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another case, that of a delicate woman, with probably congestion of the cord, a large amount of phosphate was passed in the urine, presenting, under the microscope, beautiful feathery crystals. The dose of the oil, therapeutically, ought never to exceed five drops, and even this amount cannot be administered for any length of time without deranging the stomach.
ABSENCE OF CHLORIDES IN THE URINE. In one or two cases of pneumonia, in which the disease was progressing, traces of chlorides were seen in the urine. This was discovered, by Mr Seymour (clinical clerk), to depend on an adulteration of the nitric acid, which, for testing urine, must be pure. The nitric should be tested according to the directions of the Edinburgh Pharmacopæa for hydrochloric acid, with which it is very apt to be mingled. It is of importance that pure nitric acid be added to the urine in the first instance, otherwise the nitrate of silver is very apt to throw down phosphates, which, however, may be distinguished from chlorides by being dissolved in an excess of nitric acid, which does not affect the latter salts.
ARTICLE III.-Strychnine Poisoning. By Henry LONSDALE, M.D.
Edin., F.R.C.P., Physician to the Cumberland Infirmary, etc. CASES of poisoning by strychnia are comparatively rare in England, and from the few data on record, it may be supposed that the same remark holds good on the Continent and America. The reasons for this rarity are conspicuous enough; 1st, In this country strychnine was hardly known out of the professional circle till three years ago, when the “bitter beer puff” obtained for it some notoriety. 2d, The difficulty of procuring (except from the highly careless druggist) an agent so active and deleterious as a poison, without raising suspicion in the mind of the vendor. 3d, If known as a poison, the rapid and specific effects of strychnine which has no analogue in action to any known animal or vegetable poison, would be a sufficient bar to its adoption by the multitude; in other words, strychnine will hardly ever become a popular poison like arsenic, opium, etc.
The infrequency of strychnine poisoning, and some peculiar cirumstances attached to the history of the following case induce me to record it for the benefit of toxicological inquirers. The case occurred at Longtown on the 28th November 1854.
i Perhaps this is saying too much for the drug salesman. Arsenic used to be obtained, and readily too, as a rat poison. The last person hung at Carlisle for arsenical poisoning of his wife, went on two different occasions and bought his pennyworth of the drug, and without a question being asked. He was a labouring man and quite unknown at the shop. During the last month I know that a stranger dressed as a countryman obtained an ounce of opium at one chemist's shop, and half an ounce at another; there was not the slightest demur on the part of the vendor.
Matthew Ferguson, aged 59 years, a man of large frame and strong constitution, a weaver by trade, but fonder of angling during his earlier and middle manhood ; rose at his usual hour on the morning of the 28th, and walked down to the river Esk to wash himself ; seemed in his usual health, and made no complaint to his wife or sons. About eight o'clock he is seen walking home, and on reaching his own house he complains of being severely held, is violently cramped, and declares himself dying. A doctor is immediately called who prescribes a pill, but the man, after exhibiting some marked symptoms, expires within thirty or forty minutes of his arrival at home.
The little town had scarcely awoke from its slumbers when the news of Matthew Ferguson's “awfu' sudden death” traversed every nook and corner. Rumour with its thousand tongues could explain it all ; "he was an old man, had long suffered from boils, piles, and other inward complaints, had often sought the aid of a county charity, and that very morning had been to the river to wash his body, the cold had struck him, and he was done for at last. Poor Matthew !"
The funeral was in due preparation, and would have been carried into effect had the circumstances occurred across the Scotch dyke, about four miles north of Longtown. But on the English side of the border 1 we require a medical certificate of the cause of death, and the doctor demurs; moreover it becomes known that the deceased had been to a druggist's shop that morning, so now there is great talk and disputation, nay, violent harangues, and “ crowner's quest law” is demanded and forthwith obtained.
On the 29th, the deputy coroner and jury sat supervisum corporis. To the kindness of Mr Lee, the coroner, I am indebted for the following notes:
G. F., the son of the deceased, deponed that his father had been “ troubled with piles and boils, and had been affected in his testicles, and that he had not been able to work for many years,” that on the morning of the 28th, his father, after being to the river to wash himself awoke him, and complained of being severely cramped in his legs and body, and got into bed beside him. Dr Jardine was sent for, who prescribed a pill. The witness was not aware of his father getting anything from a druggist, but that Dr Rome came and inquired after his father's death if he had got anything from any one.
William Armstrong of Longtown, druggist, said," Yesterday morning about a quarter to eight o'clock, deceased came to my shop and asked for a strong dose of purgative medicine, and added five drops of croton oil. I refused to give him this, but gave him from half a grain to a grain of jalapine, I mixed it in honey and he took it in my presence. I had frequently on previous occasions administered similar doses to other parties without any prejudicial effects that I am aware of. Jalapine is a medicine not commonly used."
