letlico-legal Jtflcmoraudum. DEPOSIT OF YELLOW ARSENIC ON THE ENDOCARDIUM IN A CASE OF ARSENICAL POISONING.
(Reported
ivith the kind
permission of
Dr.
Warden.)
By CIIUNILAL BOSE, h.b., Assistant Chemical Examiner to the Government of Bengal.
The
of arsenical poisoning features of may be consufficient apology for the publication
following
case
interesting presents Medico-legal importance, and this some
very
sidered a of this paper. It may be worth while to narrate briefly the history of the case. A parcel consisting of a wooden case reached Howrah from Patna iu August 1891, addressed to some person in Calcutta. It remained unclaimed for sometime. Having noticed a dark-coloured offensive liquid issuing from the box, the Railway authorities had the parcel opened, and the corpse of a young Mahomedau womau was found in it. The body in due course was sent to the Civil Surgeon, Howrah, for autopsy and report. The Civil Surgeon forwarded the stomach with a portion of liver, the heart and portions of large intestines separately in three glass bottles for analysis. He suspected it was a case of arsenical poisoning, and drew the attention of the Chemical Examiner to " a peculiar bright yellow deposit on the endocardial lining of the left ventricle." The stomach as received in this Department, was found cut open, and although it had been lying immersed in spirit for some time, patches of congestion could still be discerned; the congested spots, as well as other parts of the mucous membrane, were covered over with a layer of mucous mixed with fiue dirty white particles.
May
MEDICO-LEGAL MEMORANDUM.
1892.]
The appearance was characteristic of arsenic The Civil Surgeon reported the stomach to be normal in size, deeply congested, containing bloody fluid with mucus and floccu-
kidneys
in
position
poisoning.
lent matter. The mucous coat of the portion of large intestine forwarded for analysis, was found covered
yellow deposit
like yellow the At the arsenic. of mortem, post sulphide mucous membrane of the large intestine was noticed to be swollen and congested, containing a yellow fluid emitting no foecal odour. The most important post mortem appearance, however, which forms the subject of this paper, was the peculiar staining of portions of the endocardium lining the ventricles of the heart. The heart as received in the Chemical Examiner's Department was found cut open and There was nothing partiits cavities exposed. cular to note in the general appearance of the
patches
with
a
organ. There were bright yellow stains on the internal surfaces of both the ventricles. In the left ventricle the yellow patch extended from the apex of the heart upwards running parallel and close to the posterior border of the septum veutriculum to about half inch below the insertion of the mitral valve, and then curving downwards to a point about half inch above the apex. The long arm of the arch measured about 1*9 inches and the short arm about 1-25 inches; it was nearly of an uniform breadth throughout, measuring between three-fourth to half inch except the free end of the short arm which was found tapering. In the right ventricle the yellow patch was of an irregular square shape touching the apex of the heart with one of its sides, each side of the square measuring about 1*125 inches. The endocardium lining the smaller musculi papillares and column? carneae was affected, the muscle substauce being free from infiltration with any yellow particles. The endocardium lining the larger musculi papillares as well as other parts of the ventricles, the auricles, the valves and the vessels entering into and issuing from the heart was free from yellow
deposit.
In the post mortem report the yellow stain mentioned to have been detected in the left ventricle only, and the heart was described as soft from decomposition and containing no ante or post mortem clots. Whether the yellow stain in the right ventricle developed subsequent to the post mortem examination, or that it escaped the notice of the officer who conducted the autopsy, cannot be definitely ascertained. was
Other post
mortem appearances:?The lungs were reported to be collapsed, of a dark purple
colour,
mucous
firm like livera nd membrane of the
congested.
heavily ; the larynx was deeply float
Spleen
was
148
healthy
the
;
peritoneum
congested.
were
ami
" marked absence of the ordinary There was putrid odour from the body generally, and no foccal odour from the intestines." The body was in an advanced stage of decomand the face was disfigured.
