Appendix. CLASS XIII. Order I. POLYANDRIA MONOGYNIA. 160. PAPAVER SOMNIFERUM. Opium.

114 Opium,

115

General cf

m.

As the account of this important remedy given in the article Botany may not be deemed sufficiently satisfactory by our medical readers, and as in the Materia Medica we were so much confined that we could only refer to the best writers that have treated on opium, we shall here supply that deficiency, by giving a comprehensive view of the effects of opium; of the discoveries that have been made by late chemical analyses respecting the nature of its narcotic principle; shall point out the general means by which the ill effects which sometimes attend the exhibition of this medicine may be obviated, and enumerate those articles of the Materia Medica which may be most conveniently employed as substitutes for a drug now become so scarce and expensive.

Perhaps no article of the Materia Medica ranks higher in point either of antiquity or efficacy than opium. Its peculiar properties and mode of operation have, how ever, been long a subject of debate, both among theoretical and practical writers. The place assigned to it in systematic arrangement has been continually fluctuating; Cullen and his followers considering it as one of the most powerful sedatives which we possess, while Brown, Darwin, and the advocates for their doctrines, as strenuously contend that it ought to be ranked amongst the most active and diffusible stimuli. In fact, the parties engaged in this controversy appear chiefly to differ about words, and probably they are both partly right and partly wrong.

They agree that the effects of opium are similar to those of wine and alcohol, liquors which are generally, though indeed not universally, accounted stimulants. If opium produces similar effects with these, we see no good reason why it should not be arranged in the same class. All these substances may indeed be considered as both stimulant and sedative, according as we advert to their primary or secondary effects. If by a stimulant be meant something which increases the force and frequency of action in the muscular fibres, and possesses the power of sustaining or increasing the vital powers, which is, we believe, the generally received definition, we can surely not refuse this character to alcohol, and its modifications. Who that has ever felt the cheering influence of wine, that has experienced the exhilaration, the flow of spirits, and the energy of action, which are the usual effects of the bottle, can refuse to acknowledge the effects of the stimulating powers of this too fascinating beverage. Again, if by a sedative we are to understand something which diminishes the force and vigour of muscular action, and depresses all the vital energies, every one who has felt the effects consequent to a too free libation at the shrine of Bacchus, will readily admit that wine and alcohol are, in an eminent degree, possessed of sedative powers. Now, that opium resembles alcohol in both these circumstances, is generally admitted.

When a moderate quantity of opium (we mean not ects of opi- more than two grains), is received into the stomach, it excites there a gentle warmth, which is gradually diffu sed over the whole body, attended with an itching of the skin, and usually followed by an increase of perspiration. The pulsation of the heart and arteries is at first rendered fuller and more frequent, and there is commonly a heat and flushing of the face; the eyes appear enliven

ed, and the spirits are exhilarated. Pain is alleviated, Appendix. and all care for the time forgotten. The effects of this substance on those who swallow it as a substitute for wine, as is usual in the east, are familiar to most of our readers, and sufficiently prove its stimulating effect. Similar proofs appear to have been exhibited during the present war, among Europeans. We are told that the French soldiers are plied indifferently with opium or brandy, in order to increase their courage and ferocity; and we have been credibly informed, that some of the most celebrated performers on the London stage, particularly in tragic parts, which require peculiar self-command, or energy of expression, are accustomed to take doses of opium proportioned to the circumstances of the character which they are to perform.

The excretion of urine is sometimes increased; but as an increase of absortion is a usual consequence of opium, other excretions, except, as we have said, the perspiration, appear to be diminished. Opium also acts as a powerful stimulus to the genital organs, and excites the venereal appetite. It is said that on examining the bodies of Turks slain in battle, the penis has been often found in a state of erection, even in old men *.

* Murray ! Apparat. Medicam.

