An Essay on the Effects of Opium. Considered as a Poison
TextTo consider Opium in a true Light, respecting the primary Action of it in the Stomach, is, in my Opinion, to suppose it similar in Corrosivity to any other succulent vegetable Poison, with a peculiar stupefactive Power, that characterizes it.
The Effect then is to be counteracted, by disengaging the Stomach from the Poison as fast as possible, by every Means of Secretion, checking the Virus of it, and exciting and supporting Nature with warm nervous Stimulants, untill she has freed herself entirely from the dangerous Effects of this powerful Drug.
These Circumstances considered, the ensuing Process is what I should recommend. – In the first State, before the Poison has had Power to act, and only Symptoms common to Ebriety appear (which is generally very soon after it has been taken) let a Vomit be administered, to provoke the Discharge of it; as soon as possible; for Instance;
Take of simple Spearmint-Water,
Oxymel of Squills; each one Ounce;
Powder of Ipecacuanha-Root, half a Scruple; mix them for a Vomiting Potion.
The Person should, if possible, be diverted from immediate Sitting, or lying down, and frequent Draughts of a Water-Gruel; not too thin, be given to assist the Operation; which, if repeated, so as to procure four or five Vomitings, will bring with it the major Part of the Opium. This happy Effect may be presently guessed by the Smell of what is discharged from the Stomach, and will be sufficient for the Time, if the Poison taken was in a liquid State; but if in a Solid, the Vomiting should be continued, by giving fresh Gruel, even to six or seven Times; for by the compact Form, and through the stupefying Power of Opium, it will be the last Thing disengaged from the Stomach. The Strength of the vomiting Potion, if not deemed sufficient, may be encreased, according to the Strength of the Patient, with an Addition of the Powder of Ipecacuanha-Root.
This Operation may soon be over, as it depends upon the Assiduity of administering the Gruel; nor need there be much Time spent in making it, an Handful of Oatmeal being sufficient, mixing it in cold Water, and pouring warm to it, without standing to settle, or straining; Broth, Beer-Wort, or even Water alone might do; but the Gruel being easily and quickly attainable by every one, I would recommend that, as the most proper; if the Patient's Stomach had been charged with Food, but a short Time before taking the Poison, this Vomiting may be found sufficient to perform the Cure; yet is, in my Opinion, too precarious to be solely depended on. I mention this chiefly as a favourable Symptom, since the Power of Opium is to be much feared, when alone, in an empty Stomach, or one, at most, charged with Fluids.
The next Thing requisite, is to place the Patient in a Bed, or Chair, not in a lying, but sitting Posture, his Head supported, and Body covered very warm, to promote a Sweat, but not so as to incumber him with their Weight.
This is quite different from the Opinion of Dr. Jones, who recommends the Patient to be kept cold, in Proportion to the Stupor, in order to brace the relaxed Parts. If the Symptoms are extream, he advises the Person to be exposed, stark naked, to the coldest Air, or thrown into cold Water; and when you have not the Conveniency of a Vessel large enough, you are to pump or dash cold Water over the naked Body. To this extraordinary Opinion, I shall beg Leave to oppose that of Grevinus. Lib. 2. de Venenis, Cap. 16. Pag. 208. Balnea cum sint Calida & Humida, cutim extendunt, Partes refrigeratas et exsiccatas corroborant, & per insensibilem transpirationem exhalare faciunt id, quod inter Carnem & Cutim relinqui potuit, Sanguinemque pristino vigori suo restituunt. Baccius likewise, Lib. 7. de Thermis, Cap. 23. Pag. 474. particularly recommends the Use of warm Bathing, to the Recovery of those who have taken Opium, and have appeared almost dead. Add to these, the Opinions of most Authors for promoting the Secretions; which Opium powerfully interrupts, especially in cold Climates, according to Tournefort's Observation; and Willis, de Opii Nocumentis, Page 188. Who gives an Account of a robust Man, dying in four Hours, from the Time of taking the Laudanum, without the least Sleep or Evacuation. – How does Dr. Jones himself account for the Itching of the Skin, as a Symptom of Opium having been taken to Excess, but by the Obstruction of the Pores? And what will open them so soon, and promote the other necessary Secretions so readily, as a warm Bath? I should never fail therefore to advise the Use of a warm Bath, would Time admit of the Preparing it; the Recovery of the Patient depending much upon the most expeditious Applications.
