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NARCOTICS AND NARCOTICO-IRRITANTS.

the coats of the stomach and intestines, it irritates and inflames others. So again, most corrosive poisons may lose their corrosive properties by dilution with water, and then they act simply as irritants. This is the case with the mineral acids, and bromine. In some instances, it is not easy to say whether an irritant poison possesses corrosive properties or not. Thus oxalic acid acts immediately, and blanches and softens the mucous membrane of the mouth and fauces, but I have never met with any decided marks of what could be called chemical corrosion produced by it in the stomach or viscera. Irritant poisons, for the most part, belong to the mineral kingdom; and they may be divided into the nonmetallic and metallic irritants. There are a few derived from the animal and vegetable kingdom; but these are not very often employed criminally. Some of the gases likewise belong to the class of irritant poisons.

Narcotic Poisons.-Narcotic poisons have their operation confined to the brain and spinal marrow. Either immediately or some time after the poison has been swallowed, the patient suffers from cephalalgia, vertigo, paralysis, coma, and in some instances tetanus. They have no acrid burning taste like the corrosive irritants; and they very rarely give rise to vomiting or diarrhoea. When these symptoms follow the ingestion of the poison into the stomach, the effect may be generally ascribed either to the quantity in which the poison has been taken, and the mechanical effect on the stomach thereby produced, or to the poison being combined with some irritating substance, such as alcohol. The pure narcotics are not found to irritate or inflame the viscera.

Notwithstanding the well defined boundary thus apparently existing between these two classes of poisons, it must not be supposed that each class of bodies will always act in the manner indicated. Some irritants have been observed to affect the brain or the spinal marrow remotely. This is the case with oxalic acid and arsenic. Both of these common poisons have in some instances given rise to symptoms closely resembling those of narcotic poisoning; namely, coma, paralysis, and tetanic convulsions. In a case of poisoning by arsenic which occurred to Dr. Morehead, of Bombay, the symptoms of narcotism were so strongly marked that it was believed at first that the man had taken a narcotic. (Med. Gaz. vol. xliii. p. 1055.) I have met with one case of poisoning by arsenic in which there was paralysis of the extremities, with an entire absence of purging, during the eight days which the deceased survived. On the other hand, in the chapter on opium, a case of poisoning by a large dose of this drug will be found related, in which there was an absence of the usual symptoms of cerebral disturbance, and the presence of others resembling those of irritant poisoningnamely, pain and vomiting. Thus, then, we must not allow ourselves to be deceived by the idea that the symptoms are always clearly indicative of the kind of poison taken. The narcotic poisons are few in number, and belong to the vegetable kingdom. Some of the poisonous gases possess a narcotic action.

Narcotico-Irritants.-Poisons belonging to this class have, as the name implies, a compound action. They are chiefly,derived from the vegetable kingdom. At variable periods after they have been swallowed they give rise to vomiting and purging like irritants; and sooner or later produce stupor, coma, paralysis and convulsions, owing to their effect on the brain and spinal marrow. They possess the property, like irritants, of irritating and inflaming the alimentary canal. As familiar examples we may point to nux vomica, monkshood, and poisonous mushrooms. This class of poisons is very numerous, embracing a large variety of well known vegetable substances; but they rarely form a subject of difficulty to a medical practitioner. The fact of the symptoms occurring after a meal at which some of the suspicious vegetables may have been eaten, coupled with the nature of the symptoms themselves, will commonly indicate the class to which the poison belongs. Some narcotico-irritants have a hot acrid taste, such as the aconite or monkshood; others, an intensely bitter taste, as nux vomica and its alkaloid, strychnia.

EVIDENCE OF POISONING IN THE LIVING.

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CHAPTER II.

EVIDENCE OF POISONING IN THE LIVING SUBJECT-SYMPTOMS OCCUR SUDDENLY-MODIFYING CONDITIONS-ACTION OF POISONS INCREASED OR DIMINISHED BY DISEASE-SYMPTOMS CONNECTED WITH FOOD OR MEDICINE-SUDDEN DEATH FROM NATURAL CAUSES MISTAKEN FOR POISONING SEVERAL PERSONS ATTACKED SIMULTANEOUSLY-EVIDENCE FROM THE DETECTION OF POISON IN FOOD.

