Opium

[PAPAVER SOMNIFERUM, POPPY. NATURAL ORDER, PAPAVERACEiE.]

This is one of the most anciently known plants. Homer speaks of the poppy (mecon) growing in the gardens ; it was employed by Hippocrates, and is mentioned by Theophrastus, Dioscorides and Pliny. The word opium is derived from the Greek ojjos (juice), the juice par excellence, as the flower of rosemary has been called antlws, and the bark of cinchona, the bark.

Opium is derived from the poppy. We have the black and white poppy ; the seeds of the black variety are black, and the leaves red- dish ; those of the white variety have white seeds and white petals.

The flower is annual, the stems from three to four feet high, leafy, smooth, glaucous; leaves alternate, large, irregular, lobed, deeply serrated ; flowers large, petals of a purplish-white, with a large violet spot at the base of each ; the whole plant is glaucous and smooth, except that the flower stalks sometimes bear a few scattered, bristly hairs.

Papaver somniferum is a native of the east, extensively cultivated in Turkey, Persia and India, and other warm climates ; it has become naturalized in a great many European countries and in some states of the Union.

The method of obtaining opium is sufficiently simple. Mr. Charles Tenier thus describes the process of obtaining opium followed in Asia Minor: "A few days after the flower has fallen, men and women repair to the fields and cut the heads of the poppies horizon- tally, taking care that the incisions do not penetrate the internal cavity, of the shell. A white substance immediately flows out, and collects in tears on the edges of the cuts.

In this state the field is left for twenty -four hours and, on the following day, the opium is collected by large blunt knives. Each head furnishes opium once only, and that to an extent of a few grains. The first sophistication it receives is that practiced by the peasants who collect it, and who lightly scrape the epidermis from the shell to augment the weight. This operation adds about one-twelfth of foreign matters.

Thus collected, opium has the form of a glutinous and granular jelly. It is deposited in small earthen vessels, and beat up with saliva. "When asked why water was not employed in place of saliva, the answer was that water caused it to spoil. It is afterward enveloped

536 opium.

in dry leaves, and in this state it is sold. The seeds of those poppies which have yielded opium are equally good for sowing the following year."

When a lump of opium is broken, the interior should present a pretty uniform, brown color, and have a strong opiate smell as well as the marked opiate taste. It should look like a homogeneous mass. If the interior shows dirt, small pebbles, pieces of leaves and sticks, having also a burnt odor, the inference is unavoidable that the article is not pure.

Beside these foreign matters, the masses of opium which are sent to us, sometimes contain leaden balls in the centre, by means of which the weight is increased. These leaden balls are sometimes added to opium of valuable quality, but are also found in the most defective samples. These and similar adulterations show how neces- sary it is tbat those who purchase raw opium should carefully examine the article before using it. A fine outside is no guarantee that the interior is perfectly pure.

From this drag we obtain both triturations and an alcoholic tincture. The tincture of opium is generally termed laudanum, or thebaic tincture, or liquid laudanum. Laudanum may be made bv taking an ounce of the best opium, bruising it well, and digesting it with a pint of the best brandy. Each fluid ounce contains thirty grains of opium.

The most common constituents of opium are : morphia, narcotina, codein, meconic acid, a caoutchouc-like substance, and a variety of other less-important substances.

From morphia we obtain salts, the acetate and sulphate of morphine. The sulphate is most commonly used; it looks like quinine. If we do not know which of these substances we have before us, we put a little of each salt on a water-crystal, and add a drop of nitric acid to it ; the morpia will become deep red, and the quinine yellow. We cannot distinguish them by the taste, both salts being bitter.

A dose of morphia, in allceopathic practice, is from one-quarter to one-eighth of a grain, equivalent to thirty or sixty drops of laudanum.

From time immemorial, opium has been used as an anodyne, a sedative, an antiphlogistic, a soporific, an antispasmodic agent; in order to attain these various ends, the drug has often to be adminis- tered in enormous doses. The largest medicinal dose, of opium on record, for any purpose, is, I believe, forty grains. This dose was

opium. 537

given by Dr. Binns in a case of insanity. In four hours after, a scruple was given with the effect of complete restoration.

Concerning the native opium, different opinions have prevailed regarding its capability of yielding morphia. According to the statement of Dublanc and other chemists who have made this sub- ject a point of special inquiry, morphia is found in native poppy- heads in variable quantities. Certainly, the dangerous and, indeed, poisonous properties of native poppy-heads have been shown by the incontrovertible testimony of experience.

Allow me right here to advert to the abuse which oriental nations make of opium, for the purpose of intoxicating their fancy and intellect both by smoking and eating the drug.

Mr. Little uses the following language: "As the habit grows upon its unhappy victim, the first evils experienced are disturbed sleep, watchfulness, giddiness, sometimes headache, capricious appe- tite, a white tongue, frequently costiveness, indescribable oppression on the chest, and haziness of the eyes. Afterward, a copious secre- tijn of mucus takes place from the eyes, and often from the nose also; digestion becomes much impaired, and micturition difficult; a mucous discharge begins to flow from the organs of generation ; the sexual organs, at first preternaturally excited, gradually lose their tone ; the body wastes, the muscles lose their torosity, and the bones are affected with dull gnawing pains for some hours in the morning.

By and by, the figure stoops, and a peculiar shuffling gait is acquired, by which alone a practiced eye may recognize an old opium debauchee. At the same time, the eyebrow droops, the lower eyelid becomes dark, the eye itself seems to sink and grow dim, and the whole expression is that of premature old age. In both sexes the procreative power is greatly lessened, and in those women who nevertheless do bear children, the secretion of milk is defective. The influence of the habit on the generative functions is indeed so decided, that were it not for fre?h arrivals from China and other parts of the East, the population of Singapore would very soon be seriously diminished.

"Still there may be no structural derangement. At length, how- ever, food and drink are vomited almost constantly when the system is not under the primary action of a dose ; there is incessant gnaw- ing pain in the stomach, when its effect is off ; diarrhoea comes on, relieved only by fresh indulgence, aud dysentery sometimes super- venes ; a turbid mucous urine is discharged with, unusual frequeucy,

538 opium.

the result sometimes of renal disease ; and, among affections of the kidneys, Bright's disease is not uncommon. In others, difficulty of breathing is a prominent symptom, increasing gradually to an urgent sense of suffocation and depending generally on oedema of the lungs, or effusion into the pleural sac. In others, irregularity and feeble- ness of the pulse, with pain in the cardiac region, indicate the super- vention of organic disease, or severe functional disturbance of the heart.

Some suffer excessively from boils and carbuncles, from the latter of which few confirmed opium smokers recover. Foul, indolent ulcers are extremely common among the poor ; strumous affections of all kinds are apt to be developed, and the constitu- tion is prone to succumb without resistance under all violent diseases. * * * Unfortunately, the effects produced on the health by abandoning the habit of smoking opium, after it has be- come deeply rooted, are even worse than the perseverance in it.

A gloomy despondency is added to the usual symptoms of the ordinary stage of depression; a state ensues somewhat like the low state of delirium tremens, attended with extreme prostration of strength, and often with exhausting diarrhoea and vomiting; all pre-existing diseases are aggravated, dropsy frequently ensues, and death may soon result, most generally by effusion into the great cavities and general anasarca. When these effects have begun to show them- selves under a compulsory cessation of the habit, the most marked improvement of health is produced by resuming it. * * *"

The vice of opium -eating blunts the susceptibility of the system to such an extent that enormous quantities of opium can be taken into the stomach without producing any other than ordinary stimu- lating effects. The author of Confessions of an Opium-Eater states that he took one hundred and thirty grains of opium per day, not by accident or mistake, but as a habit. Professor Mitchell tells of a literary man who was at the same time a physician and author of renown, who took one hundred and sixty grains a day without being satisfied by such a dose.

Eussel tells even of a Turk, in Smyrna, who was in the habit of swallowing daily one hundred and eighty grains, and then increased the dose. In diseases, such as cancer, where opium is habitually resorted to as a palliative, patients finally acquire the faculty of consuming as much as three pints of laudanum daily, beside solid opium taken at intervals.

