3. The third variety of poisoning with arsenic places in a clear point

of view its occasional action on the nervous system. This occurs chiefly in persons who, from having taken but a small quantity, or from having vomited soon after, are eventually rescued from destruction; but it has also been met with in some cases where death ensued after a protracted illness. In such cases the progress of the poisoning may be divided into two stages. The first train of symptoms is exactly that of the first or inflammatory variety, and is commonly developed in a very perfect and violent form. In the second stage the symptoms are referrible to nervous irritation. These generally come on when the former begin to recede; yet sometimes they make their appearance earlier, while the signs of inflammation in the alimentary canal continue violent; and more rarely both classes of symptoms begin about the same period. The nervous affection varies in different individuals. The most formidable is coma; the slightest, a peculiar, imperfect palsy of the arms or legs, resembling what is occasioned by the poison of lead; and between these extremes have been observed epileptic fits, or tetanus, or an affection resembling hysteria, or mania. As these affections are of much interest, in respect to the evidence of poisoning from symptoms, it may be well to relate in abstract a few characteristic examples of each. A good example of epilepsy supervening on the ordinary symptoms of inflammation has been minutely related by Dr. Roget. A girl swallowed a drachm of arsenic, and was in consequence attacked violently with the usual symptoms of irritation in the whole alimentary canal. After being ill about twenty-four hours, she experienced several distinct remissions and had some repose, attended with fainting. In twelve hours more she began to improve rapidly; the pain subsided, her strength and spirits returned, and the stomach became capable of retaining liquids. So far this patient laboured under the common effects of arsenic. But a new train of symptoms then gradually approached. Towards the close of the second day she was harassed with frightful dreams, starting from sleep, and tendency to faint; next morning with coldness along the spine, giddiness, and intolerance of light; and on the fourth day with aching of the extremities and tingling of the whole skin. These symptoms continued till the close of the sixth day, when she was suddenly seized with convulsions of the left side, foaming at the mouth, and total insensibility. The convulsions endured two hours, the insensibility throughout the whole night. Next evening she had another and a similar fit. A third, but slighter fit occurred on the morning of the tenth; another next day at noon; and they continued to return occasionally till the nineteenth day. For some time longer she was affected with tightness across the chest and stomach complaints; but she was eventually restored to perfect health.[659] A characteristic set of similar cases, which occurred in London in 1815, has been related in a treatise on arsenic by Mr. Marshall.[660] They were the subject of investigation on the trial of Eliza Fenning, a maid-servant, who attempted to poison the whole of her master’s family by mixing arsenic with a dumpling, and whose condemnation excited an extraordinary sensation at the time, as many persons believed her to be innocent. Five individuals partook of the poisoned dish, and they were all violently seized with the usual inflammatory symptoms. But farther, one had an epileptic fit on the first day, which returned on the second, and he had besides frequent twitches of the muscles of the trunk, a feeling of numbness in one side, and heat and tingling of the feet and hands. Another had tremors of the right arm and leg on the first day, and several epileptic fits in the course of the night. During the next fifteen days he had a paroxysm every evening about the same hour; which returned after an intermission of eight days, and frequently for several months afterwards. In the following set of cases the nervous symptoms exhibited a singular combination of delirium, convulsions, tetanus, and coma, such as is frequently met with in paroxysms of hysteria; but the cases are probably not pure examples of poisoning with arsenic, for liver of sulphur was administered as a remedy to a considerable amount. Three servant girls in one of the Hebrides ate a mixture of lard, sugar, and arsenic, which had been laid for destroying rats. The ordinary signs of irritation in the stomach ensued, but on the following morning were greatly mitigated. They were then ordered twelve grains of liver of sulphur every other hour. Soon afterwards the inflammatory symptoms became more severe, the root of the tongue swelled and inflamed, and in the afternoon two of them lost the power of speech and swallowing, and were attacked with locked-jaw and general convulsions. The third had not locked-jaw, but was otherwise similarly, affected. On the morning of the third day one of the two former was found comatose, with continuance of the locked-jaw and occasional return of convulsions; and on being roused by venesection and the cold affusion, she complained of headache and heat in the throat. The sulphuret of potass, which had been discontinued on account of the locked-jaw, was then resumed. On the evening of the fourth day the headache increased, and the patient became delirious and unmanageable. The cold affusion, however, soon restored her again to her senses, and from that time her recovery was progressive. In the other patients the symptoms were similar, but less violent. In these instances the evidence of an injury of the nervous system was decisive; but it may be doubted whether the symptoms were not, in part at least, owing to the sulphuret of potass, which has been already described as an active poison, capable of inducing convulsions and tetanus. Its properties were not generally known in this country at the time the cases in question happened.[661] Sometimes the convulsions caused by arsenic assume the form of pure tetanus. At least a case of this affection is noticed by Portal.[662] He has given only a mere announcement of it; and I have not hitherto met with a parallel instance in authors. A common nervous affection in the advanced stage of the more tedious cases of poisoning with arsenic is partial palsy. Palsy in the form of incomplete paraplegia is a very common symptom even of the early stage in animals, and has been also sometimes observed during that stage in man. The paralytic affection, however, is more frequent in the advanced stage; and in those persons who recover, an incomplete paralysis of one or more of the extremities, resembling lead palsy, is often the last symptom which continues. Dehaen relates a distinct example of this disorder occurring in a female who took a small quantity of arsenic by mistake. The ordinary signs of inflammation were soon subdued, and for three days she did well; but on the fourth she was attacked with cramps, tenderness, and weakness of the feet, legs and arms, increasing gradually till the whole extremities became at length almost completely palsied. At the same time the cuticle desquamated. But the other functions continued entire. The power of motion returned first in the hands, then in the arms, and she eventually recovered; but eleven months passed before she could quit the hospital where Dehaen treated her.[663] An excellent account of a set of similar cases has been given by Dr. Murray of Aberdeen. They became the subject of judicial inquiry on the trial of George Thom, who was condemned in 1821 at the Aberdeen autumn circuit for poisoning his brother-in-law. Four persons were simultaneously affected about an hour after breakfast with the primary symptoms of poisoning with arsenic, and some in a very violent degree. But besides these symptoms, in all of them the muscular debility was great; and in two it amounted to true partial palsy. One of them lost altogether the power of the left arm, and six months after, when the account of the cases was published, he was unable to bend the arm at the elbow-joint. The other had also great general debility and long-continued numbness and pains of the legs.[664] An interesting case of the same nature with these was lately submitted to me on the part of the crown. A man after taking arsenic was attacked with vomiting, purging, and other symptoms of abdominal irritation, which were mistaken for dysentery. Five days afterwards he began to suffer also from feebleness of the limbs; amounting almost to palsy. Subsequently an improvement slowly took place; but he continued to suffer under irritative fever, diarrhœa, and faintness. Several weeks later the diarrhœa abated, but he had great stiffness, numbness, and loss of power in the joints of the hands and feet. Two months after he first took ill, and while he was slowly recovering from this paralytic affection, arsenic was again administered and proved fatal in eighteen hours. Another, somewhat similar to the preceding, has been related by M. Lachèse of Angers. Two people took about half a grain in soup twice a day for two days, and were attacked with the usual primary symptoms. One of them died in ten weeks, gradually worn out, but without any particular nervous affection. The other was seized with convulsions, and afterwards with almost complete palsy of the limbs.[665]—A well-marked case of the same nature has been noticed by Professor Bernt. It was the case formerly alluded to as arising from an over-dose of the arseniate of potass. The paralytic affection consisted in the loss of sensation and of the power of motion in the hands, and of the loss of motion in the feet, with contraction of the knee-joints. The issue of the case is not mentioned.[666]—Dr. Falconer observes in his essay on Palsy, that he had repeatedly witnessed local palsy after poisoning with arsenic, and alludes to one instance in which the hands only were paralysed, and to two others in which the palsy spread gradually from the fingers upwards till the whole arms were affected.[667]—On the whole, then, local palsy is the most frequent of the secondary effects of arsenic. It is sometimes very obstinate, as the cases related by Dehaen and Murray will show. But it even appears to be sometimes incurable. For in the German Ephemerides there is related the case of a cook, who after suffering from the usual inflammatory symptoms, was attacked with perfect palsy of the limbs, and had not any use of them during the rest of her life, which was not a short one.[668] Occasionally, instead of being palsied, the limbs are rigidly bent and cannot be extended.[669] They were contracted, as well as palsied in the case noticed by Bernt. The last nervous affection to be mentioned is mania. The only instance I have hitherto found of that disease arising from arsenic is related by Amatus Lusitanus. He has not recorded the particulars of the case, but merely observes that the individual became so outrageously mad as to burst his fetters and jump out of the window of his apartment.[670] According to Zacchias, Amatus was not very scrupulous in his adherence to fact in recording cases. The preceding remarks contain all that is known with certainty of the effect of arsenic on man when it is swallowed. Independently of the obvious nervous disorders which succeed the acute symptoms, other morbid affections of a more obscure character and chronic in their nature have been sometimes observed or supposed to arise from this poison.—Among these the most unequivocal is dyspepsia. Irritability of the stomach, attended with constant vomiting of food, has been occasionally noticed for a long time after. Wepfer has described two cases in which the primary symptoms were followed, in one by dyspepsia of three years’ standing, in the other by emaciation and an anomalous fever, which ended fatally in three years.[671]—Hahnemann farther adds, that in the advanced stage the hair sometimes drops out, and the cuticle desquamates, accompanied occasionally with great tenderness of the skin;[672] and Wibmer mentions a case of the kind, where not the cuticle and hair only, but likewise even the nails, fell off.[673] Desquamation of the cuticle and dropping of the nails are at times produced by the continued use of arsenic in medicinal doses.—Other effects have likewise been ascribed to its employment medicinally. Thus passing over what was stated by its opponents at the time when its introduction into the materia medica was made the subject of controversy over Europe, Broussais maintained that it causes chronic inflammation of the stomach or intestines;[674] and Dr. Astbury inferred, from an instance which fell under his notice, that it may bring on dropsy.[675] Neither of these ideas is supported by the general experience of the profession; and although some persons even of late have alleged that those, who take it medicinally to any material amount, invariably die soon after of some chronic disease,[676] there cannot be a doubt, that, under proper restriction, it is both an effectual and a safe remedy.—A case where salivation, with fetor and superficial ulceration of the gums, seemed to have been produced by arsenic, was lately published in an English Journal.[677] In the present place may also be considered the supposed effects of the celebrated _Aqua Toffana_ or _Acquetta di Napoli_, a slow poison, which in the sixteenth century, was believed to possess the property of causing death at any determinate period, after months for example, or even years, of ill health, according to the will of the poisoner. The most authentic description of the aqua Toffana ascribes its properties to arsenic. According to a letter addressed to Hoffman by Garelli, physician to Charles the Sixth of Austria, that Emperor told Garelli, that, being governor of Naples at the time the aqua Toffana was the dread of every noble family in the city, and when the subject was investigated legally, he had an opportunity of examining all the documents,—and that he found the poison was a solution of arsenic in _aqua cymbalariæ_.[678] The dose was said to be from four to six drops. It was colourless, transparent, and tasteless, like water. Its alleged effects are thus eloquently described by Behrends, a writer in Uden and Pyl’s Magazin. “A certain indescribable change is felt in the whole body, which leads the person to complain to his physician. The physician examines and reflects, but finds no symptom, either external or internal,—no constipation, no vomiting, no inflammation, no fever. In short, he can advise only patience, strict regimen, and laxatives. The malady, however, creeps on; and the physician is again sent for. Still he cannot detect any symptom of note. He infers that there is some stagnation or corruption of the humours, and again advises laxatives. Meanwhile the poison takes firmer hold of the system; languor, wearisomeness and loathing of food continue; the nobler organs gradually become torpid, and the lungs in particular at length begin to suffer. In a word, the malady is from the first incurable; the unhappy victim pines away insensibly, even in the hands of his physician; and thus is he brought to a miserable end through months or years, according to his enemy’s desire.”[679] An equally vigorous and somewhat clearer account of the symptoms is given by Hahnemann. “They are,” says he, “a gradual sinking of the powers of life, without any violent symptom,—a nameless feeling of illness, failure of the strength, slight feverishness, want of sleep, lividity of the countenance, and an aversion to food and drink and all the other enjoyments of life. Dropsy closes the scene, along with black miliary eruptions, and convulsions, or colliquative perspiration and purging.”[680] Whatever were its real effects, there appears no doubt it was long used secretly in Italy to a fearful extent, the monster who has given her name to it having confessed that she was instrumental in the death of no less than six hundred persons. It has been already stated, however [p. 40], that she owed her success rather to the ignorance of the age than to her own dexterity. At all events, the art of secret poisoning cannot now be easily practised. Indeed even the vulgar dread of it is almost extinct. Partly on account of the improvement in general knowledge and chiefly in consequence of the subtility and precision, which the refinement of modern physic and chemistry have introduced into medico-legal inquiries, it is rare that the suspicious scrutiny of the world now “recognizes in the accounts of the last illness of popes and princes the effects of poison insidiously introduced into the body.”