Papaver somniferum. Poppy. N.O.Papaveraceae. Opium is the dried milky juice of the green, half-ripe heads of the poppy. Tincture.
OPIUM is a very complex substance and contains a large number of alkaloids, at least eighteen in number, combined with meconic, lactic and sulphuric acids, and various fatty substances, caoutchouc, mucilage resin, albumin, glucose, and salts of ammonia, calcium and mangnesium. The principal alkaloids are morphine, codeine, papaverine, narcotine and the baine. of these, by far the most important is morphine, which, on the average, is present in opium in the proportion of 10 per cent., but varies in different specimens from 2.7 to 22.8 per cent. To its presence the action of opium is mainly due. The action of morphine is, no doubt, modified by the presence of the other alkaloids and various different substances, but only to a slight extent. The baine is the alkaloid most antagonistic to morphine, as it is a convulsant, but it is never present in a larger proportion than 0.3 per cent., so that its action is overshadowed by that of the vastly larger amount of morphine, and is only displayed in exceptional circumstances, either of special exceptional circumstances, either of special susceptibility on the part of the patient or from the specimen of opium containing much less than the average amount of morphine.
Opium must be taken as a unit, as such it has been proved, and as such it is used homoeopathically in the treatment of disease. In view, however, of its sometimes rather puzzling and contradictory action, it is well to remember that it is a complex substance made up of many elements that are not present is definitely fixed proportions.
Opium acts principally on the central nervous system, but it also affects some peripheral organs, such as the alimentary tract. It acts as a depressant, but depression is, in most cases, preceded by a brief period of excitation. This has been notably observed in the higher faculties which in some people are exalted, especially the imagination. Images are more vivid than usual, and though seems more rapid, the reaction time to flashes of light and sound is shortened, fewer errors are made in the correct association of words and sentences, and in making arithmetical computations, but at the same time the powder of reasoning and of forming correct judgments is lessened, control of thought is in abeyance, leaving the imagination to run riot, and will-power is deficient. This state of exalted imagination is soon succeeded by depression of the highest centres, and sleep follows, which may be either full of dreams or dreamless. The depression of the next highest centres occurs and the patient ceases to respond to any sound, light, or cutaneous stimulation; he feels no pain. He can, however, be aroused from the sleep, but immediately returns to it. As the dose is increased sleep becomes torpor, and finally , coma, from which he cannot be awakened. During this stage respiration is very slow, the pulse regular and moderate in frequency, the pupils are contracted to a pin point, the mouth and throat are dry, the face is purple and congested, and the skin warm and moist. As respiration becomes more depressed the face acquires a livid hue, cold perspiration collects on the forehead, the pulse is smaller and quicker, and just before the final arrest of respiration the pupils dilate widely. The heart continues to beat feebly for a short time afterwards. Death occurs from paralysis of respiration, which is slowed from the beginning, and becomes progressively slower as the dose is increased; as the rate slows the depth increases, but not sufficiently to compensate for the slowing. In late stages of poisoning Cheyne-Stokes respiration may occur.
On awaking from sleep after a moderate dose some people feel quite well, but with most there is languor, with headache, nausea, and perhaps vomiting, and also trembling and marked depression. Itching of the skin and redness may occur while the effect of the drug is passing off.
Opium depresses the cerebral motor centres but not so completely as the intellectual; the chief depressing action falls on the respiratory centres and the paths by which pain stimuli reach the consciousness.
The motor cells of the spinal cord are at first slightly stimulated and reflex excitability is exaggerated, but they are soon depressed, and reflex movements are obtained with difficulty.
The circulatory centres in the medulla are but little affected. Blood-pressure remains high, the peripheral arteries are not altered in caliber, except those of the skin, and of the head and neck, the vessels of which are dilated, rendering the face flushed and hot, and, as asphyxia comes on, purple or cyanotic. General perspiration is often observed, which on the head and body is usually warm, on the extremities cold.
Digestion.-Secretory glands are rendered less active by opium, with the exception of the sweat glands; we have consequently dry mouth and diminished gastric, intestinal and pancreatic secretions. General metabolism is slightly decreased. There are violent thirst, canine hunger without appetite, nausea and vomiting, with heaviness and pressure, and, may be, pain in the stomach. The depressing action of opium on the sympathetic nervous system causes peristalsis to be lessened or abolished, and there is obstinate constipation from torpor of the intestines. Desire for defecation is absent. Faeces and flatus accumulate in the bowels and cause great distension of the abdomen. The stools are hard, black balls, which frequently have to be extracted by the finger. Sometimes there is violent colic, with at the same time spasmodic stricture of the anus; this is probably a secondary reaction, as is also the diarrhoea which may follow recovery from a large dose, and which is common in opium smokers who are chronically poisoned by the drug.
Twitching of muscles and trembling are frequently seen in cases of chronic poisoning.
