Arsenic poisoning

“ Industrial Arsenic Poisoning.—In the extraction of arsenic and preparation of arsenious acid danger is present. But reliable accounts in literature of poisoning among those engaged in arsenic works are wanting.
Those engaged in roasting operations and packing suffer much from skin affections. Similar poisoning is reported in the smelting of other arsenical ores—nickel, cobalt, lead, copper, iron, and silver, from arsenic compounds present in the fumes. This is especially the case in the smelting of tin, which generally contains arsenical pyrites. ”

“ It is a curious fact that arsenic has been the favourite medium of female poisoners from very early times; and in two celebrated poisoning cases of later years, in both of which women were accused of murder by the administration of arsenic, the plea that the poison had been used by them for cosmetic purposes has been put forward to account for having it in their possession. The effect of arsenic on the skin is well known, and that it is frequently used, both internally and externally, to improve the skin, by women, is an undoubted fact. ”

“ When arsenic has been applied, during life, the redness, if it has had time to begin at all, extends to some distance from the points with which the poison has been in contact, and passes by degrees into the healthy colour of the surrounding membrane.
On reviewing what has been said of the pathological appearances 283caused by arsenic, it must appear that the medical jurist can never be supplied from this source alone with satisfactory evidence of the cause of death. But in some circumstances the evidence may amount to a strong probability of one variety or another of irritant poisoning. ”

“ The mouth, lungs and skin are the portals of entry for arsenic into the body. Arsenic poisoning is characterized by catarrhal inflammation of the eyes and respiratory tract, anemia, neuritis, gastritis, and degenerative changes in the liver and kidneys. Many of the symptoms of arsenic poisoning resemble those of lead poisoning such as gastric disturbances, anorexia, anemia and loss of strength. ”

“ There is no poison so liable and certain to be found as arsenic, and in almost every case of poisoning with mineral poisons, science is enabled to detect the substance, even when life has been extinct for years, and the body nearly decomposed.
What is arsenic?
Metallic arsenic is an exceedingly brittle metal, of a steel-gray color. It vaporizes, when heated, with a strong odor of garlic, a property not possessed by any other metal.
The substance used as poison, and sometimes known as ratsbane, is arsenious acid, a compound of arsenic and oxygen. ”

“ It is quite unnecessary to notice lividity of the skin among the signs of poisoning with arsenic, except for the mere purpose of reminding the medical jurist that, although it has been sometimes much relied on as a sign of death from arsenic, it is not of the slightest importance as a sign either of that or of any other kind of poisoning. ”

“ It is well to observe, that neither in these nor in other poison-eaters is there the least trace of an arsenic cachexy discernible; that the symptoms of a chronic arsenical poisoning never show themselves in individuals who adapt the dose to their constitution, even although that dose should be considerable. It is not less worthy of remark, however, that when, either from inability to obtain the acid, or from any other cause, the perilous indulgence is stopped, symptoms of illness are sure to appear, which have the closest resemblance to those produced by poisoning from arsenic. ”

“ Should the patient survive some days, no trace of arsenic may be found in the body, as the poison is rapidly eliminated by the kidneys. In all suspected cases the urine should be examined.
The symptoms of chronic poisoning by arsenic are loss of appetite, silvery tongue, thirst, nausea, colicky pains, diarrhœa, headache, languor, sleeplessness, cutaneous eruptions, soreness of the edges of the eyelids, emaciation, falling out of the hair, cough, hæmoptysis, anæmia, great tenderness on pressure over muscles of legs and arms, due to peripheral neuritis, and convulsions. ”

“ Such is an account of the symptoms of poisoning by arsenic in their most frequent form. It will of course be understood, that they are liable to a great variety as to violence, as well as their mode of combination in actual cases;—and that they are by no means all present in every instance. The most remarkable and least variable of them all, pain and vomiting, are sometimes wanting. A case, in which pain was not felt in the stomach, even on pressure, although the other symptoms of inflammation were present, has been briefly described in the Medical Repository. ”

“ After chronic poisoning a widely spread fatty degeneration is present. Arsenic is found in almost every part of the body, but is retained in largest amount by the liver, secondly by the kidneys. After death from chronic poisoning it is found present even in the brain and spongy bone. The detection of arsenic in criminal cases is effected either by Reinsch’s test or by Marsh’s test, the urine being the secretion analysed when available. ”

“ There are some trades where the dust given off acts not only as a mechanical irritant when breathed, but where the substance thus inhaled acts as a direct poison. For instance, manufacturers of white lead and other mineral paints frequently exhibit symptoms of poisoning in this way, and workmen who use arsenical compounds, as in the making of wall papers, artificial flowers, etc., are often the victims of poisoning by arsenic. ”

“ Stoklasa (1896, 1898) again found that phanerogamic plants can withstand arsenic poisoning for some time in the dark or in CO2-free air, provided that glucose is given in the food solution. The arsenic poisoning is at its maximum during carbon assimilation by means of chlorophyll. The toxic action of arsenious and arsenic acids, especially in phanerogams, is due to injury to the chlorophyll activity. The destruction of the living molecule is far more rapid in the chlorophyll apparatus than in the protoplasm of the plant cell. ”

“ The chronic form arises mainly from inhalation of minute quantities of metallic arsenic or its compounds in recovery from the ore, or from the use of arsenic compounds in the manufacture of colours, in tanyards, and in glass making. Acute industrial arseniuretted hydrogen poisoning is especially likely to occur where metals and acids react on one another and either the metal or the acid contains arsenic in appreciable amount. Further, arseniuretted hydrogen may be contained in gases given off in smelting operations and in chemical processes. ”

