Morphinum

NO3

Including the various salts, to which reference is made in the list of authorities.

Preparation , Triturations, or solutions in alcohol.

Authorities.

1 , Sertürner (the discoverer of M.), took 1/2 grain, repeated after half an hour, and again after a quarter of an hour, Annali Univerz. di Med., xxvii (Buchner's Toxicologie, 1827, p. 201); 2 , Bally, experimental effect of moderate doses, and also 2 grains of sulf. or acet., Méd. de l'Acad. Roy. de Méd. a Paris (from Wibmer); 3 , Charvet, experiments on himself, with 1 grain of acetate, Wirkung des Op., p. 176 (Wibmer); 4 , same, a man aged thirty-six, took 6 grains of acetate at one dose; 5 , same, another took 6 grains of the acetate; 6 , Chevallier, Rev. Med., 1824, took 1/4 grain of the acetate (Wibmer); 6 a , same, took next day, 1/3 grain; 6 b , same, took, the following day, 1/2 grain; 6 c , same, took, the following day, 1 grain; 7 , Wibmer, took 1/4 grain of the acetate, repeated after one hour and a half; 7 a , same, took, 1/4 grain of M., repeated after one hour and a half; 8 , Beraudi (experiments on several healthy persons, Horn's Archiv, 1829, from Wibmer), a man named Allinio took 1/8 grain of the acetate, pulse before the dose 66; 8 a , same man, subsequently took 1/4 grain; 8 b , same man, took 1 grain; 9 , Beraudi on Crispo, aged twenty-one, effects of 1/6 grain of acetate; 9 a , same man, took 1/3 grain; 9 b , same man, took 1/2 grain; , Beraudi on Rabuni, aged nineteen, effects of 1/8 grain of the acetate; , same, man, effects of 1/4 grain; , same man, 1/2 grain; , Beraudi on himself, effects of 1/2 grain of acetate; , same, 2/3 grain; , same, 1 grain; , Beraudi on Sella, effects of 1/2 grain of acetate; , Bonnet and Trousseau, Bull. Gén. de Thérap., 32 (Wibmer), general effects of the salts; , Ronander, Hecker's Annal. de Méd., 1834 (Wibmer), effects of 1/4 to 1 grain of acetate; , Tully, Bost. M. and S. J., 1832, effects of 1/4 grain of the sulphate, on himself; , same, effects of 1/4 grain of the sulphate for pain in the stomach; , Bonjean, a man took 55 grains at once, Schm. Jahrb., 52, 156; , Leissier, effects of 33 to 36 grains of acetate, in a man, Journ. de Conn. Méd., 1838 (A. H. Z., 18, 288); , Anderson, effects of 1/4 grain of sulphate, repeated in two hours, in a woman suffering from sleeplessness, Am. J. Med. Sc., 1848; , Anderson, effects of 2 ounces of a solution of the muriate during thirty-six hours, in a patient suffering from delirium tremens, Month. J. Med. Sc., 1854; , Shearman, effects of 3 grains in a woman, Med. Times and Gaz., 1857; , Kreisig, effects of a solution in a girl aged sixteen, Inaug. Diss. (S. J., 93, 175); , Salviat, effects of 2 grammes, in a man aged thirty, Union Med. d. l. Gironde, 1859 (from Tardieu, Empoison.); , Rodgers, effects of 1 grain in a man, suffering from neuralgia of face (post-mortem showed kidneys diseased), Lancet, 1861; , Zepuder, effects of 1/12th grain of the acetate in a child, eleven weeks old, Wien Med. Halle, 1861 (A. H. Z., Mbl., 3, 49); and , omitted; , Dr. A.M. Cushing, provings, Mass. Hom. Med. Soc. Trans., vol. 3, p. 569, effects of 100 drops of 3d dil., evening first and second days, 1 drachm evening third day, 1 1/2 drachms evening fourth day; , Alexander, Wien Med. Presse, 1865 (S. J. 128, p. 294), effects of 1/6 grain, in a child; , Am. Hom. Obs., 1864, p. 169, effects of 1 1/2 grain of M., by mistake for quinine, for a slight indigestion; , Maschka, fatal effects of large doses, Prag. Vjs., 1867 (A. H. Z., Mbl., 16, p. 57); , omitted; , Brain, effects of injections of 1/3 grain of acetate, in a woman aged thirty-five, for pain in a tooth, Med. Times and Gaz., 1868; , Reyher, poisoning by M., Deutsch Arch. f. Clin. Med., 4, 602; , Pfister, effects of a solution, S. J., 15, p. 16; , Verdi, effects of 15 grains in a woman, Ohio M. and S. Rep., 3, 156; , Cattell, symptoms of muriate, Br. J. of Hom., 11, 337; , Goodno, effects of a solution of acetate (3 grains to 1 ounce), teaspoonful doses for dysmenorrhœa, Am. J. H. M. M., 4, 60; , Tellar, effects of injection of 1/12th grain, A. H. Z., 83, p. 40; , Gross, effects of injections of muriate, in a girl aged twenty, suffering from chronic neuritis, Am. Hom. Obs., 1870, p. 420; , Model, effects of twelve doses of 1/4 grain of acetate, for sleeplessness, Ærzt. Intell. Bl., 1871 (A. H. Z., Mbl., 25, p. 2); , Oliver, effects in one case, Practitioner, 1871, p. 79; , Ferris, effects of a solution of muriate, for a cough and diarrhœa, Br. Med. J., 1871; , Schroff, Lehrbuch der Pharm., p. 515, general effects of small doses; , same, larger doses, 14 to 36 milligrammes; , same, doses up to 7 centigrammes; , Tardieu, poisoning by 2 grammes, Sur. l'Empoison., 1058; , Martin, effects of injection of muriate, Gaz. des Hôp., 1874; , Transk, effects of 6 or 7 grains of the sulphate on self, and 2 grains to daughter, and 3 grains to another young lady, N. Y. Med. J., 1874; , Schweig, effects of 7 grains of sulphate, in a healthy man, N. Y. Med. J., 1874; , Dr Helen J. Underwood, effects of as much as could be put on a sixpence, in a girl, threatened with chorea, Med. Invest., 1875, p. 282; , C. B. Gatchell, effect of injecting 1/4 grain into his own arm, dose repeated after fifteen minutes, Med. Invest., 1875, p. 244; ( to , Harley's experiments, Old Veg. Neurotics)

