2. The second variety of poisoning with arsenic includes a few cases in

which the signs of inflammation are far from violent or even altogether wanting, and in which death ensues in five or six hours or a little more,—at a period too early for inflammation to be always properly developed. The symptoms are then generally obscure, and are referrible chiefly to the mode of action, which is probably the cause of death in most cases,—a powerful debilitating influence on the circulation, or on the nervous system. These symptoms occasionally amount to absolute narcotism, as in some of the animals on which Sir B. Brodie experimented. Thus, when he injected a solution of the oxide into the stomach of a dog, the pulse was rendered slow and intermitting; the animal became palsied in the hind-legs, lethargic, and in no long time insensible, with dilated pupils; and soon afterwards it was seized with convulsions, amidst which it died, fifty minutes after the poison was administered.[641] In man the symptoms very seldom resembled so closely those of the narcotic poisons. In Mr. Stallard’s case, however, formerly mentioned, the symptoms of irritation which appeared at first speedily gave place to complete insensibility for two hours before death (pp. 235, 238), a similar instance has been related in Henke’s Journal. A young man who got an arsenical solution from an old woman to cure ague, was attacked after taking it with vomiting and loud cries, afterwards with incoherent talking, then fell into a deep sleep, and finally perished in convulsions in five hours.[642] In some cases of the kind now under consideration, one or two attacks of vomiting occur at the usual interval after the taking of the poison; but it seldom continues. The most uniform and remarkable affection is extreme faintness, amounting at times to deliquium. Occasionally there is some stupor, or rather oppression, and often slight convulsions. Pain in the stomach is generally present; but it is slight, and seldom accompanied with other signs of internal inflammation. Death commonly takes place in a few hours. Yet, even when it is retarded till the beginning of the second day, the faintness and stupor are sometimes more striking features in the case than the symptoms of inflammation in the stomach. This variety of poisoning has been hitherto observed only under the three following circumstances,—when the dose of poison was large,—when it was in little masses,—or when it was in a state of solution. The mode in which the first and last circumstances operate is evident; they facilitate the absorption of a large quantity of arsenic in a short space of time, so that its remote action begins before local inflammation is fully developed. But it is not easy to see how any such effect can flow from the arsenic being in little masses. It is also to be observed that none of the circumstances here mentioned is invariable in its operation. An instance is related in Rust’s Magazine, of the customary signs of irritation having been produced even by the solution.[643] On the whole, the present variety of poisoning is rather uncommon, and indeed, although the attention of the profession was pointedly called to it even in the first edition of the present work, its existence does not seem to be so generally known as it ought to be.[644] It may be right therefore to specify the cases which have been published. In the Medical and Philosophical Journal of New York,[645] is related the case of a druggist, who swallowed an ounce of powdered arsenic at once, and died in eight hours, after two or three fits of vomiting, with slight pain and heat in the stomach.—A similar case has been related by Metzger. A young woman died in a few hours, after suffering from trivial diarrhœa, pain in the stomach and strangury; her death was immediately preceded by slight convulsions and fits of suffocation; and on dissection the stomach and intestines were found quite healthy. Half an ounce of arsenic was found in the stomach.[646]—A third case similar in its particulars to the two preceding was submitted to me for investigation by the sheriff of this county in 1825. The subject, a girl fourteen years of age, took about ninety grains, and died in five hours, having vomited once or twice, complained of some little pain in the belly, and been affected towards the close with great faintness and weakness. The stomach and intestines were healthy.[647]—A fourth case allied to these is succinctly told in the Medical and Physical Journal. The person expired in five hours; and vomiting never occurred, even though emetics were given.[648]—A fifth has been related by M. Gérard of Beauvais. The subject was a man so addicted to drinking, that his daily allowance was a pint of brandy. When first seen, there was so much tranquillity, that doubts were entertained whether arsenic had really been swallowed; but at length he was discovered actually chewing it. This state continued for nearly five hours, when some vomiting ensued: coldness of the extremities and spasmodic flexion of the legs soon followed; and in a few minutes more he expired.