"Yes," said the coroner. "The certificate mentions chronic bronchial catarrh of several years' standing. Did you find any arsenic in the stomach?"
"Not in the solid form and only a little more than a hundredth of a grain altogether. The stomach was practically empty. The other organs were practically free from disease, excepting, perhaps, the kidneys, which were congested but not organically diseased."
"And as to the amount of arsenic present?"
"The analysis was necessarily a rather hasty one and probably shows less than the actual quantity; but we found, as I have said, just over a hundredth of a grain in the stomach, one and a half grains in the liver, nearly a fifth of a grain in the kidneys and small quantities, amounting in all to two grains, in the blood and tissues. The total amount actually found was thus a little over three and a half grains—a lethal dose."
"What is the fatal dose of arsenic?"
"Two grains may prove fatal if taken in solution, as it appears to have been in this case. Two and a half grains, in a couple of ounces of fly-paper water, killed a strong, healthy girl of nineteen in thirty-six hours."
"And how long does a poisonous dose take to produce death?"
"The shortest period recorded is twenty minutes, the longest, over three weeks."
"Did you come to any general conclusion as to how long deceased had been suffering from the effects of arsenic and as to the manner in which it had been administered?"
"From the distribution of the poison in the organs and tissues and from the appearance of the body, I inferred that the administration of arsenic had been going on for a considerable time. There were signs of chronic poisoning which led me to believe that for quite a long time—perhaps months—deceased had been taking repeated small doses of the poison, and that the final dose took such rapid effect by reason of the enfeebled state of the deceased at the time when it was administered."
"And as to the mode of administration? Did you ascertain that?"
"In part, I ascertained it quite definitely. When the bearers went to the house to fetch the body, I accompanied them and took the opportunity to examine the bedroom. There I found on the mantelpiece a bottle of medicine with the name of deceased on the label and brought it away with me. It was an eight ounce bottle containing when full eight doses, of which only one had been taken. Dr. Barnes and I, together, analyzed the remaining seven ounces of the medicine and obtained from it just over eleven grains of arsenic; that is a fraction over a grain and a half in each ounce dose. The arsenic was in solution and had been introduced into the medicine in the form of the solution known officially as Liquor Arsenicalis, or Fowler's Solution."
"That is perfectly definite," said the coroner. "But you said that you ascertained the mode of administration in part. Do you mean that you inferred the existence of some other vehicle?"
"Yes. A single dose of this medicine contained only a grain and a half of arsenic, which would hardly account for the effects produced or the amount of arsenic which was found in the body. Of course, the preceding dose from the other bottle may have contained the poison, too, or it may have been taken in some other way."
"What other way do you suggest?"
"I can merely suggest possibilities. A meal was taken about eight o'clock. If that meal had contained a small quantity of arsenic—even a single grain—that, added to what was in the medicine, would have been enough to cause death. But there is no evidence whatever that the food did contain arsenic."
"If the previous dose of medicine had contained the same quantity of the poison as the one that was last taken, would that account for the death of deceased?"
"Yes. He would then have taken over three grains in four hours—more than the minimum fatal dose."
"Did you see the other—the empty medicine bottle?"
"No. I looked for it and should have taken possession of it, but it was not there."
"Is there anything else that you have to tell us concerning your examination?"
"No, I think I have told you all I know about the case."
The coroner cast an interrogatory glance at the jury, and when none of them accepted the implied invitation, he released the witness and named Dr. Barnes as his successor.
I need not record in detail the evidence of this witness. Having deposed that he was a Doctor of Science and lecturer in Chemistry at St. Martha's Medical College, he proceeded to confirm Dr. Randall's evidence as to the analysis, giving somewhat fuller and more precise details. He had been present at the autopsy, but he was not a pathologist and was not competent to describe the condition of the body. He had analyzed the contents of the medicine bottle with Dr. Randall's assistance and he confirmed the last witness's statement as to the quantity of arsenic found and the form in which it had been introduced—Fowler's Solution.
