Lecture
Poisoning by functional poisons (poisoning with alcohol, ethylene glycol, dichloroethane, narcotic and other substances), caustic poisons (acetic acid essence, inorganic acids, alkalis, phenol), destructive poisons (mercury and its compounds, arsenic and its compounds, lead and its compounds), poisons acting on blood hemoglobin (aniline, sodium or potassium nitrate, carbon monoxide), agrochemicals (pesticides). Food poisoning (bacterial and non-bacterial). Poisoning from bites of venomous animals.
Acids act through their hydrogen ions. The more hydrogen ions, the stronger the action of the acid. Hydrogen ions neutralize the alkalinity of the blood, the reaction becomes acidic, which leads to a profound disturbance of metabolism and coagulation of the blood. Free hydrogen ions withdraw moisture, water from tissues, causing coagulation and complete destruction (necrosis) of protein. The mucous membrane at the sites of contact turns into dry, brittle scabs.
Alkalis act through their hydroxyl group (OH), which causes tissue death by liquefaction of proteins (colliquation). Tissues subjected to the action of alkalis appear not dry and brittle, as with acids, but soft, swollen, and smearing.
Among all poisonings, CO poisoning ranks second after alcohol. Carbon monoxide is a gas without odor or color, found everywhere, and is formed during incomplete combustion of fuels and lubricants due to an insufficient supply of air.
Carbon monoxide already acts poisonously at very small admixtures to air, since it has a much greater affinity for hemoglobin than oxygen, approximately 200-300 times greater. For example, if the air contains 19% oxygen and only 0.1% carbon monoxide, then about 51% of hemoglobin will be very firmly bound with carbon monoxide, i.e., carboxyhemoglobin is formed in toxic doses. As a result of carboxyhemoglobin formation, the blood loses its ability to become enriched with oxygen when passing through the lungs, and along with this loses its respiratory function. It is for this reason that carbon monoxide belongs to the blood poisons.
Clinical manifestations of poisoning appear already at a carbon monoxide content in the air of 0.03%. With saturation of the blood with carboxyhemoglobin at 10%, shortness of breath during work is noted; saturation of 20-30% is accompanied by headache, dizziness, ringing in the ears, flickering before the eyes, palpitations, etc. Further inhalation leads to euphoria, inability to move, ataxia, and vomiting. In this state, death often occurs as a result of vomiting and aspiration. At a concentration of carboxyhemoglobin in the blood of 60-70%, death occurs. This happens instantly if the air contains 1% or more carbon monoxide.
At autopsy of a corpse in cases of carbon monoxide poisoning, the light-red color of the livor mortis, blood, organs, and tissues is striking. It must be noted that light-red coloration of livor mortis alone is insufficient for diagnosis, since in other kinds of death (cyanide poisoning, death from cooling) the same livor mortis can occur. The color of the nails in corpses of persons who died from other causes is mostly blue-red, and only in carbon monoxide poisoning do they appear pink.
Confirmation of the diagnosis established during examination and autopsy of the corpse is made by testing the blood for the presence of carboxyhemoglobin.
CO poisonings are, for the most part, accidents or occupational in nature. However, suicides also occur, which at one time were widespread, especially in France.
At present, mercury poisoning occurs in industry and in medical institutions. Pure metallic mercury, taken by mouth, is not poisonous owing to its insolubility. It is dangerous only when it penetrates in a finely divided state through the skin, mucous membranes, and wound surfaces, and also when its vapors are inhaled. Mercury salts have high toxicity: mercuric chloride (corrosive sublimate), oxycyanide salt. Calomel is of low toxicity.
Mercury is used in the fur industry, in the manufacture of X-ray tubes, barometers, thermometers, etc. Poisoning occurs mainly through inhalation of mercury vapors.
Arsenic has long been known as a classic poison for murder and suicide. The development of reliable methods for its detection has limited its use for the purposes of murder.
The most important arsenic preparations, which are the usual cause of poisoning, are: arsenous anhydride, Fowler's solution, novarsenol, acetarsol. Of these, the leading poisoning agent is arsenous anhydride, a white powder without taste or odor, which makes it particularly suitable for intentional poisoning; moreover, it acts in insignificant doses, and its toxic effect does not begin immediately. It is readily accessible, since it is used in many industries, especially in agriculture for pest control and in veterinary practice. Accidents are quite possible. Arsenous anhydride can be mistaken for flour, salt, or sugar.
