OPIUM SYMPTOMS.

179

NEUROTIC POISONS.

CHAPTER XVI.

--PUM.—SYMPTOMS.—APPEARANCES.-ITS ACTION ON INFANTS.-POISONING WITH OPIATE COMPOUNDS.—OPIUM HABIT.-MORPHINE AND ITS SALTS.-MECONIC ACID.-PROCESS FOR

DETECTING OPIUM IN ORGANIC MIXTURES.-DIALYSIS.-CHLORODYNE.-COCAINE.

OPIUM.

Symptoms.-The symptoms which manifest themselves when a large dose of opium or its tincture has been taken are in general of a uniform character. A condition of pleasurable mental excitement, usually of very bort duration, is experienced; but this is followed by weariness, headarbe, incapacity for exertion, a sense of weight in the limbs, diminution of sensibility, giddiness, drowsiness, a strong tendency to sleep, stupor, cceeded by perfect insensibility, the person lying motionless, with the eyes closed as if in a sound sleep. In this state he may be easily roused by a loud noise and made to answer a question; but he speedily relapses iato stupor. In a later stage, when coma has supervened with stertorous breathing, it will be difficult, if not impossible, to rouse him. The pulse is at first small, quick, and irregular, the respiration hurried, and the skin warm and bathed in perspiration; but when the person becomes comase, the breathing is slow and stertorous, and the pulse slow and full. The skin is occasionally cold and pallid, sometimes livid. In the early taze the pupils are contracted; in the last stage, and when progressing to a fatal termination, they may be found dilated. In a case referred to the author in 1846, one pupil was contracted and the other dilated. In infants and children they are generally much contracted. They are comonly insensible to light. The expression of the countenance is placid, pai, and ghastly; the eyes are heavy, and the lips are livid. Sometimes there is vomiting, or even purging; and, if vomiting takes place freely before stupor sets in, there is great hope of recovery. This symptom is chiedy observed when a large dose of opium has been taken. The pecular odor of opium is often perceptible in the breath. Nausea and vomiting, with headache, loss of appetite, and lassitude may follow on recovery. la cases likely to prove fatal, the muscles of the limbs feel flabby and rehted, the lower jaw drops, the pulse is feeble and imperceptible, the sphincters are in a state of relaxation, the pupils are unaffected by light, the temperature of the body is low, there is a loud mucous rattle in breathing, and convulsions are sometimes observed before death, but more commonly in children than in adults. Just before death the pupils may dilate. One of the marked effects of this poison is to suspend all the secretions except that of the skin. Even during the lethargic state the skin, although cold, is often copiously bathed in perspiration.

The contracted state of the pupils furnishes a valuable distinctive sign of poisoning with opium or the salts of morphine. In relying upon it, it

is necessary, however, to bear in mind the fact pointed out by Wilk in apoplexy seated in the pons Varolii, the pupils are also con He describes two cases of this form of apoplexy which were mista poisoning with opium in consequence of this condition of the pupils. Times and Gaz., 1863, i. p. 214.) In carbolic acid poisoning the are much contracted, though seldom so minutely as in opium-poi and there is coma and stertorous breathing. As a rule, the peculi of carbolic acid in the breath will prevent any mistake as to the na the case. The symptoms of opium above described usually comm from half an hour to an hour after the poison has been swa Sometimes they come on in a few minutes, especially in children ; other times their appearance is protracted for a long period. If mo the active alkaloid of opium, be given subcutaneously, narcotic syn may come on within three or four minutes. It has been free observed that a person has recovered from the first symptoms, a then had a fatal relapse. There is some medico-legal interest co with this state, which has been called secondary asphyxia from although there appears to be no good reason for giving to it this na Appearances. In a case that proved fatal in fifteen hours the of the head were found unusually congested throughout. On the of the forepart of the left hemisphere of the brain there was an ecchy apparently produced by the effusion of a few drops of blood. Ther numerous bloody points on the cut surface of the brain; there serum collected in the ventricles. The stomach was quite h Fluidity of the blood is mentioned as a common appearance in c poisoning by opium. There is also engorgement of the lungsfrequently observed, according to Christison, in those cases which been preceded by convulsions. Among the external appearances t often great lividity of the skin. Extravasation of blood on the b rarely seen; serous effusions in the ventricles or between the mem are sometimes found. The stomach is so seldom found otherwise t a healthy state that the inflammatory redness said to have been occ ally seen may have been due to accidental causes. From this account appearances in the dead body, it will be perceived that there is nothing fulness of the vessels of the brain which can be looked upon as sp indicative of poisoning with opium; and even this is not always pr The medicinal dose of opium, in extract or powder, for a healthy varies from half a grain to two grains. Five grains would be a ve dose. The medicinal dose of the tincture (laudanum) is from five to minims for an adult. Persons have taken very large doses of the tin and recovered from the effects. A woman, æt. 38, is said to have ered after swallowing eight ounces. (Lancet, 1873, i. p. 468.) smallest dose of solid opium which has been known to prove fatal adult was in the case of a man, æt. 32, who died very speedily in a vulsive fit, after having taken two pills, each containing about one and a quarter of extract of opium. This quantity is equivalent to grains of crude opium. (Med. Gaz., vol. 37, p. 236.) The smallest dose of the tincture in an adult that the author found recorded, drachms. (Ed. Med. and Surg. Jour., July, 1840.) The edito known less than a grain of opium in solution destroy life in an person. In connection with this subject it is important for a m jurist to bear in mind that infants and young persons are liable killed by very small doses of opium, and appear to be peculiarly sus ble to the effects of this poison. The syrup of poppies, paregoric e Godfrey's cordial, Dalby's carminative, and a variety of soothing s

