Alexander Wynter Blyth

“ The blood, the liver, and the contents of the stomach were exhaustively analysed with the greatest care, but no trace of morphine, narcotine, or meconic acid could be separated, although the woman did not live more than six hours after taking the draught. I gave the opinion that it was, in the woman’s state, improper to prescribe a sedative of that kind, and that probably death had been accelerated, if not directly caused, by opium.
Deaths by apoplexy will only simulate opium-poisoning during life; a post-mortem examination will at once reveal the true nature of the malady. ”

“ As death takes place from an asphyxiated condition, the veins of the head and brain, and the blood-vessels of the liver, kidney and spleen, are gorged with blood, and the right side of the heart distended, while the left is empty. On the other hand, a person may die of sudden nervous shock from the ingestion of a large quantity of the acid, and in such a case the post-mortem appearances will not then exhibit precisely the characters just detailed. Putrefaction is retarded according to the dose, and there is often a smell of carbolic acid. ”

“ If, however, organic matters are specially searched for lead, hydrochloric acid is not the best solvent, but nitric should always be preferred; and, if there is reason to think that the lead exists in the form of sulphate, then the proper solvent is either the acetate or the tartrate of ammonia; but, in either case, the solution should contain an excess of ammonia. It must, however, be remembered that organic matters retain lead with great tenacity, and that in all cases where it can with any convenience be effected, the substances should be not only carbonised, but burnt to an ash ”

“ A far greater number of cases of poisoning by phosphorus occur yearly in France and Germany than in England. Phosphorus may be [216] considered as the favourite poison which the common people on the Continent employ for the purpose of self-destruction. It is an agent within the reach of anyone who has 2 sous in his pocket, wherewith to buy a box of matches, but to the educated and those who know the horrible and prolonged torture ensuing from a toxic dose of phosphorus, such a means of exit from life will never be favoured. ”

“ However, when we come to the blood of persons suffering from disease, there are changes in the diameter and even the form of the corpuscles which much complicate the matter; while, in blood-stains of any age, the blood-corpuscles, even with the most artfully-contrived solvent, are so distorted in shape that he would be a bold man who should venture on any definite conclusion as to whether the blood was certainly human, more especially if he had to give evidence in a criminal case. ”

“ Detection of Antimony in Organic Matters.—In acute poisoning by tartar emetic it is not impossible to find a mere trace only in the stomach, the greater part having been expelled by vomiting, which nearly always occurs early, so that the most certain method is, where possible, to analyse the ejected matters. If it should be suspected that a living person is being slowly poisoned by antimony, it must be remembered that the poison is mainly excreted by the kidneys, and the urine should afford some indication. ”

“ It may, however, be shortly said, that the most common changes are fatty infiltration of the liver and kidneys, fatty degeneration of the heart, enlargement of the liver, ecchymoses in the serous membranes, in the muscular, in the fatty, and in the mucous tissues. When death occurs before jaundice supervenes, there may be little in the aspect of the corpse to raise a suspicion of poison; but if intense jaundice has existed during life, the yellow staining of the skin, and it may be, spots of purpura, will suggest to the experienced pathologist the possibility of phosphorus poisoning. ”

“ The external application of oxalic acid does not appear to cause illness; workmen engaged in trades requiring the constant use of the acid often have the nails white, opaque, and brittle; but no direct injury to health is on record.
A large dose of either causes a local and a remote effect; the local is very similar to that already described as belonging to the mineral acids, i.e., more or less destructive of the mucous membranes with which the acid comes in contact. The remote effects may only be developed after a little; they consist essentially of a profound influence on the nervous system. ”

“ It was the custom of the Romans to drink hot water, a draught nauseous enough to us, but, from fashion or habit, considered by them a luxury; and, as no two men’s tastes are alike, great skill was shown by the slaves in bringing the water to exactly that degree of heat which their respective masters found agreeable. ”

“ In poisoning by laudanum there may be some remaining in the stomach, and also if large doses of morphine have been taken by the mouth; but when morphine has been administered hypodermically, and in all cases in which several hours have elapsed, one may almost say that the organ in which there is the least probability of finding the poison is the stomach. It may, in some cases, be necessary to operate on a very large scale;—to examine the fæces, mince up the whole liver, the kidney, spleen, and lungs, and treat them with acid alcohol. ”

“ The upper layers of the epithelium are also often dyed with the colouring-matter of the blood, which has been dissolved out by the cyanide. This last change is a post-mortem effect, and can be imitated by digesting the mucous membrane of a healthy stomach in a solution of cyanide. The intensity of these changes are, of course, entirely dependent on the dose and emptiness of the stomach. If the dose is so small as just to destroy life, there may be but little redness or swelling of the stomach, although empty at the time of taking the poison. ”

“ Local Action.—When strong nitric acid comes in contact with organic matters, there is almost constantly a development of gas. The tissue is first bleached, and then becomes of a more or less intense yellow colour. Nitric acid spots on the skin are not removed by ammonia, but become of an orange-red when moistened with potash and a solution of cyanide of potassium. The yellow colour seems to show that picric acid is one of the constant products of the reaction; sulphide of ammonium forms a sort of soap with the epidermis thus attacked, and detaches it. ”

