Occasionally, instead of being palsied, the limbs are rigidly bent and cannot be extended.[[669]] They were contracted, as well as palsied in the case noticed by Bernt.
The last nervous affection to be mentioned is mania. The only instance I have hitherto found of that disease arising from arsenic is related by Amatus Lusitanus. He has not recorded the particulars of the case, but merely observes that the individual became so outrageously mad as to burst his fetters and jump out of the window of his apartment.[[670]] According to Zacchias, Amatus was not very scrupulous in his adherence to fact in recording cases.
The preceding remarks contain all that is known with certainty of the effect of arsenic on man when it is swallowed. Independently of the obvious nervous disorders which succeed the acute symptoms, other morbid affections of a more obscure character and chronic in their nature have been sometimes observed or supposed to arise from this poison.—Among these the most unequivocal is dyspepsia. Irritability of the stomach, attended with constant vomiting of food, has been occasionally noticed for a long time after. Wepfer has described two cases in which the primary symptoms were followed, in one by dyspepsia of three years’ standing, in the other by emaciation and an anomalous fever, which ended fatally in three years.[[671]]—Hahnemann farther adds, that in the advanced stage the hair sometimes drops out, and the cuticle desquamates, accompanied occasionally with great tenderness of the skin;[[672]] and Wibmer mentions a case of the kind, where not the cuticle and hair only, but likewise even the nails, fell off.[[673]] Desquamation of the cuticle and dropping of the nails are at times produced by the continued use of arsenic in medicinal doses.—Other effects have likewise been ascribed to its employment medicinally. Thus passing over what was stated by its opponents at the time when its introduction into the materia medica was made the subject of controversy over Europe, Broussais maintained that it causes chronic inflammation of the stomach or intestines;[[674]] and Dr. Astbury inferred, from an instance which fell under his notice, that it may bring on dropsy.[[675]] Neither of these ideas is supported by the general experience of the profession; and although some persons even of late have alleged that those, who take it medicinally to any material amount, invariably die soon after of some chronic disease,[[676]] there cannot be a doubt, that, under proper restriction, it is both an effectual and a safe remedy.—A case where salivation, with fetor and superficial ulceration of the gums, seemed to have been produced by arsenic, was lately published in an English Journal.[[677]]
In the present place may also be considered the supposed effects of the celebrated Aqua Toffana or Acquetta di Napoli, a slow poison, which in the sixteenth century, was believed to possess the property of causing death at any determinate period, after months for example, or even years, of ill health, according to the will of the poisoner.
The most authentic description of the aqua Toffana ascribes its properties to arsenic. According to a letter addressed to Hoffman by Garelli, physician to Charles the Sixth of Austria, that Emperor told Garelli, that, being governor of Naples at the time the aqua Toffana was the dread of every noble family in the city, and when the subject was investigated legally, he had an opportunity of examining all the documents,—and that he found the poison was a solution of arsenic in aqua cymbalariæ.[[678]] The dose was said to be from four to six drops. It was colourless, transparent, and tasteless, like water.
