Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

3. Have the symptoms continued without intermission or remission, and in an aggravated form, till death?

4. The order of their occurrence.

5. The previous health or illness of the patient.

6. Have the symptoms any relation to a particular meal or article of food, &c.?

7. If patient has vomited, have the vomited matters, especially the first, been carefully preserved?

8. Preserve all vomited matters, food, medicines, &c.

9. How many were at the meal, and was what was taken common to all, or only taken by a few?

2. Evidence from Post-mortem Appearances.—The morbid appearances found in cases of poisoning will be treated more in detail when each poison, or group of poisons, comes to be separately considered. A caution may be given here against allowing the post-mortem signs of disease or external injury to exclude the idea of poisoning; for death may to all appearance be the result of disease or injury, and yet be caused by poison. An attention to the post-mortem appearances is important in all cases; for in many instances, where the symptoms were unknown to the experts at the time the inspection was made, they were subsequently found to correspond with the morbid changes which the autopsy revealed. The normal appearance of the stomach is white or nearly so, except during digestion, when it is reddened; yet we may sometimes come across cases in which the mucous membrane of this organ may be found so reddened as to lead to a suspicion of poisoning. The knowledge of this fact, and the absence of symptoms, will prevent an error in diagnosis. Ulceration from disease and from irritant poisoning must be distinguished. In that due to disease, the ulcers formed are, as a rule, small and circumscribed; in those from poison, there is diffused inflammatory redness over other parts of the stomach, and even in the intestines; and the poison, as in the case of arsenic, may be found adhering to the sides of the ulcer. Ulceration is more frequently the result of disease than of the action of poisons. Perforation of the stomach or intestines may be due to ulceration or to corrosion. The condition of the mouth and gullet will help the diagnosis. The appearance of the ulcer and the parts around it, together with the hints just given, must guide the diagnosis. Of post-mortem softening little need be said, beyond stating that it very rarely occurs, and is of course not preceded by symptoms. (For the diagnosis between inflammatory redness of the intestines and post-mortem staining, see page 45.)

3. Evidence from Chemical Analysis.—The objects of a chemical analysis are to determine: (1) The presence and nature of the poison. (2) The proportion or quantity of the poison taken. (3) The solution of certain questions connected with the administration of the poison.

The detection of poison in the body is of course the most important proof of poisoning; but it may be suggested that the poison was introduced after death, which, to say the least, is a most ingenious line of defence, but which, at the same time, must be held to be highly improbable, and impossible if found deposited in one or more of the solid organs. Again, granting that poison has been taken, is it the cause of death? This question may arise when injuries are found on the body, and it then becomes a matter of importance to know something of the symptoms which preceded death, and the morbid appearances found after death. The case of the girl who took arsenic to escape a beating by her father is a case in point. The father was tried for causing the death of the girl by undue severity, but it was subsequently shown that arsenic self-administered was the true cause of death. The poison may disappear from the body. This disappearance may be effected by vomiting, purging, or by the urine, or the poison may become absorbed and decomposed. The person poisoned may live sufficiently long to allow of the entire elimination of the poison, and yet die of the induced exhaustion. (See case of Dr. Alexander, ante.)