Text-book of forensic medicine and toxicologyBuchanan, R. J. M. (Robert James McLean)
Science
Text-book of forensic medicine and toxicology
Buchanan, R. J. M. (Robert James McLean)
Medical jurisprudence; Poisons
1. =Evidence from the Symptoms.=--As a general rule the symptoms come
on suddenly while the person is in apparent health, except in cases of
slow poisoning, when the poison may be so administered by frequently
repeated and small doses as to simulate disease, and the physician is
more easily misled than when a single large dose is given. In cases of
suspected homicide this suddenness in the accession of the symptoms
is particularly to be noticed, and we may have to decide as to the
probabilities of accident, suicide, or homicide. Here collateral
evidence must be our guide. The slowness, obscurity, and irregularity
of the symptoms are more in favour of homicide than either accident or
suicide. But it must also be borne in mind that the invasion of many
diseases is sudden, as is the case with cholera, gastritis, and some
others.
Certain conditions of the system more or less modify the effects of
some poisons. Thus, sleep delays the action of arsenic; and this may
also be the case with other poisons. Intoxication has also been said
to exert a retarding power over the action of certain poisons. This is
probably more apparent than real, the fact being that the symptoms in
the cases observed are masked.
Much more important, however, is the influence of disease. Large doses
of opium are well borne in mania, delirium tremens, dysentery, and
tetanus; whereas it is well known that even small doses of mercury in
cases of Bright‘s disease of the kidney, or in children recovering from
any of the eruptive fevers, have produced dangerous salivation.
The symptoms of poisoning go on from bad to worse in a steady course;
but there may be remissions, followed, under treatment, by their
entire disappearance, no ill effect remaining. Remissions are most
likely to occur in slow poisoning with the metallic irritants, from
fear of detection or cunning on the part of the poisoner to imitate
the progress of disease. In nervous affections, all the symptoms must
be taken into consideration, and these will be found to differ from
those of any known poison. The history of the case should also have due
attention paid to it.
In poisoning, the symptoms appear soon after food or drink has been
taken. This is open to the objection that apoplexy has occurred
immediately after a meal. The probative value of the above statement
is, however, increased if several persons have been similarly affected
after partaking of the same dish, especially if the symptoms followed
within a short time--under four hours--of the meal. But it must also be
remembered that all persons are not affected alike by the same poison.
Again, the diagnostic value is weakened if it can be proved that the
person or persons affected have taken nothing in the way of food for
two or three hours previously.
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