[681] I may add in conclusion, that I was consulted a few years ago on the part of the crown in a case which considerably resembled the effects ascribed in former times to the aqua Toffana, except that it was more acute in its character and swifter in its progress. As this case will probably be found to represent pretty nearly the usual effects of moderate doses frequently repeated, it is here given in some detail. A woman of indifferent character married a young man in circumstances which led to a breach between him and his relatives; but the pair appeared to live on good terms with one another. Eighteen months after the marriage she was attacked with sickness and faintness; and on the fourth day of this illness, while she was recovering, the symptoms unexpectedly increased, and she seemed very unwell. On the fifth day she became extremely weak, and suffered much from yellow vomiting. On the seventh, when she was first visited by a medical man, she had frequent vomiting, burning in the stomach, a yellow tongue, flushed countenance, hot skin, and hurried pulse. On the ninth the throat was sore and red, and the expression anxious; and next day the soreness was greater, affected the nose and mouth also, and was attended with excoriation of the lips and nostrils, swelling of the glands of the throat, dimness of sight, and great exhaustion. On the eleventh day, while previously again getting better, she became much worse, and suffered greatly from excessive vomiting, pain in the stomach, and an increase of the other symptoms. On the thirteenth she was very hoarse, and despaired of recovery. Next day she was occasionally incoherent, and had twitches of the facial muscles; the hands and face were swelled, the eyelids dingy, the conjunctivæ injected, and the nails blue. On the morning of the fifteenth there was for two hours violent delirium and fierce maniacal excitement, which were succeeded by coma, and this by death in the course of the evening. There was no diarrhœa, or urinary complaint, and no paralysis or eruption on the skin. A variety of circumstances of a general nature, which it would be out of place to enumerate here,—the detection of arsenic in various articles of which the woman had partaken, and in which the arsenic had been dissolved sometimes simply, sometimes with the aid of an alkali,—together with the fact, that the body five months after death was found preserved from decay, as it is now well known to be in most cases of arsenical poisoning,—left little doubt that the woman died of the effects of arsenic taken in several small doses at distant intervals, although none could be detected in the stomach or intestines. The case did not go to trial, owing to the death of an essential witness. The effects of arsenic on man, when introduced into the living body through other channels besides the stomach, will now require some observations. It is necessary for the medical jurist to be well acquainted with them, because there is hardly an accessible part of the human body to which this poison has not been applied either accidentally or by design. When some account was given of its comparative action on the different tissues of animals, it was observed that arsenic acts when applied to a wound or ulcer, to the peritonæal membrane, to the eye, and to the vagina. On man it has been known to act through an ulcer or wound, the inner membrane of the rectum, the membrane of the vagina, the membrane of the air-tubes, the membrane of the nose, and even the sound skin. Many persons have been poisoned by the application of arsenic to surfaces deprived of the cuticle, such as blistered surfaces, eruptions, ulcers, or wounds. When applied in this manner it commonly induces both local inflammation and constitutional symptoms. Amatus Lusitanus relates the case of a young man, who, against the advice of his physician, anointed an itchy eruption of the skin with an arsenical ointment, and next day was found dead in bed.[682] A similar case, not so rapidly fatal, has been recorded by Wepfer. A girl, affected with psoriasis of the scalp, had it rubbed with a liniment of butter and arsenic. In a short time she was seized with acute pain and swelling of the whole head, fainting-fits, restlessness, fever, delirium, and she died in six days.[683] Zitmann has noticed the cases of two children, eight and ten years of age, who were killed by the application of an arsenical solution to a similar eruption of the head.[684] And Belloc relates the case of a woman who, trying to cure an inveterate itch with an arsenical lotion, was attacked in consequence with severe erysipelas of the whole body, succeeded by tremors and gradual exhaustion of the vital powers, ending fatally in two years.[685] M. Errard of Injurieux in France lately met with two cases, where, in consequence of a freshly blistered surface being dressed with a cerate made with the stearine of arsenicated candles (see p. 256), local pain, nausea, pain in the stomach, urgent thirst, redness of the tongue, involuntary contractions of the muscles of the extremities, and weakness and irregularity of the pulse came on; and one person died within twenty-four hours, while the other recovered, chiefly because the dressing caused so much pain that the patient could not keep it on long.[686] Next as to ulcers; M. Roux has noticed the case of a girl, who was killed by the application of the arsenical paste to an ulcer of the breast, and in whom the constitutional symptoms were strongly marked, although the quantity of the poison must have been very small. The preparation used, which contains only a twenty-fourth of its weight of arsenic, was applied for a single night on a surface not exceeding an inch and a half in diameter. Yet she complained next day of violent colic and vomited frequently, the countenance soon became collapsed, and she died two days afterwards in great anguish.[687] Another instance of the like kind is related in the Annales d’Hygiène, where death arose from an arsenical ointment ignorantly applied for scirrhous breast over a large surface of the skin stripped of the cuticle by a blister. The particular symptoms and their duration are not stated; but there was violent irritation of the stomach.[688] Another fatal case, related by Dr. Küchler, arose from the application of Frêre Cosme’s powder to a soft fungoid tumour on the temple, which discharged serum usually and blood upon slight pressure. About a drachm and a half of arsenic mixed with fifteen grains of other powders was applied. Severe inflammation spread round the tumour next day; and soon afterwards, the patient was attacked with great difficulty of breathing, thirst, pains in the belly, and purging, then with difficulty in swallowing from swelling of the base of the tongue, delirium, cold sweating, and extreme debility; and death ensued in four days.[689] There is a singular uncertainty in the effects of arsenic when applied to ulcerated surfaces. Some persons, like Roux’s patient, are obviously affected by a single application; while others have had it applied for a long time without experiencing any other consequences than the formation of an eschar at the part. Two causes have been assigned for these differences, and probably both are founded on fact. One, which has been assigned by Mr. Blackadder, is the relative quantity of arsenic applied. He says he never witnessed but one instance of its acting constitutionally, although he often applied it to sores; and he imputes this success to his having always used a large quantity. For he considers that by so doing the organization of the part is quickly destroyed, and absorption prevented,—but that if the quantity be small, as in the mode practised by Roux, it will cause little local injury and readily enter the absorbing vessels.[690] Another unequivocal cause is pointed out by Harles in his treatise on arsenic. While treating of its therapeutic properties, and noticing the controversy that prevailed last century throughout Europe respecting the propriety of its outward application, he remarks that it may be applied with safety to the abraded skin, to common ulcers, to wounded surfaces, and to malignant glandular ulcers, even when highly irritable, provided the part be not recently wounded, so as to pour out blood.[691] The reason of this is obvious; the application of the poison to open-mouthed vessels is the next thing to its direct introduction into a vein. It is some confirmation of Harles’s opinion, that Roux, whose patient was so easily affected, recommends that before arsenic is applied to an ulcer, a fresh surface be made by paring away the granulations; and that Küchler’s patient had an ulcer which did not discharge pus, but serum, and was easily made to bleed. In the cases related above it will be remarked that the symptoms vary in their nature. Sometimes the chief disorder is inflammation, spreading over and around the eruption or ulcer, sometimes inflammation of the alimentary canal, sometimes an affection of the nervous system. In general the sufferings of the patient both from the local inflammation and constitutional symptoms are very severe. But this rule has its exceptions. In Pyl’s Memoirs there is the history of a child who died four days after an itchy eruption of the whole body had been washed with an arsenical solution, and signs of vivid inflammation were found after death in many parts; yet she appears to have complained only of headache.[692] Occasionally too, without exciting either inflammation of the part, or disorder of the stomach, or a general injury of the nervous system, it seems to give rise to partial palsy of the muscles adjoining the seat of its application. An extraordinary case is noticed in an American Journal, in which the prolonged use of an arsenical preparation for destroying a tumour on the right side of the neck, was followed by complete palsy of the muscles of the neck and arm of that side. In the next place, poisoning has been perpetrated by introducing arsenic into the fundament with an injection.[693] Foderé has noticed a case of this kind, which happened in France, and was communicated to him by a physician of Thoulouse. A lady under medical treatment for some trifling illness, died unexpectedly under symptoms of poisoning; and it was discovered that her servant, after unsuccessfully attempting to despatch her by dissolving arsenic in her soup, had ultimately succeeded by administering it repeatedly in injections.[694] There is no doubt that by this mode all the usual effects of arsenic may be induced; and on account of the facility with which the colon and rectum may be evacuated, it is not likely that the poison will be found in the gut after death, if the individual did not die in a few hours after its administration. In the third place, women have also died of poisoning by arsenic introduced into the vagina. Two examples of this revolting crime are on record. One of them occurred in 1799, in the Department of the Ourthe in France. A middle-aged female was seized with vomiting, diarrhœa, swelling of the genitals and uterine discharge; and she expired not long after. Before her death she told two of her neighbours, that her husband had some time before tried to poison her by putting arsenic in her coffee, and had at length succeeded by introducing a powder into her vagina while in the act of enjoying his nuptial rights. The vulva and vagina were gangrenous, the belly distended with gases, and the intestines inflamed.[695] The other case, which happened in Finland in 1786, gave rise to an excellent dissertation on the subject by Dr. Mangor, at that time medical inspector for Copenhagen. A farmer near Copenhagen lost his wife suddenly under suspicious circumstances, and six weeks afterwards married his maid-servant. In a few years he transferred his affections to another maid-servant, with whose aid he endeavoured to poison his second wife. For some time his attempts proved abortive; till at last one morning, after coïtion, he introduced a mixture of arsenic and flour on the point of his finger into the vagina. She took ill at mid-day and expired next morning; and the murderer soon after married his guilty paramour. But a few years had not elapsed before he got tired of her also; and one morning, after the conjugal embrace, he administered arsenic to her in the same way as to her predecessor. About three in the afternoon, while enjoying good health, she was suddenly seized with shivering and heat in the vagina. The remembrance of her former wickedness soon awoke the suspicions of the unhappy woman, and she wrung from her husband a confession of his crime. Means were resorted to for saving her life, but in vain: She was attacked with acute pain in her stomach and incessant vomiting, then became delirious, and died in twenty-one hours. After death grains of arsenic were found in the vagina, although frequent lotions had been used in the treatment. The labia were swollen and red, the vagina gaping and flaccid, the os uteri gangrenous, the duodenum inflamed, the stomach natural. In the course of the judicial proceedings which arose out of these two cases, Dr. Mangor made experiments on mares, with the view of settling the doubts which were entertained as to the likelihood of arsenic proving fatal in the manner alleged; and the results clearly showed that, when applied to the vagina of these animals, it produces violent local inflammation and fatal constitutional derangement.[696] In the fourth place, poisoning by arsenic through the bronchial membrane or membrane of the air-passages is a comparatively rare accident, which can take place only in consequence of arsenical gases or vapours being incautiously breathed. The effects of oxide of arsenic when introduced in this way are described from personal experience by Otto Tachenius, a chemist of the sixteenth century. “Once,” said he, “when I happened to breathe incautiously the fumes of arsenic, I was surprised to find my palate impressed with a sweet, mild, grateful taste, such as I never experienced before. But in half an hour I was attacked with pain and tightness in the stomach, then with general convulsions, difficult breathing, an unspeakable sense of heat, bloody and painful micturition, and finally with such an acute colic as contracted my whole body for half an hour.” By the use of oleaginous drinks he recovered from these alarming symptoms; but during all the succeeding winter he had a low hectic fever.[697] Balthazar Timæus relates a similar case which came under his notice. An apothecary of Colberg, while subliming arsenic, had not been careful enough to avoid the fumes; and was soon after seized with frequent fainting, tightness in the præcordia, difficult breathing, inextinguishable thirst, parched throat, great restlessness, watching, and pains in the feet. He had afterwards profuse daily perspiration and palsy of the legs; and several months elapsed before he got entirely well.[698] The same author says that the famous Paracelsus, being one day put out of temper by an acquaintance, made him hold his nose over an alembic in which arsenic was subliming; and that the object of this severe joke nearly lost his life in consequence. Wibmer quotes the heads of several cases where swelling of the tongue, headache and giddiness, nausea, and an oppressive sense of constriction in the throat, were occasioned by the incautious inhalation of arsenical fumes.