Treatise on Poisons by Sir Robert Christison

on the fact, that the symptoms of poisoning _appear very soon after a meal_. But we also know this to be the most frequent occasion on which some natural disorders begin. An attack of apoplexy after a hearty meal is a common occurrence. That kind of cholera which follows the immoderate use of acid fruit likewise comes on soon after eating. Sometimes mere excessive distension of the stomach after a meal proves suddenly or instantaneously fatal. Drinking cold water when the body is over-heated likewise causes at times immediate death. It appears that perforation of the stomach, the result of an insidious ulcer of its coats, and likewise rupture of the stomach from mechanical causes, are most apt to occur during the digestion, and therefore soon after the taking of a meal. These few observations will make it evident that the appearing of violent symptoms soon after eating may arise from other causes besides the administration of poison. At the same time, as the diseases which are apt to commence suddenly at that particular time are few in number, and none of them by any means frequent, it is always justly reckoned a very suspicious circumstance; and when combined with certain points of moral proof, such as that several people, who have eaten together, were seized about the same time with the same kind of symptoms, the evidence of general poisoning becomes very strong indeed. Sometimes the evidence from the date of their commencement after a meal may singly supply strong evidence, as in the case of the mineral acids and alkalis, or corrosive sublimate, which begin to act in a few seconds or minutes. On the other hand, if the symptoms do not begin soon after food, drink, or medicine has been taken (the circumstances being such as to exclude the possibility of poison being introduced by a wound, by the lungs, or by any other channel but the stomach), the presumption on the whole is against poisoning; and sometimes the evidence to this effect may be decisive. The principle now propounded may be often a very important one in the practice of medical jurisprudence; for when united with a little knowledge of the symptoms antecedent to death, it may be sufficient to decide the nature of the case. Thus it is sufficient, in my opinion, to decide the celebrated case of the Crown Prince of Sweden. The prince, while in the act of reviewing a body of troops on the 28th May, 1810, was observed suddenly to waver on his horse; and soon afterwards he fell off while at the gallop, was immediately found insensible by his staff, and expired in half an hour. As he was much beloved by the whole nation, a rumour arose that he had been poisoned; and the report took such firm root in the minds of all ranks, that a party of military, while escorting the body to Stockholm, were attacked near the city by the populace, and their commander, Marshal Fersen, murdered; and Dr. Rossi, the prince’s physician, after narrowly escaping the same fate, was in the end obliged to quit his native country. Now, no other poison but one of the most active narcotics could have caused such symptoms, and none of them could have proved so quickly fatal unless given in a large dose. It was proved, however, that on the day of his death the prince had not taken any thing after he breakfasted; and an interval of nearly four hours elapsed after that till he fell from his horse. This fact alone, independently of the marks of apoplexy found in the head after death, and the warning symptoms he repeatedly had, was quite enough to show that he could not have died of poison, as it was incompatible with the known action of the only poisons which could cause the symptoms. This is very properly one of the arguments used by the Medical Faculty of Stockholm, which was consulted on the occasion.[76] The same circumstances will often enable us to decide at once a set of cases of frequent occurrence, particularly in towns,—where the sudden death of a person in a family, the members of which are on bad terms with one another, is rashly and ignorantly imputed to poison, without any particular poison being pointed at; and where, consequently, unless the morbid appearances clearly indicate the cause of death, a very troublesome analysis might be necessary. In several cases of this kind, which have been submitted to me, I have been induced to dispense with an analysis by resting on the criterion now under consideration. The following is a good example. A middle-aged man, who had long enjoyed excellent health, one afternoon about two o’clock returned home tired, and after having been severely beaten by his wife went to bed. At a quarter past two one of his workmen found him gasping, rolling his eyes, and quite insensible; and he died in a few minutes. As his wife had often maltreated and threatened him, a suspicion arose that he had died of poison, and the body was in consequence examined judiciously by Sir W. Newbigging and myself. The only appearance of disease we could detect was a considerable tuberculation of the septum cordis and anterior parietes of both ventricles. This disease might have been the cause of death; for there is no disease of the heart which may not remain long latent, and prove fatal suddenly. But, as the man never had a symptom referrible to disease of the heart, it was impossible to infer, in face of a suspicion of poisoning, that it must have been the cause of death; since the man might very well have died of poison, the disease of the heart continuing latent. Poisoning, however, was out of the question. The man had taken nothing whatever after breakfasting about nine. Now no poison but one of the most active narcotics in a large dose could cause death so rapidly as in this case; and the operation of such a poison in such a dose could not be suspended so long as from nine till two. An analysis was therefore unnecessary.