History of Medicine

ARSENIC POISONING:

 MEDICINE IN THE COURTROOM

     Imagine wanting to eliminate a rival, whether for love or for money. What better way than poison. No violence needed, just cunning. And so it was in early 19^th century Europe, where poisoning, especially with arsenic, was fairly common. Arsenic was everywhere - as rat poison, in dyes for paints, clothing, and wallpaper, and in medications.  Sheep dipping required large amounts and it was even found in flypaper. You could buy it at the local chemist or grocer. “White arsenic” (arsenic trioxide), the common form, was odorless and tasteless, ideal for lacing food or coffee.

     In the courtroom the decision to send an accused to freedom or to the hangman often relied on circumstantial evidence rather than science. In 1815 England was shaken when a 22 year old servant, Elizabeth Fenning, crying to the last that she was innocent, was hanged for poisoning (non-fatally) the family where she worked. Circumstantial evidence alone convinced the jury, in spite of lack of hard evidence of arsenic in those affected. Thousands turned out for her funeral and a public outcry ensued, making it clear that better science, and evidence collection, were needed.

     Two years before, in France, a young physician and chemist, Mateu Orfila, noted that white arsenic powder in coffee or other organic fluids failed to precipitate with standard reagents. He correctly saw the importance of this in criminal cases. Orfila, born on the island of Minorca, had studied medicine in Valencia and

Mateu Orfila (from Wikipedia)

then chemistry in Barcelona and Paris. He was quick, bright, self-confident, and an excellent lecturer, traits that catapulted him rapidly into influential chemistry and medical circles. He was helped by a superb baritone voice (said to be adequate for the Paris Opera) that gained him entry into select Paris salons. He was a constant proponent of the value of chemistry to medicine, a theme resisted by many clinicians at the time. Orfila soon was able to isolate arsenic in organic material and rapidly widened his research. He published the first full book in years on toxicology, Traité des Poisons, in 2 volumes over 1814-5, a popular book translated into several languages. In 1819 he was appointed professor of legal medicine at the Paris Faculty of Medicine, and was consulted frequently in criminal poisoning cases. Later in life he was president of the Royal Academy of Medicine.

     One of Orfila’s students, a Scot named Robert Christison, on returning to Scotland noticed there an absence of knowledge of toxicology and published the first English language text on the

Robert Christison (from Wikipedia)

subject. He too was frequently consulted on court cases and became professor of medical jurisprudence in Edinburgh. 

     Better science soon came. In 1833, John Brodle was accused of poisoning his grandfather by placing arsenic in his coffee. The coffee grounds and stomach contents of the victim were sent off to Michael Faraday for testing, who passed them on to his assistant, James Marsh, whose findings were inconclusive - Brodle went free. Marsh appreciated that the usual precipitation methods could not detect arsenic in tiny amounts. He knew from Carl Wilhelm Scheele, an important Swedish chemist, that the combination of arsenic, zinc, and nitric acid produced a gas, arsine. He devised an apparatus (see insert) featuring a tube with a

stopcock at the top through which the arsine could pass. When the arsine was flamed a precipitate of metallic arsenic formed on a glass plate held over the stopcock. At first tricky to use, with modification it became the standard test for arsenic. Little is known of Marsh’s life except that he was a respected scientist for the military and had invented a vibrating interrupter to turn circuits off and on.

      A few years later, in 1840, in the village of Beyssac, south-central France, a Marie Lafarge was accused of poisoning her husband. Tests for arsenic on his remains were inconclusive, and when repeated were negative. The juge d’instruction ordered the body exhumed, 10 months after burial, for more tests. This time the “Marsh test”, applied to the putrid remains, was negative. But a physician who relied on the clinical picture still doubted the results so the juge ordered a fourth assay, appointing experts, including Mateu Orfila, to do the tests. Orfila’s team found arsenic this time, landing Madame in jail for life. Orfila claimed that the previous team had performed the test improperly. It was the first criminal trial decided by the Marsh test. Madame LaFarge’s case was another that evoked a media blitz which

Madame LaFarge (from Wikipedia)

divided the country “as much as the Dreyfus case”, according to some. LaFarge’s memoirs, written in jail, were a best seller.

      Aware of the sensitivity of the Marsh test, Orfila realized that he could now assay blood and tissue levels for arsenic at levels unheard of before. He was aware of experiments done a few years earlier by Francois Magendie on strychnine, proving that it was absorbed through the venous system and not the lymphatics. Orfila did similar experiments, now measuring levels in blood and tissues, something impossible for Magendie who relied on clinical effects. Testing for organic poisons, such as strychnine and nicotine, soon followed. Forensic science, and experimental pharmacology, were now established.

     “Medical jurisprudence” chairs were established in many of Europe's medical centers in succeeding years. In the U.S., by contrast, the first full time position in “legal medicine” was not until 1937 at Harvard. The physician chosen for the position, Alan Moritz, was first sent to Europe for two years to study at already existing departments. Moritz pushed the AMA to advocate for physician medical examiners. In 1944 only seven states had medical examiners - in others the coroners were laymen. The AMA agreed with Moritz and exerted its influence. Gradually medical examiners replaced lay coroners, and forensic pathology is now a board specialty in the U.S.

      

SOURCES:

           Bertomeu-Sanchez, JR, and Nieto-Galan, A, eds: Chemistry, Medicine, and Crime. 2006.

           Jentzen, JM. Death Investigation in America. 2009

           Stratmann, L. The Secret Poisoner: A Century of Murder. 2016.

           Chaille, SE. 1949.  “Origin and Progress of Medical Jurisprudence, 1776-1876”. J Crim Law and Criminology, 40: 397-444.

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