Pereira distinguishes three degrees of operation of opium on the human system.

opium. 539

"First degree. In small doses, as from a quarter of a grain to one grain, opium generally acts as a stimulant, though in this respect the symptoms are not uniform. Usually, the vascular system is somewhat excited, and a sensation of fulness is experienced about the head. Dr. Crumpe took one grain of opium when his pulse was at seventy ; it first rose to seventy-six and then went back again to seventy.

" The excitement in the cerebral vascular system is accompanied by alterations in the condition of the nervous functions. The mind is usually exhilerated ; the ideas flow more quickly ; a pleasurable or comfortable condition of the whole system is experienced, difficult to describe; there is a capability of greater exertion than usual. The symptoms are followed by a diminution of muscular power, and of susceptibility to the impression of external objects ; a desire for repose is experienced with a tendency to sleep.

While these effects are taking place, the mouth and throat become dry, and hunger is diminished, though the thirst is increased, and slight constipation usually follows. Such are the ordinary effects of a small dose of opium on persons unaccustomed to its use. By repetition, however, its influence becomes considerably diminished ; and those, therefore, who resort to it for the purpose of producing a pleasurable excite- ment, are obliged to augment the dose tq keep up an equal effect.

"Second degree. Given in a full medicinal dose, as from two to four grains, the stage of excitement is soon followed by that of depression. The pulse, which at first is increased in fulness and frequency, is afterward reduced below the natural standard. The skin becomes hot ; the mouth and throat dry ; the appetite dimin- ished ; the thirst increased ; and frequently nausea, or even vomiting, is induced.

The symptoms of excitement soon pass away, and a ' state of torpor succeeds ; the individual seems indisposed to exertion ; the muscular system, appears enfeebled ; the force of external im- pressions on the organs of the senses is diminished ; and the ideas become confused. This state is followed by an almost irresistible desire for sleep, which is frequently attended by dreams, sometimes of a pleasing, at others of a frightful nature. These effects are usually succeeded by constipation (which may continue for several days), by nausea, furred tongue, headache and listlessness.

" Third degree — poisonous effects of opium. Dr. Christison sums them up as follows: 'The symptoms of opium, when it is adminis- tered at once in a dangerous dose, begin with giddiness and stupor,

540 opium.

generally without any previous stimulus. The stupor rapidly in- creasing, the person hecomes motionless and insensible to external impressions ; the breathing is very slow, the patient generally lies quite still, with his eyes shut and the pupils contracted, and the whole expression of the countenance is that of a deep and perfect repose. As the poisoning advances, the features become ghastly, the pulse feeble and imperceptible, the muscles exceedingly relaxed, and, unless assistance is speedily procured, death ensues. If the person recovers, the sopor is succeeded by prolonged sleep, which commonly ends in twenty-four or thirty-six hours, and is followed by nausea, vomiting, giddiness and loathing of food.'"

After these interesting statements, let us hear what our own great teacher has to say in reference to this subject; his remarks consti- tute the introduction to his Provings of Opium in the second volume of the Materia Medica Pura : " The primary result of weak and moderate doses appears to be to excite, for a short time, the irrita- bility and activity of the muscles subject to its action, to excite the imagination and the courage, to relieve suffering. It is this property which has induced physicians to employ it so largely : a source of numberless evils. If the use of opium in disease were as beneficial as it is frequent, no other medicine would make so many cures; but exactly the reverse takes place.

"In all kinds of cough, diarrhoea, vomiting, sleeplessness, melan- choly, spasms, nervous affections, and, above all, in severe pain, opium is indiscriminately given, on the ground that it is the best remedy in such cases. But its innumerable evil results do not appear among the primitive effects of opium, which are exactly the reverse.

"If opium has been found to cure cough, diarrhoea, sickness, spasms, etc., in a few cases, it is only when these symptoms first show themselves in persons previously in good health, and are but slight. In such cases, as for instance in a trifling cough caused by a recent chill, the trembling arising from terror, etc., opium will sometimes restore the patient quickly to health ; because, if these symptoms are at once destroyed, the body is restored to its former condition, and the tendency to their return is suppressed.

"But because this palliative action upon slight and recent affec- tions succeeds in a few instances, it does not follow that opium really possesses the power of curing them permanently in ajl cases.

"Opium has been abused by giving it in all kinds of pain, how-

opium. 541

ever deep-seated and of however long-standing. But opium does not, strictly speaking, belong to the class of remedies that soothe and cure pain. It is almost the only medicine that does not excite a single pain during its primitive action. Other medicines elicit their own peculiar symptoms, and are therefore capable" of curing homceopathically the symptoms resembling them.

But opium has not the power of effectually curing any kind of pain whatever, be- cause, instead of exciting pain during its first action, it extinguishes the sense of it, the inevitable reaction of which causes greater sensi- tiveness than before, and consequently increases suffering.

"Therefore, all kinds of pain, soothed for the moment by opium, return after a short time, when the stupefying effect is past, as bad as before, and very often still more intense ; so that at last they will only yield to stronger and larger doses."

Interesting and eminently practical as these remarks are, they contain a few errors. According to Hahnemann, "Opium has not the power of effectually curing any kind of pain whatever,, because, instead of exciting pain during its first action, it extinguishes the sense of it, the inevitable reaction of which causes greater sensitive- ness than before, and consequently increases suffering."

It is undoubtedly true that chronic pains cannot be cured by opium ; they may be palliated, but they cannot be cured by opium. And even the palliative effects of opium in chronic and inveterate pains cannot be sustained beyond a certain period ; the susceptibili- ties of the tissues become so thoroughly blunted that opium ceases to affect them, unless it is given in enormous and really poisonous doses. But there are pains to which opium is generally homoeo- pathic. In the Journal Universal cle Medicine we read of a case of poisoning by opium, where a soldier took two drachms of the solid drug, and died in six hours and a half, after being affected with lockjaw and dreadful spasms.

For some time after swallowing the poison, the soldier had acute pain in the stomach. In another case of poisoning the accession of somnolency was attended with excru- ciating colicky pains of two days' duration. These cases show that opium does sometimes act as an irritant poison. Another, and more singular, anomaly is the spontaneous occurrence of vomiting.

Now, if we should be called upon to prescribe for a group of symptoms such as might occur in delirium tremens, where the violent cerebral irritation, the furious delirium, the excessive contraction of the pupils, or the comatose condition of the patient, with dilated pupils,

542 opium.

deeply flushed cheeks, dark, livid complexion, parched and brown tongue and lips, should constitute prominent indications for the exhibition of opium, vomiting and pain in the bowels, and even diarrhoea would not be a sufficient counter-indication to the use of this agent ; for, it is a well-known fact that, owing probably to some peculiar and inexplicable idiosyncracy, opium will even cause diarrhoea in some individuals as a primary symptom of its action upon the intestinal canal. Even neuralgic affections of the nerves of sensation and of the splanchnic nerves have been cured by the sole use of opium ; for it is undeniable that neuralgic pains are among the legitimate effects of the continued use of opium.

I have to advert to another point in this introductory chapter which leads to confusion. "Opium," says Hahnemann, "has this distinguishing property, that in irritable persons who are unaccus- tomed to it, especially in large doses, it causes a reaction, beginning very remarkably, which is very rapid and often instantaneous, but which, either by its briefness, its rare occurrence, or its nature, must not be confounded with the principal and primitive effects of opium. This reaction, rare and momentary, perfectly resembles the reaction of the human organism upon opium, and may be called its shadow. The symptoms are: a death-like paleness, coldness of the limbs and whole body, cold perspiration, anxiety, trembling, trepi- dation, but very seldom any degree of pain."

In this paragraph, Hahnemann distinguishes between the natural reaction of the organism and the reaction of the drug. This dis- tinction seems to me fanciful, not real. The heat and dryness of the skin and the throbbing of the pulse, which succeed the chill and the vascular depression caused by aconite, are not signs of a reactionary influence of the drug, but of the living organism. A distinction between the reaction of the drug and that of the organ- ism seems to be a metaphysical subtlety which not only leads to no practical results, but is altogether hypothetical and indeed rejected by the intelligent miuds of our school.

What is the stimulating effect of a small dose of opium ? It is not the direct effect of the drug, but a symptom of the organic reaction. The drug may be taken in such a large dose that the organic reaction may be entirely wanting. The symptoms which Hahnemann describes as those of medicinal reaction are really signs of organic reaction.

The death- like paleness, the coldness of the limbs and whole body, the cold perspiration, the anxiety, the trembling and trepidation alluded to

opium. 543

in the previous paragraph, denote the feehle, although unsuccessful endeavor of the organism to regain its normal condition.

