s asleep;
may be roused by loud noise, but quickly relapses. Breathing slow and
stertorous, pulse weak, countenance livid. As coma increases, pulse
becomes slower and fuller. The pupils are contracted, even to a pin's
point; they are insensible to the action of light. In deep, natural
sleep the eyes are turned upwards and the pupils contracted. Bowels
confined, skin cold and livid or bathed in sweat. Temperature subnormal.
Nausea and vomiting are sometimes present. Remissions are not
infrequent, the patient appearing about to recover and then relapsing.
Haemorrhage into the pons may give rise to contracted pupils. Young
children and infants are specially susceptible to the poison.

_Diagnosis_ is not always easy, and one has to differentiate poisoning
from _cerebral apoplexy_. In the latter one can seldom rouse the
patient, the pupils are often unequal, and hemiplegia is present. In
_compression of the brain_, fracture of the skull may be present,
subconjunctival haemorrhages may be seen, the pupils are unequal and
dilated, and the paralysis increases. In _uraemic or diabetic coma_ the
urine must be examined.

The habitual use of opium is not uncommon, and opium-eaters are able to
take enormous quantities of the drug. The opium-eater may be known by
his attenuated body, withered yellow countenance, stooping posture, and
glassy, sunken eyes.

_Post-Mortem Appearances._--Not characteristic. Turgescence of cerebral
vessels. There may be effusion under arachnoid, into ventricles, at base
of the brain, and around the cord. Rarely extravasation of blood.
Stomach and intestines usually healthy. Lungs gorged, skin livid.

_Fatal Period._--Usually nine to twelve hours; but in many cases, if
life is prolonged for eight hours, recovery takes place.

_Fatal Dose._--Four grains of opium is the smallest fatal dose in an
adult, or one drachm of laudanum; children are proportionately much more
susceptible to the action of opium than adults.

_Treatment._--Stomach-tube, emetics, strong coffee or tea, ammonia to
nostrils. Give 10 grains of permanganate of potassium in a pint of water
acidulated with sulphuric acid, and repeat the dose every half hour.
Belladonna by mouth, or atropine hypodermically. Patient must be kept
roused by dashing cold water over him, flagellating with a wet towel,
walking about, etc. In conditions of collapse, however, this treatment
must not be continued, but everything should be done to preserve the
stre