WE shall next proceed to consider the evidence of poisoning in the living subject. To the practitioner the diagnosis of a case of poisoning is of very great importance, as by mistaking the symptoms produced by a poison for those arising from natural disease, he may omit to employ the remedial measures which have been found efficacious in counteracting its effects, and thus lead to the certain death of the patient. To a medical jurist a correct knowledge of the symptoms furnishes the chief evidence of poisoning, in those cases in which persons are charged with the criminal administration of poison with intent to murder, but from the effects of which the patient ultimately recovers. The symptoms produced during life constitute also an important part of the evidence, in those instances in which the poison proves fatal. At present, however, we will suppose the case to have been, that poison has been taken and the patient survives. Most toxicological writers have laid down certain characters whereby it is said symptoms of poisoning may be distinguished from those of disease.

1. In poisoning, the symptoms appear suddenly, while the individual is in health. It is the common character of most poisons, when taken in the large doses in which they are usually administered with criminal intent, to produce serious symptoms either immediately or within a very short period after they have been swallowed. Their operation, under such circumstances, cannot be suspended, and then manifest itself after an indefinite interval; although this was formerly a matter of universal belief, and gave rise to many absurd accounts of what was termed slow poisoning.

The symptoms of poisoning by prussic acid, oxalic acid, or strychnia, appear immediately, or within a very few minutes after the poison has been swallowed. In one case, however, where the dose of prussic acid was small, and insufficient to produce death, the poison was supposed by the patient not to have begun to act until after the lapse of fifteen minutes. (Ed. Med. and Surg. Journ. lix. 72.) The symptoms caused by arsenic and other irritants, and, indeed, by all poisons/ generally, are commonly manifested in from half an hour to an hour. It is rare that the appearance of symptoms is protracted for two hours, except under certain peculiar states of the system. It is said that some narcotico-irritant poisons, such as the poisonous mushrooms, may remain in the stomach twelve or twenty-four hours without giving rise to symptoms; and this is also affirmed to be the case with some animal irritants, such as decayed meat; but with regard to the first point, it has been shown by Dr. Peddie that mushrooms may produce symptoms in half an hour; and a case has fallen under my own observation, where the symptoms from noxious food came on within as short a time after the meal as is commonly observed in irritant poisoning by mineral substances. In cases of poisoning by phosphorus, the symptoms do not commonly begin until after the lapse of many hours.

Modifying conditions. Influence of disease.-A diseased state of the body may render a person comparatively unsusceptible of the action of some poisons, while in other instances it may increase their action, and render them fatal in small doses. In dysentery and tetanus, a person will take, without being materially affected, a quantity of opium sufficient to kill an adult in average health. Mania,

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SUDDEN OCCURRENCE OF SYMPTOMS.

cholera, hysteria, and delirium tremens, are also diseases in which large doses of opium may be borne with comparative impunity. In a case of hemiplegia, a woman, æt. 29, took, for six days, three grains of strychnia daily without injurious consequences-the dose having been gradually raised (Gaz. Méd. Mai, 1845;) while one grain of strychnia is commonly regarded as a fatal dose to a healthy person. In a case of tetanus, Dupuytren gave as much as two ounces of opium at a dose (60 grammes,) without serious consequences. (Flandin, Traité des Poisons, i. 231.) It has also been remarked that persons affected with tetanus are not easily salivated by mercury. (Colles' Lectures, i. 77.) The effect of certain diseases of the nervous system as well as of habit, either in retarding the appearance of symptoms, or in blunting the operation of a poison, it is not difficult to appreciate; and they are cases which can present no practical difficulty to a medical jurist. On the other hand, in certain diseased states of the system, there is an increased susceptibility of the action of poison. Thus, in those persons who have a disposition to apoplexy, a small dose of opium may act more quickly and prove fatal. In a person labouring under inflammation of the stomach or bowels, there would be an increased susceptibility of the action of arsenic or other irritants. One of the most remarkable instances of the influence of disease in increasing the operation of poison, is perhaps seen in cases of diseased kidney (granular degeneration,) in which very small doses of mercury have been observed to produce severe salivation, leading to exhaustion and death. A knowledge of this fact is of importance in reference to charges of malapraxis, when death has arisen from ordinary doses of calomel administered to persons labouring under this disease.

