Treatise on Poisons by Sir Robert Christison

body is in a state of perfect health_; because in truth almost all acute diseases begin under the same circumstances. Connected with this subject, however, a point of difference should be noticed which may be of use for distinguishing poisoning by the irritants from acute diseases of the inflammatory kind:—the latter rarely begin without some adequate and obvious natural cause. On considering all that has now been said regarding the characteristics of the symptoms of general poisoning, as contrasted with those of natural disease, no one can hesitate to allow, that from them alone a medical jurist can never be entitled to pronounce that poisoning is certain. At the same time he must not on that account neglect them. For, in the first place, they are of great value as generally giving him the first hints of the cause of mischief, and so leading him to search in time for better evidence. Next, they will often enable him to say that poisoning was possible, probable, or highly probable; which, when the moral evidence is very strong, may be quite enough to decide the case. Thirdly, although they can never entitle him to say that poisoning was certain, they will sometimes enable him to say, on the contrary, that it was impossible. And to conclude, when the chemical or moral evidence proves that poison was given, the characters of the symptoms may be necessary to determine whether it was the cause of death. As the last statement is one of consequence, and yet has been overlooked by some authors on medical jurisprudence in this country, it may be illustrated by one or two comments. It does not follow, because a poison has been given, that it is the cause of death; and therefore in every medico-legal inquiry the cause of the first symptoms and the cause of death should be made two distinct questions. The question, whether a poison, proved to have been administered, was the cause of death, is to be answered by attending to the second and third characteristics mentioned above, and considering whether the symptoms went on progressively increasing, or altered their nature during the course of the patient’s illness, and whether the alteration, if any, was such as may occur in the case of poisoning generally, or of the special poison given. These remarks are very well exemplified by a case, of which I have related the particulars elsewhere,[77] that, namely, of Charles Munn, tried at the Inverary Spring Circuit of 1824 for the double crime of procuring abortion, and of murder by poisoning. The moral evidence and symptoms together left no doubt that arsenic had been given, and that the deceased, a girl with whom the prisoner cohabited, laboured under the effects of that poison in a very aggravated and complex form for twelve days. After that she began to recover rapidly, and in the course of a fortnight more was free of every symptom except weakness and pains in the hands and feet: In short, all things considered, she was thought to be out of danger. But she then became affected with headache and sleeplessness, and died in nineteen days more under symptoms of obscure general fever, without any local inflammation. Dr. Duncan, junior, and I, who were consulted by the Crown in this case, were of opinion,—that granting the girl’s first illness, as appeared from moral and medical evidence, was owing to arsenic, her death could not be ascribed to it with any certainty. It is true that in a few instances the primary irritant symptoms caused by arsenic have been known to pass into an obscure general fever, which has ended fatally; and that this mode of termination coincides with the effects ascribed to arsenic as the chief ingredient in the celebrated _Aqua Toffana_. But the latter phenomena, at best of doubtful authenticity, are not represented to have been preceded by the ordinary symptoms of violent irritation, or to have been developed except under the use of continuous small doses; and as for the more recent and less ambiguous cases of fever succeeding the usual primary effects of a large dose, in no instance yet recorded was there an intermission between the two stages. So much, then, for the force of the evidence drawn from the characters of the symptoms of general poisoning. According to the example of others, I might consider in the present place the force of evidence derived from the symptoms themselves, which distinguish the three classes of poisons. But this subject, together with the special natural diseases which imitate the symptoms of poisoning, will be treated of more conveniently as an introduction to each of the classes. SECTION II.—_Of the Evidence from Morbid Appearances._ The appearances left in the dead body after death by poison used formerly to be relied on as strongly as the symptoms during life; and with even less reason. Except in the instance of a very few poisons, the morbid appearances alone can never distinguish death by poison from the effects of natural disease, or from some other kinds of violent death. There is not much room, therefore, for general remarks under the present head. It was at one time thought by the profession, and is still very generally imagined by the vulgar, that unusual blackness or lividity of the skin, indicates death by poison generally. But every experienced physician is now well aware, that excessive lividity is by no means universally produced by poison, and that it is likewise produced by so many natural diseases as not even to form, in any circumstances whatever, the slightest ground of suspicion. Neither is there any difference in kind, as some imagine, between the lividity which succeeds death by poison, and that which follows natural death. Yet it is right for the medical jurist to be aware that lividity as a supposed consequence of poison ought to be strictly attended to by medical inspectors and law officers while investigating charges of poisoning, because the vulgar