CHAPTER XXV.

OF POISONING BY MECHANICAL IRRITANTS. The _fifth_ order of the irritant class of poisons includes mechanical irritants. These substances have not properly speaking any poisonous quality; but occasion symptoms like those of poisoning, and even sometimes death itself, in consequence of their mechanical qualities only. They have therefore been excluded from every toxicological system proposed in recent times; but in a medico-legal work on poisoning it would be wrong to pass them without notice. The most important of the mechanical irritants are those which cause injury by reason of their roughness, sharpness, or size. Many instances have occurred of persons having swallowed fragments of steel, copper, iron, broken glass, or entire prune-stones, cherry-stones, and the like,—who not long afterwards were attacked with signs of inflammation, or some other abdominal disease, and were carried off by it as by the administration of poison. The disorders thus induced are almost always of a chronic or lingering kind, and commonly depend on gradual perforation of the intestines by the foreign body pressing on the coats. In general the illness ends in inflammation of the peritonæum. Sometimes the irritating substance perforates the skin and muscles as well as the intestines, and escapes outwardly; and a few individuals have even recovered under these circumstances. An excellent account of the ordinary course of such accidents is given in the London Medical and Physical Journal. The person swallowed a chocolate bean, and after experiencing many uneasy sensations throughout the belly for several days, was attacked with peritonitis and died.[1595] Mr. Howship has related the particulars of the case of a woman, died after two years of constant suffering, in consequence of having swallowed a large quantity of cherry-stones.[1596] Dr. Marcet has also described the case of a sailor who died in a similar way after swallowing several large clasp-knives.[1597] Thus too, although it is a familiar fact, that needles and pins are in general swallowed with impunity, death nevertheless sometimes arises from this cause. Guersent mentions the case of a child who died in the course of two months of frequent vomiting caused by swallowing a pin, which was found after death pinning the stomach, as it were, to the liver.[1598] Dupuytren relates the case of a woman, who, after swallowing an incredible number of needles and pins, became very lean and was confined to bed by the excruciating pain excited on motion by the needles and pins escaping through the skin. There were seldom less than fifty tumours or abscesses on various parts of the body; and Dupuytren, on opening about a hundred of these, invariably found one or more needles or pins in each. She laboured under general debility, irritative fever, and marasmus, and at length died hectic. After death many hundred pins and needles were found among the muscles and viscera.[1599] Many other examples might be referred to, but these will suffice for information on the ordinary effects of mechanical irritants of the kind under consideration. From the case of Dr. Marcet and other similar facts, it appears that large and even angular bodies do not always cause serious mischief, nay, that they have been frequently swallowed without any material injury. Dr. Marcet’s sailor in the course of his life had repeatedly swallowed several clasp-knives in quick succession: and nevertheless recovered perfectly after some days of slight illness. As to prune and cherry-stones, buttons, coins, needles, pins, and the like, they have been very often taken, and even sometimes in large quantities, without any harm. It is indeed extraordinary, and almost incredible, if the facts were not authenticated beyond the possibility of a doubt, how much mechanical irritation the alimentary canal has been subjected to, without sustaining any injury. Mr. Wakefield mentions that a man, who was committed to the House of Correction, swallowed seven half-crowns, to prevent the prison authorities from depriving him of them. He suffered no inconvenience for twenty months; when, after an attack of sickness, slight bowel-complaint, and general tenderness of the belly, he discharged them all at one evacuation.[1600] Many singular instances to the same effect have been related in the various medical journals of Europe. At the head of the list, however, may be placed the following, which is related by the late Professor Osiander of Göttingen, in his work on Suicide. A young German nobleman tried to kill himself in a fit of insanity by swallowing different indigestible substances, but without success. He never suffered any particular inconvenience except a single attack of vomiting daily, though in the course of seven months after being detected he passed the following articles by stool—150 pieces of sharp, angular glass, some of them two inches long—102 brass pins—150 iron nails—three large hair pins, and seven large chair-nails—a pair of shirt-sleeve buttons—a collar-buckle, half of a shoe-buckle, and three bridle-buckles—half a dozen sixpenny pieces—three hooks, and a lump of lead—three large fragments of a currycomb, and fifteen bits of nameless iron articles, many of them two inches in length.