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[MEMORANDA ON POISONS.]

[WORKS BY THE SAME AUTHOR.]

Tanner’s Practice of Medicine.

Fifth American from the Sixth London Edition. Greatly Enlarged and Improved.

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MEMORANDA
ON
POISONS.

BY THE LATE
THOMAS HAWKES TANNER, M.D., F.L.S.
THIRD AND COMPLETELY REVISED EDITION.
PHILADELPHIA:
LINDSAY & BLAKISTON.
1872.

HENRY B. ASHMEAD, PRINTER.

[EDITOR’S PREFACE.]

The present edition of Dr. Tanner’s “Memoranda on Poisons” is in some respects almost a new book. It was, as will be seen by the Author’s Preface to the last Edition, Dr. Tanner’s object to furnish the practitioner with a useful guide to his duties in cases of poisoning. Experience has, however, shown that the book is more useful to the student than to the practitioner; and, with a view to render it still more valuable to the former, it has in great measure been remodelled. Whilst, therefore, due attention has been paid to what might be called the clinical aspects of poisoning, its chemical bearings have been more closely attended to; and the more important and reliable tests have in each instance been given, as have also the more important processes for separating poisons from organic admixture. Sick of the old and clumsy classification of poisons into Irritants, Narcotics, and Narcotico-Irritants, the editor has endeavored to form some more rational groups of toxic agents. These groups are, it is true, quite provisional; and they are somewhat similar to those adopted by Dr. Guy in his admirable textbook on Forensic Medicine. They have, however, been worked out independently, whether they be worth anything or no. Briefly they are these:—

Corrosives.—Simple Irritants, Mineral, Vegetable, and Animal.—Irritant Gases.—Specific Irritants, Mineral, Vegetable, and Animal.—Neurotics: subdivided into Narcotics, Anæsthetics, Inebriants, Delirants, Convulsives, Hyposthenisants, Depressants, Asphyxiants,—and Abortives.

Such a grouping is far from perfect; but it would be impossible to have anything worse than that still in general use. It is with the hope of rendering this little volume more generally useful these changes have been made: a reason at all times all-powerful with its lamented Author.

A. S.

[AUTHOR’S PREFACE]
TO THE SECOND EDITION.

These Memoranda are intended to refresh the memory of the practitioner on a subject which is not brought under his notice so frequently as many other departments of medicine. They are especially adapted to show at a glance the treatment to be adopted in each particular instance of poisoning to which a medical man is liable to be summoned.

There seems reason to fear that the crime of slow poisoning is more extensively practised in the present day than is generally believed. The study of the following pages will, it is hoped, put the physician on his guard; and prevent his attributing to natural disease symptoms due to the villainous administration of deadly drugs.

Henrietta Street, Cavendish Square.

[CONTENTS.]

[TOXICOLOGICAL MEMORANDA.]

INTRODUCTION.

[CHAPTER I.]

DEFINITION AND MODE OF ACTION OF POISONS.

Toxicology (τοξικὸν poison, and λόγος discourse,) is that branch of medical science which treats of the nature, properties, and effects of poisons.

It appears scarcely possible to give any definition of a poison which will bear a critical examination; insomuch that some have preferred to deal with the evil effects of any substance, that is poisoning, rather than with the substance itself, the so-called poison. Most medicines are poisonous in improper doses; and even common salt (chloride of sodium) has caused death.[A] Dr. Guy defines a poison to be any substance which, when applied to the body externally, or in any way introduced into the system, without acting mechanically, but by its own inherent qualities, is capable of destroying life. A cherrystone may cause death by becoming arrested in the vermiform appendix, and thus producing peritonitis; boiling water may cause death also; but neither are poisons: the one acting mechanically, the other by its heat merely.

Any substance which can injure the health or destroy life is regarded as a poison, if given with the intent to do mischief. The words of the statute (1 Vict. c. 85, sec. 2) are—“Whoever shall administer, or cause to be taken by any person, any poison, or other destructive thing, with intent to commit murder, shall be guilty of felony, and being convicted thereof shall suffer death.” Sometimes poisons are administered, not for the purpose of destroying life, but of causing some slight injury or annoyance. An Act passed in March, 1860 (23 Vict. c. 8), provides for the punishment of a guilty person under these circumstances. If life be endangered, or “grievous bodily harm” result, the administrator may be found guilty of felony, and sentenced to penal servitude for a term not exceeding ten years. If the intent be only to “injure, aggrieve, or annoy,” the crime is reduced to a misdemeanor, punishable with an imprisonment for not more than three years.

In accordance with the Pharmacy Act certain substances have been defined as poisons within the meaning of the Act, so as to put some restriction on their sale to the public.

Poisons may be introduced into the body in various ways and in various forms. Thus they may be administered by the mouth or by the rectum, and they may be given in the form of solids, liquids, or gases, uncombined, or mixed with various matters. Some agents are more readily absorbed than others; whilst some textures permit of absorption taking place more quickly through them than other tissues. Thus, the most diffusible poisons prove most rapidly fatal, especially when introduced directly into the circulation by a wound in a vein, or when they are injected into the subcutaneous connective tissue. Their action is also speedy when applied either in a gaseous state to the pulmonary air-cells, or as a fluid to that of the stomach or intestines. The serous membranes, too, possess an activity of absorption almost superior to that of the mucous membranes; while absorption through the skin is slow, on account of the cuticle. Poisons taken into the stomach when that viscus is empty, necessarily act much more speedily than when it is full. It is remarkable that the agents which most affect the nervous system do not appear to act at all when applied directly to the brain or trunks of nerves. There are also some poisons, as that of the viper, which, although most deadly when introduced into the blood through a wound, are harmless when swallowed.

The effects of poisons may be considered as local and remote.

The local effects are mainly of three kinds, viz., corrosion, or chemical decomposition, as is seen in the effects of the strong mineral acids and alkalies; irritation or inflammation, varying from simple redness, in its mildest, to ulceration and gangrene, in its most severe degree, such as may result from the use of corrosive sublimate; and a local specific effect, produced on the sentient extremities of the nerves, as is felt on the local application of prussic acid, aconite, &c.

The remote effects are those influencing organs remote from the part to which the poison has been applied. These may be either common or specific; common, such as the constitutional indications of inflammatory fever, however produced; specific, like the constitutional effects of opium over and above its local influences in relieving pain, &c. Various narcotic poisons produce but little local change, though their remote effects are very remarkable. For example, belladonna, in whatever way it may be introduced into the system, paralyzes the ciliary nerves and so causes dilatation of the pupil. Many substances have both a local and remote action, as is well seen in the influence of cantharides upon the part to which they are applied, and their remote effects upon the urinary organs.

These remote effects must be induced by one of two modes, or, as some contend, by both: by absorption, that is, by the passage of the poisonous particles into the blood; or by sympathy, that is, by an impression transmitted through the nerves.

In the present day every one allows that poisons may become absorbed, and that, provided they produce poisonous effects at all, they are absorbed, in whatever way they may have been applied to the body. But it is sometimes asked, Is this absorption necessary for their action? The following evidence may be briefly noticed as in some degree affording an affirmative answer to this question. Magendie divided all the parts of one of the posterior extremities of a dog, the artery and vein being reconnected by quills, so as to preclude the possibility of the effects being conveyed by the nervous filaments supplying the coats of the vessels; on applying a portion of upas tieuté to a wound in the foot, the symptoms of poisoning occurred, and death took place in ten minutes. If the veins leading from a poisoned part be tied, the arterial and nervous communication being complete, the symptoms of poisoning do not occur. Mr. Blake introduced some prussic acid into the stomach of a dog, through an opening in its parietes, after he had ligatured the vessel entering the liver (the vena portæ, which, directly or indirectly, receives the gastric veins); no effect ensued until the removal of the ligature, within one minute of which proceeding the poison began to act. And lastly, not only has prussic acid been discovered in the blood of an animal which perished in thirty-five seconds, but in some experiments made by Mr. Erichsen, in a case of extroversion of the bladder, prussiate of potass was found in the urine within one minute of its being swallowed on an empty stomach.

The chief argument in favor of a sympathetic or direct nerve action, is the almost instantaneous manner in which some poisons act; fatal effects occurring, it is said, before sufficient time has elapsed to allow of absorption. It has, however, been proved that the round of the circulation may be accomplished much more speedily than has been imagined. Thus, the ferrocyanide of potassium injected into the jugular vein of a horse was discovered throughout the entire venous system in twenty-seconds; and Mr. Blake has inferred from his experiments that a poison may be diffused through the body in nine seconds. It may therefore be concluded that in most instances poisons act by being absorbed and conveyed with the blood to the different organs which they impair, or the nerve centres which rule the functions of these; some paralyzing the heart when they reach it, some affecting the brain or the spinal cord, some stopping the play of the lungs and others acting upon the different glands. Nevertheless, in view of the extreme rapidity with which death is brought about in a few instances, the possibility of a direct shock to the nervous system causing death must not be overlooked.

The action of a poison may be variously modified, and the modifying circumstances must be carefully taken into consideration in the formation of a prognosis and in suggesting a line of treatment.

The quantity or dose is the most important of these; many substances which are deadly in large doses being exceedingly useful as remedies in small quantities; such are prussic acid, opium, digitalis, arsenic, &c. Then again, the mechanical and chemical state of aggregation are all-important; a solid being usually much less active than a fluid or a gas, and a pure substance much more active than one mixed with insoluble materials. Even more important is the chemical constitution of the poisonous agent; as already pointed out, poisonous effects result from absorption of the poisoning body and absorption implies solution; the more soluble, therefore, the compound is, the more speedy are its effects, whilst compounds insoluble in water or any of the juices of the body are inert. It is not, however, enough that the substance be insoluble in water; it must be so also in the gastric juice, or it may give rise to characteristic symptoms. Thus, calomel is insoluble in water, yet it is a powerful medicine; orpiment is insoluble in water, yet when swallowed, it may give rise to symptoms of arsenical poisoning, and so on. As already pointed out, the mode in which the poison is introduced into the body is of great consequence in estimating its effects. Then again the mental and bodily condition of the recipient must be taken into account. Thus, in excited maniacs doses of medicines may be given without producing any effect which in ordinary individuals might give rise to serious consequences. The bodily condition, especially as influenced by habit, is still more important. It may be broadly stated, that by gradually increasing the dose of a substance ordinarily poisonous, in course of time enormous quantities may be borne without producing immediate ill effects. This is especially seen in the practice of opium eating and smoking, and in a less degree in arsenic eating, as practised in Styria. The latter instance is, however, contrary to the usual rule; for whereas with vegetable substances, such as opium the dose requires to be constantly increased to keep up the effects, with minerals, the contrary seems to be the case, especially with antimony and mercury, which cannot be long given without danger to the recipient.

