CHAPTER IV.

ON POISONING WITH PHOSPHORUS AND THE OTHER BASES OF THE MINERAL ACIDS. _Of Poisoning with Phosphorus_.—The only other mineral acid that deserves mention is the phosphoric. It possesses properties nearly analogous, and hardly inferior to those of the three acids already mentioned. On its own account, however, it does not merit any notice here, since it is much too rare to be within reach of a person who intends to give or take poison. But it must be attended to, because it is formed in the course of the action of a more common poison, phosphorus. An attempt has actually been made to perpetrate murder by means of this substance. A woman at Mengshausen tried to poison her husband by putting into his soup a mixture of phosphorus, flour, and sugar, used for poisoning rats. But the soup having been kept warm on the stove, the man’s suspicions were excited by its phosphorescence, and phosphorus was detected in it.[318] Orfila found that two drachms of phosphorus given to dogs in fragments caused death in twenty-one hours, that the whole stomach and intestines were more or less inflamed, and that the phosphorus had lost much of its weight, though vomiting had been prevented by a ligature on the gullet; in fact the poison was partly oxidated. In a state of minute division, as when dissolved in oil, twenty-four grains caused death in less than five hours with all the symptoms of the most acute irritant poisoning; and after death the stomach was found extensively corroded, and perforated by two holes.[319] Other experimentalists have found that half a grain melted in hot water could kill a dog;[320] and that water, in which phosphorus had been simply received in the process for preparing it, proved in small quantities fatal to poultry.[321] There is no doubt, therefore, that phosphorus is a dangerous poison to animals. Its effects on man have not been often witnessed; but the observations hitherto made will show that it is not less injurious to him than to the lower animals. A grain and a half have actually proved fatal to man, as appears from a case mentioned by M. Worbe.[322] The subject of the case was a stout young man who took a grain and a half in hot water, after having previously taken half a grain without sustaining injury. In seven hours, and not till then, he was attacked with pain in the stomach and bowels, then with incessant vomiting and diarrhœa, excessive tenderness and tension of the belly,—all the symptoms in short of irritant poisoning; and he died exhausted in twelve days. Another fatal case somewhat similar in its circumstances has been related by M. Julia-Fontenelle.[323] An apothecary, after taking in one day first a single grain and then two grains of phosphorus without experiencing any particular effects, swallowed next day three grains at once in syrup. In the evening he felt generally uneasy, from a sense of pressure in the belly, which continued for three days; and then he was also seized with violent, continual vomiting of a matter which had an alliaceous odour. On the seventh day he had also spasms, delirium, and palsy of the left hand; and death speedily ensued.—Dr. Maier of Ulm relates a singular case occasioned by a portion of lucifer-match composition having been swallowed intentionally. Vomiting and pain in the belly ensued, then anxiety, restlessness, and excessive thirst, and death in about fifteen hours.[324]—M. Martin-Solon relates the case of a patient, affected with lead palsy, who having taken considerably less than a grain in the form of emulsion, was attacked with burning along the gullet and in the stomach, mucous vomiting, tenderness of the belly, general coldness and feebleness of the pulse. Afterwards the pulse became imperceptible, the limbs neuralgic, the intellect clouded, and the breathing stertorous; and he died in little more than two days.[325]—In the only other case I have hitherto found recorded death took place in forty hours, and the symptoms were violent pain in the stomach and continual vomiting, together with the discharge by clysters of small fragments of phosphorus, which were discovered by their shining in the dark, and subsequently by the appearance of burnt spots on the bed-linen. In this case, which is described by Dr. Flachsland of Carlsruhe,[326] the quantity of the poison taken was not ascertained. The patient, a young man, took it on bread and butter at the recommendation of a quack, to cure constipation, general debility, and impotence. At one time it was the custom to give small doses of phosphorus in medical practice; but the uncertainty and occasional severity of its operation have perhaps properly expelled it from most modern pharmacopœias. Among other properties ascribed to it in medicinal doses, it is said to be a powerful aphrodisiac: No such symptom occurred in the first of the fatal cases just related, or is mentioned in any of the others; but there is no doubt that medicinal doses sometimes produce it. As to the morbid appearances, the same changes of structure may be expected as in the instance of the mineral acids generally. In Worbe’s case quoted above, the skin was generally yellow, and