There are several other diseases to which grain is liable, and which are much more common in this country than the ergot. But very little is known of their effects on the animal body; which circumstance, since the wheat of this and other countries often suffers from them, is probably sufficient to show that their influence must be trifling, or at all events very seldom called forth. Wheat is liable to three diseases. One is a disease of the stalk and leaf rather than of the ear, and has the effect of preventing the development of the ear or its pickles, and of covering the plant with a brown powder. Of the two other diseases, which both attack the pickles of the ear, one consists in the substitution of a brown dry powder for the farina of the pickle, and the other of a deposition of black moist matter in the fissure of the pickle, the substance of which it also invades and partially destroys. One of these is called in Scotland brown rust, the other black rust.
Of the three diseases the only one which is apt to infect the flour is the black rust. The others, as they consist of a light dry powder, are almost entirely separated in thrashing and winnowing the grain. But the black rust being damp and adhesive, it is carried along with the pickles. Such pickles are almost invariably separated by the farmer if they are abundant; for otherwise, on account of the dark colour and disagreeable odour of the matter deposited on them, the flour possesses external qualities which would be at once recognized by a dealer of ordinary experience.
It is not improbable, that a moderate impregnation of bread with the powder formed by the diseases in question may take place, without leading to any unpleasant effect on the human body. Experiments to this effect were made by Parmentier with one of them, termed in France carie, or caries of wheat, which from his description appears to be the black rust of Scottish farmers. He gave two dogs each two drachms daily of the powder for fifteen days, without remarking any sign of ill health. Bread made with wheat flour containing a 64th of the powder, when eaten by various people, and Parmentier among the rest, to the amount of a pound daily for several days, caused slight headache and pain in the stomach the first day only; and in larger proportion it had as little effect.[2489]
It appears, then, that the introduction of any deleterious ingredient into wheat bread is hardly to be dreaded from the common diseases to which wheat is liable in this country.
Wheat and other grains have been supposed to acquire qualities detrimental to health, from being cut down while unripe, or used immediately after being cut down, although ripe. I am not aware that accidents have ever been traced or even imputed to such causes in this country; and, on the whole, I believe it is generally considered here, that imperfect ripening of the pickle rather lessens the quantity, than impairs the quality, of the flour. But several times epidemics have been ascribed in France to unripe wheat. In 1801 M. Bouvier read a memoir to the Society of Medicine at Paris, ascribing to new and unripe wheat an epidemic dysentery, which laid waste several districts of the department of the Oise in the autumn of 1793. These districts abound in small farms of a few acres, on the produce of which the cultivators depend in great measure for their subsistence. Hence in unfavourable seasons the corn was commonly cut down before it was ripe, and made into bread soon after being reaped. It was accordingly among the peasantry of these farms only, and not among the agriculturists in large farms, which were under better management, that the epidemic prevailed. Bouvier remarks, that at all times when the long continuance of wet weather has compelled the inhabitants of a district to cut down the wheat before it is ripe, or a previous dearth has forced them to use it when newly cut, epidemic disorders of the bowels have been observed to rage in the latter months of autumn. And as an instance of this he refers to the year 1783, when the crops around Paris were believed to have been injured by the extraordinary prevalence of fogs, and were cut down unripe and used immediately. Various epidemics broke out in the metropolis, and still more in the surrounding country.[2490] This is an important subject for farther inquiry; but at present I cannot help thinking that M. Bouvier exaggerates the effects of the immaturity of the grain. At all events, the grain is often cut down in an unripe state in various districts of this country; and I have never heard that any epidemic diseases were produced. When M. Bouvier witnessed the epidemic of 1793 in the department of the Oise, he instructed the inhabitants of his own parish to dry the unripe corn before thrashing it, to repeat the process before the grain was converted into flour, and to mix with the flour a larger quantity than usual of yeast in making it into bread; and he states that in the succeeding year, which was even more unfavourable to the crops, they were enabled, by following these directions, to use unripe corn with safety.
This is the fittest opportunity for noticing certain injurious effects sometimes observed from the use of spoiled or mouldy bread. On the continent repeated instances have occurred of severe and even dangerous poisoning from spoiled rye-bread, barley-bread, and even wheat bread. Several instances have been observed of horses having been killed in a short space of time with symptoms of irritant poisoning after eating such bread with their ordinary food.[2491] And Ur. Westerhoff has given an account of its effects on two children and several adults. In children the symptoms were redness of the features, dry tongue, frequent weak pulse, violent colic pains, urgent thirst and headache, and subsequently vomiting and diarrhœa, alternating with great exhaustion and sleepiness. The bread in these instances was made of rye.[2492] It appears that in bread so spoiled a variety of mucedinous vegetables are developed, especially the Penicillium glaucum and P. roseum; and it is imagined by some, that this circumstance may account for the deleterious effect of the bread.[2493]
Grain is also rendered more or less injurious by the accidental or intentional admixture of a variety of foreign substances, by which, in common speech, it is said to be adulterated. The subject of the adulteration of grain is a very important topic in medical police. But as this practice seldom imparts to the grain qualities decidedly poisonous, the consideration of it would be misplaced here. One variety, however, the accidental adulteration of flour with the seeds of the Lolium temulentum or darnel-grass calls for some notice; for it may occasion not only symptoms of poisoning, but even also death itself.