51 , Michael, aged forty-eight, "strong but disabled by sciatica," effects of injection of 1/4 grain of the acetate; 52 , John L., aged fifty-four, with facial neuralgia, effects of 1/6 grain of the acetate; 53 , Samuel M., aged forty-nine, with facial neuralgia, effects of injections of 1/6 grain of acetate, afterwards 1/4 grain, and again 1/2 grain; 54 , John W., aged thirty-three, with lumbar neuralgia, injected 1/4 grain, and some weeks afterward 1/2 grain; 55 , Charles V., aged thirty-two, chronic lumbago, injected 1/4 grain of acetate; 56 , Mary B., aged forty-six, lame from sciatica, injected 1/6 grain of the acetate; 57 , Mrs. N., aged forty, neuralgia in right shoulder, injected 1/7 grain Morph. acetate; 58 , Mrs. E. W., aged thirty-four, four months pregnant, hysterical and neuralgic, effects of 1/15 grain of the acetate, afterward of the 1/12 grain; 59 , Miss L., aged thirty-seven, effects of 1/8 grain, on alternate mornings; 60 , Berridge, effect of injection of 1/8 grain, N. Am. J., 1872, p. 102; 61 , Levinstein, effects of injections of M., 22 to 30 grains daily, for neuralgia, Berl. Kl. Woch., 1877; 62 , same, effects on a woman of as much as 15 grains daily, injections for chronic rheumatic symptoms; 63 , same, effects in a man, with rheumatism, of 1/2 to 1 gramme injections daily; 64 , same, in a man, injections of 1 to 1 1/2 gramme daily (commenced its use in syphilitic "iritis"); 65 , Berridge, "a man took Morph. acet. nine days after a proving of Cannabis indica," Hahn. Month., 3, 462; 66 , Fiedler, general effects, Schmidt's Jahrb., 172, 236; , same, fatal case, after stopping habitual use of M., in a woman; , same, effects of stopping habitual use, in a man, thirty-five years old; , same, another case reported by Kapf; , Roberts, effects of subcutaneous injection, in a man, Med. Times and Gaz., 1868; , Anstie, effects of 3 grains injected into rectum of a man, suffering from fistula, Med. Times and Gaz., 1863, p. 134; , Anstie, effects of prolonged use of M. in small (1/4 grain daily) doses in a lady, suffering from sciatica, Practitioner, 1871, p. 153; , Levinstein, Die Morphium-sucht, eine Monographie, Berlin, 1877, general effects. [ The delirium of Morphine intoxication convicts of a series of symptoms that possess nearly all the characteristics of alcoholic delirium. From my observation two forms of Morphine delirium may be distinguished, the acute and chronic. The chronic develops during the course of Morphine intoxication, continues during the period of abstinence, and runs its course without excitement. The acute form appears as a consequence of the withdrawal of the drug, and breaks out with violent symptoms. In the chronic form the depression is variable; most of the patients exhibit a certain joyfulness, only for a short time interrupted by anxiety; in some individuals during the day the mood is depressed, in the evening there is some excitement, and at times illusions of the senses. Trembling of the hands and twitchings of the muscles are constant forms of the disease. In spite of the alternations the patients are perfectly lucid and self-possessed. They are able to ward off for a longer or shorter time their depressed or excited moods, and they can mingle with society. The acute delirium tremens of Morphine develops in the course of six to twelve hours after the withdrawal of the drug. The patients at first become excited and restless; run constantly about the room, weep and cry, and at last become delirious, under the action of painful sensations and hallucinations. The attacks, which last only a few hours, are followed by a quiet stage, during which the patients have hallucinations which involve all the organs of sense except that of taste. They see brilliantly colored birds, hear voices, have a sensation of sitting in wet, and perceive the most various odors. These illusions are associated with a hypochondriac mood; the patient thinks he will die; thinks he has seen his own burial; seems to see persons by him constantly growing larger and larger, etc.; also frequently talks with himself and with absent people. Tremor of the hands increases, and is associated with muscular twitches, nystagmus, and trembling of the whole body. At the commencement of the acute delirium, the voice and speech became changed. This delirium tremens of Morphine must not be confounded with the condition of excitement that occurs during the period of abstinence, especially after the exhibition of Chloral hydrate; if the patient, during the first two to four days of abstinence, is given a dose of 3 or 4 grammes for sleeplessness, the individual is seized a few hours after the dose with a high degree of excitement; he has to rise in bed, leaves it and runs around the room weeping, laughing, singing crying, and knocking against doors and windows, throwing over the furniture, and at last becomes agressive to those about him; he becomes quiet only towards morning, and has a very transient sleep, from which he wakes without remembrance of the occurrences of the night, or he can recall them only with difficulty. The differential diagnosis between the delirium tremens of Morphine and other forms of delirium, is only difficult when the physician is ignorant of the cause, and when the patient is in the later stage of Morphine intoxication (when there is tremor, sleeplessness, some disturbances of speech, restlessness, anxiety, mental illusions), then it is almost identical with chronic alcoholism. Moreover, it is not easy to recognize when the person intoxicated by Morphine has been in the habit of partaking freely of alcoholic drinks, and has communicated only the latter fact to the physician. The acute delirium tremens of Morphine may be distinguished from the acute delirium tremens potatorum, by the following: lst. Delirium potatorum occurs spontaneously, or after tremors, or during the progress of acute diseases; the acute delirium of Morphine occurs only during the partial or total abstinence from Morphine.

2d. In the height of delirium potatorum the delirium mostly disappears, while in the delirium of Morphine it increases.

3d. Alcoholic drinks, which are frequently craved by the patient, mostly aggravate the paroxysm, never arrest or obliterate it. The Morphine patient longs for Morphine, and is for a time quieted by a large dose of it.

4th. Delirium potatorum continues for days or weeks, while the duration of the delirium tremens of Morphine rarely exceeds forty-eight hours.

5th. The delirium potatorum ends in a collapse, which is frequently fatal; in the delirium tremens of Morphine there is no collapse. The delirium of Morphine can scarcely be confounded with that of lead (delirium saturninum), since in the latter the lead line on the gum, extensor paralysis, and the alternating conditions of excitement and stupefaction are sufficiently distinctive.]

MIND

• Emotional.
• Conscious of a certain amount of stimulating influence upon the brain; a sensation not unlike the early physiological effects of Quinine (almost immediately), 47.
• General condition of excitement; the patient seems exceedingly lively and wide awake, with a certain uneasiness, unsteadiness, and haste, and glistening of the eyes, 66.
• Great excitement, without sleepiness, 4.
• Violent cerebral excitement, so that the patient had to be isolated, 67.
• Delirium, 62 ; (after two hours), 43.
• Hallucinations for many days, 37.
• Hallucination and delirium, 66.
• There is great similarity in the intoxication of Morphine and that of alcohol; but the delirium of alcohol is more joyous; that of Morphine is almost gloomy and melancholy, 66. [10.]
• When she tried to describe her symptoms, and ask for an explanation from her friends, she could not for her tears and sobs, which she could not repress, 49.
• (Since she has used it she enjoys a great deal of calm happiness, her mind is active and clear, though her emotions are still very easily excited), 72.
• Low-spirited (after two hours, eighteen minutes), 51.
• Complete melancholy, so that he desired to commit suicide, 68.
• Some patients sit in mute despair, casting about for some opportunity to free themselves from their suffering, 73.
• Some individuals endure their troubles with resignation; they remain quietly in bed, scarcely speaking a word, others, but very few, pass the time in a soporous condition; others have no rest at all, get out of bed, anxiously run about the room, howl and cry; they either gradually become quiet or rarely their excitement increases, 73.
• Anxious condition, with hallucinations all illusions of almost all the organs of sense, seeming to comprise the whole, somewhat analogous to that caused by alcohol, 73.
• A few hours after the last injection the patient begins to feel uncomfortable and restless, and becomes exceedingly depressed; slight paroxysms of cough, with a condition of anxiety, 73.
• Anxiety, 68.
• Internal anxiety and restlessness, 66. [20.]

