A STUDY OF THE SNOOK-HERR POISONING 
CASE. 
BY 
GILES S. MITCHELL, M.D., 
PROFESSOR OF OBSTETRICS IN THE CINCINNATI COLLEGE OF MEDICINE 
AND SURGERY; PROFESSOR OF GYNECOLOGY IN THE WOMAN'S 
MEDICAL COLLEGE OF CINCINNATI J 
AND 
JAMES G. HYNDMAN, M.D., 
PROFESSOR OF MEDICAL CHEMISTRY AND CLINICAL LARYNGOLOGY IN THE 
MEDICAL COLLEGE OF OHIO. 
THE MEDICAL. NEWS, 
FROM 
June 27, 1891. [Reprinted from The Medical News, June 27, 1891.] 
A STUDY OF THE SNOOK-HERR POISONING 
CASE.1 
GILES S. MITCHELL, M.D., 
PROFESSOR OF OBSTETRICS IN THE CINCINNATI COLLEGE OF MEDICINE 
AND SURGERY ; PROFESSOR OF GYNECOLOGY IN THE WOMAN S 
MEDICAL COLLEGE OF CINCINNATI J 
AND 
PROFESSOR OF MEDICAL CHEMISTRY AND CLINICAL LARYNGOLOGY IN THE 
MEDICAL COLLEGE OF OHIO. 
JAMES G. HYNDMAN, M.D., 
A wedding dinner was recently partaken of by 
sixty or seventy guests at the country-house of 
the bride's parents, near Louisville, Ky. Within a 
few hours the great majority of the guests were taken 
ill, all presenting the symptoms of gastro-intestinal 
inflammation. Within a few days several died. 
The lives of others were prolonged for from ten to 
fifteen days. Six cases finally terminated fatally. The 
symptoms in all the cases were essentially identical, 
differing only in intensity. Such an occurrence 
would under any circumstances have attracted 
much professional and popular attention, but in 
this instance it was probably increased by the so- 
cial prominence of the victims and the number of 
people affected. Shortly after the repast, the newly- 
married couple left for the North. When their train 
1 Read before the Cincinnati Academy of Medicine, June i, 
1891. 2 
MITCHELL AND HYNDMAN. 
reached Cincinnati, three hours later, both were feel- 
ing ill; they concluded to remain at a hotel over 
night, and continue their journey the following day. 
Dr. Mitchell was called to see Mr. Snook at io 
o'clock on the evening of April 15, 1891. The pa- 
tient was partly undressed and reclining on a lounge. 
He stated that he and his wife had arrived that 
evening from Louisville via the Shortline Railroad, 
and that the motion of the train had made him 
ill. He complained of nausea, abdominal pain, in- 
tense thirst and a constriction of the throat. He 
had vomited several times while on the train, and 
had had one stool. Upon inquiry as to what he 
nad eaten, he said that he and his wife had attended 
a reception just prior to starting, and that he 
had partaken freely of chicken-salad, ice-cream and 
cake. His wife had eaten but little, and was only 
slightly nauseated. While giving this recital he 
vomited quite freely, the vomited matter consisting 
mainly of water, mucus and bile. The case was 
regarded as one of ordinary gastro-intestinal irrita- 
tion, due to the character of the food eaten, and 
aggravated by the motion of the train, upon which 
latter point the patient laid particular stress. 
Although the pain was quite severe, it was deemed 
best to assist nature in washing out the stomach and 
unloading the bowel. The patient was given warm 
water in large quantities to drink, which was imme- 
diately vomited; after which one-tenth grain calomel 
powders were ordered to be taken one every hour, 
and mustard to be applied over the stomach. Dr. 
Mitchell then left, promising to return on the follow- 
ing morning. He was again summoned, however, at THE SNOOK-HERR POISONING. 
3 
2 a.m., and learned that the patient had continued 
to vomit. He had had three stools, and the pain in 
the stomach and bowels had become so severe as to 
be unbearable. A hypodermatic injection of one- 
third of a grain of morphine was administered. At 
the expiration of one-half hour the patient had 
become easy. At 7 a.m. on the following day Dr. 