Professor Dierhach ranges the effects of poisonous doses of opium in the following categories : The first category, or series of symp- toms, comprises the following : nausea, occasional vomiting, sopor, insensibility to external impressions, slow breathing, closing of the eyes with disposition to lie on the back, contraction of the pupils.

In the second stage we have : redness of the face, profuse per- spiration, sopor, stertorous breathing, although as a general rule the breathing is quiet and scarcely perceptible ; there is an expression of anxiety and occasionally of rage in the features ; the pupils are generally contracted to the smallest point ; the patient sinks into a deep sopor from which he can only be roused for a moment by * means of cold affusions ; the pulse is hurried, feeble, contracted, imperceptible or irregular, and constantly tending to collapse.

The third stage is characterized by a pale, cadaverous, ghost-like expression of the countenance, relaxation of all the muscles, (except an occasional paroxysm of convulsions, or even lockjaw, especially among children), cold sweats, irregular, panting breathing, which is very speedily followed by death.

The bodies of those who are poisoned by opium have a livid appearance, and are rapidly decomposed. The cerebral vessels are turgid with blood, the arachnoid membrane is injected, the eyeballs protruded and red, the pharynx looks inflamed, the lungs are dis- tended and filled with a fluid blood ; the ventricles frequently contain bloody coagula, the vessels of the stomach and bowels are engorged, the kidneys are distended with blood, and the bladder with urine.

We may consider the physiological action of opium upon the tissues under the following general categories :

CEREBROSPINAL GROUP.

"We have seen that small doses of opium cause an appearance of stimulation in the brain, and that large doses manifest the inherent stupefying or narcotizing effect of this agent. The opium-sopor is generally accompanied by a diminished power of motion, sometimes amounting to actual paralysis of the muscular fibre; at times, instead of paralysis, we have convulsions and, in the place of coma, delirium. The pupil is usually very much contracted. The general action of opium upon the brain is characterized by signs of violent ■congestion.

Beside the effects which we have already mentioned,

544 opium.

it causes furious delirium, or a sort of delirious talk about ghosts, devils aud masks which assemble around the bed for the purpose of torturing the patient. It causes, as has been stated before, violent intoxication with stupefaction. It also causes a species of vertigo, as if everything were turning around with one, and as if the patient were hovering in the air.

As regards the head, opium causes a pain in the head as if the brain were torn, accompanied with a sensation in the body as if every part in the body would be twisted wrong side up. The head totters to and fro. The head and face are swollen, the eyes inflamed and protruded, the lips look bloated and have a reddish-blue tinge- The expression of the eyes is often peculiar ; the eyes glisten and sparkle ; at times they look glassy and are immovable like those of a dying man. The pupils are insensible to the light ; at first they are very much contracted, but afterward they dilate considerably ;. the lids maybe half closed, and water sometimes runs out of the eyes.

If the patient is conscious, he complains of loss of sight and humming in the ears.

The face is likewise considerably altered by the irritating or para- lyzing action of opium upon the brain. The face may look pale and sunken, or it may be alternately red and pale, bluish, dark-red, of a cherry-brown, bloated ; sometimes the facial muscles are relaxed,, giving the face an expression of stupidity ; the lower lip inclines to drop, and it is only with great difficulty that the patient is able to raise the upper eyelid. Instead of being paralyzed, the facial muscles are sometimes spasmodically agitated, they tremble; so do the lips and tongue, and the mouth is distorted. We have stated already that the jaws may either be locked, or the lower jaw is para- lyzed, hanging down and permits the saliva to run out at the corners in long ropy threads.

If we add to these various effects of opium the appearances in the brain which post-mortem examinations have revealed to us in cases of poisoning by opium, we shall find that the physiologico-patholog- ical action of opium upon the cerebral tissues renders this drug eminently homoeopathic to several important cerebral diseases. In one case, the veins of the neck were found turgid with black blood. In other cases the sinuses and all the cerebral vessels were found distended with blood ; the two ventricles contained a teaspoonful of a bright-red fluid, the choroid plexuses were very much distended. In other cases blood has been found extravasated in the brain.

OPIUM. 545

Leroux found the pia mater injected and thicker than usual ; at the base of the brain he discovered about a teaspoon ful of a bright-red fluid, and the choroid vessels very much distended; clots of coagu- lated blood have been found in the substance of the brain by other pathologists. In the case of an infant, seven weeks old, who was killed by taking ten grains of Dover's powders, the sinuses of the dura mata were filled with dark coagula, the surface of the brain was covered by a net-work of distended vessels, containing a bright- red blood ; there was a slight extravasation of blood on the surface of the posterior lobes, and all the internal vessels of the brain were turgid with blood.

Considering all these effects of opium in their totality, may we not infer that opium is homoeopathic to apoplexy, to delirium tremens, to typhus cerebralis and to such conditions of cerebral irritation generally as are characterized by phenomena similar to the derange- ments caused by opium ? Opium may prove homoeopathic to typhoid conditions setting in during measles, scarlet-fever, small-pox or some other acute eruption. Whenever the symptomatic and pathological character of the cerebral irritation is strictly similar to the irritation which opium causes in the cerebral tissues, this agent should be exhibited, no matter what the immediate cause of the natural disease may be. An intense and suppressed mortification of one's feelings may cause a cerebral irritation to which opium is homoeopathic.

A gentleman, fifty years old, and of sensitive disposition, had his feelings deeply hurt ; he restrained his anger and suppressed his grief, and the consequence was a serious attack of cerebral irritation. He went home, laid down, and soon was oppressed with irresistible sopor. I found him with his cheeks flushed, tongue white as if covered with powdered chalk, pupils contracted, pulse quick arid irritated, skin feverish and dry, and the sopor so overpowering that it was with the greatest diffi- culty that he could be roused long enough to answer one or two questions. I gave him a few powders of opium11, and in a few hours the sopor gave place to a natural sleep, and the symptoms of gastric and vascular irritation yielded very speedily after that.

Professor Jcerg and his disciples have given us a few interesting provings of opium, obtained from the tincture and from the crude substance. The tincture was proved in doses of from one to thirty drops, and the crude substance in doses of from one-twelfth of a grain to two grains. The principal effects of opium obtained by these provers were manifested in the brain, bowels, respiratory organs and nervous system generally.

One prover observed the following symptoms which constitute a very characteristic group of headache symptoms. An aching pain

VOL. II. — 94.

546 OPIUM.

all oyer the head as from congestion, -warmth in the face and on the hairy scalp ; these signs of congestion were soon after followed hy diarrhoea. At one time the pain in the head would streak down to the tip of the nose where it terminated in a sort of griping.

From twelve drops of the tincture, the pain in the head would become stupefying, with heaviness of the head, tightness around the neck, heat and sweat in the face. Horrid and frightful dreams would likewise torture the prover.

In the case of other provers, these signs of congestion were still characterized by additional symptoms, such as : loss of ideas, violent vertigo, obscuration of sight, internal restlessness.

In the person of Professor Joerg, the stupefying pain in the head seemed principally located in the frontal eminences, streaking down to the tip of the nose ; in the case of another prover, it was accom- panied by dryness of the eyes, and sensation as if they were full of sand, with inability to keep the lids from closing.

A very common paroxysm experienced by Jcerg's provers was the following : Stupefying pain all over the head, followed by cutting in the bowels and diarrhoea. Dullness of the head, with stitching pain from the forehead to the occiput, drowsiness, ineffectual urging to stool, constituted another paroxysm of pains. The pains in the head, which were generally characterized by a feeling of oppression, heaviness, stupefaction and constriction, were in very many provers accompanied by a sense of oppression on the chest, with stitches in the chest, and even a hacking cough.

Extreme lassitude, sometimes amounting to perfect exhaustion and inability to stand, vertigo and loss of ideas either preceded or accompanied the distress in the head. The pulse, during these attacks of headache, was either feebler and more rapid than usual, or in some cases, stronger, fuller, with increased warmth of the skin.

