with opium convulsions are rare; in apoplexy they are common enough. Bloating of the countenance is likewise much more common in apoplexy than in poisoning with opium. In apoplexy, too, the pupil is generally dilated, while in poisoning with opium the pupil is almost always contracted. But such distinctions do not apply either to the narcotics as a class, or to all cases of any one kind of narcotic poisoning.
7. In the last place, a useful criterion may be derived from the duration of the symptoms in fatal cases. I believe few people die of pure narcotic poisoning who outlive twelve hours; and the greater number die much sooner,—in eight, or six hours. Apoplexy often lasts a whole day, or even longer. On the other hand, the narcotic poisons very rarely prove so rapidly fatal as apoplexy sometimes does. Apoplexy, according to the vulgar opinion, may prove fatal instantly or in a few minutes. The only late author of repute who maintains that opinion is M. Devergie. He mentions the case of an elderly man subject to somnolency, who, after complaining for a short time of headache, became suddenly pale, hung down his head, and expired immediately, and in whose body no other morbid appearance was found, except great congestion of the cerebral membranes.[1] The best modern pathologists, however, deny that apoplexy proves immediately fatal, and maintain with much apparent reason that when death is so sudden, the cause is commonly disease of the heart, and not apoplexy.[2] However this may be, it is at all events certain that apoplexy may occasion death in considerably less than an hour. Now the only narcotics in common use which can prove fatal so soon are the narcotic gases, and prussic acid. As to opium, the most common of the narcotic poisons, and by far the most important to the medical jurist, the shortest duration I have yet seen recorded is three hours. Apoplexy often proves fatal in a much shorter time.
From this enumeration of the criterions between apoplexy and the symptoms produced by narcotics, the toxicologist will conclude, that few cases can occur in which he will not be able to give a presumptive opinion of the real cause from the symptoms only,—that in many instances a diagnosis may be drawn with an approach to certainty,—and that on all occasions it will be possible to say without risk of error, whether there are materials for forming a diagnosis at all,—a point which is of great moment when the criterions are not universally applicable.
Of the Morbid Appearances.—The next subject of inquiry is the distinction between apoplexy and narcotic poisoning, as to the appearances after death. It has been already stated, that the narcotic poisons rarely produce very distinct morbid appearances,—that the greatest extent of unnatural appearance they cause in the brain is congestion of vessels,—and that the physical qualities of the blood appear to be altered, though not invariably.
