Opium And Morphine





=Opium.=--The inspissated juice of the unripe capsules of the Papaver

somniferum. As a poison it is generally taken in the form of the

tincture (laudanum), which contains 1 grain opium in 15 minims. Opium is

found in almost all so-called 'soothing syrups' for children, and in

Godfrey's cordial, Dalby's carminative, and Collis Browne's chlorodyne.

Laudanum contains 1 per cent. morphine, and it, along with all other

preparations (e.g., paregoric) which contain 1 or more per cent.

morphine, are included in Part I. of the Schedule of Poisons, and come

under the Dangerous Drugs Regulations.



The most important active principles of opium are the alkaloids morphine

and codeine.



Symptoms usually commence in from twenty to thirty minutes: Giddiness,

drowsiness and stupor, followed by insensibility. Patient seems asleep;

may be roused by loud noise, but quickly relapses. Breathing slow and

stertorous, pulse weak, countenance livid. As coma increases, pulse

becomes slower and fuller. The pupils are contracted, even to a pin's

point; they are insensible to the action of light. In deep, natural

sleep the eyes are turned upwards and the pupils contracted. Bowels

confined, skin cold and livid or bathed in sweat. Temperature subnormal.

Nausea and vomiting are sometimes present. Remissions are not

infrequent, the patient appearing about to recover and then relapsing.

Hæmorrhage into the pons may give rise to contracted pupils. Young

children and infants are specially susceptible to the poison.



Diagnosis is not always easy, and one has to differentiate poisoning

from cerebral apoplexy. In the latter one can seldom rouse the

patient, the pupils are often unequal, and hemiplegia is present. In

compression of the brain, fracture of the skull may be present,

subconjunctival hæmorrhages may be seen, the pupils are unequal and

dilated, and the paralysis increases. In uræmic or diabetic coma the

urine must be examined.



The habitual use of opium is not uncommon, and opium-eaters are able to

take enormous quantities of the drug. The opium-eater may be known by

his attenuated body, withered yellow countenance, stooping posture, and

glassy, sunken eyes.



Post-Mortem Appearances.--Not characteristic. Turgescence of cerebral

vessels. There may be effusion under arachnoid, into ventricles, at base

of the brain, and around the cord. Rarely extravasation of blood.

Stomach and intestines usually healthy. Lungs gorged, skin livid.



Fatal Period.--Usually nine to twelve hours; but in many cases, if

life is prolonged for eight hours, recovery takes place.



Fatal Dose.--Four grains of opium is the smallest fatal dose in an

adult, or one drachm of laudanum; children are proportionately much more

susceptible to the action of opium than adults.



Treatment.--Stomach-tube, emetics, strong coffee or tea, ammonia to

nostrils. Give 10 grains of permanganate of potassium in a pint of water

acidulated with sulphuric acid, and repeat the dose every half hour.

Belladonna by mouth, or atropine hypodermically. Patient must be kept

roused by dashing cold water over him, flagellating with a wet towel,

walking about, etc. In conditions of collapse, however, this treatment

must not be continued, but everything should be done to preserve the

strength. Treatment must be continued as long as life remains.



Method of Extraction from the Stomach.--Opium itself cannot be

directly detected, but we test for morphine and meconic acid. These may

be separated from organic mixtures thus: Boil the organic matter with

distilled water, spirit, and acetic acid; filter, and to the fluid

passed through add acetate of lead till precipitate ceases. Filter.

Acetate of morphine passes through, and meconate of lead remains. The

solution of acetate of morphine may be freed from excess of lead by

hydrogen sulphide and filtered, excess of hydrogen sulphide driven off

by heat, and tests applied. Put the meconate of lead with water into a

beaker and pass hydrogen sulphide; sulphide of lead is formed, and

meconic acid set free. Filter. Concentrate the solution of meconic acid,

allow a portion to crystallize, and apply tests.



Tests.--Morphine and its acetate give an orange-red colour with nitric

acid, becoming brighter on standing; decompose iodic acid, setting free

iodine; with perchloride of iron, gives a rich indigo-blue; with

bichromate of potassium, a green turning to brown. When the alkaloid is

heated in a watchglass with a drop of strong sulphuric acid until the

acid begins to fume, and is then allowed to get quite cold, a drop of

nitric acid produces a brilliant red colour. The iodic acid test is very

delicate, but requires great care, and may be used in the presence of

organic matter.



Meconic acid gives a blood-red colour with perchloride of iron, not

discharged by corrosive sublimate or chloride of gold. The similar

colour produced by sulpho-cyanide of potassium and perchloride of iron

is discharged by chloride of gold and corrosive sublimate.



=Morphine Habit.=--Individuals who have acquired this habit take the

drug usually by hypodermic injection. The victim suffers from nausea and

vomiting, and becomes so mentally debilitated that asylum treatment is

required.





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