ALKALOIDS 597 



is to be discontinued. Larger doses of morphin must be administered, or if 

 cardiac weakness intervene, digitalis or subcutaneous injections of camphor- 

 ated oil, etc., are to be employed. 



We now turn to atropin poisoning. 



The cases of poisoning where atropin has been administered as medicine 

 are very rare; Poisoning by belladonna (atropa belladonna) is more frequent. 

 These eases of poisoning occur usually in children. The characteristic symp- 

 toms are dryness of the mouth, burning of the throat, and difficulty of deglu- 

 tition. There is also extreme psychical alteration. The cardinal symptom, 

 however, is maximal dilatation and absence of reaction of the pupils, accom- 

 panied by marked acceleration of the pulse. In cases terminating fatally, deep 

 coma supervenes, then paralyses of all kinds, and the patients succumb in a 

 few hours. 



In all such forms of poisoning immediate gastric lavage is indicated, as 

 well as the employment of emetics, and subcutaneous injections of apomorphin. 



The best antidote is morphin subcutaneously injected in doses of 0.02-0.03 

 gram. 



Among the poisons of special interest to the physician is that of cocain, 

 an alkaloid produced only within the last two decades of the last century, but 

 which has found employment in medicine to a great extent as a local anes- 

 thetic. Intradural injections of cocain have lately been advised, and, unless 

 the greatest care is exercised, these will soon increase the numbers of poison- 

 ings from this remedy. 



The first symptom of cocain poisoning -is local anesthesia of the areas of 

 the body coming in contact with the cocain, a symptom which the physician is 

 frequently desirous of producing. Unfortunately this symptom does not appear 

 alone, but the respiratory and pulse frequency are increased, arrhythmia of 

 cardiac action occurs, the pupils are dilated, there is cyanosis combined with 

 pallor, and the patient succumbs to cardiac collapse. Occasionally such cases 

 are characterized by the appearance of severe mental disturbance prior to the 

 final collapse ; not rarely, however, even after these very severe symptoms, final 

 recovery takes place. Treatment: Gastric lavage if there is severe collapse; 

 warm baths with cold affusions. 



A disease which has only lately originated from the abuse of cocain is 

 cocainism, which, in its disastrous consequences, is scarcely less important than 

 chronic morphinism; the symptoms are generally referable to the nervous 

 system, and their number is legion; rapidly increasing marasmus causes the 

 early death of the patient. 



In the group of the glucbcides only one toxicosis plays a leading role, and 

 this is poisoning from the leaves of digitalis puhpdeba, which, as is well 

 known, contains two glucocides (digitalin, digitalein), besides digitonin^ and. 

 digitoxin, a soap-like substance. 



The curative effects of infusion of digitalis and tincture of digitalis, etc., 

 are known to all physicians — the increased diuresis, the stronger cardiac con- 

 traction, the slowing of the pulse. It is perhaps not so well known that in- 

 fusion of digitalis may become decomposed by the action of mold fungi and 

 bacteria and toxic substances appear in consequence. 