here and there livid; the lungs gorged with blood; the muscular coat of the stomach inflamed, but the other coats not, except near the two extremities of the organ, where they were black. In Flachsland’s case much fluid blood was discharged from the first incisions through the skin of the belly; the omentum and outside of the stomach and intestines were red; the villous coat of the stomach presented an appearance of gangrenous inflammation (probably black extravasation only); the inner membrane of the duodenum was similarly affected; the great intestines were contracted to the size of the little finger; the mesenteric glands enlarged; and the kidneys and spleen inflamed. In Maier’s case the peritonæum and omentum were dry and vascular, the stomach and small intestines pale, the great intestines contracted, almost empty, brownish-red, and here and there inflamed, the liver large, and the blood everywhere liquid. The contents of the caput cœcum had an odour of phosphorus, and here were found two yellowish lumps weighing eight grains, which shone when rubbed, exhaled a phosphoric odour, and contained 0·6 of a grain of phosphorus. In Martin-Solon’s case the gullet was cherry-red and its epithelian brittle, the villous coat of the stomach grayish and brittle, the solid viscera in the abdomen soft, and the cerebral membranes congested. _Phosphorous acid_, the effects of which have been examined experimentally by Professor Hünefeld of Greifswalde, differs in its operation from phosphoric acid. Twenty-five grains had no effect on a rabbit; but a drachm caused difficult breathing, restlessness, bloody vomiting, slight convulsions, and death in twelve hours; and the stomach was found not much injured. The urine contained phosphoric acid.[327] _Of Poisoning with Sulphur._—It does not appear that sulphur, which resembles phosphorus in many particulars, bears any resemblance to it in physiological properties;—which may be ascribed to its not being susceptible of spontaneous acidification. It certainly possesses, however, slight irritating properties. It is often given as a purgative, which is sufficient to prove that it is not altogether inert; and the veterinary school at Lyons found that a pound killed horses by producing violent inflammation, recognizable during life by the symptoms, and after death by the morbid appearances.[328] _Of Poisoning with Chlorine._—Chlorine in its gaseous state acts powerfully as an irritant on the windpipe and lungs, and on that account will be noticed under the head of the poisonous gases. But even in solution it retains to a certain degree its poisonous qualities. Orfila says that five ounces of a strong solution of chlorine will kill a dog in twenty-four hours, if it is kept in the stomach by a ligature, and that two ounces diluted with twice its volume of water will prove fatal in four days;—that the symptoms are those of irritation of the stomach;—and that in the former case he found general redness and blackness—in the latter ulceration of its villous coat.[329] OF POISONING WITH IODINE. Iodine is a poison of more consequence than chlorine, both because it is becoming a more common article, and because it is more violent in its effects on the animal economy. _Tests of Iodine._—Iodine when pure is a solid substance easily known by its scaly form, its resemblance in colour and resplendence to polished iron, its peculiar odour, the violet fumes it forms when heated, and the fine blue colour it produces with a solution of starch. It is very sparingly soluble in water, but readily so in rectified spirit and in aqueous solutions of certain salts, more especially the iodide of potassium. Its ordinary forms in the shops are iodine itself, the tincture, and the compound solution, where the solvent is a solution of iodide of potassium in water. It stains the skin brownish-yellow; but the stain is not permanent. Its fumes are intensely irritating to the nostrils, throat, and lungs. When dissolved in water or in solutions of neutral salts, it communicates to the fluid a yellowish-brown or reddish-brown colour, which is destroyed by sulphuretted hydrogen, because the iodine is converted into hydriodic acid. In the colourless fluid thus formed, if treated with chlorine,—or in the original brown fluid without chlorine,—a solution of starch, obtained by ebullition and subsequently cooled, produces a fine blue colour and precipitate; and these, if the solution be sufficiently diluted, disappear on boiling, reappear on sudden cooling, and are removed permanently by a stream of sulphuretted hydrogen. This is a very delicate and characteristic system of tests. The best mode of using chlorine for decomposing hydriodic acid is to let it descend in the gaseous form from the mouth of a bottle of nitro-hydrochloric acid upon the fluid to be examined; In this way an excess is easily avoided, which bleaches out the blue colour. Sulphuric acid, though often recommended for the purpose, does not act unless it contains nitrous acid,—from which however the sulphuric acid of commerce is seldom quite free. When mingled with organic substances, the discovery of it is a matter of some nicety; because many substances of this nature, especially in the living body, quickly convert it into hydriodic acid.