The problem therefore for solution, is the mode of distinguishing the
two species from each other. Although the leading characters are, as we
have said, the same in both, such as bilious vomiting, and purging,
violent tormina of the bowels, cold sweats, cramps, faintings, and
death, yet by a careful and circumstantial examination of the case, the
intelligent practitioner will generally be enabled to arrive at a
probable conjecture; the season of the year[155], the prevailing
epidemics, the age[156] and constitutional predisposition of the
patient, his habit with respect to diet, are circumstances which will
greatly assist the diagnosis. The progress of cholera morbus is also
rarely, or never, fatal in this climate, especially in so short a period
as that in which death occurs from the operation of a violent, corrosive
poison.[157] There are besides in this latter case, very frequently
other symptoms which do not attend _cholera spontanea_,[158] such as
sanguineous vomiting, extreme burnings in the æsophagus and region of
the stomach, swollen countenance, great dryness and tumefaction of the
fauces, peculiar fætor of the breath, ischuria, with discharges of
bloody urine, and ulcerations about the fundament[159]; this latter
symptom was particularly remarkable in the case of _Mr. Blandy_, whose
history, as related by his physician, _Dr. Addington_, will be found in
our _Appendix_, _p._ 236, and well deserves the attentive consideration
of the medical jurist. The matter voided will also sometimes lead to a
just diagnosis; in the true cholera _spontanea_ there is a discharge of
almost pure bile by vomiting and stool, simultaneously or alternately;
now, although the same vomiting and purging may arise from the action of
a poison, yet it does not follow that the matter discharged is bilious.
The evidence delivered on the extraordinary trial of _Donnall_, for the
wilful murder of his mother-in-law, _Mrs. Elizabeth Downing_, has been
also printed in the _Appendix_, as well illustrating those doubts with
which the present question is naturally encompassed. An opinion has
existed that the appearance of jaundice during, or after the severe
symptoms of _cholera_, offers a satisfactory proof of its spontaneous
origin. Upon this point we would observe, that by violent and protracted
retching a person may sometimes become jaundiced, a circumstance not
unlikely to occur in cases of poisoning. The stomach, diaphragm, and
abdominal muscles are, under such repeated efforts, very apt to be
rendered eminently irritable, so that at each effort of the former to
discharge its contents, the latter will frequently be simultaneously
thrown into strong spasmodic contractions, and the liver, together with
the gall-bladder, will be suddenly caught, and, as it were, tightly
squeezed in a powerful press, in consequence of which the bile will
regurgitate, and be carried into the _venæ cavæ_; for _Haller_ has shewn
with what facility a subtle injection, when thrown into the hepatic
duct, will escape by the hepatic veins; upon which _Dr. Saunders_ has
made the following remark, “I know this to be a fact, for I have
ascertained by experiment, that water, injected in the same direction,
will return by the veins in a full stream, although very little force is
used.”
The fact of the bile becoming, under certain circumstances, highly acrid
and deleterious, has been seized by the humoral pathologist as a
powerful argument in support of his doctrines. Amongst the more
distinguished authors who have fully treated this subject, and
maintained that our secretions may thus become acrid poisons, we have
_Galen_[160], _Aretæus_[161], _Fernelius_[162], _Morgagni_[163],
_Hebenstreit_[164], _Hilchen_[165], _Hoffman_[166], _Baumer_[167],
_Belloc_[168], _Alibert_[169], _Foderé_[170], _Mahon_[171], _De la
Mettrie_[172], and _Tronchin_[173]. Some of the authors above enumerated
have expressed their opinions in the strongest terms; thus _Morgagni_
(loco citato) “_Facile agnosco a prava ipsa corporis dispositione
internum aliquando posse venenum gigni_;” and _Hebenstreit_ observes,
“_Possunt omnino in corpore venena nasci, atque ipsi humores vitales vim
vasa sua destruendi sæpe acquirunt._[174]” _Hilchen_, after attempting
to establish a diagnosis between the effects of poison, and those
arising from a morbid degeneracy of the fluids, exclaims, apparently in
despair, “_Inquilinos corruptosque humani corporis humores, eum
acrimoniæ gradum, eamque corrodendi vim acquirere posse, quæ eosdem edat
effectus, quos venena corrosiva sistunt, eamdem sordium vomitu
rejectarum putrilaginem, fætorem, haud dissimilem, et acerrimam, et
pelves arrodentem acrimoniam certum est._” And _Plouquet_, after
describing all the phenomena of poisoning, concludes by acknowledging
“_Probe autem notandum hæc omnia etiam ex aliis statibus morbosis nasci
posse._” _De la Mettrie_ also has observed upon this question, “_Il est
prouvé que la bile se peut changer dans nos corps en espece d’Arsenic!_”
Our own countryman, _Dr. Currie_[175], has furnished the public with an
opinion upon the subject under discussion, and he states his belief
that, under a peculiar state of irritation, the biliary organs may
secrete a bile of so very acrid a nature as to excite an almost
immediately fatal impression upon the alimentary canal, especially when
suddenly effused, and in a highly concentrated form.
We have deemed it right to adduce these various authorities, in relation
to the important question before us, still, however, reserving our
opinion, that the physician will on such occasions, by means of the
subsidiary sources of discrimination above enumerated, generally be
enabled to form a diagnosis[176] which, although it may not amount to
certainty, must be considered as capable of increasing the weight of the
general mass of circumstantial evidence.
As the medical treatment to be adopted in cases of acute disease, or
poisoning, can hardly be considered a subject of Medical Jurisprudence,
we should have passed it over in silence, did not the evidence delivered
upon the trial of Donnall imperiously call upon us for some
animadversion; and we feel it our painful duty upon this occasion to
observe, that the whole tenor of the medical defence displayed a very
unbecoming contest; the witnesses conducted themselves like advocates,
raising doubts, and defending their positions with a pertinacity that
belongs to those who seek triumph rather than truth.
