In three of the instances alluded to by Mr. Burns, the patients had been worn out by debilitating diseases; and they were emaciated and anasarcous. That the solution of the coats of the stomach in these cases was properly attributed to the gastric juice is very satisfactorily shewn by the relation of the following instructive dissection. “I had occasion,” says Mr. Burns, “two days after death, to open the body of a very emaciated and anasarcous young girl, who had died from scrofulous enlargement of the mesenteric glands. On raising the coverings of the abdomen, the stomach, which was empty, presented itself to view, with its front dissolved.[[187]] The aperture was of an oblong shape, about two inches in its long diameter, and an inch in its short, with tender, flocculent, and pulpy edges. This I demonstrated to the pupils attending my class; and I especially called their attention to the fact, that the liver, which was in contact with the hole, had no impression made on it. Having proceeded thus far, I placed all the parts as they had been, stitched up the abdomen, and laid the body aside in a cold situation for two days. Then I opened it again, in presence of the same gentlemen, and we found that, now, the liver, where it lay over the dissolved part of the stomach, was pulpy; its peritoneal coat was completely dissolved, and its substance was tender to a considerable depth. At this time the other parts of the liver were equally solid as before, and as yet every part of the subject was free from putrefaction; the posterior face of the stomach, opposite to the hole, was dissolved, all except the peritoneal coat, at least the internal coats were rendered pulpy and glutinous; the peritoneal covering had become spongy and more transparent than it ought to have been.” These facts, in addition to the many other important conclusions to which they will give rise, admonish us, that in judicial investigations into the cause of dissolution of the coats of the stomach, the appearances will vary, according to the period after death at which the body is examined. But the most satisfactory case which has been reported, in proof that the post mortem solution of the stomach may occur after a lingering disease, is that just published by Dr. Haviland,[[188]] where the patient died of fever after an illness of 22 days; when upon opening the body about 12 hours after death, the following appearances were noticed: “On raising the stomach and examining the little omentum, we were surprised by the appearance of a dark-coloured fluid, which seemed to escape from the former viscus. A most careful search was now made, and a large opening was perceived in the stomach on the upper and back part, near the cardia. The stomach was then detached, with a portion of the œsophagus and duodenum, when a large perforation of the diaphragm came into view, in the muscular part, corresponding precisely to, and communicating with, the hole in the stomach; so that a portion of the contents of the latter organ had escaped into the cavity of the chest. This part of the diaphragm was next removed. A careful examination of the other abdominal and thoracic viscera did not lead to the detection of the slightest diseased appearance. There was no where the smallest evidence of previous inflammation, no adhesions or ulcerations of any part of the viscera. The fluid which had escaped appeared to be nothing more than the contents of the stomach, of which the wine and water[[189]] formed a part, and probably gave it its dark colour. The stomach, on being examined after its removal from the body, afforded the following observations. The mucous membrane appeared to be more red and vascular than usual throughout its whole extent, and, here and there, were small spots of what seemed to be extravasated blood, lying below the mucous coat—for these spots were not to be washed off, nor to be removed by the edge of the scalpel. There were two holes in the stomach, the larger very near to the cardiac end of the small curvature, and on the posterior surface: this was more than an inch in length, and about half that breadth; the other not far from the former, also on the posterior surface, about the size of a sixpence. The edges of these holes were smooth, well defined, and slightly elevated. The coats of the stomach were thin in many other spots, and in one in particular nothing was left but the peritoneum, the mucous and muscular coats being entirely destroyed. The hole in the diaphragm was through the muscular portion, where it is of considerable thickness, and was large enough to admit the end of the finger. There was no appearance of ulceration or of pus adhering to the edges of this perforation of the diaphragm.” We have extracted a full account of this dissection, as the case is in itself truly interesting. The symptoms of the patient had been carefully watched, and no pain, or uneasiness was ever heard of, throughout the whole course of the disease, except in the head.
The powers of the stomach, as it would appear from the report, had suddenly revived at about twelve hours before his death, for “he asked for food, and swallowed a few spoonsfull of calves’-foot jelly with apparent relish.” May we not then conclude by observing, that the facts above related very satisfactorily corroborate the truth of the corollary deduced by Mr. Burns, “that the digestion of the coats of the stomach may take place under two very different conditions of the body; that although such solution is most frequent in those who have been suddenly deprived of life, when in full health, that it is not confined to those alone, but does, under certain circumstances, occur in those who have died from lingering diseases.”