[330] Hence few cases can occur in medico-legal practice, where iodine will be discoverable in its free state. The following method of analysis will meet all possible cases. _Process for Compound Mixtures._—Add water if necessary, and filter. If either the fluid or solid part is little or not at all coloured, test it with cold solution of starch, assisting the action of the test on the solid part by trituration in a mortar. If a blue colour be struck, which disappears under ebullition, and reappears under refrigeration alone, or on subsequently allowing chlorine gas to descend on the surface of the fluid, there can be no doubt of the existence of iodine.—If the colour of the suspected mixture after filtration is so deep that the action of the starch cannot be expected to yield characteristic appearances, then both the solid and fluid parts should be agitated with a third of their volume of ether; and after the ethereal solution has arisen to the surface, it is to be removed and tested with solution of starch. The blue colour will be now perhaps struck, because the ether, in carrying off the iodine from the mixture, leaves many coloured organic principles behind. Should free iodine not be thus detected, strong presumptive evidence may still be procured of its actual presence, or of its having been at one time present, by continuing the examination with the view to detect hydriodic acid. This is described in p. 159. By following this method of analysis, I have found that one grain of iodine of potassium, which is equivalent to three-quarters of a grain of iodine, may be easily discovered in six ounces of urine,—a fluid as complicated as can well be conceived. The process adopted by Professor Orfila is so nearly the same with this, as scarcely to require being detailed. He uses nitric acid instead of chlorine for decomposing the hydriodic acid. Chlorine, however, is the most delicate reagent for the purpose, if it be used in the way described above. _Action of Iodine and Symptoms in Man._—Iodide has a twofold action, one local and irritating, the other general, and produced only when it has been administered long in frequent small doses. Orfila remarked that in doses of two drachms it excited in dogs symptoms of irritation in the stomach; that death slowly ensued in seven days, without the symptoms having ever become very violent; and that the villous coat of the stomach was here and there yellow, had also patches of yellow mucus lining it, and exhibited numerous little ulcers of a yellow colour. He could not observe much injury from iodine introduced into the cellular tissue; and more lately, Dr. Cogswell remarked that in this way it merely induces phlegmonous inflammation and the usual consequences.[331] An important circumstance in regard to the physiology and medical jurisprudence of this poison and its compounds is, that it may undoubtedly be detected in the blood, both when a single large dose has been taken, and in those persons who have used it for some time medicinally. Cantu, an Italian experimentalist, discovered iodine in such circumstances in the blood, sweat, urine, saliva and milk;[332] and Bennerscheidt, a German chemist, also found it in the blood, when it had been employed outwardly.[333] In the latter instance it could not be detected in the serum, but it was detected in the crassamentum by means of starch. Some interesting facts of the same nature have also been ascertained by Dr. O’Shaughnessey, from which it appears that even in acute poisoning with this substance, satisfactory proof of its administration may be procured several days afterwards by analysing certain secretions. In a dog poisoned with iodine, he detected the poison in forty minutes in the urine, and occasionally in the same secretion so late as the fifth day, when it died. It is singular, however, that he could not find it in the same quarter on the third day, although it existed at that time abundantly in the saliva.[334] In these experiments the iodine was always found in the form of hydriodic acid, having been converted into that compound in the alimentary canal. This change takes place with such rapidity, that on one occasion, in the vomited matter discharged by a dog fifteen minutes only after the administration of iodine, Dr. O’Shaughnessey could find no iodine, but a large quantity of hydriodic acid.[335] Orfila has found it not only in the urine, but likewise in the liver of animals.[336] Considerable uncertainty prevails as to the circumstances in which we may expect iodine to be detected in the organs or secretions of persons who have taken it. Thus it has been stated by an Italian physician, Dr. Cristin, that in many individuals affected with dropsy, struma, epilepsy, and other diseases, he had sought for iodine to no purpose in the urine, bronchial mucus, and other excretory fluids.