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Category: Uncategorized
Source: Disturbances Of The Heart

If the patient is weak, the circulation depressed, the blood
pressure low, and the heart rapid, the drug advisable to produce
rest and sleep is almost always morphin or some other form of opium.
Morphin, with few exceptions, is a cardiac tonic and a cardiac
stimulant, unless the dose is much too large. As long as the bowels
are daily moved and the food is not given at the time of the full
action of the morphin, when digestion might be delayed or interfered
with, in most patients the action of this drug during serious
illness is entirely for good. The greatest mistake in using morphin
for the production of sleep, or for physical and mental rest and
comfort when there is not severe pain, is in giving too large a
dose. If pain is not severe, or due to inflammatory distention of
some undilatable part, to pressure on some nerve, to distention of
some tube by a calculus or to some serious injury to the nerves,
large doses of morphin are not needed. Small doses will act much
more efficiently. It is excessively rare that a hypodermic of one-
fourth grain of morphin sulphate is needed, except for the
conditions enumerated. It is often a fact that so small a dose as
one-eighth grain of morphin or even one-sixth grain will cause
sufficient stimulation of a nervous patient, because its primary
stimulant effect on the spinal cord is greater than its depressant
effect on the brain, to require another dose (one-fourth grain
altogether) to give such a patient rest. On the other hand, this
patient may many times be quieted by one-tenth grain of morphin
sulphate on account of the size of the dose being not sufficient to
stimulate the spinal cord. Many a time clinically when one-eighth
grain has failed, a dose of one-fourth grain having been apparently
necessary, a change to one-tenth grain has proved entirely and
perfectly satisfactory.

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