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Sources: 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 di
estion 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.