[CHAPTER II.]

DIAGNOSIS OF POISONING—DUTIES OF THE PRACTITIONER.

The chief characteristics of poisoning mentioned by authors of repute are, that the symptoms commence suddenly after taking any substance or fluid into the stomach, the individual being in a state of health; that they increase steadily, and are uniform in their nature throughout their course; and that they prove rapidly fatal. There are many exceptions to these rules. Thus if the stomach be loaded the appearance of the symptoms will often be delayed some few hours. Sleep, according to Dr. Christison, may retard the action of some agents; so that if a person fall asleep soon after swallowing arsenic or strychnia, for example, no effect may ensue for four or five hours. Intoxication will mask the effect of narcotics. Again, the individual poisoned may possibly be suffering from disease, and an agent may be given which will only aggravate existing symptoms. The fact must not be forgotten that sometimes a poisonous draught is substituted for a harmless medicine. And lastly, after a poison has manifested its effects the symptoms often remit for a time.

When poison is administered with a criminal intent it is generally in such a dose as to take immediate effect, although this is by no means necessary, as there are numerous substances which accumulate in the system, and when given in small and repeated quantities, ultimately prove fatal. It must also be remembered that there are many diseases, as malignant cholera, internal hemorrhage, &c., which commence suddenly, and rapidly run to a fatal termination. In inflammation of the stomach or intestines the symptoms often set in suddenly, and might be mistaken for poisoning; such is also the case in intestinal obstruction, and especially in ulceration and perforation of the bowels. So also in organic diseases of the heart, where the symptoms may have remained latent for some time, death often occurs suddenly from syncope. The diagnosis of the effects of irritant poisons is not so difficult as it is in the case of narcotics or other neurotics, where the symptoms are very similar to those produced by apoplexy, epilepsy, tetanus, convulsions, or disease of the brain.

Generally speaking, a person may be supposed to be suffering under the effects of a poison, if soon after taking food or drink, he be seized with violent pain, vomiting, disorder of the alimentary canal, and convulsive movements: or if he be attacked under the same circumstances with vertigo, delirium, or great drowsiness. It must not be forgotten, however, that poisons may be introduced into the body, not only by the mouth, but also by means of suppositories and enemata, or in females by vaginal injections, or by inhalation, or by subcutaneous injection, or through the true skin after the removal of the cuticle. Should death ensue, the presumption of unfair play will of course be strengthened by the discovery of post-mortem appearances similar to those known to be produced by the poison from which the person apparently suffered.

The post-mortem appearances, however, except in a few instances, are not very characteristic; nevertheless they may be of great negative value in proving that a certain poison has not been administered, or that the patient died from the effects of disease. Two symptoms, excessive lividity of the body and early putrefaction, formerly supposed to indicate death by poison, are now known to frequently follow other modes of death. It may nevertheless be remarked, that the appearances after death which may be produced by poisons are, in one great class, the signs of inflammation of the alimentary canal; in another, the signs of congestion of the nervous system; and in a third, a combination of the two.

The detection of poison in some of the food which has been left untaken or in the matters vomited would seem to be conclusive evidence of the administration of poison; but it is to be recollected that designing persons have mixed noxious materials with food or rejected matters, in order to feign poisoning, or to cast unjust imputations upon others.

When called to a case of supposed poisoning during life the practitioner’s duty is two-fold. His first aim must of course be to preserve life (see next chapter); his second, to forward the interests of justice. But if he reaches the spot too late to save life his duties are undivided, for he has but to see that justice is done, and in order that there be no failure it is important that all his observations be committed as speedily as possible to writing. He should inquire the time at which any substance was last taken, the nature of the symptoms, the hour at which they commenced, and the precise time at which death occurred. He must take possession of any food, medicine, vomited matters, urine, or fæces which may be in the room; and if possible he is to seal them up, in new and clean vessels, duly labelled, for examination. Then the position and temperature of the body are to be observed, the appearance of the countenance, the presence or absence of rigor mortis, with the nature and warmth of the apartment, the situation of any marks of violence, and the condition of the inside of the mouth and gullet. In addition to the ordinary rules to be observed in conducting post-mortem examinations in cases of suspected poisoning, something more must be done with a view to preserving portions of the body for subsequent examination. The alimentary canal is the most important organ to be thus secured, and it should be removed in separate portions. A double ligature should be passed round the œsophagus in the chest, and the duodenum a few inches below the pylorus should be secured in like manner; by cutting across the gullet and gut between these ligatures, the stomach may be removed without any danger of spilling its contents. It is best to open the stomach after it has been introduced into the receptacle prepared for it, so that its pathological condition may be noted as early as possible. Another ligature should be tied low down in the rectum, and the intestines removed and introduced into a separate vessel prepared for them and then examined like the stomach. Sometimes it may be necessary to remove the gullet in like fashion. As much blood as possible should be saved for the chemist, and a portion of the liver, if not the whole organ, should also be secured. When everything has been tied up, the jars should be sealed, numbered, labelled, and initialled, to prevent subsequent confusion and to facilitate identification. In women the vagina, uterus and ovaries must be inspected, the brain, spinal cord and thoracic viscera ought likewise to be examined, and portions of the spleen, kidneys, and muscles should be reserved for analysis. No antiseptic or preservative fluid is to be used. When possible it will be best to make the autopsy within twenty-four hours after death; taking care to make the examination patiently, thoroughly, and with a mind free from any bias. Poison may be found in a body, and yet a question may arise as to its having been the cause of death. Hence in these investigations every organ of the body is to be examined, in order to learn whether any disease has existed sufficient to account for the fatal result.

Any suspicious conduct on the part of those surrounding the poisoned individual should be carefully noted. Acts of this kind arrange themselves in three heads, as occurring before, or during the fatal illness, or after death. With the first category the practitioner has ordinarily nothing to do, but his attention to those coming under the second and third is often of essential service to the ends of justice. The kind of acts will suggest themselves to every one, and need not be further referred to here.

[CHAPTER III.]

DUTIES OF THE PRACTITIONER—TREATMENT OF POISONING.

When the practitioner is called in to a case of poisoning while yet there is life, he must set himself to preserve it in whatever way he best can; in this of course he must be guided by circumstances, but several broad rules may be laid down. All have one end, but the order may be varied. That is best which is readiest, the grand rule being to lose no time. Most of the modes of treatment come under one or other of the three following heads:—1. Get rid of the poison. 2. Stop its action. 3. Remedy the mischief it has done.

1. To get rid of the poison is ordinarily the first thing to be done, but not always. To do so when the poison has been swallowed two means may be employed: vomiting or the stomach-pump.

The latter is one of the most certain means we possess of emptying the stomach; and by means of it this viscus may be washed out, and the antidote, if any be known, administered. In speaking hereafter, however, of the treatment to be adopted in each particular instance it will be seen that there are some cases, as poisoning by corrosives, in which this instrument cannot be used; as it might not only cause laceration of the tissues, but even perforation of the œsophagus or stomach. It is hardly necessary to mention that in all cases a certain tact is required in its employment; the tube having, on more than one occasion, been introduced into the trachea, and the lungs injected with water, &c. It is a good rule also to withdraw less fluid than is pumped into the stomach.

Supposing, however, that this instrument is not at hand, or that it is an improper occasion for its employment, recourse must be had to vomiting, natural or artificial. Vomiting is, in many instances, one of the first and most important signs of poisoning, especially by irritant substances. When such is the case, it is only necessary to foster the tendency by copious draughts of lukewarm water; but if there be no vomiting and the stomach pump be not at hand an emetic must be given. Of these remedies perhaps there is not one which can be generally used with so much advantage as the sulphate of zinc in scruple doses; for not only is it more rapid in its action, but its effects are less depressing than those of any others. This last recommendation will appear the more desirable when we remember that the absorption of poisons is promoted by all lowering measures; and consequently, bleeding, the exhibition of tartarised antimony, and the administration of drastic purgatives, ought to be avoided. In poisoning by opium and other narcotics, the sulphate of copper in eight or ten grain doses will often excite the stomach to act when other emetics have failed. Ipecacuan wine (six or eight drachms) is a useful agent in many cases; or if a warm stimulating draught be needed a scruple of powdered ipecacuanha, with the same quantity of the sesquicarbonate of ammonia, may be administered in a wineglassful of water. In the absence of these, mustard proves an excellent substitute; a teaspoonful or two being given in warm water, and frequently repeated. Even common salt may be used with good effect. Vomiting may also be excited by tickling the fauces, as well as by the free administration of warm water or of hot greasy water.

When the poison has been applied locally, to prevent its absorption, a ligature must be applied between the trunk and the wounded part, as near the latter as possible; while the deleterious substance is to be removed by free incisions and plentiful washings. Sucking by the mouth or by cupping-glasses may also be employed.

2. To stop the action of the poison if it cannot be readily and immediately removed.—The means whereby this is effected is ordinarily the administration of an antidote. As no universal antidote is known, the treatment will of course vary with the substance taken. This will be fully explained when speaking of each particular poison.

An antidote, according to Orfila, should possess the following properties:—It should be capable of being taken in a large dose without danger; it should act upon the poison, whether liquid or solid, at a temperature equal to or below that of the body; its action should be quick; it should be capable of combining with the poison, though shielded by the gastric juice, mucus, bile, or other substances contained in the stomach; and lastly, it should deprive the poison of its deleterious properties.

Antidotes mostly operate by forming harmless chemical combinations, or by producing insoluble compounds, and thus preventing or delaying absorption. In most cases they have no effect upon the constitution; but some may be looked upon as a kind of counter-poison. Thus, the antagonistic action of opium and belladonna seems fairly made out, and we might perhaps include under this head chloroform, as in some degree, an antidote to strychnia.

