Opium

Lecture XXVI — Papaveraceae — Opium

WE now proceed to study the Papaveraceae; an order of plants from which we obtain Opium, Sanguinaria Canadensis, and Chelidonium majus. As an order, they act on the circulation of the blood, tending to produce narcosis of a greater or less degree by engorging the blood-vessels of the brain. The effect thus produced on the sensorium ranges all the way from sleepiness to stupor. This, you know, is eminently true of Opium, and, to a less degree, of Sanguinaria and Chelidonium. Fumaria officinalis contains an enormous amount of potash in its ashes ; Argemone Mexicana, the Mexican poppy or yellow thistle, has been used in the treatment of tinea. It has a yellow juice, which, when exposed to the air, looks like Gamboge. We shall now take up the study of these drugs seriatim.

Opium.

( Brain. Emotions.

Spasms. Paralysis.

Marasmus.

Opium. \ Constipation. Bladder.

Sleep.

Chest. Lungs. Heart.

Defective reaction.

Opium is obtained, as you probably know, from the unripe capsules of the poppy plant, Papaver somniferum. The unripe capsules are usually employed in its manufacture, because they are more powerfully soporific. In some respects opium is the most remarkable drug in our materia medica. You know that many drugs owe the majority of their effects to active principles which they contain. Thus Belladonna contains Atropine ; Stramonium, Solanine ; Nux vomica, Strychnine, etc. ; but Opium seems to embrace an endless number of these active principles and each succeeding year adds to the list. Let me enumerate them—they are as follows :

Morphine, Protopine, Pseudo-morphine, Methylnornarcotine, Codeine, Deuteropine, Apocodeine, Laudanine, Thebain, Codamine, Cotamine, Papaverine, Hydrocotamine, Rhoeagenine, Apomorphine, Rhoeadine, Desoxymorphine, Dimethylnornarcotine, Nornarcotine, Meconidine, Thebenine, Cryptopine, Laudanisine, Narceine, Narcotine, Meconic acid, Lanthopine, Lactic acid.

These various substances are derived from Opium, by more or less complicated processes. They have more or less narcotic properties akin to those of Opium itself. The action of some of these alkaloids is well-known, while of the action of others we are as yet ignorant. Morphia (used principally in the form of the sulphate) is probably the best understood of these. It is largely used by old-school physicians in hypodermatic medication for the relief of pain. But we may make use of it as a homoeopathic remedy. In such violent diseases as cancer Morphia has been successfully given for one of its secondary symptoms, extreme susceptibility to pain ; pains are so violent as to threaten convulsions, or cause twitching and jerking of the limbs ; under these circumstances Morphia is a homoeopathic remedy. It does not cure, but relieves the pains, not as an opiate by stupefying the patient, but according to the law of Homoeopathy.

Morphia has the property of producing tympany. This is a very important fact for you to bear in mind, as you may find it necessary to differentiate incipient peritonitis from Morphia effects. Codeine, another of these alkaloids, is a useful drug in the treatment of phthisis. It is indicated in that dry, teasing cough which annoys the patient night and day.

Furthermore Codeiiie has caused and cured twitching of the muscles, especially of the eyelids. This is a very annoying symptom ; it is sometimes relieved by Crocus.

Apomorphia causes and cures vomiting. Now this vomiting is not of the kind for which you give Ipecac., Tartar emetic, Lobelia, etc. It is a reflex vomiting usually from the brain. Apomorphia produces vomiting if injected hypodermatically, long before it can have any local action on the stomach. You may utilize this effect of the drug in vomiting of cerebral origin, and also in that annoying disease from which many people suffer, and for which they get little sympathy, seasickness. In these cases of cerebral vomiting you may also think of Belladonna, Glonoin and Rhus tox.

There are several other of these alkaloids of which we have some provings, but nothing that has been definitely described. There are also numerous preparations made from Opium ; these are largely used in allopathic practice ; we have nothing, however, to do with them, except to undo the mischief they produce. The various preparations of Opium enter into the composition of cough-mixtures and soothingsyrups, used largely in popular practice. Their effects are decidedly pernicious, especially in children. A prominent old-school authority says that the use of soothing-syrup for children is decidedly reprehensible. It stunts their growth, makes them irritable and cross, and interferes sadly with the brain development. Nux vomica is one of the antidotes in cases of injury from anodyne preparations. Still better, perhaps, as an antidote, is Chamomilla, which is suited when opiates have been given for some time, and have produced their secondary effects ; the little one is wakeful ; slight pains are unbearable. When this condition is present, Chamomilla is your remedy, whether the patient be child or adult.

