Opium.-In poisoning by opium or morphine the patient, although unconscious, can usually be roused by shouting and shaking; the breathing and pulse are very slow, and the pupils of the eyes are reduced to pin points. There may be a history of having taken some medicine. For treatment, see Vol. II, p. 434.

Sunstroke.-Unconsciousness from sunstroke usually occurs when we have the favorable conditions for sun- or heat-stroke, and the history of exposure to the heat. For treatment, see Heat-stroke, Vol. II, p. 329.

Kidney Disease. It will often be impossible for the layman to have any correct idea as to the existence of this disease. A previous history of vomiting and watery diarrhea with dizziness may be obtained, and there may be swelling of the face and ankles from dropsy. The unconsciousness is often preceded by convulsions, as in epilepsy, but the tongue is not injured and the patient does not so rapidly return to consciousness.

Diabetes. The unconsciousness of diabetes resembles closely that of kidney disease, but the breath in diabetic coma has a peculiar sweet odor like pears, apples, or chloroform. The physician in such cases can determine the nature of the unconsciousness by drawing the urine and examining it.

Epilepsy. The insensibility begins with the fit; the tongue may be bitten and there may be a history of such attacks, and the patient regains consciousness and apparent health in a short time (see p. 311).

APOPLEXY.-This is more likely to attack men over fifty. The breathing is often loud, rattling, and snoring in character, and irregular. The patient moves arm and leg on one side of the body, while the other lies motionless, showing paralysis of one side of the body. The face may also be paralyzed on one side, the lips being puffed out on that side in breathing. There is, usually, complete insensibility, so that the patient cannot be roused. The pupils of the eyes differ in size. The patient may be also under the influence of alcohol. The limbs are entirely relaxed or stiff on the paralyzed side of the body, and the face is often drawn toward the opposite (unparalyzed) side.

The patient should be put on his back with the head raised, or turned on his side if the breathing is very noisy. Cold cloths or ice should be placed on the head, and hot water in bottles to the feet. Do not try to give food or drink while the patient is unconscious. Five grains of calomel may, however, be dropped on the root of the tongue, and the soft-rubber catheter used after being boiled, to empty the bladder. After a variable time, from a few hours to days, the patient may return to consciousness, usually to suffer from paralysis for a longer or shorter period. Death may occur during the unconsciousness. Patients who are in bed for long periods, especially when paralyzed, must be kept very clean, and be turned from time to time to avoid bedsores about the lower part of the back from pressure. Bathe such parts frequently with

alcohol and water, and see that the bedclothing is smooth under them.

DELIRIUM TREMENS ("The Horrors").— Delirium tremens does not occur in those given to occasional sprees of drinking, even if prolonged, but in the habitual, heavy drinker, and is brought on by an unusual excess in drinking, or by some nervous shock, as happens when the person suffers from bodily injury or an acute disease, especially pneumonia. The attack begins with sleeplessness, depression, and restlessness, for a day or two, and then the patient experiences a mental change. He talks continually in a rambling, disconnected manner, and is in constant motion, wanting to go out to attend to this or that matter, and is commonly filled with fear on account of objects which he imagines he sees, such as rats, snakes, and monsters, all of which drives him into such a state of terror that he is continually desiring to escape, and may try to jump out of the window or attempt suicide. There is generally some fever, a weak and rapid pulse, muscular weakness, and trembling of the hands and tongue.

Recovery is the rule from the first attack, unless some other condition is complicated with delirium tremens, as pneumonia or surgical accident.

After three or four days the patient will secure a good sleep, which is usually the favorable turning point of the disorder, when rapid improvement follows. In fatal cases the ravings, sleeplessness, and restless

ness persist, while the prostration and weakness of the pulse increase until the patient dies of heart failure.

Treatment. The patient must be watched every minute and confined to a room. The attendants must treat him with gentleness and great patience. It may be necessary to restrain the patient in bed if he is weak. A sheet may be fastened across the body and bed, but it is unwise to tie the patient's limbs. Feeding with strong soups, beef tea, milk and raw eggs every two hours, putting considerable red pepper into the broths, is of chief importance. It is best to allow no alcohol. If the pulse is very weak, give aromatic spirit of ammonia (twenty drops in a wineglass of water) every hour. To procure sleep the following prescription may be used every two hours, for two or three doses, if the pulse permits.

If this does not secure sleep, morphine1 is sometimes resorted to. A cold bath, or sponging with cold water, may produce a quieting effect, especially if there is fever. It is well to move the bowels thoroughly at the start, with five grains of calomel, or two compound cathartic pills, or other drugs.

'Caution. Morphine is a dangerous poison.

A physician's services are desirable, particularly to discover and treat any underlying and complicating condition, as pneumonia, broken rib, or other injury, to judge whether the patient's general condition warrants the use of such powerful remedies as are sometimes required, and to manage the mental aspect of the case.

ALCOHOLISM (Steady Drinking).—The steady drinker tends to lay on fat; his intellect becomes less acute, and he is irritable, restless, forgetful, and dull, especially in the morning. The judgment may become defective, and the mind is sometimes weak. Many exceptions occur in heavy, habitual drinkers who preserve a high degree of mental ability for some years. Epilepsy is sometimes a result. Chronic catarrhal inflammation of the stomach is one of the commonest effects of alcoholism, shown by a coated tongue, bad breath, and sinking feeling in the stomach, in the morning, and nausea or vomiting. The small veins on the face enlarge, producing a characteristic appearance; namely, the red nose and cheeks. There is trembling of the face and tongue. Inflammation of the nerves, especially in the legs, gives rise to pains, numbness, and, frequently, loss of strength. The heart and blood vessels become diseased. The vessels become brittle and are apt to break, occasioning apoplexy. Disease of the kidney often accompanies the change in the blood vessels and heart. The liver is often attacked, and enlargement followed by fatal contraction results.