Q. 2. Whether organic lesions, similar to those produced by poisoning, may not occasionally result from natural causes?
Q. 3. Whether the rapid progress of putrefaction, in the body generally, or in any particular part, is to be considered as affording any presumptive evidence, in favour of a suspicion of poisoning?
Q. 4. How far the absence of poison, or the inability of the chemist to detect it, in the body, or in the fluids ejected from it, is to be considered as a negative to an accusation of poisoning?
Q. 5. What degree of information can be derived from administering the contents of the stomach of a person supposed to have been poisoned, to dogs, or other inferior animals?
We shall now consider these questions in succession.
Q. 1. Whether all, or most of the symptoms, characteristic of the action of corrosive and narcotic poisons, may not arise from morbid causes of spontaneous origin?
It must be admitted that the symptoms produced by violent irritation in the primæ viæ, are not characterised by a diversity, corresponding with that of the causes which may excite it; thus it is, that we have a disease to which the term “cholera” has been assigned, and which is indicated by the following symptoms, “Humoris biliosi vomitus, ejusdem simul dejectio frequens; anxietas; tormina; surarum spasmata,” (Cullen Syn: LX. 1.) symptoms which supervene, and with nearly the same force, the spontaneous effusion of acrid bile into the intestines, and the ingestion of some acrid poison; and hence the nosologist has very properly divided cholera into two species, viz.
C. Spontanea, “Tempestate calida, sine causa manifesta oboriens.”
C. Accidentalis, “A rebus acribus ingestis.”
The problem therefore for solution, is the mode of distinguishing the two species from each other. Although the leading characters are, as we have said, the same in both, such as bilious vomiting, and purging, violent tormina of the bowels, cold sweats, cramps, faintings, and death, yet by a careful and circumstantial examination of the case, the intelligent practitioner will generally be enabled to arrive at a probable conjecture; the season of the year[[155]], the prevailing epidemics, the age[[156]] and constitutional predisposition of the patient, his habit with respect to diet, are circumstances which will greatly assist the diagnosis. The progress of cholera morbus is also rarely, or never, fatal in this climate, especially in so short a period as that in which death occurs from the operation of a violent, corrosive poison.[[157]] There are besides in this latter case, very frequently other symptoms which do not attend cholera spontanea,[[158]] such as sanguineous vomiting, extreme burnings in the æsophagus and region of the stomach, swollen countenance, great dryness and tumefaction of the fauces, peculiar fætor of the breath, ischuria, with discharges of bloody urine, and ulcerations about the fundament[[159]]; this latter symptom was particularly remarkable in the case of Mr. Blandy, whose history, as related by his physician, Dr. Addington, will be found in our Appendix, p. 236, and well deserves the attentive consideration of the medical jurist. The matter voided will also sometimes lead to a just diagnosis; in the true cholera spontanea there is a discharge of almost pure bile by vomiting and stool, simultaneously or alternately; now, although the same vomiting and purging may arise from the action of a poison, yet it does not follow that the matter discharged is bilious. The evidence delivered on the extraordinary trial of Donnall, for the wilful murder of his mother-in-law, Mrs. Elizabeth Downing, has been also printed in the Appendix, as well illustrating those doubts with which the present question is naturally encompassed. An opinion has existed that the appearance of jaundice during, or after the severe symptoms of cholera, offers a satisfactory proof of its spontaneous origin. Upon this point we would observe, that by violent and protracted retching a person may sometimes become jaundiced, a circumstance not unlikely to occur in cases of poisoning. The stomach, diaphragm, and abdominal muscles are, under such repeated efforts, very apt to be rendered eminently irritable, so that at each effort of the former to discharge its contents, the latter will frequently be simultaneously thrown into strong spasmodic contractions, and the liver, together with the gall-bladder, will be suddenly caught, and, as it were, tightly squeezed in a powerful press, in consequence of which the bile will regurgitate, and be carried into the venæ cavæ; for Haller has shewn with what facility a subtle injection, when thrown into the hepatic duct, will escape by the hepatic veins; upon which Dr. Saunders has made the following remark, “I know this to be a fact, for I have ascertained by experiment, that water, injected in the same direction, will return by the veins in a full stream, although very little force is used.”