Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

Others of less importance will be briefly considered.

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.