Nature and Source. The concrete, milky exudation, obtained by incising the unripe capsules of Papaver somniferum, the white Poppy, an annual herb of the nat. ord. Papaveraceae. In its normal, moist condition, it should yield not less than 9 per cent. of Morphine, when assayed by the official process. It contains 17 alkaloids, 2 neutral bodies, 2 organic acids,—also wax, gum, sugar, resin, extractives, odorous principles, etc. The six principal alkaloids of Opium are—
- Morphina, Morphine, Dose, gr. 1/20-½;—hypnotic, anodyne and narcotic.
- Codeina, Codeine, Dose, gr. ⅕-j ;—calmative, and less constipating.
- *Thebaina, Thebaine,—a tetanizer; not used medicinally.
- *Narceina, Narceine, gr. ⅛-½ ;—probably the most hypnotic of the six.
- *Papaverina, Papaverine ;—action doubtful, narcotic and convulsant (?).
- *Narcotina, Narcotine, Dose, gr. j-v;—wrongly named, having no narcotic action; is a tetanizer and highly antiperiodic,
These principles are combined in the plant with Meconic and Lactic Acids.
A Derivative of Morphine, obtained by the action of HCl acid, is—
- Apomorphina, Apomorphine,—an artificial alkaloid and a powerful emetic; the Hydrochlorate of which is official, and may be administered in doses of gr. ⅛ by stomach, or gr. 1/16 hypodermically.
Preparations of Opium. The principal are—
- Opii Pulvis, Powdered Opium. Dose, gr. ¼-ij ;—gr. j is a medium dose.
- Extractum Opii,—has 18 per cent. of Morphine. Dose, gr. ¼-j.
- Tinctura Opii, Tincture of Opium, (Laudanum),—Opium strength 10 p. c. ♏xj (gtt. xxij) about equal gr. j of Opium, or gr. ⅙ of Morphine Sulphate. Dose, ♏v-xxx, as per effect desired.
- Tinctura Opii Deodorati, Tincture of Deodorized Opium.
- Vinum Opii, Wine of Opium (Sydenham's Laudanum).
- Acetum Opii, Vinegar of Opium (Black Drop).
- [about above three:] All have Opium, strength 10 p.c., and Dose as the tincture.
- Tinctura Opii Camphorata, Camphorated Tincture of Opium (Paregoric),—has nearly gr. j of Opium in ℥ss, therefore only 1/20th the strength of the tincture. Dose, for an infant, ♏v-xx,—for an adult, ʒj-iv.
- *Tinctura Opii Composita, Compound Tincture of Opium, Squibb's Diarrhoea Mixture,—has Tinct. Opii, Tinct. Capsici, Spt. Camphorae, aa ℥j, Chloroformi Purif., ʒiij, Alcoholis, ad ℥v. Dose, for infants, gtt. j-x; for children, gtt. x-xxx; for adults, ʒj.
- Emplastrum Opii,—Ext. of Opium, Burgundy Pitch and Lead Plaster.
- Pilulae Opii,—each pill has gr. j of powdered Opium with Soap.
- Pulvis Ipecacuanhae et Opii, Dover's Powder,—Ipecac 1, Opium 1, Sugar of Milk 8 parts, triturated to a fine powder. Dose, gr. v-xv.
- Tinctura Ipecacuanhae et Opii,—intended to represent Dover's Powder in liquid form; has of Tinct. Opii Deod. 100 evaporated to 80, Ext. Ipecac Fl. 10, Diluted Alcohol to 100. Dose, ♏v-xx.
Preparations of Morphine, etc.
- Morphinae Acetas,—soluble when fresh in 2 ½ of water. Dose, gr. 1/20-j.
- Morphinae Hydrochloras,—soluble in 24 of cold water. Dose, gr. 1/20-j.
- Morphinae Sulphas,—soluble in 21 of water and in ¾ of boiling water; contains about 80 per cent. of Morphine. Dose, gr. 1/20-j, a medium adult dose being gr. ⅙.
