V* SMITH hti IMULiURAL DIScJERTAT 01a JrlU.-i j E3ftSMI5£ s^ Columbia JBni\>tuitp College of iPfrpstciang ano Hmrgeoits Htbrarp Digitized by the Internet Archive in 2011 with funding from Open Knowledge Commons http://www.archive.org/details/inauguraldissertOOsmit v*A<> ^\ AVo-^Cr- J * AN ON OPIUM, MBRACING ITS HISTORY, CHEMICAL ANALYSIS, AND USE AND ABUSE AS A MEDICINE, 8 Wi£ut not much of the peculiar, narcotic, heavy odour of the rurkey opium. Its taste is more bitter and nauseous, but t has less acrimony. Its sensible qualities resemble those * Beaume, however, asserts that the odorous part of the Opium is an oil. 12 of Turkey Opium, except that its colour is blacker ; its texture less plastic. It is more friable than that of Turkey, and when tritu- rated with water, no insoluble plastic residuum is left, but it is altogether taken up. Eight parts in twelve being dissolved, and the remainder, suspended in the fluid. An aqueous solution of this species, gives a deeper brown co- lour than the Turkey. Like Turkey Opium, it is alike precipitated from its solutions by the agents mentioned under that head. Exceptions. — A solution of the Acetate of Barytes does not alter the solutions of Turkey opium, but produces a copious precipitate with those of the East India. Oxalic acid also precipitates both, but the latter more copiously. Impurities. — The purest opium is that which the Asia- tics call Opium in Tears ; and which is the pure concrete juice of the poppy. But much of the opium of commerce is said to be increased in bulk, by the addition of an aque- ous extract of the plant, procured by evaporating a de- coction. The fibrous impurities usually found in opium, probably result from a slovenly manner of its preparation; though often, from a fraudulent and intentional adultera- tion, various inert substances being mixed with it for the purpose of increasing its amount. Signs of Impurity. — Opium is to be regarded as spu- rious when it is either very soft, greasy, light, or very fri- able ; or is of an intensely black colour. If it has a weak, or empyreumatic odour; a slightly bitter, or acrid, or a sweetish taste, or the quality of marking a brown, or black continuous streak, when drawn across paper, it is to be suspected as not genuine. CHEMICAL ANALYSIS. Many chemical analyses of opium have been made by different experimenters. Among the latest and most splendid are those of Derosne, Sertuerner, and Robiquet. From the experiments of these Chemists, we find the com- ponent parts of opium to be Extractive Matter, Mucilage, Foecula, Resin, Fixed Oil, 13 Coauichottc, a Vegeto- Animal Substance, And Gluten, &c. Besides these, it is found to contain two proximate prin- ciples, on which its medicinal properties chiefly depend. The one of these is an alkaline body, termed Morphia ; the other, a substance which does not appear to possess the characters of an alkali, and has received the name of Narcotin. Morphia exists in a state of union with a pecu- liar acid, which has been called the Meconic acid. This acid appears to exist in such a proportion as to form a Super-Salt, or a Super-Meconate of Morphia.* Derosne was the first Chemist who obtained a crystalline substance from opium, which he announced* in 1803, but did not describe its nature or properties. In the following year, Seguin, discovered another crystalline body in opium ; he announced it, but never hinted at its alkaline nature. About the same time, that Derosne and Seguin were en- gaged in these researches, Sertuerner, at Eimbeck in Hanover, had also obtained these crystalline bodies; but it was not until the year 1817, that even he first, unequivo- cally proclaimed the existence of the new vegetable al- kali, and assigned to it the narcotic powers, peculiar to the operation of opium. He thus named it Morphia, and it appears to be the same as the salt of Seguin. The salt of Derosne now denominated Narcotine, is quite a different principle, although it was constantly mis- taken for one of the Salts of Morphia; until M. Robiquet pointed out its distinctive characters. MORPHIA, OR MORPHINE. Various processes have been recommended for obtaining Morphia, by Sertuerner, Robiquet, Choulant, and Thomp- son ; but one of the simplest is that recommended by Mr. Brand, as follows : — " Powdered opium triturated into a paste with dilute acetic acid ; pour caustic ammonia into the filtered solu- tion, and evaporate." During the evaporation, a brown- ish substance separates, which by digestion in cold alcohol, becomes nearly colourless, and is impure Morphia. * " Dr. Paris thinks that the state of combination in which they exist, modifies the action of Opium." — Pharma. t Annales de Chimie. T. xiv. 14 Qualities. — Pure Morphia is a crystalline, transparent substance; insoluble in cold, and only sparingly soluble in boiling water. It is soluble in from 4U to 45 parts of cold, but to a greater extent in hot alcohol, and in eight parts of ether, and in