“ The symptoms produced by the sulphate of copper are those of a powerful irritant poison: there is immediate and violent vomiting; the vomited matters are of a greenish colour—a green distinguished from bile by the colour changing to blue on the addition of ammonia. There is pain in the stomach, and in a little time affections of the nervous system, as shown by spasms, cramps, paralysis, and even tetanus. Jaundice is a frequent symptom, if life is prolonged sufficiently to admit of its occurrence. ”

“ If lethal, but not excessive doses of the diluted acid are taken, the symptoms are—a burning in the mouth and throat, a peculiarly unpleasant persistent taste, and vomiting. There is faintness with pallor of the face, which is covered by a clammy sweat, and the patient soon becomes unconscious, the pulse small and thready, and the pupils sluggish to light. The respiration is profoundly affected; there is dyspnœa, and the breathing becomes shallow. Death occurs from paralysis of the respiratory apparatus, and the heart is observed to beat for a little after the respiration has ceased. ”

“ Atropine and belladonna invariably dilate the pupil, and although just before death opium has the same effect, yet we must hold that mostly opium contracts, and that a widely-dilated pupil during life would, per se, lead us to suspect that opium had not been used, although, as before mentioned, too much stress must not be laid upon the state of the pupils. In carbon oxide, the peculiar rose-red condition of the body affords a striking contrast to the pallor which, for the most part, accompanies opium poisoning. ”

“ Binz has advanced a new and original theory as to the action of arsenious acid; he considers that the protoplasm of the cells of many tissues possess the power of oxidising arsenious acid to arsenic acid, and this arsenic acid is again, by the same agency, reduced to arsenious acid, in this way, by the alternate oxidation and reduction of the arsenious acid, the cells are decomposed, and a fatty degeneration takes place. Thus arsenic causes fatty changes in the liver, kidney, and other cells by a process analogous to the action of phosphorus. ”

“ However brief and imperfect the foregoing historical sketch of the part that poison has played may be, it is useful in showing the absolute necessity of a toxicological science—a science embracing many branches of knowledge. ”

“ There is destruction of tissue, not necessarily deep, for the acid is almost immediately wiped off; but if any should reach the eye, inflammation, so acute as to lead to blindness, is the probable consequence. The skin is coloured at first white, at a later period brown, and part of it may be, as it were, dissolved. If the tract or skin touched by the acid is extensive, death may result. ”

“ If by treating a complex liquid with ammonium hydrosulphide, sulphides of zinc, manganese, and iron are thrown down mixed with chromic oxide, the same principles apply. If a chromate is present in the contents of the stomach, and the organic fluid is treated with hydrochloric acid and potassic chlorate, chromic chloride is formed, and dissolving imparts a green colour to the liquid—this in itself will be strong evidence of the presence of a chromate, but it should be supplemented by throwing down the oxide, and transforming it in the way detailed into potassic chromate. ”

“ The only certain method of detection is to produce the sulphide of zinc, best effected by saturating a neutral or feebly acid liquid with hydric sulphide. If an organic liquid, which can be easily filtered, is operated upon, it may be strongly acidulated with acetic acid, and at once treated with hydric sulphide. If, however, zinc is sought for as a part of a systematic examination (as will most likely be the case) , the solution will have been treated with hydrochloric acid, and already tested for arsenic, antimony, lead, &c., and filtered from any precipitate. ”

“ In default of pathological knowledge, the ancients attached great importance to mere outward marks and discolorations. They noted with special attention spots and lividity, and supposed that poisons singled out the heart for some quite peculiar action, altering its substance in such a manner that it resisted the action of the funeral pyre, and remained unconsumed. It may, then, fairly be presumed that many people must have died from poison without suspicion, and still more from the sudden effects of latent disease, ascribed wrongfully to poison. ”

“ In the next stage, the narcosis deepens into dangerous coma; the patient can no longer be roused by noises, shaking, or external stimuli; the breathing is loud and stertorous; the face often pale; the body covered with a clammy sweat. The pupils are still contracted, but they may in the last hours of life dilate: and it is generally agreed that, if a corpse is found with the pupils dilated, this circumstance, taken in itself, does not contra-indicate opium or morphine poisoning. Death occasionally terminates by convulsion. ”

“ Cyanogen also colours nicotine brown; the product out of alcohol is not crystalline. Platin chloride throws down a reddish crystalline precipitate, soluble on warming; and gallic acid gives a flocculent precipitate. A drop of nicotine poured on dry chromic acid blazes up, and gives out an odour of tobacco camphor; if the ignition does not occur in the cold, it is produced by a gentle heat. It is scarcely possible to confound nicotine with ammonia, by reason of its odour; and, moreover, ammonia may always be excluded by converting the base into the oxalate, and dissolving in absolute alcohol. ”