[1601] Before such articles occasion serious harm, it is necessary that some cause coincide, by means of which the foreign bodies are detained long in the same part of the intestines; otherwise the irritation they produce is too trivial to excite disease. The only substance of this kind which it is necessary to particularize is _pounded glass_. A common notion prevails that pounded glass is an active poison. There is no doubt, indeed, that it does possess some irritant properties even when finely pulverized; for it titillates and smarts the nostrils, and inflames the eyes. There is also little doubt that when swallowed in fragments of moderate size, especially if the stomach is empty, it may wound the viscera. But it is in this way only that it has any action when swallowed, and even then its effects are by no means uniformly serious. It can have no chemical action on the stomach; it cannot act through absorption, as it is quite insoluble: and when finely pulverized, it cannot easily wound the villous coat of the alimentary canal, on account of the abundance and viscidity of the lubricating mucus. Accordingly, M. Lesauvage ascertained that 2½ drachms of the powder may be given to a cat at once without hurting the animal,—that in the course of eight days seven ounces might be given to a dog without any bad consequence, although the period chosen for administering it was always some time before meals,—and that even when the glass was in fragments a line in length, no symptoms of irritation were induced. Relying indeed on these results he himself swallowed a considerable number of similar fragments; and did not sustain any injury.[1602] Caldani likewise, an Italian physician, after some experiments on animals, gave a boy fifteen years old several drachms of pounded glass, without observing any bad effects; and at his request Mandruzzato repeated his experiments on animals, and himself swallowed on two successive days two drachms and a half each day without sustaining any injury.[1603] Similar observations have been made by others also. Dr. Turner of Spanish Town, Jamaica, has informed me, that an attempt was made there by a negro to poison a whole family by administering pounded glass; but, although a large quantity was taken by seven persons, none of them suffered any inconvenience. Not long ago the occurrence of a similar case at Paris gave rise to a careful investigation of the whole subject by Baudelocque and Chaussier. A young man, Lavalley, married a girl who was pregnant by him; but it was agreed that she should live with her father till her delivery was over. A month after the marriage Lavalley invited his wife and father-in-law to dinner; and his wife ate heartily boiled pork, bloody-sausages, and roast-veal, and subsequently drank coffee with brandy in it. On returning home in the evening she became unwell, continued so all night, next morning was seized with violent pain in the stomach and vomiting, and died in convulsions. The period of her death is not mentioned in the report I have seen. A suspicion of poisoning having arisen after burial, the body was disinterred in forty-two days; and, although it was much decayed, black points and patches could be distinguished in many parts of the bowels, together with a quantity of broken down glass. The medical inspectors accordingly declared that she had died of poisoning with pounded glass; and the husband was imprisoned. Baudelocque and Chaussier, who were consulted, ascribed the black patches to putrefaction or venous congestion, and declared that in whatever way the glass had got into the bowels, she had not died of poisoning with the substance, as pounded glass is not deleterious.[1604] A similar opinion as to the properties of pounded glass was more lately given by Professor Marc, when consulted on a case of attempted poisoning, in which the person against whom the attempt was made felt the rough particles in his mouth while taking the second spoonful of soup in which the glass was contained.[1605] This opinion certainly appears to be in general true. At the same time instances are not wanting to render it probable, that pounded or broken glass is occasionally hurtful. Thus, passing over the more doubtful examples recorded by the older authors, we have the two following cases related by good authorities in the most modern times. One has been published by Mr. Hebb of Worcester. A child, eleven months old, died of a few days’ illness in very suspicious circumstances. On Mr. Hebb being requested by the coroner to examine the body, he found the inside of the stomach lined with a tough layer of mucus streaked with blood; the villous coat was highly vascular, and covered with numberless particles of glass of various sizes, some of which simply touched, while others lacerated it; and no other morbid appearance could be detected in the body.[1606] The other case is described by Portal. A man undertook for a wager to eat his wine-glass, and actually swallowed a part of it. But he was attacked with acute pain in the stomach, and subsequently with convulsions. Portal made him eat a surfeit of cabbage; and having thus enveloped the fragments, administered an emetic, which brought away the glass and vegetables together.