Treatise on Poisons by Sir Robert Christison

The early symptoms caused by them have been little noticed; for, as this variety of poisoning generally occurs during sleep, the patient is seldom seen till the symptoms are fully formed. In an attempt at self-destruction described in a French journal, the first effects were slight oppression, then violent palpitation, next confusion of ideas, and at last insensibility.[2061] Tightness in the temples, and an undefinable sense of alarm have also been remarked;[2062] and others have, on the contrary, experienced a pleasing sensation that seduced them to remain on the fatal spot.[2063] The best account of the incipient symptoms has been given by Mr. Coathupe of Wraxhall, in an account of an experiment he made with Joyce’s stove,—a preposterous invention, the fuel of which was supposed by the inventor to burn without contaminating the air, although it was neither more nor less than prepared charcoal. Having closed every aperture in a room of the capacity of eighty cubic yards, Mr. Coathupe kindled the stove and watched the results. In four hours he had slight giddiness, in five hours and a half intense giddiness, the desire to vomit without the power, excessive prostration and incapability of muscular effort, a frequent full throbbing pulse, a sense of distention of the cerebral arteries, agonizing headache, chiefly in the hindhead, but no sense of suffocation. At this time he experienced great difficulty in opening the window and removing the stove; and in seven hours, when his wife entered the room, he was unable to tell what was the matter, although quite conscious of all that was passing. He then slowly recovered.[2064] A similar account has also been given by Mr. Chapman of Tooting of the effects of this notorious stove. A young gentleman, after being only one hour in a chamber heated by it, felt first slight giddiness and headache, and afterwards violent pain in the head and tightness round the forehead and temples; the pupils became excessively dilated and nearly insensible; there was constant ringing in the ears, a feeble frequent pulse, paleness of the features and lividity of the lips and hands, coldness of the extremities, laborious irregular breathing, and extreme prostration. A temporary relief, obtained by stimulants, was succeeded by violence; which, however, was subdued by blood-letting; and he recovered.[2065] A set of cases, 70 in number, similar to the last two, but milder, occurred in January, 1836, in the church of Downham in Norfolk, which was heated by two of these stoves.[2066] The following abstract of a case by Dr. Babington will convey an accurate idea of the advanced symptoms. The waiter of a tavern and a little boy, on going to bed, left a choffer of charcoal burning beside it; and next morning were found insensible. The boy died immediately after they were discovered. The waiter had stertorous breathing, livid lips, flushing of the face, and a full, strong pulse; for which affections he was bled to ten ounces. When Dr. Babington first saw him, however, the pulse had become feeble, the breathing imperfect, and the limbs cold; the muscles were powerless but twitched with slight convulsions, the sensibility gone, the face pale, the eyelids closed, the eyes prominent and rolling, the tongue swollen and the jaw locked upon it, and there was a great flow of saliva from the mouth. The employment of galvanism at this time caused an evident amendment in every symptom. But it was soon abandoned; because each time it was applied, the excitement was rapidly followed by corresponding depression. Cold water was then dashed upon him, ammonia rubbed on his chest, and oxygen thrown into the lungs; through which means a warm perspiration was brought out, and his state rapidly improved. He was nearly lost, however, during the subsequent night by hemorrhage from the divided vein; but next day he was so well that he could even speak a little. For two days afterwards the left side of the face was paralyzed, and his mental faculties were somewhat disordered.[2067]—In such cases as this the stupor is generally very deep. There is a case in a French Journal of a girl, who, after remaining some time in a small close chamber heated by a charcoal choffer, fell down insensible, remained in that state for three hours, and found, on recovering from her lethargy, that the choffer had fallen, and burnt the skin and subjacent fat of the thighs to a cinder.[2068] Occasionally the stage of stupor is followed, as in some other varieties of narcotic poisoning, by a stage of delirium, at times of the furious kind, or by a state resembling somnambulism.[2069] It does not follow that recovery is certain because coma has thus given place to delirium,—an alteration, which in most varieties of narcotic poisoning is considered a sure sign of recovery. Collard de Martigny has related a case which eventually proved fatal, notwithstanding this sign of improvement.[2070] The narcotism induced by breathing charcoal fumes often lasts a considerable length of time,—much longer indeed than the effects of other narcotic poisons. This will appear sufficiently from the case described by Dr. Babington. One of the people, mentioned at the commencement of this chapter as having been suffocated at Gerolzhofen, lingered five days in a state of coma before he expired. Commonly in cases of recovery, there is found to have been no consciousness of any thing going on around, or recollection of what passed subsequently to the first impressions of poisoning. The reverse, however, occurred in Mr. Coathupe’s experiment; and a similar instance has been published, where the individual, though apparently insensible, knew when the room was first entered by strangers, and heard them call him by name and bid him put out his tongue, and stretch forth his arm,—without, however, his having the power to answer, or in any way to express the consciousness of understanding them.[2071] Poisoning with charcoal vapour has become a subject of great importance in French medical jurisprudence, partly on account of the frequency with which it is resorted to for the purpose of committing suicide, and partly because repeated attempts have been made to conceal murder by arranging matters so as to present the appearances of suicide. M. Devergie says, that in the years 1834 and 1835 no fewer than 360 cases of poisoning with charcoal-vapour occurred in Paris, of which nearly four-fifths proved fatal; and he has given the particulars of two attempts to conceal murder under the appearance of death from this cause.