Many persons have been poisoned by the application of arsenic to surfaces deprived of the cuticle, such as blistered surfaces, eruptions, ulcers, or wounds. When applied in this manner it commonly induces both local inflammation and constitutional symptoms. Amatus Lusitanus relates the case of a young man, who, against the advice of his physician, anointed an itchy eruption of the skin with an arsenical ointment, and next day was found dead in bed.[[682]] A similar case, not so rapidly fatal, has been recorded by Wepfer. A girl, affected with psoriasis of the scalp, had it rubbed with a liniment of butter and arsenic. In a short time she was seized with acute pain and swelling of the whole head, fainting-fits, restlessness, fever, delirium, and she died in six days.[[683]] Zitmann has noticed the cases of two children, eight and ten years of age, who were killed by the application of an arsenical solution to a similar eruption of the head.[[684]] And Belloc relates the case of a woman who, trying to cure an inveterate itch with an arsenical lotion, was attacked in consequence with severe erysipelas of the whole body, succeeded by tremors and gradual exhaustion of the vital powers, ending fatally in two years.[[685]] M. Errard of Injurieux in France lately met with two cases, where, in consequence of a freshly blistered surface being dressed with a cerate made with the stearine of arsenicated candles (see p. [256]), local pain, nausea, pain in the stomach, urgent thirst, redness of the tongue, involuntary contractions of the muscles of the extremities, and weakness and irregularity of the pulse came on; and one person died within twenty-four hours, while the other recovered, chiefly because the dressing caused so much pain that the patient could not keep it on long.[[686]]
Next as to ulcers; M. Roux has noticed the case of a girl, who was killed by the application of the arsenical paste to an ulcer of the breast, and in whom the constitutional symptoms were strongly marked, although the quantity of the poison must have been very small. The preparation used, which contains only a twenty-fourth of its weight of arsenic, was applied for a single night on a surface not exceeding an inch and a half in diameter. Yet she complained next day of violent colic and vomited frequently, the countenance soon became collapsed, and she died two days afterwards in great anguish.[[687]] Another instance of the like kind is related in the Annales d’Hygiène, where death arose from an arsenical ointment ignorantly applied for scirrhous breast over a large surface of the skin stripped of the cuticle by a blister. The particular symptoms and their duration are not stated; but there was violent irritation of the stomach.[[688]] Another fatal case, related by Dr. Küchler, arose from the application of Frêre Cosme’s powder to a soft fungoid tumour on the temple, which discharged serum usually and blood upon slight pressure. About a drachm and a half of arsenic mixed with fifteen grains of other powders was applied. Severe inflammation spread round the tumour next day; and soon afterwards, the patient was attacked with great difficulty of breathing, thirst, pains in the belly, and purging, then with difficulty in swallowing from swelling of the base of the tongue, delirium, cold sweating, and extreme debility; and death ensued in four days.[[689]]
There is a singular uncertainty in the effects of arsenic when applied to ulcerated surfaces. Some persons, like Roux’s patient, are obviously affected by a single application; while others have had it applied for a long time without experiencing any other consequences than the formation of an eschar at the part. Two causes have been assigned for these differences, and probably both are founded on fact. One, which has been assigned by Mr. Blackadder, is the relative quantity of arsenic applied. He says he never witnessed but one instance of its acting constitutionally, although he often applied it to sores; and he imputes this success to his having always used a large quantity. For he considers that by so doing the organization of the part is quickly destroyed, and absorption prevented,—but that if the quantity be small, as in the mode practised by Roux, it will cause little local injury and readily enter the absorbing vessels.[[690]] Another unequivocal cause is pointed out by Harles in his treatise on arsenic. While treating of its therapeutic properties, and noticing the controversy that prevailed last century throughout Europe respecting the propriety of its outward application, he remarks that it may be applied with safety to the abraded skin, to common ulcers, to wounded surfaces, and to malignant glandular ulcers, even when highly irritable, provided the part be not recently wounded, so as to pour out blood.[[691]] The reason of this is obvious; the application of the poison to open-mouthed vessels is the next thing to its direct introduction into a vein. It is some confirmation of Harles’s opinion, that Roux, whose patient was so easily affected, recommends that before arsenic is applied to an ulcer, a fresh surface be made by paring away the granulations; and that Küchler’s patient had an ulcer which did not discharge pus, but serum, and was easily made to bleed.
In the cases related above it will be remarked that the symptoms vary in their nature. Sometimes the chief disorder is inflammation, spreading over and around the eruption or ulcer, sometimes inflammation of the alimentary canal, sometimes an affection of the nervous system. In general the sufferings of the patient both from the local inflammation and constitutional symptoms are very severe. But this rule has its exceptions. In Pyl’s Memoirs there is the history of a child who died four days after an itchy eruption of the whole body had been washed with an arsenical solution, and signs of vivid inflammation were found after death in many parts; yet she appears to have complained only of headache.[[692]] Occasionally too, without exciting either inflammation of the part, or disorder of the stomach, or a general injury of the nervous system, it seems to give rise to partial palsy of the muscles adjoining the seat of its application. An extraordinary case is noticed in an American Journal, in which the prolonged use of an arsenical preparation for destroying a tumour on the right side of the neck, was followed by complete palsy of the muscles of the neck and arm of that side.
