Sir Robert Christison

“ Neither is there any difference in kind, as some imagine, between the lividity which succeeds death by poison, and that which follows natural death. Yet it is right for the medical jurist to be aware that lividity as a supposed consequence of poison ought to be strictly attended to by medical inspectors and law officers while investigating charges of poisoning, because the vulgar belief on the subject sometimes leads to such conduct or language on the part of the poisoner as betrays his secret at the time, and constitutes evidence of his guilt afterwards. ”

“ I have seen a wild-boar killed in the same manner with the third of a grain in ten minutes; and there is little doubt that half a grain thrust into a wound might kill a man in less than a quarter of an hour. ”

“ For my own part, I cannot help repeating, as the result of the whole inquiry, that simple cholera rarely causes death in this country, in the period within which irritant poisoning commonly proves fatal,—that, consequently, every case of the kind will naturally be apt to lead, in peculiar circumstances, to suspicion of poisoning,—and that in charges of poisoning, rapid death under symptoms of violent irritation in the alimentary canal, like those of cholera, must always be considered an important article of a chain of circumstantial or presumptive evidence. ”

“ But it is essential for the continuance of the heart’s action, that the breathing be speedily restored to a state of much greater perfection than that which attends the close of poisoning with opium. It is not improbable that the only ultimate cause of death from opium is suspension of the respiration, and that if it could be maintained artificially so as to resemble exactly natural breathing, the poison in the blood would be at length decomposed and consciousness gradually restored. ”

“ The only appearance of disease we could detect was a considerable tuberculation of the septum cordis and anterior parietes of both ventricles. This disease might have been the cause of death; for there is no disease of the heart which may not remain long latent, and prove fatal suddenly. But, as the man never had a symptom referrible to disease of the heart, it was impossible to infer, in face of a suspicion of poisoning, that it must have been the cause of death; since the man might very well have died of poison, the disease of the heart continuing latent. ”

“ I do not know of any parallel instance of death from arsenic, and cannot admit that the poison was the cause of the symptoms and fatal event.
Soon after the sickness begins, or about the same time, the region of the stomach feels painful, the pain being commonly of a burning kind, and much aggravated by pressure. Violent fits of vomiting and retching then speedily ensue, especially when drink is taken. There is often also a sense of dryness, heat, and tightness in the throat, creating an incessant desire for drink; and this affection often precedes the vomiting. ”

“ The affection of the throat and mouth precedes every other symptom when the poison is an active corrosive, and more particularly when it is either a fluid poison or is easily dissolved. Nay, sometimes burning pain of the mouth, throat, and gullet occurs during the very act of swallowing.—On the contrary if the poison is soluble with difficulty, and is only an irritant, not a corrosive, and still more if it is only one of the feebler irritants, the throat is frequently not affected sooner than the stomach, occasionally not at all. ”

“ When the sopor of apoplexy is completely formed, it is rarely possible to rouse the patient to consciousness, and never, I believe, where the risk of confounding apoplexy with poisoning is greatest,—in the cases where death happens neither instantly, nor after the interval of a day, but in a few hours. On the other hand, in many cases of poisoning with the narcotics, and particularly with the commonest variety, opium, the person may be roused from the deepest lethargy, if he is spoken to in a loud voice, or forcibly shaken for some time, or if water is injected into his ear. ”

“ A question has been recently started, whether all the processes for detecting lead in the tissues of the human body are not rendered fallacious by the alleged existence of lead in the healthy animal textures. In the first place, however, it is doubtful, as will be seen presently, whether lead ever exists naturally in the animal organs. But besides, the fallacy, if a real one, is obviated by the process of Orfila; who states that lead, naturally combined in the animal tissues, cannot be indicated by his method, if the animal matter be charred by nitric acid without deflagration. ”

“ Imaginary poisoning should rarely be the occasion of deception or embarrassment. The same wandering of the imagination which has led to a belief of injury from poison, will commonly also lead to such extravagant notions relative to the mode of administration and the symptoms, as will infallibly point out the true nature of the case to one who is well acquainted with the real effects of poisons. ”

