- trils, loud speaking, or the injection of water into the ear. The
state of restored consciousness is always imperfect, and is speedily followed again by lethargy when the exciting power is withheld.—It has been already remarked, that the possibility of thus interrupting the lethargy caused by opium is in general a good criterion for distinguishing the effects of this poison from apoplexy and epilepsy.
It was observed, in describing the mode of action of opium, that convulsions, although very frequently produced by it in animals, are rarely caused in man. It is not easy to account for this difference. Orfila has endeavoured to explain it, by supposing that convulsions are produced only by very large doses; but there are many facts incompatible with that supposition.
While convulsions are certainly not common in the human subject, yet when they do occur they are sometimes violent. Tralles mentions that he had himself several times seen convulsions excited in children by moderate doses.[1] The Journal Universel contains the case of a soldier who took two drachms of solid opium, and died in six hours and a half, after being affected with locked-jaw and dreadful spasms.[2] A case is related in the Medical and Physical Journal of a young man, who, three hours after swallowing an ounce of laudanum, was found insensible, with the mouth distorted, the jaws fixed, and the hands clenched; and who, soon after the insensibility was lessened by proper remedies, was seized with spasms of the back, neck, and extremities, so violent as to resemble opisthotonos.[3] Another good case of the kind is related by Mr. M'Kechnie, where the voluntary muscles were violently convulsed in frequent paroxysms, and affected in the intervals with subsultus, for three hours before the sopor came on.[4] Two instances of convulsions alternating with sopor are shortly related by Dr. Bright.[5] The convulsions sometimes assume the form of permanent spasm, which may affect the whole muscles of the body, as in a case related in Corvisart's Journal[6]—Another rare symptom of poisoning with opium is delirium. It appears to occur occasionally along with convulsions, as happened in Mr. M'Kechnie's case, and in one related by M. Ollivier.[7]
The state of the pulse varies considerably. In an interesting case described by Dr. Marcet it is mentioned that the pulse was 90, feeble and irregular; and such appears to be its most common condition when the dose has been so large as seriously to endanger life.[8] Frequently, however, it is much slower; and then it is rather full than feeble, just as in apoplexy. In cases where convulsions occur, it is for the most part hurried, and does not become slow till the coma becomes pure. In Mr. M'Kechnie's case the pulse was at first 126; but when the convulsions ceased, and pure sopor supervened, it fell to 55. It