In the cure of cholera the experience of the physicians of all ages
wholly concurs. In the commencement of the disease the evacuation of the
redundant bile is to be favoured by the plentiful exhibition of mild
diluents, and after the redundant bile has been thus eliminated, or when
the spasmodic affections of the alimentary canal become dangerously
violent, opiates, in sufficiently large doses, but in small bulk, may be
administered. To employ evacuants, as _Sydenham_ quaintly observes, “is
to increase the disturbance, and as it were, to endeavour to quench fire
by oil; and on the other hand, to commence with opiates is shutting up
the enemy in the bowels.” Under such authority, we presume, one of the
witnesses in the defence of Donnall, felt justified in condemning the
practice of the respectable physician who attended the deceased
(_Appendix, p._ 304); but we here see a witness assuming as a fact, what
was never proved in evidence, and then deducing conclusions from it.
_Dr. Edwards_ informed the court that “there were no symptoms of cholera
morbus when _he_ saw Mrs. Downing; but from what _he_ heard of her
complaint, he imagined that there was something offensive either in the
stomach or bowels, which ought to be evacuated.” (_Ibid. p._ 286.)
Nor are the symptoms produced by the operation of narcotic poisons so
distinct as to escape the possibility of being confounded with those of
spontaneous disease. They may, for instance, simulate those of apoplexy,
or epilepsy; but the history of the case, the odour of the breath, and
the subsequent examination of the body after death, will generally clear
up the difficulties which may at first present themselves. But we shall
have occasion to consider this subject hereafter; the difficulties of
the case are well illustrated by the evidence on the trial of
_Donellan_, for the murder of _Sir Theodosius Boughton_, with laurel
water, for which see _Appendix, p._ 243.
Before we quit the subject which involves the consideration of our
fluids degenerating, under particular circumstances, into poisons, we
may just notice the opinion of some foreign chemists, that in certain
diseases the _Prussic acid_[177] is generated in some of the fluids of
the animal body. We are not inclined to accede to this proposition,
because during life we do not think the chemical decompositions, known
to be necessary for the production of this substance, can ever take
place. At all events, it must be preceded by a state of the system which
would necessarily prevent the chance of any medico-judicial fallacy.
Q. II. _Whether organic lesions, similar to those produced by poisoning,
may not occasionally result from natural causes?_
In entertaining this question, we are prepared to meet with numerous
alleged difficulties; but as many of them appear to have arisen, rather
from the ignorance or carelessness of the operator, than from the
natural obscurity of the subject itself, we are inclined to hope that by
getting rid of the former source of fallacy, we shall be enabled to
examine with some satisfaction and advantage, those which, in a greater
or less degree, will be liable to baffle the researches of the more
experienced anatomist.
Such are the changes which an animal body undergoes after death, that
unless the anatomist be intimately acquainted with their nature and
extent, it is impossible that he should be able to derive any safe
conclusions from his dissection; thus, said _Mr. John Hunter_, we may
see appearances which are natural, and may suppose them to have arisen
from disease; we may see diseased parts, and suppose them to be in a
natural state, and we may suppose a circumstance to have existed before
death, which was, in reality, a consequence of it; or we may imagine it
to be a natural change after death, when it was truly a disease of the
living body. It is not difficult, therefore, to perceive, how a person
in such a state of ignorance must blunder, when he attempts to connect
the appearances in the dead body, with the symptoms that were observed
during life; and indeed it may be safely asserted, that the great
utility of anatomical inspections depends upon the accuracy, judgment,
and sagacity with which such comparisons are made. In our chapter, on
the art of conducting dissections, we have endeavoured to point out each
fallacy which is likely to present itself to the inexperienced
anatomist, we shall therefore confine ourselves, on the present
occasion, to the consideration of those points whose obscurity must be
admitted to belong intrinsically to the subject, and to be wholly
independent of the ignorance or skill of the dissector.
Amongst the signs of the action of poison on the human body, disclosed
by the light of dissection, the separation of the villous coat of the
stomach has been generally considered the most certain criterion.
_Hebenstreit_, whose opinion has been adopted by _Mahon_, and many other
forensic physicians, has delivered his unreserved judgment upon the
question, in the following emphatic sentence. “_Præterea sola atque
infallibilis deglutiti veneni nota est, separata et veluti decorticata
simulque cruenta interna ventriculi tunica: nam separatio ista supponit
applicatam superficiei internæ ventriculi materiam fervidam, igni
similem, quæ tunicam istam a substrata solvit vasculari nervea._”[178]
In opposition to such an opinion, it is our duty to state that several
cases stand recorded[179] in which the detachment of the villous coat of
the stomach and intestines has taken place, without the slightest ground
to suspect the administration of poison, while many vegetable poisons
destroy life without occasioning any inflammation in the _primæ viæ_,
and consequently leave no traces of disorganization. But there still
remains another source of fallacy connected with the present question
which demands a full and impartial inquiry, viz. that the gastric juice,
by its action upon the dead stomach, can occasion such changes in
structure, as may be mistaken for the effects of a corrosive poison;
these changes are according to circumstances liable to vary in every
possible degree of intensity, from the slight erosion of the interior
villous coat of the stomach, as displayed by the smooth, thin, and more
transparent condition of that viscus, to the destruction of all its
membranes, and the production of large perforations in its great
extremity. This phenomenon, the nature of which was first explained by
_Mr. John Hunter_[180], depends upon the gastric juice, which the
stomach secreted during life, becoming its solvent after death. Amongst
the endless proofs which the history of the animal economy affords of
that universal law by which chemical and vital forces are wisely
preserved in a state of perpetual hostility, there is no illustration
more striking and satisfactory, than that which is furnished by the
phenomenon in question. If animals, or parts of animals, while possessed
of the living principle, be taken into the stomach, they are not in the
least affected by the solvent powers of its juices; thence it is that we
so constantly find animals of various kinds living in the stomach, or
even being hatched and bred there; but no sooner do these animals lose
the living principle, than they become subject to the digestive powers
of the stomach, and are accordingly dissolved, and assimilated. If it
were possible, says _Mr. Hunter_, for a man’s hand to be introduced into
the stomach of a living animal, and kept there for some considerable
time, it would be found that the dissolvent powers of the stomach could
produce no impression upon it; but if the same hand were separated from
the body, and introduced into the same stomach, we should then find that
this organ would immediately act upon it. _Spallanzani_, with a patience
that almost wearies his readers, made many attempts at dissolving the
stomach by its own juice, but succeeded satisfactorily in none; he
proved, however, two important facts, _first_, that the process of
digestion, or more correctly speaking, of solution, continues after
death; and _secondly_, that the stomach itself is digestible. The truth
of the first he demonstrated by introducing food into the stomach, after
he had killed his animal; and that of the second, by giving the stomach