[649]—A sixth and very singular case of the same kind has been described by Orfila. The individual having swallowed three drachms at eight in the morning, went about for two hours bidding adieu to his friends and telling what he had done. He was then prevailed on to take emetics and diluents, which caused free, easy vomiting. He suffered very little till one, when he became affected with constricting pain and burning in the stomach, feeble pulse, cold sweats, and cadaverous expression, under which symptoms he died four hours later.[650] Orfila justly designates this case as the most extraordinary instance of poisoning with arsenic that has come under his notice.—A seventh is related by Mr. Holland of Manchester where death took place in the course of eight or nine hours, and the symptoms were at first some vomiting, afterwards little else but faintness, sickness, a sullen expression, and a general appearance which led those around to suppose the individual intoxicated.[651]—Professor Chaussier has described a still more striking case than any yet mentioned. A stout middle-aged man swallowed a large quantity of arsenic in fragments and died in a few hours. He experienced nothing but great feebleness and frequent tendency to fainting. The stomach and intestines were not in the slightest degree affected during life; and no morbid appearance could be discovered in them after death,[652]—A similar instance not less remarkable has been communicated to me by Mr. Macauley of Leicester, where the individual died with narcotic symptoms only within two hours after taking nearly a quarter of a pound of arsenic.—Another fatal in four hours has been described by Mr. Wright, where the symptoms were vomiting under the use of emetics, great exhaustion, feeble hurried pulse, cold sweating, drowsiness and finally stupor. In this case the quantity of arsenic taken was about an ounce.[653]—Another of the same nature is recorded by Morgagni. An old woman stole and ate a cake, which had been poisoned with arsenic for rats. She died in twelve hours, suffering, says Morgagni, rather from excessive prostration of strength than from pain or convulsions.[654]—The following case related by M. Laborde is most remarkable in its circumstances. A young woman was caught in the act of swallowing little fragments of arsenic, and it afterwards appeared that she had been employed most of the day in literally cracking and chewing lumps of it. When the physician first saw her the countenance expressed chagrin and melancholy, but not suffering. After being forced to drink she vomited a good deal, but without uneasiness. Two hours afterwards her countenance was anxious; but she did not make any complaint, and very soon resumed her tranquillity. Five hours after the last portions of the poison were taken she became drowsy, then remained perfectly calm for four hours more, and at length on trying to sit up in bed, complained of slight pain in the stomach, and expired without agony. A clot of blood was found in the stomach.[655]—Dr. Platner of Pavia describes a case, fatal probably in five hours, where the symptoms were a tranquil, melancholic expression, great coldness, paleness of the features, slow languid pulse, retarded respiration, and suppression of urine, but no pain or swelling of the belly, and no diarrhœa till near death, when there was one copious fluid evacuation.[656]—Lastly, Dr. Choulant has related the case of an elderly female who got a thimbleful of arsenic in soup, and died in eleven hours, affected with occasional, easy vomiting, uneasiness, thirst, and undefinable uneasiness in the chest, but without pain of any kind, or any other complaint.[657] The cases of which an abstract has here been given, will, it is apprehended, be sufficient to correct the erroneous impression of many,—that arsenic, when it proves fatal, always produces violent and well-marked symptoms. It will of course be understood that cases of the present kind pass by insensible shades into those of the first class,—the following, for example, being intermediate between the two. A young man had frequent vomiting and diarrhœa, which were supposed to depend on indigestion merely, as the countenance was calm, without any appearance of suffering, the appetite tolerable, and the abdomen quite free of tenderness. The pulse, however, quickly sunk, the voice failed, and death took place in eleven hours; and on dissection about twenty grains of arsenic were found in the stomach with strong signs of inflammation.[658]—In a case communicated to me by a former pupil, Mr. Adams of Glasgow, that of a woman who died five hours after taking six drachms of arsenic, there was some vomiting not long after she swallowed it; but subsequently she presented no prominent symptoms except a ghastly expression, redness of the eyes, a fluttering pulse and extreme prostration, until within half an hour before death, when the action of an emetic and the stomach-pump was followed by severe burning pain.