Fig. 33.—Photo-micrograph of crystals
of tartarated antimony, × 50.
(R. J. M. Buchanan.)
Chronic.—The symptoms which mark the chronic form of poisoning differ chiefly in being less intense and less rapid than in the acute. Chronic poisoning by small repeated doses is that form of poisoning which appears most in vogue of late years—as certain diseases, enteritis, etc., can be simulated by the administration of repeated small doses. The unfortunate victim complains of constant nausea and retching, with great depression. Food is objected to, as it only increases the vomiting. The matters vomited are at first merely mucus, but after a time they become mixed with bile. Each time the poison is repeated, the symptoms become aggravated. Emaciation gradually sets in, and the person dies from complete exhaustion, or from the effects of a larger dose than usual. Chronic poisoning has given rise to several errors in diagnosis, and the histories of recorded cases should put medical men on their guard. In all doubtful cases examine the urine.
Post-mortem Appearances.—The mucous membrane of the throat, gullet, and stomach is inflamed, and in some places softened and corroded. Aphthous-looking spots are not infrequently found on the mucous membrane of the stomach, and these may also be observed on the throat and on the small intestines. The liver has been found in some cases of chronic poisoning, where the fatal termination has been for some time retarded, enlarged, and its structure so soft as to be easily broken down. Fatty degeneration of the internal organs has been found after protracted fatal administration of the drug. It is stated that in Brunswick the fatty livers of the geese are produced by the judicious administration of antimony. The appearances above detailed may be more or less absent or present, according to the time that may have elapsed from the swallowing of the poison to the time at which death has occurred.
At the post-mortem examination on the body of Mr. Bravo, poisoned with tartar emetic in 1876, the mucous surfaces of the stomach and duodenum were found pale and yellowish. Ulcers were present in the cæcum, and the rest of the large intestine blood-stained, but not ulcerated. Stevenson records the post-mortem appearances of the bodies of three women poisoned by tartar emetic (B. M. J., 1903, vol. i. p. 873). They are of peculiar interest in reference to the preservative action of antimony upon the bodies of those poisoned by it. In the case of M. E. Marsh, upon whose body the examination was made eight days after death, there was no odour of putrefaction, the bowels were in a condition of acute catarrh and streaky congestion without ulceration.
The body of Bessie Taylor had been buried for twenty-one months; ordinary putrefactive changes were absent, and with the exception of the integuments, it was in a remarkably good state of preservation. The alimentary canal showed acute non-ulcerative gastro-enteritis, the stomach and duodenum were of a cinnabar-red colour, the jejunum also in patches. The ileum was covered with orange-red mucus in its lower portion, and there was an orange-coloured patch twelve inches above the ileo-cæcal valve. The patch on analysis was proved to contain antimonious sulphide. Similar orange patches were present in the colon and upper portion of the rectum. There were no ulcerations, but the mucous membrane of the intestines was of a dull cinnabar-red colour.
The body of Mary J. Spink was exhumed five years after burial, and presented a life-like aspect; there was no putrefactive odour, and no larvæ present. The stomach and intestines were of a cinnabar-red colour; there were no ulcerations; the intestines contained orange-coloured mucus.
Elimination of Antimony from the System
Antimony, taken in a large dose, or in small doses frequently repeated, appears to be rapidly absorbed, and then eliminated from the system by the kidneys. Dating from the time at which the poison was swallowed, it will be found in the organs of the body in the following order:—
1. Stomach and bowels, but slightly in the liver.
2. Absent from the stomach, but present in the liver, spleen, and kidneys—traces in the blood.