596 IMPORTANT POISONS AND THEIR TREATMENT 



calculable damage. Opium is employed extensively in the Orient and slightly 

 in our country as an intoxicant in the form of smoking. Thus used it causes 

 severe chronic poisoning to which I shall later refer. 



We shall first consider the consequences of the introduction into the body 

 of large quantities of opium or morphin. What constitutes a large quantity 

 is always relative: in a child a milligram of morphin may give rise to the 

 severest symptoms, while the morphinomaniac addicted to morphin may take 

 0.5 gram and more. At first sopor appears. This passes into deep sleep. 

 The temperature of the body falls, the respirations and the pulse become slow 

 and irregular, the pupils are narrowed, the sclerse injected, and in a few 

 hours the adult patient succumbs in deepest coma. With children, as shown 

 by the observations of Eschle and myself, spasms are prominent, and the child 

 succumbs to paralysis of the respiratory center. 



If the individual withstands the shock of the first few hours, or if, by 

 proper treatment, the dangerous stage has been fortunately passed after days 

 of coma, consciousness may return. The patient is, however, greatly debili- 

 tated; headache, vomiting, stypsis and dyspepsia continue, and frequently in 

 the period of convalescence death occurs suddenly from cardiac paralysis. 



The urine frequently shows glycosuria, alimentary as well as spontaneous. 



How is acute morphinism, or opium poisoning, to be treated ? 



First, in all cases, the stomach is to be washed out, even though morphin 

 has been injected subcutaneously, for it is excreted into the stomach. 



The sopor must be combated; a warm bath with cold affusions gives the 

 most certain results. If this procedure has no effect, venesection and the 

 inhalation of oxygen should be resorted to. In desperate cases tracheotomy is 

 also to be performed, and oxygen may be introduced through a tracheal can- 

 nula. If, as in the case of a child, respiratory disturbances are most promi- 

 nent, artificial respiration and even phrenic faradization is to be employed. 

 Threatening cardiac collapse is to be met with injections of camphorated oil 

 as well as hypodermics of strychnin. 



So much, briefly, in regard to acute morphin poisoning. 



A very important role is played by chkonic MOEPHiisr toxicosis, which 

 is widely prevalent. 



The diagnosis is not always easy, for often the patient makes every effort 

 to mislead the physician. Numerous deeply situated scars on the skin from 

 abscesses of the subcutaneous cellular tissue are suspicious. Dyspepsia, styp- 

 sis, also the symptoms of marasmus prsecox, increase the likelihood of the 

 diagnosis, but it becomes absolutely certain only when the patient confesses 

 that he uses morphin, or when solutions of morphin are found in his possession. 



The treatment of chronic morphinism can be successfully carried out only 

 m a hospital or in sanatoria adapted to this purpose. A withdrawal treatment 

 must be more or less slow, according to the somatic condition of the individual. 

 Hitzig's gastric lavage with Carlsbad water, and the simultaneous subcutaneous 

 mjection daily of decreasing quantities of morphin, are advisable. The em- 

 ployment of so-called substitution methods, i. e., the substitution of alcohol, 

 cocam, etc., for morphin, has produced no good results. 



If, under this withdrawal treatment, signs of collapse appear, the treatment 