[699] The following extraordinary case, closely allied to malignant cholera in its early stage, has been ascribed by the reporter Dr. Welper of Berlin to the inspiration of arsenical fumes,—with what probability I am not prepared to say. A stout healthy man, who in the forenoon had freely and for some time exposed himself to the steam from a vessel where he was boiling several ounces of orpiment in water, was attacked at night with sickness, and next morning with extreme weakness and some difficulty of breathing. These symptoms were greatly relieved by an emetic. But towards evening the extremities became ice-cold and very stiff, the breathing much oppressed, the pulse very hurried, and imperceptible except in the neck, the mouth and throat dry, and the tongue rigid; but the mind remained clear, though anxious and afraid of impending dissolution. His state of collapse was removed in twelve hours by fomentations, and in no long time he recovered entirely except from the dyspnœa, which continued more or less till a few years afterwards, when he died of hydrothorax.[700] The slighter effects of arsenic are said to have been repeatedly observed of late in this country from inhaling the products of the combustion of arsenicated candles,—an article of recent invention, in which arsenic, to the extent of three or four grains and a half in each candle, is introduced for the purpose of hardening the stearine chiefly used in manufacturing them. It is unnecessary to say, that such candles are prejudicial and ought to be prohibited. In a set of experiments made to try their effects by Messrs. Everitt, Bird, and Phillips in 1838, birds were killed in no long time, and small quadrupeds were severely affected, when kept in an apartment lighted with them.[701] Analogous to the effects of inhaling oxide of arsenic are those lately observed from the incautious inhalation of arseniuretted-hydrogen gas. Gehlen the chemist died of this accident, but no particular account has been published of the symptoms he suffered. Two cases, however, have been detailed within a few years. In one of these, which has been related by Dr. Schlinder, of Greifenberg, the individual inhaled in forty minutes about half a cubic inch of the gas, which is equivalent to about an eighth of a grain of arsenic. In three hours he became affected with giddiness, and soon afterwards with an uneasy sense of pressure in the region of the kidney, passing gradually into acute pain there and upwards along the back. General shivering ensued, with coldness of the extremities, and gouty-like pains in the knees, shoulders, and elbows. The hands and lower half of the fore-arms, the feet and legs nearly to the knees, the nose and region of the eyebrows, felt as if quite dead, but without any diminution of muscular power. There was also acute pain in the stomach and belly generally, painful eructation of gas, and occasional vomiting of bitter, greenish-yellow mucus. The most tormenting symptom, however, was the pain in the kidneys, which soon became attended with constant desire to pass water, and the discharge of deep reddish-brown urine, mixed with clots of blood. The whole expression of the countenance was altered, the skin becoming dark brown, and the eyeballs sunk, yellow, and surrounded by a broad livid ring. Warm drink brought out a copious sweat and removed the sense of numbness; but next day there was little change otherwise in the symptoms, except that the urine was no longer mixed with clots, and that the hair on the benumbed parts had become white. On the third day the pains had abated, and the urine became clear; but there was hiccup, an excited state of the mind, and a feeling as if a great stone lay in the lower belly. In seven days he was much better. In the third week the whole glans and prepuce became covered with little pustules which were followed by small ulcers. It was not till the close of the seventh week that he recovered completely.[702] Dr. O’Reilly has related the following case, which arose from the inhalation of hydrogen gas impregnated with arseniuretted-hydrogen in consequence of the sulphuric acid used for dissolving zinc having contained arsenic. Mr. Brittan, a Dublin chemist, wishing to ascertain the effects of hydrogen on the body, proceeded to inhale 150 cubic inches of it. Immediately after the second inhalation, he was seized with confusion, faintness, giddiness and shivering, and passed a stool, as well as two ounces of bloody urine, but without any pain. Pain in the limbs followed, and in two hours frequent vomiting and dull pain in the stomach. The pulse at this time was 90, the skin cold, and the voice feeble. Ammonia, laudanum, and emollient clysters gave him little relief. During the subsequent night there was frequent vomiting and no urine; the face became copper-coloured, and the rest of the body greenish; there was tenderness of the epigastrium and hiccup; but he was free of fever. On the third day there was diarrhœa and still no urine; but the jaundice had disappeared. On the fourth the breath was ammoniacal, and somnolency had set in. On the fifth the skin became again deeply jaundiced, and the face was œdematous; no urine had yet been discharged, and the bladder, examined with the catheter, was found empty. On the evening of the seventh day he expired. On examination of the body, two pints of red serum were found in the pleural cavities; the lungs were sound, the heart pale and flaccid, the liver indigo-blue, the gall-bladder distended with bile, the kidneys also indigo-blue, the stomach empty, and its villous coat brittle, with here and there inflamed-like spots on it, the bladder empty, the brain bloodless, the cellular tissue generally anasarcous. Arsenic was detected in the pleural serum. By an approximate calculation it was supposed that the hydrogen this gentleman inhaled had contained the equivalent arsenic of twelve grains of the oxide.[703] It would appear that arsenic acts with great rapidity and force when respired in any form. Poisoning through the lining membrane of the nostrils is a still rarer accident than that last mentioned. There is a distinct example of it in the German Ephemerides, which arose from an arsenical solution having been used by mistake as a lotion for a chronic discharge from the nostrils. The individual was attacked with a profuse discharge from the nostrils, and then with stupor approaching to coma. Weakness of sight and of memory continued after sensibility returned; and he died two years afterwards, death having been preceded for some time by convulsions.[704] Arsenic when applied to the sound skin of animals does not easily affect them. The experiments of Jaeger formerly noticed prove that no effect is produced, if the poison is simply placed in contact with the skin. Nay even when rubbed into it with fatty matters it does not operate with energy; for in that case, according to the experiments of Renault, it causes sometimes a pustular eruption, sometimes an eschar, but never any constitutional disorder.[705] It is more energetic, however, when applied to the more delicate skin of the human subject. Some experiments were made by Mr. Sherwen on himself with the view of proving this;[706] but they are not satisfactory. The following facts, however, will show that it may produce through the sound skin all the ordinary signs of poisoning. Desgranges, a good authority, relates the case of a woman who anointed her head with an arsenical ointment to kill lice, and, after using it several days, was attacked with erysipelas of the head and face, attended with ulceration of the scalp, swelling of the salivary and cervical glands, and inflammation of the eyes. There were likewise violent constitutional symptoms,—much fever, fainting, giddiness, vomiting and pain in the stomach, tenesmus, and ardor urinæ, tremors of the limbs, and even occasional delirium. Afterwards the whole body became covered with an eruption of white papulæ, which dried and dropt off in forty-eight hours. She recovered gradually; but appears to have made a narrow escape. Her hair fell out during convalescence.[707] A similar instance is recorded in the Acta Germanica for 1730. A schoolboy having found in the street a parcel of arsenic, his mother mistook it for hair powder; and as he had to deliver a valedictory speech at school next day, she advised him to powder himself well with it in the morning. This he accordingly did. In the middle of his speech he was attacked with acute pain of the face; and a fertile crop of pustules soon broke out upon it. The head afterwards swelled much, and the pustules spread all around it; he was tormented with intolerable heat in the scalp; and the hair became matted with the discharge into a thick scabby crust. This crust separated in a few weeks, and he soon recovered completely.[708] Schulze, a German physician, has related no fewer than five cases of the same description, all arising from arsenic having been mistaken for hair powder; and one of them proved fatal. Two of the cases were slight. The other persons had the same violent inflammation of the head as Desgranges’s patient and the German schoolboy. In the fatal case death took place in twenty-one days; and on dissection, besides other morbid appearances, the scalp was found gangrenous and infiltered with fluid blood, and the stomach much inflamed.[709] The two survivors, who were severely ill, it is well to add, were not attacked with the erysipelas of the scalp till six days after they powdered themselves. Sproegel mentions a fatal case from fly-powder having been applied in like manner to the head; and Wibmer quotes another, but not fatal, where from the same cause great swelling of the head and face arose, followed by erysipelas of the face, neck, and belly, and a papular eruption on the hands which continued five days.[710] From the statements now made, it is evident that arsenic applied to various parts of the external surface and natural apertures of the body, will prove poisonous, and will often act with a certainty and rapidity not surpassed by its effects when taken internally. Many of the cases furnish a striking confirmation of a circumstance formerly noticed with respect to its action,—namely, that it produces signs of irritation in the stomach, in whatever manner it is introduced into the body. In some instances, indeed, the signs of inflammation in the stomach were quite as distinct as in the cases previously described, where the poison was taken internally. The subject of the symptoms caused by arsenic will now be concluded with a few remarks on the strength of the evidence which they supply. The present doctrine of toxicologists and medical jurists seems generally to be, that symptoms alone can never supply decisive proof of the administration of arsenic. This opinion is certainly quite correct when applied to what may be called a common case of poisoning with arsenic, the symptoms of which are little else than burning pain in the stomach and bowels, vomiting and purging, feeble circulation, excessive debility, and speedy death. All these symptoms may be caused by natural disease, more particularly by cholera; and consequently every sound medical jurist will join in condemning unreservedly the practice which prevailed last century of deciding questions of poisoning in such circumstances from symptoms alone. But modern authors appear to have overstepped the mark, when they hold that the rule against deciding from symptoms does not admit of any exceptions. For there are cases of poisoning with arsenic, not numerous certainly, yet not very uncommon neither, which can hardly be confounded with natural disease; and, what is of some consequence, they are precisely those in which the power of deciding from symptoms alone is most required, because chemical evidence is almost always wanting. Either the peculiar combination of the symptoms is such as cannot arise from natural causes, so far at least as physicians are acquainted with them: or these symptoms occur under collateral circumstances, which put natural causes almost or altogether out of the question. Thus, let the medical jurist consider in the first place, the symptoms occasionally observed in those who survive five, six or ten days; let him exclude for the present the secondary nervous affections; and instead of a compounded description, which may be objected to as apt to convey a false and exaggerated idea of the facts, let him take an actual example. In a paper by Dr. Bachmann on some cases of poisoning with arsenic, there is a minute account of the case of a lady who was poisoned by her maid with fly-powder and white arsenic, and whose symptoms were those of universal inflammation of the mucous membranes. After suffering two days from retching and vomiting, colic pains and purging, these symptoms suddenly became more violent, and attended with oppressed breathing and hoarseness so that she could hardly make herself be heard,—with vesicles on the palate, burning pain in the throat, and excessive difficulty in swallowing,—with spasm and pain of the bladder in passing water,—and with extreme feebleness of the pulse. Three days afterwards the symptoms increased still more. She complained of intolerable burning and spasms of the throat, which, as well as the mouth, was excessively inflamed,—of violent burning pain in the stomach and bowels,—of burning in the fundament and genitals, both of which were inflamed even to gangrene,—of indescribable anxiety and anguish about the heart; and she died the following day, death being preceded by subsultus, delirium, and insensibility.[711] Or take the case in the trial of Miss Blandy. On two successive evenings, immediately after taking some gruel which had been prepared by the prisoner, Mr. Blandy was attacked with pricking and burning of the tongue, throat, stomach, and bowels, and with vomiting and purging. Five days after, when the symptoms were fully formed, he had inflamed pimples round the lips, and a sense of burning in the mouth; the nostrils were similarly affected; the eyes were bloodshot and affected with burning pain; the tongue was swollen, the throat red and excoriated, and in both there was a tormenting sense of burning; he had likewise swelling, with pricking and burning pain of the belly; excoriations and ulcers around the anus and intolerable burning there; vomiting and bloody diarrhœa; a low, tremulous pulse, laborious respiration, and great difficulty in speaking and swallowing. In this state he lingered several days, death supervening nine days after the first suspected basin of gruel was taken.