Primula obconica is another plant which, when handled, gives rise to an acute dermatitis of an erysipelatous character. The face swells, and large blisters form on the cheeks and chin.
XXIX.—OPIUM AND MORPHINE
Opium.—The inspissated juice of the unripe capsules of the Papaver somniferum. As a poison it is generally taken in the form of the tincture (laudanum), which contains 1 grain opium in 15 minims. Opium is found in almost all so-called 'soothing syrups' for children, and in Godfrey's cordial, Dalby's carminative, and Collis Browne's chlorodyne. Laudanum contains 1 per cent. morphine, and it, along with all other preparations (e.g., paregoric) which contain 1 or more per cent. morphine, are included in Part I. of the Schedule of Poisons, and come under the Dangerous Drugs Regulations.
The most important active principles of opium are the alkaloids morphine and codeine.
Symptoms usually commence in from twenty to thirty minutes: Giddiness, drowsiness and stupor, followed by insensibility. Patient seems asleep; may be roused by loud noise, but quickly relapses. Breathing slow and stertorous, pulse weak, countenance livid. As coma increases, pulse becomes slower and fuller. The pupils are contracted, even to a pin's point; they are insensible to the action of light. In deep, natural sleep the eyes are turned upwards and the pupils contracted. Bowels confined, skin cold and livid or bathed in sweat. Temperature subnormal. Nausea and vomiting are sometimes present. Remissions are not infrequent, the patient appearing about to recover and then relapsing. Hæmorrhage into the pons may give rise to contracted pupils. Young children and infants are specially susceptible to the poison.
Diagnosis is not always easy, and one has to differentiate poisoning from cerebral apoplexy. In the latter one can seldom rouse the patient, the pupils are often unequal, and hemiplegia is present. In compression of the brain, fracture of the skull may be present, subconjunctival hæmorrhages may be seen, the pupils are unequal and dilated, and the paralysis increases. In uræmic or diabetic coma the urine must be examined.
The habitual use of opium is not uncommon, and opium-eaters are able to take enormous quantities of the drug. The opium-eater may be known by his attenuated body, withered yellow countenance, stooping posture, and glassy, sunken eyes.
Post-Mortem Appearances.—Not characteristic. Turgescence of cerebral vessels. There may be effusion under arachnoid, into ventricles, at base of the brain, and around the cord. Rarely extravasation of blood. Stomach and intestines usually healthy. Lungs gorged, skin livid.
Fatal Period.—Usually nine to twelve hours; but in many cases, if life is prolonged for eight hours, recovery takes place.