Page:Treatise on poisons in relation to medical jurisprudence, physiology, and the practice of physic (IA treatiseonpoison00chriuoft).pdf/53

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formed in an hour, and may terminate fatally, as I have once witnessed, at the beginning of the second day. Inflammation of the stomach also begins suddenly and terminates soon. Cholera likewise answers this description: I have known the characters of ordinary cholera fully developed within an hour after the first warning symptom, and frequently in hot climates, nay, in some rare instances even in Britain, it proves fatal in a few hours. Malignant cholera frequently proves fatal in a few hours. Inflammation of the intestines, too, may begin, or at least seem to begin, suddenly and end fatally in a day: One variety of it, now well known to affect the mucous membrane, may remain quite latent till the gut is perforated by ulceration, and then the patient is attacked with acute pain, vomiting, and mortal faintness, and frequently perishes within twenty-four hours.[1] But in particular many organic diseases of the heart prove suddenly fatal, without any previous warning; and this is also true to a certain extent even of apoplexy; for, as will afterwards be seen, it is an error to suppose that apoplexy is always, or even generally, preceded by warning symptoms. The first characteristic, therefore, as applied to the symptoms of poisoning generally, contrasted with those of general disease, must appear by no means distinctive. But opportunities will occur afterwards for showing, that it is sometimes a good diagnostic in the case of particular poisons.[2]

2. As to the uniformity or uninterrupted increase of the symptoms, it is equally the attribute of many common diseases. I am not aware, that in speedily fatal cases of the internal phlegmasiæ a considerable remission is often observed. Apoplexy, too, very frequently continues its course without interruption; and the same may be said of cholera, and indeed of most acute diseases, when they prove rapidly fatal.

3. It was stated above, that the third character, uniformity in kind throughout their progress, is by no means an invariable circumstance. Still less is it distinctive; for many diseases are marked by great uniformity of symptoms. It has been enumerated nevertheless among the general characters of poisoning, because, although its presence can hardly ever add any weight to the evidence in favour of death by poison, its absence may sometimes afford even positive proof in favour of natural death. That is, changes of a certain kind occurring in the symptoms during their progress may be incompatible with the known effects of a particular poison or of all poisons, and capable of being accounted for only on the supposition of natural disease having been at least the ultimate cause of death. This statement, which is one of some importance, is illustrated by a pointed case, that of Charles Munn, mentioned at the close of the present section.

4. In the next place, it was observed that some reliance may be placed on the fact, that the symptoms of poisoning appear very soon after a meal. But we also know this to be the most frequent occa-*

  1. Archives Générales de Médecine, i. 17; also Abercrombie on Diseases of the Stomach, &c. 273.
  2. See Oxalic Acid and Nux Vomica.