He -was discharged on 12th October, and continued on duty until January 7th, 1872, when lie was re-admitted. On 6th instant, while on escort duty, he tripped and fell on his left side. Ever since there had been pain in the region of tumour. The structures constituting the root of kidney were apparently somewhat strained. He continued ailing until 27th February, when he was discharged; the kidney, however, was no longer movable, but: firmly attached to left abdominal wall,?presumably the result, of local peritonitis. No albumen was found in urine. The treatment consisted entirely of rest and demulcents. On 29th April he was again carefully examined. The tumour had decreased in size; there was less tenderness, but the pressure of his sword-belt teased him when on duty. After 18 months' service ho claimed his discharge, and returned home, where, lie asserted, a Patlian hakeem would easily dissect out the tumour. II.?COPPER OR METALLIC COLIC.
Four Trans-Indus Pathans
were admitted on tho morning with the following symptoms:?severe abdopain, which was not relieved by pressure ; purging of a greenish lienteric character; an entire absence of nausea or vomiting, and a feeling of persistent fulness of intestines, which wero not dissipated by the diarrheal flux. On enquiry, it was discovered that they had prepared a savory mess in an unprotected copper cooking-pot. on the afternoon of the 3rd, the remains of which was left standing overnight in the vessel, and partaken of cold next morning. About two hours after breakfast the generic symptoms appeared. They were easily combated by a castor-oil purge and drachm doses of tincture of iron. Although Chevallie'r concluded, in 1858, after a careful enquiry into the establishments in Paris in which workmen were exposed to the emanations of hot copper, that no such thing as copper colic exists, yet this by no means disproves the possibility of such a coincidence, as detailed, occurring. It is an interesting one, inasmuch as since Chevallier's enquiry, it appears to be the fashion of our medical and medico-legal works to exclude any reference to copper colic, which is not an uufrequont alfair in India.
of 4th minal
February,
III.?THREE CASES OP OPIUM POISONING.
CASES
AND
By Surgeon
OBSERVATIONS. J. "W. Johnston.
I.?MOVABLE KIDNEY. No. 2529, Sepoy S.-isim Gool, a Trans-Indus Pathan, was admitted into hospital on Ofch October 1871, for an ordinary attack of ague. \Vhile palpating the abdomen, I found a swelling in the left lumbar region, which, on pressure, became painful. Resting the patient 011 bis hands and knees I, bv following Sir William Jenner's method of diagnosis, discovered that the left kidney was dislocated forwards, but could be replaced by pressure downwards and backwards when in the erect posture.
(a).?Goolam Mahommet, Hindnstanee Mussulman, was admitted at 9 a.m. on 15th April, pulseless, in a comatose state, with stertorous and gasping breathing, clonic spasms, and shiverings; his body was cold and bedewed with a clammy sweat. The pupil of the right eye was contracted ; of tho left dilated, although apparently moribund. As opium poisoning was suspected, the stomach pump was passed, and the gastric contents thoroughly evacuated ; a drachm dose of sulphate of zinc exhibited, and the stomach alternately filled and emptied for an hour ; the cold douche was showered over the head and spine ; the extremities shampooed, and tourniquets applied over brachials and femorals with the view of conserving blood circulation. At the hour's end an ounco of turpentine was forced into the intestines by a three-pint enema of water, which roused him a little, when 15 grains of calomel and a pint of warm coffee were exhibited by stomach pump. He speedily relapsed ; tho symptoms abovo detailed returned and continued unabated until 11 a.m. The enemas were repeated every half hour ; cold effusion steadily persevered in, and an ammoniated infusion of coffee freely exhibited. By 1 p.m. lie could answer when his name was called. This treatment, plus alternately packing in warm sheets, and marching about, was persevered in until 6 p.m., when he became conscious. A considerable quantity of solid opium was brought up by stomach pump. His confession was that, disappointed in a lovo affair, ho had purchased and eaten 22 ruttecs (44 grains) of crude opium at 8. p.m. on tho 14 instant ; tho major portion of this must presumably have been rejected, as ho was discovered at 10 p.m. lying drunk (as was supposed) with a pool of vomit near him. The caio merits record from tho quantity partaken of, tho period that elapsed beforo ho was brought to hospital, 13 hours, the special symptoms and successful issue. on
(6.)?No. 2010, Sepoy Goolab Decn, Trans-Tndus Pathan, was 2nd April reported in a comatose state, lie had been under
July 1,
A MIRROR OP HOSPITAL PRACTICE.