Results of chemical analysis.?The fine dirtywhite substance in the stomach was found to be composed of particles of white arsenic. The yellow patches in the large intestines were found to contain arsenic (yellow sulphide) by
Reinch's
test.
Portions of endocardium beariug the yellow stains were detached, washed well with distilled water, and submitted to Reinch's test; well marked octohedral crystals of arsenic tri-oxide
.
detected. Another portion of the well washed endocar-
were
treated on a watch glass with a few of a 10 per cent, solution of caustic soda ; drops the yellow stain immediately disappeared ; the alkaline solution when treated with a slight excess of dilute hydrochloric acid threw down which was sulphide of a yellow precipitate arsenic. These tests conclusively show that the stain on the endocardium was caused by the deposit of yellow arsenic. Arsenic was detected in the substance of the heart by Reinch's test.
dium
was
Remarks.?In
arsenic,
cases
of
yellow patches
poisoning by white
sometimes discovered on the mucous coat of the stomach and the intestines as were noticed in this case too in the large intestines; these are usually referred to the formation of tri-sulphide of arsenic. But such deposits, as far as I am aware, have not hitherto been observed in the heart. It is reasonable to suppose that the yellow deposit in the heart was due to the action of are
sulphurretted hydrogen generated during put-
refaction on the arsenic deposited in the tissues ; but it is difficult to account for the irregular distribution of the sulphide. It is possible that arsenic may not be uniformly distributed throughout the structure of the heart, but that certain portions possess greater power for retaining arsenic than others. It is well known that in cases of arsenical poisoning, the element is not uniformly distributed throughout the structure of the liver.
Experiment (Results Negative).?In order this
point, a cat was poisoned with two days alter death, the heart cut removed, open, rapidly washed to remove
to
test
arsenic, and adherent
clots,
solution ot as
and then immersed in
an
aqueous The results distribution of arsenic
sulphuretted hydrogen.
regards the unequal negative.
were
The
results
experiment
is to be
published in due
continued,
course.
and the
(Reported
ivith the kind
permission of
Dr.
Warden.)
By CIIUNILAL BOSE, h.b., Assistant Chemical Examiner to the Government of Bengal.
The
of arsenical poisoning features of may be consufficient apology for the publication
following
case
interesting presents Medico-legal importance, and this some
very
sidered a of this paper. It may be worth while to narrate briefly the history of the case. A parcel consisting of a wooden case reached Howrah from Patna iu August 1891, addressed to some person in Calcutta. It remained unclaimed for sometime. Having noticed a dark-coloured offensive liquid issuing from the box, the Railway authorities had the parcel opened, and the corpse of a young Mahomedau womau was found in it. The body in due course was sent to the Civil Surgeon, Howrah, for autopsy and report. The Civil Surgeon forwarded the stomach with a portion of liver, the heart and portions of large intestines separately in three glass bottles for analysis. He suspected it was a case of arsenical poisoning, and drew the attention of the Chemical Examiner to " a peculiar bright yellow deposit on the endocardial lining of the left ventricle." The stomach as received in this Department, was found cut open, and although it had been lying immersed in spirit for some time, patches of congestion could still be discerned; the congested spots, as well as other parts of the mucous membrane, were covered over with a layer of mucous mixed with fiue dirty white particles.
May
MEDICO-LEGAL MEMORANDUM.
1892.]
