always becomes towards the close very feeble, and at length imperceptible.
The respiration is almost always slow. In Dr. Marcet's case, as in some others, it was stertorous; but this is not common. On the contrary, it is more frequently soft and gentle, as it has been in all the cases I have witnessed; and sometimes it can hardly be perceived at all, even in persons who eventually recover, as in an instance of recovery recorded by Dr. Kinnis.[1]
The pupils are always at least sluggish in their contractions, often quite insensible;—sometimes, it is said, dilated:[2] but much more commonly contracted, and occasionally to an extreme degree. In the case last noticed, they were no bigger than a pin's head. The pupils have been so invariably found contracted in all recent cases of poisoning with opium, that some doubt arises whether they are ever otherwise, and whether the earlier accounts, which represent them to have been dilated, may not be incorrect, and the result of hasty observation.
The expression of the countenance is for the most part remarkably placid, like that of a person in sound natural sleep. Occasionally there is an expression of anxiety mingled with the stupor. The face is commonly pale. Sometimes, however, it is flushed;[3] and in rare cases the expression is furious.[4]
In moderately large doses opium generally suspends the excretion of urine and fæces; but it promotes perspiration. In dangerous cases the lethargy is sometimes accompanied with copious sweating. In a fatal case, which I examined judicially, the sheets were completely soaked to a considerable distance around the body.
A remarkable circumstance, which has been noticed by a late author, is the sudden death of leeches applied to the body. The patient was a child who had been poisoned by too strong an injection of poppy-heads.[5]
In some instances the symptoms proper to poisoning with opium become complicated with those which belong rather to organic affections of the brain, in consequence of such affections being suddenly developed through means of the cerebral congestion occasioned by the poison. Thus, in a case related in Corvisart's Journal, there were convulsions and somnolency on the third day, and palsy of one arm for four days; and for nearly two months afterwards the patient complained of occasional attacks of weakness and numbness, sometimes of one extremity, sometimes of another.[6] Here the brain must have sustained some more permanent injury than usual.—A more remarkable illustration once occurred to Dr. Elliotson. A young man, seven hours after swallowing two ounces of laudanum, presented the usual effects of opium, such as contracted pupils, redness of the features, a frequent feeble pulse, coldness of the integuments, and