“ It has been noticed that, with great relaxation of the muscular system, the patients complain of every movement causing pain. With these general symptoms added to the local injury, death may follow many days after the swallowing of the fatal dose.
Death may also occur simply from the local injury done to the throat and larynx, and the patient may linger some time. Thus, in a case quoted by Taylor, [121] in which none of the poison appears actually to have been swallowed, the man died nineteen days after taking the poison from inflammation of the throat and larynx. ”

“ The use of the stomach-pump is inadvisable, for the mucous membrane of the gullet may be so corroded by the acid that the passage of the tube down will do injury; unless the neutralisation is immediate, but little good is effected; hence it will often occur that the bystanders, if at all conversant with the matter, will have to use the first thing which comes to hand, such as the plaster of a wall, &c.; and lastly, if even these rough antidotes are not to be had, the best treatment is enormous doses of water, which will dilute the acid and promote vomiting. ”

“ Alcohol and ether dissolve nicotine in every proportion; if such solutions are distilled, nicotine goes over first. The salts which it forms with hydrochloric, nitric, and phosphoric acids crystallise with difficulty; tartaric and oxalic acid form white crystalline salts, and the latter, oxalate of nicotine, is soluble in alcohol, a property which distinguishes it from the oxalate of ammonia. The best salts are the oxalate and the acid tartrate of nicotine, from which to regenerate nicotine in a pure state. ”

“ On the Continent grooms have been known to put a piece of arsenic, the size of a pea, in a little oatmeal, make it into a ball, tie it up in a linen rag, and attach it to the bit; the saliva dissolves, little by little, the poison, while both the gentle irritation and physiological action excite a certain amount of salivation, and the white foam at the mouth, and the champing of the horse, are thought vastly to improve the appearance. ”

“ Wasps, &c.—Wasps, bees, and hornets all possess a poison-bag and sting. The fluid secreted is as clear as water, and of an acid reaction; it certainly contains formic acid, with some other poisonous constituent. An erysipelatous inflammation generally arises round the sting, and in those cases in which persons have been attacked by a swarm of bees, signs of general poisoning, such as vomiting, fainting, delirium, and stupor, have been noticed. ”

“ Matthieu Joseph Bonaventura Orfila must be considered the father of modern toxicology. His great work, Traité de Toxicologie, was first published in 1814, and went through many editions. Orfila’s chief merit was the discovery that poisons were absorbed and accumulated in certain tissues—a discovery which bore immediate fruit, and greatly extended the means of seeking poisons. Before the time of Orfila, a chemist not finding anything in the stomach would not have troubled to examine the liver, the kidney, the brain, or the blood. ”

“ The habitual consumption of opium by individuals has a direct medico-legal bearing. Thus in India, among the Rajpoots, from time immemorial, infused opium has been the drink both of reconciliation and of ordinary greeting, and it is no evidence of death by poison if even a considerable quantity of opium be found in the stomach after death, for this circumstance taken alone would, unless the history of the case was further known, be considered insufficient proof. ”

“ A remarkable course not known with any other narcotic is that in which the symptoms remit, the person wakes up, as it were, moves about and does one or more rational acts, and then suddenly dies. In this case also, the death is not directly due to alcohol, but indirectly—the alcohol having developed œdema, pneumonia, or other affection of the lungs, which causes the sudden termination when the first effect of the poison has gone off. The time that may elapse from the commencement of coma till death varies from a few minutes to days ”

“ Shock may at once occur, and the patient die from collapse; but this, even with frightful destruction of tissue, appears to be rare. Vomiting supervenes; what is ejected is strongly alkaline, and streaked with blood, and has a soapy, frothy appearance. There may be diarrhœa, great tenderness of the abdomen, and quick pulse and fever. With caustic potash, there may be also noticed its toxic effects (apart from local action) on the heart; the pulse, in that case, is slow and weak, and loss of consciousness and convulsions are not uncommon. ”

“ If a small quantity of an ammoniacal solution of ferrous tartrate or citrate be added to blood containing carbon oxide, the bands do not wholly fade, but persist more or less distinctly; whereas, if the same solution is added to bright red normal blood, the two bands vanish instantly and coalesce to form the spectrum of reduced hæmoglobin. When either a solution of hæmoglobin or blood is exposed to the air for some time, it loses its bright red colour, becomes brownish-red, and presents an acid reaction. ”

“ In any case of external application, if death ensues directly from the poison, evidence of its presence will probably be found; but too much stress must not be laid upon the detection of mercury, for, as Dr. Taylor says, “Nothing is more common than to discover traces of mercury in the stomach, bowels, liver, kidneys, or other organs of a dead body.” ”

“ Insensibility from chloral, from alcohol, from belladonna or atropine, and from carbon oxide gas, are all more or less like opium poisoning. With regard to chloral, it may be that only chemical analysis and surrounding circumstances can clear up the matter. In alcohol poisoning, the breath commonly smells very strongly of alcohol, and there is no difficulty in separating it from the contents of the stomach, &c., besides which the stomach is usually red and inflamed. ”