Opium

Lungs.

Heart.

Defective reaction.

Opium is obtained, as you probably know, from the unripe capsules of the poppy plant, Papaver somniferum.

The unripe capsules are usually employed in its manufacture, because they are more power- fully soporific.

In some respects opium is the most remarkable drug in our materia medica.

You know that many drugs owe the majority of their effects to active principles which they contain.

Thus Bella- do?i?ia contains Atropine ;

Stramonium, Solanine ;

Nux vomica, Strych- nine, etc. ; but Opium seems to embrace an endless number of these ac- tive principles and each succeeding year adds to the list.

Let me enumerate them — they are as follows :

These various substances are derived from Opium, by more or less complicated processes.

They have more or less narcotic properties akin to those of Opium itself.

The action of some of these alkaloids is well-known, while of the action of others we are as yet ignorant.

Morphia (used principally in the form of the sulphate) is probably the best understood of these.

It is largely used by old-school phy- sicians in hypodermatic medication for the relief of pain.

But we may make use of it as a homoeopathic remedy.

In such violent diseases as cancer Morphia has been successfully given for one of its secondary symptoms, extreme susceptibility to pain ; pains are so violent as to threaten convulsions, or cause twitching and jerking of the limbs ; under these circumstances Morphia is a homoeopathic remedy.

It does not cure, but relieves the pains, not as an opiate by stupefying the patient, but according to the law of Homoeopathy.

Apomorphia causes and cures vomiting.

Now this vomiting is not of the kind for which you give Ipecac., Tartar emetic, Lobelia, etc.

It is a reflex vomiting usually from the brain.

Apomorphia produces vomiting if injected hypodermatically, long before it can have any local

action on the stomach.

You may utilize this effect of the drug in vomiting of cerebral origin, and also in that annoying disease from which many people suffer, and for which they get little sympathy, seasickness.

In these cases of cerebral vomiting you may also think of Belladonna, Glonoin and Rhus tox.

There are several other of these alkaloids of which we have some provings, but nothing that has been definitely described.

There are also numerous preparations made from Opium ; these are largely used in allopathic practice ; we have nothing, however, to do with them, except to undo the mischief they produce.

The various preparations of Opium enter into the composition of cough-mixtures and soothing- syrups, used largely in popular practice.

Their effects are decidedly pernicious, especially in children.

A prominent old-school authority says that the use of soothing-syrup for children is decidedly reprehen- sible.

It stunts their growth, makes them irritable and cross, and interferes sadly with the brain development.

Nux vomica is one of the antidotes in cases of injury from anodyne preparations.

Still bet- ter, perhaps, as an antidote, is Chamomilla, which is suited when opiates have been given for some time, and have produced their sec- ondary effects ; the little one is wakeful ; slight pains are unbearable.

When this condition is present, Chamomilla is your remedy, whether the patient be child or adult.

sphere.

The mind feels as if floating in the air, unincumbered by the laws of space and gravity.

The imagination has full play.

If now the dose be increased, either in quantity or by frequent repetition, there follows a sleepy state.

This sleep varies all the wa}^ from a pleasant feeling of easy drowsiness to the most profound stupor.

This narcotic and anodyne effect of Opium is the result of the increased circulation of blood in the brain, brought about not only by increasing the amount of blood supplied to the brain but also by interfering with its return to the heart.

Let me digress for a few moments and speak of the physiological explanation of sleep.

Hammond has shown that during this state, the quantity of blood circulating in the cranial cavity is greatly diminished.

If you give Opium to produce sleep, what do you do?

Do you produce ansemia of the brain?

No, just the reverse.

I ask you, then, is the administration of opiates for their anodyne effects at all rational ?

Returning to the effects of Opium — the face becomes deep red and swollen from the distension of the blood-vessels.

The more profound the stupor, the darker red is the face.

It may even become of a brownish hue.

The pupils become contracted.

The pulse is full and slow.

Respiration is deep, and as the stupor grows in intensity it becomes heavier and finally stertorous.

What is the meaning of this stertor ?

It means that as the poisonous effects of Opium increase, a paretic and finally a paralytic condition of the muscles of the palate and cheeks appears.