In the next place, poisoning has been perpetrated by introducing arsenic into the fundament with an injection.[[693]] Foderé has noticed a case of this kind, which happened in France, and was communicated to him by a physician of Thoulouse. A lady under medical treatment for some trifling illness, died unexpectedly under symptoms of poisoning; and it was discovered that her servant, after unsuccessfully attempting to despatch her by dissolving arsenic in her soup, had ultimately succeeded by administering it repeatedly in injections.[[694]] There is no doubt that by this mode all the usual effects of arsenic may be induced; and on account of the facility with which the colon and rectum may be evacuated, it is not likely that the poison will be found in the gut after death, if the individual did not die in a few hours after its administration.
In the third place, women have also died of poisoning by arsenic introduced into the vagina. Two examples of this revolting crime are on record. One of them occurred in 1799, in the Department of the Ourthe in France. A middle-aged female was seized with vomiting, diarrhœa, swelling of the genitals and uterine discharge; and she expired not long after. Before her death she told two of her neighbours, that her husband had some time before tried to poison her by putting arsenic in her coffee, and had at length succeeded by introducing a powder into her vagina while in the act of enjoying his nuptial rights. The vulva and vagina were gangrenous, the belly distended with gases, and the intestines inflamed.[[695]]
The other case, which happened in Finland in 1786, gave rise to an excellent dissertation on the subject by Dr. Mangor, at that time medical inspector for Copenhagen. A farmer near Copenhagen lost his wife suddenly under suspicious circumstances, and six weeks afterwards married his maid-servant. In a few years he transferred his affections to another maid-servant, with whose aid he endeavoured to poison his second wife. For some time his attempts proved abortive; till at last one morning, after coïtion, he introduced a mixture of arsenic and flour on the point of his finger into the vagina. She took ill at mid-day and expired next morning; and the murderer soon after married his guilty paramour. But a few years had not elapsed before he got tired of her also; and one morning, after the conjugal embrace, he administered arsenic to her in the same way as to her predecessor. About three in the afternoon, while enjoying good health, she was suddenly seized with shivering and heat in the vagina. The remembrance of her former wickedness soon awoke the suspicions of the unhappy woman, and she wrung from her husband a confession of his crime. Means were resorted to for saving her life, but in vain: She was attacked with acute pain in her stomach and incessant vomiting, then became delirious, and died in twenty-one hours. After death grains of arsenic were found in the vagina, although frequent lotions had been used in the treatment. The labia were swollen and red, the vagina gaping and flaccid, the os uteri gangrenous, the duodenum inflamed, the stomach natural. In the course of the judicial proceedings which arose out of these two cases, Dr. Mangor made experiments on mares, with the view of settling the doubts which were entertained as to the likelihood of arsenic proving fatal in the manner alleged; and the results clearly showed that, when applied to the vagina of these animals, it produces violent local inflammation and fatal constitutional derangement.[[696]]
In the fourth place, poisoning by arsenic through the bronchial membrane or membrane of the air-passages is a comparatively rare accident, which can take place only in consequence of arsenical gases or vapours being incautiously breathed. The effects of oxide of arsenic when introduced in this way are described from personal experience by Otto Tachenius, a chemist of the sixteenth century.
“Once,” said he, “when I happened to breathe incautiously the fumes of arsenic, I was surprised to find my palate impressed with a sweet, mild, grateful taste, such as I never experienced before. But in half an hour I was attacked with pain and tightness in the stomach, then with general convulsions, difficult breathing, an unspeakable sense of heat, bloody and painful micturition, and finally with such an acute colic as contracted my whole body for half an hour.” By the use of oleaginous drinks he recovered from these alarming symptoms; but during all the succeeding winter he had a low hectic fever.[[697]]
Balthazar Timæus relates a similar case which came under his notice. An apothecary of Colberg, while subliming arsenic, had not been careful enough to avoid the fumes; and was soon after seized with frequent fainting, tightness in the præcordia, difficult breathing, inextinguishable thirst, parched throat, great restlessness, watching, and pains in the feet. He had afterwards profuse daily perspiration and palsy of the legs; and several months elapsed before he got entirely well.[[698]] The same author says that the famous Paracelsus, being one day put out of temper by an acquaintance, made him hold his nose over an alembic in which arsenic was subliming; and that the object of this severe joke nearly lost his life in consequence. Wibmer quotes the heads of several cases where swelling of the tongue, headache and giddiness, nausea, and an oppressive sense of constriction in the throat, were occasioned by the incautious inhalation of arsenical fumes.[[699]] The following extraordinary case, closely allied to malignant cholera in its early stage, has been ascribed by the reporter Dr. Welper of Berlin to the inspiration of arsenical fumes,—with what probability I am not prepared to say. A stout healthy man, who in the forenoon had freely and for some time exposed himself to the steam from a vessel where he was boiling several ounces of orpiment in water, was attacked at night with sickness, and next morning with extreme weakness and some difficulty of breathing. These symptoms were greatly relieved by an emetic. But towards evening the extremities became ice-cold and very stiff, the breathing much oppressed, the pulse very hurried, and imperceptible except in the neck, the mouth and throat dry, and the tongue rigid; but the mind remained clear, though anxious and afraid of impending dissolution. His state of collapse was removed in twelve hours by fomentations, and in no long time he recovered entirely except from the dyspnœa, which continued more or less till a few years afterwards, when he died of hydrothorax.[[700]]