the oils. * These solutions are intensely bit- ter, and turn the syrup of violets green. It has all the characters of an alkali, in combining with acids to form salts ; it decomposes the solutions of metallic salts, precipi- tating their oxides, owing to its greater affinity for the acids with which they are combined. It fuses at a moder- ate heat, and acquires the aspect of melted sulphur. Morphia does not form soap with an oxidized oil. A strong heat decomposes it, and carbonate of ammonia, oil, and charcoal result. Morphia burns readily in atmospheric air. By nitric acid it is turned red, which therefore affords a test of its presence. MECONIC ACID. This acid, in its native state, is in combination with Mor- phia. It may be obtained from opium by the action of weak sulphuric acid on the magnesian residuum left after the action of the hot alcohol, in the process above described for extracting Morphia. To this solution, if we now add muriate of baryta, a precipitate, consisting of the sulphate and meconate of ba- ryta, will be formed. Digest this with hot, and very weak sulphuric acid, then filter the liquor, and by reducing sufficiently the quantity by evaporation, the meconic acid will shoot, even before cooling, into coloured crystals. " These are to be washed with a little water, dried, and sublimed in a flask." Qualities. — This acid is very soluble, both in alcohol and in water. The solutions are sour to the taste, and convert vegetable blues to a red colour. It combines with alkalies and forms Meconates, several of which crystallize. " Its distinguishing character is, that it produces an in- tensely red colour in solutions of iron oxidized ad maxi- mum." Neither this acid, nor the salts which it forms with potassa, sodae, or lime, have much medicinal action in the human system. * Paris's Chemistry, p. 425. 15 NARCOTIN, OR DEROSNE'S SALT. Qualities. — This also is a proximate principle of opium ; usually obtained in white, silky needles, insipid, and ino- dorous. It is neither acid, nor alkaline ; it does not form salts with acids, which dissolve it simply. It is also dis- solved by the oils, and ethers ; in water, on the contrary, it is almost insoluble, requiring 100 parts of cold alcohol, and 24 of this menstruum when boiling, to dissolve it. According to Dr. Bally's experiments, this substance has little action on the animal economy. Orfila, on the con- trary, believes that it exercises a stupifying and deleterious influence, when taken into the system ; while Dr. Magen- die thinks it acts as a powerful excitant. Narcotine, the subject of such various and contradictory opinions, is not used as a remedy ; it is obtained by digest- ing opium in ether. Besides the Meconic, opium would appear, also, to con- tain another acid, which is not volatile, and which has no peculiar effects upon the salts of iron ; — designated by Ro- binet, Codeic Acid. Forms of Exhibition. — Opium is given in subtance, or under the form of tincture. A grain of solid opium is an ordinary dose, to be varied according to circumstances. If opium, in powder, be made into pills with resinous sub- stances, it will be more gradual in its operation. If with mucilage, or syrup, it will be more speedy. When a very prompt effect is desired, laudanum is preferable to undis- solved opium. An aqueous infusion, made by infusing powdered opium in boiling water, will often operate, with- out producing that distressing nausea and headache, which so frequently follow the use of this substance. But there is a difficulty in regulating its strength ; hence an objection to the use of opium in this form. If the stomach readily rejects opium, it may be thrown into the rectum, as an enema. In this case, double the quantity should be employed. Opiate injections, or suppositories, are also indicated when the rectum, or parts in its vicinity, are the seat of the complaint, as in dysentery and stranguary. In the above forms, it also affords relief in spasmodic affections of the 16 bowels, and in painful diseases of the prostate gland, or bladder. In combination, the medical powers of opium are greatly multiplied, so that there is scarcely a disease, in which it may not, during some of its stages, be rendered useful. OFFICINAL PREPARATIONS OF OPIUM. Among the officinal preparations, it may not be impro- per to mention a few of the leading ones. For it would almost be an endless undertaking to enumerate them all ; opium being " the quack's sheet anchor." Opium purificatum. Pilulae Opii. Piluhe saponis cum Opio. Pulvis cornu usti cum Opio. Tinctura Opii. Confectio Opii. Tinctura Camphorse Composita. Pulvis Ipecacuanha? Compositus. But of all the preparations of opium, none are more universally or commonly used, than the simple laudanum, the black drop, or acetate of opium ; the Dover's Powder, and Paregoric Elixir. Neither Morphia, nor any of its salts, have yet come into very general use in the practice of physicians, at least, on this side