of one dog to be devoured by another. The fact then is clearly
established, that the stomach, after death, may be dissolved by its own
juice[181]; and this may exist in its cavity, or be retained in the
vessels which had secreted it. It remains for us then to examine the
circumstances under which it is likely to occur, and the appearance by
which it may be distinguished; and we may here be allowed to observe
with an ingenious writer,[182] that were these points merely of a
speculative nature, or were their decision a matter of mere curiosity,
it would be idle to consume so much valuable time in their discussion;
but when we remember that they are questions upon which the medical
practitioner may be called upon to deliver a solemn opinion, in order to
determine the fate of a criminal, they undoubtedly demand the highest
attention of those who profess to aid the administration of Justice, by
the lights of science. We have, therefore, first to inquire into _the
circumstances under which this natural erosion of the stomach is known
to take place_. _Mr. John Hunter_[183] details the history of three
examples, in which the stomach was considerably perforated. Two of the
men had died shortly after having their skulls fractured, and the third
was a man who had been hanged, so that in each of these cases the person
had been deprived of life by violence; whence _Dr. Adams_[184] inferred,
that _Mr. Hunter_ limited the action of the gastric juice on the stomach
to such as died from violent and sudden causes; and many physiologists
have, accordingly, supposed that solution of the coats of the stomach
never takes place, except where the person has died suddenly; this,
however, is an inference, as _Mr. Burns_[185] has very justly observed,
“by no means warranted by the general tenour of _Mr. Hunter’s_ essay,”
indeed he expressly states, that “there are few dead bodies in which the
stomach is not, _at its great end_, in some degree digested;” “and any
one,” continues _Mr. Hunter_, “who is acquainted with the art of
dissection, can easily trace the gradations from the smallest to the
greatest.” The consideration of the vast importance of this fact, and
frequent opportunities of investigating the subject, induced _Mr. Burns_
to collect the observations which he had made during the dissection of
those bodies in which he found the stomach digested; and these
observations, he informs us, have led him to conclude, that the
phenomenon in question is neither so rare in its occurrence as some have
imagined, nor confined to such subjects as had been, previous to death,
in a healthy condition; they have also convinced him, that other parts
of the stomach, besides the large end, may be occasionally acted on by
the gastric juice. “That the digestion of the coats of the stomach after
death is not a very rare occurrence, I think myself authorised to infer,
from my having examined nine bodies in which the solution had proceeded
to such an extent as to have made holes of considerable size through
that viscus; and, besides these nine instances in which the digestion of
part of the stomach was complete, I have had occasion to see, in opening
this viscus, various degrees of dissolution of its villous coat.”[186]
In three of the instances alluded to by _Mr. Burns_, the patients had
been worn out by debilitating diseases; and they were emaciated and
anasarcous. That the solution of the coats of the stomach in these cases
was properly attributed to the gastric juice is very satisfactorily
shewn by the relation of the following instructive dissection. “I had
occasion,” says _Mr. Burns_, “two days after death, to open the body of
a very emaciated and anasarcous young girl, who had died from scrofulous
enlargement of the mesenteric glands. On raising the coverings of the
abdomen, the stomach, which was empty, presented itself to view, _with
its front dissolved_.[187] The aperture was of an oblong shape, about
two inches in its long diameter, and an inch in its short, with tender,
flocculent, and pulpy edges. This I demonstrated to the pupils attending
my class; and I especially called their attention to the fact, that the
liver, which was in contact with the hole, had no impression made on it.
Having proceeded thus far, I placed all the parts as they had been,
stitched up the abdomen, and laid the body aside in a cold situation for
two days. Then I opened it again, in presence of the same gentlemen, and
we found that, now, _the liver, where it lay over the dissolved part of
the stomach, was pulpy; its peritoneal coat was completely dissolved,
and its substance was tender to a considerable depth_. At this time the
other parts of the liver were equally solid as before, and as yet every
part of the subject was free from putrefaction; _the posterior face of
the stomach, opposite to the hole, was dissolved, all except the
peritoneal coat, at least the internal coats were rendered pulpy and
glutinous; the peritoneal covering had become spongy and more
transparent than it ought to have been_.” These facts, in addition to
the many other important conclusions to which they will give rise,
admonish us, that in judicial investigations into the cause of
dissolution of the coats of the stomach, _the appearances will vary,
according to the period after death at which the body is examined_. But
the most satisfactory case which has been reported, in proof that the
_post mortem_ solution of the stomach may occur after a lingering
disease, is that just published by _Dr. Haviland_,[188] where the
patient died of fever after an illness of 22 days; when upon opening the
body about 12 hours after death, the following appearances were noticed:
“On raising the stomach and examining the little omentum, we were
surprised by the appearance of a dark-coloured fluid, which seemed to
escape from the former viscus. A most careful search was now made, and a
large opening was perceived in the stomach on the upper and back part,
near the cardia. The stomach was then detached, with a portion of the
œsophagus and duodenum, when a large perforation of the diaphragm came
into view, in the muscular part, corresponding precisely to, and
communicating with, the hole in the stomach; so that a portion of the
contents of the latter organ had escaped into the cavity of the chest.
This part of the diaphragm was next removed. A careful examination of
the other abdominal and thoracic viscera did not lead to the detection
of the slightest diseased appearance. There was no where the smallest
evidence of previous inflammation, no adhesions or ulcerations of any
part of the viscera. The fluid which had escaped appeared to be nothing
more than the contents of the stomach, of which the wine and water[189]
formed a part, and probably gave it its dark colour. The stomach, on
being examined after its removal from the body, afforded the following
observations. The mucous membrane appeared to be more red and vascular
than usual throughout its whole extent, and, here and there, were small
spots of what seemed to be extravasated blood, lying below the mucous
coat—for these spots were not to be washed off, nor to be removed by the
edge of the scalpel. There were two holes in the stomach, the larger
very near to the cardiac end of the small curvature, and on the
posterior surface: this was more than an inch in length, and about half
that breadth; the other not far from the former, also on the posterior
surface, about the size of a sixpence. The edges of these holes were
smooth, well defined, and slightly elevated. The coats of the stomach
were thin in many other spots, and in one in particular nothing was left
but the peritoneum, the mucous and muscular coats being entirely
destroyed. The hole in the diaphragm was through the muscular portion,
where it is of considerable thickness, and was large enough to admit the
end of the finger. There was no appearance of ulceration or of pus
adhering to the edges of this perforation of the diaphragm.” We have
extracted a full account of this dissection, as the case is in itself
truly interesting. The symptoms of the patient had been carefully
watched, and no pain, or uneasiness was ever heard of, throughout the
whole course of the disease, except in the head.
