Treatise on Poisons by Sir Robert Christison
2. When the effect is sufficiently great to receive the designation of
1185 words | Chapter 200
poisoning, the symptoms are more violent excitement, flushed face,
giddiness, confusion of thought, delirium, and various mental
affections, varying with individual character, and too familiar to
require description here. These symptoms are soon followed by dozing and
gradually increasing somnolency, which may at length become so deep as
not to be always easily broken. After the state of somnolency has
continued several hours, it ceases gradually, but is followed by
giddiness, weakness stupidity, headache, sickness, and vomiting.
This degree of injury from alcohol may prove fatal, either in itself, by
the coma becoming deeper and deeper,—or from the previous excited state
of the circulation causing diseases of the brain in a predisposed
habit,—or more frequently from the occurrence of some trifling accident,
which in his torpid state the individual cannot avoid or remedy, such as
exposure to cold, falling with the face in mud or water, suffocation
from vomited matters getting into the windpipe, and the like.
Of simple poisoning by the gradual increase of coma the following
judicial case in which I was consulted is a characteristic example. Two
brothers drank in half an hour three bottles of porter, with which three
half-mutchkins (24 ounces) of whisky had been secretly mixed by a
companion, whose object was to fill them drunk by way of joke. In the
course of drinking both became confused. In fifteen minutes after
finishing the last bottle one of them fell down insensible, and had no
recollection of what happened for twelve hours; but he recovered. The
other staggered a considerable distance for an hour, and then became
quite insensible and unable to stand. In four hours more consciousness
and sensibility were quite extinct, the breathing stertorous and
irregular, the pulse 80 and feeble, the pupils dilated and not
contractile, and deglutition impossible. In this state he remained
without any material change till his death, which took place in fifteen
hours after he finished his debauch. A surgeon saw him when he had been
five hours ill, but did little for his relief, as the case appeared
hopeless.
There is a singular variety in the principal symptoms of this form of
poisoning, even when completely formed. From a careful tabular analysis
of no fewer than twenty-six cases, chiefly of the present denomination,
collected by Dr. Ogston of Aberdeen from the experience of the
police-office there, it appears that when the stage of stupor is fully
formed, the person is sometimes capable of being roused, sometimes
immovably comatose for a long time,—that the pulse is sometimes
imperceptible or very feeble, sometimes distinct or even full, generally
slow or natural, seldom frequent, very seldom firm,—that the pupils are
occasionally contracted, much more generally dilated, and in a few
instances alternating between one state and the other,—that the
countenance is commonly pale, sometimes turgid and flushed,—and that the
breathing is for the most part slow, and also soft, yet not unfrequently
laborious, but very rarely stertorous. Convulsions are rare, having been
observed twice only, and on both occasions in young people of the age of
twelve or fourteen.[2513] Dr. Ogston has tried to group these several
symptoms together in classified cases; but the general conclusions at
which he arrives are subject to important exceptions. Neither do any of
the special symptoms seem to bear a marked relation to the ultimate
event. It is peculiarly worthy of remark, that very many cases got well
where the pupils were much dilated, the coma profound, and the pulse
imperceptible.
In the present form of poisoning with alcoholic fluids, it usually
happens that if the stage of stupor be completely overcome, recovery
speedily ensues, without any particular symptom except headache,
giddiness, sickness, and the customary consequences of a debauch. Hut on
some occasions the comatose stage is succeeded by one which indicates
much cerebral excitement,—by flushed face, injected eyes, restlessness,
a febrile state of the pulse, and delirium, even of the violent kind. In
other cases this affection puts on very much the characters of a slight
attack of typhoid fever.
In the second variety of the second degree of intoxication, an
apoplectic disposition is called into action by the excited state of the
circulating system; and death ensues from apoplexy or some other disease
of the brain, rather than from simple poisoning. Thus in some instances,
as will be more fully mentioned under the head of the morbid
appearances, extravasation of blood is found within the head after
death, preceded by the usual phenomena of ordinary intoxication. Since
this is a rare effect of intoxication, it must be considered as the
result of poisoning with spirits, exciting sanguineous apoplexy in a
predisposed constitution. In other cases the stupor of intoxication,
after putting on all the characters of apoplexy for two days and
upwards, terminates fatally without extravasation. Here the poison
operates by developing a constitutional tendency to congestive apoplexy.
Again, this mode of action is still more clearly shown in some cases,
where an interval of returning health occurs between the immediate
narcotic effects of the poison and the ultimate apoplectic coma which is
the occasion of death. Such a course of events, which, however, is of
rare occurrence, is well exemplified in the following cases. A man drank
32 ounces of rum one afternoon, and was comatose most of the ensuing
night. Next morning, though very drowsy, he was sensible when roused;
and in the evening he was considered convalescent. But two days
afterwards he became delirious; in two days more he died comatose; and
congestion was the only appearance found in the brain.[2514] Another
instance, most remarkable in its circumstances, is the following, which
has been related by Dr. Golding Bird. A workman in a distillery, after
drinking eight ounces of rectified spirit by mistake for water, suddenly
fell down senseless and motionless, and remained so for eleven hours. He
then began to recover, and came round so far that he returned to his
work next morning. After this he continued to pass dark, pitch-like
evacuations. In three weeks he became drowsy, mistook one thing for
another, answered questions sluggishly, and had a frequent pulse, and
dilated sluggish pupils; in which state he continued three weeks later
when the account was published.[2515] The following case, related by Dr.
Chowne, also seems to belong to the same category, although it presents
anomalies. A boy, eight years of age, soon after swallowing about eight
ounces of gin, said he felt like a drunk man, and suddenly became
motionless and insensible. In no long time he vomited a fluid of the
odour of gin; and in seven hours from the commencement a fluid was
withdrawn from the stomach, possessing no longer any such odour. He was
now motionless, insensible, pale, and cold; the pupils were contracted,
the pulse feeble and hurried, the breathing stertorous and slow; and he
made ineffectual efforts to vomit. Stimulants of all kind had little
effect on him for a day and a half, when the breathing became more
natural, and his look quite intelligent. Yet he could not answer
questions, exhibited no sign of volition, and had a pulse so frequent as
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