Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

(b) The face presents a peculiar appearance, the eyes are inflamed and watery, the conjunctivæ reddened and congested, there is excessive secretion from the nose resembling coryza.

(c) The disturbance of the digestive organs is revealed by the dryness of the mouth and occasional excoriation of the tongue, which may be reddened or covered with white fur and silvery in appearance; salivation may be present instead of dryness of the mouth; there may also be irritation of the throat; symptoms of gastro-enteritis, e.g. nausea and vomiting, anorexia, diarrhœa, or alternating diarrhœa and constipation.

(d) The skin eruptions are of various kinds, and comprise eczema, herpes, urticaria, erythema, keratosis, marked pigmentation and exfoliation.

(e) The nervous symptoms are those of peripheral neuritis, numbness, formication, hyperæsthesia, and tenderness, especially of the soles of the feet, the latter presenting appearances of erythro-melalgia; there is some amount of paresis, in some cases amounting to absolute paralysis of the limbs affected. The hands may be anæsthetic, while the feet are hyperæsthetic and hyperalgesic, and the perspiration much increased. Mental symptoms are not common, but there may be hebetude, or delusions.

In the Maybrick case, tried at the Liverpool Assizes in 1889, the following symptoms arose from repeated administration of arsenic during a period of probably about fourteen days. On April 27 Mr. Maybrick was seized with vomiting after taking tea. On the next day the vomiting continued, with foulness of the tongue, and he complained of stiffness in the lower limbs. On May 1 he complained of feeling unwell after taking luncheon, and he was sick on the following three days, and complained of a tickling sensation in the throat, with retching. On May 7 he was still suffering from vomiting, diarrhœa had commenced, and the throat was very dry and inflamed. On May 8 the diarrhœa was accompanied by tenesmus. On May 9 the tenesmus was distressing, and he died on May 11.

Dr. Prosper de Pietra Santa describes a disease to which workers in manufactories of paper coloured with Schweinfurt-green are liable, characterised by the appearance of vesicles, pustules, plaques muqueuses, and ulcerations on the exposed parts of the body, fingers, toes, and scrotum. Arsenical poisoning has been mistaken for nettle-rash, scarlet fever, and Addison‘s disease. In cases of slow poisoning the symptoms resemble very much those of gastritis and ulcer of the stomach, and death due to the action of arsenic has been referred to “spontaneous inflammation of the bowels.”

It must be remembered that in some cases of acute arsenical poisoning, when the acute symptoms have passed away, the nervous system exhibits its effects at a later period; in one case paresis came on on the fifth day, in another at the end of a week, and in a case recorded by Seeligmüller four weeks elapsed before the onset of nervous symptoms.

Post-mortem Appearances.—The appearances found after death depend upon the quantity of the dose and the length of time which supervenes between the taking of the poison and death. Inflammation of the stomach is a marked effect of the action of this substance on the system; and this condition is in most cases present whether the poison be swallowed, sprinkled on an ulcerated surface, or rubbed into the skin. The inflammatory redness, which may assume the appearance of crimson velvet, may be found in cases where death has taken place in two hours. It is sometimes found spreading over the entire surface of the stomach; at others, at the cardiac end only. The red colour is increased on exposing the stomach to the air. When the poison has been swallowed, the stomach may be found covered with white patches of arsenic, embedded in dark-coloured thick mucus, mixed with blood. Dr. Paterson thus describes the condition of a stomach he examined: Its lining membrane was generally very red and injected; but in addition there were very numerous stellated patches of vivid red, leading to a darker tint; in the centre of some of them was noticed a minute clot of blood; in others, an exceedingly rough particle of a crystalline substance, which was afterwards found to be arsenious acid. Perforation of the stomach is extremely rare, if it has ever occurred, but ulceration of the same organ has been observed in a person who died from the effects of arsenic in five hours (Christison, on Poisons, p. 340). In opposition to all the statements just made it has been shown that arsenic may prove fatal without leaving any sign of inflammatory action (R. v. M‘Cracken; R. v. Newton).

The mouth, pharynx, and gullet are generally found free from any inflammatory action. The small intestines may or may not be affected: in most cases the duodenum alone shows any signs of irritation. The rectum is that part of the large intestine most prone to inflammation. I have seen marked ulceration of the colon after death from inhalation of arseniuretted hydrogen. The other internal organs—the liver, spleen, and kidneys—do not appear to be appreciably affected by arsenic.

Due probably to the antiseptic properties of arsenic, the stomach and intestines retain for a long period after death the appearances of irritant poisoning. In two cases, this was so well marked as to be visible—in the one case, twelve months, and in the other, nineteen months after interment. In suspected cases portions of the liver should always be preserved and examined for arsenic.