“ Arsenic is extraordinarily variable in its effects, as Dr. Randall mentioned, both on the dead body and on the living. Very anomalous cases of arsenic poisoning have been mistaken, during life, for opium poisoning. ”

“ Assuming arsenic to have been the cause of the preservation of the bodies, it becomes a point of consequence to account for its effect, and more particularly to reconcile that effect with what has certainly been noticed in other cases of poisoning with the same substance, namely, ordinary rapidity of decay, if not actually an increased tendency to putrefaction. ”

“ The second variety of poisoning with arsenic includes a few cases in which the signs of inflammation are far from violent or even altogether wanting, and in which death ensues in five or six hours or a little more,—at a period too early for inflammation to be always properly developed. The symptoms are then generally obscure, and are referrible chiefly to the mode of action, which is probably the cause of death in most cases,—a powerful debilitating influence on the circulation, or on the nervous system. ”

“ Jugglers often swallow arsenic with impunity, because, according to Dr Blondlot, they previously take the precaution to drink milk and eat fat bacon. Hence, in cases of poisoning by arsenic, oils and fatty substances may be administered as real antidotes, capable of suspending the action of the poison for a considerable time, until more radical means of effecting a cure can be applied. The people engaged in some of the arsenic-works regard salad oil as almost a certain antidote to this poison. ”

“ Orpiment, or yellow arsenic, one of the sulphurets of arsenic, has been used occasionally as a poison. It is also largely employed in the arts [Pg 289] for paper-staining and for colouring toys. In cases of arsenical poisoning, it is this compound that is commonly found adhering to the stomach and intestines. It is formed by the sulphuretted hydrogen, the result of decomposition, acting on the white arsenic swallowed.
Realgar
Realgar, or red arsenic, is another of the sulphurets of arsenic, and, like orpiment, is largely used in the arts as a colour. ”

“ Finely powdered arsenic is readily absorbed by the skin. There have been several deaths from the use of ‘violet powder’ contaminated with arsenic, and clothing containing powdered arsenic would produce poisonous effects. Then there are certain arsenical gases—notably arsine, or arseniureted hydrogen—which are intensely poisonous and which possibly account for a part of the symptoms in poisoning from arsenical wall-papers. There seemed to me to be some suggestion of arsenical gas in Monkhouse’s case, but it was obviously not pure gas-poisoning. ”

“ The poisoning of Perrotte Mace had also been accomplished by small doses. Arsenic was found after the strictest tests, which obviated all possibility that the substance could have come from the ground in which the body was interred.
In the case of Rose Tessier the tests yielded a huge amount of arsenic. Rose had died after an illness of only four days. The large amount of arsenic indicated a brutal and violent poisoning, in which the substance could not be excreted in the usual way. ”

“ And what was even more impressive, those symptoms seemed to be closely comparable with Monkhouse’s symptoms, particularly in the suggestion of a mixed poisoning partly due to minute doses of arsine. I need not go into details, but you will remember that you make occasional references to slight attacks of jaundice (which is very characteristic of arsine poisoning) and to ‘eye-strain’ which the spectacles failed to relieve. But redness, smarting and watering of the eyes is an almost constant symptom of chronic arsenic poisoning. ”

“ As to the purchase of arsenic under the false pretence of poisoning rats, it may be observed, that a great deal more stress is usually laid on such evidence than it seems to deserve; for there are few houses, in the country particularly, which are not more or less infected by them. On the other hand, too little weight is attached to the circumstance of the purchaser not having warned his household of poison being laid. ”

“ Most vegetable and animal poisons prove fatal either in a few days or not at all; but some mineral poisons may cause death after an interval of many days. It appears probable that arsenic may cause death after an interval of several months, and it is well ascertained that the symptoms of poisoning with the mineral acids have continued uninterruptedly and without modification for eight months, and then terminated fatally. ”

“ The poisons included in this order are the oxides and salts of arsenic, mercury, copper, antimony, tin, silver, gold, bismuth, iron, chrome, zinc, barium, lead. Many other metals also form poisonous compounds with various acids and other bodies; but these are so rare as to be merely objects of physiological curiosity.
Of all the varieties of death by poison, none is so important to the medical jurist as poisoning with arsenic. ”

“ The suggestion that deceased might have taken the poison voluntarily is highly improbable in three respects. First, since deceased was mostly bed-ridden, it would have been almost impossible for him to have obtained the poison. Second, there is the nature of the poison. Arsenic has often been used for homicidal poisoning but seldom for suicide ”

“ Several very curious experiments on the poisoning of vegetables, have recently been made by M. Marcet, of Geneva.—His experiments on arsenic, which is well known to every one as a deadly poison to animals, were thus conducted. A vessel containing two or three bean plants, each of five or six leaves, was watered with two ounces of water, containing twelve grains of oxide of arsenic in solution. ”

“ Arsenic may induce at first inflammation of the alimentary canal, and afterwards palsy or epilepsy; nux-vomica may excite at first violent tetanus, and afterwards inflammation of the stomach and bowels; and corrosive sublimate, after exciting in the first instance inflammation, may prove eventually fatal by inducing excessive ptyalism. In truth, certain changes of this kind in the nature of the symptoms will, in special cases, afford strong presumption, perhaps absolute proof, not only of general poisoning, but even also of the particular poison given. ”

“ But modern authors appear to have overstepped the mark, when they hold that the rule against deciding from symptoms does not admit of any exceptions. For there are cases of poisoning with arsenic, not numerous certainly, yet not very uncommon neither, which can hardly be confounded with natural disease; and, what is of some consequence, they are precisely those in which the power of deciding from symptoms alone is most required, because chemical evidence is almost always wanting. ”