Dr. Garrod has described a series of experiments in which he employed purified animal charcoal as an antidote. Dogs, rabbits, and guinea-pigs were the animals experimented on; while the poisons consisted of large doses of opium, belladonna, aconite, nux vomica, arsenic, and other drugs. They were given without mischief when sufficient animal charcoal was administered simultaneously, or, in some instances, before the peculiar effects of the destructive drug were developed. This substance seems to act in a great measure mechanically, but it has also a power of absorbing alkaloids which may render it useful. Such substances as magnesia and gruel are sometimes given with the view of protecting the walls of the stomach, with doubtful benefit.

3. To remedy the mischief done, and obviate the tendency to death.—Unfortunately, in a great number of instances, too long an interval has elapsed between the exhibition of the poison and the time when the first-mentioned indications can be fully carried into effect; for, as before implied, if absorption has taken place, direct antidotes will be of little avail.

Our object must then be to palliate the symptoms as they arise, as well as to neutralize the effects of the poison on the constitution, by remedies of an opposite character. Thus in poisoning by depressing agents and narcotics, or such as destroy the nervous force, all lowering measures must be avoided, and agents used which will exert a contrary effect, as stimulants, cold effusion, galvanism &c. The shock to the nervous system must also be taken account, and appropriate remedies employed to aid it in rallying.

Thus direct injection of liquid ammonia into the veins has been found successful in the treatment of snake bite in Australia, by Professor Halford and others.

Claude Bernard has shown the importance of particularly attending to the way in which the poison destroys life. For example, curare paralyzes the motor nerves, puts a stop to all motion, suspends respiration, and so brings on suffocation; yet by keeping up artificial respiration for a sufficient length of time, life may be preserved till the poison is eliminated and the danger over. Strychnia attacks the sensitive portion of the nervous system; but if the external excitement, which perpetually provokes reflex action and thereby brings on fatal convulsions, be guarded against, recovery may ensue. A frog, poisoned by strychnia, rapidly dies if frequently excited; whereas left perfectly quiet under a bell-glass, it will, cæteris paribus, recover.

Lastly, we must endeavor to promote the elimination of the poison from the body, by exciting the excreting functions; for which purpose, in poisoning by arsenic, after the stomach has been well emptied, Orfila has proposed the employment of diuretics, because it has been found that this poison, like most others, is carried off in large quantities by the urine.

[CHAPTER IV.]

DETECTION OF POISONS.

The detection of a poison is, in many instances, no easy matter; it should not therefore be rashly undertaken, except by one well skilled in the minutiæ of the processes to be adopted; but on the other hand, there are so many points of practical importance which may be noted by the practitioner in charge, that his attention should be specially directed to these. The exact determination of the cause of death will depend partly on the symptoms noted during life and on the appearances found after death. These come within the province of the ordinary practitioner; on the other hand, the special physical, chemical and physiological portion of the inquiry should be referred to the expert. In a book of this scope it is impossible to give full details with regard to these last, but a brief sketch nay be useful.

The physical examination, say of the contents of the stomach and intestines, should commence with noting the smell, color, and general appearance of the matters submitted for examination. The odor, for instance, may be useful in indicating the presence of prussic acid, of alcohol, of opium, or of phosphorus. The color may indicate the presence of salts of copper, of fragments of cantharides, &c. The general appearance may give some clue to the mode of introducing the poison, the kind of food or drink used to conceal it, &c. Seeds of poisonous plants may be found: this is especially the case in India, where the seeds of datura are frequently used for criminal purposes; or the poisonous substance may have been administered in such quantity that a portion of it may at once be secured for analysis. This not unfrequently happens in poisoning by arsenic. It is not enough to employ the naked eye in examining these suspected matters; a hand lens of some power should be used; in this way characteristic crystalline forms, botanical peculiarities, and such like, may be made out.

Still these are merely introductory to the most important part of the research, which ought to be undertaken systematically, especially if the quantity of material to be operated on is small. Most frequently the matters to be examined are mixed, some soluble, some insoluble; but there may also be submitted for analysis portions of the pure substance. The object of the analyst is to obtain the substances which he has to examine chemically in as pure a condition as possible, so that there may be no doubt about the results of his testing; also, of course, to separate active substances from those that are inert, all being mixed together in the stomach and alimentary canal. Again, in dealing with such fluids as the blood, or the tissues of the body, their natural constituents must be got rid of before the foreign and poisonous body can be reached. There is this difficulty further to contend with: that some of the most poisonous of substances are of unstable composition and readily altered by chemical reagents; to this group belong many vegetable and most animal poisons. These, therefore, must be treated differently from the more stable inorganic compounds. With an inorganic poison we may destroy all organic materials mixed with it, trusting to find it still recognizable after the process; not so with an organic substance: that must be separated by other than destructive means.

When the mixture submitted for examination consists of bodies perfectly soluble and perfectly insoluble, simple filtration may suffice to secure their separation; but this is rarely the case, some colloidal material being ordinarily mixed with the crystalloid, and the plan of separating them by dialysis, as proposed by Graham, not being altogether successful. When the substances looked for are volatile, distillation may be employed to secure them in a state of purity; in this way prussic acid is separated; but in the case of the poisonous alkaloids other means must be adopted.

I. In the separation of such an alkaloid as strychnia, for example, the suspected material is first of all acidulated by one of the weaker mineral or stronger vegetable acids (hydrochloric acid is best), and the whole carefully heated over a water bath. After a time this mixture is to be filtered, and the filtrate well washed with boiling distilled water, and the filtered fluid subjected to evaporation. When dry the substance is to be rubbed up with distilled water, and again filtered; this process to be repeated until a tolerably pure product be obtained. This is next to be neutralized by hydrogen sodium carbonate, or bicarbonate of soda, and the freed alkaloid taken up by rubbing or shaking it with chloroform or ether, and the whole set aside in a well-corked tall test tube. Finally, the ether or chloroform containing the alkaloid is to be removed by a pipette and allowed to evaporate spontaneously, when the alkaloid will probably be left behind in a state fit for testing. This process is a modification of that invented by Stas, in following out the case of the Count Bocarmé.

II. For the destruction of organic matter in the search for an inorganic poison, such as arsenic, a process introduced by Fresenius and Von Babo is commonly employed. Its essentials are as follows: The organic matter is to be reduced to as fine shreds as possible, and mixed with about one-eighth of its bulk of pure hydrochloric acid. This is to be heated, and, as it boils, from time to time crystals of potassic chlorate are added, until the solids are reduced to a straw-yellow fluid. This is next treated with hydrogen sodium sulphite, or bisulphate of soda, until a distinct smell of sulphurous acid is given off, after which sulphuretted hydrogen is to be passed through the fluid, concentrated if necessary, for some hours, thus throwing down most metallic poisons in the form of sulphide. This precipitate is to be collected and further tested.

When exceedingly small quantities are dealt with the microscope is of use, and the plan of subliming alkaloids and examining their crystals under the microscope, introduced by Guy and Helwig, will be found very useful. The shape of crystalline poisons is a valuable means of determining their identity; arsenic and antimony may thus be readily distinguished, as may other well known substances.

The spectrum has not yet been applied to toxicological research, although it has been employed to determine the existence of a blood stain.

[CHAPTER V.]

CLASSIFICATION OF POISONS.

There is nothing more difficult in toxicology than to give a satisfactory classification of poisons, insomuch that some have fallen back on the no-classification, or natural history system, and grouped poisons as mineral, vegetable, and animal, according to their source. In despair of achieving anything better, a modification of the old and well-known system is here followed, poisons being classed as Corrosives, Irritants (Simple and Specific), and Neurotics; the latter group is, however, further subdivided, something in the same way as that adopted by Dr. Guy. The group of corrosives should comprehend all which by contact destroy the bodily textures, and so occasion death. These same substances, when diluted, may be incapable of destroying the tissues directly, but may do so by setting up inflammation; these with certain others having like effects, would form the group of simple irritants. They kill by virtue of their secondary effects on the constitution. But some substances, like arsenic, are not only capable of inducing local inflammations, with their secondary effects, but are also possessed of certain specific and well marked properties differing in each case. These are specific irritants.

Neurotics comprehend all poisons whose effects are mostly referable to the nervous system, necessarily a most diverse group, which we are not yet in a position to minutely analyze. Some, however, act mainly on the brain, some on the spinal cord, some on certain nerves only, or on the vasomotor system of nerves; some act it is hardly possible to tell how.

There was an old group of septic poisons; to this might still be referred certain noxious gases, such as sulphuretted hydrogen; or were it made to include all poisons acting directly on the blood, it would include the still more dangerous gas, carbonic oxide.

The following table exhibits these subdivisions, and some of the poisons contained in each:

Irritant poisons give rise to pain in the stomach and bowels, faintness and sickness, and purging with tenesmus. The evacuations are often tinged with blood, the pulse is feeble and irregular, and the skin cold. Many of the substances of this class from irritating the tissues with which they come in contact, produce a severe burning sensation in the mouth and œsophagus, as well as in the stomach. The degree of local destructive action produced will of course vary in proportion to the amount of the vehicle with which the noxious agent may be diluted. Irritants cause death by inducing collapse or convulsions, or by exciting severe inflammation; or, after a variable interval, by leading to stricture of the œsophagus. The diseases which most resemble the action of irritants are, malignant cholera, severe diarrhœa, colic, gastritis, enteritis, rupture of the stomach or intestines, and obstruction of the bowels, mechanical or otherwise.

The symptoms of apoplexy, epilepsy, and uræmia bear a resemblance to those caused by some of the poisons of the neurotic class. Others give rise to delirum with spectral illusions or convulsions. Sometimes there is tetanus, sometimes coma or syncope. Diseases of the brain and spinal cord, likely to be confounded with these, are often very insidious in their progress, and hence may suddenly give rise to suspicious symptoms. The history, mode of attack, &c., will generally negative any suspicion of poisoning.

[I.—CORROSIVES.]

[CHAPTER VI.]

THE CONCENTRATED MINERAL ACIDS.

The first division of the Corrosive consists of the Strong Mineral Acids. In this chapter we have to review the effects, &c., of the acids commonly encountered, which are Sulphuric Acid, Nitric Acid, Hydrochloric Acid, or a mixture of two or more of them.