The powers of the stomach, as it would appear from the report, had
suddenly revived at about twelve hours before his death, for “he asked
for food, and swallowed a few spoonsfull of calves’-foot jelly with
apparent relish.” May we not then conclude by observing, that the facts
above related very satisfactorily corroborate the truth of the corollary
deduced by _Mr. Burns_, “that the digestion of the coats of the stomach
may take place under two very different conditions of the body; that
although such solution is most frequent in those who have been suddenly
deprived of life, when in full health, that it is not confined to those
alone, but does, under certain circumstances, occur in those who have
died from lingering diseases.”
Having then shewn under what circumstances the phenomenon in question
may take place, we shall now proceed to describe more minutely the
appearances which it may assume, and _first, with respect to the part of
the stomach, more usually acted upon by the gastric solvent_. _Mr.
Hunter_ thought, that digestion of the stomach after death was
occasioned by that portion of the gastric juice _contained in the
cavity_ of the stomach; consequently it followed, as a fair inference
from this doctrine, that the coats of this viscus will only be acted on
at that part on which the contents of the stomach rested. In _Mr.
Hunter’s_ cases, the great end of the stomach, which in the supine
position of the body is the most depending part of this viscus, was
found to be chiefly affected; a fact which tended to corroborate and
support his opinion, and to render his conjecture extremely probable.
Other anatomists, however, have discovered instances of solution of
other parts of the stomach than the great end, indeed we have already
described such an instance in the case of the emaciated and anasarcous
girl examined by _Mr. Burns_, where the situation of the aperture was
different from what it had been in any of _Mr. Hunter’s_ cases. It was
seated _on the fore-part_ of the stomach, about an inch distant from the
pylorus, and mid-way between the smaller and greater curvatures of this
viscus; at a part of the stomach with which the gastric juice _could not
have come into contact_, as the body had constantly been in the supine
posture. “If then,” asks _Mr. Burns_, “the stomach was not acted on by
the fluid contained in its cavity, how came it to be dissolved?” To us
we confess his solution of the problem appears sensible and
satisfactory. “We cannot, with propriety, ascribe the digestion of the
stomach, in every case, to the gastric juice which has been _poured into
the cavity_ of that viscus; we are more properly in some instances to
refer it to the action of the fluid _retained in the vessels_ which had
secreted it.” If this be admitted as a correct explanation of the fact,
we shall cease to have any difficulty in accounting for the dissolution
of other parts of this viscus besides the large end. We shall learn that
the part acted on must vary, according to the place of the stomach where
the gastric juice is retained in the apparatus which secreted it, and
thus we shall be enabled to explain some cases, which, at present, seem
to be in opposition to the observation of _Mr. Hunter_.
With respect to the appearances, which such erosions assume, some
difference of opinion has also unfortunately existed. _Mr. Hunter_ has
asserted that “there are very few dead bodies, in which the stomach is
not, _at its great end_, in some degree digested; and the anatomist,”
says he, “who is acquainted with dissections can easily trace the
gradations from the smallest to the greatest. To be sensible of this
effect, nothing more is necessary than to compare the inner surface of
the great end of the stomach, with any other part of the inner surface;
what is sound will appear soft, spongy, and granulated, and without
distinct blood-vessels, opaque, and thick, while the other will appear
smooth, thin, and more transparent, and the vessels will be seen
ramifying in its surface; and upon squeezing the blood which they
contain, from the larger to the smaller branches, it will be found to
pass out at the digested ends of the vessels, and appear like drops on
the inner surface.” This condition, however, of the vessels does not
invariably accompany such solution. In three of the subjects dissected
by _Mr. Burns_, there was no appearance of vessels ramifying on the
coats of the stomach. To account for the absence of this vascular
appearance several explanations have been attempted; “but we are not,”
says _Mr. Burns_, “to regard the cause of this deviation from _Mr.
Hunter’s_ description, as depending upon the particular part of the
stomach acted on in the different cases; neither are we to imagine that
the stage of the process at which we examine the body will assist us in
this investigation; we are rather to obtain an explanation of this fact,
from contemplating the difference of condition of the different
individuals at the time of death; the subjects, whose cases are detailed
by _Mr. Hunter_, were persons cut off by violence, in the plenitude of
health, their stomachs at the time excited by the stimulus of food to
vigorous action, and the process of digestion at the instant of death
going on briskly, circumstances under which it is reasonable to infer
that all the blood-vessels would be filled with blood, which it is
evident, from the nature of the causes depriving them of life, would be
detained in the veins. This being the state of his subjects at the
moment of death, we shall not wonder that, when he afterwards opened the
bodies, he could squeeze the blood from the digested ends of the
vessels.” This is certainly an ingenious explanation, and receives
considerable support from the important fact of the stomach presenting a
very high degree of vascularity, in cases of sudden death, as
exemplified by _Dr. Yelloly_[190] in his account of the appearances
found in the stomachs of several executed criminals soon after they had
undergone the sentence of the law. So also has dissection disclosed the
same phenomena, in those cases where life has been suddenly extinguished
by a blow on the region of the stomach; inflammation, in such instances,
is necessarily out of the question, for death is immediate; the red and
inflamed appearance therefore of the stomach can alone be accounted for
by regarding it as the effect of the sudden cessation of the heart,
producing an accumulation of the blood in the extreme arterial branches.
But what shall we say of _Dr. Haviland’s_ case? so far from the patient
dying suddenly, and in the plenitude of health, he expired after a
lingering illness of three weeks, and yet, upon dissection, the stomach
was found _highly vascular_. This is in direct opposition to the theory
of _Mr. Burns_, and, we must confess, is not a little embarrassing.