Mitchell was informed that the patient had slept 
some, but he still complained of pain, vomiting 
and diarrhoea. The pulse was 100, and the axillary 
temperature 102° F. These symptoms continued 
throughout the day. Milk and lime-water were 
ordered; also a siphon of seltzer. These were 
mostly rejected, while the thirst increased. The 
calomel was discontinued, and a mixture of bismuth 
and paregoric was given. In the evening the tem- 
perature of the patient was found to be one degree 
lower. At the morning visit, on this second day, 
Mrs. S. presented the same symptoms as her hus- 
band, but not in so intense a degree. Her tem- 
perature, however, was the same as his. During 
the day Dr. Mitchell became convinced that his 
patients were not suffering from an ordinary at- 
tack of biliousness, and suspicion was aroused that 
some irritant poison had been ingested. Careful 
inquiry of the patients failed to furnish any light 
upon this point, both firmly believing that the 
motion of the train had produced their illness. 
On the morning of the 17th, Mrs. S. had slightly 
improved, but her husband was worse in every way, 
save that his temperature had fallen almost to the 
normal. It continued to fall until late in the even- 
ing, when it was found to be subnormal. Dr. Hynd- 4 
MITCHELL AND HYNDMAN. 
man was now asked to see the case in consultation, 
and from this time forward he and Dr. Mitchell 
continued in joint attendance. Mr. Snook was 
then in a condition of profound collapse. He was 
cyanotic, his heart's action very rapid and weak, 
the skin bathed in a profuse cold perspiration, and 
he axillary temperature 96°. Strophanthus was now 
administered per os. This was selected instead of 
digitalis on account of the continued irritability of 
the stomach. Morphine (one-tenth grain doses) 
combined with atropine was given hypodermatically. 
Warm applications to the body, in the form of fre- 
quent mustard baths, were employed. 
During the fourth and fifth days there was im- 
provement, the stools becoming less frequent, but 
the nausea continuing. At this time we learned of 
numerous similar cases having occurred in and about 
Louisville, all traceable to the same wedding din- 
ner. It was ordered that the urine and vomited 
matters be preserved for us, but, by some over- 
sight, we did not obtain any for examination until 
the sixth day of the patient's illness. On this day, 
and upon several subsequent occasions, the urine, 
vomited matter and mucous excretions from the 
bowel were carefully examined by Reinsch's method, 
but the bright copper strip showed no signs of the 
characteristic deposit of arsenic. 
Beginning on the third and fourth days respectively 
both cases exhibited a decided eczematous eruption 
over the arms, shoulders, face and upper portions of 
the chest. In the case of the lady this continued 
during her entire convalescence, which began about 
the sixth or seventh day. In the case of Mr. S. THE SNOOK-HERR POISONING. 
5 
the eruption had more of a papular appearance. 
Under strophanthus, whiskey and a bland diet for 
the next few days he appeared to improve. His 
heart's action became stronger, his temperature re- 
mained about ioo°, and his abdominal tenderness 
diminished. Diarrhoea and vomiting were almost 
checked. But the thirst, restlessness, and mental 
hebetude were quite pronounced. Morphine in small 
doses was continued. There was also decided sub- 
sultus tendinum. His urine, heretofore passed in 
normal quantity, was found diminished, and had to 
be withdrawn by the catheter. On the ninth day of 
his illness but four ounces were secreted. We now 
resorted to the hot vapor-bath, reinforced by the 
hypodermatic injection of one sixth of a grain of 
pilocarpine. The profuse perspiration which fol- 
lowed was accompanied by a marked amelioration 
of his mental condition. Three injections of pilo- 
carpine were made at intervals of eight hours. At 
the end of this time the kidneys appeared to have re- 
sumed their function and secreted almost the normal 
quantity; but catheterization was required from this 
time on. 
While Mr. Snook could at all times be aroused 
without much difficulty, his mind seemed sluggish. 
About the tenth day epistaxis set in. Though not 
profuse it reappeared daily for several days. On 
the twelfth day, having for three days had no stool, 
he was given a saline cathartic in divided doses. 
The resulting passages each contained a small 
amount of bright-red blood, evidently from the 
lower bowel. From this time on the bleeding 
continued. Its amount was small, but it was con- 6 
MITCHELL AND HYNDMAN. 
stant, and the patient, though able to answer ques- 
tions intelligently, did not seem to realize that 
haemorrhage was going on. His restlessness con- 
tinued, interrupted only by very brief naps, and, 
notwithstanding stimulants, his heart's action grew 
more and more feeble, occasionally intermitting. 
These intermissions grew more frequent and the 
contractions weaker, until the evening of April 30th, 
the sixteenth day of his illness, when he died. 
During the week preceding death Dr. Long, of 
the Marine-Hospital Service, and on the last day, 
Dr. P. S. Conner, saw the case in consultation 
with us. The coroner was at once notified of the 
death; upon his arrival he decided to order a post- 
mortem examination and a chemical analysis of the 
tissues. The following is the pathologists' report to 
Coroner Bange: 
" In accordance with your instructions we have 
this day, May i, 1891, made a post-mortem exami- 
nation of the body of W. B. Snook. The body 
was that of a well-developed, well-nourished, white, 
adult male, of the apparent age of about thirty-five 
years, about 5 feet 6 inches in height, and about 160 
pounds in weight. Post-mortem rigidity and post- 
mortem staining were well marked. On the right 
arm and left leg were found numerous small eleva- 
tions of the skin, resembling wheals. On section 
the subcutaneous fat was found in good quantity. 
Pleurae: In the right pleura about one ounce of 
fluid blood was found, with some extravasations of 
blood under the pleura. The lungs were normal, 
with the exception of slight hypostatic congestion. 
Heart; An extravasation of blood, about the size 
of a split pea, under the endocardium of the left 
ventricle, was found. The stomach contained about THE SNOOK-HERR POISONING. 
7 
three ounces of reddish, grumous fluid. The mucous 
membrane was marked by hyperaemia, and there was 
marked extravasation of blood in its substance. 
Intestine: The small intestine in its mucous and 
submucous coat contained extravasated blood ; the 
mucosa was very hyperaemic, and the solitary folli- 
cles and the patches of Peyer were swollen. The 
large intestine was also hyperaemic, with swelling of 
the solitary follicles. The liver was somewhat fatty. 
The spleen was slightly larger than normal, firm and 
hyperaemic. The kidneys were fatty, with small 
extravasations of blood under the capsule and under 
the lining of the pelves. Bladder: Marked extra- 
vasation of blood under the epithelium and in the 
mucosa. The brain and meninges were normal. 
" In our opinion the cause of death was, in all 
probability, the ingestion of some irritant poison. 
" Frederick Kebler. 
"E. W. Walker." 
On May 8, 1891, the following report was sub- 
mitted to the coroner by Dr. Dickore, the analytical 
chemist: 
"On Friday, May ist, you sent me for poison- 
analysis the following parts of the body of the 
deceased Mr. Snook: i. The stomach and its con- 
tents, in separate glass vessels. 2. The liver, spleen, 
heart, kidneys, intestines, a piece of rib, etc., 
in another glass jar; all of which I have carefully 
examined and analyzed for metallic poisons. 
" In the spleen, the liver, the intestines, and the 
other parts from jar No. 2, separately examined, I 
have found traces of copper-combinations in sufficient 
quantity to be separated and to answer all chemical 
tests for this metal. None of this was found in the 
stomach. 
" The analysis for arsenic by Marsh's method re- 8 
MITCHELL AND HYNDMAN. 
suited, in the case of the liver, spleen, intestines 
and stomach, in producing a few little spots on 
white porcelain, resembling those which arsenic 
gives by this method; but the spots were not larger 
than pin-points-only two of the size of small pin- 
heads-and it was impossible to produce the nitrate- 
of-silver reaction with them ; and as this is the only 
absolute and true test for this poison, I cannot con- 
scientiously call these little spots a positive proof of 
the presence of arsenic. 
"If any larger quantity of poison had been intro- 
duced into the system of the deceased, it must have 
been eliminated during the sixteen days of his ill- 
ness by physiological processes and careful medical 
treatment. Very respectfully, W. Dickore." 
Thus far we have given a full account of the two 
cases falling under our observation. The greatest 
interest necessarily attaches to the diagnosis of the 
cause of these symptoms. The diagnosis, reached 
by the process of exclusion during the life of the 
deceased, and expressed by us, was that we were 
dealing with cases of arsenical poisoning. At the 
present time, with the additional information before 
us, derived from post-mortem and chemical examin- 
ations, we feel even more confidently than before 
that our original diagnosis was correct. 
A number of explanations offered themselves. 
Among them were the possibility of the existence 
of some acute infectious disease, such as trichinosis 
or typhoid fever, of mushroom-poisoning, or poi- 
soning by tyrotoxicon or other ptomaine, or by 
irritant minerals, such as arsenic. 
The early onset and the great severity of the 
symptoms, together with the proof that no form of pork was used at the meal, exclude from con- 
sideration the possibility of trichinosis. Though 
the post-mortem lesions, so far as the intestinal tract 
is concerned, somewhat resemble those of typhoid 
fever, the almost simultaneous attack of so many 
persons leads us very quickly to abandon the sup- 
position of typhoid fever, even though we have 
before us some resemblance to the hepatic, renal and 
intestinal changes occasionally following the action 
of the typhoid bacillus, and the resultant chemical 
changes due to the ptomaines. 
The possibility of tyrotoxicon-poisoning naturally 
suggested itself. Our patients presented the nausea, 
epigastric pains, vomiting, and purging characteristic 
of the action of this ptomaine. Their pupils, how- 
ever, were never dilated, and, instead of subnormal 
temperature, they presented fever. The lesions 
found post-mortem also contra-indicate tyrotoxicon- 
poisoning ; according to Vaughan, this ptomaine 
produces the symptoms without the lesions of 
gastro-intestinal irritation. Subsequent investiga- 
tion showed that those wedding guests escaped who 
partook only of ice-cream and coffee with cream. 
Mushrooms cannot be charged with the produc- 
tion of the symptoms, because some of the most 
severe cases were those of persons who had not eaten 
any mushrooms. 
One of the latest of the many local theories of 
explanation is based upon the report that, at the 
time of the wedding, the chickens and turkeys at 
the bride's home were affected with chicken-cholera, 
and that some fowls showing evidence of being af- 
fected with this disease were used in the preparation 
THE SNOOK-HERR POISONING. 
9 10 
MITCHELL AND HYNDMAN. 
of the salad. The report states that parts of these 
chickens, which were black, were cut off and the 
remainder utilized. It is difficult under the circum- 
stances to conceive of the possibility of such an 
occurrence. We are informed by very competent 
authority that, in this vicinity, chicken-cholera is 
almost unknown so early as April; but aware, as we 
are, of the rapidity with which such pathogenic 
germs may multiply and cause general barnyard 
infection, we do not care to insist upon this objec- 
tion. Persons living on a farm and familiar with 
chicken-cholera would be the first to recognize dan- 
ger from this source. The further elaboration of the 
chicken-cholera theory is by no means convincing. 
We are told that the chicken-salad left over from 
the wedding was examined (eight or ten days later), 
and that ptomaines were found. As these investi- 
gations were not begun until after the death of sev- 
eral of the persons poisoned, and as the material 
examined consisted of such remnants of the wed- 
ding dinner as were still collectable at the end of a 
week of warm weather, it is not at all surprising 
that ptomaines should be present. Being chemical 
compounds, formed during the putrefaction of 
organic substances, such ptomaines would almost 
necessarily exist in the refuse food a week old; 
but, we are told, these ptomaines were identical 
with those found in the chickens which died of 
cholera and in the stomach of one of the victims 
(who died eight days after the wedding). As to 
this, we can only state that as far as we are ac- 
quainted with the literature of ptomaines, we be- 
lieve that the ptomaine resulting from the action of THE SNOOK-HERR POISONING. 
11 
the chicken-cholera bacillus has never yet been 
isolated. There is, therefore, good ground for 
scepticism regarding this discovery. In the light 
afforded by the symptoms, the post-mortem lesions, 
the chemical analyses, the fact, already mentioned, 
that up to the present time no such anatomical 
lesions have ever been observed to follow ptomaine- 
poisoning, and the utter absence of any reliable 
experimental observations upon these ptomaines (or 
their precedent bacilli) in man-we feel justified in 
saying that the application of the ptomaine-theory 
to this case is not tenable. 
Let us now consider the theory of a mineral irri- 
tant. The history of our cases has recorded the 
occurrence of thirst, nausea, retching and vomit- 
ing, epigastric and abdominal pain, tenderness on 
pressure, severe purging, decided fever, small, irreg- 
ular pulse, labored respiration, suppression of urine, 
great restlessness, mental hebetude, eczematous erup- 
tions, epistaxis, hsematuria and intestinal haemor- 
rhage. Many of these symptoms were manifested 
by both, and all by the fatal one, of our cases. No 
poison but that of a mineral irritant could produce 
such an array of symptoms and such lesions as have 
been described. These post-mortem conditions, 
found by two of the most competent pathologists of 
Cincinnati, led them in their report to the coroner 
to state that the cause of death was probably " the 
ingestion of some irritant poison." 
Portions of the liver, kidney, spleen, muscle, 
brain and bone were submitted to Dr. Dickore for 
chemical analysis. As stated in his report, Dr. 
Dickore found decided traces of copper, and lesser 12 
MITCHELL AND HYNDMAN. 
amounts of some other substance which might pos- 
sibly have been arsenic, but which was present in 
too minute a quantity to be absolutely determined. 
It is a well-known fact that copper, like antimony, 
silver and lead, often remains in the organs for 
many months after it has been taken. Copper 
may be taken under so many different circum- 
stances and in such diverse ways, and is, in conse- 
quence of its slow elimination, so frequently found 
in the tissues, as to lead some very able toxicologists 
to claim that it is one of the normal consistents of 
the body. It is a well-known fact that copper exists 
in some edible vegetables, being taken up from the 
soil in which they grow. Then, too, copper salts 
are often employed to impart a fine, green color to 
pickles and other preserved fruits. Its frequent 
presence in the food and its very slow elimination 
might possibly account for the discovery of copper 
in the body of our patient. Its presence should 
never, however, be supposed to indicate copper- 
poisoning unless we have the symptoms and patho- 
logical lesions which are known to follow its admin- 
istration in large quantities. These were entirely 
absent in our patients. The characteristic color of 
the vomited matter, the jaundice, the green line 
along the gums, were all absent. On the other 
hand, there were numerous bloody extravasations in 
the heart, liver, spleen and pleura, which, accord- 
ing to Tardieu, the greatest French authority, are 
altogether absent in copper-poisoning. 
Copper rarely causes fatal poisoning. Such large 
quantities are required that the styptic taste would 
call attention to it, and thus, if homicide were in- THE SNOOK-HERR POISONING. 
13 
tended, defeat the object. Natural verdigris is 
undoubtedly poisonous ; but the supposition is too 
strained that, on the occasion of a wedding, unclean 
copper vessels should be employed, or even, if used, 
that enough verdigris should exist to poison fifty 
persons, many of them fatally. It is possible that 
the poisoning may have been produced by arsenite 
of copper, the symptoms of which are mainly those 
of- the arsenical ingredient. In this case, however, 
the analyst would as likely have discovered the 
arsenical as the cupreous ingredient. 
Having, as we believe, excluded all poisons other 
than arsenic, we desire to take up a few points 
of interest in connection with this as the probable 
agent. The late appearance of the pronounced 
symptoms in many of the cases has been by some 
considered as excluding arsenic from consideration ; 
but it is recognized by all writers on this subject 
that there are few poisons which present a wider 
variation in the time of appearance of symptoms 
than arsenic. As one of the many instances of 
this fact we may mention the case recorded by 
Reese, in which, after a teaspoonful of arsenic had 
been taken by mistake, no symptoms whatever mani- 
fested themselves for six hours. It is true that no 
arsenic was discovered by ourselves in the tests made 
of the urine, the vomited matter, and the faeces. 
For this purpose the Reinsch test was employed, 
but, as stated in the narration of the cases, our tests 
of these excretions were not made until the sixth 
day. During this time vomiting and purging had 
been profuse and had probably eliminated the 
greater portion of the poison. 14 
MITCHELL AND HYNDMAN. 
The question will naturally arise, If arsenic were 
the cause of death, why was it not found in definite 
quantity in the tissues in our fatal case? We reply 
that it was simply because the patient was kept alive 
for fifteen days, and the poison was eliminated by the 
vomiting, the purging and the excretion of kidneys, 
possibly the skin, this elimination being accelerated 
by the hot vapor-bath and the pilocarpine injections. 
It is a well-known fact that the eliminative func- 
tions may in the time alluded to entirely free the sys- 
tem of arsenic. In proof of this we need only cite 
one of many cases, e. g., that of Dr. Alexander 
{Medical Times and Gazette, April 15, 1857), in 
which 11 a gentleman swallowed a large dose of 
arsenious acid, and after suffering the usual symp- 
toms, died on the sixteenth day. Chemical analysis 
detected no trace of the poison in any organ of the 
body, although it was abundantly contained in the 
food swallowed by the deceased." Casper says : 
" Arsenic may be eliminated by the excretory 
organs to that degree that it may entirely and 
completely disappear on an average of from one to 
two weeks. According to some experiments on ani- 
mals, fifteen grains disappeared completely in three 
days." Taylor states that in many undoubted cases 
of arsenical poisoning not a trace of the poison can 
be found in the stomach or the contents. "It is, 
further, a well-known fact that if an individual, to 
whom arsenic has been administered with criminal 
intent, lives for fifteen or sixteen days, no part of 
the body may present any trace of the poison." 
We are firmly convinced that had an analysis of the 
tissues been made in those cases in which death took THE SNOOK-HERR POISONING. 
15 
place during the first week, arsenic would have been 
found and the whole matter long ago have been made 
plain. Instead of this being done, we learn from 
the Louisville press that in the case of one of the 
first to die, a man of high social and business stand- 
ing, no post-mortem was made and no inquest was 
held. Instead of the pathologist and analytical 
chemist, an undertaker was summoned, who pro- 
ceeded at once to embalm the body with an arseni- 
cal fluid. Fortunately, all cases were not handled 
in this peculiar manner. Scientific interest was not 
altogether thwarted. The one missing link in this 
chain of evidence is supplied by the results of the 
examinations made by Mr. Flexner, a most compe- 
tent chemist of Louisville, who, with the attending 
physician, found arsenic (by Reinsch's method) in 
the urine of two of the non-fatal cases. A single 
positive observation of this character is of greater 
value than any number of negative and hypotheti- 
cal statements. 
In conclusion, we would say that at least one of 
our cases was so marked that, had we seen the 
arsenic administered, we could have looked for no 
more pronounced symptoms and no more charac- 
teristic pathological lesions. These, considered in 
connection with the analyses just referred to, in 
cases having the same origin and many of the same 
symptoms, leave no doubt in our minds that arsenic 
was the offending substance. 
At this distance so many difficulties and conflict- 
ing statements are encountered in our search for the 
particular ingredient containing the poison that for 16 
MITCHELL AND HYNDMAN. 
the present we purposely omit discussion of this 
feature. 
Addendum.-Since presenting the foregoing re- 
port to the Academy, the Coroner of Louisville has 
begun an inquest. The testimony of the father of the 
bride, at whose home the wedding-dinner was given, 
completely demolished the chicken-cholera theory. 
Mr. Herr stated that the chickens and turkeys on 
his place were healthy, and that not a fowl had died 
there for years. The chickens were prepared and 
dressed by a colored woman on the place, and the 
family had been eating of the giblets for three 
meals. He stated also that there were no copper 
vessels on his place. The food was cooked in iron 
vessels. THE SNOOK-HERR POISONING. 
17 
THE CINCINNATI ACADEMY OF MEDICINE. 
Meeting of June i, 1891. 
G. S. Mitchell, M.D., President; T. V. Fitzpatrick, 
M.D., Secretary. 
DISCUSSION OF A STUDY OF THE SNOOK-HERR 
POISONING CASE. 
Dr. Whittaker, in the discussion of the Snook-Herr 
poisoning case that followed, said: 
As the symptoms read, the differential diagnosis would 
include the consideration of cholera morbus, typhoid 
fever, trichinosis, meat-poisoning, mushroom-poisoning, 
and a mineral poisoning, most especially arsenic. 
Cholera morbus might be excluded because of the 
large number of people affected, but chiefly because of 
the persistence of the symptoms after the use of evacu- 
ants and morphine subcutaneously. 
Typhoid fever sometimes begins with gastro-enteric 
signs so intense as to resemble poisoning, but this is ex- 
ceptional. It would be impossible to conceive of forty 
cases all beginning in this way. In the absence of this 
knowledge the condition of the mind and the course of 
the temperature would exclude the diagnosis of typhoid 
fever. 
Trichinosis rarely shows signs of such intensity at 
the outset, and simultaneously in so many persons. 
Multiple cases of trichinosis have been considered as true 
cholera, or as poisonings, but not in late years since we 
have had definite knowledge concerning trichinosis. 
Characteristic muscle-pains and oedemas at the end of 
the first week mark this affection. 
Mushroom-poisoning also leads to severe vomiting and 
diarrhoea at periods varying from six to twenty-four 
hours after ingestion, with subsequent nervous symptoms, 18 
DISCUSSION. 
and unless the history of the case be clear (no mush- 
rooms eaten, for instance) or fragments of fungi be found 
in the discharges, the resemblance to arsenical poisoning 
may be complete. The speaker had occasion, a few 
years ago, to treat one of his fellows in Cincinnati for 
fly-fungus poisoning (muscarine) and was impressed by 
the signs of intoxication which supervened within one 
hour after ingestion. The patient chattered and raved 
incessantly, and was in and out of bed in constant ex- 
citement which he strove in vain to subdue. Inhabitants 
of Kamtschatka partake of this fungus purposely to 
secure this kind of intoxication, and the poor are said to 
drink the urine of these rich epicures to indulge the 
same passion. In the case reported the stomach-tube 
quickly relieved the physician. 
Meat-poisoning, which it is now the fashion to call 
ptomaine poisoning, we know only in connection with 
pork and veal. Most of the cases thus reported-as at 
Andelfinger, 444 cases, 10 deaths ; Kloten, 657 cases, 6 
deaths-on examination turn out to have been trichinosis 
or typhoid fever. Nevertheless, undoubted cases, inde- 
pendent of these diseases, have been reported. Perhaps 
the best-observed cases were reported by Gartner, of 
Jena : fifty-eight cases in twenty-five families ; one death, 
in a laborer aged twenty-one, taken ill in two hours 
and dead in thirty-five hours after taking the food. The 
other fifty-seven cases became sick in from twenty-four 
to thirty hours and recovered in from a few days to two 
weeks. The main symptoms were enteritis, prostration, 
sopor. The discharges were studied bacteriologically 
with the discovery of a so-called bacillus enteridis, which 
was cultivated and inoculated in various animals. As a 
rule the symptoms of meat-poisoning show themselves 
later than those of arsenical poisoning, sometimes not 
until the day following the ingestion of the poison. 
Groenouw confirms the statement of Ulrichs that in all THE SNOOK-HERR POISONING. 
19 
severe cases of meat-poisoning there is both dilatation 
of the pupils and disturbance of accommodation. 
Arsenic shows itself by gastro-intestinal irritation and 
narcosis. The practitioners in these cases, debarred 
from tests of the vomited matter at the outset, by the 
absence of all knowledge of other cases, very properly 
had the urine (in which arsenic has been detected at 
any time from five hours to two weeks after it has been 
taken) examined as soon as suspicion was aroused. 
Arsenic has been found in the liver four hours after ad- 
ministration and has been wholly eliminated from the 
body in two weeks. Flaudin found that fifteen grains might 
disappear wholly from the body of animals in three days. 
It is pretty universally distributed over the body, includ- 
ing the nervous system and the bones. In his experi- 
ments with animals, Scolosohoff found arsenic thirty-six 
times oftener in the brain and cord than in the liver, 
and in the muscles four times oftener than in the liver. 
Rand reports a case of exhumation and examination of 
the contents of the stomach two weeks after death, with 
negative results, and a re-exhumation and examination 
of the soft parts two months after death, with positive 
results. Sonnenschein found arsenic unequally dis- 
tributed in the bones, but mostly in the pelvis and adjacent 
vertebrae. So arsenic has been detected in bodies three, 
eight, ten, by Altschul fourteen, and by Steinhauser 
twenty-two years after death. 
Inasmuch as the symptoms vary so much that an ab- 
solute conclusion cannot be based upon them, or upon 
the lesions, though both symptoms and lesions read like 
arsenic in these cases, absolute proof here must rest 
upon exhumation of the bodies of some of the six vic- 
tims and examination of the viscera and bones. 
Dr. G. A. Fackler agreed with the essayists that the 
evidence presented in the paper argued strongly in favor 
of their theory. Although it cannot be positively as- 
serted that arsenic was the toxic agent, still, assuming 20 
DISCUSSION. 
this to be the case, the appearance of all symptoms can 
be readily explained. He could not, without exception, 
agree with the previous speaker as to the discovery of 
arsenic in bodies of all individuals who had died from 
the poisonous effects of that drug, even if such bodies 
be exhumed months after death. It is true that a large 
number of cases have been reported to substantiate this 
statement. Yet an equally large number have been 
reported that would contradict it. We can easily recon- 
cile such apparent contradiction by remembering the 
fact that arsenic is rapidly eliminated. The first class of 
cases, then, includes those in which the period between 
ingestion of the poison and death is brief-too brief to 
insure complete elimination. The second class, to which 
the one under discussion belongs, includes those in which 
considerable time has elapsed after the administration of 
arsenic until a fatal effect ensues,thus permitting the entire 
or nearly all of the amount absorbed to leave the body. 
We must not forget that the toxic effects of arsenic are 
not due to its direct action upon the tissues. If the 
agent be injected subcutaneously the same changes will 
be observed in the internal organs, i. e., the degenera- 
tion of glandular organs, submucous structures of the 
gastro-intestinal tract, manifestations on the part of the 
pleura identical with those described in the paper of the 
evening, etc. This action is due to the fact that arsenic, 
after its absorption, acts alternately as a reducing and as 
an oxidizing agent, arsenious acid being changed by the 
absorption of oxygen into arsenic acid ; and, again, giving 
off oxygen, this is changed to arsenious acid. Such 
changes produce a rapid interchange of oxygen within 
the protoplasmic structure of the organs in which either 
of the acids finds entry, and must exercise a destructive 
action upon them. Thus arsenic sweeps, like a fire, 
through the organism and, in cases in which life is pro- 
longed, disappears, leaving devastation behind. In these 
very cases (and the one reported probably belongs to THE SNOOK-HERR POISONING. 