Sulphuric Acid (Oil of Vitriol).—This heavy, oily looking liquid is met with in two states, concentrated and diluted; and being extensively employed in commerce and manufactures is much more frequently used as a poison than the other mineral acids. Many infants and young children have been poisoned by it; occasionally also men, under the influence of drink. The acid is not unfrequently thrown over the person, either to disfigure the features or to destroy the clothes. The parts of the body with which it is brought into contact are stained at first of a white, and afterwards of a dark brown or black color. The smallest fatal dose of concentrated acid recorded, in the adult, is one drachm; but recovery has taken place after as much as two ounces. But it must be understood that the acid proves fatal mainly by its power of corrosion, so that a small dose of the concentrated acid is more dangerous than is a much larger dose of it in the dilute form. The average period at which death occurs is from sixteen to twenty-four hours; but on the other hand, death may not occur for months, and may only follow the organic changes induced by cicatrization following the swallowing of the acid, or the malnutrition following its destructive action on the coats of the stomach.

Tests.—It is not within the province of these Memoranda to treat of the various processes by which poisons are to be detected; for to make a trustworthy analysis requires the skill of a professed chemist, whose assistance should be allowed in these medico-legal investigations. Where the character of a dead man or the life of a supposed criminal is at stake there must be no chance of error. The ordinary tests will, however, be briefly described, if only to help the physician to treat the case more satisfactorily than he could do by merely guessing that an irritant or narcotic had been employed:

Concentrated sulphuric acid is usually a brownish colored liquid, which chars or corrodes wood or other organic matter brought into contact with it, and when mixed with water gives out heat. When diluted, its presence may be thus detected:

1. The liquid is known to be acid by its action on litmus paper.

2. Add to a portion of the suspected liquid a few drops of nitric acid, and then a solution of nitrate of barium; a white precipitate (sulphate of barium) will fall if sulphuric acid be present. This test is extremely delicate; for although other acids yield a precipitate on the addition of nitrate of barium, yet as such deposits are all soluble in nitric acid the previous addition of this acid will prevent their formation.

3. The precipitate should next be collected, dried, and reduced with charcoal by the blow-pipe flame to the condition of barium sulphide. This, when treated with a drop of hydrochloric acid, gives off sulphuretted hydrogen, known by blackening paper dipped in acetate of lead solution.

To examine a piece of cloth stained with this poison it is only necessary to boil it in distilled water and then apply to the liquid the barium test as before.

Nitric Acid (Aqua fortis, Red Spirit of Nitre).—This substance has been employed as a poison for upwards of four centuries. Like the oil of vitriol it is found in commerce in a concentrated and in a diluted state. Cases of poisoning by it are rare. It produces a yellow stain on the skin. Two drachms is the smallest quantity which has destroyed life; but less than this would probably prove fatal, if it produced much corrosion about the wind-pipe. Death has occurred from it, in one hour and three quarters; the average would be within twenty-four hours.

Several cases ending fatally have followed the inhalation of the fumes of this acid, probably by inducing very extensive inflammation of the lung.

Tests.—The concentrated acid may be known by its orange-colored irritating fumes, and by its action on copper, tin, or mercury.

1. When poured on copper-filings, effervescence takes place, a red acid vapor is given off, and a green liquid remains (solution of nitrate of copper).

2. In a diluted state it is detected by its acid reaction; by no precipitate being obtained by nitrate of barium or by nitrate of silver, proving the absence of sulphuric and hydrochloric acids; further, by neutralizing the liquid with potass, evaporating it, and then procuring crystals of nitrate of potassium, in the form of lengthened fluted prisms, which are permanent in the air. These crystals may be powdered and moistened with strong sulphuric acid, when a colorless acid vapor (nitric acid) will be evolved. Or the powdered crystals may be mixed with an equal bulk of fine copper filings, moistened with water, and treated with a few drops of sulphuric acid; when ruddy acid fumes will be given off.

3. Other tests for nitric acid are, (a,) its action on morphia, which it turns red: (b,) its action on green iron sulphate, which it blackens; (c,) a trace of it along with sulphuric acid gives with narcotine a blood red color; and finally, (d,) along with hydrochloric acid it dissolves gold.

Hydrochloric Acid (Muriatic Acid, Spirit of Salt).—Not more than half a dozen cases of poisoning by this acid have occurred in the last fifteen or twenty years in this country. In May, 1859, a woman sixty-three years old was admitted into King’s College Hospital within three-quarters of an hour of swallowing half an ounce of the strong acid. She had burning pain in the throat and stomach, vomiting of brown shreddy matters, and great prostration. Death occurred in eighteen hours, from the corrosive action of the poison. This is the smallest dose which has been known to prove fatal.

Tests.—The concentrated hydrochloric acid of commerce is of a yellowish color, it fumes in the air when strong, and produces dense white fumes with the vapor of ammonia.

1. It may be identified by boiling with black oxide of manganese; chlorine being given off, which is known by its odor, color, and bleaching properties.

2. When diluted, its presence is ascertained by nitrate of silver causing a dense white precipitate (chloride of silver). The chloride is distinguished from other salts of silver by (a,) its insolubility in nitric acid, and in caustic potass; (b,) by its being soluble in ammonia; (c,) by its melting and forming a horny mass when dried and heated.

Mixed Acids.—These acids being used for commercial purposes when mixed—the nitro-muriatic (aqua regia) to dissolve gold, and the nitro-sulphuric (aqua reginæ) to dissolve silver—might occasion their being employed as poisons. Sulphate of indigo, which consists of a solution of indigo in strong sulphuric acid, has proved fatal in cases where it has been accidentally taken.

Symptoms, Treatment, &c.—The symptoms produced by the mineral acids are much the same in all cases. There is violent, burning pain in the mouth, œsophagus, and stomach, commencing immediately. The burning is followed by retching and vomiting of a dark colored liquid with shreds of mucus, and portions of the mucous membrane of the œsophagus or stomach. The inside of the mouth is shrivelled and more or less corroded unless the agent has been given in a spoon or otherwise passed over the tongue to the back of the fauces. The outside of the lips and mouth will probably present the stains characteristic of the acid used. There is great thirst, difficulty of swallowing, and impeded respiration. The bowels are confined; the urine scanty or suppressed. Next succeeds great exhaustion, the pulse becomes quick and feeble, and the skin gets cold and clammy. The countenance is anxious and expressive of great suffering; death speedily occurs, the intellectual faculties remaining clear to the last.

These acids may prove fatal without entering the stomach by causing asphyxia, the chink of the glottis becoming closed by swelling of the fauces, &c. They have sometimes been administered by the vagina, rectum, &c., and been poured into the ear during sleep.

Where recovery takes place from their immediate effects there is always fear of death resulting at the end of one or two years from stricture of the œsophagus, and even at an earlier period, unless proper treatment is adopted. Occasionally one of the secondary effects of sulphuric acid has been profuse salivation.

The post-mortem appearances are the following: The body may have a healthy appearance. Usually there are stains about the mouth, fingers, and wherever the cuticle has been reached by the acid. The inner surface of the mouth, fauces, and œsophagus, is usually white and corroded, or dark brown and shrivelled, the mucous coat being easily detached. The epiglottis and glottis are usually swollen. The gullet resembles the mouth in most respects. The outer surface of the stomach and intestines is very vascular, that of the former being sometimes corroded and occasionally perforated. The stomach is sometimes contracted, sometimes distended with gas, and contains a thick, dark brown fluid; its inner surface has a charred, blackened appearance, the mucous membrane between the rugæ being of a scarlet hue. The pylorus is mostly contracted; while the inner coat of the duodenum and small intestines presents a similar appearance, in a less degree, to that of the stomach. When perforation occurs it usually takes place posteriorly, and the edges of the rent are softened. The escaped matters may have acted on the adjacent viscera.

According to Casper, after poisoning by sulphuric acid the bodies resist putrefaction for some time, owing perhaps to the acid neutralizing the ammonia of decomposition. It may be the same with the other mineral acids.

Treatment.—Bicarbonate of soda, or calcined magnesia, or the carbonate of magnesia, should be immediately given, mixed in milk or any mucilaginous fluid; the doses being continued at short intervals, until it may be inferred that the acid is neutralized. In the absence of these remedies substitutes may be found in chalk, whiting, soap and water, or the plaster of the apartment beaten up with water. Oleaginous and mucilaginous fluids, as olive oil, linseed tea, barley water, milk gruel, &c., may be freely given, either alone, or as the vehicles of the antidote. The success of this treatment will depend upon the promptitude with which it is adopted.

The stomach pump should not be employed; the disorganized and softened state of the gullet and stomach, rendering them excessively liable to perforation.

Should the larynx be affected and the breathing impeded, tracheotomy must be at once had recourse to.

After a sufficiency of the antidote has been given the use of mucilaginous diluents must be continued for some time, and the subsequent treatment will be that for gastro-enteritis. Great benefit will be derived from the use of oily enemata.

The external parts which have been injured by the acid should be well bathed with soap and water, and treated like burns.

[CHAPTER VII.]

THE CORROSIVE VEGETABLE ACIDS.

Oxalic Acid (Acid of Sugar).—This is one of the most important poisons with which we have to deal. From its cheapness and well-known properties it is frequently made use of in cases of suicide, while from its resemblance to Epsom salts it has on several occasions been taken in mistake for that medicine. The smallest dose which is known to have proved fatal is one drachm, which killed a boy æt. sixteen in eight hours. Taylor relates the case of a woman, aged twenty-eight, who was found dead one hour after swallowing three drachms of the crystallized acid. Christison mentions an instance in which one ounce destroyed life in ten minutes, and another case where the same quantity killed a girl in thirty minutes. One example has been recorded where a fatal result ensued probably within three minutes of the acid being swallowed.

The poisonous properties of the Binoxalate of Potash (Salt of Sorrel, Essential Salt of Lemons) are due to the oxalic acid it contains. This salt, which exists in the leaves of the wood sorrel (Oxalis acetosella), is sold to bleach straw, remove ink-stains, &c. It is very cheap; is almost as powerful as oxalic acid itself, and gives rise to the same kind of symptoms; it has been taken for the purpose of suicide, as well as in mistake for the bitartrate of potash, or cream of tartar.