Its alleged effects are thus eloquently described by Behrends, a writer in Uden and Pyl’s Magazin. “A certain indescribable change is felt in the whole body, which leads the person to complain to his physician. The physician examines and reflects, but finds no symptom, either external or internal,—no constipation, no vomiting, no inflammation, no fever. In short, he can advise only patience, strict regimen, and laxatives. The malady, however, creeps on; and the physician is again sent for. Still he cannot detect any symptom of note. He infers that there is some stagnation or corruption of the humours, and again advises laxatives. Meanwhile the poison takes firmer hold of the system; languor, wearisomeness and loathing of food continue; the nobler organs gradually become torpid, and the lungs in particular at length begin to suffer. In a word, the malady is from the first incurable; the unhappy victim pines away insensibly, even in the hands of his physician; and thus is he brought to a miserable end through months or years, according to his enemy’s desire.”[[679]] An equally vigorous and somewhat clearer account of the symptoms is given by Hahnemann. “They are,” says he, “a gradual sinking of the powers of life, without any violent symptom,—a nameless feeling of illness, failure of the strength, slight feverishness, want of sleep, lividity of the countenance, and an aversion to food and drink and all the other enjoyments of life. Dropsy closes the scene, along with black miliary eruptions, and convulsions, or colliquative perspiration and purging.”[[680]]
Whatever were its real effects, there appears no doubt it was long used secretly in Italy to a fearful extent, the monster who has given her name to it having confessed that she was instrumental in the death of no less than six hundred persons. It has been already stated, however [p. [40]], that she owed her success rather to the ignorance of the age than to her own dexterity. At all events, the art of secret poisoning cannot now be easily practised. Indeed even the vulgar dread of it is almost extinct. Partly on account of the improvement in general knowledge and chiefly in consequence of the subtility and precision, which the refinement of modern physic and chemistry have introduced into medico-legal inquiries, it is rare that the suspicious scrutiny of the world now “recognizes in the accounts of the last illness of popes and princes the effects of poison insidiously introduced into the body.”[[681]]
I may add in conclusion, that I was consulted a few years ago on the part of the crown in a case which considerably resembled the effects ascribed in former times to the aqua Toffana, except that it was more acute in its character and swifter in its progress. As this case will probably be found to represent pretty nearly the usual effects of moderate doses frequently repeated, it is here given in some detail.
A woman of indifferent character married a young man in circumstances which led to a breach between him and his relatives; but the pair appeared to live on good terms with one another. Eighteen months after the marriage she was attacked with sickness and faintness; and on the fourth day of this illness, while she was recovering, the symptoms unexpectedly increased, and she seemed very unwell. On the fifth day she became extremely weak, and suffered much from yellow vomiting. On the seventh, when she was first visited by a medical man, she had frequent vomiting, burning in the stomach, a yellow tongue, flushed countenance, hot skin, and hurried pulse. On the ninth the throat was sore and red, and the expression anxious; and next day the soreness was greater, affected the nose and mouth also, and was attended with excoriation of the lips and nostrils, swelling of the glands of the throat, dimness of sight, and great exhaustion. On the eleventh day, while previously again getting better, she became much worse, and suffered greatly from excessive vomiting, pain in the stomach, and an increase of the other symptoms. On the thirteenth she was very hoarse, and despaired of recovery. Next day she was occasionally incoherent, and had twitches of the facial muscles; the hands and face were swelled, the eyelids dingy, the conjunctivæ injected, and the nails blue. On the morning of the fifteenth there was for two hours violent delirium and fierce maniacal excitement, which were succeeded by coma, and this by death in the course of the evening. There was no diarrhœa, or urinary complaint, and no paralysis or eruption on the skin. A variety of circumstances of a general nature, which it would be out of place to enumerate here,—the detection of arsenic in various articles of which the woman had partaken, and in which the arsenic had been dissolved sometimes simply, sometimes with the aid of an alkali,—together with the fact, that the body five months after death was found preserved from decay, as it is now well known to be in most cases of arsenical poisoning,—left little doubt that the woman died of the effects of arsenic taken in several small doses at distant intervals, although none could be detected in the stomach or intestines. The case did not go to trial, owing to the death of an essential witness.
The effects of arsenic on man, when introduced into the living body through other channels besides the stomach, will now require some observations. It is necessary for the medical jurist to be well acquainted with them, because there is hardly an accessible part of the human body to which this poison has not been applied either accidentally or by design. When some account was given of its comparative action on the different tissues of animals, it was observed that arsenic acts when applied to a wound or ulcer, to the peritonæal membrane, to the eye, and to the vagina. On man it has been known to act through an ulcer or wound, the inner membrane of the rectum, the membrane of the vagina, the membrane of the air-tubes, the membrane of the nose, and even the sound skin.