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If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: Treatise on Poisons - In relation to medical jurisprudence, physiology, and the - practice of physic - -Author: Robert Christison - -Release Date: May 14, 2021 [eBook #65341] - -Language: English - -Character set encoding: UTF-8 - -Produced by: Richard Tonsing, MWS, and the Online Distributed Proofreading - Team at https://www.pgdp.net (This file was produced from - images generously made available by The Internet - Archive/Canadian Libraries) - -*** START OF THE PROJECT GUTENBERG EBOOK TREATISE ON POISONS *** - - - - - A - TREATISE - ON - POISONS - IN RELATION TO - MEDICAL JURISPRUDENCE, PHYSIOLOGY, AND THE PRACTICE OF PHYSIC. - - - BY - - ROBERT CHRISTISON, M.D., F.R.S.E., - - - Professor of Materia Medica in the University of Edinburgh, Fellow of - the Royal College of Physicians, &c., Member of the American - Philosophical Society,—of the Royal Acad. of Med. of Paris,—of the Imp. - Soc. of Physicians of Vienna,—of the Imp. Med. Chir. Acad. of St. - Petersburg,—of the Med. Chir. Soc. of Berlin,—of the Med. Chir. Assoc, - of Hamburg,—of the Soc. of Nat. and Phys. of Heidelberg,—of the - Philadelphia Coll. of Pharm. - - - FIRST AMERICAN, FROM THE FOURTH EDINBURGH EDITION. - - - PHILADELPHIA: - ED. BARRINGTON & GEO. D. HASWELL. - 1845. - - - - - PREFACE - TO THE FOURTH EDITION. - - -[Illustration] - -The author regrets that circumstances beyond his control have delayed -the re-appearance of the present work beyond the period at which it was -called for by the favourable reception of the last edition. He has -endeavoured to take advantage of the numerous investigations which have -been carried on during the interval into the several departments of -Toxicology in the leading countries of Europe; and has in consequence -been led to enlarge the work materially. - -He trusts it may be allowed him to express his satisfaction at finding, -that the rapid progress made by Toxicological science during the last -eight years, while it has been productive of many important additions to -our knowledge, has nevertheless not rendered any important alterations -necessary either in the general principles formerly laid down in this -work, or in what had been there stated as well ascertained general -facts. - - EDINBURGH COLLEGE, - _November, 1844_. - - - - - CONTENTS. - - - PART FIRST.—OF GENERAL POISONING. - - PAGE - - CHAP. I. Of the Physiological Action of Poisons 9 - - SECTION 1. Of their Mode of Action 9 - - Of the Discovery of Poisons in the Blood 21 - - SECTION 2. Of the Causes which modify their Action 27 - - Application of the preceding observations to the - Treatment of Poisoning 36 - - CHAP. II. Of the Evidence of General Poisoning 39 - - SECTION 1. Of the Evidence from Symptoms 42 - - Characters of the Symptoms of Poisoning 42 - - Characters of the Symptoms of Natural Disease 46 - - SECTION 2. Of the Evidence from Morbid Appearances 51 - - SECTION 3. Of the Evidence from Chemical Analysis 54 - - Causes which remove Poisons beyond the reach of - analysis 55 - - Chemical Evidence not always indispensable to the - proof of Poisoning 59 - - SECTION 4. Evidence from Experiments on Animals 62 - - With suspected articles of food or drink 63 - - With vomited matter or contents of the stomach 67 - - With the flesh of poisoned animals 69 - - SECTION 5. Moral Evidence 71 - - Suspicious conduct of prisoner, 73 and 78.—Proof - of administration of poison, 73.—Proof of - intent, 78.—Proof from simultaneous illness of - several people, 80.—Proof from death-bed - declaration 83 - - CHAP. III. Of Imaginary, Pretended, and Imputed Poisoning 85 - - - PART II.—OF INDIVIDUAL POISONS. - - CHAP. I. Classification of Poisons 90 - - CHAP. II. CLASS FIRST. Of Irritant Poisons generally 92 - - SECTION 1. Of the Symptoms of Irritant Poisons compared with - those of Natural Disease 93 - - SECTION 2. Of the Morbid Appearances of Irritant Poisoning - compared with those of natural disease 110 - - CHAP. III. Mineral Acids 121 - - SECTION 1. Sulphuric Acid 123 - - Tests, 123, Action, 128, Morbid Appearances, 135, - Treatment, 140 - - SECTION 2. Nitric Acid 142 - - SECTION 3. Hydrochloric Acid 146 - - CHAP. IV. Phosphorus. Sulphur. Chlorine. Iodine. Iodide of - Potassium. Bromine 149 - - CHAP. V. Acetic Acid 164 - - CHAP. VI. Oxalic Acid 167 - - SECTION 1. Tests 168 - - SECTION 2. Action and Symptoms in Man 173 - - SECTION 3. Morbid Appearances 177 - - SECTION 4. Treatment 178 - - Tartaric and Citric Acid 180 - - CHAP. VII. Fixed Alkalis 180 - - CHAP. VIII. Nitre 187 - - CHAP. IX. Alkaline and Earthy Chlorides 191 - - CHAP. X. Lime 192 - - CHAP. XI. Ammonia and its salts 193 - - CHAP. XII. Alkaline Sulphurets 196 - - CHAP. XIII. Arsenic 197 - - SECTION 1. Tests for its compounds 198 - - Fly-powder 199 - - Oxide of Arsenic 200 - - Tests in its solid state 203 - - —— a pure solution 206 - - —— when in organic mixtures 215 - - Arsenite of Copper 223 - - —— of Potass 223 - - Arseniate of Potass 224 - - Sulphurets of Arsenic 224 - - Arseniuretted-hydrogen 227 - - SECTION 2. Action and Symptoms in Man 227 - - Mode of Action 227 - - Symptoms in ordinary cases 234 - - —— very short cases 241 - - —— tedious cases 244 - - Effects through other channels besides the - Stomach 251 - - Force of the evidence from Symptoms 259 - - SECTION 3. Morbid Appearances 262 - - SECTION 4. Treatment 283 - - CHAP. XIV. Mercury 289 - - SECTION 1. Tests for its preparations 289 - - Red Precipitate 290 - - Cinnabar 290 - - Turbith Mineral 290 - - Calomel 291 - - Corrosive Sublimate 291 - - —— Tests in the solid state 292 - - —— solution 292 - - —— organic mixtures 296 - - Bicyanide of Mercury 303 - - Nitrates of Mercury 303 - - SECTION 2. Mode of Action and Symptoms 303 - - Mode of Action 303 - - Symptoms of Corrosive Poisoning 310 - - Symptoms of Irritation and Erethysm combined 314 - - Symptoms of Erethysm and Mercurial Tremor 316 - - SECTION 2. Action on different Tissues and in different - Chemical forms 327 - - Force of evidence from Symptoms 336 - - SECTION 3. Morbid Appearances 337 - - SECTION 4. Treatment 342 - - CHAP. XV. Copper 345 - - SECTION 1. Tests for its Compounds 346 - - SECTION 2. Action and Symptoms 358 - - SECTION 3. Morbid Appearances 364 - - SECTION 4. Treatment 365 - - CHAP. XVI. Antimony 367 - - SECTION 1. Tests for its Compounds 367 - - SECTION 2. Action and Symptoms 371 - - SECTION 3. Morbid Appearances 376 - - SECTION 4. Treatment 377 - - CHAP. XVII. Tin, 379—Silver, 380—Gold, 383—Bismuth, - 383—Chrome, 385—Zinc, 386—Iron, 391—Other rarer - metals, 395 378 - - CHAP. XVIII. Lead 396 - - SECTION 1. Chemical History, and Tests for its Compounds 396 - - Action of Water on Lead 399 - - Action of Acidulous Fluids on Lead 416 - - Process for Lead in Organic Fluids 423 - - SECTION 2. Action and Symptoms in Man 424 - - Tradesmen who are apt to suffer from Lead 436 - - SECTION 3. Morbid Appearances 439 - - SECTION 4. Treatment, and Precautions for Workmen 441 - - CHAP. XIX. Baryta 446 - - CHAP. XX. Vegetable Acrids, Euphorbia, Castor-oil seed, - Physic-nut, Bitter Cassava, Manchineel, Croton, - Bryony, Colocynth, Elaterium, Ranunculus, - Anemone, Caltha, Clematis, Trollius, Mezereon, - Cuckoo-pint, Gamboge, Daffodil, Jalap, Savin 451 - - CHAP. XXI. Cantharides 470 - - CHAP. XXII. Poisonous Fish 477 - - CHAP. XXIII. Venomous Serpents and Insects 484 - - CHAP. XXIV. Diseased and Decayed Animal Matter 487 - - CHAP. XXV. Mechanical Irritants 501 - - Substances, irritant, in large doses,—Pepper, - Epsom Salt, Alum, Cream of Tartar, Sulphate of - Potass, Common Salt, &c. 506 - - CHAP. XXVI. CLASS II. Of Narcotic Poisons, 510—of Narcotic - Poisoning generally, and the distinction - between it and natural disease, 511 510 - - CHAP. XXVII. Opium 530 - - SECTION 1. Chemical History and Tests 530 - - SECTION 2. Action and Symptoms 539 - - Action of Morphia and Narcotine 557 - - SECTION 3. Morbid Appearances 562 - - SECTION 4. Treatment 566 - - CHAP. XXVIII. Hyoscyamus, Lactuca, and Solanum 571 - - CHAP. XXIX. Hydrocyanic Acid 577 - - SECTION 1. Tests 578 - - SECTION 2. Action and Symptoms 582 - - SECTION 3. Morbid Appearances 593 - - SECTION 4. Treatment 596 - - Of the Vegetable Substances which contain - Hydrocyanic Acid, 600—Bitter Almond, - 601—Cherry-laurel, 605—Peach, - 608—Cluster-cherry, 608—Mountain-ash, 608 - - CHAP. XXX. Carbazotic Acid 610 - - CHAP. XXXI. Poisonous Gases 611 - - What Gases are Poisonous 612 - - Effects on Man of Nitric Oxide Gas, 615—Chlorine, - 616—Ammonia, 617—Hydrochloric Acid, - 617—Hydrosulphuric Acid, 617—Carburetted - hydrogen, 622—Carbonic Acid, 624—Carbonic - Oxide, 634—Nitrous Oxide, 635—Cyanogen, - 636—Oxygen, 636 - - CHAP. XXXII. CLASS III. Narcotico-Acrid Poisons 637 - - CHAP. XXXIII. Nightshade, 639—Thorn-Apple, 644—Tobacco, 647 639 - - CHAP. XXXIV. Hemlock, 653—Water-hemlock, 657—Hemlock Dropwort, - 658—Fool’s Parsley, 661 653 - - CHAP. XXXV. Monkshood, 662—Black Hellebore, 670 662 - - CHAP. XXXVI. Squill, 671—White Hellebore and Cevadilla, - 672—Meadow-Saffron, 674—Foxglove, 678—Rue, - 681—Ipecacuan, 682 671 - - CHAP. XXXVII. Strychnia, 683—Nux Vomica, 686—St. Ignatius’ - Bean, 691—False Angustura, 692 682 - - CHAP. XXXVIII. Camphor, 694—Cocculus Indicus, 696—Upas Antiar, - 698—Coriaria myrtifolia, 698—Yew, 699 694 - - CHAP. XXXIX. Poisonous Fungi, 700—wholesome and poisonous - kinds, 701—qualities how modified, - 701—poisonous principles of, 704—effects on - man, 704—Poisonous Mosses, 710 700 - - CHAP. XL. Poisonous Grain, 710—Spurred rye, 711—Spurred - maize, 718—rust of wheat, 719—unripe grain, - 719—Darnel-grass, 721—Leguminous seeds, 722 710 - - CHAP. XLI. Alcohol, 725—symptoms in man, 725—morbid - appearances, 731—treatment, 735—ether, - 736—Empyreumatic Oils, 736 725 - - CHAP. XLII. Compound Poisoning 740 - - INDEX 745 - - Description of Plate 755, - 756 - - - - - PART FIRST. - OF GENERAL POISONING. - - -[Illustration] - - - - - CHAPTER I. - ON THE PHYSIOLOGICAL ACTION OF POISONS. - - -I shall discuss this subject by considering first the mode in which -poisons act, and secondly, the causes by which their action is liable to -be modified. - - - SECTION I.—_On the Mode of Action of Poisons._ - -On attending to the effects which follow the application of a poison to -the body, we perceive that they are sometimes confined to the part where -it is applied, and at other times extend to distant organs. Hence the -action of poisons may be naturally considered as _local_ and _remote_. - -The local effects of poisons are of three kinds. Some decompose -chemically or corrode the part to which they are applied. Others, -without immediately injuring its organization, inflame or irritate it. -Others neither corrode nor irritate, but make a peculiar impression on -the sentient extremities of the nerves, unaccompanied by any visible -change of structure. - -We have examples of local _corrosion_ or chemical decomposition in the -effects of the concentrated mineral acids or alkalis on the skin, and in -the effects of strong oxalic acid, lunar caustic, or corrosive sublimate -on the stomach. In all of these instances the part to which the poison -is applied undergoes chemical changes, and the poison itself sometimes -undergoes chemical changes also. Thus oxalic acid dissolves the gelatin -of the animal textures; and in the instance of corrosive sublimate, the -elements of the poison unite with the albumen, fibrin, and other -principles of the tissues. - -Of local _irritation_ and its various consequences we have many -examples, from redness, its slightest, to ulceration and gangrene, its -most severe effect. Thus externally, alcohol reddens the skin; -cantharides irritates the surface of the true skin and causes -vesication; tartar-emetic causes deep-seated inflammation of the true -skin and a pustular eruption; the juice of manchineel[1] spreading -inflammation of the subcutaneous cellular tissue; arsenic inflammation -of all these textures, and also death of the part and subsequent -sloughing. Internally, alcohol reddens the stomach, as it does the -skin,—but more permanently; while other substances, such as the diluted -mineral acids, arsenic, cantharides, euphorbium, and the like, may cause -all the phenomena of inflammation in the stomach and intestines, namely, -extravasation of blood, effusion of lymph, ulcers, gangrene. Many of -these irritants, such as arsenic, are in common speech called -corrosives; but they have not any power of causing chemical -decomposition: if they produce a breach in the texture of an organ, it -is merely through the medium of inflammation and its effects. - -Of _nervous impressions_, without any visible organic change, few well -authenticated and unequivocal instances are known. A good example has -been mentioned by Sir B. Brodie in the effect of monkshood on the lips -when chewed,[2] an effect which I have also often experienced: it causes -a sense of numbness and tingling in the lips and tongue, lasting for -some hours, and quite unconnected with any affection of the general -nervous system. Another instance, first mentioned to me by M. Robiquet, -and which I have verified, occurs in the effects of the strong -hydrocyanic acid: when this acid is confined in a glass tube with a -finger on its open end, the point of the finger becomes benumbed, -exactly as from the local action of great cold. These are undoubted -instances of a purely nervous local impression on the external surface -of the body. The most unequivocal instance I know of a similar -impression on internal parts is a fact related by Dr. W. Philip with -regard to opium.[3] When this poison was applied to the inner coat of -the intestines of a rabbit during life, the muscular contractions of the -gut were immediately paralyzed, without the general system being for -some time affected. The same effect has been observed by Messrs. Morgan -and Addison to follow the application of ticunas to the intestine:[4] an -instant and complete suspension of the peristaltic movement took place -as soon as it touched the gut. A parallel fact has also been described -by Dr. Monro, _secundus_:[5] when an infusion of opium was injected -between the skin and muscles of the leg of a frog, that leg soon became -palsied, while the animal was able to leap briskly on the other three. -Analogous results have farther been obtained with the prussic acid by M. -Coullon.[6] He remarked, that when one hind-leg of a frog was plunged in -the acid, it became palsied in thirty-five minutes, while the other -hind-leg continued perfectly sensible and irritable. Acetate of lead -probably possesses the same property. - -These facts are important, because some physiologists have doubted -whether any local impressions of a purely nervous nature, unconnected -with appreciable organic change, may arise from the action of poisons. -Yet the existence of impressions of the kind is essential to the -stability of the doctrine of the sympathetic operation of poisons,—that -is, of the transmission of their influence from organ to organ along the -nerves. Nay, in the instance of many poisons supposed to act in that -manner, we must still farther believe in the existence of primary -nervous impressions, which are not only unconnected with organic change, -but likewise undistinguishable by any local sign whatsoever. - -Of the three varieties in the local effects of poisons—corrosion, -irritation, and nervous impressions,—the first two may take place in any -tissue or organ; for example, they have been observed on the skin, on -the mucous membrane of the stomach, intestines, windpipe, air tubes, -bladder, and vagina, in the cellular tissue, in the serous membranes of -the chest and abdomen, in the muscular fibre. We are not so well -acquainted with the nature of local nervous impressions on different -tissues; but it is probable that in some textures of the body they are -very indistinct. - -So much for the local effects of poisons. - -On tracing the phenomena which follow more remotely, we observe that the -affected part sometimes recovers without any visible change, sometimes -undergoes the usual processes consequent on inflammation, sometimes -perishes at once and is thrown off; and if the organ is one whose -function is necessary to life, death may gradually ensue, in consequence -of that function being irrecoverably injured. The purest example of the -last train of phenomena is to be seen in the occasional effects of the -mineral acids or alkalis: death may take place simply from starvation, -because the inner surface of the stomach and intestines is so much -injured that a sufficient quantity of nutriment cannot be assimilated. - -But death and its antecedents can seldom be accounted for in this way. -For symptoms are often witnessed, which bear no direct relation to the -local injury: death is generally too rapid to have arisen from the -function of the part having been annihilated: and the rapidity of the -poisoning is not proportional in different cases to the local injury -produced. Even the mineral acids and alkalis seldom kill by impeding or -annihilating digestion, because they often prove fatal in a few hours; -and among other poisons there are few which ever cause death simply by -disturbing the function of the part primarily acted on. Death and the -symptoms preceding it arise from an injury of some other organ, to which -they are not and cannot be directly applied. We are thus led to consider -their remote action. - -The term _remote_ is here used in preference to the common phrase -_general_ action, because the latter implies an action on the general -system or whole body; whereas it appears that an action of such a kind -is rare, and that most poisons which have an indirect action exert it on -one or more of the important organs only, and not on the general system. - -There is not a better instance of the remote action of poisons than -oxalic acid. It has been already mentioned that concentrated oxalic acid -is a corrosive: yet it never kills by destroying the function of the -stomach. Man, as well as the lower animals, will live several days or -weeks without nutriment. Now this poison has been known to kill a man in -ten minutes, and a dog in three minutes only. Neither does it always -induce, when swallowed, symptoms of an injury of the stomach; for death -is often preceded by tetanus, or apoplexy, or mortal faintness. Nor is -the violence of the poisoning proportional to the extent of the local -injury: in fact, death is most rapid under circumstances in which the -stomach is least injured, namely, when the acid is considerably -diluted.[7] - -Let us now proceed to enquire, then, in what way the influence of a -poison is conveyed from one organ to another. - -Here it will at once be perceived that the conveyance can be -accomplished in one of two ways only. Either the local impression passes -along the nerves to the organ secondarily affected; or the poison enters -the bibulous vessels, mingles with the blood, and passes through the -medium of the circulation. In the former way poisons are said to act -through _sympathy_, in the latter, through _absorption_. - -1. _On the Action of Poisons through Sympathy._ In the infancy of -toxicology all poisons were believed to act through sympathy. Since -Magendie’s discoveries on venous absorption in 1809, the favourite -doctrine has on the other hand been, that most, if not all, act through -the medium of the blood. And a recent theory, combining both views, -represents that, although many poisons do enter the blood, the operation -even of these nevertheless consists of an impression made on the -sentient extremities of the nerves of the blood-vessels and conveyed -thence along their filaments to the brain or other organs. - -The nerves certainly possess the power of conveying from one organ to -another various impressions besides those of the external senses. This -is shown by many familiar phenomena; and in reference to the present -subject, is aptly illustrated by the remote or sympathetic effects of -mere mechanical injury and natural disease of the stomach. Acute -inflammation of the stomach generally proves fatal long before death can -arise from digestion being stopped; and it is accompanied with -constitutional symptoms, neither attributable to injury of that -function, nor developed in so marked a degree during inflammation in -other organs. These symptoms and the rapid death which succeeds them are -vaguely imputed to the general system sympathizing with the affected -part; but it is more probable that one organ only is thus, at least in -the first instance, acted on sympathetically, namely, the heart. The -effects of mechanical injuries are still more in point. Wounds of the -stomach may prove fatal before inflammation can begin; rupture from -over-distension may cause instant death; and in either case without -material hemorrhage. - -These observations being held in view, it is impossible to doubt, that -some organs sympathize with certain impressions made on others at a -distance; nor can we imagine any other mode of conveyance for these -impressions except along the nerves. The question, then, comes to be -what are the impressions that may be so transmitted? - -The statements already made will prepare us to expect a sympathetic -action in the case of poisons that manifestly injure the structure of -the organ to which they are applied. In the instance of the pure -corrosives its existence may be presumed from the identity of the -phenomena of their remote action with those of natural disease or -mechanical injury. It was stated above that the mineral acids when -swallowed often prove fatal in a very short space of time; and here, as -in mere injury from disease or violence, the symptoms are an -imperceptible pulse, fainting, and mortal weakness. Remote organs -therefore must be injured; and from the identity of the phenomena with -those of idiopathic affections of the stomach, even if there were no -other proof, it might be presumed that the primary impression is -conveyed along the nerves. We are not restricted, however, to such an -argument: The presumptive inference is turned to certainty by the effect -of dilution on the activity of these poisons. Dilution materially -lessens or even takes away altogether the remote action of the mineral -acids. Now dilution facilitates, instead of impeding their absorption: -consequently they do not act on remote organs through that channel. -There is no other way left by which we can conceive them to act, except -by conveyance of the local impression along the nerves.—As to the -irritants that are not corrosive, it can hardly be doubted, since they -inflame the stomach, that the usual remote effects of inflammation will -ensue, namely, a sympathetic injury of distant organs. - -But it remains to be considered, whether distant organs may sympathize -also with the peculiar local impressions called nervous,—which are not -accompanied by any visible derangement of structure. This variety of -action by sympathy is the one which has chiefly engaged the attention of -toxicologists; and it has been freely resorted to for explaining the -effects of many poisons. Nevertheless its existence is doubtful. - -The only important arguments in support of the sympathetic action of -poisons are, that unequivocal instances exist of local nervous -impressions being conveyed to a limited extent along the nerves,—and -that the rapidity of the effects of some poisons is so great as to be -incompatible with any other medium of action except the nervous system. - -In the first place it is maintained, that a limited nervous -transmission, that is, the conveyance of a local impression, purely -functional in its nature, to parts at a short distance from the texture -acted on directly, must occur in some instances,—as, for example, in the -action of belladonna in dilating the pupil when applied to the -conjunctiva of the eye, and in the effect of opium in allaying -deep-seated pain when applied to the integuments over the affected part. -It is by no means clear, however, that nervous transmission is in such -circumstances the only possible medium of action; and that the phenomena -may not as well be owing to the agent being conveyed in substance, by -imbibition or absorption, to the parts ultimately acted on. It is not -unworthy of remark too, that in the case of hydrocyanic acid,—a poison, -which, more perhaps than any other, has been held to act by sympathy, -and which produces on the integuments a direct local impression of a -peculiar and unequivocal kind,—there is positive evidence of the direct -impression not being conveyed along the nerves, even to the most limited -distance; for I have not been able to observe the slightest effect -beyond the abrupt line on the skin which defines the spot with which the -acid had been in contact. - -Secondly, it is thought that certain poisons, such as hydrocyanic acid, -strychnia, alcohol, conia, and some others, produce their remote effects -with a velocity, which is incompatible with any conceivable mode of -action except the transmission of a primary local impulse along the -nerves, and more especially incompatible with the poison having followed -the circuitous route of the circulation to the organs which are affected -by it remotely. Thus in regard to the hydrocyanic acid, Sir B. Brodie -has stated,[8] that a drop of the essential oil of bitter almonds, which -owes its power to this acid, caused convulsions instantly when applied -to the tongue of a cat; and that happening once to taste it himself, he -had scarcely applied it to his tongue, when he felt a sudden momentary -feebleness of his limbs, so that he could scarcely stand. Magendie,[9] -speaking of the pure hydrocyanic acid, compares it in point of swiftness -of action to the cannon ball or thunderbolt. In the course of certain -experiments made not long ago with the diluted acid by Dr. Freer, Mr. -Macaulay and others,[10] to decide the true rapidity of this poison, -several dogs were brought under its influence in ten, eight, five, and -even three seconds; during an experimental inquiry I afterwards -undertook for the same purpose,[11] I remarked on one occasion that a -rabbit was killed outright in four seconds; and Mr. Taylor has more -recently stated, that he has seen the effects induced so quickly in -cats, that there was no sensible interval of time between the -application of the poison to the tongue and the first signs of -poisoning.[12] Strychnia, the active principle of nux-vomica, acts -sometimes with a speed little inferior to that of hydrocyanic acid; for -Pelletier and Caventou have seen its effects begin in fifteen -seconds.[13] Alcohol, according to Sir B. Brodie,[14] also acts on -animals with equal celerity; for when he introduced it into the stomach -of a rabbit, its effects began when the injection was hardly completed. -Conia, the active principle of hemlock, is not less prompt in its -operation: when it was injected in the form of muriate into the femoral -vein of a dog, I was unable, with my watch in my hand, to observe an -appreciable interval between the moment it was injected and that in -which the animal died;[15] certainly the interval did not exceed three -or at most four seconds. - -Facts such as these have been long held adequate to prove that some -poisons must act on remote organs by sympathy or transmission of a local -impulse along the nerves; and in the last edition of this work they were -acknowledged to warrant such a conclusion. It was thought difficult to -account for the phenomena on the supposition that the poison was -conveyed in substance with the blood to the organ remotely affected by -it; for it appeared impossible that, in so short a space of time as -elapsed in some of the instances now referred to, the poison could enter -the veins of the texture to which it was applied, pass into the right -side of the heart, follow the circle of the pulmonary circulation into -the left side of the heart, and thence be transmitted by the arterial -system to the capillaries of the organ ultimately affected. But the -progress of physiological discovery has lately brought the soundness of -these views into question. Some years ago Dr. Hering of Stuttgardt -showed that the round of the circulation may be accomplished by the -blood much more speedily than had been conceived before; for the -ferro-cyanide of potassium, injected into the jugular vein of a horse, -was discovered by him throughout the venous system at large in the short -space of twenty or thirty seconds, and consequently must have passed in -that period throughout the whole double circle of the pulmonary and -systemic circulation.[16] This discovery at once shook the validity of -many, though not all, of the facts which had been previously referred to -the agency of nervous transmission on the ground of the celerity with -which the effects of poisons are manifested. More recently an attempt -has been made by Mr. Blake to prove, that the circulation is so rapid as -to admit even of the swiftest cases of poisoning being referred to the -agency of absorption. Mr. Blake, who is altogether opposed to the -occurrence of nervous transmission in the instance of any poison, has -found that ammonia, injected into the jugular vein of a dog, was -indicated in its breath in four seconds; and that chloride of barium or -nitrate of baryta, introduced into the same vessel, could be detected in -the blood of the carotid artery in about sixteen seconds in the horse, -in less than seven seconds in the dog, in six seconds in the fowl, and -in four seconds in the rabbit.[17] These interesting discoveries, -however, will not absolutely destroy the conclusiveness of all the facts -quoted above in support of the existence of a sympathetic action. For -example they do not shake the validity of those observations, in which -it appeared that an interval inappreciable, or barely appreciable, -elapsed between the application and action of hydrocyanic acid and of -conia. Mr. Blake indeed denies the accuracy of these observations, -insisting that, in those he made himself with the most potent poisons, -he never failed to witness, before the poison began to act, an interval -considerably longer than what had been observed by others, and longer -also than what he had found sufficient for the blood to complete the -round of the circulation; that, for example, the wourali poison injected -into the femoral or jugular vein did not begin to act for twenty -seconds, conia and tobacco for fifteen seconds, and extract of nux -vomica for twelve seconds; and that hydrocyanic acid dropped on the -tongue did not act for eleven seconds if the animal was allowed to -inhale its vapour, and not for sixteen seconds, if direct access to the -lungs was prevented by making the animal breathe through a tube in the -windpipe. But Mr. Blake cannot rid himself thus summarily of the -positive facts which stand in his way. Duly weighed, the balance of -testimony is in favour of those whose accuracy he impugns. For in the -first place, they had not, like him, a theory to build up with their -results, but were observing, most of them at least, the simple fact of -the celerity of action. Then, their result is an affirmation or positive -statement, and his merely a negative one: They may perfectly well have -observed what he was not so fortunate as to witness. And lastly, it is -not unreasonable to claim for Sir B. Brodie, Dr. Freer, Mr. Macaulay, -and Mr. Taylor, all of them practitioners of experience, the faculty of -noting time as accurately as Mr. Blake himself. As for my own -observations, I feel confident they could not have been made more -carefully, and that I had at the moment no preconceived views which the -results upheld, but, if anything, rather the reverse. - -It is impossible therefore to concede, that Mr. Blake’s inquiries, -merely because they are at variance with prior results, apparently not -less precise and exact than his own, put an end to the argument which -has been drawn, in favour of the existence of a sympathetic action, from -the extreme swiftness of the operation of some poisons. At the same -time, on a dispassionate view of the whole investigation, it must be -granted to be doubtful, whether this argument can be now appealed to in -its present shape with the confidence which is desirable. And on the -whole, the velocity of the circulation on the one hand, and the celerity -of the action of certain poisons on the other, are both of them so very -great, and the comparative observation of the time occupied by the two -phenomena respectively becomes in consequence so difficult and -precarious, that it seems unsafe to found upon such an inquiry a -confident deduction on either side of so important a physiological -question as the existence or non-existence of an action of poisons by -sympathy. - -In concluding these statements it is necessary to notice certain -positive arguments which have been brought against the doctrine of -nervous transmission. - -It is alleged to be contrary to nature’s rule to adopt two ways of -attaining the same end; and therefore, that, since many poisons -undoubtedly act through absorption, it is unphilosophical to hold that -others act by sympathy. There seems no sound reason, however, for thus -imposing arbitrary limits on the functional powers conferred by nature -on the organs of the animal body. And besides, the presumption thus -derived is counterbalanced by the equally plausible supposition, -that,—since nature has clearly established an action on remote organs -through the medium of the nerves in the case of poisons which cause -destruction or inflammation of the tissues to which they are -applied,—the same medium of action may also exist in the instance of -poisons which produce merely a peculiar nervous impression where they -are applied. - -But it is farther alleged, that poisons of the most energetic action -have no effect, when they are applied to a part, the connection of which -with the general system is maintained by nerves only. It is true that -poisons seem to have no effect whatever when the circulation of the part -to which they are applied has been arrested, or when every connecting -tissue has been severed except the nerves. Thus Emmert found that the -wourali poison does not act on an animal when introduced into a limb -connected with the body by nerves alone.[18] And I have ascertained that -in the same circumstances no effect is produced on the dog by pure -hydrocyanic acid dropped into the cellular tissue of the paw. But it -cannot be inferred absolutely from these facts, that the wourali poison -and hydrocyanic acid do not act through sympathy; because it has been -urged that the integrity of the functions of the sentient extremities of -the nerves, more especially their capability of receiving those nervous -impressions which are held to be communicated backwards along their -course, may be interrupted by arresting the circulation of the part. -Still, as the function of sensation is maintained for some time in a -severed limb connected with the trunk by nerves only, there is a -probability, that all other functions of the nerves must be retained for -a time also. And the presumption thus arising is strengthened by an -imperfect experiment performed by Mr. Blake, which tends to show, -although it does not absolutely prove, that a poison, introduced into -the severed limb whose nervous connection with the trunk is entire, will -not act, even if the blood be allowed to enter the limb by its artery -and to escape from a wound in its vein, so that local circulation is in -some measure maintained, without the blood returning to the trunk and -general system.[19] - -On considering impartially all the facts that have been adduced in this -inquiry, an impression must be felt that the doctrine of the sympathetic -action of those poisons which produce merely a nervous local impression -is insecurely founded. But an _experimentum crucis_ is still wanted to -decide the question. - -2. _Of the Action of Poisons through Absorption._—If doubts may be -entertained whether poisons ever act by the transmission of local -impulses, from the part to which they are applied, along the nerves to -the organ upon which they act, no reasonable doubt can be entertained -that many poisons act through the medium of absorption into the blood. - -Poisons are believed to act through the blood for the following reasons. -First, they disappear during life from the shut cavities or other -situations into which they have been introduced; that is, they are -absorbed. Several clear examples to this effect have been related by Dr. -Coindet and myself in our paper on oxalic acid. In one experiment four -ounces of a solution of oxalic acid were injected into the peritoneal -sac of a cat, and killed it in fourteen minutes; yet, on opening the -animal, although none of the fluid had escaped by the wound, we found -scarcely a drachm remaining.[20] In recent times Professor Orfila has -proved that various poisons, such as arsenic, tartar-emetic, and acetate -of lead, disappear in part or wholly from wounds into which they had -been introduced.[21] Next, many poisons act with unimpaired rapidity, -when the nerves supplying the part to which they are applied have been -previously divided, or even when the part is attached to the body by -arteries and veins only. Dr. Monro, _secundus_, proved this in regard to -opium;[22] and the same fact has been since extended by Sir B. Brodie -and Professor Emmert to wourali,[23] by Magendie to nux vomica,[24] by -Coullon to hydrocyanic acid,[25] by Charret to opium,[26] and by Dr. -Coindet and myself to diluted oxalic acid.[27] Magendie’s experiment was -the most precise of all: for, besides the communication with the -poisoned part being kept up by a vein and an artery only, these vessels -were also severed and reconnected by two quills. Farther, many poisons -will not act when they are applied to a part of which the circulation -has been arrested, even although all its other connections with the body -have been left entire. This has been shown distinctly by Emmert in -regard to the hydrocyanic acid; which, when introduced into the hind-leg -of an animal after the abdominal aorta has been tied, produces no effect -till the ligature be removed, but then acts with rapidity.[28] An -experiment of a similar nature performed by Mr. Blake with the wourali -poison yielded the same result.[29] Again, many poisons act with a force -proportional to the absorbing power of the texture with which they are -placed in contact. This is the criterion which has been commonly -resorted to for discovering whether a poison acts through the medium of -the blood. It is applicable, however, only when the poison acts sensibly -in small doses; for those which act but in large doses cannot be applied -in the same space of time over equal surfaces of different textures. The -difference in the absorbing power of the different tissues has been well -ascertained in respect to a few of them only. The most rapid channel of -absorption is by a wound, or by immediate injection into a vein; the -surface of the serous membranes is a less rapid medium, and the mucous -membrane of the alimentary canal is still less rapid. Now it is proved -of many poisons that, when applied in similar circumstances to these -several parts or tissues, their activity is proportional to the order -now laid down. Lastly, it has been proved of nux-vomica, that if the -extract be thrust into the paw of an animal after a ligature has been -tightened round the leg so as to stop the venous, but not the arterial -circulation of the limb, blood drawn from an orifice in a vein between -the wound and the ligature, and transfused into the vein of another -animal, will excite in the latter the usual effects of the poison, so as -even to cause death; while, on the contrary, the animal from which the -blood has been taken will not be affected at all, if a sufficient -quantity be withdrawn before the removal of the ligature. These -interesting facts, which are capable of important practical -applications, were ascertained by M. Vernière.[30] - -On weighing attentively the arguments here brought forward, it seems -impossible to doubt, that some poisons are absorbed into the blood -before they act, and that their entrance into the blood is not a mere -fortuitous antecedent, but a condition essential to their action. - -But it is farther held that poisons which act through absorption, do so -by being conveyed in substance along with the blood to the part where -their action is developed,—that their action eventually depends on the -organ, whose functions are thrown into disorder, becoming impregnated -with poisoned blood. Now, the arguments detailed above do not absolutely -prove this conveyance and impregnation. They show that poisons enter the -blood, and act somehow in consequence of entering it; but they do not -prove in what manner the action subsequently takes place. - -It was at one time indeed supposed that the same facts, which prove -their admission into the blood, proved also their transmission in -substance to the organs acted on by them. But Dr. Addison and Mr. Morgan -have shown that this is not a legitimate conclusion, and that a -different theoretical view may be taken of the facts,—namely, that the -action may really take place by the poison producing on the sentient -extremities of the nerves of the inner membrane of the blood-vessels a -peculiar impression which is conveyed through the nerves to the part -ultimately affected.[31] They have endeavoured to found this theory upon -evidence, that the poison is not carried beyond the venous system; or -that, if conveyed farther, it is carried incidentally, and not for the -purpose of impregnating the textures of the organ which suffers. The -evidence they have brought forward on this head is chiefly the -following. 1. Poisons which act on a particular organ at a distance do -not act more quickly when introduced into the artery which supplies it, -than when introduced into its vein, or even into the principal artery of -a distant part of the body.[32] 2. If a poison be introduced into a -great vein with a provision for preventing its passage towards the -heart, it will act with as great rapidity, as if no obstacle of the kind -existed. Thus, if the jugular vein, secured by two temporary ligatures, -be divided between them and reconnected by a tube containing wourali, -the animal will not be affected more quickly on the removal of both -ligatures, than on removing only the ligature farthest from the -heart.[33] 3. The arterial blood of a poisoned animal is incapable of -affecting another animal. Thus, if the carotid artery and jugular vein -of one dog be divided, and both ends of each reciprocally connected by -tubes with the divided ends of the corresponding vessels of another dog, -and extract of nux-vomica be introduced into a wound in the face of one -of them,—the animal directly poisoned alone perishes, and the other -remains unharmed to the last.[34] - -These are at first view strong arguments against the transmission of -poisons with the blood to the organs remotely acted on; and the facts on -which they are founded are on the other hand easily explained under the -new theory advanced by the authors, that the medium of action is the -nerves which supply the inner membrane of the blood-vessels. But their -inquiries, however ingenious and plausible, have not stood the test of -physiological scrutiny. Their first experimental fact has been -contradicted by Mr. Blake; who has found that the wourali poison, which -does not begin to act for twenty seconds when injected into a vein, will -produce obvious effects in seven seconds only if injected into the aorta -through the axillary artery.[35] The second experiment, showing that -poison confined in a vein will act although prevented by a ligature from -reaching the heart, is held by the opponents of Dr. Addison and Mr. -Morgan to be fallacious, in as much as the blood behind the ligature may -be carried backwards till it meets with an anastomosing vein and is so -carried by a collateral vessel to the heart. To the third experiment it -may be objected, that there was, in the mode in which they conducted it, -no satisfactory evidence that the reciprocal circulation was kept up by -the carotid artery and jugular vein. And this will appear an important -objection to every one practically acquainted with experiments of -transfusion. For on the one hand it is exceedingly difficult, in such -complicated experiments, to prevent coagulation of the blood in one -vessel or another, before the connection of all the arteries and veins -is established; and on the other, it may be urged, as Mr. Blake has -done, that the pressure of the blood in the distal end of the carotid -artery in the animal not directly poisoned may be equal, or even -superior, to the pressure in the proximal end of the same vessel in the -other animal,—so that the blood may not pass from the latter into the -former, although it should continue fluid. - -In opposition to the theory of Dr. Addison and Mr. Morgan, and in -support of the doctrine, that poisons act by being carried in substance -with the blood into the tissues of the remote organs on which they act, -a variety of important experimental evidence has been brought forward -since the publications of the Essay of these gentlemen. In the first -place, the concurrent testimony of a great number of recent chemical -inquirers establishes undeniably, that poisons absorbed into the veins -of the part to which they are applied are to be detected throughout many -of the tissues of distant organs. This fact will be enlarged on and -illustrated presently. Secondly, on the authority of Mr. Blake, and in -contradiction of the experiments of Dr. Addison and Mr. Morgan, it -appears that, as already stated, poisons act more quickly when injected -into the aorta than into the venous system; a fact which is easily -understood, on considering that when injected into the aorta they reach -their destination directly, whereas, if injected into a vein they must -first arrive at the right side of the heart, and then be transmitted -through the circle of the pulmonary circulation before reaching even the -aorta. Thirdly, the relative rapidity with which poisons act on -different animals follows the ratio of the velocity of the circulation -in each. Thus, Mr. Blake found, that in the horse nitrate of baryta is -conveyed by the circulation from the jugular vein to the carotid artery -in sixteen seconds, and that strychnia injected into the jugular vein -begins to act on the nervous system after exactly the same interval: -That in the dog chloride of barium passes from the vein to the artery in -seven seconds, and extract of nux-vomica begins to act as a poison in -twelve seconds: That in the fowl the passage of the blood seems to take -place in six seconds, and the nitrate of strychnia to act in six seconds -and a half: And that in the rabbit the passage of the blood is effected -in four seconds only, and the first signs of the action of strychnia -occur in four seconds and a half.[36] - -On the whole, then, it may be considered as well established, that -probably all, but certainly some, poisons,—of the kind whose topical -action does not consist in causing destruction or inflammation of the -textures to which they are applied,—produce their remote effects solely -by entering the blood, and through its means impregnating the organs -which are acted on at a distance. And farther, if this doctrine be -admitted as established, it may also be allowed, that many poisons which -do cause topically destruction or inflammation, and remotely the usual -sympathetic effects of these changes of structure, also possess the -power of affecting distant organs through the medium of the blood. - -_Of the discovery of Poisons in the Blood._—Such being the case, it -becomes an object of paramount interest, with reference both to the -practice of medical jurisprudence, to inquire whether poisons can be -detected in the circulating fluids, or generally in parts of the body -remote from the place where they are introduced. - -A variety of circumstances long rendered it impossible to determine -satisfactorily the question, whether poisons could be detected in the -blood, the secretions, and the soft textures of the body. In the first -place, we now know that the quantity of the more active poisons, which -is required to occasion death, is so small, that, considering the -crude methods of analysis formerly trusted to, and the obstacles -opposed to the successful application of them by the presence of -organic matter, there can be no wonder that chemists, even but a few -years ago, could not satisfy themselves whether the objects they were -in search of had been detected or not. Then, it was partly known -before, and is now fully established, that various poisons are removed -beyond the reach of analysis before death, in consequence of passing -off with the secretions, particularly the urine. Farther, it seems -probable that, of the poisons which act through absorption, several do -not remain or at least do not accumulate, in the blood; and that they -are not distributed with it throughout the textures indifferently, but -are deposited, as absorption goes on, in particular organs, such as -the liver,—which it was not much the practice to examine in former -investigations. And lastly, some poisons are speedily decomposed on -entering the blood: They either cause obvious changes in the -constitution of the blood, and themselves undergo alteration likewise; -or without the blood becoming appreciably different in its properties -from the healthy state, the poison undergoes a rapid change in the -molecular affinities of its elements, and so disappears. Of the former -course of things distinct illustrations are furnished by nitric oxide -gas and sulphuretted-hydrogen gas when injected into a vein in a -living animal: of the latter an equally unequivocal example occurs in -oxalic acid, which Dr. Coindet and I found to be undiscoverable in the -blood of the vena cava of a dog killed in thirty seconds by the -injection of eight grains and a half of it into the femoral vein. - -But the improvements that have been lately made in the methods of -analysis for the detection of poisons in a state of complex mixture with -organic substances have done away with a great part of the obstacles -which prevented a thorough inquiry as to the existence of poisons in the -blood and textures of the body. Some important researches of this kind -were referred to in the last edition of the present work; and since then -many additional facts, of equal variety and precision, have been -communicated by different observers, but especially by Professor Orfila. -Under the head of each poison an account will be given hereafter of the -evidence in support of the discovery of it by chemical analysis in the -blood, textures, and excretions. In the present place it is sufficient -to state in general terms that the evidence is quite satisfactory in the -instances of iodine, sal-ammoniac, oxalic acid, nitre, sulphuret of -potassium, arsenic, mercury, copper, antimony, tin, silver, zinc, -bismuth, lead, hydrocyanic acid, cyanide of potassium, carbazotic acid, -sulphuretted-hydrogen, camphor, and alcohol. - -_Of the Organs affected by the remote action of Poisons._—Having now -taken a general view of the mode in which poisons act on distant parts, -I shall next consider what organs are thus brought under their -operation. Poisons have been often, but erroneously, said to affect -remotely the general system. A few of them, such as arsenic and mercury, -do indeed appear to affect very many organs of the body. But by much the -larger proportion seem on the contrary to act on one or more organs -only, not on the general system. - -Of the poisons which act remotely through a sympathy of distant parts -with an organic injury of the textures directly acted on, many appear to -act sympathetically on the heart alone. Taking the mineral acids as the -purest examples of poisons that act independently of absorption into the -blood-vessels, it will be seen on inquiry that all the symptoms they -produce, in addition to the direct effects of the local injury, are -those of depressed action of the heart,—great feebleness, fainting, -imperceptible pulse, cold extremities. Even the less prominent of the -secondary symptoms are almost all referrible to a depressed state of the -circulation. In particular, they are not necessarily, and indeed are -seldom actually, blended with any material symptom of disorder in the -brain; which certainly could not be the case if the general or whole -system suffered. - -With respect to that more numerous class, which act remotely either -through the medium of the blood or by the transmission along the nerves -of an undiscernible impression made on their sentient extremities, some -certainly possess a very extended influence over the great organs of the -body; but the greater number are much more limited in their sphere of -action. Some act chiefly by enfeebling or paralyzing the heart, others -principally by obstructing the pulmonary capillaries, others by -obstructing the capillaries of the general system, others by stimulating -or depressing the functions of the brain or of the spinal cord, others -by irritating the alimentary canal, others by stimulating one or another -of the glandular organs, such as the salivary glands, the liver, the -kidneys, or the lymphatic glands. - -Some poisons of this kind act chiefly, if not solely, on the _heart_. -The best examples are infusion of tobacco, and upas antiar. Sir B. -Brodie observed, that when the infusion of tobacco was injected into any -part of the body, it speedily caused great faintness and sinking of the -pulse; and on examining the body instantly after death, he found the -heart distended and paralyzed, not excitable even by galvanism, and its -aortal cavities filled not with black, but with florid blood, while the -voluntary muscles were as irritable as after other kinds of death.[37] -The upas antiar he found to be similarly circumstanced.[38] Arsenic and -oxalic acid are also of this kind. In an animal killed by arsenic, and -in which the gullet and voluntary muscles continued long contractile, -Dr. Campbell found the heart immediately after death containing arterial -blood in its aortal cavities, and insensible to galvanism.[39] Dr. -Coindet and I frequently witnessed the same facts in animals killed with -oxalic acid: When the heart at the moment of death was completely -palsied and deprived of irritability, we saw the intestines moving, and -the voluntary muscles contracting long and vigorously from the mere -contact of the air.[40] - -An interesting series of investigations has been lately made by Mr. -Blake, relative to the influence of poisons on the heart, when they are -directly introduced into the great veins. It does not absolutely follow -that an action on the heart manifested in this way proves the occurrence -of a similar action when the substance is admitted into the body through -more ordinary channels, such as the stomach, intestines or cellular -tissue. For on the one hand, some of the substances used by this -physiologist cannot be admitted into the blood through ordinary channels -in the quantity necessary for developing that action on the heart, which -is excited when they are injected at once into the blood-vessels. And on -the other hand, the results at which he thus arrives are not always in -conformity with what have been obtained by prior observers, who resorted -to the ordinary channels for introducing poisons into the body. It is -possible, therefore, that Mr. Blake’s researches may not have the -extensive bearings, which might at first sight appear, on the physiology -of poisons and remedies. Nevertheless they are in themselves full of -interest. They show that the salts of magnesia, zinc, copper, lime, -strontia, baryta, lead, silver, ammonia, and potash, also oxalic acid, -and digitalis, if injected into the jugular vein, produce a powerful and -permanent depression of the heart’s action; which is evinced by the -hæmadynamometer,[41] indicating diminution of pressure in the great -arteries, by the heart becoming motionless or nearly so before the -breathing ceases, by its muscular structure presenting little or no -irritability when stimulated immediately after death, and by the left -cavities being found full of florid arterial blood.[41] - -Other poisons act on the _lungs_; but probably few, perhaps none, act on -them alone. Magendie found that in poisoning with tartar-emetic the -lungs are commonly inflamed and sometimes even hepatized.[42] Mr. Smith -and M. Orfila both remarked similar signs of pulmonary inflammation in -animals poisoned with corrosive sublimate.[43] But these poisons produce -important effects on other organs likewise. - -A set of novel and important facts setting forth the frequent operation -of poisons on the lungs when they are admitted directly into the blood, -has been recently brought to light by the researches of Mr. Blake. Many -of the poisons mentioned above as acting powerfully on the heart were -found by him not to exert any influence upon the lungs, such as oxalic -acid and the salts of magnesia, lime, zinc, copper, ammonia, potash, and -strychnia. Others, however, such as the salts of strontia, baryta, lead, -and silver, as well as digitalis, all of which powerfully affect the -heart, and, in addition to these, the salts of soda, which have no -action at all on the heart, and hydrocyanic acid, tobacco, and -euphorbium, which influence it feebly, or even dubiously,—produce, when -injected into the jugular vein, obstruction of the capillaries of the -pulmonary circulation, and consequently asphyxia. This is proved by the -hæmadynamometer introduced into a vein indicating great increase of -pressure in the venous circulation a few seconds after the introduction -of the poison; by this instrument introduced into the femoral artery -indicating great diminution of arterial pressure, although the heart -continues to beat vigorously; by the breathing becoming at the same time -laborious, without the heart suffering; by these symptoms preceding any -signs of action on the nervous system; by the heart pulsating for some -time after death; and in many instances by frothy mucus having -accumulated in the air-passages, and congestion and extravasation having -taken place in the lungs themselves.[44] - -A great number of the poisons whose action is remote, operate on the -_brain_. The most decided proof of such an action is the nature of the -symptoms; which are, giddiness, delirium, insensibility, convulsions, -palsy, coma. Some physiologists have also sought for evidence in the -body after death, and have imagined they found it in congestion of the -vessels in the brain, and even extravasation of blood there; but it will -be seen under the head of Narcotic Poisons that such appearances are far -from being essential, and indeed are seldom witnessed. All narcotic -poisons act on the brain, and most narcotico-acrids too; but very -frequently other organs are affected at the same time, and in particular -the spine and heart. - -The influence of poisons on the brain seems to be sometimes induced, not -immediately, but indirectly through the intervention of a more direct -influence on the pulmonary circulation. Thus Mr. Blake appears to have -succeeded in proving that the insensibility and tetanic convulsions -which immediately precede death, when certain substances, such as the -salts of soda, are injected into the veins, depend simply on the -obstruction directly produced in the pulmonary circulation causing -increased pressure in the systemic veins, and consequently upon the -brain and nervous centre generally. For when the jugular vein was opened -after the development of tetanic convulsions, and blood was allowed to -flow out, the nervous symptoms ceased, and the animal continued for two -hours sensible and without any return of convulsions, dying eventually -of hemorrhage.[45] But more generally the effect produced on the brain -is direct and specific. Thus opium and its active principle morphia -suspend the functions of external relation, which are peculiarly -dependent on the brain; while for a long time the respiration and -circulation are little affected. Even when the poison is admitted -directly into the veins, the pulmonary capillaries are not obstructed, -and the heart is only somewhat enfeebled in its contractions;[46] and in -ordinary cases of poisoning with these substances the heart continues to -pulsate, and the lungs also discharge their office, long after -sensibility is extinguished and voluntary motion arrested,—until at -length the circulation and respiration become affected consecutively by -the depressed state of the nervous system. - -Some poisons act specifically on the _spinal cord_. Those which are best -known to possess such an action are nux-vomica, the other species of -plants which, like it, contain strychnia, and also conia and the wourali -poison. The tribe of poisons of which nux-vomica may be taken as the -type excite violent fits of tetanus, during the intervals of which the -mind and external senses are quite entire; and death takes place during -a paroxysm, apparently from suffocation caused by spasmodic fixing of -the chest. Their action on the spine is quite independent of any action -on the brain; if indeed such action exist at all. For when the spinal -cord is separated from the brain by dividing the medulla oblongata, the -effects on the muscles supplied by the spinal cord are produced as -usual.[47] Conia, the active principle of hemlock, according to my own -researches, produces in the lower animals, howsoever introduced, -gradually increasing paralysis, without insensibility or delirium, and -without the circulation or respiration being for some time affected, -till at length death takes place from stoppage of the breathing by palsy -of the respiratory muscles; and after death the heart continues beating -vigorously, the muscles contract when irritated, and arterialization of -the blood in the lungs may be kept up long by maintaining artificial -respiration. In this instance it would appear, that the first effect is -arrestment of the functions of the spinal cord; that the paralysis does -not depend upon a direct action on the muscles; and that neither the -brain, heart, nor lungs can be influenced, except secondarily through -the consequences of general muscular paralysis.[48] Many poisons which -act on the brain also act on the spinal cord. - -Other poisons apparently possess the singular property of impeding or -arresting the _general capillary circulation_, and produce their -tangible effects more or less through the medium of this operation. Such -at least are the inferences which seem to flow from the researches of -Mr. Blake; who found that many substances, soon after they are injected -backwards by the axillary artery into the aorta, produce increased -pressure in the arterial system indicated by the hæmadynamometer during -life, and frequently congestion of the membranous textures as observed -after death. Some substances have no effect of this kind. Others act on -the general capillaries in concurrence with a similar action on the -capillaries of the pulmonary circulation, such as the salts of strontia, -baryta, lead, silver, and soda, euphorbium, tobacco and digitalis. But a -few, such as potash and ammonia, with their salts, seem to influence the -capillaries of the general circulation only.[49] These are important -conclusions, if legitimate; but it cannot be denied, that the facts on -which they are based must be very difficult to isolate and observe with -accuracy and without bias. - -The organs not immediately necessary to life may be likewise all acted -on by poisons indirectly. On this subject details are not called for at -present. It may be sufficient to remark that there is hardly a -considerable organ in the body, except perhaps the spleen and pancreas, -which is not acted on by one poison or another. Arsenic inflames the -alimentary mucous membrane, mercury the salivary organs and mouth, -cantharides the urinary organs, chromate of potass the conjunctiva of -the eyes, manganese the liver; iodine acts on the lymphatic glands; lead -on the muscles; and spurred rye causes gangrene of the limbs. - -Some poisons, as was already mentioned, may act on one important organ -only, every other being left undisturbed: thus nux-vomica in general -acts only on the spine. But much more commonly they act on several -organs at once; and the action of some of them is complicated in an -extreme degree. I may instance oxalic acid and arsenic. Oxalic acid when -swallowed irritates and inflames the stomach directly, and acts -indirectly on the brain, the spine, and the heart. A large dose causes -sudden death by paralyzing the heart; if the dose is somewhat less, the -leading symptom is violent tetanic spasm, indicating an action on the -spine, and death takes place during a paroxysm, the heart continuing to -contract for some time after; if the dose is still less, the spasms, at -first distinct, become by degrees fainter and fainter, while the -sensibility in the intervals, at first unimpaired, becomes gradually -clouded, till at length pure coma is formed without convulsions,—thus -indicating an action on the brain. As for arsenic, coupling together the -symptoms during life and the appearances in the dead body, it will be -seen afterwards to have the power of acting on the brain, heart, and -lungs,—the throat, gullet, stomach, and intestines,—the lining membrane -of the nostrils and eyelids,—the kidneys, bladder, and vagina; and, what -is remarkable, proofs of an action on all these parts may be witnessed -in the course of a single case. The effects of mercury are hardly less -multifarious. - - - SECTION II.—_On the Causes which modify the Actions of Poisons._ - -By a variety of causes the action of poisons may be modified both in -degree and in kind. The most important of them are—quantity; state of -aggregation; state of chemical combination; mixture; difference in -tissue; difference in organ; habit; idiosyncrasy; and lastly, certain -states of disease. - -1. _Quantity_ affects their action materially. Not only do they produce -their effects more rapidly in large doses; it is sometimes even quite -altered in kind. A striking example has just been related in the case of -oxalic acid; which, according to the dose, may corrode the stomach, or -act on the heart, or on the spine, or on the brain. In like manner -arsenic in a small dose may cause gastritis of several days’ duration; -while a large dose may prove fatal in two or three hours by affecting -the action of the heart. White hellebore in small doses excites -inflammation in the stomach and bowels, in larger doses giddiness, -convulsions, coma; and in either way it may prove fatal. - -2. _As to state of aggregation_,—poisons act the more energetically the -more minutely they are divided, and hence most energetically when in -solution. Some which are very energetic in the fluid state, hardly act -at all when undissolved. Morphia, the alkaloid of opium, may be given in -powder to a dog without injury in a dose, which, if dissolved in oil or -alcohol, would soon kill several. Previously dissolving poisons favours -their action in two ways,—by diffusing them quickly over a large -surface, and by fitting them for entering the bibulous vessels. Poisons, -before being absorbed, must be dissolved; and hence, those which act -though solid and insoluble in water, must, as a preliminary step, be -dissolved by the animal fluids at the mouths of the vessels. In this way -the poisonous effects of carbonate of baryta and arsenite of copper are -explained; for though insoluble in water, they are soluble in the juices -of the stomach. - -Differences in aggregation, like differences in quantity, may affect the -kind as well as the degree of action. Camphor in fragments commonly -causes inflammation of the stomach; dissolved in spirit or olive oil, it -causes delirium or tetanus and coma. - -The reduction of certain poisons to the state of vapour serves the same -end as dissolving them. When poisons are to be introduced by the skin, -no previous operation is more effectual than that of converting them -into vapour. - -3. The next modifying cause is _chemical combination_. This is sometimes -nothing more than a variety of the last. If a poison, in combining with -another substance, acquire greater solubility, it also generally -acquires greater activity, and _vice versa_: Morphia, itself almost -inert, because insoluble, becomes active by uniting with acids, for they -render it very soluble: Baryta as a very active poison, becomes quite -inert by uniting with sulphuric acid, for the sulphate of baryta is -altogether insoluble. - -In regard to the influence of chemical combination two general laws may -be laid down. One is, that _poisons which only act locally, have their -action much impaired or even neutralized, in their chemical -combinations_. Sulphuric acid and muriatic acid on the one hand, and the -two fixed alkalis on the other, possess a violent local action; but if -they are united so as to form sulphates or muriates, although still very -soluble, they become merely gentle laxatives. But the case is altered if -either of the combining poisons also act by entering the blood. For the -second general law is, that _the action of poisons which operate by -entering the blood, although it may be somewhat lessened, cannot be -destroyed or altered in their chemical combinations_. Morphia acts like -opium if dissolved in alcohol or fixed oil; if an acid be substituted as -the solvent, a salt is formed which is endowed with the same properties: -The sulphate, muriate, nitrate, acetate of morphia all act like opium. -Strychnia, arsenic, hydrocyanic acid, oxalic acid, and many more come -under the same denomination: Each produces its peculiar effects, with -whatever substance it is combined, provided it do not become insoluble. - -Mr. Blake has recently laid down what may be considered a branch or -corollary of the second of these general propositions, and has confirmed -it by many appropriate experimental facts,—namely, that _the salts of -the same base produce the same actions, independently of the acids with -which they are combined_.[50] The law, however, is a more general one, -as given above, and was stated in former editions of the present work. -It applies not only to bases, but likewise to acids, such as the -hydrocyanic, oxalic, arsenious, and arsenic acids, and also to neutral -organic principles which act through the blood, such as picrotoxin, -colocynthin, elaterin, and narcotin. - -The same author considers it to be also a probable conclusion from a -variety of experiments on the salts of various bases, that _those salts -which are isomorphous, or possess the same crystalline form, are closely -allied in action_.[51] - -4. The effect of _mixture_ depends partly on the poisons being diluted. -Dilution, by prolonging the time necessary for their being absorbed, -commonly lessens their activity; yet not always; for if a poison which -acts through the blood is also a powerful irritant, moderate dilution -will enable it to enter the vessels more easily: a small dose of -concentrated oxalic acid acts feebly as an irritant or corrosive; -moderately diluted, it quickly enters the blood and causes speedy -death.[52] The effect of mixture may depend also in part on the mere -mechanical impediment interposed between the poison and the animal -membranes. This is particularly obvious when the mass containing the -poison is solid or pulpy; for then the first portions of the poison that -touch the membrane may cause an effort of the organ to discharge the -rest beyond the sphere of action,—if, for example, it is the stomach,—by -vomiting. The effect of mixture in interposing a mechanical impediment -is also well illustrated where the substance mixed with the poison is a -fine, insoluble powder, capable of enveloping its several particles. -Thus it is that small, yet poisonous doses of arsenic may be swallowed -and retained with impunity, if mixed with finely powdered charcoal, -magnesia, and probably cinchona-bark, or the like. Besides diluting and -mechanically obstructing their application, the admixture of other -substances may alter the chemical nature of poisons, and so change their -action. - -It is important to keep in view, that the influence of mixture may be -exerted in consequence of the cavity into which a poison is introduced -being at the time filled with contents. Some of the most powerful and -unerring poisons may in such circumstances altogether fail to produce -their usual effect, if speedily vomited. Thus Wibmer notices the case of -a man, who swallowed an ounce and a half of arsenic after a very hearty -meal, had merely a severe attack of vomiting with subsequent colic, and -got quite well in four days.[53] And a still more pointed instance has -been briefly mentioned by Dr. Booth of Birmingham, where an ounce of -corrosive sublimate was swallowed after a full meal without any material -ill consequence, vomiting having been speedily induced.[54] - -5. _Difference of tissue_ is an interesting modifying power in a -physiological point of view, but does not bear so directly on -medico-legal practice as the rest, and may therefore be passed over -cursorily. - -On the corrosives and irritants a difference of tissue acts but -indirectly: their effects vary not so much with the tissue as with the -organ of which it forms part. But as to poisons which act through the -blood, their energy must evidently depend on the activity of absorption -in each texture. - -The cutaneous absorption is slow, on account of the obstacle presented -by the cuticle, and by the intricate capillaries of the true skin. -Accordingly many active poisons are quite inert when applied to the -unbroken skin, or even to the skin deprived of the cuticle. Hydrocyanic -acid, perhaps the most subtle of all poisons, was found by Coullon to -have no effect when dropped on the skin of a dog.[55] Some authors have -even gone so far as to deny that poisons can be absorbed at all through -the skin, unless they are pressed by friction through the cuticle. But -this is an error; most gaseous poisons, such as carbonic acid and -sulphuretted hydrogen, and some solid poisons when volatilized, such as -the vapours of cinnabar, will act though simply placed in contact with -the skin; and there is distinct evidence that corrosive sublimate will -bring on mercurial action in the form of a warm bath, or when used as a -liniment. - -On the mucous membrane of the stomach and intestines, poisons act much -more energetically than on the skin; which clearly depends in a great -measure on the superior rapidity of absorption there,—or, according to -some, on the facility with which poisons come in contact with the -sentient extremities of nerves. - -The serous membranes possess an activity of absorption which hardly any -other unbroken texture can equal. Accordingly many poisons act much more -rapidly through the peritonæum than through the stomach. When oxalic -acid is introduced under the same collateral circumstances into the -stomach of one dog and the peritonæum of another, the dose may be so -apportioned, that the same quantity, which does not prove fatal to the -former, kills the latter in fourteen minutes.[56] - -While the preceding modes in which poisons enter the blood are indirect, -they may be introduced directly by a wound in the vein. There is no way -in which poisons, that act through the blood, prove more rapidly fatal. -Some which act very slowly through the stomach cause instant death when -injected into a vein. A peculiar variety of this mode of introducing -poisons deserves to be distinguished, namely, the application of them to -a wound. If the surface bleeds freely, they may not act at all, because -they are washed away. But if they adhere, they soon enter the divided -veins. Hence, if they act in small doses, this mode of applying them is -hardly less direct than if they were at once injected into a vein. - -So far the effect of difference in tissue has been determined. Poisons -that act through the blood act least energetically on the skin, more -actively on the alimentary mucous membrane, still more so on serous -membranes, and most powerfully of all when introduced directly into a -vessel. There are other textures, however, which merit notice, although -their place in the scale of activity has not been exactly settled. - -On the mucous membrane of the pulmonary air-cells and tubes, poisons act -with a rapidity which is scarcely surpassed by their direct introduction -into a vein. This is plainly owing to the exceeding delicacy and wide -surface of the membrane. Hence three or four inspirations of carbonic -oxide gas will cause instant coma. A single inspiration of the noxious -gas of privies has caused instant extinction of sense and motion. Nay, -liquid poisons have been known to act through the same channel with -almost equal swiftness. For M. Ségalas found that a solution of extract -of nux-vomica caused death in a few seconds when injected in sufficient -quantity into the windpipe; and that half a grain will thus kill a dog -in two minutes, while two grains will rarely prove fatal when injected -into the stomach, peritonæum, or chest.[57] - -As to the nervous tissue, it is a fact worthy of mention, that the -poisons which appear to act on the sentient extremities of the nerves, -do not act at all on the cut surface of the brain and nerves, or upon -any part of the course of the latter. This has been proved with respect -to most active narcotics. - -The power of the cellular tissue as a medium of absorption, has not -been, and cannot easily be, ascertained. On the one hand it is difficult -to apply poisons to it, without also applying them to the mouths of -divided vessels; and, on the other hand, it is difficult to make a set -of experiments for comparison with others on the stomach, pleura, or -peritonæum, as the cellular tissue does not form an expanded cavity, and -consequently, the extent of surface to which a poison is applied cannot -be made the same in each experiment of a series. It is a ready medium, -however, for admitting poisons into the blood, especially if an -artificial cavity be made where the tissue is loose, as, for example, by -separating the skin from the muscles of the back with the finger -introduced through a small incision in the integuments. - -The variations caused by difference of tissue in the activity of poisons -have been viewed in the previous remarks as depending chiefly on the -relative quickness with which absorption goes on. But in this way it is -impossible to explain the whole amount of the differences sometimes -observed. Some poisons cause death when applied to a wound in the -minutest quantity, but are quite harmless when swallowed in large doses: -Others are diminished a little in activity, but still remain powerful -and fatal poisons. There is not much difference in the power of arsenic -when it is applied to different textures, the skin excepted. But oxalic -acid injected into the peritonæum will act eight or ten times more -rapidly than when swallowed and the poison of the viper may prove fatal -to a man through a wound in almost invisible doses, while the whole -poison of six vipers may be swallowed by so small a creature as a -blackbird, with complete impunity.[58] Differences in the absorbing -power of the tissues cannot explain these facts. - -The only rational way of accounting for them is by supposing that a part -of the poison is decomposed,—the change being greatest where absorption -is slowest and the power of assimilation strongest, namely, in the -stomach,—and least where absorption is quickest and assimilation almost -wanting, namely, in a wound. This explanation derives support from the -different effects of change of tissue on poisons of the different -kingdoms. Mineral poisons are least, and animal poisons are most, -affected in their action by differences of tissue, while vegetable -poisons hold the middle place:—an arrangement which coincides with the -respective difficulty of decomposition among mineral, vegetable, and -animal substances generally, whether under physical or under vital -processes.[59] - -6. With respect to differences arising from _difference of organ_, these -will, of course, be partly attributable to differences in tissue, but -not altogether. For example, in the case of the pure corrosives or -irritants, the injury caused will depend for its danger on the -importance of the organ to the general economy of the body: Inflammation -caused by a local poison in the stomach will be more quickly fatal than -that excited in the intestines only; and such a poison may act violently -on the external parts without materially impairing the general health. - -7. _Habit and Idiosyncrasy._—The remarks to be made under the present -head are important in a medico-legal point of view: for they show how -one man may be poisoned by a substance generally harmless, and another -not harmed by a substance usually poisonous. - -The tendency of _idiosyncrasy_ is generally to increase the activity of -poisons, or even to render some substances deleterious which are -commonly harmless. - -The effect of opium in medicinal doses is commonly pleasant and -salutary; but in some individuals it produces disagreeable and even -dangerous effects. Calomel, which in moderate doses is for the most part -a mild laxative or sialagogue, will cause in some people, even in the -dose of a few grains, violent salivation, ulceration of the mouth, nay, -fatal gangrene. On the other hand, a few substances, which to most -people are actively poisonous, have on some individuals comparatively -little effect. There are extremely few poisons, however, in regard to -which this kind of idiosyncrasy is well established and prominent. -Mercury and alcohol are examples. The compounds of mercury, which in -moderate quantity are mildly laxative or sialagogue to most people, but -to some persons dangerously poisonous in very small doses, would, on the -contrary, appear in other constitutions to be extremely inactive; for it -has occasionally been found impossible to bring on the peculiar -constitutional action of mercury by continuing the use of its -preparations for months together. In general children are not easily -affected by calomel as a sialagogue, but easily by its laxative action. -As to alcohol, it is a familiar fact, that independently of the effects -of habit, there are some constitutions which cannot be brought under the -influence of intoxicating liquors without an extraordinary quantity of -them and a long-continued debauch, while others are overpowered in a -short space of time, and by very moderate excess; and there is no reason -to doubt that very great constitutional differences also prevail in -regard to the operation of a single large dose. A rarer idiosyncrasy is -unusual insensibility to the action of opium. I am acquainted with a -gentleman unaccustomed to the use of opium who has taken without injury -nearly an ounce of good laudanum,—a dose which would certainly prove -fatal to most people. - -But not only does idiosyncrasy modify the action of poisons: Through its -means, too, some substances are actually poisonous to certain -individuals, which to mankind in general are unhurtful, nay, even -nutritive. - -With some people all kinds of red fish, trout, salmon, and even the -richer white fish, herring, mackerel, turbot, or holibut, disagree as it -is called—that is, act after the manner of poisons: They produce -fainting, sickness, pain of the stomach; and if they were not speedily -evacuated by vomiting, dangerous consequences might ensue. The same is -often the case with mushrooms. The esculent mushrooms act on some people -nearly in the same way as the poisonous varieties. Bitter almonds and -other vegetable substances that contain hydrocyanic acid, sometimes -produce stupor or nettle-rash in the small quantities used for seasoning -food. In like manner many flowers, which to most persons are agreeable -and not injurious, cannot be kept in the same room with some people on -account of the severe nervous affections that are developed. - -This idiosyncrasy may even be acquired. One of my relations, who was for -many years violently affected by very small quantities of the richer -kinds of fish, used at a previous period to eat them, and can now again -do so, with impunity. Many people have acquired a similar idiosyncrasy -with respect to eggs; instances of the same kind will be afterwards -mentioned in respect to shell-fish, particularly muscles; indeed there -are probably few articles of food in regard to which such idiosyncrasies -may not in a few rare instances be met with, if we except the grains and -common kinds of butcher-meat. I may add, that from facts which have come -under my notice, I have sometimes suspected that a similar idiosyncrasy -may be acquired in a slight degree, and for a short time only, in regard -even to some kinds of butcher-meat, especially the flesh of young -animals and pork. On this subject some illustrations will be found at -the close of the chapter on diseased and decayed animal matter. - -It does not appear well ascertained, that the effect of idiosyncrasy is -ever to impair materially the energy of poisons, except in the instances -of mercury, alcohol, and opium. - -On the contrary, the tendency of _habit_ when it does affect their -energy, is, with a few exceptions, to lessen it. By the force of habit a -person may take without immediate harm such enormous quantities of some -poisons as would infallibly kill an unpractised person or himself when -he began. There have been opium-eaters in this country who took for days -together ten or even seventeen ounces of laudanum daily. - -The influence of habit has been ascertained precisely in the case of a -few common poisons only. On the whole, it would appear that more change -is effected by habit in the action of the organic than in that of the -inorganic poisons; and that of the former, those which act on the brain -and nervous system, and produce _narcotism_, are altered in the most -eminent degree. The best examples of the influence of habit are opium -and vinous spirits. The action of such poisons is not always, however, -entirely thrown away; they still produce some immediate effect; and -farther, by being frequently taken, they may slowly bring on certain -disease, or engender a predisposition to disease. A very singular -exception to this rule prevails in the instance of tobacco; which, under -the influence of habit, may be smoked daily to a considerable amount, -and, so far as yet appears, without any cumulative effect on the -constitution, like that of opium-eating or drinking spirits. - -The inorganic poisons are most of them little impaired in activity by -the force of habit. The pure irritants, indeed, do lose a little of -their energy: for it seems that persons have acquired the power of -swallowing with impunity considerable doses of the mineral acids. But as -to inorganic poisons that enter the blood, habit certainly does not -diminish, probably rather increases, their power. There is no -satisfactory evidence, that a person by taking gradually-increasing -doses of arsenic may acquire the power of enduring a considerably larger -dose than when he began: On the contrary, the stomach rather becomes -more tender to the subsequent dose by each repetition. I have little -hesitation in avowing my disbelief of the alleged cases of -arsenic-eaters and corrosive-sublimate-eaters, who could swallow whole -drachms at once with impunity. Some have expressed surprise at this -statement having been made in former editions of the present work, when -there is such authority as Byron, Pouqueville, &c., for the hackneyed -story of Soleyman, the sublimate-eater of Constantinople, who lived to -the age of a hundred, eating a drachm of corrosive sublimate daily. I -must avow, however, that such reporters of a feat so very extraordinary, -and where deception was so highly probable, are to me no authority at -all. - -In the relative influence of habit on poisons of the three kingdoms of -nature, a new argument will be discovered for the opinion given above -respecting the partial decomposition of organic poisons in some of the -tissues. In fact this partial decomposition accounts very well for the -effect of habit: The effect of habit is probably nothing more than an -increased power acquired by the stomach of decomposing the poison,—just -as it gradually acquires an increased facility in digesting some -alimentary substances which are at first very indigestible. - -8. The last modifying cause to be mentioned comprehends certain -_diseased states of the body_. The effect of disease, like that of -habit, is in general to impair the activity of poisons. But it is only -in the instance of a few diseases that this diminution is so strongly -marked as to be important in relation to medical jurisprudence.—In the -continued fever of this country there is a diminished susceptibility of -the constitutional action of mercury; and this peculiarity is very -strongly marked in the yellow fever, as well as in the bilious fevers -generally of tropical climates. In some varieties of typhoid fever there -is obviously a diminished sensibility to the action of wine and other -spirituous liquors; but this diminution in a great majority of cases is -much inferior to what some physicians have represented.—In severe -dysentery the susceptibility of the narcotic action of opium is so much -impaired, that a person unaccustomed to the use of that drug, may -continue to take daily, for several days together, a quantity which -might prove fatal to him in a state of health. In the severe form which -dysentery occasionally puts on in this country I have known a patient -take from twenty-four to thirty grains of opium daily, and retain it -all, without experiencing more than a mild narcotic action.—In epidemic -cholera the same insensibility has been remarked to the operation of -opium.—It also occurs in the instance of excessive hemorrhagy.—According -to the doctrines and practice of the present dominant school in Italy, -there is an unusual insensibility during inflammatory dropsy to the -irritant action of gamboge, so that sixty or eighty grains may be taken -without harm.—There is no disease, however, in which the power of -mitigating the action of poisons is more remarkably exhibited, than in -tetanus: It is often scarcely possible to bring on the narcotic action -of opium by any doses which can be administered; calomel, too, acts with -much less energy than usual; and even common purgatives must be -administered in doses considerably larger than those required in most -other disorders.—Mania is similarly circumstanced: almost all remedies -must be given in increased doses, narcotic remedies in particular. But -there is good reason for believing that the impaired susceptibility of -the action of poisons remarked in this disorder is far from being always -so great as some have alleged.—Another disease allied to the last, where -the diminution of susceptibility is often great, is delirium tremens. It -has in particular been often found, that to produce sleep in this -disease opium must be given in frequent large doses,—so large indeed, -that they would undoubtedly prove fatal to a person in health. At the -same time it is worthy of remark, that in some cases of delirium -tremens, even violent in degree, the peculiarity now specified, as I -have myself several times witnessed, is far from being strongly -marked.—Hydrophobia always, and hysteria sometimes, impair the activity -of poisons. I have seen cases of hysteria, more particularly those -assuming the form of tetanus, where very large doses of opium were -required to produce a calmative effect and sleep; and in hydrophobia it -is well shown that the narcotic action of opium is not produced even by -large doses often repeated.—The same state occurs in excessive -hemorrhage. - -In the operation of this class of modifying agents it is a general law, -to which there are probably few exceptions, that they chiefly affect -poisons of the organic kingdoms, and the narcotics above all. At least -in the instance of most mineral poisons their influence is very -inferior. Their operation may be accounted for in various ways. -Sometimes, as in dysentery and cholera, the poison is carried with -unusual rapidity through the alimentary canal. Sometimes again it -remains comparatively inert, because on account of the impaired activity -of absorption, it is not taken up with the usual quickness by the -absorbent vessels. And sometimes, as in the instance of tetanus, mania, -and rabies, the nervous system is in a state of peculiar excitement, by -which the customary action of the poison is in a great measure, if not -entirely, counteracted. - -In a few diseased states of the system there is an increased -susceptibility of the action of poisons: and it is important that the -medical jurist should attend to this circumstance. When a poison has a -tendency to bring on a peculiar pathological state of the system, or of -a particular organ, which state is also produced by a disease existing -at the time or impending, violent and even fatal consequences may ensue -from doses of poisons which in ordinary circumstances are innocuous or -beneficial. Thus in persons affected with apoplexy an ordinary dose of -opium may accelerate death; and in people even with a mere tendency to -apoplexy, if it is strongly marked, or appears from what are called -warning symptoms to be on the point of developing itself, a common dose -of such narcotics as occasion determination to the brain may excite the -apoplectic attack. Thus, too, in cases of inflammatory disorders of the -alimentary canal, irritating substances, in doses not otherwise -injurious, may produce dangerous impressions on the tender membrane with -which they come in contact. But in respect to this last example, it must -be remarked, that the improvements or the caprice of medical practice -have gone directly in face of the rule, by suggesting that some internal -inflammations of the alimentary canal may be successfully treated with -irritating remedies. - -I might here perhaps have added among the causes which modify the action -of poisons, sleep, and the administration of other poisons. The latter -subject, however, will be better considered at the end of the Individual -Poisons, under the title of Compound Poisoning. The former agent is of -doubtful effect. Some observations on its influence will be found in the -chapter on the Evidence of General Poisoning, p. 41. - -_Application of the preceding remarks to the Treatment of Poisoning._ As -an appendix to what has been said respecting the physiological action of -poisons, and the causes by which it is liable to be modified, I shall -here state shortly certain applications to the treatment of poisoning. - -In the instance of internal poisoning, the great object of the physician -is to administer an antidote or counter-poison. Antidotes are of two -kinds. One kind takes away the deleterious qualities of the poison -before it comes within its sphere of action, by altering its chemical -nature. The other controls the poisonous action after it has begun, by -exciting a contrary action in the system. In the early ages of medicine -almost all antidotes were believed to be of the latter description, but -in fact very few antidotes of the kind are known. - -Chemical antidotes operate in several ways, according to the mode of -action of the poison for which they are given. If the poison is a pure -corrosive, such as a mineral acid, it will be sufficient that the -antidote destroy its corrosive quality: Thus the addition of an alkali -or earth will neutralize sulphuric acid, and destroy or at least -prodigiously lessen its poisonous properties. In applying this rule care -must be taken to choose an antidote which is either inert in itself, or, -if poisonous, is, like the poison for which it is given, a pure -corrosive or local irritant, and one whose properties are reciprocally -neutralized. - -If the poison, on the other hand, besides possessing a local action, -likewise acts remotely through absorption, or by an impression on the -inner coat of the vessels, mere neutralization of its chemical -properties is not sufficient; for we have seen above that such poisons -act throughout all their chemical combinations which are soluble. Here, -therefore, it is necessary that the chemical antidote render the poison -insoluble or nearly so; and insoluble not only in water, but likewise in -the animal fluids, more particularly the juices of the stomach. The same -quality is desirable even in the antidotes for the pure corrosives; for -it often happens that in their soluble combinations these substances -retain some irritating, though not any corrosive power. When we try by -the foregoing criterions many of the antidotes which have been proposed -for various poisons, they will be found defective; and precise -experiments have in recent times actually proved them to be so. - -The other kind of antidote operates not by altering the form of the -poison, but by exciting in the system an action contrary to that -established by the poison. On considering attentively, however, the -phenomena of the action of individual poisons, it will be found -exceedingly difficult to say what is the essence of a contrary action, -and still more how that counter-action is to be brought about. -Accordingly, few antidotes of the kind are known. Physiology or -experience has not yet brought to light any mode of inducing an action -counter to that caused by arsenic and most of the irritant class of -poisons. It appears probable that the remote operation of lead may be -sometimes corrected by mercury given to salivation, and that the violent -salivation caused by mercury may be occasionally corrected by nauseating -doses of antimony. But these are the only instances which occur to me at -present of antidotes for irritant poisoning which operate by -counter-action, unless we choose to designate by the name of antidote -the conjunction of remedial means which constitute the antiphlogistic -method of cure. In the class of narcotics we are acquainted with equally -few constitutional antidotes, although the nature of the action of these -poisons seems better to admit of them. Ammonia is to a certain extent an -antidote for hydrocyanic acid, but by no means so powerful as some -persons believe; and I am not sure that in this class of poisons we can -with any propriety mention another antidote of the constitutional kind. - -On the whole, then, it is chiefly among the changes induced by chemical -affinities that the practitioner must look for counter-poisons; and the -ingenuity of the toxicologists has thence supplied the materia medica -with many of singular efficacy. When given in time, magnesia or chalk is -an antidote for the mineral acids and oxalic acid, albumen for corrosive -sublimate and verdigris, bark for tartar-emetic, common salt for lunar -caustic, sulphate of soda or magnesia for sugar of lead and muriate of -baryta, chloride of lime or soda for liver of sulphur, vinegar or oil -for the fixed alkalis; and these substances act either by neutralizing -the corrosive power of the poison, or by forming with it an insoluble -compound. - -In recent times a new object in the treatment of poisoning has been -pointed out by the discoveries made in its physiology. As it has been -proved that many of the most deadly poisons enter the blood, and in all -probability act by circulating with that fluid, so it has been inferred -that an important object in the treatment is to promote their discharge -by the natural secretions. In support of this reasonable inference it -has been lately rendered probable by Orfila, as will be seen under the -head of the treatment of the effects of arsenic, that it is of great -advantage in some forms of poisoning to increase the discharge of urine. - -In the instance of external poisoning the main object of the treatment -is to prevent the poison from entering the blood, or to remove it from -the local vessels which it has entered. - -One mode, which has been known to the profession from early times, and -after being long in disuse was lately revived by Sir D. Barry, and -applied with success to man, is the application of cupping-glasses to -the part where the poison has been introduced.[60] This method may act -in various ways. It certainly prevents the farther absorption of the -poison by suspending for a time the absorbing power of the vessels of -the part covered by the cup. It also sucks the blood out of the wound, -and may consequently wash the poison away with it. Possibly it likewise -compresses the nerves around, and prevents the impression made by the -poison on their sentient extremities from being transmitted along their -filaments. - -Another mode is by the application of a ligature between the injured -part and the trunk, so as to check the circulation. This is a very -ancient practice in the case of poisoned wounds, and is known even to -savages. But as usually practised it is only a temporary cure: As soon -as the ligature is removed the effects of the poison begin. It may be -employed, however, for many kinds of poisoning through wounds, so as to -effect a radical cure. We have seen that most poisons of the organic -kingdom are in no long time either thrown off by the system or -decomposed in the blood. Hence if the quantity given has not been too -large, recovery will take place. Now, by means of a ligature, which is -removed for a short time at moderately distant intervals, a poison, -which has been introduced into a wound beyond the reach of extraction, -may be gradually admitted into the system in successive quantities, each -too small to cause death or serious mischief, and be thus in the end -entirely removed and destroyed. Such is a practical application which -may be made of some ingenious experiments performed not long ago by M. -Bouillaud with strychnia, the poisonous principle of nux-vomica.[61] - -The last mode to be mentioned is by a combination of the ligature with -venesection, deduced by M. Vernière from his experimental researches -formerly noticed (p. 19). Suppose a fatal dose of extract of nux-vomica -has been thrust into the paw of a dog; M. Vernière applies a tight -ligature round the limb, next injects slowly as much warm water into the -jugular vein as the animal can safely bear, and then slackens the -ligature. The state of venous _plethora_ thus induced completely -suspends absorption. The ligature is next tied so as to compress the -veins without compressing the arteries of the limb, and a vein is opened -between the wound and the ligature in such a situation, that the blood -which flows out must previously pass through, or at least near the -poisoned wound. When a moderate quantity has been withdrawn, the -ligature may be removed with safety; and the extraction of the poison -may be farther proved by the blood that has been drawn being injected -into the veins of another animal; for rapid death by tetanus will be the -result.[62] It is not improbable that in this plan the preliminary -production of venous plethora may be dispensed with; and then the -treatment may be easily and safely applied to the human subject. - - - - - CHAPTER II. - ON THE EVIDENCE OF GENERAL POISONING. - - -This subject is purely medico-legal. It comprehends an account of the -various kinds of evidence by which the medical jurist is enabled to -pronounce whether poisoning in a general sense (that is, without -reference to a particular poison), is impossible, improbable, possible, -probable, or certain. It likewise comprises an appreciation of the -circumstances which usually lead the unprofessional, as well as the -professional, to infer correctly or erroneously a suspicion of such -poisoning. - -Under the present head might likewise be included the history of -poisoning, the art of secret poisoning, and some other topics of the -like kind. But the want of proper documents, and the unmeasured -credulity which has prevailed on the subject of poisoning throughout all -ages down to very recent times, has entangled these subjects in so -intricate a maze of fable, that a notice of them, sufficiently detailed -to interest the reader, would be quite misplaced in this work. - -On the art of secret poisoning, however, as having been once an -important object of medical jurisprudence, it might be expected that -some comments should here be offered. But really I do not see any good -reason for wading through the mass of credulous conjectures and -questionable facts, which have been collected on the subject, and which -have been copied into one modern work after another, for no other cause -than that they are of classic origin, or feed our appetite for the -mysterious. No one now seriously believes that Henry the Sixth was -killed by a pair of poisoned gloves, or Pope Clement the Seventh by a -poisoned torch carried before him in a procession, or Hercules by a -poisoned robe, or that the operation of poisons can be so predetermined -as to commence or prove fatal on a fixed day, and after the lapse of a -definite and remote interval. With regard to the noted instances of -secret poisoning, which occurred towards the close of the seventeenth -century in Italy and France, it is plain to every modern toxicologist, -from the only certain knowledge handed down to us of these events, that -the actors in them owed their success rather to the ignorance of the -age, than to their own dexterity. And as to the refined secrets believed -to have been possessed by them, it is sufficient here to say, that -although we are now acquainted with ten times as many and ten times as -subtle poisons as were known in those days, yet none exist which are -endowed with the hidden qualities once so universally dreaded. - -The crime of poisoning, from its nature, must always be a secret one. -But little apprehension need be entertained of the art of secret -poisoning as understood by Toffana or Brinvilliers,[63] or as it might -be improved by a modern imitator. It seems to have escaped the attention -of those who have written on the subject, that the practice of such an -art requires the knowledge not only of a dexterous toxicologist, but -also of a skilful physician; for success must depend on the exact -imitation of some natural disease. It is only among medical men, -therefore, and among the higher orders of them, that a Saint-Croix can -arise now-a days. How little is to be dreaded on that head is apparent -from the domestic history of the European kingdoms for the last half -century, compared with their history some centuries ago. Few medical men -have even been suspected, and those few only upon visionary grounds, and -under the impulse of violent political feeling.[64] In one late instance -only, so far as I am aware, has it been proved that the physician’s art -was actually prostituted to so fearful a purpose; and the detection of -the crime in that case shows how difficult concealment will always be -wherever justice is administered rigorously, and medico-legal -investigations skilfully conducted.[65] - -Two extraordinary incidents which happened lately in Germany may appear -at first sight at variance with these views. I allude to the cases of -Anna Margaretha Zwanziger and Margaretha Gottfried, which justly excited -much interest where they occurred, and are notorious to continental -toxicologists. Zwanziger, while serving as housekeeper in various -families in the territory of Bayreuth in Bavaria during the years 1808 -and 1809, contrived to administer poison,—sometimes under the -instigation of mere revenge or spite, sometimes for the purpose of -clearing the way for her schemes of marriage with her masters,—to no -fewer than seventeen individuals in the course of nine months; and of -these three died.[66] Gottfried, a woman in affluent circumstances and -tolerable station in the town of Bremen, was even more successful. For -she pursued her criminal career undiscovered for fifteen years; and when -detected in 1828 had murdered actually fourteen persons, and -administered poison unsuccessfully to several others. Her motive, as in -the case of Zwanziger, was the mere gratification of a malevolent -temper, or the removal of supposed obstacles to her matrimonial dreams. -In neither of these instances, however, did the criminal possess any -particular skill, or observe much measure in her proceedings. The cases -of poisoning were of the common kind,—produced by arsenic,—proving in -general quickly fatal,—and presenting the ordinary phenomena. I cannot -help thinking, therefore, that the events now alluded to prove rather -the ineffectiveness of the police where they happened, than the -adroitness of the actors by whom they were brought about; and that they -constitute no sound objection to the statement, that the art of secret -poisoning is now unknown, and is not likely to be again revived. - -It must be granted, indeed, that the late discoveries in chemistry and -toxicology have made poisons known which might be employed in such a way -as to render suspicion unlikely, and to baffle inquiry. But the methods -now alluded to are hitherto very little known; they cannot easily be -attempted on account of the rarity and difficult preparation of the -poisons; they can never be practised except by a person conversant with -the minute phenomena of natural disease; and it is no part of the object -of this work to make them public. - -The evidence, by which the medical jurist is enabled to pronounce on the -existence or non-existence of poisoning in general, and to determine the -subordinate questions that relate to it, is derived from five -sources,—1, the symptoms during life; 2, the appearances in the dead -body; 3, the chemical analysis; 4, experiments and observations on -animals; and 5, certain moral circumstances, which are either -inseparably interwoven with the medical proof, or cannot be accurately -appreciated without medical knowledge. - - - SECTION I.—_Of the Evidence from Symptoms._ - -Not many years ago it was the custom to decide questions of poisoning -from the symptoms only. Till the close of last century, indeed, no other -evidence was accounted so infallible: and for the simple reason, that in -reality the other branches of evidence were even more imperfectly -understood. So lately as 1763, and even in Germany, the solemn opinions -of whole colleges were sometimes grounded almost exclusively on the -symptoms.[67] About that time, however, doubts began to be entertained -of the infallibility of such evidence; these doubts have since assumed -gradually a more substantial form; and it is now laid down by every -esteemed author in Medical Jurisprudence, that the symptoms, however -exquisitely developed, can never justify an opinion in favour of more -than high probability.[68] In laying down this doctrine medical jurists -appear to me to have injudiciously confounded together actual symptoms -with their general characteristics. If the doctrine is to be held as -applying to the evidence from symptoms, only so far as they are viewed -in questions of general poisoning,—that is, as applying to the general -characters merely of the symptoms,—it is deduced from accurate -principles. But if it is likewise to be applied, as recent authors have -done, to the actual symptoms produced by particular poisons, and in all -cases whatever of their action, then it is a rule clearly liable to -several important exceptions. These exceptions will be noticed under the -heads of the mineral acids, oxalic acid, arsenic, corrosive sublimate, -nux vomica, &c. At present it is only the general characters of the -symptoms, and the points in which they differ from the general -characters of the symptoms of natural disease, that I propose to -consider. - -The chief characteristics usually ascribed to the symptoms of poisoning -considered generally, are, that they commence suddenly and prove rapidly -fatal,—that they increase steadily,—that they are uniform in nature -throughout their course,—that they begin soon after a meal,—and that -they appear while the body is in a state of perfect health. - -1. The first characteristic is the _suddenness of their appearance and -the rapidity of their progress_ towards a fatal termination. Some of -them act instantaneously, and the effects of most of them are in general -fully developed within an hour or little more. But this character is by -no means uniform. The most violent may be made to act, so as to bring on -their peculiar symptoms slowly, or even by imperceptible degrees. Thus -arsenic, which usually causes violent symptoms from the very beginning, -may be so administered as to occasion at first nothing more than slight -nausea and general feebleness; and afterwards in slow succession its -more customary effects. In like manner corrosive sublimate may be given -in such a way as to cause at first mild salivation, and finally gangrene -of the mouth. Even many vegetable poisons might be administered in the -same way. The well-known consequences of digitalis in medicinal doses -will serve as a familiar instance. A still better illustration is -supplied by the medicinal effects of the alkaloid of nux-vomica, whose -action in other circumstances is most rapid and violent: Strychnia in a -moderate dose will cause death by violent tetanus in two or three -minutes; but when given in frequent small doses as a remedy in palsy, it -has been known to bring on first starting of the limbs, then stiffness -of the jaw, afterwards pain and rigidity of the neck; and these effects -might be increased so gradually, that the patient would seem to die -under ordinary tetanus. Nevertheless, the foregoing considerations being -kept always in mind, it still remains true, that the effects of poisons -for the most part begin suddenly, when the dose is large. This is an -important circumstance in regard to certain active poisons, such as the -mineral acids, oxalic acid, arsenic, strychnia, &c. For when it is -considered that in criminal cases they are given for the most part in -unnecessarily large doses, it follows that if the effect ascribed to -these poisons in such doses have not begun suddenly, the suspicion is -probably incorrect. - -The same remarks may be applied to the sudden termination of the -symptoms. Poison is for the most part given criminally in doses so large -that it proves rapidly fatal. Yet this is not always the case; the -diseased state occasioned by poisons has often been prolonged, as will -be seen hereafter, for several weeks, sometimes for several months; nay, -a person may be carried off by a malady, the seeds of which have been -sown by the operation of poison years before. - -The present would be the proper place for noticing the important -question regarding the interval of time, after which, if death -supervenes, it cannot be laid to the charge of the person who -administered the poison. It is unnecessary, however, to say much on the -subject. According to the English law, death must take place within a -year. As to the Scottish law, it may be inferred from what has been said -by the late Baron Hume on the subject of homicide generally, that a -charge of poisoning is relevant although the person should die at a -period indefinitely remote, and that it will infer the pains of law, -provided the operation of the poison can be distinctly traced, -unmodified by extraneous circumstances, from the commencement of the -symptoms to the fatal termination.[69] Of course the influence of these -modifying circumstances in lessening the criminal’s responsibility will -increase with the interval. The question for the medical jurist to -determine in such a case would therefore be, the distance of time to -which death may be delayed in the case of poisoning generally, and in -that of the particular poison. This question cannot be answered even -with an approach to precision, except in the instance of a few common -poisons. Most vegetable and animal poisons prove fatal either in a few -days or not at all; but some mineral poisons may cause death after an -interval of many days. It appears probable that arsenic may cause death -after an interval of several months, and it is well ascertained that the -symptoms of poisoning with the mineral acids have continued -uninterruptedly and without modification for eight months, and then -terminated fatally. - -2. The next general characteristic of the symptoms of poisoning is -_regularity in their increase_. It is clear, however, that even this -character cannot be universal. For in all cases of slow poisoning by -repeated small doses there must be remissions and exacerbations, just as -in natural diseases. Besides, as we can seldom watch the symptoms -advancing in their simple form, but must endeavour to remove them by -remedies, remissions may thus be produced and their tendency to increase -steadily counteracted. Farther, some poisons admit of exacerbations and -remissions, even when given in one large dose; and there are others, the -very essence of whose action is to produce violent symptoms in frequent -paroxysms. Of the latter kind are nux vomica, and the other substances -that contain strychnia. Of the former kind is arsenic: in cases of -poisoning with arsenic it often happens, that after the first five or -six hours have been passed in great agony, the symptoms undergo a -striking remission for as many hours, and then return with equal or -increased violence. Still it is true that on the whole the symptoms of -poisoning are steady in their progress; so that this should always be -attended to as one of the general characters. In the case of slow -poisoning, too, when the most remarkable deviations from it are -observed, the very occurrence of exacerbations and remissions, combined -with certain points of moral proof, may furnish the strongest evidence -possible. Thus, on the trial of Miss Blandy at Oxford in 1752, for the -murder of her father, one of the strongest circumstances in proof was, -that repeatedly after she gave the deceased a bowl of gruel, suspected -to be poisoned, his illness was much increased in violence.[70] - -As connected with the present subject, a question might here be noticed -that has been discussed on the occasion of various trials, namely, -whether the symptoms of poisoning are susceptible of a complete -intermission. It cannot be answered satisfactorily, however, except with -reference to particular poisons. The property alluded to has been -ascribed to several poisons, even to mercury, arsenic, and opium; but -oftener, I believe, in consequence of an improper desire on the part of -the witness to prove or to perfect their view of the case, than through -legitimate induction from facts. - -3. Another characteristic is _uniformity in the nature of the symptoms_ -throughout their whole progress. This character is the least invariable -of them all; for many poisons cause very different symptoms towards the -close from those which they cause at the beginning. Arsenic may induce -at first inflammation of the alimentary canal, and afterwards palsy or -epilepsy; nux-vomica may excite at first violent tetanus, and afterwards -inflammation of the stomach and bowels; and corrosive sublimate, after -exciting in the first instance inflammation, may prove eventually fatal -by inducing excessive ptyalism. In truth, certain changes of this kind -in the nature of the symptoms will, in special cases, afford strong -presumption, perhaps absolute proof, not only of general poisoning, but -even also of the particular poison given. The reason for mentioning so -uncertain a character as uniformity in the nature of the symptoms among -their characteristics will appear presently.—[pp. 47 & 50.] - -4. The fourth characteristic is, that _the symptoms begin soon after a -meal_, or rather, soon after food, drink, or medicine has been taken. -The occasions on which we eat and drink are so numerous and so near one -another, that unless the poison suspected is one which acts with -rapidity, it may be difficult to attach any weight to this circumstance. -Some poisons rarely produce their effects till a considerable time after -they are swallowed; the poisonous mushrooms, for example, may remain in -the alimentary canal for several hours or even an entire day and more, -before their effects begin; poisonous cheese in like manner may not act -for five or six hours,[71] or even a whole day;[72] and that kind of -cholera, which is caused in some people by putrid, diseased, and -new-killed meat, seldom begins, so far as I have observed, till twelve -hours or more after the noxious meal. With regard to the commoner -poisons, such as arsenic, corrosive sublimate, the mineral acids, oxalic -acid, nux-vomica, and the like, it is a good general rule, that the -symptoms, if violent from the beginning, must have begun soon after -food, drink, or medicine has been taken. - -In making inquiries respecting this point, however, care must be taken -not to lose sight of certain circumstances which may cause a deviation -from the general rule. - -In the first place, it should be remembered that poisons may be -administered in many other ways besides mixing them with articles of -food or drink, or substituting them for medicines. They may be -introduced into the anus; they have been introduced into the vagina; -they have also been introduced by inhalation in the form of vapour; and -there can be no difficulty in introducing some of them through wounds. - -Secondly, another circumstance which may be kept in view is, that, if a -person falls asleep very soon after swallowing a poison, especially one -of the irritants, the commencement of the symptoms may be considerably -retarded, provided it be not one of the powerful corrosives. This -statement is not so fully supported by facts as to admit of its being -laid down with confidence as a general rule. But from various incidents -which have come under my notice it appears not improbable, that sleep -does possess the power of putting off for a while the action of some -poisons. In particular some instances have occurred to me where arsenic -taken at night did not begin to act for several hours, the individual -having in the meantime been asleep.[73] The occurrence of so long an -interval between its administration and the first appearance of the -symptoms is so contrary to what generally happens, that some cause or -another must be in activity; and the insensibility of the system during -sleep to most sources of excitement seems to supply a sufficient -explanation. The slow operation of laxatives during sleep compared with -their effects during one’s waking hours, is an analogical fact. - -A third consideration to be attended to is, that poison may be secretly -administered during sleep to a person who lies habitually with his mouth -open. This is fully proved by an interesting case which will be noticed -under the head of the moral evidence of poisoning. In that particular -case the individual immediately awoke, because the poison was -concentrated sulphuric acid; but it may admit of question whether a -sound sleeper might not swallow less irritating poisons without being -awakened. In such circumstances no connexion of course could be traced -between the taking of a suspected article and the first appearance of -the symptoms. - -5. Lastly, _the symptoms appear during a state of perfect health_. This -is an important character, yet not universal; for it cannot be expected -to apply to cases of slow poisoning, and poisons may be given while the -person is actually labouring under natural disease. Cases of the last -description are generally very embarrassing; for if, instead of -medicine, a poison be administered, whose symptoms resemble the natural -disease, suspicion may not arise till it is too late to collect -evidence. - -It must be apparent from the preceding observations, that the characters -common to the symptoms of general poisoning are by no means universally -applicable. Yet on reviewing them attentively it will also appear, that, -considering the little knowledge possessed by the vulgar of the action -of poisons, and consequently the rude nature of their attempts to commit -murder by poisoning, the exceptions to the general statements made above -will not be numerous. - -It now remains to be seen how far these characters distinguish the -symptoms of poisoning from those of natural disease; and - -1. As to the _suddenness of their invasion and rapidity of their -progress_, it is almost needless to observe, that many natural diseases -commence with a suddenness and prove fatal with a rapidity, which few or -no poisons can surpass. The plague may prove instantaneously fatal; and -even the continued fever of this country may be fully formed in an hour, -and may terminate fatally, as I have once witnessed, at the beginning of -the second day. Inflammation of the stomach also begins suddenly and -terminates soon. Cholera likewise answers this description: I have known -the characters of ordinary cholera fully developed within an hour after -the first warning symptom, and frequently in hot climates, nay, in some -rare instances even in Britain, it proves fatal in a few hours. -Malignant cholera frequently proves fatal in a few hours. Inflammation -of the intestines, too, may begin, or at least seem to begin, suddenly -and end fatally in a day: One variety of it, now well known to affect -the mucous membrane, may remain quite latent till the gut is perforated -by ulceration, and then the patient is attacked with acute pain, -vomiting, and mortal faintness, and frequently perishes within -twenty-four hours.[74] But in particular many organic diseases of the -heart prove suddenly fatal, without any previous warning; and this is -also true to a certain extent even of apoplexy; for, as will afterwards -be seen, it is an error to suppose that apoplexy is always, or even -generally, preceded by warning symptoms. The first characteristic, -therefore, as applied to the symptoms of poisoning generally, contrasted -with those of general disease, must appear by no means distinctive. But -opportunities will occur afterwards for showing, that it is sometimes a -good diagnostic in the case of particular poisons.[75] - -2. As to the uniformity or _uninterrupted increase of the symptoms_, it -is equally the attribute of many common diseases. I am not aware, that -in speedily fatal cases of the internal _phlegmasiæ_ a considerable -remission is often observed. Apoplexy, too, very frequently continues -its course without interruption; and the same may be said of cholera, -and indeed of most acute diseases, when they prove rapidly fatal. - -3. It was stated above, that the third character, _uniformity in kind_ -throughout their progress, is by no means an invariable circumstance. -Still less is it distinctive; for many diseases are marked by great -uniformity of symptoms. It has been enumerated nevertheless among the -general characters of poisoning, because, although its presence can -hardly ever add any weight to the evidence in favour of death by poison, -its absence may sometimes afford even positive proof in favour of -natural death. That is, changes of a certain kind occurring in the -symptoms during their progress may be incompatible with the known -effects of a particular poison or of all poisons, and capable of being -accounted for only on the supposition of natural disease having been at -least the ultimate cause of death. This statement, which is one of some -importance, is illustrated by a pointed case, that of Charles Munn, -mentioned at the close of the present section. - -4. In the next place, it was observed that some reliance may be placed -on the fact, that the symptoms of poisoning _appear very soon after a -meal_. But we also know this to be the most frequent occasion on which -some natural disorders begin. An attack of apoplexy after a hearty meal -is a common occurrence. That kind of cholera which follows the -immoderate use of acid fruit likewise comes on soon after eating. -Sometimes mere excessive distension of the stomach after a meal proves -suddenly or instantaneously fatal. Drinking cold water when the body is -over-heated likewise causes at times immediate death. It appears that -perforation of the stomach, the result of an insidious ulcer of its -coats, and likewise rupture of the stomach from mechanical causes, are -most apt to occur during the digestion, and therefore soon after the -taking of a meal. - -These few observations will make it evident that the appearing of -violent symptoms soon after eating may arise from other causes besides -the administration of poison. At the same time, as the diseases which -are apt to commence suddenly at that particular time are few in number, -and none of them by any means frequent, it is always justly reckoned a -very suspicious circumstance; and when combined with certain points of -moral proof, such as that several people, who have eaten together, were -seized about the same time with the same kind of symptoms, the evidence -of general poisoning becomes very strong indeed. Sometimes the evidence -from the date of their commencement after a meal may singly supply -strong evidence, as in the case of the mineral acids and alkalis, or -corrosive sublimate, which begin to act in a few seconds or minutes. - -On the other hand, if the symptoms do not begin soon after food, drink, -or medicine has been taken (the circumstances being such as to exclude -the possibility of poison being introduced by a wound, by the lungs, or -by any other channel but the stomach), the presumption on the whole is -against poisoning; and sometimes the evidence to this effect may be -decisive. The principle now propounded may be often a very important one -in the practice of medical jurisprudence; for when united with a little -knowledge of the symptoms antecedent to death, it may be sufficient to -decide the nature of the case. Thus it is sufficient, in my opinion, to -decide the celebrated case of the Crown Prince of Sweden. The prince, -while in the act of reviewing a body of troops on the 28th May, 1810, -was observed suddenly to waver on his horse; and soon afterwards he fell -off while at the gallop, was immediately found insensible by his staff, -and expired in half an hour. As he was much beloved by the whole nation, -a rumour arose that he had been poisoned; and the report took such firm -root in the minds of all ranks, that a party of military, while -escorting the body to Stockholm, were attacked near the city by the -populace, and their commander, Marshal Fersen, murdered; and Dr. Rossi, -the prince’s physician, after narrowly escaping the same fate, was in -the end obliged to quit his native country. Now, no other poison but one -of the most active narcotics could have caused such symptoms, and none -of them could have proved so quickly fatal unless given in a large dose. -It was proved, however, that on the day of his death the prince had not -taken any thing after he breakfasted; and an interval of nearly four -hours elapsed after that till he fell from his horse. This fact alone, -independently of the marks of apoplexy found in the head after death, -and the warning symptoms he repeatedly had, was quite enough to show -that he could not have died of poison, as it was incompatible with the -known action of the only poisons which could cause the symptoms. This is -very properly one of the arguments used by the Medical Faculty of -Stockholm, which was consulted on the occasion.[76] - -The same circumstances will often enable us to decide at once a set of -cases of frequent occurrence, particularly in towns,—where the sudden -death of a person in a family, the members of which are on bad terms -with one another, is rashly and ignorantly imputed to poison, without -any particular poison being pointed at; and where, consequently, unless -the morbid appearances clearly indicate the cause of death, a very -troublesome analysis might be necessary. In several cases of this kind, -which have been submitted to me, I have been induced to dispense with an -analysis by resting on the criterion now under consideration. The -following is a good example. - -A middle-aged man, who had long enjoyed excellent health, one afternoon -about two o’clock returned home tired, and after having been severely -beaten by his wife went to bed. At a quarter past two one of his workmen -found him gasping, rolling his eyes, and quite insensible; and he died -in a few minutes. As his wife had often maltreated and threatened him, a -suspicion arose that he had died of poison, and the body was in -consequence examined judiciously by Sir W. Newbigging and myself. The -only appearance of disease we could detect was a considerable -tuberculation of the septum cordis and anterior parietes of both -ventricles. This disease might have been the cause of death; for there -is no disease of the heart which may not remain long latent, and prove -fatal suddenly. But, as the man never had a symptom referrible to -disease of the heart, it was impossible to infer, in face of a suspicion -of poisoning, that it must have been the cause of death; since the man -might very well have died of poison, the disease of the heart continuing -latent. Poisoning, however, was out of the question. The man had taken -nothing whatever after breakfasting about nine. Now no poison but one of -the most active narcotics in a large dose could cause death so rapidly -as in this case; and the operation of such a poison in such a dose could -not be suspended so long as from nine till two. An analysis was -therefore unnecessary. - -5. Little need be said with regard to _the symptoms beginning, while the -body is in a state of perfect health_; because in truth almost all acute -diseases begin under the same circumstances. Connected with this -subject, however, a point of difference should be noticed which may be -of use for distinguishing poisoning by the irritants from acute diseases -of the inflammatory kind:—the latter rarely begin without some adequate -and obvious natural cause. - -On considering all that has now been said regarding the characteristics -of the symptoms of general poisoning, as contrasted with those of -natural disease, no one can hesitate to allow, that from them alone a -medical jurist can never be entitled to pronounce that poisoning is -certain. At the same time he must not on that account neglect them. For, -in the first place, they are of great value as generally giving him the -first hints of the cause of mischief, and so leading him to search in -time for better evidence. Next, they will often enable him to say that -poisoning was possible, probable, or highly probable; which, when the -moral evidence is very strong, may be quite enough to decide the case. -Thirdly, although they can never entitle him to say that poisoning was -certain, they will sometimes enable him to say, on the contrary, that it -was impossible. And to conclude, when the chemical or moral evidence -proves that poison was given, the characters of the symptoms may be -necessary to determine whether it was the cause of death. - -As the last statement is one of consequence, and yet has been overlooked -by some authors on medical jurisprudence in this country, it may be -illustrated by one or two comments. It does not follow, because a poison -has been given, that it is the cause of death; and therefore in every -medico-legal inquiry the cause of the first symptoms and the cause of -death should be made two distinct questions. The question, whether a -poison, proved to have been administered, was the cause of death, is to -be answered by attending to the second and third characteristics -mentioned above, and considering whether the symptoms went on -progressively increasing, or altered their nature during the course of -the patient’s illness, and whether the alteration, if any, was such as -may occur in the case of poisoning generally, or of the special poison -given. These remarks are very well exemplified by a case, of which I -have related the particulars elsewhere,[77] that, namely, of Charles -Munn, tried at the Inverary Spring Circuit of 1824 for the double crime -of procuring abortion, and of murder by poisoning. The moral evidence -and symptoms together left no doubt that arsenic had been given, and -that the deceased, a girl with whom the prisoner cohabited, laboured -under the effects of that poison in a very aggravated and complex form -for twelve days. After that she began to recover rapidly, and in the -course of a fortnight more was free of every symptom except weakness and -pains in the hands and feet: In short, all things considered, she was -thought to be out of danger. But she then became affected with headache -and sleeplessness, and died in nineteen days more under symptoms of -obscure general fever, without any local inflammation. Dr. Duncan, -junior, and I, who were consulted by the Crown in this case, were of -opinion,—that granting the girl’s first illness, as appeared from moral -and medical evidence, was owing to arsenic, her death could not be -ascribed to it with any certainty. It is true that in a few instances -the primary irritant symptoms caused by arsenic have been known to pass -into an obscure general fever, which has ended fatally; and that this -mode of termination coincides with the effects ascribed to arsenic as -the chief ingredient in the celebrated _Aqua Toffana_. But the latter -phenomena, at best of doubtful authenticity, are not represented to have -been preceded by the ordinary symptoms of violent irritation, or to have -been developed except under the use of continuous small doses; and as -for the more recent and less ambiguous cases of fever succeeding the -usual primary effects of a large dose, in no instance yet recorded was -there an intermission between the two stages. - -So much, then, for the force of the evidence drawn from the characters -of the symptoms of general poisoning. According to the example of -others, I might consider in the present place the force of evidence -derived from the symptoms themselves, which distinguish the three -classes of poisons. But this subject, together with the special natural -diseases which imitate the symptoms of poisoning, will be treated of -more conveniently as an introduction to each of the classes. - - - SECTION II.—_Of the Evidence from Morbid Appearances._ - -The appearances left in the dead body after death by poison used -formerly to be relied on as strongly as the symptoms during life; and -with even less reason. Except in the instance of a very few poisons, the -morbid appearances alone can never distinguish death by poison from the -effects of natural disease, or from some other kinds of violent death. -There is not much room, therefore, for general remarks under the present -head. - -It was at one time thought by the profession, and is still very -generally imagined by the vulgar, that unusual blackness or lividity of -the skin, indicates death by poison generally. But every experienced -physician is now well aware, that excessive lividity is by no means -universally produced by poison, and that it is likewise produced by so -many natural diseases as not even to form, in any circumstances -whatever, the slightest ground of suspicion. Neither is there any -difference in kind, as some imagine, between the lividity which succeeds -death by poison, and that which follows natural death. Yet it is right -for the medical jurist to be aware that lividity as a supposed -consequence of poison ought to be strictly attended to by medical -inspectors and law officers while investigating charges of poisoning, -because the vulgar belief on the subject sometimes leads to such conduct -or language on the part of the poisoner as betrays his secret at the -time, and constitutes evidence of his guilt afterwards. - -Another appearance equally unimportant is early putrefaction of the -body. Early putrefaction, at one time much insisted on as a criterion of -poisoning,[78] cannot even justify suspicion. It is by no means -invariably, or even generally caused by poisons; nay, sometimes a state -precisely the reverse appears to be induced;[79] and it is seen quite as -frequently after natural death. - -Some other appearances, not more conclusive, might also be mentioned -here; but they belong properly to the effects of individual poisons, or -of classes of poisons, not to those of poisoning generally. It may -merely be remarked at present, therefore, that the appearances after -death, which are really morbid, and which may be produced by poisons, -are, in one great class, the signs of inflammation of the alimentary -canal in its progressive stages,—in another class, the signs of -congestion within the head,—and in a third, a combination of the effects -of the two preceding classes; that neither set of appearances is -invariably caused by the poisons which usually cause them; that -congestion within the head is really seldom produced by those which are -currently imagined to produce it; and that most of the appearances of -both kinds are exactly similar to those left by many natural diseases. - -But although, on the whole, the appearances after death, when considered -singly, can seldom supply evidence of poisoning even to the amount of -probability, they may nevertheless prove very important under other -points of view. Thus, in connection with the symptoms and the general -evidence, the appearances after death may furnish decisive proof; and -even should the history of the symptoms be unknown, or have been -unskilfully collected, the appearances after death, by pointing out the -nature of the previous illness, may furnish evidence enough to decide -the case, when the moral proof is strong. Again, in cases of alleged -_imputation of poisoning_ they are necessary to determine whether a -poison actually found in the body was introduced during life or after -death. Besides, the very absence of morbid appearances may afford -presumptive proof in some circumstances,—when, for example, the question -is, whether a person has died of apoplexy or of poisoning with -narcotics? Farther, a few poisons, as was formerly stated, occasionally -produce appearances so characteristic, as not to be capable of being -confounded with the effects of any other agent whatsoever: It will be -found hereafter, for example, that the mineral acids have at times left -behind them in the dead body unequivocal evidence of their operation. -And finally, in cases where no doubt can be entertained that poison was -taken, the evidence from morbid appearances may be useful or necessary -for settling whether or not it was the cause of death. Two pointed -examples of this kind will be noticed under the next section. - -When signs of the action of poison are not found in the dead body, and -on the contrary marks are found of the operation of natural disease, the -presumption of course is that the person died a natural death. But here -a few words of caution must be added with regard to the drawing of that -inference in cases where the history of the symptoms is not known. It -does not follow merely because certain appearances of natural disease -are found, that their cause was the cause of death. For death may have -arisen from a totally different cause, such as poisoning. This remark is -not, as some may imagine, the offspring of hypothetical refinement, but -a necessary caution, drawn from actual and not unfrequent occurrences. -Thus, for example, the following cases will show, that there may be -found in the dead body diseased appearances, arising from pleurisy, -hydrothorax, or peripneumony, sufficient to cause death, or to account -for death in ordinary circumstances; and that nevertheless the disease -may have been completely latent, and death have arisen from poison. In -Rust’s Magazin is related the case of a German apothecary, who poisoned -himself with prussic acid, and in whose body the lower lobe of the left -lung was found consolidated and partly cartilaginous.[80] In Corvisart’s -Journal an army-surgeon has described the case of a soldier, who died of -a few hours’ illness, and whose right lung was found after death forming -one entire abscess; yet to the very last day of his existence he daily -underwent all the fatigues of a military life; and in fact he died of -poisoning with hemlock.[81] In Pyl’s Memoirs and Observations, there is -a similar account of a woman who enjoyed tolerable health, and died -during a fit of excessive drinking, and in whose body the whole left -lung was found one mass of suppuration.[82] Under the next section will -be mentioned other equally pointed cases of death by poison, where the -apparent cause of death was external violence. - -The conclusions to be drawn from these facts are that, at all events, -the medical inspector in a question of poisoning, must take care not to -be hurried away by the first striking appearances of natural disease -which he may observe, and so be induced to conduct the rest of the -inspection superficially; and likewise, that he should not so frame his -opinion on the case, as to exclude the possibility of a different cause -from the apparent one, unless the appearances are such as must -necessarily have been the cause of death. It may be said, that in -requiring this condition for an unqualified opinion, a rigour of -demonstration is exacted, which can rarely be attained in practice. But, -on the one hand, it must not be forgotten, that an unqualified opinion -is not always necessary; and on the other hand, although it were, I -think it might be shown, if the subject did not lead to disproportionate -details, that we may often approach very near the rigour of -demonstration required. At present no more need be said, than that the -inspector should be particularly on his guard in those cases, in which -the appearances, though belonging to the effects of a deadly disease, -are trifling; and still more in those in which the appearances, though -great, belong to the effects of a disease, whose whole course may be -latent. And I may add, that, from what I have observed of medico-legal -opinions, the caution now given is strongly called for. - -It may be right to allude here also to another purpose which may be -served by a careful consideration of the morbid appearances. In cases in -which the history of the symptoms is unknown or imperfect the extent and -state of progress of the appearances will sometimes supply strong -presumptive evidence of the duration of the poisoning. This is an -obvious and important application of the knowledge of the pathology of -poisoning; but the simple mention of it is all which can be here -attempted, as special rules can hardly be laid down on the subject. - - - SECTION III.—_Evidence from Chemical Analysis._ - -The chemical evidence in charges of poisoning is generally, and with -justice, considered the most decisive of all the branches of proof. It -is accounted most valid, when it detects the poison in the general -textures of the body, or in the blood, or in the stomach, intestines or -gullet, then in the matter vomited, next in articles of food, drink or -medicine of which the sufferer has partaken, and lastly, in any articles -found in the prisoner’s possession, and for which he cannot account -satisfactorily. - -When poison is detected in any of these quarters, more especially in the -stomach or intestines, it is seldom that any farther proof is needed to -establish the fact of poisoning. In two circumstances, however, some -corroboration is necessary. - -In the first place, in cases where a defence is attempted by a charge of -imputation of poisoning it may be necessary to determine by an accurate -account of the symptoms, or by the morbid appearances, or by both -together, whether the poison was introduced into the body before or -after death. For it is said, that attempts have been made to impute -crime by introducing poison into the stomach or anus of a dead body; and -although I have not been able to find any authentic instance of so -horrible an act of ingenuity having been perpetrated, it must -nevertheless be allowed to be quite possible. - -Secondly, an account of the symptoms and morbid appearances is still -more necessary, when the question at issue is, not so much whether -poison has been given, as whether it was the cause of death, granting it -had been taken. Some remarks have been already made on this question in -the two former sections. In the present place some farther illustrations -will be added from two very striking cases. They are interesting in many -respects, and particularly as showing the importance of strict -medico-legal investigation: I am almost certain that but a few years ago -their real nature would not have been discovered in this country. The -first to be noticed occurred to Dr. Wildberg of Rostock. Wildberg was -required to examine the body of a girl, who died while her father was in -the act of chastising her severely for stealing, and who was believed by -all the bye-standers, and by the father himself, to have died of the -beating. Accordingly, Wildberg found the marks of many stripes on the -arms, shoulders and back, and under some of the marks blood was -extravasated in considerable quantity. But these injuries, though -severe, did not appear to him adequate to account for death. He -therefore proceeded to examine the cavities; and on opening the stomach, -he found it very much inflamed, and lined with a white powder which -proved on analysis to be arsenic. It turned out, that on the theft being -detected the girl had taken arsenic for fear of her father’s anger, that -she vomited during the flogging, and died in slight convulsions. -Consequently, Wildberg very properly imputed death to the arsenic. In -this case the chemical evidence proved that poison had been taken; but -an account of the symptoms and appearances was necessary to prove that -she died of it.[83] The other case occurred to Pyl in 1783. A woman at -Berlin, who lived on bad terms with her husband, went to bed in perfect -health; but soon afterwards her mother found her breathing very hard, -and on inquiring into the cause discovered a wound in the left side of -the breast. A surgeon being immediately sent for, the hemorrhage which -had never been great, was checked without difficulty; but she died -nevertheless towards morning. On opening the chest it appeared that the -wound pierced into it, and penetrated the pericardium, but did not wound -the heart; and although the fifth intercostal artery had been divided, -hardly any blood was effused into the cavity of the chest. Coupling -these circumstances with the trifling hemorrhage during life, and the -fact that she had much vomiting, and some convulsions immediately before -death, Pyl satisfied himself that she had not died of the wound: and -accordingly the signs of corrosion in the mouth and throat, and of -irritation in the stomach, with the subsequent discovery of the remains -of some nitric acid in a glass in her room, proved that she had died of -poison.[84] - -_Causes of the disappearance of poison from the body._—Chemical evidence -is not always attainable in cases of poisoning. Various causes may -remove the poison beyond reach. Hence although poison be not detected in -the body,—the experimenter being supposed skilful and the poison of a -kind which is easily discovered,—still it must not be concluded from -that fact alone that poison has not been the cause of death. For that -which was taken into the stomach may have been all discharged by -vomiting and purging, or may have been all absorbed, or decomposed; and -that which has been absorbed into the system may have been all -discharged by the excretions. - -1. It may have been discharged by vomiting and purging. Thus on the -trial of George Thom for poisoning the Mitchells, held at Aberdeen at -the Autumn Circuit of 1821, it was clearly proved, that the deceased had -died of poisoning by arsenic; yet by a careful analysis none could be -detected in the stomach or its contents; for the man lived seven days, -and during all that time laboured under frequent vomiting.[85] In a -remarkable case related by Dr. Roget, arsenic could not be found in the -matter vomited twenty-four hours after it had been swallowed;[86] in -another related by Professor Wagner of Berlin, that of an infant who -died in twelve hours under incessant vomiting after receiving a small -quantity of arsenic, none could be detected in the stomach;[87] in -another which I have described in a paper on arsenic, although the -person lived only five hours, the whole arsenic which could be detected -in the tissues and contents of the stomach did not exceed a fifteenth -part of a grain;[88] in an American Journal there is a striking case of -a grocer, who died eight hours after swallowing an ounce of arsenic, and -in whose body none could be found chemically,—at a period however -antecedent to the late improvements in analysis;[89] and in a case -communicated to me not long ago by Mr. Hewson of Lincoln, where arsenic -was given in solution, and death ensued in five hours, none of the -poison could be detected either in the contents or tissues of the -stomach by a careful analysis conducted according to the most modern -principles. - -Nevertheless, it is singular how ineffectual vomiting proves in -expelling some poisons from the stomach. Those which are not easily -soluble, and have been taken in a state of minute division, may remain -adhering to the villous coat, notwithstanding repeated and violent -efforts to dislodge them by vomiting. Many instances to this effect have -occurred in the instance of arsenic. Metzger has related a case, where, -after six hours of incessant vomiting, three drachms were found in the -stomach.[90] Mr. Sidey, a surgeon of this city, has mentioned to me an -instance of poisoning with king’s yellow, in which he found the stomach -lined with the poison, although the patient had vomited for thirty -hours. In three cases which I have investigated arsenic was detected, -although the people lived and vomited much for nearly two days;[91] and -Professor Orfila has noticed a similar instance in which that poison was -found in the contents of the stomach, although the person had vomited -incessantly for two entire days.[92] - -It is not easy to specify the period after which a poison that has -excited vomiting need not be looked for in the stomach. It must vary -with a variety of circumstances whose combined effect it is almost -impossible to appreciate, such as the solubility and state of division -of the poison, the frequency of vomiting, the substances taken as -remedies, and the like. When the poison is in solution and the patient -vomits much, an analysis may be expected to prove frequently abortive, -even though the individual survives but a few hours, as in Mr. Hewson’s -case already noticed. In other circumstances, however, as various facts -quoted above will show, poisons may frequently be found after two days -incessant vomiting; and on the whole it may be stated, that the recent -improvements in analysis render the period much longer than it has -generally been, and would naturally be imagined. Metzger has related the -case of a woman poisoned with arsenic mixed with currants, in whose -body, after eight days of frequent vomiting, he found ten or twelve -currants, which gave out an odour of garlic when burnt;[93] but here the -dose, if there was really arsenic, must have been repeated recently -before death, for it is not possible to conceive how currants could -remain in the stomach so long, whatever may be thought of the -possibility of arsenic remaining. It is farther proper to add, that -Professor Henke of Erlangen, one of the highest living authorities in -Germany, once found grains of arsenic in the gullet, although he found -none in any other part of the body, of a person who survived the taking -of the poison four days.[94] Allowing to this fact all the weight -derived from the high name of its author, I must nevertheless express -great doubt whether the arsenic was not repeated more recently before -death. - -2. The poison may have disappeared, because it has been all absorbed. It -has several times happened that in the bodies of those poisoned with -laudanum, or even with solid opium, none of the drug could be detected -after death. Sometimes indeed it is found, even though the individual -survived the taking of the poison many hours. Thus a case related by -Meyer of Berlin, in which the person lived ten hours after taking the -saffron-tincture of opium; and nevertheless it was detected in the -stomach by a mixed smell of saffron and opium.[95] But more commonly it -all disappears, unless the dose has been very large. In a case of -poisoning with laudanum, which I examined here along with Sir W. -Newbigging in 1823, none could be detected, although strong moral -circumstances left no doubt that laudanum had been swallowed seven or -eight hours before death. An instance of the same kind has been minutely -related by Pyl. It was that of an infant who was poisoned with a mixture -of opium and hyoscyamus, and in whose stomach and intestines none could -be detected by the smell.[96] Similar observations have been often made -on animals; and several additional cases of the same purport, occurring -in man, will be related under the head of opium. - -It might be of use to quote some of the numerous errors committed by -medical witnesses, in consequence of having overlooked the effect of -absorption in removing poisons beyond the reach of chemical analysis. -But not to be too prolix, I shall be content with mentioning a single -very distinct case in point, which happened at a Coroner’s Inquest in -London, in 1823. A young man one evening called his fellow-lodger to his -bedside; assured him he had taken laudanum, and should be dead by the -morrow; and desired him to carry his last farewell to his mother and his -mistress. His companion thought he was shamming; but next morning the -unfortunate youth was found in the agonies of death. The moral evidence -was not very satisfactory; but that is of little consequence to my -present object. The point in the case I would particularly refer to is -the declaration of the medical inspector, that laudanum could not have -been taken, because he did not find any by the smell or by chemical -analysis in the contents of the stomach.[97] - -3. Poisons may not be found, because the excess has been decomposed. - -Vegetable and animal poisons may be altogether destroyed by the process -of digestion. This observation will explain why sometimes no poison -could be found in cases of poisoning with crude opium or other vegetable -solids. A French physician, M. Desruelles, has related the case of a -soldier, who died six hours and a half after swallowing two drachms of -solid opium, and in whose stomach nothing was found but a yellowish -fluid, quite destitute of the smell of the drug.[98] - -Some mineral poisons, such as corrosive sublimate, lunar caustic, and -hydrochlorate of tin, are also decomposed in the stomach. But they are -not removed beyond the reach of chemical analysis. The decomposition is -the result of a chemical, not of a vital process; and the basis of the -poison may be found in the solid contents of the stomach under some -other compound form. Other poisons again may be apt to elude detection -by altering their form, by combining with other substances, without -themselves undergoing decomposition. Thus it appears from a case related -by Mertzdorff of Berlin, that, in poisoning with sulphuric acid, after -the greater part of the poison is discharged by vomiting, the remainder -may escape discovery by being neutralized: For, although he could not -find any free acid in the contents of the stomach, he discovered 4½ -grains in union with ammonia by precipitation with muriate of -baryta.[99] - -It may be also right to mention another kind of decomposition which may -render it impossible to detect a poison that has been really -swallowed—namely, that arising from decay of the body. In several recent -cases bodies have been disinterred and examined for poison months or -even years after death. In these and similar cases it would be -unreasonable to expect always to find the poison, even though it existed -in the stomach immediately after death. Some poisons, such as oxalic -acid, might be dissolved and then exude; others, such as the vegetable -narcotics, will undergo putrefaction; and others, such as prussic acid, -are partly volatilized, partly decomposed, so as to be undistinguishable -in the course of a few days only. The mineral poisons, those at least -which are solid, are not liable to be so dissipated or destroyed. Some -authors, indeed, have said that arsenic may disappear in consequence of -its uniting with hydrogen disengaged during the progress of -putrefaction, and so escaping in the form of arseniuretted-hydrogen gas; -and they have endeavoured to account in this way for the non-discovery -of it in the bodies of the people who had been killed by arsenic, and -disinterred for examination many months afterwards.[100] But the -supposition is by no means probable: at least arsenic has been detected -in the body fourteen months, nay, even seven years, after interment. For -farther details, on this curious topic, the reader may turn to the -article Arsenic. - -On the whole, the result of the most recent researches is that the -effect of the spontaneous decay of dead animal matter in involving -poisons in the general decomposition appears to be much less -considerable than might be anticipated. For this most important -medico-legal fact, the toxicologist is indebted to the experimental -inquiries of MM. Orfila and Lesueur.[101] The poisons tried by them -were—sulphuric and nitric acids, arsenic, corrosive sublimate, -tartar-emetic, sugar of lead, protomuriate of tin, blue vitriol, -verdigris, lunar caustic, muriate of gold, acetate of morphia, muriate -of brucia, acetate of strychnia, hydrocyanic acid, opium, and -cantharides. They found that after a time the acids become neutralized -by the ammonia disengaged during the decay of animal matter;—that by the -action of the animal matter the salts of mercury, antimony, copper, tin, -gold, silver, and likewise the salts of the vegetable alkaloids, undergo -chemical decomposition, in consequence of which the bases become less -soluble in water, or altogether insoluble;—that acids may be detected -after several years’ interment, not always, however, in the free -state;—that the bases of the decomposed metallic salts may also be found -after interment for several years;—that arsenic, opium, and cantharides -undergo little change after a long interval of time, and are scarcely -more difficult to discover in decayed, than in recent animal -mixtures;—but that hydrocyanic acid disappears very soon, so as to be -undistinguishable in the course of a few days. - -4. Lastly, the poison which has been absorbed into the system, and may -consequently be detected in certain circumstances in the textures of the -body at a distance from the alimentary canal, may also be removed beyond -the reach of analysis, by being gradually discharged along with the -excretions. It has been fully proved in recent times, that in poisoning -with arsenic the poison may be found in ordinary cases, for some days -after being swallowed, in the liver especially, but also in the other -textures, in the blood, and in the urine; but that if a flow of urine be -established and kept up, in nine or ten days, and sometimes much sooner, -it can no longer be discovered anywhere by the nicest analysis.[102] - -_Is the discovery of poison in the body or the evacuations essential to -establish a charge of poisoning?_ It was mentioned at the commencement -of the present section, that the chemical evidence is generally, and -correctly, considered the most decisive of all the branches of proof in -cases of poisoning. But some toxicologists have even gone so far as to -maintain that without chemical evidence, or rather, in more general -terms, without the discovery of poison either in the body itself or in -the evacuations,—no charge of poisoning ought to be held as proved. -This, however, is a doctrine to which I cannot assent. In the preceding -observations on the evidence of general poisoning it has been several -times alluded to as unsound; and repeated opportunities of establishing -exceptions will occur in the course of this work, under the head of -individual poisons. At present it may be well to illustrate its -unsoundness in reference to those charges of poisoning, where no -particular poison is pointed at by the medical evidence, but where a -whole class of poisons must be kept more or less in view. Even here I -apprehend there may be sufficient evidence in the symptoms and morbid -appearances, without any chemical facts,—to render poisoning so highly -probable, that in conjunction with strong moral evidence, no sensible -man can entertain any doubt on the subject. Several illustrations might -be here given; and some will be found scattered throughout the work. In -the present place a few instances will be mentioned which cannot be -conveniently arranged any where else, and which are well worthy of -notice, as being striking examples of the decision of questions of -poisoning without chemical evidence. - -A man of doubtful character and morals, well acquainted with chemistry -and medical jurisprudence, and of disordered finances, was known to -harbour a design on a friend’s wife, who possessed a considerable -fortune. At last he one morning invited the husband to breakfast with -him at a tavern; and they breakfasted, in a private apartment, on -beef-steaks, fried potatoes, eels, claret, and rum. They had scarcely -commenced the meal when his guest complained of feeling unwell; and soon -afterwards he vomited violently. This symptom continued, along with -excruciating pain in the belly, for a long time before the prisoner sent -for medical aid; indeed he did not procure a physician till the sufferer -had been also attacked with very frequent and involuntary purging. The -physician, who, before seeing his patient, had received the prisoner’s -explanation of the apparent cause of the illness, was led at first to -impute the whole to cholera caught by exposure to cold; but on returning -at seven in the evening, and finding the gentleman had been dead for an -hour, he at once exclaimed that he had been poisoned. On the body being -inspected much external lividity was found, contraction of the fingers, -and great inflammation of the stomach and intestines, presenting an -appearance like that of gangrene.[103] On analyzing some fluid left in -the stomach, no arsenic or other poison could be detected. The attention -of the inspectors was turned specially to arsenic, because the prisoner -was proved to have bought that poison, and to have made a solution of -some white powder in his kitchen not long before the deceased died. The -prisoner in his defence stated, that the deceased had been for some time -much weakened by the use of mercury, and while in this state was seized -with cholera; and he likewise attempted to make it probable that the -man, in despair at his not recovering from a venereal disease, might -have committed suicide. The council of physicians who were required to -give their opinion on the case state on the contrary, that the diseased -was a healthy man, without any apparent disposition to disease; that -there was no pretext whatever for supposing suicide; that the -inflammatory state of the stomach and bowels supplied strong probability -of poisoning with arsenic, but not certain evidence; that acute -gastritis from natural causes is always attended with constipation; that -the deceased presented symptoms of stupor and other signs of derangement -of the nervous system remarked in rapid cases of poisoning with arsenic; -that cholera is very rare at the end of November, the season when this -incident occurred; and that the poison might well be discharged by -vomiting. Although all the prisoner’s statements in defence were -contradicted by satisfactory proof, and the medical evidence of -poisoning was supported by a chain of the strongest general -circumstances, the crime was considered by the court as not fully -proved, because the prisoner could not be induced to confess, and -because poison was not actually detected in the body. But on account of -the very strong probability of his guilt, he was, in conformity with the -strange practice of German courts in the like cases, condemned to -fifteen years’ imprisonment.[104] In this instance—considering the kind -of symptoms, their commencement during a meal, the rapidity of death, -the signs of violent inflammation in the stomach after so short an -illness, and the facility with which the absence of poison in the -contents of the stomach may be accounted for, more especially if it be -supposed that the poison was administered in solution,—I consider the -medical evidence of death by poisoning so very strong, that, the general -evidence being also extremely strong, the prisoner’s guilt was fully -demonstrated. - -A case of the same kind, but of still greater interest, is that of Mary -Anne M’Conkey, who was tried at the Monaghan Assizes in 1841 for the -murder of her husband. I am indebted for the particulars to Dr. -Geoghegan, one of the principal Crown witnesses. The prisoner who had -been too intimate with another man, and had been heard to express her -intention of getting rid of her husband, was observed one day before -dinner to separate some greens for him from the plateful intended for -the rest of the family. None of the latter suffered at all. But her -husband was taken violently ill immediately after dinner, and died; and -a neighbour accidentally present, who partook, though sparingly, of the -same dish with him, was also similarly and violently affected but -recovered. The deceased before finishing the greens said they had a -disagreeable sharp taste, and was seized soon after with burning at the -heart, tenderness at the pit of the stomach, vomiting, coldness, a sense -of biting in the tongue and tingling through the whole flesh, excessive -restlessness, occasional incoherence, locked-jaw, clenching of the -hands, and frothing at the mouth; and he expired three hours after the -meal. His neighbour, two minutes after finishing his greens, experienced -a sense of pricking in the mouth and burning in the throat, gullet, and -stomach; then salivation, a feeling of swelling in the face without -actual fulness, general numbness and creeping in the skin; next -excessive restlessness, coldness of the integuments, dimness of sight, -and stupor; about an hour after the meal he became speechless, -repeatedly fainted, frothed at the mouth, and clenched his hands; -vomiting ensued, with considerable relief, and subsequently he had -frequent attacks of it, with purging, tenderness of the epigastrium, -cramps, and tingling in the flesh; and from these symptoms he recovered -so slowly as to be unable to work for five weeks. The only morbid -appearance of any note in the body of the deceased was a number of -irregular brownish-black patches on the inside of the stomach. No poison -could be detected in the contents or tissues of the stomach; none could -be discovered in the house except a corrosive-sublimate solution which -the prisoner used for a gargle; and none could be traced into her -possession. A variety of circumstances of a general nature, which are -passed over here for brevity, as not strictly appertaining to the -present view of the case, threw very great suspicion over the prisoner. -The medical witnesses deposed, that poisoning could alone explain the -medical circumstances; and Dr. Geoghegan was of opinion that death was -owing to some vegetable poison, although he could not specify the -particular substance. He suspected, however, that it was monkshood. In -these views, when consulted by him before the trial, I entirely -concurred. Considering the taste observed by the deceased at the time he -ate the greens, the rapidity with which he was taken ill afterwards, and -the very peculiar symptoms, unlike those of any natural disease with -which physicians are acquainted, and agreeing with those which are -produced by monkshood,—considering also that another individual, who -partook of the same dish with him, was similarly and simultaneously -attacked, and with a severity proportioned to the quantity he took, -while other persons who ate the same food from a different dish, did not -suffer at all,—it appears to me that poisoning was clearly established; -and I also think that the general evidence brought home the charge of -administering the poison to the prisoner. She was condemned and -executed, and confessed before execution, that she did poison her -husband, and that the substance she used was the powdered root of -monkshood, which is well known as a poison to the peasantry of Monaghan -under the name of Blue Rocket. - -It is scarcely necessary to add, that great caution must be observed in -applying the general principle here inculcated. But the opposite -doctrine, that no charge of poisoning can be established without the -discovery of poison in the body or in the evacuations, appears to me a -great error, though upheld by no mean authority. Under that doctrine few -criminals would be brought to justice, were they to resort to a variety -of vegetable poisons, which in certain seasons are within the reach of -every one. - - - SECTION IV.—_Evidence from Experiments on Animals._ - -Evidence from experiments on animals with articles supposed to contain -poison is more equivocal than was once imagined. But it may be doubted -whether some medical jurists have not overstepped the proper limits, -when they hold it to constitute little or no proof at all. - -Evidence from express experiments should rarely form part of a regular -medical inquiry into a charge of poisoning. For in the first place, to -make sure of performing an experiment well requires more experimental -skill than the generality of practitioners can be expected to possess; -then, as will seen in the sequel, evidence procured from this source can -very rarely be more than presumptive; and lastly, if the quantity of -poison in the suspected substance is great enough to affect one of the -perfect animals, it may generally be recognized to a certainty by its -physical or chemical properties. - -For these reasons it is not likely, that, in an inquiry undertaken by a -skilful toxicologist, he will put himself in the way of delivering an -opinion on the force of such evidence. But it is nevertheless necessary -for me to consider it in detail, because he may have to give his opinion -regarding experiments made inconsiderately by others, or accidents -caused by domestic animals eating the remains of substances suspected to -be poisoned. - -The matter subjected to trial may be either suspected food, drink, or -medicine; or it may be the stuff vomited during life, or found in the -stomach after death; or it may be the flesh of poisoned animals. - -1. The evidence derived from _the effects of suspected food, drink, or -medicine_ is better than that drawn from the effects of the vomited -matter or contents of the stomach. But an important objection has been -made to both, namely, that what is poison to man is not always poison to -the lower animals, and that, on the other hand, some of the lower -animals are poisoned by substances not hurtful to man. - -A good deal of obscurity still hangs over the relative effects of -poisons on man and the lower animals. There are two species, however, -whose mode of life in respect to food closely resembles our own, and -which, according to innumerable experiments by Orfila, are affected by -almost all poisons exactly in the same way as ourselves, namely, the cat -and dog, but particularly the latter. - -In general poisons act less violently on these animals; thus two drachms -of opium are required to kill a middle-sized dog,[105] while twenty -grains have killed a man, and undoubtedly less would be sufficient. It -appears that one poison, alcohol, acts more powerfully on them than on -man. There are also some poisons, such as opium, which, although -deleterious to them as well as to man, nevertheless produce in general -different symptoms. Yet the differences alluded to are probably not -greater than exist between man and man in regard to the same substances; -and therefore it may be assumed, that, on the whole, the effects of -poisons on man differ little from those produced on the dog and cat. - -The present objection is generally and perhaps justly considered a -stronger one, when it is applied to other species of animals. But it -must be confessed after all, that our knowledge of the diversities in -the action of poisons on different animals is exceedingly vague, and -founded on inaccurate research; and there is much reason to suspect, -that, if the subject is studied more deeply, the greater number of the -alleged diversities will prove rather apparent than real. Both reasoning -and experiment, indeed, render it probable, that some orders, even of -the perfect animals, such as the _Ruminantia_, are much less sensible -than man to many poisons, and especially to poisons of the vegetable -kingdom. But so far as maybe inferred from the only accurate inquires on -the subject, their effects differ in degree more than in kind. Some -exceptions will without doubt be found to this statement. For example, -oxalic acid, besides inflaming the stomach, causes violent convulsions -in animals, but in man it for the most part excites merely excessive -prostration; and opium most generally excites in man pure sopor, in -animals convulsions also. Other exceptions, too, exist by reason of -functional peculiarities in certain animals. Thus irritant poisons do -not cause vomiting in rabbits or horses, because these animals cannot -vomit; neither do they appear to cause much pain to rabbits, because -rabbits have not the power of expressing pain with energy. But -exceptions like these, and particularly such as are unconnected with -functional peculiarities, will probably prove fewer in number, and less -striking than is currently imagined. For it is, on the other hand, well -ascertained, that many, indeed most of the active poisons whose effects -have been examined by a connected train of experiments, produce nearly -the same effects on all animals whatever from the highest to the lowest -in the scale of perfection. It has been fully proved, that arsenic, -copper, mercury, the mineral acids, opium, strychnia, conia, white -hellebore, hydrocyanic acid, cyanogen gas, sulphuretted hydrogen, and -many others, produce nearly the same effects on man, quadrupeds, birds, -amphibious animals, and even on fishes and insects.[106] - -Accordingly there are cases, in which the evidence from experiments on -animals with suspected articles of food is unequivocal. For example;—a -sexton and his wife, who had got a bad name in their village in -consequence of informing against the bailiff for smuggling, and who were -on that account shunned by all the neighbours, accused the bailiff and -his wife of having tried to poison them by mixing poison with their -bread. Immediately after eating they were attacked, they said, with -sickness, griping, swelling, and dizziness; and they added, that a cat -was seized with convulsions after eating a part of it, had sprung away, -and never returned. A large portion of the loaf was therefore sent to -the Medical Inspector of the district; who reported, that it seemed -exactly similar to another unsuspected loaf;—that, although he was not -able to detect any poison, it might after all contain one,—vegetable -poison particularly;—but that he could hardly believe it did, for he fed -a dog, a cat, and a fowl several days with it, and they not only did not -suffer any harm, but even appeared very fond of it.[107] In this case it -was clear that poisoning was out of the question. On the other hand, the -effects of some poisons on man may be developed so characteristically in -animals as to supply pointed evidence. Thus, in the case of Mary -Bateman, an infamous fortune-teller and charm-worker, who after cheating -a poor family for a series of years, at last tried to avoid detection by -poisoning them, it was justly accounted good evidence, that a portion of -the pudding and the honey, supposed to have been poisoned, caused -violent vomiting in a cat, killed three fowls, and proved fatal to a dog -in four days, under symptoms of irritation of the stomach such as were -observed in the people who died.[108] - -It has been farther objected to experiments on animals with suspected -articles of food, drink, or medicine, that it is difficult to administer -poison to them in a state of concentration, and to prevent it from being -discharged by vomiting. This objection, however, may be obviated by -performing the experiment in the way recommended by Professor Orfila. A -small opening is made into the gullet, previously detached from its -surrounding connexions, the liquid part is introduced by a funnel thrust -into the opening, and the solid portion previously made into little -pellets is then squeezed down. Lastly, the gullet is tied under the -aperture. The immediate effect of the operation is merely an appearance -of languor; and no very serious symptom is observable till four or five -days at soonest after the tying of the gullet. Hence if signs of -poisoning commence within twenty-four hours, they are independent of the -injury done by the operation.[109] This process requires some adroitness -to execute it well. It cannot be tried successfully but by a practised -operator, who, for reasons already given, would hardly ever try -experiments of the kind with suspected articles. Mention is here made of -it, therefore, chiefly because it is the best mode of experimenting in -those cases in which it is necessary, as will presently be seen, to -determine disputed points in the physiology of poisons. - -I may here shortly notice a method which has been lately proposed for -detecting poisons that enter the blood, and which is founded on their -effects on animals. M. Vernière suggests that advantage may be taken of -the extreme sensibility of the medicinal leech to procure at least -presumptive evidence, when no evidence can be procured in any other -manner. He has related some experiments to prove that the leech, when -placed in the blood of dogs killed by nux-vomica, is affected even when -the quantity of the poison is exceedingly small.[110] It is extremely -doubtful whether any importance can be attached to this criterion, as -every one knows that the leech is apt to suffer from a variety of -obscure causes, and among the rest from some diseased states of the -body. - -2. In the case of _the vomited matter_ or _contents of the stomach_ -there are other and weightier objections to experiments on animals.—In -the first place, the poison which has caused death may have been either -in part or wholly vomited before-hand, or absorbed, or transmitted into -the intestines, or decomposed by the process of digestion. Secondly, -though abounding in the matter vomited or which remains in the stomach, -it may be so much diluted, as not to have any effect on an animal. And, -thirdly, the animal fluids secreted during disease are believed to act -occasionally as poisons. - -The first two objections are so plainly conclusive as scarcely to -require any illustration. It may be well, however, to mention as a -pointed practical lesson, that Professor Orfila once detected a -considerable quantity of arsenic in the contents of the stomach, where a -prior investigation had shown that the same article produced no effect -on two animals, and where the reporters from this and other -circumstances declared, that in their opinion death was not owing to -poison.[111] - -The last objection is a very important one; but there is reason for -suspecting that it has been a good deal exaggerated by medical -jurists.—Animal fluids are certainly poisonous when putrid. The repeated -and fatal experience of anatomists, together with the precise -experiments of M. Gaspard and M. Magendie,[112] leave no doubt that -putrid animal fluids, when introduced into an external wound, cause -spreading inflammation of the cellular tissue; and although Magendie -says he has found such fluids harmless when introduced into the stomach -of dogs,[113] it is probable, from their effects on man, that they will -act as irritants on animals not habituated to their use. I believe, too, -that independently of putrefaction, vomited matter or the contents of -the stomach may be apt to make dogs vomit on account of their nauseous -taste; and perhaps we may infer, that they will also cause some of the -other symptoms of poisoning with the irritants, particularly if not -vomited soon after being administered.—As to the influence of disease in -rendering the contents of the stomach deleterious, it is to be observed -that the effects just mentioned are probably owing to the influence of -disease on the secretions, but that beyond this we know very little of -the subject. In authors I have hitherto found only one fact to prove -that disease can render the contents of the stomach decidedly poisonous; -and on the negative side of the question there exists no facts at all. -Morgagni describes the case of a child who died of tertian ague, amidst -convulsions, and in whose stomach a greenish bile was found, which -proved so deleterious, that a little of it given with bread to a cock -caused convulsions and death in a few minutes, and a scalpel stained -with it, when thrust into the flesh of two pigeons, killed them in the -same manner.[114] It is not easy to say what to think of this -experiment; which, if admitted to the full extent of the conclusions -deducible from it, would lead to the admission, that disease may impart -to the secretions the properties of the most active narcotics. Farther -researches are certainly required before this admission can be made -unreservedly. - -On the whole, it appears that in the present state of our knowledge, -experiments or accidental observations on the effects of the contents of -the stomach, or of vomited matter, on animals are equivocal in their -import. At the same time it may be observed, as with regard to articles -of food, drink, or medicine, that the effects of some poisons on man may -be developed so characteristically on animals by the contents of the -stomach, as to supply very pointed evidence indeed. Of the force of this -statement the following example is a striking illustration. In the case -of a girl, who was proved to have died of accidental poisoning with -laudanum, the inspector evaporated the contents of the stomach to -dryness, made an alcoholic extract from the residue, and giving this to -several dogs, chickens, and frogs, found that they were all made -lethargic by it, some of them oftener than once, and that a few died -comatose.[115] Facts such as these, agreeing so pointedly with the known -effects of the poison suspected, appear to me to yield evidence almost -unimpeachable. - -3. The effects of _the flesh of poisoned animals_, eaten by other -animals, constitute the least conclusive of all the varieties of the -present branch of evidence. For the flesh of animals that have died of -poisoning is not always deleterious; while on the other hand flesh is -sometimes rendered so by natural causes, as will be seen in the Chapter -on Diseased and Decayed Animal Matter. - -This subject stands much in need of careful and methodic investigation. -And it is of more practical importance than might be imagined at first -sight. For the question has actually occurred in a legal inquiry in this -country,—Whether poisoning in the human subject may be caused by the -flesh of a poisoned animal? - -In regard to some poisons it is well established, that animals killed by -them may be eaten with impunity, such as game killed with the wourali -poison, or fish by cocculis-indicus. This seems the general rule. But it -is not clear that all poisons are similarly circumstanced. - -The only systematic researches hitherto undertaken on this question are -some recently made at Lucca by Professor Gianelli; of which however I -have only seen an abstract. He found that the blood, urine, and lungs of -animals poisoned with arsenic acted as a poison on small birds, such as -sparrows, whether the parts were taken from the body while the animal -was alive, or after death; but that alcohol, cherry-laurel water, -corrosive sublimate, sulphate of copper, tartar-emetic, acetate of lead, -nitrate of silver, trisnitrate of bismuth, chloride of tin, sulphate of -zinc, laudanum, acetate of morphia, strychnia, and cantharides, had no -such effect.[116] Orfila has since shown some reason for doubting the -conclusiveness of Gianelli’s investigations; and on repeating them, -obtained such results as render it doubtful whether any reliance can be -put upon experiments made upon small birds.[117] Guérard however has -ascertained, that dogs, fed on the flesh and entrails of sheep which had -taken arsenic, were attacked with vomiting and purging, became reduced -in flesh, and at length would not eat what was put before them; but none -of them perished, or seem to have been seriously ill. Arsenic was -detected in their urine.[118] - -The importance of the inquiry, which the preceding experiments are -intended to elucidate, will appear from the following singular case, for -the particulars of which I am indebted to the kindness of Mr. Jamieson -of Aberdeen, who was employed by the authorities to investigate it. An -elderly woman, who kept fowls which occasionally trespassed on a -neighbour’s fields, one morning observed four of them very sickly; and -in the course of the day they became so ill that she killed them. She -cleaned and prepared two of them for cooking, buried another, and gave -away the fourth to a beggar, who was afterwards lost sight of. Next day -soup made with the half of one of the fowls was given to a little girl, -who suffered severely from sickness and vomiting, and also to a cat, -which was similarly affected for the whole evening. On the day -afterwards the woman herself and a female lodger, took broth made with -what remained of the fowls, and also ate the gizzards; but the remainder -was thrown with the offal upon the dunghill. In the course of five or -six hours both women were attacked with severe illness. One had -sickness, vomiting and great coldness; but after encouraging the -vomiting with hot water and then taking some spirits, she got better in -the night-time, and next morning was pretty well. The other, who was the -owner of the fowls, was seized somewhat later than her friend with great -thirst and shivering, and next day with pains in the stomach, severe -sickness, and fruitless efforts to vomit. On the sixth day, when a -medical man first saw her, she had great pain throughout the abdomen, -much thirst, difficult breathing, a red, dry tongue, and a very -frequent, small pulse. Next day the pain and difficult breathing became -worse; and in the evening, after an attack of sneezing, she became -gradually insensible and motionless, in which state she remained till -the tenth day, when she expired. The stomach and intestines did not -present any distinct morbid appearance; but the vessels of the brain -were turgid, there were about two ounces of serosity in the lateral -ventricles, both corpora striata were softened anteriorly, and a clot of -blood as big as an almond was contained in the right anterior lobe of -the brain.—A judicial investigation being ordered, it was ascertained -that the fowl which the woman buried as well as the remains of the other -fowls which were thrown upon the dunghill, had been carried off. But on -searching the dunghill more carefully afterwards, the contents of one of -the crops, which had been taken out and examined by the lodger, were -discovered in the rubbish; and in the mass Mr. Jamieson detected a -considerable quantity of arsenic. - -This incident happened in 1836. More lately the same gentleman met with -another extraordinary attempt of the same kind. A farmer, about to be -married, gave directions for killing in the evening some fowls which -were to be sent to the house of his bride where the ceremony was to take -place. The killing of them however was accidentally delayed; and next -morning, on the hen-house door being opened, the fowls ran furiously to -the well, drank water incessantly, and died in an hour. On examining the -bodies, Mr. Jamieson found arsenic in large quantity in their crops and -gizzards. - -On each of these occasions a particular individual came under suspicion; -but the evidence against them was too slight to justify the authorities -in bringing a formal charge; and consequently the proceedings did not go -farther. In the former instance the evidence in favour of the flesh of -poisoned animals being sometimes poisonous is strong; and the history of -the woman’s case, although death seems to have been caused directly by -apoplexy, renders it probable that even dangerous results might accrue. - -The preceding remarks will enable the medical witness to know under what -circumstances accidental observations or intentional experiments on -animals furnish satisfactory proof. - -Before quitting the subject, however, I have to add, that there is -another purpose, besides procuring direct evidence, to which experiments -with animals may be applied with great propriety;—namely, the settling -disputed questions regarding the physiological and pathological -properties of a particular poison. The science of toxicology is not yet -by any means so perfect, but in particular cases topics may arise, which -have not hitherto been investigated, and which it may be necessary to -determine by experiment. Experiments on animals instituted for such -purposes by a skilful toxicologist are not liable to any important -objection. On the trial of Charles Angus at Liverpool in 1808, for -procuring abortion and murder by poison, a trial of great interest, -which will be referred to more particularly afterwards, it appeared from -the evidence of the crown witnesses, that the poison suspected, -corrosive sublimate, could not be discovered in the stomach by certain -methods of analysis; and that, although corrosive sublimate is a -powerful irritant, the villous coat of the stomach was not inflamed. But -then it was proved by experiments made by one of their number, Dr. -Bostock, that animals might be killed with corrosive sublimate without -the stomach being inflamed, and without the poison being discoverable -after death by the tests he used in the case.[119] An attempt was made -on the side of the prisoner to throw out this line of evidence as -incompetent, on the ground of the discrepant effects of poisons on man -and on the lower animals. But it was admitted by the judge, on the plea -that it was only to illustrate a general physiological fact, and not to -infer proof of poisoning. The importance of experiments on animals to -settle incidental physiological questions has lately been again -acknowledged in a very pointed manner in an English court of law: for a -set of experiments, to settle the question of the rapidity with which -hydrocyanic acid acts, was instituted before the trial by the medical -witnesses, at the request of the judge who was to try the case.[120] - - - SECTION V.—_Of the Moral Evidence._ - -It is not my object to treat under this head of the moral evidence -generally, which is required to establish a charge of poisoning. But as -it is well known that in criminal trials medical witnesses have for the -most part nothing to do with the moral proof, while at the same time in -cases of poisoning the medical and moral circumstances are always -intimately interwoven and apt to be confounded together, it is necessary -for me to specify those particulars of the moral evidence, which either -require some medical skill to appreciate them, or fall naturally under -the cognizance of the physician in his quality of practitioner. I shall -enter into greater details under this section than may perhaps appear to -the medical reader necessary, chiefly that I may redeem the pledge given -in the introduction to the lawyer and general reader, and endeavour to -show how powerful an instrument a medico-legal investigation may become -in skilful hands, for throwing light on almost every branch of the -evidence. - -The moral or general proof in charges of poisoning is almost always -circumstantial only. The circumstances of which it usually consists -relate, 1. To suspicious conduct on the part of the prisoner before the -event, such as dabbling with poisons when he has nothing to do with them -in the way of his profession, or conversing about them, or otherwise -showing a knowledge of their properties not usual in his sphere of -life:—2. To the purchase or possession of poison recently before the -date of the alleged crime, and the procuring it in a secret manner, or -under false pretences, such as for poisoning rats when there are none on -his premises, or for purposes to which it is never applied:—3. To the -administration of poison either in food, drink, medicine, or -otherwise:—4. To the intent of the prisoner, such as the impossibility -of his having administered the poison ignorantly, or by accident, or for -beneficial purposes, alleged or not alleged:—5. To the fact of other -members of the family besides the deceased having been similarly and -simultaneously affected:—6. To suspicious conduct on the part of the -prisoner during the illness of the person poisoned,—such as directly or -indirectly preventing medical advice being obtained, or the relations of -the dying man being sent for, or showing an over-anxiety not to leave -him alone with any other person, or attempting to remove or destroy -articles of food or drink, or vomiting matter which may have contained -the poison, or expressing a foreknowledge of the probability of speedy -death:—7. To suspicious conduct after the person’s death, such as -hastening the funeral, preventing or impeding the inspection of the -body, giving a false account of the previous illness, showing an -acquaintance with the real or supposed effects of poison on the dead -body:—8. To the personal circumstances and state of mind of the -deceased, his death-bed declaration, and other particulars, especially -such as tend to prove the impossibility or improbability of suicide:—9. -To the existence of a motive or inducement on the part of the prisoner, -such as his having a personal quarrel with the deceased, or a hatred of -him,—his succeeding to property by his death, or being relieved of a -burthen by it,—his knowing that the deceased was with child by him. - -Upon many of the particulars now enumerated, important evidence may be -derived from the medical part of the investigation; and not unfrequently -such evidence can be collected or appreciated only by means of a -medico-legal inquiry. - -1 and 2. On the first two articles, suspicious conduct or conversation -on the part of the prisoner before the crime, and the possession or -purchase of poison by him, little or nothing need be said. The medical -witness may of course be asked whether the conduct or conversation -proved betokens an unusual acquaintance with poisons and their effects. -And his opinion may be referred to regarding the nature of suspected -articles found in the prisoner’s possession. As to the purchase of -arsenic under the false pretence of poisoning rats, it may be observed, -that a great deal more stress is usually laid on such evidence than it -seems to deserve; for there are few houses, in the country particularly, -which are not more or less infected by them. On the other hand, too -little weight is attached to the circumstance of the purchaser not -having warned his household of poison being laid. Such conduct ought in -my opinion to be accounted extremely suspicious; for so far as I have -remarked, the fear with which unprofessional persons regard the common -poisons is such, that I can hardly believe any master of a house would -actually lay poison without warning the servants and other inmates of -his having done so. - -3. The next article, which relates to the proof of the administration of -poison, will require some details. - -Direct proof of the administration of poison by the actual giver is very -rarely attainable, that part of the transaction being for the most part -easily concealed. The proof of this point is justly accounted, however, -a very important part of the evidence; nay, on some recent trials in -this country the prosecution has failed apparently for want of such -evidence, although the case was complete in every other particular. It -is generally constituted by a chain of circumstances, and these are -often strictly medical, as will now be shown by a few examples. - -In the first place, pointed evidence as to the individual who gave the -poison may be derived from the chemical investigation,—for example, from -the comparative results of the analysis of the poisoned dish, and of the -articles of which it consisted. I am indebted to my colleague, Dr. -Alison, for the following excellent illustration from the case of -William Muir, who was condemned at Glasgow in 1812 for poisoning his -wife. In the course of the day on which she took ill she was visited by -a farmer of the neighbourhood, who had studied physic a little in his -youth. He learned from her that she had breakfasted on porridge a short -time before she felt herself ill, and that she suspected the porridge to -have been poisoned. He immediately procured the wooden bowl or _cap_ in -which the cottagers of Scotland keep the portion of meal used each time -for making the porridge; and finding in it some meal, with shining -particles interspersed, he wrapped a sample in paper, and took the -proper measures for preserving its identity. He then secured also a -sample from the family store in a barrel. The two particles were -produced by him on the trial; and from experiments made in court the -late Dr. Cleghorn was enabled to declare, that the meal from the bowl -contained arsenic, and that the meal from the barrel did not. These -facts, besides proving that the woman had next to a certainty taken -arsenic in the porridge, likewise, in conjunction with other slight -moral circumstances, established that the poison had been mixed with the -meal in the house, and on the morning when the deceased took ill, before -any stranger entered the house. The procedure of this farmer was -precisely that which ought to be followed by the medical practitioner in -a similar conjuncture. - -An instance of an opposite description related by M. Barruel also -deserves notice, as showing how evidence of this kind may afford, in -otherwise suspicious circumstances, a strong presumption of accidental -poisoning. Sixteen people near Bressières in France having been severely -affected with vomiting and colic immediately after dinner, the bread, -which was suspected, was examined by Barruel, and found to contain a -little arsenic. The flour of which the bread was made had been taken -from a large store of it, which, on being examined, was also found to be -similarly impregnated. As it was extremely improbable that any one -either could or would poison so large a mass of flour, to attain any -malicious object, it was inferred that the arsenic had been mixed with -it accidentally, and that the accident might have arisen from grain -having been taken by mistake to the flour-mill to be ground, which had -been intended originally for seed, and sprinkled with arsenic to destroy -insects.[121] - -It may be worth while observing, in the present place, that in the -instance of poisoned wine very important evidence may be obtained by -examining whether the wine with which the cork is impregnated contains -any traces of the poison. This method of investigation occurred to me in -a very singular case of poisoning with arsenic in champagne, which -happened in a baronet’s family in Scotland. In this instance, however, -such analysis was proved to be unnecessary; for the gentleman himself -brought the bottle from his cellar, broke the wires and drew the cork, -immediately before the wine was drunk.[122] - -All evidence of the like nature, though it is at present often procured -from other sources, should, for obvious reasons, be invariably -collected, if possible, with the aid of a medical person. If again a -medical man is called to a patient evidently affected with suspicious -symptoms, and finds himself obliged to declare such to be his opinion, -his thoughts, as soon as he has given directions for the treatment, -should be turned towards that part of the evidence, for the securing of -which he is naturally looked to as the person best qualified by previous -education and his opportunities at the moment. With this view, -therefore, having ascertained in what articles it is possible for poison -to have been administered, he should at once endeavour to secure the -remains of the particular portion partaken of by his patient, as well of -the general dish, if it is an article of food, and of the ingredients of -which the dish was ostensibly made, not forgetting the salt with which -it was seasoned. A case occurred some years ago in the north of -Scotland, in which arsenic was administered in porridge by mixing it -with the salt. - -It is of great consequence, before proceeding to analyze such articles, -for example suspected dishes,—to be particular in investigating every -thing connected with the cooking, serving, and eating of them. By doing -so, not only will the chemical analysis be facilitated, but likewise -facts in it will be accounted for, which might otherwise prove -embarrassing, and even lead to the drawing of false conclusions from the -result of the analysis. This statement is very well exemplified by the -following incident which occurred to myself. In 1827 a family in -Portobello were poisoned by the maid-servant; and it was believed, that, -for the sake of a trick, she had, while carrying to the oven the beef -subsequently used at dinner, maliciously mixed with it tartar-emetic or -some other poison. One-half of the beef having been preserved, and two -persons of the family having been very severely affected, Dr. Turner and -I, to whom the case was remitted, made little doubt that we should -discover the poison by chemical analysis: but we did not. Being -subsequently employed by the sheriff to inquire into the particulars, I -found that the poison had been mixed with the gravy, which had been -consumed almost to the last drop,—that the gravy had been poured over -the beef,—that the upper half of the beef had been eaten,—and that the -remainder which we analysed had been transferred upon a different plate -from that on which it was served for dinner. These particulars accounted -sufficiently for the poison not having been discovered. - -Another mode in which the chemical part of the inquiry may contribute to -discover the individual who administered the poison is by a comparative -examination of the persons of the deceased and the accused. The -following very pointed illustration has been published by MM. Ollivier -and Chevallier of Paris.—A woman who lived on bad terms with her husband -was found dead on a roadside the morning after having been seen drunk in -his company in the neighbourhood. The mouth, throat, and gullet were -proved by a careful analysis to be corroded with nitric acid, the stains -and traces of which were also found on various parts of her dress, and -on the hair, neck, and arms, but not on her hands, and not lower down -the alimentary canal than the upper fourth of the gullet. Ollivier, -suspecting from these appearances, that she had not taken the acid -voluntarily, requested to see the husband; whereupon there were found on -his coat, trousers, and hands, a great number of stains, which, like -those on the deceased, were proved by chemical analysis to have been -produced by nitric acid. Here it was scarcely possible to avoid -inferring, that the man got these stains while endeavouring to force his -intoxicated wife to take the poison Marks of nail scratches were also -observed round the mouth and on the throat; whence it was reasonably -inferred, that, having failed in his original plan, he had suffocated -her with his hands.[123] - -While these illustrations are given of the conclusiveness of the -chemical evidence in fixing the administration of poison on a particular -individual, it is essential likewise to observe that the same kind of -evidence may be at times equally conclusive of the innocence of a person -unjustly suspected. This obvious and important application of a chemical -inquiry is forcibly suggested by the following particulars of an -incident related by M. Chevallier:—An individual was accused by a woman -of having tried to poison her; and she represented that he had put the -poison into her soup, while it stood from one day to another in an iron -pot. On making a careful analysis of some of the soup which remained, -Chevallier found it so strongly impregnated with copper, that, supposing -the sulphate was the salt mixed with the soup, ten ounces must have -contained twenty-two grains. It then occurred to him, that it was -important to examine the iron pot, in which the poisoned soup was -represented to have been kept; for the probability was that a large -quantity of the copper, if any salt of that metal had really been -contained in the soup, would have been thrown down by the superior -affinity of the iron, and consequently that a coppery lining would be -found on the inside. He was led, however, to anticipate that no copper -would be found there, because there was no iron dissolved in the soup, -as would have been the case if copper had been precipitated from it by -the iron of the pot. And accordingly he not only found no copper lining -the inside of the pot; but likewise, on following the process described -by the accuser as the one pursued in cooking the soup and in -subsequently poisoning it, he satisfied himself by express trial that -there was nothing in the circumstances of the case which could have -prevented the iron from exerting its usual action on the salts of -copper. These conclusions, coupled with certain facts of general -evidence, proved substantially that the suspected person had nothing to -do with the crime charged against him; and he was therefore -discharged.[124] A case somewhat similar will be related under the head -of Imputed Poisoning. - -In the second place, evidence as to the person who administered the -poison may be procured by considering the commencement of the symptoms, -in relation to the time at which particular articles have been given in -a suspicious manner by a particular individual. The import of facts of -this nature can be properly appreciated only by the medical witness; for -he alone can be acknowledged as conversant with the symptoms which -poisons produce, the intervals within which they begin to operate, and -the circumstances in which their operation may be put off or -accelerated. - -Few cases will occur in which it is not possible to procure evidence of -the kind, when diligently sought for. It is often too very decisive in -its operation on judicial proceedings. In the case of Margaret Wishart -tried at the Perth Spring Circuit in 1827 for poisoning her blind -sister, a man who lodged with the prisoner and cohabited both with her -and with the deceased, appeared at first from general circumstances to -be implicated in the crime. He had left the house, however, on the -morning of the day before that on the evening of which the deceased took -ill; and he did not return till after her death. Now her illness -commenced suddenly and violently; and arsenic was the poison which -caused it.[125] It was quite clear, therefore, that the poison could not -have been administered, at least in a dangerous dose, so early as the -day before she was taken ill; and such I stated to be my opinion, on a -reference from the Lord Advocate. The evidence being also otherwise -insufficient, the man was set at liberty. In the case of Mrs. Smith -tried here in February of the same year, this branch of the evidence was -made the subject of question under more doubtful circumstances. The -deceased certainly died of poisoning with arsenic, and the prisoner was -strongly suspected of being the poisoner for many reasons, and among -others because, on the evening before the morning on which the deceased -took ill, the prisoner gave her in a suspicious manner a white-coloured -draught. Here the possibility of the draught having been the cause of -the symptoms must be admitted. But as they did not appear for eight -hours after the draught was taken, I stated in my evidence that it was -improbable the dose, if it contained arsenic at all, contained a -quantity sufficient to cause the violent symptoms and death which -followed.[126] - -The correspondence in point of time between the appearance of symptoms -of poisoning, and the administration of suspicious articles by an -individual, constitutes still more decisive proof in a set of cases, in -which it is of great value, as the chemical evidence is generally -defective,—namely, where poisoning is attempted with repeated moderate -doses. If the several renewals or exacerbations of illness correspond -with the periods when suspicious articles have been given by the same -individual, the circumstantial evidence of the administration may be -even tantamount to direct proof. Thus, on the trial of Miss Blandy for -the murder of her father, it was proved, that Mr. Blandy on several -occasions, after the prisoner received certain suspicious powders from -her lover, was taken ill with vomiting and purging; and that on two -occasions recently before his death, when he got from his daughter a -bowl of gruel which contained a gritty sediment, he was attacked after a -very short interval with pricking and heat in the throat, mouth, -stomach, and bowels,—with sickness, vomiting, gripes, and bloody -diarrhœa.[127] Here the proof of administration by the prisoner was -complete. - -These examples will show how the evidence of a particular person’s -criminality may be affected by the relation subsisting in point of time -between the commencement of the symptoms and the suspicious -administration of particular articles. But farther, the special period -at which the symptoms begin may even at times supply strong evidence of -his instrumentality, although there may be no direct proof from general -evidence of his having been concerned in administering anything whatever -in a suspicious manner. This statement is well exemplified by the case -of Mrs. Humphreys, who was convicted at the Aberdeen Autumn Circuit in -1830 for poisoning her husband, by pouring sulphuric acid down his -throat while he was asleep. It was clearly proved, as will be seen under -the head of sulphuric acid, that the deceased died of this poison; and -the administration was brought home to the prisoner in the following -singular manner. The only inmates of the house were the deceased, the -prisoner, and a maid-servant. The deceased got a little intoxicated one -evening at a drinking party in his own house; and after his friends all -left the house, and the street-door was barred inside, he went to bed in -perfect health, and soon fell fast asleep. But he had slept scarcely -twenty minutes, when he suddenly awoke with violent burning in his -throat and stomach; and he expired in great agony towards the close of -the second day. Now sulphuric acid, when it occasions the violent -symptoms observed in this instance, invariably excites them in a few -seconds, or in the very act of swallowing. It was, therefore, impossible -that the man could have received the poison at the time he was drinking -with his friends; and as he knew he had not taken any thing else -afterwards, and it was fully proved that he had been asleep before his -illness suddenly began,—it followed that the acid must have been -administered after he fell asleep, the accomplishment of which was -rendered easy by a practice he had of sleeping on his back with his -mouth wide open. But, after he gave the alarm, the door was found barred -as when he went to bed. Consequently no one could have administered the -poison except his wife or servant; and it was satisfactorily proved, -that no suspicion could attach to the latter. Such was one of the -principal train of circumstances, which, as it were by a process of -elimination, led to the inference that the wife was undoubtedly the -person who administered the poison. Other circumstances of a similar -tendency were also derived from the medical evidence; but these it is -unnecessary to detail at present. I have related the particulars of the -whole case fully elsewhere.[128] The prisoner strenuously denied her -guilt after being sentenced, but confessed before her execution. - -4. The next article in the moral evidence relates to the intent of the -person who is proved to have administered poison. When the -administration is proved, little evidence is in general required to -establish the intent. It is sufficient that the giver knew the substance -administered was of a deadly nature; and in regard to any of the common -poisons this knowledge is sufficiently constituted by his simply knowing -its name. - -In some cases, however, the exact nature of the poison is not -established with certainty; and then something else may be required to -prove the prisoner’s knowledge, and through that knowledge his intent. -In the case of Charles Munn, formerly alluded to [p. 50], arsenic was -the poison presumed to have been taken by the deceased. But the purchase -or possession of it by the prisoner was not for some time satisfactorily -established; neither was there any chemical evidence, the deceased -having lived forty days and upwards after taking the poison. It was -proved, however, that whatever it was which had been administered, the -prisoner knew very well that what he gave was deleterious; because he -persuaded the deceased, who was pregnant by him, to take it by assigning -to it properties which no drug either possesses, or is so much as -thought by the vulgar to possess. On one occasion he persuaded her that -it would show whether she was with child, and on another that it would -prevent people from knowing she was with child. In such cases, then, -good evidence may be derived from the arguments used by the giver to -persuade his victim to take the poison; and sometimes, as in the -instance now mentioned, it will lie with the medical witness to inform -the court whether or not the reasons assigned are false. - -Sometimes it has been pleaded by the prisoner that he gave the poison by -mistake. In all such cases, if he descends to particulars, which he -cannot help doing, there is every likelihood that the falsehood of the -defence will be made evident by the particulars of the story not -agreeing with other particulars of the moral or medical evidence. At -present it is only necessary to allude to inconsistencies in his story -with the medical facts. No general rules can be laid down on the method -of investigating a case with a view to evidence of this kind: I must be -satisfied with an illustration from an actual occurrence. On the trial -of Mr. Hodgson, a surgeon, at the Durham Autumn Assizes in 1824, for -attempting to poison his wife, it was clearly proved, that pills -containing corrosive sublimate, and compounded by the prisoner, were -given by him to her in place of pills of calomel and opium, which had -been ordered by her physician. But it was pleaded by him, that, being at -the time intoxicated, he had mistaken, for the shop-bottle which -contained opium, the corrosive-sublimate bottle which stood next it. -This was certainly an improbable error, considering the opium was in -powder, and the sublimate in crystals. But it was not the only one which -he alleged he had committed. Not long after his wife took ill, the -physician sent the prisoner to the shop to prepare for her a laudanum -draught, with water for the menstruum. When the prisoner returned with -it, the physician, in consequence of observing it to be muddy, was led -to taste it, before he gave it to the sick lady: and finding it had the -taste of corrosive sublimate, he preserved it, analyzed it, and -discovered that it did contain that poison. The prisoner stated in -defence, that he had a second time committed a mistake, and instead of -water had accidentally used for the menstruum a corrosive-sublimate -injection, which he had previously prepared for a sailor. This was -proved to have been impossible; for the injection contained only five -grains to the ounce, while the draught, which did not exceed one ounce, -contained fourteen grains.[129] - -I believe it must be allowed, that, as the medical inquiries preparatory -to trial are commonly conducted without the inspector being made -acquainted with the moral circumstances in detail, it is rarely possible -for him to foresee what points should be attended to, with the view of -illustrating the intent. But the case now related will show that it is -impossible for him to render his inquiries too minute or comprehensive; -and more particularly, it shows the propriety of ascertaining, whenever -it is possible, not only the nature but likewise the quantity of the -poison. - -5. The next article among the moral circumstances,—the simultaneous -illness of other members of the family besides the person chiefly -affected,—depends for its conclusiveness almost entirely upon the -researches and opinion of the medical witnesses. - -The fact, that several persons, who partook of the same dish or other -article, have been seized about the same time with the same symptoms, -will furnish very strong evidence of general poisoning. A few diseases, -such as those which arise from infection or from atmospheric miasmata, -may affect several persons of a family about the same time; and -hysteria, and epilepsy, have been communicated to several people in -rapid succession.[130] But I am not aware, that, among the diseases -which resemble well marked cases of poisoning either with irritants or -with narcotics, any one ever originates in such a way as to render it -possible for several persons in a family to be attacked simultaneously, -except through the merest and therefore most improbable accident. -Cholera perhaps is an exception. But when cholera attacks at one time -several people living together, it arises from bad food, and is properly -a variety of poisoning. In such cases, too, the fallacy may in general -be easily got the better of, by finding that the store or stock, from -which the various articles composing the injurious meal have been taken -was of wholesome quality. - -Hence it may be laid down as a general rule, that, perhaps if two, but -certainly if three or more persons, after taking a suspected article of -food or drink, are each affected with symptoms, furnishing of themselves -presumptive evidence of poisoning, and have been seized nearly about the -same time, and within the interval after eating within which poisons -usually begin to act,—the proof of poisoning is decisive. Several late -cases might, in my opinion, have been decided by this rule. Thus it -might have decided the important case of George Thom tried at Aberdeen -in 1821 for poisoning the Mitchells, and likewise that of Eliza Fenning, -about whose condemnation some clamour was made in London in 1815. In -both instances, as will be mentioned under the head of arsenic, the -symptoms were developed so characteristically, that from them alone -poisoning with arsenic might have been inferred almost to a certainty. -But even if the symptoms had been somewhat less characteristic, all -doubt of general poisoning was set aside by the fact, that four persons -in the former case, and five in the latter, were similarly and -simultaneously affected, and all of them at an interval after eating, -which corresponded with the interval within which arsenic usually begins -to act. - -Sometimes it happens, that while one or more of a party at a certain -meal suffer, others escape. Such an occurrence must not be hastily -assumed as inconsistent with poison having been administered at that -meal. For the guilty person may have slipped the poison into the portion -taken by the individual or individuals affected. - -If it be proved that all who ate of a particular dish have suffered, and -all who did not have escaped, the kind of moral evidence now under -review becomes strongest of all. It is well for the medical jurist to -remember also, that such evidence is very useful in directing him where -chiefly he should look for poison. - -At other times it happens that the several people affected, suffer in -proportion to the quantity taken by each of a particular dish. Too much -importance ought not to be attached to the absence of that relation; for -it has been already mentioned that habit, idiosyncrasy, and the state of -fulness of the stomach at the time, will modify materially the action of -poisons. But when present, it will often form strong evidence.—A good -illustration of what is now said may be found in the case of Thomas -Lenargan, tried in Ireland for the murder of his master, Mr. O’Flaherty. -He had for some time carried on an amour with O’Flaherty’s wife; and -afterwards, to get rid of the troublesome surveillance of the husband, -contrived to despatch him by poison. The crime was not suspected for two -years. Among the facts brought out on the trial the most pointed were, -that O’Flaherty’s daughter and two servants were affected at the same -time with the very same symptoms as himself; that they had partaken of -the same dish with him; that the severity of their several complaints -was in proportion to the quantity each had taken; and that others of the -family, who did not eat it, were not affected.[131] - -Another remarkable instance of this kind has been recorded by Morgagni. -A clergyman, while travelling in company with another gentleman and two -ladies, was setting out one afternoon to resume his journey after dining -at an inn, when he was suddenly taken ill with violent pain in the -stomach and bowels, and soon after with vomiting and purging. One of the -ladies was similarly affected, but in a less degree; and likewise the -other gentleman, though in a degree still less: but the other lady did -not suffer at all. Morgagni found, that this lady was the only one of -the party who had not tasted a dish of soup at the commencement of -dinner. But he was puzzled on finding that the gentleman who suffered -least had taken the largest share of the soup, while the clergyman had -taken less than either of the two that were seized along with him. He -then remembered, however, that in the district where the accident -happened, it was the custom to use scraped cheese with the soup in -question; and on inquiry he was informed that they had each added to the -soup a quantity of cheese proportioned to the severity of their illness. -Here, therefore, Morgagni was led to suspect the presence of poison; and -accordingly, after the whole party had fortunately recovered, the -innkeeper acknowledged, that in the hurry of preparation, he had served -up to his guests cheese seasoned with arsenic to poison rats.[132] This -interesting anecdote shows, that the truth in such cases is not always -to be discovered without minute inquiry and considerable adroitness. In -the case of poisoning with arsenic in wine formerly alluded to,—where -all the individuals at table, to the amount of six, were severely -affected during dinner,—the soup was the article suspected, because all -had partaken of it; and, accordingly, the soup and vomited matter were -sent to me for analysis. On detecting a trace of arsenic in the vomited -matter, but none in the soup, I suggested that some other article might -have been used in common by the party, and mentioned the wine as a -probable article of the kind. It turned out that all had drunk a single -glass of champagne from a particular bottle; and in the wine remaining -in this bottle arsenic was found in the proportion of half a grain per -ounce.[133] - -Cases of this nature are so instructive that no apology need be made for -mentioning one example more which lately came under my own notice. In -the case of Mary Anne Alcorn, convicted here in the summer of 1827, of -having administered poison to her master and mistress (a case already -referred to for another purpose, p. 75), it was proved that a white -powder was introduced in a suspicious manner into the gravy of baked -beef, which gravy was subsequently poured over the beef. Now the master -of the family dined heartily on beef, potatoes and rice-pudding, and -mixed the greater part of the beef gravy with his pudding; the mistress -ate moderately of the first slices of the beef, took very little gravy, -even to the beef, and none at all to the pudding; a little girl, their -niece, dined on pudding alone, without gravy; and the prisoner dined -after the family on the beef and potatoes. Accordingly the master -suffered so severely as for two or three days to be in danger of his -life, the mistress was also severely, but by no means so violently -affected, the little girl did not suffer at all, and the servant had -merely slight pain and sickness at stomach. The evidence thus procured -was exceedingly strong, more particularly when coupled with the fact, -that the beef used was half of a piece, the other half of which had been -used by the family two days before, without any ill consequences. - -6. The next article of the moral evidence relates to suspicious conduct -on the part of the prisoner during the illness of the person poisoned. -Under this head it is necessary merely to state what I conceive to be, -with reference to the present branch of the proof, the duty of the -medical practitioner who happens to attend a case of poisoning. - -In such a conjuncture he is undoubtedly placed in a situation of some -delicacy. But on considering the matter attentively, good reasons will -appear why he should adopt the course, which, I believe, our courts of -justice will expect of him, and keep some watch over the actions of any -individual who is suspected of having committed the crime. On the one -hand, no one else is by education and opportunities so capable of -remarking the motions of the different members of the family -dispassionately, without officiousness, and without being observed. And -on the other hand, it is undoubtedly a part of his private duty as -practitioner, to protect his patient against any farther criminal -attempts, as well as part of his public duty to prevent the vomited -matter and other subjects of analysis from being secretly put away or -destroyed. No one can be so occupied without many accessary particulars -coming under his notice. And certain it is, that on several trials the -practitioner has contributed, with great credit to himself, a -considerable part of the pure moral proof. For an example of discreet -and able conduct under these trying circumstances, the reader will do -well to refer to that of Dr. Addington, the chief crown witness, both as -to medical and moral facts, in the case of Miss Blandy.[134] It is -almost unnecessary to add, that in acting as now recommended, the -physician must conduct himself with circumspection, in order to avoid -giving unnecessary offence, or alarming the guilty person. - -7, and 9. On the seventh article, which respects the conduct of the -prisoner after the death of the deceased, and on the ninth, which -relates to the existence of a motive or inducement to the crime, nothing -need be said here. But on the - -8th article of the moral evidence,—comprehending the death-bed -declaration of the deceased, his state of mind, his personal -circumstances and other points which prove the possibility or -impossibility of voluntary poisoning—a few remarks are required, because -an important and little understood part of the practitioner’s duty is -connected with this branch of the proof. - -The question as to the possibility of the poisoning being voluntary is -one upon which the medical attendant will be expected to throw some -light, and into which he will also naturally inquire for his own -satisfaction. In doing so his attention will be turned to circumstances -purely moral, which may not only decide that question, but may also -criminate a particular individual. His inquiries must therefore be -conducted with discretion, and for obvious reasons should be confined as -much as possible to the patient himself. They are to be conducted not so -much by putting questions, as by leading him to disburden his mind of -his own accord; and it is well to be aware, that there is no one of whom -a patient is so ready to make a confident on such an occasion as his -medical attendant. - -If disclosures of consequence are made, and the attendant should feel it -his duty to look forward to the future judicial proceedings and to the -probability of his appearing as a witness, he ought to remember the -general rule is, that his account of what the patient told him is not -evidence in the eye of the law, unless it was told under the -consciousness of the approach of death. Of late, however, the rigour of -this principle in law has been occasionally departed from in Scottish -practice; and in regard to medical facts ascertained in the way here -mentioned, many strong reasons might be assigned for such relaxation. -Evidence of the kind is technically called the death-bed declaration of -the deceased, and is justly accounted very important. - -Here it is right to take notice of a part of the death-bed evidence, -although it does not properly belong to the question of suicide, because -it should always be collected if possible by the medical attendant, and -with much greater care than is generally bestowed on it even by him—I -mean the history of the symptoms previously to his being called in. On -this part of the history, including particularly the time and manner in -which the illness began, medical conclusions of extreme consequence are -often subsequently founded: On a single fact or two may depend the fate -of the prisoner. It is not enough, therefore, in my opinion, that such -evidence formed a part of the death-bed declaration. If a fact derived -at second hand from the deceased, and stated too by him from memory, is -a material element of any of the medical opinions on the trial, it is of -much importance that the information be procured by a medical man; and -that the person who procured it, whether professional or not, was aware -at the time of the probability of its becoming important. Such evidence, -although not collected with these precautions, is admissible; but I have -so often had occasion to witness the carelessness with which the -previous history of cases is inquired into both in medical and -medico-legal practice, that I do not see how it is possible to put trust -in evidence of the kind, unless it bear marks of having been collected -with care, and under an impression of its probable consequence. These -statements are well illustrated by the following example:—On the trial -of Mrs. Smith for poisoning her maid-servant with arsenic, it was proved -that some drug was administered by the prisoner in a suspicious manner -on a Tuesday evening. Now it appeared at the trial improbable that this -drug contained a fatal dose of arsenic, because to her fellow-servants, -of whom one slept with her, and others frequently visited her, the -deceased did not appear to be ill at all for eight hours after, or -seriously ill for nearly a day. On the contrary, however, a surgeon, who -was called to see her on the following Saturday, a few hours before her -death, deposed that, according to information communicated by herself, -she had been ill with sickness, vomiting, purging, and pain in the -stomach and bowels since the Tuesday evening. This evidence, if it could -have been relied on, would have altered materially the features of the -case, as it would have gone far to supply what all the medical witnesses -considered defective, namely, proof of the administration. But at the -time the surgeon made his inquiries, he did not even suspect that the -girl laboured under the effects of poison. Neither he therefore nor his -patient could have been impressed with that conviction of the importance -of the information communicated, which was necessary to insure its -accuracy, particularly as it related to a matter usually of so little -consequence in ordinary medical practice as the precise date of the -commencement of an illness; and it would consequently have been rash to -adopt it in face of more direct and contrary evidence. Any one who -examines the details of this trial as I have reported them, will at once -see how much the case turned on the point now alluded to.[135] - - - - - CHAPTER III. - OF IMAGINARY PRETENDED, AND IMPUTED POISONING. - - -The present seems the most convenient place for noticing the general -mode of procedure by which the medical jurist may detect cases of -imaginary, feigned, and imputed poisoning. It is by no means easy to lay -down rules for the investigation of cases suspected to be of such a -kind. But an attempt will be made to state the leading points to be -attended to, and to illustrate them by the circumstances of a few -examples of each variety. - -_Imaginary poisoning_ should rarely be the occasion of deception or -embarrassment. The same wandering of the imagination which has led to a -belief of injury from poison, will commonly also lead to such -extravagant notions relative to the mode of administration and the -symptoms, as will infallibly point out the true nature of the case to -one who is well acquainted with the real effects of poisons. It is easy, -nevertheless, to conceive cases which may be embarrassing; and -certainly, in every instance, the physician should proceed in his -inquiries with caution. - -It appears to me that in the first place, without seeming to take up at -once the conviction of his patient, he should scrupulously abstain from -treating it lightly, and should on the whole act rather as if he -suspected poison had been given. Allowing his patient therefore -apparently credit for the truth of his suspicions, the medical attendant -should request him to give a full history of existing symptoms, of their -origin and progress, of their relation in point of time to various -meals, and of the mode and vehicle in which the supposed poison was -administered. No unprofessional person can possibly go through such a -narrative, without stating many circumstances which are wholly -irreconcilable with the idea of poisoning generally, and still more of -the administration of a particular poison. - -I have met with two instances of imaginary poisoning, the nature of -which was thus at once made obvious by a host of impossibilities in the -narrative of the patient. One of these may be here given as an example. -An elderly lady, who had certain expectancies of the death of a -relation, conceived that the family of her relative had resolved to -defraud her of her supposed rights. She afterwards imagined that an -attempt was made to poison her, and camphor was the poison she fixed on -as the article which had been administered. In its general or moral -particulars the narrative was all plausible and suspicious enough; but -unluckily for its consistency, she stated that the poison could only -have been given in wine,—that she did not remark any particular taste in -the wine,—that her illness did not begin till the day after she took it; -and although she alleged, without any leading question on my part, that -camphorous perspiration was exhaled on the subsequent day, the whole -train of symptoms differed entirely in every other respect from a case -of poisoning, and resembled closely in their origin and progress a case -of slight general fever. The incompatibility of her story with the idea -of poisoning with camphor will be readily understood by referring to -what is afterwards said of the effects of that substance. - -_Feigned_ or _pretended poisoning_ is more apt to escape suspicion, and -when suspected is commonly more difficult to develope satisfactorily; -for the actor has it in his power to lay his plans with care, and even -to become acquainted with the properties of the poisons whose effects he -intends to feign. Still he can rarely enact his part so well as to -deceive a skilful physician both by existing symptoms and by his history -of their origin and progress; much less can he contrive his scheme so -adroitly that it shall not be unfolded by the refinements of chemical -analysis. - -The investigation of such a case will be directed of course in the first -instance to the state and progress of the symptoms. Here, as in -imaginary poisoning, it is of moment to conceal from the individual the -suspicion entertained of his falsehood. For even if a person who has -actually taken poison knows he is unjustly suspected of feigning, it is -not improbable that he might try to mend his story with impossibilities, -and so lead the physician into error. In a case of feigned poisoning an -excellent mode of investigation is, after hearing out the individual’s -own story, to put a number of questions involving an alternative answer, -one alternative being compatible and the other incompatible with the -alleged nature of his illness. No unprofessional person can stand such a -system of interrogation, if skilfully pursued. Not only will his answers -be often wrong; but likewise his manifest perplexity how to answer will -of itself supply evidence of falsehood. - -In the next place, great attention must be paid to the chemical -analysis. A person who feigns poisoning will commonly produce the -poisoned remains of a dish, or some other article, which he represents -himself to have swallowed. Sometimes the substance contained in it will -prove on analysis not to be poison at all, as in an instance I remember -reading some years ago in a London newspaper of pretended poisoning with -arsenic, where the dregs of a bowl of gruel contained, not arsenic, but -finely pounded glass. Sometimes the quantity of a real poison contained -in the remains of a dish may indicate, in what is said to have been -swallowed, a portion wholly incompatible with the mildness or severity -of the symptoms. Sometimes the vomited matter, even the matter first -vomited, may not contain any of the alleged poison. Sometimes poison -found in matter alleged to have been vomited may yield compounds during -analysis which are not animalized, showing that it never was in the -stomach. Sometimes the quantity of poison contained in such matter may -be greater than that alleged to have been taken. Sometimes the quantity -contained in the first matter vomited may be less than that contained in -what is vomited or said to be vomited subsequently. By these and many -other such inconsistencies the falsehood of the story may be -unequivocally unfolded. - -The following example will illustrate some of the rules now laid down. A -young married female, in the seventh month of pregnancy, having been -discovered by her friends to be secretly addicted to dram-drinking, -appeared to be much annoyed in consequence of the discovery; and one -evening was found apparently very ill by her husband on his return from -work. She represented that she had taken arsenic with a view to -self-destruction, that she was in great torture, and that she was sure -she must soon die. It was accordingly found, on reference to a -neighbouring apothecary, that she had the same forenoon purchased about -a drachm and a half of arsenic for the pretended purpose of poisoning -rats; and in the bottom of a teacup, in which she said she mixed it, -there was left a small quantity of white powder, that proved on analysis -to be pure oxide of arsenic. Notwithstanding these strong facts, the -mildness of the symptoms and the composure with which she complained of -her tortures led her friends to suspect she was feigning. On -investigating her case I first ascertained, in farther corroboration of -her story, that the powder was nowhere to be found. But she then stated -in reply to questions involving an alternative answer, that the arsenic -had a sour taste, and that the pain began in the lower part of the -belly, and spread upwards. She likewise said that she vomited a mouthful -or two into a chamber-pot twenty minutes after taking the poison; that -she vomited no more till the apothecary was sent for, who gave her -emetics of sulphate of zinc, carefully preserving the discharges; and -that she only vomited when emetics were given. When I first saw her, -five hours after the alleged date of the taking of the arsenic, the skin -was warm and moist, the face full and flushed, the pulse frequent and -firm, the muscular strength natural. The chamber-pot contained only a -small quantity of the fæces of a child and apparently a little water, -but no vomited matters, and no white powder. The fluid discharged in -presence of the apothecary was found on careful analysis to contain a -large quantity of zinc, but not an atom of arsenic. She gradually -recovered from the illness under which she laboured at the time I saw -her, and in two days she admitted she was quite well, but continued to -insist that she had taken the poison.—M. Tartra has related a singular -case of the same kind, where a young woman feigned poisoning with nitric -acid, and was not detected for several days.[136] - -_Imputed poisoning_ differs in general from feigned poisoning only in so -far as the symptoms which are feigned are imputed to the agency of -another. - -The imputation of the crime of poisoning by feigning or actually -producing the symptoms, and contriving that poison shall be detected in -the quarters where in actual cases it is usually sought for, has been -not unfrequently attempted. Two important continental cases have already -been referred to for other purposes [pp. 66, 76]; and I may here relate -the heads of two English cases, which are of great interest, and will -serve to illustrate the mode of procedure in such circumstances. - -The first of these, which I have related elsewhere in detail,[137] is a -striking example of the power of science in eliciting the truth, and -redounds highly to the credit of Mr. Thackrah, the medical gentleman who -conducted the investigation. - -Samuel Whalley was indicted at York Spring Assizes in 1821, for -maliciously administering arsenic to Martha King, who was pregnant by -him. The woman King swore, that the prisoner, after twice trying, but in -vain, to prevail on her to take drugs for the purpose of procuring -abortion, sent her a present of tarts, of which she ate one and a -half,—that in half an hour she was seized with symptoms of poisoning -with some irritant poison,—and that she continued ill for a long time -after. Mr. Thackrah found arsenic in the tarts that remained untouched, -and likewise in some matter that was vomited in his presence after the -administration of an emetic, as well as in other vomited matters which -were preserved for him between his first and second visits. Her -appearance, however, did not correspond with the complaint she made of -her sufferings, her pulse and tongue were natural, and on careful -investigation the following inconsistencies were farther detected. 1. -She said she felt a coppery taste in the act of eating the tarts, a -taste which arsenic certainly does not possess. 2. From the quantity of -arsenic in the tarts which remained she could not have taken above ten -grains, while even after repeated attacks of vomiting, the alleged -matter subsequently preserved contained nearly fifteen grains. 3. The -matter first vomited contained only one grain, while the matter alleged -to have been vomited subsequently contained fifteen grains. 4. The time -at which these fifteen grains were alleged to have been vomited was not -till between two and three hours after the symptoms began; in which case -the symptoms would before that time have been in all probability -violent. The prisoner was acquitted, and the prosecutor and another -woman who corroborated her deposition afterwards confessed that they had -entered into a conspiracy to impute the crime to him, because he had -deserted her on finding she was too intimate with other men. - -Another case not less interesting in its details was communicated to me -by my colleague Dr. Traill, who was consulted by the medical attendant, -Mr. Parr of Liverpool. A man accused his sister-in-law of administering -poison in his tea. He stated that he was seized with pain in the stomach -and uneasiness in the head half an hour after taking the tea; and when -visited soon after, the countenance was anxious, the skin pallid, the -pulse frequent, the throat red; and while Mr. Parr was examining the -throat, a quantity of matter was vomited, containing a white, gritty, -crystalline substance, which was afterwards ascertained to be oxalic -acid. The following circumstances, however, proved that the poison could -not have been given in the tea. The man alleged that he remarked in the -very first mouthful an acrid taste, followed by sweetness, which is not -the taste of oxalic acid. Notwithstanding this warning, he drank the -greater part of the tea. He stated that the poison was dissolved in the -tea, yet he vomited some oxalic acid in the solid form. Granting he was -mistaken in supposing the whole poison dissolved, the quantity swallowed -must in that case have been large; and nevertheless the symptoms were -mild, though no vomiting took place for about an hour, and next day he -was almost well. Four other individuals had tea at the same time from -the same tea-pot, without sustaining any harm; and what remained of the -infusion did not contain any oxalic acid. Finally, his niece took what -he left of his tea in the cup, without remarking any unusual taste; and -in the unwashed cup not a trace of oxalic acid could be detected. It was -quite plain, therefore, that the man’s accusation was false; and certain -points of general evidence, coupled with the medical facts, afterwards -proved that he must have taken the oxalic acid himself. - -It has been alleged, that attempts have been made to impute the crime of -poisoning by introducing poisonous substances into the body after death; -and although I have not been able to find any actual instance of such -ingenious atrocity mentioned by authors, it must be acknowledged to be -quite possible; and the medical jurist should therefore be prepared for -the requisite investigations. Every case may be clearly made out by -attending to the relative effects of poisons on the dead and on the -living tissues;—a subject which will receive some notice under the head -of the principal poisons in common use. - - - - - PART SECOND. - OF INDIVIDUAL POISONS. - - - - - CHAPTER I. - OF THE CLASSIFICATION OF POISONS. - - -After the preliminary observations on General Poisoning, I proceed next -to treat of Poisons Individually. The subsequent remarks will be -confined in a great measure to the most common poisons, which will be -examined minutely. The rest being mere objects of curiosity, and hardly -ever taken by man either intentionally or by accident, it will be -sufficient to point out their leading properties. - -It may be well to point out in the first instance the poisons in most -general use. These will appear from the following Tables. The first is -compiled from a Parliamentary Return of the cases of fatal poisoning -brought before the coroners of England in two years ending with 1838. - - 1. _Arsenical_ White arsenic 185 - Yellow arsenic 1 - —— 186 - 2. _Acids_ Sulphuric acid 32 - Nitric acid 3 - Oxalic acid 19 - —— 54 - 3. _Mercurials_ Corrosive sublimate 12 - White mercury 1 - Turbith-mineral 1 - Mercury (?) 1 - —— 15 - 4. _Other mineral irritants_ Tartar-emetic 2 - Sulphate of iron 1 - Chloride of tin 1 - Subacetate of lead 1 - Bichrom. of potash 1 - Percussion powder 1 - Carbonate of potash 1 - Black-ash 1 - —— 9 - 5. _Veget. irritants_ Colchicum 3 - Hellebore 1 - Savin 1 - Cayenne 1 - Castor seeds 1 - Morison pills 1 - —— 8 - 6. _Anim. irrits._ Cantharides 2 - 7. _Opium_ Opium or Laudan. 180 - Opium & nitric acid 1 - Poppy-syrup 4 - Godfrey’s Cordial 6 - Morphia 1 - Acetate of morphia 1 - —— 193 - 8. _Hydrocyanic acid_ Med. Hydroc. acid 27 - Do. and Laudanum 1 - Ess. oil of Almonds 5 - Bay-leaves 1 - —— 34 - 9. _Other veget. Narcotics_ Nux-vomica 3 - Strychnia 2 - Belladonna 2 - Hemlock 1 - Monkshood 2 - Spirits 4 - Fungi 4 - —— 18 - 10. _Narcot. gases._ Coal-gas 2 - 11. Unascertained 22 - ——— - Total 543 - -In France, in seven years, from 1825 to 1831, inclusive, there were 216 -trials for poisoning, at which 273 persons were charged with the crime, -and only 102 condemned. In 94 cases occurring between November 1825 and -October 1832, the substances employed were as follows.[138] - - Arsenic 54 - Orpiment 1 - Verdigris 7 - Corrosive sublimate 5 - Fly-powder 3 - Tartar-emetic 1 - Sulphate of zinc 1 - Acetate of lead 1 - Cerusse 1 - Mercurial ointment 1 - Cantharide - Nux-vomica 4 - Opium 1 - Sulphuric acid 1 - Nitric acid 1 - Unascertained 5 - -In the subsequent seven years there were 218 trials, and 153 prisoners -condemned. Among 194 of these the following were the poisons used.[139] - - Metallic arsenic 5 - Arsenious acid 132 - Arsenite of copper 1 - Compounds of copper 13 - Corrosive sublimate 10 - Artificial orpiment 3 - Sulphate of zinc 1 - Tartar-emetic 1 - Cerusse 1 - Sulphuric acid 5 - Nitric acid 2 - Muriatic acid 1 - Hydrocyanic acid 1 - Ammonia 1 - Belladonna 1 - Opium 3 - Morphia 1 - Nux-vomica 1 - Cantharides 10 - -In Denmark, in five years ending with 1835, there were 99 cases of -poisoning of all sorts, 16 by arsenic, 74 by sulphuric or nitric acid, 4 -by potash, 1 by an unascertained caustic substance, 2 by opium, 1 by -litharge, and 1 by copper. Only 5 cases, namely, 3 by arsenic and 2 by -sulphuric acid, were cases of murder, or attempt to murder.[140] - -The classification of poisons has hitherto defied the ingenuity of -toxicologists. Formerly it was thought sufficient to arrange them in -three great classes, according as they are derived from the mineral, the -vegetable, or the animal kingdom. It is evident, however, that the only -sound basis of arrangement is their action on the animal economy; for -such a classification is the only one which can be useful in practice. -Now, when we consider what has been said on their mode of action, or the -symptoms produced in consequence of that action, it must at once be -perceived, that no system founded on either of these circumstances can -be logically correct. It would be very desirable, if their mode of -action could be adopted as the basis of arrangement; but both reasoning -and experience have proved this to be impracticable. One very distinct -class indeed might be formed of purely local poisons, comprehending the -mineral acids, the fixed alkalies, and one or two of their chemical -compounds. But a vast proportion of the other poisons which act locally -have also a general or remote action; and on the other hand there are -few of the latter description which do not likewise act locally. Hence -if all which possess this double action were arranged in one class, that -class would include nine-tenths at least of known poisons; so that, in -truth, the labour of classification would still remain to be overcome. - -It would be even more fruitless to attempt an arrangement of poisons -according to their medium of action; for no sure criterion is known, by -which a poison acting through direct transmission of an impulse along -the nerves can be distinguished from one that acts by entering the -blood. - -Neither is the embarrassment of the toxicologist materially less, if he -attempts to classify poisons according to the symptoms they induce in -man. This is the principle now generally followed, and which in common -with others I shall pursue. But the reader will be at no loss to -discover that the partitions which separate the classes are exceedingly -slight, and that very many poisons might be arranged without impropriety -in either of two classes. - -The preceding statements show the impossibility of founding a good -system of arrangement on the only basis which can be acknowledged -philosophical and practical; and consequently, that, as the science of -toxicology now stands, we must altogether despair of forming one that -shall be even moderately satisfactory. - -On the whole I see no reason for deviating from the classification -adopted in the first edition of the present work, being a modification -of that previously followed by Professor Orfila. In this classification -poisons are divided into irritants, narcotics, and narcotic-acrids. - -The class of irritants includes all poisons whose sole or predominating -symptoms are those of irritation or inflammation; the narcotics those -which produce stupor, delirium, spasms, paralysis, and other affections -of the brain and nervous system; and the narcotico-acrids those which -cause sometimes irritation, sometimes narcotism, sometimes both -together. Some writers still adopt a fourth class, called septics, -because they give rise to putrefaction in the living body. But modern -physiology will scarcely sanction the continuance of such a class of -poisons. For assuredly no substance can cause putrefaction in the living -body. - - - - - CHAPTER II. - CLASS FIRST. - ON IRRITANT POISONS GENERALLY. - -The class of irritant poisons comprehends all whose sole or predominant -action consists in exciting irritation or inflammation. That is, it -comprises both those which have a purely local, irritating action, and -likewise many which also act remotely, but whose most prominent feature -of action still is the inflammation they excite wherever they are -applied. - -This subject will be introduced with an account of the general symptoms -and morbid appearances caused by the irritants, and a comparison of -these with the symptoms and morbid appearances of the natural diseases -which are chiefly liable to be confounded with irritant poisoning, or -mistaken for it. - - -SECTION I.—_Of the Symptoms of the Irritant Poisons, compared with those - of natural diseases._ - -The symptoms caused by the irritating poisons, taken internally, are -chiefly those of violent irritation and inflammation of one or more -divisions of the alimentary canal. - -The mouth is frequently affected, especially when the poison is easily -soluble, and possesses a corrosive as well as irritating power. The -symptoms referrible to the mouth are pricking or burning of the tongue, -and redness, swelling and ulceration of the tongue, palate, and inside -of the cheeks. - -The throat and gullet are still more frequently affected; and the -affection is commonly burning pain, sometimes accompanied with -constriction and difficulty in swallowing, and always with redness of -the visible part of the throat and gullet. - -The affection of the throat and mouth precedes every other symptom when -the poison is an active corrosive, and more particularly when it is -either a fluid poison or is easily dissolved. Nay, sometimes burning -pain of the mouth, throat, and gullet occurs during the very act of -swallowing.—On the contrary if the poison is soluble with difficulty, -and is only an irritant, not a corrosive, and still more if it is only -one of the feebler irritants, the throat is frequently not affected -sooner than the stomach, occasionally not at all. - -The stomach is the organ which suffers most invariably from the -operation of irritant poisons. The symptoms referrible to their -operation on it are acute and general burning pain, sometimes -lancinating or pricking pain,—sickness, vomiting, tenderness on -pressure, tension in the upper part of the belly, and occasionally -swelling. Of these symptoms the sickness is generally the first to -develope itself. In the instance of corrosive irritants pain commonly -commences along with it. The matter vomited is at first the contents of -the stomach, afterwards tough mucus, streaked often with blood and -mingled with bile, frequently clots of purer blood. The powerful -corrosives affect the stomach the moment they are swallowed; irritants -which are either liquid or very soluble also affect it very soon; but -the more insoluble irritants, such as arsenic, generally do not begin to -act till half an hour or even more than a whole hour has elapsed.—The -stomach may be affected without any other part of the alimentary canal -participating in the injury; but much more frequently other parts suffer -also, and in particular the intestines. - -The action of irritant poisons on the intestines is marked by pain -extending over the whole belly, sometimes even to the anus. This pain, -like that of the stomach, is often a sense of burning; but it is also -frequently a pricking or tearing pain, and still more frequently a -twisting, intermitting pain like that of colic. It is seldom attended -with much swelling, but often with tension, and tenderness of the whole -belly; and at times the inflammatory state of the mucous coat of the -intestines is clearly indicated by excoriation of the anus and prolapsus -of the rectum, which is of a bright red colour. The pain of the bowels -is most generally attended by purging, rarely with constipation, -frequently with tenesmus. The matter discharged, after the alimentary -and feculent contents have passed, is chiefly a mucous fluid, often -abundant, often also streaked with blood or mixed with considerable -quantities of blood. In some cases the intestines are affected when no -other part of the alimentary canal suffers, not even the stomach. But -much more generally the stomach and intestines are affected together. - -In a few very aggravated cases of poisoning with the irritants the whole -course of the alimentary canal, from the throat to the anus, is affected -at one and the same time. - -The symptoms now briefly enumerated are accompanied in almost every -instance with great disturbance of the circulation—quick, feeble -pulse—excessive prostration of strength,—coldness, and clammy moisture -of the skin. - -The other symptoms, which are often united with the preceding, do not -belong to the irritants as a class. Perhaps, however, among the symptoms -of the class may be mentioned those of irritation and inflammation of -the windpipe and lungs, and those of irritation in the urinary organs. A -great number of the irritant poisons cause hoarseness, wheezing -respiration, and other signs which indicate the spreading of the -inflammation of the throat to the windpipe: some likewise cause darting -pains throughout the chest: and not a few are very apt to cause -strangury and other signs of inflammation of the urinary passages. - -Of the effects of the irritants when applied externally little need be -said at present. Their most striking external symptoms will be noticed -under the head of one of the orders of this class, the vegetable acrids. -In the chapter on the local action of poisons some account was given of -the several effects which are produced by the application of poisons to -the skin. It is there stated that some produce merely redness, that -others cause blistering, that others bring out a crop of deep-seated -pustules, that others corrode the tissues chemically, and so give origin -to a deep slough, and that others excite spreading inflammation of the -cellular tissue under the skin and between the muscles. - -Such is a general view of the symptoms caused by the irritant poisons. -This topic will be afterwards taken up in detail under the head of the -several species. At present an important subject remains for -consideration, namely, the natural diseases whose effects are apt to be -mistaken for the effects of poison. The remarks now to be made might be -extended to many diseases. In fact, they might be extended to all which -prove fatal suddenly, for all such diseases are apt in peculiar -circumstances to give rise to a suspicion of poisoning. But those only -will be here noticed which occasion the greatest embarrassment to the -medical jurist, and which are most likely to come under his review in -courts of law. They are the following:—Distension and rupture of the -stomach; rupture of the duodenum, biliary ducts, uterus, or other organs -in the belly; the effects of drinking cold water; bilious vomiting and -common cholera; malignant cholera; inflammation of the stomach; -inflammation and perforation of the intestines; inflammation of the -peritonæum; spontaneous perforation of the stomach; melæna and -hæmatemesis: colic, iliac passion and obstructed intestine. - -1. _Distension of the Stomach._—Mere distension of the stomach from -excessive gluttony may cause sudden death. Generally indeed the symptoms -and appearances in the dead body show that death is the consequence of -apoplexy; but sometimes not. In order to preserve the continuity of the -succeeding remarks on the diseases of the stomach which imitate -poisoning, it may be useful to consider in the present place all the -varieties of the effects of distension. - -Excessive distension of the stomach, then, sometimes causes sudden death -by inducing apoplexy, which is commonly of the congestive kind,—that is, -without rupture of vessels. Mérat has related an instructive case of -this kind. A man in good health, while greedily devouring an excellent -dinner, became suddenly blue and bloated in the face; a clammy sweat -broke out over his body; and he died almost immediately. On dissection -the stomach was found enormously distended with food, and the vessels of -the brain were so gorged, that the brain appeared too large to be -contained within the skull.[141] - -There is reason, however, to suppose that death from distension is the -consequence not always of apoplexy,—but sometimes of an impression on -the stomach itself. Sir Everard Home relates the case of a child, who, -being left by its nurse beside an apple-pie, was found dead a few -minutes afterwards, and in whose body no appearance of note could be -discovered, except enormous distension of the stomach with the pie.—A -still more distinct case in point forms the subject of a medico-legal -report by Wildberg. A corpulent gentleman died suddenly fifteen minutes -after dinner; and as he lived on bad terms with his wife, a suspicion -arose that he had been poisoned. His wife said that he fell asleep -immediately after dinner; but had not slept many seconds, when he -suddenly awoke in great anguish, called out for fresh air, exclaimed he -was dying, and actually expired before his physician, who was instantly -sent for, could arrive. Wildberg found the stomach so enormously -distended with ham, pickles, and cabbage-soup, that, when the belly was -laid open, nothing could be seen at first but the stomach and colon. -Some white powder, found on the villous coat of the stomach, was at -first suspected to be arsenic; but it proved on analysis to be merely -magnesia, which the gentleman had been in the habit of taking -frequently. The diaphragm was pushed high into the chest by the -distended stomach. There was not any particular congestion in the brain. -Wildberg very properly ascribed death to simple over-distension of the -stomach.[142]—In all such cases the symptoms may be suspicious; but when -carefully considered they can scarce be said to resemble closely the -effects of irritant poisoning; and at all events the appearances in the -dead body will at once distinguish them. - -2. _Rupture of the Stomach_ is not a common occurrence; but it sometimes -imitates in its symptoms the effects of the irritant poisons. - -It is generally the consequence of over-distension, combined with -efforts to vomit. The cause of it seems to be, that the abrupt turn -which the gullet makes in entering an excessively distended stomach acts -as a valve, so that the contents cannot be discharged by vomiting. A -case of this kind is related by M. Lallemand in his Inaugural -Dissertation at Paris in 1818.[143] A woman convalescent from a tedious -attack of dyspepsia, being desirous to make amends for her long -privations as to diet, ate one day to satiety. Ere long she was seized -with a sense of weight in the stomach, nausea, and fruitless efforts to -vomit. Then she all at once uttered a piercing shriek, and exclaimed -that she felt her stomach tearing open; afterwards she ceased to make -efforts to vomit, soon became insensible, and in the course of the night -she expired. In the fore part of the stomach there was a laceration five -inches long; and a great deal of half-digested food had escaped into the -cavity of the abdomen. The coats of the body of the stomach were -healthy; but the pylorus or opening into the intestines was indurated; -which had been the cause of her dyspepsia. - -In other cases of death from rupture the laceration is caused not by the -accumulation of food, but by the accumulation of gases arising from -depraved digestion, constituting a disease almost the same as that which -attacks cattle that have fed on wet clover. A singular example of this -rare affection, in which death was preceded by the symptoms of irritant -poisoning, has been noticed by Professor Barzelotii.[144]—Another case, -which appears to have been of the same kind, is mentioned in a late -French journal. A child, a twelvemonth old, after eating cabbage-soup, -died during the night unperceived by its mother. On the body being -examined, a great quantity of fetid gas escaped from the abdomen, and a -smooth laceration like an incised wound, three inches in length, was -found in the lesser arch of the stomach.[145] - -In other cases, however, it is not easy to say what occasions the -injury. An instance, for example, has been related, where the accident -followed the drinking of a little shrub and water. The individual, a man -of middle age, who had been long liable to fits of severe pain in the -stomach, going off with vomiting, was suddenly seized the day after one -of his fits with violent pain in the epigastrium, extreme tenderness and -tension of the muscles, and for a short time with violent vomiting. In -seventeen hours he expired. On dissection a dark-brown fluid was found -in the cavity of the belly, and the fore part of the stomach presented a -laceration four inches long. There were likewise several lacerations, -one of them three inches long, which intersected the peritonæal coat -alone.[146] A case probably similar in nature has been described by Dr. -Roberts of London, that of a man who died of convulsions in five hours, -and presented after death a long rent in the stomach, with escape of its -contents into the general cavity of the belly.[147] - -Another rare variety of rupture of the stomach must also be particularly -noticed, because the course of the symptoms imitates very closely a case -of poisoning with the irritants. It is _partial rupture_,—or laceration -of the inner coat only. A very interesting case of that description has -been related by Mr. Chevallier. A youth of fourteen, on the evening -after a Christmas feast, at which he ate and drank heartily, was -attacked with violent and frequent vomiting. Next morning he said he -felt as if the blood in his heart was boiling, he was unable to swallow, -the pulse became irregular, and pressure on the heart or stomach gave -him excruciating agony. These symptoms continued till the following day, -when he vomited two pounds of blood at successive intervals, and soon -afterwards expired. The inner coat of the stomach was torn in many -places, and that of the duodenum was lacerated almost completely round. -No other disease existed in the bowels or elsewhere.[148] - -Some of the cases now mentioned could hardly be distinguished from the -effects of certain irritant poisons by the symptoms only. But the morbid -appearances in the stomach will at once determine their real nature. - -Rupture of the stomach, it may be observed, does not always occasion the -symptoms hitherto related. Sometimes it causes instant death. Thus a -healthy coal-heaver in London, while attempting to raise a heavy weight, -suddenly cried out, clapped his hand over his stomach, drew two deep -sighs, and died on the spot. On dissection a lacerated hole was found in -the stomach, big enough to admit the thumb; and the stomach did not -contain any food.[149] This case, along with those of Dr. Roberts and -Mr. Weekes, will show that rupture may take place without previous -distension. - -3. _Rupture of the Duodenum_ is a very rare accident from internal -causes. The following instance resembles considerably the symptoms of -irritant poisoning. A gentleman, 48 years old, quarrelled violently with -another while playing billiards immediately after dinner. Soon -afterwards he was seized suddenly with violent pain in the stomach, -vomiting, cold extremities, and a failing pulse; and he died very soon. -The mucous coat of the duodenum was found much inflamed, and four inches -and a half from the pylorus there was a lacerated hole involving a third -of the circumference of the gut.[150] - -4. Under the next head may be classed rupture of the other organs of the -belly. _Rupture of the Biliary Ducts_ for example, an extremely rare -accident, has been known to imitate the symptoms of irritant poisoning, -as the following case will show.—An elderly lady, after a slight attack -of jaundice, was seized with violent pain in the stomach, and vomiting -recurring in frequent fits, and in seventeen hours with extreme -tenderness, tension of the muscles, coldness of the skin, and failure of -the pulse. She expired in twenty-four hours; and after death the hepatic -duct was found torn across, a gall-stone lay at the opening of the -cystic duct, the peritonæum was here and there inflamed, and three -pounds of blood and bile were effused into the cavity of the -abdomen.[151]—The nature of such cases will be always apparent on -dissection, but by no means always from the symptoms. - -In like manner _rupture of the uterus or its appendages_ may in certain -circumstances occasion similar symptoms, and so be mistaken for the -operation of poison. A striking example of the kind once came under my -notice. A middle-aged woman much addicted to drinking, and on that -account living on indifferent terms with her husband, was suddenly -seized at two in the afternoon with pain in the belly, afterwards with -vomiting and purging, then with extreme exhaustion and coldness of the -extremities; and at ten in the evening she expired. A suspicion of -poisoning having arisen in the neighbourhood, a judicial inspection was -ordered by the sheriff of Linlithgowshire, where the case happened; and -the examination was entrusted to her medical attendant, Mr. Robertson, -and myself. On inquiry, it was found that she had taken nothing whatever -after breakfasting at eight in the morning, six hours before; and -farther, that the pain had begun violently in the lower part of the -belly. These two circumstances alone were almost, if not altogether, -incompatible with the idea of irritant poisoning having been the -occasion of death. But all doubt was completely removed by the -inspection of the body; for the lower part of the belly was filled with -a great quantity of clotted blood, which had proceeded from the rupture -of a Fallopian conception. - -5. The next accident which may be noticed on account of its being liable -to be mistaken for the effects of poison is _sudden death from drinking -cold water_. - -In Britain the most common form of death from this cause appears to have -been instant death, arising from the impression on the stomach. It is -not an uncommon thing for people to drop down instantaneously and die on -the spot, in consequence of drinking freely of cold water or other -fluids while over-heated.[152] There is an interesting report on a case -of this kind by Pyl in his Memoirs and Observations. The individual had -been quarrelling with a companion, and in the height of a fit of violent -passion swallowed a glass of beer; when he dropped down senseless and -motionless, and died immediately. His wife suspecting the administration -of poison, demanded a judicial inquiry; but nothing was found in the -body to account for death. Pyl therefore came to the conclusion that the -man died from the sudden impression caused by the cold beer.[153] Dr. -Currie, after quoting several instances of the like kind, relates the -following remarkable case which occurred to himself. A young man, having -just sat down, panting and bathed in sweat, after a severe match at -tennis, drank greedily from a pitcher of water fresh drawn from a -neighbouring pump. Suddenly he laid his hand on his stomach, bent -forward, became pale, breathed laboriously, and in a few minutes -expired.[154] - -But when combined with exposure to a burning sun, as in hot climates, -drinking cold water when the body is over-heated seems often to excite -along with irritation in the stomach congestive apoplexy. Dr. Watts has -given a good account of these effects as they occurred in the -neighbourhood of New York during the hot season of 1818. During the -summer of that year the thermometer often stood in the shade so high as -92°; and the labourers in consequence could not be restrained from -drinking frequently and excessively of cold water. Many were attacked -with pain in the stomach, sickness, giddiness, and fainting; next with -difficult breathing, and rattling in the throat; then with apoplexy; and -not a few perished.[155] These symptoms are very like the effects of -some narcotico-acrid poisons. - -Lastly, drinking cold water sometimes causes symptoms more nearly allied -to those of the pure irritants. Thus some persons, on eating ices, or -drinking iced-water, or cold ginger-beer in the hot days of summer, are -attacked with violent colic. Others in the like circumstances are -attacked with violent fits of vomiting.[156] Haller has even mentioned -an instance of a man, who after swallowing a large draught of cold water -while over-heated, was seized with symptoms of acute gastritis, and died -in fifteen days: and in the dead body the stomach was found gangrenous -and ulcerated at its fundus.[157] M. Guérard relates a similar case, -that of a quarter-master who, swallowing iced-beer after a hurried -journey in a hot day, was attacked in six hours with shivering, then -with heat and tightness in the pit of the stomach, vomiting of every -thing he took, anxiety, thirst and frequency of the pulse; next with -extreme prostration, cessation of pain, hiccup, and lividity of the -face; and he expired in five days. Signs of inflammation were found in -the stomach, such as great redness internally, with spots of -extravasation, and a blackish matter like what he vomited.[158] Cholera -has also been sometimes referred to the same cause. In the hot summer of -1825 it was remarked that a great number of persons who used to frequent -a particular coffee-house in the Palais-Royal at Paris, and the owner -among the rest, were severely affected with cholera. Poison being -suspected to be the cause, a judicial inquiry was instituted. It was -proved, however, that similar accidents had been observed at other -coffee-houses, in other cities, and likewise in former hot seasons; and -when the whole medical evidence was referred to a commission of -physicians and chemists, they gave their opinion, that the disease was -owing to the incautious use of ices and iced-water in an unusually hot -summer.[159] Perhaps cholera arising thus may prove fatal. The following -extraordinary case, which appears to have been of this nature, was -communicated to me by the late Dr. Duncan, junior. A bookbinder in this -city, previously in excellent health, rose one morning at six to kindle -his fire, and took a large draught of cold water from a pitcher used in -common by the whole family. He went immediately to bed again, -complaining of pain in the pit of the stomach, and extreme anxiety, and -affected with incessant vomiting. In twelve hours he died without any -material change in the symptoms, and no disease whatever could be -detected in the dead body. Dr. Duncan satisfied himself from general -circumstances, that poisoning was quite out of the question; so that, -however extraordinary it may appear, his death could be accounted for in -no other way than by ascribing it to the cold water.—Hoffmann says he -was acquainted with instances where fatal inflammatory fever was induced -by drinking too freely of cold water, and a suspicion of poisoning in -consequence excited.[160] - -6. _Of Bilious Vomiting and Simple Cholera._—Of all the diseases which -are apt to be confounded with the effects of the irritant poisons, there -is none which it is of so much importance that the medical jurist should -be able to distinguish as cholera. A trial for poisoning with the common -poisons hardly ever occurs, but an attempt is made to ascribe death to -that disease; for it is very frequent, and its symptoms bear a close -resemblance to those of the principal poisons of the class we are now -considering. - -It is unnecessary to give here a detailed account of the symptoms of -simple cholera. There is the same burning pain in the stomach and bowels -as in irritant poisoning, the same incessant vomiting and frequent -purging, the same tension and tenderness of the belly, the same sense of -acridity in the throat, and irritation in the anus, the same depression -and anxiety, the same state of the pulse. - -It would be wrong, however, to infer from these resemblances that the -two affections are always undistinguishable. Some cases of irritant -poisoning certainly cannot be distinguished by their symptoms from -cholera. Many other cases are similarly circumstanced, because their -particulars cannot be accurately collected. But there is no doubt that -in others the distinction between poisoning and cholera may be drawn by -the physician who has been able to ascertain the symptoms in detail. At -present those points of difference only will be noticed which relate to -the irritants as a class; others will be mentioned under the head of -poisons individually. - -The first difference is, that in cholera the sense of acridity in the -throat does not precede the vomiting, as it sometimes does in poisoning. -In cholera this sensation is caused by the vomited matter irritating the -throat, or perhaps by the irritation in the stomach being propagated -upwards by continuity of surface. But, whatever may be its cause, it is -certain that the sense of acridity or burning sometimes remarked in -cholera never begins before the vomiting. In many cases of poisoning, -though certainly not in all, it is the first symptom.—The next -difference is, that in cholera the vomiting is never bloody. I have been -at some pains to investigate this point: and I have been unable to find -any instance of the cholera of this country, which has been accompanied -with sanguinolent vomiting; neither is such a symptom mentioned in any -accounts I have read of malignant cholera. This article of diagnosis -will, of course, be open to correction from the experience of other -practitioners. Lastly, a material difference is, that the simple cholera -of this country very seldom proves fatal so rapidly as poisoning with -the irritants usually does. Death from irritant poisoning is on the -whole seldom delayed beyond two days and a half, and frequently happens -within thirty-six hours, sometimes within six hours, or even less. -Malignant cholera frequently proves fatal in as short a time; but with -regard to the cholera of this country, I believe it may be laid down as -a rule hitherto unshaken by all the controversy to which the subject has -given rise,—that death is not often caused by it at all, and that death -within three days is very rare indeed. A few cases of death within that -period, nay, even within twelve hours, have certainly occurred; but -their great rarity is obvious from the fact, that many practitioners of -experience have not met with a single instance, and others with only one -case in the course of a long practice. Dr. Duncan, senior, mentioned to -me a case, the only one of the kind he had met with, which commenced -soon after the individual ate a sour orange in the Edinburgh theatre, -and which proved fatal in twelve hours. Dr. Duncan, junior, also met -with a single case, which was the instance already noticed of cholera -produced by drinking cold water. Dr. Abercrombie also once, and once -only, met with a case fatal within two days.[161] Mr. Tatham, a late -writer on this subject, met with an instance which proved fatal in -twelve hours.[162] Dr. Burne of London has likewise related an instance -of death within fifteen hours occurring in a child.[163] And I was -informed in 1831 of a case at Leith which ended fatally in twenty-six -hours, and was at first supposed by the unprofessional inhabitants of -the place to be an instance of epidemic or malignant cholera. My -colleagues, Drs. Home, Alison, and Graham, never met with an instance -fatal in so short a time as two or three days; at a meeting of the -Medico-Chirurgical Society of this city, none of the members present -could remember to have seen such a case;[164] and of the witnesses who -were brought to swear to this point on a well-known trial, all of them -physicians of extensive practice, not one could depose that such a case -had ever come within his personal observation.[165] It has been stated -however in a controversial publication written by the late Dr. -Mackintosh of this place, that the author had seen many cases fatal -within the period now mentioned.[166] This is incomprehensible. For my -own part, I cannot help repeating, as the result of the whole inquiry, -that simple cholera rarely causes death in this country, in the period -within which irritant poisoning commonly proves fatal,—that, -consequently, every case of the kind will naturally be apt to lead, in -peculiar circumstances, to suspicion of poisoning,—and that in charges -of poisoning, rapid death under symptoms of violent irritation in the -alimentary canal, like those of cholera, must always be considered an -important article of a chain of circumstantial or presumptive evidence. - -7. _Of Malignant Cholera._—The history of this disease affords a fair -promise that, in so far as British practitioners are concerned, it may -ere long be excluded from the list of those which imitate irritant -poisoning. Meanwhile, however, malignant cholera must be allowed to -bear, in its essential symptoms and their course, a marked resemblance -to poisoning with the irritants. So much indeed is this the case that -some authors have actually compared its phenomena to the effects of -arsenic, tartar-emetic, and other powerful acrids. In many cases the two -affections are undoubtedly not so distinguishable by symptoms as to -warrant a physician to rely on the diagnosis in a medico-legal inquiry. -But in many other instances the distinction may be drawn satisfactorily. -Thus the uneasiness in the throat which sometimes attends cholera never -precedes the vomiting. The vomiting in cholera is never bloody. The -colour and expression of the countenance and whole body are peculiar. In -frequent instances the early signs which resemble poisoning are followed -by a secondary stage, sometimes of simple coma, sometimes of typhoid -fever, which a practised person may easily distinguish from the -secondary phenomena produced by some irritants. Lastly, no mistake can -arise where the patient, before presenting the symptoms common to both -affections, experiences violent burning pain or certain tastes, during -or immediately after the swallowing of food, drink, or some other -article. - -8. _Of Inflammation of the Stomach._—Chronic inflammation of the stomach -is a common disease; which, however, on account of the slowness of its -course, is not liable to be confounded with the ordinary effects of -irritant poisons. Acute inflammation, on the contrary, follows precisely -the same course as that of irritant poisoning. But great doubts may be -entertained whether true acute gastritis ever exists in this country as -a natural disease. Several of my acquaintances, long in extensive -practice, have stated to me, that their experience coincides entirely -with that of Dr. Abercrombie, who observes he has “never seen a case -which he could consider as being of that nature.”[167] An important -observation of the same purport has been made by M. Louis, one of the -most experienced and accurate pathologists of the present time. He says, -that during six years’ service at the hospital of La Charité, during -which he noticed the particulars of 3000 cases and 500 dissections, he -did not meet with a single instance of fatal primary gastritis. The -disease only occurred as a secondary affection or complicating some -other disease which was the cause of death.[168] So far as I have -hitherto been able to inquire among systematic authors, the descriptions -of idiopathic acute gastritis appear to have been taken from the -varieties caused by poison. - -The following are the only specific accounts I have hitherto met with of -an affection of the nature of idiopathic acute gastritis; and the reader -will be at no loss to perceive that in each of them it admits of being -viewed differently. The first two are the cases of inflammation referred -by Haller and Guérard to drinking cold water incautiously [p. 100]. The -next is a remarkable incident related by Lecat, and occurring in 1763. A -girl, nineteen years old, was attacked while in good health with -shivering, faintness, acute pain in the belly, cold extremities and -imperceptible pulse; and she died in sixteen hours. The stomach was -found red, and checkered with brownish patches and gangrenous pustules -(probably warty black extravasation): yet it was supposed to have been -ascertained that she had not taken any thing deleterious.[169] This -narrative is certainly to appearance pointed. But when it is added, that -the girl’s mother was attacked about the same time with precisely the -same symptoms and died in four hours, I think the reader, when he also -considers the imperfect mode in which chemical inquiries were then -conducted, will by no means rest satisfied with Lecat’s assurance that -nothing deleterious was swallowed. The last is an equally singular case -given by Dr. Hastings, of Worcester, where poisoning with cantharides -was suspected. A young lady, liable to indigestion, but at the moment in -better health than usual, was attacked with sickness before breakfast -and after it with vomiting. Three days elapsed before she was seen by -her medical attendant, who found her sinking under incessant vomiting, -severe pain in the loins, strangury, bloody urine, and swelling of the -clitoris, attended with red extravasation of the eyes, and a red -efflorescence on the skin. Death followed next day amidst convulsions; -and there was found in the dead body extravasation of blood between the -kidneys and their outer membrane, into the pelvis of each kidney, and -into the bladder,—redness of the bronchial membrane, and gorging of the -air-cells with blood,—and general redness of the inside of the stomach, -with numerous extravasated spots in the submucous coat.[170] It seems to -have been clearly proved at the coroner’s inquest that poisoning was -here out of the question. But the case appears rather to have been one -of renal irritation or inflammation than of gastritis, and the affection -of the stomach secondarily merely. - -The question as to the possibility of acute gastritis being produced by -natural causes is one of very great interest to the medical jurist. For -its possible occurrence is the only obstacle in the way of a decision in -favour of poisoning, from symptoms and morbid appearances only, in -certain cases by no means uncommon, which are characterised by signs of -violent irritation during life, early death, and unequivocal marks of -great irritation in the dead body, namely, bright redness, ulcers, and -black, granular, warty extravasation. In regard to these effects, it may -with perfect safety be said, that they can very rarely indeed all arise -from natural causes; and for my own part, the more the subject is -investigated, the more am I led to doubt whether they ever arise in this -country from any other cause than poison. The possible occurrence of a -case of the kind from natural causes must be granted. But this -concession ought not to take away from the importance of the contrary -fact as one of the particulars of a chain of circumstantial proof. - -In whatever way the fact as to the existence of idiopathic acute -gastritis may eventually be proved to stand, an important criterion of -this disease, as of cholera, will be that the sense of burning in the -throat, if present at all, does not precede the vomiting. - -9. _Inflammation of the Intestines_ in its acute form is more common -than inflammation of the stomach, as a natural disease. It is generally -accompanied, however, with constipation of the bowels. Acute enteritis, -unless we choose with some pathologists to consider cholera as of that -nature, is very rarely attended with purging. - -There is a variety of intestinal inflammation, observed only of late by -pathologists,[171] but now well known, which bears a close resemblance -to the effects of the irritants. It is a particular variety of -ulceration commonly situated near the end of the small intestines, -accompanied at first with trifling or insidious symptoms, and -terminating suddenly in perforation of the gut. It begins with -tubercular deposition under the mucous membrane in roundish patches. -Then an ulcer appears on the middle of one or more of these patches, -gradually spreads over them, and at the same time penetrates the other -coats. At last when the peritoneal coat alone is left, some trifling -accident ruptures it, the fæcal matters escape into the sac of the -peritonæum, and the patient dies in great agony in the course of one or -two days, or in a few hours. Such cases, if not distinguished by the -symptoms, will be at once recognized by the morbid appearances. -Perforation of the intestines, with similar symptoms, also takes place -without the previous tubercular deposit, by simple ulceration of the -coats.