1873.]
treatment for bronchial catarrh, and by advice of a Mooehee of three ruttees of opium extract. He was quite insensible, with stertorous breathing and contracted pupils when I first saw him. Under the usual remedies he speedily rallied. Goolab Deen not being on opium-eater suffers severely from a six dose, while his Sikh comrades eat with
partook
impunity
grain
three or four times that quantity daily. The Mooehee quack who gained access to hospital as a native barber (and had, it seems, during the three years tour of duty of 3rd Punjab Infantry, whom we relieved in November 1871, regularly treated discontented sepoys by stealth) was appreas he was found mercuriaand
punished, hended, prosecuted, lising another patient. (c.)?-No. 1224, Kliejan Singh, Sikh, of 15 years' service, with a past medical history of 15 days' sickness throughout his service, on account of three slight attacks of ague and one of bronchitis, was carried to hospital dying at 5-30 a.m. on the 25tli August. He was dead when I got there. On enquiry, the following history was elicited : that for had been in the habit of eating 9 ruttees many years the deceased (18 grains) of the watery extract of opium. On the 24th, he not only consumed his daily quantum, but in addition drunk an unknown quantity, obtained thus :? The Sikhs have a custom of mashing up, say a month's supply in a sufficiency of water ; this is boiled, strained, and the infusion gradually concentrated into a solid mass in a fair state of purity. During this process, a portion of the dessicated opium adheres to the side of the decoction pot, while the bulk settles in the centre. The latter is carefully put aside after being rolled into 3-ruttee (G-graiu) balls, for regular use ; the former is re-dissolved, and a few boon companions are invited to an orgie. The deceased had made an extraordinary brew for a native officer proceeding on sick leave, and consoled himself in moody solitary silence by drinking the residue about 9 p.m., and retiring to what proved a fatal sleep. His stertorous breathing roused his companion, who applied too late for medical aid. Kliejan Singh was a man of good character, and his death was purely accidental. An autopsy was made at 6-30 a.m. The brain was congested and swathed with dropsical fluid, which likewise filled the ventricles; the pupils widely dilated ; the heart fatty ; the liver enlarged ; all other organs were healthy. No trace of opium was found in stomach The deceased was somewhat obese, weighed 124 pounds, and stood 5 feet 7| inches in height. The organs
weighed?
Brain Cerebellum Heart
Kight Lung
Left Liver
?
Spleen Kidneys
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
lbs. oz. dr. avoirdupois, 2 9 4 0 3 6 0 10 4 1 5 0 1 4 G 3 4 4 1 6 0 0 4 0 each.
IV.?POISONING BY REPEATED SMALL DOSES OP ARSENIC. No. 144.?Havildar Goolab, 41 years of age, and 22 of inches, was admitted into hospital service, height 5 feet I saw him next morning ; on the evening of 11th January. he got ill when on cutclierry guard. He had been purged four, and vomited an indefinite number of times. On exa-
mination I found tenderness on pressure over the serobiculus cordis; he complained of slight nausea and a gnawing hot pain. The symptoms resembled what he had previously suffered from at Kohat, viz., ague (with melanin), diarrhoea with stomachic irritation amounting to sub-acute gastritis. His pulse was good. He said,?" my food has disagreed with me, but I am now all right." Diagnosis.?Diarrhoea with gastric irritation. Treatment.?Turpentine stuues, chlorodyne Jss. followed in half an hour by a full dose of castor-oil. liepeat chlorodyne, in half doses every six hours if pain continues. Diet.?Egg-flip with a sensation of rum and milk, rendered alkaline by carbonate of soda, with the view of utilising intestinal digestion. Vetpcrc.?The symptoms are slightly aggravated, emesis -of a dirtv brownish color ensued, and four motions were voided during the day.
185
12th.?Nothing of special import to be gathered from evacuations. He felt easier ; there was no tenesmus, or crampings. Treatment continued. He had another attack of purging and vomiting during the night. Y&th to 16th.?Vomiting and diarrhoea continued very slightly, and he appears better in every way. 17th.?Early yesterday evening he retched very violently, and at considerable intervals vomited small quantities of watery mucoid matter, which -was partially controlled by preceding treatment. This morning he complained of severe local pain in stomach ; there was tenderness on percussing the free depending margin of liver; the recti were remarkably tense, and retching still troublesome. Treatment.?Blister over pit of stomach ; full doses of dilute prussic acid pro-re-nata. He was very much relieved by afternoon. Retching and diarrhoea supervened about sunset. This was a^ain overcome by combining morphia with prussic acid. He passed an easy night.
18th.?Hns a haggard look, but says the pain is easier; continues to plague him. Two hours after dinner he vomited and purged severely. He had a very uncomfortable evening. The local pain was of a hot burning character ; the motions had not been retained for inspection. He reported them eanguinolent; the recti were so remarkably tense, and the pain at anterior free edge of right lobe of liver so very decided, that He was ordered to be kept under the abscess suggested itself. influence of morphia during the night. 19th.?This morning he was in great agony. The pulse was wiry and intermittent; his one cry was,?"relieve this pain ; it is killing me ; I am dying." Nausea and thirst were constant; no diarrhoea. The symptoms were puzzling. I could get no satisfaction from the hospital assistant, and as he was so very negligent in recording what took place during my absence, and had on so many occasions neglected to preserve evacuations, I requested Shankar Das, senior hospital assistant, who was convalescing from a severe illness, to take exclusive charge of the liavildar. In the evening diarrhoea and vomiting set in. This was again combated, and he spent a better night under repeated nausea
opiates.
20th.?This morning the nausea, retching, and fiery heat was very exhausting ; his lips were drawn, and his facies resembled that of a cancer patient's worn by agony. Treatment.?Continue opiates and prussic acid, to have stimulants ad libitum combined with milk or restorative diet; a second blister to be applied over stomach. He was very weak, and in no way improved ; in the evening pulse was wiry a cold clammy sweat dauks the forehead. He retained his milk and eggs, and under morphia passed a somewhat tranquil night. 2\st.?No better ; nausea excessive, but an entire absence of vomiting and purging; pulse irregular ; inspiration painful; cannot determine whether this is caused by ulceration of stomach or abscess of liver. Suspect the former. Evening very much worse ; takes his food and retains it. 22nd.?Had a very restless night; is pulseless ; pain continues very severe; his doleful cries echoing throughout the hospital; his body feels "cold and reptile-like, and is bathed with clammy perspiration. He took his food and retained it. No purging. To have full doses of morphia, as required to calm suffering. Evening.?Moribund; pulseless; collapsed; complains of He died intense agony in stomach ; takes any food given him. exhausted at 1. a.m. on morning of 23rd. The symptoms were so anomalous that I insisted on an autopsy. This was conducted in the presence of Dr. Lloyd at 10. a.m. on 23rd. The stomach was especially at lower aspect and towards pylorus inflamed, and studded with darkened sangtiinous extravasation. The upper third of duodenum was similarly, but more intensely, affected. About two inches from the pyloric valve on the posterior aspect of duodenum a patch of acute inflammation with a central ulcer existed; this had so nearly penetrated that the slightest touch of the finger point completely ruptured it. The duodenum for some distance onward presented an inflammatory tinge. No other portion of the gut was affected. The liver and spleen were somewhat enlarged and very friable. Selecting the stomach, duodenum, with portions of liver and pancreas, for chemical examination, I refrained from further inquiry, as an autopsy was very obnoxious to his friends. ?
THE INDIAN MEDICAL GAZETTE.
180
Tlie evidence of acro-irritant, presumably arsenic, poisoning, undoubted. I asked for deceased's widow, and on finding that slie was residing in the hospital assistant's house, who was
wa3
negligent, my suspicions were aroused. surprise at her being there, the subadar
On expressing informed me she residing was a woman of indifferent character, and had been with the hospital assistant's mother for some time. The hospital assistant, on being questioned regarding her presence there, equivocated so frequently that I, without further hesitation, made him a prisoner, and placed separate guards over him, his mother, and deceased's wife, so as effectually to cut off any chance of communication. so very
my
possible
Within an hour I had discovered the following facts :?That havildar's wife had called the cook, belonging to the deceased's company, on the 10th instant, and given him food ready prepared, consisting of ehupatties and meat curry, which he carried to the havildar at cutcherrv guard. He and Sultan, a sepoy (the latter very sparingly), partook of this. Sultan was the
admitted into hospital that evening for a slight attack of vomiting and diarrhoea. The havildar, who, it seems, was a very weak-
minded man, did not appear to realise that there was a laison going 011 between the hospital assistant, and it now eked out that the latter took the havildar to his own house every afternoon, where he partook of his mid-day meal.
