CHAPTER III.
GENERAL SYMPTOMS CLASSIFIED AND ANALYZED.
I am of the opinion that a clearer and consequently more thorough understanding of this part of the subject can be obtained by classing the various effects of the continued use of morphine or opium under the headings of the different systems and apparatuses, and have, therefore, adopted this method of presenting these matters to the reader.
THE DIGESTIVE APPARATUS.
(Stomach, Liver and Bowels.)
The first effect of opium or its alkaloid morphia on the stomach is, in the majority of instances, to increase the appetite and cause a pleasant sensation of warmth and a feeling of general contentment. After a time, however, especially if the drug is taken by the mouth, the appetite is materially impaired, the bowels become constipated, there is a sensation of sinking at the pit of the stomach, the circulation through the liver is interfered with, a catarrhal inflammation of the small intestine and stomach supervenes, the opening of the bile duct is partially obstructed by the swollen mucous membrane, and the result is a more or less decided staining of the skin with the biliary coloring matter. This is due, in part, to interference with the cells in the proper performance of their functions, undoubtedly through the medium of the nerves passing to them. At the same time, the gastric juice is diminished in amount and lessened in strength, as is also the case regarding the intestinal and pancreatic secretions, the digestion of food is imperfectly performed, and in consequence, a condition of malnutrition results, showing itself in wasting of the muscles and loss of the fatty tissue beneath the skin, especially of the face, breast and abdomen. As the gastric catarrh increases, nausea and finally vomiting ensue, still further debilitating the patient. Derangements of the stomach, liver and bowels are much more common among those who use the drug by the mouth. I have, however, seen patients who, while using morphia hypodermically, have suffered intensely with jaundice, catarrh of the stomach, nausea and vomiting. When these disorders do arise in the course of the subcutaneous use of morphia they are prone to be very acute in character. A gentleman, aged about 32, came under my notice some months ago, suffering from dropsy of both legs, which, from the middle of the leg to and about the ankles, were covered with collections of minute red spots, evidently points at which the capillary blood vessels had ruptured. An examination of his urine discovered thirty per cent. of albumen and some tube casts from the kidneys. Also a decided amount of morphine, and considerable blood. He was put upon tonic remedies; the legs, previously dressed with sulphate of iron ointment, were tightly bandaged. After about two weeks the dropsy lessened, the spots disappeared and the general health improved sufficiently to allow of a business trip to the West. No sooner had he neared his destination, however, than the dropsy of the legs again appeared, and the old trouble came back in full force. In addition, he became somewhat jaundiced, water made its appearance in the abdomen, and a most distressing nausea harassed him day and night. During all this time he managed to do an unusual amount of literary work, that required both knowledge and tact. On his return to New York, he was in a very weak and debilitated condition. The stomach rebelled at almost every kind of food, the belly was distended with water, the nausea intense, the vomiting frequent, and urine high colored, bloody and containing about sixty per cent. of albumen. While in the West an attempt was made to gradually diminish the amount of morphia, but owing to severe illness, was abandoned. Nor did I think it advisable to try again until the general health was better. Upon iron, in different forms (dialyzed, Bland’s pills, and muriated tincture), strychnia, phosphorus and gentian, he gradually improved, and is now just commencing the treatment by gradual reduction. He consumes daily about ten grains, using it subcutaneously. He contracted the habit some five years ago, through its being administered to him hypodermically, during a severe attack of acute articular rheumatism. Two years ago he was broken of the habit by a physician in this city, who pursued the plan of sudden deprivation, with the result of nearly killing the patient.
While traveling in Germany, for the purpose of reporting certain facts for his paper, he was suddenly taken with congestion of the brain, accompanied by intense pain and a state of semi-consciousness. A German physician who was called in, not knowing the man’s previous history, gave him a subcutaneous injection of morphia, with the result of re-establishing the habit.
Fluid in the abdomen is not a common complication, and when it does occur, crowds the stomach upward, interferes with the circulation of blood in the viscera in the abdominal cavity and renders the nausea and vomiting still more troublesome.
The stools voided by morphia-maniacs are sometimes clay-colored, being devoid of biliary coloring-matter. The absence of bile in the intestinal canal allows of decomposition of the food, with the production of ill-smelling gases which regurgitate through the stomach, or pass by the bowels. Constipation is the rule. Sometimes it alternates with severe diarrhœa. In one patient whom I saw, the fæces collected day by day in the bowels, until impaction resulted and the mass was removed, with the greatest difficulty, by means of large enemata and the handle of a spoon. This lady had been using the drug, crude opium, for only eight months.
This constipation from hardened condition of the fæces produces irritation, intestinal catarrh, and often hemorrhoids accompanied by an eczematous eruption about the anus.
Heartburn, not from an excess of gastric juice, as is so often supposed, but from an acid fermentation of the food, is not an uncommon symptom.
Some patients go on for years with no disturbance of the bowels, liver and stomach, beyond a slight catarrh and some jaundice, but these troubles are sure to come sooner or later.