II. CLASS FIRST. ON IRRITANT POISONS GENERALLY…

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.

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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.

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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]

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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]

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