Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

The poisonous properties of this drug reside in an alkaloid, morphine—in combination with an acid, meconic acid. The several varieties of opium vary considerably in the quantity of morphine which they contain, the amount varying from 2 to 9 per cent.

Opium, or its alkaloid, morphine, forms an important ingredient in Dalby‘s Carminative, Winslow‘s Soothing Syrup, Godfrey‘s Cordial, Chlorodyne, Nepenthe, &c.

Of all forms of poisoning, that by opium and its preparations is the most frequent; and it is stated that three-fourths of all the deaths from opium occur among children under five years of age.

Symptoms.—The rapidity with which the symptoms of poisoning by opium make their appearance will depend upon the form in which the poison is taken—solution, of course, increasing the activity of the drug. In most cases, an interval of from half an hour to an hour elapses after the poison has been swallowed before any evil effects become apparent. Christison, however, mentions a case in which stupor did not show itself for eighteen hours. During the first stage of poisoning by opium, the patient may become slightly excited; this state is, however, soon followed by giddiness and drowsiness. The eyes are kept open with difficulty. Stupor and insensibility now supervene, from which he may, in most cases, be temporarily aroused by a loud noise or a smart blow. As the case progresses, coma and stertorous breathing occur, and it becomes almost impossible to rouse him at all. The pulse, at first small, quick, and irregular, becomes slow and full as the coma increases. The breathing, hurried in the early stages, is now slow and stertorous. The pupils are contracted in the early stages, and may be in the later stages dilated; the former condition is most frequently present, together with insensibility to light. The pupils may be contracted in cases of hæmorrhage into the pons Varolii, and this disease has been mistaken for opium poisoning. In uræmic coma, coming on in the course of Bright‘s disease, the pupils may also be contracted; the nature of the case will be explained by the history and presence of dropsy. All the secretions, except that of the skin, are suspended, and the bowels are usually obstinately confined. The breath may be impregnated with the odour of opium. Certain anomalies in the symptoms may occur; thus, there may be vomiting and purging, convulsions (the last most frequent in children), delirium, tetanic spasms, one pupil dilated and the other contracted, paralysis, and anæsthesia. It must be borne in mind that remissions sometimes occur in the symptoms, the patient dying after an attempt at recovery.

A question of some importance may arise as to the amount of volition and power of locomotion which may exist for some time after a poisonous dose has been taken. Death may be due to causes other than the effect of poison. It must, at least, be admitted as possible, that a person, after swallowing a quantity of opium sufficient to cause death, may yet be able to walk and move about for one or two hours.

Opium-eating.—If opium be taken for some time in small doses, the system becomes tolerant of it, so that a dose which would be poisonous to most people only produces a slight and pleasurable excitement. De Quincey was in the habit of taking daily nine ounces of laudanum. The habitual opium-eater generally suffers from disorders of the digestive organs, dyspepsia and its train of unpleasant symptoms; the body becomes thin, the countenance attenuated, the eyes sunken and glassy, the gait halting, and the body bent. The craving for the drug, which becomes greater and greater, is only temporarily satisfied by larger and larger doses. The opium-eater seldom attains a great age, usually dying before forty. This is perhaps a somewhat exaggerated picture of the ill effects of opium-eating. Christison, after quoting the results of his observations in twenty-five cases of confirmed opium-eaters, concludes as follows: “These facts tend on the whole rather to show that the practice of eating opium is not so injurious, and an opium-eater‘s life is not uninsurable, as is commonly thought, and that an insured person, who did not make known his habit, could scarcely be considered guilty of concealment to the effect of voiding his insurance. But I am far from thinking (as several represent who have quoted this work) that what has now been stated can with justice be held to establish such important inferences; for there is an obvious reason why, in an inquiry of this kind, those instances chiefly should come under notice where the constitution has escaped injury—cases fatal in early life being more apt to be lost sight of, or more likely to be concealed.”

Effects of External Application.—The application of opium to the surface of the body is not usually attended with dangerous symptoms; but, in a few cases, due probably to some idiosyncrasy, alarming effects, or even death, have resulted from the external application of the drug. Orfila has tried to show that opium is readily absorbed by the coats of the rectum, and that it acts more rapidly than when taken into the stomach. This statement does not appear to be correct, for the dose administered by enema is usually twice that given by the mouth.

Post-mortem Appearances.—As might be expected, the appearances found after death are not very characteristic. The vessels of the brain are congested, and serous effusions in the ventricles or between the membranes are not uncommon. Engorgement of the lungs is most frequently present in those cases in which convulsions have occurred. The stomach is in most cases found quite healthy. The bladder may be full of urine, due probably to the person being unable to empty it from loss of consciousness.

Fatal Period.—From three-quarters of an hour and upwards.

Fatal Dose.—Four grains is about the smallest fatal dose of opium in an adult; but cases of recovery, where an ounce or more of laudanum has been taken, are not very rare. Children are very susceptible to opium. The smallest dose of morphine that has proved fatal to an infant is one-twelfth of a grain of the hydrochloride. Half a grain of the acetate has proved fatal to an adult, one grain of morphine or its salts has proved fatal on several occasions. With prompt treatment recovery has taken place after much larger doses, even as much as seventy-five grains.