Oxalate of lime exists in considerable quantity in the leaves and stalks of the common edible rhubarb (Rheum Rhaponticum). It can hardly be considered poisonous.

Symptoms.—The effects of poisoning by oxalic acid are peculiar. When the dose is large (half an ounce or more) and the solution concentrated, it proves very rapidly fatal. It produces a hot burning sensation in the fauces and œsophagus in the act of swallowing, severe burning pain in the stomach, and in most instances immediate vomiting. The vomited matters are strongly acid, of a dirty green or black color, and consist of the contents of the stomach with altered mucus and blood. The remaining symptoms are a sense of constriction or suffocation, lividity of the countenance, great prostration of strength, feeble pulse, cold clammy perspirations, and convulsions, which speedily terminate in death. When a smaller quantity has been taken, much diluted, its corrosive properties are weakened or destroyed, but the nervous symptoms, as cramps and numbness, may be well marked.

In cases of recovery the mouth may remain sore for some time, the tongue swollen, the abdomen tender, the stomach very irritable, and there may be troublesome diarrhœa. In two instances there has been loss of voice for several days, owing to the action of the poison on the nervous system. Twitching of the muscles of the face and extremities has also been observed.

Post-mortem Appearances.—The mucous membrane of the fauces, œsophagus, and stomach is generally white and brittle, but often colored with the brown mucous matter discharged. The stomach often contains a black fluid, like coffee-grounds, consisting principally of altered blood; and its sub-mucous coats are vascular and dark colored. The stomach though seldom perforated, may yet be so softened as to be with difficulty removed entire, and sometimes this is not possible. This softening may be due to the post-mortem action of the poison; but its effects during life in softening and bleaching the mucous membrane are sufficiently marked. Occasionally the stomach is black and gangrenous looking. If death has occurred quickly, the small intestines are seldom much affected; but where the symptoms have been protracted there are usually signs of congestion and inflammation.

Treatment.—Chalk, whiting, or magnesia, suspended in water, or in some demulcent fluid, must be administered immediately; and if necessary, vomiting should be excited by tickling the fauces, or administering emetics of sulphate of zinc and ipecacuan, followed by large quantities of emollient drinks. The antidote, to be effective, must be given as soon as possible, the plaster of the apartment, or any form of mortar being used in the absence of the remedies just mentioned. Alkalies (soda, potash, or their carbonates) are not only useless, but they form salts with oxalic acid, which are as injurious as the acid itself. When there are symptoms of collapse, stimulants are to be freely employed.

From the tendency to softening, the stomach-pump should not be used.

Tests.—Crystals of oxalic acid are met with as four-sided prisms, colorless, without odor permanent in the air, and very acid; this last character distinguishing them from crystals of sulphate of magnesia and sulphate of zinc. The crystals, when heated, melt, and are dissipated without combustion, and leaving no residue. This character is important as a means of distinguishing oxalic acid from other similar crystals. They are soluble in from eight to twelve parts of cold water. This acid may be thus recognised in solution:

1. Nitrate of silver throws down, with oxalic acid, an abundant white precipitate (oxalate of silver), which is soluble in nitric acid. The oxalate of silver, when dried and heated on platinum foil, detonates, and is dissipated in a white vapor.

2. Sulphate of calcium causes a white precipitate with oxalic acid (oxalate of calcium) which is soluble in nitric or hydrochloric, but not in any vegetable acid.

The solution containing the acid should be concentrated before testing, if it be not present in considerable quantity.

Lime water and all soluble lime salts throw down precipitates with oxalic acid; but as these are liable to be mistaken for a precipitate with sulphuric acid, it is better to use sulphate of calcium which is slightly soluble, as the test agent. A good deal of the test solution must be used, and the precipitate takes time to settle.

3. Sulphate of copper gives a faint bluish precipitate with oxalic acid (oxalate of copper), which is not redissolved by a few drops of hydrochloric acid.

These tests will not act if the solution contain nitric acid in excess, in which case the liquid must be evaporated to crystallization, and the crystals washed and redissolved in water.

These tests for oxalic acid should never be applied without previously separating it from all organic matter. This is best done by first of all acidulating the suspected fluid with acetic acid, and then adding acetate of lead, which combines with the oxalic acid to form a white insoluble salt, which may ordinarily be removed by filtration or subsidence. This filtrate, after being well washed, is to be diffused in water, and into this a current of sulphuretted hydrogen gas is to be passed for some considerable time. This will throw down the lead as sulphide, leaving the oxalic acid in the fluid; any organic matter will also be carried down. Filtration will separate the solids from the liquid containing the acid, which may now be evaporated until crystals are formed, which may be tested in the usual way.

Acetic Acid.—Although this acid, in its concentrated state, is highly corrosive, yet it is very seldom brought under the notice of the toxicologist.

In the case of a young woman reported by Orfila, death quickly occurred after several attacks of convulsions. At the subsequent post-mortem examination, the integuments of the dependent parts of the body were found very livid; the tongue and œsophagus were of a dirty brown color, the latter being intersected by a fine net-work of capillary vessels; and the interior of the stomach was interspersed with black elevations caused by the presence of coagulated blood in the sub-mucous areolar tissue. The mucous membrane was entire.

As regards the treatment, it is only necessary to administer draughts containing magnesia or its carbonate, followed by mucilaginous or demulcent drinks.

Tartaric Acid, though not a corrosive, may be here placed along with the other vegetable acids. Strange as it may seem, tartaric acid has destroyed life in at least one instance in this country; an ounce having been given in mistake for an aperient salt. The deceased swallowed the whole at once, and immediately called out that he had been poisoned. He complained of intense pain in the throat and stomach, as if he had swallowed oil of vitriol, or was on fire. Soda and magnesia were administered without avail; and after death, at the end of nine days’ suffering, the stomach and intestines were found much inflamed.

[CHAPTER VIII.]

THE CAUSTIC ALKALIES AND THEIR CARBONATES; POTASH, SODA, AMMONIA.

The second division of the class of Corrosives has now to be considered. It contains the Caustic Alkalies, and some of their Salts. Poisoning by any of these agents is rare.

Potash.—This substance, in its caustic state, as found in commerce, is in the form of grey-colored cakes. It has an acrid taste, is soapy to the touch, and very deliquescent. Moulded in cylinders, it is often employed as a caustic (Potassa fusa). In solution (Liquor potassæ) it is strongly alkaline, and imparts a brown stain to black cloth.

Potassium carbonate or Carbonate of Potash (Pearlash) is extensively used by laundresses and in the dressing of woollen cloth. It is generally sold in a granular condition, white, inodorous, and strongly alkaline; it is soluble in water, but not in alcohol.

Caustic Soda.—This agent resembles potash in its general properties. The Sodium Carbonate or Carbonate of Soda (Soap-lees) bears a similar resemblance to the carbonate of potash, except that it crystallizes easily, and effloresces on exposure to the air.

Ammonia.—When pure, ammonia is a colorless, pungent gas; but it is commonly met with dissolved in water, as the liquor ammoniæ. Its vapor is poisonous, and may prove fatal by producing inflammation of the larynx and trachea, and even of the lungs. A case is recorded of a French boy, æt. six, who killed his younger sister by making her swallow several teaspoonfuls of a solution of ammonia. Other instances have also occurred where the liquor ammoniæ has either been taken in mistake for the aromatic spirit of ammoniæ, or purposely, to destroy life. An instance is recorded by Dr. Taylor, as occurring in the practice of Mr. Hilton, where liquor ammoniæ, given by mistake, caused corrosion of the throat and gullet and obstruction of the bronchial tubes by false membrane. The œsophagus was completely dissolved at its junction with the stomach, and there was an aperture in the anterior wall of that organ such as might have been caused by oil of vitriol.

The Ammonium Carbonate or Carbonate of Ammonia (Hartshorn, Smelling Salts) has been used as a poison. It may be distinguished from other salts by its being alkaline, by its entire volatility, and by its pungent odor. A young woman in a state of unconsciousness, was made to swallow a quantity of hartshorn. In an hour there was great pain, sickness, and vomiting of blood. The hæmatemesis continued for some days, and then feebleness and emaciation set in, death occurring in three months. On examination the pylorus was found contracted to the size of a crow-quill, while there was a large cicatrix on the posterior wall of the stomach.

Symptoms.—The chief symptoms occasioned by the foregoing poisons are, an acrid, burning taste, with a sensation of excoriation and burning extending along the mouth and throat, to the stomach. There soon ensue exquisite pain in the epigastrium, and tenderness on pressure. Frequently there is cough, hoarseness, dyspnœa, as well as vomiting of altered mucus mixed with blood and detached portions of the mucous membrane. The tongue, mouth, and fauces become swollen, soft, and flabby, and deglutition is difficult. The surface of the body gets cold and moist, the pulse small and feeble, and there is great pain over the abdomen, with diarrhœa. Death took place, in the case of a boy, in three hours from the time of swallowing a strong solution of carbonate of potash. Ammonia, by its effect on the air passages, has proved fatal in four minutes. When recovery from the immediate effects of the poison has taken place, death has subsequently ensued from stricture of the œsophagus, producing starvation. By the proper use of bougies, &c., life may occasionally be prolonged for many months, or even for years. In some instances, however, it is almost impossible to effect dilatation, owing to the whole of the gullet becoming thickened and contracted, so that the opening into the stomach will hardly admit a crow-quill. The pylorus may also be contracted in like manner.

Post-mortem Appearances.—The mucous membrane of the mouth and gullet is softened and inflamed, and portions of it detached. The coats of the stomach and intestines are inflamed, stained of a dark color, and sometimes ulcerated. When death has resulted from ammonia, signs of inflammation are usually found in the larynx and bronchial tubes. The other caustic alkalies may also destroy life by producing inflammation of the glottis, which consequently may be found thus occluded after death.

Treatment.—The object must be to neutralize the poison, which may be effected by a weak acid. Vinegar and water is perhaps the best antidote, and that most readily procurable; its administration may be followed up by freely allowing acidulated demulcent drinks, orange juice, &c. The use of oil has been recommended, on the principle that it converts the alkali into a soap. But that its efficacy is doubtful has been in some measure shown by the death of two young children from swallowing a mixture of ammonia and oil. In one of these cases nearly two ounces of linimentum ammoniæ (made of one part of liquor ammonia to two of olive oil) were poured down an infant’s throat by a child five years old. Were, however, the oil given in much greater abundance, the result would probably be different. At all events, its administration should not be neglected.

