which came under his notice. An apothecary of Colberg, while subliming arsenic, had not been careful enough to avoid the fumes; and was soon after seized with frequent fainting, tightness in the præcordia, difficult breathing, inextinguishable thirst, parched throat, great restlessness, watching, and pains in the feet. He had afterwards profuse daily perspiration and palsy of the legs; and several months elapsed before he got entirely well.^[698] The same author says that the famous Paracelsus, being one day put out of temper by an acquaintance, made him hold his nose over an alembic in which arsenic was subliming; and that the object of this severe joke nearly lost his life in consequence. Wibmer quotes the heads of several cases where swelling of the tongue, headache and giddiness, nausea, and an oppressive sense of constriction in the throat, were occasioned by the incautious inhalation of arsenical fumes.^[699] The following extraordinary case, closely allied to malignant cholera in its early stage, has been ascribed by the reporter Dr. Welper of Berlin to the inspiration of arsenical fumes,—with what probability I am not prepared to say. A stout healthy man, who in the forenoon had freely and for some time exposed himself to the steam from a vessel where he was boiling several ounces of orpiment in water, was attacked at night with sickness, and next morning with extreme weakness and some difficulty of breathing. These symptoms were greatly relieved by an emetic. But towards evening the extremities became ice-cold and very stiff, the breathing much oppressed, the pulse very hurried, and imperceptible except in the neck, the mouth and throat dry, and the tongue rigid; but the mind remained clear, though anxious and afraid of impending dissolution. His state of collapse was removed in twelve hours by fomentations, and in no long time he recovered entirely except from the dyspnœa, which continued more or less till a few years afterwards, when he died of hydrothorax.^[700]

256The slighter effects of arsenic are said to have been repeatedly observed of late in this country from inhaling the products of the combustion of arsenicated candles,—an article of recent invention, in which arsenic, to the extent of three or four grains and a half in each candle, is introduced for the purpose of hardening the stearine chiefly used in manufacturing them. It is unnecessary to say, that such candles are prejudicial and ought to be prohibited. In a set of experiments made to try their effects by Messrs. Everitt, Bird, and Phillips in 1838, birds were killed in no long time, and small quadrupeds were severely affected, when kept in an apartment lighted with them.^[701]

Analogous to the effects of inhaling oxide of arsenic are those lately observed from the incautious inhalation of arseniuretted-hydrogen gas. Gehlen the chemist died of this accident, but no particular account has been published of the symptoms he suffered. Two cases, however, have been detailed within a few years. In one of these, which has been related by Dr. Schlinder, of Greifenberg, the individual inhaled in forty minutes about half a cubic inch of the gas, which is equivalent to about an eighth of a grain of arsenic. In three hours he became affected with giddiness, and soon afterwards with an uneasy sense of pressure in the region of the kidney, passing gradually into acute pain there and upwards along the back. General shivering ensued, with coldness of the extremities, and gouty-like pains in the knees, shoulders, and elbows. The hands and lower half of the fore-arms, the feet and legs nearly to the knees, the nose and region of the eyebrows, felt as if quite dead, but without any diminution of muscular power. There was also acute pain in the stomach and belly generally, painful eructation of gas, and occasional vomiting of bitter, greenish-yellow mucus. The most tormenting symptom, however, was the pain in the kidneys, which soon became attended with constant desire to pass water, and the discharge of deep reddish-brown urine, mixed with clots of blood. The whole expression of the countenance was altered, the skin becoming dark brown, and the eyeballs sunk, yellow, and surrounded by a broad livid ring. Warm drink brought out a copious sweat and removed the sense of numbness; but next day there was little change otherwise in the symptoms, except that the urine was no longer mixed with clots, and that the hair on the benumbed parts had become white. On the third day the pains had abated, and the urine became clear; but there was hiccup, an excited state of the mind, and a feeling as if a great stone lay in the lower belly. In seven days he was much better. In the third week the whole glans and prepuce became covered with little pustules which were followed by small ulcers. It was not till the close of the seventh week that he recovered completely.^[702] Dr. O’Reilly has related the following case, which arose from the inhalation of hydrogen gas impregnated with arseniuretted-hydrogen in consequence of the sulphuric acid used 257for dissolving zinc having contained arsenic. Mr. Brittan, a Dublin chemist, wishing to ascertain the effects of hydrogen on the body, proceeded to inhale 150 cubic inches of it. Immediately after the second inhalation, he was seized with confusion, faintness, giddiness and shivering, and passed a stool, as well as two ounces of bloody urine, but without any pain. Pain in the limbs followed, and in two hours frequent vomiting and dull pain in the stomach. The pulse at this time was 90, the skin cold, and the voice feeble. Ammonia, laudanum, and emollient clysters gave him little relief. During the subsequent night there was frequent vomiting and no urine; the face became copper-coloured, and the rest of the body greenish; there was tenderness of the epigastrium and hiccup; but he was free of fever. On the third day there was diarrhœa and still no urine; but the jaundice had disappeared. On the fourth the breath was ammoniacal, and somnolency had set in. On the fifth the skin became again deeply jaundiced, and the face was œdematous; no urine had yet been discharged, and the bladder, examined with the catheter, was found empty. On the evening of the seventh day he expired. On examination of the body, two pints of red serum were found in the pleural cavities; the lungs were sound, the heart pale and flaccid, the liver indigo-blue, the gall-bladder distended with bile, the kidneys also indigo-blue, the stomach empty, and its villous coat brittle, with here and there inflamed-like spots on it, the bladder empty, the brain bloodless, the cellular tissue generally anasarcous. Arsenic was detected in the pleural serum. By an approximate calculation it was supposed that the hydrogen this gentleman inhaled had contained the equivalent arsenic of twelve grains of the oxide.^[703]