No drug is more freely abused by both allopath and homoeopath (!) than is the one we are studying to-day. I would that I had both opportunity and ability to convince the practitioner of the old school of medicine of the absurdity of his indiscriminate use of opiates, and I could hope still more earnestly to dissuade homceopathicians from hiding their ignorance under the anodyne effects of an occasionally interpolated dose of Morphine or Laudanum. The one class, ignorant of any other means of assuaging pains, and the other class, too lazy to study their cases, seek relief for their patients in anodynes. Call them to task for their unscientific practice and they meet you with the remark, "my duty is to relieve the sick." Let me rejoin, " At any cost? Must you do what you know to be wrong? " " No, but how do you make it wrong ?

' Tet me reply by a brief resume of the modus operandi of Opium, and then if this question is not answered I make no further objections to anodynes.

In small doses, Opiit?n has primarily a transient exhilarating effect. It seems, however, to affect the emotional more than the intellectual sphere. The mind feels as if floating in the air, unincumbered by the laws of space and gravity. The imagination has full play. If now the dose be increased, either in quantity or by frequent repetition, there follows a sleepy state. This sleep varies all the way from a pleasant feeling of easy drowsiness to the most profound stupor. This narcotic and anodyne effect of Opium is the result of the increased circulation of blood in the brain, brought about not only by increasing the amount of blood supplied to the brain but also by interfering with its return to the heart. Let me digress for a few moments and speak of the physiological explanation of sleep. Hammond has shown that during this state, the quantity of blood circulating in the cranial cavity is greatly diminished. If you give Opium to produce sleep, what do you do? Do you produce ansemia of the brain? No, just the reverse. I ask you, then, is the administration of opiates for their anodyne effects at all rational ?

Returning to the effects of Opium—the face becomes deep red and swollen from the distension of the blood-vessels. The more profound the stupor, the darker red is the face. It may even become of a brownish hue. The pupils become contracted. The pulse is full and slow. Respiration is deep, and as the stupor grows in intensity it becomes heavier and finally stertorous. What is the meaning of this stertor ? It means that as the poisonous effects of Opium increase, a paretic and finally a paralytic condition of the muscles of the palate and cheeks appears. These parts, thus being thoroughly relaxed, flap back and forth with each respiration. The pulse is full, round and slow, showing you that the heart is acting with the full volume of blood, but not with the usual speed. As the case goes on hour after hour, you find a picture of complete paralysis developing. The practical application of this I will give you when speaking of typhoid fever. The sphincters lose their control, so that there is involuntary escape of urine and faeces. The pupils now are dilated and the skin is bathed in cold sweat. The lower jaw drops and finally death ensues. In these fatal cases autopsies show the cerebral convolutions to be flattened, the vessels of the cerebro-spinal axis engorged with blood; and there is effusion of serum beneath the arachnoid and into the ventricles of the brain.

These are the symptoms of acute Opium poisoning.

Now these phenomena depend upon the action of Opium on the nerves. From irritation comes the first brief excitation. From the subsequent paralyzing action come the drowsiness, muscular relaxation and coma. From the beginning, the cerebral vessels are surcharged with blood, and this gradually increases until sopor ensues. Now, gentlemen, let me ask, is it rational practice to assuage pain with a substance which paralyzes and so relieves by taking away, not the disease, but thk ability to feee, the consciousness of suffering? What are the effects produced by the habitual use of the drug? The first effect is one that I have already described to you, one of dreamy imaginative activity of the emotional mind. I^ater, as the use of the drug is continued, every tissue of the body becomes affected. The skin grows dry and sallow and hangs in folds, the limbs emaciate, and the intellect becomes dulled.

The best antidote to Opium is strong black coffee, given repeatedly until there is some sign of reaction. In addition to that you should use electricity. You should also remove any of the poison that may be in the stomach by means of an emetic or the stomach-pump, and you should force the patient to walk about to prevent stupor. Opium has so far been sufficiently described for you to see readily in what classes of disease it is indicated.

You see the picture of Opium in typhoid fever with profound cerebral congestion resulting in paralysis of the brain, dropping of the lower jaw and stertorous breathing. Often when Opium is called for in this disease, the body is bathed in a hot sweat. This sweat is not critical. It is a bad omen. It is a symptom of approaching death, in that it is a result of paralysis of the sweat glands. This symptom is also found under Stramonium.