After these effects have continued for a time, appearances of a different nature present themselves. At first. tom. ii p. a languor and lassitude not unpleasing come on, and are 282. soon followed by yawning and a strong propensity to sleep. If the quantity taken has been considerable (above two gr.), the previous symptoms of excitement are more remarkable, but they generally continue for a shorter time, and are followed by a proportional depression. Considerable nausea supervenes, and sometimes a severe vomiting is excited, by which great part of the opium is expelled from the stomach. But if this should fail to take place, and often when it has to a partial degree appeared, a heavy stupor comes on, attended with giddiness and headach; the breathing becomes difficult and laborious; the person falls into a profound sleep, from which he is roused with great difficulty, and into which, if left to himself, he speedily relapses; the face becomes pale, the lips livid, the extremities cold, universal torpor seizes the limbs, and is followed by convulsions and fatal apoplexy.

116

On examining the bodies of those animals which have Appearan- fallen victims to opium, the stomach is found distended, ces on dis...” . and containing frothy mucus, its internal coat in a state section. of inflammation, and sometimes the pyloris contracted. The vessels of the brain are exceedingly turgid, and commonly an effusion of blood is found to have taken place.

When a person awakes after having taken opium, he usually finds himself heavy and giddy, and not unfrequently complains of headach and dimness of sight; his bowels are costive, and his appetite defective. Some people, so far from being soothed and lulled to sleep by... opium, are rendered exceedingly irritable and restless others, if they are made to sleep by the influence of this medicine, are harassed with frightful dreams, and awake unrefreshed.

Effects similar to what we have described arise from opium when injected into the rectum; but they require a larger dose. When this substance is applied to the eye, the urethra, or other sensible parts, it excites pain and redness, which, however, do not long continue. * Crumpe's « When merely applied to the surface of the body, while Enquiry, the 23.

Appendix. the cuticle is entire, it produces no change; but when the tincture of opium, or opium in fine powder, mixed with an oily substance, is rubbed on the skin, pain is alleviated, sleep induced, delirium assuaged, and other sedative effycts brought on; but the stimulating effects of the medicine are, in this way, said to be less apparent

117 Ill effects of opium.

Analysis of opium.

The ill effects which sometimes attend the exhibition of opium, may arise, either directly from its stimulating power, or from consequent exhaustion.

I. The ill effects which appear to be the immediate consequence of the stimulus are, excitement, increased absorption, and determination of the blood to the head. These effects render it an improper remedy in the early stages of inflammatory diseases, particularly in phrenitis, pneumonia, catarrh, and dysentery By increasing excitement and determining to the head, opium is improper in phrenitis; and it is hurtful in the other diseases by increasing absorption, and hence lessening expectoration, and producing costiveness. In some cases of inflammation, however, where increased perspiration is desirable, as in rheumatism, if the medicine be so managed as to produce full sweating in a short time after exhibition, it may be employed with advantage.

II. The ill effects which arise from the secondary circumstances following the administration of opium, arè chiefly headach, general debility, tremors, spasms, paralysis, and hypochondriasis. Of course, in cases where these symptoms and diseases are to be apprehended, it must be employed with considerable caution.

Opium has been analysed by several chemists, especially by Gren, Bucholtz, Josse, Proust, Dr Duncan junior, and very lately by Derosne. "By evaporating a watery solution of opium to the consistence of a syrup, Derosne obtained a precipitate, which was increased by diluting it with water. He dissolved this in hot alcohol, from which it again separated on cooling. When purified by repeated solutions, it crystallized in rectangular prisms with rhomboidal bases, had no taste or smell, was insoluble in cold water, and soluble in 400 parts of boiling water, did not affect vegetable blues, was soluble in 24 parts boiling alcohol and 110 cold; soluble in hot ether and volatile oils, and separated from them as they cooled; very soluble in all acids, and * Duncan's highly narcotic *. Dispensat. 4th edit. P. 329.

119 Means of

um.

A considerable proportion of the substance of opium is insoluble both in water and alcohol; and it is remarkable that the insoluble part is very different in Turkey opium from what it is in that which comes from the East Indies; being in the former a ductile, plastic, coherent mass, in the latter an incoherent, powdery matter, diffusible in water. According to Dr Duncan, the active constituent of opium appears to be of a volatile nature; and as this must be carried off by boiling or distillation, the usual processes for purifying opium tend to diminish its medical effects.

