The tendency of habit to modify the action of arsenic is questionable. So far as authentic facts go, habit has no power of familiarizing the constitution to its use. One no doubt may hear now and then of mountebanks who swallow without injury entire scruples or drachms of arsenic, and vague accounts have reached me of patients who took unusually large doses for medicinal purposes. But as to facts of the former kind, it is clear that no importance can be attached to them; for it is impossible to know how much of the feat is genuine, and how much legerdemain. With respect to the latter facts, I have never been able to ascertain any precise instance of the kind; and so far as my own experience goes, the habit of taking arsenic in medicinal doses has quite an opposite effect from familiarizing the stomach to it.
Oxide of arsenic being sparingly soluble, its operation is often much influenced by the condition of the stomach as to food at the time it is swallowed. If the stomach be empty, it adheres with tenacity to the villous coat and acts with energy. If the stomach be full at the time, the first portions that come in contact with the inner membrane may cause vomiting before it can be diffused, so that the whole or greater part is discharged. One remarkable case of this nature has been quoted in page [29]. In another, where severe symptoms did supervene, and recovery was ascribed to the use of magnesia as an antidote, the favourable result seems to have been really owing to the circumstance, that the patient had supped heartily not long before taking the arsenic.[[600]] An extraordinary case related by Mr. Kerr, in which nearly three-quarters of an ounce were retained for two hours without causing any serious mischief, probably comes under the same category; for the arsenic was taken immediately after a meal, and the stomach was cleared out by emetics.[[601]]
In the following detail of the symptoms caused by arsenic in man, its effects when swallowed will be first noticed; and then some remarks will be added on the phenomena observed when it is introduced through other channels.
The symptoms of poisoning with arsenic may be advantageously considered under three heads. In one set of cases there are signs of violent irritation of the alimentary canal and sometimes of the other mucous membranes also, accompanied with excessive general depression, but not with distinct disorder of the nervous system. When such cases prove fatal, which they generally do, they terminate for the most part in from twenty-four hours to three days. In a second and very singular set of cases there is little sign of irritation in any part of the alimentary canal; perhaps trivial vomiting or slight pain in the stomach, but sometimes neither; the patient is chiefly or solely affected with excessive prostration of strength and frequent fainting; and death is seldom delayed beyond the fifth or sixth hour. In a third set of cases life is commonly prolonged at least six days, sometimes much longer, or recovery may even take place after a tedious illness; and the signs of inflammation in the alimentary canal are succeeded or become accompanied, about the second or fourth day or later, by symptoms of irritation in the other mucous passages, and more particularly by symptoms indicating a derangement of the nervous system, such as palsy or epilepsy. The distinctions now laid down will be found in practice to be well defined, and useful for estimating in criminal cases the weight of the evidence from symptoms.
1. In one order of cases, then, arsenic produces symptoms of irritation or inflammation along the course of the alimentary canal. Such cases are the most frequent of all. The person commonly survives twenty-four hours, seldom more than three days; but instances of the kind have sometimes proved fatal in a few hours, and others have lasted for weeks. On the whole, however, if the case is much shorter than twenty-four hours, or longer than three days, its complexion is apt to be altered. In the mildest examples of the present variety recovery takes place after a few attacks of vomiting, and slight general indisposition for a day or two.
In regard to the ordinary progress of the symptoms, the first of a decisive character are sickness and faintness. It is generally thought indeed that the first symptom is an acrid taste; but this notion has been already shown to be erroneous. For some account of the sensations felt in the act of swallowing the poison, the reader may refer to what has been stated in p. [200]. There is no doubt, that in the way in which arsenic is usually given with a criminal intent, namely, mixed with articles of food, it seldom makes any impression at all upon the senses during the act of swallowing.