[337] With regard to its operation on man, Orfila says, he has tried the effects of four or six grains on himself, and that he found this dose produce a sense of constriction in the throat, sickness, pain in the stomach, and at length vomiting and colic. There is no doubt, therefore, that in larger doses it will prove a dangerous irritant to man as well as to dogs. Accordingly, Dr. Gairdner has noticed the case of a child four years old, who died in a few hours after taking about a scruple in the form of tincture;[338] but he has not mentioned the symptoms. Dr. Jahn of Meiningen mentions a case where an over-dose produced violent pain in the belly, vomiting, profuse bloody diarrhœa, coldness and blanching of the skin, rigors, quivering of the sight and rapid pulse.[339] Two similar cases are related in a recent French journal; in one, which was produced by a drachm and a half of the ioduretted solution of hydriodate of potass, nausea, with acute pain and sense of burning in the pit of the stomach, followed immediately; in an hour there was vomiting of a yellowish matter which had the taste of iodine; excessive restlessness ensued, with headache, giddiness and paleness of the countenance; and these symptoms were not entirely dissipated for five days.[340] In the other case two drachms and a half of iodine were swallowed for the purpose of self-destruction. A sense of dryness and burning from the throat down to the stomach was immediately produced; lacerating pain in the stomach and fruitless efforts to vomit succeeded; and in an hour, when the relater of the case first saw the patient, there was suffusion of the eyes, excessive pain and tenderness of the epigastrium, and sinking of the pulse. Vomiting, however, was then brought on by warm water; copious yellow discharges, possessing the smell and taste of iodine, took place; and in nine hours the patient was well.[341] There is a singular uncertainty, however, in the action of one or more large doses. Magendie says he has taken two drachms of the tincture, containing about ten grains of iodine, without injury;[342] Dr. Gully, that he has given three times as much daily for some time; Dr. Kennedy, that he gave an average of twelve grains daily in the form of tincture for eighty days without observing any effect at all; and Mr. Delisser, that he has given a patient thirty grains in a day without injury.[343] Dr. Samuel Wright met with the case of an infant, not more than three years old, who took three drachms of the tincture at once, and suffered only from attempts to cough, some retching and much thirst.[344] It further appears that in medicinal doses, such as a quarter of a grain, frequently repeated, it is a dangerous poison, unless its effects are carefully watched. For in consequence of accumulation in the system, or gradually increasing action, it produces when long used some very singular and hazardous symptoms; and like mercury, foxglove, and some other poisons, it may be taken long without effect, and at length begin to operate suddenly. The symptoms which it then occasions are sometimes those of irritation; namely, incessant vomiting and purging, acute pain in the stomach, loaded tongue, rapid and extreme emaciation, violent cramps and small frequent pulse. These symptoms may continue many days, and even when subdued to a certain extent, vomiting and cramps are apt to recur for months after.[345] A fatal case of this form of affection has been related by M. Zink, a Swiss physician. His patient, after taking too large doses of iodine for about a month, was seized with restlessness, burning heat of skin, tremors, palpitation, syncope, excessive thirst, a sense of burning along the gullet, frequent purging of bilious and black stools, priapism, and tremulous pulse. The symptoms of local inflammation went off in a few days; but those of general fever continued; and he died after six weeks’ illness.[346] Another fatal case has been described in Rust’s Journal. The leading symptoms were pain in the region of the liver, loss of appetite, emaciation, quartan fever, diarrhœa, excessive weakness; and after the emaciation was far advanced a hardened liver could be felt. The patient appears to have died of exhaustion.[347] From this case, and another of which the appearances after death will be presently noticed, it is not improbable that iodine possesses the power of inflaming the liver. In another and more common affection, the patient is attacked with tremors, at first slight and confined to the fingers, afterwards violent and extending to the whole muscles of the arms and even of the trunk. At the same time there is excessive and rapidly increasing weakness, a sense of anxiety and sinking, a total suspension of the function of digestion, rapid and extreme muscular emaciation, tendency to fainting, and violent continued palpitation,[348] accompanied sometimes with absorption of the testicles in man, and of the mammæ in females. In the midst of these phenomena the curative powers of the poison over the disease for which it has chiefly been used, namely, goître, are developed. It has been remarked in particular, that the diminution of the goître keeps pace with the diminution of the breasts, though at times either effect has been developed without the other. An instance is related in Rust’s Journal of a female, whose breasts began to sink after she had used iodine for four months; and in four weeks hardly a vestige of them remained; but her goître was not affected.