POISON.' 



POISON. 



foul, sometime* in four houn : but it may be distinguished by the 

 > or bte oeourrenoe of the burning pun of the throat, by the 

 of romiting of blood, by the peculiar expression of the counte- 

 > and condition of the body, and by the up|*nsmon of all the 

 Mentions except the characteristic discharges from the stomach and 

 intestines. [CHOLERA.] 



The symptoms of oommon peritonitu and of common acute rntiriti* 

 [Pr.inTuMTis; K.NTiHiTis] can aoarcdy lead a competent witness of 

 them to suipect that they arin from poisoning. Hut those of peril. >nitin 

 from rupture or ulceratire perforation of any of the abdominal organs 

 may closely resemble them, and render a diagnosis very ambiguous 

 without the evidence of a post-mortem examination. Very severe 

 cases of colic may also for a time simulate the effects of poison ; I nit 

 the frequent intermission !' tln-ir symptoms, the absence of both the 

 local and the general signs of inflammation, and their rarely dangerous 

 character or fatal termination, are sufficient signs of distinction. In 

 the caste which have been called ileus, and regarded by some as 

 merely examples of severe colic, there may be some doubt till the 

 examination after death shows them to have resulted from an obstruc- 

 tion of the intestinal canal [Ii.Efs] ; and in ileus the pain is almost 

 always round or near the umbilicus. 



Other oases which are usually mentioned as simulating the effects of 

 irritant poisoning are those in which the stomach having been greatly 

 distended by gluttonous feeding, death has occurred suddenly from 

 apoplexy or some unknown influence ; and those in which death occurs 

 from drinking cold water while over-heated. In the former cases 

 death, if not produced by distinct apoplexy, is preceded by symptoms 

 more like those of narcotic than those of irritating poison ; in the 

 latter, the symptoms are very like those of common cholera, and are in 

 the tame respects different from those of poison. 



It is evident from these circumstances, that in a fatal case of sus- 

 pected poisoning by an irritant substance, it will seldom be possible to 

 decide upon the evidence of the symptoms alone. When poison has 

 actually been taken, the symptoms are sometimes so modified by 

 circumstances peculiar to the case, that even where they have been 

 carefully observed, much doubt has remained respecting their cause : 

 and, on the other hand, the symptoms of naturally excited disease 

 often too closely resemble those of poison to permit a positive conclu- 

 sion being arrived at. Cases very rarely occur iu which (unless other 

 circumstances not connected with the condition of the patient after the 

 seizure are conclusive) the evidence of post-mortem examination is not 

 absolutely necessary. 



The most general morbid appearances produced by the irritant 

 poisons are either the destruction, by corrosion, of the tissues over 

 which they pass, or some of the effects of acute inflammation in them. 

 Of the latter, that which is the least decisive is the most common 

 redness. In the stomach, no kind or degree of merely vascular redness 

 of the mucous membrane can alone certainly prove that it has been 

 inflamed. The most intense redness is sometimes found where the 

 person has had no gastric affection, and may be produced in any part 

 of the stomach by the blood settling in its vessels after death, or being 

 obstructed in them by suffocation. It is probable also that any very 

 slight irritant, such as wine, given shortly before death, may produce 

 considerable redness of the stomach. Small quantities of blood may 

 also be effused between the lining of the stomach, from any of the 

 causes which produce general diffused redness of the mucous membrane, 

 by congestion of its vessels ; but more considerable effusions of blood, 

 especially when they appear as if incorporated with the tissue, and are 

 of a brown or black colour, as if charred, are almost certain signs oi 

 poison. Any appearance of blackness, or of a dork brown discoloura- 

 tion of the stomach, as if from a chemical change in the blood filling 

 iU small vessels, is also a very suspicious, though not a certain sign. 

 But pills of aloes and sulphuric acid, prescribed for painters' cholic, 

 produce this appearance in the stomach, if given a few hours before 

 death. When redness of any part, or of the whole of the lining of the 

 stomach is accompanied by the secretion of a large quantity of tough 

 mucus upon it, it may be deemed suspicious, but it is by no means a 

 conclusive evidence of poison ; it is more nearly so when the mucus ii 

 stained or streaked with blood. An effusion of lymph on the lining ol 

 the reddened or blackened stomach is decisive of inflammation ; and 

 of poisoning, if , as is most probable, acute inflammation of the stomach 

 never arises from natural causes. The effusion of lymph, however, is 

 not a common effect of poison, and tough mucus is often mistaken foi 

 it ; they may be distinguished by the former being ropy, glaring, am 

 transparent, the latter opaque, white, and deposited in a tender brittle 

 membrane or in irregular flocculi. The softening of the mucoui 

 membrane of the stomach, and the case with which it may be separatee 

 from the subjacent tissues, are signs of inflammation, when combiner 

 with an intense bright redness, or the effusion of much mu u> 

 lymph ; without coincident redness they are not to be depended on 

 since they may mult from the digestion of the walls of the stomach, 

 which sometimes takes place after death by the action of the gastric 

 juice. An increase of thickness in the raucous and other membranes 

 by the effusion of serum beneath them, is a suspicious but far from a 

 conclusive sign of scute inflammation. 