21 
this class) the alterations and degenerative changes pro- 
duced are of such severe character as to result in a loss 
of the functional power of the affected organs that must 
lead to a fatal termination. Exhume such bodies and 
the closest scrutiny and most accurate analysis of all 
tissues will not disclose a trace of the poison. 
It is true that our knowledge of ptomaines and their 
action is very meagre. Yet we must not disregard the 
possibility of their existence. Cases have been reported, 
especially in Italian literature, in which chemical ex- 
amination has disclosed the presence of various mineral 
poisons and alkaloids, and a more careful examination 
revealed the fact that the symptoms observed ante- 
mortem, as also the post-mortem changes, were attribut- 
able to the presence of certain ptomaines. 
Dr. S. P. Kramer said that he thought that the fact 
of copper being found had not been sufficiently dwelt 
upon. Arsenic was rapidly eliminated from the system 
and copper more slowly ; therefore he thought the pos- 
sible source of poison in these cases might have been the 
tri-arsenite of copper, or Paris-green as it was more com- 
monly termed, which contained a large amount of 
copper. 
Prof. Dickore said, in answer to the statement made 
by the previous speaker in reference to Paris-green, that 
it contained a larger amount of arsenic than copper, 
and that the former was more quickly eliminated from 
the system than the copper. He still thought that the 
presence of copper might indicate one of the sources of 
the poisoning. By very careful work he had obtained 
several little black spots on white porcelain, which looked 
exactly like those produced by arsenic. Under other 
circumstances, when no medico-legal question was in- 
volved, he would have called these spots "arsenic;" 
since they were too small to produce all the arsenic reac- 
tions he could not make any other report than the one 
he had given the coroner. Small quantities of arsenic 22 
DISCUSSION. 
were sometimes found in medicinal preparations, as for 
instance in subnitrate of bismuth. It would have been 
interesting to have had the bismuth administered in these 
cases examined for arsenic. It must also be remembered 
that arsenic is by no means of uncommon occurrence in 
some sections of Kentucky, Ohio and Indiana. Most 
iron pyrites, and the water of some mineral springs, 
contain arsenic. Traces may enter the human body from 
such sources. Copper is sometimes found in articles 
of diet. Cases are on record in which fatal poisoning has 
happened from eating pickles colored with copper; also 
from other dishes of acid reaction kept or prepared in 
copper vessels. The speaker had met a brother of Mrs. 
Snook who had just recovered from the poisoning, and 
who said that an aunt who had eaten none of the chicken- 
salad had become sick and died ; another relative had par- 
taken of everything, but had drunk no coffee or water 
from the silver pitcher on the table ; this relative remained 
well. These facts speak against the theory of ptomaine- 
poisoning. In the case of the brother of Mrs. Snook, 
it was stated that the solid parts of his discharges were 
of a tea-green color; this points toward copper-poison- 
ing. He was under the impression that the water in the 
silver pitcher contained the poison. He also stated that 
the taste of the coffee was disagreeable, to such a degree 
that he could not even yet bear the smell of coffee. The 
speaker said that in his opinion the mystery was not en- 
tirely cleared up. He would recommend that the bodies 
of some of those who had died first be exhumed and 
carefully examined; should they all contain copper and 
arsenic, then Paris-green was the poison ; but should 
they show copper only, or only arsenic, then the one 
or the other of these metals would be the cause of 
death. The young man referred to had ulcers of the 
lips, gums and tongue, such as are result from mineral 
poisons. 
Dr. Mitchell, in replying to a question of Dr. Evans, THE SNOOK-HERR POISONING. 
23 
stated that he had very recently received a letter from 
Dr. Irwin, of Louisville, who had treated many of these 
poisoning cases ; that up to that date no post-arsenical 
paralysis had appeared in any of his cases. 
Dr. Hyndman, replying to a remark of one of the pre- 
vious speakers, warned him that in case any of the bodies 
now buried should be exhumed and copper should be 
found on chemical analysis, not to jump to the conclu- 
sion that that metal was the cause of death unless found 
in very large quantity. As stated in the report, copper 
is so often found in chemical analyses of the body, that 
it is claimed by some chemists to be a normal con- 
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