[712] Can the symptoms, in these two cases, attacking, as they did, at one and the same time, the whole mucous membranes, be imitated by any natural combination of symptoms? Viewing the endless variety and wonderful complexity of the phenomena of disease, the practitioner will probably, and with justice, reply that a natural combination of the kind is possible. But if his attention is confined, as in strictures it ought to real occurrences,—if he is required to speak only from actual experience, personal or derived, it is exceedingly questionable whether any one could say he had ever seen or read of such a case. At all events, if a medical witness had to give his opinion from symptoms only in such a case as that of Mr. Blandy, or that described by Bachmann, he would certainly be justified in declaring that poisoning was highly probable; and, admitting general poisoning to be proved, he would, it is likely, fix on arsenic as the substance which could most easily produce the effects. Let him next, however, take also into consideration the nervous affections that sometimes either immediately follow the inflammation of the mucous membranes, or become united with it when it has existed a few days; and confining his attention still to actual occurrences, let him reflect on the symptoms in Dr. Roget’s case, in which there was first violent inflammation of the whole alimentary canal, and then regular and obstinate epilepsy (p. 245), or on those in Dehaen’s patient, in whom the nervous disorder was partial palsy (p. 247). On reconsidering these narratives, still greater reason will appear for doubting whether such a combination of simultaneous, and in the present instance also consecutive symptoms, ever arise from natural causes. It is difficult to conceive a fortuitous concurrence of natural diseases producing at the same moment that variety and complexity of disorder which occur in the primary stage of the cases alluded to; and it would surely be a still more extraordinary combination which should farther add the supervention of epilepsy or partial palsy from a natural cause, at the exact period at which it appears as the secondary stage of poisoning with arsenic. All that any practitioner could say is, that a concurrence of the kind is within the bounds of possibility. He must be compelled to admit that it is in the highest degree improbable, and likewise that it could hardly take place from natural causes without the real causes of the symptoms being clearly indicated. But to conclude, there are likewise collateral circumstances connected with the symptoms, which, taken along with the symptoms themselves, will sometimes place the fact of poisoning with arsenic beyond the reach of a doubt. Thus, if a person were taken several times ill with symptoms of general inflammation of the mucous membranes, after partaking each time of a suspected article of food or drink, the proof of the administration of arsenic would be very strong indeed; and it would be unimpeachable if at length a nervous affection succeeded at the usual period. Or above all, suppose several persons, who have partaken of the same dish, are seized about the same time with nearly the same symptoms of irritation of the mucous membranes. The proof of general poisoning would then be unequivocal. And if one or more of them should afterwards suffer from a nervous disorder, little hesitation ought to be felt in declaring that arsenic is the only poison which could have caused their complaints. These views are of more practical consequence than may at first sight be thought. The doctrine which has been here espoused might have been applied to decide two criminal cases which at the time made a great noise in this country. One was the case of Eliza Fenning (p. 245). Here five persons were simultaneously attacked with symptoms, more or less violent, of inflammation of the whole alimentary canal; and in two of them epileptic convulsions appeared before the inflammatory symptoms departed. The other was the case of George Thom (p. 247). Here four persons were at one and the same time seized with the primary symptoms in an aggravated form; and in two of them, as these symptoms abated, obstinate partial palsy came on. On both trials, then, it might have been stated from the symptoms alone that poison had been given, and that arsenic was the only poison hitherto known to be capable of producing such effects. In applying this doctrine to parallel instances two precautions must be attended to. On the one hand, care must be taken to ascertain, as may always be done, that the simultaneous symptoms of general irritation in the alimentary canal, arising soon after a meal, are not owing to unsound meat having been used in preparing it. And on the other hand, which is of more consequence, the symptoms on which so important an opinion is founded, must be strongly marked and well ascertained by a competent person. The signs of irritation in the mucous membranes must be really general and unequivocal; and those of a disorder of the nervous system must be likewise developed characteristically. Care must be taken in particular to distinguish symptoms of the latter class from others which approach to them in nature, and are the ordinary sequels of natural disease: for example, the true palsy caused by arsenic must not be confounded with the numbness and racking pains in the limbs, which occasionally succeed cholera. With these precautions the evidence from symptoms may in certain cases be decisive of the question of poisoning with arsenic. And it is of moment to observe, as has been already hinted, that, although such cases are numerous, they are precisely of the kind in which it is most essential to the ends of justice that the symptoms should, if possible, supply evidence enough to direct the judgment; for the characteristic symptoms referred to occur chiefly when the patient either recovers or survives many days, and where consequently the chemical evidence, usually procured from the examination of the contents of the stomach, is almost always wanting. SECTION III.—_Of the Morbid Appearances caused by Arsenic._ The morbid appearances caused by arsenic will next require some details. In treating of them the same plan will be pursued as in the preceding section: the various morbid appearances left by it will first be mentioned in their order; and the subject will then be wound up with some remarks on the force of the evidence from these appearances, as they are usually combined in actual cases. In the first instance, there are some cases in which little or no morbid appearance is to be seen at all. These all belong to the second variety of poisoning, which is characterized by the absence of local inflammation, and the presence of symptoms indicating an action on the heart, or some other remote organ. In such circumstances death takes place before a sufficient interval has elapsed for inflammation to be developed. Several examples of the absence of diseased appearances in the dead body are to be found in authors. Thus in Chaussier’s case formerly quoted (p. 243), in that related by Metzger (p. 242), in another related by Etmuller, which was fatal in twelve hours,[713] and in a fourth related by Professor Wagner of Berlin, where life was also prolonged for twelve hours under incessant vomiting,[714] there was positively no morbid alteration at all. Such was also the state of the whole alimentary canal in the extraordinary case related by Orfila (p. 243). In the case quoted from the Medical and Physical Journal (p. 242), there was merely a slight redness at the pyloric end of the stomach. In the case of the American grocer too, there was only a little redness. In Mr. Wright’s case (p. 243), there was scarcely any morbid appearance,—nothing more than two small vascular spots and a minute ecchymosis. In that which fell under my own notice (p. 242), the villous coat of the stomach was of natural firmness, and had an exceedingly faint mottled-cherry-red tint, barely perceptible in a strong light; and the rest of the alimentary canal, as well as the body generally, was quite healthy. Although in these examples the morbid appearances were trifling or undistinguishable, it must not be supposed that the same happens in all cases of rapid death from arsenic. In Gérard’s case, where the usual irritant symptoms were wanting, and which proved fatal in five hours, there was dark redness of the whole villous coat of the stomach. In Mr. Holland’s case, fatal in eight or nine hours (p. 243), the stomach was of an intense purple colour at its pyloric end, and contained bloody mucus; and the mucous coat of the cœcum presented extensive softening and congestion. Mr. Alfred Taylor refers to three cases observed by Mr. Forster of Huntingdon, in which the mucous coat of the stomach was highly inflamed, though death took place in 6½, 3½, and 2 hours only:[715] in Mr. Hewson’s case, fatal in five hours, the whole stomach was exceedingly vascular, and presented both spots of extravasation, and several small erosions (p. 201). In a case alluded to at p. 239 as having fallen under my own observation, and which was also fatal in five hours, the whole villous coat of the stomach was intensely red, except where the folds of the rugæ protected it from contact with the poison; and the prominences of the rugæ presented corroded spots of ecchymosis. In Dr. Dymock’s case, fatal in two hours and a half, the stomach, which I had an opportunity of examining, presented on its mucous coat many scarlet patches, and here and there a purplish appearance (p. 240). Lastly, an instance is related by Pyl of this poison proving fatal in three hours, and leaving nevertheless in the dead body distinct signs of inflammation in the stomach.[716] In the ordinary cases in which death is delayed till the second day or later, a considerable variety of diseased appearances has been observed. They are the different changes of structure arising from inflammation in the alimentary canal, in the organs of the chest, and in the organs of generation—together with certain alterations in the state of the blood and condition of the body generally. The first set of appearances to be mentioned are those indicating inflammation of the alimentary canal, viz., redness of the throat and gullet,—redness of the villous and peritonæal coats of the stomach, blackness of its villous coat from extravasation of blood into it, softening of the villous coat, ulceration of that as well as of the other coats, effusion of coagulable lymph on the inner surface of the stomach, extravasation of blood among its contents,—finally, redness and ulceration of the duodenum and other parts of the intestinal canal, and more particularly of the rectum; to which may also be added, though not properly a morbid phenomenon, certain appearances put on by the arsenic which remains undischarged. Redness of the throat and gullet is not common, at least it does not often occur in the descriptions of cases. Jaeger, however, says that in his experiments he usually found redness at the upper and purplish stripes at the lower end of the gullet:[717] and Dr. Campbell likewise found the gullet red in animals,[718] Similar appearances have also been remarked in man. In the case of a man who lived eight days, Dr. Murray found the gullet very red;[719] in that of a woman who lived scarce seven hours, Dr. Booth observed the gullet inflamed downwards very nearly to the cardia;[720] and Wildberg has reported two cases of the same nature, in one of which it is worthy of remark that the poisoning lasted only six hours.[721] On the whole, it appears probable that inflammation of the throat and gullet would be found more frequently in the reports of cases, if it was more carefully looked for. Redness of the inner coat of the stomach is a pretty constant effect of arsenic, when the case is not very rapid. All the varieties of redness, formerly mentioned among the effects of the irritant poisons generally, may be produced by arsenic. There is nothing, however, in the redness caused by this poison, any more than in the redness of inflammation generally, by which it is to be distinguished from the pseudo-morbid varieties. (See p. 110.) It is singular, that, however severe the inflammation of the inner membrane of the stomach may be, inflammatory redness of the peritonæal coat is seldom found. Yet inflammatory vascularity does occur sometimes on the peritonæal coat. Sproegel found it in animals;[722] and it was present in the case of the girl Warden, whose death gave rise to the trial of Mrs. Smith.[723] Dr. Nissen, a Danish physician, has related another case in which the external coat of the stomach appeared as if minutely injected with wax. But the patient had been attacked with incarcerated hernia during the progress of his illness, and the whole peritonæal membrane was in consequence inflamed.[724] A common appearance when the internal inflammation is well marked, and one often unwarily put down as inflammation of the peritonæum, is turgescence of the external veins, sometimes so great as to make the stomach look livid. Blackness of the villous coat from effusion of altered blood into its texture is sometimes met with. When the colour is brownish-black, or grayish-black, not merely reddish-black, when the inner membrane is elevated into firm knots or ridges by the effusion, and the black spots are surrounded by vascularity or other signs of reaction, the appearances strongly indicate violent irritation. I have already said that such appearances are never imitated by any pseudo-morbid phenomenon. One of the most remarkable appearances occasionally observed in the stomach in those instances where the body has been buried for at least some weeks before examination, is the presence of bright yellow patches, of various sizes, which appear as if painted with gamboge, and obviously arise from the oxide of arsenic diffused throughout the tissues having been decomposed and converted into sulphuret of arsenic by the sulphuretted-hydrogen disengaged during putrefaction. I have witnessed this appearance in several cases. In the case mentioned at p. 247, where the body had been buried twenty days, numerous brilliant yellow patches were visible on the villous coat of the stomach. In the case of a female who was poisoned about the same time with that man, and, as was suspected, by the same individual, the body was not examined till three months after interment; and here broad, bright, yellow patches, disappearing under the action of ammonia, were found under the peritonæal coat of the left end of the stomach, the adjoining great intestine, and also the muscular parietes of the abdomen. In the case of Mr. Gilmour, for whose murder his wife was tried a few months ago in this city, but acquitted,—and who undoubtedly died of poisoning with arsenic, howsoever administered,—there were found fourteen weeks after death numerous yellow streaks and patches both on the inner surface of the stomach, on its outer surface under the peritonæum, on the adjoining transverse colon, and on the small intestines in contact with the stomach. From these and other parallel facts which have been occasionally noticed by the periodical press, it seems probable that the appearance in question is common in bodies which have been some time buried. It is an extremely important part of the pathological evidence. I doubt whether natural causes can occasion any appearance similar to it. And indeed, what is it but the effect of a chemical test applied to the poison by nature? The next appearance which may be mentioned is unnatural softness of the villous coat of the stomach. This coat has certainly been often found, after death from arsenic, unusually soft, brittle, and easily separable with the nail.[725] But the same state occurs in dead bodies so often and so unconnected with previous symptoms of irritation in the stomach, that it cannot with any certainty be assumed as the effect of irritation when it is found subsequently to such symptoms. So far from softening and brittleness being a necessary effect of the irritation produced by arsenic, it is a fact that a condition precisely the reverse has been also noticed. In a case which I examined, the villous coat, except where it had been disintegrated by effused blood and ulceration, was strong and firm; and the rugæ were thickened, raised and corrugated, as if seared with a hot iron.[726] Metzger once found the mucous membrane dense, thickened, and the rugæ like thick cords.[727] Pyl too once met with the same appearance, and ascribes the thickening to gorging of vessels;[728] and in a case related by Dr. Wood of Dumfries, where I had an opportunity of examining the stomach, this appearance was present in a remarkable degree, and it clearly arose from elevation of the villous coat by effusion of blood under it.[729] Remer, in his edition of Metzger’s Medical Jurisprudence, says he once met with an instance where the stomach was shrivelled like a bladder subjected to boiling water.[730] Sometimes the villous and also more rarely the other coats of the stomach are found actually destroyed and removed in scattered spots and patches. This loss of substance is occasionally owing to the same action which causes softening and brittleness of the villous coat,—the action, however, having been so intense as to cause gelatinization. That such is the nature of the process appears from the breach in the membrane being surrounded by gelatinized tissue, and not by an areola of inflammatory redness. Of this species of destruction of the coats I have seen a characteristic example.[731] But in other cases the loss of substance is owing to a process of ordinary ulceration, as is proved by the little cavities having a notched irregular shape, and being surrounded both by a red areola and a margin of firm tissue. This was the character of the ulcers in the case of Warden, which I have described elsewhere.[732] Destruction of the coats of the stomach by ulceration is not a very common consequence of poisoning with arsenic, as death frequently takes place before that process can be established. It does not often occur, unless the patient survive nearly two days. Mr. Alfred Taylor, however, mentions a case fatal in seventeen hours where he found ulceration of the stomach, and another fatal in ten hours where several small ulcers were seen on the lesser curvature, and two nearly circular ones as big as a sixpence.