HEAD

• Confusion and Vertigo.
• After a nap, the head continued dull and confused for some time, as from a disordered stomach; he then took a swallow of vinegar, after which the nausea and headache increased, and after eating, the heaviness and stupefaction of the head increased, so that he was obliged to lie down, 7. [40.]
• Vertigo, 2, 14, 17 , etc.
• Much vertigo, on rising (second morning), 50.
• Excessive vertigo, 35.
• Violent vertigo, 39.
• Disagreeable vertigo and nausea (after six hours), 15.
• Spells of dizziness and loss of sight, all day (third day), 28.
• Frequent dizzy spells, with momentary loss of sight (second day), 28.
• Felt giddy, and walked cautiously (after two hours and a half), 52.
• Some giddiness and drowsiness (fifty minutes after 1/4 grain), 54.
• Giddy and drowsy (one hour after 1/15th grain); giddiness and drowsiness passed off (two hours after 1/15th grain), 58. [50.]
• Giddiness and somnolency (after ten minutes); complained of being very giddy, and said that everything was turning round (after one hour), 56.
• Slight giddiness, 55.
• Felt a little giddy (after one hour and twenty minutes), 51.
• Felt "dreadfully tipsy" (after forty minutes), 57.
• General Head.
• Head drawn backward, 5.
• Congestion of the head, 68.
• Began to feel light-headed and sleepy (one hour and a quarter after 1/4 grain), 54.
• Dulness of the head, 35.
• Dulness and heat of the head, 44b.
• Dulness of the head, for several days, 7a. [60.]
• Some dulness of the head, with difficult thought (after half an hour), 7a.
• General dulness of the head (after one hour), 7.
• Dulness in the head, especially in the frontal region (after ten minutes), .

EYE

• Objective.
• Eyes staring, 25.
• Eyes staring, and unaffected by light (after two hours), 26.
• Glistening eyes (after fifty minutes), 9.
• Eyes very glistening (after one hour), 8.
• Eyes sparkling, 11a.
• Eyes injected, 11b, 17 ; (one hour after 1/2 grain), 53. [100.]
• Membranes of eyes much injected (half an hour after 1/2 grain), 53.
• Cornea injected (after half an hour), 6a.
• Eyes sunken, especially the right, 6.
• Eyes sunken, half open, not turned upward, but staring straight ahead, with the axes of vision parallel, 41.
• Eyes fixed, and insensible to light (after two hours), 23.
• The eyes are frequently lustreless, having a look of weakness, exhaustion, and fear, becoming after a new injection lively, fiery, or like those of a person in delirium, 73.
• *The look becomes unsteady, 66.
• Subjective.
• Pain over and at side of left eye all day, with some pain in left ear (fifth day), 28.
• Eyes early in the course were hot and lame; bits of ice were laid on them with relief, 49.
• Eyes felt small, too small for sockets (second morning), 50.
• Brow and Orbit. [110.]
• Pressure above the eyes (after fifty minutes), 11.
• *Paresis of the recti interni, 61.
• Feeling of fulness in the orbits (after one hour), 3.
• Lids.
• Lids bluish, drooping, 13.
• Slight ptosis, 64.*
• Upper lids paralyzed, 17.
• Conjunctiva.

MORPHINUM. EAR

• Some pain in left ear, with pain over and at side of left eye all day (fifth day), 28.
• Ringing in the ears (after one hour), 3.
• Surring of the ears, 40.
• Tinnitus aurium, 37.
• Roaring in the ears, 44a.

NOSE

• Sneezing, 62, 64.
• Paroxysms of sneezing, 63. [170.]
• Peculiar tickling sensation in the nose, œsophagus, and larynx, as when one has to sneeze, felt after every injection, 40.
• Coryza, 73.

FACE

• Looked very heavy (after forty minutes), 57.
• Appeared very wild (after nine hours), 24.
• Wild, confused expression after sleep, 6c.
• Countenance looked haggard and eyes watery, like one who had been dissipating (second morning), 50.
• Face flushed (after two hours), 23.
• Face slightly flushed, 54, 58.
• Face intensely flushed (after a few minutes); followed by vomiting, and then a dead faint and struggling for breath, the pulse scarcely perceptible, 70.
• Her face was reddened, 62. [180.]
• Face red (soon), 1.
• Face and lips red (after half an hour), 6a.
• Face red, lips pale, 8b.
• Face red, puffy, 9a.
• Face red, puffy, lips livid (after fifty minutes), 8.
• The usually pale face became red, with drops of perspiration on it (after thirty-five minutes), 11.
• Face very red (immediately), 42.
• Intense but evanescent redness of the face, 40.
• The face became red, almost cyanotic, 68.
• Face almost livid (after one hour), 11. [190.]
• Bluish look, 5.
• Face of a dark-blue color, 34.
• Face cyanotic, 48.
• Face and extremities cyanotic, 31.
• The face became violet, 17.
• Pale face, 18.
• Face and lips pale (after fifteen minutes), 33.
• Face pale and anxious (one hour and three-quarters after 1/12 grain), 58.
• Face pale and sunken, 66.
• Pale and cold, for four hours (after two hours), 57. [200.]
• Very pale, with contracted and painful expression of the face (after four hours), 36.
• Face swollen, 11b ; (after two hours), 43.
• Face very much swollen (immediately), .

MOUTH

• Tongue.
• Dry brown tongue, 37.
• Redness of the tongue, 10a, 11b ; (after twenty minutes), 8a, 9a , etc.
• Tip and margins of the tongue red, 10. [220.]
• Tip of the tongue red, palate scarlet-red, somewhat painful, 8b.
• Tongue red on the margin, violet in the middle, 6.
• Tongue red at the tip and margins, and violet in the middle, 11a.
• Tongue livid, 41.
• Tongue pale (second morning), 8b.
• Tongue foul (second morning), 43.
• Tongue clean and moist (before the injection); moist, a slight whitish fur, indented (after two hours), 56.
• Tongue heavy, pale (after fifteen minutes), 11.
• Tongue dry, with thick dirty mucus, 35.
• Anterior part of the tongue dryish (three hours and a half after 1/2 grain), 53. [230.]
• (The tongue symptoms, for which Quinine was prescribed, a thickened feeling, and inability to articulate distinctly, disappeared entirely), 49.
• General Mouth.
• Some mucus in the mouth, 5.
• Dryness of the mouth and throat, 13.
• Mouth dry, in the morning, and after eating (fifth day), 28.
• Mouth and fauces dry, after sleeping, 7a.
• Mouth pasty, 6, 6a.
• The mucous membrane of the mouth is usually dry, the patient complains of thirst, nausea, vomiting, aversion to meat, loss of appetite. The tongue at times trembles on extending it. The stool is almost always retarded, diarrhœa is seldom, 73.
• Saliva.
• Discharge of watery saliva from the mouth, 29.
• Taste.
• Perverted taste, 62.
• Mouth bitter, sticky (second day), 8b.

THROAT

• Dryness and constriction in the throat (after half an hour), 6a.
• Pain and obstruction (?) in the posterior portion of the throat (second morning), 11a.
• Irritation in the throat, 6b.
• Peculiar sensation about the fauces (almost immediately), 47.
• Fauces and Pharynx.
• Burning in the posterior portion of the fauces (after five minutes), 9a. [250.]
• Paralysis of the pharynx, 35.
• Muscles of fauces and glottis so much affected that deglutition was almost impossible (after fourth dose), 19.
• Swallowing.
• Complained that he could not swallow, 17.
• External Throat.
• Jugular veins swollen, 34.
• Violent pulsations in the cervical and temporal arteries, 25.

STOMACH

• Appetite.
• Diminished appetite, 64.
• Loss of appetite, 66, 68 ; (second day), 3.
• Complete loss of appetite, 69.
• Entire aversion to food (second day), 30.
• Thirst.
• Thirst, 13. [260.]
• Much thirst, 64.
• Great thirst, 8a ; (after one hour), 8.
• Burning thirst, 6b, 6c ; (second day), 23.
• Eructations and Hiccough.
• Eructations and vomiting for two days, 44b.
• Frequent eructations and nausea, with uprisings of some acid mucus, 7a.
• Violent eructations, 44b.
• Hiccough, 62 ; lasting three-quarters of an hour, 12.
• Long-continuing singultus (frequently), 40.
• Nausea and Vomiting.
• Nausea, 11a ; (after four minutes), 9 ; (after a quarter of an hour), 6 , etc.
• Nausea and eructations (after two hours and a half), 7. [270.]
• Distressed with nausea, faintness, and constant retchings, with alternate flushes of heat and cold, for five hours (after two hours), 56.
• Nausea and inclination to vomit (after four hours), 8.
• Awakened from slumber by nausea and inclination to vomit, 3.
• Nausea and inclination to vomit soon after eating, 8b.
• Constant nausea (after four hours), 11.
• Slight nausea, with increased warmth of the face, 7.
• A little nausea (at first); gone (after one hour and twenty minutes), 51 ; (between five and six hours after injection), 55.
• Sick and faint, 57, .