Hydrocyanic acid is always a lethal poison. Cyanide compounds are a favorite poison for murder and suicide, especially potassium cyanide and hydrocyanic acid. The latter can be obtained since they find application in industry (photography, the art industry); in gaseous form they are used for disinfection. Poisoning with hydrocyanic acid occurs as a result of accidents, especially in laboratories. Bitter almond water contains 0.1% hydrocyanic acid, so that 50.0 mL of this water can act fatally. About 50.0-60.0 bitter almond seeds can also cause fatal poisoning owing to the amygdalin they contain. Amygdalin is contained in the seeds of peaches, plums, cherries, etc.
Gaseous hydrocyanic acid acts fatally at a content of 0.3 mg per 1 L of air. The lethal dose of potassium cyanide is 0.1-0.2 g. Potassium cyanide in the stomach, combining with hydrochloric acid, liberates pure hydrocyanic acid, thereby significantly accelerating its action. Taken in a weakly acidic solution, in wine, or in lemon juice, potassium cyanide acts instantaneously. The rapid action of potassium cyanide is explained by the fact that it quickly penetrates through the wall of the stomach into the blood and combines within the cells with the respiratory enzyme. Thus, oxygen exchange stops, as a result of which death occurs from internal asphyxiation.
In the clinical picture at the onset of death, paralysis of the respiratory center is the dominant symptom, while cardiac activity continues for some time longer. When large doses of hydrocyanic acid are taken, death occurs within a few seconds. With smaller doses, poisoning develops more slowly and death occurs within a few minutes. Symptoms of poisoning: headache, nausea, general weakness, shortness of breath, protrusion of the eyes, a feeling of fear and tightness in the chest, brief severe convulsions, which should be regarded as a phenomenon of irritation of the motor centers due to internal asphyxiation.
Fatal poisonings with hypnotics are caused by taking anhydrous barbituric acid (luminal, veronal, barbamyl, nobarbital, etc.). These preparations are widely distributed in medical practice and are readily accessible. Their narcotic action manifests itself 15-20 minutes after intake. This state quickly passes into a coma, which may continue for 5-6 days. In the comatose state, inflammation and pulmonary edema develop.
Morphine is an alkaloid of plant origin, contained in opium, i.e., in the dried milky juice of the opium poppy. In acute poisoning with these substances, along with the narcotic action, a disturbance of the respiratory center predominantly occurs, while the vasomotor center is little affected. Death occurs in a state of deep coma with paralysis of respiration.
Morphine is preserved in a corpse for a very long time, and upon exhumation it can still be determined in the gastric mucosa. Morphine is excreted through the gastric mucosa, partly with feces, urine, and milk. The latter can be dangerous for nursing infants, who are highly sensitive to morphine.
Ethyl alcohol should be placed first by frequency of poisonings. Every state of intoxication is an acute poisoning. Usually alcohol enters the organism through the mouth. But it can be absorbed through the skin, from a wound (compresses), or through the lungs upon inhalation of vapors.
Alcohol acts on the organism as a narcotic substance, and the following phases of its action are distinguished:
a) excitation; b) narcosis; c) paralysis.
In the development of alcoholic intoxication, three stages of intoxication are observed - mild, moderate, and severe.
1. In mild intoxication, an increase in respiration and pulse rate, dilation of peripheral capillaries, and a rise in temperature are initially observed. Such subjects are excited, talkative, uninhibited. Motor excitation and a feeling of increased strength are noted. However, objective examination of the work performed indicates a decrease in muscular strength.
2. In moderate intoxication, reflexes fade, coordination of movement is disturbed (ataxia). Speech becomes incoherent, and signs of paralysis of the inhibitory centers appear. The intoxicated person becomes candid, now tender, now rough, often inclined toward violence, fighting, cursing. The pupils constrict, the temperature falls owing to increased heat loss and decreased heat production. Vomiting is observed.
3. Severe intoxication is characterized by the development of diffuse cortical inhibition. Reflexes are sharply diminished, breathing becomes rare and hoarse, the pupils do not react, the temperature falls significantly, muscular and cardiac weakness progresses, vomiting continues (aspiration of vomit). Involuntary urination and defecation occur.