Professor Bcecker has made a number of experiments with opium for the purpose of determining its influence upon the blood and upon the urinary secretions. These experiments, which were made upon perfectly healthy individuals with increasing quantities of opium, which was taken every day in doses of from one-half of a grain to one grain and a quarter of the crude drug, yielded the general conclusion that opium interferes with the renovating pro- cesses of the vital organism. It is found that under the action of opium the effete matters which should be excreted, through the urine, skin and bowels, arc retained in the system, and that conse-

opium. . 547

quently opium is possessed of the power of vitiating the organic products which it is the business of the reproductive forces of life to manufacture fcr the physiological wants of the organism out of the regularly furnished supplies of nourishment. These results were demonstrated by repeated analyses of the blood and urine of the opium-provers during the period of these interesting experi- ments. Although the whole quantity of the urine and perspiration was found to be increased by opium, yet the solid ingredients which are normally contained in the urinary and cutaneous secretions were diminished. A burning skin, drenched in a watery perspira- tion, may constitute a prominent indication for opium in various diseases, for instance in delirium tremens.

The persons whom Boecker employed for his experiments experi- enced from one grain and a half, and one grain and three-quarters, a number of interesting symptoms, most of which were likewise complained of by Joerg's prover's, such as : dizziness, sensation of intoxication, headache, trembling of the lower extremities and weari- ness in the knee-joints. Sometimes this trembling would affect the whole body. The gastric symptoms were likewise marked; they complained of nausea, retching, a bitter taste in the mouth, consti- pation, pinching pain in the bowels with spasmodic closing of the anus during the paroxysm of pain.

Dysuria and a painful crawling in the lower limbs were also ex- perienced.

The experiments which Crumpe instituted upon himself with one grain of opium, showed that under the action of opium the pulse may first rise above the ordinary number of beats, after which it becomes depressed below the normal standard.

After these statements concerning the toxicological and physio- logical action of opium upon the healthy organism, we shall have no difficulty in determining its homoeopathicity to several important affections of the cerebro-spinal system. We find it indicated in

CONGESTIVE HEADACHE, with a sensation as if the brain were constricted ; a stupefying pain, attended with dizziness, ten- dency to sopor, obscuration of sight. This distress may be attended with gastric symptoms, white coated tongue, retching, oppression in the epigastric region. A condition of this kind may result from abuse of liquor, from an intense mortification of one's feelings, or it might possibly be the commencement of a more protracted cerebral disease, such as typhus. The probability is that constipation,

548 opium.

lassitude and a feeble and hurried pulse will, generally speaking, accompany such symptoms of cerebral irritation.

A woman had, for many years, been subject to recurring headaches. Various means had been used without obtaining relief. But the intensity of the pain and the increasing duration forced the patient to seek help from new quarters with each new attack. Symptoms : Pressing, boring or stitching pain in the left supra-orbital region, increased by motion, noise and light.

The pulse is feverish. Chilliness, yawning, irritability of mind, nausea and vomiting at times precede and again accom- pany the attacks. The urine is at first clear, later it becomes darker, and forms a deposit. The temperature of the body varies at first, but soon increases moderately and at last a gentle perspiration makes its appearance, followed by amelioration of all the symptoms.

The attack is apt to come on at any time ; menstruation affects them only slightly, the weather seems to have more to do with them. During the intervals between the attacks she is perfectly well. The patient now receives opium during the attacks, and under its action they last but a few hours and come on less frequently. (Schmid in the Hygea, vol. xiv., p. 147.)

We may find opium indicated in

APOPLEXY, although we should not prescribe opium too eagerly. Aconite and belladonna deserve your first attention in cases of apoplexy, but I have generally* found that in cases of apoplexy to which these two drugs are homoeopathic, it is possible to obtain some slight sign of recognition or consciousness from the patient; but if the consciousness should be entirely gone — if the patient is profoundly comatose, the pupils are either intensely con- tracted or widely dilated and insensible, the face has a dark-red or cherry-brown appearance, the pulse is either rapid, feeble and irregular, or else full and labored, if the breathing is either imper- ceptible or stertorous, we may give opium with tolerable certaiuty that it meets the exigencies of the case.

If, after the symptoms of apoplexy have subsided, a stupid appearance should remain, with tendency to sopor and with hemi- plegia, opium, or its alkaloid, morphine, may prove useful for the cure of this paralysis, especially if the patient complains of pain and formication in the paralyzed limb. In

MANIA-A-POTU AND DELIRIUM TREMENS, the furious delirium, the expression of terror in the countenance, the constant talk about demons and frightful masks bent upon tormenting the patient, the flushed face, the inflamed and protruded eyes, the red and parched tongue, the dry and hot skin, the full, hard and throb- bing pulse, the vomiting of bile, the retention of stool and urine — these are some of the characteristic indications of opium in this sometimes terrible malady. Fetid sweats, with coldness of the skin, sallow complexion, uncontrollable restlessness, phantasms and bland delirium likewise point at opium.

opium. 549

A man, who was in the habit of using stimulants, had been drinking to overcome anger and care, and was laboring under an attack of delirium tremens, which pre- sented the following symptoms: Trembling of all the muscles of the body; distor- tion of the face ; spasmodic motion of the upper leg ; he imagines himself a murderer or a criminal and expects to undergo capital punishment ; he sees mice, scorpions, etc., which he tries to remove from his body; he jumps out of bed with fear; en- couraging talk drives off these fancies for a short time, but they return again ; per- spiration on the forehead and face ; loss of appetite ; constipation ; the pulse is small and feeble, ranging from fifty to sixty beats per minute.

Prescribed mix vom.30 with- out relief. On the following day he received opium6, and within twelve hours the whole train of symptoms had disappeared. (Weber in Archiv /. d. Bom.

Heilkunst, vol. ix., p. 131.)

Opium is an important remedy in inflammatory conditions of the brain and of Us covering membranes, but can be of use only in the late stages of the disease. It may also be called for in hydrocephalus and in cerebro-spinal meningitis. A comparison of the pathogno- monic symptoms of these diseases with the brain-symptoms of the drug will show the homoeopathicity of the remedy to these danger- ous maladies. Kafka uses the following language (Horn.

Therapie., vol. ii., p. 109) : "Opium must be used when there are present profound sopor with dropping of the lower jaw, loud snoring, slow respiration and pulse, with approaching symptoms of trismus, tetanus, or opisthotonos. It must, however, be remembered, that these symptoms usually indicate an advanced stage of the patholog- ical development and that the action of this remedy can be of advantage only when it is administered in the higher dilutions and at brief intervals (every five, ten or fifteen minutes).

The lower attenuations or triturations increase the sopor and aggravate the totality of symptoms."

The writer had charge, of the case of a middle-aged gentleman, suspected of laboring under softening of the brain. The case was exceedingly complicated and had been under the care of a prominent "regular," and was constantly ad- vancing toward a fatal termination. An intense pain in the head, deep-seated and accompanied with excessive soreness in the brain, had been the most painful symp- tom for sometime before I was consulted, and continued in spite of carefully selected remedies.

One evening, a few hours only after I had left my patient in a comfort- able condition, I was called in great haste and found him as follows : Profound sopor; lower jaw dropping; eyes half-closed ; pupils contracted ; stupid expression of the countenance ; temperature of the body slightly increased ; heavy snoring breathing; pulse sixty-two per minute, but regular and nearly normal in strength. He received opium, 3d dilution, every fifteen minutes during the night, could be roused in the morning and had recovered from the attack by noon of the next day.

We have seen that opium causes strange imaginations, fancies and even delirium. We make frequent use of the remedy in condi- tious which are characterized by such disturbances, taking pains to let the totality of the symptoms guide us in the choice of the cura- tive agent ; the delirium of opium is marked by anxiety, a tendency to be frightened easily, imaginings of wild animals and of vermin in

550 opium.

the room and on the bed, and by the belief of the patient that he is away from his own home.

We may utilize this fact in various fevers, congestions to the brain and in certain types of mental aberrations.

A man, eighty-four years of age, subject to hemorrhoidal troubles, suffered frequent- ly, and without any known cause, from a peculiar mental aberration. Symptoms : The patient fancies himself away from his own home, in a place some three hours' distant. He stops strangers and wishes to go with them to his own home. He meets violence with violence, and it required the force of two persons to keep him.

His face is fairly aglow with rush of blood to the head. He does not readily recog- nize acquaintances. Fear; wild delirium. Wants to sleep, but cannot sleep pro- foundly.

Constipation of several days' duration, with tympanitic abdomen. Reten- tion of urine, apparently from a paralytic state of the bladder. Forgetfulness. Though very sleepy, he was very lively.

