Was there no cheese rasped over this rice? demanded Morgagni. They answered in the affirmative; the priest who had little or no appetite, ate scarcely any thing but the cheese. In that case, said Morgagni, you understand already that there was arsenic among that cheese, which had probably been prepared for killing rats, and not having been laid away with sufficient care, some one had taken it to serve up with your rice during the time that you were hurrying the landlord to send up your dinner. These conjectures were verified by the confession of the landlord himself, who, having learned that the patients were out of danger, was no longer afraid to acknowledge that such had been the cause of this unfortunate accident.
The practitioner, says Orfila, will not be able to form a correct judgment in cases of this kind, if he neglect to pay attention, first, to the state of the stomach of the different persons poisoned; in fact, those who have taken a great quantity of food or drink, would feel in general less severe symptoms than others; second, to the nature of the dishes and of the drinks, as well as to the quantity that each person may have eaten or drank; third, to the existence or absence of vomitings and stools. It is evident that it may happen, that some persons have eaten a tolerably large quantity of a poisoned dish without any serious symptoms taking place, for this very reason, that the quantity of the food was considerable, and that it easily produced copious evacuations, by means of which the poison had been expelled. Numerous cases of culinary poisoning might be adduced in this place, in illustration of the important lights which are to be derived from the investigations which form the subject of the present chapter; but we have already considered the subject very fully under the head of poisons; and in the history of the effects of copper and lead, we have particularly explained the evils that may arise from the careless use of such metallic utensils in cookery.
Whether any and what remedies have been used; by whom recommended; and by whom administered?—The importance of this part of the enquiry is too obvious to require explanation; we are to learn from it whether the administration of the medicines might not have accidentally contributed to the aggravation of the symptoms they were designed to allay; suppose, for instance, we were to be told that the patient had resorted to copious libations of brandy to mitigate the sufferings of the bowels, which were afterwards found to depend upon Enteritis; the inference is obvious—but in performing this part of our professional duty, the greatest caution is necessary, and we must take care that our own medical opinions do not carry us to an unjustifiable extent in our reprehension of the plan of treatment which has been pursued by others; a striking instance of this want of propriety occurred in the late celebrated trial of Donnell, and was very properly denounced by the court, (see page 161 in the second volume, and Appendix, p. [304].) But there still remains another reason why we should cautiously and attentively examine any medicine that may have been administered, and it would be right in the practitioner to procure a portion of such medicine, with a view to its future analysis; for it has happened that where the assassin has supposed that his first dose would be insufficient to effect his purpose, he has artfully insinuated an additional dose in the medicines which are administered for the relief of his victim, and thus the hand, which is treacherously held out with promises of succour, adds a stronger poison to the cup; this occurred in the diabolical case of Mary Bateman,[[4]] better known by the name of the Yorkshire witch, who having poisoned a family with arsenic, sent a jar of honey, mixed with corrosive sublimate, for their relief.
A knowledge of the nature of the medicines that may have been taken, will also assist the chemist in his examination of the matter vomited, as we have fully explained under the history of Poisons.
Appearance of the evacuations.—This should always be attended to, for although it can hardly afford, in itself, a satisfactory indication, yet we have shewn, in the course of our history of poisons, that it may concur with the facts to heighten the probability of a case. The chemist will also require them for examination.
CASE II.
THE PATIENT IS DEAD.—THE ATTENDANTS CAN FURNISH ONLY AN IMPERFECT ACCOUNT OF HIS DISSOLUTION.
In conformity with the plan upon which we have arranged the objects of inquiry into the causes of sudden sickness and death—that of beginning with the most simple and plain, and passing in regular gradation to the more complicated and obscure problems, the present case, in which the patient is dead, but the attendants are able to furnish some history, however imperfect, very naturally constitutes the connecting link between that in which the patient is living, and that in which the great avenues of information are entirely closed upon us by the death of the individual, and the total absence of all direct testimony. The plan, therefore, upon which the investigation of this case is to be conducted, is in a great measure to be derived from the application of those precepts which are contained in the other cases; that relating to the examination of the attendants being collected from the first, and all that concerns the death, from the third.