belief on the subject sometimes leads to such conduct or language on the part of the poisoner as betrays his secret at the time, and constitutes evidence of his guilt afterwards. Another appearance equally unimportant is early putrefaction of the body. Early putrefaction, at one time much insisted on as a criterion of poisoning,[78] cannot even justify suspicion. It is by no means invariably, or even generally caused by poisons; nay, sometimes a state precisely the reverse appears to be induced;[79] and it is seen quite as frequently after natural death. Some other appearances, not more conclusive, might also be mentioned here; but they belong properly to the effects of individual poisons, or of classes of poisons, not to those of poisoning generally. It may merely be remarked at present, therefore, that the appearances after death, which are really morbid, and which may be produced by poisons, are, in one great class, the signs of inflammation of the alimentary canal in its progressive stages,—in another class, the signs of congestion within the head,—and in a third, a combination of the effects of the two preceding classes; that neither set of appearances is invariably caused by the poisons which usually cause them; that congestion within the head is really seldom produced by those which are currently imagined to produce it; and that most of the appearances of both kinds are exactly similar to those left by many natural diseases. But although, on the whole, the appearances after death, when considered singly, can seldom supply evidence of poisoning even to the amount of probability, they may nevertheless prove very important under other points of view. Thus, in connection with the symptoms and the general evidence, the appearances after death may furnish decisive proof; and even should the history of the symptoms be unknown, or have been unskilfully collected, the appearances after death, by pointing out the nature of the previous illness, may furnish evidence enough to decide the case, when the moral proof is strong. Again, in cases of alleged _imputation of poisoning_ they are necessary to determine whether a poison actually found in the body was introduced during life or after death. Besides, the very absence of morbid appearances may afford presumptive proof in some circumstances,—when, for example, the question is, whether a person has died of apoplexy or of poisoning with narcotics? Farther, a few poisons, as was formerly stated, occasionally produce appearances so characteristic, as not to be capable of being confounded with the effects of any other agent whatsoever: It will be found hereafter, for example, that the mineral acids have at times left behind them in the dead body unequivocal evidence of their operation. And finally, in cases where no doubt can be entertained that poison was taken, the evidence from morbid appearances may be useful or necessary for settling whether or not it was the cause of death. Two pointed examples of this kind will be noticed under the next section. When signs of the action of poison are not found in the dead body, and on the contrary marks are found of the operation of natural disease, the presumption of course is that the person died a natural death. But here a few words of caution must be added with regard to the drawing of that inference in cases where the history of the symptoms is not known. It does not follow merely because certain appearances of natural disease are found, that their cause was the cause of death. For death may have arisen from a totally different cause, such as poisoning. This remark is not, as some may imagine, the offspring of hypothetical refinement, but a necessary caution, drawn from actual and not unfrequent occurrences. Thus, for example, the following cases will show, that there may be found in the dead body diseased appearances, arising from pleurisy, hydrothorax, or peripneumony, sufficient to cause death, or to account for death in ordinary circumstances; and that nevertheless the disease may have been completely latent, and death have arisen from poison. In Rust’s Magazin is related the case of a German apothecary, who poisoned himself with prussic acid, and in whose body the lower lobe of the left lung was found consolidated and partly cartilaginous.[80] In Corvisart’s Journal an army-surgeon has described the case of a soldier, who died of a few hours’ illness, and whose right lung was found after death forming one entire abscess; yet to the very last day of his existence he daily underwent all the fatigues of a military life; and in fact he died of poisoning with hemlock.[81] In Pyl’s Memoirs and Observations, there is a similar account of a woman who enjoyed tolerable health, and died during a fit of excessive drinking, and in whose body the whole left lung was found one mass of suppuration.[82] Under the next section will be mentioned other equally pointed cases of death by poison, where the apparent cause of death was external violence. The conclusions to be drawn from these facts are that, at all events, the medical inspector in a question of poisoning, must take care not to be hurried away by the first striking appearances of natural disease which he may observe, and so be induced to conduct the rest of the inspection superficially; and likewise, that he should not so frame his opinion on the case, as to exclude the possibility of a different cause from the apparent one, unless the appearances are such as must necessarily have been the cause of death. It may be said, that in requiring this condition for an unqualified opinion, a rigour of demonstration is exacted, which can rarely be attained in practice. But, on the one hand, it must not be forgotten, that an unqualified opinion is not always necessary; and on the other hand, although it were, I think it might be shown, if the subject did not lead to disproportionate details, that we may often approach very near the