Others of the opium alkaloids are poisonous; but instances of poisoning by their means have not occurred, except one doubtful instance of poisoning by narcotine, recorded by Sonnenschein.
Symptoms.—When a large dose of opium or its tincture has been taken the symptoms usually manifest themselves in about twenty or thirty minutes. They commence with giddiness, drowsiness, and stupor; then ensues insensibility. The patient appears as if in a sound sleep, from which he can be roused by a loud noise, &c., although he quickly relapses. As the poisoning progresses the breathing becomes slow and stertorous, the pulse weak and feeble, and the countenance livid. The eyes are closed, while the pupils are generally contracted, often almost to the size of a pin’s point, and insensible to the stimulus of light. In some instances the skin is cold and livid, in others it is bathed in sweat. So also the countenance may be either ghastly or placid, the pupils may even be dilated, and the pulse may be unaffected, or so small and frequent as to be scarcely appreciable. Vomiting sometimes occurs, with slight reaction, so that hopes of recovery are entertained. But frequently there is a relapse, the comatose state returns, and death quickly follows, occasionally preceded by convulsions.
The possibility of rousing a patient during the earlier portion of the progress of these symptoms will assist in diagnosing the effects of poisoning by opium from those due to apoplexy, epilepsy, &c. The contracted condition of the pupil will also assist; but it must not be forgotten that in lesion of the pons Varolii the pupils are also contracted. When permanent recovery ensues it is complete; but it is usually preceded for a day or two by severe nausea, a sense of weariness, constipation, and headache.
The habitual use of opium is most injurious. Dr. Oppenheim, in his description of the state of medicine in Turkey, tells us that persons seldom attain the age of forty who have begun the practice early. The opium-eater may be known by his attenuated body, withered yellow countenance, stooping posture, and glassy, sunken eyes. He has no appetite, his bodily powers are destroyed, and he is obliged continually to increase the dose of his “grief-assuaging remedy” to obtain the wished-for effect.
Post-mortem appearances.—The appearances in acute poisoning by opium are not very characteristic. The most prominent are, great turgescence of the vessels of the brain, with effusion of serum into the ventricles and at the base. The turgid condition of the vessels often continues down the spinal cord, &c. The lungs are usually gorged with fluid blood, and the skin is of a livid hue.
Treatment.—The first object is to remove all the poison from the stomach, and this cannot be effected in any way so well as by the stomach-pump. In the absence of this instrument, emetics of half a drachm of sulphate of zinc, or a tablespoonful of mustard, must be employed. The patient at the same time is to be prevented as far as possible from going to sleep. When the stomach has been thoroughly emptied, every means must be adopted to keep the patient roused. This is to be effected by dashing cold water over his head and chest, walking him up and down or shaking him between two attendants in the open air, irritating his legs by flagellation with a wet towel, applying electro-magnetic shocks to the spine, and administering strong coffee. Bleeding has been recommended; but it is only to be used after the poison has been removed from the stomach, and when from the coma and full pulse we are sure that there is cerebral congestion. In extreme cases artificial respiration must be tried.
The remedies recommended must be perseveringly used, remembering that as long as life lasts hope of recovery is not to be banished. In the great majority of cases the treatment is successful.
Tests.—There are no direct means by which opium may be detected. We endeavor therefore to obtain evidence of the presence of morphia and meconic acid. The two substances may be separated from organic admixture by the following process: The suspected matters should be well boiled with distilled water, and spirit acidulated with acetic acid, and strained. To the fluid which has passed through, acetate of lead is to be added until precipitation ceases, and the whole, after standing, is to be thrown on a filter. The insoluble meconate of lead remains on the filter, the morphia passing through as acetate. To separate the meconic acid the substance on the filter is to be diffused through water, and sulphuretted hydrogen passed for a time. Sulphide of lead is thus thrown down and may be separated by filtration, the meconic acid remaining in solution. On concentration this should give the requisite reactions.
In the search for morphia the filtered fluid above referred to is also to be treated with sulphuretted hydrogen, to secure the precipitation of all acetate of lead, &c., which is next to be carefully separated from it by further filtration. The fluid now passing through, containing the acetate of morphia, is next to be concentrated by evaporation over a water bath, and carefully neutralized by bicarbonate of potass, if it be desired to obtain the pure alkaloid; but this is not necessary, as the acetate responds to all reagents. The acetate may be dissolved out of the mass in dilute alcohol (it is not soluble in ether), again filtered, the filtrate being finally evaporated to dryness and tested.
Morphia.—The best tests for this alkaloid, in substance or in solution (substance is preferable) are: