DIAGNOSIS OF POISONING—DUTIES OF THE PRACTITIONER.
The chief characteristics of poisoning mentioned by authors of repute are, that the symptoms commence suddenly after taking any substance or fluid into the stomach, the individual being in a state of health; that they increase steadily, and are uniform in their nature throughout their course; and that they prove rapidly fatal. There are many exceptions to these rules. Thus if the stomach be loaded the appearance of the symptoms will often be delayed some few hours. Sleep, according to Dr. Christison, may retard the action of some agents; so that if a person fall asleep soon after swallowing arsenic or strychnia, for example, no effect may ensue for four or five hours. Intoxication will mask the effect of narcotics. Again, the individual poisoned may possibly be suffering from disease, and an agent may be given which will only aggravate existing symptoms. The fact must not be forgotten that sometimes a poisonous draught is substituted for a harmless medicine. And lastly, after a poison has manifested its effects the symptoms often remit for a time.
When poison is administered with a criminal intent it is generally in such a dose as to take immediate effect, although this is by no means necessary, as there are numerous substances which accumulate in the system, and when given in small and repeated quantities, ultimately prove fatal. It must also be remembered that there are many diseases, as malignant cholera, internal hemorrhage, &c., which commence suddenly, and rapidly run to a fatal termination. In inflammation of the stomach or intestines the symptoms often set in suddenly, and might be mistaken for poisoning; such is also the case in intestinal obstruction, and especially in ulceration and perforation of the bowels. So also in organic diseases of the heart, where the symptoms may have remained latent for some time, death often occurs suddenly from syncope. The diagnosis of the effects of irritant poisons is not so difficult as it is in the case of narcotics or other neurotics, where the symptoms are very similar to those produced by apoplexy, epilepsy, tetanus, convulsions, or disease of the brain.
Generally speaking, a person may be supposed to be suffering under the effects of a poison, if soon after taking food or drink, he be seized with violent pain, vomiting, disorder of the alimentary canal, and convulsive movements: or if he be attacked under the same circumstances with vertigo, delirium, or great drowsiness. It must not be forgotten, however, that poisons may be introduced into the body, not only by the mouth, but also by means of suppositories and enemata, or in females by vaginal injections, or by inhalation, or by subcutaneous injection, or through the true skin after the removal of the cuticle. Should death ensue, the presumption of unfair play will of course be strengthened by the discovery of post-mortem appearances similar to those known to be produced by the poison from which the person apparently suffered.