In the first place, he has in many instances found the inflammation of the stomach so slight,[[233]] that on a superficial examination it might have been easily overlooked; and in most of his experiments with arsenic, death took place in too short a period to be considered as the mere effect of inflammation. In the next place we have already shewn that in whatever manner the poison is applied, whether externally to a wound, or internally, to the alimentary canal, the same inflammatory appearance will be visible in the stomach; a fact which can only be explained by admitting that the poison is absorbed, and that it acts upon these organs through the medium of the circulation; it acts at the same time upon the brain, and heart, but with different degrees of force in different cases; so that it is sometimes difficult to ascertain which of these organs is the first to fail in its functions. According then to these experiments and observations, inflammation of the alimentary canal is not to be considered as the general cause of death in poisoning by arsenic; and yet cases will occur, where the local affection may prove fatal, the animal having survived the effects produced on the organs more immediately subservient to life, as the brain and heart. Mr. Henry Earle communicated to Mr. Brodie a case highly illustrative of this fact, which occurred in St. Bartholomew’s hospital; a woman had taken arsenic, and having recovered from the alarming symptoms which first occurred, died at the end of four or five days, when upon dissection, there appeared extensive ulcerations of the stomach and bowels. This then was evidently a case of “Consecutive” poisoning.
The dissertation of Dr. Jaeger, to which we have before alluded, contains the result of a very extensive series of experiments, in illustration of the physiological action of the arsenic. He diligently examined its effects upon all classes of organized beings, as well of the vegetable as of the animal kingdoms. The general conclusions which he has drawn from his experiments on vegetables are, that arsenic is in most cases a rapidly destructive poison to them, with the exception perhaps of a few of the simplest forms of existence;[[234]] and that their death was induced by means of the gradual absorption and distribution of the poison by the vessels and cellular membrane, so that the parts died in succession, as the particles of the poison reached them. Dr. Jaegar also found that arsenic was a quick and destructive poison to animals, and that death was preceded, in every instance, from the infusory animalcula up to man, by inordinate motions; and that the secretion was most remarkably increased from the mucous membranes. His experiments also proved that arsenic exerted the most powerful effects, when it was injected into the veins, or applied to a bleeding wound; next, when it was introduced into the stomach; but less so, when injected into the large intestines, which have fewer absorbing vessels.[[235]]
Organic Lesions, discovered on Dissection.
The examination of the bodies of persons poisoned by arsenic, must not be expected to furnish constant and uniform results, since they will be found to vary very considerably in different cases. As we have already considered the value of accelerated and retarded putrefaction, as an indication of poisoning, we shall at once proceed to the description of the morbid phenomena which are presented by the internal organs on dissection. The stomach and intestines are the parts in which we may expect to find the most decided marks of the ravages from arsenic. The former viscus will be found more or less inflamed; in some instances, the dusky redness will appear in patches, interspersed with points and streaks of a brighter hue; the villous coat of the stomach will be almost always softened, and, as if macerated, can be easily rubbed off in pieces with the fingers from the coats beneath; actual ulceration and sloughing are, according to the observations of Mr. Brodie, never found unless where death is late in taking place, in which case extensive ulceration of all the coats, amounting to actual perforation, may be expected to happen. This statement agrees with the observation of Ruysch, who says that where there had been sufficient time, he found the stomach ulcerated in those who had died from the effects of arsenic, but that if death supervened earlier, he only discovered bloody points, distant from each other, throughout the viscus. On the subject of sloughs upon such occasions, our enlightened author remarks, that anatomists have often been betrayed into a fallacy respecting their true nature; on opening the stomach of a dog which had taken a large quantity of arsenic, Mr. Brodie observed a dark brown spot about an inch in diameter, having all the appearance of a slough; on a closer examination, however, it appeared that this spot was no other than a very thin layer of coagulated blood, of a dark colour, and adhering very firmly to the surface of the mucous membrane, and having a few particles of arsenic entangled in it. He states that he has at several times observed a similar appearance but occupying a less extent of surface; and he informs us that, in the Hunterian museum, there is a human stomach, which was preserved for the sake of exhibiting what was considered a slough, produced by the action of arsenic; but that, on examining the preparation carefully, the dark coloured spot was discovered to be simply a layer of coagulated blood, similar to that before described. Dr. Baillie and