Although in the course of reading I have met with a sufficient number of cases of the kind to show that compound poisoning is an object of some consequence to the medical jurist, the facts hitherto made public are not so numerous as to render a systematic arrangement of them practicable. The most advisable course, therefore, seems to be merely to describe for the present the cases which have been brought under my notice. These are as follows:
1. Poisoning with Arsenic and Alcohol.—A man, after taking twelve ounces of whisky at a debauch, swallowed, an hour afterwards, while in a state of excitement, but not particularly drunk, a quantity of arsenic, the dose of which could not be ascertained. Fifteen minutes after the arsenic was taken medical aid was procured, upon which repeated attempts were made to produce vomiting by means of ipecacuan and sulphate of zinc, but to no purpose. The stomach-pump was therefore resorted to; and, after at least an hour had been spent in previous attempts by emetics, the stomach was cleared of a fluid in which arsenic was unequivocally detected. No symptom of poisoning with arsenic followed. As the man took the arsenic seven hours after a meal, when of course the powder would at once be brought freely in contact with the villous coat of the stomach, it must, I think, be inferred, that the operation of the arsenic was impeded or prevented by the narcotism previously induced by the ardent spirits. For this case I am indebted to a former pupil, Mr. King.
Poisoning with Arsenic and Alcohol.—A case of the same description with the last, but which proved fatal in consequence of the large quantity of arsenic taken, has been related by Dr. Wood of Dumfries. A lad of seventeen, after a night’s debauch, swallowed half an ounce of arsenic early in the morning. In two hours and a half, when Dr. Wood first saw him, there was no symptom of poisoning with arsenic,—no symptom at all indeed but languor and drowsiness. A few minutes afterwards he had slight vomiting, which was repeatedly renewed by artificial means. For some hours the pulse was but little elevated. In eighteen hours he began to sink, and presented the usual constitutional symptoms of poisoning with arsenic; and in forty-one hours he expired. But from first to last he had scarcely any local symptom except vomiting, even although the stomach presented after death signs of violent irritation.[[2557]]
3. Poisoning with Tartar-Emetic and Charcoal Fumes.—Under the head of poisoning with antimony, notice has already been taken of the case of a man who, after swallowing seventeen grains of tartar-emetic, attempted to commit suicide by suffocating himself with the fumes of burning charcoal. He recovered from both attempts, suffered severely from the usual narcotic effects of carbonic acid gas, but showed scarcely any symptom of the irritant action of tartar-emetic.[[2558]]
4. Poisoning with Alcohol and with Laudanum.—Under the head of poisoning with opium, allusion has already been made to a remarkable case related by Mr. Shearman, where the usual effects of opium were much retarded in an individual who, at the time of swallowing the opium, was in a state of excitement from intoxication. For five hours there was no material stupor. But after that the usual narcotic symptoms supervened and eventually proved fatal.[[2559]] The excitement of intoxication, however, has not always the effect of suspending the action of opium; for in a case which came under my notice in the Infirmary of this city,—that of a woman, who swallowed an ounce and a half of laudanum while much intoxicated,—the usual narcotic symptoms were fully formed in an hour: and although the stomach-pump was applied soon afterwards, she expired in less than five hours from the time the laudanum was swallowed,—those who had charge of her before she was brought into the hospital having neglected to use the proper means for keeping her roused.
