Case of Poisoning by Corrosive Sublimate.

The following case is chiefly interesting, from its bearing upon a point of some importance, which was discussed on a trial for murder at the Lancaster assizes in 1808. The defendant, on that occasion, appeared to owe his acquittal to the fact, that no poisonous substance could be detected after death, in the contents of the stomach or bowels, though the proper tests were applied, with great skill and judgment, by Dr Bostock. It was the declared opinion, however, of that physician at the time, and was afterwards proved by a course of experiments on animals, * that a poison may produce fatal effects, and yet be so completely evacuated by vomiting or purging, as to leave no trace, discoverable by chemical analysis, in the contents of the alimentary canal. Some time after this period, the following case occurred to my friend Dr Holme, who obligingly pointed it out to my notice.

HANNAH TOMLINSON, aged about 20, was induced, by a series of ill-treatment, and by the apprehension of pregnancy, to form the resolution of destroying herself. With this view, she poured about a quarter of a pint of hot water on an ounce of corrosive sublimate, and drank the whole of what the water could hold, both dissolved and in suspension. The act of swallowing was attended with a violent spasm of the glottis, and a small quantity of the liquid was rejected from the mouth. In less than half an hour, she became extremely sick, and discharged the contents of her stomach. The retching, however, continued, and she threw up a considerable quantity of blood. On the following day, the sickness had not abated, though the haemorrhage had ceased. From this time to the period of her death, which, notwithstanding the most judicious treatment, happened on the sixth day, she continued to labour under sickness, anxiety, restlessness, quick pulse, and universal pains in the limbs. To these symptoms supervened, on the fourth day, great pain about the scrobiculus cordis, and tenderness on pressure; and a few hours before death, a complete paralysis of the upper and lower extremities took place.

Some of the fluid, which had been vomited about twelve hours after she had taken the sublimate, was carefully examined by Dr Roget (now physician in London) and myself. The tests applied were those which are described in my Elements of Experimental Chemistry, Vol. ii. page 393; but neither in this liquid, nor in that found in the stomach after death, were any traces of the poison discoverable.

Edinburgh Medical and Surgical Journal, v. 14.

On the day after her decease, the body was opened by Dr Roget, in the absence of Dr Holme from town. The external appearance of the stomach and intestines were perfectly natural. About two ounces of a thick yellow ropy fluid were found in the stomach, which was but moderately distended with air. Ox its inner surface, numerous dark red spots, indicating inflammation of the villous coat, were observable. They extended the whole length of the smaller curvature, and occupied the greater part of the fundus, but did not appear in the lower portion of the large curvature. To me they seemed to resemble, very closely, a similar appearance, which I have three or four times observed in the stomachs of persons who have died of hydrophobia. No abrasion of the villous coat was perceptible. The inner coat of the duodenum, as far as the middle of its length, presented the same appearance of inflammation. The lower part of the oesophagus, for about three inches above the cardia, was slightly inflamed; but higher up, it was of a natural colour. The liver and spleen were sound; the gall-bladder more empty than usual. The left kidney was of a looser texture than natural, and a small abscess was discovered in it filled with pus. The bladder was empty, and exceedingly contracted. * The uterus was of the natural size, and its cavity exhibited no marks of pregnancy. The ovaria were somewhat enlarged, and the left contained several hydatidss but no corpus luteum could be detected in either of them. The heart and lungs, it may be added, were perfectly sound..

Enlargement of the Heart.

Mr Allan Burns, in his valuable work on the Diseases of the Heart (p. 41.) has attempted to establish the diagnosis between dilatation, or simple ancurism, of that organ, and the actual increase of its substance. In the latter disease, he has observed the pulse to be weak, irregular, intermitting, and fluttering; in simple dilatation, on the contrary, uniformly full, slow, and soft. The heart itself, also, when merely dilated, he has found to contract sluggishly and equally in the chest, without that jarring sensation, which the hand receives from its stroke, in cases of enlargeThis distinction, though it may perhaps have no im

ment.

* No urine was voided after the third day; and on introducing the catheter repeatedly, the bladder was found empty. Suppression of urine (which took place also in Grice, from an over-dose of one of our most active diuretics), appears to be no uncommon effect of the administration of poisons. Vide Haller, Elem. vii, 396, edit. Lausan, 1778.

portant influence on practice, it may be interesting to try by the test of further observation; and the two following cases, as far as they go, are in favour of its accuracy.

1. THOMAS LEECH, aged 20, late a sailor in the Royal Navy, had laboured for nearly three years under palpitation of the heart and shortness of breathing. About two years before, he had been induced, by the urgency of his complaints, to desert from his ship, but had been taken, and sentenced to undergo the punishment of the fleet. His complaints, soon afterwards, increased so rapidly, that in a short time he received his discharge from service. When I first visited him, on the 23d of April 1809, as a home patient of the Manchester Infirmary, his situation was truly deplorable. The pulsation of the heart was felt as low as between the ninth and tenth ribs; was extremely violent; and was attended with that peculiar jarring, which has been described by Dr Ferriar, and other medical writers. The pulse at the wrist was 128, small and indistinct; the breathing laborious; and every attempt to lie down, brought on the sense of suffocation. He was obliged, therefore, to sit with his head reclined upon his arms, which were supported by a table. The belly was considerably swelled; the legs oedematous; and the urine scanty and high-coloured. He had a constant tendency to sickness, and frequently severe pain in the abdomen. His dissolution, indeed, seemed to me so near at hand, that I attempted nothing but to palliate the most urgent symptoms. On the 1st of May he died; and, with great difficulty, I obtained permission to inspect the body, which was done, under circumstances of haste and interruption from the young man's friends, by Mr Ransome, one of the surgeons of the infirmary.