Dr James Jardine said, "About half-past eight yesterday morning I found deceased labouring under violent spasms which almost entirely subsided for from four to seven or eight minutes. During the spasms the body was extended with the limbs somewhat separated and stiff and rigid, and there was a violent shaking of the whole body. At first the spasms were most marked down the back and legs, but in the course of ten to fifteen minutes fixed upon the thorax, also about the same time violent tetanus supervened, and the next fit carried off the patient with violent tetanus and fixation of all the muscles of respiration ; all attempts to restore animation by artificial means proved abortive. The heart's action was regular, though somewhat weaker than natural ; there was a dryness of the mouth; there was no vomiting or purg
* The Scottish “ Registration of Deaths” Bill came into operation on the 1st January 1855.
ing, nor any morbid symptoms over abdomen felt or complained of during interval of paroxysms; but during the paroxysms the abdominal muscles were rigid. Deceased was certain of death impending, and was very anxious and agitated. His intellect was perfectly clear. Pupils slightly dilated, do marked distortion of features, saving a little protrusion of the eyeballs, which, during the last paroxysm were both rather inverted, and the mouth fast locked in tetanus. The face and hands were livid, and the surface below natural temperature. Saw the deceased about an hour after death; his arms were unnaturally rigid ; the fingers inflexed, but not so as to grasp the palm." Dr J. had no experience of jalapine, and did not consider the symptoms to be caused by jalap, but was of opinion that deceased died from the effects of some narcotico-acrid poison.”
The coroner ordered a post-mortem examination and an analysis of the contents of the stomach ; and the inquest stood adjourned till the 4th of December.
Dr Jardine on his further deposition, said that he, assisted by Dr Rome and Mr Graham, surgeon, had made a post-mortem examination about thirtythree or thirty-six hours after death, and that they found nothing wrong with the brain and medulla oblongata ; that the “heart was healthy in structure, empty and unnaturally atonic.” That the lungs were much congested and friable in some parts; that the alimentary canal presented nothing morbid; “ the mucous membrane over internal sphincter was congested without an irritable appearance.” The other abdominal organs were normal except & slight congestion of left kidney. The left testicle was slightly enlarged and indurated. The lividity of skin so marked over face and hands, at and before death had almost entirely disappeared ; no emaciation, and no marks of external injury. Dr J. was not prepared to say what was the cause of death, and from the healthy external appearance of the stomach was led to believe that any internal examination of it would throw no additional light upon the case without an analysis of the contents, and this analysis he declined to undertake. He considered the congestion of the lungs to be caused by asphyxia, and that the lungs were not apoplectic.
Dr Rome, who had assisted Dr Jardine in the post-mortem inquiry, deponed that about nine o'clock of the morning on which Mr Ferguson died, William Armstrong, druggist, called him out of bed, and said he had given Mr F. some jalapine, and that he was very ill. Before he, the Dr, got dressed, Armstrong returned to say it was all over with deceased. On asking Armstrong what quantity of the drug he had given him, he was told as far as he recollected, “a grain and a half.” Dr R. concurred in the report given by Dr Jardine, but was of opinion that the flaccidity of the heart was such as to be unable to transmit the blood with sufficient force through the lungs, and that the lungs were of an apoplectic character. If on an analysis of the contents of the stomach no narcotic poison be found he would say that deceased died of apoplexy of the lung caused by the state in which we found the heart and not from the effects of jalapine. He thought the symptoms pointed to death by narcotic poisoning.
William Armstrong, on being further examined, said he got three grains of jalapine from Mr J. Todd, assistant to Wooley, wholesale druggist, Manchester, and that he gave half a grain to a young man, upon whom it had the desired effect of purging ; he gave the same jalapine to the deceased; the grain and a half which was left he had destroyed on the day that Ferguson died, having previously shown the paper containing it to Dr Rome ; said he had no strychnine in his shop.
As the medical men did not agree as to the cause of death, the coroner adjourned the inquest till Monday the 11th December, in order that the stomach might be analysed by Dr Lonsdale of Carlisle.
On the 4th, Andrew Davidson, policeman, delivered to me a sealed bottle containing stomach, and part of duodenum, etc. On
the 9th day after death, I took from the sealed bottle the stomach, with portions of esophagus and duodenum attached. On exposing the parts, a strong odour marking decomposition was evolved; there was dark discolouration of the splenic end, and likewise of the gullet and duodenum. On making an incision along the smaller curvature, a quantity of fætid gas escaped. The gastric contents, in quantity not exceeding an ounce of thick greyish-looking fluid, had a slight acid reaction. The analysis I adopted was that recommended by Orfila and Barruel, as given in our great authority's work (Christison on Poisons), with the addition of the bichromate of potash test. In conducting these experiments I had the kind assistance of my young and highly intelligent friend Mr R. Brown, house-surgeon of the Cumberland Infirmary.