Tests.—The specific character of these substances is their strongly marked alkalinity, ammonia possessing, over and above, that of volatility. Potash is known from soda by being precipitated of a creamy yellow by platinum perchloride, soda remaining unaffected by that reagent.

[II.—SIMPLE IRRITANTS.]

[CHAPTER IX.]

SALTS OF THE ALKALIES AND ALKALINE EARTHS.

Potassium Nitrate or Nitrate of Potash (Nitre, Saltpetre, Salprunelle) is a more dangerous poison than is commonly supposed, provided the dose be large. It has ordinarily been given in mistake for other salts as a purgative, and in one instance, caused death in about two hours, in another such instance, referred to by Orfila, an ounce proved fatal in three hours. It produces symptoms of irritation in the alimentary canal, vomiting, and diarrhœa. There is generally also severe pain at the pit of the stomach, trembling of the limbs, scanty urine, and collapse. Marks of violent inflammation are found after death in the stomach and along the intestinal canal.

Potassium Sulphate or Sulphate of Potash (Sal Polychrest, Sal de Duobus, &c.) has proved fatal when taken in a large dose. It has caused death in two or three cases when purposely administered to procure abortion. Taylor quotes an instance of a lady, a week after delivery, being directed by her medical attendant to take ten drachms of this salt, in divided doses as a laxative. After the first dose she was seized with severe pain in the stomach, with vomiting, &c., the symptoms increasing after each dose, and proving fatal in two hours. At the post-mortem examination the mucous membrane of the stomach and intestines was seen to be soft and pale, and the stomach contained a quantity of reddish-colored liquid. This, on being analyzed, was found to contain no other irritant but this salt.

Bitartrate of Potass or Hydrogen Potassium Tartrate (Cream of Tartar, Argol.)—This salt has caused death in one case at least, in which about an ounce and a half was taken. The symptoms were those of an irritant poison, with paralysis of the lower extremities. Death occurred within forty-eight hours.

Sulphuret of Potassium (Liver of Sulphur) has also caused death as an irritant poison.

Treatment.—As no antidotes are known to these salts the treatment must consist in producing vomiting as speedily as possible by means of emetics; or the stomach-pump may be used. Demulcent drinks should be freely given subsequently, with soothing applications to the bowels. Ice may be given in any quantity.

Lime acts as an irritant poison, though a feeble one, when taken into the stomach or applied to a vital part. One fatal instance is reported, where a boy swallowed some lime in an apple-pie. He died in nine days, after suffering from a burning pain in the abdomen, great thirst, and obstinate constipation. Unslaked or imperfectly slaked lime may also prove fatal by being inhaled, and so giving rise to inflammation of the glottis.

Barium Salts.—Two preparations of barium have caused death, viz., the chloride and the carbonate. These may also give rise to specific nervous symptoms, as cramps and convulsions.

Chloride of Barium is found crystallized in irregular plates or tables, which are permanent in the air, soluble in water, and of a disagreeable bitter taste. Half an ounce has proved fatal in two hours, after causing symptoms of irritation, with vertigo, paralysis and convulsions.

Carbonate of Baryta or Barium Carbonate, in its native state, occurs in massive radiated crystals, very heavy, and nearly colorless. Artificially prepared, as sold in the shops, it is a fine, tasteless, odorless powder, almost insoluble in hot or cold water. One drachm is said to have destroyed life, but recovery has taken place after a much larger dose.

Treatment.—The sulphate of soda or sulphate of magnesia, or some earthy sulphate, should be speedily administered, by which the poison will be converted into an inert insoluble sulphate of baryta. Emetics should also be given, or the stomach-pump used.

[CHAPTER X.]

SALTS OF THE METALS: ZINC—SILVER—TIN—BISMUTH—CHROME—IRON.

Two preparations of ZINC must be noticed:

Sulphate of Zinc (White Vitriol, White Copperas.)—This is a very mild irritant, resembling in its appearance Epsom salts and oxalic acid. It is very useful as an emetic in scruple or half-drachm doses, dissolved in any thin fluid.

In one case an ounce was accidentally taken. Great pain in the stomach, vomiting, and prostration, soon set in. Subsequently there was gastritis, and recovery only occurred after a prolonged convalescence.

Treatment.—Vomiting is to be encouraged by milk or albuminous fluids; after which remedies containing tannin (strong tea, decoction of oak bark, or tincture of Peruvian bark) are to be given.

Chloride of Zinc.—A solution of chloride of zinc forms a valuable disinfectant, but is also a dangerous irritant, or, if sufficiently strong, a corrosive poison. Sir William Burnett’s Fluid consists of gr. xxv of this salt to the drachm of water. It has been taken in mistake for fluid magnesia, pale ale, &c., and has caused death.

Symptoms.—A burning sensation in the mouth and throat is immediately produced. This is followed by nausea, vomiting, and signs of collapse. Death has occurred in less than four hours.

Post-mortem Appearances.—The mucous membrane of the throat and stomach has been found corrugated, hard, and leathery. In the case of a sailor who died from about half a pint of Burnett’s solution, the body was livid, the neck swollen, the cerebral vessels were engorged, and the lungs were congested. The mucous coat of the stomach was of a purple red, and partially corroded, while the pyloric orifice looked as if caustic had been applied to it. There were patches of congestion in different parts of the small intestines.

Treatment.—Albuminous drinks, followed by some preparation of tannin, will be needed.

Tests.—Zinc is distinguished from all other substances by giving a white precipitate with sulphuretted hydrogen. The solution containing it must not be too acid or no precipitate will be formed. Zinc also gives white precipitates with ferrocyanide of potassium and ammonia.

Nitrate of Silver (Lunar Caustic).—This is a powerful irritant, and has proved fatal in at least two instances. The antidote is common salt, which must be given immediately, followed by emetics.

Tin.—The chlorides of tin being employed in dyeing, color-making, &c., may lead to their being used as poisons, or being taken accidentally. Death from their use is rare. They are decomposed by magnesia, which should therefore be freely administered, followed by albuminous and mucilaginous drinks.

Bismuth.—The nitrate or magistery of bismuth has caused death in nine days, after a dose of two drachms. The symptoms were those of a strong irritant, but in all probability were caused by some impurity in the substance. Arsenic is frequently present in this way. As no antidote is known, vomiting must be promoted and emollient drinks freely given.

Chrome.—The bichromate of potassium is found in the form of orange-red crystals, which yield a yellow acid solution. It is used as a dye, and has caused death in more than one instance. Emetics and magnesia or chalk, must be the remedies employed.

It is well to know that this substance is apt to produce troublesome sores on the hands of those engaged in its manufacture. Some slight abrasion begins the lesion, which does not heal, but forms on its surface a tough slough, which separating, leaves a foul ulcer with hard edges, and most untractable, behind it.

Sulphate of Iron (Green Vitriol, Copperas).—Although not a powerful irritant, sulphate of iron has proved fatal when taken in a large dose. It is sometimes given to procure abortion. The perchloride of iron has also produced alarming symptoms, after being taken for the same purpose. Dr. Christison relates the case of a man who died in five weeks from an ounce and a half of the tincture. Magnesia and diluents, freely administered, must constitute the treatment.

[CHAPTER XI.]

SIMPLE VEGETABLE AND ANIMAL IRRITANTS.

This division of the class of simple irritants is an important one, on account of the substances composing it consisting in considerable part of ordinary remedies or drugs, which given in over doses, may produce symptoms of poisoning. They chiefly give rise to vomiting and purging.

VEGETABLE IRRITANTS.

The most important are aloes, colocynth, jalap, gamboge, scammony, elaterium, croton oil, castor oil seeds, various species of arum, euphorbium, bryony, mesereon, physic nut, and others less commonly known. Dr. Taylor says that aloes and colocynth are the basis of Morrison’s pills, which in many instances have induced fatal purging. In Holloway’s pills, aloes is the chief ingredient. A favorite remedy with nurses for promoting the catamenia is hierapicra, a brown powder consisting of four parts of aloes to one of canella bark. This may give rise to dangerous symptoms.

The symptoms induced by these substances are those of irritation of the intestinal canal, severe pain, vomiting, diarrhœa, tenesmus, &c.; followed by collapse, cold sweats, and occasionally convulsions. These effects may also be produced by diseased and decayed vegetables.

The treatment must be directed to the removal of the injurious substance by emetics, &c., unless spontaneous vomiting has freely taken place, when it need merely be encouraged by the use of diluents. If the irritant has passed out of the stomach into the intestines it must be carried off by purgatives, especially castor oil. The inflammatory symptoms should be cautiously combated, on account of the great prostration usually caused by these poisons. Opiates, emollient enemata, and fomentations to the abdomen will subsequently be found useful.

SIMPLE ANIMAL IRRITANTS.

The substances which require consideration under this head, though few, are important.

Poisonous Fish.—Several kinds of fish are constantly poisonous, while some only act injuriously on particular constitutions. The chief effects are sickness and vomiting, irritation of the eyes, depression, and severe urticaria or nettle-rash. In this country the different varieties of shell-fish are those most frequently injurious, especially cockles, mussels, crabs and such-like.

Poisonous Meat.—The flesh of animals which have died of disease has produced serious symptoms when eaten, and has even destroyed life. Several substances, as sausages, cheese, bacon, &c., also become poisonous from putrefaction.

The treatment in these instances should consist in the use of emetics, purgatives, and diluents. The vital power must be supported by stimulants, tonics, nutritious diet, &c.

[CHAPTER XII.]

IRRITANT GASES.

The chief are chlorine, sulphurous-acid gas, nitrous-acid gas, and hydrochloric-acid gas. When diluted, they admit of being inhaled; not so when pure.

Chlorine.—This gas has a greenish-yellow color, and a powerful suffocating odor. It is used to fumigate buildings, being a valuable disinfectant. Chlorine is employed by the calico-printer and paper-maker for its bleaching properties. The men who work in an atmosphere slightly impregnated with it suffer from dyspepsia, but are long-lived, and it has been supposed to be actually beneficial to consumptives. Any attempt to inspire chlorine in its concentrated state would at once prove fatal by closing the glottis and causing asphyxia. When diluted it excites excessive irritation of the air-passages, cough, difficulty of breathing, and inflammation.