The more serious changes resulting from poisons, such as ulcers am 

 perforations of the stomach, differ according as they have been pro 

 duced by the corroding power of the substance taken, or by the inflam 



In the case of corroding substances, a 

 istinguished from ulcers 



nation which it has excited. 



irincipal sign by which their effects would be distingui 



which are the result* of disease, is, that every part of the digestive 



canal with which poison has come in contact is affected at the same 



time, the lips, mouth, OMophagua, stomach, and even the intestines, all 



showing more or less of their influence ; whereas it is very rare for 



liiasiai to affect more than one of these parts at a time. The appear- . 



ice of an ulcer, or a perforation "f the stomach, produced by corrosion, 



also peculiar ; it is commonly large and irregular ; its edges an 



and pulpy, and usually black or brown, as if charred; and if tli<> 



tatient baa survived only an hour or two, signs of acute inflammation 



will be teen in its neighbourhood, and in nil the parts to whi.-li ill.- 



corroding material has obtained access. Similar signs of arnt<- inflam- 



uation are also always observed in the ulooration or perforation wl,i< Ii 



sometimes, but very rarely, is produced by poisons that nu rely irritate 



the digestive canal ; and these are a port of the signs by which those 



effects of poison are to be distinguished from perforations that occur 



naturally. 



Ulceration and perforation of the stomach are so rarely the effect of 

 merely irritant poison, and so i-omiimnly the effect of disease, that, 

 unless there be signs of corrosion, they afford evidence against, rather 

 .ban for, the suspicion of poison ; and if there be no other evidence, 

 and no attendant sign of recent acute inflammation, they may even be 

 regarded as proofs that such a suspicion is incorrect. (If the forms of 

 perforation of the stomach from other circumstance* than poi> 

 me of the most important is that in which, without any material 

 alteration in the surrounding parts, one or more small ulcers form in 

 ihe stomach, and becoming gradually deeper, at last, by a minut.- 

 aperture, make their way through its walls, and permit its content* to 

 escape slowly into the abdomen. These may be known at once to be 

 the effects of disease, by the complete absence of any sign of inflam- 

 mation in the lining or other tissue around them. Another form is 

 accompanied with thickening of a considerable extent of the tissues 

 adjacent to the ulcer, which is from a quarter to half an incli in 

 diameter, and perforates by a huge orifice, forming a hole with smooth 

 edges, as if a piece of the stomach had been cut out by a sharp instru- 

 ment. The thickening around the ulcer, which hog all the characters 

 of chronic inflammation, and the appearance of even a commencement 

 of cicatrisation, with the absence of all signs of acute disease of the 

 stomach, are usually quite sufficient to distinguish this form of per- 

 foration. A third, which can scarcely give rise to doubt, is that con- 

 sequent on cancerous or other malignant disease of the stomach. A 

 fourth is that in which a portion of the walls of the stomach is dis- 

 solved or digested by the gastric juice after death ; but whatever 

 uncertainty there may be respecting the circumstances under which 

 this singular effect is produced, there ought to be none in distin- 

 guishing it from the effects of poison. 



From these statements it will appear that in some cases the symp- 

 toms and morbid appearances together may prove that irritating 

 poison has been token. The diseases in which the similarity of the 

 symptoms is most embarrassing, as cholera and peritonitis, are those in 

 which the morbid appearances are most distinct from perforation of 

 the abdominal organs ; while those more chronic inflammations of the 

 stomach in which the morbid changes of structure are least decisive 

 ore those in which the symptoms admit of little doubt. This however 

 cannot apply to all, though it may to the majority of cases. When 

 death is produced slowly, the symptoms may be obscure, and the 

 morbid changes very like those of disease : and still more difficult case* 

 occur in which poison is taken by those who already suffered from 

 disease of the stomach; or in similar individuals, deceptive appearances 

 may be produced by the digestion and other changes in the stomach 

 which occur after death. Cases of these kinds form a numerous class, 

 in which the test of chemical examination, which indeed should be 

 neglected in none, con alone be conclusive. 



For this part of the subject however no general rules can be laid 

 down. The detection of each poison must depend on the pr, -p.-r 

 application of its appropriate teats; and these will be found in thu 

 several articles already referred to. [ A HSENIC, &c.] 



The symptoms produced by the different narcotic poisons are more 

 varied than those of the irritant class. The most common ore giddi- 

 ness, headache, obscurity or depravation of the sight, stupor or perfect 

 insensibility, loss of power of the voluntary muscles, or convulsions of 

 various kinds, and, towards the close, complete coma. To these the 

 several species of narcotic poisons add effects peculiar to themselves ; 

 yet not so remarkable but that they are closely simulated by those of 

 some naturally occurring diseases. The symptoms of apoplexy, for 

 example, are almost exactly similar to those of poisoning by opium 

 and the substances allied to it. In certain cases how. in_ r 



circumstances may distinguish them. Apoplexy, though it* 

 attack is sudden (which the effects of opium are not), i 

 ceded by warning symptoms, such as headache, occasional giddiness, &c. 

 If so severe as to simulate poisoning, it is not possible to arouse the 

 patient from his stnpor ; but in poisoning with opium this may usually 

 be effected to within a few hours of death ; in apoplexy, conv 

 often occur, in poisoning with opium, never ; iu the former the pupil 

 is commonly dilated, in the latter contracted. Narcotic poisoning, if 

 not fatal in twelve hours, is usually recovered from; apoplexy 

 terminates fatally after several days. 



