was found, and on the surface of the brain a spot of slight ecchymosis as big as a crown piece.[1] I have seen turgescence of vessels and serous effusion in one instance to a considerable extent: each ventricle contained three drachms of fluid, the arachnoid membrane on the surface of the brain was much infiltered, and the vessels both in the substance and on the surface of the brain were considerably gorged with blood. But congestion and effusion are by no means universal: in a case I examined judicially in November, 1822, which proved fatal in about seven hours, there was neither unusual congestion nor effusion. In the remarks on the diseased appearances caused by the narcotics generally, it was observed that extravasation of blood is a very rare effect of opium. A good example of the kind, however, is related by Mr. Jewel of London. It was the case of a young married female, who died eight hours after taking two ounces of laudanum. Several clots were found in the substance of the brain, one of which, in the anterior right lobe, was an inch long.[2] A similar case, which occurred to Dr. Elliotson, has been mentioned already at p. 546. There is little doubt that poisoning with opium may cause extravasation, by developing a disposition to apoplexy; but considering the very great rarity of this appearance in persons killed by opium, it may reasonably be questioned whether extravasation can be produced without some predisposition co-operating.
The lungs are sometimes found gorged with blood, as in many cases of apoplexy. They were so in the soldier mentioned in the Journal Universel, who died in convulsions. They were in the same state in a patient of Dr. Home, a man who died in the Infirmary here in 1825, four hours after taking two ounces of laudanum in six ounces of whisky; and likewise in the case quoted from Pyl, in which sixty grains of solid opium were taken. But this appearance is not more constant than congestion in the brain. Orfila never found it in dogs, and in three cases I have examined the lungs were perfectly natural. Perhaps they are more usually turgid when death is preceded by convulsions. They were particularly so in the case of the soldier above mentioned, and likewise in another case of the same nature recorded in Rust's Magazin.[3]
The stomach, as in Knape's case, is occasionally red, and in the woman mentioned by Lassus, who died after swallowing thirty-six grains, it is said to have been inflamed. But even redness is rare, and decided inflammation probably never occurs. In four cases I have examined, the villous coat was quite healthy; and it was equally so in another related in Knape and Hecker's Register.[4]
Lividity of the skin is almost always present more or less, and sometimes it is excessive. In one of the cases I examined it was universal over the depending surface of the body.
It has been said that the blood is always fluid. This certainly
- ↑ Reports of Medical Cases, ii. 203.
- ↑ Lond. Med. and Phys. Journal, Feb. 1816.
- ↑ Magazin für die Gesammte Heilkunde. xvii. 121.
- ↑ Kritische Jahrbucher, ii. 100. When inflammation is found, it is not improbably owing to irritants given to produce vomiting, but failing to act. This was apparently the cause in a case described by Mr. Stanley, Trans. London Coll. of Phys. vi. 414.