In view of the wide prevalence and broad action of alcohol, many crimes are committed in a state of intoxication, especially the infliction of bodily injuries and offenses against morality. Quite common is so-called pathological intoxication, which is characterized by an increased pathological reaction to alcohol, i.e., a very strong reaction occurs from insignificant doses of alcohol; in other words, the person cannot tolerate alcohol. Such a state can often occur in congenital epileptics and in persons after cranial trauma. Pathological intoxication represents a qualitative change in the reaction to alcohol, i.e., illusory perceptions, sensory deception, unmotivated anger and fear without the usual signs of intoxication are observed. Such a state can occur suddenly and end in sleep after a short time. In most cases, amnesia (loss of memory for the past) follows. The danger lies in the fact that the most serious crimes can be committed in this state.
For a non-drinking person, the lethal dose of 96 percent alcohol is 100-150.0 or 250-300.0 g of vodka (6-8 g of pure alcohol per 1 kg of body weight). Children are especially sensitive to alcohol: in a five-year-old child, 10 g of it causes dangerous phenomena. Poisoning of children caused by alcohol compresses is known.
Forensic medical examination of poisonings
According to data of the World Federation of Toxicological Centers (2000), a toxicological situation has developed in the modern world, caused by the growth in the number of acute accidental and intentional poisonings with medicinal and industrial agents.
WHO (the International Programme on Chemical Safety) indicates that the frequency of poisonings with medicinal preparations alone is increasing from year to year in practically all countries, with centrally acting agents accounting for 60 to 75%. Topical issues are the toxicological aspects of drug addiction, substance abuse, and acute overdoses.
A poison – a substance entering the organism from outside, possessing the property of exerting a chemical and physicochemical effect and capable, under certain conditions, of causing poisoning even in small doses. Poison – is a relative concept. One and the same substance, depending on the dose, can lead to fatal poisoning, produce a therapeutic effect, or prove to be indifferent, and can also, under certain conditions, be used as a medicine.
Poisons can be systematized according to their origin (mineral, organic, etc.), their capacity to cause acute or chronic poisoning, the selectivity of their action (poisons with a predominant effect on the cardiovascular, urinary, central, or peripheral nervous systems, etc.), and their capacity to exert a predominantly local or general resorptive effect on the organism depending on the aggregate state of the poison, etc. In forensic medicine, it is customary to consider poisons according to their capacity to exert one or another local damaging effect.
Caustic poisons include those causing sharp morphological changes at the site of their contact with the organism (chemical burn): concentrated acids, alkalis, hydrogen peroxide, etc.
The action of destructive poisons is associated with the formation of dystrophic and necrotic changes in organs and tissues, including at the site of contact of the poison with the organism. This group includes salts of heavy metals (mercury, copper, zinc), phosphorus, arsenic, organic mercury compounds, etc.
The third group consists of carbon monoxide and methemoglobin-forming poisons (potassium chlorate, aniline, sodium nitrite, etc.).
The most diverse is the fourth group, which includes poisons exerting a predominant effect on the central and peripheral nervous systems: those stimulating the central nervous system include the properly stimulating ones (atropine, phenamine, phenatin) and the convulsant ones (strychnine, ergotamine, etc.); those depressing the central nervous system include the narcotic ones (morphine, codeine, chloroform, ethylene glycol, ethyl and methyl alcohols, etc.) and the hypnotic ones (barbiturates); those paralyzing the central nervous system include cyanide and organophosphorus compounds; and among the poisons acting mainly on the peripheral nervous system are the natural and synthetic muscle relaxants.
1. Conditions of action of a poison on the organism
The nature of morphological and functional changes in poisonings depends on the combined influence of a whole series of conditions. These include: the properties of the poison, the state of the organism, the routes of administration, distribution, deposition, and routes of elimination of the poison from the organism, environmental conditions, and the combined action of poisons.
The properties of a poison capable of influencing the character of the poisoning include its dose, concentration, aggregate state, solubility, and persistence in the external environment. Dose – the amount of poison that has entered the organism.
Poisons may be introduced into the organism in a solid, liquid, or gaseous state. The most aggressive are those that enter the blood faster, i.e., liquid and gaseous ones. More dangerous are poisons capable of dissolving quickly in the fluids and tissues of the organism. Some poisons do not have the capacity to persist for a long time in the external environment, for example potassium cyanide.
The development and outcome of poisoning are influenced by the properties of the organism itself, body mass, the amount and character of stomach contents, age and sex, concomitant pathology, individual sensitivity, and the organism's general resistance. In a person with a smaller body mass, poisoning proceeds more severely than in a person with a greater mass. Here the distribution of the dose of poison taken per one kilogram of mass is significant. When a poison is taken internally, its amount, consistency, and the chemical composition of the stomach contents play an essential role, since these can reduce the concentration of the poison, oxidize it, reduce it, or fully or partially adsorb it. Various diseases that disturb the detoxifying function of the liver and the filtration and excretory function of the kidneys aggravate the course of poisoning and thereby promote the accumulation of the poison in the organism.
