From all that has now been said on the subject of epilepsy as a disease which imitates many varieties of narcotic poisoning, the medical jurist will probably arrive at the conclusion, that, although a diagnosis cannot always be drawn with certainty, yet in numerous cases the consideration of the symptoms and appearances after death will enable him to say positively that poisoning is out of the question, and in many others that poisoning is highly probable.
Of the Distinction between Meningitis and Narcotic Poisoning.
Inflammation of the inner membranes of the brain, which constitutes the acute hydrocephalus or acute meningitis of authors, is not in general apt to cause much ambiguity; for its progress is commonly gradual, well-marked and less rapid than most cases of narcotic poisoning: and the appearances in the dead body, such as effusion of serum, lymph or pus on the outer surface of the brain or in the ventricles, are for the most part obvious.
Dr. Abercrombie, however, has described a form of it occurring among children during the existence of other diseases, particularly of the chest, which might be the cause of perplexity; for its course is sometimes finished within a day, its symptoms are delirium, convulsions and coma intermingled, and the only morbid appearance is congestion of vessels on the surface and in the substance of the brain.[1] The affection now alluded to imitates closely, both in its progress and in its signs after death, some varieties of poisoning with the vegetable narcotico-acrids, such as belladonna, stramonium, and hemlock. But the latter cases, when they prove fatal, seldom last nearly so long as a day, while the instances of meningitis under consideration rarely cause death within twenty-four hours. Dr. Abercrombie also notices a parallel disease occurring among adults; but it is in them always marked by a considerably longer, though often more obscure course.[2]
Dr. Bright takes notice of a similar affection under the title of "Arachnitis with excessive irritability" occurring chiefly among very intemperate people, but independently of previous disease. In general the disorder has a well-marked course of at least several days' duration. But in two of the instances he has given the early stage was very obscure, the only symptoms having been headache and sickness of no great severity for four or five days; after which delirium came suddenly on, and was followed by coma, and by death within thirty-six or forty hours. The sole appearances found within the head were some serous effusion and vascularity on the surface of the brain and in the ventricles.[3] To these illustrations may be added the heads of a remarkable case which occurred here in the person of an eminent lawyer, and for the particulars of which I am indebted to Dr. Maclagan. For three days there had been occasional headache, not great enough to prevent him pursuing his ordinary avoca-*