This is the only poisonous species of the natural order of the grasses. The seeds appear to be powerfully narcotic, and at the same time to possess acrid properties. Seeger gave a dog three ounces of a decoction of the flour, and observed that it was seized in five hours with violent trembling and great feebleness, which were succeeded in four hours by sopor and insensibility; but it recovered next day.[2494]
When mixed with bread and taken habitually by man, darnel-grass has been known to cause headache, giddiness, somnolency, delirium, convulsions, paralysis, and even death. M. Cordier found by experiment on himself, that very soon after eating bread containing darnel-grass flour, he felt confusion of sight and ideas, languor, heaviness, and alternate attacks of somnolency and vomiting. The bread was commonly vomited soon after he ate it.[2495] Seeger has related some cases in which the somnolency was much more deep; and states that general tremors are almost always present.[2496] A few years ago almost the whole inmates of the Poor’s House at Sheffield, to the amount of eighty, were attacked with analogous symptoms after breakfasting on oatmeal porridge; and it was supposed that the meal had been accidentally adulterated with the lolium. The chief symptoms were a piercing stare, violent agitation of the limbs, quivering of the lips, frontal headache, confusion of sight, dilated pupil, small tremulous pulse, twitches of the muscles, and palpitation. In twelve hours all of the persons attacked were well but two, who had strong convulsions in the subsequent night, but also eventually recovered.[2497] A similar accident is mentioned by Perleb, as having happened at Freyburg in the House of Correction. The inmates, soon after eating bread made with new flour, were attacked to the number of forty, with loss of speech and somnolency; and for some days afterwards they complained of sickness.[2498] The accident was ascribed to darnel-grass. In a recent instance which happened in the workhouse of Beninghausen, and which was traced to the lolium, seventy-four people were attacked with giddiness, tremor, convulsions, and vomiting. Those who had led a dissipated life suffered most, and children least of all.[2499]
Sometimes this poison appears to excite symptoms of intestinal irritation, without acting as a narcotic. A small farmer near Poicters in France saved five bushels of the seed from a field of wheat,—had it ground with a single bushel of wheat, and afterwards made bread with the mixture for his own family. He himself, with his wife and a servant, began to eat the bread on a Thursday; but the two last were so violently affected with vomiting and purging, that they refused to continue taking it. He persevered himself, however, till on the Sunday evening he became so ill that his wife wished to send for medical aid. This he refused to allow, and next day he expired after suffering severely from fits of colic.[2500]
Bley of Bemburg has examined chemically the grain of lolium. He obtained from it a bitter extractive matter, without any characteristic chemical properties, but which killed a pigeon. The seed has a very feeble bitterish taste. Bley maintains that its poisonous properties are essential to it, and not incidental, as some think.[2501]
Among the injurious substances with which various grains are apt to be accidentally mixed from their growing together, two leguminous plants may be here shortly mentioned, as they have often been the source of disagreeable accidents on the continent.
In the department of the Cher and Loire in France, severe effects have been traced to bread made partly with flour of the Lathyrus cicera. M. Desparanches, in a report to the Prefect of the Department, says this flour occasionally forms one-half of that of which bread is made in some parishes; that it produces sometimes sudden incapability of walking, sometimes imperfect paraplegia and pain, with a draggling gait and turning in of the toes, and sometimes also slight convulsive movements of the thighs and legs.[2502] Similar effects have been traced to this substance formerly. Virey says it has been known to produce in particular a singular stiffness and state of semiflexion of the knee-joint, compelling the individual to move the limbs in one rigid mass.[2503]
The Ervum ervilia, or Bitter-vetch, which is not a native of this country, has also been found in France to possess analogous properties. In 1815, according to Virey, a great variety of herbs grew up with the grain, in consequence of the wetness of the summer; and their seeds were thus subsequently mixed with the wheat and rye. Among these he particularizes the bitter-vetch as peculiarly noxious, because it produces so great weakness of the extremities, but especially of the limbs, that the individual trembles while standing, and totters when he walks, or even requires the help of stilts; and he adds, that horses are similarly affected, so as to become almost paralytic.[2504]
The Cytisus laburnum, or laburnum tree, is another plant of the same family, which yields poisonous seeds. The whole plant is more or less deleterious. But it is chiefly the seed that has attracted attention hitherto.
