Perhaps cholera arising thus may prove fatal. The following extraordinary case, which appears to have been of this nature, was communicated to me by the late Dr. Duncan, junior. A bookbinder in this city, previously in excellent health, rose one morning at six to kindle his fire, and took a large draught of cold water from a pitcher used in common by the whole family. He went immediately to bed again, complaining of pain in the pit of the stomach, and extreme anxiety, and affected with incessant vomiting. In twelve hours he died without any material change in the symptoms, and no disease whatever could be detected in the dead body. Dr. Duncan satisfied himself from general circumstances, that poisoning was quite out of the question; so that, however extraordinary it may appear, his death could be accounted for in no other way than by ascribing it to the cold water.—Hoffmann says he was acquainted with instances where fatal inflammatory fever was induced by drinking too freely of cold water, and a suspicion of poisoning in consequence excited.[1]
6. Of Bilious Vomiting and Simple Cholera.—Of all the diseases which 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
- ↑ De cauta et circumspecta veneni dati accusatione, § 12.