In some instances the sickness and faintness, particularly when the poison was taken in solution, have begun a few minutes after it was swallowed. Thus in a case mentioned by Bernt, in which a solution of arseniate of potass was taken, the symptoms began violently in fifteen minutes;[[602]] in one related by Wildberg, where the oxide was given in coffee, the person was affected immediately on taking the second cup;[[603]] in one related by Mr. Edwards, the patient was taken ill in eight minutes,[[604]] in one mentioned by M. Lachèse of Angers, violent symptoms commenced within ten minutes after the poison was swallowed with prunes;[[605]] in a case communicated to me by Mr. J. H. Stallard of Leicester, the symptoms set in with violence ten minutes after it was taken dissolved in tea; nay, in a case of poisoning with orpiment in soup, mentioned by Valentini, the man felt unwell before he had finished his soup, and set it aside as disagreeable.[[606]] It is a mistake therefore to suppose, as I have known some do, that arsenic never begins to operate for at least half an hour. Nevertheless it must be admitted, that in general arsenic does not act for half an hour after it is swallowed.—On the other hand, its operation is seldom delayed beyond an hour. The following, however, are exceptions to this rule. Lachèse in the paper quoted above mentions an instance where the interval was two hours, and where the issue was eventually fatal. The arsenic had been in very coarse powder. Mr. Macaulay of Leicester has communicated to me a case where the individual took the poison at eight in the evening, went to bed at half-past nine, and slept till eleven, when he awoke with slight pain in the stomach, vomiting, and cold sweats. In this instance the dose was seven drachms, and death took place in nine hours. M. Devergie has related a similar case of poisoning with the sulphuret, where the symptoms did not begin for three hours; and here too the patient fell asleep immediately after swallowing the poison.[[607]] Professor Orfila has noticed an instance, to be quoted afterwards, where there appears to have been scarcely any symptom at all for five hours[[608]] (p. [243]). I suspect we must also consider as an instance of the same kind the case which gave occasion to the trial of Mrs. Smith here in 1827. A white draught was administered in a suspicious manner at ten in the evening; the girl immediately went to bed; and no symptoms appeared till six next morning, from which time her illness went on uninterruptedly.[[609]] In three of the preceding cases it will be remarked that sleep intervened between the taking of the poison and the invasion of the symptoms; and it is therefore not improbable that the reason of the retardation is the comparative inactivity of the animal system during sleep.—In voluntary poisoning, as in a case related by Dr. Roget, a slight attack of sickness or vomiting occasionally ensues immediately after solid arsenic is swallowed, and some time before the symptoms commence regularly.[[610]]
The observations now made will often prove important for deciding accusations of poisoning; for pointed evidence may be derived from the commencement of the symptoms, after a suspected meal, corresponding or not corresponding with the interval which is known to elapse in ascertained cases. The reader will see the effect of such evidence in attaching guilt to the prisoner in the case of Margaret Wishart, which I have detailed elsewhere.[[611]] In the trial of Mrs. Smith, the want of the correspondence just mentioned contributed greatly to her acquittal; for the symptoms of poisoning did not begin till more than eight hours after the only occasion on which the prisoner was proved to have administered any thing in a suspicious manner. As I was not at the time acquainted with any parallel case except that recorded by Orfila, I hesitated to ascribe the symptoms to the draught; and consequently, as the other medical witnesses felt the same hesitation on the same account, the proof of administration was considered to have failed. I am not sure that I should have now felt the same difficulty. The intervening state of sleep probably affords an explanation of the long interval; and the cases noticed by Mr. Macaulay and M. Devergie are parallel, though the interval in them was certainly not so great.—There is a limit, however, to the possible interval in such cases. It seems impossible that the action of the poison shall be suspended for three entire days. Yet death has been ascribed to arsenic in such circumstances. A child 3½ years old having swallowed eight grains with bread and butter, but being soon made to vomit forcibly by emetics, presented no decided symptom at the time, or for three days more; but on the fourth day difficult breathing ensued, with anxiety of expression, frequency of the pulse, and heat of the skin; and next day death took place. There was no morbid appearance found in the body.[[612]] I do not know of any parallel instance of death from arsenic, and cannot admit that the poison was the cause of the symptoms and fatal event.
Soon after the sickness begins, or about the same time, the region of the stomach feels painful, the pain being commonly of a burning kind, and much aggravated by pressure. Violent fits of vomiting and retching then speedily ensue, especially when drink is taken. There is often also a sense of dryness, heat, and tightness in the throat, creating an incessant desire for drink; and this affection often precedes the vomiting. Occasionally it is wanting, at other times so severe as to be attended with suffocation and convulsive vomiting at the sight of fluids.[[613]] Hoarseness and difficulty of speech are commonly combined with it. The matter vomited is greenish or yellowish; but sometimes streaked or mixed with blood, particularly when the case lasts longer than a day.
In no long time after the first illness diarrhœa generally makes its appearance, but not always. In some cases, instead of it, the patient is tormented by frequent, ineffectual calls: in others the great intestines are scarcely affected. About this time the pain in the stomach is excruciating, and is often likened by the sufferer to a fire burning within him. It likewise extends more or less downwards, particularly when the diarrhœa or tenesmus is severe; and the belly is commonly tense and tender, sometimes also swollen, though not frequently,—sometimes even on the contrary drawn in at the navel.[[614]] When the diarrhœa is severe, the anus is commonly excoriated and affected with burning pain.[[615]] In such cases the burning pain may extend along the whole course of the alimentary canal from the throat to the anus. Nay at times the mouth and lips are also inflamed, presenting dark specks or blisters.[[616]]