"What is the strength of Fowler's Solution?"
"It contains four grains of arsenic—or, more strictly, of arsenious acid—to the fluid ounce. So that, as the full bottle of medicine must have contained just over twelve and a half grains of arsenious acid, the quantity of Fowler's Solution introduced must have been a little over three fluid ounces; three point fourteen, to be exact."
"You are confident that it was Fowler's Solution that was used?"
"Yes; the chemical analysis showed that; but in addition, there was the colour and the smell. Fowler's Solution is coloured red with Red Sandalwood and scented with Tincture of Lavender as a precaution against accidents. Otherwise it would be colourless, odourless and tasteless, like water."
On the conclusion of Dr. Barnes' evidence, the coroner remarked to the jury: "I think we ought to be clear on the facts with regard to this medicine. Let Mabel Withers be recalled."
Once more the housemaid took her place by the table and the coroner resumed the examination.
"You say that the last bottle of medicine came early in the afternoon. Can you tell us the exact time?"
"It was about a quarter to three. I remember that because when I took up the new bottle, I asked Mr. Monkhouse if he had had his medicine and he said that his brother, Mr. Amos Monkhouse, had given him a dose at two o'clock just before he left."
"Did you open the fresh bottle?"
"I took off the paper wrapping and the cap but I didn't take the cork out."
"Was the old bottle empty then?"
"No; there was one dose left in it. That would be due at six o'clock."
"Do you know what became of the old bottle?"
"Yes. When I had given him his last dose—that was out of the new bottle—I took the old bottle away and washed it at once."
"Why did you wash the bottle?"
"The used medicine bottles were always washed and sent back to Dr. Dimsdale."
"Did you send back the corks, too?"
"No, the corks were usually burned in the rubbish destructor."
"Do you know what happened to this particular cork?"
"I took it down with me in the morning and dropped it in the bin which was kept for the rubbish to be taken out to the destructor. The cork must have been burned with the other rubbish the same day."
"When you gave deceased that last dose of medicine from the new bottle, did you notice anything unusual about it? Any smell, for instance?"
"I noticed a very faint smell of lavender. But that was not unusual. His medicine often smelt of lavender."
"Do you know if the previous bottle of medicine smelt of lavender?"
"Yes, it did. I noticed it when I was washing out the bottle."
"That, gentlemen," said the coroner, as he wrote down the answer, "is a very important fact. You will notice that it bears out Dr. Randall's opinion that more than one dose of the poison had been given; that, in fact, a number of repeated small doses had been administered. And, so far as we can see at present, the medicine was, at least, the principal medium of its administration. The next problem that we have to solve is how the poison got into the medicine. If none of you wish to put any questions to the very intelligent witness
whom we have just been examining, I think we had better call Dr. Dimsdale and hear what he has to tell us."
The jury had no questions to put to Mabel but were manifestly all agog to hear Dr. Dimsdale's evidence. The housemaid was accordingly sent back to her seat, and the doctor stepped briskly—almost too briskly, I thought—up to the table.
5. MADELINE'S ORDEAL
I was rather sorry for Dimsdale. His position was a very disagreeable one and he fully realized it. His patient had been poisoned before his very eyes and he had never suspected even grave illness. In a sense, the death of Harold Monkhouse lay at his door and it was pretty certain that every one present would hold him accountable for the disaster. Indeed, it was likely that he would receive less than justice. Those who judged him would hardly stop to reflect on the extraordinary difficulties that beset a busy medical man whose patient is being secretly poisoned; would fail to consider the immense number of cases of illness presented to him in the course of years of practice and the infinitely remote probability that any one of them is a case of poison. The immense majority of doctors pass through the whole of their professional lives without meeting with such a case; and it is not surprising that when the infinitely rare contingency arises, it nearly always takes the practitioner unawares. My own amazement at this incredible horror tended to make me sympathetic towards Dimsdale and it was with some relief that I noted the courteous and considerate manner that the coroner adopted in dealing with the new witness.