5. Poisoning with Laudanum and Corrosive Sublimate.—Of all the cases of compound poisoning I have met with, the most remarkable is an instance which occurred in Edinburgh Castle, a few years ago, of poisoning with laudanum and corrosive sublimate. In this case, the individual, a young soldier, swallowed about the same time two drachms of the latter and half an ounce of the former. He had at first no violent symptoms whatever, indicating the operation of corrosive sublimate; which is an extremely rare occurrence. Afterwards he had frequent purging and tenesmus, with bloody stools and all the usual phenomena of violent dysentery, but no pain of belly, no tenderness even on firm pressure, no vomiting except under the use of emetics. On the fourth day a violent salivation set in; and under this and the dysenteric affection he became quickly exhausted, yet not so much, but that on the day of his death, the ninth after he took the poison, he was able to walk a little in his room without assistance. He died on the close-stool rather unexpectedly. I have unfortunately lost the original notes I had of this case, and have forgotten whether any narcotic symptoms were present at first; but my impression is that they were present, though in a slight degree only. Most of the previous particulars were communicated to me by the late Dr. Mackintosh. The stomach, duodenum, ileum, colon, and rectum were found after death enormously inflamed, ulcerated, and here and there almost gangrenous.—In this instance some of the corrosive sublimate must have been decomposed by the laudanum, and an insoluble meconate of mercury formed. But the quantity thus decomposed could have been but a small proportion of the whole,—as was indeed proved by the extensive ravages actually committed in the whole alimentary canal. I conceive, therefore, that there is no other way of accounting for the slight apparent effects of the corrosive sublimate, at the commencement particularly, than by supposing that the narcotic operation of the opium veiled or actually retarded the irritant action of the corrosive sublimate.
6. Poisoning with Opium and Belladonna.—A lady, who used a compound infusion of opium and belladonna as a wash for an eruption in the vulva, took it into her head one day to use the wash as an injection; and actually received three successive injections, containing each the active matter of a scruple of opium and half an ounce of belladonna leaves. Fortunately none of the three was retained above a few minutes, except the last, which was not discharged for ten minutes. In less than an hour, she was found in bed in a deep sleep, but the true cause was not suspected till three hours later. She was then completely insensible and motionless, with the face pale, the pupils excessively dilated and not contractile, the pulse frequent and small, and the breathing hurried. After the use of purgative injections, blood-letting, leeches to the head, and sinapisms to the legs, she began in five hours to show some sign of returning consciousness, which improved after a fit of vomiting. When thoroughly roused, her vision continued dim, the pupils excessively dilated, and the ideas somewhat confused. For three days the pulse continued frequent, and the pupils somewhat dilated.[[2560]] Here the opium seems to have prevented the delirium usually induced by belladonna in the early stage, while on the other hand the belladonna prevented the usual effect of opium on the pupils, and actually produced the opposite action.
7. In the following cases, the active poisons to which the individuals were exposed were so numerous, that it is impossible to say which or how many of them occasioned the symptoms. A colour-maker was superintending a process in which cobalt, arsenic, mercury, sal-ammoniac, and nitric acid were subjected to heat in a mattrass, when the mattrass suddenly gave way, and a dense vapour was instantly discharged. The manufacturer, before he could escape, fell down insensible; and though speedily removed, he died in no long time, affected with enormous swelling of the abdomen. A workman who was also present, escaped by a window; but was nevertheless immediately attacked with swelling of the belly, which speedily became very great, and was attended with pain in the jaws, and dimness of sight. These symptoms were very slowly dissipated under the use of cold bathing and purgatives, which brought away an enormous quantity of fetid gas.[[2561]]
These are not the only examples of compound poisoning which have come under my attention. But others I have noticed are not detailed with sufficient exactness to make it worth while to quote them. The instances given, however, are sufficient to show that poisons of opposite qualities given about the same time in large doses will disguise one another’s effects, or impede, or perhaps even prevent them, in a manner which renders such a combination of circumstances an important subject of inquiry for the medico-legal toxicologist.
It is probable that the modifying influence is established in one of two ways,—either by one poison producing a state of venous plethora or distension, which impedes, or for a time prevents, the absorption of the other,—or by one poison producing an insensibility of the membrane with which the other is in contact; so that not only the local injury actually done has not the usual remote effect on the constitution, or on distant organs, but likewise is at times substantially less extensive than in ordinary circumstances. These reflexions arise naturally from a review of the preceding cases; but of course further facts are necessary to give them weight.