The appearance was characteristic of arsenic The Civil Surgeon reported the stomach to be normal in size, deeply congested, containing bloody fluid with mucus and floccu-
kidneys
in
position
poisoning.
lent matter. The mucous coat of the portion of large intestine forwarded for analysis, was found covered
yellow deposit
like yellow the At the arsenic. of mortem, post sulphide mucous membrane of the large intestine was noticed to be swollen and congested, containing a yellow fluid emitting no foecal odour. The most important post mortem appearance, however, which forms the subject of this paper, was the peculiar staining of portions of the endocardium lining the ventricles of the heart. The heart as received in the Chemical Examiner's Department was found cut open and There was nothing partiits cavities exposed. cular to note in the general appearance of the
patches
with
a
organ. There were bright yellow stains on the internal surfaces of both the ventricles. In the left ventricle the yellow patch extended from the apex of the heart upwards running parallel and close to the posterior border of the septum veutriculum to about half inch below the insertion of the mitral valve, and then curving downwards to a point about half inch above the apex. The long arm of the arch measured about 1*9 inches and the short arm about 1-25 inches; it was nearly of an uniform breadth throughout, measuring between three-fourth to half inch except the free end of the short arm which was found tapering. In the right ventricle the yellow patch was of an irregular square shape touching the apex of the heart with one of its sides, each side of the square measuring about 1*125 inches. The endocardium lining the smaller musculi papillares and column? carneae was affected, the muscle substauce being free from infiltration with any yellow particles. The endocardium lining the larger musculi papillares as well as other parts of the ventricles, the auricles, the valves and the vessels entering into and issuing from the heart was free from yellow
deposit.
In the post mortem report the yellow stain mentioned to have been detected in the left ventricle only, and the heart was described as soft from decomposition and containing no ante or post mortem clots. Whether the yellow stain in the right ventricle developed subsequent to the post mortem examination, or that it escaped the notice of the officer who conducted the autopsy, cannot be definitely ascertained. was
Other post
mortem appearances:?The lungs were reported to be collapsed, of a dark purple
colour,
mucous
firm like livera nd membrane of the
congested.
heavily ; the larynx was deeply float
Spleen
was
148
healthy
the
;
peritoneum
congested.
were
ami
" marked absence of the ordinary There was putrid odour from the body generally, and no foccal odour from the intestines." The body was in an advanced stage of decomand the face was disfigured.
Results of chemical analysis.?The fine dirtywhite substance in the stomach was found to be composed of particles of white arsenic. The yellow patches in the large intestines were found to contain arsenic (yellow sulphide) by
Reinch's
test.
Portions of endocardium beariug the yellow stains were detached, washed well with distilled water, and submitted to Reinch's test; well marked octohedral crystals of arsenic tri-oxide
.
detected. Another portion of the well washed endocar-
were
treated on a watch glass with a few of a 10 per cent, solution of caustic soda ; drops the yellow stain immediately disappeared ; the alkaline solution when treated with a slight excess of dilute hydrochloric acid threw down which was sulphide of a yellow precipitate arsenic. These tests conclusively show that the stain on the endocardium was caused by the deposit of yellow arsenic. Arsenic was detected in the substance of the heart by Reinch's test.
dium
was
Remarks.?In
arsenic,
cases
of
yellow patches
poisoning by white
sometimes discovered on the mucous coat of the stomach and the intestines as were noticed in this case too in the large intestines; these are usually referred to the formation of tri-sulphide of arsenic. But such deposits, as far as I am aware, have not hitherto been observed in the heart. It is reasonable to suppose that the yellow deposit in the heart was due to the action of are
sulphurretted hydrogen generated during put-
refaction on the arsenic deposited in the tissues ; but it is difficult to account for the irregular distribution of the sulphide. It is possible that arsenic may not be uniformly distributed throughout the structure of the heart, but that certain portions possess greater power for retaining arsenic than others. It is well known that in cases of arsenical poisoning, the element is not uniformly distributed throughout the structure of the liver.
Experiment (Results Negative).?In order this
point, a cat was poisoned with two days alter death, the heart cut removed, open, rapidly washed to remove
to
test
arsenic, and adherent
clots,
solution ot as
and then immersed in
an
aqueous The results distribution of arsenic
sulphuretted hydrogen.
regards the unequal negative.
were
The
results
experiment
is to be
published in due
continued,
course.
and the