the Atlantic. This may be partly owing to the high price which it continues to command, and partly, to an adherence to the old established maxim, never to aban- don an article whose virtues are known, and universally acknowledged, for one not yet proved, and but just intro- duced. When Morphia is used, it is in form of the sulphate, ci- trate, and the acetate, and what is usually called the Ano- dyne Drops. These may be given either in solution, or in syrup. One of the more common forms is, the solution of the acetate of Morphine. Besides these forms, the ace- tate and sulphate may be given in form of pills ; in electu- ary ; in draughts, or in mixture. The dose being from one fourth of a grain to a grain in twenty-four hours. Incompatibles. — Bi-chloride of Mercury, Acetate of Lead, the Alkalies, most of the Metallic Oxides, Infusion of Galls, Nitrate of Silver, and yellow Cinchona. When our object is to obtain the sedative efjfecl of opium, it should not be combined with stimulants. Antidotes. — To persons poisoned by a large quantity of opium, a powerful emetic of sulphate of zinc, or the sulphate of copper, should immediately be given, propor- tioning the amount to the emergency of the case, and re- peated at short intervals till vomiting is produced. The vegetable acids, viz. vinegar and lemon juice, should be administered after the stomach had been thoroughly emptied by the ordinary means, otherwise, such a practice would accelerate the solution and activity of the opium. Strong coffee and tea may be freely administered ; also, cordial stimulants, which are not of the narcotic kind, as ammonia, musk, and the aromatics. The patient should be kept erect, and moved frequently, and the surface of the body excited by friction, rubefacients, or blisters. Jf the patient be comatose, venesection is proper. MEDICINAL EFFECTS. By whom opium was first introduced, and particularly retained as an article of the materia medica, nothing certain is known ; but that it was from the earliest times, valued as a remedial agent of no small power, is al- lowed by all. As a medicinal agent, it has been traced to the time of Diagoras, who was cotemporary, or nearly so with Hippocrates; but though it was thus early pre- scribed in the treatment of disease, its medicinal qualities and intrinsic worth, as an article of the materia medica, were imperfectly understood, and destined to be realized, and properly appreciated, only by the physician of modern times. In works on Pharmacy, opium is ranked under the head )f Narcotics, from vccquoo), I stupify. It is also called 4.nodyne, from a priv. and ddvvrj, to allay pain. And Se- dative, from another word, vtzvoco, I put to sleep. This medicine has given rise to much controversy, re- specting its modus operandi. Dr. Cullen contended that t was always sedative, and that the resistance of the vis ritce, occasioned it to act as a stimulant whenever it did so ; while Brown and his followers, supported that its effects on the living svstem were alwavs that of a sti- 18 umlaut. The fact appears to be, that it acts primarily by stimulating the nervous system, while its secondary ef- fect is a diminution of nervous energy, producing torpor, insensibility and sleep. Administered in a moderate dose to a man in health, it produces within a short time, gene- rally from five to twenty minutes, a marked effect oo the brain and nervous system. There is an increase of the animal spirits, or a tranquil confidence and serenity of mind ; which is afterwards followed by a tendency to sleep. It diminishes the sensibility of the animal system ; and the body becomes less susceptible of annoyance, pain, or disturbance from external causes ; in mode- rate doses, it lessens irritability in the various organs and textures, so that their functions are manifestly re- tarded. Primarily it operates as a powerful and very diffusible stimulus ; but this primary operation is followed by narcotic and sedative effects, in a degree much greater than could be expected from the previous excitement it induces. It is not known to produce any change in the composition of the blood, but increases the aqueous exhalations from the lungs. * In moderate doses, it increases the fulness, the force, and the frequency of the pulse ; augments the heat of the body ; quickens respiration, and invigorates both the corporeal and mental functions. But, by degrees, these effects are succeeded by languor, lassitude, and sleep ; and, in many instances, headache, sickness, thirst, tremors, and other symptoms of debility such as usually follow the excessive use of ardent spirits, supervene. It acts on the different tissues, by lessening their natural secretions and excretions, excepting the secretion from the skin, which it promotes. " Its operation is often attended with an itch- ing, or sense of pricking of the skin, which is sometimes terminated by a species of miliary eruption." All the chylopoetic viscera are rendered