[172] - -Another form of intestinal inflammation may also be here particularized, -because it imitates the effects of the irritants in the cases in which -they prove slowly fatal. It is a form of aphthous ulceration of the -mucous membrane of the alimentary canal, which appears to affect almost -every part of it from the throat downwards, and begins commonly in the -throat. I once met with a remarkable case in which it appeared in the -form of little white ulcers in the back of the throat, and gradually -travelled downwards to the stomach and from that to the -intestines,—being characterized by burning pain in every one of its -seats, and successively by difficulty of swallowing, by sickness, -vomiting, and tenderness of the stomach, and finally by purging. Such -cases resemble the slow forms of poisoning with arsenic. But they differ -in attacking the several divisions of the alimentary canal in turn, -while in the examples of poisoning with arsenic now alluded to, the -whole canal from the mouth to the anus is affected simultaneously. Dr. -Abercrombie has described a similar disorder, which he appears to have -occasionally seen affecting both the stomach and intestines at the same -time; but he seems to doubt whether it ever occurs as an idiopathic -disease, or independently of some co-existing or preceding fever or -local inflammation.[173] - -10. _Inflammation of the Peritonæum_, or lining membrane of the belly, -will not require many remarks. When acute, it is rarely attended in its -early stage by vomiting; rarely also by irregular action of the -intestines, and never by diarrhœa; and it is at once distinguished in -the dead body by unequivocal marks of peritonæal inflammation, which are -very seldom caused by irritant poisons.[174] - -11. The subject of _Spontaneous Perforation of the Stomach_ is an -important topic for the medical jurist, because both the symptoms before -death and the appearances in the dead body are occasionally very like -the effects of some of the most active irritant poisons. The following -is a statement of the most material facts hitherto ascertained on this -subject; but it must be premised that a good deal of obscurity still -hangs over some parts of it. - -Spontaneous perforation of the stomach is of three kinds. One is the -last stage of some varieties of scirrhus. The indurated membrane -ulcerates, the ulcer penetrates first the villous, then the muscular, -and at last the outer or peritoneal coat, so that the contents of the -stomach escape into the belly. The symptoms of the perforation are a -sense of something giving way in the pit of the stomach, acute pain -gradually extending over the whole abdomen, great tenderness and -tension, excessive prostration, and death commonly within twenty-four -hours. The symptoms which precede the perforation in general clearly -indicate organic derangement of the stomach, namely, aggravated -dyspepsia of long standing. Several cases of this description may be -seen in a thesis by M. Laisné,[175] a pupil of Professor Chaussier. Two -characteristic cases have been published by Dr. Crampton;[176] and Mr. -Alfred Taylor has referred to several others, the stomachs of which are -preserved in Guy’s Hospital Museum, and gives the particulars of some -which had occurred in the practice of that institution or to his -friends.[177] Occasionally no symptom exists prior to the perforation, -as in an instance related by Dr. Kelly of a stout healthy servant, who -was suddenly seized with excruciating pain in the stomach and expired in -eighteen hours, and in whose body the stomach was found perforated in -the middle of an extensive thickening and induration of the villous -coat.[178] - -The second variety of perforation takes place by simple ulceration -without previous scirrhus. In one of Dr. Crampton’s papers will be found -some remarks by Mr. Travers, along with a case of this kind. The subject -of it was a man of a strumous habit, who enjoyed good health, till one -day at dinner he was suddenly attacked with acute pain in the pit of the -stomach, and died in thirteen hours. The stomach was found perforated in -the centre of a superficial ulcer of the mucous coat, occupying -two-thirds of the ring of the pylorus.[179] This case shows that the -present variety of perforation may take place without the preliminary -organic disease being indicated by any symptom. The circumstances under -which it commenced are peculiarly important in relation to the medical -jurisprudence of poisoning. Another case which has been lately described -with great exactness by M. Duparcque, was preceded only by very trivial -dyspeptic symptoms. Here the whole mischief arose from a small ulcer -eight lines long and five in breadth on the inside of the stomach, and -not more than a line and a half in diameter at the perforation through -the peritonæum.[180] Several excellent examples of the same disease have -been related by Dr. Abercrombie.[181] In one of these the ulcer in the -centre of which the perforation had been formed, was not bigger than a -shilling, and the rest of the stomach quite healthy. A very instructive -case of a similar nature, but of unusual duration, has been related by -Mr. Alfred Taylor. A young woman, after suffering for some time from -nausea and constant craving for food, but inability to indulge it, and -occasionally from pain in the stomach, was attacked suddenly with the -usual symptoms of perforation, and died forty-two hours afterwards. The -villous coat of the stomach, though generally healthy, presented at the -lesser curvature several small elevated points, and in the middle of two -of these a sharply-defined ulcer, one affecting the mucous coat only, -while the other, which was half an inch in diameter where it affected -the mucous coat, perforated the muscular and peritonæal coats by a hole -no bigger than a crow-quill.[182] A case still more remarkable has been -also related by the same author, where the circumstances naturally gave -rise to a strong suspicion of poisoning. A young female in a noble -family, subject to slight dyspepsia, was suddenly attacked, three hours -after a meal, with violent vomiting and pain in the belly. Collapse soon -ensued, and in fifteen hours she died, under so strong suspicions of -poisoning that various antidotes were administered. This suspicion was -in some measure borne out by proofs of an intrigue having been carried -on between her and a male person in the house, and by the discovery -after death of the signs of recent sexual intercourse. On examining the -cavity of the abdomen, however, there was found, at the upper and back -part of the stomach near the pylorus, an oval perforation, half an inch -wide, surrounded by a firm, smooth, almost cartilaginous margin, without -any inflammation near it. Mr. Taylor properly points out, that the -sudden occurrence of such violent symptoms so long after a meal is -incompatible with the action of any poison which could cause perforation -in fifteen hours; and that the characters of the perforation were those -of a natural disease long latent. He could not detect a trace of any -poison in the stomach.[183]—In some cases, as in that of M. Duparcque, -the pain at the moment the perforation is completed is not at first -violent, because the close proximity of some adjoining organ, such as -the liver, prevents the contents of the stomach from escaping for a -time, so that inflammation of the peritonæum is but gradually developed. - -The third variety of spontaneous perforation is of a much more singular -kind. It is produced not by ordinary ulceration, but by a jelly-like -softening of the coats. The gelatinization sometimes extends over a -great extent of surface, affecting chiefly the villous coat, so that the -aperture through the other membranes is surrounded by extensive -pulpiness of the internal membrane. It is seldom accompanied by -vascularity. Its symptoms are exceedingly obscure. In adults there is -very rarely any symptom at all till the perforation is complete;[184] in -children, as appears from a paper by Dr. J. Gairdner of this city, and -another by Dr. Pitschaft, a German author,[185] the early symptoms -indicate an obscure chronic gastritis. The nature of this singular -disease will be discussed in the section on the morbid appearances. At -present it may merely be observed, that the injury caused to the coats -of the stomach seems to be precisely the same with the gelatinization, -which is sometimes found after death in persons who had no symptoms of -an affection of the stomach, and which is ascribed by John Hunter,[186] -and most British pathologists, to the solvent action of the gastric -juice in the dead body. This disease is well described by Laisné in his -thesis formerly quoted. The following is a good example: a young lady, -previously in good health, was awakened at three one morning with -excruciating pain in the stomach, which nothing could alleviate. She -expired seven hours after; and on dissection two holes were found in the -back part of the stomach, surrounded with much softening of the villous -coat.[187] Another case will be mentioned in page 118.—The appearances -produced by this disease have been mistaken for the effects of corrosive -poisons. - -12. The _gullet_ may be perforated in a similar manner either with or -without symptoms. Under the head of the morbid appearances (119) two -instances will be mentioned in which there were no corresponding -symptoms. In the following case symptoms did pre-exist. A man, six weeks -after being bit by a dog, which was killed without its state of health -having been ascertained, was attacked with a sense of strangling, -impossibility of swallowing, delirium, excessive irritability, glairy -vomiting; and he died within twenty-four hours. The gullet, a little -above the diaphragm, was perforated by a hole two-thirds of an inch in -diameter, with thin edges; and effusion had taken place into the -posterior mediastinum.[188] - -13. _Perforation of the alimentary canal by worms_ may here also be -noticed shortly as a disease liable in careless hands to be confounded -with irritant poisoning. This is far from being a common accident, and -very rarely takes place during life. In most of the cases in which it -has been witnessed the symptoms antecedent to death were those not of -irritant, but of narcotic poisoning, and were then owing simply to the -great accumulation of worms in the alimentary canal. On this subject the -reader is referred to the article Epilepsy in the introductory remarks -on the effects of the narcotic class of poisons. But at times the -symptoms have been like those of irritant poisoning. Thus the following -is a case of perforation by worms during life giving rise to all the -phenomena and symptoms of peritonæal inflammation. A soldier at -Mauritius was seized with slight general fever and severe pain, at first -in the pit of the stomach, and afterwards over the whole belly, which on -the third day began to enlarge. A tendency to suppression of urine and -costiveness ensued, then bilious vomiting; and he died on the fourth -day, the belly having continued to increase to the end. On dissection, -several quarts of muddy fluid were found in the sac of the peritonæum, -the viscera were agglutinated by lymph, a round worm was discovered -among the intestines between the navel and pubes, and the ileum was -perforated six inches from the colon by a hole corresponding in size -with the worm.[189]—A singular case, not however fatal, but which -confirms the fact, that worms may make their way through the intestines -and other textures during life, is mentioned in Rust’s journal. A woman -after a tedious illness first vomited several lumbrici, and was then -seized with a painful swelling in the left side, which in the process of -time suppurated, and discharged along with the purulent matter three -other worms of the same species.[190] Another instance of the same kind, -where the perforation of the gut succeeded strangulated hernia, and was -followed by the discharge of two lumbrici and ultimate recovery, is -detailed in the Revue Médicale.[191] - -Symptoms like those of narcotico-acrid poisoning may be caused by worms -without perforation. A girl, eight years old and in excellent health, -was suddenly seized with violent colic pains, vomiting, bloody stools, -tenderness and swelling of the belly, followed by convulsions and coma, -and proving fatal in seven hours. No other explanation of the case could -be discovered on dissection except the presence of several hundred -ascarides in the intestines and thirteen in the stomach.[192] - -14. The next diseases to be mentioned are melæna and hæmatemesis, or -purging and vomiting of pure or of altered blood. - -It is hardly possible to mistake them for poisoning, as the pain which -accompanies them is seldom acute, and the discharge of blood generally -profuse. - -15. The last are _colic_, _iliac passion_, and _obstructed intestine_. -As the symptoms of some poisons are the same with those of colic, it is -of course sometimes impossible to distinguish the natural disease from -the effects of poison by attending to the abdominal symptoms only. But -the distinction in severe cases of poisoning may almost always be drawn -from collateral symptoms and extraneous circumstances.—The iliac passion -is distinguished by a complete reversion of the vermicular motion of the -intestines in consequence of which the fæces are often discharged by -vomiting. I am not aware that stercoraceous vomiting is ever caused by -poisoning.—A case has been recorded in Corvisart’s journal, in which -iliac passion, originating in obstruction of the ileum by hardened -fæces, and proving fatal in twenty-six hours, gave rise to a judicial -inquiry into the possibility of poisoning.[193] Another instance, that -led to a strong suspicion of poisoning, has been lately published by M. -Rostan, in which there was continued vomiting and pain of abdomen, -proving fatal in two days, and arising from the small intestines being -obstructed by an adventitious band.[194] In this case the first -inspectors failed to observe the true cause of the symptoms; but Rostan -and Orfila, who were appointed to examine the body a second time, -discovered the constriction, and were unable to find any poison in the -stomach by analysis. Stercoraceous vomiting occurred during life; which -might have been held sufficient to settle the real nature of the -case.—Obstruction of the intestines arising from twisting of the gut, -intussusception, foreign bodies, or strangulated hernia, is easily known -by the seat where the pain begins, by the obstinate constipation, and -also by the excessive enlargement of the belly,—which last, however, is -rather an equivocal symptom. - -The preceding observations will enable the medical jurist to determine, -how far a diagnosis may be drawn from the symptoms between poisoning -with the irritant and the diseases which resemble it. It will be -remarked that the most embarrassing disease, on account of its -frequency, and peculiar symptoms, is cholera. Cholera, however, may be -recognised in some instances even considered in regard to the irritants -as a class; and we shall presently find that it may be distinguished -still better from the effects of some individual poisons. - - - SECTION II.—_Of the Morbid Appearances caused by Irritant Poisons, - compared with those of certain natural diseases._ - -The next subject for consideration is the morbid appearances produced by -the irritants as a class, together with those of a similar nature, which -arise from natural causes. - -The powerful irritants, which are not corrosives, produce simply the -appearances characteristic of inflammation of the alimentary canal in -its various stages,—in the mouth, throat, and gullet vascularity, and -also, if the case has lasted long enough, ulceration;—in the stomach, -vascularity, extravasation of blood under and in the substance of the -villous coat and likewise into the cavity of the organ, abundant -secretion of tough mucus, deposition of coagulable lymph in a fine -network, ulceration of the membranes, occasionally perforation, -preternatural softness of the whole or of part of the villous coat, and -on the other hand sometimes uncommon hardness and shrivelling of that -coat; in the intestines vascularity, extravasation, and -ulceration.—Sometimes several of these appearances are to be seen in the -whole alimentary canal at once. In poisoning with arsenic or corrosive -sublimate it is no unusual thing to meet with redness or ulceration of -the throat, great disease in the stomach, vascularity of the small -intestines, ulcers in the great intestines, and excoriation of the -anus.—When the poison is an active corrosive much more extensive ravages -are sometimes caused, particularly in the stomach. After poisoning by -the mineral acids, for example, the whole mucous membrane of the stomach -is at times found wanting; nay, large patches of the whole coats may be -wanting, and the deficiency supplied by the adhesion of the margin of -the aperture to the adjoining viscera, and the conversion of the outer -membrane of these viscera into an inner membrane for the stomach. - -Of the appearances here briefly enumerated the particulars will be -related partly under what is now to be said of the appearances arising -from natural causes, which are liable to be confounded with the effects -of poisons, partly under the head of individual poisons. - - - _Of redness of the stomach and intestines from natural causes, and its - distinction from the redness caused by poisons._ - -Simple redness of the alimentary mucous membrane in all its forms, -whether of mere vascularity, or actual extravasation, not only does not -distinguish poisoning from inflammatory disorders of natural origin, but -will even seldom distinguish the effects of poison from those of -processes that occur independently of disease, and subsequent to death. -On the subject of real inflammation, as distinguished from redness -originating after death, or pseudo-morbid redness, as it is commonly -termed,—a subject of great consequence to the medical jurist,—the reader -may consult with advantage a paper by Dr. Yelloly,[195] an essay by MM. -Rigot and Trousseau,[196] or that of M. Billard.[197] The former authors -proved by experiment, that various kinds of pseudo-morbid redness may be -formed, which cannot be distinguished from the parallel varieties caused -by inflammation; that these appearances are formed after death, and not -till three, five, or eight hours after it; that they are to be found -chiefly in the most depending turns of intestines, and in the most -depending parts of each turn, or of the stomach; and that after they -have been formed, they may be made to shift their place, and appear -where the membrane was previously healthy, by simply altering the -position of the gut. M. Billard, on the other hand, has laid down their -characters, and made a minute arrangement of the several kinds. He has -divided them into ramiform, capilliform, punctated, striated, laminated, -and diffuse redness,—terms which need hardly be explained. I must be -content with merely referring to these sources of information for a -particular account of the appearances in question. But it may be right -at the same time to quote an instance of the most aggravated form of -pseudo-morbid redness, in order to convince the reader that all forms -may equally arise from the same causes. Among other example, then, which -have been related of laminated redness, or redness in patches from -extravasation, M. Billard mentions the case of a man who hanged himself, -and in whose body was found, on the mucous membrane of the small -intestine where it lay in the right flank, “a large, amaranth-red patch, -six finger-breadths wide, covered with bloody exudation, and not -removable by washing:” and in the lower pelvis there was a similar patch -of even larger dimensions.[198] - -Although morbid and pseudo-morbid redness of the inner coat of the -alimentary canal cannot be distinguished from one another by any -intrinsic character, M. Billard thinks this may be done by attending to -collateral circumstances. According to his researches, redness is to be -accounted inflammatory only when it occurs in parts not depending in -position, or is not limited to such parts: when the mesenteric veins -supplying the parts are not distended, nor the great abdominal veins -obstructed at the time of death; when the reddened membrane is covered -with much mucus, particularly if thick, tenacious, and adhering; when -the mucous membrane itself is opaque, so that when dissected off and -stretched over the finger, the finger is not visible; when the cellular -tissue which connects that membrane with the subjacent coat is brittle, -so that the former is easily scratched off with the nail. - -Some observations may be here also made on another appearance, allied to -the present group, but which there is strong reason to believe always -indicates some violent irritation at least, if not even irritation from -poison only, in the organ where it is found. It is an effusion under the -villous coat of the stomach, and incorporation with its substance, of -dark brownish-black, or as it were charred, blood; which is thus altered -either by the chemical action of the poison, or by a vital process. In -many cases of poisoning with the mineral acids, oxalic acid, arsenic, -corrosive sublimate, and the like, there are found on the villous coat -of the stomach little knots and larger irregular patches and streaks, -not of a reddish-brown, reddish-black, or violaceous hue, like -pseudo-morbid redness, but dark-grayish-black, or brownish-black, like -the colour of coal or melanosis,—accompanied too with elevation of the -membrane, frequently with abrasion on the middle of the patches, and -surrounded by vascularity. This conjunction of appearances I have never -seen in the stomach, unless it had been violently irritated; and several -experienced pathologists of my acquaintance agree with me in this -statement. It bears a pretty close resemblance to melanosis of the -stomach;[199] but is distinguished by melanotic blackness being arranged -in regular abruptly-defined spots, and still better by melanosis not -being preceded by symptoms of irritation in the stomach. - -Referring to what was already said under the head of the symptoms of -gastritis [p. 102], I must again express my doubts whether the -appearances now described ever arise in this country from natural -disease. In the intestines they are sufficiently familiar to the -physician, as arising from idiopathic enteritis, and from dysentery. But -in the stomach their existence as the effect of natural disease is very -doubtful. - -Another kind of coloration of the inner membrane of the stomach, which -may be shortly alluded to, because it has actually been mistaken for the -effect of irritation from poison, although by no means like it,—is -staining of the membrane with a reddish, brownish, yellowish, or -greenish tint, observed in bodies that have been kept some time, and -produced by the proximity of the liver, spleen, or colon if it contains -fæces. No unprejudiced and skilful inspector could possibly mistake this -appearance for inflammation. But under the impulse of prejudice it has -been considered such, and imputed to poison. On the occurrence of such -stains an attempt was made by the French to ascribe to poison the death -of the republican general Hoche. He died rather suddenly on his way from -Frankfort to join his troops; and as poisoning was suspected, the body -was opened in the presence of three French army-surgeons, and a French -and two German physicians. The only appearance of note in the alimentary -canal was two darkish spots on the villous coat of the stomach. The -surgeons drew up a report which imputed his death to poison; but the -physicians refused to sign it; and other medical people who were -subsequently added to the commission decided with the latter.[200] The -surgeons probably would not have been so hasty, if they had not known -that the result of their complaisance would have been the levying of a -heavy fine on the inhabitants. - -The last kind of discoloration of the inner coat which requires mention -is dyeing from the presence of coloured fluids in the contents. A -remarkable instance has been recorded where redness of this nature was -mistaken for inflammation, and the death of the individual in -consequence ascribed at first to poison. A person long in delicate -health died suddenly after taking a laxative draught; and the stomach, -as well as the gullet, being found on dissection red and livid in -various places, it was hastily inferred by his medical attendants, that -these appearances were the effect of poison, and that the apothecary had -committed some fatal error in compounding the draught. But another -physician, who was acquainted with the deceased, although he did not -attend him professionally, strongly suspected he had died a natural -death; and happening to know he was in the practice of taking a strong -infusion of corn-poppy, inferred that the supposed signs of inflammation -were merely stains arising from the habitual use of this substance. -Accordingly, on making the experiment, he found that in dogs to which a -similar infusion was given, appearances were produced identically the -same.[201] - -_Of the effusion of mucus and lymph from natural causes._—The abundant -secretion of tough mucus in the stomach is a sign of that organ having -been irritated. But the effusion of lymph is more characteristic. This -may be produced by natural inflammation as well as by irritating -poisons. As arising from either cause, however, it is rare; and -certainly by no means so common as would be supposed from what is said -in systematic works; for tough mucus has been often mistaken for it. -Reticulated lymph adhering to the villous coat, and accompanied with -corresponding reticulated redness of that coat, such as I have seen in -animals poisoned with arsenic or oxalic acid, is an unequivocal sign of -inflammation. - -_Of idiopathic ulcers and perforation of the stomach and intestines, and -their distinction from those caused by poison._—Both ulceration and -perforation may be produced by natural disease. In the ulceration -produced by poisons there is generally speaking nothing to distinguish -it from natural ulcers; but that caused by some poisons, such as iodine, -is said to differ by the surrounding coloration of the membrane; and -when the ulcer is caused by a sparingly soluble poison in a state of -powder, such as arsenic, the cavity of the ulcer is sometimes filled -with the powder. Perforation is a rare effect of the simple irritant -poisons; but it is often caused by corrosives. It is imitated by two of -the varieties of perforation from natural disease. - -The form of natural perforation caused by a common ulcer is precisely -the same as that caused by the simple irritants, and is incapable of -being distinguished, except when it is attended with scirrhus. - -By far the most remarkable variety, however, of spontaneous perforation -is that which takes place, without proper inflammatory action, from -simple gelatinizing of the coats. It is very apt to be mistaken, and in -a celebrated trial, which will be immediately noticed, was actually -mistaken for the effect of corrosive poison. - -It may be situated on any part of the stomach, but is oftenest seen on -the posterior surface. It is sometimes small, more often as big as a -half-crown, frequently of the size of the palm, and occasionally so -great as to involve an entire half of the stomach. Sometimes there is -more than one aperture. The margin is of all shapes, commonly fringed, -and almost always formed of the peritoneum, the other coats being more -extensively dissolved. In one instance, however, the peritonæal surface -was on the contrary the most extensively destroyed;[202] and in a case -which occurred in the infirmary here, and was pointed out to me by the -late Dr. W. Cullen, the peritonæum alone was extensively softened, and -partly dissolved, so as to lay the muscular coat bare on its outer -surface. The gelatinization therefore sometimes, though very rarely, -begins on the outside of the stomach. Internally the whole is surrounded -by pulpiness of the mucous coat, generally white, occasionally bluish or -blackish, never granulated like an ulcer, very rarely vascular; and when -vascular, the blood may be squeezed out of the loaded and open vessels. -The organs in contact with the hole are also frequently softened. Thus -an excavation is sometimes found in the liver or spleen; or the -diaphragm is pierced through and through. The margins of the latter -holes are without any sign of vascular action, but are generally -besmeared with a dark pulpy mass, the remains of the softened tissue. -The pulp never smells of gangrene; with which, indeed, this species of -softening is wholly unconnected. The edge of the hole in the stomach -never adheres to the adjoining organ; yet, even when the hole is very -large, the contents of the stomach have not always made their escape. -Often the dissolution of the coats is incomplete. John Hunter and -others, indeed, have said that a stomach is rarely seen without more or -less solution of the mucous coat.[203] The best account of the -appearances in this state is given by Jaeger of Stuttgardt.[204] - -The circumstances under which this extraordinary appearance occurs are -singularly various. Professor Chaussier and the French pathologists -conceive it to be always a morbid process constituting a peculiar -disease; and doubtless cases have occurred in which death appears to -have arisen from the stomach being perforated during life by -gelatinization.[205] But it has been found much more frequently, when -death was clearly the consequence of a different disease, and when there -did not exist during life a single sign of disorder in the stomach. Thus -it has been found in women who died of convulsions after delivery,—in -children who died convulsed or of hydrocephalus,—after death from -suppuration of the brain, both natural and the result of violence,—from -coma following an old ulcer of the back, which communicated with the -spinal canal,—from diseased mesenteric glands,—from phthisis,—from -nervous fever,—and after sudden death from fracture of the skull or -hanging:[206] and in all of these circumstances it has occurred without -any previous symptom referrible to a disorder in the stomach. - -The opinions of pathologists are divided as to its nature. The French -conceive it arises from a morbid corrosive action, which, however, may -extend after death, in consequence of the fluids acquiring a solvent -power. Hunter ascribed it entirely to the solvent power of the gastric -juice after death. There are difficulties in the way of both doctrines. -A full examination of the whole inquiry, which is one of much interest -and considerable complexity, would be misplaced in this work; but some -remarks are called for, by reason of the important medico-legal -relations of the subject, and the uncertainty in which it is at present -involved. - -In the first place, then, it appears difficult, if not impossible, to -comprehend how a vital erosive action can account for the perforations -observed after death from diseases wholly unconnected with the stomach, -and unattended during life by any symptom of disorder in that organ. -For, not to dwell on other less weighty arguments,—on the one hand, -there is during life no symptom of perforation, an accident which if -deep stupor be not present at the same time is always attended with -violent symptoms when it arises from any cause but gelatinization,—and -on the other hand, there is frequently no escape of the contents of the -stomach into the cavity of the abdomen, though the hole is of enormous -size, and its edge not adherent to the adjoining organs.—All such -perforations, however, are perfectly well accounted for, on the other -theory, by what is now known of the properties of the gastric juice. -This will appear from the following exposition. - -The power of the gastric juice to dissolve the stomach and other soft -animal textures was long thought to be fully proved by the well-known -researches of Spallanzani,[207] Stevens,[208] and Gosse.[209] In later -times doubts were entertained on the subject in consequence of negative -results having been obtained by other experimentalists, more especially -by Montégre.[210] But these apparently discrepant facts and opinions -have been reconciled by the ulterior experiments of Tiedemann and Gmelin -on digestion;[211] who found that the nature and quality of the fluid -secreted by the stomach vary much in different circumstances,—that, when -its villous coat is not subjected to some stimulus, the fluid which -lines it is not acid, and does not possess any particular solvent -action,—but that when the membrane is stimulated by the presence of food -or other sources of excitement, the quality of the secretion is -materially changed, for it becomes strongly acid and is capable of -dissolving alimentary substances both in and out of the body. And still -more lately the solvent power of the proper gastric juice over the -stomach, and its capability of producing perforation in animals after -death, have been established in the most satisfactory manner by Dr. -Carswell,[212] who has shown by a series of incontrovertible facts,—that -in the rabbit when killed during the digestion of a meal, and left for -some hours afterwards in particular positions, all the phenomena of -spontaneous gelatinized perforations observed at times in man, may be -easily produced at will,—that acidity of the gastric juice is an -invariable circumstance when such perforations are remarked,—and that -the appearances in question as they occur in the rabbit are the result -of chemical action alone, and occur only after death. Thus, then, the -physiological experiments of Tiedemann and Gmelin, together with the -investigations of Carswell, not merely establish positively the fact, -that the stomach may be perforated after death by the gastric juice, but -likewise account clearly for the negative results obtained by other -experimentalists. For example, passing over earlier experiments, they -explain sufficiently the negative results obtained by Dr. Pommer of -Heilbronn,[213] an experimentalist of some reputation in Germany; for, -falling into the error of some of the less recent experimentalists on -this subject, he made his observations on animals killed slowly by -starving,—in which circumstance there is no proper gastric juice in the -stomach, and consequently no solvent action can exist. - -These statements relative to the causes and phenomena of gelatinized -perforation in the stomach supply the strongest possible presumption -which analogy can furnish, that a great proportion of spontaneous -gelatinized perforations in the human subject are owing to the action of -the gastric juice after death. And this presumption is increased to -something not far removed from demonstration by the circumstance, that -in man the process of softening has actually been traced extending in -the dead body. This interesting fact was first noticed by Mr. Allan -Burns.[214] In the body of a girl who died of diseased mesenteric glands -he found an aperture in the fore part of the stomach with the usual -pulpy margin, and the liver in contact with the hole uninjured. In two -days more the liver opposite the hole had become pulpy, and its -peritonæal coat quite dissolved; and the back part of the stomach -opposite the hole was also dissolved, so that only its peritonæal coat -remained. Dr. Sharpey has communicated to me a similar observation. On -finding in the body of a child the stomach perforated and gelatinized, -but the adjoining organs uninjured, he sewed up the body, to show the -appearances to some of his friends next day. By that time the peritonæal -surfaces of the spleen and left kidney were found much softened and -pulpy where they lay in contact with the hole in the stomach. I have -since met with a similar occurrence where the perforation affected the -duodenum (p. 120). - -It must be admitted, then, that the action of the gastric juice after -death is quite sufficient to account for the greater number of -gelatiniform perforations in the human stomach. - -But in the second place, it seems scarcely possible to explain every -perforation of the kind in this way. The solvent action of the gastric -juice for example, affords no explanation of a singular case related by -M. Récamier,[215] where, after death in the secondary stage of -small-pox, the stomach was transparent and brittle, and perforated in -the splenic region by a gelatinized hole large enough to admit the -fist,—although the fluid in the stomach was subsequently found incapable -of dissolving another stomach, and almost destitute of free acid. And -still less will the solvent action of the gastric juice account for such -cases as those of Laisné and Gastellier, quoted in pp. 107–8, or the -French medico-legal case to be mentioned in p. 118,—where death is -preceded by a short illness, indicating a violent disorder of the -stomach, and sometimes even characterized by all the marked symptoms of -perforation. In the last description of cases, which are comparatively -very rare, it seems necessary to admit that the gelatinization takes -place during life; unless, indeed, it be supposed that the stomach is -first perforated during life by ordinary ulcerative absorption, and then -gelatinized after death, in consequence of the irritation existing -before death having given rise to an unusual secretion of gastric juice. - -Passing now to the differences between these gelatinized perforations, -and the perforations caused by corrosive poisons, it may in the first -instance be observed, that the margin of a corroded aperture is -sometimes of a peculiar colour,—for example, yellow with nitric acid, -brown with sulphuric acid or the alkalis, orange with iodine. But a much -better, perhaps indeed an infallible criterion, and one of universal -application, is the following. Either the person dies very soon after -the poison is introduced, in which case vital action may not be excited -in the stomach: or he lives long enough for the ordinary consequences of -violent irritation to ensue. In the former case, as a large quantity of -poison must have been taken, and much vomiting cannot have occurred, -part of the poison will be found in the stomach: In the latter case, the -poison may have been all ejected; but in consequence of the longer -duration of life, deep vascularity, or black extravasation must be -produced round the hole, and sometimes too in other parts of the -stomach; changes which will at once distinguish the appearance from a -gelatinized aperture. There is no doubt that the stomach may be -perforated by the strong corrosives, and yet hardly any of the poison be -found in the stomach after death. Thus in a case related by Mertzdorff -of poisoning with sulphuric acid, where life was prolonged for twelve -hours, he could detect by minute analysis only 4½ grains of the acid in -the contents and tissue of the stomach. But then the hole was surrounded -by signs of vital reaction, and so was the spleen upon which the -aperture opened.[216] Judging from what I have often seen in animals -killed with oxalic acid, which is the most rapidly fatal of all -corrosives, so that little time is allowed for vital action, and also -several times in persons who had died quickly from the action of -sulphuric acid, I believe no poison can dissolve the stomach, without -such unequivocal signs of violent irritation of the undissolved parts of -the villous coat, as will secure an attentive observer from the mistake -of confounding with these appearances the effects of spontaneous -erosion. Spontaneous erosion is very generally united with unusual -whiteness of the stomach, and there is never any material vascularity. - -Resting on the description now given of the spontaneous and poisonous -varieties of corrosion, it is an easy matter to decide a controversy, -which at the time it occurred made a great deal of noise, and upon which -the opinions of toxicologists have been unnecessarily divided. It is the -question regarding death by poison which occurred in the trial of Mr. -Angus at Liverpool in 1808 for the murder of his housekeeper Miss Burns. -The poison suspected was corrosive sublimate. The symptoms were those of -irritation in the alimentary canal,—vomiting, purging, and pain. In the -dead body there was not any particular redness either of the intestines -or of the stomach. But on the fore part of the stomach an aperture was -found between the size of a crown piece and the palm of the hand; it had -a ragged, pulpy margin; and the dissolution of the inner coat extended -two inches from it all round the hole. No mention is made of adhesion or -coloration of the margin. This description, it will be remarked, answers -exactly that given above of spontaneous gelatinized perforation; and the -absence of the signs of vital action around the hole and in the rest of -the stomach is incompatible with the effects of a strong corrosive -poison, unless death had occurred very soon after it was swallowed. -This, however, was out of the question; for then the poison would have -been found in the stomach,—which it was not.[217] - -The case of Angus is not the only instance in recent times of -spontaneous perforation having given rise to an opinion by medical men -in favour of poisoning, and consequently to a criminal trial. Six years -afterwards a similar incident occurred in France. A young woman near -Montargis having died of a short illness, and a large erosion having -been found in the stomach after death, six practitioners, on a view of -the parts, and without referring to the antecedent symptoms or -attempting an analysis of the contents of the stomach, declared that she -died of the effects of some corrosive poison. The husband and -mother-in-law, against whom there does not appear to have been a shadow -of general evidence, were therefore imprisoned and subsequently tried -for their lives. Luckily, however, an intelligent physician of the town -saw the error of the reporters, and after vainly endeavouring to -persuade them to revise their opinion, was the means of the case being -remitted to the medical faculty of Paris. That distinguished body, with -Professor Chaussier at its head, gave a unanimous and decided opinion, -not only that there was not any proof of poisoning, but likewise that -the woman could have died of nothing else than spontaneous perforation. -The leading features of the medical evidence will at once show how -indefensible the conduct and opinion of the original reporters were. The -last meal taken by the woman before she became ill, and the only one at -which poison could have been administered by the prisoners, was her -supper; her illness did not begin till past six next morning; the -symptoms were mortal coldness, fainting, general pains, headache, pain -in the stomach, purging and colic, without vomiting, and she died after -twenty-four hours’ illness; the morbid appearances were general redness -of the stomach, softening and pulpy destruction of a third part of its -posterior parietes, and nevertheless the presence in the stomach of a -pint and a half of fluid matter, containing evidently the remains of -soup taken by the woman after she felt unwell. On the decision of the -Parisian faculty the prisoners were discharged; and the original -reporters were deservedly handled with great severity in several -publications that appeared not long after.[218] - -_Of perforations of the Gullet and Intestines from natural causes, and -their distinctions from those produced by poisons._—The intestines, and -sometimes even the gullet, may be perforated by the same erosive or -solvent process as the stomach. Thus Mr. Allan Burns observes, that in -four plump children, whose previous history he could not learn, he found -every part of the alimentary canal, from the termination of the gullet -down to the beginning of the rectum, reduced to a gluey, transparent -pulp, like thick starch. The bodies were quite free from putrefaction; -but the abdomen exhaled a very sour smell when opened. No other organic -derangement could be detected.[219] The particulars of a similar case, -with an account of the symptoms, have been lately published by Mr. -Smith, a London surgeon. In the body of a child who died of protracted -diarrhœa subsequent to weaning, the whole intestines, from the duodenum -to the sigmoid flexure of the colon, were found fourteen hours after -death gelatinous, semitransparent, and so soft and brittle that they -could not bear their own weight, but tore when lifted between the -fingers. The stomach and rectum were healthy.[220] I lately met with the -following instance, where the erosion clearly took place after death. In -the body of a girl who died within twelve hours of poisoning with -red-precipitate, the stomach and duodenum were found much inflamed, but -quite entire and firm three days after death. Eighteen days afterwards, -when I had an opportunity of examining these organs, their textures -remained firm everywhere, except a few inches below the pylorus, where I -found two apertures in the duodenum, each as big as a crown, and -surrounded by extensive jelly-like softening. - -The following case from Laisné’s treatise shows that the gullet may be -also dissolved in the same way. A woman three days after delivery was -attacked with puerperal peritonitis, and died in four days. In the belly -were found the usual morbid appearances of peritonitis: but in addition -there was in the lower part of the gullet a large oval aperture two -inches long, which penetrated through the posterior mediastinum into the -lungs.[221] Another singular instance of the same kind has already been -mentioned under the head of the symptoms (see p. 107). Another has been -described by Dr. Marshall Hall. In a child who died of bronchitis, an -opening was found in the gullet about the size of a pea, so that the -canal of the gullet communicated with the sac of the pleura; and several -veins appeared also to have been opened.[222] The stomach was likewise -perforated. - -It is not difficult to draw the distinction between these perforations -and the effects of poison. The throat and gullet may be partially -disorganized or corroded by the strong corrosives; but they are very -rarely penetrated, since the greater part of the poison must pass into -the stomach or be rejected by vomiting. Destruction of the mucous coat -is a common consequence, and stricture occasionally follows; but I have -hitherto met with only one instance among the innumerable published -cases of poisoning with the mineral acids, alkalis, and other -corrosives, where the gullet was perforated. In that case the -perforation was the result of slow ulceration from poisoning with -sulphuric acid, where life was prolonged for two months.[223] -Perforation from simple corrosion never occurs. The intestines are never -perforated by chemical corrosion from within, for either the poison is -in a great measure expelled from the stomach by vomiting, or the pylorus -contracts and prevents the passage of every poison that is sufficiently -concentrated to corrode. Both the small and great intestines might be -corroded from without, in consequence of the poison escaping through a -hole in the stomach. I am not acquainted, however, with any case of the -kind where, intestinal perforation has occurred. - -When the intestines are pierced by true ulceration, it is impossible to -tell whether it arose from natural disease or an irritant poison. - -The mode of forming a diagnosis between the symptoms and appearances of -irritant poisoning and those of natural disease being thus explained, -the different species of poisons which have been arranged in the class -of irritants will now be considered in their order. - -The irritant class of poisons may be divided into five orders: the acids -and their bases; the alkalies and their salts; the metallic compounds; -the vegetable and animal irritants; the mechanical irritants. In a short -appendix some substances will be mentioned which are not usually -considered poisonous, but are capable of causing violent symptoms when -taken in large doses. - -The greater number of poisons included in the first order have a very -powerful local action. Most of them possess true corrosive properties -when they are sufficiently concentrated. Most of them likewise act -remotely. One of them, oxalic acid, is evidently not so much an irritant -as a narcotico-acrid; but since its most frequent action as seen in man -is irritation, it seems inexpedient to break the natural arrangement for -the sake of logical accuracy. This is far from being the only instance -where the toxicologist is compelled to violate the principles of -philosophical classification. - -In the present Order are included four of the mineral acids, the -sulphuric, nitric, muriatic and phosphoric, with their bases, -phosphorus, sulphur, and chlorine: To these may be added iodine and -bromine, with their compounds, and also oxalic and acetic acid, two of -the vegetable acids. - - - - - CHAPTER III. - OF POISONING WITH THE MINERAL ACIDS. - - -Of the mineral acids, the most important, because the most common, are -_sulphuric_, _hydrochloric_, and _nitric_ acids. They are remarkably -similar in their effects on the animal economy. Phosphoric acid is of -much less consequence, and will be noticed cursorily. - -Sulphuric acid (_vitriolic acid_, _vitriol_—_oil of vitriol_), -hydrochloric acid (_muriatic acid_,—_spirit of salt_) and nitric acid -(_aqua-fortis_), have been long known to be possessed of very energetic -properties; and consequently cases of poisoning with them have often -been observed. The instances of the kind hitherto published have been -chiefly the result of suicide; a considerable number have originated in -accident; and, however extraordinary it may appear, a few have been -cases of murder. Tartra, in an excellent memoir on the subject of -poisoning with nitric acid, quotes an instance of a woman having been -poisoned while in a state of intoxication by that acid being mixed with -wine and poured down her throat.[224] Valentini has related the case of -a woman who was killed by frequent doses of sulphuric acid given under -the pretence of administering medicines.[225] In 1829 an hospital -servant was condemned at Strasbourg for trying to murder his wife in -like manner, by first making her ill with tartar-emetic and then giving -her sulphuric acid in syrup, under the pretence of curing her.[226] At -the Aberdeen autumn circuit in 1830 a woman Humphrey was convicted of -murdering her husband by pouring the same acid down his throat while he -lay asleep with his mouth open.[227] On the whole, considering the -powerful taste and excessively acrid properties of these poisons, it is -probable that they will seldom be resorted to for the purpose of making -away with another person, who is an adult, and in a state of -consciousness. Of late, however, there have been several instances in -our country of murder committed on infants in this barbarous manner. A -woman Malcolm was executed here in 1808 for murdering her own child, an -infant of eighteen months, by pouring sulphuric acid down its -throat;[228] another woman Clark was tried for the same crime at Exeter -in 1822; a man was executed lately at Manchester for murdering in the -same way his son, a child four years and a half old;[229] and the -particulars of an interesting trial will be presently noticed, that of -Overfield, who was executed at Shrewsbury in 1824, for poisoning his -child in the like manner.[230] - -In a medico-legal point of view, the mineral acids are interesting on -another account. Of late a new crime has arisen in Britain, the -disfiguring of the countenance by squirting oil of vitriol on it. It -originated in Glasgow, during the quarrels in 1820, between masters and -workmen regarding the rate of wages,[231] and became at last so -frequent, that the Lord Advocate, in applying for an act of Parliament -to extend the English Stabbing and Maiming act to Scotland, added a -clause which renders the offence now alluded to capital. In 1828 a woman -Macmillan was tried here and condemned under that act.[232] The crime -afterwards became common in England. Three cases were noticed in the -newspapers as having occurred in London, in November, 1828; and two -others near Manchester in the spring of 1829. It is now much less -frequent. - -The mineral acids are also very interesting on scientific grounds. They -afford the purest examples of true corrosive poisons, their poisonous -effects depending entirely on the organic injury they occasion in the -textures to which they are applied. It is of use to set out, in -investigating the effects of poisons, by determining the phenomena -presented under such circumstances. When made aware of the rapidity with -which other irritating poisons prove fatal, and the slight signs they -commonly leave of their operation, one cannot fail to be struck with -discovering what the animal frame will sometimes endure from these the -most violent of all irritants, and nevertheless recover. - -In laying down the mode of determining by chemical evidence a case of -supposed poisoning with any of the three mineral acids mentioned above, -it will be unnecessary to notice any of their chemical properties, -except those from which their medico-legal tests are derived. - -The only common properties that require notice are, their power of -reddening the vegetable blue colours, for showing which litmus-paper is -commonly used, and is most convenient: and their power of staining and -corroding all articles of dress, especially such as are made of wool, -hair, and leather. This last property is specified, though a familiar -one, because it always forms important evidence in criminal cases. In -order to give precision to such evidence, it is necessary to remember, -that if the article of dress is a coloured one, it is generally rendered -red by the mineral acids; but that the vegetable acids also will redden -most articles of dress, although they do not corrode them. - - - I.—OF POISONING WITH SULPHURIC ACID. - -Sulphuric acid is extensively employed in very many trades, is used even -for some domestic purposes, and is consequently familiar to every one. -Hence it is the mineral acid which has been most commonly used as a -poison, especially for committing suicide. Of 35 cases of poisoning with -the mineral acids which occurred in England in the years 1837 and 1838, -32 were caused by this acid (p. 90). - - - SECTION I.—_Of the Tests for Sulphuric Acid._ - -Sulphuric acid is known as a poison chiefly in the form of the -concentrated commercial acid. But a few cases of poisoning have also -been produced by blue-liquor or the solution of indigo in strong -sulphuric acid; and one instance[233] has been recorded of poisoning -with the aromatic sulphuric acid of the Pharmacopœias, which is an -infusion of aromatics in a mixture of sulphuric acid, ether and alcohol. -In the following remarks on its tests, it will be sufficient to consider -it _first_ in the concentrated form,—_secondly_, in a state of simple -dilution,—and _thirdly_, when mixed with various impurities, more -especially with vegetable and animal matter. The acid solution of indigo -may be known by the tests for the concentrated acid, and its blue -colour, removable by a solution of chlorine; and the aromatic sulphuric -acid may be distinguished by its odour and the tests for the diluted -acid. - -1. _When concentrated_ it is oily-looking, colourless, or brownish from -having acted on organic particles, without odour, much heavier than -water, and capable of quickly corroding animal substances. If from these -properties, and its effect in reddening litmus, its exact nature be not -considered obvious, it may be heated with a few chips of copper; when -sulphurous acid is disengaged and may be readily recognised by its -odour. - -2. _When diluted_, it may be distinguished from all ordinary acids by -solution of nitrate of baryta occasioning a heavy white precipitate of -sulphate of baryta, which is insoluble in nitric acid. Selenic and -sulphurous acids, however, and also, as Mr. Alfred Taylor informs me he -has lately found, the fluo-silicic acid, are similarly acted on in all -respects. But selenic and fluo-silicic acids in all forms, and -sulphurous acid in a state of solution, are so seldom met with, being -known only in the laboratory of the scientific chemist, that they can -scarcely be considered sources of fallacy. Sulphuric acid may at once be -distinguished from sulphurous acid, by the latter possessing a peculiar -pungent odour. From the two other acids it may be distinguished by -collecting and drying the barytic precipitate, mixing this with -charcoal, converting it into sulphuret of barium by heating it in a -platinum spoon before the blowpipe, and then adding diluted muriatic -acid to the sulphuret, so as to disengage sulphuretted hydrogen -gas,—which again is easily known by its odour, or its property of -blackening paper dipped in solution of acetate of lead. A much more -important source of fallacy than these is the possible presence of a -bisulphate in solution, or a neutral sulphate along with any other free -acid; for these substances will present the same reactions with litmus -and barytic salts as free sulphuric acid itself. Much has been published -lately upon this point; but the difficulty has not yet been -satisfactorily overcome. It may be got rid of indeed by proving, that no -bisulphate or neutral sulphate is present. Their absence may be shown by -no solid residuum being left on evaporating the suspected fluid, or at -least no more than a mere haziness, owing to the sulphate of lead which -commercial sulphuric acid always contains in small quantity. Or as -Orfila suggests, we may establish their absence still better by -concentrating the fluid, and finding that neither carbonate of soda, -which would cause a precipitate with earthy or metallic bases, nor -chloride of platinum, which would do so with potash or ammonia in -combination, nor fluo-silicic acid, which precipitates soda salts, has -any effect when applied to separate portions of the subject of inquiry. -But suppose it appears in the course of these trials that one or more -bases are actually present, how is it to be settled whether the -sulphuric acid, indicated by litmus and a salt of baryta, is really free -or not? To this question I must reply, that no method has yet been -proposed, which is at once satisfactory and easily available. Mr. Alfred -Taylor proposes to concentrate the fluid, and agitate it with alcohol, -in the hope that the alcohol will remove sulphuric acid, and not a -sulphate, from the water.[234] But it removes sulphuric acid from a -bisulphate even when dry, and still more when a little water is present. -Orfila[235] proposes, in the case of sulphuric acid in vinegar,—where -there is both a vegetable acid and a neutral sulphate of lime,—to -concentrate to a sixth, and agitate the residuum with four times its -volume of sulphuric ether, in the expectation that this fluid will -remove the free acid alone, and separate it from sulphates. But -notwithstanding the authority of his name for the fact, pure ether will -not remove sulphuric acid from a watery fluid; and etherized alcohol, -which does remove it, takes it away also, like alcohol itself, from -bisulphates. These results I have observed in some careful trials made -along with Dr. Douglas Maclagan. I suspect, therefore, that where -sulphates or bisulphates do exist, there is no absolutely satisfactory -way of determining whether free sulphuric acid also co-exists, except by -a quantitative analysis, for ascertaining whether the amount of acid and -of bases corresponds with this supposition or not. And it is scarcely -necessary to add, that so operose a method is scarcely applicable to -ordinary medico-legal investigations. - -3. It is seldom that the medical jurist is called on to search for -sulphuric acid in either of the states already mentioned. Much more -generally it has mingled with and acted on various organic substances. -The circumstances in which it has usually to be sought for in the -practice of medical jurisprudence are twofold,—on the one hand, in -stains on clothes,—and on the other, in vomited matter, the contents of -the stomach, or organic mixtures generally. - -_Process for analyzing stains on clothes._—When sulphuric acid is thrown -upon your clothes, it produces a permanent red, reddish-brown, or -yellowish stain, destroys the cloth entirely or renders it brittle, and -in consequence of its strong attraction for water keeps the stain long -in a moist state. In the course of the decomposition of the cloth a part -of the acid is itself decomposed, sulphurous acid being disengaged. But -it is an important medico-legal fact, that after a time the change -either goes on very slowly, or is arrested altogether, possibly by the -dilution of the acid with moisture from the atmosphere; and that -consequently it may be discovered in a free state in stains after a much -longer interval than would _à priori_ be expected. In the case of -Macmillan formerly alluded to, Dr. Turner and I, who were employed by -the crown to examine the different injured articles of dress, found on a -man’s hat, stock, shirt-collar and coat many discoloured and corroded -spots, which were sour to the taste fourteen days after the crime was -committed; in the subsequent case of Mrs. Humphrey I discovered -six-tenths of a grain of free sulphuric acid in two small spots on a -blanket seven weeks after the crime; and from an express experiment on -the same blanket with two drops of acid of known strength, it appeared -that only one-half of the acid disappeared in seven weeks. It may -therefore be inferred, that, in every instance where stains have been -produced by concentrated sulphuric acid on clothes, at least on woollen -clothes, and no attempt has been made to remove the remaining acid by -washing or neutralization, a sufficient quantity will be present even -after several weeks to admit of being satisfactorily detected by -chemical analysis. - -The following are the steps of the process which appear to me the most -delicate and equivocal. Cut away the stained spots; boil them for a -minute or two in several successive small portions of distilled water; -and filter if necessary. Next prove the acidity of the fluid by litmus, -and likewise by the taste if the quantity of solution is large enough to -allow of so coarse a test being used; and with a few drops ascertain the -existence of sulphuric acid in one form or another by nitrate of baryta -and nitric acid, as mentioned in the process for the pure diluted acid. -If no precipitate appears, the search for sulphuric acid is at an end. -But if a precipitate is produced, ascertain the absence of bisulphates -and sulphates by proving the absence of bases, according to the method -described in the process for the simple diluted acid. If, however, bases -be found in material proportion to the acid, the analysis is subject to -all the difficulties mentioned above in speaking of the detection of the -diluted acid in similar circumstances. - -_Process for the contents of the stomach and other complex -mixtures._—When sulphuric acid has been mixed with various mineral and -organic substances, it may in no long time cease to exist in the free -state. Part may be decomposed by organic matter in the way formerly -mentioned. Or the whole may be neutralized at once by earthy or alkaline -carbonates, administered purposely as antidotes. Or it may also be -neutralized more slowly by the gradual development of ammonia in -consequence of the decay of the animal matter co-existing in the -mixture. Thus in a case mentioned by Mertzdorff of a child killed in -twelve hours with sulphuric acid, the contents of the stomach did not -redden litmus, but on the contrary had an ammoniacal odour; and they -contained a considerable quantity of a soluble sulphate, probably the -sulphate of ammonia.[236] In like manner MM. Orfila and Lesueur found -that when this acid was left some months in a mixture which contained -putrefying azotized matter, it was gradually neutralized by -ammonia.[237] It appears from Orfila’s latest researches,[238] that in -most cases of acute poisoning with this substance some free acid will be -found in the contents or tissues of the stomach, provided alkalis or -earths were not given as antidotes, and the examination of the body be -made before decay sets in. - -The detection of sulphuric acid in complex organic mixtures, simple -though it appears at first sight, is one of the most difficult problems -in medico-legal chemistry. The difficulty arises from a variety of -sources,—from the probable presence of neutral sulphates along with free -hydrochloric, acetic, or some other acid,—the possible presence of a -bisulphate,—the occasional neutralization of the sulphuric acid by -antidotes given during life, or ammonia evolved during decay after -death,—or its neutralization, together with the development of a -different free acid, by its having displaced this acid from a salt -existing in the mixture. - -The subject was investigated in most of its relations in the last -edition of the present work, and a process proposed which overcame some -difficulties, but left others untouched. The inquiry has been since -undertaken also by M. Devergie and Professor Orfila, but with most -success in Germany by Dr. Simon.[239] The result of all these researches -is, that a satisfactory process for detecting sulphuric acid in organic -mixtures still remains to be discovered. Meanwhile the most eligible -method appears to me to be the following. - -a. _If the mixture be acid_, add distilled water, if necessary, boil, -filter, and test a few drops of the fluid with nitrate of baryta, -followed by nitric acid. If there be no precipitate, the search for -sulphuric acid is at an end. If a precipitate form, distil the fluid -from a muriate of lime or oil bath, at a temperature not above 240°, -till the residuum acquire a thick syrupy consistence; and preserve apart -the last sixth of the distilled liquor. In this liquor test for -hydrochloric acid by litmus-paper and nitrate of silver, and for acetic -acid by litmus-paper, and the odour and taste of the liquid. If these -acids be not in the distilled fluid, they are not in the residuum. In a -portion of this residuum search for nitric acid, and in another portion -for oxalic acid, by the processes for these poisons in complex mixtures. -If all these acids be thus proved to be absent, it is most unlikely that -the acidity of the mixture is owing to any other but sulphuric acid, -especially in the case of the contents or textures of the stomach. - -Dilute now what remains of the syrupy extract, and add nitrate of baryta -with nitric acid. If a precipitate arise, there is a strong presumption -that the acidity of the mixture was owing either to a bisulphate or to -free sulphuric acid. And between these the question may be almost -settled, first by the probability or improbability of a bisulphate -having come in the way, and secondly, by the symptoms and morbid -appearances. The result however cannot justify more than a presumptive -opinion.—But if hydrochloric, acetic or nitric acid be indicated in the -subject of analysis, or an acid sulphate, the whole process is vitiated, -and it is scarcely possible to arrive at any trustworthy conclusion. - -The difficulties adverted to above have been made the ground-work of -various processes; which however seem to me all imperfect.—It has been -proposed to divide the mixture into two equal parts, to precipitate one -directly by a barytic salt, to do the same with the other after drying -and incinerating it, to compare the weight of the precipitates, and to -infer the presence of free sulphuric acid if the former is more than -double the latter. Various objections however may be brought against -this check, not the least serious being its difficulty in ordinary -hands, whenever the precipitates are none of them considerable.—Simon -proposes to exhaust the residuum of evaporation with absolute alcohol, -in the hope that free sulphuric acid will alone be taken up;[240] but he -himself found that neutral sulphates are dissolved partially; and -besides, alcohol removes sulphuric acid from bisulphates.—Orfila -proposes to remove free sulphuric acid by agitating the concentrated -liquor with sulphuric ether, and separating and evaporating off the -ether; for he holds that all neutral and acid salts of sulphuric acid -are insoluble in ether.[241] This proposal is unaccountable. Simon -stated in his paper three years before, that ether does not remove -sulphuric acid from watery fluids containing it. And Dr. Douglas -Maclagan and I, on inquiring into the matter, found that we could not, -by means of ether, separate a particle of sulphuric acid from an ounce -of rice soup and mucilage to which ten drops of the acid had been added. -The process of Orfila for establishing the absence of bases in a simple -watery solution is applicable to organic mixtures also, after -incineration. But if bases be present in material quantity, all the -difficulties now in question remain in full force. - -b. _When the mixture is neutral_, sulphuric acid may be detected in it -by the first steps of the preceding process. But the inference, that it -once existed free can only be drawn when the subject of examination is -not in a state of decay, when the quantity of sulphate of baryta -obtained is considerable, when the administration of an antidote is -proved, and when the ashes after incineration contain the antacid base -which is said to have been administered. Even then the inference is only -presumptive. - - - SECTION II.—_Of the Mode of Action of Sulphuric Acid, and the Symptoms - caused by it in Man._ - -It was formerly observed that the action of the strong mineral acids is -independent of the function of absorption. They act by the conveyance -along the nerves of an impression produced by the irritation or -destruction of the part to which they are applied. There is very little -difference between the three acids in the symptoms they excite or the -action they exert. - -When sulphuric acid is introduced directly into a vein it causes death -by coagulating the blood. Thus, when Professor Orfila injected in the -jugular vein of a dog half a drachm diluted with an equal weight of -water, he observed that the animal at once struggled violently, -stretched out its limbs, and expired; and on opening the chest -immediately, he found the heart and great vessels filled with coagulated -blood.[242]—Nitric acid and hydrochloric acid act in the same way. - -If, on the other hand, they are introduced into the stomach, the blood -as usual remains fluid for some time after death; the symptoms are -referrible almost solely to the abdomen; and in the dead body the -stomach is found extensively disorganised, and the other abdominal -viscera sometimes inflamed. If the dose be large, and the animal -fasting, death may take place in so short a time as three hours: but in -general it lives much longer.[243] - -When the strong mineral acids are applied outwardly, they irritate, -inflame, or corrode the skin. The most rapid in producing these effects -is the nitric, or rather the nitrous acid. The strong, fuming nitrous -acid even causes effervescence when dropped on the skin. - -Orfila has proved that sulphuric acid, as well as the two other mineral -acids, is absorbed; for they may be detected in the urine, when they are -introduced either into the stomach or through a wound.[244] He could not -succeed, however, in detecting any of them in the liver or spleen; in -which organs it will be seen, hereafter, that various other poisons may -be discovered by chemical analysis. But Mr. Scoffern seems to have found -sulphuric acid in the kidney, even although the individual survived the -taking of the poison nearly two days.[245] It is also worthy of remark, -that, as will be proved presently, these acids may pass through the -coats of the stomach by transudation, and so be found on the surface of -the other organs in the belly. - -Toxicology is indebted to M. Tartra for the first methodic information -published respecting the symptoms caused in man by sulphuric acid and -the other mineral acids:[246] but many important additional facts have -been made known by numberless cases of poisoning which have since -appeared, chiefly in the periodic journals. - -The symptoms caused by all the three acids are so nearly the same, that -after a detailed account of those occasioned by sulphuric acid, it will -not be necessary to add much on the subject under the head of nitric and -muriatic acid. - -M. Tartra considers that four varieties may be observed in the effects -of the mineral acids. 1. Speedy death from violent corrosion and -inflammation; 2. Slow death from a peculiar organic disease of the -stomach and intestines; 3. Imperfect recovery, the person remaining -liable ever after to irritability of the stomach; 4. Perfect recovery. - -1. The most ordinary symptoms are those of the first variety,—namely, -all the symptoms that characterise the most violent gastritis, -accompanied likewise with burning in the throat, which is increased by -pressure, swallowing, or coughing;[247]—eructations proceeding from the -gases evolved in the stomach by its chemical decomposition;—and an -excruciating pain in the stomach, such as no natural inflammation can -excite. The lips are commonly shrivelled, at first whitish, but -afterwards brownish in the case of sulphuric acid. Occasionally there -are also excoriations, more rarely little blisters. Similar marks appear -on other parts of the skin with which the acid may have come in contact, -such as the cheeks, neck, breast, or fingers; and these marks undergo -the same change of colour as the marks on the lips. I had an opportunity -of witnessing this in the case of the man who was disfigured by the -Macmillans (p. 122) with sulphuric acid. He was cruelly burnt on the -face as well as on the hands, which he had raised to protect his face; -and the marks were at first white, but in sixteen hours became brownish. -The inside of the mouth is also generally shrivelled, white, and often -more or less corroded; and as the poisoning advances, the teeth become -loose and yellowish-brown about the coronæ. The teeth sometimes become -brown in so short a time as three hours.[248] Occasionally the tongue, -gums, and inside of the cheeks are white, and as it were polished, like -ivory.[249] There is almost always great difficulty, and sometimes -complete impossibility, of swallowing. In the case of a child related by -Dr. Sinclair, of Manchester, fluids taken by the mouth were returned by -the nose; and the reason was obvious after death; for even then the -pharynx was so much contracted as to admit a probe with difficulty.[250] -On the same account substances taken by the mouth have been discharged -by an opening in the larynx which had been made to relieve impending -suffocation. The matter vomited, if no fluids be swallowed, is generally -brownish or black, and at first causes effervescence, if it falls on a -pavement containing any lime. Afterwards this matter is mixed with -shreds of membrane, which resemble the coats of the stomach, and -sometimes actually consists of the disorganised coats, but are generally -nothing more than coagulated mucus. The bowels are obstinately costive, -the urine scanty or suppressed; and the patient is frequently harassed -by distressing tenesmus and desire to pass water. The pulse all along is -very weak, sometimes intermitting, and towards the close imperceptible. -It is not always frequent; on the contrary, it has been observed of -natural frequency, small and feeble in a patient who survived fifteen -days.[251] The countenance becomes at an early period glazed and -ghastly, and the extremities cold and clammy. The breathing is often -laborious, owing to the movements of the chest increasing the pain in -the stomach,—or because pulmonary inflammation is also at times -present,—or because the admission of air into the lungs is impeded by -the injury done to the epiglottis and entrance of the larynx. To these -symptoms are added occasional fits of suffocation from shreds of thick -mucus sticking in the throat, and sometimes croupy respiration, with -sense of impending choking. - -Such is the ordinary train of symptoms in cases of the first variety. -But sometimes, especially when a large dose has been swallowed, instead -of these excruciating tortures, there is a deceitful tranquillity and -absence of all uneasiness. Thus, in the case of a woman who was poisoned -by her companions making her swallow while intoxicated aqua-fortis mixed -with wine, although she had at first a good deal of pain and vomiting, -there were subsequently none of the usual violent symptoms; and she died -within twenty hours, complaining chiefly of tenesmus and excessive -debility.[252] Occasionally eruptions break out over the body:[253] but -their nature has not been described. - -Death is seldom owing to the mere local mischief, more generally to -sympathy of the circulation and nervous system with that injury. -According to Bouchardat death arises from the acid entering the blood in -sufficient quantity to cause coagulation.[254] But although this -certainly happens sometimes to the blood in the vessels of the stomach -and adjacent organs, as will be proved under the head of the morbid -appearances, there is no evidence that the same takes place throughout -the blood-vessels generally, or in the great veins and heart in -particular. Bouchardat’s proofs of the detection of sulphuric acid in -the blood are not satisfactory. - -The duration of this variety of poisoning with the acids is commonly -between twelve hours and three days. But sometimes life is prolonged for -a week[255] or a fortnight;[256] and sometimes too death takes place in -a very few hours. The shortest duration among the numerous cases of -adults mentioned by Tartra is six hours;[257] but Dr. Sinclair, of -Manchester, has related a case which lasted only four hours and a -half;[258] a man lately died in the Edinburgh Infirmary within four -hours; and Professor Remer of Breslau once met with a case fatal in two -hours.[259] - -The quantity required to produce these effects has not been ascertained, -and must be liable to the same uncertainty here as in other kinds of -poisoning. The smallest fatal dose of sulphuric acid I have hitherto -found recorded was one drachm. It was taken with sugar by mistake for -stomachic drops by a stout young man, and killed him in seven days.[260] -An infant of twelve months has been killed in twenty-four hours by half -a tea-spoonful, or about thirty minims.[261] A man has recovered after -taking six drachms.[262] - -2. The second variety of symptoms belong to a peculiar modification of -disease, which is described by Tartra in rather strong language. It -begins with the symptoms already noticed; but these gradually abate. The -patient then becomes affected with general fever, dry skin, spasms and -pains of the limbs, difficult breathing, tension of the belly, -salivation, and occasional vomiting, particularly of food and drink. -Afterwards membranous flakes are discharged by vomiting, and the -salivation is accompanied with fœtor. These flakes are often very like -the mucous membrane of the stomach and intestines; and such they have -often been described to be. More probably, however, they are of -adventitious formation; for the mere mucous coat of the alimentary canal -cannot supply the vast quantity that is evacuated. There is no doubt, -however, that the lining membrane of the alimentary canal is -occasionally discharged. Dr. Wilson has mentioned an instance of the -ejection by coughing of about nine inches of the cylindrical lining of -the pharynx and gullet six days after sulphuric acid was taken.[263] -Sometimes worms are discharged dead, and evidently corroded by the -poison.[264] Digestion is at the same time deranged, the whole functions -of the body are languid, and the patient falls into a state of marasmus, -which reduces him to a mere skeleton, and in the end brings him to the -grave. Death may take place in a fortnight, or not for months. In one of -Tartra’s cases the patient lived eight months. The vomiting of -membranous flakes continues to the last. - -3. The third variety includes cases of imperfect recovery. These are -characterized by nothing but the greater mildness of the primary -symptoms, and by the patient continuing for life liable to attacks of -pain in the stomach, vomiting of food and general disorder of the -digestive function. - -4. The last variety comprehends cases of perfect recovery, which are -sufficiently numerous even under unpromising appearances. From the -average of 55 cases recorded by Tartra it appears that the chances of -death and recovery are nearly equal. Twenty-six died, 19 of the primary, -7 of the secondary disorder. Twenty-nine recovered, and of these -twenty-one perfectly. Suicidal are for obvious reasons more frequently -fatal than accidental cases. - -Tartra has not taken notice in his treatise of another form of poisoning -with the strong acids,—in which the injury is confined to the gullet and -neighbouring parts. In Corvisart’s Journal there is the case of a man, -who began to drink sulphuric acid for water while intoxicated, but -suddenly found out his error before he had swallowed above a few drops; -and consequently the chief symptoms were confined to the throat. After -his physician saw him he was able to take one dose of a chalk mixture; -but from that time he was unable to swallow at all for a fortnight.[265] -Martini likewise met with a similar instance of complete dysphagia from -stricture in the gullet caused by sulphuric acid.[266] His patient -recovered. - -It also appears exceedingly probable, that the strong acids may cause -death, without reaching the stomach or even the gullet, by exciting -inflammation and spasm of the glottis and larynx. Such an effect may -very well be anticipated from an attempt to commit murder with these -poisons; as the person, if he retains consciousness at the time, may -become aware of their nature before he has swallowed enough to injure -the stomach. - -Thus, Dr. A. T. Thomson says in 1837, that he once met with the case of -a child, who, while attempting to swallow strong sulphuric acid by -mistake for water, died almost immediately, to all appearance from -suffocation caused by contraction of the glottis; and it was ascertained -after death that none of the poison had reached the stomach.[267] -Professor Quain describes a similar case, occurring also in a child, -where impending death was prevented by artificial respiration, and acute -bronchitis ensued, which proved fatal in three days. In this instance -thickening of the epiglottis and great contraction of the upper opening -of the larynx showed the violent local injury inflicted there, -inflammation could be traced down the trachea into the bronchial tubes, -but no trace of injury could be detected in the gullet and stomach.[268] -In a very interesting and carefully detailed case by Mr. Arnott, where -the poison taken was the nitric acid, the injury was confined in a great -measure to the gullet and larynx,—the stomach, which was distended with -food at the time, being very little affected. The chief symptoms at -first, besides great general depression, were croupy respiration and -much dyspnœa, which became so urgent, that laryngotomy was performed, -and with complete relief to the breathing. But the patient nevertheless -rapidly sunk under the symptoms of general exhaustion, and died in -thirty-six hours without presenting any particular signs of the -operation of the poison on the stomach; and the traces of action found -there after death were trifling.[269] - -The importance of the fact established by these cases will appear from -the following medico-legal inquiries. A Prussian medical college was -consulted in the case of a new-born child, in which the stomach and -intestines were healthy, and did not contain poison, but in which the -cuticle of the lips was easily scraped off, the gums, tongue, and mouth -yellowish-green, as if burnt, the velum and uvula in the same state, the -rima glottidis contracted, and the epiglottis, larynx, and fauces -violently inflamed. The College declared, that a concentrated acid had -been given, and that death had been occasioned by suffocation. Sulphuric -acid was found in the house; and the mother subsequently confessed the -crime.[270] A case was formerly quoted (p. 75), where MM. Ollivier and -Chevallier found traces of the action of nitric acid on the lips, mouth, -throat and upper fourth of the gullet, but not lower. In this instance -the reporters came to the opinion from the absence of injury in the more -important parts of the alimentary canal, as well as from the marks of -nail scratches on the neck, and the gorged state of the lungs, that -death had been produced by strangling, after an unsuccessful attempt by -the forcible administration of nitric acid. It is quite possible, -however, that death might quickly ensue from the effects of the poison -on the throat and gullet. In the course of the judicial inquiries M. -Alibert stated that he had known repeated instances of death from -swallowing nitric acid, although none of it reached lower down than the -pharynx. Ollivier in his paper doubts the accuracy of this statement; -but the cases quoted above show clearly that such injury may be done to -the glottis as will be adequate of itself to occasion death.[271] - -It seems farther not improbable that, among the terminations of -poisoning with the strong mineral acids, scirrhous pylorus must also be -enumerated. This is a very rare effect of the action of corrosive -poisons. But M. Bouillaud has related an instance of death from -scirrhous pylorus in its most aggravated shape, which supervened on the -chronic form of the effects of nitric acid, and which proved fatal in -three months.[272] - -In some circumstances the stomach seems to acquire a degree of -insensibility to the action of the strong acids. Tartra, in alluding to -what is said of certain whisky-drinkers acquiring the power of -swallowing with impunity small quantities of the concentrated acids, has -related the case of a woman at Paris, who, after passing successively -from wine to brandy and from that to alcohol, at last found nothing -could titillate her stomach except aqua-fortis, of which she was seen to -partake by several druggists of veracity.[273] The fire-eating -mountebanks too are said to acquire the same power of endurance; but -much of their apparent capability is really legerdemain. On the other -hand, a very extraordinary sensibility to the action of the diluted -mineral acids has been supposed to exist in the case of infants at the -breast,—so great a sensibility, that serious symptoms and even death -itself have been ascribed to the nurse’s milk becoming impregnated with -sulphuric acid, in consequence of her having taken it in medicinal -doses. By two writers in the London Medical Repository griping pains, -tremors and spasms have been imputed to this cause;[274] and a writer in -the Medical Gazette says he has seen continued griping, green diarrhœa -and fatal marasmus ensue,—apparently, he thinks, from ulceration of the -gastro-intestinal mucous membrane.[275] Without questioning the great -delicacy and tenderness of that membrane in infants, I must nevertheless -express my doubts whether so small a quantity taken by a nurse, -amounting in the cases in question only to four or six drops a day, -could really produce fatal or even severe effects on her child. - -Sulphuric acid is not less deadly when admitted into the body through -other channels besides the mouth. Thus, it may prove fatal when -introduced into the rectum. A woman at Bruges in Belgium had an -injection administered, in which, being prepared hastily in the middle -of the night, sulphuric acid had been substituted by mistake for -linseed-oil. The patient immediately uttered piercing cries, and passed -the remainder of the night in excessive torture. In the morning the -bed-clothes were found corroded, and a portion of intestine had -apparently come away; and she expired not long afterwards.[276] - -Death may also be occasioned by the introduction of this acid into the -ear. Dr. Morrison relates a case of the kind, where nitric acid, which -is analogous in action, was poured by a man into his wife’s ear, while -she lay insensible from intoxication. She awoke in great pain, which -continued for two or three days. In six days an eschar detached itself -from the external passage of the ear; and this was followed by profuse -hemorrhage, which recurred daily more or less for a month. On the day -after the eschar came away, and without any precursory symptom -referrible to the head, she was attacked with complete palsy of the -right arm, and in eight days more with tremors and incomplete palsy of -the rest of that side of the body. These symptoms subsequently abated; -but they again increased after an imprudent exertion, and she died in a -state of exhaustion seven weeks after the injury. The whole petrous -portion of the temporal bone was found carious, but without any distinct -disease of the brain or its membranes.[277] - -Sulphuric acid and the other mineral acids are equally poisonous when -inhaled in the form of gas or vapour; and they then act chiefly by -irritating or inflaming the mucous membrane of the air-passages and -lungs. For some observations on their effects in this form both on -plants and animals the reader may refer to the Chapter on Poisonous -Gases. - -Sulphuric acid belongs to the poisons alluded to under the head of -General Poisoning,—of whose operation satisfactory evidence may be -occasionally drawn from symptoms only. If immediately after swallowing a -liquid which causes a sense of burning in the throat, gullet, and -stomach, violent vomiting ensues, particularly if the vomited matter is -mixed with blood; if the mouth becomes white, and stripped of its lining -membrane, and the cheeks, neck, or neighbouring parts show vesications, -or white, and subsequently brown excoriated spots;—if the clothes show -red spots and are moist and disintegrated there,—I cannot see any -objection to the inference, that either sulphuric or muriatic acid has -been taken. In this opinion I am supported by a good authority, Dr. -Mertzdorff, late medical inspector at Berlin.[278] - - - SECTION III.—_Of the Morbid Appearances caused by Sulphuric Acid._ - -The outward appearance of the body in cases of Tartra’s first variety in -the action of the acids is remarkably healthy; every limb is round, -firm, and fresh-looking. - -On the lips, fingers, or other parts of the skin, spots and streaks are -found where sulphuric acid has disorganized the cuticle. These marks are -brownish or yellowish-brown, and present after death the appearance of -old parchment or of a burn; sometimes there are little blisters.[279] - -The lining membrane of the mouth is more or less disorganized, generally -hardened, and whitish or slightly yellowish. The pharynx is either in -the same state, or very red or even swelled. The rima glottidis, as in -the case described by Dr. Sinclair and in that of Mr. Arnott, is -sometimes contracted, the epiglottis swelled, or on the contrary -shrivelled, and the commencement of the larynx inflamed.[280] The gullet -is often lined with a dense membrane, adhering firmly, resembling the -inner coat, but probably in general a morbid formation; and the -subjacent tissue is brown or red. Sometimes, however, the inner coat or -epithelian of the gullet loses its vitality, and is detached in part or -altogether. In Mr. Arnott’s case the pharynx and upper gullet were lined -by a pale lemon-coloured membrane, which in the lower two-thirds of the -canal was completely detached and was plainly the œsophageal membrane; -in the case related by Mertzdorff, the whole inner coat of the gullet, -as well as that of the throat, epiglottis, and mouth, was stripped from -the muscular coat;[281] and in Dr. Wilson’s case (p. 131), which proved -fatal in ten months, the upper third of the gullet shone like an old -cicatrix, and the lower two-thirds were narrowed, vascular, and softened -on the surface.[282] In a few rare cases of chronic poisoning with the -mineral acids the gullet is found perforated by an ulcerative -process;[283] but it is never perforated by their corrosive action in -quickly fatal cases. Occasionally the gullet is not affected at all, -though both the mouth and the stomach are severely injured; and an -instance has even been published where the acid, in this instance the -nitric, left no trace of its passage downwards till near the -pylorus.[284] - -The outer surface of the abdominal viscera is commonly either very -vascular or livid, or bears even more unequivocal signs of inflammation, -namely, effusion of fibrin and adhesions among the different turns of -intestine; and these appearances may take place although the stomach is -not perforated.[285] The cause of this appearance, which is seldom -observed in poisoning with other irritants, more especially with the -metallic irritants, is that the acid passes through the membranes of the -stomach by transudation during life,—as will be proved immediately. It -must be observed, that the peritonæum is sometimes quite natural after -death from sulphuric acid, even although the stomach was perforated. I -have seen this in a case which proved fatal in twelve hours. An -important appearance in the abdomen, to which less attention has been -hitherto paid than it deserves, is gorging of the vessels beneath the -peritonæal membrane of the stomach and adjoining organs with dark, -firmly coagulated blood, arising from the acid having transuded through -the membranes and acted on the blood chemically. My attention was first -turned to this appearance by an interesting case, which I saw in 1840 in -the Royal Infirmary of this city, and of which an able account has been -published by Dr. Craigie.[286] The whole vessels of the stomach were -seen externally to be most minutely injected and gorged, and the blood -in them was coagulated into firmly-cohering cylindrical masses, as if -the vessels had been successfully filled with the matter of an -anatomical injection. This appearance was also observed in the superior -mesenteric arteries, in the omental vessels, and over the greater part -of the mesentery. It was occasioned by the chemical action of the acid -coagulating the colouring matter and albumen; for the clotted blood was -strongly acid to litmus-paper. So too was the peritoneal surface of the -stomach, omentum and intestines. And the acid had transuded through the -stomach and into the omentum and tissues of the intestines during life; -for in the first place, there was no perforation of the stomach, and -secondly, I ascertained that there was no free acid either in the matter -discharged from the stomach before death after the free administration -of antacids, or in the contents of the stomach obtained at the -examination of the dead body. - -The stomach, if not perforated, is commonly distended with gases. It -contains a quantity of yellowish-brown or black matter, and is sometimes -lined with a thick paste composed of disorganized tissue, blood and -mucus. The pylorus is contracted. - -The mucous membrane is not always corroded. If the acid was taken -diluted, the coats may escape corrosion; but there is excessive -injection, gorging, and blackness of the vessels, general blackness of -the membrane, sometimes even without softening, as in a case related by -Pyl of a woman who first took aqua-fortis and then stabbed herself.[287] -More commonly, however, along with the blackness there is softening of -the rugæ or actual removal of the villous coat, and occasionally regular -granulated ulceration with puriform matter on it.[288] The stomach is -not always perforated. But if it is, the holes are commonly roundish, -and the coats thin at the margin, coloured, disintegrated, and -surrounded by vascularity and black extravasation. In some rare cases -there is no mark of vital reaction except in the neighbourhood of the -aperture. A case of this kind is related by Mertzdorff: The margin of -the hole was surrounded to the distance of half an inch with apparent -charring of the coats, and this areola was surrounded by redness; but -the rest of the stomach was grayish-white.[289] I examined with the late -Dr. Latta of Leith a similar case, where the limitation of the injury -was evidently owing to the stomach having been at the time filled with -porridge. The patient, a child two years old, died in twelve hours; and -on the posterior surface of the fundus of the stomach, towards the -pylorus, there was a hole as big as a half-crown, which was surrounded -to the distance of an inch with a black mass formed of the disorganized -coats, and of incorporated charred blood. But the rest of the stomach -was quite healthy. The most remarkable instance of chemical destruction -of the coats yet known to me is a case mentioned by Mr. Watson of this -city, where suicide was effected by cutting the throat about half an -hour after two ounces of sulphuric acid had been swallowed. The -individual was at first thought to have died simply of the wound of the -throat. But on dissection the usual signs of acid poisoning were found; -and among other effects, it was observed that nearly three-fourths of -the stomach had been entirely destroyed.[290] The perforation, if the -patient lives long enough, is generally accompanied with a copious -effusion into the belly of the usual muddy liquor of peritonitis; and -the outer surface of the viscera feels unctuous, as if from a slight -chemical action of the acid on them. The acid has actually been found in -the contents poured out from the stomach into the sac of the -peritonæum.[291] - -One would expect to find the acid always in the stomach when it is -perforated. Nevertheless it is sometimes almost all discharged. In -Mertzdorff’s case, that of an infant who was killed in twelve hours, a -hole was found in the stomach ¾ths of an inch in diameter, and the -contents of the stomach were effused into the belly: yet by a careful -analysis the whole acid he could procure from the contents and tissues -together was only 4½ grains. Sometimes of course the disappearance of -the acid may be owing, as in Dr. Craigie’s case, to the effectual -administration of antacids during life. - -The inner coat of the duodenum often presents appearances closely -resembling those of the stomach. Sometimes, however, as in the case just -related from Mertzdorff, and in the infant I examined, the inner coat of -the small intestines is not affected at all, probably because in such -rapid cases the pylorus retains a state of spasmodic contraction till -death or even after it. - -The urinary bladder is commonly empty. The thoracic surface of the -diaphragm is sometimes lined with lymph, indicating inflammation of the -chest. In the case which was fatal in two hours [p. 131], Professor -Remer found the surface of the lungs, as well as that of the liver and -spleen, brown and of a leathern consistence, and the tissue beneath -scarlet;—appearances which he thinks arose from the acid penetrating in -vapour and acting chemically. I have not found this appearance mentioned -by any other writer; but I have seen it in animals poisoned with oxalic -acid. The blood in the heart and great vessels has been several times -seen forming a firm black clot. Kerkring[292] relates an instance of the -kind; in Dr. Latta’s case the appearance was very distinct; and it is -dwelt on strongly in a recent paper by M. Bouchardat.[293] Bouchardat -thinks this state of the blood is simply the effect of the absorbed -acid; but coagulation of the blood in the heart and great vessels,—a -striking appearance in contradiction to what is observed after death -from most other poisons,—is more probably the healthy state of the -blood, and not the effect of the particular poison. - -The general appearance of the body of those who have died of the second -or chronic variety of poisoning with the acids, is that of extreme -emaciation. The stomach and intestines are excessively contracted: The -former has been found so small as to measure only two inches and a half -from the cardia to the pylorus, and two inches from the lesser to the -greater curvature.[294] Tartra says the intestines are sometimes no -thicker than a writing quill. They are in other respects sound -outwardly, except that they sometimes adhere together. - -Internally the pylorus is contracted. In a case of slow poisoning, fatal -in three months, which has been described by Dr. Braun of Fürth, the -chief appearance besides excessive emaciation was a thickening of the -coats round and behind the pylorus to such a degree that the opening of -the pylorus was formed of an almost cartilaginous ring several lines -broad, and only wide enough to pass a quill.[295] There are spots over -the stomach apparently of regenerated villous tissue, smoother and -redder than the natural membrane. At the points where the stomach -adheres to the neighbouring organs, its coats are sometimes wanting -altogether, so that when its connections are torn away, perforations are -produced. The other parts of the body are natural. - -It may in some circumstances be necessary to determine from the -appearances in the dead body whether sulphuric acid has been the -occasion of death or has been introduced into the body after death. This -may always be easily done. If a few drachms of sulphuric acid be -injected into the anus immediately after death, and the parts be -examined in twenty-four hours, it will be found, that wherever the acid -touches the gut, its mucous coat is yellowish and brittle, its muscular -and peritonæal coats white, as if blanched, and the blood in the vessels -charred; the injury is confined strictly to the parts actually touched, -is surrounded by an abrupt line of demarcation, and shows no sign of -inflammatory redness. Nitric acid produces nearly the same effects. The -whole tunics are yellow, and the disorganization is greater. For these -facts we are indebted to Orfila.[296] - -In closing this account of the morbid appearances, some observations -will be required on the force of evidence derived from them; because -circumstances may exclude all other branches of medical proof. In many -instances both of acute and of chronic poisoning with the strong acids, -I conceive, contrary to the general statements of most systematic -writers on modern medical jurisprudence, that distinct evidence might be -derived from morbid appearances only. Thus, what fallacy can intervene -to render the following opinion doubtful? In a case several times -alluded to as described by Mertzdorff, there were vesicles and brown -streaks on the lips, neck, and shoulders, similar to the effects of -burning,—almost total separation of the lining membrane of the mouth, -throat, epiglottis, and gullet,—perforation of the stomach, with a -margin half an inch wide, which was extensively charred, and surrounded -by a red areola. From the appearances alone Mertzdorff declared that the -child must have been poisoned with sulphuric acid. Perhaps he should -have said sulphuric or muriatic acid. - -Or take the case of Richard Overfield, who was condemned at Shrewsbury -Assizes in 1824 for murdering his own child, a babe three months old, by -pouring sulphuric acid down its throat. In the dead body the following -appearances were found: The lips were blistered internally and of a dark -colour externally; the gullet was contracted and its inner coat -corroded; the lining membrane of the mouth and tongue of a dull white -colour; the great curvature of the stomach corroded and converted into a -substance like wet brown paper; the stomach perforated and a -bloody-coloured fluid in the sac of the peritonæum.[297] If to these -appearances be added the fact that the child’s dress was reddened, what -is there to prevent the medical jurist from declaring, without reference -to chemical evidence, that this case must have been one of poisoning by -sulphuric acid or some other mineral acids? - -In like manner in the case of Mrs. Humphrey, who was condemned at -Aberdeen in 1830 for murdering her husband by pouring sulphuric acid -down his throat while he was asleep, there was found, on examining the -dead body, two brown spots on the outside of the lips,—whiteness of the -inside of the lips and of the gums,—glazing of the palate,—redness, with -here and there ash-coloured discoloration, of the uvula, posterior part -of the throat, pharynx and epiglottis,—abrasion of most of the inner -coat of the gullet,—erosion and dark-red ulceration of the inner coat of -the stomach in winding furrows. When to these appearances it is added, -that the man was in good health only forty-seven hours before death, and -was taken ill instantaneously and violently with burning pain in the -throat and stomach,[298] it is not easy to see what other opinion could -be formed of the case, unless that he died of poisoning with a mineral -acid, and probably with sulphuric acid. - -Among the appearances justifying an opinion where chemical evidence -happens to be wanting, not the least important seems to me to be the -peculiar turgescence and induration of vessels under the peritonæum of -the stomach and neighbouring organs, occasioned by the chemical -coagulation of blood in them. It is an appearance, which, when once -seen, cannot be confounded with any natural morbid phenomenon I have -ever witnessed. - -I am far from desiring to encourage rashness of decision, or to revive -the loose criterions of poisoning relied on in former times. But there -cannot, in my opinion, be a rational doubt that in the instance of -sulphuric acid there may often be distinct exceptions to the general law -regarding the feebleness of the evidence from morbid appearances; and -that a witness would certainly be guilty of thwarting the administration -of justice, if, relying on general rules, he refused to admit such -exceptions. What natural disease could produce appearances like those -described above? Assuredly no form of spontaneous perforation bears any -resemblance to that caused in most cases of death from sulphuric acid; -nor is it easy to mention any combination of natural diseases which -could produce the peculiar conjunction of appearances remarked in the -case of the man Humphrey. - - - SECTION IV.—_Of the Treatment of Poisoning with Sulphuric Acid._ - -Since this acid and the other mineral acids act entirely as local -irritants, it may be inferred that their poisonous action will be -prevented by neutralizing them. But in applying that principle to the -treatment it is necessary to bear in mind their extremely rapid -operation; for if much time is lost in seeking for an antidote, -irreparable mischief may be caused before the remedy is taken. Should it -be possible then to administer chalk or magnesia without delay, these -are the antidotes which ought to be preferred; but it may be well for -the physician to remember, that in the absence of both he may at once -procure a substitute in the plaster of the apartment beat down and made -into thin paste with water. M. Chevallier, in a paper on the antidotes -for the mineral acids, quotes five cases of poisoning with sulphuric -acid and two with nitric acid, where life seems to have been saved by -the speedy and free administration of magnesia, although in some cases -so large a quantity as two ounces of the poison had been -swallowed.[299]—A solution of soap is another antidote of no small -value. While the antidote is in preparation, the acid should be diluted -by the free use of any mild fluid, such as milk or oleaginous -matters.—The alkaline bicarbonates are also excellent antidotes; but -their carbonates are ineligible, being themselves possessed of corrosive -properties. In a paper on poisoning with the mineral acids by Dr. -Lunding of Copenhagen, the author is disposed to ascribe the large -proportion of deaths in his practice to the system pursued in the -Copenhagen hospital of administering carbonate of potass as an antidote -daily for weeks together.[300] On the other hand however it may be -mentioned, that in a late memoir, on this description of poisoning Dr. -Ebers of Breslau endeavours to show, that there is no reason to dread -the administration of the alkaline carbonates, even the carbonate of -potash, provided they be given with mucilaginous fluids and syrup in a -rather concentrated form; and he gives three cases illustrative of the -good effects of this mode of treatment, which he maintains to be free of -all danger, and preferable to every other antidotal method, because the -remedy may be administered in small volume,—an advantage possessed by it -especially over chalk or magnesia.[301] - -After the proper antidote has been given to a sufficient extent, the use -of diluents ought to be continued, as they render the vomiting more -easy.—Some have recommended the stomach-pump for administering antidotes -and diluents; but this is unnecessary. When it is wished to evacuate the -stomach, there is an advantage in allowing it to do so by its own -efforts, if possible; because the evacuation is accomplished in this way -more completely than by the stomach-pump. Besides, if the patient cannot -swallow fluids, still less can he suffer the tube of the stomach-pump to -be introduced. On several occasions, indeed, it has been found -impracticable to introduce it.[302] - -The treatment of the surpervening inflammation does not differ from that -of inflammation of the stomach. Where there is great difficulty of -breathing, evidently from obstruction of the larynx, and where the -absence of abdominal pain, tension or vomiting affords a presumption -that little injury has been done to the stomach, laryngotomy appears an -advisable remedy, and has been known to give very great relief.[303] But -the patient may nevertheless die soon of the sympathetic disorder of the -circulation. - - - II.—OF POISONING WITH NITRIC ACID. - -Nitric acid is more frequently used as a poison abroad than in this -country. But even in Britain it is not an uncommon cause of severe -accidents and death. - - - _Of the Tests for Nitric Acid._ - -1. _When concentrated_, nitric acid is easily known by the odour of its -vapour, which is peculiar. When pure, the acid as well as its vapour is -colourless; when mixed with nitrous acid it is of various tints, and -generally yellow. The acid of commerce is at times rendered impure by -sulphuric acid, a circumstance which must be attended to in applying the -subsequent tests.—The simplest test for nitric or nitrous acid is the -action of copper, lead, or tin. If any of these metals in small -fragments, or powder, be thrown into either acid previously diluted with -an equal volume of water, an effervescence takes place, which in the -case of lead or copper is much accelerated by heat; nitric oxide gas is -disengaged; and ruddy fumes of nitrous acid gas are formed when the gas -comes in contact with the oxygen of the air. Another characteristic -test, which has the advantage of being applicable on an extremely small -scale, is morphia, the alkaloid of opium. This substance is turned in a -few seconds to a beautiful orange-red colour by nitric acid, and after -longer contact forms with it a bright yellow solution. No other acid has -this effect. Muriatic acid, as Dr. O’Shaughnessey has remarked,[304] -does not act at all on morphia, and sulphuric acid chars and blackens -it. When nitric acid is added to a solution of narcotin in sulphuric -acid, the colour of the solution is changed from yellow to -blood-red.[305] When it is added to a solution of proto-sulphate of -iron, the solution becomes brown, and the addition of sulphuric acid -then alters the colour to violet.[306] When it is added even in the most -minute proportion to sulphuric acid, the addition of a few particles of -the alkaloid brucia will render the whole fluid red, passing gradually -to yellow.[307]—Many other characteristic tests might be mentioned; but -those now specified are more than enough. - -2. _In a diluted state_ this acid is not so easily recognised as the -other mineral acids, for it does not form any insoluble salt or -precipitate with bases. - -The most convenient process consists in first ascertaining the acidity -of the fluid, then neutralizing it with potass, evaporating to dryness, -and heating the residue in a tube with sulphuric acid. The vapour -disengaged, if abundant, may be known by its orange colour in the tube -and its odour. But if small in quantity it is best to distil over the -vapour in a proper apparatus, and to subject the condensed product to -the tests of morphia, narcotin dissolved in sulphuric acid, and -proto-sulphate of iron dissolved in water. A convenient tube for the -purpose is that represented in Fig. 3; into which the materials are -introduced by the funnel, Fig. 4. The wide part of the tube may then be -drawn out in the spirit-lamp flame to any length or fineness that may be -necessary, so as to conduct the vapour into another tube as a condenser, -or directly into the substances to be used as tests. - -3. _When in a state of compound mixture_, nitric acid, like sulphuric -acid in similar circumstances, may be after a time partly decomposed and -partly neutralized; and when the matter with which it is mixed belongs -to either of the organic kingdoms, more particularly to the animal -world, its decomposition is more rapid than that of sulphuric acid. -Still it is an important fact, that some of the acid may be discovered -after a considerable interval. M. Ollivier detected it in various stains -on the skin at least a day after it had been applied;[308] Dr. -O’Shaughnessey detected it in a stain on cloth sent to him from Ireland -to Edinburgh;[309] and I have found it in stains made on broad-cloth -with detached drops seven weeks before. - -_Process for Stains._ Nitric acid produces on the skin a yellow stain, -which gradually becomes dirty orange, and finally of a dirty -yellowish-brown; but in all of these states it is at once rendered for a -time lively yellow by the action of ammonia. I am not aware that any -other yellow stain is similarly affected. Stains on cloth are generally -yellow, reddish-yellow, or brownish-yellow, and are attended with more -or less disintegration of the texture of the cloth. The method of -analyzing all these stains is as follows:—The stained parts is to be -boiled in a few drachms of pure water several times in succession; and -the liquid is then filtered, and may be subjected to litmus-paper for -the purpose of ascertaining its acidity. It is then to be rendered -neutral, or for the sake of greater facility, feebly alkaline, by adding -a few drops of a diluted solution of caustic potass, after which the -whole is evaporated to dryness, and in a vapour-bath, if practicable. -The residuum is then to be decomposed by sulphuric acid in the same way -as recommended above for the simple diluted acid.—Orfila thinks it -advantageous to let the stains macerate for some hours in a solution of -bicarbonate of soda rather than to boil them in water. In that case, -however, it is necessary to ascertain the acidity of the stains with -litmus-paper before proceeding to macerate them. - -_Process for Mixtures._ The detection of nitric acid in compound -mixtures, such as the contents of the stomach, is not so easy a matter -as its detection in stains; and indeed a sure and delicate process is -still a desideratum in medico-legal chemistry. The process varies, as in -the case of sulphuric acid, according as the subject of analysis is acid -or neutral. - -a. _If the mixture be acid_, and the proportion of the acid -considerable, it maybe detected without difficulty. It is merely -necessary to ascertain the acidity of the mixture by litmus-paper, to -neutralize with potass, water being added if necessary, and then to -filter and evaporate to a convenient degree of concentration. Crystals -will form on cooling, which may be decomposed by sulphuric acid in the -usual way. But the medical jurist ought not to flatter himself with the -expectation of meeting often with a proportion large enough to admit of -being discovered by so coarse a method of analysis. In general the -crystallization of the nitrate of potass is prevented by co-existing -animal or vegetable matter. When the proportion appears inconsiderable, -therefore, a different process must be pursued. In preparing the former -edition of this work, the present topic was investigated with some care, -and a method suggested which appeared to me at that time more effectual, -delicate, and conclusive than any previously made public. Since then -Professor Orfila has also investigated the subject attentively, and -after trying various methods, has ended in adopting one which is -substantially the same as that now referred to, but without a -precaution, which seems to me essential for success in certain probable -enough circumstances.[310] I am therefore disposed to retain my former -process, with some variations and additions in the details. - -Macerate the subject of analysis for a few hours in distilled water, -if it be not already liquid enough; and then boil for a few minutes, -and filter it. Ascertain now whether the fluid be acid to litmus; and -if it be so, neutralize it with solution of potash, or as Orfila -suggests, with a solution of the purer salt, the bicarbonate of soda. -Evaporate gently, to obtain crystals if possible; and if these do not -tend to the cubical form, distil them with sulphuric acid, and proceed -as directed for nitric acid simply diluted. If crystals do not appear, -or their form tend to the cube,—in which case chloride of sodium is -present,—redissolve the whole residue of evaporation in distilled -water; add a slight excess of a warm solution of acetate of silver, to -throw down organic matter and the chlorine of any chlorides that may -be present; filter and evaporate to dryness, and distil the residuum -with sulphuric acid, applying as usual to the vapour the tests of -litmus-paper and morphia,—also, as Orfila proposes, the solution of -narcotin in sulphuric acid, and proto-sulphate of iron in water,—and -if the quantity of vapour be great enough, the sense of smell and the -action of copper with the condensed vapour. - -b. _If the mixture be neutral_, proceed exactly as above, except that it -becomes unnecessary to neutralize the liquid with potash or bicarbonate -of soda. This variety in the process will be principally required, where -earths or alkalis have been administered as antidotes. - -The process now detailed requires a word or two of commentary.—Organic -matter is inconvenient because it prevents the nitrate of potash or soda -in the mixture from crystallizing. But it will not prevent the evolution -of nitric acid vapour by distillation with sulphuric acid, even although -the material be a simple extract without crystals. At the same time it -is better to get rid of as much organic matter as possible, if distinct -crystals be not obtained by evaporation. A more serious difficulty, -however, to which Orfila does not advert, arises from the co-existence -of a chloride. For, in that case, distillation with sulphuric acid may -disengage not nitric acid, but chlorine, in consequence of the reaction -which takes place between the nitric and hydrochloric acids in the act -of being liberated. This is a more important reason for purifying the -liquid by acetate of silver before subjecting it to concentration; but -in addition, by removing organic matter, this precaution increases the -chance of crystals of nitrate of potash or soda being obtained. Its -necessity, where a chloride co-exists, will appear from the following -experiment. Four drops of nitric acid neutralized with potass were mixed -with six ounces of strong barley-broth; from which half an ounce of -limpid fluid was procured by filtration. One-half of this evaporated to -dryness gave a crystalline residue, which, heated with sulphuric acid in -a tube, emitted a strong odour of chlorine; and the moisture which -bedewed the tube scarcely affected morphia. The residuum of the other -half of the filtered fluid was redissolved, treated with acetate of -silver, again filtered, and evaporated to dryness; and the residue was -gently heated in a tube with sulphuric acid. An odour of nitric acid was -now disengaged, and the moisture on the tube close to the mixture turned -a fragment of morphia to bright orange-red. - -Acetate of silver is prepared by mixing strong solutions of acetate of -potass and nitrate of silver, draining and compressing between folds of -bibulous paper the crystalline precipitate which forms, dissolving this -precipitate by agitating it in boiling water, and finally crystallizing -the salt again by refrigeration. The crystals, which are sparingly -soluble in cold water, should be then separated, slightly washed with a -little water, and again dried by compression. When put to use, a -solution should be made by agitating the salt in boiling water, because -at low temperatures water retains very little of the salt; but actual -ebullition should be avoided, because acetate of silver is thus quickly -decomposed. - -In all medico-legal analyses for nitric acid, care must be taken that -the different reagents used are free of this acid, and also of nitrates. -Sulphuric acid often contains a little nitric, or rather nitrous acid; -which may be discovered by the sulphuric acid becoming brown or dark-red -when a solution of proto-sulphate of iron is gently poured over it in a -test-tube; and which may be removed either by boiling the acid with a -few grains of sugar, according to the formula of the Edinburgh -Pharmacopœia, or, as Orfila directs, by boiling it with sulphate of -ammonia. - - -SECTIONS II. III. IV.—_Of the Action, Symptoms, Morbid Appearances, and - Treatment of Poisoning with Nitric Acid._ - -All the observations made on these topics under the head of sulphuric -acid apply, with few exceptions, to the nitric acid also. A few -statements therefore on the peculiarities ascertained to exist in the -latter case are all that will be required in the present sections. - -Nitric acid is not less powerful as a corrosive and irritant than -sulphuric acid. It will act with energy as an irritant even when -considerably diluted, for example with six or eight parts of water or -even more.—The lips which are rendered at first whitish by all the -acids, and eventually brownish by sulphuric acid, becomes soon yellow -with nitric acid. The tongue too sometimes acquires a yellow colour -instead of a white glazed appearance; but this character is not -invariable.—All spots caused by it on the skin become speedily yellow, -and long retain this hue; or if the tint become dull, which generally -happens in a few days, it is enlivened and the yellow colour restored -for a time, by ammonia, potash, soda, or soap.—An important fact, for -which toxicology is indebted to Professor Orfila, is that the acid may -be often found in the urine, both when it had been swallowed, and when -it had been introduced through the medium of the cellular tissue.[311] -It is to be discovered by the process for compound mixtures. Orfila adds -that he has hitherto been unable to find it in the liver or spleen. - -A difference of tint in the lining membrane of the mouth and gullet is -the only difference observed in the morbid appearances caused by nitric -and sulphuric acid. The former sometimes renders these parts yellow; but -this appearance is far from being invariable. - -The treatment in both instances is the same in every respect. - - - III.—OF POISONING WITH HYDROCHLORIC ACID. - -This acid occurs more rarely than any of the other mineral acids in -medico-legal cases; a fact which appears singular enough on considering, -that it is a powerful corrosive, and more perhaps in the hands of the -working-classes than any other. - - - SECTION I.—_Of the Tests for Hydrochloric Acid._ - -Like the other acids, hydrochloric acid occurs in the concentrated -shape, in a state of simple dilution, and mixed with various matters, -especially from organic kingdoms. - -1. Hydrochloric acid, _in its concentrated state_, is colourless, if -pure, but yellowish as usually sold; and it is easily known by the -peculiar appearance and odour of its fumes. A convenient additional -test, which, however, is not absolutely distinctive, is the formation of -white vapour when a rod dipped in it is brought near another dipped in -ammonia. If any farther evidence be desired, the strong acid must be -diluted with water, and examined by the tests for it in a diluted state. - -2. _When diluted_, it is recognised with facility, first by -litmus-paper, and then by the nitrate of silver, which forms with it a -dense, white precipitate, the chloride of silver. This is soluble in -ammonia, reappears on neutralizing the ammonia by nitric acid, and is -not redissolved by a large excess of nitric acid, even aided by heat. -Its permanence under an excess of nitric acid distinguishes it from -every other silver salt, but the cyanide; which again is known by -disappearing when boiled with a large excess of the acid. - -3. In the last edition of this work I proposed for the detection of -hydrochloric acid in _compound organic mixtures_ a process, to which -Professor Orfila has since made an important addition,[312] and which -the investigations of that toxicologist, as well as my own, lead me to -suppose superior to any other yet suggested, although it is not entirely -free from objection. This process divides itself into two, according as -the subject of analysis is acid or neutral; but in the latter case its -indications are of dubious import. - -a. If the matter to be examined be acid, boil it with water if -necessary, filter, and distil it with a gentle heat till the residue -acquire the consistence of a very thin syrup. Subject the distilled -liquor to the tests for diluted hydrochloric acid. It will seldom be -found there, however, because it is apt to be retained by the -co-existence of organic matter. If it be not found, add to the thin -extract in the retort a slight excess of a strong solution of tannin, -filter, and distil the filtered liquid by means of a hot bath of -solution of hydrochlorate of lime (consisting of two parts of -crystallized salt and one of water,)—taking care that the temperature of -the bath never exceeds 240°; and stop the distillation just before the -residuum becomes dry. Examine now the distilled liquor with the tests -for diluted hydrochloric acid. - -Hydrochloric acid has a tendency to adhere with obstinacy to organic -matters, especially when these are abundant; and therefore Orfila -properly proposes to remove organic principles as far as possible by -precipitating them with solution of tannin. I have found, as he did, -that the acid may be obtained by distillation after this measure, when -it could not be obtained previously.—Orfila objects to the process -however that hydrochlorate of ammonia will pass over in the -distillation. But I have not found this to be the fact, when the -temperature did not rise above 240°; which in his experiments seem to -have been considerably exceeded.—A more important fallacy is, that -hydrochloric acid will be indicated by the process in a mixture which -contains both a neutral chloride, such as common salt, and sulphuric -acid. This fallacy can only be obviated by ascertaining that sulphuric -acid is not present.—But the most important fallacy of all is, that free -hydrochloric acid constitutes an essential part of the gastric juice, -and an ingredient of the secretions of the stomach in various states of -disordered digestion.[313] It is not easy to see how this fallacy can be -obviated, unless the acid be obtained in large quantity; nor am I -prepared to say what quantity would justify the conclusion, that the -acid had been derived from an external source. Dr. Prout once found -between four and five grains of pure acid in sixteen ounces of the fluid -of water-brash.[314] The quantity of hydrochloric acid is to be known by -drying, heating and weighing the chloride of silver thrown down in the -distilled fluid by nitrate of silver, and allowing 100 parts of -concentrated commercial acid for 145 of chloride. - -b. When the mixture is neutral, hydrochloric acid can be no longer -detected in it without the aid of sulphuric acid to decompose the -chloride that has been formed. This should be added to the filtered -fluid obtained after organic matter has been separated by solution of -tannin. Hydrochloric acid will then distil over.—It is seldom however -that the discovery of the acid in this way will warrant the conclusion, -that it had ever existed free in the mixture whence it is obtained. For -it may have proceeded from chlorides contained in the subject of -analysis from the first, more especially chloride of sodium, which -exists in small quantity in all animal fluids and solids, and more -largely in many articles of food and drink. The only circumstance indeed -in which the detection of hydrochloric acid by decomposition with -sulphuric acid will yield any evidence,—and even then the evidence will -only be presumptive,—is when it is known that an earth or alkali was -given as an antidote, and when the alkali or earth which was used is -found in the suspected substance. - - -SECTION II.—_Of the Action and Symptoms produced by Hydrochloric Acid._ - -Hydrochloric acid has been found by Professor Orfila to exert the same -action as sulphuric and nitric acids; but it is a less powerful -corrosive and irritant.—In the gaseous state, it is a most destructive -poison to vegetables, as will be shown in the article on the Poisonous -Gases. - -The symptoms it occasions in man are very like those produced by -sulphuric acid. As few cases however of poisoning with this substance -have yet been published, its effects are not so well known as those of -the other powerful acids; and it may therefore be right to mention the -leading particulars of some of the cases which are met with in -authors.—Mr. Quekett has related the case of a man, who, on arriving at -home one day, told the woman he lodged with that he had poisoned himself -with spirit of salt, but presented at the moment so little sign of -uneasiness, that she at first scarcely believed him. In a short time -however he suddenly became faint and fell down. On being removed to the -London Hospital, magnesia and milk were given, about three hours after -the acid had been taken; but no relief was experienced. He suffered -intense thirst, complained of excessive pain in the stomach and throat, -and expired in about fifteen hours.[315]—Mr. J. F. Crawfurd of Newcastle -has related a still more rapid case which was occasioned by two ounces -of an equal mixture of hydrochloric acid and “tincture of steel,” -probably the tincture of chloride of iron. Vomiting occurred soon -afterwards, but subsequently ceased; there was no complaint made either -of pain or heat anywhere, or of thirst; and questions were answered -intelligently. But the pulse was imperceptible, and the muscles of the -extremities contracted; and death took place in five hours and a -half.[316]—Orfila mentions that an hospital patient, affected with -inflammation of the brain after a fall on the head, having got by -mistake from his nurse 45 grammes, or two fluid ounces, of hydrochloric -acid, was attacked with acute pain in the stomach, efforts to vomit, -hiccup, extreme restlessness, a small pulse, a fiery red tongue, -blackness of the lips, and a burning skin; and next day he died in a -state of constant delirium, and covered with a cold clammy sweat.[317] - -These cases present nearly the same violence and variety of action with -that which results from the two other acids. - - - SECTION III.—_Of the Morbid Appearances caused by Hydrochloric Acid._ - -The morbid appearances are on the whole similar to what are caused by -sulphuric acid. In Mr. Quekett’s case the stomach outwardly was -leaden-coloured and its vessels gorged with black blood; the intestinal -peritonæum injected and speckled with fibrinous effusion; the villous -coat of the stomach lined with yellow, curdled milk, and itself -irregularly black here and there, as if charred, and in some places -softened and corroded, so that a rent was made in handling it; the inner -membrane of the duodenum similarly affected, and also even the jejunum, -though more irregularly. The contents of the stomach were not acid, and -did not contain any chloride.—In Mr. Crawfurd’s case the villous coat -presented black elevated ridges, as if charred, and the furrows between -were scarlet-red; black granular extravasation had taken place at many -points into the submucous tissue; similar appearances were seen in the -duodenum and jejunum; and the lower part of the gullet looked as if it -had been cauterized.—In the case related by Orfila the gullet and -pharynx were red, and at one or two places excoriated; the stomach -inflamed externally, and its inner membrane spotted with gangrenous (?) -patches, and very brittle; the duodenum thickened, and the jejunum -perforated by a round worm. - - - - - CHAPTER IV. - ON POISONING WITH PHOSPHORUS AND THE OTHER BASES OF THE MINERAL ACIDS. - - -_Of Poisoning with Phosphorus_.—The only other mineral acid that -deserves mention is the phosphoric. It possesses properties nearly -analogous, and hardly inferior to those of the three acids already -mentioned. On its own account, however, it does not merit any notice -here, since it is much too rare to be within reach of a person who -intends to give or take poison. But it must be attended to, because it -is formed in the course of the action of a more common poison, -phosphorus. An attempt has actually been made to perpetrate murder by -means of this substance. A woman at Mengshausen tried to poison her -husband by putting into his soup a mixture of phosphorus, flour, and -sugar, used for poisoning rats. But the soup having been kept warm on -the stove, the man’s suspicions were excited by its phosphorescence, and -phosphorus was detected in it.[318] - -Orfila found that two drachms of phosphorus given to dogs in fragments -caused death in twenty-one hours, that the whole stomach and intestines -were more or less inflamed, and that the phosphorus had lost much of its -weight, though vomiting had been prevented by a ligature on the gullet; -in fact the poison was partly oxidated. In a state of minute division, -as when dissolved in oil, twenty-four grains caused death in less than -five hours with all the symptoms of the most acute irritant poisoning; -and after death the stomach was found extensively corroded, and -perforated by two holes.[319] Other experimentalists have found that -half a grain melted in hot water could kill a dog;[320] and that water, -in which phosphorus had been simply received in the process for -preparing it, proved in small quantities fatal to poultry.[321] - -There is no doubt, therefore, that phosphorus is a dangerous poison to -animals. Its effects on man have not been often witnessed; but the -observations hitherto made will show that it is not less injurious to -him than to the lower animals. A grain and a half have actually proved -fatal to man, as appears from a case mentioned by M. Worbe.[322] The -subject of the case was a stout young man who took a grain and a half in -hot water, after having previously taken half a grain without sustaining -injury. In seven hours, and not till then, he was attacked with pain in -the stomach and bowels, then with incessant vomiting and diarrhœa, -excessive tenderness and tension of the belly,—all the symptoms in short -of irritant poisoning; and he died exhausted in twelve days. Another -fatal case somewhat similar in its circumstances has been related by M. -Julia-Fontenelle.[323] An apothecary, after taking in one day first a -single grain and then two grains of phosphorus without experiencing any -particular effects, swallowed next day three grains at once in syrup. In -the evening he felt generally uneasy, from a sense of pressure in the -belly, which continued for three days; and then he was also seized with -violent, continual vomiting of a matter which had an alliaceous odour. -On the seventh day he had also spasms, delirium, and palsy of the left -hand; and death speedily ensued.—Dr. Maier of Ulm relates a singular -case occasioned by a portion of lucifer-match composition having been -swallowed intentionally. Vomiting and pain in the belly ensued, then -anxiety, restlessness, and excessive thirst, and death in about fifteen -hours.[324]—M. Martin-Solon relates the case of a patient, affected with -lead palsy, who having taken considerably less than a grain in the form -of emulsion, was attacked with burning along the gullet and in the -stomach, mucous vomiting, tenderness of the belly, general coldness and -feebleness of the pulse. Afterwards the pulse became imperceptible, the -limbs neuralgic, the intellect clouded, and the breathing stertorous; -and he died in little more than two days.[325]—In the only other case I -have hitherto found recorded death took place in forty hours, and the -symptoms were violent pain in the stomach and continual vomiting, -together with the discharge by clysters of small fragments of -phosphorus, which were discovered by their shining in the dark, and -subsequently by the appearance of burnt spots on the bed-linen. In this -case, which is described by Dr. Flachsland of Carlsruhe,[326] the -quantity of the poison taken was not ascertained. The patient, a young -man, took it on bread and butter at the recommendation of a quack, to -cure constipation, general debility, and impotence. - -At one time it was the custom to give small doses of phosphorus in -medical practice; but the uncertainty and occasional severity of its -operation have perhaps properly expelled it from most modern -pharmacopœias. Among other properties ascribed to it in medicinal doses, -it is said to be a powerful aphrodisiac: No such symptom occurred in the -first of the fatal cases just related, or is mentioned in any of the -others; but there is no doubt that medicinal doses sometimes produce it. - -As to the morbid appearances, the same changes of structure may be -expected as in the instance of the mineral acids generally. In Worbe’s -case quoted above, the skin was generally yellow, and here and there -livid; the lungs gorged with blood; the muscular coat of the stomach -inflamed, but the other coats not, except near the two extremities of -the organ, where they were black. In Flachsland’s case much fluid blood -was discharged from the first incisions through the skin of the belly; -the omentum and outside of the stomach and intestines were red; the -villous coat of the stomach presented an appearance of gangrenous -inflammation (probably black extravasation only); the inner membrane of -the duodenum was similarly affected; the great intestines were -contracted to the size of the little finger; the mesenteric glands -enlarged; and the kidneys and spleen inflamed. In Maier’s case the -peritonæum and omentum were dry and vascular, the stomach and small -intestines pale, the great intestines contracted, almost empty, -brownish-red, and here and there inflamed, the liver large, and the -blood everywhere liquid. The contents of the caput cœcum had an odour of -phosphorus, and here were found two yellowish lumps weighing eight -grains, which shone when rubbed, exhaled a phosphoric odour, and -contained 0·6 of a grain of phosphorus. In Martin-Solon’s case the -gullet was cherry-red and its epithelian brittle, the villous coat of -the stomach grayish and brittle, the solid viscera in the abdomen soft, -and the cerebral membranes congested. - -_Phosphorous acid_, the effects of which have been examined -experimentally by Professor Hünefeld of Greifswalde, differs in its -operation from phosphoric acid. Twenty-five grains had no effect on a -rabbit; but a drachm caused difficult breathing, restlessness, bloody -vomiting, slight convulsions, and death in twelve hours; and the stomach -was found not much injured. The urine contained phosphoric acid.[327] - -_Of Poisoning with Sulphur._—It does not appear that sulphur, which -resembles phosphorus in many particulars, bears any resemblance to it in -physiological properties;—which may be ascribed to its not being -susceptible of spontaneous acidification. It certainly possesses, -however, slight irritating properties. It is often given as a purgative, -which is sufficient to prove that it is not altogether inert; and the -veterinary school at Lyons found that a pound killed horses by producing -violent inflammation, recognizable during life by the symptoms, and -after death by the morbid appearances.[328] - -_Of Poisoning with Chlorine._—Chlorine in its gaseous state acts -powerfully as an irritant on the windpipe and lungs, and on that account -will be noticed under the head of the poisonous gases. But even in -solution it retains to a certain degree its poisonous qualities. Orfila -says that five ounces of a strong solution of chlorine will kill a dog -in twenty-four hours, if it is kept in the stomach by a ligature, and -that two ounces diluted with twice its volume of water will prove fatal -in four days;—that the symptoms are those of irritation of the -stomach;—and that in the former case he found general redness and -blackness—in the latter ulceration of its villous coat.[329] - - - OF POISONING WITH IODINE. - -Iodine is a poison of more consequence than chlorine, both because it is -becoming a more common article, and because it is more violent in its -effects on the animal economy. - -_Tests of Iodine._—Iodine when pure is a solid substance easily known by -its scaly form, its resemblance in colour and resplendence to polished -iron, its peculiar odour, the violet fumes it forms when heated, and the -fine blue colour it produces with a solution of starch. It is very -sparingly soluble in water, but readily so in rectified spirit and in -aqueous solutions of certain salts, more especially the iodide of -potassium. Its ordinary forms in the shops are iodine itself, the -tincture, and the compound solution, where the solvent is a solution of -iodide of potassium in water. It stains the skin brownish-yellow; but -the stain is not permanent. Its fumes are intensely irritating to the -nostrils, throat, and lungs. - -When dissolved in water or in solutions of neutral salts, it -communicates to the fluid a yellowish-brown or reddish-brown colour, -which is destroyed by sulphuretted hydrogen, because the iodine is -converted into hydriodic acid. In the colourless fluid thus formed, if -treated with chlorine,—or in the original brown fluid without -chlorine,—a solution of starch, obtained by ebullition and subsequently -cooled, produces a fine blue colour and precipitate; and these, if the -solution be sufficiently diluted, disappear on boiling, reappear on -sudden cooling, and are removed permanently by a stream of sulphuretted -hydrogen. This is a very delicate and characteristic system of tests. -The best mode of using chlorine for decomposing hydriodic acid is to let -it descend in the gaseous form from the mouth of a bottle of -nitro-hydrochloric acid upon the fluid to be examined; In this way an -excess is easily avoided, which bleaches out the blue colour. Sulphuric -acid, though often recommended for the purpose, does not act unless it -contains nitrous acid,—from which however the sulphuric acid of commerce -is seldom quite free. - -When mingled with organic substances, the discovery of it is a matter of -some nicety; because many substances of this nature, especially in the -living body, quickly convert it into hydriodic acid.[330] Hence few -cases can occur in medico-legal practice, where iodine will be -discoverable in its free state. The following method of analysis will -meet all possible cases. - -_Process for Compound Mixtures._—Add water if necessary, and filter. If -either the fluid or solid part is little or not at all coloured, test it -with cold solution of starch, assisting the action of the test on the -solid part by trituration in a mortar. If a blue colour be struck, which -disappears under ebullition, and reappears under refrigeration alone, or -on subsequently allowing chlorine gas to descend on the surface of the -fluid, there can be no doubt of the existence of iodine.—If the colour -of the suspected mixture after filtration is so deep that the action of -the starch cannot be expected to yield characteristic appearances, then -both the solid and fluid parts should be agitated with a third of their -volume of ether; and after the ethereal solution has arisen to the -surface, it is to be removed and tested with solution of starch. The -blue colour will be now perhaps struck, because the ether, in carrying -off the iodine from the mixture, leaves many coloured organic principles -behind. - -Should free iodine not be thus detected, strong presumptive evidence may -still be procured of its actual presence, or of its having been at one -time present, by continuing the examination with the view to detect -hydriodic acid. This is described in p. 159. - -By following this method of analysis, I have found that one grain of -iodine of potassium, which is equivalent to three-quarters of a grain of -iodine, may be easily discovered in six ounces of urine,—a fluid as -complicated as can well be conceived. - -The process adopted by Professor Orfila is so nearly the same with this, -as scarcely to require being detailed. He uses nitric acid instead of -chlorine for decomposing the hydriodic acid. Chlorine, however, is the -most delicate reagent for the purpose, if it be used in the way -described above. - -_Action of Iodine and Symptoms in Man._—Iodide has a twofold action, one -local and irritating, the other general, and produced only when it has -been administered long in frequent small doses. - -Orfila remarked that in doses of two drachms it excited in dogs symptoms -of irritation in the stomach; that death slowly ensued in seven days, -without the symptoms having ever become very violent; and that the -villous coat of the stomach was here and there yellow, had also patches -of yellow mucus lining it, and exhibited numerous little ulcers of a -yellow colour. He could not observe much injury from iodine introduced -into the cellular tissue; and more lately, Dr. Cogswell remarked that in -this way it merely induces phlegmonous inflammation and the usual -consequences.[331] - -An important circumstance in regard to the physiology and medical -jurisprudence of this poison and its compounds is, that it may -undoubtedly be detected in the blood, both when a single large dose has -been taken, and in those persons who have used it for some time -medicinally. Cantu, an Italian experimentalist, discovered iodine in -such circumstances in the blood, sweat, urine, saliva and milk;[332] and -Bennerscheidt, a German chemist, also found it in the blood, when it had -been employed outwardly.[333] In the latter instance it could not be -detected in the serum, but it was detected in the crassamentum by means -of starch. Some interesting facts of the same nature have also been -ascertained by Dr. O’Shaughnessey, from which it appears that even in -acute poisoning with this substance, satisfactory proof of its -administration may be procured several days afterwards by analysing -certain secretions. In a dog poisoned with iodine, he detected the -poison in forty minutes in the urine, and occasionally in the same -secretion so late as the fifth day, when it died. It is singular, -however, that he could not find it in the same quarter on the third day, -although it existed at that time abundantly in the saliva.[334] In these -experiments the iodine was always found in the form of hydriodic acid, -having been converted into that compound in the alimentary canal. This -change takes place with such rapidity, that on one occasion, in the -vomited matter discharged by a dog fifteen minutes only after the -administration of iodine, Dr. O’Shaughnessey could find no iodine, but a -large quantity of hydriodic acid.[335] Orfila has found it not only in -the urine, but likewise in the liver of animals.[336] - -Considerable uncertainty prevails as to the circumstances in which we -may expect iodine to be detected in the organs or secretions of persons -who have taken it. Thus it has been stated by an Italian physician, Dr. -Cristin, that in many individuals affected with dropsy, struma, -epilepsy, and other diseases, he had sought for iodine to no purpose in -the urine, bronchial mucus, and other excretory fluids.[337] - -With regard to its operation on man, Orfila says, he has tried the -effects of four or six grains on himself, and that he found this dose -produce a sense of constriction in the throat, sickness, pain in the -stomach, and at length vomiting and colic. There is no doubt, therefore, -that in larger doses it will prove a dangerous irritant to man as well -as to dogs. Accordingly, Dr. Gairdner has noticed the case of a child -four years old, who died in a few hours after taking about a scruple in -the form of tincture;[338] but he has not mentioned the symptoms. Dr. -Jahn of Meiningen mentions a case where an over-dose produced violent -pain in the belly, vomiting, profuse bloody diarrhœa, coldness and -blanching of the skin, rigors, quivering of the sight and rapid -pulse.[339] Two similar cases are related in a recent French journal; in -one, which was produced by a drachm and a half of the ioduretted -solution of hydriodate of potass, nausea, with acute pain and sense of -burning in the pit of the stomach, followed immediately; in an hour -there was vomiting of a yellowish matter which had the taste of iodine; -excessive restlessness ensued, with headache, giddiness and paleness of -the countenance; and these symptoms were not entirely dissipated for -five days.[340] In the other case two drachms and a half of iodine were -swallowed for the purpose of self-destruction. A sense of dryness and -burning from the throat down to the stomach was immediately produced; -lacerating pain in the stomach and fruitless efforts to vomit succeeded; -and in an hour, when the relater of the case first saw the patient, -there was suffusion of the eyes, excessive pain and tenderness of the -epigastrium, and sinking of the pulse. Vomiting, however, was then -brought on by warm water; copious yellow discharges, possessing the -smell and taste of iodine, took place; and in nine hours the patient was -well.[341] - -There is a singular uncertainty, however, in the action of one or more -large doses. Magendie says he has taken two drachms of the tincture, -containing about ten grains of iodine, without injury;[342] Dr. Gully, -that he has given three times as much daily for some time; Dr. Kennedy, -that he gave an average of twelve grains daily in the form of tincture -for eighty days without observing any effect at all; and Mr. Delisser, -that he has given a patient thirty grains in a day without injury.[343] -Dr. Samuel Wright met with the case of an infant, not more than three -years old, who took three drachms of the tincture at once, and suffered -only from attempts to cough, some retching and much thirst.[344] - -It further appears that in medicinal doses, such as a quarter of a -grain, frequently repeated, it is a dangerous poison, unless its effects -are carefully watched. For in consequence of accumulation in the system, -or gradually increasing action, it produces when long used some very -singular and hazardous symptoms; and like mercury, foxglove, and some -other poisons, it may be taken long without effect, and at length begin -to operate suddenly. The symptoms which it then occasions are sometimes -those of irritation; namely, incessant vomiting and purging, acute pain -in the stomach, loaded tongue, rapid and extreme emaciation, violent -cramps and small frequent pulse. These symptoms may continue many days, -and even when subdued to a certain extent, vomiting and cramps are apt -to recur for months after.[345] A fatal case of this form of affection -has been related by M. Zink, a Swiss physician. His patient, after -taking too large doses of iodine for about a month, was seized with -restlessness, burning heat of skin, tremors, palpitation, syncope, -excessive thirst, a sense of burning along the gullet, frequent purging -of bilious and black stools, priapism, and tremulous pulse. The symptoms -of local inflammation went off in a few days; but those of general fever -continued; and he died after six weeks’ illness.[346] Another fatal case -has been described in Rust’s Journal. The leading symptoms were pain in -the region of the liver, loss of appetite, emaciation, quartan fever, -diarrhœa, excessive weakness; and after the emaciation was far advanced -a hardened liver could be felt. The patient appears to have died of -exhaustion.[347] From this case, and another of which the appearances -after death will be presently noticed, it is not improbable that iodine -possesses the power of inflaming the liver. - -In another and more common affection, the patient is attacked with -tremors, at first slight and confined to the fingers, afterwards violent -and extending to the whole muscles of the arms and even of the trunk. At -the same time there is excessive and rapidly increasing weakness, a -sense of anxiety and sinking, a total suspension of the function of -digestion, rapid and extreme muscular emaciation, tendency to fainting, -and violent continued palpitation,[348] accompanied sometimes with -absorption of the testicles in man, and of the mammæ in females. In the -midst of these phenomena the curative powers of the poison over the -disease for which it has chiefly been used, namely, goître, are -developed. It has been remarked in particular, that the diminution of -the goître keeps pace with the diminution of the breasts, though at -times either effect has been developed without the other. An instance is -related in Rust’s Journal of a female, whose breasts began to sink after -she had used iodine for four months; and in four weeks hardly a vestige -of them remained; but her goître was not affected.[349] An American -physician, Dr. Rivers, has twice noticed barrenness apparently induced -by the prolonged use of iodine; and as in these instances the females -were young and previously very prolific, but ceased to bear children -from the time the iodine was used, his observations seem worthy of -attention.[350] Dr. Jahn[351] specifies among the leading effects of the -poison when slowly accumulated in the body,—absorption of the -fat,—increase of all the excretions,—dinginess of the skin, with -frequent clammy sweat,—hurried anxious breathing,—diuresis and an -appearance of oil floating in the urine,—increased discharge of fæces, -which are unusually bilious, but free of mucus,—increased secretion of -semen,—increased menstrual discharge,—swelling of the subcutaneous veins -and lividity of the lips,—feebleness of the pulse, with superabundance -of serosity in the blood,—impaired digestion and diminished secretion of -saliva and mucus. This affection, which, in conformity with the name he -has given it, may be termed Iodism [_Iodkrankheit_], he contrasts with -mercurialism, the constitutional effect of the accumulation of mercury -in the body; and he considers the former not more unmanageable than the -latter. The dose required to produce these effects are very various. -Some people appear almost insensible to its action; in one instance, -nine hundred and fifty-three grains were taken in daily portions varying -from two to eighteen grains, without any bad effect;[352] and I have -known an average of four grains daily taken for fifteen months, with the -effect only of increasing the appetite. On the other hand, Dr. Gairdner -has seen severe symptoms commence when half a grain was taken three -times a day for a single week;[353] and Coindet has seen bad effects -from thirty drops of the solution of ioduretted hydriodate taken daily -for five days.[354] - -Iodine and iodide of potassium in medicinal doses have been supposed by -Dr. Lawrie to be capable of exciting in certain constitutions an -affection resembling _cynanche laryngea_ in its symptoms, consisting of -inflammation of the salivary glands, glottis, and other adjacent parts, -and proving sometimes fatal.[355] This property is doubtful; but several -instances have been published of profuse salivation and soreness of the -mouth during a course of iodine; it is apt to cause chronic irritation -of the Schneiderian membrane; and some think that it may affect in like -manner the bronchial membrane in the lungs.[356] - -_Morbid Appearances from Iodine._—The only account I have seen of the -appearances left in the body after death from slow poisoning with iodine -is contained in the essay of Dr. Zink. In a second fatal case which came -under his notice he found enlarged abdomen from distension of the -intestines with gases, enlargement of the other viscera and serous -effusion into the peritonæum; adhesion of the viscera to one another; -redness of the intestines, in some places approaching to gangrenous -discoloration; redness and excoriation of the peritonæal coat of the -stomach, and also of its villous coat; enlargement and pale rose-red -coloration of the liver. In the chest serum was found in the sac of the -pleura. The gullet was contracted in diameter, and red internally. - - - ON POISONING WITH IODIDE OF POTASSIUM. - -To these remarks on iodine a few observations may be added on the iodide -of potassium, one of its compounds, which is now generally substituted -in medicine for the simple substance. The tests and actions of this -poison have been examined by M. Devergie; and more lately its -medico-legal chemistry has been investigated by Dr. O’Shaughnessey and -Professor Orfila. - -It is sold in the shops of various degrees of purity. Pure iodide of -potassium is in white crystals, tending to the cubical form, permanent -in the air, possessing a faint peculiar odour, and easily soluble in -both water and rectified spirit. Another variety has the same form, but -possesses an odour of iodine, is often yellowish in colour, and -deliquesces slightly in moist air. This contains an excess of iodine, -but may be otherwise pure. A third variety is impure. It presents less -tendency to assume a crystalline form, is more or less deliquescent, -dissolves but partially in alcohol, and when dissolved effervesces with -acids. The principal ingredient in this article is carbonate of potass; -and sometimes the proportion of iodide is inconsiderable. In one -specimen I procured 74·5 per cent. of carbonate of potass, 16 of water, -and only 9·5 of iodide of potassium. - -In the solid state the iodide of potassium may be known by the effect of -strong sulphuric or nitric acid, which turns it brown with -effervescence, and when aided by heat disengages violet fumes of iodine. - -In solution many tests will detect it, such as chlorine, nitric acid, -corrosive sublimate, acetate of lead, protonitrate of mercury, muriate -of platinum, and starch with chlorine or nitric acid. Chlorine or nitric -acid forms a brown or orange-coloured solution by disengaging iodine. -Corrosive sublimate forms a fine carmine-red precipitate, the biniodide -of mercury; acetate of lead a fine yellow precipitate, the iodide of -lead; protonitrate of mercury a yellow protiodide of mercury, which -gradually fades into a dirty brown. Solution of starch, followed by -chlorine in solution or in vapour, strikes a deep blue colour, which, if -the fluid is sufficiently diluted, disappears on boiling, reappears on -sudden cooling, and is permanently removed by a stream of sulphuretted -hydrogen gases. Of these tests the most characteristic is starch with -chlorine; and it is also extremely delicate. Too much chlorine however -bleaches the blue colour away. - -In compound mixtures most and sometimes all of these tests are useless. -If the mixture is deeply coloured, none will act characteristically. If -carbonate of potass be present in such proportion as is often met with -in the shops, the tests cannot be trusted to. - -_Process for Compound Mixtures._—The following method of analysis is -applicable to all mixtures, organic and inorganic. Add water, if -necessary, and filter; and if the fluid which passes through is -tolerably free from colour, test a little of it with solution of starch -and chlorine. If the colour is too deep to admit of this trial, or the -test on trial does not act, unite the fluid and solid parts and transmit -sulphuretted hydrogen to convert any free iodine into hydriodic acid. -Drive off the excess of gas, supersaturate with a considerable excess of -potass, filter, and evaporate to dryness. Char the residue at a low red -heat in a covered crucible; pulverize the charcoaly mass, and exhaust -with water. This solution will probably act characteristically with -starch and chlorine; but on the whole it is better in the first instance -to remove some of the salts by evaporating to dryness, and exhausting -the residuum with alcohol. The alcoholic solution contains the -hydriodate of potass, with some other salts; and on being evaporated to -dryness, a residuum is left, on which, when dissolved in water, the -starch and chlorine will act characteristically. No other test is -necessary; and frequently no other test will act, on account of -co-existing salts. - -I have found that a grain of iodide of potassium may thus be easily -detected in six ounces of urine, which must be considered a very -complicated fluid. In the solution ultimately procured nitrous acid -struck a pale brown tint, and on the addition of solution of starch a -dark-blue precipitate was formed; which, after being sufficiently -diluted, disappeared under ebullition, leaving a colourless fluid. On -cooling, no change took place; but on the subsequent addition of a drop -of sulphuric acid, the blue colour and precipitation were immediately -restored. No other reagent acted characteristically, although there was -a sufficient quantity of solution to try the starch test ten times at -least. - -Dr. O’Shaughnessey has proposed a more complex method by precipitation -with chloride of platinum.[357] Professor Orfila says it is sufficient -to boil and filter the suspected matter, and to heat first the liquid -and then the solid part with solution of chloride, when violet vapours -of iodine are disengaged, which may be condensed and subjected to -various tests.[358] I have not compared this method with the one I have -been in the practice of using; but, notwithstanding the strong -assurances of its proposer, its superiority in point of delicacy seems -dubious, although no one can deny its simplicity.[359] - -_Action and Symptoms in Man._—From the experiments of Devergie on -animals, iodide of potassium seems to be in large doses an irritant, -though not a powerful one. Two drachms in an ounce of water killed a dog -in three days with violent vomiting, and signs of irritation were found -in the stomach, namely, black extravasated spots and ulcers in the -middle of them. A solution injected into the cellular tissue caused only -local inflammation. Injected into the jugular vein in the dose of four -grains, it produced tetanus and death in a minute and a half.[360] The -latter investigations of Dr. Cogswell confirm essentially these results. - -Discrepant accounts have been given of the effects of iodide of -potassium on man. When first introduced into medicine, it was conceived -to be an active poison, not much inferior to iodine itself. Many however -have since had an opportunity of observing that it is in general by no -means so energetic. Its medicinal doses were gradually raised from one -grain to five, ten, twenty grains; and at last Dr. Elliotson gave to not -a few patients so much as two, four, or even six drachms daily in -divided doses, without observing any remarkable effect.[361] These and -other similar observations however were made at a period when the salt -used in British practice was much adulterated, often indeed containing -eighty or ninety per cent. of impurity; at the same time it does appear -that large doses of a pure salt have been occasionally taken with -impunity. On the other hand it has evidently in some instances acted -with great force. Mr. Alfred Taylor mentions a case, on the authority of -Mr. Ericksen, where five grains produced alarming dyspnœa, attended with -inflammation of the nostrils and conjunctiva of the eyes.[362] An -instance has been published where twelve grains in four doses occasioned -shivering, vomiting, purging, general fever, and extreme prostration; -and the purging continued for some days.[363] Dr. Moore Neligan informs -me he met with the case of an elderly lady in 1841, who, on taking three -five-grain doses for two days, while labouring under irregular gout, was -seized with severe headache, thirst, and swelling of the face; which -symptoms were succeeded in two days by swelling of the tongue, -ulceration of the gums, and profuse salivation for a week. Dr. Lawrie -says he has known two grains and a half given thrice in one day, -followed by great dyspnœa and irritation in the throat; and is even -inclined to think that death resulted on two occasions from repeated -medicinal doses.[364] It would farther appear from some important -researches made in France, that the protracted use of iodide of -potassium in small doses with the food may produce serious derangement -of the health,—swelling of the face, headache, urgent thirst, -inflammation of the throat, violent colic pains, and frequently bloody -diarrhœa. A disease characterized by the symptoms now described appeared -repeatedly as an epidemic a few years ago in various parts of France, -and spread so widely in one parish, that not less than a sixth of the -whole population were attacked. After several careful investigations, it -seems to have been fully proved that the affection was owing to the use -of salt fraudulently adulterated with an impure salt, obtained from kelp -after the separation of carbonate of soda, and consequently impregnated -with an appreciable proportion of hydriodate of potass.[365] - -It is difficult to arrive at any satisfactory conclusions from these -statements as to the nature and energy of the action of this salt as a -poison. But on the whole it appears to be not in general very active; -and the few instances of unusual activity which have occurred may -probably be put to the account of idiosyncrasy. The most remarkable of -its idiosyncratic effects from medicinal doses are salivation, and a -series of symptoms which imitate sometimes catarrh, and sometimes a cold -in the head. I do not know any facts to warrant the general statement of -M. Devergie that 18 or 30 grains may constitute a fatal dose.[366] The -present question is far from being unimportant in a medico-legal point -of view. Mr. A. Taylor mentions the heads of a case, very dubious -however in its nature, where it was suspected that a single dose of six -grains of iodide of potassium had been the occasion of death.[367] - -It is important to remember in medico-legal researches, that iodide of -potassium may be detected in the blood, liver, spleen, muscles, urine, -and other textures and secretions; and especially that it may be found -in the urine, when it may no longer exist in the alimentary canal or in -vomited matters. These interesting facts have been clearly proved by the -researches of Wöhler,[368] Stehberger,[369] O’Shaughnessey,[370] and Dr. -Cogswell.[371] - -_Of Poisoning with Bromine._—This singular substance is not an object of -much interest in relation to medical jurisprudence, because it is rare, -and only to be met with in the laboratory of the chemist. Hence, -although it appears to be a poison of some activity, it scarcely -requires to be dwelt on particularly. - -It is easily known from all other substances by its fluidity, its great -density, which is thrice as great as that of water, its reddish-brown -colour by reflected, and blood-red colour by transmitted light, the -orange fumes which occupy the upper part of a bottle partly filled with -it, and its intensely acrid suffocating vapour, which is so irritating -that an incautious inhalation is followed by all the phenomena of severe -coryza and catarrh. Its odour, however, apart from its acridity, is very -far from being so disagreeable as its discoverer in naming it seems to -have imagined. In its properties it bears a close resemblance to -chlorine and iodine. - -The toxicological effects and medico-legal relations of bromine have -been examined by M. Barthez,[372] Dr. Butske,[373] Dr. Dieffenbach,[374] -and Dr. M. Glover.[375] - -M. Barthez has given the following process for detecting bromine in -compound mixtures, such as the contents of the stomach or vomited -matter. First separate the fluid matter by filtration, and subject it to -the action of chlorine, which will produce a fine orange colour. Should -this effect not result, or the change of colour be observed by the deep -tint of the fluid, treat the solid matter with solution of caustic -potass; filter and add what passes through to the former fluid; -evaporate to dryness and char by a red heat; act on the residue with -distilled water. The solution contains the bromide of potassium, and is -therefore turned orange-red by chlorine. The orange tint, whether struck -at once in the fluid part of the mixture, or after carbonization and -solution of the residue, is removed by agitation with ether; and the -etherial solution of bromine in its turn loses colour when treated with -solution of caustic potass, hydro-bromate of potass being again formed. - -M. Barthez found, that a solution of twelve grains injected into the -jugular vein of a dog, sometimes occasioned immediate tetanus and death; -and that the heart was gorged with clotted blood. Sometimes however even -seventeen drops did not prove fatal, but produced merely restlessness, -difficult breathing, dilated pupil, frequency of the pulse, and -sneezing. Dieffenbach remarked similar effects in the rabbit: The animal -either died immediately, or soon recovered altogether. In a cat, after -the injection of twelve drops of a concentrated solution into its -jugular vein, death took place in fifteen minutes; but in another from -which a little blood was drawn after the symptoms were fully formed, -complete recovery gradually ensued. Butske found a horse suffer so much -from mortal prostration immediately after five grains dissolved in two -ounces of water were injected into its jugular vein, that he supposed it -was about to die; but it quickly revived, and ultimately got quite well. -Dr. Glover obtained similar results. When recovery took place, the -leading symptoms were panting, sneezing, discharge from the nostrils, -rigors and debility. - -When introduced into the stomach of dogs, M. Barthez found that twenty -drops on a full stomach had no particular effect; that thirty drops -occasioned vomiting, and temporary acceleration of the pulse and -breathing; and that from forty to sixty drops on an empty stomach -brought on violent vomiting, sneezing, cough, dilated pupil and -prostration, succeeded in a few hours by languor without any other -symptom, and by death in four or five days. In the dead body he remarked -numerous little ulcers of the villous coat, some of which had an -ash-gray appearance at the bottom, while others were covered with a -black slough, easily removed by friction. When the gullet was tied to -prevent vomiting, less doses proved more quickly fatal. He likewise -observed that the matter vomited in these experiments, even a few -minutes after the administration of the poison, had no appearance or -odour of bromine; whence it is reasonable to conclude, that, as in the -instance of iodine, a chemical change takes place with the aid of -certain vital operations, so that the bromine becomes hydrobromic -acid.—The experiments of Dr. Butske assign to it more activity as a -poison than those now related. For he found that a dog died in a day -from taking only five grains dissolved in two ounces of water; and the -symptoms were laborious breathing, loud cries, and convulsions. In the -dead body he found the stomach internally chequered with bloody -extravasation, and filled with bloody mucus, the duodenal mucous -membrane universally injected, but the rest of the alimentary canal in a -healthy state.—Dr. Glover remarked in such cases, besides the usual -symptoms of an irritant action on the stomach, coryza, sneezing, -salivation and difficult breathing. Sixty minims killed a cat in -seventeen minutes, two fluid drachms a dog in five hours and a half, ten -grains a rabbit in five minutes. A dog twice got twenty grains in -solution and recovered, but died after a third dose of the same amount. -Another got twenty grains in solution every two or three days for a -month without injury. In some of these experiments hydrobromic acid was -detected in the blood and urine. - -Little is yet known of the effects of bromine on man. Butske found that -a drop and a half in half an ounce of water produced a sense of heat in -the mouth, gullet, and stomach, and subsequently colic pains; and that -two drops and a half in an ounce of mucilage excited, in addition to the -preceding symptoms, great nausea, hiccup, and increased secretion of -mucus. On the other hand M. Fournet, who gave doses gradually increasing -from two to sixty drops daily for many weeks, observed that the lowest -doses excited itching in the hands and feet, and sometimes colic; that -an increase in the quantity caused heat in the chest and nausea; and -that forty-five drops occasioned also severe burning and sense of -acidity in the stomach, which however were temporary. The appetite was -in general rather improved, and the body became more plump.[376]—Bromine -appears on the whole to be a pure local irritant. It acts most -energetically when most thoroughly dissolved in water. - -_Hydrobromic acid_ seems from the experiments of Dr. Glover to be a pure -irritant and corrosive, allied in action and energy to hydrochloric -acid. The same experimentalist found that _bromine of potassium_ in the -dose of forty grains had sometimes little or no effect on dogs when -injected into the blood-vessels, while in other instances less doses -cause speedy death by paralysing the heart. Barthez observed that half a -drachm in solution produced dulness and depression in dogs, but no other -bad effect; and that two drachms retained in the stomach by tying the -gullet occasioned death in three days with symptoms of irritant -poisoning. M. Maillet observed that two ounces of this salt in the form -of ointment, administered to a dog by rubbing it over his nose, and -letting him lick it off and swallow it, had no effect whatever.[377] - - - - - CHAPTER V. - OF POISONING WITH ACETIC ACID. - - -Acetic acid, although in its ordinary state undoubtedly possessed of -little activity as a poison, has nevertheless proved in some -circumstances deleterious, and capable of occasioning death even in the -human subject. It exists in various forms. The most common is ordinary -vinegar, in which it is much diluted. Another common form is the -pyroligneous vinegar, pyroligneous acid, or pyroligneous acetic acid, as -it is variously called, which when impure has a reddish-brown colour, -but when pure is almost or altogether colourless, and the strength of -which is much greater than that of common vinegar. What is called proof -vinegar has a density about 1005, and contains about four per cent. of -concentrated acid. The pyroligneous acid sold in the shops of this town -has a density about 1035, and contains about 25 per cent.; but the -pyroligneous acid of the London Pharmacopœia is stronger, for its -density is 1050, and 100 parts contain about 50 of the strong acid. A -third form is the concentrated or pure acetic acid of the apothecary, -which is familiarly known as the chief ingredient and menstruum of a -common perfume, aromatic vinegar. - - - SECTION I.—_Of the Tests for Acetic Acid._ - -In all its forms acetic acid is easily known by its very peculiar odour, -together with its acid reaction on litmus. But if farther evidence of -its nature be required, it will be requisite to neutralise the fluid -suspected to contain it with carbonate of potass, and then to procure -the acetate of potass by evaporation. This salt is known by its extreme -tendency to deliquesce, and by a concentrated solution in water, -yielding, when distilled with sulphuric acid, a fluid possessing the -peculiar odour and pungency of concentrated acetic acid. - -When in a state of compound admixture with organic substances, such as -the contents of the stomach, it has been proved by late researches of -Orfila,[378] that this acid may be present in considerable proportion -without distinctly reddening litmus. For such mixtures the following -process of analysis, devised by the Parisian professor, will be found -convenient and effectual. The fluid being put into a retort with a -receiver attached, the retort is to be heated in a muriate of lime bath -till the residuum be dry. The distilled fluid may then be tested -tentatively for sulphuric and muriatic acids; and these being proved to -be absent, the acidity and peculiar smell of the liquid will supply -strong presumption of the presence of acetic acid. This presumption may -be turned to certainty by forming acetate of potass, as already directed -for the pure diluted acetic acid. - -Orfila has omitted in his paper a serious fallacy to which this, as well -as every process for the detection of acetic acid in the contents of the -stomach is exposed,—namely, that the natural secretions of the stomach, -according to the researches of many physiologists, but more especially -in recent times those of Tiedemann and Gmelin in Germany, and those of -Leuret and Lassaigne in Paris, frequently contain a small proportion of -acetic acid. Hence, the inference in favour of the introduction of -acetic acid into the stomach from without, founded on the process -related above, is only legitimate when the quantity discovered is -considerable.—The medical jurist ought also to keep in mind that vinegar -is a common remedy with the vulgar for many diseases, and especially for -poisoning. - - - SECTION II.—_Of the Effects of Acetic Acid on Man and Animals._ - -In the first edition of this work, it was stated that acetic acid could -scarcely be considered a poison. And in illustration, a case was -mentioned which fell under my own notice,—that of a gentleman, who -during dinner swallowed at a draught about eight ounces of vinegar by -mistake for beer, and who nevertheless sustained no harm although he -retained it all, and as the only measure of precaution, swallowed after -it an equal quantity of port wine. In farther confirmation of what is -here mentioned, it may be added, that an ounce of acid equal in strength -to the pyroligneous vinegar, has been found by Schubarth of Berlin to -produce very little effect when administered to a dog. The animal merely -frothed a little at the mouth; cried and became restless for a time; -then had one or two attacks of vomiting; and in an hour appeared quite -well again.[379] Nay, it has even been found by Pommer of Heilbronn, -that a considerable quantity of diluted acetic acid may be injected into -the blood without causing any mischief. He injected six drachms of -distilled vinegar into the femoral vein of one dog, and an ounce into -the jugular vein of another, but observed no effect whatever, except a -slight labour of respiration for a short time afterwards.[380] - -It appears, however, from some experiments performed by Professor Orfila -on occasion of a judicial case to be mentioned presently, that all the -forms of acetic acid will prove injurious and even fatal to dogs, if -given in sufficient quantity and prevented from being discharged by -vomiting. An ounce of pyroligneous vinegar, administered to dogs of -middle size, and retained in the stomach by a ligature on the gullet, -produces efforts to vomit, evident suffering, prostration of strength, -and death in five, seven, or nine hours. An ounce of concentrated acetic -acid occasioned death in one hour and a quarter; and four or five ounces -of common vinegar proved fatal in ten or fifteen hours. These -experiments would make it appear that acetic acid is scarcely less -active as an irritant poison than even the mineral acids.[381] They are -in some measure confirmed by the prior experiments of Schubarth; who -operated, however, with an impure reddish-brown pyroligneous acid, and -was led to ascribe its energy to the presence of some empyreumatic oil, -because he found, as was already remarked, that a pure acid of equal -strength appeared almost inert. From half an ounce to an ounce of the -impure acid given to dogs, caused fruitless efforts to vomit, sometimes -free vomiting, occasionally great flow of tears, always weakness in the -hind-legs, and feeble, irregular pulse, and death either in two days -without any new symptom of consequence, or more rapid death in four or -five hours, with previous convulsions, and sometimes insensibility.[382] -These experiments were made with an acid which neutralized 50 grains of -carbonate of lime per ounce, consequently contained at least 50 grains -of concentrated acid, or about a tenth of its weight. - -To these observations it may be added, that according to the experiments -of Hébréart, a small quantity of acetic acid dropped into the windpipe, -produces hissing respiration, rattling in the throat, and death in three -days from true croup.[383] - -In all the preceding experiments distinct evidence was obtained in the -dead body of the irritant action of the poison. The stomach contained -brownish-black blood, the villous coat was blackish, and the subjacent -cellular tissue injected with black blood; sometimes there was an -appearance of erosion on the surface of the villous coat; and in the -instance of the concentrated acid perforations were found. In the -experiments of Hébréart the lining membrane of the windpipe was covered -with a fibrinous pseudo-membrane, exactly as after croup. - -Although acetic acid in its various forms is daily in the hands of every -body, one case only of poisoning with it in the human subject has -hitherto been made public. It is described by MM. Orfila and -Barruel.[384] A girl was seen in a village near Paris at eleven at night -apparently intoxicated. Five hours afterwards she was found lying on the -ground in great agony; and after complaining of pain in the stomach and -experiencing several attacks of convulsions, she expired. On the -subsequent examination of the body considerable lividity was observed on -the skin of the depending parts. The back of the tongue was brownish and -leathery, and the inner membrane of the gullet blackish-brown, -intersected by a fine network of vessels. The stomach presented -internally several large, black, firm elevations, owing to the injection -of coagulated blood into the submucous cellular tissue; and elsewhere it -had a grayish-white tint, with here and there a reddish colour; but the -mucous membrane was perfectly entire. The cavity contained above eight -ounces of a thick, blackish fluid; and a thicker pulpy matter of the -same colour adhered firmly to the villous coat. The intestines were -healthy, and so also were the other organs in the belly and chest. The -uterus contained a fœtus two months and a half old. The contents of the -stomach were subjected to a careful analysis by MM. Orfila and Barruel, -who found that they did not contain any appreciable quantity of free -sulphuric or muriatic acid, or of any of the common metallic poisons; -and by the process of analysis formerly described, they succeeded in -separating from the impure mass three drachms of a pure, and tolerably -concentrated acetic acid, besides two drachms more from the contents of -the intestines. As the residue of the distillation left behind in the -retort did not yield any bitter principle to boiling alcohol, so as to -countenance the idea of a vegetable alkaloid having been given along -with the acetic acid, they inferred that this acid had been swallowed -alone; and the experiments of Orfila on dogs, performed for the -occasion, induced them to conclude that it was the cause of death. - -To these observations it is only farther necessary to add, that the -concentrated acid is a powerful irritant and even corrosive when applied -externally; which properties are owing to its power of dissolving many -of the soft animal solids.[385] - - - - - CHAPTER VI. - OF POISONING WITH OXALIC ACID. - - -The last poison of this order is oxalic acid. It is a substance of very -great interest; for it is a poison of great energy, and in this country -is in common use for committing suicide, and has been often taken by -accident for Epsom salt. - -It is certainly ill adapted for the purposes of the murderer; for -although it might be easily given to a sick person instead of a laxative -salt, yet its real nature would betray itself too soon and too -unequivocally for the chief object of the prisoner,—secrecy. -Nevertheless, attempts of the kind have been made. At the trial of James -Brown for assaulting his wife, held at the Middlesex Autumn Assizes -1827, it was brought out in evidence that he had previously tried to -poison her by giving her oxalic acid in gin;[386] and Mr. Alfred Taylor -says he is acquainted with two similar cases, where an attempt was made -to administer it in tea.[387] - -It was first made known as a poison by Mr. Royston in 1814.[388] Its -properties have been examined by Dr. A. T. Thomson of London,[389] and -Dr. Perey of Lausanne;[390] in 1823, the whole subject of poisoning with -oxalic acid in its medico-legal relations was examined by Dr. Coindet of -Geneva and myself;[391] and in 1828, another experimental inquiry, which -confirms most of the results we obtained, was published by Dr. Pommer of -Heilbronn.[392] - - - SECTION I.—_Of the Tests for Oxalic Acid._ - -Oxalic acid is commonly in small crystals of the form of flattened -six-sided striated prisms, transparent, colourless, free of odour, very -acid to the taste, and permanent in the air. Two other common vegetable -acids, the citric and tartaric acids, present a totally different -crystalline form. In general appearance it greatly resembles the -sulphate of magnesia, for which it has been so often and so fatally -mistaken. So close, indeed, is the resemblance, that repeatedly, on -desiring several persons to point out which was the poison and which the -laxative, I have found as many fix on the wrong as on the right parcel. -The sulphate of magnesia has of course a very different taste, being -strongly bitter. Various plans have been devised for preventing the -accident to which this unlucky resemblance has given rise. The best of -them imply the use of a safeguard by the patient before he takes his -laxative draught. It seems to have escaped the notice of those who have -proposed the plans in question, that, if accidents are to be prevented -in this manner, by far the simplest and most effectual security will be -to let the public know, that a laxative salt ought always to be tasted -before being swallowed. Its solubility has been much overrated by some -chemists. It does not appear to me soluble in less than eleven parts of -water. - -In determining the medico-legal tests for oxalic acid, it will be -sufficient to consider it in two states,—dissolved in water,—and mixed -with the contents of the stomach and intestines or vomited matter. If -the substance submitted to examination is in the solid state, the first -step is to convert it into a solution. - -1. In the form of a pure solution, its nature may be satisfactorily -determined by the following process. - -The acidity of the fluid is first to be established by its effect on -litmus-paper.—A small portion is next to be tested with ammonia, which, -if the solution of the acid be sufficiently concentrated, will produce a -radiated crystallization, as the oxalate of ammonia formed is much less -soluble than oxalic acid itself. This property, according to Dr. -O’Shaughnessey, distinguishes it from every other acid.[393] The -remainder of the fluid is next to be subjected to the following -reagents. - -_Hydrochlorate of lime_ causes a white precipitate, the oxalate of lime; -which is dissolved on the addition of a drop or two of nitric acid,—and -is not dissolved when similarly treated with hydrochloric acid, unless -the acid is added in very large proportion. - -The easy solubility of the oxalate of lime in nitric acid distinguishes -the precipitate from the sulphate of lime, which the present test might -throw down from solutions of the sulphates, and which is not soluble in -a moderate quantity of nitric acid without the aid of heat. The -insolubility of the oxalate of lime in hydrochloric acid on the other -hand distinguishes the precipitate from the tartrate, citrate, carbonate -and phosphate of lime, which the test might throw down from any solution -containing a salt of these acids. The last four precipitates are -redissolved by a drop or two of hydrochloric acid; but the oxalate is -not taken up till a large quantity of that acid is added. - -_Sulphate of lime_ in solution causes a white precipitate with oxalic -acid, and not with any other.[394] - -_Sulphate of copper_ causes a faint bluish-white, or greenish-white -precipitate, which is not redissolved on the addition of a few drops of -hydrochloric acid. The precipitate is the oxalate of copper. It is -redissolved by a large proportion of hydrochloric acid. - -This test does not precipitate the sulphates, hydrochlorates, nitrates, -tartrates, citrates. But with the carbonates and phosphates it forms -precipitates resembling the oxalate of copper. The oxalate, however, is -distinguished from the carbonate and phosphate of copper by not being -redissolved on the addition of a few drops of hydrochloric acid. - -_Nitrate of silver_ causes a dense, white precipitate, the oxalate of -silver; which, when collected on a filter, dried and heated, becomes -brown on the edge, then fulminates faintly and is dispersed. - -The object of the supplementary test of fulmination is to distinguish -the oxalate of silver from the numberless other white precipitates which -are thrown down by the nitrate of silver from solutions of other salts. -The property of fulmination, which is very characteristic, requires, for -security’s sake, a word or two of explanation, in consequence of the -effect of heat on the tartrate and citrate of silver. The citrate when -heated becomes altogether brown, froths up, and then deflagrates, -discharging white fumes and leaving an abundant, ash-gray, coarsely -fibrous, crumbly residue, which on the farther application of heat -becomes pure white, being then pure silver. The tartrate also becomes -brown and froths up, but does not even deflagrate, white fumes are -discharged, and there is left behind a botryoidal mass, which, like the -residue from the citrate, becomes pure silver when heated to redness. -Another distinction between the oxalate and tartrate is that the former -continues permanent at the temperature of ebullition, while the latter -becomes brown. The preceding process or combination of tests will be -amply sufficient for proving the presence of oxalic acid, free or -combined, in any fluid, which does not contain animal or vegetable -principles. - -2. The only important modifications in the analysis rendered necessary -by the admixture of organic principles, occur in the case of the -contents of the alimentary canal or vomited matters. - -Dr. Coindet and I proved, that oxalic acid has not any chemical action -with any of the common animal principles except gelatin, which it -rapidly dissolves;—and that this solution is of a peculiar kind, not -being accompanied with any decomposition, either of the acid or of the -gelatin.[395] Consequently oxalic acid, so far as concerns the tissues -of the stomach or its ordinary contents, is not altered in chemical -form, and remains soluble in water. - -In such a solution, however, a variety of soluble principles are -contained, which would cause abundant precipitates with two of the tests -of the process,—sulphate of copper and nitrate of silver; so that the -oxalates of these metals could not possibly be detached in their -characteristic forms. The process for a pure solution, therefore, is -inapplicable to the mixtures under consideration. - -But changes of still greater consequence are effected on the poison by -exhibiting antidotes during life. It is now generally known, that the -proper antidotes for oxalic acid are magnesia and chalk. Each of these -forms an insoluble oxalate; so that if either had been given in -sufficient quantity, no oxalic acid will remain in solution, and the -proofs of the presence of the poison must be sought for in the solid -contents of the stomach or solid matter vomited. - -The following process for detecting the poison will apply to all the -alterations which it may thus have undergone. - -_Process for Compound Mixtures._—If chalk or magnesia has not been given -as an antidote, the suspected mixture is to be macerated if necessary -for a few hours in a little distilled water, then filtered, and the -filtered fluid neutralized with carbonate of potass. If on the other -hand chalk or magnesia has been given, the mixture is to be left at rest -for some time, and the supernatant fluid then removed. This fluid, if -not acid, may be thrown away; but if acid, it may be treated as already -directed for a suspected mixture, where chalk or magnesia has not -obtained entrance. After the removal of the supernatant liquid, pick out -as many solid fragments of animal or vegetable matter as possible; and -add as much pure water to the insoluble residue as will give the mass a -sufficiently thin consistence. Add now to the mixture about a twentieth -of its weight of carbonate of potass, and boil gently for two hours, or -till the organic matter is all dissolved. While dissolution thus takes -place, a double interchange is effected between the elements of the -carbonate of potass on the one hand, and those of the earthy oxalate on -the other, so that an oxalate of potass will at length exist in -solution. The fluid when cold is next to be filtered, then rendered very -faintly acidulous with nitric acid, then filtered and rendered very -faintly alkaline with carbonate of potass, and filtered a third time. At -each of these steps some animal matter will be thrown down. - -From this point onwards the process proceeds in the same way, whatever -may have been the original form in which the acid existed in the -mixture; for the oxalate of lime or magnesia in the second case is -converted into oxalate of potass. - -Add now the solution of acetate of lead to the fluid as long as any -precipitate is formed. Collect the precipitate on a filter, wash it -well, and dry it by compression between folds of bibulous paper. Remove -this precipitate, which consists of oxalate of lead and organic matter -in union with oxide of lead, and rub it up very carefully while damp -with a little water in a mortar. Transmit sulphuretted hydrogen gas -briskly for an hour, so that the whole white precipitate shall be -thoroughly blackened; filter and boil. In this manner is formed a -sulphuret of lead, which retains a great deal of animal matter; and the -oxalic acid being set free, is found in the solution tolerably pure. -Filtration before boiling is an essential point in this step, to prevent -animal matter being dissolved by the water from the sulphuret of lead. -More animal matter may still be separated by evaporating the liquid to -dryness at 212°, keeping it at that temperature for a few minutes, and -redissolving and filtering. The solution will now exhibit the properties -of oxalic acid. - -I have found that when this process was applied to a decoction of an -ounce of beef in six ounces of water, with which one grain of anhydrous -oxalic acid had been mixed, all the tests acted characteristically on -the solution ultimately procured. I have farther found, that when two -grains of oxalate of lime, which correspond with one grain of oxalic -acid, were mixed with a similar decoction in which some fragments of -beef were purposely left to complicate the process, a solution was -eventually obtained, which gave with muriate of lime a white precipitate -insoluble in a little muriatic acid, with sulphate of copper a -greenish-white precipitate also insoluble in a little muriatic acid, and -with nitrate of silver a white precipitate which fulminated and was -almost all dispersed, but left a little charcoal, owing to its -containing a small proportion of animal matter. In a case which lately -happened in London, every test acted as here described, except that the -oxalate of lime did not fulminate, owing to the presence of organic -impurities.[396] In order to try the test of fulmination in such -circumstances, it is essential to dry the precipitated oxalate of silver -thoroughly before raising the temperature to the point at which -fulmination usually occurs. - -The process now recommended is both delicate and accurate. An objection -has been advanced against it,—that acetate of lead will throw down -chloride of lead as well as the oxalate of lead; that both will -subsequently be decomposed by the sulphuretted-hydrogen? and that the -hydrochloric acid thus brought into the solution with the oxalic acid -will be precipitated by the nitrate of silver, and form a mixture of -salts which will not fulminate characteristically.[397] This objection -is not well founded. Chloride of lead being soluble in thirty parts of -temperate water, it will seldom be thrown down from such fluids as occur -in medico-legal inquiries; and besides it is easily removed, as I have -ascertained, by washing the precipitate with moderate care on the -filter. - -Professor Orfila has advanced another objection,—that the process will -yield all the indications mentioned above, if binoxalate of potash be -present, or sorrel-soup, which contains a little of that salt.[398] The -objection is valid, were these substances apt to come in the way. But -the binoxalate of potash is not put to any medicinal use in Britain, and -English cookery does not acknowledge the “soupe à l’oseille.” The -process he recommends to meet the difficulty, an important one in -France, is the following: 1. Having made a watery solution as above, -evaporate nearly to dryness, agitate the residue with cold pure alcohol, -repeatedly during a period of several hours; decant the tincture, and -repeat this step with more alcohol; evaporate to obtain crystals, if -possible; dissolve these again in cold pure alcohol, and crystallize a -second time by evaporation. If crystals do not form on first -concentrating the alcoholic solution, evaporate it till a pellicle -begins to form, agitate the residue with cold pure alcohol, and -concentrate again to obtain crystals. Lastly, examine the crystals by -the tests for pure oxalic acid. The object of these steps in the process -is to separate binoxalate of potass, oxalate of magnesia and oxalate of -lime, which, he says, are all either not soluble, or very sparingly so, -in absolute alcohol. 2. More oxalic acid may be got by acting with -distilled water on the matter left by the action of alcohol, evaporating -this watery solution nearly to dryness, agitating the residuum with cold -alcohol as before, and so on. 3. The preceding operations may have left -oxalate of magnesia and oxalate of lime unacted on by the water among -the solids remaining on the filter. The former compound may be dissolved -out by cold hydrochloric acid diluted with four times its volume of -water; and by an excess of pure carbonate of potass, the oxalate of -magnesia in the solution is converted into insoluble carbonate of -magnesia and soluble oxalate of potass, from which oxalic acid is to be -obtained by a salt of lead and sulphuretted-hydrogen, as explained in my -own process. 4. Oxalate of lime, which may still remain, is to be sought -for by boiling the residuum of the action of hydrochloric acid with -solution of bicarbonate of potash, so as to obtain here also an oxalate -of potass in solution. I have not had an opportunity of trying this -method. But I find, that, contrary to Orfila’s statement, binoxolate of -potass, though sparingly soluble in cold alcohol of the density of 800, -is sufficiently so to vitiate the principle on which the process is -founded. - -Caustic potass must not be used for decomposing oxalate of lime or -magnesia, because the pure alkali, as Gay-Lussac has shown, produces -oxalic acid in acting on animal substances at a boiling temperature. -Carbonate of potass has no such effect. - -The discovery of oxalic acid in the form of oxalate of lime in the -stomach or vomited matter is exposed to a singular fallacy, if a -material quantity of rhubarb has been taken recently before death, or -before the discharge of the vomited matter. For according to the -researches of M. Henry of Paris, rhubarb root always contains some -oxalate of lime, and some samples yield so much as 30 and even 33 per -cent.[399] - - -SECTION II.—_On the Action of Oxalic Acid and the Symptoms it causes in - Man._ - -The action of oxalic acid on the animal economy is very peculiar. - -When injected in a state of concentration into the stomach of a dog or -cat, it causes exquisite pain, expressed by cries and struggling. In a -few minutes this is succeeded by violent efforts to vomit; then by -sudden dulness, languor, and great debility; and death soon takes place -without a struggle. The period which elapses before death varies from -two to twenty minutes, when the dose is considerable,—half an ounce, for -example. After death the stomach is found to contain black extravasated -blood, exactly like blood acted on by oxalic acid out of the body; the -inner coat of the stomach is of a cherry-red colour, with streaks of -black granular warty extravasation; and in some places the surface of -the coat is very brittle and the subjacent stratum gelatinized, -evidently by the chemical action of the poison.[400] If the stomach is -examined immediately after death, little corrosion will be found, -compared with what is seen if the inspection be delayed a day or -two.[401] - -Such are the effects of the concentrated acid. When considerably -diluted, the phenomena are totally different. When dissolved in twenty -parts of water, oxalic acid, like the mineral acids in the same -circumstances, cease to corrode; nay it hardly even irritates. But, -unlike them, it continues a deadly poison; for it causes death by acting -indirectly on the brain, spine, and heart. The symptoms then induced -vary with the dose. When the quantity is large, the most prominent -symptoms are those of palsy of the heart; and immediately after death -that organ is found to have lost its contractility, and to contain -arterial blood in its left cavities. When the dose is less the animal -perishes after several fits of violent tetanus, which affects the -respiratory muscles of the chest in particular, causing spasmodic fixing -of the chest and consequent suffocation. When the dose is still less, -the spasms are slight or altogether wanting, and death occurs under -symptoms of pure narcotism like those caused by opium: the animal -appears to sleep away. - -This poison acts with violence, and produces nearly the same effects to -whatever texture of the body it is applied. It causes death with great -rapidity when injected into the sac of the peritonæum, or into that of -the pleura; it acts with still greater quickness when injected into a -vein; and it also acts when injected into the cellular tissue beneath -the skin, but with much less celerity than through any other channel. -Eight grains injected into the jugular vein of a dog occasioned almost -immediate death: Thirty-three grains injected into the pleura killed -another in twelve minutes. The same quantity did not prove fatal, though -it caused violent effects, when retained in the stomach by a ligature on -the gullet. One hundred and sixty grains injected under the skin of the -thigh and belly did not prove fatal for about ten hours. The symptoms -were nearly the same in every case.[402] - -It is probable from the facts now stated, that oxalic acid, when not -sufficiently concentrated to occasion death by the local injury -produced, acts on the nervous system through the medium of the blood. -Nevertheless it is a remarkable circumstance that it cannot be detected -in that fluid. Mention has already been made of an experiment performed -by Dr. Coindet and myself (p. 22), where even after the injection of -eight grains of oxalic acid into the femoral vein, and the consequent -death of the animal in thirty seconds, none of the poison could be -detected in the blood of the iliac vein or vena cava. Similar results -have been more lately obtained by Dr. Pommer. In dogs killed by the -gradual injection of from five to thirty grains into the femoral vein, -he never could detect the poison in the blood of the right side of the -heart or great veins, except in the instance of the largest doses, where -a little could be detected near the opening in the vein. Dr. Pommer’s -experiments likewise agree with those of Dr. Coindet and myself as to -the absence of any change in the physical qualities of the blood.[403] -When to these circumstances it is added that very small quantities of -oxalic acid may be detected in blood, into which it has been introduced -immediately after removal from the body by venesection, it appears -reasonable to conclude that the poison is quickly decomposed in the -blood by vital operations. - -According to Orfila, however, it may be detected in the urine, in which -crystals of oxalate of lime form on cooling, and more may be obtained on -the addition of hydrochlorate of lime. Yet he could not detect any -oxalic acid in the liver or spleen.[404] - -In man the most prominent symptoms hitherto observed have been those of -excessive irritation, because it has been almost always swallowed in a -large dose and much concentrated. - -It is the most rapid and unerring of all the common poisons. The London -Courier contains an inquest on the body of a young man who appears to -have survived hardly ten minutes;[405] an equally rapid case of a young -lady, who poisoned herself with an ounce, is mentioned in the St. -James’s Chronicle;[406] and few of those who have died survived above an -hour. This rule, however, is by no means without exception. Mr. Hebb has -described a case which did not prove fatal for thirteen hours;[407] Dr. -Arrowsmith of Coventry has favoured me with the particulars of a very -interesting case which lasted for the same period: and Mr. Frazer has -accurately described another, in which, after the patient seemed to be -doing tolerably well, an exhausting fever, with dyspepsia and singultus, -carried him off in twenty-three days.[408] - -Among the fatal cases the smallest dose has been half an ounce; but -there can be little doubt that less would be sufficient to cause death. -Dr. Babington of Coleraine has published a case where very severe -effects were produced by only two scruples.[409] - -Very few persons have recovered where the quantity was considerable. - -In every instance in which the dose was considerable, and the solution -concentrated, the first symptoms have been immediate burning pain in the -stomach, and generally also in the throat. But when the dose was small, -more particularly if the solution was also rather diluted, the pain has -sometimes been slight, or slow in commencing. Mr. Hebb’s patient, who -took only half an ounce dissolved in ten parts of water, and diluted it -immediately after with copious draughts of water, had not any pain in -the belly for six hours. - -In general, violent vomiting follows the accession of pain, either -immediately, or in a few minutes; and it commonly continues till near -death. Some, however, have not vomited at all, even when the acid was -strong and in a large dose; and this is still more apt to happen when -the poison has been taken much diluted. The man last mentioned did not -vomit at all for seven hours, except when emetics were administered. The -vomited matter, as in this man’s case, and in that of Mr. Frazer’s -patient, is sometimes bloody. Instant discharge of the poison by -vomiting does not always save the patient’s life: A woman who swallowed -two ounces died in twenty minutes, although she vomited almost -immediately after taking the poison.[410] - -The tongue and mouth occasionally become inflamed if the case lasts long -enough. In an instance of recovery, which happened not long ago in St. -Thomas’s Hospital, London, the tongue was red, swollen, tense and -tender, the day after the acid was swallowed.[411] - -Death commonly takes place so soon, that the bowels are seldom much -affected. But when life is prolonged a few hours, they are evidently -much irritated. Dr. Arrowsmith’s patient, who lived thirteen hours, had -severe pain in the bowels and frequent inclination to go to stool, and -Mr. Hebb’s patient, who also lived thirteen hours, had a constant, -involuntary discharge of fluid fæces, occasionally mixed with blood. -Bloody diarrhœa is very common in dogs. - -The signs of depressed circulation are always very striking. In general -the pulse fails altogether, it is always very feeble, and the skin is -cold and clammy. Contrary to the general fact, however, I once remarked -in a dog the pulsation of the heart so strong as to be audible at a -distance of several yards. - -In some cases nervous symptoms have occurred, but in none so distinctly -as in animals that have taken the diluted acid. It should be remarked, -however, that few published cases contain good histories of the -symptoms; since they commonly come to an end before being seen by the -physician. Convulsions appear to have occurred in some instances either -at the time of death or soon before it. In the slower cases various -nervous affections have been observed. A girl, who swallowed by mistake -about two drachms, and did not vomit till emetics were given, complained -much at first of pain, but afterwards chiefly of great lassitude and -weakness of the limbs, and next morning of numbness and weakness there -as well as in the back. This affection was at first so severe that she -could hardly walk up stairs; but in a few days she recovered -entirely.[412] Analogous effects took place in Mr. Hebb’s patient and in -Dr. Arrowsmith’s case. The first thing the former complained of was -acute pain in the back, gradually extending down the thighs, occasioning -ere long great torture, and continuing almost till the moment of death. -Dr. Arrowsmith’s patient had the same symptoms, complained more of the -pain shooting down from the loins to the limbs than of the pain in the -belly, and was constantly seeking relief in a fresh change of posture. -Mr. Frazer’s patient had from an early period a peculiar general -numbness, approaching to palsy. Dr. Babington’s patient, who took two -scruples by mistake for tartaric acid in an effervescing draught, -suffered, after the first twenty-four hours, chiefly from headache, -extreme feebleness of the pulse, and a sense of numbness and tingling or -pricking in the back and thighs. In a recent case described by Mr. -Tapson, which occurred in London, and where it was supposed, but on -insufficient grounds,[413] that so much as two ounces had been taken, -violent symptoms of irritation in the alimentary canal came on as usual, -but soon afterwards a sense as if the hands were dead, loss of -consciousness for eight hours, and then lividity, coldness, and almost -complete loss of the power of motion in the legs; which symptoms were -not entirely removed for fifteen days. In a case related by Mr. Alfred -Taylor, where death was caused by seven drachms in fifteen or twenty -minutes, there was first violent vomiting, then severe pain in the -stomach, and finally clammy perspiration and convulsions, with two or -three deep inspirations before death.[414] The effects in this case came -very near those generally observed in animals. - -In Dr. Arrowsmith’s case two symptoms occurred, which I have not seen -mentioned in any other. The first was an eruption or mottled appearance -of the skin in circular patches, not unlike the roundish red marks on -the arms of stout healthy children, but of a deeper tint. The second was -the poisoning and death of leeches applied to the stomach. “They were -healthy,” says Dr. Arrowsmith in the notes with which he obligingly -furnished me, “small, and fastened immediately. On looking at them in a -few minutes I remarked that they did not seem to fill, and on touching -one it felt hard and immediately fell off, motionless and dead. The -others were all in the same state. They had all bitten and the marks -were conspicuous; but they had drawn scarcely any blood. They were -applied about six hours after the acid was taken.” This curious fact -illustrates the observations formerly quoted from Vernière’s experiments -[p. 67]. It will be observed that the leeches were applied several hours -after the poison was swallowed, and in a case in which the acid was -largely diluted in the stomach;—so that it might have entered the blood -and been diffused throughout the body before the observation was made. - - - SECTION III.—_Of the Morbid Appearances caused by Oxalic Acid._ - -The external appearance of the body is commonly natural. In one instance -the cellular tissue was distended with gases ten hours after death.[415] -Violent marks of irritation have been commonly found in the stomach; and -sometimes that organ has been even perforated.[416] It is probable that -the extensive destruction of the coats noticed by some authors has taken -place in part after death from the action of the acid on the dead -tissues.—The usual conjunction of morbid appearances is well described -by Mr. Hebb. The mucous coat of the throat and gullet looked as if it -had been scalded, and that of the gullet could be easily scratched off. -The stomach contained a pint of thick fluid. This is commonly dark, like -coffee-grounds, as it contains a good deal of blood. The inner coat of -the stomach was pulpy, in many points black, in others red. The inner -membrane of the intestines was similarly but less violently affected. -The outer coat of both stomach and intestines was inflamed. The lining -membrane of the windpipe was also very red.—The appearances have also -been excellently described in the case published by Mr. Alfred Taylor. -The inside of the gullet was pale, as if boiled, strongly corrugated and -brittle, and covering a ramification of vessels filled with consolidated -blood. The stomach presented externally numerous vessels in the same -state; and its villous coat was pale, soft, brittle, but here and there -injected with vessels. The duodenum and part of the jejunum were red, -the other intestines natural, the liver, spleen, and kidneys congested. -The stomach contained a brownish jelly, in which gelatin was detected, -as well as oxalic acid. The blood was fluid every where except in the -vessels of the gullet and stomach.[417] The consolidated condition of -the blood there was evidently owing to the local action of a strong -acid, and is the same with what has been observed in poisoning with the -mineral acids.—In Mr. Frazer’s patient the whole villous coat of the -stomach was either softened or removed, as well as the inner membrane of -the gullet, so that the muscular coat was exposed; and this coat -presented a dark gangrenous-like appearance, being much thickened and -highly injected. - -Although these signs of violent irritation are commonly present, it must -at the same time be observed, that some cases have occurred where the -stomach and intestines were quite healthy. In a girl who died about -thirty minutes after swallowing an ounce of the acid, no morbid -appearance whatsoever was to be seen in any part of the alimentary -canal.[418] In the case of a girl, described by Mr. Anderson, where -death took place in twenty minutes, there was no appearance but -contraction of the rugæ of the gullet and stomach, one spot of -extravasation in the latter and doubtful softening of its villous -coat.[419] - -The state of the other organs of the body has not been taken notice of -in published cases. In several instances, as in Mr. Taylor’s case, the -blood in the veins of the stomach is described as having been black and -as it were charred; probably by the chemical action of the acid after -death. - - - SECTION IV.—_Of the Treatment of Poisoning with Oxalic Acid._ - -The chief part of the treatment of this kind of poisoning is obvious. On -account of its dreadful rapidity, remedies cannot be of material use -unless they are resorted to immediately after the acid has been -swallowed. Emetics may be given, if vomiting is not already free; but -time should never be lost in administering them if an antidote is at -hand. In particular it is necessary to avoid giving warm water with a -view to accelerate vomiting, unless it is given very largely; for -moderate dilution will promote the entrance of the poison into the -blood, if it has not the effect of immediately expelling it. - -The principal object of the practitioner should be to administer as -speedily as possible large doses of magnesia or chalk suspended in -water. Chalk has been given with great advantage in several cases,[420] -and magnesia has also been of service.[421] As no time should be lost, -the plaster of the apartment may be resorted to, when chalk or magnesia -is not at hand. These substances not only neutralize the acid so as to -take away its corrosive power, but likewise render it insoluble, so as -to prevent it from entering the blood. There appears no particular -reason for using the stomach-pump when antidotes are at hand. But -fashion seems to have authorised the employment of this instrument for -every kind of poison.[422] Alkalis are inadmissible. As might be -inferred from the general statements formerly made on the effect of -chemical changes on poisons [p. 28], the alkalis, as they form only -soluble salts, will not deprive oxalic acid of its remote or indirect -action; and instances are not wanting of their inutility in actual -practice. - -Oxalic acid is one of the poisons alluded to under the head of General -Poisoning,—of whose operation distinct evidence may sometimes (though -certainly not always) be found in the symptoms. If a person, immediately -after swallowing a solution of a crystalline salt, which tasted purely -and strongly acid, is attacked with burning in the throat, then with -burning in the stomach, vomiting particularly of bloody matter, -imperceptible pulse and excessive languor, and dies in half an hour, or -still more in twenty, fifteen, or ten minutes, I do not know any fallacy -which can interfere with the conclusion, that oxalic acid was the cause -of death. No parallel disease begins so abruptly and terminates so soon; -and no other crystalline poison has the same effects. - -_Poisoning with the Oxalates._—Oxalic acid is one of the best examples -of a poison that acts through all its soluble chemical combinations. Dr. -Coindet and I found that the oxalates of potash and ammonia are little -inferior in energy to the acid. They do not corrode, indeed, and -scarcely ever irritate; but they produce tetanus and coma, like the -diluted acid. Half a drachm of oxalic acid neutralized with potass will -kill a rabbit in seventeen minutes; ninety grains of neutral oxalate of -ammonia will kill a strong cat in nine minutes.[423] The binoxalate of -potash, the most familiar of the salts of oxalic acid, was not tried by -us. But the preceding facts would leave little doubt of its being a -poison. - -Since the last edition of this work was published several cases have -occurred which amply confirm the results of experimental inquiry. In Dr. -Babington’s case alluded to above, the greater part of the oxalic acid -had been neutralized by bicarbonate of soda [p. 176].—Mr. Tripier has -communicated the particulars of a case in which half an ounce of the -binoxalate of potash was taken by mistake for bitartrate of potash in -hot water, and caused death in eight minutes, after an attack of violent -pain and convulsions.[424]—A young woman at Bordeaux was attacked with -frequent vomiting after a dose of a drachm and a half of the same salt -dissolved in a ptisane. Next morning a similar dose caused bloody -vomiting and acute pain at the pit of the stomach; and a third dose the -following day excited delirium, more violent vomiting, and death in the -course of an hour.[425]—A girl in London swallowed about an ounce of the -same salt dissolved in hot water. Sickness and faintness ensued, with -imperceptible pulse, cold, clammy skin, rigors, scalding of the mouth -and throat, pain in the back, soreness of the eyes, redness of the -conjunctivæ, and dilatation of the pupils. Afterwards there was -reaction, with a full frequent pulse, hot skin, flushed countenance, -headache, thirst, and tenderness of the abdomen. She recovered under the -use of chalk, external heat, ether and opium draughts, leeches and -sinapisms to the belly, and carbonate of ammonia.[426] - -No account has yet been published of the morbid appearances in man. - -The proper antidote is sulphate of magnesia. Failing this, weak milk of -lime may be given with advantage. - -_Appendix on Tartaric and Citric Acid._—These two acids may be taken in -considerable quantities without injury. Dr. Coindet and I gave a drachm -of each in solution to cats, without observing that the animals suffered -any inconvenience.[427] Dr. Sibbald, a surgeon of this place, has -informed me of an instance in which a patient of his took in twenty-four -hours six drachms of tartaric acid, having by mistake omitted the -carbonate of potass sent along with the acid to make effervescing -draughts; and yet he did not suffer any more inconvenience then the cats -on which Dr. Coindet and I experimented. - -Pommer, however, found that tartaric acid is scarcely less active than -oxalic acid when injected into the blood. When fifteen grains -dissolved in half an ounce of water were injected into the femoral -vein of a dog in four doses, difficult breathing and discharge of -fæces and urine were produced after each operation, and death speedily -ensued without any other particular symptom. As in the instance of -oxalic acid, the blood in the great veins was not apparently changed -in any of its physical qualities. The heart continued contractile long -after death, while in the case of oxalic acid its contractility was -suddenly extinguished.[428] - - - - - CHAPTER VII. - OF THE ALKALIS AND ALKALINE SALTS. - - -The second order of the class of irritants comprehends the alkalis, some -of the alkaline salts, and lime. The species which it includes are -little allied to one another except in chemical composition; and in -particular they are little allied in physiological properties. It -appears impossible, however, to make a better arrangement than that -proposed by Orfila, which will therefore be here followed. - -Most of the poisons of the second order are powerful local irritants. -Some of them likewise act indirectly on distant organs; and a few are -more distinguished by their remote than by their local effects. This -order may be conveniently divided into two groups,—the one embracing the -two fixed alkalis with their carbonates, nitrates, and chlorides, and -also lime,—the other ammonia, with its salts, and likewise the alkaline -sulphurets. - -The action of the first group is purely irritant and strictly local. -When concentrated, the fixed alkalis and their carbonates produce -chemical decomposition, softening the animal tissues, and reducing them -eventually to a pulpy mass; which change depends on their possessing the -power, as chemical agents, of dissolving almost all the soft solids of -the body. When much diluted, they produce inflammation, without -corroding the textures; and it does not appear that they are even then -absorbed in such quantity as to prove injurious to any remote organ. The -action of the alkaline nitrates and of lime is that of irritants only; -at least their chemical action is obscure and feeble. - - - _Of the Fixed Alkalis and their Carbonates._ - - - _Section_ I.—_Of their Tests._ - -_Potass_ in its caustic state, as usually met with in the shops, forms -little gray-coloured cylinders or cakes which have a radiated, -crystalline fracture, and an excessively acrid caustic taste, and feel -soapy if touched with the wet finger. It deliquesces rapidly in moist -air, and then attracts carbonic acid from the atmosphere. It is easily -fused by heat, and is exceedingly soluble in water. The solution has a -strong alkaline reaction on vegetable colours, restoring reddened litmus -to blue, turning syrup of violets or infusion or red cabbage to green, -and rendering infusion of turmeric brown. It is distinguished from the -alkaline earths when in solution, by not precipitating with carbonic or -sulphuric acid, and from soda by the tests to be presently mentioned for -its carbonate. - -_Carbonate of potash_ [subcarbonate, salt of tartar], is usually sold, -when pure, in small white grains, formed by melting the salt and -stirring it rapidly as it cools. In its impure state it is called in -this country potashes, and when somewhat purified, pearl ash. It has -then a mixed grayish, yellowish, or bluish colour, and is sold in -crumbly lumps of various sizes. In every state it is deliquescent and -very caustic. It cannot be crystallized. It gives out carbonic acid gas -with the addition of any stronger acid, such as sulphuric, muriatic, or -acetic acid. Its solution precipitates yellow with the chloride of -platinum, gives a crystalline precipitate with perchloric acid, when the -salt forms not less than a fortieth or fiftieth part,—is similarly acted -on by a considerable excess of tartaric acid, if the salt constitute -about a thirtieth of the fluid,—and yields with the soluble salts of -baryta a white precipitate soluble in nitric acid. - -_Soda_ resembles potass closely in chemical as well as physiological -properties; and the _carbonate_ bears the same resemblance to the -carbonate of potass. The chief differences are the following. The -carbonate of soda is easily crystallized, and effloresces on exposure to -the air. A solution in twenty parts of water yields no precipitate with -either perchloric acid or an excess of tartaric acid, because there is -no sparingly soluble perchlorate or bitartrate, as in the case of -potash. Its solution is precipitated by antimoniate of potash, because -the antimoniate of soda is very sparingly soluble. All its salts remain -unaffected by the chloride of platinum, because their base cannot form -like potass an insoluble triple salt with the reagent. The acetate of -soda is permanent in the air, while the acetate of potass is one of the -most deliquescent salts known. In trying this last test, which is very -characteristic, care must be taken to avoid an excess of acid in the -acetate of soda by expelling it at a temperature of 212°, otherwise the -salt is as deliquescent as the acetate of potass.—Another difference is, -that the chloride of sodium, being nearly as soluble in temperate as in -boiling water, crystallizes with difficulty and but sparingly by cooling -a concentrated boiling solution; while the chloride of potassium is much -more soluble in hot than in cold water, and crystallizes easily and -abundantly when a concentrated boiling solution is cooled down. - -_Process for Potash and its Carbonate in Organic Mixtures._—The -following method has been lately recommended for the detection of potash -and its carbonate in complex organic mixtures. Ascertain that the -mixture is alkaline in its action on litmus-paper and turmeric-paper, -and that it is not ammoniacal in odour. Distil to one-third; ascertain -that it has still an alkaline reaction, and evaporate to dryness in a -porcelain basin. Agitate the residue, when cold, with absolute alcohol; -boil, pour off the liquor, and filter it while hot. Repeat this with the -residuum and more alcohol. Distil off most of the alcohol, and evaporate -to dryness. Raise the heat to char the residuum, continue the heat as -long as vapours come off, remove the charcoaly matter, and incinerate it -for forty-five minutes in a silver crucible. Try to separate potash from -what remains by means of absolute alcohol; and if this do not succeed, -remove carbonate of potash by boiling water. In either case search for -potash by litmus-paper, turmeric-paper, chloride of platinum, and -perchloric acid.[429] - -The conclusiveness of this process depends upon the fact, that absolute -alcohol cannot dissolve from solid organic substances such a proportion -of lactate, tartrate, acetate, sulphate, or phosphate of potash, or -chloride of potassium, as to be acted on by chloride of platinum or -perchloric acid.[430]—It is to be observed that carbonate of potash -singly is insoluble in absolute alcohol; but it becomes soluble in that -fluid, when it is conjoined with various organic matters. Hence it is -that this process, intended fundamentally for caustic potash alone, is -applicable to carbonate of potash also. - -_Process for Soda and its Carbonate in Organic Mixtures._—These -substances may be separated by the method just described for potash. If -the alcoholic solution of the extract of the suspected matter be -alkaline in its action on litmus, and be afterwards found to contain -soda or its carbonate, the evidence of these substances having been -derived from without is satisfactory, because the carbonate of soda -contained in many animal matters cannot be so detached. But if no -indications of the presence of soda be thus obtained, it is not enough -that soda be found in the alcoholic solution of the incinerated -alcoholic extract, because the natural carbonate of soda of animal -matter may be separated in that manner.[431] - - - SECTION II.—_Of the Action of the fixed Alkalis, and the Symptoms they - cause in Man._ - -The action of the two fixed alkalis and their carbonates on the animal -system is so nearly the same, that the facts which have been ascertained -in respect to one of them will apply to all the rest. The operation of -potass and its carbonate has been carefully investigated by Professor -Orfila,[432] and by M. Bretonneau of Tours.[433] - -When caustic potass is injected in minute portions into the veins, it -instantly coagulates the blood. Five grains, according to Orfila, will -in this way kill a dog in two minutes. But when small doses either of -potash itself, or its carbonate, or indeed any of its salts are used, -Mr. Blake found, that without coagulating the blood, they arrested the -action of the heart in ten seconds, if injected into the jugular vein; -and that when they were injected into the carotid artery, they -occasioned in four seconds signs of great obstruction in the capillary -circulation, and arrestment of the heart’s action in thirty-five -minutes, through means of this effect. Next to the salts of baryta he -thought the potash salts the most powerful on the heart’s action of all -those he tried.[434] When introduced into the stomach potash acts -powerfully as an irritant, and generally corrodes the coats of that -organ. Thirty-two grains given by Orfila to a dog caused pain in the -gullet, violent vomiting, much anguish, restlessness, and death on the -third day. On dissection he found the inner coat of the gullet and -stomach black and red; and near the pylorus there was a perforation -three-quarters of an inch wide, and surrounded by a hard, elevated -margin. The observations of Bretonneau are in some respects different. -When potass was swallowed by dogs in the dose of 40 grains, he found -that the animals, after suffering for some time from violent vomiting, -always died sooner or later of wasting and exhaustion; and that the -action of the poison was confined chiefly to the gullet, which was -extensively destroyed and ulcerated on its inner surface. But when the -gullet was defended by the potass being passed at once into the stomach -in a caustic holder, larger doses, even several times repeated, did not -prove fatal. The usual violent symptoms of irritation prevailed for two -or three days; but on these subsiding, the animals rapidly recovered -their appetite and playfulness, appearing in fact to be restored to -perfect health. Yet there could be no doubt that the stomach all the -while was severely injured; for in some of the animals, which were -strangled for the sake of examination several weeks after they took the -poison, the villous coat was found extensively removed, and even the -muscular and peritonæal coats were here and there destroyed and -cicatrized. Bretonneau farther adds, that ten or fifteen grains -introduced into the rectum caused death sooner than three times as much -given by the mouth. - -The carbonate of potass possesses properties similar in kind, but -inferior in degree to those of the caustic alkali. Two drachms given by -Orfila to a dog killed it in twenty-five minutes, violent vomiting and -great agony having preceded death. The stomach was universally of a -deep-red colour on its inner surface. - -Potash and its carbonate are absorbed in the course of their action, and -may be detected by Orfila’s process in the liver, kidneys, and -urine.[435] - -The actions of soda and its carbonate seem on the whole the same with -those of potash; but they are not so energetic. In one respect however -soda and its salts differ most materially from those of potash. For -while the latter, when admitted directly into a vein, act by arresting -the action of the heart, soda and its salts, according to the inquiries -of Mr. Blake, have no such effect, but cause death by obstructing the -circulation of the pulmonary capillaries, and preventing the return of -blood from the lungs to the left side of the heart. This conclusion -seems to flow from the following facts. The respiration becomes in a few -seconds laborious and soon ceases, whilst the heart continues to beat -vigorously: arterial pressure is greatly reduced, while venous pressure -is much increased owing to accumulation of blood in the right side of -the heart: after death the lungs are found congested and often full of -froth: and the heart continues contractile, very turgid in the right -side, but quite empty of blood in its left cavities.[436] - -Poisoning with the caustic alkalis is rare. In 1842, a lady suffering -from inflammation of the bowels took an ounce of solution of potass by -mistake for kali-water, or a solution of bicarbonate of potash -surcharged with carbonic acid. She suffered severely at the time, and -died in a fortnight, probably of the conjunct effects of her disease and -the poison.[437] This is the only case I have found in print of -poisoning with a caustic alkali. But the effects of their carbonates -have been several times witnessed, and appear to resemble closely those -of the concentrated mineral acids. - -The symptoms are in the first instance an acrid burning taste, and rapid -destruction of the lining membrane of the mouth; then burning and often -constriction in the throat and gullet, with difficult and painful -deglutition; violent vomiting, often sanguinolent, and tinging vegetable -blues green; next acute pain in the stomach and tenderness of the whole -belly; subsequently cold sweats, excessive weakness, hiccup, tremors and -twitches of the extremities; and ere long violent colic pains, with -purging of bloody stools and dark membranous flakes. So far the symptoms -are nearly the same in all cases; but in their subsequent course several -varieties may be noticed. - -In the worst form of poisoning death ensues at an early period, for -example within twenty-four hours, nay even before time enough has -elapsed for diarrhœa to begin. A case of this kind, which has been very -well described by Mr. Dewar of Dunfermline, and which arose from the -patient, a boy, having accidentally swallowed about three ounces of a -strong solution of carbonate of potass, proved fatal in twelve hours -only.[438] Here death was owing to the general system or some vital -organ being affected through sympathy by the injury sustained by the -alimentary canal. - -In the mildest form, as in a case related by Plenck[439] of a man who -swallowed an ounce of the carbonate of potass, the symptoms represent -pretty nearly an attack of acute gastritis when followed by -recovery,—the effects on man being then analogous to those observed by -Bretonneau in animals, when the poison was introduced into the stomach -without touching the gullet. - -But a more common form than either of the preceding is one, similar to -the chronic form of poisoning with the mineral acids, in which constant -vomiting of food and drink, incessant discharge of fluid, sanguinolent -stools, difficulty of swallowing, burning pain from the mouth to the -anus, and rapid emaciation, continue for weeks or even months before the -patient’s strength is exhausted; and where death is evidently owing to -starvation, the alimentary canal being no longer capable of assimilating -food. Two characteristic examples of this singular affection have been -recorded in the Medical Repository,[440] and a third, of which the event -has not been mentioned, but which would in all likelihood end fatally, -has been communicated by M. Jules Cloquet to Orfila.[441] Of the two -first cases, which were caused by half an ounce of carbonate of potass -having been taken in solution by mistake for a laxative salt, one proved -fatal in little more than a month, the other three weeks afterwards. In -Cloquet’s case, at the end of the sixth week the membrane of the mouth -was regenerated; but the gullet continued to discharge pus, and the -stools were purulent and bloody. - -Another form perhaps equally common with that just described, and not -less certainly fatal, commences like the rest with violent symptoms of -irritation in the mouth, gullet, and stomach; but the bowels are not -affected, and by and by it becomes apparent that the stomach is little -injured; dysphagia or even complete inability to swallow, burning pain -and constriction in the gullet, hawking and coughing of tough, leathery -flakes, are then the leading symptoms; at length the case becomes one of -stricture of the œsophagus with or without ulceration; the bougie gives -only temporary relief, and the patient eventually expires either of mere -starvation, or of that combined with an exhausting fever. Mr. Dewar has -related a very striking example of this form of poisoning with the -alkalis.[442] His patient, after the first violent symptoms had -exhausted themselves, which took place in sixteen or eighteen hours, -suffered little for four or five days till the sloughs began to separate -from the lining membrane of the mouth, throat, and gullet. The affection -of the gullet then became gradually predominant, and terminated in -stricture, of which she appears to have been several times so much -relieved as to have been thought in a fair way of recovery. After -repeatedly disappointing Mr. Dewar’s hopes of a successful issue by her -intemperance in the use of spirituous liquors, she died of starvation -about four months after swallowing the poison. Sir Charles Bell has -noticed three parallel cases, and has given delineations of the -appearance in the gullet of two of them.[443] One of his patients did -not die till twenty years after swallowing the poison, which in this -instance was soap-less; yet he does not hesitate to ascribe the -stricture to that cause, and says death arose purely from starvation. - -The carbonate of soda, though a salt in very common use, has not -hitherto been the cause of accident, which has found its way into print. -It is plainly much less actively corrosive than carbonate of potass, and -is therefore probably in every sense less energetic. - - - SECTION III.—_Of the Morbid Appearances caused by the fixed Alkalis._ - -The morbid appearances caused by potass, soda, and their carbonates -differ with the nature of the case. - -In the boy who died in twelve hours Mr. Dewar found the inner membrane -of the throat and gullet almost entirely disorganized and reduced to a -pulp, with blood extravasated between it and the muscular coat. The -inner coat of the stomach was red, in two round patches destroyed, and -the patches covered with a clot of blood;—its outer coat, as well as all -the other abdominal viscera, was sound. - -In the two chronic cases mentioned in the Medical Repository the -mischief was much more general, the whole peritonæum being condensed, -the omentum dark and turgid, the intestines glued together by lymph, the -external coats of the stomach thick, the villous coat almost all -destroyed, what remained of it red and near the pylorus ulcerated, and -the pyloric orifice of the stomach plugged up with lymph so as barely to -admit a small probe. - -In Mr. Dewar’s patient who died of stricture of the gullet the -intestines were sound, the inner surface of the stomach red especially -towards the cardia, the inner and muscular coats of the gullet thickened -and firmly incorporated together by effused lymph, the inner coat here -and there wanting, the passage of the gullet every where contracted, and -to such a degree about two inches above the cardia as hardly to pass a -common probe. In Sir C. Bell’s cases the appearances were similar. - -Orfila says he is led to conclude from a great number of facts that of -all corrosive poisons potass is the one which most frequently perforates -the stomach.[444] This appearance, however, has not been mentioned in -any case of poisoning in the human subject. - - - SECTION IV.—_Of the Treatment of Poisoning with the fixed Alkalis._ - -In the treatment of poisoning with the alkalis the first object is -evidently to neutralize the poison. This may be done either with a weak -acid, or with oil. Of the acids the acetic in the form of vinegar is -most generally recommended, as it is not itself injurious. A successful -case in very unpromising circumstances, where two ounces and a half of -carbonate of potash had been taken by mistake for cream of tartar, and -where the antidote was not administered for half an hour, has been -related by M. Liégard of Caen. Great relief was experienced to the -burning in the throat and stomach, the chilliness, difficult breathing, -and frequent efforts to vomit, which were the first symptoms; and after -repeated alternations of collapse and reaction, convalescence was -established in eight days.[445]—M. Chereau thinks that for the mineral -alkalis and their carbonates fixed oil is a preferable antidote to -vinegar; and he has given the heads of two cases of poisoning with large -doses of carbonate of potass, in which the free employment of almond oil -prevented the usual fatal consequences. It appears to act partly by -rendering the vomiting free and easy, partly by converting the alkali -into a soap. It must be given in large quantity, several pounds being -commonly required.[446] For the subsequent treatment the reader may -consult the paper of Mr. Dewar, which contains many useful hints on the -management of the most complex description of cases. - - - - - CHAPTER VIII. - OF POISONING WITH NITRATE OF POTASS. - - -The _nitrate of potass_ [nitre, saltpetre, sal-prunelle], is a dangerous -poison. It has been often mistaken for the saline laxatives, especially -the sulphate of soda, and has thus been the source of fatal accidents. - - - SECTION I.—_Of the Chemical Tests for Nitrate of Potass._ - -It exists in commerce and the arts in two forms, fused and crystallized. -The fused nitre [sal-prunelle] is sold in little button-shaped masses, -spheres of the size of musket-balls, or larger circular cakes, of a -snow-white tint. The crystallized salt [sal-petre] is sold in whitish, -sulcated crystals, which are often regular and large. They are six-sided -prisms, more or lest flattened, and terminated by two converging planes. -In both forms nitre has a peculiar, cool, but sharp taste. - -Its chemical properties are characteristic. In the solid form, it -animates the combustion of burning fuel, and yields nitrous fumes when -heated with strong sulphuric acid. In solution it is precipitated yellow -by the chloride of platinum, and yields, when not greatly diluted, a -crystalline precipitate with perchloric acid. The crude salt of commerce -contains chloride of sodium; and hence the odour disengaged by sulphuric -acid may be mixed with that of chlorine or hydrochloric acid gas. When -mixed with any vegetable or animal infusion by which it is coloured, -crystals may sometimes be easily procured in a state of sufficient -purity by filtration and evaporation. But if not, then the same process -must be resorted to with that formerly recommended for nitric acid (p. -143), the first step of neutralization with potass being of course -dispensed with.—A process nearly the same with this has been suggested -by M. Kramer of Milan. He proposes to free the liquid in part of animal -matter by adding acetate of lead, transmitting sulphuretted-hydrogen -through the filtered fluid to remove any excess of lead, boiling the -fluid after another filtration, and then proceeding with acetate of -silver to remove chlorides, as in the process I have adopted. In this -way he found nitre even in the blood.[447] - - - SECTION II.—_Of the Action of Nitrate of Potass and its Symptoms in - Man._ - -This substance forms an exception to the general law formerly laid down -with regard to the effect of chemical neutralization on the local -irritants. Both its acid and its alkali are simple irritants; yet the -compound salt, though certainly much inferior in power, is still -energetic. Nay, the experiment of Orfila and the particulars of some -recently published cases tend even to prove, that the action of its -alkali and acid is materially altered in kind by their combination with -one another; for, besides inflaming the part to which it is applied, -nitre has at times produced symptoms of a secondary disorder of the -brain and nerves. - -The experiments of Orfila upon dogs show that on these animals it has a -twofold action, the one irritating, the other narcotic. He found that an -ounce and a half killed a dog in ninety minutes when the gullet was -tied, and a drachm another in twenty-nine hours: that death was preceded -by giddiness, slight convulsions, dilated pupil, insensibility and -palsy; that after death the stomach was externally livid, internally -reddish-black, and the heart filled in its left cavities with florid -blood; that when the gullet was not tied the animals recovered after -several attacks of vomiting, and general indisposition for twenty-four -hours; and that when the salt was applied externally to a wound it -excited violent inflammation, passing on to gangrene, but without any -symptom which indicated a remote or indirect operation.[448] Mr. Blake -found that this salt, when injected into the veins of a dog in the dose -of fifteen grains dissolved in twenty-four parts of water, causes sudden -depression and arrestment of the action of the heart, and death in less -than a minute; but that, like other salts of potash, it has no influence -on the capillaries of the lungs, though a powerful effect in obstructing -the systemic capillary system.[449]—When taken in the ordinary way, it -is absorbed in the course of its action, and has been detected both in -the blood and the urine by Kramer of Milan.[450] - -As to its effects on man, it must first be observed, that considerable -doses are necessary to cause serious mischief. In the quantity of one, -two, or three scruples, it is given medicinally several times a day -without injury; and Dr. Alexander found by experiments on himself, that -an ounce and a half, if largely diluted, might thus be safely -administered in the course of twenty-four hours.[451] Sometimes, too, -even large single doses have been swallowed with impunity. A gentleman -of my acquaintance once took nearly an ounce by mistake for Glauber’s -salt, and retained it above a quarter of an hour: nevertheless, except -several attacks of vomiting, no unpleasant symptom was induced. M. -Tourtelle has even related an instance where two ounces were retained -altogether and caused only moderate griping, with considerable purging -and flow of urine.[452] Resting on such facts as these Tourtelle, with -some physicians in more recent times,[453] has maintained that nitre is -not a worse poison than other saline laxatives; and some practitioners -of the present day have consequently ventured to administer it for the -cure of diseases, in the quantity of half an ounce in one dose.[454] It -is not easy to say, why these large doses are at times borne by the -stomach without injury,—whether the cause is idiosyncrasy, or a -constitutional insensibility engendered by disease, or some difference -in the mode of administering the salt. But at all events, the facts -which follow will leave no doubt that in general it is a dangerous and -rapid poison in the dose of an ounce. - -Dr. Alexander found that, in the quantity of a drachm or a drachm and a -half, recently dissolved in four ounces of water, and repeated every -ninety minutes, the third or fourth dose caused chilliness and stinging -pains in the stomach and over the whole body; and these sensations -became so severe with the fourth dose, that he considered it unsafe to -attempt a fifth.[455] - -Two cases which were actually fatal have been described in the Journal -de Médecine for 1787, the one caused by one ounce, the other by an ounce -and a half. In the latter the symptoms were those of the most violent -cholera, and the patient died in two days and a half;[456] in the former -death took place in three hours only, and in addition to the symptoms -remarked in the other there were convulsions and twisting of the -mouth.[457] In both the pulse failed at the wrist, and a great tendency -to fainting prevailed for some time before death. Dr. Geoghegan has -communicated to Mr. Taylor a case where an ounce and a half taken by -mistake caused severe pain in the stomach, vomiting, and death in two -hours.[458] - -Similar effects have been remarked in several cases which have been -followed by recovery. A woman in the second month of pregnancy, -immediately after taking a handful of nitre in solution, was attacked -with pain in the stomach, swelling of the whole body and general pains; -she then miscarried, and afterwards had the usual symptoms of gastritis -and dysentery, united with great giddiness, ringing in the ears, general -tremors and excessive chilliness. She seems to have made a narrow -escape, as for three days the discharges by stool were profuse, and -composed chiefly of blood and membranous flakes.[459] Dr. Falconer has -related another instance, where also the patient’s life seems to have -been in great danger. The quantity taken was two ounces, and it was -swallowed in half a pint of warm water by mistake instead of a laxative -salt. Violent pain in the belly was immediately produced, in half an -hour frequent vomiting, and in three hours a discharge of about a quart -of blood from the stomach. After the administration of gruel and butter -the symptoms began to subside; but they receded slowly; and even six -months afterwards the man, though otherwise in good health, had frequent -pain in the stomach and flatulence.[460] In the case of a female in the -second month of pregnancy, described by Dr. Butter, miscarriage did not -take place, although the symptoms were very violent and lasting. The -quantity taken was two ounces. The symptoms were first bloody vomiting, -afterwards dysentery, which continued seven days; and on the tenth day a -nervous affection supervened exactly like chorea, and of two months’ -duration.[461] The effects of the poison in the latter period of this -woman’s illness tend to establish the existence of a secondary operation -on the nervous system. But this kind of action is more strongly pointed -out by the following cases. Three puerperal women in the Obstetric -Hospital of Pavia got each an ounce of nitre by mistake for sulphate of -magnesia. Two, who vomited immediately, did not suffer. The third, who -retained the salt fifteen minutes, had pain in the stomach and vomiting, -followed by paleness of the countenance, stiffness of the jaw, some -stupor, and convulsive movements of the limbs; which symptoms continued -till next day, when she gradually recovered.[462] A German physician, -Dr. Geiseler, met with an instance, in which the only disorder produced -appeared to depend on derangement of the cerebral functions. A woman, -after swallowing an ounce of nitre instead of Glauber’s salt, lost the -use of speech and the power of voluntary motion, then became insensible, -and was attacked with tetanic spasms. This state lasted till next day, -when some amelioration was brought about by copious sweating. It was -not, however, till eight days after, that she recovered her speech, or -the entire use of her mental faculties; and the palsy of the limbs -continued two months.[463] Her case resembles the account given by -Orfila of the effects of nitre on animals. - - - SECTION III.—_Of the Morbid Appearances caused by Nitrate of Potass._ - -The morbid appearances observed in man are solely those of violent -inflammation of the stomach and intestines. In Laflize’s case, which -proved fatal in three hours, the stomach was distended, and the contents -deeply tinged with blood; its peritonæal coat of a dark-red colour -mottled with black spots; its villous coat very much inflamed and -detached in several places. The liquid contents gave satisfactory -evidence of nitre having been swallowed; for a portion evaporated to -dryness deflagrated with burning charcoal. In Souville’s patient, who -lived sixty hours, the stomach was every where red, in many places -checkered with black spots, and at the centre of one of these spots the -stomach was perforated by a small aperture. The whole intestinal canal -was also red. In Dr. Geoghegan’s case, the stomach contained bloody -mucus, and its villous coat was brownish-red, and here and there -detached. He could not detect any nitre in it. - - - - - CHAPTER IX. - OF POISONING WITH THE ALKALINE AND EARTHY CHLORIDES. - - -There can be little doubt that the _chlorides_ of _soda_, _potass_, and -_lime_ are active poisons; but the first two have alone been hitherto -carefully investigated by physiological experiments. - -The two alkaline chlorides are usually seen in the form of colourless -solutions. That of potass is little known in this country; but that of -soda is familiar to all in the shape of Fincham’s chloride of soda or -bleaching liquid. The chloride of lime, which is best known of them all, -is usually in the form of a dry powder, deliquescent, and acrid, -commonly termed bleaching powder. All these substances are easily known -by their peculiar odour of chlorine, and the copious disengagement of -that gas on the addition of sulphuric acid. - -The action of chloride of soda on the animal body has been examined by -Segalas, who infers that it is an irritant poison, which, however, at -times occasions symptoms of an affection of the nervous system. He -remarked that three ounces of the solution, commonly sold in Paris under -the name of Labarraque’s disinfecting liquid, caused immediate death by -coagulating the blood in the heart, when injected into a vein in a dog. -Two ounces introduced into the peritonæum excited palpitation, oppressed -breathing, constant restlessness, and death in ten minutes; and three -drachms did not prove fatal for some hours, tetanic spasms being -produced in the first instance, and peritonæal inflammation being found -after death. One ounce introduced into the stomach of a dog excited -immediate vomiting, and no farther inconvenience; and two ounces -retained by a ligature on the gullet brought on violent efforts to -vomit, from which the animal was gradually recovering, when it was -killed in twenty-four hours for the sake of observing the appearances. -The stomach was found generally inflamed and interspersed with dark, -gangrenous-like spots.[464] - -I am not acquainted with any case of poisoning with these substances in -the human subject. But it is probable that symptoms of pure irritation -and inflammation will occur, and that moderate doses may prove fatal. - - - - - CHAPTER X. - OF POISONING WITH LIME. - - -Lime, the last poison of the present group, is a substance of little -interest to the toxicologist, as its activity is not great. - -Its physical and chemical properties need not be minutely described. It -is soluble, though sparingly, in water; and the solution turns the -vegetable blues green, restores the purple of reddened litmus, gives a -white precipitate with a stream of carbonic acid gas, and with oxalic -acid a very insoluble precipitate, which is not redissolved by an excess -of the test. - -Its action is purely irritant. Orfila has found that a drachm and a half -of unslaked lime, given to a little dog, caused vomiting and slight -suffering for a day only, but that three drachms killed the same animal -in five days, vomiting, languor, and whining being the only symptoms, -and redness of the throat, gullet, and stomach, the only morbid -appearances.[465] - -Though a feeble poison, it has nevertheless proved fatal in the human -subject. Gmelin takes notice of the case of a boy who swallowed some -lime in an apple-pie, and died in nine days, affected with thirst, -burning in the mouth, burning pain in the belly, and obstinate -constipation.[466] A short account of a case of this kind of poisoning -is also given by Balthazar Timæus. A young woman, afflicted with pica or -depraved appetite, took to the eating of quicklime; and in consequence -she was attacked with pain and gnawing in the belly, sore throat, -dryness of the mouth, insatiable thirst, difficult breathing and cough; -but she recovered.[467] It is well known that quicklime also inflames -the skin or even destroys its texture, apparently by withdrawing the -water which forms a component part of all soft animal tissues. When -thrown into the eyes it causes acute and obstinate ophthalmia, which may -end in loss of sight. On this account it will belong, I presume, to the -poisons included in the Scottish act against disfiguring or maiming with -corrosives. - - - - - CHAPTER XI. - OF POISONING WITH AMMONIA AND ITS SALTS. - - -The second group of the order of alkaline poisons, including ammonia -with its salts, and the sulphuret of potass, have a double action on the -system, analogous to that possessed by many metallic poisons. They are -powerful irritants; but they produce besides, through the medium of the -blood, a disorder of some part of the nervous system; and their remote -is sometimes more dangerous than their local action. The nervous -affection produced by ammonia and the sulphuret of potass closely -resembles tetanus, and therefore depends probably on irritation of the -spinal column. - -_Of the Chemical tests for the Ammoniacal Salts._—Ammonia is when pure a -gaseous body; but as commonly seen, it exists in solution in water, -which dissolves it in large quantity. The solution has the usual effects -of alkalis on vegetable colours, with the difference, however,—that the -changes of colour are not permanent under the action of heat. It forms a -yellow precipitate, as potass does, with chloride of platinum. It may at -once be distinguished from other fluids by its peculiar pungent odour, -which is possessed by no other substance except its carbonate. - -Various _carbonates_ are known in chemistry, but the only one known in -commerce or met with in the shops is the sesqui-carbonate -(subcarbonate—smelling salt—volatile salt—hartshorn). It is solid, -white, fibrous, and has the same odour as pure ammonia. Its solution -differs little in physical properties from the pure liquid ammonia; but, -unlike it, is precipitated by the salts of lime. - -The _hydrochlorate_ (muriate of ammonia—sal-ammoniac)—is known by its -solid, white, crystalline appearance; its ductility; its volatility; and -by the effect of caustic potass and nitrate of silver, the former of -which disengages an ammoniacal odour, while the latter causes in a -solution of the salt a white precipitate, the chloride of silver. - -_Of the action of the Ammoniacal Salts, and their effects on man._—To -determine the action of ammonia on the animal system, Professor Orfila -injected sixty grains of the pure solution into the jugular vein of a -dog. Immediately the whole legs were spasmodically extended; at times -convulsions occurred; and in ten minutes it died. The chest being laid -open instantly, coagulated florid blood was seen in the left ventricle, -and black fluid blood in the right ventricle of the heart. No unusual -appearance was discernible any where else except complete exhaustion of -muscular irritability.[468] The experiments of Mr. Blake also show that -ammonia introduced in large doses into the veins acts by suddenly -extinguishing the irritability of the heart. Small doses first lower -arterial pressure from debility of the heart’s action, and then increase -it by obstructing the systemic capillaries. When injected into the aorta -from the axillary artery, it causes great increase of arterial pressure, -owing to the latter cause; and then arrests the heart, while the -respiration goes on. Four seconds are sufficient for the ammonia to pass -from the jugular vein into the heart, so as to be discovered there by -muriatic acid causing white fumes.[469] Half a drachm of a strong -solution, introduced by Orfila into the stomach of a dog and secured by -a ligature on the gullet, caused at first much agitation. But in five -minutes the animal became still and soporose; after five hours it -continued able to walk; in twenty hours it was found quite comatose; and -death ensued in four hours more. The only morbid appearance was slight -mottled redness of the villous coat of the stomach. A third dog, to -which two drachms and a half of the common carbonate were given in fine -powder, died in twelve minutes. First it vomited; next it became -slightly convulsed; and the convulsions gradually increased in strength -and frequency till the whole body was agitated by dreadful spasms; then -the limbs became rigid, the body and head were bent backwards, and in -this state it expired, apparently suffocated in a fit of tetanus.[470] - -Several cases of poisoning with ammonia or its carbonate have occurred -in the human subject. Plenck has noticed shortly a case which proved -fatal in four minutes, and which was caused by a little bottleful of -ammonia having been poured into the mouth of a man who had been bitten -by a mad-dog.[471] The symptoms are not mentioned, but it is probable, -from the rapidity of the poisoning, that a nervous affection must have -been induced. More generally, however, the effects are simply irritant; -and the seat of the irritation will vary with the mode in which the -poison is given. If it is swallowed, the stomach and intestines will -suffer; if it is imprudently inhaled in too great quantity, inflammation -of the lining membrane of the nostrils and air-passages will ensue. -Huxham has related a very interesting example of the former affection, -as it occurred in a young man, who had acquired a strange habit of -chewing the solid carbonate of the shops. He was seized with great -hemorrhage from the nose, gums, and intestines; his teeth dropt out; -wasting and hectic fever ensued; and, although he was at length -prevailed on to abandon his pernicious habit, he died of extreme -exhaustion, after lingering several months.[472] But the most frequent -cases of poisoning with ammonia have arisen from its being inhaled, and -thus exciting bronchial inflammation. An instructive instance of the -kind has been related by M. Nysten. A medical man, liable to epilepsy, -was found in a fit by his servant, who ignorantly tried to rouse him by -holding assiduously to his nostrils a handkerchief dipped in ammonia. In -this way about two drachms appear to have been consumed. On recovering -his senses, the gentleman complained of burning pain from the mouth -downwards to the stomach, great difficulty in swallowing, difficult -breathing, hard cough, and copious expectoration, profuse mucous -discharge from the nostrils, and excoriation of the tongue. The -bronchitis increased steadily, and carried him off in the course of the -third day, without convulsions or any mental disorder having -supervened.[473] A case precisely similar is related in the Edinburgh -Medical and Surgical Journal. A lad, while convalescent from an attack -of fever, was seized with epilepsy, for which his attendant applied -ammonia under his nose “with such unwearied, but destructive -benevolence, that suffocation had almost resulted. As it was, dyspnœa -with severe pain of the throat and breast, immediately succeeded; and -death took place forty-eight hours afterwards.”[474] A third instance -has been recorded of analogous effects produced by the incautious use of -ammonia as an antidote for prussic acid. The patient had all the -symptoms of a violent bronchitis, accompanied with redness and scattered -ulceration of the mouth and throat; but he recovered in thirteen -days.[475] A fourth case, similar to the preceding, has been related by -M. Souchard of Batignolles. A druggist, who inhaled while asleep the -fumes of ammonia from a broken carboy, awoke in three-quarters of an -hour, with the mucous membrane of the mouth and nostrils corroded, and a -bloody discharge from the nose. A severe attack of bronchitis followed, -during which he could not speak for six days; but being actively treated -with antiphlogistic remedies, he recovered.[476]—An extraordinary case -has been published by Mr. Paget of death from injecting ammonia into the -blood-vessels. A solution weak enough to allow of the nose being held -over it was injected into a nævis in a child two years old. An attack of -convulsions immediately followed, and in a minute the child -expired.[477] - -Nysten’s case is the only one in the human subject in which the _morbid -appearances_ were ascertained. The nostrils were blocked up with an -albuminous membrane. The whole mucous coat of the larynx, trachea, -bronchi, and even of some of the bronchial ramifications, was mottled -with patches of lymph. The gullet and stomach showed red streaks here -and there; and there was a black eschar on the tongue, and another on -the lower lip. - -_Of Poisoning with Hydrochlorate of Ammonia._—The effects of the -hydrochlorate of ammonia on animals have been examined by Professor -Orfila and Dr. Arnold; but I have not yet met with any instance of its -operation as a poison on man. When given to dogs it irritates and -inflames the parts it touches, and causes the ordinary symptoms of local -irritation. But it also acts remotely. For, first, like arsenic, and -other poisons of the third order of irritants, it produces inflammation -of the stomach, in whatever way it is applied to the body,—Orfila having -found that organ affected when the salt was applied to the subcutaneous -cellular tissue;[478] and, secondly, according to the experiments of -Arnold, it causes, when swallowed, excessive muscular weakness, slow -breathing, violent action of the heart, and tetanic spasms,—effects -which cannot arise from mere injury of the stomach. Half a drachm will -thus kill a rabbit in eight or ten minutes;[479] and two drachms a small -dog in an hour.[480] - - - - - CHAPTER XII. - OF POISONING WITH THE ALKALINE SULPHURETS. - - -The liver of sulphur, or sulphuret of potass of the pharmacopœias, the -last poison of this order to be mentioned, is allied to the ammoniacal -salts in action. It is of no great consequence in a toxicological point -of view in this country, being put to little use; but several accidents -have been caused by it in France, where it is employed for manufacturing -artificial sulphureous waters; and farther, its properties should be -accurately ascertained, because till lately it was erroneously resorted -to as an antidote for some metallic poisons. - -_Chemical Tests._—It has a grayish, greenish, or yellowish colour when -solid; its dust smells of sulphuretted hydrogen, which is also -copiously disengaged from it by the mineral acids: and it forms with -water a yellow solution of the same odour.—In composite fluids it may -be detected by heating it with acetic acid, and passing the disengaged -gases through solution of acetate of lead, in which a black -precipitate of sulphuret of lead is produced, from the action of -sulphuretted-hydrogen.[481] - -_Action and Symptoms._—Orfila found that a solution of six drachms and a -half, secured in the stomach of a dog by a ligature on the gullet, -caused death by tetanus in seven minutes, without leaving any morbid -appearance in the body; that inferior doses caused death in the same -manner, but at a later period, and with symptoms of irritation in the -alimentary canal, which also was seen red, black, or even ulcerated -after death; that a solution of twenty-two grains injected into the -jugular vein killed a dog in two minutes, convulsions having preceded -death, and the heart being found paralysed immediately after it; and -that a drachm and a half thrust in small fragments under the skin -occasioned death in thirteen hours with coma and extensive inflammation -of the cellular tissue.[482] There can be no doubt, therefore, that -liver of sulphur is a true narcotic acrid poison.—It is absorbed, and -may be detected in the blood, liver, kidneys, and urine by Orfila’s -process.[483] - -Orfila has collected three cases of poisoning in the human subject with -this substance;[484] and a fourth has been related by M. Cayol.[485] Of -these cases two proved fatal in less than fifteen minutes; and the -symptoms were acrid taste, slight vomiting, mortal faintness, and -convulsions, with an important chemical sign, the tainting of the air -with the odour of sulphuretted-hydrogen. The dose in one case was about -three drachms. The two other patients, who recovered, were for some days -dangerously ill. The symptoms were burning pain and constriction in the -throat, gullet, and stomach; frequent vomiting, at first sulphureous, -afterwards sanguinolent; purging, at first sulphureous; sulphureous -exhalations from the mouth; pulse at first quick and strong, afterwards -feeble, fluttering, and almost imperceptible; in one case sopor; finally -severe inflammation of the gullet, stomach and intestines, which abated -in three days. One of these patients took four drachms of sulphuret of -soda, the other two ounces of sulphuret of potass; but it is probable, -that the latter dose was partly decomposed by long keeping. - -_Morbid Appearances._—The morbid appearances in the two fatal cases were -great lividity of the face and extremities, and exhaustion of muscular -contractility immediately after death; the stomach was red internally, -and lined with sulphur; the duodenum also red; the lungs soft, gorged -with black fluid blood, and not crepitant. - -_Treatment._—The most appropriate treatment consists in the instant -administration of any diluent, then of frequent doses of the chloride of -soda, and lastly the antiphlogistic mode of subduing inflammation. The -chloride of soda or lime decomposes sulphuretted hydrogen, the -disengagement of which is the probable cause of death in the quickly -fatal cases.[486] - - - - - CHAPTER XIII. - OF POISONING WITH ARSENIC. - - -The third order of the irritant class of poisons includes the compounds -of the metals. These are of great importance to the medical jurist. They -are frequently used for criminal purposes; they give rise to the -greatest variety of symptoms; and the medical evidence on trials -respecting them, while much skill is required on the part of the witness -to collect it, is also the most conclusive. - -It must not be inferred from their being arranged in the class of -irritants that their action is merely local. In fact this is the case -with a very few of them only, which produce chemical corrosion. The -greater number likewise act indirectly on organs at a distance from the -part to which they are applied. Nevertheless the most prominent symptoms -generally produced by them are those of violent local irritation; so -that they may be justly considered in the place which has been assigned -them. - -The poisons included in this order are the oxides and salts of arsenic, -mercury, copper, antimony, tin, silver, gold, bismuth, iron, chrome, -zinc, barium, lead. Many other metals also form poisonous compounds with -various acids and other bodies; but these are so rare as to be merely -objects of physiological curiosity. - -Of all the varieties of death by poison, none is so important to the -medical jurist as poisoning with arsenic. On account of the shameful -facility with which it may be procured in this country, even by the -lowest of the vulgar, and the ease with which it may be secretly -administered, it is the poison most frequently chosen for the purpose of -committing both suicide and murder. In 1837 and 1838 no fewer than 186 -cases of fatal poisoning with arsenic were known to have occurred in -England alone (see p. 90). Of 221 cases of murder by poison in France -during ten years subsequent to 1829, in which the poison given was -ascertained, there were 149 where the substance administered was -arsenic.[487] It is fortunate, therefore, that there are few substances -in nature, and perhaps hardly any other poison, whose presence can be -detected in such minute quantities and with so great certainty. - - - SECTION I.—_Of the Chemical Tests for the Compounds of Arsenic._ - -Metallic arsenic has an iron-gray colour, a specific gravity of 8·308, -and a crystalline fracture. It is very brittle. It has a strong tendency -to oxidate, so that it undergoes this change in air, in water, and even -in alcohol. In air, particularly when moist, it becomes rapidly -tarnished, a black powder being formed, which some have regarded as a -regular protoxide.[488]—When exposed to heat, metallic arsenic is -usually said to sublime at the temperature of 356° F.; but according to -some late experiments by Dr. Mitchell of Philadelphia this does not -happen under a low red heat, luminous in the dark.[489] In close vessels -it condenses unchanged; but when heated in the open air, it passes to -the state of white oxide, and rises in white fumes. This substance is a -sesquioxide, consisting of two equivalents of metal and three of oxygen. -Another oxide likewise exists, which contains two equivalents of metal -and five of oxygen, and, possessing strong acid properties, is -denominated arsenic acid. The sesquioxide and arsenic acid unite with -bases, and produce compounds which, with the exception of those they -form with the alkalis, are mostly insoluble. Metallic arsenic unites -with sulphur in two proportions, forming an orange-red and a -sulphur-yellow compound. The compounds of arsenic have very little -chemical action with vegetable and animal principles. - -Of the compounds which arsenic thus forms, those which it will be -necessary to particularize are the following:—1. The protoxide of -Berzelius, or _fly-powder_. 2. The arsenious acid, or _white arsenic_. -3. The arsenite of copper, or _mineral green_. 4. The arsenite of potass -as contained in _Fowler’s solution_. 5. The arsenite of potass; 6. The -various sulphurets, pure and impure, namely, _realgar_, _orpiment_, and -_king’s yellow_; and 7. Arseniuretted-hydrogen gas. - - - _Of the Tests for Fly-powder._ - -This substance is rarely known as a poison in Britain, but is a familiar -poison in France and Germany, under the names of _Poudre à mouches_, and -_Fliegenstein_. Of late it has been occasionally used in Scotland for -poisoning rats. - -It is a fine grayish-black powder, formed by exposing powdered arsenic -for a long time to the air; but it also frequently contains fragments of -the metal. It is usually considered by chemists to be a mixture of -metallic arsenic and its white oxide. - -It is acted on by water, the white oxide being found ere long in -solution by its proper tests. Oxidation and solution, however, are also -effected upon pure metallic arsenic in the same manner. A thousand -grains of water take up a grain in the course of half an hour when -boiled on the metal.[490] - -A very simple and decisive test for fly-powder is derived from the -effect of heat. If it is heated in a tube two substances are sublimed, -first a white crystalline powder, and then a bright metallic crust, the -former being the white oxide, the latter the metal. The metallic crust -thus formed possesses physical properties, which distinguish arsenic -from all other substances, capable of being sublimed by a low heat: The -surface next the tube is very like polished steel, being a little darker -in colour, but equal in brilliancy and polish; and the inner surface is -either brilliantly crystalline to the naked eye, like the fracture of -cast-iron, or has a dull grayish-white colour, but appears crystalline -before a common magnifying lens of four or five powers. If these -characters be attended to, particularly the appearance of the inner -surface, it appears to me scarcely possible to mistake for an arsenical -crust any other substance which can be sublimed by any of the methods -for subliming arsenic. - -If a farther test should be desired, it is only necessary, as was first -proposed by Dr. Turner of London,[491] to chase the crust up and down -the tube with the spirit-lamp flame till it is all oxidated, when little -octaedral crystals of adamantine lustre are formed, on which, either -with the naked eye or with the aid of a common lens, triangular facettes -may be distinguished. - -The niceties to be attended to in applying the preceding tests will be -considered presently under the head of the next compound, the -sesquioxide. - - - 2. _Of the Tests for Arsenious Acid._ - -Arsenious acid, the sesquioxide, or white oxide of arsenic, usually -called white arsenic, or simply arsenic, is the most common and -important of all the arsenical preparations. - -It is met with in the shops in two forms,—as a snow-white gritty powder, -and in solid masses generally opaque, but sometimes translucent. When -newly sublimed it is in translucent or even almost transparent masses of -a vitreous lustre, conchoidal fracture and sharp-edged. By keeping it -becomes opaque and white. The nature of the change has not been -determined; but some alteration is certainly effected, for Guibourt, who -has examined both varieties with care, found that the opaque variety is -more soluble in water than the other. He adds that the former is -alkaline, the latter acid, in its action on litmus paper; but I have -always found the opaque variety acid.[492] The powder soon becomes -analogous to the opaque variety of the oxide in mass. - -The oxide of arsenic has a specific gravity of 3·729, according to the -experiments of Dr. Ure,—of 3·529 when opaque, according to Mr. Alfred -Taylor, and 3·798, when translucent. Very incorrect notions prevail as -to its taste. It was long universally believed to be acrid,[493] and is -described to be so in many systematic works and express treatises; but -in reality it has little or no taste at all. The reader will find some -details on this point in a paper I published in the Edinburgh Medical -and Surgical Journal.[494] In the present work it is sufficient to -observe, that I have repeatedly made the trial, and seen it made at my -request by several scientific friends, and that, after continuing the -experiment as long, and extending the poison along the tongue as far -back, as we thought safe, all agreed that it had scarcely any taste at -all,—perhaps towards the close a very faint sweetish taste. It appears -to me that the experiments made on that occasion might have set at rest -the question as to the taste of arsenic, and corrected an important -error long committed by systematic authors in chemistry as well as -medical jurisprudence. And accordingly in this country the truth is -generally known.[495] Professor Orfila, however, continues to repeat the -error; for even in the last edition of his Toxicologie he says it has “a -rough, not corrosive, slightly styptic taste, perceptible not for a few -seconds, but persistent, and attended with salivation.”[496] These -sensations must be either imaginary or the indications of an organ -peculiarly constituted. It is impossible to make satisfactory -experiments with safety on its impressions on the back of the palate. -But we may rest assured that in general it makes no impression there at -all; for it has been often swallowed unknowingly with articles of food. -Not a few have in such circumstances noticed merely its grittiness, and -thought there was sand in their food. Two instances only am I hitherto -acquainted with, where an acrid sensation would seem really to have been -experienced in the act of eating or swallowing. In one of these, noticed -in Rust’s Journal, the individual who was poisoned, could not finish the -poisoned dish on account of its unpleasant, very peppery taste.[497] In -the other case, which was lately communicated to me by Mr. Hewson of -Lincoln, the individual, who was poisoned by arsenic dissolved in his -tea-kettle,—happening in the first instance to wash his mouth with the -water,—observed at the time to his daughter, that it had a very odd -taste; which subsequently was called a burning taste. These facts, -however, are evidently not altogether satisfactory. It is not improbable -that, in an _ex post facto_ description, the reporters, as others in the -same circumstances have clearly done[498], confounded the subsequent -inflammation with mere taste in the act of chewing or swallowing. At all -events it is absolutely certain that the great majority of people who -have been poisoned with arsenic remarked in taking it either no taste at -all, or merely a roughness owing to the gritty condition of its powder. - -The oxide of arsenic when subjected to heat is sublimed at 380°, or, -according to Dr. Mitchell, 425° F.[499] and condenses in the form of a -crystalline powder, which, if the operation is performed slowly and on a -small quantity proportioned to the size of the tube, evidently consists -of little, adamantine octaedres.—When it is mixed with carbonaceous -matter and heated, it is reduced, and the metal is sublimed. This -constitutes the test of reduction, which, when conducted with due care, -may be rendered singly a certain proof of the presence of arsenic. - -Water dissolves it. Its solubility is a point of some medico-legal -importance; for a doubt may arise whether the quantity of a solution -that has been swallowed contained a sufficient dose to cause severe -symptoms or death. Different statements have gone forth on this head. -Klaproth found, that a thousand parts of temperate water take up only -two parts and a half,—and that a thousand parts of boiling water take up -77·75 parts or a thirteenth, and retain on cooling 30 parts or a -thirty-third of their weight.[500] Guibourt found a difference between -the transparent and opaque varieties; for a thousand parts of temperate -water dissolved in thirty-six hours 9·6 of the transparent, 12·5 of the -opaque variety; and the same quantity of boiling water dissolved of the -transparent variety 97 parts, retaining 18 when cooled, but of the -opaque variety took up 115 and retained on cooling 29.[501] More lately -Mr. Alfred Taylor observed that temperate water, simply poured on the -opaque oxide and left for seventy-two hours, contained one grain in a -thousand, but if often agitated, 8·5 grains; that boiling water, -occasionally agitated for the same period, contained 9·27 or 9·54 -grains; that water, boiling gently for an hour dissolved 31·5, and on -cooling and resting for three days retained 17; that with violent -ebullition for an hour, it took up 46·3, and retained 24·7 grains on -cooling and resting for three days; that a saturated boiling solution -after six months contained 24 or 26 grains; and that a saturated boiling -solution of the transparent oxide contained 46 or 47·5 grains, and on -cooling and resting for two days retained 18·7 or 13·4 grains.[502] It -is impossible to account for these discrepancies; for all the -experimentalists conducted their investigations with care, and with a -view to the medico-legal question stated above. Hahnemann farther -remarked, that at the temperature of the blood a thousand parts of water -dissolve ten parts with the aid of ten minutes’ agitation;[503] and -Navier, that boiling water kept for an hour on it, and decanted off in -the way an infusion is usually made, dissolves 12·5 grains in every -thousand.[504] - -Its solubility is impaired by the presence of organic principles. When -mixed with mucus or milk it dissolves, according to Hahnemann, with -great difficulty; and I have found that a cup of tea, left beside the -fire at a temperature of 200° for half an hour upon two grains of the -oxide, does not take up entirely even that small quantity. An important -consequence of the fact now mentioned is, that when swallowed in the -solid state, little or no arsenic may be found in the fluid contents of -the stomach. In a case which occurred to Scheele three grains of solid -arsenic were found in the contents, but hardly a trace in solution.[505] -It would be wrong, however, to suppose that it is never found in the -fluid contents. For, not to mention the observations of others, I have -myself often detected it in the fluid part of the stomach in persons -poisoned by arsenic. - -The solution of oxide of arsenic in boiling water yields minute crystals -on cooling, which, when their form is defined, are octaedres. In this -state, on account of its whiteness and brilliancy, it exceedingly -resembles pounded sugar. By spontaneous evaporation I have procured in -twelve months fine octaedres nearly as large as peas. These do not -become opaque by keeping, like the sublimed masses. - -A difference of opinion prevails as to the action of the oxide on -vegetable colours. This is a matter of no great consequence to the -medical jurist; but it is right not to leave a disputed point without -some notice. Guibourt says the transparent variety faintly reddens -litmus, while the opaque variety faintly restores to blue litmus -previously reddened.[506] My own experiments are at variance with these -statements: I have always found that the solution of the powder, which -is of the opaque variety, faintly reddens litmus, and does not alter -reddened litmus. - -The remaining chemical properties of the oxide, which it is necessary -for the medical jurist to know, will be mentioned under what is now to -be said of the principal test by which its presence may be ascertained. -Under this head will be noticed, first the tests for the solid oxide, -secondly, those for its solution, and lastly, the method of detecting it -when mingled with vegetable or animal solids and fluids, such as the -contents and tissues of the stomach. - - - _Of the Tests for Arsenic in the solid state._ - -The most characteristic and simple test for oxide of arsenic in its -solid state, either pure or mixed or combined with inorganic substances, -is its reduction to the metallic state. - -Various methods have been at different times proposed for employing the -test of reduction. In the ruder periods of analytic chemistry we find -Hahnemann recommending a retort as the fittest instrument, and stating -ten grains as the least quantity he could detect.[507] Afterwards Dr. -Black substituted a small glass tube, coated with clay and heated in a -choffer; and in this way he could discover a single grain.[508] In a -paper published in the Edinburgh Medical and Surgical Journal, I showed -how to detect a sixteenth of a grain; and afterwards even so minute a -quantity as a hundreth part of a grain.[509] - -The process is performed in a glass tube; which, when the quantity of -the oxide is very small, should not exceed an eighth of an inch in -diameter, and may be conveniently used of the form first recommended by -Berzelius, and represented in Fig. 3.—The best material for reducing the -oxide is recently ignited charcoal, if the quantity of suspected -substance be very small. For when any of the ordinary alkaline fluxes is -used, more than half of the arsenic is retained, probably in the form of -an arseniuret of the alkaline metalloid. But when the quantity of matter -for analysis is considerable, charcoal is inconvenient, as it is apt to -be projected up the tube on the application of heat; and an alkaline -flux is on that account preferable. For this purpose soda-flux,—made by -grinding crystals of carbonate of soda with an eighth of their weight of -charcoal, and then heating the mixture gradually to redness, so as to -drive off all water,—is better than the more familiar black flux, which -contains carbonate of potash; because the latter attracts much moisture -when kept for some time.—If the quantity operated on is large it should -be mixed with the flux before being introduced into the tube; if it is -small, it may be dropped into the tube and covered with charcoal. The -materials are to be introduced along a little triangular gutter of stiff -paper, if the tube is large; but with a small tube it is preferable to -use the little glass funnel represented in Fig. 2, to which a wire is -previously fitted, for pushing the matter down when it adheres. The -material should not be closely impacted. Heat is best applied with the -spirit-lamp, first to the upper part of the material, with a small -flame, and then to the bottom of the tube, the flame being previously -enlarged. A little water, disengaged in the first instance, should be -removed with a roll of filtering paper, before a sufficient heat is -applied to sublime the metal. As soon as the dark crust begins to form, -the tube should be held steady in the same part of the flame. With these -precautions a well defined crust will be procured with facility. - -The characters of the crust have been mentioned already under the head -of fly-powder (p. 199). They are distinct even in crusts weighing only a -300th of a grain. A crust of this weight, a tenth of an inch broad and -four times as long, may show characteristically all the physical -characters of an arsenical sublimate a hundred times larger. - -The fallacies to which the test has been supposed to be liable -(excluding at present that part of it which consists in the oxidation of -the metal, and which renders it quite unimpeachable), are the -following.— Dr. Paris says he has known an instance where a person, “by -no means deficient in chemical address, mistook for it a deposit of -charcoal,”[510] and I have known the same mistake happen in the hands of -one of my pupils, a beginner in the study of medico-legal chemistry. The -outer surface of a charcoal crust may be mistaken for arsenic by a -careless person; but with ordinary care it is quite impossible to err if -the inner surface be examined, for that of charcoal is brown, powdery, -and perfectly dull.—It has been suggested to me and has been stated in -print,[511] that the preparations of antimony yield by reduction a -sublimate resembling closely an arsenical crust. But in consequence of -repeated trials I am certain that no preparation of antimony, reduced -either by charcoal or the black flux with the fullest red heat of the -blowpipe will yield any metallic sublimate; and the same facts were -observed by the late Dr. Turner.—It has even been said by Mr. Donovan -that the action of the flux on glass which contains lead causes a stain -similar to an arsenical crust.[512] If it be meant by this observation, -that the lead contained in the glass usually gives that part of the tube -which contains the flux a glimmering appearance and impairs its -transparency, the author is correct: but it is impossible that a -sublimate can be so formed.—Dr. Mitchell of Philadelphia in an elaborate -paper on the process of reduction seems to consider the crust -undistinguishable from that formed in similar circumstances by -cinnabar.[513] Crusts of cinnabar, however, do not present the peculiar -character possessed by the internal surface of arsenic.