An increased susceptibility to poisons has been noted in children compared with adults, which is usually explained by the insufficiently formed general resistance of the child's organism to various exogenous influences, as well as by the low activity of biotransformation of the child's liver enzymes.
It is known that during periods of pregnancy and menstruation, the resistance of the female organism to poison decreases. The action of a poison on an organism sensitized by that poison can lead to severe consequences and even fatal outcomes at a relatively small, non-lethal dose. Tachyphylaxis (rapid protection) is also observed – a decrease in the organism's sensitivity to certain substances upon their repeated administration at short intervals of time.
The particular course of poisoning may be due to genetic causes. It is known that in approximately 1 of every 1000 inhabitants, the activity of serum cholinesterase, which hydrolyzes dithylin used for induction anesthesia, is sharply reduced. In some inhabitants of Africa, Southeast Asia, and the Mediterranean region there is a genetically determined deficiency of the activity of the erythrocyte enzyme glucose-6-phosphate dehydrogenase, which makes them poorly sensitive to sulfonamides, phenacetin, and certain antibiotics, the administration of which leads to hemolysis of erythrocytes.
Repeated administration of small doses of certain poisons into the body induces habituation and increases tolerance to that poison. Thus, drug addicts survive after taking doses of narcotics that repeatedly exceed lethal levels. The course and outcome of intoxication are also influenced by the general resistance of the body. Poisoning proceeds more severely in people weakened by trauma, chronic diseases, in detrained individuals, and in those who are mentally exhausted.
The significance of the routes of entry of a poison into the body is determined by how quickly they ensure the poison's entry into the blood. Cutaneous application of a poison is the least dangerous, although some poisons (phenol, tetraethyl lead, certain fat-soluble substances) are sufficiently aggressive on contact with the skin surface, depending on the area and duration of contact. The most dangerous are aerogenic and parenteral entry of a poison, although there are also substances that are hazardous mainly on oral intake and almost harmless on subcutaneous administration (barium carbonate). The aerogenic route of entry usually leads to poisoning under industrial conditions when the maximum allowable concentration (MAC) in the air of the work zone is exceeded.
All other conditions being equal, direct introduction of the poison into the blood is the most dangerous. The mucous membrane of the gastrointestinal tract has good absorptive capacity, so introduction of the poison through the mouth or rectum leads to its rapid entry into the blood and the development of acute poisoning. A poison can be rapidly absorbed into the blood through the vaginal mucous membrane. The specific features of the course of poisoning when poisons are introduced through the rectum and vagina are due to the fact that the poisons enter the blood bypassing the hepatic barrier, and thereby exert a more pronounced toxic effect than when the same poisons enter in the same doses through the mouth.
The distribution and deposition of a poison in the body largely depend on the chemical structure and physical state of the poison, and its ability to dissolve in various tissues and media of the body. Fat-soluble poisons (dichloroethane, carbon tetrachloride, benzene, etc.) accumulate in adipose tissue, the liver, and the brain. Water-soluble poisons, spreading throughout the body, are mainly concentrated in muscle tissue, the brain, the liver, and the kidneys. Some poisons can be deposited in the bones and hair (arsenic, lead, phosphorus, etc.).
Excretion of poisons from the body occurs in most cases through the kidneys and lungs. Through the kidneys, mainly water-soluble and non-volatile poisons are excreted; through the lungs – volatile and gaseous substances. Poisons are excreted less actively through the gastrointestinal tract (alkaloids, heavy metal salts, methyl alcohol, etc.). Alcohols, narcotics, and essential oils are excreted with the bile; through the salivary and mammary glands – heavy metal salts, morphine, ethyl alcohol, pilocarpine, and potassium chlorate; through the sweat glands – phenol, halogens.
The routes of entry, the pattern of distribution and deposition, and the routes of excretion of poisons often determine the localization, nature, and extent of morphological changes in a given type of poisoning. Knowledge of these features of intoxication is necessary for the targeted search for a poison in the body.
