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618                                                MEDICAL JURISPRUDENCE

several hours.   The symptoms manifest themselves in three stages, viz.  (1)
stage of excitement; (2) stage of sopor ;  (3) stage of narcosis.

1.    Stage of Excitement.—During this stage the symptoms are increased
mental activity, loquacity, restlessness, or even hallucinations, flushing of the
face and increased action of the heart.   This stage is of a short duration, and
may be absent if a large dose is taken.   In children convulsions are a marked
feature in the first stage.   In adults a widely excited, and even a maniacal
condition may be seen in this stage.   An Indian soldier at Poona who com-
mitted suicide by taking opium was very excited and noisy for about a
quarter of an hour and then became deeply comatose.^

2.    Stage of Sopor,—The nerve centres are depressed during this stage,
which sometimes comes on quite suddenly.   The symptoms are headache,
giddiness, lethargic condition, drowsiness, and an -uncontrollable desire to
sleep, from which the patient may be roused by external stimuli.   The pupils
are contracted, the face and lips are cyanosed and an itching sensation is felt
all over the skin.   The pulse and respirations are still normal.

3.    Stooge of Narcosis.—The patient now passes into deep coma from
which he cannot be roused.   During this stage the muscles are relaxed, and
the reflexes are lost.   All the secretions are almost completely suspended,
except that of the skin, which feels cold and clammy.   The face is pale, the
lips are livid, and the lower jaw drops.   The pupils are contracted to pin
points and are insensible to light.   The conjunctivas are injected.   The pulse
is slow, small and compressible.   The respirations are slow, laboured and

At this stage recovery may take place by prompt and proper treatment j
otherwise in the case of fatal termination lividity of the surface increases.
The pulse becomes slower, more irregular and imperceptible. The respira-
tions are slower, more feeble, and assume the character of Cheyne-Stokes,
death occurring from asphyxia. The heart may continue to beat for a short
time after respiration has stopped. Convulsive twitchings in groups of the
muscles are observed, and the pupils become widely dilated towards the end*
Sometimes, death occurs from failure of the heart, The odour of opium may
be present in the breath throughout the illnofef This is sometimes masked
by the injudicious administration of alcohol by relatives.

Unusual Symptoms.—^Vomitin^^aoxdpurgiixg may be present in a few
cases. In a case in which a sweep^rTnLahore, an addict to opium, died
from an overdose, one of the chief symptoms was waiting. Hie vomited
matter on chemical analysis showed the presence of optain.a A young Hindu
of Pangaon in Barsi Taluka, who died after taking th« food prepared by his
wife, had symptoms of vomiting and purging. An analysis of the viscera
revealed the presence of opium alone and no other poison.4

Convulsions of_a^tetajQoj^^ character are occasionally prtsent, more
frequent In dhtildrentKa^^              In the case of a student of the Agra

College, who died of opium poisoning, .the prominent symptoms were con-
vulsions and a rise of temperature, which misled a medical attendant very
much in the correct diagnosis. In the case of a private soldier in the first
Yemen Infantry at Aden who died of opium poisoning, the chief symptoms
were remittent attacks of convulsions and a rise of temperature to 104°F,
before death.5 In the case 6 of a-female, aged 32, who died of opium poison-

2.   Bombay Chemical Analyser's Annual Report, J$2$r p, 7,

3.   Punjab Chemical Examiner's Annual Report, 1925, p. 2.

4.   Bombay Chemical Analyser's Annual Report, 192i, p. 4.

5.   Bombay Chemical Analyser's Annual Report, 1925, p. 4

6.   Shah, The Bombay Medical Jour., Vol. I, No. 5, p, 171