Dr. Yelloly have found the stomach thickened in several parts, as if by coaguable lymph, and in one case the thickening of the coats was the only alteration of structure observable; and M. Renault relates a case, where the arsenic was taken in large pieces, which produced no other effect than slight syncope on the approach of death; and that, upon opening the body, the arsenic was found in the state it was swallowed, but there was neither inflammation nor erosion of the stomach. Where the arsenic has been swallowed in substance, it will be generally found attached to the membrane of the stomach by a peculiar glairy fluid; if the poison should have been administered in solution, the same organic lesions will be discovered, but the presence of the arsenic in the stomach can scarcely be expected, although the contents of the viscus, as well as all the matter ejected from the body before death, must be carefully examined by a chemical process to be hereafter described. The duodenum, like the stomach, generally affords evidence of the same inflamed and disorganized condition; and the whole track of the intestinal canal will be found more or less affected, according to the quantity of arsenic that has been administered, the period of time which has elapsed before death, and other circumstances which have been already enumerated as capable of modifying the action of this destructive substance. It however deserves notice that in many cases the rectum appears to be more affected than the other intestines; Dr. Male[[236]] states, that he has frequently found it abraded and ulcerated, and even more inflamed than the stomach itself; Mr. Brodie likewise observed, in his physiological experiments upon this substance, that the inflammation produced by it was greatest in the stomach and the rectum. Dr. Baillie has recorded several instances where a mortification of the rectum followed as an effect of this poison; and in the case of Mr. Blandy, detailed in the Appendix, p. 237, Dr. Addington stated, that the extremity of the rectum was extremely painful, and surrounded by excoriations and ulcers.
Mr. Brodie has stated, in the paper to which we have so often alluded, that the organic lesions occasioned by arsenic are confined to the stomach and intestines, and that he never found any appearance of inflammation in the pharynx or œsophagus. This statement, however, is at variance with a great weight of authority; we have ourselves witnessed cases in which dissection has demonstrated extensive inflammation in these parts; indeed it would appear, that this poison acts more particularly on the mucous membranes; and it is reasonable therefore to conclude, that those with which it comes in actual contact will not escape its virulence. The serous membranes which receive less blood, and more lymphatics, are necessarily less affected by it.
In the case of William Mitchell, as related at page [188], the patient complained of soreness of the eyes, heat and uneasiness in the mouth and throat; and the surgeon observed the membrane on the palate and uvula to be detached; so in that, again, of Mr. Blandy, Dr. Addington found on inspection that “his tongue was swelled, and his throat inflamed and excoriated; his lips, especially the upper one, dry and rough, and having angry pimples on them; the inside of his nostrils in the same condition, and his eyes a little blood shot.” (Append. l. c.). In the celebrated Scotch case of Oglivy and Nairne (see page [184]) Peter Meik, surgeon of Alyth, deposed, that, upon inspecting the body four or five days afterwards, he found “the tongue swelled beyond its natural size, and cleaving to the roof of the mouth, which he had never observed after a natural death.” Many more instances might be adduced to shew that the fauces, pharynx, and œsophagus are very frequently inflamed and excoriated by the ingestion of arsenic. Mortification of the pudenda[[237]] has been said to be an effect peculiar to the action of arsenic; certain it is that in males, priapism is sometimes a symptom of this poison, and the penis is found swollen and red after death, as was observed in the case of William Mitchell (p. [190]). The scrotum was also enlarged and of a dark colour. We have been long aware that persons exposed to the fumes of arsenic, or accustomed to handle any of its preparations, have been liable to a peculiar affection of these parts, but we have generally explained the fact by supposing that the poison had in such cases, been locally applied to them. The author has been lately informed by his friend Mr. Parkes, that several persons in his establishment were thus attacked, during the time they were engaged in preparing an arsenical solution, as a dye for the calico printers; and we have stated on another occasion,[[238]] that the smelters and workmen engaged in the copper works, and tin burning houses of Cornwall, are occasionally affected with a cancerous disease in the scrotum, somewhat similar to that which infests chimney sweepers. It is also singular that Stahl, in describing the putrescent tendency in the bodies of those who die from this poison, mentions in particular the gangrenous appearances of the parts of generation. The other organs of the body do not exhibit any particular appearances, which ought to be regarded as characteristic of death by arsenic; we must necessarily expect to find the traces of morbid action, especially where life has been unusually protracted; and the serous effusions found in the body of William Mitchell, are to be referred to such a cause.