I am not acquainted with any experiments relative to the action of the seeds on animals.—Its effects on man present considerable variety, and show that it is a true narcotico-acrid. In some instances they seem to have been purely narcotic. My colleague Dr. Traill has communicated to me two cases of this nature. In one of these, that of a child two years old, the first evident effects were sudden paleness and a fit of screaming, followed immediately by insensibility, and then by coldness of the whole body and lividity of the face; but vomiting having been induced by warm water and mustard, the seeds were discharged, the symptoms abated, and next day he was quite well. The other case was that of a boy who was left by his companions at Dr. Traill’s door in a state of complete insensibility, with froth at the mouth and a feeble pulse. An emetic, administered immediately, brought up a large quantity of laburnum seeds; after which the pulse became firmer, and sensibility quickly returned.—Mr. North has briefly noticed a similar case of a child, who after eating laburnum flowers, was seized with paleness and twitches of the face, coldness of the skin, laborious breathing, efforts to vomit, and great feebleness of the pulse. But recovery took place after the flowers were vomited.[2505]—In other instances the effects have been chiefly limited to an irritant action on the stomach and bowels. Dr. Bigsby of Newark informs me that a few years ago a little girl in his neighbourhood, in consequence of eating the seeds, was attacked with violent vomiting and purging, and became in other respects very ill, but recovered in forty-eight hours.—Most generally, however, the effects are partly irritant, partly narcotic. In 1839 Dr. Annan of Kinross communicated to me the case of a little boy, who in an hour after swallowing a small quantity of unripe seeds, was attacked with violent vomiting and ghastly expression of countenance, and then fell into a very drowsy state, from which he was constantly roused by shaking him and dashing cold water on his body. But for a month afterwards he continued subject to vomiting and diarrhœa.—Mr. Bonney of Brentford has related the particulars of eleven cases, which presented all the varieties of poisoning with the seeds. The subjects were children from seven to nine years of age; and they took, some of them one seed, and none more than five. Three scarcely suffered at all. One vomited the poison and got well at once. Of the others, some had only nausea and feebleness of the pulse, another had also dilatation of the pupils, some had vomiting and purging, others great drowsiness, others again both sets of symptoms. In all the pulse was weak and generally rapid. Emetics, laxatives and ammonia were administered with success.[2506]
The leaves of this plant are stated by Vicat, a good authority, to possess the property of acting violently as an emetic and purgative;[2507] and Cadet says the unripe pods have been known to produce in small quantities severe vomiting, and profuse, protracted diarrhœa.[2508]
My attention was lately turned by a criminal trial in this country to the effects of the bark, which is not alluded to as a poison by any author, although its properties seem well known to the peasantry in the north of Scotland. A lad Gordon was tried lately at Inverness for administering poison to a fellow-servant, and it was proved that he gave her laburnum-bark in broth. She immediately became very sick, and was soon attacked with incessant vomiting and purging, pain in the belly, rigor, and extreme feebleness; and several days elapsed before she could return to her work. The sickness, vomiting, purging and pain continued afterwards to recur more or less; great emaciation ensued; in six weeks she was so much reduced as to be compelled to quit service; and even six months afterwards, she continued so ill with a chronic dysenteric affection, that fears were entertained for her life, although eventually she did recover. Being consulted in the case, I was inclined to rely in the general properties of the plant and the peculiar, intense, nauseous bitterness of the bark, even more intense there than in the seeds, as adequate proof that the bark was capable of producing the effects observed in this case. I was scarcely prepared, however, to find it so deadly a narcotic poison, as it proved to be on careful experiment. Dr. Ross of Dornoch, who saw the woman and was also consulted on the part of the crown in the case, found that from twenty to seventy grains of dried laburnum-bark caused speedy and violent vomiting when administered to dogs, but no other marked effect. I found that when an infusion of a drachm of dried bark was injected into the stomach of a strong rabbit, the animal in two minutes began to look quickly from side to side, as if alarmed and uncertain in which direction to go, then twitched back its head two or three times, and instantly fell on its side in violent tetanic convulsions, with alternating opisthotonos and emprosthotonos so energetic that its body bounded with great force upon the side up and down the room. Suddenly in half a minute more all motion ceased, respiration was at an end, and, excepting that the heart continued for a little to contract with some force, life was extinct. No morbid appearance was visible anywhere. The heart was gorged, but irritable. Dr. Ross subsequently repeated this experiment, and obtained analogous results; but the animals he operated on did not die for half an hour or upwards.[2509]
MM. Chevallier and Lassaigne have discovered in the seeds an active principle called cytisin, a nauseous, bitter, brownish-yellow, neutral, uncrystallizable substance, of which small doses killed various animals amidst vomiting and convulsions, and eight grains taken by man in four doses brought on giddiness, violent spasms, and frequency of the pulse, lasting for two hours, and followed by exhaustion.[2510]
A great number of Brown’s division Papilionaceæ of the present natural family probably possess similar properties.
The last group of the narcotico-acrids comprehends alcohol, ether, and the oleaginous products of combustion.
