In animals killed by alcohol, Orfila says he found the villous coat of the stomach constantly of a cherry-red odour. I have several times remarked the same appearance. When the stomach was empty before the alcohol was introduced, I have always found the prominent part of its rugæ of a deep cherry-red tint, the margin of the patches being more florid, and evidently consisting of a minute network of vessels.
In man these signs of irritation have not been always observed. In the patient who died in the Infirmary here, the stomach was quite natural to appearance. Dr. Ogston notices injection of the small intestines and thickening of the mucous membrane of the stomach and intestines as common appearances in the cases he has examined; but he seems to consider these the effects not of the last fatal dose, but of the habit of frequent excessive drinking.[[2527]]
The blood in the heart and great vessels is commonly fluid and very dark, and the lungs are sometimes more or less gorged with the same fluid.
The state of the brain differs much according to the mode of death. Sometimes great congestion and even actual extravasation of blood are found in the heads of persons who have died of excessive continuous drinking,—the excitement of such a debauch being apt, as already mentioned, to induce apoplexy in a predisposed habit. Accordingly extravasation was found by Professor Bernt of Vienna in no less than four cases of the kind, two of which happened in the persons of young men not above twenty-two years of age;[[2528]] and Dr. Cooke quotes another in his work on nervous diseases.[[2529]] I have myself met with another remarkable instance. A female out-pensioner of Trinity Hospital here, who was much addicted to drinking, and for fourteen days after the New-year of 1830 had been very little in her sober senses, soon after arriving at home one evening much intoxicated, fell down comatose, and died in ten or twelve hours. An enormous extravasation of clotted blood was found in the ventricles, producing extensive laceration of the right middle and anterior lobes of the brain.—In such cases it is natural to suppose that a predisposition to apoplexy must concur with the intoxication; otherwise it is not easy to see why death from extravasation is not more frequently produced by excessive drinking.
Extravasation is not apt to occur in the cases of rapid death brought on by a very large quantity swallowed at once. The circulation, indeed, is during life in a state quite the reverse of excitement; and accordingly the brain and its membranes are found quite healthy. They were particularly so in the man who died in the hospital here. It is right to mention, however, that one of Bernt’s cases, although the symptoms and other particulars are not mentioned, possibly belongs to the present variety, as the man swallowed for a wager a quart of brandy at a draught.[[2530]] According to Dr. Ogston, who has given the best account of the appearances within the head in the ordinary cases of this kind, there is usually serous effusion under the arachnoid membrane, occasionally minute injection of vessels, commonly more or less general gorging of the larger veins, and especially effusion of serosity to the amount of two or even four ounces in the ventricles.[[2531]]
When delirium tremens proves fatal, effusion is commonly found among the membranes of the brain; and occasionally to a great extent. In one instance, which proved fatal in two or three days, I have seen minute vascularity of the membranes, with effusion of fibrin, and without effusion of serosity; but such cases are rare. There is also, according to Andral, very extensive softening of the mucous coat of the stomach.[[2532]] In an instance mentioned in Rust’s Journal, besides effusion into the cerebral membranes, there was found an enormous accumulation of fat in all the cavities, a conversion of the muscular substance into fat, and a nauseous sweet smell from the whole body.[[2533]]
In all cases of rapid poisoning with spirituous liquors some of the poison will be found in the stomach. For when the case is one of pure narcotic poisoning, unaided by the effects of blows, exposure to cold, or the like, and the person dies in a few hours, the poison cannot be all absorbed before death.—Although the spirituous liquors used in Britain have all very powerful odours, the inspector in a case of importance ought not to confine himself to this test alone. He must subject the suspected matter to distillation; and then remove the water from what distils over by repeated agitation with dry carbonate of potass, till he procures the alcohol of the spirit in such a state of purity as to be inflammable.
Alcohol may also be in some circumstances detected in the tissues and secretions of the body. A spirituous odour has been remarked not infrequently in various parts, and especially in the brain. Dr. Cooke mentions a case in which the fluid in the ventricles of the brain had the smell and taste of gin, the liquor which had been taken;[[2534]] Dr. Ogston adverts to an instance, in which after death by drowning during intoxication, he found in the ventricles nearly four ounces of fluid, having a strong odour of whisky;[[2535]] in the case which occurred in the hospital here the odour of whisky was said to have been perceived in the pericardium; and in a man who died of long-continued intoxication from immoderate drinking Dr. Wolffe found that the surface, and still more the ventricles, of the brain had a strong smell of brandy, although the contents of the stomach had not.[[2536]]
The presumption afforded by such facts as these, in favour of the absorption of alcohol and the possibility of detecting it throughout the animal system, has been turned to certainty by the late experimental researches of Dr. Percy; who found that in animals poisoned with alcoholic fluids, as well as in the case of a man who died during the night after drinking a bottle of rum, alcohol could be detected, generally in the urine, and also in the brain, by cautious distillation, and removing the water from the distilled fluid by means of dry carbonate of potass.[[2537]] Dr. Percy gave me an opportunity of verifying his results with the brain of the man; and I had no difficulty in obtaining from a few ounces of brain a sufficiency of spirit to exhibit its combustion on asbestus repeatedly.
It is hardly necessary to add, that when the individual has survived the taking of the poison a considerable length of time, an odour of spirits will not be perceived either in the stomach or elsewhere. In the out-pensioner of Trinity Hospital, for example, who survived about twelve hours, no spirituous odour could any where be perceived. In such cases the poison disappears during life by absorption.—A question may even be entertained, whether the odour may not sometimes be imperceptible at the inspection of the body, although the poison was really present immediately after death. It is probable that, as in the instance of hydrocyanic acid, the alcohol, on account of its volatility or fluidity, will evaporate or percolate away in a few days. In this manner only can be explained the occasional absence of the odour in persons who have been killed in the early stage of drunkenness. I could not perceive any odour of whisky in the stomach of the woman Campbell, who was murdered by the notorious resurrectionist Burke, although she had drunk spirits to intoxication half an hour before her death. The body was not examined till thirty-eight hours after.[[2538]] It must be observed, however, that alcohol may exist in the contents of the stomach and be detected by chemical analysis, although it is not indicated by its odour. I have twice had occasion to observe this, where the bodies were disinterred some time after death.