There is, however, one object of inquiry which may be mentioned in this place with peculiar propriety, as the obscure and often erroneous evidence which is given in cases of sudden death, during an affray, renders it highly important to learn, whether the deceased had died during a paroxysm of passion. We have little doubt but that many persons have been convicted of murder, where the death of the individual in question, was the sole effect of the high state of irritation in which he had been placed. That life may be suddenly extinguished by the violent impulse of passion we have already shewn under the consideration of Syncope (p. [26]), and we are farther prepared to assert that Apoplexy[[5]], and other fatal diseases may also, in certain states of predisposition, result from the same powerful cause; violent transports of the mind may likewise occasion the return of any particular disease to which the patient had been formerly subject, as epilepsy, and other spasmodic diseases; they may likewise bring a chronic disease at once to a fatal crisis, as we have seen in the case related at page 29 of the 2d volume; the fact has been also well illustrated by Dr. Gordon Smith, in the case which occurred to a surgeon of his acquaintance in one of the midland counties, of which the following is an outline. “In the course of an altercation between a man and his wife, the woman died, and a clamour was raised that the husband had murdered her: an inquest being held, a verdict was returned against him, and he stood his trial at the following assizes; he was, however, acquitted, for it appeared in evidence that he had not even touched his wife during the quarrel. The deceased was a person of an extremely violent temper, and on opening her body, it was found that she had been labouring under suppuration of the liver, and that an abscess had burst into the cavity of the abdomen, in consequence of the agitation into which she had been thrown.” Baron Larey describes the case of a person who had been violently wounded in the thorax by a sword in a duel; but the man was progressively recovering, when in the fourth month from the period of the injury, he died suddenly in consequence of a violent fit of anger; upon dissection, the heart and pericardium exhibited traces of inflammation. We should also learn, if possible, whether the deceased had been at the time of death in a state of intoxication: for in such a condition a comparatively slight injury may occasion death. The following case, related by Dr. Cheyne, in which Mr. Charles Bell was concerned, we quote from Mr. Shaw’s excellent Manual of Anatomy[[6]], (p. 165.) “An industrious man returning home from his work, found his house empty; the bed he was to lie upon, and the tools of his trade, sold for liquor by his wife, whom he found in a gin shop, where she had been drinking and dancing. He brought her home, and in the passage of his house struck her, and ordered her to go up stairs; she refused to go; he carried her upon his shoulders, and the contention continuing up stairs, he struck her again. There having been no one present, we have only the husband’s account of her death. He said that whilst sitting on her chair, she fell down, upon which he threw her on the bed, conceiving that she was in a fit, such as he had seen her in formerly. Some of her neighbours coming in, found her dead. Mr. C. Bell was requested to examine the body of this woman. The man was afterwards tried at the Old Bailey, for murder, when Mr. Bell deposed, that upon taking out the brain, and tracing the vessels in the base, the anterior artery of the cerebrum going off from the internal carotid of the left side, was found torn half way across. The cause of this woman’s death was the bursting of the blood from the ruptured vessel; as to the cause of the rupture, Mr. Bell’s opinion coincided with the best authorities in pathology, that there is a state of the vessels, in which an external injury or shock is more apt to produce rupture; and drunkenness may be supposed to be the artificial state of excitement which most resembles this state of the vessels. Being asked whether the blows were the cause of the rupture, he said he conceived it very likely that a shock would rupture the vessel; and being then asked whether he conceived that this woman was more likely to have a vessel ruptured, from having been intoxicated—he was of opinion that intoxication, and the struggle, were likely to produce such a degree of activity of the circulation in the head, that a less violent blow might produce rupture, than what, in other circumstances, would have proved fatal.” The prisoner was acquitted.—At the York assizes in the year 1820, a somewhat analogous question arose,—whether the deceased might not have been attacked with apoplexy during the struggle? The light of anatomical dissection will be required in such a case, and the remarks which Mr. Shaw has offered upon the subject, appear to us to be extremely judicious and valuable; if, says he, effusion of blood be found between the dura mater and scull, and if a bruise on the scalp corresponds to the part, we may conclude that it has been caused by the blow; but if blood is found between the dura mater and the brain, though we should discover the marks of blows, or even fracture of the scull, still the question may be entertained whether the patient might not have been attacked with apoplexy during the struggle.
How soon is the deceased supposed to have died, after the alleged cause of his dissolution.—This is a very important question, for by learning the length of the interval between the attack and the death, we shall at once be enabled to accept as probable, or reject as impossible, the accounts given by the friends and neighbours. Thus, poisons, in general, require some time for their operation. Apoplexy does not generally destroy life under several hours[[7]].