Symptoms appear during a state of health.-Symptoms of poisoning often manifest themselves in a person while in a state of perfect health, without any apparent cause. This rule is, of course, open to numerous exceptions, because the person on whose life the attempt is made may be actually labouring under disease; and, under these circumstances, the symptoms of poisoning are so obscure as often to disarm all suspicion. When poison is exhibited in medicine, a practitioner is very liable to be deceived, especially if the disease under which the party is labouring be of an acute nature, and attended by symptoms of disorder in the alimentary canal. Several cases of poisoning have occurred within the last few years, where arsenic was criminally substituted for medicine, and given to the parties while laboring under a disorder of the bowels. We are, however, justified in saying with respect to this character of poisoning, that, when in a previously healthy person, violent vomiting and purging occur suddenly, and without any assignable cause, such as disease or indiscretion in diet, to account for them, there is strong reason to suspect that irritant poison has been taken. When the person is already labouring under disease, we must be especially watchful, on the occurrence of any sudden change in the character or violence of the symptoms, unless such change can be easily accounted for on common or well-known medical principles. In most cases of criminal poisoning, we meet with alarming symptoms without any obvious or sufficient natural cause to explain them. The practitioner will of course be aware that there are certain diseases which are liable to occur suddenly in healthy people, the exact cause of which may not at first sight be apparent; therefore this criterion is only one out of many on which a medical opinion should be founded.

2. In poisoning, the symptoms appear soon after a meal, or soon after some kind of food or medicine has been taken.-This is by far the most important character of poisoning in the living body. It has been already observed, that most poisons begin to operate within about an hour after they have been swallowed; and although there are a few exceptions to this remark, yet they occur under circumstances easily to be appreciated by a practitioner. Thus, then, it follows, that, supposing the symptoms under which a person is labouring to depend on poison, the substance has most probably been swallowed either in food or medi

THEIR CONNEXION WITH FOOD OR MEDICINE.

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cine, from half an hour to an hour previously. It must be observed, however, that cases of poisoning may occur without the poison being introduced by the mouth. Oil of vitriol has been thrown up the rectum in the form of enema, and caused death: the external application of arsenic, corrosive sublimate, and cantharides, has destroyed life. In one case arsenic was introduced into the vagina of a female, and she died in five days under all the symptoms of arsenical poisoning. (Schneider, Ann. der Ges. Staatsarzneikunde, i. 229.) Such cases are rare, but nevertheless the certainty that they have occurred where their occurrence could hardly have been anticipated, shows that in a suspicious case a practitioner should not deny the fact of poisoning, merely because it is proved that the patient could not have taken the poison in the usual way-by deglutition. Again, persons may be destroyed by the vapours of ether, chloroform, prussic acid, or other powerful volatile poisons, introduced into the system through the lungs. Such a mode of suicide, or murder, might disarm suspicion, from the fact of no noxious material being found in the stomach. An act of Parliament has been recently passed, which makes it felony to administer, or even attempt to administer, poisons in this manner (14 and 15 Vict. c. 19, sec. 111.)

Let us suppose, however, the circumstances to have been such that these secret means of destruction could not have been resorted to, and that the poison is one of those most commonly selected by a murderer, such as arsenic, oxalic acid, or corrosive sublimate, then we may expect that this character of poisoning will be made evident to us, and that something must have been swallowed by the patient shortly before the alarming symptoms appeared. By observations attentively made, it may be in our power to connect the appearance of the symptoms with the use of a particular article of food, and thus indirectly lead to the detection of the criminal. Supposing that many hours have passed since food or medicine was taken by the patient, without any effect ensuing,--it becomes very probable that the symptoms are due to some other cause, and not to poison. The time of the occurrence of the symptoms in relation to a particular meal, is then a fact of especial importance in forming an opinion when poisoning is suspected.

Among numerous cases which might be adduced in support of this view, I select the following, which was communicated by Mr. George, of Bath, to the Provincial Journal, (January 24th, 1849.) The patient, a girl æt. 16, was preg nant: she complained of a painful swelling of the leg. On the day of her death she made a hearty dinner of beef, vegetables, and porter, with the family at one o'clock, and remained in the same room where she had partaken of that meal until three o'clock. On quitting the apartment, she began to groan, complained of agony at the pit of the stomach, and became faint: there was vomiting, and in threequarters of an hour she died. On inspection, there was an inflamed appearance both of the duodenum and stomach. A careful analysis of the viscera, as well as of the matter vomited, revealed no poison; and the fact that no symptoms had occurred during a period of two hours after the meal, strongly corroborated the conclusion that the deceased had died from natural causes.