reported the matter to the officer commanding, soliciting a of inquest, which was speedily granted. The result was that the hospital assistant, his mother, and deceased's wife to the civil authorities. The were bunded over prisoners chemical examiner, as was anticipated, found evidence of arsenic in all the preparations forwarded. The Deputy Commissioner tried and committed them to the I
court
sessions. The Commissioner discharged the hospital assistant, as definite proof was not forthcoming, owing: to the dresser perjuring himself; his mother was also acquitted; the widow The High Court, in confirming was transported for 14 years. the sentence of transportation, recorded that the conduct of the hospital assistant was of such a character that, had the Commissioner condemned him to bo executed, the sentence would have been confirmed. As the matter stood, they requested that he should be discharged from, and in future debarred, all Government employ. This was done in due course. Remarks.?There can be little doubt of the guilt of the hosassistant. A day or two prior to the first sickness of the havildar, I procured two ounces of white arsenic to destroy rats, and locked it in the poison chest of which be kept the key.
pital
No suspicions of and it was difficult it haunted one, but to distinguish the
foul play ever entered the head of deceased, for me to entertain such an idea. Latterly until after death there was little or nothing affection from ulceration of the stomach leading to perforation or acute abscess of liver. There was no photophobia; irritation of conjunctiva; inflammation of mouth
throat; jaundice; strangury or eczematous eruption ; no stiffness, tingling or tetantic spasms; excessive prostration ; restlessness and anxiety plus local pain amounting to agony, latterly was all we had to come and go on. The remarkable rigidity of the recti is noteworthy.
or
So far
three
I can discover there is no instance on record of of the duodenum by arsenical poisoning, and only of perforative ulceration of stomach.
as
perforation cases
I should recommend any confrere with a similar case under treatment to apply conclusively the experimenium crticis, viz., test the urine in the manner recommended by Bezzelius' modification of Marsh's process; but, as Sir Robert Christison remarks on an allied case :?"It may be doubted whether there are noWja dozen medical practitioners (in England) who could have applied it with confidence and quickness and probable
success."
This is the first instance I can trace in the Punjab of poisoning of arsenic. I conclude it was so, for
by repeated small doses one can scarcely fail
to perceive the very general daily exacerbations of the.symptoms after partaking of food in the hospital assistant's house.
The celebrated Wooler case detailed by Sir Robert Christison in J*o3. VII. and ^ III. of the Edinburgh Aledical Journal for January and February 185G, is a somewhat parallel one. Death likewiso resulted. The presumed murderer wa?
acquitted.
(To
be
continued.)
[July 1,
1873.
Four Trans-Indus Pathans
were admitted on tho morning with the following symptoms:?severe abdopain, which was not relieved by pressure ; purging of a greenish lienteric character; an entire absence of nausea or vomiting, and a feeling of persistent fulness of intestines, which wero not dissipated by the diarrheal flux. On enquiry, it was discovered that they had prepared a savory mess in an unprotected copper cooking-pot. on the afternoon of the 3rd, the remains of which was left standing overnight in the vessel, and partaken of cold next morning. About two hours after breakfast the generic symptoms appeared. They were easily combated by a castor-oil purge and drachm doses of tincture of iron. Although Chevallie'r concluded, in 1858, after a careful enquiry into the establishments in Paris in which workmen were exposed to the emanations of hot copper, that no such thing as copper colic exists, yet this by no means disproves the possibility of such a coincidence, as detailed, occurring. It is an interesting one, inasmuch as since Chevallier's enquiry, it appears to be the fashion of our medical and medico-legal works to exclude any reference to copper colic, which is not an uufrequont alfair in India.
of 4th minal
February,
III.?THREE CASES OP OPIUM POISONING.
CASES
AND
By Surgeon
OBSERVATIONS. J. "W. Johnston.
I.?MOVABLE KIDNEY. No. 2529, Sepoy S.-isim Gool, a Trans-Indus Pathan, was admitted into hospital on Ofch October 1871, for an ordinary attack of ague. \Vhile palpating the abdomen, I found a swelling in the left lumbar region, which, on pressure, became painful. Resting the patient 011 bis hands and knees I, bv following Sir William Jenner's method of diagnosis, discovered that the left kidney was dislocated forwards, but could be replaced by pressure downwards and backwards when in the erect posture.