Opium, one-quarter of a grain, produced quiet sleep, from which the patient awakened with full consciousness. (Schueler in Annalen d Horn., Hartlaub and Trinks, vol. iv., p. 331.)

CEEEBRAL TYPHUS In cerebral typhus opium is indicated

in the paralytic stage, by sopor, with low muttering delirium, accompanied with symptoms of paralysis, such as depression of the lower jaw and upper lip and eyelid, dilatation of the pupils, hot and dry or clammy skin, small, rapid and jerking pulse, sunken and livid or even cadaverous countenance ; or in the congestive stage, where the symptoms of violent congestion and erethism prevail instead of those of general prostration of the vital forces. The pulse may be full, irritated and throbbing, the skin hot and dry, the face deeply flushed, the tongue parched and covered with a thick, glazed, brownish coating ; the patient wants to drink all the time, unless he should be so comatose that he is no longer conscious of his natural wants.

A woman, some twenty years old, of scrofulous constitution and with an inherited tendency to mental disturbances, had been sick with typhus when, after a few days, cerebral symptoms showed themselves. The fever-heat was very great, the pulse 130 and light, there was congestion of blood to the brain, violent pressive pain in both temples, the eyes were sparkling and wild, and with these she had anxious restless- ness, short sleep, suddenly interrupted as from fright, vivid dreams, great thirst, dry lips, red tongue.

She received belladonna3, but on the third night she suddenly became furiously delirious. She talked, yelled, laughed, sang, wept, one after the other in quick alternation, wanted to run away and had to be held by force. I gave her two drops of the first dilution of opium every hour. After the third dose the delirium lessened in violence, assuming the form of mere hallucinations, as birds, etc., floating in the air, of whom she was afraid, trying to hide ; but after a few more doses this disappeared, and the case, now one of simple abdominal typhus, made a good recovery under acidum phosphoricum and china.

(Trinks in the Allg. Horn. Zeitg., vol. xxxvi.)

Opium may induce convulsions, and may be used as a true homoeopathic agent in such an attack. These convulsions are symptomatic of a violent irritation of the brain, with accomp.i liv- ing congestion of the cerebral vessels and pressure upon the cerebral

opium. 551

mass. The convulsions excited by opiuni differ from those caused by strychnine in this, that during the strychnine convulsions the consciousness of the patient remains unimpaired; the attack pro- ceeds from the spinal cord and cerebellum, whereas the opiuni convulsions arise secondarily or by reflex-action from a primary irritation of the cerebral centres. During the attack the features assume an expression of terror, and the complexion is of a dark cherry-brown, or even blackish color, with contraction of the pupils or alternate contraction and dilatation.

The action of opium upon the pupil varies ; the pupil may contract or dilate, or else it may remain unaffected by the drag. In an attack of convulsions to which opium is homoeopathic, the pupil may likewise be variously affected, either contracting to the smallest dimensions or else dilat- ing to a size which leaves only a narrow ring of the iris visible. The consciousness is suspended by the stupor or coma which seizes upon the sensorium. Froth oozes out at the mouth; the jaws are tightly locked, the breathing is stertorous, and the whole body is frequently jerked' up by the violent shock.

If, after confinement, the patient should show signs of sopor or stupor, and complain of a violent distress in the head, with a heavy, full pulse, coldness of the extremities, and dark flushes on the cheeks, it may be well to be prepared for an attack of convulsions and to administer opium at once. In

PUERPERAL CONVULSIONS or eclampsia, opium is un- doubtedly a most valuable agent.

A lady, thirty years old, had been confined without difficulty. She was going on finely, when one morning, six days after her confinement, she seemed unnaturally merry. A few hours after, she was seized with violent convulsions. The physician arrived after the third paroxysm, and found the patient in deep sopor, with her face flushed.

Pulse large, full, rather frequent. Opium was administered after the fifth paroxysm; but the sopor was so profound that she was unable to swallow and allowed the solution to escape at the corners of the mouth. After the seventh paroxysm, which was more violent than any of the preceding, the twitchings of the extremities and of the muscles became frightful ; the respiration stopped for a whole minute, after which the breathing became stertorous, with oozing of froth and vesicular sputa from the mouth.

The face had assumed a blue, and even blackish hue. After the seventh paroxysm, the face, neck, and upper portion of the chest exhibited this change of color. After the eighth paroxysm, a marked change took place. The' patient fell into a quiet sleep, and the face, neck and chest again assumed a natural color.

Two hours after, she sat up in her bed, unconsciously performing with her hands a variety of motions ; she uttered inarticulate sounds. She took her medicine easily, but without consciousness. This gradually returned. Next morning the pa- tient felt tolerably comfortable, except a peculiar sadness and depression of spirits, which yielded to the use of camphor in about a week.

When the case was reported, the patient had been twenty-two years without having had a return of any kind of nervous disorder. {Frank's Magazine.)

In this case opium was undoubtedly the specific homoeopathic

hOZ OPIUM.

remedy. Though administered by an alloeopathic physician at the rate of five drops every two hours, we have yet a perfect right to claim the successful treatment of this case for homoeopathy. In reporting the case, Dr. Loweg expressly states that venesection would doubtless have resulted in fatal apoplexy. In

PUERPERAL MANIA, with paroxysms of excessive mirthful- ness or daring rage, exhibition of supernatural strength, flushed face, glistening eyes, full, excited, hard pulse, and occasionally sopor and stertorous breathing, opium will be found a powerful remedy. In puerperal mania which is distinguished by paroxysms of rage, tendency to acts of violence, flushed countenance, glisten- ing eyes and subsequent sopor and slow, stertorous breathing, opium may likewise prove valuable.

The first effect of opium upon the sentient nerves is to diminish sensibility ; hence, if numbness or diminished sensibility are present among a group of symptoms to which opium seems homoeopathic, this may be regarded as an additional indication for its use. In

TRAUMATIC OR IDIOPATHIC TETANUS, opium has been administered by old-school physicians in enormous doses. A few cures of this disease are recorded where opium was used by the pint; but as a general rule, opium has been dethroned in tetanus by strychnine. Cases of tetanus may occur where opium may prove a valuable remedy; in other cases aconite has effected a cure; many cases require strychnine.

The tetanic convulsions which opium excites, are not primary manifestations of the irritating action of the drug, like the tetanic spasms excited by nux vomica. These opium-spasms are symp- tomatic of a primary irritation of the cerebral fibre. Hence they are invariably preceded by manifest symptoms of violent cerebral congestion. The face flushes up, the eyes become unsteady, the facial muscles and the lips begin to quiver ; the convulsive paroxysm results from the mediate irritation transmitted to the ganglionic system from the cerebral centers.

It is only to such mediate or secondary spasms that opium is at all in curative adaptation ; never to idiopathic tetanus where the spasm has its origin or takes its starting point from the spinal marrow, or from the nervous centers immediately connected with it. In this form of tetanus, opium may be given by the pint, without manifesting any curative action. The opium-spasms are sometimes accompanied by general tremor and a sensation as if the nerves would be pulled to pieces.

OPIUM. 00-3

EPILEPSY comes within the curative range of opium, if the symptoms correspond with the picture of the drug as repeatedly described. It is especially serviceable in recent cases which are the result of a fright, in nocturnal epilepsy, and in cases where suffoca- tion during the convulsions seems imminent.

Miss — , aged fifteen years, had been subject to epilepsy for three years. In De- cember, 187 1, she presented the following symptoms : She had fits only after going to sleep. She would not sleep ten minutes during the day or night, before she would, with a sudden spring, become violently convulsed; foaming at the mouth, and bleed- ing from her bitten tongue ; her face was puffed, and so congested as to look almost purple ; her eyes were dull and turned upward ; lids half closed ; head hot ; severe opisthotonos.

The convulsion would last from ten to thirty minutes, when she would sink into a deep heavy sleep, with loud snoring and rattling in the chest. This respite would seldom last more than half an hour ; sometimes not five minutes, when she would suddenly go into another convulsion, as at first. Thus she would pass the entire night. In the morning she would awaken, feeling lame and tired, but wholly unconscious of not having had a quiet night's sleep.