It would appear that arsenic acts with great rapidity and force when respired in any form.

Poisoning through the lining membrane of the nostrils is a still rarer accident than that last mentioned. There is a distinct example of it in the German Ephemerides, which arose from an arsenical solution having been used by mistake as a lotion for a chronic discharge from the nostrils. The individual was attacked with a profuse discharge from the nostrils, and then with stupor approaching to coma. Weakness of sight and of memory continued after sensibility returned; and he died two years afterwards, death having been preceded for some time by convulsions.^[704]

Arsenic when applied to the sound skin of animals does not easily affect them. The experiments of Jaeger formerly noticed prove that no effect is produced, if the poison is simply placed in contact with the skin. Nay even when rubbed into it with fatty matters it does not operate with energy; for in that case, according to the experiments of Renault, it causes sometimes a pustular eruption, sometimes an eschar, but never any constitutional disorder.^[705] It is more energetic, 258however, when applied to the more delicate skin of the human subject. Some experiments were made by Mr. Sherwen on himself with the view of proving this;^[706] but they are not satisfactory. The following facts, however, will show that it may produce through the sound skin all the ordinary signs of poisoning. Desgranges, a good authority, relates the case of a woman who anointed her head with an arsenical ointment to kill lice, and, after using it several days, was attacked with erysipelas of the head and face, attended with ulceration of the scalp, swelling of the salivary and cervical glands, and inflammation of the eyes. There were likewise violent constitutional symptoms,—much fever, fainting, giddiness, vomiting and pain in the stomach, tenesmus, and ardor urinæ, tremors of the limbs, and even occasional delirium. Afterwards the whole body became covered with an eruption of white papulæ, which dried and dropt off in forty-eight hours. She recovered gradually; but appears to have made a narrow escape. Her hair fell out during convalescence.^[707] A similar instance is recorded in the Acta Germanica for 1730. A schoolboy having found in the street a parcel of arsenic, his mother mistook it for hair powder; and as he had to deliver a valedictory speech at school next day, she advised him to powder himself well with it in the morning. This he accordingly did. In the middle of his speech he was attacked with acute pain of the face; and a fertile crop of pustules soon broke out upon it. The head afterwards swelled much, and the pustules spread all around it; he was tormented with intolerable heat in the scalp; and the hair became matted with the discharge into a thick scabby crust. This crust separated in a few weeks, and he soon recovered completely.^[708] Schulze, a German physician, has related no fewer than five cases of the same description, all arising from arsenic having been mistaken for hair powder; and one of them proved fatal. Two of the cases were slight. The other persons had the same violent inflammation of the head as Desgranges’s patient and the German schoolboy. In the fatal case death took place in twenty-one days; and on dissection, besides other morbid appearances, the scalp was found gangrenous and infiltered with fluid blood, and the stomach much inflamed.^[709] The two survivors, who were severely ill, it is well to add, were not attacked with the erysipelas of the scalp till six days after they powdered themselves. Sproegel mentions a fatal case from fly-powder having been applied in like manner to the head; and Wibmer quotes another, but not fatal, where from the same cause great swelling of the head and face arose, followed by erysipelas of the face, neck, and belly, and a papular eruption on the hands which continued five days.^[710]