[1607] The same feat has undoubtedly been sometimes accomplished with impunity. For example, in the Edinburgh Medical and Surgical Journal, an instance is related of a man who champed and swallowed three-fourths of a drinking-glass without suffering any harm; and the person mentioned by Osiander swallowed many pieces of glass, and sustained no inconvenience (p. 503). But these facts will not altogether outweigh the equally pointed narratives of Portal and Mr. Hebb. And, on the whole, the medical jurist must come to the conclusion, that broken and pounded glass, though generally harmless, may sometimes prove injurious or even fatal.[1608] Powdered glass, however, is probably inert. Another variety of injury from the mechanical irritants is inflammation from hot liquids, such as _melted lead or boiling water_. These, when swallowed, may unquestionably cause serious mischief, and even death; and the symptoms they induce are exactly those of the irritant poisons properly so called. The effects of boiling water have been investigated experimentally by Dr. Bretonneau of Tours; and the results illustrate forcibly the observations which have been repeatedly made in the course of this work, respecting the slight constitutional derangement caused by such poisons as have merely a local irritating power. He found that when boiling water was injected in the quantity of eight ounces into the stomach of dogs, it excited inflammation, passing on to gangrene, both in the villous and muscular coats. The symptoms, however, were trifling. For a day or two the animals appeared languid; but in three days they generally became lively and playful, one of them actually lined a bitch, and it was only on strangling them and examining the bodies, that the extent of the mischief was discovered.[1609] I am not aware that any such case have hitherto occurred in man. Death from drinking boiling water, indeed, is not an uncommon accident, particularly in Ireland and some parts of England, where children, who are in the habit of drinking cold water from the tea-kettle, have swallowed boiling water by mistake. It appears, however, that in these instances death is not owing to inflammation of the gullet and stomach, but to inflammation of the upper part of the windpipe,—the water never passing lower than the pharynx. The best information on this subject is contained in an interesting paper by Dr. Hall.[1610] He has there given the particulars of four cases which came under his notice; from which it follows that the disease induced is always _cynanche laryngea_, proving fatal by suffocation. Two of his patients died suffocated; another, while in imminent danger, was relieved by tracheotomy, but died afterwards of exhaustion; the fourth recovered suddenly during a fit of screaming, when apparently about to be choked; and it was supposed that the vesicles around the glottis had been burst by the cries. Pouring melted lead down the throat was a frequent mode of despatching criminals and prisoners in former ages. Only one authentic case is to be found on record of death from this cause in modern times. It occurred at the burning of the Eddistone light-house. A man, while gazing up at the fire with his mouth open, received a shower of melted lead from the building, and expired after twelve days of suffering. Seven ounces and a half of lead had reached the stomach; and the stomach was severely burnt, and ulcerated.[1611] In concluding the Irritant Poisons, and before proceeding to the next class, the Narcotics, it is necessary to observe, that besides the substances which have been treated of, there are others not usually considered poisons, and some that are even used daily for seasoning food, which, nevertheless, when taken in large quantities, will prove injurious and even occasion all the chief symptoms of the active irritants. These substances connect the true poisons with substances which are inert in regard to the animal economy. It is impossible to particularize all the articles of the kind now alluded to. But in illustration, I may refer in a few words to six common substances, pepper, Epsom salt, alum, cream of tartar, sulphate of potash, and common salt. _Pepper_, which is daily used by all ranks with impunity, will nevertheless cause even dangerous symptoms when taken in large quantity. In Rust’s Journal is noticed the case of a man affected with a tertian ague, who after taking between an ounce and a half and two ounces of pepper in brandy, was attacked with convulsions, burning in the throat and stomach, great thirst, and vomiting of every thing he swallowed. His case was treated as one of simple gastritis, and he recovered.