The temperature centre in the brain is less sensitive from the taking of opium, with the result that the patient’s body is not accommodated to changes of temperature so well as usual.
Skin.-Opium may produce an erythematous eruption on the skin and much itching, more noticeable with morphine than with opium. Continued use of opium leads to toleration, when sometimes enormous doses are necessary to produce any effect.
The peculiarity of the action of opium is the slightness of the stage of stimulation and the predominance of that of depression. The main influence is exerted on the highest, or latest evolved, portion of the nervous system. In man this will involve the intellectual faculties; in other mammals the excito- motor areas are chiefly affected, and in them the initial period of excitation may be accompanied by convulsive movements; in frogs the stress falls upon the spinal cord, and violent convulsions occur. In some men and in children the stage of excitation is more evident than in the average individual, and delirium, sleeplessness, muscular twitchings and even convulsive actions may be produced. Children are easily poisoned by it, and women are more easily affected than men.
Opium is excreted by the bowel, a small quantity appears in the urine and milk, and the remainder is oxidized in the liver.
Opium has for centuries been used to relieve pain and to induce sleep, especially when sleeplessness has been due to pain, and to allay excessive cough and the paroxysms of asthma. It should not be used in chest diseases when there is excessive expectoration, as its sedative effect lessens cough and leads to accumulation of mucus in the bronchial tubes, which might end in asphyxia.
Opium is used to lessen the movements of the bowels in obstruction, peritonitis, perforation, haemorrhage and other intestinal disorders, to antagonize the spasm of the intestines that occurs in lead colic and to check diarrhoea. Old cases of malaria and diabetes have been thought to benefit from its administration. It is often given either as opium or by hypodermic injection as morphia as a preliminary to general anesthesia, and when given in association with scopolamine it has been used in labour (twilight sleep), and also as an anesthetic in operations. For this latter purpose, one-sixth of a grain of morphine with one two-hundredth of a grain of scopolamine is injected one and a half hours and half an hour before an operation. Morphine is also used with scopolamine for the induction of spinal anesthesia. Combined with ipecacuanha in Dover’s powder it is used as a diaphoretic.
These are the conditions in which opium is daily administered by the orthodox school. This treatment is not homoeopathic; the results are obtained by making use of the direct action of the drug in abolishing the sensation of pain and diminishing reflex action. Its employment is from a homoeopathic point of view justifiable only to tide over an emergency, as, for example, in a case of perforation of the bowel, or in chronic cases to allay pain or produce sleep when recovery is hopeless. But in any ordinary case of pain or sleeplessness, resort to opium on the part of the physician indicates that his knowledge of homoeopathy is deficient, as these troubles can always be overcome by removing the cause, if it can be found, and by administering the similarly acting drug. The use of opium in chronic disease will very likely induce the opium habit, for the increasing tolerance of the drug demands ever increasing doses to produce the desired effect, and in addition many evils result, such as diminished appetite, impaired digestion, nausea and vomiting, constipated bowels, a general mental and moral deterioration, increased sensitiveness to pain, and, last, but not least, a masking of symptoms that renders diagnosis of the true condition of the patient more difficult.
Sensorium.-Opium is used homoeopathically not to suppress or abolish pain, but in the opposite conditions, in complaints that are marked by painlessness, inactivity and torpor, when there is absence of reaction to stimuli. Thus it is useful in conditions of stupid, comatose sleep, with rattling, stertorous breathing, such as occurs in apoplexy from effusion of blood into the pons varolii, and also in people who exhibit signs of passive cerebral congestion that threaten an attack of apoplexy, people who are somnolent after meals, have a hot, congested face, injected eyes and suffer from heavy occipital or frontal headaches, of a paralyzing kind, that begin in the morning and are so violent that the patient feels he cannot raise the head from the pillow or bear the least jar or noise, he wants to be uncovered and in the cool air. Opium is also useful in fevers accompanied by great sleepiness and intense thirst, but where there is no local inflammatory process, there is slight jerking of the limbs and the body is burning hot and perspiring. It has been used in uraemic coma.