The ill effects of opium are to be obviated or counobviating the il. ef teracted by regulating the dose according to the effect fects of opi- intended to be produced; by the mode of administration, whether internally, or by friction, or by combining with it some correcting substance which has the effect of counteracting its unpleasant properties, such as lemon juice, ammonia, tartrate of antimony and potash, submuriate of mercury, or aromatics. The languor and

general debility feit after having taken opium, are best Appendix. relieved by wine and exercise.

When a person has swallowed such a quantity of opium as there is reason to fear will prove fatal, if its effects are not prevented or counteracted, it is proper to exhibit an emetic as soon as convenient, in order to evacuate from the stomach as much of the opium as possible. With this view, a scruple or half a dram of sulphate of zinc dissolved in a little water, is to be given, and the action of vomiting promoted several times by proper diluting liquors. We should then administer lemon juice in considerable quantities; and i the stupor be very great, all methods are to be employed for rousing the patient, and obliging him to exert himself in moving about. If the more alarming symptoms are made to yield, we should give wine, ether, or other stimulants, in moderate doses, still taking care to keep alive the attention of the patient. Strong coffee has been highly recommended in these cases.

120

As opium is now become a very expensive article, it Substitutes is of consequence to consider what other remedies that for opi are likely to produce the same good effects may be substituted for it. Several of the narcotic vegetables have been employed for this purpose, especially luctuca virosa, conium maculatum or hemlock, datura strumonium or thorn apple, atropa belladonna or deadly nightshade, humulus lupulus or hop, and hyoscyamus niger or henOf these the two last seem to be best adapted to this purpose.

bane.

Preparation d. EXTRACTUM OPII AQUOSUM, Dub.

121

The Dublin College have made some alteration in Watery extheir mode of preparing this extract, though they pre-tract of be triturated with hot water for ten minutes, when the serve the same proportions, They direct the opium to opin water is to be poured off, a fresh quantity added, and the trituration continued for the same period. This trituration to be repeated a third time. Then all the liquors are to be mixed together, suffered to stand in an open vessel for two days, strained through linen, and then inspissated to the consistence of an extract.

Tincture of digitalis.

125

Order. 2 ANGIOSPERMIA.

180. DIGITALIS PURPUREA. Preparation b. TINCTURA DIGITALIS PURPUREÆ.

This medicine is now introduced into the Dublin Pharmacopoeia, and is prepared in the same manner as directed by the Edinburgh college.

CLASS XIX. Order 2. SYNGENESIA POLYGAMIA SUPERFLUA.

216. ANTHEMIS NOBILIS.

Compound Preparation a*. DECOCTUM CHAMEMÆLI COMPOSIdecoction of TUM, Dub. Compound decoction of chamomile.

ehamomile.

126 Tincture of ralis.

127 Calefacient laster.

128

Compound

CLASS XXI. Order 8. MONOECIA POLYANDRIA. 226. QUERCUS CERRIS. Galls.

Preparation a. TINCTURA GALLARUM, Dub. Tincture of galls.

Prepared by digesting four ounces of powdered galls in two pints of proof spirit for seven days, and straining.

A strong solution of the astringent principle of galls. Order 10. MONADELPHIA.

228. PINUS ABIES. Burgundy pitch. Preparation b. EMPLASTRUM CALEFACIENS, Dub. Calefacient plaster.

A warm stimulating plaster, made by melting together, with a moderate heat, seven parts of Burgundy pitch and one part of ointment of cantharides.

Order 12. SYNGENESIA.

236. CUCUMIS COLOCYNTHIS.

Preparation b. PILULE COLOCYNTHIDISCOMPOSITÆ, ills of co- Dub. Compound pills of colocynth. >cynth.

129 avine intment.

