[CHAPTER XXII.]
NARCOTICS.
NEUROTICS, ACTING ON THE BRAIN AND PRODUCING SLEEP.
Opium.
Opium is the inspissated juice of the unripe capsules of the Papaver somniferum, or white poppy, and is a very complex substance. Its principal properties, however, are due to the presence of morphia, as meconate of morphia; but others of its constituent substances undoubtedly modify its action.
It is sometimes used as a poison in its crude state, but more frequently in solution in alcohol, forming tincture of opium, or laudanum. Unfortunately, opium is the powerful ingredient of most soothing syrups for children, to whom opium is at all times especially dangerous; and many who do not die from its direct effects, do from the wasting indirectly produced.
Of domestic quieting physic the chief preparations are Godfrey’s Cordial, supposed to consist of one grain of opium in two ounces; and Dalby’s Carminative, which is one-fourth weaker.
The smallest quantity of laudanum which is known to have proved fatal to an adult is two drachms, from which death occurred within twelve hours. The exact quantity taken was, however, doubtful. Two grains and a half of the extract, a quantity said to be equal to four grains of crude opium, have produced a similar result. Much larger doses are, however, taken with impunity on many occasions, more especially by those habituated to the use of this drug, who remain almost unaffected by surprisingly large quantities. De Quincey, the English opium-eater, once found in a pirated edition of “Buchan’s Domestic Medicine,” a caution against taking more than “twenty-five ounces” of laudanum at one dose. He says that he always bore this excellent advice in mind; and it does not appear that he ever took more than sixteen ounces of the tincture of opium as his daily allowance. In certain diseases, patients quite unaccustomed to the use of sedatives can take excessive amounts without narcotism being produced. In some cases of tetanus, for example, upwards of four ounces of laudanum have been given daily for a week, without any marked effect.
On the other hand, it must not be forgotten that not a few individuals are unable to take even one-third of a grain without being narcotised. Young children are particularly susceptible of its effects; the tenth and twelfth parts of a grain having respectively proved fatal to infants two and five days old. Dr. Edward Smith has even recorded the case of an infant seven days old, who died comatose eighteen hours after having had administered to it about the twelfth of a grain of opium, or the quantity contained in one drop of laudanum.[C] The smallest fatal dose for a child on record is one of paregoric elixir equivalent to about one-ninetieth of a grain of opium. On the other hand, they sometimes recover from very large doses indeed.
The duration of a fatal case is generally from seven to twelve hours. The shortest period recorded is three-quarters of an hour; the longest, twenty-four hours. If the patient survives twelve hours there is good hope of recovery.
The quantity of Morphia found in opium varies from two to ten per cent. The chief salts of this alkaloid are the acetate, the hydrochlorate, and the sulphate, all being very energetic poisons. They cause symptoms similar to those about to be described as produced by opium. But, in addition, there has been especially noticed great itching of the skin, convulsive twitchings of the muscles of the face and limbs, and occasionally tetanus. Small doses of any of the salts of morphia may cause death. In a delicate woman half a grain is supposed to have proved fatal; in several instances one grain has proved fatal; and certainly a dose of two grains might kill a healthy adult unaccustomed to opiates. Nevertheless, under the influence of custom, large quantities may be taken. A young lady, who has long been under notice, has for the last three years taken daily fifteen grains of the hydrochlorate of morphia, without obtaining more than two or three hours’ sleep from it; while for many days in succession, when suffering much pain, she increases the quantity to one scruple. From attempts to diminish the dose, made without the patient’s knowledge, only mischief has resulted.