SECT. XLII.—ON THE JUICE OF THE POPPY.
When one has drunk of the juice of the poppy drowsiness comes on, with coldness and intense itching, so that often when the medicine takes effect such an itching comes on that the person is roused from sleep thereby. The smell of the medicine too is emitted from the whole body. The remedies in such cases, after rejecting the substance taken by vomiting with oil, and evacuating downwards by a stimulant clyster, are oxymel drank with salts, or honey with warm rose-oil, and much undiluted wine with wormwood and cinnamon, and warm vinegar by itself, and natron with water, and marjoram with lye, the seed of rue and pepper given with castor, and oxymel, savory, or the decoction of marjoram with wine. We must also rouse by aromatics, put the person into a hot bath, and foment on account of the pruritus which supervenes; and after the bath we may use fat broths, with wine or must. Marrow also drunk with oil is useful.
Commentary. According to Nicander, the symptoms of poisoning by poppy-juice are coldness of the extremities, eyes fixed, heaviness of the eyelids, profuse and fetid perspiration, paleness, swelling of the lip, relaxation of the under jaw, slow respiration, cold breath, and the usual precursors of dissolution, namely, distortion of the nostrils, lividity of the nails, and hollow eyes. His remedies are emetics, such as the oil of iris or of roses, wine and honey; hot drink and rousing the patient by cries, striking his body in different places, and wrapping it in cloths smeared with oil and hot wine, and the hot bath as a restorative.
The symptoms mentioned by Dioscorides are lethargy, violent pruritus, and the perspiration smelling of opium. His remedies are the same as those of our author, namely, emetics at first, then clysters, and afterwards wine and vinegar, with various stimulant and strong-scented things; such as pepper, cinnamon, castor, marjoram, &c. The patient is to be roused as directed by Nicander; and baths and fomentations are to be used to relieve the pruritus.
Galen relates the case of a person reduced to the last stage of coldness, whom he saved by administering freely a strong, light-coloured, and fragrant wine. Yet, he remarks correctly, a small quantity of weak wine operates unfavorably by promoting the distribution of the poison over the system. He, in particular, recommends vomiting at first with wine and oil, and afterwards strong clysters.
Aëtius mentions, among the symptoms, violent pruritus and convulsions. None of the other Greek writers mention convulsions, but, among the Arabians, Avicenna, Rhases, and Alsaharavius, have mentioned them. Modern experience has determined that they are an occasional, but not a frequent symptom produced by the immoderate administration of opium.
Scribonius Largus directs us, after repeated vomiting, to apply embrocations of vinegar and roses to the head, to rub the feet, and to put sinapisms to them and the thighs. Simeon Seth strongly recommends vinegar.
Haly Abbas and Alsaharavius, and, in short, all the Arabians recommend nearly the same treatment; namely, emetics of oil and water, or oil and wine, hot clysters, acrid and strong-scented things, such as castor, assafœtida, savin, &c., and the warm bath, friction, sternutatories, and every means calculated to arouse, and to prevent sleep.
Serapion, Rhases, Avicenna, Haly Abbas, and Alsaharavius, agree in stating that the smallest dose of opium which will prove destructive to human life is two drachms. Modern authors are not agreed as to the smallest quantity which may prove fatal, but surely, as Dr. Christison remarks, Dr. Paris has fixed the minimum dose too low, when he affirms that four grains may be sufficient to produce this effect. On the other hand, we should think that a smaller dose than that mentioned by the Arabians might be sufficient to destroy life. Perhaps the ancient opium may have been weaker than that now in use.
It is worthy of remark, that most of the ancient authorities recommend vinegar in cases of poisoning by opium, but we are inclined to think that none of them administered it at the commencement, nor until the poison had been removed from the bowels. This practice agrees very well with the rule of treatment laid down by Orfila, Paris, and Christison, who state that vinegar is prejudicial, if given at first, by favouring the solution of the poison, but proves useful afterwards by acting as a restorative to the system.
None of the ancient authorities recommend venesection.