In poisoning by chlorine, the inhalation of a small quantity of sulphuretted hydrogen appeared to afford relief in a case reported by Christison, but with that, or any other of the irritant gases, our treatment must chiefly consist in the instant removal of the sufferer to pure air. Then the cautious inhalation of ammonia, sulphuric ether, or the vapor of warm water, will be useful.

Sulphurous Acid Gas is one of the products formed by the combustion of ordinary coal. It possesses bleaching and antiseptic properties; and is very irritating when inspired.

Nitrous Acid Gas is a very violent poison when inhaled, producing inflammation of the lungs, &c. It has proved fatal in several instances, when given off by nitric acid.

Hydrochloric Acid Gas is irrespirable in its concentrated state, and when diluted produces great irritation of the lungs and air-passages. This gas, which is a waste product in the manufacture of washing soda, is the chief cause of the barrenness which surrounds soda works where it is allowed to escape, it being extremely destructive to vegetable life.

Ammonia.—It has been already noticed (p. [48]) that the vapor of ammonia is poisonous, exciting inflammation of the larynx, bronchitis, and pneumonia. Serious symptoms have sometimes arisen from its indiscriminate application in cases of syncope, &c.

[III.—SPECIFIC IRRITANT POISONS.]

By Specific Irritant Poisons we mean those which, taken internally, produce local inflammation or irritation, these being of course indicated by certain constitutional symptoms; but over and above these, which may be the result of ordinary inflammation, there are certain specific signs of the action of a poison, in most instances peculiar, and frequently pointing directly to the poison employed. This group is one of the utmost importance in Toxicology, and includes substances acting in many different ways, all, however, giving rise to the common symptoms of gastric irritation.

[CHAPTER XIII.]

SPECIFIC MINERAL IRRITANTS.

IODINE AND IODIDE OF POTASSIUM.

Iodine is obtained from kelp (the ash of marine plants) and is a bluish black scaly substance. It strikes an intense blue color with starch, and when heated gives off an irritating purple vapor. It likewise imparts a yellowish-brown stain to the skin (which may be removed by liquor potassæ) and mucous membranes, and slowly corrodes these tissues.

Iodine is an active poison, although its effects are variable. Some constitutions are violently affected by two or three grains, whereas others are uninjured by ten or twenty. Iodine is commonly employed in medicine in combination with potassium (iodide of potassium). Of this substance very large doses may be given (thirty grains or more, three times a day) in tertiary syphilis, with none but good effect.

The symptoms of poisoning by iodine consist of an acrid taste, tightness about the throat, epigastric pain, vomiting, and purging, especially if much has been taken. In a case which came under observation, a man took an ounce of the compound tincture of iodine, in mistake for a purgative draught. He was immediately seized with an intense burning pain in the throat and epigastrium, and vomiting, followed by great thirst, headache, and syncope. The vomiting was encouraged, large quantities of arrowroot given, starch enemata administered, and in twelve hours all the symptoms had disappeared, leaving him in a state of exhaustion, from which he recovered in a few days.

In chronic poisoning (iodism) there are signs of irritation of the alimentary canal, often a measly eruption, ptyalism, running from the nose and eyes, mental and bodily depression, and loss of flesh. Nothing leads to the belief that it causes absorption of the testicles or mammæ, as is often asserted.

The post-mortem appearances would be those due to an irritant poison, namely, inflammation and softening of the stomach; the mucous membrane being detached in different parts, and stained of a yellow color.

The treatment should consist in the encouragement of vomiting, and the free administration of amylaceous fluids, as gruel, arrowroot, boiled starch, &c. This should be continued until the matters vomited are of their natural color; for as long as any iodine remains they will be rendered blue, iodide of starch being formed.

The crystals of iodide of potassium are white cubes, very soluble in water, and permanent in the air; though when impure they have a yellowish tinge, and are deliquescent. In a few instances this valuable medicine appears to have given rise to troublesome symptoms, even when administered in small doses. Mr. Erichsen has reported a remarkable case, in which five grains produced coryza, conjunctivitis, difficulty of breathing, and other serious effects, promptly ceasing with the discontinuance of the medicine. The treatment must consist in emptying the stomach by emetics or the stomach-pump, and administering starchy diluents.

Tests. 1. Iodine may be readily detected by the blue color it gives to starch.

Iodide of potassium gives the same when the iodine is set free by an acid, such as sulphuric acid.

2. It also forms a scarlet precipitate with perchloride of mercury; and

3. It gives a yellow precipitate with acetate of lead.

[CHAPTER XIV.]

PHOSPHORUS.

This substance is sold in a pure state in small wax-like cylinders, which must be preserved under water. It is soluble in oil, alcohol, ether, and chloroform, and still more so in carbon disulphide; it is luminous in the dark, and it ignites at a very low temperature, giving off a dense white smoke. Phosphorus is much more frequently used as a poison abroad than in England; but since restrictions have been put on the sale of poisons, and rat poisons containing it have been more common, cases of poisoning have more frequently occurred, and are likely to do so even oftener in future. The cases which have occurred show that it is a very powerful irritant, and capable of causing death when taken, even in small doses. One grain has caused death; the shortest period in which it has followed the administration of the poison being four hours.

The phosphorous paste sold consists of flour, sugar, and fat, with phosphorous, ordinarily colored with Prussian blue. Coloring matter is also generally present in lucifer-match tops, which contain phosphorus and chlorate of potash, or nitre; hence, the vomited matters after either of these has been swallowed may be variously colored. In the so-called “safety matches” the phosphorus is on the box and not on the match. Phosphorus does not readily lend itself to the purposes of the criminal, its luminosity, its taste, and its garlic odor rendering it difficult of concealment.

The symptoms of poisoning by phosphorus are very varied, often insidious. At first there may be merely the ordinary signs of irritant poisoning. The vomited matters are luminous in the dark, sometimes bilious, sometimes bloody. There is very great prostration, and there may be diarrhœa with bloody stools. These symptoms sometimes abate, and everything seems going on well, when suddenly a new train of symptoms, still more serious, develop themselves. These are such as would occur in the worst forms of blood poisoning: harsh, dry, yellow skin, with discharges of blood from the various passages, and the formation of extravasations below the skin. The urine is ordinarily retained or suppressed, what little there is being albuminous or bile-stained. Finally, acute delirium with convulsions sets in; the patient dies comatose a few hours after taking the poison, or it may be as many months.

The post-mortem appearances after death by phosphorus are very peculiar. If the case has proved rapidly fatal there will be the ordinary signs of irritant poisoning, with, in addition, softening of the stomach, bloody or gangrenous patches, blood in the intestines and bladder, and bloody serum in the peritoneal cavity. In many respects the lesions resemble those of the worst forms of sea scurvy; but the most marked changes are the remarkable fatty degeneration of the liver, kidneys, heart and other muscles, especially of the first, which is often greatly atrophied.

The diagnosis will depend on the peculiar odor of garlic exhaled by the patient and the luminosity of the vomited matters, in addition to the other signs referred to.

Treatment.—There is no regular antidote for phosphorus; early evacuation by the stomach-pump and the free promotion of vomiting are the main points. Magnesia or its carbonate should be given freely in mucilaginous fluids. Oils had better be avoided, except for the purpose of removing all traces of the poison by the stomach-pump. Prompt treatment is all in all.

Detection.—There is but one really satisfactory plan for detecting phosphorus in organic mixtures, that invented by Mitscherlich. The suspected material is introduced into a retort, and acidulated with sulphuric acid. The stem of the retort is conducted into a glass vessel kept cool by a stream of water on the outside. The retort is heated, and distillation allowed to go on in the dark. If phosphorus be present it passes over as vapor, and is condensed in the cool vessel beyond. At each condensation a flash of light is perceived, which is the test relied on.

Chronic Poisoning by phosphorus used to be exceedingly common among match manufacturers, but is now, comparatively speaking, rare, allotropic or amorphous phosphorus being much more generally employed than it used to be, and the ventilation of the workshops being better. Its subjects used to be attacked with caries of the gums, gradually extending and implicating the jaw, and giving rise to great deformity.

[CHAPTER XV.]

ARSENIC.

Arsenic is by far the most important of metallic poisons, whether we consider the deadliness of its effects or the fatal frequency with which they are made manifest. Arsenic exists as an impurity in several metallic ores, notably in iron pyrites, which being commonly employed as a material for the manufacture of sulphuric acid, renders arsenic one of the most frequent impurities of commercial oil of vitriol. This should never be forgotten in testing any substance for the poison. To the common medicinal preparation of arsenic, consisting of arsenious acid, or arsenites, and the so-called chloride of arsenic, must be added the arseniates of potash and soda; the sulphides of arsenic—as, the red sulphide, or realgar, and the yellow sulphide, or orpiment; the arsenite of copper, or Scheele’s green, and others. They all produce similar symptoms, and poisoning by either of them requires nearly the same treatment.

According to Von Tschudi, some of the peasants in parts of Styria and Hungary eat arsenic, taking from two to five grains daily; the men doing so in order that they may gain strength, and be able to endure fatigue, the women that they may improve their complexions. These statements are so contrary to all that we know of the power of this poison, that they have been regarded as unworthy of credit. Evidence has, however, been brought forward by Dr. Craig Maclagan, of Edinburgh, which shows clearly that arsenic-eating is something more than a mere fiction. This gentleman gave, and saw a Styrian eat, a piece of arsenious acid, weighing over four grains, and afterwards determined the presence of arsenic in urine passed in his presence by the said peasant. Advantage was taken of these reports in the trial of Miss Madeline Smith (Edinburgh, July, 1857), when the court was asked to believe that arsenic found in the possession of the prisoner was used by her as a cosmetic.