Where the gastric solution has proceeded so far as to produce
perforations in its coats, _Mr. Hunter_ states that, “the contents of
the stomach are generally found loose in the cavity of the abdomen,
about the spleen and diaphragm; and that in many subjects this digestive
power extends much farther than through the stomach. I have often
found,” says he, “that after it had dissolved the stomach at the usual
place, the contents had come into contact with the spleen and diaphragm,
and had partly dissolved the spleen, &c.” With respect to the appearance
of the gastric perforations, _Mr. Hunter_ characterises them as having
“their edges apparently half dissolved, very much resembling that kind
of dissolution which fleshy parts undergo when half digested in a living
stomach, viz. pulpy, tender, and ragged.”
As certain corrosive poisons will occasionally produce such organic
lesions in the stomach, as lead to perforations in its membranes, a
question naturally arises, _how are we to distinguish such
disorganizations, produced by causes acting during life, from those
which result from solution after death_? To this we may at once return a
general answer, that in a judicial investigation, we ought not to
attribute erosion of the stomach to poison, except it be accompanied by
evident marks of previous inflammation and reaction, or with gangrenous
appearances; unless indeed the poisonous substance be found in the
stomach, or the symptoms, previous to death, be characteristic and
satisfactory. It has been stated that the edges of the natural
perforation are “pulpy, tender, and ragged,” whereas those produced by
the caustic action of a poison will generally be found well defined, and
of the same thickness as any other part of the stomach. But let it be
remembered, that, after all, it is upon the detection of poisonous
matter in the stomach, that the prudent physician will place his great
reliance. We have thus offered a review of the different opinions which
have been entertained upon this important question, and in conclusion we
may observe, that there will necessarily exist in each particular case,
circumstances which no general views can comprehend, and upon which the
practitioner must exercise his judgment and discretion. It is not our
intention at present to enter fully into the several questions which
were raised on the memorable trial of _Charles Angus_ for the murder of
_Margaret Burns_, but as we have already very frequently alluded to the
medical evidence delivered on this occasion, and as we shall hereafter
be called upon to notice some of its more striking features, we have
subjoined a report of the trial, and of the unhappy and ill-conducted
controversy to which it has given origin.[191] Whether the holes in the
stomach were the effects of corrosive poison or of that solvent action
after death, which we have just endeavoured to explain, must remain a
matter of doubt, for the erosion in this case was so considerable, and
the inflammation so slight, that it is impossible to assert that they
both depended on the same cause.
With respect to the possibility of confounding the appearances of
gangrene, in the stomach, with those of putrefaction, some notice is
necessary in this place; and we cannot better illustrate the subject,
than by introducing the marks of discrimination which are considered by
_Mahon_[192] as decisive upon such occasions. The spots in the stomach,
resulting from putrefaction, says he, may be distinguished from those
which have resulted from violent causes, during life, in the following
manner. If the stomach retain its natural colour, and the spots are
mixed with a red hue, or the ulcers have pale, or bright red edges, such
have been the effect of some violent impression upon the living
membrane; whereas, on the contrary, if the stomach be pale, livid, or
green, and exhibit spots of the same colour, but of rather a deeper hue,
we may safely conclude that they are the genuine phenomena of
putrefaction. See the interesting account of the dissection of _William
Mitchell_, p. 191.
Q. 3. _Whether the rapid progress of putrefaction, in the body,
generally, or in any particular part, is to be considered as affording
presumptive evidence, in support of an accusation of poisoning?_
There are few opinions more popular than that which considers the speedy
putrefaction of the body as the universal and never failing consequence
of poisoning. To appreciate, however, the true value of such an
indication, and to avoid the fallacies with which it is surrounded, it
is essential to remember that the body of a person dying suddenly, and
in what may be called full health, is very liable to run rapidly into a
state of decomposition. As far, however, as our observations enable us
to deduce any conclusion, certain vegetable poisons appear to accelerate
such a change; for, very shortly after death, the body, under such
circumstances, will frequently swell, become highly offensive, assume a
black[193] appearance, and exhibit gangrenous spots on its surface. No
such appearances, however, it is said, usually follow as the _specific_
consequence of the fatal operation of _mineral_ poisons; _Dr. Jaeger_ in
an Inaugural dissertation,[194] which deserves to be better known,
states, as the result of numerous experiments, that the putrefaction of
animal bodies, poisoned by arsenic, whether buried or not, does not
appear to be either unusually accelerated or retarded; and he moreover
found that the generation of infusory animals, the production of larvæ
and subterraneous vegetation, in and about the bodies of poisoned
animals, took place as usual; and he remarked that “the immediate
contact of an arsenical solution seemed, in several instances, to
retard, in some degree, the putrefaction of the part to which it was
applied in sufficient quantity.” In the extraordinary case examined by
_Metzger_, in which the largest quantity of arsenic ever, perhaps, taken
into the stomach, was found after death, the body was not opened until
eighteen days after dissolution, and yet, says the anatomist, “_cadaver,
quod mireris, sine ullo fœtore aut putredinis signo erat, ut et absque
maculis lividis, si digitorum apices excipias_.” A case is also related
by _Dr. Yelloly_,[195] in which death was occasioned by arsenic, but
where not the slightest appearance of putrefaction was visible at the
time of examination, which did not take place until forty-nine hours
after death.
On the other hand, _Morgagni_[196] states that, on dissecting a female
who died from Arsenic, “_facies corporis posterior, ne suris quidem et
calcibus exceptis, tota erat nigra_.” And in the interesting case of
_William Mitchell_, as hereafter related, the appearance of the body
appears to have indicated that decomposition had proceeded with more
than ordinary celerity.
The fact of accelerated, or retarded putrefaction, therefore, cannot be
received with any confidence as a collateral indication of poisoning.
_Dr. Carson_, however, in the trial of _Charles Angus_, adduced the
circumstance of its absence, as a negative proof that the deceased had
not been poisoned; and in the celebrated Scotch trial of _Patrick
Ogilvy_, and _Catharine Nairne_,[197] the same fact was forcibly urged
in their defence.
