CASES FROM PRACTICE. CASE OF ARSENICAL POISONING.
Civil
By W. P. Haiiris, M.D., Assistant-Surgeon, Sliahjehanpore.
This case confirms the truth of the observations of Dr. Bonavia recorded at page 252, and of Dr. MoLeod at page 302, of the Medical Gazette of last year. Waidoola Khan, aged twenty-two, a young man of a respectable family, after quarrelling with hio relations, was taken ill at 4 p. m., on the 11th ultimo, with symptoms of irritant poisoning, and died at 10 p.m. When his friends urged him to confess "whether he had taken " poison, he laughed and told them he didn't intend to live, he would die." Body examined at 7-30 a.m. on 12th. I. External Appearances.?Face and lips livid ; a little dark fluid blood trickling from the nose. Cranial Cavity.?Vessels of pia mater immensely enlargII. ed from congestion; extensive effusion of scrum into meshes of arachnoid, and a little extravasation of thin black blood on the the left hemisphere. upper surface of Thoracic Cavity.?Right cavities of the heart contained III. a quantity of dark fluid blood; lining membrane, valves, columnse carnese, &c., quite healthy, and not in the least stained. Left ventricle contained a little dark fluid blood, and its lining membrane was deeply stained in vertical patches of an inch in length, penetrating to a depth of a line or two into the substance of the heart. IV. Abdominal Cavity.?Stomach containing much brownish fluid, with jelly or towlike particles floating in it, but without food or lumps of arsenic ; mucous membrane not highly
congested.
Small intestines contained lumps of white arsenic of the size of a pea. Large intestines were filled with fluid fceces deeply tinged with bile, and the mucous membrane was covered, in one or two places, with what looked like a little dab of yellow paint. Remarks. It has been said that the size of the patches in the heart appears to bear some relation to the extent of those met with in the stomach.. I think, however, it should rather be said that they both are related to the greater or less amount of the poison taken. What is the cause of these patches ? As even small doses of arsenic cause congestion of all the internal organs, it does not require a great stretch of the imagination to conceive that a larger dose may produce a^tage of disease in advance of this, in the form of effusion from the already congested vessels of these organs, constituting, in the brain, serous or sanguineous effusion into the meshes of the arachnoid; and in the heart, sanguineous effusion into the endocardium :?the last, perhaps, immediately due to the bruising of the congested capillaries of the endocardium by the left side of the heart. powerful muscular action of the It will be very interesting in future to observe the stethoseopic sounds in these cases during life. With reference to the post-mortem symptoms of serous apoplexy in this case, I may mention that I have met with this state of the brain before. I find entered in my case-book on the 29th August last, in a post-mortem on a case of undoubted arsenic poisoning, the following,?" much effusion of blood and serum upon the brain." This state of the brain is worthy of remark, as Taylor does not mention it in the 5th edition of his " Medical Jurisprudence." The patches of 3'ellow paint-like substances found in the large intestines in this case, have been before observed by me in suspected poisoning by ivhite arsenic, and they give one the idea that the drug used was orpiment, though really the colour is due to the nresence of bile.
Civil
By W. P. Haiiris, M.D., Assistant-Surgeon, Sliahjehanpore.
This case confirms the truth of the observations of Dr. Bonavia recorded at page 252, and of Dr. MoLeod at page 302, of the Medical Gazette of last year. Waidoola Khan, aged twenty-two, a young man of a respectable family, after quarrelling with hio relations, was taken ill at 4 p. m., on the 11th ultimo, with symptoms of irritant poisoning, and died at 10 p.m. When his friends urged him to confess "whether he had taken " poison, he laughed and told them he didn't intend to live, he would die." Body examined at 7-30 a.m. on 12th. I. External Appearances.?Face and lips livid ; a little dark fluid blood trickling from the nose. Cranial Cavity.?Vessels of pia mater immensely enlargII. ed from congestion; extensive effusion of scrum into meshes of arachnoid, and a little extravasation of thin black blood on the the left hemisphere. upper surface of Thoracic Cavity.?Right cavities of the heart contained III. a quantity of dark fluid blood; lining membrane, valves, columnse carnese, &c., quite healthy, and not in the least stained. Left ventricle contained a little dark fluid blood, and its lining membrane was deeply stained in vertical patches of an inch in length, penetrating to a depth of a line or two into the substance of the heart. IV. Abdominal Cavity.?Stomach containing much brownish fluid, with jelly or towlike particles floating in it, but without food or lumps of arsenic ; mucous membrane not highly
congested.
Small intestines contained lumps of white arsenic of the size of a pea. Large intestines were filled with fluid fceces deeply tinged with bile, and the mucous membrane was covered, in one or two places, with what looked like a little dab of yellow paint. Remarks. It has been said that the size of the patches in the heart appears to bear some relation to the extent of those met with in the stomach.. I think, however, it should rather be said that they both are related to the greater or less amount of the poison taken. What is the cause of these patches ? As even small doses of arsenic cause congestion of all the internal organs, it does not require a great stretch of the imagination to conceive that a larger dose may produce a^tage of disease in advance of this, in the form of effusion from the already congested vessels of these organs, constituting, in the brain, serous or sanguineous effusion into the meshes of the arachnoid; and in the heart, sanguineous effusion into the endocardium :?the last, perhaps, immediately due to the bruising of the congested capillaries of the endocardium by the left side of the heart. powerful muscular action of the It will be very interesting in future to observe the stethoseopic sounds in these cases during life. With reference to the post-mortem symptoms of serous apoplexy in this case, I may mention that I have met with this state of the brain before. I find entered in my case-book on the 29th August last, in a post-mortem on a case of undoubted arsenic poisoning, the following,?" much effusion of blood and serum upon the brain." This state of the brain is worthy of remark, as Taylor does not mention it in the 5th edition of his " Medical Jurisprudence." The patches of 3'ellow paint-like substances found in the large intestines in this case, have been before observed by me in suspected poisoning by ivhite arsenic, and they give one the idea that the drug used was orpiment, though really the colour is due to the nresence of bile.
