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OPIUM                                                 619

ing, the chief symptoms were muscular rigidity, violent delirium, frequent
respirations (58 per minute) and a temperature of 106°F. Opium was
detected by the Chemical Analyser in the stomach and its contents and in the
other viscera, viz. the liver, spleen and kidneys.

In a few cases the pupils may be found dilated in the earlier stage,
especially when chlorodyne has been taken. The dilatation of the pupils is
probably due to hydrocyanic acid contained in it.

Syncope may occur in some individuals after the subcutaneous adminis-
tration of morphine. A case is recorded where one-sixth of a grain of mor-
phine hydrochloride injected subcutaneously almost proved fatal to an old

After an apparent remission of symptoms, sometimes it so happens that
they return with more severity to end in death. This is explained by the
fact that absorption is practically in abeyance during the stage of depression,
and the poison is reabsorbed from the alimentary canal, when circulation
has improved.

Codeine resembles morphine in its action, although it is much less
poisonous. It excites the brain and the cord more than morphine. The
symptoms produced by codeine poisoning are sometimes nausea, vomiting,
abdominal pain, delirium and convulsions, and thus differ from those caused
by morphine poisoning. There is also less constipation than with morphine.

Diagnosis.—Opium poisoning has to be diagnosed from apoplexy, uraemic
coma, diabetic coma, epileptic coma, hysterical coma, acute alcoholic poison-
ing, carbolic acid poisoning, and compression of the brain.

Apoplexy.—In apoplexy the patient affected is usually fat and old. The
onset is sudden and abrupt. The chief symptoms are a slow, full pulse and
paralysis, usually hemiplegia. The pupils are dilated except when the lesion
is in the pons Varolii, when they are contracted but not symmetrical, and the
temperature is raised to 103° or 104 °F. A case 8 is reported where encepha-
litis lethargica was diagnosed as opium poisoning, as the patient was semi-
comatose with the pupils fixed and contracted to pin points and his tempera-
ture was subnormal.

l/rcemic Cowa.—In uraemic coma there is always the previous history
of a kidney disease with the presence of albumin and casts in, the urine and
anasarca. Epileptiform convulsions generally precede coma.

Diabetic Coma.—The onset is gradual and the skin is flushed. The res-
pirations are slow and deep, and the breath has a sweet odour of acetone.
The urine contains sugar and aceto-acetic acid.

Epileptic Coma.—This follows an epileptic fit, which, may affect persons
of all ages. The face and lips are generally livid. The pupils are dilated.
The patient is easily roused, as the coma is less profound.

Hysterical Coma,—This is commonly met with in females and rauely in
males. There is a history of hysterical fits with convulsive movements.
Saliva may be seen issuing from the mouth. The tongue is, as a rule, not
bitten and the reflexes are not altered. Kecovery is generally rapid.

Acute Alcoholic Poisoning.—In acute alcoholic poisoning the chief symp-
toms are the congested face, injected eyes, dilated pupils, odour of alcohol in
the breath and snoring respirations. The patient may be roused by Iou4
shouts or vigorous shaking, and there is no paralysis.

7,   Blyth, Poisons, their Effects and Detection, Ed. V, p. 307.

8.   Toms, Brit Med* Jour., Nov. 1, 1924, p. 814.            ,                        ; ,     :