period now mentioned.[1] 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.
7. Of Malignant Cholera.—The history of this disease affords a fair promise that, in so far as British practitioners are concerned, it may ere long be excluded from the list of those which imitate irritant poisoning. Meanwhile, however, malignant cholera must be allowed to bear, in its essential symptoms and their course, a marked resemblance to poisoning with the irritants. So much indeed is this the case that some authors have actually compared its phenomena to the effects of arsenic, tartar-emetic, and other powerful acrids. In many cases the two affections are undoubtedly not so distinguishable by symptoms as to warrant a physician to rely on the diagnosis in a medico-legal inquiry. But in many other instances the distinction may be drawn satisfactorily. Thus the uneasiness in the throat which sometimes attends cholera never precedes the vomiting. The vomiting in cholera is never bloody. The colour and expression of the countenance and whole body are peculiar. In frequent instances the early signs which resemble poisoning are followed by a secondary stage, sometimes of simple coma, sometimes of typhoid fever, which a practised person may easily distinguish from the secondary phenomena produced by some irritants. Lastly, no mistake can arise where the patient, before presenting the symptoms common to both affections, experiences violent burning pain or certain tastes, during or immediately after the swallowing of food, drink, or some other article.
8. Of Inflammation of the Stomach.—Chronic inflammation of the stomach is a common disease; which, however, on account of the slowness of its course, is not liable to be confounded with the ordinary effects of irritant poisons. Acute inflammation, on the contrary, follows precisely the same course as that of irritant poisoning. But great doubts may be entertained whether true acute gastritis ever exists in this country as a natural disease. Several of my acquaintances, long in extensive practice, have stated to me, that their experience coincides entirely with that of Dr. Abercrombie, who observes he has "never seen a case which he could consider as being of that nature."[2] An important observation of the same purport has been made by M. Louis, one of the most experienced and accurate pathologists of the present time. He says, that during six years' service at the hospital of La Charité, during