slower in the perform- ance of their functions ; f the appetite is less keen, ami digestion slower ; the peristaltic motion is lessened ; the urine is diminished ; and the mucous of the throat and fauces rendered thick and more sparing. It relaxes mus- cular action, and in very large doses, the primary excite- * Buidach. Arzneymittellehre, b. iii. s. 491. t The foeces of persons, says Dr, Paris, after the use of opium, is often clay-coloured 19 ment is scarcely apparent ; the pulse seems to be at once diminished ; drowsiness and stupor immediately come on ; and are followed by delirium, sighing, deep, and stertorous breathing, cold sweats, convulsions, and death. When opium is introduced into the cavity of the perito- neum, it speedily produces convulsions and death. Ac- cording to Orfila, " the effects of opium are, in general, more decided when it is injected in glysters, than when it has been introduced into the stomach." This, Dr. Eberle supposes to be owing to its not having been primarily subjected to the action of the digestive power. It acts, according to Nysten and Orfila, more energetically when injected into the cellular texture of the body.* The same writer states also, that this article does not de- stroy the contractility of the muscles to which it is ap- plied, and that a heart will continue to contract for a considerable time when plunged into a solution of opium. But Wilson Philip contradicts this, and states that although he found opium, when applied to the exter- nal surface of the heart and alimentary canal, to produce no sensible effect on their muscular power ; yet, when brought in contact with their internal surface, it produces '" the same effect, as when directly applied to the muscular fibres themselves, immediately, unless the quantity be ex- tremely small, impairing their power, and destroying it instantly, if the quantity be considerable." Dr. Chapman asserts that " the practice of applying opium as an embrocation is altogether delusive, and de- serves no attention." But this opinion appears to be un- founded ; for the same gentleman allows that the use of it as a " local remedy to assuage pain, may be effica- cious." Wow if he at all allows, that, as a local remedy, it may allay pain, he allows in fact that it does so through the medium of the skin ; end by acceding this point, which he does, in fact, he admits at once, that this re- medy so applied, is efficacious by acting on the sentient extremities of the part to which such " local remedy," or " embrocations" are applied. And if it does this on one part, there is no just reason to believe it incapable of do- ing so when applied to any other part of the surface. In combination with vegetable acids, the narcotic quail 18 Qrfila'g 1 System of Toxicology, p 250 r 20 ties of opium are increased in consequence of the forma- tion of soluble salts. PRACTICAL REMARKS ON THE USE OF OPIUM. Opium is employed in the treatment of numerous dis- eases : but my subject being already too much length- ened, I must defer mentioning many in which it is usually prescribed. A few remarks on the judicious use of this article in the treatment of diseases generally, may suffice on this head. There is scarcely a disease in which opium may not, during some of its stages, be brought to bear, by the judi- cious physician, with advantage : it has been used with the happiest effects in the phlegmasial diseases, after free venesection. By the late Dr. Post, it was a practice ; and iri such cases, the dose is recommended to be particularly heroic. The experienced Armstrong, and some others, also speak of its use in inflammations. But as a general rule, inflammations of passages bear opium better than those of circumscribed cavities, and those of mucous membranes better than those of serous, or cellular textures ; inflammations of the latter kind be- come susceptible of benefit from opium, only in their secondary stages, and after depletion has been carried to an extent which renders it no longer admissible. In the early stages of simple fevers, opium almost al- ways does harm ; it can rarely be given with prudence in any case of strong arterial excitement, and its use is equally improper when there exists a determination to the head ; yet, after full venesection, there is not the smallest danger in its administration, especially if combined with ca- lomel.* All persons are not equally susceptible of the influence of opium ; nor the same persons in all situations. The robust bear more than the weak and delicate, and persons long addioted to its use, more than the unaccus- * Med. CMrurg. vol. iii. p. 223.-^Scott on Cystitis. 