During the day she seemed listless and drowsy ; she complained of itching of the skin, but there was no appearance of an eruption ; she was indifferent to her surroundings and preferred to be let alone. I gave her opium6, one powder half an hour before going to bed. The patient, for the first time in two months, passed a night without convulsions, although restless and often starting in her sleep. She continued well, when a sud- den and violent cold produced menstrual disturbance and brought on a return of her old trouble. * * * Then the convulsions took on their old form, but opium6 did not relieve it, while the first attenuation, given every hour, checked it promptly.

She had no more fits for two months, when they again returned during sleep. Prescribed opium12, one dose before retiring. Since she look that single dose eight months have passed, and she has been perfectly free from fits, or signs of fits. (Dr.

H. E. Spald- ing in New Eng. Med.

Gazette, May, 1873.)

CHTLO-POIETIC GROUP.

According to Pereira the usual effects of opium upon the organs of digestion are the following : It diminishes secretion and exhala- tion from the whole canal ; thus it causes dryness of the month and throat, and diminishes the liquidity of the stools ; it excites thirst, lessens hunger, checks the digestive process (for in some animals poisoned by opium, food which they had taken previously, has been found in the stomach unchanged) ; and in some cases it excites vomiting. Kerr, in his Medical Observations and Enquiries, tells ns that in the famine which prevailed in the East Indies, in the year 1770, opium was purchased by the unhappy sufferers, at extra- ordinary prices, to allay the cravings of hunger, and to banish the dreadful prospect of death.

The Tartar couriers, who travel im- mense distances in a short period of time, take opium only during the journey, to support them. It diminishes the sensibility and contractility of the digestive organs ; hence the difficulty, in severe cases of poisoning, of producing vomiting. The constipation which follows the use of opium depends partly on the same cause, and in part also on the diminished secretion of bile and a diminished secre-

554 opium.

tion from the gastrointestinal mucous membrane. Sproegel found the ductus choledochus of animals to which opium had been given, filled with bile ; yet it had not passed into the intestines, for the feces were scarcely tinged by it, but had the appearance which we observe them to have in jaundiced patients.

The digestive functions of opium-eaters are entirely ruined ; they eat by fits and starts, or have no desire for food whatsoever. Opium may cause nausea and vomiting, even vomiting of blood ; it also causes an indescribable distress in the pit of the stomach ; but these are exceptional cases and cannot be considered as regular effects of opium. These effects of the action of opium may suggest its use in

ACUTE CAKDIALGIA with distress in the pit of the stomach, vomiting of blood and mucus, attended with symptoms of cerebral congestion, flushed face, protruded and suffused eyes, or else pale- ness, sopor, cold skin, and thin, hurried pulse.

A woman, twenty-six years old, had had during the last eight months, four attacks of the following difficulty : grass-green vomiting of very large amount of slime, con- tinuous choking and oppression, with a sensation as if a stone were lying in the epi- gastric region ; there is no sensitiveness to pressure ; an indescribable nausea seems to rise from the umbilicus upward, accompanied by such restlessness and anxiety, that she does not remain quiet for one moment, but keeps up a constant tumbling about in bed with frequent outcries.

Loss of appetite ; sour taste in the mouth ; the tongue is coated white; thirst, with a desire for beer; water is immediately rejected by the stomach. Obstinate constipation. Copious, pale urine. Arsenic, veratrum, nux, tabacum, etc., had been used during previous attacks, without giving relief.

Prescribed opium, 1st dilution, every hour. After the third dose vomiting ceased, and she was cured in a short time. (Hofrichter, Allg. Hoin.

Zeit., vol. xliv.)

ATONY OF THE STOMACH.— In atony of the stomach, in- duced by the excessive use of ardent spirits, with variable appetite or complete anorexia, opium may restore the irritability of the lining membrane. In

VOMITING, the sour vomiting of children, for instance, or vom- iting of drunkards, accompanied or followed by sopor or stupor, flushed face, cold extremities, etc., opium is useful.

Diarrhoea even has been caused by opium in its primary action upon the bowels. In the case of a lady who was in the habit of using opium for toothache, a watery diarrhoea came on whenever she used this drug for such a purpose. This may have been the result of a peculiar idiosyncrasy. In the case of this patient, if she had been attacked by watery diarrhoea, in consequence of exposure for instance, opium might have proved a true remedial agent.

Many of Joerg's provers were attacked with diarrhoea preceded by cutting pains in the bowels.

DIARRHOEA. — As a general rule the primary effect of opium

opium. 555

upon the bowels is to diminish the alvine secretions. This, however, does not militate against the use of opium in certain forms of diar- rhoea where the stools are slimy or watery, and of an exceedingly foul smell. In diarrhoea to which opium is homoeopathic, unmis- takable signs of cerebral congestion are generally present, such as -violent headache, drowsiness, vertigo, flushed face; even typhoid symptoms, a dry, brown and parched tongue, excessive prostration dry heat of the skin, unquenchable thirst, small, rapid and rather jerking pulse, may characterize such an attack of diarrhoea. For the purpose of illustrating my remarks I will cite the following case from the Archives Generates :

A sailor, aged forty years, of good constitution, but impoverished in consequence of miserable fare, was brought to the hospital in the following condition : Pale face ; eyes sunken ; sullen expression of the countenance, with alteration of the features expressive of distress in the bowels ; pulse small, feeble, hurried and irregular; scanty secretion of urine ; but frequent, or rather unceasing discharges of yellow, watery, fetid stools. After the ineffectnal employment of a variety of means, the patient be- came much worse.

On the third day after his reception in the hospital, the stools were passed without consciousness ; the patient had grown thin ; the tongue was rather dry, the abdomen tympanitic, the head confused, features elongated; oppres- sion on the chest, and rattling breathing. He was put on the extract of opium, in half-grain doses, of which he took fourteen grains in the space of six days. The diarrhoea ceased without any symptoms of narcosis having made their appearance, and with proper nourishing diet, his strength returned and his health was completely restored.

The old-school mode of using opium in diarrhoea is sometimes productive of dangerous, and even fatal, cerebral congestions. The sudden checking of the diarrhoea, which is very frequently a natural relief to abdominal congestion, forces the congestion back upon the brain. The diarrhoea is a curative effort instituted by the brain for the purpose of relieving abdominal congestion. A large dose of opium paralyzes the curative action of the brain in this direction, and transfers the pathological process to the central organ of all vital activity, where the first perception of every disease which in- vades the organism must necessarily take place.

Hence, dangerous cerebral congestions, paralysis and even apoplexy may be the con- sequences of such treatment. In

LEAD COLIC, or painter's colic, opium is one of the most valu- able remedies. It restores the action of the mucous exhalents, moves the bowels and arrests the spasmodic pains. It may have to be given in doses of from one to five drops every hour. In

CONSTIPATION, arising from a deficient flow of bile through the ductus choledochus, and from deficiency of peristaltic action, opium is a most useful remedy ; the feces may consist of small,, hard balls, and look blackish or discolored.

556 opium.

A girl of twelve years had been subject to obstinate constipation for a number of years. Every two or three days she passed hard, grayish stools, in small balls like the dung of sheep. She suffered at the same time from pressure over the eyes, anxiety about the heart, stitching pains in the chest and abdomen ; she looked pale and sickly. Sulphur, nux vomica, calcarea had failed to relieve her. Repeated small doses of opium30 cured her. (Kirsch in the Hygea, vol. iv., p. 1 1 9.)

C. J. H., aged sixty-eight years, has been a confirmed invalid for years. During the last few years he has been greatly troubled with obstinate constipation, owing to a deficiency of peristaltic action of the bowels.

His appetite was excellent and his digestion was good, with the exception of the above-mentioned difficulty. After going for three or four days without an evacuation, his bowels felt, heavy, became bloated and somewhat sensitive to the touch ; much rumbling in the bowels ; hard balls could frequently be felt in the abdomen, especially about the sigmoid flexure. This symptom would increase until the bowels moved, which occurred at constantly- increasing intervals, of late only about every week or ten days.

Injections failed to relieve. Small doses of opium, 1st decimal trituration, were usually followed by prompt action of the bowels. Higher attenuation failed to relieve.

Mrs. , aged fifty-six years, had suffered from constipation to such a degree that

she had not had an evacuation of the bowels without enemata or purgatives for twenty years. During the last few years purgatives had so far failed that copious enemata were alone used. She had occasionally passed one and even two weeks without any interference with the bowels, vainly hoping that nature would bring relief. I gave the patient, on retiring, one dose of opium*200.