[733] Mr. Hewson too informs me he found many eroded spots even in his case which proved fatal in five hours (p. 56). I suspect, however, that spots of healthy membrane surrounded by vascular redness are sometimes mistaken for ulcers in such cases; for indeed nothing can more exactly resemble them. In many general works on Medical Jurisprudence, and in some express treatises on arsenic, it is stated that this poison may cause complete perforation of the stomach.[734] But this effect is exceedingly rare. I have related one distinct example of it;[735] Professor Foderé has briefly alluded to a case he witnessed which proved fatal in two days and a half;[736] I have likewise found in an account of a trial in North America, an instance in which the stomach was perforated by numerous small holes, so that when held before the light it appeared as if riddled like a sieve;[737] but I have not been able to find in medical authors any farther authority for the general statement. Destruction of the coats of the stomach as produced by arsenic has been variously described by authors under the terms erosion, corrosion, dissolution, ulceration. But the correct mode of describing it appears to be by the terms gelatinization, or ulceration, according to the nature of the diseased action by which it is induced. At all events it is necessary to beware of being misled by the terms erosion, corrosion, and the like, which all convey the idea of a chemical action; while it is well ascertained that a chemical action either does not exist at all between arsenic and the animal tissues, or, if it has existence, tends to harden and condense rather than to dissolve or corrode them. Arsenic is not a corrosive. Another species of destruction of the coats of the stomach, which will require a little notice, is sloughing or gangrene. This appearance occurs frequently in the narratives of the older writers; but it has not been enumerated in the list of morbid appearances at the commencement of this section, because its existence as one of the effects of arsenic is problematical. It has not been witnessed so far as I know by any recent good authority. Those who have mentioned it have probably been misled by the appearance put on by the black extravasated patches, when they are accompanied by disintegration of the villous coat and effusion of clots of black blood on its surface—an appearance which resembles gangrene closely in everything but the fetor. Sir B. Brodie has stated that Mr. John Hunter has preserved in his museum, as an example of a slough of the villous coat caused by arsenic, which turned out on examination to be nothing else than an adhering clot.[738] It is clear too, that, when Mr. James speaks of having found “several gangrenous patches” on the villous coat of the stomach, and “patches of sphacelus” in the intestines, on examining the body of a notorious French criminal, Soufflard, who poisoned himself with arsenic in prison in 1839, he mistook for gangrene what was merely extravasation; for the man lived only twelve hours.[739] Various secretions have been found on the inner surface of the stomach. The mucous secretion of the inner membrane is generally increased in quantity. Frequently it is thin, but viscid, as in its natural state; but sometimes it is both abundant and solid, as if coagulated; and then it forms either a uniform attached pellicle, or loose shreds floating among the contents.[740] In both forms it has been mistaken for the mucous membrane itself. I believe this increased secretion and preternatural firmness of the gastric mucus cannot take place without some irritating agent being applied to the stomach. Both may occur without any other sign of inflammation in the mucous membrane. In a case of suicide after seduction which came under my notice in this city in 1843, and which proved fatal in five hours [p. 239], the mucus in the stomach, which was very abundant, put on the appearance of curdled milk, owing to its being rendered opaque and white by the large quantity of finely powdered arsenic diffused through it; and it was actually mistaken for curdled milk by several medical men.—Sometimes the matter effused is true coagulable lymph. This is rarely seen as the effect of arsenic. I have remarked it, however, very distinctly in dogs, and Dr. Baillie saw it once in the human subject.[741] It is of course quite decisive of the presence of inflammation. It is known from tough mucus, to which it bears some resemblance, by its reticulated disposition, and by the threads of the reticulation corresponding with inflamed lines on the stomach beneath. Another very common appearance is the presence of a sanguinolent fluid, or even actual blood in the cavity of the stomach. In several of the cases which have come under my own notice, the subject of analysis was a thick, dirty brownish-red fluid, evidently containing a large proportion of blood; and many other examples of the same nature are on record.[742] In Laborde’s case formerly mentioned actual clots were found among the contents; in the instance of a woman who died in five days, as related by Zittmann, half a pound of coagulated blood was found in the stomach;[743] and in another case mentioned by Professor Bernt, the stomach contained no less than three pounds of black ichor mixed with clots of blood.[744] A good deal of reliance has been placed on bloody effusion in proof of the administration of arsenic or some other active irritant. It is of some importance, as it appears not to be an effect of that irritation which causes cholera. Among the appearances observed in the stomach the presence of arsenic may be included, though not properly speaking a morbid appearance. Under the head of the medical evidence of poisoning generally it was stated, that many causes conspire to remove from the stomach during life poisons which have actually caused death. In addition to the illustrative cases there alluded to, I may here also refer to an interesting case communicated to me by Mr. J. H. Stallard, and already noticed for a different purpose [p. 235]. Arsenic in no large quantity had been swallowed in tea, and death took place in four hours only. Here none of the poison could be detected by Marsh’s process, either in the contents of the stomach, or in its tissues, or in the liver.—In the instance of arsenic, however, the operation of the causes which tend to remove the poison is prevented by various circumstances, in particular by its insolubility and firm adhesion to the stomach. Hence it happens, that even after long-continued vomiting a portion still generally remains behind, either in the contents of the stomach or in its tissues. Sometimes the arsenic exists dissolved in the contents; more commonly it is present there in the solid form; and is then either in loose particles, or enveloped in coagulated mucus,[745] or in little clots of blood,[746] or is wrapped up in the more solid parts of the contents.[747] Frequently it adheres to the coats of the stomach, and is then either scattered in the form of fine dust or collected in little knots. The adhering particles are always covered by mucus; they are often surrounded by redness of the membrane or by effused blood; and sometimes they are imbedded in little ulcers.—A remarkable appearance which the arsenic sometimes puts on is a brilliant yellowness of its surface, owing to its conversion into the sulphuret. This appearance existed in six cases which have come under my own notice, first in one related in the Edinburgh Medico-Chirurgical Transactions,[748] next in the instance of Margaret Warden,[749] again in the case of a young woman whose death gave rise to the trial of John Lovie held at Aberdeen in the Autumn Circuit of 1827, again in a case described by Dr. Wood, which I had an opportunity of examining;[750] and lastly, in two others which I had occasion to examine in 1842 and 1843. In one of these, the case of Mr. Gilmour, adverted to at p. 265, Drs. Wylie and M’Kinlay, who examined the body in the country, found the inner surface of the stomach thickly sprinkled with small yellow particles, some of which were very bright. In all of these cases oxide was found, as well as the sulphuret of arsenic. In the case related by Dr. Nissen [p. 264], a similar yellow appearance, observed on the surface of the arsenic, was ascribed with justice to the action of sulphuretted hydrogen-water, which had been given as an antidote during life.[751] In a very important case examined here a few years ago by my colleague Dr. Traill, and which will be noticed more particularly for a different purpose afterwards, this conversion of the oxide into sulphuret had taken place to a great extent [p. 277]. In every instance of the kind yet examined, however, the conversion has been only partial, so that a large proportion of oxide could easily be detected by the usual process. Care must be taken not hastily to consider as arsenic every white powder which may be found lining the inside of the stomach. Many other white powders may obtain entrance from without; and besides, small, white, shining, pulverulent scales, not unlike finely powdered arsenic, but rarely composed of animal matter, sometimes form naturally on the mucous coat of the stomach and intestines. In a medico-legal report published a few years ago, Professor Orfila has noticed two instances in which these scales were mistaken for arsenic;[752] in another published not long after he mentions that he found white particles which crackled when bruised, and appeared brilliant before the microscope, and which nevertheless were not arsenic.[753] Buchner too says he is acquainted with an instance where, in a medical inspection on account of a suspicion of poisoning, the villous coat of the stomach was found lined with a white granular substance which presented the properties of a fat and contained no mineral admixture;[754] and in the case of Warden I remarked a similar appearance, which, as arsenic was found in the stomach, I was disposed to consider a sprinkling of that poison, until the contrary was ascertained by analysis. The present caution, therefore, is not superfluous. In a few cases the stomach is the only situation where morbid appearances are visible, even though life has been prolonged for so much as two days. This state of matters is well exemplified by a French case of death in forty-three hours, where the stomach presented much redness and extravasated patches, but where the intestines, the larynx and the contents of the head and chest were in a natural condition.[755] Such limitation, however, of the diseased appearances are rare. Redness of the mucous membrane of the intestines is often present when the stomach is much inflamed. Dissolution of the mucous coat is much less frequent in the intestines than in the stomach. Ulceration occasionally occurs in lingering cases. In the case of Mitchell, which has been several times alluded to, the inner coat of the duodenum was dark-red, pulpy, thickened, easily separable; and on a spot as big as a crown piece, both the inner and the muscular coats were wanting.[756] Perforation of the small intestine was found in a case communicated to me by Mr. Sandell, and detailed at page 277. But as the person survived only eight hours, and had laboured under symptoms of disease in the bowels for some days before taking the arsenic, it is unlikely that this appearance, which has not been observed, to my knowledge, in any other instance, arose from the action of the poison. The signs of inflammation are seldom distinct in the small intestines much lower down than the extremity of the duodenum; and they do not often affect the colon. But the rectum is sometimes much inflamed, though the colon, and more particularly the small intestines, are not. Dr. Male mentions, that in man he has found the rectum abraded, ulcerated, and even redder than the stomach itself;[757] and Dr. Baillie also notices two cases in which the lower end of the rectum was ulcerated.[758] A common appearance in lingering cases is excoriation of the anus,[759] and it is said that even gangrene has been produced.[760] A late writer draws attention to the fact that in the only two fatal cases he had seen the whole colon was contracted to an extraordinary degree;[761] and this state is mentioned in other cases. The appearance deserves notice; but of course whatever empties the colon thoroughly will have the same effect. The chief appearances in the alimentary canal have now been mentioned. The next quarter in which deceased appearances are to be met with is the cavity of the chest. Here are sometimes seen redness of the pleura, redness and congestion of the lungs, redness of the inner surface of the heart, and redness of the lining membrane of the windpipe. Redness of the diaphragmatic part of the pleura, or even of the whole of that membrane, has been at times observed; as one would expect, indeed, from the pectoral symptoms which occasionally prevail during life. Inflammation of the lungs themselves has also been noticed. Dr. Campbell twice found great congestion of blood in the lungs of animals poisoned by the application of arsenic outwardly.[762] Sproegel likewise found the pleura, pericardium, and whole lungs deeply inflamed in animals.[763] Dr. Venables found the pleura of a bright crimson colour in some poultry maliciously poisoned with arsenic,—more redness there indeed than in the stomach.[764] Mr. James says that in his experiments on animals he constantly found the lungs much gorged with blood, unless when death occurred quickly; but that he could see no evidence of the congestion being inflammatory.[765] A distinct example of advanced pneumonia in man is related in Pyl’s Magazine: the patient died after vomiting and purging incessantly for eight days; and on dissection the lungs were found “in the highest state of inflammation; and so congested as to resemble a lump of clotted blood.”[766] A distinct case of the same nature is related in Henke’s Journal; this patient had obvious pneumonic symptoms during life; and in the dead body the lungs were found so gorged, that, on being cut into, nothing could be seen but clotted blood in their cellular structure.[767] In a case formerly adverted to [p. 252] of death from arsenic applied externally for scirrhus, excessive congestion was found in the lungs, “both lungs being completely gorged with blood, and presenting all the characters of pulmonary apoplexy.”[768] In another described by Dr. Booth of Birmingham, where death occurred in seven hours only, the lungs presented sufficient congestion to have completely impeded respiration.[769] It has been alleged that the inner surface of the heart has been found red from inflammation. In a case examined judicially at Paris by Orfila, the left cavities of the heart were of a mottled red hue, and in the ventricle were seen many small crimson specks which penetrated into the muscular part of the parietes. The right cavities had a deep reddish-black tint, and the ventricle of that side contained specks like those in the other, but more faint. Orfila adds, that he had previously seen the same appearance in animals.[770] These observations are not satisfactory. There is no evidence that the observer drew the distinction between the redness of inflammation, and that produced by the dyeing of the membrane with blood after death. The subject was afterwards brought before the Royal Academy of Medicine at Paris by M. Godard, who had also observed the appearance in question in a person killed by arsenic, and who dwelt strongly on it as characteristic of this species of poisoning. It was distinctly proved, however, by many members present that the appearance arises from various other causes.[771] The inner membrane of the windpipe is said to be sometimes affected with inflammatory redness. Jaeger found it so in animals;[772] and the symptoms referrible to the windpipe during life would lead us to expect the same thing in man. The organs of generation are occasionally affected. The penis in the male and the labia in the female have been found distended and black; in an interesting case related by Bachmann the external parts of generation (in a female) were surrounded by gangrene;[773] and in a case related in Pyl’s collection the inside of the uterus and Fallopian tubes was inflamed.