§ 727. The Subacute Form.—The subacute form is that which is most common; it exhibits some variety of phenomena, and individual cases vary much in the matter of time. The commencement of symptoms is, as in the most acute form, usually within the hour, but exceptions to this rule occur. In a case quoted by Taylor,[735] and recorded by M. Tonnelier, the poison did not cause any marked illness for eight hours; it was found, on post-mortem examination, that a cyst had been formed in the stomach which sheathed the arsenic over, and in some degree explained this delay. In another case, again, ten hours elapsed, and this is considered to be the maximum period yet observed. As with the acute form, there is a feeling of nausea, followed by vomiting, which continues although the stomach is quite empty; at first the ejected matter is a watery fluid, but later it may be streaked with blood. The tongue is thickly coated; there is great thirst, but the drinking of any liquid (even of ice-cold water) increases the vomiting. Nearly always pain is felt in the epigastrium, spreading all over the abdomen, and extending to the loin (which is tense and tender on pressure). Deglutition is often painful, and is accompanied by a sort of spasmodic constriction of the pharyngeal muscles. Diarrhœa follows the vomiting, and has the same characters as that previously described; occasionally, however, this feature is absent. In the case recorded by Martineau,[736] a man, aged 25, was seized at 10 A.M. suddenly with vomiting, which persisted all that day and the next, during which time the bowels were obstinately confined. On the second day a purgative was administered, whereupon diarrhœa set in, and continued until his death, which occurred in about two days and sixteen hours from the commencement of the symptoms. This case is also remarkable from the absence of pain or tenderness of the abdomen.
[735] Taylor’s Principles and Practice of Jurisprudence, vol. i. p. 251; Flandin, vol. i. p. 535.
[736] Tardieu, op. cit., Obs. xix.
In subacute cases the urine has several times been suppressed, and it is generally scanty and red in colour. Irregularity of the heart’s action and feebleness are tolerably constant phenomena. As the end approaches, there is excessive muscular weakness, the face is pale, the eyes hollow; the mucous membranes first, and then the skin, take a bluish tint; the skin itself is covered with perspiration, and there has been noticed a peculiar odour, which has been likened to arsine (arseniuretted hydrogen). The respiration is troubled, convulsive movements of the limbs have been observed, and cramps in the calves of the legs; death follows in a variable time—from twenty-four hours to several days. In certain cases there is a curious remission after violent symptoms, the patient rallies and seems to have recovered; but the appearance is deceptive, for the symptoms recur, and death follows. Recovery may also take place partially from the primary effects, and then inflammatory changes in the stomach, &c., set in, with fever and the ordinary symptoms which are common in all internal inflammation.
A single dose of arsenious acid may cause a prolonged and fatal illness, one of the best known examples being that of the suicide of the Duc de Praslin,[737] who took, with suicidal intent, on Wednesday, August 18, 1847, a dose of arsenious acid. The exact time of the act could not be ascertained, but the first effects appeared at 10 P.M.; there were the usual signs of vomiting, followed on the next day by diarrhœa, fainting, and extreme feebleness of the pulse. On Friday there was a remission of the symptoms, but great coldness of the limbs, intermittency and feebleness of the heart’s action, and depression. On Saturday there was slight fever, but no pain or tenderness in the abdomen, vomiting, or diarrhœa; on this day no urine was passed. On the Sunday he complained of a severe constriction of the throat, and deglutition was extremely painful; thirst was extreme, the tongue intensely red, as well as the mucous membrane of the mouth and pharynx, and the patient had a sensation of burning from the mouth to the anus. The abdomen was painful and distended, the heat of the skin was pronounced, the pulse frequent and irregular,—sometimes strong, at others feeble,—the bowels had to be relieved by injections, the urine was in very small quantity; during the night there was no sleep. The duke died at 4.35 A.M. on Tuesday the 24th, the sixth day; intelligence was retained to the last. As the end approached, the respiration became embarrassed, the body extremely cold, and the pulse very frequent.
[737] Tardieu, “Relation Médico-Légale de l’Assassinat de la Duchesse de Praslin,” Ann. d’Hyg. Pub. et de Médico-Lég., 1847, t. xxxviii. p. 390; also op. cit., Obs. xi.