- Pulvis Morphinae Compositus, Tully's Powder,—gr. x contains gr. ⅙ of Morphine Sulphate, with Camphor, Liquorice and Calcium Carbonate.
- *Tinctura Chloroformi et Morphinae, (B.P.),—each 10-minim dose contains of Morphine Hydrochlorate, gr. 1/48, of Chloroform, ♏j ¼, of Dilute HCN Acid, ♏⅝, with ether, alcohol, oil of peppermint, liquorice, treacle and syrup. Intended as a substitute for Chlorodyne, (see ante, page 139).
- *Liquor Morphinae Sulphatis, Magendie's Solution,—has gr. xvj of Morphine Sulphate in ℥j of Distilled Water, or gr. ¼ in ♏vijss. Morphine in solution will change to Apomorphine if kept long.
- *Liquor Morphinae Sulphatis, U.S.P. 1870,—has gr. j of Morphine Sulphate to the ℥ of Distilled Water. Dose, ♏xxx-℥ss.
- Codeina, Codeine,—soluble in 80 of water, in 17 of boiling water, and in 3 of alcohol. Dose, gr. ¼-ij; but gr. ⅙ has produced alarming symptoms in children.
- *Codeinae Phosphas,—is sufficiently soluble for hypodermic use, 1 in 20 of water is the usual solution. Dose, as Codeine.
Changes in Opium Preparations. The official dried Opium should now contain 13 to 15 per cent. of Morphine, instead of 10 per cent., as required by the Phar. of 1870. The liquid preparations, except Paregoric, are required to be of the uniform Opium strength of 10 per cent. by weight, making the Wine 2 per cent. weaker, the Acetum ⅓ weaker, and the others ½ stronger in Morphine than formerly. So that, if the former full anodyne dose of Tincture be taken at ♏xxxiv, = gr. ¼ of Morph. Sulph., the corresponding dose under the new system will be ♏xvj.
Tests for Morphine. Nitric Acid produces a blood red, turning orange, then yellow, then disappearing. Ferric Chloride gives a rich blue with Morphine, a dark brown with Meconic Acid or any preparation of Opium. Iodic Acid liberates Iodine, which may be tested by starch.
Minimum Fatal Dose of Opium. In a child one day old ♏j of Laudanum was fatal; and in another aged nine months a few drops of Paregoric caused death. In the adult gr. ⅙ of Morphine, or gr. iv of Opium have proved fatal.
Treatment of Opium Poisoning. The chief indications are-to evacuate the stomach, maintain respiration, and keep up the circulation. Potassium Permanganate, in dose one-half greater than the amount of Morphine ingested, is said to be a perfect antidote to Opium or Morphine in the stomach. Atropine antagonizes its cerebral action, also its action on the pupil, respiration, heart and arterial tension (?), but if given too freely will endanger the case by substituting Belladonna narcosis for Opium narcosis; gr. 1/120, hypodermically, every 15 minutes, for three doses, is generally sufficient. Strychnine. Coffee, Caffeine, and Cocaine are also physiologically antagonistic to Morphine. Faradization of the chest muscles, cold affusion and artificial respiration are of great value. Flagellation is a very dangerous procedure, from the exhaustion produced; strong faradic currents are much more efficient. Evacuation of the bladder is important, to prevent reabsorption.
Physiological Action. Opium is analgesic, hypnotic, diaphoretic, antispasmodic, narcotic, also a cardiac and respiratory depressant, after primary brief stimulation thereof. In medium dose (gr. j),—it dries all the secretions, except those of the breasts and the skin, the latter being increased , produces dryness of the mouth and throat, arrest of the gastric secretion, retarded digestion and anorexia; stimulates the brain by increasing the blood supply; and does not affect the conductivity of the nerves. The action of the heart is increased, and the arterial tension raised the pupils slightly contracted; the mind, at first stimulated, becomes calm; sleep follows, disturbed by dreams; and headache, constipation and some depression result.
