Such is an account of the symptoms of poisoning by arsenic in their most frequent form. It will of course be understood, that they are liable to a great variety as to violence, as well as their mode of combination in actual cases;—and that they are by no means all present in every instance. The most remarkable and least variable of them all, pain and vomiting, are sometimes wanting. A case, in which pain was not felt in the stomach, even on pressure, although the other symptoms of inflammation were present, has been briefly described in the Medical Repository.[638] A similar case fatal in fourteen hours and a half, where there was much vomiting and some heat in the stomach, but no pain or tenderness, has been related by Dr. E. Gairdner.[639] Another very striking example of this anomalous deficiency has been detailed by Dr. Yellowly. A lad sixteen years old died twenty-one hours after swallowing half an ounce of the white oxide; and the presence of inflammation was denoted all along by sickness, vomiting, purging, and heat in the tongue; yet he never complained of pain, neither did he ever seem to his friends to suffer any. Another anomaly in the case was, that the pulse, contrary to what is usual, was very slow: twelve hours after he took the poison, the pulse was 40, and two hours before death it was so slow as 30.[640] These deviations from the ordinary course of the symptoms are taken notice of merely to put the practitioner on his guard, and prevent the medical jurist from drawing hasty conclusions. Upon the whole, they are rare; and the symptoms of poisoning by arsenic are in general very uniform. 2. The second variety of poisoning with arsenic includes a few cases in which the signs of inflammation are far from violent or even altogether wanting, and in which death ensues in five or six hours or a little more,—at a period too early for inflammation to be always properly developed. The symptoms are then generally obscure, and are referrible chiefly to the mode of action, which is probably the cause of death in most cases,—a powerful debilitating influence on the circulation, or on the nervous system.