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2. Evidence from the appearances in the body.—One of the chief means of determining whether a person has died from poison, is an examination of the body after death. In relation to external appearances, there are none indicative of poisoning upon which we can safely rely. It was formerly supposed that the bodies of persons who were poisoned putrefied more rapidly than those of others who had died from natural disease; and evidence for or against poisoning was at one time derived from the external appearance of the body. This is now known to be an error: the bodies of persons poisoned are not more rapidly decomposed, cæteris paribus, than those of others who have died a sudden and violent death from any cause whatever.

Irritant poison acts chiefly upon the stomach and intestines, which they irritate, inflame, and may corrode. We may likewise meet with all the consequences of inflammation, such as softening, thickening, ulceration, perforation, or gangrene. Sometimes the coats of the viscera are thickened, at other times thinned and softened, by the action of an irritant.

Neurotic poisons do not commonly leave any well-marked appearances in the body. The stomach and intestines may present no unnatural changes. There may be greater or less fulness of the vessels of the brain and spinal marrow, as well as of their membranes; but even this is often so slight as to escape notice, unless attention be particularly directed to these organs. Effusion of blood is rarely found.

It is important to bear in mind that both irritants and neurotics may destroy life without leaving any appreciable changes in the body. To -uch cases as these, the remarks about to be made do not apply. The proofs of poisoning must, in such exceptional cases, be procured entirely from other sources. Any evidence derivable from the appearances in the body of a person poisoned will be imperfect unless we are able to distinguish them from those analogous changes often met with as the results of ordinary disease. These are confined to the mucous membrane of the Stomach and bowels. They are redness, ulceration, softening, and perforation. Each of these conditions may depend upon disease, as well as upon the action of irritant poisons.

Redness. It is a main character of the irritants to produce, as a result of inflammation, redness of the mucous or lining membrane of the stomach and small intestines. This redness, when first seen, is usually of a deep crimson color, becoming brighter by exposure to air. It may be diffused over the whole mucous membrane: at other times it is seen in patches, dots, or lines (striæ) spread irregularly over the surface of the stomach. It is sometimes met with at the smaller, but more commonly at the larger, end of this organ; and, again, we occasionally find the folds or prominences only of the mucous membrane presenting this red or inflamed appearance. Redness of the mucous membrane may, however, be due to gastritis, active digestion, the use of stimulants, or disease; and in order to assign the true cause of inflammation, it will be necessary to have an account of the symptoms preceding death, or some chemical proof of the existence of irritant poison in the contents of the stomach or in the tissues of the body.

In the healthy state, the mucous membrane of the stomach is pale and white, or nearly so, except during digestion, when it is slightly reddened; and redness has often remained in the stomachs of those who have died during the performance of the digestive process. When in contact with the spleen or liver, after death, the stomach is apt to acquire a deep livid color from the transudation of blood; and it is well known that the bowels acquire a somewhat similar color from the gravitation of blood

which always takes place after death. In sudden death from disease of the heart, the mucous membrane of the stomach is s found intensely reddened. None of these appearances are likely t taken for the action of an irritant poison.

There is an important class of cases in which redness of the membrane of the stomach is found after death, not dependent on t of poison or on any easily assignable cause. These cases, owing being so little known, and involved in much obscurity, des attention of a medical jurist, since the appearances closely resem produced by irritant poison. A person may die without suffer any symptoms of disordered stomach; but on an inspection of t a general redness of the mucous membrane of this organ will not distinguishable from the redness which is so commonly arsenical poisoning. Several cases of this kind have occurred; a ings which have been made of the appearance presented by the are preserved in the Guy's Hospital Museum. Tidy is, how opinion that there is always ecchymosis of the stomach after de arsenical poisoning.

The redness of the lining membrane of the stomach, in cases o ing, is so speedily altered by putrefaction, when circumstances a able to this process, as frequently to render it impossible for a w speak with any certainty upon its cause. Putrefactive infiltratio blood contained in the adjacent viscera and muscles will give a appearance to a stomach otherwise in a healthy condition. Grea has arisen respecting the length of time during which rednes stomach produced by an irritant will be recognizable and ea tinguishable from putrefactive changes. It is sufficient to say certain rule can be laid down on the subject: it must be left to th edge and discretion of the witness. We have distinctly seen marked appearances of inflammation produced by arsenic in the stor duodenum in exhumed bodies twenty-eight days and six month tively after interment; and, in another instance, the reddened sta mucous membrane, in a case of arsenical poisoning, was plainly ble on removing a layer of arsenic nineteen months after interm however, there should be a reasonable doubt respecting the caus redness, and no poison is detected, it would be unsafe to rely u appearance alone as evidence of poisoning. (See page 70, ante.)

