Related entry: Opium under diaphoretics
The concrete juice of Papaver somniferum.—Asia.
Preparations.—Opium is given in substance (pill), in powder, in tincture, the alkaloid morphia and its salts, the sulphate of morphia being most commonly employed.
Dose.—The dose of Opium and its preparations varies greatly, according to the condition of the patient and the indications to be fulfilled. The ordinary dose of Opium is one to two grains. Of a tincture (U. S. P. laudanum), ten to thirty drops. Morphia is used in doses of from one-eighth of a grain to one half grain; larger doses should be rarely employed.
Therapeutic Action.—Opium or its preparations, in fatal doses, produce the following phenomena: Vision is impaired, weakness ensues, consciousness is lost, coma supervenes, the surface becomes cold, the pulse small, respiration hurried and stertorous, occasionally convulsions, and finally symptoms of an apoplectic character are fully developed. Before insensibility occurs, as well as when the effects are passing off, the patient often experiences an itching of the skin, and in some cases a miliary eruption appears. They are said to cause difficulty in voiding the urine, which is supposed to arise from the weakened ur paralyzed state of the bladder. This last effect, according to Pereira, is more liable to follow the acetate of morphia.
They are employed with benefit in all cases of excessive pain, violent spasmodic action, in cases of loss of sleep, extreme restlessness, in gastric irritation with nausea and vomiting, in irritation of the respiratory organs attended with troublesome coughing and redundant expectoration, dysentery and dysenteric tenesmus, cholera morbus, cholera in faut a m, etc. lu these cases, and many others in which they may be employed, they relieve pain and local irritation, promote rest, and in this way not only act as palliatives, checking the progress of the disease, but in many cases as curative agents—the natural powers of the system being sufficient to remove the cause of the disease, if the nervous excitement is subdued.
It must be recollected that when we wish to obtain the primary stimulant effects of opium, as in the low forms of fever, etc., or its influence in the suppression of morbid discharges, the salts of morphia are not so efficient in action as the crude article.
We have found the sulphate of morphia a very valuable remedy in cases of excessive nausea and vomiting, as in cholera morbus, Asiatic cholera, etc. In some cases where there are indications of crude ingesta or any morbid accumulation in the stomach, a gentle emetic may be given. As soon as the stomach is thoroughly evacuated, the sulphate of morphia may be given in doses of front one-eighth to one-fourth of a grain in a small quantity of cold water or lemonade, repeated as often as may be necessary, all fluids being interdicted for several hours. This course rarely fails to tranquilize the stomach, and prepare it for the reception of other remedies.
In mania caused by intemperance, these agents have been found highly useful. In febrile and inflammatory affections, and. various diseased states of the system, attended with violent pain and great nervous excitement, they are invaluable for relieving pain, quieting restlessness, reducing exalted organic action, inducing diaphoresis, and in spasmodic states of the bowels, facilitating the action of cathartics.
As topical applications, the salts of morphia possess great advantages over the opium. In painful diseases of a local character, as neuralgia, rheumatism, etc., they seldom fail to afford more or less relief. In using them for this purpose, a blister is applied over the affected part, the epidermis removed, when they are applied to the naked derma. In cases of excessive nausea and vomiting, and also in gastrodynia, spasm of the bowels, etc., the same mode of employment is often productive of prompt relief. We occasionally adopt this mode of exhibition when we wish to bring the general system under its sedative, anodyne, and soporific influence, where from certain causes their exhibition by the mouth is impracticable. When used endermically, double or even triple the ordinary dose is to be employed, in order to secure their anodyne influence. They are sometimes used in the form of enemata to relieve pain, dysenteric tenesmus, nausea and vomiting, when the stomach is weak and irritable. For this purpose they are dissolved in a solution of starch and mucilage.
Where these preparations can not be taken by mouth, the effect is obtained by the use of the hypodermic injection of morphia. The action is prompt and certain, and there is not the danger of slow or imperfect absorption, or change of thes remedy by the digestive fluids. The common solution fo. hypodermic injection is—Rx Sulphate of morphia gr. x., distilled water ℥j., of which from gtt. x. to ʒss. may be used.
The hypodermic injection of morphia has been extensively employed for the relief of neuralgia, and in some cases the relief has been prompt, and permanently curative. But in many other cases it only gives temporary relief, and requires frequent repetition, with increase of dose, and is not curative. In other cases its permanent influence is had, arresting secretion, impairing the appetite and digestion, interfering with nutrition and normal innervation. To obtain the greatest relief in these cases, the injection should be used at the point of pain. This is contrary to the common use, which selects the inside of the arm as the most favorable point for injection, and trusts to its general rather than its topical action. In deep seated neuralgia, as in sciatica, I have made the deep puncture, and discharged the solution of morphia in contact with the nerve.
In some cases of inflammation, in the early stage, the hypodermic injection has been used with good results. This has been especially the case in pleurisy and acute peritonitis (not zymotic). But when used in inflammation there must be a soft pulse, a moist skin, and a moist tongue. If the skin is dry, the tongue dry, and the pulse hard, no preparation of opium should be used, either by the mouth or by hypodermic injection.
The hypodermic injection of morphia has been employed in cholera morbus, and associated with strychnia it can be used with good results. It has been used with success in Asiatic cholera, and is one of the means that should be thoroughly listed in the coming epidemic. I have used the hypodermic injection of strychnia, keeping patients alive twenty-four hours longer than they could have lived otherwise; and it is possible that in many cases the two remedies can be associated.
The hypodermic injection of morphia is the treatment for puerperal convulsions. In every ease in which I have used it, it has been successful, and others give a like favorable report. The quantity injected should be from one-third to one-half grain, repeated necessary. It has served my purpose better than chloroform, relieving the convulsions quicker, and being more permanent in its effect.
In surgery it may be used to relieve a patient from shock, either at the time of injury or from an operation. It is also claimed that a small hypodermic injection of morphia is a good preparation for chloroform. One thing is certain, that very much less chloroform can be used, if the patient has had morphine.