Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

ALCOHOL

It will be necessary to consider poisoning by this substance under two forms—acute and chronic. So many anomalies present themselves that it is difficult to give a clear outline of the symptoms.

Acute.—In most cases the symptoms come on within a few minutes after the poison is swallowed. Giddiness, confusion of ideas, and a difficulty in walking straight are among the first effects produced, these being followed by stupor and coma. Nausea and vomiting are the early signs of recovery. In some cases there may be no premonitory symptoms, sudden and complete stupor supervening some time after a large dose of alcohol has been taken.

The patient not infrequently recovers from the first symptoms. A relapse takes place; he becomes insensible, and dies convulsed. The countenance wears a vacant expression, the face flushed and bloated, the lips livid, and the pupils dilated and insensible to light. The pupils may be contracted, but dilate on irritating the skin by a pin-prick or pinch. The sensibility of the pupil to the action of light should be regarded as a favourable symptom. The rapidity with which alcohol acts is not so great as to prevent the individual from walking some distance and performing certain acts of volition. The rapidity with which the symptoms show themselves will depend upon the previous habits of the individual, and the strength and quantity of the alcohol taken. Alcohol, when diluted, induces a preliminary stage of excitement, followed by stupor; but when concentrated, stupor may come on almost immediately after the spirit is swallowed.

The vapour of alcohol may act as a poison, giving rise to the symptoms above mentioned.

Congestion of the lungs or brain, or both together, is in most cases the cause of death in acute poisoning by alcohol.

Chronic.—The habitual dram-drinker suffers from many diseases. The appetite becomes impaired; there is considerable irritation of the stomach and bowels, marked by vomiting and purging. Then follows a long list of organic diseases. The structure of the liver becomes changed; it may increase in size, become lighter in colour and cirrhotic, being then known as “hobnailed” or dram-drinker‘s liver. Jaundice and dropsy may be present as the result of this altered condition of the gland. The kidneys also suffer from granular degeneration. Then follow a long series of nervous complaints: congestion of the brain, paralysis, delirium tremens, and insanity. Sudden death by coma not infrequently ends the career of the drunkard.

Delirium tremens is one of the most common results of the habit of drinking; and this affection, it is stated, may be induced by the sudden discontinuance of alcohol in those who are habitually given to its use.

Post-mortem Appearances.—The stomach may present the usual signs of inflammation, due to the irritant action of alcohol. The colour of the mucous membrane of the stomach may be bright red, dark red, brown, or quite pale. The brain and its membranes are sometimes congested, and the intracranial vessels gorged with blood. The odour of alcohol may be present in the contents of the stomach; and alcohol may, in some cases, be detected in the lungs, brain, and other organs of the body. The lungs are not infrequently found congested, and the right cavities of the heart full of dark-coloured blood. Casper examined a case in which the cavities of the heart were empty. The blood is remarkably fluid, and of a dark colour. “Lymphatic exudation between the cerebral meninges, so that the pia mater upon the cerebral hemispheres is seen here and there whitish as if varnished, is not a result of death from drinking, but is the result of the chronic irritation of the brain by habitual drunkenness, and is therefore a very common appearance in the bodies of all drunkards, from whatever cause they have died.” One other condition occurring in those dying from the effects of alcohol, is the remarkably long continued presence of the rigor mortis, and perfect freedom from putrefaction, even up to the ninth day, in an atmosphere by no means unfavourable to early decomposition. A condition of the skin known as cutis anserina, or “goose skin,” was present in some of the cases examined by Casper.

Absorption and Elimination.—From experiments on animals, it has been shown that alcohol is rapidly absorbed, and then eliminated from the system, and that all traces of alcohol may disappear in a few hours, and yet death be the result of its action. Alcohol is supposed to be decomposed in the body, but the exact changes it undergoes do not appear to be very clearly made out.

Fatal Period.—Death has occurred in a few minutes after a large dose of alcohol had been swallowed. The average fatal period is about twenty-four hours. Death may also be an indirect result of the action of alcohol on the system.

Fatal Dose.—Uncertain. The age and habits of the individual must be considered. Between three and four ounces proved fatal to a boy seven years of age.

Table showing the Points of Distinction between Concussion
of the Brain, Alcoholic Poisoning, and
Poisoning by Opium.

Concussion of the Brain.	Alcoholic Poisoning.	Poisoning by Opium.
1. Marks of violence on	1. The absence of	1. Same as under
the head.	marks of violence,	alcohol.
	unless the person has
	fallen on the ground.
	The history of the
	case will help in
	forming an opinion.
2. Stupor comes on	2. Excitement	2. The symptoms
suddenly.	previous to the	slow in appearing;
	stupor, which comes	drowsiness, stupor,
	on suddenly.	lethargy. Muscles
		relaxed, and
		locomotion impossible.
		The patient may be
		roused by a sharp
		question.
3. Face pale and cold;	3. Face flushed; and	3. The face pale,
the pupils sluggish and	pupils generally	pupils contracted.
insensible to light	dilated.
sometimes dilated.
4. Remissions are	4. Partial recovery	4. Remissions are, as
rare, the patient	may take place,	a rule, rare in this
recovering slowly,	followed by death	form of poisoning.
and with some	after the lapse
confusion of ideas.	of some hours.
5. Absence of the	5. Presence of the	5. Odour of opium
odour of alcohol in	odour of alcohol in	in the breath.
breath; if present,	the breath.
it is probably due
to the treatment of
bystanders.

Chemical Analysis.—Tests for Alcohol:

1. Characteristic smell.

2. It dissolves camphor.

3. Treated with dilute sulphuric acid and a strong solution of bichromate of potash, the green oxide of chromium is set free, and the vapour of aldehyde may be detected by the smell.

4. Burnt under the mouth of a test tube, moistened with solution of baryta or lime-water, a deposit is formed in the tube of carbonate of baryta or lime.

5. If a few drops of a solution of iodine in iodide of potassium be added to alcohol, and then sufficient caustic potash be added to decolourise it, a crystalline precipitate of iodoform with its characteristic odour will be formed.

6. If copper turnings be added to a solution containing alcohol, then some strong nitric and sulphuric acid, and the mixture warmed, the odour of sweet spirit of nitre will be given off.

7. On warming with sodium or lead acetate and sulphuric acid the odour of acetic ether is evolved.

Alcohol in the Contents of the Stomach or in the Tissues.—The contents of the stomach, or the tissues bruised and macerated in distilled water, should be carefully distilled in a water bath. It will be necessary to neutralise the liquid prior to distillation. The distillate should be mixed with chloride of calcium or anhydrous sulphate of copper, and re-distilled. The liquid thus obtained is shaken with dry carbonate of potash, and allowed to settle. The alcohol rises to the top of the mixture, whence it may be removed by the aid of a pipette, and tested as before mentioned.

Treatment.—Immediate use of the stomach pump and emetics; to empty the stomach a hypodermic injection of apomorphine may be given. Affusion of cold water to the head, or the injection of cold water into the ears, may be tried. The administration of ammonia, and the employment of galvanism, have been of service in some cases.