These parts, thus being thoroughly relaxed, flap back and forth with each respiration.

The pulse is full, round and slow, showing you that the heart is acting with the full volume of blood, but not with the usual speed.

As the case goes on hour after hour, you find a picture of complete paralysis developing.

The prac- tical application of this I will give you when speaking of typhoid fever.

The sphincters lose their control, so that there is involuntary escape of urine and faeces.

The pupils now are dilated and the skin is bathed in cold sweat.

The lower jaw drops and finally death ensues.

Now these phenomena depend upon the action of Opium on the nerves.

From irritation comes the first brief excitation.

From the

subsequent paralyzing action come the drowsiness, muscular relaxa- tion and coma.

From the beginning, the cerebral vessels are sur- charged with blood, and this gradually increases until sopor ensues.

Now, gentlemen, let me ask, is it rational practice to assuage pain with a substance which paralyzes and so relieves by taking away, not the disease, but thk ability to feee, the consciousness of suffering?

What are the effects produced by the habitual use of the drug?

The first effect is one that I have already described to you, one of dreamy imaginative activity of the emotional mind.

I^ater, as the use of the drug is continued, every tissue of the body becomes affected.

The skin grows dry and sallow and hangs in folds, the limbs emaciate, and the intellect becomes dulled.

The best antidote to Opium is strong black coffee, given repeatedly until there is some sign of reaction.

In addition to that you should use electricity.

You should also remove any of the poison that may be in the stomach by means of an emetic or the stomach-pump, and you should force the patient to walk about to prevent stupor.

You see the picture of Opium in typhoid fever with profound cere- bral congestion resulting in paralysis of the brain, dropping of the lower jaw and stertorous breathing.

Often when Opium is called for in this disease, the body is bathed in a hot sweat.

This sweat is not critical.

It is a bad omen.

It is a symptom of approaching death, in that it is a result of paralysis of the sweat glands.

This symptom is also found under Stramonium.

Opium must be considered in the treatment of apoplexy.

It is natural to suppose that a remedy producing such fulness of the cere- bral blood-vessels might, in persons predisposed, readily cause their rupture, and the consequent symptoms of extravasation of blood into the cerebral substance.

Opium is indicated by the color of the face, by the stertorous breathing, and by tetanic rigidity of the body.

Especially is it indicated in the apoplexy of drunkards.

Opium follows Belladonna in apoplexy.

Opium is useful in ma?iia a potu or delirium tremens.

Especially is it indicated in "old sinners;" in those whose long lives of excess have thoroughly destroyed their constitutions ; in those who have had the disease time after time.

It takes but a small quantity of liquor to throw them again into the delirium.

The face wears a constant ex- pression of fright or terror. .

They have visions of animals springing up from various parts of the room.

They imagine that they see ghosts, devils, etc., with whom they converse, though they are terri- fied by the subjects of their visions.

If they succeed in obtaining sleep, it is of the stertorous character already referred to.

Still another remedy is Cannabis Indica, or the hashish.

This is one of the best.

It has thus far been given only in low potency.

The symptoms which seem to characterize it are, ideas of grandeur and errors of perception as to space and as to time.

You may use Opium in cholera infantum when the face is red or pale, and is associated with fatally advancing stupor ; the pupils react to the stimulus of light either not at all or else very sluggishly.

The disease seems to begin by involving the brain, or such a mishap threat- ens during its course ; as yet there is neither diarrhoea nor vomiting ; the child appears as if it had been drugged.

Opium administered in a case like this will restore the patient to consciousness.

Diarrhoea sets in, and the disease proceeds naturally to recovery.

This remedy may also be given when there is a lack of vitality, and the well-selected remedy refuses to act.

The patient is either sluggish or drowsy.

It is just as useful in these cases as are Carbo veg.t Sulphur, Valerian, Ambra grisea, Psoiinum, or any of the other drugs called for in defect- ive reaction.

There is a remedy which I wish to give you here, but with some caution, because it is what has been termed a "breech-presentation," that is, it was used clinically before provings of it were made.

That remedy is frerrum phos.

It is called for in cholera infantum when the discharges from the bowels are frequent; within twenty-four hours the child is greatly reduced, and falls into a stupor, with red face, dilated pupils, rolling of the head, and soft, full-flowing pulse.

