under which cases of the kind occur are generally so apparent, as at once to point out their real nature to a careful inquirer.
In regard to apoplexy as the disease which resembles most closely the effects of the narcotics, it was formerly stated that this disease is apt to occur soon or immediately after taking a meal (p. 95).[1] In the greater number of such cases, however, where the meal has been the exciting cause of the disease, the symptoms have begun immediately after, or even during a meal. This is very rarely the case with the symptoms of narcotic poisoning, and never happens in respect to those of the commonest of the narcotics, opium: An interval of 10, 15, 20 or 30 minutes always occurs. The deleterious gases and hydrocyanic acid, with its compounds, are the only familiar narcotic poisons which act more swiftly.
5. Another criterion relates to the progress of the symptoms. The symptoms of narcotic poisoning advance for the most part gradually: but those of apoplexy in general begin abruptly. Sometimes apoplexy commences at once with deep sopor. Narcotic poisoning never begins in that way, except in the instances of hydrocyanic acid and the narcotic gases; the sopor is at first imperfect, and it increases gradually, though sometimes very rapidly. Apoplexy, however, does not always begin with deep sopor; occasionally the sopor begins and increases like that of narcotism.
6. Although there is a great resemblance between the symptoms of apoplexy and those of narcotism, so far as regards their general features, there are particulars which are not indeed always present, but which when present will help to distinguish the one from the other. When the sopor of apoplexy is completely formed, it is rarely possible to rouse the patient to consciousness, and never, I believe, where the risk of confounding apoplexy with poisoning is greatest,—in the cases where death happens neither instantly, nor after the interval of a day, but in a few hours. On the other hand, in many cases of poisoning with the narcotics, and particularly with the commonest variety, opium, the person may be roused from the deepest lethargy, if he is spoken to in a loud voice, or forcibly shaken for some time, or if water is injected into his ear. Even in cases of poisoning with opium, however, the coma may have continued too long to admit of this temporary restoration to sense; the susceptibility of being roused is not so often remarked in other varieties of narcotic poisoning; and in some, such as poisoning with prussic acid, I am not aware that it has ever been remarked, at least in fatal cases.
There are some other symptoms which in special cases may help to distinguish narcotic poisoning from apoplexy. Thus in poisoning
- ↑ Instances of congestive apoplexy thus arising were then quoted. I may here add a very opposite instance of hemorrhagic apoplexy, occurring in similar circumstances. Dr Jennings, an American physician, mentions the case of a female fifty years of age, who, after a full meal, tumbled down in a fit of insensibility and immediately expired, and in whom after death there was found enormous distension of the stomach with food, an extensive effusion of blood into the central parts of the brain, and ossification of the cerebral arteries. (London Med. Gazette, xvi. 735.)