—Zinc, it is -said, may be sublimed in its metallic state; but the sublimation of zinc -requires a full white heat; which in the process for arsenic cannot be -generated.—Tellurium, cadmium, and potassium sublime at a lower heat; -but these metals are so exceedingly rare, that it is quite unnecessary -to particularize the characters of their sublimates.—Lastly, it is said -that a crust may be produced from arsenic contained in the glass of the -tube. A few years ago MM. Ozanam and Idt of Lyons detected arsenic in -the remains of a body which had been seven years interred; but -subsequently M. Idt imagined he had discovered that the glass used in -the analysis contained arsenic, and yielded it by the process of -reduction. He accordingly retracted his original opinion; and the person -accused of administering the poison was acquitted. An extended inquiry, -however, was in consequence undertaken by the Parisian Academy of -Medicine at the request of the French government. And the result was -that no arsenic could be detected in the glass tubes used by MM. Ozanam -and Idt; and that although arsenic is sometimes used in glass-making, -and a trace of it may be retained in some opaque glasses or enamels, it -cannot be detected by any process of analysis in any of the clear glass -met with in commerce,[514] the whole arsenic being volatilized during -the manufacture of the glass. - -It may therefore be safely laid down that the appearances exhibited by a -well-formed arsenical crust, even in the minute quantity of a 300th part -of a grain, are imitated by no substance in nature which can be sublimed -by the process for the reduction of arsenic. - -But should farther evidence be required as to the nature of the crust, -this may be obtained by subjecting it to oxidation by heat. - -The best method of doing so is to heat the ball containing the flux -deprived of arsenic, to attach a bit of glass tube to its end, and to -draw this gently off in the spirit-flame, taking care to prevent the -flux being driven forward on the crust. This being done, the whole -crust, or, if it is large, a portion of it, is to be chased up and down -the tube with a small spirit-lamp flame till it is all converted into a -white powder. In order to show the crystalline form of the powder -distinctly, let the flame be reduced to the volume of a pea by drawing -in the wick, and let the part of the tube containing the oxide be held -half an inch or an inch above it. By repeated trials sparkling crystals -will at length be formed, which are octaedres,—the crystalline form of -arsenious acid. The triangular facettes of the octaedres may be -sometimes seen with the naked eye, though the original crust was only a -fiftieth of a grain or even less; and they may be always seen with a -lens of four powers, the tube being held between the eye and a lighted -candle or a ray of sunshine, either of which is preferable to diffuse -daylight for making this observation.—For the success of the oxidation -test it is indispensable that the inside of the tube be not soiled with -an alkaline flux: because the alkali would unite with the oxide. It is -also requisite not to heat the tube suddenly to redness before the oxide -is sublimed; because then the oxide is apt to unite with the glass, -forming a white, opaque enamel. The physical characters of the sublimed -oxide are so delicate and precise, that they may be accurately -distinguished, even when those of the metallic crust are obscure, owing -to its minuteness. Sometimes too, the metal may be so scanty that it is -oxidated at once in the act of subliming, and never presents the -appearance of a metallic crust. Although the characters of the -crystalline oxide in either of these cases are very precise and -distinctive, it may be right to subject it to a farther test when the -metal is not previously exhibited with its characteristic properties. -For this purpose it is sufficient to cut away with a file the portion of -the tube which contains the sublimate, to boil it in another tube with a -few drops of distilled water till the sublimate disappear, and then to -test the solution with one of the fluid tests to be presently described, -the ammoniacal nitrate of silver. - -After all that has been recently written as to the old and newer -processes for detecting arsenic, I must nevertheless avow my conviction, -that for solid arsenic no test is, for medico-legal purposes, at once so -satisfactory, convenient, and delicate as the test of reduction, -especially with the addition of the supplementary test of oxidation. -That other methods are still more delicate may be readily granted. But -where the suspected substance is in the solid form, what possible -occasion can there be for a method more delicate than one which will -detect a 300th part of a grain? A method ten times less so would meet -every case in actual practice.—A variety of supplementary tests have -been proposed. But they are all greatly inferior in facility, or -conclusiveness, or both, to the process of oxidation, and ought -therefore to be expelled from medico-legal practice,—not even excepting -the alliaceous odour of metallic arsenic in the act of subliming, a -character, the fallaciousness of which was long ago pointed out by -myself as well as others, and to which a preposterous importance has -been attached in some late inquiries. The reader will find in the last -edition of this work an attempt to estimate the value of various tests -supplementary to that of reduction. This disquisition is now omitted, as -it seems no longer necessary. - - - _Of the Tests for Oxide of Arsenic in Solution._ - -Oxide of arsenic in a state of solution may be detected in one of four -ways; by what are called the liquid tests; by precipitating it with one -of these, and subliming metallic arsenic from the precipitate, which -method is usually termed the reduction process; by Marsh’s method, which -consists in disengaging it in the form of arseniuretted-hydrogen gas, -and decomposing the gas by combustion; or by the method of Reinsch, in -which metallic arsenic is deposited on the surface of copper, and then -separated by heat for farther examination. - -_Process by Liquid Reagents._—The first method is by the employment of -several liquid tests, which cause in the solution peculiar precipitates. -Many such tests have been proposed; but the most characteristic and -precise are _hydrosulphuric acid_, _ammoniacal nitrate of silver_, and -_ammoniacal sulphate of copper_. The indications of each of the three -tests must concur, otherwise, in a medico-legal case, no one can be -entitled to speak with certainty to the existence of arsenic. But when -they do concur, the evidence is unimpeachable. When this method of -analysis is followed, corresponding experiments ought always to be made -with the water that is used for diluting or otherwise preparing the -subject of examination, or with distilled water, if the article be -already sufficiently aqueous. This precaution is necessary on account of -the risk of accidental impregnation of the water or other reagents with -arsenic.[515] - -_Hydrosulphuric acid_ [sulphuretted-hydrogen] is obtained by decomposing -proto-sulphuret of iron with diluted sulphuric acid in such an apparatus -as is represented at Fig. 5. And the gas may be either applied directly -to the suspected fluid, or condensed in distilled water, and thus kept -in store for occasional use in the liquid shape. Before applying this -test, the suspected fluid must be acidulated with acetic or hydrochloric -acid; because an excess of alkali prevents the action. And if an acid be -indicated by litmus in the fluid, neutralization, or slight -supersaturation, with potash must be effected, before adding acetic or -hydrochloric acid; for if the acidity should happen to be owing to an -excess of sulphuric or nitric acid, the test is decomposed, and -yellowish-white sulphur deposited.—These precautions being taken, -hydrosulphuric acid occasions a sulphur-yellow or lemon-yellow -precipitate. If the arsenical solution, however, be very weak, a yellow -colour merely is struck, because the precipitate, which is -sesqui-sulphuret of arsenic, is dissolved by the excess of the test; but -it separates after ebullition, or a few hours’ exposure to the air. -Co-existing animal and vegetable principles sometimes enable the fluid -to retain a minute portion even after ebullition, so as to acquire a -yellow milkiness; but they do not in any case prevent the test from -producing the yellow colour. Acidulation with acetic or hydrochloric -acid favours its subsidence in all cases; and according to Mr. Boutigny, -alkaline sulphates, muriates and nitrates have the same effect.[516] -Hydrosulphuric acid is so delicate as to act on the oxide in a hundred -thousand parts of water. The proper colour of the precipitate is lemon -or sulphur-yellow; which, when vegetable or animal matter is present, -acquires a shade of white or brown. - -It is not liable to any material fallacy. The salts of cadmium yield -with it precipitates nearly of the same colour: but they are exceedingly -rare; and the precipitate, unlike sulphuret of arsenic, is insoluble in -ammonia.—The salts formed by selenic acid, if decomposed by another -acid, also yield yellow precipitates; but these salts are extremely -rare.—The salts of peroxide of tin give a dirty grayish-yellow -precipitate; which however ammonia turns brown.—A lead solution -acidulated with hydrochloric acid gives at first a yellow precipitate; -but this becomes brownish-black when more gas is transmitted.[517] The -contents of the human intestines sometimes yield a yellowish precipitate -though no arsenic be present; and it is dissolved, like sulphuret of -arsenic, by ammonia.[518] The tartrate of antimony and potash -(tartar-emetic) does not form, as was once thought, any source of -fallacy, the antimonial precipitate having always a tint of orange-red; -besides it is not, like sulphuret of arsenic, soluble in carbonate of -ammonia.—Other fallacies exist, unless the test be used with the -precautions mentioned above. But these need not enumeration here. - -_Ammoniacal nitrate of silver_ is prepared by precipitating the oxide of -silver by means of ammonia, from a solution of nitrate of silver or -lunar caustic in ten parts of water, and then redissolving the -precipitate nearly, but not entirely, by adding gradually an excess of -ammonia. When thus prepared, it causes, even in a very diluted solution -of the oxide of arsenic, a lively lemon-yellow precipitate of arsenite -of silver; which passes to dark brown under exposure to the light.—The -action of this test is prevented by nitric, acetic, citric, or tartaric -acid in excess, particularly by the first and last. It is also prevented -by an excess of ammonia; and in very diluted solutions by the nitrate of -ammonia. These facts will suggest the necessity of certain obvious -precautions. Its action is obscured by the co-existence of various -salts, which singly cause a white precipitate with nitrate of silver; -for the yellow colour is then much lessened in intensity. The only one -of these requiring special notice, because it occurs in very many of the -fluids which are likely to be subjected to the researches of the medical -jurist, is common sea-salt, the chloride of sodium. The best way of -getting rid of the difficulty is to use in the first instance, not the -ammoniacal nitrate, but the simple nitrate of silver, as long as any -white precipitate falls down, to add a slight excess of that test, and -then, after subsidence, to drop in ammonia. No arsenic is thrown down by -the first steps of this process; but if any be present, it is -subsequently thrown down in the form of the yellow arsenite of silver, -on the addition of ammonia. This simple mode of getting rid of chloride -of sodium was first proposed by Dr. Marcet.[519]—Ammoniacal nitrate of -silver is of no use as a test for a moderately diluted solution of the -oxide of arsenic, if vegetable or animal matter be present; either the -colour of the precipitate is essentially altered, or no precipitate is -formed at all.[520] - -If the presence of arsenic is to be inferred only when the full -lemon-yellow colour of the precipitate is developed, this test is not -liable to any material fallacy. The presence of a phosphate, a serious -obstacle according to an old way of using the silver test, is not a -source of fallacy in the instance of the ammoniacal nitrate; for the -yellow phosphate of silver is so soluble in the ammonia of the test, -that it is not thrown down unless the phosphatic solution is very -strong.—The silver test, which is extremely delicate, was proposed by -Mr. Hume, a chemist of London; and in its improved state was suggested -by the late Dr. Marcet. Various foreign authors have fallen into the -error of supposing that nitrate of silver without an alkali precipitates -oxide of arsenic: without an alkali, pure nitrate of silver gives no -precipitate, or at most a bluish-white or yellowish-white haze when both -solutions are strong. - -_Ammoniacal sulphate of copper_ is prepared by the same process with the -last test, sulphate of copper being substituted for nitrate of silver. -It is a test of very great delicacy. It causes in solutions of the oxide -of arsenic an apple-green or grass-green precipitate of the arsenite of -copper. The particular tint is altered apparently by trifling -circumstances; but after the precipitate has stood some hours it always -assumes a tint intermediate between apple-green and grass-green. The -operation of this test is prevented by hydrochloric, nitric, sulphuric, -acetic, citric, and tartaric acids in excess; and also by an excess of -ammonia. These difficulties are obviated by manifest precautions. It is -also prevented, according to Hünefeld, by muriate, nitrate, and sulphate -of ammonia;[521] and by almost all vegetable infusions and animal -fluids, when the oxide of arsenic is not abundant: these difficulties -cannot be obviated. Even when not prevented by such fluids, its -operation is often obscured, the precipitate not possessing its -characteristic colour. - -Ammoniacal sulphate of copper is more open to fallacies than the silver -test. Of these the most important is that in some organic fluids it -strikes a green precipitate, like the arsenite of copper, though arsenic -be not present.[522] The solution of bichromate of potass is turned -green but not precipitated by it. - -On reviewing all that has now been stated regarding the liquid tests for -arsenic, it will appear that there is no single test on which absolute -reliance can be placed; but that the fallacies to which they are liable -are generally remote, and each of them applicable to one test only. -Hence if each of the three reagents, applied with due care, gives a -precipitate of the characteristic tint, the proof of the presence of -arsenic is decisive. - -This particular view of the indications of the liquid tests, however -obvious it may seem, has been often overlooked by the numerous chemists -and medical jurists who have written for and against them. The -antagonists of the tests have been content with proving how so many -fallacies lie in the way of each, that no dependence can be put in any -one of them: They have not considered that the fallacies attached to one -are obviated by the conjunct indications of the others. - -I am of opinion therefore that the analysis for arsenic by liquid -reagents has been unjustly neglected in the present day. It is an -exceedingly convenient method, and one of extreme delicacy, because by -using small tubes it is easy to operate with precision on very minute -portions of a suspected fluid. It is also perfectly conclusive, so far -as chemical knowledge now goes. On a remarkable trial a few years ago in -this country, a distinguished chemist, who, as witness for the prisoner, -was made by counsel to throw discredit on the liquid tests individually, -nevertheless admitted to the counsel for the prosecution, that no other -substance in nature but arsenic could produce the same effects as it -with the whole three tests in succession. - -_Reduction process._—The process by reduction of arsenic to the metallic -state, as applied to the poison in a state of solution, consists in -separating the whole arsenic by a liquid test in such a state as to -admit of the precipitated compound being subjected to the process of -reduction and sublimation. The best method of the kind is a modification -of one described by me in 1824.[523] This consists in throwing down the -whole arsenic in the form of sulphuret by means of hydrosulphuric acid, -converting the sulphuret by the process of reduction to the metallic -state, and oxidating the metal thus procured. The hydrosulphuric acid is -preferred to other liquid reagents, because the precipitate it forms, -while possessing a very characteristic colour, is also more bulky than -those caused by the other tests, and is therefore more easily -collected,—and because its action is not liable to be prevented or -obscured by so many disturbing causes. The steps of the process are the -following:— - -The fluid to be examined must be acidulated with acetic or hydrochloric -acid. If the fluid be neutral or alkaline, the acid may be added at -once. If on the other hand the fluid redden litmus, and the acid be -either unknown or a mineral acid, potash must first be added in a slight -excess, and then the alkali must be supersaturated with acetic or -hydrochloric acid. The reasons for these precautions are stated under -hydrosulphuric acid as a liquid reagent. The fluid being thus prepared, -it is subjected to a stream of hydrosulphuric acid gas for ten or -fifteen minutes. The first portions of the gas turn the arsenical -solution to a bright lemon-yellow colour, and the subsequent portions -throw down a yellow flocculent sulphuret of arsenic. If the proportion -of oxide in solution is small, a yellowness or yellow milkiness only is -caused, owing to the sulphuret being soluble in an excess of -hydrosulphuric acid. But on expelling that excess by boiling, a distinct -precipitate and colourless fluid are produced. The precipitate is then -to be collected thus. The precipitate is allowed to subside, and the -supernatant fluid being withdrawn, the remainder is poured into a -filter. When all the fluid has passed through, the portions of -precipitate on the upper part of the filter are washed down to the -bottom. The filter is then gently compressed between folds of bibulous -paper, and the sulphuret removed with the point of a knife before it -dries, and dried in little masses on a watch-glass by the side of a -chamber-fire, or still better in a vapour-bath. In this way it is very -easy to collect a twenty-fifth part of a grain of the sulphuret. Another -method which takes more time, but will enable the least skilful person -to collect extremely small quantities, is to allow the sulphuret to -subside in the original fluid in which it is formed, to pour off the -supernatant liquid, and pour the remainder into a small glass tube, Fig. -7. After the precipitate has thoroughly subsided, the supernatant liquid -is to be withdrawn, and its place filled up with boiling water. The -operation of alternate subsidence and affusion being repeated a -sufficient number of times, the last portions of water should be gently -driven off by heat, and wiped off the inside of the tube as the drops -condense on it. Finally, the bottom of the tube, with the precipitate -attached, is to be cut away with the file, and broken into small -fragments with the view of preserving the whole sulphuret for the -process of reduction. The sulphuret having been collected in either of -these ways, it is now to be dropt into the tube, Fig. 3, and covered by -means of the funnel, Fig. 4, with soda-flux. The process in other -particulars is the same with that for reducing solid oxide of arsenic. - -This method of investigation gives extremely precise results, because it -presents the poison successively in three distinct forms, as sulphuret, -metal, and crystallized oxide, all of which possess very prominent and -characteristic external properties. It is also a method which is capable -of detecting very minute quantities of oxide of arsenic. And it has the -advantage over the process by liquid reagents of being applicable to -organic fluids. It was accordingly followed in most medico-legal -researches until the recent discovery of the methods of Marsh and -Reinsch. - -In order to render it quite satisfactory, it is necessary to go through -the steps of the analysis at the same time with distilled water, lest -any of the reagents used should accidentally contain arsenic. - -_Process of Marsh._—This method consists in disengaging arsenic from the -solution in the form of arseniuretted-hydrogen gas, burning the gas in -such way as to obtain either metallic arsenic or oxide of arsenic, and -subjecting the product to various tests. - -I have called this beautiful method of analysis Marsh’s process, because -it appears to me that injustice has been done its discoverer both by -himself and those who have since investigated the subject, when they -denominated it merely a test. Medico-legal analysis stood in no need of -a new test for arsenic, but very much of an easy and infallible method -of detaching minute quantities of it in a state of purity from simple -and compound fluids, so as to admit of its being accurately examined. It -is this important object, and not strictly speaking a new test, that has -been attained through means of the discovery of Mr. Marsh. - -His discovery consists in the observation, that, if hydrogen gas be -disengaged by the action of sulphuric acid or zinc in a fluid containing -arsenic dissolved in any form, arseniuretted-hydrogen gas is disengaged -along with the hydrogen; and that if the two gases be burnt together in -a fine flame, metallic arsenic is deposited on a white porcelain surface -held in the flame, and oxide of arsenic if the porcelain be held -immediately above it.[524] The production of a brilliant mirror-like -crust in the former case, and of a white powdery one in the other, -constituted Marsh’s test as originally proposed; and it was at first -conceived to furnish unimpeachable evidence of the detection of arsenic. -Afterwards many inquirers, and among them the discoverer himself, became -satisfied that certain fallacies stand in the way of a conclusion based -on such simple premises. Various supplementary tests were in consequence -proposed. And at length it seems to be agreed, that the proper mode of -applying Marsh’s discovery is to employ a succession of tests, of which -that originally pointed out by him is the first. A vast variety of -methods of analysis founded on this principle have been proposed by -British and continental chemists. It would be tedious and unprofitable -to discuss or even to state them here. The reader will probably be -satisfied with a reference to the most important of them[525] and with a -description of that process, which appears to me, from repeated trials -in medico-legal practice, to be at once most convenient, delicate, and -conclusive. - -Let the liquid to be examined be introduced into a Döbereiner’s lamp -[Fig. 10], or an apparatus constructed with a bottle and a funnel upon -the same principle [Fig. 11]; and dilute the liquid with distilled -water, until the lower cavity of the apparatus be nearly full, leaving -space however for the tube of the funnel, a fragment of zinc, and some -sulphuric acid. Put in a cylinder or rod of zinc, _a_; and then add -sulphuric acid until a moderate effervescence ensue. Close the junction -of the two vessels, and then, allowing a little gas to escape at _c_, -shut the stop-cock, and let the gas fill the vessel A, by driving the -liquid up into B. Having meanwhile fitted by a cork to the exit-tube, -_c_, the glass tube, _d e_, which is loosely stuffed with raw cotton at -the end _d g_, and has a bent plate of copper or tinned iron hung over -it at _f_,—open the stop-cock, allow a little gas to escape so as to -expel the air in _d e_, and then kindle the gas at _e_, which must be -contracted to a capillary opening. Keep the flame low, and hold the -surface of a white porcelain vessel across the middle of it for a few -seconds. If no stain be produced on the porcelain, there is no arsenic -in the fluid. If a stain be formed, regulate the escape of gas by the -stop-cock so that the fluid may not rise above the middle of the lower -vessel of the apparatus, and apply the heat of a spirit-lamp flame to -the tube _d e_ on the left hand of the plate _f_, the purpose of which -is to prevent the heat being communicated beyond that point. By and by, -if there be arsenic in the fluid, a brilliant metallic ring will appear -beyond _f_, owing to decomposition of arseniuretted-hydrogen gas. As -soon as the crust is thick enough to present its properties -characteristically, withdraw the spirit-lamp; place the tube _e h_ so -that the flame at _e_ shall be completely within the ball, _i_; let the -tube incline very slightly in the direction from _k_ to _l_; and allow a -stream of cold water to trickle down upon the portion _k l_, which -should be wrapped in a single layer of calico. Oxide of arsenic will -gradually condense, partly in white powder or minute sparkling crystals -in the ball and between _i_ and _k_, and partly between _k_ and _l_ in -the form of a solution, which collects at the bend _l_. The solution -which may be increased in quantity by boiling a little distilled water -upon the powder in the ball and bend _i k_, is then to be subjected in -small portions to the three liquid reagents, ammoniacal nitrate of -silver, ammoniacal sulphate of copper, and hydrosulphuric acid. - -Some experience is required to apply this process successfully. But with -due attention it furnishes conclusive evidence with great delicacy and -precision. A solution containing only a millionth part of oxide of -arsenic will part with it readily in the form of arseniuretted-hydrogen; -and the slightest trace of that gas in the hydrogen is indicated by the -method recommended above.—The process is compounded of Mr. Marsh’s -original discovery, the supplementary test of reduction in the exit-tube -recommended by Berzelius,[526] and the formation and examination of the -oxide proposed by myself.[527]—With certain precautions and modes of -manipulating, it is applicable to the most complex organic fluids, as -well as to simple solutions. - -The discovery of Mr. Marsh had not been long made before the test in its -original simple form was found liable to divers important fallacies. It -appeared, for example, that antimony yields very nearly the same -appearance of metallic crust and of white powder, according to the -position of the porcelain in the flame; that some porcelains glazed with -oxide of zinc are similarly stained by a flame of simple hydrogen gas; -that a great variety of metallic salts, if spirted up into the -exit-tube, undergo reduction in the flame, and cause imitative stains on -the porcelain; that iron-salts seems to form stains from the same -chemical action as what occurs in the case of arsenic; and that certain -compounds of phosphorous acid with ammonia and animal matter, or even -mere animal matters themselves, will in some circumstances produce a -stain more or less similar to that which is occasioned by arsenic. - -There is no doubt, that the resemblance of most of these spurious stains -to an arsenical crust has been much exaggerated. But still the -similarity is sufficient to satisfy every impartial judge, that the mere -production of a brilliant metallic, or white powdery stain, or both, -upon porcelain, is not conclusive evidence of the detection of arsenic -in medico-legal inquiries. It is strong presumptive evidence; and the -non-production of such stains is absolute proof that arsenic is not -present. But in order to obtain irrefragable proof of its presence, the -substance which forms the crusts and stains must be subjected to farther -examination. And such is the object of the supplementary methods in the -process detailed above. That process is perfectly free of fallacy. No -substance yet known but arsenic can yield the succession of phenomena -which have been detailed. My opinion farther is, that the process may be -safely simplified by withdrawing Berzelius’s supplementary test of -reduction in the exit-tube, and retaining the test of oxidation only, -with the examination of the oxide by liquid reagents. I have retained -the former in deference to the opinion expressed by a committee -appointed by the French Institute, who examined the whole subject with -unwearied zeal, but who, it may be observed, seem never to have had in -their view the check-test of oxidation; which, with the consecutive -tests, is superior in conclusiveness to the check of reduction only. - -_Reinsch’s process_, like the former, has been inconveniently called a -new test for arsenic. The fact discovered by Dr. Reinsch is valueless as -supplying a mere test; but it forms the ground-work of the best process -of all yet proposed for the detection of arsenic in solution. The -discovery is, that arsenic in solution is deposited in the metallic -state upon copper-leaf, when the fluid is acidulated with hydrochloric -acid, and heated till it boils gently or is about to do so; and that by -heating the copper gently in a glass tube the arsenic is sublimed from -it in the form of oxide or metal according to the quantity present.[528] - -This method is so simple and easy as scarcely to require any detailed -explanation. The fluid should contain about a tenth of its volume of -hydrochloric acid. It must be heated near ebullition before the copper -is introduced, otherwise the copper becomes tarnished, though arsenic be -not present. Copper-leaf, or copper-plate worn thin by the action of -diluted nitric acid, or fine copper gauze, is the best form for use. In -the feeblest solutions ten or fifteen minutes elapse before arsenic is -visibly deposited, and forty minutes should be allowed for strong -deposition; but in strong solutions, the action takes place in a few -seconds. The result is a thin, brittle brilliant, steel like coating of -metallic arsenic. As soon as the deposit is formed, the copper is to be -removed, dried with a gentle heat, cut into small shreds, and heated -with a spirit-lamp in the smallest glass tube that will conveniently -contain the whole; upon which a metallic ring of arsenic is sometimes -sublimed, but more generally a ring of small sparkling crystals. These -are first to be examined as to their form with a common pocket lens; and -then dissolved in boiling distilled water, after shaking out the copper, -so that a solution may be obtained and subjected to the liquid reagents, -especially the ammoniacal nitrate of silver as being the readiest and -most delicate. In all medico-legal inquiries it is necessary to perform -a preliminary experiment with distilled water and the hydrochloric acid -used, lest the acid contain arsenic. - -The process here described is one which I have followed with great -facility, certainty and despatch in several medico-legal cases.[529] It -is extremely delicate; for it will detect at least a 250,000th part of -arsenic in solution; and it removes from the fluid every particle of -arsenic, because none can be afterwards discovered by means even of -Marsh’s method. It is not subject to any fallacy. The mere formation of -a brilliant coating on the copper is not evidence of arsenic being -present; for as Reinsch himself ascertained, solutions of bismuth, tin, -zinc, and antimony produce a coating more or less similar to an -arsenical one. But the farther steps of the process entirely put aside -all these sources of error. The non-formation of a metallic tarnish of -copper, however, is perhaps not absolute proof of the absence of -arsenic. For, according to a late statement by Drs. Fresenius and Von -Babo,[530] “all nitrates, and various salts of mercury and other metals, -render the separation of arsenic by copper difficult or even -impossible.” The authors of this objection, although the paper is -otherwise elaborate and detailed, have not given any particulars in -illustration of so important a criticism. - - - _Of the Tests for Oxide of Arsenic in Organic Mixtures._ - -The present is by far the most important of the conditions under which -it may be necessary to search for arsenic in medico-legal cases; for in -nine cases out of ten the subject of analysis is either some article of -food or drink, the contents or tissues of the stomach, or the textures -of other organs of the body into which the poison has been carried by -absorption. - -Accordingly much attention has been paid to this subject for some years -past, and many valuable methods of analysis have been suggested, more -especially since the recent discovery that arsenic, like many other -poisons, undergo absorption, and is diffused by the circulation -throughout the body generally. It was proved by me in 1824,[531] that -the tests for arsenic, at that time in general use, are so fallacious -when applied to complex organic mixtures as to be unfit for medico-legal -investigations except merely as trial-tests; and a process was proposed, -which has since undergone various modifications from others as well as -myself. This process, in the form in which it was adopted in the last -edition of the present work, is still applicable to a great proportion -of cases; and indeed a recent modification of it has been thought by -Drs. Fresenius and von Babo to be superior even yet to every other in -all circumstances.[532] But two new methods are at present generally -preferred, and probably not without reason. At least they have been much -employed and with great success in numerous medico-legal researches, -where the quantity of arsenic was to all appearance extremely small, and -the subject of examination most complex and troublesome to bring within -the sphere of analysis. And in particular they have been successfully -employed to detect arsenic in those organs of the human body into which -it can obtain admission only through the medium of absorption. - -In the following statement I shall describe four processes only, that of -Reinsch, by which the arsenic is first separated as a crust on -copper,—that of Marsh, who first detaches it in the form of -arseniuretted-hydrogen,—my own method, which consists in obtaining in -the first instance a sulphuret of arsenic,—and that of Drs. Fresenius -and von Babo, which has the same foundation. - -_Process of Reinsch._—This is the simplest and easiest of all. Remove in -the first place any white or gray powder which can be detached from the -mixture; and either subject it to the process of reduction by charcoal -or soda-flux, as described at p. 203, or dissolve it in boiling -distilled water and subject the solution to the three liquid reagents, -p. 207, or if there be enough, examine it in both ways. If arsenic be -thus obtained, it is seldom necessary to proceed any farther. But if -not, cut all soft solids into small fragments, add distilled water if -necessary, then add hydrochloric acid to the amount of a tenth of the -whole mixture, and more if the subject of analysis be decayed and -ammoniacal, so that there may be a decided excess of acid. Boil gently -for an hour, or until all soft solids be either dissolved or broken down -into fine flakes and grains. Filter through calico; bring the filtered -fluid again to the boiling point; and then proceed as described for -Reinsch’s method in simple arsenical solutions [p. 214]. - -The only important precaution to be attended to in employing this -process is to take care that the water, hydrochloric acid, and calico -are free of accidental impregnation with arsenic. This is guarded -against by applying the process to them in the first instance. I have -lately employed this method of analysis with success in two medico-legal -cases where the bodies had been buried for several months, and where the -quantity of arsenic must have been very minute. Satisfactory evidence -was obtained from a sixth part of the stomach, and also from the same -proportion of the liver. - -_Process of Marsh._—The chief difficulties in applying the process of -Marsh to complex organic mixtures arise from the tendency of oxide of -arsenic to adhere with obstinacy to some organic principles in the solid -state, and from the liability of the gas disengaged in the apparatus to -raise organic fluids in a fine froth, which breaks up slowly, and is -therefore apt to pass over into the exit-tube. Many contrivances have -been devised, to meet these difficulties, especially by the French -chemists and toxicologists, whose attention was turned earnestly to the -subject by the investigations carried on in certain late criminal trials -of great interest and importance. The various devices now alluded to -were subjected to trial in 1841 by a Committee of the French Institute; -who came to the opinion that the following method suggested by MM. -Flandin and Danger is the most convenient and comprehensive.[533] - -Heat the organic matter with a sixth of its weight of strong sulphuric -acid; when complete solution has taken place, concentrate the fluid to a -friable almost dry charcoal; add a little concentrated nitric acid -gradually to this when cold, and again evaporate to dryness; then act on -the residue with boiling distilled water, and a solution of a -reddish-brown colour is obtained, which may be used in such an apparatus -as that of Döbereiner without risk of obstruction from froth.—The -arseniuretted-hydrogen, thus disengaged along with the hydrogen gas, is -to be submitted to the succession of tests described in speaking of -Marsh’s process for detecting arsenic in a state of simple solution [p. -212]. - -This method of investigation is exceedingly precise and conclusive. The -sulphuric acid aided by heat destroys organic matter sufficiently to -prevent frothing in the apparatus and dissolves out arsenic from a state -of combination with organic principles; and nitric acid afterwards -converts any arsenic in the half-charred mass into the soluble arsenic -acid. It has been employed with success in various medico-legal -proceedings in France. It answers well for detecting oxide of arsenic in -the viscera, muscles, and other parts of the body into which the poison -has been conveyed through absorption. - -_Process by Hydrosulphuric Acid._—This method may be employed in two -ways, according as the object is merely to prove the presence of oxide -of arsenic, or to ascertain also its quantity. - -a. If proof of its presence be all that is wanted, cut any soft solids -into small pieces, add distilled water if necessary, boil for half an -hour, let the decoction cool, and filter it. Add a little acetic acid to -the filtered fluid, and if any precipitate form, filter again. Evaporate -to dryness, first by ebullition, afterwards over the vapour-bath. -Dissolve the residuum again in repeated portions of boiling distilled -water, and filter the solution. If it be not acid to litmus-paper add -more acetic acid, and transmit hydrosulphuric acid gas through the fluid -until an excess be indicated by the sense of smell after agitation, Then -expel the excess of gas by boiling; and if the precipitate of sulphuret -of arsenic do not subside readily add a little of a strong solution of -hydrochlorate of ammonia, which will facilitate subsidence. When the -precipitate has fallen to the bottom, withdraw the supernatant fluid -with the pipette, Fig. 8; and replace it with a little boiling distilled -water. Lastly, collect the precipitate on a filter, and proceed as by -the reduction process with soda-flux for oxide of arsenic, in a state of -simple solution. - -This method answers very well for ordinary cases where the quantity of -arsenic is not extremely minute. But I have met with instances in -medico-legal practice where the process of Reinsch, as well as that of -Marsh, succeeded in detecting the poison in sources to which the method -by hydrosulphuric acid had been applied without avail; because -apparently the organic matter existing in solution prevented the action -of the gas, or, as Orfila thinks, because boiling water will not in all -circumstances remove oxide of arsenic from the textures of the animal -body which are impregnated with it. In particular I doubt whether this -method is sufficiently delicate to detect arsenic in those organs and -textures into which it has been conveyed in cases of poisoning through -absorption into the blood.—Another objection is its tediousness. The -first filtration, if the substance to be examined be the stomach or its -contents, may take two days; and one way or another the analysis can -seldom be completed within four days. Reinsch’s process may be brought -to a conclusion in two hours or less, even in the most difficult -circumstances. - -b. The last process to be mentioned, is one based, like the previous -one, upon the precipitation of arsenic in the form of sulphuret, but -with very material modifications, the purpose of which is to enable the -analyst to separate the whole arsenic in a state of purity, so as to -ascertain the exact amount of the poison in the mixture. This method has -been recently proposed by Drs. Fresenius and von Babo.[534] - -Cut any soft solids into small pieces, put the whole into a porcelain -basin, add as much hydrochloric acid as equals the probable weight of -the dry matter in the mixture, and then water enough to form a thin -pulp. Heat the basin over the vapour-bath, adding every five minutes -about half a drachm of chlorate of potass, and stirring frequently, -until the liquid become clear-yellow, homogeneous, and thin. Add now two -drachms more of the chlorate; filter through linen, washing the residuum -on the filter with boiling water; concentrate to a pound; add a strong -solution of sulphurous acid till its odour predominates, and expel the -excess of it by heat. The liquid is now ready for the transmission of -hydrosulphuric acid gas, which should be transmitted in a slow stream -for twelve hours. Wash away any sulphuret adhering to the tube by means -of ammonia, and add the solution to the principal liquid; which is next -to be left at a gentle heat about 80° F., in a vessel covered with -paper, till the sulphureous smell entirely disappear. The precipitate, -which contains organic matter as well as sulphuret, is then to be -collected on a paper filter, washed, and dried with the filter over the -vapour-bath. The animal matter is next destroyed, and the sulphuret -converted into arsenic acid, by dropping on it fuming nitrous acid till -the whole is moistened, drying the product thoroughly over the -vapour-bath, moistening the residuum with concentrated sulphuric acid, -heating the mixture again in the vapour-bath for two or three hours, and -raising the heat afterwards gradually in a sand-bath to 300° F., till a -charred brittle mass be obtained. This is to be heated over the -vapour-bath with twenty parts of distilled water, filtered, and washed -with boiling water on the filter till what passes through ceases to -redden litmus. The solution, which ought to be colourless, is next -acidulated with hydrochloric acid, and treated as formerly with -hydrosulphuric acid gas. When the sulphuret has been collected on a -small filter, diluted ammonia is to be sent through the filter as long -as it dissolves any sulphuret, and is to be received in a weighed -porcelain basin, in which the ammonia and water are to be driven off at -a temperature not exceeding 212°. The sulphuret which is alone left may -now be weighed by again weighing the basin; and one grain of sulphuret -is equivalent to 0·803 of a grain of oxide of arsenic.—The authors add -an elaborate process for obtaining from this the whole arsenic by -reduction. But such a proceeding is unnecessary. It is sufficient in -medico-legal inquiries to ascertain by the simpler method given above -[p. 204], that it does yield by reduction with soda-flux a true -arsenical crust, and that this yields by oxidation white, sparkling -crystals with triangular facettes. - -After a comparative trial of the most esteemed process, Drs. Fresenius -and von Babo state that they found the one now described as delicate as -any other, and the only method by which the quantity of oxide of arsenic -can be ascertained with accuracy.—The hydrochloric acid used at the -commencement enables the water to dissolve compounds of arsenic which -water alone will not act on; and it farther facilitates solution by -breaking up or dissolving organic textures. The addition of chlorate of -potash prevents the escape of oxide of arsenic during the subsequent -evaporation; which is apt to happen when hydrochloric acid is present. -The subsequent addition of sulphuric acid converts arsenic acid into -arsenious acid, in which shape the sulphuret of arsenic is more readily -formed by the action of hydrosulphuric acid gas, when organic matter -co-exists in the solution. The steps for destroying organic matter -thrown down with the sulphuret at its first formation require no further -commentary: They are the most important particulars in the process for -its main object,—the determination of the quantity of pure -sesqui-sulphuret, and, through it, of the sesquioxide originally in the -subject of analysis. - - - _Of certain alleged Fallacies in the case of Organic Mixtures._ - -Before taking leave of the detection of arsenic in organic mixtures, it -is necessary to notice certain alleged fallacies in the way of every -process, arising from arsenic obtaining admission into the subject of -analysis through other means than its intentional addition or its -introduction as a poison into the body. This topic, one of paramount -importance in medico-legal chemistry, has lately undergone careful -investigation during and since the notorious trial of Madame Lafarge. -The results are the following:— - -It has been alleged that arsenic may obtain accidental admission into -the subject of analysis, 1, because the reagents used in the processes -may be adulterated with arsenic; 2, because the material of the -apparatus may contain it; 3, because it may have existed in antidotes -administered during life; 4, because it sometimes forms a constituent -part of the human body in the natural state; and 5, because it exists in -the soil of some churchyards. - -1. _Arsenic may exist as an adulteration in some reagents._—It must be -apt to occur in _sulphuric acid_, when that substance is prepared with -pyritic sulphur, which commonly contains some sulphuret of arsenic; and -it has actually been found in abundance in the acid by various -experimentalists, and in England for the first time by Dr. Rees.[535] It -may be detected by transmitting hydrosulphuric acid gas through the -diluted acid; and it may be effectually removed in the same way,[536] -the acid being afterwards filtered in a funnel whose throat is -filled with asbestus, and the excess of gas being expelled by -heat.—_Hydrochloric acid_ may contain arsenic, because it may have been -prepared with an arsenicated sulphuric acid. The impurity may be -detected and removed in the same way as in that substance. Nitric acid -seems not apt to be similarly adulterated;[537] but it may be tested by -Marsh’s process, after neutralizing the acid with potash, and adding -more sulphuric acid than is required to decompose the nitre thus formed. -_Zinc_ occasionally contains a little arsenic, which will be evolved in -Marsh’s process. Dr. Clark of Aberdeen says zinc is scarcely ever free -of a trace of arsenic; and it has been occasionally detected by others. -Orfila, however, very seldom found so much as to be discoverable by -Marsh’s test applied continuously for a great length of time.[538] A -committee of the French Institute came to the same conclusion.[539] M. -Jaquelain, acting under the directions of Professor Dumas, could not -detect an atom in any French specimen of zinc, or its carbonate or -silicated oxide, as met with in commerce.[540] Lastly, Mr. Brett -satisfied himself that no British or foreign zinc he could obtain -indicated the presence of arsenic by a process capable of detecting a -5000th of that metal in zinc.[541] It is an obvious inference from all -these inquiries that no difficulty can be experienced in obtaining zinc -so pure as to exhibit not a trace of arsenic by Marsh’s method. Neither -is there any difficulty in obtaining sulphuric, muriatic, and nitric -acid free of that adulteration. - -But at the same time it is equally obvious, that in medico-legal -analyses, unless the reagents used be previously known to be free of -arsenic, they ought invariably to be subjected in the first instance to -the process, whatever it may be, which the analyst proposes to employ -for detecting arsenic in a suspected substance. - -2. _Arsenic may be present in some articles of chemical -apparatus._—Arsenic has been detected in the metal of cast-iron -pots,[542] which Orfila and others have proposed to employ in certain -analyses on the large scale, as, for example, when the poison is sought -for in the whole soft solids of the human body. It is denied, however, -that any of that arsenic can be dissolved out of cast-iron by the -process which has been followed in such circumstances.[543] - -The primary fact, and the qualification of it, are in my opinion of -equally little medico-legal importance. It is not likely that such -enormous masses of material will ever be operated on again, as those -which were made use of in some late, French trials, and for which great -iron pots were found indispensable;—because it has been proved that -absorbed arsenic is chiefly to be met with in particular organs or -secretions, such as the liver and urine. Besides, a false importance has -been attached to the enthusiastic analyses of the whole human carcase, -with which some French chemists have been astounding the minds of the -scientific world, as well as the vulgar, on the occasion of certain late -trials for poisoning. I confess I could not find fault with a jury, who -might decline to put faith in the evidence of poisoning with arsenic, -when the analyst, after boiling an entire body, with many gallons of -water, in a huge iron cauldron, making use of whole pounds of sulphuric -acid, nitric acid, and nitre, and toiling for days and weeks at the -process, could do no more than produce minute traces of the poison. What -man of common sense will believe, that, with such bulky materials and -crude apparatus, it is possible to guard to a certainty against the -accidental admission of a little arsenic? At all events I am much -mistaken if any British jury would condemn a prisoner on such -evidence,—or any British chemist find fault with them for declining to -do so. - -3. _Arsenic may have existed in antidotes administered during life._—It -is now generally known, that the only chemical antidote for arsenic is -the hydrated sesquioxide of iron. But this substance appears -occasionally to contain a little arsenic, obviously derived from the -compound of iron whence the oxide is prepared.[544] Such an adulteration -must be rare in what is prepared by the ordinary processes, according to -which the oxide of arsenic ought to remain in solution. The only -effectual mode, however, of guarding against this source of error, when -the antidote has been administered, is to examine a portion of the stock -whence the patient was supplied, by dissolving it in an excess of -sulphuric acid, and subjecting it to Marsh’s test. - -4. _Arsenic sometimes exists naturally in the human body._—This -startling proposition was first advanced by M. Couerbe, and by Professor -Orfila soon afterwards.[545] The latter subsequently stated, that it -exists only in the bones, and not in any of the soft solids.[546] It is -now clear, however, that both of these experimentalists must have -committed an error. Orfila himself admits that his early researches are -vitiated by the subsequent discovery of arsenic in some kinds of -sulphuric acid;[547] and all recent attempts by others to obtain his -results have failed. Thus MM. Flandin and Danger could not detect -arsenic in any part of the human body, when it had not been -administered:[548] Pfaff was unable to detect an atom of it in the bones -of man or the lower animals by Orfila’s own process:[549] Dr. Rees was -equally unsuccessful:[550] and in 1841 a committee of the French -Institute, who superintended the performance of an analysis in three -cases by Orfila, reported that he failed in every instance to find a -trace of arsenic, by a process which could detect a 65th part of a grain -intentionally mixed with an avoirdupois pound of bones.[551] - -There is the strongest possible presumption, therefore, that human bones -never contain any arsenic. And besides, supposing they did, the source -of fallacy would be utterly insignificant; for, when it becomes -necessary to search for arsenic absorbed into the textures of the body, -it is never necessary to have recourse to the bones. - -5. _Arsenic may exist in the soil of churchyards._—This proposition too -was first announced by Professor Orfila, who found a little in the -churchyard of Villey-sur-Tille, near Dijon, and of the Bicêtre, -Mont-Parnasse, and New Botanic Garden at Paris.[552] And although MM. -Flandin and Danger afterwards denied they could ever find any,[553] a -committee of the Parisian Academy of Medicine reported that Orfila -proved before them the accuracy of his statement.[554] But the arsenic -exists in a state in which it cannot be dissolved out by boiling water: -It has been hitherto separable only by boiling the churchyard mould with -concentrated sulphuric acid. Hence it cannot pass by percolation through -a coffin into a body; and consequently it becomes a source of fallacy -only when the coffin has been broken up in the course of time, and the -mould lies in actual contact with the organs to be analysed.[555] - -It plainly appears, then, that most of the fallacies alleged against the -validity of the evidence derived from the discovery of arsenic within -the human body in cases of poisoning have no real existence; and that -those which are real can easily be provided against by simple and -obvious precautions. - - - 3. _Arsenite of Copper_. - -The arsenite of copper [Scheele’s-green, Mineral-green] deserves notice, -because it is in use as a pigment, and has actually been used as a -poison. Dr. Duncan once detected it in pills, given to a pregnant female -with the view of procuring abortion; in Paris it has been detected in -sweetmeats, having been used to give them a fine green colour;[556] and -Mr. Ainley of Bingley in Yorkshire informs me he found it to constitute -a pigment sold by London pastry-cooks under the name of emerald-green -for colouring preserves, and which in his practice had proved poisonous -to children who had eaten apple-tarts coloured with it. - -It is a compound of arsenious acid and deutoxide of copper, is sold in -powder or pulverulent cakes, and has a pale grass-green colour. Its -nature may be ascertained by heating it in a glass tube. Crystals of -oxide of arsenic sublime, and oxide of copper remains, which, on being -dissolved in nitric acid, yields a fine violet-blue solution with -ammonia. - -The mineral-green of the shops, however, is seldom arsenite of copper. -The substance sold in Edinburgh under that name, although believed by -colourmen to be a preparation of arsenic, is not the arsenite of copper, -but a mixture of hydrated oxide of copper and carbonate of lime; which -will be mentioned more particularly under the head of the poisons of -copper. - -_Process for Organic Mixtures._—The suspected mixture is to be heated -with a little hydrochloric acid and well stirred. The arsenite being -thus dissolved, the solution is to be allowed to cool and then filtered. -A stream of hydrosulphuric-acid gas will now cause a dark-brown or -yellowish-brown muddiness or precipitate, which is a mixture of -sulphuret of copper and sulphuret of arsenic. The precipitate being -separated after boiling, and properly cleansed by the process of -subsidence and affusion, or if it is large, by washing on a filter, the -two sulphurets are to be separated by ammonia, which dissolves sulphuret -of arsenic but leaves the sulphuret of copper; and the sulphuret of -arsenic may be recovered from the filtered fluid by expelling the -ammonia with heat. The sulphuret of arsenic is next to be reduced as -directed at page 211; and the sulphuret of copper examined as -recommended under the head of copper. - - - 4. _Arsenite of Potass_. - -This salt is an object of some importance to the medical jurist, as it -forms the basis of a common medicine, Fowler’s Solution, or the -Tasteless Ague Drop. This preparation contains in every ounce four -grains of arsenious acid. It has a brownish-red colour, and an odour of -lavender. It is strongly alkaline to litmus. When acidulated with -hydrochloric acid, hydrosulphuric-acid gas causes in it a dirty -brownish-yellow precipitate; and Reinsch’s process will detach arsenic -from it upon copper in a state capable of being subjected to the usual -tests [see p. 214]. - - - 5. _Arseniate of Potass._ - -This substance is so rarely met with as to be an object of little -consequence to the medical jurist: nevertheless I have found in the -course of reading two instances of poisoning with it. A very dangerous -and tedious case has been related by Professor Bernt, which arose from -too great a quantity having been given medicinally by an ignorant -druggist;[557] and a case of accidental poisoning with it has been -related in the London Medical Repository.[558] A singular account too -has been published of the accidental poisoning of seven horses with it -at Paris. They all died, most of them with the symptoms and morbid -appearances of well-marked inflammation of the alimentary canal.[559] - -When solid it forms tetraedral prismatic crystals, acuminated by four -planes. It is very soluble in water, fuses at a red heat, and on cooling -concretes into a crumbly, foliaceous mass, having a pearly lustre. It is -easily known by the effect of the process of reduction—of the nitrate of -silver, the salts of copper, and sulphuretted-hydrogen. Heated with -charcoal in a tube it gives off metallic arsenic in the usual manner; -but a stronger heat is required than for the reduction of the arsenious -acid. Dissolved in water and treated with nitrate of silver it yields a -brick-red precipitate, the arseniate of silver. With the salts of copper -its solution gives a pale bluish-white precipitate, the arseniate of -copper. With sulphuretted-hydrogen gas, preceded by acidulation with -muriatic acid, and transmitted for a considerable length of time, it -yields the yellow sulphuret of arsenic. When in solution it yields -arsenic both by Reinsch’s process and the method of Marsh. - - - 6. _The Sulphurets of Arsenic._ - -In the arts various substances are known which contain a compound of -sulphur and arsenic. In the first place, two pure sulphurets are known -in chemistry and in painting, the one of a fine orange colour, and known -by the name of realgar, the other of a rich sulphur-yellow, and termed -orpiment. Secondly, the name of orpiment is familiarly given to a -pigment in more general use than either of the former, which has a less -lively colour, and consists of pure orpiment with a large admixture of -arsenious acid. Lastly, orpiment also forms a great proportion of -another common pigment, King’s yellow. - -The orange-red sulphuret (realgar, risigallum, Σανδαραχη, sandaracha), -is chiefly a natural production. It is solid, of a bright orange-red -colour, and composed of small shining scales, so soft as to be scratched -with the nail. It is composed of one equivalent of metal and one of -sulphur. Its best chemical characters are the disengagement of metallic -arsenic when it is heated in a tube with potass or the black flux; and -its undergoing sublimation unchanged when heated alone in a tube. - -The yellow sulphuret (orpiment, auripigmentum, αρσενικον), is both a -natural production, and the result of many chemical operations. The -sulphuret thrown down from solutions of arsenic by sulphuretted-hydrogen -is quite conformable in physical and chemical characters with the -natural orpiment. Natural orpiment, when in mass, consists of broad -scales of much brilliancy and of a rich yellow colour. It is composed of -two equivalents of metal and three of sulphur. Its most striking -chemical characters are the same with those of realgar, from which it is -distinguished chiefly by its colour. - -It has been stated by Hahnemann in his elaborate work on Arsenic, that -the pure sulphurets are somewhat soluble in water,—that native orpiment -is soluble in 5000 parts of water with the aid of ebullition, and that -artificial orpiment by precipitation is soluble in 600 parts.[560] -Hahnemann, however, was mistaken in supposing that the water dissolved -these sulphurets. It does not dissolve, but decomposes them. Very lately -M. Decourdemanche has found that, by slow action in cold water, and much -more quickly with the aid of heat, the arsenical sulphuret is decomposed -by virtue of a simultaneous decomposition of the water, hydrosulphuric -acid being evolved and an oxide of arsenic remaining in solution. And he -has farther remarked, that this change is promoted by the presence of -animal and vegetable principles dissolved in water.[561] These facts are -interesting, as they explain certain apparent anomalies to be noticed -presently in the physiological properties of the sulphurets. - -The common orpiment of the shops is not a pure sulphuret like the -natural orpiment, but a much more active substance, a mixture of -orpiment and arsenious acid. It is made by subliming in close vessels a -mixture of sulphur and oxide of arsenic. It is met with in the shops in -two forms, in that of a fine powder possessing a yellow colour with a -faint tint of orange, and in that of concave masses composed of layers -of various tints of white, yellow and orange, commonly also lined -internally with tetraedral white pyramidal crystals. Till lately it was -accounted a variety of sulphuret, and some ingenious conjectures were -made as to the cause of its superior energy over the other sulphurets as -a poison. But M. Guibourt has proved that it always contains oxide of -arsenic, and is commonly impregnated with it to a very large amount, -some parcels containing so much as 96 per cent.[562] The inner surface I -have often seen lined with large crystals of pure oxide. In a very -interesting account by Dr. Symonds of Bristol, describing the case of -Mrs. Smith, for whose murder a woman Burdock was executed in that city a -few years ago, it is stated that artificial orpiment was the poison -given, that death took place in a very few hours, and that a sample from -the druggist’s shop where the poison was bought contained on an average -79 per cent. of oxide of arsenic.[563] - -Another impure sulphuret, a good deal used in painting, and a favourite -poison in this country for killing flies, is King’s yellow. It is sold -in the form of a light powder or in loose conical cakes. It has an -intense sulphur-yellow colour. This substance is soluble, though not -entirely, in water, both cold and warm, and forms a colourless solution, -from which, on cooling, or by evaporation, a yellow powder separates. In -this respect it differs essentially from the pure sulphurets. The -solution is not acted on by reagents in the same way as the solution of -arsenious acid. Lime-water and hydrosulphuric acid have no effect on it, -the ammoniacal nitrate of silver causes a copious dirty brown, and the -ammoniacal sulphate of copper a scanty, dirty lemon-yellow precipitate. -I have not seen any account of the mode of preparing it or an analysis -of its composition. But according to my own experiments it contains a -large proportion of sulphuret of arsenic, a considerable proportion of -lime, and about 16 per cent. of sulphur. Its nature is best shown by the -following method of analysis. Let the powder be agitated in diluted -ammonia till the colour becomes white. The filtered fluid contains the -sulphuret of arsenic, which, on addition of an acid, falls down, and may -be separated and reduced in a tube with the black flux. The remaining -white powder, well freed from adhering sulphuret by washing, is next to -be agitated in diluted acetate or hydrochloric acid and again filtered. -The solution on being neutralized precipitates abundantly with oxalate -of ammonia and the alkaline carbonates, showing that lime was taken up -by the acid: and, as the acid operates without effervescence, the lime -must have been in the caustic state. The powder which remains after the -action of the acid will be found to fuse with a gentle heat and to burn -almost entirely away with a blue flame, emitting sulphureous vapours. -These experiments make it obvious that King’s yellow contains sulphuret -of arsenic, caustic lime, and free sulphur; and in all probability the -lime exists in the form of a triple sulphuret of lime and arsenic. - -All the preparations containing the sulphuret of arsenic are interesting -to the medical jurist, but particularly the two impure sulphurets last -mentioned. The King’s yellow above all should be carefully studied, -because on account of its frequent employment as a fly-poison it has -been the source of fatal accidents. It was likewise taken intentionally -a few years ago in this city, and proved fatal in thirty-six hours. Dr. -Duncan also, while he was Professor of Medical Jurisprudence, met with -an instance of an attempt to poison by mixing King’s yellow with tea; -and at the Glasgow Spring Circuit of 1822 a woman was tried for -poisoning her child with it. - -_Process for Organic Mixtures._—If sulphuret of arsenic be present in -such mixtures in appreciable quantity, the particles, owing to their -intense yellow colour, will be visible in any mass which has not the -same tint. From this state of admixture they may be removed by adding -caustic ammonia which dissolves sulphuret of arsenic; and the solution, -on being acidulated with muriatic acid, will deposit the sulphuret -sufficiently pure for undergoing the process of reduction. - -Sulphuret of arsenic sometimes exists in small quantity in the stomach, -although the poison was given in the form of oxide; for a portion of the -oxide is subject to be converted into the sulphuret by hydrosulphuric -acid gas evolved in the stomach after death.[564] In every instance of -the kind yet carefully examined a large proportion of the oxide has -remained unacted on, although the intense colour of the mixed sulphuret -makes it appear as if that were the only compound present. - - - 7. _Arseniuretted-Hydrogen._ - -This compound presents the form of a colourless gas, possessing a fetid -garlicky odour, a density of nearly 2·7, and great virulence as a -poison. It is mentioned here, because accidental poisoning with it has -happened occasionally within a few years, chiefly owing to the -occasional adulteration of sulphuric acid with arsenic, and the -liability of the arsenic to form arseniuretted-hydrogen when such -sulphuric acid is used to prepare hydrogen gas. Dr. O’Reilly has -mentioned a melancholy instance of a young chemist losing his life in -this way.[565] Dr. Schlinder of Greifenberg has related another, which -did not prove fatal.[566] And it is well known that the German chemist -Gehlen lost his life by accidentally breathing arseniuretted-hydrogen -while engaged in examining its chemical properties.[567] It is an -inflammable body; and its presence in any other gas is easily detected -by burning it according to the method of Marsh. - - - SECTION II.—_Of the Action of Arsenic and the Symptoms it excites in - Man._ - -It is now generally admitted that arsenic produces in the living body -two classes of phenomena,—or that, like the narcotico-acrids, it has a -twofold action. One action is purely irritant, by virtue of which it -induces inflammation in the alimentary canal and elsewhere. The other, -although it seldom occasions symptoms of narcotism properly so called, -yet obviously consists in a disorder of parts or organs remote from the -seat of its application. - -It is also the general opinion of toxicologists, that arsenic occasions -death more frequently through means of its remote effects than in -consequence of the local inflammation it excites. In some cases indeed -no symptoms of inflammation occur at all; and in many, although -inflammation is obviously produced, death takes place long before it has -had time to cause material organic injury. Nevertheless in some, though -certainly in comparatively few instances, the local action, it must be -admitted, predominates so much, that the morbid changes of the part -primarily acted on are alone adequate to account for death. - -Its chief operation being on organs remote from the part to which it is -applied, a natural object of inquiry is, whether this action results -from the poison entering the blood, and so passing to the remote organs -acted on, or simply arises from the organ remotely affected sympathizing -through the medium of the nerves with the impression made on the organ -which is affected primarily. On this question precise experiments are -still wanted. The general opinion has for some time been that it acts -through the blood. And this view has of late been strengthened by -indisputable evidence, that the poison does enter the blood, and is -diffused by it throughout the body. - -For a long period chemists sought in vain for arsenic in the animal -tissues and secretions at a distance from the alimentary canal. Such was -the position of matters at the date of the last edition of this work; in -which the failure was ascribed to the methods of analysis then known not -being delicate enough to discover the small quantity of arsenic which -disappears by absorption in cases of poisoning.[568] That statement is -now referred to, because in a late controversy in France an attempt was -made, by an erroneous quotation of this work, to deprive Professor -Orfila of the honour, which is due to him alone, of having recently been -the first to demonstrate the possibility of detecting arsenic throughout -the organs and secretions generally of the bodies of men and animals -poisoned with it. - -This most important discovery, pregnant alike with interesting -physiological deductions and valuable medico-legal applications, was -first announced by him to the Parisian Academy of Medicine in January, -1839; when he stated that arsenic is absorbed in such quantity in cases -of poisoning as to admit of being discovered by an improved process of -analysis in various organs and fluids of the body, such as the liver, -spleen, kidneys, muscles, blood, and urine.[569] In November, 1840, he -proved these facts to the satisfaction of a committee of the -academy.[570] And since then they have been confirmed by others, not -merely in express experiments, but likewise in the familiar experience -of medico-legal practice. The situations where arsenic is met with in -largest quantity are the liver, the spleen, and the urine, but above all -the liver. The precise circumstances in which it may be found in one or -another of these quarters have not yet been determined. But in most -cases of acute arsenical poisoning where the search has been made at -all, it has proved successful in the liver. In two late instances I have -readily found arsenic by the process of Marsh or Reinsch in the liver -after four months’ interment. - -Since arsenic then is clearly absorbed into the blood, it becomes an -interesting question whether the organization of the blood is thereby -changed. This question cannot be answered with confidence. But in all -probability the blood does undergo some change in its _crasis_; for in -most cases of acute poisoning that fluid is found after death in a -remarkable state of fluidity [see Section on the Morbid Appearances]; -and Mr. James observed that if venous or arterial blood be received into -a solution of arsenic, instead of coagulating in the usual way, a -viscous jelly first forms, and lumpy clots separate afterwards.[571] - -Our knowledge of the affection induced by the remote action of arsenic -is in some respects vague. Toxicologists have for the most part been -satisfied with calling it a disorder of the general nervous system. When -employed to designate the state of collapse which accompanies or forms -the chief feature of acute cases of poisoning with arsenic, this term is -misapplied. The whole train of symptoms is that not of a general nervous -disorder, but simply of depressed action of the heart. That this is the -chief organ remotely acted on in such cases farther appears probable -from certain physiological experiments, in which it has been remarked, -that immediately after rapid death from arsenic the irritability of the -heart was exhausted or nearly so, while that of the intestines, gullet, -and voluntary muscles continued as usual.[572] As to the singular -symptoms which often arise in the advanced stage of lingering cases, the -term, disorder of the general nervous system, is more appropriately -applied to them. They clearly indicate a deranged state sometimes of the -brain, sometimes of particular nerves. - -Arsenic belongs to those poisons which act with nearly the same energy -whatever be the organ or texture to which they are applied. The -experiments of Sproegel,[573] repeated by Jaeger,[574] and by Sir -Benjamin Brodie,[575] leave no doubt, that when applied to a fresh wound -it acts with at least equal rapidity as when swallowed. Although in such -circumstances the signs of irritation are often distinct, yet the -symptoms are on the other hand sometimes more purely narcotic than by -any other mode of administering it,—Sir B. Brodie in particular having -observed loss of sense and motion to be induced, along with occasional -convulsions. Arsenic likewise acts with energy when applied to the -conjunctiva of the eye, as was proved by Dr. Campbell. It acts too with -great energy when inhaled in the state of vapour into the lungs, or in -the form of arseniuretted-hydrogen. It farther acts with violence -through the mucous membrane of the vagina, producing local inflammation, -and the usual constitutional collapse. These facts were determined -experimentally by the Medical Inspectors of Copenhagen on the occasion -of a singular trial which will be noticed afterwards. Arsenic also acts, -as may easily be conceived, when injected into the rectum. And farther, -it acts as a poison, when it is applied to the surface of ulcers, yet -certainly not under all circumstances. Its power of acting through the -unbroken skin has been questioned. Jaeger found that, when it was merely -applied and not rubbed on the skin of animals, it had no effect.[576] -But some cases will be afterwards mentioned which tend to show that the -reverse probably holds in regard to man. According to the last-mentioned -author, who is the only experimentalist that has hitherto examined the -subject consecutively, arsenic is most active when injected into a vein, -or applied to a fresh wound, or introduced into the sac of the -peritonæum; it is less powerful when taken into the stomach; it is still -less energetic when introduced into the rectum; and it is quite inert -when applied to the nerves. - -It is a striking fact in the action of that poison that, whatever be the -texture in the body to which it is applied, provided death do not ensue -quickly, it almost always produces symptoms of inflammation in the -stomach; and on inspection after death traces of inflammation are found -in that organ. In some instances of death caused by its outward -application, the inflamed appearance of the stomach has been greater -than in many cases where it had been swallowed. Sproegel met with a good -example of this in a dog killed by a drachm applied to wounds. The whole -stomach and intestines, outwardly and inwardly, were of a deep-red -colour, blood was extravasated between the membranes, and clots were -even found in the stomach.[577] - -Of the different preparations of arsenic, it may be said in general -terms, that those are most active which are most soluble. In conformity -with what appears to be a general law in toxicology, the metal itself is -inert. It is difficult to put this fairly to the test, because it is not -easy to pulverize the metal without a sufficient quantity being oxidated -to cause poisonous effects. Bayen and Deyeux, however, found that a -drachm carefully prepared might be given in fragments to dogs without -injuring them; and they once gave a cat half an ounce without any other -consequence than temporary loss of flesh.[578] Its alloys are also -inert. The same experimentalists found it inactive when combined with -tin; and Renault likewise found it inactive when united with sulphur and -iron in the ore mispickel, or arsenical pyrites.[579] - -It is probable that all the other preparations of arsenic are more or -less deleterious. - -A difference of opinion prevails as to the power of the sulphurets. -Various statements have been published on the subject. But it may be -sufficient to observe, that in consequence of the poisonous properties -of the sulphurets having been imputed to the oxide, with which they are -often adulterated,—Professor Orfila made some experiments with native -orpiment and realgar, and with the sulphuret procured by -sulphuretted-hydrogen gas (which are all pure sulphurets); and he found -that in doses varying from 40 to 70 grains they all caused death in two, -three, or six days, whether they were applied to a wound, or introduced -into the stomach.[580] It may appear at first view singular that the -sulphurets, being insoluble, should be poisonous; but the apparent -anomaly vanishes on considering the experiments of M. Decourdemanche -formerly noticed; which prove that in animal fluids the sulphurets are -rapidly changed into the oxide (see p. 225). The sulphurets, however, -are much less active than the preparations in which the metal exists -already oxidated. Yet in sufficient doses they will prove rapidly fatal. -In the Acta Germanica there is the case of a woman who was killed in a -few hours by realgar, mixed by her step-daughter in red cabbage -soup.[581] The common artificial orpiment procured by sublimation is -very active, in consequence of the oxide mixed with it. Renault found -three grains killed a dog in nine hours.[582] - -Among the less active preparations of arsenic may also be enumerated -such of the arsenites and arseniates as are not soluble in water. They -have not indeed been actually tried. But there can be little doubt that -they will prove poisonous; because, though insoluble in water, they are -probably somewhat soluble in the animal juices. We may infer from their -sparing solubility, even in these menstrua, that they will be less -active than the preparations now to be mentioned, which are more -soluble. - -These are the alkaline arsenites and arseniates, arsenic acid, arsenious -acid, the black oxide or fly-powder, and arseniuretted-hydrogen. With -regard to arsenic acid, and the alkaline arseniates and arsenites, it is -probable, from their effects in medicinal doses, that they are as active -as the white oxide, if not more so. But they have not been particularly -examined, as they are not objects of great interest to the medical -jurist. - -The fly-powder or black oxide is very active. Renault found that four -grains killed a middle-sized dog in ten hours.[583] It has been likewise -known to prove quickly fatal to man. In a French journal there is a case -related which ended fatally in sixteen hours;[584] and in the Acta -Germanica is an account of four persons, who died in consequence of -eating a dish of stewed pears poisoned with it, and of whom three died -within eighteen hours.[585] The dose is not mentioned; but it is -probable from the collateral circumstances that it was not considerable. - -Arseniuretted-hydrogen is probably the most active of all arsenical -compounds. The celebrated German chemist Gehlen, having accidentally -inhaled a small portion of it, died in nine days with the usual symptoms -of arsenical poisoning. In Dr. O’Reilly’s case, which proved fatal in -seven days, it was computed that the equivalent of twelve grains of -oxide had been inhaled. And Dr. Schlinder’s patient had inhaled a -quantity of gas corresponding with only an eighth of a grain of -sesquioxide; yet he appears to have made a narrow escape.[586] - -It is of some consequence to settle with precision the power of the -white oxide. Witnesses are often asked on trials how small a quantity -will occasion death? It is obvious that this question admits only of a -vague answer: It can be answered at all only in reference to concomitant -circumstances, and even then but presumptively. Nevertheless, it is -right to be aware what facts are known on the subject. - -It has been stated by various systematic authors that the white oxide -will prove fatal to man in the dose of two grains. Hahnemann says in -more special terms, that in circumstances favourable to its action four -grains may cause death within twenty-four hours, and one or two grains -in a few days.[587] But neither he nor any of the other authors alluded -to have referred to actual cases. Foderé knew half a grain cause colic -pains in the stomach and dysenteric flux, which continued obstinately -for eight days;[588] and I have related an instance where six persons, -after taking each a grain in wine during dinner, were seriously and -violently affected for twelve hours.[589] Mr. Alfred Taylor mentions -three similar cases occasioned by arsenic accidentally taken in port -wine after dinner,—one, an infant of sixteen months who got about a -third of a grain, another, a lady who took a grain and a half, and the -third, a gentleman, who had two grains and a half,—in all of whom -violent vomiting, and prostration, without pain, occurred for three or -four hours; and the gentleman of the party did not recover for several -days.[590] M. Lachèse mentions his having met with a number of cases of -poisoning from small doses taken in bread or soup; whence he concludes, -that an eighth of a grain taken in food may cause vomiting;—that a -quarter of a grain or twice as much taken once only causes vomiting, -colic, and prostration,—that the same quantity repeated next day renews -these symptoms in such force as to render the individual unfit for work -till three or four days afterwards,—and that four such doses, taken at -intervals during two days, that is between one and a half and two grains -in all, excite acute gastro-enteritis and may prove fatal, since two -individuals who had taken this much died, one in seven weeks, the other -three weeks later.[591] The smallest fatal dose I have found recorded -elsewhere is four grains and a half; and death ensued in six hours -only.[592] But the subject was a child, four years old, and the poison -was taken in solution. Alberti mentions the case of a man who died from -taking six grains; but I am unacquainted with the particulars, not -having seen the original account.[593] Two children, whose cases are -alluded to in the Proceedings of the Academy of Medicine of Paris, died, -the one in two days, the other a day later, after taking rather less -than sixteen grains. The former was four years and a half old, the -latter seven years.[594] Valentini alludes to a case where thirty grains -of the oxide in powder killed an adult in six days.[595] The effects of -medicinal doses, which seldom exceed a quarter of a grain without -causing irritation of the stomach, and the fatal effects of somewhat -larger doses on animals, Renault having found that a single grain in -solution killed a large dog in four hours,[596] must convince every one -that the general statement of Hahnemann cannot be very wide of the -truth. Mr. Taylor thinks his own cases mentioned above throw doubt over -this inference. But it must be remembered, that his patients had dined -just before taking the poison. - -It is not improbable that the activity of oxide of arsenic is impaired -by admixture with other insoluble powders. M. Bertrand, conceiving from -some experiments on animals that he had found an antidote for arsenic in -charcoal powder, took no less than five grains of the oxide mixed with -that substance, and he did not suffer any injury, although his stomach -was empty at the time, and he did not vomit.[597] But Orfila afterwards -showed, that other insoluble powders, such as clay, have the same -effect; that no such powder can be of any use if not introduced into the -stomach till after the arsenic is swallowed; and that they appear to act -solely by enveloping the arsenical powder and preventing it from -touching the membrane of the alimentary canal.[598] Although M. -Bertrand’s discovery will not supply the physician with an antidote, the -medical jurist will not lose sight of the interesting fact, that, by -certain mechanical admixtures, arsenic in moderate doses may be entirely -deprived of its poisonous quality. A singular case of recovery from no -less a dose than sixty grains, which happened in the case of an American -physician, probably comes under the same head with the experiments of -Bertrand,—a large quantity of powder of cinchona-bark having been -swallowed along with the arsenic. In this case, however, the symptoms -were severe for three days.[599] - -The tendency of habit to modify the action of arsenic is questionable. -So far as authentic facts go, habit has no power of familiarizing the -constitution to its use. One no doubt may hear now and then of -mountebanks who swallow without injury entire scruples or drachms of -arsenic, and vague accounts have reached me of patients who took -unusually large doses for medicinal purposes. But as to facts of the -former kind, it is clear that no importance can be attached to them; for -it is impossible to know how much of the feat is genuine, and how much -legerdemain. With respect to the latter facts, I have never been able to -ascertain any precise instance of the kind; and so far as my own -experience goes, the habit of taking arsenic in medicinal doses has -quite an opposite effect from familiarizing the stomach to it. - -Oxide of arsenic being sparingly soluble, its operation is often much -influenced by the condition of the stomach as to food at the time it is -swallowed. If the stomach be empty, it adheres with tenacity to the -villous coat and acts with energy. If the stomach be full at the time, -the first portions that come in contact with the inner membrane may -cause vomiting before it can be diffused, so that the whole or greater -part is discharged. One remarkable case of this nature has been quoted -in page 29. In another, where severe symptoms did supervene, and -recovery was ascribed to the use of magnesia as an antidote, the -favourable result seems to have been really owing to the circumstance, -that the patient had supped heartily not long before taking the -arsenic.[600] An extraordinary case related by Mr. Kerr, in which nearly -three-quarters of an ounce were retained for two hours without causing -any serious mischief, probably comes under the same category; for the -arsenic was taken immediately after a meal, and the stomach was cleared -out by emetics.[601] - -In the following detail of the symptoms caused by arsenic in man, its -effects when swallowed will be first noticed; and then some remarks will -be added on the phenomena observed when it is introduced through other -channels. - -The symptoms of poisoning with arsenic may be advantageously considered -under three heads. In one set of cases there are signs of violent -irritation of the alimentary canal and sometimes of the other mucous -membranes also, accompanied with excessive general depression, but not -with distinct disorder of the nervous system. When such cases prove -fatal, which they generally do, they terminate for the most part in from -twenty-four hours to three days. In a second and very singular set of -cases there is little sign of irritation in any part of the alimentary -canal; perhaps trivial vomiting or slight pain in the stomach, but -sometimes neither; the patient is chiefly or solely affected with -excessive prostration of strength and frequent fainting; and death is -seldom delayed beyond the fifth or sixth hour. In a third set of cases -life is commonly prolonged at least six days, sometimes much longer, or -recovery may even take place after a tedious illness; and the signs of -inflammation in the alimentary canal are succeeded or become -accompanied, about the second or fourth day or later, by symptoms of -irritation in the other mucous passages, and more particularly by -symptoms indicating a derangement of the nervous system, such as palsy -or epilepsy. The distinctions now laid down will be found in practice to -be well defined, and useful for estimating in criminal cases the weight -of the evidence from symptoms. - -1. In one order of cases, then, arsenic produces symptoms of irritation -or inflammation along the course of the alimentary canal. Such cases are -the most frequent of all. The person commonly survives twenty-four -hours, seldom more than three days; but instances of the kind have -sometimes proved fatal in a few hours, and others have lasted for weeks. -On the whole, however, if the case is much shorter than twenty-four -hours, or longer than three days, its complexion is apt to be altered. -In the mildest examples of the present variety recovery takes place -after a few attacks of vomiting, and slight general indisposition for a -day or two. - -In regard to the ordinary progress of the symptoms, the first of a -decisive character are sickness and faintness. It is generally thought -indeed that the first symptom is an acrid taste; but this notion has -been already shown to be erroneous. For some account of the sensations -felt in the act of swallowing the poison, the reader may refer to what -has been stated in p. 200. There is no doubt, that in the way in which -arsenic is usually given with a criminal intent, namely, mixed with -articles of food, it seldom makes any impression at all upon the senses -during the act of swallowing. - -In some instances the sickness and faintness, particularly when the -poison was taken in solution, have begun a few minutes after it was -swallowed. Thus in a case mentioned by Bernt, in which a solution of -arseniate of potass was taken, the symptoms began violently in fifteen -minutes;[602] in one related by Wildberg, where the oxide was given in -coffee, the person was affected immediately on taking the second -cup;[603] in one related by Mr. Edwards, the patient was taken ill in -eight minutes,[604] in one mentioned by M. Lachèse of Angers, violent -symptoms commenced within ten minutes after the poison was swallowed -with prunes;[605] in a case communicated to me by Mr. J. H. Stallard of -Leicester, the symptoms set in with violence ten minutes after it was -taken dissolved in tea; nay, in a case of poisoning with orpiment in -soup, mentioned by Valentini, the man felt unwell before he had finished -his soup, and set it aside as disagreeable.[606] It is a mistake -therefore to suppose, as I have known some do, that arsenic never begins -to operate for at least half an hour. Nevertheless it must be admitted, -that in general arsenic does not act for half an hour after it is -swallowed.—On the other hand, its operation is seldom delayed beyond an -hour. The following, however, are exceptions to this rule. Lachèse in -the paper quoted above mentions an instance where the interval was two -hours, and where the issue was eventually fatal. The arsenic had been in -very coarse powder. Mr. Macaulay of Leicester has communicated to me a -case where the individual took the poison at eight in the evening, went -to bed at half-past nine, and slept till eleven, when he awoke with -slight pain in the stomach, vomiting, and cold sweats. In this instance -the dose was seven drachms, and death took place in nine hours. M. -Devergie has related a similar case of poisoning with the sulphuret, -where the symptoms did not begin for three hours; and here too the -patient fell asleep immediately after swallowing the poison.[607] -Professor Orfila has noticed an instance, to be quoted afterwards, where -there appears to have been scarcely any symptom at all for five -hours[608] (p. 243). I suspect we must also consider as an instance of -the same kind the case which gave occasion to the trial of Mrs. Smith -here in 1827. A white draught was administered in a suspicious manner at -ten in the evening; the girl immediately went to bed; and no symptoms -appeared till six next morning, from which time her illness went on -uninterruptedly.[609] In three of the preceding cases it will be -remarked that sleep intervened between the taking of the poison and the -invasion of the symptoms; and it is therefore not improbable that the -reason of the retardation is the comparative inactivity of the animal -system during sleep.—In voluntary poisoning, as in a case related by Dr. -Roget, a slight attack of sickness or vomiting occasionally ensues -immediately after solid arsenic is swallowed, and some time before the -symptoms commence regularly.[610] - -The observations now made will often prove important for deciding -accusations of poisoning; for pointed evidence may be derived from the -commencement of the symptoms, after a suspected meal, corresponding or -not corresponding with the interval which is known to elapse in -ascertained cases. The reader will see the effect of such evidence in -attaching guilt to the prisoner in the case of Margaret Wishart, which I -have detailed elsewhere.[611] In the trial of Mrs. Smith, the want of -the correspondence just mentioned contributed greatly to her acquittal; -for the symptoms of poisoning did not begin till more than eight hours -after the only occasion on which the prisoner was proved to have -administered any thing in a suspicious manner. As I was not at the time -acquainted with any parallel case except that recorded by Orfila, I -hesitated to ascribe the symptoms to the draught; and consequently, as -the other medical witnesses felt the same hesitation on the same -account, the proof of administration was considered to have failed. I am -not sure that I should have now felt the same difficulty. The -intervening state of sleep probably affords an explanation of the long -interval; and the cases noticed by Mr. Macaulay and M. Devergie are -parallel, though the interval in them was certainly not so great.—There -is a limit, however, to the possible interval in such cases. It seems -impossible that the action of the poison shall be suspended for three -entire days. Yet death has been ascribed to arsenic in such -circumstances. A child 3½ years old having swallowed eight grains with -bread and butter, but being soon made to vomit forcibly by emetics, -presented no decided symptom at the time, or for three days more; but on -the fourth day difficult breathing ensued, with anxiety of expression, -frequency of the pulse, and heat of the skin; and next day death took -place. There was no morbid appearance found in the body.[612] I do not -know of any parallel instance of death from arsenic, and cannot admit -that the poison was the cause of the symptoms and fatal event. - -Soon after the sickness begins, or about the same time, the region of -the stomach feels painful, the pain being commonly of a burning kind, -and much aggravated by pressure. Violent fits of vomiting and retching -then speedily ensue, especially when drink is taken. There is often also -a sense of dryness, heat, and tightness in the throat, creating an -incessant desire for drink; and this affection often precedes the -vomiting. Occasionally it is wanting, at other times so severe as to be -attended with suffocation and convulsive vomiting at the sight of -fluids.[613] Hoarseness and difficulty of speech are commonly combined -with it. The matter vomited is greenish or yellowish; but sometimes -streaked or mixed with blood, particularly when the case lasts longer -than a day. - -In no long time after the first illness diarrhœa generally makes its -appearance, but not always. In some cases, instead of it, the patient is -tormented by frequent, ineffectual calls: in others the great intestines -are scarcely affected. About this time the pain in the stomach is -excruciating, and is often likened by the sufferer to a fire burning -within him. It likewise extends more or less downwards, particularly -when the diarrhœa or tenesmus is severe; and the belly is commonly tense -and tender, sometimes also swollen, though not frequently,—sometimes -even on the contrary drawn in at the navel.[614] When the diarrhœa is -severe, the anus is commonly excoriated and affected with burning -pain.[615] In such cases the burning pain may extend along the whole -course of the alimentary canal from the throat to the anus. Nay at times -the mouth and lips are also inflamed, presenting dark specks or -blisters.[616] - -Sometimes there are likewise present signs of irritation of the lungs -and air-passages,—almost always shortness of breath (which, however, is -chiefly owing to the tenderness of the belly),—often a sense of -tightness across the bottom of the chest, and more rarely decided pain -in the same quarter, darting also through the upper part of the chest. -Sometimes pneumonia has appeared a prominent affection during life, and -been distinctly traced in the dead body.[617] - -In many instances, too, the urinary passages are affected, the patient -being harassed with frequent, painful and difficult micturition, -swelling of the penis, and pain in the region of the bladder, or, if a -female, with burning pain of the vagina and excoriation of the -labia.[618] Sometimes the irritation of the urinary organs is so great -as to be attended with total suppression of urine, as in a case related -by Guilbert of Montpellier, in which this symptom continued several -days.[619] During the late contentions among chemists, physiologists, -and physicians, occasioned by the case of Madame Lafarge, it was alleged -by Flandin and Danger that in animals the urine is always suppressed, by -Orfila that it is always secreted, by Professor Delafond of the Alfort -Veterinary School, that it is never suppressed, but always diminished, -and sometimes even to a sixth of the natural quantity.[620] There is, -however, no invariable rule in the matter. And in fact, urinary symptoms -are seldom present unless the lower bowels are likewise strongly -irritated; but are then seldom altogether wanting. They are rarely well -marked in cases of the present variety, unless life is prolonged three -days or more. - -When symptoms of irritation of the alimentary canal have subsisted a few -hours, convulsive motions often occur. They commence on the trunk, -afterwards extend over the whole body, are seldom violent, and generally -consist of nothing else than tremors and twitches. Cramps of the legs -and arms, a possible concomitant of every kind of diarrhœa, is -peculiarly severe and frequent in that caused by arsenic. - -The general system always sympathizes acutely with the local -derangement. The pulse commonly becomes very small, feeble and rapid -soon after the vomiting sets in; and in no long time it is often -imperceptible. This state is naturally attended with great coldness, -clammy sweats, and lividity of the feet and hands. Another symptom -referrible to the circulation which has been observed, though, very -rarely, is palpitation.[621] - -The countenance is commonly collapsed from an early period, and almost -always expressive of great torture and extreme anxiety or despair; the -eyes are red and sparkling; the conjunctiva often so injected as to seem -inflamed; the tongue and mouth parched; and the velum and palate -sometimes covered with little white ulcers. - -Delirium sometimes accompanies the advanced stage, and stupor also is -not unfrequent. Coma occasionally precedes death, as in Mr. Stallard’s -case (p. 235), in which the symptoms of irritation, at first very -violent, gradually gave place in two hours to complete insensibility, -proving fatal in two hours more. Very often, however, the patient -remains quite sensible to the last. Death in general comes on calmly, -but is sometimes preceded by a paroxysm of convulsions.[622] In some -cases it takes place quite unexpectedly, as if from sudden deliquium, as -in a case mentioned by Dr. Dymock of this city. The patient, a girl who -had taken two ounces intentionally, rose from her bed without help two -hours and a half afterwards, went to a chair at the fireside, and had -scarce sat down when she expired.[623] - -Various eruptions have at times been observed, especially in those who -survive several days; but they are more frequent in the kind of cases to -be considered afterwards, in which life is prolonged for a week or more. -The eruptions have been variously described as resembling petechiæ, or -measles, or red miliaria, or small-pox. In the case already quoted from -Guilbert a copious eruption of miliary vesicles appeared on the fifth -day, and for fifteen days afterwards. They were attended with -perspiration and abatement of the other symptoms, and followed with -desquamation of the cuticle. Another external affection which may be -noticed is general swelling of the body. Several cases of this nature -have been described by Dr. Schlegel of Meiningen; and in one of them the -swelling, particularly round the eyes, appears to have been -considerable.[624] - -In some cases of the kind now under consideration a short remission or -even a total intermission of all the distressing symptoms has been -witnessed, particularly when death is retarded till the close of the -second or third day.[625] This remission, which is accompanied with -dozing stupor, is most generally observed about the beginning of the -second day. It is merely temporary, the symptoms speedily returning with -equal or increased violence. Sometimes the remission occurs oftener than -once, as in a case related in the London Medical and Physical Journal. -The patient, a child seven years old, lived thirty-six hours in a state -of alternate calm and excitement; and during the state of calm no pulse -was to be felt at the wrists.[626]—So far as at present appears a long -intermission is impossible. - -In cases such as those now described death often occurs about -twenty-four hours after the poison is swallowed, and generally before -the close of the third day. But on the one hand life has been sometimes -prolonged, without the supervention of the symptoms belonging to a -different variety of cases, for five or six days,[627] nay perhaps even -for several weeks. And, on the other hand, the symptoms of irritation of -the alimentary canal are sometimes distinct, although death takes place -in a much shorter period than twenty-four hours. Metzger has related a -striking case, fatal in six hours, in which the symptoms were acute -colic pain, violent vomiting, and profuse diarrhœa;[628] and Wildberg -has related a similar case fatal in the same time.[629] Hohnbaum -describes another fatal in five hours;[630] and I met with as brief a -case in this city in 1843, where all the usual symptoms of irritation in -the stomach and bowels were violent. These symptoms were also present at -first in Mr. Stallard’s case, which was fatal in four hours; Pyl has -recorded one, where all the signs of irritation in the stomach and -intestines were present, except vomiting, and which proved fatal in -three hours;[631] and Dr. Dymock met here with a similar instance which -lasted only two hours and a half.[632] This is one of the shortest -undoubted cases of poisoning from arsenic I have hitherto found in -authentic records. Dr. Male mentions one, which was fatal in four -hours;[633] Wepfer another equally short;[634] Johnston another fatal in -three hours and a half;[635] and I shall presently mention others -without symptoms of irritation which ended fatally in two, five, or six -hours [p. 242].[636] Wibmer has even quoted a case fatal in half an -hour; but there seems to have been some doubt whether the poison taken -was arsenic.[637] - -Such is an account of the symptoms of poisoning by arsenic in their most -frequent form. It will of course be understood, that they are liable to -a great variety as to violence, as well as their mode of combination in -actual cases;—and that they are by no means all present in every -instance. The most remarkable and least variable of them all, pain and -vomiting, are sometimes wanting. A case, in which pain was not felt in -the stomach, even on pressure, although the other symptoms of -inflammation were present, has been briefly described in the Medical -Repository.[638] A similar case fatal in fourteen hours and a half, -where there was much vomiting and some heat in the stomach, but no pain -or tenderness, has been related by Dr. E. Gairdner.[639] Another very -striking example of this anomalous deficiency has been detailed by Dr. -Yellowly. A lad sixteen years old died twenty-one hours after swallowing -half an ounce of the white oxide; and the presence of inflammation was -denoted all along by sickness, vomiting, purging, and heat in the -tongue; yet he never complained of pain, neither did he ever seem to his -friends to suffer any. Another anomaly in the case was, that the pulse, -contrary to what is usual, was very slow: twelve hours after he took the -poison, the pulse was 40, and two hours before death it was so slow as -30.[640] These deviations from the ordinary course of the symptoms are -taken notice of merely to put the practitioner on his guard, and prevent -the medical jurist from drawing hasty conclusions. Upon the whole, they -are rare; and the symptoms of poisoning by arsenic are in general very -uniform. - -2. The second variety of poisoning with arsenic includes a few cases in -which the signs of inflammation are far from violent or even altogether -wanting, and in which death ensues in five or six hours or a little -more,—at a period too early for inflammation to be always properly -developed. The symptoms are then generally obscure, and are referrible -chiefly to the mode of action, which is probably the cause of death in -most cases,—a powerful debilitating influence on the circulation, or on -the nervous system. - -These symptoms occasionally amount to absolute narcotism, as in some of -the animals on which Sir B. Brodie experimented. Thus, when he injected -a solution of the oxide into the stomach of a dog, the pulse was -rendered slow and intermitting; the animal became palsied in the -hind-legs, lethargic, and in no long time insensible, with dilated -pupils; and soon afterwards it was seized with convulsions, amidst which -it died, fifty minutes after the poison was administered.[641] In man -the symptoms very seldom resembled so closely those of the narcotic -poisons. In Mr. Stallard’s case, however, formerly mentioned, the -symptoms of irritation which appeared at first speedily gave place to -complete insensibility for two hours before death (pp. 235, 238), a -similar instance has been related in Henke’s Journal. A young man who -got an arsenical solution from an old woman to cure ague, was attacked -after taking it with vomiting and loud cries, afterwards with incoherent -talking, then fell into a deep sleep, and finally perished in -convulsions in five hours.[642] - -In some cases of the kind now under consideration, one or two attacks of -vomiting occur at the usual interval after the taking of the poison; but -it seldom continues. The most uniform and remarkable affection is -extreme faintness, amounting at times to deliquium. Occasionally there -is some stupor, or rather oppression, and often slight convulsions. Pain -in the stomach is generally present; but it is slight, and seldom -accompanied with other signs of internal inflammation. Death commonly -takes place in a few hours. Yet, even when it is retarded till the -beginning of the second day, the faintness and stupor are sometimes more -striking features in the case than the symptoms of inflammation in the -stomach. - -This variety of poisoning has been hitherto observed only under the -three following circumstances,—when the dose of poison was large,—when -it was in little masses,—or when it was in a state of solution. The mode -in which the first and last circumstances operate is evident; they -facilitate the absorption of a large quantity of arsenic in a short -space of time, so that its remote action begins before local -inflammation is fully developed. But it is not easy to see how any such -effect can flow from the arsenic being in little masses. It is also to -be observed that none of the circumstances here mentioned is invariable -in its operation. An instance is related in Rust’s Magazine, of the -customary signs of irritation having been produced even by the -solution.[643] - -On the whole, the present variety of poisoning is rather uncommon, and -indeed, although the attention of the profession was pointedly called to -it even in the first edition of the present work, its existence does not -seem to be so generally known as it ought to be.[644] It may be right -therefore to specify the cases which have been published. - -In the Medical and Philosophical Journal of New York,[645] is related -the case of a druggist, who swallowed an ounce of powdered arsenic at -once, and died in eight hours, after two or three fits of vomiting, -with slight pain and heat in the stomach.—A similar case has been -related by Metzger. A young woman died in a few hours, after suffering -from trivial diarrhœa, pain in the stomach and strangury; her death -was immediately preceded by slight convulsions and fits of -suffocation; and on dissection the stomach and intestines were found -quite healthy. Half an ounce of arsenic was found in the -stomach.[646]—A third case similar in its particulars to the two -preceding was submitted to me for investigation by the sheriff of this -county in 1825. The subject, a girl fourteen years of age, took about -ninety grains, and died in five hours, having vomited once or twice, -complained of some little pain in the belly, and been affected towards -the close with great faintness and weakness. The stomach and -intestines were healthy.[647]—A fourth case allied to these is -succinctly told in the Medical and Physical Journal. The person -expired in five hours; and vomiting never occurred, even though -emetics were given.[648]—A fifth has been related by M. Gérard of -Beauvais. The subject was a man so addicted to drinking, that his -daily allowance was a pint of brandy. When first seen, there was so -much tranquillity, that doubts were entertained whether arsenic had -really been swallowed; but at length he was discovered actually -chewing it. This state continued for nearly five hours, when some -vomiting ensued: coldness of the extremities and spasmodic flexion of -the legs soon followed; and in a few minutes more he expired.[649]—A -sixth and very singular case of the same kind has been described by -Orfila. The individual having swallowed three drachms at eight in the -morning, went about for two hours bidding adieu to his friends and -telling what he had done. He was then prevailed on to take emetics and -diluents, which caused free, easy vomiting. He suffered very little -till one, when he became affected with constricting pain and burning -in the stomach, feeble pulse, cold sweats, and cadaverous expression, -under which symptoms he died four hours later.[650] Orfila justly -designates this case as the most extraordinary instance of poisoning -with arsenic that has come under his notice.—A seventh is related by -Mr. Holland of Manchester where death took place in the course of -eight or nine hours, and the symptoms were at first some vomiting, -afterwards little else but faintness, sickness, a sullen expression, -and a general appearance which led those around to suppose the -individual intoxicated.[651]—Professor Chaussier has described a still -more striking case than any yet mentioned. A stout middle-aged man -swallowed a large quantity of arsenic in fragments and died in a few -hours. He experienced nothing but great feebleness and frequent -tendency to fainting. The stomach and intestines were not in the -slightest degree affected during life; and no morbid appearance could -be discovered in them after death,[652]—A similar instance not less -remarkable has been communicated to me by Mr. Macauley of Leicester, -where the individual died with narcotic symptoms only within two hours -after taking nearly a quarter of a pound of arsenic.—Another fatal in -four hours has been described by Mr. Wright, where the symptoms were -vomiting under the use of emetics, great exhaustion, feeble hurried -pulse, cold sweating, drowsiness and finally stupor. In this case the -quantity of arsenic taken was about an ounce.[653]—Another of the same -nature is recorded by Morgagni. An old woman stole and ate a cake, -which had been poisoned with arsenic for rats. She died in twelve -hours, suffering, says Morgagni, rather from excessive prostration of -strength than from pain or convulsions.[654]—The following case -related by M. Laborde is most remarkable in its circumstances. A young -woman was caught in the act of swallowing little fragments of arsenic, -and it afterwards appeared that she had been employed most of the day -in literally cracking and chewing lumps of it. When the physician -first saw her the countenance expressed chagrin and melancholy, but -not suffering. After being forced to drink she vomited a good deal, -but without uneasiness. Two hours afterwards her countenance was -anxious; but she did not make any complaint, and very soon resumed her -tranquillity. Five hours after the last portions of the poison were -taken she became drowsy, then remained perfectly calm for four hours -more, and at length on trying to sit up in bed, complained of slight -pain in the stomach, and expired without agony. A clot of blood was -found in the stomach.[655]—Dr. Platner of Pavia describes a case, -fatal probably in five hours, where the symptoms were a tranquil, -melancholic expression, great coldness, paleness of the features, slow -languid pulse, retarded respiration, and suppression of urine, but no -pain or swelling of the belly, and no diarrhœa till near death, when -there was one copious fluid evacuation.[656]—Lastly, Dr. Choulant has -related the case of an elderly female who got a thimbleful of arsenic -in soup, and died in eleven hours, affected with occasional, easy -vomiting, uneasiness, thirst, and undefinable uneasiness in the chest, -but without pain of any kind, or any other complaint.[657] - -The cases of which an abstract has here been given, will, it is -apprehended, be sufficient to correct the erroneous impression of -many,—that arsenic, when it proves fatal, always produces violent and -well-marked symptoms. It will of course be understood that cases of the -present kind pass by insensible shades into those of the first -class,—the following, for example, being intermediate between the two. A -young man had frequent vomiting and diarrhœa, which were supposed to -depend on indigestion merely, as the countenance was calm, without any -appearance of suffering, the appetite tolerable, and the abdomen quite -free of tenderness. The pulse, however, quickly sunk, the voice failed, -and death took place in eleven hours; and on dissection about twenty -grains of arsenic were found in the stomach with strong signs of -inflammation.[658]—In a case communicated to me by a former pupil, Mr. -Adams of Glasgow, that of a woman who died five hours after taking six -drachms of arsenic, there was some vomiting not long after she swallowed -it; but subsequently she presented no prominent symptoms except a -ghastly expression, redness of the eyes, a fluttering pulse and extreme -prostration, until within half an hour before death, when the action of -an emetic and the stomach-pump was followed by severe burning pain. - -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 in -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 course 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. - -Dehaen 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 knee-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 opponents 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 symptoms 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 -recovery. 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 gradual 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 part 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 with 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 membrane -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] - -The 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 for 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, however, 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 body, -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 feebleness 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 doubting 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 the 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 stomach. 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] - -In the ordinary cases in which death is delayed till the second day or -later, a considerable variety of diseased appearances has been observed. -They are the different changes of structure arising from inflammation in -the alimentary canal, in the organs of the chest, and in the organs of -generation—together with certain alterations in the state of the blood -and condition of the body generally. - -The first set of appearances to be mentioned are those indicating -inflammation of the alimentary canal, viz., redness of the throat and -gullet,—redness of the villous and peritonæal coats of the stomach, -blackness of its villous coat from extravasation of blood into it, -softening of the villous coat, ulceration of that as well as of the -other coats, effusion of coagulable lymph on the inner surface of the -stomach, extravasation of blood among its contents,—finally, redness and -ulceration of the duodenum and other parts of the intestinal canal, and -more particularly of the rectum; to which may also be added, though not -properly a morbid phenomenon, certain appearances put on by the arsenic -which remains undischarged. - -Redness of the throat and gullet is not common, at least it does not -often occur in the descriptions of cases. Jaeger, however, says that in -his experiments he usually found redness at the upper and purplish -stripes at the lower end of the gullet:[717] and Dr. Campbell likewise -found the gullet red in animals,[718] Similar appearances have also been -remarked in man. In the case of a man who lived eight days, Dr. Murray -found the gullet very red;[719] in that of a woman who lived scarce -seven hours, Dr. Booth observed the gullet inflamed downwards very -nearly to the cardia;[720] and Wildberg has reported two cases of the -same nature, in one of which it is worthy of remark that the poisoning -lasted only six hours.[721] On the whole, it appears probable that -inflammation of the throat and gullet would be found more frequently in -the reports of cases, if it was more carefully looked for. - -Redness of the inner coat of the stomach is a pretty constant effect of -arsenic, when the case is not very rapid. All the varieties of redness, -formerly mentioned among the effects of the irritant poisons generally, -may be produced by arsenic. There is nothing, however, in the redness -caused by this poison, any more than in the redness of inflammation -generally, by which it is to be distinguished from the pseudo-morbid -varieties. (See p. 110.) - -It is singular, that, however severe the inflammation of the inner -membrane of the stomach may be, inflammatory redness of the peritonæal -coat is seldom found. Yet inflammatory vascularity does occur sometimes -on the peritonæal coat. Sproegel found it in animals;[722] and it was -present in the case of the girl Warden, whose death gave rise to the -trial of Mrs. Smith.[723] Dr. Nissen, a Danish physician, has related -another case in which the external coat of the stomach appeared as if -minutely injected with wax. But the patient had been attacked with -incarcerated hernia during the progress of his illness, and the whole -peritonæal membrane was in consequence inflamed.[724] A common -appearance when the internal inflammation is well marked, and one often -unwarily put down as inflammation of the peritonæum, is turgescence of -the external veins, sometimes so great as to make the stomach look -livid. - -Blackness of the villous coat from effusion of altered blood into its -texture is sometimes met with. When the colour is brownish-black, or -grayish-black, not merely reddish-black, when the inner membrane is -elevated into firm knots or ridges by the effusion, and the black spots -are surrounded by vascularity or other signs of reaction, the -appearances strongly indicate violent irritation. I have already said -that such appearances are never imitated by any pseudo-morbid -phenomenon. - -One of the most remarkable appearances occasionally observed in the -stomach in those instances where the body has been buried for at least -some weeks before examination, is the presence of bright yellow patches, -of various sizes, which appear as if painted with gamboge, and obviously -arise from the oxide of arsenic diffused throughout the tissues having -been decomposed and converted into sulphuret of arsenic by the -sulphuretted-hydrogen disengaged during putrefaction. I have witnessed -this appearance in several cases. In the case mentioned at p. 247, where -the body had been buried twenty days, numerous brilliant yellow patches -were visible on the villous coat of the stomach. In the case of a female -who was poisoned about the same time with that man, and, as was -suspected, by the same individual, the body was not examined till three -months after interment; and here broad, bright, yellow patches, -disappearing under the action of ammonia, were found under the -peritonæal coat of the left end of the stomach, the adjoining great -intestine, and also the muscular parietes of the abdomen. In the case of -Mr. Gilmour, for whose murder his wife was tried a few months ago in -this city, but acquitted,—and who undoubtedly died of poisoning with -arsenic, howsoever administered,—there were found fourteen weeks after -death numerous yellow streaks and patches both on the inner surface of -the stomach, on its outer surface under the peritonæum, on the adjoining -transverse colon, and on the small intestines in contact with the -stomach. From these and other parallel facts which have been -occasionally noticed by the periodical press, it seems probable that the -appearance in question is common in bodies which have been some time -buried. It is an extremely important part of the pathological evidence. -I doubt whether natural causes can occasion any appearance similar to -it. And indeed, what is it but the effect of a chemical test applied to -the poison by nature? - -The next appearance which may be mentioned is unnatural softness of the -villous coat of the stomach. This coat has certainly been often found, -after death from arsenic, unusually soft, brittle, and easily separable -with the nail.[725] But the same state occurs in dead bodies so often -and so unconnected with previous symptoms of irritation in the stomach, -that it cannot with any certainty be assumed as the effect of irritation -when it is found subsequently to such symptoms. So far from softening -and brittleness being a necessary effect of the irritation produced by -arsenic, it is a fact that a condition precisely the reverse has been -also noticed. In a case which I examined, the villous coat, except where -it had been disintegrated by effused blood and ulceration, was strong -and firm; and the rugæ were thickened, raised and corrugated, as if -seared with a hot iron.[726] Metzger once found the mucous membrane -dense, thickened, and the rugæ like thick cords.[727] Pyl too once met -with the same appearance, and ascribes the thickening to gorging of -vessels;[728] and in a case related by Dr. Wood of Dumfries, where I had -an opportunity of examining the stomach, this appearance was present in -a remarkable degree, and it clearly arose from elevation of the villous -coat by effusion of blood under it.[729] Remer, in his edition of -Metzger’s Medical Jurisprudence, says he once met with an instance where -the stomach was shrivelled like a bladder subjected to boiling -water.[730] - -Sometimes the villous and also more rarely the other coats of the -stomach are found actually destroyed and removed in scattered spots and -patches. This loss of substance is occasionally owing to the same action -which causes softening and brittleness of the villous coat,—the action, -however, having been so intense as to cause gelatinization. That such is -the nature of the process appears from the breach in the membrane being -surrounded by gelatinized tissue, and not by an areola of inflammatory -redness. Of this species of destruction of the coats I have seen a -characteristic example.[731] But in other cases the loss of substance is -owing to a process of ordinary ulceration, as is proved by the little -cavities having a notched irregular shape, and being surrounded both by -a red areola and a margin of firm tissue. This was the character of the -ulcers in the case of Warden, which I have described elsewhere.[732] -Destruction of the coats of the stomach by ulceration is not a very -common consequence of poisoning with arsenic, as death frequently takes -place before that process can be established. It does not often occur, -unless the patient survive nearly two days. Mr. Alfred Taylor, however, -mentions a case fatal in seventeen hours where he found ulceration of -the stomach, and another fatal in ten hours where several small ulcers -were seen on the lesser curvature, and two nearly circular ones as big -as a sixpence.[733] Mr. Hewson too informs me he found many eroded spots -even in his case which proved fatal in five hours (p. 56). I suspect, -however, that spots of healthy membrane surrounded by vascular redness -are sometimes mistaken for ulcers in such cases; for indeed nothing can -more exactly resemble them. In many general works on Medical -Jurisprudence, and in some express treatises on arsenic, it is stated -that this poison may cause complete perforation of the stomach.[734] But -this effect is exceedingly rare. I have related one distinct example of -it;[735] Professor Foderé has briefly alluded to a case he witnessed -which proved fatal in two days and a half;[736] I have likewise found in -an account of a trial in North America, an instance in which the stomach -was perforated by numerous small holes, so that when held before the -light it appeared as if riddled like a sieve;[737] but I have not been -able to find in medical authors any farther authority for the general -statement. Destruction of the coats of the stomach as produced by -arsenic has been variously described by authors under the terms erosion, -corrosion, dissolution, ulceration. But the correct mode of describing -it appears to be by the terms gelatinization, or ulceration, according -to the nature of the diseased action by which it is induced. At all -events it is necessary to beware of being misled by the terms erosion, -corrosion, and the like, which all convey the idea of a chemical action; -while it is well ascertained that a chemical action either does not -exist at all between arsenic and the animal tissues, or, if it has -existence, tends to harden and condense rather than to dissolve or -corrode them. Arsenic is not a corrosive. - -Another species of destruction of the coats of the stomach, which will -require a little notice, is sloughing or gangrene. This appearance -occurs frequently in the narratives of the older writers; but it has not -been enumerated in the list of morbid appearances at the commencement of -this section, because its existence as one of the effects of arsenic is -problematical. It has not been witnessed so far as I know by any recent -good authority. Those who have mentioned it have probably been misled by -the appearance put on by the black extravasated patches, when they are -accompanied by disintegration of the villous coat and effusion of clots -of black blood on its surface—an appearance which resembles gangrene -closely in everything but the fetor. Sir B. Brodie has stated that Mr. -John Hunter has preserved in his museum, as an example of a slough of -the villous coat caused by arsenic, which turned out on examination to -be nothing else than an adhering clot.[738] It is clear too, that, when -Mr. James speaks of having found “several gangrenous patches” on the -villous coat of the stomach, and “patches of sphacelus” in the -intestines, on examining the body of a notorious French criminal, -Soufflard, who poisoned himself with arsenic in prison in 1839, he -mistook for gangrene what was merely extravasation; for the man lived -only twelve hours.[739] - -Various secretions have been found on the inner surface of the stomach. -The mucous secretion of the inner membrane is generally increased in -quantity. Frequently it is thin, but viscid, as in its natural state; -but sometimes it is both abundant and solid, as if coagulated; and then -it forms either a uniform attached pellicle, or loose shreds floating -among the contents.[740] In both forms it has been mistaken for the -mucous membrane itself. I believe this increased secretion and -preternatural firmness of the gastric mucus cannot take place without -some irritating agent being applied to the stomach. Both may occur -without any other sign of inflammation in the mucous membrane. In a case -of suicide after seduction which came under my notice in this city in -1843, and which proved fatal in five hours [p. 239], the mucus in the -stomach, which was very abundant, put on the appearance of curdled milk, -owing to its being rendered opaque and white by the large quantity of -finely powdered arsenic diffused through it; and it was actually -mistaken for curdled milk by several medical men.—Sometimes the matter -effused is true coagulable lymph. This is rarely seen as the effect of -arsenic. I have remarked it, however, very distinctly in dogs, and Dr. -Baillie saw it once in the human subject.[741] It is of course quite -decisive of the presence of inflammation. It is known from tough mucus, -to which it bears some resemblance, by its reticulated disposition, and -by the threads of the reticulation corresponding with inflamed lines on -the stomach beneath. - -Another very common appearance is the presence of a sanguinolent fluid, -or even actual blood in the cavity of the stomach. In several of the -cases which have come under my own notice, the subject of analysis was a -thick, dirty brownish-red fluid, evidently containing a large proportion -of blood; and many other examples of the same nature are on record.[742] -In Laborde’s case formerly mentioned actual clots were found among the -contents; in the instance of a woman who died in five days, as related -by Zittmann, half a pound of coagulated blood was found in the -stomach;[743] and in another case mentioned by Professor Bernt, the -stomach contained no less than three pounds of black ichor mixed with -clots of blood.[744] A good deal of reliance has been placed on bloody -effusion in proof of the administration of arsenic or some other active -irritant. It is of some importance, as it appears not to be an effect of -that irritation which causes cholera. - -Among the appearances observed in the stomach the presence of arsenic -may be included, though not properly speaking a morbid appearance. Under -the head of the medical evidence of poisoning generally it was stated, -that many causes conspire to remove from the stomach during life poisons -which have actually caused death. In addition to the illustrative cases -there alluded to, I may here also refer to an interesting case -communicated to me by Mr. J. H. Stallard, and already noticed for a -different purpose [p. 235]. Arsenic in no large quantity had been -swallowed in tea, and death took place in four hours only. Here none of -the poison could be detected by Marsh’s process, either in the contents -of the stomach, or in its tissues, or in the liver.—In the instance of -arsenic, however, the operation of the causes which tend to remove the -poison is prevented by various circumstances, in particular by its -insolubility and firm adhesion to the stomach. Hence it happens, that -even after long-continued vomiting a portion still generally remains -behind, either in the contents of the stomach or in its tissues. -Sometimes the arsenic exists dissolved in the contents; more commonly it -is present there in the solid form; and is then either in loose -particles, or enveloped in coagulated mucus,[745] or in little clots of -blood,[746] or is wrapped up in the more solid parts of the -contents.[747] Frequently it adheres to the coats of the stomach, and is -then either scattered in the form of fine dust or collected in little -knots. The adhering particles are always covered by mucus; they are -often surrounded by redness of the membrane or by effused blood; and -sometimes they are imbedded in little ulcers.—A remarkable appearance -which the arsenic sometimes puts on is a brilliant yellowness of its -surface, owing to its conversion into the sulphuret. This appearance -existed in six cases which have come under my own notice, first in one -related in the Edinburgh Medico-Chirurgical Transactions,[748] next in -the instance of Margaret Warden,[749] again in the case of a young woman -whose death gave rise to the trial of John Lovie held at Aberdeen in the -Autumn Circuit of 1827, again in a case described by Dr. Wood, which I -had an opportunity of examining;[750] and lastly, in two others which I -had occasion to examine in 1842 and 1843. In one of these, the case of -Mr. Gilmour, adverted to at p. 265, Drs. Wylie and M’Kinlay, who -examined the body in the country, found the inner surface of the stomach -thickly sprinkled with small yellow particles, some of which were very -bright. In all of these cases oxide was found, as well as the sulphuret -of arsenic. In the case related by Dr. Nissen [p. 264], a similar yellow -appearance, observed on the surface of the arsenic, was ascribed with -justice to the action of sulphuretted hydrogen-water, which had been -given as an antidote during life.[751] In a very important case examined -here a few years ago by my colleague Dr. Traill, and which will be -noticed more particularly for a different purpose afterwards, this -conversion of the oxide into sulphuret had taken place to a great extent -[p. 277]. In every instance of the kind yet examined, however, the -conversion has been only partial, so that a large proportion of oxide -could easily be detected by the usual process. - -Care must be taken not hastily to consider as arsenic every white powder -which may be found lining the inside of the stomach. Many other white -powders may obtain entrance from without; and besides, small, white, -shining, pulverulent scales, not unlike finely powdered arsenic, but -rarely composed of animal matter, sometimes form naturally on the mucous -coat of the stomach and intestines. In a medico-legal report published a -few years ago, Professor Orfila has noticed two instances in which these -scales were mistaken for arsenic;[752] in another published not long -after he mentions that he found white particles which crackled when -bruised, and appeared brilliant before the microscope, and which -nevertheless were not arsenic.[753] Buchner too says he is acquainted -with an instance where, in a medical inspection on account of a -suspicion of poisoning, the villous coat of the stomach was found lined -with a white granular substance which presented the properties of a fat -and contained no mineral admixture;[754] and in the case of Warden I -remarked a similar appearance, which, as arsenic was found in the -stomach, I was disposed to consider a sprinkling of that poison, until -the contrary was ascertained by analysis. The present caution, -therefore, is not superfluous. - -In a few cases the stomach is the only situation where morbid -appearances are visible, even though life has been prolonged for so much -as two days. This state of matters is well exemplified by a French case -of death in forty-three hours, where the stomach presented much redness -and extravasated patches, but where the intestines, the larynx and the -contents of the head and chest were in a natural condition.[755] Such -limitation, however, of the diseased appearances are rare. - -Redness of the mucous membrane of the intestines is often present when -the stomach is much inflamed. Dissolution of the mucous coat is much -less frequent in the intestines than in the stomach. Ulceration -occasionally occurs in lingering cases. In the case of Mitchell, which -has been several times alluded to, the inner coat of the duodenum was -dark-red, pulpy, thickened, easily separable; and on a spot as big as a -crown piece, both the inner and the muscular coats were wanting.[756] -Perforation of the small intestine was found in a case communicated to -me by Mr. Sandell, and detailed at page 277. But as the person survived -only eight hours, and had laboured under symptoms of disease in the -bowels for some days before taking the arsenic, it is unlikely that this -appearance, which has not been observed, to my knowledge, in any other -instance, arose from the action of the poison. - -The signs of inflammation are seldom distinct in the small intestines -much lower down than the extremity of the duodenum; and they do not -often affect the colon. But the rectum is sometimes much inflamed, -though the colon, and more particularly the small intestines, are not. -Dr. Male mentions, that in man he has found the rectum abraded, -ulcerated, and even redder than the stomach itself;[757] and Dr. Baillie -also notices two cases in which the lower end of the rectum was -ulcerated.[758] A common appearance in lingering cases is excoriation of -the anus,[759] and it is said that even gangrene has been produced.[760] - -A late writer draws attention to the fact that in the only two fatal -cases he had seen the whole colon was contracted to an extraordinary -degree;[761] and this state is mentioned in other cases. The appearance -deserves notice; but of course whatever empties the colon thoroughly -will have the same effect. - -The chief appearances in the alimentary canal have now been mentioned. -The next quarter in which deceased appearances are to be met with is the -cavity of the chest. Here are sometimes seen redness of the pleura, -redness and congestion of the lungs, redness of the inner surface of the -heart, and redness of the lining membrane of the windpipe. - -Redness of the diaphragmatic part of the pleura, or even of the whole of -that membrane, has been at times observed; as one would expect, indeed, -from the pectoral symptoms which occasionally prevail during life. -Inflammation of the lungs themselves has also been noticed. Dr. Campbell -twice found great congestion of blood in the lungs of animals poisoned -by the application of arsenic outwardly.[762] Sproegel likewise found -the pleura, pericardium, and whole lungs deeply inflamed in -animals.[763] Dr. Venables found the pleura of a bright crimson colour -in some poultry maliciously poisoned with arsenic,—more redness there -indeed than in the stomach.[764] Mr. James says that in his experiments -on animals he constantly found the lungs much gorged with blood, unless -when death occurred quickly; but that he could see no evidence of the -congestion being inflammatory.[765] A distinct example of advanced -pneumonia in man is related in Pyl’s Magazine: the patient died after -vomiting and purging incessantly for eight days; and on dissection the -lungs were found “in the highest state of inflammation; and so congested -as to resemble a lump of clotted blood.”[766] A distinct case of the -same nature is related in Henke’s Journal; this patient had obvious -pneumonic symptoms during life; and in the dead body the lungs were -found so gorged, that, on being cut into, nothing could be seen but -clotted blood in their cellular structure.[767] In a case formerly -adverted to [p. 252] of death from arsenic applied externally for -scirrhus, excessive congestion was found in the lungs, “both lungs being -completely gorged with blood, and presenting all the characters of -pulmonary apoplexy.”[768] In another described by Dr. Booth of -Birmingham, where death occurred in seven hours only, the lungs -presented sufficient congestion to have completely impeded -respiration.[769] - -It has been alleged that the inner surface of the heart has been found -red from inflammation. In a case examined judicially at Paris by Orfila, -the left cavities of the heart were of a mottled red hue, and in the -ventricle were seen many small crimson specks which penetrated into the -muscular part of the parietes. The right cavities had a deep -reddish-black tint, and the ventricle of that side contained specks like -those in the other, but more faint. Orfila adds, that he had previously -seen the same appearance in animals.[770] These observations are not -satisfactory. There is no evidence that the observer drew the -distinction between the redness of inflammation, and that produced by -the dyeing of the membrane with blood after death. The subject was -afterwards brought before the Royal Academy of Medicine at Paris by M. -Godard, who had also observed the appearance in question in a person -killed by arsenic, and who dwelt strongly on it as characteristic of -this species of poisoning. It was distinctly proved, however, by many -members present that the appearance arises from various other -causes.[771] - -The inner membrane of the windpipe is said to be sometimes affected with -inflammatory redness. Jaeger found it so in animals;[772] and the -symptoms referrible to the windpipe during life would lead us to expect -the same thing in man. - -The organs of generation are occasionally affected. The penis in the -male and the labia in the female have been found distended and black; in -an interesting case related by Bachmann the external parts of generation -(in a female) were surrounded by gangrene;[773] and in a case related in -Pyl’s collection the inside of the uterus and Fallopian tubes was -inflamed.[774] It is probable that signs of inflammation in the internal -organs of generation will be found if there have been corresponding -symptoms during life. But in truth this part of the pathology of -poisoning with arsenic has not been particularly attended to. - -To complete this account of the morbid appearances of the mucous -membranes, it may be added that the conjunctiva of the eyes frequently -presents vascularity and spots of extravasation.[775] - -It now only remains, under the head of the morbid appearances produced -by arsenic, to mention certain alterations that are said to take place -in the state of the blood and general condition of the body. - -With regard to the state of the blood Sir B. Brodie observes in general -terms, that in animals killed by arsenic it is commonly fluid.[776] -Harles, on the authority of Wepfer, Sproegel, and Jaeger, says it is -black, semi-gelatinous, and sometimes pultaceous.[777] Novati alleges -that the blood after death is without exception black and liquid as -after cholera, of a blackish-purple tint that colours linen -reddish-brown, viscid, opaque, and without any trace of -coagulation.[778] In a fatal case related by Wildberg the blood was -everywhere fluid.[779] This condition, however, is not uniform; for Dr. -Campbell found the blood coagulated in the heart of a rabbit;[780] and -Wepfer found it also coagulated in the dog.[781] - -It has been stated by some authors in medical jurisprudence that the -dead body occasionally exhales an aliaceous odour, resembling that of -sublimed arsenic. This is a very questionable statement. The only fact -of the kind worth mentioning is one brought forward by Dr. Klanck, as -occurring in the course of certain experiments, which will presently be -noticed, on the antiseptic virtues of arsenic. Several animals which had -been killed with arsenic are said to have exhaled an odour like that of -sublimed arsenic from three to eight weeks after death.[782] - -A great discordance of opinion at one time prevailed among authors, as -to the influence of arsenic on the putrefactive process in the bodies of -those poisoned with it. The vulgar idea, borrowed probably from the -ancient classics, that the bodies of those who have been poisoned decay -rapidly, was till lately the prevalent doctrine of medical men, and even -of medical jurists; and it was applied to arsenic as well as other -poisons. Even so lately as 1776 we find Gmelin stating in his History of -Mineral Poisons, that the bodies of those who have died of arsenic pass -rapidly into putrefaction, that the nails and hair often fall off the -day after death, and that almost the whole body quickly liquefies into a -pulp.[783] A similar statement has been made in 1795 by a respectable -author, Dr. John Johnstone.[784] It appears that this rapid or premature -decay does really occur in some instances. Thus in a case related by -Plattner of death from arsenic administered as a seasoning for -mushrooms, the body had a very putrid odour the day after death.[785] -Loebel also asserts he found by experiments on animals, that after death -from arsenic putrefaction took place rapidly, even in very cold -weather.[786] - -In other instances the body probably decays in the usual manner. For -example, in Rust’s Magazin is related the case of a child who died in -six hours of poisoning with arsenic, and in whose body, fourteen days -after death, the integuments were found considerably advanced in -putrefaction, and the liver and kidneys beginning to soften.[787] In the -case of a man who died in two days, and in whose body arsenic was found -by MM. Chapeau and Parisel throughout many of the tissues, “putrefaction -was so far advanced eight days after death as to render the examination -of parts obscure.”[788] And in the course of some experiments on dogs -poisoned with the oxide Dr. Seeman found the usual changes after five -months’ interment.[789] - -But it has been proved in recent times that in general arsenic has -rather the contrary tendency—that, besides the antiseptic virtues which -it has been long known to exert when directly applied in moderate -quantity to animal substances, it also possesses the singular property -of enabling the bodies of men and animals poisoned with it both to -resist decay unusually long, and to decay in an unusual manner. The -observations and inquiries which have been made abroad on this subject -were little known any where else than in Germany before the publication -of the earlier editions of the present work; but parallel examples have -been since met with both in Britain and France; and in this country the -importance of the subject is generally appreciated. - -The first occasion on which the antiseptic property of arsenic was -brought under public notice was about the beginning of the present -century, in the course of the trial of the widow of a certain -state-councillor, Ursinus of Berlin. Some time before that Dr. Welper, -then medical inspector in the Prussian capital, having remarked that the -body of a person poisoned with arsenic remained quite fresh for a whole -week in summer, he attended carefully to the subject at every -opportunity, and invariably, he says, found that the body resisted -putrefaction. Not long after making this remark, he was concerned in -1803, by virtue of his office, in the investigations in the case of the -widow Ursinus. This lady having been discovered in an attempt to poison -her servant, suspicions arose regarding the previous sudden death of -three persons in her family, her husband, a young officer who had -carried on an amour with her, and an aunt from whom she derived an -inheritance. They had all died in mysterious circumstances, and the lady -had been their only nurse. Dr. Welper disinterred the bodies of the -husband and aunt, which had been buried, the former two years and a half -before at Berlin, the latter half a year afterwards at Charlottenberg; -and he found them not putrid, but dried up; and specks of an appearance, -which is described as being gangrene, but which was probably warty -extravasation, were visible in the stomach. Arsenic could not be -detected. - -He afterwards got Dr. Klanck, his acquaintance, to make some express -experiments on animals; and the results were strikingly conformable. In -dogs poisoned with arsenic and left for two months sometimes buried in a -damp cellar, sometimes exposed to the air of the cellar, the flesh and -alimentary canal were red and fresh, as if pickled; and though the place -where the carcases were subsequently buried again was flooded for eight -months after, the intestines were eventually found entire and red, the -fat converted into adipocire, and most of the muscles unaltered,—those -only being soft and greasy which were directly acted on by the water. -From a set of comparative experiments which were made on dogs killed by -blows, or poisoned by corrosive sublimate, or by opium, Klanck found, -that, after being buried in the same place, and for the same space of -time the whole soft parts of the carcases were converted into a greasy -mass. In a subsequent year he repeated his experiments, the bodies, -however, being this time left exposed to the air of the cellar. The -experiments were commenced in the month of August. In ten days there -appeared slight signs of incipient putrefaction; a faint putrid smell -was exhaled, and all flies that settled on the carcase died. This state -continued for eight or ten weeks without increasing. After that the soft -parts began to grow firmer and drier, and at the same time the putrid -odour was succeeded by a smell like that of garlic, which became -insupportably strong when the carcases were removed into warm air. The -bodies, three years afterwards, still continued dry and undecayed.[790] - -A similar set of facts was again brought before the public between 1809 -and 1811, during the criminal proceedings in a case like that of the -widow Ursinus, tried first at Bayreuth and afterwards by appeal at -Munich. A lady near Bayreuth died of five days’ illness, under symptoms -of violent general irritation of the alimentary canal. Some months -afterwards a variety of circumstances having raised a suspicion that she -had been poisoned by her maid, Margaretha Zwanziger, a judicial -investigation was set on foot; the consequence of which was, that the -same woman came under suspicion of having also previously poisoned -another lady and a gentleman with whom she had been successively in -service. The bodies of the three people were accordingly disinterred, -one of them five months, another six months, and the third fourteen -months after death. In all of them the external parts were not properly -speaking putrid, but hard, cheesy, or adipocirous; in the last two the -stomach and intestines were so entire as to allow of their being tied, -taken out, cut up, and handled; and in one a sloughy spot was found in -the region of the pylorus. Arsenic was detected in two of the bodies by -Rose’s process of analysis.[791] - -The next example to the same effect which will be mentioned is perhaps -the most satisfactory of all, because it was the result of an express -experiment on the human subject. Dr. Kelch of Königsberg buried the -internal organs of a man who had died of arsenic, and whose body had -remained without burial till the external parts had begun to decay; and -on examining the stomach and intestines five months after, he found that -the hamper in which they were contained was very rotten; but that “they -had a peculiar smell, quite different from that of putrid bowels, were -not yet acted on by putrefaction, but as fresh as when first taken from -the body, and might have served to make preparations. They had lost -nothing of their colour, glimmer, or firmness. The inflamed spots on the -stomach had not disappeared, and the small intestines also showed in -some places the inflammatory redness unaltered.”[792] - -In a recent French case, although the degree of preservation was less -remarkable, the other circumstances are so striking as to render it well -worthy of notice. In this instance the body was disinterred after having -been seven years in the ground, in a high situation and sandy soil. The -coffin, which was of oak, had become dry and brittle, and no moisture -appeared on the inside. The body was entire: the head, trunk, and limbs -retained their situation; but the organs of the chest and belly were -converted into a brown soft mass of the consistence of plaster, which -lay on each side of the spine. In this mass MM. Ozanam and Idt, the -medical inspectors, succeeded in discovering by chemical analysis a -considerable quantity of arsenic.[793] - -M. Ollivier describes another French case, where the body had been -buried for three years, and was found so completely dried up that the -trunk weighed only two pounds. The integuments were entire, dark-brown, -and of a faint odour like decayed wood. The organs of the chest and -belly were confounded together in a foliaceous membranous mass, in which -the liver only could be distinguished, but in an exceedingly shrivelled -state. Arsenic was detected in the membranous matter by MM. Barruel and -Henri. The preservative power of the arsenic was promoted in this case -by the sandy nature of the soil.[794] - -In the case of the girl Warden, which has been several times alluded to, -the internal organs were also preserved somewhat in the same manner as -in the German cases. The body had been buried three weeks; yet the -mucous coat of the stomach and intestines, except on its mere surface, -was very firm, and all the morbid appearances were consequently quite -distinct. Nay, three weeks after disinterment, except that the -vascularity had disappeared, the membranes and the appearances in them -remained in the same state.[795] A similar case has been recorded by -Metzger. It is that of an old man who died of six hours’ illness, and in -whose stomach three drachms of arsenic were found. The body had been -kept ten days in February before burial, and was disinterred eight days -after that; yet there was not the slightest sign of putrefaction any -where.[796] A parallel case was described by myself in the Edinburgh -Medico-Chirurgical Transactions;[797] and I have met with three others -of the same kind since. - -In a very important case, that of Mrs. Smith, which was made the subject -of investigation at Bristol in December, 1834, the body was also found -in a state of great preservation, modified, however, by adipocirous -decomposition, owing to the presence of water in the coffin. The body -had been fourteen months interred. The internal parts, especially of the -head and neck, were here and there decayed somewhat or converted into -adipocire, the muscles and internal organs entire, though more or less -shrivelled, the alimentary tube remarkably preserved, “every part being -almost as distinct as if the inspection had been made at a very short -period after death,” “the mucous membrane sufficiently tenacious to be -lifted by the forceps in as large flakes as usual;” and the reporters, -Drs. Riley and Symonds, Messrs. Herapath and Kelson, seem to have had no -difficulty in ascertaining the absence of vascularity, extravasation, or -even abrasion of the inner membrane. Artificial orpiment, the -preparation proved to have been given [see p. 225], was found in the -stomach by Mr. Herapath, and the quantity appeared to be about half a -drachm.[798] - -A similar instance, very remarkable in all its circumstances, was -investigated here in 1834 by my colleague Dr. Traill to whom I am -indebted for the particulars. The master of a foreign vessel died in -about twenty-four hours, apparently of malignant cholera, at a small -port in the neighbourhood of Edinburgh: and the body was forthwith -buried. A suspicion, however, having arisen in his native country that -he had been poisoned by his mate, an inquiry was instituted at the -request of the foreign government; and the body was disinterred five -months after death. The face and neck was swollen, black, and decayed; -but the rest of the body was quite free of the usual signs of -putrefaction. The skin was white and firm, the muscles fresh, the lungs -crepitating, the liver and spleen much shrivelled, the stomach and -intestines entire throughout their whole tissues, and capable of being -handled freely without injury. On the mucous coat of the stomach several -dark patches of extravasation were found, likewise several spots and -large patches which presented on their surface a firmly adhering bright -yellow crust; and the contents of the stomach consisted of a -considerable quantity of yellow sandy matter of the consistence of -paste. The contents and adhering crusts were found to consist chiefly of -oxide of arsenic partially converted into sulphuret. In this instance, -as in that last described, the coffin contained water, owing to its -having laid in a sandy soil resting on clay. - -An important case of the same nature was communicated to me in 1843 by -Mr. Sandell of Potton, Bedfordshire, and afterwards published by Mr. -Hedly of Bedford. A man Dazley at Wrestlingford, affected with symptoms -of gastro-enteric irritation for five or six days, was seized with -sickness, vomiting, heat and constriction in the throat, and great -weakness, about an hour after getting a white powder from his wife; and -in eight hours he expired, without any suspicion of unfair usage arising -at the time. Suspicions, however, being entertained afterwards, the body -which had not been examined at first, was disinterred in five months, -during the month of March. The countenance was so entire as to be -recognisable. Adipocire had been formed in many places. The stomach and -intestines were “in a most perfect state of preservation,” as if death -had taken place only a few days previously. The stomach presented yellow -patches on its outer and inner surface,—was generally red over its -villous coat, which had also been abraded near the cardiac end,—and, -together with the small intestines, was lined with white powder and -contained more of it enveloped in much red mucus. This powder proved to -be arsenic. About the middle of the small intestines a small ulcerated -opening was found, through which some arsenic had escaped.[799] - -The following cases which have come under my own notice during the last -five years are also worthy of observation. In a case submitted to me on -the part of the crown in 1841, which has been adverted to above for -another purpose [p. 265], the body after being three months interred was -found with the head and face decayed and putrid; but the muscular -substance was little changed; and the inspectors were particularly -struck with the state of preservation of the body, and also with the -very distinct state of inflammation seen over almost the whole external -and internal surfaces of the alimentary canal,—a description, the -accuracy of which I had afterwards an opportunity of verifying. In the -case of Mr. Gilmour (p. 265), whose body had been buried 101 days, the -external parts were more decayed; but the alimentary canal appeared -equally entire both to the original inspectors, Drs. M’Kinlay and Wylie, -and likewise to myself three weeks later. But the following instance, in -which I was consulted in 1839, is the most remarkable one of the kind -that has hitherto occurred to me; because the observations then made -were the result of an express experiment in a medico-legal -investigation. The history of this case, which arose from small doses of -arsenic frequently administered, has been already given above in some -detail [p. 250]. Arsenic not having been detected in the contents or -tissues of the stomach, and the trial of the individual suspected of -giving the poison being necessarily postponed for some months, I -recommended that a third examination of the body,—for it had been twice -disinterred for inspection within ten days after death,—should be made -at as distant an interval as possible, in order to ascertain whether it -underwent preservation from decay. It was accordingly disinterred again, -five months after death. It had an ammoniacal, but not a putrid odour. -The skin was here and there covered with a thin sebaceous matter, at one -or two places stripped of the epidermis, but for the most part natural -in appearance, firm, and elastic. The nails were loose. The muscles of -the head and near the tops of the scapulæ were adipocirous, on the chest -and abdomen obscurely fibrous in texture and hardened, but elsewhere -unaltered, and “in the lower extremities so perfect that they might have -been used for an anatomical demonstration.” The liver and lungs were -also in a state of good preservation, and the latter crepitated when -cut. The other viscera had been removed at the previous examinations. - -It may be added that the experiments of Klanck on dogs adverted to above -have been more recently repeated by Hünefeld on rabbits and mice, with -precisely the same results. The animals were sometimes left in the air, -at other times buried, and generally in a moist place. In every instance -putrefaction made more or less progress at first; but in a few days a -peculiar garlicky odour arose, from which time the progress of decay -seemed to be arrested; and the bodies underwent a process of hardening -and desiccation which completely preserved them.[800] - -On considering attentively the illustrations now given, the toxicologist -can hardly doubt that in some cases arsenic has appeared both to retard -and to modify putrefaction in the bodies of persons poisoned with it. - -Assuming arsenic to have been the cause of the preservation of the -bodies, it becomes a point of consequence to account for its effect, and -more particularly to reconcile that effect with what has certainly been -noticed in other cases of poisoning with the same substance, namely, -ordinary rapidity of decay, if not actually an increased tendency to -putrefaction. - -At the outset of this part of the inquiry some light may be thrown upon -it by separating the local from the general operation of arsenic. - -Arsenic is a good preservative of animal textures when it is directly -applied to them in sufficient quantity. This is well known to stuffers -of birds and beasts, was experimentally ascertained by Guyton -Morveau,[801] and has come also under my observation.[802] It is now -likewise known to be an excellent substance for preserving bodies, when -injected in the form of solution into the blood-vessels. - -Hence, if in a case of poisoning the arsenic be not discharged by -vomiting, and the patient die soon, it will act as an antiseptic on the -stomach at least, perhaps on the intestines also; while the rest of the -body may decay in the usual manner. This is very well shown in a case -examined by Dr. Borges, medical inspector at Minden, fourteen weeks -after death. The stomach and intestines were firm, of a grayish-white -colour, and contained crumbs of bread, while all the other organs in the -belly were pulpy, and the external parts adipocirous.[803] It is also -equally well exemplified in a case that happened at Chemnitz so early as -1726, and which was examined five weeks after burial. The skin was every -where very putrid, but the stomach and intestines were perfectly -fresh.[804] In the case of Warden the appearances were precisely the -same. Three weeks after burial the Dundee inspectors found the external -parts much decayed, yet three weeks later the stomach and intestines -were found by myself in a state of almost perfect preservation. A -striking experiment performed by Dr. Borges on a rabbit will likewise -illustrate clearly the fact now under consideration. The rabbit was -killed in less than a day with ten grains of arsenic, and its body was -buried for thirteen months in a moist place under the eaves of a house. -At the end of this period it was found, that “the skin, muscles, -cellular tissue, ligaments and all the viscera, except the alimentary -canal, had disappeared, without leaving a trace; but the alimentary -canal from the throat to the anus, along with the hair and the bare -bones, was quite entire.”[805] - -In all of these cases arsenic was found in the body. In the rabbit -experimented on by Dr. Borges, above five grains of arsenic were -separated in the form of a metallic sublimate. - -But, on the contrary, if the arsenic is all or nearly all discharged by -vomiting, not only the body generally, but likewise even the stomach and -intestines, may follow the usual course of decay. Accordingly, in the -case of the child formerly quoted (273), where the body putrified in the -usual manner, only four grains and a half of arsenic had been taken; and -as it was swallowed in a state of solution and caused violent vomiting, -it must have been almost all ejected. Nay, in such circumstances, the -alimentary canal, in consequence of its unnatural supply of moisture and -incipient disorganization, may decay somewhat faster than other parts. -Thus Dr. Murray observed in the case of a man formerly mentioned (264), -who lived under violent gastritic symptoms for seven days, and vomited -much, that the stomach, which was removed for more minute examination, -decayed so rapidly that in twenty-four hours an examination was -impracticable, while the body in general rather resisted -putrefaction.[806] - -The preceding statements on the differences in the state of preservation -of the body after poisoning with arsenic are not then incapable of some -explanation. Nevertheless, it must be granted that the reasons assigned -will not account for all the apparent cases of the preservative powers -of arsenic. And especially they will not explain how the whole body has -sometimes resisted decay altogether, and become as it were mummified. It -is impossible to ascribe this preservation to the spelling power of the -arsenic diffused throughout the body in the blood; the quantity there -being extremely small. Consequently if the preservation of the bodies is -not occasioned by some accidental collateral cause (a mode of accounting -for the phenomena which seems inadmissible), this property of arsenic -must depend on its causing, by some operation on the living body, a -different disposition and affinity among the ultimate elements of -organized matter, and so altering the operation of physical laws on it. -There appears no sound reason for rejecting this supposition, especially -as it is necessary to admit an analogous change of affinities as the -only mode of accounting for a still more incomprehensible violation of -the ordinary laws of nature,—the spontaneous combustion, or -preternatural combustibility, of the human body. - -The following judicious observations by Harles on this subject are -worthy of attention:—“In regard,” says he, “to this singular property of -arsenic, now no longer doubtful, it should be remembered that certain -circumstances will limit or impair it, while others will favour or -increase it;—circumstances, for example, connected with the soil of the -burying-ground, or the air of the vaults where the bodies are deposited. -Different soils and different conditions of the air will materially -affect the decomposition of all bodies indiscriminately, and will -therefore affect likewise the antiseptic properties of arsenic. For it -would be absurd to ascribe to arsenic the power of preventing -putrefaction in all circumstances whatsoever,—a power which those who -make use of it for preserving skins know very well it does not possess, -and a power possessed by no antiseptic whatever, not even by -alcohol.”[807] - -An important consequence of the preservative tendency of arsenic is, -that in many instances the body in this kind of poisoning may be found -long after death in so perfect a state as to admit of an accurate -medico-legal inspection and a successful chemical analysis. In one of -his cases Dr. Bachmann detected arsenic in the stomach fourteen months -after interment; Dr. Borges had no difficulty in detecting it in an -animal after thirteen months; Mr. Herapath discovered it after -fourteen months in the human body; M. Henry detected it after three -years and a half, and obtained no less than seven grains of metallic -arsenic from the shrivelled viscera;[808] and MM. Ozanam and Idt found -it after the long interval of seven years.—The late experiments of -Orfila and Lesueur confirm the fact that arsenic may remain long in -contact with decaying animal matter, and yet continue in such a state -as to be easily detected.[809] It might be supposed that the poison -would pass off partly in the gaseous state by being converted into -arseniuretted-hydrogen, partly in the liquid state by becoming -arsenite of ammonia, a very soluble compound. But the fact -nevertheless is, that, notwithstanding these reasons for its -disappearance, it may be detected after the lapse of several years. - -Under the head of the diseased appearances left by arsenic in the dead -body, every change of structure has now been described which has been -mentioned by authors and supported by trustworthy statements. Another -set of appearances may still be noticed; but they are here separated -from the rest, because the author who first notices them has not been -supported in the statement by any special observations of his own, or by -an adequate number of facts observed by others. In an elaborate essay on -a case of poisoning by Professor Seiler of Wittemberg, it is said in -general terms that arsenic may cause gorging of the vessels of the -brain, effusion of serum into the ventricles, inflammation of the brain, -and even extravasation of blood.[810] Turgescence of vessels is -mentioned in several published cases, and I have myself met with it. But -it is seldom so considerable as to attract attention. In the following -instance, however, which has been related by Dr. Hofer of Biberach the -evidence of cerebral congestion was unequivocal. A man addicted to -intoxication, but enjoying good health otherwise, was attacked after -supper with sickness, vomiting, and pain in the belly. On going to bed -he fell soon quiet; and six hours after he took ill, he was found dead. -Arsenic was detected in the stomach, and in what he vomited; and -considerable redness was seen on the villous coat of the stomach. But -the most remarkable appearances were gorging of the cerebral vessels, -adhesion of the dura mater to the membranes beneath, and the effusion of -eight ounces of serosity into the lateral ventricles.[811] The only -instance I am acquainted with to justify the opinion that extravasation -of blood into the brain may occur from poisoning with arsenic, is the -remarkable case of apparent death from eating poultry poisoned with -arsenic, which was communicated to me by Mr. Jamieson of Aberdeen. The -individual, after suffering under the usual primary symptoms, became -apoplectic after a fit of sneezing, and died three days afterwards; and -in the dead body, besides other signs of disease in the brain, a recent -clot of blood was found in the right anterior lobe. (See p. 69.) - -It is quite unnecessary to notice lividity of the skin among the signs -of poisoning with arsenic, except for the mere purpose of reminding the -medical jurist that, although it has been sometimes much relied on as a -sign of death from arsenic, it is not of the slightest importance as a -sign either of that or of any other kind of poisoning. (See p. 51.) - -The action of arsenic on the alimentary canal after death will now -require a few remarks; the purpose of which is to prepare the medical -inspector for investigating attempts to impute the crime of poisoning to -innocent persons, by introducing arsenic into the dead body. Such -attempts, according to Orfila, have been made; but I am not acquainted -with any actual instance. - -The action of arsenic on dead intestine has been fully examined by the -last mentioned author. If it is introduced into the anus immediately -after death, and allowed to remain there twenty-four hours, the mucous -membrane in contact with it becomes of a lively red colour, with darker -interspersed patches as if from extravasation. The other coats are -natural; and so is the mucous membrane itself wherever the poison does -not actually touch it. Consequently the margin of the coloration is -abrupt and well defined. When the arsenic is not introduced till -twenty-four hours after death, the part to which it is actually applied -presents dark patches, while the rest of the membrane is quite -healthy.[812] - -The appearance of redness in the former case is probably the result of -lingering vitality. The cause of the dark appearance in the latter it is -not easy to comprehend. - -When arsenic has been applied, during life, the redness, if it has had -time to begin at all, extends to some distance from the points with -which the poison has been in contact, and passes by degrees into the -healthy colour of the surrounding membrane. - -On reviewing what has been said of the pathological appearances caused -by arsenic, it must appear that the medical jurist can never be supplied -from this source alone with satisfactory evidence of the cause of death. -But in some circumstances the evidence may amount to a strong -probability of one variety or another of irritant poisoning. Mere -redness, conjoined or not with softening of the mucous membrane, may -justify suspicion only. But if there should be found in the body of a -person who has died of a few days’ illness, redness, black warty -extravasation, and circumscribed ulcers of the villous coat of the -stomach,—effusion of blood or bloody clots among the contents of that -organ,—also redness of the intestines, more especially redness and -ulceration of the colon and rectum,—and redness of the pharynx, or of -this along with the gullet,—the proof of poisoning with some irritant -will amount to a strong presumption. At least it is difficult to mention -any natural disease which could produce in so short a time such a -conjunction of appearances as this; which arsenic and other analogous -poisons sometimes occasion. - - - SECTION IV.—_On the Treatment of Poisoning with Arsenic._ - -It was formerly proved that arsenic acts in all its forms of chemical -combination, which have been hitherto tried, and nearly in the ratio of -their solubility. This general fact is conformable with the law laid -down as to the influence of chemical changes on the energy of poisons -which enter the blood [p. 37]. Hence every supposed chemical antidote -must be useless, which does not render the arsenic insoluble not only in -water, but likewise in the contents and secretions of the stomach. - -The antidotes chiefly trusted to until recent times, such as vinegar, -sugar, butter and other oily substances, lime-water, bitter decoctions, -and the like, have now justly fallen into disuse. The liver of sulphur -or sulphuret of potassium, which maintained its character for some time -longer on account of its chemical action with oxide of arsenic in -solution, is not more efficacious. The experiments of Renault on the -counter-poisons for arsenic, confirmed by the subsequent researches of -Orfila, have proved that the arsenical sulphuret formed by solutions of -the liver of sulphur is scarcely less active than the oxide itself.[813] - -It appears that fine impalpable powders, though inert as physiological -agents, and destitute of any true chemical action with oxide of arsenic, -may nevertheless prove useful in certain limited circumstances. Thus Mr. -Hume of London and others have apparently found some advantage in the -administration of large doses of magnesia.[814] If this substance be of -any use at all, which is doubtful, it can act only by covering the -arsenical particles with its fine insoluble powder, and so preventing -them from coming in contact with the surface of the stomach; for in its -state of magnesia it has no chemical action with oxide of arsenic. -Another remedy of the same nature is charcoal powder, which was proposed -in 1813 with much confidence by M. Bertrand.[815] That it has some -efficacy when swallowed along with the poison seems to admit of no -doubt; for the proposer of it himself swallowed five grains of arsenic -in one dose along with charcoal in a state of emulsion, and sustained -little inconvenience of any kind. In all probability it acts merely by -enveloping the particles of arsenic. But it may possibly be also of -service, if recently exposed to heat, by the superficial attraction it -exerts over substances in solution; through means of which property it -will remove many soluble substances from a fluid, and render them -insoluble. Charcoal, however, has been proved to be destitute of all -efficacy when not administered till after the arsenic is swallowed. The -one must be given along with the other, otherwise it is useless.[816] - -For some time past the formation of an insoluble arsenite has been aimed -at by most experimentalists who have endeavoured to discover an antidote -for arsenic. But in general the arsenites, though very insoluble in -water, are sufficiently so in weak acids or in organic fluids, so that -they are soluble enough in the juices of the stomach to enter the blood -in such quantity as to prove fatal. The only exception now admitted to -exist is the arsenite produced when a solution of oxide of arsenic is -brought in contact with the hydrated sesquioxide of iron. The compound -thus formed is held to be insoluble in the secretions of the stomach; -and consequently the hydrated sesquioxide of iron is usually regarded as -a true antidote. - -The substance, the Ferrugo of the Edinburgh Pharmacopœia,—a compound -which differs little from the older preparation, the rust of iron, when -not deprived of its combined water,—was announced in 1834 by Drs. Bunsen -and Berthold as an effectual remedy even when given some time after the -arsenic is swallowed.[817] Their experiments were repeated with variable -success. Similar results were obtained by MM. Soubeiran and Miquel, as -well as MM. Orfila and Lesueur, in some experiments on dogs, and by M. -Boullay on the horse.[818] The last experimentalist found that the -effects of a dose adequate ta occasion death are almost entirely -prevented in the horse by giving the oxide of iron either immediately -after the poison, or within four hours. Results of the same nature were -obtained in this country by Mr. Donald Mackenzie.[819] Others, however, -such as Mr. Brett[820] and Mr. Orton,[821] have failed to observe any -antidotal virtues, and even deny that the sesquioxide of iron can remove -oxide of arsenic from a state of solution. But in 1840 the causes of -these discrepant statements were explained by Dr. Douglas Maclagan,[822] -who found, in corroboration of the remarks of Drs. Bunsen and Berthold, -as well as various French authorities, that the oxide must be given in -large quantity, and that the failures of some were owing to the quantity -used having been too small. He ascertained, that, in order to remove one -part of arsenic from a state of solution, twelve parts of oxide of iron -in the moist state are necessary, and sixty parts if it be previously -dried; that the arsenic so appropriated is with difficulty removed from -the insoluble matter even by boiling; and that, as the discoverers of -this antidote first stated, the preparation made by precipitating the -sesquioxide of iron by means of ammonia, is a more active form than any -other. As the oxide prepared in this way always contains ammonia, and -the proportion necessary for removing the arsenic is far greater than -what is required to constitute a simple arsenite of iron, it is -reasonable to infer that the ammonia forms a part of the insoluble -compound actually produced. At all events the action of the antidote -would appear to be chemical, and not mechanical, as has been thought by -many, and as was stated to be probable in the last edition of this work. -In confirmation of these views, and as a fact worthy of farther -investigation on its own account, it is worthy of notice, that, -according to Dr. Duflos, the acetate of sesquioxide of iron answers -equally well as an antidote with the sesquioxide itself. It precipitates -both arsenious and arsenic acid from every state of solution, and always -the more quickly the more the solution is diluted; and the co-existence -of acetic acid is no obstacle to this action taking place.[823]—More -recently Professor Orfila has called in question the absolute efficacy -generally ascribed to the sesquioxide of iron. He alleges that the -arsenical compound formed, though insoluble in water, is soluble to some -extent in the gastric juices, and is consequently a poison to animals; -that the sesquioxide is therefore only partial in its operation as a -remedy; but yet that the influence of the animal fluids in the stomach -in counteracting it may be overcome by giving it in excess, so that, as -fast as the compound is dissolved, it is thrown down again.[824] - -The cases of the successful employment of this antidote in the human -subject, which have appeared in the periodical press during the last -eight years, are so numerous, that its utility can scarcely be called in -question, whatsoever may be its precise mode of action. The hydrated -sesquioxide of iron ought therefore to be kept in readiness in every -druggist’s establishment; for it cannot be prepared when wanted without -great loss of time. The quickest way to make it is to dissolve the -common anhydrous sesquioxide, formerly miscalled carbonate of iron, in -diluted sulphuric acid aided with a gentle heat; to decompose the hot -solution with an excess of strong ammonia; to filter off the fluid by -means of a cloth filter and wash the precipitate well with warm water; -and then to let it drain thoroughly and to squeeze out more of the water -by expression. It should be kept in this state, and not allowed to dry. - -In regard to all antidotes for arsenic, it must be observed, that they -can seldom be otherwise employed than in unfavourable circumstances. If, -as most generally happens, the poison has been taken some time before -medical aid is obtained, its powder is diffused over the surface of the -stomach, adheres with tenacity to the villous coat, and excites the -secretion of tough mucus, through which it is with difficulty reached by -any antidote possessing a chemical action with it. In all cases, -therefore, it is advisable to promote vomiting occasionally, if not -already full and free, so as to aid the stomach in clearing itself of -the secreted mucus. - -If the existence of a chemical antidote for arsenic be doubtful, much -less is there any one known of that rarer denomination which operates by -exciting in the system an action contrary to that established by the -poison. - -A good deal, however, may be done by general medical treatment to -improve the chance of recovery. If vomiting should be delayed, as often -happens, for half an hour or more, advantage ought to be taken of the -opportunity to administer an emetic of the sulphate of zinc, with the -view of withdrawing the powder in mass before it is diffused over the -stomach; and for the same purpose milk should be drunk both before and -after vomiting has begun, as it appears to be the best substance for -enveloping the powder, and so procuring its discharge. The patient -should never be allowed to exhaust his strength in retching without a -little milk or other fluid in his stomach to act on. At the same time, -there is probably some justice in the opinion expressed by a late writer -on this subject, that large draughts of diluents are injurious; and -that, unless the stomach is allowed to contract fully and frequently on -itself, it cannot discharge from its surface the mucous secretion, in -which the powder of arsenic is in general closely enveloped.[825] The -stomach-pump, although it has been applied to cases of poisoning with -arsenic, does not possess any advantage whatever over emetics or the -natural efforts of nature, and is less effectual in expelling the mucus -which envelopes the poison. Even emetics are unnecessary, when full -vomiting is caused by the poison itself. If milk in sufficient quantity -cannot be procured, strong farinaceous decoctions will probably prove -useful. - -Supposing the poison to have been removed from the stomach, or that the -patient has been put on the course which appears best fitted to -accomplish that end,—two objects remain to be accomplished, namely, to -allay the inflammation of the alimentary canal, and to support the -system under that extraordinary depression which it undergoes in the -generality of cases. Were it not for the latter of these objects, the -treatment would be both obvious and frequently successful. But it is -highly probable that the active remedies, to which the physician trusts -in internal inflammations generally, and which are urgently called for -by the inflammation caused by arsenic, cannot be enforced with the -requisite vigour, on account of the remote depressing effects also -produced by this poison on the body. - -Nevertheless, it is certain that in a few even very aggravated cases the -purest and most vigorous antiphlogistic treatment has been resorted to -with success. Dr. Roget’s patient, whose case was formerly referred to -for another purpose, seems to have been saved by venesection; and at all -events, the amelioration effected was unequivocal. In the Medical -Repository there is another good example of the beneficial effects of -blood-letting carried even to a greater extent than in Roget’s -case;[826] and in the Medical and Physical Journal[827] a third instance -will be found, which after the first twenty-four hours assumed the form -of pure gastritis, and was treated as such with success. Blood-letting -ought not to be practised till the poison is nearly all discharged from -the stomach, because it promotes absorption by causing emptiness of the -blood-vessels. - -Orfila has lately advocated the use of blood-letting, on the ground that -it tends to remove from the system a portion of the poison which -circulates with the blood, and is the main source of danger to life. He -has endeavoured to show by experiments on animals, that doses adequate -to cause death may be given without this result following, if depletion -be vigorously enforced along with other treatment. And he has related a -case of recovery in the human subject under unfavourable circumstances, -where blood-letting was practised five times, and on every occasion with -marked relief.[828] - -It is not probable that any material advantage will be derived from -topical blood-letting, at least in the early stage, because if depletion -is to be of use at all, it must be carried at once to a far greater -extent than it is possible to attain by local evacuants. Blisters on the -abdomen will prove useful auxiliaries in the advanced stage. - -While many have advocated the employment of blood-letting and other -antiphlogistics, and have used them with apparent advantage, Rasori was -of opinion, and more recently Giacomini has strenuously maintained that -the proper treatment in all cases of arsenical poisoning is the purely -stimulant method. The remedy recommended by the latter is a mixture of -eight ounces of beef-tea and two ounces of wine. These notions are -evidently dictated by the prevailing pathological delusions of the -Italian school. Although upheld in some measure by a Report of the -Parisian Academy of Medicine upon some experiments by M. Rognetta on -this subject,[829] Professor Orfila subsequently proved, that the -practice recommended is utterly useless, if not even hurtful.[830] At -the same time no one who has ever seen a case of poisoning by arsenic -can doubt that it is often necessary to counteract the overwhelming -languor of the circulation by the moderate use of stimulants. - -Opium in repeated doses will prove useful, when the poison has been -removed, and the inflammation subdued by blood-letting. And I conceive -that to the form of gastritis, caused by arsenic, may be applied a -method of treatment by anodynes, which has been successfully used in -acute inflammation generally,—the free administration of opium -immediately after copious depletion. For the safe employment of this -method, however, it is essential that the arsenic be completely removed -from the stomach and intestines. And from the results of many cases -there must always be great reason to apprehend, that, before the -treatment can be with propriety resorted to, the patient’s strength will -be exhausted. - -The harassing fits of vomiting which often continue long after the -poison has been discharged from the stomach are best removed by opium in -the form of clyster, or rubbed over the inside of the rectum in the form -of ointment with the finger. - -The use of laxatives is particularly required in all cases in which -there is tenesmus instead of diarrhœa, or where, in the latter stages, -diarrhœa is succeeded by constipation; and castor oil is the laxative -generally preferred. While diarrhœa is present, and the evacuations are -profuse or the intestines have been thoroughly emptied, laxatives are -unnecessary or even hurtful; but emollient clysters are advisable, and -opium in the form of enema or suppository. In short, so far as regards -the intestinal affection, the treatment of the acute stage of dysentery -is to be enforced. - -Professor Orfila lays great stress on the employment of diuretics after -the stomach has been cleared out, and founds this practice on his -observations which show that arsenic is absorbed into the blood, and -gradually discharged by the secretions, especially the urine. Experience -seems to confirm theory. Dogs, after receiving a small dose, adequate to -occasion death, recovered under the active administration of diuretics. -Having ascertained that this animal was constantly killed in a period -varying from thirty to forty-eight hours by two grains applied to a -wound, provided no remedies were employed, he tried the diuretic method -with six which had been thus poisoned; and all of them recovered.[831] -The diuretic he recommends is a mixture of ten pounds of water, five of -white [French] wine, a bottle of Selzer water, and three ounces of -nitre; the dose of which is two wine-glassfuls frequently.[832] This -method has been followed with success in the human subject. M. Augouard -relates a case where 230 grains produced in half an hour all the usual -symptoms, which he immediately proceeded to treat by administering a -grain and a half of tartar-emetic, to excite full vomiting. Having -accomplished this object, he gave frequent doses of decoction of mallow -“strongly salpetred,” which in seven hours excited so profuse a diuresis -that in the ensuing ten hours no less than eighteen imperial pints was -discharged. At the close of this period a material amendment took place, -and recovery was complete in fifteen days.[833] It may be observed, -however, that it is sometimes impossible to excite diuresis.[834] - -Little need be said of the practice to be pursued in the advanced stages -of poisoning with arsenic, when convalescence has begun. The principal -object is to support the system by mild nourishment, avoiding at the -same time stimulant diet of every kind, but especially spirituous and -vinous liquors. Whatever may be the difference of results obtained with -the antiphlogistic mode of cure, the opposite system has been invariably -detrimental in the advanced stage. - -The treatment of the nervous and dyspeptic affections, which may -supervene after the symptoms of local inflammation have ceased, is not a -fit object of review in this work, as it would lead to great details. - - - - - CHAPTER XIV. - OF POISONING WITH MERCURY. - - -The next genus of the metallic poisons includes the preparations of -mercury. Some of these are hardly less important than the arsenical -compounds. They act with equal energy, produce the same violent -symptoms, and cause death with the same rapidity. They have therefore -been often given with a criminal intent; and have thus become the -subject of inquiry upon trials. In another respect, too, they claim the -regard of the medical jurist: their effects on the body, when -insidiously introduced in the practice of the arts in which mercury is -used, form a branch of that department of medical police, which treats -of the influence of trades on the health. - - - SECTION I.—_Of the Chemical History and Tests for the preparations of - Mercury._ - -Mercury is a fluid metal, exceedingly brilliant, of a silver-white -colour, and of the specific gravity 13·568. - -When heated to about 660° F. it sublimes, and on cooling it condenses -unchanged. If this experiment is made in a small glass tube, the metal -forms a white ring of brilliant globules, which may be made to coalesce -into a single large one. In this way its physical properties may be -recognised, though the quantity is exceedingly minute. - -Two oxides of this metal, a protoxide and peroxide, exist in combination -with acids. A bluish-gray or grayish-black protoxide is separated from -the salts of the protoxide by the fixed alkalis. The peroxide has an -orange-red colour, and is the common red precipitate of the apothecary. -Mercury unites with sulphur in two proportions. The proto-sulphuret, -which is black, is formed from the salts of the protoxide by the action -of sulphuretted-hydrogen: the bisulphuret is the well known pigment, -cinnabar or vermilion. Mercury likewise unites with chlorine in two -proportions, forming an insoluble protochloride and a soluble -bichloride, the former calomel, the latter corrosive sublimate. It -likewise unites with cyanogen. Mercury also unites in the state of -protoxide and peroxide with the acids. Several compound salts are known -to the chemist, but few occur in commerce or the arts. - -Among the compounds resulting from the action of this metal with other -substances, those which require notice in a toxicological treatise are -the following:—1. The binoxide or _red precipitate_; 2. The bisulphuret -or _vermilion_; 3. The protochloride or _calomel_; 4. The bichloride or -_corrosive sublimate_; 5. The sulphate or _Turbith mineral_; 6. The -_bicyanide_ or prussiate of mercury; and 7. The _nitrates_ of mercury. -Its other compounds are of little consequence to the toxicologist. - - - 1. _Of Red Precipitate._ - -Red precipitate, when well prepared, is in the form of fine powder or -small, brilliant, heavy scales of a scarlet or orange colour. It -consists of 101 mercury and 8 oxygen. It is insoluble in water. - -It is easily distinguished from all other substances by the action of -heat. If a little of it is heated in a small glass tube, it becomes dark -brown, and on cooling recovers its original colour. But if the heat be -raised higher, metallic globules are sublimed, and oxygen gas is -disengaged. The escape of oxygen may be ascertained by plunging to the -bottom a small bit of burning wood, when the combustion will be observed -to be enlivened. - - - 2. _Of Cinnabar._ - -Cinnabar or vermilion, the bisulphuret of mercury, usually exists in the -arts in the form of a fine, heavy, red powder, of a peculiar tint, which -is termed from this substance vermilion-red. In mass its structure is -coarsely-fibrous, and its colour reddish-brown; and it has some lustre. -When thrown down from a solution of corrosive sublimate by -sulphuretted-hydrogen, or the alkaline hydrosulphates, it forms a black -powder, which acquires a red tint by being sublimed. It is composed of -101 metal and 16 sulphur. - -It is distinguished from other substances by the operation of heat, and -by the effects of reduction with iron filings. Heated alone in a tube it -sublimes without change. Its colour, indeed, which is fugacious under -heat unless particular manipulations are used, becomes darker and dingy; -but its lustre and crystalline texture are retained. Heated with iron -filings in a tube, it gives off globules of mercury; and the existence -of sulphuret of iron in what remains may be proved by the escape of -sulphuretted-hydrogen on the addition of diluted sulphuric acid. - - - 3. _Of Turbith Mineral._ - -The Turbith mineral, or subsulphate of the binoxide of mercury, exists -in the form of a bright lemon-yellow, heavy powder. It is soluble in -2000 parts of water, and has an acrid taste. - -It may be known by the effects of heat. When heated in a tube, globules -of mercury are sublimed, and at the same time sulphurous acid gas is -disengaged, as may be ascertained by the smell. But a better method of -proving the existence of sulphuric acid in it is to expose it to the -action of a solution of caustic potass: The potass separates from it the -brownish-yellow peroxide, and appropriates the sulphuric acid, which may -be found in the solution by acidulating with nitric acid, and then -adding hydrochlorate of baryta, when a heavy, snow-white precipitate of -sulphate of baryta will form. The nitric acid used in this process must -be quite pure, and free of sulphuric acid, which the acid of commerce -often contains. - - - 4. _Of Calomel._ - -Calomel (muriate, mild muriate, chloride, protochloride of mercury), is -commonly met with in the shops in the form of a heavy powder, having a -faint yellowish-white colour, and no taste or smell. In mass it forms -compact, fibrous, translucent, shining cakes of great density. It is -insoluble in water. - -It is distinguished by the effects of heat, and those of the solution of -caustic potass. Heated in a tube it sublimes unchanged, and condenses in -a crystalline or crumbly mass. The solution of caustic potass or soda -turns it at once black, disengaging protoxide of mercury and acquiring -hydrochloric acid, the presence of which is proved by neutralizing the -solution with nitric acid, and adding nitrate of silver, when a heavy -white precipitate is formed, the chloride of silver. In applying this -process, care must be taken to employ potass quite free of muriates, and -nitric acid free of muriatic acid. Ammonia also renders calomel powder -black, but the action and product are much more complex in their nature. - - - 5. _Of Corrosive Sublimate._ - -Corrosive sublimate (oxymuriate, corrosive muriate, bichloride of -mercury), is by far the most important of the mercurial poisons, as it -is both the most active of them, and the one most frequently used for -criminal purposes. It is commonly met with in the form of a heavy, -snow-white powder, or of small, broken crystals, or in white, compact, -concave, crystalline cakes. It is permanent in the air; but in the -sunshine is slowly decomposed, a gray insoluble powder being formed. It -readily crystallizes, and the common form of the crystals is the -quadrangular prism. Its specific gravity is 5·2. Its taste is strongly -styptic, metallic, acrid, and persistent; and its dust powerfully -irritates the nostrils. It is soluble, according to Thenard, in 20, -according to Orfila, in 11 parts of temperate water, and in thrice its -weight of boiling water. Its solution faintly reddens litmus. It is more -soluble in alcohol than in water, boiling alcohol dissolving its own -weight, and retaining when it cools, a fourth part. It is also very -soluble in ether, so that ether will remove it from its aqueous -solution. Corrosive sublimate may become the subject of a medico-legal -analysis in three states. It may be in the solid form; it may be -dissolved in water along with other mineral substances; and it may be -mixed with vegetable and animal fluids or solids. - - - _Of the Tests for Corrosive Sublimate in the solid state._ - -Corrosive sublimate in the solid state is distinguished from other -substances by the action of the heat, and the effects of solution of -caustic potass. Subjected to heat alone it sublimes in white acrid -fumes; and if the experiment is made in a little tube, it condenses -again unaltered in a crystalline cake. Treated with solution of caustic -potass, it becomes yellow, the binoxide being disengaged, and -hydrochloric acid uniting with the potass, as may be proved by nitrate -of silver, after filtration and neutralization with nitric acid. The -yellow colour of the binoxide which is separated in this process -distinguishes corrosive sublimate from calomel, which is also decomposed -by the potass solution, but yields a black protoxide. Caustic soda has -the same effect. Not so caustic ammonia: Ammonia blackens calomel, but -does not change the colour of corrosive sublimate, as it forms with it a -white triple salt, commonly called white precipitate. - -The process here described is the best and simplest method of -determining chemically the nature of corrosive sublimate in its solid -state. But two other tests may also be mentioned, as they have been a -good deal used. A very good test is the process of reduction with -potass, by which globules of mercury are sublimed, and a chloride of -potassium left in the flux, as may be proved by the action of nitrate of -silver on the solution of the flux previously neutralized with nitric -acid. This test alone will not distinguish corrosive sublimate from -calomel: The solubility of the former must be taken into -account.—Another satisfactory test is the solution of protochloride of -tin. Corrosive sublimate, when left for some time in this solution, -first becomes grayish-black, and ere long its place is supplied by -globules of mercury,—the chlorine being entirely abstracted by the -protochloride of tin, which consequently passes to the state of a -bichloride. Calomel is similarly affected. - - - _Of the Tests for Corrosive Sublimate in a state of Solution._ - -Two processes may be mentioned for the detection of corrosive sublimate -in mineral solutions,—a process by reduction, and a process by liquid -tests. - -_Reduction process._—In order to procure mercury in its characteristic -metallic state from a solution of corrosive sublimate, the following -plan of procedure will be found the most delicate and convenient. Add to -the solution, previously acidulated with hydrochloric acid if very weak, -a little of the protochloride of tin, which will be seen presently to be -a liquid reagent of great delicacy. If the solution is not darkened -there is not present an appreciable quantity of mercury. If mercury is -present a bluish-gray or grayish-black precipitate falls down, owing to -the chemical action already particularized. After ebullition, this -precipitate is to be allowed to subside, first in a tall glass vessel -suited to the quantity of the solution, and afterwards in the small -glass tube, Fig. 7, the superincumbent fluid being previously decanted -off as far as possible. After it has subsided in the tube, the remaining -fluid is withdrawn with the pipette, Fig. 8; water is poured over it; -and this is withdrawn again after the precipitate has subsided a third -time. The bottom of the tube is then cut off with a file, and the -moisture which remains is driven off with a gentle heat. When this is -accomplished, the powder, which is nothing else than metallic mercury, -sometimes runs into globules. Should it not do so, the bit of tube is to -be broken in pieces and heated in the tube, Fig. 1, when a brilliant -ring of fine globules will be formed. If the globules are too minute to -be visible to the naked eye, the tube is to be cut off with the file -close to the ring; and the globules may then be easily made to coalesce -into one or more of visible magnitude by scraping the inside of the tube -with the point of a penknife. - -This process is not recommended as preferable to the plan by liquid -reagents which is next to be mentioned, and which is both more easily -put in practice, and at the same time quite as satisfactory. It is -related chiefly because it forms the ground-work of a process for -detecting mercury in mixed animal or vegetable fluids. It will be -remarked that the process does not prove with what acid the mercury was -combined in the solution. But this is a defect of little consequence; -for the only other soluble salts of mercury ever met with in the arts, -namely, the nitrate, acetate, and cyanide, are too rare to be the source -of any material fallacy; and are besides all equally poisonous with -corrosive sublimate. - -_Process by Liquid Tests._—The process by liquid reagents consists in -the application of several tests to separate portions of the solution. -The tests which appear to me the most satisfactory are hydrosulphuric -acid gas, hydriodate of potass, protochloride of tin, and nitrate of -silver. - -1. _Hydrosulphuric acid gas_ transmitted in a stream through a solution -of corrosive sublimate causes a dark, brownish-black precipitate, the -bisulphuret of mercury. When the solution is not very diluted, the gas -forms a whitish or yellowish precipitate before the blackening -commences,—an effect which, according to Pfaff, distinguishes the salts -of the peroxide of mercury from all other metals that are thrown down -black from their solutions by sulphuretted-hydrogen.[835] The cause of -this is that the particles of sulphuret first formed acquire a thin -covering of corrosive sublimate by that property which chemists of late -have termed superficial attraction. Hydrosulphuric acid is a very -delicate test of the presence of mercury. It will detect corrosive -sublimate, where its proportion is only a 35000th of the solution.[836] - -This test is not alone sufficient, unless reliance be placed on Pfaff’s -criterion, which is rather a trivial one; for hydrosulphuric acid -occasions a black precipitate in other metallic solutions, for example, -in solutions of lead, copper, bismuth and silver. In mixed organic -fluids its action is not liable to be prevented; but the precipitate -formed is often kept intimately suspended, as in the instance of milk. -It may be conveniently used in the form of hydrosulphate of ammonia. -This test produces a dark-brown precipitate, which is said to pass -slowly to a bright cinnabar red; but I have not been able to observe any -transformation of the kind. - -_Hydriodate of Potass_ causes in solutions of corrosive sublimate a -beautiful pale scarlet precipitate, which rapidly deepens in tint. The -precipitate is the biniodide of mercury. This is a test of great -delicacy when skilfully used, as it acts where the salt forms only a -7000th of the solution (Devergie). Care must be taken, however, not to -add too much of the test, because the precipitate is soluble in an -excess of the hydriodate, or too little, because the precipitate is also -soluble in a considerable excess of corrosive sublimate. - -The action of hydriodate of potass is not liable to any important -ambiguity: no other iodide resembles in colour the biniodide of mercury. -It is not a certain test, however, when other salts exist in solution -along with corrosive sublimate. Chloride of sodium, nitrate of potass, -and probably also other neutral salts possess the power of dissolving -the precipitate. Sulphuric and nitric acids, even considerably diluted, -oxidate and dissolve the mercury, and disengage iodine, which colours -the fluid reddish-brown. When corrosive sublimate is dissolved in -coloured vegetable infusions or animal fluids, the hydriodate of potass -cannot be relied on, the colour of the precipitate being altered, as in -infusion of galls, or the action of the test being suspended altogether, -as by milk. - -_Protochloride of Tin_ causes first a white precipitate, which, when -more of the test is added, gives place to a grayish-black one. In very -diluted solutions the colour struck is grayish or grayish-black from the -beginning. In such solutions Devergie has found it useful to acidulate -with hydrochloric acid before adding the test. The chemical action here -is peculiar. The white powder thrown down at first is protochloride of -mercury; a part of the chlorine of the bichloride of mercury having been -abstracted by the protochloride of tin, which becomes in consequence the -bichloride. On more of the test being added these changes are repeated, -the chlorine is removed from the protochloride of mercury, and metallic -mercury falls down. This test is one of extreme delicacy, affecting -solutions which contain only an 80,000th of salt. It is prepared by -acting on tin powder or tinfoil with strong hydrochloric acid aided by a -gentle heat. The solution must be kept carefully excluded from the air; -otherwise bichloride of tin is formed, which does not act at all on the -solution of corrosive sublimate. - -The protochloride of tin is not liable to any fallacy. Neither is it -liable to be suspended in its action by the co-existence of other saline -substances. It causes precipitates with almost all animal and most -vegetable fluids. But when corrosive sublimate is present, even in very -small proportion, the precipitate is always darker than when no -mercurial salt exists in solution, and frequently has its proper -grayish-black tint. This property, as will presently be seen, is the -foundation of a process for the detection of mercury in all states of -admixture with organic matters. - -_Nitrate of Silver_ causes a heavy white precipitate, the chloride of -silver, which darkens under exposure to light. This is a test for the -chlorine of the corrosive sublimate, but not for the mercury, and is a -necessary addition to the three former tests in order to determine how -the mercury is kept in solution. It acts with very great delicacy. - -It is of no use, however, when chlorine or hydrochloric acid is present -either free or combined with other bases. It is not of use, therefore, -in animal fluids and vegetable infusions, because very many of them, -besides organic principles which form white precipitates with this test, -contain a sensible proportion of hydrochlorate of soda. - -Although the preceding liquid reagents when employed conjunctly are -amply sufficient for determining the presence of corrosive sublimate in -a fluid, many other tests hardly less characteristic and delicate have -been used by medical jurists. These will now be shortly mentioned. - -1. _Lime-Water_ throws down the binoxide of mercury in the form of a -heavy yellow powder. The precipitate first thrown down is lemon-yellow, -an additional quantity of the test gives it a reddish-yellow tint, and a -still larger quantity restores the lemon-yellow. This test is -characteristic, but not so delicate as those already mentioned.—2. -_Caustic Potass_ has precisely the same effect as lime-water, except -that the tint of the precipitate is always yellow—3. _Caustic Ammonia_ -causes a fine, white, flocculent precipitate of intricate composition, -commonly called precipitate. It is a very delicate test; but ammonia -likewise causes a white precipitate in other metallic solutions.—4. -_Carbonate of Potass_ causes a brisk-red precipitate, by virtue of a -double decomposition, the precipitate being carbonate of mercury.—5. The -_Ferro-cyanate of Potass_ causes at first a white precipitate, the -ferro-cyanide of mercury. The precipitate becomes slowly yellowish, and -at length pale-blue, owing, it is believed, to the admixture of a small -quantity of iron with the corrosive sublimate.—6. _A polished plate of -Copper_ immersed in a solution of corrosive sublimate becomes in a few -seconds tarnished and brownish; and in the course of half an hour a -grayish-white powder is formed on its surface. This powder, according to -Orfila,[837] is a mixture of calomel, mercury, and a copper amalgam. If -it is wiped off, and the plate then rubbed briskly where tarnished, it -assumes a white argentine appearance.—7. _A little Mercury_ put into a -solution of corrosive sublimate is instantly tarnished on the surface; -the solution in a few seconds becomes turbid, a heavy grayish -precipitate is formed, and in no long time with the aid of agitation the -whole corrosive sublimate is removed from the solution. The powdery -precipitate is a mixture of finely divided mercury and calomel; the -former being derived from the surface of the mercury, and the latter -produced by the corrosive sublimate uniting with a larger proportion of -the metal to form the protochloride.—8. _A solution of Albumen_ causes a -white precipitate, which is soluble in a considerable excess of the -reagent. The nature of this precipitate will be discussed presently.—A -_slip of Gold_ aided by galvanism, becomes silver-white in the solution, -in consequence of the formation of an amalgam. When the solution is -concentrated, it may be thus tested by simply putting a few drops on a -bit of gold, and touching the gold through the solution with an iron -point, as recommended by Mr. Sylvester and Dr. Paris.[838] When the -solution is very weak, a different method is necessary, and a process -for the purpose has been proposed by M. Devergie, which appears so -delicate, accurate, and at the same time simple, a mode of detecting -traces of mercury in very weak solutions, as to deserve detailed notice. -A thin plate of gold, and another of tin, a few lines broad, and two or -three inches long, being closely applied to one another by silk threads -at the ends, and then twisted spirally, this galvanic pile is left for -twenty-four or thirty-six hours in the solution previously acidulated -with muriatic acid; upon which the gold is found whitened, and mercury -may be obtained in globules by heating the gold in a tube. Distinct -indications may be obtained by this method, where the corrosive -sublimate forms but an 80,000th of the water.[839] For facility of -application, an important condition is, that the quantity of fluid -should not exceed three or four ounces, because in a larger quantity the -pile of the size stated above cannot remove the whole mercury. Somewhat -similar to this is the galvanic method of Mr. Davy of Dublin. He -proposes to place the suspected solution in a platinum crucible with -hydrochloric acid, diluted with its own weight of water, to excite -galvanic action by immersing in the fluid a plate of zinc, and to -sublime and collect the reduced mercury, by washing the crucible, -heating it over a spirit-lamp, and condensing the mercurial vapours on a -plate of glass placed over the mouth of the crucible.[840] - - -_Of the Tests for Corrosive Sublimate when mixed with Organic Fluids and - Solids._ - -The process for detecting corrosive sublimate in mixtures of organic -fluids and solids, such as the contents of the stomach, is now to be -described. But some remarks are previously required on the chemical -relations subsisting between this poison and various principles of the -vegetable and animal kingdoms. - -These relations are important in a medico-legal point of view on several -grounds. On the one hand, the chemical changes which corrosive sublimate -undergoes often alter so much the action of its tests, as to render -necessary a process of analysis materially different from any hitherto -described. And on the other hand, these chemical changes, of which some -take place rapidly, others slowly, will hinder the corrosive sublimate, -more or less completely, from exerting its usual operation on the animal -system; so that it may thus either accidentally fail to act as intended, -or be checked in its operation by antidotes administered for the -purpose. - -It appears from the researches of M. Boullay, confirmed by those of -Professor Orfila, that various vegetable fluids, extracts, fixed oils, -volatile oils and resins, possess the power of decomposing corrosive -sublimate. According to M. Boullay, a part of the chlorine is gradually -disengaged in the form of hydrochloric acid, and the salt is -consequently converted into calomel, which is deposited in a state of -mixture or combination with vegetable matter.[841] Some vegetable fluids -produce this change at once, others not for some hours, others not for -days, and only when aided by a temperature approaching ebullition. For -example, a strong infusion of tea, mixed with a solution of a few grains -of corrosive sublimate, becomes immediately muddy, and an insoluble -cloud separates in half an hour. But the remaining fluid slowly becomes -muddy again, and in eight days a considerable precipitate is formed. -Both precipitates contain mercury; the former, I find, contains 31 per -cent. On the other hand, an infusion of galls in like circumstances does -not become muddy for six or seven hours. A solution of sugar does not -undergo any change after being mixed with a solution of corrosive -sublimate for months at the ordinary temperature of the atmosphere; but -at the temperature of ebullition Boullay has found that the usual -changes ensue, though to no great extent. - -The experiments of Professor Taddei of Florence have farther shown, that -the property of decomposing corrosive sublimate is possessed in an -eminent degree by one of the vegetable solids, gluten. If the salt in -solution is properly mixed with a due proportion of gluten of wheat, -that is, about four times its weight, the water will be found no longer -to contain any mercury, while the gluten becomes whitish, brittle, hard, -and not prone to putrefaction. A ternary compound is formed, the -protochloride of mercury and gluten.[842] This change is effected with -rapidity. - -The researches of Berthollet,[843] repeated and extended by Professor -Orfila,[844] have also shown that the same property is possessed by most -animal fluids and solids. Among the soluble animal principles, albumen, -caesin, osmazôme, and gelatin possess it in a high degree, but above all -albumen, the action of which has been examined with some care, as it -supplies the physician with the most convenient and effectual antidote -against the effects of the poison. - -If a solution of albumen, for example that procured by beating white of -eggs in water, is dropped by degrees into a solution of corrosive -sublimate, a white flaky precipitate is immediately thrown down, which -when separated and dried forms horny masses, hard, brittle, and -pulverizable. The precipitate is soluble in a considerable excess of -albumen; so that wherever albumen abounds in any fluid, to which -corrosive sublimate has been added, a portion of the mercury will always -be found in solution. The precipitate is also soluble in a considerable -excess of corrosive sublimate. The dry precipitate I have found to -contain 6 per cent. of metallic mercury. - -The action of casein as it exists in milk is precisely the same. A -solution of corrosive sublimate, poured into a large quantity of milk, -causes no change; but if the proportion of salt be considerable, a flaky -coagulum is formed, and the milk becomes clear. The principles, osmazôme -and gelatin, are similar in their effects, though not quite so powerful. -Urea has no chemical action with corrosive sublimate. Of the compound -animal fluids, blood and serum have the same effects as albumen. - -Many insoluble animal principles, as well as all the soft solids of the -animal body, act in the same manner with vegetable gluten. Fibrin, for -example, coagulated albumen, or coagulated casein, acts precisely in the -same way. Muscular fibre, the mucous and serous membranes, the fibrous -textures, and the brain, have all the same effect: they become firmer, -brittle, white, and a white powder detaches itself from their surface, -which contains mercury and animal matter. This chemical action, which -Taddei has proved to take place in the living[845] as well as in the -dead body, is the source of the corrosive property of the poison, as was -first pointed out by Berthollet in his essay formerly quoted. - -In all of the compounds thus formed by vegetable and animal substances, -the presence of mercury is easily proved by boiling the powder in a -solution of caustic potass. The organized matter is dissolved; a heavy, -grayish-black powder is formed, which is protoxide of mercury; and if -this be collected in the way formerly described, it forms running -quicksilver when heated. - -A difference of opinion prevails as to the nature of the changes -effected by the mutual action of corrosive sublimate and organic matter. -For example, in the instance of the action of albumen, which has been -most carefully examined, Berzelius and Lassaigne[846] regard the -precipitate as a compound of bichloride of mercury with albumen. -Professor Rose and Dr. Geoghegan[847] have proved it, in their opinion, -to be a compound of binoxide of mercury and albumen without any -chlorine. And according to Boullay it is composed of albumen in union -with calomel.[848] Lassaigne says he has found it to be a compound of -ten equivalents of albumen with one of mercury, or 93·33 per cent. of -the former, and 6·67 of the latter.[849] The compound with fibrin he -considers to be analogous in composition. - -With regard to the changes induced by these effects of organized matter -on the operation of the liquid tests for corrosive sublimate, it will in -the first place be manifest that the poison may thus be wholly removed -from their sphere of action: it may be thrown down as an insoluble -substance, on which any process by liquid tests hitherto mentioned will -of course fail to act. But secondly, even when a moderate quantity does -remain in solution, the operation of the liquid tests, as formerly -noticed under the head of each, will be materially modified. It is of -some moment for the medical jurist to remember, that by reason of the -slowness with which the changes in question sometimes takes place, the -poison may exist abundantly in solution at one time, and yet be present -only in small quantity after an interval of some hours or days. - -_Process for Organic Mixtures._—Various processes have been proposed for -detecting corrosive sublimate in organic mixtures. The first I shall -mention is one proposed by myself in former editions of this work. It is -a double one; of which sometimes the first part, sometimes the second, -sometimes both may be required. The first removes the corrosive -sublimate undecomposed from the mixture, which may be accomplished when -its proportion is considerable; the second, when the proportion of -corrosive sublimate is too small to admit of being so removed, separates -from the mixture metallic mercury; and the analyst will know which of -the two to employ by using the protochloride of tin as a trial-test in -the following manner. - -A fluid mixture being in the first instance made, if necessary, by -dividing and bruising all soft solids into very small fragments, and -boiling the mass in distilled water, a small portion is to be filtered -for the trial. If the protochloride of tin causes a pretty deep ash-gray -or grayish-black colour, the first process may prove successful; if the -shade acquired is not deep, that process may be neglected, and the -second put in practice at once. - -_First branch of the Process._—In order to remove the corrosive -sublimate undecomposed, the mixture, without filtration, is to be -agitated for a few minutes with about a fourth part of its volume of -sulphuric ether; which possesses the property of abstracting the salt -from its aqueous solution. On remaining at rest for half a minute or a -little more, the etherial solution rises to the surface, and may then be -removed by suction with the pipette (Fig. 8). It is next to be filtered -if requisite, evaporated to dryness, and the residue treated with -boiling water; upon which a solution is procured that will present the -properties formerly mentioned as belonging to corrosive sublimate in its -dissolved state. This branch of the process is derived from one of -Orfila’s methods. - -_Second branch of the Process._—If the preceding method should fail, or -shall have been judged inapplicable, as will very generally be the case, -the mixture is to be treated in the following manner. In the first -place, all particles of seeds, leaves, and other fibrous matter of a -vegetable nature, are to be removed as carefully as possible. This being -done, the mixture, without undergoing filtration, is to be treated with -protochloride of tin as long as any precipitate or coagulum is formed. -If there were solid animal matters in the mixture, besides being cut and -carefully bruised as directed above, they should also be brought -thoroughly in contact with the salt of tin by trituration. The mixture, -even if it contains but a very minute proportion of mercury, will -acquire a slate-gray tint, and become easily separable into a liquid and -coagulum. The coagulum is to be collected, washed and drained on a -filter; from which it is then to be removed without being dried; and -care should be taken not to tear away with it any fibres of the paper, -as these would obstruct the succeeding operations. The mercury exists in -it in the metallic state for reasons formerly mentioned. - -The precipitate is next to be boiled in a moderately strong solution of -caustic potass contained in a glass flask, or still better in a smooth -porcelain vessel glazed with porcelain; and the ebullition is to be -continued till all the lumps disappear. The animal and vegetable matter, -and oxide of tin united with them, will thus be dissolved; and on the -solution being allowed to remain at rest, a heavy grayish-black powder -will begin to fall down in a few seconds. This is chiefly metallic -mercury, of which, indeed, globules may sometimes be discerned with the -naked eye or with a small magnifier. - -In order to separate it, leave the solution at rest under a temperature -a little short of ebullition for fifteen or twenty minutes, or longer, -if necessary. Fill up the vessel gently with hot water without -disturbing the precipitate, so that a fatty matter, which rises to the -surface in the case of most animal mixtures, may be skimmed off first -with a spoon, and afterwards with filtering paper. Then withdraw the -whole supernatant fluid, which is easily done on account of the great -density of the black powder. Transfer the powder into a small glass -tube, and wash it by the process of affusion and subsidence till the -washings do not taste alkaline. Any fibrous matter which may have -escaped notice at the commencement of the process, and any lumpy matter -which may have escaped solution by the potass, should now be picked out. -The black powder is the only part which should be preserved. If the -quantity of powder is very minute, an interval of twelve hours should be -allowed for each subsidence, and the tube represented in Fig. 7 should -be used. - -Lastly, the powder is to be removed, heated, and sublimed, as in the -last stage of the process described in page 293, for detecting corrosive -sublimate in a pure solution. - -The second branch of this process is very delicate. I have detected by -it a quarter of a grain of corrosive sublimate mixed with two ounces of -beef, or with five ounces of new milk, or porter, or tea made with a -liberal allowance of cream and sugar. I have also detected a tenth part -of a grain in four ounces of the last mixture, that is in 19,200 times -its weight. - -It may be applied successfully and without difficulty to a very large -majority of medico-legal cases. The only difficulty in the way of -applying it to all organic mixtures whatever arises from the occasional -presence of some vegetable matters, such as seeds, leaves, ligneous -fibre and the like, which are insoluble in caustic potass, and which may -therefore be left behind with the mercurial precipitate, and obstruct -the subsequent sublimation of the metal. This difficulty may be -sometimes got rid of, as recommended above, by picking such matters out -of the mixture before the protochloride of tin is added. No mercury is -lost by so doing, for none of it is united with these vegetable matters: -corrosive sublimate does not form any chemical compound with them as it -does with other vegetable matters soluble in caustic potass, and with -the soft animal solids. When the particles are too small to admit of -being thus removed, or cannot be afterwards removed during the process -of washing the black powder, which is left after the action of -potass—the analyst must be content with the increased facility of -sublimation derived from the abstraction of other vegetable and animal -admixtures, and take care to use a tube of greater length and with a -larger ball than usual. If the sublimate is too much obscured by -empyreumatized matter to exhibit distinctly its metallic, globular -appearance, the portion of the tube is to be broken off, and scraped, -washed, and boiled with a little rectified spirit in a tube. If the -globules do not then become visible, a second sublimation will render -them distinct. This supplemental operation, however, will be very seldom -required; and the process given above will be found to apply to a great -majority of instances. - -Various objections brought against this process by reviewers and others -were noticed in previous editions of this work. The result of the -investigation is, that, though not by any means a perfect process, it is -one of the most convenient and certain, and least fallacious of all yet -proposed. The first step for separating corrosive sublimate by ether in -the undecomposed state,—which is borrowed from a suggestion of Professor -Orfila, will seldom succeed; for the poison is seldom present in -sufficient quantity. - -It must be observed that this as well as every other method yet proposed -for discovering corrosive sublimate in compound mixtures merely -indicates the presence of mercury, and does not point out its state of -combination. More especially, in the case of the contents of the -stomach, if mercury be not obtained from the filtered fluid, it is -impossible to know whether what is detected in the solid matter only may -not have proceeded from calomel given medicinally. This objection can be -obviated solely by sufficient evidence that calomel was not -administered; at least the different criterions laid down by Professor -Orfila for distinguishing calomel in the alimentary canal from the -products of the decomposition of corrosive sublimate do not appear -sufficiently precise, or commonly applicable.[850] - -Various processes for detecting corrosive sublimate in organic mixtures -have been proposed by others. But none of these seem to me preferable to -the method detailed above, with the exception of one which has been -lately proposed by Professor Orfila, and which is particularly deserving -of notice, because, although complex, he has found it sufficiently -manageable and delicate for detecting mercury in the animal textures and -secretions, into which it has obtained admission through the medium of -absorption in cases of poisoning with the compounds of mercury. Like the -previous process, however, it merely detects mercury, and cannot point -out the state of combination in which mercury was administered, or mixed -with the substance examined. - -If the suspected matter be sufficiently liquid, boil for a few minutes -and filter; acidulate the product with a few drops of hydrochloric acid; -and immerse some slips of copper-leaf in it for a few hours. Should they -be tarnished, dissolve oxide and chloride of copper from the surface by -means of ammonia; wash them and press them between folds of filtering -paper; cut them in pieces, and heat these in a glass tube. Globules of -mercury may be obtained or not. In either case, let the liquid, in which -the plates were first immersed, be evaporated to dryness over the -vapour-bath; add to the residue a sixth of sulphuric acid in a retort -with a receiver; and heat gently till a nearly dry carbonaceous mass be -obtained. Boil this with an ounce and a half of nitro-hydrochloric acid -[Edin. Pharm.], until the charcoal be again nearly dry. Heat what -remains with boiling distilled water, filter, apply to a small part of -the liquid the copper test as just described, and try whether corrosive -sublimate can be detached from the remainder by means of sulphuric ether -(p. 299). The distilled fluid in the receiver may contain corrosive -sublimate in considerable proportion, relatively to what existed in the -subject of analysis. In order to discover it, boil the liquid for -fifteen minutes with nitro-hydrochloric acid; transmit chlorine gas for -an hour, filter, and evaporate to dryness over the vapour-bath; dissolve -the residue in water, and search for corrosive sublimate both by copper -plates, and by agitation with ether. - -If mercury be not thus detected, proceed to the solid matter left on the -filter, by which the subject of analysis was in the first instance -separated into a liquid and solid part. Examine this by evaporation to -dryness over the vapour-bath, and charring with sulphuric acid in a -retort with a receiver attached; and then subject the product to the -same steps as those detailed above for the dried residuum of the liquid -part. - -If the materials for analysis be soft solids, especially the stomach, -intestines, liver, and the like, commence at once with the process of -charring with sulphuric acid. In the case of the urine, examine both the -liquid and sediment. Filter the liquid, transmit chlorine to excess, let -the product rest twenty-four hours, filter, evaporate to dryness, -dissolve the residue in water acidulated with hydrochloric acid, and -test the solution both with copper-leaf and by agitation with ether. -Heat the sediment with nitro-hydrochloric acid as directed above, and -then proceed as with the liquid portion of the urine.[851] - -Some other processes, but probably inferior to that of Professor Orfila, -will be found in the last edition of this work. It seems unnecessary to -reproduce them here. - - - 6. _Of Bicyanide of Mercury._ - -The bicyanide of mercury is a compound of mercury and cyanogen. It is -usually sold in the form of white, opaque, heavy, crystals, which are -rhomboidal prisms. It has a disagreeable, corrosive, metallic taste. It -is easily known from every other substance by the effects of heat. If a -small quantity of it, previously well dried, be introduced into a glass -phial to which a small tube is fitted by means of a cork, on the -application of heat the salt becomes black; mercury is sublimed, and -condenses in globules on the upper part of the phial; and a gas escapes, -which has the odour of prussic acid, and burns with a beautiful rose-red -flame. - - - 7. _Of the Nitrates of Mercury._ - -The nitrates of mercury are used in some of the arts, but have so rarely -been the cause of injury to man that they are of little medico-legal -importance. I am acquainted with only one case of poisoning with -them.[852] - -There are two nitrates, the protonitrate and pernitrate. 1. The -protonitrate is in transparent colourless crystals, entirely soluble in -water with the aid of a slight excess of nitric acid; and the solution -is precipitated black by the alkalis, black by sulphuretted-hydrogen, -white by muriatic acid, and yellow by hydriodate of potass. The crystals -when heated discharge fumes of nitrous acid, and when the whole acid is -driven off the red oxide is left, which by farther heat is converted -into metallic mercury. 2. The pernitrate is similarly affected by heat. -Its crystals form white or yellowish needles. Water decomposes them, -separating an insoluble yellowish subnitrate, and dissolving a -supernitrate, which is precipitated yellow by the alkalis, black by -sulphuretted-hydrogen, carmine-red by the hydriodate of potass. Copper -separates mercury from both nitrates; and so does gold or platinum when -aided by a galvanic current. - - - SECTION II.—_Of the mode of Action of Mercury and the Symptoms it - excites in Man._ - -The effects of mercury on the animal body are more diversified than -those of any other poison. It acts on a great number of important -organs, and in consequence the phenomena of its action are -proportionately various. It is not surprising, therefore, that some -ambiguity still prevails as to its mode of action and the circumstances -by which the action is regulated. - -The attention of toxicologists in their physiological researches has -been chiefly turned to the more active preparations of mercury, and -especially to corrosive sublimate, when given in such quantity as to -prove fatal in a few days at farthest. The more immediate and prominent -properties of corrosive sublimate have consequently received some -elucidation. But its qualities as a slow poison, as well as the -analogous operation of the less active compounds of mercury, have not -been experimentally examined with the same care: indeed it is -questionable whether the phenomena of the latter description as they -occur in man can be studied with much advantage by means of experiments -on animals.—In treating of the mode in which the compounds of mercury -act, the most convenient method will be to consider at present its -action in the form of corrosive sublimate in large doses as ascertained -by late experiments, and to reserve the consideration of the general -action of mercurial poisons at large till their effects on man have been -fully described. - -The mode of action of corrosive sublimate has been examined particularly -by Sir B. Brodie in 1812;[853] by Dr. Campbell in 1813,[854] by M. Smith -in 1815,[855] by M. Gaspard in 1821,[856] and more lately by Professor -Orfila.[857] The following is a short analysis of their experiments and -results. - -The leading phenomena remarked by Sir B. Brodie, on large doses being -introduced into the stomach, were very rapid death, corrosion of the -stomach, and paralysis of the heart. In rabbits and cats, from six to -twenty grains, injected in a state of solution into the stomach, -produced in a few minutes insensibility and laborious breathing, then -convulsions, and death immediately afterwards,—the whole duration of the -poisoning varying from five to twenty-five minutes. After death the -inner membrane of the stomach was gray, brittle, and here and there -pulpy,—changes precisely the same with those produced by corrosive -sublimate on the dead stomach. When the chest was opened immediately -after death, the heart was found either motionless or contracting -feebly; and in both circumstances the blood in its left cavities was -arterial. - -These experiments make it evident that the brain was acted on as well as -the heart, and that the immediate cause of death was stoppage of the -heart’s action. But they do not show whether the action takes place -through absorption, or by a primary nervous impression transmitted along -the nerves. - -I am not acquainted with any other experiments of consequence on the -operation of corrosive sublimate when introduced into the alimentary -canal. But some interesting observations have been made by Campbell, -Smith, Gaspard, and Orfila severally as to its effects when applied to -the cellular tissue or injected at once into the blood of a vein. It -follows from their researches, taken along with those of Sir B. Brodie, -that, like arsenic, corrosive sublimate is an active poison, to whatever -part or tissue in the body it is applied. - -Campbell, Smith, and Orfila all agree in assigning to it dangerous -properties, when it is applied to a wound or the cellular tissue of -animals. Even in the solid state, and in the dose of three, four, or -five grains only, it causes death in the course of the second, third, -fourth, or fifth day. The symptoms antecedent to death are generally -those of dysentery; and corresponding appearances are found after death, -namely, redness, blackness, or even ulceration of the villous coat of -the stomach and rectum, the intermediate part of the alimentary canal -being sound. This poison, therefore, has, like arsenic, the singular -power of inflaming the stomach and intestines, even when it is -introduced into the system through a wound. - -But this is not its only property in such circumstances. According to -Smith and Orfila, it also possesses the power of inflaming both the -lungs and the heart. Orfila found the lungs unusually compact and -œdematous in some parts; and Smith observed on their anterior surface -black spots, elevated in the centre, evidently the consequence of -effusion of blood. As to the heart, in one of Smith’s experiments black -spots were found in its substance, immediately beneath the lining -membrane of the ventricles; and Orfila invariably found in one part or -another of the lining membrane, most commonly on the valves, little -spots of a cherry-red or almost black colour; nay, on one occasion he -observed these spots so soft that slight friction made little cavities. -The production of pneumonia by corrosive sublimate when applied to a -wound appears well established; but the appearances assumed as -indications of carditis are equivocal, since they may have arisen simply -from dyeing of the membrane of the heart in the fluid part of the blood -after death. - -The researches of Gaspard were confined to the effects of the poison -when injected at once into the blood. They show still more clearly its -tendency to cause inflammation of the lungs; and they prove that through -the channel of the blood, as through the cellular tissue, it is apt to -cause inflammation of the stomach and rectum. The symptoms were -vomiting, bloody diarrhœa, difficult breathing, apparent pain of chest, -and bloody sputa; and death took place in a few seconds or in three or -four days, according to the dose, which varied from one to five grains. -The appearances in the dead body were principally redness in the mucous -membrane of the intestines; and in the lungs, according to the length of -time the animal survived, either black ecchymosed spots, or black -tubercular masses, some inflamed, others gangrenous, others suppurated, -or finally, regular abscesses separated from one another by healthy -pulmonary tissue.[858] - -Besides the effects mentioned in the preceding abstract, two of the -experimentalists referred to have likewise observed in animals the same -remarkable operation on the salivary organs which forms so conspicuous a -feature in the action of the compounds of mercury on man. Dr. Campbell -observed mercurial fetor, and M. Gaspard mercurial salivation. Another -writer, Zeller, found that dogs might be made to salivate, but not -graminivorous animals.[859] Schubarth, however, remarked profuse -salivation in a horse, to which twenty-four ounces of strong mercurial -ointment were administered in the way of friction in sixteen days:[860] -and I observed the same symptoms in a rabbit on the sixth day after the -commencement of daily mercurial inunction. - -The result of the preceding inquiry is, that corrosive sublimate causes, -when swallowed, corrosion of the stomach, and in whatever way it obtains -entrance into the body, irritation of that organ and of the rectum, -inflammation of the lungs, depressed action and perhaps also -inflammation of the heart, oppression of the functions of the brain, -inflammation of the salivary glands. These phenomena are diversified -enough. But it will presently be found that other organs still are -implicated in its effects on man. - -Before proceeding, however, to its effects on man, some notice may be -taken of a question, connected with its mode of action, which has long -been the subject of controversy. The experiments already quoted render -it probable that corrosive sublimate, before it can exert its remote -action, must enter the blood; and the facts to be enumerated under the -next head of the present section will render it probable that the milder -compounds of mercury used in medicine also act in a similar manner. -Physicians and chemists, therefore, long sought to discover this metal -in the solids and fluids of the body while under its influence; and the -failure of some attempts to detect it has naturally led to its presence -throughout the system being called in question by many. This inquiry, -besides its interest in a physiological point of view, is highly -important in respect to medico-legal practice, since it forms a material -branch of the general questions which at present occupy the attention of -medical jurists,—whether poisons that act through the blood should be -sought for by chemical analysis in other parts of the body besides the -stomach, intestines, or other organ to which they have been directly -applied—and in what particular quarters the search should be principally -made. - -In the case of mercury, the evidence of the absorption of the poison, -and of its entering the tissues and secretions of the body, is now -unimpeachable. This is chiefly derived from observations and experiments -made on man and animals after the long-continued use of the milder -preparations of mercury; it being imagined that if the poison enters the -blood at all, the greatest quantity will be found under these -circumstances. The facts may be arranged under three heads. Some relate -to the discharge of metallic mercury from the living body during a -mercurial course for medicinal purposes; others to the discovery of -metallic mercury in the dead body after a mercurial course, and others -to the detection of mercury by a careful chemical analysis in the fluids -and solids during life or after death. - -Many stories are related by the older authors of the discharge of -running quicksilver from the living body during a mercurial course. Some -of the most authentic of them have been collected by Zeller. In his list -of cases it is stated that Schenkius met with an instance of the -discharge of a spoonful of quicksilver by vomiting; that Rhodius twice -remarked quicksilver pass with the urine; and that Hochstetter once saw -it exhaled with the sweat.[861] Fallopius likewise states, that in -people who had used mercurial inunction for three years, and who had the -bones of the leg laid bare by suppurating nodes, he had seen quicksilver -collected in globules on the tibia; and he speaks of its being the -practice in his day to draw the mercury from the body, when overloaded -with it, by successively amalgamating a bit of gold in the mouth and -heating the amalgam to expel the mercury.[862] With regard to these -statements of the older authors it may be observed that, although their -singularity renders them questionable, they ought not to be rejected at -once, as some have done, merely because corresponding facts have not -been witnessed in modern times; for no one can now-a days have such -opportunities for observation as were enjoyed by Fallopius and his -contemporaries. The experiment of amalgamating gold in the mouth of a -person under a course of mercury has always failed in modern times. But -who can now have an opportunity of making the experiment during a -mercurial course of three years? Besides, the statements quoted above -are not all destitute of modern confirmation. Thus Fourcroy has noticed -the case of a gilder attacked with an eruption of little boils, in each -of which was contained a globule of quicksilver. Bruckmann mentions the -case of a lady who subsequently to a course of mercury remarked after a -dance many small black stains on her breast, and minute globules of -quicksilver in the folds of her shift.[863] And Dr. Jourda has described -in a late French periodical a case where fluid mercury was passed by the -urine. The last fact appears satisfactory in all its circumstances. A -patient had been taking corrosive sublimate for a month in the dose of a -grain, besides using for the first sixteen days a gargle containing -metallic mercury finely divided. Towards the close of the month he -observed on the sill of the window, on which he used to turn up his -chamber-pot after using it, many little globules of mercury, amounting -in all to four grains. Dr. Jourda on learning this observation of his -patient collected some of the urine with care, and after it had stood -some time found in it a black, powdery sediment, which, when separated -and dried, formed little globules of mercury.[864] - -The next class of facts in favour of the entrance of mercury into the -blood are derived from the discovery of the metal in the bodies of -persons who had undergone a long mercurial course recently before death. -In the German Ephemerides it is said that no less than a pound of it was -found in the brain and two ounces in the skull-cap of one who had been -long salivated.[865] This is certainly too marvellous a story. But -analogous observations have been made lately. In Hufeland’s Journal it -is mentioned that a skull found in a churchyard contained running -quicksilver in the texture of its bones, and that there is preserved in -the Lubben cabinet of midwifery a pelvis infiltered with mercury, and -taken from a young woman who died of syphilis.[866] An unequivocal fact -of the same nature has been related by Mr. Rigby Brodbelt. In a body of -which he could not learn the history he found mercurial globules as big -as a pin-head lying on the os hyoides, laryngeal cartilages, frontal -bone, sternum, and tibia.[867] Another equally unquestionable fact of -the kind has been supplied by Dr. Otto. On scraping the periosteum of -several of the bones of a man who had laboured under syphilis, he -remarked minute globules issuing from the osseous substance: in some -places globules were deposited between the bone and periosteum, where -the latter had been detached in the progress of putrefaction; and in -other places, when the bones were struck, a shower of fine globules fell -from them.[868] Wibmer observes that Fricke, surgeon to the Hamburg -Infirmary, has obtained mercury by boiling the bones of persons who had -been long under a course of mercurial inunction.[869] - -The third and most satisfactory class of facts are the result of actual -chemical analysis. These results were long variable. On the one hand, -Mayer, Marabelli,[870] and Devergie,[871] failed to detect mercury in -the fluids of people under a mercurial course; and I myself,[872] as -well as Dr. Samuel Wright,[873] had no better success in some -experiments on animals. On the other hand, Zeller detected it after -death in the blood and bile, Cantu procured it from the urine, Buchner -found it in the blood, saliva, and urine, and Schubarth extracted it -from the blood. The first experimentalist found that in the blood and -bile of animals killed by mercurial inunction, mercury could be detected -by destructive distillation, but not by any fluid tests.[874] Cantu, by -operating on sixty pounds of urine, taken from persons under the action -of mercury, procured no less than twenty grains of the metal from the -sediment.[875] The experiments of Buchner are very satisfactory. By -destructive distillation of the crassamentum of seven ounces of blood -taken from a patient who was salivated by mercury, he obtained rather -more than a quarter of a grain of globules; two pounds of saliva yielded -in the same way a 200th of a grain; and the urine contained so much that -it became brownish-black with sulphuretted-hydrogen.[876] Buchner -likewise adds, that Professor Pickel of Würzburg procured mercury by -destructive distillation from the brain of a venereal patient who had -long taken corrosive sublimate.[877] Not less satisfactory are the -experiments of Dr. Schubarth. A horse after being rubbed for twenty-nine -days with mercurial ointment to the total amount of eighty ounces, died -of fever, emaciation, diarrhœa, and ptyalism. On the sixteenth day, when -ptyalism had set in, a quart of blood was drawn from the jugular vein, -and after death another quart was collected from the heart, great -vessels and lungs,—extreme care being taken to collect it perfectly -pure. In each specimen there was procured by destructive distillation a -liquor, in which minute metallic globules were visible. A copper coin -agitated in the liquor was whitened; and when the oily matter was -separated by filtration and boiling in alcohol, the residue gave with -nitric acid a solution, which produced an orange precipitate with -hydriodate of potass. - -These researches were considered adequate to prove the strong -probability of the absorption of mercurial preparations when introduced -into the animal. But the frequency with which negative results were -obtained by competent inquirers, and in circumstances apparently -favourable, threw an air of doubt over the positive facts, however clear -they seem to be in themselves,—till at length Professor Orfila proved by -a series of careful experiments that the cause of failure must generally -have been the want of a process sufficiently delicate: for in all -ordinary circumstances, by using his process described above, he -succeeded in obtaining mercury in the urine and liver of animals -poisoned with corrosive sublimate, as well as in the urine of patients -who were taking that salt in medicinal doses. He could not detect it, -however, in the blood.[878] Since these investigations, Professor -Landerer of Athens detected mercury in the brain, liver, lungs and -spinal cord of a man who poisoned himself with two ounces and a half of -corrosive sublimate;[879] and M. Audouard has twice found it in the -urine and once in the saliva of persons salivated with mercury, by -simply transmitting chlorine, exposing the liquid to the air for a day, -evaporating it nearly to dryness, dissolving the residue in water -slightly acidulated with hydrochloric acid, immersing copper-leaf for -twenty-four hours, and heating the stained portions in a tube.[880] - -The cases of poisoning with the preparations of mercury, which have been -observed in the human subject, may be conveniently arranged under three -varieties. In one variety the sole or leading symptoms are those of -violent irritation of the alimentary canal. In another the symptoms are -at first the same as in the former, but subsequently become united with -salivation and inflammation of the mouth, or some of the other disorders -incident to mercurial erethysm, as it is called. In a third variety the -preliminary stage of irritation in the alimentary canal is wanting, and -the symptoms are from beginning to end those of mercurial erethysm in -one or another of its multifarious forms. - -The first variety of poisoning with mercury is remarked only in those -who have taken considerable doses of its soluble salts, particularly -corrosive sublimate. The second is produced by the same preparations. -The third may be caused by any mercurial compound. - -1. The symptoms in the first variety are very like what occur in the -ordinary cases of poisoning with arsenic,—namely, vomiting, especially -when any thing is swallowed, violent pain in the pit of the stomach, as -well as over the whole belly, and profuse diarrhœa. But there exist -between the effects of the two poisons some shades of difference which -it is necessary to attend to. - -In the first place,—taking corrosive sublimate as the best example of -the preparations which cause this variety of poisoning with mercury,—the -symptoms generally begin much sooner than those caused by arsenic. The -symptoms of irritation in the throat may begin immediately, nay, even -during the very act of swallowing;[881] and those in the stomach may -appear either immediately,[882] or within five minutes.[883] - -Secondly, the taste is much more unequivocal and strong. Even a small -quantity of corrosive sublimate, either in the solid or fluid state, and -considerably diluted, has so strong and so horrible a taste, that no one -could swallow it in a form capable of causing much irritation in the -stomach, without being at once made sensible by the taste that he had -taken something unusual and injurious. Occasionally, indeed, persons -thus warned of their danger while in the act of swallowing the poison, -have stopped in time to escape fatal consequences.[884] - -Thirdly, the sense of acridity which it excites in the gullet during the -act of deglutition, and throughout the whole course of the subsequent -inflammation of the alimentary canal, is usually much stronger. If the -dose be not small, or largely diluted, or in the solid form, the sense -of tightness, acridity, or burning in the throat and gullet during -deglutition is often far greater than ever occurs at any stage in the -instance of arsenic; and sometimes it is very severe even when corrosive -sublimate is taken in the solid form.[885] The tightness and burning in -the throat often continue throughout the whole duration of the -poisoning; and may be so excessive as to cause complete inability to -swallow,[886] or even to speak.[887] Occasionally the affection of the -throat is the only material injury inflicted by the poison, as in a case -related by Dr. J. Johnstone of a young woman, who tried to swallow two -drachms of corrosive sublimate in the solid state, but was unable to -force it down on account of the constriction it caused in the gullet. -She died in six days of mortification of the throat.[888] The greater -violence of the action of corrosive sublimate on the throat, compared -with that of arsenic, is evidently owing to its greater solubility and -powerful chemical operation on the animal textures. - -Fourthly, instead of the contracted ghastly countenance observed in -cases of poisoning with arsenic (but which, it will be remembered, is -not invariable in that kind of poisoning), those who are suffering under -the primary effects of corrosive sublimate have frequently the -countenance much flushed, and even swelled.[889] - -Corrosive sublimate seems to occasion more frequently than arsenic the -discharge of blood by vomiting and purging,—obviously because it is a -more powerful local irritant. - -It likewise gives rise more frequently to irritation of the urinary -passages. This irritation generally consists in frequent, painful -micturition; but the secretion of urine is often suppressed altogether. -Instances of this kind have been related by Mr. Valentine,[890] by my -colleague, Professor Syme,[891] by an anonymous writer in the Medical -and Physical Journal,[892] by Dr. Venables,[893] by Mr. Blacklock,[894] -and by M. Ollivier, in whose case, however, the poison was the bicyanide -of mercury.[895] In the last three cases the suppression was total, and -continued till death; which did not ensue, in one till eight, in the -next till five, and in the last till nine days after the poison was -taken. Sometimes, as in Ollivier’s case, the urinary irritation is -attended with symptoms of excitement of the external parts, such as -swelling and blackness of the scrotum and erection of the penis. - -Another distinction seems to be that corrosive sublimate is more apt -than arsenic to cause nervous affections during the first inflammatory -stage. The tendency to doze, which sometimes interrupts the inflammatory -symptoms caused by arsenic, has been more frequently observed in cases -of poisoning with corrosive sublimate.[896] The same may be said of -tremors and twitches of the extremities. Sometimes the stupor approaches -even to absolute coma;[897] and the twitches occasionally amount to -distinct, nay violent convulsions.[898] In other instances paraplegia -has been witnessed.[899] - -Another difference is, that the effects of mercurial irritants are fully -more curable than those of arsenic. Recovery has taken place even after -half an ounce was swallowed, with the effect of inducing both bloody -vomiting and purging.[900] This may depend in part on the greater -solubility of mercurial preparations, so that they are more easily -discharged than arsenic, which often remains in the stomach after days -of continual vomiting,—and in part on corrosive sublimate and other -soluble salts of mercury being converted, in no long time and much more -easily, into comparatively innocuous compounds, either by antidotes -intentionally given for the purpose, or by animal principles in the -secretions and accidental contents of the alimentary canal. - -Lastly, deviations from the ordinary course and combination of the -symptoms appear to be more rare in the instance of corrosive sublimate -than in that of arsenic. - -To these general statements, it may be right to add the heads of -one or two actual cases, lest an exaggerated idea be conveyed of -the combination of the symptoms as they usually occur. For this -purpose it will be sufficient to refer to a fatal case related by -M. Devergie, to an instance of recovery, without salivation having -supervened, which is contained in Orfila’s Toxicology, and to -another by Dr. Vautier, presenting the mildest possible symptoms -of this variety. In Devergie’s case, the patient, a female, -swallowed three drachms of corrosive sublimate in solution, and -was soon after seized with vomiting, purging, and pain in the -belly. In five hours, when she was first seen by Devergie, the -skin was cold and damp, the limbs relaxed, the face pale, the eyes -dull, and the expression that of horror and anxiety. The lips and -tongue were white and shrivelled; and she had dreadful fits of -pain and spasm in the throat whenever she attempted to swallow -liquids, also burning and pricking along the course of the gullet, -and increase of pain in these parts on pressure. There was -likewise frequent vomiting of mucous and bilious matter, with -burning pain in the stomach and tenderness of the epigastrium on -the slightest pressure. She had farther profuse diarrhœa, with -pricking pain and tenesmus. The pulsation of the heart was deep -and slow, the pulse at the wrist almost imperceptible, and the -breathing much retarded. In eighteen hours these symptoms -continued without any material change; but the limbs were also -then insensible. In twenty-three hours she died in a fit of -fainting, the mind having been entire to the last.[901]—Orfila’s -case was that of a gentleman who drank by mistake an alcoholic -solution of corrosive sublimate, but fortunately was so much -alarmed by its taste while drinking it, that he did not finish the -poisonous draught. Nevertheless, he was instantly attacked with a -sense of tightness in the throat and burning in the stomach, and -then with vomiting and purging. Two hours after the accident -Orfila found him with the face very full and red, the eyes -sparkling and restless, the pupils contracted, and the lips dry -and cracked. There was also acute pain along the whole course of -the alimentary canal, particularly in the throat. The belly was -swelled, and so tender that he could not bear the weight of -fomentation-cloths. The pulse was 112, small and sharp; the skin -intensely hot and pungent; micturition scanty, frequent, and -difficult; the breathing very much oppressed; the purging bilious. -The patient had likewise a tendency to doze, and was affected with -occasional convulsive twitches of the face and extremities, and -with constant cramps in the limbs. Next morning all the symptoms -were sensibly mitigated; and they went on decreasing till -convalescence was established in eight days. In the course of a -few weeks he recovered his usual health, without suffering -salivation.[902]—In Vautier’s case, where sixteen grains had been -swallowed, the patient was immediately attacked with pain in the -throat and stomach, cold extremities, trembling of the arms and -legs, vomiting, paleness of the features, and great feebleness of -the pulse. Vomiting being promoted by frequent draughts of warm -water, and white of egg given subsequently, no further symptoms -ensued, those first excited slowly subsided, and in a few days -recovery took place, without any salivation. Yet it was upwards of -half an hour before any measures could be taken for his -relief.[903] - -The only material and common symptom which was wanting in the case now -related was blood in the stools and in the matter vomited. In other -respects they are good examples of the ordinary train of symptoms in -cases of the present variety. For other examples of the same nature the -reader may refer particularly to the paper of Mr. Valentine, who has -described five cases that happened at one time in the same family, the -mother having attempted to poison herself and four children.[904] - -It may sometimes be necessary to know the usual duration of this variety -of mercurial poisoning, and also the extremes of its duration. On these -points I have not hitherto had opportunities of consulting a sufficient -number of cases to be able to lay down the general rule with precision. -But, so far as my inquiries go, the ordinary duration in fatal cases is -from twenty-four to thirty-six hours. It is probable that a few may last -three days,[905] but only one instance has come under my notice where -the duration was greater; and in that instance, which is described by -Dr. Venables, life was prolonged under great agony from pain of the -belly, bloody vomiting, diarrhœa and suppression of urine, but without -salivation, for no less than eight days.[906] In cases of recovery the -symptoms of irritation may continue very long, and nevertheless not pass -into the second variety of this kind of poisoning,—a transition, -however, which on the whole is uncommon. In the case of which an -analysis has been given from Orfila’s narrative, and likewise in one of -Mr. Valentine’s patients who recovered, the symptoms all along were -those of irritation in the alimentary canal; there was not any ptyalism, -or other symptom of proper mercurial erethysm.—The shortest duration yet -recorded is two hours and a half. This was in a case related by Dr. -Bigsby of Newark-on-Trent, where a tea-spoonful of a concentrated -solution of nitrate of mercury was swallowed by a lad sixteen years old, -and where the chief symptoms were burning pain from the mouth to the -stomach, tenderness of the whole belly, mucous vomiting, and feculent -purging.[907] In a case which occurred in London, and which has been -published succinctly by Mr. Illingworth, death must have occurred either -as soon, or very shortly afterwards. The dose of corrosive sublimate, -though not positively ascertained, was large.[908] Next to this the -shortest case recorded proved fatal in eleven hours.[909] - -2. The second variety of poisoning with mercury comprehends the cases, -which begin, like the former, with irritation in the alimentary canal, -but in which the symptoms of what is called mercurial erethysm gradually -supervene. In fatal cases of this description death sometimes arises -from the primary action of the poison, exactly as in the previous -variety; but in other instances it is owing to general disturbance of -the constitution, or the local devastation, brought on by the secondary -effects. - -It is unnecessary to describe here the several forms of mercurial -erethysm which may thus be developed, because they will immediately be -considered under the third variety of mercurial poisoning. It is -sufficient to state in passing that the leading affection is -inflammation of the organs in and adjoining the mouth, and more -particularly of the salivary glands. - -But it may be right to endeavour in the present place to fix the period -of the poisoning at which these secondary affections may and usually do -commence. This cannot be done so satisfactorily as might be wished, -because the cases already published which I have been able to examine do -not form a large enough induction. Among the recorded cases I have -hitherto seen, salivation has never been retarded beyond the third -day;[910] but in an instance of suicide by corrosive sublimate which -happened in the Castle of Edinburgh in 1826, and which was communicated -to me by the late Dr. Shortt, the salivation did not begin till the -fourth. Salivation seldom comes on sooner than the beginning of the -second;[911] and the most usual date of its commencement is towards the -close of the second day. There is little doubt that it may be retarded -till a period considerably later than I have yet found recorded. It is -doubtful whether true mercurial salivation ever begins much sooner than -after the first twenty-four hours. Occasionally, however, corrosive -sublimate produces salivation of a different kind, which has been -mistaken for the specific variety caused by mercury. Thus in a paper on -the cure of gonorrhœa by corrosive sublimate in single large doses, -communicated by Mr. Addington of West Bromwich to Dr. Beddoes, it is -stated that a grain and a half, taken at once in half an ounce of -rectified spirit, causes immediately “a great burning in the throat and -stomach, and quickly afterwards a copious salivation, lasting between an -hour and a half and two hours, and amounting frequently to more than a -quart.”[912] These facts have been appealed to by authors in medical -jurisprudence as proving the rapid production of mercurial salivation. -But the effect produced is not the specific ptyalism of mercury; for its -brief duration is scarcely consistent with this supposition. And -farther, the author goes on to observe, that, if the dose be taken on -going to bed, the latter part of the night is passed quietly, and no -inconvenience is felt afterwards, even when the dose is taken five or -six times at intervals of three or four days. The effects here observed -is a sympathetic phenomenon depending on the topical action of the -poison. And such, I have no doubt, has been the nature of the salivation -in several cases of poisoning with corrosive sublimate, which have been -supposed to be at variance with the general rule, that this affection -does not begin till about twenty-four hours have elapsed. Such seems to -have been the nature of the salivation in a case published by Dr. -Perry,[913] that of a girl who was attacked with swelling of the cheeks -and lower lip, burning in the throat, flushed face, feeble pulse, and -cold, clammy extremities after swallowing corrosive sublimate, and who -had a copious flow of saliva in an hour and a half; for there is no -mention made of fetor, and the girl was well enough to leave the -hospital in a few days,—which could scarcely happen if she had been -affected with ptyalism from the constitutional action of mercury.—In -like manner Dr. Alexander Wood has related a case, fatal in fourteen -days, in which the patient said salivation came on in seven hours.[914] -But, notwithstanding Dr. Wood’s argument in support of the patient’s -statement,—for he did not see him till nine days after the poison was -taken,—there is no satisfactory evidence that the salivation was the -true constitutional salivation of mercury, and not simply the result of -its topical action, which seems to have been very severe.—Farther, in an -instance related by Dr. H. Anderson of Belfast, where salivation -appeared to him to begin in nineteen hours, it seems not improbable that -he mistook for mercurial ptyalism the common salivation arising from -inability to swallow on account of sore throat; for this patient too was -quite convalescent in three days.[915]—Mr. Alfred Taylor alludes to a -case in Guy’s Hospital of salivation occurring in four hours; but so -briefly, that its true influence on the present question cannot be -judged of.[916]—On the whole, then, although it is clear that ptyalism -of one kind or another may occur very soon after corrosive sublimate is -swallowed, it remains a matter of doubt, whether the true, specific -ptyalism, depending on the constitutional action of the poison begins -sooner than after an interval of above twenty-four hours. - -As to the total duration of this variety in fatal cases, I have found an -instance fatal on the fourth day, salivation having begun on the -second;[917] and Orfila quotes a case from Degner, in which the -gastro-enteritic symptoms were succeeded by ptyalism about the same -period, and which proved fatal in fifteen days.[918] These periods, -however, probably do not form the extremes; for in such cases as the -former death is the consequence of the primary affection, and may -therefore ensue immediately after the secondary stage has begun to -develope itself; and when death arises from profuse salivation, as in -Degner’s patient, or from the ravages committed by ulceration and -gangrene, it may be delayed almost as long as in cases of the third -variety of mercurial poisoning, in which there is no precursory stage of -inflammation in the alimentary canal. - -Death may arise, not only from the primary action of the poison, or from -the exhaustion caused by mercurial erethysm, but likewise from -incidental occurrences. Thus, in Dr. Alexander Wood’s case, referred to -above, death arose directly from sudden profuse hemorrhage from the -bowels, to the amount of six pounds. - -The present variety of poisoning with corrosive sublimate may be -concluded with the heads of an excellent example related in the Medical -and Physical Journal. The patient, a stout young girl, swallowed soon -after supper a drachm of corrosive sublimate dissolved in beer, and in a -few minutes she was found on her knees in great torture. All the primary -symptoms of this kind of poisoning were present in their most violent -form,—burning in the stomach, extending towards the throat and mouth, -followed in no long time by violent vomiting of a matter at first -mucous, afterwards bilious and bloody; by purging of a brownish, fetid -fluid; suppression of urine and much tenderness of the urethra and -bladder; small, contracted, frequent pulse, anxious countenance, and -considerable stupor, interrupted frequently by fits of increased pain. -All these symptoms were developed in four hours. Subsequently the pain -in the stomach became much easier, but that in the throat much worse. At -length in the course of the second day, the teeth became loose, the gums -tender, the saliva more abundant than natural; profuse ptyalism and -great fetor of the breath ensued, and the patient expired towards the -close of the fourth day.[919] - -3. The third variety of poisoning with mercury comprehends all the forms -of what is called mercurial erethysm. Without endeavouring to settle the -precise meaning of this term, which is now used in rather a vague sense, -I shall consider under the present head all the secondary and chronic -effects of mercury. These may be caused by any of its preparations, but -are most frequently seen as the consequence of its milder compounds, -either given medicinally in frequent small doses, or applied -continuously to the bodies of workmen who are exposed by their trade to -its fumes. - -The secondary and chronic effects of mercury are multifarious enough in -reality; but if credit were given to all that has been written, and is -still sometimes maintained on this subject, almost every disease in the -nosology might be enumerated under the present head; for there is -scarcely a disease of common occurrence, which has not been imputed by -one author or another to the direct or indirect operation of mercury. -The present remarks, however, will be confined as much as possible to -what is well ascertained, and bears on the medical evidence of poisoning -with mercury, or is important in regard to medical police. With this -view, salivation and its concomitants, the most usual of the secondary -effects of mercury, will first be treated of. Some observations will -then be made on the shaking palsy, or mercurial tremor, which is caused -in those who work with mercury. And in conclusion, a short view will be -taken of the other diseases which are more indirectly induced by this -poison, as well as some which have been ascribed to it on insufficient -grounds. This being done, the mode of action of mercurial poisons will -be resumed, and a description given of their relative effects when -introduced by different channels and in different chemical forms. - -_Of Mercurial Salivation._—Mercurial salivation may be caused by any of -the preparations of mercury, and either by a single dose or by -frequently repeated small doses. It may be caused by corrosive sublimate -as the secondary stage of a case which commenced with inflammation in -the alimentary canal; or it may be the first sign of mercurial action, -as in the medicinal mode of administering calomel and blue pill. Even in -the latter case a single dose, and that not large, may be sufficient to -induce ptyalism of the most violent kind. When induced by a single dose -it usually commences between the beginning of the second and end of the -third day, rarely within twenty-four hours. But an extraordinary case is -mentioned by Dr. Bright, where five grains, put on the tongue in -apoplexy and not washed over, excited in three hours most violent -salivation, with such swelling of the tongue that scarifications became -necessary.[920] It commences with a brassy taste and tenderness of the -mouth, swelling, redness, and subsequently ulceration of the gums; -peculiar fetor of the breath; and at last an augmentation is observed in -the flow of the saliva, commonly accompanied with fulness around the -lower jaw. These symptoms increase more or less rapidly. Sometimes they -are very mild; nay, this form of the secondary effects of mercury may -consist in nothing else than brassy taste, tenderness of the mouth, -redness of the gums, and fetor. On the other hand, the symptoms are -often very violent, the salivation being profuse, the face swelled so as -to close the eyes, and almost fill up the space between the jaw and -clavicles, the tongue swollen so as to threaten suffocation, the inside -of the mouth ulcerated, nay gangrenous, and at times the gangrene -extends over the face. It is not uncommon to observe severe and -extensive ulceration without particular increase of the saliva. - -These local affections are almost always accompanied with more or less -constitutional disorder. If severe, they are attended with the -symptomatic fever proper to inflammation and gangrene, from whatever -cause they spring. But independently of that, mercurial salivation is -accompanied, and indeed commonly preceded, by a constitutional disorder -or symptomatic fever of its own, which occasionally exhibits some -peculiarities. The mildest affection of the mouth and salivary glands is -very generally preceded by some exaltation of the pulse and temperature, -and other symptoms of fever. But when the local disorder begins -violently, and above all when this takes place by idiosyncrasy from -small doses of mild preparations, there is often great rapidity of the -pulse, irregular action of the heart, and various nervous disorders -possessing the hysteric character,—all of which, except the quick pulse, -will sometimes gradually abate or even disappear, when the salivation is -fairly established. - -The phenomena of ordinary mercurial salivation being familiar to every -practitioner, it is unnecessary to quote here any illustrative example; -but the following instance may be given to exemplify its most malignant -forms. A patient of Mr. Potter of Chipping-Ongar, in Essex, after taking -eighteen grains of blue pill in divided doses during three days, was -seized with excessive salivation and great constitutional disturbance, -indicated by offensive evacuations, copious sweating, bleeding from the -nose, purple spots on the skin, dilated pupils, and such severe local -disease that the teeth dropped out, and he expired six days after -mercurial action set in.[921] - -As the phenomena of mercurial salivation have been often known to lead -to important evidence and much contrariety of opinion upon trials, it -will be necessary to dwell at some length on some parts of the subject. - -In the first instance, then, the dose which is required to bring on -salivation may be noticed. It is needless to mention the ordinary -quantity required in mercurial courses. A more useful object of -consideration is the departure from the ordinary rule. One of the most -common and important of these deviations is excessive sensibility to the -action of mercury, in consequence of which the individuals who have this -idiosyncrasy may be profusely salivated by one or two small doses even -of the mildest preparations. Three grains of corrosive sublimate divided -into three doses have caused violent ptyalism.[922] Fifteen grains of -blue pill, taken in three doses, one every night, have excited fatal -salivation.[923] Nay, two grains of calomel have caused ptyalism, -extensive ulceration of the throat, exfoliation of the lower jaw, and -death.[924] Three drachms of mercurial ointment applied externally have -caused violent ptyalism and death in eight days. On the other hand, it -is well known that some constitutions resist the action of mercurials -very obstinately, so as even sometimes to appear incapable of being -salivated at all. I have more than once met with cases of the last -description, where mercurial courses had been continued for three months -and upwards without avail. It may be added, that, except in -constitutions naturally predisposed to suffer from a few small doses, a -few large doses do not appear apt to excite severe salivation, or even -to cause any at all. This has been clearly shown in the course of the -practice lately introduced of administering calomel in doses of a -scruple. On that subject more will be said by and by. At present I may -mention, that, in conformity with the practice alluded to, I have -several times, in various diseases, given eight or ten grains of calomel -five or six times a day for two or three days together, without -observing that ptyalism was apt to ensue. - -The next point to be considered is, whether mercurial salivation can be -confounded with any other affection. In a very difficult case of -poisoning which was tried here in 1817, that of William Patterson for -murdering his wife,[925] it appeared probable that he had given her -repeatedly large doses of calomel. But the proof of this was -circumstantial only, and an important circumstance in the chain of -evidence was a deposition to the occurrence of salivation during the -woman’s illness. This fact, however, rested on the skill and testimony -of a quack doctor only; and the admissibility of such a person to decide -on a point of this nature, will depend on the facility with which the -true mercurial form of salivation can be recognised. This statement will -show the practical object of what is to follow. - -Many other causes may excite a preternatural flow of saliva. Several -other poisons may have that effect, for example, preparations of gold, -preparations of copper, antimony, croton-oil, and foxglove: foxglove has -been known to cause violent salivation for three weeks.[926] Opium too -has occasionally excited salivation,[927] and also hydrocyanic acid and -iodide of potassium. - -Even a common sore throat, if the swelling and pain are so great as to -render swallowing very difficult and distressing, may be accompanied, as -every physician must have remarked, with a profuse flow of saliva; and -in the ulcerative stage there is also often a fetor that is hardly -distinguishable from the mercurial kind. In the ulceration of the mouth -called _cancrum oris_ there is some salivation with great fetor of the -breath. - -Salivation likewise forms an idiopathic disease, and may then be both -profuse and obstinate. Mr. Davies has described a case of spontaneous -ptyalism which had lasted for a fortnight before he was called to see -the patient; and during all that time the quantity of saliva discharged -was two or three pints daily. How long it endured afterwards he does not -mention; but it must have continued for some time, because during his -attendance first one physician and then another were called into -consultation with him. Laxatives slowly removed it. Mr. Davies has not -described the state of the mouth; but the first physician mistook the -salivation for a mercurial one.[928] In the same journal which contains -this case another has been related which lasted four months.[929] -Another very remarkable case has been recorded by Mr. Power. The -patient, a young lady, discharged for more than two years from sixteen -to forty ounces of saliva daily. In the last two cases the mouth was not -affected.[930] Two other instances have been related by M. Bayle, in one -of which the patient was cured after spitting five pounds daily for nine -years and a half; while the other continued to be affected after -spitting profusely for three years. In neither was there any ulceration -of the mouth.[931] An instance has been related by an Italian physician, -Dr. Petrunti, where, in the course of various nervous affections of the -hysteric character, the patient became affected with heat and tightness -in the throat, and so profuse a salivation for two months, that between -three and four pounds were discharged daily.[932] A case somewhat -similar is related in Rust’s Magazin of a man who suffered upwards of -two years from a daily salivation alternating occasionally with a mucous -discharge from the bowels or lungs.[933] M. Guibourt describes the case -of a lady who had an attack of profuse salivation every thirty, forty, -or fifty days, lasting between twenty-four and forty-eight hours, and -unaccompanied with any other affection of the mouth or adjoining parts -except a sense of tightness in the throat.[934] M. Gorham relates an -interesting case of a lady who in three successive pregnancies was -attacked soon after impregnation with excessive ptyalism, which -continued to the extent of between two and four quarts daily until the -period of quickening on two occasions, and on the third till her -delivery; but there was never any fetor or any affection of the -gums.[935] I have likewise met with a singular case where spontaneous -ptyalism accompanied an ulcerated sore throat of the mercurio-syphilitic -kind. The patient had taken mercury to salivation about six months -before coming under my care, and got completely rid of both the sore -throat and salivation. But the sore throat returned, together with the -salivation, two months before I saw him, and the salivation continued -for two months longer to the extent of twenty or even thirty ounces -daily,—the ulcer of the throat during that interval being sometimes -healed up, and again returning as severely as ever. In three weeks more -the discharge rapidly diminished, and ceased. During all the time he was -under my care there was no fetor of the breath, and no redness, -ulceration, or sponginess of the gums. A singular account of an epidemic -salivation which occurred in connection with a continued tertian fever, -has been given in an inaugural dissertation contained in one of Haller’s -Collections. The author, Quelmalz, says that the ptyalism sometimes -continued for three weeks, that it was in one instance as great in -extent as the most violent mercurial salivation, and that it was -accompanied by fetor, superficial ulceration of the mouth, pustules on -the tongue, relaxation of the gums, and looseness of the teeth.[936] - -Salivation may likewise be produced by the influence of the imagination. -I have seen a singular example of this. A woman who had a great aversion -to calomel was taking it with digitalis for a dropsical complaint. Some -one having told her what she was using, she immediately began to -complain of soreness of the mouth, salivated profusely, and even put on -the expression of countenance of a salivating person, although she had -taken only two grains. On being persuaded, however, that she had been -misinformed, the discharge ceased gradually in the course of one night. -Two days afterwards she was again told on good authority that calomel -was contained in her medicines, upon which the salivation began again -and was profuse. It did not last above twenty-four hours; but the -symptoms during that period resembled a commencing mercurial salivation -in every thing but the want of fetor and redness of the gums. - -In general, mercurial salivation may be easily distinguished from all -the preceding varieties by an experienced practitioner. If its progress -has been traced from the first appearance of brassy taste and fetor to -the formation of ulcers and supervention of ptyalism, no attentive -person can run any risk of mistaking it. Its characters are also quite -distinct at the time salivation just begins. The fetor of the breath and -sponginess and ulceration of the gums at this stage distinguish it from -every other affection. But if the state of the mouth is not examined -till the ulcers have existed several days, the characters of the -mercurial disorder are much more equivocal. They cannot be -distinguished, for example, from some forms of idiopathic ulceration of -the mouth connected with unsoundness of the constitution, and -characterized by extensive sloughing, ptyalism, and gangrenous -fetor.[937] In particular they cannot be distinguished from the effects -of the disease called _cancrum oris_. A few years ago indeed a London -physician was charged, in consequence of this resemblance, with having -killed, by mercurial salivation, a patient to whom it was proved that he -had not given a particle of mercury, and who clearly died of the disease -in question;[938] and a similar case, where fatal mercurial salivation -was suspected, but which was clearly proved on a Coroner’s Inquest to -have been also a case of cancrum oris, has been more lately published by -Mr. Dunn.[939] - -For distinguishing these and such other affections from mercurial -salivation Dr. Davidson of Glasgow has lately proposed a character, the -exact scope of which cannot yet be appreciated,—namely, that in true -mercurial salivation there is never any sulpho-cyanic acid in the -saliva; so that sesquichloride of iron does not render it red. The -presence of sulpho-cyanic acid may possibly prove that salivation is not -mercurial; but the converse does not hold good, because other causes -tend to deprive human saliva of its sulpho-cyanic acid.[940] - -The next point to be noticed regarding mercurial salivation is, that a -long interval may elapse after the administration of the mercury has -been abandoned, before the effect on the salivary glands and mouth -begins,—mercury in small doses being what is called a cumulative poison, -or a poison whose influence accumulates silently for some time in the -body before its symptoms break forth. Swédiaur has met with instances -where the interval was several months,[941] Cullerier with a case in -which it was three months.[942] It will at once be seen how strongly -such facts may bear on the evidence in a criminal case, where the -administration of mercury in medicinal doses, which have been long -abandoned, is brought forward to account for salivation, appearing weeks -or months after, and giving rise, in conjunction with other -circumstances, to a suspicion of mercurial poisoning of more recent -date. - -Another question which has been made the subject of discussion is the -duration of mercurial ptyalism. The medical witness may be required to -give his opinion how long this affection may last after the -administration of mercury has been abandoned. The present question may -be cut short by stating, that there appears to be hardly any limit to -its possible duration. Linnæus met with an instance of its continuing -inveterately for a whole year;[943] Swédiaur says he has known persons -languish for months and years from its effects;[944] and M. Colson knew -an individual who had been salivated for six years.[945] These, however, -are very rare incidents. After an ordinary mercurial course the mouth -and salivary glands generally return to the healthy state in the course -of a fortnight or three weeks. - -A fifth question, whether the ptyalism, or, speaking in general terms, -the erethysm of mercury, is susceptible of a complete intermission, -formed a material subject of inquiry, and the cause of much -contradictory statement on a noted criminal trial, that of Miss -Butterfield in 1775 for the murder of her master, Mr. Scawen. She was -accused of administering corrosive sublimate; and it was alleged in her -defence, that the salivation and consequent sloughing of which he died -might have arisen, without the fresh administration of mercury, from the -renewal of a previous ptyalism, which had been brought on by a common -mercurial course, and had ceased two months before the second salivation -began. It appeared that Mr. Scawen was salivated with a quack medicine -from the beginning till the middle of April; and that about the middle -of June he was again seized with violent salivation, of which he died. -It was rendered very improbable, that during the interval between the -two salivations any more mercury had been taken medicinally. The -question then was, whether the original ptyalism could have reappeared -after so long an interval, without the fresh administration of mercury? -The witnesses for the prosecution, gentlemen in extensive practice, said -it could not. But one of the prisoner’s witnesses, Mr. Bloomfield of the -London Lock Hospital, said he had repeatedly known salivation reappear -after a long intermission; that it was quite common for hospital -patients to have a second salivation, when thought well enough to go out -the next dismissal day;[946] that in one case the interval was three -months; and that one of his patients was attacked periodically with -salivation at intervals of six weeks or a month for a whole year. Mr. -Howard, another surgeon of the Lock Hospital, deposed to the same -effect; and the prisoner was acquitted, apparently upon their -evidence.[947] - -Notwithstanding what was said by these gentlemen, I believe the -recurrence of mercurial salivation after so long an interval, without -the repetition of mercury, is exceedingly rare. Dr. Gordon Smith, in -alluding to the trial of Miss Butterfield, has mentioned a case which -occurred to the late Dr. Hamilton of this University, and used to be -related by him in his lectures. The interval was so great as four -months.