On opening the thorax, the heart, from its enormous size, presented a very striking appearance. It completely distended the pericardium, to which membrane it had not formed any adhesion. There was no unusual quantity of fluid either in the pericardium or the general cavity of the thorax. The increase of the heart was general; but if any part was in excess, it was the left ventricle. When perfectly freed from blood, it weighed a pound and founteen ounces, avoirdupois. The valves between the auricles and ventricles, and the semilunar valves, were perfectly natural; and the heart, in every respect, except that of magnitude, had a healthy appearance. The lungs were sound, and we could discover in the thorax no morbid structure, that could have presented an impediment to the circulation. The contents of the abdomen we were not permitted to examine.

2. WILLIAM BARLOW, aged 16, was admitted an in-patient of the Infirmary, under my care, on the 24th of December 1810. He dated his complaints from about a month previously to his admission; but it is probable, from the sequel, that the disease of the heart had a much earlier origin. At that time, he was seized suddenly with violent pain in the head, and lost the use of the right side. This, however, he soon recovered; but was attacked by a train of still more distressing symptoms. The belly and legs began to swell, and the breathing to be short and laborious. The cedema has now extended to the face, the eyelids, and the scrotum. He has a violent cough and spitting, and the lips have a livid hue. The palpitation of the heart is considerable, and the seat of that organ lower than natural; but the stroke is indistinct and distant. There is a visible pulsation of the veins of the neck. At the wrist, the pulse is small, irregular, rapid, and not always synchronous with the motions of the heart. The appetite is tolerably good; the bowels regular; and the urine natural in quantity.

Notwithstanding the plan of treatment, the most important part of which was the administration of foxglove, he became gradually worse, and died on the 14th of January. On the following day, the body was opened by Mr Ransome. The right sac of the pleura contained about a pint and a half of serum; and about nine ounces were found in the pericardium, which had no adhesion to the heart. The heart itself was enlarged, and the parietes of both ventricles were thicker than natural. In the left ventricle, the columnæ carnea were in some places cartilaginous, and in others partially ossified. The right ventricle contained one of those substances which have been erroneously called polypi. But the chief seat of disease was in the right auricle and sinus venosus, which were dilated to twice their natural size, and were ossified in spots. All the valves of the heart, and those at the origin of the large arteries, were healthy. The weight of the heart was 14 troy ounces, perhaps double what it ought to have been in proportion to the size of the subject. * In the abdomen, the only deviation from a sound state of the viscera was an enlargement of the right kidney.

The pain of the head and paralysis (though not the subsequent removal of the latter), were satisfactorily accounted for on examining the brain. Its membranes were sound, and no hydropic effusion had taken place between them. But in the posterior part of the brain, immediately above the cornu ammonis of

Vid. Senac, Traité du Cœur, i. 131.

the left lateral ventricle, an abscess was discovered, containing about two drachms of dark-coloured pus. The ventricles themselves contained, if any thing was remarkable, less than their natural quantity of fluid.

IV.

Case of Deformity of the Face and Throat from Burning, removed by Chirurgical Operations. By GEORGE NESSE HILL, Surgeon, Chester.

GENTLEMEN,

SIR JA

JAMES EARLE, in his "Essay on the Means of Lessening the Effects of Fire on the Human Body" (1803), has given an interesting case of burnt throat, with an annexed drawing in profile, illustrative of the effects of a surgical operation upon the contracted parts. The subsequent narrative might, therefore, at first sight, be deemed an unnecestary repetition: but as that was a much less extensively mischievous accident than the one recorded below, and not requiring such extended means of relief, the relator hopes you will admit it into your repository of valuable communications; especially when he presumes to remind you, how interesting every case productive of a deviation from the common routine of practice, becomes to young practitioners, however diminutive may be the proportion of new or improved GEORGE NESSE HILL.

treatment.

Chester, Dec. 31st, 1810.

A lively handsome boy, eight years of age, was one day standing alone near a large kitchen fire, when a sudden current of air from an open door at his back, drew his brat or pinafore to the bars of the grate, and set it in a flame. The garment being tied behind, and the fire ascending with violence in every direction, prevented the unfortunate little fellow from extricating himself, or obtaining assistance for that purpose, until his whole throat, from the breast bone, the chin, under lip, and left side of the face, including the eye and part of the forehead, were miserably scorched. Immediate surgical assistance being procured, the important parts thus injured were dressed in the usual manner, being, as in similar cases, much swoln and disfigured. In about nine months the whole hurt surface was cicatrized; during which arduous process, the throat, face, and eye, had gradually assumed the appearance attempted to be expressed by fig. 4. of the annexed plate;