Treatise on Poisons by Sir Robert Christison

the gradual contamination of air in a confined apartment. Every one must have read of the horrible death of the Englishmen who were locked up all night in a close dungeon in Fort William at Calcutta. One hundred and forty-six individuals were imprisoned in a room twenty feet square, with only one small window; and before next morning all but 23 died under the most dreadful of tortures,—that of slowly increasing suffocation. They seem to have been affected nearly in the same way as the workmen at Leadhills.[2094] A similar accident happened in London in 1742. The keeper of the round-house of St. Martin’s, crammed 28 people into an apartment six feet square and not quite six feet high; and four were suffocated.[2095] The morbid appearances left on the body after poisoning with carbonic acid gas have been chiefly observed in persons killed by charcoal vapour. According to Portal the vessels of the brain are congested, and the ventricles contain serum; the lungs are distended, as if emphysematous; the heart and great veins are gorged with black fluid blood; the eyes are generally glistening and prominent, the face red, and the tongue protruded and black.[2096]—Gorging of the cerebral vessels seems to be very common. Yet sometimes it is inconsiderable, as in two cases related by Dr. Bright, where, except in the sinuses and in the greater veins of the ventricles and substance of the brain, no particular gorging or vascularity seems to have been met with,—the external membranes in particular having been very little injected.[2097] This, however, is certainly a rare occurrence. Serous effusion in the ventricles and under the arachnoid membrane is very general, yet not invariable.—Dr. Schenck, medical inspector of Siegen, in reporting two cases of death caused by the vapours of burning wood, notices paleness of the countenance as a singular accompaniment of cerebral congestion; and calls the attention of medical jurists to the extreme calmness of the features as a general character of this variety of poisoning.[2098] Although the same appearance has also been noticed by others,[2099] the countenance nevertheless is often livid. But whether livid or pale, it is always composed.—It appears from an account in Pyl’s Essays of several cases of suffocation from the fumes of burning wood, that besides the appearances mentioned by Portal, there is usually great livor of the back, frothiness as well as fluidity of the blood, and more or less gorging of the lungs with blood.[2100]—A common appearance where the poisonous emanation has been charcoal vapour, is a lining of dark, or sometimes actually black dust on the mucous membranes of the air passages, thickest near the external opening of the nostrils, and disappearing towards the glottis. There are obvious reasons why this appearance cannot always be expected to occur; but when present, it may be in doubtful circumstances a very important article of evidence.[2101] In Wildberg’s collection of cases there is a report on two people who were suffocated in bed, in consequence of the servant having neglected to open the flue-trap when she kindled the stove in the bed-chamber; and in each of them Wildberg found all the appearances now quoted from Portal and Pyl. The tongue was black and swelled.[2102]—Mertzdorff has related a case of death from the same cause, in which, together with the preceding appearances, an effusion of blood was found between the arachnoid and pia mater over the whole surface of both hemispheres.[2103] In one of Dr. Bright’s cases there was a small ecchymosis in the cortical substance on the outer side of the anterior lobe, and not extending into the medullary matter. Fallot mentions an instance of suffocation from charcoal vapour, where a little coagulated blood was found between the layers of the arachnoid membrane of the cerebellum in the region of the left occipital hollow.[2104] Three instances of extravasation are enumerated in a list of German cases analysed by Dr. Bird.[2105] Such appearances might be expected more frequently, considering the manifest tendency of this kind of poisoning to cause congestion in the head.—The blood is generally described as being liquid and very dark. But M. Ollivier has lately called attention to the fact, that the blood both before and after death is not unusually more florid in the veins than natural.[2106] In a case mentioned by M. Rayer globules of an oily-looking matter were found swimming on the surface of the blood and urine.[2107] This is a solitary observation.—The body usually remains flaccid, and the customary stage of rigidity is imperfect. In some instances, however, as in those related by Dr. Schenck, the stage of rigidity is passed through in the usual manner. It is not uncommon to find vomited matter lying beside the body, a circumstance which may naturally mislead the unpractised. This is represented by Professor Wagner of Berlin to have occurred uniformly in his experience;[2108] and it is also mentioned in many of the cases reported by others;[2109] but it is not invariable.—A red appearance in the stomach and intestines has been noticed in many cases,[2110] and often ascribed to inflammation; but it is probably nothing more than the result of the venous congestion, which pervades most of the membranous surfaces of the body. The least variable appearances according to Dr. Bird are general lividity, protrusion of the tongue, a calm expression and attitude, cerebral congestion, and serous effusion. This author’s paper in the Medical Gazette, 1838–39, i., or in Guy’s Hospital Reports, iv., enters very fully into the appearances after death, and may be consulted with advantage for further details. The treatment of poisoning with carbonic acid consists chiefly in the occasional employment of the cold affusion, and in moderate blood-letting either from the arm or from the head. In a case which happened at Paris, where a lady tried to make away with herself by breathing charcoal fumes, and was found in a state of almost hopeless insensibility, various remedies were tried unsuccessfully, till cupping from the nape of the neck was resorted to; and she then rapidly recovered.[2111] Another instance where blood-letting was also singularly successful deserves particular mention; because for three hours the patient remained without pulsation in any artery, and without the slightest perceptible respiration. At first neither by cupping nor by venesection could any blood be obtained; and it was only after the long interval just mentioned, and constant artificial inflation of the lungs, that the blood at length trickled slowly from the arm. The pulse and breathing were after this soon re-established; but it was not till eight hours later that sensibility returned.