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.