_Gaspard à Reies_,[198] and other writers, have maintained that the
discovery of _living_ worms in the intestines of a person, suspected to
have died from poison, ought to be received as a direct refutation of
the charge. We are, however, not disposed to concur in such an opinion.
With respect to the value of the indication supposed to be afforded by
the circumstance of froth issuing from the mouth of the corpse, soon
after death, _Mr. Hunter_ has given a very satisfactory opinion, and to
which we must refer the reader, see _Appendix_, p. 273.
Q. IV. _How far the absence of poison, or the inability of the chemist
to detect it, in the body, or in the fluids ejected from it, is to be
received as a negative to an accusation of poisoning?_
We have already stated, that of all the proofs which can be adduced by
the physician, in support of a charge of murder by poison, no one can be
put in competition with that which arises from the discovery of the
poisonous substance itself, in the stomach, or in the contents of the
matter ejected by vomiting or purging. The law expects, therefore, that
the professional witness should be prepared to state, that every
experiment, calculated to detect the presence of poison, has been
scrupulously and faithfully performed; and we may take this occasion to
observe, that the circumstance of advanced putrefaction can rarely, in
the present state of our chemical knowledge, be admitted as a
satisfactory plea for not having proceeded to an anatomical inspection,
as preliminary to chemical inquiry; and, as to the danger of such
dissections, _Dr. Gordon Smith_ has very truly observed, “that much is
placed to this account which belongs merely to disgust.” Had an
examination of the body taken place in the case of _Ogilvy_ and
_Nairne_, how many doubts would have been cleared away; indeed, this
omission afforded the prisoners a strong ground of defence; they
complained that the informer had intentionally prevented the dissection
of the body, being conscious that the suspicions he had raised, and the
project he had formed for their ruin, would, by such a measure, have
been totally removed and defeated. To this it was answered, that when
the informer (a younger brother of the deceased) arrived, he did insist
on the body being opened and examined, as soon as a physician of
eminence could be present, which the prisoners did not then oppose; but
that when the physician arrived on the ensuing day, he declared the body
to be in such a putrid state, that no certain conclusions could be drawn
from outward appearances, nor even from a dissection of the body, which,
besides, could not be performed with safety to the surgeon and
attendants, and that he therefore thought proper to decline the
investigation. Fortunately for the ends of justice, the circumstantial
evidence of guilt was too strong to be affected by this culpable defect
in the medical testimony, although it has been often asserted that the
prisoners should have received the benefit of the omission by an
acquittal. See _Donellan’s_ case in the _Appendix_, p. 243.
With respect to the mode of conducting a chemical analysis upon these
occasions, we have reserved our directions, until we shall enter on the
discussion of poisons individually. We have, however, in this place some
remarks of a general nature to offer, to which we are desirous of
drawing the attention of those, who, without much experience, may be
called upon to conduct such investigations. In the first place, we are
desirous of convincing him, that the processes which he must institute,
for the detection of a mineral body, are by no means so elaborate and
embarrassing, as a superficial view of the subject may lead him to
conclude. During the progress of the present work the author has
repeatedly felt the truth of the opinion which he is now expressing;
for, like _Becher_, he has laid down his pen, and taken up his tests,
and, by the most simple modes of manipulation, has satisfied his own
mind of the extreme delicacy of the different processes which are
recommended for the detection of a poisonous mineral; in short, it is
very difficult to convince those whose chemical knowledge is wholly
theoretical, with how little trouble, and with how much pleasure and
profit, such experiments may be conducted. If such then be the perfect
state at which our analytical knowledge has arrived, the reader may
perhaps conclude, that _in every case of mineral poisoning the
deleterious substance should be found, and that the inability of the
chemist to detect its presence, should go far to negative the charge_.
Such an inference, however, is neither correct, nor philosophical, for
the poison may have been absorbed, or eliminated, during life, it may
have undergone chemical changes, or it may have entered into
combinations, by which its characters are masked, or wholly changed. To
_Dr. Bostock_ the judicial physician is under many obligations, but
there is no discovery for which he is more deeply indebted to him, than
for that which has resulted from his satisfactory experiments, in
elucidation of the present question. He has shewn, in the instance of
_Corrosive Sublimate_,[199] that an animal may be suddenly killed by
receiving a metallic poison into the stomach, and yet that the most
delicate chemical re-agents may not be able to detect any portion of
such poison, after death, in the contents of that viscus. _Dr. Henry_,
in a letter to _Dr. Duncan_,[200] communicates the case of _Hannah
Tomlinson_, aged twenty, who died, under the care of _Dr. Holme_, on the
sixth day after a dose of _Corrosive Sublimate_. In this case, although
an ounce of the mercurial salt had been swallowed, and the fluid ejected
from the stomach was examined, only twelve hours afterwards, by _Drs.
Henry_ and _Roget_, yet not the slightest trace of the poison could be
detected! More recently we have received from the pen of _Mr. Alexander
Murray_,[201] surgeon of Alford, some highly interesting cases of
poisoning by Arsenic, and which are so illustrative of the present
question, as well as several others that have fallen under
consideration, that no apology can be necessary for introducing some
account of them in this place. A family of the name of _Mitchell_, and
which consisted of _William_, a robust man, aged 45, _James_, æt: 52,
_Mary_, æt: 50, and _Helen_, æt: 48, breakfasted together on Sunday
morning, (August 19, 1821) on porridge, consisting of milk, salt, and
meal. _William_ partook largely, but _James_, who perceived “a sickening
taste,” took less than common, while the sisters had their usual
quantity. _William_ was seized with sickness shortly afterwards, about
10 _a. m._, on his way to church, and then with thirst and headache;
and, on his return home, between three and four in the afternoon, he was
seized with vomiting, which recurred often during the next four or five
days, especially on his attempting to quench his thirst. In the early
part of the week, he was heard to complain of pain in his stomach, eyes,
throat, breast, and arms; he was observed to void his urine frequently;
and about this time, he pointed out to one of his sisters a hollow[202]
between his breast and belly, into which according to her expression,
“she could have laid her arm.”