[1612] A very striking instance, which may be arranged under the present head, has also been related to me, of apparent poisoning with Epsom salt. A boy ten years old took two ounces of this laxative partly dissolved, partly mixed in a tea-cupful of water; and had hardly swallowed it before he was observed to stagger and become unwell. When the surgeon saw him half an hour after, the pulse was imperceptible, the breathing slow and difficult, the whole frame in a state of extreme debility, and in ten minutes more the child died without any other symptom of note, and in particular without any vomiting. The circumstances having been investigated judicially, it appeared that the substance taken was pure Epsom salt; that the father, who was doatingly fond of the child, gave the laxative on account of a trifling illness which he supposed might arise from worms; and that on the most careful inspection of the body, no morbid appearance whatever could be found in any part of it. For the particulars of this singular case, I am indebted to Dr. Dewar of Dunfermline, the medical inspector under the sheriff’s warrant. It shows that in certain circumstances even the laxative neutral salts may be irritating enough to cause speedy death. Of the same nature probably are the cases which have lately led some to ascribe poisonous properties to _sulphate of potash_, a purgative salt at one time in common use. About three years ago several instances of apparent poisoning with this substance occurred in Paris; and one of them proved fatal. This was the case of a woman, recently delivered, who got 100 grains every fifteen minutes till she had taken six doses. Immediately after the first dose she was seized with severe pain in the stomach, nausea, vomiting, numbness, and cramps in the arms and legs, then with dyspnœa and severe purging, and in two hours she expired. The stomach and intestines were emphysematous, but otherwise healthy; and the stomach contained sulphate of potash, but not a trace of any of the common poisons. The stock of this salt in the shop where it had been purchased was found to be perfectly pure.[1613]—A remarkable case of the same kind lately led to a criminal trial in London. A man Haynes was charged with attempting to procure abortion by giving his wife sulphate of potash. It was proved that on two successive evenings he gave her a dose of two ounces of the salt; that she was seized after the first dose with excessive and alarming sickness, from which, however, she soon recovered without apparent harm; but that after the second dose she had violent vomiting and profuse purging, of which she died in five hours, without any alteration in the symptoms, except that she became insensible for five minutes before death. The whole gastro-intestinal mucous membrane was bright red, the vessels of the brain were much congested, and between two and three ounces of blood had escaped from the neighbourhood of the occipital sinus. The salt had been swallowed in a single tumbler of water, so that part of it was undissolved. Mr. Brande, who analyzed the sample which had been used, found it free of all the ordinary irritant poisons. Mr. Coward of Hoxton, to whom I owe the particulars of this singular case, was of opinion, along with other medical gentlemen concerned in it, that death arose from apoplexy brought on by the violent and unceasing vomiting. Another cathartic, undoubtedly in general very mild in its action, the _bitartrate of potash_, has also proved fatal, when taken in immoderate quantity. Thus, a man, endeavouring to quench his thirst and cool his stomach the morning after he had been drunk, ate a quarter of a pound of this salt in lumps at once, and a good deal more throughout the day afterwards. He was in consequence attacked with incessant vomiting, frequent purging, and other signs of irritation in the alimentary canal. He died on the third day; and the stomach and bowels were found much inflamed.[1614] Even _common salt_ has been known to act as a poison when taken in large quantity. A striking instance of the kind occurred in London in September, 1828. A man, who had been in the custom of exhibiting various feats of gluttony, proposed to some of his comrades one afternoon to sup a pound of _common salt_ in a pint of ale, and actually finished his nauseous dish, but not without being warned of his imprudence by an attack of vomiting in the middle of it. He was soon after seized with all the symptoms of irritant poisoning, and died within twenty-four hours. The stomach and intestines were found after death excessively inflamed.[1615] This remarkable case is not without its parallel. In 1839, a girl in the North of England died in consequence of taking upwards of half a pound of salt as a vermifuge.[1616] Not long ago I met with an instance of somewhat similar, but less violent effects. A student having taken upwards of two ounces of salt as an emetic, dissolved in a small quantity of water, was seized with acute burning pain in the stomach, tenderness in the epigastrium and great anxiety, without any vomiting until he drank a large quantity of warm water as a remedy. Before I saw him he had vomited freely, but still suffered severe, intermitting pain, which was removed by a large dose of muriate of morphia. In France, though not hitherto, so far as I know, in Britain, several instances have occurred of extensive sickness in particular districts, which have been traced to the accidental adulteration of _common salt_ with certain deleterious articles. In an investigation conducted by M. Guibourt, in consequence of several severe accidents having been produced apparently by salt in Paris and at Meaux, oxide of arsenic was detected;[1617] and this discovery was subsequently confirmed by MM. Latour and Lefrançois, who ascertained that the proportion of arsenic was sometimes a quarter of a grain per ounce.