ABDOMEN

• Umbilical.
• Pain in the umbilical region, 5 ; (after four hours), 8, 11.
• Violent pain in the umbilical region, 9b.
• General Abdomen.
• Moderate meteorismus, 31.
• Rumbling in the abdomen (after twenty minutes), 9.
• Frequent rumbling in the abdomen (after half an hour), 7a.
• Pain in the bowels (after half an hour), 43.
• Acute pain in the abdomen, and along the spinal column, on every inspiration, 6b. [320.]
• Colic, 14, 45 ; relieved by turning on back, in morning (fifth day), 28.
• Awoke with severe colic (third day), 28.

STOOL

• Diarrhœa.
• Diarrhœa, 62, 64 , etc.; (second morning), 11 ; second and following days, 11b ; (evening, first day), 11.
• The acetate generally produced diarrhœa, 13.
• Watery diarrhœa (after two hours), 9 ; (second morning), 8b.
• Bowels had acted loosely twice (after two hours), 57.
• Two painful stools (second day), 8b.
• Desire for stool for two hours, then small stool with great straining, in the morning; soft, loose stool at 2 P.M., with horrid tenesmus, straining , and burning in the rectum, almost causing frenzy (fifth day), 28.
• Copious evacuations of the bowels, 5.
• Constipation.
• Constipation, 2, 3, 18 , etc.; (second day), 23 ; (third day), 30. [330.]
• Morphia always caused constipation, 13.
• Constipation for a long time, 4.
• Constipation often followed by diarrhœa, 14.
• Retention of stool, 44b.
• Almost complete stoppage of the evacuation of stool and urine, 69.
• No stool, contrary to habit (second morning); but at 2 o'clock there occurred a very indolent evacuation of a little fæces, with painful urging, 7.

URINARY ORGANS

• Bladder.
• Paresis of the bladder, 61.
• Slight paresis of the bladder, 62.
• Pain in the region of the bladder (after one hour), 8.
• Pain in the bladder, 8b ; (after two hours), 9.
• Micturition. [340.]
• Emission of scanty urine, with great urging (after four hours), 11.
• Passed very little urine, with great difficulty (first night), 43.
• Ineffectual efforts to urinate (after seven hours); he succeeded in urinating (nine hours later), 3.
• Constant desire to urinate, and inability to do so for twelve hours, 44b.
• Complete ischuria, 18.
• Strangury is often caused, 13.
• Retention of urine, 2.
• Urine.
• Urine high-colored and scanty, 66.
• Urine scanty, 25.
• Diminished secretion of urine, 14. [350.]
• Frequently the secretion is diminished, though at times it is increased, 13.
• Suppression of urine (second day), 23.
• Suppression of urine and fæces, 35.
• Complete suppression of urine, 4.
• Urine turbid and slimy, 6b.
• The urine yielded albumen, without structural elements, 64.
• Passed 3ix urine, sp. gr. 1010.4 (on rising, before injection); 3xviiiss. urine, alkaline, sp. gr. 1008.8 (after two hours); 3vij, freely acid, sp. gr. 1009.2 (after four hours), 55.
• The kidneys excrete albuminous urine, in severe cases. The evacuation of urine is often difficult, and the amount frequently scanty; the specific gravity varies within the most extreme limits; I have found urine of 1004 to 1038; generally the urine at first has the highest specific gravity; towards the end of the cure the specific gravity diminishes; naturally this varies according to the amount of urine passed. The urine of nearly all suffering from Morphine intoxication reduces an alkaline solution of Cuprum sulphate without precipitating it as an oxide, at the same time the urine usually turns the polarization ray to the left, .

SEXUAL ORGANS

• Male.
• Impotency; the testimony of all men suffering from Morphine intoxication is uniform in that their sexual power is affected by the drug. Sometimes the sexual excitement, voluptuous sensations, and in part erections are incomplete, less energetic, and of shorter duration, or they do not occur at all. So in this case all grades may be found, from simple sexual weakness to complete impotency. The great majority refrain from sexual intercourse, either from lack of interest or from inability, owing to the fact that erections are incomplete or wanting altogether. Unmarried men become impotent sooner than married men. In many men the first effect of Morphine is excitement of the sexual sphere, afterwards the usual paralysis. Many unmarried men make use of this fact to smother their sexual desires when they become aroused during the interval free from Morphine. The question arises whether there may not be other causes than that of Morphine for the impotency. The condition of depression which is induced in many persons might be supposed to be a psychical impotency, but there are also cases in which there was a condition of eutropia, and also still others upon whose emotional nature Morphine has no influence whatever, that are more or less impotent. Whether the power of erection ceases sooner, or since the emissions are not of a frequent occurrence the function of the seminiferous organs ceases sooner, is uncertain from want of sufficient data. The testimony of men is usually not clear; many dislike to speak of their impotency; many healthy men are, indeed, unaware of this condition, or pass it over lightly, or are silent about it. In the register of the Morphine poisonings in Maison de Santé, it is found that the wives of none of the men who had injected large doses of Morphine have had a normal pregnancy during the last two years, although they were young women, and, previous to the use of Morphine by their husbands, had had children every year, 73.
• Impotence, 61.
• He had become impotent since he used Morphia, 64.
• Pain in the genitals and urinary organs, especially in the right spermatic cord (after one hour and a half), 8.
• Diminished sexual desire, 66, 68.
• Female. [370.]
• Amenorrhœa. In all the women treated by me for Morphine intoxication, menstruation had been irregular, or suppressed for months or years. These women varied in age from twenty-five to thirty-five, and had used subcutaneous infections of Morphine for a long time. The symptoms noticed at the commencement and during the course of the amenorrhœa, such as headache, vertigo, disinclination to work, loss of appetite, vomiting, constipation, palpitation, hysterical attacks, etc., coincide with those of Morphine intoxication, so that it is often difficult to distinguish whether they are caused by the toxication of Morphine, or are the consequence of the amenorrhœa. I have never observed swelling of the breasts or vicarious hæmorrhages in my cases. The amenorrhœa of Morphine is gradually developed from dysmenorrhœa, or it occurs suddenly. Conception has never been noticed in amenorrhœic women, while some of the women have been repeatedly pregnant previous to the use of Morphine. Therefore, it seems probable that the cessation of menstruation is dependent upon anomalies of the ovaries, in that they seem inactive. According of Pflüger's theory, in the amenorrhœa of Morphine, the growth of the cells of the ovaries ceases from one period to another, and in consequence, the irritability that is transmitted by the ovarian cells and causes, on the one hand, bursting of the Graafian follicles, and on the other, determines the reflex condition of congestion of the sexual organs, is wanting. As a consequence, Morphine affects the ovaries as it does other secretory glands, namely, it renders them unable to perform their functions. It is most probable that menstruation ceases because ovulation ceases, and this also explains the sterility. The supposition that Morphine injection causes the arrest of the function of the organs of generation is justified by the fact that, after the cessation of Morphine, these organs recover their activity. The sexual desire is at first increased by the habitual use of Morphine, but after the graver symptoms of poisoning have been developed it almost entirely disappears, as in men. It is also noteworthy that women who have suffered from fluor albus, are generally free from it during the prolonged use of Morphine; this reappears only after the withdrawal of the drug, often with labor like pains. Women suffering from Morphine intoxication, in whom menstruation continues normal, may conceive; but I have noticed that the pregnancy runs a normal course only when the women use small doses; they abort from large doses, .