(a).?Goolam Mahommet, Hindnstanee Mussulman, was admitted at 9 a.m. on 15th April, pulseless, in a comatose state, with stertorous and gasping breathing, clonic spasms, and shiverings; his body was cold and bedewed with a clammy sweat. The pupil of the right eye was contracted ; of tho left dilated, although apparently moribund. As opium poisoning was suspected, the stomach pump was passed, and the gastric contents thoroughly evacuated ; a drachm dose of sulphate of zinc exhibited, and the stomach alternately filled and emptied for an hour ; the cold douche was showered over the head and spine ; the extremities shampooed, and tourniquets applied over brachials and femorals with the view of conserving blood circulation. At the hour's end an ounco of turpentine was forced into the intestines by a three-pint enema of water, which roused him a little, when 15 grains of calomel and a pint of warm coffee were exhibited by stomach pump. He speedily relapsed ; tho symptoms abovo detailed returned and continued unabated until 11 a.m. The enemas were repeated every half hour ; cold effusion steadily persevered in, and an ammoniated infusion of coffee freely exhibited. By 1 p.m. lie could answer when his name was called. This treatment, plus alternately packing in warm sheets, and marching about, was persevered in until 6 p.m., when he became conscious. A considerable quantity of solid opium was brought up by stomach pump. His confession was that, disappointed in a lovo affair, ho had purchased and eaten 22 ruttecs (44 grains) of crude opium at 8. p.m. on tho 14 instant ; tho major portion of this must presumably have been rejected, as ho was discovered at 10 p.m. lying drunk (as was supposed) with a pool of vomit near him. The caio merits record from tho quantity partaken of, tho period that elapsed beforo ho was brought to hospital, 13 hours, the special symptoms and successful issue. on
(6.)?No. 2010, Sepoy Goolab Decn, Trans-Tndus Pathan, was 2nd April reported in a comatose state, lie had been under
July 1,
A MIRROR OP HOSPITAL PRACTICE.
1873.]
treatment for bronchial catarrh, and by advice of a Mooehee of three ruttees of opium extract. He was quite insensible, with stertorous breathing and contracted pupils when I first saw him. Under the usual remedies he speedily rallied. Goolab Deen not being on opium-eater suffers severely from a six dose, while his Sikh comrades eat with
partook
impunity
grain
three or four times that quantity daily. The Mooehee quack who gained access to hospital as a native barber (and had, it seems, during the three years tour of duty of 3rd Punjab Infantry, whom we relieved in November 1871, regularly treated discontented sepoys by stealth) was appreas he was found mercuriaand
punished, hended, prosecuted, lising another patient. (c.)?-No. 1224, Kliejan Singh, Sikh, of 15 years' service, with a past medical history of 15 days' sickness throughout his service, on account of three slight attacks of ague and one of bronchitis, was carried to hospital dying at 5-30 a.m. on the 25tli August. He was dead when I got there. On enquiry, the following history was elicited : that for had been in the habit of eating 9 ruttees many years the deceased (18 grains) of the watery extract of opium. On the 24th, he not only consumed his daily quantum, but in addition drunk an unknown quantity, obtained thus :? The Sikhs have a custom of mashing up, say a month's supply in a sufficiency of water ; this is boiled, strained, and the infusion gradually concentrated into a solid mass in a fair state of purity. During this process, a portion of the dessicated opium adheres to the side of the decoction pot, while the bulk settles in the centre. The latter is carefully put aside after being rolled into 3-ruttee (G-graiu) balls, for regular use ; the former is re-dissolved, and a few boon companions are invited to an orgie. The deceased had made an extraordinary brew for a native officer proceeding on sick leave, and consoled himself in moody solitary silence by drinking the residue about 9 p.m., and retiring to what proved a fatal sleep. His stertorous breathing roused his companion, who applied too late for medical aid. Kliejan Singh was a man of good character, and his death was purely accidental. An autopsy was made at 6-30 a.m. The brain was congested and swathed with dropsical fluid, which likewise filled the ventricles; the pupils widely dilated ; the heart fatty ; the liver enlarged ; all other organs were healthy. No trace of opium was found in stomach The deceased was somewhat obese, weighed 124 pounds, and stood 5 feet 7| inches in height. The organs
weighed?
Brain Cerebellum Heart
Kight Lung
Left Liver
?
Spleen Kidneys
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
lbs. oz. dr. avoirdupois, 2 9 4 0 3 6 0 10 4 1 5 0 1 4 G 3 4 4 1 6 0 0 4 0 each.