"I think," the former observed, "that we had better, in the first place, pursue our inquiries concerning the medicine. You have heard the evidence of Dr. Randall and Dr. Barnes. This bottle of medicine, before any was taken from it, contained twelve and a half grains of arsenious acid, in the form of just over three fluid ounces of Fowler's Solution. Can you suggest any explanation of that fact?"
"No," replied Dimsdale, "I cannot."
"What should the bottle have contained? What was the composition of the medicine?"
"The medicine was just a simple, very mild tonic and alternative. The bottle contained twenty-four minims of Tincture of Nux Vomica, sixteen minims of Liquor Arsenicalis, half a fluid ounce of Syrup of Bitter Orange to cover the taste of the Nux Vomica and half an ounce of Compound Tincture of Cardamoms. So that each dose contained three minims of Tincture of Nux Vomica and two minims of Liquor Arsenicalis."
"Liquor Arsenicalis is another name for Fowler's Solution, I understand?"
"Yes, it is the official name; the other is the popular name."
"Who supplied this medicine?"
"It was supplied by me."
"Do you usually supply your patients with medicine?"
"No. Only a few of my old patients who prefer to have their medicine from me. Usually, I write prescriptions which my patients have made up by chemists."
"This bottle, then, was made up in your own dispensary?"
"Yes."
"Now, I put it to you, Dr. Dimsdale: this medicine did actually contain Fowler's Solution, according to the prescription. Is it not possible that some mistake may have occurred in the amount put into the bottle?"
"No, it is quite impossible."
"Why is it impossible?"
"Because I made up this particular bottle myself. As my dispenser is not a qualified pharmacist, I always dispense, with my own hands, any medicines containing poisons. All dangerous drugs are kept in a poison cupboard under lock and key, and I carry the key on my private bunch. This is the key, and as you see, the lock is a Yale lock."
He held up the bunch with the little flat key separated, for the coroner's and the jurymen's inspection.
"But," said the coroner, "you have not made it clear that a mistake in the quantity was impossible."
"I was coming to that." replied Dimsdale. "The poisons in the cupboard are, of course, powerful drugs which are given only in small doses, and a special measure-glass is kept in the cupboard to measure them. This glass holds only two drachms—a hundred and twenty minims, that is, a quarter of an ounce. Now, the analysts found in this bottle three fluid ounces of Fowler's Solution. But to measure out that quantity, I should have had to fill the measure-glass twelve times! That is impossible. No one could do such a thing as that inadvertently, especially when he was dispensing poisons.
"But that is not all. The poison bottles are all quite small. The one in which the Liquor Arsenicalis is kept is a four ounce bottle. It happened that I had refilled it a few days previously and it was full when I dispensed this medicine. Now, obviously, if I had put three ounces of the Liquor into the medicine bottle, there would have remained in the dispensing bottle only one ounce. But the dispensing bottle is still practically full. I had occasion to use it this morning and I found it full save for the few minims that had been taken to make up the deceased's medicine.
"And there is another point. This medicine was coloured a deepish pink by the Tincture of Cardamoms. But if it had contained three ounces of Fowler's Solution in addition, it would have been a deep red of quite a different character. But I clearly remember the appearance of the bottle as it lay on the white paper when I was wrapping it up. It had the delicate pink colour that is imparted by the cochineal in the Tincture of Cardamoms."
The coroner nodded as he wrote down the reply, and enquired:
"Would any of you, gentlemen, like to ask any questions concerning the bottle of medicine?"
"We should like to know. Sir," said the foreman, "whether this bottle of medicine ever left the doctor's hands before it was sent to deceased?"
"No, it did not," replied Dimsdale. "As the dispenser was absent, I put up the bottle entirely myself. I put in the cork, wrote the label, tied on the paper cap, wrapped the bottle up, sealed the wrapping, addressed it and gave it to the boy to deliver."