Having then shewn under what circumstances the phenomenon in question may take place, we shall now proceed to describe more minutely the appearances which it may assume, and first, with respect to the part of the stomach, more usually acted upon by the gastric solvent. Mr. Hunter thought, that digestion of the stomach after death was occasioned by that portion of the gastric juice contained in the cavity of the stomach; consequently it followed, as a fair inference from this doctrine, that the coats of this viscus will only be acted on at that part on which the contents of the stomach rested. In Mr. Hunter’s cases, the great end of the stomach, which in the supine position of the body is the most depending part of this viscus, was found to be chiefly affected; a fact which tended to corroborate and support his opinion, and to render his conjecture extremely probable. Other anatomists, however, have discovered instances of solution of other parts of the stomach than the great end, indeed we have already described such an instance in the case of the emaciated and anasarcous girl examined by Mr. Burns, where the situation of the aperture was different from what it had been in any of Mr. Hunter’s cases. It was seated on the fore-part of the stomach, about an inch distant from the pylorus, and mid-way between the smaller and greater curvatures of this viscus; at a part of the stomach with which the gastric juice could not have come into contact, as the body had constantly been in the supine posture. “If then,” asks Mr. Burns, “the stomach was not acted on by the fluid contained in its cavity, how came it to be dissolved?” To us we confess his solution of the problem appears sensible and satisfactory. “We cannot, with propriety, ascribe the digestion of the stomach, in every case, to the gastric juice which has been poured into the cavity of that viscus; we are more properly in some instances to refer it to the action of the fluid retained in the vessels which had secreted it.” If this be admitted as a correct explanation of the fact, we shall cease to have any difficulty in accounting for the dissolution of other parts of this viscus besides the large end. We shall learn that the part acted on must vary, according to the place of the stomach where the gastric juice is retained in the apparatus which secreted it, and thus we shall be enabled to explain some cases, which, at present, seem to be in opposition to the observation of Mr. Hunter.
With respect to the appearances, which such erosions assume, some difference of opinion has also unfortunately existed. Mr. Hunter has asserted that “there are very few dead bodies, in which the stomach is not, at its great end, in some degree digested; and the anatomist,” says he, “who is acquainted with dissections can easily trace the gradations from the smallest to the greatest. To be sensible of this effect, nothing more is necessary than to compare the inner surface of the great end of the stomach, with any other part of the inner surface; what is sound will appear soft, spongy, and granulated, and without distinct blood-vessels, opaque, and thick, while the other will appear smooth, thin, and more transparent, and the vessels will be seen ramifying in its surface; and upon squeezing the blood which they contain, from the larger to the smaller branches, it will be found to pass out at the digested ends of the vessels, and appear like drops on the inner surface.” This condition, however, of the vessels does not invariably accompany such solution. In three of the subjects dissected by Mr. Burns, there was no appearance of vessels ramifying on the coats of the stomach. To account for the absence of this vascular appearance several explanations have been attempted; “but we are not,” says Mr. Burns, “to regard the cause of this deviation from Mr. Hunter’s description, as depending upon the particular part of the stomach acted on in the different cases; neither are we to imagine that the stage of the process at which we examine the body will assist us in this investigation; we are rather to obtain an explanation of this fact, from contemplating the difference of condition of the different individuals at the time of death; the subjects, whose cases are detailed by Mr. Hunter, were persons cut off by violence, in the plenitude of health, their stomachs at the time excited by the stimulus of food to vigorous action, and the process of digestion at the instant of death going on briskly, circumstances under which it is reasonable to infer that all the blood-vessels would be filled with blood, which it is evident, from the nature of the causes depriving them of life, would be detained in the veins. This being the state of his subjects at the moment of death, we shall not wonder that, when he afterwards opened the bodies, he could squeeze the blood from the digested ends of the vessels.” This is certainly an ingenious explanation, and receives considerable support from the important fact of the stomach presenting a very high degree of vascularity, in cases of sudden death, as exemplified by Dr. Yelloly[[190]] in his account of the appearances found in the stomachs of several executed criminals soon after they had undergone the sentence of the law. So also has dissection disclosed the same phenomena, in those cases where life has been suddenly extinguished by a blow on the region of the stomach; inflammation, in such instances, is necessarily out of the question, for death is immediate; the red and inflamed appearance therefore of the stomach can alone be accounted for by regarding it as the effect of the sudden cessation of the heart, producing an accumulation of the blood in the extreme arterial branches. But what shall we say of Dr. Haviland’s case? so far from the patient dying suddenly, and in the plenitude of health, he expired after a lingering illness of three weeks, and yet, upon dissection, the stomach was found highly vascular. This is in direct opposition to the theory of Mr. Burns, and, we must confess, is not a little embarrassing. Where the gastric solution has proceeded so far as to produce perforations in its coats, Mr. Hunter states that, “the contents of the stomach are generally found loose in the cavity of the abdomen, about the spleen and diaphragm; and that in many subjects this digestive power extends much farther than through the stomach. I have often found,” says he, “that after it had dissolved the stomach at the usual place, the contents had come into contact with the spleen and diaphragm, and had partly dissolved the spleen, &c.” With respect to the appearance of the gastric perforations, Mr. Hunter characterises them as having “their edges apparently half dissolved, very much resembling that kind of dissolution which fleshy parts undergo when half digested in a living stomach, viz. pulpy, tender, and ragged.”