Arsenite of Copper, in one form or another, either as Scheele’s green, emerald green, Brunswick green, &c., is unfortunately largely employed in the manufacture of green paper-hangings, artificial flowers, toys, and even some kinds of confectionery. Too many cases of ill-health caused by this practice have been recorded to permit any doubt as to its deleterious effects. These may be manifested by people living in rooms furnished with such paper-hangings. The chief symptoms are, sneezing, lachrymation, frontal headache, nausea, and loss of appetite, with colicky pains, thirst, &c. Among those employed in preparing the paper-hangings more serious symptoms manifest themselves. The irritation of the pigment gives rise to circular patches of ulceration on the alæ of the nose, in the folds of the arm, in the groin and scrotum—in short, wherever dirt tends to lodge. These prove very untractable, except the employment be abandoned. In November, 1861, a young woman died in London from the poisonous effects of arsenite of copper used in dusting wax leaves. The workmen who employ the pigment in its dry state suffer, while those who use it in a moist condition are probably unaffected by it. A simple method for roughly detecting arsenite of copper in these fabrics was published in the Chemical News (vol. 1, p. 12). A small portion of the suspected material is to be put into a test tube with strong ammonia. If a blue tint be produced, a salt of copper is shown to be present. Withdraw the object, and drop a piece of nitrate of silver into the ammonia; if arsenic be there, the nitrate of silver will be covered with a yellow coating of arseniate of silver, which will disappear on stirring. On igniting arsenical paper and allowing it to smoulder, the odor of garlic may be detected in the fumes given off. Another mode in which the noxious effects of arsenic are produced is by the use of bright green tarlatans as ball dresses. One could hardly conceive a more deadly amusement than dancing in an arsenicated dress, sweeping against an arsenicated wall-paper. When both are lightly adherent the arsenic is scattered in showers about the room.

Arsenious Acid (White Oxide of Arsenic, White Arsenic, Arsenic).—This is the preparation of arsenic most frequently used as a poison; the facility with which it used to be procured, its cheapness (twopence an ounce), and the ease with which it may be administered, all tended to recommend it to the murderer or suicide. According to a parliamentary report, the number of fatal cases of poisoning in England in the years 1837, 1838, amounted to 543, of which no less than 186 were caused by arsenic, 185 arising from the use of the arsenious acid, and 1 from orpiment or yellow arsenic.

Since the Act of 1851 (14 Vict. cap. xiii.) the deaths from this agent have greatly decreased. This statute chiefly enacts that arsenic is not to be sold without the seller entering the transaction in a proper book, without a witness, nor without its being mixed with soot or indigo, unless such admixture would render it unfit for the purchaser’s business.

Arsenious acid is found in commerce in the form of a white powder or in small opaque cakes. It is very feebly acid, tasteless, or slightly sweet in small doses, though not very soluble, an ounce of cold water dissolving about one grain. The quantity so held in solution may, however, be increased by dissolving the arsenic in boiling water and allowing it to cool. The shortest period within which it was believed arsenic would cause death was two hours; but Dr. Taylor gives a case where death with tetanic symptoms followed the fatal dose in twenty minutes. The smallest quantity known to have proved fatal is two grains. Two grains and a half killed a girl nineteen years of age in thirty-six hours. Half a grain will produce alarming symptoms; and yet recovery has ensued after doses of half an ounce or an ounce.

Symptoms.—These commence within half an hour or an hour of swallowing the poison. There is faintness, nausea, incessant vomiting, and a burning pain in the epigastrium, increased on pressure, and gradually extending over the whole abdomen, followed by headache, diarrhœa, a sense of constriction and heat in the fauces and throat, great thirst, and catching, painful respiration. The heart’s action becomes depressed, the pulse is quick and feeble; there is great restlessness and anxiety; cold, clammy skin, and perhaps coma are present; and death usually occurs within twenty-four hours.

These symptoms are liable to great variety, the pain and vomiting being occasionally absent, and the patient being affected as if by a narcotic poison. In some instances there is troublesome tenesmus, with heat and excoriation about the anus. Convulsive movements in the extremities often occur, with cramp in the legs, especially if the diarrhœa is severe. Death sometimes takes place calmly from collapse, sometimes it follows on convulsions.

The vomited matters may be red or brown from admixture with blood or bile; or they may be blue or black, if the arsenic has been colored with indigo or soot. Although the vomiting, pain, &c., are generally continuous, yet sometimes all the symptoms remit, and the patient rallies for a time, only to sink more rapidly.

The symptoms of chronic poisoning by arsenic are loss of appetite, a silvery coating to the tongue, thirst, nausea, colicky pains, diarrhœa, frontal headache, langor, sleeplessness, cutaneous eruptions, soreness of the edges of the eyelids, emaciation, anæmia, convulsions, and death. In some cases, when small doses have been administered for many days in succession, with the intent to destroy life, the symptoms have been masked by other substances. The most marked results of this practice have been sickness and vomiting, pain in the bowels, nervous irritability, and emaciation. The practitioner must be careful not to mistake these symptoms for those due to simple gastritis or enteritis.

Arsenic is not a poison that accumulates in the system, but is slowly eliminated from it especially by the kidneys, but partly also by the bile.

The local application of arsenic to the mucous membranes, to wounds, or to surfaces deprived of their cuticle, produces constitutional effects similar to those just described. The only difference is that the symptoms show themselves more slowly. Not a few lives have been sacrificed from the application by ignorant quacks of a mixture of arsenious acid, realgar, and oxide of iron to ulcerating cancers.

Cases of compound poisoning have been met with. When arsenic is taken mixed with opium, the symptoms produced by the former are masked.

Post-mortem Appearances.—Arsenic appears to exercise a specific influence over the alimentary canal, and more especially over the stomach; for in whatever manner it may have been introduced into the system, it is to this organ that we must look for its effects. These effects consist in the signs of acute inflammation commencing in this viscus, and often extending along the duodenum, small intestines, and colon. In acute cases the stomach is the viscus most affected; but in chronic cases the whole alimentary canal is found inflamed and ulcerated, particularly the duodenum and rectum. When death has occurred within five hours of taking the poison, the stomach has been found intensely inflamed in an adult; while the same result was witnessed in a child who died at the end of two hours. The stomach often contains a dark grumous fluid, occasionally tinged with blood. On removing the contents the mucous membrane is seen red and inflamed, the inflammation being most intense around certain spots. On examining these spots, particles of arsenic will probably be found adhering to the walls of the stomach and surrounded by a zone of inflammatory redness. Sometimes also blood is effused into the visceral walls, giving rise to an appearance resembling gangrene. Ulceration of any of the coats of the stomach is rare, and perforation is still more so.

In a few exceptional cases there has been no appearance of inflammation in the stomach or bowels.

Putrefaction of the body is said to be remarkably retarded after death from arsenic.

Treatment.—The first object must be to expel the poison from the stomach, for which purpose the stomach-pump may be advantageously employed, or emetics of sulphate of zinc, mustard, or ipecacuan administered, unless vomiting is already present. The sickness must be promoted by the free use of albuminous or mucilaginous diluents. Raw eggs beaten up in milk are particularly useful, as is likewise a mixture of albumen, milk, and limewater. Taylor advises equal parts of oil and limewater, for the oil invests the poison, and the lime renders it less soluble. A large dose of castor oil (℥j to ℥ij) may be given, to carry off any of the poison which may have passed into the intestines, as soon as sickness has subsided. Animal charcoal, calcined magnesia, &c., when taken in large quantities, may be of service by enveloping the arsenic, and preventing its contact with the mucous membrane of the stomach; but oil or milk will act more efficiently in this manner. The hydrated peroxide of iron[B] should be administered moist, and in large doses, after the stomach-pump has been used; or indeed, mixed with water, it may be first introduced and then expelled, thus washing out the stomach by means of the stomach-pump. This is the most efficient antidote known.

The subsequent treatment must be conducted on general principles, according to the severity of the symptoms; but the great depression of the nervous and vascular systems must not be overlooked in combating any inflammatory action. Henbane or opium, in many instances combined with stimulants, ice internally, and hot fomentations externally, will frequently be found of great service.

Tests.—In its solid state arsenious acid may be known by the following properties. Heated on platinum foil or on the point of a penknife, it produces a white smoke and is entirely volatilized. If some of the powder be heated in a small test tube, it will be sublimed, and small octahedral crystals, visible to the naked eye or by a lens, obtained. If arsenious acid be mixed with freshly-burnt powdered charcoal, and heated in a small test tube, a ring of shining metallic arsenic of a grey color will be found on the cool portion of the tube, and an odor of garlic is perceptible. If this deposit be driven about from place to place it will gradually become oxidized, and octahedral crystals of arsenious acid formed. Further, if the tube be divided and the part containing the arsenious acid be washed out with distilled water, the liquid tests may be applied to the solution. This is called the Reduction test. It is very delicate, detecting according to Christison, the 300th part of a grain.

In solution, this substance may be detected by what are called the liquid tests. A solution of arsenic in water is colorless, almost tasteless, and has a very slightly acid reaction. If a few drops be evaporated on a glass slide and examined by the microscope, numerous minute and mostly imperfect octahedral crystals, or an amorphous deposit, will be seen, presenting triangular surfaces by reflected light.

1. The ammonio-nitrate of silver (prepared by adding a few drops of liquor ammoniæ to a solution of nitrate of silver, till the brown oxide of silver at first precipitated is nearly redissolved) throws down with arsenious acid a rich yellow deposit of arsenite of silver.

2. The ammonio-sulphate of copper (formed by adding liquor ammoniæ to a solution of sulphate of copper till the bluish-white oxide of copper is almost redissolved) produces a pale green precipitate, arsenite of copper, or Scheele’s green. Care must be taken not to add too much of the test in the first instance, otherwise its blue may overpower the green of the precipitate.

3. Sulphuretted hydrogen water precipitates a yellow deposit of sulphide of arsenic. It is better, however, to use pure and well-washed sulphuretted hydrogen generated in the usual manner. Care must be taken that the liquid is not alkaline, or no precipitate will be produced, even though arsenic be present. For this reason yellow sulphide of ammonium will not precipitate arsenic until acidulated with pure hydrochloric or some such acid. The precipitate should be collected, carefully washed, and dried. It should then be mixed with black flux or dry ferrocyanide of potassium and reduced, as already described.

These tests are so delicate, especially the first, that they will detect the 8000th part of a grain of arsenic in solution; they should be employed successively. There are several other processes which require to be noticed, namely, Marsh’s process, the process known as Reinsch’s process, Fresenius’s process, and the Destillation process.