His illness had scarcely at any time confined him to bed. On the evening
of Friday, the 24th of August, he rode six miles, for the purpose of
consulting _Mr. Murray_, the surgeon, and reporter of the cases; on
Wednesday the 22d he had taken a dose of Epsom salts which operated, and
at the time _Mr. Murray_ first saw him he complained of the following
symptoms:—pain and heat in the region of the stomach and lower part of
the chest; occasional uneasiness in the abdomen, and sometimes
ineffectual efforts to go to stool; thirst; difficulty of breathing;
heat and uneasiness of throat, with hoarseness; soreness of eyes, which
had the common appearance of inflammation; shifting pains in his
extremities, particularly the arms, which had not their usual strength;
great restlessness; anxious expression of countenance; pulse frequent,
100-110, not strong.
A blister was applied over the stomach and lower part of the chest, and
he took an opiate at bed time. On the following day, (Saturday 25th)
_Mr. Murray_ visited him at his own house, and found him nearly as
before, except that his countenance more strongly exhibited a disturbed
and anxious expression, and the redness of the eyes, and the hoarseness
were increased. _Mr. Murray_ also observed small roundish white
accuminated prominences, on the palate and uvula, apparently as if the
membrane covering the palate bones and _velum pendulum_, was detached at
the parts by a whitish liquid. This day he took an ounce of castor oil,
which operated in the afternoon, his illness was not observed to change
during the evening, and he retired at about eight o’clock to rest. At a
little past two in the morning, he rose in search of water to drink, and
on returning to bed he was heard to utter a deep groan; after which he
lay motionless and quiet, and very soon was found to have expired. The
surgeon who saw the body, about 10 _a. m._, states that “_many bluish
spots were observed on the inferior extremities_.” _James_, _Mary_, and
_Helen Mitchell_ were attacked the same forenoon with their brother
_William_, and with nearly similar symptoms; they were all, however,
fortunate enough to recover, although a considerable period elapsed
before their usual strength returned, and in all of them a numbness of
the arms, or legs, occurred, together with a loss of muscular power.
The body of _William Mitchell_ was, owing to particular circumstances,
not opened until the 29th of August, (3 days 8 hours after death) when
the following appearances presented themselves. “The face had a natural,
composed appearance; and the rigidity of the body did not appear to be
different from what is common. The right ear, and corresponding side of
the face, as well as the scalp, exhibited a deep clay-blue colour. On
the chest and belly, several spots and streaks, some green, others blue,
were observed; and the back, upon which the body lay, was from head to
foot of a livid colour; while several roundish spots, of a still deeper
hue, gave to the shoulders and neck a mottled appearance. The penis was
much swollen and red. The scrotum also was enlarged, and of a dark blue
colour.
Upon opening the abdomen, the smell was not unusually offensive, and its
contents did not appear to have undergone alteration after death, but
several ounces of a highly-coloured liquid were found in the cavity. The
surface of the jejunum and ilium presented many purple spots, some of
which were several inches in circumference. The peritoneal surface of
the stomach, in a tract which extended from the cardia, and occupied,
for some distance downwards, the whole circumference of that viscus,
except the small curvature, was of a clear, dark red colour; and through
this space dark lines, apparently veins, were observed to ramify. This
appearance, perhaps, from 20 to 30 square inches in extent, was strongly
marked in contrast with the natural state of the inferior extremity and
small curvature. The substance connecting the stomach to the spleen,
was, as well as a small part of the transverse colon, of a red colour.
The spleen was gorged with blood; the liver healthy. The duodenum, from
a small distance below the pylorus, almost to its inferior extremity,
and round nearly the whole intestine, was of a very dark purple colour.
Upon opening the stomach, the internal surface of that part where the
outward appearance, already described, existed, was found of a bright
red colour, and over this lighter dots were thickly scattered[203],
making such an appearance as might be produced by a red colour being
dashed from a painter’s pencil, upon a somewhat darker _ground_.
The internal coats of the duodenum were very dark coloured, with a
slightly reddish hue, pulpy, thickened, and easily separated from the
peritoneal covering, while in one roundish spot, of the size of a crown
piece, the villous and muscular coats were entirely wanting. Red patches
were observed on the inner surface of the jejunum and ilium, the shape,
size, and situation of which were the same as those of the appearances
already noted as occurring on the outside of these intestines. The
stomach and duodenum contained about a quart of a brown, semi-opaque,
thickish liquid; the jejunum and ilium were empty, and coated with a
yellow viscid matter. The lungs and heart were quite healthy; but in the
cavity of the thorax were ten ounces of a reddish turbid liquid, and
about half that quantity in the pericardium. The pharynx was of an
unusually red colour. The whole of the brain was healthy, and of firm
consistence.”
_Mr. Murray_ concludes by stating that no part of the salt and milk used
on the sunday morning, was to be found after he visited the family, and
that although the remainder of the meal, and also the contents of
_William Mitchell’s_ stomach and duodenum were examined by _Drs.
Henderson_ and _Fraser_, of Aberdeen, as well as by _Mr. Craigie_,
surgeon, who assisted in the dissection, and _Mr. Alexander Murray_,
yet, “_no poisonous ingredient was detected in these substances_.”
The pathological and anatomical facts were, however, in themselves, so
striking and satisfactory, that not the slightest doubt can exist as to
the cause of the sufferings and death of the deceased; while, as _Mr.
Murray_ very justly states, the high probability, arising from the
separate symptoms of each individual, is strengthened almost to
certainty, by the simultaneous occurrence of these in a whole family of
four persons; while no similar disease, indeed no epidemic of any kind,
prevailed at that time.
We have only to add that the brother-in-law of this family was, in
October, 1821, tried before the Judiciary Court at Aberdeen, for
administering poison to his four relations; when the testimony given by
the medical witnesses induced the judge and jury to consider the
abstract act of poisoning proved. The accused afterwards confessed his
guilt, and that he perpetrated the crime by means of _Arsenic_, put
among the salt on the sunday morning on which the family were taken ill.
The public, and the profession, are greatly indebted to _Mr. Alexander
Murray_ for the details of this instructive case; and the patient
attention and judgment with which he conducted the investigation,
deserve the highest commendation, and afford an example which we
sincerely hope future practitioners will endeavour to follow.