[774] It is probable that signs of inflammation in the internal organs of generation will be found if there have been corresponding symptoms during life. But in truth this part of the pathology of poisoning with arsenic has not been particularly attended to. To complete this account of the morbid appearances of the mucous membranes, it may be added that the conjunctiva of the eyes frequently presents vascularity and spots of extravasation.[775] It now only remains, under the head of the morbid appearances produced by arsenic, to mention certain alterations that are said to take place in the state of the blood and general condition of the body. With regard to the state of the blood Sir B. Brodie observes in general terms, that in animals killed by arsenic it is commonly fluid.[776] Harles, on the authority of Wepfer, Sproegel, and Jaeger, says it is black, semi-gelatinous, and sometimes pultaceous.[777] Novati alleges that the blood after death is without exception black and liquid as after cholera, of a blackish-purple tint that colours linen reddish-brown, viscid, opaque, and without any trace of coagulation.[778] In a fatal case related by Wildberg the blood was everywhere fluid.[779] This condition, however, is not uniform; for Dr. Campbell found the blood coagulated in the heart of a rabbit;[780] and Wepfer found it also coagulated in the dog.[781] It has been stated by some authors in medical jurisprudence that the dead body occasionally exhales an aliaceous odour, resembling that of sublimed arsenic. This is a very questionable statement. The only fact of the kind worth mentioning is one brought forward by Dr. Klanck, as occurring in the course of certain experiments, which will presently be noticed, on the antiseptic virtues of arsenic. Several animals which had been killed with arsenic are said to have exhaled an odour like that of sublimed arsenic from three to eight weeks after death.[782] A great discordance of opinion at one time prevailed among authors, as to the influence of arsenic on the putrefactive process in the bodies of those poisoned with it. The vulgar idea, borrowed probably from the ancient classics, that the bodies of those who have been poisoned decay rapidly, was till lately the prevalent doctrine of medical men, and even of medical jurists; and it was applied to arsenic as well as other poisons. Even so lately as 1776 we find Gmelin stating in his History of Mineral Poisons, that the bodies of those who have died of arsenic pass rapidly into putrefaction, that the nails and hair often fall off the day after death, and that almost the whole body quickly liquefies into a pulp.[783] A similar statement has been made in 1795 by a respectable author, Dr. John Johnstone.[784] It appears that this rapid or premature decay does really occur in some instances. Thus in a case related by Plattner of death from arsenic administered as a seasoning for mushrooms, the body had a very putrid odour the day after death.[785] Loebel also asserts he found by experiments on animals, that after death from arsenic putrefaction took place rapidly, even in very cold weather.[786] In other instances the body probably decays in the usual manner. For example, in Rust’s Magazin is related the case of a child who died in six hours of poisoning with arsenic, and in whose body, fourteen days after death, the integuments were found considerably advanced in putrefaction, and the liver and kidneys beginning to soften.[787] In the case of a man who died in two days, and in whose body arsenic was found by MM. Chapeau and Parisel throughout many of the tissues, “putrefaction was so far advanced eight days after death as to render the examination of parts obscure.”[788] And in the course of some experiments on dogs poisoned with the oxide Dr. Seeman found the usual changes after five months’ interment.[789] But it has been proved in recent times that in general arsenic has rather the contrary tendency—that, besides the antiseptic virtues which it has been long known to exert when directly applied in moderate quantity to animal substances, it also possesses the singular property of enabling the bodies of men and animals poisoned with it both to resist decay unusually long, and to decay in an unusual manner. The observations and inquiries which have been made abroad on this subject were little known any where else than in Germany before the publication of the earlier editions of the present work; but parallel examples have been since met with both in Britain and France; and in this country the importance of the subject is generally appreciated. The first occasion on which the antiseptic property of arsenic was brought under public notice was about the beginning of the present century, in the course of the trial of the widow of a certain state-councillor, Ursinus of Berlin. Some time before that Dr. Welper, then medical inspector in the Prussian capital, having remarked that the body of a person poisoned with arsenic remained quite fresh for a whole week in summer, he attended carefully to the subject at every opportunity, and invariably, he says, found that the body resisted putrefaction. Not long after making this remark, he was concerned in 1803, by virtue of his office, in the investigations in the case of the widow Ursinus. This lady having been discovered in an attempt to poison her servant, suspicions arose regarding the previous sudden death of three persons in her family, her husband, a young officer who had carried on an amour with her, and an aunt from whom she derived an inheritance. They had all died in mysterious circumstances, and the lady had been their only nurse. Dr. Welper disinterred the bodies of the husband and aunt, which had been buried, the former two years and a half before at Berlin, the latter half a year afterwards at Charlottenberg; and he found them not putrid, but dried up; and specks of an appearance, which is described as being gangrene, but which was probably warty extravasation, were visible in the stomach. Arsenic could not be detected. He afterwards got Dr. Klanck, his acquaintance, to make some express experiments on animals; and the results were strikingly conformable. In dogs poisoned with arsenic and left for two months sometimes buried in a damp cellar, sometimes exposed to the air of the cellar, the flesh and alimentary canal were red and fresh, as if pickled; and though the place where the carcases were subsequently buried again was flooded for eight months after, the intestines were eventually found entire and red, the fat converted into adipocire, and most of the muscles unaltered,—those only being soft and greasy which were directly acted on by the water. From a set of comparative experiments which were made on dogs killed by blows, or poisoned by corrosive sublimate, or by opium, Klanck found, that, after being buried in the same place, and for the same space of time the whole soft parts of the carcases were converted into a greasy mass. In a subsequent year he repeated his experiments, the bodies, however, being this time left exposed to the air of the cellar. The experiments were commenced in the month of August. In ten days there appeared slight signs of incipient putrefaction; a faint putrid smell was exhaled, and all flies that settled on the carcase died. This state continued for eight or ten weeks without increasing. After that the soft parts began to grow firmer and drier, and at the same time the putrid odour was succeeded by a smell like that of garlic, which became insupportably strong when the carcases were removed into warm air. The bodies, three years afterwards, still continued dry and undecayed.[790] A similar set of facts was again brought before the public between 1809 and 1811, during the criminal proceedings in a case like that of the widow Ursinus, tried first at Bayreuth and afterwards by appeal at Munich. A lady near Bayreuth died of five days’ illness, under symptoms of violent general irritation of the alimentary canal. Some months afterwards a variety of circumstances having raised a suspicion that she had been poisoned by her maid, Margaretha Zwanziger, a judicial investigation was set on foot; the consequence of which was, that the same woman came under suspicion of having also previously poisoned another lady and a gentleman with whom she had been successively in service. The bodies of the three people were accordingly disinterred, one of them five months, another six months, and the third fourteen months after death. In all of them the external parts were not properly speaking putrid, but hard, cheesy, or adipocirous; in the last two the stomach and intestines were so entire as to allow of their being tied, taken out, cut up, and handled; and in one a sloughy spot was found in the region of the pylorus. Arsenic was detected in two of the bodies by Rose’s process of analysis.[791] The next example to the same effect which will be mentioned is perhaps the most satisfactory of all, because it was the result of an express experiment on the human subject. Dr. Kelch of Königsberg buried the internal organs of a man who had died of arsenic, and whose body had remained without burial till the external parts had begun to decay; and on examining the stomach and intestines five months after, he found that the hamper in which they were contained was very rotten; but that “they had a peculiar smell, quite different from that of putrid bowels, were not yet acted on by putrefaction, but as fresh as when first taken from the body, and might have served to make preparations. They had lost nothing of their colour, glimmer, or firmness. The inflamed spots on the stomach had not disappeared, and the small intestines also showed in some places the inflammatory redness unaltered.”[792] In a recent French case, although the degree of preservation was less remarkable, the other circumstances are so striking as to render it well worthy of notice. In this instance the body was disinterred after having been seven years in the ground, in a high situation and sandy soil. The coffin, which was of oak, had become dry and brittle, and no moisture appeared on the inside. The body was entire: the head, trunk, and limbs retained their situation; but the organs of the chest and belly were converted into a brown soft mass of the consistence of plaster, which lay on each side of the spine. In this mass MM. Ozanam and Idt, the medical inspectors, succeeded in discovering by chemical analysis a considerable quantity of arsenic.[793] M. Ollivier describes another French case, where the body had been buried for three years, and was found so completely dried up that the trunk weighed only two pounds. The integuments were entire, dark-brown, and of a faint odour like decayed wood. The organs of the chest and belly were confounded together in a foliaceous membranous mass, in which the liver only could be distinguished, but in an exceedingly shrivelled state. Arsenic was detected in the membranous matter by MM. Barruel and Henri. The preservative power of the arsenic was promoted in this case by the sandy nature of the soil.[794] In the case of the girl Warden, which has been several times alluded to, the internal organs were also preserved somewhat in the same manner as in the German cases. The body had been buried three weeks; yet the mucous coat of the stomach and intestines, except on its mere surface, was very firm, and all the morbid appearances were consequently quite distinct. Nay, three weeks after disinterment, except that the vascularity had disappeared, the membranes and the appearances in them remained in the same state.[795] A similar case has been recorded by Metzger. It is that of an old man who died of six hours’ illness, and in whose stomach three drachms of arsenic were found. The body had been kept ten days in February before burial, and was disinterred eight days after that; yet there was not the slightest sign of putrefaction any where.[796] A parallel case was described by myself in the Edinburgh Medico-Chirurgical Transactions;[797] and I have met with three others of the same kind since. In a very important case, that of Mrs. Smith, which was made the subject of investigation at Bristol in December, 1834, the body was also found in a state of great preservation, modified, however, by adipocirous decomposition, owing to the presence of water in the coffin. The body had been fourteen months interred. The internal parts, especially of the head and neck, were here and there decayed somewhat or converted into adipocire, the muscles and internal organs entire, though more or less shrivelled, the alimentary tube remarkably preserved, “every part being almost as distinct as if the inspection had been made at a very short period after death,” “the mucous membrane sufficiently tenacious to be lifted by the forceps in as large flakes as usual;” and the reporters, Drs. Riley and Symonds, Messrs. Herapath and Kelson, seem to have had no difficulty in ascertaining the absence of vascularity, extravasation, or even abrasion of the inner membrane. Artificial orpiment, the preparation proved to have been given [see p. 225], was found in the stomach by Mr. Herapath, and the quantity appeared to be about half a drachm.[798] A similar instance, very remarkable in all its circumstances, was investigated here in 1834 by my colleague Dr. Traill to whom I am indebted for the particulars. The master of a foreign vessel died in about twenty-four hours, apparently of malignant cholera, at a small port in the neighbourhood of Edinburgh: and the body was forthwith buried. A suspicion, however, having arisen in his native country that he had been poisoned by his mate, an inquiry was instituted at the request of the foreign government; and the body was disinterred five months after death. The face and neck was swollen, black, and decayed; but the rest of the body was quite free of the usual signs of putrefaction. The skin was white and firm, the muscles fresh, the lungs crepitating, the liver and spleen much shrivelled, the stomach and intestines entire throughout their whole tissues, and capable of being handled freely without injury. On the mucous coat of the stomach several dark patches of extravasation were found, likewise several spots and large patches which presented on their surface a firmly adhering bright yellow crust; and the contents of the stomach consisted of a considerable quantity of yellow sandy matter of the consistence of paste. The contents and adhering crusts were found to consist chiefly of oxide of arsenic partially converted into sulphuret. In this instance, as in that last described, the coffin contained water, owing to its having laid in a sandy soil resting on clay. An important case of the same nature was communicated to me in 1843 by Mr. Sandell of Potton, Bedfordshire, and afterwards published by Mr. Hedly of Bedford. A man Dazley at Wrestlingford, affected with symptoms of gastro-enteric irritation for five or six days, was seized with sickness, vomiting, heat and constriction in the throat, and great weakness, about an hour after getting a white powder from his wife; and in eight hours he expired, without any suspicion of unfair usage arising at the time. Suspicions, however, being entertained afterwards, the body which had not been examined at first, was disinterred in five months, during the month of March. The countenance was so entire as to be recognisable. Adipocire had been formed in many places. The stomach and intestines were “in a most perfect state of preservation,” as if death had taken place only a few days previously. The stomach presented yellow patches on its outer and inner surface,—was generally red over its villous coat, which had also been abraded near the cardiac end,—and, together with the small intestines, was lined with white powder and contained more of it enveloped in much red mucus. This powder proved to be arsenic. About the middle of the small intestines a small ulcerated opening was found, through which some arsenic had escaped.