In Full Dose (gr. v),—it arrests digestion; causes nausea and vomiting; greatly increases the sweat; prevents the conductivity of the nerves; depresses the heart and circulation, impairing oxidation and lowering temperature; contracts the pupil by stimulating the motor oculi; causes intense pruritus, especially of the nose; often retention of urine; and soon profound sopor (in some cases coma-vigil, delirium); leaving as after-effects nausea, depression, constipation, vertigo, anorexia, nasal pruritus, fetid pathological secretions.
A Toxic Dose produces cold, clammy sweat, very slow heart, abolished reflexes, coma; the pupil minutely contracted, but dilated as the end approaches; and death by suspension of respiration, due to the direct action of the poison on the respiratory centres in the medulla.
Post-mortem shows only a wet brain, congested lungs, and engorgement of the venous trunks and the right side of the heart.
Morphine and Codeine. As compared with the action of Opium, that of Morphine is more anodyne and hypnotic. It causes more intense pruritus, is less stimulant, less convulsant, less constipating and less diaphoretic. Codeine may be considered chemically a Methyl-morphine, and like all methyl compounds has an action similar to that of Curare, viz.—motor-paralyzant. It exalts the spinal cord more than Morphine, and affects the cerebrum less, producing muscular tremor in excess of sedation. It reduces the urinary sugar in diabetes, and has a selective sedative influence on the pneumogastric.
Therapeutics. The chief indications for the use of Opium are (1) to relieve pain; (2) to produce sleep; (3) to allay irritation; (4) to check excessive secretions; (5) to support the system; (6) as a sudorific. It is badly borne usually by women and children, and in some persons great nausea and depression follow its use, which may usually be averted by the conjoined administration of Potassium Bromide, Hydrobromic Acid, or Spirit of Ether, with each dose of the opiate used. It is especially valuable in—
- Pain from any cause except acute inflammation of the brain.
- Low Fevers when insomnia and low muttering delirium, and to support the system when sufficient food cannot be taken or retained.
- Irritation of the bronchi, bladder, stomach, as in acute severe vomiting.
- Peritonitis,—used freely, even to narcotism, it has often saved life.
- Diarrhoea, Dysentery, Enteritis, etc.,—it is a very efficient remedy.
- Acute Uraemia,—Loomis urges its use to control convulsions and promote diuresis; large doses required in this condition.
- Colds and Muscular Rheumatism,—Dover's powder as a diaphoretic, conjoined with hot drinks and hot foot-baths.
- Gastralgia,—no remedy equal to Morphine and Bismuth Subnitrate.
- Colic,—rectal suppositories containing the Aqueous Extract of Opium.
- Spasm,—Morphine hypodermically in muscular spasm, is efficient.
- Cholera Morbus and Dysentery,—gr. 1/12 of Morphine with gr. 1/120 of Atropine, promptly effective after ingesta removed by an active cathartic.
- Serous Inflammation,—the Deodorized Tincture to slight narcotism.
- Cerebro-spinal Meningitis,—Opium the one remedy if given early, before exudation has set in.
- Superficial Inflammations,—Opium or Morphine locally, of great value.
- Diabetes Mellitus,—Codeine or Morphine per orem reduce the sugar promptly, but have little or no effect when used hypodermically.
- Dyspnoea from any cause is relieved by Morphine, especially that of cardiac disease. "It gives the power to breathe " (Huchard).
- Cardiac Disease, especially aortic stenosis or insufficiency, with dyspnoea, paroxysms of angina pectoris, or signs of cerebral anaemia,—Morphine hypodermically presents the greatest advantages.
- Hemorrhages, especially uterine, due to fibroids or cancer,—the influence of Opium on the circulation is invaluable.
- Contraindications for the use of Opium are—alcoholism, disease of the respiratory organs, advanced disease of the kidneys, and some forms of cerebral congestion and cardiac disease.
A Compend of Materia Medica, Therapeutics, and Prescription Writing, 1902, by Sam'l O. L. Potter, M.D., M.R.C.P.L.