Eighteen hours after taking this dose, she had a diarrhceic movement of the bowels of considerable vio- lence. No more movement then for three days. She repeated the medicine. Her bowels moved again the next day, and have moved naturally, without any interfer- ence, every day since, that is, for two years.

(Dr. R. N'. Foster in the Am.

Homce- opathist, September, 1877.)

ILEUS. — Opium is one of our most important remedies in ileus, intussusception of the bowels, and in

INCARCERATED HERNIA— These conditions are always ac- companied with much danger, and the possibility of necessary surgical interference, at almost any time, should be carefully remembered. Opium is one of the few drugs which may saye the necessity of an operation which is fraught with much danger to the life of the patient. The following symptoms indicate its use : The abdomen is greatly distended and the intestines are knotted-up (the German term wurstartig, or sausage-like, expresses the idea exactly) ; her face looks congested, red, stupid ; there is intense pain in the bowels ; vomiting of fecal matter (ileus).

A lady in the fifth month of pregnancy had taken some cina for worms. She passed a few worms, but the bowels became costive. The abdomen was distended, painless ; she had little appetite, not much thirst, nor was there any fever. The con- stipation defied all cathartics; the abdomen became painful; vomiting set in, first vomiting of mucus, and afterward of feces.

Emollient fomentations, even injections of tobacco, remained fruitless. Gangrene of the bowels was considered inevitable. The extremities had become cold and covered with a clammy sweat. Singultus had set in, with frequent discharges of copious quantities of a watery urine.

This fact led the attending physician to diagnosticate spasmodic ileus, and with a trembling hand he gave the patient a grain of opium. That same night, a discharge of white mucus took place, and when the physician reached the house, several vessels had been filled with both liquid and hard feces, mingled with lumbrici. The emaciated patient soon recovered, and gave birth to a healthy child. [J^ran/c's Magazine.)

opium. 557

Mrs. F., forty-eight years old, a hearty and well woman, had been suffering, for several clays, from loss of appetite, disturbed sleep and an annoying, intermitting, pinching and again boring pain in the bowels. Her bowels were constipated and she took a laxative ; this did not operate. At present her tongue is somewhat coated ; some tenderness upon pressure in the ileo-ccecal region ; an old hernia.

Nux3 and injections failed to bring on a passage from the bowels. Suddenly fecal vomiting set in, accompanied by great anxiety, and returning three or four times. Constipa- tion and constant pain in the ileo-ccecal region. Great prostration.

Opium3 gave immediate relief. {Allg. Horn. Zcitg.)

URINARY AND SEXUAL GROUPS.

The general action of opium upon the ureters aud bladder seems to be to diminish the sensibility or the contractility, or both, of the bladder and ureters. Alloeopathic physicians avail themselves of this knowledge for the purpose of palliating the pam caused by the passage of a calculus through the ureter. They give opium in a palliative dose, from twenty to thirty drops or more, as the case may be. Strictly speaking, this need not be considered as an infraction of the homoeopathic law.

The healing law has nothing to do with a case like this. We are summoned to afford relief from pain ; we have to diminish the spasmodic irritability of the fibre, and at the same time depress the sensibility of the tissues. We frequently accomplish this result with very small doses of aconite, belladonna, chamomilla or mix vomica. The most appropriate means of relief, in some cases, may be a palliative dose of opium.

If an homoeopathic practitioner should, under such circumstances, sacrifice his patient to the dogmatic application of an essentially humane and all-providing law, he would become recreant to the duties which he owes to common humanity, and he would not only stultify himself in the eyes of all enlightened homoeopathists, but expose homoeopathy to disgrace and derision.

RETENTION OF URINE In some cases of poisoning by opium the bladder has been found quite full, although no urine was voided; hence in retention of urine, caused by deficient irrita- bility of the fibres of the bladder, opium would be a true homoe- opathic agent. This condition may occur as a symptom in cerebral affections to which opium is homoeopathic, such as delirium tre- mens, typhus. It may occur as an habitual condition in the case of old topers, in which case it may be associated with habitual constipation and depression of the cerebral reaction as characterized by imbecility, loss or decrease of memory, drowsiness, anorexia.

If opium causes paralysis of the sphincter, as it sometimes does, an involuntary discharge of urine ensues ; hence an

INVOLUNTARY FLOW OF URINE, caused by paralysis of

558 opium.

the sphincter, would be relieved by opium, unless some other medi- cine should be more specifically indicated. These peculiar conditions of the bladder may co-exist with other symptoms in more general derangements to which opium is homoeopathic, such as : delirium tremens, typhus, mania ; such secondary conditions, if met by the drug, constitute additional confirmation of its homoeopathicity to the general disease.

In spasmodic conditions where opium is indicated, the involun- tary discharge of watery urine would not counter-indicate this agent.

ABNORMAL SEXUAL EXCITEMENTS.— The first effect of opium is to cause an increase of the sexual desire aud power. This, however, may be followed by the opposite condition of impotence. Hence we prescribe opium both for abnormal sexual excitements, manifested by libidinous fancies, violent erections, dreams, noctur- nal emissions, and for

IMPOTENCE, without desire, occasioned by previous abuse, or by abuse of spirits, coffee.

NYMPHOMANIA. — In affections of the female sexual system opium may be of great use ; its curative powers in nymphomania, especially in the last stage of this dreadful disease, when the organic powers of the system seem threatened with paralysis, the lower jaw is depressed, and a ropy saliva is hanging out at the corners of the mouth ; when the skin is cold and clammy, the patient is emaciated, the pulse hurried and empty, the alvine evacuations take place involuntarily, and what little power of the brain is left, is directed toward sexual things, as evidenced by the character of the mutter- ing delirium, provided the power to articulate is not altogether extinct — in this condition opium may still prove useful.

In the case of parturient women, if the labor -pains are of a spasmodic and distressingly-painful nature, opium is one of the remedies which relieves these pains.

RESPIRATORY GROUP.

WHOOPING-COUGH. — Opium causes dryness in the larynx, hoarseness, a dry and spasmodic cough, with blueness of the face, and subsequent sopor and cold sweat. It has also caused spitting of blood, and may therefore be useful during the spasmodic stage of whooping-cough, and in some forms of

H/EMOPTYSIS — You recollect that the provers of Professor Jcerg experienced oppression on the chest, aching and stitching

opium. 559

pains in the chest striking from the anterior portion to the back part of the chest, burning distress in the chest, hacking cough.

The breathing is likewise powerfully affected by opium. It is sometimes stertorous, at others so superficial that it is scarcely perceptible. It is likewise irregular, and may even intermit at times for a few minutes.

PNEUMONIA Opium may be of service in the treatment of pneumonia. The characteristic indications are : the development and aggravation of these attacks (i. e., attacks of suffocation and seeming cessation of breathing) during sleep ; absence of painful sensations except constriction of the chest ; laborious respiration, or very slow, hardly perceptible, even wholly interrupted breathing ; sudden cyanotic appearance of the countenance ; staring, immov- able and half-open eyes ; somnolence before or after the attack ; trembling, twitching and jerking of the whole body, or tetanic rigidity, general coolness of the surface ; irregular, intermitting pnlse ; constipation.

It is well known that the following are fre- quently considered general indications : Consequences of fright or fear, of intemperance; complaints of old people; torpor of the nervous system, and want of reaction to remedies. (Clotar Muller.)

Opium is as useful in the pneumonia of infants as it is in the pneumonia of old people ; in both forms the presence of character- istic brain-symptoms would justify the use of the remedy.

Mr. F. H., aged forty years, of a phlegmatic temperament; double pneumonia. At times he feels as though he were not in his own house, which he expresses by saying, " I wish I could be in the house with my family." Although in a desperate condition, he is not much alarmed and wants to sit up a great part of the time be- cause the bed feels too hot.

His whole body, except the lower extremities, perspire profusely ; the sweat is very hot. The perspiring parts are covered by a heavy crop ■of sudamina. He gropes with his hands about the bed as though he were hunting for something. I had given bryonia, phosphorus, etc.

About the eleventh day opium' was given, which was followed by a sudden change and a most satisfactory recovery without the aid of any other remedy. (Dr. C. Bernreuter in the U.