[349] An American physician, Dr. Rivers, has twice noticed barrenness apparently induced by the prolonged use of iodine; and as in these instances the females were young and previously very prolific, but ceased to bear children from the time the iodine was used, his observations seem worthy of attention.[350] Dr. Jahn[351] specifies among the leading effects of the poison when slowly accumulated in the body,—absorption of the fat,—increase of all the excretions,—dinginess of the skin, with frequent clammy sweat,—hurried anxious breathing,—diuresis and an appearance of oil floating in the urine,—increased discharge of fæces, which are unusually bilious, but free of mucus,—increased secretion of semen,—increased menstrual discharge,—swelling of the subcutaneous veins and lividity of the lips,—feebleness of the pulse, with superabundance of serosity in the blood,—impaired digestion and diminished secretion of saliva and mucus. This affection, which, in conformity with the name he has given it, may be termed Iodism [_Iodkrankheit_], he contrasts with mercurialism, the constitutional effect of the accumulation of mercury in the body; and he considers the former not more unmanageable than the latter. The dose required to produce these effects are very various. Some people appear almost insensible to its action; in one instance, nine hundred and fifty-three grains were taken in daily portions varying from two to eighteen grains, without any bad effect;[352] and I have known an average of four grains daily taken for fifteen months, with the effect only of increasing the appetite. On the other hand, Dr. Gairdner has seen severe symptoms commence when half a grain was taken three times a day for a single week;[353] and Coindet has seen bad effects from thirty drops of the solution of ioduretted hydriodate taken daily for five days.[354] Iodine and iodide of potassium in medicinal doses have been supposed by Dr. Lawrie to be capable of exciting in certain constitutions an affection resembling _cynanche laryngea_ in its symptoms, consisting of inflammation of the salivary glands, glottis, and other adjacent parts, and proving sometimes fatal.[355] This property is doubtful; but several instances have been published of profuse salivation and soreness of the mouth during a course of iodine; it is apt to cause chronic irritation of the Schneiderian membrane; and some think that it may affect in like manner the bronchial membrane in the lungs.[356] _Morbid Appearances from Iodine._—The only account I have seen of the appearances left in the body after death from slow poisoning with iodine is contained in the essay of Dr. Zink. In a second fatal case which came under his notice he found enlarged abdomen from distension of the intestines with gases, enlargement of the other viscera and serous effusion into the peritonæum; adhesion of the viscera to one another; redness of the intestines, in some places approaching to gangrenous discoloration; redness and excoriation of the peritonæal coat of the stomach, and also of its villous coat; enlargement and pale rose-red coloration of the liver. In the chest serum was found in the sac of the pleura. The gullet was contracted in diameter, and red internally. ON POISONING WITH IODIDE OF POTASSIUM. To these remarks on iodine a few observations may be added on the iodide of potassium, one of its compounds, which is now generally substituted in medicine for the simple substance. The tests and actions of this poison have been examined by M. Devergie; and more lately its medico-legal chemistry has been investigated by Dr. O’Shaughnessey and Professor Orfila. It is sold in the shops of various degrees of purity. Pure iodide of potassium is in white crystals, tending to the cubical form, permanent in the air, possessing a faint peculiar odour, and easily soluble in both water and rectified spirit. Another variety has the same form, but possesses an odour of iodine, is often yellowish in colour, and deliquesces slightly in moist air. This contains an excess of iodine, but may be otherwise pure. A third variety is impure. It presents less tendency to assume a crystalline form, is more or less deliquescent, dissolves but partially in alcohol, and when dissolved effervesces with acids. The principal ingredient in this article is carbonate of potass; and sometimes the proportion of iodide is inconsiderable. In one specimen I procured 74·5 per cent. of carbonate of potass, 16 of water, and only 9·5 of iodide of potassium. In the solid state the iodide of potassium may be known by the effect of strong sulphuric or nitric acid, which turns it brown with effervescence, and when aided by heat disengages violet fumes of iodine. In solution many tests will detect it, such as chlorine, nitric acid, corrosive sublimate, acetate of lead, protonitrate of mercury, muriate of platinum, and starch with chlorine or nitric acid. Chlorine or nitric acid forms a brown or orange-coloured solution by