From the statements now made, it is evident that arsenic applied to various parts of the external surface and natural apertures of the 259body, will prove poisonous, and will often act with a certainty and rapidity not surpassed by its effects when taken internally. Many of the cases furnish a striking confirmation of a circumstance formerly noticed with respect to its action,—namely, that it produces signs of irritation in the stomach, in whatever manner it is introduced into the body. In some instances, indeed, the signs of inflammation in the stomach were quite as distinct as in the cases previously described, where the poison was taken internally.

The subject of the symptoms caused by arsenic will now be concluded with a few remarks on the strength of the evidence which they supply.

The present doctrine of toxicologists and medical jurists seems generally to be, that symptoms alone can never supply decisive proof of the administration of arsenic. This opinion is certainly quite correct when applied to what may be called a common case of poisoning with arsenic, the symptoms of which are little else than burning pain in the stomach and bowels, vomiting and purging, feeble circulation, excessive debility, and speedy death. All these symptoms may be caused by natural disease, more particularly by cholera; and consequently every sound medical jurist will join in condemning unreservedly the practice which prevailed last century of deciding questions of poisoning in such circumstances from symptoms alone. But modern authors appear to have overstepped the mark, when they hold that the rule against deciding from symptoms does not admit of any exceptions. For there are cases of poisoning with arsenic, not numerous certainly, yet not very uncommon neither, which can hardly be confounded with natural disease; and, what is of some consequence, they are precisely those in which the power of deciding from symptoms alone is most required, because chemical evidence is almost always wanting. Either the peculiar combination of the symptoms is such as cannot arise from natural causes, so far at least as physicians are acquainted with them: or these symptoms occur under collateral circumstances, which put natural causes almost or altogether out of the question.

Thus, let the medical jurist consider in the first place, the symptoms occasionally observed in those who survive five, six or ten days; let him exclude for the present the secondary nervous affections; and instead of a compounded description, which may be objected to as apt to convey a false and exaggerated idea of the facts, let him take an actual example. In a paper by Dr. Bachmann on some cases of poisoning with arsenic, there is a minute account of the case of a lady who was poisoned by her maid with fly-powder and white arsenic, and whose symptoms were those of universal inflammation of the mucous membranes. After suffering two days from retching and vomiting, colic pains and purging, these symptoms suddenly became more violent, and attended with oppressed breathing and hoarseness so that she could hardly make herself be heard,—with vesicles on the palate, burning pain in the throat, and excessive difficulty in swallowing,—with spasm and pain of the bladder in passing water,—and with extreme 260feebleness of the pulse. Three days afterwards the symptoms increased still more. She complained of intolerable burning and spasms of the throat, which, as well as the mouth, was excessively inflamed,—of violent burning pain in the stomach and bowels,—of burning in the fundament and genitals, both of which were inflamed even to gangrene,—of indescribable anxiety and anguish about the heart; and she died the following day, death being preceded by subsultus, delirium, and insensibility.^[711] Or take the case in the trial of Miss Blandy. On two successive evenings, immediately after taking some gruel which had been prepared by the prisoner, Mr. Blandy was attacked with pricking and burning of the tongue, throat, stomach, and bowels, and with vomiting and purging. Five days after, when the symptoms were fully formed, he had inflamed pimples round the lips, and a sense of burning in the mouth; the nostrils were similarly affected; the eyes were bloodshot and affected with burning pain; the tongue was swollen, the throat red and excoriated, and in both there was a tormenting sense of burning; he had likewise swelling, with pricking and burning pain of the belly; excoriations and ulcers around the anus and intolerable burning there; vomiting and bloody diarrhœa; a low, tremulous pulse, laborious respiration, and great difficulty in speaking and swallowing. In this state he lingered several days, death supervening nine days after the first suspected basin of gruel was taken.^[712] Can the symptoms, in these two cases, attacking, as they did, at one and the same time, the whole mucous membranes, be imitated by any natural combination of symptoms? Viewing the endless variety and wonderful complexity of the phenomena of disease, the practitioner will probably, and with justice, reply that a natural combination of the kind is possible. But if his attention is confined, as in strictures it ought to real occurrences,—if he is required to speak only from actual experience, personal or derived, it is exceedingly questionable whether any one could say he had ever seen or read of such a case. At all events, if a medical witness had to give his opinion from symptoms only in such a case as that of Mr. Blandy, or that described by Bachmann, he would certainly be justified in declaring that poisoning was highly probable; and, admitting general poisoning to be proved, he would, it is likely, fix on arsenic as the substance which could most easily produce the effects.