These are prepared by beating together half an ounce of the pith of colocynth, half an ounce of hepatic aloes, and the same quantity of scammony, all in powder, with two drams of Spanish soap, a dram of cloves, and a sufficient quantity of simple syrup, to form a mass for pills. This is a strong cathartic, and may be given in a dose of 10 or 15 grains.

244. JUNIPERUS SABINA.

a. PULVIS QUERCUS MARINE, Dub. Powder of sea. Powder of wrack. sea-wrack,

This is prepared by drying and cleaning any quantity of yellow bladder wrack, gathered while in fruit; then exposing it to the fire in an iron pot or crucible, covered with a perforated lid, till the volatile matters have evaporated, and the mass becomes of a dull red colour. This is to be reduced to a very fine powder, and kept in close vessels.

The medical virtues of this preparation, if it have any, are similar to those of burnt sponge, and it given in the same dose.

Order 3. ALGE.

may be

132

256. LICHEN ISLANDICUS, N° 799. Preparation a. DECOCTUM LICHENIS ISLANDICI, Decoction Dub. Decoction of Iceland liverwort.

This is prepared by digesting half an ounce of Iceland' vessel, then boiling for 15 minutes, and straining off liverwort in a pint of hot water for two hours, in a close the liquor while hot.

CHAP. III. Mineral Substances. SECT. 2. Inflammable Substances. 260. SULPHUR SUBLIMATUM.

of Iceland liverwort.

Preparation. AQUA SULPHURETI AMMONIE, Dub. Water of Water of sulphuret of ammonia.

This is prepared by shaking four ounces of freshburnt lime in an earthen vessel, which is to be kept covered till the lime has fallen into powder, and become cool; when there are to be added four ounces of powsulphur mixed together, avoiding the vapours. The dered muriate of ammonia, and two ounces of sublimed whole is now to be put into a retort, and distilled with a sudden and pretty strong heat, and the liquor that comes over is to be kept in a phial well closed with a

sulphuret of ammonia.

135

Preparation g. ATHER NITROSUs, Dub. Nitrous Nitrous

ether.

Prepared by pouring gradually, and in different portions, upon a pound and a half of nitre, dried and coarsely powdered, in a tubulated retort, placed in a bath of cold U u water,

ether.

Appendix. so as to reduce the mixture to the consistence of syrup,

riate of

mercury.

till the whole of the mercury disappears; then still continuing the trituration, adding first a dram of magnesia, and when all are well mixed, a pint of hot water, and shaking the mixture. When the sediment has completely subsided, the liquor is to be poured off, and the washing twice repeated, so as to dissolve the whole of the manna. To the sediment, still moist, are to be added three drams more of magnesia, and the compound is to be dried on blotting paper.

This preparation is similar in its medical effects to the hydrargyrus cum creta, described in MATERIA MEDICA, N 914.

145 Ammoniat- Preparations. SUBMURIAS HYDRARGYRI AMMOed submu- NIATUM. Dub. Ammoniated submuriate of mercury. Prepared by adding to the liquor from which precipitated submuriate of mercury has been obtained, a quantity of caustic water of ammonia, washing the precipitate with cold distilled water, and drying on blotting paper. The same with the calx hydrargyri alba, London.

148

Preparation f. TINCTURA MURIATIS FERRI CUM Tincture of OXIDO RUBRO, Dub. Tincture of muriate of iron with muriate of red oxide. iron with red cxides

Prepared by digesting an ounce of red oxide of iron with four ounces by measure of muriatic acid for 24 hours, then boiling for half an hour, evaporating the filtered liquor to the consistence of syrup, and when cold, adding rectified spirit of wine, with frequent agitation, till the tincture acquires the specific gravity of 1050.

A modification of the tincture of muriated iron described under MATERIA MEDICA, N° 965, and is employed in similar cases.

The above appear to be the most material changes made in the new edition of the Dublin Pharmacopoeia. A few articles of less consequence are omitted, and the new names of others will be seen in the following Table. In this Table we have followed the alphabetical order of the last Edinburgh Pharmacopoeia, and in the third column we have caused the London names to be printed in Italics, leaving a space above each for the insertion of such new names as may occur in the