The slighter effects of arsenic are said to have been repeatedly observed of late in this country from inhaling the products of the combustion of arsenicated candles,—an article of recent invention, in which arsenic, to the extent of three or four grains and a half in each candle, is introduced for the purpose of hardening the stearine chiefly used in manufacturing them. It is unnecessary to say, that such candles are prejudicial and ought to be prohibited. In a set of experiments made to try their effects by Messrs. Everitt, Bird, and Phillips in 1838, birds were killed in no long time, and small quadrupeds were severely affected, when kept in an apartment lighted with them.[[701]]
Analogous to the effects of inhaling oxide of arsenic are those lately observed from the incautious inhalation of arseniuretted-hydrogen gas. Gehlen the chemist died of this accident, but no particular account has been published of the symptoms he suffered. Two cases, however, have been detailed within a few years. In one of these, which has been related by Dr. Schlinder, of Greifenberg, the individual inhaled in forty minutes about half a cubic inch of the gas, which is equivalent to about an eighth of a grain of arsenic. In three hours he became affected with giddiness, and soon afterwards with an uneasy sense of pressure in the region of the kidney, passing gradually into acute pain there and upwards along the back. General shivering ensued, with coldness of the extremities, and gouty-like pains in the knees, shoulders, and elbows. The hands and lower half of the fore-arms, the feet and legs nearly to the knees, the nose and region of the eyebrows, felt as if quite dead, but without any diminution of muscular power. There was also acute pain in the stomach and belly generally, painful eructation of gas, and occasional vomiting of bitter, greenish-yellow mucus. The most tormenting symptom, however, was the pain in the kidneys, which soon became attended with constant desire to pass water, and the discharge of deep reddish-brown urine, mixed with clots of blood. The whole expression of the countenance was altered, the skin becoming dark brown, and the eyeballs sunk, yellow, and surrounded by a broad livid ring. Warm drink brought out a copious sweat and removed the sense of numbness; but next day there was little change otherwise in the symptoms, except that the urine was no longer mixed with clots, and that the hair on the benumbed parts had become white. On the third day the pains had abated, and the urine became clear; but there was hiccup, an excited state of the mind, and a feeling as if a great stone lay in the lower belly. In seven days he was much better. In the third week the whole glans and prepuce became covered with little pustules which were followed by small ulcers. It was not till the close of the seventh week that he recovered completely.[[702]] Dr. O’Reilly has related the following case, which arose from the inhalation of hydrogen gas impregnated with arseniuretted-hydrogen in consequence of the sulphuric acid used for dissolving zinc having contained arsenic. Mr. Brittan, a Dublin chemist, wishing to ascertain the effects of hydrogen on the body, proceeded to inhale 150 cubic inches of it. Immediately after the second inhalation, he was seized with confusion, faintness, giddiness and shivering, and passed a stool, as well as two ounces of bloody urine, but without any pain. Pain in the limbs followed, and in two hours frequent vomiting and dull pain in the stomach. The pulse at this time was 90, the skin cold, and the voice feeble. Ammonia, laudanum, and emollient clysters gave him little relief. During the subsequent night there was frequent vomiting and no urine; the face became copper-coloured, and the rest of the body greenish; there was tenderness of the epigastrium and hiccup; but he was free of fever. On the third day there was diarrhœa and still no urine; but the jaundice had disappeared. On the fourth the breath was ammoniacal, and somnolency had set in. On the fifth the skin became again deeply jaundiced, and the face was œdematous; no urine had yet been discharged, and the bladder, examined with the catheter, was found empty. On the evening of the seventh day he expired. On examination of the body, two pints of red serum were found in the pleural cavities; the lungs were sound, the heart pale and flaccid, the liver indigo-blue, the gall-bladder distended with bile, the kidneys also indigo-blue, the stomach empty, and its villous coat brittle, with here and there inflamed-like spots on it, the bladder empty, the brain bloodless, the cellular tissue generally anasarcous. Arsenic was detected in the pleural serum. By an approximate calculation it was supposed that the hydrogen this gentleman inhaled had contained the equivalent arsenic of twelve grains of the oxide.[[703]]
It would appear that arsenic acts with great rapidity and force when respired in any form.