Let him next, however, take also into consideration the nervous affections that sometimes either immediately follow the inflammation of the mucous membranes, or become united with it when it has existed a few days; and confining his attention still to actual occurrences, let him reflect on the symptoms in Dr. Roget’s case, in which there was first violent inflammation of the whole alimentary canal, and then regular and obstinate epilepsy (p. 245), or on those in Dehaen’s patient, in whom the nervous disorder was partial palsy (p. 247). On reconsidering these narratives, still greater reason will appear for 261doubting whether such a combination of simultaneous, and in the present instance also consecutive symptoms, ever arise from natural causes. It is difficult to conceive a fortuitous concurrence of natural diseases producing at the same moment that variety and complexity of disorder which occur in the primary stage of the cases alluded to; and it would surely be a still more extraordinary combination which should farther add the supervention of epilepsy or partial palsy from a natural cause, at the exact period at which it appears as the secondary stage of poisoning with arsenic. All that any practitioner could say is, that a concurrence of the kind is within the bounds of possibility. He must be compelled to admit that it is in the highest degree improbable, and likewise that it could hardly take place from natural causes without the real causes of the symptoms being clearly indicated.

But to conclude, there are likewise collateral circumstances connected with the symptoms, which, taken along with the symptoms themselves, will sometimes place the fact of poisoning with arsenic beyond the reach of a doubt. Thus, if a person were taken several times ill with symptoms of general inflammation of the mucous membranes, after partaking each time of a suspected article of food or drink, the proof of the administration of arsenic would be very strong indeed; and it would be unimpeachable if at length a nervous affection succeeded at the usual period. Or above all, suppose several persons, who have partaken of the same dish, are seized about the same time with nearly the same symptoms of irritation of the mucous membranes. The proof of general poisoning would then be unequivocal. And if one or more of them should afterwards suffer from a nervous disorder, little hesitation ought to be felt in declaring that arsenic is the only poison which could have caused their complaints.

These views are of more practical consequence than may at first sight be thought. The doctrine which has been here espoused might have been applied to decide two criminal cases which at the time made a great noise in this country. One was the case of Eliza Fenning (p. 245). Here five persons were simultaneously attacked with symptoms, more or less violent, of inflammation of the whole alimentary canal; and in two of them epileptic convulsions appeared before the inflammatory symptoms departed. The other was the case of George Thom (p. 247). Here four persons were at one and the same time seized with the primary symptoms in an aggravated form; and in two of them, as these symptoms abated, obstinate partial palsy came on. On both trials, then, it might have been stated from the symptoms alone that poison had been given, and that arsenic was the only poison hitherto known to be capable of producing such effects.