disengaging iodine. Corrosive sublimate forms a fine carmine-red precipitate, the biniodide of mercury; acetate of lead a fine yellow precipitate, the iodide of lead; protonitrate of mercury a yellow protiodide of mercury, which gradually fades into a dirty brown. Solution of starch, followed by chlorine in solution or in vapour, strikes a deep blue colour, which, if the fluid is sufficiently diluted, disappears on boiling, reappears on sudden cooling, and is permanently removed by a stream of sulphuretted hydrogen gases. Of these tests the most characteristic is starch with chlorine; and it is also extremely delicate. Too much chlorine however bleaches the blue colour away. In compound mixtures most and sometimes all of these tests are useless. If the mixture is deeply coloured, none will act characteristically. If carbonate of potass be present in such proportion as is often met with in the shops, the tests cannot be trusted to. _Process for Compound Mixtures._—The following method of analysis is applicable to all mixtures, organic and inorganic. Add water, if necessary, and filter; and if the fluid which passes through is tolerably free from colour, test a little of it with solution of starch and chlorine. If the colour is too deep to admit of this trial, or the test on trial does not act, unite the fluid and solid parts and transmit sulphuretted hydrogen to convert any free iodine into hydriodic acid. Drive off the excess of gas, supersaturate with a considerable excess of potass, filter, and evaporate to dryness. Char the residue at a low red heat in a covered crucible; pulverize the charcoaly mass, and exhaust with water. This solution will probably act characteristically with starch and chlorine; but on the whole it is better in the first instance to remove some of the salts by evaporating to dryness, and exhausting the residuum with alcohol. The alcoholic solution contains the hydriodate of potass, with some other salts; and on being evaporated to dryness, a residuum is left, on which, when dissolved in water, the starch and chlorine will act characteristically. No other test is necessary; and frequently no other test will act, on account of co-existing salts. I have found that a grain of iodide of potassium may thus be easily detected in six ounces of urine, which must be considered a very complicated fluid. In the solution ultimately procured nitrous acid struck a pale brown tint, and on the addition of solution of starch a dark-blue precipitate was formed; which, after being sufficiently diluted, disappeared under ebullition, leaving a colourless fluid. On cooling, no change took place; but on the subsequent addition of a drop of sulphuric acid, the blue colour and precipitation were immediately restored. No other reagent acted characteristically, although there was a sufficient quantity of solution to try the starch test ten times at least. Dr. O’Shaughnessey has proposed a more complex method by precipitation with chloride of platinum.[357] Professor Orfila says it is sufficient to boil and filter the suspected matter, and to heat first the liquid and then the solid part with solution of chloride, when violet vapours of iodine are disengaged, which may be condensed and subjected to various tests.[358] I have not compared this method with the one I have been in the practice of using; but, notwithstanding the strong assurances of its proposer, its superiority in point of delicacy seems dubious, although no one can deny its simplicity.[359] _Action and Symptoms in Man._—From the experiments of Devergie on animals, iodide of potassium seems to be in large doses an irritant, though not a powerful one. Two drachms in an ounce of water killed a dog in three days with violent vomiting, and signs of irritation were found in the stomach, namely, black extravasated spots and ulcers in the middle of them. A solution injected into the cellular tissue caused only local inflammation. Injected into the jugular vein in the dose of four grains, it produced tetanus and death in a minute and a half.[360] The latter investigations of Dr. Cogswell confirm essentially these results. Discrepant accounts have been given of the effects of iodide of potassium on man. When first introduced into medicine, it was conceived to be an active poison, not much inferior to iodine itself. Many however have since had an opportunity of observing that it is in general by no means so energetic. Its medicinal doses were gradually raised from one grain to five, ten, twenty grains; and at last Dr. Elliotson gave to not a few patients so much as two, four, or even six drachms daily in divided doses, without observing any remarkable effect.[361] These and other similar observations however were made at a period when the salt used in British practice was much adulterated, often indeed containing eighty or ninety per cent. of impurity; at the same time it does appear that large doses of a pure salt have been occasionally taken with impunity. On the other hand it has evidently in some instances acted with great force. Mr. Alfred Taylor mentions a case, on the authority of Mr. Ericksen, where five grains produced alarming dyspnœa, attended with inflammation of the nostrils and conjunctiva of the eyes.