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626                                               MEDICAL JURISPRUDENCE

the drug in a larger dose to combat the feelings of lethargy and mental
depression as the symptoms of the first dose wear off.

It is a well-known fact that opium addicts can easily tolerate much larger
quantities of the drug than an ordinary fatal dose. Chopra and Grewal
ascertained in their investigations that Sikhs accustomed to opium in
Calcutta took it in quantities, varying from 10 to 15 grains, in twenty-four
hours.27 In the Punjab it is not unusual for an addict to take 100 grains of
opium a day and continue with it for years.~a Cases are also on record in
which individuals injected hypodermically 15 to 20 or more grains of mor-
phine per day. A case 20 is reported from the North-West Frontier Province
in which 60 grains of morphine a day were taken by hypodermic injection.
It should, however, be remembered that the opium addict may suffer from
the symptoms of poisoning by the same drug, if he exceeds his usual limit or
if he loses his power of toleration owing to unusual conditions of his system.

Unlike alcohol, opium does not seem to produce injurious effects on the
system- or to shorten life, if used in moderation; but its abuse for a prolonged
period leads to the derangement of appetite and digestion, disturbance of
sleep, vomiting, sluggishness of the bowels, emaciation, impotence, noura.s-
thenic condition, mental perversion of morality, premature old age and
dementia or mania. These symptoms are more evident in morphine eaters
than in opium eaters, and are known as morphinism or morphinomania. The
habitue is so depraved in morals, that he will stoop to any mean or criminal
act to obtain the drug which has become a necessity to him*

The best treatment for such a condition is the total deprivation of the
drug from the patient,, but this cannot be achieved without great moral con-
trol over one's mind which is not possible in such persons* Moreover, the
sudden deprivation of the drug produces cerebral excitement, restlessness,
yawning, sneezing, excessive salivation, malaise, palpitation, cramps, vomit*
ing, relaxation of the bowels, pain in the stomach and a burning sensation in
the back due to the formation of oxydimorphine, an acrid, irritating .sub-
stance, in the tissues. In order to prevent these symptoms it is advisable to
administer lecithin and glucose before opium is completely withdrawn* A
pill containing 10 grains of lecithin three times a day is given usually for the
first five days and 25 ccm. of 25 per cent glucose solution are given intra-
venously each morning for the first three or four days. Glucose may then
be administered by the mouth. In severe cases attended with cramps an
addition of 10 ccm. of a 10 per cent solution of calcium gluconate to gmcose
solution given intravenously would help greatly in ameliorating this symp-
tom. The diet should consist of fluids only for the first two or three days
and then light solids rich in protein and lecithin should be added gradually^

27.    Ind. Jour, of JWed. Research, July 1927, p. 57.

28.   Punjab Chem. Exam. Annual Rep., 1931, jp. 10.

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p 388.                   a                      ^ Ind M*d' Ga*" May 1937> *