The first object is the evacuation of the stomach by vomiting; for which purpose, the patient should be made to swallow from fifteen grains to a scruple of sulphate of zinc; or, from five to ten grains of sulphate of copper dissolved in water; and the vomiting should be kept up for a considerable time, and urged by irritation of the fauces. Where the act of vomiting cannot be established, in consequence of the paralysed state of the nervous system, cold affusion, applied by means of a shower bath, has been said to restore the energy of the brain, and thus to render the patient susceptible of the stimulus of an emetic.[[424]] Venesection has also, under the same circumstances, been greatly extolled; and, as vascular congestion in the brain is one of the effects of this poison, it is reasonable to conclude that, by unloading the vessels of this organ, we may restore its lost sensibility. Tissot has strongly recommended the practice,[[425]] and the experiments of Orfila have shewn that it never aggravated the symptoms of poisoning by opium, nor accelerated the moment of death; but on the contrary, that in some instances he found that it restored the animals which would have died, if it had not been put in practice. Where the operation is performed, the blood should be drawn from the jugular vein, in preference to any other. Should these means prove insufficient to provoke vomiting, M. Orfila asks, whether one or two grains of tartarized antimony, dissolved in one or two ounces of water, might not be injected into the veins? It was formerly proposed by Boerhaave to empty the stomach of its poisonous contents, by the introduction of a syringe; an operation which, it is said, has been lately performed with success.[[426]] Vinegar and vegetable acids were long considered as antidotes to opium; but the experiments of M. Orfila have clearly established that, as long as any portion of the opium remains in the stomach, these potations, so far from relieving, aggravate the symptoms of poisoning by this narcotic, in consequence of the power which they possess of dissolving it. Where, however, the opium has been expelled by vomiting, these acid drinks possess the property of diminishing the consecutive symptoms, and of thus realising the expectations which Virgil[[427]] has so poetically raised,
----“quo non præsentius ullum
Auxilium venit, ac membris agit atra venena.”
The powers of the habit should, at the same time, be supported by brandy, strong coffee, and cordials. The sufferer should be kept awake; and, if possible, in a continued gentle motion. Dr. Currie[[428]] has recommended the affusion of warm water at 106°, or 108°, for removing the stupor.
A case is recorded by Dr. Marcet, in the first volume of the Medico-chirurgical Transactions, where six ounces of laudanum were taken by a young man, and remained for five hours in the stomach before any remedies were applied for its removal; a strong dose of sulphate of copper, however, provoked vomiting, and by judicious treatment he eventually recovered.
Organic lesions discovered on dissection.
It has been very truly remarked that although the instances in which opium has proved fatal to human life have been very numerous, yet that the accounts which we have received of the appearances of the body post mortem, are by no means so satisfactory as we could desire. M. Orfila asserts that no alteration can be discovered on dissection, in the digestive canal of persons who have swallowed any narcotic poison; and that if facts contrary to this assertion be met with in various authors, it is because there have been administered irritating substances capable of producing inflammation.[[429]] The lungs, however, frequently exhibit morbid phenomena; their colour is sometimes violet, and frequently a deeper red than in the natural state. Their texture is also more dense, and less crepitating; and they are marked by livid spots. The blood contained in the ventricles of the heart, and in the veins, is said to be found in a liquid state; but Orfila advances a diametrically opposite opinion, and asserts that it is frequently coagulated. The brain and its membranes often exhibit a state of vascular congestion; in the case recorded by Mr. Stanley, in the sixth volume of the Transactions of the College of Physicians, the cellular tissue of the pia mater was found to contain water.[[430]]
Of the detection of Opium.
There is no mode of identifying opium, whether in a liquid or solid form, so satisfactory as that which is at once afforded by its powerful and highly characteristic odour. In fatal instances, we shall always meet with it in the contents of the alimentary canal, and in such quantities as will leave no doubt as to its nature. The chemist may also proceed to a farther examination, by obtaining morphia from its solution, by a process which we have already described under the chemical history of opium.