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.