In another work we have thus explained the ancient theory of the action of opium upon the human frame. “In order to understand properly the ideas entertained by the ancients respecting the modus operandi of opium, it will be necessary to say a few words in explanation of their opinions upon certain points of physiology. Aristotle taught that the prime cause of all the operations of life is mind, and that the prime instrument by which it performs them is heat, which, therefore, he denominates the co-cause (συνάιτιον). He illustrates his meaning by comparing the mind to the artificer, and heat to the wimble or saw by which he performs his work. Having remarked, no doubt, that the heart is the warmest part of the body, he appears to have considered it as the spring which turns the whole machinery of the animal frame, the brain and nerves deriving their origin and influence from it. (I need scarcely mention how well these ideas accord with the ingenious hypothesis lately advanced by M. Serres.) Many facts, indeed, seem to point out the supreme importance of the heart. It is, as the ancients remarked, the primum movens et ultimum moriens; and, along with its accessory organ, the lungs, it is evidently the part which, in the higher classes of animals, renders them independent of the many variations of heat and cold to which they are subjected. It is this wonderful organ which, under the guidance of the principle of life, preserves the heat of the body unaltered in all the different gradations of temperature, from more than 100 degrees above the boiling, to as many below the freezing point of the thermometer. It seems, in fact, a real Prometheus that steals the fire from heaven. The connexion between heat and the vital actions is very apparent also in the inferior animals, who are not provided with such an apparatus for preserving an equability of temperature. Thus the zoophyta, insecta, et vermes, with the loss of heat, lose also sensibility and muscular energy, which they recover again when their heat is restored. In this case it is evident that heat is the cause (or at least the co-cause) of the vital actions, and not the vital actions of heat. It has always appeared to me a striking fact, illustrative of the great influence of heat over the vital actions, that the strength of all animals is, bulk to bulk, proportionate to the degree of their animal heat.
“This doctrine of the supreme authority of the heart, as being the focus of heat, thus maintained by Aristotle, was eagerly defended by the great Arabian commentator, Averrhoes, and by his countryman, Avenzoar, who keenly attacked Galen for having questioned its truth, and taught, as they represent, that the brain is the leading organ in the animal frame. After having, however, carefully ransacked every part of Galen’s works, in which I could suppose it likely to meet with any allusion to this doctrine, I am led to believe that these Arabians, in the heat of controversy, have misrepresented the real opinion of their master’s rival. Galen appears decidedly to have maintained with Hippocrates—‘that there is in the body no one beginning, but that all parts are alike, beginning and end: for a circle has no beginning.’ Agreeably to this idea, Galen remarks, that the brain cannot properly be said to derive its powers from the heart, since an animal will run, breathe, and cry after its heart has been taken out; nor can the heart be said properly to derive its powers from the brain, since it will palpitate and contract, after all communication with the brain is cut off, nay, after it has been removed from the body. In so far, then, the functions of the brain and the heart are independent of one another. But the brain is dependent upon the heart and its appendages for vital heat, without which it would be unable to continue its functions; and the heart, on the other hand, is dependent upon the brain for imparting nervous influence to the respiratory organs, without which it could not preserve its vital heat unaltered. Hence the mutual connexion and sympathy of important organs—a doctrine much insisted upon by ancient authors, and which bears some resemblance to the theory lately advanced by Mr. Morgan and Dr. Addison.
“We shall now have no difficulty in understanding the ideas of the ancients regarding the operation of opium. Galen and Avicenna believed that the poison exerts its primary influence upon the heart, and impairs its vital heat. Of course they considered its operation on the brain as secondary. They called the action of narcotics frigorific or congealing, no doubt because they remarked that it was attended with a diminution of vital heat, and to this they attributed the loss of sensibility and muscular energy. I leave it to the reader to judge whether this theory or the modification of it lately proposed by Messrs. Morgan and Addison be the more plausible.” (Edinburgh Medical and Surgical Journal, No. 103.)
But although the ancient physiologists maintained that the prime organs of the animal frame suffer sympathetically in cases of poisoning, they did not hold, it will be remarked, that all poisons exert their primary action on the nervous system. This is the hypothesis lately advocated by Messrs. Morgan and Addison, but which is, in fact, only a revival of that maintained by Schulze in his ‘Toxicologia Veterum.’ He thus states his theory of the action of poisons,—“Omnia symptomata et lethales venenorum effectus hoc unum quam luculentissimè demonstrant, ab omnibus venenis nervos ipsos graviter affligi. Nervea igitur vis seu vitalis, a veneni stimulis commota, aut majori impetu agit, aut prævalente veneni vehementia prorsus silet, nexusque omnes sensorii communis cum reliquis nervis turbantur, vitâ animali aut graviter periclitante, aut prorsus interiturâ.” (Toxic. Vet. vii.) Dr. Mead also, in his last edition of his work on Poisons, advocates this hypothesis.
It appears to us, however, that this theory, although very simple and plausible, is somewhat too exclusive. And that there are other modes by which poisons operate than through the brain and nerves appears to be demonstrated by the fact now clearly established, that poisons act upon vegetables as well as upon animals. (V. Annales de Chimie, t. xxix.) Now as vegetables are possessed of neither sensibility nor motion, it seems preposterous to suppose that they have any nervous system.
Perhaps, then, we cannot do better than revert to the old doctrine delivered by Alsaharavius. Sometimes, he says, poisons act upon the heart, and thereby prove instantly fatal; sometimes upon the liver, producing jaundice and phthisis; sometimes upon the brain, when they occasion delirium; and sometimes their action is local, giving rise to corruption and lividity of the part. (Pract. xxx. 2, 18.)
That the primary action of narcotics is upon the heart appears to us, upon the whole, the most probable theory hitherto advanced upon the subject.