- stances of death from apoplexy in young women; my colleague Dr.
Alison has related to me a similar case; Professor Bernt has described another of a young girl who died apoplectic from extravasation of blood over the whole brain and in the ventricles also;[1] and Mr. Greenhow, a surgeon of London, has even noticed a case of apoplexy from effusion of blood over the surface of the brain in a child two years and a half old.[2] On this subject the treatise of Rochoux supplies excellent information: of his sixty-three cases sixty-one were above thirty years of age, two less than thirty, none younger than twenty.[3] It is plain, therefore, that apoplexy in young people is rare. On the other hand, a great proportion of cases of poisoning with the narcotics when they have been taken intentionally (and such cases are most likely to lead to medico-legal questions), has occurred among the young, especially of the female sex.
3. The next criterion is, that apoplexy occurs chiefly among fat people. But it is here mentioned only that the medical jurist may be cautioned against the belief that it is in all circumstances a correct criterion. Upon this particular Rochoux has furnished some satisfactory data. Among his sixty-three patients thirty were of an ordinary habit, twenty-three were of a thin, meager habit, and ten only were large, plethoric and fat.[4] In receiving this statement, however, it is necessary to consider, that although the vulgar idea, that most apoplectic people are fat, does not apply to persons in the rank of Rochoux's patients, who were mostly hospital inmates, yet it may apply better to the upper ranks. For the same circumstances which predispose to apoplexy, namely, great strength, vigorous constitution and good digestive powers, likewise predispose to corpulency, so that whenever the condition of life permits the disposition to corpulency to be developed, the connexion of apoplexy with it will appear.
4. A fourth criterion is drawn from the relation which the appearance of the symptoms bears to the last article of food or drink that was taken. I believe that the effects of the common narcotics, in the cases where they prove fatal, begin not later than an hour, or at the utmost two hours, after they are taken; and in a great majority of instances they begin in a much shorter time, namely, in fifteen or thirty minutes. Hence if it can be proved that the nervous symptoms, under which a person died, did not begin till several hours after he took food, drink or medicine, it appears almost, if not absolutely certain, that a narcotic poison cannot have been the cause of death. To some narcotic, or rather narcotico-acrid poisons this rule certainly will not apply, such as the poisonous fungi and spurred rye; which seldom begin to act for several hours, sometimes for not less than a day and a half. Neither will the rule apply to poisoning with the deleterious gases, as their action has no connexion at all with eating or drinking. But these facts do not form a material objection to the rule laid down; because the circumstances