EXPERIMENT I.-(a.) Portions of the stomach and contents were boiled in water pretty strongly acidulated with sulphuric acid ; the mixture was then filtered, and to the liquid thus obtained a quantity of carbonate of lime was added, sufficient to neutralize the acid. This was evaporated to dryness and digested with rectified spirit; after which it was again filtered, to remove all insoluble matter. The result—a clear liquid was then evaporated to the consistence of syrup, which had a slightly yellowish colour, and when tasted, was distinctly and persistently bitter.
(6.) To this alcoholic extract a few drops of strong sulphuric acid was added, and then a small quantity of powdered bichromate of potash. A purplish tint was at first observed, but it very speedily changed to a beautiful light green, which remained permanent.
(c.) A very small quantity of the above extract was mixed with sulphuric acid and peroxide of lead; but there was no appreciable change in colour.
(d.) A similar quantity was tried with the bichromate of potash test, with a very slight change of colour, hardly appreciable. With a large quantity the colour was unmistakeable. (Vide Experiment, b.)
EXPER. II.-To a cat was given in a piece of meat two grains of strychnine. A very small quantity of that was, however, taken by the animal. About two hours afterwards the animal was found dead. About forty hours after death the contents of the stomach were treated in exactly a similar manner to that detailed above, and the result was precisely the same as regards the development of the transient purple and permanent green colours with the bichromate of potash test.
EXPER. III.-A small crystal of strychnine was dissolved in a drachm of rectified spirit ; and the bitter taste was exactly of the same character as the alcoholic extract derived from Experiment I.
EXPER. IV.-To an alcoholic solution of strychnine was added sulphuric acid and bichromate of potash, with the effect of producing at first a tinge of purple, rapidly succeeded by the green, quite undistinguishable from that obtained from the two stomachs. This green colour, as in the other experiments, remained.
N.B.When the three experiments were placed alongside of each other, it was impossible to discover the slightest difference in colour. Three gentlemen were present to test the colours.
Exper. V.-To a crystal of strychnine was added a drop of sulphuric acid, and then bichromate of potash. A beautiful purple colour was at once developed, which in about three hours became yellowish-brown. No green visible at any stage.
EXPER. VI.--Two very small strychnine crystals were dissolved in separate portions of sulphuric acid, mixed with onehundredth part of nitric acid. To the one bichromate of potash was added ; to the other, the peroxide of lead. The former showed at once the presence of the alkaloid; the latter gave no indication of its presence; but on the addition of a little more strychnine, a beautiful violet colour was displayed.
EXPER. VII.–Strychnine, to which strong hydrochloric acid had been added twelve hours previously, was unaffected by the bichromate of potash test
EXPER. VIII.—Jalapine was subjected to the bichromate of potash test and sulphuric acid, also the peroxide of lead; but there were no results worthy of note.
On the second adjournment of the inquest (December 11), the evidence of Dr Jardine and others was read to me, and I had no hesitation in giving my opinion that, from the symptoms observed by Dr Jardine, and the results of the chemical analysis and comparative experiments detailed above, that Matthew Ferguson died from the effects of strychnine.
On the second adjournment, the widow of deceased corroborated her son's testimony, and added, “ Dr Jardine gave me a prescription for Mr Irving, druggist. I went to Armstrong, who said I had got to the wrong place, but he (Armstrong) did not tell me that he had given my husband anything that morning."
It is unnecessary to give minutely the summing up of the coroner. The verdict of the jury, after a few minutes deliberation, was, that the deceased had died from strychnine, administered by Armstrong in mistake.
Several questions arise out of the consideration of this case. Why did the poor man, on finding himself so ill, not mention the fact of his having been to a druggist's shop for physic? It appears from his history, that he was frequently complaining, and desirous of obtaining physic, and that he was a silent man in his
1 The case of poisoning by strychnine recorded in Medical Times and Gazette (December 15, 1854), is worthy of perusal in connection with this case.
2 Whilst claiming, as I have done, some credit for “ Crowner's quest-law," in England, in clearing up many unaccountable deaths which in Scotland might escape the “precognition” of the sheriff, it is but fair to admit that this official sifts everything to the bottom, and excuses neither ignorance nor wilfuluess in the wrong administration of medicine. Scotland is an example to England in this respect.