IV.?POISONING BY REPEATED SMALL DOSES OP ARSENIC. No. 144.?Havildar Goolab, 41 years of age, and 22 of inches, was admitted into hospital service, height 5 feet I saw him next morning ; on the evening of 11th January. he got ill when on cutclierry guard. He had been purged four, and vomited an indefinite number of times. On exa-
mination I found tenderness on pressure over the serobiculus cordis; he complained of slight nausea and a gnawing hot pain. The symptoms resembled what he had previously suffered from at Kohat, viz., ague (with melanin), diarrhoea with stomachic irritation amounting to sub-acute gastritis. His pulse was good. He said,?" my food has disagreed with me, but I am now all right." Diagnosis.?Diarrhoea with gastric irritation. Treatment.?Turpentine stuues, chlorodyne Jss. followed in half an hour by a full dose of castor-oil. liepeat chlorodyne, in half doses every six hours if pain continues. Diet.?Egg-flip with a sensation of rum and milk, rendered alkaline by carbonate of soda, with the view of utilising intestinal digestion. Vetpcrc.?The symptoms are slightly aggravated, emesis -of a dirtv brownish color ensued, and four motions were voided during the day.
185
12th.?Nothing of special import to be gathered from evacuations. He felt easier ; there was no tenesmus, or crampings. Treatment continued. He had another attack of purging and vomiting during the night. Y&th to 16th.?Vomiting and diarrhoea continued very slightly, and he appears better in every way. 17th.?Early yesterday evening he retched very violently, and at considerable intervals vomited small quantities of watery mucoid matter, which -was partially controlled by preceding treatment. This morning he complained of severe local pain in stomach ; there was tenderness on percussing the free depending margin of liver; the recti were remarkably tense, and retching still troublesome. Treatment.?Blister over pit of stomach ; full doses of dilute prussic acid pro-re-nata. He was very much relieved by afternoon. Retching and diarrhoea supervened about sunset. This was a^ain overcome by combining morphia with prussic acid. He passed an easy night.
18th.?Hns a haggard look, but says the pain is easier; continues to plague him. Two hours after dinner he vomited and purged severely. He had a very uncomfortable evening. The local pain was of a hot burning character ; the motions had not been retained for inspection. He reported them eanguinolent; the recti were so remarkably tense, and the pain at anterior free edge of right lobe of liver so very decided, that He was ordered to be kept under the abscess suggested itself. influence of morphia during the night. 19th.?This morning he was in great agony. The pulse was wiry and intermittent; his one cry was,?"relieve this pain ; it is killing me ; I am dying." Nausea and thirst were constant; no diarrhoea. The symptoms were puzzling. I could get no satisfaction from the hospital assistant, and as he was so very negligent in recording what took place during my absence, and had on so many occasions neglected to preserve evacuations, I requested Shankar Das, senior hospital assistant, who was convalescing from a severe illness, to take exclusive charge of the liavildar. In the evening diarrhoea and vomiting set in. This was again combated, and he spent a better night under repeated nausea
opiates.
20th.?This morning the nausea, retching, and fiery heat was very exhausting ; his lips were drawn, and his facies resembled that of a cancer patient's worn by agony. Treatment.?Continue opiates and prussic acid, to have stimulants ad libitum combined with milk or restorative diet; a second blister to be applied over stomach. He was very weak, and in no way improved ; in the evening pulse was wiry a cold clammy sweat dauks the forehead. He retained his milk and eggs, and under morphia passed a somewhat tranquil night. 2\st.?No better ; nausea excessive, but an entire absence of vomiting and purging; pulse irregular ; inspiration painful; cannot determine whether this is caused by ulceration of stomach or abscess of liver. Suspect the former. Evening very much worse ; takes his food and retains it. 22nd.?Had a very restless night; is pulseless ; pain continues very severe; his doleful cries echoing throughout the hospital; his body feels "cold and reptile-like, and is bathed with clammy perspiration. He took his food and retained it. No purging. To have full doses of morphia, as required to calm suffering. Evening.?Moribund; pulseless; collapsed; complains of He died intense agony in stomach ; takes any food given him. exhausted at 1. a.m. on morning of 23rd. The symptoms were so anomalous that I insisted on an autopsy. This was conducted in the presence of Dr. Lloyd at 10. a.m. on 23rd. The stomach was especially at lower aspect and towards pylorus inflamed, and studded with darkened sangtiinous extravasation. The upper third of duodenum was similarly, but more intensely, affected. About two inches from the pyloric valve on the posterior aspect of duodenum a patch of acute inflammation with a central ulcer existed; this had so nearly penetrated that the slightest touch of the finger point completely ruptured it. The duodenum for some distance onward presented an inflammatory tinge. No other portion of the gut was affected. The liver and spleen were somewhat enlarged and very friable. Selecting the stomach, duodenum, with portions of liver and pancreas, for chemical examination, I refrained from further inquiry, as an autopsy was very obnoxious to his friends. ?