In typhoid fever with threatening paralysis of the brain, you should remember Lachesis, the symptoms of which I described to you w Then lecturing on that drug ; also Hyoscyamus, which has the stertorous breathing; but there are differences, as you will learn in a future lecture. Opium must be considered in the treatment of apoplexy. It is natural to suppose that a remedy producing such fulness of the cerebral blood-vessels might, in persons predisposed, readily cause their rupture, and the consequent symptoms of extravasation of blood into the cerebral substance. Opium is indicated by the color of the face, by the stertorous breathing, and by tetanic rigidity of the body. Especially is it indicated in the apoplexy of drunkards. Opium follows Belladonna in apoplexy.

In apoplexy occurring in drunkards, you should think also of Baryta carb. and Lachesis.

Arnica suits in apoplexy, when the pulse is full and strong. The paralysis is on the left side and there is stertorous breathing. Apis is called for when the coma fails to yield to Opium. For apoplexy with convulsions, think of Belladonna, Hyoscyamus, Lachesis and Opium.

For apoplexy followed by paralysis, Arnica, Belladonna, Lachesis, Nux vomica and Rhus tox.

When followed by idiocy, Helleborus.

In apoplectic congestion with sleepiness after meals Opium should be compared with Nux vomica and Arnica.

Opium is useful in mania a potu or delirium tremens. Especially is it indicated in "old sinners;" in those whose long lives of excess have thoroughly destroyed their constitutions ; in those who have had the disease time after time. It takes but a small quantity of liquor to throw them again into the delirium. The face wears a constant expression of fright or terror. . They have visions of animals springing up from various parts of the room. They imagine that they see ghosts, devils, etc., with whom they converse, though they are terrified by the subjects of their visions. If they succeed in obtaining sleep, it is of the stertorous character already referred to. There are several remedies which, if given soon enough, will enable you to carry your patients with delirium tremens safely through the attack. I have already mentioned Opium ; another is Lachesis ; especially is this indicated when the patients have visions of snakes and other hideous objects; sensation in the throat as if choking; and springing out of sleep suddenly as if from a dream.

Another remedy is Stramoniitm, to which you will be guided by the violence of the symptoms. The patient starts from sleep in perfect horror, with visions of animals coming toward him from every corner of the room ; he makes efforts to escape ; his face is bright red.

Still another remedy is Cannabis Indica, or the hashish. This is one of the best. It has thus far been given only in low potency. The symptoms which seem to characterize it are, ideas of grandeur and errors of perception as to space and as to time.

In other cases we have to use Arsenicum, when there is fear of death and the patient will not permit himself to be left alone. A remedy often forgotten, but useful, nevertheless, is Calcarea ostrearum. The minute the patient closes his eyes he sees visions which compel him to open them again in affright.

You may use Opium in cholera infantum when the face is red or pale, and is associated with fatally advancing stupor ; the pupils react to the stimulus of light either not at all or else very sluggishly. The disease seems to begin by involving the brain, or such a mishap threatens during its course ; as yet there is neither diarrhoea nor vomiting ; the child appears as if it had been drugged. Opium administered in a case like this will restore the patient to consciousness. Diarrhoea sets in, and the disease proceeds naturally to recovery. This remedy may also be given when there is a lack of vitality, and the well-selected remedy refuses to act. The patient is either sluggish or drowsy. It is just as useful in these cases as are Carbo veg.

t Sulphur, Valerian, Ambra grisea, Psoiinum, or any of the other drugs called for in defective reaction.

There is a remedy which I wish to give you here, but with some caution, because it is what has been termed a "breech-presentation," that is, it was used clinically before provings of it were made. That remedy is frerrum phos. It is called for in cholera infantum when the discharges from the bowels are frequent; within twenty-four hours the child is greatly reduced, and falls into a stupor, with red face, dilated pupils, rolling of the head, and soft, full-flowing pulse. We know that Iron has that kind of a pulse ; we know that congestion belongs. to all the preparations of Iron. In one of my cases with the above symptoms, Belladonna and Sulphur-were each given in turn, but failed. I then gave Ferrum phos. , and in twelve hours the child returned to consciousness, and is alive to-day.

You may also use Opium in suppuration of the lungs occurring in those greatly addicted to the use of intoxicating liquors; the breathing is labored, and is attended with rattling and snoring. Cough is very difficult, and is attended with smothering spells ; the face becomes blue during the cough.

Another affection of the lungs occurring in drunkards, namely, haemoptysis, calls for Opium when the chest is hot and the limbs are cold ; the cough is violent, and is attended with an expectoration of frothy mucus and blood ; the patient is drowsy with the cough. Antimonium tartaricum also has cough with drowsiness and gaping. We find Opium sometimes indicated in spasms, especially when they occur as the immediate result of fright or anger ; or when a nursing infant has a convulsion after its wet-nurse has been frightened ; the body is in a condition of tetanic rigidity ; opisthotonos ; the spasm is ushered in with a loud shriek ; there is foaming at the mouth ; the face becomes dark red, or even purple, and the body is often bathed in a hot sweat ; deep, snoring sleep follows the spasm.