rigour of demonstration required. At present no more need be said, than that the inspector should be particularly on his guard in those cases, in which the appearances, though belonging to the effects of a deadly disease, are trifling; and still more in those in which the appearances, though great, belong to the effects of a disease, whose whole course may be latent. And I may add, that, from what I have observed of medico-legal opinions, the caution now given is strongly called for. It may be right to allude here also to another purpose which may be served by a careful consideration of the morbid appearances. In cases in which the history of the symptoms is unknown or imperfect the extent and state of progress of the appearances will sometimes supply strong presumptive evidence of the duration of the poisoning. This is an obvious and important application of the knowledge of the pathology of poisoning; but the simple mention of it is all which can be here attempted, as special rules can hardly be laid down on the subject. SECTION III.—_Evidence from Chemical Analysis._ The chemical evidence in charges of poisoning is generally, and with justice, considered the most decisive of all the branches of proof. It is accounted most valid, when it detects the poison in the general textures of the body, or in the blood, or in the stomach, intestines or gullet, then in the matter vomited, next in articles of food, drink or medicine of which the sufferer has partaken, and lastly, in any articles found in the prisoner’s possession, and for which he cannot account satisfactorily. When poison is detected in any of these quarters, more especially in the stomach or intestines, it is seldom that any farther proof is needed to establish the fact of poisoning. In two circumstances, however, some corroboration is necessary. In the first place, in cases where a defence is attempted by a charge of imputation of poisoning it may be necessary to determine by an accurate account of the symptoms, or by the morbid appearances, or by both together, whether the poison was introduced into the body before or after death. For it is said, that attempts have been made to impute crime by introducing poison into the stomach or anus of a dead body; and although I have not been able to find any authentic instance of so horrible an act of ingenuity having been perpetrated, it must nevertheless be allowed to be quite possible. Secondly, an account of the symptoms and morbid appearances is still more necessary, when the question at issue is, not so much whether poison has been given, as whether it was the cause of death, granting it had been taken. Some remarks have been already made on this question in the two former sections. In the present place some farther illustrations will be added from two very striking cases. They are interesting in many respects, and particularly as showing the importance of strict medico-legal investigation: I am almost certain that but a few years ago their real nature would not have been discovered in this country. The first to be noticed occurred to Dr. Wildberg of Rostock. Wildberg was required to examine the body of a girl, who died while her father was in the act of chastising her severely for stealing, and who was believed by all the bye-standers, and by the father himself, to have died of the beating. Accordingly, Wildberg found the marks of many stripes on the arms, shoulders and back, and under some of the marks blood was extravasated in considerable quantity. But these injuries, though severe, did not appear to him adequate to account for death. He therefore proceeded to examine the cavities; and on opening the stomach, he found it very much inflamed, and lined with a white powder which proved on analysis to be arsenic. It turned out, that on the theft being detected the girl had taken arsenic for fear of her father’s anger, that she vomited during the flogging, and died in slight convulsions. Consequently, Wildberg very properly imputed death to the arsenic. In this case the chemical evidence proved that poison had been taken; but an account of the symptoms and appearances was necessary to prove that she died of it.[83] The other case occurred to Pyl in 1783. A woman at Berlin, who lived on bad terms with her husband, went to bed in perfect health; but soon afterwards her mother found her breathing very hard, and on inquiring into the cause discovered a wound in the left side of the breast. A surgeon being immediately sent for, the hemorrhage which had never been great, was checked without difficulty; but she died nevertheless towards morning. On opening the chest it appeared that the wound pierced into it, and penetrated the pericardium, but did not wound the heart; and although the fifth intercostal artery had been divided, hardly any blood was effused into the cavity of the chest. Coupling these circumstances with the trifling hemorrhage during life, and the fact that she had much vomiting, and some convulsions immediately before death, Pyl satisfied himself that she had not died of the wound: and accordingly the signs of corrosion in the mouth and throat, and of irritation in the stomach, with the subsequent discovery of the remains of some nitric acid in a glass in her room, proved that she had died of poison.[84] _Causes of the disappearance of poison from the body._—Chemical evidence is not always attainable in cases of poisoning. Various causes may remove the poison beyond reach. Hence although poison be not detected in the body,—the experimenter being supposed skilful and the poison of a kind which is easily discovered,—still it must not be concluded from that fact alone that poison has not been the cause of death. For that which was taken into the stomach may have been all discharged by vomiting and purging, or may have been all absorbed, or decomposed; and that which has been absorbed into the system may have been all discharged by the excretions.