abruptly_. The individual is suddenly observed to cry out, often to
vomit, and instantly falls down in convulsions. The effects of the
narcotic poisons, if we except some cases of poisoning with hydrocyanic
acid, the narcotic gases, and a few rare alkaloids, never begin
otherwise than gradually, though their progress towards their extreme of
violence is often rapid. This distinction is generally an excellent one.
But it will not apply so well to some cases of epilepsy in which the
convulsions are trivial. Esquirol says an epileptic fit may consist of
nothing more than coma, with convulsive movements of the eyes, or lips,
or chest, or a single finger.[1647] Still even then the coma generally
begins abruptly, so that if the case is seen from the beginning, it can
hardly be mistaken for narcotic poisoning. Some forms of epilepsy, in
which the fit is constituted merely by giddiness, staring, wandering of
the mind, and imperfect loss of recollection,[1648] might be confounded
with the milder forms of narcotic poisoning. But collateral
circumstances will scarcely ever be wanting to distinguish such cases
from one another.
The varieties of narcotic poisoning which, in the violence and
abruptness of their commencement, bear the closest resemblance to an
epileptic attack, are some cases of poisoning with hydrocyanic acid or
with the deleterious gases. Both of these varieties, however, when they
begin so abruptly, are distinguished from a fatal paroxysm of epilepsy
by the fourth characteristic to be mentioned presently; and besides, in
abrupt cases of poisoning with hydrocyanic acid, the poison under
certain conditions will be found in the body; while in sudden poisoning
with the narcotic gases, the nature of the accident is rendered obvious
to a cautious inquirer by the collateral circumstances.