RESPIRATORY ORGANS

• Slight rattling of mucus in the trachea, 31.
• Voice.
• More or less hoarseness, 15.
• Frequently hoarseness when speaking for any length of time, whereas her voice is usually extremely clear, 40.
• Speech indistinct (inaudible), (soon, after fifteen minutes), 33.
• Respiration.
• Breathing loud and rattling (after eleven hours and a half), 71.
• Respiration stertorous, 34.
• Breathing stertorous, amounting to no more than 4 or 5 per minute, 20. [380.]
• Respirations increased, with acute pains in the chest, 6b.
• Respiration 19, 20 (before the injection); 15, regular (three-quarters of an hour after 1/4 gr.); 16, regular (ten minutes after 1/2 gr.); 14, regular (three hours and a half after 1/2 gr.), 53.
• Respiration 9 and 10 all day (second day), 30.
• Respiration rattling, slow, 8 to the minute, 29.
• Respiration very superficial, occurring only every twelve or fifteen seconds, 41.
• Respiration short and irregular, 35.
• Respiration irregular, with frequent sighs (one hour and three-quarters after 1/2 gr.), 58.
• Respiration indescribable, thoracic respiration being apparently entirely suspended, 48.
• Respiration difficult, 68 ; (after five minutes), 8 ; (after fifteen minutes), 11.
• Respiration slow and difficult (after four hours), 36. [390.]
• Slight difficulty in breathing (after third dose); respiration greatly obstructed (after fourth dose), 19.
• Very difficult respiration, 5.
• Struggling for breath, 70.

CHEST

• Tightness of the chest and difficulty in breathing, and she asked to be raised, saying she felt as if she were dying (after fifteen minutes), 33.
• Great pain in the chest, and could not take a long breath (after half an hour); pain principally in the middle of the sternum, the breathing was short and quick, and she sighed often (after four hours), 43.
• Felt very ill, with "an indescribable sensation, worse to bear than any pain," behind the lower half of the sternum (after one hour), 57.

HEART AND PULSE

• Heart's Action.
• Palpitations, 40, 66.
• Violent throbbing in the heart and carotids, 35.
• The beat of the heart could not be felt; with the ear could be indistinctly heard only at times, 41.
• Congestions of the head, palpitations of the heart, with tense pulse; the latter often suddenly disappears and gives place to a scarcely perceptible, thready, slow, and intermittent pulse, that marks the beginning of a serious collapse; increased reflex irritability; the patient has frequent attacks of sneezing and yawning; he starts up in fright if one approaches him; touch of the skin causes cramp and twitching, 73.
• Pulse. [400.]
• Pulse full and slightly accelerated (after two hours), 23.
• Pulse strong and frequent, 37.
• The pulse in severe cases in small, at times tense or thready. In some cases oppression of respiration and palpitation are observed, 73.
• Pulse strong, rapid, 6b ; (after half an hour), 6a.
• Pulse small and rapid, 66, 67.
• Pulse small, contracted, rapid, 18.
• Pulse scarcely perceptible, rapid, weak, fluttering, about 140 or 150, 41.
• Pulse feverish, 11a.
• The pulse at first sinks, and then rises several beats, 44a.
• Pulse 79 (after twenty minutes), 9. [410.]
• Pulse ranging from 140 to 160, extremely non-resistant, feeble, fluttering, 48.
• Pulse 63 (before taking); 108 (after half an hour), 10.
• Pulse 66 (before taking); 94 (after twenty minutes), 8.
• Pulse rose from 68 to 78 (immediately); to 88 (after one hour), 8b.
• Pulse rose from 84 to 94 (after half an hour), 9b.
• Pulse rose from 61 to 86 (after a few minutes), 11a.
• Pulse rose from 66 to 82 (after half an hour); to 90 (after one hour and a half), 10b.
• Pulse 60 (before taking); 80 (after half an hour), 11b.

NECK AND BACK

• Stiff neck (second morning), 43.
• Great pain in the back (after two hours), 43. [450.]
• Pains extending along the spine, 6a.
• Pain and twitchings all down her spine (after four hours), 43.
• Weakness of the loins, for several days, 7a.

EXTREMITIES IN GENERAL

• Objective.
• Tremor of the hands, 73.
• Trembling of the limbs, 61.
• Trembling of the limbs, and general oppression, 67.
• Twitching of the limbs, 1.
• Her fingers were involuntarily contracted and extended; she experienced some uneasiness about the elbows and knees (after third dose); the muscles of the hands and feet became rigidly contracted; the legs were drawn upon the thighs, and they upon the abdomen; the arms were alternately flexed, extended, and then contracted across the thorax (after fourth dose); in fact, the spasmodic action of all the voluntary muscles was so great as to simulate a genuine case of traumatic tetanus; alcohol, ammonia, coffee, cold and hot ablutions, and constant frictions were resorted to with no effect; the spasmodic action commenced at 2 P.M., and continued till 5.30 P.M., 19.
• Slight stiffness or heaviness of the limbs (after one hour), 7.
• Limbs paralyzed (after two hours), 23. [460.]
• Limbs weak, 6a.
• Weakness and some trembling of the limbs, 7a.
• Weakness of the joints, 11a.
• Subjective.
• Her arms and legs felt as if they were alive, and as if they were going to jump up (after twenty hours), 43.
• Feeling of great weariness, in the limbs, with inclination of the right lids to close; great longing for rest (after one hour), 7a.
• Abnormal sensations in the extremities associated with salivation, 73.
• Heaviness of the limbs, 17 ; (after half an hour), 7a.
• Pains in the joints, 8b, 66.
• Violent pain in the joints, 66.

SUPERIOR EXTREMITIES

• Stiffness and pain in the arms, after sleep, 6b. [470.]
• Heaviness of arms (after first 1/4 grain), 50.
• A peculiar drawing, almost painful sensation in the wrist, 44b.
• Trembling of the hands, 63.
• Hands somewhat tremulous, after sleeping, 7a.
• Slight trembling and unsteadiness of the hands, while writing, 7.
• Fingers numb, and both thumbs firmly drawn into the palms of the hands, 33.

INFERIOR EXTREMITIES

• Gait insecure and tottering, 66.
• Gait irregular; staggered like a drunken man (second morning), 50.
• Her legs were twitched up, and she begged that they might be held, as she could not keep them quiet, and said it felt as if there were worms in them (after four hours), 43.
• A few twitches of left leg (after one hour), 60. [480.]
• Legs swollen, so that he could not put on boots (second day), 45.
• Cramps of the several muscles, 61.