Poisoning through the lining membrane of the nostrils is a still rarer accident than that last mentioned. There is a distinct example of it in the German Ephemerides, which arose from an arsenical solution having been used by mistake as a lotion for a chronic discharge from the nostrils. The individual was attacked with a profuse discharge from the nostrils, and then with stupor approaching to coma. Weakness of sight and of memory continued after sensibility returned; and he died two years afterwards, death having been preceded for some time by convulsions.[[704]]
Arsenic when applied to the sound skin of animals does not easily affect them. The experiments of Jaeger formerly noticed prove that no effect is produced, if the poison is simply placed in contact with the skin. Nay even when rubbed into it with fatty matters it does not operate with energy; for in that case, according to the experiments of Renault, it causes sometimes a pustular eruption, sometimes an eschar, but never any constitutional disorder.[[705]] It is more energetic, however, when applied to the more delicate skin of the human subject. Some experiments were made by Mr. Sherwen on himself with the view of proving this;[[706]] but they are not satisfactory. The following facts, however, will show that it may produce through the sound skin all the ordinary signs of poisoning. Desgranges, a good authority, relates the case of a woman who anointed her head with an arsenical ointment to kill lice, and, after using it several days, was attacked with erysipelas of the head and face, attended with ulceration of the scalp, swelling of the salivary and cervical glands, and inflammation of the eyes. There were likewise violent constitutional symptoms,—much fever, fainting, giddiness, vomiting and pain in the stomach, tenesmus, and ardor urinæ, tremors of the limbs, and even occasional delirium. Afterwards the whole body became covered with an eruption of white papulæ, which dried and dropt off in forty-eight hours. She recovered gradually; but appears to have made a narrow escape. Her hair fell out during convalescence.[[707]] A similar instance is recorded in the Acta Germanica for 1730. A schoolboy having found in the street a parcel of arsenic, his mother mistook it for hair powder; and as he had to deliver a valedictory speech at school next day, she advised him to powder himself well with it in the morning. This he accordingly did. In the middle of his speech he was attacked with acute pain of the face; and a fertile crop of pustules soon broke out upon it. The head afterwards swelled much, and the pustules spread all around it; he was tormented with intolerable heat in the scalp; and the hair became matted with the discharge into a thick scabby crust. This crust separated in a few weeks, and he soon recovered completely.[[708]] Schulze, a German physician, has related no fewer than five cases of the same description, all arising from arsenic having been mistaken for hair powder; and one of them proved fatal. Two of the cases were slight. The other persons had the same violent inflammation of the head as Desgranges’s patient and the German schoolboy. In the fatal case death took place in twenty-one days; and on dissection, besides other morbid appearances, the scalp was found gangrenous and infiltered with fluid blood, and the stomach much inflamed.[[709]] The two survivors, who were severely ill, it is well to add, were not attacked with the erysipelas of the scalp till six days after they powdered themselves. Sproegel mentions a fatal case from fly-powder having been applied in like manner to the head; and Wibmer quotes another, but not fatal, where from the same cause great swelling of the head and face arose, followed by erysipelas of the face, neck, and belly, and a papular eruption on the hands which continued five days.[[710]]
From the statements now made, it is evident that arsenic applied to various parts of the external surface and natural apertures of the body, will prove poisonous, and will often act with a certainty and rapidity not surpassed by its effects when taken internally. Many of the cases furnish a striking confirmation of a circumstance formerly noticed with respect to its action,—namely, that it produces signs of irritation in the stomach, in whatever manner it is introduced into the body. In some instances, indeed, the signs of inflammation in the stomach were quite as distinct as in the cases previously described, where the poison was taken internally.
The subject of the symptoms caused by arsenic will now be concluded with a few remarks on the strength of the evidence which they supply.
The present doctrine of toxicologists and medical jurists seems generally to be, that symptoms alone can never supply decisive proof of the administration of arsenic. This opinion is certainly quite correct when applied to what may be called a common case of poisoning with arsenic, the symptoms of which are little else than burning pain in the stomach and bowels, vomiting and purging, feeble circulation, excessive debility, and speedy death. All these symptoms may be caused by natural disease, more particularly by cholera; and consequently every sound medical jurist will join in condemning unreservedly the practice which prevailed last century of deciding questions of poisoning in such circumstances from symptoms alone. But modern authors appear to have overstepped the mark, when they hold that the rule against deciding from symptoms does not admit of any exceptions. For there are cases of poisoning with arsenic, not numerous certainly, yet not very uncommon neither, which can hardly be confounded with natural disease; and, what is of some consequence, they are precisely those in which the power of deciding from symptoms alone is most required, because chemical evidence is almost always wanting. Either the peculiar combination of the symptoms is such as cannot arise from natural causes, so far at least as physicians are acquainted with them: or these symptoms occur under collateral circumstances, which put natural causes almost or altogether out of the question.
