2. Poisonous.—Smallest recorded: one grain, (Lancet, Dec. 16th, 1837), two grains, (Provincial Journal, 1848, p. 347); average smallest, 2½ grains. Recoveries have been described after enormous doses, up to 1½ ounce, taken solid and therefore not dissolved, rejected by vomiting or purging, or prevented from irritant action by abundance of food (see a case in the Lancet, Jan. 13th, 1849, when 1oz. was taken with recovery).[139]
Idiosyncrasy may cause smaller doses to be dangerous; on the other hand, habit may cause tolerance of the poison, as already mentioned with regard to arsenic eaters. Nitre is said to increase the poisonous action (Med. Times, 1844, p. 216). Antimony by its prostrating action would have the same effect.
PHYSIOLOGICAL EFFECTS.
The symptoms usually commence in ½ to 1 hour after administration (Taylor), but vary with dose, form, &c. They have also been immediate (case of Lofthouse, York, 1835); in ten minutes (Guy and Ferrier); in ¼ hour (Taylor); in 5, 7, 8, and 10 hours (Med. Gaz. xlvii. 722); in 23 hours (Med. Times, Oct. 21, 1848); in four days (Woodman and Tidy, Forens. Med. p. 134).
As to the character of the symptoms, irritation of the stomach and intestines is the main feature. Burning pain, vomiting and purging, cramps and occasionally tetanus (Orfila, i., 449) occur. Rarely there is insensibility and no pain. Great thirst, constriction of the throat, headache, and finally exhaustion are common. Sometimes epilepsy or paralysis has been caused. The truth is, that every variety of constitutional disturbance may be caused by the violent irritation of the alimentary canal, except that the intellect is rarely affected. In many cases the effects closely resemble those of acute diarrhœa or English Cholera. One anomalous case is on record when death occurred in four hours after sound sleep, and no inflammation of the stomach was found (Lancet, xii., 194). For a detailed list of cases, see Guy and Ferrier’s Forens. Med. p. 457.
Fatal period.—Shortest, twenty minutes (Taylor); average, about twenty-four hours. Death in three to eight hours is common. But the end has been sometimes far more protracted, even to two years (Ibid., Med. Jur. i., 256).
The vomit is usually yellowish (L’Angelier) from bile: occasionally it is tinged with blood; rarely white. If the arsenic has been mixed with soot or indigo, these will affect its colour.
Post Mortem Appearances.—The lining membrane of the stomach and intestines is almost always inflamed and reddened, rarely darker from congestion. White patches, covered with mucus, should be examined for solid arsenic. Perforation, ulceration, and gangrene are rare. In bodies long buried, the arsenic is often converted into sulphide by putrefaction, and then appears as a yellow coating. Occasionally inflammatory appearances are found in the mouth, throat and other organs. Congestion of the brain is uncommon.
Among the effects of chronic poisoning by arsenic may be noted inflammation of the eyelids (conjunctivitis), skin eruptions, irritability of the stomach, jaundice, and local paralysis (for cases see Taylor’s Med. Jur., i. 252).
TREATMENT AND ANTIDOTES.