MORPHINE. 
§ 366.] 
305 
system, and, in addition, act energetically as muscle poisons, soon 
destroying the contractile power of the voluntary muscles with which 
they first come into contact at the place of injection, and more gradually 
affecting the other muscles of the body. 1 
§ 366. Action on Man. —There are at least three forms of opium 
poisoning:—(1) The common form , as seen in about 99 per cent, of 
cases ; (2) a very sudden form, in which death takes place with fearful 
rapidity (the foudroyante variety of the French) ; 2 and (3) a very rare, 
entirely abnormal form, in which there is no coma, but convulsions. 
In the common form there are three stages, viz. :—(1) Excitement; 
(2) Narcosis ; (3) Coma. In from half an hour to an hour 3 the first 
symptoms commence, the pulse is quickened, the pupils are contracted, 
the face flushed, and the hands and feet reddened—in other words, the 
capillary circulation is active. This stage has some analogy to the action 
of alcohol; the ideas mostly flow with great rapidity, and instead of a 
feeling of sleepiness, the reverse is the case. It, however, insensibly 
and more or less rapidly, passes into the next stage of heaviness and 
stupor. There is an irresistible tendency to sleep ; the pulse and the re¬ 
spiration become slower; the conjunctivse are reddened,the face and head 
often flushed. In some cases there is great irritability of the skin, and an 
eruption of nettle-rash. If the poison has been taken by the mouth, 
vomiting may be present. The bowels are usually—in fact almost invari¬ 
ably—constipated. There is also some loss of power over the bladder. 
In the next stage, the narcosis deepens into dangerous coma ; the 
patient can no longer be roused by noises, shaking, or external stimuli; 
the' breathing is loud and stertorous ; the face often pale ; the body 
covered with a clammy sweat. The pupils are still contracted, but they 
may in the last hours of life dilate ; and it is generally agreed that, if a 
corpse is found with the pupils dilated, this circumstance, taken in itself, 
does not contra-indicate opium or morphine poisoning. Death occasion¬ 
ally terminates by convulsion. 
The sudden form is that in which the individual sinks into a deep 
sleep almost immediately—that is, within five or ten minutes—and dies 
in a few hours. In these rapid cases the pupils are said to be constantly 
dilated. 
Examples of the convulsive form are to be sought among opium-eaters, 
or persons under otherwise abnormal conditions. 
A man, 40 years old, who had taken opiates daily since his 22nd 
year—his dose being 6 grms. (92-4 grains) of solid opium—when out 
hunting, of which sport he was passionately fond, took cold, and, 
1 R. Stockman and Dott, Brit. Med. Journ. (2), 1890, 189-192. 
2 Tardieu, Etude med.-legale sur V Empoisonnevient. 
3 In a remarkable case related by Taylor, a lady took a large dose (supposed to be 
H oz.) of laudanum, and there were no symptoms for four and a half hours. She 
died in twenty-four hours. 
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