We know that Iron has that kind of a pulse ; we know that congestion belongs. to all the preparations of Iron.

In one of my cases with the above symptoms, Belladonna and Sulphur -were each given in turn, but failed.

I then gave Ferrum phos. , and in twelve hours the child returned to consciousness, and is alive to-day.

Opium may be used in bladder troubles, especially in retention of urine.

It is indicated when this retention has resulted from fright, and when it follows parturition.

This last-named symptom I have twice confirmed.

Veratrum album has colic as if the bowels were twisted; abdomen tense.

The longer delayed is the emission of flatus, the more difficult is it to pass.

Opium has been of service in incarcerated hernia, ileus and typhlitis, with complete constipation, vomiting of faecal matter or at least of substances of a faecal odor.

Puerperal fever sometimes calls for Opium, especially when caused by fright.

There is over-excitement of all the senses ; even distant sounds annoy the patient ; the discharge from the uterus is very foetid.

The case approaches a condition of stupor.

Before proceeding with our study of Sanguinaria, I will say that there is a variety of the poppy plant which grows in Mexico called the Argemoyie Mexicana.

It is used in Mexico in much the same man- ner as we use Opium.

It causes cutaneous eruptions and has been used in the expulsion of tape-worm.

The juice of the plant when col- lected and dried has much the appearance of gamboge.

I mention this, not because it is a matter of importance, but as a piece of informa- tion that may in time prove beneficial.

I propose considering first, to-day, Helleborus niger.

This is also termed the Christmas rose, because it blossoms in midwinter.

It has a dark brown root, which contains two active principles, Helleborin and Hellebore i?i.

The latter is said to be the poisonous constituent of the plant.

It is an active cardiac poison, and also causes violent purg- ing, vomiting, abdominal pains, and finally collapse.

This purgative action resembles Veratrum album, and the collapse, Camphor, Ca?rbo veg., China, etc.

Veratrum album has not the apathy of Hellebore;

Carbo veg. has cold feet and cold knees, rarely unconsciousness;

Camphor has most .prominently the coldness, sometimes with an inter- nal feeling of heat, impelling the patient to throw off the clothes.

The Helleborin is either inoperative, or, according to some authors, exerts a narcotic influence, and produces paresis of both sensation and motion.

symptoms; for instance, we note diminished power of the mind over the body; the patient is slow in answering questions, as though he did not comprehend what was asked him; he sees imperfectly, or does not seem to comprehend what -he sees; hearing is imperfect; taste is ab- sent, or nearly so; he has the desire to work or to occupy himself, but lacks the muscular strength to do so.

So you see that all the senses are benumbed by the action of Helleboras.

Even what has been termed the muscular sense is affected by it.

Muscles do not obey the will readily unless the mind is strongly exerted.

If, for instance, the patient is holding anything in his hand and you speak to him, and so divert his mind, the muscles in action relax and he drops what he is holding.

Even the heart muscle does not escape these paretic effects, and we have slow action of that organ.

The patient feels a heaviness or weight over the entire body.

There is a pressing headache of a stupefying character.

Sometimes there is a sensation as though the contents of the head were bulging at the forehead and eyes.

Bella- donna is thus not the only remedy that has the sensation as though the brain were being pushed through the forehead.

The face is ex- pressive of the stupidity under which the patient is laboring.

We may find Hellebore indicated in typhoid fever, or in other con- ditions in which this sensorial depression, with the symptoms already enumerated, is present.

In these cases you will also note the follow- ing symptoms: there is a dark soot about the nostrils; the nostrils are dry ; the tongue is yellow and dry, with red edges; the breath is hor- ribly offensive; drinks roll audibly into the stomach.

The fever ac- companying these symptoms is most marked in the afternoon, from 4 to 8 p. m.

The face is at times pale and almost cold, and the pulse faint, weak, and almost imperceptible.

There is also meaningless picking at the lips or clothing.

In this sensorial depression Helleborus is similar to Phosphoric acid, Sweet spirits of nitre and Opium.

Like Phosphoric acid, it has sensorial depression, apathy, and perfect indifference.