When symptoms resembling those of poisoning speedily follow the ingestion of food or medicine, there is, however, always great room for suspicion; but caution should be observed in drawing inferences, since the most extraordinary coincidences sometimes present themselves. In the celebrated case of Sir Theodosius Boughton, who was poisoned by his brother-in-law, Donellan, in 1781, the fact of alarming symptoms coming on in two minutes after the deceased had swallowed what was supposed to be a simple medicinal draught, was a most important fact in the evidence against the prisoner. There is no doubt that laurel water had been substituted for the medicine by the prisoner. I may here remark, that the practice of substituting poisonous mixtures for medicinal draughts or powders, is by no means unusual; although it might be supposed to indicate a degree of refinement and knowledge not commonly to be found among the lower classes of criminals. Medical practitioners are thus apt to be imposed upon, and the fol

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SEVERAL PERSONS ATTACKED SIMULTANEOUSLY.

An

lowing case, related by one of our present judges, will serve as a caution. apothecary prepared a draught, into which another person put poison, intending thereby to destroy the life of the patient for whom the medicine was prescribed. The patient, not liking the taste of the draught, and thinking there was something suspicious about it, sent it back to the apothecary, who, knowing the ingredients of which he had composed it, and wishing to prove to his patient that he had done nothing wrong, drank it himself, and died. He was thus the unconscious agent of his own death; and although the draught was intended for another, the party who poisoned it was held guilty of murder. This case contains a serious warning to medical witnesses. It is not very unusual, on trials for poisoning, when the poison is conveyed through medicine, to find a medical witness offering to swallow his own draught in a court of law, in order to furnish to the court and jury a convincing practical illustration of the innocence of the medicine! I need hardly observe that an exhibition of this kind is never required of a medical witness. The court will receive his deposition, without compelling him to swallow his own medicine, even supposing it to have been secretly poisoned. If any doubt be raised of the innocent properties of a draught, a chemical analysis of its contents will be far more satisfactory, and attended with no kind of risk to the practitioner.

On the other hand, the occurrence of symptoms resembling those produced by poison, soon after food or medicine has been taken, may be a pure coincidence. In such a case, poison is always suspected by the vulgar; and it will be the duty of a medical jurist to guard against the encouragement of such a suspicion, until he has strong grounds to believe it to be well founded. No public retraction or apology can ever make amends for the injury which may in this way be inflicted on the reputation of another; for they who hear the accusation may never hear the defence. In all such cases, a practitioner may entertain a suspicion, but he should always avoid expressing it, or giving it publicity. When death is not a consequence, it is difficult to clear up such cases, except by the aid of a chemical analysis; but this, as we know, is not always applicable. If death ensues, the real cause is usually apparent, and a suspicion of poisoning is thus often removed by a post-mortem examination.

3. In poisoning, when several partake at the same time of the same food or medicine (mixed with poison) all suffer from similar symptoms.-This character of poisoning cannot always be procured; but it furnishes good evidence of the fact when it exists. Thus, supposing after a meal made by several persons from the same dish, only one suffers, the suspicion of poisoning is considerably weakened. The poisoned article of food may be detected by observing whether they who suffer under any symptoms of poisoning have partaken of one particular solid or liquid in common. In a case of accidental poisoning at a dinner-party, a friend of mine observed that those who suffered had taken port-wine only: the contents of the bottle were examined, and found to be a saturated solution of arsenic in wine. In general, considerable reliance may be placed upon this character, because it is very improbable that any common cause of disease should suddenly attack, with violent and alarming symptoms, many healthy persons at the same time, and within a short period after having partaken of food together. We must beware of supposing that, in those cases in which poison is really present, all will be attacked with precisely similar symptoms; because, as we have seen, there are many circumstances which may modify their nature and progress. In general, that person who has partaken most freely of the poisoned dish will suffer most severely, but even this does not always follow. There is a well-known case recorded by Bonnet, where, among several persons who partook of a dish poisoned with arsenic, they who had eaten little and did not vomit, speedily died; while others who had partaken largely of the dish, and had in consequence vomited freely, recovered.

It was just now remarked that there is no disease likely to attack several

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