§ 264. Post-mortem Appearances.[249]—If we for the moment leave out of consideration any changes which may be seen in the stomach after doses of potassic cyanide, then it may be affirmed that the pathological changes produced by hydric and potassic cyanides mainly coincide with those produced by suffocation. The most striking appearance is the presence of bright red spots; these bright red spots or patches are confined to the surface of the body, the blood in the deeper parts being of the ordinary venous hue, unless, indeed, an enormous dose has been taken; in that case the whole mass of blood may be bright red; this bright colour is due, according to Kobert, to the formation of cyanmethæmoglobin. The lungs and right heart are full of blood, and there is a backward engorgement produced by the pulmonic block. The veins of the neck and the vessels of the head generally are full of blood, and, in like manner, the liver and kidneys are congested. In the mucous membrane of the bronchial tubes there is a bloody foam, the lungs are gorged, and often œdematous in portions; ecchymoses are seen in the pleura and other serous membranes; and everywhere, unless concealed by putrefaction, or some strong-smelling ethereal oil, there is an odour of hydric cyanide.
[249] Hydric cyanide has, according to C. Brame, a remarkable antiseptic action, and if administered in sufficient quantity to animals, preserves them after death for a month. He considers that there is some more or less definite combination with the tissues.
Casper has rightly recommended the head to be opened and examined first, so as to detect the odour, if present, in the brain. The abdominal and chest cavities usually possess a putrefactive smell, but the brain is longer conserved, so that, if this course be adopted, there is a greater probability of detecting the odour.
The stomach in poisoning by hydric cyanide is not inflamed, but if alcohol has been taken at the same time, or previously, there may be more or less redness.
In poisoning by potassic cyanide, the appearances are mainly the same as those just detailed, with, it may be, the addition of caustic local action. I have, however, seen, in the case of a gentleman who drank accidentally a considerable dose of potassic cyanide just after a full meal, not the slightest trace of any redness, still less of corrosion. Here the contents of the stomach protected the mucous membrane, or possibly the larger amount of acid poured out during digestion sufficiently neutralised the alkali. Potassic cyanide, in very strong solution, may cause erosions of the lips, and the caustic effect may be traced in the mouth, throat, gullet, to the stomach and duodenum; but this is unusual, and the local effects are, as a rule, confined to the stomach and duodenum. The mucous membrane is coloured blood-red, reacts strongly alkaline,[250] is swollen, and it may be even ulcerated. The upper layers of the epithelium are also often dyed with the colouring-matter of the blood, which has been dissolved out by the cyanide. This last change is a post-mortem effect, and can be imitated by digesting the mucous membrane of a healthy stomach in a solution of cyanide. The intensity of these changes are, of course, entirely dependent on the dose and emptiness of the stomach. If the dose is so small as just to destroy life, there may be but little redness or swelling of the stomach, although empty at the time of taking the poison. In those cases in which there has been vomiting, and a part of the vomit has been drawn into the air-passages, there may be also inflammatory changes in the larynx. If essence of almonds has been swallowed, the same slight inflammation may be seen which has been observed with other essential oils, but no erosion, no strong alkaline reaction, nor anything approaching the effects of the caustic cyanide.
[250] The following case came under my own observation:—A stout woman, 35 years of age, the wife of a French polisher, drank, in a fit of rage, a solution of cyanide of potassium. It was estimated that about 15 grains of the solid substance were swallowed. She died within an hour. The face was flushed, the body not decomposed; the mouth smelt strongly of cyanide; the stomach had about an ounce of bloody fluid in it, and was in a most intense state of congestion. There was commencing fatty degeneration of the liver, the kidneys were flabby, and the capsule adherent. The contents of the stomach showed cyanide of potassium, and the blood was very fluid. The woman was known to be of intemperate habits.