Ulceration.—In irritant poisoning the stomach is occasionall ulcerated; but this is, comparatively speaking, a rare occurrence. cases the mucous membrane is removed in small, distinct circular under the edges of which the poison (often arsenic) may be found. tion of the stomach is a more common result of disease than of th of poison. As a consequence of disease, it is very insidious, g often for weeks together without giving any indication of its e except perhaps slight gastric disturbance, with occasional nausea ing, and loss of appetite. In this case, the ulceration is commo in small, circumscribed patches. It is worthy of remark, as a n distinction, that ulceration has never been known to take pla arsenic or any irritant poison until symptoms indicative of irritant ing have occurred. In ulceration from disease, the mucous mem commonly reddened in the neighborhood of the ulcer. In ulcerati poison, the redness is generally diffused over other parts of the as well as over the duodenum and small intestines. A case, h occurred in Guy's Hospital, in which, with a small circular patch o tion near the cardiac opening, the whole mucous membrane was

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injected; but this singular condition of the stomach, so closely resembling the effects of an irritant peison, was unaccompanied by any marked ymptoms of irritation during life. The history of a case previous to death will thus commonly enable us to determine to what cause the ulceration found may be due. Care must be taken to distinguish ulceration from corrosion. Ulceration is a vital process: the substance of a part is removed by the absorbents as a result of inflammation. Corrosion, on the other hand, is a chemical action: the parts are removed by the immediate contact of the poison; they are decomposed; their vitality is destroyed, and they combine with the corrosive matter itself. Ulceration requires time for its establishment, while corrosion is a very rapid effect. Softening. The coats of the stomach are not unfrequently found so soft as to yield and break down under very slight pressure; and this may be the result either of poisoning, of some spontaneous morbid change in its structure during life, or of the solvent action of the gastric juice after death. As this condition of the stomach, when caused by poison, is produced by those substances only which possess corrosive properties, it follows that, in such cases, traces of their action will be perceived in the mouth, throat, and gullet. In softening from disease, the change will be confined to the stomach alone, and it is commonly found only at the cardiac or greater end of the organ. When softening is really caused by an irritant poison, it is generally attended by other striking and unambiguous marks of its operation. Softening is not to be regarded as a common characteristic of poisoning, and is only an occasional appearance. Instances have been met with where the coats of the stomach were considerably hardened by sulphuric acid, or, oftener, by carbolic acid. Softening can never be inferred to have proceeded from poison, unless other wellmarked changes are present, or unless the poison is discovered in the softened parts. The stomachs of infants have been frequently found Softened from natural causes: such cases could not be mistaken for poisoning, since the history of them during life, the want of other appearances indicative of poisoning, and the total absence of poison from the viscera, would prevent such a suspicion from being entertained.

Perforation. The stomach may become perforated, either as a result of poisoning or of disease. Perforation from poisoning. This may arise: 1, from corrosion; 2, from ulceration. The perforation by corroon is by far the most common variety of perforation from poisoning. It is occasionally witnessed when a strong mineral acid has been taken, especially sulphuric acid; the stomach, in such cases, is blackened and extensively destroyed, the aperture is large, the edges are rough and irregu lar, and the coats are easily lacerated. The acid escapes into the abdomen, and may be detected there by chemical analysis. The perforation from ulceration, caused by irritant poison (arsenic), is but little known. There are but few instances on record. In a great number of poisoned subjects examined during many years past at Guy's Hospital, not a single case has occurred. It must then be looked upon as a rare appearance in cases of irritant poisoning. Perforation from disease.-This is by no means an unusual condition. Many cases of this disease will be found reported elsewhere. (Guy's Hosp. Rep., ser. i., vol. iv., p. 8.) It is invariably fatal when it proceeds so far that the contents of the stomach escape into the abdomen; but sometimes the stomach becomes glued to the pancreas or other organs during the ulcerative process, and then the person may recover. Several instances of this kind of adhesion have been met with in inspections. The symptoms from perforation commonly attack a person suddenly, while apparently enjoying perfect health.

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SPONTANEOUS PERFORATION OF THE STOMACII