The foreman expressed himself as fully satisfied with this answer and the coroner then resumed: "Well, we seem to have disposed of the medicine so far as you are concerned, Doctor. We will now go on to consider the condition of deceased during the last few days. Did no suspicion of anything abnormal ever occur to you?"
"No, I neither perceived nor suspected anything abnormal."
"Is that not rather remarkable? I realize that poisoning would be the last thing that you would be looking for or expecting. But when it occurred, is it not a little strange that you did not recognize the symptoms?"
"Not at all," replied Dimsdale. "There was nothing to recognize. The classical symptoms of arsenic poisoning were entirely absent. You will remember that Sir Robert Detling had no more suspicion than I had."
"What are the classical symptoms, as you call them, of arsenic poisoning?"
"The recognized symptoms—which are present in the immense majority of cases—are acute abdominal pain and tenderness, intense thirst, nausea, vomiting and purging: the symptoms, in fact, of extreme irritation of the stomach and intestines. But in the case of deceased, these symptoms were entirely absent. There was, in my opinion, nothing whatever in his appearance or symptoms to suggest arsenic poisoning. His condition appeared in no way different from what I had known it to be on several previous occasions; just a variation for the worse of his ordinary ill-health."
"You do not doubt that arsenic poisoning was really the cause of his death?"
"The analysis seems to put the matter beyond question; otherwise—I mean apart from the analysis—I would not have entertained the idea of arsenic poisoning for a moment."
"But you do not dispute the cause of death?"
"No. Arsenic is extraordinarily variable in its effects, as Dr. Randall mentioned, both on the dead body and on the living. Very anomalous cases of arsenic poisoning have been mistaken, during life, for opium poisoning."
The coroner wrote down the answer and having glanced over his notes, asked: "What was the condition of deceased when his wife went away from home?"
"He was much better. In fact his health seemed to be improving so much that I hoped he would soon be about again."
"And how soon aft
er his wife's departure did his last attack begin?"
"I should hardly call it an attack. It was a gradual change for the worse. Mrs. Monkhouse went away on the 29th of August. On the 2nd of September deceased was not so well and was extremely depressed and disappointed at the relapse. From that time his condition fluctuated, sometimes a little better and sometimes not so well. On the 8th he appeared rather seriously ill and was no better on the 9th, the day of the consultation with Sir Robert Detling After that he seemed to improve a little, and the slight improvement was maintained up to the 12th. His death came, at least to me, as quite a surprise."
"You spoke just now of several previous occasions on which attacks—or, if you prefer it, relapses—of a similar kind occurred. Looking back on those relapses by the light of what we now know, do you say that they were quite similar, in respect of the symptoms, to the one which ended in the death of deceased?"
"I should say they were identically similar. At any rate, I can recall no difference."
"Did any of them seem to be as severe as the fatal one?"
"Yes; in fact the last of them—which occurred in June—seemed to be more severe, only that it was followed by improvement and recovery. I have here the section of my card-index which relates to deceased. In the entry dated June 19 you will see that I have noted the patient's unsatisfactory condition."
He handed a small pack of index-cards to the coroner, who examined the upper card intently and then, with a sudden raising of the eyebrows, addressed the jury.
"I had better read out the entry. The card is headed 'Harold Monkhouse' and this entry reads: 'June 19. Patient very low and feeble. No appetite. Considerable gastric discomfort and troublesome cough. Pulse 90, small, thready. Heart sounds weak. Sending report to Mrs. Monkhouse. '"
He laid the cards down on the table, and, looking fixedly at Dimsdale, repeated: "'Sending report to Mrs. Monkhouse?' Where was Mrs. Monkhouse?"
"Somewhere in Kent, I believe. I sent the report to the headquarters of the Women's Freedom League in Knightrider Street, Maidstone, from whence I supposed it would be forwarded to her."
Dr. Thorndyke Omnibus Vol 5 Page 5