To return to the Point in View. We must correct what remaining Powers of the Poison are left in the Body, after the Evacuations by Vomit, which are to be carried off by Sweat, observing the Use of cordial Medicines, to support, strengthen, and brace the Frame, using likewise Blisters, which will not only rouse Nature by their Stimulus, but derive a Portion of the Humours to themselves.
Take of simple Penny-Royal-Water, one Ounce and a Half, Strong Nutmeg-Water, Distilled Vinegar; each two Drachms. The Cardiac Confection, Powder of Mountain Valerian; each half a Drachm. Syrup of Saffron, two Drachms; Tincture of Castor; twenty Drops; mix these for one Dose, to be taken immediately, and repeated every half Hour, to four Times, and afterwards every second, third, or fourth Hour, as the Exigency of the Case may require.
The Sickness of the Stomach, occasioned by a large Dose of Opium, brings me to consider the Power of Stimulants in the first Passages. As soon as the Stomach becomes sensible of the Vellication therefrom, a nervous Fluid is derived to the Part, and the Pectoral Muscles called into Action; this Struggle in the first Passages being excited, yet so discretionally as to avoid an Inflammation, puts the Party into a gentle Sweat, by which, if promoted by Warmth and Diluents, Nature will breathe off the Virus.
Thus we may account for the Operations of alterative Medicines; these consisting in a Stimulus, excited to such a Degree, as is just sufficient to bring the nervous Coats of the Stomach and Muscles into Action, and corresponds with that brought on by Exercise. Vide Dr. Willis. Phar. Ration. de Sudatione. Pag. 117. A Diaphoresis is introduced and promoted by the Consent of the arterial Fluid, which may be practiced to a greater or less Degree, according to the Proportion of the Stimulus; thus are the profuse Sweats brought on by Opium, according to the Quantity used, as likewise by the different Preparations of Mercury and Antimony, and in fact, every other mineral or vegetable Production, that may prove a Stimulative in the Primæ Viæ.
To return to the Cure of the milder Effects of this Poison; the Patient, during Vomiting, probably will be excited to Stool, by the Help of the Oxymel of Squills first taken; if not, give a Sufficiency, according to the Strength of the Subject, of Powder of Jalap, corrected with some few Grains of the Aromatic Species, to procure Stools; but not to any Excess, nor before some of the nervous cordial Medicines have been taken, lest the necessary Sweats should be interrupted, and an immediate Relaxation introduced. Jalap, as a Purge, is to be preferred, it being more certain in Effect, and a Root loaded with a Resin, that may carry down with itself any mucous Part of the Opium, which may adhere to the Coats of the Stomach after Vomiting; for this Reason, both Wedelius and Jones recommend aloetic Purges. Opium interrupts, for the most Part, the present Action of purging Medicines, wherefore they should be given in encreased Doses, to produce the desired Effect.
The Patient, though on the Bed, must, by every Art imaginable, be kept from immediate Sleep, by giving him Wine-Whey, frequently shaking him, and such like Methods, applying to the Nostrils and Temples, Oil of Amber, or other Antispasmodics, such as the Tincture of Assafœtida, Soot, Valerian, &c. and this more or less, as there may be Occasion, by which, and the Power of the Medicines already taken, and the continuing the Use of Correctors and Nervous Stimulants, his Sweat will grow profuse, and the Party not so inclinable to Sleep; or, if he should, those Sleeps would not be permanent; which his Attendants should endeavour to prevent, never permitting any one to continue so long as half an Hour at a Time, between Whiles repeating the nervous Medicines, and the Draughts of strong Wine-Whey, in Proportion to such Inclination. If, on the other Hand, the Sleep should be so powerful, as that the Party cannot easily be roused, Blisters must be applied to the Arms. This Process, I persuade myself, will prove sufficient, in the first Instance, where the Opium has been recently taken, especially if the Quantity was not very large, and in such Cases, the Camphire Julip may be very advantageously added to the above Regimen.