OPIUM HABIT-MORPHINE.

181

owe their narcotic effects to the presence of opium. The symptoms and Ipearances which they produce, when taken in a large dose, are similar those caused by opium or its tincture. One-sixtieth part of a grain of pam has thus destroyed the life of an infant. (Brit. Med. Jour., 1875, p. 570.)

3

It has been remarked that most cases of poisoning with opium prove tal in from about six to twelve hours. Those who recover from the tapor, and survive longer than this period, generally do well; but there may be a partial recovery, or a remission of the symptoms, and afterwards fatal relapse. The symptoms, however, generally progress steadily to fatal termination, or the stupor suddenly disappears, vomiting ensues, and the person recovers. Several instances are recorded of this poison having destroyed life in from seven to nine hours. One occurred within the author's knowledge, in which an adult died in five hours after taking the drug prescribed for him by a quack. Christison met with a case which could not have lasted above five, and another is mentioned by him which only lasted three hours. Barwis communicated to the author the case of an adult which proved fatal in three hours and a half. This drug in all its forms is especially fatal to infauts. They die rapidly from very wall doses.

Fatal Period. When swallowed, opium may kill within a period of two hours; but more commonly the patient does not succumb till after the lapse of from six to eighteen hours.

Opium Habit. It must be borne in mind by the medical jurist that persons may habituate themselves to the use of enormous doses of opium and its chief alkaloid morphine (opium-eating; morphine habit). The practice of subcutaneously injecting morphine is very prevalent. Sixteen grains of morphine per diem is not a very unusual quantity to be habituly used by a person given to this degrading practice, and even fortyFight grains have been used per diem.

Recently a unique case was tried in which the plea of morphine-taking was successfully urged as a defence in a charge of murder by morphine. The deceased man, Dr. Lyddon, a hard drinker and morphine-taker, was found in a dying condition, with an empty bottle near which had contained the pharmacopoeial solution of hydrochlorate of morphine. His brother was charged with administering the poison to him, and was acquitted. (Reg. v. Lyddon, C. C. C., March, 1891.)

Morphine and its Salts.-Morphine (morphia) is the poisonous alkaloid of opium, of which it forms from five to ten per cent. The two principal salts of this alkaloid are the hydrochlorate and the acetate. Opium owes its narcotic properties chiefly to the presence of morphine in combination with meconic acid. A dose of one grain of a salt of morphine has detroyed life. One-fourth of a grain, and even one-sixth of a grain, injerted beneath the skin has, in the editor's experience, killed an adult. Ertz met with a case in which an overdose of the hydrochlorate, suppled by mistake for quinine, destroyed the life of a lady in from forty to fifty minutes. Symptoms of narcotism appeared in a quarter of an hour. In one case observed by the editor, a dose of ten grains destroyed the life of a woman in from half an hour to an hour; and, when subcutaneously injected, the salts of morphine may kill in even a shorter time. (For a Fery full account of the appearances and analysis, see Vierteljahrsschr. f Gerichtl. Med, 1873, 1, p. 281.)

In 1888, a child, æt. 2 years, died narcotised twenty hours after tasting a ten per cent. solution of acetate of morphine. No symptoms were noticeable for at least three hours after the poison was taken, though the

182

MORPHINE-CHEMICAL ANALYSIS.

child was seen by two medical men.

In the urine drawn off si:

before death the editor detected morphine.

Morphine and its salts rapidly destroy life by absorption when to a wounded or ulcerated surface. A woman thus lost her life i by reason of an ignorant druggist applying thirty grains of mor] an ulcerated breast. Morphine is in part excreted in the urine, cording to the recent researches of Tauber, more especially in th even when the alkaloid is administered hypodermically.