Q. V. _What degree of information can be derived from administering the
contents of the stomach of a person supposed to have been poisoned, to
dogs, or other animals?_
It has from time immemorial been generally believed, that no proof of
poisoning is more satisfactory than that which is furnished by the
effects produced upon dogs, by their swallowing the contents of the
stomach of persons who are supposed to have died from poison. Writers on
Forensic medicine have, however, adduced several objections to the
validity of such a test; some of which are undoubtedly worthy of
consideration, while others are the deductions of a theory which
receives no support from experience. In the first place it has been
stated, that substances poisonous to man, will not always occasion
deleterious effects upon animals[204]; this, to a certain extent, is
undoubtedly true; some of the _Ruminantia_ appear to be less sensible to
the operation of narcotic plants, than carnivorous animals. _Aloes_ are
injurious to dogs and foxes. Oxen are said to eat the _Philandria
Palustris_, which is pernicious to horses; but we are very much inclined
to believe that a poison sufficiently powerful to destroy the life of a
man, would if administered in the same state of concentration, destroy
that also of an inferior animal. It is in smaller doses only that the
difference in the action of such bodies upon various animals becomes
evident and appreciable. This opinion is confirmed by numerous
experiments. _Mr. John Hunter_, in his evidence[205] on the trial of
_Donellan_, in answer to the question, whether any certain conclusion
can be drawn respecting the poisonous operation of a substance upon man,
from its effects upon an animal of the brute creation, replied, “_As far
as my experience goes, which is not a very confined one, because I have
poisoned some thousands of animals, they are very nearly the same;
opium, for instance, will poison a dog similar to a man; arsenic will
have very near the same effect upon a dog, as it would have, I take it
for granted, upon a man; I know something of the effects of them, and I
believe their operations will be nearly similar._” If any farther
confirmation of this opinion were required, how extensively and
satisfactorily has it been afforded by the late experiments of _M.
Orfila_.[206] _Mr. Hunter_ also, on the memorable trial above mentioned,
explained a source of fallacy which attends such experiments upon
animals; he is asked “whether there are not many things which kill
animals almost instantaneously, that will have no detrimental or noxious
effect upon a human subject, such, for instance, as spirits?” He replies
that a great deal depends upon the manner of conducting the experiment,
and that by forcing an animal to drink, the liquor often passes into the
lungs. See _Appendix_, _p._ 272. _Orfila_, in his valuable work on
poisons, instituted a series of experiments upon this subject, with the
intention of determining the value of an experiment so generally
accredited; from which he is led to conclude, 1st. That the practitioner
should never attempt by force to make an animal swallow the suspected
substance, nor should he put it into his food; for by such a proceeding
he would not only run the hazard of losing the greatest part of it,
because the animal would reject it, but the food with which it is
combined might exert upon it some chemical action, or so envelope it as
to protect the coats of the stomach from its contact; besides which it
would, says he, happen, at least six times in ten, that a part of it
would flow through the larynx into the lungs, and the animal will die of
Asphyxia. 2d. The best method that can be employed, consists in
detaching the œsophagus, perforating it with a small hole, introducing
into it a glass funnel, and pouring the liquid into the stomach; that
being done, the œsophagus is to be tied below the opening. It would,
observes _M. Orfila_, be imprudent to prefer to this method, the use of
an elastic gum tube adapted to a syringe, for many bite the tube, pierce
it with holes, and the fluid then flows out of the mouth; besides which,
syringes of tin might decompose certain poisonous fluids. The obvious
objection to such a mode of administration is anticipated by this
laborious experimenter with much ingenuity. It may be asserted, says he,
that the animal perished from the operation of tying the œsophagus, and
not from the action of the poison thus introduced into the stomach, but
such an objection has no foundation in truth, for either the suspected
substance is in quantity sufficient to destroy the animal, or it is not;
in the first case death will take place during the first forty-eight
hours, and will be preceded by symptoms more or less severe, a
phenomenon never observed in the simple ligature of the œsophagus; in
the second case, the experiment will not be more conclusive, than if the
œsophagus had not been tied: and the author asserts, that the operation
of tying the œsophagus would not, of itself, produce during the first
forty-eight hours any other symptom than a slight dejection, and that
consequently all other morbid phenomena that may be observed, upon such
trials, ought to be attributed to the poisonous substance. To all this
we reply, that we believe, in the hands of _Orfila_ who has made a
thousand experiments, that such results may be satisfactory, but we feel
no hesitation in declaring, that we should not place the smallest
reliance upon such an experiment when conducted by a person unaccustomed
to the operations of experimental physiology. If there be no other mode
of employing an animal as a test for poison, but by tying his œsophagus,
we must, in a judicial point of view, reject it altogether.
But there still remains another source of fallacy connected with these
experiments, to which considerable importance has been attached. It has
been said that the acrid humours ejected from the stomach of a person
labouring under a _spontaneous_ disease, may kill an animal.
_Morgagni_[207] relates a very remarkable instance, in illustration of
this fact. A child having died of a fever was opened, when a quantity of
green bile was found in the stomach, which changed the colour of the
scalpel to violet; having dipped the point of the knife into this bile,
two pigeons were wounded with it, and they soon died in convulsions. The
bile was then mixed with some bread, and given to a cock, which also
died in the same manner. From this general view of the subject before
us, the forensic physician will be enabled to appreciate its just value,
and to apply the indications it may furnish, in each particular case,
without the risk of error. In some instances such experiments may prove
nothing, in others they may afford only equivocal results, but which may
add something to the general weight of circumstantial evidence; while
others, again, may furnish proofs so unquestionable, as to leave no
doubt upon the subject; such was the case in the instance of _Michael
Whiting_[208], who was convicted of administering corrosive sublimate to
his brothers-in-law, when it appeared in evidence that a portion of the
poisoned dumpling was given to a sow, who in consequence became sick,
and remained ill for several days.
We have now disposed of the several questions connected with the subject
of poisoning, which must be regarded, in their forensic relations, as
being of the highest importance. In considering the subjects, generally,
there must necessarily remain doubts, many of which will be considerably
diminished, or entirely removed, upon their application to particular
cases; still, however, the nature of medical evidence upon such
occasions must be frequently regarded as only sustaining high
probabilities, and the professional witness may exclaim with
_Hoffman_[209] “_Ardua sane provincia ei imponitur cui determinandæ
ejusmodi quæstiones exhibentur._”