Opium causes and cures constipation ; a constipation in which there is inertia of the rectum and the entire intestinal tract ; there is no inclination whatever for the bowels to move ; thus the bowels become impacted with faeces ; flatus accumulates in the upper portion of the intestines and presses upward against the chest. This symptom is very common after diseases that are debilitating or long-lasting. In such cases I have been in the habit of giving Opium in repeated doses until colicky pains are produced ; this indicates restoration of peristaltic action of the bowels. I then order an injection of cocoa-nut oil or soap and water to soften the faecal masses, when an easy evacuation of the bowels follows. The Opium stool in its complete picture consists of little hard, dry, black balls. This form of constipation reminds us of that of Alumina, Plumbum and Bryonia.

Bryonia has constipation with inertia of the rectum and lack of intestinal secretion ; the stools are large and dry.

Plumbum closely resembles Opium, but there is some spasmodic constriction of the anus ; the stools consist of hard, black balls. Alumina has inertia of the rectum with hard, dry, knotty stools, but often attended with soft faeces.

In tympanites or accumulation of flatus, especially in advanced stages of peritonitis, compare Opium with Terebinthina, Lycopodium, Carbo veg., Colchicum, and Raphanus.

The characteristic symptom calling for the last-named remedy in tympanites is, that the patient passes flatus neither upward nor downward for days.

Opium may be used in bladder troubles, especially in retention of urine. It is indicated when this retention has resulted from fright, and when it follows parturition. This last-named symptom I have twice confirmed.

In this retention of urine after labor, compare with Opium, Hyoscyamus, Causticum, and Arsenicum.

In suppression of urine you may think of Stramonium, Zingiber, Lycopodium, and Pulsatilla.

The power of Opium to cause shriveling of every fibre of the body suggests its use in marasmus in children. The patient is wrinkled and like a little dried-up old man ; the characteristic Opium stupor is present.

When the above-named condition has been produced by Opium, Sulphur, Argentum nitricum, or Sarsaparilla may be used as an antidote. Muriatic acid is the remedy for the continued muscular debility following the use of Opium.

We may find Opium indicated in that very dangerous condition, strangulation of the bowels. There are violent colicky pains and vomiting of matters having a faecal odor.

In colic it may be given when there is great tympany and pressure downward on the rectum and bladder ; there is a great deal of belching without relief.

Compare here Nux vomica, China and Lycopodium.

Veratrum album has colic as if the bowels were twisted; abdomen tense. The longer delayed is the emission of flatus, the more difficult is it to pass. Opium has been of service in incarcerated hernia, ileus and typhlitis, with complete constipation, vomiting of faecal matter or at least of substances of a faecal odor.

Sometimes we find Opium useful in metrorrhagia, whether after labor or not. The patient is restless; the sheets feel hot to her; she is sleepy, but cannot sleep.

In fevers other than typhoid, it may be given when the chill is accompanied by heat of the head and great drowsiness ; the body is burning hot, even when covered with a copious sweat ; desire to uncover ; unconsciousness ; feels as if his legs belonged to some one else. (Compare Baptisia and Stramonium.)

Puerperal fever sometimes calls for Opium, especially when caused by fright. There is over-excitement of all the senses ; even distant sounds annoy the patient ; the discharge from the uterus is very foetid. The case approaches a condition of stupor.

In haemorrhage from the uterus, compare Belladonna, which has a flow of bright blood feeling hot to both physician and patient. Hyoscyamus also has this. But under this remedy there is a great deal of spasmodic jerking of the body.

You will see from what I have said that Opium is an invaluable remedy for the bad effects of fright, whether that emotion produces convulsions or diarrhoea.

Gelsemium, Pulsatilla, and Veratrum album, you will recall as being useful in diarrhoea after fright.

For the remote consequences of fright Opium does not always suffice; you should then remember Natrum muriaticum, Silicea, and Phosphoric acid ; the first named especially for chorea or paralytic weakness of this origin.

Opium, like Bovista and Arnica, is useful for the bad effects of inhalation of charcoal vapors.

In spasms of the lungs, compare Moschus and Ipecac.

Drosera is likewise indicated in the spasmodic cough of consumption, coming on in the evening, and perhaps again after midnight. Every effort to raise a little phlegm ends in retching and vomiting.