But to conclude, there are likewise collateral circumstances connected with the symptoms, which, taken along with the symptoms themselves, will sometimes place the fact of poisoning with arsenic beyond the reach of a doubt. Thus, if a person were taken several times ill with symptoms of general inflammation of the mucous membranes, after partaking each time of a suspected article of food or drink, the proof of the administration of arsenic would be very strong indeed; and it would be unimpeachable if at length a nervous affection succeeded at the usual period. Or above all, suppose several persons, who have partaken of the same dish, are seized about the same time with nearly the same symptoms of irritation of the mucous membranes. The proof of general poisoning would then be unequivocal. And if one or more of them should afterwards suffer from a nervous disorder, little hesitation ought to be felt in declaring that arsenic is the only poison which could have caused their complaints.
These views are of more practical consequence than may at first sight be thought. The doctrine which has been here espoused might have been applied to decide two criminal cases which at the time made a great noise in this country. One was the case of Eliza Fenning (p. [245]). Here five persons were simultaneously attacked with symptoms, more or less violent, of inflammation of the whole alimentary canal; and in two of them epileptic convulsions appeared before the inflammatory symptoms departed. The other was the case of George Thom (p. [247]). Here four persons were at one and the same time seized with the primary symptoms in an aggravated form; and in two of them, as these symptoms abated, obstinate partial palsy came on. On both trials, then, it might have been stated from the symptoms alone that poison had been given, and that arsenic was the only poison hitherto known to be capable of producing such effects.
In applying this doctrine to parallel instances two precautions must be attended to. On the one hand, care must be taken to ascertain, as may always be done, that the simultaneous symptoms of general irritation in the alimentary canal, arising soon after a meal, are not owing to unsound meat having been used in preparing it. And on the other hand, which is of more consequence, the symptoms on which so important an opinion is founded, must be strongly marked and well ascertained by a competent person. The signs of irritation in the mucous membranes must be really general and unequivocal; and those of a disorder of the nervous system must be likewise developed characteristically. Care must be taken in particular to distinguish symptoms of the latter class from others which approach to them in nature, and are the ordinary sequels of natural disease: for example, the true palsy caused by arsenic must not be confounded with the numbness and racking pains in the limbs, which occasionally succeed cholera.
With these precautions the evidence from symptoms may in certain cases be decisive of the question of poisoning with arsenic. And it is of moment to observe, as has been already hinted, that, although such cases are numerous, they are precisely of the kind in which it is most essential to the ends of justice that the symptoms should, if possible, supply evidence enough to direct the judgment; for the characteristic symptoms referred to occur chiefly when the patient either recovers or survives many days, and where consequently the chemical evidence, usually procured from the examination of the contents of the stomach, is almost always wanting.
Section III.—Of the Morbid Appearances caused by Arsenic.
The morbid appearances caused by arsenic will next require some details. In treating of them the same plan will be pursued as in the preceding section: the various morbid appearances left by it will first be mentioned in their order; and the subject will then be wound up with some remarks on the force of the evidence from these appearances, as they are usually combined in actual cases.
In the first instance, there are some cases in which little or no morbid appearance is to be seen at all. These all belong to the second variety of poisoning, which is characterized by the absence of local inflammation, and the presence of symptoms indicating an action on the heart, or some other remote organ. In such circumstances death takes place before a sufficient interval has elapsed for inflammation to be developed.
Several examples of the absence of diseased appearances in the dead body are to be found in authors. Thus in Chaussier’s case formerly quoted (p. [243]), in that related by Metzger (p. [242]), in another related by Etmuller, which was fatal in twelve hours,[[713]] and in a fourth related by Professor Wagner of Berlin, where life was also prolonged for twelve hours under incessant vomiting,[[714]] there was positively no morbid alteration at all. Such was also the state of the whole alimentary canal in the extraordinary case related by Orfila (p. [243]). In the case quoted from the Medical and Physical Journal (p. [242]), there was merely a slight redness at the pyloric end of the stomach. In the case of the American grocer too, there was only a little redness. In Mr. Wright’s case (p. [243]), there was scarcely any morbid appearance,—nothing more than two small vascular spots and a minute ecchymosis. In that which fell under my own notice (p. [242]), the villous coat of the stomach was of natural firmness, and had an exceedingly faint mottled-cherry-red tint, barely perceptible in a strong light; and the rest of the alimentary canal, as well as the body generally, was quite healthy.
Although in these examples the morbid appearances were trifling or undistinguishable, it must not be supposed that the same happens in all cases of rapid death from arsenic. In Gérard’s case, where the usual irritant symptoms were wanting, and which proved fatal in five hours, there was dark redness of the whole villous coat of the stomach. In Mr. Holland’s case, fatal in eight or nine hours (p. [243]), the stomach was of an intense purple colour at its pyloric end, and contained bloody mucus; and the mucous coat of the cœcum presented extensive softening and congestion. Mr. Alfred Taylor refers to three cases observed by Mr. Forster of Huntingdon, in which the mucous coat of the stomach was highly inflamed, though death took place in 6½, 3½, and 2 hours only:[[715]] in Mr. Hewson’s case, fatal in five hours, the whole stomach was exceedingly vascular, and presented both spots of extravasation, and several small erosions (p. [201]). In a case alluded to at p. [239] as having fallen under my own observation, and which was also fatal in five hours, the whole villous coat of the stomach was intensely red, except where the folds of the rugæ protected it from contact with the poison; and the prominences of the rugæ presented corroded spots of ecchymosis. In Dr. Dymock’s case, fatal in two hours and a half, the stomach, which I had an opportunity of examining, presented on its mucous coat many scarlet patches, and here and there a purplish appearance (p. [240]). Lastly, an instance is related by Pyl of this poison proving fatal in three hours, and leaving nevertheless in the dead body distinct signs of inflammation in the stomach.[[716]]
In the ordinary cases in which death is delayed till the second day or later, a considerable variety of diseased appearances has been observed. They are the different changes of structure arising from inflammation in the alimentary canal, in the organs of the chest, and in the organs of generation—together with certain alterations in the state of the blood and condition of the body generally.