[2072] The subject has therefore been carefully examined by various authors, but by none so successfully as by M. Devergie; of whose important researches the following is a brief analysis. In stating the various sources whence charcoal-vapour may become incidentally the cause of death, he dwells particularly on the risk of its admission from adjoining vents, even in other houses from that where the accidents happen,—because there may be currents in the apartment which occasion back-draught. Three remarkable cases of this kind, very obscure in their origin, have been related by M. d’Arcet.[2073] The very discrepant effects of the poison on different individuals, simultaneously and to appearance alike exposed to it, have usually been explained by reference to the great density of the gas, which consequently accumulates near the floor. Some, however, have doubted the fact that the gas is unequally diffused. Mr. Taylor in particular says he ascertained by analysis, that air collected above and below a choffer of burning charcoal was equally contaminated, that what was collected a foot above its level contained 4·65 per cent., and that another portion taken the same distance below it contained 4·5 of carbonic acid.[2074] M. Devergie has discovered the source of these discrepant opinions. He has found,[2075] that, notwithstanding the high density of carbonic acid gas, the currents caused by the heat, disengaged when charcoal is burnt in a room, without an issue for the products of combustion, produce an equable mixture of gases at all elevations in the apartment, provided the air be examined while still warm, and not long after the charcoal has burnt out; but that, at a later period, such as twelve hours, the carbonic acid partly separates and sinks, so that, while the air at the top contains only a 78th, that near the floor contains four times as much, or a 19th of carbonic acid gas. Disputes have also arisen as to the precise nature of the emanations from burning charcoal,—some believing that carbonic acid is alone discharged in such quantity as to prove injurious, and is singly sufficient to account for the effects which have been observed,—while others maintain that carbonic oxide, carburetted-hydrogen, or some peculiar pyrogenous vapour, may be also formed, and prove the real cause of the active properties of the vapour. According to the researches of Orfila, charcoal in a state of vivid ignition emits carbonic acid only, a hundred parts of the consumed air having been ascertained by him to be composed of 42 azote, 46 common air, and 12 carbonic acid. But when the combustion is low, a hundred parts consist of 52 azote, 20 common air, 14 carbonic acid, and 14 carburetted-hydrogen; so that not only is the air more thoroughly consumed; but likewise an additional poisonous gas is brought into action.[2076] The difference thus indicated has been supposed to account for what is often observed in countries where charcoal choffers are much in use for warming close apartments,—namely, that the practice is attended with most danger when the combustion is low, and that it is unsafe to close the doors of an apartment till the fuel is in a state of vivid ignition. M. Guérard again maintains, that when the supply of air is incomplete and combustion low, carbonic oxide gas is formed in considerable quantity; and that this gas, confessedly a much more powerful narcotic than carbonic acid, is probably the cause of many cases of poisoning with charcoal fumes.[2077] M. Devergie doubts the exactness of Orfila’s experiments on this head, but gives no new analysis. He observes that charcoal-vapour gives the air of a room a peculiar odour and bluish misty appearance, the latter of which slowly diminishes, and in twelve hours disappears; and that possibly there may be both a little carbonic oxide and carburetted-hydrogen in the air. But nevertheless he is of opinion that the carbonic acid alone is adequate to occasion all the effects observed in man or animals.[2078] Professor Hünefeld is of a different opinion, and has supplied the most satisfactory explanation of the important fact, that charcoal fumes are most noxious when the fuel has been just kindled and burns low; for he ascertained that at first it gives out a pyrogenous acid, which occasions headache and tendency to sickness, and which is not a product of combustion at the moment, but exists ready formed; and that when charcoal is at a full red heat, this noxious substance is no longer given off.[2079] Mr. Coathupe also thinks the cause of poisoning by charcoal fumes is an unknown pyrogenous body, and not carbonic acid gas.[2080]—This department of inquiry is obviously susceptible of more precise information. But meanwhile, whatever may be the probability that, besides carbonic acid, some other gases, or some peculiar pyrogenous body, may occasionally exist in charcoal fumes, and increase their poisonous property, little doubt can exist that the carbonic acid is singly sufficient to account for all the leading phenomena. M. Devergie has been led to the opinion that air, in which a fourth part of its oxygen has been converted into carbonic acid, and which therefore contains five per cent. of that gas, is amply enough impregnated to occasion death.[2081] This corresponds with the observations of M. Ollivier, who found that three per cent. was as much as could be breathed with impunity even for a moderate length of time.[2082] Less, however, will suffice to prove injurious or even fatal, if the air be breathed long. Mr. Coathupe inferred from a rough estimate, that in the dangerous experiment he made upon himself, the carbonic acid, if uniformly diffused in the apartment, which was probably the case, amounted to only two per cent.; but his data were inadequate.[2083] Proceeding from the fact that five per cent. of carbonic acid is sufficient to cause death, Devergie points out what quantity of charcoal is required to form that proportion,—a question of no small moment in respect to charges of murder, concealed under the semblance of suicide by suffocation with charcoal fumes. And he shows, that a French bushel, or decalitre, weighing 3000 grammes, is sufficient for a close apartment of 1275 cubic mètres, that is 6·6 pounds avoirdupois for a space of 1666 English cubic yards, provided the gas be uniformly diffused.[2084] The quantity of charcoal burnt in a given case may be arrived at pretty nearly from the weight of ashes left, which is estimated in round numbers at a twenty-fifth by himself,[2085] and at a twentieth by Ollivier.[2086] It is important to remark that complete closure of an apartment is by no means essential for the action of carbonic acid, whether disengaged within it or introduced from without. For poisoning has occurred, even where a window was partially open.[2087]