Chemical Analysis. Opium.-There are no means of detecting itself, either in its solid or liquid state, except by its smell, taste, an physical properties, or by giving a portion of the suspected subst an animal, and observing whether any narcotic effects are produced smell is said to be peculiar, but a similar smell is possessed by lactu which contains neither meconic acid nor morphine. The odor is concomitant test of the presence of the drug, whether it be in a fr or dissolved in alcohol or water, but it is not perceptible by many when the solution is much diluted. The taste is bitter. The ana cases of poisoning by opium is therefore limited to the detection phine and meconic acid.

Morphine.-Morphine may be identified by the following prop 1. It crystallizes in hexahedral prisms, which are white and perfect ding to their degree of purity (Fig. 19). The crystals obtained by weak ammonia to a solution of morphine in hydrochloric acid form. When slowly produced they sometimes present the forms sented in the engraving (Fig. 20). 2. When heated on platinu Fig. 19.

Fig. 20.

crystals melt, become dark colored, and burn like a resin with a smoky flame, leaving a carbonaceous residue. If this experiment formed in a small tube it will be found, by employing test-paper, th monia is one of the products of decomposition. 3. It is scarcely in cold water, as it requires 1000 parts to dissolve it; it is soluble parts of boiling water, and the hot solution has a faint alkaline rea By its great insolubility in water it is readily known from its salts. not very soluble in ether or chloroform, thus differing from narcotin it is dissolved by fifty parts of cold, and thirty parts of boiling, al It is dissolved by a solution of potash or soda, from which it can easily removed by ether. It is soluble in acetic ether, and this liqu been employed for the purpose of separating morphine from o liquids. 4. It is easily dissolved by a very small quantity of all o

TESTS FOR MORPHINE-MECONIC ACID.

183

gils, mineral and vegetable. 5. Morphine and its solutions have a bitter taste. 6. The salts of morphine are not precipitated in a crystalline form by solutions of sulphocyanide of potassium, ferricyanide of potassium, or chromate of potassium. In this respect they are strikingly distinguished from the salts of strychnine, which give well-marked crystalline precipitates with these three reagents. Like all alkaloids, the morphine in solution is thrown down white by the chloriodide of potassium and mercury made by dissolving six grains of corrosive sublimate and twenty-two grains of iodide of potassium in a fluidounce of water). This liquid precipitates albumen; hence this substance, if present, should be removed by boiling the liquid before applying the test.

In order to apply the test for morphine, the alkaloid may be dissolved in a few drops of a diluted acid, either acetic or hydrochloric. If the hydrochlorate or the acetate of morphine is presented for analysis, the salt may be at once dissolved in a small quantity of warm water. The tests for this alkaloid are the following: 1. Nitric acid. This, when added to a moderately strong solution of a salt of morphine, produces slowly a deep orange-red color. If added to the crystals of morphine or its salts, red fumes are evolved; the alkaloid is entirely dissolved, and the solution acquires instantly the deep red-color above described, becoming, however, ghter on standing. In order that this effect should follow, the solution of morphine must not be too much diluted, and the acid must be strong and added in rather large quantity. The color is rendered much lighter by boiling; therefore the test should never be added to a hot solution. 2. Iolic acid. A drop or two of solution of iodic acid should be mixed with its volume of chloroform. There should be no change of color. On adding a small quantity of these mixed liquids to morphine or its salts, either solid or in solution, the iodine is separated from the iodic acid and dissolved by the chloroform, which sinks to the bottom, acquiring a pink color, varying in intensity according to the quantity of morphine present. Now make alkaline with ammonia and shake the pink color is discharged from the chloroform, and the supernatant watery solution acquires a deep browa color This reaction distinguishes morphine from all other alkaloids and from other bodies, such as the sulphocyanides (in saliva), which erate iodine from iodic acid. The presence of morphine may be thus Pasily detected, in spite of the presence of organic matter, in one drop of the tincture of opium, in chlorodyne, or other opiate liquids. If chloroform is not used, iodine may be detected by starch paste, which is turned e. 3. Sulphomolybdic acid. This is made by dissolving about oneirth of a grain of powdered molybdic acid in a drachm of warm pure centrated sulphuric acid and cooling. The liquid should be freshly prepared and kept from contact with air and organic matter. When one or two drops are rubbed with dry morphine or any of its salts, an intense dish-purple or crimson color is produced. This changes to a dingy green and ultimately to a splendid sapphire hue. 4. Sulphuric acid and bichromate of potassium. When strong sulphuric acid is poured on pure morphine in a solid state, there is either no effect, or the alkaloid acquires a light pinkish color. On adding to this a drop of solution of bichromate of potassium, or a small fragment of a crystal, it immediately becomes Teen, and retains this color for some time.

Meconic acid-This is an acid, commonly seen in scaly white crystals. It is combined with morphine in opium, of which it forms on an average six per cent., and it serves to render this alkaloid soluble in water and other menstrua. Tests. Many tests have been proposed for meconic acid; but there is only one upon which any reliance can be placed, namely,