Hence these cases may be easily mistaken for those of irritant The principal facts observed with regard to this formidable disea following:-1. It often attacks young women from eighteen t three years of age. 2. The preceding illness is extremely slig times there is merely loss of appetite, or a capricious app uneasiness after eating. 3. The attack commences with a su severe pain in the abdomen, generally soon after a meal. usually comes on gradually in irritant poisoning, and slowly in severity 4. Vomiting, if it exists at all, is commonly sligh chiefly confined to what is swallowed. There is no purging: t are generally constipated. In irritant poisoning the vomiting severe, and purging is seldom absent. 5. The person dies con from eighteen to thirty-six hours: this is also a usual period of the most common form of irritant poisoning, i. e. by arsenic; 1 case yet recorded has arsenic caused perforation of the stoma twenty-four hours, and it appears probable that a considerable t elapse before such an effect could be produced by this or any irr In perforation from disease the symptoms and death are clearly re peritonitis. 7. In the perforation from disease the aperture is e of an oval or rounded form, about half an inch in diameter, situa near the lesser curvature of the stomach, and the edges are smoo outer margin of the aperture is often blackened, and the apertur funnel-shaped from within outwards; i. e., the mucous coat is removed, and the outer or peritoneal coat the least. The coa stomach, round the edge of the aperture, are usually thickened distance; and when cut they have almost a cartilaginous These characters of the aperture will not alone indicate whether result of poisoning or disease; but the absence of poison stomach, with the want of other characteristic marks of irritan ing, would enable us to say that disease was the cause. Bes history of the case during life would materially assist us in our ju The great risk on these occasions is that the effects of disease mistaken for those of poisoning; for we are not likely to mista foration caused by irritant poison for the result of disease. standing the well-marked differences above described, it is con meet with cases of imputed poisoning where death has really from peritonitis following perforation. A case of this kind will elsewhere recorded. (Guy's Hosp. Rep., 1851, p. 226.) In ano body was exhumed after several months' burial, and the stom found perforated from disease in the usual situation.

Spontaneous or Gelatinized Perforation.-The stomach is occa subject to a spontaneous change, by which its coats are softened, a way, generally at the cardiac or greater end As the effusion of tents of the organ in such a case never gives rise to peritoneal inflam and no symptoms occur prior to death to indicate the existence of tensive a destruction of parts, it is presumed to be a change in t body, and the coats of the stomach are supposed to undergo a pr solution or digestion. It is commonly attributed to the solvent a the gastric juice, the spleen, diaphragm, and other viscera being times softened. Wilkes states that this post-mortem or cadaveri ration of the stomach is so rare a condition that it is not met with five hundred cases. In the last two cases in which it was obser him, one patient had died from albuminuria, and the other from affection; but in neither of these could there be found any pecu regarding their food, the time of the last meal, or the state of the

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to account for the spontaneous destruction of the coats of the stomach. In January, 1845, the author met with an instance of this perforation in a child between two and three years of age. It was seized with convulsions, became insensible, and died twenty-three hours afterwards. After death, the greater end of the stomach was found destroyed to the extent 6: three inches; and the edges were softened and blackened. There was no food in the stomach, and nothing had passed into this organ for thirtytwo hours before death. It was therefore impossible to ascribe death to the perforation or the perforation to poison. (Med. Gaz., vol. 36, p. 32.) An inspection of the body, with a general history of the case, will commonly suffice to remove any doubt in forming an opinion whether the extensive destruction, so commonly met with, has or has not arisen from poison.. Thus in a post-mortem perforation, the aperture is generally situated in that part of the stomach which lies to the left of the cardia; it is very large, of an irregular form, and ragged and pulpy at the edges, which have the appearance of being scraped. The mucous membrane of the stomach is not found intamed. There is occasionally slight redness, with dark brown or almost black lines (striæ) in and near the dissolved coats, which have an acid reaction. It can only be confounded with perforation by the action of corrosives; but the well-marked symptoms during life, and the detection of the poison after death, together with the changes in the throat and gallet, will at once indicate the perforation produced by corrosive poison. Pavy has shown that after death the gastric juice dissolves the stomach. [Dr. Hartshorne comments on the vital importance, in cases of this kind, of the post-mortem being conducted by an experienced, thoroughly-trained examiner, of sufficient judgment to fully and distinctly understand the appearances herein before indicated, and shows how valueless the examination would be if made by ignorant and untrained practitioners. He cites the case of John Hendrickson, Jr., convicted by this latter class of evidence, as exposed by Dr. C. Lee (Am. Jour. Med. Sci., October, 1885, p. 447), and insists that medical evidence, whether as to anatomical appearances, odor and color, form, or microscopical inquiry, is and should, in the nature of things, be restricted to the very few experts who could be found competent to give reliable evidence in these cases.

Prof. Reese claims that Chap. XI., supra, regarding chemical analysis in establishing the proof of poisoning, is most important and valuable, and says that it is very dangerous in a case of life and death to rely either upon symptoms or autopsic appearances, or even upon both, as affording positive proof of poison. While unwilling to claim that the chemical evidence is always indispensable to prove the administration of poison in certain cases where chemical detection is impossible, yet in these exceptional cases the other two factors-symptoms and the anatomical lesionsas well as the moral circumstances of the case, should be so positive and unequivocal as to leave no shadow of doubt.

Wharton and Stillé, in commenting on this subject, say: "These verifcations (the symptoms and the autopsy) once established, and a harmony between the lesions shown by the physician and physiologist, and the substance discovered by chemical analysis being settled, then and only then can the conclusion be reached that death was due to poison:" Vol. II., P 287, 1873.]