[362] An instance has been published where twelve grains in four doses occasioned shivering, vomiting, purging, general fever, and extreme prostration; and the purging continued for some days.[363] Dr. Moore Neligan informs me he met with the case of an elderly lady in 1841, who, on taking three five-grain doses for two days, while labouring under irregular gout, was seized with severe headache, thirst, and swelling of the face; which symptoms were succeeded in two days by swelling of the tongue, ulceration of the gums, and profuse salivation for a week. Dr. Lawrie says he has known two grains and a half given thrice in one day, followed by great dyspnœa and irritation in the throat; and is even inclined to think that death resulted on two occasions from repeated medicinal doses.[364] It would farther appear from some important researches made in France, that the protracted use of iodide of potassium in small doses with the food may produce serious derangement of the health,—swelling of the face, headache, urgent thirst, inflammation of the throat, violent colic pains, and frequently bloody diarrhœa. A disease characterized by the symptoms now described appeared repeatedly as an epidemic a few years ago in various parts of France, and spread so widely in one parish, that not less than a sixth of the whole population were attacked. After several careful investigations, it seems to have been fully proved that the affection was owing to the use of salt fraudulently adulterated with an impure salt, obtained from kelp after the separation of carbonate of soda, and consequently impregnated with an appreciable proportion of hydriodate of potass.[365] It is difficult to arrive at any satisfactory conclusions from these statements as to the nature and energy of the action of this salt as a poison. But on the whole it appears to be not in general very active; and the few instances of unusual activity which have occurred may probably be put to the account of idiosyncrasy. The most remarkable of its idiosyncratic effects from medicinal doses are salivation, and a series of symptoms which imitate sometimes catarrh, and sometimes a cold in the head. I do not know any facts to warrant the general statement of M. Devergie that 18 or 30 grains may constitute a fatal dose.[366] The present question is far from being unimportant in a medico-legal point of view. Mr. A. Taylor mentions the heads of a case, very dubious however in its nature, where it was suspected that a single dose of six grains of iodide of potassium had been the occasion of death.[367] It is important to remember in medico-legal researches, that iodide of potassium may be detected in the blood, liver, spleen, muscles, urine, and other textures and secretions; and especially that it may be found in the urine, when it may no longer exist in the alimentary canal or in vomited matters. These interesting facts have been clearly proved by the researches of Wöhler,[368] Stehberger,[369] O’Shaughnessey,[370] and Dr. Cogswell.[371] _Of Poisoning with Bromine._—This singular substance is not an object of much interest in relation to medical jurisprudence, because it is rare, and only to be met with in the laboratory of the chemist. Hence, although it appears to be a poison of some activity, it scarcely requires to be dwelt on particularly. It is easily known from all other substances by its fluidity, its great density, which is thrice as great as that of water, its reddish-brown colour by reflected, and blood-red colour by transmitted light, the orange fumes which occupy the upper part of a bottle partly filled with it, and its intensely acrid suffocating vapour, which is so irritating that an incautious inhalation is followed by all the phenomena of severe coryza and catarrh. Its odour, however, apart from its acridity, is very far from being so disagreeable as its discoverer in naming it seems to have imagined. In its properties it bears a close resemblance to chlorine and iodine. The toxicological effects and medico-legal relations of bromine have been examined by M. Barthez,[372] Dr. Butske,[373] Dr. Dieffenbach,[374] and Dr. M. Glover.[375] M. Barthez has given the following process for detecting bromine in compound mixtures, such as the contents of the stomach or vomited matter. First separate the fluid matter by filtration, and subject it to the action of chlorine, which will produce a fine orange colour. Should this effect not result, or the change of colour be observed by the deep tint of the fluid, treat the solid matter with solution of caustic potass; filter and add what passes through to the former fluid; evaporate to dryness and char by a red heat; act on the residue with distilled water. The solution contains the bromide of potassium, and is therefore turned orange-red by chlorine. The orange tint, whether struck at once in the fluid part of the mixture, or after carbonization and solution of the residue, is removed by agitation with ether; and the etherial solution of bromine in its turn loses colour when treated with solution