[1618] Another singular adulteration which appears fully more frequent is with hydriodate of soda. At a meeting of the Parisian Academy of Medicine in December, 1829, a report was read by MM. Boullay and Delens, subsequent to an inquiry by M. Sérullas, into the nature of a sample of salt which appears to have occasioned very extensive ravages. In 1829, various epidemic sicknesses in certain parishes were suspected to have arisen from salt of bad quality. In the month of July no less than 150 persons in two parishes were attacked, some with pain in the stomach, nausea, slimy and even bloody purging, others with tension of the belly, puffiness of the face, inflammation of the eyes and swelling of the legs; and in several parishes in the Department of the Marne a sixth part of the population was similarly affected. The salt being suspected to be the source of the mischief, as it had an unusual smell which some compared to the effluvia of marshy ground, M. Sérullas analyzed it, and after him MM. Boullay and Delens; and both analyses indicated the presence of a hundredth of its weight of hydriodate of soda, besides a little free iodine.[1619] Subsequently, in reference to the discovery of arsenic by other chemists in different samples of suspected salt, M. Sérullas repeated his analysis, but could detect none of that poison.[1620] Still more lately the whole subject has been investigated with great care by M. Chevallier.[1621] M. Barruel states that he observed the occasional adulteration of salt with some hydriodate accidentally in 1824, while preparing experiments for Professor Orfila’s lectures. He found it in two samples from different grocers’ shops in Paris.[1622] No satisfactory explanation has yet been given of the source of the adulteration with arsenic; but the presence of hydriodate of soda has been traced to the fraudulent use of impure salt from kelp [see p. 160]. Some difference of opinion prevails among toxicologists in regard to the alleged deleterious qualities of _alum_. On the whole it scarcely appears so active as to deserve the name of a poison; yet, like other salts, it may in large doses do serious injury. It merits particular mention among the present description of substances, partly on account of a trial at Paris, where dangerous effects were alleged to have been produced by it, and partly for the physiological inquiries made on that occasion. A druggist supplied a lady by mistake with powder of burnt alum instead of gum-arabic; and the lady, who had long laboured under chronic derangement of the stomach and bowels, took a single dose of a solution containing between ten and twenty grains of the salt. She immediately complained of acute pain in the stomach and gullet, burning in the mouth, and nausea; the symptoms of a severe attack of inflammation in the stomach and bowels ensued; and she was not considered out of danger for several days. The druggist was accordingly prosecuted, and heavy damages claimed. The attending physician ascribed the symptoms to the alum. But Marc and Orfila, who were consulted, declared that this was impossible except on the supposition that the lady had a very unusual sensibility of the stomach to irritating substances;—that it was a common thing to give three, four, and even five times the quantity in the treatment of diseases, without any such consequences resulting;—and that at the very time of the inquiry a physician in Paris was using it to the amount of six or eight drachms in a day. From an experimental inquiry conducted by Professor Orfila it appears, that large doses of calcined alum, such as one or even two ounces, excite in dogs little more than one or two attacks of vomiting, even although retained between ten and thirty minutes,—that one ounce will not excite any marked symptoms though secured in the stomach by a ligature,—but that two ounces given in the same way prove fatal in five hours, under symptoms of excessive exhaustion and insensibility.[1623] A similar inquiry was instituted about the same time by M. Devergie, who seems, however, to have remarked more activity in alum than is indicated by Orfila’s experiments. He infers that two ounces may sometimes kill dogs, even though they vomit freely; that half that quantity is fatal if the gullet be tied; that calcined alum is more active than a solution of the salt; that it is a corrosive or irritant; and that probably man is more sensible to its operation than the lower animals.[1624] Whatever may be thought of the effects of alum on the animal body when administered in large doses, it is plain from its frequent medicinal use as an internal astringent that it is not poisonous when given in small doses, like that taken by the patient in the trial alluded to. I may add that it appears very doubtful whether any injury accrues from the long-continued use of very small doses. Bakers, it is well known, are in the practice of using it in minute proportion for improving the whiteness of bread; and it has been imagined that chronic disorders of the stomach and bowels may consequently originate, by reason of its constipating tendency. These fears, however, are not borne out by facts. Either the quantity is insufficient to do harm in the way supposed; or the constitution becomes accustomed to the continual operation of the salt, and does not suffer.