Mr. Brodie has stated that, in animals killed by arsenic, the blood is usually found fluid in the heart and vessels after death; this agrees with the observation of Ruysch, who says that he never found the blood coagulated in the human body, after death occasioned by this poison; as well as with that of Dr. Jaeger, who describes the cavities of the heart, especially of the right side, to be, upon these occasions, turgid with blood, but that coagula are very seldom found in them.
A question, of a very considerable importance in a forensic point of view, has arisen with respect to the means, by which we may distinguish whether arsenic, found in the body, had been introduced into the digestive canal during life, or after death. In general, this fact is placed beyond suspicion by the testimony of those to whose care the body had been confided, previous to dissection. But cases have occurred where a poisonous substance has been introduced into the rectum of a dead body, with the diabolical intention of accusing an innocent person of having been the perpetrator of the poisoning. We are not aware of any English case of this kind, but M. Orfila states that in the proceedings of the Criminal Court of Stockholm such a case stands recorded. Fortunately there would not be much difficulty in detecting the crime; for were the arsenic applied to the rectum after death, the change of structure would not extend beyond the part in actual contact with it, but would be distinctly separated from the rest of the intestine by a well defined line of demarcation, which can never happen where the arsenic has acted during life; for, in this latter case, the transition from the diseased to the healthy structure will be gradual, and the limits of each imperceptible.
Before we conclude our observations upon the organic lesions occasioned by arsenic, we may caution the anatomist not to confound the red or violet colour which characterises inflammation, with that which has been occasionally found to arise from the ingestion of certain coloured drinks. The following case related by Foderé, and cited by Orfila, may serve to illustrate this subject. “A private person of Châlons sur-Marne, who was in a state of convalescence from a disease under which he had laboured, took a slight purgative, and died very shortly afterwards. He was believed to have been poisoned through some error in the medicine, and in order to be assured of this, the body was opened. The œsophagus and stomach were found to be red, and in certain places livid, as if in a state of gangrene. These appearances at first induced a belief that the deceased had died from poison; but M. Varnier, a physician of Châlons, concluded from the appearances, that death was the consequence of the disease, and that the apparent convalescence was only an insidious respite. It became therefore necessary to give some account of the state of the œsophagus and stomach; and having learnt that the deceased was in the habit of using a strong infusion of red poppies, the idea immediately struck him that the extraordinary colour of these organs might possibly depend on this infusion. In order to determine the validity of this explanation, he caused a dog to swallow, several times, a similar infusion; when upon opening its body, he discovered that the corresponding parts of this animal had assumed the same colour as had been observed in the stomach of the deceased above-mentioned, and, moreover, that this violet red colour was so firmly fixed that it resisted the action of repeated washings.” Tincture of Cardamoms will also be liable to occasion a coloured appearance in the stomach, as described in Mr. Stanley’s case of the death of a woman by a dose of opium.[[239]]