Of its Action on Animals, and Symptoms in Man.—Alcohol has been generally believed, since the experiments of Sir B. Brodie,[2511] to act on the brain through the medium of the nerves, and to do so without entering the blood. This may be doubted. At least in some experiments performed several years ago by Dr. C. Coindet and myself it appeared not to act so swiftly, but that absorption might easily have taken place before its operation began. At all events, through whatever channel it may operate, there is no doubt that it enters the blood; for in man the breath has a strong smell of spirit for a considerable time after it is swallowed; and it has been found in the tissues and secretions after death from large doses. Professor Orfila found that alcohol is a violent poison when injected into the cellular tissue; and that it produces through that channel the same effects as when taken into the stomach.[2512] In the course of our experiments Dr. C. Coindet and I found that it acted with great rapidity when injected into the cavity of the chest.
Authors who have treated of the action of alcohol and spirituous liquors on man, have distinguished three degrees in its immediate effects.
1. When the dose is small, much excitement and little subsequent depression are produced.
2. When the effect is sufficiently great to receive the designation of poisoning, the symptoms are more violent excitement, flushed face, giddiness, confusion of thought, delirium, and various mental affections, varying with individual character, and too familiar to require description here. These symptoms are soon followed by dozing and gradually increasing somnolency, which may at length become so deep as not to be always easily broken. After the state of somnolency has continued several hours, it ceases gradually, but is followed by giddiness, weakness stupidity, headache, sickness, and vomiting.
This degree of injury from alcohol may prove fatal, either in itself, by the coma becoming deeper and deeper,—or from the previous excited state of the circulation causing diseases of the brain in a predisposed habit,—or more frequently from the occurrence of some trifling accident, which in his torpid state the individual cannot avoid or remedy, such as exposure to cold, falling with the face in mud or water, suffocation from vomited matters getting into the windpipe, and the like.
Of simple poisoning by the gradual increase of coma the following judicial case in which I was consulted is a characteristic example. Two brothers drank in half an hour three bottles of porter, with which three half-mutchkins (24 ounces) of whisky had been secretly mixed by a companion, whose object was to fill them drunk by way of joke. In the course of drinking both became confused. In fifteen minutes after finishing the last bottle one of them fell down insensible, and had no recollection of what happened for twelve hours; but he recovered. The other staggered a considerable distance for an hour, and then became quite insensible and unable to stand. In four hours more consciousness and sensibility were quite extinct, the breathing stertorous and irregular, the pulse 80 and feeble, the pupils dilated and not contractile, and deglutition impossible. In this state he remained without any material change till his death, which took place in fifteen hours after he finished his debauch. A surgeon saw him when he had been five hours ill, but did little for his relief, as the case appeared hopeless.
There is a singular variety in the principal symptoms of this form of poisoning, even when completely formed. From a careful tabular analysis of no fewer than twenty-six cases, chiefly of the present denomination, collected by Dr. Ogston of Aberdeen from the experience of the police-office there, it appears that when the stage of stupor is fully formed, the person is sometimes capable of being roused, sometimes immovably comatose for a long time,—that the pulse is sometimes imperceptible or very feeble, sometimes distinct or even full, generally slow or natural, seldom frequent, very seldom firm,—that the pupils are occasionally contracted, much more generally dilated, and in a few instances alternating between one state and the other,—that the countenance is commonly pale, sometimes turgid and flushed,—and that the breathing is for the most part slow, and also soft, yet not unfrequently laborious, but very rarely stertorous. Convulsions are rare, having been observed twice only, and on both occasions in young people of the age of twelve or fourteen.[2513] Dr. Ogston has tried to group these several symptoms together in classified cases; but the general conclusions at which he arrives are subject to important exceptions. Neither do any of the special symptoms seem to bear a marked relation to the ultimate event. It is peculiarly worthy of remark, that very many cases got well where the pupils were much dilated, the coma profound, and the pulse imperceptible.
In the present form of poisoning with alcoholic fluids, it usually happens that if the stage of stupor be completely overcome, recovery speedily ensues, without any particular symptom except headache, giddiness, sickness, and the customary consequences of a debauch. Hut on some occasions the comatose stage is succeeded by one which indicates much cerebral excitement,—by flushed face, injected eyes, restlessness, a febrile state of the pulse, and delirium, even of the violent kind. In other cases this affection puts on very much the characters of a slight attack of typhoid fever.
