Hot, strong, black coffee is useful in keeping up the respirations and averting collapse. It is usually given by the mouth, if the patient can swallow; if not, by means of the stomach-siphon or by rectal injection. If the respiration be come too infrequent the hypodermic jection of strychnine to grain) will be found useful, and may be repeated as the symptoms demand.
Alcoholic stimulants may be required. Ammonia and respiratory stimulants amyl-nitrite, atropine, etc.—may prove ineffectual, and recourse may then be had to artificial respiration. If the surface temperature fall, external heat to the trunk and the extremities will assist in maintaining the body-heat. While opium coma does not iu itself kill, the patient may in that state cease breathing, and as any method of rousimg the patient will accelerate and deepen the respiratory action, it is important that the patient be kept awake by continuously walking him between two assistants or by flagellation. As death occurs by paralysis of the re spiratory centres, the maintenance of re spiratory action should be our chief aim.
and eternal vigilance should be observed until all danger is over.
Case of opium poisoning in a year-old child, to whom the mother by mistake administered a teaspoonful of Syden ham's laudanum. The father immedi ately gave the child as much milk as it could take, and afterward a tablespoon ful of syrup of ipecac. The milk, coagu lating in the stomach, imprisoned the laudanum and the ipecac caused it to be vomited in the curds. The child's life was thus saved without any symptoms of poisoning, absorption not having taken place on account of the coagnlation of the milk. Gibert (Union Med du Nord est, _Apr., '94).
Venesection in opium poisoning is effi cacious in apparently hopeless cases, where death is impending, owing to fail ure of respiratory action due to disten sion of the right side of the heart with backward pressure. D. G. Marshall (Indian Med. Gaz., June, '96).
Case of opium poisoning in which the patient swallowed a solution containing about 30 grains of morphine acetate, and was not discovered until three hours later. The pupils were contracted, pulse slow, and respirations slow and shallow. Patient rapidly grew worse, and, in spite of washing out the stomach, hypoder mic injections of various stimulants, and application of faradism, cyanosis became profound. and death seemed imminent.
Oxygen was then given and artificial respiration commenced; six hours later there was a slight attempt at respira tion, and, at expiration of two hours more, artificial respiration was tempo rarily discontinued; IS hours after the ingestion of the poison the patient was practically out of danger, and ultimately recovered. This is believed to be the largest dose followed by recovery hith erto recorded, considering the fact that the drug was taken upon an empty stomach, and no treatment employed for three hours. It is thought the oxygen alone saved the patient's life. D. T. Playfair (Lancet, Aug. 27. 'OS).
Case of accidental administration of a fiuidrachm of liquor morphime (B. P.) to a 3-month-old baby. Within ten min utes child was seized with violent tetanic convulsions and with periodic cessation of breathing. Pupils were contracted to pin-point. Later child was comatose. Artificial respiration was continued con stantly for three hours and occasionally for the succeeding six or seven. Within an hour child was given grain of atropine, subcutaneously; half an hour later '/,, grain. Twice afterward 'Imo grain was administered. Strong decoc tion of coffee and peptonized milk were given by the rectum, and fomentations were applied to the epigastriurn. Face, upper part of chest, and other accessible parts were slapped with cold, wet towels. Child opened its eyes at the end of twenty-four hours, and not before forty eight hours would it suck from the mother. At this time bronchopneu monia developed, from which the child recovered entirely in ten days. J. Foth eringham (Brit. Med. Jour., Oct. 22, '98).
Though valuable in some cases of mor phine poisoning, atropine is often useless or positively harmful. They are not only not antagonists in many important respects, but rather synergistic. Both are narcotics; both first excite and then depress the respiratory centre and the heart; both cause motor depression, pro duce sleep, and lead to paralysis and convulsions in sufficiently large doses, etc. It may be useful in morphine poi soning, but only before the stage of coma, and even then only in small or moderate dosage. Given in large doses during the stage of depression it is posi tively harmful by intensifying the action of the morphine. E. T. Reichert (Therap. Monthly, 1, No. 1, 1901).