A good example of epilepsy supervening on the ordinary symptoms of inflammation has been minutely related by Dr. Roget. A girl swallowed a drachm of arsenic, and was in consequence attacked violently with the usual symptoms of irritation in the whole alimentary canal. After being ill about twenty-four hours, she experienced several distinct remissions and had some repose, attended with fainting. In twelve hours more she began to improve rapidly; the pain subsided, her strength and spirits returned, and the stomach became capable of retaining liquids. So far this patient laboured under the common effects of arsenic. But a new train of symptoms then gradually approached. Towards the close of the second day she was harassed with frightful dreams, starting from sleep, and tendency to faint; next morning with coldness along the spine, giddiness, and intolerance of light; and on the fourth day with aching of the extremities and tingling of the whole skin. These symptoms continued till the close of the sixth day, when she was suddenly seized with convulsions of the left side, foaming at the mouth, and total insensibility. The convulsions endured two hours, the insensibility throughout the whole night. Next evening she had another and a similar fit. A third, but slighter fit occurred on the morning of the tenth; another next day at noon; and they continued to return occasionally till the nineteenth day. For some time longer she was affected with tightness across the chest and stomach complaints; but she was eventually restored to perfect health.[[659]]
A characteristic set of similar cases, which occurred in London in 1815, has been related in a treatise on arsenic by Mr. Marshall.[[660]] They were the subject of investigation on the trial of Eliza Fenning, a maid-servant, who attempted to poison the whole of her master’s family by mixing arsenic with a dumpling, and whose condemnation excited an extraordinary sensation at the time, as many persons believed her to be innocent. Five individuals partook of the poisoned dish, and they were all violently seized with the usual inflammatory symptoms. But farther, one had an epileptic fit on the first day, which returned on the second, and he had besides frequent twitches of the muscles of the trunk, a feeling of numbness in one side, and heat and tingling of the feet and hands. Another had tremors of the right arm and leg on the first day, and several epileptic fits in the course of the night. During the next fifteen days he had a paroxysm every evening about the same hour; which returned after an intermission of eight days, and frequently for several months afterwards.
In the following set of cases the nervous symptoms exhibited a singular combination of delirium, convulsions, tetanus, and coma, such as is frequently met with in paroxysms of hysteria; but the cases are probably not pure examples of poisoning with arsenic, for liver of sulphur was administered as a remedy to a considerable amount. Three servant girls in one of the Hebrides ate a mixture of lard, sugar, and arsenic, which had been laid for destroying rats. The ordinary signs of irritation in the stomach ensued, but on the following morning were greatly mitigated. They were then ordered twelve grains of liver of sulphur every other hour. Soon afterwards the inflammatory symptoms became more severe, the root of the tongue swelled and inflamed, and in the afternoon two of them lost the power of speech and swallowing, and were attacked with locked-jaw and general convulsions. The third had not locked-jaw, but was otherwise similarly, affected. On the morning of the third day one of the two former was found comatose, with continuance of the locked-jaw and occasional return of convulsions; and on being roused by venesection and the cold affusion, she complained of headache and heat in the throat. The sulphuret of potass, which had been discontinued on account of the locked-jaw, was then resumed. On the evening of the fourth day the headache increased, and the patient became delirious and unmanageable. The cold affusion, however, soon restored her again to her senses, and from that time her recovery was progressive. In the other patients the symptoms were similar, but less violent. In these instances the evidence of an injury of the nervous system was decisive; but it may be doubted whether the symptoms were not, in part at least, owing to the sulphuret of potass, which has been already described as an active poison, capable of inducing convulsions and tetanus. Its properties were not generally known in this country at the time the cases in question happened.[[661]]
Sometimes the convulsions caused by arsenic assume the form of pure tetanus. At least a case of this affection is noticed by Portal.[[662]] He has given only a mere announcement of it; and I have not hitherto met with a parallel instance in authors.
A common nervous affection in the advanced stage of the more tedious cases of poisoning with arsenic is partial palsy. Palsy in the form of incomplete paraplegia is a very common symptom even of the early stage in animals, and has been also sometimes observed during that stage in man. The paralytic affection, however, is more frequent in the advanced stage; and in those persons who recover, an incomplete paralysis of one or more of the extremities, resembling lead palsy, is often the last symptom which continues.
Dehaen relates a distinct example of this disorder occurring in a female who took a small quantity of arsenic by mistake. The ordinary signs of inflammation were soon subdued, and for three days she did well; but on the fourth she was attacked with cramps, tenderness, and weakness of the feet, legs and arms, increasing gradually till the whole extremities became at length almost completely palsied. At the same time the cuticle desquamated. But the other functions continued entire. The power of motion returned first in the hands, then in the arms, and she eventually recovered; but eleven months passed before she could quit the hospital where Dehaen treated her.[[663]]
An excellent account of a set of similar cases has been given by Dr. Murray of Aberdeen. They became the subject of judicial inquiry on the trial of George Thom, who was condemned in 1821 at the Aberdeen autumn circuit for poisoning his brother-in-law. Four persons were simultaneously affected about an hour after breakfast with the primary symptoms of poisoning with arsenic, and some in a very violent degree. But besides these symptoms, in all of them the muscular debility was great; and in two it amounted to true partial palsy. One of them lost altogether the power of the left arm, and six months after, when the account of the cases was published, he was unable to bend the arm at the elbow-joint. The other had also great general debility and long-continued numbness and pains of the legs.[[664]]
An interesting case of the same nature with these was lately submitted to me on the part of the crown. A man after taking arsenic was attacked with vomiting, purging, and other symptoms of abdominal irritation, which were mistaken for dysentery. Five days afterwards he began to suffer also from feebleness of the limbs; amounting almost to palsy. Subsequently an improvement slowly took place; but he continued to suffer under irritative fever, diarrhœa, and faintness. Several weeks later the diarrhœa abated, but he had great stiffness, numbness, and loss of power in the joints of the hands and feet. Two months after he first took ill, and while he was slowly recovering from this paralytic affection, arsenic was again administered and proved fatal in eighteen hours.
Another, somewhat similar to the preceding, has been related by M. Lachèse of Angers. Two people took about half a grain in soup twice a day for two days, and were attacked with the usual primary symptoms. One of them died in ten weeks, gradually worn out, but without any particular nervous affection. The other was seized with convulsions, and afterwards with almost complete palsy of the limbs.[[665]]—A well-marked case of the same nature has been noticed by Professor Bernt. It was the case formerly alluded to as arising from an over-dose of the arseniate of potass. The paralytic affection consisted in the loss of sensation and of the power of motion in the hands, and of the loss of motion in the feet, with contraction of the knee-joints. The issue of the case is not mentioned.[[666]]—Dr. Falconer observes in his essay on Palsy, that he had repeatedly witnessed local palsy after poisoning with arsenic, and alludes to one instance in which the hands only were paralysed, and to two others in which the palsy spread gradually from the fingers upwards till the whole arms were affected.[[667]]—On the whole, then, local palsy is the most frequent of the secondary effects of arsenic.
It is sometimes very obstinate, as the cases related by Dehaen and Murray will show. But it even appears to be sometimes incurable. For in the German Ephemerides there is related the case of a cook, who after suffering from the usual inflammatory symptoms, was attacked with perfect palsy of the limbs, and had not any use of them during the rest of her life, which was not a short one.[[668]]