In the second variety of the second degree of intoxication, an apoplectic disposition is called into action by the excited state of the circulating system; and death ensues from apoplexy or some other disease of the brain, rather than from simple poisoning. Thus in some instances, as will be more fully mentioned under the head of the morbid appearances, extravasation of blood is found within the head after death, preceded by the usual phenomena of ordinary intoxication. Since this is a rare effect of intoxication, it must be considered as the result of poisoning with spirits, exciting sanguineous apoplexy in a predisposed constitution. In other cases the stupor of intoxication, after putting on all the characters of apoplexy for two days and upwards, terminates fatally without extravasation. Here the poison operates by developing a constitutional tendency to congestive apoplexy. Again, this mode of action is still more clearly shown in some cases, where an interval of returning health occurs between the immediate narcotic effects of the poison and the ultimate apoplectic coma which is the occasion of death. Such a course of events, which, however, is of rare occurrence, is well exemplified in the following cases. A man drank 32 ounces of rum one afternoon, and was comatose most of the ensuing night. Next morning, though very drowsy, he was sensible when roused; and in the evening he was considered convalescent. But two days afterwards he became delirious; in two days more he died comatose; and congestion was the only appearance found in the brain.[2514] Another instance, most remarkable in its circumstances, is the following, which has been related by Dr. Golding Bird. A workman in a distillery, after drinking eight ounces of rectified spirit by mistake for water, suddenly fell down senseless and motionless, and remained so for eleven hours. He then began to recover, and came round so far that he returned to his work next morning. After this he continued to pass dark, pitch-like evacuations. In three weeks he became drowsy, mistook one thing for another, answered questions sluggishly, and had a frequent pulse, and dilated sluggish pupils; in which state he continued three weeks later when the account was published.[2515] The following case, related by Dr. Chowne, also seems to belong to the same category, although it presents anomalies. A boy, eight years of age, soon after swallowing about eight ounces of gin, said he felt like a drunk man, and suddenly became motionless and insensible. In no long time he vomited a fluid of the odour of gin; and in seven hours from the commencement a fluid was withdrawn from the stomach, possessing no longer any such odour. He was now motionless, insensible, pale, and cold; the pupils were contracted, the pulse feeble and hurried, the breathing stertorous and slow; and he made ineffectual efforts to vomit. Stimulants of all kind had little effect on him for a day and a half, when the breathing became more natural, and his look quite intelligent. Yet he could not answer questions, exhibited no sign of volition, and had a pulse so frequent as 160. In twenty-four hours more the breathing became laborious and rattling, and the lips livid; and death took place near the close of the third day. The only appearances of any note in the dead body were general injection of the arachnoid membrane of the brain, and effusion of frothy mucus into the bronchial ramifications.[2516] Similar to these is the following extraordinary case which has been communicated to me by Dr. Traill. A boy seven years of age, who was persuaded by two miscreants to take nearly five ounces of undiluted whisky, suffered for two days from the ordinary symptoms of excessive intoxication, which were then immediately followed by epileptic convulsions. These continued to recur with more or less violence, but always frequently, for two months down to the date of the judicial investigation to which the case gave rise. All these forms of the effects of drinking ardent spirits can scarcely be considered as simple poisoning, but as the result of poisoning developing a tendency to diseases of the head.
The third variety of poisoning with spirits in the second degree proves fatal, not in itself, but by some trivial accident happening, from which the individual cannot escape on account of his powerless insensibility. Thus, it is no uncommon thing for persons in a state of deep intoxication to fall down in an exposed place, where they perish from cold, or to tumble with the face in a puddle, and so be suffocated, or to be choked by inhaling the contents of the stomach imperfectly vomited, or by lying in such a posture that their neck-cloth produces strangulation. These statements are so familiar, that it is unnecessary to illustrate them by special facts. The reader’s attention was called to such accidents in the previous editions of this work. Two well-marked cases of the kind have been since published by Mr. Skae.[2517]
In cases of simple poisoning in the second degree the progress of the symptoms is on the whole remarkably uniform, gradual and uninterrupted. But there are likewise some anomalies which it may be well to notice. Thus, occasionally after the phenomena of ordinary intoxication have gone on gradually increasing without having attained a very great height, sudden lethargy supervenes at once, and may prove fatal with singular rapidity. My colleague, Dr. Alison, has communicated to me the particulars of a case of the kind where death took place from simple intoxication, twenty minutes after the state of lethargy began. The individual reached his home in a state of reeling drunkenness, but able to speak and give an indistinct account of himself. He then became lethargic, and died in the course of twenty minutes. On examining the body, Dr. Alison could not discover any morbid appearance, except some watery effusion on the surface of the brain and in the ventricles; but the contents of the stomach had a strong smell of spirits. Instances of such excessive rapidity, however, are rare, unless from the third form of poisoning.—An anomaly of a different kind, of which a remarkable example was brought judicially under my notice, is sudden supervention of deep insurmountable stupor, without the usual precursory symptoms, yet not till after a considerable interval subsequently to drinking. In May, 1830, a lad of sixteen, in consequence of a bet with a spirit-dealer, swallowed sixteen ounces of whisky in the course of ten minutes, and, pursuant to the terms of the wager, walked up and down the room for half an hour. He then went into the open air, apparently not at all the worse for his feat; but in a very few minutes, while in the act of putting his hand into his pocket to take out some money, he became so suddenly senseless as to forget to withdraw his hand, and so insensible that his companions could not rouse him. A surgeon, who was immediately procured, contented himself with giving several clysters and a dose of tartar-emetic, which did not operate; and the young man died in the course of sixteen hours. The cause of the retardation of the symptoms was partly perhaps that he had taken supper only an hour before drinking the spirits, but chiefly, I presume, because the stupor was kept off for a time by the stimulus of determination to win his bet.—Several cases somewhat similar have been described by Dr. Ogston. In these sudden insensibility came on while the individuals had been drinking freely for some time, without showing any marked sign of approaching intoxication.[2518] The cause of the postponement and sudden invasion of the stupor does not exactly appear; but a familiar cause of its abrupt invasion in ordinary cases of drunkenness is sudden exposure to cold.