[948] Mr. Green of Bristol has lately described another -unequivocal case, where the interval was six weeks.[949] Dr. Mead says -he met with an instance where the interval was six months;[950] and Dr. -Male mentions another where mercury brought on moderate salivation in -March, and after a long interval excited a fresh salivation in October, -of which his patient died in a few weeks.[951] M. Louyer-Villermé met -with a case, where, in consequence of exposure to cold, a sudden attack -of salivation was caused a twelvemonth after the removal of syphilis by -mercury.[952] Some other cases not less wonderful have been recorded by -M. Colson in his paper on the effects of mercury. He quotes Dr. Fordyce -for the case of a man who had repeated attacks of salivation, with -metallic taste, which lasted for three weeks, although mercury had not -been taken for twelve years; and Colson himself knew a surgeon who had a -regular and violent attack of all the symptoms of mercurialism eight -years after he had ceased to take mercury.[953] It is impossible to -attach credit to such marvellous stories as the last two. Granting the -ptyalism to be really mercurial, it would require much better evidence -than any practitioner could procure, to determine the fact that mercury -had not been given again during the supposed interval. This objection -indeed will apply more or less even to the instances where the alleged -interval did not exceed a few months. - -The last point to be noticed regarding mercurial salivation is the -manner in which it proves fatal. Death may ensue from the mildest -preparations, and from the smallest doses, in consequence of severe -salivation being produced by them in peculiar habits. Two instances have -been already mentioned which illustrate both of these statements, and -others might easily be referred to were the fact not familiar. - -Death may be owing to a variety of causes. Some of those which have been -assigned are direct and unquestionable in their operation; others -indirect and more doubtful. - -The most direct and obvious manner is by extensive spreading gangrene of -the throat, mouth, face, and neck. The late happy changes, introduced -into the treatment of syphilis and other diseases which are benefited by -mercury, render this mode of death rare in the present day. Yet I may -mention that I have seen an example of it in a woman who was salivated -to death, because her medical attendant, a firm believer in the powers -of mercury as an antidote, forgot that the antidote is itself a poison, -if not given in moderation. In general, when gangrene is the cause of -death, it begins within the mouth or in the throat, and spreads from -that till it even reaches the face. But sometimes it begins at once on -the external surface, at a distance from the primary ulcers. An example -of such a progress of the symptoms has been related by Dr. Grattan. A -child ten years old was violently salivated by twenty grains of calomel -given in six days. On the fifth day of the salivation, a little vesicle -appeared on the skin near the mouth on each side, and was the -commencement of a gangrenous ulcer, which spread over the whole cheek, -and proved fatal eight days after its appearance.[954] - -Another cause of death appears to be exhaustion from profuse and -protracted discharge of saliva, without material injury of the mouth or -adjoining organs. - -A third manner of death which I have witnessed is exhaustion from -laryngeal phthisis; and from the circumstances of the case, I have -little doubt but, in the state to which patients are then sometimes -reduced, death may also take place suddenly from suffocation. My patient -had undergone before I saw him five long salivations for a venereal -complaint, and had latterly been attacked with symptoms of ulceration of -the glottis. This affection went on slowly increasing, and he died of -exhaustion after many weeks of suffering. During this period he was -repeatedly attacked with alarming fits of suffocation, which were -relieved by the hawking of mucous flakes. The symptoms were explained on -dissection by the appearance of extensive ulceration and thickening of -the glottis, and almost total destruction of the epiglottis. - -The other causes of death are more indirect, and will be mentioned -presently. They depend on the pre-existence of other diseases, on which -mercury acts deleteriously during the state of erethysm excited by it in -the constitution. - -_Of Mercurial Tremor._—The second division of the secondary effects of -mercury comprehends the palsy or tremor, with the collateral disorders -induced in miners, gilders, and other workmen, whose trade exposes them -to the operation of this poison. Under the present head, which might be -treated at considerable length as an important branch of medical police, -I shall confine myself chiefly to an analysis of an interesting essay by -Mérat on the _Tremblement Metallique_, and to some remarks by Jussieu on -the health of the quicksilver miners of Almaden in Spain. - -Mérat’s account of the shaking palsy induced by mercury is very -interesting.[955] The disease, he states, may sometimes begin suddenly; -but in general it makes its approaches by slow steps. The first symptom -is unsteadiness of the arms, then quivering, finally tremors, the -several movements of which become more and more extensive till they -resemble convulsions, and render it difficult or impossible for the -patient to walk, to speak, or even to chew. All voluntary motions, such -as carrying a morsel to the mouth, are effected by several violent -starts. The arms are generally attacked first and also most severely. If -the man does not now quit work, loss of memory, sleeplessness, delirium, -and death ensue. But as the nature of the disease soon renders working -almost impossible, he cannot well continue; and in that case death is -rare. The concomitant symptoms of the trembling are a peculiar brown -tint of the whole body, dry skin, flatus, but no colic, no disorder of -respiration, and, except in very old cases, no wasting or impaired -digestion. The pulse is almost always slow.—This description agrees with -a somewhat later account of the disease by Dr. Bateman, as he observed -it in mirror-silverers;[956] and also with some interesting cases -recently published by Dr. Bright.[957] - -In general the tremors are cured easily, though slowly, several months -being commonly required. One of Dr. Bright’s patients got almost well in -little more than a fortnight under the use of sulphate of zinc. -Sometimes, however, the trembling is incurable.[958] I have said the -disease is rarely fatal. Mérat quotes three cases only, in one of which -death was owing to profuse salivation and gangrene, in the others to -marasmus. On the whole, those who are liable to the shaking palsy do not -appear liable to salivation. Yet the two affections are sometimes -conjoined, as in three of the cases described by Dr. Bright, and in some -noticed by Mr. Mitchell among the mirror-silverers of London.[959] -Gilders, miners, and barometer-makers are all subject to the disease. -Even those who undergo mercurial frictions may have it, according to -Mérat; and M. Colson, who confirms this statement, quotes Swédiaur as -another authority for it.[960] It is not merely long-continued exposure -to mercurial preparations that causes the shaking palsy: a single strong -exposure may be sufficient; and the same exposure may cause tremor in -one and salivation in another. Professor Haidinger of Vienna some time -ago mentioned to me an accident a barometer-maker of his acquaintance -met with, which illustrates both of these statements. This man and one -of his workmen were exposed one night during sleep to the vapours of -mercury from a pot on a stove, in which a fire had been accidentally -kindled. They were both most severely affected, the latter with -salivation, which caused the loss of all his teeth, the former with -shaking palsy, which lasted his whole life. - -In regard to all such workmen, it is exceedingly probable that with -proper care the evils of their trade may be materially diminished. This -appears at least to be the result of the observations made long ago by -Jussieu on the miners of Almaden in La Mancha. Most quicksilver mines -are noted for great mortality among the workmen. But Jussieu maintains -that the trade is not by any means so necessarily or so dreadfully -unhealthy as is represented, or as it really is in some places. The free -workmen at Almaden, he says, by taking care on leaving the mine to -change their whole dress, particularly their shoes, preserved their -health, and lived as long as other people; but the poor slaves, who -could not afford a change of raiment, and who took their meals in the -mine, generally without even washing their hands, were subject to -swelling of the parotids, aphthous sore throat, salivation, pustular -eruptions, and tremors.[961] - -_Of the indirect effects of mercurial erethysm._—The last division of -the secondary effects of mercury relates to its indirect action when -concurring with other diseases or predispositions to disease. - -Of these effects there are some of which the poison appears to be the -chief, if not even the sole cause. Thus, during the symptomatic fever -which precedes salivation there are sometimes remarked imitative -inflammations, or coma, or affections of the heart, which go off as -salivation is established. - -Other effects require the distinct co-operation of collateral causes. -Many inflammatory diseases, not easily excited in ordinary -circumstances, arise readily from improper exposures during salivation, -for example dropsy, pneumonia, phrenitis, iritis, erysipelas, and -various chronic eruptions. - -Other effects again require the co-operation of disease, such as -sloughing gangrene supervening on ordinary ulcers during the action of -mercury,—a not uncommon accident. This appears most likely to happen -when the ulcers are constitutional. - -Lastly, in conjunction with other diseased morbid actions, either going -on at the same time, or immediately preceding mercurial erethysm, this -poison is apt to occasion some modifications of disease which are rarely -otherwise witnessed. Modifications of the kind have already been traced -in the instances of lues venerea and scrofula; but there is reason to -believe that the same singular property may also exist in relation to -other constitutional disorders. - -These observations conclude the inquiry into the symptoms caused in man -by mercurial poisons generally. Returning now to its mode of action, we -have to examine its relative effects through the different animal -textures, and in its various chemical forms. - -The result of the previous remarks as to its action on animals, it will -be remembered, was, that its soluble preparations cause when swallowed -corrosion of the stomach, and in whatever way it enters the body -irritation of the stomach and rectum, inflammation of the lungs, -depressed action and perhaps inflammation of the heart, oppression of -the functions of the brain, and inflammation of the salivary glands. All -of these effects have likewise been mentioned in the preceding sketch, -as occurring in a greater or less degree in consequence of its operation -on man. - -Mercury acts as a poison on man in whatever way it is introduced into -the body,—whether it be swallowed, or inhaled in the form of vapour, or -applied to a wound, or even simply rubbed or placed on the sound skin. -But the kind of action excited differs according to the channel by which -it is introduced. - -The most ordinary and dangerous cases of poisoning arise from the -introduction of corrosive sublimate into the stomach. The poison then -kills by corroding or inflaming the alimentary canal, or by causing -salivation and its concomitants. - -When applied to a wound or ulcer corrosive sublimate does not often -occasion dangerous symptoms. Yet it is sometimes a hazardous remedy. It -is not a convenient escharotic even in a concentrated state; for its -escharotic action is not incompatible with its absorption; at all events -it certainly sometimes acts constitutionally through the surface of -wounds and ulcers, and the symptoms brought on in this way are generally -violent. They are the symptoms of mercurial salivation, accompanied at -times with well-marked inflammation of the alimentary canal. When -applied to sores in a diluted state it has also been known to cause -dangerous effects if too long persevered in. A case of the kind has been -related by Mr. Robertson, an army-surgeon. After anointing an itchy -eruption of the arms for seven days with a solution of corrosive -sublimate containing five grains to the ounce, his patient was attacked -with fever, inflammation of the stomach and bowels, and in two days more -with violent salivation.[962] A case of the same nature has been related -by Mr. Sutleffe.[963] His patient, a child, in consequence of having an -eruption of the head washed with a solution of corrosive sublimate, was -attacked with violent salivation, which proved fatal in a few days. -Pibrac has recorded three fatal cases from the free application of -corrosive sublimate to ulcerated surfaces. One of these proved fatal in -five days, another in twenty-four hours, and a third during the night -after the poison was applied. The symptoms generally indicated violent -action on the alimentary canal.[964] In an instance mentioned by Degner, -fatal in twenty-five days, there was also violent irritation of the -stomach; but the chief affection was excessive swelling of the face and -throat, together with profuse ptyalism.[965] - -One of the readiest modes of bringing the system under the poisonous -action of mercury is by introducing its preparations into the lungs. It -appears from some experiments by Schlöpfer that the fluid preparations -act rapidly through the lining membrane of the air-passages. Six grains -of corrosive sublimate in solution will thus kill a rabbit in five -minutes.[966] But the effects of mercury through this channel are much -better exemplified when its preparations are inhaled in the form of -vapour. Corrosive sublimate when incautiously sublimed in chemical -experiments has been known to cause serious effects. Dr. Coldstream of -Leith informs me, that while subliming about twenty-four grains of it -with the blowpipe when a student, he and several of his -fellow-apprentices were seized with painful constriction of the throat, -several had headache, and one had sickness and vomiting. The phenomena -produced by the various preparations of mercury in more violent cases, -are sometimes protracted tremors,[967] sometimes severe ptyalism and -tedious dysentery,[968] sometimes salivation and gangrene of the mouth -ending fatally.[969] This last form was produced remarkably in a -chimney-sweeper, after cleaning a gilder’s chimney, during which -operation he felt a disagreeable sense of tightness in the throat. - -Several extraordinary instances have happened of poisoning from -long-continued inhalation of the vapours which arise from metallic -mercury. That vapours do arise from metallic mercury of the ordinary -temperature of the atmosphere has been fully proved by Mr. Faraday; who -found, that when a bit of gold was suspended from the top of a phial, -the bottom being covered with a little mercury, the gold soon became -amalgamated.[970] The vapours thus discharged may produce the worst -species of mercurialism, if they are diffused through an apartment -insufficiently ventilated. One of the most striking examples known of -the baneful effects of mercury thus gradually insinuated into the -system, occurred in a well-known accident which befel the ships Triumph -and Phipps. These vessels were carrying home in 1810 a large quantity of -quicksilver saved from the wreck of a ship near Cadiz, when by some -accident several of the bags were burst and the mercury spilled. On the -voyage home the whole crews of both vessels were more or less severely -salivated, two died, many were dangerously ill, all the copper articles -on board became amalgamated, all the rats, mice, cockroaches, and other -insects, as well as a canary-bird and several fowls, and all larger -animals, such as cats, dogs, goats, and sheep were destroyed.[971] - -The action of mercury is often violently excited when it is applied to -the skin even not deprived of the cuticle. The effects of mercurial -inunction form a well-known and satisfactory proof of this. Even without -the aid of infriction, the soluble preparations of mercury will excite -mercurial action by being put simply in contact with the skin. Thus it -has been shown by a German physician, Dr. Guérard, that ptyalism may be -induced by a warm bath of corrosive sublimate in the proportion of an -ounce to 48 quarts of water, and that the effect commonly begins after -the third bath with an interval of three days between them.[972] It is -not so generally known that the more active preparations, such as -corrosive sublimate or nitrate of mercury, may, like arsenic, cause -through the sound skin effects almost as violent as through the -alimentary canal. The following pointed illustration is related by Dr. -Anderson. A gentleman affected with rheumatism, was persuaded by a -friend to use a nostrum, which was nothing else than a solution of half -a drachm of corrosive sublimate in an ounce of rum. This was rubbed on -the affected part for several minutes before going to bed. Ere the -friction was ended, he felt a sensation of heat in the part, to which, -however, he paid little attention. But during the night he was attacked -with pain in the stomach, sickness, and vomiting, and soon after with -purging and tenesmus. In the morning Dr. Anderson found him very weak -and vomiting incessantly. The arm up to the shoulder was prodigiously -swelled, red, and blistered. Next day he complained of brassy taste and -tenderness of the gums, and regular salivation soon succeeded.[973] -Another case of much interest has been described by my colleague, -Professor Syme, where a solution of the nitrate was rubbed by mistake -upon the hip and thigh instead of camphorated oil. Intense pain -immediately followed, and afterwards shivering; the urine was suppressed -for five days, without any insensibility, and during its suppression -urea was detected in the blood; ptyalism appeared on the third day, -became very profuse, and was followed by exfoliation of the alveolar -portion of the lower jaw, but recovery nevertheless slowly took -place.[974] - -The mere carrying of mercurial preparations for a length of time near -the skin, though not in direct contact with it, may be sufficient to -induce the peculiar effects of the poison, as the following example will -show. A man applied to a German physician, Dr. Scheel, affected with -violent salivation evidently mercurial which proved fatal, but which it -was impossible to trace to its real cause till after death, when a -little leathern bag containing a few drachms of mercury was found -hanging at his breast; and it was then discovered that he had been in -the practice of carrying this bag for six years as a protection against -itch and vermin, and during that period had frequent occasion to renew -the mercury.[975] - -The effects of mercury as a poison differ with the chemical form in -which it is introduced into the system. - -In its metallic state it is probably inactive. This fact is a material -one for the medical jurist to determine precisely; for running -quicksilver has been given with a criminal intent. A case of the kind -forms the subject of a medico-legal report in Pyl’s Repertory;[976] and -another is mentioned in Klein’s Annals.[977] - -It is well ascertained that large quantities of fluid mercury have been -repeatedly swallowed, without any injury or peculiar effect having -followed. In neither of the German cases now referred to was any bad -effect produced; and it has proved equally harmless when given -medicinally to remove obstruction in the intestines. Farther, M. Gaspard -mentions in his paper quoted in a former page, that he has left large -quantities shut up for many hours in the various cavities of the body in -animals, without observing any other result than at times inflammation, -which was evidently owing to the mere presence of a foreign body, and -not to the action of an irritant poison.[978] - -It has been already stated, however, that the vapours of metallic -mercury, even at the temperature of the air, produce mercurialism when -inhaled. But then, in all likelihood, some of the metal is oxidated -before being inhaled. At least the chemist knows that the surface of a -mercurial trough soon tarnishes, especially when the mercury is not -pure. - -But it may be said that the blue ointment, which is made with running -quicksilver, will not act as a mercurial when rubbed upon the skin. Here -too, however, some oxidation takes place in the making of the ointment. -Mr. Donovan endeavoured to prove that some of the mercury is always -oxidated;[979] and I have generally found a sufficient quantity of oxide -to account for the effects.[980] - -It has been farther said, in proof of the poisonous action of -quicksilver in its metallic state,—that patients, who have taken it for -obstructed bowels, have sometimes been salivated. This accident has, I -believe, happened in a few instances where the mercury was retained long -in the body. But such cases are undoubtedly very rare. Zwinger mentions -the case of a man, who took four ounces for colic, and was seized in -seven days with salivation.[981] Laborde relates the particulars of -another instance where seven ounces taken in fourteen days excited -ptyalism, ulceration of the mouth, and great feebleness of the -limbs.[982] In the days of Dr. Dover, when the administration of large -doses of fluid mercury was a fashionable practice for a variety of -purposes, it was alleged to have even sometimes proved fatal; and the -case of an actor is specially mentioned, to whom, when convalescent from -ague, Dover gave mercury to the amount of two pounds in five days, and -who at the close of that period was seized with headache, colic, -restlessness, and costiveness, proving fatal in two days; and the whole -lower intestines were found black and lined with minute metallic -globules.[983] Perhaps then it must be admitted that fluid mercury is -not altogether inactive, speaking medicolegally. But this admission is -no argument in favour of the metal being physiologically a poison; -because in the course of the cases referred to, a part is in all -likelihood oxidated by the oxygen in the intestinal gases. It is said to -have been taken in the dose of an ounce daily for nine months, without -either good or harm resulting.[984] - -The question regarding the poisonous qualities of running quicksilver -was carefully investigated some years ago by the Berlin College of -Physicians in a report on the case in Pyl’s Repertory.[985] They observe -that the opinion of Pliny, Galen, Hippocrates, Dioscorides, and many of -the earlier moderns, including even Zacchias, had led to the popular -belief in the deadly properties of fluid mercury; but that this belief -is erroneous; for many surgeons, and among the rest Ambrose Paré, had -given without injury to their patients several pounds of it to cure -obstructed bowels; and in 1515 the Margrave of Brandenburg, over-heated -on his marriage night with love and wine, and rising to quench his -thirst, drank by mistake a large draught of quicksilver without -suffering any harm. Fallopius mentions that he had known instances of -women swallowing pounds of mercury, for the purpose of procuring -miscarriage, and who did not suffer any injury.[986] - -The sulphurets of mercury, like the metal, are not possessed of any -deleterious action on the animal body. Orfila found that half an ounce -of the sulphuret, formed in a solution of corrosive sublimate by -sulphuretted-hydrogen, and half an ounce or six drachms of cinnabar, had -no effect whatever on dogs.[987] The sulphurets which have appeared -injurious in the hands of Smith[988] and other previous experimentalists -must therefore have been impure. - -Of the compounds of mercury, the red-precipitate and Turbith-mineral act -as irritants, besides possessing the property common to all mercurial -compounds, of causing mercurial erethysm. But they are not escharotics, -though generally termed such. That is, they do not chemically corrode -the animal textures. The effects of red-precipitate have been variable. -Mr. Allison relates the case of a girl who in a fit of jealousy -swallowed thirty grains of it. Being immediately detected, an emetic was -given, which operated freely, and subsequently the stomach-pump was -used; but on neither occasion was any red powder brought away. She was -attacked with burning pain in the stomach, which was removed by opium, -and for a week she had a distaste for food, but no other symptom of -consequence.[989] Mr. Brett has described a case, in which the symptoms -were occasional vomiting, stupor, languid pulse, cold clamminess of the -skin, afterwards severe cramps of the legs, tenderness of the abdomen, -dysuria, and some purging, and on the third day ptyalism; but the -patient recovered.[990] M. Devergie has given a case somewhat similar, -but without any ptyalism having followed the irritant effects of the -poison.[991] In 1840 I was consulted on the part of the Crown in the -case of a girl, who, there was every reason to suppose, had been killed -in twelve hours by red-precipitate. The symptoms towards the close were -pain in the throat, inability to swallow, vomiting, and excessive -prostration; extensive red patches were found on the villous coat of the -stomach after death; and I detected mercury in the solid contents and -likewise in the inner coat of the stomach. The case did not go to trial, -because, although a man by whom she was pregnant came under some -suspicion, it rather appeared that the deceased had herself swallowed -the poison with the view of inducing miscarriage. Dr. Sobernheim has -given the particulars of the case of a young man who died from -swallowing an ounce of red-precipitate. He suffered for some hours from -vomiting, diarrhœa, pain in the stomach, tenderness of the belly, and -colic; next day he had no pain, but coldness, lividity, stiffness, and -an imperceptible pulse; and he expired in thirty-three hours. The poison -was found abundantly in the stomach and duodenum after death, and some -grains of it rested upon little ulcers.[992] As to Turbith-mineral, two -scruples will kill a cat in four hours and a half; and several instances -of violent and even fatal poisoning with it are mentioned by the older -modern authors.[993] - -The white precipitate or chloride of mercury and ammonia is probably -also irritant, though inferior in power to the preparations just -mentioned. Two scruples given to a dog occasion vomiting, pain, and some -diarrhœa; and cases are recorded of death in the human subject from less -doses.[994] But there are no recent facts as to the activity of this -compound, and the older cases, which would assign to it very great -energy, are open to the objection that this preparation was in former -times often impure. - -The bichloride or corrosive sublimate is a powerful corrosive or -irritant, according to the dose and state of concentration; and it also -excites mercurial erethysm in a violent degree. The nitrates too are -corrosive, and not inferior in activity to the bichloride, as may be -inferred from Dr. Bigsby’s case, noticed at page 314. - -The bicyanide or prussiate of mercury, from the researches of Ollivier, -and an interesting case he has published of poisoning with it in the -human subject, appears to resemble corrosive sublimate closely in all -its effects, except that it does not corrode chemically. Twenty-three -grains and a half proved fatal in nine days.[995] M. Thibert has -described a case in which ten grains caused death in the same period of -time.[996] The symptoms in both instances were those of severe -irritation of the stomach, extensive inflammation of the organs in the -mouth, and suppression of urine; and in Thibert’s case a small quantity -of albuminous fluid was discharged from the bladder instead of urine. - -The protochloride or calomel, and probably also the protoxide, are the -most manageable of the preparations of mercury for inducing ptyalism. -Calomel is also an irritant; that is, it causes irritation and -inflammation in the alimentary canal when swallowed. This part of its -properties as a poison will require a word or two of explanation. - -Calomel is universally employed as a laxative, but to secure this effect -being produced it is commonly combined with other purgatives. When given -alone a few grains will in some constitutions induce a violent -hypercatharsis; and larger, but still moderate, doses have with most -people such a tendency to cause severe griping and diarrhœa as to have -led to the practice of combining it with opium when the object is to -salivate. These considerations clearly establish that calomel, in a -moderate dose of five or ten grains, is an irritant. - -It farther appears that in larger doses it is said to have occasionally -produced very violent effects, nay, even death itself, by its irritant -operation. Hoffmann has mentioned two instances where fifteen grains of -calomel proved fatal to boys between the ages of twelve and fifteen. One -of them had vomiting, tremors of the hands and feet, restlessness and -anxiety, and died on the sixth day. The other, he merely mentions, died -after suffering from extreme anxiety and black vomiting.[997] Another -fatal case has been related by Ledelius in the German Ephemerides, which -was caused by a dose of half an ounce taken accidentally. Vomiting soon -ensued, and a sense of acridity in the throat; then profuse diarrhœa to -the extent of twenty evacuations in the day; next excessive prostration -of strength and torpor of the external senses; and death followed in -little more than twenty-four hours.[998] Wibmer quotes Vigetius, an -author of the beginning of last century, for a similar case, likewise -fatal, which was occasioned by half an ounce,—also Hellweg, a writer of -the previous century, for the case of a physician, who took an ordinary -medicinal dose by way of experiment, and died in five hours under all -the symptoms of violent irritant poisoning.[999] - -These observations being kept in view, what explanation will the -toxicologist give of the effects which in modern times have been -ascribed to large doses of calomel? It was stated not many years ago by -several East India surgeons, apparently with the universal assent of -their brethren in later times, that this drug in the dose of a scruple -administered even several times a day, is not only not an irritant, but -even on the contrary a sedative;[1000] and that in some diseases, for -example yellow fever, it has been given in the dose of five, ten, or -twenty grains, four or six times a day, till several hundred grains were -accumulated in the body, yet without causing hypercatharsis, nay, with -the effect of checking the irritation which gives rise to black vomit in -yellow fever, and to the vomiting and diarrhœa observed in the cholera -of the East. It is quite impossible for a European physician to doubt -these statements; for all practitioners in hot climates concur in them, -and now that analogous practices have been transferred to Britain, -repeated opportunities have occurred for establishing the fidelity of -the original reporters. Some American physicians, advancing beyond the -Hindostan treatment, have since given calomel in bilious fever in the -dose of forty grains, one drachm, two drachms, and even three drachms, -repeatedly in the course of twenty-four hours for several days -together,—and with similar phenomena. In one instance 840 grains were -given in the course of eight days in these enormous doses. The largest -dose was three drachms; and it was followed by only one copious -evacuation, and that not till after the use of an injection.[1001] This -practice appears not to have been altogether unknown in former times. -Ledelius, the author formerly quoted, states, that he had been -accustomed to give doses of a scruple, and that Zwölffer even gave a -drachm in one dose.[1002] - -It must be also added, that while the facts quoted above from Hoffmann, -Ledelius, and others assign to single large doses a powerful and -dangerous irritant action, very different results have been occasionally -observed in recent times where even so large a quantity as one or two -ounces had been taken. Thus, in the case of a lady mentioned by Wibmer, -who took by mistake the enormous quantity of fourteen drachms, although -acute pain in the belly ensued, together with vomiting and purging, -these symptoms were speedily subdued by oleaginous demulcents; and after -a smart salivation, she recovered entirely in six weeks.[1003] Another -case has been related by Mr. H. P. Robarts, where an ounce was swallowed -by a young lady by mistake for magnesia, with no other effect than -nausea at first, rather severe griping and slight tenderness of the -belly afterwards, and subsequently languor, headache and indigestion; -yet the powder was retained two hours.[1004] - -It is impossible in the present place to enter into the physiological -action of calomel as a remedy; but every one must be satisfied that, -with all which has been already written, much still remains to be done -before the facts now mentioned can be explained satisfactorily. Can the -violent effects described by Hoffmann, Ledelius and Hellweg have arisen -from the calomel having been imperfectly prepared and adulterated with a -little corrosive sublimate? Or may they be explained by reference to the -fact, that the presence of hydrochlorates in solution, particularly -hydrochlorate of ammonia, tends to convert calomel into corrosive -sublimate.[1005] Mr. Alfred Taylor has made some experiments, to show -that the latter explanation will not suffice.[1006] - -Meanwhile, taking the facts as they stand, it is plain that great -caution must be used in ascribing violent irritant properties generally, -or even symptoms of irritant poisoning in a particular case, to large -doses of calomel. - -With the view of illustrating the importance of the preceding -observations, it may be useful to mention here the heads of a case -already briefly alluded to for another purpose, the trial of William -Paterson for murder (319).[1007] His wife during the month previous to -her death had two attacks of diarrhœa, with an interval of a fortnight -between them. On the second occasion it became profuse and exhausting, -but without any material pain or considerable vomiting; looseness of the -teeth and salivation ensued, and she died in nine days. On examination -of the body, the anus was found excoriated, the whole intestines -checkered with dark patches, and the stomach red, ulcerated, and spotted -with black, warty excrescences; but the late Dr. Cleghorn of Glasgow -could not detect any poison by chemical analysis. It was proved that the -prisoner, besides procuring, a few months before his wife’s death, a -variety of poisons, such as hydrochloric acid, cantharides, and arsenic, -had also on different occasions during her last illness purchased in a -suspicious manner four doses of calomel varying from 30 to 60 grains -each. Among the various ways in which he was charged with having -poisoned the deceased, that which was best borne out by the general as -well as medical facts consisted in his taking advantage of an existing -inflammation of the mucous membrane of the bowels,—whether arising from -a natural cause or from poison it was in this view of the case -immaterial to inquire,—and keeping up and aggravating the inflammation -by purposely administering at intervals large doses of calomel. On the -trial Dr. Cleghorn and other witnesses gave their opinion that the doses -purchased by the prisoner, if administered, would cause the symptoms and -morbid appearances observed in the case. On the other hand, the late Dr. -Gordon deposed to the effect, that all the symptoms of the case might -arise under the operation of natural disease, and that such doses of -calomel were by no means necessarily injurious; the late Mr. John Bell -deposed, that it had even been given in much larger doses without -injury; and the profession are now well aware, though not at the time of -this trial, that in the very malady alleged by the prisoner to have -carried off the deceased, namely dysentery, the administration of -calomel in repeated large doses is accounted by many a proper method of -cure. The doses purchased by the prisoner were considerably larger, it -is true. But there was not any evidence of his having administered his -purchases in single doses as he got them; and even though there had been -evidence to that effect, it would not remove altogether the difficulty -of deciding the question, as to the irritating action of calomel, on -which the issue of the trial in one view of the case chiefly depended. - -It is probable that all the compounds formed by corrosive sublimate with -animal and vegetable substances are feebly poisonous, or at least very -much inferior in activity to corrosive sublimate itself. This has been -shown by Orfila to be the case with the compound formed by albumen. -Sixty grains of this compound, being equivalent to nearly five grains of -corrosive sublimate, produced no bad effect whatever on a dog or a -rabbit.[1008] The same has been satisfactorily proved by Taddei as to -the compound formed by gluten. Twelve grains of corrosive sublimate -decomposed by his emulsion of gluten had no effect whatever on a -dog.[1009] It is important to remark, however, that if there be an -excess of the decomposing principle, so that the precipitate is party -redissolved, the irritant action of the corrosive sublimate is not so -much reduced, though it is still certainly diminished. Orfila has -settled this point in regard to albumen.[1010] The power of producing -mercurial erethysm is possessed by all mercurial compounds whatever, and -among the rest by the compounds now under consideration.[1011] - -The present section may now be concluded with a few remarks on the -strength of the evidence derived from the symptoms which are produced by -the compounds of mercury. - -If the medical jurist should meet with a case of sudden death like that -of the animals experimented on by Sir B. Brodie, the symptoms alone -could not constitute any evidence of poisoning with corrosive sublimate. -All he could say would be that this variety of poisoning was possible, -but that various natural diseases might have the same effect. This -feebleness in the evidence from symptoms, however, is of little moment; -because the dose must be great to cause such symptoms, and little can be -vomited before death; so that the poison will be certainly found in the -stomach. - -Should the patient die under symptoms of general irritation in the -alimentary canal, poisoning may be suspected. But it would be impossible -to derive from them more than presumptive evidence. The suspicion must -become strong, however, if the ordinary signs of irritation in the -alimentary canal are attended with the discharge of blood upwards and -downwards. And the presumption will, I apprehend, approach very near to -certainty,—at least of the administration of some active irritant -poison,—if, at the moment of swallowing a suspected article, and but a -short time before the symptoms of irritation began in the stomach and -bowels, the patient should have remarked a strong, acrid, metallic -taste, and constriction or burning in the throat. - -When upon all these symptoms salivation is superinduced, the evidence of -poisoning with corrosive sublimate or some other soluble salt of mercury -is almost unequivocal. That is, if, after something has been taken which -tasted acrid, and caused an immediate sense of heat, pricking, or -tightness in the throat, the characteristic signs of poisoning with the -irritants make their appearance in the usual time, and are soon after -accompanied or followed by true mercurial salivation,—it may be safely -inferred that some soluble compound of mercury has been taken. Before -drawing this inference, however, it will be necessary to determine with -precision all the classes of symptoms, more particularly the nature of -the salivation. It should also be remembered that salivation may -accompany or follow the symptoms of inflammation in the stomach, in -consequence of calomel having been used as a remedy. But if proper -attention be paid to the fallacies in the way of judgment, I conceive -that an opinion on the question of poisoning with corrosive sublimate -may be sometimes rested on the symptoms alone. This is another exception -to the rule laid down by most modern toxicologists and medical jurists -respecting the validity of the evidence of poisoning from symptoms. - -For a good example of the practical application of these precepts, the -reader may consult the trial of Mr. Hodgson, for attempting to poison -his wife. In the instance which gave rise to the trial in question, a -violent burning sensation in the throat was felt during the act of -swallowing some pills; in the course of ten minutes violent vomiting -ensued, afterwards severe burning pain along the whole course of the -gullet down to the stomach, next morning diarrhœa, and on the third day -ptyalism. There were many other points of medical evidence which left no -doubt that corrosive sublimate was swallowed in the pills. But even the -history of the symptoms alone would have led to that inference.[1012] - - - SECTION III.—_Of the Morbid Appearances caused by Mercury._ - -The morbid appearances observed in the bodies of persons killed by -corrosive sublimate will not require many details; since most of the -remarks formerly made under the head of the pathology of the irritants -generally, and of arsenic in particular, apply with equal force to the -present species of poisoning. Still there are some peculiarities -deserving of notice, which arise from the greater solubility or stronger -irritant action of corrosive sublimate. - -The mouth and throat are more frequently affected than by arsenic; and a -remarkable appearance sometimes observed, and not excited, so far as I -know, by arsenic, is shrivelling of the tongue, with great enlargement -of the papillæ at its root.[1013] - -The disorder of the alimentary canal is also usually more general, and -reaches a greater height before death takes place. Sometimes the -irritation and organic injury are confined to the stomach;[1014] but -more commonly the throat, stomach, gullet, rectum, nay, even also the -colon, are affected. The black or melanotic extravasation into the -mucous membrane of the stomach, which has been already several times -described as a common effect of the more violent irritants, is also -produced by corrosive sublimate. In Devergie’s case and in that of Dr. -Venables it was present in a very great degree.[1015] - -The coats of the stomach, and also those of the intestines, more -particularly the colon and rectum, have frequently been found destroyed. -So far as I have been able to ascertain, two kinds of destruction of the -coats may be met with,—corrosion and ulceration. - -The first is the result of chemical decomposition of the tissues. This -kind is evidently to be looked for only when the quantity has been -considerable and the dose concentrated. Nay even then it is rare. For on -account of the solubility of corrosive sublimate, the facility with -which it is decomposed by the secretions or accidental contents of the -stomach, and the violence and frequency of the vomiting, this poison is -peculiarly liable to be prevented from exerting its corrosive action on -the membranes. Hence it is that proper chemical corrosion of the coats -of the stomach is seldom witnessed in man. - -The appearance of this corrosion differs according to the rapidity of -the poisoning. In very rapid cases, for example in animals which have -survived only twenty-five minutes, the villous coat has a dark gray -appearance, without any sign of vital reaction.[1016] But this variety -has never been witnessed in man, in whom the action has been hitherto -much less rapid. In the most rapid cases, such as that of Dr. Bigsby, -which terminated in two hours and a half (314), or those related by Mr. -Valentine, of which one ended fatally in eleven and another in -twenty-four hours, the corrosion was black, like the charring of -“leather with a red-hot coal, and the rest of the stomach scarlet-red or -deep rose-red;—showing that inflammation had set in.” In the former of -these two cases the corrosion was as big as a half-crown, in the latter -three inches in diameter. In a third case, where the patient lived -thirty-one hours, the stomach was perforated.[1017] In the case -described by Dr. Venables, and formerly alluded to, where life was -prolonged for eight days, there was a patch on the under surface of the -stomach as large as two crown-pieces, hard, elevated, and of a very dark -olive or almost black colour, besides very general erosion of the -villous coat.[1018] In all these cases the disintegrated spot was -probably situated where the poison first chiefly lodged. - -The corrosion caused by mercury, if examined before the slough is thrown -off, will be found to possess an important peculiarity: the disorganized -tissue yields mercury by chemical analysis. Professor Taddei repeatedly -obtained the metal from the membranes of animals which he had poisoned -with corrosive sublimate.[1019] It is probable that mercury may be thus -detected although death may not have taken place for some time after the -poison was swallowed. For the slough was found adhering in one of Mr. -Valentine’s cases, where life was prolonged for seventy hours; and it -was not entirely removed even in eight days in one of the cases -described by Dr. Venables. - -Although, however, it is sometimes possible to find the poison in the -stomach, the medical jurist must not perhaps expect to find it so often -in the present instance as in that of poisoning with arsenic. For on -account of its greater solubility corrosive sublimate cannot adhere with -such obstinacy to the villous coat, and is therefore more subject to be -discharged by vomiting. Nevertheless, the insoluble compound formed by -antidotes may adhere to the coats like arsenic, and so resist the -tendency of vomiting to displace them. In Devergie’s case, -notwithstanding twenty-three hours of incessant vomiting, although no -poison could be detected in the fluid contents of the stomach, it was -distinctly found in small whitish masses that lay between the folds of -the rugæ.[1020] - -It may be here farther observed that corrosive sublimate, as well as -other salts of mercury, may undergo in the alimentary canal after death -the same change which is produced in arsenic from the gradual action of -hydrosulphuric acid gas. It may be converted into the sulphuret. I am -not acquainted indeed with any actual instance of such conversion; but -that it may occur we can scarcely doubt, not merely from theoretical -considerations, but likewise because Orfila met with an instance where -calomel taken daily in a case of gastro-cephalitis was discharged by -stool in the form of a black sulphuret.[1021] - -Another important consideration is, that corrosive sublimate may be -decomposed and reduced to the metallic state by the admixture of various -substances either given at the same time or subsequently, and the longer -the inspection is delayed, the more complete will be the decomposition -which is accomplished. Iron, zinc, and other metals are the most active -of these substances.[1022] - -The other forms of destruction of the coats of the alimentary canal is -common ulceration, either such from the beginning, or what was -originally corrosion converted into an ulcer in consequence of the -disorganized spot being thrown off by sloughing. - -I have seen this appearance to an enormous extent in the great -intestines of a man who survived nine days. Numerous large, black, -gangrenous ulcers, just like those observed in bad cases of dysentery, -were scattered over the whole colon and rectum. In this instance, which -occurred to the late Dr. Shortt, the stomach was also ulcerated, but the -small intestines were not. - -Sometimes the ulceration seems to be a variety of softening of the -mucous tissue, as in a case described by Dr. Alexander Wood of this -city, which proved fatal in fourteen days, and in which the stomach, -cæcum, and ascending colon presented round, softened, greenish spots -about the size of a sixpence, and accompanied in the stomach with a -tendency to detaching of the membrane in the form of a slough.[1023] - -The destruction of the villous coat of the stomach occasioned by -corrosive sublimate and other soluble salts of mercury may be -distinguished from spontaneous gelatinization by one of two characters. -If the slough remains attached, mercury will be detected in it: if -separation has taken place, the ulcer exposed presents surrounding -redness and other signs of reaction.[1024] - -All the other effects of inflammation may be produced by corrosive -sublimate, as by arsenic and other irritants. More frequently here than -in the case of arsenic peritonæal inflammation is met with. In -Devergie’s case the external surface of the stomach along both its -curvatures presented the appearance of red points on a violet ground. In -Mr. Valentine’s cases there was much minute vascularity, not only of the -outside of the stomach but also of the whole peritonæum lining the -viscera and inside of the abdomen; and there was even some serous -effusion into the cavity. In Dr. Venables’s case the peritonæal coat of -the stomach was highly vascular and inflamed, and the omentum also -injected. - -The urinary organs, and particularly the kidneys, are often much -inflamed by poisoning with corrosive sublimate. Dr. Henry has related a -case in which this poison proved fatal on the ninth day, and where the -left kidney was found to contain an abscess.[1025] In all of Mr. -Valentine’s cases the kidneys were inflamed, and the bladder excessively -contracted, so as not to exceed the size of a walnut. In Ollivier’s -case, caused by the cyanide of mercury, the scrotum was gorged and -black, the penis erected, and the kidneys a third larger than natural. -In the case described by Dr. Venables both kidneys, but especially the -left, were large, flaccid, and vascular, the ureters turgid and purple, -and the bladder contracted, empty, and red internally. - -Orfila has observed that the internal membrane of the heart is sometimes -inflamed and checkered with brownish-black spots. Some remarks have been -already made on the light in which this appearance ought to be viewed by -the pathologist (p. 271). - -Whatever may be the real state of the fact as to the alleged power of -arsenic to preserve from decay the bodies of those poisoned with it, all -authors agree that corrosive sublimate possesses no such property. Yet -it is well known to be a good antiseptic, when applied topically. The -experiments of Klanck, noticed under the head of Arsenic, prove that -corrosive sublimate at all events does not retard putrefaction in the -bodies of those poisoned with it; and Augustin in his analysis of -Klanck’s researches infers that it even promotes decay.[1026] I have met -with one example in the human subject which seems to confirm Augustin’s -opinion. In the case formerly quoted from the Medical and Physical -Journal, which was fatal in four days, the relater found the body -forty-two hours after death so putrid, though in the month of January, -that the examination of it was very unpleasant, the belly being black, -and a very offensive odour being exhaled.[1027] Little importance, -however, can be attached to a solitary case; for on the contrary Sallin -relates a case where the body of a man supposed to have been poisoned -with corrosive sublimate was found not decayed, but imperfectly -mummified, after sixty-seven days.[1028] - -It is unnecessary to detail the proofs to be found in the dead body of -mercurial salivation having existed during life. They are of course to -be looked for in the mouth, and in the adjoining organs. We must not, -however, expect to see much appearance of disease in the salivary -glands; for according to Cruveilhier, in persons who die of mercurial -salivation these glands do not present any trace of inflammation -themselves, but merely serous effusion into the cellular tissue around -them.[1029] - -Professor Orfila has made some useful experiments as to the effects of -corrosive sublimate on dead intestine, which it may be proper to notice -in a few words. When applied in the form of powder to the rectum of an -animal newly killed, the part with which it is in contact becomes -wrinkled, and as it were granulated, harder than natural, and of -alabaster whiteness, intermingled with rose-red streaks, apparently the -ramifications of vessels. When the membrane is stretched upon the -finger, the wrinkling disappears. The muscular coat is of a snow-white -colour, and even the serous coat is white, opaque, and thickened. The -parts not in contact with the powder retain their natural appearance, -and the line of demarcation between the affected and unaffected portions -is abrupt. If the powder is not applied till twenty-four hours after -death, the parts it touches become thick, white, and hard; but no red -lines are visible. It is easy to draw the distinction between these -appearances and the effects of corrosive sublimate during life. - -Little need be said of the force of the evidence of poisoning with -corrosive sublimate, derived from the morbid appearances. If the gullet, -stomach, and colon be all inflamed and ulcerated, and these injuries -have taken place during a short illness, the presumption in favour of -some form of irritant poisoning will be strong. And the presumption of -poisoning with corrosive sublimate will be strong, if the usual marks of -salivation are also found in the mouth and throat. But such evidence can -never amount to more than a strong presumption or probability. - - - SECTION IV.—_Of the Treatment of Poisoning with Mercury._ - -The treatment of poisoning by the compounds of mercury may be referred -to two heads,—that which is required when irritation of the alimentary -canal is the prominent disorder, and that which is designed to remove -mercurial salivation. - -Irritation and inflammation of the alimentary canal are to be treated -nearly in the same way as when arsenic has been the poison swallowed. In -the instance of corrosive sublimate we also possess a convenient and -effectual antidote. - -Several substances may be used as antidotes; but those which have -hitherto been most employed are albumen and gluten. - -It has been already hinted that albumen, in the form of white of eggs -beat up with water, impairs or destroys the corrosive properties of -bichloride of mercury, by decomposing it and producing an insoluble -mercurial compound. For this discovery and the establishment of albumen -as an antidote, medicine is indebted to Professor Orfila. He has related -many satisfactory experiments in proof of its virtues. The following -will serve as an example of the whole. Twelve grains of corrosive -sublimate were given to a little dog, and allowed to act for eight -minutes, so that its usual effects might fairly begin before the -antidote was administered. White of eight eggs was then given; after -several fits of vomiting the animal became apparently free from pain; -and in five days it was quite well.[1030] According to Peschier the -white of one egg is required to render four grains of the poison -innocuous.[1031] The experiments of the Parisian toxicologist have been -repeated and confirmed by others and particularly by Schloepfer; who -found that when a dose was given to a rabbit sufficient to kill it in -seven minutes if allowed to act uncontrolled, the administration of -albumen, just as the signs of uneasiness appeared, prevented every -serious symptom.[1032] Dr. Samuel Wright has found that if the -administration of albumen is followed up by giving some astringent -decoction or infusion, the beneficial effects are more complete, because -the compound formed is less soluble in an excess of albumen.[1033] - -The virtues of albumen have also been tried in the human subject with -equally favourable results. The recovery of the patient, whose case was -quoted formerly (p. 312), from Orfila’s Toxicology, seems to have been -owing in great measure to this remedy. In the Medical Repository another -case is related, in which it Was also very serviceable.[1034] A third -very apposite example of its good effects is related by Dr. Lendrick. -His patient had taken about half a drachm of corrosive sublimate, and -was attacked with most of the usual symptoms, except vomiting. White of -eggs was administered a considerable time afterwards, the beneficial -effects of which were instantaneous and well-marked; and the patient -recovered.[1035] A few years ago Orfila’s discovery was the means of -saving the life of M. Thenard the chemist. While at lecture, this -gentleman inadvertently swallowed, instead of water, a mouthful of a -concentrated solution of corrosive sublimate; but having immediately -perceived the fatal error, he sent for white of eggs, which he was -fortunate enough to procure in five minutes. Although at this time he -had not vomited, he suffered no material harm. Without the prompt use of -the albumen, he would almost infallibly have perished.[1036] - -Albumen is chiefly useful in the early stage of poisoning with corrosive -sublimate, and is particularly called for when vomiting does not take -place. But it farther appears to be an excellent demulcent in the -advanced stages. - -On a previous occasion, mention was made of a few of the facts brought -forward by Professor Taddei to prove the virtues of the gluten of wheat -as an antidote for poisoning with corrosive sublimate [297, 336], so -that nothing more need be said on the subject in the present place. As -it is difficult to bring the whole of a fluid containing corrosive -sublimate into speedy contact with pulverized gluten, which when put -into water becomes agglutinated into a mass, the discoverer of this -antidote proposes to give it in the form of emulsion with soft soap. -This is made by mixing, partly in a mortar and partly with the hand, -five or six parts of fresh gluten with fifty parts of a solution of soft -soap. And in order to have a store always at hand, this emulsion, after -standing and being frequently stirred for twenty-four hours, is to be -evaporated to dryness in shallow vessels, and reduced to powder. The -powder may be converted into a frothy emulsion in a few minutes.[1037] -Taddei made use of this powder with complete success in the case of a -man who had swallowed seven grains of corrosive sublimate by mistake for -calomel. Violent symptoms followed the taking of the poison; but they -were immediately assuaged by the administration of the antidote; and the -person soon got quite well.[1038] It is probable that wheat flour will -prove an effectual antidote by reason of the gluten it contains. On -agitating for a few seconds a solution of twelve grains of corrosive -sublimate along with three ounces of a strong emulsion of flour, and -immediately filtering,—I find that ammonia and carbonate of potass have -little or no effect, that hydriodate of potass occasions a yellow -precipitate, and that the acrid, astringent taste of the solution is -removed; whence it may be inferred, that the corrosive sublimate is all -decomposed, that little mercury remains in solution, and that what does -remain is in the form of a chloride of mercury and gluten. - -When neither albumen nor gluten is at hand, milk is a convenient -antidote of the same kind. - -Iron filings would appear to be also a good antidote. MM. Milne-Edwards -and Dumas have found that when they were administered in the dose of an -ounce to animals after twelve or eighteen grains of corrosive sublimate -had remained long enough in the stomach for the symptoms to begin, the -animals recovered from the effects of the poison, and died only some -days afterwards of the effects of tying the gullet, which operation was -necessary to prevent them vomiting. The iron obviously acts by reducing -the corrosive sublimate to the metallic state.[1039] - -Meconic acid, the peculiar acid of opium, which will be described under -the head of that poison, is also probably a good antidote. Pettenkoffer -correctly remarks that this acid has a great tendency to form very -insoluble salts with the metallic oxides, particularly with the -deutoxides, and above all when the acid is previously in union with a -base which constitutes a soluble salt.[1040] On this account it must be -a good antidote. Pettenkoffer adds, that the precipitating action of the -meconates is the reason why “the operation of corrosive sublimate on the -animal body is almost entirely prevented by opium.” Opium, however, -cannot be safely used in such quantity as to decompose all the corrosive -sublimate in a case of poisoning; for I find that an infusion of -thirty-three grains is required to precipitate all which can be thrown -down from a solution of five grains of the mercurial salt. I am not -aware of any instances on record where poisoning with corrosive -sublimate has been prevented or cured by opium given so as to decompose -the salt; but a very remarkable case will be related under the head of -Compound Poisoning, where the phenomena of its action were masked and -altered in a singular manner. There is little doubt that the alkaline -meconates must prove valuable antidotes for corrosive sublimate. At -present an effectual barrier to their employment is their rarity; but -they might be rendered more accessible, as a great quantity of meconate -of lime, which is at present put to no use, is formed in the manufacture -of muriate of morphia; and meconate of potass may easily be prepared in -sufficient quantity from the meconate of lime. - -It has been alleged by Dr. Buckler of Baltimore, that a mixture of -gold-dust and iron filings is an effectual antidote; but Orfila denies -this statement; and the fact if true would be unimportant, on account of -the improbability of the materials being ever at hand in practice.[1041] - -M. Mialhe suggested not long ago as an antidote the proto-sulphuret of -iron prepared by decomposing sulphate of protoxide of iron by -hydrosulphate of ammonia; and Orfila found that it is a perfect chemical -antidote, which altogether prevents the poisonous action of corrosive -sublimate, if administered to animals either before or immediately after -the poison; but he further ascertained that the lapse of ten minutes was -sufficient to render it of no use.[1042] It is difficult, however, to -perceive why in this respect it should differ from white of egg or any -other chemical antidote. - -As to the old antidotes for poisoning with corrosive sublimate, such as -the alkaline carbonates, the alkaline hydrosulphates, cinchona, mercury, -charcoal,—Orfila has given them all a fair trial, and found them all -inefficacious. It would appear, however, from a case related in a late -American journal, that frequent doses of charcoal powder have much -effect in soothing the bowels and allaying the inflammation after the -poison is evacuated.[1043] - -The treatment of mercurial salivation consists in exposure to a cool -pure air, nourishing diet, and purgatives, if the intestinal canal is -not already irritated. In some of the inflammatory affections it -induces, venesection is required; in others it is hurtful. In some -complaints induced by mercury, as in iritis, the poison appears to be -its own antidote; for nothing checks the inflammation so soon and so -certainly as mercurial salivation. - -Dr. Finlay of the United States proposed to check mercurial salivation -by small doses of tartar emetic frequently repeated, so as to act on the -skin;[1044] and Mr. Daniell has recommended large doses of the acetate -of lead as an effectual antidote for the same purpose.[1045] I have -tried both of these plans several times with apparent success. In one -instance particularly, where a severe salivation was threatened by the -administration of six grains of calomel in three doses, and where -profuse salivation, ulceration of the tongue and swelling of the face -actually did commence with violence, the mercurial affection after a few -days rapidly receded under the use of large doses of acetate of -lead.—Dr. Klose, a German physician, says he has found iodine to possess -the property of arresting the effects of mercury on the mouth.[1046] The -iodide of potassium is generally acknowledged to be one of the best -remedies for eradicating the constitutional infirmities left in many by -severe courses of mercury. - -A great deal might be said on the treatment of the secondary effects of -poisoning with mercury. But a thorough investigation of the subject -would lead to such details as would be inconsistent with the other -objects of this work. - - - - - CHAPTER XV. - OF POISONING WITH COPPER - - -Poisoning with the salts of copper was not long ago a common accident, -in consequence of the metal being much used in the fabrication of -vessels for culinary and other domestic purposes, or ignorantly resorted -to by confectioners and others to impart a good colour to sweetmeats and -preserves. Such accidents have been materially diminished in frequency -since the poisonous qualities of the metal, and the circumstances under -which it is acted on by articles of food, have become known. -Nevertheless they are still frequent enough. The diffusion among the -common people of the knowledge of the properties of copper has also -naturally led some persons to have recourse to its preparations for the -purpose of self-destruction. Poisoning with copper has seldom been -caused by the wilful act of another person; for the deep colour of its -compounds and their strong disagreeable taste render it a difficult -matter to administer them secretly. This, however, though difficult, is -not impossible: whatever may be swallowed accidentally, may be also -administered secretly. In 1795 a woman Inglis was tried at Aberdeen for -administering sulphate of copper with intent to poison; but the charge -was not proved.[1047] In 1842 an attempt was made at Béziers in France -to poison a young woman by dissolving this salt in her coffee; but the -first mouthful caused such a sense of constriction in the throat as to -apprize her of something deleterious being present, and she escaped -after suffering from soreness of the mouth, vomiting and cramps.[1048] A -case of imputed poisoning with sulphate of copper has been related at -page 76. - - - SECTION I.—_Of the Chemical History and Tests of the Preparations of - Copper._ - -Metallic copper has a special red colour, to which it gives its own -name. Its specific gravity is nearly 9, its hardness considerable, its -tenacity great, its point of fusion about 27° W. or at a full white -heat. - -It unites with oxygen in two proportions, forming a yellowish-red -protoxide, and a peroxide, which, when dry, is brownish-black—when -hydrated, azure-blue. It unites also with sulphur in two corresponding -proportions, forming a gold-yellow proto-sulphuret, the natural -copper-pyrites, and a black bisulphuret, which is formed by -sulphuretted-hydrogen in all the solutions of this metal. The peroxide -unites with ammonia. The acids all unite with the oxide and form blue or -green salts, some of which are soluble, some insoluble. The oxide is -frequently mixed with other matters to form various pigments; but in -such compounds the union is generally mechanical, not chemical. Of the -substances thus formed and existing in nature and the arts the following -only require notice here. 1. _Mineral green_, and other pigments formed -with the hydrated oxide. 2. _Natural verdigris_, or the carbonate. 3. -_Blue vitriol_, or the sulphate. 4. _Artificial verdigris_, or the mixed -acetates. - - - 1. _Mineral Green._ - -The description of this substance and its chemical properties must be -introduced with a short account of the tests for the unmixed _peroxide_. -When free of water the peroxide is a brownish-black powder or granular -mass, which is usually procured by decomposing nitrate of copper at a -low red heat. It is easily known by the solvent power of nitric acid, -the blue colour of the filtered solution, and the beautiful deep violet -tint communicated to the solution by an excess of ammonia. The last -property is considered by chemists the most satisfactory proof of the -presence of oxide of copper in a fluid. It is alone quite free of -fallacy, and may be applied to all the soluble and also many insoluble -compounds of copper, provided they are not mixed with a large proportion -of vegetable or animal fluids, in which case the colour is often -greenish. - -In the case of the peroxide and of copper poisons generally, the process -of reduction, which has been applied with such delicacy and precision to -arsenical and mercurial poisons, loses all its advantages. The metal -remains in the flux, and intimately diffused; so that of its physical -qualities the colour only can be estimated, and even that but -inaccurately, except in the instance of one compound, verdigris. - -The _hydrated peroxide of copper_, when newly formed and well prepared, -has a fine azure-blue colour; but on exposure to a gentle heat, it parts -with its water, and becomes the anhydrous peroxide. It is procured by -precipitating any of the soluble salts of copper by means of caustic -potass. It is at once known by the action of ammonia, which immediately -forms with it a deep violet-blue solution. - -_Mineral green_, as already mentioned under the head of Arsenic (p. -223), was originally an arsenical pigment introduced into the art of -colour-making by Scheele, and now sometimes sold in this country by the -name of emerald-green. But the mineral green of the colourist now -contains no arsenic, being a hydrate of peroxide of copper intimately -mixed with a little lime, which is generally carbonated. This variety of -mineral-green probably varies a little in composition. Some parcels I -have found to contain the lime in the state of carbonate; in others the -lime was chiefly caustic. - -The best method of determining its nature is to dissolve it in diluted -hydrochloric acid, which leaves only a slight cloudiness from accidental -impurities; and then to transmit through the filtered solution a stream -of sulphuretted hydrogen gas. The copper on boiling is all thrown down -in the form of a black bisulphuret, and hydrochlorate of lime remains in -solution. The lime is then to be detected by its proper tests, after the -solution has been filtered and neutralized (see p. 192). In general this -long process is unnecessary, as the medical jurist may be simply -required to say whether the suspected substance contains copper. In that -case it is only requisite to subject the substance to the action of -ammonia, as if it was hydrated peroxide. - -_Verditer_, another green pigment, the basis of which is always oxide of -copper, does not appear to differ essentially in composition from -mineral green. The samples I have examined consist of a large proportion -of hydrated oxide of copper, and a small proportion of carbonate of -lime. - - - 2. _Natural Verdigris._ - -This is a compound of no great importance in a medico-legal point of -view. Nevertheless an instance has been lately published in which it was -taken for the purpose of committing suicide, and was found abundantly in -the stomach.[1049] The carbonate of copper exists naturally in two -states. In one form it constitutes the rust of copper, or natural -verdigris, and is produced as a powdery crust on metallic copper by long -exposure to moist air. It is insipid and insoluble, so that pure water -left in vessels incrusted with it does not become poisonous. It -dissolves with effervescence in sulphuric acid, and without -effervescence in ammonia, forming the usual violet solution. In another -form it exists in the mineral kingdom, constituting the chief part of a -beautiful ore, malachite, and also a considerable proportion of some -blue-copper ores. - - - 3. _Blue Vitriol._ - -Blue vitriol, blue copperas, blue stone, vitriol of copper, as it is -variously called in common speech, is the sulphate of copper. In the -solid form it constitutes large crystals of a deep blue colour, and an -acrid, astringent, metallic taste, efflorescent in dry air, and very -soluble in water. Under the action of heat it first loses its water of -crystallization without undergoing the watery effusion; then its -sulphuric acid is driven off partly unchanged, partly decomposed; and at -last the brown peroxide is left behind in a state of considerable -purity. If carbonaceous matter be previously mixed with the sulphate, -the oxide is decomposed at a low red heat, so that the process of -reduction may be performed in a glass tube. For the reasons formerly -stated, this process does not constitute a convenient or characteristic -test for sulphate of copper. The best mode of ascertaining its nature is -to dissolve it, and then to apply the tests for the solution. - -There are many excellent tests for copper in solution. But the four -following are the most delicate and characteristic,—ammonia, -sulphuretted hydrogen, ferro-cyanate of potass, and metallic iron. - -1. _Ammonia_ causes a pale azure precipitate, which is redissolved by an -excess of the test, forming a deep violet-blue transparent fluid. If the -solution is very diluted, there is no previous precipitation; the fluid -becomes violet without its transparency being disturbed. This is a -perfectly characteristic test of copper, and one of great delicacy. - -2. _Sulphuretted hydrogen gas_ causes a dark brownish-black precipitate, -the sulphuret of copper. This test is one of very great delicacy; but it -is not alone decisive of the presence of copper, since lead, bismuth, -mercury, and silver, are similarly affected by it. A method, however, -will be presently described, by which the precise nature of the -sulphuret may be determined. - -The alkaline hydrosulphates, for example the hydrosulphate of ammonia, -answer equally well with sulphuretted-hydrogen. The solution of the -common liver of sulphur throws down, not a black, but a chestnut -precipitate. - -3. _Ferro-cyanate of potass_ causes a fine hair-brown precipitate, the -ferro-cyanide of copper. This test is also exceedingly delicate and -characteristic. - -4. A polished rod or plate of _metallic iron_, held in a solution of -sulphate of copper, soon becomes covered with a red powdery crust, which -is metallic copper; and ere long the solution is changed in colour from -blue to greenish-yellow. The action is simple; the iron merely displaces -the copper in the solution, in which a sulphate of iron is consequently -formed. This test is characteristic, and even of considerable delicacy. -At the same time other substances may cause a reddish encrustation on -iron by simply rusting it, so that the test cannot be relied on alone. - -The four preceding reagents taken together are amply sufficient to prove -the existence of copper in a solution. Three other tests, however, may -be here briefly alluded to. - -Caustic potass in a solution not too diluted causes a fine azure-blue -precipitate, the hydrated peroxide of copper. - -Oxide of arsenic, with the previous addition of a few drops of ammonia, -causes a fine apple-green or grass-green precipitate, the arsenite of -copper. This test, which is both delicate and characteristic, has been -already fully considered under the head of Arsenic. - -The process by fluid reagents, as hitherto laid down, merely proves the -presence of copper, but does not indicate the acid with which the oxide -is combined. In order to determine whether it is sulphuric acid, the -fluid must also be tested with nitrate of baryta followed by nitric -acid: a heavy white precipitate is thus produced, which the excess of -nitric acid does not redissolve. - - - 4. _Artificial Verdigris._ - -_Artificial verdigris_ is a common pigment, which is met with in the -form either of earth-like masses, or of a light powder of a -greenish-blue colour and peculiar disagreeable smell, approaching that -of vinegar. Like blue vitriol it has a strong metallic, astringent -taste. The effect of heat is peculiar. Some acetic acid is in the first -place distilled over; a portion of the acid, however, is decomposed and -reduces the oxide; and a low red heat is sufficient to make the outer -crust of the verdigris distinctly copper-red, when the material is -contained in a glass tube. - -Artificial verdigris varies somewhat in composition. Foreign verdigris -contains chiefly the hydrated diacetate, with a little carbonate, oxide, -and even metallic copper, along with particles of the fruit and -fruit-stalks of the grape. British verdigris consists of little else -than the hydrated diacetate. It is known by the following characters. -Ammonia dissolves it almost entirely, forming a deep violet solution. -Diluted sulphuric acid dissolves it, evolving an odour of acetic acid, -and forming a solution of sulphate of copper, which may be known by the -tests for that salt. Boiling water converts it partly into an insoluble -brown powder, which is oxide of copper in union with a small proportion -of acetic acid, and partly into a greenish-blue neutral acetate, which -is dissolved, and may be known by the four tests for sulphate of copper, -and the want of action of nitrate of baryta. - -It may be right to notice shortly three other salts of copper, the -nitrate, the ammoniacal sulphate, and the muriate. The _nitrate_ forms a -violet solution, which is acted on by reagents in the same way as the -dissolved acetate, but has not any odour of vinegar. The _ammoniacal -sulphate_ [ammoniated copper—ammoniuret of copper], has been -occasionally used in medicine. It forms, when solid, small scaly -crystals, of an intense violet colour and strong ammoniacal odour; and -when dissolved it retains its peculiar colour even though very much -diluted.—The _muriate_ of copper has a lively grass-green colour, and is -acted on by reagents in the same way as the solution of verdigris. - -_Of the corrosion of copper by articles of food and drink._—To these -observations on the chemical history of copper a few remarks must be -added relative to the action of various articles of food or drink upon -the metal. Unpleasant accidents have often happened from the use of -copper vessels in the preparation of food; and it is therefore necessary -for the medical jurist to know the circumstances, so far as they have -been investigated, under which the poison may be dissolved. - -Dr. Falconer found, that distilled water kept several weeks on a -polished plate of copper, neither injured its lustre, nor acquired any -taste, nor become coloured with ammonia;[1050] and Drouard afterwards -observed, that distilled water, kept for a month on copper filings, did -not contain any of the metal.[1051] Eller of Berlin, however, remarked, -that water, if it contain a considerable quantity of common salt, as -four ounces in five pounds, or a twentieth part, will give slight traces -of copper after being boiled in a brass pan; and that if the pan be made -of copper, a powder is procured by evaporation, which when treated with -acetic acid yields so much as 20 grains of acetate of copper.[1052] But -it is a singular circumstance, also observed by the same -experimentalist, that if beef of fish be boiled with the usual allowance -of salt, and with the addition also of various vegetable substances, the -liquid does not yield any copper. This observation has been lately -denied by Professor Orfila; who says he found copper deposited on a -plate of iron in salt water in which beef had been boiled, and that he -also obtained copper from the beef itself.[1053] The quantity thus -dissolved, however, must be exceedingly small, if the copper be kept -clean and free of oxide; for copper vessels, although they have often -been the source of fatal accidents, if carelessly used in the -preparation of food, have appeared under careful management to be quite -harmless. An excellent practical confirmation of this will be found in -Michaelis’s Commentaries. He states, that in the Orphan Hospital of -Hallé, the food was in his time prepared in large copper vessels, which -were kept remarkably clean; and that out of a population of eight or -nine hundred he never heard of any one having suffered from symptoms of -poisoning with copper.[1054] Several other saline matters promote the -solution of copper in water. Thus Dr. Falconer found that alum has this -effect when aided by heat; and probably nitre and Epsom salt possess the -same quality.[1055] Their mode of action is not very well known. - -It is a common though erroneous idea, that milk, heated or allowed to -stand in a copper vessel, becomes impregnated with the metal. Eller has -shown, that, on the contrary, if the vessel be well cleaned, milk, tea, -coffee, beer, and rain-water, kept in a state of ebullition for two -hours, do not contract the slightest impurity from copper;[1056] and the -same remark has been also made by Dr. Falconer with respect to cabbage, -potatoes, turnips, carrots, onions, rice, and barley.[1057] - -But Eller farther remarked, that, if the vessel is not thoroughly clean, -then all acid substances dissolve the carbonate that encrusts it, -especially if left in it for some time. Nay, it appears that some acid -matters, though they do not dissolve clean copper by being merely boiled -in it a few minutes, nevertheless, if allowed to cool and stand some -time in it, will acquire a sensible impregnation.[1058] Dr. Falconer -also observed that syrup of lemons, boiled fifteen minutes in copper or -brass pans, did not acquire a sensible impregnation; but if it was -allowed to cool and remain in the pans for twenty-four hours, the -impregnation was perceptible even to the taste, and was discovered by -the test of metallic iron.[1059] This fact has been farther confirmed by -the researches of Proust,[1060] who states, that, in preparing food or -preserves in copper, it is not till the fluid ceases to cover the metal, -and is reduced in temperature, that solution of the metal begins. -Inattention to this difference has been the cause of fatal accidents, of -which the following case from Wildberg’s Practical Manual will serve as -a good example. A servant left some sour-krout for only a couple of -hours in a copper pan which had lost the tinning. Her mistress and a -daughter, who took the cabbage to dinner, died after twelve hours -illness; and Wildberg found the cabbage so strongly impregnated with -copper, that it was detected by the test of metallic iron.[1061] - -Some wines have the same power, by reason of the acid they contain. -Hence Eller found twenty-one grains of the acetate in five pounds of -French white wine, after being boiled in a copper vessel. An epidemic -disease, mentioned by Fabricius, which broke out in 1592 among the -senators of Bern, and a number of their guests who had been invited to a -great entertainment, was supposed to have arisen from a poisonous -impregnation of this kind. The wine used at the feast had been kept cool -in copper vessels immersed in a very cold well. Many of the company were -attacked with dysenteric symptoms, and some died.[1062] - -Vinegar also dissolves metallic copper. Dupuytren observed that the -vinegar sold by hawkers in the streets of Paris generally contained -copper from the action of the acetic acid on the stop-cocks of the -little vessels used in retailing it.[1063] Others in like manner have -found copper in vinegar pickles prepared in copper vessels. Thus Dr. -Percival found a strong impregnation of copper in pickled samphire, of -which a young lady ate one morning two breakfast platefuls, and which -proved fatal to her in nine days.[1064] And Dr. Falconer once detected -so large a quantity in some pickled cucumbers bought at a great London -grocer’s, that it was deposited on a plate of iron, and imparted its -peculiar taste and smell to the pickles.[1065] It seems indeed to have -been at one time the custom to make a point of adulterating pickles with -copper; for in many old cookery-books the cook is told to make her -pickles in a copper pan, or to put some halfpence among the pickles to -give them a fine green colour.[1066] - -The action of the vegetable acids, and more particularly of vinegar on -copper, depends on the co-operation of the atmospheric air held in -solution by the fluid, and in contact with its surface. Without such -co-operation the copper cannot be oxidated. This fact, which was -determined experimentally by Proust,[1067] will explain the observations -of Eller and Falconer,—that it is not dangerous to boil acidulous -liquids in copper vessels, while it is very unsafe to keep these fluids -cold in the same vessels. In the latter instance the liquid is -impregnated with atmospheric air, while in the former the usual aëriform -contents are driven off by the heat. I must observe, however, in -limitation of Proust’s statement, that strong vinegar, such as the -pyroligneous acetic acid, will become impregnated to a certain extent if -boiled in copper vessels. The action which takes place is the same as -that remarked by him in the case of cold vinegar:[1067] the copper where -it is always covered remains quite bright; but at the edge of the fluid -it becomes oxidated, and the oxide is dissolved by the occasional -bubbling up of the acid. - -In the last place, the property of oxidating and uniting with copper is -likewise possessed by fatty matters and oils. According to Falconer, -fatty substances do not act on metallic copper unless they are -rancid.[1068] But Proust is probably more correct when he states, that -they will act, though fresh, provided they are aided by the co-operation -of atmospheric air.[1069] I have found, that, if a plate of copper be -thrust into a mass of fresh butter, its surface becomes dark in -twenty-four hours, and the butter becomes green wherever it is in -contact both with the copper and the air, but not where it covers the -metal closely. In fresh hog’s lard, however, I have found that the whole -lard in contact with the copper becomes blue even at a depth to which -the air can scarcely reach. The action of oils is similar. It is even -probable that they act when hot; for Mr. Travis found that hot oil -became green when kept for only four or five minutes in a copper -vessel.[1070] Dr. Falconer mentions that the property of acting on -copper is possessed in an eminent degree by volatile oils, and -especially by oil of cloves and oil of cinnamon.[1071] - -The general result of the preceding observations is, that there is -hardly any article of food or drink which may not become impregnated -with copper if kept in copper vessels, as there are few articles which -do not contain either an acid or some fatty matter; and it farther -appears, that the impregnation will scarcely ever take place during the -boiling of such articles, but only during the preservation of them in a -cold state. It must also be considered, that, independently of these -chemical impregnations, articles of food may be mixed mechanically with -copper, in consequence of the vessels being allowed, through the -carelessness of the cook, to become covered with rust or carbonate, -which is subsequently removed by the friction of the solid parts of any -article that is boiled in them. - -In order to prevent accidental impregnations, copper vessels are usually -tinned. The tinning consists of an alloy of tin and lead, which is much -less easily attacked than the copper, and the safety of which is farther -insured by the circumstance, that the substances endowed with the -property of dissolving lead, cannot attack that metal before the whole -tin of the alloy is oxidated.[1072] The tinning of copper, however, has -been found to be but a partial protection, as the tinning is apt to be -worn away without attracting the attention of servants. Hence the use of -copper in the fabrication of kitchen utensils is becoming every day more -and more limited, especially since the manufacture of cast-iron vessels -was brought to perfection in this country. - -Many instances might be adduced of the ignorance and carelessness which -prevailed, even not far back in the last century, as to the employment -of copper vessels for culinary purposes. In addition to the instances -already quoted, the following are well deserving of notice. Gmelin was -consulted by the abbot of a monastery, on account of a violent disease -which prevailed throughout the whole brotherhood of monks. The symptoms -were obstinate and severe colic, retching and bilious vomiting, -costiveness, flatus, burning pain in the pit of the stomach, under the -sternum, in the kidneys and extremities, and paralytic weakness in the -arms. On inquiring into the cause of this singular combination of -symptoms, Gmelin found that every vessel in the kitchen, the pots and -pans, and even the milk pails and butter dishes for storing the butter, -were made of copper.[1073] In 1781 an establishment of Jacobin monks at -Paris were all violently affected from a similar error. The cook on a -Friday and the subsequent Saturday, after boiling fish for the dinner of -the monks in a copper pan, and drawing off the water, poured vinegar -over the fish, and left it thus in the pan for a considerable time. On -the evening of Friday several of them were taken severely ill with -headache, acute pain in the stomach and bowels, precordial anxiety, -purging, great feebleness, and cramps in the legs. The rest of them, to -the number of twenty-one in all, were similarly attacked next morning; -and the symptoms continued in most of them for five or six days.[1074] - -A singular variety of adulteration with copper was brought not long ago -into public notice on the continent,—namely, the impregnation of bread -with the sulphate of copper, which was used in small quantity for -promoting the fermentation of the dough. This practice was first -detected in some of the towns of Flanders, but was afterwards found to -prevail in France.[1075] Some chemists of reputation have indeed doubted -altogether the existence of the practice; and M. Barruel in particular, -who was consulted on the subject by the Prefecture of Paris, publicly -declared his disbelief, because he remarked that, instead of favouring -the panary fermentation, a very small proportion of sulphate of copper -actually impeded it, and besides gave the bread a greenish colour of -such depth that no customer would take it for a wholesome article.[1076] -Subsequent inquiries, however, have shown that Barruel must have allowed -himself to be misled, probably by using too much of the sulphate of -copper. For the bakers of St. Omer admitted that they practised this -ulceration for the sake of saving their yeast, the proportion required -being an ounce of the salt in two pints of water, for every hundred -weight (_quintal_) of dough, or about an 1800th part.[1077] And it -appears from an interesting set of experiments by M. Meylink, a chemist -of Deventer, that, contrary to the statements of Barruel, sulphate of -copper not only possesses the property of promoting the panary -fermentation, but likewise constitutes in several important respects a -source of adulteration, which ought to be prohibited and strictly looked -after. He found that when he added to half a Flemish pound of dough from -one grain to eight grains of sulphate of copper, fermentation took place -more quickly than in the same dough without such addition, and nearly in -proportion to the quantity of the salt used;—that the adulterated loaves -when taken out of the oven were much better raised, and the loaf with -only one grain of the salt likewise much whiter, than those which were -not adulterated;—that a slight increase, however, in the proportion -rendered the loaf greenish, and gave it a peculiar taste; but especially -that the employment of the salt of copper even in the small proportion -of one grain had the singular effect of bringing about the complete -fermentation of the dough with considerably less loss of weight than -occurs in the common process of baking, the loss in the sound and in the -adulterated loaves being in the proportion of 116 to 100.[1078] It -certainly seems fully proved, then, that the adulteration of bread with -sulphate of copper is an important fraud in more ways than one. Some -doubt may be entertained whether any injury can result to the human body -from even the habitual use of so small a quantity as that employed by -the bakers; and at all events, we may be satisfied that if any bad -effects do result, this can only happen from the continual use of the -adulterated bread for a great length of time. But there can be no doubt -that the practice is a fraud on the public, by enabling the baker to -make his loaves of the standard weight with a less allowance of -nutritive material. - -Another important adulteration also indicated by foreign chemists, is -that of syrup made with the coarsest kinds of sugar, and decolorized by -means of sulphate of copper. The colour is removed by adding a solution -of the sulphate to the syrup boiling hot, and decomposing the salt by -lime; but a portion of the salt is often left behind, and in consequence -accidents have arisen from such syrups being used in making various -medicinal preparations.[1079] - -_Of the detection of copper in organic mixtures._—As in the instance of -arsenic and mercury, so in that of copper the presence of vegetable and -animal principles interposes material obstacles in the application of -the ordinary tests and methods of analysis. Some substances, such as -albumen, milk, tea, coffee, and the like, decompose the solutions of the -salts of copper, throwing down the oxide of copper in union with various -proximate principles. Others, such as red wine, bile, vomited matter, -and the tissues composing the stomach, although they do not decompose -the soluble copper salts, alter materially the action of reagents on -them. These facts were established long ago by Professor Orfila;[1080] -and various processes were suggested by him, by myself in former -editions of this work, and by various other authors, with the view of -overcoming the difficulties in question. - -More lately a fresh difficulty has been started, which has been thought -to render every prior process fallacious, including that which I have -proposed. For it is alleged that copper exists naturally as a -constituent part of many vegetable and animal substances, and more -especially in the organs of the human body. This statement is so -important as to deserve attentive consideration before fixing on a -method of analysis for medico-legal cases. - -Some time ago Meissner pointed out the existence of a trace of copper in -some vegetable substances;[1081] and more recently M. Sarzeau alleged -that a minute quantity of this metal, sometimes not above a 1,500,000th -and never exceeding a 120,000th part, may be detected not only in all -vegetable substances, but likewise in the blood, as well as other fluids -and solids of the animal body. Among vegetable substances he examined -with great care cinchona-bark, madder, coffee, wheat and flour; and he -succeeded in separating metallic copper from them all.[1082] - -The accuracy of these researches was called in question. By some -chemists the discoveries of Meissner and Sarzeau were confirmed so far -as they relate to vegetable substances. By others the confirmation was -extended to the animal body, and more especially to the human organs and -secretions. Thus M. Devergie says, that, having been struck with the -singular circumstance of two cases occurring to him in a single year, -where analysis indicated copper in the tissues of the alimentary canal -of persons suspected of having died of poison, he was led to inquire, -along with M. O. Henry, whether the metal was contained naturally in the -textures of the human body; and that in the course of many experiments, -although unable to detect any in a solution made by means of weak acetic -acid, he could always find it by the process of incineration.[1083] -Orfila has also repeatedly detected traces of copper in the bodies of -animals not poisoned with the preparations of that metal.[1084] - -By other experimentalists opposite results have been obtained, more -especially in regard to animal solids and fluids. In the course of an -inquiry relative to the question, whether poisons pass into the blood, I -failed to detect copper in the blood, muscles, or spinal marrow of -animals, although the method of analysis must have enabled me to -discover extremely minute quantities of that metal. Afterwards M. -Chevreul was unable to detect the slightest trace of copper in beef, -veal, or mutton; nor was he more successful in the case of wheat, -provided care was taken to keep the sample clean.[1085] And more -recently MM. Flandin and Danger have denied that there is any copper -ever found naturally in the body.[1086] - -These discrepant results appear to be in a great measure reconciled in -an extensive inquiry into the subject by M. Boutigny; who found that -wheat, wine, cider, and some other substances of a vegetable nature, do -frequently present minute traces of copper, but only when copper is -contained in the manure used in raising the grain, apples, and the like; -that manure from the streets of great towns always contains copper, and -introduces it into vegetable articles grown where such manure is used; -and that the occasional presence of the same metal in animal substances -may be traced either to copper vessels having been employed in preparing -or preserving them, or to the animals producing them having been fed on -vegetables presenting from the causes mentioned above a faint cupreous -impregnation.[1087]—Another fallacy, which may account for the alleged -invariable success of some chemists, has been pointed out by M. -Hiers-Reynaert of Bruges. Having once obtained copper in a specimen of -suspected bread, when he used paper for a filter, but none when he used -linen, he was led to examine various filtering papers, and found that -some kinds contain an appreciable trace of copper.[1088] This important -fact must be attended to in all medico-legal investigations. - -On the whole, whatever may be thought of the physiological question, -whether copper forms a constituent of the textures and fluids of -vegetables and animals, it seems well established that this metal is -often present there in minute proportion; and consequently its possible -presence must not be overlooked in medico-legal researches. Fortunately -methods of analysis are known which this source of fallacy does not -affect. - -_Process._ The following method embraces all possible cases; and it is -exempt, so far as yet appears, from every source of error. - -1. Should the subject of analysis not be a liquid, render it such by -dividing it into small fragments, and boiling it gently for an hour in -distilled water acidulated with acetic acid, which must previously be -ascertained not to contain any copper. If the liquid be not viscid, -filter it at once; but if it be too viscid for filtration, pass it -through a muslin sieve, add two volumes of rectified spirit to it when -cool, and then filter it. Transmit through a small portion of it a -stream of hydrosulphuric acid gas; and if a brownish-black precipitate -or cloud form, subject the whole liquid to the gas. A brown precipitate, -which is sulphuret of copper, will separate either immediately, or after -ebullition and repose for an hour. Collect the precipitate, if abundant, -by filtration, if scanty, by repeated subsidence and affusion. Dry it, -subject it to a low red heat, and then heat it with a little strong -nitric acid, which will convert the sulphuret into the sulphate of -copper. This salt, dissolved out by boiling distilled water, may be -subjected to the tests described above, and especially to ammonia. - -2. If the copper be extremely minute in quantity, sulphuretted hydrogen -will not act upon it in a fluid much charged with organic matter. To -meet this possible case, which may occur when the subject of analysis is -an organ of the human body into which the poison has been conveyed by -absorption,—let the liquid be evaporated to dryness, and charred in the -following manner. Heat in a porcelain basin a quantity of nitric acid -equal in weight to the residuum, together with a fifteenth of chlorate -of potash. Add the dry residuum in successive portions of such magnitude -as not to occasion too great effervescence. When it has been all added, -heat the product till it become dark-red and thick. It will then, or -soon afterwards, begin suddenly to char, and at length a thick vapour -will arise in dense clouds; upon which, the charring being complete, the -heat must be withdrawn. Pulverise the carbonaceous mass; boil it with -nitric acid diluted with its own volume of water; and evaporate the -filtered fluid to dryness, so as to expel any excess of acid. Dissolve -the saline residuum, and test the solution with the usual reagents. - -The first branch of this process is nearly the same with the one adopted -in the last edition of the present work. The second is derived from a -process lately proposed by Orfila.[1089] - -The principles on which it is founded are these. 1. Of the numerous -organic compounds formed by vegetable and animal principles with the -salts of copper, all either dissolve in very weak acetic acid, or part -with their oxide of copper to it. This was pointed out by me in my last -edition. 2, Weak acetic acid, as already mentioned (p. 356), has been -shown by M. Devergie to be incapable of dissolving that copper which is -contained naturally in the tissues, at least so as to render it -discoverable by the subsequent steps of the process. 3, According to -Orfila, copper naturally present in organic substances, is never -indicated by the second branch of the process, provided the charred -product of the action of nitric acid and chlorate of potash be not -heated to incineration. It does not appear why the charring process, -when so conducted, should separate adventitious copper, and not that -which is present naturally. But the empirical fact may be accepted in -the mean time, as it rests on apparently careful experiments. - -Orfila does not use acetic acid in the first branch of his process, but -merely infuses the suspected matter in cold water, and if copper be not -thus found, he has recourse to boiling water. But this method introduces -needless complexity; and besides neither maceration, nor boiling with -mere water, will dissolve out the whole oxide of copper. Acidulation -with acetic acid dissolves it all; and Devergie has shown that this -advantage is gained without any additional fallacy arising from the -possible presence of copper as a natural ingredient of the substance -under examination (p. 356). - - - SECTION II.—_Of the Action of Copper, and the Symptoms it excites in - Man._ - -The symptoms caused by copper have at least two varieties in their -character. One class arises from its local action on the alimentary -canal; the other from its operation on distant organs. - -This double influence is proved by the experiments of Drouard on -animals, published in his inaugural dissertation at Paris in 1802; and -by those of Orfila in his Toxicology. - -When Drouard gave twelve grains of verdigris to a strong dog fasting, he -observed that it caused aversion to food, efforts to vomit, diarrhœa, -listlessness, and death in twenty-two hours; and that the stomach was -but little inflamed. When two grains dissolved in water were injected -into the jugular vein of another dog, it caused vomiting and discharge -of fæces in seven minutes, then rattling in the throat, and death in -half an hour; and there was no particular morbid appearance in the -body.—Half a grain killed another in four days; and in addition to the -preceding symptoms, there was palsy of the hind legs for a day before -death. Six grains of the sulphate introduced into the stomach killed a -dog in half an hour, without producing any appearance of -inflammation.[1090] - -These experiments prove that it is not by causing local irritation that -this poison proves fatal. But its mode of action is more distinctly -shown in the later and more accurate experiments of Orfila. He found -that twelve or fifteen grains of the neutral acetate generally killed -dogs within an hour; and that besides the usual symptoms of irritation -in the stomach, they often had insensibility, almost always convulsions, -and immediately before death rigidity, or even absolute tetanus. He -likewise remarked violent convulsions and insensibility when a grain of -this salt was injected into the veins; and death was then seldom delayed -beyond ten minutes. In no case was there any particular morbid -appearance, except loss of contractility in the voluntary muscles.[1091] -More recently results nearly the same have been obtained by -Mitscherlich; and when doses of two drachms of sulphate of copper were -given, he observed after death pale blueness of the villous coat of the -stomach, mingled with brownness,—the apparent effect of chemical -action.[1092] - -Allied to these results are those obtained by my late colleague, Dr. -Duncan, and by Mitscherlich, when the sulphate was applied to a wound. -Dr. Duncan observed that death took place in twenty-two hours, and the -body was every where in a healthy state. Mitscherlich found that a -drachm of either sulphate or acetate proved fatal in four hours, with -symptoms of extreme prostration. The experiments of M. Smith, repeated -by Orfila, are at variance with these; for one or two drachms of the -acetate applied to a wound in the thigh of a dog caused only local -inflammation, and no constitutional symptoms.[1093] - -It follows from the researches now detailed, that the salts of copper -act in whatever way they are introduced into the system, and the more -energetically, the more directly they enter the blood. The inquiries -of Mr. Blake farther show, that when injected into the blood-vessels, -they act with peculiar force in exhausting muscular irritability, and -occasion death by paralysing the heart if they are injected into a -vein. Six grains of the sulphate injected into the jugular vein of a -dog reduced the force of the heart’s contractions, and fifteen grains -arrested them in twelve seconds, leaving in the dead body distension -of the heart, loss of contractility, and florid blood in the left -cavities. Ten grains injected into the aorta through the axillary -artery caused no sign of obstruction in the capillary system; and -small doses of three or four grains occasioned vomiting, dyspnœa, and -stiffness of the limbs; and immediately after death the muscles had -lost their irritability.[1094] - -Copper has been sought for, with variable success, in the blood of -animals poisoned with its salts. Drouard was unable to detect it in the -blood. But this need not excite surprise, because the same physiologist -could not detect it, even when he had injected it into a -vein.—Lebküchner, who published a thesis at Tübingen in 1819, on the -permeability of the living membranes, succeeded in discovering it. He -introduced four grains of the ammoniacal sulphate into the bronchial -tubes of a cat, and five minutes afterwards, when the animal was under -the action of the poison, he drew some blood from the carotid artery and -jugular vein; and he detected copper in the serum of the former, but not -in the latter, by sulphuretted-hydrogen and hydrosulphate of -ammonia.[1095]—Afterwards Dr. Wibmer of Munich also succeeded in -discovering it. In a dog which had taken from four to twenty grains of -the neutral acetate daily for several weeks, he found the metal in the -substance of the liver, but not anywhere else. In the charcoally matter -left by incinerating the liver, nitric acid formed a solution, which -when neutralized gave the characteristic action of the salts of copper -with sulphuretted-hydrogen, ferro-cyanate of potash, and ammonia.[1096] -Fischer also found copper in the blood of a dog which in forty-three -days had got gradually-increasing doses of acetate of copper, till at -length twelve grains were taken daily.[1097] Orfila has recently often -detected copper in the liver, spleen, heart, kidneys, and lungs of -animals poisoned with its salts.[1098] These facts are not all -invalidated by the late discovery of the presence of copper in the -animal tissues of men and animals not poisoned with its preparations. -For in the experiments of Wibmer and of Orfila the quantity found in -cases of poisoning was much larger than in the ordinary state of things; -and the poison was accumulated in particular organs, especially the -liver. The absorption of copper may therefore be considered as fully -substantiated; and it is equally important whether it be regarded as a -physiological or medico-legal fact. - -Dr. Duncan’s experiment on its effect when applied to a wound shows that -it may prove fatal when applied externally. Yet in small quantities, the -sulphate is daily used with safety for dressing ulcers. - -As to the preparations of copper which are poisonous, it is pretty -certain that, like all other metals, it is not deleterious unless -oxidated, and that its soluble salts are by far the most energetic. -Portal, indeed, has related the case of a woman who, while taking from a -half a grain to four grains of copper filings daily, was seized with -symptoms of poisoning.[1099] But it is probable the filings were -oxidated; for Drouard gave an ounce to dogs without injuring them at -all,[1100] and Lefortier more lately observed that two drachms had no -effect.[1101] The same explanation must be given of the injury sustained -by those artisans who prepare and use what is called “bronze dust” in -printing and paper-staining. If the substance employed be nothing else -than an alloy of copper and zinc, as is alleged, the injurious effects -to be mentioned presently can only be explained on the supposition that -the copper becomes oxidated either before or after coming in contact -with the body. It deserves to be added, that many persons have swallowed -copper coins and retained them for weeks without having any symptoms of -poisoning. - -The sulphuret is equally innocuous with the metal if pure; but it -appears probable that it becomes oxidated by long exposure to the air, -and passes into the state of sulphate. Orfila found that an ounce of -recently prepared sulphuret had no effect on a dog; but half an ounce of -a parcel which had been long kept caused vomiting, and yielded a little -sulphate to water.[1102] The power of the oxides has not been -ascertained. They are certainly poisonous; and Lefortier found that both -the red dioxide and black protoxide undergo solution in no long time in -the stomachs of dogs.[1103] The hydrated protoxide is probably more -active. From some experiments made at the hospital of St. Louis in -Paris, it appears that twelve grains will cause nausea, pain in the -stomach and bowels, vomiting and diarrhœa.[1104] There is no doubt that -the carbonate or natural verdigris, the phosphate, and even the -subphosphate, though quite insoluble in water, are capable of acting as -poisons, because Lefortier found that they are soon dissolved in the -stomachs of dogs, and in small doses cause severe vomiting in the course -of fifteen minutes.[1105] But it is chiefly in the soluble salts that we -are to look for the full development of the action of this poison. A -very small quantity of the sulphate will prove fatal; for, as already -noticed, Drouard found that six grains killed a dog in half an hour. - -The symptoms caused by the soluble salts of copper in man are, in a -general point of view, the same with those caused by arsenic and -corrosive sublimate. But there are likewise some peculiarities. -According to the cases related by Orfila in his Toxicology, the first -symptom is violent headache, then vomiting and cutting pains in the -bowels, and afterwards cramps in the legs and pains in the thighs. -Sometimes throughout the whole course of the symptoms there is a -peculiar coppery taste in the mouth, and a singular aversion to the -smell of copper. Drouard notices this in his thesis; and says, that, -having himself been once poisoned with verdigris, the smell of copper -used to excite nausea for a long time after.[1106] Another symptom, -which occasionally occurs in this kind of poisoning, and never, so far -as I know, in poisoning with arsenic or corrosive sublimate, is -jaundice. It likewise appears that, when the case ends fatally, -convulsions and insensibility generally precede death. - -A set of cases illustrating the slighter forms of poisoning with copper -has been published by M. Bonjean of Chambéry. The cause was the -preparation of an acid confection in a copper vessel. Two women suffered -from severe headache, constriction of the throat, nausea, colic, and -extreme weakness. Two young men, who had eaten the confection more -freely, had for some hours excruciating colic, severe pain in the mouth -and throat, impeded breathing, and hurried irregular pulse; and for -twenty-four hours they suffered severely from headache and prostration -of strength.[1107] - -The following case communicated to Professor Orfila by one of his -friends will convey a good idea of the symptoms in severe cases, which -do not prove fatal. A jeweller’s workman swallowed intentionally half an -ounce of verdigris, suspended in water. In fifteen minutes he was -attacked with colic pains and profuse vomiting and purging. When seen by -the physician eight hours afterwards there was not much vomiting, but -frequent eructation of a matter containing verdigris, some salivation, a -small pulse, and blueness about the eyes. In sixteen hours jaundice -began to appear. In the course of the night he was a good deal relieved -from the colic pains by three alvine discharges; and next morning he had -ceased to vomit, and the pain had disappeared. But he complained of a -taste of copper in his mouth, and the jaundice had increased. From this -time he recovered rapidly, and on the fourth day convalescence was -confirmed.[1108] - -When the poisoning ends fatally, convulsions, palsy, and insensibility, -the signs in short of some injury done to the brain, are very generally -present. This is illustrated by a good example in Pyl’s Essays and -Observations. It was the case of a confectioner’s daughter, who took two -ounces of verdigris, and died on the third day under incessant vomiting -and diarrhœa, attended towards the close with convulsions, and then with -palsy of the limbs. This case, however, is chiefly valuable for the -dissection, which will be noticed presently.[1109] But two cases of the -same description are related in greater detail by Wildberg in his -Practical Manual, which clearly show the action of this poison on the -brain. They are the cases formerly alluded to of a lady and her daughter -who were poisoned by sour-krout kept in a copper pan. Soon after dinner -they were attacked first with pain in the stomach, then with nausea and -anxiety, and next with eructation and vomiting of a green, bitter, sour, -astringent matter. The pain afterwards shot downwards throughout the -belly, and was then followed by diarrhœa; afterwards by convulsions, at -first transient, then continued; and finally by insensibility. The -daughter died in twelve hours, the mother an hour later.[1110] In these -three cases, although there was not any jaundice noticed during life, -the skin was very yellow after death.—In some instances it would appear -that narcotic symptoms form the commencement and irritant symptoms the -termination of the poisoning. This unusual relation occurs in a case of -recovery related by M. Julia-Fontenelle, and also, though less -remarkably, in a fatal case mentioned by Wibmer. The subject of the -former was a man who intentionally took a solution of copper in vinegar, -prepared by keeping several sous-pieces seven days in that fluid. In -three hours he was found in a state of insensibility, with the jaws -locked, the muscles rigid and frequently convulsed, the breathing -interrupted, and the pulse small and slow. In half an hour he was so far -roused that he could tell what he had done; and soon after taking white -of eggs the convulsions ceased: but next day the belly was hard and -tender, and the repeated application of leeches was required to subdue -the abdominal irritation that ensued.[1111] In the fatal case by Wibmer, -that of a girl of 18, who was poisoned by a dish of beans having been -cooked in a copper vessel, sickness, pain of the belly and vomiting -speedily arose, but were soon followed by convulsions and loss of -consciousness. Next day there was little pain, but extraordinary -paralytic weakness of the arms and legs: the abdomen afterwards became -distended and painful; and death took place in seventy-eight -hours.[1112]—A case where convulsions were produced by two drachms of -blue vitriol is mentioned by Dr. Percival.[1113]—In other instances it -would appear that no nervous affection occurs at all, as in the case of -a young lady related by Percival, who, when poisoned with pickled -samphire containing copper, suffered chiefly from pains in the stomach, -an eruption over the breast, general shooting pains, thirst, a frequent -small pulse, vomiting, hiccup, and purging. Death occurred on the ninth -day, without stupor or convulsions.[1114] - -Besides these effects when introduced in considerable doses and in the -form of soluble salts, copper is said to produce other disorders when -applied to the body for a long time in minute quantities and in its -metallic or oxidized state. Among those artisans who work much with -copper various affections are thought to be gradually engendered by -merely handling the metal. Patissier in his treatise on the diseases of -artisans says, that copper-workers have a peculiar appearance which -distinguishes them from other tradesmen,—that they have a greenish -complexion,—that the same colour tinges their eyes, tongue, and hair, -their excretions, and even their clothes through the medium of the -perspiration,—that they are spare, short in stature, bent, their -offspring ricketty, and they themselves old and even decrepit at their -fortieth or fiftieth year.[1115] Mérat also asserts that they are liable -to the painters’ colic, that peculiar disease soon to be noticed as a -common effect of the long-continued application of lead.[1116] - -But these notions must be received with some limitation. At least the -alleged effects on copper-workers are by no means invariable. For -copper-workers now-a days in this country and elsewhere are by no means -the unhealthy persons Patissier represents them to be. As to colica -pictonum, it is very rare among them; and possibly the cases noticed by -Mérat might have been produced by the secret introduction of lead into -the body, if indeed they were not cases of common colic. - -A very singular set of cases was lately brought under notice by Mr. -Gurney Turner, where poisoning seemed to have been occasioned by the -external application or inhalation of the fine dust used for imitating -gilding by painters, paper-stainers, and porcelain-painters, and which -is said to be essentially brass in a state of fine division. The workmen -who use it, are very apt to be attacked with irritation about the -private parts, and a vesicular eruption about the hairs on the -pubes,—with loss of appetite, tendency to vomiting, and other symptoms -of irritation in the stomach,—with obstinate constipation,—with soreness -and dryness of the throat and irritation in the nose,—and with want of -sleep, and a remarkable greenness of the hair over the whole body.[1117] - - - SECTION III.—_Of the Morbid Appearances caused by Copper._ - -The appearances found in the body after death by poisoning with copper -are chiefly the signs of inflammation. - -Where death takes place very rapidly, however, it is probable, that no -diseased appearance whatever will be perceptible. At least this was the -case in the animals experimented on by Drouard and Orfila; and little -doubt can therefore be entertained that the result would be the same -with man also in similar circumstances. - -When death ensues more slowly, as in the only fatal cases yet on record -of its action on man, the marks of inflammation coincide with the signs -of irritation during life. The best account I have seen of the morbid -appearances under such circumstances is in the cases related by Pyl, by -Wildberg, by Wibmer, and by Dégrange. - -In Pyl’s case the whole skin was yellow. The intestines, particularly -the lesser intestines, were of an unusual green colour, inflamed, and -here and there gangrenous. The stomach was also green; its inner coat -was excessively inflamed; and near the pylorus there was a spot as big -as a crown, where the villous coat was thick, hard, and covered with -firmly adhering verdigris. The lungs are likewise said to have been -inflamed. The blood was firmly coagulated. - -In the cases related by Wildberg, which are very like each other, the -skin on various parts, and particularly on the face, was yellow, but on -the depending parts livid. The outer coat of the stomach and intestines -was here and there inflamed; and the inner coat of the former was very -much inflamed, and even gangrenous[1118] near the pylorus and cardia. -The duodenum and jejunum, and likewise the gullet, were in a similar -state. The blood in the heart and great vessels was black and fluid. - -In the case of the girl referred to by Wibmer, the skin was -ochre-yellow, the stomach green, much inflamed, especially near the -pylorus, the gullet and intestines also inflamed, the diaphragm red, the -brain healthy, the lungs and heart “gorged with thick blood.” - -In the case of poisoning with carbonate of copper described by Dégrange -[p. 348], in which, however, it is probable that death was accelerated -by a fall, there was found congestion of the surface of the brain, -arborescent redness of the gullet and a green sand over its surface, -general greenness of the villous coat of the stomach, with vascularity -of the fundus and points of superficial ulceration, greenness of the -whole intestines, with black vascular ecchymosed spots and softening, -except in the ileum, and redness of the inner surface of the heart. -Copper was detected in the contents of the stomach and intestines. - -The intestines have been found perforated by ulceration, and their -contents thrown out into the sac of the peritonæum. Portal has related -one case where the small intestines were perforated, and several where -the perforation was in the rectum, which portion of the intestines, as -well as the duodenum, jejunum, and ileum, was also extensively -ulcerated.[1119] - -The existence of verdigris in the form of powder lining the inside of -the stomach after incessant vomiting for three days, is of course an -important circumstance in the inspection of the body. But too much -reliance ought not to be placed on mere bluish or greenish colouring of -the membranes. For Orfila[1120] and Guersent[1121] have both observed, -that the inside of the stomach as well as its contents may acquire these -tints in a remarkable degree in consequence of natural disease. - - - SECTION IV.—_Of the Treatment of Poisoning with Copper._ - -The treatment of poisoning with the salts of copper has been examined in -relation to the antidotes by M. Drouard, M. Marcelin-Duval, Professor -Orfila, and M. Postel. - -The alkaline sulphurets were at one time thought to be antidotes for the -poisons of copper, but without any reason. Drouard found that fifteen -grains of verdigris killed a dog in thirty hours, notwithstanding the -free use of the liver of sulphur.[1122] - -Afterwards M. Marcelin-Duval was led from his experiments to infer that -sugar was an antidote,[1123] and in the first editions of his Toxicology -Professor Orfila agreed with him, and related some experiments of his -own, which, along with those of Duval, seemed to place the fact beyond -all doubt. Later and more careful experiments, however, satisfied -Orfila, that it only acts as an emollient after the poison has been -removed from the stomach, and that it has no effect at all if the poison -is retained by a ligature in the gullet.[1124] Sugar being thus rejected -as well as the sulphurets, he was led to try the effects of albumen; and -his experiments induced him to recommend that substance as an antidote -in preference to every thing else. He found that the white of six eggs -completely neutralized the activity of between 25 and 36 grains of -verdigris; so that even when the mixture was retained in the stomach by -a ligature on the gullet no effect ensued which could be ascribed to the -poison. He infers that white of egg is the best antidote for poisoning -with copper.[1125] He likewise found the ferro-cyanate of potass not -inferior.[1126] - -Since the publication of these inquires the subject has been again -examined by M. Postel, who reverts to the original proposition of Duval, -that sugar is really a good antidote; and he rests this conclusion -partly on direct comparative experiments, showing that it is at least -equally effective with white of egg, and partly on the singular fact -ascertained by him, that sugar, which was believed to decompose the -salts of copper only at the temperature of 212°, does actually -accomplish this decomposition at the temperature of the human body, and -throws down the copper in the form of oxide.[1127] - -According to the experiments of MM. Milne-Edwards and Dumas, metallic -iron is likewise a good antidote: they found that when fifteen, twenty, -and even fifty grains of sulphate of copper, acetate of copper, or -verdigris, were given to animals, and an ounce of iron filings -administered either immediately before, or immediately afterwards,—the -gullet being tied to prevent the discharge of the poison,—death did not -ensue for five, six, or even eight days, and consequently proceeded from -the operation on the gullet; and that in one experiment, on the ligature -being removed from the gullet, the opening healed up, and complete -recovery took place.[1128] - -Before quitting the subject of the treatment, it is necessary to caution -the practitioner particularly against the employment of vinegar,—a -substance often ignorantly used for this, in common with many other, -species of poisoning. On account of its solvent power over the insoluble -compounds formed by the salts of copper with animal and vegetable -matters, it must be injurious rather than useful. - - - - - CHAPTER XVI. - OF POISONING WITH ANTIMONY. - - -The fourth genus of the metallic irritants includes the preparations of -antimony. Poisoning with antimonial preparations is not common. They are -employed extensively in medicine, however, and consequently accidents -have sometimes occurred with them. One of them is also often foolishly -used, in the way of amusement, to cause sickness and purging, and -likewise to detect servants who are suspected of making free with their -mistress’s tea-box or whisky-bottle; and in both of these ways alarming -effects have sometimes been produced. In 1837 a woman was tried in -England for attempting to poison a child with tartar-emetic; but the -poison appeared to have been given through ignorance.[1129] In large -doses some of the antimonial compounds may cause death; and one of them, -the chloride of antimony, now very little used in this country, is a -violent corrosive. - - - SECTION I.—_Of the Chemical History and Tests for the preparations of - Antimony._ - -Metallic antimony has a bluish-white colour, not liable to tarnish. Its -specific gravity is 6·7. It is easily fused, but is not very volatile. -In certain circumstances, however, it easily undergoes a spurious -sublimation, by being carried along with gases disengaged while it is in -the act of being reduced. - -A great number of preparations of antimony were at one time to be found -in the shop of the apothecary; but they are now reduced to a few. Those -which require notice here are the oxide, chloride, and tartar-emetic. - -The _oxide_ [sesquioxide] is a white heavy powder, which is best known -by its solubility in tartaric acid, and the effects of the tests for -tartar-emetic on the solution. - -The _chloride_ [sesquichloride], as usually seen, is a yellow or reddish -liquid, but when pure is colourless. It is highly corrosive. It is -readily known by the effect of water in decomposing it,—an insoluble -white subchloride being thrown down, and hydrochloric acid remaining in -solution. The latter is detected by nitrate of silver; and the -precipitate is known by being soluble in a solution of tartaric acid, -and then presenting the reactions of tartar-emetic. - - - _Tartar-Emetic._ - -In its solid state tartar-emetic forms regular tetraedral or more -generally octaedral crystals, which are colourless when pure, -efflorescent, and of a slightly metallic taste. As commonly seen in the -shops it is in the form of a white, or pale yellowish-white powder. - -When heated it decrepitates and then chars; and if the heat be increased -the oxide of antimony is reduced by the carbonaceous matter, and little -globules appear, like those of quicksilver in point of colour. The best -way of reducing tartar-emetic is to char it in a porcelain vessel or -watch-glass, and then to increase the heat till the charred mass takes -fire. Or the charred mass may be introduced into a tube and heated -strongly with the blowpipe, after which globules of antimony will be -found lining the bottom of the glass where the material has been. None -of it is ever sublimed. It is not easy to procure distinct globules by -heating tartar-emetic at once in a small tube. - -According to Dr. Duncan, tartar-emetic is soluble in three parts of -boiling and fifteen of temperate water. The solution presents the -following characters with reagents. - -1. _Caustic potass_ precipitates a white sesquioxide, but only if the -solution is tolerably concentrated. The first portions of the test have -no effect. The precipitate is redissolved by an excess of potass. - -2. _Nitric acid_ throws down a white precipitate, and takes it up again -when added in excess. - -3. The _Infusion of Galls_ causes a dirty, yellowish-white precipitate; -but it will not act on a solution which contains much less than two -grains per ounce. - -4. The best liquid reagent is _Hydrosulphuric acid_. In a solution -containing only an eighth part of a grain per ounce, it strikes an -orange-red colour, which, when the excess of gas is expelled by heat, -becomes an orange-red precipitate; and if the proportion of salt is -greater, the precipitate is thrown down at once.—The colour of the -precipitate is so peculiar as to distinguish it from every other -sulphuret; but if any doubt regarding its nature should occur, it may be -known by collecting it, dissolving it with the aid of gentle heat in -hydrochloric acid, and adding water to the solution; which will then -yield a white precipitate, the sesquioxide of antimony in union with a -little chlorine. - -5. When the solution is put into Marsh’s apparatus for detecting arsenic -[p. 211], the flame yields a dark brownish-black, obscurely shining -crust on a surface of porcelain held across it, and a white crystalline -powder if the porcelain be held just above the flame. The dark crust is -antimony, the white one its oxide. The former has only a distant -resemblance to the brilliant stain of arsenic, notwithstanding all that -has been said of their similarity. It is well, however, to use some -other test for distinguishing the two metals besides their appearance; -and the most convenient is a solution of chloride of lime, which -instantly makes an arsenical crust disappear, but does not affect an -antimonial one. - -Tartar-emetic, like the soluble salts of mercury and copper, is -decomposed by various organic principles. All vegetable substances that -contain a considerable quantity of tannin have this effect; of which an -example has been already mentioned in the action of infusion of galls. -Decoctions of cinchona-bark decompose it still more effectually. The -animal principles do not act on tartar-emetic, with the exception of -milk, which is slightly coagulated by a concentrated solution. Many -vegetable and animal substances, though they do not decompose it, alter -the operation of the fluid tests. Thus tea, though it does not effect -any distinct decomposition of the salt, will prevent the action of -gall-infusion; and French wine gives a violet tint to the precipitates -with that test and with acids.[1130] Hydrosulphuric acid, however, acts -under all circumstances, and always characteristically, whatever the -colour of the fluid may be. Dr. Turner found that when transmitted -through a diluted solution in tea, porter, broth, and milk, with certain -precautions to be mentioned presently, he procured a precipitate which -either showed its proper colour at once, or did so at the margin of the -filter on which it was collected.[1131] - -The circumstances now referred to render it necessary to resort to other -means, besides the simple application of liquid reagents, for the -purpose of detecting tartar-emetic in complex organic mixtures. This -subject has been ably investigated, first by Dr. Turner,[1132] and -afterwards by Professor Orfila.[1133] The result of the researches of -both seems to me to be that the most convenient method yet proposed is -the following. - -_Process for Tartar-emetic in Organic Mixtures._—If the subject of -analysis be not already liquid enough, add distilled water. Then -acidulate with a little hydrochloric and tartaric acids; the former of -which throws down some animal principles, while the latter dissolves -readily all precipitates formed with tartar-emetic by reagents or -organic principles except the sulphuret. Filter the product. - -1. Subject a small portion of the liquid to a stream of hydrosulphuric -acid gas, and if it be perceptibly coloured orange-red, treat the whole -liquid in the same way; boil to expel the excess of gas, collect the -precipitate, dry it, and reduce it by hydrogen gas in the following -manner. Put the sulphuret in a little horizontal tube, transmit hydrogen -through the tube by means of the apparatus represented in Figure 9, and -when all the air of the apparatus is expelled, apply heat to the -sulphuret with a spirit-lamp. Hydrosulphuric acid gas is evolved, and -metallic antimony is left, if the current of hydrogen be gentle, or it -is sublimed if the current be rapid.—When there is much animal or -vegetable matter present in the sulphuret, the metal is not always -distinctly visible. In that case, dissolve the antimony by the action of -nitric acid on the mixed material and broken fragments of the tube, and -throw down the orange sulphuret again from the neutralized solution by -hydrosulphuric acid. - -2. If hydrosulphuric acid do not distinctly affect the liquid, or if no -precipitate be separated after boiling, or so small a quantity as cannot -well be collected,—evaporate the liquid to dryness, char it by means of -nitric acid and chlorate of potash, as directed for copper (p. 357), -boil the carbonaceous mass for half an hour in a mixture of eight parts -of hydrochloric acid and one of nitric acid, and introduce the filtered -solution into the modification of Marsh’s apparatus for detecting -arsenic described in page 204, but without the tube _e h_. Kindle the -gas at _e_, and try whether a black, dull stain, not removable by -solution of chloride of lime, be produced on a surface of porcelain held -across the flame. If no stain be produced, there was no antimony in the -liquid under examination. If the porcelain be stained, apply the heat of -a spirit-lamp flame to the tube _d e_. Antimony will be deposited within -the tube where the heat is applied. In order to ascertain its nature, -break the tube, heat the portion containing the crust with -nitro-hydrochloric acid, evaporate to dryness, dissolve the residue in -hydrochloric acid, decompose a part of this solution with water, and -subject the rest to a stream of hydrosulphuric acid gas, which will -produce the usual orange sulphuret of antimony. - -3. If antimony be not indicated in either of these ways in the fluid -part of the subject of analysis, the solid portion may next be subjected -to the second process; but success will very seldom attend the search -when the previous steps have failed. - -The first branch of this process,—a slight modification of Dr. -Turner’s,—is a very delicate and satisfactory method of detecting -antimony in organic mixtures. Some practice is required to transmit the -hydrogen gas with the proper rapidity. The gas ought to be allowed to -pass for some time before the spirit-lamp flame is applied, otherwise -the oxygen remaining in the apparatus may cause an explosion, or will -oxidate the metallic antimony, formed by the reduction of the sulphuret. -As soon as the reduction of the sulphuret begins, the tube is blackened -on account of the action of the sulphuretted-hydrogen on the lead -contained in the glass. This obscures the operations within the tube; -but on subsequently breaking it, a metallic button or a sublimate will -be easily seen. When the sulphuret is considerable in quantity and the -gaseous current slow, the metal remains where the sulphuret was; but if -the mass of sulphuret is small and the current rapid, then the metal is -sublimed and condensed in minute scaly brilliant crystals. - -The second branch of the process is a modification of the method lately -employed by Professor Orfila for detecting antimony in the textures and -secretions of animals poisoned with tartar-emetic. It is probably more -delicate than the other, but not more satisfactory. - -The method of analysis here recommended, as well as every other yet -proposed for organic mixtures, merely detects the presence of antimony. -It does not indicate the state in which the metal was combined. It is a -process in short for antimony in every state of combination. - -It is almost unnecessary to observe that when the contents of the -stomach or vomited matters are the subject of analysis, care must be -taken to ascertain that tartar-emetic was not administered as a remedy. - - -SECTION II.—_Of the Action of Tartar-Emetic, and the Symptoms it excites - in Man._ - -There is little peculiarity in what is hitherto known of the symptoms of -poisoning with tartar-emetic in man. Cases in which it has been taken to -the requisite extent are rarely met with; and it has seldom remained -long enough in the stomach to act deleteriously. But its action on -animals would appear from the experiments of Magendie to be in some -respects peculiar. - -He found that dogs, like man, may take a large dose with impunity, for -example half an ounce, if they are allowed to vomit; but that if the -gullet is tied, from four to eight grains will kill them in a few hours. -His subsequent experiments go to prove that death is owing to the poison -exciting inflammation in the lungs. When six or eight grains dissolved -in water were injected into a vein, the animal was attacked with -vomiting and purging, and death ensued commonly within an hour. In the -dead body he found not only redness of the whole villous coat of the -stomach and intestines, but also that the lungs were of an orange-red or -violet colour throughout, destitute of crepitation, gorged with blood, -dense like the spleen, and here and there even hepatized. A larger -quantity caused death more rapidly without affecting the alimentary -canal; a smaller quantity caused intense inflammation there and death in -twenty-four hours; but the lungs were always more or less -affected.[1134] - -It is a fact, too, worthy of notice, that in whatever way this poison -enters the body its effects are nearly the same. This is shown not only -by the researches of Magendie already mentioned, but likewise by the -experiments of Schloepfer, who found that a scruple dissolved in twelve -parts of water and injected into the windpipe, caused violent vomiting, -difficult breathing, and death in three days; and in the dead body the -lungs and stomach were much inflamed, particularly the former.[1135] It -farther appears from an experiment related by Dr. Campbell, that, when -applied to a wound, it acts with almost equal energy as when injected -into a vein. Five grains killed a cat in this way in three hours, -causing inflammation of the wound, and vivid redness of the -stomach.[1136] He did not find the lungs inflamed. - -Magendie infers from his own researches that tartar-emetic occasions -death when swallowed, not by inflaming the stomach, but through means of -a general inflammatory state of the whole system subsequent to its -absorption,—of which disorder the affection of the stomach and -intestines and even that of the lungs are merely parts or symptoms. The -later experiments of Rayer tend in some measure to confirm these views, -by showing that death may occur without inflammation being excited any -where. In animals killed in twenty-five minutes by tartar-emetic applied -to a wound, he, like Dr. Campbell, could see no trace of inflammation in -any organ of the great cavities.[1137] - -Orfila has proved by analysis the important fact that tartar-emetic is -absorbed in the course of its action, and may be detected in the animal -tissues and secretions. He found that, when it is applied to the -cellular tissue of small dogs, two grains disappear before death: That -antimony may be detected by his process given above throughout the soft -textures generally, but especially in the liver and kidneys: but that it -is quickly discharged from these quarters through the medium of the -urine. Hence in an animal that died in four hours he found it abundantly -in the liver and still more in the urine; in one that survived seventeen -hours, the liver presented mere traces of the poison, but the urine -contained it in abundance; and in one that lived thirty-six hours, there -was a large quantity in the urine, but none at all in the liver. He also -ascertained that antimony is generally to be found in the urine of -persons who are taking tartar-emetic continuously in large doses for -pneumonia according to Rasori’s mode of administering it.[1138] These -results have been confirmed by the conjoined researches of Panizza and -Kramer, who found antimony in the urine and blood of a man during a -course of tartar-emetic.[1139] And Flandin and Danger also satisfied -themselves that in animals it may be generally detected in the -liver.[1140] - -_Effects on Man._—When tartar-emetic is swallowed by man, it generally -causes vomiting very soon and is all discharged; and then no other -effect follows. But if it remains long in the stomach before it excites -vomiting, or if the dose be large, more permanent symptoms are sometimes -induced. The vomiting recurs frequently, and is attended with burning -pain in the pit of the stomach, and followed by purging and colic pains. -There is sometimes a sense of tightness in the throat, which may be so -great as to prevent swallowing. The patient is likewise tormented with -violent cramps. Among the cases hitherto recorded no notice is taken of -pulmonary symptoms; which might be expected to occur if Magendie’s -experiments are free of fallacy. - -The late introduction of large doses of tartar-emetic into medical -practice having excited some doubt as to its poisonous properties, it -becomes a matter of some moment to possess positive facts on the -subject. The following cases may therefore be quoted, which will satisfy -every one that this substance is sometimes an active irritant. - -The first is particularly interesting from its close resemblance to -cholera. It occurred in consequence of an apothecary having sold -tartar-emetic by mistake for cream of tartar. The quantity taken was -about a scruple. A few moments afterwards the patient complained of pain -in the stomach, then of a tendency to faint, and at last he was seized -with violent bilious vomiting. Soon after that he felt colic pains -extending throughout the whole bowels, and accompanied ere long with -profuse and unceasing diarrhœa. The pulse at the same time was small and -contracted, and his strength failed completely; but the symptom which -distressed him most was frequent rending cramp in the legs. He remained -in this state for about six hours, and then recovered gradually under -the use of cinchona and opium; but for some time afterwards he was -liable to weakness of digestion.[1141] - -The next case to be mentioned, where the dose was forty grains, proved -fatal, although the person vomited soon after taking it. The symptoms -illustrate well the compound narcotico-acrid action often observed in -animals. The poison was taken voluntarily. Before the person was seen by -M. Récamier, who relates the case, he had been nearly two days ill with -vomiting, excessive purging, and convulsions. On the third day he had -great pain and tension in the region of the stomach, and appeared like a -man in a state of intoxication. In the course of the day the whole belly -became swelled, and at night delirium supervened. Next day all the -symptoms were aggravated; towards evening the delirium became furious; -convulsions followed; and he died during the night, not quite five days -after taking the poison.[1142] - -Severe effects have also been caused by so small a dose as six grains. A -woman, who swallowed this quantity, wrapped in paper, was seized in half -an hour with violent vomiting, which soon became bloody. In two hours -the decoction of cinchona was administered with much relief. But she had -severe colic, diarrhœa, pain in the stomach, and some fever; of which -symptoms she was not completely cured for five days.[1143] A case has -been published, where a dose of only four grains caused pain in the -belly, vomiting, and purging, followed by convulsions, failure of the -pulse, and loss of speech; and recovery took place very slowly.[1144] -Under the head of the treatment another case will be noticed where half -a drachm excited severe symptoms, and was probably prevented from -proving fatal only by the timely use of antidotes. - -While these examples prove that tartar-emetic is occasionally an active -irritant in the dose of a scruple or less, it must at the same time be -admitted to be uncertain in its action as a poison. This appears from -the late employment of it in large doses as a remedy for inflammation of -the lungs. The administration of tartar-emetic in large doses was a -common enough practice so early as the seventeenth century, and was also -occasionally resorted to by physicians between that and the present -time. But it is only in late years that, by the recommendations of -Professor Rasori of Milan,[1145] and M. Laennec of Paris, it has again -become a general method of treatment. According to this method, -tartar-emetic is given to the extent of twelve, twenty, or even thirty -grains a day in divided doses; and not only without producing any -dangerous irritation of the alimentary canal, but even also not -unfrequently without any physiological effect whatever. Doubts were at -one time entertained of the accuracy of the statements to this effect -published by foreign physicians; but these doubts are now dissipated, as -the same practice has been tried, with the same results, by many in -Britain. Rasori ascribes the power the body possesses of enduring large -doses of tartar-emetic without injury, to a peculiar diathesis which -accompanies the disease and ceases along with it. And it is said, that -the same patients, who, while the disorder continues, may take large -doses with impunity, are affected in the usual manner, if the doses are -not rapidly lessened after the disease has begun to give way. The -testimony of Laennec on the subject is impartial and decisive. He -observes he has given as much as two grains and a half every two hours -till twenty grains were taken daily, and once gave forty grains in -twenty-four hours by mistake; that he never saw any harm result; and -that vomiting or diarrhœa was seldom produced, and never after the first -day. The power of endurance he found to diminish, but not, as Rasori -alleges, to cease altogether, when the fever ceases; for some of his -patients took six, twelve, or eighteen grains daily when in full -convalescence.[1146] My own observations correspond with Laennec’s, -except as to the effects of large doses during convalescence, of which -effects I have had no experience. I have seen from six to twenty grains, -given daily in several doses of one or two grains, check bad cases of -pneumonia and bronchitis, without causing vomiting or diarrhœa after the -first day, and also without increasing the perspiration. At the same -time I have twice seen the first two or three doses excite so violent a -purging and pain in the stomach and whole bowels, that I was deterred -from persevering with the remedy. In continued fever too I have -repeatedly found that the doses mentioned above did not cause any -symptoms of irritation in the stomach or intestines. - -The large quantities now mentioned have even been sometimes given in a -single dose with nearly the same results. Dr. Christie mentions in his -Treatise on Cholera that he sometimes gave a scruple in one dose with -the effect of exciting merely some vomiting and several watery stools. -But he admits that in one instance symptoms were induced like those of a -case of violent cholera.[1147] - -The same large doses have been given by some in delirium tremens without -any poisonous effect being produced. A correspondent of the Lancet has -even mentioned that on one occasion, after gradually increasing the -dose, he at last wound up the treatment, successfully as regarded the -disease, and without any injury to the patient, by giving four doses of -twenty grains each, in the course of twenty minutes.[1148] - -These facts are sufficiently perplexing, when viewed along with what -were previously quoted in support of the poisonous effects of -tartar-emetic. On a full consideration of the whole circumstances, -however, I conceive the conclusion which will be drawn is, that this -substance is not so active a poison as was till lately supposed;—that in -the dose of four, six, or ten grains, it may cause severe symptoms, but -is uncertain in its action,—and that although there appears to be some -uncertainty in the effects of even much larger doses, such as a scruple, -yet in general violent irritation will then be induced, and sometimes -death itself. - -An instance is related in the Journal Universel of a man who, while in a -state of health, swallowed seventeen grains, and then tried to suffocate -himself with the fumes of burning charcoal. He recovered, though not -without suffering severely from the charcoal fumes; but he could hardly -be said to have been affected at all by the tartar-emetic.[1149] Here -the inactivity of the poison was probably owing to the narcotic effects -of the fumes. - -The effects of tartar-emetic on the skin are worthy of notice; but they -have not yet been carefully studied. Some facts tend to show that even -its constitutional action may be developed through the sound skin. Mr. -Sherwen attempted to prove by experiments on himself and two pupils, -that five or seven grains in solution will, when rubbed on the palms, -produce in a few hours nausea and copious perspiration.[1150] His -observations have been confirmed by Mr. Hutchinson.[1151] But Savary, a -French physician, on repeating these experiments, could remark nothing -more than a faint flat taste and slight salivation;[1152] and Mr. -Gaitskell could not remark any constitutional effect at all.[1153] -Sometimes it has appeared to cause severe symptoms of irritant poisoning -when used in the form of ointment to excite a pustular eruption. An -instance of this has been described in a late French Journal.[1154] Nay, -in the Medical Repository there is a case, in which the external use of -tartar-emetic ointment is supposed to have been the cause of death. The -subject was an infant, two years old, who, soon after having the spine -rubbed with this ointment, was seized with great sickness and frequent -fainting, which in forty-eight hours proved fatal.[1155] Considering the -numerous opportunities which medical men have had of witnessing the -effects of tartar-emetic applied in the same manner, and that these are -solitary cases, doubts may be entertained whether the irritant symptoms -in the one case, or the child’s death in the other, were occasioned in -the way supposed. - -Although the constitutional action of tartar-emetic is not easily -developed through the sound skin, its local effects are severe and -unequivocal. When applied to the skin it does not corrode, but excites -inflammation, on which account it is much used instead of cantharides. -It does not blister; but after being a few days applied, it brings out a -number of painful pustules; if it be persevered in, the skin ulcerates; -and if it be applied to an ulcerated surface it causes profuse -suppuration, or sometimes even sloughing. - -Tartar-emetic is one of the substances which appear to possess the -property of acting on the infant through the medium of its nurse’s milk. -I do not know, indeed, what may be the general experience on this point; -but a French physician, M. Minaret, has published a clear case of the -kind, in the instance of a young woman who was taking tartar-emetic for -pleurisy, and whose infant was attacked with a fit of vomiting -immediately after every attempt to suck the breast.[1156] - -There is some reason to suppose, that the vapours of antimony may prove -injurious when inhaled. Four persons, constantly exposed in preparing -antimonial compounds to the vapour of antimonious acid and chloride of -antimony, were attacked with headache, difficult breathing, stitches in -the back and sides, difficult expectoration of viscid mucus, want of -sleep and appetite, mucous discharge from the urethra, loss of sexual -propensity, atrophy of the testicles, and a pustular eruption on various -parts, but especially on the scrotum. They all recovered.[1157] - - - SECTION III.—_Of the Morbid Appearances produced by Tartar-emetic._ - -The morbid appearances caused by tartar-emetic have not been often -witnessed in man. - -In M. Récamier’s case there were some equivocal signs of reaction in the -brain. The organs in the chest were healthy. The villous coat of the -stomach, except near the gullet, where it was healthy, was everywhere -red, thickened, and covered with tough mucus. The whole intestines were -completely empty. The duodenum was in the same state as the stomach; but -the other intestines were in their natural condition. - -M. Jules Cloquet observed in the body of a man who died of apoplexy, and -who in the course of five days had taken forty grains of tartar-emetic, -without vomiting or purging,—that the villous coat of the stomach had a -deep reddish-violet colour, with cherry-red spots interspersed; and that -the whole small intestines were of a rose-red tint spotted with -cherry-red.[1158] - -The only other dissection I have seen noticed is one by Hoffmann. He -says that in a woman poisoned by tartar-emetic he found the stomach -gangrenous, and the lungs, diaphragm, and spleen as it were in a state -of putrefaction.[1159] Little credit can be given to this description. - -In animals Schloepfer found the blood always fluid.[1160] - - - SECTION IV.—_Of the Treatment of Poisoning with Antimony._ - -The treatment of poisoning with tartar-emetic is simple. If the poison -be not already discharged, large draughts of warm water should be given -and the throat tickled, to bring on vomiting. At the same time some -vegetable decoction should be prepared, which possesses the power of -decomposing the poison; and none is better or more likely to be at hand -than a decoction of cinchona-bark, particularly yellow-bark. The -tincture is also a good form for giving this antidote. The -administration of bark has been found useful even after vomiting had -continued for some length of time, probably because a part of the poison -nevertheless remained undischarged. Before the decoction is ready, it is -useful to administer the bark in powder. It is alleged, however, by M. -Toulmouche that decoction of cinchona is not nearly so serviceable as -infusion of galls, and that powder of galls is better still.[1161] When -there is reason to believe that the patient has vomited enough, and that -a sufficient quantity of the antidote has been taken, opium is evidently -indicated and has been found useful; but venesection may be previously -necessary if the signs of inflammation in the stomach are obstinate. - -The following case related by M. Serres was probably cured by cinchona. -At all events, the effect of the antidote was striking. A man purchased -half a drachm in divided doses at different shops, and swallowed the -whole in a cup of coffee. Very soon afterwards he was attacked with -burning pain in the stomach, convulsive tremors, and impaired -sensibility,—afterwards with cold clamminess of the skin, hiccup, and -some swelling of the epigastrium, but not with vomiting. Decoction of -cinchona was given freely. From the first moment almost of its -administration he felt relief, and began to sweat and purge. Next -morning, however, he vomited, and for some days there were evident signs -of slight inflammation in the stomach; nay, for a month afterwards he -had occasional pricking pains in that region; but he eventually -recovered.[1162] Another and more pointed case has been related by Dr. -Sauveton of Lyons. A lady swallowed by mistake for whey a solution of -sixty grains of tartar emetic. In ten minutes she was seen by her -physician, and at this time vomiting had not commenced. Tincture of bark -was immediately given in large doses. No unpleasant symptom occurred -except nausea and slight colic.[1163] - -Orfila considers that the diuretic plan of treatment recommended by him -for arsenic [p. 288] is equally applicable in the case of antimony. -Having ascertained that a grain and a half of tartar-emetic applied to a -wound constantly killed dogs in a period varying from seventeen to -thirty-six hours, if no treatment was employed,—he administered to them -in this way a dose varying from a grain and a half to three grains, and -by then giving diuretics effected a cure in four out of five -instances.[1164] - - - _Chloride of Antimony._ - -The chloride of antimony [sesquichloride, muriate, or butter of -antimony] being now put to little use and seldom seen except as an -intermediate product obtained in the preparation of other compounds of -antimony, it is rarely met with as the cause of poisoning, and therefore -scarcely deserves notice here, were it not that its effects differ -widely from those of tartar-emetic and other antimonials. - -It is easily known by the characters mentioned above. It has not yet -been made the subject of investigation by experiments on the lower -animals. Mr. Taylor has collected three cases of poisoning with it, -which show that it is a powerful corrosive and irritant, and that its -effects, as hitherto witnessed, seem to depend entirely on this action. -In one instance, that of a boy, twelve years old, who swallowed four or -five drachms of the solution by mistake for ginger-beer, the symptoms -were vomiting in half an hour, then faintness and extreme feebleness, -and next day heat in the mouth and throat, difficulty in swallowing, -slight abrasions of the lining membrane of the mouth, and general fever; -but he got quite well in eight days. In the case of another boy, ten -years old, who got about the same quantity by mistake for antimonial -wine, there was an immediate sense of choking and inability to speak, -then vomiting and pain in the throat, next a general state of collapse, -with dilated pupils and a tendency to stupor, and on the subsequent day -bright scarlet patches on the throat, with difficulty of swallowing. -This patient also recovered completely in a few days. The third was the -case of a surgeon who took intentionally between two and three fluid -ounces, and was found in an hour by his medical attendant in a state of -great prostration, and affected with severe efforts to vomit, violent -griping, and urgent tenesmus. Reaction soon ensued, the pain abated, and -the pulse rose to 120; a strong tendency to doze succeeded; and in ten -hours and a half he expired. The whole inside of the alimentary canal, -from the mouth to the jejunum, was black as if charred; the mucous -membrane seemed to have been removed along the whole of this extent of -the canal; and the submucous and peritoneal coats were so soft as to be -easily torn with the finger.[1165] - - - - - CHAPTER XVII. - OF POISONING WITH TIN, SILVER, GOLD, BISMUTH, CHROME, ZINC, AND IRON. - - -Several other metallic compounds produce effects analogous to those of -the preparations of arsenic, copper, mercury, and antimony. But they may -be passed over shortly; because they are little known as poisons, and it -is therefore only necessary that their leading properties be mentioned. -They are the compounds of tin, silver, gold, bismuth, chrome, zinc, and -iron. - - - _Of Poisoning with Tin._ - -The chlorides of _tin_ are used in the arts of colour-making and dyeing, -and the oxide of tin forms part of the putty-powder used for staining -glass and polishing silver plate. - -There are two chlorides, the protochloride and bichloride. They both -form acicular crystals, which are very soluble. It is needless to notice -their tests or chemical history; but in order that the following account -of their effects on man and animals may be understood, it is necessary -to mention, that they are decomposed by almost all vegetable infusions -and animal fluids. - -Orfila found, that a solution of six grains of the protochloride -injected into the jugular vein of a dog killed it in one minute,—that -two grains caused death by tetanus in fifteen minutes,—and that so small -a quantity as half a grain caused death in twelve hours, the only -symptoms being somnolency and catalepsy or fixedness of position. - -To these dreadful effects when introduced into the blood, its effects -when swallowed are not nearly proportionate. From eighteen to forty-four -grains killed dogs in one, two, or three days, efforts to vomit and -great depression being the only symptoms; and after death the stomach -was found excessively inflamed, and sometimes ulcerated. Its effects -when applied externally are still less violent. Two drachms applied to a -wound merely caused violent inflammation and sloughing of the part, and -death in twelve days, without any internal symptom during life or -appearance after death.[1166] - -These phenomena, considered along with the violent symptoms excited when -the poison is injected into the veins, show that, when swallowed or -applied outwardly, it acts only as a local irritant. - -Tin is absorbed in the course of its action, and may be detected in the -liver, spleen, and urine, by boiling them in water acidulated with -hydrochloric acid, evaporating the decoction to dryness, charring the -residue by means of nitric acid as directed for copper, treating the -carbonaceous mass with a mixture of twenty parts of hydrochloric acid -and one of nitric acid, evaporating the solution to dryness so as to -expel any excess of acid, dissolving what is left in hydrochloric acid -diluted with twice its volume of water, and then transmitting -hydrosulphuric acid gas. If the precipitated sulphuret of tin has not a -fine yellow colour, it must be heated with a little strong nitric acid; -after which, if the residuum be again dissolved in diluted hydrochloric -acid, a characteristic yellow bisulphuret will be thrown down by -hydrosulphuric acid gas. This process may be applied to all organic -mixtures containing tin.[1167] - -The oxide of tin, according to Schubarth, is quite inactive; for he gave -an entire drachm to a dog without being able to observe any effect from -it whatever.[1168] This is what would be expected from its extreme -insolubility. Yet Orfila has stated in the early editions of his -Toxicology, and repeats in that of 1843, but without noticing the -contradictory observations of Schubarth, that one or two drachms of the -oxide occasion in dogs all the phenomena of irritant poisoning, and -prove invariably fatal.[1169] - -The metal has been proved by Bayen and Charlard to be inactive.[1170] It -has been given expressly to dogs without any effect being observed; and -it is given in large doses to man for worms, without detriment. No -importance therefore can be attached to some alleged cases of poisoning -with this metal.[1171] - -Cases of poisoning with the preparations of tin are rare. Orfila briefly -notices a set of cases which occurred to M. Guersent. Several persons in -a family took the protochloride, in consequence of the cook having -mistaken a packet of it for salt and dressed their dinner with it. They -had all colic, some of them diarrhœa; none vomited; and all recovered in -a few days.[1172] A case is related in the Medical Times of death -apparently caused by so small a quantity as half a tea-spoonful of a -solution of protochloride. The effects were vomiting, acute pain in the -stomach, anxiety, restlessness, thirst, and a frequent, hard, small -pulse. These symptoms increased next day; and on the third day death -took place, preceded by delirium.[1173] As this was a case of suicide, -it is probable that some other poison, or a larger dose of the chloride -of tin was taken. - -Little need be said of the morbid appearances. Besides the signs of -violent irritation caused by the poisons of tin in common with other -irritants, Orfila always found in dogs a peculiar tanned appearance of -the villous coat of the stomach. In the case from the Medical Times the -gullet was red, the stomach inflamed externally, and internally -thickened, vascular, and pulpy. - - - _Of Poisoning with Silver._ - -Of the preparations of _silver_, the only one which requires notice is -the nitrate or lunar caustic. - -It exists in two forms,—crystallized in broad, transparent, colourless -tables,—and fused into cylindrical, crystalline, grayish pencils. Both -forms are essentially the same in chemical nature.—The most convenient -tests are, 1, _Hydrochloric acid_, or any hydrochlorate, which even in a -state of extreme dilution causes with it a dense white precipitate, -passing, under exposure to light, into dark brown; and 2, _Ammonia_, -followed by the solution of oxide of arsenic; if the nitrate of silver -is not too much diluted it gives a dark brown precipitate with ammonia, -soluble, however, in an excess of that alkali; and when the solution has -thus been restored, arsenic throws down a lively yellow precipitate, -passing rapidly to brown, if left exposed to the light. - -Most organic substances, but in particular all animal fluids, with the -exception of gelatin, decompose nitrate of silver. - -It appears from the experiments of Orfila, that, like the chlorides of -tin, the nitrate of silver is a deadly poison when introduced into the -veins; but that, by reason of its facility of decomposition, it cannot -enter the blood through ordinary channels in a quantity sufficient to -develope any remote action. When two grains in solution were injected -into the jugular vein of a dog it died in six minutes, difficult -respiration being the chief symptom; the third part of a grain caused -death in four hours and a half, violent tetanus having preceded death; -and in both animals the blood in the heart was found very black and the -lungs gorged, or vivid red. According to Mr. Blake, the salts of silver -when directly introduced into the blood, do not act on the heart, but -operate by causing obstruction of the capillary system. If they are -injected into the aorta, the systemic capillaries are obstructed, the -nervous system is consequently oppressed, respiration is arrested -through the medium of this nervous oppression, and death takes place by -asphyxia, the heart continuing to beat vigorously. If again they are -injected into a great vein, immediate obstruction of the pulmonary -capillaries takes place, so that the blood ceases to be transmitted to -the left side of the heart.[1174] - -To the violent action exerted by nitrate of silver when directly -admitted into the blood, its effects through the medium of the stomach -bear no proportion or resemblance. Thus, when twelve grains of the salt -were introduced into the stomach in the solid state, its effects were so -slight as not to be distinguishable from those of the ligature on the -gullet practised to prevent its discharge by vomiting. When introduced -in a state of solution, however, and in a larger dose, in the dose of 36 -grains, for example, it is more energetic. Death ensued in thirty-six -hours, but without any particular symptoms; and in the dead body the -villous coat of the stomach was found generally softened, and corroded -near the pylorus by little grayish eschars like those formed by this -poison on the skin.[1175] - -Hence it appears that nitrate of silver does not act remotely, but -simply as a local irritant and corrosive. The corrosion it produces is -incompatible with its absorption in large quantity. This inference is -confirmed by the experiments of Schloepfer, on its effects when -introduced into the trachea. He found that it caused inflammation of the -windpipe, and pneumonia passing on to hepatization of the lungs, but no -symptom referrible to a remote action.[1176] Its pure corrosive -properties have long pointed it out to the surgeon as the most -convenient of all escharotics. - -Nitrate of silver is absorbed, however, in the course of its action. It -would seem to be absorbed when it is taken medicinally in frequent small -doses. It is not easy to account otherwise for the singular blueness of -the skin, sometimes observed after the protracted use of lunar caustic -as a remedy for epilepsy and other diseases.[1177] The effects of the -poison on the constitution in such cases are not very well known. It -appears, however, that considerable doses may be taken for a great -length of time without injury, and that the first and only unpleasant -effects produced by its too free administration are such as indicate -simply an injury of the stomach. The only exception to this general -statement I have met with is a case by Wedemeyer, where, after the -remedy had been taken for six months on account of epilepsy, that -disease disappeared, and dropsy, with diseased liver at the same time -commenced, and soon proved fatal. It is probable, however, that the -nitrate of silver had no share in the ultimate event. In this instance -the whole internal organs were more or less blue; and metallic silver, -it is said, was found in the pancreas, and in the choroid plexus of the -brain.[1178] Silver has been found in the urine of persons who were -taking it medicinally. A young man who had used the nitrate for some -time observed that his urine became muddy soon after being passed, and -that the sediment became black if exposed to the light; and when the -sediment was digested in ammonia, chloride of silver was detached by -neutralizing the ammoniacal liquor.[1179] - -But it also appears that some nitrate of silver is absorbed when it is -given in a single large dose. For in animals poisoned with it Orfila -found that silver may be detected in the liver and spleen by charring -these organs with nitric acid as in the instance of poisoning with -copper, and then treating the residue with boiling diluted nitric acid, -and adding hydrochloric acid to the solution. He also found silver in -the urine by charring the extract with heat, acting on the charcoal with -ammonia, and saturating the filtered ammoniacal solution,—chloride of -silver being then detached.[1180] These results have been confirmed by -the experiments of Drs. Panizza and Kramer of Milan,[1181] who found -silver in the blood after the administration both of the nitrate and -chloride. - -Boerhaave has noticed a case of poisoning with this substance, but in -very brief terms. He says it caused gangrene. Schloepfer in his thesis -notices a case by Dr. Albers of Bremen in which croup was brought on by -a bit of lunar caustic dropping into the windpipe. M. Poumarede has -related an instance of poisoning with an ounce of nitrate of silver in -solution. A few hours afterwards the individual was found insensible, -with the eyes turned up, the pupils dilated, the jaws locked, and the -arms and face agitated with convulsions. A solution of common salt was -immediately given as an antidote. In two hours there was some return of -consciousness, and abatement of the convulsions, but still complete -insensibility of the limbs, with redness of the features, and pain in -the stomach. In eleven hours he could articulate. For thirty-six hours -he continued subject to fits of protracted coma; but he eventually -recovered. Sixteen hours after taking the poison he vomited a large -quantity of chloride of silver.[1182] - -The treatment of poisoning with the nitrate of silver is obvious. The -muriate of soda by decomposing it will act as an antidote; and any signs -of irritation left will be subdued by opium. - - - _Of Poisoning with Gold._ - -_Gold_ in various states of combination was at one time much used in -medicine, and an attempt has been lately made to revive its employment. - -Its poisonous properties are powerful, and closely allied to those of -the chlorides of tin and nitrate of silver. In the state of chloride it -occasions death in three or four minutes when injected into the veins, -even in very minute doses; and the lungs are found after death so turgid -as to sink in water. But if swallowed, corrosion takes place; the salt -is so rapidly decomposed, that none is taken up by the absorbents; and -death ensues simply from the local injury.[1183] It has been of late -used in medicine in France as an antisyphilitic; but even doses so small -as a tenth of a grain have been known to produce an unpleasant degree of -irritation in the stomach.[1184] - -In the state of fulminating gold, this metal has given rise to alarming -poisoning in former times, when it was used medicinally. Plenck in his -Toxicologia says it excites griping, diarrhœa, vomiting, convulsions, -fainting, salivation; and sometimes has proved fatal.[1185] Hoffmann -likewise repeatedly saw it prove fatal, and the most remarkable symptoms -were vomiting, great anxiety and fainting. In one of his cases the dose -was only six grains.[1186] These compounds are now so little met with -that they need not be noticed in greater detail. - - - _Of Poisoning with Bismuth._ - -_Bismuth_, in its saline combinations, is also an active poison. One of -its compounds, the trisnitrate, white bismuth, or magistery of bismuth, -is a good deal used in medicine and the arts; and pearl white, one of -the paints used in the cosmetic art, is the tartrate of this metal. - -The former substance is an active poison. It is got by dissolving -bismuth in nitric acid, and pouring hot water over the crystals; a -supernitrate being left in solution, and the trisnitrate thrown down in -the form of a white powder. - -Orfila found that the soluble part of fifteen grains of the nitrate, -when injected into the jugular vein of a dog, caused immediate giddiness -and staggering, and death in eight minutes. He also remarked that forty -grains mixed with water and introduced into the stomach, caused all the -customary signs of irritation, and death in twenty-four hours; and that -a great part of the villous coat of the stomach was reduced to a pulpy -mass, and likewise exhibited several ulcers.[1187] - -Similar effects were produced by the trisnitrate; but a larger dose was -required. Two drachms and a half killed a dog in twenty-four hours; and -redness and eroded spots were found in the stomach. - -In some more recent researches Orfila found that the poison is absorbed, -and may be detected, like other metallic poisons, in the liver, spleen, -and urine. The process for this purpose, applicable also to all organic -mixtures, consists in boiling the solids in water acidulated with a -twentieth of nitric acid, evaporating the solution to dryness, charring -the residue with nitric acid, as directed for copper, boiling the -charcoal in diluted nitric acid, and thus obtaining an acid solution of -nitrate of bismuth, which may be known by the effects of water and of -hydrosulphuric acid.[1188] - -Orfila remarks, that Camerarius of Tübingen once detected the -adulteration of wine with the oxide of bismuth, and that the bakers in -some parts of England used to render their bread white and heavy by -mixing the trisnitrate with flour; but he has not stated his authority -for this accusation. It may be discovered in any such mixture by -calcining the suspected substance in a crucible, and then separating the -metallic bismuth by means of nitric acid. But the adulteration of bread -with bismuth is very questionable, as there are many cheaper methods for -effecting the purpose, without adding any thing positively deleterious. - -The following is the only case with which I am acquainted of poisoning -with the preparations of bismuth in the human subject. A man subject to -water-brash took two drachms of the trisnitrate with a little cream of -tartar by mistake for a mixture of chalk and magnesia. He was -immediately attacked with burning in the throat, brown vomiting, watery -purging, cramps, and coldness of the limbs, and intermitting pulse, and -then with inflammation of the throat, difficult swallowing, dryness of -the membrane of the nose, and a constant nauseous metallic taste. On the -third day he had hiccup, laborious breathing, and swelling of the hands -and face; and suppression of urine was then discovered to have existed -from the first. On the fourth day swelling and tension of the belly were -added to the pre-existing symptoms, on the fifth day salivation, on the -sixth delirium, on the seventh, swelling of the tongue and enormous -enlargement of the belly; and on the ninth he expired. The urine -continued suppressed till the eighth day.—On inspection of the body it -was found that from the back of the mouth to the rectum there were but -few points of the alimentary canal free of disease. The tonsils, uvula, -pharynx, and epiglottis, were gangrenous, the larynx spotted black, the -gullet livid, the stomach very red, with numerous purple pimples, the -whole intestinal canal red, and here and there gangrenous, especially at -the rectum. The inner surface of the heart was bright red. The kidneys -and brain were healthy.[1189] - - - _Of Poisoning with Chrome._ - -The next metal whose properties deserve notice is _chrome_. As it is now -extensively used in the art of dyeing it is necessary to mention its -effects, more especially as they are singular. They have been -ascertained experimentally with great care by Professor Gmelin of -Tübingen. He found that in the dose of a grain the _chromate of potass_ -had no effect when injected into the jugular vein of a dog,—that four -grains produced constant vomiting, and death in six days without any -other striking symptom,—and that ten grains caused instant death by -paralysing the heart. Its effects, when introduced under the skin, are -still more remarkable. It seems to cause general inflammation of the -lining membrane of the air-passages. When a drachm was thrust in the -state of powder under the skin of the neck of a dog, the first symptoms -were weariness and a disinclination to eat. But on the second day the -animal vomited, and a purulent matter was discharged from the eyes. On -the third day it became palsied in the hind legs; on the fourth it could -not breathe or swallow but with great difficulty; and on the sixth it -died. The wound was not much inflamed; but the larynx, bronchi, and -minute ramifications of the air tubes contained fragments of fibrinous -effusion, the nostrils were full of similar matter, and the conjunctiva -of the eyes was covered with mucus. In another dog, an eruption appeared -on the back, and the hair fell off.[1190] - -The effects of the salts of chrome on man have not been well -ascertained, but seem to be peculiar. Dr. Schindler of Greifenberg -relates the following case of fatal poisoning with bichromate of potash. -A colourman having swallowed a solution of it, vomiting was brought on -by warm water, soap and oil, and kept up until the discharges ceased to -be yellow. The man got apparently well and passed a quiet night; but -next morning he felt excessively weary, had stitches in his back and -kidneys, passed no urine, and was affected with purging. A restless -night followed. On the subsequent morning, he lay motionless and like -one fatigued to the extremest degree; in which state he died, fifty-four -hours after swallowing the poison. The stomach was healthy, the -intestines reddish, the kidneys gorged with blood and marbled internally -with dark-red patches, and the bladder empty.[1191]—Mr. Wilson of Leeds -has described the case of an elderly man who took the poison in the -evening, and was found dead about twelve hours afterwards, without any -sign of vomiting, purging, or convulsions; and no morbid appearance was -found but redness of the villous coat of the stomach, and an inky-like -fluid in it, containing a large quantity of bichromate of potash.[1192] - -To these facts may be added another not less singular, which my late -colleague Dr. Duncan informed me has been observed by the workmen in -Glasgow, who use the bichromate of potass in dyeing. When this salt was -first introduced into the art of dyeing, the workmen who had their hands -often immersed in its solution were attacked with troublesome sores on -the parts touched by it; and the sores gradually extended deeper and -deeper, without spreading, till they sometimes actually made their way -through the arm or hand altogether.[1193] - - - _Of Poisoning with Zinc._ - -The compounds of _zinc_, which have been long used in considerable doses -in medicine, have sometimes occasioned serious and even fatal effects. -Partly on this account, and partly because one of them, the sulphate of -zinc, being the emetic most commonly used in the treatment of poisoning, -is apt to complicate various medico-legal analyses, it will be proper to -notice both its physiological properties and the mode of detecting it by -chemical means. - -The only important compound of this metal is the sulphate or _white -vitriol_. As usually sold in the shops, it forms small, prismatic -crystals, transparent, colourless, of a very styptic metallic taste, and -exceedingly soluble in water. That which is kept by the apothecary is -tolerably pure; but there is a salt sometimes met with in commerce which -contains an admixture of sulphate of iron, and with which the natural -action of the tests for zinc is materially modified. - -The solution of the pure salt is precipitated white by the _caustic -alkalis_, an oxide being thrown down, which is soluble in an excess of -ammonia. The _alkaline carbonates_ also precipitate it white, the -carbonate of ammonia being the most delicate of these reagents. The -precipitate is soluble in an excess of carbonate of ammonia, and is not -thrown down again by boiling. The precipitate produced both by the -alkalis and by their carbonates becomes yellow, when heated nearly to -redness; and on cooling it becomes again white. This is a characteristic -property, by which the oxide of zinc may be known from most white -powders. But oxide of antimony is similarly affected. The _ferro-cyanate -of potass_ also causes a white precipitate. A stream of -_sulphuretted-hydrogen_ likewise causes a white precipitate, the -sulphuret of zinc, the colour of which distinguishes the present genus -of poisons from all those previously mentioned, as well as from the -poisons of lead. The precipitate is apt to be suspended till the excess -of gas is expelled by ebullition. The action of this test will not -distinguish sulphate of zinc from the salts of peroxide of iron, by -which white sulphur is disengaged from the gas in consequence of the -peroxide of iron being reduced to the state of protoxide. The same -decomposition takes place wherever there is free chlorine, as in impure -samples of muriatic or nitric acid. - -When the sulphate of zinc contains iron, the alkalis throw down a -greenish-white precipitate, the alkaline carbonates a grayish or -reddish-white, the ferro-cyanate of potass a light-blue, but -sulphuretted-hydrogen the usual white precipitate. Tincture of galls, -which merely renders the pure salt hazy, causes a deep violet coagulum -if there is any ferruginous impurity. - -The sulphate of zinc is acted on by albumen and milk precisely in the -same manner as the sulphate of copper. The salt is decomposed, and the -metallic oxide forms an insoluble compound with the animal matter. - -When the sulphate of zinc has been mixed with vegetable and animal -substances, the action of the tests mentioned above is modified. In such -circumstances I have found the following process convenient. - -The mixture being strained through gauze, it is to be acidulated with -acetic acid, and filtered through paper. The acetic acid dissolves any -oxide of zinc that may have been thrown down in union with animal -matter. The filtered fluid is then to be evaporated to a convenient -extent, and treated when cool with sulphuretted-hydrogen gas,—upon which -a grayish or white milkiness or precipitate will be formed. The excess -of gas must now be expelled by boiling, and the precipitate washed by -the process of subsidence and affusion, and collected on a filter. It is -then to be dried and heated to redness in a tube. When it has cooled, it -is to be acted on by strong nitric acid, which dissolves the zinc and -leaves the sulphur. The nitrous solution should next be diluted, and -neutralized with carbonate of ammonia; after which the liquid tests -formerly mentioned will act characteristically. The effect of carbonate -of ammonia, and that of heat on the carbonate of zinc which is thrown -down, ought to be particularly relied on. - -I have tried this process with the matter vomited after the -administration of sulphate of zinc, in a case of pretended poisoning, -and found it to answer exceedingly well. - -Orfila has lately suggested the following method. Boil the suspected -substance in water, evaporate the filtered decoction to dryness, char -the residuum with nitric acid as directed for copper in similar -circumstances, digest the charcoal in diluted muriatic acid, and subject -the filtered solution to hydrosulphuric acid. If the sulphuret be not -white, but yellowish from iron, heat it with strong nitric acid, dry the -product, and heat it to redness; dissolve it in weak nitric acid; throw -down the oxide of iron by an excess of ammonia, which retains the oxide -of zinc; and then having filtered the fluid, separate the oxide of zinc -by neutralizing the ammonia.[1194] - -Orfila has furnished the only accurate information hitherto possessed -regarding the effects of sulphate of zinc on the animal system.[1195] He -found that dogs might be made to swallow 7½ drachms without any -permanent harm being sustained, provided they were allowed to vomit; for -in a few seconds the whole poison was invariably discharged, and the -animals, after appearing to suffer for four or five hours, gradually -recovered their usual liveliness. But the result is different if the -gullet be tied: violent efforts to vomit ensue, and death follows in -three days, the intermediate phenomena being those of local irritation -chiefly, and the appearances in the dead body those of incipient -inflammation of the stomach, without corrosion.—When injected into the -veins, the effect of sulphate of zinc is much more violent, in an -inferior dose. Forty-eight grains occasioned almost instant death; and -half the quantity proved fatal in three minutes. Orfila does not appear -to have ascertained the cause of death in the last two experiments. But -Mr. Blake found that when this salt is injected into the veins in the -dose of three grains, it causes some depression of the heart; that -thirty grains arrest the action of the heart in eight seconds, leaving -that organ exhausted of irritability and full of florid blood in its -left cavities; and that when injected into the arterial system in the -dose of sixteen grains, it seemed not to cause any obstruction of the -capillaries, but to act on the nervous system, producing extreme -prostration, without insensibility or convulsions.[1196] These -experiments, when taken together, show that sulphate of zinc, though a -moderately active irritant, is more indebted for its activity to a -remote operation on some vital organ. - -Sulphate of zinc is absorbed in the course of its action; for Orfila has -lately found it by his process for complex mixtures in the spleen, -liver, and urine of animals.[1197] - -The effects of the preparations of zinc on man in large doses have not -been particularly studied. In the dose of a scruple or a drachm, the -sulphate is the most immediate emetic known; and it is to be inferred, -that if larger doses are rejected, as is the fact, with equal rapidity, -they will in general cause no more harm than the medicinal dose. - -Nevertheless, some people have suffered severely from over-doses of -sulphate of zinc, and a few have even perished. Instead of presenting -here a general view of the symptoms, it will be preferable to relate the -heads of such cases as have been published. - -The first to be mentioned is related by Foderé, who, in consequence of -the violent symptoms produced, assigns to the present poison very active -properties. “A patient of mine,” says he, “a custom-house officer, -having got from a druggist six grains of sulphate of zinc to cure a -gonorrhœa, was attacked with inflammation in the lower belly, attended -by retraction of the navel and severe colic, which yielded only to -repeated blood-letting, general as well as local, oleaginous emollients, -opiates, and the warm bath.”[1198] This case is noticed here chiefly to -prevent any one from being misled by it, as it has been quoted by other -medico-legal authors. For assuredly some other cause must have -co-operated before such symptoms could arise; since I have in many cases -given the same dose thrice daily for several days, without ever -observing more than slight sickness; and Dr. Babington once gave -thirty-six grains thrice a day for some weeks with as little -effect.[1199] - -Parmentier, the chemist, met with an instance, in which about two ounces -of white vitriol in solution were swallowed by mistake. The countenance -became immediately pale, the extremities cold, the eyes dull, and the -pulse fluttering. The patient, a young lady, then complained of a -burning pain in the stomach, and vomited violently. But potass being now -administered in syrup, the pain ceased, the vomiting gradually abated, -and the lady soon recovered completely.[1200] - -In the Journal de Médecine, another instance is related by M. Schueler, -in which a very large dose did not produce material injury. The symptoms -were pain in the stomach and bowels, with vomiting and diarrhœa. They -were dispelled in a few hours by the administration of cream, butter, -and chalk.[1201] - -The following is a fatal case recorded by Metzger, but it is not a pure -example of poisoning with zinc, though accounted such by the relater; -for a small quantity of sulphate of copper was mixed with the sulphate -of zinc. Three persons in a family took this mixture, which had been -given them by a grocer in mistake for pounded sugar. They were all -seized with violent vomiting; and a boy twelve years of age died in less -than twelve hours.[1202] - -Another and an unequivocal case has been lately recorded in Horn’s -Archiv from Mertzdorff’s experience. No part of the history of the -symptoms is mentioned, except that there had been vomiting. But -Mertzdorff has described carefully the morbid appearances, which are -interesting; and he detected the poison in the stomach by a satisfactory -analysis.[1203] - -Two other cases, which are presumed to have arisen from the commercial -sulphate of zinc, and which proved fatal, have been recently published -by Dr. Sartorius of Aachen; but they do not appear to me to have been -satisfactorily traced to this poison, and it is therefore unnecessary to -quote them.[1204] - -Dr. Werres of Cologne has related the particulars of three cases of -poisoning with some preparation of zinc in milk-porridge. One of the -persons, a child four years old, was seized with vomiting in three -minutes, and, after frequent violent returns of it, died in convulsions -within eight hours. The others also suffered severely from vomiting, but -recovered.[1205] - -It does not appear that workmen who are exposed to the fumes of zinc -ever suffer materially. But there is a case in Rust’s Magazin, which -shows that these fumes are not quite harmless. An apothecary’s -assistant, while preparing philosopher’s wool, incautiously filled the -whole laboratory with it. The same day he was seized with tightness in -the chest, headache and giddiness; next morning with violent cough, -vomiting, and stillness of the limbs; on the third day with a coppery -taste in the mouth, some salivation, gripes, and such an increase of -giddiness that he could not stand. He was then freely purged, after -which a fever set in, ending in perspiration; and he got well in three -weeks.[1206] - -From these cases, and the experimental researches of Orfila, it is clear -that the preparations of zinc, though not very active poisons, are -nevertheless far from being innocuous. We are not acquainted with their -effects when long and habitually introduced into the body in small -quantities. About the time when physicians began to study with care the -dangerous consequences of employing lead and copper in the manufacture -of culinary vessels, it was conceived by some that zinc might prove a -safe substitute. It was farther imagined by some military economists in -France, that zinc might be profitably used instead of tinned iron in the -manufacture of canteens and other articles of camp equipage, because the -worn and damaged vessels would sell as old metal at little short of -their original price, while tinned iron as old metal bears no value at -all. But from the experiments of Deyeux and Vauquelin it subsequently -appeared, that in the course of many culinary operations zinc is more -liable to be attacked than either copper or lead;—that water left for -some time in zinc vessels oxidates them, and acquires a metallic -taste;—that if water acidulated with vinegar or lemon-juice is boiled in -zinc, a solution is formed, in which the metal may be detected by its -tests;—and that sea-salt, sal-ammoniac, and even butter, have the power -of dissolving it also.[1207] Some singular inquiries were afterwards -prosecuted by Devaux and Dejaer among the Spanish prisoners at Liége, -with the view of proving, that frequent small quantities of zinc -dissolved in the manner mentioned, and habitually taken with the food, -have no injurious tendency; that even in large doses it can hardly be -accounted poisonous, as it merely gives rise to vomiting and slight -diarrhœa; and that an adulteration to such an amount would always betray -itself by its strong disagreeable taste.[1208] These are certainly -valuable facts, though not quite satisfactory. But it is unnecessary to -inquire minutely into their validity; for, independently of all other -considerations, vessels constructed of zinc are too brittle for domestic -purposes. With regard to the effects of frequent small doses of sulphate -of zinc, the only positive information I can communicate is, that I have -often given medicinally from three to six grains thrice a day for two or -three weeks, without observing any particular effect except in some -persons sickness when the largest doses were taken; and others have -frequently made the same observation.[1209] On the other hand, Dr. Nasse -of Berlin says a patient of his, who had taken twenty grains of oxide of -zinc daily till 3247 grains were swallowed, was attacked with paleness, -emaciation, weakness of intellect, obstinate constipation, coldness and -œdema of the limbs, extreme dryness of the skin, and a thready scarcely -perceptible pulse. But he quickly recovered under the use of laxatives -and tonics.[1210] - -Sulphate of zinc is said to have proved fatal when applied externally. -In Pyl’s memoirs there is a case of this nature, which was attributed to -sulphate of zinc having been used as a lotion for a scabby eruption on -the head. The subject was a child, six years old, and otherwise healthy. -The wash, which was a vinous solution, had not been long applied before -the child complained of acute burning pain of the head, which was -followed by vomiting, purging, convulsions, and death in five hours. The -cause of these symptoms, though the particulars of the case were -ascertained judicially by an able medical jurist, Dr. Opitz of Minden, -is nevertheless very doubtful, as daily use is made of the salt for -similar purposes without any such effect. Appearances of congestive -apoplexy were found within the skull; and the reporter ascribes death to -the wash having produced repulsion of the cutaneous disease, and -determination of blood to the head.[1211] - -The only opportunities which have occurred of observing the morbid -appearances after poisoning with sulphate of zinc taken internally, are -the cases by Metzger, Mertzdorff, and Werres. - -In the first, which was a mixed case, the only appearances of note were -slight inflammation in the stomach, and excessive gorging of the lungs -with fluid blood; from which Metzger oddly enough concludes that the -child was suffocated by the vomiting. In the second case, Mertzdorff -found the stomach and intestines, but particularly the latter, -contracted,—their outer surface healthy—the inner membrane of the -stomach grayish-green, with several spots of effused blood, and -greenish, fluid contents,—the inner membrane of the small intestines -similarly spotted,—the rest of the body quite natural. It has been -already mentioned that Mertzdorff detected the poison in the body. He -found it not only in the contents, but likewise in the coats of the -stomach and intestines. In the third, Werres found a reddish-brown patch -and some vascularity in the stomach. - - - _Of Poisoning with Iron._ - -In previous editions of this work the preparations of iron were arranged -among those substances which are not usually considered poisonous, but -which may nevertheless prove injurious when taken in large quantity. But -the soluble salts of iron, although not very active, seem sufficiently -so to entitle them to a regular place among poisons; and one of them, -the sulphate, has actually been used, as will presently appear, for the -purpose of committing murder. There are many soluble salts of iron which -in all probability may prove hurtful; but the only ones which have been -brought under notice in medico-legal researches are the sulphate of the -protoxide, and the mixed chlorides. - -The sulphate of the protoxide of iron, commonly called green vitriol or -copperas, occurs in commerce in crystals or crystalline masses of -various shades of bluish-green. It is easily known by its colour and its -strong styptic inky taste. When in solution, the iron may be detected by -ferro-cyanate of potash, sulphuretted-hydrogen, and tincture of galls. -Ferro-cyanate of potash causes a blue precipitate, at first pale, but -gradually passing to deep Prussian blue. Sulphuretted-hydrogen has no -effect, but if an alkali, such as ammonia, be added to disengage the -oxide of iron, a black precipitate of sulphuret of iron is immediately -produced. Tincture of galls occasions a deep purplish-black precipitate, -the tannate of iron, and it acts with greater delicacy in very diluted -solutions, if the oxide of iron be disengaged by carbonate of soda. -These tests prove the presence of iron in solution. A white precipitate -under the action of nitrate of baryta will indicate that the oxide is -dissolved by sulphuric acid. - -The most familiar form of chloride of iron is the tincture of the -chloride, which sometimes contains only the sesquichloride, sometimes -consists of a mixture of this with the protochloride. It is known by the -three tests for oxide of iron described above, and by nitrate of silver -occasioning a heavy white precipitate, insoluble in nitric acid. - -For detecting iron in organic mixtures, where the liquid reagents do not -act satisfactorily, the simplest process is to digest the mixture, if -there be any solid matter, in water acidulated with acetic acid, to -evaporate the filtered liquid to dryness, to incinerate the extract in a -porcelain crucible, to act on the product with diluted sulphuric acid, -and then to treat the solution with the three liquid reagents. - -Professor Gmelin found that sulphate of iron merely caused vomiting in -dogs who were made to swallow two drachms of it, that rabbits might take -forty grains without any apparent injury, and that twenty grains in a -state of solution might even be injected into the veins of a dog without -producing any particular symptom.[1212] From these and some other facts -of the like kind it was generally held, that sulphate of iron is not a -poison. But Smith ascertained that a dose of two drachms will prove -fatal to dogs in little more than twenty-tour hours, when it is -introduced into the stomach, and in half that time if applied to a -wound; and that it occasions some redness of the alimentary mucous -membrane, and the effusion of a thick layer of tough mucus. It is -remarkable, however, that, like Gmelin, he found no effect to flow from -the transfusion of a solution of seven grains into the veins, except -transient vomiting and expressions of pain.[1213] - -The effects which have been observed in the human subject are -conformable with those witnessed in experiments on the lower animals, -the symptoms being those of pure irritant poisoning. Few illustrative -cases, however, have as yet been made public. In Rust’s Journal there is -the case of a girl, who took as an emmenagogue, an ounce of green -vitriol dissolved in beer, and suffered in consequence from colic pains, -constant vomiting and purging for seven hours, but eventually recovered -under the use of mucilaginous and oily drinks.[1214] A fatal case of -poisoning with this substance occurs in the Parliamentary Returns of -death from poison in England during the years 1837–38 [see p. 90].—Dr. -Combe of Leith has communicated to me an instructive case of fatal -poisoning with the tincture of the chloride of iron, which was taken to -the extent of an ounce and a half by a gardener accidentally instead of -whisky. Violent pain in the throat and stomach, tension and contraction -of the epigastrium, and nausea immediately ensued; afterwards coldness -of the skin and feebleness of the pulse were remarked; and then vomiting -of an inky fluid, with subsequently profuse vomiting of mucus and blood, -and also bloody stools under the use of laxatives. He remained for some -days in a very precarious state, but then began to rally, and in three -weeks resumed his occupation. But in two weeks more Dr. Combe found him -emaciated, cadaverous in appearance, and affected with pains in the -stomach, costiveness, and thirst; in which state he lingered for five -days more, and then died. In the dead body there was found great -thickening towards the pylorus, a cicatrized patch there three inches -long and two inches broad, and another large patch of inflammatory -redness surrounded by a white border. The preparation taken in this -instance contained a third of its volume of hydrochloric acid and a -tenth of its weight of oxide of iron; and consequently some of the acid -was free. - -The following remarkable case, in which I was lately consulted on the -part of the Crown, will show that sulphate of iron is a more important -poison than has been commonly thought. Suspicions having arisen in -December, 1840, respecting the death of a child in the county of Fife -about four months before, an investigation was made by the law -authorities; and the body was disinterred and inspected by Mr. Dewar and -Dr. James Dewar of Dunfermline. It was ascertained that the child, a -girl four years of age, and previously in good health, was attacked with -violent vomiting and purging immediately after breakfasting on porridge, -and died in the course of the afternoon of the same day. A boy two years -older, having seen a blue solution put into the porridge, and observing -that the porridge had a bad taste, took only three spoonfuls of it, but -became for a time very sick. The girl, being fed by a woman in the -house, was made to take all her share; and in the course of the day the -same person was seen by two children of the family to give a blue -solution to the sick girl for drink. The woman was proved to have -purchased sulphate of copper, and admitted having bought about this time -both that salt and sulphate of iron, for the alleged purpose of dyeing -some clothes. Poisoning with sulphate of copper was therefore suspected. -On examining the body, which had been buried four months, the Messrs. -Dewar found the external parts considerably decayed,—the stomach soft, -gelatinous, and of a uniform intense black colour through the whole -thickness of its parietes,—the gullet and duodenum similarly affected, -but not so deeply on their outer surface,—the spleen, kidneys, and lower -parts of the liver similarly stained with a black pulp, which could be -wiped off,—and the whole alimentary canal lined with a thick layer of -jet-black mucus, from the pharynx down to the very anus. Inferring that -the cause of this extraordinary blackness was decomposition of sulphate -of copper by hydrosulphuric acid gas disengaged during the decay of the -body, they proceeded to search for that metal in the form of sulphuret -both in the contents and texture of the stomach, but without success: -there was not a trace of copper to be found. Being then led from some -circumstances in the analysis to suspect that the black matter might be -sulphuret of iron, they proceeded to search for that substance, and -ascertained that a large quantity existed both in the textures of the -stomach and in the black mucus which lined it. They further ascertained -that there was no iron in a state capable of being dissolved by water, -but that a much larger quantity of sulphuric acid was associated with -the black matter than could have proceeded from the sulphates naturally -contained in the animal textures or in the mucous secretions. They had -also an opportunity of examining several large buff-coloured stains on -various articles of dress, worn by the child and by the woman at the -time the poisoning was supposed to have happened; and they detected a -large quantity of oxide of iron in all of them. The whole case was -subsequently submitted to me for my opinion, together with a portion of -the stomach, the entire intestines, and several stained articles of -dress. The results of the analysis of the tissues of the stomach, the -black intestinal mucus, and the stains on the cloth were the same in my -hands.—It is not easy to see how any other conclusion could be drawn -from the whole circumstances, than that a soluble preparation of iron -had been administered a short time before death, and that it had been -entirely decomposed and converted into sulphuret of iron by the -evolution of hydrosulphate of ammonia during the decay of the body. In -consequence of important defects in the evidence criminating a -particular individual, and especially because all the essential facts -depended on the testimony of children, who, after the lapse of some -time, did not adhere to their original statement, it was judged improper -to bring this case to a trial. - -A few years afterwards another case somewhat similar was submitted by -the law authorities to the same gentlemen, to whom I am indebted for the -particulars. A woman far advanced in pregnancy, and enjoying excellent -health, was suddenly seized about midnight with vomiting and purging, -and died in fourteen hours. Various circumstances having raised -suspicions as to the cause of death, the body was disinterred a few days -after burial, and carefully examined by Mr. Dewar and Dr. Dewar. The -organs were in general healthy. There were some dark-red patches on the -villous coat of the stomach, and a general blush pervaded the whole -alimentary canal, which was empty of every thing but a reddish-brown -mucus. The intestines were in several places irregularly contracted and -hard. The stomach, small intestines, and rectum contained iron in large -quantity, dissolved either by sulphuric or hydrochloric acid. Sulphate -of iron was found in the house.—No trial took place in this instance -either, because there was a want of evidence to attach guilt to any -particular individual, although it was highly improbable that the woman -had taken the poison herself.[1215] - -A short notice may here be added of the toxicological effects of the -rarer metals, which have been examined chiefly by Professor Gmelin of -Tübingen.[1216]—Oxide of _osmium_ is nearly as active as arsenic, for a -grain and a half will kill a dog in a few hours by the stomach, and in -one hour through a vein. Twelve grains of hydrochlorate of _platinum_ -will kill a dog within a day through the stomach, with symptoms of pure -irritation; and so will half that quantity through a vein.—The -hydrochlorates of _iridium_ and _rhodium_ are rather less active.—The -hydrochlorate of _palladium_ is equally powerful when introduced into -the stomach, and much more so through a vein, for two-thirds of a grain -will kill dogs in a minute. - -The salts of other metals appear less active.—_Molybdenum_, in the form -of molybdate of ammonia, seems a feeble poison; thirty grains killed a -rabbit in two hours, but produced in dogs merely some vomiting and -purging; and ten grains injected into the jugular vein did not prove -fatal.—_Manganese_, according to Gmelin, is likewise a feeble poison, -but has peculiar effects. A drachm of the sulphate killed a rabbit in an -hour. Thirty grains swallowed by a dog had no effect. Two drachms thrust -into the cellular tissue had no effect. Twelve grains injected into a -vein occasioned death in five days: and in the dead body, the stomach, -duodenum, and liver were found much inflamed. Manganesic acid, according -to Professor Hünefeld, appears also to act on the liver, but is a feeble -poison. A rabbit received two drachms in three days in doses of ten or -fifteen grains, without presenting any symptom except increased flow of -urine. Being then killed, the liver was found soft, at one part bright -red, elsewhere dark-brownish-red, and it yielded manganese by -incineration.[1217] Some singular observations have been lately -published by Dr. Couper of Glasgow, the purport of which is, that -manganese belongs to the class of insidious, cumulative poisons, and -that it has the property of slowly bringing on, in those who breathe or -handle the oxide, a paraplegic affection which is incurable unless taken -under treatment early. Five cases of the kind occurred subsequently to -1828, in the great chemical manufactory of Tennant and Company, among -the workmen employed in grinding the black oxide of manganese.[1218] On -the other hand, Dr. Thomson of Glasgow has recently stated that an ounce -of sulphate of manganese is an effectual and safe laxative.[1219] -_Uranium_ is an active poison when injected into a vein, for three -grains of the muriate proves fatal instantly; but dogs may swallow -fifteen, or from that to sixty grains without any other effect except -slight vomiting [Gmelin]. _Cobalt_ is more active. Thirty grains of the -oxide occasion death in a few hours through the stomach. Twenty-four -grains of the muriate applied to the cellular tissue excite vomiting. -Three grains of sulphate injected into a vein prove fatal in four -days.—_Tungsten_, _cerium_, _cadmium_, _nickel_, and _titanium_ can -scarcely be considered poisons. _Tungstate_ of ammonia in the dose of a -drachm had no effect when swallowed by a dog; forty grains of tungstate -of soda, which is more soluble, operated as an emetic; but this dose -will prove fatal to rabbits in a few hours. A drachm of the muriate of -_cerium_ had little or no effect on a dog, and half that dose had no -effect on a rabbit. The oxide of _cadmium_ in the dose of twenty grains, -made a dog vomit; and ten grains had no effect at all.[1220] Twenty -grains of sulphate of _nickel_ made a dog vomit; forty grains applied to -the cellular tissue had no effect at all on the general constitution; -but ten grains injected into the jugular vein occasioned immediate death -[Gmelin]. A drachm of _titanic_ acid had no effect on a dog. - - - - - CHAPTER XVIII. - OF POISONING WITH LEAD. - - -Poisoning with lead is a subject of great consequence in Medical Police, -as well as Medical Jurisprudence. Its preparations have been used for -the purpose of intentional poisoning. At the Taunton Assizes in March, -1827, a servant-girl was tried for attempting to administer sugar of -lead to her mistress in an arrow-root pudding: and although the charge -was not made out, it appeared from the prisoner’s confession that she -really had made the attempt. Sugar of lead has also been often taken by -accident. - -In relation to medical police lead is a subject of great importance. -This metal is used in so many forms, and in so many of the arts, and its -effects when gradually introduced into the body are so slow and -insidious, that instances of its deleterious operation are frequently -met with. Such accidents, indeed, are less common now, than they used to -be before the late improvements in chemistry. But they are still -sufficiently frequent to render it necessary for the toxicologist to -investigate the properties of lead attentively. - - - SECTION I.—_Of the Chemical History and Tests for the Preparations of - Lead._ - -The physical characters of lead in its metallic state are familiar to -every one. It is easily known by the dull bluish-gray colour it assumes -when exposed some time to the air, by the brilliant bluish-gray colour -of a fresh surface, and by the facility with which it may be cut. The -compounds which require particular notice are four in number, litharge, -red lead, white lead, sugar of lead, and Goulard’s extract. The first -three are very much used by house-painters and glaziers, the last two -are extensively employed in surgery, and the sugar of lead is also used -in many of the arts. - - - 1. _Of Litharge and Red Lead._ - -_Litharge_ is the protoxide of lead in a state of semivitrification. -_Red lead_ is a compound of two equivalents of protoxide and one of -deutoxide. The former is generally in the form of a grayish-red heavy -powder, sometimes partly crystalline; the latter in the form of a bright -red powder approaching in colour to vermilion. They may be known by -their colour;—by their becoming black when suspended in water and -treated with a stream of sulphuretted-hydrogen gas;—and by litharge -being entirely, and red lead partly, soluble in nitric acid, and forming -a solution which possesses the properties to be mentioned presently for -solutions of the acetate. The chemical actions concerned in these -changes are obvious, except in the instance of nitric acid on red lead. -Here the acid dissolves the protoxide only, and the deutoxide, which -seems to act the part of an acid in the pigment, is separated in the -form of a brown powder. - - - 2. _Of White Lead._ - -_White lead_, which is the carbonate of the metal, is in the form of a -heavy snow-white powder, or in white chalk-like masses. It consists of -variable proportions of the hydrated oxide and neutral carbonate; those -specimens are the whitest which contain most carbonate; and the best -English white lead I find to contain four equivalents of carbonate and -one of hydrated protoxide. The grayer variety, formed by the action of -distilled water on metallic lead, consists of only two of the former to -one of the latter.[1221] It may be known by its being blackened like the -two former compounds by sulphuretted-hydrogen,—by being soluble with -effervescence in nitric acid,—and by becoming permanently yellow when -heated to redness, in consequence of the expulsion of its carbonic acid, -and its conversion into protoxide. These tests, however, apply with -exactness only to the pure carbonate, in which state white lead is not -often met with in the shops. It is generally adulterated with sulphates, -in consequence of which it is only partially acted on by nitric acid, -and does not become distinctly yellow under a strong red heat. Dutch -white-lead contains no less than between 78·5 and 25 per cent. of -impurities insoluble in nitric acid, Venetian white-lead from 11 to 14·5 -per cent., Munich white-lead between 1 and 7·5 per cent.[1222] I have -met, however, with perfectly pure specimens in the shops of this city. - - - 3. _Of Sugar of Lead._ - -_Sugar of lead_ is the acetate of this metal. It is sold in the form -either of a white heavy powder, or of aggregated masses of long -four-sided prismatic crystals. It has a sweetish astringent taste, and a -slight acetous odour. It is very soluble. - -When in the solid state, it may be known by its solubility in water, and -by the effects of heat. It first undergoes the aqueous fusion, then -abandons a part of its acid empyreumatized, as may be perceived by the -smell, next becomes charred, and finally presents globules of lead -reduced by the charcoal of the acid. The best way of effecting its -reduction on the small scale is to char it, and then direct on the mass -the point of a blowpipe-flame: in an instant globules are developed. It -is not easily reduced in a tube; at least I have never been able to -succeed in that way. - -In the fluid state the acetate of lead, as well as all its -soluble salts, may be detected by the following system of -reagents,—hydrosulphuric acid, bichromate of potass, hydriodate of -potass, and metallic zinc,—which are the best of the numerous reagents -yet proposed. - -1. _Hydrosulphuric acid_ causes a black precipitate, the sulphuret of -lead. This is a test of extreme delicacy; and it acts in whatever state -of combination the lead exists, whether fluid or solid. - -It is preferable to the hydrosulphate of ammonia as a medico-legal test; -for, as Fourcroy observed, the hydrosulphate of ammonia acts on many -sound wines as if they contained lead,[1223] while hydrosulphuric acid -never causes with them a black precipitate, unless they contain either -lead or some other metallic impregnation. It must be remembered that -many other metallic solutions, such as those of mercury, copper, silver -and bismuth, yield a black precipitate with this test. - -2. _Chromate of potass_, both in the state of proto-chromate and -bichromate, causes a fine gamboge-yellow precipitate, the chromate of -lead. For the characteristic action of this reagent, it is desirable -that the suspected liquid be neutral. It forms with solutions of the -sulphate of copper a precipitate nearly of the same colour as the -chromate of lead. - -3. _Hydriodate of potass_ causes also a lively gamboge-yellow -precipitate, the iodide of lead. The action of this test is impaired in -delicacy by a considerable excess of nitric acid, or acetic acid. These -acids cause a yellow coloration with the test, though no lead be -present. - -4. _A rod of zinc_ held for some time in the solution displaces the -lead, taking its place, and throwing down the lead in the form of a -crystalline arborescence. This is a very characteristic test; and also -one of much delicacy; for I have found a small thread of zinc will very -easily detect a twentieth part of a grain of lead dissolved in the form -of acetate in 20,000 parts of water. It acts also on the nitrate of -lead. Its action is impaired or prevented by an excess of acetic or -nitric acid. - -These tests are amply sufficient for determining the presence of lead in -a solution, provided they act characteristically. Others have been also -used, however; and it is therefore right to notice them cursorily. - -The _alkaline carbonates_ throw down a white precipitate in a very -diluted solution of lead. This test is ineligible, because the alkaline -carbonates cause a white precipitate with many other salts. It might be -rendered decisive, however, by washing the precipitate thoroughly, -suspending it in pure water and transmitting sulphuretted-hydrogen, -which blackens it. No other white carbonate is similarly altered except -those of bismuth and silver, which are rare. - -The _soluble sulphates_ likewise cause with solutions of lead a white -precipitate, the sulphate of lead. To this test the same objections -apply as to the carbonates of the alkalis. - -The _ferro-cyanate of potash_ causes a white precipitate, the -ferro-cyanate of lead. This is an objectionable test, as many other -substances besides lead are similarly acted on by it. - - - 4. _Goulard’s Extract._ - -Goulard’s extract, the diacetate of lead, is easily distinguished from -the acetate or sugar of lead by the effect of a stream of carbonic acid, -which throws down a copious precipitate of carbonate of lead. The proper -method of analyzing it is to transmit this gas till it ceases to act any -longer, and then to subject the precipitate and solution to the tests -for carbonate of lead, and acetate of lead. Solutions of the common -acetate usually give a scanty white precipitate with carbonic acid, in -consequence of containing a faint excess of oxide. - -The presence of vegetable or animal matters may either decompose the -salts of lead, or materially alter the action of the preceding reagents. - -It appears from the experiments of Orfila, that most vegetable infusions -possess the power of decomposing them more or less. The acetate -furnishes, for example, an abundant precipitate with infusion of galls, -or with infusion of tea. Almost all animal fluids, with the exception of -gelatin, possess the same property; albumen, milk, bile, beef-tea, all -give with it a copious precipitate. In fluids which do not decompose it -altogether, the colour of the precipitate formed by the tests is so -materially altered, that they cannot be relied on for the detection of -lead. The test, however, which undergoes least alteration is -hydrosulphuric acid. - -Before proceeding to the detection of lead in complex organic mixtures, -some remarks will be required on its relations to medical police. Here -the various ways in which it is apt to be insidiously introduced into -the body, chiefly by the action of chemical agents on metallic lead -itself, will come under consideration. - - - _Of the Action of Air and Pure Water on Lead._ - -When lead is exposed to the air it becomes tarnished. This arises from a -thin crust of carbonate of lead being formed; for the crust dissolves -with brisk effervescence in acetic acid. The formation of carbonate is -accelerated by moisture and probably by the presence of an unusual -proportion of carbonic acid in the air. - -The action of water on lead, which is of much greater consequence, has -been made the subject of observation by the curious for many ages. The -Roman architect, Vitruvius, who, it is believed, nourished in the time -of Cæsar and Augustus, forbids the use of this metal for conducting -water, because cerusse, he says, is formed on it, which is hurtful to -the human body.[1224] Galen also condemns the use of lead pipes, because -he was aware, that water transmitted through them contracted a muddiness -from the lead, and those who drank such water were subject to -dysentery.[1225] If we trace the sciences of architecture, chemistry, -and medicine downwards from these periods, nothing more will be found -than a repetition of the statements of Vitruvius and Galen, with but a -few particular facts in support of them, till we arrive at the close of -the last and beginning of the present century. - -The first person that examined the subject minutely, was Dr. Lambe of -Warwick; who inferred from his researches, that most, if not all, spring -waters possess the power of corroding and dissolving lead to such an -extent as to be rendered unfit for the use of man, and that this solvent -power is imparted to them by some of their saline ingredients.[1226] The -inquiry was afterwards undertaken more scientifically by Guyton-Morveau; -who, in opposition to Dr. Lambe, arrived at the conclusion, that -distilled water, the purest of all waters, acts rapidly on lead by -converting it into a hydrated oxide, and that some natural waters, which -hardly attack lead at all, are prevented doing so by the salts they hold -in solution.[1227] A few years later Dr. Thomson of Glasgow also -examined the subject, and, assenting to Dr. Lambe’s proposition, that -most spring waters attack lead, maintains nevertheless that the lead is -only held in suspension, not in solution; and that the quantity -suspended in such waters, after they have passed through lead pipes, -pumps, and cisterns, is too minute to prove injurious to those who make -habitual use of them.[1228] In the first edition of this work an -extended account was given of an investigation I made into the whole -subject of the action of different waters on lead.[1229] Additional -observations were afterwards published on the same point by Captain -Yorke,[1230] and by Mr. Taylor.[1231] And I have added some new facts in -a late paper.[1232] - -The inquiry is of so great practical consequence, that I need not offer -any apology for reproducing it here in detail, with such additions as -ulterior experience and the researches of others enable me to make. -Professor Orfila takes no notice of this important subject, except in a -few lines containing several inaccurate statements.[1233] - -Distilled water, deprived of its gases by ebullition, and excluded from -contact with the air, has no action whatever on lead. If the water -contains the customary gases in solution, the surface of the metal, -freshly polished, becomes quickly dull and white. But if the surface of -the water be not at the same time exposed to the air, the action soon -comes to a close.—When the air, on the other hand, is allowed free -access to the water, a white powder appears in a few minutes on and -around the lead; and this goes on increasing till in the course of a few -days there is formed a large quantity of white matter which partly -floats in the water or adheres to the lead, but is chiefly deposited on -the bottom of the vessel. If this experiment be made with atmospheric -air deprived of carbonic acid, the white substance puts on the form of a -fine powder, which I find to be a hydrated oxide; for when dried at -180°F. it gives off water on being heated to redness, and dissolves -without effervescence in weak nitric acid.—But if the surface of the -water be exposed to the open air, the substance formed consists of -minute brilliant pearly scales, which with the aid of a powerful -microscope are seen to be thin equilateral triangular tables, often -grouped into hexaedral tables, or worn at the edges into the form of -rosettes. This substance, which has a pale grayish hue when dried, I -have ascertained to be a carbonate of lead, consisting of two -equivalents of neutral carbonate and one of hydrated protoxide.[1234] -The formation of carbonate takes place with considerable rapidity. In -twelve ounces of distilled water, contained in a shallow glass basin -loosely covered to exclude the dust, twelve brightly polished lead rods -weighing 340 grains, will lose two grains and a half in eight days; and -the lead will then show evident marks of corrosion. The process of -corrosion goes on so long as atmospheric air is allowed to play freely -on the surface of the water. In twenty months I have obtained 120 grains -from an ounce of lead rods kept in 24 ounces of distilled water. - -During these changes, a minute quantity of lead is dissolved. This is -best proved by carefully filtering the water, then acidulating with a -drop or two of nitric acid, and evaporating to dryness. I have never -failed to detect lead in the residue by expelling the excess of nitric -acid by heat, dissolving it in distilled water, and applying -hydrosulphuric acid, hydriodate of potass, and chromate of potass to the -solution. The lead is first dissolved in the form of hydrated oxide. -For, if the air admitted to the water be deprived of carbonic acid, a -clear liquid is obtained by filtration, and this is turned brown by -hydrosulphuric acid. But a great part of the hydrate is speedily -separated in the form of carbonate. For the filtered liquid speedily -becomes turbid if exposed to the air; and on evaporating it, the -residuum dissolves in weak nitric acid with brisk effervescence. Captain -Yorke estimates the quantity dissolved when the water is saturated at a -10,000th part.[1235] - -By far the greatest part of the lead, however, which disappears, will be -found in the white pearly crystals. This crystalline powder is not,—as -alleged by Guyton-Morveau, and after him by some systematic writers, a -hydrated oxide of lead, but, as stated above, a particular variety of -carbonate, containing more hydrated oxide than exists in common white -lead. At first I thought it was neutral carbonate. Captain Yorke was led -to suppose it hydrated oxide. In 1842 I found that, if it be exposed for -some time to the action of aërated water after the lead has been -removed, it invariably consists of two equivalents of neutral carbonate -and one of hydrated oxide. - -It will be inferred from the preceding facts, that distilled water for -economical use should never be preserved in leaden vessels or otherwise -in contact with lead. Even the distilled water of aromatic plants should -not be so preserved, because the essential oil which communicates to -them their fragrance does not take away the power which pure distilled -water possesses of acting on lead. This fact was first announced in the -second edition of the present work. A druggist in Edinburgh requested me -to examine a reddish-gray crystalline, pearly sediment formed copiously -in a sample of orange-flower water. I found this to be carbonate of lead -coloured by the colouring matter of the water, and obviously produced by -the action of the water on lead solder used instead of tin solder, and -coarsely and liberally applied to the seams of the copper vessel in -which the water had been imported from France. The filtered fluid did -not contain a particle of lead. The same observation has been since made -by a French pharmaceutic chemist, M. Barateau, who seems at a loss, -however, to account for the formation of the carbonate of lead.[1236] It -appears from an inquiry of MM. Labarraque and Pelletier, conducted at -the request of the Prefecture of Paris, that the orange-flower water, -which is extensively used there, is often adulterated with lead in -solution. They impute this to careless distillation; for then some of -the decoction is driven over with the distilled liquid, and consequently -produces a fluid which becomes acetous by keeping and dissolves the lead -solder of the _estagnons_ or copper vessels. Pure orange-flower water -does not acidify by keeping.[1237] M. Chevallier in a more recent -investigation arrived at the same results, and found that few specimens -of the orange-flower water of Paris were altogether free of lead.[1238] -In none of these inquiries have the authors adverted to the action of -pure water in forming carbonate of lead. - - - _Of the Action of Solutions of Neutral Salts on Lead._ - -The property which pure aërated water possesses of corroding lead is -variously affected by foreign ingredients which it may hold in solution. - -Of these modifying substances none are more remarkable in their action -than the neutral salts, which all impair the corrosive power of the -water. Important practical consequences flow from that action; for it -involves no less than the possibility of employing lead for most of the -economical purposes to which the ingenuity of man has applied that -useful metal. The first experimentalist who made it an object of -attention was Guyton-Morveau; whose experiments are imperfect and in -some respects erroneous. Having found that distilled water corrodes -lead, he proceeded to inquire why no change of the kind takes place in -some natural waters; and being aware that most spring and river waters -differ from that which has been distilled, chiefly in containing -sulphate of lime and muriate of soda, he tried a solution of each of -these salts, and discovered that the addition of a certain quantity of -either to distilled water takes away from it the power of attacking -lead,—that this preservative power is possessed by so small a proportion -as a 500th part of sulphate of lime in the water,—and that the nitrates -are also probably endowed with the same singular property.[1239] Here -his researches terminated. - -Extending Guyton-Morveau’s inquiries to other proportions of the same -salts, and likewise to many other neutral salts, I was led to the -conclusion, that all of them without exception possess the power of -impairing the action of distilled water on lead. At least I found this -power to exist in the case of sulphates, muriates, carbonates, -hydriodates, phosphates, nitrates, acetates, tartrates, and arseniates. - -The degree of this preservative power differs much in different salts. -The acetate of soda is but an imperfect preventive when dissolved in the -proportion of a hundredth part of the water: white crystals are formed, -and the lead loses about a fourth of what is lost in distilled water in -the same time. On the contrary, arseniate of soda is a complete -preservative when dissolved in the proportion of a 12,000th; and -phosphate of soda and hydriodate of potass are almost effectual -preservatives in the proportion of a 30,000th part only of the -water.[1240] Muriate of soda and sulphate of lime hold a middle place -between these extremes, and are both of them much more powerful than -Guyton-Morveau imagined: the former preserves in the proportion of a -2000th to the water, the latter in the proportion of nearly a 4000th. -Nitrate of potass is little superior to the acetate of soda: in the -proportion of a hundredth it prevents the action of the water almost -entirely; but if the proportion be diminished to a 160th, the loss -sustained by the lead is fully a third of the loss in distilled water. - -When lead has been exposed for a few weeks to a solution of a protecting -salt and has acquired a thin film over its surface, it not only is not -acted on by the solution, but is even also rendered incapable of being -acted on by distilled water. - -The preservative power depends on the acid, not on the base of the salt. -The acetate, muriate, arseniate, and phosphate of soda differ -exceedingly in power. On the other hand, the sulphates of soda, -magnesia, and lime, as well as the triple sulphate of alumina and -potass, preserve as nearly as can be determined in the same proportion. - -When we attempt to ascertain the relative preserving power of the -neutral salts, it will appear that those whose acid forms with the lead -a soluble salt of lead are the least energetic; while those whose acid -forms an insoluble salt of lead are most energetic. The protecting -powers of acetate of soda, nitrate of potass, muriate of soda, sulphate -of lime, arseniate of soda, and phosphate of soda, are inversely as the -solubility of the acetate, nitrate, muriate, sulphate, arseniate, and -phosphate of lead. The existence of this ratio might naturally lead to -the inference that the protecting power depends simply on the salt in -solution being decomposed, so that there is formed on the surface of the -lead a thin crust consisting of the oxide of the metal in union with the -acid of the decomposed salt, and constituting an insoluble film which is -impermeable to aërated water: for example, that phosphate of soda acts -in the small proportion of a 30,000th part by forming on the surface of -the metal an impermeable film of phosphate of lead, which is known to be -one of the most insoluble of all the neutral salts. But this is not -altogether a correct statement of the fact. - -When the protection afforded is complete, as for example by a 27,000th -of phosphate of soda, a 12,000th of arseniate of soda, or a 4000th of -sulphate of soda, the lead undergoes no change in appearance or in -weight for several hours, or even days. At length the surface becomes -dull, then white, and gradually a uniform film is formed over it. This -film, examined at an early period, is found to consist of carbonate of -lead,—being entirely soluble in diluted acetic acid, although the salts -in solution is a sulphate or phosphate. But after a few weeks the -carbonate is mixed with a salt of lead, containing the acid of a part of -the neutral salt dissolved in the water: if, after five or six weeks’ -immersion in a preservative solution of phosphate or sulphate of soda, -the film on the lead be scraped off and immersed in diluted acetic acid, -effervescence and solution take place, but a part of the powder remains -undissolved; and if the protecting salt has been the muriate of soda, -the whole powder is dissolved, but muriatic acid will be found in -solution by its proper test, the nitrate of silver.—In all such -protecting solutions the lead gains weight for some weeks; but at length -it ceases to undergo farther change, and is not acted on even if removed -into distilled water. The crust, when formed thus slowly, adheres with -great firmness. The most careful analysis cannot detect any lead, either -dissolved in the water, or floating in it, or united with the insoluble -matter left on the side of the glass by evaporation. In short, the -preservation of the lead from corrosion, and of the water from -impregnation with lead, is complete.[1241] - -When the protection afforded is not quite complete,—for example in -distilled water containing a 4000th of muriate of soda, a 6000th of -sulphate of soda, a 15,000th of arseniate of soda, or a 35,000th of -phosphate of soda,—besides a powdery crust, small crystals, with several -facettes, are sometimes formed on the lead, while, at the same time, a -minute white film will very slowly appear on the bottom of the glass, on -its side where it is left dry by the evaporation of the water, and -likewise on the surface of the water itself. These detached films are -composed of carbonate of lead, with a little of the muriate, sulphate, -arseniate, or phosphate of lead, according to the nature of the acid in -the alkaline salt which is dissolved in the water. In the course of the -changes now described, the lead in general no longer gains, but loses -weight. The loss, however, is exceedingly small.—No lead can be -discovered in solution, if the water before evaporation is carefully -filtered. - -On progressively trying solutions of weaker and weaker preservative -power, it will be remarked, that the quantity of the detached powder, -and the proportion of carbonate in it, progressively increase; and -likewise, that what is formed on the lead adheres more and more loosely. -In distilled water and weak solutions of acetate of soda, or nitrate of -potass, the lead never becomes so firmly encrusted, but that gentle -agitation of the water will shake off the powder. - -It is worthy of notice that, although a small quantity of lead is -dissolved by distilled water after it has remained some time in contact -with the metal, yet not a trace is found in solution where a protecting -salt is present. In solutions even weakly preservative I never could -detect any lead dissolved. Thus, in distilled water containing a 4000th -of muriate of soda, or a 160th of nitre, the lead lost weight, and loose -crystals of carbonate were formed; yet even after thirty days no lead -could be found in solution by the process with which I have always -detected it in pure distilled water. Free exposure to the air is -probably in part the cause of this. For it will be seen afterwards that -some natural waters in passing through a long course of lead pipes, -within which the action goes on without direct access of the atmosphere, -contract an impregnation, which is invisible when the water is newly -drawn, but after a few hours’ exposure to the air shows itself in the -form of a white film and milkiness. - -The general result of these experiments appears to be, that neutral -salts in various, and for the most part minute, proportions, retard or -prevent the corrosive action of water on lead,—allowing the carbonate to -deposit itself slowly, and to adhere with such firmness to the lead as -not to be afterwards removable by moderate agitation, adding -subsequently to this crust other insoluble salts of lead, the acids of -which are derived from the neutral salts in solution,—and thus at length -forming a permanent impermeable skreen, through which the action of the -water cannot any longer be carried on. - -An important subject of inquiry regards the natural causes by which the -preservative power of the neutral salts is impaired. This topic I have -not hitherto been able to examine with all the care which is desirable. - -From the effect of the water of Edinburgh when highly charged with -carbonic acid, I was led to infer in former editions of this work that -an unusual quantity of carbonic acid is a counteracting agent. For if -Edinburgh water charged with it be corked up with some lead rods in a -phial half-filled with water, and half with atmospheric air, the lead, -which in common Edinburgh water, as will presently be mentioned, hardly -loses any of its brilliancy for six or seven days, becomes quite white -in twelve or sixteen hours. Subsequent experiments by Captain Yorke -seemed to him to render this conclusion doubtful; nor do I attach much -consequence to the observation just quoted. On the other hand it is said -Professor Daniell has found all waters dissolve lead, if they contain an -excess of carbonic acid.[1242] The point would be best settled by the -effect of a natural carbonated water passing through a long lead pipe. - - - _On the Action of Natural Waters on Lead._ - -The preceding observations on the action of water on lead may be -resorted to for explaining many interesting facts, and correcting some -erroneous statements, which have been published by authors as to the -corrosion of lead by natural processes. - -_Rain and Snow-Water._—It has been stated by Dr. Lambe that rain-water -does not corrode lead, that “its effect is so slight as not to be -discernible within a moderate compass of time.”[1243] But this -observation is far from being correct. Rain or snow-water, collected in -the country at a distance from houses, and before it touches the earth, -being nearly as pure as distilled water, ought to act with equal -rapidity on lead. I have accordingly found by a comparative experiment -with that mentioned in p. 401, that in twelve ounces of snow-water, -collected ten miles west from Edinburgh, and at some distance from any -house, twelve lead rods weighing 340 grains lost two grains in eight -days, and the usual crystals began to form in less than an hour. But -when collected in a great city, rain or snow-water is much impaired in -activity. Thus in an experiment made with eaves’-droppings collected -from the roof of my house in Edinburgh, after half an hour of gentle -rain from the south-east,—the first rain which had fallen for several -weeks,—there was no action at all. Yet even when collected in a great -city, and in circumstances which at first sight would appear not very -favourable to its action,—for example from eaves’-droppings a few hours -after the beginning of a shower,—it retains a little of its corroding -property; and when collected in like manner after twelve or twenty-four -hours’ rain, it corrodes almost as rapidly as distilled water. Thus with -four ounces of eaves’-droppings collected after the shower last alluded -to had continued four hours, the crystalline powder began to cover the -bottom of the glass in five hours, and in nine days three lead rods -weighing fifty-seven grains lost a fifth of a grain. And in another -experiment made with eaves’-droppings after a day’s steady rain from the -north-east, the powder began to form in half an hour, and the loss -sustained by the lead in thirty-three days was a grain and a third, -being very nearly what is lost in distilled water during the same time. - -We must obviously be prepared to look for an explanation of these -differences in the relative purity of the different waters. Accordingly, -in the eaves’-droppings at the beginning of the shower the nitrates of -baryta and silver caused, the former a distinct, the latter a faint -precipitation, which, as oxalate of ammonia had no effect, arose from -the presence of alkaline sulphates and muriates: but after a four hours’ -shower nitrate of baryta alone acted, and caused merely a faint haze: -and after a twenty-four hours’ shower, as well as in snow-water from the -country, none of the three tests had any effect whatever. - -Hence, perhaps even in a town, but at all events certainly in the -country, it would be wrong to use for culinary purposes rain or -snow-water which has run from lead roofs or spouts recently erected. -When the roof or spout has been exposed for some time to the weather the -danger is of course much lessened, if not entirely removed; because -exposure to the weather encrusts it with a firmly adhering coat of -carbonate, through which, as already observed, even distilled water will -not act. But I believe it would be right to condemn the turning even old -leaden roofs to the purpose of collecting water for the kitchen. -Although the purest rain-water cannot act on them when it is once fairly -at repose, we do not know what may be the effect of the impetus of the -falling rain on the crust of carbonate; and if the crust should happen -to be thus worn considerably, or detached by more obvious accidents, the -corrosion would then go on with rapidity as long as the shower lasted. -Acid emanations too disengaged in the neighbourhood, and other more -obscure causes may enable rain-water actually to dissolve even the crust -of carbonate. - -These remarks on the effect of rain-water on lead are pointedly -illustrated by what Tronchin has recorded of the circumstances connected -with the spreading of the lead colic at Amsterdam, about the time he -wrote his valuable essay on that disease. Till that period lead colic -was seldom met with in the Dutch capital. But soon after the citizens -began to substitute lead for tiles on the roofs of their -dwelling-houses, the disease broke out with violence and committed great -ravages. Tronchin very properly ascribed its increase to lead entering -the body insidiously along with the water, which for culinary purposes -was chiefly collected from the roofs during rain. He farther attempts to -account for the rain-water having acquired the power of corroding the -lead, by supposing that it was rendered acid in consequence of the roofs -having been covered with decaying leaves from trees which abounded in -the city; and without a doubt this explanation accords with the season -at which the lead colic was observed to be most frequent,—namely, the -autumn. But he does not seem to have been aware that rain-water itself -possesses the corroding property, independently of any extrinsic -ingredient except the gases it receives in its passage through the -atmosphere.[1244]—Mérat has referred to a Dutch author, Wanstroostwyk, -for an account of a similar incident which happened at Haarlem.[1245] - -The co-operating effect of acid emanations in the atmosphere is well -exemplified by an interesting incident which occurred this year in -Manchester, as detailed in some documents put into my hands by Dr. -Hibbert Ware. A gentleman being seized with symptoms, which in the -opinion of his medical adviser were owing to the insidious introduction -of lead into the body, it was found by Mr. Davies that the rain-water -from a leaden roof, which had been used in the family for nine years, -contained a considerable impregnation of lead. At first this excited -some surprise, because the roof was an old one. But on farther inquiry -it was found, that the rain in descending contracted an impregnation of -hydrochloric acid from the vapours which escaped from an adjoining -manufactory. A portion of the water which was sent to me contained so -much lead dissolved that it became dark-brown on the addition of -hydrosulphuric acid, and a considerable black precipitate was slowly -deposited. - -_Spring Water._—Most spring waters, unlike rain or snow-water, have -little or no action on lead, because they generally contain a -considerable proportion of muriates and sulphates. - -As an example of a spring water which does not act on lead at all, the -mineral water of Airthrey, near Stirling, may be mentioned. In four -ounces of water from the strongest spring at Airthrey, I kept for -thirty-five days three bright rods of lead weighing 47·007 grains; and -at the end of that period the rods were very nearly as brilliant as when -they were first put in, and weighed 47·004 grains. This result is easily -explained on considering the nature of the water. It contains no less -than a seventy-seventh part of its weight of saline matters, which are -chiefly muriates, and partly sulphates. - -Another good illustration occurred to me lately, which contrasts well -with some instances of an opposite description to be mentioned -presently. The house of Phantassie in East-Lothian was supplied with -water by a lead pipe from a distance of a mile. About a year afterwards, -when I had an opportunity of examining into the circumstances, I found -the cistern singularly clean and free of incrustation, and the water -quite free of lead. The composition of the water explained these facts. -It contains a 4,900th of salts, a large proportion of which consists of -carbonates of lime and magnesia. - -The water of Edinburgh is another example of spring water nearly -destitute of action on lead. But it is not so completely inactive as the -water of Airthrey. In four ounces of water three bright rods weighing -fifty-seven grains lost in seven days a 250th of a grain, in twenty-one -days a 100th, in thirty-five days a 66th, and in sixty-three days a 59th -of a grain. In seven days the lead was hardly tarnished at all, and not -a speck of powder could be seen in the water, or on the glass. In -twenty-one days, but still more in thirty-five or sixty-three days, the -lead was uniformly dull; and on the surface of the water, as well as on -the bottom of the glass, and on the side where left dry by the -evaporation of the water, there were many white, filmy specks, which -became black with the hydrosulphate of ammonia. In another experiment -145 grains of lead kept for six months in six ounces of Edinburgh water, -which was filled up as it evaporated, lost a fifteenth of a grain; and -the white incrustation on the bottom and sides of the glass gave a large -proportion of black precipitate when scraped together and treated with -hydrosulphate of ammonia. These experiments are of some practical -importance. For they show that the impregnation which the water of -Edinburgh can receive in a few days from being kept in lead is so small -as to be barely perceptible by the nicest analysis; but that the -impregnation may be material if the same portion of water is kept in -lead for a considerable length of time. Hence the perfect safety of the -leaden cisterns and service-pipes used in this city. The same portion of -water rarely remains in them above a single day, and therefore cannot -become impregnated in a degree that is appreciable by the nicest -examination. Dr. Thomson of Glasgow, in an interesting inquiry made in -1815 into the purity of the water which supplies Tunbridge, has stated -that, when he lived in Edinburgh some years before, he could always -detect a minute trace of lead suspended in the water, which at that time -was brought six miles in leaden pipes.[1246] I presume it is owing to -the main pipes being now made of iron that this impregnation no longer -exists. For I have found that the residue of two gallons of water, very -carefully collected by gentle evaporation of successive portions in a -small vessel, did not furnish the slightest trace of lead, when strongly -heated with black flux and then acted on by nitric acid.[1247] The -feeble action of the Edinburgh water on lead arises from the salts it -holds in solution. It contains about a 12,000th part of its weight of -solid matter, of which about two-thirds are carbonate of lime, and -one-third consists of the sulphates and muriates of soda, lime, and -magnesia. - -Many instances might be quoted of spring waters which act with -inconvenient or dangerous rapidity on lead. But it is hardly worth while -mentioning more than one or two of these, because the nature of the -waters has been seldom described. - -A striking example was related by Dr. Wall of Worcester. A family in -that town, consisting of the parents and twenty-one children, were -constantly liable to stomach and bowel complaints; and eight of the -children and both parents died in consequence. Their house being sold -after their death, the purchaser found it necessary to repair the pump; -because the cylinder and cistern were riddled with holes and as thin as -a sieve. The plumber who renewed it informed Dr. Wall that he had -repaired it several times before, and in particular had done so not four -years before the former occupant died.[1248] The nature of the water was -not determined. Most of the water around Worcester is very hard; but -this will not account for its operation in the instance now described. - -Another incident of the same kind, but hardly so unequivocal in its -circumstances, was related in 1823 by Dr. Yeats of Tunbridge. A plumber -undertook to supply that town with water for domestic purposes, and in -1814 laid a course of leaden pipes for a quarter of a mile. In the -subsequent year many cases of lead colic occurred among the inhabitants -who were supplied by those pipes; and one lady particularly, who was a -great water-drinker, lost the use of her limbs for some months. The -inhabitants naturally became alarmed; iron pipes were substituted; and -no case of colic appeared afterwards. Mr. Brande analyzed the water -which had passed through the pipes and detected lead in it, while at the -same time none could be detected at the source.[1249] Some uncertainty -was supposed to have been thrown over these statements by the analytic -researches of Drs. Thomson, Scudamore, and Prout, and Mr. -Children.[1250] But water like that in question can scarce fail to act -powerfully on lead in favourable circumstances; for according to the -analysis of Dr. Thomson it is extremely pure, as it contains only a -38,000th part of saline matter, three-fourths of which are a feebly -protecting salt, the muriate of soda.[1251] I am satisfied, therefore, -from my experiments, and the facts which follow, that no such water -could be safely conveyed through new lead pipes; and that it would be -dangerous even to keep it long in a lead cistern. It is difficult to -account for the failure of the gentlemen above mentioned to find lead in -the water, except by supposing that they had analyzed what had been -exposed for some time to the air, and deposited its oxide of lead in the -form of carbonate. - -Since my attention was first turned to this subject, the three following -incidents have occurred to me, which show the danger of conveying very -pure water in long lead pipes. 1. A gentleman in Dumfries-shire resolved -to bring to his house in leaden pipes the water of a fine spring on his -estate, from a distance of three-quarters of a mile. As I happened to -visit him at the time, I took the opportunity of examining the action of -a tumbler of the water on fresh cut lead, and could not remark any -perceptible effect in fourteen days. It appeared to me, therefore, that -the water might be safely conveyed in lead pipes; and they were laid -accordingly. No sooner, however, did the water come into use in the -family, than it was observed to present a general white haze, and the -glass decanters in daily use acquired a manifest white, pearly -incrustation. On examining the cistern, the surface of the water, as -well as that of the cistern itself, where in contact with it, was found -completely white, as if coated with paint; and the water taken directly -from the pipe, though transparent at first, became hazy and white when -heated or left some hours exposed to the air. On afterwards analyzing -the water direct from the spring, I found it of very unusual purity; as -it contained scarcely a 22,000th of solid ingredients, which were -sulphates, muriates, and carbonates. The reader can be at no loss to -perceive why the experiment with a few sticks of lead in a tumbler was -not a correct representation of what was subsequently to go on in the -pipes: in fact, as the pipes were 4000 feet long, and three-fourths of -an inch in diameter, each portion of water may be considered as passing -successively over no less than 784 square feet of lead before being -discharged. The remedy employed in this case will be mentioned presently -[p. 415]. 2. A gentleman in Banffshire introduced a fine spring into his -house from a distance of three-quarters of a mile by means of a lead -pipe. Two years and a half afterwards he was attacked with stomach -complaints, obstinate constipation, and severe colic, for which he was -under medical treatment for three months, with only partial and -temporary relief. At last on leaving home and repairing to Edinburgh, he -soon got quite well. Two other members of his family were similarly, but -more slightly affected. On returning home some time afterwards, the same -symptoms began to show themselves; but he had not been many weeks there, -when his attention was accidentally drawn to a notice of my experiments, -and of the last case, in Chambers’s Journal. He then saw that a white -film lined the inside of the water-bottle in his dressing-room; and the -water was declared by a chemist to contain lead. I lately had an -opportunity of analyzing the water, and found it to contain only a -16,500th of solid matter, the principal salt being chloride of sodium, -and the others being sulphates of magnesia and lime, with very little -carbonate. This, therefore, was exactly a case in which action upon lead -might have been anticipated, as the principal proportion of the very -small quantity of saline matter present was a feebly protective salt. 3. -The third instance occurred at a country residence of Lord Aberdeen. Mr. -Johnston, surgeon at Peterhead, being called to visit the housekeeper, -found her affected with vomiting, constipation, acute pain at the pit of -the stomach, retraction of the navel, and great feebleness. Little -improvement was effected in three days, when Mr. Johnston, astonished at -this, and reflecting on the cause, suddenly was attracted by the -appearance of a silvery film on the inside of his patient’s -water-bottle, and recollected at the same time my narrative of the -Dumfries-shire case. He then perceived that the disease was lead-colic, -treated it accordingly, and slowly accomplished a cure. The -housekeeper’s niece, a young girl who had resided only a few weeks with -her, and who was the only other individual that had lived in the house -above a few days together for more than a year before, had begun also to -suffer from the premonitory symptoms. About twelve months before this -incident happened, a spring of water, which had been analyzed and -pronounced extremely pure, was brought to the house in a lead pipe; and -the housekeeper had used this water for eight months before she took -ill. Mr. Johnston found that the water issued from the pipe was quite -clear, but that a white silvery film formed on its surface under -exposure to the air; and he ascertained that the first-drawn water -contained lead in solution, and that the film was carbonate of lead. I -had an opportunity of analyzing the water, which proved to be by no -means very pure, as it contained a 4460th of solids. But as the solid -matter consisted almost entirely of chlorides, namely, in a great -measure of chloride of sodium and a very little of the chlorides of -magnesium and calcium, as there was no carbonate present, and the -sulphates constituted only a 32,000th of the water,—it is plain from the -principles formerly laid down that the action which took place was to be -anticipated from the nature of the spring.[1252] - -For other instances of the corrosive action of spring water on lead the -reader may refer to Dr. Lambe’s treatise. Dr. Lambe was led by his -researches to imagine that no spring water whatever was destitute of -this property in a dangerous degree. This wide conclusion is not -supported by valid facts. Yet his work contains several accurative and -instructive examples of the action in question. Thus among other -instances he mentions that he had found the water of Warwick to act on -lead with great rapidity, and once saw holes and furrows in a cistern -there, which was the second that had been used in the course of ten -years.[1253] Sir G. Baker, in a letter to Dr. Heberden, has related -another striking instance of the same kind. Lord Ashburnham’s house in -Sussex was supplied from some distance with water, which was conveyed in -leaden pipes. The servants being often affected with colic, which had -even proved fatal to some of them, the water was carefully examined, and -found to contain lead. The solvent power of the water was ascribed to -its containing an unusual quantity of carbonic acid gas.[1254] This may -be doubted. - -In the course of the preceding remarks, allusion has been made to the -danger of keeping the same portion of water for a length of time in -leaden cisterns, if it has the power of acting on lead even in a -trifling degree. The following illustrations deserve particular notice. - -It was mentioned in p. 409, as the result of experiments on the small -scale, that although the water of Edinburgh does not contract a sensible -impregnation of lead on remaining a few days in contact with it, yet a -sufficient action ensues in the course of a few months, to show that it -might be dangerous to keep that water long in a lead cistern. After -coming to this conclusion, I had an opportunity of verifying it on a -large scale. A cistern in my laboratory in the University having been -left undisturbed for four or five months with about six inches of water -in it, I found so large a quantity of pearly crystals lying loose on the -cistern and diffused through the water, that when the whole was shaken -up and transferred to a glass vessel, the water appeared quite opaque. -Mérat observes that at the laboratory of the Medical Faculty of Paris -there was procured by evaporating six loads, or probably about 1000 -pounds of water, which had been kept two months in a leaden pneumatic -trough, no less than two ounces of finely crystallized carbonate of -lead.[1255] Water in such circumstances has proved eminently poisonous. -Thus, the crew of an East India packet having been put on short -allowance of water, in consequence of being delayed by contrary winds, -the men got their share each in a bottle; but the officers united their -shares and kept it all in a lead cistern. In three weeks all the -officers began to suffer from stomach and bowel complaints, and had the -lead colic for six weeks; while the men continued to enjoy good health. -The surgeon detected lead in a tumbler of water without the process of -concentration, by adding to it the sulphuret of potass.[1256] A similar -accident has been briefly alluded to by Van Swieten. He mentions, that -he was acquainted with a family who were all attacked with colica -pictonum in consequence of using for culinary purposes water collected -in a large leaden cistern and kept there for a long time.[1257] The -composition of the water has not been mentioned in any of these -instances; but the water of Paris is so strongly impregnated with -calcareous salts, that in ordinary circumstances its action on lead must -be trifling. - -It was probably from confounding the consequences of keeping the same -water long in a lead cistern with the action in ordinary circumstances, -that Dr. Lambe was led into the error of supposing that all spring -waters whatever act on lead so powerfully, as to render it in his -opinion advisable to abandon the use of this metal in the fabrication of -pipes and cisterns. It must be admitted, however, that in all likelihood -many waters will contain a trace of lead, without being kept more than -the usual time in the pipe or cistern. For Dr. Lambe’s results -correspond to a certain extent with the more recent and accurate -researches of Dr. Thomson, who mentions many instances where a faint -trace of lead was found in the residue of the evaporation of a large -quantity of spring water by himself, as well as by Dr. Dalton, Dr. -Wollaston, and Mr. Children.[1258] But, as Dr. Thomson properly adds, -when the quantity does not exceed a 600,000th or a millionth part of the -water, as in these instances, it is ridiculous to imagine that any harm -can result to man from the constant use of it for domestic purposes. - -Another fact of some practical consequence, which flows from the -experimental conclusions stated above is, that although it may be -perfectly safe to keep some waters in leaden cisterns, it may be very -unsafe to use covers of this metal, because the water which condenses on -the covers must be considered as pure as distilled water. It has been -found that white lead forms in much larger quantity on the inside of the -covers of cisterns than on the cisterns themselves, where both are -constructed of lead. A remarkable illustration of this is mentioned in a -paper read before the Academy of Sciences at Paris in 1788 by the Comte -de Milly. About a year after getting two leaden cisterns erected in his -house, to keep the water of the Seine for general domestic purposes, he -was attacked with severe and obstinate colic; which led him to examine -his cisterns. He found that the sides, where they were occasionally left -exposed by the subsidence of the water, and more especially the leaden -cover, were lined with a white liquid, which was constantly dropping -from the lid into the cistern, like the drops in caverns where -stalactites are formed. The water was in consequence so strongly -impregnated with lead as to give a dark precipitate with liver of -sulphur.[1259] The reason of this occurrence is, that the water in the -cistern is a solution of preventive salts, but what reaches the lid is -in a manner distilled. In Edinburgh the lids of the cisterns are -invariably made of wood, whether on account of its superior cheapness -merely, or because a leaden cover had been found perishable, I have not -been able to discover. - -It may be well to conclude these remarks on the action of spring waters -on lead with a general summary of the chief circumstances to be adverted -to in using lead for keeping or conveying water; to which may be added a -few hints for preventing action where it is found to have taken place. - -The general results of the preceding inquiries are that rain or -snow-water for culinary use should not be collected from leaden roofs, -nor preserved nor conveyed in lead;—that the same rule applies to spring -waters of unusual purity, where for example the saline impregnation does -not exceed a 15,000th of the water;—that spring water which contains a -10,000th or 12,000th of salts may be safely conveyed in lead pipes, if -the salts in the water be chiefly carbonates and sulphates;—that lead -pipes cannot be safely used, even where the water contains a 4000th of -saline matter, if this consist chiefly of muriates;—that spring water, -even though it contain a large proportion of salts, should not be kept -for a long period in contact with lead;—and that cisterns should not be -covered with lids of this metal. - -Where action is observed to take place in the instance of particular -waters, it may in some cases be impossible to prevent it by any -attainable means. But the inquiries detailed above suggest two modes by -which a remedy may be generally found. It appears that, where a crust of -carbonate is allowed to form slowly and quietly on the surface of lead, -even distilled water ceases to have any material action; and that the -action is reduced almost to nothing if a crust be thus formed in a -solution containing a minute quantity of some powerfully protecting -salt, such as phosphate of soda. It appears to me then that a remedy may -be often found in the instance of unusually pure spring waters—either by -leaving the new pipes filled with the water for a few months, care being -taken not draw any water from them in the interval,—or perhaps even more -effectually by filling the pipes for a similar period with a solution -containing about a 25,000th of phosphate of soda. I had determined to -try the latter plan with the pipes in the Dumfries-shire case mentioned -above, but recommended that in the first instance the pipes should be -left for a few months full of the water of the spring, and the -stop-cocks kept carefully shut; and on this being done for three or four -months, it was found that the water afterwards passed with scarcely any -impregnation of lead, and what little was contracted at first gradually -diminished in the course of time.—Probably neither of these methods will -be of more than temporary use, when the chief or only salt present is -chloride of sodium, even though the proportion be considerable. Both -plans seemed to answer for a time in the instance which occurred at Lord -Aberdeen’s (p. 411); but after a while the action recommenced, probably -owing to the deposited carbonate being slowly dissolved. At the time of -publication of my paper in the Transactions of the Royal Society of -Edinburgh, the cure appeared complete, and was there represented to be -so. - -I should add that an effectual remedy has been lately introduced by a -patent invention for covering lead pipes both externally and internally -with a thin coating of tin. - -In the remarks now made on the action of water on lead no account has -been taken of the effect of the galvanic fluid in promoting it. This, -however, is a most important co-operating agent, or rather perhaps it -ought to be considered a distinct power; for it acts with energy where -water alone acts least, namely, when there is saline matter in solution, -because then a galvanic current of greater force is excited. In general -it is necessary that two different metals be present in the water before -galvanic action be excited; but a very slight difference may be -sufficient. For example, it seems enough that the lead contain here and -there impurities, constituting alloys slightly different from the -general mass of the pipe or cistern. It is probable that galvanic action -may be thus excited by the joinings being soldered with the usual -mixture of lead and the more fusible metals. At least I have seen pipes -deeply corroded externally, when made of sheets of lead rolled and -soldered; and the action was deepest on each side of the solder, which -had itself entirely escaped corrosion. Even inequalities in the -composition of the lead may have the same effect. Sheet lead long -exposed to air or water is sometimes observed to be corroded in -particular spots; and these will always be found in the neighbourhood of -parts of the metal differing in colour, hardness or texture from the -general mass. I have not analyzed such spots; but I conceive the -supposition now made is exceedingly probable, and supplies a ready -explanation of the corrosion. Similar effects may arise simply from -fragments of other metals lying long in contact with the lead. They may -also arise from portions of mortar being allowed to lie on the lead; but -the action here is not galvanic. - -I have no doubt that many of the instances of unusually rapid corrosion -of lead by water, such as that mentioned by Dr. Wall [p. 410] are really -owing, not to the simple action of water, but to an action excited -obscurely in one or other of the ways now mentioned. - - - _Of the Action of Acidulous Fluids on Lead and its Oxide._ - -Water acidulated with various acids acts on lead with different degrees -of rapidity. - -The effect of acidulation with _carbonic acid_ has not yet been -accurately ascertained. The effect of _sulphuric acid_ is peculiar. -Distilled water feebly acidulated with that acid acts much less rapidly -on lead than when quite pure. Thus I have found that, if it contained a -4000th or even only a 7000th of sulphuric acid, fifty grains of lead -kept in it for thirty-two days gained a seventh or a twelfth of a grain -in weight, and were covered with beautiful crystals of sulphate of lead. -A minute trace of lead could be detected in the water. _Hydrochloric -acid_ is somewhat more active as a solvent. Distilled water containing a -3000th of that acid acquired in thirty-two days a sweetish taste, and -yielded by evaporation a considerable quantity of muriate of lead, while -the lead rods lost weight, and were covered with acicular crystals of -the same salt. - -It is much more important, however, to consider the effects of the -vegetable acids on lead and its oxide, because their solvent power is a -fruitful source of the accidental as well as intentional adulteration of -many articles of food and drink. - -_Acetic acid_ in the form of common vinegar, even when much diluted, -attacks and dissolves metallic lead, if by exposing the surface of the -fluid to the air, a constant supply of oxygen be maintained to produce -oxidation. The _citric acid_ will attack it under the same -circumstances, but acts more slowly. In a solution of five grains of -citric acid in twenty-four parts or two drachms of water, three lead -rods lost two grains in weight in nine weeks. The greater part of the -citrate of lead separated slowly in white powdery crystals; but a small -portion was dissolved by the excess of acid, and imparted to the fluid a -pleasant sweetness. _Tartaric acid_ acts much less energetically. In a -comparative experiment with the last, the lead gained nearly half a -grain in weight by acquiring a crystalline coat of tartrate of lead. But -I could not detect any lead in solution; and there was no loose powder. -The tartrate of lead is very sparingly soluble in an excess of its acid, -so that a sweet taste cannot be communicated by it to a fluid acidulated -with tartaric acid. _Malic acid_, according to MM. Chevallier and -Ollivier, acts so quickly as a solvent, that if a solution be kept in a -lead vessel for three hours, the metal may be detected in the fluid by -any of its ordinary tests.[1260] - -The acids act with greater rapidity on the protoxide of lead than on the -metal; and the presence of air is of course not required to enable them -to effect its solution. - -The solvent power of the acids is liable to be counteracted by various -substances; the operation of which, however, has not been well -ascertained. It appears that substances containing gallic acid or tannin -throw down the lead; and on this account various adulterations which -would otherwise take place are either prevented or corrected. It has -been also ascertained by Proust, that the vegetable acids do not attack -lead when it is alloyed with tin. For as the latter metal has a stronger -attraction than the former for acids, no lead can be oxidated before the -tin undergoes that change.[1261] - -From what has been said of the action of the vegetable acids, it follows -that the preparation or preservation of articles of food and drink in -leaden vessels is fraught with danger. For, if they contain a vegetable -acid, more particularly the acetic, as many of them do, and if they are -allowed to remain in the vessel for a moderate length of time, they will -be apt to be impregnated with the metal. In this way lead has been often -insidiously introduced into the food of man. - -Thus milk has been poisoned by being kept in leaden troughs. An instance -of the kind has been related by Dr. Darwin. A farmer’s daughter used to -wipe the cream from the edge of the milk which was kept in leaden -cisterns, and being fond of cream, had a habit of licking it from her -finger. She was seized in consequence with the symptoms of lead colic, -afterwards with paralytic weakness of the hands, and she died of general -exhaustion.[1262] The circumstances under which the lead is acted on -have not been carefully examined. It appears to be sometimes used with -safety. It will of course be dissolved, if the milk should become sour. - -Rum has been also supposed to be sometimes adulterated with lead by -being left in contact with the metal. The dry belly-ache of the West -Indies, which appears to be the same disease with the lead colic, has -been ascribed by some to the same cause. But on this subject precise -information is still wanted. Dr. J. Hunter has stated, that an epidemic -colic, which attacked three of our regiments in Jamaica during the years -1781 and 1782, and which seized almost every man of them, was traced by -him to the presence of lead in the rum; and he endeavours to show that -the spirit might dissolve the lead in passing through the leaden worms -of the distilling apparatus.[1263] He adds in another work, that, -according to information communicated by Dr. Franklin, the legislature -of Massachusetts passed an act in 1723, prohibiting the use of leaden -still-heads and worms in the distillation of spirituous liquors.[1264] -It is certain that rum has been often impregnated with lead; but it is -by no means clear that Dr. Hunter has successfully accounted for the -mode in which the adulteration is effected. - -Wine has been accidentally impregnated in like manner, in consequence of -the bottles having been rinsed with shot, and some of the shot left -behind. An interesting example of this has been related in the -Philosophical Magazine. Severe abdominal symptoms were caused by a -bottle of wine; and the cause was discovered to be the action of the -wine on some shot in the bottom of the bottle. The shot had been so -completely dissolved, that it crumbled when squeezed between the -fingers.[1265] The illness in this instance must have been owing to the -arsenic contained in the shot, because the quantity of lead was hardly -sufficient to excite violent symptoms.—At one time home-made British -wines must have been frequently adulterated with lead, from the makers -being ignorant of the dangerous nature of the adulteration. Sir G. Baker -quotes the following receipt in a popular cookery book of his time: “_To -hinder wine from turning._—Put a pound of melted lead in fair water into -your cask, pretty warm, and stop it close.”[1266] - -But by far the most remarkable adulteration of the kind now under review -is that of cider. At one time a disease in every respect the same as the -lead colic used to prevail in some of the south-west counties of England -at the cider season; and it was generally ascribed, in consequence -apparently of the opinion of Huxham, to the working people indulging too -freely in their favourite beverage during the season of plenty. The -subject, however, was carefully investigated in 1767 by Sir George -Baker, who succeeded in proving, that the disease arose from the cider -being impregnated with lead, sometimes designedly for the purpose of -correcting its acescency when spoiled, but chiefly by accident, in -consequence of the metal being used for various purposes in the -construction of the cider-house apparatus. The substance of his -researches is,—that a disease in all respects the same with the lead -colic was in his time so prevalent in Devonshire as to have supplied 289 -cases to the Exeter Hospital in five years, and 80 to the Bath Infirmary -in a single season (1766); while, on the contrary, it was little, if at -all, known in the adjoining counties of Gloucester, Worcester, and -Hereford, although cider is there an equally common drink among all -ranks:—that in the latter counties lead was seldom or never used in -constructing the apparatus of the cider-houses, while in Devonshire it -was used sometimes for lining the presses, but more commonly for -fastening the iron cramps, and filling up the stone joinings of the -grinding troughs, and for conveying the liquor from vessel to -vessel:—that lead did not exist in the cider of Herefordshire, but might -be detected both in the ripe cider, and more especially in the must, of -Devonshire:—that from eighteen bottles of cider, a year in bottle, 4½ -grains of metallic lead were procured.[1267] The accuracy of these -facts, and the soundness of the conclusions which Sir George Baker drew -from them have been universally admitted; and lead is now, I believe, -completely excluded from the cider apparatus. - -Notwithstanding the notoriety of these facts, accidents from adulterated -cider seem still to occur occasionally in France. So recently as 1841 a -set of cases which presented the incipient symptoms of lead colic were -traced by MM. Chevallier and Ollivier to cider having been adulterated -with lead to the amount of nearly two grains and a half per quart, in -consequence of a publican having kept his cider for two days in a vessel -lined with lead.[1268] - -If lead is previously oxidated, the presence of vegetable acids in -articles kept in contact with it is still more likely to give rise to a -poisonous impregnation, than in the case of lead itself. - -Of accidental adulterations of this kind the most important is that -which arises from the action of vegetable acids on the glazing of -earthenware. This glaze is well known to contain generally a -considerable quantity of oxide of lead, and in consequence is more or -less easily dissolved by vegetable acids. A good example has been -noticed by Dr. Beck.[1269] A family in Massachusetts, consisting of -eight persons, were all seized with spasmodic colic, obstinate -costiveness, and vomiting; and the disease was satisfactorily traced to -a store of stewed apples, which had been kept some months in an -earthenware vessel and had corroded the lead glazing. Another -interesting example has been described by Dr. Hohnbaum of -Hildburghausen. A family of five persons were all violently affected for -a long time with spasmodic colic, and some with partial palsy. After -examining many articles of food, Dr. Hohnbaum at last found that the -vinegar for dressing their salads was kept in a large earthenware vessel -capable of holding eight or ten quarts, and glazed with lead; that an -ounce of vinegar remaining in the vessel contained no less than nine -grains of lead; and that the whole glazing of the vessel was completely -dissolved.[1270] Accidents like this appear from the statements of the -same author to have been common in Germany not long ago. Luzuriaga -attributes the great prevalence of colic in Madrid and the neighbourhood -to the general use in the kitchen of earthenware glazed with lead.[1271] -Jacob imputes it to the same cause.[1272] But others have doubted the -accuracy of this explanation. - -The effect of acids on lead glazing appears to be variable. Sometimes -they hardly act on it at all.[1273] The difference probably depends on -differences in the composition of the glaze. Gmelin says, that if there -is little oxide of lead present, acids and fat do not corrode it; but -that potters often use too much, to render the glaze more fusible; and -that then it is easily corroded.[1274] Westrumb states, that, if the -lead glaze is thoroughly vitrified and not cracked, the strongest acids -do not attack it.[1275] Farther experiments are still required to -elucidate this subject. - -It is not, however, by accident only that the food or drink of man is -subject to be poisoned with lead. Many articles are adulterated with it -designedly for a variety of purposes. These adulterations it is -necessary for the medical jurist to study. - -No kind of adulteration with lead is more common than that of wine; -which, when too acid and harsh from the first, or rendered acescent by -decay, may be materially improved in taste by the addition of litharge. - -The practice of correcting unsound wines in this way seems to have been -well known at an early period. Betwixt the years 1498 and 1577, various -decrees were passed against it by the German emperors; and in some -provinces the crime was even punished capitally.[1276] For some time -afterwards the dangerous effects of the practice appear to have been -lost sight of in Germany. But towards the close of the seventeenth -century, the attention of physicians and legislators in that country was -pointedly directed to the subject by various writers in the _Acta -Germanica_.[1277] The same practice has been long prevalent in France. -The famous endemic colic of Poitou, which appeared in 1572, and raged -for sixty or seventy years, has been with justice ascribed in modern -times to the adulteration of wine with lead, and has given to the lead -colic its scientific name of _colica pictonum_. More recently, the -practice became exceedingly prevalent in Paris. About the year 1750, the -farmers-general found that for some years before that, 30,000 hogsheads -of sour wine were annually brought into Paris for the alleged purpose of -making vinegar, while the previous yearly imports did not exceed 1200. -An inquiry was accordingly set on foot; which led to the discovery, that -the vinegar merchants corrected the sour wines with litharge, and thus -made them marketable.[1278] Notwithstanding the active system of medical -police in the French capital, the crime is not yet eradicated. Indeed -the small tart wines used so abundantly there by all ranks, hold out -great encouragement and facilities to its perpetration. - -The process employed for correcting the acescency of wine is not -precisely known. Some wines are easily corrected; Mérat found that a -bottle of harsh wine, which had a sharp, bitterish, rather acrid taste, -took up in forty-eight hours twelve grains of litharge, and became -palatable.[1279] With other wines this simple method will not answer, -because the colour is destroyed, and a taste is substituted which has no -resemblance to that of the genuine wine. Thus Orfila remarked, that -Burgundy, neutralized with litharge, acquired a saccharine taste and -became pale-red, because the insoluble salts of lead which were formed, -combined with and removed the colouring matter.[1280] On the whole, it -is probable that the adulteration of wine with lead can only be -practised with success on the common tart kinds, such as those used by -the lower orders on the continent. - -Some excellent observations have been published on this subject by -Fourcroy. In order to render what he has said intelligible, it is -necessary to premise, that in the course of the fermentation of wine, -the bitartrate of potass, which accelerates the conversion of the sugar -of the fruit into alcohol, is itself partly converted into malic acid; -that in sound wine, therefore, there is a mixture of tartaric and malic -acids; but that if the malic acid originally existed in the fruit in too -great abundance, the fermentation of the sugar is imperfect, and the -wine is consequently both too acid and too weak; and lastly, that all -wines, if neglected, are apt to ferment too much, in consequence of -which they pass the vinous stage of fermentation, and become impregnated -with acetic acid.[1281] - -Now Fourcroy found that the oxide and other preparations of lead correct -acescency and harshness in wines, not so much by throwing down the -acids, as by combining with them in solution, and imparting to the -liquor the peculiar sweetness of lead. Hence tart wines, which owe their -acidity to too great a proportion of tartaric acid or bitartrate of -potass, cannot be improved by adulteration with oxide of lead. For the -bitartrate of potass cannot act at all as a solvent on the oxides or -carbonate of lead, and even pure tartaric acid takes up so little, that -wine containing it, could not acquire the sweet taste which is the -purpose of the adulteration. This statement I have confirmed. But the -case is very different when the wine contains acetic acid, the presence -of which is the general cause of spoiling or acidity. For Fourcroy -remarked, that acetic acid dissolves not only oxide and carbonate of -lead, but likewise the tartrate, notwithstanding its great insolubility -in water or in its own acid. Hence the presence of tartaric acid in a -wine spoiled by co-existence of the acetic, will not prevent the liquor -from taking up oxide of lead in sufficient quantity to acquire an -improved taste and flavour. Nay, an obvious mode of correcting excessive -acidity, produced by too much tartaric acid, is to add tartaric acid, -and then to treat the mixture with oxide of lead. Fourcroy farther -thinks, that the malic acid possesses the same solvent power as the -acetic over tartrate of lead, and that its presence may therefore be the -reason why some tart wines, which do not contain the acetic acid, become -nevertheless impregnated with the poison. The solvent power of acetic -acid is increased by the presence of other vegetable principles in the -wine.[1282] I may add, that I have found the citric acid to possess the -same property with the acetic and malic acids. It dissolves so much of -the tartrate of lead as to acquire a pleasant sweetness, unmixed with -metallic astringency. - -The practice of adulterating wine with lead does not seem to have been -ever pursued to any material extent in Britain. Home-made wines may be -adulterated in this way, as may be inferred from the receipt formerly -quoted for preventing acescency. But I have never heard that any such -adulteration has been suspected in the foreign wines usually drunk in -this country. Considering, indeed, the nature of these wines, and the -class of people who alone make use of them, it is not likely that -adulteration with lead could be practised with success. If the foreign -wines used in Britain should become acescent, lead could hardly restore -their taste so thoroughly as to impose on the consumer. - -Sometimes spirituous liquors and preserves have been adulterated with -lead, in consequence of sugar of lead having been used to clarify them, -or to render them colourless. Cadet de Gassicourt says it is a common -practice in France to clarify honey and sugar of grapes, and to make -brandy pale in this way; and M. Boudet has detected lead in many samples -of these articles in Paris.[1283] Hollands has likewise been poisoned in -the same manner. Dr. Shearman mentions his having detected an extensive -adulteration of smuggled Geneva by an excise officer, which had been -sold and dispersed over an extensive tract of country, and which -committed great ravages among the inhabitants.[1284] - -The adulterations hitherto noticed take place through means of the -chemical action of the adulterated articles on lead or its oxide. Some -other substances are occasionally contaminated by its compounds being -merely mechanically mixed with them. There is no end to the number and -variety of adulterations of this kind. But the following will serve as -examples. Gaubius once detected an adulteration of butter with white -lead at a time when it was very scarce in Flanders, owing to a dreadful -mortality among cattle.[1285] An instance of poisoning with lead, in -consequence of cheese having been mixed with red lead, is mentioned in -the Repertory of Arts.[1286] This variety deserves to be remembered. Red -lead was at one time a good deal used to communicate the peculiar -reddish-yellow colour, which is supposed to characterize the finer -qualities of certain kinds of English cheese. In the Transactions of the -Medical Society of London, a singular instance has been related by Mr. -Deering, of lead colic attacking a whole family, and proving fatal to -two of them, in consequence of the insidious introduction of white lead -into the body. Although the nature of the symptoms in the several cases -left no doubt that lead was the cause of them, it was long before the -source of the poison was discovered. Every vessel and article used in -the kitchen was in vain examined; when at length it was discovered that -the sugar used by the family had been taken from a barrel which had -formerly contained white lead, and that, as the sugar from the centre of -the barrel had been dug out, and given away to various friends, the -outer part of it next the white lead was chiefly used by the family -themselves.[1287] - - - _Process for detecting Lead in Organic Mixtures._ - -In the first place, a little nitric acid should be added to the -suspected matter before filtration; for nitric acid redissolves any -insoluble compound formed by the salts of lead with albumen and other -animal principles, as well as some of those formed with vegetable -principles; and consequently renders it more probable, that the poison -will be detected in the first part of the analysis, if present at -all.