THE INDIAN MEDICAL GAZETTE.
180
Tlie evidence of acro-irritant, presumably arsenic, poisoning, undoubted. I asked for deceased's widow, and on finding that slie was residing in the hospital assistant's house, who was
wa3
negligent, my suspicions were aroused. surprise at her being there, the subadar
On expressing informed me she residing was a woman of indifferent character, and had been with the hospital assistant's mother for some time. The hospital assistant, on being questioned regarding her presence there, equivocated so frequently that I, without further hesitation, made him a prisoner, and placed separate guards over him, his mother, and deceased's wife, so as effectually to cut off any chance of communication. so very
my
possible
Within an hour I had discovered the following facts :?That havildar's wife had called the cook, belonging to the deceased's company, on the 10th instant, and given him food ready prepared, consisting of ehupatties and meat curry, which he carried to the havildar at cutcherrv guard. He and Sultan, a sepoy (the latter very sparingly), partook of this. Sultan was the
admitted into hospital that evening for a slight attack of vomiting and diarrhoea. The havildar, who, it seems, was a very weak-
minded man, did not appear to realise that there was a laison going 011 between the hospital assistant, and it now eked out that the latter took the havildar to his own house every afternoon, where he partook of his mid-day meal.
reported the matter to the officer commanding, soliciting a of inquest, which was speedily granted. The result was that the hospital assistant, his mother, and deceased's wife to the civil authorities. The were bunded over prisoners chemical examiner, as was anticipated, found evidence of arsenic in all the preparations forwarded. The Deputy Commissioner tried and committed them to the I
court
sessions. The Commissioner discharged the hospital assistant, as definite proof was not forthcoming, owing: to the dresser perjuring himself; his mother was also acquitted; the widow The High Court, in confirming was transported for 14 years. the sentence of transportation, recorded that the conduct of the hospital assistant was of such a character that, had the Commissioner condemned him to bo executed, the sentence would have been confirmed. As the matter stood, they requested that he should be discharged from, and in future debarred, all Government employ. This was done in due course. Remarks.?There can be little doubt of the guilt of the hosassistant. A day or two prior to the first sickness of the havildar, I procured two ounces of white arsenic to destroy rats, and locked it in the poison chest of which be kept the key.
pital
No suspicions of and it was difficult it haunted one, but to distinguish the
foul play ever entered the head of deceased, for me to entertain such an idea. Latterly until after death there was little or nothing affection from ulceration of the stomach leading to perforation or acute abscess of liver. There was no photophobia; irritation of conjunctiva; inflammation of mouth
throat; jaundice; strangury or eczematous eruption ; no stiffness, tingling or tetantic spasms; excessive prostration ; restlessness and anxiety plus local pain amounting to agony, latterly was all we had to come and go on. The remarkable rigidity of the recti is noteworthy.
or
So far
three
I can discover there is no instance on record of of the duodenum by arsenical poisoning, and only of perforative ulceration of stomach.
as
perforation cases
I should recommend any confrere with a similar case under treatment to apply conclusively the experimenium crticis, viz., test the urine in the manner recommended by Bezzelius' modification of Marsh's process; but, as Sir Robert Christison remarks on an allied case :?"It may be doubted whether there are noWja dozen medical practitioners (in England) who could have applied it with confidence and quickness and probable
success."
This is the first instance I can trace in the Punjab of poisoning of arsenic. I conclude it was so, for
by repeated small doses one can scarcely fail
to perceive the very general daily exacerbations of the.symptoms after partaking of food in the hospital assistant's house.
The celebrated Wooler case detailed by Sir Robert Christison in J*o3. VII. and ^ III. of the Edinburgh Aledical Journal for January and February 185G, is a somewhat parallel one. Death likewiso resulted. The presumed murderer wa?
acquitted.
(To
be
continued.)
[July 1,
1873.
