A handy-book of forensic medicine and toxicology / by W. Bathurst Woodman and Charles Meymott Tidy.

Date:: 1877

Credit: A handy-book of forensic medicine and toxicology / by W. Bathurst Woodman and Charles Meymott Tidy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

1177/1268 (page 1141)

$move the tongue to the ninth ; difficulty in swallowing, and stertorous breathing to the eighth pair, &c. &c. Compression is very like drunkenness. There are some cases in which it is not possible to distinguish one from the other at certain stages. Concussion, also, resembles the effects of alcohol. The man whose brain is injured, or whose skull may be fractured, may have had brandy given him, and his breath may smell of it. Again, the brain-lesion may involve both sides. The same difficulty is met with as regards apoplexy and drunkenness, and some forms of opium poisoning. The following signs may make us suspect that we have to do with alcoholic coma, or dead drunkenness, and not with apoplexy, or compression of the brain, viz.:—The temperature being greatly lowered ; instead of 98-6° F. [37° C.], we get 95°, 90°, or 87° F. [35°, 32'2°, 30'6 C.]; the loss of power (paralysis), and loss of sensation (anaesthesia), instead of being unilateral, are symmetrical, i. e. on both sides, and almost total; the bladder is generally full of limpid urine, of low specific gravity, almost colourless, and furnishing on distillation, a large amount of spirit. A single drop gives a bright green with the bichromate solution [300 of sulphuric acid to 1 of potassium bichromate]. There is generally less stertor than in apoplexy, or fracture of the skull. The pupils are sometimes contracted, and sometimes dilated. On the other hand, all these symptoms may, though rarely, be met with in apoplexy, and fracture of the skull. Doubtful cases of this kind ought not to be left to the diagnosis or treatment of policemen, or shut up in a police cell, as so many have been, with almost certainty of death. All cases of complete unconsciousness ought to be carefully examined by a medical man, and to be treated in hospital, unless skilled assistance can be had in their own homes ; for, although medical men may not be able to make a certain diagnosis at the moment, yet in a short time symptoms may set in, which will not only settle the nature of the case, but give indications for treatment. And in a large number of cases a skilful medical man can make a diagnosis ; whereas, the policeman relies solely upon the one test-of the smell of alcoholic liquor, which we have shown to be fallacious. Scarcely a week elapses without a case of apoplexy, or injury to the brain, being mistaken for drunkenness, and locked up in a police-cell; where such cases usually die, unless the authorities, becoming alarmed, remove them, when too late, to some hospital. In cases of opium poisoning, and death from chloral-hydrate, and other narcotics, the symptoms may be very similar to those of apoplexy of the pons varolii, or of a large extravasation of blood, pressing on both sides of the brain. In all these cases the pupils are contracted ; we get almost absolute loss of motor power and of sensation, with stertor, coma, and other symptoms, common to all these conditions. An examina- tion and analysis of the vomited matters, or of the contents of the stomach, or of the urine, may sometimes show us the nature of the case. And sometimes the breath by its odour will reveal the poison, as in prussic acid poisoning, and its compounds. Blood may be extravasated as a result of excitement, without any blow or injury. See p. 1081. Many other cases are given in Taylor \_loc. cit., p. 624, <fec.]. Where one or more blows are also struck, and marks of violence are visible, it is not always possible for a medical witness to say whether the excitement or the blow caused the extravasation. If the injury be very severe, it is not unreasonable to blame the violence; 4 n$