[1288] This being done, sulphuretted-hydrogen gas is to be -transmitted through the fluid part of the mixture; and if a -dark-coloured precipitate is formed, the whole is to be boiled and -filtered to collect the precipitate. - -In order to ascertain that the precipitate positively contains lead, -those who are accustomed to use the blowpipe may put the sulphuret into -a little hole in a bit of charcoal, and reduce it by the fine point of a -blowpipe-flame; when a single globule is procured, which is easily -distinguished by its lustre and softness. A better process, for those -not accustomed to the blowpipe, and perhaps a better test of the -existence of lead in all circumstances, is to heat the sulphuret to -redness in a tube, and to treat it with strong nitric acid, without heat -or with the aid of a gentle heat only. The lead is thus dissolved -without the sulphur being acted on. The solution is then to be diluted -with water, filtered, evaporated to dryness, and gently heated to expel -the excess of nitric acid. If the residue be dissolved in water, it will -present the usual characters of a lead solution when subjected to the -proper liquid tests. Of these the hydriodate of potass is to be -preferred when the quantity is too small for trying more of them. But -for this purpose care must be taken to expel all the excess of nitric -acid, because an excess will strike a yellow colour with the test though -lead be not present. - -If the preceding process should not detect lead in the filtered part of -the mixed fluid, then the insoluble matter left on the filter is to be -incinerated, and the residuum dissolved in nitric acid, and tested as -above. This branch, however, will be rarely required, if lead be -present, because the precaution of adding nitric acid, previous to -filtration, dissolves the lead from most of its compounds which are -insoluble in water. The process of incineration in medico-legal analysis -generally should be avoided if possible, as it is not easily managed by -unpractised persons.—The present branch of the process of analysis will -be particularly required for the contents of the stomach or vomited -matter, when any sulphate or phosphate has been given as an antidote. - -A process different from the preceding, and analogous to those for -detecting copper and antimony in complex organic mixtures, has lately -been proposed by Professor Orfila, especially for those cases in which -lead is to be sought for in the textures of the body, where death is -supposed to have been occasioned by it. The subject of analysis, such as -the liver, spleen, or kidneys, being cut into small pieces, and boiled -in distilled water, and the filtered decoction being evaporated to -dryness, the extract is to be carbonized with nitric acid as directed -under the head of copper (p. 357); and care must be taken that the heat -be not raised to redness, so as to inflame the mass. The residuum is -then to be boiled with nitric acid; the solution being evaporated to -dryness to expel the excess of acid, the saline matter left is to be -redissolved and acted on by hydrosulphuric acid gas; and the sulphuret -thus formed may be recognized by the means mentioned above.[1289] - -A question has been recently started, whether all the processes for -detecting lead in the tissues of the human body are not rendered -fallacious by the alleged existence of lead in the healthy animal -textures. In the first place, however, it is doubtful, as will be seen -presently, whether lead ever exists naturally in the animal organs. But -besides, the fallacy, if a real one, is obviated by the process of -Orfila; who states that lead, naturally combined in the animal tissues, -cannot be indicated by his method, if the animal matter be charred by -nitric acid without deflagration. And farther, in regard to the tissues -of the stomach in cases of acute poisoning with the preparations of -lead, it appears that in most instances there may be seen on the villous -coat little white points, which are blackened by hydrosulphuric acid, a -phenomenon never occasioned by lead naturally contained in the substance -of the membrane. [See p. 439.] - - -SECTION II.—_Of the Action of Lead and the Symptoms it excites in Man._ - -The effects of the preparations of lead on the body are very striking. -They differ according to the rapidity with which it enters the system. -Large doses of its soluble salts cause symptoms of irritant poisoning. -The gradual introduction of any of its oxidated preparations in minute -quantities brings on a peculiar and now well-known variety of colic, -which is often followed by partial palsy, and in violent cases by -apoplexy. - -The physiological effects and mode of action of the soluble salts in -irritating doses have been examined experimentally by Professor Orfila, -M. Gaspard, Dr. Schloepfer, and Dr. Campbell. Their experiments agree in -showing that these poisons have a direct irritating action, and a remote -operation of an unknown kind; but the results obtained by different -experimentalists differ as to some of the details. The acetate may be -taken as a type of the whole genus. - -Orfila found that it was hardly possible to bring dogs under the action -of the acetate if swallowed in solution, because they speedily -discharged it all by vomiting. But if the salt was given in powder in -the dose of half an ounce, or if the solution was retained in the -stomach by a ligature on the gullet, the symptoms produced were those of -violent irritation in the first instance, succeeded by extreme weakness -and death, sometimes in nine hours, more generally not till the second -day or later. The appearances in the body were unnatural whiteness of -the villous coat when death was rapid, and vascular redness when death -was slower. The whiteness in the former case Orfila ascribes to chemical -action. But as neither this appearance nor the redness in the latter -case was considerable, while at the same time the symptoms were not -those of continuous irritation, he was led to doubt whether the poison -causes death in consequence of its irritant properties. And the -phenomena observed by him when acetate of lead was injected into the -jugular vein prove that death is owing to certain remote effects. -Introduced through this channel thirteen grains killed a dog almost -immediately, death being preceded by no other symptom except convulsive -respiration; five grains killed another in five days, and the leading -symptoms were weariness, languor, staggering, and slight convulsions, -none of which symptoms appeared till the third day; and it is remarkable -that in neither animal could he find any morbid appearance on -dissection.[1290] Mr. Blake states that large doses, such as a drachm, -suddenly arrest the heart’s action; but that small doses of three -grains, injected into the jugular vein, cause diminished action of that -organ, and afterwards gorging and hepatization of the lungs; and that -when injected backwards into the aorta from the axillary artery, this -salt occasions obstruction of the capillary circulation, indicated by -increased arterial pressure,—and then an action on the nervous system, -producing insensibility, violent movements of the tail, and at last -arrestment of the respiration. It may be inferred from Mr. Blake’s -researches that lead obstructs both the systemic and pulmonary -capillaries, that it acts powerfully on the nervous centre, and that it -likewise depresses the heart’s action when the dose is large.[1291] - -The experiments of Gaspard coincide with those of Orfila in assigning -considerable activity to the acetate of lead when it is directly -introduced into the blood,—the quantity of two or four grains generally -causing death in three or five days.[1292] The experiments of Campbell -farther show that death may be induced by applying it to a wound, and -that the symptoms antecedent to death resemble those remarked by Orfila -when it is injected into a vein.[1293] But the two last experimentalists -differ from Orfila in assigning to sugar of lead a property like that -possessed by arsenic, of acting on the alimentary canal, even when -applied to a wound, or directly introduced into the blood. For Campbell -found the stomach corrugated and red, and the small intestines also -vascular; while Gaspard not only observed analogous appearances after -death, but even also witnessed all the symptoms of violent dysentery -during life. In farther proof of the local irritating power of this -poison, it may be added, that when sugar of lead was injected into the -rectum Campbell found it to cause purging, tenesmus, itching of the -anus, and great debility. - -I have found that the nitrate of lead is powerfully irritant and -corrosive in the dose of 400 grains. This quantity dissolved in four -ounces of water killed a strong dog in sixteen hours, producing violent -efforts to vomit and diarrhœa. And after death the whole inner membrane -of the gullet and stomach, and the villi of the upper half of the small -intestines, were uniformly white, brittle, and evidently disintegrated; -and the mucous coat of the great intestines was bright red in parallel -lines. - -The only inquiries I have hitherto met with, which assign to lead in -continued small doses the power of producing in animals the peculiar -colic and palsy often produced by it in man are those of Schloepfer, -related in his thesis on the effects of poisons when injected into the -windpipe. He found that the acetate, introduced through this channel in -successive doses of ten grains, brought on all the symptoms of _colica -pictonum_, preceded by oppressed breathing, and ending fatally with -palsy and convulsions in the course of three weeks.[1294] More recently -Dr. Wibmer, in the course of some experiments on the long-continued use -of acetate and carbonate of lead, remarked weakness and stiffness of the -limbs in dogs; and in the rabbit I have observed in the like -circumstances gradually increasing weakness, ending in complete palsy of -the fore-legs. - -The compounds of lead seem to produce their effects on the animal body -through the medium of absorption. At all events they are absorbed in the -course of their action, and are diffused throughout the animal textures. -Lead was long sought for with variable and dubious success in the fluids -and solids of men and animals killed by it or labouring under its -effects. But the late improvements in physiological science and chemical -analysis have demonstrated, that it may always be detected in favourable -circumstances in the liver and kidneys, often in the spleen and in the -urine, and sometimes even in the muscles. Wibmer was the first who -satisfactorily proved its presence. In dogs poisoned slowly by the -acetate or carbonate of lead in frequent small doses, and dying with -symptoms of lead-colic and palsy, he found the metal distinctly in the -liver, muscles, and spinal cord, and more obscurely in the blood, by -drying and deflagrating the animal matter with nitre, acting on the -residue with nitric acid, neutralizing the solution, and testing it with -hydrosulphuric acid, carbonate of potash, and iodide of potassium.[1295] -On repeating these experiments, I succeeded in detecting lead in very -minute quantity in the lumbar and dorsal muscles of rabbits, but not any -where else.[1296] Professor Orfila has since frequently found lead, by -means of his method of analysis described at page 424, in the kidneys, -liver, and urine of animals which had taken large doses of acetate of -lead, and once in the urine of a girl who had swallowed above an ounce -of the acetate twenty-five hours before the urine was passed.[1297] -About the same time M. Ausset, under the directions of Lassaigne, -detected lead largely in the blood and urine of a horse during life, and -in the liver and kidneys after death.[1298] Mr. Alfred Taylor found -traces of it in the milk of a cow accidentally poisoned by carbonate of -lead.[1299] M. Tanquerel Desplanches says it has been detected by M. -Devergie and himself in the palsied parts of persons who had died of -colica pictonum;[1300] and Dr. Budd observes, that Mr. Miller found lead -in abundance in the paralysed extensors of the hand in a man who died in -a London Hospital of the epileptic form of the effects of this -poison.[1301] - -These facts seem to outweigh the negative results obtained by others. -Nor are they invalidated by the alleged existence of lead in the healthy -animal textures. For in the first place,—although M. Devergie says he -has always found traces of lead in the substance of the stomach and -intestines of men and women, who had not used preparations of lead or -been in any way exposed to it,[1302] and Professor Orfila confirmed -these observations by also finding traces of lead in the alimentary -canal under similar circumstances,[1303]—the conclusion flowing from -their researches is after all doubtful; for in a later inquiry MM. -Danger and Flandin could not find any lead, unless it had been purposely -introduced into the body.[1304] And secondly,—Devergie adds to his -remarks, that the quantity of lead he found in the textures and -secretions of those who had died of lead-colic was far greater than in -those who had not been exposed to lead preparations before death; and -Orfila ascertained that the process by which he detects adventitious -lead is incapable of indicating that which may be present naturally in -the body.[1305] - -It is probable that all the preparations of lead are poisonous except -the metal, and perhaps also the sulphuret. The experimentalists at the -Veterinary School of Lyons found that nearly four ounces of the metal -might be given to a dog without even vomiting being excited; and Orfila -remarked that an ounce of carefully prepared sulphuret had as little -effect.[1306] The effects, which have been occasionally ascribed to -lead-shot, and which will be mentioned by and by [_see_ p. 435], seem at -variance with these experiments, but cannot outweigh such precise -negative results. It is probable that irritant poisoning can be produced -only by those compounds which are soluble, such as the acetate, -subacetate, and nitrate. It appears indeed from the experiments of -Orfila with the acetate and my own with the nitrate, that these -compounds are true corrosives, and of no mean energy when given in large -doses moderately diluted. - -The insoluble compounds, such as the carbonate, red oxide and protoxide, -possess little irritant power. The experimentalists of Lyons found -litharge to be irritant in large doses of half an ounce.[1307] Orfila -gave dogs large doses of the red oxide and carbonate without observing -any signs of irritation in the stomach. A case has been published of a -young woman who swallowed accidentally an ounce and a half of the -carbonate without any bad effect whatever either at the time or -afterwards;[1308] and Dr. Ogston of Aberdeen has informed me he met with -a similar case, that of a girl who took an ounce with the view of -destroying herself, but without sustaining any harm whatever. In a -remarkable case, published by Mr. Cross of London, in which six drachms -were taken accidentally by a pregnant female instead of magnesia, -vomiting and violent colic were produced, and afterwards fainting, -paralysis of the extensor muscles, and contraction of the flexors; all -of which symptoms, however, after enduring without abatement till eight -hours after the poison was swallowed, gradually disappeared under -antidotes and laxatives. But such a case bears no great resemblance -either to the acute or chronic form of poisoning with lead, and was -probably hysterical.[1309] Orfila has found that an ounce and a quarter -of sulphate of lead had no effect whatever on a dog.[1310] Mr. Taylor -mentions a case where the chloride of lead caused vomiting, but no other -ill consequence.[1311] Dr. Cogswell found that three drachms of iodide -of lead caused in a dog merely depression and weakness for a few days; -but forty grains killed a rabbit in twelve days, with symptoms of -exhaustion and constipation; and doses frequently repeated, to the -amount of eleven drachms in eighteen days, killed a dog under symptoms -nearly the same.[1312] - -It may be presumed that all the compounds of lead which are soluble in -water or in the animal fluids may produce in favourable circumstances -the lead colic and palsy. Dr. A. T. Thomson, indeed,[1313] has -endeavoured to show by some experiments, that the carbonate is the only -compound of lead which possesses this singular power; and that if the -acetate of lead produces similar effects, it is only because that salt -usually contains an excess of oxide which becomes carbonate from the -action of free carbonic acid in the stomach and other parts of animals, -or because the salt is decomposed by double decomposition from the -accidental presence of alkaline carbonates. It does not appear to me, -however, that the researches of Dr. Thomson, taken along with the prior -inquiries of other physiologists, will bear out this conclusion. The -experiments of Wibmer in particular would seem to show that the -carbonate is at least not more active than the acetate; nor does it -appear probable that the small doses of acetate given by him, seldom -exceeding two or three grains at a time, could yield any carbonate in -the alimentary canal of a dog, where there is commonly much free -muriatic acid. Farther, in many of the instances of lead colic related -above as produced by cider, wine, and other acid substances acting on -lead or its oxide, the acid must have been so greatly in excess, that it -was scarcely possible that carbonate of lead could have been formed -afterwards by any ordinary accident. And even supposing the carbonate to -be more active than other compounds in occasioning colic and palsy, as -Dr. Thomson’s inquiries would tend to show, the fact may be admitted -without necessarily leading to the inference, that it is the only active -compound of lead, or that other preparations must be converted into the -carbonate before they can act as slow poisons. For the superior activity -of the carbonate may be owing to the great obstinacy with which its -impalpable powder adheres to moist membranous surfaces, and the -consequent greater certainty of its ultimate absorption. It certainly -appears at least but consistent with a general law, to which hitherto no -undoubted exception has been found, that the carbonate must be dissolved -before it can act constitutionally. - -The symptoms observed in man from the preparations of lead are of three -kinds. One class of symptoms indicate inflammation of the alimentary -canal: another spasm of its muscles: and a third injury of the nervous -system, sometimes apoplexy, more commonly palsy, and that almost always -partial and incomplete. Each of these classes of symptoms may exist -independently of the other two; but the last two are more commonly -combined. - -The irritant effects of large doses of the soluble salts of lead come -first under consideration. Of these the acetate, or sugar of lead may be -taken as an example. - -Here it will, in the first instance, be observed that, according to the -experiments mentioned above, the acetate of lead, though certainly an -irritant poison, is not very energetic,—being much less so than the -vulgar generally believe, and far inferior to most of the metallic -poisons hitherto treated of. This farther appears from the experience of -physicians as to its effects in medicinal doses. The acetate has been -often given in pretty large doses in medical practice; and although it -has sometimes excited colic when continued too long, ordinary irritation -of the stomach seems to have been rarely observed. Mr. Daniell, in a -paper on its effects as a remedy for mercurial salivation, states that -he gave it in doses of ten grains three times a day, and that he never -observed it to excite any other unpleasant symptom except slight colic, -which seldom came on till after the fourth dose.[1314] I have often -given it in divided doses to the amount of eighteen grains daily for -eight or ten days, without remarking any unpleasant symptom whatever, -except once or twice slight colic. Van Swieten even mentions a case in -which it was given to the amount of a drachm daily for ten days before -it caused any material symptom.[1315] - -Yet facts are not wanting to prove that acetate of lead in an improper -dose will produce violent and immediate effects. The symptoms are then -either those of simple irritation, or more commonly those of -inflammation united with the peculiar spasmodic colic of lead, and -sometimes followed by convulsions and coma, or by local palsy. - -In one of Sir George Baker’s essays there is an instance of immediate -and violent symptoms having been caused by a drachm taken twice with a -short interval between the doses. The subject was a soldier who took it -in milk to cure a diarrhœa. Five hours after the first dose he was -seized with pain in the bowels and a feeling of distension round the -navel. After the second these symptoms became much more acute; and he -was soon after seized with bilious vomiting, loss of speech, delirium, -and profuse sweating, while the pulse fell down to 40. He recovered, -however, with the aid of diluents and cathartics.[1316] - -A case which proved rapidly fatal has been related in a French journal. -A drummer in a French regiment, who was much given to drinking, stole -some Goulard’s extract, and drank it for wine. Neither the first -symptoms nor the dose could be ascertained. On the second day he was -affected with loss of appetite, paleness, costiveness, and excessive -debility; on the third day he had severe and excessive colic, drawing in -of the belly, loss of voice, cold sweats, locked jaw, and violent -convulsions; and he expired before the evening of the same day. The -morbid appearances will be mentioned in their proper place. Sugar of -lead was detected in the stomach.[1317] - -In both these instances the disorder excited partook very much of the -character of the spasmodic colic which is caused by the gradual -introduction of lead into the body; and in the last the whole course of -the man’s illness was very like that of the worst or most acute form of -_colica pictonum_. But in another example which came under my own -notice, the symptoms were more nearly those of ordinary -irritation,—namely, vomiting, burning, and pricking pain in the throat, -gullet, and stomach, with trifling colic subsequently; but the patient -recovered in two or three days. The quantity taken was supposed to -exceed a quarter of an ounce. So, too, in a case which occurred to M. -Villeneuve of Paris, the symptoms were chiefly vomiting and purging, -with faintness and some convulsions. His patient swallowed intentionally -above an ounce of acetate of lead in solution. Sulphate of soda and -sulphate of magnesia were given promptly as antidotes; in an hour the -symptoms had abated materially; and next day she was well.[1318] This -was the case in which Orfila found lead in the urine. Of the same -nature, also, are two cases briefly alluded to by Mr. Taylor, as having -been caused in London in 1840 by Goulard’s extract. The subjects, who -were children, were seized with vomiting, purging, and other symptoms -like those of Asiatic cholera; and both died within thirty-six -hours.[1319] - -In another instance, related by Mr. Iliff of London, where an ounce of -the acetate was accidentally swallowed in solution, the symptoms were at -first colic pains and vomiting, in the course of a few hours vomiting -and tenderness, and, after these symptoms receded, a peculiar state of -rigidity and numbness, which was not entirely removed for several days. -In this case no remedies were used for three hours; and even two hours -later, when the stomach-pump was resorted to on account of the -slightness of the vomiting, lead was found in the first fluid -withdrawn,—a new proof of the feeble action of acetate of lead, compared -with some other metallic poisons.[1320] - -So much for the operation of the acetate of lead in large doses. -Physicians, however, are much better acquainted with the effects of lead -when introduced in the body continuously and insidiously in minute -quantities. For all tradesmen who work much with its preparations are -apt to suffer in this way, and many other persons have been brought -under its action in consequence of articles of food and drink being -impregnated with it. The disease which is thus induced may be divided -into two distinct stages. - -The first stage is an affection of the alimentary canal, the leading -feature of which is violent and obstinate colic. This symptom at times -begins abruptly during a state of sound health; but much more commonly -it is ushered in by a deranged state of the stomach, not unlike common -dyspepsia, seldom so severe as to excite alarm, and commonly imputed at -first to a wrong cause. There is general uneasiness and depression, a -dingy yellowish complexion, weakness and numbness in the limbs, a -sweetish styptic taste and fetid breath, a slaty tint of the teeth and -gums, with a blue line along the margin of the gums where they touch the -teeth, a slow hard pulse, great emaciation, loss of appetite and -tendency to indigestion. This state, which was first well characterized -by Mr. Wilson[1321] of Leadhills, and has lately been more fully -described by M. Tanquerel,[1322] is of great moment as apprizing the -workman of the necessity of taking active measures for preventing the -more formidable effects, which otherwise are sure to follow. Of the -warning symptoms none is so invariable or so characteristic as the blue -line along the edge of the gums, an appearance which was first noticed -by Dr. Burton of St. George’s, London,[1323] and has been since observed -in every case of lead colic, whether impending or present.—If alarm be -not taken in time, the obscure complaints hitherto mentioned become -attended by and by with uneasy sensations in the stomach, stretching ere -long throughout the whole belly. At the same time the stomach becomes -irritable, and the food is rejected by vomiting. Cramps in the pit of -the stomach then arise, and extend to the rest of the belly, till at -length the complete colic paroxysm is formed. The pain is sometimes -pretty constant; sometimes it ceases at intervals altogether; but much -more commonly there are remissions rather than intermissions; and it is -remarked that both the remissions and exacerbations are much longer than -those of common colic. The pain is very generally, yet not invariably, -relieved by pressure; even strong pressure seldom causes any uneasiness, -provided it be not made on the epigastrium; nay, some patients have been -known to bear, with relief to the paroxysms, the weight of two or three -people standing on the belly.[1324] The belly is almost always hard, the -abdominal muscles being contracted: sometimes it is rather full, more -commonly the reverse, and the navel is often drawn in so as almost to -touch the spine. The bowels all the while are obstinately costive. -Either there is no discharge from them at all; or scanty, knotty fæces -are passed with much straining and pain. This state, long supposed to -depend on spasm, is now known to arise on the contrary from paralysis, -of the intestinal muscular coat. In a few instances diarrhœa takes the -place of the opposite affection. The urine is commonly diminished. The -saliva has been described as greater than natural in quantity and bluish -in colour; but Dr. Burton says he did not observe a single instance of -this in forty cases which he carefully examined. From the beginning, or -more generally after a few hours or days, the limbs are racked with -diffuse cutting pains; which, according to Tanquerel, affect chiefly the -limbs, especially near the joints, are worst at night, are often -attended with cramps, and are relieved by pressure. The aspect of the -countenance is dull, anxious, and gloomy: in advanced cases the -expression of gloomy anxiety exceeds that of almost all other diseases. -It appears from the latest works on this disease published in France, -and particularly from the able treatise of Mérat, that the pulse is -rarely accelerated, but on the contrary often retarded.[1325] This does -not accord with the experience of some earlier writers;[1326] and in the -few cases I have seen in this city the pulse has been always frequent. -It cannot be questioned, however, that, as Mérat states, fever is not -essential. The skin has a dull, dirty, cadaverous appearance, is often, -though not always hot, and in either case is bedewed with irregular, -clammy, cold perspiration. - -This, the first stage of colica pictonum, may end in three ways. In the -first place, the patient may recover at once from it as from an ordinary -colic; and it is consolatory to know, that a first attack, taken under -timely management, is for the most part easily made to terminate in that -favourable manner. In such circumstances it rarely endures beyond eight -days. But it is exceedingly apt to recur, if, for example, the patient -expose himself to what in ordinary circumstances would cause merely a -common colic or diarrhœa; and if he returns to a trade which exposes him -again to the poison of lead, the disease is sure to recur sooner or -later, and repeatedly, unless he observes the greatest precautions. In -one or other of these returns, sometimes even in the first attack, the -colic is not succeeded by complete recovery, but gives place to another -more obstinate and more alarming disease. This secondary affection is of -two sorts. One, which occurs chiefly in fatal cases, is a species of -apoplexy. The other, which does not of itself prove fatal, is partial -palsy. - -In violent and neglected cases of colica pictonum, the colic becomes -attended in a few days with giddiness, great debility, torpor, and -sometimes delirium; as the torpor advances the pains in the belly and -limbs abate; at length the patient becomes convulsed and comatose, from -which state very few recover. Tanquerel, who is unnecessarily minute in -subdividing the various affections produced by the poison of lead, -distinguishes four kinds of affections of the head, coma, epilepsy, -delirium, and a combination of all these.[1327] A very rare termination -allied to that now described is sudden death during the colic stage, -without any symptom which would lead one to suspect its approach. A case -of this kind has been related by M. Louis. His patient, five minutes -after talking to the attendant of his ward, was found at his bedside in -the agony of death; and no cause for so sudden a death could be found on -dissection.[1328] Somewhat similar was a case which occurred in 1838 at -the hospital of La Charité at Paris. A man labouring for three days -severely under the colic stage of the disease, began to breathe -stertorously soon after straining at stool, and died in three -hours.[1329] In a case which occurred to Dr. Elliotson death was owing -to concomitant perforation of the stomach, a concurrence which was -probably accidental, but which was also once observed by Dr. -Copland.[1330] - -In cases, on the other hand, which have not been neglected, and -particularly when the attack is not the first, the departure of the -colic often leaves the patient in a state of extreme debility, which by -and by is found to be a true partial palsy, more or less complete. This -affection is sometimes present before the colic departs, but is apt to -escape notice till the pain abates. Occasionally it supervenes on a -sudden, but more generally it is preceded by a sense of weariness, -numbness and tremor of the parts. The palsy is of a peculiar kind. It -affects chiefly the upper extremities, and is attended with excessive -muscular emaciation. The loss of power and substance is most remarkable -in the muscles which supply the thumb and fingers; and in every case -which I have seen the extensors suffered more than the flexors. The -paralysis is hardly ever complete, except perhaps in the extensors of -the fingers. When it is considerable, the position of the hands is -almost characteristic of the disease. The hands are constantly bent, -except when the arms hang straight down by the side; they dangle loosely -when the patient moves; he cannot extend them, and raises one arm with -the aid of the other. The palsy is attended, according to Tanquerel, -with diminished heat in the parts, and feeble pulsation in the arteries -which supply them. There is seldom any loss of sensation in the affected -parts. But the paralysis sometimes affects the nerves of the other -senses. Thus two cases of paralysis of the nerves of vision have been -related by Dr. Alderson of Hull;[1331] and Tanquerel says this affection -is not uncommon in Paris, and is attended with dilated and immovable -pupils. The latter author also once met with deafness in the same -circumstances.—Patients affected with lead palsy usually complain of -racking pains in the limbs and arms, digestion is feeble, and trivial -causes renew the colic. From this deplorable condition it is still -possible to restore the sufferer to health, chiefly by rigorous -attention to regimen. But he too often dies in consequence of a fresh -attack of colic as soon as he returns to his fatal trade. - -The lead palsy, however, does not always come on in this regular manner. -Sometimes the primary stage of colic is wanting, so that the wasting of -the muscles and loss of power are the first symptoms. I have seen a -characteristic example of the kind in a sailor who had been employed for -a month in painting a vessel. He had great weakness and wasting of the -arms and hands, particularly of the ball of the thumb; but except a -tendency to indigestion, costiveness, and transient slight pain of the -belly, he had suffered no previous disorder of the intestines. I have -seen the paralytic affection confined to the extensors of one hand in a -compositor, and Dr. Chowne met with a similar affection of both hands in -a gas-fitter.[1332] Dr. Bright observed palsy without colic in the case -of a painter three times in the course of seven years.[1333]—In like -manner, according to Tanquerel, the neuralgic affection may occur -severely without any precursory colic; and the same author has witnessed -both coma and convulsions in the same circumstances. - -Colica pictonum, with the collateral disorders specified above, is the -only disease which has been distinctly traced to the operation of lead -insidiously introduced into the body. But many other disorders have been -ascribed to its agency. Boerhaave seems to have imagined that -consumption might be so induced; and Dr. Lambe thought that to this -cause may be traced the increased prevalence of “scrofula, phthisis, -dropsy, chronic rheumatism, stomach complaints, hypochondriasis, and the -host of nervous complaints which infest modern life.”[1334] These -conjectures are wholly destitute of foundation in fact. - -In whatever form lead is habitually applied to the body, it is apt to -bring on the train of symptoms mentioned above;—the inhalation of its -fumes, the habitual contact of any of its compounds with the skin, the -prolonged use of them internally as medicines, or externally as unguents -and lotions, and the accidental introduction of them for a length of -time with the food, may sooner or later equally induce colica pictonum. - -Instances have occurred of colic being produced by the prolonged -employment of the compounds of lead inwardly in medical practice. Such -cases are so uncommon that it is evident some strong constitutional -tendency must co-operate. But it is in vain to deny, as some do, that -the medicinal employment of preparations of lead internally is -unattended with any risk whatever of slow poisoning. Dr. Billing of -Mulhausen relates a case of death, apparently from the comatose -affection succeeding the colic stage of poisoning with lead, in the -instance of a boy of fifteen, to whom he gave acetate of lead in -gradually increasing doses for six weeks, till he took two grains -daily.[1335] Tanquerel met with a case of colic produced by 130 grains -taken in fourteen days, and another occasioned by 149 grains in sixteen -days.[1336] Sir George Baker has mentioned similar instances.[1337] It -would even appear that metallic lead may have the same effect when taken -inwardly. Thus Dr. Ruva of Cilavegno has related the case of a man who -was violently attacked with the colic form of the effects of lead after -taking six ounces of shot by direction of a quack for the cure of -dyspepsia, and was seized again with the same symptoms six days -afterwards on taking four ounces more. On the second occasion he had -violent colic, great feebleness of the limbs, constant vomiting of any -thing he swallowed, severe headache, and other analogous symptoms, of -which he was not effectually cured for seven weeks.[1338] A case -somewhat similar, but less severe, has been described by Dr. -Bruce.[1339]—With regard to lead colic being excited by unguents and -lotions applied to the surface of the body, Sir George Baker mentions a -case of violent colic brought on by litharge ointment applied to the -vagina; he adds that children have been thrown into convulsions by the -same substance sprinkled on sores: and he quotes Zeller for a case where -symptoms of poisoning were occasioned by sprinkling the axilla with it, -as a cure for redness of the face.[1340] Dr. Wall, in a letter to the -preceding author, mentions his having seen the bowels affected by -Goulard’s extract applied to ulcers; in another paper he has given two -unequivocal cases, in one of which colic was brought on by saturnine -lotions applied to a pustular disease, and in the other by immersing the -legs twice a day for ten days in a bath of the solution of acetate of -lead:[1341] and lately Dr. Taufflieb of Barr observed lead colic to -arise from the continued use of diachylon plaster during eleven weeks -for dressing an extensive ulcer.[1342] Such accidents are exceedingly -rare, and some auxiliary cause must have favoured the operation of the -poison in the cases now noticed; for every one knows that free use is -made of lead unguents and lotions, yet we seldom hear of any bad -consequences.—These cases, however, will probably remove the doubts -which some entertain of the possibility of lead colic being induced by -the application of the compounds of lead to the sound skin in those -trades which compel the workmen to be constantly handling them. At the -same time it must be admitted, that in all these trades there exists a -more obvious and ready channel for the introduction of the poison; -because the workmen are either exposed to breathe its fumes, or are apt -to transfer its particles from the fingers into the stomach with their -food.—Of all exposures none is more rapid and certain than breathing the -vapours or dust of the preparations of lead. But for that very reason -workmen who are so exposed seldom suffer; because the greatness of the -risk has led to the discovery of means to avert it, and the openness of -the danger renders it easy for the workmen to apply them. Tanquerel -mentions a singular case of a woman who was attacked in consequence of -the fine dust of white lead ascending through chinks in the floor from a -room below, where a perfumer was in the practice of grinding and sifting -that substance.[1343]—It may be added that Dr. Otto of Copenhagen has -published an extraordinary instance of fatal lead-colic, originating in -the habitual use of Macuba snuff adulterated with twenty per cent. of -red lead.[1344] - -To these observations on the various ways in which lead insidiously -enters the system a few remarks may be added on the trades which expose -workmen to its influence. The most accurate information on this subject -is contained in the work of Mérat. - -He places foremost in the list miners of lead. In this country miners -are now rarely affected, because the frequency of colica pictonum among -them formerly led their masters to study the subject, and to employ -proper precautions for removing the danger. It has been stated by Dr. -Percival, and is generally thought, that the whole workmen in lead mines -are apt to be attacked with the colic,—those who dig the sulphuret as -well as those who roast the ore.[1345] If this idea were correct, it -would be in contradiction with the general principle in toxicology, that -the metals are not poisonous unless oxidated. But the opinion is in all -probability founded on error; for, according to information communicated -to me by Mr. Braid, and confirmed since by personal investigation, the -workmen at Leadhills who dig and pulverize the ore, although liable to -various diseases connected with their profession, and particularly to -pectoral complaints, never have lead colic till they also work at the -smelting furnaces. Next to miners may be ranked manufacturers of -litharge, red-lead and white-lead. The workmen at these manufactories -are exposed to inhale the fumes from the furnaces or the dust from the -pulverizing mills. It has been chiefly among the workmen of a former -white-lead manufactory in the neighbourhood of Edinburgh that I have had -an opportunity of witnessing the lead colic. By a simple change the -proprietor made in the process, and which will be mentioned presently, -the disease was almost extirpated some years before the manufactory was -given up. - -Next in order, perhaps in the same class with colour-makers, are -house-painters. The causes of their liability is the great quantity of -the preparations of lead contained in the paints they use. It would -appear that lead colic is most frequent among people of that trade in -cities of the largest size. In Geneva, as I am informed by my friend Dr. -C. Coindet of that place, colica pictonum is now almost unknown and -never occurs among painters. In Edinburgh it is also little known among -painters. A journeyman painter, a patient of mine in the Infirmary, had -been seventeen years in the trade, and yet did not know what the -painters’ colic or lead palsy meant. In London, according to the -Dispensary reports, and in Paris, according to the tables of Mérat, many -workmen of that trade suffer. I have been informed by an intelligent -workman, once a patient of mine, who had been a journeyman painter both -in London and Edinburgh, that the number of his acquaintances who had -been affected with colic in the metropolis was incomparably greater than -here. This man ascribed the difference to the working hours being more -in the former place, so that the men had not leisure enough to make it -worth their while to clean themselves carefully in the intervals. This -appears a rational explanation. I do not know how the great prevalence -of colic among painters in Paris is to be accounted for. - -Plumbers, sheet-lead manufacturers, and lead-pipe makers, are also for -obvious reasons apt to suffer; but as they are not necessarily exposed -to the vapours of lead, and suffer only in consequence of handling it in -the metallic form, it ought to be an easy matter to protect them. They -themselves conceive that a very hazardous part of their occupation is -the removing the melted lead from the melting pot, to make the sheets or -pipes; but this operation cannot be dangerous if the melting pots are -properly constructed. - -A few cases of lead colic occur among glass-blowers, glaziers, and -potters, who use the oxide of lead in their respective trades. - -There are a few also among lapidaries and others, who use it for -grinding and polishing, and among grocers and colourmen who sell its -various preparations. Printers seldom suffer from the colic, but are -generally thought liable to partial palsy of the hands, which is -ascribed to frequent handling of the types. I have met with one case -apparently of this nature. - -Lead is not the only metal to which the power of inducing colica -pictonum has been ascribed. Mérat has mentioned several instances of the -disease occurring among brass-founders and other artizans who work with -copper.[1346] Tronchin quotes Scheuchzer for a set of well-marked cases -in a convent of monks, where the malady was supposed to have been traced -to all the utensils for preparing and keeping their food having been -made of untinned copper.[1347] The same author mentions two cases, one -of which came under his immediate notice, where the apparent cause was -the long-continued use of antimonial preparations internally.[1348] -Mérat likewise found a few iron-smiths and white-iron-smiths in the -lists kept at one of the Parisian hospitals.[1349] Chevallier alleges -that colic occurs at times among money-changers at Paris, and others who -constantly handle silver.[1350] Cases have even been noticed by Mérat -among varnishers, plasterers, quarrymen, stone-hewers, marble-workers, -statuaries, saltpetre-makers;[1351] and Tronchin enumerates among its -causes the immoderate use of acid wine or of cider, checked -perspiration, sea-scurvy, and melancholy. But the only substance besides -lead, whose operation in producing colica pictonum has been traced with -any degree of probability, is copper; and even among artizans who work -with copper the disease is very rare. As to the other tradesmen -mentioned by Mérat, it is so very uncommon among them, that we may -safely impute it, when it does occur, to some other agent besides what -the trade of the individual exposes him to; and in general the secret -introduction of lead into the body may be presumed to be the real cause. -Still, however, the connection of colica pictonum with other causes -besides the poison of lead is upheld by so many facts, and is believed -by so many authorities, that this disease cannot be safely assumed, even -in its most characteristic form, as supplying undoubted evidence of the -introduction of lead into the system. Dr. Burton thinks it will when the -blue line at the edge of the gums is seen. - -The work of Mérat contains some interesting numerical documents, -illustrative of the trades which expose artisans to colica pictonum. -They are derived from the lists kept at the hospital of La Charité in -Paris, during the years 1776 and 1811. The total number of cases of -colica pictonum in both years was 279. Of these, 241 were artisans whose -trades exposed them to the poison of lead, namely, 148 painters, 28 -plumbers, 16 potters, 15 porcelain-makers, 12 lapidaries, 9 -colour-grinders, 3 glass-blowers, 2 glaziers, 2 toy-men, 2 shoemakers, a -printer, a lead-miner, a leaf-beater, a shot-manufacturer. Of the -remainder, 17 belonged to trades in which they were exposed to copper, -namely, 7 button-makers, 5 brass-founders, 4 braziers, and a -copper-turner. The remaining twenty-one were tradesmen, who worked -little, or not at all with either metal, namely, 4 varnishers, 2 -gilders, 2 locksmiths, a hatter, a saltpetre-maker, a winegrocer, a -vine-dresser, a labourer, a distiller, a stone-cutter, a calciner,[1352] -a soldier, a house-servant, a waiter, and an attorney’s clerk.—Age or -youth seems not to afford any protection against the poison. Of the 279 -cases, 24 were under twenty, and among these were several painter-boys -not above fifteen years old; 113 were between nineteen and thirty; 66 -between twenty-nine and forty; 38 between thirty-nine and fifty; 28 -between forty-nine and sixty; and 10 older than sixty. These proportions -correspond pretty nearly with the relative number of workmen of similar -ages.—Among the 279 cases fifteen died, or 5·4 per cent. - -There seems to have lately been little or no diminution in the frequency -of the disease in Paris. In 1833–4–5–6, there were treated in the -hospitals 1541 cases, or 385 annually; of whom one in 39½ died. And in -1839–40–41 there were 761 cases, or 252 annually; of whom one in 24½ -died. Of 302 cases in 1841 no fewer then 266 were from white-lead -manufactories.[1353] - - - SECTION III.—_Of the Morbid Appearances caused by Lead._ - -The morbid appearances caused by poisoning with lead are in some -respects peculiar. - -In acute poisoning, from the irritant action of its soluble salts, as in -the case of the drummer poisoned by Goulard’s extract, the lower end of -the gullet, the whole stomach and duodenum, part of the jejunum, and the -ascending and transverse colon, have been found much inflamed, and the -villous coat of the stomach as if macerated. In Mr. Taylor’s two cases -Dr. Bird found the villous coat of the stomach gray, but otherwise -natural; and the intestines were much contracted. - -The stomach in the first of these cases contained a reddish-brown, -sweetish, styptic fluid, in which lead was detected by chemical -analysis,[1354]—an important medico-legal fact, since the man survived -nearly three days. Some valuable observations have been made by -Professor Orfila as to the presence of lead in the textures of the -stomach in such instances. When small doses of acetate or nitrate of -lead were administered to dogs and allowed to act for two hours only, -the villous coat presented numerous streaks of white points, which -contained lead, as hydrosulphuric acid blackened them. These points, -though less distinct, were still visible, when the animals were allowed -to live four days after the excess of salt had been removed; and even -after seventeen days, although no such appearance remained, lead could -still be detected in the tissues of the stomach.[1355] - -The blood in animals is sometimes altered. Dr. Campbell found it fluid. -In a dog poisoned with litharge, the experimentalists of the Veterinary -School at Lyons found it of a vermilion colour in the veins, and -brighter than usual in the arteries.[1356] Mitscherlich also found it -unusually red and firmly coagulated.[1357] - -The appearances in the bodies of those who have died of the various -forms of lead colic are different, and wholly unconnected with -inflammation. - -The valuable work of Mérat contains four inspections after death from -the acute or comatose form of colica pictonum. The bodies were plump, -muscular and fat. The alimentary canal was quite empty, and the colon -much contracted,—in one to an extraordinary degree. The mucous coat of -the alimentary canal was everywhere healthy. He therefore infers that -the disease is an affection of the muscular coat only. It is a striking -circumstance, and conformable with what will be afterwards established -in regard to the true narcotics, that although both of the men died -convulsed and comatose, no morbid appearance was visible within the -head.[1358] Another case, which confirms the foregoing facts, has been -described by Mr. Deering. It was that of a lady who died convulsed after -suffering in the usual manner, and in whose body no trace of disease -could be detected any where.[1359] Senac informed Tronchin that he had -dissected above fifty cases of colica pictonum, and found no morbid -appearances.[1360] Schloepfer’s observations on animals are to the same -effect. In rabbits which died of colica pictonum the great intestines -were excessively contracted, but all the other organs of the body were -healthy except the liver, which was dark and brittle.[1361] Mitscherlich -observed in his animals extravasation of blood into the intestines, also -sometimes into the cavities of the pleura and peritoneum, and -occasionally under the peritoneal covering of the kidneys.[1362] The -only instance I have met with where morbid appearances were found within -the head, was in a case mentioned by Sir G. Baker, of a gentleman who -died apoplectic after many attacks of colica pictonum, and in whom the -brain was found unusually soft, and blood extravasated on its surface to -the amount of an ounce.[1363] - -The appearances in those who have been long affected with the paralytic -form of colica pictonum have been rarely observed in modern times. I am -indebted to my late colleague, Dr. Duncan, Junior, for an account of the -appearances in the intestinal canal of a plumber, who had been long and -frequently afflicted with colica pictonum and its sequelæ. The -intestines were dark, tender, and far advanced in putrefaction. The -cardiac orifice of the stomach was so narrow that it would admit a -goose-quill. The mesenteric glands were enlarged and hardened. The -thoracic duct was surrounded by many large bodies like diseased glands, -exactly of the colour of lead, and composed of organized cysts -containing apparently an inorganic matter. The analysis of this matter -was unfortunately neglected. The muscles in similar circumstances are -much diseased. When the paralysis is not of long standing, it appears -from the experiments of Schloepfer (whose animals survived about three -weeks), that the whole muscular system becomes pale, bloodless, and -flaccid. When the palsy is of long standing, this change increases so -much, that the muscles in some parts, as in the arms and thumbs, acquire -the colour and general aspect of white fibrous tissue. Some observations -on the nature of these changes will be found in the essays of Sir G. -Baker.[1364] The facts are communicated by Mr. John Hunter. On examining -the muscles of the arm and hand of a house-painter who was killed by an -accident, Mr. Hunter found them all of a cream colour, and very opaque, -their fibres distinct, and their texture unusually dry and tough. These -alterations he at first imagined might have been the result merely of -the palsy and consequent inactivity of the muscles, but on finding the -same alterations produced by the direct action of sugar of lead on -muscle, he inferred that the poison gradually effected a change either -on the muscles directly, or on the blood which supplied them. - -In a late elaborate inquiry into the pathology of lead-colic, M. -Tanquerel has arrived at the conclusion, that “the pathological -phenomena are not caused by anatomical changes cognisable by the -senses,” and that such appearances as may be found are the effects, not -the cause, of the disease.[1365] - - - SECTION IV.—_Of the Treatment of Poisoning with Lead._ - -The treatment of poisoning with lead, and the mode of protecting workmen -from its influence, will now require a few remarks. - -For the irritant form of poisoning, a safe and effectual antidote exists -in any of the soluble alkaline or earthy sulphates. If none of these be -at hand, then the alkaline carbonates may be given, particularly the -bicarbonates, which are not so irritating as the carbonates. The -phosphate of soda is also an excellent antidote. If the patient does not -vomit, it will be right also to give an emetic of the sulphate of zinc. -In other respects, the treatment does not differ from that of poisoning -with the irritants generally. - -Colica pictonum is usually treated in this country with great success by -a practice much followed here in colic and diarrhœa of all kinds,—the -conjunction of purgatives with anodynes. A full dose of a neutral -laxative salt is given, and an hour afterwards a full dose of opium. -Sometimes alvine discharges take place before the opium acts, more -commonly not till its action is past, and occasionally not for a -considerable time afterwards. But the pain and vomiting subside, the -restlessness and irritability pass away, and the bowels return nearly or -entirely to their natural condition. Sometimes it is necessary to repeat -the practice. It is almost always successful. I have seldom seen the -second dose fail to remove the colic, leaving the bowels at worst in a -state of constipation. Dr. Alderson of Hull, who has had many -opportunities of treating the workmen of a white-lead manufactory there, -says powerful purgatives, such as croton-oil, are highly serviceable in -severe cases, and are borne well notwithstanding the extreme debility -often present.[1366] M. Tanquerel says he has found this treatment more -effectual in Paris than any other means.[1367] When the pulse is full -and strong, I have seen venesection premised with apparent advantage; in -some instances it appeared to me to be called for by the flushing of the -face and the violence of the spasms; and I have never seen it otherwise -than a safe remedy, notwithstanding the fears expressed by Dr. Warren -and others.[1368] - -The hospital of La Charité in Paris has long enjoyed a high reputation -for the treatment of this disease. In the first place a decoction is -given of half an ounce of senna in a pound of water, mixed with half an -ounce of sulphate of magnesia and four ounces of the wine of antimony. -Next day an ounce of sulphate of magnesia and three grains of -tartar-emetic are administered in two pounds of infusion of cassia, to -keep up the operation of the first laxative. In the evening a clyster is -given, containing twelve ounces of wine and half as much oil. After this -the patient is made to vomit with tartar-emetic, then drenched with -_ptisanes_ for several days, and the treatment is wound up with another -dose of the first purgative succeeded by gentle anodynes. I am not aware -of any particular advantage possessed by this complicated and tormenting -method of cure, which is not equally possessed by the simpler plan -pursued in Britain. - -In 1831 M. Gendrin announced to the French Institute that he had found -sulphuric acid to be at once the most effectual remedy, and the most -certain preventive, for the injurious effects of lead; and he has -subsequently spoken in strong terms of the utility of this -treatment.[1369] But the experience of others does not bear out his -conclusions.[1370] - -Among the many other methods of cure that have been proposed for the -primary stage of this disease, salivation by mercury deserves to be -particularized. It appears to have been often used with success, the -colic yielding as soon as ptyalism sets in.[1371] If the case, however, -is severe, there is no time to lose in waiting for the action of the -mercury to commence. - -The treatment in the advanced period of the disease, when palsy is the -chief symptom remaining, depends almost entirely on regimen. The patient -must for a time at least quit altogether his unlucky trade. He should be -allowed the most generous food he can digest. He ought to take frequent -gentle exercise in the open air, but never to fatigue. The hands being -the most severely injured of the affected parts, and at the same time -the most important to the workman, the practitioner’s attention should -be directed peculiarly to the restoration of their muscular power. This -appears to be most easily brought about by frictions, electricity, and -regulated exercise, the hands being also supported in the intervals by -splints extending from the elbows to the fingers. The dragging of the -emaciated muscles by the weight of the dangling hands certainly seems to -retard recovery.—Strychnia has also been repeatedly found of service in -restoring muscular action. Tanquerel states that electricity and -strychnia, but especially the latter, have appeared to him by far the -most efficacious remedies both for muscular paralysis and for -amaurosis.—In the head affections the best treatment consists in relying -on nature and merely combating symptoms; and blood-letting is of no use, -however much it may seem to be indicated by the coma and convulsions. - -When a person has been once attacked with colica pictonum, he is more -easily attacked again. Hence if he is young enough, he should, if -possible, change his profession for one in which he is not brought into -proximity with lead. Few, however, have it in their power to do so. The -prophylaxis, therefore, or mode of preventing the influence of the -poison, becomes a subject of great importance; and more particularly -when we consider the vast number of workmen in different trades, whose -safety it is intended to secure. - -On this subject many useful instructions are laid down in the work of -Mérat. He very properly sets out with insisting on the utmost regard -being paid to cleanliness,—a point too much neglected by most artizans, -and particularly by those to whom it is most necessary, the artizans who -work with the metals. In proof of the importance of this rule, he -observes he knew a potter, who contracted the lead colic early in life -when he was accustomed to go about very dirty, but for thirty years -after had not any return of it, in consequence simply of a scrupulous -attention to cleanliness. In order to secure due cleanliness three -points should be attended to. In the first place, the face and hands -should be washed once a day at least, the mouth well rinsed, and the -hair occasionally combed. Secondly, frequent bathing is of great -consequence, both with a view to cleanliness and as a general tonic; so -that masters should provide their workmen with sufficient means and -opportunities for practising it. Lastly, the working clothes should be -made, not of woollen, but of strong, compact linen, should be changed -and washed at least once and still better twice a week, and should be -worn as little as possible out of the workshop. While at work a cap of -some light impervious material should always be worn. - -Next to cleanliness, the most important article of the prophylaxis -relates to the means for preventing the food being impregnated with -lead. For this end it is essential that the workmen never take their -meals in the workshop, and that before eating they wash their lips and -hands with soap and water, and brush out all particles of dirt from the -nails. It is also of moment that they breakfast before going to work in -the morning. - -Derangements of the digestive organs should be watched with great care. -If they appear to arise from the poison of lead, the individual should -leave off work with the very first symptom, and take a laxative. -Habitual constipation should be provided against. - -The nature of the diet of the workmen is of some consequence. It should -be as far as possible of a nutritive and digestible kind. Mérat condemns -in strong terms the small tart wines generally used by the lower ranks -of his countrymen. They constitute a very poor drink for all artizans; -and are peculiarly ill adapted for those who work with lead, because, -besides being at times themselves adulterated with that poison, they are -also apt to disorder the bowels by their acidity. Beer is infinitely -preferable. Various articles of diet have been recommended as tending to -impede the operation of the poison. Hoffmann recommends brandy, the -efficacy of which few workmen will dispute. There is some reason for -believing that the free use of fat and fatty articles of food is a -preservative. Dehaen was informed by the proprietor and the physician of -a lead mine in Styria, that the work-people were once very liable to -colic and palsy, but that, after being told by a quack doctor to eat a -good deal of fat, especially at breakfast, they were exempt for three -years.[1372] Another fact of the kind was communicated to Sir George -Baker by a physician at Osterhoüt, near Breda. The village contained a -great number of potters, among whom he did not witness a single case of -lead colic in the course of fifteen years; and he attributes their -immunity to their having lived much on cheese, butter, bacon, and other -fatty kinds of food.[1373] Mr. Wilson says, in his account of the colic -at Leadhills in Lanarkshire, that English workmen, who live much on fat -meat, suffer less than Scotchmen, who do not.[1374] - -Professor Liebig says that lead colic is unknown in all white-lead -manufactories, where the workmen use as a beverage lemonade or -sugar-water acidulated with sulphuric acid; and it was stated above that -the same announcement has been made by Mr. Gendrin. This, however, is -doubtful. The prophylactic effects of sulphuric acid have been denied in -France by M. Tanquerel,[1375] and M. Grisolle;[1376] the latter of whom -in particular says that no advantage whatever was derived from it at the -white-lead manufactory of Clichy near Paris. - -Some have likewise proposed as an additional preservative, that the -exposed parts of the body should be anointed with oily or fatty matters. -But Mérat maintains with some reason, that the lead will be thereby -enabled to penetrate the cuticle more easily by friction and pressure. - -The observance of the preceding rules will depend of course in a great -measure on the intelligence and docility of the workmen. It would appear -that particular care should be taken in hot weather, statistical facts -having shown that three times as many workmen are attacked in Paris -during the month of January as in July.[1377] - -Some other objects of much consequence are to be attained by the -humanity and skill of the masters. - -The workshop should be spacious, and both thoroughly and systematically -ventilated, the external air being freely admitted when the weather will -allow, and particular currents being established, by which floating -particles are carried away in certain invariable and known courses. -Miners and others who work at furnaces in which lead is smelted, fused, -or oxidated, should be protected by a strong draught through the -furnaces. According to Mr. Braid, wherever furnaces of such a -construction were built at Leadhills, the colic disappeared; while it -continued to recur where the furnaces were of the old, low-chimneyed -form. Manufacturers of litharge and red-lead used formerly to suffer -much in consequence of the furnaces being so constructed as to compel -them to inhale the fine dust of the oxides. In drawing the furnaces the -hot material is raked out upon the floor, which is two or three feet -below the aperture in the furnace; and the finer particles are therefore -driven up and diffused through the apartment. But this obvious danger is -now completely averted by a subsidiary chimney, which rises in front of -the drawing aperture, and through which a strong current of air is -attracted from the apartment, the hot material on the ground performing -the part of a fire. - -In white-lead manufactories a very important and simple improvement has -been effected of late in some places by abandoning the practice of -dry-grinding. In all manufactories of the kind, the ultimate pulverizing -of the white lead has been long performed under water. But in general -the preparatory process of rolling, by which the carbonate is separated -from the sheets of lead on which it is formed, continues to be executed -dry. This is a very dangerous operation, because the workmen must inhale -a great deal of the fine dust of the carbonate. In a white-lead -manufactory which formerly existed at Portobello, the process was -entirely performed under water or with damping; and to this precaution -in a great measure was imputed the improvement effected by the -proprietor in the health of the workmen, and their superior immunity -from disease over those of Hull and other places, where the same -precaution was not taken at that time. The only operation latterly -considered dangerous at the Portobello works was the emptying of the -drying stove, and the packing of the white lead in barrels; and the dust -diffused in that process was kept down as much as possible by the floor -being maintained constantly damp. By these precautions, by making the -workmen wash their hands and faces before leaving the works for their -meals, and by administering a brisk dose of castor oil on the first -appearance of any complaint of the stomach or bowels, the manufacturer -succeeded in extirpating colica pictonum entirely for several -years.—This trade continues to be a very pernicious one in France; for -no fewer than 266 cases of colic were admitted into the Parisian -hospitals in 1841 from the white-lead manufactories in and near the -capital. Yet facts are not wanting there to prove that with proper care -the disease may be all but extirpated. A French manufacturer, whose -workmen at one time suffered severely, had no case of colic among them -for nine years after breaking them in to the observance of due -precautions.[1378] Another says, from his own experience and information -obtained at other works, he is satisfied the risk is very much greater -among the intemperate than among sober workmen.[1379] - - - - - CHAPTER XIX. - OF POISONING WITH BARYTA. - - -Baryta and its salts, the last genus of the metallic irritants which -requires particular notice, are commonly arranged among earthy -substances, but on account of their chemical and physiological -properties, may be correctly considered in the present place. These -poisons are worthy of notice, because they are not only energetic, but -likewise easily procured, so that they may be more extensively used, -when more generally known. - - - SECTION I.—_Of the Chemical Tests for the preparations of Baryta._ - -Three compounds of this substance may be mentioned, the pure earth or -oxide, the muriate, or chloride of barium, and the carbonate. The pure -earth, however, is so little seen, that it is unnecessary to describe -its chemical or physiological properties. - -The _Carbonate of Baryta_ is met with in two states. Sometimes it is -native, and then commonly occurs in radiated crystalline masses, of -different degrees of coarseness of fibre, nearly colourless, very heavy, -and effervescing with diluted muriatic acid. It is also sold in the -shops in the form of a fine powder of a white colour, prepared -artificially by precipitating a soluble salt of baryta with an alkaline -carbonate. It is best known by its colour, insolubility in water, -solubility with effervescence in muriatic acid, and the properties of -the resulting muriate of baryta. - -The _Muriate of Baryta_, or chloride of barium, is the most common of -the compounds of this earth, having been for some time used in medicine -for scrofulous and other constitutional disorders. It is procured either -by evaporating the solution of the carbonate in hydrochloric acid, or by -decomposing a more common mineral, the sulphate, by means of charcoal -aided by heat, dissolving in boiling water the sulphuret so formed, and -decomposing this sulphuret by hydrochloric acid. - -It is commonly met with in the shops irregularly crystallized in tables. -It has an acrid, irritating taste, is permanent in the air, and -dissolves in two parts and a half of temperate water. - -The solution is distinguished from other substances by the following -chemical characters. From all other metallic poisons hitherto mentioned, -it is easily distinguished by means of hydrosulphuric acid, which does -not cause any change in barytic solutions. From the alkaline and -magnesian salts it is distinguished by the effects of the alkaline -sulphates, which have no visible action except on the barytic solution, -and cause in it a heavy white precipitate, insoluble in nitric acid. -From the chlorides of calcium and strontium, it is to be distinguished -by evaporating the solution till it crystallizes. The crystals are known -not to be chloride of calcium, because they are not deliquescent. The -chloride of strontium (which resembles that of barium in many -properties, but which must be carefully distinguished, as it is not -poisonous), differs in the form of the crystals, which are delicate -six-sided prisms, while those of the barytic salt are four-sided tables, -often truncated on two opposite angles, sometimes on all four,—by its -solubility in alcohol, which does not take up the chloride of -barium,—and by its effect on the flame of alcohol, which it colours -rose-red, while the barytic salts colour it yellow. The chloride of -barium is known from other soluble barytic salts, by the action of -nitrate of silver, which throws down a white precipitate. - -Vegetable and animal fluids do not decompose the solution of chloride of -barium, except by reason of the sulphates and carbonates which most of -them contain in small quantities. But the action of its tests may be -distinguished, although the salt has not undergone decomposition. In -that case the most convenient method of analysis is to add a little -nitric acid, which will dissolve any carbonate of baryta that may have -been formed,—to filter and then throw down the whole baryta in the form -of sulphate, by means of the sulphate of soda,—and to collect the -precipitate, and calcine it with charcoal for half an hour in a platinum -spoon or earthen crucible, according to the quantity. A sulphuret of -baryta will thus be procured, which is to be dissolved out by boiling -water, and decomposed after filtration by muriatic acid. A pure solution -is thus easily obtained. Orfila has lately proposed a process more -complex in its details, but the same in principle.[1380] - - -SECTION II.—_Of the Action of the Salts of Baryta, and the Symptoms they - excite in Man._ - -The action of the barytic salts on the body is energetic. Like most -metallic poisons, they seem to possess a twofold action,—one local and -irritating, the other remote and indicated by narcotic symptoms. This -narcotic action is more decided and invariable than in the instance of -any of the metallic poisons hitherto noticed. Such at least is the -result of the experiments of Sir B. Brodie,[1381] which have since been -amply confirmed by Professor Orfila[1382] and Professor Gmelin.[1383] -Orfila found that when the chloride was injected into the veins of a dog -in the dose of five grains only, death ensued in six minutes, and was -preceded by convulsions, at first partial, but afterwards affecting the -whole body. Sir B. Brodie found the same effects follow in twenty -minutes, when ten grains were applied to a wound in the back of a -rabbit,—the convulsions being preceded by palsy, and ending in coma. -Half an ounce when injected into the stomach excited the same symptoms -in a cat, and proved fatal in sixty-five minutes, though the animal -vomited. Schloepfer observed, that when a scruple, dissolved in two -drachms of water, was injected into the windpipe of a rabbit, it fell -down immediately, threw back its head, was convulsed in the fore-legs, -and died in twelve minutes.[1384] Gmelin observed in his experiments -that it caused slight inflammation of the stomach, and strong symptoms -of an action on the brain, spine, and voluntary muscles. He found the -voluntary muscles destitute of contractility immediately after death; -yet the heart continued to contract vigorously for some time, even -without the application of any stimulus. From some experiments made on -horses by Huzard and Biron, by order of the Société de Santé of Paris, -it appears that the hydrochlorate, when given to these animals in the -dose of two drachms daily, produced sudden death about the fifteenth -day, without previous symptoms of any consequence.[1385] In the -experiments now related, very little appearance of inflammation was -found in the parts to which the poison was directly applied. It is also -worthy of remark that the heart does not seem to have been particularly -affected; and yet according to the recent researches of Mr. Blake, the -barytic salts are the most powerful of all inorganic poisons in their -action on the heart, when they are injected into the veins. A quarter of -a grain of the chloride appreciably depresses arterial action; two -grains completely arrest the heart’s contractions in twelve seconds; and -when it is injected back into the aorta from the axillary artery, it -causes at first some obstruction to the capillary circulation, but soon -arrests the action of the heart, as when it is introduced into the -veins.[1386] - -The pure earth appears to produce nearly the same effects in an inferior -dose. When swallowed, the symptoms of local irritation are more violent; -but death ensues in a very short space of time, and is preceded by -convulsions and insensibility. The stomach after death is found of a -reddish-black colour, and frequently with spots of extravasated blood in -its villous coat. - -The carbonate in a state of minute division is scarcely less active than -the hydrochlorate, since it is dissolved by the acid juices of the -stomach. A drachm killed a dog in six hours; vomiting, expressions of -pain, and an approach to insensibility preceded death; and marks of -inflammation were found in the stomach.[1387] Pelletier made many -experiments on the poisonous properties of the carbonate. Fifteen grains -of the native carbonate killed one dog in eight hours, and another in -fifteen.[1388] Dr. Campbell found it to be a dangerous poison, even when -applied externally. Twelve grains introduced into a wound in the neck of -a cat, excited on the third day languor, slow respiration, and feeble -pulse; towards evening the animal became affected with convulsions of -the hind-legs and with dilated pupils; and death followed not long -afterwards.[1389] This substance, before its real nature was known, used -at one time to be employed in some parts of England as a variety of -arsenic for poisoning rats. - -The salts of baryta are absorbed in the course of their action. The -chloride has been detected by Dr. Kramer both in the blood and urine by -incineration with carbonate of potash, washing the ashes with weak -solution of carbonate of potash, dissolving the residue in diluted -nitric acid, and testing the solution for baryta.[1390] Orfila has also -obtained baryta, by his process alluded to above, in the liver, kidneys, -and spleen of animals killed by the chloride.[1391] - -The symptoms produced by the salts of baryta in man have seldom been -particularly described. An instance is shortly noticed in the Journal of -Science, where an ounce of the hydrochlorate was taken by mistake for -Glauber’s salt, and proved fatal. The patient immediately after -swallowing it felt a sense of burning in the stomach; vomiting, -convulsions, headache, and deafness ensued; and death took place within -an hour.[1392] A similar case, fatal in two hours, has been related by -Dr. Wach of Merseburg. A middle-aged woman who, though generally in good -health, had suffered for a day or two from pains in the stomach, took -one morning a solution of half an ounce of chloride of barium by mistake -for sulphate of soda. She was soon seized with sickness, retching, -convulsive twitches of the hands and feet, vomiting of clear mucus, -great anxiety, restlessness, and loss of voice; and she died under -constant efforts to vomit, and violent convulsive movements, but with -her faculties entire.[1393] - -Unpleasant effects have been observed from too large doses of the -chloride administered medicinally. A case is mentioned in the Medical -Commentaries of a gentleman who was directed to take a solution as a -stomachic, but swallowed one evening by accident so much as seventy or -eighty drops. He had soon after profuse purging without tormina, then -vomiting, and half an hour after swallowing the salt excessive muscular -debility, amounting to absolute paraplegia of the limbs. This state -lasted about twenty-four hours, and then gradually went off.[1394] I -have known violent vomiting, gripes, and diarrhœa produced in like -manner by a quantity not much exceeding the usual medicinal doses. - -Dr. Wilson of London has lately described a distinct case of poisoning -with the carbonate. The quantity taken was half a tea-cupful; but -emetics were given, and operated before any symptoms showed themselves. -In two hours the patient complained of dimness of sight, double vision, -headache, tinnitus, and a sense of distension in the stomach, and -subsequently of pains in the knees and cramps of the legs, with -occasional vomiting and purging next day; for some days afterwards the -head symptoms continued, though more mildly, and she was much subject to -severe palpitations; but she was in the way of recovery when the account -of her case was published.[1395] Mr. Parkes mentions that, according to -information communicated to him by the proprietor of an estate in -Lancashire, where carbonate of baryta abounds, many domestic animals on -his estate died in consequence of licking the dust of the carbonate, and -that it once proved fatal to two persons, a woman and her child, who -took each about a drachm.[1396] Dr. Johnstone says he once swallowed ten -grains of this compound, without experiencing any bad effect.[1397] - - -SECTION III.—_Of the Morbid Appearances caused by the Salts of Baryta._ - -In animals the mucous membrane of the stomach is usually found of a -deep-red colour, unless death take place with great rapidity, in which -case the alimentary canal is healthy. In all the animals, which in Dr. -Campbell’s experiments were killed by the application of the muriate to -wounds, the brain and its membranes were much injected with blood; and -in one of them the appearances were precisely those of congestive -apoplexy. - -In Wach’s case the stomach was dark brownish-red externally, and the -small intestines brighter red. Internally the stomach presented uniform -deep redness, with clots of blood, and bloody mucus scattered over it; -and near the cardiac end there was a perforation, above half an inch in -diameter within, and half as wide at the outside, and surrounded with -swollen edges and extensive thickening of the villous coat. The small -intestines were internally very red and lined with red mucus -interspersed with clots of blood. The great intestines were extremely -contracted. The lungs were gorged, the heart full of dark liquid blood, -and the cerebral vessels distended. Chloride of barium was detected in -the stomach and intestines. The perforation in this case was evidently -an accidental concurrence. - - - SECTION IV.—_Of the Treatment._ - -The treatment of this variety of poisoning consists chiefly in the -speedy administration of some alkaline or earthy sulphate, such as the -sulphate of soda or sulphate of magnesia. The poison is thus immediately -converted into the insoluble sulphate of baryta, which is quite inert. -Two drachms of muriate of baryta were injected by Orfila into the -stomach of a dog, and eight minutes afterwards two drachms of sulphate -of soda. The gullet was then secured by a ligature. At first efforts -were made to vomit, and in an hour sulphate of baryta was discharged -with the alvine evacuations. There was neither insensibility nor -convulsions; and the next morning the animal evidently suffered only -from the ligature on the gullet. This fact not only proves the efficacy -of the sulphate, but likewise shows that in the kinds of poisoning where -diarrhœa occurs, the poison is very soon discharged, and ought therefore -to be looked for in the evacuations from the bowels.[1398] - - -A few observations may be here added on the effects of the salts of -_strontia_ on the animal frame. These compounds bear a close resemblance -to the salts of baryta, and the two earths were consequently long -confounded together till Dr. Hope pointed out their distinctions. One of -the most striking differences is, that the salts of the strontia are -very feebly poisonous. Some experiments of this purport were made by M. -Pelletier of Paris,[1399] and by Blumenbach; but the most accurate -researches are those of Professor Gmelin. He found that ten grains of -the chloride in solution had no effect when injected into the jugular -vein of a dog,—that two drachms had no effect when introduced into the -stomach of a rabbit,—that half an ounce was required to cause death in -that way,—that two drachms of the carbonate had no effect,—and that two -drachms of the nitrate, dissolved in six parts of water and given to a -rabbit, merely caused increase of the frequency and hardness of the -pulse and a brisk diarrhœa.[1400] Mr. Blake also found that small doses -of the salts of strontia have little effect when injected into the -veins; but that forty grains arrest the action of the heart in fifteen -seconds.[1401] - - - - - CHAPTER XX. - - -The fourth order of the irritant poisons contains a great number of -genera derived from the vegetable kingdom, and at one time commonly -arranged in a class by themselves under the title of Acrid Poisons. The -order includes many plants of the natural families _Ranunculaceæ_, -_Cucurbitaceæ_, and _Euphorbiaceæ_, and other plants scattered -throughout the botanical system. It likewise comprehends a second group -consisting of some acrid poisons from the animal kingdom, namely, -cantharides, poisonous fishes, poisonous serpents, and animal matters -become poisonous by disease or putrefaction. - - - OF POISONING WITH THE VEGETABLE ACRIDS. - -The vegetable acrids are the most characteristic poisons of this order. -They will not require many details, as they are seldom resorted to for -criminal purposes, and their mode of action, their symptoms, and their -morbid appearances are nearly the same in all. - -We are chiefly indebted to Professor Orfila for our knowledge of their -_mode of action_. He has subjected them to two sets of experiments. In -the first place, he introduced the poison in various doses into the -stomach, sometimes tying the gullet, sometimes not: and, secondly, he -applied the poison to the subcutaneous cellular tissue by thrusting it -into a recent wound. - -In the former way he found that, unless the gullet was tied, the animal -soon discharged the poison by vomiting, and generally recovered; but -that, if the gullet was tied, death might be caused in no long time by -moderate doses. The symptoms were seldom remarkable. Commonly efforts -were made to vomit; frequently diarrhœa followed; then languor and -listlessness; sometimes, though not always, expressions of pain; very -rarely convulsions; and death generally took place during the first day, -often within three, six, or eight hours. The appearances in the dead -body were redness over the whole mucous coat of the stomach, at times -remarkably vivid, often barely perceptible, and occasionally attended -with ulcers; very often a similar state of the whole intestines, more -especially of the rectum; and in some instances a slight increase of -density, with diminished crepitation, in patches of the lungs. - -When the poison, on the other hand, was applied to a recent wound of the -leg, the animal commonly whined more or less; great languor soon -followed; and death took place on the first or second day, without -convulsions or any other symptom of note. It was seldom that any morbid -appearance could then be discovered in the bowels. But in every instance -active inflammation was found in the wound, extending to the limb above -it and even upwards on the trunk. Every part affected was gorged with -blood and serum; and an eschar was never formed. The appearances in -short were precisely those of diffuse inflammation of the cellular -tissue, when it proves fatal in its early stage.[1402] - -Since these poisons do not appear to act more energetically through a -wound than through the stomach, it has been generally inferred that they -do not enter the blood, and consequently that the local impression they -produce is conveyed to distant organs through the nerves. This inference -is correct in regard to such species of the vegetable acrids as act in -small doses. But the validity of the conclusion may be questioned when -the poison acts only in large doses, as in the case with many of those -now under consideration. For they cannot be applied to a wound over a -surface equal to that of the stomach, and may therefore be more slowly -absorbed in the former than in the latter situation. And, in point of -fact, a few plants of the present order have been found to act through -the medium of absorption, as soon as chemistry discovered their active -principles, and thus enabled the physiologist to get rid of fallacy by -using the poison in small quantity. This principle has been proved to be -in some plants a peculiar resin, in others a peculiar extractive matter, -in others an oil, in others an alkaloid, and in others a neutral -crystalline matter. But in all there exists some principle or other in -which are concentrated the poisonous properties of the plant. Some of -these principles appear to act through the medium of the blood. - -There is no doubt, however, but many plants of the present order, as -well as their active principles, have a totally different and very -peculiar action. They produce violent spreading inflammation of the -subcutaneous cellular tissue, and acute inflammation of the stomach and -intestines, without entering the blood; and death is the consequence of -a sympathy of remote organs with the parts directly injured. - -As to their forming a natural order of poisons, it is evident, that if a -general view be taken of their properties, they are distinguished by -obvious phenomena from the three orders hitherto noticed. But if their -effects on man be alone taken into account, when of course their -influence on the external surface of the body must be left out of view, -nothing will be discovered to distinguish them from several of the -metallic irritants. - -The _symptoms_ occasioned in man by the irritant poisons of the -vegetable kingdom, are chiefly those indicating inflammation of the -villous coat of the stomach and intestines. When taken in large doses, -they excite vomiting soon after they are swallowed; by which means the -patient’s life is often saved. But sometimes, like the mineral poisons -that possess emetic properties, the vegetable acrids present a singular -uncertainty in this respect: they may be retained without much -inconvenience for some length of time. If this should happen, or if the -dose be less, in which case vomiting may not be produced at all, or if -only part of a large dose be discharged at an early period by -vomiting,—the other phenomena they give rise to are sometimes fully -developed. The most conspicuous symptom then is diarrhœa, more or less -profuse. The diarrhœa and vomiting are commonly attended by twisting -pain of the belly, at first remittent, but gradually more constant, as -the inflammation becomes more and more strongly marked. Tension, fulness -and tenderness of the belly, are then not unfrequent. The stools may -assume all the characters of the discharges in natural inflammation of -the intestinal mucous membrane, but an additional character worthy of -notice is the appearance of fragments of leaves or flowers belonging to -the plant which has been swallowed. At the same time there is generally -excessive weakness. Sometimes, too, giddiness and a tendency to delirium -have been observed. But the latter symptoms are rare: if they occurred -frequently, it would be necessary to transfer any poison which produced -them to the class of narcotico-acrids. - -The properties now mentioned have long ago attracted the attention of -physicians, and led them to introduce many vegetable irritants into the -materia medica. In fact they comprehended a great number of the most -active, or, as they are technically called, drastic purgatives. Among -others, elaterium, euphorbium, gamboge, colocynth, scammony, croton, -jalap, savin, stavesacre, are of this description. The effect of most of -them, however, is so violent and uncertain, that few are now much used -except when combined with other milder laxatives. - -The _morbid appearances_ they leave in the dead body are the same with -those noticed under the head of their mode of action,—more or less -redness of the stomach, ulceration of its villous coat, redness of the -intestines, and especially of the rectum and colon, which are often -inflamed when the small intestines are not visibly affected. - -In the following account of the particular poisons of this order, a very -cursory view will be taken of their physical and chemical properties. A -knowledge of these properties will be best acquired from any author on -the materia medica; and an account of them would be misplaced in a work -which professes to describe only the leading objects of the medical -jurist’s attention. - -A great number of genera might be arranged under the present head. But -the following list comprehends all which require mention. _Euphorbia_, -or spurge, the _ricinus_, or castor-oil tree, the _jatropha_, or -cassava-plant, croton-oil, _elaterium_, or squirting cucumber, -_colocynth_, or bitter-apple, _bryony_, or wild cucumber, _ranunculus_, -or buttercup, _anemone_, _stavesacre_, _celandine_, _marsh marigold_, -_mezereon_, _spurge-laurel_, _savine_, _daffodil_, _jalap_, -_manchineel_, _cuckow-pint_. - -The first plants to be noticed belong to the natural order -_Euphorbiaceæ_, namely, the euphorbia, ricinus, jatropha, and croton. - - - _Of Poisoning with Euphorbium._ - -_Euphorbium_ is the inspissated juice of various plants of the genus -euphorbia or spurge, but is principally procured from the _E. -officinarum_, a species that abounds in Northern Africa. It contains a -variety of principles; but its chief ingredient is a resin, in which its -active properties reside. It has been analysed by Braconnot, Pelletier, -Brandes,[1403] and Drs. Buchner and Herberger. According to Brandes the -resin forms above 44 per cent. of the crude drug, and is so very acrid, -that the eyelid is inflamed by rubbing it with the finger which has -touched the resin, even although it be subsequently washed with an -alkali.[1404] According to the most recent analysis, that of Drs. -Buchner and Herberger, this resin is a compound substance, which -consists of two resinous principles, one possessing in some degree the -properties of an acid, and the other the properties of a base. The -latter, which they have called euphorbin, is considered by them the true -active principle of euphorbium.[1405] It will be mentioned under the -head of Jalap, that they have taken the same view of the nature of other -resinous poisons. - -Orfila found that a large dog was killed in twenty-six hours and a half -by half an ounce of powder of euphorbium introduced into the stomach, -and retained there by a ligature on the gullet. - -The whole coats of the stomach, but especially the villous membrane, -were of a deep-red or almost black colour; the colon, and still more the -rectum, were of a lively red internally, and their inner membrane was -checkered with little ulcers. Two drachms of the powder thrust into a -wound in the thigh, and secured by covering it with the flaps of the -incision, killed a dog in twenty-seven hours; and death was preceded by -no remarkable symptom except great languor. The wounded limb was found -after death highly inflamed, and the redness and sanguinolent -infiltration, which were alluded to in the general observations on the -vegetable acrids, extended from the knee as high up the trunk as the -fifth rib,—a striking proof of the rapidity with which this variety of -inflammation diffuses itself.[1406] Mr. Blake concludes from his -experiments, that euphorbium, when injected in a state of solution in -the jugular vein, acts by obstructing both the pulmonary and systemic -capillaries, and so preventing the passage of the blood into the left -side of the heart; but that the heart is not primarily acted on.[1407] - -The most common symptoms occasioned in man by euphorbium are violent -griping and purging, and excessive exhaustion; but it appears probable -that narcotic symptoms are also at times induced. A case of irritant -poisoning with it has been related in the Philosophical Transactions; -but it is not a pure one, as a large quantity of camphor was taken at -the same time. Much irritation was produced in the alimentary canal; but -by the prompt excitement of vomiting and the subsequent use of opium the -patient soon recovered.[1408] Mr. Furnival has related a fatal case -which arose from a farrier having given a man a tea-spoonful by mistake -for rhubarb. Burning heat in the throat and then in the stomach, -vomiting, irregular hurried pulse, and cold perspiration were the -leading symptoms; and the person died in three days. Several gangrenous -spots were found in the stomach, and its coats tore with the slightest -touch.[1409] The operation of this substance is so violent and -uncertain, that it has long ceased to be employed inwardly in the -regular practice of medicine, and has been even excluded from some -modern Pharmacopœias. It is still used by farriers as an external -application; and in the Infirmary of this city I met with a fatal case -of poisoning in the human subject, which was supposed to have been -produced by a mixture containing it, and intended to cure horses of the -grease. Pyl has related the proceedings in a prosecution against a man -for putting powder of euphorbium into his maid-servant’s bed; and from -this narrative it appears, that, when applied to the sound skin, it -causes violent heat, itching and smarting, succeeded by inflammation and -blisters.[1410] Dr. Veitch denies that the powder has any such -power;[1411] but the effects described by Pyl correspond with popular -belief. - -Probably all the species of euphorbium possess the same properties as -_E. officinarum_. Orfila found that the juice of the leaves of E. -_cyparissias_ and _lathyris_ produces precisely the effects described -above. Sproegel applied the juice of the latter to his face, and was -attacked in consequence with an eruption like nettle-rash; and he found -that it caused warts and hair to drop out.[1412] Vicat mentions -analogous facts, and Lamotte notices the case of a patient who died in -consequence of a clyster having been prepared with this species instead -of the mercurialis.[1413] The seeds and root of the _E. lathyris_ or -caper-spurge are used by the inhabitants of the northern Alps in the -dose of fifteen grains as an emetic; and very lately the oil of the -seeds has been employed in Italy as an active purgative, which in the -dose of two or eight grains is said to possess all the efficacy of -croton oil.[1414] MM. Chevallier and Aubergier have also found the seeds -of the _E. hybeua_ and their expressed oil to be very energetic. The -seeds yield 44 per cent. of oil, which in the dose of ten drops produces -copious watery evacuations without pain, and resembles closely -croton-oil in its effects.[1415] The _E. esula_ appears to be a very -active species. Scopoli says that a woman who took thirty grains of the -root died in half an hour, and that he once knew it cause fatal gangrene -when imprudently applied to the skin of the belly.[1416] Withering -observes that all the indigenous species blister and ulcerate the skin, -and that many of them are used by country people for these -purposes.[1417] - -I have no where seen any notice taken by authors of narcotic symptoms as -the effect of poisoning with euphorbium; and indeed this substance has -always been considered a pure irritant. I am informed, however, by the -Messrs. Herring, wholesale druggists in London, that their workmen are -subject to headache, giddiness and stupor, if they do not carefully -avoid the dust thrown up while it is ground in the mill; and that the -men themselves are familiarly acquainted with this risk. An analogous -fact has likewise been communicated to me by Dr. Hood of this city, -relative to the effects of the seeds of the _E. lathyris_. A child two -years of age ate some of the seeds, and soon after vomited severely, -which is the usual effect. Drowsiness, however, succeeded; and after a -few returns of vomiting, which were promoted by an emetic, deep sleep -gradually came on, broken by convulsions, stertorous breathing and -sighs. Sensibility was somewhat restored by blood-letting and the warm -bath; after which the tendency to sleep was interrupted by frequent -agitation and exercise in the open air. The vomiting then recurred for a -time; but the child eventually got well. - - - _Of Poisoning with the Seeds of the Castor-Oil Tree._ - -_Castor-oil_ at present so extensively used as a mild and effectual -laxative, is nevertheless derived from a plant hardly inferior in -activity as a poison to that just considered. It is the expressed oil of -the seeds of the _Ricinus communis_ or Palma Christi. Much discussion -has taken place as to the source of the acrid properties of this seed, -some supposing that they reside in the embryo, others in the perisperm, -others in the cotyledon, others in a principle formed from the oil by -heat; and the question is scarcely yet settled. It is certain, however, -that, although castor oil owes its occasional acridity to changes -effected by the heat to which it is sometimes exposed in the process of -separation, nevertheless the cotyledons are in themselves acrid.[1418] - -Two or three of the seeds will operate as a violent cathartic. Bergius, -as quoted by Orfila, says he knew a stout man who was attacked with -profuse vomiting and purging after having masticated a single seed. -Lanzoni met with an instance where three grains of the fresh seeds, -taken by a young woman, caused so violent vomiting, hiccup, pain in the -stomach, and faintness, that for some time her life was considered in -great danger.[1419] Mr. Alfred Taylor met with three cases of poisoning -with castor-oil seeds. Two sisters, who took each from two to four -seeds, suffered severely; and a third, who took twenty, died in five -days, with symptoms like those of malignant cholera.[1420] Climate -probably affects their activity; for I have known a person eat without -any effect several seeds ripened in the open air in this neighbourhood. -Dogs vomit so easily that they may take thirty seeds without material -inconvenience, if the gullet is not tied. But if the gullet is secured, -a much less quantity will occasion death in six hours. They produce -violent inflammation when applied to a wound.[1421] - - - _Of Poisoning with the Physic-nut._ - -The plants of the genus _Jatropha_, belonging to the same natural -family, have all of them the same acrid properties as the castor-oil -tree. The seeds of the _J. curcas_, the physic-nut of the West Indies, -when applied in the form of powder to a wound, produce violent spreading -inflammation of the subcutaneous cellular tissue; and when introduced -into the stomach they inflame that organ and the intestines.[1422] Four -seeds will act on man as a powerful cathartic.[1423] I have known -violent vomiting and purging occasioned by a few grains of the cake, -left after expression of the fixed oil from the bruised seeds; and in -some experiments performed a few years ago, I found that twelve or -fifteen drops of the oil produced exactly the same effects as an ounce -of castor-oil, though not with such certainty. In the last edition of -this work some observations were made, on the authority of MM. Pelletier -and Caventou, respecting the properties of a pure oil and a volatile -acid, supposed by them to exist in the physic-nut; but they analyzed the -croton seed by mistake for it. - -Two other species have been also examined, but not with care, namely, -the _Jatropha multifida_, and the _Jatropha_ or _Janipha manihot_. It is -probable that the seeds of both are acrid, and also the oil which may be -extracted from them by pressure. But a much more interesting part of the -latter species in a toxicological point of view is the root; the juice -of which is a most energetic poison. The _Janipha manihot_, or -cassava-plant, has two varieties, one of which produces a small, -spindle-shaped, bland root, called, in the West Indies, sweet cassava, -while the other has a much larger, bitter, poisonous root, called bitter -cassava, and in universal use for obtaining the well-known amylaceous -substance, tapioca. The juice of the bitter variety is watery, and so -poisonous that, according to Dr. Clark of Dominica, negroes have been -killed in an hour by drinking half a pint of it.[1424] It has been -commonly, but erroneously, arranged among acrid poisons. It really -belongs to the narcotic class, for it occasions coma and convulsions. -And we now know the cause of this extraordinary anomaly in the natural -family to which the species belongs; because MM. Henry and Boutron -ascertained that the juice imported into France, as well as what they -expressed from fresh roots sent from the West Indies, contains -hydrocyanic acid, produces in animals all the usual effects of that -poison, and is rendered inert by such means as will remove the acid,—for -example, by the addition of nitrate of silver.[1425] I confirmed this -singular discovery in 1838 by examination of some well-preserved juice -from Demerara. It is easy to see how tapioca, which is obtained from the -poisonous root by careful elutriation, becomes quite bland during the -process. - - - _Of Poisoning with Manchineel._ - -The _manchineel_ [_Hippomane mancinella_], another plant of the same -natural family, contains a milky juice, which is possessed of very acrid -properties. Orfila and Ollivier have made some careful experiments with -it on animals,[1426] and M. Ricord has since added some observations on -its effects on man.[1427] From the former it appears that two drachms of -the juice applied to a wound in a dog will cause death in twenty-eight -hours, by exciting diffuse cellular inflammation; and that half that -quantity will prove fatal in nine hours when introduced into the -stomach. From the observations of M. Ricord it follows that inflammation -is excited wherever the juice is applied, even in the sound skin; but he -denies the generally received notion, that similar effects ensue from -sleeping under the branches of the tree, or receiving drops of moisture -from the leaves. This notion, however, it is right to add, has been -adopted by other recent authors. Descourtils, for example, states that -it is dangerous to sleep under the tree; that drops of rain from the -leaves will blister any part of the skin on which they fall; and that on -these accounts the police of St. Domingo were in the practice of -destroying the trees wherever they grew.[1428] Other species of -Hippomane are equally poisonous. The _H. biglandulosa_ and _H. spinosa_ -are peculiarly so, especially the latter, which is known to the negroes -of St. Domingo by the name of Zombi apple, and is familiarly used by -them as a potent poison.[1429] - - - _Of Poisoning with Croton._ - -The oil of the _Croton Tiglium_ has been familiarly known for some years -as a very powerful hydragogue cathartic in the dose of a few drops; and -therefore little doubt could exist that both the oil and the seed which -yields it must be active irritant poisons in moderate doses. Accordingly -it has been lately found by experiments in Germany that forty seeds will -kill a horse in the course of seven hours;[1430] and Rumphius mentions -that it was a common poison in his time at Amboyna among the natives. I -have known most violent watery purging and great prostration caused by -four drops of the expressed oil. A fatal case of poisoning with it -occurred not long ago in France. A young man who swallowed two drachms -and a half of the oil by mistake, instead of using it as an embrocation, -was soon seized with tenderness of the belly, violent efforts to vomit, -cold sweating, laborious respiration, blueness of the lips and fingers, -and an almost imperceptible pulse,—then with profuse, involuntary -discharges by stool, burning along the throat and gullet, and -insensibility of the skin;—and in four hours he expired. The villous -coat of the stomach was soft, but not otherwise injured.[1431] - -The activity of the seed and oil seems to depend on a peculiar volatile -acid, which was discovered by MM. Pelletier and Caventou when they -analysed the croton seed by mistake as the seed of the _Jatropha -curcas_, or physic-nut. When the oil was saponified by potash and then -freed of the acid by distillation, it became inert. On the other hand, -the acid was found by them to excite inflammation of the stomach, and -spreading inflammation of the cellular tissue, according as it was -administered internally or applied to a wound.[1432] - -The next natural family in which plants are to be found that possess the -properties of the acrid poisons, is the _Cucurbitaceæ_, or gourds. This -family, it should be remarked, does not in general possess poisonous -properties. On the contrary, they are, with a few exceptions, remarkably -mild; and many of them supply articles of luxury for the table. The -melon, gourd, and cucumber belong to the order. The only poisons of the -order which have been examined with any care are elaterium, bryony, and -colocynth. - - - _Of Poisoning with Bryony._ - -The roots of the _Bryonia alba_ and _Dioica_ possesses properties -essentially the same with those of euphorbium. The _B. dioica_ is a -native of Britain, where it grows among hedges, and is usually known by -the name of wild vine, or bryony. The flowers are greenish, and are -succeeded by small, red berries. The root, which is the most active part -of the plant, is spindle-shaped, and varies in size from that of a man’s -thigh to that of a radish. - -Orfila found that half an ounce of the root introduced into the stomach -of a dog, killed it in twenty-four hours, when the gullet was tied; and -that two drachms and a half applied to a wound brought on violent -inflammation and suppuration of the part, ending fatally in sixty -hours.[1433] - -Bryony root owes its power to an extractive matter discovered in it by -Brandes and Firnhaber, to which the name of Bryonine has been given. -According to the experiments of Collard de Martigny, bryonine acts on -the stomach and on a wound exactly as the root itself, but more -energetically. When introduced into the cavity of the pleura it causes -rapid death by true pleurisy, ending in the effusion of fibrin.[1434] - -Before bryony-root was expelled from medical practice, it was often -known to produce violent vomiting, tormina, profuse watery evacuations, -and fainting. Pyl mentions a fatal case of poisoning with it, which -happened at Cambray in France. The subject was a man who took two -glasses of an infusion of the root to cure ague, and was soon after -seized with violent tormina and purging, which nothing could arrest, and -which soon terminated fatally.[1435] Orfila quotes a similar case from -the Gazette de Santé, which proved fatal within four hours, in -consequence of a strong decoction of an ounce of the root having been -administered, partly by the mouth and partly in a clyster, to repel the -secretion of milk.[1436] - - - _Of Poisoning with Colocynth._ - -Colocynth, or bitter-apple, is another very active and more common acrid -derived from a plant of the same family, the Cucumis colocynthis. It is -imported into this country in the form of a roundish, dry, light fruit, -as big as an orange, of a yellowish-white colour, and excessively bitter -taste. Its active principle is probably a resinoid matter discovered by -Vauquelin, which is very soluble in alcohol and sparingly so in water, -but which imparts even to the latter an intensely bitter taste.[1437] It -is termed Colocynthin. - -According to the experiments of Orfila, colocynth powder or its -decoction produces the usual effects of the acrid vegetables on the -stomach and on the subcutaneous cellular tissue. Three drachms proved -fatal in fifteen hours to a dog through the former channel when the -gullet was tied, and two drachms killed another when applied to a -wound.[1438] - -A considerable number of severe cases of poisoning with this substance -have occurred in the human subject; and a few have proved fatal. Tulpius -notices the case of a man who was nearly carried off by profuse, bloody -diarrhœa, in consequence of taking a decoction of three colocynth -apples.[1439] Orfila relates that of a rag-picker, who, attempting to -cure himself of a gonorrhœa by taking three ounces of colocynth, was -seized with vomiting, acute pain in the stomach, profuse diarrhœa, -dimness of sight, and slight delirium; but he recovered under the use of -diluents and local blood-letting.[1440] In 1823 a coroner’s inquest was -held at London on the body of a woman who died in twenty-four hours, -with incessant vomiting and purging, in consequence of having swallowed -by mistake a tea-spoonful and a half of colocynth powder.[1441] M. -Carron d’Annecy has communicated to Orfila the details of an instructive -case, which also proved fatal. The subject was a locksmith, who took -from a quack two glasses of decoction of colocynth to cure hemorrhoids, -and was soon after attacked with colic, purging, heat in the belly, and -dryness of the throat. Afterwards the belly became tense and excessively -tender, and the stools were suppressed altogether. Next morning he had -also retention of urine, retraction of the testicles and priapism. On -the third day the retention ceased, but the other symptoms continued, -and the skin became covered with clammy sweat, which preceded his death -only a few hours. The intestines were red, studded with black spots, and -matted together by fibrinous matter; the usual fluid of peritonitis was -effused into the belly; the villous coat of the stomach was here and -there ulcerated; and the liver, kidneys, and bladder also exhibited -traces of inflammation.[1442] - - - _Of Poisoning with Elaterium._ - -Elaterium, which is procured from a third plant of the cucurbitaceæ, the -_Momordica elaterium_ or squirting cucumber, possesses precisely the -same properties with the two preceding substances. It appears, however, -to be more active; for a single grain has been known to act violently on -man. There can be no doubt that small doses will prove fatal; but its -strength and consequently its effects are uncertain. British elaterium, -which is the feculence that subsides in the juice of the fruit, is the -most powerful; French elaterium, which is the extract of the same juice, -is much weaker; and a still weaker preparation sometimes made is an -extract of the juice of the whole plant. The plant itself is probably -poisonous. But the only case in point with which I am acquainted is a -singular instance of poisoning, apparently produced in consequence of -the plant having been carried for some time betwixt the hat and head. A -medical gentleman in Paris, after carrying a specimen to his lodgings in -his hat, was seized in half an hour with acute pain and sense of -tightness in the head, succeeded by colic pains, fixed pain in the -stomach, frequent watery purging, bilious vomiting, and some fever. -These symptoms continued upwards of twelve hours.[1443] - -The active properties of this substance reside in a peculiar crystalline -principle, discovered by Mr. Morries-Stirling, and named by him -_Elaterine_. It is procured by evaporating the alcoholic infusion of -elaterium to the consistence of thin oil, and throwing it into boiling -distilled water; upon which a white crystalline precipitate is formed, -and more falls down as the water cools. This precipitate when purified -by a second solution in alcohol and precipitation by water, is pure -elaterine. In mass it has a silky appearance. The crystals are -microscopic rhombic prisms, striated on the sides. It is intensely -bitter. It does not dissolve in the alkalis, or in water, is sparingly -soluble in diluted acids, but easily soluble in alcohol, ether, and -fixed oil. It has not any alkaline reaction on litmus.—It is a poison of -very great activity. A tenth of a grain, as I have myself witnessed, -will sometimes cause purging in man; and a fifth of a grain in two -doses, administered at an interval of twenty-four hours to a rabbit, -killed it seventeen hours after the second dose. The best British -elaterium contains 26 per cent. of it, the worst 15 per cent.; but -French elaterium does not contain above 5 or 6 per cent.[1444] These -facts account for the great irregularity in the effects of this drug as -a cathartic. The principle discovered by Mr. Morries-Stirling was also -discovered about the same time by Mr. Hennell[1445] of London. - - - _Of Poisoning with the Ranunculaceæ._ - -The natural family of the Ranunculaceæ abounds in acrid poisons. Indeed -few of the genera included in it are without more or less acrid -property. - -The genus _Ranunculus_ is of some interest to the British toxicologist, -because many species grow in this country, and unpleasant accidents have -been occasioned by them. The most common are the _R. bulbosus_, _acris_, -_sceleratus_, _Flammula_, _Lingua_, _aquatilis_, _repens_, _Ficaria_, -which are all abundant in the neighbourhood of this city. The -_Ranunculus acris_ is the only species that has been particularly -examined. Five ounces of juice, extracted by triturating the leaves with -two ounces of water, killed a stout dog in twelve hours when taken -internally. Two drachms of the aqueous extract applied to a wound killed -another in twelve hours by inducing the usual inflammation.[1446] - -Krapf, as quoted in Orfila’s Toxicology, found by experiments on -himself, that two drops of the expressed juice of the _Ranunculus acris_ -produced burning pain and spasms in the gullet and griping in the lower -belly. A single flower had the same effect. When he chewed the thickest -and most succulent of the leaves, the salivary glands were strongly -stimulated, his tongue was excoriated and cracked, his teeth smarted, -and his gums became tender and bloody.[1447] Dr. Withering alleges that -it will blister the skin. A man at Bevay in the north of France, after -swallowing by mistake a glassful of the juice which had been kept for -some time as a remedy for vermin on the head, was seized in four hours -with violent vomiting and colic, and expired in two days.[1448] The -acridity of the genus ranunculus is entirely lost by drying, either with -or without artificial heat. The _R. acris_, however, is far from being -the most active species of the genus. The taste of the leaves of _R. -bulbosus_, _alpestris_, _gramineus_, and _Flammula_, and also of the -unripe germens of _R. sceleratus_, is much more pungent. The _R. -repens_, _Ficaria_, _auricomus_, _aquatilis_, and _Lingua_, I have found -to be bland. - -The genus _Anemone_ produces similar effects on the animal economy. The -most pungent species I have examined are the _A. pulsatilla_, _A. -hortensis_, and _A. coronaria_; the _A. nemorosa_ and _A. patens_ are -less active; and the _A. hepatica_, as well as the _A. alpestris_, are -bland. The powder of the _A. pulsatilla_ causes itching of the eyes, -colic and vomiting, if in pulverizing it the operator do not avoid the -fine dust which is driven up; and Bulliard relates the case of a man -who, in applying the bruised root to his calf for rheumatism, was -attacked with inflammation and gangrene of the whole leg.[1449] The same -author mentions an instance where violent convulsions were produced by -an infusion of the _A. nemorosa_, and the person was for some time -thought to be in great danger.[1450] The acridity of the anemone is -retained under desiccation even in the vapour-bath; but is very slowly -lost under exposure to the air, not entirely, however, in two months. -The ripe fruit of the _A. hortensis_ is bland. The activity of the -anemones is owing to a volatile oil, which, when left for some time in -the water with which it passes over in distillation is converted into a -neutral crystalline body called anemonine, and a peculiar acid termed -anemonic acid.[1451] - -The _Caltha palustris_, or marsh marigold, a plant closely allied in -external characters to the ranunculus, is considered by toxicologists a -powerful acrid poison. Wibmer observes that it has an acrid, burning -taste,[1452]—a remark which has been also made by Haller.[1453] On the -continent the flower buds are said to be sometimes pickled and used for -capers on account of their pungency. The following set of cases which -happened in 1817 near Solingen will show that in some localities it -possesses energetic and singular properties. The poison was taken -accidentally by a family of five persons, in consequence of their having -been compelled by the badness of the times to try to make food of -various herbs. They were all seized half an hour after eating with -sickness, pain in the abdomen, vomiting, headache, and ringing in the -ears, afterwards with dysuria and diarrhœa, next day with œdema of the -whole body, particularly of the face, and on the third day with an -eruption of pemphigous vesicles as large as almonds, which dried up in -forty-eight hours. They all recovered.[1454] - -Notwithstanding these apparently pointed facts, however, I have no doubt -that the marsh marigold is in some circumstances bland, and is commonly -so in this country, or at least but feebly poisonous. Haller, in -speaking of its acrid taste, adds that when young it is eaten with -safety by goats. For my own part I have never been able to remark any -distinct acridity in tasting it either before inflorescence, or in the -young flower-buds, or in any part of the plant while in full flower. It -produces a peculiar, disagreeable impression on the back of the tongue, -when collected in dry situations; but never occasions that pungent -acridity which so remarkably characterizes many species of ranunculus, -anemone, and clematis. - -The _stavesacre_, or _Delphinium staphysagria_, another plant of the -same natural family, is interesting in a scientific point of view, -because its properties have been distinctly traced to a peculiar -alkaloid. The seeds, which alone have been hitherto examined, were -analyzed by MM. Lassaigne and Feneulle, who, besides a number of inert -principles, discovered in them an alkaloid, possessing in an eminent -degree the poisonous qualities of the seeds. This alkaloid is solid, -white, pulverulent but crystalline, fusible like wax, very bitter and -acrid, almost insoluble in water, very soluble in ether and alcohol, and -capable of forming salts with most of the acids.[1455] It has been named -_delphinia_. It was also discovered about the same time by -Brandes.[1456] - -Orfila found that six grains of it diffused through water, introduced -into the stomach of a dog and retained there with a ligature on the -gullet, brought on efforts to vomit, restlessness, giddiness, -immobility, slight convulsions, and death in two or three hours. The -same quantity, if previously dissolved in vinegar, will cause death in -forty minutes. In the former case, but not in the latter, the inner coat -of the stomach is found to be generally red.[1457] - -An ounce of the bruised seeds themselves killed a dog in fifty-four -hours when introduced into the stomach, and two drachms applied to a -wound in the thigh killed another in two days. In the former animal a -part of the stomach was crimson-red; in the latter there was extensive -subcutaneous inflammation reaching as high as the fourth rib.[1458] - -Besides these four genera of the ranunculaceæ many other genera of the -same natural order are equally energetic. The _Clematis vitalba_ or -traveller’s-joy is said to be acrid, but does not taste so: the _C. -flammula_, however, is pungently acrid to the taste; it reddens and -blisters the skin; and when swallowed excites inflammation in the -stomach. The _trollius_ or globe flower is also considered acrid; and -its root in appearance, smell, and taste, has been said to resemble -closely that of the black hellebore. The herb, however, in Scotland, has -certainly none of the peculiar acrid pungency of the ranunculus, -anemone, or clematis, but is on the contrary bland. Some other genera of -equal power have been usually arranged with the narcotico-acrid poisons -on account of their action on the nervous system; and probably some of -the present group of acrids might with equal propriety be removed to the -same class. - -Of plants possessing acrid properties and interspersed throughout other -natural families, the only species I shall particularly notice are the -mezereon, cuckow-pint, gamboge, daffodil, jalap-plant, and savine. - - - _Of Poisoning with Mezereon._ - -The _mezereon_ and several other species of the genus Daphne to which it -belongs are powerfully acrid. They belong to the natural order Thymeleæ. -The active properties of the bark of mezereon have been traced to a very -acrid resin; and those of the allied species, _Daphne alpina_, to a -volatile, acrid acid.[1459] - -The experiments of Orfila have been confined to a foreign species, the -_D. Gnidium_ or _garou_ of the French. Three drachms of the powder of -its bark retained in the stomach of a dog killed it in twelve hours; and -two drachms applied to a wound killed another in two days.[1460] The -action of the other species has not been so scientifically investigated; -but fatal accidents have arisen from them when taken by the human -species. Children have been tempted to eat the berries of the _D. -mezereon_ by their singular beauty; and some have died in consequence. -Three such cases, not fatal, have been related by Dr. Grieve of -Dumfries. Two of the children had violent vomiting and purging: in the -third narcotic symptoms came on in five hours, namely, great drowsiness, -dilatation of the pupils, extreme slowness of the pulse, retarded -respiration, and freedom from pain.[1461] Vicat relates the case of a -man who took the wood of it for dropsy, and was attacked with profuse -diarrhœa and obstinate vomiting, the last of which symptoms recurred -occasionally for six weeks.[1462] A fatal case, in a child about eight -years of age, occurred a few years ago in this city. Linnæus in his -_Flora Suecica_ says that six berries will kill a wolf, and that he once -saw a girl die of excessive vomiting and hæmoptysis, in consequence of -taking twelve of them to check an ague.[1463] The _D. laureola_ or -spurge-laurel, a common indigenous species, abounding in low woods, is -said by Withering to be very acrid, especially its root.[1464] - - - _Of Poisoning with Cuckow-pint._ - -The _Arum maculatum_, or cuckow-pint, one of our earliest spring -flowers, not uncommon in moist ground, under the shelter of woods, is -one of the most violent of all acrid vegetables inhabiting this country. -I have known acute burning pain of the mouth and throat, pain of the -stomach and vomiting, colic and some diarrhœa, occasioned by eating two -leaves. The genus possesses the same properties in other climates, the -several species being everywhere among the most potent acrid poisons in -their respective regions. The _Arum seguinum_, or dumb cane of the West -Indies, is so active that two drachms of the juice have been known to -prove fatal in a few hours.[1465] It is not a little remarkable that the -acridity of the arum is lost not merely by drying, but likewise by -distillation. I have observed that when the roots are distilled with a -little water, neither the distilled water nor the residuum possesses -acridity. Reinsch says he has eaten powder of arum root, which, though -not acrid to the taste, produced severe burning of the throat not long -after it was swallowed.[1466] - - - _Of Poisoning with Gamboge._ - -The familiar pigment and purgative _gamboge_ is one of the pure acrids, -and possesses considerable activity. It appears from the researches of -Orfila,[1467] some experiments by Schubarth,[1468] and various earlier -inquiries quoted by Wibmer,[1469] that two drachms will kill a sheep; -that a drachm and a half will kill a dog if retained by a ligature on -the gullet, while much larger doses have little effect without this -precaution, as the poison is soon vomited; that an ounce has little -effect on the horse; that eighteen grains will prove fatal to the rabbit -within twenty-four hours; and that the symptoms are such as chiefly -indicate an irritant action. Orfila farther found that it produces -intense spreading inflammation when applied to a recent wound, and in -this way may occasion death as quickly and with as great certainty as -when administered internally. - -Gamboge in its action on man is well known to be one of the most certain -and active of the drastic cathartics, from three to seven grains being -sufficient to cause copious watery diarrhœa, commonly with smart colic. -Larger doses will induce hypercatharsis. A drachm has proved fatal, as -is exemplified by a case in the German Ephemerides where the symptoms -were excessive vomiting, purging, and faintness.[1470] - -Under this head are probably to be arranged the repeated cases, which -have lately occurred in this country, of fatal poisoning with a noted -quack nostrum, Morison’s pills. Almost every physician in extensive -practice has met with cases of violent hypercatharsis occasioned by the -incautious use of these pills; and three instances are now on record -where death was clearly occasioned by them.[1471] No toxicologist will -feel any surprise at such results, when he learns that one sort -contains, besides aloes and colocynth, half a grain of gamboge, and -another three times as much, in each pill; and that ten, fifteen, or -even twenty pills are sometimes taken for a dose once or oftener in the -course of the day.[1472] The symptoms in the cases alluded to were -sickness, vomiting and watery purging, pain, tension, fulness, -tenderness, and heat in the abdomen, with cold extremities and sinking -pulse; and in the dead body the appearances were great redness of the -stomach with softening of its villous coat, in the intestines softening -and slate-gray coloration of the same coat, and in one instance -intestinal ulceration. - -Gamboge is one of the poisons whose energy seems to be irregularly -modified by the co-existence of certain constitutional states in -disease. Physicians in Britain cannot but be startled to hear of the -practice, prevailing among the followers of Rasori in Italy, of -administering this purgative in doses of a drachm and upwards in -inflammatory diseases. But it is nevertheless undeniable, that it has -been given to that extent in such circumstances, with no further -consequence than brisk purging. Professor Linoli mentions two cases of -inflammatory dropsy, in which he gave gamboge-powder in gradually -increasing doses, till he reached in one instance an entire drachm, and -in the other 86 grains. In the course of a month one of his patients got -1044 grains, and the other took 850 grains in twelve days. Both -recovered from their dropsy, and the purging was never great.[1473] - - - _Of Poisoning with Daffodil._ - -The common _daffodil_, the _Narcissus pseudo-narcissus_ of botanists, -though commonly arranged with the vegetable acrids, seems not entitled -to a place among them. At least the experiments of Orfila rather tend to -show that it acts through absorption on the nervous system. Four drachms -of the aqueous extract of this plant secured in the stomach in the usual -way killed a dog in less than twenty-four hours; and one drachm applied -to a wound killed another in six hours. In both cases vomiting or -efforts to vomit seemed the only symptom of note; and in both the -stomach was found here and there cherry-red. The wound was not much -inflamed.[1474] - - - _Of Poisoning with Jalap._ - -_Jalap_, the powder of the root of the _Ipomæa purga_, and a common -purgative, is an active poison in large doses; and this every one should -know, as severe and even dangerous effects have followed its incautious -use in the hands of the practical joker. Its active properties reside in -a particular resinous principle. It contains a tenth of its weight of -mixed resin, which, like the resin of euphorbium, has been separated by -Drs. Buchner and Herberger into two, one possessing some of the -properties of acids, the other some of the properties of bases; and the -latter they consider the active principle, and have accordingly named -Jalapine.[1475] Mr. Hume of London some time ago procured from the crude -drug a powdery substance, to which he gave the same name, and which he -conceived to be the active principle. His analysis has not been -generally relied on by chemists; but it is not improbable that his -principle differs little from that of the German chemists. - -The action of jalap has been examined scientifically by M. Felix Cadet -de Gassicourt, who found that it produced no particular symptom when -injected into the jugular vein of a dog in the dose of twenty-four -grains, or when applied to the cellular tissue in the dose of a drachm. -But when rubbed daily into the skin of the belly and thighs it excited -in a few days severe dysentery; when introduced into the pleura it -excited pleurisy, fatal in three days; when introduced into the -peritonæum it caused peritonitis and violent dysentery, fatal in six -days; and when introduced into the stomach or the anus, the animals died -of profuse purging in four or five days, and the stomach and intestines -were then found red and sometimes ulcerated. Two drachms administered by -the mouth proved fatal.[1476] _Scammony_, which is procured from another -species of the same family, the _Convolvulus scammonea_, has been found -by Orfila to be much less active. Four drachms given to dogs produced -only diarrhœa.[1477] - - - _Of Poisoning with Savin._ - -The leaves of the _Juniperus sabina_, or savin, have been long known to -be poisonous. They have a peculiar heavy, rather disagreeable odour, and -a bitter, acrid, aromatic, somewhat resinous taste. They yield an -essential oil, which possesses all their qualities in an eminent degree. - -A dog was killed by six drachms of the powdered leaves confined in the -stomach. It appeared to suffer pain, died in sixteen hours, and -exhibited on dissection only trivial redness of the stomach. Two drachms -introduced into a wound of the thigh caused death after the manner of -the other vegetable acrids in two days; and besides inflammation of the -limb there was found redness of the rectum.[1478] - -Savin is a good deal used in medicine for stimulating old ulcers and -keeping open blistered surfaces; which may be done without danger, -although it cannot be applied to a fresh wound without risk of diffuse -inflammation. Both the powder and the essential oil are of some -consequence in a medico-legal point of view, as they have been often -used with the intent of procuring abortion. The oil is generally -believed by the vulgar to possess this property in a peculiar degree. -Doubts, however, may be entertained whether any such property exists -independently of its operation as a violent acrid on the bowels. It has -certainly been taken to a considerable amount without the intended -effect; of which Foderé has noticed an unequivocal example. The woman -took daily for twenty days no less than a hundred drops of the oil, yet -carried her child to the full time.[1479] The powder has likewise been -taken to a large extent without avail. A female, whose case is noticed -by Foderé, took without her knowledge so much of the powder that she was -attacked with vomiting, hiccup, heat in the lower belly, and fever of a -fortnight’s duration; nevertheless she was not delivered till the -natural time.[1480] There is no doubt, however, that if given in such -quantity as to cause violent purging, abortion may ensue; but unless -there is naturally a predisposition to miscarriage, the constitutional -injury and intestinal irritation required to induce it are so great, as -to be always attended with extreme danger, independent of the uterine -disorder. Of this train of effects the following case, for which I am -indebted to Mr. Cockson of Macclesfield, is a good illustration. A -female applied to a pedlar to supply her with the means of getting rid -of her pregnancy: and under his direction appears to have taken a large -quantity of a strong infusion of savin-leaves on a Friday morning and -again next morning. A very imperfect account was obtained of the -symptoms, as no medical man witnessed them; but it was ascertained that -she had violent pain in the belly and distressing strangury. On the -Sunday afternoon she miscarried; and on the ensuing Thursday she died. -Mr. Cockson, who examined the body next day, found extensive peritonæal -inflammation unequivocally indicated by the effusion of fibrinous -flakes,—the uterus presenting all the signs of recent delivery,—the -inside of the stomach of a red tint, checkered with patches of florid -extravasation,—and its contents of a greenish colour, owing evidently to -the presence of a vegetable powder, as was proved by separating and -examining it with the microscope. My colleague Dr. Traill has -communicated to me the particulars of a similar case. A servant-girl, -after being for some time in low spirits, was seized with violent colic -pains, frequent vomiting, straining at stool, tenderness of the belly, -dysuria and general fever; under which symptoms she died after several -days of suffering. The stomach was inflamed, in parts black, and at the -lower curvature perforated. The uterus with its appendages was very red, -and contained a fine _membrana decidua_, but no ovum. The lower -intestines were inflamed. There was found in the stomach a greenish -powder, which, when washed and dried, had the taste of savin. - -A singular case is quoted by Wibmer of a woman who died from taking an -infusion of the herb for the purpose of procuring miscarriage, and in -whom death seems to have been occasioned by the gall-bladder bursting in -consequence of the violent fits of vomiting.[1481] - -In a charge of wilful abortion the mere possession of oil of savin would -be a suspicious circumstance, because the notion that it has the power -of causing miscarriage is very general among the vulgar; while it is -scarcely employed by them for any useful purpose. The leaves in the form -of infusion are in some parts of England a popular remedy for worms; and -the oil is used in regular medicine as an emmenagogue. - -The following list includes all the other plants which have been either -ascertained experimentally to belong to the present order, or are -believed on good general evidence to possess the same or analogous -properties. - -By careful experiment Orfila has ascertained that the Gratiola -officinalis, Rhus radicans and Rhus toxicodendron, Chelidonium majus and -Sedum acre, possess them; and the following species are also generally -considered acrid, namely, Rhododendron chrysanthum and ferrugineum, -Pedicularis palustris, Cyclamen Europæum, Plumbago Europæa, Pastinaca -sativa, Lobelia syphilitica and longiflora, Hydrocotyle vulgaris. To -these may be added the common elder or Sambucus nigra, the leaves and -flowers of which caused in a boy, once a patient of mine, dangerous -inflammation of the mucous membrane of the bowels lasting for eight -days. - - - - - CHAPTER XXI. - OF POISONING WITH CANTHARIDES. - - -The second group of the present Order of poisons comprehends most of -those derived from the animal kingdom. In action they resemble -considerably the vegetable acrids, their most characteristic effect -being local inflammation; but several of them also induce symptoms of an -injury of the nervous system. - -This group includes cantharides, poisonous fishes, venomous serpents, -and decayed or diseased animal matter. - -The first of these is familiarly known as a poison even to the common -people. I am not aware that it has ever been used for the purpose of -committing murder. But on account of its powerful effect on the organs -of generation it has often been given by way of joke, and sometimes -taken for the purpose of procuring abortion. Fatal accidents have been -the consequence. - -The appearance of the fly is well known. When in powder, as generally -seen, it has a grayish-green colour, mingled with brilliant green -points. It has a nauseous odour and a very acrid burning taste. Alcohol -dissolves its active principle. This principle appears from a careful -analysis by M. Robiquet to be a white, crystalline, scaly substance, -insoluble in water, but soluble in alcohol as well as in oils, and -termed cantharidin.[1482] - -In compound mixtures cantharides may generally be detected by the green -colour and metallic brilliancy even of its finest powder, if examined in -the sunshine—and sometimes by making an etherial extract of the -suspected matter, and producing with this extract the usual effects of a -blister on a tender part of the arm. By these two tests Barruel -discovered cantharides in chocolate cakes, part of which had been -wickedly administered to various individuals. - -From the late important researches of M. Poumet[1483] it appears, that -cantharides cannot be detected by its chemical properties in the -contents, or on the inner surface, of the alimentary canal of animals -poisoned with it; and that in such circumstances it is seldom to be -discerned even by the shining green colour of its particles, unless the -matter to be examined be dried. The method he recommends for a -medico-legal investigation is to detach the stomach, small intestines, -and great intestines, each separately from the body,—to wash out their -contents with rectified spirit, and dry the pulpy fluid on sheets of -glass,—to dry the stomach and intestines by distending them, removing -their mesentery, and hanging them up vertically with a weight attached -to stretch them,—and then to examine both the surface of the glass, and -the inside of the stomach and intestines with the aid of sunshine or a -bright artificial light. In this way cantharides may be detected, by the -peculiar green hue of its powder, in most cases where this poison may -have proved fatal; for M. Poumet constantly found it in dogs. The same -author ascertained that the green particles generally abound most in the -contents of the great intestine or on its inner membrane, next in the -small intestines, and least of all in the stomach; and that they may be -seen in the bodies of animals at least seven months after interment. -Orfila had previously ascertained, that cantharides powder may be -recognized by its brilliancy in various organic mixtures after interment -for nine months.[1484] Poumet farther states that the green particles of -cantharides may be confounded with the particles of other coleopterous -insects, and also somewhat resemble particles of copper and tin. But he -with reason asks, what possible accident could introduce the powder of -any other coleopterous insect into the alimentary canal? And as to -particles of copper or tin, he ascertained, that, unlike cantharides, -these substances are visible in the contents, or on the tissues, of the -stomach and intestines only before desiccation, and never after it. - - -SECTION I.—_Of the Action of Cantharides and the Symptoms it excites in - Man._ - -Cantharides, either in the form of powder, tincture, or oily solution, -is an active poison both to man and animals. As to its action on -animals, Orfila found that a drachm and a half of a strong oleaginous -solution, injected into the jugular vein of a dog, killed it in four -hours with symptoms of violent tetanus; that three drachms of the -tincture with eight grains of powder suspended in it caused death in -twenty-four hours, if retained in the stomach by a ligature on the -gullet,—insensibility being then the chief symptom; and that forty -grains of the powder killed another dog in four hours and a half, -although he was allowed to vomit. In all the instances in which it was -administered by the stomach, that organ was found much inflamed after -death; and generally fragments of the poison were discernible if it was -given in the form of powder. When applied to a wound the powder excites -surrounding inflammation; and a drachm will in this way prove fatal in -thirty-two hours without any particular constitutional symptom except -languor.[1485] M. Poumet has since obtained results not materially -different. - -These experiments do not furnish any satisfactory proof of the -absorption of the poison, but rather tend to show that it does not enter -the blood. Such a conclusion, however, must not be too hastily drawn; -since its well-known effects on man when used in the form of a blister -lead to the conclusion that it is absorbed, and that it produces its -peculiar effect on the urinary system through the medium of the -circulation. On account of the magnitude of the dose required to produce -severe effects on animals, Orfila’s experiments on the stomach and -external surface of the body cannot, for reasons formerly assigned (452) -be properly compared together. - -The effect of cantharides, when admitted directly into the blood, seems -much less than might be expected. Mr. Blake found that an infusion of -two drachms injected into the jugular vein of a dog, caused some -difficulty of breathing, irregularity of the pulse, and diminished -arterial pressure, but apparently no great inconvenience to the -animal.[1486] The greater effect observed in Orfila’s experiment was -probably owing to obstruction of the pulmonary capillaries by the oil. - -Orfila has examined with care not only the preparations of cantharides -already mentioned, but likewise the various principles procured by M. -Robiquet during his analysis; and it appears to result, that the active -properties of the fly reside partly in the crystalline principle, and -partly in a volatile oil, which is the source of its nauseous odour. - -The symptoms produced by cantharides in man are more remarkable than -those observed in animals. A great number of cases are on record; but -few have been minutely related. Sometimes it has been swallowed for the -purpose of self-destruction, sometimes for procuring miscarriage. But -most frequently, on account of a prevalent notion that it possesses -aphrodisiac properties, it has been both voluntarily swallowed and -secretly administered, to excite the venereal appetite. That it has this -effect in many instances cannot be doubted. But the old stories, which -have been the cause of its being so frequently used for the purpose, are -many of them fabulous, and all exaggerated. Often no venereal appetite -is excited, sometimes even no affection of the urinary or genital organs -at all; and the kidneys and bladder may be powerfully affected without -the genital organs participating. It is established, too, by frequent -observation, that the excitement of the genital organs can never be -induced, without other violent constitutional symptoms being also -brought on, to the great hazard of life. - -The following abstract of a case by M. Biett of Paris gives a rational -and unexaggerated account of the symptoms as they commonly appear. A -young man, in consequence of a trick of his companions, took a drachm of -the powder. Soon afterwards he was seized with a sense of burning in the -throat and stomach; and in about an hour with violent pain in the lower -belly. When M. Biett saw him, his voice was feeble, breathing laborious, -and pulse contracted; and he had excessive thirst, but could not swallow -any liquid without unutterable anguish. He was likewise affected with -priapism. The pain then became more extensive and severe, tenesmus and -strangury were added to the symptoms, and after violent efforts he -succeeded in passing by the anus and urethra only a few drops of blood. -By the use of oily injections into the anus and bladder, together with a -variety of other remedies intended to allay the general irritation of -the mucous membranes, he was considerably relieved before the second -day; but even then he continued to complain of great heat along the -whole course of the alimentary canal, occasionally priapism, and -difficult micturition. For some months he laboured under difficulty of -swallowing.[1487]—Another case very similar in its circumstances has -been related by M. Rouquayrol. In addition to the symptoms observed in -Biett’s patient there was much salivation, and towards the close of the -second day a large cylindrical mass, apparently the inner membrane of -the gullet, was discharged by vomiting.[1488]—A case of the same kind, -but less severe, is related in the Medical Gazette. A woman, who had -taken an ounce of the tincture, was observed throughout the day to be -apparently intoxicated. Next morning, when she for the first time told -what she had done, she had excruciating pain, great tenderness and -distension of the belly, a flushed anxious countenance, a dry, pale -tongue, a natural pulse, and urine loaded with sediment and fibrinous -matter. In the evening there was extreme weakness, cold extremities, a -scarcely perceptible pulse, and retention of urine; and at night she was -delirious. After this she recovered progressively, the chief symptoms -then being pain in the kidneys and inability to pass urine.[1489] - -Among the symptoms the affection of the throat, causing difficult -deglutition and even an aversion to liquids, appears to be pretty -constant. The sense of irritation along the gullet and in the stomach is -also generally considerable. Sometimes it is attended with bloody -vomiting, as in four cases related by Dr. Graaf of Langenburg;[1490] and -at other times, as in the instance of poisoning with the acids, there is -vomiting of membranous flakes. These have been mistaken for the lining -membrane of the alimentary canal, but are really in general a morbid -secretion.[1491] At the same time there is reason to believe that a -portion of the membrane of the gullet was discharged in Rouquayrol’s -case; for there were ramified vessels in it, and one so large that blood -issued on pricking it. A prominent symptom in general is distressing -strangury, and it commonly concurs with suppression of urine and the -discharge of blood.[1492] It would appear that, when the genital organs -are much affected, the inflammation may run on to gangrene of the -external parts. Ambrose Paré notices a fatal instance of the kind, which -was caused by a young woman seasoning comfits for her lover with -cantharides.[1493] - -The preceding symptoms are occasionally united with signs of an -injury of the nervous system. Headache is common, and delirium is -sometimes associated with it.[1494] In a case communicated to Orfila -the leading symptoms at first were strangury and bloody urine; but -these were soon followed by violent convulsions and occasional loss -of recollection.[1495] The quantity in that instance was only eight -grains; and it was taken for the purpose of self-destruction. In one -of Graaf’s four cases the patient was attacked during convalescence -with violent phrensy of three days’ continuance.[1496] An instance -is also related in the Transactions of the Turin Academy, of tetanic -convulsions and hydrophobia appearing three days after a small -over-dose of the tincture of cantharides was taken, and continuing -for several days with extreme violence.[1497] The cause of the -symptoms, however, is here doubtful. - -A rare occurrence is relapse after apparent convalescence. In a case -communicated to me by Dr. Osborne of Dundee, which there was every -reason to believe had arisen from cantharides administered to a girl by -an unprincipled scoundrel, the usual symptoms of violent irritation in -the bladder and rectum prevailed for 36 hours; and an interval of quiet -and apparent convalescence ensued for three days. But on the fifth day -the urinary symptoms returned, and were attended with great prostration, -a rapid feeble pulse, and severe diarrhœa for two days longer. She -eventually recovered. Another girl, poisoned at the same time, had most -distressing irritation in the bladder, and for some time passed nothing -but drops of blood; but she got well in two days, and had no relapse. - -The following fatal cases deserve particular mention. Orfila quotes one -from the _Gazette de Santé_ for May, 1819, which was caused by two doses -of twenty-four grains taken with the interval of a day between them, for -the purpose of suicide. The ordinary symptoms of irritation in the -bowels and urinary organs ensued, miscarriage then took place, and the -patient died on the fourth day, with dilated pupils and convulsive -motions, but with unimpaired sensibility.[1498] Another instance related -by Dr. Ives of the United States, presented two stages, like that -related by Orfila, but with the remarkable difference that an interval -of several days intervened between the irritant and narcotic effects. A -man swallowed an ounce of the tincture and was seized in a short time -with hurried breathing, flushed face, redness of the eyes and -lacrymation, convulsive twitches, pain in the stomach and bladder, -suppression of urine and priapism; in the evening delirium set in, and -next morning there was loss of consciousness; but from this time under -the use of blood-letting, emetics, blisters, sinapisms, and castor-oil, -he got well and continued so for fourteen days. But after that interval -he was suddenly attacked with headache and shivering, then with -convulsions, and subsequently with coma; which, however, was removed for -a time by outward counter-irritants. Next day the coma returned at -intervals, and on the subsequent day the convulsions also, which -gradually increased in severity for three days more, and then proved -fatal.[1499] In this case it admits of question whether the affection -which proved the immediate cause of death really arose from the -cantharides, or was an independent disease.—A third case, fatal on the -fourth day, occurred in April, 1830, near Uxbridge in the south of -England. I have not been able to learn the particulars exactly; but it -appears to have been produced by cantharides powder, which was mixed -with beer by two scoundrels at a dancing party for the purpose of -exciting the venereal appetite of the females. A large party of young -men and women were in consequence taken severely ill; and one girl died, -who had been prevailed on to take the powder at the bottom of the -vessel, on being assured that it was ginger. - -The quantity of the powder or tincture requisite to prove fatal or -dangerous has not been accurately settled. Indeed practitioners differ -much even as to the proper medicinal doses. The smallest dose of the -powder yet known was twenty-four grains (Orfila); and the smallest fatal -dose of the tincture was one ounce, which is equivalent to six grains of -powder.[1500] It is probable that this is one of the poisons whose -operation is liable to be materially affected by idiosyncrasy. The -medicinal dose is from half a grain to two grains of the powder, and -from ten drops to two drachms of the tincture. But Dr. Beck has quoted -an instance where six ounces of the tincture were taken without -injury.[1501] On the other hand Werlhoff has mentioned the case of a lad -who used to be attacked with erection and involuntary emission on merely -smelling the powder.[1502] This statement, though extraordinary, is not -without support from the parallel effects of other substances. - -The familiar effects of cantharides on the external surface of the body -are not unattended with danger, if extensive, or induced in particular -states of the constitution. An ordinary blistered surface often -ulcerates in febrile diseases; and in the typhoid state which -characterizes certain fevers, this ulceration has been known to pass on -to fatal sloughing, especially when the blister has been applied to -parts on which the body rests. I have met with two such cases. On the -other hand if the blistered surface be very extensive, death may take -place in the primary stage of the local affection, in consequence of the -great constitutional disturbance excited. Thus in 1841 a girl, affected -with scabies, received cantharides ointment by mistake instead of -sulphur ointment from an hospital-serjeant at Windsor Barracks; and -having anointed nearly her whole body with it, was seized with violent -burning pain of the integuments, followed by vesication, general fever, -and the usual symptoms of the action of this poison on the urinary -organs. These effects were so severe that she died in five days.[1503] - - - SECTION II.—_Of the Morbid Appearances caused by Cantharides._ - -The only precise account I have hitherto seen of the morbid appearances -caused by cantharides is contained in the history of the case from the -_Gazette de Santé_. The brain was gorged with blood. The omentum, -peritonæum, gullet, stomach, intestines, kidneys, ureters, and internal -parts of generation were inflamed; and the mouth and tongue were -stripped of their lining membrane.—In dogs Schubarth observed, besides -the usual signs of inflammation in the alimentary canal, great redness -of the tubular part of the kidneys, redness and extravasated patches on -the inside of the bladder, and redness of the ureters as well as of the -urethra.[1504] M. Poumet denies that any morbid appearance is ever found -in any part of the genito-urinary organs of animals; but he sometimes -found blood effused into the stomach and intestines.[1505] In Dr. Ives’s -case the blood-vessels of the brain and cerebellum were gorged, the -cerebellum spread over with lymph, the villous coat of the stomach -softened and brittle, and the kidneys inflamed and presenting blood in -their pelvis. - -When the case has been rapid, the remains of the powder may be found in -the stomach or intestines by Poumet’s process. From the researches of -Orfila and Lesueur, confirmed by those of Poumet, it appears not to -undergo decomposition for a long time when mixed with decaying animal -matters. After nine months’ interment the resplendent green points -continue brilliant.[1506] - - - SECTION III.—_Of the Treatment of Poisoning with Cantharides._ - -The treatment of poisoning with cantharides is not well established. No -antidote has yet been discovered. At one time fixed oil was believed to -be an excellent remedy. But the experiments of Robiquet on the active -principle of the poison, and those of Orfila on the effects of its -oleaginous solution, rather prove that oil is the reverse of an -antidote. The case mentioned in the Genoa Memoirs was evidently -exacerbated by the use of oil. When the accident is discovered early -enough, and vomiting has not already begun, emetics may be given; and if -vomiting has begun, it is to be encouraged. Oleaginous and demulcent -injections into the bladder generally relieve the strangury. The warm -bath is a useful auxiliary. Leeches and blood-letting are required, -according as the degree and stage of the inflammation may seem to -indicate. - -Many other insects besides the _Cantharis vesicatoria_ possess similar -acrid properties. Two of them, however, may be briefly alluded to, -because they have caused fatal poisoning. The one is the _Meloë -proscarabæus_, the _Maiwurm_ of the Germans, a native of most European -countries. In Rust’s Magazin there is an account of four persons who -took the powder of this insect from a quack for spasms in the stomach. -The principal symptoms were stifling and vomiting; and two of the people -died within twenty-four hours.[1507] The other is the _Bombyx_, of which -at least two species are believed to possess powerful irritant -properties, the _B. pityocarpa_ and _B. processionea_. The following is -an instance of their effects. A child ten years old had a common blister -applied to the neck and spine as a remedy for deafness; and four days -afterwards her mother dressed the abraded skin with the leaves of -beet-root, from which she had previously shaken a great number of -caterpillars. The child soon complained of insupportable itching and -burning in the part, and endeavoured to tear off the dressings. The -mother persevered, however; and her child died in two days of gangrene -of the whole integuments of the back. The surgeon who saw the child on -the last day of her life, ascribed the gangrene to the insects mentioned -above, and states that they possess the power of exciting erysipelas -when applied even to the sound skin.[1508] It is probable that many -other insects in Europe have similar properties. The _Mylabris -cichorii_, which is partially used in Italy,[1509] and is in common use -in India and China for blistering, possesses active irritant properties. -The _Cantharis ruficollis_, another species used in the Nizam’s -Territories in India, is also energetic. Other species known to possess -activity are _Mylabris fusselini_, _Meloe majalis_, _M. trianthemum_, -_Coccinella bipunctata_, _C. septem-punctata_, and _Cantharis vittata_. - - - - - CHAPTER XXII. - OF THE DELETERIOUS EFFECTS OF POISONOUS FISH. - - -The species of fish which act deleteriously, either always or in -particular circumstances, have also been commonly arranged in the -present order of poisons. - -The subject of fish-poison is one of the most singular in the whole -range of toxicology, and none is at present veiled in so great -obscurity. It is well ascertained that some species of fish, -particularly in hot climates, are always poisonous,—that some, though -generally salubrious and nutritive, such as the oyster and still more -the muscle, will at times acquire properties which render them hurtful -to all who eat them,—and that others, such as the shell-fish now -mentioned, and even the richer sorts of vertebrated fishes, though -actually eaten with perfect safety by mankind in general, are -nevertheless poisonous, either at all times or only occasionally to -particular individuals. But hitherto the chemist and the physiologist -have in vain attempted to discover the cause of their deleterious -operation. - -A good account of the poisonous fishes of the tropics has been given by -Dr. Chisholm[1510] and by Dr. Thomas;[1511] and some farther -observations on the same subject have been published by Dr. -Fergusson.[1512] These essays may be consulted with advantage. On the -effects of poisonous muscles several interesting notices and essays have -been written, among which may be particularized one by Dr. Burrows[1513] -of London, another by Dr. Combe of Leith,[1514] and the observations of -Professor Orfila, including some cases from the Gazette de Santé, and -from the private practice of Dr. Edwards.[1515] Of all the sources of -information now mentioned, that which appears to me the most -comprehensive and precise, is the essay of Dr. Combe, who has collected -many facts previously known, added others equal in number and importance -to all the rest put together, and weighed with impartiality the various -inferences which have been or may be drawn from them. The succeeding -remarks will be confined to a succinct statement of what appears well -established. - -In this work, however, the poisonous fishes of the West Indies and other -tropical countries may be laid aside, because we are still too little -acquainted with the phenomena of their action to be entitled to -investigate its cause, and they are objects of much less interest to the -British medical jurist than the fish-poison of his own coast. - -There is little doubt that some of the inhabitants of the sea on the -coast of Britain are always poisonous. Thus it is well known that some -of the molluscous species irritate and inflame the skin wherever they -touch it,—a fact which is familiar to every experienced swimmer. The -fishermen of the English coast are also aware that a small fish known by -the name of Weever (_Trachinus vipera_, Cuv.) possesses the power of -stinging with its dorsal fin so violently as to produce immediate -numbness of the arm or leg, succeeded rapidly by considerable swelling -and redness; and indeed an instance of this accident, which happened at -Portobello on the Firth of Forth, has been mentioned to me by Mr. Stark, -author of the Elements of Natural History, who witnessed the effects of -the poison. But our knowledge of the poisons of that class is too -imperfect to require more particular notice. - -Of fishes which are commonly nutritive, but sometimes acquire poisonous -properties, by far the most remarkable is the common _Muscle_. -Opportunities have often occurred for observing its effects,—so often, -indeed, that its occasional poisonous qualities have become an important -topic of medical police, and in some parts, as in the neighbourhood of -Edinburgh and Leith, it has of late been abandoned by many people as an -article of food, although generally relished, and in most circumstances -undoubtedly safe. This result originated in an accident at Leith in -1827, by which no fewer than thirty people were severely affected and -two killed. - - - _Of the Symptoms and Morbid Appearances caused by Poisonous Muscles._ - -The effects of poisonous muscles differ in different cases. Sometimes -they have produced symptoms of local irritation only. Thus Foderé -mentions the case of a sailor in Marseilles, who, in consequence of -eating a large dish of them, died in two days, after suffering from -vomiting, nausea, pain in the stomach, tenesmus, and quick contracted -pulse. The stomach and intestines were found after death red and lined -with an abundant tough mucus.[1516] One of the cases described by Dr. -Combe, which, however, terminated favourably, is of the same nature. The -patient had severe stomach symptoms from the commencement, attended with -cramps and ending in peritonitis, which required the frequent use of the -lancet. - -But much more commonly the local effects have been trifling, and the -prominent symptoms have been almost entirely indirect and chiefly -nervous. Two affections of this kind have been noticed. One is an -eruptive disease resembling nettle-rash, and accompanied with violent -asthma; the other a comatose or paralytic disorder of a peculiar -description. - -Of the former affection several good examples have been recorded in -different numbers of the Gazette de Santé.[1517] In these the number of -muscles eaten was generally small; in one instance ten, in another only -six. Nay, in a case related with several others by Möhring in the German -Ephemerides, the patient only chewed one muscle and swallowed the fluid -part, having spit out the muscle itself.[1518] The symptoms have usually -commenced between one and two hours after eating, and rapidly attained -their greatest intensity. In the patient who was affected by ten muscles -the first symptoms were like those of violent coryza; swelling and -itching of the eyelids, and general nettle-rash followed; and the -eruption afterwards gave place to symptoms of urgent asthma, which were -removed by ether. In other cases the symptoms of asthma preceded the -eruption. In one instance the eruption did not appear at all. The -swelling has not been always confined to the eyelids, but, on the -contrary, has usually extended over the whole face. All the patients -were quickly relieved by ether. The eruption, though generally called -nettle-rash, is sometimes papular, sometimes vesicular, but always -attended with tormenting heat and itchiness. Several cases of this kind -have been related by Möhring. The eruption was preceded by dyspnœa, -lividity of the face, insensibility, and convulsive movements of the -extremities. All recovered under the use of emetics.[1519] This -affection, however, may prove fatal. In the cases of two children -related by Dr. Burrows, the symptoms began, as in Möhring’s cases, with -dyspnœa, nettle-rash, and swelling of the face, combined with vomiting -and colic; but afterwards the leading symptoms were delirium, -convulsions, and coma; and death took place in three days. - -In these children it is worthy of remark, that none of the symptoms -began till twenty-four hours after eating. In Möhring’s cases, on the -contrary, the symptoms began in a few minutes. - -The other affection is well exemplified in the correct delineations of -Dr. Combe. The following is his general summary of the cases, which, -with the exception of the instance of peritonitis already alluded to, -were all singularly alike in their leading features.—“None, so far as I -know, complained of anything peculiar in the smell or taste of the -animals, and none suffered immediately after taking them. In general, an -hour or two elapsed, sometimes more; and then the bad effects consisted -rather in uneasy feelings and debility, than in any distress referable -to the stomach. Some children suffered from eating only two or three; -and it will be remembered that Robertson, a young and healthy man, only -took five or six. In two or three hours they complained of a slight -tension at the stomach. One or two had cardialgia, nausea, and vomiting; -but these were not general or lasting symptoms. They then complained of -a prickly feeling in their hands; heat and constriction of the mouth and -throat; difficulty of swallowing and speaking freely; numbness about the -mouth, gradually extending to the arms, with great debility of the -limbs. The degree of muscular debility varied a good deal, but was an -invariable symptom. In some it merely prevented them from walking -firmly, but in most of them it amounted to perfect inability to stand. -While in bed they could move their limbs with tolerable freedom; but on -being raised to the perpendicular posture, they felt their limbs sink -under them. Some complained of a bad coppery taste in the mouth, but in -general this was an answer to what lawyers call a leading question. -There was slight pain of the abdomen, increased on pressure, -particularly in the region of the bladder, which suffered variously in -its functions. In some the secretion of urine was suspended, in others -it was free, but passed with pain and great effort. The action of the -heart was feeble; the breathing unaffected; the face pale, expressive of -much anxiety; the surface rather cold; the mental faculties unimpaired. -Unluckily the two fatal cases were not seen by any medical person; and -we are therefore unable to state minutely the train of symptoms. We -ascertained that the woman, in whose house were five sufferers, went -away as in a gentle sleep; and that a few minutes before death, she had -spoken and swallowed.”[1520] She died in three hours. The other fatal -case was that of a dock-yard watchman, who was found dead in his box six -or seven hours after he ate the muscles. - -The inspection of the bodies threw no light on the nature of these -singular effects. No appearance was found which could be called -decidedly morbid. The stomach contained a considerable quantity of the -fish half digested. - -Dr. Combe’s narrative agrees with that of Vancouver, four of whose -sailors were violently affected, and one killed in five hours and a -half, after eating muscles which they had gathered on shore in the -course of his voyage of discovery.[1521] - -In closing this account, allusion may be briefly made to a case related -by Dr. Edwards, which differs from all the preceding. The symptoms were -uneasiness at stomach, followed by epileptic convulsions, which did not -entirely cease for a fortnight. Dr. Edwards imputed the illness to -muscles; but it must be observed that this is a solitary instance of -simple convulsions arising from such a cause.[1522] The case deserves -particular attention, because a suspicion of intentional poison might -have been excited by the circumstances in which it occurred. The -individual, a young man, was attacked soon after eating in company with -another, who was about to marry his mother, and with whom on that -account he lived on bad terms. - - - _Of the Source of Poison of Muscles._ - -Various opinions have been formed as to the cause or causes of the -poisonous qualities of some muscles. - -The vulgar idea that the poisonous principle is copper, with which the -fish becomes impregnated from the copper bottoms of vessels, is quite -untenable. Copper does not cause the symptoms described above. I -analyzed some of the muscles taken from the stomach of one of Dr. -Combe’s patients, without being able to detect a trace of copper. Others -have arrived at the same result in former cases. The only instance -indeed to the contrary is a late analysis by M. Bouchardat; who does not -mention the quantity of copper he detected, or what was the source of -the poisonous fish.[1523] - -The theory which ascribes their effects to changes induced by decay is -equally untenable. In Dr. Burrows’s two cases the muscles appear to have -been decayed; yet he very properly refuses to admit this fact as -explanatory of their operation. And, indeed, it rather complicates than -facilitates the explanation; as it shows that the poison differs from -animal poison generally, in not being destroyed by putrefaction. Dr. -Combe’s inquiries must satisfy every one, that in the Leith cases decay -was out of the question, and I may add my testimony to the statement: -the muscles taken from the stomach of one of his fatal cases, and -likewise others obtained in the shell, and brought to me for analysis, -were perfectly fresh. - -By some physicians, and especially by Dr. Edwards, their poisonous -effects have been referred to idiosyncrasy on the part of the persons -who suffer. It can hardly be doubted that this is the cause in some -instances. It was formerly mentioned that muscles, oysters, crabs, and -even the richer sorts of vertebrated fishes, such as trout, salmon, -turbot, holibut, herring, mackerel, are not only injurious to some -people, while salutary to mankind generally, but likewise that this -singular idiosyncrasy may be acquired. A relation of mine for many years -could not take a few mouthfuls of salmon, trout, herring, turbot, -holibut, crab, or lobster, without being attacked in a few minutes or -hours with violent vomiting; yet at an early period of life, he could -eat them all with impunity; and at all times he has eaten without injury -cod, ling, haddock, whiting, flounder, oysters, and muscles. Among the -cases which have come under Dr. Edwards’s notice in Paris, there is one -evidently of the same nature. In two others, the idiosyncrasy existed in -regard to the muscle, and although in both of these the affection -induced was slight, there is no doubt but idiosyncrasy will also account -even for some instances of the severe disorders specified above. In -particular, it appears sometimes to operate in the production of -nettle-rash and asthma; for in the instance quoted from the Gazette de -Santé, as arising from ten muscles, it happened that the father of the -patient partook very freely of the same dish without sustaining any harm -whatever; and in each of three distinct accidents mentioned by Möhring, -it appeared that other individuals had eaten of the same dish with equal -impunity.[1524] - -But idiosyncrasy will not account for all the cases of poisoning with -muscles, oysters, and other fish. For, passing over other less -unequivocal objections, it appears that, when the accident related above -happened at Leith, every person who ate the muscles from a particular -spot was more or less severely affected; and an important circumstance -then observed for the first time was, that animals suffered as severely -as man, a cat and a dog having been killed by the suspected article. - -Another theory ascribes the poisonous quality to disease in the fish; -but no one has hitherto pointed out what the disease is. The poisonous -muscles at Leith were large and plump, and seemed to have been chosen on -account of their size and good look. Dr. Coldstream, however, at the -time a pupil of this University, and a zealous naturalist, thought the -liver was larger, darker, and more brittle than in the wholesome fish, -and certainly satisfied me that there was a difference of the kind. But -whether this was really disease or merely a variety of natural -structure, our knowledge of the natural history of the fish hardly -entitles us to pronounce. - -Considering the failure of all other attempts to account for the -injurious properties acquired by muscles, it is extraordinary that no -experiments have been hitherto made with the view of discovering in the -poisonous fish a peculiar animal principle. It certainly seems probable, -that the property resides in a particular part of the fish or in a -particular principle. In 1827, I made some experiments on those which -caused the fatal accident at Leith, but without success. My attention -was turned particularly to the liver; but neither there nor in the other -parts of the fish could I detect any principle which did not equally -exist in the wholesome muscle. This result, however, should not deter -others, any more than it would myself, from a fresh investigation; for -the want of a sufficient supply prevented me from making a thorough -analysis; and the reader will presently find an instance related, where -another singular poison, sometimes contained in sausages and in cheese, -was, after repeated failures, at length traced successfully to the real -cause by the hand of the analytic chemist. - -M. Lamouroux, in a letter to Professor Orfila, conjectures that the -poison may be a particular species of Medusa, and enters into some -ingenious explanations of his opinion. But it is not supported by any -material fact, and seems to be surrounded by insuperable -difficulties.[1525] It is not a new conjecture; for Möhring mentions in -his paper formerly quoted, that several writers before him had conceived -such a cause might afford an explanation of the phenomena.[1526] - -Little or no light is thrown on this singular subject by the nature of -the localities in which the poisonous muscle has been found. Even on -this point we possess little information. Both in Dr. Burrows’s and Dr. -Combe’s cases the fish was attached to wood. At Leith they were taken -from some Memel fir logs, which formed the bar of one of the wet-docks, -and had lain there at least fifteen years. From the stone-walls of the -dock in the immediate vicinity of this bar muscles were taken which -proved quite wholesome. It is impossible, however, to attach any -importance to these facts; for Dr. Coldstream informs me, that he -examined muscles which were attached to the fir piles of the Newhaven -Chain-pier, about a mile from Leith, and found them wholesome. In the -latter animals the liver was not large, as in the poisonous muscles of -Leith. Lamouroux states, but I know not on what authority, that muscles -never become poisonous unless they are exposed alternately to the air -and the sea in their place of attachment, and unless the sea flows in -gently over them without any surf,—these conditions being considered by -him requisite for the introduction of the poisonous Medusæ into the -shell. - - - _Of Poisonous Oysters._ - -_Oysters_ sometimes acquire deleterious properties analogous to those -acquired by muscles. But fewer facts have been collected regarding them. -M. Pasquier has mentioned some cases which occurred not long ago at -Havre, in consequence apparently of an artificial oyster-bed having been -established near the exit of the drain of a public necessary. But I have -not been able to consult his work.[1527] Another instance of their -deleterious operation occurred a few years ago at Dunkirk. At least an -unusual prevalence of colic, diarrhœa, and cholera was believed to have -been traced to an importation of unwholesome oysters from the Normandy -coast. Dr. Zandyk, the physician who was appointed to investigate the -matter, found that the suspected fish contained a slimy water, and that -the membranes were retracted from the shell towards the body of the -animal.[1528] Dr. Clarke believes that even wholesome oysters have a -tendency to act deleteriously on women immediately after delivery. He -asserts that he has repeatedly found them to induce apoplexy or -convulsions; that the symptoms generally came on the day after the -oysters were taken; and that two cases of the kind proved fatal.[1529] I -am not aware that these statements have been since confirmed by any -other observer. - - - _Of Poisonous Eels._ - -_Eels_ have also been at times found in temperate climates to acquire -poisonous properties. Virey mentions an instance where several -individuals were attacked with violent tormina and diarrhœa a few hours -after eating a paté made of eels from a stagnant castle-ditch near -Orleans; and in alluding to similar accidents having previously happened -in various parts of France, he adds that domestic animals have been -killed by eating the remains of the suspected dish.[1530] - - - - - CHAPTER XXIII. - OF POISONING BY VENOMOUS SNAKES. - - -Another entire group of poisons allied to the acrid vegetables in their -action, but infinitely more energetic, comprehends the poisons of the -venomous serpents. If we were to trust the impressions the vulgar -entertain of the effects of the bite of serpents, the poisons now -mentioned would be considered true septics or putrefiants; for they were -once universally believed, and are still thought by many, to cause -putrefaction of the living body. This property has been assigned them -probably on no other grounds, except that they are apt to bring on -diffuse subcutaneous inflammation, which frequently runs on to gangrene. -But there are some serpents, especially among those of hot climates, -which appear also to act remotely on the centre of the nervous system, -and to occasion death through means of that action. - -The present group of poisons is of little consequence to the British -medical jurist, as an opportunity of witnessing their effects in this -country is seldom to be found. The viper is the only poisonous snake -known in Britain, where its poison is hardly ever so active as to -occasion death.[1531] - -This serpent, like all the other poisonous species, is provided with a -peculiar apparatus by which the poison is secreted, preserved, and -introduced into the body of the animal it attacks. The apparatus -consists of a gland behind each eye, of a membranous sac at the lateral -and anterior part of the upper jaw, and of a hollow curved tooth -surrounded and supported by the sac. The cavity of the tooth -communicates with that of the sac, and terminates near the tip, in a -small aperture, by which the poison is expelled into the wound made by -the tooth. - -The symptoms caused by the bite of the viper are lancinating pain, which -begins between three minutes and forty minutes after the bite, and -rapidly stretches up the limbs,—swelling, at first firm and pale, -afterwards red, livid and hard,—tendency to fainting, bilious vomiting, -sometimes convulsions, more rarely jaundice,—quick, small, irregular -pulse,—difficult breathing, cold perspiration, dimness of vision, and -injury of the mental faculties. Death may ensue. A case is related in -Rust’s Magazin of a child twelve years old, who died two days after -being bitten in the foot;[1532] another instance is briefly noticed in -the French Bulletins of Medicine, of a person forty years old, dying -also in two days;[1533] Dr. Wagner of Schlieben mentions his having met -with two instances where persons bit on the toes died before assistance -could be procured;[1534] and notice has been taken in Hufeland’s Journal -of a girl, eleven years old, having been killed in three hours at -Schlawe in Prussia.[1535] In the last case burning in the foot, which -was the part bitten, then severe pain in the belly, inextinguishable -thirst, and vomiting, preceded a fit of laborious breathing, which -ushered in death. The most remarkable instance, however, of death from -the bite of the European viper is one lately described by Dr. Braun, as -having been occasioned in the Dutchy of Gotha by the Coluber Chersea -[Kreuzotter of the Germans]. A man, who represented himself to be a -snake-charmer, insisted on showing his skill before Dr. Lenz, a -naturalist of Schnepfenthal; and putting the head of a viper belonging -to this gentleman’s collection into his mouth, he pretended to be about -to devour it. Suddenly he threw the snake from him, and it was found -that he had been bitten near the root of the tongue. In a few minutes he -became so faint that he could not stand, the tongue swelled a little, -the eyes became dim, saliva issued from the mouth, rattling respiration -succeeded, and he died within fifty minutes after being bitten.[1536] A -French writer observes that the common viper of France is not very -deadly; but that the bite of the red viper may occasion death in a few -hours.[1537] - -The activity of the poison of the viper depends on a variety of -circumstances. When kept long confined, the animal loses its energy; and -after it has bitten repeatedly in rapid succession, its bite ceases for -some time to be poisonous, as the supply of poison is exhausted. It -appears also to be most active in hot and dry climates. Those cases are -always the most severe in which the symptoms begin soonest; and the -danger increases with the number of bites. An important observation made -by Dr. Wagner is that danger need not be dreaded except when the bite is -inflicted on small organs such as the fingers or toes, because larger -parts cannot be fully included between the animal’s jaws, and fairly -pierced by its fangs, but can only be scratched. The properties of the -fluid contained in the reservoir do not cease with the animal’s life; -nay they continue even when the fluid is dried and preserved for a -length of time. It may be swallowed in considerable quantity without -causing any injury whatever. In the course of some experiments lately -made in Italy, a pupil of Professor Mangili swallowed at once the whole -poison of four vipers without suffering any inconvenience; and that of -six vipers was given to a blackbird, that of ten to a pigeon, and that -of sixteen to a raven, with no other effect beyond slight and transient -stupor.[1538] - -For the most recent account of the far more terrible effects of the -cobra di capello and rattlesnake, the reader may refer to the -authorities below.[1539] - -It was stated above that the poison of the viper retains its activity -when dried. I have had an opportunity of observing this in regard to the -poison of the cobra di capello, which is said to be preserved in India -by simply squeezing out the contents of the poison-bag, and drying the -liquid in a silver dish exposed to the sun. The specimen in my -possession, for which I am indebted to Mr. Wardrop of London, has the -appearance of small fragments of gum-arabic. It had been kept for -fifteen years when I tried its effects on a strong rabbit. A grain and a -half dissolved in ten drops of water, having been introduced between the -skin and muscles of the back, the animal in eight minutes became very -feeble and averse to stir, so that it remained still even when placed in -irksome postures; occasional slight twitches of the limbs supervened; at -length it became extremely torpid, and breathed slowly by means of the -abdominal muscles and diaphragm alone; and in twenty-seven minutes it -died exhausted, without any precursory insensibility. The heart -contracted readily, when irritated nine minutes after death; so that the -poison seemed to operate by causing muscular paralysis, and consequently -arresting the respiration. - -There might also be arranged in an appendix to the present group of -poisons those _insects_ whose sting is poisonous. The European insects -known to have a poisonous sting, are chiefly the scorpion, tarantula, -bee and wasp; of which the last two only are natives of Britain. - -The poison of these insects occasions diffuse cellular inflammation, -which always ends in resolution. It is said, however,[1540] and it may -be readily believed, that death has been sometimes caused in consequence -of a whole hive attacking an intruder and covering his body with their -stings. In an old French journal is shortly noticed the case of a -peasant who died soon after being stung over the eye by a single -bee.[1541] A more probable story has been told in the Gazette de Santé -of a gardener who died of inflammation of the throat, in consequence of -being stung there by a wasp while he was eating an apple, in which it -had been concealed.[1542] But the same accident has often occurred -without any material danger. - -The treatment of poisoning by venomous serpents need not be detailed -here. The subject is introduced merely to mention that the treatment of -poisoned wounds by the application of cupping-glasses has been lately -resorted to with success for curing the bite of the viper. A patient of -M. Piorry, two hours after being bitten, had all the constitutional -symptoms strongly developed, such as slow, very feeble pulse, nausea, -vomiting, and swelling of the face. When a cupping-glass was applied for -half an hour, the general symptoms ceased and did not return. Next day -diffuse inflammation began; but it was checked by leeches.[1543] An -equally successful case is related in the Calcutta Transactions by Mr. -Clarke.[1544] - - - - - CHAPTER XXIV. - OF POISONING BY DISEASED AND DECAYED ANIMAL MATTER. - - -Another and much more important group of poisons, that may be arranged -in the present order, comprehends animal matter usually harmless or even -wholesome, but rendered deleterious by disease or decay. These poisons -are formed in three ways, by morbid action local or constitutional, by -ordinary putrefaction, and by modified putrefaction. - - - _Of Animal Matter rendered Poisonous by Diseased Action._ - -Under the first variety might be included the latent poisons by means of -which natural diseases are communicated by infection, contact, and -inoculation. Such poisons, however, being usually excluded from a strict -toxicological system, the only varieties requiring notice are the animal -poisons engendered by disease, and which do not produce peculiar -diseases, but merely inflammation. Several species of this kind may be -mentioned, comprehending the solids and fluids in various unhealthy -states of the body. - -One of these poisons, contained in the blood and perhaps in some of the -secretions of overdriven cattle, arises under circumstances in which the -body seems to deviate little from its natural condition. A good account -of the effects thus induced has been given in an essay on the subject by -Morand.[1545] From the cases he describes it follows, that the flesh of -such animals is wholesome enough when cooked and eaten; but that if the -blood or raw flesh be applied to a wound or scratch, nay even sometimes -to the unbroken skin, a dangerous and often fatal inflammation is -excited, which at times differs little from diffuse cellular -inflammation, and at other times consists of a general eruption of -gangrenous boils, the _pustules malignes_ of the French. The deleterious -effects occasionally observed to arise from offal are probably analogous -in their nature and their cause. On this subject Sir B. Brodie has made -some remarks which tend to show that the application of various kinds of -offal to wounds, and especially pricks of the fingers with spiculæ of -bone from the hare, may cause an obstinate chronic erysipelas of the -hand.[1546] I have met with a case of this nature, where the affection -was erratic erythema of the hand. - -Another species of poison, allied to the preceding in its effects and -equally obscure in its nature, includes certain fluids of the human body -after natural death, which are probably modified, if not even formed -altogether, by morbid processes during life. Such poisons are the most -frequent source of the dreadful cellular inflammation, often witnessed -as the consequence of pricks received during dissection by the -anatomist. On this interesting but obscure subject, much minute -information will be found in the works quoted below.[1547] - -It is still a matter of question among pathologists what these poisons -are, and in what circumstances they spring up. By some their baneful -properties have been suspected to arise from the operation of particular -diseases on natural or morbid secretions;[1548] and although the precise -diseases inducing these properties, and the precise fluids which acquire -them have by no means been satisfactorily ascertained, it appears well -established that no fluid possesses them more frequently or in a higher -degree than the serum effused into the cavities of the chest and belly -by recent inflammation of the serous membranes of these cavities. By -others the origin of the poison is suspected to be wholly independent of -diseased action in the living body and to lie merely in certain changes -effected in healthy secretions by decay. And as the accidents produced -by this poison have occurred chiefly during the dissection of bodies -recently dead, it is supposed to exist only for a short time at the -commencement of decay, and to disappear in the farther progress of -putrefaction. - -But whatever may be its nature and origin, we are well enough acquainted -with its effects; which are diffuse inflammation and violent -constitutional excitement, quickly passing to a state resembling typhoid -fever. Sometimes the inflammation spreads steadily towards the trunk -from the part to which the poison was applied; sometimes the -inflammation around the injury is trifling and limited, but a similar -inflammation appears in or near the axilla, and subsequently on other -parts of the body; and the latter form of disease is always attended -with the highest constitutional derangement and with the greatest -danger. - -Another singular poison, unequivocally the product of disease, and which -acts as a local irritant, is the flesh or fluids of animals affected at -the time of their death with a carbuncular disorder, denominated in -Germany _Milzbrand_, and analogous to the _pustule maligne_ of the -French. The disease, so far as I know, has not received a vulgar name in -the English language, being fortunately rare in Britain. It is a -constitutional and epidemic malady, which sometimes prevails among -cattle on the continent to an alarming extent, and is characterized by -the eruption of large gangrenous carbuncles on various parts of the -body. This distemper has the property of rendering the solids and fluids -poisonous to so great a degree, that not only persons who handle the -skin, entrails, blood, or other parts, but even also those who eat the -flesh, are apt to suffer severely. The affection thus produced in man is -sometimes ordinary inflammation of the alimentary canal, or -cholera;[1549] more commonly a disorder precisely the same as the -pustule maligne;[1550] but most frequently of all an eruption of one or -more large carbuncles resembling those of the original disease of -cattle.[1551] It is often fatal. The carbuncular form has been known to -cause death in forty-eight hours.[1552] It is an interesting fact, for -the knowledge of which we are indebted to M. Dupuy, that the carbuncle -of cattle may be caused by applying to a wound the blood or spleen of an -animal killed by gangrene of the lungs.[1553] - -A poison analogous to the former in its nature, which has sometimes -occasioned severe and even fatal effects in man is the matter of -_glanders_, a contagious disease to which the horse is peculiarly -subject, and which is communicated probably by means of a morbid -secretion from the nostrils. This disease has been propagated to man by -infection; at least instances have been related where grooms attending -glandered horses, although they had no external injury through which -inoculation could take place, were attacked with profuse fetid discharge -from the nostrils, a pustular eruption on the face, and colliquative -diarrhœa, which has sometimes ended fatally in a few days.[1554] In -other instances inoculation of the hand with the blood of the glandered -horse has produced alarming diffuse inflammation, and a carbuncular -eruption.[1555] - -It appears probable, that some peculiar circumstances with which we are -not yet acquainted must concur with the operation of the poisons now -under review, before they can take effect. At least unequivocal facts -have been published which show, that the fluids and solids, as well as -the emanations of animals infected and even killed by glanders or the -_pustule maligne_, may be often handled and breathed with impunity. Such -is the result of a careful inquiry made under the direction of the -Parisian Board of Health into the nuisance occasioned by the great -Nackery of Montfaucon.[1556] Parent-Duchatelet, the author of an -elaborate report on the subject, considers it clearly established that -neither the workmen nor the horses connected with the establishment, nor -the tanners who are supplied with hides from it, have ever presented a -single instance of disease referrible to the operation of diseased -animal matter. Yet upwards of twelve thousand horses are annually flayed -there, and among these it is calculated that at least three thousand six -hundred are affected with carbuncle, glanders, or farcy.[1557] - - - _Of Animal Matter rendered Poisonous by common Putrefaction._ - -The second mode in which animal matters, naturally wholesome or -harmless, may acquire the properties of irritant poisons, is by their -undergoing ordinary putrefaction. - -The tendency of putrefaction to impart deleterious qualities to animal -matters originally wholesome has been long known, and is quite -unequivocal. To those who are not accustomed to the use of tainted meat, -the mere commencement of decay is sufficient to render meat -insupportable and noxious. Game, only decayed enough to please the -palate of the epicure, has caused severe cholera in persons not -accustomed to eat it in that state. The power of habit, however, in -reconciling the stomach to the digestion of decayed meat is -inconceivable. Some epicures in civilized countries prefer a slight -taint even in their beef and mutton; and there are tribes of savages -still farther advanced in the cultivation of this department of -gastronomy, who eat with impunity rancid oil, putrid blubber, and -stinking offal. How far putrefaction may be allowed to advance without -overpowering the preservative tendency of habit, it is not easy to tell. -But with the present habits of this and other civilized nations, the -limit appears very confined. - -Putrid animal matter when injected into the veins of healthy animals -proves quickly fatal; and from the experiments of Gaspard and -Magendie,[1558] together with the more recent researches of MM. Leuret -and Hamont,[1559] the disease induced seems to resemble closely the -typhoid fever of man. - -Similar effects were observed by Magendie, when dogs were confined over -vessels in which animal matter was decaying, so that they were obliged -always to breathe the exhalations.[1560] These discoveries throw some -light on the question regarding the tendency of putrid effluvia to -engender fever in man; and notwithstanding many well ascertained facts -of an opposite import, they show that, probably in peculiar -circumstances, decaying animal matter may excite epidemic fevers. A -detailed investigation of this important topic would be misplaced here, -as it belongs more to medical police than to medical jurisprudence; but -the two works quoted below are referred to for examples, in my opinion, -of the unequivocal origin of continued fever in the cause now alluded -to;[1561] and other instances of the like kind will be found in the -Report of the Parliamentary Commission on the Health of Towns. - -Another affection sometimes brought on by putrid exhalations is violent -diarrhœa or dysentery, of which a remarkable instance lately occurred in -the person of a well-known French physician, M. Ollivier. While visiting -a cellar where old bones were stored, he was seized with giddiness, -nausea, tendency to vomit and general uneasiness; and subsequently he -suffered from violent colic with profuse diarrhœa, which put on the -dysenteric character and lasted for three days.[1562] Chevallier, in -noticing this accident, mentions his having been affected somewhat in -the same way when exposed to the emanations of dead bodies; and it is a -familiar fact that medical men, who engage in anatomical researches -after long disuse, are apt to suffer at first from smart diarrhœa. - -The same remark must be applied here as at the close of the observations -in the last section. Without peculiar concurring circumstances no bad -effect results. This will follow from many facts illustrative of the -innocuous nature of various trades where the workmen are perpetually -exposed to the most noisome putrid effluvia. But no facts of the kind -are so remarkable as those collected in regard to the establishment at -Montfaucon by Parent-Duchatelet, who makes it appear that this most -abominable concentration of the worst of all possible nuisances is not -merely not injurious to the health of the men and animals employed in -and around it, but actually even preserves them from epidemic or -epizootic diseases.[1563] - -The effects of putrid animal matter when applied to wounds have been -investigated experimentally by Professor Orfila; who found that putrid -blood, bile, or brain, caused death in this way within twenty-four -hours,—producing extensive local inflammation of the diffuse kind, and -great constitutional fever. In man also several instances of diffuse -cellular inflammation have been observed as the consequence of pricks -received during the dissection of putrid bodies. The disease, as -formerly observed, certainly arises in general from pricks received in -dissecting recent bodies. At the same time, a few cases have been traced -quite unequivocally to inoculation with putrid matter;[1564] and if any -doubts existed on this point, the experiments of Orfila would remove -them. - -M. Lassaigne has examined chemically the putrid matter formed by keeping -flesh long in close vessels, and has found it to consist of carbonate of -ammonia, much caseate of ammonia, and a stinking volatile oil,—the last -of which is probably the poisonous ingredient. - - - _Of Animal Matter rendered Poisonous by Modified Putrefaction._ - -The third way in which animal matters naturally wholesome may become -irritant poisons, is by their undergoing a modified putrefaction. - -It is probable that many common articles of food occasionally become -poisonous in this way; but none are so liable to acquire injurious -properties as certain articles much used in Germany, namely, a -particular kind of sausage, a particular kind of cheese, and bacon. The -last two species of poison have been occasionally observed in France, -and probably occur in Britain also. But the first has been hitherto met -with only in some districts of Germany. - -The best account yet given of the _sausage-poison_ is contained in two -essays published by Dr. Kerner,[1565] in a Thesis by Dr. Dann,[1566] and -in a prize-essay by Dr. W. Horn.[1567] It has at various times committed -great ravages in Germany, especially in the Würtemberg territories, -where 234 cases of poisoning with it occurred between the years 1793 and -1827; and of that number no less than 110 proved fatal.[1568] - -The symptoms of poisoning seldom begin till twenty-four, or even -forty-eight hours, after the noxious meal, and rather later than -earlier. The tardiness of their approach seems owing to the great -indigestibility of the fatty matter with which the active principle is -mixed. The first symptoms are pain in the stomach, vomiting, purging, -and dryness of the mouth and nose. The eyes, eyelids, and pupils then -become fixed and motionless; the voice is rendered hoarse, or is lost -altogether; the power of swallowing is much impaired; the pulse -gradually fails, frequent swoonings ensue, and the skin becomes cold and -insensible. The secretions and excretions, with the exception of the -urine, are then commonly suspended; but sometimes profuse diarrhœa -continues throughout. The appetite is not impaired; fever is rarely -present; and the mind continues to the last unclouded. Fatal cases end -with convulsions and oppressed breathing between the third and eighth -day. In cases of recovery the period of convalescence may be protracted -to several years. The chief appearances in the dead body are signs of -inflammation in the mucous membrane of the alimentary canal,—such as -whiteness and dryness of the throat, thickening of the gullet, redness -of the stomach and intestines; also croupy deposition in the windpipe; -great flaccidity of the heart; and a tendency in the whole body to -resist putrefaction. In a set of cases which occurred so lately as 1841, -there was found after death abscesses in the tonsils, dark bluish -redness of the membrane of the pharynx, windpipe and bronchial -ramifications, gorging of the pulmonary air-tubes and condensation of -the pulmonary tissue itself, dark redness of the fundus of the stomach, -with circumscribed softening, a dark gray, red, or black appearance of -the mucous coat of the intestines, accumulation of greenish-yellow fæces -in the colon, brittleness of the liver, and enlargement of the -spleen.[1569] - -The article which is apt to occasion these baneful effects is of two -sorts, the white and the bloody sausage (_leberwürste_, _blut-würste_). -Both are of large size, the material being put into swine’s stomachs; -and they are cured by drying and smoking them in a chimney with -wood-smoke. Those which have been found to act as poisons possess an -acid reaction, are soft in consistence, have a nauseous, putrid taste, -and an unpleasant sweetish-sour smell, like that of purulent matter. -They are met with principally about the beginning of spring, when they -are liable to be often alternately frozen and thawed in the curing. -Those sausages only become poisonous which have been boiled before being -salted and hung up. They are poisonous only at a particular stage of -decay, and cease to be so when putrefaction has advanced so far that -sulphuretted-hydrogen is evolved. The central part is often poisonous -when the surface is wholesome. - -Various opinions have been entertained of the cause of the deleterious -qualities thus contracted. In recent times the principle has been -supposed to be pyroligneous acetic acid, hydrocyanic acid, or cocculus -indicus. Dr. Kerner, however, has shown that none of these notions will -account for the phenomena; and at first conceived he had proved the -poisonous principle to be a fatty acid analogous to the sebacic acid of -Thenard, and originating in a modified process of putrefaction. From the -poisonous sausage he procured by double decomposition an acid similar in -chemical properties to that obtained from fat by destructive -distillation; and by experiments on animals he thought he observed, that -the acid procured in either way produced symptoms analogous to those of -poisoning with the deleterious sausage. Subsequently, however, he -changed his views in some measure; and he now considers that the poison -is a compound one, consisting of a fatty acid analogous to the sebacic, -and of a volatile principle.[1570] The results obtained by Dr. Dann -coincide with the last opinion. Dann infers from his researches that the -poisonous principle does not necessarily reside in an acid, but is an -acrid empyreumatic oil, which when pure is not active, but is rendered -so by uniting with various fatty acids.[1571] - -The results lately obtained by Buchner after an elaborate and careful -analysis are somewhat different and probably nearer the truth. He first -ascertained that the product of the distillation of fat has no analogy -with the sausage-poison. He found it to consist of animalized acetic -acid, and a fetid empyreumatic oil, the former of which has no injurious -effect on animals, while the latter, though an active poison, is purely -narcotic in its operation. On next examining a sausage sent to him from -Würtemberg, which had violently affected four individuals and killed one -of them in six days, he remarked that the poisonous principle is not -soluble in water, or capable of being distilled over with it; and that -cold alcohol removes a granular fatty matter, which, when purified by -distilled water, has a yellowish colour, a peculiar nauseous smell, and -a disagreeable oleaginous taste, followed by extraordinary dryness of -the throat for several hours. Although it does not possess an acid -reaction on litmus, it forms a soap with alkalis, and is separated again -by acids unchanged; and consequently it may be considered a fatty acid, -to which Buchner proposes to give the name of Botulinic acid -[Würst-fett-saüre]. It concentrates in itself the poisonous properties -of the crude sausage. Thirty grains of it, which formed three-fourths of -the whole product of a single sausage, were given in two doses to a -puppy with an interval of a day between them. For some hours after the -second dose no apparent effect was produced. But gradually the animal -became dull, lay in the same spot, wasted rapidly away notwithstanding a -vigorous appetite, and died of exhaustion on the thirteenth day. Half a -grain causes insupportable dryness in the throat, which does not go off -for several hours.[1572] With these results the contemporaneous and -unconnected researches of Dr. Schumann accord very remarkably. Alcohol -boiled on the poison-sausage deposited on cooling a fatty matter, which, -when washed with distilled water, possessed all the properties specified -by Buchner, as characterizing his fatty acid, and acted on animals in -the same way as the sausage-poison.[1573] - -The _poison of cheese_ has been for some time more generally known. Dr. -Henneman has published an interesting essay on several cases which -happened at Schwerin in 1823.[1574] Another account of a similar -accident which happened at Minden in 1825 has been published in Rust’s -Magazin.[1575] But by far the best information on the subject is to be -obtained from two papers in Horn’s Archiv,—the one by Professor Hünefeld -of Greifswald, describing the phenomena as he witnessed them in that -city in 1827, and containing an elaborate chemical analysis and -physiological experiments, by means of which he conceives he has -discovered the deleterious principles contained in the cheese,[1576]—the -other by Dr. Westrumb of Hameln, who investigated the particulars of -seven cases which came under his notice in 1826, and with the aid of -Sertürner, the chemist, traced the properties of the poison to almost -the same principles with those indicated by the researches of -Hünefeld.[1577] Besides the cases which have given origin to these -papers, others have occurred throughout Germany in the same period; and -during the third quarter of last century this kind of poisoning was so -common, that several of the German states investigated the subject, and -legislative enactments were passed in consequence. - -For a long time the prevalent belief was that the cheese acquired an -impregnation from copper vessels used in the dairies; and accordingly -the Austrian, Wirtemberg and Ratesberg States prohibited the use of -copper for such purposes. This opinion, however, was proved by chemical -analysis to be untenable; and the inquiries of Hünefeld and Sertürner, -have now rendered it probable that the poisonous property of the cheese -resides in two animal acids, analogous, if not identical, with the -caseïc and sebacic acids. - -The mode in which the formation of these acids is accounted for is as -follows. According to the researches of Proust the sharp peculiar taste -of old cheese is owing to the gradual conversion of the curd or casein -into the caseate of ammonia, which in sound cheeses is always united -with the excess of alkali. In the cheese in question (_barscher-käse_, -_quark-käse_, _hand-käse_) the curd, before being salted, is left for -some time in a heap to ferment, in consequence of which it becomes sour -and afterwards ripens faster. But if the milk has been curdled with -vinegar,—if the acid liquor formed while it ferments is not carefully -drained off,—if the fermentation is allowed to go too far,—if too little -salt is used in preserving the curd,—or if flour has been mixed with the -curd, the subsequent ripening or decaying of the cheese follows a -peculiar course, and a considerable excess of caseïc acid is formed, as -well as some sebacic acid. - -The poisonous cheeses, according to Westrumb, present no peculiarity in -their appearance, taste or smell. But Hünefeld says that they are -yellowish-red, soft, and tough, with harder and darker lumps -interspersed, that they have a disagreeable taste, redden litmus, and -becomes flesh-red instead of yellow, under the action of nitric acid. - -The symptoms they cause in man appear to be nearly the same with those -produced by the poisonous sausage, and usually commence, according to -Hünefeld, in five or six hours, according to Westrumb in half an hour. -They constitute various degrees and combinations of gastro-enteric -inflammation. In the most severe of Hünefeld’s cases the quantity taken -did not exceed four ounces, and was sometimes only an ounce. - -The same author found that a drachm and a half of the caseïc acid, which -he procured from the cheese, killed a cat in eight minutes, and the same -quantity of the sebacic acid another in three hours. His experiments, -however, are not quite conclusive of the fact that these acids are -really the poisonous principles, as he has not extended his experimental -researches to the caseïc and sebacic acids prepared in the ordinary way. -His views will probably be altered and simplified, if future experiments -should confirm the late inquiries of Braconnot, who has stated that -Proust’s caseïc acid is a modification of the acetic, combined with an -acrid oil.[1578] Westrumb procured analogous results with those of -Hünefeld when he gave to animals the acid fat which he separated in the -course of his analysis. - -The poisonous cheese has been hitherto met with chiefly in some parts of -Germany. From information communicated to me by Dr. Swanwick of -Macclesfield, there is some reason to think that a parallel poison is -occasionally met with in Cheshire, among the small hill-farms, where the -limited extent of the dairies obliges the farmer to keep the curd for -several days before a sufficient quantity is accumulated for the larger -cheeses.—I am indebted to Mr. Wilson of Lockerby for the particulars of -a set of cases, which seem to have been owing to some obscure poison in -cheese. A gentleman, an hour after eating the suspected cheese, was -seized with extreme weakness and severe vomiting for four hours, then -with general soreness and a mercurial taste in the mouth, and afterwards -with tenesmus, bloody stools, soreness of the gums, and cramps in the -limbs; from which symptoms he did not recover for four weeks. Five other -members of his household suffered similarly, but less severely, and also -the shop-boy who ate a little while selling it. None of the ordinary -mineral poisons could be detected in it.—It is hardly necessary to add, -that analogous properties may be imparted to cheese by the intentional -or accidental addition of other poisons of a mineral nature. This -subject has been already alluded to in the section upon lead. - -As connected, though indeed but remotely, with the cheese-poison, some -notice may be here taken of a peculiar mode in which it has been -supposed that _milk_ may acquire the properties of an acrid poison. It -has been several times remarked on the continent, that the milk even of -the cow, but more particularly that of the ewe and goat, may act like a -violent poison, although no mineral or other deleterious impregnation -could be detected in it; and these effects have been variously and -vaguely ascribed to the animal having been diseased, or to its having -fed on acrid vegetables, which pass into the milk without injury to its -health, because though poisonous to most animals, they are not so to the -Ruminantia. This singular topic cannot be thoroughly investigated, as -precise facts are still wanting. But the two following examples of the -accident alluded to may be mentioned. One occurred at Aurillac, a -village in France. Fifteen or sixteen customers of a particular dealer -in goats’ milk were at one and the same time attacked with all the -symptoms of violent cholera; and about twenty-four hours afterwards the -goat too was taken ill with the same affection, and died in three -days.[1579] The other instance occurred at Hereford in Westphalia. Six -people of a family, after partaking of goat’s butter-milk, were -simultaneously attacked with violent vomiting, tension of the -epigastrium, and retraction of the lower belly; and several of them -suffered so severely as even to have been thought by their physician, -Dr. Bonorden, to be in danger.[1580] Dr. Westrumb has alluded to similar -cases in his memoir on the poison of cheese, and has proved that the -ordinary explanations of them are far from satisfactory. Among other -judicious observations he remarks, that the poison has been generally -believed to arise sometimes from the cattle having fed on the _Euphorbia -esula_, a species of spurge; that, according to Viridet in his -_Tractatus de Prima Coctione_, l. i. c. 15, certain fields in the -neighbourhood of Embrim were of necessity abandoned by the shepherds, -because the milk of their cows was rendered useless by the abundance of -that plant among the herbage; but that he himself has found cattle will -not touch it so long as grass and other wholesome vegetables are to be -found in the pasturage.[1581] Professors Orfila and Marc, who were -appointed by the Society of Medicine of Paris to report upon the -accident at Aurillac, state, that in parallel cases which had been -referred to them by the police at Paris they had been unable to detect -any mineral poison; that none of the received explanations are in their -opinion satisfactory; and that they are disposed to ascribe the -poisonous alteration of the milk to new principles formed by a vital -process. - -Another common article of food, which has occasionally produced similar -effects with the poisonous sausages and cheese, is bacon. Dr. Geiseler -has related an accident which occurred in a family of eight persons, and -which he traced to this cause. The symptoms were almost exactly the same -with those described by Kerner, with the addition, however, of delirium -and loss of recollection; and in two they were so violent as seriously -to endanger life. The father of the family alone escaped, having stewed -his bacon, while the rest ate it raw.[1582] His escape might have arisen -from the fatty acid having been decomposed, or the acrid oil expelled, -by the heat. It is not improbable that other varieties of cured meat may -also become poisonous. Cadet de Gassicourt mentions, that he had been -frequently desired by the police to examine cured meat which had -produced symptoms of poisoning at Paris,[1583] and Orfila makes the same -remark in his Lectures on Medical Jurisprudence.[1584] As the meat -always came from the shops of meat-curers, and did not contain any -mineral poison, it probably owed its qualities to the same ingredient as -the bacon in Geiseler’s cases. A full and interesting account of an -accident of the kind has also been given by M. Ollivier, of which the -following is an analysis. Three members of a family at Paris, on the day -after eating a ham-pie, were seized with shivering, cold sweats, violent -pain in the stomach, frequent vomiting, burning thirst, excessive -tenderness of the belly, profuse purging, and colic; but they all -recovered under antiphlogistic treatment. On subsequent inquiry it -appeared that about the same period other customers of the pastry-cook -who supplied the pie had been similarly affected; and consequently an -investigation was made into the cause under the authority of the police. -After a very careful analysis, however, by MM. Barruel and Ollivier, it -was clearly made out, that the pie did not contain a trace of any of the -common mineral poisons; and therefore the only conclusion Ollivier -conceived it possible to draw was, that the ham had acquired the -properties of the poisonous sausage or cheese of Germany.[1585] Two -similar reports have been since published, one by MM. Lecanu, -Labarraque, and Delamorlière, another by Chevallier; and both agree in -ascribing the poisonous effects to the decay of the meat, the ordinary -poisons having been sought for in vain. In the cases examined by -Chevallier, the article was a sort of sausage, called in Paris “Italian -Cheese,” and made of scraps of various kinds of meat, especially -pork.[1586] M. Boutigny has published an account of a similar accident -which befel a great number of people at a festival in France. He could -not find any of the ordinary poisons in the meat, which had been taken -chiefly in the form of sausages; and being consequently persuaded that -the suspected articles were wholesome, he dined on stuffed turkey, sold -by the dealer who had supplied them. But he was seized with chilliness, -contracted pulse, cold sweating, lividity of the countenance, great -anxiety, and then with vomiting and purging; after which he slowly -recovered.[1587] - -Other articles of food have been occasionally observed to act -injuriously on the health. Thus M. Ollivier has given an account of a -whole family having been apparently poisoned with mutton under the -influence of modified decay. Six individuals were attacked soon after -dinner with vomiting, purging, colic, tenderness of the belly, extreme -prostration, and a small hurried pulse. Four of them died within eight -days. General inflammatory redness, with some extravasation under the -mucous coat, was found throughout the whole course of the small -intestines. No trace could be detected of any of the ordinary poisons; -and Ollivier was therefore led to ascribe the accident to some -peculiar change produced in stewed mutton, which all the individuals -had partaken of at dinner.[1588] In 1839 a singular accident happened -at Zurich, which was ascribed to decayed _veal_ and _ham_. On a -fete-day 600 people, who had dined upon cold roast-veal and ham in a -wooden erection, were all taken ill with shivering, giddiness, -headache, burning fever, diarrhœa and vomiting; some had delirium, -others a fœtid salivation and even ill-conditioned ulcers of the -mouth; and in the worst cases collapse of the countenance, involuntary -stools, and extreme prostration preceded death. On dissection the -alimentary mucous membrane was found softened and the intestinal -follicles ulcerated. The cause was supposed to have been -satisfactorily traced to incipient putrefaction of the veal and ham, -which constituted the fundamental part of the repast.[1589] Effects -somewhat similar have been observed from spoiled _goose-grease_, used -in dressing food. Dr. Siedler has related four cases where violent -symptoms were thus induced. Two adults and two children, after eating -a dish seasoned with goose-grease, were seized with giddiness, -prostration of strength, anxiety, sweating,—burning pain in the lower -belly, aggravated by pressure,—violent vomiting, in one case -sanguinolent,—involuntary stools, and urine, and dilatation of the -pupil. In one of the adults there was also complete insensibility, -with imperceptible pulse for six minutes. No metallic poison could be -found. The grease was acid, and of a repulsive odour; and three ounces -given to a dog acted violently and in the same manner.[1590] Another -article of food which has appeared occasionally to produce parallel -effects is _smoked sprats_. An instance of their injurious operation -is briefly described in the work quoted below;[1591] and Dr. -O’Shaughnessey informed me some years ago, that, while in London, he -met with the case of a female, advanced in pregnancy, who after eating -smoked sprats, in which she remarked a disagreeable sharp taste, was -attacked with severe colic, sickness, vomiting of food mixed with -streaks and clots of blood, and some diarrhœa. Putrid _pickled salmon_ -has occasioned death in this country;[1592] and I may mention that I -have known most violent diarrhœa occasioned in two instances by a very -small portion of the oily matter about the fins of _kipper_ or smoked -salmon, so that I have no doubt a moderate quantity would produce -serious effects. - -Although these illustrations of the effects of modified putrefaction in -rendering wholesome meat noxious have been taken in a great measure from -continental experience, this has been done rather because the subject -has been more fully and accurately investigated there, than because -similar poisons are unknown in Britain. The defective system of medical -police in this country would allow such accidents as those mentioned -above to pass sometimes without notice, and almost always without -scientific examination; but it must not therefore be supposed that they -are wholly unknown. - -The following incident, which happened a few years ago on the Galloway -coast, is an instance of poisoning not less alarming than any of those -which have occurred in Germany. In the autumn of 1826 four adults and -ten children ate at dinner a stew made with meat taken from a dead calf, -which was found by one of them on the sea shore, and of which no history -could be procured. For three hours no ill effect followed. But they were -then all seized with pain in the stomach, efforts to vomit, purging, and -lividity of the face, succeeded by a soporose state like the stupor -caused by opium, except that when roused the patient had a peculiar wild -expression. One person died comatose in the course of six hours. The -rest, being freely purged and made to vomit, eventually got well; but -for some days they required the most powerful stimulants to counteract -the exhaustion and collapse which followed the sopor. The meat, they -said, looked well enough at the time it was used. Yet the remains of the -fish which formed the noxious meal had a black colour and nauseous -smell; and the uncooked flesh had a white, glistening appearance, and -was so far decayed that its odour excited vomiting and fainting.[1593] -It is much to be regretted that this accident was not properly inquired -into. The only conjecture which the facts will warrant as to the cause -of the poisonous quality of the meat is, that in consequence of having -lain long in the water, the flesh had begun to undergo the adipocirous -putrefaction; and that in the course of the changes thus induced the -meat became impregnated with some poisonous principle, like that of the -German sausages, or cheese. - -An accident of a similar nature, for the particulars of which I am -indebted to Dr. Swanwick of Macclesfield, occurred at Stockport in the -summer of 1830. A family of five persons took for dinner broth made of -beef, which, owing to its black colour, the master of the family had -previously said to his wife he thought bad and unfit for use. In the -course of some hours two boys were attacked with sickness and vomiting, -but appear to have got soon well, probably owing to the early discharge -of the poison. Next morning a washerwoman who had dined with the family -was seized with violent pain in the bowels, diarrhœa, racking pains and -weakness in the limbs; and she did not recover for ten days. On the -evening of the second day the master of the house was similarly -affected, and was ill for a fortnight. And a day later his wife was also -seized with a similar disorder, preceded by soreness of the throat and -tongue and difficulty of swallowing, and ending fatally in fourteen -days. The last person was previously in delicate health, and subject to -disorder in the stomach and bowels. The investigation made by the police -authorities into the circumstances of this accident was extremely -imperfect: but there seems little reason to doubt that unsound meat was -the cause. - -I am not sure under what head to arrange the following observations, -communicated to me by Dr. M’Divitt of Canterbury, and of which he has -since published a detailed account.[1594] But they may be mentioned, -perhaps not inappropriately, in the present place; and at all events -they deserve careful attention, as referring to a description of cases -which may be mistaken for other kinds of poisoning. - -It is well known that pork in all forms, but especially when fresh, is -apt to cause indigestion in many persons who are not accustomed to it. -But Dr. M’Divitt has shown by a number of interesting cases, that even -in those habituated to its use, it may, from unascertained causes, -excite symptoms closely allied to those of irritant poisoning. The -effects sometimes begin within three hours, the symptoms being those of -an affection of the stomach, such as sudden violent pain in the -epigastrium, difficult breathing, irregularity of the pulse, great -prostration and alarm, coldness of the extremities and vomiting. If a -longer period elapses,—and sometimes no injury accrues for many hours, -or even a whole day,—the symptoms indicate an affection of the abdomen, -namely, pain in the region of the duodenum, or of the sigmoid flexure of -the colon, with the other symptoms just enumerated, but which ere long -become attended with more pungent pain, tension and tenderness of the -belly, frequency of the pulse, and ineffectual straining to evacuate the -bowels. In the less urgent and slower cases of this nature there is -little or no vomiting. Sometimes nettle-rash appears. Stimulants, -opiates, and blood-letting are of no avail; and the only useful remedies -are emetics and cathartics, which speedily put an end to the symptoms by -removing their cause. In all the cases related by the author the pork -was either fresh or recently salted, fatter than usual, but not ill -preserved or otherwise faulty in any appreciable respect. In every -instance the individuals had eaten pork often before without injury; and -on several occasions others ate without harm the same pork which seemed -deleterious. - - - - - CHAPTER XXV. - OF POISONING BY MECHANICAL IRRITANTS. - - -The _fifth_ order of the irritant class of poisons includes mechanical -irritants. - -These substances have not properly speaking any poisonous quality; but -occasion symptoms like those of poisoning, and even sometimes death -itself, in consequence of their mechanical qualities only. They have -therefore been excluded from every toxicological system proposed in -recent times; but in a medico-legal work on poisoning it would be wrong -to pass them without notice. - -The most important of the mechanical irritants are those which cause -injury by reason of their roughness, sharpness, or size. - -Many instances have occurred of persons having swallowed fragments of -steel, copper, iron, broken glass, or entire prune-stones, -cherry-stones, and the like,—who not long afterwards were attacked with -signs of inflammation, or some other abdominal disease, and were carried -off by it as by the administration of poison. The disorders thus induced -are almost always of a chronic or lingering kind, and commonly depend on -gradual perforation of the intestines by the foreign body pressing on -the coats. In general the illness ends in inflammation of the -peritonæum. Sometimes the irritating substance perforates the skin and -muscles as well as the intestines, and escapes outwardly; and a few -individuals have even recovered under these circumstances. An excellent -account of the ordinary course of such accidents is given in the London -Medical and Physical Journal. The person swallowed a chocolate bean, and -after experiencing many uneasy sensations throughout the belly for -several days, was attacked with peritonitis and died.[1595] Mr. Howship -has related the particulars of the case of a woman, died after two years -of constant suffering, in consequence of having swallowed a large -quantity of cherry-stones.[1596] Dr. Marcet has also described the case -of a sailor who died in a similar way after swallowing several large -clasp-knives.[1597] Thus too, although it is a familiar fact, that -needles and pins are in general swallowed with impunity, death -nevertheless sometimes arises from this cause. Guersent mentions the -case of a child who died in the course of two months of frequent -vomiting caused by swallowing a pin, which was found after death pinning -the stomach, as it were, to the liver.[1598] Dupuytren relates the case -of a woman, who, after swallowing an incredible number of needles and -pins, became very lean and was confined to bed by the excruciating pain -excited on motion by the needles and pins escaping through the skin. -There were seldom less than fifty tumours or abscesses on various parts -of the body; and Dupuytren, on opening about a hundred of these, -invariably found one or more needles or pins in each. She laboured under -general debility, irritative fever, and marasmus, and at length died -hectic. After death many hundred pins and needles were found among the -muscles and viscera.[1599] Many other examples might be referred to, but -these will suffice for information on the ordinary effects of mechanical -irritants of the kind under consideration. - -From the case of Dr. Marcet and other similar facts, it appears that -large and even angular bodies do not always cause serious mischief, nay, -that they have been frequently swallowed without any material injury. -Dr. Marcet’s sailor in the course of his life had repeatedly swallowed -several clasp-knives in quick succession: and nevertheless recovered -perfectly after some days of slight illness. As to prune and -cherry-stones, buttons, coins, needles, pins, and the like, they have -been very often taken, and even sometimes in large quantities, without -any harm. It is indeed extraordinary, and almost incredible, if the -facts were not authenticated beyond the possibility of a doubt, how much -mechanical irritation the alimentary canal has been subjected to, -without sustaining any injury. Mr. Wakefield mentions that a man, who -was committed to the House of Correction, swallowed seven half-crowns, -to prevent the prison authorities from depriving him of them. He -suffered no inconvenience for twenty months; when, after an attack of -sickness, slight bowel-complaint, and general tenderness of the belly, -he discharged them all at one evacuation.[1600] Many singular instances -to the same effect have been related in the various medical journals of -Europe. At the head of the list, however, may be placed the following, -which is related by the late Professor Osiander of Göttingen, in his -work on Suicide. - -A young German nobleman tried to kill himself in a fit of insanity by -swallowing different indigestible substances, but without success. He -never suffered any particular inconvenience except a single attack of -vomiting daily, though in the course of seven months after being -detected he passed the following articles by stool—150 pieces of sharp, -angular glass, some of them two inches long—102 brass pins—150 iron -nails—three large hair pins, and seven large chair-nails—a pair of -shirt-sleeve buttons—a collar-buckle, half of a shoe-buckle, and three -bridle-buckles—half a dozen sixpenny pieces—three hooks, and a lump of -lead—three large fragments of a currycomb, and fifteen bits of nameless -iron articles, many of them two inches in length.[1601] - -Before such articles occasion serious harm, it is necessary that some -cause coincide, by means of which the foreign bodies are detained long -in the same part of the intestines; otherwise the irritation they -produce is too trivial to excite disease. - -The only substance of this kind which it is necessary to particularize -is _pounded glass_. A common notion prevails that pounded glass is an -active poison. There is no doubt, indeed, that it does possess some -irritant properties even when finely pulverized; for it titillates and -smarts the nostrils, and inflames the eyes. There is also little doubt -that when swallowed in fragments of moderate size, especially if the -stomach is empty, it may wound the viscera. But it is in this way only -that it has any action when swallowed, and even then its effects are by -no means uniformly serious. It can have no chemical action on the -stomach; it cannot act through absorption, as it is quite insoluble: and -when finely pulverized, it cannot easily wound the villous coat of the -alimentary canal, on account of the abundance and viscidity of the -lubricating mucus. - -Accordingly, M. Lesauvage ascertained that 2½ drachms of the powder may -be given to a cat at once without hurting the animal,—that in the course -of eight days seven ounces might be given to a dog without any bad -consequence, although the period chosen for administering it was always -some time before meals,—and that even when the glass was in fragments a -line in length, no symptoms of irritation were induced. Relying indeed -on these results he himself swallowed a considerable number of similar -fragments; and did not sustain any injury.[1602] Caldani likewise, an -Italian physician, after some experiments on animals, gave a boy fifteen -years old several drachms of pounded glass, without observing any bad -effects; and at his request Mandruzzato repeated his experiments on -animals, and himself swallowed on two successive days two drachms and a -half each day without sustaining any injury.[1603] - -Similar observations have been made by others also. Dr. Turner of -Spanish Town, Jamaica, has informed me, that an attempt was made there -by a negro to poison a whole family by administering pounded glass; but, -although a large quantity was taken by seven persons, none of them -suffered any inconvenience. Not long ago the occurrence of a similar -case at Paris gave rise to a careful investigation of the whole subject -by Baudelocque and Chaussier. A young man, Lavalley, married a girl who -was pregnant by him; but it was agreed that she should live with her -father till her delivery was over. A month after the marriage Lavalley -invited his wife and father-in-law to dinner; and his wife ate heartily -boiled pork, bloody-sausages, and roast-veal, and subsequently drank -coffee with brandy in it. On returning home in the evening she became -unwell, continued so all night, next morning was seized with violent -pain in the stomach and vomiting, and died in convulsions. The period of -her death is not mentioned in the report I have seen. A suspicion of -poisoning having arisen after burial, the body was disinterred in -forty-two days; and, although it was much decayed, black points and -patches could be distinguished in many parts of the bowels, together -with a quantity of broken down glass. The medical inspectors accordingly -declared that she had died of poisoning with pounded glass; and the -husband was imprisoned. Baudelocque and Chaussier, who were consulted, -ascribed the black patches to putrefaction or venous congestion, and -declared that in whatever way the glass had got into the bowels, she had -not died of poisoning with the substance, as pounded glass is not -deleterious.[1604] A similar opinion as to the properties of pounded -glass was more lately given by Professor Marc, when consulted on a case -of attempted poisoning, in which the person against whom the attempt was -made felt the rough particles in his mouth while taking the second -spoonful of soup in which the glass was contained.[1605] - -This opinion certainly appears to be in general true. At the same time -instances are not wanting to render it probable, that pounded or broken -glass is occasionally hurtful. Thus, passing over the more doubtful -examples recorded by the older authors, we have the two following cases -related by good authorities in the most modern times. One has been -published by Mr. Hebb of Worcester. A child, eleven months old, died of -a few days’ illness in very suspicious circumstances. On Mr. Hebb being -requested by the coroner to examine the body, he found the inside of the -stomach lined with a tough layer of mucus streaked with blood; the -villous coat was highly vascular, and covered with numberless particles -of glass of various sizes, some of which simply touched, while others -lacerated it; and no other morbid appearance could be detected in the -body.[1606] The other case is described by Portal. A man undertook for a -wager to eat his wine-glass, and actually swallowed a part of it. But he -was attacked with acute pain in the stomach, and subsequently with -convulsions. Portal made him eat a surfeit of cabbage; and having thus -enveloped the fragments, administered an emetic, which brought away the -glass and vegetables together.[1607] The same feat has undoubtedly been -sometimes accomplished with impunity. For example, in the Edinburgh -Medical and Surgical Journal, an instance is related of a man who -champed and swallowed three-fourths of a drinking-glass without -suffering any harm; and the person mentioned by Osiander swallowed many -pieces of glass, and sustained no inconvenience (p. 503). But these -facts will not altogether outweigh the equally pointed narratives of -Portal and Mr. Hebb. And, on the whole, the medical jurist must come to -the conclusion, that broken and pounded glass, though generally -harmless, may sometimes prove injurious or even fatal.[1608] Powdered -glass, however, is probably inert. - -Another variety of injury from the mechanical irritants is inflammation -from hot liquids, such as _melted lead or boiling water_. These, when -swallowed, may unquestionably cause serious mischief, and even death; -and the symptoms they induce are exactly those of the irritant poisons -properly so called. - -The effects of boiling water have been investigated experimentally by -Dr. Bretonneau of Tours; and the results illustrate forcibly the -observations which have been repeatedly made in the course of this work, -respecting the slight constitutional derangement caused by such poisons -as have merely a local irritating power. He found that when boiling -water was injected in the quantity of eight ounces into the stomach of -dogs, it excited inflammation, passing on to gangrene, both in the -villous and muscular coats. The symptoms, however, were trifling. For a -day or two the animals appeared languid; but in three days they -generally became lively and playful, one of them actually lined a bitch, -and it was only on strangling them and examining the bodies, that the -extent of the mischief was discovered.[1609] - -I am not aware that any such case have hitherto occurred in man. Death -from drinking boiling water, indeed, is not an uncommon accident, -particularly in Ireland and some parts of England, where children, who -are in the habit of drinking cold water from the tea-kettle, have -swallowed boiling water by mistake. It appears, however, that in these -instances death is not owing to inflammation of the gullet and stomach, -but to inflammation of the upper part of the windpipe,—the water never -passing lower than the pharynx. The best information on this subject is -contained in an interesting paper by Dr. Hall.[1610] He has there given -the particulars of four cases which came under his notice; from which it -follows that the disease induced is always _cynanche laryngea_, proving -fatal by suffocation. Two of his patients died suffocated; another, -while in imminent danger, was relieved by tracheotomy, but died -afterwards of exhaustion; the fourth recovered suddenly during a fit of -screaming, when apparently about to be choked; and it was supposed that -the vesicles around the glottis had been burst by the cries. - -Pouring melted lead down the throat was a frequent mode of despatching -criminals and prisoners in former ages. Only one authentic case is to be -found on record of death from this cause in modern times. It occurred at -the burning of the Eddistone light-house. A man, while gazing up at the -fire with his mouth open, received a shower of melted lead from the -building, and expired after twelve days of suffering. Seven ounces and a -half of lead had reached the stomach; and the stomach was severely -burnt, and ulcerated.[1611] - - -In concluding the Irritant Poisons, and before proceeding to the next -class, the Narcotics, it is necessary to observe, that besides the -substances which have been treated of, there are others not usually -considered poisons, and some that are even used daily for seasoning -food, which, nevertheless, when taken in large quantities, will prove -injurious and even occasion all the chief symptoms of the active -irritants. These substances connect the true poisons with substances -which are inert in regard to the animal economy. - -It is impossible to particularize all the articles of the kind now -alluded to. But in illustration, I may refer in a few words to six -common substances, pepper, Epsom salt, alum, cream of tartar, sulphate -of potash, and common salt. - -_Pepper_, which is daily used by all ranks with impunity, will -nevertheless cause even dangerous symptoms when taken in large quantity. -In Rust’s Journal is noticed the case of a man affected with a tertian -ague, who after taking between an ounce and a half and two ounces of -pepper in brandy, was attacked with convulsions, burning in the throat -and stomach, great thirst, and vomiting of every thing he swallowed. His -case was treated as one of simple gastritis, and he recovered.[1612] - -A very striking instance, which may be arranged under the present head, -has also been related to me, of apparent poisoning with Epsom salt. A -boy ten years old took two ounces of this laxative partly dissolved, -partly mixed in a tea-cupful of water; and had hardly swallowed it -before he was observed to stagger and become unwell. When the surgeon -saw him half an hour after, the pulse was imperceptible, the breathing -slow and difficult, the whole frame in a state of extreme debility, and -in ten minutes more the child died without any other symptom of note, -and in particular without any vomiting. The circumstances having been -investigated judicially, it appeared that the substance taken was pure -Epsom salt; that the father, who was doatingly fond of the child, gave -the laxative on account of a trifling illness which he supposed might -arise from worms; and that on the most careful inspection of the body, -no morbid appearance whatever could be found in any part of it. For the -particulars of this singular case, I am indebted to Dr. Dewar of -Dunfermline, the medical inspector under the sheriff’s warrant. It shows -that in certain circumstances even the laxative neutral salts may be -irritating enough to cause speedy death. - -Of the same nature probably are the cases which have lately led some to -ascribe poisonous properties to _sulphate of potash_, a purgative salt -at one time in common use. About three years ago several instances of -apparent poisoning with this substance occurred in Paris; and one of -them proved fatal. This was the case of a woman, recently delivered, who -got 100 grains every fifteen minutes till she had taken six doses. -Immediately after the first dose she was seized with severe pain in the -stomach, nausea, vomiting, numbness, and cramps in the arms and legs, -then with dyspnœa and severe purging, and in two hours she expired. The -stomach and intestines were emphysematous, but otherwise healthy; and -the stomach contained sulphate of potash, but not a trace of any of the -common poisons. The stock of this salt in the shop where it had been -purchased was found to be perfectly pure.[1613]—A remarkable case of the -same kind lately led to a criminal trial in London. A man Haynes was -charged with attempting to procure abortion by giving his wife sulphate -of potash. It was proved that on two successive evenings he gave her a -dose of two ounces of the salt; that she was seized after the first dose -with excessive and alarming sickness, from which, however, she soon -recovered without apparent harm; but that after the second dose she had -violent vomiting and profuse purging, of which she died in five hours, -without any alteration in the symptoms, except that she became -insensible for five minutes before death. The whole gastro-intestinal -mucous membrane was bright red, the vessels of the brain were much -congested, and between two and three ounces of blood had escaped from -the neighbourhood of the occipital sinus. The salt had been swallowed in -a single tumbler of water, so that part of it was undissolved. Mr. -Brande, who analyzed the sample which had been used, found it free of -all the ordinary irritant poisons. Mr. Coward of Hoxton, to whom I owe -the particulars of this singular case, was of opinion, along with other -medical gentlemen concerned in it, that death arose from apoplexy -brought on by the violent and unceasing vomiting. - -Another cathartic, undoubtedly in general very mild in its action, the -_bitartrate of potash_, has also proved fatal, when taken in immoderate -quantity. Thus, a man, endeavouring to quench his thirst and cool his -stomach the morning after he had been drunk, ate a quarter of a pound of -this salt in lumps at once, and a good deal more throughout the day -afterwards. He was in consequence attacked with incessant vomiting, -frequent purging, and other signs of irritation in the alimentary canal. -He died on the third day; and the stomach and bowels were found much -inflamed.[1614] - -Even _common salt_ has been known to act as a poison when taken in large -quantity. A striking instance of the kind occurred in London in -September, 1828. A man, who had been in the custom of exhibiting various -feats of gluttony, proposed to some of his comrades one afternoon to sup -a pound of _common salt_ in a pint of ale, and actually finished his -nauseous dish, but not without being warned of his imprudence by an -attack of vomiting in the middle of it. He was soon after seized with -all the symptoms of irritant poisoning, and died within twenty-four -hours. The stomach and intestines were found after death excessively -inflamed.[1615] This remarkable case is not without its parallel. In -1839, a girl in the North of England died in consequence of taking -upwards of half a pound of salt as a vermifuge.[1616] Not long ago I met -with an instance of somewhat similar, but less violent effects. A -student having taken upwards of two ounces of salt as an emetic, -dissolved in a small quantity of water, was seized with acute burning -pain in the stomach, tenderness in the epigastrium and great anxiety, -without any vomiting until he drank a large quantity of warm water as a -remedy. Before I saw him he had vomited freely, but still suffered -severe, intermitting pain, which was removed by a large dose of muriate -of morphia. - -In France, though not hitherto, so far as I know, in Britain, several -instances have occurred of extensive sickness in particular districts, -which have been traced to the accidental adulteration of _common salt_ -with certain deleterious articles. In an investigation conducted by M. -Guibourt, in consequence of several severe accidents having been -produced apparently by salt in Paris and at Meaux, oxide of arsenic was -detected;[1617] and this discovery was subsequently confirmed by MM. -Latour and Lefrançois, who ascertained that the proportion of arsenic -was sometimes a quarter of a grain per ounce.[1618] Another singular -adulteration which appears fully more frequent is with hydriodate of -soda. At a meeting of the Parisian Academy of Medicine in December, -1829, a report was read by MM. Boullay and Delens, subsequent to an -inquiry by M. Sérullas, into the nature of a sample of salt which -appears to have occasioned very extensive ravages. In 1829, various -epidemic sicknesses in certain parishes were suspected to have arisen -from salt of bad quality. In the month of July no less than 150 persons -in two parishes were attacked, some with pain in the stomach, nausea, -slimy and even bloody purging, others with tension of the belly, -puffiness of the face, inflammation of the eyes and swelling of the -legs; and in several parishes in the Department of the Marne a sixth -part of the population was similarly affected. The salt being suspected -to be the source of the mischief, as it had an unusual smell which some -compared to the effluvia of marshy ground, M. Sérullas analyzed it, and -after him MM. Boullay and Delens; and both analyses indicated the -presence of a hundredth of its weight of hydriodate of soda, besides a -little free iodine.[1619] Subsequently, in reference to the discovery of -arsenic by other chemists in different samples of suspected salt, M. -Sérullas repeated his analysis, but could detect none of that -poison.[1620] Still more lately the whole subject has been investigated -with great care by M. Chevallier.[1621] M. Barruel states that he -observed the occasional adulteration of salt with some hydriodate -accidentally in 1824, while preparing experiments for Professor Orfila’s -lectures. He found it in two samples from different grocers’ shops in -Paris.[1622] No satisfactory explanation has yet been given of the -source of the adulteration with arsenic; but the presence of hydriodate -of soda has been traced to the fraudulent use of impure salt from kelp -[see p. 160]. - -Some difference of opinion prevails among toxicologists in regard to the -alleged deleterious qualities of _alum_. On the whole it scarcely -appears so active as to deserve the name of a poison; yet, like other -salts, it may in large doses do serious injury. It merits particular -mention among the present description of substances, partly on account -of a trial at Paris, where dangerous effects were alleged to have been -produced by it, and partly for the physiological inquiries made on that -occasion. A druggist supplied a lady by mistake with powder of burnt -alum instead of gum-arabic; and the lady, who had long laboured under -chronic derangement of the stomach and bowels, took a single dose of a -solution containing between ten and twenty grains of the salt. She -immediately complained of acute pain in the stomach and gullet, burning -in the mouth, and nausea; the symptoms of a severe attack of -inflammation in the stomach and bowels ensued; and she was not -considered out of danger for several days. The druggist was accordingly -prosecuted, and heavy damages claimed. The attending physician ascribed -the symptoms to the alum. But Marc and Orfila, who were consulted, -declared that this was impossible except on the supposition that the -lady had a very unusual sensibility of the stomach to irritating -substances;—that it was a common thing to give three, four, and even -five times the quantity in the treatment of diseases, without any such -consequences resulting;—and that at the very time of the inquiry a -physician in Paris was using it to the amount of six or eight drachms in -a day. From an experimental inquiry conducted by Professor Orfila it -appears, that large doses of calcined alum, such as one or even two -ounces, excite in dogs little more than one or two attacks of vomiting, -even although retained between ten and thirty minutes,—that one ounce -will not excite any marked symptoms though secured in the stomach by a -ligature,—but that two ounces given in the same way prove fatal in five -hours, under symptoms of excessive exhaustion and insensibility.[1623] A -similar inquiry was instituted about the same time by M. Devergie, who -seems, however, to have remarked more activity in alum than is indicated -by Orfila’s experiments. He infers that two ounces may sometimes kill -dogs, even though they vomit freely; that half that quantity is fatal if -the gullet be tied; that calcined alum is more active than a solution of -the salt; that it is a corrosive or irritant; and that probably man is -more sensible to its operation than the lower animals.[1624] Whatever -may be thought of the effects of alum on the animal body when -administered in large doses, it is plain from its frequent medicinal use -as an internal astringent that it is not poisonous when given in small -doses, like that taken by the patient in the trial alluded to. I may add -that it appears very doubtful whether any injury accrues from the -long-continued use of very small doses. Bakers, it is well known, are in -the practice of using it in minute proportion for improving the -whiteness of bread; and it has been imagined that chronic disorders of -the stomach and bowels may consequently originate, by reason of its -constipating tendency. These fears, however, are not borne out by facts. -Either the quantity is insufficient to do harm in the way supposed; or -the constitution becomes accustomed to the continual operation of the -salt, and does not suffer. - - - - - CHAPTER XXIV. - CLASS SECOND. - OF NARCOTIC POISONS GENERALLY. - - -The term narcotism has been used by different writers with different -significations, but is now generally understood to denote the effects of -such poisons as bring on a state of the system like that caused by -apoplexy, epilepsy, tetanus, and other disorders commonly called -nervous. Narcotic poisons, therefore, are such as produce chiefly or -solely symptoms of a disorder of the nervous system. - -The mode in which most narcotic poisons act has been well ascertained: -they act on the brain or spine or both by entering the blood-vessels. -Hence they are most active when most directly introduced into the blood, -that is, when injected into the veins; and when they are applied to an -entire membranous surface, their energy is in the ratio of its absorbing -power. Thus, when injected into the chest, they act more rapidly than -when swallowed. According to the generally received opinion, they are -conveyed with the blood to the brain and spine on which they act. But, -according to the views of Messrs. Morgan and Addison, they produce on -the inner coats of the blood-vessels a peculiar impression, which is -conveyed to the centre of the nervous system along the nerves. - -The usual symptoms in man and the higher order of animals are giddiness, -headache, obscurity or deprivation of the sight, stupor or perfect -insensibility, palsy of the voluntary muscles or convulsions of various -kinds, and towards the close complete coma. The symptoms of each poison -are pretty uniform, when the dose is the same. But each has its own -peculiarities, either in the individual symptoms, or in the mode in -which they are combined together. - -The morbid appearances they leave in the dead body are commonly -insignificant. In the brain, where chiefly the physician is led from the -symptoms to expect unnatural appearances, the organs are in general -quite healthy. Sometimes, however, the veins are gorged with blood, and -the ventricles and membranes contain serosity. The blood appears to be -sometimes altered in nature; but the alteration is by no means -invariable, and sometimes none is remarked at all. Many of the -statements to be found in authors on the morbid appearances caused by -narcotics are far from being accurate. - -Before proceeding to notice the genera of this class in their order, -some remarks must be premised on the principal diseases which resemble -them in the symptoms and morbid appearances. Of these the only diseases -of much consequence are _apoplexy, epilepsy, inflammation of the brain, -hypertrophy of the brain, inflammation of the spinal cord, and syncopal -asphyxia_. - - - _Of the Distinction between Apoplexy and Narcotic Poisoning._ - -_Of the Symptoms._—The symptoms of apoplexy are almost exactly the same -as those of the narcotic poisons, namely, more or less complete -abolition of sense and the power of motion, frequently combined with -convulsions. This disease commonly arises from congestion or effusion of -blood within the skull; but one variety of it, the nervous apoplexy of -older authors, or simple apoplexy of the moderns, is believed to be an -affection of the brain, unaccompanied by any recognizable derangement of -structure. - -Apoplexy and narcotic poisoning may be often distinguished by the -following criterions: - -1. Apoplexy is sometimes preceded at considerable intervals by warning -symptoms, such as giddiness, headache, ringing in the ears, depraved -vision, or partial palsy. But it is an error to suppose that warning -symptoms always occur; nay, if we may trust the experience of M. -Rochoux, they are by no means common: of sixty-three cases which came -under his notice nine only had distinct precursory symptoms.[1625] -Poisoning with narcotics of course has not any precursory symptom except -by fortuitous combination. And consequently, if warning symptoms have -occurred, the presumption is, that the cause of death is a natural one. - -2. Apoplexy attacks chiefly the old. It is not, however, confined to the -old. On the trial of Captain Donnellan for poisoning Sir T. Boughton, -Mr. John Hunter mentioned that he had met with two instances of death -from apoplexy in young women; my colleague Dr. Alison has related to me -a similar case; Professor Bernt has described another of a young girl -who died apoplectic from extravasation of blood over the whole brain and -in the ventricles also;[1626] and Mr. Greenhow, a surgeon of London, has -even noticed a case of apoplexy from effusion of blood over the surface -of the brain in a child two years and a half old.[1627] On this subject -the treatise of Rochoux supplies excellent information: of his -sixty-three cases sixty-one were above thirty years of age, two less -than thirty, none younger than twenty.[1628] It is plain, therefore, -that apoplexy in young people is rare. On the other hand, a great -proportion of cases of poisoning with the narcotics when they have been -taken intentionally (and such cases are most likely to lead to -medico-legal questions), has occurred among the young, especially of the -female sex. - -3. The next criterion is, that apoplexy occurs chiefly among fat people. -But it is here mentioned only that the medical jurist may be cautioned -against the belief that it is in all circumstances a correct criterion. -Upon this particular Rochoux has furnished some satisfactory data. Among -his sixty-three patients thirty were of an ordinary habit, twenty-three -were of a thin, meager habit, and ten only were large, plethoric and -fat.[1629] In receiving this statement, however, it is necessary to -consider, that although the vulgar idea, that most apoplectic people are -fat, does not apply to persons in the rank of Rochoux’s patients, who -were mostly hospital inmates, yet it may apply better to the upper -ranks. For the same circumstances which predispose to apoplexy, namely, -great strength, vigorous constitution and good digestive powers, -likewise predispose to corpulency, so that whenever the condition of -life permits the disposition to corpulency to be developed, the -connexion of apoplexy with it will appear. - -4. A fourth criterion is drawn from the relation which the appearance of -the symptoms bears to the last article of food or drink that was taken. -I believe that the effects of the common narcotics, in the cases where -they prove fatal, begin not later than an hour, or at the utmost two -hours, after they are taken; and in a great majority of instances they -begin in a much shorter time, namely, in fifteen or thirty minutes. -Hence if it can be proved that the nervous symptoms, under which a -person died, did not begin till several hours after he took food, drink -or medicine, it appears almost, if not absolutely certain, that a -narcotic poison cannot have been the cause of death. To some narcotic, -or rather narcotico-acrid poisons this rule certainly will not apply, -such as the poisonous fungi and spurred rye; which seldom begin to act -for several hours, sometimes for not less than a day and a half. Neither -will the rule apply to poisoning with the deleterious gases, as their -action has no connexion at all with eating or drinking. But these facts -do not form a material objection to the rule laid down; because the -circumstances under which cases of the kind occur are generally so -apparent, as at once to point out their real nature to a careful -inquirer. - -In regard to apoplexy as the disease which resembles most closely the -effects of the narcotics, it was formerly stated that this disease is -apt to occur soon or immediately after taking a meal (p. 95).[1630] In -the greater number of such cases, however, where the meal has been the -exciting cause of the disease, the symptoms have begun _immediately_ -after, or even during a meal. This is very rarely the case with the -symptoms of narcotic poisoning, and never happens in respect to those of -the commonest of the narcotics, opium: An interval of 10, 15, 20 or 30 -minutes always occurs. The deleterious gases and hydrocyanic acid, with -its compounds, are the only familiar narcotic poisons which act more -swiftly. - -5. Another criterion relates to the progress of the symptoms. The -symptoms of narcotic poisoning advance for the most part gradually: but -those of apoplexy in general begin abruptly. Sometimes apoplexy -commences at once with deep sopor. Narcotic poisoning never begins in -that way, except in the instances of hydrocyanic acid and the narcotic -gases; the sopor is at first imperfect, and it increases gradually, -though sometimes very rapidly. Apoplexy, however, does not always begin -with deep sopor; occasionally the sopor begins and increases like that -of narcotism. - -6. Although there is a great resemblance between the symptoms of -apoplexy and those of narcotism, so far as regards their general -features, there are particulars which are not indeed always present, but -which when present will help to distinguish the one from the other. When -the sopor of apoplexy is completely formed, it is rarely possible to -rouse the patient to consciousness, and never, I believe, where the risk -of confounding apoplexy with poisoning is greatest,—in the cases where -death happens neither instantly, nor after the interval of a day, but in -a few hours. On the other hand, in many cases of poisoning with the -narcotics, and particularly with the commonest variety, opium, the -person may be roused from the deepest lethargy, if he is spoken to in a -loud voice, or forcibly shaken for some time, or if water is injected -into his ear. Even in cases of poisoning with opium, however, the coma -may have continued too long to admit of this temporary restoration to -sense; the susceptibility of being roused is not so often remarked in -other varieties of narcotic poisoning; and in some, such as poisoning -with prussic acid, I am not aware that it has ever been remarked, at -least in fatal cases. - -There are some other symptoms which in special cases may help to -distinguish narcotic poisoning from apoplexy. Thus in poisoning with -opium convulsions are rare; in apoplexy they are common enough. Bloating -of the countenance is likewise much more common in apoplexy than in -poisoning with opium. In apoplexy, too, the pupil is generally dilated, -while in poisoning with opium the pupil is almost always contracted. But -such distinctions do not apply either to the narcotics as a class, or to -all cases of any one kind of narcotic poisoning. - -7. In the last place, a useful criterion may be derived from the -duration of the symptoms in fatal cases. I believe few people die of -pure narcotic poisoning who outlive twelve hours; and the greater number -die much sooner,—in eight, or six hours. Apoplexy often lasts a whole -day, or even longer. On the other hand, the narcotic poisons very rarely -prove so rapidly fatal as apoplexy sometimes does. Apoplexy, according -to the vulgar opinion, may prove fatal instantly or in a few minutes. -The only late author of repute who maintains that opinion is M. -Devergie. He mentions the case of an elderly man subject to somnolency, -who, after complaining for a short time of headache, became suddenly -pale, hung down his head, and expired immediately, and in whose body no -other morbid appearance was found, except great congestion of the -cerebral membranes.[1631] The best modern pathologists, however, deny -that apoplexy proves immediately fatal, and maintain with much apparent -reason that when death is so sudden, the cause is commonly disease of -the heart, and not apoplexy.[1632] However this may be, it is at all -events certain that apoplexy may occasion death in considerably less -than an hour. Now the only narcotics in common use which can prove fatal -so soon are the narcotic gases, and prussic acid. As to opium, the most -common of the narcotic poisons, and by far the most important to the -medical jurist, the shortest duration I have yet seen recorded is three -hours. Apoplexy often proves fatal in a much shorter time. - -From this enumeration of the criterions between apoplexy and the -symptoms produced by narcotics, the toxicologist will conclude, that few -cases can occur in which he will not be able to give a presumptive -opinion of the real cause from the symptoms only,—that in many instances -a diagnosis may be drawn with an approach to certainty,—and that on all -occasions it will be possible to say without risk of error, whether -there are materials for forming a diagnosis at all,—a point which is of -great moment when the criterions are not universally applicable. - -_Of the Morbid Appearances._—The next subject of inquiry is the -distinction between apoplexy and narcotic poisoning, as to the -appearances after death. It has been already stated, that the narcotic -poisons rarely produce very distinct morbid appearances,—that the -greatest extent of unnatural appearance they cause in the brain is -congestion of vessels,—and that the physical qualities of the blood -appear to be altered, though not invariably. - -_Of Simple Apoplexy._—Apoplexy may, in the first place, occasion death -without leaving any sign at all in the dead body. Cases of this sort -were called nervous apoplexy by the older authors; but for the purpose -of avoiding a name that involves a theory as to their nature, they have -been more appropriately termed by Dr. Abercrombie simple apoplexy. At -one time they were believed to be common. The researches of modern -pathologists, however, have shown that they are rare, and that the -apparent absence of morbid appearances may be often with justice -ascribed to an insufficient examination; for it is not always easy to -detect, without minute attention, two disorders little known till in -recent times, and sometimes closely allied in their symptoms to -apoplexy,—hypertrophy of the brain, and inflammation of its substance. -On this account some have even gone so far as to deny altogether the -existence of simple or nervous apoplexy; and M. Rostan, who is of this -opinion, has supported it by the fact, that in the course of his -pathological researches he had examined no less than 4000 heads, and -never met with an instance of it.[1633] But although this statement, -made by so eminent a pathologist, is sufficient to prove the rarity of -the disease, it does not establish its non-existence in the face of -positive observations, made by others after the phenomena and effects of -cerebral inflammation were well known. - -Among the modern authorities to whom reference may here be made for -examples of simple apoplexy, Dr. Abercrombie, M. Louis, my colleague Dr. -Alison, and M. Lobstein, may be particularized. Dr. Abercrombie has seen -four cases,[1634] M. Louis has recorded three,[1635] M. Lobstein -one,[1636] and Dr. Alison informs me, that he has seen one and got the -particulars of another from the late Dr. Gregory. In several of these -cases the individuals were at the time of the apoplectic seizure -affected with other diseases, such as asthma, anasarca, or slight -febrile symptoms; but in four of them the coma commenced during a state -of perfect health. I have myself seen two of the former class, one -occurring during convalescence from a slight pleurisy, the other -terminating a complicated case of pulmonary emphysema and catarrh, -diseased kidneys and anasarca. Reference may be also made under this -head to several cases of apoplexy described in Corvisart’s Journal, as -connected with the enormous accumulation of worms in the intestines. -Such a connexion is said to be common on the coast of Brittany; and one -striking instance is related of a young man, who, after an attack of -headache, vomiting, and loss of speech, died comatose in two days, and -in whose body no unnatural appearance could be seen except a prodigious -mass of worms in the small intestines.[1637] - -In none of all the cases of apoplexy now under consideration was there -found within the head any appearance corresponding with the symptoms, -except occasionally a slight turgescence of vessels. - -This form of apoplexy, then, is a very important affection in a -medico-legal point of view. The possibility of its occurrence is in fact -the chief obstacle, which, in many cases involving the question of -poisoning with narcotics, prevents the physician from coming to a -positive decision on a review merely of symptoms and appearances after -death. Instances will occur where it is impossible to draw a diagnosis -between the natural and the violent form of death. And indeed it might -even be a fair subject of inquiry, whether death from at least some -narcotic poisons, such as opium, is any thing else than death from -simple apoplexy. - -It may be mentioned,—although too much importance ought not to be -attached to the fact, as forming the ground of a diagnosis in certain -rapid cases of narcotic poisoning,—that of the instances of simple -apoplexy referred to above none proved fatal in less than five hours. -This was Dr. Gregory’s case. Dr. Alison’s proved fatal in seven hours; -M. Louis’s cases in eight, nine, and ten hours; one of Dr. Abercrombie’s -in eight hours; the three others in about twenty-four hours; and M. -Lobstein’s in five days. - -Another consideration is, that simple apoplexy is undoubtedly very rare, -more particularly in persons who enjoy perfect health. Hence, although -it is impossible to distinguish the effects of narcotics from this -disease by the appearances in the body after death, yet, when the -general evidence of poisoning is strong, and none of the medical -circumstances are at variance with the supposition of narcotic -poisoning, the evidence of poisoning, as judged of by the jury from the -whole facts, medical and general, will be commonly sufficient,—so far as -regards the possibility of death from simple apoplexy. For such a -concurrence of circumstances as is here supposed can scarcely be -outweighed by a mere possibility of death from so rare a natural -disease. - -It is worthy of remark, in reference to charges and suspicions of -poisoning during a state of ill health, that simple apoplexy occurring -in the course of a considerable period of indifferent health is far from -uncommon. Such incidents, however, ought not to be confounded with -narcotic poisoning, because the coma comes on gradually. From what I -have myself frequently observed, cases of this nature are often -connected with the granular disintegration of the kidneys, which has -been brought under the notice of physicians by the able researches of -Dr. Bright. I have related two instances of the kind,[1638] and several -others have been since published by Dr. James Arthur Wilson.[1639] In -none of these could there have been any risk of mistaking the phenomena -for narcotic poisoning. But it may be well to advert to the subject here -for the sake of turning the attention of the profession to the propriety -of examining the state of the kidneys in all medico-legal cases of death -in a state of coma. - -_Of Congestive Apoplexy._—Apoplexy may, in the second place, leave in -the dead body no other sign but congestion of vessels within the head. -This form or variety of apoplexy is so generally admitted, that it is -hardly necessary to mention special instances. But, for the sake of -those who may prefer special facts to general propositions, the two -following cases by M. Rostan are referred to. One of his patients, -without any precursory symptom, was suddenly deprived of sense, soon -became delirious and comatose, and expired in a day and a half. The -other, also without any previous symptom, became rapidly comatose, and -died in twenty-four hours. In both the whole membranes were minutely -injected with blood; and in one the whole brain had also a rose-red -colour.[1640] In regard to the diagnosis between such cases and -poisoning with narcotics, it must be remembered, that congestion of the -cerebral vessels is considered by many a common effect of such poisons, -and that therefore the diagnosis cannot be rested on the appearances in -the dead body. I have not perused a sufficient number of fatal cases of -congestive apoplexy to enable me to attempt a diagnosis; but, so far as -I have gone, it appears to me, that this form of the disease, which is -not often fatal without extravasation also being produced, does not -cause death till after an interval of nearly a day at least. Should this -prove a general fact, it would form the ground of a diagnosis between -congestive apoplexy and many forms of narcotic poisoning, which, if -death ensues, prove fatal much sooner. - -_Of Serous Apoplexy._—Apoplexy may, in the third place, produce serous -effusion on the external surface, and in the ventricles of the brain. -This form of the disease, which has been named serous apoplexy, although -not very uncommon as an insulated affection, is for the most part united -with inflammation of the cerebral substance. Serous effusion is more -frequently the termination of an inflammatory disorder of the brain, -than of that deranged state which constitutes the apoplectic attack. But -nevertheless it does occur in connexion with pure apoplexy, as may be -seen, for example, on referring to Dr. Abercrombie’s work,[1641] or to -Bernt’s Contributions to Medical Jurisprudence,[1642] or to the Hospital -Reports of Dr. Bright.[1643] In such cases the only appearances have -been the effusion of an unusual quantity of serum on the surface of the -brain, in its ventricles, and in the base of the skull. Cases of this -sort agree very exactly as to the signs in the dead body with some cases -of narcotic poisoning. When serous effusion is preceded by decided -apoplectic symptoms, the disease, so far as I have been able to inquire, -is always of several days’ duration. But sometimes the symptoms are to -the very last obscure and different from those of apoplexy, as in an -instance related by Dr. Abercrombie.[1644] - -_Of Apoplexy from extravasation._—The last variety of apoplexy is that -which leaves in the dead body extravasation of blood within the head. -This, the most common of all its forms, is very rarely imitated by -narcotic poisoning. A case, however, will be afterwards mentioned of -extravasation produced apparently by poisoning with opium, another of -extravasation caused by carbonic acid, another by poisonous fungus, and -several by spirits. The existence, therefore, of extravasated blood is -not absolutely certain proof, but supplies, in relation to most -narcotics, a strong presumption of natural death. - -Here it will be necessary to add a word or two of caution regarding what -are called apoplectic cells or cavities, containing blood in the brain. -If an apoplectic cell be found, it must not be at once considered as the -cause of death. When blood is extravasated in the brain, the patient may -gradually recover altogether, and the cell nevertheless continue full. -Such persons often die of a subsequent attack of apoplexy, or of -inflammation around the cell. We can say with certainty, that an -apoplectic cell has been the occasion of death only when the blood is -recent, or when it is surrounded by signs of recent inflammation. - -So much, then, as to the criterions derived from morbid appearances -within the skull, for distinguishing poisoning with narcotics from -apoplexy. - -It has been proposed to derive other criterions from the state of the -blood. But on considering the effects of the individual poisons of the -class, it will appear that the state of the blood is by no means -characteristic. - -It may be useful to conclude this view of the distinctions between -poisoning and apoplexy with the particulars of an interesting case, in -which the medical witnesses fell into an egregious error by disregarding -the most palpable criterions. In 1841, an elderly gentleman at Chambéry -in France, subject to apoplexy, one day after having made a hearty -dinner and afterwards supped on bread, cheese, and white wine, was -suddenly seized with staggering immediately after finishing his wine, -and soon lost all consciousness. Emetics and stimulants restored his -faculties so far as to enable him to say he felt better and had no pain; -but the tongue and mouth were drawn to the left side, and there was -great prostration. Four hours after his first seizure the countenance -became livid; he again became unconscious and insensible; the twisting -of the mouth increased; and the left arm presented spasmodic -contraction. Blood-letting and other remedies were resorted to without -avail; the pulse, previously strong and regular, became gradually -feeble; and in six hours after his first illness he expired, without -ever having had convulsions of any kind. On the body being examined -seven days after death, great congestion was found in the vessels on the -surface of the brain; on raising the brain, a dense dark clot of the -size of a large egg escaped from the lower part of the ventricles; and -an abundant extravasation of the same nature was found under the -_tentorium cerebelli_. - -It appears scarcely possible to find a more characteristic case than -this of apoplexy from extravasation. The slight intermission in the -symptoms was the only unusual circumstance. Yet because the inspectors -remarked in various parts of the body a peculiar odour, which they could -not at the time characterise, but which they afterwards thought was the -odour of bitter almonds,—and misled by the sudden invasion of the -symptoms instantly after a meal,—they gave their opinion that death had -arisen from some narcotic poison; a chemical examination was made of -various textures of the body (not, however, of the contents of the -stomach), which yielded obscure and very doubtful indications of -hydrocyanic acid; poisoning with hydrocyanic acid was accordingly -declared to have been the cause of death; and, in defiance of an able -report by Professor Orfila, pointing out the error of the primary -witnesses, the nephew and heir of the deceased was condemned.[1645] It -is almost unnecessary to point out the impossibility of death having -arisen in this case from hydrocyanic acid. The length of time the -deceased survived, the want of convulsions, the presence of deflexion of -the mouth and tongue, the intermission of the symptoms, and the morbid -appearances, all clearly indicate that death in the way supposed was -impossible; and the chemical evidence, which it would require too much -space to analyze here, was proved by Orfila to be completely -unsatisfactory. - - - _Of the Distinction between Epilepsy and Narcotic Poisoning._ - -_Of the Symptoms._—Epilepsy is distinguished from other diseases by the -abolition of sense and by convulsions. It resembles closely the symptoms -caused by prussic acid, and by some of the narcotic gases, such as -carbonic acid gas and the asphyxiating gas of privies. It also bears the -same resemblance to the effects of many narcotico-acrid poisons, such as -belladonna, stramonium, hemlock, and others of the first group of that -class, also camphor, cocculus indicus, and the poisonous fungi. - -Epilepsy is in general a chronic disease, and for the most part ends -slowly in insanity. But sometimes it proves fatal during a paroxysm. The -circumstances by which an epileptic fit may be distinguished from -narcotic poisoning are the following: - -1. The epileptic fit _is sometimes preceded by certain warnings_, such -as stupor, a sense of coldness, or creeping, or of a gentle breeze -proceeding from a particular part of the body towards the head. -Warnings, however, are by no means universal. M. Georget, indeed, has -even stated that they do not occur in more than five cases in the -hundred.[1646] But this estimate probably underrates their frequency. - -2. The symptoms of the epileptic fit _almost always begin violently and -abruptly_. The individual is suddenly observed to cry out, often to -vomit, and instantly falls down in convulsions. The effects of the -narcotic poisons, if we except some cases of poisoning with hydrocyanic -acid, the narcotic gases, and a few rare alkaloids, never begin -otherwise than gradually, though their progress towards their extreme of -violence is often rapid. This distinction is generally an excellent one. -But it will not apply so well to some cases of epilepsy in which the -convulsions are trivial. Esquirol says an epileptic fit may consist of -nothing more than coma, with convulsive movements of the eyes, or lips, -or chest, or a single finger.[1647] Still even then the coma generally -begins abruptly, so that if the case is seen from the beginning, it can -hardly be mistaken for narcotic poisoning. Some forms of epilepsy, in -which the fit is constituted merely by giddiness, staring, wandering of -the mind, and imperfect loss of recollection,[1648] might be confounded -with the milder forms of narcotic poisoning. But collateral -circumstances will scarcely ever be wanting to distinguish such cases -from one another. - -The varieties of narcotic poisoning which, in the violence and -abruptness of their commencement, bear the closest resemblance to an -epileptic attack, are some cases of poisoning with hydrocyanic acid or -with the deleterious gases. Both of these varieties, however, when they -begin so abruptly, are distinguished from a fatal paroxysm of epilepsy -by the fourth characteristic to be mentioned presently; and besides, in -abrupt cases of poisoning with hydrocyanic acid, the poison under -certain conditions will be found in the body; while in sudden poisoning -with the narcotic gases, the nature of the accident is rendered obvious -to a cautious inquirer by the collateral circumstances. - -3. As in apoplexy, so in epilepsy the patient _in general cannot be -roused_ by external stimuli. This, as already observed, is often, -although certainly not always, practicable in cases of poisoning with -narcotics. Sometimes, too, in the epileptic fit a partial restoration of -consciousness may be effected by loud speaking, so that in reply to -questions the patient will roll his eyes or move his lips. It is -therefore to be understood in applying the present criterion, that it is -only a safe guide when, as in many cases of poisoning with opium, the -individual can be roused to a state of tolerably perfect consciousness. - -4. When a person dies in a fit of epilepsy, _the paroxysm generally -lasts long_, sometimes more than a day. So far as I have been able to -ascertain (though on this point it must be confessed authors are -singularly silent), it never proves fatal in a shorter time than several -hours, unless there have been many previous fits; and even then it -rarely proves fatal more rapidly. I have met with a case which, after -many previous fits, proved fatal in little more than an hour.[1649] In -an instance mentioned by Mr. Clifton of irregularly recurring epilepsy, -the patient after being exempt for four months was attacked twice a day -for four days, and during an interval of ease fell down in the street -and died. General congestion and excessive softening of the brain were -found.[1650] I have met with a case very like this, where death was -owing to enormous extravasation of blood into the ventricles. So rapid a -termination never occurs except after several paroxysms; and probably -never without well-marked appearances in the dead body. The variety of -poisoning with which epilepsy is most apt to be confounded, poisoning -with hydrocyanic acid, has hitherto always proved fatal within -three-quarters of an hour, and can probably never prove fatal so late as -a whole hour after the symptoms begin, unless the dose has been small -and given repeatedly. Poisoning with the gas of privies,—another -variety, which sometimes imitates precisely a fit of epilepsy, appears -not to prove fatal in its convulsive form later than two hours after the -exposure. - -5. M. Esquirol, a writer of high authority, says that epilepsy _very -rarely proves fatal in the first paroxysm_. I suspect it may be said -that the first paroxysm never proves fatal. For the cases considered and -described as such have been either inflammation of the brain or its -membranes, or hypertrophy of the brain, or inflammation of the spinal -cord, or effusion of serum or blood into the spinal canal, or worms in -the intestines,—all of which may be known by the morbid appearances. I -have also seen cases of continued fever with typhomania and convulsions, -which might have been considered by a careless observer examples of -epilepsy fatal in the first fit. On the present characteristic it would -be wrong to speak with confidence, as the question regarding the -possible fatality of epilepsy in the first fit must depend greatly on -the degree of extension given to the term epilepsy. I can only say, that -in the course of reading I have not hitherto met with an instance fatal -in the first paroxysm, which might not have been referred by the morbid -appearances to one or other of the diseases mentioned above. - -_Of the Morbid Appearances._—With regard to the morbid appearances found -in the bodies of epileptics, much difference of opinion prevails among -pathologists. The most frequent are tumours within the cranium, -excrescences from the bone or dura mater, concretions in the brain -itself, or abscesses there, and effusion into the ventricles or on the -surface of the brain. Other appearances which have also been remarked -are probably little connected with the disease; and at all events have -been often seen when epilepsy did not precede death.[1651] - -The morbid appearances connected with epilepsy are not always to be -looked for within the head. The cause which produces the fit is often -some irritation in distant organs.—The presence of worms in the -intestines of children may occasion fatal epilepsy. It is believed also -that they may cause fatal epilepsy even in adults; and whether their -presence has been the cause of death or not, it is certain that they -have been found enormously accumulated in the stomach or intestines of -adult epileptic subjects.[1652] The most recent information on this -subject is furnished by M. Gaultier de Claubry. In a girl seven years -old, who died of convulsions in six days, he found eleven _lumbrici_ in -the general cavity of the belly, and the coats of the stomach perforated -with holes, in some of which other worms were sticking. In another child -of the same age, who died in seven days of convulsions, he found -thirty-six worms in the peritoneal sac, a great mass of them in the -stomach, and twenty-seven making their way through holes in its -coats.[1653] In a singular case related by M. Lepelletier of a boy -twelve years old, who died of convulsions in four days, the only morbid -appearance found was a perforation of the gullet six lines in diameter, -through which two lumbrici had made their way into a cavity in the -middle right lobe of the lungs, while another was sticking in the hole, -six more occupied the lower part of the gullet, and three lay in the -stomach.[1654]—The irritation of teething may also excite epilepsy, and -in cases where it has proved fatal may be recognized by the redness and -swelling of the gum, by the tooth being on the point of piercing the -alveolar process, and by the turgescence of vessels around.[1655]—A -well-known but rather rare cause is the presence of some hard substance -in the course of a nerve. This variety, like those already mentioned, -may prove fatal in the fit, as appears from the following interesting -case. A stout young woman became suddenly liable to epilepsy, and, after -suffering repeated fits in the course of twenty months, died comatose in -a paroxysm of thirty-three hours’ duration. The fits having always begun -with acute pain in a particular part of the thigh, this part of the body -was carefully examined, and a bony tumour as big as a nut was found on a -branch of the sciatic nerve.[1656]—Other appearances might likewise be -here enumerated, which have been supposed the cause of symptomatic -epilepsy.[1657] But few of these have been so thoroughly ascertained as -to be allowed much influence on a medico-legal opinion. - -It cannot, I apprehend, be denied, that in many cases of epilepsy no -decided morbid appearance is to be found in the body; and that in many -others the appearances are either so equivocal as not to be -satisfactorily recognized in any circumstances, or so hidden in their -situation that they may escape notice, unless the inspector’s attention -be drawn to the particular spot by a knowledge of the symptoms. - -Hence in actual questions as to the occurrence of narcotic poisoning -when the symptoms resemble epilepsy, it will be seldom possible to found -on the absence of morbid appearances more than a presumptive opinion -that death did not proceed from the natural cause. It is right to -remember, however, that in considering the absence of morbid appearances -in reference to the diagnosis of narcotic poisoning and epilepsy, the -attention should be confined to cases of epilepsy which prove fatal -during the fit. Now I suspect no such case ever occurs, at least in -adults, without an adequate cause being discoverable in the dead body, -either in the head, or in the course of some nerve, or in the -accumulation of worms in the intestines. This statement must not be -considered as made with confidence; but it deserves investigation. - -From all that has now been said on the subject of epilepsy as a disease -which imitates many varieties of narcotic poisoning, the medical jurist -will probably arrive at the conclusion, that, although a diagnosis -cannot always be drawn with certainty, yet in numerous cases the -consideration of the symptoms and appearances after death will enable -him to say positively that poisoning is out of the question, and in many -others that poisoning is highly probable. - - - _Of the Distinction between Meningitis and Narcotic Poisoning._ - -Inflammation of the inner membranes of the brain, which constitutes the -_acute hydrocephalus_ or acute _meningitis_ of authors, is not in -general apt to cause much ambiguity; for its progress is commonly -gradual, well-marked and less rapid than most cases of narcotic -poisoning: and the appearances in the dead body, such as effusion of -serum, lymph or pus on the outer surface of the brain or in the -ventricles, are for the most part obvious. - -Dr. Abercrombie, however, has described a form of it occurring among -children during the existence of other diseases, particularly of the -chest, which might be the cause of perplexity; for its course is -sometimes finished within a day, its symptoms are delirium, convulsions -and coma intermingled, and the only morbid appearance is congestion of -vessels on the surface and in the substance of the brain.