21 tomed, and all its effects are modified by the actual con- dition of the system at the time opium is exhibited. ABUSE, etc. Opium should never be exhibited simply to rouse the spirits, to awaken the fancy, or to give a temporary ex- ertion to brilliant wit, this practice is most deleterious. Neither should it ever be used, except to obviate some symptoms of disease, or for such other purposes as judg- ment sanctions. Opium should never be used as a subsfi- tute for the ordinary stimulus either of wine or spirits : for when it is thus used, it seldom fails to lay the founda- tion for a long train of morbid symptoms, which, sooner or later, terminate in all the wretchedness, which disease is capable of inflicting ; yet this drug is in every day's use, and particularly among the better circles of society, and by the softer sex. Fearful of names, rather than of consequences, opium is continually resorted to by many of both sexes, but particularly by females, and these of the higher circles, as a substitute for the stimulus ordinarily afforded by gin or brandy. And hence the emaciation, and most of the long train of dyspeptic symptoms, and gastric derange- ments so commonly met with in persons in this class of so- ciety. But there is another class who resort to opium, in some one or other of its forms, either from indolence, or carelessness, or both ; I mean mothers, nurses, and those to whom are intrusted the charge of infants. The youthful, inconsiderate mother and the idle nurse, too frequently resort to opium, to hush the infant's cries, which might have been done, by the ordinary and only best means of nursing. The gay and youthful mother, rather than forego the pleasures of a crowded assembly, or the gaudy charms of a dramatic scene, a single evening, not unfrequently com- mits the unfortunate infant to its cradle under the influ- ence of opium, in the form, either of Dalby's Carminative, the Paregoric Elixir, or Godfrey's Cordial, and even lau- danum itself. Many instances of this nature could be adduced; one, however, may suffice on this occasion. CASK. Eliza, aged one year and ten mouths, born at the full time, of healthful parents, herself healthful, and at birth weighed ten and a half pounds. Mother young and fond of social amusements, with means to obtain them. When about three months old, Eliza became cross, and somewhat troublesome, particularly at night. Paregoric was given in order to induce sleep ; continued with increased doses. After some time, this ceased to. have its desired effect. Laudanum was now given in place of the Paregoric, com- mencing at first with gtt. iii. in Annisi. infusion, or tansy — increased gradually to gtt. x. and so on ; and now, at the age above stated, from 50 to 60 gtt. have been taken regularly every night for upwards of eleven months. On February 5th, of the present year, I went with a medical friend, whose advice was required in Eliza's case, she being much afflicted with diarrheae. Her countenance bore marks of premature age — expression that ef a child three or four years old ; head disproportionally large ; abdomen prominent and tumified ; extremities dispropor- tionally small, and like her face, pale. Integuments much wasted, flaccid, soft, or somewhat doughy, resembling in some degree bleached tallow or wax, which had been ex- posed to the air. She does not walk ; general debility ; eye sunken, small, heavy, and having but little or no ex- pression — integument of the lids somewhat corrugated, from a loss of support formerly afforded by the balls of the eye, which have receded preternaturally. Appetite vari- able, and at no time good. Pulse small, soft, and rather slow ; soldom sleeps, except under the influence of her usual dose ; troubled with periodical diarrhsea, the food always passing away indigested, and in lumps, until the time arrives for the repetition of her usual dose, Eliza re- mains in a semi-torpid, listless state ; peevish, and having a desire more for fluids, than solid food. Now that this periodical diarrhaea has been induced end kept up by the long and injudicious use of opium, ad- nuts of no doubt. Its long- use, and in such quantities, having so far impaired the muscular vigour of the coats of the stomach, and of the alimentary canal, together with the functions of the absorbents, most of the phenomena above described, are to be imputed. But the injudicious use of opium is not confined alone to mothers and nurses, many practitioners of medicine are also culpable. Like calomel and jalap, which, because it is allowed to be useful in almost all cases, it is often for- gotten that there are, nevertheless, many cases in which opium, like that prescription, is not admissible. In hope, however, that as the science of chemistry ad- vances, it will continue to unfold even more minutely than it has already done, the hidden principle of activity, alike of many other agents of the Materia Medica, as of opium, we trust that error, like the dew, will vanish under the shining influence of improvement in the profession. THE END. COLUMBIA UNIVERSITY This bqok is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special ar- rangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE C2816381M50 u> RIE M-RM666 'ERSITY LIBRA 848208 Smith DLUMBIA UNI\ 0050 Sm6