The patient is wholly indifferent as to his fate; he cares not whether he lives or dies.

The difference between the two drugs is that under Phosphoric acid there is drowsiness from which the patient is easily aroused, and then is per- fectty conscious; this is not the case with Helleborus, which has a con- dition more nearly approaching the stupor of Opium.

Phosphoric acid lacks the complete muscular relaxation belonging to Helleborus.

It also has not so markedly black soot about the nostrils.

Opium, the last drug on the list, you will recognize at once as simi- lar to Helleborus.

The cerebral congestion is more profound under the Opium.

The breathing is loud and stertorous, a symptom not marked in Helleborus.

Then, too, the face is dark, brownish-red, or often blue; under Helleborus it is pale, and often cold or at least cooler than nat- ural, and at times livid and covered with a cold sweat.

The pulse will help you to discriminate between these two remedies, it being full and slow under Opium, and small, weak, and almost imperceptible under Helleborus.

Hydrocyanic acid and Cina have the symptom, " drinks roll audibly into the stomach." Cina has it in whooping-cough, but when it oc- curs in approaching paralysis of the lungs and brain, Hydrocya?iic acid is the best remedy.

Phosphorus has it in typhoidal conditions.

Cu- prum has gurgling in the oesophagus when drinking.

Next, we find Helleborus called for in meningitis when exudation has taken place.

You have present all or some of the symptoms of sensorial apathy already mentioned, showing you the depressed condi- tion of the system.

In addition you have shooting pains in the head.

If the patient is a child, it will, of course, be unable to describe this last symptom, but you will notice by the sudden screaming or crying out that it has these sharp shooting pains.

The child bores its head into the pillow; the head is hot, and the forehead wrinkled into a frown from contraction of the corrugator supercilii muscles.

There

is automatic motion of one arm and one foot.

This automatic motion may recur at regular intervals.

I remember one case in which, every three minutes, the child's head was jerked to one side and the arm thrown up over the head, it would then utter a half -pitiful cry and become quiet again.

In the Helleborus child, the eyeballs are drawn upward, so that you can scarcely see the cornea; the face be- comes flushed, and then gradually turns pale.

When offered a drink of water the child seizes the proffered glass with avidity, as though it were thirsty; this it does, not only on account of the thirst, but also because of the nervousness.

The bowels are usually constipated, or, if there is any stool, it is white, scanty, and jelly-like.

The urine is dark, scanty, and loaded with albumen.

The nearest remedy to Helleborus in tuberculous meningitis is Apis.

This drug has more of the cri encephalique and more excitement and irritability than Helleborus, which has, characteristically, sensorial de- pression.

In Apis we often find spasms of the flexors, so that the big toes are drawn upward.

This symptom has not been noticed under Helleborus.

Digitalis is very similar to Helleborus in dropsies of the brain.

Both remedies cause great depression of the sensorium, both are suited to post-scarlatinal dropsy, and both cause meningitis with effusion.

Dig- italis is to be chosen by the scanty, albuminous urine, and by its char- acteristically slow pulse, which may be even slower than the beating of the heart.

In addition to these symptoms there may be a cold sweat on the surface of the body.

Ziyicum is useful in cases where one of the exanthemata has been checked, or has not developed properly.

The child is so enervated that it has not sufficient strength to develop an eruption.

It arouses from sleep as if in fear; it has constant fidgety motion of the feet.

Other forms of dropsy in which Helleborus is indicated are general dropsy or anasarca, and especially ascites.

Here you may give Helle- borus when the trouble has arisen from post-scarlatinal nephritis.

The urine is dark and scanty, or smoky from the admixture of decomposed blood.

On standing it deposits a sediment looking like coffee-grounds.

The stool contains jelly-like mucus, and is passed with much straining.

As illustrative further of the depression of Helleborus, I may men- tion its successful employment in a case of shock from a blow on the head.

Arnica had failed, and the patient became drowsy; one pupil was larger than the other; the patient answered questions slowly as if comprehension were imperfect; one leg was dragged in walking.

The pulse was scarcely fifty per minute, and the patient in general was worse from 4 to 8 p. m.

Helleborus cured the case.