3. Symptoms of the third and highest degree. Soon after a large dose of Arsenic has been swallowed, an austere taste, and a sense of heat and constriction of the pharynx and œsophagus are perceived; in a short period excruciating pains in the stomach and bowels, accompanied with vomiting of the most violent character, the matter voided being generally of a brown colour, and not unfrequently mixed with blood; with these symptoms are conjoined an inexpressible anxiety about the præcordia, and frequent faintings; the stomach at the same time acquires such a high degree of irritability, as to reject the mildest fluids. The alvine discharges now become frequent and painful, and consist of dark and extremely fœtid matter, frequently mixed with blood. The thirst is unquenchable, and the heat of the surface becomes extreme. The pulse is small, frequent, and irregular; palpitations of the heart, violent cramps in the legs, sometimes a painful strangury and bloody micturition ensue. The powers of life begin to fail, respiration becomes laborious, cold sweats break out, hiccup occurs, the countenance assumes a singular character of anxiety and distress, a livid circle appears around the eyes, the pulse is imperceptible, the body swells and sometimes becomes covered with a species of miliary eruption, or with dark purple spots. In some cases convulsions ensue, but delirium, or loss of reason, is very rarely the consequence of this species of poisoning, and the unfortunate sufferer is conscious until a few moments before the termination of his existence. Such are the general symptoms, but it is rare to see them all united in the same case; sometimes the greater part of them are absent. M. Chaussier reports the case of a robust middle aged man, who swallowed a quantity of arsenious acid in large lumps, and died without discovering any other symptom than slight syncope; other cases are related where only vomiting and purging[[223]] have been observed, and the symptoms have been mistaken for those of cholera spontanea.
The practitioner is therefore not to withhold his belief in a case of poisoning, on account of the absence of several of those symptoms which are enumerated in systematic works on Toxicology.
It is only by the study of individual cases, that he can learn to appreciate the just value of those pathognomonic combinations which afford the least exceptionable evidence upon such occasions.
The different modes of Poisoning by Arsenious Acid.
It has been proved by numerous experiments that the life of an animal may be destroyed with equal certainty by arsenious acid, whether it be internally administered, or externally applied to abraded surfaces, sores, or bleeding wounds; and it has been, moreover, shewn, that in either instance the symptoms will be analogous, except in the latter case they will often be more rapid in their course.
Lionardo di Capoa relates the case of a child killed by the violent vomiting and purging arising from a slight wound made in the head by a comb, wet with oil in which arsenic had been infused for the purpose of killing vermin; and we have numerous instances on record, where the application of arsenical cerates and ointments has been followed by violent and dangerous symptoms. We also learn from the different historians of the Plague of London, that the arsenical amulets which were worn, as preservatives, on that occasion, were sometimes attended with deleterious consequences; Crato[[224]] observed an ulcer of the breast produced by them. Verzascha, violent pains and syncope. Diemerbroeck,[[225]] and Dr. Hodges,[[226]] death itself. Amongst the foreign authors who have related cases of poisoning by the external application of arsenic we may mention Desgranges,[[227]] who records the history of a chambermaid, poisoned by having rubbed her head with an arsenical ointment for the purpose of destroying vermin; and Roux,[[228]] who confessed to have killed a girl of eighteen by an application of the “Pâte Arsenicale” to a cancerous breast. M. Renault has also given us the results of his experiments upon Arsenic when applied externally to dogs; when the skin was sound, it excited a pustular eruption without inflammation; but, when the skin was broken, more serious effects followed, both general and local, and in some cases death.[[229]]. In an experiment performed by Mr. Hunter, and Mr. Home, in which arsenic was applied to a wound in a dog, the animal died in twenty-four hours, and the stomach was found to be considerably inflamed. Mr. Brodie repeated the experiment several times, always with the precaution of tying a bandage, to prevent the animal licking the wound; the results were uniform; the stomach was, in every case, not only more violently, but more rapidly, inflamed, than when the poison had been internally administered, and it even preceded any inflammatory appearance of the wound. In the Journal de Medecine, the following case is related of a woman who was killed by her husband having insinuated powdered arsenic into the vagina,[[230]] at the moment of enjoying the conjugal rites. “A woman at Leneux, departement de l’Ourthe, aged forty, having died after a short illness, attended with considerable tumefaction of the genital parts, uterine hemorrhage, vomiting, and purging, the body was inspected by order of the mayor, when the surgeons reported that they found the vulva in a state of gangrene, the abdomen much distended with air, and the intestines inflamed and gangrenous. The culprit was arrested, convicted, and executed.” In the Acts of the Society of Copenhagen, a similar crime stands recorded, and which was also committed by a peasant; in this latter case, although some small pieces of arsenic were found within the vagina, yet some doubts arose respecting the possibility of such a species of poisoning, and the magistrates accordingly consulted the College of Medicine of Copenhagen, who decided the question in the affirmative, having first instituted a series of experiments upon horses.
Death may also be produced by the introduction of arsenic into the rectum; it is said that Sir Thomas Overbury, after the failure of the various poisons[[231]] that were administered to him, was at last despatched by an arsenical glyster.
With respect to the quantity of arsenic required for the production of such effects it is difficult to offer a decided opinion, as its operation must in every case be liable to contingency; but a very few grains are in general amply sufficient.
Physiological action of Arsenious Acid.
It had long been supposed that arsenic occasioned death by inflaming the stomach; but Mr. Brodie[[232]] has very satisfactorily proved, that its influence arises from its being absorbed, and that it must be regarded as a vital rather than as a chemical agent, and as having a constitutional, not a local mode of operation.