[1658] The -affection now alluded to imitates closely, both in its progress and in -its signs after death, some varieties of poisoning with the vegetable -narcotico-acrids, such as belladonna, stramonium, and hemlock. But the -latter cases, when they prove fatal, seldom last nearly so long as a -day, while the instances of meningitis under consideration rarely cause -death within twenty-four hours. Dr. Abercrombie also notices a parallel -disease occurring among adults; but it is in them always marked by a -considerably longer, though often more obscure course.[1659] - -Dr. Bright takes notice of a similar affection under the title of -“Arachnitis with excessive irritability” occurring chiefly among very -intemperate people, but independently of previous disease. In general -the disorder has a well-marked course of at least several days’ -duration. But in two of the instances he has given the early stage was -very obscure, the only symptoms having been headache and sickness of no -great severity for four or five days; after which delirium came suddenly -on, and was followed by coma, and by death within thirty-six or forty -hours. The sole appearances found within the head were some serous -effusion and vascularity on the surface of the brain and in the -ventricles.[1660] To these illustrations may be added the heads of a -remarkable case which occurred here in the person of an eminent lawyer, -and for the particulars of which I am indebted to Dr. Maclagan. For -three days there had been occasional headache, not great enough to -prevent him pursuing his ordinary avocations, yet becoming so -troublesome on the morning of the third day as to induce him to have -leeches applied. But next morning he was seized rather suddenly with -quickly increasing coma, and in forty hours more he expired. In this -instance the whole surface of the arachnoid membrane, both over the -hemisphere and in the ventricles, was found lined with soft, -yellowish-green lymph. - -In such cases it is apparent that an inspection after death will often -unfold their real nature, where the history of the symptoms may leave it -in doubt. But even without an inspection it is not likely that a careful -physician could mistake them for narcotic poisoning; for independently -of other considerations, the severe symptoms are ushered in by a -precursory stage of ill health, commonly indicating an obscure affection -of the head, and such as no one but a careless observer could fail to -discover and appreciate. - -It is not improbable, however, that acute meningitis may seem to prove -suddenly fatal, in consequence of its course being in a great measure -latent. The following case reported by Mr. Davies of Somers Town, seems -of this nature. A woman, who had previously complained only of slight -headache, was attacked after breakfast with violent vomiting for half an -hour, when she fell down, and immediately expired. After death there was -found great gorging of the vessels of the cerebral membranes, with -opacity and thickening of the pia mater and arachnoid coats, and an -effusion of nearly five ounces of bloody serum under the dura -mater.[1661] Such a case might give rise to great perplexity in a charge -of poisoning, until the examination of the body unfolded its true -nature. - -I should scarcely have thought it necessary to mention _chronic -meningitis_ among the diseases apt to imitate the effects of narcotic -poisons, because it is commonly marked by a long and distinct course. -But the following case, for which I am indebted to Dr. Arnoldi of -Montreal, will show that, like other diseases of the head, chronic -meningitis may be latent in its early stage, and may, after developing -itself, terminate in a day, and then in some measure imitate poisoning -with narcotics. A middle-aged female, subject for a twelvemonth to a -purulent discharge from the left ear, and occasional headache, which was -supposed to be rheumatic, was seized one morning with acute pain in the -head, followed in a few hours by convulsions and tendency to coma; under -which symptoms she died within twenty hours, although treated actively -from the commencement. On dissection, the brain and pia mater were found -healthy, except at the part corresponding with the petrous portion of -the left temporal bone, where the brain was a little softened. The -corresponding part of the temporal bone and the adjacent part of the -occipital were completely denuded and covered with pus, which had -established a passage for itself into the cavity of the ear. - - - _Of the Distinction between Inflammation of the Brain and Narcotic - Poisoning._ - -Inflammation of the brain itself, the _ramollissement_ of French -writers, occasionally excites symptoms not unlike those produced by some -narcotic poisons; and in a few instances its course has appeared to be -equally short. It requires particular notice, because the appearances -left in the dead body are sometimes apt to escape observation. - -This disease in its well-marked form has been noticed by various authors -from Morgagni downwards. But the first regular accounts of it were given -in 1818 by Dr. Abercrombie,[1662] and in 1819 by M. Rostan[1663] of -Paris, and Professor Lallemand[1664] of Montpellier. Its symptoms are -allied to those of apoplexy and epilepsy. But the comatose state is -generally preceded by delirium or imperfect palsy, and often by a -febrile state of the circulation. Contraction of the voluntary muscles, -once supposed to be a distinguishing sign of this disease, is neither -essential nor peculiar to it. In the dead body it is recognized by the -presence either of an abscess in the brain,—or more commonly of a -nucleus of disorganized cerebral tissue surrounded by unnatural redness -or softness,—or sometimes of a clot of blood surrounded by similar -softening. Occasionally, when the disease kills in its early stage, -nothing is found but redness of a part of the brain, and slight -softening of the tissue, recognizable only by scraping it with the edge -of the scalpel. - -In the form in which it is commonly seen, and as described by Rostan and -Lallemand from a great number of cases, it can hardly be confounded with -the effects of narcotic poisons; for its course is much slower, being -seldom less than several days when it proves fatal.[1665] Yet in some -instances it may prove fatal instantly. Lancisi notices the case of an -Italian nobleman, who after an apoplectic fit became liable to frequent -attacks of lethargy,—who at length died quite suddenly more than a year -afterwards,—and in whose brain an organized clot was found, with -extensive suppuration of the brain around it.[1666] An unequivocal case -of the same kind has been related by Mr. Dickson, a navy-surgeon. An -elderly sailor, who for months before had done duty, eaten his rations, -and drunk his grog as usual, suddenly dropped down while in the act of -pulling his oar, and died at once; and after death there was found in -the middle lobes of the brain an extensive abscess, which had made its -way to the surface.[1667] Such cases might, in certain circumstances, be -mistaken for the effects of large doses of hydrocyanic acid; but the -morbid appearances are of course quite characteristic. M. Louis has -related an instance like the last two, but where the disease was -altogether latent. His patient after a long illness died of diseased -heart, the ventricles of which communicated together. He never had a -symptom of disorder of the head; yet on dissection an extensive recent -softening was found in the right _corpus striatum_ and another in the -right _thalamus_.[1668] - -None of the treatises I have seen on the subject make mention of a -variety of this disease intermediate between suddenly fatal cases and -those which last several days,—a form in which the patient’s illness -endures for a few hours only, and which, both in the special symptoms -and in their course, imitates exactly the effects of some narcotics. Two -such cases have come under my notice, both of them judicial, poisoning -having been suspected. One of them proved fatal in an hour and a half, -the individual having previously been in excellent health; and the only -appearance of disease was softening of a considerable part of the -surface of the brain where it lies over the left orbit. The other was -more remarkable in its circumstances. In November, 1822, a man, who had -previously enjoyed excellent health, was found one morning in a low -lodging-house in the Lawnmarket comatose, and convulsed; and he died -seven hours afterwards. The neighbours spread a report, that the woman -of the house had poisoned him, with the view of selling the body; and by -an odd coincidence the police, when they went to apprehend the woman, -found an anatomist hid in a closet. The body was judicially examined by -Sir W. Newbigging and myself; and we found an ulcer on the forepart of -the left hemisphere of the brain, and a small patch of softening on each -middle lobe. - -It is only in cases like the last two that the disease is likely to be -mistaken for the effects of poison; and the morbid appearances will at -once distinguish them. But it is requisite to remember that softening of -the brain when not far advanced is apt to escape notice, as it is not -necessarily attended with a change in the colour of the diseased part. -In the first of the two cases I have related, the cause of death was -very nearly assumed to have been simple apoplexy, when at length the -true disorder was unexpectedly noticed. I presume, indeed, that strictly -speaking, both of the cases which came under my notice ought to be -considered as simple apoplexy excited by pre-existing _ramollissement_. - - - _Of the Distinction between Hypertrophy of the Brain and Narcotic - Poisoning._ - -This disease is not here mentioned, because its symptoms and progress -resemble very closely those of poisoning with the narcotics; for it -causes epileptic symptoms, which, besides that they are preceded for -some time by other head affections, very seldom prove fatal in less than -three days. But some notice of it is necessary, because the disease is -rare and of recent discovery, so that the appearances left by it in the -dead body may escape observation. Besides, the physician is at present -imperfectly acquainted with it, and therefore, when a more extensive -collection of cases shall have been made, it may be found to prove at -times fatal so rapidly as to admit of being confounded with narcotic -poisoning. Hypertrophy of the brain, it is true, is always a chronic or -slow disease, but, like other diseases of the brain, its early stages -may possibly be so completely latent that the patient may appear to die -of a few hours’ illness. This, however, must be left to the -determination of future experience. The most rapid case yet published -proved fatal twenty-four hours after the first appearance of symptoms. - -The appearances left in the body are increased density and firmness of -the whole brain or a part of it,—flattening of the convolutions on their -outer surface, so that their grooves are almost obliterated and the -investing membrane uncommonly dry,—unusual emptiness of the -blood-vessels of the brain and its membranes,—and a protrusion of the -brain upwards on removal of the skull-cap, as if the organ were too -large for its containing cavity.[1669] - -Some pathologists doubt the existence of hypertrophy of the brain as a -distinct disease, and conceive that the appearance of flattening of the -convolutions is produced by serum effused between the dura mater and -arachnoid membrane. But this explanation will not account for those -cases in which it is expressly stated that little or no fluid was to be -found in any part of the brain or in the base of the skull. - - - _Of the Distinction between Diseases of the Spinal Cord and Narcotic - Poisoning._ - -It is not necessary to say much on the acute diseases of the spinal -cord, which are apt to be confounded with the effects of narcotic -poisons. The diseases are extravasation of blood into the spinal canal, -inflammation of the membranes, and inflammation [_ramollissement_] of -the cord itself. These disorders are commonly marked by obvious and -characteristic symptoms, as well as a much slower course than that of -the affections induced by narcotic poisons. But occasionally they -approach closely the characters of some of the slow cases of narcotic -poisoning,—palsy being absent, the leading symptoms consisting of -delirium, convulsions, and coma, and the fatal event occurring within -the third day. Dr. Abercrombie and M. Ollivier have related examples of -the kind arising from extravasation of blood,[1670] serous -effusion,[1671] and softening of the cord.[1672] Such cases are -exceedingly rare; but the possibility of their occurrence should impose -on the medical jurist the necessity of examining the spine with care in -all judicial cases of alleged narcotic poisoning, especially when death -has not been rapid. - - - _Of the Distinction between syncopal Asphyxia, and Narcotic Poisons._ - -The only other natural disease requiring notice under the present head -is the _Asphyxia Idiopathica_ of the late Mr. Chevallier. It may be the -cause of embarrassment in questions regarding narcotic poisoning, when -the course of the symptoms to their fatal termination is rapid, and was -not witnessed by any person; for it causes death with equal rapidity, -and its signs in the dead body are very obscure. It has been observed -chiefly among women in the latter months of pregnancy, or soon after -delivery; but it has also been known to attack the male sex. It -generally commences during a state of perfect health, and is seldom -preceded by any warning of danger. The person suddenly complains of -slight sickness, giddiness, and excessive faintness, immediately seems -to sleep or swoon away, and expires gently without a struggle. The only -appearance of note found in the dead body is unusual flaccidity and -emptiness of the heart.[1673] But even these slight appearances are not -constant; for in a case related by Rochoux of a woman who, while in a -state of perfect health, suddenly grew pale, slipped off her chair, and -died on the spot, the auricles of the heart contained a great deal of -blood.[1674] This singular disorder appears to consist of nothing else -than a mortal tendency to fainting; and it may prove fatal either in the -first fit of syncope, or after an hour and a half.—Under the same head -are probably to be arranged the cases of sudden death described by M. -Devergie under the title of Death by Syncope. He has given scarcely any -account of the circumstances attending death; but it may be inferred -from his classification of the cases that fainting immediately preceded -it. In all of them he found blood in both sides of the heart; and the -blood, contrary to what happens in other kinds of sudden death, had -separated into clear serum, and fibrin free of colouring -matter.[1675]—Under the same head also may be noticed a denomination of -cases, which, though alluded to before by various pathologists, were -first distinctly characterized by M. Ollivier, where death is caused on -a sudden, apparently by the disengagement of a large quantity of -aëriform fluid from the blood in the heart and great vessels. Among the -instances described by Ollivier, it appears that death repeatedly -occurred quite suddenly while the individuals enjoyed sound health; and -the only appearances of any note found in the body were tympanitic -distension of the heart, absence of blood there and in the great -vessels, and the existence of a gaseous fluid in numerous globules -throughout the blood-vessels of the brain. The circumstances of death -and the appearances in the dead body are much the same with those -observed from the admission of air into the veins during surgical -operations. A case of this kind, owing to its suddenness, might be -confounded with the effects of the more active narcotic poisons, such as -hydrocyanic acid, especially as its characters in the dead body might -escape notice.[1676] - -Death often takes place from sudden syncope in _organic diseases of the -heart_. Such cases may be confounded with the most rapid variety of -poisoning with hydrocyanic acid; and if the duration of the symptoms -preceding death is unknown, they may give rise to a suspicion of -poisoning generally. But they are at once distinguished by the morbid -appearances. A trivial organic derangement may be the occasion of -instant death. - -The genera comprehended in the class of narcotics are opium, henbane, -lettuce-opium, solanum, hydrocyanic acid, and the deleterious gases. Of -these genera the last is by no means a pure one, for it includes many -gases which act as irritants only; but it is more convenient to consider -them together, than to distribute them into separate classes. Some other -vegetable substances besides henbane, lettuce-opium, and solanum, -possess nearly the same properties; but as they likewise cause -irritation, they are arranged more appropriately in the next class, the -narcotico-acrids. - -Most narcotic vegetables owe their poisonous properties to a peculiar -principle, probably of an alkaline nature, and slightly different in -each. This discovery was made with regard to opium in 1812; and the -discovery of the active principle in that drug has been followed by the -detection of analogous principles in most narcotics, as well as in many -narcotico-acrids. - -These principles are generally crystalline, soluble in alcohol and the -acids, little soluble in water, free from mineral admixture, and -entirely destructible by heat. When purified with the greatest care, -they still retain decided alkaline properties; but on account of their -number and the low power of neutralization their alkaline nature was -long denied; and they have been conventionally styled alkaloids. - -In their natural state they exist in combination with various ternary -acids, some of which are peculiar; and they are likewise intimately -blended, or more probably united chemically, with other inert principles -of the vegetable kingdom, particularly resinous and extractive matters, -to which they adhere with great obstinacy. - -They are all highly energetic, and generally concentrate in themselves -the leading properties of the substance from which they are obtained. - -The experiments, which have led to the conclusion, that the narcotic -poisons act on the brain by entering the blood-vessels, have been -repeated with their alkaloids, and have yielded similar results. But the -alkaloids are in equal quantities much more energetic than the crude -poisons. Their effects indeed are truly formidable, and some well -authenticated instances of their action appear hardly less marvellous -than the most extravagant notions entertained in ancient times of the -operation of poisons. One of them, the principle of nux vomica, which, -however, does not belong to the present class, is so active that in all -probability a man might be killed with the third part of a grain in less -than fifteen minutes. - -It is very difficult to detect some of the vegetable alkaloids; and it -is fortunate, therefore, that they are rare, and not to be procured but -by complex processes. - -Chemical analysis does not by any means supply so good evidence of -poisoning with the narcotics as it does of poisoning with the irritants. -Their chemical properties are not very characteristic, and they are not -well developed unless with a larger quantity of the poison than will -usually be met with in medico-legal investigations. This remark, -however, does not apply universally; and it is probable, that, as -organic analysis goes on improving, better and more delicate processes -will be discovered. - - - - - CHAPTER XXVII. - OF POISONING WITH OPIUM. - - -To the medical jurist opium is one of the most important of poisons; -since there is hardly any other whose effects come more frequently under -his cognizance. It is the poison most generally resorted to by the timid -to accomplish self-destruction, for which purpose it is peculiarly well -adapted on account of the gentleness of its operation. It has also been -often the source of fatal accidents, which naturally arise from its -extensive employment in medicine. It has likewise been long very -improperly employed to create amusement. And in recent times it has been -made use of to commit murder, and to induce stupor previous to the -commission of robbery. Mr. Burnett, in his work on Criminal Law, has -mentioned a trial for murder in 1800, in which the prisoners were -accused of having committed the crime by poisoning with opium; and -although a verdict of _not proven_ was returned, there is little doubt -that the deceased, an adult, was poisoned in the way supposed. A few -years ago, a remarkable trial took place at Paris, where poisoning was -alleged to have been effected by means of the alkaloid principle of -opium; and the prisoner, a young physician of the name of Castaing, was -condemned and executed. - -In several parts of Britain during the last fifteen years many persons -have been brought into great danger by opium having been administered as -a narcotic to facilitate robbery; and some have actually been killed. In -December, 1828, a conviction was obtained in the Judiciary Court of -Edinburgh for this crime, in which instance the persons who had taken -the opium recovered. A fatal case, which was strongly suspected to be of -the same nature, was submitted to me by the sheriff of this county in -1828; but sufficient evidence could not be procured. In July, 1829, a -man Stewart and his wife were condemned, and subsequently executed for -the same crime, the person to whom they gave the opium having been -killed by it. And about a year afterwards a similar instance occurred at -Glasgow, for which a man Byers and his wife were condemned at the Autumn -Circuit of 1831. - - - SECTION I.—_Of the Chemical History and Tests of Opium._ - -Opium is the inspissated juice of the capsules of the _Papaver -somniferum_. It has a reddish-brown colour, and a glimmering lustre on a -fresh surface. It is soft and plastic when recent; but if pure, may be -dried so as to become brittle. Its smell is strong and quite peculiar. -It has a very bitter and most peculiar taste. In consequence of this -taste one would suppose it no easy matter to administer opium secretly. -The plan resorted to by thieves and robbers seems to be, to deaden the -sense of taste by strong spirits, and then to ply the person with porter -or ale drugged with laudanum, or the black drop, which possesses less -odour. - -The following account of the chemical history of opium will be confined -in a great measure to the leading properties of the principles, in which -its active qualities are concentrated, or which are likely by their -chemical characters to supply proof of its presence. - -The common solvents act readily on opium. Water dissolves its active -principles even at low temperatures. So does alcohol. So particularly do -the mineral and vegetable acids when much diluted. Ether removes from it -little else than one of its active principles, narcotine. By the action -of these agents are procured various preparations in common use. -_Laudanum_ is a spirituous infusion, and contains the active ingredients -of a twelfth part of its weight of opium. _Scotch Paregoric Elixir_, a -solution in ammoniated spirit, is only one-fifth of the strength of -laudanum; and _English Paregoric_, tincture of opium and camphor for its -chief ingredients, is four times weaker still. _Wine of opium_ contains -the soluble part of a sixteenth of its weight. The _black drop_ and -_Battley’s sedative liquor_ are believed to be solutions of opium in -vegetable acids, and to possess, the former four, the latter three times -the strength of laudanum. But their strength has been greatly -exaggerated; neither of them, according to my own experience, being -above half what is supposed. The juice and infusion of the garden poppy -are also powerfully narcotic, so as even to have caused death both when -given by the mouth and in the way of injection.[1677] Many other -pharmaceutic preparations contain opium. - -If opium be infused in successive portions of cold water, the water -dissolves all its poisonous principles, and also a peculiar acid -possessing characteristic chemical properties. These principles are -separated by means of the alkalis, the alkaline carbonates, or the -alkaline earths. The most important of them are _morphia_, the chief -alkaloid of opium,—_narcotine_, a feeble poison, not an alkaloid,—a -peculiar acid, termed _meconic acid_,—and a _resinoid substance_. Other -crystalline principles also exist in opium, though apparently in too -small proportion either to affect its action or to be available in -medico-legal analysis as the means of detecting the drug. These are -codeïa, meconine, narceïne, paramorphia, and porphyroxine. - -Of the various principles now indicated it is necessary to notice here -only morphia, narcotine, codeïa, porphyroxine and meconic acid. They -require mention either as being active poisons, or because a knowledge -of their leading characters may be useful in conducting a medico-legal -analysis in a case of poisoning with opium. - -Meconic acid, as procured by evaporation, is usually in little scales of -a pale brown or yellowish tint, being rendered so by adhering resin or -extractive matter; but when nearly colourless, it forms long, extremely -delicate tabular crystals, which in mass have a fine silky appearance -like spermaceti. 1. When heated in a tube, it is partly decomposed, and -partly sublimed; and the sublimate condenses in filamentous, radiated -crystals. 2. When dissolved even in a very large quantity of water, the -solution acquires an intense cherry-red colour with the perchloride of -iron. The sublimed crystals have the same property. Only one other acid -is so affected, namely, the sulpho-cyanic, a very rare substance. It has -been repeatedly stated,[1678] that the redness produced by meconic acid -may be distinguished by the effect of an alkali, which is said to bleach -the colour produced by sulpho-cyanic acid, but to deepen the cherry-red -tint occasioned by the meconic. This is not correct; an alkali added to -the red solution of meconate of iron precipitates oxide of iron and -renders the liquid colourless. The best distinction yet proposed is the -following which has been suggested by Dr. Percy. Acidulate the red fluid -with sulphuric acid, drop in a bit of pure zinc, and suspend at the -mouth of the tube a bit of paper moistened with solution of acetate of -lead: If the redness be caused by sulpho-cyanic acid, hydrosulphuric -acid gas is evolved, and blackens the paper; but no such effect ensues, -it the redness be owing to meconic acid.[1679]—According to Dr. Pereira, -solutions of the acetates, an infusion of white mustard, decoctions of -Iceland moss, and of the _Gigantina helminthocorton_, besides other more -rare substances, are reddened, like solution of meconic acid, by the -salts of peroxide of iron.[1680] 3. The solution of meconic acid gives a -pale-green precipitate with the sulphate of copper, and, if the -precipitate is not too abundant, it is dissolved by boiling, but -reappears on cooling. - -_Of the Tests for Morphia and its Salts._—Morphia, when pure, is in -small, beautiful, white crystals. Various forms have been ascribed to -it; but in the numerous crystallizations I have made, it has always -assumed when pure the form of a slightly flattened hexangular prism. It -has a bitter taste, but no smell. - -A gentle heat melts it, and if the fluid mass is then allowed to cool, a -crystalline radiated substance is formed. A stronger heat reddens and -then chars the fused mass, white fumes of a peculiar odour are -disengaged, and at last the mass kindles and burns brightly.—Morphia is -very little soluble in water. It is more soluble, yet still sparingly -so, in ether. But its proper solvents are alcohol, or the diluted acids, -mineral as well as vegetable. All its solutions are intensely bitter, -and that in alcohol has an alkaline reaction.—From its solutions in the -acids crystallizable salts may be procured; and morphia may be separated -by the superior affinity of any of the inorganic alkalis; but it is -easily redissolved by an excess of potash.—Morphia when treated with -nitric acid is dissolved with effervescence, and becomes instantly -orange-red, which, if too much acid be used, changes quickly to yellow. -The coloration of morphia by nitric acid is a characteristic property; -which, however, it possesses in common with some other alkaloids, such -as brucia, and also strychnia when not quite pure. The change of colour -is said by some chemists to depend on adhering resinoid matter, and not -to be possessed by perfectly pure morphia; but this is a mistake. It is -probable that some other vegetable substances besides the three -alkaloids, morphia, brucia, and strychnia, may be turned orange-red by -nitric acid. Dr. Pereira says that oil of pimento undergoes the same -change.[1681]—When suspended in water, in the form of fine powder and -then treated with a drop or two of perchloride of iron containing little -or no free hydrochloric acid, it is dissolved and forms a deep blue -solution, the tint of which is more purely blue, the stronger the -solution, and the purer the morphia. This is a property even more -characteristic than the former, since no such effect is produced on any -other known alkaloid. Like the effect of nitric acid, it is said not to -be essential to morphia, but to depend on adhering resinoid matter; yet -the blue colour is always strongly produced with powdered morphia of -snowy-whiteness.—Another property by which morphia maybe also -distinguished is the decomposition of iodic acid. A solution of iodic -acid is turned brown either by morphia or its salts, owing to the -formation of iodine; and the test is so delicate that it affects a -solution containing a 7000th of morphia.[1682] So many other substances, -however, possess the property of disengaging iodine from iodic acid, -that little importance can be attached to this criterion. - -_Acetate of Morphia_ is in some countries the common medicinal form for -administering morphia; but it has been almost entirely superseded in -this city by the hydrochlorate, since Dr. W. Gregory pointed out a cheap -mode of procuring that salt in a state of purity.[1683] The acetate is -in confused crystals, often of a brownish colour from impurities. The -stronger acids disengage acetic acid. The alkalis throw down morphia -from its solution in water. Nitric acid and perchloride of iron act on -it as on morphia itself. - -_Hydrochlorate of Morphia._—The muriate or hydrochlorate must be -carefully attended to by the medical jurist, because it is extensively -used in medical practice instead of opium. As now prepared, it is -snowy-white and apparently pulverulent, but is in reality a congeries of -filiform crystals. It decrepitates slightly when heated, then melts, and -at the same time chars, exhaling a strong odour somewhat like that of -truffles. Nitric acid and perchloride of iron act on it as on morphia. -Boiling water dissolves fully its own weight, and very easily -three-fourths of its weight of hydrochlorate of morphia; and on cooling -down to 60° F. it retains seven parts per cent., and deposits the rest -in tufts of beautiful filiform crystals. The solution commonly employed -in medicine contains one per cent. of the salt. Nitric acid turns the -solution yellow, acting distinctly enough when the water contains a -hundredth, and perceptibly when it contains only a two-hundredth of its -weight. Perchloride of iron strikes a deep blue with a solution -containing a hundredth of its weight, very distinctly when the -proportion is a two-hundredth, and even perceptibly when it is only a -five-hundredth. A solution much more diluted than even the last has a -strong bitter taste. When moderately concentrated, morphia is -precipitated from it by the alkalis. - -Of the preceding properties of morphia and its salts, those which -constitute the most characteristic tests are the effects of perchloride -of iron and of nitric acid on all of them, the effect of heat on -morphia, and the effect of an alkali on its solutions in acids. - -_Of the Tests for Narcotine._—Narcotine is rather distinguished by -negative than by positive chemical properties. When pure, it is in -transparent colourless pearly crystals, which, as formed from alcohol, -may be either very flat, oblique, six-sided prisms, or oblong four-sided -tables obliquely bevelled on their sides. But when crystallized from -sulphuric ether the crystals are prisms with a rhombic base. They fuse -with heat, and concrete on cooling into a resinous-like mass. They are -soluble in ether, and fixed oil, less so in alcohol, insoluble in water -or the alkalis, very soluble in the diluted acids, but without effecting -neutralization; and if perfectly pure, they do not undergo the changes -produced on morphia by perchloride of iron or nitric acid. Few specimens -of narcotic, however, are so pure as not to render nitric acid yellow. -Care must be taken not to confound narcotine with morphia. When -crystallized together from alcohol and not quite pure, narcotine forms -tufts of pearly thin tabular crystals, while morphia is in short, thick, -sparkling prisms. - -_Of Codeïa._—This substance is, like morphia, an alkaloid, capable of -combining with acids. It differs from morphia and narcotine in being -moderately soluble in water; and from this solution it may be -crystallized in large crystals affecting the octaedral form. It is -unnecessary to detail its chemical properties. - -_Of the Tests for Porphyroxine._—This principle is a neutral crystalline -body, insoluble in water, soluble in alcohol and ether, and also soluble -in weak acids, which part with it unchanged on the addition of an -alkali. When heated with hydrochloric acid, a fine purple or rose-red -solution is produced; whence its name. It is supposed that this property -may be of use in medico-legal researches; and the following mode of -developing it has been proposed by Dr. Merck, its discoverer.[1684] -Decompose the suspected fluid with caustic potash; agitate the mixture -with sulphuric ether; dip a bit of white filtering paper repeatedly in -the etherial solution, drying it after each immersion; then wet the -paper with hydrochloric acid, and expose it to the vapour of boiling -water; upon which the paper will become more or less acid. - - - _Of the Process for detecting Opium in mixed fluids and solids._ - -Having stated these particulars of the chemical history of opium and its -chief component ingredients, I shall now describe what has appeared to -me the most delicate and satisfactory method of detecting it in a mixed -state. - -1. If there be any solid matter, it is to be cut into small fragments, -water is to be added if necessary, then a little acetic acid sufficient -to render the mixture acidulous, and when the whole mass has been well -stirred, and has stood a few minutes, it is to be filtered, and -evaporated at a temperature somewhat below ebullition to the consistence -of a moderately thick syrup. To this extract strong alcohol is to be -gradually added, care being taken to break down any coagulum which may -be formed: and after ebullition and cooling, the alcoholic solution is -to be filtered. The solution must then be evaporated to the consistence -of a thin syrup, and the residue dissolved in distilled water and -filtered anew. - -2. Add now the solution of acetate of lead as long as it causes -precipitation, filter and wash. The filtered fluid contains acetate of -morphia, and the precipitate on the filter contains meconic acid united -with the oxide of lead. - -3. The fluid part is to be treated with hydrosulphuric acid gas, to -throw down any lead which may remain in solution. It is then to be -filtered while _cold_, and evaporated sufficiently in a vapour-bath. The -solution in this state will sometimes be sufficiently pure for the -application of the tests for morphia; but in most cases it is necessary, -and in all advisable, to purify it still farther. For this purpose the -morphia is to be precipitated with carbonate of soda; and the -precipitate having been collected, washed, and drained on a filter, the -precipitate and portion of the filter to which it adheres are to be -boiled in a little pure alcohol. The alcoholic solution,—filtered, if -necessary,—will give by evaporation a crystalline residue of morphia, -which becomes orange-red with nitric acid, and blue with perchloride of -iron. The latter property I have sometimes been unable to develope when -the former was presented characteristically. - -4. It is useful, however, to separate the meconic acid also; because, as -its properties are more delicate, I have repeatedly been able to detect -it satisfactorily, when I did not feel satisfied with the result of the -search for morphia. Dr. Ure made the same remark in his evidence on the -trial of Stewart and his wife. He detected the meconic acid, but could -not separate the morphia. It may be detected in one of two ways,—by -means of hydrosulphuric acid, or by sulphuric acid. - -If the former method be chosen, suspend in a little water the -precipitate caused by the acetate of lead (par. 2); transmit -hydrosulphuric acid gas till the whole precipitate is blackened; filter -immediately without boiling; then boil, and if necessary filter a second -time. A great part of the impurities thrown down by the acetate of lead -will be separated with the sulphuret of lead; and the meconic acid is -dissolved. But it requires in general farther purification, which is -best attained by again throwing it down with acetate of lead, and -repeating the steps of the present paragraph. The fluid is now to be -concentrated by evaporation at a temperature not exceeding 180° F., and -subjected to the tests for meconic acid, more particularly to the action -of perchloride of iron, when the quantity is small. If there is -evidently a considerable quantity of acid, a portion should be -evaporated till it yields crystalline scales; and these are to be heated -in a tube to procure the arborescent crystalline sublimate formerly -described. About a sixth of a grain of meconic acid, however, is -required to try the latter test conveniently. - -If the method of separating meconic acid by means of sulphuric acid be -preferred, the precipitate formed by acetate of lead is to be treated -with weak sulphuric acid, which forms insoluble sulphate of lead, and -disengages the meconic acid. The liquid obtained by filtration is then -to be evaporated as above, to obtain crystals, which are to be examined -by the tests for meconic acid. Orfila thinks this method more delicate -than the mode by hydrosulphuric acid gas. I am inclined from my own -experiments to doubt his statement. - -5. If there be a sufficiency of the original material, Merck’s process -for detecting porphyroxin may be tried [see p. 534]. But I doubt whether -this process is sufficiently delicate for medico-legal purposes. - -I wish I could add my testimony to the opinion, expressed on a -remarkable occasion by Professor Chaussier, in favour of the delicacy of -the tests for morphia and its compounds, that they might be detected -“jusqu’à une molécule.”[1685] In one sense this statement may be -correct. Morphia, separated from the complex mixture of principles with -which it is combined in opium, may be detected in extremely small -quantities. Accordingly, M. Lassaigne has supplied, for the discovery of -acetate of morphia in mixed fluids, an excellent process, whence the -chief part of the three first paragraphs of the preceding method for -opium are borrowed; and from the facts stated by him in his paper,[1686] -as well as from the experimental testimony of Professor Orfila,[1687] it -appears that Lassaigne’s process will furnish strong indications, if not -absolute proof of the presence of that salt, in the proportion of two -grains to eight ounces of the most complex mixtures. Hence the search -for acetate of morphia in a suspected case is by no means hopeless. But -the detection of acetate of morphia is an object of small moment, -compared with the detection of morphia in its natural state of -combination in opium. Now my own observations lead me to entertain -serious doubts, whether the best method of operating hitherto known -could be successfully applied to the detection of the equivalent opium -in complex mixtures. By the process I have recommended it is easy to -procure, from an infusion of ten grains of opium in four ounces of -water, satisfactory proof of the presence of morphia by the action of -ammonia, perchloride of iron and nitric acid, and equally distinct proof -of the presence of meconic acid by perchloride of iron, as well as -sulphate of copper. But on proceeding to apply the process to organic -mixtures, I have found that when the soluble part of ten grains of opium -was mixed with four ounces of porter or milk, I could develope no -property of morphia but its bitterness, and no indication of meconic -acid but the action of perchloride of iron. MM. Larocque and Thibierge, -it is right to add, have in similar circumstances found the process -somewhat more delicate.[1688] - -It is of great consequence, however, to remark, that in cases of -poisoning with opium, the medical jurist will seldom have the good -fortune to operate even upon so large a proportion of the poison as in -my experiments; because the greater part of it disappears from the -stomach before death. This will not happen always, as may be seen from -various cases mentioned afterwards in the section on the morbid -appearances caused by opium. But, according to my own observations, the -poison will often disappear in a short time, so far as to render an -analysis abortive. Thus in the case of a young woman who died five hours -after taking not less than two ounces of laudanum, I could apply to the -fluid, procured from the contents of the stomach, by paragraphs 1, 2, -and 3 of my process, only the test of its taste, which had the -bitterness of morphia. In the case of another young woman, whose stomach -was emptied by the stomach-pump four hours after she took two ounces of -laudanum, I could obtain from the evacuated fluid, when properly -prepared, only the indications of the presence of morphia supplied by -its bitterness and the imperfect action of nitric acid,—and the -indication of the presence of meconic acid supplied by the imperfect -action of perchloride of iron. In a third case, where the stomach was -evacuated two hours after seven drachms of laudanum had been swallowed, -even the first portions of fluid withdrawn had not any opiate odour, and -did not yield any indication of the presence even of meconic acid. Now, -on the one hand, the quantity taken in these instances is rarely -exceeded in cases of poisoning with laudanum; and, on the other hand, -the interval during which it remained in the stomach subject to vital -operations is considerably less than the average in medico-legal, and -above all in fatal cases. It may be laid down, therefore, as a general -rule, that in poisoning with opium the medical jurist, by the best -methods of analysis yet known, will often fail in procuring satisfactory -evidence, and sometimes fail to obtain any evidence at all, of the -existence of the poison in the contents of the stomach. In a case -published by Dr. Bright from the experience of Mr. Walne of London, it -is stated that the matter removed from the stomach only half an hour -after an ounce and a half of laudanum had been taken, while the stomach -was empty, did not smell of opium.[1689] This case is quoted to put the -reader on his guard. But at the same time it does appear extremely -improbable that the whole opium had disappeared from the stomach in so -short a time, and much more likely that it might have been found by -analysis in the matter first withdrawn. - -I have taken some pains to establish the proposition laid down above, -because in a matter of such importance it is always essential, that the -medical inspector know the real extent of his resources; and it has -appeared to me that, greatly as the hand of the chemist has been -strengthened by late discoveries in vegetable analysis, his power has -been overrated both by his scientific brethren, and by the medical -profession generally. I am happy to find, since the first publication of -these remarks, that they coincide with the experience and opinion of so -eminent an authority as Professor Buchner; who has observed that a -chemical analysis must often fail to detect opium where there could be -no doubt of its having been administered in large quantity.[1690] - -It is of moment to add, that in two of the instances mentioned above the -odour of laudanum was perceived in the subject of analysis,—faintly, -however, and only for a few hours after it was removed from the stomach. -Although the peculiar odour of opium is a delicate criterion of its -presence, it does not follow that it should be preferred to an elaborate -chemical analysis. For it is a test of extreme uncertainty. There is in -the contents of the stomach such a complication of odours, that with a -rather delicate sense of smell, I have sometimes been unable to satisfy -myself of the presence of the opiate odour where others were sure it -existed. At the same time the medical jurist should not neglect it as a -subsidiary test. It is always strongest and most characteristic, first, -when the stomach is just opened, or the contents just withdrawn, and -again, when the fluid, in the course of preparation, as directed in -paragraph 1 (p. 535), is just reaching the point of ebullition. The -latter odour is somewhat different from the former, yet quite peculiar, -and such as every chemist must have remarked on boiling an infusion of -opium. It is further to be observed, that although the odour of opium is -a very delicate test of its presence even in complex organic mixtures, -chemical analysis may be successful, where this character fails. Dr. -Morehead of the Bombay service, in applying my process to the fluid -withdrawn by the stomach-pump, detected morphia both by nitric acid and -perchloride of iron, although he could not detect any odour of opium in -the fluid.[1691] - -So much for the delicacy of the process. As to its precision,—from what -I have myself witnessed, as well as from the experience of Dr. Ure, it -will often happen in actual practice, that the only indication of opium -to be procured by the process consists in the deep red colour struck by -perchloride of iron with the meconic acid. Now, will this alone -constitute sufficient proof of the presence of opium? On the whole, I am -inclined to reply in the affirmative. Sulpho-cyanic acid, it is true, -has the same effect, and this acid has been proved by Professors Gmelin -and Tiedemann to exist in the human saliva,[1692]—a fact which was -called in question by Dr. Ure in his evidence on the trial of the -Stuarts, but which at the time I had verified, and which Dr. Ure has -since been compelled by experiments of his own to admit.[1693] But it -must be very seldom possible to procure a distinct blood-red coloration -from the saliva, after it has been mixed with the complex contents of -the stomach, and subjected to the process of analysis detailed -above;[1694] and the check proposed by Dr. Percy (p. 532) will -distinguish it. - - - SECTION II.—_Of the Action of Opium, and the Symptoms it excites in - Man._ - -The symptoms and mode of action of opium have been long made the subject -of dispute, both among physicians and toxicologists; and in some -particulars our knowledge is still vague and insufficient. - -Under the head of general poisoning, some experiments were related, from -which it might be inferred that opium has the power of stupefying or -suspending the irritability of the parts to which it is immediately -applied. The most unequivocal of these facts, which occurred to Dr. -Wilson Philip, was instant paralysis of the intestines of a dog, when an -infusion of opium was applied to their mucous coat;[1695] another hardly -less decisive was palsy of the hind-legs of a frog, observed by Dr. -Monro Secundus, when opium was injected between the skin and the -muscles;[1696] and a third, which has been remarked by several -experimentalists, is immediate cessation of the contractions of the -frog’s heart when opium is applied to its inner surface.[1697] - -The poison has also powerful constitutional or remote effects, which are -chiefly produced on the brain. Much discussion has arisen on the -question, whether these constitutional effects are owing to the -conveyance of the local torpor along the nerves to the brain, or to the -poison being absorbed, and so acting on the brain through the blood. The -question is not yet settled. It appears pretty certain, however, that -the poison cannot act constitutionally without entering the -blood-vessels; although it is not so clear, that after it has entered -them, it acts by being carried with the blood to the brain. The newest -doctrine supposes that it enters the blood-vessels, and produces on -their inner coat an impression which is conveyed along the nerves. - -According to the experiments of Professor Orfila, it is more energetic -when applied to the surface of a wound than when introduced into the -stomach, and most energetic of all when injected into a vein.[1698] The -inference generally drawn from these and other analogous -experiments[1699] is, that the blood transmits the poison in substance -to the brain. They certainly, however, do not prove more than that the -poison must enter the blood before it acts. - -The old doctrine, that the blood-vessels have no concern with its -action, and that it acts only by conveyance along the nerves of a -peculiar local torpor arising from its direct application to their -sentient extremities, has been long abandoned by most physiologists as -untenable. But some have adopted a late modification of this doctrine, -by supposing that opium may act both by being carried with the blood to -the brain, and by the transmission of local torpor along the nerves. -They believe, in fact, that opium possesses a double mode of -action,—through sympathy as well as through absorption. It would be -fruitless to inquire into the grounds that exist for adopting or -rejecting this doctrine, because sufficient facts are still wanting to -decide the controversy. So far as they go, however, they appear adverse -to the supposition of a conveyance of impressions along the nerves, -without the previous entrance of the poison within the blood-vessels. -The difficulties, in the way of the theory of the sympathetic action of -opium, would be removed by the doctrine of Messrs. Morgan and Addison. -According to their views, the experiments, which appear at first sight -to prove that this substance operates by being carried with the blood to -the part on which it acts, are easily explained by considering that the -opium makes a peculiar impression on the inside of the vessels, which -impression subsequently passes along the nerves to the brain.[1700] But, -as stated in the introductory chapter on the physiology of poisoning, -this theory requires support. - -The effects of opium, through whatever channel it may produce them, are -exerted chiefly on the brain and nervous system. This appears from the -experiments of a crowd of physiologists, as well as from the symptoms -observed a thousand times in man. In animals the symptoms are different -from those remarked in man. Some experimentalists have indeed witnessed -in the higher orders of animals, as in the human subject, pure lethargy -and coma. But the latest researches, among the rest those of M. Orfila, -show that much more generally it causes in animals hurried pulse, -giddiness, palsy of the hind-legs, convulsions of various degrees of -intensity, from simple tremors to violent tetanus, and a peculiar -slumber, in the midst of which a slight excitement rouses the animal and -renews the convulsions. These symptoms are produced in whatever way the -poison enters the body, whether by the stomach, or by a wound, or by -direct injection into a vein, or by the rectum. In man, convulsions are -sometimes excited; but much more commonly simple sopor and coma. - -According to the inquiries of M. Charret, which were extended to every -class of the lower animals, opium produces three leading effects. It -acts on the brain, causing congestion, and consequently sopor; on the -general nervous centre as an irritant, exciting convulsions; and on the -muscles as a direct sedative. It is poisonous to all animals,—man, -carnivorous quadrupeds, the _rodentia_, birds, reptiles, amphibious -animals, fishes, insects, and the _mollusca_. But of its three leading -effects some are not produced in certain classes or orders of animals. -In the _mammalia_, with the exception of man, there is no cerebral -congestion induced, and death takes place amidst convulsions. In birds -there is some cerebral congestion towards the close; but still the two -other phenomena are the most prominent.[1701] - -It has been rendered probable, by what is stated above, that opium -enters the blood. The question, therefore, naturally arises, whether its -presence there can be proved by chemical analysis? But considering the -imperfection of the processes for detecting it when mixed with organic -substances, no disappointment ought to be felt if this proof should fail -in regard to so complex a fluid as the blood. The only person who has -represented himself successful in the search is M. Barruel of Paris. He -examined the urine and blood of a man under the influence of a poisonous -dose of laudanum, amounting to an ounce and a half; and procured -indications of morphia in both. When three ounces of urine were boiled -with magnesia, and the insoluble matter was collected, washed, dried, -and boiled, in alcohol, the residue of the alcoholic solution formed a -white stain, which became deep orange-red on the addition of nitric -acid. The blood was subjected to a more complex operation. One pound and -ten ounces of it were bruised in a mortar, diluted with two pounds of -water, strongly acidulated with sulphuric acid, boiled, filtered, and -washed. The filtered fluid was saturated with chalk, and the excess of -carbonic acid driven off by heat. The fluid was then filtered again, and -after being washed with water, was acted on by diluted acetic acid. The -acetic solution left on evaporation a residue which was repeatedly acted -on by alcohol; and the residue of the alcoholic solutions was treated -with pure alcohol and carbonate of lime. The new solution when filtered -and evaporated left several small white stains, which became orange-red -with nitric acid.[1702] These results have been since contradicted by M. -Dublanc. He in vain sought for morphia in the blood and urine of people -who were taking acetate medicinally, or of animals that were killed by -it.[1703] Barruel’s results are also at variance with some pointed -experiments of M. Lassaigne, who could not detect any acetate of morphia -even in blood drawn from a dog twelve hours after thirty-six grains were -injected into the crural vein;[1704] nor any in the liver or venous -blood of a dog poisoned with eight ounces of Sydenham’s laudanum.[1705] - -In investigating the effects of opium and its principles on man, the -natural order of procedure is to consider in the first place those of -opium itself in its various forms. - -The effect of a small dose seems to be generally in the first instance -stimulating: the action of the heart and arteries is increased, and a -slight sense of fulness is caused in the head. This stimulus differs -much in different individuals. In most persons it is quite -insignificant. In its highest degree it is well exemplified by Dr. Leigh -in his Experimental Inquiry, as they occurred to a friend of his who -repeatedly made the experiment. If in the evening when he felt sleepy, -he took thirty drops of laudanum, he was enlivened so that he could -resume his studies; and if, when the usual drowsiness approached, which -it did in two hours, he took a hundred drops more, he soon became so -much exhilarated, that he was compelled to laugh and sing and dance. The -pulse meanwhile was full and strong, and the temporal arteries throbbed -forcibly. In no long time the customary torpor ensued. The stimulant -effect of opium given during a state of exhaustion is also well -illustrated by Dr. Burnes in his account of Cutch. “On one occasion,” -says he, “I had made a very fatiguing night march with a Cutchee -horseman. In the morning, after having travelled above thirty miles, I -was obliged to assent to his proposal of haulting for a few minutes, -which he employed in sharing a quantity of about two drachms of opium -between himself and his jaded horse. The effect of the dose was soon -evident on both, for the horse finished a journey of forty miles with -great apparent facility, and the rider absolutely became more active and -intelligent.”[1706] - -By repeating small doses frequently, the stimulus may be kept up for a -considerable time in some people. In this way are produced the -remarkable effects said to be experienced by opium-eaters in the east. -These effects seem to be in the first instance stimulant, the -imagination being rendered brilliant, the passions exalted, and the -muscular force increased; and this state endures for a considerable time -before the usual stage of collapse supervenes. A very poetical, but I -believe also a faithful, picture of the phenomena now alluded to is -given in the Confessions of an English Opium-eater,—a work well known to -be founded on the personal experience of the writer. It is singular that -our profession should have observed these phenomena so little, as to be -accused by him of having wholly misrepresented the action of the most -common drug in medical practice. In reply to this charge the physician -may simply observe, that he seldom administers opium in the way -practised by the opium-eater; that when given in the usual therapeutic -mode it rarely causes material excitement; that some professional people -prefer giving it in frequent small doses, with the view of procuring its -sedative effect, and undoubtedly do succeed in attaining their object; -that in both of these medicinal ways of administering it, excitement is -occasionally produced to a great degree and of a disagreeable kind; that -the latter phenomena have been clearly traced to idiosyncrasy; and -therefore that the effects on opium-eaters are probably owing either to -the same cause, or to the modifying power of habit. This much at all -events is certain,—that in persons unaccustomed to opium it seldom -produces material excitement in a single small dose, and does not always -cause continuous excitement when taken after the manner of the -opium-eater. The effect of a full medicinal dose of two or three grains -of solid opium, or forty or sixty grains of the tincture, is to produce -in general a transient excitement and fulness of the pulse, but in a -short time afterwards torpor and sleep, commonly succeeded in six, -eight, or ten hours by headache, nausea, and dry tongue. - -The symptoms of poisoning with opium, administered at once in a -dangerous dose, begin with giddiness and stupor, generally without any -previous stimulus. The stupor rapidly increasing, the person soon -becomes motionless and insensible to external impressions; he breathes -slowly; generally lies still, with the eyes shut and the pupils -contracted; and the whole expression of the countenance is that of deep -and perfect repose. As the poisoning advances, the features become -ghastly, the pulse feeble and imperceptible, the muscles excessively -relaxed, and, unless assistance speedily arrive, death ensues. If -recovery take place, the sopor is succeeded by prolonged sleep, which -commonly ends in twenty-four or thirty-six hours, and is followed by -nausea, vomiting, giddiness, and loathing of food. - -The period which elapses between the taking of the poison and the -commencement of the symptoms is various. A large quantity, taken in the -form of tincture, on an empty stomach, may begin to act in a few -minutes; but for obvious reasons it is not easy to learn the precise -fact as to this particular. Dr. Meyer, late medical inspector at Berlin, -has related a case of poisoning with six ounces of the saffron tincture -of opium, where the person was found in a hopeless state of coma in half -an hour,[1707] and M. Ollivier has described another instance of a man -who was found completely soporose at the same distance of time after -taking an ounce and a half of laudanum.[1708] In these cases, the -symptoms must have begun in ten or fifteen minutes at farthest. In a -case noticed by M. Desruelles the sopor was fairly formed in fifteen -minutes after two drachms of solid opium were taken.[1709] For the most -part, however, opium, taken in the solid form, does not begin to act for -half an hour or even almost a whole hour,—that period being required to -allow its poisonous principles to be separated and absorbed by the -bibulous vessels. It is singular that an interval of an hour was -remarked in a case where the largest quantity was taken which has yet -been recorded. The patient swallowed eight ounces of crude opium; but in -an hour her physician found her able to tell connectedly all she had -done; and she recovered.[1710] In some rare cases the sopor is put off -for a longer period: thus, in a case mentioned in Corvisart’s Journal, -there seems to have been no material stupor till considerably more than -an hour after the person took two ounces and a half of the tincture with -a drachm of the extract.[1711] - -The result of almost universal observation, however, is, that in pure -poisoning with opium the commencement of the symptoms is not put off -much beyond an hour. Such being the fact, it is extremely difficult to -account for the following extraordinary case, which was communicated to -me by Dr. Heude, of the East India Company’s service. A man swallowed an -ounce and a half of laudanum, and in an hour half as much more, and then -lay down in bed. Some excitement followed, and also numbness of the arms -and legs. But he continued so sensible and lively seven hours after the -first dose was taken, that a medical gentleman, who saw him at that time -and got from him a confession of what he had done, very naturally did -not believe his story. It was not till at least the eighteenth hour that -stupor set in; but two hours later, when Dr. Heude first saw him, he -laboured under all the characteristic symptoms of poisoning with opium -in an aggravated degree. The stomach-pump brought away a fluid quite -free of the odour of opium. In seven hours more, under assiduous -treatment, after having been in an almost hopeless state of -insensibility, he had recovered so far as to be safely left in charge of -a friend; and eventually he got quite well. No particular cause could be -discovered for the long apparent suspension of the usual effects of -opium. - -Although the symptoms are very rarely postponed beyond an hour in pure -poisoning with this substance, there is some reason for thinking that -the interval may be much longer, if at the time of taking the opium the -person be excited by intoxication from previously drinking spirits. Mr. -Shearmen has related a striking case of an habitual drunkard, who took -two ounces of laudanum while intoxicated to excitement with beer and -spirits, and had no material stupor for five hours, during which period -vomiting could not be induced. Five hours afterwards, he was found -insensible, and he eventually died under symptoms of poisoning with -opium.[1712] - -The most remarkable symptom in the generality of cases of poisoning with -opium is the peculiar sopor. This state differs from coma, in as much as -the patient continues long capable of being roused. It may be difficult -to rouse him; but unless death is at hand, this may be commonly -accomplished by brisk agitation, tickling the nostrils, loud speaking, -or the injection of water into the ear. The state of restored -consciousness is always imperfect, and is speedily followed again by -lethargy when the exciting power is withheld.—It has been already -remarked, that the possibility of thus interrupting the lethargy caused -by opium is in general a good criterion for distinguishing the effects -of this poison from apoplexy and epilepsy. - -It was observed, in describing the mode of action of opium, that -convulsions, although very frequently produced by it in animals, are -rarely caused in man. It is not easy to account for this difference. -Orfila has endeavoured to explain it, by supposing that convulsions are -produced only by very large doses; but there are many facts incompatible -with that supposition. - -While convulsions are certainly not common in the human subject, yet -when they do occur they are sometimes violent. Tralles mentions that he -had himself several times seen convulsions excited in children by -moderate doses.[1713] The Journal Universel contains the case of a -soldier who took two drachms of solid opium, and died in six hours and a -half, after being affected with locked-jaw and dreadful spasms.[1714] A -case is related in the Medical and Physical Journal of a young man, who, -three hours after swallowing an ounce of laudanum, was found insensible, -with the mouth distorted, the jaws fixed, and the hands clenched; and -who, soon after the insensibility was lessened by proper remedies, was -seized with spasms of the back, neck, and extremities, so violent as to -resemble opisthotonos.[1715] Another good case of the kind is related by -Mr. M’Kechnie, where the voluntary muscles were violently convulsed in -frequent paroxysms, and affected in the intervals with subsultus, for -three hours before the sopor came on.[1716] Two instances of convulsions -alternating with sopor are shortly related by Dr. Bright.[1717] The -convulsions sometimes assume the form of permanent spasm, which may -affect the whole muscles of the body, as in a case related in -Corvisart’s Journal.[1718]—Another rare symptom of poisoning with opium -is delirium. It appears to occur occasionally along with convulsions, as -happened in Mr. M’Kechnie’s case, and in one related by M. -Ollivier.[1719] - -The state of the pulse varies considerably. In an interesting case -described by Dr. Marcet it is mentioned that the pulse was 90, feeble -and irregular; and such appears to be its most common condition when the -dose has been so large as seriously to endanger life.[1720] Frequently, -however, it is much slower; and then it is rather full than feeble, just -as in apoplexy. In cases where convulsions occur, it is for the most -part hurried, and does not become slow till the coma becomes pure. In -Mr. M’Kechnie’s case the pulse was at first 126; but when the -convulsions ceased, and pure sopor supervened, it fell to 55. It always -becomes towards the close very feeble, and at length imperceptible. - -The respiration is almost always slow. In Dr. Marcet’s case, as in some -others, it was stertorous; but this is not common. On the contrary, it -is more frequently soft and gentle, as it has been in all the cases I -have witnessed; and sometimes it can hardly be perceived at all, even in -persons who eventually recover, as in an instance of recovery recorded -by Dr. Kinnis.[1721] - -The pupils are always at least sluggish in their contractions, often -quite insensible;—sometimes, it is said, dilated:[1722] but much more -commonly contracted, and occasionally to an extreme degree. In the case -last noticed, they were no bigger than a pin’s head. The pupils have -been so invariably found contracted in all recent cases of poisoning -with opium, that some doubt arises whether they are ever otherwise, and -whether the earlier accounts, which represent them to have been dilated, -may not be incorrect, and the result of hasty observation. - -The expression of the countenance is for the most part remarkably -placid, like that of a person in sound natural sleep. Occasionally there -is an expression of anxiety mingled with the stupor. The face is -commonly pale. Sometimes, however, it is flushed;[1723] and in rare -cases the expression is furious.[1724] - -In moderately large doses opium generally suspends the excretion of -urine and fæces; but it promotes perspiration. In dangerous cases the -lethargy is sometimes accompanied with copious sweating. In a fatal -case, which I examined judicially, the sheets were completely soaked to -a considerable distance around the body. - -A remarkable circumstance, which has been noticed by a late author, is -the sudden death of leeches applied to the body. The patient was a child -who had been poisoned by too strong an injection of poppy-heads.[1725] - -In some instances the symptoms proper to poisoning with opium become -complicated with those which belong rather to organic affections of the -brain, in consequence of such affections being suddenly developed -through means of the cerebral congestion occasioned by the poison. Thus, -in a case related in Corvisart’s Journal, there were convulsions and -somnolency on the third day, and palsy of one arm for four days; and for -nearly two months afterwards the patient complained of occasional -attacks of weakness and numbness, sometimes of one extremity, sometimes -of another.[1726] Here the brain must have sustained some more permanent -injury than usual.—A more remarkable illustration once occurred to Dr. -Elliotson. A young man, seven hours after swallowing two ounces of -laudanum, presented the usual effects of opium, such as contracted -pupils, redness of the features, a frequent feeble pulse, coldness of -the integuments, and stupor, from which he could be roused without -particular difficulty. The stomach-pump brought away a fluid which had -not any odour of opium; powerful stimulants were given, such as ether, -ammonia and brandy; and he was kept constantly walking between two men. -In an hour and a half, when sensibility had been materially restored, -his head suddenly dropped down upon his breast, and he fell down dead. -The sinuses and veins of the brain were turgid, and a moderately thick -layer of blood was effused over the arachnoid membrane.[1727]—Under the -same head must be arranged the following extraordinary case related by -Pyl. That author admits it as one of simple poisoning, with a complete -remission of the symptoms for several days. But the possibility of such -a remission must be received with great hesitation. It is well known -that most of the symptoms may be dispelled by vigorous treatment, and -the patient nevertheless relapse immediately if left to himself, and -even die. This is acknowledged on all hands. Pyl, however, admits the -possibility of a much more complete and longer interval. His case is -shortly as follows. A man who had taken a large quantity of opium, and -became very dangerously ill, was made to vomit in twelve hours, and -regained his senses completely. The bowels continued obstinately -costive; but he had for some days no other symptom referrible to the -poison; when at length the whole body became gradually palsied and -stiff, and he died on the tenth day. No importance can be attached to a -solitary case differing so widely from every other. The only way in -which opium could cause death in such a manner, must be by calling forth -some disposition to natural disease. Pyl’s case was probably one of -supervening _ramollissement_, or inflammation of the substance of the -brain.[1728] - -Notwithstanding the purely narcotic or nervous symptoms, which opium -produces in a vast proportion of instances, there is no doubt that it -also excites in a few rare cases those of irritation. Thus, although it -generally constipates the bowels, it has been known to induce diarrhœa -or colic in particular constitutions. In the first volume of the Medical -Communications, it is observed by Michaëlis that both diarrhœa and -diuresis may be produced by it. The soldier, whose case was quoted as -having been accompanied with convulsions, had acute pain in the stomach -for some time after swallowing the poison; and in the case just quoted -from Corvisart’s Journal, the accession of somnolency was attended with -excruciating pain of two days’ duration. - -Another and more singular anomaly is the spontaneous occurrence of -vomiting. Sometimes a little vomiting immediately succeeds the taking of -the poison. This may not interrupt, however, the progress of the -symptoms;[1729] but more commonly it is the means of saving the person’s -life, as in a striking case described by Petit of an English -officer,[1730] who, in consequence of vomiting immediately after taking -two ounces of laudanum, had only moderate somnolency. At other times -vomiting occurs at a much later period. Pyl, in his Essays and -Observations, gives a case in which, some hours after thirty grains were -swallowed, vomiting took place spontaneously, and recurred frequently -afterwards; in the same paper is an account of another case by the -individual himself, who attempted to commit suicide by taking a large -dose of laudanum, but was disappointed in consequence of the poison -being spontaneously vomited after the sopor had fairly set in;[1731] and -a similar case is related by M. Mascarel, where, after seven ounces of -Sydenham’s laudanum had been taken, vomiting occurred spontaneously, and -was followed only by inconsiderable stupor.[1732]—Vomiting is a common -enough symptom after the administration of emetics, or subsequent to the -departure of the somnolency.[1733] - -The _ordinary duration_ of a fatal case of poisoning with opium is from -seven to twelve hours. Most people recover who outlive twelve hours. At -the same time fatal cases of longer duration are on record: Réaumur -mentions one which proved fatal in fifteen hours,[1734] Orfila another -fatal in seventeen hours,[1735] Leroux another fatal in the same -time,[1736] Alibert another fatal in nearly twenty-four hours.[1737] An -instance has even been related, which appeared to prove fatal not till -towards the close of the third day;[1738] but the whole course of the -symptoms was in that case so unusual, that some other cause must have -co-operated in occasioning death. Sometimes, too, death takes place in a -shorter time than seven hours; six hours is not an uncommon duration; I -once met with a judicial case, which could not have lasted above five -hours; an infirmary patient of my colleague, Dr. Home, died in four -hours; in the 31st volume of the Medical and Physical Journal, there is -one which proved fatal in three hours.[1739] This is the shortest I have -read of. - -The dose of opium requisite to cause death has not been determined. -Indeed it must vary so much with circumstances, that it is almost vain -to attempt to fix it. Pyl relates a case, quickly fatal, where the -quantity taken was 60 grains;[1740] Lassus an instance of death from 36 -grains;[1741] Wildberg has related a fatal case caused by little more -than half an ounce of the Berlin tincture,[1742] which contains the -soluble matter of forty grains; and Mr. Skae has mentioned a case fatal -in about thirteen hours, where the dose seems to have been well -ascertained not to have exceeded half an ounce of common laudanum, or -about twenty grains of opium.[1743] Dr. Paris, without quoting any -particular fact, says four grains may prove fatal.[1744] I should have -felt some difficulty in admitting this statement, as I have repeatedly -known persons, unaccustomed to opium, take three or four grains without -any other effect than sound sleep. But I have been favoured with the -particulars of a case by Mr. W. Brown of this city, where a dose of four -grains and a half, taken by an adult along with nine grains of camphor, -was followed by the usual signs of narcotism, and death in nine hours. -The man took the opium for a cough at seven in the morning; at nine his -wife found him in a deep sleep, from which she could not rouse him; -nothing was done for his relief till three in the afternoon, when Mr. -Brown found him labouring under all the usual symptoms of poisoning with -opium, contracted pupils among the rest; and death ensued in an hour, -notwithstanding the active employment of remedies. On examining the body -no morbid appearance was found of any note except fluidity of the -blood,—a common appearance in those who have died of the effects of this -drug. - -It is more important than may at first sight be imagined to acquire an -approximative knowledge of the smallest fatal dose. For, in consequence -of the dread entertained of opium by many unprofessional persons, it is -currently believed to be much more active than it is in reality; and -instances of natural death have been consequently imputed to medicinal -doses taken fortuitously a short time before. The facts stated above -comprehend the only precise information I have been able to collect as -to the smallest fatal doses in adults. I may add some farther -observations, however, on the smallest fatal doses in children. Very -young children are often peculiarly sensible to the poisonous action of -opium, so that it is scarcely possible to use the most insignificant -doses with safety. Sundeling states in general terms that extremely -small doses are very dangerous to infants on account of the rapidity of -absorption. This opinion is amply supported by the following cases.—An -infant three days old got by mistake about the fourth part of a mixture -containing ten drops of laudanum. No medical man was called for eleven -hours. At that time there was great somnolency and feebleness, but the -child could be roused. The breathing being very slow, artificial -respiration was resorted to, but without advantage: the child died in -twenty-four hours, the character of the symptoms remaining unchanged to -the last. At the inspection of the body, which I witnessed, no morbid -appearance was found.—Of the same kind was a case communicated to me by -Dr. Simson of this city, where the administration of three drops of -laudanum in a chalk mixture, for diarrhœa, to a stout child fourteen -months old, was followed by coma, convulsions, and death in about six -hours. Dr. Simson satisfied himself, as far as that was possible, that -the apothecary who made up the mixture did not commit a mistake.—Dr. -Kelso of Lisburn met with a similar case in an infant of nine months, -who died in nine hours after taking four drops.[1745]—My colleague, Dr. -Alison, tells me he has met with a case where an infant a few weeks old -died with all the symptoms of poisoning with opium after receiving four -drops of laudanum, and that he has repeatedly seen unpleasant deep sleep -induced by only two drops.—These remarks being kept in view, it will, I -suspect, be difficult to go along with an opinion against poisoning -expressed by a German medico-legal physician in the following -circumstances. A child’s maid, pursuant to a common but dangerous custom -among nurses, gave a healthy infant, four weeks old, an anodyne draught -to quiet its screams. The infant soon fell fast asleep, but died -comatose in twelve hours. There was not any appearance of note in the -dead body; and the child was therefore universally thought to have been -killed by the draught. But the inspecting physician declared that to be -impossible, as the draught contained only an eighth of a grain of opium -and as much hyoscyamus.[1746] In the first edition of this work an -opinion was expressed to the same purport. But the facts stated above -throw doubt on its accuracy, and rather show that the dose was -sufficient in the circumstances to occasion death. - -A very important circumstance to attend to in respect to the dose of -opium required to prove fatal is the influence of constitutional -circumstances in rendering this drug unusually energetic. In some -persons this peculiar anomaly exists always, even during a state of -health. Thus, I am acquainted with a gentleman on whom seven drops of -laudanum act with great certainty as a hypnotic. In such a one doses, -which are safely taken by many, might prove dangerous. - -It is more usual, however, to meet with this anomaly in the course of -some diseases. These have not yet been satisfactorily indicated. I have -several times, however, met with unusually energetic action from -medicinal doses in elderly persons affected with severe habitual -catarrh; and in one instance death occurred after a dose of twenty-five -drops in the advanced stage of acute catarrh supervening on its chronic -form, the symptoms being those of poisoning with opium, succeeding -apparently a state of comfortable sleep.—A case seemingly of the same -nature, where the dose was fifteen drops of Battley’s Sedative Liquor, -occurred at Islington in 1841. An elderly lady, in delicate health, and -affected severely with asthma, which for ten days prevented her from -sleeping, got from a neighbouring druggist a draught of Battley’s -solution, syrup, and camphor-mixture. Next morning she was found -insensible and livid in the face, with cold extremities and contracted -pupils; and she died about twelve hours after taking the draught. There -was no sign of natural disease in the dead body to account for death. -The druggist was absurdly blamed for giving such a dose to a frail old -lady; for the dose was not more than would be generally given in such -circumstances. This case was communicated to me by the druggist in -question.—Another of the like kind has been communicated to me by Mr. -Garstang of Clitheroe. An elderly female, long subject to severe cough, -having enjoyed a comfortable night’s rest after a dose of a preparation -containing half a grain of opium, took in the morning the equivalent of -two grains and a half, or three grains at the utmost, and fell asleep -soon after. In no long time, her husband, alarmed because he could not -rouse her, sent for Mr. Garstang, who found her husband labouring under -all the symptoms of poisoning with opium; and, notwithstanding active -treatment, she died six hours after the second dose. Her husband took -half a grain with her the evening before, but experienced no effect from -it at all. Not the slightest ground could exist in this case for -suspecting either foul play or pharmaceutic error.—As a farther -illustration, the following incident deserves notice, which occurred -last year in London, and was communicated to me by Dr. G. Johnson, a -former pupil. A little girl, five years and a half old, affected with -violent cough, got a mixture containing opium, which was repeated six, -thirteen, and twenty-six hours afterwards. She slept soundly after each -dose, and awoke readily after the first three; but after the fourth she -had more stupor and much uneasiness; in which state, but with at least -one interval of sensibility, she died in nine hours more, or thirty-five -hours after the first dose. According to the prescriber’s intention, the -child ought to have taken only two minims of laudanum in all; but, -according to a rough analysis by Mr. Alfred Taylor, each dose contained -an eighth of a grain of opium, or a trifle more. In either view it is -impossible that doses so small, and so distant, could produce these -effects in ordinary circumstances. - -Such cases are important in several respects, but especially because -they naturally give rise to suspicions of an over-dose of opium having -been incautiously given, and thus to misrepresentations injurious to the -druggist or medical attendant. In the last case a Coroner’s Jury brought -in the preposterous verdict, that death was caused by “too much opium -ordered without due instructions.” - -It is scarcely necessary to add, that the dose required to prove fatal -is very much altered by habit. Those who have been accustomed to eat -opium are obliged gradually to increase the dose, otherwise its usual -effects are not produced. Some extraordinary, but I believe correct -information on this subject, is contained in the confessions of an -English opium-eater. The author took at one time 8000 drops daily, or -about nine ounces of laudanum. - -An important topic relative to the effects of opium on man is its -operation on the body when used continuously in the manner practised by -opium-eaters. This subject was brought forcibly under my notice in 1831, -in consequence of a remarkable civil trial, in which I was concerned as -a medical witness,—that of Sir W. Forbes and company against the -Edinburgh Life Assurance Company. The late Earl of Mar effected -insurances on his life to a large amount while addicted to the vice of -opium-eating; which was not made known at the time to the insurance -company. He died two years afterwards of jaundice and dropsy. The -company refused payment, on the ground that his lordship had concealed -from them a habit which tends to shorten life; and Sir W. Forbes and -company, who held the policy of insurance as security for money lent to -the earl, raised an action to recover payment. - -In consequence of inquiries made on this occasion, I became for the -first time aware of the frequency of the vice of opium-eating among both -the lower orders and the upper ranks of society; and at the same time -satisfied myself, that the habit is often easily concealed from the most -intimate friends,—that physicians even in extensive practice seldom -become acquainted with such cases,—that the effects of the habit on the -constitution are not always what either professional persons or the -unprofessional would expect,—and generally that practitioners and -toxicologists possess little or no precise information on the matter. In -what is about to be offered on the subject, some facts will be stated -which appear to me interesting, and may induce others to contribute -their knowledge towards filling up so important a blank in medico-legal -toxicology. - -The general impression is, that the practice of opium-eating injures the -health and shortens life. But the scientific physician in modern times -has seen so many proofs of the inaccuracy of popular impressions -relative to the operation of various agents on health and -longevity,[1747] that he will not allow himself to be hastily carried -along in the present instance by vague popular belief. The general -conviction of the tendency of opium-eating to shorten life has obviously -been derived in part from the injurious effects which opium used -medicinally has on the nervous system and functions of the alimentary -canal,—and partly on the reports of travellers in Turkey and Persia, who -have enjoyed opportunities of watching the life and habits of -opium-eaters on a great scale. The statements of travellers, however, -are so vague that they cannot be turned to use with any confidence in a -scientific inquiry. Chardin, one of the earliest (1671) and best of -modern travellers in Turkey, merely says the opium-eater becomes -rheumatic at fifty, and “never reaches an extreme old age;”[1748] and -his successors have seldom been more precise,—no one having given -information as to the diseases which it tends to engender. By far the -greater number of authorities, however, agree in representing the -practice to be hurtful. Mr. Madden, a recent and professional authority, -even alleges that it is very rare for an opium-eater at Constantinople -to outlive his thirtieth year, if he began the practice early. On the -other hand, a few late observers deny altogether the accuracy of these -statements. To this number belongs Dr. Burnes of the Bombay army; whose -opinion is worthy of notice, because he had ample opportunities of -observation during his residence in Cutch and at the Court of Sinde for -several years prior to 1831. From what he there witnessed, Dr. Burnes is -inclined to think “it will be found in general that the natives do not -suffer much from the use of opium,”—that “this powerful narcotic does -not seem to destroy the powers of the body, nor to enervate the mind to -the degree that might be imagined.”[1749] Dr. Macpherson of the Madras -army, who had occasion to observe the effects of the parallel practice -of opium-smoking in China, coincides in opinion with Dr. Burnes. He -says, “were we to be led away by the popular opinion that the habitual -use of opium injures the health and shortens life, we should expect to -find the Chinese a shrivelled, emaciated, idiotic race. On the contrary, -although the habit of smoking opium is universal among rich and poor, we -find them to be a powerful, muscular, and athletic people, and the lower -orders more intelligent and far superior in mental acquirements to those -of corresponding rank in our own country.”[1750] - -The familiar effects of the medicinal use of opium in disordering the -nervous system and the digestive functions constitute a better reason, -than the loose statements of eastern travellers, for the popular -impression of the danger of its habitual and long-continued use. Yet -this consideration ought not to be allowed too much weight; because the -functions of the nervous system and of digestion may be deranged by -other causes, for example by hysteria, without necessarily and -materially shortening life. It is desirable therefore to appeal if -possible to precise facts. - -The following is a summary of twenty-five cases, the particulars of -which I have obtained from various quarters. The general result rather -tends to throw doubt over the popular opinion.—1. A lady about thirty, -in good health, has taken it largely for twenty years, having been -gradually habituated to it from childhood by the villany of her maid, -who gave it frequently to keep her quiet. 2. A female who died of -consumption at the age of forty-two, had taken about a drachm of solid -opium for ten years, but had given up the practice for three years -before her death, and led in other respects a licentious life from an -early age. 3. A well-known literary author, about sixty years of age, -has taken laudanum for thirty-five years, with occasional short -intermissions, and sometimes an enormous quantity, but enjoys tolerable -bodily health. 4. A lady, after being in the practice of drinking -laudanum for at least twenty years, died at the age of fifty,—of what -disease I have been unable to learn. 5. A lady about fifty-five, who -enjoys good health, has taken opium many years, and at present uses -three ounces of laudanum daily. 6. A lady about sixty gave it up after -using it constantly for twenty years, during which she enjoyed good -health; and subsequently she resumed it. 7. Lord Mar after using -laudanum for thirty years, at times to the amount of two or three ounces -daily, died at the age of fifty-seven of jaundice and dropsy; but he was -a martyr to rheumatism, and besides lived rather freely. 8. A woman, who -had been in the practice of taking about two ounces of laudanum daily -for very many years, died at the age of sixty or upwards. 9. An eminent -literary character, who died about the age of sixty-three, was in the -practice of drinking laudanum to excess from the age of fifteen; and his -daily allowance was sometimes a quart of a mixture consisting of three -parts of laudanum and one of alcohol. 10. A lady, who died lately at the -age of seventy-six, took laudanum in the quantity of half an ounce daily -for nearly forty years. 11. An old woman died not long ago at Leith at -the age of eighty, who had taken about half an ounce of laudanum daily -for nearly forty years, and enjoyed tolerable health all the time. 12. -Visrajee, a celebrated Cutchee chief, mentioned by Dr. Burnes, had taken -opium largely all his life, and was alive when Dr. Burnes drew up his -Narrative, at the age of eighty, “paralyzed by years, but his mind -unimpaired.”[1751] - -For the particulars of the remaining cases I am indebted to Dr. Tait, -surgeon of police in this city. 13. M. C., a ruddy, healthy-looking -woman, sixty years of age, has taken laudanum for twenty-five years to -the extent of half an ounce daily in a single dose. 14. M. H., a flabby, -dissipated-looking woman of thirty-six, has taken for ten years thirty -grains of opium daily in three doses. 15. M. T., a widow, forty-eight -years of age, who takes twice daily a dose of one fluidrachm of -laudanum, and has done so for fourteen years, cannot observe any -permanent injury except diminution of appetite. 16. Mrs. G., aged -twenty-four, has taken a single dose of sixty drops regularly at -bed-time for five years, and has not suffered in health in any respect, -except that she is costive. 17. F. S., a thin, sallow woman of forty-six -years of age, has taken a fluidrachm of laudanum three times a day for -ten years, cannot take food without it, but is so well as to be able to -get up regularly at six in the morning. 18. H. S., a shrivelled -old-looking woman, who for thirty-eight years had taken daily towards a -drachm of opium in one dose, and who latterly was strong, lively, and of -good appetite, died recently at the age of sixty-nine. 19. Mrs. S., who -has taken about a scruple of opium for twenty-one years, is a tall, -active, old-looking woman of fifty-seven, enjoys good health when she -uses the opium, but suffers from an affection like delirium tremens, -when she cannot get her usual quantity. 20. M. A., aged thirty-one, has -taken half a drachm of opium daily in two doses for ten years, was a -thin, drunken, starved-looking prostitute some years ago, but, having -reformed her ways, is now “a fine-looking, bouncing woman,” younger in -appearance than formerly, and not liable to any suffering either before -or after her doses, except that she cannot take food without them. 21. -Miss M., who has taken ten grains of opium three times a day for five -years, is a healthy, florid young woman of twenty-seven, liable to -costiveness, and, when without her opium, to languor and want of -appetite, but otherwise free of complaint. 22. Mrs. ——, a plump, -hale-looking old lady of seventy, has taken opium for six and twenty -years, and for some years to the extent of a drachm daily in two doses. -She thinks her health improved by it, and has suffered no inconvenience -except merely costiveness, and always aversion to food till she gets her -dose. 23. J. B., aged 23, has taken laudanum since she was fourteen, and -some time past to the amount of an ounce or ten drachms in three or four -doses daily. She has only menstruated twice since first using the -laudanum, has bilious vomiting once a month, and looks older than her -years, but is otherwise quite healthy, and has two children. 24. Mrs. -M’C., a ruddy young-looking woman of forty-two, has taken opium during -two years for cough and pain in the stomach, latterly to the extent of -ten grains twice a day. She has never menstruated since, but has enjoyed -better health, and in particular has a good appetite after her dose, and -has got entirely quit of a former tendency to constipation. 25. An army -officer’s widow, fifty-five years old, healthy and young-looking, -although subject to costiveness and rather defective appetite, has taken -laudanum for eleven years, and latterly opium to the extent of fifteen -grains morning and evening. - -These facts tend on the whole rather to show, that the practice of -eating opium is not so injurious, and an opium eater’s life not so -uninsurable, as is commonly thought; and that an insured person, who did -not make known this habit, could scarcely be considered guilty of -concealment to the effect of voiding his insurance. But I am far from -thinking,—as several represent who have quoted this work,—that what has -now been stated can with justice be held to establish such important -inferences; for there is an obvious reason, why in an inquiry of this -kind those instances chiefly should come under notice where the -constitution has escaped injury, cases fatal in early life being more -apt to be lost sight of, or more likely to be concealed. - -Meanwhile, insurance companies and insurance physicians ought to be -aware, that not a few persons in the upper ranks of life are confirmed -opium-eaters without even their intimate friends knowing it. And the -reason is, that at the time the opium-eater is visible to his friends, -namely, during the period of excitement, there is frequently nothing in -his behaviour or appearance to attract particular attention. From the -information I have received, it appears that the British opium-eater is -by no means subject to the extraordinary excitement of mind and body -described by travellers as the effect of opium-eating in Turkey and -Persia; but that the common effect merely is to remove torpor and -sluggishness, and make him in the eyes of his friends an active and -conversible man. The prevailing notions of the nature of the excitement -from eating opium are therefore very much exaggerated. Another singular -circumstance I have ascertained is, that constipation is by no means a -general effect of the continued use of opium. In some of the cases -mentioned above no laxatives have been required; and in others a gentle -laxative once a week is sufficient. - -In the civil suit regarding Lord Mar’s insurances, the insurance company -was at first found not entitled to refuse payment,—not, however, on the -ground that the habit of opium-eating is harmless to longevity,—but -chiefly on a technical ground, implying that they did not make inquiry -into his habits with the care usually observed by insurance companies, -and were therefore to be understood as accepting the life at a venture. -A new trial was granted by the court on the ground of the judge’s charge -having been not according to evidence; but on this occasion the parties -compromised the case.[1752] - -The previous remarks on the symptoms of poisoning with opium in man have -been confined to its effects when swallowed. But it was mentioned under -the head of its mode of action, that this poison has been known to act -with energy upon animals through every channel by which it can be -introduced into the system. It is natural to expect that the same will -be the case with man also. - -The only other modes in which poisoning with opium is reported to have -been produced in man, besides administration by the mouth, have been by -injections into the anus, by application to the skin deprived of its -cuticle, perhaps even also to the unbroken skin, and by its introduction -into the external opening of the ear. - -In the Journal de Chimie Médicale, an instance is shortly noticed of a -lady who was poisoned by the administration of too strong an anodyne -injection prepared by herself from fresh poppy-heads. She -recovered.[1753] - -It is generally believed in France that opium acts more energetically -through the medium of the rectum, than through the stomach. Orfila in -particular has endeavoured to establish this proposition by experiments -on animals, and quotations from cases recorded by some authors of its -action upon man.[1754] But neither the experiments nor the quotations -appear to me satisfactory; and the rule they go to support is completely -at variance with the practice pursued in the medicinal administration of -the drug in Britain. It is the custom to give at least twice as much in -an enema as in a draught. I have given by injection, without producing -more than the usual somnolency, one drachm and even two drachms by -measure of laudanum, a dose which, were Orfila’s statement correct, -would prove fatal. - -As to the action of opium through the skin when deprived of its -cuticle, I am not acquainted with any fatal case of the kind, but have -no doubt that such may happen. One of my friends very nearly lost his -life in the way alluded to. He had applied an opium-poultice to the -scrotum to allay the violent irritation caused by a blister, and fell -into a state of profound sopor, which was luckily interrupted by a -visitor, so that the cause was discovered before it was too late. An -instance of the same kind has also been published by M. Pelletan. A -child two months old very nearly perished, in consequence of a cerate -containing fifteen drops of laudanum having been kept for twenty-four -hours on a slight excoriation produced by a fold of the skin. When the -cause of illness was discovered, the child had been for some hours -almost completely insensible, with a slow, obscure pulse, and -occasional convulsions.[1755] - -But perhaps opium may in some circumstances act even through the -unbroken skin. It has certainly been often applied in this way to -relieve local pain without avail. Yet on the other hand its effect is at -times unequivocal; and the following incidents seem to show, that it may -even prove fatal, both when the skin is healthy, and in certain diseased -states of the integuments. A young dramatic writer in Paris was directed -by his father, a physician, to apply over the stomach a poultice -moistened with a few drops of laudanum. The patient, in order to relieve -his pain more quickly, poured the whole contents of the bottle over the -poultice, and soon fell into a deep sleep. Prompt assistance was -obtained, but proved of no avail, and death is said to have ensued with -great rapidity.[1756] A soldier affected with erysipelas of the leg, had -a linseed poultice applied, which his surgeon ordered to be sprinkled -with 15 drops of laudanum. Next morning the patient was found in a state -of deep sopor, accompanied with convulsive twitches of the muscles of -the face and limbs; and in no long time he expired. His soporose state -turned the surgeon’s attention to the poultice, which he found coloured -yellow and smelling strongly of opium; and on removing it he discovered -that it was completely soaked with laudanum, which the attendant had -carelessly poured on it to the extent of an ounce. The patient died -notwithstanding all the remedies which his state called for; and the -viscera were found quite healthy; but in many places the blood is said -to have had a strong odour of opium.[1757] - -In an instance reported by M. Tournon of Bordeaux, death is supposed to -have arisen from the introduction of opium into the external opening of -the ear, as a remedy for ear-ache. It is possible that fatal poisoning -may thus be induced by laudanum too freely and frequently renewed: but -it seems very unlikely that death was owing to opium in the instance in -question, since it was used in the solid form, and in the quantity of -four grains; so that the dose was small, and absorption must have been -very slow. The account merely states that the patient fell asleep, but -his sleep was that of death.[1758] - - - _Of the Action of Morphia, Narcotine, Codeïa, and Meconic Acid._ - -The action and symptoms caused by two active principles of opium, -morphia, and narcotine, have been examined by many experimentalists. - -The action of _morphia_ is nearly the same as that of opium, but more -energetic. In its solid state it has little effect, being nearly -insoluble. But when dissolved in olive oil, or in alcohol, or in weak -acids, it excites in animals the same symptoms as opium. -Experimentalists are not yet agreed as to its power. The trial of -Castaing gave rise to a physiological inquiry by three French -physicians, Deguise, Dupuy, and Leuret, who assigned to it feeble -properties; but more reliance is usually placed in the experiments of -Orfila, who found that one part of morphia is equal in energy to two -parts of the watery extract, and to four parts of crude opium. The -observations I have made on the medicinal effects of morphia and its -muriate, lead me to believe that half a grain is fully equal in power to -three grains of the best Turkey-opium. Probably those who have observed -but slight effects from it have accidentally used narcotine instead of -it; for at one time they were often confounded together. - -On man morphia acts like opium; it produces somnolency. It was at one -time thought that in medicinal doses it does not produce either the -disagreeable subsequent or idiosyncratic effects of opium; Magendie made -some observations to this purport;[1759] and Dr. Quadri of Naples was -led to the same conclusion.[1760] Others, however, have doubted the -accuracy of these authors, and opposite results appear to have been -procured by some. My own experience with the muriate of morphia inclines -me to concur in opinion with Magendie and Quadri. - -The effects of morphia on man in fatal doses have hitherto been observed -in a few cases only. An instance, which was the occasion of a criminal -trial at Aberdeen in 1842, has been communicated to me by Dr. Traill, -who was consulted in the case on the part of the crown. A schoolmaster -gave ten grains of the muriate to a girl immediately after she came out -of an epileptic fit. In fifteen minutes she seemed to fall asleep; she -continued in this state for some hours before it was discovered that she -was in a state of stupor, from which she could not be roused; and she -expired twelve hours after the poison was administered. A similar case -occasioned by ten grains, and also fatal, occurred at Cheltenham in -1839. - -Orfila relates the particulars of the case of a young Parisian graduate, -who swallowed twenty-two grains for the purpose of self-destruction. In -ten minutes he felt heat in the stomach and hindhead, with excessive -itchiness; in three hours and a half he had also a sense of pricking in -the eyes, with dimness of vision; and in an hour more he for the first -time felt approaching stupor. Half an hour afterwards, when the people -of the house entered his room he could not see them, though he was -sensible enough to be able to reply to their inquiries, that he lay in -bed because he had not slept the night before. Soon after this he fell -into a state of profound stupor and lost all consciousness. In thirteen -hours he was visited by Orfila, who found him cold, quite comatose, and -affected with locked-jaw; the pupils were feebly dilated, the pulse 120, -the breathing hurried and stertorous, the belly tense and tympanitic; -and there were occasional convulsions, with intense itching of the skin. -By means of copious venesection, sinapisms, ammoniated friction, -stimulant clysters, ice on the head, and acidulous drinks, he was -gradually roused, so that in six hours he recognised his physician. In -the subsequent night and following day he had difficult and scanty -micturition, with pain in the kidneys and bladder, and difficulty in -swallowing; but these symptoms went off during the second night; and on -the third morning he was quite well.[1761] The itching of the skin -remarked in this case is considered by M. Bally an invariable symptom of -the operation of morphia even in medicinal doses.[1762] It is not, -however, always produced. - -Another case, which occurred at Lunéville, is very remarkable in its -circumstances. A young man addicted to opium-eating, but who had left -off the practice for a twelvemonth, took first ten grains, and in ten -minutes forty grains more of acetate of morphia. In five minutes he had -excessive general feebleness and a sense of impending dissolution, which -forced him to confess what he had done. In fifteen minutes more M. -Castara, who describes the particulars, found him motionless, almost -comatose, and breathing laboriously. The limbs were flaccid, the pupils -contracted, the face and lips livid, the skin warm and moist, the pulse -full and hard, and deglutition impossible. Tartar-emetic was ordered, -but could not be administered. He was then bled at the arm to eighteen -ounces; upon which he started as from sleep, rubbed his eyes, said every -thing turned round him, and that he could not see the people present. -When left to himself he quickly fell into a calm slumber; but if kept -awake, he told collectedly all that happened before he became comatose. -He complained chiefly of intense itching and a general sense of -bruising. In an hour, by keeping him constantly roused, consciousness -was almost restored, and this without vomiting having been produced, -though two grains of tartar-emetic had been swallowed and three -administered by the rectum. In four hours after he swallowed the poison -he vomited freely and had diarrhœa. He then steadily recovered, the -sleepiness continued all next day, and the itching of the skin even -longer.[1763] - -M. Julia-Fontenelle met with a case of poisoning with this alkaloid, in -consequence of its having been administered with a clyster in the form -of sulphate. The subject was a child five years old, the dose five -grains, the symptoms those of apoplexy, and death supervened within -twenty-four hours.[1764] - -Another case worthy of particular mention is that of the French -gentleman who was supposed to have been poisoned by Dr. Castaing. It is -not a pure one, for besides the symptoms of a consumptive complaint -under which he had laboured for some time, there were circumstances in -his last illness which indicated the administration of other deleterious -substances. About thirty-six hours before his death, however, they were -exactly such as might be expected from a large dose of morphia. About -five minutes after the administration of a draught by the prisoner, the -gentleman was attacked with convulsions, and not long afterwards his -physician found him quite insensible, unable to swallow, bathed in a -cold sweat, with a small pulse, a burning skin, the jaws locked, the -neck rigid, the belly tense, and the limbs affected with spasmodic -convulsions. In this state he seems to have continued till his death. -The only appearances found in the dead body, which bore any relation to -the poison suspected, were congestion of blood and serous effusion in -the vessels of the cerebral membranes. If morphia was the cause of -death, it is highly probable that, besides what was administered -thirty-six hours before he died, several doses were given subsequently; -otherwise, from what is known of the action of opium, the narcotism -could scarcely have lasted uninterruptedly for so long a period.[1765] - -For the following extraordinary case I am indebted to one of my pupils, -Mr. Clark of Montrose: A woman took one morning by mistake ten grains of -pure muriate of morphia, which had been prepared not long before by Mr. -Clark in my laboratory, and was freed of codeïa. The mistake having been -discovered almost immediately, means were taken to prevent any ill -effects from the accident, and within half an hour after the poison was -swallowed, the stomach was completely cleared by the stomach-pump. At -this time she was quite sensible. But stupor quickly came on after the -poison was evacuated, and deep imperturbable coma gradually formed, so -that nothing could rouse her in the slightest degree except cold -affusion of the head and chest, which caused faint signs of returning -consciousness. Before night she expired, though all the usual remedies -were resorted to. An inspection of the body was not obtained, which is -much to be regretted, since without it the case is quite obscure. I do -not know a single instance of fatal coma from opium where the proper -remedies were resorted to before the stupor commenced; and death in such -circumstances is so inconceivable, that we must ascribe the result in -this case to apoplexy, either incidentally concurring, or brought on by -the operation of the poison. - -Morphia, like opium, may occasion serous effects when too freely applied -to a blistered surface. In a case related by M. Dupont, four-tenths of a -grain of acetate of morphia, applied to a blister on the side, caused in -twenty minutes dimness of vision, vomiting, and delirium; and though it -was then removed, the patient had afterwards continued vomiting, dilated -pupils, and great feebleness of the pulse. Recovery took place, but the -patient was not quite free of incoherence next day.[1766] The dose here -was so small, and the symptoms were so unlike the usual effects of -morphia, that doubts arise whether the case was really one of poisoning. - -The effects of _narcotine_ have been examined experimentally by Magendie -and Orfila; but their results do not coincide. According to Orfila it is -not easy to poison dogs with it, as it excites vomiting and is -discharged. But when the gullet is tied, the animal dies in two, three -or four days, without any remarkable symptom but languor and hard -breathing.[1767] In these experiments it was dissolved in olive oil; it -does not act at all in the solid state. Magendie found that it produces -in dogs a state like reverie, accompanied with convulsions. They lie -still except when convulsed, and they are apparently asleep or dreaming; -but they are really alive to external objects, and even in a state of -acute irritability. In short, he considers the symptoms to constitute an -aggravated form of the subsequent and idiosyncratic effects caused by -opium on man. Vinegar, he says, destroys altogether the poisonous -properties of narcotine. According to Orfila it only weakens them. -Muriatic acid would seem to annihilate them entirely; for Orfila found -no effect in dogs from forty grains dissolved in water with the aid of -muriatic acid; and Bally gave sixty grains in like manner to a patient -without injury.[1768] Forty grains dissolved by sulphuric acid, proved -fatal to a dog in twenty-four hours.[1769] - -Narcotine, like other narcotic poisons, is more powerful when introduced -at once into the blood, but produces nearly the same effects as when it -is swallowed. Orfila found that a single grain was as powerful through -the former, as eight grains through the latter channel.[1770] -Dieffenbach observed that half a grain dissolved in water by means of a -drop or two of hydrochloric acid killed cats in five minutes when -injected into a vein, and always produced congestion within the head, -and extravasation on the surface of the cerebellum. A remarkable -circumstance observed in the course of his experiments was, that -leeches, applied to a rabbit under the influence of narcotine, died -immediately in convulsions; and that a portion of the blood of the same -rabbit when injected into the vein of another produced drowsiness, -languor, and pandiculation for nearly a day.[1771] - -The effects of narcotine on man have not been much inquired into. From -the only researches on the subject I have yet seen, those of Dr. Wibmer -of Munich, it appears to be but a feeble poison. He found by experiment -on himself, that two grains dissolved in olive oil produced merely -slight transient headache; that eight grains dissolved by means of -muriatic acid had no effect at all; and that the same quantity of solid -narcotine occasioned temporary headache, and in twenty-eight hours a -singular state of excitement, with trembling of the hands, restlessness, -and inability to fix the thoughts on any object. These effects went off -in a few hours.[1772] - -The effects of _codeïa_ have been examined by Dr. Kunkel. He found that -twelve grains, dissolved in water and introduced into the stomach, -killed a rabbit in three minutes; that six grains in solution when -injected into the cellular tissue occasioned death in little more than -two hours; that the same quantity administered by the mouth sometimes -had little effect; that when given in powder its action was very feeble; -and that the symptoms were excitement of the pulse, convulsions, and -tetanus, without any tendency to sopor or somnolency.[1773] Hence codeïa -is conceived to be a stimulant of the nervous system, and consequently -the cause of the excitant effects sometimes produced by opium. It may be -doubted, however, whether its proportion in opium is sufficient for -explaining these effects. - -_Meconic acid_ is inert. Sertuerner, indeed, thought the meconate of -soda acted as a powerful poison in some experiments made on himself and -on dogs; but more careful researches have since proved that he was -misled by some error. Sömmering found that ten grains of meconic acid or -meconate of soda had no effect whatever on dogs.[1774] Subsequently, in -consequence of two people having died suddenly at Turin after taking -each a grain of the acid, some careful experiments were made by Drs. -Feneglio and Blengini, who gave eight grains to dogs, crows, and frogs, -and four grains to various men, without remarking any injurious effects -whatever.[1775] - -The _distilled water_ of opium was formerly considered an active poison; -but Orfila found it nearly or altogether inert. Two pounds introduced -into the stomach of a dog, and two ounces and a half injected into a -vein, had no effect whatever.[1776] - - - SECTION III.—_Of the Morbid Appearances caused by Opium._ - -In discussing this subject the appearances in the best marked cases will -be first noticed; and then some account; will be given of the variations -to which they are liable. - -In Knape’s Annals there is a good example of the most aggravated state -of the appearances left by opium. It is the case of an infant who was -killed in the course of a night by a decoction of poppy-heads. There was -much lividity over the whole back part of the body. All the sinuses and -vessels of the brain were gorged with fluid blood; and a good deal of -serosity was found in the ventricles and base of the skull. The pharynx -was red. The lungs were distended, and so gorged with fluid blood, that -it ran out in a stream when they were cut. The cavities of the heart -contained the same fluid blood. There was some redness in the villous -coat of the stomach and intestines; and poppy-seeds were found in the -stomach. Although the body had been kept only two days in the month of -February, the belly emitted a putrid odour when it was laid open.[1777] - -In commenting upon these appearances, it may be first remarked, that -turgescence of the vessels in the brain, and watery effusion into the -ventricles, and on the surface of the brain, are generally met with. Dr. -Bright mentions an instance where unusual turgescence was found, and on -the surface of the brain a spot of slight ecchymosis as big as a crown -piece.[1778] I have seen turgescence of vessels and serous effusion in -one instance to a considerable extent: each ventricle contained three -drachms of fluid, the arachnoid membrane on the surface of the brain was -much infiltered, and the vessels both in the substance and on the -surface of the brain were considerably gorged with blood. But congestion -and effusion are by no means universal: in a case I examined judicially -in November, 1822, which proved fatal in about seven hours, there was -neither unusual congestion nor effusion. In the remarks on the diseased -appearances caused by the narcotics generally, it was observed that -extravasation of blood is a very rare effect of opium. A good example of -the kind, however, is related by Mr. Jewel of London. It was the case of -a young married female, who died eight hours after taking two ounces of -laudanum. Several clots were found in the substance of the brain, one of -which, in the anterior right lobe, was an inch long.[1779] A similar -case, which occurred to Dr. Elliotson, has been mentioned already at p. -546. There is little doubt that poisoning with opium may cause -extravasation, by developing a disposition to apoplexy; but considering -the very great rarity of this appearance in persons killed by opium, it -may reasonably be questioned whether extravasation can be produced -without some predisposition co-operating. - -The lungs are sometimes found gorged with blood, as in many cases of -apoplexy. They were so in the soldier mentioned in the Journal -Universel, who died in convulsions. They were in the same state in a -patient of Dr. Home, a man who died in the Infirmary here in 1825, four -hours after taking two ounces of laudanum in six ounces of whisky; and -likewise in the case quoted from Pyl, in which sixty grains of solid -opium were taken. But this appearance is not more constant than -congestion in the brain. Orfila never found it in dogs, and in three -cases I have examined the lungs were perfectly natural. Perhaps they are -more usually turgid when death is preceded by convulsions. They were -particularly so in the case of the soldier above mentioned, and likewise -in another case of the same nature recorded in Rust’s Magazin.[1780] - -The stomach, as in Knape’s case, is occasionally red, and in the woman -mentioned by Lassus, who died after swallowing thirty-six grains, it is -said to have been inflamed. But even redness is rare, and decided -inflammation probably never occurs. In four cases I have examined, the -villous coat was quite healthy; and it was equally so in another related -in Knape and Hecker’s Register.[1781] - -Lividity of the skin is almost always present more or less, and -sometimes it is excessive. In one of the cases I examined it was -universal over the depending surface of the body. - -It has been said that the blood is always fluid. This certainly appears -to be very generally the case. For example, the blood was fluid in the -case of the soldier who died in convulsions, in Dr. Home’s patient, in -four adults I have examined, in Dr. Traill’s case of death from morphia, -and likewise in Pyl’s case. But at the same time this condition of the -blood is not invariable: In the case related in Knape and Hecker’s -Register, it was coagulated in the left cavities of the heart; in -another related by Petit in Corvisart’s Journal, there were clots in -both ventricles;[1782] and in the case of the first infant mentioned in -page 549, clots were also found in both ventricles. In Alibert’s case a -large fibrinous concretion was found in the heart, clearly showing that -the blood had coagulated after death as usual. - -It appears that the body is often apt to pass rapidly into putrefaction. -In one of the cases I examined, although the body had been kept only -thirty hours in a cool place in the month of December, the cuticle was -easily peeled off, the joints were flaccid, and an acid smell was -exhaled. In Réaumur’s case, that of a young man who died in fifteen -hours, in consequence of his companions in a drunken frolic having mixed -a drachm of opium in his wine, the body soon became covered with large -blue stains, and gave out an insupportable odour. A French physician has -related in the Journal de Médecine a still more pointed case of a lady -who died seven hours after taking a large quantity of laudanum by -mistake, and whose body was so far gone in putrefaction fourteen hours -after death, that the dissection could not be delayed any longer. The -hair and cuticle separated on the slightest friction, and the stomach, -intestines, and large vessels were distended with air.[1783] - -It is doubtful whether this is a constant appearance or not. In one case -I examined, the body was free from putrefaction forty-eight hours after -death. - -Although opium is generally believed to suspend all the secretions and -excretions but the sweat, instances have been met with where a great -collection of urine was found in the bladder after death. In a paper on -the signs of death by opium, in Augustin’s Repertorium, it is stated -that Welper of Berlin always found the bladder full of urine, and the -kidneys gorged with blood, both in man and animals.[1784] I am not -prepared to say how far this is a common condition, as the state of the -urinary organs is seldom noticed in published cases. - -In the examination of the dead body unequivocal evidence will sometimes -be procured by the discovery of a portion of the poison in the stomach. -But it must not always be concluded that opium has not been swallowed, -because the sense of smell, chemical analysis, and experiments on -animals fail to detect it. For, as previously remarked, the opium may -not remain in the stomach after death, though a large quantity was -swallowed, and not vomited. This may arise from two causes. It may be -all absorbed, as will often happen when it has been taken in the liquid -form: or it may be partly absorbed and partly decomposed by the process -of digestion. But in one or other of these ways it may certainly -disappear, and that in a very few hours only. Several instances to this -effect have been already mentioned (pp. 57, 537). These remarks are -important, because the fact is generally believed to be the reverse. Dr. -Paris, in his work on Medical Jurisprudence, has tended to propagate the -misconception, by asserting that in all fatal cases opium may be -detected in the stomach;[1785] and in the last edition of his -Toxicology, Orfila has overrated the facility and frequency with which -an analysis may be conducted successfully. [See p. 538.] - -At the same time there is no doubt that the poison may sometimes be -found in the stomach. In Knape and Hecker’s Register there is the case -of a girl who died about eight hours after taking half an ounce of -laudanum; and the reporters found that an extract prepared from the -contents of the stomach caused deep sleep in frogs, chickens, and dogs, -and threw some of them into a comatose state, which proved fatal.[1786] -Wildberg has related a very interesting case of a young lady of Berlin, -who had been seduced, and finding herself pregnant, swallowed about half -an ounce of laudanum in the evening, and died during the night. In this -instance the contents of the stomach had a narcotic odour, and their -extract when given to a young dog caused excessive sleep, reeling, palsy -of the legs, convulsions, and death.[1787] - -M. Petit has related another case fatal in about ten hours, where the -contents of the stomach had the smell of opium; and their alcoholic -extract had a bitter taste, and killed guinea-pigs, with symptoms of -narcotism.[1788] In a case related by Mayer in Rust’s Magazin, which -also proved fatal after an interval of ten hours, the poison, which in -this instance was the saffron-tincture, was distinctly detected in the -stomach by a strong odour of opium and saffron.[1789] In a case where -the patient lived between thirteen and fourteen hours, that of the -individual for whose murder Stewart and his wife were executed at -Edinburgh, Dr. Ure succeeded in detecting meconic acid in the contents -of the stomach, which had been removed by the pump about three hours -after the opium was swallowed.[1790] In another case published by Mr. -Skae of this city, where death was caused by half an ounce in thirteen -hours, without any attempt having been made to evacuate the stomach, the -contents of that organ, treated according to the process at p. 534, -yielded evident indications of morphia, and obscure evidence of meconic -acid.[1791] Lastly, it may be added that in Dr. Traill’s case of -poisoning with ten grains of muriate of morphia, when the contents of -the stomach were decomposed by magnesia, a solution was obtained from -the precipitate by rectified spirit, which, when concentrated, had the -strong bitter taste of morphia, and became yellow with nitric acid; and -yet the individual survived no less than twelve hours. - -An important fact, ascertained by MM. Orfila and Lesueur, is that -neither opium nor the salts of morphia undergo decomposition by being -long in contact with decaying animal matter. Even after many months they -may be discovered; at least the putrefaction of the matter with which -they are mingled does not add any impediment in the way of their -discovery. It is only necessary to observe that the alkaloid may be -rendered insoluble by the evolution of ammonia, which separates it from -its state of combination.[1792] - - - SECTION IV.—_Of the Treatment of Poisoning with Opium._ - -The treatment of poisoning with opium, owing partly to the numerous -cases that have been published, and partly to the experiments of Orfila -on the supposed antidotes,—is now well understood. - -The primary object is to remove the poison from the stomach. This is -proper even in the rare cases in which vomiting occurs spontaneously. It -is by no means easy to remove all the opium by vomiting, especially if -it was taken in the solid state; for it becomes so intimately mixed with -the lining mucus of the villous coat, that it is never thoroughly -removed till the mucus is also removed, which is always effected with -difficulty. - -The removal of the poison is to be accomplished in one of three ways, by -emetics administered in the usual manner, by the stomach-pump, or by the -injection of emetics into the veins. - -By far the best emetic is the _sulphate of zinc_ in the dose of half a -drachm or two scruples, which may be repeated after a short interval, if -the first dose fails to act. In order to insure its action it is of -great use to keep the patient roused as much as possible,—a point which -is often forgotten.—The _sulphate of copper_ has been used by some as an -emetic; but it is not so certain as the sulphate of zinc. Besides, as it -is a much more virulent poison, it may prove injurious, if retained long -in the stomach. In Dr. Marcet’s case the patient, after recovering from -the lethargic symptoms, suffered much from pain in the throat and -stomach, occasioned probably by the sulphate of copper which he took -remaining some time undischarged. _Tartar emetic_, from the uncertainty -of its action when given in considerable doses, is even worse adapted -for such cases. This is illustrated by a case in the seventh volume of -the Medical and Surgical Journal, the same which has already been -referred to as exemplifying the occasional occurrence of convulsions and -delirium in poisoning with opium. A scruple of tartar emetic was -administered to cause vomiting, but to no purpose. When it had remained -fifteen minutes, sulphate of zinc was also given, and with immediate -effect. But the patient, after recovering from the sopor, was attacked -with pains in the stomach and bowels, and with tenesmus, which lasted -several days. - -Emetics should be preferred for evacuating the stomach, provided the -case be not urgent. Even then, however, they sometimes fail -altogether. The best practice in that case is to endeavour to remove -the poison with the stomach-pump; and this in urgent cases should be -the first remedy employed. The treatment by the stomach-pump has now -become so generally known, that it is unnecessary to describe it -particularly. It was recommended in this country by the late Dr. Monro -in his lectures; but does not appear to have been tried by him. In -1803 it was first published by Renault in his treatise on the -counter-poisons of arsenic; and he had tried it on animals.[1793] But -the first person who used it in an actual case of poisoning with opium -was Dr. Physick of Philadelphia. He saved the life of a child with it -in 1812; and not long afterwards his countryman, Dr. Dorsey, cured two -other individuals.[1794] More lately it was again proposed in London -by Mr. Jukes, who does not appear to have been acquainted with these -prior trials and experiments. Although he cannot be considered in the -light of a discoverer, the profession is much indebted to him for -having recalled their attention to this treatment, and for having by -his success and activity fairly established its reputation. An account -will be seen of his apparatus and of several cases in the Medical and -Physical Journal for September and November, 1822. In using the -stomach-pump care must be taken not to injure the stomach by too -forcible suction.—When it is not at hand, Mr. Bryce of this city -recommended the substitution of a long tube with a bladder attached. -After the stomach has been filled with warm water from the bladder, -the tube is to be turned down so as to act upon the contents of the -stomach as a syphon. Dr. Alison cured a patient in this way.[1795] - -Another method of removing opium from the stomach, which has been -practised successfully where the patient could not be made to submit to -the common treatment, is the injection of tartar-emetic into the rectum. -A case is related by Dr. Roe of New York where this treatment proved -successful. Fifteen grains in half a gallon of water excited free -vomiting, and ten grains more renewed it. Care was taken to insure the -discharge of the whole tartar-emetic by a subsequent purgative -injection.[1796] - -The last method for removing opium from the stomach is a desperate one, -which can only be recommended when emetics by the mouth have utterly -failed, and when a stomach-pump or Mr. Bryce’s substitute, cannot be -procured. It is the injection of an emetic into the veins. Tartar-emetic -answers best for this purpose, and its effect is almost certain. A grain -is the dose. While injecting it, care must be taken by the operator not -to introduce air into the vein. - -The next object in conducting the treatment of poisoning with opium is -to keep the patient constantly roused. This alone is sufficient when the -dose is not large, and the poison has been discharged by vomiting; and -in every case it forms, next to the evacuation of the stomach, the most -important of the treatment. - -The best method of keeping the patient roused is to drag him up and down -between two men, who must be cautioned against yielding to his -importunate entreaties and occasional struggles to get free and rest -himself. For the sopor returns so rapidly, that I have known a patient -answer two or three short questions quite correctly on being allowed to -stand still, and suddenly drop the head in a state of insensibility -while standing. The duration of the exercise should vary according to -circumstances from three, to six, or twelve hours. When he is allowed at -length to take out his sleep, the attendants must ascertain that it is -safe to do so by rousing him from time to time; and if this should -become difficult, he must be turned out of bed again and exercised as -before. - -It appears from some cases published not long ago by Mr. Wray[1797] and -Dr. Copland,[1798] and more lately also by Dr. Bright,[1799] that the -most insensible may be roused to a state of almost complete -consciousness for a short time, by dashing cold water over the head and -breast. This treatment can never supersede the use of emetics: and as -its effect is but temporary, it ought not to supersede the plan of -forced exercise. But it appears to be an excellent way to insure the -operation of emetics. If the emetic is about to fail in its effect, cold -water dashed over the head restores the patient for a few moments to -sensibility, during the continuance of which the emetic operates. -Dashing cold water over the head may perhaps be dangerous in the -advanced stage, when the body is cold and the breathing imperceptible; -but the most desperate remedies may be then tried, as the patient is -generally in almost a hopeless state. In one of the cases mentioned by -Dr. Bright from the experience of Mr. Walne, complete recovery was -accomplished, mainly by cold affusion of the head, where there appeared -reason to believe that more than an ounce and a half of laudanum had -disappeared from the stomach before evacuating remedies were used.—This -treatment seems to have been first proposed in 1767 by a German -physician, Dr. Gräter.[1800] A suggestion, which is probably an -improvement, has been recently made by Dr. Boisragon of Cheltenham, to -alternate the use of cold with that of warm water, applied to children -in the shape of warm bath, and to adults in the form of warm-sponging -and the foot-bath. The alternating impression of heat and cold may act -better as a stimulant than either agent singly; and the occasional -employment of heat prevents the risk of collapse from too continuous -exposure to cold. Dr. Boisragon saved in this way two cases in very -unpromising circumstances.[1801] - -In some cases internal stimulants have been given with advantage, such -as assafœtida, ammonia, camphor, musk, &c. It is always useful to -stimulate the nostrils from time to time, by tickling them or holding -ammonia under the nose; but the application should be neither frequent -nor long continued, as the ammonia may cause deleterious effects when -too freely inhaled. Pulling the hair and injecting water into the ears -are also powerful modes of rousing the patient. - -Venesection has been recommended and successfully used by some -physicians. If the stomach be emptied, and the patient kept roused, as -may almost always be done when means are resorted to in time, -venesection will be unnecessary. Sometimes, however, when the pulse is -full and strong, it may be prudent to withdraw blood; and it certainly -appears that in most cases where this remedy has been employed the -sensibility began to return almost immediately after. This is very well -shown in a case of poisoning with opium related by Mr. Ross[1802] in the -Edinburgh Medical Journal, in another described in the same journal by -Mr. Richardson,[1803] and also in two cases of poisoning with acetate of -morphia mentioned in a former page. Sometimes, on the contrary, it has -seemed injurious, probably because it was not had recourse to till the -patient was moribund. It is a sound general rule that blood-letting -ought not to be resorted to until the poison is thoroughly removed from -the stomach; for it favours absorption. And yet facts are not wanting to -show that this rule, now generally admitted since the researches of -Magendie on absorption, is not infallible. Dr. Young of the United -States has given the particulars of a case where imperturbable coma was -formed, together with puffing stertorous respiration, in consequence of -an ounce of laudanum having been swallowed,—and where recovery took -place, without the poison having been removed at all, simply under the -employment of three blood-lettings to the amount of twenty-eight ounces -altogether, of cold to the head, and of sinapisms to the legs.[1804] - -Galvanism has been sometimes resorted to, but seldom with decided -advantage. I saw it tried, with dubious utility, a few years ago in an -urgent case which was treated in the Edinburgh Infirmary. Six ounces of -laudanum had been swallowed, but most of it was removed in -three-quarters of an hour by the stomach-pump. A stage of deep sopor -followed, after which sensibility was restored, and maintained for four -hours by forced exercise. A state of pure and extreme coma then ensued, -during which galvanism was for some time of great service, in rousing -the patient. Gradually, however, it ceased to have any effect of the -kind. Recovery took place eventually under the use of external and -internal stimuli. Mr. Erichsen of the University-College Hospital, -London, has related a case, in which electro-magnetism was of undoubted -service. The usual symptoms had been occasioned by an ounce of laudanum. -The poison had been withdrawn by the stomach-pump, when unavailing -attempts were made to restore sensibility by means of various -stimulants. At length several electro-magnetic shocks were passed from -the forehead to the upper part of the spine, with the effect of speedily -eliciting signs of consciousness; in twenty minutes the patient could -answer questions and walk a little; and eventually complete recovery -took place.[1805] - -In desperate circumstances artificial respiration may be used with -propriety. After the breathing has been almost or entirely suspended the -heart continues to beat for some time; and so long as its contractions -continue, there is some hope that life may be preserved. But it is -essential for the continuance of the heart’s action, that the breathing -be speedily restored to a state of much greater perfection than that -which attends the close of poisoning with opium. It is not improbable -that the only ultimate cause of death from opium is suspension of the -respiration, and that if it could be maintained artificially so as to -resemble exactly natural breathing, the poison in the blood would be at -length decomposed and consciousness gradually restored. The following is -an interesting example by Mr. Whately, in which artificial respiration -proved successful. A middle-aged man swallowed half an ounce of crude -opium and soon became lethargic. He was roused from this state by -appropriate remedies, and his surgeon left him. But the poison not -having been sufficiently discharged, he fell again into a state of -stupor; and when the surgeon returned, he found the face pale, cold and -deadly, the lips black, the eyelids motionless, so as to remain in any -position in which they were placed, the pulse very small and irregular, -and the respiration quite extinct. The chest was immediately inflated by -artificial means, and when this had been persevered in for seven -minutes, expiration became accompanied with a croak, which gradually -increased in strength till natural breathing was established. Emetics -were then given, and the patient eventually recovered.[1806]—Dr. Ware of -Boston (U. S.) has more lately described another case, where artificial -respiration was employed with marked advantage, and would probably have -saved the patient’s life in very unfavourable circumstances, but for the -disease on account of which the opium was given.[1807]—Another has been -lately described by Mr. C. J. Smith of Madras. The patient was not seen -for four hours, and received no benefit from the ordinary remedies -during the next hour and a half. Artificial respiration was then -resorted to and maintained for nearly five hours with an hour of -interval; and this measure certainly seems to have brought the case to a -favourable termination under most unpromising circumstances.[1808]—Dr. -Watson of Glasgow has mentioned to me the particulars of an instructive -base in the person of an infant three weeks old, in whom, after the -breathing had stopped and the heart had nearly ceased to beat, the -occasional inflation of the chest with the breath at intervals of two or -three minutes restored for a time the action both of the heart and -lungs, and eventually accomplished recovery. On physiological principles -it appears probable, that this simple mode of procedure may prove more -frequently successful than might at first be thought. - -It would be a fruitless task to examine into the merits of the numerous -antidotes which have from time to time been proposed for poisoning with -opium. Professor Orfila has examined many of them with great care, such -as vinegar, tartaric acid, lemonade, infusion of coffee, decoction of -galls, solution of chlorine, camphor, diluents; and he has found them -all useless before the poison is expelled from the stomach, with the -single exception of decoction of galls. As he remarked that this fluid -throws down the active principles of an infusion of opium, and -subsequently found that such a mixture acts more feebly on the animal -system than the opiate infusion itself, he thinks the decoction of galls -may with propriety be used as an imperfect antidote, till the poison can -be evacuated from the stomach.[1809] His experiments, however, do not -assign to it very material activity as a remedy; and certainly the whole -efforts of the physician ought in the first instance to be directed to -the removal of the opium, and to keeping the patient roused. When the -opium has been completely removed, the vegetable acids and infusion of -coffee have been found useful in reviving the patient, and subsequently -in subduing sickness, vomiting, and headache; but till the poison is -completely removed the administration of acids is worse than useless, -provided the opium was given in the solid state, because its solution in -the juices of the stomach is accelerated. It has been maintained that -iodine, chlorine, and bromine are all antidotes for poisoning with the -vegetable alkaloids.[1810] Some notice will be taken of this statement -in the chapter on Nux Vomica. It has also been lately alleged in the -United States that opium has no effect when given with acetate of lead; -and an hospital case is reported as having occurred at New York, where -the poison was swallowed in this way to the extent of thirty grains, -without any injurious effect.[1811] There must have been some mistake -here, however. When given with acetate of lead in medicinal doses, opium -exerts its usual sedative and anodyne action; and indeed there is no -chemical or physiological reason why it should not do so. - - - - - CHAPTER XXVIII. - OF POISONING WITH HYOSCYAMUS, LACTUCA, AND SOLANUM. - - -_Of Poisoning with Hyoscyamus._—Of the narcotic poisons none bears so -close a resemblance to opium in its properties as the _hyoscyamus_ or -henbane. Several species are poisonous; but the only one that has been -examined with care is the _H. niger_, from which the extract of the -apothecary is prepared. - -The hyoscyamus has been analyzed by various chemists, and found to -contain a peculiar alkaloid, in which the properties of the plant are -concentrated. It is named hyoscyamia. This substance in its pure state, -as first obtained by MM. Geiger and Hesse, is a solid body, in fine -silky crystals, without odour, of a strong acrid taste like tobacco, -partially volatilizable with boiling water, entirely volatilizable alone -at a somewhat higher heat, very soluble in alcohol and ether, but -sparingly so in water.[1812] - -Farther, hyoscyamus, like many other narcotic vegetables, stramonium, -digitalis, opium, tobacco, and hemlock, has been found by Mr. Morries -Stirling to yield by destructive distillation an empyreumatic oil of -great activity. Its poisonous properties, however, are not essential to -the oil, but reside in a volatile principle which may be detached by -weak acetic acid. The relation of this principle to hyoscyamia has not -been ascertained; but it is an active poison, small doses producing in -rabbits, convulsions, coma, and speedy death.[1813] - -Runge proposes as evidence of poisoning with hyoscyamus, in common, -however, with stramonium and belladonna, to concentrate a solution of -the contents of the stomach, and apply it to a cat’s eye to dilate the -pupil. Dilatation, he says, was even produced by an extract obtained -from the urine of a rabbit which had been fed some time on -hyoscyamus.[1814] - -According to the experiments of Professor Orfila, the juice or extract -procured from the leaves, stems, and especially the root, produces in -animals a state of sopor much purer than that caused by opium. It is -most active when injected into the jugular vein, less so when applied to -the cellular tissue, and still less when introduced into the stomach. -Except occasional paralysis of the heart, indicated by florid blood in -its left cavities, no morbid appearance is to be found in the dead body. -Six drachms of the pharmaceutic extract of the leaves killed a dog in -two hours and a quarter when swallowed; and three drachms killed another -in four hours through a wound in the back. Its action appears to be -exerted through the medium of the blood-vessels, and is purely -narcotic.[1815] - -It is probable that the activity of this plant is much affected by -season; and the energy of its preparations varies greatly with the -manner of obtaining them. The information, however, which is at present -possessed on these two points is vague, because the influence of the two -circumstances has seldom been viewed carefully apart. - -The leaves, from which the pharmaceutic preparations of hyoscyamus are -obtained, are commonly held to be most active during the inflorescence -of the plant in the second summer of its existence. On general -principles this appears probable; but there are no satisfactory -experiments on the subject, even the late researches of Mr. Houlton -having left much still to be determined.[1816] - -Orfila has made some important remarks as to the effect of season and -vegetation on the energy of the root as a poison. The root he maintains -is the most active part of the plant; but in the spring it is nearly -inert. Thus the juice of three pounds of the root collected near the end -of April, when the plant has hardly begun to shoot, killed a dog in -somewhat less than two days; while a decoction of an ounce and a half -collected on the last day of June, when the plant was in full -vegetation, proved fatal in two hours and a half. - -The extract of the leaves, procured from different shops, was found by -Orfila to vary greatly in point of strength, some samples being -absolutely inert.[1817] The causes of these differences have been -ascertained experimentally by Brandes to be, that the herb loses its -active principle in part by decomposition in the process of simple -desiccation, and also when long kept; and that the greater part is also -similarly decomposed in preparing an extract, unless the process be -finished quickly, and at a low heat. - -The seeds of hyoscyamus are poisonous, as well as the leaves and root. -Indeed the whole plant is so. The seeds contain much more hyoscyamia -than the leaves. - -The effects of hyoscyamus on man differ somewhat from those on animals, -and vary greatly with the dose. - -In medicinal doses it commonly induces pleasant sleep. This indeed has -been denied by M. Fouquier, who infers from his experiments that it -never causes sleep, but always headache, delirium, nausea, vomiting, and -feverishness.[1818] I have certainly seen it sometimes have these -effects; but much more generally it has acted as a pleasant hypnotic and -anodyne. - -Its effect in large doses have been well described by M. Choquet as they -occurred in two soldiers who ate by mistake the young shoots dressed -with olive oil. They presently became giddy and stupid, lost their -speech, and had a dull, haggard look. The pupils were excessively -dilated, and the eyes so insensible that the eyelids did not wink when -the cornea was touched. The pulse was small and intermitting, the -breathing difficult, the jaw locked, and the mouth distorted by _risus -sardonicus_. Sensibility was extinct, the limbs were cold and palsied, -the arms convulsed, and there was that singular union of delirium and -coma which is usually termed typhomania. One of the men soon vomited -freely under the influence of emetics, and in a short time got quite -well. The other vomited little. As the palsy and somnolency abated, the -delirium became extravagant, and the patient quite unmanageable till the -evening of the subsequent day, when the operation of brisk purgatives -restored him to his senses. In two days both were fit for duty.[1819] - -In a treatise on vegetable poisons, Mr. Wilmer has related the history -of six persons in a family, who were poisoned by eating at dinner the -roots of the hyoscyamus by mistake instead of parsneps. Several were -delirious and danced about the room like maniacs, one appeared as if he -had got drunk, and a woman became profoundly and irrecoverably comatose. -Emetics could not be introduced into the stomach, stimulant clysters had -no effect, external stimuli of every kind failed to rouse her, and she -expired next morning at six.[1820] The roots in this instance were -gathered in the winter time,—a fact, which does not quite coincide with -the conclusions of Orfila, that the plant must be in full vegetation -before the energy of the root is considerable. - -From these and other cases, the abstracts of which are to be seen in -Orfila’s Toxicology, or in Wibmer’s Treatise on the Operation of -Medicines and Poisons, it follows that hyoscyamus in a poisonous dose -causes loss of speech, dilatation of the pupil, coma, and delirium, -commonly of the unmanageable, sometimes of the furious kind. In general -a stage of delirium precedes coma; and sometimes as the coma passes off, -delirium returns for a time. It has been known to act powerfully in the -form of clyster.[1821] It has also been known to act with considerable -energy even through the sound skin, as appears from a case which -occurred to Wibmer. He was called to a lady affected with great stupor, -dilated pupils, flushed face, loss of speech, full hard pulse, and -swelling of the abdomen; and he found that these symptoms were owing to -several ounces of henbane leaves having been applied to the belly in a -poultice, on account of strangury and tympanitis. She was still capable -of being roused by speaking loudly close to her ear; and under proper -treatment she recovered.[1822] - -Henbane seldom causes any distinct symptoms of irritant poisoning. In -several, however, of the cases related by the older modern authors some -pain in the belly, a little vomiting, and more rarely diarrhœa, appear -to have occurred.[1823] Plenck quotes, from a Swedish authority, an -instance of its having produced burning in the stomach, intense thirst, -watching, delirium, depraved vision, and next day a crowded eruption of -dark spots and vesicles, which disappeared on the supervention of a -profuse diarrhœa.[1824] The same author alludes to cases where it proved -fatal; but this event is rare in the present day, obviously because the -precursory stage of delirium gives an opportunity of removing the -poison, before the stage of coma is formed. A fatal case, which occurred -to Mr. Wibmer, has been mentioned above; and another has been related in -Pyl’s Magazin. Two boys a few minutes after eating the seeds were -attacked with convulsions and heat in the throat; and one of them, who -could not be made to vomit, died in the course of the ensuing -night.[1825] - -The accidents it has occasioned have commonly arisen from the -individuals confounding the root with that of the wild chicory or with -the parsnep, the latter of which it somewhat resembles. - -Of the other species of the hyoscyamus, the _H. albus_ has been known to -cause symptoms precisely the same with those above described. Professor -Foderé has given a good example of its effects on man, as they occurred -in the crew of a French corvette in the Archipelago. The plant was -boiled and distributed among the whole ship’s company, as several of the -sailors said they knew it to be eatable and salubrious. But in no long -time they were all seized with giddiness, vomiting, convulsions, colic, -purging, and delirium of the active kind. They were all soon relieved by -emetics and purgatives.[1826] - -Dr. Archibald Hamilton has described a case of the same nature, which -was caused by the seeds of this plant. A young medical student, who took -about twenty-five grains of the seeds, was seized in half an hour with -lassitude and somnolency, and successively with dryness of the throat, -impeding deglutition, convulsive movements of the arms, incoherency, -total insensibility of the skin, and loss of recollection. These -symptoms continued about twelve hours, and then slowly receded.[1827] - -Three other species, the _H. aureus_, _physaloides_ and _scopolia_ are -represented by Orfila to be equally deleterious. - -The alkaloid hyoscyamus possesses in an intense degree the active -properties of the plant. It has not been hitherto examined in this -respect with much care. But extremely minute quantities produce -excessive enlargement of the pupil, when put within the eyelids in the -form of neutral salt. - -_Treatment._—The treatment of poisoning with hyoscyamus consists in -removing the poison, diminishing cerebral congestion, and restoring -sensibility. It is therefore substantially the same as in poisoning with -opium, except that general or local evacuation of blood is more -frequently required, in consequence of the greater tendency of -hyoscyamus to induce determination of blood towards the head and -congestion there. It has been lately alleged by an Italian author that a -large dose of lemon-juice is an immediate antidote for the effects of -too large a medicinal dose, even when the poison was administered in the -form of injection.[1828] This does not seem probable. - - - _Of Poisoning with Lactuca._ - -Allied in its effects, but greatly inferior in power to opium and -hyoscyamus, is the _Lactuca virosa_, together with the _Lettuce-opium_, -or inspissated juice of _L. sativa_, and _L. virosa_. - -Orfila found that three drachms of the extract of _L. virosa_ introduced -into the stomach of a dog killed it in two days, without causing any -remarkable symptom; that two drachms applied to a wound in the back -induced giddiness, slight sopor, and death in three days; and that -thirty-six grains injected in a state of solution into the jugular vein -caused dulness, weakness, slight convulsions, and death in eighteen -minutes.[1829] This poison, therefore, like other narcotics, acts -through absorption. But it is far from being energetic. The extract is -very uncertain in strength,—as may indeed be inferred from the variable -nature of the processes by which it is prepared. - -Lactucarium, the inspissated juice, especially that obtained from _L. -virosa_, is obviously a more active preparation than the extract. Doses -of no great magnitude kill small animals. But there is a want of good -observations on its effects and energy as a poison. - - - _Of Poisoning with Solanum._ - -Different species of _solanum_, a genus of the same natural order with -the hyoscyamus, have been considered by Orfila to possess the same -properties, though in a much feebler degree. The _S. dulcamara_ or -bittersweet has been erroneously believed by some to possess distinct -narcotic properties.[1830] M. Dunal found that a dog might take 180 of -the berries or four ounces of the extract without any inconvenience, and -quotes an experiment on the human subject where thirty-two drachms of -extract were taken in two doses also without injury.[1831] If it has any -power at all, therefore, it must possess too little to be entitled to -the name of a poison. Chevallier says he knew an instance of a -druggist’s apprentice being attacked with deep somnolency for ten hours -after carrying a large bundle of it on his head;[1832] but some other -cause may be justly suspected to have here been in operation. The _S. -nigrum_ or common nightshade has been made the subject of experiment by -Orfila, who found its extract to possess nearly the power and energy of -lettuce-opium.[1833] The following seems a genuine case of poisoning -with the berries of this species. Three children near Nantes in France -were seized with severe headache, giddiness, colic, nausea, and -vomiting. One of them then had excessive dilatation of the pupils, -sweating and urgent thirst; loss of voice, stertorous breathing, and -tetanic spasms ensued; and in twelve hours he died. Another had swelling -of the face, alternate contraction and dilatation of the pupils, -repeated vomiting, and eventually coma; but he recovered. The third was -similarly, but more slightly affected, and also recovered. The children -who recovered pointed out the berries they had eaten; which were found -to be those of _S. nigrum_.[1834] The _S. fuscatum_ is rather more -active, fifteen berries having caused hurried breathing and -vomiting.[1835] The _S. mammosum_ is also probably an active species, -the capsule of the berries having been known to excite vomiting, -giddiness, and confusion of mind.[1836] In the _S. nigrum_ and -_dulcamara_, M. Desfosses discovered in 1821 a peculiar alkaloid, which -induces somnolency in animals, but is not a very active poison.[1837] - -It has been supposed by some that the tubers of _Solanum tuberosum_, the -common potato, may acquire in certain circumstances poisonous qualities -of no mean energy. Dr. Kabler of Prague has described the cases of four -individuals in a family who were seized with alarming narcotic symptoms -after eating potatoes which had begun to germinate and shrivel. The -father of the family, who had eaten least of them all, appeared as if -tipsy, and soon became insensible. The mother and two children became -comatose and convulsed. All had vomited before becoming insensible. They -recovered under the use of ether, frictions, and coffee; and in two -hours were out of danger.[1838] - -An alkaloid has been indicated by several chemists in various species of -solanum. The most recent account, that of Otto, represents it to be a -pearly, white, pulverulent substance, alkaline in reaction, and capable -of uniting with acids. One grain of sulphate of solania killed a rabbit -in six hours, and three grains a stronger rabbit in nine hours,—the -symptoms being those of narcotic poisoning.[1839] - -Violent effects have often been assigned to the genus Solanum, in -consequence of its similarity to a powerful poison, the _Atropa -belladonna_; which indeed is described by the older authors under the -name of _Solanum furiosum_. It will be noticed among the Narcotico-acrid -Poisons. - - - - - CHAPTER XXIX. - OF POISONING WITH HYDROCYANIC ACID. - - -The poisons, whose energy depends on the presence of the prussic or -hydrocyanic acid, are of great interest to the physiologist as well as -the medical jurist. Some of them are natural productions, derived from -the leaves, bark, fruit-kernels, and roots of certain plants; others are -formed artificially by complex chemical processes. The species to be -here noticed are the _hydrocyanic acid_ itself, and the essential oils -and distilled waters of the _bitter almond_, _cherry-laurel_, -_peach-blossom_, _cluster-cherry_, _mountain-ash_, and _bitter cassava_. -These poisons have for some time attracted great attention on account of -their extraordinary power. And indeed in rapidity of action, or the -minuteness of the quantity in which they operate, no poison surpasses -and very few equal them. They are exceedingly interesting to the medical -jurist, because, as they are now generally known, their effects often -become the subject of medico-legal investigation: they have been -repeatedly taken by accident; they have often been resorted to for -committing suicide; and they have likewise been employed as the -instruments of murder. A remarkable instance occurred in England towards -the close of last century, where murder was committed with the -cherry-laurel water; and two cases have been tried in England where -death arose from hydrocyanic acid, and the prisoners were charged with -administering it, but were found not guilty. These cases will be noticed -presently. - - - _Of the Hydrocyanic Acid._ - SECTION I.—_Of its Chemical History and Tests._ - -This singular substance was discovered some time ago by Scheele; but -Gay-Lussac was the first who obtained it in a state of purity. It is -familiarly known to chemists under two forms,—as a pure acid, and -diluted with water. - -The pure acid is liquid, limpid, and colourless. It has an acrid, -pungent taste, and a very peculiar odour, which, when diffused through -the air, has a very distant resemblance to that of bitter almonds, but -is accompanied with a peculiar impression of acridity on the nostrils -and back of the throat. It is an error, however, to suppose, as is very -generally done, that the odour is the same with that of the almond. It -boils at 80°; freezes at 5°; and is very inflammable. I have kept it -unchanged for a fortnight in ice-cold water; but at ordinary -temperatures it decomposes spontaneously, and becomes brown, sometimes -in an hour, and commonly within twelve hours. On this account it is -extremely improbable that a case will ever happen, in which the medical -jurist will have to examine it in its concentrated form. - -When united with water it forms the acid discovered by Scheele, and now -kept in the druggist’s shop. In this state it has the same appearance, -taste, and smell as the pure acid; but it is less volatile, does not -burn, and may be preserved long without change, if excluded from the -light. In consequence of its volatility, however, it becomes weak, -unless kept with great care; many samples of it also undergo -decomposition, and deposit brown flakes, if not excluded from the light; -and hence the acid of the shops is very variable in point of strength. -The acid prepared by decomposing the solution of the ferro-cyanate of -potass by sulphuric acid may be kept for years, even exposed to diffuse -light, without being decomposed at all. A French physician made some -experiments not long ago on the uncertainty of the strength of the -medicinal acid; and he found that he could swallow a whole ounce of one -sample, and a drachm of a stronger sample, without sustaining any -injury; but on trying some which had been recently prepared by -Vauquelin, he was immediately taken ill, as will be related presently, -and narrowly escaped with his life.[1840]—The acid of commerce differs -much in strength, according to the process by which it has been -prepared, and independently of decomposition by keeping. The medicinal -acid long used in this country is intended to be an imitation of that of -Vauquelin, which contains 3·3 per cent.;[1841] but the London College of -Physicians, in adopting it in their last Pharmacopœia, improperly -altered the strength to 2 per cent. That of Giese, which keeps well, is -of the same strength as the first; that of Schrader contains only one -per cent.; that of Göbel 2·5 per cent.; that of Ittner 10 per -cent.;[1842] that of Robiquet 50 per cent.[1843] Of the alcoholic -solutions the best known are that of Schrader, which contains about 1·5 -per cent. of pure acid,—that of the Bavarian Pharmacopœia, which -contains 4 per cent.,—that of Duflos, 9 per cent.,—that of Pfaff, 10 per -cent.,—and that of Keller, 25 per cent.[1842] These statements are -necessary for understanding the cases of poisoning published in foreign -works. - -The tests for hydrocyanic acid has been examined by M. Lassaigne of -Paris, by Dr. Turner of London, and by Professor Orfila. They are its -odour, the salts of copper, the salts of iron, and nitrate of silver. - -The _peculiar odour_ of the acid is a very characteristic and delicate -test of its presence. According to Orfila, the smell is perceptible when -no chemical reagent is delicate enough to detect it.[1844] But I doubt -the accuracy of this statement, and may farther observe, that I have -known some persons nearly insensible of any smell, even in a specimen -which was tolerably strong. Hence, when the odour is resorted to as a -test, it ought to be tried by several persons. - -_Sulphate of copper_ forms with hydrocyanic acid, when rendered alkaline -with a little potass, a greenish precipitate, which becomes nearly -white, on the addition of a little hydrochloric acid. The purpose of the -hydrochloric acid is to redissolve some oxide of copper thrown down by -the potass. The precipitate is then the cyanide of copper. This test, -according to Lassaigne, will act on the poison when dissolved in 20,000 -parts of water. But as the precipitate is not coloured, the test is an -insignificant one compared with the next. - -If the acid be rendered alkaline by potass, the _salts of the mixed -peroxide and protoxide of iron_ produce a grayish-green precipitate, -which, on the addition of a little sulphuric acid, becomes of a deep -prussian blue colour. Common green vitriol answers very well for this -purpose. The salts of the peroxide of iron will also often answer, -because, unless carefully prepared, they are never altogether free of -protoxide. But the salts of the pure peroxide of iron have no such -effect. They cause with the potass a brownish precipitate, which is -redissolved on the addition of sulphuric acid, leaving the solution -limpid. Mr. Ilott of Bromley has pointed out to me, that the iron test -does not act on a weak solution of hydrocyanic acid, if there be an -excess of ammonia present, either such from the first, or disengaged by -potash from muriate of ammonia; that the blue precipitate is produced by -driving off the ammonia with heat; but not by neutralizing it with an -acid. - -The _nitrate of silver_ is a delicate and characteristic reagent for -hydrocyanic acid. A white precipitate, the cyanide of silver, is -produced in a very diluted solution; and this precipitate is -distinguished from the other white salts of silver, by being insoluble -in nitric acid at ordinary temperatures, but soluble in that acid at its -boiling temperature. In this action it is necessary to observe that -something more is accomplished than simple solution; the cyanide is -decomposed, nitrate of silver is formed, and hydrocyanic acid is -disengaged by the ebullition. A more characteristic property is, that -the precipitate when dried and heated emits cyanogen gas; which is -easily known by the beautiful rose-red colour of its flame.[1845] - -Sometimes it is necessary to determine the strength of diluted -hydrocyanic acid; because, on account of its tendency to decomposition, -doubts may be entertained whether a mixture which contains it is strong -enough to be dangerously poisonous. According to Orfila, the best method -of ascertaining the strength either of a pure solution or of a mixture -in syrup, is to throw down the acid with the nitrate of silver and dry -the precipitate; a hundred parts of which correspond to 20·33 of pure -hydrocyanic acid. - -_Process for Mixed Fluids._—Some important observations have been made -by MM. Leuret and Lassaigne on the effect of mixing animal matters with -hydrocyanic acid. The most material of their results are, that if the -body of an animal poisoned with the acid is left unburied for three -days, the poison can no longer be detected; and that if it is buried -within twenty-four hours the poison may be found after a longer -interval, but never after eight days. The reason is either that the acid -volatilizes, or that it is decomposed. The possibility thus indicated of -detecting the poison in the body some days after death has been since -confirmed by actual examination in a medico-legal case. In a case of -poisoning with hydrocyanic acid, followed by dismemberment of the body -for the purpose of concealment, distinct proof of the presence of the -poison seven days after death was obtained by the second of the -succeeding processes, although the trunk of the body had never been -buried, but had been for some time lying in a drain.[1846] - -For detecting the poison in mixed fluids Orfila has lately advised the -following process. The fluid may be treated with animal charcoal without -heat. The colour being thus generally destroyed, the test will sometimes -act as usual. Or, without this preparation, a slip of bibulous paper -moistened with pure potass, may be immersed in the suspected fluid for a -few minutes, and then touched with a solution of sulphate of iron: upon -which the usual blue colour will be produced on the paper. If neither of -these methods should answer, the fluid is to be distilled.[1847] - -Distillation of the fluid is on the whole the best mode of procedure. It -was proposed some time before by Lassaigne and Leuret for detecting the -poison in the stomach after death. The steps of their process, which -appears to me the best yet proposed, are as follows. The contents after -filtration are to be neutralized with sulphuric acid if they are -alkaline, in order to fix the ammonia which may have been disengaged by -putrefaction; the product is then to be distilled from a vapour-bath -till an eighth part has passed over into the receiver; and the distilled -fluid is to be tested with the sulphate of iron in the usual way.[1848] -Orfila maintains that from hydrocyanized syrup only two-thirds of the -acid can be distilled over; and cautions the analyst against estimating -quantity by such means.[1849] M. Ossian Henry has proposed to condense -the acid in distillation by a much more complex process, which consists -in obtaining it in the first instance in the form of cyanide of -silver.[1850] But with a good refrigeratory there is no difficulty in -condensing every particle of acid with no other aid than cold water. - -By this process Lassaigne could detect the poison in a cat or dog killed -by twelve drops and examined twenty-four or forty-eight hours after -death.[1851] But Dr. Schubarth has objected to it,—and the same -objection will apply to every process in which heat is used,—that -hydrocyanic acid may be formed during distillation by the decomposition -of animal matter.[1852] His objection, however, appears only to rest on -conjecture or presumption at farthest; and I doubt whether, supposing -the distillation to go on slowly in the vapour-bath, the heat is -sufficient to bring about the requisite decomposition. The force of the -objection must be decided by future researches. - -It is worthy of remark that hydrocyanic acid is apt to be formed in the -course of the changes produced by various agents in organic matters. -These are probably more numerous than the toxicologist is at present -exactly aware of. An instance of its formation in the course of the -decay of unsound cheese has been ascertained lately by Dr. -Witling;[1853] and another example will be mentioned under the head of -spurred rye. - -_Cyanide of Potassium._—The only compound of hydrocyanic acid which -requires notice is the cyanide of potassium. This is, when pure, a white -salt, bitter, not decomposable by a red heat unless in contact with air, -very soluble in water, and sparingly so in rectified spirit. Its watery -solution restores the blue of reddened litmus, and does not precipitate -lime-water: the mixed sulphates of the two oxides of iron form with it -Prussian blue: nitrate of silver causes a white precipitate insoluble in -cold nitric acid, but disappearing when the acid is boiled: sulphate of -copper causes an apple-green precipitate, which becomes white on the -addition of hydrochloric acid: chloride of platinum or perchloric acid -will indicate the potash. In a complex organic mixture it is difficult -to detect the potash; but hydrocyanic acid may be obtained from it by -distilling the suspected fluid with tartaric acid.[1854] - - - SECTION II.—_Of the Action of Hydrocyanic Acid and the Symptoms it - excites in Man._ - -The effects of hydrocyanic acid on the animal system have been examined -by several physiologists. The best experiments with the concentrated -acid are those of M. Magendie; who says that, if a single drop be put -into the throat of a dog, the animal makes two or three deep hurried -respirations, and instantly drops down dead; that it causes death almost -as instantaneously when dropped under the eyelid; and that when it is -injected into the jugular vein, the animal drops down dead at the very -instant, as if struck with a cannon ball or with lightning.[1855] - -On repeating these experiments in order to determine less figuratively -the shortest period which elapses before the poison begins to operate, -as well as the shortest time in which it proves fatal,—two points it -will presently be found important to know,—I remarked that a single -drop, weighing scarcely a third of a grain, dropped into the mouth of a -rabbit, killed it in eighty-three seconds, and began to act in -sixty-three seconds,—that three drops weighing four-fifths of a grain, -in like manner killed a strong cat in thirty seconds, and began to act -in ten,—that another was affected by the same dose in five and died in -forty seconds,—that four drops weighing a grain and a fifth did not -affect a rabbit for twenty seconds, but killed it in ten seconds -more,—and that twenty-five grains, corresponding with an ounce and a -half of medicinal acid, began to act on a rabbit as soon as it was -poured into its mouth, and killed it outright in ten seconds at -farthest. Three drops injected into the eye acted on a cat in twenty -seconds, and killed it in twenty more; and the same quantity dropped on -a fresh wound in the loins acted in forty-five and proved fatal in 105 -seconds. Dr. A. T. Thomson says he has seen the concentrated acid kill a -strong dog in two seconds.[1856] Mr. Blake on the other hand alleges -that all the accounts which represent the action of the poison to begin -in less than ten seconds are exaggerated, because he could never find it -to act more quickly, even when thirty minims of concentrated acid were -injected at once into the femoral vein.[1857] But it is impossible that -any negative results can outweigh positive observations, especially when -made, as mine were, expressly with the view of ascertaining the shortest -interval. In the slower cases enumerated above there were regular fits -of violent tetanus; but in the very rapid cases the animals perished -just as the fit was ushered in with retraction of the head. In rabbits -opisthotonos, in cats emprosthotonos, was the chief tetanic symptom.—The -practical application of these experiments will appear presently. - -Of all the forms in which the pure acid can be administered, that of -vapour appears the most instantaneous in operation. M. Robert found, -that when a bird, a rabbit, a cat, and two dogs were made to breathe air -saturated with its vapour, the first died in one second, the second also -in a single second, the cat in two, one dog in five, and the other dog -in ten seconds.[1858] - -The effects of the diluted acid are the same when the dose is large, but -somewhat different when inferior doses are given. These effects have -been observed by many physiologists; but the most accurate and extensive -experiments are those of Emmert published in 1805,[1859] those of -Coullon in 1819,[1860] and those of Krimer in 1827.[1861] They found -that when an animal is poisoned with a dose not quite sufficient to -cause death, it is seized in one or two minutes with giddiness, weakness -and salivation, then with tetanic convulsions, and at last with -gradually increasing insensibility; that after lying in this state for -some time, the insensibility goes off rapidly and is succeeded by a few -attacks of convulsions and transient giddiness; and that the whole -duration of such cases of poisoning sometimes does not exceed half an -hour, but may extend to a whole day or more.—When the dose is somewhat -larger the animal perishes either in tetanic convulsions or comatose; -and death for the most part takes place between the second and fifteenth -minute. I have seen the diluted acid, however, prove fatal with a -rapidity scarcely surpassed by the pure poison. Thus in an experiment -with Vauquelin’s acid, made on a strong cat at the same time with the -second and third of the experiments with the pure acid detailed above, I -found that thirty-two grains, which contain one of real acid, began to -act in fifteen seconds, and proved fatal in twenty-five more. According -to Schubarth’s experiments death may be sometimes delayed for thirty-two -minutes;[1862] but if the animal survives that interval, it recovers. He -farther states, that during the course of the symptoms the breath -exhales an odour of hydrocyanic acid.[1863] Coullon once saw a dog die -after nineteen hours of suffering; but cases of this duration are -exceedingly rare.[1864] When the dose is very large Mr. Macaulay, as -will afterwards be mentioned (p. 590), has found death take place in a -few seconds, exactly as when the pure acid is given. - -The body presents few morbid appearances of note. The brain is generally -natural. Yet occasionally its vessels are turgid; and Schubarth once -found even an extravasation of blood between its external membranes in -the horse.[1865] The heart and great vessels are distended with black -blood, which is commonly fluid, but occasionally coagulated as usual. -The lungs, according to Schubarth, are sometimes pale, but much more -generally injected and gorged with blood.[1866] The pure acid, according -to Magendie, exhausts the irritability of the heart and voluntary -muscles so completely, that they are insensible even to the stimulus of -galvanism.[1867] The diluted acid has not always this effect. In the -experiments of Coullon the heart and intestines contracted, and the -voluntary muscles continued contractile, after death as usual.[1868] So -too Mr. Blake remarked both by inspection of the body after death, and -by means of the hæmadynamometer during life, that, when the poison is -introduced directly into a vein, so as to prove fatal in forty-five -seconds, the contractions of the heart, though irregular, are not -materially impaired in energy.[1869] On the other hand Schubarth states -that the heart is never contractile, although the intestines and -voluntary muscles retain their contractility.[1870] The reason of these -discrepant statements is that, as I have had occasion to observe, a -considerable difference really prevails in experiments conducted under -circumstances apparently the same. In eight experiments on cats and -rabbits with the pure acid the heart contracted spontaneously, as well -as under stimuli, for some time after death, except in the instance of -the rabbit killed with twenty-five grains, and one of the cats killed by -three drops applied to the tongue. In the last two the pulsations of the -heart ceased with the short fit of tetanus which preceded death; and in -the rabbit, whose chest was laid open instantly after death, the heart -was gorged and its irritability utterly extinct. The later researches of -Dr. Lonsdale likewise show great varieties in the condition of the -heart; and he has been led to conclude that the diluted acid does not -perceptibly influence the heart, while the pure acid enfeebles it, if -introduced into the stomach, but arrests it, if injected into the -windpipe.[1871] - -The experiments of Emmert, Coullon, and Krimer show that the diluted -acid acts most energetically through the serous membranes, and next upon -the stomach; that it also acts with energy on the cellular tissue; that -it has no effect when applied to the trunks or cut extremities of -nerves, or to a fissure made in the brain or spinal marrow; that its -action is prevented when the vessels of any part are tied before the -part is touched with the poison; that its action is not prevented by -previously dividing the nerves; and that it may sometimes be discovered -in the blood after death by chemical analysis,[1872] and frequently by -the smell when analysis cannot succeed in separating it.[1873] These -results favour the supposition that hydrocyanic acid acts through the -medium of the blood-vessels. But the extreme rapidity of its operation -in large doses is usually considered incompatible with an action through -the blood, or any other channel except direct conveyance along the -nerves. The tremendous rapidity of action indicated by the experiments -of Magendie, or of Mr. Macaulay (p. 543), of M. Robert, as well as in -some of those performed by myself,—certainly appears rather inconsistent -with the notion, that the acid must enter the blood-vessels before -producing its effects. - -This acid acts on the brain and also on the spine independently of its -action on the brain. Its action on both is clearly indicated by the -combination of coma with tetanus. The independent action on the spine is -well shown by the following experiment of Wedemeyer. In a dog the spinal -cord was divided at the top of the loins, so that no movement took place -when the hind-legs were pricked: hydrocyanic acid being then introduced -into a wound in the left hind-leg, symptoms of poisoning commenced in -one minute, and the hind-legs were affected with convulsions as well as -the fore-legs.[1874] - -Hydrocyanic acid affects all animals indiscriminately. From the highest -to the lowest in the scale of creation all are killed by it; and all -perish nearly in the same manner. Such is the result of a very extensive -series of experiments by Coullon. - -It is scarcely necessary to observe that hydrocyanic acid acts -energetically as a poison, through whatever channel it is introduced -into the body. Whether it be swallowed, or injected into the rectum, or -dropped into the eye, or applied to a fresh wound, or inhaled in the -form of vapour, its action is exerted with tremendous energy. Perhaps it -may even act through the sound skin. It has not, hitherto, indeed, been -found to affect animals in this way, evidently because their skin is too -thick and impermeable. But M. Robiquet informed me that once, while he -was making some experiments on the tension of its vapour, his fingers, -after being some time exposed to it, became affected with numbness, -which lasted several days; I have repeatedly remarked the same effect -when handling tubes which contained the concentrated acid; and Emmert -found that the essential oil of bitter almond, applied to the uninjured -skin of the back of a rabbit, produced the usual symptoms and death: and -that the peculiar odour of the poison was quite distinct after death in -the deep-seated muscles of the back.[1875] - -This substance is poisonous in all its chemical combinations. Coullon -remarked that two drops of the hydrocyanate of ammonia killed a sparrow -in two minutes.[1876] Robiquet and Magendie found that a hundredth part -of a grain of the cyanide of potassium killed a linnet in thirty -seconds, and five grains a large pointer in fifteen minutes;[1877] -Orfila has related an instance of death in the human subject within an -hour after the administration of six grains of cyanide of potassium in -an injection;[1878] and in a recent experimental investigation the same -author found that this salt produces all the effects of hydrocyanic -acid.[1879] Schubarth killed a dog in twenty minutes with twenty drops -of the diluted acid neutralized by ammonia,[1880] and another in three -hours with twenty-five drops neutralized by potass. These facts are a -sufficient answer to a statement made by Mr. Murray of London, to the -effect, that a considerable dose of the acid may be given without injury -to a rabbit,[1881] if previously rendered alkaline by ammonia. But, -nevertheless, as will be seen under the head of the treatment, ammonia, -as Mr. Murray stated, is a good antidote when administered after the -poison as a stimulant. - -The _ferro-cyanates_, or prussiates, do not possess deleterious -properties. These salts were at one time considered compounds of -hydrocyanic acid with a double oxidized base, oxide of iron being one. -Thus the prussiate of potass was considered a compound of hydrocyanic -acid with potass and oxide of iron. But since the investigations of Mr. -Porrett, it has been admitted that there is only one base, potash; and -that it is in union with a hydracid, called ferro-cyanic acid, the -radicle of which is a ternary body composed of carbon, azote, and iron. -The physiological effects of this substance, which have been examined by -many experimentalists, are favourable to Porrett’s opinion; for although -some have found it poisonous, all agree in assigning it very feeble -properties, and some have not been able to discover in it any -deleterious quality at all. Coullon observes that Gazan killed a dog -with two drachms, and Callies another with three drachms of the salt met -with in commerce.[1882] Schubarth found that half an ounce had not any -material effect on dogs, even when vomiting did not occur for half an -hour;[1883] and Callies, who found the salt of commerce somewhat -poisonous, also remarked, that when it was carefully prepared, several -ounces might be given without harm.[1884] D’Arcet once swallowed half a -pound of a solution without any injury.[1885] Similar results were -obtained previously with smaller doses by Wollaston, Marcet,[1886] and -Emmert,[1887] as well as afterwards by Dr. Macneven,[1888] and -Schubarth,[1889] who found that a drachm or even two drachms might be -taken with impunity by man and the lower animals. - -The _sulpho-cyanic acid_, another substance analogous in chemical nature -to the ferro-cyanic, was once supposed like it to be a poison of great -activity, but this is doubtful. Professor Mayer of Bonn ascertained that -a drachm and a half of a moderately strong solution of the acid -sometimes killed a rabbit in ninety seconds when injected into the -windpipe, and that the same quantity of a solution of sulpho-cyanate of -potassa might occasion death in the course of four hours; but that some -rabbits took half an ounce of the former and three drachms of the latter -without material harm, both when administered through the windpipe, when -injected into the rectum, and when introduced into the stomach by a -gullet-tube. In the fatal cases death took place under symptoms of -oppressed breathing, rarely attended with convulsions; and extensive -traces of irritation were found in the alimentary canal.[1890] Dr. -Westrumb of Hameln, however, seems to have found it more active in the -form of sulpho-cyanate of potassa. Two scruples in an ounce of water -produced in a dog spasmodic breathing, convulsions, efforts to vomit, -and death in seven minutes; and forty grains killed another in less than -two hours. In the latter animal he detected the poison by the sulphate -of iron in the blood, lungs, liver, spleen and kidneys.[1891] Some -experiments by Soemering would even make it out to be a poison of very -great energy; for half a drachm of concentrated sulpho-cyanic acid given -to a dog occasioned immediate death; and the same quantity of -sulpho-cyanate of potassa killed another in one minute.[1892] - -_Cyanic and cyanous acids_ are not poisonous, according to the -experiments of Hünefield;[1893] but _cyanogen_ is a powerful poison, as -will be mentioned under the head of the Narcotic Gases. - -The symptoms of hydrocyanic acid observed in man are very similar to -those witnessed in animals. - -Coullon has given a good account of the effects of small doses as -ascertained by experiment on himself. When he took from 20 to 86 drops -of a diluted acid, he was attacked for a few minutes with nausea, -salivation, hurried pulse, weight and pain in the head, succeeded by a -feeling of anxiety, which lasted about six hours.[1894] Such symptoms -are apt to be induced by too large medicinal doses. Another remarkable -symptom which has been sometimes observed during its medicinal use is -salivation with ulceration of the mouth. Dr. Macleod thrice had occasion -to remark this in patients who had been using the drug for about a -fortnight, and twice in one individual; and Dr. Granville says he had -also twice witnessed the same effect.[1895] - -As to the effects of fatal doses, it is probable that in man, as in -animals, two varieties exist. When the dose is very large, death will in -general take place suddenly, without convulsions. But for obvious -reasons the symptoms in such cases have not been hitherto witnessed. - -The most complete account of the symptoms from fatal doses when -convulsions occur, is given in a case reported by Hufeland of a man, -who, when apprehended for theft, swallowed an ounce of alcoholized acid, -containing about forty grains of the pure acid. He was observed -immediately to stagger a few steps, and then to sink down without a -groan, apparently lifeless. A physician, who instantly saw him, found -the pulse gone and the breathing for some time imperceptible. After a -short interval he made so forcible an expiration that the ribs seemed -drawn almost to the spine. The legs and arms then became cold, the eyes -prominent, glistening, and quite insensible; and after one or two more -convulsive expirations he died, five minutes after swallowing the -poison.[1896] - -In Horn’s Journal is recorded another case which also proved fatal in -five minutes, with precisely the same symptoms.[1897] A short notice of -what appears to have been a similar case is given in the Annales de -Chimie. The person was a chemist’s servant, who swallowed a large -quantity of the alcoholic solution by mistake for a liqueur, the poison -having been accidentally left on the table by her master, who had been -showing it as a curiosity to some friends. No account is given of the -symptoms, farther than that she died apoplectic in two minutes.[1898] To -these cases may be also added a short notice of the French physician’s -case mentioned at the commencement of this chapter. It will convey a -good idea of the operation of the poison when not quite sufficient to -kill. Very soon after swallowing a tea-spoonful of the diluted acid he -felt confusion in the head, and soon fell down insensible, with -difficult breathing, a small pulse, a bloated countenance, dilated -insensible pupils, and locked jaw. Afterwards he had several fits of -tetanus, one of them extremely violent. In two hours and a half he began -to recover his intellects and rapidly became sensible; but for some days -he suffered much from ulceration of the mouth and violent pulmonary -catarrh, which had evidently been excited by the ammonia given for the -purpose of rousing him. This gentleman had eructations with the odour of -the acid three or four hours after he took it; and during the earlier -symptoms the same odour was exhaled by his breath.[1899] The hydrocyanic -odour of the breath is of course an important distinguishing character, -which would appear, from the observations of Dr. Lonsdale on -animals,[1900] to occur more frequently than might be supposed from the -silence observed on the subject by the reporters of cases. - -Hydrocyanic acid is not considered a cumulative poison,—that is, the -continued use of frequent small doses is not believed to possess the -power recognised in iodine, mercury, and foxglove, of gradually and -silently accumulating in the body, and then suddenly breaking out with -dangerous or fatal violence. The frequent experience of practitioners in -this and other countries seems to prove that hydrocyanic acid possesses -no such property. It is right at the same time to mention, that a case -published by Dr. Baumgärtner of Freyburg has been thought by some[1901] -to establish the reverse. A man had taken for two months, on account of -chronic catarrh, ten drops of Ittner’s acid daily in doses of one grain, -without experiencing the slightest toxicological effect. At length he -was found one morning in bed apparently labouring under the poisonous -operation of the acid. He had headache, blindness, dilated insensible -pupil, feeble irregular pulse, occasional suspension of the breathing, -and rapidly increasing insensibility. The cold affusion and ammonia were -immediately resorted to, and at first with advantage. But in no long -time spasms commenced in the toes, and gradually affected the rest of -the body, till at length violent fits of general tetanus were formed, -lasting for six or ten minutes, and alternating in the intervals with -coma. Venesection was next resorted to; after which the spasms were -confined to the jaw and eyes. Delirium succeeded, but was removed by a -repetition of the blood-letting. At four in the afternoon he was -tolerably sensible; during the night delirium returned; at ten next -morning he recovered his sight; and on the subsequent morning he had no -complaint but headache and pain in the eyes.[1902] This case differs so -much from every other in the collateral circumstances, as well as in -duration, that, although the symptoms themselves correspond with those -of poisoning with hydrocyanic acid, we may justly suspect either some -other cause, or the accidental administration of too large a dose. It -ought, however, to turn the attention of practitioners to the -possibility of this poison acting by the accumulation of the effects of -small doses frequently repeated for a great length of time. - -The period within which hydrocyanic acid usually proves fatal is fixed -with considerable accuracy, not only by the cases observed in the human -subject, but likewise by the experiments of many physiologists, and more -especially those of Schubarth (p. 583). It is probable that very large -doses occasion death in a few seconds; and at all events a few minutes -will suffice to extinguish life when the dose is considerable; but if -the individual survive forty minutes, he will generally recover. In the -course of a dreadful accident which happened a few years ago in one of -the Parisian hospitals, when seven epileptic patients were killed at one -time by too large doses of the medicinal acid, it was found that several -did not die for forty-five minutes.[1903] But the researches of -Schubarth would certainly justify the expectation that recovery will -take place under active treatment when the patient survives so -long.—These facts may be highly important in the practice of medical -jurisprudence. - -The period within which it begins to operate ought also to be accurately -ascertained for the same reason. Indeed in a very interesting trial, -which took place a few years ago in this country, the fate of the -prisoner depended in a great measure on the question, within how short a -time the effects of this poison must show themselves?[1904] The nature -of the case was as follows: An apothecary’s maid-servant at Leicester -who was pregnant by her master’s apprentice, was found one morning dead -in bed; and she had obviously been poisoned with hydrocyanic acid. -Circumstances led to the suspicion that the apprentice was accessary to -the administration of the poison. On the other hand, it was distinctly -proved that the deceased had made arrangements for a miscarriage by -artificial means on the night of her death; and it was therefore -represented, on the part of the prisoner, that she had taken the poison -of her own accord. But the body was found stretched out in bed in a -composed posture, with the arms crossed over the trunk, and the -bed-clothes pulled smoothly up to the chin; and at her right side lay a -small narrow-necked phial, from which about five drachms of the -medicinal prussic acid had been taken, and which was corked and wrapped -in paper. There naturally arose a question, whether the deceased, after -drinking the poison out of such a vessel, could, before becoming -insensible, have time to cork up the phial, wrap it up, and adjust the -bed-clothes?[1905] To settle this point, experiments were made at the -request of the judge, by Mr. Macaulay, Mr. Paget, and several other -medical men of Leicester; and on the trial they, with the exception of -Mr. Paget, gave it as their opinion, founded on the experiments, that -the supposed acts of volition, although within the bounds of -possibility, were in the highest degree improbable. The chief -experiments were three in number, from which it appeared that one dog -was killed with four drachms in eight seconds, another with four drachms -in seven seconds, and another with four drachms and a half in three -seconds; but in other experiments the interval was greater.—For these -particulars I am indebted to Mr. Macaulay. - -In the first edition of this work I expressed my concurrence with the -majority of the witnesses. But some facts, which came subsequently under -my notice, led me to think that this concurrence was given rather too -unreservedly. I still adhere so far to my original views as to think it -improbable that, if the deceased, after swallowing the poison, had time -to cork the phial, wrap it in paper, pull up the bed-clothes, and place -the bottle at her side, the progress of the symptoms could have been so -rapid and the convulsions so slight, as to occasion no disorder in the -appearance of the body and the bed-clothes,—and I still likewise think, -that after swallowing so large a dose it was improbable she could have -performed all the successive acts of volition mentioned above—with -ordinary deliberation. But I am informed on good authority, that some -gentlemen interested in the case found by actual trial, that all the -acts alluded to might be accomplished, if gone about with promptitude, -within the short period, which, in some of their experiments, the -witnesses found to elapse, before the action of the poison commenced. -And such being the fact, we ought not perhaps to attach too great -importance to the other argument I have employed,—the probability of -disorder in the body and bed-clothes from the convulsions; for if the -poisoning commenced very soon, the convulsions might have been slight. -The results of my own experiments related in p. 582, although on the -whole confirmatory of those of Mr. Macaulay and his colleagues, are -nevertheless sufficient to prove that large doses occasionally do not -begin to operate with such rapidity as was observed in their -experiments; for in one instance four drops of concentrated acid, -equivalent to two scruples of medicinal acid, did not begin to act on a -rabbit for twenty seconds; and certainly, for so small an animal, two -scruples are as large a dose as five drachms for a grown-up girl. - -The two following cases will throw some farther light on the time within -which this poison begins to act on man when taken in large quantity. The -first case shows, that even when an enormous dose is taken, a few simple -voluntary acts may be executed before the symptoms begin. In this -instance which is related by Dr. Gierl of Lindau, the dose was no less -than four ounces of the acid of the Bavarian Pharmacopœia, which -contains four per cent. of pure acid, and is equivalent to five ounces -at least of that commonly used in Britain and France. The subject, an -apothecary’s assistant, was found dead in bed, with an empty two-ounce -phial on each side of the bed,—the mattrass, which is used in Germany -instead of blankets, pulled up as high as the breast,—the right arm -extended straight down beneath the mattrass,—and the left arm bent on -the elbow.[1906] The second case proves that, although one or two acts -of volition may be accomplished, the interval is so very brief that -these acts can only be of the simplest kind. An apothecary’s -apprentice-lad was sent from the shop to the cellar for some carbonate -of potass; but he had not been a few minutes away, when his companions -heard him cry in a voice of great alarm, “Hartshorn! Hartshorn!” On -instantly rushing down stairs, they found him reclining on the lower -steps and grasping the rail; and he had scarcely time to mutter “Prussic -acid!” when he expired,—not more than five minutes after leaving the -shop. On the floor of the cellar an ounce-phial was found, which had -been filled with the Bavarian hydrocyanic acid, but contained only a -drachm. It appeared that he had taken the acid ignorantly for an -experiment; and from the state of the articles in the cellar, it was -evident that, alarmed at its instantaneous operation, he had tried to -get at the ammonia, which he knew was the antidote, but had found the -tremendous activity of the poison would not allow him even to undo the -coverings of the bottle.[1907] - -When the quantity of the poison is small, a much longer interval may -elapse before the commencement of its action. Thus, when the dose is -barely short of what is required to occasion death, the effects may be -postponed even for fifteen minutes, as in a case which occurred to Mr. -Garson of Stromness.[1908] This, so far as I am at present aware, is the -extreme limit of interval hitherto observed. - -In the trial related above the prisoner Freeman was found _Not Guilty_. - -It is important to fix, if possible, the smallest fatal dose of -hydrocyanic acid. This will vary with particular circumstances, such as -the strength of the individual, and the fulness or emptiness of the -stomach at the time. The cases of the Parisian epileptics, who were -killed each by a draught containing two-thirds of a grain of pure -acid,[1909] will supply pointed information. For, on the one hand, -considering the long time they survived, it is not probable that a dose -materially less would have a fatal effect on man. And on the other hand -repeated instances of recovery have been observed, where the dose was as -great or even greater. Thus Dr. Geoghegan had a patient who recovered -from a state of extreme danger after taking two-thirds of a grain;[1910] -and Mr. Banks of Lowth met with a case of recovery in similar -circumstances, where the dose was very nearly a whole grain.[1911] - -It is almost unnecessary to add, that in man, as in animals, this poison -will act violently, through whatever channel it may be introduced into -the body. It has not been positively ascertained to act with force -through the unbroken skin. The chemist Scharinger indeed was supposed to -have been killed in consequence of accidentally spilling the acid on his -naked arm;[1912] but this was in all probability a mistake. Should the -skin be freely exposed to the air it seems reasonable to expect that the -poison will evaporate before it could act with energy; but if confined -by pledgets or otherwise, a different result might ensue. Through every -other surface, however, besides the unbroken skin, hydrocyanic acid acts -with very great power; and it is in particular important to remember -that its power is very great when inhaled, so that dangerous accidents -have ensued even from its vapour incautiously snuffed up the nostrils. I -have known a strong man suddenly struck down in this way; a French -physician, M. Damiron, has related the case of an apothecary who -remained insensible for half an hour subsequently to the same -accident;[1913] and cases of the kind are more apt to occur than might -at first view be thought, because, contrary to what is generally -believed and stated in chemical as well as medico-legal works, its smell -is for a few seconds barely perceptible, and never of the kind which -these accounts would lead one to anticipate. Accidental death may -readily arise from its action on a wound or an abraded surface. -Sobernheim mentions that Mr. Scharring, a druggist at Vienna, was -poisoned in consequence of a phial of the acid breaking in his hand and -wounding it; and he expired in an hour.[1914] - -The only case with which I am acquainted of poisoning with the -artificial compounds of hydrocyanic acid is that formerly alluded to as -having been occasioned by the cyanide of potassium. Six grains dissolved -in a clyster amounting to six ounces, occasioned general convulsions, -palpitations, slow laboured breathing, coldness of the limbs, dilated -pupil, fixing of the eyeballs, and death in one hour,—phenomena much the -same with those produced by the acid itself.[1915]—Another case has been -published, in which a French physician, ignorant of the correct dose, -prescribed a potion with three grains of cyanide of potassium twice a -day. Immediately after the first dose the patient was seized with the -usual symptoms of poisoning with hydrocyanic acid; and expired in -three-quarters of an hour.[1916] In noticing the first of these cases, -Orfila draws the attention of practitioners particularly to the fact, -that not long before a similar dose of a sample of cyanide, which had -been moist for some time, was twice administered with impunity. The -reason is that the cyanide of potassium undergoes decomposition when -acted on by water, or when long kept. - - - SECTION III.—_Of the Morbid Appearances produced by Hydrocyanic Acid._ - -Under this head the appearances in a special case will first be -mentioned, and then the varieties to which they are liable. - -In _Hufeland’s_ case [p. 587] the inspection was made the day after -death. The eyes were still glistening, like those of a person alive; but -the countenance was pale and composed like one asleep. The spine and -neck were stiff, the belly drawn in, the back alone livid. The body -generally, the blood even within the head, and especially the serous -cavities, exhaled a hydrocyanic odour, so strong as to irritate the -nostrils. The blood was every where very fluid, so that two pounds -flowed from the incision in the scalp and twelve ounces from that of the -dura mater; and it had a glimmering bluish appearance, as if Prussian -blue had been mixed with it. The vessels of the brain were gorged, the -substance of the brain natural, and the left ventricle distended with -half an ounce of serum. The villous coat of the stomach was red, easily -removed with the nail, and gangrenous.[1917] The intestines were -reddish, and the liver gorged. The lungs were also turgid, and to such a -degree in the depending parts as to resemble the liver. The arteries and -left cavities of the heart were empty, the veins and right cavities -distended. - -In commenting on this description it is first to be remarked, that the -blood, as in the preceding case, is generally altered in nature. Ittner, -who made some good experiments on the subject, found it in animals -black, viscid, and oily in consistence.[1918] Emmert found it fluid and -of a cochineal colour. In a case related by Mertzdorff of an -apothecary’s apprentice, who was found dead in bed after swallowing -three drachms and a half of diluted acid,[1919] in the case recorded in -Horn’s Archiv, and in that related by Dr. Gierl, it was fluid. It was -also perfectly fluid every where in the bodies of the seven epileptic -patients poisoned at Paris. Yet this state is not invariable. Coullon, -though his results tally in general with those of Ittner and Emmert, has -given some experiments in which the blood coagulated after flowing from -the body;[1920] and in the case of an apothecary related in Rust’s -Journal it was found coagulated in the heart.[1921] - -In the next place, Magendie and other physiologists have observed that, -as in Hufeland’s case, the blood and cavities of the body in animals -exhale a hydrocyanic odour, even though the quantity taken was small. -The blood did so likewise in the heart of the apothecary just mentioned -as well as throughout the whole body in the case described in Horn’s -Journal. The odour, however, is not always present. For example, there -was none in the case of another German apothecary, who poisoned himself -with an ounce, as recorded in a later volume of Rust’s Journal;[1922] -neither was there any odour in the blood in Mertzdorff’s case, although -it was strong in the stomach; nor in the blood nor any other part of the -body in the Parisian epileptics. It also appears from an experiment by -Schubarth,[1923] and from a case by Leuret where life was prolonged -above fifteen minutes,[1924]—that the odour may be distinct in the -blood, brain, or chest, when hardly any is to be perceived in the -stomach. Schubarth has inquired with some care into the circumstances -under which the hydrocyanic odour may, or may not, be expected. He -states, as the result of his researches, that if the dose is sufficient -to cause death within ten minutes, the peculiar odour will always be -remarked in the blood of the heart, lungs, and great vessels, provided -the body have not been exposed to rain or to a current of air, and the -examination be made within a moderate interval,—for example, twenty-one -hours for so small an animal as a dog; but that, if the dose is so small -that life is prolonged for fifteen, twenty-seven, or thirty-two minutes, -then even immediately after death it may be impossible to remark any of -the peculiar odour, evidently because, as already mentioned, the acid is -rapidly discharged by the lungs; and that even when the dose is large -enough to cause death in four minutes, the smell may not be perceived if -the carcase has been left in a spacious apartment for two days, or -exposed to a shower for a few hours only. These facts explain -satisfactorily why no odour could be perceived in the bodies of the -Parisian epileptics; for they lived from half an hour to forty-five -minutes. The poison may exist in the stomach, though not appreciable by -the sense of smell. In Chevallier’s case mentioned above, the contents -of the stomach had not any odour of hydrocyanic acid; which, however, -was evident to the sense of smell, and plainly indicated by various -tests, in the fluid obtained by distilling the contents. - -The presence of this odour in the blood may be accounted strong evidence -of poisoning with hydrocyanic acid, if it is unequivocal to the sense of -several individuals. An exhalation of the same kind is occasionally -formed by natural processes in the excrement. Itard once remarked in a -case of inflammation of the intestines, and again in a case of inflamed -liver, a strong smell of bitter almonds in the fæces, although no -medicine containing hydrocyanic acid had been given.[1925] Mr. Taylor -mentions that he once observed a sort of hydrocyanic odour in the brain -of a person who died of natural disease.[1926] These facts will render -the inspector cautious, but can scarcely throw a doubt over evidence -derived from an unequivocal hydrocyanic odour in the blood. - -Few successful attempts have yet been made to detect the acid in the -blood by chemical analysis. The odour may be present, although chemical -analysis fails in eliciting any indication. This follows from the -observations of Dr. Lonsdale,[1927] as well as of various authors quoted -by him in his paper. The cyanide of potassium has been detected by Mayer -not merely in the blood, but likewise in the serous secretions and -sundry soft solids.[1928] - -In most instances,—for example, in the Parisian epileptics, the state of -the brain, as to turgescence of vessels, has corresponded with the -description given by Hufeland. Venous turgescence and emptiness of the -arterial system are commonly remarked throughout the whole body. Thus in -the epileptic patients, the heart and great arteries were empty; the -great veins gorged; the spleen gorged, soft, and pultaceous; the veins -of the liver gorged; and the kidneys of a deep violet colour, much -softened, and their veins gorged with black blood. - -It is impossible that hydrocyanic acid could cause gangrene of the -stomach, which is said to have been witnessed in Hufeland’s case. But -there are often signs of irritation in that organ. The villous coat has -been found red in animals; it was shrivelled, and its vessels were -turgid with black blood in the instance of the apothecary mentioned in -the fourteenth volume of Rust’s Journal; in Mertzdorff’s case it was red -and checkered with bloody streaks; and in the case related by Dr. Gierl, -where four ounces were swallowed, it was dark-red, as it were tanned or -steeped in spirits, and easily separated from the subjacent contents. -The contents of the stomach have in every instance had a strong -hydrocyanic odour, except in the cases of the Parisian epileptics, and -in those related by Leuret and by Chevallier. According to the -experiments of Lassaigne and Schubarth, formerly noticed, it is not to -be looked for when the body has been kept a few days, more especially if -the individual lived some time. Dr. Lonsdale generally found it eight or -nine days after death in animals, which had been either buried during -that time, or kept in an apartment at the temperature of 50° F.[1929] In -a case which occurred not long ago in London the poison was found in the -stomach five days after death. A coroner’s inquest had terminated in a -verdict of natural death. But suspicions having arisen, that the man had -poisoned himself in anticipation of a charge of forgery, another inquiry -was made; when the odour of hydrocyanic acid was evolved from the -contents of the stomach, and the distilled water obtained from them -yielded decisive chemical evidence of its being present.[1930] It is -important to observe, in reference to the evidence of hydrocyanic acid -in the stomach, that here, as in the instance of the blood, the odour -may be strong, and yet the poison may not be discoverable by analysis. -This fact rests on the united testimony of Coullon, Vauquelin, Leuret, -Turner, and Dr. Lonsdale; the last of whom mentions that he could not -detect it chemically after the fourth day in the bodies of some animals, -in which it was perceptible by its odour even four or five days -later.[1931] It is possible, however, that these failures to detect the -poison by analysis may have sometimes arisen from imperfections in the -method of analysis employed; for it was detected by the process formerly -mentioned in the stomach of the apothecary last alluded to, in -Chevallier’s case, though not perceptible to the smell, and frequently -by Lassaigne in animals. - -Mertzdorff remarked both in his case of poisoning with hydrocyanic acid, -and likewise in a parallel instance of poisoning with the essential oil -of bitter almonds,[1932] a singular appearance in the bile, the colour -of which was altered to deep blue. - -Coullon and Emmert say they have observed, that the bodies of animals -resist putrefaction. The latter in particular mentions, that he had left -them several days in a warm room without perceiving any sign of decay. -This certainly would not _à priori_ be expected, considering the state -of the blood. And it is not universal; for in one instance, the case of -Mertzdorff, putrefaction commenced within thirty hours after death. In -the Parisian epileptics, the bodies passed through the usual stage of -rigidity. - -It appears that even long after death the eye, as in Hufeland’s case, -has a peculiar glistening and staring expression, so as to render it -difficult to believe that the individual is really dead; and this -appearance has been considered by Dr. Paris so remarkable, as even alone -to supply “decisive evidence of poisoning by hydrocyanic acid.”[1933] -But the accuracy of this opinion may be questioned. The appearance is -indeed very general in cases of poisoning with preparations containing -hydrocyanic acid. Besides occurring in the case of Hufeland, and in that -which gave occasion to Dr. Paris’s statement, it was witnessed by -Mertzdorff, and in the instance described in Horn’s Journal. But it is -not a constant appearance; for it was not observed in the seven Parisian -epileptics. Neither is it peculiar; for death from carbonic acid has the -same effect; I have remarked it six hours after death in a woman who -died of cholera; and it has been observed in cases of death during the -epileptic paroxysm. - - - SECTION IV.—_Of the Treatment of Poisoning with Hydrocyanic Acid._ - -Much attention has been lately paid to the treatment of this variety of -poisoning; and the object of those who have studied it has naturally -been the discovery of an antidote. - -An antidote to hydrocyanic acid must either be a substance which renders -it immediately insoluble, or one which exerts upon the body an action -contrary to that excited by the poison, that is, a powerful stimulant -action on the nervous system. Hence all such remedies as oil, milk, -soap, coffee, treacle, turpentine, at one time thought serviceable, are -quite inert.[1934] - -Antidotes have hitherto been chiefly sought for among the powerful, -diffusible stimulants. And it is plain, that even although a chemical -antidote were known, a stimulant antidote is indispensable also, because -the mischief done, before the poison can be rendered inert, is generally -sufficient to cause death, unless counteracted by treatment. - -Of the diffusible stimulants, _ammonia_ is considered by many the most -energetic antidote. The first who made careful experiments with it was -Mr. John Murray of London; and he was so convinced of its efficacy, that -he expressed himself ready to swallow a dose of the acid large enough to -prove fatal, provided a skilful person were beside him to administer the -antidote.[1935] The favourable results obtained by Murray were -afterwards confirmed by M. Dupuy.[1936] Afterwards, however, the -efficacy of ammonia was called in question. Orfila stated in the third -edition of his Toxicology that he had several times satisfied himself of -the complete inutility of this as well as many other antidotes.[1937] -And Dr. Herbst of Göttingen made some careful experiments, from which he -concludes that ammonia, though useful when the dose of poison is not -large enough to kill, and even capable of making an animal that has -taken a fatal dose jump up and run about for a little, yet will never -save its life.[1938] But farther experiments by Orfila have led him to -modify his former statement, and to admit, that, although liquid ammonia -is of no use when introduced into the stomach, yet if the vapour from it -is inhaled, life may sometimes be preserved, provided the dose of the -poison be not large enough to act with great rapidity. He remarked, that -when from eight to fourteen drops of the medicinal acid were given to -dogs of various sizes, they died in the course of fifteen minutes if -left without assistance, but were sometimes saved by being made to -inhale ammoniacal water, and recovered completely in little more than an -hour.[1939] As this is very nearly the conclusion to which Mr. Murray -was led by his experiments performed in 1822, it is rather -extraordinary, that his name, as the undoubted discoverer of the remedy, -has never been mentioned by the Parisian Professor. Buchner, it is right -to add, had found this remedy useful in the same year in which Mr. -Murray’s experiments were made.[1940] A gentleman who took an over-dose -of two drachms of hydrocyanic acid while using it medicinally, and who -seems to have been in great danger, owed his recovery to the assiduous -use of carbonate of ammonia held to the nostrils, and spirit of ammonia -internally. Relief was obtained immediately.[1941] Orfila suggests an -important caution,—not to use a strong ammoniacal liquor, otherwise the -mouth, air-passages, and even the alimentary canal may be attacked with -inflammation,—as indeed happened to the French physician whose case was -formerly mentioned. The strong _aqua ammoniæ_ should be diluted with -several parts of water. - -Another remedy of the same kind with ammonia as to action is _chlorine_. -This substance was first proposed as a remedy in 1822 by Riauz, a -chemist of Ulm, who found that, when a pigeon, poisoned with hydrocyanic -acid, was on the point of expiring, it immediately began to revive, on -being made to breathe chlorine, and in fifteen minutes was able to fly -away.[1942] Buchner repeated Riauz’s experiments and arrived at the same -results. More lately M. Simeon, apothecary to the hospital of St. Louis -at Paris, apparently without being acquainted with the observations of -the German chemists, was likewise led to suppose, that this gas might -prove a useful antidote;[1943] and MM. Cottereau and Vallette have -formed the same conclusion.[1944] Orfila in his paper already quoted -expresses his conviction, that this remedy is the most powerful antidote -of all hitherto proposed. His experiments have convinced him, that -animals, which have taken a dose of poison sufficient to kill them in -fifteen or eighteen minutes, will be saved by inspiring water -impregnated with a fourth part of its volume of chlorine, even although -the application of the remedy be delayed till the poison has operated -for four or five minutes. In some of his experiments he waited till the -convulsive stage of the poisoning was passed, and the stage of -flaccidity and insensibility had supervened; yet the animals were -obviously out of danger ten minutes after the chlorine was first -applied, and recovered entirely in three-quarters of an hour.[1945] - -The last remedy of this nature which deserves notice is the _cold -affusion_. This was first recommended by Dr. Herbst of Göttingen, who, -on account of the success he witnessed from it in animals, considers it -the best remedy yet proposed. When the dose of the poison was -insufficient to prove fatal in ordinary circumstances, two affusions he -found commonly sufficient to dispel every unpleasant symptom. When the -dose was larger, it was necessary to repeat the effusion more -frequently. Its efficacy was always most certain when resorted to before -the convulsive stage of the poisoning was over; yet even in the stage of -insensibility and paralysis it was sometimes employed with success. In -the latter instance the first sign of amendment was renewal of the -spasms of the muscles. Many experiments are related by the author in -support of these statements. But the most decisive is the following. Two -poodles of the same size being selected, hydrocyanic acid was given to -one of them in repeated small doses till it died. The whole quantity -administered being seven grains of Ittner’s acid, this dose was given at -once to the other dog. Immediately it fell down in convulsions, violent -opisthotonos ensued, and in half a minute the convulsive stage was -followed by flaccidity, imperceptible respiration, and failing pulse. -The cold affusion was immediately resorted to, but at first without any -amendment. After the second affusion, however, the opisthotonos -returned, and was accompanied by cries; and on the remedy being repeated -every fifteen minutes, the breathing gradually became easier and easier, -the spasms abated, and in a few hours the animal was quite well.[1946] -Professor Orfila repeated Dr. Herbst’s experiments, with analogous -results; but he considers the cold affusion inferior to -chlorine.[1947]—It is probably advantageous to apply the cold water -rather in the form of cold douche to the head and spine than to the body -at large. Dr. Robinson of Sunderland found that rabbits, which had taken -doses adequate to occasion death, might be saved by pouring on the -hindhead and along the spine cold water impregnated with common salt and -nitre.[1948] A case, which seems to have been cured in this way, has -been published by Mr. Banks of Lowth. A young woman took by mistake a -solution containing very nearly a grain of real acid, and immediately -became insensible and convulsed. Ordinary stimulants were of no use. But -in fifteen minutes, when the convulsions had ceased, and she lay in a -state of complete coma and general paralysis, the cold douche on the -head first renewed the convulsions, then strengthened the pulse and -restored some appearance of consciousness, and finally roused her, so -that in a few hours she was quite well.[1949] - -It is probable, that _bleeding from the jugular vein_ deserves more -attention as a remedy than it has yet received. The right side of the -heart is almost invariably found much gorged with blood in animals -examined at the moment of death; and the contractions of the heart, in -such circumstances imperfect or arrested altogether, have often been -observed by experimentalists to be instantly restored on promptly -removing the state of turgescence. Accordingly Dr. Cormack found that a -dog, at the point of death after receiving a fatal dose of the acid, was -speedily roused and eventually saved by bleeding from the jugular -vein.[1950] And in a careful inquiry by Dr. Lonsdale, it was ascertained -that the turgescence of the heart might be effectually diminished in -this way, and that recovery might frequently be accomplished when the -poison was otherwise amply sufficient to have occasioned speedy -death.[1951] In a case treated by Magendie, that of a young lady -poisoned by too large a medicinal dose, the chief remedies were ammonia -and blood-letting from the jugular vein; and she recovered.[1952] - -Few observations have hitherto been made on the chemical antidotes for -hydrocyanic acid, or those substances which render it innoxious by -converting it into an insoluble compound. It is plain that several -probable antidotes of this kind exist. But toxicologists have been -apparently deterred from trying them by the fearful rapidity with which -the poison acts, and the consequent improbability that in practice any -such antidote can be administered in time. It has lately been shown, -however, by Messrs. T. and H. Smith of this city, that the effects of a -fatal dose may be warded off by the timely administration of the -reagents necessary for converting the acid into Prussian blue. They -found that if a solution of carbonate of potash followed by a solution -of the mixed sulphates of iron be given to animals very soon after the -administration of a dose of thirty drops of the Edinburgh medicinal -acid, containing three per cent. of real acid, recovery in general takes -place, and sometimes little inconvenience seems to be sustained. The -solutions they used were one of 144 grains of carbonate of potash in two -ounces of water, and another composed of a drachm and a half of sulphate -of protoxide of iron, together with two drachms of the same salt -converted into sulphate of sesquioxide by means of sulphuric and nitric -acids in the usual way. About 52 minims of each of these solutions will -remove the whole acid contained in 100 grains of the Edinburgh medicinal -acid; but for certainty, three or four times as much should be -used,—which may be done with perfect safety.[1953] - -On the whole, then, it appears that the proper treatment of a case of -poisoning with hydrocyanic acid consists in the cold affusion applied to -the head and spine, the inhalation of diluted ammonia or chlorine, -venesection at the jugular vein, and the administration of carbonate of -potash and the mixed sulphates of iron, if aid has been obtained in good -time. - -It is right to remember, however, that on account of the dreadful -rapidity of this variety of poisoning, it will rarely be in the -physician’s power to resort to any treatment soon enough for -success;—and farther, that his chance of success must generally be -feeble even though the case be taken in time, because when hydrocyanic -acid is swallowed by man, the dose is commonly so large as not to be -counteracted by any remedies. - - - _On the Vegetable Substances which contain Hydrocyanic Acid._ - -Hydrocyanic acid exists in several plants; which are consequently -poisonous. I have considered it advisable to describe their effects -separately from those of the pure acid. - -The plants which have been thoroughly examined and found to yield it -belong chiefly to the division _Drupaceæ_, of Decandolle’s Natural -Family the _Rosaceæ_. These are the bitter almond, cherry-laurel, -bird-cherry, and peach. The leaves and seeds of the nectarine and -apricot, and the seeds of the plum and cherry, have the same taste with -these four, and therefore will certainly be found to contain the acid -also. The same inference may be drawn from the taste of some pomaceous -seeds; and accordingly I have obtained a hydrocyanated oil from the -seeds of the New York pippin, and those of the white-beam-tree, the -_Pyrus aria_. The poison procured from these sources exists in two -forms,—as a distilled water, and as an essential oil. Further, the acid -has been discovered to constitute the active poison of the juice of the -_Janipha manihot_, or bitter cassava [see p. 457]. - -The distilled waters yield hydrocyanic acid, as is shown by the blue -precipitate they give with potass and the mixed sulphates of iron. They -have a powerful, peculiar, grateful odour, which is usually likened to -that of pure hydrocyanic acid. But the smell really bears very little -resemblance to that of hydrocyanic acid, and is not owing to its -presence: the odour remains equally strong after the acid is thrown down -by the test now mentioned. The active part of the distilled water may be -separated in the form of a volatile oil. This is colourless at first, -afterwards yellowish or reddish, acrid, bitter, heavier than water, and -very volatile. The essential oil of the bitter almond has been carefully -examined by various chemists. Vogel, by subjecting it twice to -distillation from caustic potass, procured hydrocyanate of potass in the -residue; and a volatile oil was distilled over, which no longer -contained hydrocyanic acid, but nevertheless had the odour of the -original oil.[1954] This purified oil he considered equally poisonous -with that which contains hydrocyanic acid, a single drop of it having -killed a sparrow; and his opinion was confirmed by the experiments of -Professor Orfila. But according to some careful experiments by -Stange,[1955] which have been amply confirmed by Dr. Göppert of -Breslau,[1956] and also by MM. Robiquet and Boutron-Charlard,[1957]—if -the purified oil retains active poisonous properties, this must be owing -to the acid not having been entirely removed. Göppert in particular -remarked that twenty-five drops of the purified bitter-almond oil, -cherry-laurel oil, or bird-cherry oil had very little effect on rabbits, -not more indeed than the same quantity of the common essential oils. The -purified oil, according to all these chemists, possesses the odour of -the original oil, as Vogel first stated. - - - _Of the Bitter Almond._ - -The bitter almond was once extensively used in medicine, and is still -much employed by confectioners for flavouring puddings, sweetmeats, and -liqueurs. It is the kernel of the fruit of the _Amygdalus communis_. -This species has two varieties, the _dulcis_ and the _amara_; which -differ from one another in the fruit only. The fruit of the former -yields the sweet, and of the latter the bitter almond. The bitter almond -is the smaller of the two. The two plants, according to Murray, are -convertible into each other,—the sweet variety becoming bitter by -neglect,—the bitter becoming sweet by cultivation, or certain modes of -management not well known,—and the seed of either variety producing -plants of both.[1958] These statements as to the mutual convertibility -of the two varieties require confirmation. - -The bitter almond depends for its activity on the essential oil, which -is common to all the vegetable poisons belonging to the present tribe. -According to the researches of Robiquet and Boutron-Charlard, followed -up by Liebig, the oil does not, like common essential oils, exist ready -formed in the almond, but is only produced when the almond-pulp comes in -contact with water. It cannot be separated by any process whatever from -the almond without the co-operation of water,—neither, for example, by -pressing out the fixed oil, nor by the action of ether, nor by the -action of absolute alcohol. After the almond is exhausted by ether, the -remaining pulp gives the essential oil as soon as it is moistened; but -if it is also exhausted by alcohol, the essential oil is entirely lost. -The reason is that alcohol dissolves out a peculiar crystalline -principle, named amygdalin, which, with the co-operation of water, forms -the essential oil by reacting on a variety of the albuminous principle -in the almond, called emulsion or synoptase. - -In some respects, therefore, the essential oil of almonds is quite -peculiar in its nature, and quite different from the common essential or -volatile oils.—The presence of hydrocyanic acid in it is easily proved -by dissolving it with agitation in water, and treating the solution with -caustic potass, followed by the mixed sulphates of iron and sulphuric -acid.—The quantity of essential oil which may be procured from the -bitter almond amounts, according to Krüger of Rostock, to four drachms -from five pounds or a ninety-sixth part.[1959] The quantity of -hydrocyanic acid in the oil varies considerably: Schrader got from an -old sample 8·5 per cent., from a new sample 10·75;[1960] but Göppert got -from another specimen so much as 14·33 per cent.[1961] - -_Effects on Animals._—The bitter almond is a powerful poison, which acts -in the same way as hydrocyanic acid, but likewise excites at times -vomiting and other signs of irritation. The first good experiments on it -are those related in Wepfer’s treatise on the Cicuta; but its properties -seem to have been known even to Dioscorides. The symptoms it induces in -animals are trembling, weakness, palsy, convulsions, often of the -tetanic kind, and finally coma. But frequently it occasions vomiting -before these symptoms begin, and the animal in that way may -escape.[1962] According to Orfila, twenty almonds will kill a dog in six -hours by the stomach if the gullet be tied; and six will kill it in four -days when applied to a wound.[1963] - -The essential oil is not much inferior in activity to the pure -hydrocyanic acid. A single drop of it applied by Sir B. Brodie on the -tongue of a cat caused violent convulsions and death in five -minutes.[1964] But more generally a larger dose, or about seven drops, -has been found necessary to kill a middle-sized dog. Five drops, -according to Göppert, will kill a rabbit in six minutes. When entirely -freed of hydrocyanic acid, it becomes, as already mentioned, not more -poisonous than common volatile oils. - -_Symptoms in Man._—The effects of the almond and of the oil upon man are -equally striking with those of hydrocyanic acid. - -In small doses the bitter almond produces disorder of the digestive -organs, nausea, vomiting, and sometimes diarrhœa. These symptoms are -occasionally brought on by the small quantities used for flavouring -sweetmeats, if the confectioner has not been careful in compounding -them. Virey says that accidents occasionally happen to children at Paris -from their eating freely of macaroons, which are sometimes too strongly -flavoured with the bitter almond.[1965] In this country accidents from -the same cause may be with justice apprehended, as confectioners now -generally use, not the bitter almond, but its essential oil, which is -distilled for the purpose in London, and sold in the druggists shops -under the name of peach-nut oil. Göppert suggests that this oil ought to -be freed of its hydrocyanic acid by repeated distillation with caustic -potassa, because the flavour is not in the least injured by the process, -while its activity as a poison is greatly lessened. - -In peculiar constitutions the minutest quantity, even a single almond, -will cause a state resembling intoxication, succeeded by an eruption -like nettle-rash. The late Dr. Gregory was subject to be affected in -this way. Other vegetable bitters had the same effect on him, but none -so remarkably as bitter almonds. They caused first sickness, generally -tremors, then vomiting, next a hot fit with an eruption of urticaria, -particularly on the upper part of the body. At the same time the face, -and head swelled very much, and there was generally a feeling like -intoxication. The symptoms lasted only for a few hours. The rash did not -alternately appear and disappear as in common nettle-rash.[1966] A lady -of my acquaintance is liable to be attacked with urticaria even from -eating the sweet almond. - -The quantity of bitter almonds which may be eaten with impunity is -unknown; but Wibmer mentions an experimentalist who took half an ounce -without any other effect besides headache and sickness.[1967] Two cases -of death in the human subject from eating them have been quoted by -Coullon from the Journal de Médecine of Montpellier. One is a doubtful -case, but the other is unequivocal. A bath-woman gave her child the -“expressed juice” of a handful of bitter almonds to cure worms. The -child, who was four years old, was immediately attacked with colic, -swelling of the belly, giddiness, locked jaw, frothing at the mouth, -general convulsions, and insensibility, and died in two hours.[1968] -Murray, however, asserts in his Apparatus Medicaminum that the expressed -juice is sweet and not poisonous.[1969] But this apparent contradiction -is easily explained by referring to the chemical relations of the -almond,—the oil expressed without water being free from essential oil, -while the milky fluid expressed from the pulp beat up with water is -strongly impregnated with it.—Another case was published not long ago by -Mr. Kennedy of London; but the symptoms were imperfectly ascertained. -The person, a stout labourer, appeared to have eaten a great quantity of -bitter almonds, which were subsequently found in the stomach. He was -seen to drop down while standing near a wall; soon after which the -surgeon who was sent for found him quite insensible, with the pulse -imperceptible, and the breath exhaling the odour of bitter almonds; and -death took place in no long time.[1970] - -Coullon has noticed many other instances where alarming symptoms were -produced by this poison, but were dissipated by the supervention of -spontaneous vomiting. - -The effects of small doses of the oil have been tried by Sir B. Brodie -on himself; and a fatal case of poisoning with it has been recorded by -Mertzdorff. In the course of his experiments Sir B. Brodie once happened -to touch his tongue with the end of a glass rod which happened to be -dipped in the oil; and he says he had scarcely done so before he felt an -uneasy, indescribable feeling in the pit of the stomach, great -feebleness of his limbs, and loss of power to direct the muscles, so -that he could hardly keep himself from falling. These sensations were -quite momentary.[1971] - -Mertzdorff’s case is interesting, not only as being accurately related, -but likewise on account of the exact resemblance of the symptoms to -those observed in the celebrated case of Sir Theodosius Boughton, which -will presently be mentioned. A hypochondriacal gentleman, 48 years old, -swallowed two drachms of the essential oil. A few minutes afterwards, -his servant, whom he sent for, found him lying in bed, with his features -spasmodically contracted, his eyes fixed, staring, and turned upwards, -and his chest heaving convulsively and hurriedly. A physician, who -entered the room twenty minutes after the draught had been taken, found -him quite insensible, the pupils immoveable, the breathing stertorous -and slow, the pulse feeble and only 30 in a minute, and the breath -strongly impregnated with the odour of bitter almonds, death ensued ten -minutes afterwards.[1972] A fatal case occurred lately in London, where -the individual, intending to compound a nostrum for worms with beech-nut -oil, got by mistake from the druggist peach-nut oil, which is nothing -else than the oil of bitter almond.—A singular case of recovery from a -very large dose of this poison has been lately published by M. Chevasse. -A shopkeeper, who swallowed half an ounce by mistake for spirit of -nitric ether, had an attack of spontaneous vomiting, which was forthwith -encouraged by sulphate of zinc. He nevertheless became pale and -convulsed; the pulse disappeared; and delirious muttering ensued, with -_risus sardonicus_, sparkling of the eyes, and panting respiration. -Recovery, however, took place under the use of brandy and ammonia.[1973] - -The morbid appearances are the same as in poisoning with the pure acid. -In Mertzdorff’s case the whole blood and body emitted a smell of -almonds; putrefaction had begun, though the inspection was made -twenty-nine hours after death; the blood throughout was fluid, and -flowed from the nostrils and mouth; the veins were every where turgid; -the cerebral vessels gorged; the stomach and intestines very red.—In the -case from the Medical and Physical Journal of poisoning with the almond -itself, the vessels of the brain were much gorged, and the eyes -glistening and staring as if the person had been alive. - - - _Of the Cherry-Laurel._ - -The cherry-laurel, or _Cerasus lauro-cerasus_, was at one time much used -for flavouring liqueurs and sweetmeats. But it is now less employed than -formerly, as fatal accidents have happened from its having been used in -too large quantity. The custom, however, has not been altogether -abandoned; for there is an account in an English newspaper in 1823 of -two persons killed by ratifia’d brandy, which had been flavoured with -this plant; and Dr. Paris has mentioned an instance of several children -at an English boarding-school having been dangerously affected by a -custard flavoured with the leaves.[1974] Almost every part of the plant -is poisonous, especially the leaves and kernels; but the pulp of the -cherry is not. The flower has a totally different odour from the leaves. -The healthy vigorous shoots in the early part of summer, and the inner -bark, both then and in autumn, smell strongly of the bitter almond when -broken across. The kernels of the seeds have a strong taste of bitter -almonds.—The plant yields a distilled water and an essential oil, which -Robiquet found to have all the chemical properties of the oil of bitter -almond.[1975]—A very peculiar source of danger in using the leaves of -this plant, for imparting a ratafia flavour to sweetmeats and liqueurs, -is that the proportion of oil varies excessively according to the age of -the leaf. It abounds most in the young undeveloped leaves, and -diminishes gradually afterwards. Hence, the leaves being evergreen and -outliving more than two summers, the young leaves in May or June -contain, as I have found, nearly ten times as much oil as the old ones -at the same moment. - -Cherry-laurel oil, according to Schrader, contains 7·66 per cent. of -hydrocyanic acid;[1976] but according to Göppert, a specimen supposed to -be genuine gave only 2·75 per cent.[1977] It is probably therefore a -weaker poison than the oil of bitter almond. The latest experiments made -with this oil are those of some Florentine physicians, performed at the -laboratory of the Marquess Rodolphi, and described by Professor -Taddei.[1978] Sixteen drops put on the tongue of rabbits killed them in -nine, fifteen, or twenty minutes; and ten or twelve drops injected in -oil into the anus killed them in four minutes. The symptoms were slow -breathing, palsy of the hind-legs, then general convulsions; and death -was preceded by complete coma. A very extraordinary appearance was found -in the dead body,—blood extravasated abundantly in the trachea and -lungs. - -The cherry-laurel water, prepared by distillation from the leaves of -this plant, was long the most important of the poisons which contain the -hydrocyanic acid, as it was the most common before the introduction of -the acid itself into medical practice. Water dissolves by agitation 3·25 -grains of oil per ounce; which may be considered the proportion in a -saturated distilled water. The water contains, according to Schubarth, -only 0·25 per cent. of hydrocyanic acid;[1979] according to -Schrader[1980] only half as much; and by long keeping even that small -proportion will gradually disappear, as I have ascertained by -experiment. Hence its strength must vary greatly,—a fact which will -explain the very different effects of the same dose in different -instances. - -From experiments on animals by a great number of observers, it appears -that, whether it is introduced into the stomach, or into the anus, or -into the cellular tissue, or directly into a vein, it occasions -giddiness, palsy, insensibility, convulsions, coma, and speedy -death;—that the tetanic state brought on by the pure acid, is not always -so distinctly caused by cherry-laurel water;—and that tetanus is most -frequently induced by medium doses. - -The attention of physicians was first called to this poison by an -account, published by Dr. Madden in the Philosophical Transactions for -1737, of several accidents which occurred at Dublin in consequence of -strong ratifia’d brandy having been prepared with it. Foderé has also -given an account of two cases, caused by servants having stolen and -drunk a bottle of it, which they mistook for a cordial.[1981] Being -afraid of detection, they swallowed it quickly, and in a few minutes -expired in convulsions. Murray has noticed several others in his -Apparatus Medicaminum.[1982] In most of these cases the individuals -suddenly lost their speech, fell down insensible, and died in a few -minutes. Convulsions do not appear to have been frequent. Coullon has -also related an instance where a child seems to have been killed by the -leaves applied to a large sore on the neck.[1983] - -The dose required to occasion these effects, and more especially to -prove fatal, has not been determined with care. It must vary with the -age of the sample used. It will vary also according as the water has -been filtered or not; for what is not filtered often presents -undissolved oil suspended in it or floating on its surface. One ounce -has proved fatal;[1984] and half an ounce has caused only temporary -giddiness, loss of power over the limbs, stupor, and sense of pressure -in the stomach.[1985] - -The appearances found in the dead body have varied. In general the blood -has been fluid. The smell of bitter almond has commonly been distinct in -the stomach. - -The cherry-laurel water has attracted much attention in this country, in -consequence of being the poison used by Captain Donnellan for the murder -of Sir Theodosius Boughton. The trial of Donnellan, the most important -trial for poisoning which ever took place in Britain, has given rise to -some discrepance of opinion both among barristers and medical men, as to -the sufficiency of the evidence by which the prisoner was -condemned.[1986] For my part, taking into account the general, as well -as medical circumstances of the case, I do not entertain a doubt of his -guilt. - -Leaving the general evidence out of view, however, as foreign to the -objects of the medical jurist’s regard, it must be admitted that the -medical evidence, taken by itself, was defective. It may be summed up -shortly in the following terms:—Sir Theodosius was a young man of the -age of twenty, and in perfect health, except that he had a slight -venereal complaint of old standing, for which he occasionally took a -laxative draught. On the morning of his death, his mother, Lady -Boughton, remarked, while giving him his draught, that it had a strong -smell of bitter almonds. Two minutes after he took it, she observed a -rattling or gurgling in his stomach; in ten minutes more he seemed -inclined to doze; and five minutes afterwards she found him quite -insensible, with the eyes fixed upwards, the teeth locked, froth running -out of his mouth, and a great heaving at his stomach and gurgling in his -throat. He died within half an hour after swallowing the draught. The -body was examined ten days after death, and the inspectors found great -congestion of the veins every where, gorging of the lungs, and redness -of the stomach. But the examination was unskilfully conducted. For the -head was not opened; the fæces were allowed to rush from the intestines -into the stomach; and, as a great quantity of fluid blood was found in -each cavity of the chest, the subclavian veins must have been divided -during the separation of the clavicles. Very little reliance, therefore, -can be placed in the evidence from the inspection of the body.[1987] - -On comparing these particulars with what has been said above regarding -the effects of hydrocyanic acid and this whole genus of poisons, it will -be seen that every circumstance coincides precisely with the supposition -of poisoning with the cherry-laurel water. The symptoms were exactly the -same as in Mertzdoff’s case of poisoning with the essential oil of -almonds (p. 604). When to this are added, the smell of the draught, -which Lady Boughton could hardly mistake, the rarity of apoplexy in so -young and healthy a person as Sir Theodosius, and the improbability of -either that or any other disease of the head proving fatal so -quickly,—the conclusion at which, in my opinion, every sound medical -jurist must arrive is, that poisoning in the way supposed was very -probable. But I cannot go along with those who think that it was -certain; nor is it possible to see on what grounds such an opinion can -be founded, when the general or moral circumstances are excluded. - -The medical evidence in Donnellan’s case has been much canvassed, and -especially that of Mr. John Hunter. It would be foreign to the plan -hitherto pursued in this work to analyze and review what was said by him -and his brethren. But I must frankly observe, that Mr. Hunter’s evidence -does him very little credit, and that his high professional eminence is -the reverse of a reason for palliating his errors, or treating them with -the lenity which they have experienced from his numerous critics. - - - _Of the Peach, Cluster-Cherry, Mountain-Ash, &c._ - -Little need be said of the other plants formerly mentioned among those -which yield hydrocyanic acid, and act on the system in consequence of -containing that substance. - -The _Amygdalus persica_ or peach is the most active of them. Most parts -of the plant exhale the odour of the bitter-almond, but particularly the -flowers and kernels. According to the chemical researches of M. -Gauthier, the fresh young shoots of the peach collected in July contain, -weight for weight, even more essential oil than the bitter almond, or -cherry-laurel leaves; for 250 grains yielded nearly five grains of it or -two per cent.; and he found the oil may be easily procured by distilling -the shoots without addition till the product begins to pass over -clear.[1988] The kernels of the peach, when distilled with water, yield -nearly one grain of hydrocyanic acid per ounce.[1989] - -Coullon has collected two instances of poisoning with the peach-blossom. -One is the case of an elderly gentleman, who swallowed a sallad of the -flower to purge himself. Soon afterwards he was seized with giddiness, -violent purging, convulsions, and stupor; and he died in three days. -Here the poison must have proved fatal by inducing true apoplexy in a -predisposed habit; at least poisoning with hydrocyanic acid never lasts -nearly so long. The other, a child eighteen months old, after taking a -decoction of the flowers to destroy worms, perished with frightful -convulsions, efforts to vomit, and bloody diarrhœa.[1990] The -peach-blossom would therefore appear to be rather a narcotico-acrid, -than a narcotic.—Peach-leaves are represented to have produced even -purely irritant effects. A man, who took a decoction of a handful boiled -in a quart of water down to a third,—when of course no hydrocyanic acid -could remain,—was attacked with tightness in the chest, a sense of -suffocation, violent colic, pain in the stomach and frequent desire to -vomit, followed by a hard pulse, restlessness, and flushing of the face. -But he recovered slowly under the use of fomentations and opiates.[1991] - -The bark of the _Prunus padus_, or cluster-cherry, a native of this -country, owes its poisonous qualities to the same substance as the -preceding plants. Heumann found that the distilled water obtained from -two ounces of bark in March contains two grains of acid, two ounces of -developed leaves half a grain, and two ounces of the seed a trifle -less.[1992] Its distilled water has the odour of bitter almonds, -contains the same essential oil with that of the bitter almond, and -yields more hydrocyanic acid than the cherry-laurel water.[1993] The -oil, according to Schrader, contains 9·25[1994] per cent. of hydrocyanic -acid, according to Göppert only 5·5 per cent.[1995] Bremer, who has -examined this plant with great care, found that both the distilled water -and the essential oil kill mice when put into the mouth, eye, nose, ear, -anus, or a wound; and that half an ounce of the water killed a dog in -twelve minutes.[1996] The fruit is also poisonous. It has a nauseous -taste, but communicates a pleasant flavour to spirituous liquors. The -kernels yield by expression a transparent, fixed oil, concrete at 41° -F., which contains a small quantity of the essential oil; and the cake -which is left yields so much of the latter, that, as we are informed by -M. Chancel of Briançon, a handful has proved fatal to cows in a short -time.[1997] In these kernels, as in the bitter almond, the essential oil -does not exist ready formed, but is developed only in consequence of the -contact of water; and hence, if the fixed oil by expression contains a -little of it, as Chancel says, this must arise from the kernels having -been moist when squeezed. - -The _Sorbus aucuparia_, mountain-ash, or Rowan-tree as it is called in -Scotland, has been lately added to the list of plants which abound in -the same poisonous principle. M. Grassmann of St Petersburgh has found -that many parts of this tree, such as the flowers and the bark of the -trunk and branches, contain more or less of the peculiar essential oil; -and that the root in particular contains so much in the month of May as -to smell strongly of it when broken across, and to yield a distilled -water which holds fully as much hydrocyanic acid as that procured from -an equal weight of cherry-laurel leaves.[1998] - -Several other plants of the same natural order possess similar though -weaker properties, such as the _Prunus avium_, or black-cherry, or -mazzard, the _Prunus insititia_, or bullace, the _Prunus spinosa_, or -sloe, the _Amygdalus nana_, or dwarf-almond, and even the leaves and -kernels of the common cherry, the _Cerasus communis_. Twelve ounces of -cherry kernels distilled with water, yield, according to Geiseler, seven -grains of hydrocyanic acid.[1999] I have no doubt, from my experiments, -that the seeds of _Pyrus malus_, the apple, _Pyrus aria_, the -white-beam, and also, if the taste may be taken for a criterion, the -whole seeds of the _Pomaceæ_, yield by distillation with water a large -quantity of hydrocyanic acid. - - - - - CHAPTER XXX. - OF POISONING WITH CARBAZOTIC ACID. - - -A substance long known to chemists by the name of indigo-bitter, which -is procured by the action of nitric acid on indigo, silk, and other -azotized substances, and which has been found to consist chiefly of a -peculiar acid, termed by Liebig, from its composition, the carbazotic -acid, appears to be a pure narcotic poison of considerable -activity.[2000] It is in the form of shining crystals, of an excessively -bitter taste, and of a yellow colour so singularly intense that it -imparts a perceptible tint to a million parts of water. The pure -crystals are composed of carbon, azote, and oxygen. - -The only account I have seen of the physiological properties of this -substance is a full analysis by Buchner in his Toxicology, of some -interesting experiments by Professor Rapp of Tübingen.[2001] He found -that sixteen grains in solution, when introduced into the stomach, -killed a fox, ten grains a dog, and five grains a rabbit, in an hour and -a half; that the injection of a watery solution into the windpipe -occasioned death in a few minutes; that the introduction of it into the -cavity of the pleura or peritonæum occasioned death in several hours; -that a watery solution of ten grains injected into the jugular vein of a -fox killed it instantaneously, and in like manner five grains affected a -dog in three minutes and killed it in twenty-four hours; and that thirty -grains applied to a wound killed a rabbit. The symptoms remarked from -its introduction into the stomach of the fox were in half an hour -tremors, grinding of the teeth, constant contortion of the eyes and -convulsions, in an hour complete insensibility, and death in half an -hour more. In the dog there was also remarked an attack of vomiting and -feebleness of the pulse. - -In the dead body no particular alteration of structure was remarked. The -heart, examined immediately after death from the introduction of the -poison into the stomach, was found much gorged and motionless; but the -irritability of the voluntary muscles remained. The stomach was not -inflamed, but dyed yellow. A very interesting appearance was dyeing of -various textures and fluids throughout the body. In the fox killed by -swallowing sixteen grains the conjunctiva of the eyes, the aqueous -humour, the capsule of the lens, the membranes of the arteries, in a -less degree those of the veins, the lungs, and in many places the -cellular tissue, had acquired a lemon-yellow colour. The dog killed in -the same manner presented similar appearances, also those killed by -injection of the poison into the pleura or peritonæum; and in the latter -animals the urine was tinged yellow. In a rabbit killed by the -application of the poison to a wound the same discoloration was also -every where remarked, together with yellowness of the fibrin of the -blood. But no yellowness could be seen any where in the dog, which died -in twenty-four hours after receiving five grains into the jugular vein. -In no instance was there any yellow tint perceptible in the brain or -spinal cord. - -These facts form an interesting addition to the physiology of poisons. -They supply unequivocal proof that this substance is absorbed in the -course of its operation, and furnish strong presumption that other -poisons, which act on organs remote from the place where they are -applied, and which have been sought for without success in the blood, as -well as in other fluids and solids throughout the body, have not been -detected, merely because the physiologist does not possess such simple -and extremely delicate means of searching for them. - -The researches of Professor Rapp have been arranged under the title of -carbazotic acid, because this acid forms the most prominent substance in -the matter with which his experiments appear to have been made. But it -is right to state, that the article actually used was, if I understand -correctly the abstract given by Buchner, not the pure crystals, but the -yellow fluid, from which the crystals are procured, and which contains -also a resinous matter and artificial tannin.—The bitter principle of -Welther produced by the action of nitric acid on silk, and that formed -by Braconnot by the action of the same acid on aloes, appear to be -impure carbazotic acid. - - - - - CHAPTER XXXI. - OF THE POISONOUS GASES. - - -The subject of the poisonous gases is one of great importance in -relation to medical police, as well as medical jurisprudence. They are -objects of interest to the medical jurist, because their effects may be -mistaken for those of criminal violence, and because they have even been -resorted to for committing suicide. They are interesting as a topic of -medical police, since some trades expose the workmen to their influence. - -It has hitherto been chiefly on the continent that use has been made of -the deleterious gases for the purpose of self-destruction. Osiander -mentions, that Lebrun, a famous player on the horn, suffocated himself -at Paris in 1809 with the fumes of sulphur; and that an apothecary at -Pyrmont killed himself by going into the _Grotto del Cane_ there, which, -like that near Naples, is filled with carbonic acid gas.[2002] Many -instances have lately occurred in France of suicide caused by the -emanations from burning charcoal in a close chamber. - -But these poisons come under the notice of the medical jurist chiefly -because their effects may be mistaken for those of other kinds of -violent death. Several mistakes of this nature are on record. Zacchias -mentions the case of a man, who was found dead in prison under -circumstances which led to the suspicion, that he had been privately -strangled by the governor. But Zacchias proved this to be impossible, -and ascribed death to the fumes from a choffer of burning charcoal left -in the room.[2003] A more striking instance of the kind occurred a few -years ago at London. A woman, who inhabited a room with other five -people, alarmed the neighbours one morning with the intelligence that -all her fellow-lodgers were dead. On entering the room they found two -men and two women actually dead, and another man quite insensible and -apparently dying. This man, however, recovered; and as it was said that -he was too intimate with the woman who gave the alarm, a report was -spread that she had poisoned the rest, to get rid of the man’s wife, one -of the sufferers. She was accordingly put in prison, various articles in -the house were carefully analysed for poison, and an account of the -supposed barbarous murder was hawked about the streets. At last the man -who recovered remembered having put a choffer of coals between the two -beds, which held the whole six people; and the chamber having no vent, -they had thus been all suffocated.[2004]—The following is a similar -accident not less remarkable in its circumstances. Four people in -_Gerolzhofen_ in Bavaria, were found one morning in bed, some dead, -others comatose; and only one recovered. A neighbour who had supped with -them, but slept at home, did not suffer. The stomach and intestines were -found very red and black; and the coats of the stomach brittle. The -contents of the stomach, the remains of their supper, and the wine were -analysed without any suspicious substance being found. A little smoke -having been noticed in the room by those who first entered it, the stove -and fuel were examined, but without furnishing any insight into the -cause of the accident. At last the cellar was examined, and then it was -found that one of the sufferers had heated a copper vessel there so -incautiously, that the fire communicated with the unplastered planks of -the floor above. The planks had burnt with a low smothered flame, and -the vapours passed through the crevices in the floor.[2005] - - - _What Irrespirable Gases are Poisonous?_ - -Some gases act negatively on the animal system by preventing the access -of respirable air to the lungs; others are positively poisonous. The -first point, therefore, is to ascertain which are negatively, and which -positively hurtful. - -M. Nysten, who has made the most connected train of experiments on this -subject, conceived that a gas will not act through any other channel -besides the lungs, if it exerts merely a negative action:—and that, on -the contrary, it certainly possesses a direct and positive power, if it -has nearly the same effects, in whatever way it is introduced into the -body.[2006] He therefore thought the best way to ascertain the action of -the gases would be, to inject them into the blood,—conceiving that, -after allowance is made for the mere mechanical effects of an aëriform -body, the phenomena would point out the true operation of each. - -His first object then was to learn what phenomena are caused by the -mechanical action of atmospheric air. He found that four cubic inches -and a half, injected into the jugular vein of a dog, killed it -immediately amidst tetanic convulsions, by distending the heart with -frothy blood;—that a larger quantity introduced, gradually caused more -lingering death, with symptoms of oppressed breathing, which arose from -gorging of the lungs with frothy blood;—and that a small quantity, -injected into the carotid artery towards the brain, occasioned speedy -death by apoplexy, which arose from the brain being deprived by means of -the air of a due supply of its proper stimulus, the blood. Numerous -experimental inquiries have been since made on this subject, the latest -of which, those of Dr. Cormack, coincide with the first results of -Nysten, that air injected into the veins causes death by arrestment of -the action of the heart.[2007] - -Proceeding with these data, Nysten found that _oxygen_ and _azote_ had -the same effect when apart, as when united in the form of atmospheric -air; that _carburetted hydrogen_, _hydrogen_, _carbonic oxide_, and -_phosphuretted hydrogen_ likewise seemed to act in the same way; and -that the _nitrous oxide_, or intoxicating gas, although it does not -cause so much mechanical injury as the others, on account of its -superior solubility in the blood, has the same effect when injected in -sufficient quantity, and produces little or none of the symptoms of -intoxication excited by it in man.[2008] As to _carbonic acid gas_, he -found that, on account of its great solubility in the blood, it is -difficult to produce mechanical injury with it; that sixty-four cubic -inches are absorbed, and do not excite any particular symptoms; but that -when injected into the carotid artery, it occasions death by apoplexy, -although it is rapidly absorbed by the blood.[2009] - -The other gases he tried were hydrosulphuric acid, nitric oxide, ammonia -and chlorine; and all of these proved to be positively and highly -deleterious. - -Two or three cubic inches of _hydrosulphuric acid gas_ caused tetanus -and immediate death, when injected into the veins, although the gas was -at once absorbed by the blood. The same quantity acted with almost equal -rapidity when injected into the cavity of the chest. Similar results -were obtained when it was injected into the cellular tissue, or even -when it was left for some time in contact with the sound skin.[2010] The -last important fact has been since confirmed by Lebküchner in his Thesis -on the permeability of the tissues;[2011] and it had previously been -observed also by the late Professor Chaussier, whose experiments will be -mentioned presently (p. 617). In none of Nysten’s experiments with this -gas was the blood changed in appearance. - -_Nitric oxide gas_, according to Nysten, is the most energetic of all -the poisonous gases. A very small quantity causes death by tetanus, when -introduced into a vein, the cavity of the chest, or the cellular tissue; -and it always changes the state of the blood, giving it a -chocolate-brown colour, and preventing its coagulation. In one of -Nysten’s experiments a cubic inch and three-quarters injected into the -chest killed a little dog in 45 minutes.[2012] Dr. John Davy appears to -have found this gas not so active.[2013] - -Nysten found the two other gases, _ammonia_ and _chlorine_, to be acrid -in their action. When injected into the veins they kill by -over-stimulating the heart; and when injected into the cavity of the -chest, they excite inflammation in the lining membrane.[2014] Hébréart -farther remarked in his experiments relative to the action of irritants -on the windpipe, that chlorine when inspired, produces violent -inflammation in the windpipe and its great branches, ending in the -secretion of a pseudo-membrane like that of croup;[2015] and that a very -small quantity of ammonia has the same effect. - -From this abstract of Nysten’s researches, it appears to follow, that -ammonia and chlorine are irritants; hydrosulphuric acid and nitric -oxide, narcotics; oxygen, azote, hydrogen, carburetted hydrogen, -phosphuretted hydrogen, carbonic oxide, and nitrous oxide, negative -poisons; and carbonic acid, doubtful in its nature. Some of these -conclusions do not correspond with the effects observed in man; which -will presently be found to lead to the inference, that not only carbonic -acid, but likewise carbonic oxide, nitrous oxide, and carburetted -hydrogen are narcotics. The reason Nysten did not find these gases -injurious was probably, that, before they could pass from the vein into -which they were injected, to the brain on which they act, they were in a -great measure exhaled from the lungs. The experiments of physiologists -since Nysten’s time likewise tend to show that oxygen gas is a positive -poison when pure, and that even hydrogen possesses active properties. -The inquiries of Mr. Broughton led him to consider hydrogen a positive -poison, because animals die in it in half a minute, and the heart -immediately after death is found to have lost its contractility. -Previous experimentalists had also remarked hypnotic effects from the -inhalation of it diluted with oxygen.[2016] As to oxygen, the same -physiologist ascertained that when pure, it is a narcotic poison, though -a feeble one, as at least five hours of continuous respiration in the -pure gas are required to prove fatal.[2017] - - - _Of the Effects of the Poisonous Gases on Man._ - -According to the effects of the poisonous gases on man, they may be -arranged in two groups, the first including the _irritants_, the second -the _narcotics_. It might have been therefore a more philosophical mode -of arrangement, if the former had been considered under the irritant -class of poisons; but it is more convenient to examine the whole -deleterious gases together. - -The _irritant gases_ are nitric oxide gas and nitrous acid vapour, -hydrochloric acid gas, chlorine, ammonia, sulphurous acid, and some -others of little consequence. - -_Of Nitric oxide gas and Nitrous acid vapour._—Before nitric oxide gas -can be breathed in ordinary circumstances, it is transformed by the -oxygen of the air into nitrous acid vapour, of a ruddy colour and -irritating odour. Hébréart found that in animals killed by inhaling it -the windpipe was much inflamed.[2018] Sir H. Davy tried to inhale it, -and with this view took the precaution of previously breathing the -nitrous oxide or intoxicating gas, in order to expel the atmospheric air -as much as possible from his lungs. But he found that the small quantity -of nitrous acid fumes formed with the remaining air was sufficient to -cause a sense of burning in the throat, and at once stimulated the -glottis to contract, so that none of the nitric oxide gas could pass -into the larynx. The subsequent entrance of the external air into the -mouth, which Sir Humphrey unluckily had not provided for, was of course -attended by the immediate formation of more acid fumes, by which his -tongue, cheeks, and gums, were irritated and inflamed; and there is no -doubt, as Sir Humphrey himself remarks, that if he had succeeded in -inhaling the nitric oxide gas, the same chemical change would have -happened in the lungs and excited pneumonia.[2019] - -The following cases will prove that nitrous acid vapour, disengaged from -the fuming nitrous acid, is a very violent and dangerous poison when -inhaled. A chemical manufacturer, in endeavouring to remove from his -store-room a hamper in which some bottles of nitrous acid had burst, -breathed the fumes for some time, and was seized in four hours with -symptoms of inflammation in the throat and stomach. At night the urine -was suppressed; the skin then became blue; at last he was seized with -hiccup, acute pain in the diaphragm, convulsions, and delirium; and he -died twenty-seven hours after the accident.[2020] Another case has been -described in the Bulletins of the Medical Society of Emulation. It -proved fatal in two days, and the symptoms were those of violent -pneumonia. In this instance there was pneumonia of one side, and -pleurisy of the other; the uvula and throat were gangrenous, and the -windpipe and air-tubes dark-red; the veins throughout the whole body -were much congested, the skin very livid in many places, and the blood -fluid in the heart, but coagulated in the vessels.[2021] Dr. Reitz, a -writer in Henke’s Journal, met with two cases of death from the same -cause in hatters. They had incautiously exposed themselves too much to -the fumes, which are disengaged during the preparation of nitrate of -mercury for the operation of felting, and which are well known to be -nitric oxide gas converted into nitrous acid vapour by contact with the -air. Two men died of inflammation of the lungs excited in that manner; -and a third, a boy of fourteen, after sleeping all night in an apartment -where the mixture was effervescing, was attacked in the morning with -yellowness of the skin, giddiness, and colic, which ended fatally in six -days.[2022] - -_Of Poisoning with Chlorine._—The experiments of Nysten and Hébréart -with chlorine, and its well-known irritating effects when inhaled in the -minutest quantities, show that it will produce inflammation of the lungs -and air-passages. The following is the only instance of poisoning with -it in man which has come under my notice. A young man, after breathing -diluted chlorine as an experiment, was instantly seized with violent -irritation in the epiglottis, windpipe, and bronchial branches, cough, -tightness, and sense of pressure in the chest, inability to swallow, -great difficulty in breathing or articulating, discharge of mucus from -the mouth and nostrils, severe sneezing, swelling of the face, and -protrusion of the eyes. Ammonia was of no use; but singular relief was -obtained from the inhalation of a little sulphuretted hydrogen, so that -in an hour and a half he was tolerably well.[2023] - -Although this gas is very irritating to an unaccustomed person, yet by -the force of habit one may breathe with impunity an atmosphere much -loaded with it. I have been told by a chemical manufacturer at Belfast, -that his men can work in an atmosphere of chlorine, where he himself -could not remain above a few minutes. The chief consequences of habitual -exposure are acidity and other stomach complaints, which the men -generally correct by taking chalk. He has likewise observed that they -never become corpulent, and that corpulent men who become workmen are -soon reduced to an ordinary size. It is not probable, however, that the -trade is an unhealthy one; for several of this gentleman’s workmen have -lived to an advanced age; one man, who died not long ago at the age of -eighty, had been forty years in the manufactory; and I have seen in Mr. -Tenant’s manufactory at Glasgow a healthy-looking man who had been also -about forty years a workman there. It is an interesting fact, that -during the epidemic fever which raged over Ireland from 1816 to 1819, -the people at the manufactory at Belfast were exempt from it. - -_Of Poisoning with Ammonia._—For an account of the effects of _ammonia_, -which, when in the state of gas, acts violently as an irritant on the -mouth, windpipe, and lungs, the reader is referred to the chapter on -ammonia and its salts in page 193. It appears to form one of the gases -disengaged from the soil of necessaries, as will be noticed presently, -and excites inflammation in the eyes of workmen who are incautiously -exposed to it.[2024] - -_Of Poisoning with Hydrochloric Acid Gas._—I have not met with any -account of the effects of _hydrochloric acid gas_ on man. But no doubt -can be entertained that it will likewise act as a violent and pure -irritant. - -It is exceedingly hurtful to vegetable life. In the course of some -experiments performed in 1827 by Dr. Turner and myself on the effects of -various gases on plants, we found that a tenth of a cubic inch diluted -with 20,000 times its volume of air, so as to be quite imperceptible to -the nostrils, shrivelled and killed all the leaves of various plants, -which were exposed to it for twenty-four hours.[2025] These experiments -were repeated in 1832 by Messrs. Rogerson, apparently in ignorance of -them. Their results are on the whole the same; and the slighter effect -obtained by them from minute proportions of the gas was evidently owing -to the small size of their glass-jars not allowing them to use a -sufficient quantity of it.[2026] They farther found that proportions of -hydrochloric acid gas, amounting to a twentieth of the air, kill small -animals in half an hour with symptoms of obstructed respiration. Their -experiments with less proportions are not precise, yet warrant the -inference that even a thousandth part of the gas will probably prove -fatal in no long time.[2027] - -_Of Poisoning with Hydrosulphuric Acid Gas._—The _narcotic gases_ -are of much greater importance than the irritants, on account of -the singularity of their effects, and the greater frequency of -accidents with them. This group includes hydrosulphuric acid, -carburetted-hydrogen, carbonic acid, carbonic oxide, nitrous -oxide, cyanogen, and oxygen. - -Hydrosulphuric acid gas is probably the most deleterious of all the -gases. According to Thenard and Dupuytren, air containing only an 800th -of it will kill small birds in a few seconds; and a 290th is sufficient -to kill a dog; which, however, will sustain so much as a 400th.[2028] -Chaussier previously found, that a horse was killed by breathing -atmospheric air which contained a 250th of hydrosulphuric acid gas; and -that it acts with energy on animals, whether it be inhaled, or injected -into the stomach, anus, or cellular tissue, or even simply applied to -the skin. Nine quarts of the gas injected into the anus of a horse -killed it in one minute; and a rabbit, whose skin alone was exposed to -it, died in ten minutes.[2029] Ulterior inquiries by MM. -Parent-Duchâtelet and Gaultier de Claubry,—scarcely so precise however -as those of their predecessors,—appear to lead to the conclusion, that -its energy is in some circumstances not so great. While superintending -the clearing out of some of the choked drains of Paris, they found that -the workmen suffered no harm, though they habitually breathed an -atmosphere containing from 25 to 80 ten-thousandths of hydrosulphuric -acid gas, and on some occasions even so much as one per cent.; nay, on -one occasion Gaultier remained several minutes without injury, -collecting air for chemical analysis in an atmosphere, which proved to -be loaded with three per cent. of the gas.[2030] None of these -researches point out the precise manner of death. Dr. Percy of -Nottingham informs me he found in 1839, that dogs, which breathed air, -containing this gas, quickly died in convulsions like those caused by -hydrocyanic acid; that in some instances the heart’s action was observed -to have ceased, when the body was opened immediately after death; but -that in general it either continued to beat for some time, or could be -made to do so when its state of congestion was relieved by withdrawing a -little blood. - -Dr. Turner and I found that hydrosulphuric acid gas is very injurious to -vegetables, and that it acts differently from muriatic acid gas, as it -appeared to exhaust the vitality of plants and to cause in them a state -analogous to narcotic poisoning in animals. Four cubic inches and a -half, diluted with eighty volumes of air, caused drooping of the leaves -of a mignonette plant in twenty-four hours; and the plant, though then -removed into the open air, continued to droop till it bent over -altogether and died.[2031] - -The best description of the effects of this gas on man has been given by -M. Hallé,[2032] in his account of the nature and effects of the -exhalations from the pits of the Parisian necessaries; which exhalations -appear, from the experiments of Thenard and Dupuytren, to be mixtures -chiefly of ammonia and sulphuretted-hydrogen. The symptoms, in cases -where the vapours are breathed in a state of concentration, are sudden -weakness and all the signs of ordinary asphyxia. The individual becomes -suddenly weak and insensible; falls down; and either expires -immediately, or, if he is fortunate enough to be quickly extricated, he -may revive in no long time, the belly remaining tense and full for an -hour or upwards, and recovery being preceded by vomiting and hawking of -bloody froth.[2033] When the noxious emanations are less concentrated, -several affections have been noticed, which may be reduced to two -varieties, the one consisting of pure coma, the other of coma and -tetanic convulsions. In the comatose form, the workman seems to fall -gently asleep while at work, is roused with difficulty, and has no -recollection afterwards of what passed before the accident. The -convulsive form is sometimes preceded by noisy and restless delirium, -sometimes by sudden faintness, heaving or pain in the stomach, and pains -in the arms, and almost always by difficult breathing, from weakness in -the muscles of the chest. Insensibility, and a state resembling asphyxia -rapidly succeed, during which the pupil is fixed and dilated, the mouth -filled with white or bloody froth, the skin cold, and the pulse feeble -and irregular. At last convulsive efforts to breathe ensue; these are -followed by general tetanic spasms of the trunk and extremities; and if -the case is to prove fatal, which it may not do for two hours, a state -of calm and total insensibility precedes death for a short -interval.[2034] When the exposure has been too slight to cause serious -mischief, the individual is affected with sickness, colic, imperfectly -defined pains in the chest, and lethargy.[2035] - -The appearances in the bodies of persons killed by these emanations are -fluidity and blackness of the blood, a dark tint of all the internal -vascular organs, annihilation of the contractility of the muscles, more -or less redness of the bronchial tubes, and secretion of brown mucus -there as well as in the nostrils, gorging of the lungs, an odour -throughout the whole viscera like that of decayed fish, and a tendency -to early putrefaction.[2036] Chaussier in his experiments also remarked -in animals, that when a plate of silver or bit of white lead was thrust -under the skin it was blackened.[2037] Dr. Percy could not detect the -gas in the brain of animals killed by inhaling it. - -These extraordinary accidents may be occasioned not only by exposure to -the vapours from the _fosses_, but likewise by the incautious inhalation -of the vapours proceeding from the bodies of persons who have been -asphyxiated there. Sickness, colic, and pains in the chest, are often -caused in the latter mode; and Hallé has even given an instance of the -most violent form of the convulsive affection having originated in the -same manner.[2038] - -In order that the reader may comprehend the exact cause of these -accidents,—as it is not easy for an Englishman to comprehend how -suffocation may arise from the fumes of a privy,—it may be necessary to -explain, that in Paris the pipe of the privy terminates under ground in -a pit, which is usually contained in a small covered vault, or is at the -bottom of a small square tower open at the roof of the house; and that -the pit is often several feet long, wide and deep. Here the filth is -sometimes allowed to accumulate for a great length of time, till the pit -is full; and it is in the process of clearing it out that the workmen -are liable to suffer. Hallé has given an interesting narrative of an -attempt made to empty one of these pits in presence of the Duc. de -Rochefoucault, the Abbé Tessier, himself, and other members of the -Academy of Sciences, who were appointed by the French government to -examine into the merits of a pretended discovery for destroying the -noxious vapours. The pit chosen was ten feet and a half long, six wide, -and at least seven deep; and repeated attempts had been previously made -without success to empty it. For some time the process went on -prosperously; when at last one of the workmen dropped his bucket into -the pit. A ladder being procured, he immediately proceeded to descend, -and would not wait to be tied with ropes. “But hardly,” says Hallé, “had -he descended a few steps of the ladder, when he tumbled down without a -cry, and was overwhelmed in the ordure below, without making the -slightest effort to save himself. It was at first thought he had slipped -his foot, and another workman promptly offered to descend for him. This -man was secured with ropes in case of accident. But scarcely had he -descended far enough to have his whole person in the pit except his -head, when he uttered a suppressed cry, made a violent effort with his -chest, slipped from the ladder, and ceased to move or breathe. His head -hung down on his breast, the pulse was gone; and his complete state of -asphyxia was the affair of a moment. Another workman, descending with -the same precautions, fainted away in like manner, but was so promptly -withdrawn that the asphyxia was not complete, and he soon revived. At -last a stout young man, secured in the same way as the rest, also went -down a few steps. Finding himself seized like his companions, he -re-ascended to recover himself for a moment; and still not discouraged, -he resolved to go down again, and descended backwards, keeping his face -uppermost, so that he was able to search for his companion with a hook -and withdraw the body.” It was impossible to go on with the operation of -clearing out; and the pit was shut up again. The first workman never -showed any sign of life; the second recovered after discharging much -bloody froth; all the persons in the vault were more or less affected; -and a gentleman who, in trying to resuscitate the dead workman, -incautiously breathed the exhalations from his mouth, was immediately -and violently seized with the convulsive form of the affection.[2039] - -The same kind of accident has been observed at Paris in the vaults of -cemeteries, owing to the same cause,—the disengagement of hydrosulphuric -acid and hydrosulphate of ammonia during putrefaction. A remarkable -instance is related by Guérard.[2040] Analogous accidents have happened -in this country in clearing out drains. - -In none of the French investigations on this singular subject has any -allusion been made to the question, whether the health sustains any -injury from long-continued exposure to the gas in very minute -proportion. It is probably injurious however. At one time, while in the -practice of not using any precautions against inhaling the gas in -chemical researches, I used to remark that daily exposure to it in -minute quantity caused in a few weeks an extraordinary lassitude, -languor of the pulse, and defective appetite. Strohmeyer in the like -circumstances was liable to severe headache. Mr. Taylor says that the -workmen in the Thames Tunnel suffered severely for some time from a -similar exposure. Many of them became affected with giddiness, sickness, -general debility and emaciation, then with a low fever attended with -delirium, and in the course of a few months several died. No cause could -be discovered for their illness except the frequent escape of -sulphuretted-hydrogen from the roof. The affection only disappeared, -when the communication from bank to bank was completed, so that the -tunnel could be thoroughly ventilated.[2041] - -The presence of hydrosulphuric acid in all such emanations is best -proved by exposing to them a bit of filtering paper moistened with a -solution of lead. The smell alone must not be relied on, as putrescent -animal matter exhales an odour like that of hydrosulphuric acid, though -none be present. Workmen ought to be aware that hydrosulphuric acid may -be quickly fatal where lights burn with undiminished brilliancy; and -that in places where it is apt to accumulate, the degree of purity of -the air may vary so much in the course of working, as to be wholesome -only a few minutes before, as well as a few minutes after a fatal -accident.[2042] - -In the present place, some notice may be taken of an extraordinary -accident, which happened in 1831 near London. Great doubts may be -entertained whether hydrosulphuric acid was the cause of it; and while -these exist, it is not possible to arrange it under a proper head. It is -too important, however, in relation to Medical Jurisprudence, to be -omitted in this work; and I take the opportunity of mentioning it here, -as the accident was ascribed to hydrosulphuric acid by those who -witnessed it. - -In August, 1831, twenty-two boys living at a boarding-school at Clapham -were seized in the course of three or four hours with alarming symptoms -of violent irritation in the stomach and bowels, subsultus of the -muscles of the arms, and excessive prostration of strength. Another had -been similarly attacked three days before. This child died in -twenty-five, and one of the others in twenty-three hours. On examination -after death, the Peyerian glands of the intestines were found in the -former case enlarged, and as it were tuberculated; in the other there -were also ulcers of the mucous coat of the small intestines, and -softening of that coat in the colon. A suspicion of accidental poisoning -having naturally arisen, the various utensils and articles of food used -by the family were examined but without success. And the only -circumstance which appeared to explain the accident was, that two days -before the first child took ill, a foul cess-pool had been opened, and -the materials diffused over a garden adjoining to the children’s -play-ground. This was considered a sufficient cause of the disease by -Dr. Spurgin and Messrs. Angus and Saunders of Clapham, as well as by -Drs. Latham and Chambers, and Mr. Pearson of London, who personally -examined the whole particulars.[2043] Their explanation may be the only -rational account that can be given of the matter. But as no detail of -their chemical inquiries was ever published, their opinion cannot be -received with confidence by the medical jurist and the physician; since -it is not supported, so far as I am aware by any previous account of the -effects of hydrosulphuric acid gas. - -_Of Poisoning with Carburetted Hydrogen._—Of the several species of -carburetted hydrogen gas it is probable that all are more or less -narcotic; but they are much inferior in energy to sulphuretted hydrogen. - -Sir H. Davy found that when he breathed a mixture of two parts of air -and three of carburetted hydrogen, procured from the decomposition of -water by red-hot charcoal, he was attacked with giddiness, headache, and -transient weakness of the limbs. When he breathed it pure, the first -inspiration caused a sense of numbness in the muscles of the chest; the -second caused an overpowering sense of oppression in the breast, and -insensibility to external objects; during the third he seemed sinking -into annihilation, and the mouthpiece dropped out of his hand. On -becoming again sensible, which happened in less than a minute, he -continued for some time to suffer from a feeling of impending -suffocation, extreme exhaustion, and great feebleness of the pulse. -Throughout the rest of the day he was affected with weakness, giddiness -and rending headache.[2044] These experiments show that the gas is -deleterious. Yet Nysten found it inert when injected into the veins, and -what is more to the point, colliers breathe the air of coal mines -without apparent injury when strongly impregnated with it. - -The mixed gases of coal-gas or oil-gas appear likewise to be inert when -considerably diluted; for gas-men breathe with impunity an atmosphere -considerably loaded with them; and in the course of some researches on -the illuminating power and best mode of burning these gases, Dr. Turner -and myself daily, for two months, breathed air strongly impregnated with -them, but never remarked any unpleasant effect whatever. - -It would seem, however, from several accidents in France and England, -that when the impregnation is carried a certain length, poisonous -effects may ensue; and that the symptoms then induced are purely -narcotic. The first case, which occurred at Paris in 1830, has been -related by M. Devergie. In consequence of a leak in the service-pipe -which supplied a warehouse, five individuals who slept in the house were -attacked during the night with stupor; and if one of them had not been -awakened by the smell and alarmed the rest, it is probable that all -would have perished. As it was, one man was found completely comatose -and occasionally convulsed, with froth issuing from the mouth, -occasional vomiting, stertorous respiration, and dilated pupils. Some -temporary amendment was procured by blood-letting, but the breathing -continued laborious, and he expired about nine hours after the party -went to bed, and six hours after the alarm was given. On dissection the -vessels of the brain were found much gorged, the blood in the heart and -great vessels firmly coagulated, one of the lungs congested, and its -bronchial tube blocked up by a kidney bean. The immediate cause of death -in this case is therefore doubtful.