Environmental conditions (elevated and reduced temperature, humidity, atmospheric pressure, etc.) are of greatest importance in occupational poisonings under conditions of special industries. In general, unfavorable external conditions weaken the overall resistance of the body and thus intensify the clinical course of intoxication. A classic example is the aggravating effect of low ambient temperature on the course of alcohol poisoning. Lack of ventilation is a factor contributing to the occurrence of poisoning by gases present in the atmosphere of mines and underground wells (methane, hydrogen sulfide, carbon dioxide, etc.).
When several poisons enter the body simultaneously, they may produce a combined effect: synergists (alcohol and barbiturates, novocaine and physostigmine, ephedrine and adrenaline, etc.) aggravate the course of poisoning, while antagonists (pachycarpine and scopolamine, alcohol and caffeine, potassium cyanide and glucose, cyanides and sodium nitrite, strychnine and chloral hydrate, etc.) mutually weaken each other's toxic effect. Chemical and physicochemical antagonism of poisons is widely used in antidote therapy.
The properties of a poison and the totality of conditions accompanying its action determine the clinical and morphological consequences of poisoning, which may be expressed by mild, moderate, or severe degrees of poisoning; a fulminant, acute, subacute, or chronic clinical course; local or general manifestations; primary and metatoxic action; selectivity of action on subtle biochemical processes in the body; predominant damage to particular body systems with a corresponding syndromal course; various routes and intensity of excretion of the poison; and a variety of immediate causes of death (pain and toxic shock, infectious complications, acute renal and hepatic failure, exhaustion, etc.). The complex process of interaction between the poison and the body is encompassed by the concept of toxicodynamics.
The fate of various poisons in the body is not the same. Some do not undergo significant changes, while others – are oxidized, reduced, neutralized, or adsorbed. In this process, new compounds are formed with either decreased or increased toxicity. Benzene, for example, is first oxidized in the body and then broken down with the formation of toxic metabolites: oxyhydroquinone, phenylmercapturic acid, and muconic acid. Hydrolysis of organophosphorus compounds leads to a loss of their toxicity, while oxidation – leads to a sharp increase. The processes of biotransformation of poisons mainly take place in the liver, the gastrointestinal tract, the lungs, the kidneys, adipose tissue, and other organs. The degree of activity of poison transformation in the liver is of the greatest importance. As it is retained in the body, a poison can become bound to the proteins of tissues and blood plasma. In such cases, the resulting «poison – protein» complex becomes partially or completely non-toxic, while in other cases – the protein performs the function of carrying the poison to the structures it affects. The formation of non-toxic complexes is often accompanied by the expenditure of substances important for the vital functions of the body. A deficiency of these substances in the body can lead to severe, and sometimes irreversible, changes in carbohydrate and other types of metabolism. The transformations of a poison in the body are defined by the concept of toxicokinetics.
2. Forensic medical diagnosis of poisoning
The sources of information used in the forensic medical diagnosis of poisoning are: the investigation materials, the medical records of the victim, the data of the forensic medical examination of the body, and the results of forensic chemical analysis and other additional studies.
The external and internal examination of the body in the morgue have mutually complementary objectives. During the external examination, an attempt is made to establish signs indicating:
1) the route of entry of the poison into the body (chemical burns on the lips, skin, around the mouth, on the oral mucous membrane, the skin of the perineum and the mucous membrane of the vaginal vestibule, puncture wounds from syringe injections, etc.);
2) the chemical nature of the poison (the color of livor mortis, the character of chemical burns, the size of the pupils, the color of the sclerae, etc.);
3) the rate of onset of death (the intensity of livor mortis, the presence of post-mortem ecchymoses, subconjunctival hemorrhages, etc.).
The purpose of the internal examination of the body is to establish:
1) the routes of entry of the poison (burns of the mucous membrane of the esophagus, stomach, vagina, and other organs, the presence of poison residues in the stomach, etc.);
2) the organs and tissues affected to the greatest extent;
3) the nature of the contact changes (chemical burns) and dystrophic changes in the internal organs;
4) the presence and nature of complications that have developed;
5) signs characteristic of the action of individual poisons (the color of the blood and internal organs, the character of chemical burns of the mucous membranes, the localization and character of inflammatory changes in the gastrointestinal tract, a specific odor from the opened body cavities and from the opened internal organs, etc.);
6) the immediate cause and the rate of onset of death;
7) the collection of materials for additional laboratory studies.
Among the additional methods, forensic chemical examination of the internal organs, tissues, and body fluids is of the greatest importance. Its purpose is to detect the poison and determine its quantitative content and distribution in the body. Although of great significance, the results of forensic chemical examination are not absolute.