S. Med. Inves- tigator, February 15, 1879.)

Kafka states that opium is of great value when inspiration is short and noiseless, while expiration is accompanied with much whistling and rattling, and a strong effort of the abdominal muscles. He looks upon the presence of asthmatic symptoms as a most relia- ble indication for the use of the remedy.

PULMONARY CONGESTION. — In cases of poisoning with opium, the lungs have been found inflamed and turgescent with air and a black, frothy blood. These various symptomatic and patho- logical manifestations convey the impression that in certain forms

560 opium.

of pulmonary congestion, characterized by such pains as we have described, oppressive and stitching pains, burning distress, with the cerebral symptoms characteristic of the action of opium upon the brain, spasmodic cough, expectoration of a black, thick blood, opium may prove a most useful remedy.

In consumptive patients, an attack of haemoptysis may often be relieved by opium even if the original disease is incurable.

The haemoptysis of drunkards often yields to opium.

Opium may cause a burning distress in the region of the heart, as from red-hot coal. In cases of poisoning, the ventricles of the heart, particularly the right, have been found to contain a quantity of black, coagulated blood, the auricles being empty and relaxed. These symptoms and post-mortem appearances show the great use which opium may afford in certain forms of

CONGESTION OF THE HEART with burning distress, such as drunkards may complain of, or as is sometimes experienced in consequence of violent grief, mortification or disappointment.

VASCULAE GEOUP.

Small doses of opium raise, and large doses depress, the pulse. During a paroxysm of convulsions caused by opium, the pulse is generally hurried; during sopor or coma it is generally slower and weaker than natural. There are exceptions to this rule. In some cases of poisoning we find the pulse quicker than in its normal con- dition.

These differences may, in a great measure, depend upon pre- existing constitutional peculiarities, and upon peculiar idiosyncratic relations between the brain and the poison. Under any circum- stances, the pulse is no criterion for the selection of opium. The homoeopathicity of opium to a given disease depends upon the cere- bral symptoms more than upon any other. In view of these symp- toms, we find opium indicated in the cerebral diseases which we have mentioned in our first category.

EXANTHEMATOUS GEOUP.

Opium diminishes the sensitiveness of the skin, but it promotes cutaneous perspiration. This is true, however, only of massive doses ; small doses seem to have a tendency to diminish the cutaneous action. We mean by this that the primary action of opium, which is to pro- mote the cutaneous secretions, is met by the opposing action or reaction of the organism, and that this reaction is characterized by heat and dryness of the skin. Hence, in typhus fever, delirium

opium. 5G1

tremens, or any other disease to which opium is homoeopathic, heat and dryness of the skin and a moderately excited pulse Avould con- stitute additional indications for the use of this agent. In such cases, opium should be given in small doses. On the other hand, the symptoms of organic reaction in a sinking condition, as it were, might be a cold and clammy skin, feeble and irregular pulse, sopor, incipient paralysis of the brain. Under these circumstances opium might still be homoeopathic to the symptoms.

"We may here add that the dryness of the skin, caused by opium, is often accompanied by itching and stinging.

Opium is not much used in eruptive diseases. Its action upon the skin is simply to cause a redness and itching of the skin, with the appearance of blotches after scratching. Nevertheless, it may fulfil important uses in exanthematous diseases. If an acute eruption, for instance, should manifest a tendency to strike in, the brain becomes prostrated, symptoms of coma or paralysis supervene, with cold and clammy skin, feeble, hurried, irregular pulse, and perhaps involun- tary diarrhoea: opium may prove one of our most valuable agents to free the brain from the dangerous prostration into which it has been plunged by the action of an mimical miasm.

We therefore com- mend opium to your careful attention in sudden retrocession of acute eruptions.

A boy, who had confluent small-pox, suddenly showed symptoms of paralysis of the brain. The pulse became hurried and small, the patient was taken with diarrhoeic stools and the pustules suddenly collapsed, some of them assuming a thin, watery pus. One drop of the tincture of opium every two hours, and lastly three drops every three hours, removed the danger and effected a radical improvement.

Another child, a girl of eight years, was attacked with small-pox. The stigmata had already broken out, when they suddenly disappeared. A train of dangerous nervous symptoms developed themselves, such as: convulsions, epileptic paroxysms, burning heat of the skin, involuntary stools, etc. Next day the patient became very restless; breathing short and moaning; chiu depressed, face and extremities cold, forehead and abdomen burning hot, eyes half closed with the eyeballs rolled upward, inability to swallow, collapse of pulse, hippocratic countenance.

Five drops of the tincture of opium were administered at one dose. Half an hour after, the patient became quiet, a profuse sweat broke out, the exanthem reappeared and the patient recovered.

In all such cases, the small-pox miasm, or the measle or scarlet- fever miasm, or the miasm of any other exanthematous disease, threatens the life of the brain, and it is here in the inmost fibres of this central organ of vitality that the inimical principle is met by the specific drug force which, if successful, compels the exanthem to pur- sue its normal course of development. We have a number of agents which act in this direction, opium, camphor, arsenic, and others.

VOL. II. — 35.

5Q2 opium.

POLYPUS. — In the successful treatment of polypus the tincture of opium has proved quite useful. Cases have been published, show- ing that polypus can be removed by touching it with a tincture of opium. Polypus of the nose has been successfully treated in this way. A case is reported in Huf eland's Journal, where a nasal poly- pus was extirpated twice by an operation, but grew again and was finally touched with opium. Gradually it shrank to a withered little sac which was readily pinched off. Even

UTERINE POLYPUS has been gradually removed by means of opium. A polypus protruded to the length of two inches between the labia majora of an unmarried woman of forty-three years, through a small aperture of the hymen which had not been ruptured, and was very firm. The polypus bled readily at the least contact. Twice a day it was penciled pretty thoroughly with opium.

In twenty days it had retreated behind the hymen. The operation was continued by means of a canula to which a camel's hair pencil was attached. Within seven weeks the excrescence was entirely de- stroyed. In

GANGRENA SENILIS, when a cure cannot possibly be expected, we may afford relief from the pain by palliative doses of opium. Even the further spread of the mortification has been prevented by this means. In the

ACNE EOSACEA of drunkards, the burning and itching of the eruption may sometimes be palliated by the internal use of small doses of opium, and the simultaneous application of a mild opium- wash.

FEVER GROUP.

CEREBRAL TYPHUS— We have already pointed out the spe- cific homceopathicity of opium to cerebral typhus in the different stages of this disease. It may likewise be of great value in those dangerous forms of

INTERMITTENT FEVER where apoplexy may set in after the second or third attack, a fever described by Hufeland and others as febris intermittens perniciosa, and by others as apoplectic intermit- tent fever. By the exhibition of opium the dangerous comatose symptoms are frequently effectually controlled. But even in a less threatening form of this disease opium may prove a valuable remedy, provided we have : tendency to sleep during the paroxysm, snoring, dropping of the jaw, and great heat of the body during the sweating stage of the disease.

OPIUM. 5G3

A boy of nine years had been sick with intermittent fever for six weeks ; the par- oxysms came on every third day, but during the last three weeks it had assumed the daily type, commencing at 1 1 A. M. with a violent shake, followed by sleep, which was accompanied with heat and subsequent sweating, lasting about an hour. Upon waking, the patient complained of headache and prostration. The case was cured by three doses of opium.

SCARLET FEYER may demand the exhibition of opium when characteristic brain symptoms are present. We may use it in attacks of the disease which commence with sopor, dark-red and bloated countenance, great heat of the body, profuse perspiration, quick and superficial breathing, rapid pulse, or in cases in which we find, during the advanced stage, profound coma, heavy, stertorous breathing, dark-red or purple face, contrasted pupils, twitching of the face, or general convulsive movements of the body, slow, hard pulse.

MENTAL GROUP.

Opium, stupefies the mind ; it causes imbecility and stupid indif- ference to pain or pleasure. It causes complete loss of memory, or a crowding of ideas upon the mind, or of elevated and profound meditations. De Quincy informs us that opium would exalt his imagination and call up the sublimest and most ecstatic fancies. In others it excites frightful visions of ghosts, demons and horrid beasts.

It causes furious delirium and mania with redness and bloating of the face, or stupor with signs of cerebral paralysis, inar- ticulate speech, low muttering delirium. These symptoms suggest opium as one of our mightiest agents in typhus, delirium tremens, mania, imbecility and other cerebral derangements to which your attention has been directed before.