[2045] A similar set of cases -happened at Leeds in 1838. An old woman and her grand-daughter were -found dead in bed one morning at nine o’clock, ten hours and a half -after they had been seen alive and well. The air of the apartment was -loaded with coal-gas from a leak in a street-pipe ten feet from the -bedroom. One body was cold and stiff when found, and the other became -rigid very soon. The attitude and expression were calm, the integuments -pale, the cerebral membranes natural, the brain itself turgid, and its -ventricles distended, in the case of the girl, with an ounce and a half -of serosity, the lungs congested, the alimentary mucous membrane red, -and the blood every where fluid, and unusually florid, even in the right -side of the heart.[2046] Another accident of the same kind, which proved -fatal to five individuals, occurred at Strasbourg in 1841. Four were -found dead, another survived twenty-four hours after the accident was -discovered, and a sixth recovered. It appears from the statement of this -person, that the first symptoms were headache and giddiness, then nausea -and vomiting, afterwards confusion of ideas, and at length -insensibility. General prostration, partial palsy, coma, and convulsions -were the leading symptoms after the accident was observed. In the four -people found dead the most remarkable appearances were cerebral -congestion, redness of the bronchial membrane, accumulation of bloody, -frothy mucus in the air tubes, scarlet redness of the lungs, coagulation -and darkness of the blood. In the person who was found alive, but did -not recover, there was no cerebral congestion, gorging of the air tubes, -or redness of the lungs. Professor Tourdes, who reports these cases, -ascertained that air containing a fiftieth of coal-gas kills rabbits in -twelve or fourteen minutes, and that even a thirtieth proves fatal, -though slowly. The gas which caused the accident, and which was prepared -from a mixture of water and slate coal, consisted of 22·5 per cent. -light carburetted hydrogen, 6·0 bicarburetted hydrogen, 21·9 carbonic -oxide, 31 hydrogen, 14 azote, and 4·6 carbonic acid; and by experiment -the author found that the most energetic of these gases as a poison is -the carbonic oxide, and that the action of the two carburetted-hydrogens -is quite feeble.[2047] It is somewhat remarkable that no such accident -has ever happened in Edinburgh, where nevertheless coal-gas is more used -for purposes of illumination in private houses than in any other city. -The fine quality of the gas,—for it contains a mere trace of carbonic -acid, and probably less than four per cent. of carbonic oxide,—may be -the reason why accidents are not occasioned by it. It is a singular -fact, however, that the powerful odour of the gas, when it accidentally -escapes in the night-time, generally awakes very soon those who are -exposed to inhale it. - -_Of Poisoning with Carbonic Acid Gas._—Carbonic acid gas is the most -important of the deleterious gases; for it is the daily source of fatal -accidents. It is extricated in great quantity from burning fuel; it is -given out abundantly in the calcining of lime; it is disengaged in a -state of considerable purity in brew-houses by the fermentation of beer; -it is often met with in mines and caverns, particularly in coal-pits and -draw-wells; it may collect in apartments where fuel is burnt without a -proper outlet for the vitiated air, or where persons are crowded too -much for the capacity of the room. Hence many have been killed by -descending incautiously into draw-wells, by falling into beer-vats, and -by sleeping before the traps of lime-kilns, or in apartments without -vents and heated by choffers. Instances have even occurred of the same -accident from sleeping in greenhouses during the night, when plants -exhale much carbonic acid; and some dreadful cases have occurred of -suffocation from confinement in small crowded rooms. - -Physiologists, as already remarked, are not quite agreed as to the -action of carbonic acid gas,—whether it is a positive poison, or simply -an asphyxiating gas. But in my opinion reasons enough exist for -believing that it is positively and energetically poisonous. This is -perhaps shown by its effects being much more rapidly produced, and much -more slowly and imperfectly removed, than asphyxia from immersion in -hydrogen or azote.[2048] Thus immersion for twenty-five seconds in an -atmosphere of carbonic acid gas has been found sufficient to kill an -animal outright; and fifteen seconds will kill a small bird.[2049] But -it is more unequivocally established by the three following facts: - -In the first place, if, instead of the nitrogen contained in atmospheric -air, carbonic acid gas be mixed with oxygen in the same proportion, -animals cannot breathe this atmosphere for two minutes without being -seized with symptoms of poisoning.[2050] Even a much less proportion has -the same effect. Five per cent. in the air will affect small birds in -two minutes, and kill them in half an hour.[2051] Persons have become -apoplectic in an atmosphere of carbonic acid gas, which to those who -entered it appeared at first quite respirable.[2052] - -Secondly, Professor Rolando of Turin having found that the land tortoise -sustained little injury when the great air-tube of one lung was tied,—he -contrived to make it breathe carbonic acid gas with one lung, while -atmospheric air was inhaled by the other; and he remarked that death -took place in a few hours.[2053] - -Thirdly, the symptoms caused by inhaling the gas may be also produced by -applying it to the inner membrane of the stomach or to the skin. On the -one hand aërated water has been known to cause giddiness or even -intoxication when drunk too freely at first;[2054] and the sparkling -wines probably owe their rapid intoxicating power to the carbonic acid -they contain. And, on the other hand, M. Collard de Martigny has found -that, if the human body be enclosed in an atmosphere of the gas, due -precautions being taken to preserve the free access of common air to the -lungs, the usual symptoms of poisoning with carbonic acid are produced, -such as weight in the head, obscurity of sight, pain in the temples, -ringing in the ears, giddiness, and an undefinable feeling of terror; -and that if the same experiment be made on animals and continued long -enough, death will be the consequence.[2055] - -When a man attempts to inhale pure carbonic acid gas, for example by -putting the face over the edge of a beer-vat, or the nose into a jar -containing chalk and weak muriatic acid, the nostrils and throat are -irritated so strongly, that the glottis closes and inspiration becomes -impossible. Sir H. Davy in making this experiment, farther remarked, -that the gas causes an acid taste in the mouth and throat, and a sense -of burning in the uvula.[2056] I have remarked the same effects from -very pure gas disengaged by tartaric acid from carbonate of soda. Hence, -when a person is immersed in the gas nearly or perfectly pure, as in a -beer-vat, or old well, he dies at once of suffocation. - -The effects are very different when the gas is considerably diluted; for -the symptoms then resemble apoplexy. As they differ somewhat according -to the source from which the gas is derived, and the admixtures -consequently breathed along with it, it will be necessary to notice -separately the effects of the pure gas diluted with air,—of the -emanations from burning charcoal, tallow, and coal,—and finally of air -vitiated by the breath. - -1. M. Chomel of Paris has related a case of poisoning with the gas -diluted with air, in the person of a labourer, who was suddenly immersed -in it at the bottom of a well, and remained there three-quarters of an -hour. He was first affected with violent and irregular convulsions of -the whole body and perfect insensibility, afterwards with fits of spasm -like tetanus; and during the second day, when these symptoms had gone -off, he continued to be affected with dumbness.[2057]—It is worthy of -particular remark that, contrary to general belief, these effects may be -produced in situations where the air is not sufficiently impure to -extinguish lights. Thus M. Collard de Martigny relates the case of a -servant, who, on entering a cellar where grape-juice was fermenting, -became suddenly giddy, and, under a vague impression of terror, fled -from the place, dropping her candle on the floor and shutting the door -behind her. She fell down insensible outside the door, and those who -went to her assistance found on opening the door that the light -continued to burn.[2058]—Mr. Taylor indeed has since ascertained that a -candle will burn in air, which contains ten, or even twelve per cent. of -carbonic acid,[2059]—a proportion more than sufficient to cause -poisoning in no long time. It is also important to observe, that, -contrary to what would be expected from the statements of Sir H. Davy -and other experimentalists on the effects of the pure gas, it will often -happen that no odour or taste is perceived. M. Bonami, in an account of -an accident which happened at Nantes to two workmen who descended an old -well, says that the first while descending uttered a piercing cry and -fell down; and that as soon as his comrade, who tried to rescue him, was -lowered ten or twelve feet, he felt as if he was about to be suffocated -for want of breath, but perceived no strong or disagreeable smell.[2060] -It should be remembered therefore by workmen, that there may be danger -in descending pits where none is indicated by the sense of smell, or by -the extinguishing of a light. - -2. The fumes of burning charcoal have been long known to be deleterious. -The early symptoms caused by them have been little noticed; for, as this -variety of poisoning generally occurs during sleep, the patient is -seldom seen till the symptoms are fully formed. In an attempt at -self-destruction described in a French journal, the first effects were -slight oppression, then violent palpitation, next confusion of ideas, -and at last insensibility.[2061] Tightness in the temples, and an -undefinable sense of alarm have also been remarked;[2062] and others -have, on the contrary, experienced a pleasing sensation that seduced -them to remain on the fatal spot.[2063] The best account of the -incipient symptoms has been given by Mr. Coathupe of Wraxhall, in an -account of an experiment he made with Joyce’s stove,—a preposterous -invention, the fuel of which was supposed by the inventor to burn -without contaminating the air, although it was neither more nor less -than prepared charcoal. Having closed every aperture in a room of the -capacity of eighty cubic yards, Mr. Coathupe kindled the stove and -watched the results. In four hours he had slight giddiness, in five -hours and a half intense giddiness, the desire to vomit without the -power, excessive prostration and incapability of muscular effort, a -frequent full throbbing pulse, a sense of distention of the cerebral -arteries, agonizing headache, chiefly in the hindhead, but no sense of -suffocation. At this time he experienced great difficulty in opening the -window and removing the stove; and in seven hours, when his wife entered -the room, he was unable to tell what was the matter, although quite -conscious of all that was passing. He then slowly recovered.[2064] A -similar account has also been given by Mr. Chapman of Tooting of the -effects of this notorious stove. A young gentleman, after being only one -hour in a chamber heated by it, felt first slight giddiness and -headache, and afterwards violent pain in the head and tightness round -the forehead and temples; the pupils became excessively dilated and -nearly insensible; there was constant ringing in the ears, a feeble -frequent pulse, paleness of the features and lividity of the lips and -hands, coldness of the extremities, laborious irregular breathing, and -extreme prostration. A temporary relief, obtained by stimulants, was -succeeded by violence; which, however, was subdued by blood-letting; and -he recovered.[2065] A set of cases, 70 in number, similar to the last -two, but milder, occurred in January, 1836, in the church of Downham in -Norfolk, which was heated by two of these stoves.[2066] - -The following abstract of a case by Dr. Babington will convey an -accurate idea of the advanced symptoms. The waiter of a tavern and a -little boy, on going to bed, left a choffer of charcoal burning beside -it; and next morning were found insensible. The boy died immediately -after they were discovered. The waiter had stertorous breathing, livid -lips, flushing of the face, and a full, strong pulse; for which -affections he was bled to ten ounces. When Dr. Babington first saw him, -however, the pulse had become feeble, the breathing imperfect, and the -limbs cold; the muscles were powerless but twitched with slight -convulsions, the sensibility gone, the face pale, the eyelids closed, -the eyes prominent and rolling, the tongue swollen and the jaw locked -upon it, and there was a great flow of saliva from the mouth. The -employment of galvanism at this time caused an evident amendment in -every symptom. But it was soon abandoned; because each time it was -applied, the excitement was rapidly followed by corresponding -depression. Cold water was then dashed upon him, ammonia rubbed on his -chest, and oxygen thrown into the lungs; through which means a warm -perspiration was brought out, and his state rapidly improved. He was -nearly lost, however, during the subsequent night by hemorrhage from the -divided vein; but next day he was so well that he could even speak a -little. For two days afterwards the left side of the face was paralyzed, -and his mental faculties were somewhat disordered.[2067]—In such cases -as this the stupor is generally very deep. There is a case in a French -Journal of a girl, who, after remaining some time in a small close -chamber heated by a charcoal choffer, fell down insensible, remained in -that state for three hours, and found, on recovering from her lethargy, -that the choffer had fallen, and burnt the skin and subjacent fat of the -thighs to a cinder.[2068] - -Occasionally the stage of stupor is followed, as in some other varieties -of narcotic poisoning, by a stage of delirium, at times of the furious -kind, or by a state resembling somnambulism.[2069] It does not follow -that recovery is certain because coma has thus given place to -delirium,—an alteration, which in most varieties of narcotic poisoning -is considered a sure sign of recovery. Collard de Martigny has related a -case which eventually proved fatal, notwithstanding this sign of -improvement.[2070] - -The narcotism induced by breathing charcoal fumes often lasts a -considerable length of time,—much longer indeed than the effects of -other narcotic poisons. This will appear sufficiently from the case -described by Dr. Babington. One of the people, mentioned at the -commencement of this chapter as having been suffocated at Gerolzhofen, -lingered five days in a state of coma before he expired. - -Commonly in cases of recovery, there is found to have been no -consciousness of any thing going on around, or recollection of what -passed subsequently to the first impressions of poisoning. The reverse, -however, occurred in Mr. Coathupe’s experiment; and a similar instance -has been published, where the individual, though apparently insensible, -knew when the room was first entered by strangers, and heard them call -him by name and bid him put out his tongue, and stretch forth his -arm,—without, however, his having the power to answer, or in any way to -express the consciousness of understanding them.[2071] - -Poisoning with charcoal vapour has become a subject of great importance -in French medical jurisprudence, partly on account of the frequency with -which it is resorted to for the purpose of committing suicide, and -partly because repeated attempts have been made to conceal murder by -arranging matters so as to present the appearances of suicide. M. -Devergie says, that in the years 1834 and 1835 no fewer than 360 cases -of poisoning with charcoal-vapour occurred in Paris, of which nearly -four-fifths proved fatal; and he has given the particulars of two -attempts to conceal murder under the appearance of death from this -cause.[2072] - -The subject has therefore been carefully examined by various authors, -but by none so successfully as by M. Devergie; of whose important -researches the following is a brief analysis. - -In stating the various sources whence charcoal-vapour may become -incidentally the cause of death, he dwells particularly on the risk of -its admission from adjoining vents, even in other houses from that where -the accidents happen,—because there may be currents in the apartment -which occasion back-draught. Three remarkable cases of this kind, very -obscure in their origin, have been related by M. d’Arcet.[2073] - -The very discrepant effects of the poison on different individuals, -simultaneously and to appearance alike exposed to it, have usually been -explained by reference to the great density of the gas, which -consequently accumulates near the floor. Some, however, have doubted the -fact that the gas is unequally diffused. Mr. Taylor in particular says -he ascertained by analysis, that air collected above and below a choffer -of burning charcoal was equally contaminated, that what was collected a -foot above its level contained 4·65 per cent., and that another portion -taken the same distance below it contained 4·5 of carbonic acid.[2074] -M. Devergie has discovered the source of these discrepant opinions. He -has found,[2075] that, notwithstanding the high density of carbonic acid -gas, the currents caused by the heat, disengaged when charcoal is burnt -in a room, without an issue for the products of combustion, produce an -equable mixture of gases at all elevations in the apartment, provided -the air be examined while still warm, and not long after the charcoal -has burnt out; but that, at a later period, such as twelve hours, the -carbonic acid partly separates and sinks, so that, while the air at the -top contains only a 78th, that near the floor contains four times as -much, or a 19th of carbonic acid gas. - -Disputes have also arisen as to the precise nature of the emanations -from burning charcoal,—some believing that carbonic acid is alone -discharged in such quantity as to prove injurious, and is singly -sufficient to account for the effects which have been observed,—while -others maintain that carbonic oxide, carburetted-hydrogen, or some -peculiar pyrogenous vapour, may be also formed, and prove the real cause -of the active properties of the vapour. According to the researches of -Orfila, charcoal in a state of vivid ignition emits carbonic acid only, -a hundred parts of the consumed air having been ascertained by him to be -composed of 42 azote, 46 common air, and 12 carbonic acid. But when the -combustion is low, a hundred parts consist of 52 azote, 20 common air, -14 carbonic acid, and 14 carburetted-hydrogen; so that not only is the -air more thoroughly consumed; but likewise an additional poisonous gas -is brought into action.[2076] The difference thus indicated has been -supposed to account for what is often observed in countries where -charcoal choffers are much in use for warming close apartments,—namely, -that the practice is attended with most danger when the combustion is -low, and that it is unsafe to close the doors of an apartment till the -fuel is in a state of vivid ignition. M. Guérard again maintains, that -when the supply of air is incomplete and combustion low, carbonic oxide -gas is formed in considerable quantity; and that this gas, confessedly a -much more powerful narcotic than carbonic acid, is probably the cause of -many cases of poisoning with charcoal fumes.[2077] M. Devergie doubts -the exactness of Orfila’s experiments on this head, but gives no new -analysis. He observes that charcoal-vapour gives the air of a room a -peculiar odour and bluish misty appearance, the latter of which slowly -diminishes, and in twelve hours disappears; and that possibly there may -be both a little carbonic oxide and carburetted-hydrogen in the air. But -nevertheless he is of opinion that the carbonic acid alone is adequate -to occasion all the effects observed in man or animals.[2078] Professor -Hünefeld is of a different opinion, and has supplied the most -satisfactory explanation of the important fact, that charcoal fumes are -most noxious when the fuel has been just kindled and burns low; for he -ascertained that at first it gives out a pyrogenous acid, which -occasions headache and tendency to sickness, and which is not a product -of combustion at the moment, but exists ready formed; and that when -charcoal is at a full red heat, this noxious substance is no longer -given off.[2079] Mr. Coathupe also thinks the cause of poisoning by -charcoal fumes is an unknown pyrogenous body, and not carbonic acid -gas.[2080]—This department of inquiry is obviously susceptible of more -precise information. But meanwhile, whatever may be the probability -that, besides carbonic acid, some other gases, or some peculiar -pyrogenous body, may occasionally exist in charcoal fumes, and increase -their poisonous property, little doubt can exist that the carbonic acid -is singly sufficient to account for all the leading phenomena. - -M. Devergie has been led to the opinion that air, in which a fourth part -of its oxygen has been converted into carbonic acid, and which therefore -contains five per cent. of that gas, is amply enough impregnated to -occasion death.[2081] This corresponds with the observations of M. -Ollivier, who found that three per cent. was as much as could be -breathed with impunity even for a moderate length of time.[2082] Less, -however, will suffice to prove injurious or even fatal, if the air be -breathed long. Mr. Coathupe inferred from a rough estimate, that in the -dangerous experiment he made upon himself, the carbonic acid, if -uniformly diffused in the apartment, which was probably the case, -amounted to only two per cent.; but his data were inadequate.[2083] - -Proceeding from the fact that five per cent. of carbonic acid is -sufficient to cause death, Devergie points out what quantity of charcoal -is required to form that proportion,—a question of no small moment in -respect to charges of murder, concealed under the semblance of suicide -by suffocation with charcoal fumes. And he shows, that a French bushel, -or decalitre, weighing 3000 grammes, is sufficient for a close apartment -of 1275 cubic mètres, that is 6·6 pounds avoirdupois for a space of 1666 -English cubic yards, provided the gas be uniformly diffused.[2084] The -quantity of charcoal burnt in a given case may be arrived at pretty -nearly from the weight of ashes left, which is estimated in round -numbers at a twenty-fifth by himself,[2085] and at a twentieth by -Ollivier.[2086] - -It is important to remark that complete closure of an apartment is by no -means essential for the action of carbonic acid, whether disengaged -within it or introduced from without. For poisoning has occurred, even -where a window was partially open.[2087] - -3. It is probable that in some circumstances a very small quantity of -the mixed gases proceeding from the slow combustion of tallow and other -oily substances will produce dangerous symptoms. Dr. Blackadder remarked -in the course of his experiments on flame, that the vapour into which -oil is resolved, previous to its forming flame round the wick, excites -in minute quantities intense headache.[2088] The emanations from the -burning snuff of a candle, which are probably of the same nature, seem -to be very poisonous. An instance indeed has been recorded in which they -proved fatal. A party of iron-smiths, who were carousing on a festival -day at Leipzig, amused themselves with plaguing a boy, who was asleep in -a corner of the room, by holding under his nose the smoke of a candle -just extinguished. At first he was roused a little each time. But when -the amusement had been continued for half an hour he began to breathe -laboriously, was then attacked with incessant epileptic convulsions, and -died on the third day.[2089]—The effects of such emanations are probably -owing to empyreumatic volatile oil, which will be presently seen to be -an active poison. - -4. The vapours from burning coal are the most noxious of all kinds of -emanations from fuel, and cause peculiar symptoms. But they are less apt -to lead to accidents than the vapour of charcoal, as they are much more -irritating to the lungs. This effect depends on the sulphurous acid gas -which is mingled with the carbonic acid. - -Sulphurous acid gas is exceedingly deleterious to vegetable life, being -hardly inferior in that respect to hydrochloric acid. Dr. Turner and I -found that a fifth of a cubic inch diluted with ten thousand times its -volume of air destroyed all the leaves of various plants in forty-eight -hours.[2090] I am not acquainted with any experiments on animals or -observations on man regarding the effects of the pure gas. But it will -without a doubt prove a powerful irritant. - -Some of the peculiarities in the cases now to be mentioned were possibly -owing to the admixture of sulphuric acid gas with the carbonic, both -being inhaled in a diluted state. The cases are described by Mr. Braid, -at the time surgeon at Leadhills. In March, 1817, several of the miners -there were violently affected, and some killed, in consequence, it was -supposed, of the smoke of one of the steam-engines having escaped into -the way-gates, and contaminated the air in the workings. Four men who -attempted to force their way through this air into the workings below -were unable to advance beyond, and seem to have died immediately. The -rest attempted to descend two hours after, but were suddenly stopped by -the contaminated air. As soon as they reached it, although their lights -burnt tolerably well, they felt difficulty in breathing, and were then -seized with violent pain and beating in the head, giddiness and ringing -in the ears, followed by vomiting, palpitation and anxiety, weakness of -the limbs and pains above the knees, and finally with loss of -recollection. Some of them made their escape, but others remained till -the air was so far purified that their companions could descend to their -aid. When Mr. Braid first saw them, some were running about frantic and -furious, striking all who came in their way,—some ran off terrified -whenever any one approached them,—some were singing,—some -praying,—others lying listless and insensible. Many of them retched and -vomited. In some the pulse was quick, in others slow, in many irregular, -and in all feeble. All who could describe their complaints had violent -headache, some of them tenesmus, and a few diarrhœa. In a few days all -recovered except the first four and three others who had descended to -the deeper parts of the mine.[2091]—Another accident of the same nature, -and followed by the same phenomena, happened more lately at -Leadhills.[2092] Similar accidents have been also witnessed by Mr. Bald, -civil engineer, among the coal-miners who work in the neighbourhood of a -burning mine belonging to the Devon Company. It is worthy of remark, -that the men sometimes worked for a considerable length of time before -they were taken ill. Such being the case, it will be readily conceived -that the burning of the lights was not a test of the wholesomeness of -the air. Here, as at Leadhills and in other instances already mentioned, -the lights continued to burn where the men were poisoned.[2093] - -5. Somewhat analogous to the symptoms now described are the effects of -the gradual contamination of air in a confined apartment. Every one must -have read of the horrible death of the Englishmen who were locked up all -night in a close dungeon in Fort William at Calcutta. One hundred and -forty-six individuals were imprisoned in a room twenty feet square, with -only one small window; and before next morning all but 23 died under the -most dreadful of tortures,—that of slowly increasing suffocation. They -seem to have been affected nearly in the same way as the workmen at -Leadhills.[2094] A similar accident happened in London in 1742. The -keeper of the round-house of St. Martin’s, crammed 28 people into an -apartment six feet square and not quite six feet high; and four were -suffocated.[2095] - -The morbid appearances left on the body after poisoning with carbonic -acid gas have been chiefly observed in persons killed by charcoal -vapour. According to Portal the vessels of the brain are congested, and -the ventricles contain serum; the lungs are distended, as if -emphysematous; the heart and great veins are gorged with black fluid -blood; the eyes are generally glistening and prominent, the face red, -and the tongue protruded and black.[2096]—Gorging of the cerebral -vessels seems to be very common. Yet sometimes it is inconsiderable, as -in two cases related by Dr. Bright, where, except in the sinuses and in -the greater veins of the ventricles and substance of the brain, no -particular gorging or vascularity seems to have been met with,—the -external membranes in particular having been very little injected.[2097] -This, however, is certainly a rare occurrence. Serous effusion in the -ventricles and under the arachnoid membrane is very general, yet not -invariable.—Dr. Schenck, medical inspector of Siegen, in reporting two -cases of death caused by the vapours of burning wood, notices paleness -of the countenance as a singular accompaniment of cerebral congestion; -and calls the attention of medical jurists to the extreme calmness of -the features as a general character of this variety of poisoning.[2098] -Although the same appearance has also been noticed by others,[2099] the -countenance nevertheless is often livid. But whether livid or pale, it -is always composed.—It appears from an account in Pyl’s Essays of -several cases of suffocation from the fumes of burning wood, that -besides the appearances mentioned by Portal, there is usually great -livor of the back, frothiness as well as fluidity of the blood, and more -or less gorging of the lungs with blood.[2100]—A common appearance where -the poisonous emanation has been charcoal vapour, is a lining of dark, -or sometimes actually black dust on the mucous membranes of the air -passages, thickest near the external opening of the nostrils, and -disappearing towards the glottis. There are obvious reasons why this -appearance cannot always be expected to occur; but when present, it may -be in doubtful circumstances a very important article of evidence.[2101] -In Wildberg’s collection of cases there is a report on two people who -were suffocated in bed, in consequence of the servant having neglected -to open the flue-trap when she kindled the stove in the bed-chamber; and -in each of them Wildberg found all the appearances now quoted from -Portal and Pyl. The tongue was black and swelled.[2102]—Mertzdorff has -related a case of death from the same cause, in which, together with the -preceding appearances, an effusion of blood was found between -the arachnoid and pia mater over the whole surface of both -hemispheres.[2103] In one of Dr. Bright’s cases there was a small -ecchymosis in the cortical substance on the outer side of the anterior -lobe, and not extending into the medullary matter. Fallot mentions an -instance of suffocation from charcoal vapour, where a little coagulated -blood was found between the layers of the arachnoid membrane of the -cerebellum in the region of the left occipital hollow.[2104] Three -instances of extravasation are enumerated in a list of German cases -analysed by Dr. Bird.[2105] Such appearances might be expected more -frequently, considering the manifest tendency of this kind of poisoning -to cause congestion in the head.—The blood is generally described as -being liquid and very dark. But M. Ollivier has lately called attention -to the fact, that the blood both before and after death is not unusually -more florid in the veins than natural.[2106] In a case mentioned by M. -Rayer globules of an oily-looking matter were found swimming on the -surface of the blood and urine.[2107] This is a solitary -observation.—The body usually remains flaccid, and the customary stage -of rigidity is imperfect. In some instances, however, as in those -related by Dr. Schenck, the stage of rigidity is passed through in the -usual manner. It is not uncommon to find vomited matter lying beside the -body, a circumstance which may naturally mislead the unpractised. This -is represented by Professor Wagner of Berlin to have occurred uniformly -in his experience;[2108] and it is also mentioned in many of the cases -reported by others;[2109] but it is not invariable.—A red appearance in -the stomach and intestines has been noticed in many cases,[2110] and -often ascribed to inflammation; but it is probably nothing more than the -result of the venous congestion, which pervades most of the membranous -surfaces of the body. - -The least variable appearances according to Dr. Bird are general -lividity, protrusion of the tongue, a calm expression and attitude, -cerebral congestion, and serous effusion. This author’s paper in the -Medical Gazette, 1838–39, i., or in Guy’s Hospital Reports, iv., enters -very fully into the appearances after death, and may be consulted with -advantage for further details. - -The treatment of poisoning with carbonic acid consists chiefly in the -occasional employment of the cold affusion, and in moderate -blood-letting either from the arm or from the head. In a case which -happened at Paris, where a lady tried to make away with herself by -breathing charcoal fumes, and was found in a state of almost hopeless -insensibility, various remedies were tried unsuccessfully, till cupping -from the nape of the neck was resorted to; and she then rapidly -recovered.[2111] Another instance where blood-letting was also -singularly successful deserves particular mention; because for three -hours the patient remained without pulsation in any artery, and without -the slightest perceptible respiration. At first neither by cupping nor -by venesection could any blood be obtained; and it was only after the -long interval just mentioned, and constant artificial inflation of the -lungs, that the blood at length trickled slowly from the arm. The pulse -and breathing were after this soon re-established; but it was not till -eight hours later that sensibility returned.[2112] - -_Of Poisoning with Carbonic Oxide Gas._—Carbonic oxide gas, according to -Nysten, has not any effect on man when injected into the pleura; but -when thrown slowly into the veins, it gives the arterial blood a -brownish tint, and induces for a short time a state resembling -intoxication.[2113] The quantity injected into the veins was probably -too small to produce the full effect, or it was discharged in passing -through the lungs; for this gas certainly appears to be very deleterious -when breathed by man, or the lower animals. M. Leblanc found by -experiment that a sparrow was killed almost immediately in air -containing only a twentieth of it, and that so little even as a -hundredth part proved fatal in two minutes.[2114] - -A set of interesting but hazardous experiments were made with it in 1814 -by the assistants of Mr. Higgins of Dublin. One gentleman, after -inhaling it two or three times, was seized with giddiness, tremors, and -an approach to insensibility, succeeded by languor, weakness, and -headache of some hours’ duration. The other had almost paid dearly for -his curiosity. Having previously exhausted his lungs, he inhaled the -pure gas three or four times, upon which he was suddenly deprived of -sense and motion, fell down supine, and continued for half an hour -insensible, apparently lifeless, and with the pulse nearly extinct. -Various means were tried for rousing him, without success; till at last -oxygen gas was blown into the lungs. Animation then returned rapidly: -but he was affected for the rest of the day with convulsive agitation of -the body, stupor, violent headache, and quick irregular pulse; and after -his senses were quite restored, he suffered from giddiness, blindness, -nausea, alternate heats and chills, and then feverish, broken, but -irresistible sleep.[2115] A French aëronaut, who used for his balloon a -mixture of carbonic oxide and hydrogen, obtained by decomposing water -with red-hot charcoal, lately suffered from similar symptoms in a milder -degree, in consequence of the gas being disengaged upon him from the -safety-valve of his balloon.[2116] - -_Of Poisoning with Nitrous Oxide Gas._—The nitrous oxide or intoxicating -gas is the last of the narcotic gases to be noticed. Nysten found, that, -when slowly injected in large quantity into the veins of animals, it -only caused slight staggering.[2117] Frequent observation, however, has -shown that it is by no means so inert when breathed by man. Sir H. Davy, -who first had the courage to inhale it, observed that it excited -giddiness, a delightful sense of thrilling in the chest and limbs, -acuteness of hearing, brilliancy of all surrounding objects, and an -unconquerable propensity to brisk muscular exertion. These feelings were -of short duration, but were generally succeeded by alertness of body and -mind, never by the exhaustion, depression, and nausea, which follow the -stage of excitement brought on by spirits or opium.[2118] Although many -have since experienced the same enticing effects, yet they are by no -means uniform. For others have been suddenly seized with great weakness, -tendency to faint, loss of voice, and sometimes convulsions; and two of -Thenard’s assistants, on making the experiment, fainted away, and -remained some seconds motionless and insensible.[2119] It is a -remarkable circumstance in the operation of this gas, that, unlike other -stimulants, it does not lose its virtues under the influence of habit. -Neither does the habitual use of it lead to any ill consequence. Sir H. -Davy, in the course of his researches, which were continued above two -months, breathed it occasionally three or four times a day for a week -together, at other periods four or five times a week only; yet at the -end his health was good, his mind clear, his digestion perfect, and his -strength only a little impaired.[2120] - -Nitrous oxide gas is one of the few gases that are not injurious to -vegetables. Dr. Turner and I found that seventy-two cubic inches, -diluted with six times their volume of air, had no effect on a -mignionette plant in forty-eight hours.[2121] - -_Of Poisoning with Cyanogen Gas._—_Cyanogen gas_ has been proved by the -experiments of M. Coullon to be an active poison to all animals,—the -guinea-pig, sparrow, leech, frog, wood-louse, fly, crab; and the -symptoms induced were coma, and more rarely convulsions.[2122] These -results are confirmed by the later experiments of Hünefeld, who found -that it produces in the rabbit anxious breathing, slight convulsions, -staring of the eyes, dilated pupils, coma, and death in five or six -minutes.[2123] Buchner likewise found that small birds, held for a few -seconds over the mouth of a jar containing cyanogen, died very speedily; -and on one occasion remarked, while preparing the gas, that the -fore-finger, which was exposed to the bubbles as they escaped, became -suddenly benumbed, and that this effect was attended with a singular -feeling of pressure and contraction in the joints of the thumb and -elbow.[2124] It would undoubtedly be most dangerous to breathe this gas, -except much diluted, and in very small quantity. - -Of all narcotic gases it is the most noxious to vegetables. Dr. Turner -and I found that a third of a cubic inch, diluted with 1700 times its -volume of air, caused the leaves of a mignionette plant to droop in -twenty-four hours. As usual with the effects of narcotic gases on -vegetables, the drooping went on after the plant was removed into the -open air; and in a short time it was completely killed.[2125] - -_Of Poisoning with Oxygen Gas._—Of all the narcotic gases, none is -more singular in its effects than oxygen. When breathed in a state of -purity by animals, they live much longer than in the same volume of -atmospheric air. But if the experiment be kept up for a sufficient -length of time, symptoms of narcotic poisoning begin to manifest -themselves. For an hour no inconvenience seems to be felt; but the -breathing and pulse then become accelerated; a state of debility next -ensues; at length insensibility gradually comes on, with glazing of -the eyes, slow respiration and gasping; coma is in the end completely -formed; and death ensues in the course of six, ten, or twelve hours. -If the animals are removed into the air before the insensibility is -considerable, they quickly recover. When the body is examined -immediately after death, the heart is seen beating strongly, but the -diaphragm motionless; the whole blood in the veins as well as the -arteries is of a bright scarlet colour; some of the membranous -surfaces, such as the pulmonary pleura, have the same tint, and the -blood coagulates with remarkable rapidity. The gas in which an animal -has died rekindles a blown out taper. These experiments, which -physiology owes to the researches of Mr. Broughton,[2126] furnish a -solitary example of death from stoppage of the respiration, although -the heart continues to pulsate, and the lungs to transmit florid -blood. Death is probably owing to hyper-arterialization of the blood. - - - - - CHAPTER XXXII. - CLASS THIRD. - OF NARCOTICO-ACRID POISONS GENERALLY. - - -The third class of poisons, the narcotico-acrids, includes those which -possess a double action, the one local and irritating like that of the -irritants, the other remote, and consisting of an impression on the -nervous system. - -Sometimes they cause narcotism; which is generally of a comatose nature, -often attended with delirium; but in one very singular group there is -neither insensibility nor delirium, but merely violent tetanic spasms. - -At other times they excite inflammation where they are applied. This -effect, however, is by no means constant. For Orfila justly observes, -that under the name of narcotico-acrids several poisons are usually -described which seldom excite inflammation. Those which inflame the -tissues where they are applied rarely occasion death in this manner. -Some of them may produce very violent local symptoms; but they generally -prove fatal through their operation on the nervous system. - -For the most part, their narcotic and irritant effects appear -incompatible. That is, when they act narcotically, the body is -insensible to the local irritation; and when they irritate, the dose is -not large enough to act narcotically. In large doses, therefore, they -act chiefly as narcotics, in small doses as irritants. Sometimes, -however, the narcotic symptoms are preceded or followed by symptoms of -irritation; and more rarely both exist simultaneously. - -Most, if not all, of them, to whatever part of the body they are -applied, act remotely by entering the blood-vessels; but it has not been -settled whether they operate by being carried with the blood to the part -on which they act, or by producing on the inner membrane of the vessels -a peculiar impression, which is conveyed along the nerves. Some of them -produce direct and obvious effects where they are applied. Thus -monkshood induces a peculiar numbness and tingling of the part with -which it is placed in contact. The organs on which they act remotely are -the brain and spine, and sometimes the heart also. - -The appearances in the dead body are, for the most part, inconsiderable; -more or less inflammation in the stomach or intestines, and congestion -in the brain; but even these are not constant. - -As a distinct class, they differ little from some poisons of the -previous classes. Several of the metallic irritants, and a few vegetable -acrids are, properly speaking, narcotico-acrids: they excite either -narcotism or irritation, according to circumstances. But still, the -poisons about to be considered form a good natural order when contrasted -with these irritants. For the irritants which possess a double action -are nevertheless characterized by the symptoms of inflammation being at -least their most prominent effects; while the most prominent feature in -the effects of the poisons now to be considered is injury of the nervous -system. It is more difficult to draw the line of separation between the -present class and the pure narcotics; for many narcotico-acrids rarely -cause any symptom but those of narcotism. - -The narcotico-acrids are all derived from the vegetable kingdom. Many of -them owe their power to an alkaloid, consisting of oxygen, hydrogen, -carbon, and azote. - -The characters which distinguish the symptoms and morbid appearances of -the narcotico-acrids from those of natural disease, do not require -special mention; for almost all the remarks made in the introduction to -the class of narcotics are applicable to the present class also. A few -of the characters, however, which have been laid down, do not apply so -well to the narcotico-acrids as to the narcotics. In particular, it -appears that what was said on the short duration of the effects of the -narcotics does not apply so well to the present class of poisons; some -of which, in a single dose, continue to cause symptoms even of narcotism -for two or three days. But the rule, that they seldom prove fatal if the -case lasts above twelve hours, is still applicable,—at all events they -rarely prove fatal after that interval by their narcotic action. The -poisonous fungi, however, have proved fatal as narcotics so late as -thirty-six hours, or even three days, after they were taken; and perhaps -digitalis has proved fatal narcotically at the remote period of three -weeks. But such cases are extremely rare. - -Some narcotico-acids, such as the different species of _strychnos_, are -quite peculiar in their effects; so that their symptoms may be -distinguished at once from natural disease. - -Orfila divides the narcotico-acrids into six groups, and this -arrangement will be followed in the present work; but they are not all -very well distinguished from one another. - - - - - CHAPTER XXXIII. - OF POISONING WITH NIGHTSHADE, THORN-APPLE, AND TOBACCO. - - -The first group of the narcotico-acrids comprehends these whose -principal symptom in the early stage of their effects is delirium. All -the plants of the group belong to the natural order _Solanaceæ_, and -Linnæus’s class Pentandria Monogynia. Those which have been particularly -examined are deadly nightshade, thorn-apple, and tobacco. - - - _Of Poisoning with Deadly Nightshade._ - -The deadly nightshade, or _Atropa belladonna_, is allied in -physiological and botanical characters to the _hyoscyamus_ and _solanum_ -formerly mentioned; and by the older writers, indeed, was confounded -with the latter. It is a native of Britain, growing in shady places, -particularly on the edge of woods. The berries, which ripen in -September, have a jet-black colour. Their beauty has frequently tempted -both children and adults to eat them, although they have a mawkish -taste; and many have suffered severely. It is not the berry alone which -is poisonous; the whole plant is so; and the root is probably the most -active part.[2127] From one to four grains of the dried powder of the -root will occasion dryness in the throat, giddiness, staggering, flushed -face, dilated pupils, and sometimes even delirium.[2128] The juice of -the leaves is very energetic, two grains of its extract being, when well -prepared, a large enough dose to cause disagreeable symptoms in man. It -is a very uncertain preparation, unless when procured by evaporation _in -vacuo_; for some samples from the Parisian shops have been found by -Orfila to be quite inert. - -It contains a peculiar alkaloid, named _atropia_. In the belladonna -Brandes obtained a volatile, oily-like, alkaloidal fluid, of a -penetrating narcotic smell, and bitterish, acrid taste, which he -supposed to be the active principle of the plant.[2129] The ulterior -researches of Geiger and Hesse, however, as well as the simultaneous -analysis of Mein, have proved that this fluid is not the pure alkaloid -of belladonna, and that the real atropia is a solid substance, forming -colourless, silky crystals, soluble in ether and alcohol, sparingly so -in water, slightly bitter, liable to decomposition under contact with -air and moisture, volatilizable, but with some decomposition, a little -above 212°, and capable of forming definite crystallizable salts with -acids.[2130] The aqueous solutions of its salts exhale during -evaporation a narcotic vapour, which dilates the pupil, and causes -sickness, giddiness, and headache.[2131] - -The ordinary extract of belladonna in the dose of half an ounce will -kill a dog in thirty hours when introduced into the stomach. Half that -quantity applied to a wound will kill it in twenty-four hours. And -forty grains injected into the jugular vein prove even more quickly -fatal. Convulsions are rarely produced, but only a state like -intoxication.[2132] - -The oleaginous atropia of Brandes in a dose of two or three drops kill -small birds instantaneously like concentrated hydrocyanic acid; in less -doses it occasions staggering, gasping, and in a few minutes death -amidst convulsions; and the dead body presents throughout the internal -organs great venous turgescence and even extravasation of blood, but -more especially excessive congestion within the head.[2133] The pure -crystalline atropia of Mein, when dissolved in water and greatly -diluted, causes extreme and protracted dilatation of the pupils. - -_Symptoms in Man._—On man the effects of belladonna are much more -remarkable. In small doses, whatever be the kind or surface to which it -is applied,—such as the skin round the eye, or the surface of a wound, -or the inner membrane of the stomach,—it causes dilatation of the pupil. -This effect may be excited without any constitutional derangement. When -the extract is rubbed on the skin round the eye, or a solution of it -dropped upon the eyeball, vision is not impaired; but when it is taken -internally so as to affect the pupils, the sight is commonly much -obscured. The effects of large or poisonous doses have been frequently -witnessed in consequence of children and adults being tempted to eat the -berries by their fine colour and bright lustre. From the cases that have -been published the leading symptoms appear in the first instance to be -dryness in the throat, then delirium with dilated pupils, and afterwards -coma. Convulsions are rare, and, when present, slight. - -The dryness of the throat is not a constant symptom. It is often, -however, very distinct. It occurred, for example, in 150 soldiers who -were poisoned near Dresden, as related by M. Gaultier de Claubry,[2134] -and in six soldiers whose cases have been described by Mr. -Brumwell.[2135] The former had not only dryness of the throat, but -likewise difficulty in swallowing. - -The delirium is generally extravagant, and also most commonly of the -pleasing kind, sometimes accompanied with immoderate uncontrollable -laughter, sometimes with constant talking, but occasionally with -complete loss of voice, as in the cases of the 150 soldiers. At other -times the state of mind resembles somnambulism, as in the instance of a -tailor who was poisoned with a belladonna injection, and who for fifteen -hours, though speechless and insensible to external objects, went -through all the customary operations of his trade with great vivacity, -and moved his lips as if in conversation.[2136] Sometimes frantic -delirium is almost the only symptom of consequence throughout the whole -duration of the poisoning. Thus a gentleman at Perigueux in France, who -took by mistake a mixture containing a drachm and a half of extract, was -attacked in half an hour with delirium, which soon became furious, and -continued till next day, when it gradually left him.[2137] In others the -delirium is attended with a singular and total loss of consciousness, -but without coma, as in the following case which occurred not long ago -at St. Omer. A young man having taken by mistake an infusion of two -drachms of dried leaves, was seized in an hour with great dryness of the -mouth and throat, afterwards slight delirium, loss of consciousness, and -dilatation of the pupil, next with retention of urine, convulsive -twitches of the face and extremities, and incessant tendency to walk up -and down. In three hours, after the action of an emetic and a clyster, -he lay down, but still in a state of total unconsciousness and muttering -delirium. Blood-letting being at last resorted to as a remedy, he -speedily recovered his senses, and eventually got well, after suffering -for some time from headache, fatigue, and much debility.[2138] - -The pupil is not only dilated in all cases, but likewise for the most -part insensible;[2139] and, as in the soldiers at Dresden, the eyeball -is sometimes red and prominent. The vision also, as in these soldiers, -is generally obscure; sometimes it is lost for a time;[2140] and so -completely that even the brightest light cannot be distinguished.[2141] - -The sopor or lethargy, which follows the delirium, occasionally does not -supervene for a considerable interval. In a case related by Munnik it -did not begin till twelve hours after the poison was taken.[2142] -Sometimes, as in the same case, the delirium returns when the stupor -goes off. A patient of my colleague Dr. Simpson, after using a -belladonna suppository consisting of two grains of extract, was attacked -with dryness of the throat and delirium, followed soon by drowsiness and -stupor; and in five or six hours more, as the stupor wore off, the -delirium returned, prompting to constant movements as if she was busy -with her toilette and various other ordinary occupations. Sometimes the -relation of the delirium to the coma is reversed, as in a case related -by Mr. Clayton, where sopor came on first, and delirium ensued in six -hours. The dose in this instance was forty grains of the extract.[2143] -Frequently the stupor is not distinct at any stage.—Even the delirium is -not always formed rapidly. A man whose case is described by Sir John -Hill did not become giddy for two hours after eating the berries, and -the delirium did not appear till five hours later.[2144] In Mr. -Brumwell’s cases, the delirium was not particularly noticed till the -morning after the berries were taken. - -Convulsions, it has been already stated, are rare. In the case from the -24th volume of Sedillot’s Journal, the muscles of the face were somewhat -convulsed: there is also at times more or less locked-jaw,[2145] or -subsultus tendinum;[2146] and occasionally much abrupt agitation of the -extremities.[2147] But well-marked convulsions do not appear to be ever -present. - -The effects now detailed are by no means so quickly dissipated as those -of opium. Almost every person who has taken a considerable dose has been -ill for a day at least. The case from Sedillot’s Journal lasted three -days, delirium having continued twelve hours, the succeeding stupor for -nearly two days, and the departure of the stupor being attended with a -return of delirium for some hours longer. One of Mr. Brumwell’s -patients, too, was delirious for three days; and Plenck has noticed -several instances where the delirium was equally tedious.[2148] Sage has -related a case in which the individual was comatose for thirty -hours.[2149] Blindness is also a very obstinate symptom, which sometimes -remains after the affection of the mind has disappeared. This happened -in Plenck’s cases. In two children whose cases have been described in a -late French journal, the eyes were insensible to the brightest light for -three days.[2150] In general, the dilated state of the pupils continues -long after the other symptoms have departed. It further appears from an -official narrative in Rust’s Journal, that dilated pupil is not the only -symptom which may thus continue, but that various nervous affections, -such as giddiness, disordered vision, and tremors, may prevail even for -three or four weeks.[2151] - -Hitherto little or no mention has been made of symptoms of irritation -from this poison. They are in fact uncommon, and seldom violent. In the -cases related by Gaultier de Claubry and by Mr. Brumwell, dryness and -soreness of the throat and difficult deglutition were remarked, and -appear not unusual. These symptoms were especially noticed by Buchner, -who by way of curiosity took half a drachm of seeds digested in beer. -The sense of dryness and constriction of the throat were such as to -prevent him swallowing even the saliva.[2152] Sage’s patient passed -blood by stool; and after the symptoms of narcotic poisoning ceased, he -had aphthous inflammation in the throat, and swallowing was so difficult -as for some time to excite convulsive struggles. Aphthæ in the throat -and swelling of the belly also succeeded the delirium in Munnik’s case. -Mr. Wibmer alludes to the case of a man who, besides difficult -deglutition at the beginning, had violent strangury towards the -close.[2153] An instance of violent strangury with suppression of urine -and bloody micturition is also related by M. Jolly. In the early stage, -the patient had redness of the throat and burning along the whole -alimentary canal, combined with the customary delirium and loss of -consciousness. The symptoms were caused by forty-six grains of the -extract given by mistake instead of jalap.[2154] Nausea and efforts to -vomit are not infrequent at the commencement. - -If the accident be taken in time, poisoning with belladonna is rarely -fatal; for, as the state first induced is delirium, not sopor, suspicion -is soon excited, and emetics may be made to act before a sufficient -quantity of the poison has been absorbed to prove fatal. Hence few fatal -instances have occurred in recent times. Mr. Wilmer, however, has -mentioned two fatal cases occurring in children, and terminating within -twenty-four hours.[2155] M. Boucher, a writer in the old French Journal -of Medicine, has referred to several cases of the same nature;[2156] -Gmelin has described the particulars of a good example;[2157] and many -others have been succinctly quoted by Wibmer, chiefly from the older -authors.[2158] - -Cases of poisoning with this plant have occurred in man through other -channels besides the stomach. Allusion has already been made to the -instance of a tailor who was poisoned by an injection. A small quantity -will sometimes suffice when administered in that way. A woman, whose -case is mentioned in Rust’s Journal, was attacked with wild delirium, -flushed face and glistening eyes, in consequence of receiving, during -labour, a clyster, that contained six grains of the common -extract;[2159] and Dr. Simpson’s patient, who was severely affected, had -only two grains. - -Perhaps the berry is in some circumstances not very active. A French -physician, M. Gigault of Pontcroix, says he has frequently had occasion -to treat cases of poisoning with it, as accidents of the kind are -extremely common in his neighbourhood; that he never knew it prove -fatal; and that in one instance a young man took a pound of the berries -before going to bed, and was not subjected to treatment till next -morning, when he was found in a state of delirium, but speedily -recovered after the free operation of emetics.[2160] - -_Morbid Appearances._—I have hitherto seen but one good account of the -appearances after death from poisoning with belladonna. It is described -by Gmelin. The subject was a shepherd who died comatose twelve hours -after eating the berries. When the body was examined twelve hours after -death, putrefaction had begun, so that the belly was swelled, the -scrotum and penis distended with fetid serum, the skin covered with dark -vesicles, and the brain soft. The blood-vessels of the head were gorged, -and the blood every where fluid, and flowing profusely from the mouth, -nose, and eyes.[2161] In the only other fatal case I have read, where -the body was inspected, there appears to have been no unusual appearance -at all.[2162] - -As the husks and seeds of the berries are very indigestible, some of -them will almost certainly be found in the stomach, as happened in the -instance last quoted. It should likewise be remembered that the best -possible evidence of the cause of the symptoms may be derived during -life from the presence of the seeds, husks, or even entire berries, in -the discharges. If vomiting has not been brought on at an early -period, we may expect to find these remains both in the vomited matter -and in the alvine evacuations. Mr. Wilmer mentions an instance in -which the black husks appeared in the stools brought away by laxatives -at least thirty hours after the poison was swallowed.[2163] One of Mr. -Brumwell’s patients vomited the seeds towards the close of the third -day.[2164] Several patients of M. Boucher vomited fragments of the -fruit on the second day, and passed more by stool and injections on -the third, although they had been treated with activity from the -commencement.[2165] - -While most of the cases of poisoning with belladonna have originated in -accident, at the same time they have not been all of this description. -Gmelin has quoted an instance of intentional and fatal poisoning by the -juice of the berries being mixed with wine; and another singular case of -poisoning with the decoction of the buds, given by an old woman for the -purpose of committing theft during the stupor of the individual.[2166] - -Other species of atropa are probably similar to belladonna in -properties. Wibmer quotes a single instance of frantic delirium -occurring among several shepherds, as well as their cattle, from eating -the herb of the _A. mandragora_.[2167] This is well known to have been -used anciently as a medicinal narcotic. - - - _Of Poisoning with Thorn-Apple._ - -The thorn-apple, or _Datura stramonium_, is another plant of the same -natural order, which it is proper to notice, because people have often -been poisoned with it, and it has become a common ornament of our -gardens. The cases of poisoning which have occurred in recent times in -this country have been all accidental. But not long ago the thorn-apple -appears to have been extensively used in Germany to cause loss of -consciousness and lethargy, preparatory to the commission of various -crimes.[2168] It was also proved to have been used lately in France for -this purpose. Some thieves made a man insensible with wine in which -stramonium seeds had been steeped, and robbed him of five hundred francs -while in this state. For twenty-four hours the victim knew nothing of -what became of him; he was met wandering in a wood, affected with -delirium, unconsciousness, staring of the eyes, and oppression of the -breathing; and for some time he was taken for a madman.[2169] In the -Eastern Archipelago, according to Mr. Crawford, this is a common mode of -committing theft and robbery.[2170] - -It is chiefly the fruit and seeds that have hitherto been examined; but -the whole plant is probably poisonous. Brandes discovered in it a -volatile, oleaginous, alkaline substance, which he supposed to be its -active principle.[2171] But, though his observations were confirmed by -Bley,[2172] it now appears that the real principle is a colourless, -crystalline alkaloidal substance, of an acrid taste like tobacco, which -was discovered more lately by Geiger and Hesse; this is named daturine, -or daturia.[2173] - -The physiological effects of the extract have been determined by Orfila. -He found that half an ounce killed a dog within twenty-four hours after -being swallowed, that a quarter of an ounce applied to a wound killed -another in six hours, and that thirty grains killed another when -injected into the jugular vein. The symptoms were purely nervous, and -not very prominent. Hence this poison, like the former, acts through the -blood-vessels, and probably on the brain.[2174] Bley’s daturia proves -quickly fatal to small animals in the dose of a few drops. The -crystalline daturia of Geiger and Hesse kills a sparrow in the dose of -an eighth of a grain, and occasions great and persistent dilatation of -the pupil when applied to the eye. - -_Symptoms in Man._—The symptoms produced by a poisonous dose in man are -variable. The leading features are great delirium, dilatation of the -pupils, and stupor; but sometimes spasms occur, and occasionally palsy. - -Dr. Fowler has related the case of a little girl who took a drachm and a -half of the seeds. In less than two hours she was attacked with maniacal -delirium, accompanied with spectral illusions; and she remained in this -state most of the following night, but had some intervals of lethargic -sleep. Next morning, after the operation of a laxative, she fell fast -asleep, and after some hours she awoke quite well.[2175] In a case -somewhat like this, related in Henke’s Journal, the child had general -redness of the skin, swelling of the belly, locked jaw, tremors of the -extremities, and an attitude and expression as if about to tumble into a -pit. Recovery took place after the action of an emetic.[2176] - -In two instances, one related by Vicat in his treatise on the poisonous -plants of Switzerland,[2177] the other by Dr. Swaine[2178] in the Edin. -Phys. and Lit. Essays, the leading symptoms were furious delirium and -palsy of the whole extremities. In the instances of three children -related by Alibert there were delirium, restlessness, constant -incoherent talking, dancing and singing, with fever and flushed -face.[2179] In another recorded by Dr. Young, there were some -convulsions, and livid suffusion of the countenance.[2180] In an -instance communicated to me by my colleague Dr. Traill, where eighteen -or twenty grains of extract of stramonium were taken by mistake for -sarsaparilla, the symptoms were dryness of the throat immediately -afterwards, then giddiness, dilated pupils, flushed face, glancing of -the eyes, and incoherence, so that he seemed to his friends to be -intoxicated: and subsequently there was incessant unconnected talking, -like that of demency. Emetics were given without effect, and little -amendment was obtained from blood-letting, leeches on the temples, cold -to the head, or purgatives. But after a glass of strong lemonade -vomiting took place, the symptoms began to recede, in ten hours he -recognized those around him, and next day he was pretty well. Kaauw -Boerhaave has related with great minuteness the case of a girl who very -nearly lost her life in consequence of a man having given her the powder -in coffee with the view of seducing her. The symptoms were redness of -the features, delirium, nymphomania, loss of speech; then fixing of the -eyes, tremors, convulsions, and coma; afterwards tetanic spasm and slow -respiration with the coma. She was with much difficulty roused for a -time by the operation of emetics, and eventually got well after her -lethargy had lasted nearly a day.[2181] In another related in Rust’s -Magazin, and caused by a decoction of the fruit, which was mistaken for -thistle-heads, the leading symptoms were spasmodic closing of the -eyelids and jaws, spasms also of the back, complete coma, and excessive -dilatation and insensibility of the pupil.[2182] This case, which seems -to have been a very dangerous one, was rapidly cured by free -blood-letting. Blood-letting, indeed, seems peculiarly called for in -poisoning with thorn-apple, on account of the strong signs of -determination of blood to the head.—Gmelin has quoted several fatal -cases, one of which endured for six hours only;[2183] and Dr. Young -says, that a child has been killed by a single apple.[2184] The most -complete account yet published of the phenomena of poisoning with -stramonium when fatal is given by Mr. Duffin of London. A child of his -own, two years old, swallowed about 100 seeds without chewing them. Soon -after she became fretful and like a person intoxicated; in the course of -an hour efforts to vomit ensued, together with flushed face, dilated -pupils, incoherent talking, and afterwards wild spectral illusions and -furious delirium. In two hours and a half she lost her voice and the -power of swallowing, evidently owing to spasms of the throat. Then -croupy breathing and complete coma set in, with violent spasmodic -agitation of the limbs, occasional tetanic convulsions, warm -perspiration, and yet an imperceptible pulse. Subsequently the pulse -became extremely rapid, the belly tympanitic, and the bladder paralyzed, -but with frequent involuntary stools, probably owing to the -administration of cathartics; and death took place in twenty-four hours. -At an early period twenty seeds were discharged by an emetic: the stools -contained eighty; and none were found in the alimentary canal after -death. There was never any marked sign of congestion of blood in the -head, except flushed face at the beginning.[2185] Dr. Droste of Osnaburg -has related a fatal case occasioned by a decoction of 125 seeds given to -remove colic. In fifteen minutes the patient became delirious, but soon -fell apparently fast asleep, and died in seven hours without again -awaking.[2186] - -Dangerous effects may result from the application of the thorn-apple to -the skin when deprived of the cuticle. An instance has been lately -published of alarming narcotism from the application of the leaves to an -extensive burn.[2187] - -_Morbid Appearances._—As to the _morbid appearances_, Droste found in -his case redness of the cardiac end of the stomach, which contained two -table-spoonfuls of a pulpy matter mixed with black and white grains, the -remains of the teguments of the seeds; and there was also lividity of -the back, lividity of the lungs, emptiness of the cavities of the heart, -and gorging of the vessels of the brain. Haller says he once found -general congestion of the brain and sinuses,[2188]—an appearance which -may naturally be expected, considering the signs of strong determination -of blood towards the head, which often prevail during life. In Mr. -Duffin’s case, however, the brain was healthy, not congested; the -stomach and intestines presented no morbid appearance; and the only -unusual appearances observed were a slight blush over the pharynx, -larynx, and upper third of the gullet, thickening and swelling of the -rima glottidis, and a semi-coagulated state of the blood. - - - _Of Poisoning with Tobacco._ - -A plant of the same natural order with the two former, tobacco, the -_Nicotiana tabacum_ of botanists, is familiarly known to be in certain -circumstances a virulent poison. Every part of the plant possesses -active properties. It has been used as a poison in this country for -criminal purposes. - -_Vauquelin_ analyzed it some time ago, and procured an acrid volatile -principle which he called nicotine.[2189] This substance, which was -afterwards obtained in a purer state as a crystalline body by -Hermbstädt, has been more recently ascertained by MM. Posselt and -Reimarus to be nothing else than essential oil of tobacco, which is sold -at ordinary temperatures; and they succeeded in procuring another -principle which they consider the true nicotina. This is fluid at 29° -F., volatile, extremely acrid, alkaline, and capable of forming -crystallizable salts with some of the acids.[2190] Tobacco then appears -to contain an acrid alkaline principle, and an essential oil to which -the alkaloid adheres with great obstinacy. The relation of the -empyreumatic oil of tobacco to these principles has not been accurately -ascertained, though it probably contains one or other of them. It is -well known to be an active poison, which produces convulsions, coma and -death. Mr. Morries-Stirling found that its active part is removed from -the oil by washing with weak acetic acid, as he also observed in the -instance of similar oils obtained from various narcotic -vegetables.[2191] - -_Process for detecting Tobacco in Organic mixtures._—In a medico-legal -case which happened at Aberdeen in 1834, and of which some notice is -taken at page 651, Dr. Ogston of that city successfully employed the -following process for detecting tobacco in the contents of the stomach. -The contents, consisting of a pulpy fluid, were acidulated with acetic -acid, digested, and filtered; the liquid was treated with diacetate of -lead, filtered again, freed of lead by hydrosulphuric acid, filtered a -third time, treated with caustic potash, and then allowed to settle. The -supernatant liquid, which had the taste of tobacco-juice, was separated -and distilled to half its volume. The distilled liquor had a strong -tobacco odour and taste, and some acridity, and gave a precipitate with -infusion of galls. The residuum in the retort presented oily particles -on its surface, and when heated in an open basin filled the apartment -with a vapour which had a strong odour of tobacco smoke, and caused in -several persons present a sense of acridity of the throat, watering of -the eyes, and tendency to sneeze. Various additional experiments -confirmatory of these results were also performed; and a simultaneous -examination of tobacco-powder gave precisely the same indications. I am -indebted to Dr. Ogston for these particulars and a detailed narrative of -his investigation; which appears to supply a convenient and conclusive -process for the detection of tobacco.—Perhaps the ordinary process for -obtaining nicotina may also be employed with advantage. This consists in -distilling the suspected substance with caustic potash, neutralizing the -distilled liquor with sulphuric acid, concentrating the product to a -thin syrup, exhausting this with etherized alcohol, evaporating off the -solvent, and distilling the extract with strong solution of potash. -Nicotina passes over, and may be recognized by its sensible and chemical -qualities. - -The effects of tobacco are somewhat different from those of belladonna -and thorn-apple; but it is here arranged with them, as it belongs to the -same natural family. Orfila remarked that 5½ drachms of common rappee, -introduced into the stomach of a dog and secured by a ligature, caused -nausea, giddiness, stupor, twitches in the muscles of the neck, and -death in nine hours; and that two drachms and a quarter applied to a -wound proved fatal in a single hour. Mr. Blake thinks tobacco has no -direct action on the heart, even when admitted directly into the blood -by the jugular vein;—that it acts primarily on the capillary circulation -of the lungs, by obstructing which it prevents the blood from reaching -the left cavities of the heart, and thus acts on that organ indirectly. -For he observed, that laboured respiration always preceded any sign of -depressed action of the heart, that forcible action of the heart often -returned after its first cessation, and that its contractility continued -after death.[2192] An infusion of ten grains caused laborious breathing -in ten seconds, and in twenty seconds temporary arrestment of the -heart’s action, which then returned, and was attended for a time with -increased arterial pressure. Soon afterwards the animal recovered, -without any convulsions or loss of sensibility. Two scruples had the -same effect. But when three drachms were used, convulsions succeeded -similar phenomena, and death ensued in two minutes, the heart continuing -to act for some time after respiration had ceased, until at length it -was stopped by the usual consequences of asphyxia.[2193] On the other -hand, Sir B. Brodie found that the effects are very different, according -to the form in which the poison is used. Thus four ounces of a strong -infusion, when injected into the anus of a dog, killed it in ten minutes -by paralyzing the heart; for after death the blood in the aortal -cavities was arterial. But the empyreumatic essential oil does not act -in that manner: it excites convulsions and coma, without affecting the -heart. It may prove fatal in two minutes.[2194] Like other violent -poisons, tobacco has no effect when applied directly to the brain or -nerves.[2195] Two drops of the alkaloid, nicotina, injected into the -jugular vein of a dog, begin to act in ten seconds, and will prove fatal -in a minute and a half.[2196] - -_Symptoms in Man._—The effects observed in man are allied to those -produced in dogs by the infusion. In a slight degree they are frequently -witnessed in young men, while making their first efforts to acquire the -absurd practice of smoking. The first symptoms are acceleration and -strengthening of the pulse, with very transient excitement, then sudden -giddiness, fainting and great sickness, accompanied with a weak, -quivering pulse. These effects are for the most part transient and -trifling, but not always. Some degree of somnolency is not uncommon. Dr. -Marshall Hall has given an interesting account of a young man who smoked -two pipes for his first debauch, and in consequence was seized with -nausea, vomiting, and syncope, then stupor, stertorous breathing, -general spasms and insensible pupils. Next day the tendency to faint -continued, and in the evening the stupor, stertor and spasms returned; -but from that time he recovered steadily.[2197] Gmelin has quoted two -cases of death from excessive smoking,—caused in one by seventeen, in -the other by eighteen pipes, smoked at a sitting.[2198] It is likewise -mentioned by Lanzoni that an individual fell into a state of somnolency -and died lethargic on the twelfth day in consequence of taking too much -snuff;[2199] Dr. Cheyne says, “he is convinced apoplexy is one of the -evils in the train of that disgusting practice;”[2200] and I have met -with an instance where the excessive use of snuff, occasioned twice, at -distant intervals, an attack resembling imperfect apoplexy, united with -delirium. Such cases, however, must be admitted to be rare; and the -practice of taking snuff is in general unattended with injury. - -Serious consequences have resulted from the application of tobacco to -the abraded skin. In the Ephemerides an account is given of three -children who were seized with giddiness, vomiting, and fainting from the -application of tobacco-leaves to the head for the cure of -ring-worm.[2201] Dr. Merriman has also alluded to an instance of death -in a child from the incautious employment of a strong decoction of -tobacco as a lotion for ring-worm of the scalp.[2202] And in Leroux’s -Journal there is an account of a man, who, after using a tobacco -decoction for the cure of an eruptive disease, was seized with symptoms -of poisoning, and died in three hours.[2203] - -In recent times poisoning with tobacco has been often produced by the -employment of too large doses in the way of injection. Richard has -mentioned a case, not fatal, which arose from an infusion of five leaves -in a choppin of water, used as an injection by a lady for costiveness. -She was immediately seized with colic, giddiness, buzzing in the ears, -headache, nausea, and then syncope of seven hours’ duration. During this -period the breathing was difficult, the pulse very slow, the pupils -dilated, the skin cold and moist, the urine suppressed, the efforts to -vomit constant, and the belly depressed, contracted, and affected with -constant borborygmus. She recovered under the use of emollient -injections and fomentations.[2204] Dr. Grahl of Hamburg has related -minutely a fatal case, which arose from an ounce of rather more, boiled -for fifteen minutes in water, and administered by advice of a female -quack. The individual, who laboured merely under dyspepsia and obstinate -costiveness, was seized in two minutes with vomiting, violent -convulsions, and stertorous breathing, and died in three-quarters of an -hour.[2205] Another accident of the same kind is noticed in the Journal -de Chimie Médicale, where the person became as it were intoxicated, and -died immediately. Instead of an infusion of two drachms she had used a -decoction of two ounces.[2206]—M. Tavignot describes the following -remarkable case occasioned by a similar dose. An infusion prepared by -mistake with two ounces and one drachm, instead of a drachm and a half, -was used as an injection for a stout man affected with ascarides. In -seven minutes he was seized with stupor, headache, paleness of the skin, -pain in the belly, indistinct articulation, and slight convulsive -tremors, at first confined to the arms, but afterwards general. Extreme -prostration and slow laborious breathing soon ensued, and then coma, -which ended fatally in eighteen minutes.[2207]—Even two drachms, -however, or a drachm and a half, are by no means a safe dose. An -anonymous writer in the Medical and Surgical Journal says a patient of -his died in convulsions an hour or two after receiving a clyster -composed of two drachms infused in eight ounces.[2208] Nay, in the Acta -Helvetica there is an account by an anonymous writer of the case of a -woman, who, after an injection made with one drachm only, was seized -with pain in the belly, anxiety and faintings, proving fatal in a few -hours.[2209] And a case, fatal in thirty-five minutes, which was -occasioned by the same dose, occurred not long ago in Guy’s Hospital, -London.[2210] - -Tobacco is an equally deadly poison when swallowed in large quantity. M. -Caillard has related the particulars of the case of a lunatic, who, -having swallowed half an ounce of snuff during a lucid interval, was -seized with vomiting, and afterwards with oppression, incoherence, cold -sweats, a slow full pulse, and dilated pupils; but he slowly -recovered.[2211] The French poet Santeuil was killed in this way by a -practical joker at the Prince of Condé’s table. When the bottle had -circulated rather freely, a boxful of Spanish snuff was emptied into a -large glass of wine, and thus administered to the unlucky victim, who -was in consequence “attacked with vomiting and fever, and expired in two -days amidst the tortures of the damned.”[2212] The following important -case has been communicated to me by Dr. Ogston of Aberdeen, who was -employed in the judicial investigations connected with it. An elderly -man, a pensioner, was seen to enter a brothel, while in perfect health; -and in an hour he was carried out insensible and put down in a passage, -where he was found by the police unable to speak or move. While carrying -him to the watch-house hard by, the officers observed him attempt to -vomit; but he was scarcely laid down before the fire, when he expired. -It was ascertained, that he had drunk both rum and whisky in the -brothel, and that something had been given him “to stupefy him or set -him asleep.” On dissection the blood was found every where very fluid, -and four ounces of serosity were collected from the lateral ventricles -and base of the skull. But there was no other unusual appearance, except -that the stomach contained about four ounces of a thick brownish pulp, -in which were seen several pellets of a powder resembling snuff. In -these contents Dr. Ogston could not detect any opium; but he detected -tobacco by the process mentioned above. No doubt could exist that the -man died of poisoning with tobacco; but as no evidence could be obtained -to inculpate any one in particular of many individuals who were in the -brothel with him, the case was not made the subject of trial. - -Evidence is not wanting, therefore, to prove that this plant is a very -active poison; yet every one knows that under the influence of habit it -is used in immense quantities over the whole world as an article of -luxury, without any bad effect having ever been clearly traced to it. -Its poisonous qualities were known in Europe as soon as it was brought -from America; and the belief that such properties could not fail to be -attended, as in the case of spirits and opium, with evil consequences -from its habitual use, led to much opposition on the part of various -governments to its introduction. Soon after it was brought to England by -Sir W. Raleigh, King James wrote a philippic against it, entitled “The -Counter-blaste to Tobacco.” Some countries even prohibited it by severe -edicts. Amurath the 4th in particular made the smoking of tobacco -capital; several of the Popes excommunicated those who smoked in the -church of St. Peter’s; in Russia it was punished with amputation of the -nose; and in the Canton of Bern it ranked in the tables next to -adultery, and even so lately as the middle of last century a particular -court was held there for trying delinquents.[2213] Like every other -persecuted novelty, however, smoking and snuff-taking passed from place -to place with rapidity; and now there appear to be only two luxuries -which yield to it in prevalence, spirituous liquors and tea. - -The only accounts I have seen of the morbid appearances after poisoning -with tobacco are contained in the cases of Dr. Grahl and Dr. Ogston. In -the former there was great lividity of the back, paleness of the lips, -flexibility of the joints (two days after death), diffuse redness of the -omentum without gorging of vessels, similar redness with gorging of -vessels both on the outer and inner coats of the intestines, in some -parts of the mucous coat patches of extravasation, unusual emptiness of -the vessels of the abdomen; while the stomach was natural, the lungs -pale, the heart empty in all its cavities, and the brain natural. The -appearances in Dr. Ogston’s case have been already stated. - -Writers on the diseases of artisans have made many vague statements on -the supposed baneful effects of the manufacture of snuff on the -workmen.[2214] It is said they are liable to bronchitis, dysentery, -ophthalmia, carbuncles and furuncles. At a meeting of the Royal Medical -Society of Paris, however, before which a memoir to this purport was -read, the facts were contradicted by reference to the state of the -workmen at the Royal Snuff Manufactory of Gros-Caillou, where 1000 -people are constantly employed without detriment to their health.[2215] -This subject was afterwards investigated with care by MM. -Parent-Duchatelet and D’Arcet, who inquired minutely into the state of -the workmen employed at all the great tobacco-manufactories of France, -comprising a population of above 4000 persons; and the results at which -they arrived are,—that the workmen very easily become habituated to the -atmosphere of the manufactory,—that they are not particularly subject -either to special diseases, or to disease generally,—and that they live -on an average quite as long as other tradesmen.[2216] These facts are -derived from accurate statistical returns, showing the number of days -each person was annually off work from sickness, the ages at which -superannuated allowances were granted, the period of death, and the -prevalent diseases. - - - - - CHAPTER XXXIV. - OF POISONS OF THE UMBELLIFEROUS ORDER OF PLANTS. - - -The Natural Order _Umbelliferæ_ contains a variety of plants, to which -narcotico-acrid properties have been at different times ascribed. But -these properties have been satisfactorily traced in the instance of four -species only, the _Conium maculatum_, _Œnanthe crocata_, _Cicuta -virosa_, and _Æthusa cynapium_. It is supposed that others may be -poisonous. But the facts on the subject are equivocal; for the several -species of the family are very apt to be confounded with one another, -and there is reason to think that other species have repeatedly been -mistaken for one of the four already mentioned. - -The symptoms caused by the umbelliferous narcotics comprehend chiefly -coma, convulsions, paralysis, and delirium. But the knowledge possessed -on this head is rather vague, and the phenomena are not unfrequently -complex and difficult to observe with accuracy; so that their nature has -been sometimes misunderstood. The irritant properties of the poisons of -this tribe of narcotico-acrids are seldom well defined. - - - _Of Poisoning with Hemlock._ - -The first to be mentioned is the common hemlock, or _Conium maculatum_, -one of the most abundantly diffused of umbelliferous vegetables. It is -distinguished from all those which it resembles by its tall, smooth, -spotted stem,—its smooth leaves,—the rugged edge of the five ribs of its -fruit,—its singular mousy odour,—and the very peculiar odour of conia, -emitted when the pulp or juice of the leaves is mixed with caustic -potash. The only other umbelliferous native which has a spotted stem, -the _Myrrhis temulenta_, is easily distinguished from hemlock by the -whole plant being very hairy. - -Cases of poisoning with hemlock are not infrequent on the continent, the -root having been mistaken for fennel, asparagus, parsley, but -particularly parsnep.[2217] It is generally believed to have furnished -the poison which was used in ancient times, and especially among the -Greeks, for despatching criminals; but we have not any precise -information on the subject. - -A peculiar alkaloid was indicated in hemlock not long ago by Brandes, -half a grain of which killed a rabbit with symptoms like those of -tetanus.[2218] Other chemists were unable to obtain his results. But the -subject was afterwards taken up with success by Geiger, who obtained -from the plant a volatile, oleaginous alkaloid, which possesses great -energy as a poison.[2219] Mr. Morries-Stirling procured from hemlock by -destructive distillation an empyreumatic oil similar in properties to -those of hyoscyamus, stramonium and tobacco, but producing in animals a -state of pure coma.[2220] - -The effects of hemlock on the animal system have been variously -described by different observers. Sometimes they have appeared to be -purely soporific like those of opium; at other times they have resembled -the effects of belladonna and thorn-apple; and in the lower animals they -are quite different, as I have witnessed them, from what they have been -described to be in man,—the phenomena being simply those of asphyxia -from paralysis of the muscles, without material convulsions and without -insensibility. Its irritant action is not well established. - -Orfila observed that an ounce of the extract of the leaves killed a dog -in forty-five minutes when swallowed, ninety grains killed another -through a wound in an hour and a half, and twenty-eight grains another -through a vein in two minutes. It therefore acts by entering the -blood-vessels. The extract is a very uncertain preparation; the reason -of which is, that the alkaloid conia is very easily decomposed in its -natural state of mixture by heat or age, being converted into an inert -resinoid matter,—that the dried leaves of hemlock contain scarcely any -of it,—and that even an extract of the fresh leaves contains little, -unless prepared with a gentle heat, yet speedily.[2221] The symptoms -remarked by Orfila were convulsions and insensibility; and in the dead -body the blood of the left cavities of the heart was sometimes found -arterial.—The result of my observations is quite at variance with this -statement. In various experiments with a strong extract prepared from -the green seeds with absolute alcohol, the only effect I could remark -were palsy, first of the voluntary muscles, next of the chest, lastly of -the diaphragm,—asphyxia in short from paralysis, without insensibility, -and with slight occasional twitches only of the limbs, and the heart was -always found contracting vigorously for a long time after death. Thirty -grains of a soft extract introduced between the skin and muscles of the -back killed a rabbit in five minutes, and a five months’ puppy in twenty -minutes.[2222] - -The root is much less energetic than is represented by some authors, and -probably varies in this respect at different seasons. I have found that -four ounces and a half of juice, the produce of twelve ounces of roots -collected in November, had no effect on a dog when secured in its -stomach by a ligature on the gullet; and that four ounces obtained from -ten ounces of roots in the middle of June, when the plant was coming -into flower, merely caused diarrhœa and languor. Orfila had previously -observed that three pounds of roots had no effect in the month of April; -but that two pounds in the end of May, when the plant was in full -vegetation, killed a dog in six hours.[2223] The alcoholic extract of -the juice obtained from six ounces of roots on the last day of May, I -have found to kill a rabbit in thirty-seven minutes, when introduced in -a state of emulsion between the skin and muscles of the back; and the -effects were analogous to those obtained with the extract of the leaves. -The differences depending on season will probably account for various -persons having found the juice of the root harmless. Gmelin quotes an -instance where four ounces of the juice were taken without injury. He -adds another where three ounces of the juice of the herb were swallowed -daily for eight days with as little effect. But, as he judiciously -observes, other less active plants have probably been sometimes mistaken -for hemlock.[2224] - -The alkaloid, conia, seems to be the active principle of hemlock, and is -a poison of extraordinary virulence. On investigating this subject in -1835,[2225] I found that it is a local irritant, possessing an acrid -taste, and capable of exciting redness or vascularity in any membrane to -which it is applied; but that these topical effects are readily -overwhelmed by its swift and intense narcotic action. This action -consists of swiftly spreading palsy of the muscles, which affects first -those of voluntary motion, then the respiratory muscles of the chest and -abdomen, and lastly the diaphragm, so as to terminate by causing -asphyxia. The paralytic state is usually interrupted from time to time -by slight convulsive twitches of the limbs and trunk at the beginning. -The muscular contractility is impaired or annihilated by the topical -action of the poison, but not by its indirect action through absorption. -The heart is not appreciably affected; for it contracts vigorously long -after all motion, respiration, and other signs of life are extinct; and -it contains after death, not florid but dark blood in its left cavities. -The blood undergoes no alteration. The external senses are little, if at -all impaired, until the breathing is almost arrested; and volition too -is retained. But a contrary inference may be drawn by a careless -observer, in consequence of the paralytic state taking away the means, -by which in animals sensation is expressed and volition exercised. The -action of conia, in short, is confined to the spinal cord; and it acts -as a sedative, by exhausting the nervous energy. - -Conia is probably a deadly poison to all orders of animals: at least I -found it to be so to the dog, cat, rabbit, mouse, frog, fly, and flea; -and Geiger killed the kite, pigeon, sparrow, slow-worm, and earth-worm -with it. It acts through every texture where absorption is carried on -readily, through the stomach, eye, lungs, cellular tissue, peritonæum, -or veins; and its activity is in proportion to the speed with which -absorption is carried on in the part. It acts therefore through -absorption. Its activity is increased by neutralization with an acid, by -which it is rendered much more soluble in water. Few poisons equal it in -subtility and swiftness. A single drop, applied to the eye of a rabbit, -will kill it in nine minutes; and three drops in the same way will kill -a strong cat in a minute and a half. Five drops, introduced into the -throat of a little dog, began to act in thirty seconds, and proved fatal -in one minute. And when two grains, neutralized with thirty drops of -weak hydrochloric acid, were injected into the femoral vein of a young -dog, it died before there was time to note the interval, so that only -two or three seconds at most had elapsed, before all internal signs of -life were extinct. This extraordinary rapidity of action seems -incompatible with its operation taking place by conveyance of the poison -with the blood to the spinal cord. Mr. Blake, as formerly mentioned (p. -15), denies that its action in this way was ever so swift in his hands, -and alleges that he could never observe the interval to be shorter than -fifteen seconds. If the reader, however, will consult the original -account of my experiment,[2226] which was made along with Dr. Sharpey, -he will see that we could scarcely be mistaken as to the interval in -that instance. - -_Symptoms in Man._—M. Haaf, a French army-surgeon, has described a fatal -case of poisoning with hemlock, which closely resembled poisoning with -opium. The subject of it, a soldier, had partaken along with several -comrades of a soup containing hemlock leaves, and appeared to them to -drop asleep not long after, while they were conversing. In the course of -an hour and a half they became alarmed on being all taken ill with -giddiness and headache; and the surgeon of the regiment was sent for. He -found the soldier, who had fallen asleep, in a state of insensibility, -from which, however, he could be roused for a few moments. His -countenance was bloated, the pulse only 30, and the extremities cold. -The insensibility became rapidly deeper and deeper, till he died, three -hours after taking the soup.[2227] His companions recovered. - -Dr. Watson has briefly described two cases which were fatal in the same -short space of time. The subjects were two Dutch soldiers, who, in -common with several of their comrades, took broth made with hemlock -leaves and various other herbs. Giddiness, coma, and convulsions were -the principal symptoms. The men who recovered were affected exactly as -if they had taken opium.[2228] - -When the dose is not sufficient to prove fatal, there is sometimes -paralysis, attended with slight convulsions, as in a case noticed by -Orfila.[2229] More commonly there is frantic delirium. Matthiol has -related an instance of this last description, occurring in the cases of -a vine-dresser and his wife, who mistook the roots for parsneps Both of -them became in the course of the night so delirious that they ran about -the house, knocking themselves against every object which came in their -way.[2230] Kircher, as quoted by Wibmer, tells a parallel story of two -monks who became so raving mad after eating the roots, that they plunged -into water, imagining that they were turned into geese, and they were -affected for three years with incomplete palsy and neuralgic -pains.[2231] These and some other cases of the like kind, recorded by -the older medical authors, must be received with reserve. Independently -of other considerations, there is often no certainty that the poison was -really the hemlock of modern botanists, and not some other umbelliferous -vegetable. - -_Morbid Appearances._—In Haaf’s case the vessels of the head were much -congested; and the blood must have been very fluid, for on the head -being opened a quantity flowed out, which twice filled an ordinary -chamber-pot. This state of the blood likewise occurred in a case which I -examined here some years ago along with Dr. C. Coindet of Geneva. A -hypochondriacal old woman took by advice of a neighbour two ounces of a -strong infusion of hemlock leaves with the same quantity of whisky, -which she swallowed in the morning fasting. She died in an hour, -comatose and slightly convulsed. The vessels within the head were not -particularly turgid; but the blood was everywhere remarkably fluid. Dr. -Coindet subsequently found that a small portion of the infusion prevents -fresh drawn blood from coagulating; but I suspect there must have been -some mistake here, for a carefully prepared alcoholic extract of very -great power, which was used in my experiments alluded to above, had no -such effect on blood fresh drawn from rabbits and dogs. On account of -this extreme fluidity of the blood, it often flows from the nose, but -the skin is much marked with lividity.[2232] The fluidity of the blood -is nothing more than the result of the proximate cause of death,—slowly -formed asphyxia. - - - _Of Poisoning with Water-Hemlock._ - -Another plant of the order Umbelliferæ, the water-hemlock or _Cicuta -virosa_, possesses also great energy as a poison; and in its effects it -appears to resemble considerably the hydrocyanic acid. The plant is -indigenous. It is easily known from other umbelliferous species -inhabiting watery places by the peculiar structure of its root-stock, -which is not fleshy, but hollow, and composed of a number of large cells -with transverse plates. - -From a numerous set of experiments with the root of the cicuta performed -by Wepfer, it appears to cause true tetanic convulsions in frequent -paroxysms, and death on the third day.[2233] Simeon ascertained that the -alcoholic extract of the root is very poisonous.[2234] Schubarth found -that an ounce of the juice of the stems and leaves, collected after the -flowers had begun to blow, produced no effect on the dog.[2235] It is -probably inert, or at all events feebly poisonous in this climate, -although it grows luxuriantly in many localities. I have found that -twelve ounces of juice, expressed from sixteen ounces of roots in the -beginning of August, merely caused some efforts to vomit, when secured -in the stomach of a dog by a ligature on the gullet; that the alcoholic -extract of twelve ounces of leaves gathered at the same time had no -effect when introduced in the form of emulsion between the skin and -muscles of the back of a rabbit; and that the alcoholic extract of two -ounces of unripe seeds proved equally inert when imployed in the same -way. - -_Symptoms in Man._—Wepfer has likewise related several instances which -occurred in the human subject. Among the rest he has described the cases -of eight children who ate the roots instead of parsneps. Of those who -were seriously affected, one, a girl six years old, who ultimately -recovered, had tetanic fits, followed by deep coma, from which it was -impossible to rouse her for twenty-four hours. Two of them died. The -first symptoms in these two were swelling in the pit of the stomach, -vomiting or efforts to vomit, then total insensibility, with involuntary -discharge of urine, and finally severe convulsions, during which the -jaws were locked, the eyes rolled, and the head and spine were bent -backwards, so that a child might have crept between the body and the -bed-clothes. One of them died half an hour after being taken ill, and -the other not long after.[2236] Mayer of Creutsburg mentions four cases, -which were occasioned by the roots. One of the individuals, a child -three years old, was attacked with colic, vomiting, and convulsions, and -died in a few hours. The three others, the eldest of whom was six years -of age, had coldness, paleness of the features, dilated immoveable -pupils, violent colic, general spasms, and insensibility. The action of -the heart was intermitting and the breathing oppressed. After the -remains of the roots were brought up by emetics, and infusion of gall -was administered, they gradually recovered. They had eaten between them -no more than a single root weighing about two ounces, as they had in -their possession another of that weight, which they said was not so -large. This accident happened in the middle of March.[2237] - -According to Guersent, poisoning with the cicuta commences with dimness -of sight, giddiness, acute headache, anxiety, pain in the stomach, -dryness in the throat, and vomiting.[2238] - -Mertzdorff has related the particulars of the inspection of three cases -which proved quickly fatal with convulsions and vomiting. Nothing -remarkable seems to have been found except great gorging of the cerebral -vessels.[2239] - - - _Of Poisoning with Hemlock Dropwort._ - -The _Œnanthe crocata_ of botanists, the hemlock dropwort, -five-finger-root, or dead-tongue of vernacular speech in England, a -species of the same family with the last two, and an abundant plant in -some localities throughout this country, has usually been held one of -the most virulent of European vegetables. It seems well entitled to this -character in general; but climate, or some other more obscure cause, -renders it inert in some situations. - -It is said to be liable to be confounded with common hemlock, or _Conium -maculatum_,—a mistake which can happen only in very ignorant hands. It -has smooth, dark-green leaves, more fleshy, and much less minutely -divided, than those of hemlock; it presents a purplish appearance at the -joints only of the stem, and no diffused purple spots; its fruit is -oblong and black, not round, rough, and light brown; and its root, -instead of being single, long, tapering, and little branched, consists -of from two to ten tubers, like fingers, which are white, and terminate -in a few rootlets. These tubers are formed annually in summer from the -flowering stem of the season, and send out flowering stems the -subsequent year. During the first autumn, winter, and spring they are -firm, white, and amylaceous; but in their second summer they become more -pulpy, less amylaceous, and grayer. At all times they emit, when broken -across, an oleo-resinous juice, which quickly becomes yellow; this juice -abounds most when the plant, which is growing at their expense, is about -to flower; and it abounds much more at this period in localities in the -south of England, than in Scotland, especially in the neighbourhood of -Edinburgh. - -Brotero and some others have attempted to subdivide the species into -two, the _Œnanthe crocata_ proper, and the _Œ. apiifolia_. But the best -authorities deny that these can be distinguished; and from what I have -now seen in sundry localities, it appears to me that the distinctions -pointed out by Brotero, confessedly obscure enough in themselves, are -the result of differences in climate, soil, and situation. - -The only analysis of this plant with which I am acquainted is one -executed in 1830 by MM. Cormerais and Pihan-Dufeillay, who found in the -root a resinoid matter, which adheres obstinately to the solid portion -of it, and which seems to be the active ingredient.[2240] I have -subjected the roots to various processes, and among the rest to that by -which Geiger detected conia in hemlock, but without discovering any -indication of the existence of an alkaloid. My materials, however, were -not well fitted for a chemical analysis; because the œnanthe root of -this neighbourhood is inert or nearly so. The whole plant contains a -heavy-smelling volatile oil, which may be obtained by distillation in -the usual way, and most abundantly from the ripe seeds. This oil is -yellowish, viscid, and inert. - -It is strange that a plant, so universally considered a potent poison, -and so frequently the cause of fatal accidents, has not yet been made -the subject of physiological investigation. A few imperfect experiments -by M. Cormerais and his companion, made with the resinoid matter of the -roots, show that this substance produces in animals dulness, convulsions -of the voluntary muscles, a semi-paralytic state of the hind legs, and -sometimes shortness of breath, vomiting, and fluid evacuations by stool. -All the animals experimented on recovered. On repeating these -experiments with larger quantities I found the resin of the root, grown -near Woolwich, and kindly sent to me by Dr. Pereira, to be a poison of -great energy and singular properties. Twenty-four grains obtained from -eight ounces of roots in the middle of December, when introduced in the -form of emulsion between the skin and muscles of the rabbit, caused in -half an hour depression, uneasiness, and hurried breathing,—then -twitches of the ears, neck, and fore-legs,—next combined spasm and -convulsive starting of the head and limbs,—then, after a quiet interval, -a more violent fit of the same kind, affecting the whole body with a -singular combination of tetanus and convulsive starting,—finally, after -several such fits, a paroxysm more violent than before, ending in -immoveable tetanic rigidity, which speedily proved fatal, 78 minutes -after the application of the poison. No morbid appearance could be -detected in the body. The heart contracted vigorously for some time -after death. These phenomena correspond in the main with what has been -recorded of the symptoms caused by the roots in man.—Dr. Pereira informs -me he had found the juice both of the root and leaves to act as a -poison, either when introduced into the peritonæum, or when injected -into the veins; and in the latter way it was so energetic as to prove -fatal in one minute. - -_Symptoms in Man._—Since Lobel first took notice of the poisonous -properties of the œnanthe root in 1570, an uninterrupted series of -observations has been published, down to the present day, showing that -in France, Germany, Holland, Spain, and various parts of England as far -north as Liverpool, it is at all seasons of the year, even in October -and in the beginning of January, a poison of great activity. In several -of the cases death has been occasioned by a single handful of the roots, -in one instance by a piece no bigger than the finger, or even in -consequence of the individuals merely tasting them. A girl seems to have -had a narrow escape after eating, with an interval of three hours, two -pieces of the size of a walnut. Very seldom has death been delayed -beyond four hours, and on some occasions a single hour has been -sufficient. Sometimes the symptoms have been slow in making their -appearance, an hour and a half having occasionally elapsed before the -effects were evident; but in every instance their progress was rapid, -once the symptoms had fairly set in; and some died in convulsions almost -immediately after being taken ill. - -The particular effects have been variable. Most generally the first -symptoms have been giddiness and staggering, as if from ordinary -intoxication, occasionally headache, and often extreme feebleness of the -limbs. Stupor has then generally succeeded, sometimes with the -intervention of efforts to vomit, sometimes too with an interval of -delirium. Convulsions have also commonly made their appearance in the -next place; and ere long a state of insensibility has ensued attended in -every instance with occasional violent convulsive fits like epilepsy, -and with permanent locked-jaw; which symptoms have continued till near -death. In one or two cases the individual has suddenly, without any -premonitory symptoms, fallen down convulsed, and died almost -immediately. In one or two instances again, the effects have rather been -those of irritant poisoning, namely, inflammation of the mouth and -throat, spasms of the muscles of the throat, vomiting, and excessive -weakness and faintness, without any convulsions or insensibility.—It -appears then that this plant is a true narcotico-acrid poison. The -emanations from the plant are said on some occasions to have proved -injurious; but the effect here was probably the work of the imagination. - -Aware of these singular properties being generally ascribed to the -_Œnanthe crocata_, I was anxious to make a methodical examination of the -subject, physiologically as well as chemically,—especially as the plant -grows in great abundance and very luxuriantly in a locality not far from -Edinburgh. But I have found it in that situation, to all appearance, -quite inert. The juice of fourteen ounces of the root in the end of -October had no effect on a little dog when secured in the stomach by a -ligature on the gullet. The juice of sixteen ounces in the middle of -June was also without effect. An alcoholic extract of four ounces of the -full grown leaves in the end of June, introduced into the cellular -tissue in the form of emulsion, had no effect on a rabbit. An alcoholic -extract of three ounces of the ripe seeds was administered in the same -way with the same result. Finally, the resinoid extract of eight ounces -of the root, analogous to that which had proved so deadly in my hands -when obtained from Woolwich plants, had also no effect whatever, when -prepared from those growing in the neighbourhood of Edinburgh. Relying -upon these results, I ate a whole tuber weighing an ounce, without -observing any effect, except its disagreeable taste; which was the only -circumstance that prevented me from trying a larger quantity.—It may be -well to add, that, amidst the numerous cases of poisoning with œnanthe -now on record, there is not one that has occurred in Scotland. At the -same time, the common people in Scotland are not at all given to rash -experiments in cookery, or to make use of vegetables not produced by the -care of the gardener or farmer.[2241] - -The only other locality from which I have been hitherto able to obtain -plants for examination is the neighbourhood of Liverpool, where a fatal -case of poisoning with it occurred near the close of last century. When -the juice of sixteen ounces of this root in the beginning of September -was secured in the stomach of a dog, efforts to vomit were produced, -followed by several fits of violent convulsions and spasm of the -voluntary muscles, a paralytic state of the fore-legs, and a constant -tendency to fall backwards; but the animal recovered. - -No morbid appearances of any note have been observed after death in any -of the fatal cases which are recorded.—The most appropriate treatment -consists in the prompt employment of emetics, and diffusible stimulants. - - - _Of Poisoning with Fool’s Parsley._ - -Another umbelliferous plant of great activity is fool’s parsley, or -_Æthusa cynapium_. It has occasioned several accidents by reason of its -resemblance to parsley,—from which, however, it is at once distinguished -by the leaves being dark and glistening on their lower surface, and by -the nauseous smell they emit when rubbed. It contains an alkaloid, which -crystallizes in rhombic prisms, and is soluble in water and alcohol, but -not in ether. It was discovered by Professor Ficinus of Dresden.[2242] - -Orfila found that six ounces of the juice, when retained in the stomach -of a dog, by a ligature, caused convulsions and stupor, and death in an -hour.[2243] - -_Symptoms in Man._—Some interesting information on the characters and -properties of this plant is contained in the Medical and Physical -Journal. Among other cases the writer relates those of two ladies who -ate a little of it in a sallad instead of parsley, and who were soon -seized with nausea, vomiting, headache, giddiness, somnolency, pungent -heat in the mouth, throat, and stomach, difficulty in swallowing and -numbness of the limbs.[2244] Gmelin has related the case of a child, who -died in eight hours in consequence of having eaten the æthusa. The -symptoms were spasmodic pain in the stomach, swelling of the belly, -lividity of the skin, and difficult breathing.[2245] In two children who -recovered, the chief symptoms at the height of the poisoning were -complete insensibility, dilated, insensible pupil, and staring of the -eyes. In one of them there was also frequent vomiting, in the other -convulsions. The treatment consisted in the administration of milk, -sinapisms to the legs, and cold spunging with vinegar.[2246] - - - - - CHAPTER XXXV. - OF THE NARCOTIC RANUNCULACEÆ. - - -The greater part of the poisons belonging to the Natural Family -_Ranunculaceæ_ are acrid only in their action, and have been already -taken notice of among the irritants. Two only are yet known to possess -narcotic properties, namely, _monkshood_, and _black hellebore_. The -latter is a true narcotico-acrid. The former has till lately been always -considered so; but its acrid properties seem doubtful or feeble, while -its action on the nervous system is most intense. - - - _Of Poisoning with Monkshood._ - -Monkshood, the _Aconitum napellus_ of botanists, is an active poison, -and has commonly been considered a true narcotico-acrid. But its effects -have been hitherto much misunderstood. It has been used for criminal -purposes in Ireland; and in 1841, a woman, M’Conkey, who was executed -there for poisoning her husband, was proved to have administered this -substance [see p. 61]. The root of another species, the _A. ferox_, is -well known to be in common use as a poison, under the name of Bikh, in -Bengal, and Nabee, in the Madras Presidency. - -The toxicological history of the genus, and of this species in -particular, has been rendered complex and obscure, by the extreme -difficulty of distinguishing accurately the several species from one -another. The whole genus, now a numerous one, is generally conceived to -be eminently poisonous. But from some observations of my own, as well as -an elaborate inquiry, not yet made public, by Dr. Alexander -Fleming,[2247] a recent graduate of this university, I am inclined to -think that this is a mistake, that the poisonous species are not -numerous, and that many aconites are inert, at least in this climate. - -The _A. napellus_, a doubtful native of Britain, and the most common -species in our gardens, shoots up annually a leafy stem from a black, -tapering, spindle-shaped root. The stem, which is from two to five feet -high, ends in a long dense spike of fine blue flowers; and when the -seeds ripen in autumn, it dies down, and the root also shrivels and -perishes. But in the spring, while the stem is rising, one or more -tubers form near the crown of the root; each tuber quickly assumes the -spindle-shaped form of its parent, but has a light brown, instead of a -brownish-black tegument; and when the plant is in flower, the new tuber, -destined for the root of next year’s plant, is as large as the parent -one, firmer, more amylaceous, and not so apt to shrivel in drying. This -mode of propagation has led some to describe the root erroneously as -sometimes palmated. Dr. Fleming considers the young, full-grown tuber to -be the most active part of the plant; but the root of the existing -plant, the leaves, and also the seeds, are highly energetic; and every -part is more or less so. - -Every part of the _A. napellus_, but especially the root, affects -remarkably the organs of taste, producing a very singular sense of heat, -numbness, and tingling of those parts of the mouth to which it is -applied. Dr. Fleming has ascertained, that this peculiar taste, or -rather sensation, is a property belonging to the narcotic principle of -monkshood, and that in all probability it is a measure of the activity -of the plant as a poison. It is most intense in the root, next in the -seeds, and next in the leaves before the flowers blow. Geiger first -ascertained, and I have since observed, that the sensation thus -occasioned by the leaves diminishes in intensity as the flowers expand, -and almost disappears when the seeds ripen. Contrary to what has been -often stated, it is not diminished by drying the leaves, even with the -heat of the vapour-bath. Nor is it materially lessened by time, if the -dried leaves be preserved with care; for I have found it intense after -six years. Geiger observed some years ago, that several species or -varieties do not possess it. I have ascertained that _A. napellus_, -_sinense_, _tauricum_, _uncinatum_, and _ferox_, possess it intensely, -_A. schleicheri_ and _nasutum_ feebly, _A. neomontanum_ very feebly; all -of which are therefore probably poisonous, in proportion to the -intensity of their taste. _A. ferox_, well known as a deadly poison in -the East, and undoubtedly the most virulent of all the species, produces -by far the most intense and persistent effect on the mouth of all the -species I have had an opportunity of examining. Those which do not -produce it at all, at least in this climate, are _A. paniculatum_, -_lasiostomum_, _vulparia_, _variegatum_, _nitidum_, _pyrenaïcum_, and -_ochroleucum_. It would be premature to say that all these species are -inert; but I suspect they are: and, at all events, I have ascertained -that the leaves of _A. paniculatum_, although the officinal species -recognised in the London Pharmacopœia, are quite inactive in this -climate; and Dr. Fleming has found the root inert in medicinal doses of -considerable magnitude. - -The properties of monkshood have been traced by Geiger and Hesse to a -peculiar alkaloid, named aconitina: which is white, pulverulent, -fusible, not volatile, soluble in ether and alcohol, sparingly so in -water, and capable of forming crystallizable salts with acids. It -produces most intensely the peculiar impression caused by the plant on -the mouth, tongue, and lips; and it is a poison of tremendous activity, -probably indeed the most subtle of all known poisons. Although not a -volatile principle, it has been supposed peculiarly liable to -decomposition by heat, at least in its natural state of combination in -the plant or its pharmaceutic preparations. This opinion is founded on -the uncertainty of the medicinal action of the common extract of the -shops, and on the results of experiments on animals by Orfila.[2248] In -one experiment he found that half an ounce of the extract of the -Parisian shops had no effect at all on a dog, while a quarter of an -ounce killed another within two hours. Careless preparation may account -for such differences; but at the same time an error in choosing the -species of plant is an equally probable explanation. The properties of -monkshood appear to me to resist a heat of 212°, either in drying the -plant or in preparing an extract from it. - -The medico-legal chemistry of monkshood has not been studied. If any of -the suspected matter be obtained in a pure state, its best character is -its remarkable taste; to which I have found nothing exactly similar in -the numerous trials I have made with other narcotic and acrid plants. A -complex substance, such as the contents of the stomach, or vomited -matter, should be evaporated over the vapour-bath to the consistence of -thin syrup, and agitated with absolute alcohol. The filtered alcoholic -solution being then evaporated, the extract may be subjected to the -sense of taste. - -_Action._—The action of monkshood is a subject of great interest, but -has hitherto been much misunderstood. Sir B. Brodie, who was the first -to examine it in recent times, found that the leading phenomena in -animals, were staggering, excessive weakness, slow laborious -respiration, and slight convulsive twitches before death.[2249] Had -these observations been followed up by his successors with a -discriminating eye, toxicologists would not have been so much misled as -they have been. Orfila, who was the next to examine the subject -experimentally, failed to appreciate the phenomena with exactness.[2250] -He thinks monkshood acts peculiarly upon the brain, causing delirium, -and that it is a local irritant, capable of developing more or less -intense inflammation. A single experiment made in 1836 convinced me that -the former statement is incorrect, and led me to consider that the -symptoms depend in a great measure on gradually-increasing paralysis of -the muscles, which terminates in immobility of the chest and diaphragm, -and consequent asphyxia. Dr. Pereira, in some experiments with an -alcoholic extract, published in 1842, took notice of two remarkable -phenomena,—an extraordinary diminution of common sensation, evidenced by -the animal being insensible to pinching and pricking,—and the total -absence of stupor, as shown by the animal following its owner, and -recognizing him when called.[2251] Similar observations have been made -in poisoning with monkshood in man. The ablest investigation yet -undertaken into the actions of this substance is contained in the -unpublished Inaugural Dissertation of Dr. Fleming. - -He found that the most remarkable symptoms are weakness and staggering, -gradually increasing paralysis of the voluntary muscles, slowly -increasing insensibility of the surface, more or less blindness, great -languor of the pulse, and convulsive twitches before death. He farther -observed that the pupil becomes much contracted; that the irritability -of the voluntary muscles is impaired; that the veins are congested after -death, the blood unaltered, and the heart capable of contracting for -some time after respiration has ceased. Lastly, he maintains that this -poison has not, as is generally thought, any irritant properties, that -neither the plant, nor its extract, nor its alkaloid occasions -vascularity in any membrane to which it is applied, even, for example, -in the lips or tongue while burning and tingling from its topical -action; that this peculiar effect is therefore merely a nervous -phenomenon; and that he never could observe either the diffuse cellular -inflammation described by Orfila to arise from the application of -monkshood to a wound, or the inflammatory redness of the alimentary -canal noticed by others as one of its effects when swallowed. - -Orfila ascertained that monkshood exerts its action through the medium -of the blood; for its effects are greater when it is introduced into a -wound, than when it is swallowed, and they are still greater when it is -injected directly into a vein. It is a poison of very great activity. I -have found that thirty grains of an alcoholic extract, the produce of -three-quarters of an ounce of fresh leaves, will kill a rabbit in two -hours and a quarter, if introduced between the skin and muscles of the -back. Five drachms of the root in one of Orfila’s experiments with the -dog, occasioned death in twenty-one minutes, when swallowed. - -The alkaloid, aconitina, seems to produce in animals precisely the same -effects as the plant or its extract. Orfila and Dr. Pereira agree in -this; and my own observation, limited to a single experiment, is to the -same effect. It is probably the most subtile of all known poisons. Dr. -Pereira mentions that the fiftieth part of a grain has endangered life -when used medicinally.[2252] In my experiment the tenth of a grain, -introduced in the form of hydrochlorate into the cellular tissue of a -rabbit, killed it in twelve minutes. - -_Symptoms in Man._—A perplexing discrepance exists in the accounts that -have been published of the effects of monkshood on man; which seems to -have arisen, less from any actual contrariety in the phenomena, than -from loose observation, or a misunderstanding of the facts; for most of -the recent statements of competent observers are consistent with one -another. - -Dr. Fleming says that in medicinal doses it occasions warmth in the -stomach, nausea, numbness and tingling in the lips and cheeks, extending -more or less over the rest of the body, diminution in the force and -frequency of the pulse, which sometimes sinks to 40 in the minute, great -muscular weakness, confusion of sight or absolute blindness; and if the -dose be unduly large, there is a sense of impending death, sometimes -slight delirium, and a want of power to execute what the will directs, -but without any loss of consciousness. The warmth which is excited is -unattended with any elevation of temperature, vascularity of the skin, -or acceleration of the pulse. No true hypnotic effect is produced; but -by inducing serenity, or deadening pain, it may predispose to sleep. The -highest degree of these effects is not unattended with danger. - -When it is administered in doses adequate to occasion death, it seems in -general to operate by inducing extreme depression of the circulation. -Dr. Fleming recognizes two other modes of death in animals,—first, by an -overwhelming depression of the nervous system, proving fatal in a few -seconds, without arresting the action of the heart,—and secondly, by -asphyxia, or arrestment of the respiration, the result of paralysis -gradually pervading the whole muscular system, respiratory, as well as -voluntary. But these effects, he thinks, cannot be recognized in the -cases which have been published of poisoning in man, because the dose -required to produce either of them is very large. The least variable -symptoms in the human subject are, first, numbness, burning, and -tingling in the mouth, throat, and stomach,—then sickness, vomiting, and -pain in the epigastrium,—next, general numbness, prickling, and impaired -sensibility of the skin, impaired or annihilated vision, deafness, and -vertigo,—also frothing at the mouth, constriction at the throat, false -sensations of weight or enlargement in various parts of the body,—great -muscular feebleness and tremor, loss of voice, and laborious -breathing,—distressing sense of sinking and impending death,—a small, -feeble, irregular, gradually-vanishing pulse,—cold, clammy sweat and -pale bloodless features,—together with perfect possession of the mental -faculties, and no tendency to stupor or drowsiness,—finally, sudden -death at last, as from hemorrhage, and generally in a period varying -from an hour and a half to eight hours. The symptoms may begin in a few -minutes, as in a case observed by Dr. Fleming, which was occasioned by -the tincture of the root; or they may be postponed for three-quarters of -an hour, as in an instance recorded by Dr. Pereira,[2253] which arose -from the root being used by mistake for horse-radish. Two or three -drachms of the root are sufficient to kill a man; and Dr. Fleming -mentions one instance where two grains of the alcoholic extract -occasioned alarming effects, and another where four grains proved fatal. -I may observe, however, that I have given six grains of a carefully -prepared alcoholic extract (the same of which thirty grains killed a -rabbit in little more than two hours), to a female suffering from -rheumatism, without being able to observe any effect whatsoever. - -If all the reports of cases now on record are to be trusted, the -following anomalies have occurred. Some persons are said to have -presented convulsions. Slight spasmodic twitches of the muscles are not -uncommon, and probably depend, as Dr. Fleming suggests, on venous -congestion, the result of incomplete asphyxia. Stupor and even -apoplectic insensibility are also sometimes represented to have been -observed. If really ever present, they must depend on the same cause; -but there is reason to apprehend, that extreme nervous depression and -faintness have been mistaken for stupor and coma. Delirium of the -frantic kind, mentioned by some of the older authors, is justly -considered by Dr. Fleming to be of doubtful occurrence, as it has never -been observed in recent times. Irritation in the alimentary canal is -distinctly mentioned as indicated by prominent symptoms, even in some -cases observed but a few years ago, and apparently with care. Dr. -Fleming properly objects to nausea, vomiting, or pain in the epigastrium -as evidence of irritation in the stomach; for these symptoms may all -depend on the same local nervous impression which is produced on the -organs of taste. And he denies that purging is ever produced in any -genuine case of poisoning with monkshood. The following, however, seem -unequivocal examples of irritation in the alimentary canal. M. -Pallas[2254] mentions, that three out of five persons, who took a -spirituous infusion of the root by mistake for lovage [_Ligusticum -levisticum_], died in two hours with burning in the throat, vomiting, -colic, swelling of the belly and purging. A similar set of cases is -described by M. Degland.[2255] Four persons took the tincture of the -root by mistake for tincture of lovage; and three of them were seized -with burning pain from the throat to the stomach, a sense of enlargement -of the tongue and face, colic, tenderness of the belly, vomiting, and -purging. One of these, who ultimately recovered, had frantic delirium -for some time after the other symptoms went off. The two others died, -one in two hours, the other half an hour later. Dr. Pereira[2256] and -Dr. Fleming doubt the authenticity of these cases; and it may be, that -such unusual symptoms may have arisen either from some other root -mistaken by the narrators for monkshood, or from irritant substances -given along with or after it. At the same time I may mention, that in -the first trials I made with monkshood as a medicine, using a carefully -prepared extract of the root, I was deterred from proceeding by two -patients being attacked with severe vomiting, griping, and diarrhœa. - -It may be well to conclude these general statements by the particulars -of a few well authenticated cases. Dr. Pereira describes two that were -occasioned by the root having been dug up in February by mistake for -horse-radish.[2257] The parties, a gentleman and his wife, ate, the -former about a root and a half, the latter not much more than half a -root. Both of them in three-quarters of an hour had burning, and -numbness in the lips, mouth, and throat, extending to the stomach and -followed by vomiting. The husband had subsequently violent and frequent -vomiting, partly owing to an emetic. His extremities became cold, the -lips blue, the eyes glaring, and the head covered with cold sweat. There -was no spasm or convulsion, but some tremor. He had no delirium, or -stupor, or loss of consciousness, but complained of violent headache. -The respiration was not affected; and although he felt very weak, he was -able to walk with a little assistance only a few minutes before death; -which took place, as if from fainting, about four hours after the poison -was swallowed.—His wife, in addition to the early symptoms already -mentioned, had such weakness and stiffness of the limbs that she was -unable to stand; and she could utter only unintelligible sounds; but she -had no spasms or convulsions. She experienced a strange sensation of -numbness in the hands, arms, and legs, diminution of sensibility over -the whole integuments, especially of the face and throat, where the -sense of touch was almost extinguished. She had also some dimness of -vision, giddiness, and at times an approach to loss of consciousness, -but no delirium, sleepiness, or deafness. She recovered, under the use -of emetics, laxatives, and stimulants. In neither of these cases was -there any diarrhœa.—A patient of Mr. Sherwen,[2258] five minutes after -taking a tincture of the root, suffered from the same incipient symptoms -as above, but without actual vomiting. The face seemed to her to swell, -and the throat to contract; she became nearly blind, and excessively -feeble, but did not lose her consciousness. The eyes were fixed and -protruded, and the pupils contracted, the jaws stiff, the face livid, -the whole body cold, the pulse imperceptible, the heart’s action feeble -and fluttering, and the breathing short and laborious. An emetic was -followed first by violent convulsions, and then by vomiting; after which -she slowly recovered. At all times she was so sensible as to be able to -tell how the accident happened.—Dr. Ballardini of Brescia met with -twelve simultaneous cases of poisoning with the juice of the leaves, -used by mistake for scurvy-grass [_Cochlearia officinalis_]. Each person -had three ounces of juice. Three of them died in two hours; but the rest -were saved. The chief symptoms were extreme weakness and anxiety, -paleness and distortion of the features, dilatation of the pupils, -dulness of the eyes, giddiness, headache, chiefly occipital, some -distension and pain of the belly, vomiting of a green matter, and in -some diarrhœa. The whole body was cold, the nails livid, the limbs -cramped, the pulse small and scarcely perceptible. In the fatal cases -there were convulsions.[2259]—MM. Pereyra and Perrin mention, that, -while using the alcoholic extract in the Hospital of St. André at -Bordeaux, the sample of the drug happened to be changed when the dose -had been raised so high as ten grains; and that the patients who were -taking it were then all seized with burning in the mouth and throat, -vomiting, pungent pains in the extremities, cold sweating, anxiety, -extreme general prostration, great slowness and irregularity of the -pulse, convulsions, and congestion in the venous system. One patient -died; the others recovered under no other treatment than stimulant -friction along the spine.[2260] An infant at Suippe, in the French -Department of the Marne, ate a few leaves and flowers of monkshood, -while walking in a garden. Soon afterwards he began to stagger as if -tipsy, and to complain of pain in the belly. In two hours an emetic was -given; but a few minutes afterwards, the eyes became convulsed, the jaws -locked, the trunk bent rigidly backward, and the limbs convulsed; and -death ensued in five minutes more.[2261] - -_Morbid Appearances._—In Ballardini’s fatal cases the pia mater and -arachnoid were much injected; there was much serosity under the -arachnoid and in the base of the cranium; the lungs were considerably -gorged with blood; the heart and great vessels contained but a little -black fluid blood: the villous coat of the stomach was spotted with red -points; and the small intestines presented inwardly red patches and much -mucus. In the Bordeaux case there was venous congestion in the head and -chest, the lungs particularly being much gorged with blood. The right -side of the heart was full of blood, of gelatinous consistence. In -Pallas’s cases the gullet, stomach, small intestines and rectum were -very red, the lungs dense, dark, and gorged, and the cerebral vessels -turgid. - -Few trustworthy observations have been made on the effects of the other -species of aconite. Dr. Pereira found the A. ferox of the East Indies to -be a much more deadly poison to animals than common monkshood; but its -effects were otherwise identical.[2262] Three grains of the root put -into the throat of a rabbit, killed it in nineteen minutes; one grain of -the alcoholic extract, introduced into the peritonæum, proved equally -deadly. Nine grains will kill a cat in four hours.[2263]——Of the other -aconites the A. cammarum, and A. lycoctonum are said to have proved -fatal frequently in Germany; but no accurate facts on the subject are on -record.—It was stated above that the A. paniculatum, supposed by De -Candolle to have been the true aconite of Baron Störck, is inert in this -country. I introduced the alcoholic extract of three ounces of the fresh -leaves collected near the end of June, into the cellular tissue between -the skin and muscles of a young rabbit, having previously converted the -extract into an emulsion with mucilage and water. This was four times -the dose of A. napellus, which I had found sufficient to kill a strong -adult rabbit in two hours and a quarter; but no effect whatever was -produced.—Mr. Ramsay of Broughty Ferry has described a case of fatal -poisoning with a handful of aconite leaves which were mistaken for -parsley, and which he supposes to have been those of A. neomontanum. The -subject, a boy of fourteen, was attacked with a sense of burning in the -mouth, throat, and stomach, afterwards with vomiting and convulsions, -and died considerably within five hours.[2264] The very feeble taste of -this species—which besides is little cultivated in Scotland,—inclines me -to doubt whether it was the species that produced such violent effects. - - - _Of Poisoning with Black Hellebore._ - -Black hellebore, or Christmas-rose, the _Helleborus niger_ of botanists, -is a true narcotico-acrid poison. It is a doubtful native of this -country. It produces a large white ranunculus-like flower about -midwinter. The root, the only part used in medicine, or to be found in -the shops, consists of a short root-stock and numerous, long, black -undivided rootlets. The fresh root in January is not acrid to the taste. -Its active principle appears from the researches of MM. Feneulle and -Capron, to be an oily matter containing an acid.[2265] - -Its action has not yet been examined with particular care. Two or three -drachms of the root killed a dog in eighteen hours, when swallowed; two -drachms killed another in two hours, when applied to a wound; and six -grains in a wound caused death in twenty-three hours. In all cases the -leading symptoms are efforts to vomit, giddiness, palsy of the -hind-legs, and insensibility.[2266] Ten grains of the extract introduced -into the windpipe killed a rabbit in six minutes.[2267] Orfila found -redness of the rectum, when the animals survived a few hours. But none -of these experiments show the powerful irritant action exerted by the -root upon man. - -The Bulletins of the Medical Society of Emulation mention two cases of -poisoning with hellebore, which arose from the ignorance of a quack -doctor. Both persons, after taking a decoction of the root, were seized -in forty-five minutes with vomiting, then with delirium, and afterwards -with violent convulsions. One died in two hours and a half, the other in -less than two hours.[2268] Morgagni has related a case which proved -fatal in about sixteen hours, the leading symptoms of which were pain in -the stomach, and vomiting. The dose in this instance was only half a -drachm of the extract.[2269] In a case not fatal, related by Dr. -Fahrenhorst, the symptoms were those of irritant poisoning generally, -that is, burning pain in the stomach and throat, violent vomiting, to -the extent of sixty times in the first two hours, cramps of the limbs, -and cold sweating. The most material symptoms were at this time quickly -subdued by sinapisms to the belly and anodyne demulcents given -internally; and in four days the patient was well. The dose here was a -table-spoonful of the root in fine powder.[2270] In small doses of ten -or twenty grains, it is well known to be a powerful purgative to man. I -have known severe griping produced by merely tasting the fresh root in -January. - -The morbid appearances in Morgagni’s case were the signs of inflammation -in the digestive canal, particularly in the great intestines. In the -case described in the French Bulletins, there was gorging of the lungs, -and the stomach had a brownish-black colour as if gangrenous. - -The other species of hellebore have not been carefully examined; but it -is probable that they all possess similar properties. The _H. hyemalis_ -and _viridis_ are said by Buchner to be weaker than the _H. niger_; and -the _H. fœtidus_ is the most poisonous of all.[2271] - - - - - CHAPTER XXXVI. -OF POISONING WITH SQUILL, MEADOW-SAFFRON, WHITE HELLEBORE, AND FOXGLOVE. - - -The natural family _Liliaceæ_, and the allied family, _Melanthaceæ_, -contain many species which possess narcotico-acrid properties. Those -which are best known in Europe are squill, meadow-saffron, cevadilla, -and white hellebore. To these may be added foxglove, as possessing -properties in some measure analogous, and also rue and ipecacuan. - - - _Of Poisoning with Squill._ - -The root of the squill, or _Squilla maritima_, possesses the properties -of the narcotico-acrids. Orfila’s experiments on animals, indeed, assign -to it only an action on the nervous system. He found that two ounces and -a half of the fresh root, when secured in the stomach of a dog by a -ligature on the gullet, excited efforts to vomit, dilated pupil, and -lethargy; and in two hours the animal suddenly fell down in a violent -fit of tetanus, and expired. From thirty-six grains injected into the -jugular vein no effect followed for sixteen hours; when at last, as in -the former case, the animal dropped down convulsed and died -immediately.[2272] - -The effects, however, caused by squill on man leave no doubt that it is -also an active irritant; for it causes sickness, vomiting, diarrhœa, -gripes, and bloody urine, when given in over-doses. It has likewise -produced narcotic symptoms in man. Lange mentions an instance of a -woman, who died from taking a spoonful of the root in powder to cure -tympanitis. She was immediately seized with violent pain in the stomach; -and in a short time expired in convulsions. The stomach was found every -where inflamed, and in some parts eroded.[2273]—A woman, whose case is -mentioned in a French journal, after taking from a female quack a vinous -tincture made with seventy-five grains of extract of squill, was seized -with nausea and severe colic, to which were added in twenty-four hours a -small contracted pulse, extreme tenderness of the belly, and cold -extremities; and she died in the course of the second day.[2274] -Twenty-four grains of the powder have proved fatal.[2275] I have seen a -quarter of an ounce of the syrup of squills, which is a common medicinal -dose, cause severe vomiting, purging, and pain. - -An acrid principle, named scillitin, has been discovered in the squill. -A difference of opinion prevails as to its nature. Some chemists -consider it to be a resin; but Landerer has obtained it in the -crystalline form, with alkaline properties. A grain of it will kill a -dog. - - - _Of Poisoning with White Hellebore and Cevadilla._ - -White hellebore, the root-stock of _Veratrum album_, and cevadilla, the -seed and capsules of _Asagræa officinalis_, and possibly of _Veratrum -sabadilla_, seem to be characteristic examples of the narcotico-acrid -poisons. They both possess a strong bitter taste, followed by acridity. -The cevadilla-seed in particular has an intensely disagreeable and -persistent bitter taste, and produces at the same time a combination of -acridity and numbness of the lips, tongue, and cheeks. They owe their -active properties chiefly to an alkaloid of great energy, termed -veratria. - -White hellebore root is familiarly known to be a virulent poison. The -best account of its effects is contained in a Thesis by Dr. Schabel, -published at Tübingen in 1817. Collecting together the experiments -previously made by Wepfer, Courten, Viborg, and Orfila, and adding a -number of excellent experiments of his own, he infers that it is -poisonous to animals of all classes,—horses, dogs, cats, rabbits, -jackdaws, starlings, frogs, snails, and flies;—that it acts in whatever -way it is introduced into the system,—by the stomach, rectum, windpipe, -nostrils, pleural membrane of the chest, an external wound, or the -veins;—that it produces in every instance symptoms of irritation in the -alimentary canal, and injury of the nervous system;—and that it is very -active, three grains of the extract applied to the nostrils of a cat -having killed it in sixteen hours.[2276] - -_Symptoms in Man._—Its effects on man are similar. A singular account of -several cases of poisoning with the root is contained in Rust’s Journal. -A family of eight people, in consequence of eating bread for a whole -week, in which the powder of the root had been introduced by mistake -instead of cumin seeds, were attacked with pains in the belly, a -sensation as if the whole intestines were wound up into a clue, swelling -of the tongue, soreness of the mouth, and giddiness; but they all -recovered by changing the bread and taking gentle laxatives.[2277] - -Another set of cases of a more aggravated nature, though still not -fatal, is given in Horn’s Archives.[2278] Three people took the root by -mistake for galanga. The symptoms that ensued were characteristic of its -double action. In an hour they all had burning in the throat, gullet, -and stomach, followed by nausea, dysuria, and vomiting; weakness and -stiffness of the limbs; giddiness, blindness, and dilated pupil; great -faintness, convulsive breathing, and small pulse. One of them, an -elderly woman, who took the largest share, had an imperceptible pulse, -stertorous breathing, and total insensibility even to ammonia held under -the nose. Next day she continued lethargic, complained of headache, and -had an eruption like flea-bites. A fatal case is quoted by Bernt from -Schuster’s Medical Journal. A man took twice as much as could be held on -the point of a knife, was attacked with violent and incessant vomiting, -and lived only from morning till night. The gullet, stomach, and colon -were here and there inflamed.[2279] - -No detailed inquiry has yet been made respecting the properties of -cevadilla; but there can be no doubt that it will prove an energetic -poison, similar in its effects to white hellebore, and probably more -active. Wibmer quotes Villemet for the fact, that half a drachm of the -seeds excites vomiting and convulsions in the cat and dog, and Lentin -for the case of a child, who died in convulsions in consequence of the -powder having been used inwardly and outwardly.[2280] - -The alkaloid, veratria, has been made the subject of experiment by -various physiologists. The most complete investigation yet undertaken is -that of Dr. Esche;[2281] who found that it causes in a few minutes -restlessness, anxiety, salivation, slowness and irregularity of the -pulse, slow respiration, nausea, violent vomiting, borborygmus, spasms -of the abdominal muscles and brisk purging of watery mucus, often tinged -with blood;—that by and by the muscles become extremely feeble, so that -the animal cannot support itself;—that coldness of the surface succeeds, -together with spasmodic contractions of the throat, face, and -extremities, but without any stupor;—and that finally the respiration -and pulse gradually become extinguished, extreme prostration ensues, and -death takes place in a fit of tetanic spasm. No particular morbid -appearance was found in the dead body, and especially no sign of -inflammation. Magendie found, that one grain in the form of acetate -killed a dog in a few seconds when injected into the jugular vein, and -in nine minutes when injected into the peritonæum; and that the -principal symptom in such rapid cases was tetanic spasm. - - - _Of Poisoning with Meadow-Saffron._ - -The _Colchicum autumnale_, meadow-saffron, or autumn-crocus, is a more -familiar poison in this country than white hellebore, and seems to -possess very similar properties. Two parts of the plant are met with in -the shops, the _cormus_ or bulb, and the seeds; both of which are -poisonous. Both have a strong, disagreeable, persistent, bitter taste. -The seeds, and probably the bulb also, contain a bitter crystalline -principle, called colchicina, which is soluble in water, neutralizes -acids, and possesses intense activity as a poison. - -A good physiological investigation into the action of colchicum as a -poison is still wanting. Baron Störck found that two drachms of the -dried bulb caused in dogs violent diarrhœa and diuresis, ending -fatally.[2282] Sir Everard Home observed that the active part of about -two drachms dissolved in sherry, caused in a dog, when injected into the -jugular vein, slow respiration, languor of the pulse, vomiting, -diarrhœa, extreme prostration, and death in five hours.[2283]—Geiger and -Hesse, the discoverers of colchicina, gave a cat a tenth of a grain, -which occasioned salivation, vomiting, purging, staggering, extreme -languor, colic, and death in twelve hours.[2284] - -The effects of colchicum on man, like those observed in animals, rather -associate it with the acrid than with the narcotic poisons. - -In the Edinburgh Journal a case is briefly noticed of a man who took by -mistake an ounce and a half of the wine of the bulb, and died in -forty-eight hours, after suffering much from vomiting, acute pain in the -stomach, colic, purging, and delirium.[2285]—Chevallier has described a -similar case arising from the wine of the bulb having been given -intentionally as a poison. In a few minutes burning pain, urgent thirst, -and frequent vomiting of mucus ensued; and death took place in three -days.[2286]—Three American soldiers, who drank by mistake a large -quantity of colchicum wine prepared from the bulb, died with similar -symptoms. One of them, who took eighteen ounces, and died in two days, -presented the leading symptoms of malignant cholera, namely, frequent -vomiting, copious rice-water stools, cramps of the abdominal muscles and -flexion of the extremities, coldness of the skin, tongue, and breath, -blueness of the nails, dull, sunken eyes, contracted pupils, and -collapse of the features. The two others had at first similar symptoms, -which passed into those of chronic dysentery, and proved fatal in a few -weeks.[2287]—M. Caffe has related the case of a young lady who destroyed -herself by taking five ounces of the wine containing the active matter -of rather more than the fourth part of one bulb. She was soon seized -with acute pain in the stomach, then with frequent vomiting, general -coldness and paleness, a sense of tightness in the chest and oppression -of the breathing, a slow thready pulse, and extreme prostration,—and -subsequently with severe and constant cramps in the soles of the feet. -In eleven hours she had less frequent efforts to vomit, but was -excessively exhausted; in twenty hours the pulse was imperceptible; and -in two hours more she died. There was no suppression of urine, no -purging, no diminution of sensibility, delirium, convulsions, or change -in the state of the pupils.[2288] About a twelvemonth afterwards the -sister of this patient put an end to herself with the same preparation, -of which she took the same quantity; and she died, with precisely the -same symptoms, in twenty-eight hours.[2289] M. Ollivier met with two -cases of death within twenty-four hours, in consequence of a tincture -being taken which contained the active part of forty-eight grains of the -dry bulb; and a third case of death in three days caused by three doses -of a watery decoction made each time with 46 grains of the bruised bulb -collected in July. Severe purging and prostration followed each dose. -There was no symptom of any affection of the brain.[2290]—Mr. Henderson -describes a case occasioned by an ounce of the tincture. No injury -accrued for three hours. The patient then had gnawing pain in the -stomach followed by vomiting, and then by purging, at first bilious, -afterwards watery, and attended with numbness in the feet, and -subsequently a sense of prickling. In the course of the second day there -was intense gnawing pain in all the joints of the extremities, profuse -acid sweating, tightness in the head, and pain in the hindhead and nape -of the neck. Blood-letting, laxatives, and hyoscyamus were employed with -success; but the case seems very nearly to have proved fatal.[2291] - -The seeds produce similar effects. Bernt has noticed the cases of two -children who were poisoned by a handful of colchicum seeds, and who -died in a day, affected with violent vomiting and purging.[2292] Mr. -Fereday of Dudley relates a carefully detailed case of a man who died -in forty-seven hours after swallowing by mistake two ounces of the -wine of the seeds, and in whom the symptoms were acute pain, coming on -in an hour and a half, then retching, vomiting, and tenesmus, feeble -pulse, anxious expression, afterwards incessant coffee-coloured -vomiting, suppression of urine, excessive weakness of the limbs and -feeble respiration, and, for a short period before death, profuse, -dark, watery purging. There was neither insensibility nor -convulsions.[2293]—Blumhardt relates a similar case caused by an -infusion of a large table-spoonful of the seeds. In three-quarters of -an hour the man was seized with griping, and then profuse diarrhœa and -vomiting. Next morning, twelve hours after the poison was taken, his -physician found him still affected with vomiting and purging, but not -with pain. He seemed, indeed, to suffer so little, and to improve so -much under the use of emollients, that he was thought to be fairly -recovering. But next day the pulse was almost imperceptible, the -countenance and extremities were cold, the voice hoarse, the breathing -hurried, the eyes sunk, the pupils dilated, the epigastrium tender, -and the forehead affected with pain; and he died at twelve the same -day.[2294] - -The leaves, too, are poisonous. Dr. Bleifus has related a case in proof -of this. A man gathered the leaves in the middle of May, and, after -cooking them, ate about two ounces for supper. In six hours he was -seized with violent colic, vomiting, and purging. In fifteen hours, when -his physician first saw him, the countenance was ghastly as in malignant -cholera, the pupils dilated and scarcely contractile, but the mind -entire. He complained of rheumatic pains in the neck, and burning pain -in the pit of the stomach. He had frequent vomiting and purging, spasms -of the muscles of the belly, coldness of the skin, a slow, small, wiry -pulse, and cramps of the fingers and the calves of the legs. Coffee and -lemon-juice allayed the vomiting, and a temporary amendment ensued. But -early on the third morning he became worse, and soon afterwards the -narrator of the case found him dying.[2295] - -The flowers are not less poisonous than the bulbs, leaves, and seeds. A -case is noticed in Geiger’s Journal of poisoning with a decoction of -some handfuls of the flowers, where death occurred within twenty-four -hours, under incessant colic, vomiting and purging.[2296] - -Doubts exist as to the degree of activity of colchicum. Some -practitioners direct half an ounce of the tincture of the seeds to be -given as a medicinal dose,[2297] even four times a day.[2298] Others -administer from one to two drachms night and morning. According to more -general experience, these are dangerous doses. Dr. Lewins, junior, has -seen dangerous symptoms from a drachm given thrice a day for a -week;[2299] a fatal case occurred a few years ago in the Edinburgh -Infirmary, from this amount having been given for a few days only; I -have known very violent effects produced by half an ounce taken by -mistake, although most of it was brought away by emetics in an hour; -and, in medical practice, I have seldom seen the dose of a sound -preparation gradually raised to a drachm thrice a day, without such -severe purging and sickness ensuing as rendered it prudent to diminish -or discontinue the remedy. There is no doubt, however, that larger doses -have occasionally been taken without any ill effect. Constitutional -peculiarity can alone account for such differences in the instance of -the tincture of the seeds. As to the preparations of the bulb, an -additional source of diversity of effect is a difference in the activity -of the bulb according to season. On this point no accurate facts have -yet been brought forward. The bulb is usually directed to be gathered in -July, when it is most plump and firm, and most charged with starch. -Orfila, however, says that three bulbs, collected at this time, had no -effect whatever on a dog;[2300] and Buchner maintains that it is most -energetic in the autumn, when the flowering stem is rising.[2301] I -suspect, on the other hand, that it is very energetic in the spring, -when it is watery, more membranous, and shrivels much in drying; for it -is then very bitter. - -The morbid appearances are chiefly those of inflammation of the -alimentary canal. - -In the bodies of the children mentioned by Bernt there was considerable -redness of the stomach and small intestines; in Geiger’s case -inflammation of the stomach and duodenum only; in the case mentioned in -the Edinburgh Journal, and in that related by Chevallier, there was no -morbid appearance at all to be found. In Mr. Fereday’s case the omentum -was curled and folded up between the stomach on the one hand, and the -liver and diaphragm on the other; the stomach and intestines were coated -with much mucus; there was no appearances of inflammation there but on -two points, one in the stomach, the other in the jejunum, where a red -patch appeared, owing to blood effused between the muscular and -peritoneal coats; the bladder was empty, the pleura red, the lungs much -gorged, their surface, as well as that of the diaphragm and heart, -covered with ecchymosed spots; and the skin over most of the body -presented patches of a purple efflorescence.—In Blumhardt’s case the -muscles were rigid twenty-three hours after death; the heart and great -vessels contained coagulated blood; the cardiac end of the gullet was -internally dark-violet; the stomach externally of a clear violet hue, -and its veins turgid; the gall-bladder turgid with greenish-yellow bile; -and the inner membrane of the whole small intestines chequered here and -there with red, inflamed-like spots.[2302]—In one of M. Caffe’s cases -there was congestion of the cerebral vessels, coagulated blood in the -heart, uniform grayness, softness, and brittleness of the mucous coat of -the stomach, and enlargement of the muciparous follicles of the small -intestines, as well as unusual distinctness and lividity of the Peyerian -glands. In the other case putrefaction was so far advanced in -forty-eight hours as to make the appearances equivocal. - -The treatment consists in evacuation of the stomach and bowels by -emetics and oleaginous laxatives in the early stage, and afterwards in -the employment of opium, stimulants, the warm bath, and occasionally -blood-letting. - - - _Of Poisoning with Foxglove._ - -Foxglove, or _Digitalis purpura_, a plant which is common in this -country both as a native and in gardens, possesses powerful and peculiar -properties. The leaves are considered its most active part. They contain -an alkaloid; but chemists have not fixed its nature with precision. M. -Le Royer of Geneva procured a pitchy, deliquescent, uncrystallizable -substance;[2303] but more lately M. Pauguy obtained a principle in fine -acicular crystals, soluble in alcohol and ether, but insoluble in water, -alkaline in its reaction, and of a very acrid taste. This principle is -called digitalin.[2304] It seems to be the same substance, which has -also been detected by Radig, as quoted by Dr. Pereira.[2305] The leaves, -like those of other narcotic vegetables, yield by destructive -distillation an empyreumatic oil similar in chemical qualities and -physiological effects to the empyreumatic oil of hyoscyamus.[2306] - -From an extensive series of experiments on animals by Orfila with the -powder, extract and tincture of the leaves, foxglove appears to cause in -moderate doses vomiting, giddiness, languor, and death in twenty-four -hours, without any other symptoms of note; but in larger doses, it -likewise produces tremors, convulsions, stupor and coma. It acts -energetically both when applied to a wound, and when injected into a -vein.[2307] Mr. Blake has inferred from his researches, that when -injected into the jugular vein, it occasions both obstruction of the -pulmonary capillaries, and direct depression of the heart’s action. In -the dog an infusion of three drachms of leaves arrested in five seconds -the action of the heart; which was motionless after death, turgid, -inirritable, and full of florid blood in its left cavities. An infusion -of an ounce, injected back into the aorta from the axillary artery, -caused in ten seconds great obstruction of the systemic capillaries, -indicated by sudden increase of arterial pressure in the -hæmadynamometer; the heart was unaffected for forty-five seconds, when -it became slow in its pulsations, and the arterial pressure diminished; -and in four minutes the heart ceased to beat, although for a little -longer it continued excitable by stimulation. As no affection of the -brain or spine was apparent before the heart became affected, the author -infers that the action depends on the poisoned blood being circulated -through the substance of the heart, and not on any intermediate -influence upon the nervous centre.[2308] - -_Symptoms in Man._—Upon man its effects as a poison have been frequently -noticed, partly in consequence of its being given by mistake in too -large a dose as a medicine, partly on account of the singular property -it possesses, in common with mercury, of accumulating silently in the -system, when given long in moderate doses, and at length producing -constitutional effects even after it has been discontinued. The effects -of a dose somewhat larger than is usually given, are great nausea, -frontal headache, sense of disagreeable dryness in the gums and pharynx, -some salivation, giddiness, weakness of the limbs, feebleness and -increased frequency of the pulse, in a few hours an appearance of sparks -before the eyes, and subsequently dimness of vision, and a feeling of -pressure on the eyeballs. These effects may be occasioned by so small a -dose as two or three grains of good foxglove.[2309] The symptoms arising -from its gradual accumulation are in the slighter cases nausea, -vomiting, giddiness, want of sleep, sense of heat throughout the body, -and of pulsation in the head, general depression, great languor and -commonly retardation of the pulse, sometimes diarrhœa, sometimes -salivation, and for the most part profuse sweating. A good instance of -this form of the effects of foxglove is mentioned in the Medical -Gazette. A man took it at his own hand for dropsy during twenty days, -when the pulse sank to half its previous frequency, he was seized with -restless, want of sleep, incoherent talking with imaginary persons, -dilated pupils, nausea, thirst, and increase of urine; and these -complaints did not materially subside for six days.[2310] The depressed -action of the heart may be the occasion of death in particular -circumstances. Mr. Brande mentions from the experience of Dr. Pemberton -the case of an elderly woman, who, while under the full influence of -foxglove, fell in a fainting fit on walking across the floor; after -which, although she at first got better, there were frequent attacks of -fainting and vomiting till she died.[2311] In other instances -convulsions also occur; and it appears from a case mentioned by Dr. -Blackall, that the disorder thus induced may prove fatal. One of his -patients, while taking two drachms of the infusion of the leaves daily, -was attacked with pain over the eyes and confusion, followed in -twenty-four hours by profuse watery diarrhœa, delirium, general -convulsions, insensibility, and an almost complete stoppage of the -pulse. Although some relief was derived from an opiate clyster, the -convulsions continued to recur in frequent paroxysms for three weeks; in -the intervals he was forgetful and delirious; and at length he died in -one of the convulsive fits.[2312] - -A case which exemplifies the effects of a single large dose is related -in the Edinburgh Journal. An old woman drank ten ounces of a decoction -made from a handful of the leaves in a quart of water. She grew sick in -the course of an hour, and for two days she had incessant retching and -vomiting, with great faintness and cold sweats in the intervals, some -salivation and swelling of the lips, and a pulse feeble, irregular, -intermitting, and not above 40. She had also suppression of urine for -three days.[2313] - -A somewhat similar instance may be found in the Journal de Médecine. A -man, fifty-five years old took by mistake a drachm instead of a grain -for asthma, and was attacked in an hour with vomiting, giddiness, -excessive debility, so that he could not stand, loss of sight, colic, -and slow pulse. These effects continued more or less for four days, when -the vomiting ceased; and the other symptoms then successively -disappeared, the vision, however, remaining depraved for nearly a -fortnight.[2314] - -A very interesting fatal case, which arose from an over-dose -administered by a quack doctor, and which became the ground of a -criminal trial at London in 1826, is shortly noticed in the same -Journal. Six ounces of a strong decoction when taken as a laxative early -in the morning. Vomiting, colic, and purging, were the first symptoms; -towards the afternoon lethargy supervened; about midnight the colic and -purging returned; afterwards general convulsions made their appearance; -and a surgeon, who saw the patient at an early hour of the succeeding -morning, found him violently convulsed, with the pupils dilated and -insensible, and the pulse, slow, feeble, and irregular. Coma gradually -succeeded, and death took place in twenty-two hours after the poison was -swallowed.[2315] - -This is the only case in which I have seen an account of the appearances -in the dead body, and they are related imperfectly. It is merely said -that the external membranes of the brain were much injected with blood, -and the inner coat of the stomach red in some parts. - -The affections induced by poisoning with digitalis are often much more -lasting than the effects of most other vegetable narcotics. Dr. -Blackall’s case is one instance in point, and another no less remarkable -in its details is described in Corvisart’s Journal. The usual local and -constitutional symptoms were produced by a drachm of the powder being -taken by mistake; and the slowness of the pulse did not begin to go off -for seven days, the affection of the sight not for five days more.[2316] - -The preparations of foxglove are very uncertain in strength. From what I -have observed in the course of their medicinal employment, I conceive -few powders retain the active properties of the leaves, and even not -many tinctures. Two ounces of the tincture of the London College have -been taken in two doses with a short interval between them, yet without -causing any inconvenience.[2317] This assuredly could not happen with a -sound preparation. - - - _Of Poisoning with Rue._ - -The _Ruta graveolens_, or rue, although its wild variety is expressly -declared by Dioscorides to be mortal when taken too largely, has -attracted little attention as a poison in recent times, and is indeed -scarcely considered deleterious. Orfila seems to have found it by no -means active; for the juice of two pounds of leaves, secured in the -stomach of a dog by tying the gullet, did not prove fatal till the -second day, the symptoms were not well marked, and the only appearances -in the dead body were the signs of slight inflammation in the stomach. -Even when the distilled water was injected into a vein, the only effects -were a temporary nervous disorder similar to intoxication.[2318] - -According to the late experimental inquiry, however, by M. Hélie,[2319] -rue is possessed of peculiar and energetic properties. All parts of its -organization, especially the roots and leaves, produce the effects of -the narcotico-acrid poisons; and although he never met with any instance -of a fatal result, its activity is such as to render this event not -improbable, even when the dose is by no means very large. His attention -was drawn to the subject in consequence of finding, that it was often -employed in his neighbourhood for producing abortion,—a property -ascribed to it immemorially by the country people of France; and all the -instances he has seen of its poisonous action were cases in which it had -been given with this object. Sometimes the juice of the leaves is given, -sometimes an infusion of them, sometimes a decoction of the root; and in -one instance a woman took a decoction of two roots, each about as thick -as the finger. The effects were, severe pain in the stomach, followed by -violent and obstinate vomiting, drowsiness, giddiness, confusion, -dimness of sight, difficult articulation, staggering, contracted pupils, -convulsive movements of the head and arms, like those of chorea, -retention of urine, slowness of the pulse, and great prostration. There -was never any purging. In the course of two days or a little more -miscarriage took place, preceded by the usual precursors, and followed -by abatement of the symptoms of poisoning. At the period of the -milk-fever, however, these symptoms again increased, and the patient was -also attacked with swelling and pain in the tongue and copious -salivation. In about ten days the pulse began to increase in frequency; -and a mild typhoid fever commonly succeeded, from which recovery took -place slowly. In another case the symptoms throughout their whole course -were so mild, that, although miscarriage occurred, the subject of it was -not confined to bed, and in fifteen days recovered her health -completely. M. Hélie adds, that with full knowledge of the doubts -entertained by eminent authorities, whether any substance whatever -possesses a peculiar property of inducing miscarriage, he is strongly -persuaded that rue is really a substance of the kind, and that it will -take effect even when there is no natural tendency to miscarriage, or -any particular weakness of constitution. - -Notwithstanding these statements, it may be suspected that M. Hélie has -overrated both its poisonous properties and its virtues as a drug -capable of inducing miscarriage. - - - _Of Poisoning with Ipecacuan._ - -Ipecacuan is well known as an emetic. It is procured from a plant of the -natural family Rubiaceæ, the _Cephaëlis ipecacuanha_. It contains a -peculiar principle, not yet crystallized, which is white, permanent in -the air, sparingly soluble in water, easily soluble in alcohol and -ether, fusible about 122° F., capable of forming crystallizable salts -with acids, and possessing an alkaline reaction on litmus. It was -discovered by M. Pelletier.[2320] - -Ipecacuan itself is not known to be a poison; because in consequence of -its emetic properties it is quickly discharged from the stomach. But in -doses of considerable magnitude it would probably be dangerous. In some -constitutions the odoriferous effluvia from the powder induce difficult -breathing, anxiety, and imperfect convulsions. I have met with several -instances of this singular idiosyncrasy, and one in particular where the -subject of it, a surgeon’s apprentice, suffered so often and so severely -as to be induced to abandon the medical profession. A German physician, -Dr. Prieger, has published a remarkable case of a druggist’s servant, -who, in consequence of incautiously inhaling the dust of ipecacuan -powder, was attacked with a sense of tightness in the chest, vomiting, -and soon after an alarming sense of suffocation from tightness of the -throat. When these symptoms had continued several hours the uneasiness -in the throat was removed after the use of a decoction of uva-ursi and -rhatany-root; but the dyspnœa remained several days.[2321] - -Its active principle, emeta, is a powerful poison. Two grains of the -pure alkaloid will kill a dog; and the symptoms are frequent vomiting, -followed by sopor and coma, and death in fifteen or twenty-four hours. -In the dead body the lungs and stomach are found inflamed. The same -effects result from injecting it into a vein, or applying it to a -wound.[2322] It appears, then, to be a narcotico-acrid. But its irritant -properties are so prominent that it might be properly arranged with the -vegetable acrids. - - - - - CHAPTER XXXVII. - OF POISONING WITH STRYCHNIA, NUX VOMICA, AND FALSE ANGUSTURA. - - -The next group of the narcotico-acrids includes a few vegetable poisons -that act in a very peculiar manner. They induce violent spasms, exactly -like tetanus, and cause death during a fit, probably by suspending the -respiration. But they do not impair the sensibility. During the -intervals of the fits the sensibility is on the contrary heightened, and -the faculties are acute. - -Death, however, does not always take place by tetanus. In some cases the -departure of the convulsions has been followed by a fatal state of -general and indescribable exhaustion. - -Besides thus acting violently on the nervous system, they also possess -local irritant properties; but these are seldom observed on account of -the deadliness and quickness of their remote operation on the spine and -nerves. - -They exert their action by entering the blood-vessels. The dose required -to prove fatal is exceedingly small. The organ acted on is chiefly the -spinal cord; but sometimes they seem also to act on the heart. - -They seldom leave any morbid appearances in the dead body. Like the -other causes of death by obstructed respiration, such as drowning and -strangling, they produce venous congestion; but this is frequently -inconsiderable. Sometimes, however, they leave signs of inflammation in -the alimentary canal. - -Their energy resides in peculiar alkaloids. The only poisons included in -this group, are derived from the genus _Strychnos_. The bark of _Brucea -antidysenterica_ was long supposed also to possess similar properties; -but it is now known that the bark of _Strychnos nux-vomica_ was mistaken -for the bark of that tree. - -Several species of _Strychnos_ have been examined, namely, the _S. -Nux-vomica_, the _S. Sancti Ignatii_ or St. Ignatius bean, the _S. -colubrina_, or snake-wood, the _S. tieuté_, which yields an Indian -poison the Upas tieuté, the _S. Guianensis_, and likewise the _S. -potatorum_ and _Pseudo-kina_; and all have been found to possess the -same remarkable properties, except the last two, which are inert. - -All of them, except the _S. pseudo-kina_, and probably the _S. -potatorum_,[2323] contain an alkaloid to which their poisonous -properties are owing. This is _strychnia_ or strychnin, a substance -which has lately been made the subject of many experiments by chemists -and physiologists. - - - _Of Poisoning with Strychnia._ - -Strychnia was discovered by Pelletier and Caventou soon after the -discovery of morphia.[2324] For an account of the best process for -preparing it, the reader may consult a paper by M. Henry in the journal -quoted below.[2325] - -Its leading properties are the following. Its crystals when pure are -elongated octaedres. It has a most intensely bitter taste, perceptible, -it is said, when a grain is dissolved in 80 pounds of water.[2326] It is -very sparingly soluble in water, but easily soluble in alcohol and the -volatile oils. Its alcoholic solution has an alkaline reaction. It forms -neutral and crystallizable salts with the acids. In its ordinary form it -is turned orange-red by the action of nitric acid; which tint becomes -violet-blue on the gradual addition of hydrosulphate of ammonia. The -action of nitric acid is owing to the presence of a yellow colouring -matter, or of another alkaloid, brucia, which is also contained in nux -vomica, but exists in larger quantity in the false angustura bark. Pure -strychnia is not turned orange-red by nitric acid.[2327] - -No poison is endowed with more destructive energy than strychnia. I have -killed a dog in two minutes with a sixth part of a grain injected in the -form of alcoholic solution into the chest; I have seen a wild-boar -killed in the same manner with the third of a grain in ten minutes; and -there is little doubt that half a grain thrust into a wound might kill a -man in less than a quarter of an hour. It acts in whatever way it is -introduced into the system, but most energetically when injected into a -vein. The symptoms produced are very uniform and striking. The animal -becomes agitated and trembles, and is then seized with stiffness and -starting of the limbs. These symptoms increase till at length it is -attacked with a fit of violent general spasm, in which the head is bent -back, the spine stiffened, the limbs extended and rigid, and the -respiration checked by the fixing of the chest. The fit is then -succeeded by an interval of calm, during which the senses are quite -entire or unnaturally acute. But another paroxysm soon sets in, and then -another and another, till at length a fit takes place more violent than -any before it; and the animal perishes suffocated. The first symptoms -appear in 60 or 90 seconds, when the poison is applied to a wound. When -it is injected into the pleura, I have known them begin in 45 seconds, -and Pelletier and Caventou have seen them begin in 15 seconds.[2328] M. -Bouillaud has recently found that it has no effect when directly applied -to the nerves.[2329] The experiments of Mr. Blake tend to show, that its -action is exerted solely on the nervous system, and that it has no -direct action on the heart, even when directly admitted into the blood -by the jugular vein.[2330] It appears to act peculiarly by irritating -the spinal cord. - -Dangerous effects have often been occasioned by an accidental over-dose -in ordinary medical practice. These are well exemplified by a case -communicated to Dr. Bardsley by Dr. Booth of Birmingham. A man of 46, -affected with hemiplegia for nearly four weeks, began to use strychnia, -and had been affected by it for eleven days without particular -inconvenience. During this period he took twice a day gradually -increasing doses, till the amount of one grain was attained; when the -usual physiological effect having ceased to occur, the quantity was -increased to a grain and a half. But the first dose caused anxiety and -excitability, in three hours stupor and loss of speech, and at length -violent tetanic convulsions, which proved fatal in three hours and -three-quarters.[2331] A fatal case, occasioned by the large dose of two -scruples, has been recorded by a German physician, Dr. Blumhardt. In -fifteen minutes, imperfect vomiting was brought on by emetics. At this -time, the patient, a lad of seventeen, lay on his back, quite stiff, and -with incipient fits of locked-jaw. The spasms gradually extended to the -rest of the body, till at last violent fits of general tetanus were -established, under which the whole body became as stiff as a board, the -arms spasmodically crossed over the chest, the legs extended, the feet -bent, so that the soles were concave, the breathing arrested, the -eyeballs prominent, the pupils dilated and not contractile, and the -pulse hurried and irregular. In the second severe fit he died, one hour -and a half after taking the poison.[2332] I have known very dangerous -tetanic spasm induced by so small a dose as two-thirds of a grain of the -ordinary impure strychnia of the shops; and Dr. Pereira describes a -case, communicated by a friend, where death was occasioned by a dose of -half a grain administered three times a day.[2333] As each fit of spasm -went off, respiration, which was found to have ceased, was maintained -artificially; but no sooner did natural breathing return, than the -paroxysm of tetanus returned also; and at length artificial inflation of -the lungs failed to restore life. - -The only accounts I have seen of the morbid appearances after death from -strychnia are in the cases of Dr. Booth and Dr. Blumhardt. In the -former, the muscles were in a rigid state, the fingers contracted, the -vessels of the brain gorged, the membranes of the spinal cord highly -injected; and four patches of extravasated blood were found between the -spinal arachnoid and the external membrane. In the latter, twenty-four -hours after death, there was general lividity of the skin, and -extraordinary rigidity of the muscles. Fluid blood flowed in abundance -from the spinal cavity, where the veins were gorged, the pia mater -injected, the spinal column softened at its upper part, and here and -there almost pulpy. There was also congestion and softening of the -brain. The head and great vessels were flaccid, and contained scarcely -any blood. The inner membrane of the stomach and intestines presented -some redness, but not more than is often seen independently of -irritation there. - -Strychnia has been found by Pelletier and Caventou in four species of -_Strychnos_, the _S. nux vomica_, _Sancti Ignatii_, _Colubrina_, and -_Tieuté_; and from the researches of MM. Martius and Herberger on the -composition and properties of the American poison Wourali, it is also -probably contained in the _S. guianensis_.[2334] Vauquelin could not -find it in the _S. pseudo-kina_, which is destitute of bitterness. - - - _Of Poisoning with Nux Vomica._ - -_Tests of Nux Vomica._—Nux vomica, the most common of these poisons, is -a flat, roundish seed, hardly an inch in diameter, of a yellowish or -greenish-brown colour, covered with short silky hair, and presenting a -little prominence on the middle of one of its surfaces. In powder it has -a dirty greenish-gray colour, an intensely bitter taste, and an odour -like powder of liquorice. It inflames on burning charcoal, and when -treated with nitric acid acquires an orange-red colour, which is -destroyed by the addition of protochloride of tin. Its infusion also is -turned orange-red by nitric acid, and precipitated grayish-white with -tincture of galls. - -Orfila and Barruel have made some experiments on the mode of detecting -it in the stomach, and the following is the plan recommended by them. -The contents of the stomach, or the powder, if it can be separated, must -be boiled in water acidulated with sulphuric acid. The liquid after -filtration is neutralized with carbonate of lime, and then evaporated to -dryness. The dry mass is then acted on with successive portions of -alcohol, and evaporated to the consistence of a thin syrup. The product -has an intensely bitter taste, yields a precipitate with ammonia, -becomes deep orange-red with nitric acid, and will sometimes deposit -crystals of strychnia on standing two or three days.[2335] By this -process Dr. R. D. Thomson, in a case which proved fatal in three hours, -detected nux-vomica, although vomiting had been induced by -emetics.[2336] - -These experiments it is important to remember, because, contrary to what -takes place in regard to vegetable poisons generally, nux vomica is -often found in the stomachs of those poisoned with it. - -_Its Mode of Action and Symptoms in Man._—The poisonous properties of -nux vomica are now well known to the vulgar; and in consequence it is -occasionally made the instrument of voluntary death, although no poison -causes such torture. It is difficult to conceive, considering its -intensely bitter taste, how any one could make it the instrument of -murder. But a fact is stated in Rust’s Journal, which shows that it may -be used for that purpose. At a drinking party one man wagered with -another, that if he took a little _Cocculus indicus_ in beer, he would -be compelled to walk home on his head. The wager was taken and the -potion drunk; but nux vomica was substituted for the Cocculus indicus, -itself too a virulent poison; and the man went home and died in -convulsions fifteen minutes afterwards.[2337] - -Many experiments have been made on animals with nux vomica; but the -first accurate inquiry was that of Magendie and Delille read before the -French Institute in 1809. The symptoms they remarked were precisely the -same with those produced by strychnia. Half a drachm of the powder -killed a dog in forty-five minutes, and a grain and a half of the -alcoholic extract thrust into a wound killed another in seven minutes. -The animals uniformly experienced dreadful fits of tetanic spasm, with -intervals of relaxation and sensibility, and were carried off during a -paroxysm. - -The cause of death appears to be prolonged spasm of the thoracic muscles -of respiration. The spasm of these muscles is apparent in the unavailing -efforts which the animals make to inspire. The external muscles of the -chest may be felt during the fits as hard almost as bone; and, according -to an experiment of Wepfer, the diaphragm partakes in the spasm of the -external muscles.[2338] - -On account of the singular symptoms of irritation of the spinal cord, -uncombined with any injury of the brain, this poison is believed to act -on the spinal marrow alone. This is farther shown by the experiments of -Mr. Blake with strychnia alluded to above. But from some experiments by -Segalas it appears also to exhaust the irritability of the heart: for in -animals he found that organ could not be stimulated to contract after -death, and life could not be prolonged by artificial breathing.[2339] A -similar observation was made long ago by Wepfer, who found the heart -motionless and distended with arterial blood in its left cavities;[2340] -and a case of poisoning in the human subject to the same effect will be -presently related. The pulse is always very weak, often wholly -suppressed during a paroxysm; and in the case alluded to it was found on -dissection pale, flaccid and empty, having been apparently affected with -spasm. The action exerted through the medium of the spinal cord on the -muscles is wholly independent of the brain; for Stannius found that in -frogs the removal of the brain does not interfere with the -effects.[2341] - -Of late poisoning with nux vomica has been common. The most -characteristic example yet published is a case related by Mr. Ollier, of -a young woman, who in a fit of melancholy, took between two and three -drachms of the powder in water. When the surgeon first saw her, half an -hour afterwards, she was quite well. But going away in search of an -emetic, and returning in ten minutes, he found her in a state of great -alarm, with the limbs extended and separated, and the pulse faint and -quick. She then had a slight and transient convulsion succeeded by much -agitation and anxiety. In a few minutes she had another, and not long -afterwards a third, each about two minutes in duration. During these -fits, “the whole body was stiffened and straightened, the legs pushed -out and forced wide apart; no pulse or breathing could be perceived; the -face and hands were livid, and the muscles of the former violently -convulsed.” In the short intervals between the fits she was quite -sensible, had a feeble rapid pulse, complained of sickness with great -thirst, and perspired freely. “A fourth and most violent fit soon -succeeded, in which the whole body was extended to the utmost from head -to foot. From this she never recovered: she seemed to fall into a state -of asphyxia, relaxed her grasp, and dropped her hands on her knees. Her -brows, however, remained contracted, her lips drawn apart, salivary foam -issued from the corners of the mouth, and the expression of the -countenance was altogether most horrific.” She died an hour after -swallowing the poison.[2342]—A case precisely similar, produced by three -pence worth of the powder, and fatal in little more than an hour, is -related by Mr. Watt of Glasgow.[2343]—Another apparently also similar -but fatal in three hours, is related by Dr. R. D. Thomson.[2344] There -is in fact very little variety of symptoms in different cases, where -death occurs in the primary stage.—Occasionally even in such rapid cases -there is a little vomiting in the first instance. This was remarked in -Mr. Watt’s case, and also in another described by MM. Orfila and -Ollivier.[2345] - -When death does not take place thus suddenly in a fit of spasm, the -person continues to be affected for twelve or sixteen hours with -similar, but milder paroxysms; and afterwards he may either recover -without farther symptoms, or expire in a short time apparently from -exhaustion, or suffer an attack of inflammation of the stomach and -intestines, which may or may not prove fatal. - -M. Jules Cloquet has described a case, where the patient seemed to die -of the excessive exhaustion produced by the violent, long continued -spasms. The tetanic fits lasted about twenty-four hours, the sensibility -in the intervals being acute. Slight signs of irritation in the stomach -succeeded; and death ensued on the fourth morning.[2346] - -In the Bulletins of the Medical Society of Emulation another case is -related, which arose from an over-dose of the alcoholic extract being -taken by an old woman who was using it for palsy. She took three grains -at once. Violent tetanus was soon produced; and afterwards she had a -regular attack of inflammation of the stomach and intestines, which -proved fatal in three days. - -The last instance to be noticed exemplifies very well the effects of the -poison when the quantity is insufficient to cause death. A young woman -swallowed purposely a drachm mixed in a glass of wine. In fifteen -minutes she was seized with pain and heat in the stomach, burning in the -gullet, a sense of rending and weariness in the limbs succeeded by -stiffness of the joints, convulsive tremors, tottering in her gait, and -at length violent and frequent fits of tetanus. Milk given after the -tetanus began excited vomiting. She was farther affected with redness of -the gums, inflammation of the tongue, burning thirst, and pain in the -stomach. The pulse also became quick, and the skin hot. Next day, though -the fits had ceased, the muscles were very sore, especially on motion. -The tongue and palate were inflamed, and there was thirst, pain in the -stomach, vomiting, colic and diarrhœa. These symptoms, however, abated, -and on the fourth day disappeared, leaving her exceedingly weak.[2347] - -This and the previous case show clearly the double narcotico-acrid -properties of the poison. - -With regard to the dose requisite to prove fatal, the smallest fatal -dose of the alcoholic extract yet recorded is three grains, which was -the quantity taken in the case from the Parisian bulletins: Hoffmann -mentions a fatal case caused by two fifteen grain doses of the -powder;[2348] and in Hufeland’s Journal there is another caused by two -drachms, which was fatal in two hours.[2349]—A dog has been killed by -eight grains of the powder, and a cat by five.[2350] It is even said -that a dog has been killed by two grains.[2351] - -It has been thought, from some observations by Mr. Baker on the -medicinal use of nux vomica in Hindostan that, by the force of habit, -the constitution may become to a certain extent accustomed to large -doses of this poison, in the same manner as it acquires the power of -enduring large doses of opium. The natives of Hindostan, often take it -morning and evening for many months continuously, beginning with an -eighth part of a nut, and gradually increasing the dose to an entire -nut, or about twenty grains. If it is taken either immediately before or -after meals, it never occasions any unpleasant effects; but if this -precaution be neglected, spasms are apt to ensue.[2352] As it is found -unsafe, however, to increase the dose beyond one nut, and the poison is -taken in the form of coarse powder, in which state it must be slowly -acted on by the fluid in the stomach, it is probable that the modifying -influence of habit is inconsiderable. Habit certainly does not -familiarize the system to strychnia used medicinally. The same dose, -which has once excited its peculiar physiological action, will for the -most part suffice to excite it again, however frequently the dose may be -repeated.—The facts mentioned by Mr. Baker show that nux vomica is not a -cumulative poison; and European experience, in the instance of -strychnia, is to the same effect. - -_Morbid Appearances._—The morbid appearances differ according to the -period at which death occurs. In Mr. Ollier’s case, where death took -place in an hour, the appearances were insignificant. The stomach was -almost natural, the vessels of the brain somewhat congested, the heart -flaccid, empty, and pale. In the case in Hufeland’s Journal there was -general inflammation of the stomach, duodenum and part of the jejunum. -In Cloquet’s case, a slower one, there was very little appearance of -inflammation. In that from the Parisian bulletins, on the contrary, the -stomach was highly inflamed, the intestines violet-coloured, in many -places easily lacerated and apparently gangrenous. In an interesting -dissection of a case, which was quickly fatal,—that related by Orfila -and Ollivier, there was found much serous effusion on the surface of the -cerebellum, and softening of the whole cortical substance of the brain, -but especially of the cerebellum. Blumhardt too, found softening of the -cerebellum and congestion of the cerebral vessels, together with -softening of the spinal cord and general gorging of the spinal veins. -This is some confirmation of an opinion advanced not long ago in France -by Flourence and others, that nux vomica acts particularly on the -cerebellum.[2353] In Dr. R. D. Thomson’s case, which was examined by Mr. -Taylor, there was found much congestion of the whole membranes and -substance of the brain and cerebellum, and even some extravasation of -blood within the cavity of the arachnoid over the upper surface of the -former. Mr. Watt remarked in his case (sixty hours, however, after death -in summer) softening of the substance of the brain and the lumbar part -of the spinal cord.—In Orfila and Ollivier’s case the lungs were found -much gorged with black fluid blood.—In Blumhardt’s case the heart and -great vessels were entirely destitute of blood.—There is sometimes seen, -as in Dr. R. D. Thomson’s case, a brown powder lining the stomach, even -although vomiting may have occurred. - -The body appears sometimes to retain for a certain period after death -the attitude and expression impressed on it by the convulsions during -life. In the instance mentioned by Orfila and Ollivier the muscles -immediately after death remained contracted, the head bent back, the -arms bent, and the jaws locked. This state may even continue for some -hours, so that the body appears to pass into the state of rigidity which -precedes decay, without also passing through the preliminary stage of -flaccidity immediately after death. In the case related by Mr. Ollier, -the body five hours after death “was still as stiff and straight as a -statue, so that if one of the hands was moved the whole body moved along -with it;” and in Blumhardt’s case the rigidity twenty hours after death -was unusually great. This state of rigidity, however, does not -invariably occur. On the contrary, in animals the limbs become very -flaccid immediately after death; but the usual rigidity supervenes at an -early period.[2354] In Dr. R. D. Thomson’s case flaccidity immediately -followed death. - -_Treatment._—Little is known of the treatment in this kind of poisoning. -But it is of the greatest moment to evacuate the stomach thoroughly, and -without loss of time. Hence emetics are useful; but if the stomach-pump -is at hand it ought to be resorted to without waiting for the operation -of emetics. Torosiewicz describes the case of a young woman who, after -the usual symptoms had begun to appear in consequence of the -administration of a tea-spoonful of powder, recovered under the action -of an emetic followed by rhatany-root.[2355] When nux vomica is taken in -powder,—the most frequent form in which it has been used,—it adheres -with great obstinacy to the inside of the stomach. Consequently whatever -means are employed for evacuating the stomach, they must be continued -assiduously for a considerable time. If the patient is not attacked with -spasms in two hours, he will generally be safe. - -M. Donné of Paris has stated that he has found iodine, bromine, and -chlorine to be antidotes for poisoning with the alkaloid of nux vomica, -as well as for the other vegetable alkaloids. Iodine, chlorine, and -bromine, he says, form with the alkaloid compounds which are not -deleterious,—two grains and a half of the iodide, bromide, and chloride -of strychnia, having produced no effect on a dog. Animals which had -taken one grain of strychnia or two grains of veratria, did not sustain -any harm, when tincture of iodine was administered immediately -afterwards. But the delay of ten minutes in the administration of the -antidote rendered it useless. In the compounds formed by these antidotes -with the alkaloids, the latter are in a state of chemical union, and not -decomposed. Sulphuric acid separates strychnia, for example, from its -state of combination with chlorine, iodine, or bromine, and forms -sulphate of strychnia, with its usual poisonous qualities.[2356] It -remains to be proved that the same advantages will be derived from the -administration of these antidotes in the instance of poisoning with the -crude drug, nux vomica, as in poisoning with its alkaloid. - -In general little difficulty will be encountered in recognizing a case -of poisoning with nux vomica. _Tetanus_ or locked-jaw is the only -disease which produces similar effects. But that disease never proves so -quickly fatal as the rapid cases of poisoning with nux vomica; and it -never produces the symptoms of irritation observed in the slower cases. -Besides, the fits of natural tetanus are almost always slow in being -formed; while nux vomica brings on perfect fits in an hour or less. It -is right to remember, however, that nux vomica may be given in small -doses, frequently repeated, and gradually increased, so as to imitate -exactly the phenomena of tetanus from natural causes. Medical men will -be at no loss to discover, on reflection, how the preparations of this -drug may be rendered formidable secret poisons. - - - _Of Poisoning with the St. Ignatius Bean and Upas Tieuté._ - -The _Strychnos Sancti Ignatii_, or St. Ignatius bean, contains about -three times as much strychnia as nux vomica, namely, from twelve to -eighteen parts in the 1000. It is very energetic. Dr. Hopf has mentioned -an instance of a man, who was attacked with tetanus of several hours’ -duration after taking the powder of half a bean in brandy, and who seems -to have made a narrow escape.[2357] - -The _Strychnos tieuté_ is the plant which yields the Upas tieuté, one of -the Javanese poisons. This substance has been analyzed by Pelletier and -Caventou, and found to contain strychnia.[2358] From the experiments of -Magendie and Delille, the Upas tieuté appears to be almost as energetic -as strychnia itself.[2359] Mayer found that the bark of the plant which -yields it, when applied in the dose of fifty grains to a wound, killed a -rabbit in two hours and a half.[2360] Dr. Darwin has given an account of -its effects on the Javanese criminals, who used formerly to be executed -by darts poisoned with the tieuté. The account quoted by him is not very -authentic; yet it accords precisely with what would be expected from the -known properties of the poison. He says, that a few minutes after the -criminals are wounded with the instrument of the executioner, they -tremble violently, utter piercing cries, and perish amidst frightful -convulsions in ten or fifteen minutes.[2361] - - - _Of Poisoning with False Angustura Bark._ - -Besides these poisons of the genus Strychnos, the present group -comprehends another, of the same properties, which was once supposed to -be derived from a plant of a different family, the _Brucea -antidysenterica_. - -A species of bark, commonly called the false angustura bark, was -introduced by mistake into Europe instead of the true angustura, -cusparia, or bark of the _Galipea officinalis_. It was long supposed to -be the bark of the _Brucea antidysenterica_; but it is now known to be -the bark of _S. nux vomica_.[2362] It is a poison of great energy. It -gave rise to so many fatal accidents soon after its introduction, that -in some countries on the continent all the stores of angustura were -ordered to be burnt. It contains a less proportion of strychnia, but -more of the alkaloid brucia than nux vomica, the seed of the plant. - -According to Andral, brucia is twenty-four times less powerful than -strychnia;[2363] but the bark itself is as strong nearly as nux-vomica, -for Orfila found that eight grains killed a dog in less than two -hours.[2364] - -The symptoms it induces are the same as those caused by nux vomica. They -are minutely detailed in a paper by Professor Emmert of Bern.[2365] It -appears that during the intervals of the fits the sensibility is -remarkably acute: a boy who fell a victim to it implored his physician -not to touch him, as he was immediately thrown into a fit. Professor -Marc of Paris was once violently affected by this poison, which he took -by mistake for the true angustura to cure ague. He took it in the form -of infusion, and the dose was only three-quarters of a liqueur-glassful; -yet he was seized with nausea, pain in the stomach, a sense of fulness -in the head, giddiness, ringing in the ears, and obscurity of vision, -followed by stiffness of the limbs, great pain on every attempt at -motion, locked-jaw, and impossibility of articulating. These symptoms -continued two hours; and abated under the use of ether and -laudanum.[2366] - -Some interesting experiments were made by Emmert with this poison to -show that it acts on the spine directly, and not on that organ through -the medium of the brain. If an animal be poisoned by inserting the -extract of false angustura bark into its hind-legs after the spinal cord -has been severed at the loins, the hind-legs as well as the fore-legs -are thrown into a state of spasm; or if the medulla oblongata be cut -across and respiration maintained artificially, the usual symptoms are -produced over the whole body by the administration of it internally or -externally,—the only material difference being that they commence more -slowly, and that a larger dose is required to produce them, than when -the medulla is not injured. On the other hand, when the spinal cord is -suddenly destroyed after the symptoms have begun, they cease -instantaneously, although the circulation goes on for some -minutes.[2367] - -The true angustura bark has a finer texture than the other, and is -darker coloured, aromatic, pungent, and less bitter. The ferro-cyanate -of potass causes in a muriatic infusion of the false bark a precipitate, -which is first green and then becomes blue; and the same reagent -converts into blue the reddish powder which lines the bark. No such -effects are produced on the true angustura bark. Nitric acid renders the -rusty efflorescence of the spurious bark deep dirty blue, but has no -such effect on the true bark; which, besides, never exhibits a yellow -efflorescence. - -With the preceding poisons Orfila has arranged also some poisons used by -the American Indians; but, as in Europe they are mere objects of -curiosity, it is scarcely necessary to treat of them particularly here. - -The most interesting and best known of them is the _wourali poison_ of -Guiana, variously called woorara, urari, or curare, by different -authors. It is believed to have been traced by Martius to a new species -of strychnos, the _S. guianensis_, and more recently by Dr. Schomburg to -a different species, the _S. toxicaria_ of that traveller. But the -action it exerts does not correspond exactly with what would be expected -of a plant belonging to that genus. - -The effects of wourali have been investigated by Sir B. Brodie in the -Philosophical Transactions for 1811–12, in Orfila’s Toxicology, in -Magendie’s Memoir on Absorption, and in Fontana’s Traité des Poisons. -But the most detailed inquiry is that by Emmert, published in 1818. It -produces, not convulsions or spasm of the muscles, but on the contrary -paralysis, and probably occasions death in this way by suspending the -respiration, in the same way as hemlock and conia. According to Emmert’s -experiments the spine only is acted on, and not the brain also.[2368] -Some remarkable experiments were made in 1839 by Mr. Waterton, to show -the power of artificial respiration in accomplishing recovery from its -effects. After the animals had fallen down motionless from the action of -the poison introduced through a wound, and when the action of the heart -had become so feeble as not to affect the pulse, artificial respiration, -continued in one instance for seven hours and a half, and in another for -two hours, had the effect of restoring the animals to health.[2369] - - - - - CHAPTER XXXVIII. - OF POISONING WITH CAMPHOR, COCCULUS INDICUS, ETC. - - -The third group of the narcotico-acrids resemble strychnia in their -action so far, that they occasion in large doses convulsions of the -tetanic kind. But they differ considerably by producing at the same time -impaired sensibility or sopor. They are camphor, Cocculus indicus, its -active principle picrotoxin, the Coriara myrtifolia, the Upas antiar, a -Java poison, and perhaps also the yew-tree. - - - _Of Poisoning with Camphor._ - -Camphor dissolved in oil soon causes in dogs paroxysms of tetanic spasm. -At first the senses are entire in the intervals; but by degrees they -become duller, till at length a state of deep sopor is established, with -noisy laborious breathing, and expiration of camphorous fumes; and in -this state the animal soon perishes. A solution of twenty grains in -olive oil will kill a dog in less than ten minutes when injected into -the jugular vein. When camphor is given to dogs in fragments, it does -not excite convulsions, but kills them more slowly by inducing -inflammation of the alimentary canal. These are the results of numerous -experiments by Orfila.[2370] - -They are confirmed by others performed more lately by Scudery of -Messina; but this experimentalist likewise remarked, that the -convulsions were attended with a singular kind of delirium, which made -the animals run up and down without apparent cause, as if they were -maniacal. He also found the urinary organs generally affected, and for -the most part with strangury.[2371] Lebküchner discovered camphor in the -blood of animals poisoned with it.[2372] - -_Symptoms in Man._—The symptoms caused by camphor in man may not have -been observed; but so far as they have been witnessed, they establish -its claim to be considered a narcotic and acrid poison. Its effects -appear to be singularly uncertain: at least they are very discrepant; -and the reason for this is not apparent. - -Its narcotic effects are well exemplified in an account given by Mr. -Alexander from personal experience, and by Dr. Edwards of Paris, as they -occurred in a patient of his who received a camphor clyster. - -Mr. Alexander, in the course of his experiments on his own person with -various drugs, was nearly killed by this poison, and has left the best -account yet published of its effects in dangerous doses on man. After -having found, by a previous experiment, that a scruple did not cause any -particular symptom, he swallowed in one dose two scruples mixed with -syrup of roses. In the course of twenty minutes he became languid and -listless, and in an hour giddy, confused, and forgetful. All objects -quivered before his eyes, and a tumult of undigested ideas floated -through his mind. At length he lost all consciousness, during which he -was attacked with strong convulsive fits and maniacal frenzy. These -alarming symptoms were dispelled, on Dr. Monro, who had been sent for, -accidentally discovering the subject of his patient’s experimental -researches, and administering an emetic. But a variety of singular -mental affections continued for some time after. The emetic brought away -almost the whole camphor which had been swallowed three hours -before.[2373] - -In Dr. Edwards’s patient, the symptoms were excited by an injection -containing half a drachm of camphor. In a few minutes he felt a -camphrous taste, which was followed by indescribable uneasiness. On then -going down stairs for assistance, he was astonished to feel his body so -light, that he seemed to himself to skim along the floor almost without -touching it. He afterwards began to stagger, his face became pale, he -felt chilly, and was attacked with a sense of numbness in the scalp. On -then taking a glass of wine, which he asked for, he became gradually -better; but for some time his mind was singularly affected. He felt -anxious, without thinking himself in danger; he shed tears, but could -not tell why; they flowed in fact involuntarily. For twenty-four hours -his breath exhaled a camphrous odour.[2374] - -Hoffmann has related a case analogous to those of Alexander and Edwards. -The dose was two scruples taken in oil; the symptoms vertigo, -chilliness, anxiety, delirium, and somnolency.[2375] - -These cases would seem to indicate very considerable activity; yet there -can be little doubt that even larger doses have been at times taken with -much less effect. Thus, from an account given by Dr. Eickhorn of New -Orleans, of its operation on himself, when incautiously swallowed to the -amount of two drachms in frequent small doses within three hours, it -would appear that the only result was great heat, palpitation, hurried -pulse, and pleasant intoxication, then moisture of the skin, next -profound sleep for some hours, attended with excessive sweating, and -finally no ultimate ill consequence except great debility.[2376] I am -assured by a correspondent, Dr. Jennison of Cambridge, U. S., that a -medical friend of his has given 90 grains of camphor four times a day in -phrenitis, with safety and advantage. - -Professor Wendt of Breslau has related an instance, which proves the -irritant action of camphor on man, and likewise the uncertainty of the -dose required to act deleteriously. In the case of Mr. Alexander, two -scruples would in all probability have proved fatal, had they not been -discharged in time by vomiting. In the case now to be noticed, 160 -grains were taken in a state of solution in alcohol, and were not -vomited; yet the individual recovered. He was a drunkard, who took four -ounces of camphorated spirit, prescribed for him as an embrocation. Soon -afterwards he was attacked with fever, burning heat of the skin, -anxiety, burning pain in the stomach, giddiness, flushed face, dimness -of sight, sparks before the eyes, and some delirium. He soon got well -under the use of almond oil and vinegar, but did not vomit.[2377] - -_Morbid Appearances._—The morbid appearances caused by camphor have not, -so far as I know, been witnessed in man. In dogs examined immediately -after death, the heart is no longer contractile, and its left cavities -contain arterial blood of a reddish-brown colour. When the poison has -been given in fragments, it leaves marks of inflammation in the stomach -and intestines. Orfila found these organs much inflamed in such -circumstances.[2378] Scudery found the membranes of the brain much -injected, and the brain itself sometimes softened; the inner membrane of -the stomach either very red, or checkered with black, gangrenous-like -spots of the size of millet-seeds; the duodenum in the same state; the -ureters, urethra, and spermatic cords inflamed; and every organ in the -body, even the brain, impregnated with the odour of camphor.[2379] - - - _Of Poisoning with Cocculus Indicus._ - -The _Menispermum cocculus_, _Cocculus suberosus_, or _Anamirta cocculus_ -of botanists, is a creeping plant which grows in the island of Ceylon, -on the Malabar coast, and in other parts of the East Indies. Its fruit, -which is the only part of the plant hitherto particularly examined, is -like a large, rough, grayish-black pea, and is known in the shops by the -name of Cocculus indicus. It has a rough, ligneous pericarp, enclosing a -pale grayish-yellow, brittle kernel, of a very strong lasting bitter -taste. The medical jurist should make himself well acquainted with its -external characters, because, besides being occasionally used in -medicine, it is a familiar poison for destroying fish, and has also been -extensively used by brewers as a substitute for hops,—an adulteration -which is prohibited in Britain by severe statutes. It has been analyzed -by M. Boullay of Paris,[2380] who found in it besides other matters, a -peculiar principle termed picrotoxin. This principle constitutes, -according to Boullay, about a fifth part of the kernel; according to -Nees von Esenbeck, only a hundreth part:[2381] and my own experiments -agree with the results of the latter. It is moderately soluble in water, -and crystallizes readily from a hot acidulous watery solution. It is -more soluble in hot alcohol, from which it crystallizes in granular -masses. Ten grains of it killed a dog in twenty-five minutes in the -second paroxysm of tetanus. - -The seeds themselves occasion vomiting soon after they are swallowed; so -that animals may often swallow them, if not without injury, at all -events without danger. But if the gullet be tied, the animal soon begins -to stagger; the eye acquires a peculiar haggard expression, which is the -sure forerunner of a tetanic paroxysm; and the second, third, or fourth -fit commonly proves fatal. Three or four drachms will kill a dog when -introduced into the stomach; less will suffice when it is applied to a -wound; and still less when it is injected into a vein.[2382] Wepfer has -related a good experiment, from which he infers that Cocculus indicus -acts by exhausting the irritability of the heart. In the intervals of -the fits the pulse could not be felt; and on opening the chest -immediately after death, he found the heart motionless and all its -cavities distended.[2383] Orfila also sometimes found the heart -motionless, and its left cavities filled with reddish-brown blood.[2384] - -This poison does not seem to possess distinct acrid properties in regard -to animals. M. Goupil indeed found that it produced vomiting and -purging,[2385] but Orfila could not observe any such effect. According -to Goupil it possesses the singular property of communicating to the -flesh of animals, more particularly of fish, that have been killed with -it, some of the poisonous qualities with which it is itself endowed. The -accuracy of this statement may be doubted, the alleged fact being -contrary to analogy. Besides, this poison has been used immemorially in -the East for taking fish; and it is familiarly used for the same purpose -in some parts of France, though prohibited by statute. Chevallier -mentions that in a particular parish the inhabitants live half the year -on fish caught with this poison; and that a friend of his made trial of -fish so caught, without the slightest injury.[2386] - -_Symptoms in Man._—Although it is well known that malt liquors have -often been adulterated with Cocculus indicus for the purpose of -economizing hops, cases of poisoning in the human subject are rare, -because the quantity required to communicate the due degree of -bitterness is small. Professor Bernt has shortly noticed a set of cases, -which arose in consequence of an idiot having seasoned soup with it by -mistake. Nine people were taken ill with sickness, vomiting, pain in the -stomach and bowels; and one died in twelve days.[2387] The symptoms -under which this person died are not stated; but the account of the -accident sent to Bernt imputed death to the poison,—which is improbable, -considering the length of the interval before death. - -In the same group with camphor and Cocculus indicus Orfila has arranged -_Upas antiar_, a Javanese poison. This poison is a very bitter milky -juice or extract, which is known in Europe only as an article of -curiosity. It has been sometimes confounded with the Upas tieuté. It -owes its properties to a neutral principle called antiarin.[2388] From -the experiments of MM. Magendie and Delille,[2389] as well as from those -of Sir B. Brodie[2390] and of Emmert[2391] it appears to act in the same -manner, and to produce the same effects, as camphor and Cocculus -indicus. In small doses it acts as an irritant; in large doses it causes -convulsions and coma. - -It is here noticed principally because it is one of the poisons which -act violently on the heart. If the body of an animal be examined -immediately after death from the Upas antiar, the heart is found to have -lost its irritability, and the left ventricle to contain florid blood: -Schnell found, that, like many other active poisons, it has no effect -when applied to the divided end of a nerve.[2392] - -The _Coriaria myrtifolia_ is also supposed by some to possess the -properties of the present group, and is sufficiently important from its -energy, and its occasional injurious effects on man, to claim some -notice here. - -Its toxicological action has been investigated by Professor Mayer of -Bonn, who found that it excites in most animals violent fits of tetanus, -giving place to apoplectic coma; and that in the dead body the brain is -seen gorged with blood, the blood in the heart and great vessels fluid, -the heart not irritable immediately after death, and the inner membrane -of the stomach yellowish and shrivelled. A drachm of the extract of the -juice killed a cat in two hours when swallowed; half a drachm applied to -a wound killed another in eighty-five minutes; and six grains in the -same way killed a kitten in three hours and a half. A drachm swallowed -by a young dog killed it in two hours and a half. Ten grains of the -extract of the infusion applied to a wound killed a kitten in six hours; -and three grains another in three hours. A buzzard was killed in -three-quarters of an hour by half a drachm of the extract of the juice. -Frogs are also soon killed by it. Rabbits, it is remarkable, are -scarcely affected by this poison, either administered internally, or -applied to a wound,—a drachm in the former way, and half as much in the -latter, having produced no effect at all. A grain, however, injected -into the jugular vein occasioned in about five hours a single convulsive -paroxysm, which proved immediately fatal.[2393] - -Instances of poisoning with this substance have occurred in the human -subject,—generally in consequence of its having been taken in various -parts of the continent with senna, which it is employed to adulterate. -Sauvages has recorded two cases of death occasioned by the berries. In -one, a child, death took place within a day under symptoms like -epileptic convulsions; and in the other, an adult, who swallowed only -fifteen berries, convulsions, coma, and lividity of the face were -produced, ending fatally the same evening, though the greater part of -the berries were discharged by emetics.[2394] In recent French journals -various similar cases are recorded. M. Fée describes five cases, one of -them fatal. In this instance, a male adult, death occurred within four -hours after he took an infusion of senna adulterated with the coriaria; -and the symptoms were violent convulsions, locked-jaw and colic.[2395] -M. Roux has noticed a great number of cases in the fullest paper yet -published on its effects on man, and gives the details of three which -came under his own notice, and of which one proved fatal. In the fatal -case, that of a child three years and a half old, who took between -eighty and a hundred berries, the symptoms were heat and pricking of the -tongue, sparking and rolling of the eyes, loss of voice, locked-jaw, and -convulsions recurring in occasional fits of eight or ten minutes in -duration. Death ensued in sixteen hours and a half.[2396] Roux refers -also among other instances to those of no fewer than ten soldiers, who -were attacked at the same time in consequence of eating the berries, and -of whom two died. In Roux’s fatal case there was injection of the -membranes of the brain, and no other particular appearance; in that -mentioned by Fée, there was inflammation of the stomach and bowels; and -in one of Sauvages’s cases no morbid appearance at all was discovered. - -Considering these very pointed proofs of the poisonous qualities of the -coriaria, it is not a little singular that doubts have lately arisen -whether it is a poison at all. Peschier of Geneva says he has -ascertained that tanners, who use it in their trade on account of the -powerful astringency of the leaves, also take it internally for gleet, -and that he gave a decoction of an ounce to chickens, dogs, and men, -without witnessing any ill effect.[2397] - - - _Of Poisoning with Yew._ - -The leaves and berries of the _Taxus baccata_, or yew, are known to be -poisonous; but their effects have not been investigated with care. I -have arranged it in the meantime with the present group. - -M. Grognier, as quoted by Orfila, ascertained that a decoction of eight -ounces of berries without seeds had no effect on a dog; that a pound and -a half of seeds had no effect on a horse; that three ounces of the juice -of the leaves given to a large dog merely caused vomiting; and that a -decoction of twelve ounces of leaves, confined in the stomach of a dog -by a ligature on the gullet, had also no effect. But two ounces of the -juice of the leaves killed a small dog; and Orfila himself ascertained, -that thirty-six grains of extract of the leaves, injected into the -jugular vein, caused giddiness, stupor, and death.[2398] - -Accidents have repeatedly happened to children in this country from -yew-berries. Mr. Hurt of Mansfield has given the particulars of an -interesting case. A child, three years and a half old, two hours after -eating the berries, was observed to look ill at dinner, and became -affected with lividity and heaviness of the eyes, as if he was about to -fall asleep. Vomiting followed, without any pain; and he died before a -medical man, who was sent for, could arrive. Four other children, -somewhat older, who had eaten the seeds, were made to vomit by emetics, -and got well. The dead body of the first child presented many livid -spots, redness of the villous coat of the stomach, and gorging of the -brain and membranes with blood. A mass of berries, seeds, and potatoes -was found in the stomach.[2399]—Dr. Hartmann of Frankfort mentions that -a girl, who took a decoction of the leaves to produce abortion, died in -consequence, but without having miscarried.[2400]—Dr. Percival has -related other cases in his essays.[2401] - - - - - CHAPTER XXXIX. - OF THE POISONOUS FUNGI. - - -A fourth group of poisons possessing narcotico-acrid proper ties, -includes the poisonous _fungi_ or mushrooms. - -Accidents arising from the deadly fungi being mistaken for eatable -mushrooms are common on the continent, and especially in France. They -are not uncommon, too, in Britain; but they are less frequent than -abroad, because the epicure’s catalogue of mushrooms in this country -contains only three species, whose characters are too distinct to be -mistaken by a person of ordinary skill; while abroad a great variety of -them have found their way to the table, many of which are not only -liable to be confounded with poisonous species, but are even also -themselves of doubtful quality. - -The present subject cannot be thoroughly studied without a knowledge of -the appearance and characters of all the fungi which have been -ascertained to be esculent, as well as of those which are known to be -deleterious. This information, however, I cannot pretend to communicate, -as it would lead to great details. In what follows, therefore, a simple -list will be given of the two classes, with references to the proper -source for minute descriptions of them, and some general observations on -the effects of the poisonous species. - -_List of the wholesome and poisonous Fungi._—The only good account yet -published of the innocent or eatable fungi of Great Britain is contained -in an elaborate essay on the subject by Dr. Greville of this place. He -enumerates no fewer than twenty-six different species, which grow -abundantly in our woods and fields, and which, although most of them -utterly neglected in this country, are all considered abroad to be -eatable, and many of them delicate. They are the following: _Tuber -cibarium_, or common truffle; _T. moschatum_ and _T. album_, two species -of analogous qualities; _Amanita cæsarea_ or _aurantiaca_, the Oronge of -the French, a species which is often confounded by the ignorant with a -very poisonous one, the _A. muscaria_, or _pseudo-aurantiaca_; _Agaricus -procerus_; _A. campestris_, the common mushroom of meadows; _A. edulis_, -or white caps; _A. oreades_, or Scotch bonnets; _A. odorus_; _A. -uburneus_; _A. ulmarius_; _A. ostreatus_; _A. violaceus_; _A. -deliciosus_; _A. piperatus_; and _A. acris_; _Boletus edulis_; and _B. -scaber_; _Fistulina hepatica_; _Hydnum repandum_; _Morchella esculenta_, -the common morelle; _Helvella mitra_, and _H. leucophæa_. Of these the -_Agaricus acris_, _procerus_, and _piperatus_ are probably unwholesome; -and the _Amanita cæsarea_ is very rare in this country, if indeed it is -indigenous at all. The _A. muscaria_, with which it is apt to be -confounded, is common enough. The species to which our cooks confine -their attention are the _Tuber cibarium_ or truffle, the _Agaricus -campestris_, or common mushroom, and the _Morchella esculenta_, or -morelle. The _Agaricus edulis_ is also to be met with in some markets, -but is not in general use.[2402] - -The best description of the poisonous species is to be found in Orfila’s -Toxicology. He enumerates the _Amanita muscaria_, _alba_, _citrina_, and -_viridis_; the _Hypophyllum maculatum_, _albocitrinum_, _tricuspidatum_, -_sanguineum_, _crux-melitense_, _pudibundum_ and _pellitum_; the -_Agaricus necator_, _acris_, _piperatus_, _pyrogalus_, _stypticus_, -_annularis_, and _urens_.[2403] To these may be added the _Agaricus -semiglobatus_, on the authority of Messrs. Brande and Sowerby,[2404] the -_A. campanulatus_,[2405] the _A. procerus_, on the authority of a case -by Dr. Peddie of this city,[2406] the _A. myomica_, on the authority of -Ghiglini,[2407] the _A. panterinus_ on that of Dr. Paolini of -Bologna,[2408] the _A. bulbosus_ of Bulliard, or _Amanita venenata_, on -that of Pouchet,[2409] the _Agaricus vernus_, _insidiosus_, -_globocephalus_, _sanguineus_, _torminosus_ and _rimosus_, on that of -Letellier,[2410] and the _Hypophyllum niveum_ on the authority of -Paulet. - -_Circumstances which modify their qualities._—The qualities of the fungi -as articles of food are liable to considerable variety. Some, which are -in general eaten in safety, occasionally become hurtful; and some of the -poisonous kinds may under certain circumstances become inert, or even -esculent. But the causes which regulate these variations are not well -ascertained. - -It has been thought by some that most fungi become safe when they have -been dried;[2411] and there may be some truth in this remark, as their -poisonous qualities appear to depend in part on a volatile principle. -But it is by no means universally true. Foderé mentions that the -_Agaricus piperatus_ continues acrid after having been dried.[2412] - -Climate certainly alters their properties. The _Agaricus piperatus_ is -eaten in Prussia and Russia;[2413] but is poisonous in France. The -_Agaricus acris_ and _A. necator_, also enumerated above as meriting -their names, are used freely in Russia.[2414] The _Amanita muscaria_ in -France and Britain is a violent poison, and is considered so even in -Russia;[2415] but in Kamschatka it yields a beverage which is used as a -substitute for intoxicating liquors.[2416] - -There is some reason to believe also that the weather or period of the -season influences some of the esculent species. Thus Foderé has -mentioned instances of the common morelle having appeared injurious -after long-continued rain.[2417] - -Even the _Agaricus campestris_ or common mushroom is generally believed -to become somewhat unsafe towards the close of the season, or as it -turns old. Its external characters at that time are sensibly altered; -the margin of the cap is more acute, its white colour less lively, and -the fleshy hue of its lamellæ is changed to brown or black. In this -state, however, I have often eaten it freely and with impunity. - -Cooking produces some difference on their effects. The very best of them -are indigestible when raw; and some of the poisonous species may lose in -part their deleterious qualities when cooked, because heat expels the -volatile principle; but, on the whole, I believe the effect of cooking -has not been satisfactorily shown to be considerable. Dr. Pouchet of -Rouen seems to have clearly proved, that the poisonous properties of two -of the most deadly fungi, the _Amanita muscaria_ and _A. venenata_, may -be entirely removed by boiling them in water. A quart of water, in which -five plants had been boiled for fifteen minutes, killed a dog in eight -hours, and again another in a day; but the boiled fungi themselves had -no effect at all on two other dogs; and a third, which had been fed for -two months on little else than boiled amanitas, not only sustained no -harm, but actually got fat on this fare.[2418] Pouchet is inclined to -think that the whole poisonous plants of the family are similarly -circumstanced.—On the other hand some cryptogamous botanists have -maintained that the qualities of the esculent mushrooms are injured by -cooking, and that when used in the raw state they may be taken for a -long time as a principal article of food without injury. This statement, -as to the effect of mushrooms when used for a length of time as food, -will be more fully considered presently. It is easy to understand how -boiling may remove their active properties, although other modes of -cookery may not do so. Roasting had no effect in impairing the activity -of _Agaricus procerus_ in the case observed by Dr. Peddie. - -On certain persons all mushrooms, even the very best of the eatable -kinds, act more or less injuriously. They cause vomiting, diarrhœa, and -colic. In this respect they are on the same footing with the richer -sorts of fish, which by idiosyncrasy act as poisons on particular -constitutions. It is probably under this head that we must arrange an -extraordinary case mentioned by Sage of a man who died soon after eating -a pound of truffles. He was seized with headache, a sense of weight in -the stomach, and faintness; and he lived only a few hours.[2419] - -Lastly, it is not improbable from a singular set of cases to be related -presently, that, contrary to what some botanists have alleged, the best -mushrooms when taken in large quantity, and for a considerable length of -time, are deleterious to every one. - -Foderé,[2420] Orfila,[2421] Decandolle,[2422] and Greville,[2423] have -laid down general directions for distinguishing the esculent from the -poisonous varieties; but it is extremely questionable whether their -rules are always safe; and certainly they are not always accurate, as -they would exclude many species in common use on the continent. It -appears that most fungi which have a warty cap, more especially -fragments of membrane adhering to their upper surface, are poisonous. -Heavy fungi, which have an unpleasant odour, especially if they emerge -from a _vulva_ or bag, are also generally hurtful. Of those which grow -in woods and shady places a few are esculent, but most are unwholesome; -and if moist on the surface they should be avoided. All those which grow -in tufts or clusters from the trunks or stumps of trees ought likewise -to be shunned. A sure test of a poisonous fungus is an astringent, -styptic taste, and perhaps also a disagreeable, but certainly a pungent, -odour. Some fungi possessing these properties have indeed found their -way to the epicure’s table; but they are of very questionable quality. -Those whose substance becomes blue soon after being cut are invariably -poisonous. Agarics of an orange or rose-red colour, and boleti which are -coriaceous or corky, or which have a membranous collar round the stem, -are also unsafe; but these rules are not universally applicable in other -genera. Even the esculent mushrooms, if partially devoured and abandoned -by insects, are avoided by some as having in all probability acquired -injurious qualities which they do not usually possess; but this test I -have often disregarded.—These rules for knowing deleterious fungi seem -to rest on fact and experience; but they will not enable the collector -to recognise every poisonous species. The general rules laid down for -distinguishing wholesome fungi are not so well founded, and therefore it -appears necessary to specify them. - -_On the Poisonous Principle of the Fungi._—Few attempts have been -hitherto made to discover by chemical analysis the principles on which -the effects of the poisonous mushrooms depend. M. Braconnot analyzed a -considerable number both of the esculent and poisonous species, and -found in some a saccharine matter, in others an acrid resin, in others -an acrid volatile principle, and in all a spongy substance, which forms -the basis of them, and which he has denominated fungin.[2424] The last -ingredient is innocuous, and it does not appear that M. Braconnot could -trace the peculiar powers of the fungi to any of the acrid principles. -The subject was afterwards resumed by M. Letellier, who says he found in -some of them one, in others two poisonous principles. One of these is an -acrid matter so fugacious, that it disappears when the plant is either -dried, or boiled, or macerated in weak acids, alkalis, or alcohol. To -this principle he says are owing the irritant properties of some fungi. -The other principle is more fixed, as it resists drying, boiling, and -the action of weak alkalis and acids. It is soluble in water, has -neither smell nor taste, and forms crystallizable salts with acids; but -he did not succeed in separating it in a state of purity. To this -principle he attributes the narcotic properties of the fungi. He found -it in the _Amanita bulbosa_, _muscaria_, and _verna_; and he therefore -proposed to call it amanitine. Its effects on animals appear to resemble -considerably those of opium.[2425]—Chansarel found that the poisonous -principle resides in the juice, and not in the fleshy part after it is -well washed.[2426] - -_Of the Symptoms produced in Man by the Poisonous Fungi._—The mode of -action of the poisonous fungi has not been particularly examined; but -the experiments of Paulet long ago established that they are poisonous -to animals as well as to man.[2427] - -The symptoms produced by them in man are endless in variety, and fully -substantiate the propriety of arranging them in the class of -narcotico-acrid poisons. Sometimes they produce narcotic symptoms alone, -sometimes only symptoms of irritation, but much more commonly both -together. It is likewise not improbable, that fungi, even though not -belonging to the varieties commonly acknowledged as poisons, induce, -when taken for a considerable length of time, a peculiar depraved state -of the constitution, leading to external suppuration and gangrene. Each -of these statements will now be illustrated by a few examples. - -The following is a good instance of pure narcotism. A man gathered in -Hyde Park a considerable number of the _Agaricus campanulatus_ by -mistake for the _A. campestris_, stewed them, and proceeded to eat them; -but before ending his repast, and not above ten minutes after he began -it, he was suddenly attacked with dimness of vision, giddiness, -debility, trembling, and loss of recollection. In a short time he -recovered so far as to be able to go in search of assistance. But he had -hardly walked 250 yards when his memory again failed him, and he lost -his way. His countenance expressed anxiety, he reeled about, and could -hardly articulate. The pulse was slow and feeble. He soon became so -drowsy that he could be kept awake only by constant dragging. Vomiting -was then produced by means of sulphate of zinc; the drowsiness gradually -went off; and next day he complained merely of languor and -weakness.[2428]—An equally remarkable set of cases of pure narcotism, -which occurred a few years ago in this city, has been related by Dr. -Peddie. Half an hour after eating the _Agaricus procerus_, an elderly -man and a boy of thirteen were attacked with giddiness and staggering, -as if they were intoxicated; and in an hour they became insensible, the -man indeed so much so that for some time he could not be roused by any -means. Emetics having little effect, the stomach was cleared out by the -pump, and powerful stimulants were employed both inwardly and outwardly, -by means of which sensibility was in some degree restored. Occasional -convulsive spasms ensued, and afterwards furious delirium, attended with -frantic cries and vehement resistance to remedies, and followed by a -state like delirium tremens. The pupils were at first much contracted, -afterwards considerably dilated as sensibility returned, and in the boy -contracted while he lay torpid, but dilated when he was roused. In -neither instance was there any pain felt at any time; nor were the -bowels affected. Another boy who took a small quantity only had no other -symptom but giddiness, drowsiness, and debility.[2429]—A singular form -of the narcotic effects of the fungi occurred in the case of a boy of -fourteen, who had eaten the _Agaricus panterinus_ near Bologna. In the -course of two hours he was seized with delirium, a maniacal disposition -to rove, and some convulsive movements. Ere long these symptoms were -succeeded by a state resembling coma in every way, except that he looked -as if he understood what was going on: and in point of fact really did -so. He recovered speedily under the use of emetics.[2430] - -In the next set of cases the symptoms were those of almost pure -irritation. Several French soldiers in Russia ate a large quantity of -the _Amanita muscaria_, which they had mistaken for the _Amanita -cæsarea_. Some were not taken ill for six hours and upwards. Four of -them, who were very powerful men, thought themselves safe, because while -their companions were already suffering, they themselves felt perfectly -well; and they refused to take emetics. In the evening, however, they -began to complain of anxiety, a sense of suffocation, frequent fainting, -burning thirst, and violent gripes. The pulse became small and -irregular, and the body bedewed with cold sweat; the lineaments of the -countenance were singularly changed, the nose and lips acquiring a -violet tint; they trembled much; the belly swelled, and a profuse fetid -diarrhœa supervened. The extremities soon became livid, and the pain of -the abdomen intense; delirium ensued; and all four died.[2431] - -Such cases, however, do not appear to be very common; and much more -generally the symptoms of poisoning with the fungi present a well-marked -conjunction of deep narcotism and violent irritation, as the instances -now to be mentioned will show. - -Besides the four soldiers whose cases have just been described, several -of their comrades were severely affected, but recovered. Two of these -had weak pulse, tense and painful belly, partial cold sweats, fetid -breath and stools. In the afternoon they became delirious, then -comatose, and the coma lasted twenty-four hours. - -A man, his wife, and three children, ate to dinner carp stewed by -mistake with the _Amanita citrina_. The wife, the servant, and one of -the children had vomiting, followed by deep sopor; but they recovered. -The husband had true and violent cholera, but recovered also. The two -other children became profoundly lethargic and comatose, emetics had no -effect, and death soon ensued without any other remarkable symptom. The -individuals who recovered were not completely well till three weeks -after the fatal repast.[2432] This set of cases shows the tendency of -the poisonous fungi to cause in one person pure irritation, and in -another pure narcotism. - -The last set of cases to be mentioned were produced by the _Hypophyllum -sanguineum_, a small conical fungus of a mouse colour, well known to -children in Scotland by the name of _puddock-stool_. This species seems -to cause convulsions as well as sopor. A family of six persons, four of -whom were children, ate about two pounds of it dressed with butter. The -incipient symptoms were pain in the pit of the stomach, a sense of -impending suffocation, and violent efforts to vomit; which symptoms did -not commence in any of them till about twelve hours after the poisonous -meal, in one not till twenty hours, and in another not till nearly -thirty hours. One of the children, seven years of age, had acute pain of -the belly, which soon swelled enormously; afterwards he fell into a -state of lethargic sleep, but continued to cry; about twenty-four hours -after eating the fungi the limbs became affected with permanent spasms -and convulsive fits; and in no long time he expired in a tetanic -paroxysm. Another of the children, ten years old, perished nearly in the -same manner, but with convulsions of greater violence. The mother had -frequent bloody stools and vomiting; the skin became yellow; the muscles -of the abdomen were contracted spasmodically, so that the navel was -drawn towards the spine; profound lethargy and general coldness -supervened; and she too died about thirty-six hours after eating the -fungus. A third child, after slight symptoms of amendment had shown -themselves, became worse again, and died on the third day with -trembling, delirium, and convulsions. This patient, who had taken very -little of the poison, was not attacked till about thirty hours after the -meal. The fourth child, after precursory symptoms like those of the -rest, became delirious, and had an attack of colic and inflammation of -the bowels, without diarrhœa; but he eventually recovered. The father -had a severe attack of dysentery for three days, and remained five days -speechless. For a long time afterwards he had occasional bloody -diarrhœa; and, although he eventually recovered, his health continued to -suffer for an entire year.[2433] The cases now mentioned illustrate -clearly the simultaneous occurrence of narcotic and irritant symptoms in -the same individuals. - -A striking circumstance in respect to the symptoms of poisoning with the -fungi, is the great difference in the interval which elapses before they -begin. In the first case the symptoms appear to have commenced in a few -minutes; but, on the contrary, an interval of twelve hours is common; -and Gmelin has quoted a set of cases, seventeen in number, in which, as -in one of those related by Picco, the interval is said to have been a -day and a half.[2434] The tardiness of the approach of the symptoms is -owing to the indigestibility of most of the fungi. Their indigestibility -is in fact so great, that portions of them have been discharged by -vomiting so late as fifty-two hours after they were swallowed.[2435] - -Another circumstance, worthy of particular notice, is the great -durability of the symptoms. Even the purely narcotic effects of some -fungi have been known to last above two days. In the instance just -alluded to, the vomiting of the poison was the first thing that -interrupted a state of deep lethargy, which had prevailed for fifty-two -hours. The symptoms of irritation, after their violence has been -mitigated, might continue, as in the instance quoted from Orfila, for -about three weeks. - -It was stated above, that some people are apt to suffer unpleasant -effects from eating even the best and safest of the esculent mushrooms. -These effects, which depend on idiosyncrasy, are confined chiefly to an -attack of vomiting and purging, followed by more or less indigestion. -Some persons have been similarly affected, even by the small portion of -mushroom-juice which is contained in an ordinary ketchup seasoning. This -accident, however, may very well be often unconnected with idiosyncrasy; -as I have seen those who gather mushrooms near Edinburgh, for the -purpose of making ketchup, picking up every fungus that came in their -way. - -There is some reason for suspecting that even the best mushrooms, when -taken as a principal article of food for a considerable length of time, -will prove injurious, and that they then induce a peculiar depraved -habit, which leads to external suppuration and gangrene. The only cases -which have hitherto appeared in support of this statement, were lately -published in Rust’s Journal. A family, consisting of the mother and four -children, were seized with a kind of tertian fever, and the formation of -abscesses, which discharged a thin, ill-conditioned pus, passed rapidly -into spreading gangrene, and proved fatal to the mother and one of the -children. No other cause could be discovered to account for so -extraordinary a conjunction of symptoms in so many individuals, except -that for two months they had lived almost entirely on mushrooms; and the -probability of this being really the cause, was strengthened by the -fact, that the father who slept always with his family, and who alone -escaped, lived on ordinary food at a place where he worked not far -off.[2436] In opposition, however, to the natural inference from this -narrative, some have believed, that mushrooms may be safely eaten to a -large amount and for a long time, provided they be used raw. A botanist -of Persoon’s acquaintance, while studying the cryptogamous plants in the -vicinity of Nuremberg, says he found that the peasants ate them in large -quantities as their daily food; and, in imitation of their custom, he -ate for several weeks nothing but bread and raw mushrooms; yet at the -end he experienced an increase rather than a diminution of strength, and -enjoyed perfect health. He adds that they lose their good qualities by -cooking; but he has supplied no facts in support of that -statement.[2437] It is said that eatable fungi, used for a considerable -time as a principal article of food, as in Russia, cause greenness of -the skin.[2438] There is no reason for supposing, as some have -done,[2439] that wholesome mushrooms may produce the effects of the -poisonous kinds, if eaten in large quantity. - -_Of the Morbid Appearances._—The morbid appearances left in the bodies -of persons poisoned by this deleterious fungi have been but imperfectly -collected. - -The body is in general very livid, and the blood fluid; so much so -sometimes, that it flows from the natural openings in the dead -body.[2440] In general, the abdomen is distended with fetid air, which, -indeed, is usually present during life. The stomach and small intestines -of the four French soldiers (p. 705), presented the appearance of -inflammation passing in some places to gangrene. In two of them -especially, the stomach was gangrenous in many places, and far advanced -in putrefaction. The same appearances were found in Picco’s cases. In -these there was also an excessive enlargement of the liver. The lungs -have sometimes been found gorged or even inflamed. The vessels of the -brain are also sometimes very turgid. They were particularly so in a -case related by Dr. Beck, where death was occasioned in seven hours by -an infusion of the _Amanita muscaria_ in milk. The whole sinuses of the -dura mater, as well as the arteries were enormously distended with -blood; the arachnoid and pia mater were of a scarlet colour; the vessels -of the membrane between the convolutions, together with the plexus -choroides, were also excessively gorged; and the substance of the brain -was red. Lastly, a clot of blood, as big as a bean, was found in the -cerebellum.[2441]—The stomach, unless there had been vomiting or -diarrhœa, will usually contain fragments of the poison, if it has not -been taken in a state of minute division; and this evidence of the cause -of death may be obtained, even although the individual survived two days -or upwards. Sometimes fragments are found in the intestines. In one of -Picco’s patients who lived twenty-four hours, there was found in the -neighbourhood of the ileo-cæcal valve, which was much inflamed.[2442] - -_Of the Treatment._—The treatment of poisoning with the fungi does not -call for any special observations. Emetics are of primary importance; -and after the poison has been by their means dislodged, the sopor and -inflammation of the bowels are to be treated in the usual way. No -antidote is known. Several have at different times been a good deal -confided in; but none are of any material service. Chansarel found acids -useless, but thought infusion of galls advantageous.[2443] - -In concluding the present chapter it is necessary to take notice of a -variety of poisoning, not altogether unimportant in a medico-legal point -of view. A person may seem to die of poisoning with the deleterious -fungi, from eating esculent mushrooms intentionally drugged with some -other vegetable or mineral poison. It must be confessed, that if the -murderer is dexterous in the choice and mode of administering the -poison, such cases might readily escape suspicion, and even when -suspected might not be cleared up without difficulty. The ascertaining -the species of mushroom, by finding others where it has been gathered, -will not supply more than presumptive proof of the wholesomeness of that -which has been eaten; because the esculent and poisonous species -sometimes grow near one another, and have a mutual resemblance, so that -a mistake may easily occur. The presumption may be somewhat strengthened -by evidence derived from the interval which elapses before the symptoms -begin, from the nature and progress of the symptoms themselves, and from -the morbid appearances. Some one or other of these circumstances may -establish the fact of poisoning with a deleterious fungi. It is -impossible, however, that they shall ever establish satisfactorily that -the fungus was naturally wholesome; and, on the whole, the only decided -evidence of poisoning by some other means will be the actual discovery -of another poison. - -The case now under consideration is not a mere hypothetical one. Ernest -Platner has related a very interesting example, which proves how easily -poisoning of the kind supposed may be accomplished without suspicion. A -servant-girl poisoned her mistress by mixing oxide of arsenic with a -dish of mushrooms. She died in twenty hours, after suffering severely -from vomiting and colic pains. On dissection there were found -inflammation of the stomach, gangrenous spots in it, clots of blood in -its contents, and redness of the intestines. Her death, however, was -ascribed to the mushrooms having been unwholesome; and the real cause -was not discovered till thirteen years after, when the girl was -convicted of murdering a fellow-servant in a somewhat similar way by -mixing arsenic with her chocolate, and then confessed both crimes.[2444] - -_Poisonous Mosses._—It is not improbable that some of the mosses possess -poisonous properties similar to those of the deleterious fungi. Dr. -Winkler of Innsbruch mentions that the _Lycopodium selago_ is used in -the Tyrol in the way of infusion for killing vermin on animals; and that -unpleasant accidents have been produced in man by its accidental use. -Its effects appear to be sometimes irritant, but more generally narcotic -in their nature.[2445] - - - - - CHAPTER XL. - OF THE EFFECTS OF POISONOUS GRAIN AND PULSE. - - -The different sorts of grain are subject to certain diseases, in -consequence of which meal or flour made from them is apt to be -impregnated with substances more or less injurious to animal life. It is -likewise believed, that unripe grain possesses properties which render -it to a certain extent unfit for the food of man. - -It is for the most part difficult to trace satisfactorily the operation -of the poisons now alluded to, because they are seen acting only in -times of famine and general distress, when it is not always easy to make -due allowance for the effect of collateral circumstances. There is one -poison of the kind, however, whose baneful influence has been so -frequently and unequivocally witnessed, that no doubt now exists -regarding its properties, I mean _spurred rye_, or _ergot_. It is a -poison of no great consequence, perhaps, to the English toxicologist; -for indeed I am not aware that a single instance of its operation has -hitherto been observed in Britain.[2446] But its effects are so -singular, and the ravages it has often committed on the continent have -been so dreadful, that a short account of it cannot fail to interest -even the English reader. Besides, it has lately been introduced into the -materia medica, as possessing very extraordinary medicinal qualities; -and since its use is gaining ground, every medical jurist ought to be -conversant with its properties as a poison. I have also met with an -instance where it was administered for the purpose of procuring -miscarriage. - - - _Of Poisoning with Spurred Rye._ - -_Spurred Rye_, or _Secale cornutum_, the _Seigle ergoté_, or _Ergot_ of -the French, and _Mutterkorn_, or _Roggenmutter_, of the Germans, is a -disease common to various grains, in consequence of which the place of -the pickle is supplied by a long, black substance, like a little horn or -spur. It has been known to attack many plants of the order -Graminaceæ;[2447] and among those used as food by man, it has been -observed on barley, oats, spring-wheat, winter-wheat, and rye. But the -rye seems peculiarly subject to it, almost all the poison which has -caused epidemics, as well as what is now used in medicine, being -produced by that grain. - -_Of the Cause and Nature of the Spur in Rye._—The spur attacks rye -chiefly in damp seasons, and in moist clay soils, particularly those -recently redeemed from waste lands in the neighbourhood of forests. Of -all the places where the spur has been hitherto observed none combines -these conditions so perfectly, and none has been so much infested with -the disease, as the district of Sologne, situated between the rivers -Loire and Cher, in France. According to the statistical researches of -the _Abbé Tessier_, who in 1777 was deputed by the Parisian Society of -Medicine to investigate the causes of the extraordinary prevalence of -the ergot in that district, the country was then so much intersected by -belts of wood around the fields, that the traveller in passing along -might imagine he was constantly approaching an immense forest; the -arable land was so poor, that, although it lay fallow every third -season, it was exhausted in nine or twelve years at farthest, and then -remained a long time in pasture before it could again bear white crops; -the surface was so level, and consequently so wet, that crops were -obtained only when the seed was sown on the tops of furrows a foot high; -and the climate is so moist, that from the month of September till late -in spring the whole country is overhung by dense fogs.[2448] Here the -rye, the common food of the peasantry, appears to have been in Tessier’s -time more liable to be attacked by the spur than in any other part of -the continent. Tessier found, that after being thrashed it contained on -an average about a forty-eighth part of ergot, even in good seasons; but -in bad seasons, and taking into account a considerable proportion which -is shaken out of the ears and sheaves before they reach the barn, the -proportion of ergot in the whole crop has been estimated so high as a -fourth or even a third. In Sologne the disease was farther observed by -Tessier to be always most prevalent in the dampest parts of a field, and -to affect above all the first crop of fields redeemed from waste land, -or from land which had previously been for some time in pasture.[2449] -The same connexion between moisture and the development of the ergot has -been repeatedly traced in other parts of France, as well as in -Germany.[2450] And according to the experiments of Wildenow, it may be -brought on at any time, by sowing the rye in a rich damp soil, and -watering the plants exuberantly in warm weather.[2451] - -Opinions are much divided as to the cause and nature of the spur. It had -been conceived by some that nothing else is required for its production -but undue moisture combined with warmth; and that under these -circumstances the spur is formed simply by a diseased process from the -juices of the plant.[2452] By others, such as Tillet, Fontana, and Réad, -who also consider it to be simply a diseased formation, it has been held -to arise from the germen being punctured when young by an insect;[2453] -and in support of this statement, General Field says he saw flies -puncture the glumes in their milky state where spurs afterwards formed, -and imitating the operation with a needle obtained the same -result.[2454] On the other hand, Decandolle, reviving a previous -doctrine that the spur is a kind of fungus, conceived he had given -strong grounds for believing this excrescence to be a species of -_sclerotium_, which he terms _S. clavus_. Wiggers supports this doctrine -by chemical analysis; for he endeavours to show that the basis of the -structure of the spur is almost identical in chemical properties with -the principle fungin.[2455] Lastly, the most recent researches, those of -Smith,[2456] Queckett,[2457] and Bauer,[2458] founded chiefly on -microscopical observations, tend to a union and modification of these -two views,—namely, that the great mass of the spur is a peculiar morbid -formation, and that the whitish bloom which covers fresh specimens -consists of a multitude of microscopic fungi in the form of _sporidia_, -which thickly envelope and impregnate the parts of fructification in the -nascent state of the embryo, and are in all probability the exciting -cause of the morbid degeneration of the pickle.[2459] - -Various opinions have been formed as to the mode of propagation of the -spur. Fontana has alleged that one variety of it may spread from plant -to plant over a field; and that he has expressly transmitted it by -contact from one ear to another.[2460] His opinion and statement of -facts are at variance with experiments lately made by Hertwig, a German -physician, who found that even when the ear while in flower was -surrounded for twelve days with powder of spurred rye, the healthiness -of the future grain was not in the slightest degree affected.[2461] The -same results have also been obtained by Wiggers, and more recently by -Dr. Samuel Wright.[2462] Wiggers, however, although he could not produce -spurs in the way indicated by Fontana, observed that the white dust on -the surface of the spurs will produce the disease in any plant, if -sprinkled in the soil at its roots, appearing therefore to be analogous -to the sporules or spawn of the admitted fungi. Mr. Queckett has made -the most precise experiments on the mode of reproduction of the disease. -He succeeded in infecting rye repeatedly with ergot by means of the -sporidia developed on the spurs; but it is remarkable that he could not -in the same way infect wheat or barley.[2463] - -_Description and analysis of Spurred Rye._—The spur varies in length -from a few lines to two inches, and is from two to four lines in -thickness. If it is long, there is seldom more than one or two on a -single ear, and the remaining pickles of the ear are healthy. But the -ears which have small spurs have generally several, sometimes even -twenty; and when there are many, few of the remaining pickles are -altogether without blackness at the tips.[2464] The substance of the -spur is of a pale grayish-red tint; and externally it is bluish-black or -violet, with two, sometimes three, streaks of dotted gray. It is -specifically lighter than water, while sound rye is specifically -heavier, so that they are easily separated from one another.[2465] It is -tough and flexible when fresh, brittle and easily pulverized when dry. -The powder is disposed to attract moisture. It has a disagreeable heavy -smell, a nauseous, slightly acrid taste, and imparts its taste and smell -both to water and alcohol. Bread which contains it is defective in -firmness, liable to become moist, and cracks and crumbles soon after -being taken from the oven.[2466]—It is easily known, when entire, by its -external characters. Its powder, which is of an obscure grayish-red hue, -is best known by the action of solution of potash, which immediately -disengages a powerful odour of ergot, and forms a lake-red pulp; and -this pulp yields by filtration a splendid lake-red solution, which gives -a beautiful lake-red flaky precipitate, when either neutralized by -nitric acid, or treated with an excess of solution of alum. - -Spurred rye has been repeatedly subjected to analysis. The earlier -researches of Vauquelin[2467] and of Pettenkofer[2468] do not lead to -any pointed results. The presence of hydrocyanic acid indicated by -Robert,[2469] would not account for the very peculiar effects of ergot, -and has besides been denied by Wiggers. Winkler obtained various -principles from it, and among the rest a thick, rancid, slightly acrid -oil, and a nauseous, sweetish, acrid fluid; but he did not determine, -any more than his predecessors, in which of these principles the active -properties of the spur reside.[2470] Wiggers supplied more definite -information on the subject. He denies the presence of hydrocyanic acid, -and says he found ergot to consist chiefly of a heavy-smelling fixed -oil, fungin, albumen, osmazome, waxy matter, and an extractive substance -of a strong, peculiar taste and smell, in which, from experiments on -animals, he was led to infer that its active properties reside. I have -obtained all his chief results, except the most important of them; for -the substance which ought to have been his ergotin was destitute of -marked taste or smell of any kind.[2471] Dr. Wright too could not obtain -the ergotin of Wiggers, and concludes from his own experiments, that the -spur consists of fungin, modified starch, mucilage, gluten, osmazome, -colouring matter, various salts, and thirty-one per cent. of fixed oil, -in which the active properties of the poison seemed to him to -reside.[2472] Buchner, however, thinks that the oil is not itself -active, but owes its apparent energy to an acrid principle which alcohol -removes from it, and which is not removed from the crude substance in -separating the oil in the usual way by sulphuric ether, unless the ether -be somewhat alcoholized.[2473] However this may be, it seems ascertained -by the experiments of Dr. Wright, that the fixed oil, obtained by means -of common ether, concentrates in itself the peculiar properties -possessed by ergot, either in small doses as a medicine, or in a single -large dose as a poison. - -_Effects of Spurred Rye on Man and Animals._—Before proceeding to relate -the effects of this poison on man, it should be mentioned, that at -different times doubts have been entertained, whether the baneful -effects ascribed to it might not really arise from some other cause. But -independently of the connexion which has been frequently traced between -the poison and the diseases imputed to it in the human subject, the -question has been set at rest by the experiments which have been tried -on animals, and which indeed were instituted with a view to settle the -point in dispute. - -The experiments hitherto made on animals are variable in their results, -yet sufficient to show that spurred rye is an active poison of a very -peculiar kind. According to the observations collected by Dr. Robert -from a variety of authors, it follows that it is injurious and even -fatal to all animals which are fed for a sufficient length of time with -a moderate proportion of it, unless they escape its action by early -vomiting; that dogs and cats, in consequence of discharging it by -vomiting, suffer only slight symptoms of irritant poisoning;—but that -swine, moles, geese, ducks, fowls, quails, sparrows, as well as leeches -and flies, are sooner or later killed by it;—and that the symptoms it -causes in beasts and birds are in the first instance giddiness, dilated -pupil, and palsy, and afterwards diarrhœa, suppurating tumours, -scattered gangrene throughout the body, and sometimes dropping off of -the toes. Wiggers ascertained that nine grains of the substance he has -considered its active principle occasioned in a fowl dulness, apparent -suffering, gradually increasing feebleness, coldness and insensibility -of the extremities, and in three days a fit of convulsions, ending in -death.[2474] Taddei lately found, that sparrows were killed by six -grains of it in six or seven hours, with symptoms merely of great -weakness, torpor, and indisposition to stir.[2475] - -Dr. Wright, whose experiments are the most extensive and precise yet -made on this subject, found that a single dose, consisting of a strong -infusion of between two drachms and a half and six drachms of ergot, if -introduced into the jugular vein of a dog, occasions death, sometimes in -a few minutes, sometimes not for more than two hours, with symptoms of -alternating spasm and paralysis, occasionally a tendency to coma, and -often depressed or irregular action of the heart, or even complete -arrestment of its function;—that, when introduced into the cellular -tissue, it produces inflammation and suppuration, sometimes -circumscribed, sometimes diffuse, and always attended with an unhealthy -discharge and great exhaustion;—and that, when admitted into the -stomach, it excites irritation of the alimentary canal, excessive -muscular prostration, at first excitability, but afterwards singular -dulness or even complete obliteration of the senses, and occasional -slight spasms; but that it is not a very active poison through this -channel, as above three ounces are required to prove fatal to a dog. -When it was administered in frequent small doses, he could not observe -the effects remarked by Robert, but found that it induced a peculiar -cachectic state, indicated by extreme muscular emaciation and weakness, -loss of appetite, frequency of the pulse, repulsive fetor of the -secretions and excretions, congestion of the alimentary mucous membrane, -excessive contraction of the spleen, enlargement of the liver and -absorbent glands, and non-formation of callus at the ends of fractured -bones.[2476] - -With regard to its effects on man, it has been found by express -experiment, that a single dose of two drachms excites giddiness, -headache, flushed face, pain and spasms in the stomach, nausea, and -vomiting, colic, purging, and a sense of weariness and weight in the -limbs.[2477] But it is not in this way that it has been usually -introduced into the system; nor are these precisely the symptoms already -hinted at as particular in its action. The effects now to be mentioned -form a peculiar disease, which has often prevailed epidemically in -different territories on the continent, and which arises from the spur -being allowed to mix with the grain in the meal, and being taken as food -for a continuance of time in rye-bread. The affection produced differs -much in different epidemics and even in different cases of the same -epidemic. Two distinct disorders have been noticed; the one a nervous -disease, characterized by violent spasmodic convulsions; the other a -depraved state of the constitution, which ends in that remarkable -disorder, dry gangrene; and it does not appear that the two affections -are apt to be blended together in the same case. - -The first form of disease, the _convulsive ergotism_ of the French -writers, has been very well described by Taube, a German physician, as -it occurred in the north of Germany in 1770–1. In its most acute form, -it commenced suddenly with dimness of sight, giddiness and loss of -sensibility, followed soon by dreadful cramps and convulsions of the -whole body, _risus sardonicus_, yellowness of the countenance, excessive -thirst, excruciating pains in the limbs and chest, and a small, often -imperceptible pulse. Such cases usually proved fatal in twenty-four or -forty-eight hours. In the milder cases the convulsions came on in -paroxysms, were preceded for some days by weakness and weight of the -limbs, and a strange feeling as of insects crawling over the legs, arms, -and face; in the intervals between the fits the appetite was voracious, -the pulse natural, the excretions regular; and the disease either -terminated in recovery, with scattered suppurations, cutaneous -eruptions, anasarca or diarrhœa, or it proved in the end fatal amidst -prolonged sopor and convulsions.[2478] Another more recent and very -clear account of this form of the disease has been given by Dr. Wagner -of Schlieben from his experience of an epidemic which prevailed in the -neighbourhood of that place so lately as the years 1831 and 1832. In -consequence of unusual moisture and late frosts in the summer of 1831, -the rye was so much spurred in many fields that a fifth at least of the -pickles was diseased. As soon as the country people proceeded to use the -new rye, convulsive ergotism began to show itself, and it recurred more -or less till next midsummer, when the diseased grain was all consumed. -The usual symptoms were at first periodic weariness, afterwards an -uneasy sense of contraction in the hands and feet, and at length violent -and permanent contraction of the flexor muscles of the arms, legs, feet, -hands, fingers and toes, with frequent attacks of a sense of burning or -creeping on the skin. These were the essential symptoms; but a great -variety of accessory nervous affections occasionally presented -themselves. There was seldom any disturbance of the mind, except in some -of the fatal cases, where epileptic convulsions and coma preceded death. -Every case was cured by emetics, laxatives, and frequent small doses of -opium, provided it was taken in reasonable time, and the unwholesome -food was completely withdrawn.[2479] - -The other form of disease, which has been named _gangrenous ergotism_, -by the French writers, and is known in Germany by the vulgar name of -creeping-sickness (_kriebelkrankheit_), has been minutely described by -various authors. In the most severe form, as it appeared in Switzerland -in 1709 and 1716, it commenced, according to Lang, a physician of -Lucerne, with general weakness, weariness, and a feeling as of insects -creeping over the skin; when these symptoms had lasted some days or -weeks, the extremities became cold, white, stiff, benumbed, and at -length so insensible that deep incisions were not felt; then -excruciating pains in the limbs supervened, along with fever, headache, -and sometimes bleeding from the nose; finally the affected parts, and in -the first instance the fingers and arms, afterwards the toes and legs, -shrivelled, dried up, and dropped off by the joints. A healthy -granulation succeeded; but the powers of life were frequently exhausted -before that stage was reached. The appetite, as in the convulsive form -of the disease, continued voracious throughout.[2480] In milder cases, -as it prevailed at different times in France, nausea and vomiting -attended the precursory symptoms, and the gangrenous affection was -accompanied with dark vesications.[2481] In another variety, which has -been witnessed in various parts of Germany, the chief symptoms were -spasmodic contraction of the limbs at first, and afterwards weakness of -mind, voracity and dyspepsia, which, if not followed by recovery, as -generally happened, either terminated in fatuity or in fatal -gangrene.[2482] - -These extraordinary and formidable distempers were first referred to the -operation of spurred rye in 1597 by the Marburg Medical Faculty, who -witnessed the ravages of the poison in Hessia during the preceding year. -Since then repeated epidemics have broken out in Germany, Bohemia, -Holstein, Denmark, Sweden, Lombardy, Switzerland, and France.[2483] -About the close of last century, partly in consequence of the attention -of the respective governments being turned to the subject, partly by -reason of the improved condition of the peasantry in these countries, -and the greater rarity of seasons of famine, the epidemics became much -less common or extensive. Nevertheless the creeping-sickness has been -several times noticed in Germany since the present century began.[2484] - -Spurred rye is now generally believed to possess another singular -quality, in consequence of which it has been lately introduced into the -materia medica of this and other countries,—a power of promoting the -contractions of the gravid uterus. This property seems to have been long -familiar to the quacks and midwives of Germany; and towards the close of -last century it rendered ergot so favourite a remedy with them, that -several of the German states prohibited the use of it by severe -statutes.[2485] It was first fairly brought under the notice of regular -accoucheurs by the physicians of the United States between the years -1807 and 1814.[2486] There appears little reason for doubting that it -possesses the power of increasing the contractions of the uterus when -unnaturally languid; and consequently it has been employed, apparently -with frequent good effect, to hasten languid natural labour, to promote -the separation of the placenta, and to quicken the contraction of the -womb after delivery. These facts, however, are mentioned chiefly as -preparatory to the statement, that it has been also supposed to possess -the power of producing abortion, and has been actually employed for that -purpose in some foreign countries, and even in this city. Accurate -information is still much wanted on this subject. No other poison seems -so likely to possess a peculiar property of the kind. Nevertheless it is -the opinion of the best authorities, that spurred rye has no such power, -except in connexion with violent constitutional injury produced by -dangerous doses; and that it is endowed with the property only of -accelerating natural labour, not of inducing it, particularly in the -early months of pregnancy. - -It seems from the experiments of Dr. Wright to have no power whatever of -inducing miscarriage in the lower animals.[2487] Notwithstanding the -improbability, however, of its possessing the property of bringing on -abortion, it is one of the substances at present occasionally employed -with the view of feloniously causing this accident. In a case of attempt -to procure abortion, which occurred not long ago in this city, one of -the articles repeatedly employed, but without success, was powder of -spurred rye,—as I had occasion to ascertain by chemical analysis. - -_Of Spurred Maize._—It has been already observed, that many other plants -of the Natural Family of Grasses are subject to the ergot besides rye. -But the only other species in which the disease has been particularly -examined is Indian corn or maize [_Zea Mays_]. It appears from the -inquiries of M. Roullin that maize is very subject to the spur in the -provinces of Neyba and Maraquita in Colombia; that the spur forms a -black, pear-shaped body on the ear in place of the pickle; and that in -this state the grain, which is known by the name of _maïs peladero_, -possesses properties injurious to animal life. Its effects, however, are -somewhat different from those of spurred rye. Men who eat the ergotted -maize lose their hair and sometimes their teeth, but are never attacked -with dry gangrene or convulsions. When swine eat it, which after a time -they do with avidity, the bristles drop off, and the hind-legs become -feeble and wasted. Mules likewise lose their hair, and the hoofs swell. -Fowls lay their eggs without the shell. Apes and parrots, which frequent -the fields of spurred maize, fall down as if drunk; and the native dogs -and deer experience similar effects.[2488] - - - _Of the Rust of Wheat._ - -There are several other diseases to which grain is liable, and which are -much more common in this country than the ergot. But very little is -known of their effects on the animal body; which circumstance, since the -wheat of this and other countries often suffers from them, is probably -sufficient to show that their influence must be trifling, or at all -events very seldom called forth. Wheat is liable to three diseases. One -is a disease of the stalk and leaf rather than of the ear, and has the -effect of preventing the development of the ear or its pickles, and of -covering the plant with a brown powder. Of the two other diseases, which -both attack the pickles of the ear, one consists in the substitution of -a brown dry powder for the farina of the pickle, and the other of a -deposition of black moist matter in the fissure of the pickle, the -substance of which it also invades and partially destroys. One of these -is called in Scotland _brown rust_, the other _black rust_. - -Of the three diseases the only one which is apt to infect the flour is -the black rust. The others, as they consist of a light dry powder, are -almost entirely separated in thrashing and winnowing the grain. But the -black rust being damp and adhesive, it is carried along with the -pickles. Such pickles are almost invariably separated by the farmer if -they are abundant; for otherwise, on account of the dark colour and -disagreeable odour of the matter deposited on them, the flour possesses -external qualities which would be at once recognized by a dealer of -ordinary experience. - -It is not improbable, that a moderate impregnation of bread with the -powder formed by the diseases in question may take place, without -leading to any unpleasant effect on the human body. Experiments to this -effect were made by Parmentier with one of them, termed in France -_carie_, or caries of wheat, which from his description appears to be -the black rust of Scottish farmers. He gave two dogs each two drachms -daily of the powder for fifteen days, without remarking any sign of ill -health. Bread made with wheat flour containing a 64th of the powder, -when eaten by various people, and Parmentier among the rest, to the -amount of a pound daily for several days, caused slight headache and -pain in the stomach the first day only; and in larger proportion it had -as little effect.[2489] - -It appears, then, that the introduction of any deleterious ingredient -into wheat bread is hardly to be dreaded from the common diseases to -which wheat is liable in this country. - - - _Of Unripe Grain._ - -Wheat and other grains have been supposed to acquire qualities -detrimental to health, from being cut down while unripe, or used -immediately after being cut down, although ripe. I am not aware that -accidents have ever been traced or even imputed to such causes in this -country; and, on the whole, I believe it is generally considered here, -that imperfect ripening of the pickle rather lessens the quantity, than -impairs the quality, of the flour. But several times epidemics have been -ascribed in France to unripe wheat. In 1801 M. Bouvier read a memoir to -the Society of Medicine at Paris, ascribing to new and unripe wheat an -epidemic dysentery, which laid waste several districts of the department -of the Oise in the autumn of 1793. These districts abound in small farms -of a few acres, on the produce of which the cultivators depend in great -measure for their subsistence. Hence in unfavourable seasons the corn -was commonly cut down before it was ripe, and made into bread soon after -being reaped. It was accordingly among the peasantry of these farms -only, and not among the agriculturists in large farms, which were under -better management, that the epidemic prevailed. Bouvier remarks, that at -all times when the long continuance of wet weather has compelled the -inhabitants of a district to cut down the wheat before it is ripe, or a -previous dearth has forced them to use it when newly cut, epidemic -disorders of the bowels have been observed to rage in the latter months -of autumn. And as an instance of this he refers to the year 1783, when -the crops around Paris were believed to have been injured by the -extraordinary prevalence of fogs, and were cut down unripe and used -immediately. Various epidemics broke out in the metropolis, and still -more in the surrounding country.[2490] This is an important subject for -farther inquiry; but at present I cannot help thinking that M. Bouvier -exaggerates the effects of the immaturity of the grain. At all events, -the grain is often cut down in an unripe state in various districts of -this country; and I have never heard that any epidemic diseases were -produced. When M. Bouvier witnessed the epidemic of 1793 in the -department of the Oise, he instructed the inhabitants of his own parish -to dry the unripe corn before thrashing it, to repeat the process before -the grain was converted into flour, and to mix with the flour a larger -quantity than usual of yeast in making it into bread; and he states that -in the succeeding year, which was even more unfavourable to the crops, -they were enabled, by following these directions, to use unripe corn -with safety. - - - _Of Spoiled Bread._ - -This is the fittest opportunity for noticing certain injurious effects -sometimes observed from the use of spoiled or mouldy bread. On the -continent repeated instances have occurred of severe and even dangerous -poisoning from spoiled rye-bread, barley-bread, and even wheat bread. -Several instances have been observed of horses having been killed in a -short space of time with symptoms of irritant poisoning after eating -such bread with their ordinary food.[2491] And Ur. Westerhoff has given -an account of its effects on two children and several adults. In -children the symptoms were redness of the features, dry tongue, frequent -weak pulse, violent colic pains, urgent thirst and headache, and -subsequently vomiting and diarrhœa, alternating with great exhaustion -and sleepiness. The bread in these instances was made of rye.[2492] It -appears that in bread so spoiled a variety of mucedinous vegetables are -developed, especially the _Penicillium glaucum_ and _P. roseum_; and it -is imagined by some, that this circumstance may account for the -deleterious effect of the bread.[2493] - - - _Of the Effects of Darnel-Grass._ - -Grain is also rendered more or less injurious by the accidental or -intentional admixture of a variety of foreign substances, by which, in -common speech, it is said to be adulterated. The subject of the -adulteration of grain is a very important topic in medical police. But -as this practice seldom imparts to the grain qualities decidedly -poisonous, the consideration of it would be misplaced here. One variety, -however, the accidental adulteration of flour with the seeds of the -_Lolium temulentum_ or darnel-grass calls for some notice; for it may -occasion not only symptoms of poisoning, but even also death itself. - -This is the only poisonous species of the natural order of the grasses. -The seeds appear to be powerfully narcotic, and at the same time to -possess acrid properties. Seeger gave a dog three ounces of a decoction -of the flour, and observed that it was seized in five hours with violent -trembling and great feebleness, which were succeeded in four hours by -sopor and insensibility; but it recovered next day.[2494] - -When mixed with bread and taken habitually by man, darnel-grass has been -known to cause headache, giddiness, somnolency, delirium, convulsions, -paralysis, and even death. M. Cordier found by experiment on himself, -that very soon after eating bread containing darnel-grass flour, he felt -confusion of sight and ideas, languor, heaviness, and alternate attacks -of somnolency and vomiting. The bread was commonly vomited soon after he -ate it.[2495] Seeger has related some cases in which the somnolency was -much more deep; and states that general tremors are almost always -present.[2496] A few years ago almost the whole inmates of the Poor’s -House at Sheffield, to the amount of eighty, were attacked with -analogous symptoms after breakfasting on oatmeal porridge; and it was -supposed that the meal had been accidentally adulterated with the -lolium. The chief symptoms were a piercing stare, violent agitation of -the limbs, quivering of the lips, frontal headache, confusion of sight, -dilated pupil, small tremulous pulse, twitches of the muscles, and -palpitation. In twelve hours all of the persons attacked were well but -two, who had strong convulsions in the subsequent night, but also -eventually recovered.[2497] A similar accident is mentioned by Perleb, -as having happened at Freyburg in the House of Correction. The inmates, -soon after eating bread made with new flour, were attacked to the number -of forty, with loss of speech and somnolency; and for some days -afterwards they complained of sickness.[2498] The accident was ascribed -to darnel-grass. In a recent instance which happened in the workhouse of -Beninghausen, and which was traced to the lolium, seventy-four people -were attacked with giddiness, tremor, convulsions, and vomiting. Those -who had led a dissipated life suffered most, and children least of -all.[2499] - -Sometimes this poison appears to excite symptoms of intestinal -irritation, without acting as a narcotic. A small farmer near Poicters -in France saved five bushels of the seed from a field of wheat,—had it -ground with a single bushel of wheat, and afterwards made bread with the -mixture for his own family. He himself, with his wife and a servant, -began to eat the bread on a Thursday; but the two last were so violently -affected with vomiting and purging, that they refused to continue taking -it. He persevered himself, however, till on the Sunday evening he became -so ill that his wife wished to send for medical aid. This he refused to -allow, and next day he expired after suffering severely from fits of -colic.[2500] - -Bley of Bemburg has examined chemically the grain of lolium. He obtained -from it a bitter extractive matter, without any characteristic chemical -properties, but which killed a pigeon. The seed has a very feeble -bitterish taste. Bley maintains that its poisonous properties are -essential to it, and not incidental, as some think.[2501] - - - _Of the Effects of certain Poisonous Leguminous Seeds._ - -Among the injurious substances with which various grains are apt to be -accidentally mixed from their growing together, two leguminous plants -may be here shortly mentioned, as they have often been the source of -disagreeable accidents on the continent. - -In the department of the Cher and Loire in France, severe effects have -been traced to bread made partly with flour of the _Lathyrus cicera_. M. -Desparanches, in a report to the Prefect of the Department, says this -flour occasionally forms one-half of that of which bread is made in some -parishes; that it produces sometimes sudden incapability of walking, -sometimes imperfect paraplegia and pain, with a draggling gait and -turning in of the toes, and sometimes also slight convulsive movements -of the thighs and legs.[2502] Similar effects have been traced to this -substance formerly. Virey says it has been known to produce in -particular a singular stiffness and state of semiflexion of the -knee-joint, compelling the individual to move the limbs in one rigid -mass.[2503] - -The _Ervum ervilia_, or Bitter-vetch, which is not a native of this -country, has also been found in France to possess analogous properties. -In 1815, according to Virey, a great variety of herbs grew up with the -grain, in consequence of the wetness of the summer; and their seeds were -thus subsequently mixed with the wheat and rye. Among these he -particularizes the bitter-vetch as peculiarly noxious, because it -produces so great weakness of the extremities, but especially of the -limbs, that the individual trembles while standing, and totters when he -walks, or even requires the help of stilts; and he adds, that horses are -similarly affected, so as to become almost paralytic.[2504] - -The _Cytisus laburnum_, or laburnum tree, is another plant of the same -family, which yields poisonous seeds. The whole plant is more or less -deleterious. But it is chiefly the seed that has attracted attention -hitherto. - -I am not acquainted with any experiments relative to the action of the -seeds on animals.—Its effects on man present considerable variety, and -show that it is a true narcotico-acrid. In some instances they seem to -have been purely narcotic. My colleague Dr. Traill has communicated to -me two cases of this nature. In one of these, that of a child two years -old, the first evident effects were sudden paleness and a fit of -screaming, followed immediately by insensibility, and then by coldness -of the whole body and lividity of the face; but vomiting having been -induced by warm water and mustard, the seeds were discharged, the -symptoms abated, and next day he was quite well. The other case was that -of a boy who was left by his companions at Dr. Traill’s door in a state -of complete insensibility, with froth at the mouth and a feeble pulse. -An emetic, administered immediately, brought up a large quantity of -laburnum seeds; after which the pulse became firmer, and sensibility -quickly returned.—Mr. North has briefly noticed a similar case of a -child, who after eating laburnum flowers, was seized with paleness and -twitches of the face, coldness of the skin, laborious breathing, efforts -to vomit, and great feebleness of the pulse. But recovery took place -after the flowers were vomited.[2505]—In other instances the effects -have been chiefly limited to an irritant action on the stomach and -bowels. Dr. Bigsby of Newark informs me that a few years ago a little -girl in his neighbourhood, in consequence of eating the seeds, was -attacked with violent vomiting and purging, and became in other respects -very ill, but recovered in forty-eight hours.—Most generally, however, -the effects are partly irritant, partly narcotic. In 1839 Dr. Annan of -Kinross communicated to me the case of a little boy, who in an hour -after swallowing a small quantity of unripe seeds, was attacked with -violent vomiting and ghastly expression of countenance, and then fell -into a very drowsy state, from which he was constantly roused by shaking -him and dashing cold water on his body. But for a month afterwards he -continued subject to vomiting and diarrhœa.—Mr. Bonney of Brentford has -related the particulars of eleven cases, which presented all the -varieties of poisoning with the seeds. The subjects were children from -seven to nine years of age; and they took, some of them one seed, and -none more than five. Three scarcely suffered at all. One vomited the -poison and got well at once. Of the others, some had only nausea and -feebleness of the pulse, another had also dilatation of the pupils, some -had vomiting and purging, others great drowsiness, others again both -sets of symptoms. In all the pulse was weak and generally rapid. -Emetics, laxatives and ammonia were administered with success.[2506] - -The leaves of this plant are stated by Vicat, a good authority, to -possess the property of acting violently as an emetic and -purgative;[2507] and Cadet says the unripe pods have been known to -produce in small quantities severe vomiting, and profuse, protracted -diarrhœa.