It is impossible to fix the extremes of duration of the present form of poisoning in fatal cases. For, on the one hand, one or other of the accidents mentioned above may bring the case to a speedy close; and, on the other hand, the supervention of apoplexy may protract it to several days. The ordinary duration in fatal cases seems to be from twelve to eighteen hours.
3. The third degree of poisoning is not so often witnessed, because, in order to produce it, a greater quantity of spirits must be swallowed pure and at once, than is usually taken by those among whom poisoning in the second degree chiefly occurs. When swallowed in large quantity, as by persons who have taken foolish wagers on their prowess in drinking, there is seldom much preliminary excitement; coma approaches in a few minutes and soon becomes profound, as in apoplexy. The face is then sometimes livid, more generally ghastly pale; the breathing stertorous, and of a spirituous odour; the pupils sometimes much contracted, more commonly dilated and insensible; and if relief is not speedily procured, death takes place,—generally in a few hours, and sometimes immediately. According to Mr. Bedingfield, who witnessed many cases of poisoning with rum at Liverpool, which always follow the arrival of the West India vessels, the patient will recover if the iris remains contractile; but if it is dilated and motionless on the approach of a light, recovery is very improbable.[2519]
A case is briefly alluded to by Orfila of a soldier, who drank eight pints of brandy for a wager, and died instantly.[2520] A case of the same kind is quoted by Professor Marx.[2521] Another, which happened in the person of a London cabman, is noticed in a French Journal. The man, for a bribe of five shillings, drank at a draught a whole bottle of gin; and in a few minutes he dropped down dead.[2522] Similar accidents occur not infrequently in this country; but I have not met with any fully described by authors. A case of the less rapid variety of the present form occurred at the Infirmary here in 1820. A man stole a bottle of whiskey; and, being in danger of detection, took what he thought the surest way of concealing it, by drinking it all. He died in four hours with symptoms of pure coma.
Convulsions are not common in such cases. I have seen a remarkable example, however, in which the coma was accompanied with constant alternating opisthotonos and emprosthotonos. The subject was a boy who had been induced to drink raw whisky by an acquaintance, and had been two hours insensible before I saw him. The stomach-pump, which was immediately applied, brought away a large quantity of fluid with a strong spirituous odour; and he recovered his senses in fifteen minutes, but remained very drowsy for the rest of the day.
Such are the forms of poisoning with spirits usually admitted by authors. But it also appears to act sometimes as an irritant. After its ordinary narcotic action passes off, another set of symptoms occasionally appear, which indicate inflammation of the alimentary canal. Cases of this kind are exceedingly rare; yet they have been met with, as the following extract shows. “A young man at Paris had been drinking brandy immoderately for several successive days, when at length he was attacked with shivering, nausea, feverishness, pain in the stomach, vomiting of everything he swallowed except cold water, thirst, and at last hiccup, delirium, jaundice, and convulsions; and death took place on the ninth day. On examining the body the stomach was found gangrenous over the whole villous coat; the colon too was much inflamed; and all the small intestines were red.”[2523]
A case of great complexity, but probably of the same nature, has been related by Opitz in Pyl’s Memoirs. The subject was a woman liable to epilepsy, and addicted to excessive drinking. After one of her drinking-bouts she was seized with vomiting and severe pain of the bowels, afterwards with delirium, then with convulsions, and she died in twenty-four hours after the first attack. The stomach and intestines were greatly inflamed, a table-spoonful of blood was effused into the ventricles of the brain, and the left lung was purulent.[2524]
Besides the immediately fatal effects of spirituous liquors now described, there is still another variety of poisoning more common than any yet mentioned, and constituting a peculiar disease. People who fall into the unhappy vice of habitual intoxication, after remaining in a state of drunkenness for several days together, are often attacked with a singular maniacal affection, which is accompanied with tremors, particularly of the hands, and after enduring for several days, ends at last in coma. When the delirium is not so violent, the disease by proper treatment may be cured. But frequently, after the delirium and tremor have continued mildly for some time, they increase, and the delirium becomes furious, or coma rapidly supervenes; in either of which cases the disorder commonly proves fatal in two or three days more. This disease, which is now familiar to the physician, is called delirium tremens. It is supposed by some to depend on inflammation of the membranes of the brain, followed by effusion.
