OPIUM OR BELLADONNA POISONI.NG.— From opium poisoning, pin-point pupils, and from belladonna poisoning, the equal dilation of the pupils usually exclude alcoholism, but alcohol may be present with either of the other poisons. Some times the greatly lowered temperature points to alcoholism.
APOPLEXY.—The respiration is usually stertorous and the coma deeper. Hemi plegia may be evident from the greater flaccidity of the limbs on one side. The urine may contain albumin; ausculta tion may reveal some cardiac lesion; the breath will not smell of alcohol, unless the attack has occurred in a person who has been drinking, or some one, since the attack, has administered some alco holic stimulant. Conjugate deviation of the eyes may exist.
EPILEPSY.—In this disease there is a history of clonic convulsions. The pulse is rapid, dicrotic (Trousseau), and rather fast; frequently the urine and forces have escaped, while the tongue may have been bitten.
The frequent mistakes in diagnosis committed by medical experts have dem onstrated the practically insuperable dif ficulty in forming an accurate judgment till time be given for the disappearance of alcoholic symptoms. "For a time it may be impossible to determine whether the condition is due to urremia, profound alcoholism, or haemorrhage into the pons Varolii." Diagnosis between acute alcoholism and traumatism: external injury sug gests the possibility of grave internal lesion. However, no mark of violence may be found upon the closest inspec tion; a fracture of the skull or a luem orrhage within the cranium may have no outward sign. Or a heavy wagon may pass over the body, fracturing the ribs, rupturing the liver, perforating the in testines, or injuring other vital organs without producing any external mark. (See AnDOMEN, Coxrusioxs.) Primary shock, following immediately upon the injury, will exhibit a subnormal tempera ture and a small and fluttering pulse, nausea, vomiting, cold and clammy skin, and relaxed sphincters.
Depressed fractures at the vertex may be detected by palpation. Fissured fract ures may be found upon inspection, with the help of an incision if necessary, or the finger-nail or a probe may be passed across the surface. When the blood is
wiped from a suspected part and no fresh blood appears, there is a suture; if fresh blood oozes to the surface, there is a fis sured fracture. In fracture of the base there w ill usually be found haemorrhage from the nose, mouth, and ears, and ecchymosis into the conjunctiva or sub cutaneous cellular tissue; or vomited blood may have been swallowed after fracture of the ethmoid or sphenoid, fol lowed by hemorrhage into the posterior nares. But absence of such haemorrhage does not necessarily indicate absence of fracture.
A rare, but positive, symptom of fract ure of the base is the escape of a watery fluid, probably cerebrospinal fluid, from the ears, the nose, or the mouth. Fract ures of the petrous portion of the tem poral bone involving the tympanum may produce in the temporal or mastoid re gion a pneumatocele: a smooth, circum scribed, resonant, non-fluctuating tumor.
Cerebral irritation usually follows a blow upon the forehead or the temple. The patient lies on one side, is restless, with the extremities flexed and the eye lids firmly closed. If the eyelids are forcibly opened, the pupils are found con tracted and intolerant of light. The sur face is pale and cool. or even cold. The pulse is small, feeble, and slow. The patient is irritable, muttering, and grinds his teeth when disturbed. The sphincters are not usually alTeeted and there is no stertor.
There will he a rise in temperature in head injuries, except in primary shock and in large uncomplicated when the temperat tire is likely to be sub normal (Phelps). Other signs of intra cranial lesion are photophobia, with the eyelids firmly closed, intolerance of sound, the carotids beating forcibly, a blowing of the lips, a flapping of the cheeks, rigid contraction of limbs, and clonic or tetanic convulsions. The Cheyne-Stokes respiration is found in injury to the brain and cerebral haemor rhage. The breathing becomes, by de grees. deeper and more rapid up to a cer tain point, and then subsides in the same gradual manner until there is a complete cessation of respiration, with a deep silence, the pause before the next respira tion lasting a variable time.