[799] The following cases which have come under my own notice during the last five years are also worthy of observation. In a case submitted to me on the part of the crown in 1841, which has been adverted to above for another purpose [p. 265], the body after being three months interred was found with the head and face decayed and putrid; but the muscular substance was little changed; and the inspectors were particularly struck with the state of preservation of the body, and also with the very distinct state of inflammation seen over almost the whole external and internal surfaces of the alimentary canal,—a description, the accuracy of which I had afterwards an opportunity of verifying. In the case of Mr. Gilmour (p. 265), whose body had been buried 101 days, the external parts were more decayed; but the alimentary canal appeared equally entire both to the original inspectors, Drs. M’Kinlay and Wylie, and likewise to myself three weeks later. But the following instance, in which I was consulted in 1839, is the most remarkable one of the kind that has hitherto occurred to me; because the observations then made were the result of an express experiment in a medico-legal investigation. The history of this case, which arose from small doses of arsenic frequently administered, has been already given above in some detail [p. 250]. Arsenic not having been detected in the contents or tissues of the stomach, and the trial of the individual suspected of giving the poison being necessarily postponed for some months, I recommended that a third examination of the body,—for it had been twice disinterred for inspection within ten days after death,—should be made at as distant an interval as possible, in order to ascertain whether it underwent preservation from decay. It was accordingly disinterred again, five months after death. It had an ammoniacal, but not a putrid odour. The skin was here and there covered with a thin sebaceous matter, at one or two places stripped of the epidermis, but for the most part natural in appearance, firm, and elastic. The nails were loose. The muscles of the head and near the tops of the scapulæ were adipocirous, on the chest and abdomen obscurely fibrous in texture and hardened, but elsewhere unaltered, and “in the lower extremities so perfect that they might have been used for an anatomical demonstration.” The liver and lungs were also in a state of good preservation, and the latter crepitated when cut. The other viscera had been removed at the previous examinations. It may be added that the experiments of Klanck on dogs adverted to above have been more recently repeated by Hünefeld on rabbits and mice, with precisely the same results. The animals were sometimes left in the air, at other times buried, and generally in a moist place. In every instance putrefaction made more or less progress at first; but in a few days a peculiar garlicky odour arose, from which time the progress of decay seemed to be arrested; and the bodies underwent a process of hardening and desiccation which completely preserved them.[800] On considering attentively the illustrations now given, the toxicologist can hardly doubt that in some cases arsenic has appeared both to retard and to modify putrefaction in the bodies of persons poisoned with it. Assuming arsenic to have been the cause of the preservation of the bodies, it becomes a point of consequence to account for its effect, and more particularly to reconcile that effect with what has certainly been noticed in other cases of poisoning with the same substance, namely, ordinary rapidity of decay, if not actually an increased tendency to putrefaction. At the outset of this part of the inquiry some light may be thrown upon it by separating the local from the general operation of arsenic. Arsenic is a good preservative of animal textures when it is directly applied to them in sufficient quantity. This is well known to stuffers of birds and beasts, was experimentally ascertained by Guyton Morveau,[801] and has come also under my observation.[802] It is now likewise known to be an excellent substance for preserving bodies, when injected in the form of solution into the blood-vessels. Hence, if in a case of poisoning the arsenic be not discharged by vomiting, and the patient die soon, it will act as an antiseptic on the stomach at least, perhaps on the intestines also; while the rest of the body may decay in the usual manner. This is very well shown in a case examined by Dr. Borges, medical inspector at Minden, fourteen weeks after death. The stomach and intestines were firm, of a grayish-white colour, and contained crumbs of bread, while all the other organs in the belly were pulpy, and the external parts adipocirous.[803] It is also equally well exemplified in a case that happened at Chemnitz so early as 1726, and which was examined five weeks after burial. The skin was every where very putrid, but the stomach and intestines were perfectly fresh.[804] In the case of Warden the appearances were precisely the same. Three weeks after burial the Dundee inspectors found the external parts much decayed, yet three weeks later the stomach and intestines were found by myself in a state of almost perfect preservation. A striking experiment performed by Dr. Borges on a rabbit will likewise illustrate clearly the fact now under consideration. The rabbit was killed in less than a day with ten grains of arsenic, and its body was buried for thirteen months in a moist place under the eaves of a house. At the end of this period it was found, that “the skin, muscles, cellular tissue, ligaments and all the viscera, except the alimentary canal, had disappeared, without leaving a trace; but the alimentary canal from the throat to the anus, along with the hair and the bare bones, was quite entire.”[805] In all of these cases arsenic was found in the body. In the rabbit experimented on by Dr. Borges, above five grains of arsenic were separated in the form of a metallic sublimate. But, on the contrary, if the arsenic is all or nearly all discharged by vomiting, not only the body generally, but likewise even the stomach and intestines, may follow the usual course of decay. Accordingly, in the case of the child formerly quoted (273), where the body putrified in the usual manner, only four grains and a half of arsenic had been taken; and as it was swallowed in a state of solution and caused violent vomiting, it must have been almost all ejected. Nay, in such circumstances, the alimentary canal, in consequence of its unnatural supply of moisture and incipient disorganization, may decay somewhat faster than other parts. Thus Dr. Murray observed in the case of a man formerly mentioned (264), who lived under violent gastritic symptoms for seven days, and vomited much, that the stomach, which was removed for more minute examination, decayed so rapidly that in twenty-four hours an examination was impracticable, while the body in general rather resisted putrefaction.[806] The preceding statements on the differences in the state of preservation of the body after poisoning with arsenic are not then incapable of some explanation. Nevertheless, it must be granted that the reasons assigned will not account for all the apparent cases of the preservative powers of arsenic. And especially they will not explain how the whole body has sometimes resisted decay altogether, and become as it were mummified. It is impossible to ascribe this preservation to the spelling power of the arsenic diffused throughout the body in the blood; the quantity there being extremely small. Consequently if the preservation of the bodies is not occasioned by some accidental collateral cause (a mode of accounting for the phenomena which seems inadmissible), this property of arsenic must depend on its causing, by some operation on the living body, a different disposition and affinity among the ultimate elements of organized matter, and so altering the operation of physical laws on it. There appears no sound reason for rejecting this supposition, especially as it is necessary to admit an analogous change of affinities as the only mode of accounting for a still more incomprehensible violation of the ordinary laws of nature,—the spontaneous combustion, or preternatural combustibility, of the human body. The following judicious observations by Harles on this subject are worthy of attention:—“In regard,” says he, “to this singular property of arsenic, now no longer doubtful, it should be remembered that certain circumstances will limit or impair it, while others will favour or increase it;—circumstances, for example, connected with the soil of the burying-ground, or the air of the vaults where the bodies are deposited. Different soils and different conditions of the air will materially affect the decomposition of all bodies indiscriminately, and will therefore affect likewise the antiseptic properties of arsenic. For it would be absurd to ascribe to arsenic the power of preventing putrefaction in all circumstances whatsoever,—a power which those who make use of it for preserving skins know very well it does not possess, and a power possessed by no antiseptic whatever, not even by alcohol.”[807] An important consequence of the preservative tendency of arsenic is, that in many instances the body in this kind of poisoning may be found long after death in so perfect a state as to admit of an accurate medico-legal inspection and a successful chemical analysis. In one of his cases Dr. Bachmann detected arsenic in the stomach fourteen months after interment; Dr. Borges had no difficulty in detecting it in an animal after thirteen months; Mr. Herapath discovered it after fourteen months in the human body; M. Henry detected it after three years and a half, and obtained no less than seven grains of metallic arsenic from the shrivelled viscera;[808] and MM. Ozanam and Idt found it after the long interval of seven years.—The late experiments of Orfila and Lesueur confirm the fact that arsenic may remain long in contact with decaying animal matter, and yet continue in such a state as to be easily detected.[809] It might be supposed that the poison would pass off partly in the gaseous state by being converted into arseniuretted-hydrogen, partly in the liquid state by becoming arsenite of ammonia, a very soluble compound. But the fact nevertheless is, that, notwithstanding these reasons for its disappearance, it may be detected after the lapse of several years. Under the head of the diseased appearances left by arsenic in the dead body, every change of structure has now been described which has been mentioned by authors and supported by trustworthy statements. Another set of appearances may still be noticed; but they are here separated from the rest, because the author who first notices them has not been supported in the statement by any special observations of his own, or by an adequate number of facts observed by others. In an elaborate essay on a case of poisoning by Professor Seiler of Wittemberg, it is said in general terms that arsenic may cause gorging of the vessels of the brain, effusion of serum into the ventricles, inflammation of the brain, and even extravasation of blood.[810] Turgescence of vessels is mentioned in several published cases, and I have myself met with it. But it is seldom so considerable as to attract attention. In the following instance, however, which has been related by Dr. Hofer of Biberach the evidence of cerebral congestion was unequivocal. A man addicted to intoxication, but enjoying good health otherwise, was attacked after supper with sickness, vomiting, and pain in the belly. On going to bed he fell soon quiet; and six hours after he took ill, he was found dead. Arsenic was detected in the stomach, and in what he vomited; and considerable redness was seen on the villous coat of the stomach. But the most remarkable appearances were gorging of the cerebral vessels, adhesion of the dura mater to the membranes beneath, and the effusion of eight ounces of serosity into the lateral ventricles.[811] The only instance I am acquainted with to justify the opinion that extravasation of blood into the brain may occur from poisoning with arsenic, is the remarkable case of apparent death from eating poultry poisoned with arsenic, which was communicated to me by Mr. Jamieson of Aberdeen. The individual, after suffering under the usual primary symptoms, became apoplectic after a fit of sneezing, and died three days afterwards; and in the dead body, besides other signs of disease in the brain, a recent clot of blood was found in the right anterior lobe. (See p. 69.) It is quite unnecessary to notice lividity of the skin among the signs of poisoning with arsenic, except for the mere purpose of reminding the medical jurist that, although it has been sometimes much relied on as a sign of death from arsenic, it is not of the slightest importance as a sign either of that or of any other kind of poisoning. (See p. 51.) The action of arsenic on the alimentary canal after death will now require a few remarks; the purpose of which is to prepare the medical inspector for investigating attempts to impute the crime of poisoning to innocent persons, by introducing arsenic into the dead body. Such attempts, according to Orfila, have been made; but I am not acquainted with any actual instance. The action of arsenic on dead intestine has been fully examined by the last mentioned author. If it is introduced into the anus immediately after death, and allowed to remain there twenty-four hours, the mucous membrane in contact with it becomes of a lively red colour, with darker interspersed patches as if from extravasation. The other coats are natural; and so is the mucous membrane itself wherever the poison does not actually touch it. Consequently the margin of the coloration is abrupt and well defined. When the arsenic is not introduced till twenty-four hours after death, the part to which it is actually applied presents dark patches, while the rest of the membrane is quite healthy.[812] The appearance of redness in the former case is probably the result of lingering vitality. The cause of the dark appearance in the latter it is not easy to comprehend. When arsenic has been applied, during life, the redness, if it has had time to begin at all, extends to some distance from the points with which the poison has been in contact, and passes by degrees into the healthy colour of the surrounding membrane. On reviewing what has been said of the pathological appearances caused by arsenic, it must appear that the medical jurist can never be supplied from this source alone with satisfactory evidence of the cause of death. But in some circumstances the evidence may amount to a strong probability of one variety or another of irritant poisoning. Mere redness, conjoined or not with softening of the mucous membrane, may justify suspicion only. But if there should be found in the body of a person who has died of a few days’ illness, redness, black warty extravasation, and circumscribed ulcers of the villous coat of the stomach,—effusion of blood or bloody clots among the contents of that organ,—also redness of the intestines, more especially redness and ulceration of the colon and rectum,—and redness of the pharynx, or of this along with the gullet,—the proof of poisoning with some irritant will amount to a strong presumption. At least it is difficult to mention any natural disease which could produce in so short a time such a conjunction of appearances as this; which arsenic and other analogous poisons sometimes occasion. SECTION IV.—_On the Treatment of Poisoning with Arsenic._ It was formerly proved that arsenic acts in all its forms of chemical combination, which have been hitherto tried, and nearly in the ratio of their solubility. This general fact is conformable with the law laid down as to the influence of chemical changes on the energy of poisons which enter the blood [p. 37]. Hence every supposed chemical antidote must be useless, which does not render the arsenic insoluble not only in water, but likewise in the contents and secretions of the stomach. The antidotes chiefly trusted to until recent times, such as vinegar, sugar, butter and other oily substances, lime-water, bitter decoctions, and the like, have now justly fallen into disuse. The liver of sulphur or sulphuret of potassium, which maintained its character for some time longer on account of its chemical action with oxide of arsenic in solution, is not more efficacious. The experiments of Renault on the counter-poisons for arsenic, confirmed by the subsequent researches of Orfila, have proved that the arsenical sulphuret formed by solutions of the liver of sulphur is scarcely less active than the oxide itself.