of caustic potass, hydro-bromate of potass being again formed. M. Barthez found, that a solution of twelve grains injected into the jugular vein of a dog, sometimes occasioned immediate tetanus and death; and that the heart was gorged with clotted blood. Sometimes however even seventeen drops did not prove fatal, but produced merely restlessness, difficult breathing, dilated pupil, frequency of the pulse, and sneezing. Dieffenbach remarked similar effects in the rabbit: The animal either died immediately, or soon recovered altogether. In a cat, after the injection of twelve drops of a concentrated solution into its jugular vein, death took place in fifteen minutes; but in another from which a little blood was drawn after the symptoms were fully formed, complete recovery gradually ensued. Butske found a horse suffer so much from mortal prostration immediately after five grains dissolved in two ounces of water were injected into its jugular vein, that he supposed it was about to die; but it quickly revived, and ultimately got quite well. Dr. Glover obtained similar results. When recovery took place, the leading symptoms were panting, sneezing, discharge from the nostrils, rigors and debility. When introduced into the stomach of dogs, M. Barthez found that twenty drops on a full stomach had no particular effect; that thirty drops occasioned vomiting, and temporary acceleration of the pulse and breathing; and that from forty to sixty drops on an empty stomach brought on violent vomiting, sneezing, cough, dilated pupil and prostration, succeeded in a few hours by languor without any other symptom, and by death in four or five days. In the dead body he remarked numerous little ulcers of the villous coat, some of which had an ash-gray appearance at the bottom, while others were covered with a black slough, easily removed by friction. When the gullet was tied to prevent vomiting, less doses proved more quickly fatal. He likewise observed that the matter vomited in these experiments, even a few minutes after the administration of the poison, had no appearance or odour of bromine; whence it is reasonable to conclude, that, as in the instance of iodine, a chemical change takes place with the aid of certain vital operations, so that the bromine becomes hydrobromic acid.—The experiments of Dr. Butske assign to it more activity as a poison than those now related. For he found that a dog died in a day from taking only five grains dissolved in two ounces of water; and the symptoms were laborious breathing, loud cries, and convulsions. In the dead body he found the stomach internally chequered with bloody extravasation, and filled with bloody mucus, the duodenal mucous membrane universally injected, but the rest of the alimentary canal in a healthy state.—Dr. Glover remarked in such cases, besides the usual symptoms of an irritant action on the stomach, coryza, sneezing, salivation and difficult breathing. Sixty minims killed a cat in seventeen minutes, two fluid drachms a dog in five hours and a half, ten grains a rabbit in five minutes. A dog twice got twenty grains in solution and recovered, but died after a third dose of the same amount. Another got twenty grains in solution every two or three days for a month without injury. In some of these experiments hydrobromic acid was detected in the blood and urine. Little is yet known of the effects of bromine on man. Butske found that a drop and a half in half an ounce of water produced a sense of heat in the mouth, gullet, and stomach, and subsequently colic pains; and that two drops and a half in an ounce of mucilage excited, in addition to the preceding symptoms, great nausea, hiccup, and increased secretion of mucus. On the other hand M. Fournet, who gave doses gradually increasing from two to sixty drops daily for many weeks, observed that the lowest doses excited itching in the hands and feet, and sometimes colic; that an increase in the quantity caused heat in the chest and nausea; and that forty-five drops occasioned also severe burning and sense of acidity in the stomach, which however were temporary. The appetite was in general rather improved, and the body became more plump.[376]—Bromine appears on the whole to be a pure local irritant. It acts most energetically when most thoroughly dissolved in water. _Hydrobromic acid_ seems from the experiments of Dr. Glover to be a pure irritant and corrosive, allied in action and energy to hydrochloric acid. The same experimentalist found that _bromine of potassium_ in the dose of forty grains had sometimes little or no effect on dogs when injected into the blood-vessels, while in other instances less doses cause speedy death by paralysing the heart. Barthez observed that half a drachm in solution produced dulness and depression in dogs, but no other bad effect; and that two drachms retained in the stomach by tying the gullet occasioned death in three days with symptoms of irritant poisoning. M. Maillet observed that two ounces of this salt in the form of ointment, administered to a dog by rubbing it over his nose, and letting him lick it off and swallow it, had no effect whatever.[377]