GENERAL SYMPTOMS

• Objective.
• Emaciation, 69.
• He lost about 15 pounds of body weight, 63.
• General cachexia, 66.
• Trembling, 68.
• Whole body trembles, 66.
• Twitching of the muscles, 5, 62, 69.
• Twitching of the muscles of the face and limbs, at times, 7.
• Both sides of her mouth were twitching; the arms were bent and moved backwards and forwards convulsively; the motions soon ceased but returned (after two hours), 43. [490.]
• Jerking in the whole body, 68.
• Violent jerking in the arms, head, and especially in the face, 3.
• Convulsive motions, 2 ; (second day), 23.
• Convulsive and tetanic spasms, 25.
• Convulsions, 66.
• Convulsions of the extremities and face, with partial opisthotonos; convulsions renewed by tickling or pressure upon the skin, without any loss of consciousness, 21.
• Partial opisthotonos (after two hours), 43.
• Eclampsia, 37.
• Drawing and stiffness of the muscles, 66.
• Patient rigid, absolutely immovable; extremities exhibited no flexibility whatever, and the transient contraction seemed like rigor mortis; indeed, it was with difficulty that the joints could be moved, 41. [500.]
• Muscular system very much relaxed (after four hours), 36.
• The sensory nerves had almost ceased to act, and the motor portion was also materially affected by the drug (after four hours), 36.
• Phrenic and pneumogastric nerves considerably narcotized (after four hours), 36.
• Great weariness (after thirty-six hours), 23.
• Weakness, 1, 8b, 14 , etc.
• Mental and physical weakness and laxity, 66.
• Weakness of the limbs, small of the back, neck, and joints (after twenty-five minutes), .

SKIN

• Objective.
• Skin deathly pale, 29.
• The skin lost its elasticity, 69.
• Eruption over the whole body (second morning), 9a.
• Eruptions of red pimples, 6b.
• Numerous dark bluish spots on the back and thigh, 35.
• Eruption over the face and large portion of the body (second day), 9b.
• Eruption in the eighth intercostal space, which, except for the absence of pain, resembled herpes zoster, 61.
• The skin loses its turgescence, color, and tension. The subcutaneous cellular tissue atrophies (though, in some cases, especially in women, it contains fat). The face is mostly pale, ashy gray, seldom deep red, sometimes of a normal color; the perspiration is usually much more profuse than normal, exanthema is very seldom observed. Inflammation of the sebaceous glands, zoster, affecting especially the chin, cheeks, intercostal spaces, occurs from time to time, disappearing and returning, or in some cases persistent. At the point of injection of Morphine abscesses form and infiltrate in the skin, sometimes of a very large size. The patient complains of coldness or even chilliness, 73. [560.]
• Arms and legs covered with red pimples, 6c.
• Subjective.
• Biting in the skin; this biting is sometimes accompanied by small round elevations, 2.
• Crawling, tickling, and itching over the whole body, 68.
• Formications, 62.
• Formication all over (second day), 23.
• Itching in the skin, 14, 18, 66 ; (after thirty-five minutes), 11 ; (after half an hour), 8.
• Soon wakened by an itching sensation over the whole body, which induced vigorous and constant scratching; this sensation was felt in every part of the body, from the crown of the head to the soles of the feet; head itched as though innumerable insects were crawling through my hair; face felt as though covered with cobwebs, which I would try to wipe off; bottom of feet felt as if I had chilblains; the legs, arms, abdomen, chest, and back, all itched as though being tickled with feathers, and I was kept busy scratching from head to feet; this lasted till morning, and I should be afraid to say how many times I raked over my entire body with my ten finger-nails; I think that after giving myself a thorough going over, I would drop asleep, but soon be awakened by the itching, and have to scratch more vigorously than ever. I expected to find my body covered with blotches, but my skin was as white and smooth as ever; at intervals all next day and evening, feel here and there, on body, slight itching; and if I were on the sand-beach of Carolina would think it suggested fleas, .

SLEEP AND DREAMS

• Sleepiness.
• Yawning, 62, 64.
• Inclination to sleep (after five minutes), 8.
• Sleepiness, 9 ; (after half an hour), 8.
• Occasionally slight excess of sleepiness, making it rather difficult for the patient to rouse herself in the morning, 72.
• So sleepy that it was with much difficulty that I was able to reach my room and undress (soon after second injection), 50.
• Heaviness and sleepiness throughout the day, 59.
• Continued heavy and sleepy (after one hour and twenty minutes), 51. [580.]
• Drowsiness (after fifteen minutes); since then sleep (after thirty minutes); had continued drowsy and still remained so (after two hours and eighteen minutes); slept about two hours (later), 51.
• Drowsiness (fifteen minutes after 1/15 gr.); felt drowsy and giddy (after one hour); the drowsiness and giddiness now passed off (two hours after 1/15 gr.); had napped for twenty minutes (one hour and three-quarters after 1/12 gr.); slept half an hour more (three hours and a half after 1/12 gr.); drowsiness continued for a short time, after walking home, 58.
• Occasional drowsiness (second day), 30.
• Some drowsiness and giddiness (fifty minutes after 1/4 gr.); sleepy and light-headed (one hour and a quarter after 1/4 gr.); dozed and had some sound sleep (from one hour and a half to three hours after 1/4 gr.); slept soundly for half an hour, and was now very sleepy and giddy (one hour and a quarter after 1/2 gr.), 54.
• Drowsiness gone off (after one hour), 57.
• Somnolency; he feel asleep and had a short nap (half an hour after 1/6 gr.); somnolency had continued and he still felt a little sleepy (two hours after 1/6 gr.); great somnolency (fifteen minutes after 1/4 gr.); somnolency continued (two hours and a quarter after 1/4 gr.); at no time so great that he could not prevent sleep, and when he gave way to it, he passed into a gentle slumber from which a slight noise awoke him (after 1/4 gr.); began to feel very sleepy (ten minutes after 1/2 gr.); unchanged (two hours after 1/2 gr.); less, but continued very sleepy (three hours after 1/2 gr.); had slept throughout comfortably and a little more soundly than in ordinary sleep; was not conscious of dreaming, but muttered a good deal (three hours and a half after 1/2 gr.); a little sleepiness during the next forty-eight hours, 53.

MORPHINUM. FEVER

• Chilliness.
• Skin cool; the feet warm, 34.
• Surface rapidly becoming cold (after nine hours and a half), 71.
• The skin of the whole body was somewhat livid, especially the lips and nails, and, with the extremities which were covered, it was very cold, and covered with cold, clammy perspiration, 41.
• Cold and pale, for four hours (after two hours), 57.
• Generally cold and tremulous (one hour and three-quarters after 1/12 gr.), 58.
• Skin icy cold, 29. [620.]
• Diminished temperature (immediately), 44.
• Temperature lowered from a quarter to half a degree (after half an hour), 46.
• Temperature at first falls and afterwards rises, 44a.
• Chilliness, 62.
• Chills creeping over her, especially from the hips to the knees, and back again to hips, 49.
• Violent shudderings, 2.
• Rigors, 64.
• The warmth of the face diminished, and it became paler than usual; with general weakness (consequence of nausea), (after two hours), 7.
• Extremities cool, 35.
• Head, face, and hands cool (two hours and a quarter after 1/4 gr.), 53. [630.]
• Extremities cold (after fifteen or twenty minutes), 32.
• Extremities cold, nails blue (after four hours), 36.
• All the extremities and hands cold and livid, 17.
• Hands and feet became cold (after third dose), 19.
• Lower extremities cold, 5.
• Heat.
• Skin hot and dry, 37.
• Burning heat of the skin (after half an hour), 8a.
• Temperature rises 2/10° (Centigrade), 44b.
• General diffusion of warmth throughout the body (one hour after 1/2 gr.), 53.
• General increase of warmth, especially in the face (after half an hour), 7a. [640.]

CONDITIONS

• Aggravation.
• ( Morning ), On waking, disappearing on moving about; head painful.
• ( After eating ), Heaviness, etc., of head; pain in stomach.
• ( After sleep ), Stiffness in arms; hands tremulous.

SUPPLEMENT: MORPHINUM. Authorities.