[813] It appears that fine impalpable powders, though inert as physiological agents, and destitute of any true chemical action with oxide of arsenic, may nevertheless prove useful in certain limited circumstances. Thus Mr. Hume of London and others have apparently found some advantage in the administration of large doses of magnesia.[814] If this substance be of any use at all, which is doubtful, it can act only by covering the arsenical particles with its fine insoluble powder, and so preventing them from coming in contact with the surface of the stomach; for in its state of magnesia it has no chemical action with oxide of arsenic. Another remedy of the same nature is charcoal powder, which was proposed in 1813 with much confidence by M. Bertrand.[815] That it has some efficacy when swallowed along with the poison seems to admit of no doubt; for the proposer of it himself swallowed five grains of arsenic in one dose along with charcoal in a state of emulsion, and sustained little inconvenience of any kind. In all probability it acts merely by enveloping the particles of arsenic. But it may possibly be also of service, if recently exposed to heat, by the superficial attraction it exerts over substances in solution; through means of which property it will remove many soluble substances from a fluid, and render them insoluble. Charcoal, however, has been proved to be destitute of all efficacy when not administered till after the arsenic is swallowed. The one must be given along with the other, otherwise it is useless.[816] For some time past the formation of an insoluble arsenite has been aimed at by most experimentalists who have endeavoured to discover an antidote for arsenic. But in general the arsenites, though very insoluble in water, are sufficiently so in weak acids or in organic fluids, so that they are soluble enough in the juices of the stomach to enter the blood in such quantity as to prove fatal. The only exception now admitted to exist is the arsenite produced when a solution of oxide of arsenic is brought in contact with the hydrated sesquioxide of iron. The compound thus formed is held to be insoluble in the secretions of the stomach; and consequently the hydrated sesquioxide of iron is usually regarded as a true antidote. The substance, the Ferrugo of the Edinburgh Pharmacopœia,—a compound which differs little from the older preparation, the rust of iron, when not deprived of its combined water,—was announced in 1834 by Drs. Bunsen and Berthold as an effectual remedy even when given some time after the arsenic is swallowed.[817] Their experiments were repeated with variable success. Similar results were obtained by MM. Soubeiran and Miquel, as well as MM. Orfila and Lesueur, in some experiments on dogs, and by M. Boullay on the horse.[818] The last experimentalist found that the effects of a dose adequate ta occasion death are almost entirely prevented in the horse by giving the oxide of iron either immediately after the poison, or within four hours. Results of the same nature were obtained in this country by Mr. Donald Mackenzie.[819] Others, however, such as Mr. Brett[820] and Mr. Orton,[821] have failed to observe any antidotal virtues, and even deny that the sesquioxide of iron can remove oxide of arsenic from a state of solution. But in 1840 the causes of these discrepant statements were explained by Dr. Douglas Maclagan,[822] who found, in corroboration of the remarks of Drs. Bunsen and Berthold, as well as various French authorities, that the oxide must be given in large quantity, and that the failures of some were owing to the quantity used having been too small. He ascertained, that, in order to remove one part of arsenic from a state of solution, twelve parts of oxide of iron in the moist state are necessary, and sixty parts if it be previously dried; that the arsenic so appropriated is with difficulty removed from the insoluble matter even by boiling; and that, as the discoverers of this antidote first stated, the preparation made by precipitating the sesquioxide of iron by means of ammonia, is a more active form than any other. As the oxide prepared in this way always contains ammonia, and the proportion necessary for removing the arsenic is far greater than what is required to constitute a simple arsenite of iron, it is reasonable to infer that the ammonia forms a part of the insoluble compound actually produced. At all events the action of the antidote would appear to be chemical, and not mechanical, as has been thought by many, and as was stated to be probable in the last edition of this work. In confirmation of these views, and as a fact worthy of farther investigation on its own account, it is worthy of notice, that, according to Dr. Duflos, the acetate of sesquioxide of iron answers equally well as an antidote with the sesquioxide itself. It precipitates both arsenious and arsenic acid from every state of solution, and always the more quickly the more the solution is diluted; and the co-existence of acetic acid is no obstacle to this action taking place.[823]—More recently Professor Orfila has called in question the absolute efficacy generally ascribed to the sesquioxide of iron. He alleges that the arsenical compound formed, though insoluble in water, is soluble to some extent in the gastric juices, and is consequently a poison to animals; that the sesquioxide is therefore only partial in its operation as a remedy; but yet that the influence of the animal fluids in the stomach in counteracting it may be overcome by giving it in excess, so that, as fast as the compound is dissolved, it is thrown down again.[824] The cases of the successful employment of this antidote in the human subject, which have appeared in the periodical press during the last eight years, are so numerous, that its utility can scarcely be called in question, whatsoever may be its precise mode of action. The hydrated sesquioxide of iron ought therefore to be kept in readiness in every druggist’s establishment; for it cannot be prepared when wanted without great loss of time. The quickest way to make it is to dissolve the common anhydrous sesquioxide, formerly miscalled carbonate of iron, in diluted sulphuric acid aided with a gentle heat; to decompose the hot solution with an excess of strong ammonia; to filter off the fluid by means of a cloth filter and wash the precipitate well with warm water; and then to let it drain thoroughly and to squeeze out more of the water by expression. It should be kept in this state, and not allowed to dry. In regard to all antidotes for arsenic, it must be observed, that they can seldom be otherwise employed than in unfavourable circumstances. If, as most generally happens, the poison has been taken some time before medical aid is obtained, its powder is diffused over the surface of the stomach, adheres with tenacity to the villous coat, and excites the secretion of tough mucus, through which it is with difficulty reached by any antidote possessing a chemical action with it. In all cases, therefore, it is advisable to promote vomiting occasionally, if not already full and free, so as to aid the stomach in clearing itself of the secreted mucus. If the existence of a chemical antidote for arsenic be doubtful, much less is there any one known of that rarer denomination which operates by exciting in the system an action contrary to that established by the poison. A good deal, however, may be done by general medical treatment to improve the chance of recovery. If vomiting should be delayed, as often happens, for half an hour or more, advantage ought to be taken of the opportunity to administer an emetic of the sulphate of zinc, with the view of withdrawing the powder in mass before it is diffused over the stomach; and for the same purpose milk should be drunk both before and after vomiting has begun, as it appears to be the best substance for enveloping the powder, and so procuring its discharge. The patient should never be allowed to exhaust his strength in retching without a little milk or other fluid in his stomach to act on. At the same time, there is probably some justice in the opinion expressed by a late writer on this subject, that large draughts of diluents are injurious; and that, unless the stomach is allowed to contract fully and frequently on itself, it cannot discharge from its surface the mucous secretion, in which the powder of arsenic is in general closely enveloped.[825] The stomach-pump, although it has been applied to cases of poisoning with arsenic, does not possess any advantage whatever over emetics or the natural efforts of nature, and is less effectual in expelling the mucus which envelopes the poison. Even emetics are unnecessary, when full vomiting is caused by the poison itself. If milk in sufficient quantity cannot be procured, strong farinaceous decoctions will probably prove useful. Supposing the poison to have been removed from the stomach, or that the patient has been put on the course which appears best fitted to accomplish that end,—two objects remain to be accomplished, namely, to allay the inflammation of the alimentary canal, and to support the system under that extraordinary depression which it undergoes in the generality of cases. Were it not for the latter of these objects, the treatment would be both obvious and frequently successful. But it is highly probable that the active remedies, to which the physician trusts in internal inflammations generally, and which are urgently called for by the inflammation caused by arsenic, cannot be enforced with the requisite vigour, on account of the remote depressing effects also produced by this poison on the body. Nevertheless, it is certain that in a few even very aggravated cases the purest and most vigorous antiphlogistic treatment has been resorted to with success. Dr. Roget’s patient, whose case was formerly referred to for another purpose, seems to have been saved by venesection; and at all events, the amelioration effected was unequivocal. In the Medical Repository there is another good example of the beneficial effects of blood-letting carried even to a greater extent than in Roget’s case;[826] and in the Medical and Physical Journal[827] a third instance will be found, which after the first twenty-four hours assumed the form of pure gastritis, and was treated as such with success. Blood-letting ought not to be practised till the poison is nearly all discharged from the stomach, because it promotes absorption by causing emptiness of the blood-vessels. Orfila has lately advocated the use of blood-letting, on the ground that it tends to remove from the system a portion of the poison which circulates with the blood, and is the main source of danger to life. He has endeavoured to show by experiments on animals, that doses adequate to cause death may be given without this result following, if depletion be vigorously enforced along with other treatment. And he has related a case of recovery in the human subject under unfavourable circumstances, where blood-letting was practised five times, and on every occasion with marked relief.[828] It is not probable that any material advantage will be derived from topical blood-letting, at least in the early stage, because if depletion is to be of use at all, it must be carried at once to a far greater extent than it is possible to attain by local evacuants. Blisters on the abdomen will prove useful auxiliaries in the advanced stage. While many have advocated the employment of blood-letting and other antiphlogistics, and have used them with apparent advantage, Rasori was of opinion, and more recently Giacomini has strenuously maintained that the proper treatment in all cases of arsenical poisoning is the purely stimulant method. The remedy recommended by the latter is a mixture of eight ounces of beef-tea and two ounces of wine. These notions are evidently dictated by the prevailing pathological delusions of the Italian school. Although upheld in some measure by a Report of the Parisian Academy of Medicine upon some experiments by M. Rognetta on this subject,[829] Professor Orfila subsequently proved, that the practice recommended is utterly useless, if not even hurtful.[830] At the same time no one who has ever seen a case of poisoning by arsenic can doubt that it is often necessary to counteract the overwhelming languor of the circulation by the moderate use of stimulants. Opium in repeated doses will prove useful, when the poison has been removed, and the inflammation subdued by blood-letting. And I conceive that to the form of gastritis, caused by arsenic, may be applied a method of treatment by anodynes, which has been successfully used in acute inflammation generally,—the free administration of opium immediately after copious depletion. For the safe employment of this method, however, it is essential that the arsenic be completely removed from the stomach and intestines. And from the results of many cases there must always be great reason to apprehend, that, before the treatment can be with propriety resorted to, the patient’s strength will be exhausted. The harassing fits of vomiting which often continue long after the poison has been discharged from the stomach are best removed by opium in the form of clyster, or rubbed over the inside of the rectum in the form of ointment with the finger. The use of laxatives is particularly required in all cases in which there is tenesmus instead of diarrhœa, or where, in the latter stages, diarrhœa is succeeded by constipation; and castor oil is the laxative generally preferred. While diarrhœa is present, and the evacuations are profuse or the intestines have been thoroughly emptied, laxatives are unnecessary or even hurtful; but emollient clysters are advisable, and opium in the form of enema or suppository. In short, so far as regards the intestinal affection, the treatment of the acute stage of dysentery is to be enforced. Professor Orfila lays great stress on the employment of diuretics after the stomach has been cleared out, and founds this practice on his observations which show that arsenic is absorbed into the blood, and gradually discharged by the secretions, especially the urine. Experience seems to confirm theory. Dogs, after receiving a small dose, adequate to occasion death, recovered under the active administration of diuretics. Having ascertained that this animal was constantly killed in a period varying from thirty to forty-eight hours by two grains applied to a wound, provided no remedies were employed, he tried the diuretic method with six which had been thus poisoned; and all of them recovered.[831] The diuretic he recommends is a mixture of ten pounds of water, five of white [French] wine, a bottle of Selzer water, and three ounces of nitre; the dose of which is two wine-glassfuls frequently.[832] This method has been followed with success in the human subject. M. Augouard relates a case where 230 grains produced in half an hour all the usual symptoms, which he immediately proceeded to treat by administering a grain and a half of tartar-emetic, to excite full vomiting. Having accomplished this object, he gave frequent doses of decoction of mallow “strongly salpetred,” which in seven hours excited so profuse a diuresis that in the ensuing ten hours no less than eighteen imperial pints was discharged. At the close of this period a material amendment took place, and recovery was complete in fifteen days.[833] It may be observed, however, that it is sometimes impossible to excite diuresis.[834] Little need be said of the practice to be pursued in the advanced stages of poisoning with arsenic, when convalescence has begun. The principal object is to support the system by mild nourishment, avoiding at the same time stimulant diet of every kind, but especially spirituous and vinous liquors. Whatever may be the difference of results obtained with the antiphlogistic mode of cure, the opposite system has been invariably detrimental in the advanced stage. The treatment of the nervous and dyspeptic affections, which may supervene after the symptoms of local inflammation have ceased, is not a fit object of review in this work, as it would lead to great details.