[2112] _Of Poisoning with Carbonic Oxide Gas._—Carbonic oxide gas, according to Nysten, has not any effect on man when injected into the pleura; but when thrown slowly into the veins, it gives the arterial blood a brownish tint, and induces for a short time a state resembling intoxication.[2113] The quantity injected into the veins was probably too small to produce the full effect, or it was discharged in passing through the lungs; for this gas certainly appears to be very deleterious when breathed by man, or the lower animals. M. Leblanc found by experiment that a sparrow was killed almost immediately in air containing only a twentieth of it, and that so little even as a hundredth part proved fatal in two minutes.[2114] A set of interesting but hazardous experiments were made with it in 1814 by the assistants of Mr. Higgins of Dublin. One gentleman, after inhaling it two or three times, was seized with giddiness, tremors, and an approach to insensibility, succeeded by languor, weakness, and headache of some hours’ duration. The other had almost paid dearly for his curiosity. Having previously exhausted his lungs, he inhaled the pure gas three or four times, upon which he was suddenly deprived of sense and motion, fell down supine, and continued for half an hour insensible, apparently lifeless, and with the pulse nearly extinct. Various means were tried for rousing him, without success; till at last oxygen gas was blown into the lungs. Animation then returned rapidly: but he was affected for the rest of the day with convulsive agitation of the body, stupor, violent headache, and quick irregular pulse; and after his senses were quite restored, he suffered from giddiness, blindness, nausea, alternate heats and chills, and then feverish, broken, but irresistible sleep.[2115] A French aëronaut, who used for his balloon a mixture of carbonic oxide and hydrogen, obtained by decomposing water with red-hot charcoal, lately suffered from similar symptoms in a milder degree, in consequence of the gas being disengaged upon him from the safety-valve of his balloon.[2116] _Of Poisoning with Nitrous Oxide Gas._—The nitrous oxide or intoxicating gas is the last of the narcotic gases to be noticed. Nysten found, that, when slowly injected in large quantity into the veins of animals, it only caused slight staggering.[2117] Frequent observation, however, has shown that it is by no means so inert when breathed by man. Sir H. Davy, who first had the courage to inhale it, observed that it excited giddiness, a delightful sense of thrilling in the chest and limbs, acuteness of hearing, brilliancy of all surrounding objects, and an unconquerable propensity to brisk muscular exertion. These feelings were of short duration, but were generally succeeded by alertness of body and mind, never by the exhaustion, depression, and nausea, which follow the stage of excitement brought on by spirits or opium.[2118] Although many have since experienced the same enticing effects, yet they are by no means uniform. For others have been suddenly seized with great weakness, tendency to faint, loss of voice, and sometimes convulsions; and two of Thenard’s assistants, on making the experiment, fainted away, and remained some seconds motionless and insensible.[2119] It is a remarkable circumstance in the operation of this gas, that, unlike other stimulants, it does not lose its virtues under the influence of habit. Neither does the habitual use of it lead to any ill consequence. Sir H. Davy, in the course of his researches, which were continued above two months, breathed it occasionally three or four times a day for a week together, at other periods four or five times a week only; yet at the end his health was good, his mind clear, his digestion perfect, and his strength only a little impaired.[2120] Nitrous oxide gas is one of the few gases that are not injurious to vegetables. Dr. Turner and I found that seventy-two cubic inches, diluted with six times their volume of air, had no effect on a mignionette plant in forty-eight hours.[2121] _Of Poisoning with Cyanogen Gas._—_Cyanogen gas_ has been proved by the experiments of M. Coullon to be an active poison to all animals,—the guinea-pig, sparrow, leech, frog, wood-louse, fly, crab; and the symptoms induced were coma, and more rarely convulsions.[2122] These results are confirmed by the later experiments of Hünefeld, who found that it produces in the rabbit anxious breathing, slight convulsions, staring of the eyes, dilated pupils, coma, and death in five or six minutes.[2123] Buchner likewise found that small birds, held for a few seconds over the mouth of a jar containing cyanogen, died very speedily; and on one occasion remarked, while preparing the gas, that the fore-finger, which was exposed to the bubbles as they escaped, became suddenly benumbed, and that this effect was attended with a singular feeling of pressure and contraction in the joints of the thumb and elbow.[2124] It would undoubtedly be most dangerous to breathe this gas, except much diluted, and in very small quantity. Of all narcotic gases it is the most noxious to vegetables. Dr. Turner and I found that a third of a cubic inch, diluted with 1700 times its volume of air, caused the leaves of a mignionette plant to droop in twenty-four hours. As usual with the effects of narcotic gases on vegetables, the drooping went on after the plant was removed into the open air; and in a short time it was completely killed.[2125] _Of Poisoning with Oxygen Gas._—Of all the narcotic gases, none is more singular in its effects than oxygen. When breathed in a state of purity by animals, they live much longer than in the same volume of atmospheric air. But if the experiment be kept up for a sufficient length of time, symptoms of narcotic poisoning begin to manifest themselves. For an hour no inconvenience seems to be felt; but the breathing and pulse then become accelerated; a state of debility next ensues; at length insensibility gradually comes on, with glazing of the eyes, slow respiration and gasping; coma is in the end completely formed; and death ensues in the course of six, ten, or twelve hours. If the animals are removed into the air before the insensibility is considerable, they quickly recover. When the body is examined immediately after death, the heart is seen beating strongly, but the diaphragm motionless; the whole blood in the veins as well as the arteries is of a bright scarlet colour; some of the membranous surfaces, such as the pulmonary pleura, have the same tint, and the blood coagulates with remarkable rapidity. The gas in which an animal has died rekindles a blown out taper. These experiments, which physiology owes to the researches of Mr. Broughton,[2126] furnish a solitary example of death from stoppage of the respiration, although the heart continues to pulsate, and the lungs to transmit florid blood. Death is probably owing to hyper-arterialization of the blood.