Of the Action of Morphia, Narcotine, Codeïa, and Meconic Acid.
The action and symptoms caused by two active principles of opium, morphia, and narcotine, have been examined by many experimentalists.
The action of morphia is nearly the same as that of opium, but more energetic. In its solid state it has little effect, being nearly insoluble. But when dissolved in olive oil, or in alcohol, or in weak acids, it excites in animals the same symptoms as opium. Experimentalists are not yet agreed as to its power. The trial of Castaing gave rise to a physiological inquiry by three French physicians, Deguise, Dupuy, and Leuret, who assigned to it feeble properties; but more reliance is usually placed in the experiments of Orfila, who found that one part of morphia is equal in energy to two parts of the watery extract, and to four parts of crude opium. The observations I have made on the medicinal effects of morphia and its muriate, lead me to believe that half a grain is fully equal in power to three grains of the best Turkey-opium. Probably those who have observed but slight effects from it have accidentally used narcotine instead of it; for at one time they were often confounded together.
On man morphia acts like opium; it produces somnolency. It was at one time thought that in medicinal doses it does not produce either the disagreeable subsequent or idiosyncratic effects of opium; Magendie made some observations to this purport;[[1759]] and Dr. Quadri of Naples was led to the same conclusion.[[1760]] Others, however, have doubted the accuracy of these authors, and opposite results appear to have been procured by some. My own experience with the muriate of morphia inclines me to concur in opinion with Magendie and Quadri.
The effects of morphia on man in fatal doses have hitherto been observed in a few cases only. An instance, which was the occasion of a criminal trial at Aberdeen in 1842, has been communicated to me by Dr. Traill, who was consulted in the case on the part of the crown. A schoolmaster gave ten grains of the muriate to a girl immediately after she came out of an epileptic fit. In fifteen minutes she seemed to fall asleep; she continued in this state for some hours before it was discovered that she was in a state of stupor, from which she could not be roused; and she expired twelve hours after the poison was administered. A similar case occasioned by ten grains, and also fatal, occurred at Cheltenham in 1839.
Orfila relates the particulars of the case of a young Parisian graduate, who swallowed twenty-two grains for the purpose of self-destruction. In ten minutes he felt heat in the stomach and hindhead, with excessive itchiness; in three hours and a half he had also a sense of pricking in the eyes, with dimness of vision; and in an hour more he for the first time felt approaching stupor. Half an hour afterwards, when the people of the house entered his room he could not see them, though he was sensible enough to be able to reply to their inquiries, that he lay in bed because he had not slept the night before. Soon after this he fell into a state of profound stupor and lost all consciousness. In thirteen hours he was visited by Orfila, who found him cold, quite comatose, and affected with locked-jaw; the pupils were feebly dilated, the pulse 120, the breathing hurried and stertorous, the belly tense and tympanitic; and there were occasional convulsions, with intense itching of the skin. By means of copious venesection, sinapisms, ammoniated friction, stimulant clysters, ice on the head, and acidulous drinks, he was gradually roused, so that in six hours he recognised his physician. In the subsequent night and following day he had difficult and scanty micturition, with pain in the kidneys and bladder, and difficulty in swallowing; but these symptoms went off during the second night; and on the third morning he was quite well.[[1761]] The itching of the skin remarked in this case is considered by M. Bally an invariable symptom of the operation of morphia even in medicinal doses.[[1762]] It is not, however, always produced.
Another case, which occurred at Lunéville, is very remarkable in its circumstances. A young man addicted to opium-eating, but who had left off the practice for a twelvemonth, took first ten grains, and in ten minutes forty grains more of acetate of morphia. In five minutes he had excessive general feebleness and a sense of impending dissolution, which forced him to confess what he had done. In fifteen minutes more M. Castara, who describes the particulars, found him motionless, almost comatose, and breathing laboriously. The limbs were flaccid, the pupils contracted, the face and lips livid, the skin warm and moist, the pulse full and hard, and deglutition impossible. Tartar-emetic was ordered, but could not be administered. He was then bled at the arm to eighteen ounces; upon which he started as from sleep, rubbed his eyes, said every thing turned round him, and that he could not see the people present. When left to himself he quickly fell into a calm slumber; but if kept awake, he told collectedly all that happened before he became comatose. He complained chiefly of intense itching and a general sense of bruising. In an hour, by keeping him constantly roused, consciousness was almost restored, and this without vomiting having been produced, though two grains of tartar-emetic had been swallowed and three administered by the rectum. In four hours after he swallowed the poison he vomited freely and had diarrhœa. He then steadily recovered, the sleepiness continued all next day, and the itching of the skin even longer.[[1763]]
M. Julia-Fontenelle met with a case of poisoning with this alkaloid, in consequence of its having been administered with a clyster in the form of sulphate. The subject was a child five years old, the dose five grains, the symptoms those of apoplexy, and death supervened within twenty-four hours.[[1764]]
Another case worthy of particular mention is that of the French gentleman who was supposed to have been poisoned by Dr. Castaing. It is not a pure one, for besides the symptoms of a consumptive complaint under which he had laboured for some time, there were circumstances in his last illness which indicated the administration of other deleterious substances. About thirty-six hours before his death, however, they were exactly such as might be expected from a large dose of morphia. About five minutes after the administration of a draught by the prisoner, the gentleman was attacked with convulsions, and not long afterwards his physician found him quite insensible, unable to swallow, bathed in a cold sweat, with a small pulse, a burning skin, the jaws locked, the neck rigid, the belly tense, and the limbs affected with spasmodic convulsions. In this state he seems to have continued till his death. The only appearances found in the dead body, which bore any relation to the poison suspected, were congestion of blood and serous effusion in the vessels of the cerebral membranes. If morphia was the cause of death, it is highly probable that, besides what was administered thirty-six hours before he died, several doses were given subsequently; otherwise, from what is known of the action of opium, the narcotism could scarcely have lasted uninterruptedly for so long a period.[[1765]]
For the following extraordinary case I am indebted to one of my pupils, Mr. Clark of Montrose: A woman took one morning by mistake ten grains of pure muriate of morphia, which had been prepared not long before by Mr. Clark in my laboratory, and was freed of codeïa. The mistake having been discovered almost immediately, means were taken to prevent any ill effects from the accident, and within half an hour after the poison was swallowed, the stomach was completely cleared by the stomach-pump. At this time she was quite sensible. But stupor quickly came on after the poison was evacuated, and deep imperturbable coma gradually formed, so that nothing could rouse her in the slightest degree except cold affusion of the head and chest, which caused faint signs of returning consciousness. Before night she expired, though all the usual remedies were resorted to. An inspection of the body was not obtained, which is much to be regretted, since without it the case is quite obscure. I do not know a single instance of fatal coma from opium where the proper remedies were resorted to before the stupor commenced; and death in such circumstances is so inconceivable, that we must ascribe the result in this case to apoplexy, either incidentally concurring, or brought on by the operation of the poison.