In applying this doctrine to parallel instances two precautions must be attended to. On the one hand, care must be taken to ascertain, as may always be done, that the simultaneous symptoms of general irritation in the alimentary canal, arising soon after a meal, are not owing to unsound meat having been used in preparing it. And on 262the other hand, which is of more consequence, the symptoms on which so important an opinion is founded, must be strongly marked and well ascertained by a competent person. The signs of irritation in the mucous membranes must be really general and unequivocal; and those of a disorder of the nervous system must be likewise developed characteristically. Care must be taken in particular to distinguish symptoms of the latter class from others which approach to them in nature, and are the ordinary sequels of natural disease: for example, the true palsy caused by arsenic must not be confounded with the numbness and racking pains in the limbs, which occasionally succeed cholera.

With these precautions the evidence from symptoms may in certain cases be decisive of the question of poisoning with arsenic. And it is of moment to observe, as has been already hinted, that, although such cases are numerous, they are precisely of the kind in which it is most essential to the ends of justice that the symptoms should, if possible, supply evidence enough to direct the judgment; for the characteristic symptoms referred to occur chiefly when the patient either recovers or survives many days, and where consequently the chemical evidence, usually procured from the examination of the contents of the stomach, is almost always wanting.

Section III.—Of the Morbid Appearances caused by Arsenic.

The morbid appearances caused by arsenic will next require some details. In treating of them the same plan will be pursued as in the preceding section: the various morbid appearances left by it will first be mentioned in their order; and the subject will then be wound up with some remarks on the force of the evidence from these appearances, as they are usually combined in actual cases.

In the first instance, there are some cases in which little or no morbid appearance is to be seen at all. These all belong to the second variety of poisoning, which is characterized by the absence of local inflammation, and the presence of symptoms indicating an action on the heart, or some other remote organ. In such circumstances death takes place before a sufficient interval has elapsed for inflammation to be developed.

Several examples of the absence of diseased appearances in the dead body are to be found in authors. Thus in Chaussier’s case formerly quoted (p. 243), in that related by Metzger (p. 242), in another related by Etmuller, which was fatal in twelve hours,^[713] and in a fourth related by Professor Wagner of Berlin, where life was also prolonged for twelve hours under incessant vomiting,^[714] there was positively no morbid alteration at all. Such was also the state of the whole alimentary canal in the extraordinary case related by Orfila (p. 243). In the case quoted from the Medical and Physical Journal (p. 242), there was merely a slight redness at the pyloric end of the 263stomach. In the case of the American grocer too, there was only a little redness. In Mr. Wright’s case (p. 243), there was scarcely any morbid appearance,—nothing more than two small vascular spots and a minute ecchymosis. In that which fell under my own notice (p. 242), the villous coat of the stomach was of natural firmness, and had an exceedingly faint mottled-cherry-red tint, barely perceptible in a strong light; and the rest of the alimentary canal, as well as the body generally, was quite healthy.

Although in these examples the morbid appearances were trifling or undistinguishable, it must not be supposed that the same happens in all cases of rapid death from arsenic. In Gérard’s case, where the usual irritant symptoms were wanting, and which proved fatal in five hours, there was dark redness of the whole villous coat of the stomach. In Mr. Holland’s case, fatal in eight or nine hours (p. 243), the stomach was of an intense purple colour at its pyloric end, and contained bloody mucus; and the mucous coat of the cœcum presented extensive softening and congestion. Mr. Alfred Taylor refers to three cases observed by Mr. Forster of Huntingdon, in which the mucous coat of the stomach was highly inflamed, though death took place in 6½, 3½, and 2 hours only:^[715] in Mr. Hewson’s case, fatal in five hours, the whole stomach was exceedingly vascular, and presented both spots of extravasation, and several small erosions (p. 201). In a case alluded to at p. 239 as having fallen under my own observation, and which was also fatal in five hours, the whole villous coat of the stomach was intensely red, except where the folds of the rugæ protected it from contact with the poison; and the prominences of the rugæ presented corroded spots of ecchymosis. In Dr. Dymock’s case, fatal in two hours and a half, the stomach, which I had an opportunity of examining, presented on its mucous coat many scarlet patches, and here and there a purplish appearance (p. 240). Lastly, an instance is related by Pyl of this poison proving fatal in three hours, and leaving nevertheless in the dead body distinct signs of inflammation in the stomach.^[716]