Treatise on Poisons by Sir Robert Christison

apoplexy and those of narcotism, so far as regards their general features, there are particulars which are not indeed always present, but which when present will help to distinguish the one from the other. When the sopor of apoplexy is completely formed, it is rarely possible to rouse the patient to consciousness, and never, I believe, where the risk of confounding apoplexy with poisoning is greatest,—in the cases where death happens neither instantly, nor after the interval of a day, but in a few hours. On the other hand, in many cases of poisoning with the narcotics, and particularly with the commonest variety, opium, the person may be roused from the deepest lethargy, if he is spoken to in a loud voice, or forcibly shaken for some time, or if water is injected into his ear. Even in cases of poisoning with opium, however, the coma may have continued too long to admit of this temporary restoration to sense; the susceptibility of being roused is not so often remarked in other varieties of narcotic poisoning; and in some, such as poisoning with prussic acid, I am not aware that it has ever been remarked, at least in fatal cases. There are some other symptoms which in special cases may help to distinguish narcotic poisoning from apoplexy. Thus in poisoning with opium convulsions are rare; in apoplexy they are common enough. Bloating of the countenance is likewise much more common in apoplexy than in poisoning with opium. In apoplexy, too, the pupil is generally dilated, while in poisoning with opium the pupil is almost always contracted. But such distinctions do not apply either to the narcotics as a class, or to all cases of any one kind of narcotic poisoning.