74 , Le Cliniq. (Lond. Med. Gaz., vol. iii, 1829, p. 851), Mr. G. took 24 grains of the Acetate dissolved in 1 ounce distilled water; 75 , M. Martin-solon, Bull. de l'Acad. Roy. de Méd., 1836, and Brit. and For. Med. Rev. (Am. Journ. of Med. Sci., 22, 1838, p. 202), effects of dipping the point of a lancet in an aqueous solution and inserting beneath the epidermis; [From inoculation of all common preparations of Opium he saw the same effects, except that the papillæ sometimes acquired a diameter of an inch and a half, and then became radiated and diffuse.]

76 , same, effects of the Muriate experienced by Dr. Lafargue, from thirteen punctures on the front of the forearm; 77 , Blanchard Fosgate, M.D., Amer. Journ. of Med. Sci., New Ser., 1, 1841, p. 112, for toothache took 1 ounce of a solution containing 1 1/4 grains of the Sulphate, after taking no food nor drink for eighteen hours; 78 , omitted; 79 , Lond. Med. Gaz. (Bost. Med. and Surg. Journ., vol. xxxiii, 1845, p. 128), a young woman, for scirrhus of uterus, vomiting, and pain in the stomach, applied to the epigastrium, from which the skin had been removed by a blister, 1/32 grain of the Muriate; the same was repeated the next morning; 80 , Chas. Foulke, M.D., Amer. Journ. Med. Sci., New Ser., 15, 1848, p. 568, Mrs. R., æt. sixteen years, eight months pregnant, for labor-pains, took 11 1/2 grains of the Sulphate in three hours; 81 , C. S. S., Bost. Med. and Surg. Journ., 63, 1860, p. 325, a young man made habitual use of Morphine, generally taking one-fifth of a bottleful (1-8 ounces) in water; 82 , J. S. L., ibid., p. 391, Mrs. A. H. S., æt. forty-two years, had taken Morphine for years; when first seen she was taking from 4 to 6 drachms per week; 83 , B. Woodward, M.D., ibid., vol. lxv, p. 157, I took 1/3 grain of the Sulphate at 7, 10, 1, and 4 o'clock. I repeated this experiment four times, at intervals of five days, with same effects; afterwards subjected five young men to same experiment, and with four obtained a very large increase and lower specific gravity of the urine; with one of them, on two trials, I found no perceptible increase or diminution of, but a marked lessening of, specific gravity; I did not obtain same results from Opium itself, but there was no difference whether the Muriate or Sulphate were used; 84 , Wm. Norris, M.D., Amer. Journ. Med. Sci., New Ser., 44, 1862, p. 395, a person, æt. nineteen years, took 75 grains of Sulphate in water; 85 , Medical Circular, June 10th, 1863 (Brit. Journ. of Hom., 22, 348), effects of solution of Mor. mur., taken in the usual doses, but too frequently, for cold in the chest; 86 , Dr. J. L. Prentiss, Chicago Med. Journ., December, 1866 (Amer. Journ. of Med. Sci., New Ser., 53, p. 565), a woman was said to have taken 5 grains of Morphia; 87 , J. R. Wiest, M.D., Cincin. Journ. of Med. May, 1867, p. 265, Mr. W., æt. fifty years, took an unknown number of pills, each containing 1/6 grain of the Sulphate; , Benj. B. Wilson, M.D., Med. and Surg. Reporter, vol. xix, 1868, p. 369, a woman who had been receiving hypodermic injections of 1/4 grain of the Sulphate, now received a somewhat larger one; , J. J. Lyons, M.D., New Orleans Med. and Sur. Journ., vol. xxii, 1869, p. 292, a girl, æt. five years, took 5 grains of Sulphate to prevent the return of an intermittent, from which she had been suffering the previous week; , John Sprott, M.D., ibid., p. 506, for rheumatism, used daily for three years, from 2 to 4 grains of Sulphate; , C. H. Alden, Philad. Med. Times, vol. i, 1871, p. 295, L. R. took by enema between 12 and 15 grains of Sulphate, dissolved in 2 fluid ounces of water; , W. W. Grisson, M.D., St. Louis Med. and Surg. Journ., 1872, p. 353, a woman, æt. thirty-one years, took 6 grains of Morphine; , Geo. Bayles, M.D., Virginia Med. Rec., 1875, p. 188, Mr. S., for pleuritis of the right side, took within three hours and a half 50 minims of Squibb's solution of Morphia; , Dr. A. P. Hull, Philad. Med. Times, September, 1876, p. 581, a child, æt. six weeks, took 1/2 grain of Sulphate; , E. H. Coover, Philad. Med. and Surg. Reporter, vol. xxxvi, 1877, p. 452, John H., æt. thirty years, for an abscess on the left parotid, took 2 powders, containing probably 2 1/2 grains of Sulphate, at an interval of twelve hours; , S. B. Chase, ibid., vol. xxxiv, p. 37, a man, æt. thirty-five years, took 6 or 7 grains of Morphia.

MIND

• I found her, as she had been for some hours, crazy, with three or four holding her in bed; during the intervals of slight convulsions she was in this crazy condition, 80.
• Subsequent to the commencement of the nausea, and previous to the exhibition of a gill of cold strong coffee, my mind was depressed, and considerable anxiety pervaded it, but it was at the same time restrained to a consideration of the condition of my system, and no pleasurable sensations had been experienced. The coffee, however, soon raised this weight of oppression, and, I may add, also the controlling power of reason, and in their stead, fancy in her wildest range roved on through scenes of rapture and splendor, which the mind of the patient, unassisted by such powerful influences, is utterly incapable of attaining. This delightful revelling of the imagination continued five or six hours, and during this interval my attendants, who spoke to me several times, could not determine whether I was asleep or not; neither can I settle the question myself, for, if asleep, I awoke so easily that the transition could not be perceived. But I am conscious that this state of mental delirium ended in a sound sleep, which was succeeded by a few hours of lassitude, 77.
• So nervous that the least movement in the room would make her spring from the bed, 82.
• Sometimes talking in a partially incoherent, excited manner (after three hours), 91.
• Incoherency in speech for three weeks, 79. [680.]
• Mind much confused, but when persistently addressed, her attention was aroused, and she replied, though rather incoherently (after three hours); mind quite clear (fourth day), 91.
• Lost his recollection (after six or seven minutes), 74.
• Stupor, 79.
• Stupor was fast approaching, but was not complete, occasionally, she would wake and fret (after three hours), 79.
• Complete insensibility, 89, 96 , etc.
• Comatose, although by persistent shaking and loud talking, he could be roused for a brief period, 87.

HEAD

• Dizziness, 79.
• Slowly rolling her head (after three hours), 91.
• Pain in the head, 79.
• Head felt very heavy (after three hours), 91. [690.]
• Heaviness of the head, 76.

EYE

• Eyes sunken in the head, 82.
• Eyelids half closed; conjunctivæ injected, pupils contracted to mere points; irides immovable (after three hours); pupils natural size or nearly so, and the irides movable (fourth day), 91.
• Pupil contracted (after three hours), 95 , etc.
• Pupils contracted to a pin's point, 94 , etc.
• Pupils contracted to a little more than a pin's point, 96.
• Contracted pupil and complete insensibility, 96.
• Great contraction of the pupils, almost perfect blindness, 89.
• Saw every object double and very indistinctly (after three hours), 91.
• She saw only one-half of surrounding objects; for instance, in the case of a person standing before her, she could see only the right or left half of the body; it was three weeks before vision was completely restored, 79.

EAR. [700.]

• Ringing in the ears, 79.