Thus, let the medical jurist consider in the first place, the symptoms occasionally observed in those who survive five, six or ten days; let him exclude for the present the secondary nervous affections; and instead of a compounded description, which may be objected to as apt to convey a false and exaggerated idea of the facts, let him take an actual example. In a paper by Dr. Bachmann on some cases of poisoning with arsenic, there is a minute account of the case of a lady who was poisoned by her maid with fly-powder and white arsenic, and whose symptoms were those of universal inflammation of the mucous membranes. After suffering two days from retching and vomiting, colic pains and purging, these symptoms suddenly became more violent, and attended with oppressed breathing and hoarseness so that she could hardly make herself be heard,—with vesicles on the palate, burning pain in the throat, and excessive difficulty in swallowing,—with spasm and pain of the bladder in passing water,—and with extreme feebleness of the pulse. Three days afterwards the symptoms increased still more. She complained of intolerable burning and spasms of the throat, which, as well as the mouth, was excessively inflamed,—of violent burning pain in the stomach and bowels,—of burning in the fundament and genitals, both of which were inflamed even to gangrene,—of indescribable anxiety and anguish about the heart; and she died the following day, death being preceded by subsultus, delirium, and insensibility.[[711]] Or take the case in the trial of Miss Blandy. On two successive evenings, immediately after taking some gruel which had been prepared by the prisoner, Mr. Blandy was attacked with pricking and burning of the tongue, throat, stomach, and bowels, and with vomiting and purging. Five days after, when the symptoms were fully formed, he had inflamed pimples round the lips, and a sense of burning in the mouth; the nostrils were similarly affected; the eyes were bloodshot and affected with burning pain; the tongue was swollen, the throat red and excoriated, and in both there was a tormenting sense of burning; he had likewise swelling, with pricking and burning pain of the belly; excoriations and ulcers around the anus and intolerable burning there; vomiting and bloody diarrhœa; a low, tremulous pulse, laborious respiration, and great difficulty in speaking and swallowing. In this state he lingered several days, death supervening nine days after the first suspected basin of gruel was taken.[[712]] Can the symptoms, in these two cases, attacking, as they did, at one and the same time, the whole mucous membranes, be imitated by any natural combination of symptoms? Viewing the endless variety and wonderful complexity of the phenomena of disease, the practitioner will probably, and with justice, reply that a natural combination of the kind is possible. But if his attention is confined, as in strictures it ought to real occurrences,—if he is required to speak only from actual experience, personal or derived, it is exceedingly questionable whether any one could say he had ever seen or read of such a case. At all events, if a medical witness had to give his opinion from symptoms only in such a case as that of Mr. Blandy, or that described by Bachmann, he would certainly be justified in declaring that poisoning was highly probable; and, admitting general poisoning to be proved, he would, it is likely, fix on arsenic as the substance which could most easily produce the effects.
Let him next, however, take also into consideration the nervous affections that sometimes either immediately follow the inflammation of the mucous membranes, or become united with it when it has existed a few days; and confining his attention still to actual occurrences, let him reflect on the symptoms in Dr. Roget’s case, in which there was first violent inflammation of the whole alimentary canal, and then regular and obstinate epilepsy (p. [245]), or on those in Dehaen’s patient, in whom the nervous disorder was partial palsy (p. [247]). On reconsidering these narratives, still greater reason will appear for doubting whether such a combination of simultaneous, and in the present instance also consecutive symptoms, ever arise from natural causes. It is difficult to conceive a fortuitous concurrence of natural diseases producing at the same moment that variety and complexity of disorder which occur in the primary stage of the cases alluded to; and it would surely be a still more extraordinary combination which should farther add the supervention of epilepsy or partial palsy from a natural cause, at the exact period at which it appears as the secondary stage of poisoning with arsenic. All that any practitioner could say is, that a concurrence of the kind is within the bounds of possibility. He must be compelled to admit that it is in the highest degree improbable, and likewise that it could hardly take place from natural causes without the real causes of the symptoms being clearly indicated.