[2508] - -My attention was lately turned by a criminal trial in this country to -the effects of the bark, which is not alluded to as a poison by any -author, although its properties seem well known to the peasantry in the -north of Scotland. A lad Gordon was tried lately at Inverness for -administering poison to a fellow-servant, and it was proved that he gave -her laburnum-bark in broth. She immediately became very sick, and was -soon attacked with incessant vomiting and purging, pain in the belly, -rigor, and extreme feebleness; and several days elapsed before she could -return to her work. The sickness, vomiting, purging and pain continued -afterwards to recur more or less; great emaciation ensued; in six weeks -she was so much reduced as to be compelled to quit service; and even six -months afterwards, she continued so ill with a chronic dysenteric -affection, that fears were entertained for her life, although eventually -she did recover. Being consulted in the case, I was inclined to rely in -the general properties of the plant and the peculiar, intense, nauseous -bitterness of the bark, even more intense there than in the seeds, as -adequate proof that the bark was capable of producing the effects -observed in this case. I was scarcely prepared, however, to find it so -deadly a narcotic poison, as it proved to be on careful experiment. Dr. -Ross of Dornoch, who saw the woman and was also consulted on the part of -the crown in the case, found that from twenty to seventy grains of dried -laburnum-bark caused speedy and violent vomiting when administered to -dogs, but no other marked effect. I found that when an infusion of a -drachm of dried bark was injected into the stomach of a strong rabbit, -the animal in two minutes began to look quickly from side to side, as if -alarmed and uncertain in which direction to go, then twitched back its -head two or three times, and instantly fell on its side in violent -tetanic convulsions, with alternating opisthotonos and emprosthotonos so -energetic that its body bounded with great force upon the side up and -down the room. Suddenly in half a minute more all motion ceased, -respiration was at an end, and, excepting that the heart continued for a -little to contract with some force, life was extinct. No morbid -appearance was visible anywhere. The heart was gorged, but irritable. -Dr. Ross subsequently repeated this experiment, and obtained analogous -results; but the animals he operated on did not die for half an hour or -upwards.[2509] - -MM. Chevallier and Lassaigne have discovered in the seeds an active -principle called cytisin, a nauseous, bitter, brownish-yellow, neutral, -uncrystallizable substance, of which small doses killed various animals -amidst vomiting and convulsions, and eight grains taken by man in four -doses brought on giddiness, violent spasms, and frequency of the pulse, -lasting for two hours, and followed by exhaustion.[2510] - -A great number of Brown’s division Papilionaceæ of the present natural -family probably possess similar properties. - - - - - CHAPTER XLI. - OF POISONING WITH ALCOHOL, ETHER, AND EMPYREUMATIC OILS. - - -The last group of the narcotico-acrids comprehends _alcohol_, _ether_, -and the _oleaginous products of combustion_. - - - _Of Poisoning with Alcohol._ - -_Of its Action on Animals, and Symptoms in Man._—Alcohol has been -generally believed, since the experiments of Sir B. Brodie,[2511] to act -on the brain through the medium of the nerves, and to do so without -entering the blood. This may be doubted. At least in some experiments -performed several years ago by Dr. C. Coindet and myself it appeared not -to act so swiftly, but that absorption might easily have taken place -before its operation began. At all events, through whatever channel it -may operate, there is no doubt that it enters the blood; for in man the -breath has a strong smell of spirit for a considerable time after it is -swallowed; and it has been found in the tissues and secretions after -death from large doses. Professor Orfila found that alcohol is a violent -poison when injected into the cellular tissue; and that it produces -through that channel the same effects as when taken into the -stomach.[2512] In the course of our experiments Dr. C. Coindet and I -found that it acted with great rapidity when injected into the cavity of -the chest. - -Authors who have treated of the action of alcohol and spirituous liquors -on man, have distinguished three degrees in its immediate effects. - -1. When the dose is small, much excitement and little subsequent -depression are produced. - -2. When the effect is sufficiently great to receive the designation of -poisoning, the symptoms are more violent excitement, flushed face, -giddiness, confusion of thought, delirium, and various mental -affections, varying with individual character, and too familiar to -require description here. These symptoms are soon followed by dozing and -gradually increasing somnolency, which may at length become so deep as -not to be always easily broken. After the state of somnolency has -continued several hours, it ceases gradually, but is followed by -giddiness, weakness stupidity, headache, sickness, and vomiting. - -This degree of injury from alcohol may prove fatal, either in itself, by -the coma becoming deeper and deeper,—or from the previous excited state -of the circulation causing diseases of the brain in a predisposed -habit,—or more frequently from the occurrence of some trifling accident, -which in his torpid state the individual cannot avoid or remedy, such as -exposure to cold, falling with the face in mud or water, suffocation -from vomited matters getting into the windpipe, and the like. - -Of simple poisoning by the gradual increase of coma the following -judicial case in which I was consulted is a characteristic example. Two -brothers drank in half an hour three bottles of porter, with which three -half-mutchkins (24 ounces) of whisky had been secretly mixed by a -companion, whose object was to fill them drunk by way of joke. In the -course of drinking both became confused. In fifteen minutes after -finishing the last bottle one of them fell down insensible, and had no -recollection of what happened for twelve hours; but he recovered. The -other staggered a considerable distance for an hour, and then became -quite insensible and unable to stand. In four hours more consciousness -and sensibility were quite extinct, the breathing stertorous and -irregular, the pulse 80 and feeble, the pupils dilated and not -contractile, and deglutition impossible. In this state he remained -without any material change till his death, which took place in fifteen -hours after he finished his debauch. A surgeon saw him when he had been -five hours ill, but did little for his relief, as the case appeared -hopeless. - -There is a singular variety in the principal symptoms of this form of -poisoning, even when completely formed. From a careful tabular analysis -of no fewer than twenty-six cases, chiefly of the present denomination, -collected by Dr. Ogston of Aberdeen from the experience of the -police-office there, it appears that when the stage of stupor is fully -formed, the person is sometimes capable of being roused, sometimes -immovably comatose for a long time,—that the pulse is sometimes -imperceptible or very feeble, sometimes distinct or even full, generally -slow or natural, seldom frequent, very seldom firm,—that the pupils are -occasionally contracted, much more generally dilated, and in a few -instances alternating between one state and the other,—that the -countenance is commonly pale, sometimes turgid and flushed,—and that the -breathing is for the most part slow, and also soft, yet not unfrequently -laborious, but very rarely stertorous. Convulsions are rare, having been -observed twice only, and on both occasions in young people of the age of -twelve or fourteen.[2513] Dr. Ogston has tried to group these several -symptoms together in classified cases; but the general conclusions at -which he arrives are subject to important exceptions. Neither do any of -the special symptoms seem to bear a marked relation to the ultimate -event. It is peculiarly worthy of remark, that very many cases got well -where the pupils were much dilated, the coma profound, and the pulse -imperceptible. - -In the present form of poisoning with alcoholic fluids, it usually -happens that if the stage of stupor be completely overcome, recovery -speedily ensues, without any particular symptom except headache, -giddiness, sickness, and the customary consequences of a debauch. Hut on -some occasions the comatose stage is succeeded by one which indicates -much cerebral excitement,—by flushed face, injected eyes, restlessness, -a febrile state of the pulse, and delirium, even of the violent kind. In -other cases this affection puts on very much the characters of a slight -attack of typhoid fever. - -In the second variety of the second degree of intoxication, an -apoplectic disposition is called into action by the excited state of the -circulating system; and death ensues from apoplexy or some other disease -of the brain, rather than from simple poisoning. Thus in some instances, -as will be more fully mentioned under the head of the morbid -appearances, extravasation of blood is found within the head after -death, preceded by the usual phenomena of ordinary intoxication. Since -this is a rare effect of intoxication, it must be considered as the -result of poisoning with spirits, exciting sanguineous apoplexy in a -predisposed constitution. In other cases the stupor of intoxication, -after putting on all the characters of apoplexy for two days and -upwards, terminates fatally without extravasation. Here the poison -operates by developing a constitutional tendency to congestive apoplexy. -Again, this mode of action is still more clearly shown in some cases, -where an interval of returning health occurs between the immediate -narcotic effects of the poison and the ultimate apoplectic coma which is -the occasion of death. Such a course of events, which, however, is of -rare occurrence, is well exemplified in the following cases. A man drank -32 ounces of rum one afternoon, and was comatose most of the ensuing -night. Next morning, though very drowsy, he was sensible when roused; -and in the evening he was considered convalescent. But two days -afterwards he became delirious; in two days more he died comatose; and -congestion was the only appearance found in the brain.[2514] Another -instance, most remarkable in its circumstances, is the following, which -has been related by Dr. Golding Bird. A workman in a distillery, after -drinking eight ounces of rectified spirit by mistake for water, suddenly -fell down senseless and motionless, and remained so for eleven hours. He -then began to recover, and came round so far that he returned to his -work next morning. After this he continued to pass dark, pitch-like -evacuations. In three weeks he became drowsy, mistook one thing for -another, answered questions sluggishly, and had a frequent pulse, and -dilated sluggish pupils; in which state he continued three weeks later -when the account was published.[2515] The following case, related by Dr. -Chowne, also seems to belong to the same category, although it presents -anomalies. A boy, eight years of age, soon after swallowing about eight -ounces of gin, said he felt like a drunk man, and suddenly became -motionless and insensible. In no long time he vomited a fluid of the -odour of gin; and in seven hours from the commencement a fluid was -withdrawn from the stomach, possessing no longer any such odour. He was -now motionless, insensible, pale, and cold; the pupils were contracted, -the pulse feeble and hurried, the breathing stertorous and slow; and he -made ineffectual efforts to vomit. Stimulants of all kind had little -effect on him for a day and a half, when the breathing became more -natural, and his look quite intelligent. Yet he could not answer -questions, exhibited no sign of volition, and had a pulse so frequent as -160. In twenty-four hours more the breathing became laborious and -rattling, and the lips livid; and death took place near the close of the -third day. The only appearances of any note in the dead body were -general injection of the arachnoid membrane of the brain, and effusion -of frothy mucus into the bronchial ramifications.[2516] Similar to these -is the following extraordinary case which has been communicated to me by -Dr. Traill. A boy seven years of age, who was persuaded by two -miscreants to take nearly five ounces of undiluted whisky, suffered for -two days from the ordinary symptoms of excessive intoxication, which -were then immediately followed by epileptic convulsions. These continued -to recur with more or less violence, but always frequently, for two -months down to the date of the judicial investigation to which the case -gave rise. All these forms of the effects of drinking ardent spirits can -scarcely be considered as simple poisoning, but as the result of -poisoning developing a tendency to diseases of the head. - -The third variety of poisoning with spirits in the second degree proves -fatal, not in itself, but by some trivial accident happening, from which -the individual cannot escape on account of his powerless insensibility. -Thus, it is no uncommon thing for persons in a state of deep -intoxication to fall down in an exposed place, where they perish from -cold, or to tumble with the face in a puddle, and so be suffocated, or -to be choked by inhaling the contents of the stomach imperfectly -vomited, or by lying in such a posture that their neck-cloth produces -strangulation. These statements are so familiar, that it is unnecessary -to illustrate them by special facts. The reader’s attention was called -to such accidents in the previous editions of this work. Two well-marked -cases of the kind have been since published by Mr. Skae.[2517] - -In cases of simple poisoning in the second degree the progress of the -symptoms is on the whole remarkably uniform, gradual and uninterrupted. -But there are likewise some anomalies which it may be well to notice. -Thus, occasionally after the phenomena of ordinary intoxication have -gone on gradually increasing without having attained a very great -height, sudden lethargy supervenes at once, and may prove fatal with -singular rapidity. My colleague, Dr. Alison, has communicated to me the -particulars of a case of the kind where death took place from simple -intoxication, twenty minutes after the state of lethargy began. The -individual reached his home in a state of reeling drunkenness, but able -to speak and give an indistinct account of himself. He then became -lethargic, and died in the course of twenty minutes. On examining the -body, Dr. Alison could not discover any morbid appearance, except some -watery effusion on the surface of the brain and in the ventricles; but -the contents of the stomach had a strong smell of spirits. Instances of -such excessive rapidity, however, are rare, unless from the third form -of poisoning.—An anomaly of a different kind, of which a remarkable -example was brought judicially under my notice, is sudden supervention -of deep insurmountable stupor, without the usual precursory symptoms, -yet not till after a considerable interval subsequently to drinking. In -May, 1830, a lad of sixteen, in consequence of a bet with a -spirit-dealer, swallowed sixteen ounces of whisky in the course of ten -minutes, and, pursuant to the terms of the wager, walked up and down the -room for half an hour. He then went into the open air, apparently not at -all the worse for his feat; but in a very few minutes, while in the act -of putting his hand into his pocket to take out some money, he became so -suddenly senseless as to forget to withdraw his hand, and so insensible -that his companions could not rouse him. A surgeon, who was immediately -procured, contented himself with giving several clysters and a dose of -tartar-emetic, which did not operate; and the young man died in the -course of sixteen hours. The cause of the retardation of the symptoms -was partly perhaps that he had taken supper only an hour before drinking -the spirits, but chiefly, I presume, because the stupor was kept off for -a time by the stimulus of determination to win his bet.—Several cases -somewhat similar have been described by Dr. Ogston. In these sudden -insensibility came on while the individuals had been drinking freely for -some time, without showing any marked sign of approaching -intoxication.[2518] The cause of the postponement and sudden invasion of -the stupor does not exactly appear; but a familiar cause of its abrupt -invasion in ordinary cases of drunkenness is sudden exposure to cold. - -It is impossible to fix the extremes of duration of the present form of -poisoning in fatal cases. For, on the one hand, one or other of the -accidents mentioned above may bring the case to a speedy close; and, on -the other hand, the supervention of apoplexy may protract it to several -days. The ordinary duration in fatal cases seems to be from twelve to -eighteen hours. - -3. The third degree of poisoning is not so often witnessed, because, in -order to produce it, a greater quantity of spirits must be swallowed -pure and at once, than is usually taken by those among whom poisoning in -the second degree chiefly occurs. When swallowed in large quantity, as -by persons who have taken foolish wagers on their prowess in drinking, -there is seldom much preliminary excitement; coma approaches in a few -minutes and soon becomes profound, as in apoplexy. The face is then -sometimes livid, more generally ghastly pale; the breathing stertorous, -and of a spirituous odour; the pupils sometimes much contracted, more -commonly dilated and insensible; and if relief is not speedily procured, -death takes place,—generally in a few hours, and sometimes immediately. -According to Mr. Bedingfield, who witnessed many cases of poisoning with -rum at Liverpool, which always follow the arrival of the West India -vessels, the patient will recover if the iris remains contractile; but -if it is dilated and motionless on the approach of a light, recovery is -very improbable.[2519] - -A case is briefly alluded to by Orfila of a soldier, who drank eight -pints of brandy for a wager, and died instantly.[2520] A case of the -same kind is quoted by Professor Marx.[2521] Another, which happened in -the person of a London cabman, is noticed in a French Journal. The man, -for a bribe of five shillings, drank at a draught a whole bottle of gin; -and in a few minutes he dropped down dead.[2522] Similar accidents occur -not infrequently in this country; but I have not met with any fully -described by authors. A case of the less rapid variety of the present -form occurred at the Infirmary here in 1820. A man stole a bottle of -whiskey; and, being in danger of detection, took what he thought the -surest way of concealing it, by drinking it all. He died in four hours -with symptoms of pure coma. - -Convulsions are not common in such cases. I have seen a remarkable -example, however, in which the coma was accompanied with constant -alternating _opisthotonos_ and _emprosthotonos_. The subject was a boy -who had been induced to drink raw whisky by an acquaintance, and had -been two hours insensible before I saw him. The stomach-pump, which was -immediately applied, brought away a large quantity of fluid with a -strong spirituous odour; and he recovered his senses in fifteen minutes, -but remained very drowsy for the rest of the day. - -Such are the forms of poisoning with spirits usually admitted by -authors. But it also appears to act sometimes as an irritant. After its -ordinary narcotic action passes off, another set of symptoms -occasionally appear, which indicate inflammation of the alimentary -canal. Cases of this kind are exceedingly rare; yet they have been met -with, as the following extract shows. “A young man at Paris had been -drinking brandy immoderately for several successive days, when at length -he was attacked with shivering, nausea, feverishness, pain in the -stomach, vomiting of everything he swallowed except cold water, thirst, -and at last hiccup, delirium, jaundice, and convulsions; and death took -place on the ninth day. On examining the body the stomach was found -gangrenous over the whole villous coat; the colon too was much inflamed; -and all the small intestines were red.”[2523] - -A case of great complexity, but probably of the same nature, has been -related by Opitz in Pyl’s Memoirs. The subject was a woman liable to -epilepsy, and addicted to excessive drinking. After one of her -drinking-bouts she was seized with vomiting and severe pain of the -bowels, afterwards with delirium, then with convulsions, and she died in -twenty-four hours after the first attack. The stomach and intestines -were greatly inflamed, a table-spoonful of blood was effused into the -ventricles of the brain, and the left lung was purulent.[2524] - -Besides the immediately fatal effects of spirituous liquors now -described, there is still another variety of poisoning more common than -any yet mentioned, and constituting a peculiar disease. People who fall -into the unhappy vice of habitual intoxication, after remaining in a -state of drunkenness for several days together, are often attacked with -a singular maniacal affection, which is accompanied with tremors, -particularly of the hands, and after enduring for several days, ends at -last in coma. When the delirium is not so violent, the disease by proper -treatment may be cured. But frequently, after the delirium and tremor -have continued mildly for some time, they increase, and the delirium -becomes furious, or coma rapidly supervenes; in either of which cases -the disorder commonly proves fatal in two or three days more. This -disease, which is now familiar to the physician, is called _delirium -tremens_. It is supposed by some to depend on inflammation of the -membranes of the brain, followed by effusion. - -Other diseases, besides _delirium tremens_, are also slowly induced by -the habitual and excessive use of spirituous liquors; but in general -the habit of intoxication acts in inducing these diseases only as a -predisposing cause. A particular variety of tuberculated liver -probably arises from the habitual use of spirits without the -co-operation of other causes. That variety of disease of the kidney, -which was first brought under the notice of the profession by Dr. -Bright,[2525] is also obviously often connected with the habit of -drinking spirits. The following have been enumerated among the -diseases where the same habit acts powerfully as a predisposing -cause—indurated pancreas,—indurated mesenteric glands,—scirrhous -pylorus,—catarrh of the bladder,—inflammation, suppuration and -induration of the kidneys,—incontinence of urine,—aneurism of the -heart and great vessels,—apoplexy of the lungs,—varicose -veins,—mania,—epilepsy,—tendency to gangrene of wounds,—spontaneous -combustion.[2526] - -_Of the Morbid Appearances._—Some doubts exist as to the morbid -appearances in the bodies of those poisoned by spirituous liquors. - -In animals killed by alcohol, Orfila says he found the villous coat of -the stomach constantly of a cherry-red odour. I have several times -remarked the same appearance. When the stomach was empty before the -alcohol was introduced, I have always found the prominent part of its -rugæ of a deep cherry-red tint, the margin of the patches being more -florid, and evidently consisting of a minute network of vessels. - -In man these signs of irritation have not been always observed. In the -patient who died in the Infirmary here, the stomach was quite natural to -appearance. Dr. Ogston notices injection of the small intestines and -thickening of the mucous membrane of the stomach and intestines as -common appearances in the cases he has examined; but he seems to -consider these the effects not of the last fatal dose, but of the habit -of frequent excessive drinking.[2527] - -The blood in the heart and great vessels is commonly fluid and very -dark, and the lungs are sometimes more or less gorged with the same -fluid. - -The state of the brain differs much according to the mode of death. -Sometimes great congestion and even actual extravasation of blood are -found in the heads of persons who have died of excessive continuous -drinking,—the excitement of such a debauch being apt, as already -mentioned, to induce apoplexy in a predisposed habit. Accordingly -extravasation was found by Professor Bernt of Vienna in no less than -four cases of the kind, two of which happened in the persons of young -men not above twenty-two years of age;[2528] and Dr. Cooke quotes -another in his work on nervous diseases.[2529] I have myself met with -another remarkable instance. A female out-pensioner of Trinity Hospital -here, who was much addicted to drinking, and for fourteen days after the -New-year of 1830 had been very little in her sober senses, soon after -arriving at home one evening much intoxicated, fell down comatose, and -died in ten or twelve hours. An enormous extravasation of clotted blood -was found in the ventricles, producing extensive laceration of the right -middle and anterior lobes of the brain.—In such cases it is natural to -suppose that a predisposition to apoplexy must concur with the -intoxication; otherwise it is not easy to see why death from -extravasation is not more frequently produced by excessive drinking. - -Extravasation is not apt to occur in the cases of rapid death brought on -by a very large quantity swallowed at once. The circulation, indeed, is -during life in a state quite the reverse of excitement; and accordingly -the brain and its membranes are found quite healthy. They were -particularly so in the man who died in the hospital here. It is right to -mention, however, that one of Bernt’s cases, although the symptoms and -other particulars are not mentioned, possibly belongs to the present -variety, as the man swallowed for a wager a quart of brandy at a -draught.[2530] According to Dr. Ogston, who has given the best account -of the appearances within the head in the ordinary cases of this kind, -there is usually serous effusion under the arachnoid membrane, -occasionally minute injection of vessels, commonly more or less general -gorging of the larger veins, and especially effusion of serosity to the -amount of two or even four ounces in the ventricles.[2531] - -When delirium tremens proves fatal, effusion is commonly found among the -membranes of the brain; and occasionally to a great extent. In one -instance, which proved fatal in two or three days, I have seen minute -vascularity of the membranes, with effusion of fibrin, and without -effusion of serosity; but such cases are rare. There is also, according -to Andral, very extensive softening of the mucous coat of the -stomach.[2532] In an instance mentioned in Rust’s Journal, besides -effusion into the cerebral membranes, there was found an enormous -accumulation of fat in all the cavities, a conversion of the muscular -substance into fat, and a nauseous sweet smell from the whole -body.[2533] - -In all cases of rapid poisoning with spirituous liquors some of the -poison will be found in the stomach. For when the case is one of pure -narcotic poisoning, unaided by the effects of blows, exposure to cold, -or the like, and the person dies in a few hours, the poison cannot be -all absorbed before death.—Although the spirituous liquors used in -Britain have all very powerful odours, the inspector in a case of -importance ought not to confine himself to this test alone. He must -subject the suspected matter to distillation; and then remove the water -from what distils over by repeated agitation with dry carbonate of -potass, till he procures the alcohol of the spirit in such a state of -purity as to be inflammable. - -Alcohol may also be in some circumstances detected in the tissues and -secretions of the body. A spirituous odour has been remarked not -infrequently in various parts, and especially in the brain. Dr. Cooke -mentions a case in which the fluid in the ventricles of the brain had -the smell and taste of gin, the liquor which had been taken;[2534] Dr. -Ogston adverts to an instance, in which after death by drowning during -intoxication, he found in the ventricles nearly four ounces of fluid, -having a strong odour of whisky;[2535] in the case which occurred in the -hospital here the odour of whisky was said to have been perceived in the -pericardium; and in a man who died of long-continued intoxication from -immoderate drinking Dr. Wolffe found that the surface, and still more -the ventricles, of the brain had a strong smell of brandy, although the -contents of the stomach had not.[2536] - -The presumption afforded by such facts as these, in favour of the -absorption of alcohol and the possibility of detecting it throughout the -animal system, has been turned to certainty by the late experimental -researches of Dr. Percy; who found that in animals poisoned with -alcoholic fluids, as well as in the case of a man who died during the -night after drinking a bottle of rum, alcohol could be detected, -generally in the urine, and also in the brain, by cautious distillation, -and removing the water from the distilled fluid by means of dry -carbonate of potass.[2537] Dr. Percy gave me an opportunity of verifying -his results with the brain of the man; and I had no difficulty in -obtaining from a few ounces of brain a sufficiency of spirit to exhibit -its combustion on asbestus repeatedly. - -It is hardly necessary to add, that when the individual has survived the -taking of the poison a considerable length of time, an odour of spirits -will not be perceived either in the stomach or elsewhere. In the -out-pensioner of Trinity Hospital, for example, who survived about -twelve hours, no spirituous odour could any where be perceived. In such -cases the poison disappears during life by absorption.—A question may -even be entertained, whether the odour may not sometimes be -imperceptible at the inspection of the body, although the poison was -really present immediately after death. It is probable that, as in the -instance of hydrocyanic acid, the alcohol, on account of its volatility -or fluidity, will evaporate or percolate away in a few days. In this -manner only can be explained the occasional absence of the odour in -persons who have been killed in the early stage of drunkenness. I could -not perceive any odour of whisky in the stomach of the woman Campbell, -who was murdered by the notorious resurrectionist Burke, although she -had drunk spirits to intoxication half an hour before her death. The -body was not examined till thirty-eight hours after.[2538] It must be -observed, however, that alcohol may exist in the contents of the stomach -and be detected by chemical analysis, although it is not indicated by -its odour. I have twice had occasion to observe this, where the bodies -were disinterred some time after death. - -From all that has been said, there ought seldom to be much difficulty in -recognizing a case of poisoning with spirituous liquors. - -But, before quitting the subject, a form of it must be noticed which may -be extremely difficult to distinguish. It was formerly remarked that the -eatable mushrooms have been sometimes poisoned with substances -possessing effects on the system analogous to those caused by the -deleterious fungi. In the same manner spirituous liquors may be poisoned -with narcotics allied to them in action. Thus, in former parts of this -work, it has been stated that a young man was killed during a debauch in -consequence of his companions having mingled opium with his wine; that -many persons have been poisoned and some killed by fermented liquors -drugged in the same manner; that murder has been accomplished by -poisoning wine with nightshade; and that several fatal accidents have -occurred in consequence of liqueurs having been too strongly impregnated -with hydrocyanic acid, to give them a ratafia flavour. Cases of this -nature may be embarrassing. In general, they may be made out by -attending strictly to the symptoms, the quantity of liquor taken, and -the contents of the stomach. But, it must be admitted, that if a -murderer, who chooses such a method, should season his guest’s drink -judiciously, and ply him well with it, a medical jurist might be puzzled -to determine whether the liquor was to blame in point of quality or -quantity. - -_Of the Treatment._—The treatment of poisoning with alcoholic fluids -does not differ essentially from that of poisoning with opium. In the -former, as in the latter, the chief objects must be to remove the poison -from the stomach, and to rouse the patient from his state of stupor; but -in poisoning with alcoholic fluids it is also frequently necessary to -treat a secondary stage of reaction by local and even general -antiphlogistic measures. As to the primary object, the removal of the -poison from the stomach, it appears that in the present form of -poisoning emetics are more seldom effectual than in the case of other -narcotics, and that the stomach-pump should be promptly resorted to. It -is remarkable that the operation of clearing out the stomach is likewise -often a sufficient stimulus to dispel stupor immediately and even -permanently. I have seen almost complete consciousness permanently -restored with the discharge of the alcoholic fluid; and the same remark -has been made by others. Where the senses are not thus restored, one of -the most effectual stimulants, according to the practice of the -police-office of this city, is the injection of water into the ears. -Great advantage has been derived, as in poisoning with opium, from the -cold affusion applied to the head. Dr. Ogston, who has appended to his -paper formerly quoted a very useful summary of the treatment of -poisoning with spirits, has found this a safe and effectual remedy where -the heat of the head was unnaturally great and that of the body not too -low.[2539] Cases have been published where it proved successful although -the pulse was gone at the wrist, the breathing scarcely perceptible, and -the temperature of the whole body greatly reduced.[2540] It is doubtless -a powerful remedy: but where the general temperature of the surface is -much lowered, I conceive it should be restricted to the head and neck, -and conjoined with the application of warmth to the body. Dr. Ogston -objects to the general use of blood-letting in cases of poisoning with -spirits, as being often apt to be followed by sudden sinking. Where -other remedies are judiciously used, it is probably seldom called for; -and the purpose it is intended to serve, namely, the relief of cerebral -congestion and determination, is better fulfilled by the local -employment of cold, and local blood-letting. Ammonia and its acetate -have been found useful as internal stimulants where the stupor is deep. -The treatment of the secondary affections adverted to above does not -require specific mention. - - - _Of Poisoning with Sulphuric and Nitric Ether._ - -Sulphuric ether and nitric ether are poisons of the same nature with -alcohol. But the effects produced by them when taken in considerable -doses are not very well known. - -Orfila found that half an ounce of sulphuric ether introduced into the -stomach of a dog and secured there by a ligature on the gullet, excited -efforts to vomit, in ten minutes inability to stand, and in six minutes -more, insensibility. In fifteen minutes more the animal revived a -little, but soon became again comatose; and it died in three hours after -the commencement of the experiment. The villous coat of the stomach was -reddish-black, the other coats of a lively red colour.[2541] - -The effects of the ethers on man have not been accurately ascertained. -From some observations published in the Journal of Science, sulphuric -ether appears to act energetically even in small doses. In moderate -quantity it produces a strong sense of irritation in the throat, a -feeling of fulness in the head, and other symptoms like those excited by -nitrous-oxide gas. A gentleman, in consequence of inhaling it too long, -was attacked with intermitting lethargy for thirty-six hours, depression -of spirits and lowness of pulse.[2542] When long and habitually used, as -by persons afflicted with asthma, its dose must be gradually increased; -and it appears that considerable quantities may then be taken for a -great length of time without material injury. I have been informed of an -instance of an asthmatic gentleman about sixty years of age who consumed -sixteen ounces every eight or ten days, and had been in the habit of -doing so for many years. Yet, with the exception of his asthma, he -enjoyed tolerable health. - -An interesting case has been published which proves that nitric ether in -vapour is a dangerous poison when too freely and too long inhaled. A -druggist’s maid-servant was found one morning dead in bed, and death had -evidently arisen from the air of her apartment having been accidentally -loaded with vapour of nitric ether, from the breaking of a three-gallon -jar of the _spiritus etheris nitrici_. She was found lying on her side, -with her arms folded across the chest, the countenance and posture -composed, and the whole appearance like a person in deep sleep. The -stomach was red internally, and the lungs were gorged.[2543] The editor -of the journal, where this case is related, says he is acquainted with a -similar instance where a young man became completely insensible from -breathing air loaded with sulphuric ether, remained apoplectic for some -hours, and would undoubtedly have perished had he not been discovered -and removed in time. - - - _Of Poisoning with the Oleaginous products of Combustion._ - -The physiological effects of these substances have not yet been -extensively investigated. It has been already mentioned, that the -empyreumatic oils of tobacco and other narcotic vegetables are active -poisons; and that the emanations from candle snuffings and imperfectly -consumed tallow probably owe their injurious properties to a peculiar -oil. Many empyreumatic oils are known, and some are used in medicine, -which act powerfully on the animal system as stimulants and -antispasmodics. Among these may be enumerated naphtha, oil of galbanum, -oil of guiaiac, oil of amber, oil of wax, and Dippel’s oil. The last in -particular, which is the rectified empyreumatic oil of hartshorn, but is -prepared also from blood and various animal matters,[2544] has been a -good deal used of late on the continent for medical purposes, and has -even been resorted to as a poison for the purpose of self-destruction. - -The only one of these substances whose physiological properties have -been examined with particular care, is the empyreumatic oil procured by -the destructive distillation of lard. When freed of adhering acid by -rectification from quicklime, this oil is limpid and very volatile, has -an insupportable smell, and when diffused in the air, irritates the eyes -and nostrils, and even excites giddiness. Buchner found it to possess -simple narcotic properties. When a mouse was confined under a jar, into -which a little of its vapour was introduced, it suddenly tried to -escape, immediately fell down exhausted, and, although soon afterwards -removed into the open air, expired in about fifteen minutes, without -convulsions. It is much less powerful when introduced into the stomach, -yet is still a dangerous poison through that channel; for five drops -projected into the throat of a chaffinch very nearly proved fatal; and -the only symptoms were excessive exhaustion, slow respiration, and -insensibility.[2545] - -Similar effects have been occasionally observed in man. The late -Professor Chaussier has related a case of poisoning in the human subject -from the _oil of Dippel_, or rectified empyreumatic oil of hartshorn. It -is merely mentioned, however, that the individual, on taking a spoonful -by mistake, died immediately; and that no morbid appearance could be -discovered in the dead body.[2546] Another case has been more recently -related, where the poison was the impure oil of commerce, from which the -oil of Dippel is prepared by rectification. The subject was a woman, who -took it intentionally in the dose of an ounce and a half. The symptoms -induced could not be ascertained; but it appeared, that she had been -attacked with vomiting, and, finding the action of the poison either -less speedy, or less supportable than she expected, had thrown herself -into a well and been drowned. The appearances in the body clearly showed -that in this instance the poison had not acted as a pure narcotic. The -whole body exhaled the peculiar fetid odour of the oil. The palate, -tongue, throat, and gullet, were white and shrivelled. The stomach had -outwardly a diffuse rose tint, crossed by gorged black veins, which here -and there had burst and formed patches of extravasation. The contents of -the stomach consisted of remains of food, a good deal of the oil, some -water, and likewise some extravasated blood. Its villous coat was thick, -covered with red points, corrugated into prominent rugæ, but not eroded. -The intestines also presented signs of irritation, but in an inferior -degree.[2547] Dr. Kurtze, a German author, mentions that the impure oil -[Oleum Animale Fœtidum] was given with malicious intention in repeated -doses to an infant eighteen days old, whom he attended, and that it -caused crying and vomiting; and he quotes Froriep’s Notizen, for the -case of a woman of thirty, who swallowed nearly two ounces, and, after -repeated attacks of vomiting, threw herself into a well and was -drowned.[2548] - -These facts seem to establish sufficiently the propriety of arranging -the empyreumatic oils among the narcotico-acrids. - -_Oil of turpentine_ possesses somewhat similar properties; but is much -less active. It was found by Professor Schubarth, that two drachms of -this oil administered to a dog produced immediate staggering, cries, -tetanus, failure of the pulse and breathing, and death in three minutes; -and in the dead body he remarked flaccidity of the heart, gorging of the -lungs, and redness of the stomach.[2549] It is likewise well known to be -a powerful poison for vermin, such as lice, fleas, and worms.—On man its -effects are capricious. It is frequently used along with other laxatives -against obstinate constipation of the bowels, and either in the same -manner or alone as a remedy for intestinal worms. For these purposes it -has been at times administered in very large doses, for example in the -quantity of two, three, or four ounces, without any other effect than -brisk purging. But on the other hand it has sometimes, in much inferior -doses, induced violent hypercatharsis, or acted severely on the urinary -organs, producing strangury and bloody micturition, or affected the -brain, producing a state like intoxication, followed by trance for many -hours.[2550] I am not aware that it has ever proved fatal. - -_Oil of tar_, a composite substance obtained by the distillation of -wood-tar, is another pyrogenous fluid of poisonous properties. Messrs. -Slight of Portsmouth have related the case of a seaman, who, after -taking nearly four ounces by mistake for spirits, was attacked with -frequent vomiting of a matter having a strong odour of tar, attended -with excessive pain in the bowels and loins. Nothing was done for his -relief till about seven hours afterwards, when he was freely bled and -purged, with immediate relief; and next morning he was so better as to -be able to resume his work. The urine had a strong tarry odour, and for -some time he suffered from heat in passing it.[2551] A case occurred in -the London Hospital, in which the symptoms were very different. A lad of -eighteen, while intoxicated, took two or three draughts of oil of tar, -although aware of its being poisonous. Not long afterwards he became -insensible, and had laborious, rattling respiration, coldness of the -extremities, suffusion of the conjunctiva, contraction of the pupils, -and an exceedingly feeble pulse. The stomach-pump brought away a liquid -with an overpowering smell of tar. Stimulants, external as well as -internal, venesection, and turpentine clysters were of little avail; the -insensibility continued, with only a short and imperfect interval; and -he died about twenty-four hours after swallowing the poison. The -pulmonary mucous membrane was highly injected, the lungs gorged with -blood and of a tarry odour, the stomach and intestines natural, except -that the whole _valvulæ conniventes_ were yellow,—the brain and its -membranes also natural.[2552] It is mentioned in the paper of Messrs. -Slight that a gentleman at Brighton died in consequence of a druggist -using oil of tar by mistake for something else in making up a -prescription. - -_Creasote_ is another pyrogenous substance possessing considerable -activity as a poison. It is now extensively used in small doses as a -medicine for a variety of purposes. - -It has been made the subject of physiological experiment by various -inquirers, and especially by Dr. Cormach; who found that doses of -twenty-five or forty drops caused death in a few seconds when injected -into the jugular vein of a dog, by arresting the heart’s action, and -without visibly altering the condition of the blood; that a quantity -somewhat larger caused only sopor and spasmodic twitches of the muscles, -if injected into the carotid artery, and without proving fatal; that -thirty drops introduced into the stomach of a rabbit excited -convulsions, acute cries, and death in one minute, apparently from -arrestment of the action of the heart; and that the same dose given to a -dog brought on salivation, giddiness, tetanic spasm, a feeble, -fluttering, almost imperceptible pulse, and general insensibility, with -dilated immovable pupils; but recovery took place under the employment -of blood-letting.[2553]—The effects of too large a medicinal dose in man -are pain in the stomach and vomiting, and also, according to Dr. -Elliotson, giddiness, headache, and stupor.[2554] Dr. Pereira alludes to -a case, mentioned in the Times newspaper, of death caused in 36 hours by -two drachms taken at once; and in this instance acute pain in the -abdomen was a prominent symptom.[2555] I presume this is the same case -which is mentioned in the Edinburgh Medical and Surgical Journal as -having occurred at Liverpool.[2556]—The results of Dr. Cormack’s -experiments on animals lead to the conclusion, that in poisoning with -creasote, this substance may always be detected in the body, if it has -not been removed by artificial means a considerable time before death. - - - - - CHAPTER XLII. - OF COMPOUND POISONING. - - -Having now investigated the three great classes of poisons in their -relations to physiology, practice of physic, and medical jurisprudence, -it will be necessary to offer a few observations on a subject of -considerable medico-legal importance, which has been almost overlooked -in systems of Toxicology,—Compound Poisoning. - -When two poisons of different or opposite properties are administered -about the same time in poisonous doses, the effects of the one may -overpower and prevent the operation of the other, or they may merely -modify the action of one another. In this manner the usual symptoms -produced by one or by both may be entirely or in a great measure -wanting; and even in the dead body the usual appearances occasioned by -one or both may be modified or perhaps altogether absent. - -Although in the course of reading I have met with a sufficient number of -cases of the kind to show that compound poisoning is an object of some -consequence to the medical jurist, the facts hitherto made public are -not so numerous as to render a systematic arrangement of them -practicable. The most advisable course, therefore, seems to be merely to -describe for the present the cases which have been brought under my -notice. These are as follows: - -1. _Poisoning with Arsenic and Alcohol._—A man, after taking twelve -ounces of whisky at a debauch, swallowed, an hour afterwards, while in a -state of excitement, but not particularly drunk, a quantity of arsenic, -the dose of which could not be ascertained. Fifteen minutes after the -arsenic was taken medical aid was procured, upon which repeated attempts -were made to produce vomiting by means of ipecacuan and sulphate of -zinc, but to no purpose. The stomach-pump was therefore resorted to; -and, after at least an hour had been spent in previous attempts by -emetics, the stomach was cleared of a fluid in which arsenic was -unequivocally detected. No symptom of poisoning with arsenic followed. -As the man took the arsenic seven hours after a meal, when of course the -powder would at once be brought freely in contact with the villous coat -of the stomach, it must, I think, be inferred, that the operation of the -arsenic was impeded or prevented by the narcotism previously induced by -the ardent spirits. For this case I am indebted to a former pupil, Mr. -King. - -_Poisoning with Arsenic and Alcohol._—A case of the same description -with the last, but which proved fatal in consequence of the large -quantity of arsenic taken, has been related by Dr. Wood of Dumfries. A -lad of seventeen, after a night’s debauch, swallowed half an ounce of -arsenic early in the morning. In two hours and a half, when Dr. Wood -first saw him, there was no symptom of poisoning with arsenic,—no -symptom at all indeed but languor and drowsiness. A few minutes -afterwards he had slight vomiting, which was repeatedly renewed by -artificial means. For some hours the pulse was but little elevated. In -eighteen hours he began to sink, and presented the usual constitutional -symptoms of poisoning with arsenic; and in forty-one hours he expired. -But from first to last he had scarcely any local symptom except -vomiting, even although the stomach presented after death signs of -violent irritation.[2557] - -3. _Poisoning with Tartar-Emetic and Charcoal Fumes._—Under the head of -poisoning with antimony, notice has already been taken of the case of a -man who, after swallowing seventeen grains of tartar-emetic, attempted -to commit suicide by suffocating himself with the fumes of burning -charcoal. He recovered from both attempts, suffered severely from the -usual narcotic effects of carbonic acid gas, but showed scarcely any -symptom of the irritant action of tartar-emetic.[2558] - -4. _Poisoning with Alcohol and with Laudanum._—Under the head of -poisoning with opium, allusion has already been made to a remarkable -case related by Mr. Shearman, where the usual effects of opium were much -retarded in an individual who, at the time of swallowing the opium, was -in a state of excitement from intoxication. For five hours there was no -material stupor. But after that the usual narcotic symptoms supervened -and eventually proved fatal.[2559] The excitement of intoxication, -however, has not always the effect of suspending the action of opium; -for in a case which came under my notice in the Infirmary of this -city,—that of a woman, who swallowed an ounce and a half of laudanum -while much intoxicated,—the usual narcotic symptoms were fully formed in -an hour: and although the stomach-pump was applied soon afterwards, she -expired in less than five hours from the time the laudanum was -swallowed,—those who had charge of her before she was brought into the -hospital having neglected to use the proper means for keeping her -roused. - -5. _Poisoning with Laudanum and Corrosive Sublimate._—Of all the cases -of compound poisoning I have met with, the most remarkable is an -instance which occurred in Edinburgh Castle, a few years ago, of -poisoning with laudanum and corrosive sublimate. In this case, the -individual, a young soldier, swallowed about the same time two drachms -of the latter and half an ounce of the former. He had at first no -violent symptoms whatever, indicating the operation of corrosive -sublimate; which is an extremely rare occurrence. Afterwards he had -frequent purging and tenesmus, with bloody stools and all the usual -phenomena of violent dysentery, but no pain of belly, no tenderness even -on firm pressure, no vomiting except under the use of emetics. On the -fourth day a violent salivation set in; and under this and the -dysenteric affection he became quickly exhausted, yet not so much, but -that on the day of his death, the ninth after he took the poison, he was -able to walk a little in his room without assistance. He died on the -close-stool rather unexpectedly. I have unfortunately lost the original -notes I had of this case, and have forgotten whether any narcotic -symptoms were present at first; but my impression is that they were -present, though in a slight degree only. Most of the previous -particulars were communicated to me by the late Dr. Mackintosh. The -stomach, duodenum, ileum, colon, and rectum were found after death -enormously inflamed, ulcerated, and here and there almost gangrenous.—In -this instance some of the corrosive sublimate must have been decomposed -by the laudanum, and an insoluble meconate of mercury formed. But the -quantity thus decomposed could have been but a small proportion of the -whole,—as was indeed proved by the extensive ravages actually committed -in the whole alimentary canal. I conceive, therefore, that there is no -other way of accounting for the slight apparent effects of the corrosive -sublimate, at the commencement particularly, than by supposing that the -narcotic operation of the opium veiled or actually retarded the irritant -action of the corrosive sublimate. - -6. _Poisoning with Opium and Belladonna._—A lady, who used a compound -infusion of opium and belladonna as a wash for an eruption in the vulva, -took it into her head one day to use the wash as an injection; and -actually received three successive injections, containing each the -active matter of a scruple of opium and half an ounce of belladonna -leaves. Fortunately none of the three was retained above a few minutes, -except the last, which was not discharged for ten minutes. In less than -an hour, she was found in bed in a deep sleep, but the true cause was -not suspected till three hours later. She was then completely insensible -and motionless, with the face pale, the pupils excessively dilated and -not contractile, the pulse frequent and small, and the breathing -hurried. After the use of purgative injections, blood-letting, leeches -to the head, and sinapisms to the legs, she began in five hours to show -some sign of returning consciousness, which improved after a fit of -vomiting. When thoroughly roused, her vision continued dim, the pupils -excessively dilated, and the ideas somewhat confused. For three days the -pulse continued frequent, and the pupils somewhat dilated.[2560] Here -the opium seems to have prevented the delirium usually induced by -belladonna in the early stage, while on the other hand the belladonna -prevented the usual effect of opium on the pupils, and actually produced -the opposite action. - -7. In the following cases, the active poisons to which the individuals -were exposed were so numerous, that it is impossible to say which or how -many of them occasioned the symptoms. A colour-maker was superintending -a process in which cobalt, arsenic, mercury, sal-ammoniac, and nitric -acid were subjected to heat in a mattrass, when the mattrass suddenly -gave way, and a dense vapour was instantly discharged. The manufacturer, -before he could escape, fell down insensible; and though speedily -removed, he died in no long time, affected with enormous swelling of the -abdomen. A workman who was also present, escaped by a window; but was -nevertheless immediately attacked with swelling of the belly, which -speedily became very great, and was attended with pain in the jaws, and -dimness of sight. These symptoms were very slowly dissipated under the -use of cold bathing and purgatives, which brought away an enormous -quantity of fetid gas.[2561] - -These are not the only examples of compound poisoning which have come -under my attention. But others I have noticed are not detailed with -sufficient exactness to make it worth while to quote them. The instances -given, however, are sufficient to show that poisons of opposite -qualities given about the same time in large doses will disguise one -another’s effects, or impede, or perhaps even prevent them, in a manner -which renders such a combination of circumstances an important subject -of inquiry for the medico-legal toxicologist. - -It is probable that the modifying influence is established in one of two -ways,—either by one poison producing a state of venous plethora or -distension, which impedes, or for a time prevents, the absorption of the -other,—or by one poison producing an insensibility of the membrane with -which the other is in contact; so that not only the local injury -actually done has not the usual remote effect on the constitution, or on -distant organs, but likewise is at times substantially less extensive -than in ordinary circumstances. These reflexions arise naturally from a -review of the preceding cases; but of course further facts are necessary -to give them weight. - - - - - INDEX. - - - Absorption, its extreme rapidity, 15 - - — action of poisons through, 17 - - — effect of in removing poisons beyond the reach of analysis, 57 - - Acetatæ of lead, tests of, in its pure state, 398 - - — — — process for detecting it in organic mixtures, 423 - - — — — effects on the animal body. See _Lead_. - - Acetates of copper, their tests, 350 - - — — morphia, its tests, 533 - - Acid, acetic, its tests in the pure and mixed state, 164 - - — — effects on man and animals, 165 - - Acid, arsenious, its chemical properties, 200 - - — — its taste, 200 - - — — its solubility in various menstrua, 201 - - — — its tests when in the solid state, 203 - - — — its tests when in solution, 206 - - — — its liquid tests give complete evidence conjunctly, not separately, - 209 - - — — its tests when mixed with organic substances, 215 - - — — Marsh’s process for, 211, 217 - - — — Reinsch’s process for, 214, 216 - - — — process for by hydrosulphuric acid, 217 - - — — process for by Fresenius and Von Bab, 218 - - — — fallacies in the process for detecting, 219 - - — — its effects on the body. See _Arsenic_. - - Acid, carbonic. See _Gas_. - - — carbazotic, a poison, 610 - - — citric, not poisonous, 180 - - Acid, hydrochloric, tests for, in its pure and mixed state, 146 - - Acid, hydrocyanic, its action on the body, 582 - - — — rapidity of its action, 582, 590 - - — — acts in all its chemical combinations, 585 - - — — acts through every animal tissue, 584, 592 - - — — enters the blood and communicates its odour, 594 - - Acid, hydrocyanic, why its odour is not always perceptible in the - blood, 594 - - — — contained in many plants, renders them poisonous, 600 - - — — its tests when pure, 578 - - — — process for detecting it in organic mixtures, 580 - - — — symptoms it induces in man, 587 - - — — may cause instant death, 582, 590 - - — — morbid appearances caused by it, 593 - - — — treatment of poisoning with, 596 - - Acid, meconic, its tests, 532 - - Acid, nitric, its tests in the pure and mixed state, 142, 143 - - — — process for stains produced by, 143 - - Acid, oxalic, its action on the animal body, 173 - - — — its morbid appearances, 177 - - — — symptoms caused by it in man, 173 - - — — its symptoms are occasionally of themselves complete proof of - poisoning, 179 - - — — its tests when pure, 168 - - — — process for, in organic mixtures, 170 - - — — treatment of poisoning with, 178 - - Acid, phosphorous, a feeble poison, 152 - - — — sulpho-cyanic, not a poison, 587 - - Acid, sulphuric, its tests in the pure state, 123 - - — — process for it in the mixed state, 126 - - — — process for stains occasioned by, 125 - - — — action on animals, 128 - - — — morbid appearances, 135 - - — — the morbid appearances are at times of themselves complete proof of - poisoning, 139 - - Acid, sulphuric, symptoms in man classified, 129 - - — — the symptoms are at times alone complete proof of poisoning, 135 - - — — throwing of, to disfigure or disable, is a capital crime, 122 - - — — treatment of poisoning with, 140 - - Acid, sulphuric, effects of on the intestines after death, 139 - - Aconitina, the alkaloid of monkshood, 662 - - _Aconitum_, poisoning with, 662 - - Acrid poisons of the vegetable and animal kingdoms, 451 - - Action of poisons, 9 - - — — — by absorption, 17 - - — — — causes which modify the, 27 - - — — — local, 9 - - — — — remote, 11 - - — — — organs acted on by the remote, 22 - - — — — rapidity of the, 14, 582 - - — — — through sympathy, 12 - - — — — applied to the discovery of antidotes, 37 - - Administration of poison by prisoner, necessity of the proof of, on - trials, 72 - - — — — by prisoner, may be proved by pure medical evidence, 73 - - _Æthusa_, poisoning with, 662 - - Aggregation, state of, its effects on the action of poisons, 28 - - Alcohol, poisoning with, 725 - - — morbid appearances induced by, 731 - - — poisoning of with other poisons, 734 - - — symptoms of poisoning with, in its several degrees, 725 - - — treatment of poisoning with, 735 - - Alkalies and Alkaline salts, fixed, 180 - - — — — — their mode of action, 183 - - — — — — morbid appearances caused by them, 186 - - — — — — symptoms caused in man, several varieties of, 183 - - — — — — tests for, 181 - - — — — — treatment of poisoning with, 187 - - Alkaline sulphurets. See _Sulphurets_. - - Almond. See _Bitter-Almond_. - - Alum, effects of on man and animals, 509 - - Ammonia and its salts, tests of, 193 - - — — — — their effects on man and animals, 193 - - Ammoniacal gas, effects of, on man, 194 - - Amygdalus. See _Bitter Almond_. - - Anemone, its effects as a poison, 463 - - Angustura bark, false, its effects on man and animals, 692 - - Animal acrids, general observations on their effects, 470 - - Animal matter poisoned by disease, 487 - - — — poisonous from ordinary putrefaction, 490 - - — — poisonous from modified putrefaction, 492 - - Animals, evidence of poisoning from experiments on, 62 - - Animals, effects of suspected articles of food on, 63 - - — effects of suspected matters of vomiting or contents of stomach on, - 67 - - — experiments on, may illustrate physiological points disputed on - trials, 71 - - — various effects of poisons on different, 63 - - Antidotes, by what principles the search for them must be regulated, 37 - - Antimony, tests for its compounds, 367 - - — tartrate of. See _Tartar-emetic_. - - Apoplexy, distinction between it and narcotic poisoning, drawn from - symptoms, 511 - - — distinction between it and narcotic poisoning, drawn from morbid - appearances, 514 - - — congestive appearances of, 517 - - — from extravasation, 517 - - — serous, 517 - - — simple, 515 - - Arseniate of potass, its tests, 224 - - Arsenic, tests for its compounds, 198 - - — action of, illustrated by experiments on animals, 227 - - — acts through all the animal tissues, 229 - - — acts in all its chemical forms, except in the metallic state, 230 - - — action of, is a little impaired by the effects of mixture—not by - habit, 233 - - — acts when applied to ulcers and eruptions, 251 - - — acts when applied to the sound skin, 257 - - — acts when introduced into the rectum, 253 - - — acts when thrust into the vagina, 254 - - — acts powerfully when inhaled, 254 - - — does it exist in the blood of those poisoned with it?, 228 - - Arsenic, dose required to cause death, 232 - - — morbid appearances caused by it, 262 - - — morbid appearances sometimes not caused by it at all, 262 - - — morbid appearances caused by it after death, 282 - - — does it prevent the bodies of those poisoned with it from - putrefying?, 273 273 - - — symptoms it causes in man classified according to three varieties, - 234 - - — symptoms of, at times supply alone complete evidence of poisoning, - 259 - - Arsenic, symptoms of, occasionally very trifling, even where fatal, 286 - - — symptoms of, how soon may they begin, and how long may they be - delayed?, 234 - - — symptoms of, how soon may they kill?, 239 - - — symptoms of, how long may they last?, 248 - - — treatment of poisoning with, 283 - - — treatment of, no antidotes known, 285 - - — changes it undergoes in the stomach after death, 268 - - — metallic, not a poison, 230 - - — oxide of. See _Acid, arsenious_. - - — sulphurets of. See _Sulphurets_. - - Arsenite of copper, its tests, 223 - - — — — seldom contained in mineral green, 223, 346 - - — of potass, its tests, 223 - - Arseniuretted-hydrogen, 227 - - — — its effects, 256 - - _Arum maculatum_, poisoning with, 465 - - _Asagræa officinalis_, 672 - - _Atropa_, poisoning with, 639 - - — symptoms induced by it in man, 640 - - — morbid appearances caused by it, 643 - - Atropia, alkaloid of belladonna, 639 - - - Bacon, poisonous at times, 497 - - Baryta, poisoning with its compounds, 446 - - — muriate of, tests for, 446 - - — — — and carbonate, their effects on man and animals, 448 - - — morbid appearances caused by, 450 - - — treatment of poisoning with, 450 - - Bee, its poisonous sting, 487 - - Belladonna. See _Atropa_. - - Bichloride of mercury. See _Corrosive Sublimate_. - - Bicyanide of mercury, 303 - - Biliary ducts, rupture of, imitates irritant poisoning, 97 - - Bilious vomiting, imitates irritant poisoning, 100 - - Bismuth, poisoning with its compounds, 383 - - Bitartrate of potash, a poison in large doses, 507 - - Bitter-almond, its poisonous effects, 602 - - — may cause death, 603 - - — essential oil of, its effects as a poison, 604 - - — essential oil of, its composition, 601 - - — essential oil of, its formation, 602 - - Bitter-apple, poisoning with, 460 - - Bitter cassava, poisoning with, 457 - - Bitter-sweet, a feeble poison, 576 - - Blood, discovery of poisons in the, 21 - - Boiling water, effects of, when swallowed, 505 - - — — causes cynanche laryngea, 506 - - _Bombyx processionaria_, its poisonous effects, 477 - - Brain, inflammation of its membranes, distinguished from narcotic - poisoning, 523 - - — inflammation of its substance, distinguished from narcotic poisoning, - 524 - - — hypertrophy of, distinguished from narcotic poisoning, 526 - - Bread, adulteration of, with the sulphate of copper, 354 - - — effects of spoiled, 720 - - Bromine, tests for, 161 - - — its effects on animals, 162 - - _Brucea antidysenterica_, not the False Angustura tree, 692 - - Brucia, alkaloid of false angustura bark, 692 - - Bryony-root, effects of, on man and animals, 459 - - - Calomel, its tests, 292 - - — can it be considered an irritant poison?, 332 - - _Calthapalustris_, its effects as a poison, 463 - - Camphor, its effects on animals, 694 - - — morbid appearances caused by, 696 - - — symptoms excited by, in man, 694 - - Cantharides, physical characters of, 471 - - — action of, on animals, 471 - - — morbid appearances caused by, 476 - - — symptoms it excites in man, 472 - - — treatment of poisoning with, 476 - - Carbonate of ammonia, 193 - - — of baryta, tests of, 446 - - — of lead, tests of, 398 - - — of lead is formed on lead by the action of air and water,—and see - _Lead_, 399 - - Carbonates of potass and soda, tests of, 181 - - Carbonic acid. See _Gas_. - - Carbonic oxide gas, effects of, on man, 624 - - Carburetted-hydrogen gas, its effects on man, 622 - - Cassada, bitter, its effects, 457 - - Castor-oil-seeds, effects of, on man and animals, 456 - - Cerasus Lauro-cerasus. See _Cherry-laurel_. - - Cevadilla, a poison, 672 - - Cheese, occasionally poisonous without intentional adulteration, 494 - - Chemical analysis, evidence of general poisoning from, 54 - - — — may be rendered unavailing by vomiting and purging, 55 - - — — may be rendered useless by absorption, 57 - - — — may be fruitless, because the poison has been decomposed, 58 - - — — is often successful after long interment, 58 - - Chemical combination, its influence in modifying the operation of - poisons, 28 - - Chemical decomposition, its effects in removing poisons beyond the - reach of analysis, 58 - - Chemical evidence not always indispensable to the proof of poisoning, - 59 - - Cherry-laurel water, a deadly poison, 605 - - — essential oil of, is the same as the oil of bitter-almond, 605 - - — effects of the distilled water and oil on animals and man, 605, 606 - - Chlorine, its effects on man and animals, 152, 616 - - Chloride of barium, 446 - - — of iron, poisoning with, 392 - - Chlorides of soda, potassa and lime, their action as poisons, 191 - - Cholera imitates irritant poisons, and how to be distinguished, 100 - - — its shortest duration, 101 - - — supposed to have been caused by emanations from a cess-pool, 621 - - — impairs the activity of some poisons, 35 - - — malignant, how distinguished from irritant poisoning, 102 - - Chrome, poisoning with the compounds of, 385 - - _Cicuta_, its effects on man and animals, 662 - - Cinnabar, its tests, 290 - - Citric acid, not a poison, 180 - - Classification of poisons, 90 - - Cluster-cherry, its distilled water and essential oil are active - poisons, 608 - - Cocculus indicus, its effects on man and animals, 696 - - _Colchicum autumnale_, effects of, on man, 674 - - Colchina, alkaloid of colchicum, 674 - - Cold water, death from drinking it, imitating irritant poisoning, 98 - - Colic, how it is distinguished from irritant poisoning, 109 - - Colica pictonum, causes of, 426, 431, 437 - - — — trades which are subject to suffer, 436 - - Colica pictonum, precautions for preventing it in workmen, 443 - - Colocynth, effects of, on man and animals, 460 - - Common salt, a poison in very large doses, 508 - - Compound poisoning, 740 - - Conduct of prisoner, illustrated by medical evidence, may prove his - guilt, 73 - - Conia, alkaloid of hemlock, 653 - - _Conium_, effects of, on man and animals, 654 - - Copper, poisoning with, 345 - - — action of its compounds, 358 - - — adulteration of bread with, 354 - - — corrosion of, by articles of food and drink, 350, 353 - - — corroded by saline solutions, 350 - - — corroded by wine and vegetable acids, 352 - - — corroded by fatty matters, 352 - - — metallic, not poisonous, 360 - - — morbid appearances caused by, 364 - - — process for detecting its salts when pure, 346 - - — process for detecting it in organic mixtures, 355 - - — sulphuret not poisonous, unless long exposed to the air, 361 - - — symptoms of poisoning with in man, 361 - - — treatment of poisoning with, 365 - - — contained in most vegetable substances, 355 - - — is it contained in the blood of animals poisoned with it?, 360 - - _Coriaria myrtifolia_, poisoning with, 698 - - Corrosion caused by poisons, examples of, 9 - - Corrosive sublimate, action on animals. See _Mercury_. - - — — action on dead intestine, 341 - - — — chemical properties of, 291 - - — — is decomposed by organic principles, 297 - - — — process for, in the solid state, 292 - - — — process by reduction when it is dissolved, 292 - - — — process by liquid tests when it is dissolved, 293 - - — — process for it in organic mixtures, 296 - - — — additional tests for it in the pure state, 294 - - — — symptoms caused by it in man. See _Mercury_. - - Cream of tartar, a poison in large doses, 507 - - Creasote, a poison, 739 - - Croton-oil and seed, effects of, 459 - - Cuckow-pint, poisoning with, 465 - - Cupping-glasses, in the treatment of external poisoning, 38 - - Cyanide of mercury, tests for, 303 - - — its effects on man, 332 - - Cyanogen gas, its effects on animals, 636 - - Cyanous acid, a feeble poison, 587 - - _Cytisus Laburnum_, its poisonous effects, 723 - - - Daffodil, its effects as a poison, 467 - - _Daphne_, effects of its different species on man and animals, 465 - - Darnel-grass, its effects on man, 721 - - _Datura_, poisoning with, 644 - - Daturia, alkaloid of thorn-apple, 645 - - Dead-tongue, poisoning with, 658 - - Death-bed, evidence in cases of poisoning, its importance, and hints - for collecting it, 84 - - Delirium tremens, impair the activity of some poisons, 35 - - — — the effect of alcohol, 731 - - Delphinia, alkaloid of stavesacre, 464 - - _Delphinium_, poisoning with, 464 - - Digestion of poisons, tends to remove them beyond the reach of - analysis, 58 - - _Digitalis_, poisoning with, 678 - - Dippel’s oil, a poison, 737 - - Diseases, their influence on the operation of poisons, 35 - - Distension of stomach, death from, how distinguished from irritant - poisoning, 95 - - Dysentery impairs the activity of opium as a poison, 35 - - - Eels sometimes poisonous, 484 - - Elaterium and elaterin, their poisonous properties, 461 - - Emeta, its poisonous properties, 682 - - Empyreumatic oils are active poisons, 737 - - Epilepsy, distinction between it and narcotic poisoning from the - symptoms, 519 - - — distinction of, from narcotic poisoning by morbid appearances, 521 - - Epsom salt, a poison in large doses, 506 - - Ergot. See _Spurred rye_. - - _Ervum Ervilia_ is a poison, 722 - - Ether, effects of, on man and animals, 736 - - Euphorbium, its effects on man and animals, 454 - - Evidence of poisoning. See _Symptoms. Morbid Appearances. Chemical - Evidence. Animals._ - - — of general poisoning from symptoms, 43 - - — — — — from morbid appearances, 51 - - — — — — from chemical analysis, 54 - - Evidence of general poisoning from experiments on animals, 62 - - — — — — from moral circumstances, 71 - - Evidence, medical, of the administration in charges of poisoning, 72 - - — — may prove the prisoner’s intent, 78 - - — — on death-bed, 83 - - - Fainting, mortal, distinction between it and narcotic poisoning, 527 - - Feigned poisoning, 86 - - Ferro-cyanate of potass not poisonous, 586 - - Fever impairs the activity of some poisons, 35 - - Fish-poison, 477 - - Fly-powder, tests for, 199 - - Fool’s parsley, effects on man and animals, 661 - - Foxglove, its effects on man and animals, 678 - - Fowler’s solution, tests of, 223 - - Fungi, list of the wholesome, 700 - - — list of the deleterious, 701 - - — circumstances which modify their qualities, 702 - - — rules for knowing poisonous, 703 - - — active principles of, 704 - - — symptoms of poisoning with, 704 - - — morbid appearances caused by, 708 - - — treatment of poisoning with, 709 - - — poisoning of wholesome kinds with other poisons, 709 - - - Gamboge, poisoning with, 466 - - Gas, carbonic acid, morbid appearances caused by, 632 - - — — — is poisonous positively, not negatively, 614, 624 - - — — — symptoms caused by, when pure, 625 - - — — — symptoms it causes when diluted with air, 625 - - — — — symptoms, when from burning charcoal, 626 - - — — — symptoms, when from burning coal, 631 - - — — — symptoms, when from burning tallow, 630 - - — — — symptoms when formed by respiration, 632 - - — — — treatment of poisoning with, 634 - - Gas, carbonic oxide, its effects on man, 634 - - — carbureted-hydrogen, effects on man, 622 - - — coal and oil, effects on man, 622 - - — chlorine, its effects on man, 616 - - — cyanogen, its effects on animals and plants, 636 - - — hydrosulphuric acid, effects when injected into the veins, 613 - - — — — effects when breathed by man, 618 - - — — — effects on vegetables, 618 - - Gas, hydrosulphuric acid, morbid appearances caused by, 619 - - — — — proves fatal though applied to the skin only, 614, 617 - - — muriatic acid, very poisonous to plants, 617 - - — nitric oxide and nitrous acid, effects when injected into the veins, - 614 - - — nitrous acid, effects on man, 615 - - — nitrous oxide, its effects on man and plants, 635 - - — oxygen, a positive poison, 636 - - — sulphurous acid, extremely poisonous to plants, 631 - - Gases, poisonous, medico-legal importance of, 611 - - — which of them are negatively, and which positively poisonous, 612 - - Gastritis. See _Stomach_. - - General poisoning, evidence of, 39 - and see _Evidence_. - - Glass-powder, is it a poison?, 503 - - Gold, poisoning with its compounds, 383 - - Goulard’s extract, tests for, 399 - - Grain, sometimes poisonous, 710 - - — unripe, its supposed effects on man, 719 - - Green vitriol. See _Sulphate of Iron_. - - Gullet, perforation of, how distinguished from irritant poisoning, 108, - 119 - - - Habit, its effect in modifying the action of poisons, 34 - - Hæmatemesis, how distinguished from irritant poisoning, 109 - - Heart, organic diseases of, may imitate narcotic poisoning, 528 - - Hellebore, effects of its different species on man and animals, 672 - - Hellebore, white. See _Veratrum_. - - Hemlock, its effects on man and animals, 653 - - — dropwort, its effects as a poison, 660 - - Henbane. See _Hyoscyamus_. - - _Hippomane Mancinella_, its poisonous effects, 458 - - Hot liquids cause symptoms of irritant poisoning, 505 - - Hydrochlorate of ammonia. See _Ammonia_. - Also, 193 - - Hydrochlorates. See _Muriates_. - - Hydrochloric acid. See _Acids_. - - Hydrocyanic acid. See _Acid_. - - Hyoscyamus, its effects on man and animals, 573 - - Hydrophobia impairs the activity of some poisons, 35 - - Hypertrophy of brain. See _Brain_. - - Hysteria lessens the effect of opium, 35 - - - Idiosyncrasy, its influence in modifying the action of poisons, 32 - - — sometimes renders wholesome articles deleterious to individuals, 33, - 68 - - Iliac passion imitates irritant poisoning, 109 - - Imaginary poisoning, 85 - - Imputed poisoning, 88 - - Inflammation of brain. See _Brain_. - - — of intestine. See _Intestines_. - - — of stomach. See _Stomach_. - - Insects, poisonous, 486 - - Intent in the administration of poison may be sometimes proved by - medical evidence, 78 - - Interment for years may not prevent the detection of poisons, 58 - - Intestines, inflammation of, how distinguished from irritant poisoning, - 99 - - — obstruction of, may imitate irritant poisoning, 109 - - — perforation of, how distinguished from irritant poisoning, 108, 119 - - Iodide of potassium, effects, 157 - - — — — tests of, 158 - - Iodine, its effects on man and animals, 154 - - — its tests in the pure and mixed state, 152 - - Ipecacuan, poisoning with, 682 - - Ipomæa Purga, a poison, 467 - - Iron, poisoning with the salts of, 391 - - Irritant poisons, general observations on, 92 - - — — distribution of into orders, 121 - - — — morbid appearances of, contrasted with those of various natural - diseases, 110 - - — — symptoms of, contrasted with those of various natural diseases, 93 - - Irritation, examples of, caused by poisons, 9 - - - Jalap, its effects as a poison, 467 - - _Jatropha_, its effects on man and animals, 457 - - _Juniperus Sabina_, its poisonous effects, 468 - - - King’s yellow, its tests and composition, 225 - - - Laburnum seeds poisonous, 723 - - _Lacluca_, poisoning with, 575 - - _Lathyrus Cicera_ is a poison, 722 - - Lead, tests for its compounds, 396 - - — action of air and water on, 399 - - — adulteration of wines with, 420 - - — adulteration of spirits with, 422 - - — adulteration of a mechanical nature, 422 - - — corrosion of, by distilled water, 401 - - — corrosion of, by water prevented by salts in solution, 403 - - — corrosion of, prevented by excessively minute proportions of some - salts, 403 - - — corrosion of, by natural waters, 406 - - — corrosion of, by rain and snow-water, 406 - - Lead, corrosion of, by spring waters, how prevented, 414 - - — corrosion of, not caused by some spring waters, 408 - - — dissolved by many acidulous fluids, 415 - - — dissolved by these fluids much more rapidly if it is oxidated, 419 - - — metallic, is not poisonous, 427 - - — mode of action on the animal body, 424 - - — does it exist in the blood or organs of animals poisoned with it?, - 426 - - — morbid appearances caused by, 439 - - — process for detecting its compounds, 396 - - — process for detecting it in organic mixtures, 422 - - — sulphuret of, not poisonous, 427 - - — symptoms caused by, in man, classified according to two varieties, - 429 - - — symptoms caused by, as an irritant, 429 - - — symptoms of, constituting the disease colica pictonum, 431 - - — tradesmen who are subject to suffer from poisoning with, 436 - - Lead, treatment of poisoning with, 441 - - Lead glazing is rapidly acted on by acidulous fluids in some - circumstances, not in others, 419 - - Lettuce-opium, effect of, on animals, 575 - - Lime, poisoning with, 192 - - Liver of sulphur. See _Sulphurets_. - - Litharge, tests for, 396 - - Lividity is no evidence of poisoning, 51 - - Local action of poisons, 9 - - _Lolium temulentum_, its effects on man, 721 - - - Maize, spurred, 718 - - Manchineel, its effects on man and animals, 458 - - Mania impairs the activity of some poisons, 35 - - Marsh marigold, its effects on man and animals, 464 - - Meadow-saffron, its effects on man, 674 - - Mechanical irritants produce the same effects as irritant poisons, 501 - - Meconic acid, its tests, 53 - - — — is not poisonous, 562 - - _Meloe proscarabæus_, its poisonous effects, 477 - - Melanosis of stomach imitates the effects of irritant poisons, 112 - - Melæna, how distinguished from irritant poisoning, 109 - - Meningitis, how distinguished from narcotic poisoning, 523 - - _Menispermum Cocculus_, poisoning with, 696 - - Mercurial salivation in cases of poisoning, when does it begin?, 314 - - Mercurial salivation, phenomena of, 316 - - — — can it be confounded with any other disorder?, 319 - - — — may it return after a long intermission?, 322 - - — — its duration, 322 - - — — in what modes it may prove fatal, 324 - - Mercurial tremor, 324 - - Mercury, action of its soluble compounds on the animal body, 303 - - — acts through all animal tissues, 327 - - — acts in all soluble chemical compounds, 329 - - — acts not, when in the metallic state, 330 - - — acts not, in the form of sulphuret, 331 - - — acts not, when its soluble compounds are decomposed by organic - principles, 336 - - — existence in the blood of those who have taken it is extremely - probable, 306 - - — morbid appearances caused by, 337 - - Mercury, processes for its compounds when pure, 289 - - — process for detecting it in organic mixtures, 299 - - — symptoms of poisoning with, classified according to three varieties, - 310 - - — symptoms of corrosive poisoning with, their longest duration, 312 - - — symptoms of, their shortest duration in fatal cases, 313 - - — symptoms of, sometimes furnish of themselves decisive evidence of - poisoning, 337 - - — treatment of poisoning with an antidote, 342 - - Metals, not poisonous unless oxidated, 230, 329, 360, 427 - - Mezereon, its effects on man and animals, 465 - - Milk at times poisonous without intentional adulteration, 496 - - Mineral-green, tests of, 347 - - — See _Arsenite of Copper_. - - Mixture, its effect in modifying the action of poisons, 29 - - _Momordica Elaterium_, its poisonous properties, 461 - - Monkshood, its effects on man and animals, 662 - - Moral evidence of poisoning, 71 - - Morbid appearances, evidence of general poisoning from, 51 - - — — sometimes supply alone full proof of poisoning, 139 - - Morphia, its tests, 532 - - — its effects on man and animals, 557 - - Mosses, poisonous, 710 - - Mountain-ash is poisonous, as containing hydrocyanic acid, 609 - - Muriate of baryta. See _Baryta_. - - Muriate of morphia, its tests, 533 - - Muriate of mercury. See _Calomel_—_Corrosive Sublimate_. - - Muriate of soda, a poison in large quantity, 508 - - Muriatic acid, 146 - - Muriatic acid gas, 617 - - Muscles are occasionally poisonous, 479 - - — causes why they become poisonous, 481 - - — copper cannot account for their effects, 481 - - — decay, does it render them poisonous?, 481 - - — disease, will this explain their effects?, 482 - - — idiosyncrasy sometimes makes them poisonous, 482 - - — insects of a poisonous nature entering their shell, will this explain - their effects?, 483 - - Muscles, principle of a poisonous nature not yet discovered in them, - 482 - - — symptoms and morbid appearances caused by the poisonous, 479 - - Mushrooms. See _Fungi_. - - - _Narcissus Pseudo-narcissus_, a poison, 467 - - Narcotico-acrid poisons, general remarks on, 637 - - Narcotic poisoning, its symptoms and morbid appearances, contrasted - with those of natural disease, 510 - - Narcotics, their active principles, 529 - - Narcotine, its tests, 534 - - — its effects on animals, 560 - - Nervous local impressions, examples of, caused by poisons, 10 - - _Nicotiana Tabacum._ See _Tobacco_. - - Nicotianin, poisonous principle of tobacco, 647 - - Nightshade. See _Solanum_—_Atropa_. - - Nitrates of mercury, their tests, 303 - - Nitre, its tests, 187 - - — its action and symptoms in man, 188 - - — morbid appearances caused by, 191 - - Nitric acid. See _Acids, Mineral_. - - Nitric oxide gas, its effects on animals, 614 - - Nitrous acid vapour, its effects on man, 615 - - Nitrous oxide gas, its effects on man, 635 - - Nux-vomica, action of, on animals, 688 - - — morbid appearances caused by, 689 - - — symptoms it excites in man, 686 - - Nux-vomica, symptoms of, sometimes alone are complete evidence of - poisoning, 690 - - — its tests, 686 - - — treatment, 690 - - - _Œnanthe_, poisoning with, 653 - - Oil of Dippel, 737 - - Oil of tar, 738 - - Oil of turpentine, 738 - - Oils, empyreumatic, are poisonous, 737 - - Opium, frequently used for the purpose of poisoning, 530 - - — action of, illustrated by experiments, 539 - - — acts as a poison through every animal tissue, even the skin, 556 - - — chemical history of, 530 - - — chemical analysis cannot detect it in the blood, 541 - - — morbid appearances caused by, 562 - - — process for detecting it in organic mixtures, 534 - - — may cause death and not be discoverable in the stomach why?, 537 - - Opium, symptoms of, in man, 539 - - — symptoms of, how soon may they begin, and how long may they be - delayed?, 543 - - Opium, ordinary, shortest, and longest duration of fatal poisoning - with, 547 - - — smallest fatal dose of, in adults, 549 - - — fatal dose in infants extremely small, 549 - - — principles contained in, 531 - - — tests for the principles of, when pure, 532 - - — treatment of poisoning with, 566 - - Opium-eaters, are they short lived?, 551 - - Orpiment, 224, 230 - - Osmium, 395 - - Oxygen, a poison, 636 - - Oysters, sometimes poisonous, 483 - - - Peach flowers may cause fatal poisoning, 608 - - Pepper, a poison in very large doses, 506 - - Perforation. See _Stomach_—_Intestines_—_Gullet_. - - Peritonæum, inflammation of, how distinguished from irritant poisoning, - 105 - - Phosphorus, its effects on man and animals, 149 - - Phosphorous acid, a feeble poison, 152 - - Picrotoxin, active principle of Cocculus Indicus, 696 - - Pretended poisoning, 85 - - Protochloride of Mercury, See _Calomel_. - - _Prunus Lauro-cerasus._ See _Cherry-Laurel_. - - _Prunus Padus._ See _Cluster-Cherry_. - - Prussiate. See _Ferro-cyanate_. - - Prussic acid. See _Hydrocyanic_. - - Putrefaction of the body, not a proof of poisoning when premature, 51 - - — does not always prevent the detection of poisons, 59 - - — does arsenic preserve the body from?, 273 - - Putrefied animal matter, its effects as a poison on man and animals, - 492 - - - Quantity or dose, its influence in modifying the action of poisons, 27 - - - _Ramollissement._ See _Brain_. - - Ranunculaceæ, their effects on man and animals, 462, 662 - - Ranunculus, its poisonous effects, 462 - - Realgar, its tests, 224 - - Remote action of poisons, through what channel is it carried on?, 12 - - Red-lead, tests for, 397 - - Red precipitate, tests for, 290 - - Redness of Stomach. See _Stomach_. - - Ricinus. See _Castor oil_. - - Rue, poisoning with, 681 - - Rupture of stomach, death from, how distinguished from irritant - poisoning, 97 - - Rupture of duodenum, death from, how distinguished from irritant - poitant poisoning, 97 - - Rupture of biliary ducts, 97 - - — of uterus, 98 - - Rust of wheat is not poisonous, 719 - - Rye. See _Spurred rye_. - - - Sal-ammoniac, its tests, 193 - - — its action on animals, 196 - - Salivation may be caused by various poisons, 319 - - — may be caused by ulcerated sore throat, 319 - - — sometimes an idiopathic disease, 319 - - — sometimes arises from the influence of the imagination, 321 - - Salivation, mercurial. See _Mercurial_. - - Salmon, pickled or kippered, sometimes injurious, 499 - - Salt, common, a poison in very large quantity, 508 - - Savin, its effects on man and animals, 468 - - Sausages, occasionally poisonous, 492 - - _Scilla maritima_, effects on man and animals, 671 - - _Secale cornutum._ See _Spur_. - - Secret poisoning, 39, 249 - - Serpents, venomous, 484 - - Silver, poisoning with its compounds, 380 - - Simultaneous illness of several persons, important proof of general - poisoning, 80 - - Skin, poisons act slowly or not at all through the sound, 30 - - Skin, poisons act through it sometimes when long applied or rubbed in, - or in the gaseous state, 257, 328, 435, 556, 614, 618, 625 - - Snakes, venomous, 484 - - _Solanum_, effects of its species on man and animals, 576 - - _Sorbus aucuparia._ See _Mountain-ash_. - - Spinal cord, diseases of, distinguished from narcotic poisoning, 527 - - Spirituous liquors. See _Alcohol_. - - Sprats smoked, sometimes poisonous, 499 - - Spur, what kinds of grain are attacked by, 711 - - Spurred maize, 718 - - Spurred rye, its causes, 711 - - — chemical analysis of, 713 - - — effects on man and animals, 714 - - — miscarriage supposed to be induced by, 717 - - Squill, poisoning with, 670 - - Stavesacre, its effects on man and animals, 464 - - St. Ignatius’ bean, effects of, on man and animals, 691 - - Stomach, distension of, death from, contrasted with irritant poisoning, - 95 - - — fibrinous and mucous effusion in, imitates the effects of irritant - poisoning, 113 - - — gelatinization of, a cause of perforation, 107 - - — inflammation of, how distinguished from irritant poisoning, 102 - - — inflammation of, is it in its acute state ever a natural disease?, - 102 - - — partial laceration of, contrasted with irritant poisoning, 97 - - — redness of, from natural causes, imitates the effects of irritant - poisons, 110 - - — rupture of, contrasted with the effects of irritant poisons, 96 - - — spontaneous perforation of, distinguished from irritant poisoning, - 105 - - — spontaneous perforation of, its symptoms and varieties, 105 - - — spontaneous perforation of, its morbid appearances, nature and - causes, 113 - - — ulceration of, how distinguished from the effects of irritant - poisons, 113 - - Stomach-pump, discovery of, 567 - - Stramonium, its effects on man and animals, 645 - - Strontia, its salts not poisonous, 451 - - Strychnia, alkaloid of the _Strychni_, effects of, on animals, 683 - - _Strychnos_, which of its species are poisonous, 683 - - Sugar of Lead. See _Acetate_. - - Sulphate of copper, tests for, 348 - - — — — adulteration of bread with, 354 - - — — iron occasionally poisonous, 392 - - — — magnesia, poisonous in very large doses, 506 - - — — mercury, its tests, 290 - - — — potash, poisonous in large doses, 507 - - — — zinc, tests of when pure, 386 - - — — — effects on animals, 387 - - — — — effects on man, 388 - - — — — morbid appearances by, 391 - - — — — process for detecting it in organic mixtures, 386 - - Sulpho-cyanic acid a feeble poison, 586 - - Sulphur, its effects on man and animals, 152 - - Sulphurets of the alkalis, effects on man, morbid appearances, and - treatment of poisoning with, 196 - - Sulphurets of antimony, tests of, 367 - - — — arsenic, tests of, 224 - - — — arsenic, its effects as a poison, 230 - - Sulphuret of copper, not poisonous unless long exposed to the air, 360 - - — — lead not poisonous, 428 - - — — mercury its tests, 290 - - — — mercury, not poisonous, 331 - - Sulphuretted hydrogen. See _Gas_. - - Sulphuric acid. See _Acids, Mineral_. - - Sympathetic effects of poisons, 12 - - Symptoms of poisoning, evidence from, 42 - - — — — general character of, contrasted with those of the symptoms of - natural disease, 42, 46 - - — — — suddenness of the invasion of, 43, 46 - - — — — commence after a meal, 45, 47 - - — — — commence during health, 49 - - — — — regularity of their increase, 44, 47 - - — — — uniformity of their nature, 45, 47 - - — — — may sometimes of themselves be complete evidence of poisoning, - 179, 259, 337, 691 - - Syncopal asphyxia, how distinguished from narcotic poisoning, 527 - - - Tartar-emetic, action of, on animals, 371 - - — action on the skin, 375 - - — morbid appearances caused by, 376 - - — process for detecting it in a pure solution, 368 - - — process for detecting it in organic mixtures, 369 - - — symptoms excited in man by, 372 - - — sometimes not poisonous in large doses, 373 - - Tartar-emetic, treatment of poisoning with, 377 - - Tartaric acid, not a poison, 180 - - Tetanus lessens the activity of some poisons, 35 - - Thorn-apple effects on man and animals, 645 - - Ticunas, an American poison, 693 - - Tin, poisoning with its compounds, 378 - - Tissues, influence of different, in modifying the action of poisons, 30 - - Tobacco, effects on man and animals, 649 - - — effects of, by the way of injection, 650 - - — not injurious to workmen who manufacture it, 652 - - Toffana, alleged effects of the _Aqua Toffana_, 249 - - _Trachinus_ has poisonous spines, 478 - - _Tremblement metallique_, its nature and causes, 325 - - Treatment of poisoning, general inferences as to, drawn from the - physiological action of poisons, 36 - - Turbith-mineral, its tests, 290 - - - Unripe grain, its supposed deleterious effects, 719 - - Upas antiar, 698 - - — tieuté, 691 - - Uterus, rupture of, imitates irritant poisoning, 97 - - - Vegetable acrids, general remarks on their effects, 451 - - Venomous insects, 486 - - Venomous serpents, 484 - - Veratria, alkaloid of _veratrum_, 673 - - _Veratrum_, poisoning with the different species of, 672 - - Verdigris, artificial, tests of, 349 - - Verdigris, natural, tests of, 348 - - Verditer, tests of, 347 - - Vermilion, tests of, 290 - - Vitriol, blue. See _Sulphate of Copper_. - - Vomiting, effects of, in removing poisons beyond the reach of analysis, - 55 - - - Wasp, its poisonous effects, 480 - - Water-hemlock, effects of, on man and animals, 658 - - Weever, poisonous spines of, 478 - - Wheat, rust of, is hardly poisonous, - - White-lead, tests for, 397 - - White vitriol. See _Sulphate of Zinc_. - - White precipitate, 332 - - Worms perforating the intestines may imitate irritant poisoning, 108 - - — producing epilepsy may imitate narcotic poisoning, 521 - - Woorara, an American poison, 693 - - - Yew, poisoning with, 699 - - - Zinc, poisoning with its compounds, 386 - - — sulphate of. See _Sulphate_. - - - - - DESCRIPTION OF THE PLATE. - - - 1. Small funnel-shaped tube for testing minute portions of liquids. - - 2. Apparatus for the distillation of fluids suspected to contain - acids, one-seventh the natural size. - - 3. Tube for reducing very small portions of arsenic or mercury. The - figure is of half the natural size. The ball may be blown larger, if - the material to be reduced is bulky. - - 4. A small glass funnel for introducing the material into the tube - Fig. 1, without soiling its inside. - - 5. The ordinary apparatus for disengaging sulphuretted-hydrogen. The - funnel must be a little longer than the emerging tube. The fluid - should not be at any time much higher than in the figure, in order - to secure the operator against its effervescing up into the emerging - tube. The figure is a fourth of the natural size. - - 6. Instrument for washing down scanty precipitates on filters. It is a - thin bottle capable of standing heat—half-filled with water, which - may be boiled on occasion,—and having its cork pierced with a small - tube drawn at its outer end to a very fine bore. The breath is - impelled into the bottle, and, the bottle being then reversed, a - very fine stream issues with great force. - -[Illustration: Fig. 1.] - -[Illustration: Fig. 2.] - -[Illustration: Fig. 3.] - -[Illustration: Fig. 4.] - -[Illustration: Fig. 5.] - -[Illustration: Fig. 6.] - - 7. Tubes of natural size for collecting small portions of mercury by - the process, p. 300. - - 8. Pipette, one-fourth the natural size, for removing by suction - fluids lying over precipitates. Some have a rectangular bend in the - upper part, by means of which the operator sees better the point of - the instrument when in action; but such pipettes are difficult to - clean. That represented in the figure is easily cleaned with a - feather. - - 9. Apparatus for reducing the sulphurets of some metals by a stream of - hydrogen. A, the vessel with zinc and diluted sulphuric acid, the - latter of which may be renewed by the funnel B. C, a ball on the - emerging tube to prevent the liquid thrown up by the effervescence - from passing forward. D, E, corks by which C and G are fitted into - F, the tube which contains the sulphuret at F. G, the exit-tube for - the sulphuretted-hydrogen, plying into a vessel containing acetate - of lead. When the hydrogen has passed long enough to expel all the - air, the spirit-lamp flame is applied at F; and when - sulphuretted-hydrogen is formed, the lead solution is blackened. The - figure is one-third the size of the apparatus. - - For Description of Figures 10 and 11, see p. 212. - -[Illustration: Fig. 7.] - -[Illustration: Fig. 8.] - -[Illustration: Fig. 9.] - -[Illustration: Fig. 10.] - -[Illustration: Fig. 11.] - ------ - -Footnote 1: - - Orfila and Ollivier, Archives Générales de Médecine, x. 360. - -Footnote 2: - - Philosophical Transactions, 1811, 186. - -Footnote 3: - - Experiments on Opium, 1795, reprinted in his Treatise on Fevers, iv. - 697. - -Footnote 4: - - Essay on the Operation of poisonous agents on the living body, 1829, - p. 63. - -Footnote 5: - - Edin. Phys. and Lit. Essays, iii. 311. - -Footnote 6: - - Researches sur l’Acide Hydrocyanique, 1819, p. 179. - -Footnote 7: - - Experimental Inquiry on poisoning with oxalic acid. By Dr. Coindet and - myself.—Edin. Med. and Surg. Journal, xix. _passim_. - -Footnote 8: - - Philosophical Transactions, 1811, p. 184. - -Footnote 9: - - Annales de Chimie et de Physique, vi. 349. - -Footnote 10: - - Report of the Trial of Freeman for the murder of Judith Buswell, - London Medical Gazette, viii. 796–8. - -Footnote 11: - - See subsequently the chapter on Hydrocyanic acid. - -Footnote 12: - - Taylor’s Medical Jurisprudence, p. 18. - -Footnote 13: - - Annales de Chim. et de Phys. xxvi. 54. - -Footnote 14: - - Philosophical Transactions, 1811, p. 182. - -Footnote 15: - - Trans. Royal Soc. of Edinburgh, xiii. 393. - -Footnote 16: - - Zeitschrift für die Physiologie, iii. i. 81. - -Footnote 17: - - Edin. Med. and Surg. Journal, liii. 35, and lvi. 412. - -Footnote 18: - - Archiv. für Anatomie und Physiologie, iv. 192. - -Footnote 19: - - Ed. Med. and Surg. Journ. liii. 46. - -Footnote 20: - - Ed. Med. and Surg. Journ. xix. 335. - -Footnote 21: - - Bull. de l’Acad. Roy. de Méd. iii. 426, _et passim_. - -Footnote 22: - - Edin. Phys. and Lit. Essays, iii. 334. - -Footnote 23: - - Philosophical Transactions, 1811, 198; and Archiv. für Anatomie und - Physiologie, iv. 192. - -Footnote 24: - - Sur le Mechanisme de l’Absorption, 1809; republished, in Journ. de - Physiol. i. 26. - -Footnote 25: - - Recherches sur l’Acide Hydrocyanique, 180. - -Footnote 26: - - Revue Médicale, 1827, i. 515. - -Footnote 27: - - Edin. Med. and Surg. Journal, xix. 173. - -Footnote 28: - - Diss. Inaug. de Venenatis acidi Borussici effectibus. Tubingæ, 1805. - -Footnote 29: - - Edin. Med. and Surg. Journal, liii. 45. - -Footnote 30: - - Journal des Progrès des Sciences Méd. 1827, iii. 121. - -Footnote 31: - - Essay on the Operation of Poisonous Agents on the Living Body. - -Footnote 32: - - Essay, &c. pp. 75, 76. - -Footnote 33: - - Essay, &c. pp. 69, 71. - -Footnote 34: - - Ibidem, pp. 81, 87. - -Footnote 35: - - Edin. Med. and Surg. Journal, liii. 35. - -Footnote 36: - - Ed. Med. and Surg. Journal, lvi. 412. - -Footnote 37: - - Philosophical Transactions, 1841, p. 186. When death begins with any - other organ but the heart, the heart remains irritable for some time - after, and contains black blood in all its cavities. - -Footnote 38: - - Ib. p. 196. - -Footnote 39: - - Diss. Inaug. de Venenis Mineralibus. Edinburgi, 1813. - -Footnote 40: - - Edin. Med. and Surg. Journal, xix. _passim_. - -Footnote 41: - - Edin. Med. and Surg. Journal, li. 330; liv. 339; lvi. 104. The - Hæmadynamometer is an instrument invented by M. Poiseulle, which, when - communicating with the interior of a blood-vessel, indicates the force - of the circulation by the pressure of the blood on a column of - mercury. - -Footnote 42: - - Mémoire sur l’Emétique—Bulletins de la Société Philomatique, 1812–13, - p. 361. - -Footnote 43: - - Orfila, Toxicologie Générale, i. 258. - -Footnote 44: - - Edin. Med. and Surg. Journal, lvi. 104, and other papers there quoted - above. - -Footnote 45: - - Ibid. liv. 121. - -Footnote 46: - - Ibid. li. 344. - -Footnote 47: - - Emmert, Archiv. für Anatomie und Physiologie, i. l. 180. See also the - Article False Angustura. - -Footnote 48: - - Transactions of the Roy. Soc. of Edinburgh, xiii. - -Footnote 49: - - Edin. Med. and Surg. Journal, li. 330, liv. 339, lvi. 104. - -Footnote 50: - - Archives Gén. de Med. Nov. 1839, and Edin. Med. and Surg. Journal, - lvi. 106. - -Footnote 51: - - Ibidem, lvi. 123 and 422. - -Footnote 52: - - Ibid. xix. 326, 327. - -Footnote 53: - - Die Wirkung der Arzneimittel und Gifte, i. 278. - -Footnote 54: - - London Med. Gazette, xiv. 63. - -Footnote 55: - - Recherches sur l’Acide Hydrocyanique, 140. - -Footnote 56: - - Edin. Med. and Surg. Journal, xix. 330. - -Footnote 57: - - Journal de Physiologie, iv. 285. - -Footnote 58: - - Giornale di Fisica, ix. 458. - -Footnote 59: - - These views regarding the decomposition of poisons, were suggested to - me in 1823 by my friend Dr. Coindet, Junior, of Geneva. - -Footnote 60: - - It is not any part of the object of this work to enter into the - history of toxicology, more especially in early times. But it may be - well here to state, that the claim which has been made by some for Dr. - Barry, of having discovered this mode of treatment, is groundless. It - is distinctly laid down by Nicander, Celsus, Dioscarides, Galen, and - others who lived in their times; and among the moderns who have - mentioned it, Gräter, in 1767, notices it in his thesis, “de venenis - in genere,” printed at Frankfort. On the ancient history of toxicology - the reader will find an excellent summary by Mr. Adams in the - Edinburgh Medical and Surgical Journal, xxxiii. 315, and a full - exposition in Professor Marx’s elaborate work, “die Lehre von den - Giften.” - -Footnote 61: - - Archives Générales de Médecine, Nov. 1826. - -Footnote 62: - - Journal des Progrès des Sciences Médicales, 1827, iii. 121. - -Footnote 63: - - See the Chapter on Arsenic for some remarks on this subject.—Also - Beckman’s History of Inventions. - -Footnote 64: - - See subsequently the cases of the Crown Prince of Sweden, in the first - section of the present chapter, and that of General Hoche, Part II. - Chap. ii. Sect. 2. - -Footnote 65: - - I allude to the case of Castaing. See Opium. - -Footnote 66: - - Feuerbach. Actenmässige Darstellung Merkwürdiger Verbrechen, i. 1. For - some observations on the three fatal cases, see the Chapter on - Arsenic, under the head of the effects of that poison as an - antiseptic. - -Footnote 67: - - See an opinion of the Berlin College in Pyl’s Repertorium für die - gerichtliche Arzneikunde, i. 244. - -Footnote 68: - - Orfila. Médecine-Légale, ii. 360. - Henke. Lehrbuch der gerichtlichen Medizin, 448. - Tortosa. Istituzioni di Medicina Forense, ii. 86. - Beck’s Medical Jurisprudence, 419. - -Footnote 69: - - Hume on Crimes, i. 178. - -Footnote 70: - - Howell’s State Trials, xviii. 1135. - -Footnote 71: - - Hünefeld in Horn’s Archiv, 1827, i. 203. - -Footnote 72: - - Weiss in Revue Médicale, Janv. 1826. - -Footnote 73: - - See subsequently the Chapter on Arsenic, Section ii. - -Footnote 74: - - Archives Générales de Médecine, i. 17; also Abercrombie on Diseases of - the Stomach, &c. 273. - -Footnote 75: - - See Oxalic Acid and Nux Vomica. - -Footnote 76: - - Rossi. Ueber die Art und Ursache des Todes des hochseligen Kronprinzen - von Schweden. Berlin, 1812. - -Footnote 77: - - Edinburgh Medico-Chirurgical Transactions, ii. 309. - -Footnote 78: - - Alberti, Systema Jurispr. Medic, i. c. 13. § 4. - -Footnote 79: - - See Arsenic—Morbid appearances. - -Footnote 80: - - Magazin für die gesammte Heilkunde, xiv. 104. - -Footnote 81: - - Journal de Médecine, xxix. 107. - -Footnote 82: - - Aufsätze und Beobachtungen aus der gerichtlichen Arzneiwissenschaft, - v. 103. - -Footnote 83: - - Wildberg. Praktisches Handbuch für Physiker, iii. 227. - -Footnote 84: - - Aufsätze und Beobachtungen, &c. ii. 122. - -Footnote 85: - - Edinburgh Medical and Surgical Journal, xviii. 171. - -Footnote 86: - - London Medico-Chirurgical Transactions, ii. 158. - -Footnote 87: - - Archiv für Medizinische Erfahrung, 1834, p. 754. - -Footnote 88: - - Edinburgh Medico-Chirurgical Transactions, ii. 303. - -Footnote 89: - - New York Medical and Philosophical Journal, iii. No. 1. - -Footnote 90: - - De Veneficio caute dijudicando in Schlegel’s Collectio opusculorum, - &c. iv. 22. - -Footnote 91: - - Edinburgh Medico-Chirurgical Transactions, ii. 291, Edinburgh Medical - and Surgical Journal, xxvii. 457, and xxix. 26. - -Footnote 92: - - Archives Générales de Médecine, ii. 58. - -Footnote 93: - - Materialien für die Staatsarzneikunde, 130. - -Footnote 94: - - Ueber die gerichtlich-medizinische Beurtheilung der Vergiftungen. - Kopp’s Jahrbuch, vii. 159. - -Footnote 95: - - Rust’s Magazin für die gesammte Heilkunde, iii. 24. - -Footnote 96: - - Aufsätze und Beobachtungen, viii. 92. - -Footnote 97: - - Morning Chronicle, Jan. 8, 1823. - -Footnote 98: - - Journal Universel des Sciences Médicales, xix. 340. - -Footnote 99: - - Horn’s Archiv für Medizinische Erfahrung, 1823, i. 451. - -Footnote 100: - - Bachmann. Einige auserlesene gerichtlich-medizinische Abhandlungen, - von Schmitt, Bachmann, &c. p. 21. - -Footnote 101: - - Revue Médicale, 1828, ii. 469. - -Footnote 102: - - Orfila, in Journ. de Chim. Med. 1842, p. 77. - -Footnote 103: - - Probably black extravasation. - -Footnote 104: - - Marx, die Lehre von den Giften, i. ii. 429, from Hitzig’s Zeitschrift - für die Criminal-Rechts-Pflege, I. i. 1. - -Footnote 105: - - Charret, in Revue Médicale, 1827, i. 514. - -Footnote 106: - - As a specimen of the vague, desultory, and erroneous nature of the - investigations which have been made by authors on this subject, I may - quote some remarks published by Virey in the Journal Universel (vi. - 26), and drawn, he says, from a comparison of statements in various - works. He states that arsenic, which is so fatal to animals in - general, merely purges dogs and wolves more or less; that nux vomica - is less fatal to man than to dogs; that pepper is fatal to hogs, - parsley to parrots, the agrostis arundinacea to goats, elder-berries - to poultry, chenopodium vulvaria to swine; that on the contrary the - goat eats with impunity hemlock, daphne gnidium, and some species of - euphorbia; that the camel eats all species of euphorbia, the hedgehog - cantharides, the horse monkshood, ranunculus flammula, and buckthorn; - asses and mules white hellebore, swine yew-berries; all which are - poisonous to animals in general. He does not state special authorities - for these facts; but they are taken from authors not of the most - modern times, and must be received, in my opinion, with great reserve, - notwithstanding the respect which he claims for the older writers. - Some of the statements are plainly false. - - In a more recent paper Virey lays it down as a general principle, that - poisons from the inorganic kingdom act more or less on the whole - animated creation, but that vegetable and animal poisons are such only - in respect to particular animals; that carnivorous animals are more - sensible to the action of vegetable poisons, but less so to that of - animal poisons, than herbivorous or graminivorous animals; and that - the activity of poisons on different animals bears a ratio in the - first place to their relative sensibility, and secondly, to the - digestive power of their stomach. I question whether these views will - be generally admitted by toxicologists, without much more extensive - and more careful inquiries than any hitherto made. [Journ. de Chim. - Méd. vii. 214.] - - Another singular illustration of the facility with which facts are - admitted in proof of the varying effects of poisons on different - animals, is a statement by a German naturalist, Dr. Lenz, to the - effect that the hedgehog altogether resists the most powerful poisons. - He states that he has seen one receive ten or twelve wounds from a - viper on the ears, muzzle, and tongue, without sustaining any harm; - and that ultimately it kills and devours the snake. He quotes Palias - for the fact that it has taken 100 cantharides flies without injury, - and says a medical friend who wished to dissect a hedgehog, gave it - successively hydrocyanic acid, arsenic, opium, and corrosive - sublimate, without being able to kill it [L’Institut. ii. 84]. His - countryman Reich, however, contradicts these statements, observing - that he has poisoned the hedgehog with hydrocyanic acid, arsenic, and - corrosive sublimate, but that doses considerably larger are required - for a dog or cat. Ninety grains of medicinal hydrocyanic acid, thirty - of arsenic, and twenty of corrosive sublimate, occasioned death. - [Annalen der Pharmacie, i. 358.] One of my colleagues having lately - quoted Lenz’s assertion in his lectures, some of his pupils brought me - two hedgehogs to be subjected to experiment. A drop of the pure acid - put upon the tongue killed each within a minute. - - The following experiments by Professor Gohier of the veterinary school - of Lyons are worth mentioning; but in order to be satisfactory would - require to be performed in a more consecutive train. Muriate of soda - in the dose of two or three pounds causes in the horse great disorder - and even death. Calomel has no effect. The juice of rhus toxicodendron - has no effect on the _solipedes_ either internally or applied to the - skin. Ten drachms of opium cause in the horse tympanitis and stupor, - not somnolency. Thirty-six grains of opium had no effect on a dog. - Cantharides does not injure the horse in the dose of a drachm, or the - dog in that of nine grains. When the sheep swallows yew-leaves it is - soon seized with locked-jaw and convulsive movements of the lips and - flanks: in the horse they cause dilated pupil, convulsive movements of - the eyes, and restlessness: the goat and dog eat them with impunity - [Corvisart’s Journal de Médecine, xix. 156]: man is severely affected - by them. Hyoscyamus, stramonium, hemlock, and other narcotic - vegetables, though powerfully narcotic to man, will not affect the - domestic animals unless given in doses 100 times as great as those - given to man. [Ibid. 154.] - - The most important researches I have yet seen in this line of inquiry - are those of Professor Viborg of Copenhagen, read in the Royal Danish - Society of Sciences in 1792. He instituted a connected series of - experiments, expressly to determine how far the effects of poisons on - man correspond with those on the lower animals. The results were, that - mineral poisons appeared to act nearly in the same manner on all - orders of animals, antimonial and barytic salts alone excepted, the - former of which acted powerfully on man, the carnivorous animals, and - swine, but scarcely at all on ruminating and herbivorous animals, - while the latter in doses of a drachm had no effect on horses: That - animal poisons resemble mineral poisons in their leading effects on - most animals: That the vegetable acrids also act pretty uniformly on - most animals: and that of the vegetable narcotics there are few which - possess poisonous properties in regard to certain animals only. - Yew-leaves kill all ruminating animals, and, notwithstanding Virey’s - statement, swine, mules, and horses, also chickens; and they produce - violent symptoms in geese, ducks, cats and dogs, although Gohier says - dogs eat them with impunity. An ape ate a large quantity of the Æthusa - cynapium without injury. Dogs took from an ounce and a half to three - ounces of belladonna without dangerous symptoms. [Marx, die Lehre von - den Giften,—from Viborg’s Sammlung von Abhandlungen für Thierärzte, i. - 277.] - - Professor Mayer of Bonn, in an inquiry into the effects of the - Coriaria myrtifolia, found that rabbits are not affected at all by a - drachm of the extract of the juice given internally, or applied to a - wound; while half a drachm swallowed by a cat kills it in a few hours, - and three grains will have the same effect when introduced into a - wound. He likewise found that it is a deadly poison to the dog, the - hawk, and the frog. [Journal der Praktischen Heilkunde, lxviii. 4, - 43.] - - Professor Giacomini of Padua says, that “in many experiments performed - by him on dogs and rabbits, he has constantly observed, that the - former, as being carnivorous by nature, sustain stimulating substances - tolerably well; while rabbits, being herbivorous, stand stimulants - ill, but sedatives well.” “Hence many herbivorous animals eat with - impunity large quantities of vegetable poisons of the sedative kind - which prove fatal to carnivorous animals.” [Annali Univ. di Med. 1841, - i. 372.] This may be true as a general rule. But it is not universally - applicable; for alcoholic fluids kill dogs with great swiftness in no - great dose. - - An extraordinary statement was lately brought before the French - Institute, to the effect that 120 sheep, affected with an epidemic - pleurisy, got each about 500 grains of arsenic without sustaining the - slightest harm; and that it was also ascertained to have no poisonous - action upon sheep even in a state of health. A commission of the - Institute, however, which was appointed to test this assertion, found - that healthy sheep were killed by a dose of 155 grains, if they had - fasted for some time before [Annales d’Hyg. Publ. &c. 1843, xxix. - 468.] It is reasonable to suppose, that ruminating animals, whose - alimentary canal is scarcely ever empty should suffer less than - carnivorous animals from such poisons as arsenic. - - Lassaigne, in some experiments with arsenic, incidentally remarked, - that 246 grains of solid arsenic given daily for four days had no - effect whatever on a horse; but that this result seemed to depend on - the difficulty which the stomach must experience in appropriating it - among the bulky materials of its food; for 154 grains in solution - killed the same animal in six hours [Journ. de Chim. Méd. 1841, - 82].—Gianelli of Lucca found that a horse was killed in eight hours by - 185 grains of powder of arsenic given in the form of bolus [Annales - d’Hyg. Publ. &c. 1842, xxviii. 88]. - - I might easily extend these extracts. But the result would be merely a - mass of contradiction, from which no sound conclusion could be drawn, - otherwise the subject would have been discussed in the text. - -Footnote 107: - - Pyl’s Aufsätze und Beobachtungen, i. 29. - -Footnote 108: - - Celebrated Trials, vi. 55. - -Footnote 109: - - Toxicologie Générale, ii. 676. - -Footnote 110: - - Journal des Progrès des Sciences Médicales, 1827, iv. 124. See - subsequently the articles Oxalic Acid and Narcotine. - -Footnote 111: - - Journal de Chimie Méd. vii. 131. - -Footnote 112: - - Journal de Physiologie, ii. 1, and iii. 81. - -Footnote 113: - - Ibidem, iii. 84. - -Footnote 114: - - De Sedibus et Causis Morborum, T. ii. Ep. lix. 18. - -Footnote 115: - - Knape und Hecker’s Kritische Jahrbücher der Staatsarzneikunde, ii. - 100. - -Footnote 116: - - L’Examinateur Médical, 1 Juin, 1842, from Bulletino delle Scien. Med. - Jan. 1842. - -Footnote 117: - - Annales d’Hyg. Publ. et de Méd. Lég. 1842, xxviii. 84. - -Footnote 118: - - Ibid. 1843, xxix. 471. - -Footnote 119: - - Trial.—This is a good illustration. Nevertheless, it will be seen - under the head of morbid appearances caused by the irritant class of - poisons, that Dr. Bostock’s experiments, though conclusive as to the - statement in the text, did not affect the real questions in the case. - -Footnote 120: - - See trial of Freeman—_article_ Hydrocyanic Acid. - -Footnote 121: - - I have unfortunately mislaid the reference to this interesting fact, - which was taken, I think, from a French periodical. In this country - arsenic is never employed for the purpose mentioned in the text. - -Footnote 122: - - Edinburgh Med. and Surg. Journal, xxxiii. 67. - -Footnote 123: - - Archives Générales de Médecine, xxi. 364. - -Footnote 124: - - Journal de Chimie Médicale, vi. 149. - -Footnote 125: - - Edin. Med. and Surg. Journal, xxix. 23. - -Footnote 126: - - Ibid., xxvii. 441. On considering, however, this and other instances - of the kind which have since come under my notice, I suspect the case - is rendered intelligible by the effect of sleep in suspending or - delaying for a time the action of arsenic and other simply irritating - poisons. See above—_evidence from symptoms beginning soon after a - meal_, p. 46.—also _article_ Arsenic. - -Footnote 127: - - Howell’s State Trials, xviii. - -Footnote 128: - - Edinburgh Med. and Surg. Journal, xxxv. 298. - -Footnote 129: - - Edinburgh Medical and Surgical Journal, xxii. 438. - -Footnote 130: - - For a very striking example of the latter description see Hufeland’s - Journal der Praktischen Heilkunde, xii. i. 110. Fourteen people were - seized about the same time in a charity workhouse. - -Footnote 131: - - Having mislaid the copy I possessed of this trial, I am unable to give - here the reference. - -Footnote 132: - - De Sedibus et Causis Morborum, T. ii. Ep. lix. 7. - -Footnote 133: - - Edin. Med. and Surg. Journal, xxxiii. 67. - -Footnote 134: - - Howell’s State Trials, xviii. - -Footnote 135: - - Edin. Med. and Surg. Journal, xxvii. 441. The reader will remember - that what was considered defective in the proof in this trial, the - connection between the administration of a suspicious article and the - first invasion of the symptoms, would now appear less so, for the - reason assigned in note [126] p. 77. - -Footnote 136: - - Sur l’Empoisonnement par l’acide nitrique, p. 243. - -Footnote 137: - - Edinburgh Medical and Surgical Journal, xxix. 19. - -Footnote 138: - - MM. Chevallier et Boys de Loury, in Annales d’Hyg. Publ. et Méd. Lég. - xivv. 400. - -Footnote 139: - - MM. Lecanu and Chevallier in Annales d’Hyg. Publ. 1840, xxiv. 282. - -Footnote 140: - - London Medical Gazette, 1839–40, i. 575. - -Footnote 141: - - Dictionnaire des Sciences Médicales, Art. Indigestion, xxiv. p. 374. - -Footnote 142: - - Praktisches Handbuch für Physiker, iii. 292. - -Footnote 143: - - See also Dictionnaire des Sciences Médicales, _Art._ Rupture, xlix. - 225. - -Footnote 144: - - Médicina Légale, ii. 22. - -Footnote 145: - - Archives Générales de Médecine, xx. 433. - -Footnote 146: - - Mr. Weekes, in London Medico-Chirurgical Transactions, xiv. 447. - -Footnote 147: - - London Medical and Physical Journal, June, 1831, vol. lxvi. - -Footnote 148: - - London Medico-Chirurgical Transactions, v. 93. - -Footnote 149: - - London Medical Repository, xvii. 108. - -Footnote 150: - - Bulletins des Sciences Médicales, x. 64. - -Footnote 151: - - Journal des Progrès des Sciences Médicales, xiv. - -Footnote 152: - - For an instance, see Bulletins des Sciences Médicales, ix. 249. - -Footnote 153: - - Aufsätze und Beobachtungen aus der gerichtlichen Arzneiwissenschaft, - v. 89. - -Footnote 154: - - Med. Rep. on the Effects of Cold Water, 1798, p. 96. - -Footnote 155: - - New York Medical Register. - -Footnote 156: - - Ann. d’Hyg. Publ. et de Méd. Lég. xxvii. 57. - -Footnote 157: - - Abercrombie on Diseases of the Stomach, &c. 14. - -Footnote 158: - - Ann. d’Hyg. Publ. xxvii. 60. - -Footnote 159: - - Bulletins des Sciences Médicales, vi. 34. - -Footnote 160: - - De cauta et circumspecta veneni dati accusatione, § 12. - -Footnote 161: - - Edinburgh Medical and Surgical Journal, xxviii. 88. - -Footnote 162: - - Ibid. xxix. 70. - -Footnote 163: - - London Medical Gazette, viii. 496. - -Footnote 164: - - Edinburgh Medical and Surgical Journal, xxviii. 99. - -Footnote 165: - - Trial of Donnal.—See Paris and Fonblanque’s Medical Jurisprudence, - iii. Appendix, 277, _et seq._ - -Footnote 166: - - Edinburgh Medical and Surgical Journal, xxviii. 87. - -Footnote 167: - - On Diseases of the Stomach and other Abdominal Viscera, p. 15. - -Footnote 168: - - Recherches sur la Gastro-entérite, ii. 51. - -Footnote 169: - - Laisné sur les Perforations Spontanées, p. 206, from Recueil des - observations des Hopitaux Militaires, i. 375.—This case is also given - by MM. Petit and Serres in their treatise entitled “de la Fièvre - Entéro-Mésenterique,” p. 197, and is considered by them an instance of - that particular disease. - -Footnote 170: - - Trans. of Provinc. Med. and Surg. Association, vol. i. - -Footnote 171: - - Louis in Archives Générales de Médecine, i. 17, or Edin. Med. and - Surg. Journal, xxi. 239, also Abercrombie on Diseases of the Stomach, - &c. 273, and Louis Recherches sur la Gastro-entérite, _passim_. - -Footnote 172: - - Abercrombie on Diseases of the Stomach, &c. pp. 156 and 243. - -Footnote 173: - - Abercrombie on Diseases of the Stomach, &c., p. 52. - -Footnote 174: - - For cases of this disease, see Abercrombie on Diseases of the Stomach, - &c., p. 156 and 181. - -Footnote 175: - - Considérations Medico-légales sur les perforations spontanées de - l’estomac, 1819. This thesis, published with three others on - medico-legal subjects, is understood to have been in a great measure - the work of the late Professor Chaussier. - -Footnote 176: - - Trans. of the Dublin College of Physicians, i. 2, and London - Medico-Chirurgical Transactions, viii. 228. - -Footnote 177: - - Guy’s Hospital Reports, 1839, iv. 20. - -Footnote 178: - - Abercrombie on Diseases of the Stomach, 41. - -Footnote 179: - - London Medico-Chirurg. Transactions, viii. 233. - -Footnote 180: - - Archives Générales de Médecine, xxvi. 123. - -Footnote 181: - - On Diseases of the Stomach, pp. 35, 37. - -Footnote 182: - - Guy’s Hospital Reports, 1839, iv. 16. - -Footnote 183: - - Guy’s Hosp. Rep. 1839, 52. - -Footnote 184: - - Edinb. Med-Chirurgical Transactions, i. 311. - -Footnote 185: - - Rust’s Magazin für die gesammte Heilkunde, xxi. 199. This paper is - analysed in Edinburgh Med. and Surg. Journal, xxvi. 451. - -Footnote 186: - - Philosophical Transactions, lxii. 447. - -Footnote 187: - - Gastellier in Leroux’s Journal de Médecine, xxxiii. 24. - -Footnote 188: - - Archives Générales de Médecine, xi. 463. - -Footnote 189: - - Mr. Kell in London Medical Gazette, ii. 649. - -Footnote 190: - - Magazin für die gesammte Heilkunde, xviii. 107. - -Footnote 191: - - Revue Médicale, 1826, i. 100. - -Footnote 192: - - Jahrbuch des Oesterreiches Staates, xxii. 54, or Arch. Gén. de Méd. - xlvi. 480. - -Footnote 193: - - Journal de Médecine, xxxiv. 25. - -Footnote 194: - - Affaire Hullin. Archives Générales de Médecine, xix. 332. - -Footnote 195: - - London Medico-Chirurgical Transactions, iv. 371. - -Footnote 196: - - Archives Générales de Médecine, Oct. and Nov. 1826; also Edin. Medical - and Surgical Journal, xxviii. 149. - -Footnote 197: - - De la Membranes Muqueuse Gastro-intestinale, 1825. - -Footnote 198: - - Ibid. p. 220. - -Footnote 199: - - For a case of this rare and singular disease, see Edin. Medical and - Surgical Journal, xxvi. 214. - -Footnote 200: - - Kopp’s Jahrbuch der Staatsarzneikunde, ii. 169. - -Footnote 201: - - Journal de Médecine, vii. 333. Also Foderé, Traité de Médecine-Légale, - iv. 282. - -Footnote 202: - - Nouvelle Bibliothèque Médicale, 1828, iii. 141. - -Footnote 203: - - Philos. Trans. lxii. 450. - -Footnote 204: - - See Analysis of his Essay by Dr. Gumprecht, Lond. Med. Repos. x. 416. - -Footnote 205: - - Laisné, Sur les Perforations Spontanées, 149. - -Footnote 206: - - The last cases were observed by Hunter. See Philos. Transactions, - lxii. 452. - -Footnote 207: - - Fisica Animale e Vegetabile. Dissertazione quinta, § ccxxiii.-ccxxxi. - T. ii. 86–89, Edit. Venezia, 1782. - -Footnote 208: - - De Alimentorum Concoctione. Diss. Inaug. Edinburgh 1777. - -Footnote 209: - - Experiments on Digestion. Appendix to Spallanzani’s Dissertations - relative to the Natural History of Animals and Vegetables. London - Edition, 1784, i. 317. - -Footnote 210: - - Expériences sur la Digestion dans l’homme. Paris, 1814, pp. 20, _et - seq._ - -Footnote 211: - - Die Verdauung nach Versuchen, &c. Heidelberg, 1825, or the French - Edition, Recherches Expérimentales Physiologiques et Chimiques sur la - Digestion, 1826, _passim_. - -Footnote 212: - - Inquiry into the Chemical Solution of the stomach after death. - Edinburgh Med. and Surg. Journal, xxxiv. 282. - -Footnote 213: - - Medizinisch-Chirurgische Zeitung, 1828, ii. 57, 77, 93, and 107. - -Footnote 214: - - Edinb. Med. and Surg. Journal, vi. 135. - -Footnote 215: - - Journal Complémentaire du Dict. des Scien. Med. xxxvii. 194. - -Footnote 216: - - Horn’s Archiv für Medizinische Erfahrung, 1823, i. 45. - -Footnote 217: - - Trial of Angus for the murder of Margaret Burns, 1808. - -Footnote 218: - - Laisné sur les Perforations de l’Estomac, p. 190, and Bìllìard, - Considérations sur l’Empoisonnement par les Irritans, _passim_. - -Footnote 219: - - Edin. Med. and Surg. Journal, vi. 137. - -Footnote 220: - - London Medical Gazette, ii. 619. - -Footnote 221: - - Laisné. &c. p. 564. - -Footnote 222: - - Edin. Med. and Surg. Journal, xxxii. 38. - -Footnote 223: - - London Med. Gazette, xiv. 30. - -Footnote 224: - - Traité de l’Empoisonnement par l’acide Nitrique, 1802, p. 87. - -Footnote 225: - - Novellæ Medico-legales, Cas. xxix. p. 211. - -Footnote 226: - - Bulletins ties Sciences Médicales, Janvier, 1830. - -Footnote 227: - - Edinburgh Medical and Surgical Journal, xxxv. 298. - -Footnote 228: - - Burnett on Criminal Law, 544. _Note._ - -Footnote 229: - - Edinburgh Med. and Surg. Journal, xxxvi. 102. - -Footnote 230: - - Ibidem, xxii. 222. - -Footnote 231: - - Report of the Committee of the House of Commons on the Combination - Laws, June, 1825, pp. 323–328. Evidence of Mr. Campbell and Mr. - Robinson. - -Footnote 232: - - Cases and Observations in Medical Jurisprudence, Case iii. Edin. Med. - and Surg. Journal, xxxi. 229. - -Footnote 233: - - London Med. Gazette, 1839–40, i. 944. - -Footnote 234: - - A Manual of Medical Jurisprudence, 1844, p. 94. - -Footnote 235: - - Toxicologie Générale, 1843, i. - -Footnote 236: - - Archiv für Medizinische Erfahrung, 1823, i. 456. - -Footnote 237: - - Revue Médicale, 1824, ii. 469. - -Footnote 238: - - Toxicologie Gén. 4ème edition, 1843, i. 112. - -Footnote 239: - - Poggendort’s Annalen der Physik und Chemie, xli. 643. Buchner’s - Repertorium, 1838, lxiv. 20. - -Footnote 240: - - Buchner’s Repertorium, lxiv. 32. - -Footnote 241: - - Journal de Chimie Médicale, 1841, 474. - -Footnote 242: - - Toxicologie Gén. i. 77. - -Footnote 243: - - Ibidem, 78. - -Footnote 244: - - Journal de Chimie Médicale, 1842, 266. - -Footnote 245: - - London Medical Gazette, 1841–42, ii. 254. - -Footnote 246: - - Traité de l’Empoisonnement par l’acide nitrique, 1802. - -Footnote 247: - - Lebidois, Arch. Gén. de Med. xiii. 367. - -Footnote 248: - - Martini in Rust’s Magazin für die gesammte Heilkunde, xviii. 159. - -Footnote 249: - - Correa de Serra in Journal de Chimie Médicale, ii. 209, on the third - day. - -Footnote 250: - - Edinburgh Med. and Surg. Journal, xxxvi. 103. - -Footnote 251: - - Archives Générales de Médecine, xiii. 367. - -Footnote 252: - - Tartra, iii. 87. - -Footnote 253: - - Desgranges, Recueil Périodique de la Société de Médecine, vi. 22. - Tulpius, Observationes Medicinales, iii. 43. - -Footnote 254: - - Annales d’Hygiène Publique, xvii. 362. - -Footnote 255: - - Journal der Praktischen Heilkunde, vii. ii. 18. - -Footnote 256: - - Archives Générales, xiii. 367. - -Footnote 257: - - Tartra, p. 160. - -Footnote 258: - - Edinburgh Med. and Surg. Journal, xxxvi. 102. - -Footnote 259: - - Journal der Praktischen Heilkunde, xlix. iii. 60. - -Footnote 260: - - Journal der Praktischen Heilkunde, vii. ii. 18. - -Footnote 261: - - Mr. J. B. Thomson in London Med. Gazette, 1841–42, i. 146. - -Footnote 262: - - Martini’s case. - -Footnote 263: - - London Med. Gazette, 1834, xiv. 489. - -Footnote 264: - - Tendering in Horn’s Archiv für Medizinische Erfahrung, 1825, i. 458. - -Footnote 265: - - Journal de Médecine par Corvisart, xix. 263. - -Footnote 266: - - Rust’s Magazin für die gesammte Heilkunde, xxiii. 156. - -Footnote 267: - - Lancet, 1836–37, ii. 835. - -Footnote 268: - - Lancet, 1836–37, i. 195. - -Footnote 269: - - London Medical Gazette, xii. 219. - -Footnote 270: - - Augustin’s Repertorium, i. ii. 15. - -Footnote 271: - - Archives Gén. de Méd., xxi. 372, _note_. - -Footnote 272: - - Journal Hebdomadaire. - -Footnote 273: - - Tartra, p. 124. - -Footnote 274: - - Dr. Bartley, iv. 289, and Mr. Diamond, v. 110. - -Footnote 275: - - Mr. Bevan, i. 756. - -Footnote 276: - - Journal de Chimie Médicale, 1835, 426. - -Footnote 277: - - Dublin Journal of Med. and Chem. Science, No. 25. - -Footnote 278: - - Horn’s Archiv für Medizinische Erfahrung, 1823, i. 465. - -Footnote 279: - - Ibid. 452. - -Footnote 280: - - Edin. Med. and Surg. Journal, xxxvi. 101. Lond. Med. Gazette, xii. - 221. - -Footnote 281: - - Horn’s Archiv, &c. 453. - -Footnote 282: - - London Medical Gazette, xiv. 489, and 1837–8, ii. 76. - -Footnote 283: - - Louis, ibidem, xiv. 30. - -Footnote 284: - - Philadelphia Journal of Med. and Phys. Sciences, iv. 410. - -Footnote 285: - - London Medical Gazette, viii. 76. - -Footnote 286: - - Edinburgh Med. and Surg. Journal, liii. 406. - -Footnote 287: - - Aufsätze und Beobachtungen, ii. 122. - -Footnote 288: - - Archives Générales de Médecine, xiii. 368. - -Footnote 289: - - Horn’s Archiv, &c. 1823, i. 456. - -Footnote 290: - - Edin. Med. and Surg. Journal, liii. 401. - -Footnote 291: - - Edin. Med and Surg. Journ. xxii. 222, and xxxvi. 103. - -Footnote 292: - - Kerkringii opera omnia, p. 146. - -Footnote 293: - - Annales d’Hygiène Publique, &c. xvii. 362. - -Footnote 294: - - Robert in Nouvelle Bibliothèque Médicale, 1827, iv. 415. - -Footnote 295: - - Henke’s Zeitschrift für die Staatsarzneikunde, xxxii. 161. - -Footnote 296: - - Toxicologie Générale, ii. 689. - -Footnote 297: - - Edinburgh Med. and Surg. Journal, xxii. 222. - -Footnote 298: - - Ibidem, xxxv. 302. - -Footnote 299: - - Journal de Chimie Médicale, 1840, 30. - -Footnote 300: - - Medizinisch-Chirurgische Zeitung, 1824, iv. 276. - -Footnote 301: - - Rust’s Magazin für die gesammte Heilkunde, 1837, l. 501. - -Footnote 302: - - Dr. Sinclair. Edin. Med. and Surg. Journal, xxxvi. 99; and case of - Humphrey. Ibidem, xxxv. 301. - -Footnote 303: - - London Medical Gazette, xii. 219. Mr. Arnott’s Case. - -Footnote 304: - - Lancet, 1829–30, ii. 330 and 432. - -Footnote 305: - - Orfila. Journal de Chimie Médicale, 1842, p. 5. - -Footnote 306: - - Peligot. Journal de Pharmacie, 1833, p. 644. - -Footnote 307: - - Barthemot. Journal de Pharmacie, 1841, 560. - -Footnote 308: - - Archives Générales de Médecine, xxi. 365. - -Footnote 309: - - Lancet, 1829–30, ii. 840. - -Footnote 310: - - Annales d’Hygiène Publique, &c. xxviii. 200. Also Toxicologie - Générale. 1843, i. 142. - -Footnote 311: - - Journal de Chim. Médicale, 1842, 266. - -Footnote 312: - - Annales d’Hygiène Publique, 1842, xxviii. 317. - -Footnote 313: - - Prout, Philosophical Transactions, 1824, p. 45.—Tiedemann and Gmelin, - Die Verdauung nach Versuchen, _passim_.—_Children_, Annals of - Philosophy, 1824, viii. 68. - -Footnote 314: - - Philosophical Transactions, 1824, p. 49. - -Footnote 315: - - London Medical Gazette, 1839–40, i. 285. - -Footnote 316: - - Lancet, 1839–40, i. 899. - -Footnote 317: - - Toxicologie Générale, i. 155. - -Footnote 318: - - Lins in Buchner’s Repertorium, lxviii. 389. - -Footnote 319: - - Toxicologie Générale, i. 56. - -Footnote 320: - - Worbe in Mémoires de la Société Médicale d’Emulation, ix. 507. - -Footnote 321: - - Annales de Chimie, xxvii. 87. - -Footnote 322: - - Worbe, &c. and Edin. Med. and Surg. Journal, xxviii. 228. - -Footnote 323: - - Revue Médicale, 1829, iii. 429. - -Footnote 324: - - Buchner’s Repertorium für die Pharmacie, lxxi. 341. - -Footnote 325: - - Diction. de Méd. et de Chir. Pratiques, xii. 707. - -Footnote 326: - - Medizinisch-Chirurgische Zeitung, 1826, iv. 183. - -Footnote 327: - - Horn’s Archiv für Medizinische Erfahrung, 1830, ii. 861. - -Footnote 328: - - Corvisart’s Journal de Médecine, xxi. 70. - -Footnote 329: - - Toxicologie Générale, i. 141. - -Footnote 330: - - Dr. O’Shaughnessey, in Lancet, 1829–30, ii. 632. - -Footnote 331: - - Experimental Essay on Iodine, &c. 1837, p. 21. - -Footnote 332: - - Journal de Chimie Médicale, ii. 291. - -Footnote 333: - - Ibid. iv. 388. - -Footnote 334: - - Lancet, 1830–31, vol. i. 613. - -Footnote 335: - - Ibidem, 612. - -Footnote 336: - - Annales d’Hygiène Publique, xxviii. 431. - -Footnote 337: - - Annali Universali di Med. 1833. - -Footnote 338: - - Essay on the Effects of Iodine, 1824, p. 20. - -Footnote 339: - - Horn’s Archiv für Medizinische Erfahrung, 1829, i. 340. - -Footnote 340: - - Dessaigne in Journal de Chim. Médicale, iv. 65. - -Footnote 341: - - Moncourrier, Ibidem, iv. 216. - -Footnote 342: - - Formulaire pour les Nouveaux Médicaments, 1825, p. 161. - -Footnote 343: - - Quoted in Dr. Cogswell’s Experimental Essay, p. 23. - -Footnote 344: - - Quoted in Dr. Cogswell’s Experimental Essay, p. 27. - -Footnote 345: - - Gairdner on the Effects of Iodine, p. 9. - -Footnote 346: - - Journal Complémentaire, xviii. 126. - -Footnote 347: - - Magazin für die gesammte Heilkunde, xvi. 111. - -Footnote 348: - - Gairdner, &c. p. 12. - -Footnote 349: - - Magazin für die gesammte Heilkunde, xxii. 291. - -Footnote 350: - - American Journal of Medical Science, viii. 546. - -Footnote 351: - - Archiv für Medizinische Erfahrung, 1829, i. 342. - -Footnote 352: - - Johnson’s Preface to his Translation of Coindet on Iodine, p. ix. - -Footnote 353: - - Gairdner, p. 20. - -Footnote 354: - - Coindet on Iodine, p. 17. - -Footnote 355: - - London Medical Gazette, 1839–40, ii. 588. - -Footnote 356: - - Cogswell’s Essay, p. 42. - -Footnote 357: - - Lancet, 1829–30, ii. 635. - -Footnote 358: - - Toxicologie Générale, 1843, i. 74. - -Footnote 359: - - Lancet, 1829–30, ii. 638. - -Footnote 360: - - Archives Générales de Médecine, x. 255. - -Footnote 361: - - Lancet, 1831–32. - -Footnote 362: - - Manual of Medical Jurisprudence, 128. - -Footnote 363: - - London Medical Gazette, 1841. - -Footnote 364: - - Ibidem, 1839–40, i. 588. - -Footnote 365: - - This adulteration and its effects have been indicated by various - chemists. For the best account, see Chevallier, sur les falsifications - qu’on fait subir au sel marin, Annales d’Hyg. Publ. et de Méd. Lég. - viii. 250. At one time he found about a third of the salt in Paris - thus sophisticated. - -Footnote 366: - - Cours de Médecine-Légale, 1840, iii. 183. - -Footnote 367: - - Manual of Medical Jurisprudence, p. 38. - -Footnote 368: - - Zeitschrift für Physiologie, ii. - -Footnote 369: - - Ibidem. - -Footnote 370: - - Lancet, 1830–31, i. 613. - -Footnote 371: - - Experimental Essay on Iodine, &c. 1837, p. 91. - -Footnote 372: - - De l’Action du Brôme et de ses combinaisons sur l’économie animale. - Thèse Inaug. à Paris, 1828. - -Footnote 373: - - Hufeland’s Bibliothek der Praktischen Heilkunde, Sept. 1829; or - Archives Gén. de Méd. xxiv. 289. - -Footnote 374: - - Meckel’s Archiv für Anatomie und Physiologie, xiv. 222. - -Footnote 375: - - Edin. Med. and Surg. Journal, lviii. 120. - -Footnote 376: - - Bulletins de Thérapeutique, Février, 1830. - -Footnote 377: - - Journal de Chimie Médicale, 1837, 227. - -Footnote 378: - - Annales d’Hygiène Publ. et de Méd. Lég. vi. 169. - -Footnote 379: - - Beiträge zur Kentniss der Wirkungen der Arzneimittel und Gifte. Horn’s - Archiv. 1824, i. 59. - -Footnote 380: - - Medizinische Zeitung, 1828, ii. 256. - -Footnote 381: - - Ann. d’Hyg. Publ. et de Méd. Lég. vi. 160. - -Footnote 382: - - Beiträge, &c. Horn’s Archiv, 1824, i. 56. - -Footnote 383: - - Corvisart’s Journal de Médecine, xxiv. 215. - -Footnote 384: - - Annales d’Hyg. Publ. et de Méd. Lég. vi. 159. - -Footnote 385: - - See Trousseau and Blanc, Arch. Gén. de Méd. Sept. 1830. - -Footnote 386: - - London Courier, September 22, 1827. - -Footnote 387: - - Manual of Medical Jurisprudence, 116. - -Footnote 388: - - London Medical Repository, i. 382. - -Footnote 389: - - Lond. Med. Rep. iii. 382. - -Footnote 390: - - Dissertatio Inauguralis de Acidi Oxalici vi venenata, Edin. 1821. - -Footnote 391: - - Edinburgh Med. and Surg. Journal, xix. 163. - -Footnote 392: - - Medizinisch-Chirurgische Zeitung, 1828, ii. 203, _et seq._ - -Footnote 393: - - Lancet, 1830–31, i. 96. - -Footnote 394: - - Mr. A. Taylor. Manual of Medical Jurisprudence, p. 120. - -Footnote 395: - - Edin. Med. and Surg. Journal, xix. 168. - -Footnote 396: - - Mr. Davies in Lancet, 1838–39, i. 30. - -Footnote 397: - - Lancet, 1830–31, i. 187. - -Footnote 398: - - Toxicologie Gén. 1843, i. 190. - -Footnote 399: - - Bulletins de Pharmacie, vi. 87. - -Footnote 400: - - Edin. Med. and Surg. Journal, xix. 166. - -Footnote 401: - - Ibid. 169. - -Footnote 402: - - Edin. Med. and Surg. Journal, xix. _passim_. - -Footnote 403: - - Medizinisch-Chirurgische Zeitung, 1828, ii. 203, 219, 235, 254. - -Footnote 404: - - Toxicologie Gén., 1843, i. 187. - -Footnote 405: - - London Courier, Feb. 1, 1823. - -Footnote 406: - - St. James’s Chronicle, August 17, 1826. - -Footnote 407: - - London Medical Repository, xxii. 476. - -Footnote 408: - - Edin. Med. and Surg. Journal, xiv. 606. - -Footnote 409: - - London Medical Gazette, 1842–43, i. 490. - -Footnote 410: - - Edin. Med. and Surg. Journal, xix. 187. - -Footnote 411: - - London. Med. Gaz. i. 737. - -Footnote 412: - - Dr. Scott, in Edin. Med. and Surg. Journal, xxiv. 67. - -Footnote 413: - - London Medical Gazette, 1842–43, i. 490. The quantity could scarcely - have been two ounces, 1, because a penny-worth, which was what the - person bought, amounts only to two drachms, and 2, because it could - not have been dissolved, as the patient said was done, in four ounces - of water. The word _ounces_ is probably a misprint for drachms. - -Footnote 414: - - Guy’s Hospital Reports, 1838, iii, 353. - -Footnote 415: - - London Med. Repository, xi. 20. - -Footnote 416: - - Ibid. vi. 474. - -Footnote 417: - - Guy’s Hospital Reports, 1838, iii. 353. - -Footnote 418: - - London Med. Repository, iii. 380. - -Footnote 419: - - Lancet, 1838–39, ii. 748. - -Footnote 420: - - London Medical Repository, xii. 18. London Medical Gazette, i. 737. - Edinburgh Medical and Surgical Journal, xxiv. 67. - -Footnote 421: - - Edin. Med. and Surg. Journal, xiv. 607. - -Footnote 422: - - London Medical Gazette, i. 737. - -Footnote 423: - - Edinburgh Med. and Surg. Journal, xix. 190. - -Footnote 424: - - Journal de Chim. Med. 1842, 211, and Orfila, Toxicologie Gén. 1843, i. - 195. - -Footnote 425: - - Annales d’Hyg. Publique, 1842, xxvii. 422. - -Footnote 426: - - Lond. Med. Gazette, 1840–41, i. 480. - -Footnote 427: - - Edin. Med. and Surg. Journal, xix. 185. - -Footnote 428: - - Medizinisch-Chirurgische Zeitung, 1828, ii. 255. - -Footnote 429: - - Orfila, in Journal de Chimie Médicale, 1842, 145. - -Footnote 430: - - Annales d’Hygiène, Publique, 1842, xxviii. 206. - -Footnote 431: - - Journal de Chimie Médicale, 1842, 197. - -Footnote 432: - - Toxicol. Gén. i. 164, 3me Edition. - -Footnote 433: - - Ibid. 166, and also Archives Gén. de Méd. xiii. 373. - -Footnote 434: - - Edin. Med. and Surg. Journal, li. 335, lvi. 345, lvi. 123. - -Footnote 435: - - Annales d’Hyg. Publique, xxviii. 212. - -Footnote 436: - - Edin. Med. and Surg. Journal, liv. 341. - -Footnote 437: - - London Medical Gazette, 1842–43, i. 188. - -Footnote 438: - - Edin Med. and Surg. Journal, xxx. 310. - -Footnote 439: - - Toxicologia, p. 225. - -Footnote 440: - - London Med. Repository, vii. 118. - -Footnote 441: - - Orfila, Toxic. Gén. i. 167. - -Footnote 442: - - Edin. Med. and Surg. Journ. xxx. 310. - -Footnote 443: - - Surgical Observations, Part i. 82. - -Footnote 444: - - Toxic. Gén. i. 169. - -Footnote 445: - - Bulletin de l’Acad. Roy. de Méd. 1836, i. 151. - -Footnote 446: - - Journal de Pharmacie, ix. 355, or Med. Repos. xx. 441. - -Footnote 447: - - Annales d’Hygiène Publique, xxix. 417. - -Footnote 448: - - Toxic. Gén. i. 193. - -Footnote 449: - - Edinburgh Med. and Surg. Journal, li. 334, liv. 346. - -Footnote 450: - - Annales d’Hygiène Publique, xxix. 415. - -Footnote 451: - - Experimental Essays, p. 113. - -Footnote 452: - - Journal de Médecine, lxxiii. 22. - -Footnote 453: - - Tartra sur l’empoisonnement par l’acide nitrique, 136. - -Footnote 454: - - London Med. Repository, xxiii. 523. - -Footnote 455: - - Experimental Essays, pp. 114, 115. - -Footnote 456: - - Souville in Journal de Médecine, lxxiii. 19. - -Footnote 457: - - Laflize in Journ. de Méd. lxxi. 401. - -Footnote 458: - - Manual of Medical Jurisprudence, 1844, 130. - -Footnote 459: - - Alexander, Experimental Essays, p. 109. - -Footnote 460: - - Memoirs of London Med. Society, iii. 527. - -Footnote 461: - - Edin. Med. and Surg. Journ. xiv. 34. - -Footnote 462: - - Annali Univers. di Medicina, 1836, iii. 333. - -Footnote 463: - - Journal der Praktischen Heilkunde, lvii. i. 124. - -Footnote 464: - - Journal de Physiologie, iii. 243. - -Footnote 465: - - Toxicol. Gén. i. 174. - -Footnote 466: - - Gmelin’s Geschichte der Mineralischen Gifte, s. 252.7 - -Footnote 467: - - Timæi Casus Medicinales, lvii. c. 12. - -Footnote 468: - - Orfila, Toxic. Gén. i. 220. - -Footnote 469: - - Edinburgh Med. and Surg. Journal, li. 336, lvi. 422, liii. 38. - -Footnote 470: - - Toxicol. _ut supra_. - -Footnote 471: - - Plenck, Toxicologia, 226. - -Footnote 472: - - Essay on Fevers, p. 308. - -Footnote 473: - - Bulletins de la Soc. de Méd. 1815, No. viii. T. iv. 352. - -Footnote 474: - - Edinburgh Medical and Surgical Journal, xiv. 642. - -Footnote 475: - - Revue Médicale, xvii. 265. - -Footnote 476: - - Journal de Chimie Médicale, 1840, 499. - -Footnote 477: - - London Medical Gazette, 1837, xxi. 529. - -Footnote 478: - - Orfila, Toxicol Gén. i. 229. - -Footnote 479: - - De salis ammoniaci, vi, &c. Heidelberg, 1826. Analysed in Revue Med. - 1827, i. 284. - -Footnote 480: - - Orfila, i. 228. - -Footnote 481: - - Orfila, Annales d’Hygiène Publique, xxviii. 431. - -Footnote 482: - - Toxic. Gén. i. 177. - -Footnote 483: - - Annales, _ut supra_. - -Footnote 484: - - Toxicologie Gén. 1843, i. 269. Two from an Essay by M. Chantourelle, - read before the Acad. de Médecine,; and one from M. Lafranque in Ann. - de la Méd. Physiolog. Février, 1825. - -Footnote 485: - - Journ. Universel, xviii. 265. - -Footnote 486: - - See _Poisonous Gases_. - -Footnote 487: - - Journal de Chimie Médicale, 1842, p. 656. - -Footnote 488: - - It appears that arsenic does not always undergo this change. Berzelius - once kept some fragments in an open phial for three years without - observing any change in appearance or weight. [Annales de Chimie et de - Physique, xi. 240.] Buchner once made a similar observation, and is - inclined to think that oxidation does not occur, if the metal is quite - pure. [Repertorium für die Pharmacie, xxi. 29.] - -Footnote 489: - - American Journ. of Med. Science, x. 122. - -Footnote 490: - - Hahnemann, Uber die Arsenic-vergiftung, 13. - -Footnote 491: - - Edin. Medico-Chirurgical Transactions, ii. 292. - -Footnote 492: - - Journal de Chimie Médicale, ii. 61. - -Footnote 493: - - As far back at least as the time of Zacchias. See his Quæstiones - Medico-legales, iii. 37, 11. - -Footnote 494: - - Edin. Med. and Surg. Journal, 1827, xxviii. 96. - -Footnote 495: - - Consult among others, Taylor’s Manual of Medical Jurisprudence, p. - 135. - -Footnote 496: - - Toxicologie Gén. 1843, i. 376. - -Footnote 497: - - Magazin für die gesammte Heilkunde, v. 66. - -Footnote 498: - - Mr. Blandy, for example, who said he “perceived an extraordinary - grittiness in his mouth, attended with a very painful pricking and - burning pain in his tongue, throat, stomach, and bowels.” [Howell’s - State Trials, xviii. 1135.] - -Footnote 499: - - American Journal of Medical Science, x. 122. - -Footnote 500: - - Schweigger’s Journal der Chemie. vi. 232. - -Footnote 501: - - Journal de Chimie Médicale, ii. 61. - -Footnote 502: - - London Philosophical Journal, 1837, ii. 482. - -Footnote 503: - - Ueber die Arsenic-vergiftung, 10. - -Footnote 504: - - Contrepoisons de l’Arsenic du sublimé corrosif, &c. i. 20. - -Footnote 505: - - Neues Nordisches Archiv. i. - -Footnote 506: - - Journal de Chimie Médicale, ii. 61. - -Footnote 507: - - Ueber die Arsenic-vergiftung, 223. - -Footnote 508: - - Lectures on Chemistry, ii. 430. - -Footnote 509: - - Edin. Med. and Surg. Journal, xxii. 82, and Edin. Medico-Chirurgical - Transactions, ii. 293. - -Footnote 510: - - Paris and Fonblanque’s Medical Jurisprudence, ii. 251. - -Footnote 511: - - Donovan in Dublin Phil. Journal, ii. 402. - -Footnote 512: - - Ibid. - -Footnote 513: - - American Journal of Medical Science, x. 126. - -Footnote 514: - - Annales d’Hyg. Pub. et de Med. Lég. xi. 224. - -Footnote 515: - - The only probable source of such impregnation is pyritic sulphur, - which is frequently used abroad, and has of late been occasionally - employed in this country, for making sulphuric acid. As pyrites - commonly contains arsenic, the acid becomes adulterated with oxide of - arsenic, and may communicate the same impregnation to various other - reagents which are prepared by means of sulphuric acid. The oxide may - easily be detected in that acid by a stream of hydrosulphuric acid - gas, after moderate dilution with water; for pure acid is rendered - milky; but an arsenical acid yields a yellow precipitate of sulphuret - of arsenic. - -Footnote 516: - - Journal de Chim. Méd. viii. 449. - -Footnote 517: - - Reinsch, in Repertorium für die Pharmacie, lvi. 183. - -Footnote 518: - - This has been occasionally observed by Chevallier [Journal de Chim. - Méd. 1840, 434], and once by M. Roturier [Ibidem, 627]. The former met - with a medico-legal case where from this circumstance an erroneous - opinion was at first formed in favour of poisoning. - -Footnote 519: - - London Med. Chirurgical Transactions, iii. 342. - -Footnote 520: - - See a paper by myself in Edin. Med. and Surg. Journal, xxii. 60, where - the fallacies to which the liquid tests are liable are investigated at - great length. - -Footnote 521: - - Horn’s Archiv für Medizinische Erfahrung, 1827, i. 230. - -Footnote 522: - - Edin. Med. and Surg. Journal, xxii. 74. - -Footnote 523: - - Edinburgh Med. and Surg. Journal, July, 1824. - -Footnote 524: - - Edinburgh New Philosophical Journal, 1836, xxi. 229. - -Footnote 525: - - Mr. L. Thomson in Lond. Phil. Journal, 1837, i. 353.—Orfila, Journal - de Chimie Médicale, 1841, p. 212.—Bischoff, Repertorium für die - Pharmacie, lxxv. 411.—Mr. H. H. Watson, Manchester Memoirs, vi. - 603.—Pettenkoffer, Repertorium für die Pharmacie, lxxvi. - 289.—Berzelius, and a Committee of the French Institute, Journal de - Chimie Médicale, 1841, 393.—Flandin and Danger, Ibidem, 1841, - 435.—Malapert, Ibidem, 1841, 295.—Lassaigne, Ibidem, 1840, 638,—Mr. - Ellis, Lancet, 1843.—A paper of my own, Edinburgh Monthly Journal of - Med. Science, iii. 257. - -Footnote 526: - - Journal de Chimie Médicale, 1841, 393. Rapport de l’Institut. - -Footnote 527: - - Edinburgh Monthly Journal of Medical Science, 1843, iii. 257. - -Footnote 528: - - Journal für Praktischen Chemie, 1842, xxiv. 242. - -Footnote 529: - - See Edinburgh Monthly Journ. of Med. Science, 1843, iii. 774. - -Footnote 530: - - Annalen der Chimie und Pharmacie, 1844, xlix. 291. - -Footnote 531: - - Edinburgh Medical and Surgical Journal, 1824, xxii. 78. - -Footnote 532: - - Annalen der Chemie und Pharmacie, xlix. 308. - -Footnote 533: - - Journal de Chimie Médicale, 1841, p. 413. - -Footnote 534: - - Annalen der Chemie und Pharmacie, 1844, Mär 3, xlix. 308. - -Footnote 535: - - London Medical Gazette, 1840–41, i. 723. - -Footnote 536: - - Annales de Hygiène Publique, 1839, xxii. 404. - -Footnote 537: - - Ibidem, p. 418. - -Footnote 538: - - Journal de Chimie Médicale, 1839, 452. - -Footnote 539: - - Ibidem, 1841, 534. - -Footnote 540: - - Ibidem, 1842, 650. - -Footnote 541: - - London Philosophical Journal, 1842, ii. 403. - -Footnote 542: - - Wohler, Journal de Chim. Médicale, 1840, 96. - -Footnote 543: - - Bulletins de l’Acad. Roy. de Médecine, 1839, iii. 1073. - -Footnote 544: - - Journal de Chimie Médicale, 1840, 645, and 1841, 242. - -Footnote 545: - - Journ. de Chim. Méd. 1839, 346. - -Footnote 546: - - Annales d’Hygiène Publique, 1839, xxii. - -Footnote 547: - - Ibidem, 404. - -Footnote 548: - - Journal de Chimie Médicale, 1841, 223. - -Footnote 549: - - Repertorium für die Pharmacie, lxxv. 107. - -Footnote 550: - - Guy’s Hospital Reports, 1841, vi. 163. - -Footnote 551: - - Journal de Chimie Médicale, 1841, 17, 421, 431. - -Footnote 552: - - Annales d’Hygiène Publique, xxii. 450. - -Footnote 553: - - Journal de Chimie Médicale, 1841, 223. - -Footnote 554: - - Ibidem, 1840, 690. - -Footnote 555: - - Annales, &c. _ut supra_. - -Footnote 556: - - Revue Médicale. 1827, i. 365. - -Footnote 557: - - Beiträge zur gerichtlichen Arzneikunde, iv. 221. - -Footnote 558: - - January, 1819. - -Footnote 559: - - Annales d’Hygiène Publ. et de Med. Légale, xii. 393. - -Footnote 560: - - Ueber die Arsenic-vergiftung, pp. 14, 45. - -Footnote 561: - - Journal de Pharmacie, xiii. 207. - -Footnote 562: - - Journal de Chim. Med. ii. 113. - -Footnote 563: - - Trans. of Provincial Med. and Surg. Association, iii. 465. - -Footnote 564: - - See subsequently _Morbid Appearances_. - -Footnote 565: - - Dublin Journal of the Med. Sciences, xx. 422. - -Footnote 566: - - Repertorium für die Pharmacie, lxix. 271. - -Footnote 567: - - Buchner’s Toxicologie, 476. - -Footnote 568: - - Treatise on Poisons, third edition, pp. 270, 271. - -Footnote 569: - - Bulletins de l’Acad. Roy. de Médecine, 1839, iii. 426. - -Footnote 570: - - Journal de Chimie Médicale, 1840, p. 690. - -Footnote 571: - - Gazette Médicale, 1839, No. 20. - -Footnote 572: - - In a rabbit killed by arsenic applied to a wound Sir B. Brodie found - the heart contracting feebly after death; and in a dog there were - tremulous contractions incapable of supporting circulation. Sproegel - found the peristaltic motion of the intestines and gullet vigorous in - a dog an hour after death. [Diss. Inaug. in Halleri Disput. Med. Prac. - vi. Exp. 31] Orfila in some experiments found the heart apparently - inflamed and its irritability destroyed. [Arch. Gén. de Med. i. 147.] - -Footnote 573: - - Haller’s Disput. Med. Pract. vi. Exp. 35. - -Footnote 574: - - Diss. Inaug. Tubing. 1808. De effectibus Arsenici in var. organismos. - -Footnote 575: - - Phil. Trans. cii. 211. - -Footnote 576: - - Jaeger, p. 28. - -Footnote 577: - - Halleri Disput., &c., Exp. 36. - -Footnote 578: - - Renault sur les Contrepoisons de l’Arsénic, p. 42. - -Footnote 579: - - Ibidem, 45. - -Footnote 580: - - Journal de Chim. Méd. ii. 153. - -Footnote 581: - - Acta Germanica, v. Observ. 102. - -Footnote 582: - - Sur les Contrepoisons de l’Arsénic, p. 57. - -Footnote 583: - - Sur les Contrepoisons de l’Arsénic, p. 48. - -Footnote 584: - - Nov. Bibliothèque Méd. 1827, ii 59. - -Footnote 585: - - Acta Germanica, v. Observ. 102 - -Footnote 586: - - For the references to these cases, see p. 227. - -Footnote 587: - - Ueber Arsenic-Vergiftung, p. 53–4. - -Footnote 588: - - Journal Complémentaire, i. 107. - -Footnote 589: - - Edin. Med. and Surg. Journal, xxxiii. 67. - -Footnote 590: - - Guy’s Hospital Reports, 1841, vi. 29. - -Footnote 591: - - Annales d’Hygiène Publique, 1837, xvi. 336, 345. - -Footnote 592: - - Rust’s Magazin für die gesammte Heilkunde, xx. 492. - -Footnote 593: - - Wibmer. Die Wirkung der Arzneimittel und Gifte, i. 257. From Alberti, - Jurisp. Med. v. 619, cas. 24. - -Footnote 594: - - Bulletins de l’Académie Roy. de Médecine, 1841, v. 145. - -Footnote 595: - - Valentini Pandectæ Med.-legales, 1. iii. c. 24. - -Footnote 596: - - Sur les Contrepoisons de l’Arsénic, p. 62. - -Footnote 597: - - Foderé, in Journal Complémentaire, i. 107, from Bertrand, Manuel - Medico-legal des Poisons, p. 185. - -Footnote 598: - - Toxicologie Gén. i. 429. - -Footnote 599: - - American Journal of Med. Science, xi. 61. - -Footnote 600: - - Mr. Hume, London Medical and Physical Journal, xlvi. 467. - -Footnote 601: - - Edinburgh Med. and Surg. Journal, xxxvi. 94. - -Footnote 602: - - Beiträge zur gerichtlichen Arzneikunde, iv. 221. - -Footnote 603: - - Praktisches Handbuch für Physiker, iii. 298. - -Footnote 604: - - London Med. and Phys. Journal, xlix 117. - -Footnote 605: - - Annales d’Hygiène Publique, xvii. 338. - -Footnote 606: - - Pandectæ Medico-legales, P. i. s. iii. cas. xxvi. pp. 134, 135. - -Footnote 607: - - Diction. de Méd. et de Chir. Pratique, Art. Arsenic, iii. 340. - -Footnote 608: - - Archives Gén. de Médecine, vii 14.—Another case somewhat analogous has - been related by Tonnelier in Corvisart’s Journal de Médecine (iv. 15). - The person, a girl nineteen years of age, took the poison at eleven, - dined pretty heartily at two, and concealed her sufferings till seven. - Even before dinner, however, she had been observed occasionally to - change countenance, as if uneasy. - -Footnote 609: - - Edin. Med. and Surg. Journal, xxvii. 450. - -Footnote 610: - - London Med. Chir. Trans. ii. 134. - -Footnote 611: - - Edin. Med. and Surg. Journal, xxix. 23. See also above, p. 77. - -Footnote 612: - - Mr. Page, Lancet, 1836–37, ii. 626. - -Footnote 613: - - Wendland in Augustin’s Archiv der Staatsarzneikunde, ii. 34. - -Footnote 614: - - Pyl’s Aufsätze und Beob. i. 55. - -Footnote 615: - - Bachmann. See subsequently, p. 260. State Trials, xviii. Case of Miss - Blandy. - -Footnote 616: - - Wepfer, Historia Cicutæ, 276. - -Footnote 617: - - In a case by Schlegel. See Henke’s Zeitschrift für die - Staatsarzneikunde, i. 81. - -Footnote 618: - - Buchmann, p. 40. - -Footnote 619: - - Journal de Médecine, iv. 383. - -Footnote 620: - - Journal de Chimie Med. 1842, p. 580. - -Footnote 621: - - Pyl’s Aufsätze und Beob. i. 55. - -Footnote 622: - - Metzger’s Materialien für die Staatsarzneikunde, ii. 96.—Lond. Med. - Phys. Journ. xxviii. 345—and Wildberg’s Praktisches Handbuch, iii. - 235–390. - -Footnote 623: - - Edinburgh Med. and Surg. Journal, lix. 350. - -Footnote 624: - - Henke’s Zeitschrift für die Staatsarzneikunde, i. 29. - -Footnote 625: - - Tonnelier’s case. Corvisart’s Journal de Médecine, iv.—Roget’s case. - Med. Chir. Transactions, ii. - -Footnote 626: - - Med. and Phys. Journal, xxviii. 347. - -Footnote 627: - - Henke’s Zeitschrift, i. 31. - -Footnote 628: - - De Veneficio caute dijudicando. Schlegel’s Opusc. iv. 22. - -Footnote 629: - - Praktisches Handbuch für Physiker, iii. 298. - -Footnote 630: - - Zeitschrift für die Staatsarzneikunde, ii. 307. - -Footnote 631: - - Aufsätze und Beobachtungen, v. 106. - -Footnote 632: - - Edinburgh Med. and Surg. Journal, 1843, lix. 350. - -Footnote 633: - - Elements of Juridical Medicine, 68. - -Footnote 634: - - Historia Cicutæ, p. 282. - -Footnote 635: - - Essay on Mineral Poisons, 1795, p. 30. - -Footnote 636: - - These facts are important, because they will enable the medical jurist - in some circumstances to decide a question which may be started as to - the possibility of arsenic having been the cause of death when it is - very rapid. I have dwelt on them more particularly than may appear - necessary, because some loose statements on the subject were made in a - controversy on the occasion of a trial of some note, that of Hannah - Russell and Daniel Leny, at Lewes Summer Assizes 1826, for the murder - of the husband of the former. Arsenic was decidedly detected in the - stomach, and it was proved that the deceased did not live above three - hours after the only meal at which the prisoners could have - administered the poison. Now during the controversy which arose after - the execution of one of the prisoners, it was alleged by one of the - parties, among other reasons for believing arsenic not to have been - the cause of death, that this poison never proves fatal so soon as in - three hours,—that Sir Astley Cooper and Mr. Stanley of London had - never known a case prove fatal in less than seven hours—and that Dr. - Male’s case mentioned above is the shortest on record. The instances - quoted above overthrow this whole line of statement. It was mentioned - by Mr. Evans, the chief crown witness, but I know not on what - authority, that, on the trial of Samuel Smith for poisoning, held at - Warwick Summer Assizes 1826, the deceased was proved to have expired - in two hours after taking a quarter of an ounce of arsenic. I have - examined with some care the documents in the Lewes case, which were - obligingly communicated to me by Mr. Evans; and I have been quite - unable to discover any reason for questioning the reality of - poisoning, or for the ferment which it seems the subsequent - controversy excited. The case seems to have been satisfactorily made - out by Mr. Evans in the first instance; and no sound medical jurist - would for a moment suffer a shadow of doubt to be thrown over his mind - by the criticisms of Mr. Evans’s antagonist. - -Footnote 637: - - Die Wirkung der Arzneimittel und Gifte, i. 271. - -Footnote 638: - - London Medical Repository, ii. 270. - -Footnote 639: - - Edinburgh Med. and Surg. Journal, xxxii. 305. - -Footnote 640: - - Ibidem, v. 389. - -Footnote 641: - - Philos. Transactions, 1812, p. 212. - -Footnote 642: - - Henke’s Zeitschrift für die Staatsarzneikunde, v. 410. - -Footnote 643: - - Magazin für die gesammte Heilkunde, xxii. 483. - -Footnote 644: - - This statement might be excellently illustrated by the particulars of - an English trial in 1842, where the prisoner escaped, though arsenic - was found in the stomach of the deceased, because the judge, resting - on the medical evidence, urged that arsenic caused so much pain in the - stomach as generally to make the person shriek with agony, while in - this case there was no uneasiness except pain in the head. As the - case, however, was by no means creditable to the parties concerned in - it, I shall rest satisfied with the present allusion. - -Footnote 645: - - Vol. iii. quoted in Kopp’s Jahrbuch, vii. 401. - -Footnote 646: - - Materialien für die Staatsarzneikunde, ii. 95. - -Footnote 647: - - Edin. Med. Chir. Transactions, ii. 298. - -Footnote 648: - - Lond. Med. Phys. Journal, xxxiv. - -Footnote 649: - - Revue Médicale, 1822, vii. 105. - -Footnote 650: - - Archives Gén. de Médecine, vii. 14. - -Footnote 651: - - London Medical Gazette, xv. 828. - -Footnote 652: - - Orfila, Toxicologie Gén. i. 397. - -Footnote 653: - - Lancet, xvi. 612. - -Footnote 654: - - Epist. Anat. lix. 3. - -Footnote 655: - - Journal de Médecine, lxx. 89. - -Footnote 656: - - Annali Universali di Medicina, 1836, ii. 43. - -Footnote 657: - - Zeitschrift für die Staatsarzneikunde, xlii. 402. - -Footnote 658: - - Journal Hebdomadaire, 1832, viii. 476. - -Footnote 659: - - London Med. Chir. Transactions, ii. 134. - -Footnote 660: - - See also a full abstract in Edin. Med. and Surg. Journal, xiii. 507. - -Footnote 661: - - Edin. Med. and Surg. Journal, xv. 553. - -Footnote 662: - - Traitement des Asphyxiés, 135. - -Footnote 663: - - Ratio Medendi, iii. 113. - -Footnote 664: - - Edin. Med. and Surg. Journal, xviii. 167. - -Footnote 665: - - Annales d’Hygiène Publique, xvii. 336. - -Footnote 666: - - Beiträge zur gerichtlichen Arzneikunde, iv. 221. - -Footnote 667: - - Mem. of London Medical Society, ii. 224. - -Footnote 668: - - Nova Acta Naturæ Curiosorum, iii. 532. - -Footnote 669: - - Hahnemann über die Arsenic-Vergiftung, 59. - -Footnote 670: - - Curationes Medicinales. Cent. ii. Obs. 33. - -Footnote 671: - - Cicutæ Aquaticæ Historia et Noxæ, 280. - -Footnote 672: - - Ueber die Arsenic-Vergiftung, 61. - -Footnote 673: - - Die Wirkung der Arzneimittel und Gifte, i. 266. - -Footnote 674: - - Diet. des Sciences Méd. ii. 307. - -Footnote 675: - - Edin. Med. and Surg. Journal, xv. 415. - -Footnote 676: - - Cadet de Gassicourt. Article Arsenic in Dict. des Sc. Méd. - -Footnote 677: - - London Medical Gazette, 1839–40, p. 266. - -Footnote 678: - - Hoffman, Medicina Rationalis Systematica, i. 198. - -Footnote 679: - - Magazin für die gerichtlichen Arzneikunde, ii. 473. - -Footnote 680: - - Ueber die Arsenic-Vergiftung, 63. - -Footnote 681: - - Gmelin’s Geschichte der Mineralischen Gifte. Gmelin attempts to show - from symptoms, that the Popes Pius Third and Clement Fourteenth died - of arsenic secretly and gradually given, p. 107. - -Footnote 682: - - Curat. Medic. C. ii. Obs. 33. - -Footnote 683: - - De Cicuta, p. 289. - -Footnote 684: - - Quoted by Hahnemann, über die Arsenic-Vergiftung, p. 41. - -Footnote 685: - - Cours de Médecine Légale, p. 121. - -Footnote 686: - - London Medical Gazette, 1842–43, i. 351; from Gazette Médicale, 1842, - Nov. 5. - -Footnote 687: - - Elémens de Médecine Opératoire. - -Footnote 688: - - Annales d’Hyg. Publ. et de Méd. Lég. xi. 461. - -Footnote 689: - - Journ. de Chimie Médicale, 1836, 482. - -Footnote 690: - - On Phagedæna Gangrænosa, or Med. Phys. Journal, xl. 238. - -Footnote 691: - - De Arsenici usu in Medicina, p. 158. - -Footnote 692: - - Aufsätze und Beobachtungen, i. 43. - -Footnote 693: - - Paris and Fonblanque, ii. 222. - -Footnote 694: - - Médecine, Légale, iv. 226. - -Footnote 695: - - Ansiaulx, Clinique Chirurgicale, and Henke’s Zeitschrift für die - Staatsarzneikunde, ii. 188. - -Footnote 696: - - Acta Hafniensia, iii. 178. - -Footnote 697: - - Hippocrates Chymicus, c. 24. p. 213. - -Footnote 698: - - Casus Medicinales, lib. vii. cas. 11. - -Footnote 699: - - Die Wirkung der Arzneimittel und Gifte, i. 299. - -Footnote 700: - - Journal der Praktischen Heilkunde, lxxii. v. 134. - -Footnote 701: - - London Medical Gazette, 1837–38, i. 585. - -Footnote 702: - - Buchner’s Repertorium für die Pharmacie, lxix. 271. - -Footnote 703: - - Dublin Journal of the Medical Sciences, xx. 422. - -Footnote 704: - - Eph. Curios. Naturæ, Dec. iii. An. 9 and 10, Obs. 220. - -Footnote 705: - - Sur les Contrepoisons de l’Arsénic, p. 112. - -Footnote 706: - - Mem. of London Medical Society, ii. 397. - -Footnote 707: - - Recueil Périod. de la Soc. de Med. vi. 22. - -Footnote 708: - - Acta Germanica, ii. 33. - -Footnote 709: - - Knape und Hecker’s Kritische Annalen der Staatsarzneikunde, i. - 143–159. - -Footnote 710: - - Die Wirkung der Arzneimittel und Gifte, i. 241. - -Footnote 711: - - Einige auserlesene Medizinisch-gerichtliche abhandlungen von Schmitt, - Bachmann, &c. p. 40. - -Footnote 712: - - State Trials, xviii. - -Footnote 713: - - Ephem. Academ. Cæsareo-Leopoldinæ, 1715. Obs. cxxvi. - -Footnote 714: - - Horn’s Archiv für Medizinische Erfahrung, 1834, 755. - -Footnote 715: - - Guy’s Hospital Reports, 1841, vi. 278. - -Footnote 716: - - Aufsätze und Beobachtungen, i. 53, and v. 107. - -Footnote 717: - - Diss. Inaug. Tubingæ, 1808, de Effectibus Arsenici in varios - organismos, p. 39. - -Footnote 718: - - Diss. Inaug. Edin. 1813, de Venen. Mineralibus, pp. 5, 6, 12. - -Footnote 719: - - Edin. Med. and Surg. Journal, xviii. 171. - -Footnote 720: - - London Medical Gazette, xiv. 62. - -Footnote 721: - - Praktisches Handbuch, iii. 232 and 304. - -Footnote 722: - - Dissert. Exp. 36. - -Footnote 723: - - Edin. Med. and Surg. Journal, xxvii. 453. - -Footnote 724: - - Nordisches Archiv, i. 334. - -Footnote 725: - - Jaeger, p. 40. - -Footnote 726: - - Edin. Med. and Surg. Journal, xxvii. 453. - -Footnote 727: - - Schlegel, Collect. Opusc. &c. 423. - -Footnote 728: - - Aufsätze und Beobachtungen, i. 58. - -Footnote 729: - - Edinburgh Med. and Surg. Journal, xxxiii. 66. - -Footnote 730: - - Metzger’s System der gerichtlichen Arzneikunde, von Remer, 1820, p. - 257. - -Footnote 731: - - Edin. Med. and Surg. Journal, xxix. 25. - -Footnote 732: - - Edin. Med. and Surg. Journal, xxvii. 453. - -Footnote 733: - - Guy’s Hospital Reports, 1837, ii. 29, and 1841, vi. 266. - -Footnote 734: - - Gmelin’s Geschichte der Mineralischen Gifte, 124, Foderé, - Médecine-Légale, iv. 127. Sallin, Journal Gén. de Médecine, iv. - -Footnote 735: - - Edin. Med. and Surg. Journal, xxix. 25. - -Footnote 736: - - Journal Complémentaire, i. 106. - -Footnote 737: - - Trial of Medad Mackay at Allegany, 1821. The prisoner was found not - guilty. But the presence of arsenic in the stomach was proved by - several tests. - -Footnote 738: - - Philosophical Transactions, cii. 216. - -Footnote 739: - - Archives Gén. de Médecine, 1. 107. - -Footnote 740: - - Harles de Arsenico, 153, and Renault sur les Contrepoisons de - l’Arsénic. - -Footnote 741: - - Morbid Anatomy, p. 128. - -Footnote 742: - - Metzger in Schlegel’s Opuscula, iv. 23. Pyl’s Aufs. und Beob. i. 60. - Platner, Quæstiones Medicinæ Forenses, 206. - -Footnote 743: - - Medicina Forensis, Cent. v. Cas. 45, quoted by Wibmer. - -Footnote 744: - - Beiträge zur gerichtlichen Arzneikunde, iv. 221. - -Footnote 745: - - Bernt, Beiträge zur gerichtlichen Arzneikunde, iv. 221. - -Footnote 746: - - Metzger’s Materialien für die Staatsarzneikunde, ii. 95. - -Footnote 747: - - ii. 284. - -Footnote 748: - - Edin. Med. and Surg. Journal, xxvii. 457. - -Footnote 749: - - Ibid, xxxiii. 66. - -Footnote 750: - - Sproegel’s Dissert. Exp. xxxi. - -Footnote 751: - - Pfaff and Scheele’s Nordisches Archiv. i. 345. - -Footnote 752: - - Archives Gén. de Med. vii. 1. - -Footnote 753: - - Ibidem, vii. 285. - -Footnote 754: - - Repertorium für die Pharmacie, xxiv. 144. - -Footnote 755: - - Archives Gén. de Méd. ii. 58. - -Footnote 756: - - Edin. Med. and Surg. Journal, xviii. 171. - -Footnote 757: - - Elements of Juridical Medicine, 76. - -Footnote 758: - - Morbid Anatomy, p. 128. - -Footnote 759: - - Case of Mr. Blandy, State Trials, xviii. - -Footnote 760: - - Bachmann’s Essay (see p. 259). - -Footnote 761: - - Houlton in London Med. Gazette, xiv. 712. - -Footnote 762: - - Diss. Inaug. Edin. 1813, pp. 11 and 12. - -Footnote 763: - - Diss. in Haller’s Disp. de Morbis, vi. Exp. xxxvi. - -Footnote 764: - - London Med. Gazette, x. 115. - -Footnote 765: - - Gazette Médicale de Paris, 1839, No. 20. - -Footnote 766: - - Neues Magazin, I. iii. 508. - -Footnote 767: - - Zeitschrift für die Staatsarzneikunde, i. 32. - -Footnote 768: - - Annales d’Hyg. Publique, xi. 461. - -Footnote 769: - - London Med. Gazette, xiv. 62. - -Footnote 770: - - Archives Gén. i. 147. - -Footnote 771: - - Nouvelle Bibliothèque Médicale, 1829, i. 395. - -Footnote 772: - - Jaeger, de Effectibus Arsenici, p. 40. - -Footnote 773: - - Bachmann’s Essay, p. 41, or above, p. 259. - -Footnote 774: - - Aufsätze und Beobachtungen, i. 50. - -Footnote 775: - - Wibmer. Die Wirkung der Arzneimittel und Gifte, i. 281, 283. - -Footnote 776: - - Phil. Trans. cii. 214. - -Footnote 777: - - De Arsenici usu in Medicina, 1811, p. 154. - -Footnote 778: - - Journal de Chimie Médicale, 1839, p. 127. - -Footnote 779: - - Practisches Handbuch, iii. 229. - -Footnote 780: - - De Venenis Mineralibus. Diss. Inaug. Edinburgi, 1813. - -Footnote 781: - - Historia Circutæ, 288. - -Footnote 782: - - Augustin’s Repertorium. Neue Entdeckungen betreffend die Kennzeichen - der Arsenic-vergiftung, I. i. 30. - -Footnote 783: - - Geschichte der Mineralischen Gifte. - -Footnote 784: - - Essay on Mineral Poisons, 36. - -Footnote 785: - - Quæst. Medicinæ Forenses, 206. - -Footnote 786: - - Jaeger, de Effectibus Arsenici, p. 47. - -Footnote 787: - - Magazin für die gesammte Heilkunde, xx. 485. - -Footnote 788: - - Bulletins de l’Acad. Roy. de Méd. v. 137. - -Footnote 789: - - Geiger’s Magazin für Pharmacie, xxxii. 301, from Seeman’s Dissert. - Inaug. Berolini, 1824. - -Footnote 790: - - For an excellent analysis of the case of Ursinus and the experiments - of Klanck, see Augustin—Neue Entdeckungen betreffend die Kennzeichen - der Arsenic-vergiftung und Berichtigung älterer Angaben über diesen - Gegenstand,—in Augustin’s Repertorium, I. i. 36. - -Footnote 791: - - Bachmann, Einige auserlesene gerichtlich-medizinische abhandlungen, - von Schmidt, Bachmann, und Küttlinger. Nürnberg, 1813. - -Footnote 792: - - Hufeland’s Journal, xix. iv. 11, and xxii. i. 166. - -Footnote 793: - - Archives Gén. de Med. xxi. 615, or Revue Médicale, 1830, i. 165. - -Footnote 794: - - Annales d’Hygiène Publique, 1837, xviii. 466; and Journal de - Pharmacie, 1837, 386. - -Footnote 795: - - Edin. Med. and Surg. Journal, xxvii. 457. - -Footnote 796: - - De veneficio caute dijudicando, in Schlegel’s Opuscula, iv. 23. - -Footnote 797: - - Edin. Med. Chir. Trans. ii. 284. - -Footnote 798: - - Dr. Symonds’s Account of the Examination, &c., Trans. of Provincial - Med. and Surg. Association, iii. 432. - -Footnote 799: - - Lancet, 1843–44, ii. 801. - -Footnote 800: - - Dissertatio de vera Chemiæ Organicæ notione, additis experimentis de - vi Arsenici in corpore organico mortuo. 1822. Quoted fully by Wibmer, - die Wirkung der Arzneimittel und Gifte, i. 312. - -Footnote 801: - - Elémens de Chymie, ii. 343. - -Footnote 802: - - See this work, First Ed. 1829, p. 258. - -Footnote 803: - - Kopp’s Jahrbuch, ii. 226. - -Footnote 804: - - Bernt’s Beiträge zur gerichtlichen Arzneikunde, iv. 219. - -Footnote 805: - - Ueber eine Vergiftung durch weissen Arsenic—Rust’s Magazin für die - gesammte Heilkunde, v. 61. - -Footnote 806: - - Edin. Med. and Surg. Journal, xviii. 172. - -Footnote 807: - - De usu Arsenici, 164. - -Footnote 808: - - Journal de Pharmacie, 1837, p. 386. - -Footnote 809: - - Revue Médicale, 1828, ii. 470. - -Footnote 810: - - Knape und Hecker’s Kritische Jahrbücher, ii. 76. - -Footnote 811: - - Henke’s Zeitschrift für die Staatsarzneikunde, xxxix. 176. - -Footnote 812: - - Toxicologie Générale, ii. - -Footnote 813: - - Sur les Contrepoisons de l’Arsenic, pp. 33, 35. - -Footnote 814: - - London Med. and Phys. Journal, xlvi. 466, 545. Mr. Edwards, Ibidem, - xlix. 117. Mr. Buchanan, London Med. Repository, xix. 288. - -Footnote 815: - - Journal Gén. de Médecine, 1813 and 1815, p. 363. - -Footnote 816: - - Toxicologie Gén. i. 429. - -Footnote 817: - - Das Eisenoxydhydrat, ein Gegengift der Arsenigen saüre, Göttingen, - 1834. - -Footnote 818: - - Annales d’Hygiène Publique, xiv. 134. - -Footnote 819: - - Probationary Essay, Edin. Roy. Coll. of Surgeons, 1839. - -Footnote 820: - - London Medical Gazette, xv. 220. - -Footnote 821: - - Lancet, 1834–35 p. 232. - -Footnote 822: - - Edinburgh Medical and Surgical Journal, liv. 106. - -Footnote 823: - - Buchner’s Repertorium für die Pharmacie, lxvi. 126. - -Footnote 824: - - Journal de Chimie Médicale, 1841, p. 240. - -Footnote 825: - - Mr. Kerr in Edin. Med. and Surg. Journal, xxxvi. 97. - -Footnote 826: - - London Med. Repository, ix. 456. - -Footnote 827: - - Med. and Phys. Journal, xxix. - -Footnote 828: - - Journal de Chimie Médicale, 1839, p. 189. - -Footnote 829: - - Bulletins de l’Acad. Roy. de Méd. iii. 1124. - -Footnote 830: - - Ibidem, 1840, vi. 135. - -Footnote 831: - - Bulletins de l’Académie Roy. de Médecine, 1840, vi. 136. - -Footnote 832: - - Journal de Chimie Médicale, 1840, p. 711. - -Footnote 833: - - Ibidem, 1843, p. 265. - -Footnote 834: - - Ibidem, 1841, p. 258. - -Footnote 835: - - Kopp’s Jahrbuch der Staatsarzneikunde, iv. 354. - -Footnote 836: - - Devergie. Annales d’Hyg. Publ. xi. 418. - -Footnote 837: - - Toxicologie Gén. i. 241. - -Footnote 838: - - Medical Jurisprudence, ii. 208. - -Footnote 839: - - Annales d’Hyg. Publ. et de Méd. Lég. xi. 411. - -Footnote 840: - - Philosophical Transaction, 1831, cxxi. 155, 160. - -Footnote 841: - - Annales de Chimie, xliv. 176, and Orfila, Toxicol. Gén. i. 243. - -Footnote 842: - - Taddei, Recherches sur un nouvel Antidote contre le sublimé corrosif. - -Footnote 843: - - Berthollet, sur la Causticité des sels Métalliques. Mém. de l’Acad. - 1780. - -Footnote 844: - - Toxic. Gén. i. 245. - -Footnote 845: - - Recherches, &c. p. 60. - -Footnote 846: - - Journal de Chimie Médicale, 1837, p. 161. - -Footnote 847: - - Poggendorff’s Annalen der Physik und Chemie, xxviii, 135. - -Footnote 848: - - Annalen der Pharmacie, xxiv. 36. - -Footnote 849: - - Annales de Chimie, xliv. 176. - -Footnote 850: - - Toxicologie Générale, i. 301. - -Footnote 851: - - Annales d’Hygiène Publique, xxviii. 424. - -Footnote 852: - - Dr. Bigsby in London Medical Gazette, vii. 329. - -Footnote 853: - - Philosophical Transactions, cii. 222. - -Footnote 854: - - Tentamen Inaugurale de Venenis Mineralibus, Edinb. 1813, p. 36. - -Footnote 855: - - Orfila, Toxicologie Gén. i. 257. - -Footnote 856: - - Journal de Physiologie, i. 165 and 242. - -Footnote 857: - - Toxicologie, i. 261. - -Footnote 858: - - Journal de Physiologie, i. 165. - -Footnote 859: - - Autenrieth und Zeller über das Daseyn von Quecksilber in der Blutmasse - der Thiere. Reil’s Archiv für die Physiologie, viii. 216. - -Footnote 860: - - Horn’s Archiv für Medizinische Erfahrung, 1823, ii. 417. - -Footnote 861: - - Diss. Inaug. Tubingæ, 1808, sistens experimenta quædam circa effectus - hydrargyr in animalia viva, pp. 25, 31, also Reil’s Archiv, _ut - supra_. - -Footnote 862: - - Tract. de Morb. Gall. in Opera Omnia, pp. 728, 729. - -Footnote 863: - - Archiv für Medizinische Erfahrung, 1810, ii. 252. - -Footnote 864: - - Corvisart’s Journ. de Méd. xxvii. 244. - -Footnote 865: - - Dec. I. Ann. i. Obs. 8. - -Footnote 866: - - Journ. der Prakt. Heilkunde, li. 5, p. 117. - -Footnote 867: - - Mem. of Lond. Med. Soc. v. 112. - -Footnote 868: - - Seltene Beobachtungen zur Anat. Physiol. und Pathol. Berlin, 1824, ii. - 36. Quoted by Marx, die Lehre von den Giften, I. ii. 163. - -Footnote 869: - - Die Wirkung der Arzneimittel und Gifte, iii. 86. - -Footnote 870: - - Zeller, in Reil’s Archiv. viii. 233. - -Footnote 871: - - Nouvelle Bibliothèque Médicale, 1828, iv. 17 and 18. - -Footnote 872: - - See the last Edition of this work, p. 366. - -Footnote 873: - - See my Dispensatory, 1842, p. 507. - -Footnote 874: - - Reil’s Archiv., viii. 228. - -Footnote 875: - - Journal der Praktischen Heilkunde, lx. 115. - -Footnote 876: - - Toxicologie 3te Auflage, 539. - -Footnote 877: - - Ibidem, 433. - -Footnote 878: - - Journal de Chimie Médicale, 1842, p. 428. - -Footnote 879: - - Buchner’s Repertorium für die Pharmacie, lxxvi. 249. - -Footnote 880: - - Journal de Chimie Médicale, 1843, p. 137. - -Footnote 881: - - Hodgson’s Trial, Edin. Med. and Surg. Journal, xxii. 439, also a case - by Mr. Blacklock, Ibid. xxxvi. 92. - -Footnote 882: - - Case by Ollivier in Archives Gén. de Méd. ix. 100; also one by Mr. - Valentine, Edin. Med. and Surg. Journal, xiv. 471. - -Footnote 883: - - Case by Fontenelle, Arch. Gén. de Méd. v. 345; also Hodgson’s Trial. - -Footnote 884: - - Hodgson’s Trial; also Orfila, Tox. Gén. i. 263: and Mr. Valentine’s - 5th case, the only survivor. - -Footnote 885: - - Hodgson’s Trial; also Mr. Buchanan’s case in Lond. Med. Repos. xix. - 374. - -Footnote 886: - - Mr. Valentine’s Cases, Edin. Med. and Surg. Journal, xiv. 470. - -Footnote 887: - - Mr. Anderson’s case in Edin. Med. and Surg. Journal, xiv. 474. - -Footnote 888: - - Essay on Mineral Poisons, p. 52. - -Footnote 889: - - Dumonceau in Journ. de Med. lxix. 36; Orfila, Tox. Gén. i. 264; and - Blacklock’s case. - -Footnote 890: - - Edin. Med. and Surg. Journal, xiv. 468. - -Footnote 891: - - Ibid. xliv. 26. - -Footnote 892: - - xli. 204. - -Footnote 893: - - London Medical Gazette, viii. 616. - -Footnote 894: - - Edin. Med. and Surg. Journal, xxxvi. 92. - -Footnote 895: - - Archives Gén. de Méd. ix. 99. - -Footnote 896: - - Orfila, Tox. Gén. i. 265. - -Footnote 897: - - Mr. Valentine’s cases. - -Footnote 898: - - Ollivier’s case, and Fontenelle’s. - -Footnote 899: - - Case by Devergie in Arch. Gén. de Méd. ix. 463. - -Footnote 900: - - Houlston, in London Med. Journal, vi. 271. - -Footnote 901: - - Arch. Gén. de Méd. ix. 463. - -Footnote 902: - - Toxicol. Gén. i. 263. - -Footnote 903: - - Journal de Chimie Médicale, 1842, p. 294. - -Footnote 904: - - Edin. Med. and Surg. Journal, xiv. 468. - -Footnote 905: - - Mr. Valentine’s 4th case. - -Footnote 906: - - London Medical Gazette, viii. 616. - -Footnote 907: - - London Medical Gazette, vii. 329. - -Footnote 908: - - Ibidem, 1842–43, i. 556. - -Footnote 909: - - Mr. Valentine’s case 1st. - -Footnote 910: - - Case in Med. and Phys. Journal, xli. - -Footnote 911: - - Case by Dr. Anderson in Edin. Med. and Surg. Journal, vii. 437. - -Footnote 912: - - Beddoes’ Contributions to Physical and Medical Knowledge, 1799, p. - 231. - -Footnote 913: - - London Medical Gazette, 1842–43, i. 941. - -Footnote 914: - - Edinburgh Med. and Surg. Journal, li. 114. - -Footnote 915: - - Ibidem, xiv. 474. - -Footnote 916: - - Manual of Medical Jurisprudence, 162. - -Footnote 917: - - Lond. Med. and Phys. Journal, xli. - -Footnote 918: - - Toxic. Générale, i. 282, from Degneri Historia Med. de Dysent. Bilios. - Contag. 250. - -Footnote 919: - - Lond. Med. and Phys. Journal, xli. 204. - -Footnote 920: - - Reports of Medical Cases, ii. 337. - -Footnote 921: - - Lancet, 1838–39, i. 215. - -Footnote 922: - - M. Colson in Arch. Gén. de Méd. xii. 84. - -Footnote 923: - - Dr. Ramsbotham in Lond. Med. Gazette, i. 775. - -Footnote 924: - - Dr. Crampton, Trans. Dublin College of Physicians, iv. 91. - -Footnote 925: - - See page 335. - -Footnote 926: - - Rust’s Magazin, xxv. 578. - -Footnote 927: - - Journal der Praktischen Heilkunde, ix, ii. 201. - -Footnote 928: - - Lond. Med. and Phys. Journal, xxvi. 452. - -Footnote 929: - - Ibid. xxvii. 275. - -Footnote 930: - - Trans. Lond. Coll. Phys. i. 34. - -Footnote 931: - - Revue Medicale, 1828, iv. 76. - -Footnote 932: - - Ibidem, 1829, i. 467, from Osservatore Medico di Napoli, Febb. 1829. - -Footnote 933: - - Dr. Tott, in Rust’s Magazin für die gesammte Heilkunde, xxxv. 50. - -Footnote 934: - - Journ. de Chem. Med. ix. 197. - -Footnote 935: - - London Medical Gazette, 1837–38, ii. 578. - -Footnote 936: - - De Ptyalismo Febrili. Diss. Inaug. Lipsiæ, in Halleri Disput. de Morb. - Histor. i. 469. - -Footnote 937: - - See Evidence of Mr. Bromfield on the Trial of Miss Butterfield for the - murder of Mr. Scawen, p. 40. - -Footnote 938: - - London Medical Gazette, 1839–40, ii. 875. - -Footnote 939: - - Lancet, 1843–44, i. 60. - -Footnote 940: - - London Medical Gazette, 1841–42, i. 338. - -Footnote 941: - - Swédiaur on Venereal Diseases, ii. 251. - -Footnote 942: - - Colson in Arch. Gén. de Méd. xii. 99. - -Footnote 943: - - Flora Suecica. - -Footnote 944: - - On the Venereal Disease, ii. 143. - -Footnote 945: - - Colson in Arch. Gén. de Méd. xii. 99. - -Footnote 946: - - The exact time is not mentioned. - -Footnote 947: - - Trial by Gurney and Blanchard, pp. 39, 47. - -Footnote 948: - - Principles of Forensic Medicine, 2d Ed. 118. - -Footnote 949: - - Trans. of the Prov. Med. and Surg. Association, ii. 262. - -Footnote 950: - - Mead’s Medical Works, p. 202. - -Footnote 951: - - Male’s Juridical Medicine, 89. - -Footnote 952: - - Archives Gén. de Méd. xl. 254. - -Footnote 953: - - Ibid. xii. 100. - -Footnote 954: - - Trans. Dublin Coll. Physicians, iii. 236. - -Footnote 955: - - Appendix to his Traité de la Colique Metallique, p. 275. - -Footnote 956: - - Edin. Med. and Surg. Journal, viii. 376, and ix. 180. - -Footnote 957: - - Reports of Medical Cases, ii. 495. - -Footnote 958: - - Fernelius, de Lues Ven. Curat. c. vii. - -Footnote 959: - - London Med. and Phys. Journal, lxvii. 394. - -Footnote 960: - - Arch. Gén. de Méd. xiv. 109. - -Footnote 961: - - Mém. de l’Acad. des Sciences, 1719, p. 474. - -Footnote 962: - - Edin. Med. and Surg. Journal, viii. 195. - -Footnote 963: - - London Medical Repository, xvi. 458. - -Footnote 964: - - Mémoires de l’Acad. de Chirurgie, iv. 154. - -Footnote 965: - - Wibmer. Die Wirkung der Arzneimittel und Gifte, iii. 46. - -Footnote 966: - - Diss. Inaug. de Effectibus Liquidorum in vias aëriferas applicatorum, - p. 35. - -Footnote 967: - - Hufeland’s Journal, xlii. - -Footnote 968: - - Mr. Hill in Edin. Med. Ess. iv. 38. - -Footnote 969: - - Corvisart’s Journal, xxv. 209. - -Footnote 970: - - London Journal of Science, x 354. - -Footnote 971: - - Edin. Med. and Surg. Journal, vi. 513, and London Medical and Physical - Journal, xxvi. 29. - -Footnote 972: - - Horn’s Archiv für Medizinische Erfahrung, 1831, 519. - -Footnote 973: - - Edin. Med. and Surg. Journal, vii. 437. - -Footnote 974: - - Ibidem, xliv. 26. - -Footnote 975: - - Medizinisch-Chirurgische Zeitung, 1833, v. 330. - -Footnote 976: - - Repertorium für die öffentl. und gerichtl. Arzneiwissenschaft, i. 223. - -Footnote 977: - - Annalen der Gesetz-gebung, iii. 55. - -Footnote 978: - - Journ. de Physiologie, i. - -Footnote 979: - - Annals of Philos. xiv. 241, 321. - -Footnote 980: - - See my Dispensatory, 1842, p. 500. - -Footnote 981: - - Acta Naturæ Curiosorum, Dec. ii. Ann. vi. Obs. 231. - -Footnote 982: - - Journal de Médecine, l. 3. - -Footnote 983: - - Dr. Sigmond in Lancet, 1837–38, i. 228, from Turner’s Treatise on - Diseases of the Skin. - -Footnote 984: - - Ibidem, p. 227. - -Footnote 985: - - I. 240. - -Footnote 986: - - Opera Omnia, p. 729. - -Footnote 987: - - Arch. Gén. de Médecine, xix. 330. - -Footnote 988: - - Sur l’usage et les Abus des Caustiques. Paris, 1817. Quoted by Wibmer - Smith found two drachms kill a dog when swallowed, and half a drachm - proved fatal in two dogs when applied to a wound. - -Footnote 989: - - Lancet, 1836–37, i. 401. - -Footnote 990: - - London Medical Gazette, xiii. 117. - -Footnote 991: - - Cours de Médecine-Légale. - -Footnote 992: - - Handbuch der Toxicologie, 1838, p. 250. - -Footnote 993: - - Wibmer. Die Wirkung der Arzneimittel und Gifte, iii. 66. - -Footnote 994: - - Ibidem, iii. 647. - -Footnote 995: - - Arch. Gén. ix. 102. - -Footnote 996: - - Thibert, Anatomie Pathologique, extracted in the American Journal. of - Med. Science, April, 1842, p. 490. - -Footnote 997: - - De Medicamentis insecuris et infidis, in Oper. Omn. vi. 314. - -Footnote 998: - - Miscellanea Curiosa, 1692. Dec. ii. Ann. x. p. 34. - -Footnote 999: - - Die Wirkung der Arzneimittel und Gifte, iii. 72. - -Footnote 1000: - - Johnson on Tropical Climates, pp. 45, 151, 267.—Annesley on the - Diseases of India.—Musgrave on Mercury, in Edin. Med. and Surg. Journ. - xxviii. 42. - -Footnote 1001: - - Dr. Fletcher. American Journal of Med. and Phys. Sciences, vii. 561. - -Footnote 1002: - - Miscellanea Curiosa, l. c. - -Footnote 1003: - - Die Wirkung der Arzneimittel und Gifte, iii. 72. - -Footnote 1004: - - London Medical Gazette, 1837–38, ii. 610. - -Footnote 1005: - - M. Mialhe in Annales de Chimie et de Physique, Juin, 1842. - -Footnote 1006: - - Manual of Medical Jurisprudence, p. 178. - -Footnote 1007: - - For the documents in this trial I am indebted to my late colleague Dr. - Duncan, Junior, who was concerned in it. - -Footnote 1008: - - Toxicol. Gén. i. 310. - -Footnote 1009: - - Recherches sur un Nouvel Antidote contre le sublimé corrosif, p. 34. - -Footnote 1010: - - Toxicol. Gén. p. 311. - -Footnote 1011: - - Taddei, Recherches, &c. p. 92. - -Footnote 1012: - - Edin. Med. and Surg. Journal, xxii. 438. - -Footnote 1013: - - As in Devergie’s Case (Arch. Gén. ix 468), in which they were as big - as peas. - -Footnote 1014: - - Ibidem. - -Footnote 1015: - - Devergie in Arch. Gén. ix 468. - -Footnote 1016: - - Sir B. Brodie in Philos. Trans. 1812. - -Footnote 1017: - - Edin. Med. and Surg. Journ., xiv. 472, 473. - -Footnote 1018: - - London Medical Gazette, viii. 618. - -Footnote 1019: - - Recherches sur un Nouvel Antidote, &c. p. 61. - -Footnote 1020: - - Archives Gén. de Méd. ix. 470. - -Footnote 1021: - - Journal de Chim. Médicale, viii. 268. - -Footnote 1022: - - Orfila, Traité de Médecine Légale, iii. 134. - -Footnote 1023: - - Edin. Med. and Surg. Journal, li. 115. - -Footnote 1024: - - The reader may apply this statement to the trial of Mr. Angus, p. 118. - -Footnote 1025: - - Edin. Med. and Surg. Journal, vii. 151. - -Footnote 1026: - - Augustin’s Repertorium, B. i. H. ii. 11. - -Footnote 1027: - - xli. 207. - -Footnote 1028: - - Journal de Médecine, l. iii. 15, or Recueil Périodique de la Soc. de - Méd. vii. 343. - -Footnote 1029: - - Revue Medicale, 1830, ii. - -Footnote 1030: - - Toxicologie Gén. i. 313. - -Footnote 1031: - - Corvisart’s Journal de Médecine, xxxviii. 77. - -Footnote 1032: - - Dissert. Inaug. p. 36. - -Footnote 1033: - - See my Dispensatory, p. 518. Dr. Wright’s Thesis on certain points - connected with the action of mercury and its salts has not yet been - published. - -Footnote 1034: - - London Med. Repository, xix. 408. - -Footnote 1035: - - Trans. of Dublin Coll. of Phys. iii. 310. - -Footnote 1036: - - Journal de Chim. Méd. Mars, 1825. - -Footnote 1037: - - Recherches sur un Nouvel Antidote, &c. p. 26. - -Footnote 1038: - - Giornale di Fisica, 1826, vi. 170, and Buchner’s Repertorium für die - Pharmacie ii. 229. - -Footnote 1039: - - London Medico-Chirurgical Review, v. 612. - -Footnote 1040: - - Buchner’s Repertorium für die Pharmacie, iv. 51. - -Footnote 1041: - - Annales d’Hygiène Publique, xxviii. 427. - -Footnote 1042: - - Journal de Chimie Médicale, 1843, p. 10. - -Footnote 1043: - - Dr. Hort. American Journal of Med. Science, vi. 540. - -Footnote 1044: - - Edin. Med. and Surg. Journal, xxix. 218. - -Footnote 1045: - - Lond. Med. Repos. N. S. vi. 368. - -Footnote 1046: - - Lond. Med. Gazette, 1836–37, ii. 144. - -Footnote 1047: - - Burnett on Criminal Law, 547. - -Footnote 1048: - - Journal de Chimie Médicale, 1842, p. 771. - -Footnote 1049: - - Dégrange, London Medical Gazette, 1842–43, i. 495. - -Footnote 1050: - - Falconer on the Poison of Copper, p. 23. - -Footnote 1051: - - Expériences sur l’Empoisonnement par l’oxyde de Cuivre. Diss. Inaug. - Paris, 1802. Quoted in Orfila’s Toxicol. i. 502. - -Footnote 1052: - - Sur l’usage prétendu dangereux de la vaisselle de cuivre dans nos - cuisines. Histoire de l’Acad. Roy. des Sciences de Berlin, 1756, p. - 12. - -Footnote 1053: - - Toxicol. Gén. 1843, i. 612. - -Footnote 1054: - - Beck’s Medical Jurisprudence, 460. - -Footnote 1055: - - Falconer, &c. pp. 48, 98, 110. - -Footnote 1056: - - Sur l’usage, &c. p. 12. - -Footnote 1057: - - Falconer, &c. p. 63. - -Footnote 1058: - - Histoire de l’Acad. de Berlin, 1756, p. 16. - -Footnote 1059: - - Falconer, &c. p. 79. - -Footnote 1060: - - Annales de Chimie, lvii. 79, 81. - -Footnote 1061: - - Practisches Handb. für Physiker, iii. 312, Case 49. - -Footnote 1062: - - Fabricii Hildani Opera omnia. Genevæ, 1682. De Dysenteria, p. 669. - -Footnote 1063: - - Orfila, Toxicol. Générale, i. 507. - -Footnote 1064: - - Trans. London College of Physicians, iii. 80. - -Footnote 1065: - - On the Poison of Copper, 86. - -Footnote 1066: - - On the Poison of Copper, 88; also Paris and Fonblanque’s Medical - Jurisprudence, ii. 289. - -Footnote 1067: - - Annales de Chimie, lvii. 80. - -Footnote 1068: - - On the Poison of Copper, p. 18. - -Footnote 1069: - - Annales, &c. p. 80. - -Footnote 1070: - - Medical Observations and Inquiries, ii. 11. - -Footnote 1071: - - On the Poison of Copper, 106. - -Footnote 1072: - - Proust, Annales de Chimie, lvii. 83. - -Footnote 1073: - - Geschichte der Mineralischen Gifte, p. 77. - -Footnote 1074: - - Lond. Med. Journal, ii. 411, from Journ. de Méd. - -Footnote 1075: - - Archives Gén. de Méd. xix. 471. - -Footnote 1076: - - Annales d’Hygiène Publ. et de Méd. Légale, iii. 342. - -Footnote 1077: - - Archives Gén. de Méd. xxi. 145. - -Footnote 1078: - - Buchner’s Repertorium für die Pharmacie, xxxiii. 236. - -Footnote 1079: - - Pignant in Journ. de Chim. Méd. viii. 339. - -Footnote 1080: - - Toxicologie Gén. 1826, i. 510. - -Footnote 1081: - - Schweigger’s Journal der Chemie, xvi. 340, 436. - -Footnote 1082: - - Journal de Pharmacie, xvi. 505. - -Footnote 1083: - - Bulletins de la Société Roy. de Méd. 1838–39, p. 113. - -Footnote 1084: - - Journal de Chimie Médicale, 1840, p. 475. - -Footnote 1085: - - Ibid. viii. 442, 573. - -Footnote 1086: - - L’Experience, Avril 27, 1843. - -Footnote 1087: - - Journal de Chimie Méd. ix. 147. - -Footnote 1088: - - Ibidem, 1840, p. 28. - -Footnote 1089: - - Toxicologie Gén. 1843, i. 637. - -Footnote 1090: - - Orfila. Toxic. Gén. i. 511. - -Footnote 1091: - - ibid. Toxic. i. 513. - -Footnote 1092: - - Buchner’s Repertorium für die Pharmacie, lxxvi. 352. - -Footnote 1093: - - Toxicol. Générale, i. 515. - -Footnote 1094: - - Edinburgh Med. and Surg. Journal. lvi. 110. - -Footnote 1095: - - Utrum per viventium adhuc anim. membr. et arter. pariet. mat. - ponderab. permeare queant, 13. - -Footnote 1096: - - Ueber die Wirkung des Kupfers auf den thierischen Organismus, in - Buchner’s Repertorium für die Pharmacie, xxxii. 337, 1829. - -Footnote 1097: - - Ibidem, lxxii. 56. - -Footnote 1098: - - Journal de Chimie Médicale, 1840, p. 475. - -Footnote 1099: - - Observations sur les effets des vapeurs méphitiques, 437. - -Footnote 1100: - - Orfila, Toxicol. Gén. i. 500. - -Footnote 1101: - - Annales d’Hygiène Publique, 1840, xxiv. 100. - -Footnote 1102: - - Arch. Gén. de Médecine, xix. 329. - -Footnote 1103: - - _Ut supra_, 103, 106. - -Footnote 1104: - - Corvisart’s Journal de Médecine, xviii. 54. - -Footnote 1105: - - _Ut supra_, 108, 110, 113. - -Footnote 1106: - - _Ut supra_, xviii. 56. - -Footnote 1107: - - Journal de Chimie Médicale, 1841, p. 309. - -Footnote 1108: - - Toxicol. Gén. i. 519. - -Footnote 1109: - - Aufsätze und Beobacht. aus der gericht. Arneiwiss. viii. 85. - -Footnote 1110: - - Practisches Handbuch für Physiker, iii. 308. - -Footnote 1111: - - Journ. de Chimie Médicale, v. 413. - -Footnote 1112: - - Die Wirkung der Arzneimittel und Gifte, ii. 253. - -Footnote 1113: - - Trans. London Coll. Phys. iii. 88. - -Footnote 1114: - - Quoted by Dr. Thomson in Lancet, 1836–37, ii. 640. - -Footnote 1115: - - Traité des Maladies des Artizans, p. 78. - -Footnote 1116: - - Traité de la Colique Métallique, p. 103. - -Footnote 1117: - - London Medical Gazette, 1838–39, i. 195, 697. - -Footnote 1118: - - Gangrene could not have taken place in thirteen hours. The appearance - must have been black extravasation, which has often been mistaken for - gangrene. See page 267. - -Footnote 1119: - - Portal sur les effets des vapeurs méphitiques, 436, 439. - -Footnote 1120: - - Orfila, Tox. Gén. i. 530. - -Footnote 1121: - - Dict. des Sciences Médicales, vii. 564. - -Footnote 1122: - - Orfila, Tox. Gén. i. 534. - -Footnote 1123: - - Orfila, Tox. Gén. i. 535. - -Footnote 1124: - - Ibidem, i. 539. - -Footnote 1125: - - Ibidem, i. 540. - -Footnote 1126: - - Ibidem, i. 541. - -Footnote 1127: - - Journal de Pharmacie, xviii. 570. - -Footnote 1128: - - London Medico-Chirurgical Review, v. 611. - -Footnote 1129: - - Taylor’s Medical Jurisprudence, 1844, p. 206. - -Footnote 1130: - - Orfila, Toxicol. Générale, i. 466. - -Footnote 1131: - - Edinburgh Med. and Surg. Journal, xxviii. 71. - -Footnote 1132: - - Ibid, xxviii. 71. - -Footnote 1133: - - Journal de Chimie Médicale, 1840. - -Footnote 1134: - - Memoire sur l’Emétique, or Orfila, Toxicol. Gén. i. 469. - -Footnote 1135: - - De Effectibus liquidorum, &c. p. 32. - -Footnote 1136: - - Diss. Inaug. de Venenis Mineral. Edin. 1813. P. 23. - -Footnote 1137: - - Diction. de Méd. et de Chir. Pratiques, Art. Antimoine, iii. 69. - -Footnote 1138: - - Journal de Chim. Médicale, 1840, p. 291, and Orfila, Toxicologie - Générale, 1843, i. 475. - -Footnote 1139: - - Annales d’Hygiène Publique, xxix. 427. - -Footnote 1140: - - Buchner’s Repertorium für die Pharmacie, lxxviii. 107, from Comptes - Rendus de l’Institut. - -Footnote 1141: - - Orfila, Toxicol, i. 74. - -Footnote 1142: - - Ibid. i. 478. - -Footnote 1143: - - Bulletins des Sciences Médicales, xvii. 243. - -Footnote 1144: - - Taylor’s Medical Jurisprudence, 205, from Casper’s Wochenschrift. - -Footnote 1145: - - Edin. Med. and Surg. Journal, xxii. 227. - -Footnote 1146: - - Laennec, Auscultation Médiate, i. 493. - -Footnote 1147: - - On the Nature and Treatment of Cholera, p. 24. - -Footnote 1148: - - Mr. Greenwood, Lancet, 1835–36, ii. 142. - -Footnote 1149: - - Renauld in Journ. Univ. des Sciences Médicales, xvii. 120. - -Footnote 1150: - - Mem. of Lond. Med. Soc. ii. 386. - -Footnote 1151: - - Ibidem, v. 81. - -Footnote 1152: - - Corvisart’s Journ. de Med. xxvi. 221. - -Footnote 1153: - - Mem. of Lond. Med. Soc. iv. 79. - -Footnote 1154: - - Journal de Chimie Médicale, iv. - -Footnote 1155: - - Lond. Med. Repos, xvi. 357. - -Footnote 1156: - - London Medical Gazette, xii. 496. - -Footnote 1157: - - Lohmerer in Journal de Chimie Médicale, 1840, p. 629. - -Footnote 1158: - - Orfila, Toxicol. Générale, i. 480. - -Footnote 1159: - - De Medicamentis Venenorum vim habentibus. Opera Omnia, T. 1. p. ii. - 213. - -Footnote 1160: - - Diss. Inaug. de Effectibus liquidorum, &c. p. 32. - -Footnote 1161: - - Archives Générales de Médecine, xlvii. 364. - -Footnote 1162: - - Orfila, Toxicol. Générale, i. 475. - -Footnote 1163: - - Bulletins des Sciences Médicales, vi. 259. - -Footnote 1164: - - Bulletins de l’Acad. Roy. de Médecine, 1840, vi. 140. - -Footnote 1165: - - Manual of Medical Jurisprudence, 1844, p. 209. - -Footnote 1166: - - Toxicologie Générale, i. 555. - -Footnote 1167: - - Orfila, Journal de Chimie Médicale, 1842, p. 346. - -Footnote 1168: - - Horn’s Archiv für Medizinische Erfahrung, 1823, ii. 415. - -Footnote 1169: - - Toxicol. Gén. 1843, ii. 10. - -Footnote 1170: - - Recherches Chimiques sur l’Etain, Paris, 1781. - -Footnote 1171: - - See Wibmer, die Wirkung der Arzneimittel und Gifte, v. 168. - -Footnote 1172: - - Toxicologie Gén. 1843, ii. 5. - -Footnote 1173: - - Medical Times, Oct. 9, 1841. - -Footnote 1174: - - Edinburgh Med. and Surg. Journal, lvi. 119. - -Footnote 1175: - - Toxicol. Gén. i. 581. - -Footnote 1176: - - De Effect. Liquid. ad vias aëriferas applic. Tübingæ, 1816, p. 33. - -Footnote 1177: - - London Medico-Chirurgical Transactions, vii. 2. Journal der - Practischen Heilkunde, Juli, 1824. - -Footnote 1178: - - Wibmer. Die Wirkung, &c. i. 212, from Rust und Casper’s Kritische - Repertorium, xix. 454. - -Footnote 1179: - - Journal de Chimie Médicale, 1842, p. 351. - -Footnote 1180: - - Ibid. 1843, p. 348. - -Footnote 1181: - - Annales d’Hygiène Publique, xxix. 430. - -Footnote 1182: - - Journal de Chimie Médicale, 1839, p. 434. - -Footnote 1183: - - Orfila, Toxicol. Générale, i. 593. - -Footnote 1184: - - Magendie, Formulaire pour les nouveaux Médicamens. - -Footnote 1185: - - Toxicol. 241. - -Footnote 1186: - - Medicina Rationalis Syst. ii. c. 8. Sect. 12. - -Footnote 1187: - - Toxicol. Gén. i. 501. - -Footnote 1188: - - Journal de Chimie Médicale, 1842, p. 344. - -Footnote 1189: - - Bulletins des Sciences Méd. xx. 188. From the Heidelberg Klinische - Annalen, also Wibmer, Die Wirkung der Arzneimittel und Gifte, i. 416. - -Footnote 1190: - - Versuche über die Wirkungen des Baryts, Strontians, Chrom, &c. auf den - thierischen Organismus. 1824. - -Footnote 1191: - - Buchner’s Repertorium für die Pharmacie, lxix. 387. - -Footnote 1192: - - London Medical Gazette, 1843–44, ii. - -Footnote 1193: - - Ed. Med. and Surg. Journ. xxvi. 133. - -Footnote 1194: - - Journal de Chimie Médicale, 1842, p, 353. - -Footnote 1195: - - Toxicologie Gén. i. 569. - -Footnote 1196: - - Edinburgh Med. and Surg. Journal, lvi. 110. - -Footnote 1197: - - Journal de Chimie Médicale, 1842, p. 353. - -Footnote 1198: - - Médecine Légale, iv. 165. - -Footnote 1199: - - Guy’s Hospital Reports, vi. 17. - -Footnote 1200: - - Orfila, Tox. i. 573. - -Footnote 1201: - - Journal Gén. de Médecine, lvi. 22. - -Footnote 1202: - - Materialien für die Staatsarzneikunde, i. 122. - -Footnote 1203: - - Horn’s Archiv, 1824, ii. 259. - -Footnote 1204: - - Buchner’s Repertorium für die Pharmacie, xxvii. 317, and xxxiii. 104. - -Footnote 1205: - - Henke’s Zeitschrift für die Staatsarzneikunde, xxiii. 164. - -Footnote 1206: - - Magazin für die gesammte Heilkunde, xxi. 563. - -Footnote 1207: - - Annales de Chimie, lxxxvi. 59. - -Footnote 1208: - - Orfila’s Toxicologie, i. 567, from the Procès-verbal of the public - meeting of the Society of Liége in 1813. - -Footnote 1209: - - See Dr. Babington’s Paper in Guy’s Hospital Reports, vi. 16. - -Footnote 1210: - - Journal de Chimie Médicale, 1839, p. 389, from Casper’s Wochenschrift. - -Footnote 1211: - - Aufsätze und Beob. ii. 12. - -Footnote 1212: - - Versuche über die Wirkung des Baryts, &c. - -Footnote 1213: - - Toxicologie Gén. 1843, ii. 44. - -Footnote 1214: - - Magazin für die gesammte Heilkunde, xxi. 247. - -Footnote 1215: - - I shall take an early opportunity, with the permission of Messrs - Dewar, of publishing some of the details of these two cases, which are - most interesting in various respects. - -Footnote 1216: - - Versuche über die Wirkung des Baryts, &c. Heidelberg, 1824. - -Footnote 1217: - - Horn’s Archiv für Medizinische Erfahrung, 1830, ii. - -Footnote 1218: - - British Annals of Medicine, i. 41. - -Footnote 1219: - - Ibidem, 132. - -Footnote 1220: - - Schubarth, Journal der Praktischen Heilkunde, lii. 101. - -Footnote 1221: - - See a paper by myself in Edinburgh Royal Society Trans., 1842, xv. - 276, 274. - -Footnote 1222: - - Buchner’s Repertorium für die Pharmacie, xxxviii. 125. - -Footnote 1223: - - Mem. de l’Acad. des Sc. 1787, 281, sur les vins lithargyriés. - -Footnote 1224: - - Vitruv. de Architectura, L. viii. c. 7, Quot modis ducantur aquæ. - Editio Dun. Barbari, 1567, pp. 262, 265. - -Footnote 1225: - - De Medic. secundum locos, lvii. - -Footnote 1226: - - Researches into the Properties of Spring Waters, 1803, p. 193. - -Footnote 1227: - - Annales de Chim. lxxi. 197, l’an 1809. - -Footnote 1228: - - Experiments in Scudamore’s analysis of Tunbridge Water, 1816. - -Footnote 1229: - - A Treatise on Poisons, &c. First Edition, 1829. - -Footnote 1230: - - Philosophical Magazine. Third Series, v. 81, 1834. - -Footnote 1231: - - Guy’s Hospital Reports, 1838, iii. 60. - -Footnote 1232: - - Transactions of the Royal Society of Edinburgh, 1842, xv. 265. - -Footnote 1233: - - Toxicologie Gén. 1843, i. 657. - -Footnote 1234: - - Transactions of the Royal Society of Edinburgh, xv. 265. - -Footnote 1235: - - The statement here given of these phenomena is somewhat different from - what is contained in the last edition of this work. The present - account is derived from ulterior experiments, partly published in my - paper in the Edinburgh Transactions. The discrepancies formerly - prevailing between my own researches and those of Captain Yorke are - now completely reconciled. - -Footnote 1236: - - Journal de Chim. Méd. ix 714. - -Footnote 1237: - - Annales d’Hyg. Publ. et de Méd. Lég. iv. 55. 1830. - -Footnote 1238: - - Journal de Chim. Médicale, ix. 716. This adulteration has likewise - since then attracted attention in London. See British Annals of - Medicine, 1837, i. 15. - -Footnote 1239: - - Annales de Chimie, lxxi. 197. - -Footnote 1240: - - In distilled water containing a 12,000th of anhydrous _arseniate of - soda_ three lead rods weighing 71·235 grains became in thirty-three - days 71·240; in a solution of a 15,000th the lead, though slightly - whitened, retained its weight exactly, weighing at the end, as at the - beginning, of the experiment 62·622 grains. In distilled water - containing a 35,000th of anhydrous _phosphate of soda_, three lead - rods, which weighed together 73·949 grains, became in thirty-two days - 73·946; and in a comparative experiment with a solution containing a - 27,000th they gained 0·015. - -Footnote 1241: - - Sometimes, however, a minute trace of white powder is attached to the - bottom of the glass wherever the lead touches it. This is carbonate of - lead at first, and afterwards a mixture like that described in the - text. - -Footnote 1242: - - Mr. Morson in Pharmaceutic Journal, ii. 355. - -Footnote 1243: - - On Spring Waters, p. 23. - -Footnote 1244: - - Tronchin de Col. Pict. 66.—1757. - -Footnote 1245: - - De la Colique Métallique, 99, from Wanstroostwyk de l’Electricité - Médicale, p. 224. - -Footnote 1246: - - Appendix to Dr. Scudamore’s Analysis of the Mineral Water of - Tunbridge, p. 51. - -Footnote 1247: - - Some effect may perhaps be also owing to a difference between the - proportion of saline matter contained in the water of the Crawley - spring, which has been introduced into the city since Dr. Thomson - resided here, and the proportion in the water with which the city was - at that time supplied, I am not aware, however, of the difference - between them, or that any material difference does exist. - -Footnote 1248: - - Trans. of London College of Physicians, ii. 400. - -Footnote 1249: - - Hints on a mode of procuring Soft Water at Tunbridge—Journal of - Science, xiv. 352. - -Footnote 1250: - - Scudamore’s Pamphlet—Appendix—_passim_. - -Footnote 1251: - - Ibidem, p. 47. - -Footnote 1252: - - Edinburgh Royal Society Transactions, xv. 265. - -Footnote 1253: - - On Spring Waters, p. 14. - -Footnote 1254: - - Ibidem, 116. - -Footnote 1255: - - De la Colique Métallique, p. 98. - -Footnote 1256: - - Dr. Duncan’s Medical Commentaries, xix. 313. - -Footnote 1257: - - Comment. ad Boerhaave. § 1060, T. iii. 347. Edit. Lugd. Batav. 1753. - -Footnote 1258: - - Scudamore on the Analysis of Tunbridge Water, Appendix, 51, 53. - -Footnote 1259: - - Rozier. Observations sur la Physique, xiii. 145. - -Footnote 1260: - - Annales d’Hygiène Publique, 1842, xxvii. 111. - -Footnote 1261: - - Ann. de Chim. lvii. 82. - -Footnote 1262: - - Zoonomia, ii. 130. - -Footnote 1263: - - Trans. of London College of Physicians, iii. 227. - -Footnote 1264: - - On the Diseases of the Army in Jamaica, p. 269. - -Footnote 1265: - - Philosophical Magazine, liv. 229. - -Footnote 1266: - - Trans. of London College of Physicians, i. 216. - -Footnote 1267: - - On the Cause of the Endemical Colic of Devonshire. Transactions of the - London Coll. of Phys., i. ii. and iii. - -Footnote 1268: - - Annales d’Hygiène Publique, 1842, xxvii. 104. - -Footnote 1269: - - Elements of Medical Jurisprudence, ii. 319. - -Footnote 1270: - - Zeitschrift für die Staatsarzneikunde, 1827, xiii. 151. - -Footnote 1271: - - Mérat de la Colique Métallique. - -Footnote 1272: - - Diss. Inaug. sur la Collique de Madrid. Analyzed in Corvisart’s - Journal de Médecine, xxxiv. 208. - -Footnote 1273: - - Hohnbaum, &c. p. 157. - -Footnote 1274: - - Geschichte der Mineralischen Gifte, 194. - -Footnote 1275: - - Note in an Essay by his Son,—Ueber Vergiftung durch Käse. Horn’s - Archiv. 1828, i. 83. - -Footnote 1276: - - Gmelin’s Geschichte der Mineralischen Gifte, 216. - -Footnote 1277: - - Cockelius, Acta, &c. Dec. i. An. iv. Obs. 30. Brunnerus, Ibidem, Obs. - 92. Vicarius, Ibidem, Obs. 100. Riselius, Ibidem, Dec. i. An. v. Obs. - 251. - -Footnote 1278: - - Paris and Fonblanque’s Med. Jurisprudence, ii. 347. - -Footnote 1279: - - De la Colique Métallique, 212. - -Footnote 1280: - - Toxicologie Gén. i. 616. - -Footnote 1281: - - Dr. Macculloch on the Art of Wine-making, in Edin. Horticultural Mem. - i. 134. - -Footnote 1282: - - Sur les Vins lithargyriés Mém. de l’Académie, 1787, p. 280. - -Footnote 1283: - - Journal Gén. de Médecine, xliv. 321. - -Footnote 1284: - - Edin. Medical and Surgical Journal, viii. 213. - -Footnote 1285: - - Dehaen, Ratio Medendi, P. x. c. viii. § 1. - -Footnote 1286: - - Repertory of Arts, First Series, viii. 262. - -Footnote 1287: - - Trans. of Lond. Med. Society, i., or Edin. Med. and Surg. Journal, - viii. 211. - -Footnote 1288: - - The precipitate formed by the acetate of lead with albumen is - dissolved by nitric acid. From that formed with milk the acid removes - the oxide of lead entirely, leaving the casein. - -Footnote 1289: - - Journal de Chimie Médicale, 1842, 339. - -Footnote 1290: - - Toxicologie Générale, i. 630. - -Footnote 1291: - - Edin. Med. and Surg. Journal, lvii. 117. - -Footnote 1292: - - Journal de Physiologie, i. 284. - -Footnote 1293: - - Diss. Inaug. p. 27. - -Footnote 1294: - - De Effectibus liquidorum in vias aëriferas, &c. p. 43. - -Footnote 1295: - - De effectu plumbi in organismo animali sano, &c. auctore Carol. - Wibmer. Monachii, 1829, p. 29. - -Footnote 1296: - - Treatise on Poisons, Edition 1836, p. 509. - -Footnote 1297: - - Bulletin de l’Académie Roy. de Méd. 1840, vi. 283, and Toxicologie - Gén. 1843, i. 668, 684. - -Footnote 1298: - - Journal de Chim. Med. 1842, 344. - -Footnote 1299: - - Guy’s Hospital Reports, 1841, vi. 175. - -Footnote 1300: - - Archives Gén. de Médecine, liv. 106. - -Footnote 1301: - - London Med. Chir. Trans., 1842, xxv. 115. - -Footnote 1302: - - Annales d’Hygiène Publique, xx. 463, xxiv. 180. - -Footnote 1303: - - Ibidem, xxi. 164. - -Footnote 1304: - - L’Experience, Avril 27, 1843. - -Footnote 1305: - - Toxicologie Gén. 1843, i. 670. - -Footnote 1306: - - Arch. Gén. de Médecine, xix. 328. - -Footnote 1307: - - Corvisart’s Journal de Médecine. - -Footnote 1308: - - Krüger in Rust’s Magazin für die gesammte Heilkunde, xi. 535. - -Footnote 1309: - - Lancet, 1838, i. 786. - -Footnote 1310: - - Toxicologie Gén. i. 690. - -Footnote 1311: - - Manual of Medical Jurisprudence, 189. - -Footnote 1312: - - Experimental Inquiry on Iodine, p. 140. - -Footnote 1313: - - London Medical Gazette, v. 538. - -Footnote 1314: - - Lond. Med. Repos. N. S. vi. 368. - -Footnote 1315: - - Comment. 1060, T. iii. p 347. Editio Dan Barbari. - -Footnote 1316: - - Trans. Coll. Phys. London, iii. 426. - -Footnote 1317: - - Journal Universel, xx. 351. - -Footnote 1318: - - Bulletin de la Soc. Roy. de Méd. 1840, vi. 283. - -Footnote 1319: - - Manual of Medical Jurisprudence, p. 186. - -Footnote 1320: - - London Medical Repository, 1824, N. S. iii. 37. - -Footnote 1321: - - Edinburgh, Phys. and Lit. Essays, i. - -Footnote 1322: - - Traité des Maladies de Plomb. 1843. - -Footnote 1323: - - London Medical Gazette, 1839–40, 1, 687. - -Footnote 1324: - - Mérat de la Colique Métallique, 51. - -Footnote 1325: - - Ibid., p. 55. - -Footnote 1326: - - Tronchin de Colica Pictonum. Genevæ, 1757. - -Footnote 1327: - - Archives Gén. de Médecine, liv. 111. - -Footnote 1328: - - Louis, Recherches Pathologiques - -Footnote 1329: - - London Medical Gazette, 1837–38, ii. 158. - -Footnote 1330: - - British Annals of Medicine, i. 145. - -Footnote 1331: - - London Med.-Chir. Transactions, xxii. 82. - -Footnote 1332: - - Lancet, 1838–39, i. 65. - -Footnote 1333: - - Reports of Medical Cases, p. 394. - -Footnote 1334: - - Lambe on Spring Waters, p. 71. - -Footnote 1335: - - Hufeland’s Journal der Praktischen Heilkunde, Mars, 1839. - -Footnote 1336: - - Archives Gén. de Médecine, liv. 106. - -Footnote 1337: - - Transactions of London Coll. of Phys. i. 236, 301, 304. - -Footnote 1338: - - Annali Universali di Medicina, 1837, iv. 426. - -Footnote 1339: - - Lancet, Dec. 31, 1842. - -Footnote 1340: - - Trans. of Lond. Coll. Phys. i. 311. - -Footnote 1341: - - Ibid. iii. 435. - -Footnote 1342: - - Archives Gén. de Médecine, 1838, i. 353. - -Footnote 1343: - - Ibid., liv. 106. - -Footnote 1344: - - London Medical Gazette, April, 1843. - -Footnote 1345: - - On the Poison of Lead, p. 22. - -Footnote 1346: - - De la Colique Métallique. - -Footnote 1347: - - De Colica Pictonum, p. 56. - -Footnote 1348: - - Ibid. p. 65. - -Footnote 1349: - - De la Colique Métallique, p. 23. - -Footnote 1350: - - Journal de Chim. Médicale, 1840, 328. - -Footnote 1351: - - Ibid. _passim_. - -Footnote 1352: - - Calcineur,—a calciner of gypsum, I believe. - -Footnote 1353: - - Annales d’Hygiène Publique, xix. 23, xxv. 543, xxviii. 226. - -Footnote 1354: - - Journal Universel, xx. 353. - -Footnote 1355: - - Annales d’Hygiène Publique, xxi. 149. - -Footnote 1356: - - Corvisart’s Journ. de Médecine. - -Footnote 1357: - - British Annals of Medicine, i. 205. - -Footnote 1358: - - De la Colique Métallique, p 213. - -Footnote 1359: - - Trans. of Lond. Med. Society, 1810, or Edin. Med. and Surg. Jour. - viii. 211. - -Footnote 1360: - - Tronchin de Colica Pict. p. 117. - -Footnote 1361: - - De effectibus liquidorum ad vias aërif. applic. p. 43. - -Footnote 1362: - - British Annals of Medicine, i. 205. - -Footnote 1363: - - Trans. of Lond. Coll. of Physicians, i. 469. - -Footnote 1364: - - Trans. of Lond. Coll. Phys. i. 317. - -Footnote 1365: - - Annales d’Hygiène Publique, xxviii. 234. - -Footnote 1366: - - London Med. Chir. Transactions, 1839, xxii. 87. - -Footnote 1367: - - Traité des Maladies de Plomb, 1839, and Annales d’Hygiène Publique, - 1842, xxviii. 232. - -Footnote 1368: - - Trans. of London Coll. of Phys., ii. 83. - -Footnote 1369: - - Transactions Médicales, 1832, or, Annales d’Hygiène, 1841, xxv. 463, - and xxvi. 543. - -Footnote 1370: - - Annales d’Hygiène, xxv. 466. - -Footnote 1371: - - Clark, in Edin. Med. Comment, xi. 102. Berger, in Horn’s Archiv für - Mediz. Erfahrung, xi. 344. London Med. and Phys. Journ. xxvi. 46. - -Footnote 1372: - - Ratio Medendi, P. I. c. ix. de Variis. - -Footnote 1373: - - Trans. of London Coll. of Phys. ii. 457. - -Footnote 1374: - - Ed. Phys. and Lit. Ess. i. 521. - -Footnote 1375: - - Annales d’Hygiène Publique, xxv. 466. - -Footnote 1376: - - Archives Gén de Médecine, xli. 136. - -Footnote 1377: - - Annales d’Hygiène Publique, xv. 22. - -Footnote 1378: - - Annales d’Hygiène Publique, xv. 36. - -Footnote 1379: - - Annales d’Hygiène Publique, xix. 14. - -Footnote 1380: - - Annales d’Hygiène Publique. 1842, xxviii. 217. - -Footnote 1381: - - Philosophical Transactions, 1812, p. 218. - -Footnote 1382: - - Toxicologie Gén. i. 208. - -Footnote 1383: - - Versuche über die Wirkungen, &c. - -Footnote 1384: - - Diss. Inaug. de effectibus liquidorum ad vias aërif. applic. p. 30. - -Footnote 1385: - - Nicholson’s Journal, First Series, i. 529. - -Footnote 1386: - - Ed. Med. and Surg. Journ., lvi. 114. - -Footnote 1387: - - Orfila, Toxicol. Gén. i. 213. - -Footnote 1388: - - Observations sur la Strontiane. Ann. de Chimie, xxi. 119. - -Footnote 1389: - - Diss. Inaug. de venenis Mineralibus, p. 31. - -Footnote 1390: - - Annales d’Hygiène Publique, 1842, xxix. 425. - -Footnote 1391: - - Ibidem, xxviii. 216. - -Footnote 1392: - - Journal of Science, iv. 382. - -Footnote 1393: - - Henke’s Zeitschrift für die Staatsarzneikunde, 1835, xxx. 1. - -Footnote 1394: - - Medical Commentaries, xix. 267. - -Footnote 1395: - - London Medical Gazette, 1833–34, ii. 487. - -Footnote 1396: - - Parkes’s Chemical Essays, ii. 219. - -Footnote 1397: - - Essay on Poisons, p. 143. - -Footnote 1398: - - Toxicologie Gén. i. 216. - -Footnote 1399: - - Observations sur la Strontiane, Annales de Chimie, xxi. 119. - -Footnote 1400: - - Versuche über die Wirkungen, &c. - -Footnote 1401: - - Edin. Med. and Surg. Jour. lvi. 113. - -Footnote 1402: - - Toxicol. Gén. i. _passim_. - -Footnote 1403: - - Supplement to Dr. Duncan’s Dispensatory, p. 53. - -Footnote 1404: - - Buchner’s Repertorium für die Pharmacie, vi. 175. - -Footnote 1405: - - Ibidem, xxxvii. 203. - -Footnote 1406: - - Toxicologie Gén. i. 710. - -Footnote 1407: - - Edin Med. and Surg. Journal, li. 341. - -Footnote 1408: - - Phil. Trans. 1760, li. 662. - -Footnote 1409: - - Journal of Science, iii. 51. - -Footnote 1410: - - Aufsätze und Beobachtungen, i. 79. - -Footnote 1411: - - Edin. Med. and Surg Journal, xlix. 488. - -Footnote 1412: - - Toxicol. Gén. i. 712. - -Footnote 1413: - - Toxicol. Gén. i. 713. - -Footnote 1414: - - Archives Gén. de Méd. viii. 615. - -Footnote 1415: - - Journal de Chim. Méd. viii. 671. - -Footnote 1416: - - Orfila, Toxicol. Gén. 714. - -Footnote 1417: - - Botanical Arrangement, ii. 501. Stokes’s Edition. - -Footnote 1418: - - See on this subject Deyeux in Ann. de Chim. lxxiii. 106. - Boutron-Charlard et Henri, in Journal de Pharmacie, x. 466. Bussy et - Lecanu, ibid. xii. 481. - -Footnote 1419: - - Tractatus de Venenis in Opp. I. i. 308, quoted by Marx, die Lehre von - den Giften, i. 128. - -Footnote 1420: - - Manual of Medical Jurisprudence, 224. - -Footnote 1421: - - Toxicol. Gén. i. 706. - -Footnote 1422: - - Ibidem, i. 715. - -Footnote 1423: - - Mr. Bennet in London Medical Gazette, ix. 7. - -Footnote 1424: - - Med. Facts and Observations, vii. 293. - -Footnote 1425: - - Journal de Pharmacie, xxii. 118. - -Footnote 1426: - - Journ. de Chim. Méd. i. 343. - -Footnote 1427: - - Ibidem, i. 483. - -Footnote 1428: - - Flora Médicale des Antilles, iii. 14. - -Footnote 1429: - - Flore Médicale des Antilles, iii. 27. - -Footnote 1430: - - Landsberg. Therapeutische und Toxikologische Würdigung der Grana - Tiglii. Horn’s Archiv für Medizinische Erfahrung, 1831, 565. - -Footnote 1431: - - Journal de Chim. Médicale, 1839, 509. - -Footnote 1432: - - Journal de Pharmacie, iv. 289. - -Footnote 1433: - - Toxicol. Gén. i. 679. - -Footnote 1434: - - Nouv. Bibliothèque Medicale, Mai, 1827, p. 221. - -Footnote 1435: - - Neues Magazin. i. 3, p. 557. - -Footnote 1436: - - Toxicol. Gén. i. 680. - -Footnote 1437: - - Journal de Pharmacie, x. 416. - -Footnote 1438: - - Toxicol. Gén. i. 691. - -Footnote 1439: - - Observat. Medicinales, iv. c. 27, p. 218. - -Footnote 1440: - - Toxicol. Gén. i. 695. - -Footnote 1441: - - London Courier, Sept. 9, 1823. - -Footnote 1442: - - Toxicol. Gén. i. 695. - -Footnote 1443: - - Annales d’Hygiène Publique et de Méd. Lég. viii. 333. - -Footnote 1444: - - Edin. Med. and Surg. Journal, xxxv. 339. - -Footnote 1445: - - Journal of the Royal Institution, i. 532. - -Footnote 1446: - - Toxicol. Gén. i. 754. - -Footnote 1447: - - Toxicologie Gén. i. 754. - -Footnote 1448: - - Journal de Chimie Médicale, 1836, 273. - -Footnote 1449: - - Histoire des Plantes Vénéneuses de la France, p. 178. - -Footnote 1450: - - Ibidem, 180. - -Footnote 1451: - - Buchner’s Repertorium für die Pharmacie, lxviii. 346. - -Footnote 1452: - - Die Wirkung der Arzneimittel und Gifte, i. 17. - -Footnote 1453: - - Historia Stirpium Helvet. - -Footnote 1454: - - Rust’s Magazin für die Gesammte Heilkunde, xx. 451. - -Footnote 1455: - - Ann. de Chim. et de Phys xii. 358. - -Footnote 1456: - - Schweigger’s Journal der Chimie, xxv. 369. - -Footnote 1457: - - Toxicol. Gén. i. 739. - -Footnote 1458: - - Ibidem, 741. - -Footnote 1459: - - Journal de Chim. Méd. v. 567. - -Footnote 1460: - - Toxicol. Gén. i. 703. - -Footnote 1461: - - Lancet, 1837–38, i. 44. - -Footnote 1462: - - Hist. des Plantes Venen. de la Suisse, p. 140. - -Footnote 1463: - - Flora Suecica, No. 338. - -Footnote 1464: - - Withering’s Arrangement, i. 403, Stokes’s Edition. - -Footnote 1465: - - Descourtils. Flora Médicale des Antilles, iii. 57. - -Footnote 1466: - - Buchner’s Repertorium, lxviii. 80. - -Footnote 1467: - - Toxicologie Gén. ii. - -Footnote 1468: - - Horn’s Archiv für Mediz. Erfahrung, 1824, i. 65. - -Footnote 1469: - - Die Wirkung der Arzneim. und Gifte, ii. 388. - -Footnote 1470: - - Acta Curios. Nat. Dec. I. Ann. viii. p. 139. - -Footnote 1471: - - Trial of Webb. Lond. Med. Gaz. xiv. 612. Inquest on Rebecca Cross. - Ibidem, 759. Case by Drs. Labatt and Stokes. Dublin Journ. of Med. and - Chem. Science, iv. 237. - -Footnote 1472: - - Analysis by Mr. West in the first of these cases. - -Footnote 1473: - - Annali Universali di Medicina, 1839, iii. 41. - -Footnote 1474: - - Toxicol. Gén. i. 744. - -Footnote 1475: - - Repertorium für die Pharmacie, xxxvii. - -Footnote 1476: - - Dissertation Inaugurale, quoted in Orfila, Toxicol. Gén. i. 683. - -Footnote 1477: - - Tox. Gén. i. 758. The drug must have been much adulterated, as it very - generally is; for half a scruple is an active purgative to man. - -Footnote 1478: - - Orfila, Toxicol. Gén. i. 724. - -Footnote 1479: - - Méd. Légale, iv. 430. - -Footnote 1480: - - Ibid. iv. 431. - -Footnote 1481: - - Die Wirkung der Arzneimittel und Gifte, iii. 191. - -Footnote 1482: - - Annales de Chimie, lxxvi. - -Footnote 1483: - - Annales d’Hygiène Publique, xxviii. 347. - -Footnote 1484: - - Revue Medicale, 1828, ii. 475. - -Footnote 1485: - - Toxicol. Gén. ii. 4. - -Footnote 1486: - - Edin. Med. and Surg. Journal, li. 344. - -Footnote 1487: - - Orfila, Toxicol. Gén. ii. 28. - -Footnote 1488: - - Annales de la Med. Physiologique, Octobre, 1829—extracted in Edin. - Med. and Surg. Journal, xxxiv. 214. - -Footnote 1489: - - London Medical Gazette, 1841–42, i. 63. - -Footnote 1490: - - Hufeland’s Journal der Praktischen Heilkunde, lii. 2, 112. - -Footnote 1491: - - See an interesting case in Memorie della Soc. Med. di Genova, ii. 1, - p. 29. - -Footnote 1492: - - Graaf’s Cases, and Rouquayrol’s. - -Footnote 1493: - - Lib. xxi. des Venins. - -Footnote 1494: - - See the case in Memorie della Soc. Med. di Genova, ii. 1, p. 29. - -Footnote 1495: - - Toxicol. Gén. ii. 23. - -Footnote 1496: - - Hufeland’s Journal, lii. 2, 114. - -Footnote 1497: - - Mem. dell’ Acad. de Torino, 1802–3. - -Footnote 1498: - - Toxicol. Gén. ii. 30. - -Footnote 1499: - - Medizinische-Chirurgische Zeitung, 1834, iv. 298, from American - Journal of Medical Science. - -Footnote 1500: - - Taylor’s Manual of Medical Jurisprudence, 228. - -Footnote 1501: - - Medical Jurisprudence, 574, from New York Med. and Phys. Journal. - -Footnote 1502: - - Mem. della Soc. Med. di Genova, ii. 1, 29. - -Footnote 1503: - - Report of the Coroner’s Inquest in Standard Newspaper, Jan. 1841. - -Footnote 1504: - - Archiv. für Medizinische Erfahrung, 1834, i. 61–64. - -Footnote 1505: - - Annales d’Hygiène Publique, xxviii. 383. - -Footnote 1506: - - Revue Médicale, 1828, ii. 475. - -Footnote 1507: - - Magazin für die gesammte Heilkunde, xviii. 109. - -Footnote 1508: - - Journal Complémentaire, xviii. 184. - -Footnote 1509: - - Cuvier, Règne Animal, v. 63. - -Footnote 1510: - - Edin. Med. and Surg. Journal, iv. 393. - -Footnote 1511: - - Memoirs of the London Medical Society, v. 94. - -Footnote 1512: - - Edin. Philos. Journal., i. 194. - -Footnote 1513: - - Lond. Med. Repository, iii. 445. - -Footnote 1514: - - Edin. Med. and Surg. Journal, xxix. 86. - -Footnote 1515: - - Toxicol. Gén. ii. 37. - -Footnote 1516: - - Médecine Légale, iv. 85. - -Footnote 1517: - - 1er Mars, 1812; 1er Octobre, 1812; 21 Mars, 1813; Avril, 1813. - -Footnote 1518: - - De Mytilorum quorundam veneno,—Acta Physico-Medica - Acad.—Cæsareo-Leopoldino-Carol. &c. 1744. Appendix, p. 124. - -Footnote 1519: - - De Mytilorum, &c. p. 115. - -Footnote 1520: - - Edin Med. and Surg. Journal, xxix. 88. - -Footnote 1521: - - Voyage of Discovery, ii. 285. - -Footnote 1522: - - Orfila, Toxic. Gén. ii. 44. - -Footnote 1523: - - Annales d’Hygiène Publique, xvii. 360. - -Footnote 1524: - - De Mytilorum, &c. p. 117, 121, 124. - -Footnote 1525: - - Toxicol. Gén. ii. 45. - -Footnote 1526: - - De Mytilorum, &c. p 134. - -Footnote 1527: - - Journal de Pharmacie, v. 25, from Essai Medical sur les huitres. - -Footnote 1528: - - London Med. Repository, xiii. 58. - -Footnote 1529: - - Trans. London Coll. of Phys. v. 109. - -Footnote 1530: - - Journal de Pharmacie, v. 509. - -Footnote 1531: - - For a severe case, not fatal, occurring in Kent, see London Medical - Gazette, xii. 464. - -Footnote 1532: - - Magazin für die gesammte Heilkunde, xx. 155. - -Footnote 1533: - - Bulletins des Sciences Medicales, x. 92. - -Footnote 1534: - - Ibidem, xx. 195. - -Footnote 1535: - - Journal der Praktischen Heilkunde, 1829, ii. iv. 120. - -Footnote 1536: - - Rust’s Magazin für die gesammte Heilkunde, xxxii. 361. - -Footnote 1537: - - Robineau-Devoidy in Archives Gén. de Méd. xxi. 626. - -Footnote 1538: - - Giornale di Fisica. ix. 458, and Meckel’s Archiv für Anat. und - Physiol. iii. 639. - -Footnote 1539: - - Edin. Med. and Surg. Journal, xviii.; Phil. Trans. 1810. - -Footnote 1540: - - Wibmer, Die Wirkung der Arzneimittel und Gifte, i. 200. - -Footnote 1541: - - Journal de Médecine, 1765. - -Footnote 1542: - - Gazette de Santé, 1776. - -Footnote 1543: - - Archives Gén. de Médecine, xi. 30. - -Footnote 1544: - - Trans. of Med. and Phys. Soc. of Calcutta, iv. 442. - -Footnote 1545: - - Histoire d’une Maladie très-singulière, &c. in Hist. de l’Académie des - Sciences, 1766, i. 97. - -Footnote 1546: - - London Med. and Phys. Journal, lvii. 342. - -Footnote 1547: - - Dr. Duncan’s Cases of Diffuse Inflammation of the cellular texture—in - Edin. Med. Chirurg. Trans. i. 455, 470, 1824. Also, - -Footnote 1548: - - Mr. Travers on Constitutional Irritation, 1826. - -Footnote 1549: - - Rust’s Magazin, xxiv. 490. Also Annali Univ. di Med. 1811, iii. 449. - -Footnote 1550: - - Ibidem, xxv. 108. - -Footnote 1551: - - Kopp’s Jahrbuch, v. 67, and vi. 95. - -Footnote 1552: - - Rust’s Magazin, xxv. 105. - -Footnote 1553: - - Revue Médicale, 1827, ii. 488. - -Footnote 1554: - - Journal der Praktischen Heilkunde, liv. iii. 62. - -Footnote 1555: - - Magazin der Ausländischen Literatur, iii. 460, v. 168. - -Footnote 1556: - - I have taken the liberty of applying this term to an establishment - unique perhaps in the history of the world. The Voirie et Chantier - d’Ecarrissage of Montfaucon, which has existed close to the walls of - Paris for several centuries, is an enclosure of many acres, where the - contents of the necessaries of the city are collected in enormous - pits, and where horses, dogs, and cats are flayed to the amount of - forty or fifty thousand annually. The fat is melted for blowpipe - lamps; the bones are in a great measure burnt on the premises for - fuel; the intestines are made into coarse gut for machinery; the - flesh, blood, and garbage are heaped to putrefy for manure; and in - summer a bed of compost is spread to breed maggots for feeding - poultry. There is no drain. Description cannot convey an idea of the - stench. The committee of the Board of Health, appointed to make - inquiries into the best mode of abating the nuisance, in vain - attempted to penetrate into the place. Yet the workmen and their - families are stout, healthy, and long lived. - -Footnote 1557: - - Des Chantiers d’Ecarrissage. Annales d’Hyg. Publ. et de Méd. Lég. - viii. 139. Sur l’enfouissement des Animaux morts de maladies - contagieuses. Ibid. ix. 109. - -Footnote 1558: - - Journal de Physiologie, ii. 1, and iii. 81. - -Footnote 1559: - - Journal des Progrès des Sciences Médicales, 1827, vi. 181. - -Footnote 1560: - - Journal de Physiologie, iii. 85. - -Footnote 1561: - - De divers accidens graves occasionnés par les miasmes d’animaux en - putréfaction. Mém. de la Soc. de Med. i. 97.—London Med. Chirurg. - Review, vi. 202. - -Footnote 1562: - - Annales d’Hyg. Publique et de Med. Légale, vii. 216. - -Footnote 1563: - - Ibidem, viii. and ix. _ut supra_. - -Footnote 1564: - - Dr. Duncan, Edin. Med. Chirurg. Trans. i. 502 and 520. - -Footnote 1565: - - Neue Beobachtungen über die Vergiftungen durch dens genuss - geraücherten Würste. Tübingen, 1820.—Das Fettgift, oder die Fettsaüre, - und ihre Wirkungen auf den thierischen Organismus. Tübingen, 1822. - -Footnote 1566: - - De Veneni Botulini viribus et natura. Diss. Inaug. Berolini, 1828. - -Footnote 1567: - - De Veneno in Botulis. Commentatio in certamine lit. a gratioso Med. - Ord. Berol. Præmio ornata, 1828. Analyzed by Dr. Arrowsmith in Edin. - Med. and Surg. Journal, xxxiii. 28. - -Footnote 1568: - - Horn’s Archiv, 1828, i. 558. - -Footnote 1569: - - Röser, in London Med. Gazette, 1842–43, i. 271. - -Footnote 1570: - - Weiss, die neuste Vergift. durch Verdorbene Würste, &c. mit Vorrede - und Anhang begleitet, von Dr. J. Kerner. Carlsruhe, 1821. - -Footnote 1571: - - Horn’s Archiv, 1828, i. 596. - -Footnote 1572: - - Toxicologie, Zweite Auff. 1829, p. 136. - -Footnote 1573: - - Das Wurst-fett-gift. oder neue Untersuchung, &c. Archiv für - Medizinische Erfahrung, 1829, i. 30 and 75. - -Footnote 1574: - - Hufeland’s Journal, lvii. 2, 106. - -Footnote 1575: - - Magazin für die gesammte Heilkunde, xxi. 247. - -Footnote 1576: - - Die Chemische Ausmittelung des Käsegifts. Horn’s Archiv, 1827, i. 203. - -Footnote 1577: - - Ueber die Vergiftung durch Käse. Horn’s Archiv, 1828, i. 65. - -Footnote 1578: - - Ann. de Chimie et de Physique, xxxvi. 159. - -Footnote 1579: - - Archives Gén. xv. 460. - -Footnote 1580: - - Rust’s Magazin, xxvii. 193. - -Footnote 1581: - - Horn’s Archiv. 1828, i. 76. - -Footnote 1582: - - Rust’s Magazin, xvi. 111. - -Footnote 1583: - - London Medical and Physical Journal, xlvi. 68. - -Footnote 1584: - - Orfila, Médecine-Légale, ii. 322. - -Footnote 1585: - - Archives Gén. de Méd. - -Footnote 1586: - - Journ. de Chim. Méd. viii. 726. - -Footnote 1587: - - Annales d’Hygiène Publique, xxi. 234. - -Footnote 1588: - - Annales d’Hygiène Publique, xx. 413. - -Footnote 1589: - - Journal de Chimie Med. 1842, 872. - -Footnote 1590: - - Journal of the Institution, ii. 414, from Hufeland Journal. - -Footnote 1591: - - Bulletins des Sciences Méd. xx. 197. - -Footnote 1592: - - London Med. Gazette, xiv. 656. - -Footnote 1593: - - London Med. Repository, Third Series, iii. 372. - -Footnote 1594: - - Edin. Med. and Surg. Journal, xlvi. 293. - -Footnote 1595: - - London Medical and Physical Journal, xxxv. 100. - -Footnote 1596: - - Observations on Surgery. 276. - -Footnote 1597: - - London Medico-Chirurgical Transactions, xii. 52. - -Footnote 1598: - - Annales d’Hygiène Publique, xxi. 188. - -Footnote 1599: - - Sur les Blessures par armes de guerre, i. 82. Also, Lond. Med. Gaz. - 1838–39, ii 799. - -Footnote 1600: - - London Med. Gazette, 1836–37, ii. 275. - -Footnote 1601: - - Ueber den Selbstmord, p. 168, from Schmucker’s Vermischte Chirurgische - Schriften. - -Footnote 1602: - - Diss. Inaug., Paris, 1810. Analyzed in Sedillot’s Journal de Méd. - xxxix. 331. - -Footnote 1603: - - Saggi scient. e litter. dell’ Acad. di Padova, T. iii. P. ii. p. 1, - quoted in Marx, die Lehre von den Giften, I. ii. 196. - -Footnote 1604: - - Meyan, Causes Célèbres. Edit. 2, 1808. T. ii. 324, quoted by Marx, die - Lehre von den Giften, I. ii. 298. - -Footnote 1605: - - Ann. d’Hyg. Pub. et de Méd. Lég. iii. 365. - -Footnote 1606: - - Midland Medical and Surgical Reporter, i. 47, 1828. - -Footnote 1607: - - Instruction sur le Traitement des Asphyxiés, &c. p. 118. - -Footnote 1608: - - Med. and Surg. Journal, xxii. 233. - -Footnote 1609: - - Arch. Gén. de Méd. xiii. 372. - -Footnote 1610: - - London Medico-Chirurgical Transactions, xii. 1. - -Footnote 1611: - - Philosophical Transactions, xlix. 477, 483. - -Footnote 1612: - - Magazin für die gesammte Heilkunde, xxi. 549. - -Footnote 1613: - - Annales de Hygiène Publique, 1842, xxvii. 397. - -Footnote 1614: - - London Med. Gazette, 1837–38, i. 177. - -Footnote 1615: - - London Courier, Oct. 1, 1828. - -Footnote 1616: - - London Med. Gazette, 1839–40, i. 559. - -Footnote 1617: - - Journal de Chim. Méd. vi. 265. - -Footnote 1618: - - Ibidem, vi. 458. - -Footnote 1619: - - Archives Gén. de Méd. xxi. 616, or Journ. de Chim. Méd. v. 621, and - vi. 63. - -Footnote 1620: - - Journal de Pharmacie, xvi. 322, or Journ. de Chim. Méd. vi. 263. - -Footnote 1621: - - Annales d’Hyg. Publique et de Méd. Légale, viii. 25. - -Footnote 1622: - - Journal de Chim. Med. iv. 275. - -Footnote 1623: - - Annales d’Hyg. Publique et de Med. Légale, i. 235. - -Footnote 1624: - - Dictionnaire de Méd. et Chirurg. Pratiques, v. 124. - -Footnote 1625: - - Recherches sur l’Apoplexie, p. 70. - -Footnote 1626: - - Beiträge zur Gerichtlichen Arzneikunde, iii. 40. - -Footnote 1627: - - London Medical and Physical Journal, xlvii. 181. - -Footnote 1628: - - Recherches sur l’Apoplexie, 212. - -Footnote 1629: - - Ibidem, p. 214. - -Footnote 1630: - - Instances of congestive apoplexy thus arising were then quoted. I may - here add a very apposite instance of hemorrhagic apoplexy, occurring - in similar circumstances. Dr. Jennings, an American physician, - mentions the case of a female fifty years of age, who, after a full - meal, tumbled down in a fit of insensibility and immediately expired, - and in whom after death there was found enormous distension of the - stomach with food, an extensive effusion of blood into the central - parts of the brain, and ossification of the cerebral arteries. (London - Med. Gazette, xvi. 735.) - -Footnote 1631: - - Annales d’Hygiène Publique, xx. 170. - -Footnote 1632: - - Rochoux, Recherches sur l’Apoplexie, 66. - -Footnote 1633: - - Recherches sur le Ramollissement du Cerveau, p. 150. - -Footnote 1634: - - Pathological and Practical Researches on Diseases of the Brain, p. - 210. - -Footnote 1635: - - Recherches Pathologiques, 460, 466, and 472. - -Footnote 1636: - - Archives Gén. de Méd. xxiii. 260. - -Footnote 1637: - - Journal de Médecine, xiii. 315. - -Footnote 1638: - - Edin. Med. and Surg. Journal, xxxii. 262. - -Footnote 1639: - - London Med. Gazette, xi. 777. - -Footnote 1640: - - Recherches sur le Ramollissement du Cerveau, p. 133 and 135. - -Footnote 1641: - - Pathological Researches, 214. - -Footnote 1642: - - Beiträge zur gerichtl. Arzneik. ii. 61, iii. 42, iv. 42. - -Footnote 1643: - - Reports of Medical Cases, ii. 240, 242, 244. - -Footnote 1644: - - Pathological Researches, 216. - -Footnote 1645: - - Annales d’Hygiène Publique, 1841, xxvi. 399. - -Footnote 1646: - - Article Epilepsie in Dictionnaire de Médecine, viii. 209. - -Footnote 1647: - - Diction. de Med. xii. 512. - -Footnote 1648: - - Georget, _in loco cit._ 212. - -Footnote 1649: - - The body in this case was not examined. - -Footnote 1650: - - Edin. Med. and Surg. Journal, x. 40. - -Footnote 1651: - - Esquirol, Dict. des Sciences Méd. xii. 528. - -Footnote 1652: - - Corvisart’s Journ. de Méd. xiii. 315, and xl. 81; also Prost, la - Médecine éclairée par l’ouverture des cadavres, ii. 382, 389, 394. - -Footnote 1653: - - Nouveau Journal de Médecine, ii. 269. - -Footnote 1654: - - Journal Hebdomadaire et Universel, iv. 366. - -Footnote 1655: - - Portal, Observations sur la nature et le traitement de l’Epilepsie, p. - 65 and 67. - -Footnote 1656: - - Memorie della Soc. Méd. di Genova, i. 89. - -Footnote 1657: - - Portal, _passim_. - -Footnote 1658: - - On Diseases of the Brain and Spine, Cases 18, 19, 20. - -Footnote 1659: - - On Chronic Inflammation of the Brain, Ed. Med. and Surg. Journal, xiv. - -Footnote 1660: - - Reports of Medical Cases, ii. 14, 15. - -Footnote 1661: - - Lancet, 1838–39, ii. 236. - -Footnote 1662: - - On Diseases of the Brain and Spine, Cases 16 and 17. - -Footnote 1663: - - Recherches sur le Ramollissement de Cerveau, 1819, 1823. - -Footnote 1664: - - Recherches Anat. Pathol. sur l’Encephale. 1820. - -Footnote 1665: - - See also Dr. Abercrombie on Diseases of the Brain and Spinal Cord, p. - 71. - -Footnote 1666: - - Opera varia, Venetiis, 1739.—De Mortibus Subitaneis, p. 12. - -Footnote 1667: - - London Medical Repository, N. S. ii. 318. - -Footnote 1668: - - Recherches Anatomico-Pathologiques, 313. - -Footnote 1669: - - Laennec, Revue Médicale, 1828, iv. Dance, Répertoire Gén. d’Anatomie - Pathologique, vi. 197. - -Footnote 1670: - - On the Diseases of the Brain and Spinal Cord, Case 132. - -Footnote 1671: - - Ibidem, Case 131. Ollivier, Traité de la moelle épinière, Obs. 42. - -Footnote 1672: - - Abercrombie, Case 138. - -Footnote 1673: - - London Medico-Chirurgical Transactions, i. 157. - -Footnote 1674: - - Recherches sur l’Apoplexie, p. 159. - -Footnote 1675: - - Annales d’Hygiène Publique, xx. 173. - -Footnote 1676: - - Archives Gén. de Med. 1838, i. 40. - -Footnote 1677: - - Archives Gén. xiv. 406. - -Footnote 1678: - - London Medical Gazette, viii. 47. - -Footnote 1679: - - Lancet, July 31, 1841. - -Footnote 1680: - - Elements of Materia Medica, 1842, p. 1738. - -Footnote 1681: - - London Medical Gazette, xviii. 930. - -Footnote 1682: - - Serullas Journ. de Chim. Méd. vi. - -Footnote 1683: - - Edin. Med. and Surg. Journal, xxxv. 331. - -Footnote 1684: - - Buchner’s Repertorium für die Pharmacie, 2te Reihe, xxxii. 104. - -Footnote 1685: - - Procès de Castaing, p. 113. - -Footnote 1686: - - Ann. de Chim. et de Phys. xxv. 102. - -Footnote 1687: - - Toxicol. Gén. ii. 60. - -Footnote 1688: - - Orfila, Tox. Gén. 1813, ii. 254. - -Footnote 1689: - - Reports of Medical Cases, ii. 203. - -Footnote 1690: - - Repertorium für die Pharmacie, xxxi. 174.—Professor Orfila, in the - last edition of his Toxicologie Gén. [1843, ii. 253], has attacked in - no very measured terms this opinion of Professor Buchner and myself. - But, although he professes to give a literal translation of the - passage above, he has translated it so incorrectly as wholly to - misrepresent our opinion. The close of the paragraph, “chemical - analysis must often fail to detect opium where there could be no doubt - of its _having been administered_ in large quantity,” is rendered into - French by the Parisian Professor in these words,—“l’analyse chimique, - propre à constater l’existence de l’opium, est souvent inutile, même - dans le cas _ou il existe_ une grande quantité de cette - substance,”—which is a very different proposition. Orfila clearly - overrates the utility of the process for detecting opium, both in this - criticism and in his whole observations on the subject, by losing - sight of the tendency of absorption to remove the poison beyond reach. - -Footnote 1691: - - Bombay Med. Phys. Transactions, i. 322. - -Footnote 1692: - - Die Verdauung nach Versuchen, &c. - -Footnote 1693: - - Journal of Science, N. S. vi. 56. - -Footnote 1694: - - Dr. Pereira states that he is obliged to differ from me upon this - important subject for he “has several times obtained from the stomach - of subjects in the dissecting-room a liquor which reddened the salts - of iron” (Elements of Materia Medica, p. 1741). This fact, however, - does not exactly touch the question. The reddening must be occasioned, - not in the crude fluid, but with a substance obtained by the process - of analysis for detecting meconic acid in complex organic - mixtures,—otherwise the proposition in the text stands good. - -Footnote 1695: - - Experiments on Opium. Appendix to Treatise on Febrile Diseases, vi. - 697. - -Footnote 1696: - - Edin. Lit. and Phys. Essays, iii. 309. - -Footnote 1697: - - Monro, Ibidem, 331, and Philip, _ut supra_, p. 680. - -Footnote 1698: - - Toxicol. Gén. ii. 77. - -Footnote 1699: - - Monro, Edin. Phys. and Lit. Essays, ii. 335, 324.—Charret, Revue - Médicale, 1827, i. 515. - -Footnote 1700: - - On the Operation of Poisonous Agents on the Living Body, _passim_. - -Footnote 1701: - - Revue Médicale, 1827, i. 514. - -Footnote 1702: - - Archives Gén. vii. 558. - -Footnote 1703: - - Arch. Gén. i. 150. - -Footnote 1704: - - Ann. de Chim. et de Phys. 1824, xxv, 102. - -Footnote 1705: - - Journ. de Chim. Méd. 1841, 488. - -Footnote 1706: - - Narrative of a Visit to the Court of Sinde, p. 231. - -Footnote 1707: - - Rust’s Magazin, iii. 24. - -Footnote 1708: - - Archives Gén. vii. 550. - -Footnote 1709: - - Journal Universel, xix. 340. - -Footnote 1710: - - American Medical Recorder, xiii. 418, from Gemeinsame Deutsche - Zeitschrift für Geburtshilfe, 1826, i. 1. - -Footnote 1711: - - Corvisart’s Journal de Médecine, xvi. 22. - -Footnote 1712: - - Lond. Med. and Phys. Journal, xlix. 119. - -Footnote 1713: - - De Usu Opii, iv. 149. - -Footnote 1714: - - Journal Universel, xix. 340. - -Footnote 1715: - - London Med. and Phys. Journal, xxxi. 468. - -Footnote 1716: - - Edin. Med. and Surg. Journal, vii. 305. - -Footnote 1717: - - Reports of Medical Cases, ii. 205, 206. - -Footnote 1718: - - Journal de Médecine, xvi. 21. - -Footnote 1719: - - Arch. Gén. vii. 552. - -Footnote 1720: - - London Med. Chir. Trans. i. 77. - -Footnote 1721: - - Edin. Med. and Surg. Journ. xiv. 603. - -Footnote 1722: - - Journ. Universel, xix. 340. - -Footnote 1723: - - Edin. Med. and Surg. Journal, vii. - -Footnote 1724: - - Journ. Universel, xix. 340. - -Footnote 1725: - - Melier in Archives Gén. de Méd. xiv. 406. - -Footnote 1726: - - Corvisart’s Journ. de Méd. xvi. 21. - -Footnote 1727: - - Lancet, 1836–37, i. 271. - -Footnote 1728: - - Aufsätze und Beobachtungen, i. 93. - -Footnote 1729: - - Ollivier’s case in Arch. Gén. vii. 550. - -Footnote 1730: - - Corv. Journ. de Méd. xxxiv. 274. - -Footnote 1731: - - Aufsätze und Beobachtungen, i. 94, 100. - -Footnote 1732: - - Archives Gén. de Méd. li. 495. - -Footnote 1733: - - These effects must not be confounded with those which poppy-juice has - been known to cause when spoiled. A whole family of Jews were attacked - with violent vomiting and purging, in consequence of partaking of a - decoction of poppy-heads, which had been kept four days in a hot - stove, and had consequently undergone decomposition. The usual - narcotism was not produced at all. (Rust’s Magazin, xxii. 484.) - -Footnote 1734: - - Mém. de l’Acad. des Sciences, xxxviii. 1735. - -Footnote 1735: - - Toxicol Gén. from Bibliothèque Médicale, Août, 1806. - -Footnote 1736: - - Corvisart’s Journal de Médecine, iv. 3. - -Footnote 1737: - - Nouveaux Elémens de Thérapeutique, ii. 60. - -Footnote 1738: - - London Med. and Phys. Journal, xxviii. 81. This patient took at 4 A.M. - two ounces of wine of opium, became drowsy at 6, was capable of being - roused at 9, vomited by emetics a liquid coloured with laudanum, and - was kept awake for the rest of the day. But at 7 P.M. having - previously had a cough and brown sputa from vinegar entering his - windpipe, he became gradually more and more insensible, till at last - he was quite comatose; and in this state he continued till his death - on the evening of the third day. On dissection nothing was found in - the brain or stomach attributable to opium. - -Footnote 1739: - - London Med. and Phys. Journal, xxxi. 468. - -Footnote 1740: - - Aufsätze und Beobachtungen, i. 85. - -Footnote 1741: - - Mémoires de l’Institut—Sc. Physiques, ii. 107. - -Footnote 1742: - - Practisches Handbuch für Physiker, iii. 329. - -Footnote 1743: - - Edin. Med. and Surg. Journal, liv. 151. - -Footnote 1744: - - Paris and Fonblanque’s Medical Jurisprudence, ii. 388. - -Footnote 1745: - - Lancet, 1837–38, i. 304. - -Footnote 1746: - - Pyl’s Repert. für die gerichtl. Arzneiwissenschaft, iii. 145. - -Footnote 1747: - - See, for example, Parent-Duchatelet and D’Arcet on the health and - longevity of Tobacco-manufacturers and Woodfloaters, in Annales d’Hyg. - Publ. et de Méd. Lég. l. 169, and iii. 245. - -Footnote 1748: - - Voyages en Perse, iii. 93. - -Footnote 1749: - - Narrative of a Visit to the Court of Sinde, p. 230. - -Footnote 1750: - - Two Years in China, 1843, p. 243. - -Footnote 1751: - - Narrative, &c. p. 231. - -Footnote 1752: - - Edin. Medical and Surgical Journal, xxxvii. 123. - -Footnote 1753: - - Journal de Chimie Méd. iii. 24. - -Footnote 1754: - - Toxicologie Gén. ii. 81, 82. - -Footnote 1755: - - Journal de Chim. Méd. vii. 250. - -Footnote 1756: - - Ibidem, 1842, 583. - -Footnote 1757: - - Journal de Chimie Médicale, Avril, 1827, and Edin. Med. Journ. xxix. - 450. - -Footnote 1758: - - Ibidem, vii. 114. - -Footnote 1759: - - Bulletins de la Société Philomatique, 1818, p. 54:—Journal de Chimie - Médicale, Avril, 1827. - -Footnote 1760: - - Annali Universali di Med. xxxi. 169, xxxiv. 100. - -Footnote 1761: - - Journal de Chim. Méd. v. 410. - -Footnote 1762: - - Mém. de la Soc. Roy. de Médecine, i. 142. - -Footnote 1763: - - Journal de Chim. Méd. vii. 135. - -Footnote 1764: - - Revue Médicale, 1829, iii. 424. - -Footnote 1765: - - Procés Complet d’Edme-Samuel Castaing, p. 31. - -Footnote 1766: - - Edinburgh Med. and Surg. Journal, lvi. 296. - -Footnote 1767: - - Toxicol. Gén. ii. 70. - -Footnote 1768: - - Traité de Médecine Légale, iii. 353. - -Footnote 1769: - - Ibidem, iii. 356. - -Footnote 1770: - - Toxicol. Générale, ii. 70. - -Footnote 1771: - - Meckel’s Archiv für Anat. und Physiol. xiv. 19. - -Footnote 1772: - - Buchner’s Repertorium für die Pharmacie, xxxvi. 204. - -Footnote 1773: - - Journal de Chim. Méd. ix. 223. - -Footnote 1774: - - Bachner’s Toxicologie, p. 203. - -Footnote 1775: - - Henke’s Zeitschrift für die Staatsarzneikunde, xiv. 456. - -Footnote 1776: - - Toxicologie Générale, ii. 86. - -Footnote 1777: - - Krit, Annalen der Staatsarzn. I. iii. 501. - -Footnote 1778: - - Reports of Medical Cases, ii. 203. - -Footnote 1779: - - Lond. Med. and Phys. Journal, Feb. 1816. - -Footnote 1780: - - Magazin für die Gesammte Heilkunde, xvii. 121. - -Footnote 1781: - - Kritische Jahrbücher, ii. 100. When inflammation is found, it is not - improbably owing to irritants given to produce vomiting, but failing - to act. This was apparently the cause in a case described by Mr. - Stanley, Trans. London Coll. of Phys. vi. 414. - -Footnote 1782: - - Journ. de Méd. xxxiv. 267. - -Footnote 1783: - - The reference to this case has been lost. - -Footnote 1784: - - Augustin’s Repertorium, i. 2, 12. - -Footnote 1785: - - Medical Jurisprudence, ii. 394. - -Footnote 1786: - - Kritische Jahrbücher, ii. 100. - -Footnote 1787: - - Praktisches Handbuch für Physiker, iii. 331. - -Footnote 1788: - - Corvisart’s Journal de Médecine, xxxiv. 263. - -Footnote 1789: - - Magazin für die gesammte Heilkunde, iii. 24. - -Footnote 1790: - - Oral evidence at the Trial, also London Journal of Science, N. S. vi. - 56. - -Footnote 1791: - - Edinburgh Med. and Surg. Journal, liv. 151. - -Footnote 1792: - - Revue Médicale, 1828, ii. 473, 475. - -Footnote 1793: - - Sur les Contrepoisons de l’Arsénic, 93. - -Footnote 1794: - - Beck’s Medical Jurisprudence, 435. - -Footnote 1795: - - Edin. Med. and Surg. Journal, xxiii. 416. - -Footnote 1796: - - American Journal of the Med. Sciences, vii. 555. - -Footnote 1797: - - London Med. Repository, xviii. 26. - -Footnote 1798: - - London Med. and Phys. Journal, xlviii. 225. - -Footnote 1799: - - Reports of Medical Cases, ii. 203. - -Footnote 1800: - - Diss. Inaug. de Venenis in genere. Argentorati, 1767, quoted by Marx, - die Lehre von den Giften, I. ii. 237. - -Footnote 1801: - - London Med. Gazette, 1839–40, i. 878. - -Footnote 1802: - - Edin. Med. and Surg. Journal, xix. 247. - -Footnote 1803: - - Ibidem, xvii. 226. - -Footnote 1804: - - London Medical Gazette, xiv. 655. - -Footnote 1805: - - Lond. Med. Gaz., 1840–41, i. 390. - -Footnote 1806: - - London Med. Obs. and Inq., vi. 331. - -Footnote 1807: - - North American Med. and Surg. Journal, July 1826. - -Footnote 1808: - - London Med. and Chir. Transactions, xx. 86. - -Footnote 1809: - - Toxicol. Gén. ii. 110. - -Footnote 1810: - - Le Globe, vii. 525. Août, 1829. - -Footnote 1811: - - London Medical Gazette, 1840–41, i. 318. - -Footnote 1812: - - Annalen der Pharmacie, 1833, vii. 270. - -Footnote 1813: - - Edinburgh Medical and Surg. Journal, xxxix. 381. - -Footnote 1814: - - Orfila, Médecine-Légale, iii. 374. - -Footnote 1815: - - Orfila, Toxicologie Gén. ii. 137. - -Footnote 1816: - - Pharmaceutic Journal, 1843–44, 578. - -Footnote 1817: - - Orfila, Toxicol. Gén. ii. 137. - -Footnote 1818: - - Archives Gén. de Méd. i. 297. - -Footnote 1819: - - Corvisart’s Journal de Méd. xxvi. 353. - -Footnote 1820: - - On the Poisonous Vegetables of Great Britain, p. 3. - -Footnote 1821: - - Foderé, Médecine-Légale, iv. 25. - -Footnote 1822: - - Die Wirkung der Arzneimittel und Gifte, iii. 154. - -Footnote 1823: - - Acta Curiosorum Naturæ. Also Wibmer, Die Wirkung, &c. 146–154. - -Footnote 1824: - - Toxicologia, p. 87. - -Footnote 1825: - - Neues Magazin, ii. 3, p. 100. - -Footnote 1826: - - Foderé, Médecine-Légale, iv. 23. For another instance of the effects - of the seeds, not however fatal, see Acta Helvetica, v. 333. - -Footnote 1827: - - Edin. Phys. and Lit. Essays, ii. 268. - -Footnote 1828: - - Medoro in Edinburgh Med. and Surg. Journal, lv. 265. - -Footnote 1829: - - Toxicol. Gén. ii. 184. - -Footnote 1830: - - Dr. Schlegel, in Hufeland’s Journal, liv. ii. 29. - -Footnote 1831: - - Histoire des Solanum. 1813. - -Footnote 1832: - - Annales d’Hyg. Publique et de Méd. Légale, viii. 334. - -Footnote 1833: - - Toxicol. Gén. ii. 190. - -Footnote 1834: - - Journal de Chimie Médicale, 1840, 142. - -Footnote 1835: - - Dunal, &c. - -Footnote 1836: - - M. Des-Alleurs in Journ. de Chim. Méd. ii. 30. - -Footnote 1837: - - Bulletins de la Soc. Méd. d’Emul.—Mars, 1821. - -Footnote 1838: - - Journal de Chimie Médicale, 1837, 130. - -Footnote 1839: - - Journal de Pharmacie, xx. 96. - -Footnote 1840: - - Revue Médicale, xvii. 265. - -Footnote 1841: - - Schubarth in Journal der Praktischen Heilkunde, li. i. 125. - -Footnote 1842: - - Fechner’s Repertorium der Organischen Chemie, ii. 70, 75. - -Footnote 1843: - - Codex Medicamentarius, 389. - -Footnote 1844: - - Archives Gén. de Médecine, xx. 386. - -Footnote 1845: - - Archives Gén de Méd. xx. 386. - -Footnote 1846: - - Chevallier, Annales d’Hygiène Publique, &c. ix. 337. - -Footnote 1847: - - Archives Gén. de Méd. xx. 387. - -Footnote 1848: - - Journ. de Chim. Méd. ii. 561. - -Footnote 1849: - - Médecine-Légale, iii. 385. - -Footnote 1850: - - Journal de Pharmacie, 1837, p. 27. - -Footnote 1851: - - Ann. de Chim. et de Phys., xxvii. 200. - -Footnote 1852: - - Hufeland’s Journal der Praktischen Heilkunde, lii. i. 92. - -Footnote 1853: - - Journal de Chim. Méd. vi. 723. - -Footnote 1854: - - Ibidem, 1843, 94. - -Footnote 1855: - - Ann. de Chim. et de Phys. vi. 347. - -Footnote 1856: - - Lancet, 1836–37, ii. 324. - -Footnote 1857: - - Edinburgh Med. and Surg. Journal, li. 339. - -Footnote 1858: - - Annales de Chimie, xcii. 59. - -Footnote 1859: - - Diss. Inaug. de Venenatis Acidi Borussici in Animalia effectibus. - Tubingæ, 1805. - -Footnote 1860: - - Recherches et Considérations sur l’Acide Hydrocyanique. Paris, 1819. - -Footnote 1861: - - Journal Complémentaire, xxviii. 33. - -Footnote 1862: - - Bemerkungen über die Wirkungen der Blausaure. Hufeland’s Journal der - Praktischen Heilkunde, lii. 88. - -Footnote 1863: - - Bemerkungen, &c. 85. - -Footnote 1864: - - Recherches, &c. p. 136. - -Footnote 1865: - - Bemerkungen, &c. 81. - -Footnote 1866: - - Ibid. 82. - -Footnote 1867: - - Ann. de Chim. et de Phys. vi. - -Footnote 1868: - - Recherches, &c. 146. - -Footnote 1869: - - Edin. Med. and Surg. Journal, li. 339. - -Footnote 1870: - - Bemerkungen, &c. 83. - -Footnote 1871: - - Edin. Med. and Surg. Journal, li. 39. - -Footnote 1872: - - Krimer detected the acid in the blood of the heart of an animal killed - in 36 seconds by a few drops put on the tongue. Journ. Complémentaire, - xxviii. 37. - -Footnote 1873: - - Lassaigne, Journ. de Chim. Med. ii. - -Footnote 1874: - - Versuche ueber das Nervensystem, 271, quoted by Marx, die Lehre von - den giften, I. ii. 154. - -Footnote 1875: - - Ueber das Amerikanische Pfeilgift. Meckel’s Archiv. für Anat. und - Physiol. iv. 203. - -Footnote 1876: - - Recherches, &c. 221. - -Footnote 1877: - - Journal de Physiol. iii. 230. - -Footnote 1878: - - Annales d’Hyg. Publique et de Méd. Légale, xi. 240. - -Footnote 1879: - - Journal de Chim. Médicale, 1843, 94. - -Footnote 1880: - - Horn’s Archiv. 1824, i. 75. - -Footnote 1881: - - Edin. Journal of Science, ii. 215. - -Footnote 1882: - - Recherches, &c. 221. - -Footnote 1883: - - Horn’s Archiv für Medizinische Erfahrung, 1827, i. 73. - -Footnote 1884: - - Coullon, 221. - -Footnote 1885: - - Revue Médicale, xvii. 271. - -Footnote 1886: - - Nicholson’s Journal, xxxi. 191. - -Footnote 1887: - - Ueber die giftige Wirkungen der unächten Angustura.— Hufeland’s - Journal, xl. iii. 68. - -Footnote 1888: - - Archives Gén. de Méd. iii. 269. - -Footnote 1889: - - Hufeland’s Journal, lii. i. 93. - -Footnote 1890: - - Wibmer. Die Wirkung der Arzneimittel und Gifte, iii. 138, from - Harless, Jahrbuch der Medizin, ix. 1. - -Footnote 1891: - - Meckel’s Archiv für Anat. und Physiol. vii. 543, 545. - -Footnote 1892: - - Wibmer. Die Wirkung der Arzneimittel, &c. iii. 136. - -Footnote 1893: - - Horn’s Archiv für Medizinische Erfahrung, 1830, ii. 858. - -Footnote 1894: - - Recherches, &c. 127. - -Footnote 1895: - - London Med. and Phys. Journal, xlvi. 359 and 363. - -Footnote 1896: - - Journal der Praktischen, Heilkunde, xl. i. 85. - -Footnote 1897: - - Archiv für Mediz. Erfahrung, 1813, 510. - -Footnote 1898: - - Ann. de Chimie, xcii. 63. - -Footnote 1899: - - Revue Médicale, 1825, i. 265. - -Footnote 1900: - - Edinburgh Med. and Surg. Journal, li. 51. - -Footnote 1901: - - Such as Sobernheim in his Handbuch der Toxicologie, 1838, 455. - -Footnote 1902: - - Medinisch-chirurgische Zeitung, 1829. i. 377. - -Footnote 1903: - - Annales d’Hyg. Publ. et de Med. Lég. ii. 497. - -Footnote 1904: - - Trial of Freeman for the murder of Judith Buswell at Leicester, April - 2, 1829. - -Footnote 1905: - - Professor Amos of the London University, in criticizing in his - Lectures what I have said of this case in the first edition of the - present work, has accused me of misstating the evidence, and grounds - the charge on a Report by a professional Reporter, where no notice is - taken of the phial having been wrapped up in paper, or of the - bed-clothes having been pulled up to the chin, or of the arms being - crossed over the trunk [Lond. Med. Gazette, viii. 577]. I have - nevertheless thought it right to retain my original statement of the - evidence, as it was derived from what I still consider the best - authority,—the medical witness, who mentions the special fact on which - he founded the most important, indeed the only important professional - opinion in the case, and to which therefore his attention must have - been more pointedly turned than that of any Law-Reporter. The Report - alluded to by Professor Amos was afterwards published in the Medical - Gazette, viii. 759. - -Footnote 1906: - - Medizinisch-chirurgische Zeitung, 1829, i. 396. - -Footnote 1907: - - Buchner’s Repertorium für Pharmacie, xxi. 313. - -Footnote 1908: - - Edinburgh Medical and Surg. Journal, lix. 72. - -Footnote 1909: - - Orfila, Annales d’Hyg. Publ. et de Méd. Lég. i. 507. - -Footnote 1910: - - Dublin Medical Journal, viii. 308. - -Footnote 1911: - - Edinburgh Med. and Surg. Journal, xlviii. 44. - -Footnote 1912: - - Coullon, Recherches, &c. p. 200. - -Footnote 1913: - - Journ. de Chim. Médicale, vii. 426. - -Footnote 1914: - - Handbuch der Toxikologie, 1838, 443. - -Footnote 1915: - - Annales d’Hyg. Publique, &c. xi. 240. - -Footnote 1916: - - Journal de Chimie Médicale, 1843, 95, 98. - -Footnote 1917: - - See Note at p. 365. - -Footnote 1918: - - Beiträge zur Geschichte der Blausaure, 1809. - -Footnote 1919: - - Journal Complémentaire, xvii. 366. - -Footnote 1920: - - Recherches, &c. - -Footnote 1921: - - Magazin für die ges. Heilkunde, xiv. 104. - -Footnote 1922: - - Magazin für die ges. Heilkunde, xxiii. 375. - -Footnote 1923: - - Bemerkungen, &c. Hufeland’s Journal, lii. i. 76. - -Footnote 1924: - - Annales d’Hyg. Publ. et de Méd. Lég. iv. 422. - -Footnote 1925: - - Rust’s Magazin, xx. 577. - -Footnote 1926: - - Manual of Medical Jurisprudence, 251. - -Footnote 1927: - - Edinburgh Med. and Surg. Journal, li. 52. - -Footnote 1928: - - Archiv für Anatomie und Physiologie, iii. 485, vi. 37. - -Footnote 1929: - - Edinburgh Medical and Surgical Journal, li. 53. - -Footnote 1930: - - Lancet, 1838–39, i. 880, and ii. 14. - -Footnote 1931: - - _Ut supra_, p. 52. - -Footnote 1932: - - Journal Complémentaire, xvii. 366. - -Footnote 1933: - - London Med. and Phys. Journal, lvii. 151. - -Footnote 1934: - - Coullon, Recherches sur l’Acide Hydrocyanique, 225, _et passim_. - -Footnote 1935: - - Edin. Philosoph. Journal, vii. 124 and Edin. Journal of Science, ii. - 214. - -Footnote 1936: - - Archives Gén. de Méd. xi. 30. - -Footnote 1937: - - Toxicologie Gén. ii. 167. - -Footnote 1938: - - Archiv für Anatomie und Physiologie, 1828, p. 208. - -Footnote 1939: - - Annales d’Hyg. Publ. et de Méd. Lég. i. 511. - -Footnote 1940: - - Repertorium für die Pharmacie, xii. 144. - -Footnote 1941: - - Dr. Geoghegan, in Lancet, 1835–36, i. 174. - -Footnote 1942: - - Repertorium für die Pharmacie, xii. 141. - -Footnote 1943: - - Ibidem, xii. 144. - -Footnote 1944: - - London Med. and Surg. Journal, iii. 58. - -Footnote 1945: - - Annales d’Hyg. Publ. et de Méd. Lég. 525. - -Footnote 1946: - - Archiv für Anatomie und Physiologie, 1828, p. 208. - -Footnote 1947: - - Annales d’Hyg. Publ. et de Méd. Lég. i. 518. - -Footnote 1948: - - Buchner’s Repertorium für die Pharmacie, lxxv. 403. - -Footnote 1949: - - Edinburgh Med. and Surg. Journal, xlviii. 44. - -Footnote 1950: - - Prize Thesis “On the Presence of Air in the Organs of Circulation.” - Edinburgh, 1837. - -Footnote 1951: - - Edinburgh Medical and Surgical Journal, li. 57. - -Footnote 1952: - - Formulaire pour les Nouveaux Médicamens. - -Footnote 1953: - - Lancet, 1844, October 5. - -Footnote 1954: - - Journal de Pharmacie, vii. 465. - -Footnote 1955: - - Buchner’s Repertorium für die Pharmacie, xvi. 100. - -Footnote 1956: - - Rust’s Magazin für die gesammte Heilkunde, xxxii. 494. - -Footnote 1957: - - Annales de Chim. et de Phys. xliv. 352. - -Footnote 1958: - - Murray, Apparatus Medicaminum, iii. 257. - -Footnote 1959: - - Buchner’s Repertorium für die Pharmacie, xii. 135. - -Footnote 1960: - - Fechner’s Repertorium der Organischen Chemie, ii. 65. - -Footnote 1961: - - Rust’s Magazin für die gesammte Heilkunde, xxxii. 500. - -Footnote 1962: - - Wepferi, Cicutæ aquaticæ Historia et Noxæ, 244; and Coullon, - Recherches sur l’Acide Hydrocyanique, 55. - -Footnote 1963: - - Toxicol. Gén. ii. 179. - -Footnote 1964: - - Philosophical Transactions, 1811, p. 184. - -Footnote 1965: - - Journal de Pharmacie, ii. 204. - -Footnote 1966: - - Dr. Alison’s Manuscript Lectures. - -Footnote 1967: - - Die Wirkung der Arzneimittel und Gifte, i. 166. - -Footnote 1968: - - Recherches, &c. 60. - -Footnote 1969: - - Apparatus Medicaminum, iii. 257. - -Footnote 1970: - - London Med. and Phys. Journal, lvii. 150. - -Footnote 1971: - - Philosophical Transactions, 1811, p. 183. - -Footnote 1972: - - Journal Complémentaire, &c. xvii. 366. - -Footnote 1973: - - Journal de Chimie Médicale, 1840, 92. - -Footnote 1974: - - Medical Jurisprudence, ii. 402. - -Footnote 1975: - - Journal de Pharmacie, viii. 304. - -Footnote 1976: - - Buchner’s Repertorium, xii. 130. - -Footnote 1977: - - Rust’s Magazin für die gesammte Heilk. xxxii. 497. - -Footnote 1978: - - Bericht über einige Versuche über die Wirkung des Oleum Essentiale - Laurocerasi.—Hufeland’s Journal der Praktischen Heilkunde, liv. iii. - 27. - -Footnote 1979: - - Bemerkungen, &c. Journal der Praktischen Heilkunde, li. i. 125. - -Footnote 1980: - - Fechner’s Repertorium der Org. Chemie, ii. 65. - -Footnote 1981: - - Médecine Légale, iv. 27. - -Footnote 1982: - - Apparatus Medicaminum, iii. 216. - -Footnote 1983: - - Recherches, &c. p. 95. - -Footnote 1984: - - Philosophical Transactions, 1739, No. 452. - -Footnote 1985: - - Wibmer, die Wirkung der Arzneimittel und Gifte, ii. 90. - -Footnote 1986: - - Considerations on the criminal proceedings of this country, on the - danger of convictions on circumstantial evidence, and on the case of - Mr. Donnellan. By a Barrister of the Inner Temple, 1781.—Phillips’s - Treatise on the Law of Evidence, Appendix, p. 30.—Male’s Juridical - Medicine, p. 86.—These authorities all consider the guilt of the - prisoner doubtful. - -Footnote 1987: - - Trial, &c. taken in short hand by Gurney. - -Footnote 1988: - - Buchner’s Repertorium für die Pharmacie, xxviii. 416. - -Footnote 1989: - - Geiseler in Repertorium für die Pharmacie, lxix. 291. - -Footnote 1990: - - Recherches, &c. p. 74. - -Footnote 1991: - - Journal de Chimie Médicale, 1837, 99. - -Footnote 1992: - - Repertorium für die Pharmacie, lxxv. 220. - -Footnote 1993: - - Bremer, Bemerkungen und Erfahrungen über die Wirksamkeit des - Trauben-Kirschbaums.—Archiv für Medizinische Erfahrung, 1812, i. 41. - -Footnote 1994: - - Buchner’s, Repertorium, xii. 130. - -Footnote 1995: - - Rust’s Magazin, xxxii. 500. - -Footnote 1996: - - Bemerkungen, &c. Horn’s Archiv, 1812, i. 71. - -Footnote 1997: - - Journal de Pharmacie, iii. 275. - -Footnote 1998: - - Buchner’s Repertorium für die Pharmacie, xxvii. 238. - -Footnote 1999: - - Buchner’s Repertorium für die Pharmacie, lxix. 293. - -Footnote 2000: - - Annales de Chim. et de Phys. xxxv. 72. - -Footnote 2001: - - Toxikologie, 373. - -Footnote 2002: - - Ueber den Selbstmord, p. 176. - -Footnote 2003: - - Quæstionum Medico-legalium, T. iii. 63. Consilium 44. - -Footnote 2004: - - London Courier, Jan. 16, 1823. - -Footnote 2005: - - Buchner’s Toxikologie, 331. - -Footnote 2006: - - Nysten, Recherches Chimico-Physiologiques, p. 11. - -Footnote 2007: - - On the Presence of Air in the Organs of Circulation. Prize Thesis at - Edinburgh, 1837. - -Footnote 2008: - - Nysten, Recherches Chimico-Physiologiques, _passim_. - -Footnote 2009: - - Ibidem, p. 81. - -Footnote 2010: - - Rech. Chemico-Physiologiques, p. 114. - -Footnote 2011: - - Diss. Inaug. utrum, per viventium adhuc animalium membranas materiæ - ponderabiles permeare queant. Tubingæ, p. 10. - -Footnote 2012: - - Nysten, Recherches, &c. p. 137. - -Footnote 2013: - - Philosophical Transactions, cxiii. 508. - -Footnote 2014: - - Nysten, Recherches, &c. p. 140. - -Footnote 2015: - - Corvisart’s Journal de Méd. xxiv. 249. - -Footnote 2016: - - Allen and Peys, also Wetterstedt. See Dr. Apjohn’s article on - Toxicology in Cycl. of Pract. Med. iv. 238. - -Footnote 2017: - - London Quarterly Journal of Science, vi. N. S. - -Footnote 2018: - - Corvisart’s Journal de Méd. xxiv. 246. - -Footnote 2019: - - Researches, Chemical and Philosophical, concerning nitrous oxide gas, - p. 475. - -Footnote 2020: - - Desgranges in Corvisart’s Journal de Méd. viii. 487. - -Footnote 2021: - - Bulletins de la Soc. Méd. d’Emulation, Oct. 1823. - -Footnote 2022: - - Zeitschrift für die Staatsarzneikunde, xvii. 383. - -Footnote 2023: - - Wibmer. Die Wirkung der Arzneimittel und Gifte, ii. 109, from Archiv - des Apothekers-Vereins, xviii. 101. - -Footnote 2024: - - Hallé, Recherches sur la nature du Méphitisme des fosses d’aisance, p. - 107. - -Footnote 2025: - - Edin. Med and Surg. Journal, xxviii. 361. - -Footnote 2026: - - London Medical Gazette, x. 314. - -Footnote 2027: - - Ibidem, 352. - -Footnote 2028: - - Dictionnaire des Sciences Médicales, ii. 391. - -Footnote 2029: - - Sedillot’s Journal de Médecine, xv. 28, 34. - -Footnote 2030: - - Annales d’Hygiène Publique, 1829, ii. 83, 143. - -Footnote 2031: - - Edin. Med. and Surg. Journal, xxviii. 361. - -Footnote 2032: - - Recherches sur la nature du Méphitisme des fosses d’aisance, 1785. - -Footnote 2033: - - Recherches, &c. p. 55. - -Footnote 2034: - - Recherches, &c. pp. 57, 99, 144; and Nouv. Journ. de Méd. i. 237. - -Footnote 2035: - - Nouv. Journal, &c. - -Footnote 2036: - - Ibidem. - -Footnote 2037: - - Sedillot’s Journ. de Méd. xv. 25. - -Footnote 2038: - - Recherches, &c. p. 57. - -Footnote 2039: - - Hallé, Recherches, &c. p. 50. - -Footnote 2040: - - Annales d’Hygiène Publique, 1840, xxiii. 131. - -Footnote 2041: - - Manual of Medical Jurisprudence, 1844, p. 559. - -Footnote 2042: - - Hallé, Recherches, &c. pp. 46, 58. - -Footnote 2043: - - London Medical Gazette, pp. 375, 410, 448. - -Footnote 2044: - - Researches on Nitrous Oxide Gas, p. 467. - -Footnote 2045: - - Annales d’Hyg. Publ. et de Méd. Lég. iii. 457. - -Footnote 2046: - - Mr. Pridgin’s Teale in Guy’s Hospital Reports, 1839, iv. 106. - -Footnote 2047: - - Annales d’Hygiène Publique, 1842, xxvii. 232. - -Footnote 2048: - - M. Collard de Martigny in Arch. Gén. de Méd. xiv. 209. - -Footnote 2049: - - Journal der Praktischen Heilkunde, 1831, iv. 119. - -Footnote 2050: - - Collard de Martigny, 204. - -Footnote 2051: - - Dr. Bird in Guy’s Hospital Reports, 1839, iv. 81. - -Footnote 2052: - - Nouv. Biblioth. Méd. 1827, iii. 91. - -Footnote 2053: - - Archives Gén. de Med. v. 132. - -Footnote 2054: - - Foderé, Méd. Légale, iv. 37. - -Footnote 2055: - - Archives, &c. p. 211. - -Footnote 2056: - - Recherches on Nitrous Oxide, p. 472. - -Footnote 2057: - - Nouv. Journal de Méd. ii. 196. - -Footnote 2058: - - Archives Gén. de Médecine, xiv. 205. - -Footnote 2059: - - Manual of Medical Jurisprudence, 1844, 555. - -Footnote 2060: - - Histoire de la Soc. Roy. de Med. i. 353. - -Footnote 2061: - - Nouv. Biblioth. Méd. 1827, iii. 91. - -Footnote 2062: - - Collard de Martigny, Arch. Gén. de Méd. xiv. 205. - -Footnote 2063: - - Orfila, Toxicol. Gén. ii. 475. Note. - -Footnote 2064: - - Lancet, 1838–39, i. 260. - -Footnote 2065: - - Lond. Med. Gazette, 1838–39, i. 427. - -Footnote 2066: - - Dr. G. Bird in Guy’s Hospital Reports, 1839, iv. 84. - -Footnote 2067: - - London Med. Chir. Transactions, i. 83. - -Footnote 2068: - - Nouv. Journ. de Méd. - -Footnote 2069: - - Nouv. Biblioth. Med. 1827, iii. 91. - -Footnote 2070: - - Archives Gén. de Méd. xiv. 210. - -Footnote 2071: - - Fallot, in Journal Complémentaire, Mai, 1829. - -Footnote 2072: - - Annales d’Hygiène Publique, 1840, xxiii. 176. - -Footnote 2073: - - Ibidem, xvi. 30. - -Footnote 2074: - - Manual of Medical Jurisprudence, 1844, p. 557. - -Footnote 2075: - - Annales, _ut supra_, 186. - -Footnote 2076: - - Toxicologie Gén. 1826, ii. 474. - -Footnote 2077: - - Annales d’Hygiène Publique, xxix. 53. - -Footnote 2078: - - Annales, _ut supra_, p. 191. - -Footnote 2079: - - Annalen der Pharmacie, 1836, xx. 156. - -Footnote 2080: - - Lancet, _ut supra_. - -Footnote 2081: - - Annales, &c. _ut supra_, p. 197. - -Footnote 2082: - - Annales, &c. xx. 134. - -Footnote 2083: - - Lancet, _ut supra_. - -Footnote 2084: - - Annales, _ut supra_, 197. - -Footnote 2085: - - Ibidem, p. 199. - -Footnote 2086: - - Ibidem, xx. 132. - -Footnote 2087: - - Devergie, _ut supra_, 200. - -Footnote 2088: - - On the Constitution of Flame—Edin. New Philos. Journal, i. 224, 226. - -Footnote 2089: - - Ammann.—Medicina Critica, Cas. 59, p. 365. - -Footnote 2090: - - Edin. Med. and Surg. Journal, xxviii. 359. - -Footnote 2091: - - Edinburgh Med. and Surg. Journal, xiii. 353. - -Footnote 2092: - - Ibidem, xxxii. 345. - -Footnote 2093: - - Edin. New Phil. Journal, v. 110. - -Footnote 2094: - - Holwell, Narrative of the deplorable Deaths of the English gentlemen - and others who were suffocated in the Black Hole at Fort William. - -Footnote 2095: - - Smith’s Principles of Forensic Medicine, 221. - -Footnote 2096: - - Instruction sur le traitement des Asphyxiés, 25. - -Footnote 2097: - - Reports of Medical Cases, ii. 226, 227. - -Footnote 2098: - - Horn’s Archiv für Medizinische Erfahrung, 1823, i. 93. - -Footnote 2099: - - London Medical Gazette, 1838–39, i. 923. - -Footnote 2100: - - Aufsätze und Beobachtungen, i. 1. and vii. 95. - -Footnote 2101: - - See various cases quoted in detail in Wibmer, die Wirkung der - Arzneimittel, &c. ii. 49, 51, 55. - -Footnote 2102: - - Practisches Handbuch für Physiker, iii. 278. - -Footnote 2103: - - Beiträge zur gerichtl. medizin.—Horn’s Archiv für Medizinische - Erfahrung, 1823, i. 296. - -Footnote 2104: - - Journal Complémentaire, Mai, 1829. - -Footnote 2105: - - Guy’s Hospital Reports, _ut supra_. - -Footnote 2106: - - Annales d’Hygiène Publique, xx. 114. - -Footnote 2107: - - Revue Médicale, 1827, iii. 528. - -Footnote 2108: - - Horn’s Archiv. für Medizinische Erfahrung, 1834, 746. - -Footnote 2109: - - Bird, _ut supra_, iv. 93. - -Footnote 2110: - - Wibmer, die Wirkung der Arzneimittel, &c. ii. 47, _et seq._ - -Footnote 2111: - - Nouvelle Bibliothèque Méd. 1829, i. 374. - -Footnote 2112: - - René-Bourgeois, Archives Gén. de Méd. xx. 508. - -Footnote 2113: - - Nysten, Recherches Chimico-Physiologiques, pp. 88, 92, 96. - -Footnote 2114: - - Annales d’Hygiène Publique, xxix. 54. - -Footnote 2115: - - Mr. Witter in London Philosophical Journal, 1814, xliii. 367. - -Footnote 2116: - - Guérard in Annales d’Hygiène Publique, xxix. 52. - -Footnote 2117: - - Nysten, Recherches, &c. - -Footnote 2118: - - Davy’s Chemical and Philosophical Researches, _passim_. - -Footnote 2119: - - Thenard, Traité de Chimie, iii. 675. - -Footnote 2120: - - Researches, &c., p. 462. - -Footnote 2121: - - Edin. Med. and Surg. Journal, xxviii. 363. - -Footnote 2122: - - Journal Universel des Sc. Méd. ii. 240. - -Footnote 2123: - - Archiv für Medizinische Erfahrung, 1830, ii. 859. - -Footnote 2124: - - Toxikologie, 382. - -Footnote 2125: - - Edin. Med. and Surg. Journal, xxviii. 363. - -Footnote 2126: - - London Quarterly Journal of Science, January, 1830. - -Footnote 2127: - - Buchner’s Toxikologie, 188. - -Footnote 2128: - - Wibmer, Die Wirkung der Arzneimittel, &c. i. 360, 362. - -Footnote 2129: - - Annalen der Pharmacie, i. 68. - -Footnote 2130: - - Ibidem, 1833, or Journal de Pharmacie, xx. 87. - -Footnote 2131: - - Buchner’s Repertorium für die Pharmacie, ix. 71 and 77. - -Footnote 2132: - - Orfila, Toxicol. Gén. ii. 261. - -Footnote 2133: - - Annalen der Pharmacie, i. 71. - -Footnote 2134: - - Sedillot’s Journ. Gén. de Méd. Dec. 1813, 364. - -Footnote 2135: - - Lond. Med. Obs. and Inquiries, vi. 223. - -Footnote 2136: - - Journ. Universel, xxii. 239. - -Footnote 2137: - - Journal de Chimie Médicale, 1837, p. 591. - -Footnote 2138: - - Ibid. 1839, 122. - -Footnote 2139: - - Sedillot’s Journ. de Méd. xxiv. 228. - -Footnote 2140: - - Edin. Med. and Surg. Journal, ix. 380. - -Footnote 2141: - - Journ. de Chim. Méd. ii. 586. - -Footnote 2142: - - Sedillot’s Journal de Médecine, xxiv. 228. - -Footnote 2143: - - London Medical Gazette, 1838–39, i. 681. - -Footnote 2144: - - British Herbal, 329. - -Footnote 2145: - - Journ. Universel, xxii. 239.—Edin. Med. and Surg. Journal, xxix. 452. - -Footnote 2146: - - Plenck’s Toxicologia, 109. - -Footnote 2147: - - Roux’s Journal de Med. xxiv. 310. - -Footnote 2148: - - Toxicologia, 109. - -Footnote 2149: - - Moyens de remédier aux Pois Végét. - -Footnote 2150: - - Journ. de Chim. Méd. iii. 586. - -Footnote 2151: - - Magazin für die gesammte Heilkunde, xxi. 550. - -Footnote 2152: - - Toxikologie, p. 220. - -Footnote 2153: - - On Vegetable Poisons, 17. - -Footnote 2154: - - Nouvelle Biblioth. Méd. 1828, iii. - -Footnote 2155: - - On Vegetable Poisons, p. 18. - -Footnote 2156: - - Roux’s Journal de Méd. xxiv. 321. - -Footnote 2157: - - Geschichte der Pflanzengifte, p. 538. - -Footnote 2158: - - Die Wirkung der Arzneimittel und Gifte, i. 347–364. - -Footnote 2159: - - Mag. für die gesammte Heilk. xxv. 578. - -Footnote 2160: - - Journal de Chim. Méd. iv. 390. - -Footnote 2161: - - Geschichte der Pflanzengifte, p. 538. - -Footnote 2162: - - Histoire de l’Acad. de Paris, 1703, p. 69. - -Footnote 2163: - - On Vegetable Poisons, p. 21 - -Footnote 2164: - - Med. Obs. and Inq. vi. 224. - -Footnote 2165: - - Roux’s Journ. de Méd. xxiv. 317. - -Footnote 2166: - - Geschichte des Pflanzengifte, 527. - -Footnote 2167: - - Die Wirkung der Arzneimittel, &c. i. 378. - -Footnote 2168: - - Gmelin, Geschichte der Pflanzengifte, 416. As examples of such crimes - he mentions the following. Diebe und Huren um ihr Verbrechen desto - ungehinderter zu begehen, wenn sie die Leute damit eingeschläfert - haben; Hurenwirthinnen, um in ihren gemietheten Mägdchen alles Gefühl - der natürlichen Schaam zu ersticken; alte Hurer um junge Mägdchen zu - verführen; Missethäter um ihre Wächter sinnlos zu machen; - Ehebrecherinnen, um ihre Männer zu ruhigen Zuschauern ihrer - Schandthaten zu machen. For most of these purposes gin and whisky are - the instruments of villany in Britain; and of late, as already - mentioned, opium has been resorted to. - -Footnote 2169: - - Journal de Chimie Médicale, 1836, 319. - -Footnote 2170: - - History of the Eastern Archipelago, i. 466. - -Footnote 2171: - - Schweigger’s Journal, xxvi. 98. - -Footnote 2172: - - Annalen der Pharmacie, iii. 135. - -Footnote 2173: - - Journal de Pharmacie, xx. 94. - -Footnote 2174: - - Orfila, Tox. ii. 271. - -Footnote 2175: - - Edin. Medical Commentaries, v. 163. - -Footnote 2176: - - Braun in Henke’s Zeitschrift für die Staatsarzneikunde, xxix. 177. - -Footnote 2177: - - Orfila, Toxicol. Gén. ii. 247. - -Footnote 2178: - - Edin. Phys. and Lit. Essays, ii. 272. - -Footnote 2179: - - Corvisart’s Journ. de Méd. xxiii. 157. - -Footnote 2180: - - Edin. Med. and Surg. Journal, xv. 154. - -Footnote 2181: - - Gmelin, Gesch. der Pflanzengifte, 421. - -Footnote 2182: - - Magazin für die gesammte Heilkunde, xvii. 564. - -Footnote 2183: - - Gmelin, 420. - -Footnote 2184: - - Edin. Med. and Surg. Journal, xv. 154. - -Footnote 2185: - - London Medical Gazette, iv. 320. - -Footnote 2186: - - Henke’s Zeitschrift für die Staatsarzneikunde, xxxiii. 129. - -Footnote 2187: - - Journal de Chim. Méd. vi. 722. - -Footnote 2188: - - Hist. Stirp. Helvet. Indig. i. 259. - -Footnote 2189: - - Vauquelin—Annales de Chimie, lxxi. 139. - -Footnote 2190: - - Bulletin des Scien. Méd. xii. 177, from Geiger’s Magazin für - Pharmacie, Nov. und Dec. 1828. - -Footnote 2191: - - Edinburgh Med. and Surg. Journal, xxxix. 382. - -Footnote 2192: - - Edinburgh Med. and Surg. Journal, li. 340. - -Footnote 2193: - - Ibidem. - -Footnote 2194: - - Philosophical Transactions, ci. 186, 181. - -Footnote 2195: - - Macartney.—Orfila, Toxicol. Gén. ii. 282. - -Footnote 2196: - - Blake, in Edin. Med. and Surg. Journal, liii. 44. - -Footnote 2197: - - Edin. Med. and Surg. Journal, xii. 11. - -Footnote 2198: - - Pflanzengifte, 550. - -Footnote 2199: - - Ephem. Cur. Nat. Dec. ii.—Ann. x. p. 222. - -Footnote 2200: - - On Apoplexy and Lethargy, p. 150. - -Footnote 2201: - - Ephem. Cur. Nat. Dec. ii.—Ann. iv. p. 467. - -Footnote 2202: - - London Medical Gazette, 1839–40, i. 561. - -Footnote 2203: - - Journal de Chimie Médicale, 1839, 329. - -Footnote 2204: - - Ibidem, 165. - -Footnote 2205: - - Hufeland’s Journal der Praktischen Heilkunde, lxxi. iv. 100. - -Footnote 2206: - - Journal de Chimie Médicale, iii. 23. - -Footnote 2207: - - Gazette Med. de Paris, 28 Novembre, 1840, or Edinburgh Med. and Surg. - Journal, lv. 558. - -Footnote 2208: - - Edin. Med. and Surg. Journal, ix. 159. - -Footnote 2209: - - Acta Helvetica, 1762, v. 330. - -Footnote 2210: - - Journal de Chim. Médicale, 1839, 328. - -Footnote 2211: - - Ibidem, 327. - -Footnote 2212: - - Julia-Fontenelle, Ibidem, 1836, 652. From Mémoires du Duc de St. - Simon. - -Footnote 2213: - - Paris and Fonblanque’s Medical Jurisprudence, ii. 415. - -Footnote 2214: - - Rammazini, de Morb. Opificum, 535.—Fourcroy. Essai sur les Mal. des - Artizans, 89.—Patissier, Traité des Mal. des Art. 202. - -Footnote 2215: - - Revue Médicale, 1827, iii. 168. - -Footnote 2216: - - Annales d’Hygiène Publique et de Med. Lég. i. 169. 1829. - -Footnote 2217: - - Gmelin’s Pflanzengifte, S. 598. - -Footnote 2218: - - Philosophical Magazine, N. S. iv. 231. - -Footnote 2219: - - Geiger’s Magazin für Pharmacie, xxxv. 72, 259. - -Footnote 2220: - - Edin. Medical and Surgical Journal, xxxix. 383. - -Footnote 2221: - - Geiger, in Magazin für Pharmacie, xxxv. 284. - -Footnote 2222: - - Edinburgh Roy. Soc. Transactions, xiii. 398, 415. - -Footnote 2223: - - Toxicologie Gén. ii. 303. - -Footnote 2224: - - Pflanzengifte, S. 605. - -Footnote 2225: - - Transactions of the Royal Soc. of Edinburgh, xiii. 383. - -Footnote 2226: - - Transactions, &c. xiii. 393, 315. - -Footnote 2227: - - Corvisart’s Journal de Méd. xxix. 107. - -Footnote 2228: - - Philos. Transactions, xliii. No. 473, p. 18. - -Footnote 2229: - - Toxicol. Gén. ii. 311. - -Footnote 2230: - - Gmelin’s Pflanzengifte, p. 604. - -Footnote 2231: - - Die Wirkung der Arzneimittel und Gifte, i. 172. - -Footnote 2232: - - Gmelin’s Pflanzengifte, p. 603. - -Footnote 2233: - - Cicut. Aquaticæ Hist. et Noxæ, 134. - -Footnote 2234: - - Annalen der Pharmacie, xxxi. 258. - -Footnote 2235: - - Archiv für Medizin. Erfahr. 1824, i. 84. - -Footnote 2236: - - Cic. Aquat. &c. 80, and 107. - -Footnote 2237: - - Journal de Chimie Médicale, 1842, 877. - -Footnote 2238: - - Article Ciguë, Diction. des Sciences Méd. - -Footnote 2239: - - Journal Complémentaire, xvii. 361. - -Footnote 2240: - - Journal de Chimie Médicale, 1830. - -Footnote 2241: - - Instead of quoting special facts on the subject of poisoning with - Œnanthe, I have thought it better to give in the meantime a short - analysis of a long investigation, which I have from time to time made - on the subject, and which was read in the Royal Society of Edinburgh - last year. This paper will be published ere long; and the references - and experiments will then be supplied, which, if introduced here, will - lead to disproportionate details. - -Footnote 2242: - - Lond. Philos. Magazine, N. S. ii. 392. - -Footnote 2243: - - Toxicol. Gén. ii. 323. - -Footnote 2244: - - London Med. and Phys. Journal, xiv. 425. - -Footnote 2245: - - Geschichte der Pflanzengifte, 571. - -Footnote 2246: - - Wittke in Magazin für Pharmacie, xxxii. 228. - -Footnote 2247: - - Prize Thesis, on the Physiological and Medicinal Properties of the - Aconitum napellus. Edinburgh, 1844. - -Footnote 2248: - - Toxicologie Gén. 1827, ii. 211. - -Footnote 2249: - - Philosophical Transactions, 1811, p. 183. - -Footnote 2250: - - Toxicologie Gén. 1827, ii. 211, and 1843, ii. 361. - -Footnote 2251: - - Elements of Materia Medica, 1842, ii. 1804. - -Footnote 2252: - - Elements of Materia Medica, 1842, ii. 1811. - -Footnote 2253: - - Elements of Materia Medica, 1842, ii. 1806. - -Footnote 2254: - - Thèse Inaugurale, Paris, 1822, quoted by Orfila, Toxic. Gén., 1827, - ii. 221. - -Footnote 2255: - - Journal de Chimie Médicale, iii. 344. - -Footnote 2256: - - Elements of Materia Medica, ii. p. 1807. - -Footnote 2257: - - Ibidem, p. 1806. - -Footnote 2258: - - Lancet, 1836–37, ii. 13. - -Footnote 2259: - - Annali Universali di Medicina, 1840, iii. 635. - -Footnote 2260: - - Buchner’s Repertorium für die Pharmacie, lxviii. 199. - -Footnote 2261: - - Journal de Chimie Medicale, 1840, 94. - -Footnote 2262: - - Edinburgh Journal of Natural Science, 1830, 235. - -Footnote 2263: - - Dr. Hunter. Calcutta Med. Phys. Transactions, ii. 410. - -Footnote 2264: - - Northern Journal of Medicine, 1844, i. 120. - -Footnote 2265: - - Journal de Pharmacie, vii. 503. - -Footnote 2266: - - Orfila, Tox. Gén. ii. 225. - -Footnote 2267: - - Schabel, Diss. Inaug. be Effectibus Veratri albi et Hellebori nigri, - p. 8, Tubing. - -Footnote 2268: - - Bullet. de la Soc. Méd. d’Em. Avril, 1818. - -Footnote 2269: - - De Sedibus et Causis Morborum, Epist. lix. 15. - -Footnote 2270: - - Wibmer, die Wirkung der Arzneimittel und Gifte, iii. 10. - -Footnote 2271: - - Buchner’s Toxicologie, 272. - -Footnote 2272: - - Toxicol. Gén. ii. 202. - -Footnote 2273: - - Tentamen Physico-medicum de Remediis Brunsvicensibus, 176. - -Footnote 2274: - - Journal de Chimie Médicale, 1842, p. 651. - -Footnote 2275: - - Vogel—Journal de Physique, lxxv. 194. - -Footnote 2276: - - De Effectibus Ver. alb. et Hell. nigri. Tubingæ, 1817. - -Footnote 2277: - - Mag. für die gesammte Heilkunde, xiv. 547. - -Footnote 2278: - - Archiv für Mediz. Erfahrung, 1825. - -Footnote 2279: - - Beiträge zur Gerichtl. Arzneik. iv. 47. - -Footnote 2280: - - Die Wirkung der Arzneimittel und Gifte, v. 437. - -Footnote 2281: - - Diss. Inaug. De Veratriæ Ellectibus, Lipsiæ, 1836, quoted by Wibmer, - v. 434. - -Footnote 2282: - - Libellus de Colchico, 1763, p. 17. - -Footnote 2283: - - Philosophical Transactions, 1816. - -Footnote 2284: - - Annalen der Pharmacie, vii. 275. - -Footnote 2285: - - Edin. Med. and Surgical Journal, xiv. 262. - -Footnote 2286: - - Journal de Chimie Médicale, viii. 351. - -Footnote 2287: - - Repertorium für die Pharmacie, lxxi. 131. - -Footnote 2288: - - Annales d’Hygiène Publique, xvi. 394. - -Footnote 2289: - - Ibid. xii. 397. - -Footnote 2290: - - Journal de Chimie Médicale, 1839, 589. - -Footnote 2291: - - London Medical Gazette, 1838–39, ii. 763. - -Footnote 2292: - - Beiträge, &c. iv. 246. - -Footnote 2293: - - London Medical Gazette, x. 160. - -Footnote 2294: - - Repertorium für die Pharmacie, lxix. 382. - -Footnote 2295: - - Ibidem, 377. - -Footnote 2296: - - Magazin für Pharmacie, xxx. 237. - -Footnote 2297: - - Dr. Duncan’s Dispensatory, 953. - -Footnote 2298: - - Spillan, quoted by Lewins. - -Footnote 2299: - - Edinburgh Medical and Surg. Journal, lvi. 186. - -Footnote 2300: - - Toxicologie Gén. 1827, ii. 257. - -Footnote 2301: - - Toxikologie, 349. - -Footnote 2302: - - Repertorium für die Pharmacie, lxix. 384. - -Footnote 2303: - - Bibliothèque Universelle de Génève, xxvi. 102. - -Footnote 2304: - - Duncan’s Supplement to the Dispensatory, p. 49. - -Footnote 2305: - - Elements of Materia Medica, 1842, p. 1208. - -Footnote 2306: - - Dr. Morries, Edin. Med. and Surg. Journal, xxxix. 377. - -Footnote 2307: - - Toxicologie Gén. ii. 286. - -Footnote 2308: - - Edinburgh Med. and Surg. Journal, li. 342. - -Footnote 2309: - - Wibmer, Die Wirkung, &c. ii. 312, from Schroek, de Digit. Purpurea, - 1829. - -Footnote 2310: - - London Med. Gazette, 1842–43, i. 270, from Schmidt’s Jahrbücher, Aug. - 1842. - -Footnote 2311: - - Dictionary of Mat. Med. and Pharmacy, 1839, 219. - -Footnote 2312: - - Blackall on Dropsy, p. 173. - -Footnote 2313: - - Edin. Med. and Surg. Journ. vii. 149. - -Footnote 2314: - - Bidault de Villiers, Journal de Médecine, Novembre, 1817. - -Footnote 2315: - - Edin. Med. and Surg. Journ. xxvii. 223, from Morning Chronicle, Oct. - 30 and 31, 1826. - -Footnote 2316: - - Journal de Méd. xl. 193. - -Footnote 2317: - - Williams in Medical Gazette, i. 744. - -Footnote 2318: - - Toxicologie Gén. 1843, ii. 442. - -Footnote 2319: - - Annales d’Hygiène Publique, 1838, xx. 180. - -Footnote 2320: - - Recherches Chim. et Physiol. sur l’Ipecacuanha. Journal de Pharmacie, - iii. 145. - -Footnote 2321: - - Rust’s Magazin für die gesammte Heilkunde, xxxii. 182. - -Footnote 2322: - - Magendie. Formulaire pour la Préparation, &c. de plusieurs Nouv. - Médicamens. 5eme ed. 67. - -Footnote 2323: - - Plantes Usuelles des Braziliens, Livraison, i. 3. - -Footnote 2324: - - Ann. de Chim. et de Phys. x. 142. - -Footnote 2325: - - Journal de Pharmacie, viii. 401. - -Footnote 2326: - - Ann. de Chim. et de Phys. x. 153. - -Footnote 2327: - - Pelletier and Caventou, Ibidem, xxvi. 56. - -Footnote 2328: - - Annales de Chim. et de Phys. xxvi. 44. - -Footnote 2329: - - Archives Gén. de Méd. xii. 463. - -Footnote 2330: - - Edinburgh Medical and Surgical Journal, li. 338. - -Footnote 2331: - - Transactions of Provinc. Med. and Surg. Association, ii. 215. - -Footnote 2332: - - Journal de Chimie Médicale, 1837, 481. - -Footnote 2333: - - Elements of Materia Medica, ii. 1310. - -Footnote 2334: - - Buchner’s Repertorium für die Pharmacie. - -Footnote 2335: - - Archives Gén. de Méd. viii. 22. - -Footnote 2336: - - British Annals de Medecine, i. 106. - -Footnote 2337: - - Magazin für die gesammte Heilkunde, xvii. 119. - -Footnote 2338: - - Cicutæ Aquat. Hist. Noxæ, p. 295. - -Footnote 2339: - - Magendie, Journal de Physiol. ii. 361. - -Footnote 2340: - - Cicutæ Aquat. Hist. et Noxæ, p. 198. - -Footnote 2341: - - Archives Gén. de Médecine, xlvi. 365. - -Footnote 2342: - - Lond. Med. Repository, xix. 448. - -Footnote 2343: - - Glasgow Medical Journal. August, 1830. - -Footnote 2344: - - British Annals of Medicine, i. 103. - -Footnote 2345: - - Archives Gén. de Méd. viii. 17. - -Footnote 2346: - - Nouv. Journ. de Méd. x. 157. - -Footnote 2347: - - Tacheron, London Med. Repository, xix. 456. - -Footnote 2348: - - Med. Rat. System, ii. 175. - -Footnote 2349: - - Journ. der Practischen Heilkunde, iv. 492. - -Footnote 2350: - - Hillefeld, Exp. quædam circa venena. Gott. 1760. Quoted by Marx, die - Lehre von den Giften, i. ii. 26. - -Footnote 2351: - - Rossi, Exp. de nonnullis plantis quæ pro venenatis habentur. Pisis, - 1762. See Marx, i. ii. 29. - -Footnote 2352: - - Trans. of the Calcutta Med. and Phys. Soc. i. 138. - -Footnote 2353: - - Arch Gén. de Méd. viii. 18. - -Footnote 2354: - - I have not altered the statement as to this point in the former - editions. Yet I strongly suspect that authors, who describe the spasm - which precedes death to continue as it were into the rigidity which - occurs after death, must have observed inaccurately. For in the - numerous experiments I have made and witnessed in animals, flaccidity - invariably took place at the time of death, and continued for a - moderate interval. - -Footnote 2355: - - Repertorium für die Pharmacie, lxv. 80. - -Footnote 2356: - - Le Globe, vii. 525.—Août 19, 1829. - -Footnote 2357: - - Henke’s Zeitschrift für die Staatsarzneikunde, ii. 169. - -Footnote 2358: - - Ann. de Chim. et de Phys. xxvi. 44. - -Footnote 2359: - - Orfila, Toxicol. Gén. ii. 364. - -Footnote 2360: - - Journal de Chim. Méd. vi. 593. - -Footnote 2361: - - Botanic Garden, ii. 256. - -Footnote 2362: - - See my Dispensatory, p. 395. Orfila adheres to the old error in the - last edition of his Toxicology, in 1843. - -Footnote 2363: - - Magendie, Journ. de Physiologie, iii. 267. - -Footnote 2364: - - Toxicol. Gén. ii. 377. - -Footnote 2365: - - Ueber die giftige Wirkungen der unächten Angustura.—Hufeland’s - Journal, xl. iii. 68. - -Footnote 2366: - - Journal de Pharmacie, ii. 507. - -Footnote 2367: - - Meckel’s Archiv für Anatomie und Physiologie, i. 1. - -Footnote 2368: - - Ueber das Amerikanische Pfeilgift. Meckel’s Archiv für Anatomie und - Physiologie, iv. 65. - -Footnote 2369: - - Reported by Dr. Reid Clanny in Lancet, 1838–39, ii. 285. - -Footnote 2370: - - Toxicol. Gén. ii. 400. - -Footnote 2371: - - Annali Univ. di Med. xxxvi. 102. - -Footnote 2372: - - Diss. Inaug. Tubingæ, 1819, p. 9. - -Footnote 2373: - - Experimental Essays, 128. - -Footnote 2374: - - Orfila, Toxic. Gén. ii. 406. - -Footnote 2375: - - Ibid., 407. - -Footnote 2376: - - London Med. Gazette, xi. 772. From American Journal of Med. Science. - -Footnote 2377: - - Rust’s Magazin für die gesammte Heilkunde, xxv. 88. - -Footnote 2378: - - Toxicol. Gén. ii. 400. - -Footnote 2379: - - Annali, &c. xxxvi. 106. - -Footnote 2380: - - Ann. de Chimie, lxxx. 109. - -Footnote 2381: - - Buchner’s Repertorium für die Pharmacie, xxiv. 55. - -Footnote 2382: - - Orfila, Toxicol. Gén. ii. 411. - -Footnote 2383: - - Cicut. Aquat. Hist. p. 186. - -Footnote 2384: - - Toxicol. Gén. ii. 412, 414. - -Footnote 2385: - - Ibidem, ii. 410. - -Footnote 2386: - - Annales d’Hygiène Publique, xxix. 346. - -Footnote 2387: - - Beiträge zur Gerichtl. Arzneikunde, iii. 241. - -Footnote 2388: - - Mulder in Pharmaceutisches Central-Blatt, 1838, p. 511. - -Footnote 2389: - - Orfila Toxicol. Gén. ii. 396. - -Footnote 2390: - - Philos. Trans. 1811. - -Footnote 2391: - - Diss. Inaug. sistens historiam Veneni Upas antiar, &c. Tubingæ, 1815. - -Footnote 2392: - - Diss. Inaug. de Veneno Upas antiar, Tubingæ, 1815, p. 27. - -Footnote 2393: - - Buchner’s Repertorium, xxxi., and Hufeland’s Journal, lxviii. iv. 43. - -Footnote 2394: - - Mém. de l’Acad. des Sciences, 1739, p. 47. - -Footnote 2395: - - Journal de Chim. Méd. iv. 528. - -Footnote 2396: - - London Medical and Physical Journal, April, 1829. - -Footnote 2397: - - Mémoires de la Soc. de Phys. et d’Hist. Nat. de Génève, v. 194. - -Footnote 2398: - - Lancet, 1836–37, i. 394. - -Footnote 2399: - - Ibid. - -Footnote 2400: - - Rust’s Magazin für die gesammte Heilkunde, xxiii. 374. - -Footnote 2401: - - Essays, &c. iii. 257. - -Footnote 2402: - - On the Esculent Fungi of Great Britain. Mem. Wernerian Society, iv. - 339. - -Footnote 2403: - - Toxicol. Gén. 417–428. - -Footnote 2404: - - London Med. and Phys. Journal, iii. 41. - -Footnote 2405: - - Ibid. xxxvi. 451. - -Footnote 2406: - - Edinburgh Med. and Surg. Journal, xlix. 192. - -Footnote 2407: - - Journal de Chimie Médicale, 1835, 488. - -Footnote 2408: - - Annali Universali di Medicina, 1842, i. 549. - -Footnote 2409: - - Journal de Chimie Médicale, 1839, 325. - -Footnote 2410: - - Journal de Pharmacie, 1837, 369. - -Footnote 2411: - - Foderé, Médecine Légale, iv. 61, and 58. - -Footnote 2412: - - Ibidem. - -Footnote 2413: - - Haller, Hist. Stirp. Helv. Indig. ii. 328. - -Footnote 2414: - - Bongard, London Medical Gazette, 1838, i. 414. - -Footnote 2415: - - Ibidem. - -Footnote 2416: - - Greville, p. 344, from Langsdorf’s Annalen der Wetterrauischen - Gesellschaft. - -Footnote 2417: - - Foderé, Médecine Légale, iv. 59. - -Footnote 2418: - - Journal de Chimie Médicale, 1839, 322. - -Footnote 2419: - - Edin. Med. and Surg. Journal, ix. 379. - -Footnote 2420: - - Médecine Légale, iv. 55, _et passim_. - -Footnote 2421: - - Toxicol. Gén. ii. 445. - -Footnote 2422: - - Essai Sur les Propriétés Médicales des Plantes, 320. - -Footnote 2423: - - Mem. Wernerian Soc. iv. 342. - -Footnote 2424: - - Ann. de Chimie, lxxix. 265; lxxx. 272; lxxxvii. 237. - -Footnote 2425: - - Archives Gén. de Méd. xi. 94. - -Footnote 2426: - - Repertorium für die Pharmacie, lxvi. 117. - -Footnote 2427: - - Traité des Champignons.—Also Mém. sur les Champignons coëffés. Mem. de - la Soc. Roy. de Méd. i. 431. - -Footnote 2428: - - London Med. and Phys. Journal, xxxvi. 451. - -Footnote 2429: - - Edinburgh Medical and Surgical Journal, xlix. 192. - -Footnote 2430: - - Annali Universali di Medicina, 1842, i. 549. - -Footnote 2431: - - Corvisart’s Journ. de Méd. xxxi. 323, from Vadrot. Diss. Inaug. sur - l’empoisonnement par les Champignons. - -Footnote 2432: - - Orfila, Toxicol. Gén. ii. 433. - -Footnote 2433: - - Picco—Mem. de la Soc. Roy. de Méd. 1780–81, p. 355. - -Footnote 2434: - - Geschichte der Pflanzengifte, 639. - -Footnote 2435: - - Aymen, in Hist. de la Soc. Roy. de Méd. i. 344. - -Footnote 2436: - - Rust’s Magazin für die gesammte Heilkunde, xvi. 115. - -Footnote 2437: - - Persoon, Traité sur les Champignons comestibles, 157. - -Footnote 2438: - - Journal de Pharmacie, Sept. 1836. - -Footnote 2439: - - Edwards in Lancet, 1836–37, ii. 512. - -Footnote 2440: - - Picco—Hist. de la Soc. &c. pp. 357, 359. - -Footnote 2441: - - Hist. de la Soc. &c. p. 357. - -Footnote 2442: - - Ibidem. - -Footnote 2443: - - Repertorium für die Pharmacie, lxvi. 117. - -Footnote 2444: - - Quæstiones Medicinæ Forenses, 1824, p. 206. - -Footnote 2445: - - Repertorium für die Pharmacie, xiv. 311. - -Footnote 2446: - - In the Philosophical Transactions for 1762 an account is given of a - family of eight people in Suffolk, who had the gangrenous form of the - disease induced by spurred rye. They had lived on damaged wheat, but - never used rye meal. See Dr. Wollaston’s paper, lii. 523, and Mr. - Bone’s Letter, Ibid. 526. - -Footnote 2447: - - The Phalaris canariensis and aquatica, Panicura miliaceum Phleum, - pratense, Alopecurus pratensis and geniculatus, Agrostis stolonifera, - Aira cristata, Poa fluitans, Festuca duriuscula, Arundo arenaria and - cinnoides, Lolium perenne, Elymus arenarius and europæus, Triticum - spelta, junceum and repens, Holcus avenaceus and lanatus, Dactylis - glomerata, besides those mentioned in the text.—See Robert, - Erläuterungen und Beiträge zur Geschichte des Mutterkorns.—Rust’s - Magazin für die gesammte Heilkunde, xxv. 8. - -Footnote 2448: - - Mémoire sur la Sologne, in Hist. de la Soc. Roy. de Méd. i. 61. - -Footnote 2449: - - Mem. sur la mal. du Seigle appellée Ergot. Hist. de la Soc. Roy. de - Méd. i. 427. - -Footnote 2450: - - Robert’s paper, _passim_. - -Footnote 2451: - - Hecker’s Jahrbücher der Staatsarzneikunde, i. 240. - -Footnote 2452: - - Robert, in Rust’s Magazin, xxv. 20. Tessier seems to have been of the - same way of thinking. - -Footnote 2453: - - Tillet, Dissertation sur la cause qui corrompe les bles—Fontana, - Lettre sur l’Ergot. Journ. de Phys. vii. 42.—Réad, Traité sur le - Seigle Ergoté. 1771. - -Footnote 2454: - - Annals of Philosophy, N. S. xi. 14. - -Footnote 2455: - - Flore Française, VI.—Robert’s paper, p. 15. - -Footnote 2456: - - Inquisitio in Secale cornutum, &c. Commentatio præmio regio ornata, - Gottingæ, 1831. Analyzed in Annalen der Pharmacie, i. 129. - -Footnote 2457: - - Linnæan Transactions, 1840, xviii, 449. - -Footnote 2458: - - Ibidem, 453. - -Footnote 2459: - - Ibidem, 475. - -Footnote 2460: - - Lettre sur l’Ergot. Journal de Physique, vii. 42. - -Footnote 2461: - - Lorinser, Beob. und Vers. über die Wirkung des Mutterkorns, 1824, - noticed in Robert’s paper, p. 28. - -Footnote 2462: - - Edinburgh Medical and Surgical Journal, lii. 306. Harveian Prize - Essay. - -Footnote 2463: - - Linnæan Transactions, xix. 140. - -Footnote 2464: - - Tessier, 421. - -Footnote 2465: - - Ibid. 428. - -Footnote 2466: - - Robert, 28. - -Footnote 2467: - - Bulletins de la Soc. Philomatique, 1817, 58. - -Footnote 2468: - - Buchner’s Repertorium für die Pharmacie, iii. 65. - -Footnote 2469: - - Rust’s Magazin, xxv. 43, also Keyl, Dissertatio de Secali Cornuto - ejusque vi in corpus humanum salubri et noxia. - -Footnote 2470: - - Rust’s Mag. für die gesammte Heilk. xxv. 47. - -Footnote 2471: - - Annalen der Pharmacie, i. 159. - -Footnote 2472: - - Edinburgh Medical and Surgical Journal, lii. 302, and liv. 51. - -Footnote 2473: - - Repertorium für die Pharmacie, lxxv. 168. - -Footnote 2474: - - Annalen der Pharmacie, i. 180. - -Footnote 2475: - - Annali Universali di Medicina, 1839, iv. 12. - -Footnote 2476: - - Edinburgh Medical and Surgical Journal, lii. 119, liii. 1. - -Footnote 2477: - - Robert’s paper, p. 223, also Lorinser’s Versuche, &c. of which there - is an analysis in Edinb. Med. and Surg. Journal, xxvi. 453. - -Footnote 2478: - - Taube—Geschichte der Kriebelkrankheit, quoted in Robert’s paper, p. - 209. - -Footnote 2479: - - Journal der Praktischen Heilkunde, lxxiii. iv. 3, and lxxiv. v. 71, - vi. 3. - -Footnote 2480: - - Descriptio morborum ex usu clavorum secalinorum cum pane, 1717. A full - extract is given of this work in Acta Eruditorum, An. 1718. Lipsiæ, p. - 309. - -Footnote 2481: - - L’Abbé Tessier, Mém. sur les effets du Seigle Ergoté. Hist. de la Soc. - Roy. de Méd. ii. 611. - -Footnote 2482: - - Robert, in Rust’s Magazin, xxv. 205. - -Footnote 2483: - - Ibid. 200. - -Footnote 2484: - - Ibid. 204. - -Footnote 2485: - - Ibid. 231, 232. - -Footnote 2486: - - Stearn’s in New York Med. Rep. 1307.—Bigelow in New England Journal of - Med. and Surg. v.—Prescott in Lond. Med. and Phys. Journ. xxxvi. - -Footnote 2487: - - Edinburgh Medical and Surgical Journal, liii. 29. - -Footnote 2488: - - Revue Médicale, 1829, iii. 332. - -Footnote 2489: - - Hist. de la Soc. Roy. de Méd. i. 346. - -Footnote 2490: - - Sedillot’s Journ. Gén. de Méd. xiv. 200. - -Footnote 2491: - - Journal de Chimie Médicale, viii. 558. - -Footnote 2492: - - Journal de Chimie Médicale, vii. 122. - -Footnote 2493: - - Guérard in Annales d’Hygiène Publique, xxix. 35. - -Footnote 2494: - - Orfila, Toxic. Gén. ii. 466, from Seeger, Diss. Inaug. Tubingæ, 1760. - -Footnote 2495: - - Sur les Effets de l’Ivraie.—Nouv. Journ. de Méd. vi. 379. - -Footnote 2496: - - Orfila, Toxicol. Gén. ii. 466. - -Footnote 2497: - - London Med. and Phys. Journal, xxviii. 182. - -Footnote 2498: - - Buchner’s Toxikologie, 174. - -Footnote 2499: - - Annalen der Pharmacie, xvi. 318. - -Footnote 2500: - - Hist. de la Soc. Roy. de Méd. ii. 297. - -Footnote 2501: - - Repertorium für die Pharmacie, xlviii. 160. - -Footnote 2502: - - Nouvelle Bibliothèque Méd. iii. 439. - -Footnote 2503: - - Journal de Pharmacie, ii. 397. - -Footnote 2504: - - Journ. de Pharm., ii. 397. - -Footnote 2505: - - London Medical and Physical Journal, lxii. 86. - -Footnote 2506: - - Lancet, 1840–41, 552. - -Footnote 2507: - - Hist. des Plantes Ven. de la Suisse, 1776, p. 49. - -Footnote 2508: - - Bulletins de la Société de Pharmacie, 1809, p. 48. - -Footnote 2509: - - Cases and Observations in Medical Jurisprudence.—Edinburgh Medical and - Surgical Journal, 1843, lx. 303. - -Footnote 2510: - - Journal de Pharmacie, iv. 340, 554. - -Footnote 2511: - - Philosophical Transactions, ci. 118. - -Footnote 2512: - - Toxicol. Gén. ii. 451. - -Footnote 2513: - - Edin. Med. and Surg. Journal, xl. 277. - -Footnote 2514: - - Cooke on Nervous Diseases, i. 219. - -Footnote 2515: - - Lancet, 1839–40, i. 466. - -Footnote 2516: - - Ibid., 1838–39, ii. 233. - -Footnote 2517: - - Edinburgh Medical and Surgical Journal, liv. 147. - -Footnote 2518: - - Edin. Medical and Surg. Journal, xl. 278. - -Footnote 2519: - - Edinb. Med. and Surg. Journal, xii. 489, from Bedingfield’s Compendium - of Med. Practice. - -Footnote 2520: - - Toxicol. Gén. ii. 454. - -Footnote 2521: - - Die Lehre von den Giften, I. ii. 306. - -Footnote 2522: - - Journal de Chimie Médicale, 1839, 129. - -Footnote 2523: - - Corvisart’s Journ. de Méd. xvii. 43. - -Footnote 2524: - - Aufsätze, v. 94. - -Footnote 2525: - - Bright’s Reports of Medical Cases, i. 1. - -Footnote 2526: - - See on this subject, Grötzner, über die Truncksucht unde ihre - Folgen.—Rust’s Mag. für die ges. Heilkunde, xx. 522. - -Footnote 2527: - - Edin. Medical and Surg. Journ. xl. 292. - -Footnote 2528: - - Beiträge zur Gerichtl. Arzneik. ii. 59, iii. 38. - -Footnote 2529: - - On Nervous Diseases, i. 219. - -Footnote 2530: - - Beiträge zur Gerichtl. Arzneik. iii. 38. - -Footnote 2531: - - Edin. Med. and Surg. Journal, xl. 282, 284, 293. - -Footnote 2532: - - Répertoire Gén. Anat. et de Physiol. Pathologique, i. 51. - -Footnote 2533: - - Magazin für die ges. Heilkunde, xxi. 522. - -Footnote 2534: - - Treatise on Nervous Diseases, i. 222. - -Footnote 2535: - - Edin. Medical and Surgical Journal, xl. 293. - -Footnote 2536: - - Rust’s Magazin für die gesammte Heilkunde, xxv. 126. - -Footnote 2537: - - Prize Inaugural Dissertation, on the presence of alcohol in the brain - after poisoning with it. Edinburgh, 1839, _passim_. - -Footnote 2538: - - Cases and Observations in Medical Jurisprudence.—Edin. Med. and Surg. - Journal, xxxi. 239. - -Footnote 2539: - - Edin. Medical and Surgical Journal, xl. 295. - -Footnote 2540: - - Smith, London Medical Gazette, ix. 502. - -Footnote 2541: - - Toxicol. Gén. ii. 456. - -Footnote 2542: - - Journal of Science, iv. 158. - -Footnote 2543: - - Midland Med. and Surg. Reporter, i., or Edin. Med. and Surg. Journal, - xxxv. 452. - -Footnote 2544: - - Fechner’s Repertorium für Organischen Chemie, i. 1078. - -Footnote 2545: - - Toxikologie, 395.w - -Footnote 2546: - - Diction. des Scien. Méd. xxi. 605. - -Footnote 2547: - - Journal Universel. Novembre, 1829. - -Footnote 2548: - - Henke’s Zeitschrift für die Staatsarzneikunde, xxx. 425. - -Footnote 2549: - - Horn’s Archiv für Med. Erfahrung, 1824, i. 89, 91. - -Footnote 2550: - - Duncan’s Dispensatory, 12th edition, p. 552. - -Footnote 2551: - - Lancet, 1832–33, ii. 598. - -Footnote 2552: - - Lancet, 1833–34, i. 902. - -Footnote 2553: - - Natural, Chemical, Medicinal, and Physiological Properties of - Creasote. Harveian Prize Essay, 1836, p. 66 to 99. - -Footnote 2554: - - Medico-Chirurgical Transactions, xix. - -Footnote 2555: - - Elements of Materia Medica, 1842, i. 419. - -Footnote 2556: - - lii. 291. - -Footnote 2557: - - Edin. Med. and Surg. Journal, xxxiii. 61. - -Footnote 2558: - - Journal Universel des Sc. Méd. xvii. 120. - -Footnote 2559: - - London Med. and Phys. Journal, xlix. 119. - -Footnote 2560: - - Martin-Solon. Journal Hebdomadaire, viii. 73. - -Footnote 2561: - - Gueneau de Mussy. Archives Gén. de Med. Deuxiême Série, i. 594. - - - THE END. - ------------------------------------------------------------------------- - - - - - TRANSCRIBER’S NOTES - - - 1. P. 476, changed “exasperated by the use of oil” to “exacerbated by - the use of oil”. - 2. P. 513, changed “I may here add a very opposite instance of - hemorrhagic apoplexy” to “I may here add a very apposite instance - of hemorrhagic apoplexy”. - 3. P. 712, added missing anchor for the last footnote. - 4. 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