“ There is little peculiarity in what is hitherto known of the symptoms of poisoning with tartar-emetic in man. Cases in which it has been taken to the requisite extent are rarely met with; and it has seldom remained long enough in the stomach to act deleteriously. But its action on animals would appear from the experiments of Magendie to be in some respects peculiar.
He found that dogs, like man, may take a large dose with impunity, for example half an ounce, if they are allowed to vomit; but that if the gullet is tied, from four to eight grains will kill them in a few hours. ”

“ 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. ”

“ But I am not aware, that, among the diseases which resemble well marked cases of poisoning either with irritants or with narcotics, any one ever originates in such a way as to render it possible for several persons in a family to be attacked simultaneously, except through the merest and therefore most improbable accident. Cholera perhaps is an exception. But when cholera attacks at one time several people living together, it arises from bad food, and is properly a variety of poisoning. ”

“ 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 ”

“ 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 ”

“ Internally, alcohol reddens the stomach, as it does the skin,—but more permanently; while other substances, such as the diluted mineral acids, arsenic, cantharides, euphorbium, and the like, may cause all the phenomena of inflammation in the stomach and intestines, namely, extravasation of blood, effusion of lymph, ulcers, gangrene. Many of these irritants, such as arsenic, are in common speech called corrosives; but they have not any power of causing chemical decomposition: if they produce a breach in the texture of an organ, it is merely through the medium of inflammation and its effects. ”

“ We have examples of local corrosion or chemical decomposition in the effects of the concentrated mineral acids or alkalis on the skin, and in the effects of strong oxalic acid, lunar caustic, or corrosive sublimate on the stomach. In all of these instances the part to which the poison is applied undergoes chemical changes, and the poison itself sometimes undergoes chemical changes also. Thus oxalic acid dissolves the gelatin of the animal textures; and in the instance of corrosive sublimate, the elements of the poison unite with the albumen, fibrin, and other principles of the tissues. ”

“ Conia is probably a deadly poison to all orders of animals: at least I found it to be so to the dog, cat, rabbit, mouse, frog, fly, and flea; and Geiger killed the kite, pigeon, sparrow, slow-worm, and earth-worm with it. It acts through every texture where absorption is carried on readily, through the stomach, eye, lungs, cellular tissue, peritonæum, or veins; and its activity is in proportion to the speed with which absorption is carried on in the part. It acts therefore through absorption. ”

“ 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. ”

“ 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. ”

“ It is of great consequence, however, to remark, that in cases of poisoning with opium, the medical jurist will seldom have the good fortune to operate even upon so large a proportion of the poison as in my experiments; because the greater part of it disappears from the stomach before death. This will not happen always, as may be seen from various cases mentioned afterwards in the section on the morbid appearances caused by opium. But, according to my own observations, the poison will often disappear in a short time, so far as to render an analysis abortive. ”

“ 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, on the other hand, M. Collard de Martigny has found that, if the human body be enclosed in an atmosphere of the gas, due precautions being taken to preserve the free access of common air to the lungs, the usual symptoms of poisoning with carbonic acid are produced, such as weight in the head, obscurity of sight, pain in the temples, ringing in the ears, giddiness, and an undefinable feeling of terror; and that if the same experiment be made on animals and continued long enough, death will be the consequence. ”

“ The effects of hydrocyanic acid on the animal system have been examined by several physiologists. The best experiments with the concentrated acid are those of M. Magendie; who says that, if a single drop be put into the throat of a dog, the animal makes two or three deep hurried respirations, and instantly drops down dead; that it causes death almost as instantaneously when dropped under the eyelid; and that when it is injected into the jugular vein, the animal drops down dead at the very instant, as if struck with a cannon ball or with lightning. ”

“ It is hardly necessary to add, that when the individual has survived the taking of the poison a considerable length of time, an odour of spirits will not be perceived either in the stomach or elsewhere. In the out-pensioner of Trinity Hospital, for example, who survived about twelve hours, no spirituous odour could any where be perceived. In such cases the poison disappears during life by absorption.—A question may even be entertained, whether the odour may not sometimes be imperceptible at the inspection of the body, although the poison was really present immediately after death. ”