Treatise on Poisons by Sir Robert Christison
6. _Of Bilious Vomiting and Simple Cholera._—Of all the diseases which
940 words | Chapter 53
are apt to be confounded with the effects of the irritant poisons, there
is none which it is of so much importance that the medical jurist should
be able to distinguish as cholera. A trial for poisoning with the common
poisons hardly ever occurs, but an attempt is made to ascribe death to
that disease; for it is very frequent, and its symptoms bear a close
resemblance to those of the principal poisons of the class we are now
considering.
It is unnecessary to give here a detailed account of the symptoms of
simple cholera. There is the same burning pain in the stomach and bowels
as in irritant poisoning, the same incessant vomiting and frequent
purging, the same tension and tenderness of the belly, the same sense of
acridity in the throat, and irritation in the anus, the same depression
and anxiety, the same state of the pulse.
It would be wrong, however, to infer from these resemblances that the
two affections are always undistinguishable. Some cases of irritant
poisoning certainly cannot be distinguished by their symptoms from
cholera. Many other cases are similarly circumstanced, because their
particulars cannot be accurately collected. But there is no doubt that
in others the distinction between poisoning and cholera may be drawn by
the physician who has been able to ascertain the symptoms in detail. At
present those points of difference only will be noticed which relate to
the irritants as a class; others will be mentioned under the head of
poisons individually.
The first difference is, that in cholera the sense of acridity in the
throat does not precede the vomiting, as it sometimes does in poisoning.
In cholera this sensation is caused by the vomited matter irritating the
throat, or perhaps by the irritation in the stomach being propagated
upwards by continuity of surface. But, whatever may be its cause, it is
certain that the sense of acridity or burning sometimes remarked in
cholera never begins before the vomiting. In many cases of poisoning,
though certainly not in all, it is the first symptom.—The next
difference is, that in cholera the vomiting is never bloody. I have been
at some pains to investigate this point: and I have been unable to find
any instance of the cholera of this country, which has been accompanied
with sanguinolent vomiting; neither is such a symptom mentioned in any
accounts I have read of malignant cholera. This article of diagnosis
will, of course, be open to correction from the experience of other
practitioners. Lastly, a material difference is, that the simple cholera
of this country very seldom proves fatal so rapidly as poisoning with
the irritants usually does. Death from irritant poisoning is on the
whole seldom delayed beyond two days and a half, and frequently happens
within thirty-six hours, sometimes within six hours, or even less.
Malignant cholera frequently proves fatal in as short a time; but with
regard to the cholera of this country, I believe it may be laid down as
a rule hitherto unshaken by all the controversy to which the subject has
given rise,—that death is not often caused by it at all, and that death
within three days is very rare indeed. A few cases of death within that
period, nay, even within twelve hours, have certainly occurred; but
their great rarity is obvious from the fact, that many practitioners of
experience have not met with a single instance, and others with only one
case in the course of a long practice. Dr. Duncan, senior, mentioned to
me a case, the only one of the kind he had met with, which commenced
soon after the individual ate a sour orange in the Edinburgh theatre,
and which proved fatal in twelve hours. Dr. Duncan, junior, also met
with a single case, which was the instance already noticed of cholera
produced by drinking cold water. Dr. Abercrombie also once, and once
only, met with a case fatal within two days.[161] Mr. Tatham, a late
writer on this subject, met with an instance which proved fatal in
twelve hours.[162] Dr. Burne of London has likewise related an instance
of death within fifteen hours occurring in a child.[163] And I was
informed in 1831 of a case at Leith which ended fatally in twenty-six
hours, and was at first supposed by the unprofessional inhabitants of
the place to be an instance of epidemic or malignant cholera. My
colleagues, Drs. Home, Alison, and Graham, never met with an instance
fatal in so short a time as two or three days; at a meeting of the
Medico-Chirurgical Society of this city, none of the members present
could remember to have seen such a case;[164] and of the witnesses who
were brought to swear to this point on a well-known trial, all of them
physicians of extensive practice, not one could depose that such a case
had ever come within his personal observation.[165] It has been stated
however in a controversial publication written by the late Dr.
Mackintosh of this place, that the author had seen many cases fatal
within the period now mentioned.[166] This is incomprehensible. For my
own part, I cannot help repeating, as the result of the whole inquiry,
that simple cholera rarely causes death in this country, in the period
within which irritant poisoning commonly proves fatal,—that,
consequently, every case of the kind will naturally be apt to lead, in
peculiar circumstances, to suspicion of poisoning,—and that in charges
of poisoning, rapid death under symptoms of violent irritation in the
alimentary canal, like those of cholera, must always be considered an
important article of a chain of circumstantial or presumptive evidence.
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