A negative result of forensic chemical examination does not always exclude poisoning. In a case of known poisoning, it may be due to the following causes: antemortem transformations of the poison in the body (destruction, oxidation, reduction, neutralization, formation of complexes with proteins, etc.), excretion of the poison from the body (by natural routes, with vomiting, gastric lavage, etc.), administration of antidote therapy, improper collection of biological material for forensic chemical analysis, improper storage of the seized biological material, improper choice of the chemical analysis method, low sensitivity of the chemical examination method used, or technical errors.
A positive result of forensic chemical examination does not always indicate poisoning. The causes of a positive result of such an analysis (in the absence of poisoning) may be: endogenous formation of the poison in various diseases (for example, the formation of acetone in diabetes), prolonged use of medications, prolonged occupational contact with the poison, postmortem formation of certain poisons during decomposition of the body, postmortem penetration of the poison into the tissues of the body from the soil or clothing, deliberate postmortem introduction of the poison, accidental introduction of the poison during improper sanitary treatment of the body, or errors in the organization and technique of forensic chemical examination.
Therefore, the forensic medical proof of poisoning must be the result of an evaluation of all the data collected: the investigation materials, the case history data, and the results of the autopsy, histological, and forensic chemical examinations.
Simple alcohol intoxication
Single (simple) alcohol intoxication – is acute alcohol intoxication. Ethyl alcohol exerts a general depressant effect on the central nervous system. This manifests itself in the form of three main stages:
1) the stage of excitation;
2) the stage of narcosis;
3) the agonal stage.
The rate of onset and the severity of the symptoms of intoxication are determined by the amount and quality of the alcoholic beverages consumed, the psychophysical state, and individual sensitivity to alcohol.
Mild, moderate, and severe degrees of intoxication are distinguished.
Biochemical parameters (blood alcohol content) of the degree of intoxication:
1) mild – 0,5–1,5 %;
2) moderate – 1,5–2,5 %;
3) severe – 2,5–5 %;
4) lethal – 5–6 %.
In the initial period, with a mild degree of intoxication, a pleasant feeling of warmth, muscular relaxation, and physical comfort arises. Mood is elevated: the person is pleased with themselves and those around them, self-confident, optimistically overestimates their own abilities, and boastful. The intoxicated person talks a great deal and loudly, easily switching from one topic to another. Movements lose their precision. Self-criticism and criticism of others decreases.
As intoxication approaches the moderate degree, the benevolently euphoric mood begins to be increasingly replaced by irritability, touchiness, and compliance, and this is reflected in the content of statements and behavior.
The clarity of perception of the surroundings decreases, and thought processes and associative activity slow down.
Speech becomes abrupt, indistinct, and slurred, and perseverations appear.
As a result of the decrease in conscious, critical attitude toward the behavior of others and toward one's own personality, intoxicated persons often commit inadequate actions. Emerging desires and thoughts can easily be realized in impulsive aggressive acts against those around them. As a result of the action of alcohol on the body, individual characterological features are sharpened or exposed.
At this stage of intoxication, long-standing psychotraumatic experiences and grievances readily resurface. This leads to quarrels, fights, etc.
Pain and temperature sensitivity decrease. Memories relating to the period of intoxication, as with the mild degree, remain fairly complete.
With the severe degree, a change in consciousness of varying depth is observed – from stupor to coma.
Coordination of movements is sharply impaired, and orientation in space and time deteriorates. Vestibular disturbances appear (dizziness, nausea, vomiting, etc.). Cardiac activity weakens, blood pressure and temperature decrease, physical weakness increases, and interest in the surroundings is lost.
The intoxicated person appears drowsy and soon falls into a narcotic sleep, sometimes in the most unsuitable places. In a number of cases, involuntary urination, defecation, and convulsions are observed.
After a deep sleep, real events during the period of intoxication may be retained in memory; recollections are often fragmentary, and complete amnesia is also possible.
In forensic practice, atypical states of simple intoxication are encountered, with hysterical phenomena, elements of exaggeration, mischief, deliberate licentiousness, brashness, etc.
Minor quarrels, an offensive word, an unfortunate remark, or an unfulfilled desire prove to be sufficient grounds for aggressive actions by the intoxicated person, which are carried out immediately. The ability to comprehend the actual nature and social danger of one's actions, or to control them, is retained, sometimes only weakened.
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