As certain corrosive poisons will occasionally produce such organic lesions in the stomach, as lead to perforations in its membranes, a question naturally arises, how are we to distinguish such disorganizations, produced by causes acting during life, from those which result from solution after death? To this we may at once return a general answer, that in a judicial investigation, we ought not to attribute erosion of the stomach to poison, except it be accompanied by evident marks of previous inflammation and reaction, or with gangrenous appearances; unless indeed the poisonous substance be found in the stomach, or the symptoms, previous to death, be characteristic and satisfactory. It has been stated that the edges of the natural perforation are “pulpy, tender, and ragged,” whereas those produced by the caustic action of a poison will generally be found well defined, and of the same thickness as any other part of the stomach. But let it be remembered, that, after all, it is upon the detection of poisonous matter in the stomach, that the prudent physician will place his great reliance. We have thus offered a review of the different opinions which have been entertained upon this important question, and in conclusion we may observe, that there will necessarily exist in each particular case, circumstances which no general views can comprehend, and upon which the practitioner must exercise his judgment and discretion. It is not our intention at present to enter fully into the several questions which were raised on the memorable trial of Charles Angus for the murder of Margaret Burns, but as we have already very frequently alluded to the medical evidence delivered on this occasion, and as we shall hereafter be called upon to notice some of its more striking features, we have subjoined a report of the trial, and of the unhappy and ill-conducted controversy to which it has given origin.[[191]] Whether the holes in the stomach were the effects of corrosive poison or of that solvent action after death, which we have just endeavoured to explain, must remain a matter of doubt, for the erosion in this case was so considerable, and the inflammation so slight, that it is impossible to assert that they both depended on the same cause.
With respect to the possibility of confounding the appearances of gangrene, in the stomach, with those of putrefaction, some notice is necessary in this place; and we cannot better illustrate the subject, than by introducing the marks of discrimination which are considered by Mahon[[192]] as decisive upon such occasions. The spots in the stomach, resulting from putrefaction, says he, may be distinguished from those which have resulted from violent causes, during life, in the following manner. If the stomach retain its natural colour, and the spots are mixed with a red hue, or the ulcers have pale, or bright red edges, such have been the effect of some violent impression upon the living membrane; whereas, on the contrary, if the stomach be pale, livid, or green, and exhibit spots of the same colour, but of rather a deeper hue, we may safely conclude that they are the genuine phenomena of putrefaction. See the interesting account of the dissection of William Mitchell, p. 191.
Q. 3. Whether the rapid progress of putrefaction, in the body, generally, or in any particular part, is to be considered as affording presumptive evidence, in support of an accusation of poisoning?
There are few opinions more popular than that which considers the speedy putrefaction of the body as the universal and never failing consequence of poisoning. To appreciate, however, the true value of such an indication, and to avoid the fallacies with which it is surrounded, it is essential to remember that the body of a person dying suddenly, and in what may be called full health, is very liable to run rapidly into a state of decomposition. As far, however, as our observations enable us to deduce any conclusion, certain vegetable poisons appear to accelerate such a change; for, very shortly after death, the body, under such circumstances, will frequently swell, become highly offensive, assume a black[[193]] appearance, and exhibit gangrenous spots on its surface. No such appearances, however, it is said, usually follow as the specific consequence of the fatal operation of mineral poisons; Dr. Jaeger in an Inaugural dissertation,[[194]] which deserves to be better known, states, as the result of numerous experiments, that the putrefaction of animal bodies, poisoned by arsenic, whether buried or not, does not appear to be either unusually accelerated or retarded; and he moreover found that the generation of infusory animals, the production of larvæ and subterraneous vegetation, in and about the bodies of poisoned animals, took place as usual; and he remarked that “the immediate contact of an arsenical solution seemed, in several instances, to retard, in some degree, the putrefaction of the part to which it was applied in sufficient quantity.” In the extraordinary case examined by Metzger, in which the largest quantity of arsenic ever, perhaps, taken into the stomach, was found after death, the body was not opened until eighteen days after dissolution, and yet, says the anatomist, “cadaver, quod mireris, sine ullo fœtore aut putredinis signo erat, ut et absque maculis lividis, si digitorum apices excipias.” A case is also related by Dr. Yelloly,[[195]] in which death was occasioned by arsenic, but where not the slightest appearance of putrefaction was visible at the time of examination, which did not take place until forty-nine hours after death.
On the other hand, Morgagni[[196]] states that, on dissecting a female who died from Arsenic, “facies corporis posterior, ne suris quidem et calcibus exceptis, tota erat nigra.” And in the interesting case of William Mitchell, as hereafter related, the appearance of the body appears to have indicated that decomposition had proceeded with more than ordinary celerity.
The fact of accelerated, or retarded putrefaction, therefore, cannot be received with any confidence as a collateral indication of poisoning. Dr. Carson, however, in the trial of Charles Angus, adduced the circumstance of its absence, as a negative proof that the deceased had not been poisoned; and in the celebrated Scotch trial of Patrick Ogilvy, and Catharine Nairne,[[197]] the same fact was forcibly urged in their defence.