FACE

• Suffused and purple countenance, 88.
• Complexion cyanotic, 93.
• Countenance of a dark color, 94.
• Face and lips livid, 80.
• Constantly rubbing the nose, eyes, and face, 89.
• Jaws rigid, 96.
• Masseter muscles rigid (after six hours), 86.

MOUTH

• Teeth firmly closed (after six hours), 86.
• Tongue dry and cracked in places, 82. [710.]
• Clamminess of the mouth, 76.
• The saliva of the mouth was being churned into a froth, which welled up and then disappeared at every return and subsidence of the respiratory movement, 93.
• Slow of speech, although if sharply questioned he would answer his name, 84.
• It was with great difficulty that she could talk so as to be understood, 82.

STOMACH

• Thirst, 84.
• Great nausea and many efforts to vomit (after five hours), 77.
• Vomited at intervals (after three hours), 91.
• Vomiting in the evening, 85.
• The pain in her stomach recurred every few minutes, and became at times very intense; she made loud cries, ground her teeth, and threw her arms about violently; she described the pain as like that of cramp (after six hours); the pain became gradually less, and was felt more in the region of the umbilicus (after nine hours), 91.
• It often produces a painful cramp of the stomach, and especially is it liable to do so in persons not in the habit of using it. This effect is readily relieved by a small quantity of some stimulant, brandy or spirits of camphor being the most effectual. One-eighth of a grain acts more powerfully on an empty stomach than half a grain after eating, 90.

URINARY ORGANS. [720.]

• Pain across the kidneys, followed by diuresis, 81.
• Vesical tenesmus, but was unable to pass urine; about 8 or 10 fluid ounces removed by the catheter (after three hours); urine removed twice, about 12 fluid ounces each time (second day); passed urine naturally (third day), 91.
• It acts almost invariably as a diuretic in from one to two hours, 90.
• Passed 28 ounces of urine, with specific gravity of 1014, in twenty-four hours (before the experiment); measured all the urine passed at 9 P.M., and found it to be 48 ounces, very limpid, specific gravity 1003 (the day of the experiment), 83.

RESPIRATORY ORGANS

• When taken in a full dose it changes the voice, producing a temporary hoarseness, 90.
• Respiration hurried, 82.
• Breathing not more than once in forty-six seconds (after five hours and a half), 80.
• The child breathed about once in fifty seconds for seven hours, 90.
• Respiration stertorous, 10 to the minute, 87.
• Stertorous breathing, 94. [730.]
• Stertorous breathing was strongly marked, in fact, the patient ceased to breathe, the interval being lengthened out one-fourth of a minute or nearly so, 88.
• Breathing was stertorous, irregular, and very slow, not more than two respirations in a minute, 93.
• Respiration stertorous and feeble, so much so that he breathed but four times a minute (five hours after second dose), 93.
• Breathing stertorous; at times arrested for a minute (after six hours), 86.
• Breathing peculiar to the last stage of Opium poisoning, 96.
• Respiration suspended, 92.

HEART AND PULSE

• Circulation full but slow, 77.
• Strong and frequent pulse, 79.
• Pulse 130 and feeble, 92.
• Pulse 120 and of moderate strength, 87. [740.]
• Pulse 110, 82.
• Pulse 80, moderately full (after six hours), 86.
• Pulse 80 and soft, 84.
• Pulse full and slightly excited (after three hours), 89.
• Pulse 60 (after three hours), 91.
• Pulse feeble and irregular (five hours after second dose), 95.
• A slow, laboring pulse, 94.
• The pulse was intermittent, and so weak as to be almost imperceptible at the wrists, and there was a fluttering movement observable on both sides of the neck, 93.
• Pulseless, 96.

INFERIOR EXTREMITIES

• Gait staggering, 84. [750.]
• Lower extremities deficient in sensibility and lying motionless (after three hours), 91.

GENERALITIES

• Very much emaciated, 82.
• Some half dozen slight convulsions, 80.
• Convulsions, 79.
• Frightful convulsions, 74, 96.
• After half an hour a sensation of thickening and stiffening of the muscles of the back of the neck, which soon extended to the flexor muscles of all the limbs, and which continued until the morbid action was broken in upon. This was not a condition of rigidity such as obtains in cramps, but subject to volition, and was rather of that feeling that we imagine would be experienced in a paroxysm of catalepsy could the patient be made sensible of the movements of his limbs, 77.
• The child was under the influence of the Morphia; perfectly limber, for seven hours, 80.
• Suddenly collapsed (four hours after second powder), 95.
• Considerable degree of prostration and apathy, 77.
• A few hours of lassitude, after the sound sleep, 77. [760.]
• By keeping slightly under its influence, it is a perfect antidote against taking cold, 90.

SKIN

• Livid, 92.
• Skin about face, neck, chest, arms, and hands had a cyanotic appearance (five hours after second dose), 95.
• Skin yellow and shrivelled up, 82.
• Finger-nails dark (five hours after second dose), 95.
• About a minute and a half after the operation a small pimple, with a diffuse rosy areola and slightly itching, is observed. In about twenty minutes the pimple becomes about four lines in diameter and one line in thickness; it is flattened. Its color is somewhat more than that of the skin, it is hard, its areola is very red, and about an inch and a half in diameter; its heat has increased, but the sensation of itching remains about the same. During the first hour the pimple and its areola are at their highest degree of development; from this time the appearances diminish, and at the end of two or three hours the red color of the skin has entirely disappeared, the pimple has become very flat, but it does not entirely disappear, until from twelve to twenty-four hours after the operation. If several punctures are made near each other, in the same manner, the appearances of the pimples are as above described, but the areolæ are confluent; the heat and itching are considerably increased. The appearances, however, disappear in the same manner as when a single puncture is made, 75.
• Rash beginning on the face spread itself over the entire body, quickly extending from the face to the neck, trunk, and lower extremities; so strongly did it resemble measles, at least in having the crescentic arrangement, that it had been pronounced such by another medical man; the discontinuance of the cause was followed by a speedy resolution of the seeming exanthem, and next day there was little trace of the eruption, 85.
• Intolerable itching of the skin (after three hours), 89, 91.
• Itching and pricking of the skin intolerable, 80.
• Considerable pricking of the skin, 77.

SLEEP. [770.]

• Frequent yawnings, 76.
• Excessive drowsiness, "falling asleep, even while she was speaking," 83.
• Invincible desire to sleep, 76.
• The tendency to sleep increased somewhat for a time, and twice fell asleep, though constantly talked to, but was soon aroused (after three hours), 91.
• Would sleep even when standing up, if those supporting him did not keep him constantly in motion, 84.
• Profoundly asleep, could not be aroused (five hours after second dose), 95.
• Profound sleep; if left to herself she quickly fell into a state of profound stupor, and lost all consciousness, not breathing more than once in forty-six seconds (after five hours and a half), 90.
• Profound somnolence for eighteen hours; partial somnolence between two hours and a half and three hours and a half, 93.

FEVER

• Skin cold (after six hours), 86, 96.
• Skin cool; feet quite cold (after three hours), 91. [780.]
• Skin pale, rather cool, and bathed with perspiration, 87.
• Extremities cold, 92.
• Hot and dry skin, 79.
• Skin warm and moist, 80.
• If he deferred the habitual dose beyond a certain number of hours, perspiration came on, and his system felt relaxed, 81.
• Body bathed with cold perspiration (five hours after second dose), 95.
• Surface of face, scalp, and hands loaded with large beads of cold perspiration, which, about the nose and mouth, coalesced and trickled down upon the bed-linen, 93.
• Clammy sweat over the whole surface, 82.