Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

Cholera.—Extreme and sudden prostration. The breath is cold to the hand in the last stages. The body is cold, shrivelled, and livid, or of a leaden hue. Vomiting and purging are present; the former is never bloody, the latter resembling rice-water. The thirst is intense, and in this particular alone resembles the effects of irritant poison. Death in from one to two days, or even less.

Summary of the General Evidence of Poisoning,
in a Tabular Form

Poison.	Natural Causes.
1. The symptoms come on suddenly,	1. Many diseases come on
and rapidly progress.	suddenly—cholera, gastritis,
	&c—and run a rapid course to
	a fatal termination.
2. The symptoms begin while	2. Some acute diseases begin
the person is in sound health.	under like circumstances.
3. The symptoms of poisoning	3. This is also the case with
go on from bad to worse in a	many common diseases.
steady increase.
4. Uniformity in the nature of	4. The uniformity of the symptoms
the symptoms.	is common to many diseases;
	but in some cases the absence
	of uniformity may be a proof
	of disease.
5. The symptoms come on	5. Apoplexy, colic, cholera, and
immediately after a meal.	some other diseases may follow
	a meal. But the fact that some
	hours have elapsed since the
	last meal is against the
	probability of poisoning.
6. Several persons are attacked,	6. As a general principle it may
after partaking of the same	be stated that there is no
meal, with the same symptoms.	disease likely to attack
	several persons at once, but
	there are cases on record of
	this having occurred.
7. Poison found in the food,	7. Poison may be mixed with food,
vomited matters, urine, &c.	&c, in cases of imputed poisoning.

English Cholera.—In this disease all the symptoms of irritant poisoning are present. Pain in the belly, and vomiting. But in this disease the vomit and alvine discharges are never bloody, most frequently bilious. An acrid taste in the mouth and throat succeeds the vomiting. This is due to the acrid nature of the vomited matters. The stools contain bile in English cholera; in irritant poisoning, sometimes blood. Death is rare within three days.

Gastritis.—Acute idiopathic gastritis is so rare in this country as scarcely to need description. Most of the cases recorded of acute gastritis have been found to be due to irritants. We must, therefore, consider the period and order of the occurrence of the symptoms in relation to the last meal. Costiveness of the bowels would point to the presence of gastritis or enteritis, violent purging and vomiting to irritant poisoning.

Enteritis.—Though more common than gastritis, enteritis is a rare disease. The bowels are generally confined. Tubercular and aphthous inflammation of the intestines may simulate irritant poisoning, especially chronic poisoning by arsenic. The post-mortem and a chemical analysis will reveal the true cause of death.

Peritonitis.—In the early stages of the disease vomiting is rare, and constipation is the rule, with marked tenderness over the whole abdomen. The morbid appearances in the peritoneum are seldom caused by irritants.

Perforation of the Stomach.—The symptoms supervene immediately after a meal; the pain, which is very acute, gradually extending over the abdomen. In most cases the patient has suffered for some time previously from dyspepsia.

Hernia.—Examine the seat of pain, the cause will be soon detected. But an omental hernia may be present, giving rise to twisting pain at umbilicus.

Intussusception of the Bowels.—Pain, sudden and confined to one spot below the stomach. Vomiting is present without purging, thus differing from diarrhœa and cholera. After a time the vomit becomes fæcal.