Nervous System.-The preliminary excitability of the imagination and emotions caused by opium has its therapeutic application in the cure of complaints that arise from undue stimulation of these faculties, as in complaints from sudden joy, anger, shame, or fright. The patient is unduly affected by these causes, and cannot keep the disturbances provoked by them under control on account of his lessened powers of reason and will. Fear and fright are especially easily evoked, and it has been observed that the old opium eater is in a constant state of anxiety and fear. The patient cannot get rid of the original cause of his fear, and this remains with him in his complaints. Thus opium is the remedy for epilepsy that has originated from a fright, when the fear of the fright remains, and the cause of it is re-presented to the patient’s consciousness before each attack comes on. It is useful for the convulsive spasms of children who are frightened by the approach of strangers, or the fear of chastisement, and for the convulsions occurring in nursing babies whose mother have had a fright. There is screaming before the during the paroxysm, and the convulsions are often of a tetanic nature, with opisthotonos. Opium is indicated also in epilepsy when the fits occur during sleep, the face is purple or livid, the breathing stertorous, and the patient is liable to be suffocated by his face becoming buried in the pillow or bedclothes. It is a useful remedy for the somewhat similar mental state occurring in delirium tremens, when the countenance has a constant expression of fright, there is great loquacity, and visions of ferocious animals or other horrors are seen about the room. The mental diseases for which opium is suitable are conditions of stupor, confusion, with illusions of sight, hearing, &c., the stupor and paralysis of later stages of general paralysis of the insane, agitated melancholia and anxiety neurosis.
Digestive System.-The action of opium in diminishing peristalsis of the intestines, and lessening the secretion of their mucous membrane, provides an opportunity for one of its most frequent therapeutic applications, viz., to cure constipation. The constipation is from inactivity of the bowels, and the stools are composed of hard, round, black balls (alum., kali c., plumb.). It will also be suitable for constipation from retention of stools, caused by ileus or paresis of the intestines; there may be a sensation as if something were forced through a narrow space in the abdomen. it is effectual to relieve simple obstruction of the bowels of a paralytic nature, and has been said occasionally to overcome incarcerated umbilical or inguinal hernia.
As a secondary or reaction effect of the constipation caused by opium there may be set up a troublesome diarrhoea (vide Clarke’s “Dict. of Mat. Medorrhinum”), and this symptom has been alleviated by it, as ex. gr. in cholera infantum, when accompanied by stupor, snoring and convulsions, especially when occurring after the diarrhoeic has been suppressed. The diarrhoeic stools are whitish, pasty, frothy and cause burning in the anus, or they are black and foetid. Opium is indicated also for diarrhoea succeeding constipation or occurring intercurrently in chronic constipation, and may not only cure the diarrhoea, but the constipation as well. It is the remedy for the diarrhoea caused by physical shock or fright.
Urine.-Opium will relieve paralytic retention of urine from paralysis of the muscular fibres of the fundus of the bladder, or that due to shock or fright.
Sexual.-similarly it has been used for suppressed lochia, threatened abortion and amenorrhoea due to fright, and for uterine inertia during labour, caused by dread and fear of parturition.
Sleep.-Though states of great drowsiness are those usually requiring this remedy, yet in some persons it is useful for the reverse of this, for great sleeplessness with such acuteness of hearing that distant sounds that are usually unheard, keep them awake; they are sleepy, but cannot sleep.
Fevers.-In intermittent fevers it should be used when the cold stage predominates, when the fever occurs with great heat of the head and face and general drowsiness, the body being burning hot, though covered with a profuse sweat, which does not relieve the heat or drowsiness.
Opium vies with sulphur in its power to stir up the system to react to remedies which, though properly selected, produce no effect. It will stimulate ulcers that are painless and indolent to take on healing action. It will often bring the patient out of the comatose condition in pneumonia or typhoid, and enable him to react to the appropriate drug: the darker red the face the more it is indicated. It is suitable for children suffering from marasmus, who look wrinkled and dried up like old men.
Treatment of Acute Poisoning.-Wash out the stomach every quarter of an hour with liq. potass. permang. diluted with three times its quantity of warm water; give apomorphine as an emetic subcutaneously; flap the patient with a towel, pinch, or otherwise stimulate him; inject strong coffee into the rectum, and inject one-fiftieth of a grain of sulphate of atropine subcutaneously (this should not be repeated); oxygen inhalations may be used, and if the breathing is very difficult artificial respiration should be employed. Treatment must be kept up till all danger is over.
(1) Abnormal painlessness; absence of sensations; depression and paralysis of functional activity; no reaction.
(2) Sleepiness; stupor.
(3) Face bloated, hot, purple, or cyanotic.
(4) Pupils strongly contracted.
(5) Diminution of all secretions except sweat.
(6) Constipation from torpidity of the intestines. Retention of urine from paralysis of the bladder.
(7) Exalted sensitiveness, with fear; exalted and uncontrolled imagination.
(8) Ailments from fright, and the fear of the fright remains; epilepsy.
(9) Respiration irregular, slow and stertorous; cerebral apoplexy.
(10) Persons insensitive to well-indicated remedies.
(11) Emaciated; withered, wrinkled appearance.
(12) Children; old persons; drinkers.
(13) Persons of light hair, lax muscles and want of bodily irritability.
From heat, brandy, wine, while perspiring, during and after sleep, anxiety, fear, during pregnancy.
From coffee, vomiting (except trembling), uncovering the head (head symptoms), cold air (laboured breathing), physical stimulation if not exhausting.