It is necessary to remember, that an universal Relaxation must be the Consequence of a Conflict of the whole Mechanism; and from these several Evacuations in so small a Space, the human Frame must be weakened, by her Endeavours to extricate herself from the deleterious Effects of this Poison. This Inconvenience is easily repairable, by persevering in the Use of cordial and bracing Medicines, which should likewise be continued some Days, to bring the Frame to its pristine State; the Patient must live upon light, but good Nutriment, drink after Meals, in Moderation, of generous Wine, and avoid Sauces with Butter, that all Danger of nervous Tremors, and Loss of Appetite, may be, as much as possible, prevented; but if such should happen to be the Consequence, the Tincture of the Peruvian Bark, with Elixir of Vitriol, in small Doses, will certainly remove them.
As I have condemned the Use of Alkalious Medicines, by endeavouring to prove the Impropriety of them, and as the great Mead has mentioned them indefinitely, it may be proper to examine their Antithesis, or contrary Principle of Acids, the Use of which, as Sudorifics and Bracers, to compleat the Cure, are indispensably necessary.
As we find, upon the Examination of Opium, by chemical Analysis, that it contains a very large Proportion of a volatile Salt, and corrosive Oil, Alkalies will undoubtedly encrease the Volatility of the one, and Corrosivity of the other, and thereby assist their Expansion. On the other Hand, Acids condense Volatiles, and destroy their Power; and furthermore, will prevent the Expansion of the corrosive Oil, by checking the Activity of the Salts. We see, by putting the mineral Acids to volatile Spirits, they destroy their Volatility, and produce fixt Bodies. Vide Boerhave, de Regeneratione Salis Armoniaci, &c. process. 20. Partis 3. de Operationibus Chemiæ. Likewise by a vegetable Acid, thus, when distilled Vinegar is poured to the Volatile Spirit of Sal Armoniac, the Volatility is destroyed, as in making the Spiritus Mindereri. The Antients, sensible of this, used frequently to prepare Opium with vegetable Acids, to correct its Power; and by that Means could give it in larger Doses; but this Practice, being in many Cases inconvenient, was laid aside.
Acids are of two Sorts, either Mineral or Vegetable; the Mineral are the stronger, and very corrosive, being drawn from Fossils by the Help of intense Heat, as Vitriol, Nitre, &c. the Vegetable are Native, in Fruits, as Citrons, Oranges, Limons, Limes, &c. in some Plants, as Sorrell, &c. or produced by Fermentation, as Tartar and Vinegar.
Opium being a vegetable Production, replete with a volatile, urinous Salt, what can be more efficacious to counteract the Power of it, than a vegetable Acid, which is not of a corrosive Nature, so as to prevent the taking of it, even alone, into the Stomach without Injury? and this surely cannot be said of a mineral Acid. Wedelius, Lib. I. Sect. 2. p. 53. strenuously asserts the Use of Acids, Acida enim Sulphura tum Salium tum aliorum obtundunt, præcipitant, invertuntque ac exhalationem et resolutionem remorantur, quod infinitis Experimentis Chimicis demonstrari posset. And, he further says, p. 59. "That Vinegar is a most powerful Remedy for such as are poisoned with Opium, that it will correct the Acrimony and Heat of it, and thereby the volatile Parts will become mild, and as it were fixed."
The Affect of Opium upon the Nerves, being by Stupefaction, and a subsequent Relaxation, what Principle can so readily restore them, as light fermented Acids, and so soon promote, by their gentle Pungency, a Disposition to Sweat? The crude Acids of Fruits and Herbs are more sharp and contracting, than those by Fermentation; nor can they be used with Safety in such Quantities, though they stand particularly recommended. I prefer, therefore, the Acetum Stillatitium, or distilled Vinegar, it being an Acid of sufficient Strength, and of a pure Nature, which, joined with nervous and cordial Medicines, has fully answered my Expectations.