Other diseases, besides delirium tremens, are also slowly induced by the habitual and excessive use of spirituous liquors; but in general the habit of intoxication acts in inducing these diseases only as a predisposing cause. A particular variety of tuberculated liver probably arises from the habitual use of spirits without the co-operation of other causes. That variety of disease of the kidney, which was first brought under the notice of the profession by Dr. Bright,[2525] is also obviously often connected with the habit of drinking spirits. The following have been enumerated among the diseases where the same habit acts powerfully as a predisposing cause—indurated pancreas,—indurated mesenteric glands,—scirrhous pylorus,—catarrh of the bladder,—inflammation, suppuration and induration of the kidneys,—incontinence of urine,—aneurism of the heart and great vessels,—apoplexy of the lungs,—varicose veins,—mania,—epilepsy,—tendency to gangrene of wounds,—spontaneous combustion.[2526]
Of the Morbid Appearances.—Some doubts exist as to the morbid appearances in the bodies of those poisoned by spirituous liquors.
In animals killed by alcohol, Orfila says he found the villous coat of the stomach constantly of a cherry-red odour. I have several times remarked the same appearance. When the stomach was empty before the alcohol was introduced, I have always found the prominent part of its rugæ of a deep cherry-red tint, the margin of the patches being more florid, and evidently consisting of a minute network of vessels.
In man these signs of irritation have not been always observed. In the patient who died in the Infirmary here, the stomach was quite natural to appearance. Dr. Ogston notices injection of the small intestines and thickening of the mucous membrane of the stomach and intestines as common appearances in the cases he has examined; but he seems to consider these the effects not of the last fatal dose, but of the habit of frequent excessive drinking.[2527]
The blood in the heart and great vessels is commonly fluid and very dark, and the lungs are sometimes more or less gorged with the same fluid.
The state of the brain differs much according to the mode of death. Sometimes great congestion and even actual extravasation of blood are found in the heads of persons who have died of excessive continuous drinking,—the excitement of such a debauch being apt, as already mentioned, to induce apoplexy in a predisposed habit. Accordingly extravasation was found by Professor Bernt of Vienna in no less than four cases of the kind, two of which happened in the persons of young men not above twenty-two years of age;[2528] and Dr. Cooke quotes another in his work on nervous diseases.[2529] I have myself met with another remarkable instance. A female out-pensioner of Trinity Hospital here, who was much addicted to drinking, and for fourteen days after the New-year of 1830 had been very little in her sober senses, soon after arriving at home one evening much intoxicated, fell down comatose, and died in ten or twelve hours. An enormous extravasation of clotted blood was found in the ventricles, producing extensive laceration of the right middle and anterior lobes of the brain.—In such cases it is natural to suppose that a predisposition to apoplexy must concur with the intoxication; otherwise it is not easy to see why death from extravasation is not more frequently produced by excessive drinking.
Extravasation is not apt to occur in the cases of rapid death brought on by a very large quantity swallowed at once. The circulation, indeed, is during life in a state quite the reverse of excitement; and accordingly the brain and its membranes are found quite healthy. They were particularly so in the man who died in the hospital here. It is right to mention, however, that one of Bernt’s cases, although the symptoms and other particulars are not mentioned, possibly belongs to the present variety, as the man swallowed for a wager a quart of brandy at a draught.[2530] According to Dr. Ogston, who has given the best account of the appearances within the head in the ordinary cases of this kind, there is usually serous effusion under the arachnoid membrane, occasionally minute injection of vessels, commonly more or less general gorging of the larger veins, and especially effusion of serosity to the amount of two or even four ounces in the ventricles.[2531]
When delirium tremens proves fatal, effusion is commonly found among the membranes of the brain; and occasionally to a great extent. In one instance, which proved fatal in two or three days, I have seen minute vascularity of the membranes, with effusion of fibrin, and without effusion of serosity; but such cases are rare. There is also, according to Andral, very extensive softening of the mucous coat of the stomach.[2532] In an instance mentioned in Rust’s Journal, besides effusion into the cerebral membranes, there was found an enormous accumulation of fat in all the cavities, a conversion of the muscular substance into fat, and a nauseous sweet smell from the whole body.[2533]
In all cases of rapid poisoning with spirituous liquors some of the poison will be found in the stomach. For when the case is one of pure narcotic poisoning, unaided by the effects of blows, exposure to cold, or the like, and the person dies in a few hours, the poison cannot be all absorbed before death.—Although the spirituous liquors used in Britain have all very powerful odours, the inspector in a case of importance ought not to confine himself to this test alone. He must subject the suspected matter to distillation; and then remove the water from what distils over by repeated agitation with dry carbonate of potass, till he procures the alcohol of the spirit in such a state of purity as to be inflammable.
