XXIX Opium and Morphine
Opium.—The inspissated juice of the unripe capsules of the Papaver somniferum. As a poison it is generally taken in the form of the tincture (laudanum), which contains 1 grain opium in 15 minims. Opium is found in almost all so-called ‘soothing syrups’ for children, and in Godfrey’s cordial, Dalby’s carminative, and Collis Browne’s chlorodyne. Laudanum contains 1 per cent. morphine, and it, along with all other preparations (e.g., paregoric) which contain 1 or more per cent. morphine, are included in Part I. of the Schedule of Poisons, and come under the Dangerous Drugs Regulations.
The most important active principles of opium are the alkaloids morphine and codeine.
Symptoms usually commence in from twenty to thirty minutes: Giddiness, drowsiness and stupor, followed by insensibility. Patient seems 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. Hæmorrhage 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 hæmorrhages may be seen, the pupils are unequal and dilated, and the paralysis increases. In uræmic 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 strength. Treatment must be continued as long as life remains.
Method of Extraction from the Stomach.—Opium itself cannot be directly detected, but we test for morphine and meconic acid. These may be separated from organic mixtures thus: Boil the organic matter with distilled water, spirit, and acetic acid; filter, and to the fluid passed through add acetate of lead till precipitate ceases. Filter. Acetate of morphine passes through, and meconate of lead remains. The solution of acetate of morphine may be freed from excess of lead by hydrogen sulphide and filtered, excess of hydrogen sulphide driven off by heat, and tests applied. Put the meconate of lead with water into a beaker and pass hydrogen sulphide; sulphide of lead is formed, and meconic acid set free. Filter. Concentrate the solution of meconic acid, allow a portion to crystallize, and apply tests.
Tests.—Morphine and its acetate give an orange-red colour with nitric acid, becoming brighter on standing; decompose iodic acid, setting free iodine; with perchloride of iron, gives a rich indigo-blue; with bichromate of potassium, a green turning to brown. When the alkaloid is heated in a watchglass with a drop of strong sulphuric acid until the acid begins to fume, and is then allowed to get quite cold, a drop of nitric acid produces a brilliant red colour. The iodic acid test is very delicate, but requires great care, and may be used in the presence of organic matter.
Meconic acid gives a blood-red colour with perchloride of iron, not discharged by corrosive sublimate or chloride of gold. The similar colour produced by sulpho-cyanide of potassium and perchloride of iron is discharged by chloride of gold and corrosive sublimate.
Morphine Habit.—Individuals who have acquired this habit take the drug usually by hypodermic injection. The victim suffers from nausea and vomiting, and becomes so mentally debilitated that asylum treatment is required.