Alcohol may also be in some circumstances detected in the tissues and secretions of the body. A spirituous odour has been remarked not infrequently in various parts, and especially in the brain. Dr. Cooke mentions a case in which the fluid in the ventricles of the brain had the smell and taste of gin, the liquor which had been taken;[2534] Dr. Ogston adverts to an instance, in which after death by drowning during intoxication, he found in the ventricles nearly four ounces of fluid, having a strong odour of whisky;[2535] in the case which occurred in the hospital here the odour of whisky was said to have been perceived in the pericardium; and in a man who died of long-continued intoxication from immoderate drinking Dr. Wolffe found that the surface, and still more the ventricles, of the brain had a strong smell of brandy, although the contents of the stomach had not.[2536]
The presumption afforded by such facts as these, in favour of the absorption of alcohol and the possibility of detecting it throughout the animal system, has been turned to certainty by the late experimental researches of Dr. Percy; who found that in animals poisoned with alcoholic fluids, as well as in the case of a man who died during the night after drinking a bottle of rum, alcohol could be detected, generally in the urine, and also in the brain, by cautious distillation, and removing the water from the distilled fluid by means of dry carbonate of potass.[2537] Dr. Percy gave me an opportunity of verifying his results with the brain of the man; and I had no difficulty in obtaining from a few ounces of brain a sufficiency of spirit to exhibit its combustion on asbestus repeatedly.
It is hardly necessary to add, that when the individual has survived the taking of the poison a considerable length of time, an odour of spirits will not be perceived either in the stomach or elsewhere. In the out-pensioner of Trinity Hospital, for example, who survived about twelve hours, no spirituous odour could any where be perceived. In such cases the poison disappears during life by absorption.—A question may even be entertained, whether the odour may not sometimes be imperceptible at the inspection of the body, although the poison was really present immediately after death. It is probable that, as in the instance of hydrocyanic acid, the alcohol, on account of its volatility or fluidity, will evaporate or percolate away in a few days. In this manner only can be explained the occasional absence of the odour in persons who have been killed in the early stage of drunkenness. I could not perceive any odour of whisky in the stomach of the woman Campbell, who was murdered by the notorious resurrectionist Burke, although she had drunk spirits to intoxication half an hour before her death. The body was not examined till thirty-eight hours after.[2538] It must be observed, however, that alcohol may exist in the contents of the stomach and be detected by chemical analysis, although it is not indicated by its odour. I have twice had occasion to observe this, where the bodies were disinterred some time after death.
From all that has been said, there ought seldom to be much difficulty in recognizing a case of poisoning with spirituous liquors.
But, before quitting the subject, a form of it must be noticed which may be extremely difficult to distinguish. It was formerly remarked that the eatable mushrooms have been sometimes poisoned with substances possessing effects on the system analogous to those caused by the deleterious fungi. In the same manner spirituous liquors may be poisoned with narcotics allied to them in action. Thus, in former parts of this work, it has been stated that a young man was killed during a debauch in consequence of his companions having mingled opium with his wine; that many persons have been poisoned and some killed by fermented liquors drugged in the same manner; that murder has been accomplished by poisoning wine with nightshade; and that several fatal accidents have occurred in consequence of liqueurs having been too strongly impregnated with hydrocyanic acid, to give them a ratafia flavour. Cases of this nature may be embarrassing. In general, they may be made out by attending strictly to the symptoms, the quantity of liquor taken, and the contents of the stomach. But, it must be admitted, that if a murderer, who chooses such a method, should season his guest’s drink judiciously, and ply him well with it, a medical jurist might be puzzled to determine whether the liquor was to blame in point of quality or quantity.
Of the Treatment.—The treatment of poisoning with alcoholic fluids does not differ essentially from that of poisoning with opium. In the former, as in the latter, the chief objects must be to remove the poison from the stomach, and to rouse the patient from his state of stupor; but in poisoning with alcoholic fluids it is also frequently necessary to treat a secondary stage of reaction by local and even general antiphlogistic measures. As to the primary object, the removal of the poison from the stomach, it appears that in the present form of poisoning emetics are more seldom effectual than in the case of other narcotics, and that the stomach-pump should be promptly resorted to. It is remarkable that the operation of clearing out the stomach is likewise often a sufficient stimulus to dispel stupor immediately and even permanently. I have seen almost complete consciousness permanently restored with the discharge of the alcoholic fluid; and the same remark has been made by others. Where the senses are not thus restored, one of the most effectual stimulants, according to the practice of the police-office of this city, is the injection of water into the ears. Great advantage has been derived, as in poisoning with opium, from the cold affusion applied to the head. Dr. Ogston, who has appended to his paper formerly quoted a very useful summary of the treatment of poisoning with spirits, has found this a safe and effectual remedy where the heat of the head was unnaturally great and that of the body not too low.[2539] Cases have been published where it proved successful although the pulse was gone at the wrist, the breathing scarcely perceptible, and the temperature of the whole body greatly reduced.[2540] It is doubtless a powerful remedy: but where the general temperature of the surface is much lowered, I conceive it should be restricted to the head and neck, and conjoined with the application of warmth to the body. Dr. Ogston objects to the general use of blood-letting in cases of poisoning with spirits, as being often apt to be followed by sudden sinking. Where other remedies are judiciously used, it is probably seldom called for; and the purpose it is intended to serve, namely, the relief of cerebral congestion and determination, is better fulfilled by the local employment of cold, and local blood-letting. Ammonia and its acetate have been found useful as internal stimulants where the stupor is deep. The treatment of the secondary affections adverted to above does not require specific mention.