Opium.

Properties: Small doses stimulant, large doses sedative and narcotic.

Physiological action: Opium is obtained by incising the unripe capsule of the white poppy, the resulting concrete milky exudation being what is used. In very small doses opium or morphine at first act as stimulants, then in a very short time there is a desire to steep accompanied by a placid sensation, freedom from care; no noise or disturbance will now arrest the patient's desire to sleep. The pulse is slightly quickened, mouth gets dry and perspiration sets in. Sleep lasts from one to two hours. On awakening there may be nausea and perhaps vomiting, headache and there is always diminished secretion, except of the skin, constipation generally follows. If taken in larger doses above symptoms are more marked, head feels full, mind gets confused, a burning sensation is felt in the ears; delirium may occur followed by marked exhaustion. In this stage the pulse will become slower and more irregular, heaviness of the head, but the fullness is less severe; intoxication results. After awakening the symptoms of nausea, vomiting, diminished secretion and constipation are more marked then where smaller doses are taken. If taken in very large poisonous doses after the excitement there is great depression, confusion of mind, pulse becomes slow, face dusky, breathing stentorous, patient falls into a comatose state from which it is almost impossible to arouse him, momentarily. This followed after a few hours or more by pale face, weak and thready pulse, contracted pupils, cool and clammy skin, cold extremities, stentorous breathing, profuse perspiration; it is now impossible to rouse patient and death soon ends the scene. The slow pulse at first is caused by its stimulating effect on the vasomotor centers, and as these become paralyzed the pulse becomes rapid. The pupils are contracted at first by its stimulating effect on the oculomotor nerves; as death approaches these become paralyzed and the pupils dilate. Death in all cases results from paralysis of respiration. Sleep is produced by lessening cerebral activity. Its action is divided into two stages. In the first stage there is hyperemia of the brain and stimulation manifesting itself by flushed face and bright eyes. In the second stage the reaction takes place the nervous system gets exhausted, coma comes on, breathing becomes stentorous and congestion of the brain results. Opium or morphine often cause an eruption. Its application to wounds has a narcotic effect. Children should never have it nor should a mother use it while nursing a child. Should never be given when contra-indicated.

Indications: Pain without cerebral engorgement. It may be used when the pulse is soft and open and the skin moist, perhaps relaxed and cool, tongue moist.

Use: Opium and morphine are so much abused, resulting, in the morphine or opium habit that a word of warning is not out of place. Use it judiciously and only when other agents fail to give desired relief. Its indication and contra-indication should always be borne in mind. Opium acts through the nervous system producing sleep by lessening cerebral action. In small quantities it is a temporary stimulant. It checks secretion of the mucous membrane, diminishes appetite, increases thirst and arrests digestion. We think of it in emergencies where other remedies less objectionable fail to relieve. In severe spasmodic troubles with intense pain, painters' colic, passage of biliary calculi, when indicated. Morphine we think of in passage of calculi, puerperal convulsions, dyspnea and pain of angina pectoris, in fact in severe uncontrollable spasms and pain where other remedies fail and morphine and opium are indicated. If labor progresses slowly on account of the rigidity of the circular fibers of the os uteri opium is one of our best remedies. If pain is intense and speedy relief is required morphine acts more quickly than opium. It is well if not contra-indicated to give before an operation to nervous patients, a little before anesthetics are administered. As its primary action is that of a brain and nerve stimulant, it is contra-indicated in any case where there is over-stimulation of the nervous system, manifesting itself by flushed face, bright eyes, contracted pupils, hot and dry skin, dry and coated tongue and deficient activity of the excretory functions.

The Materia Medica and Clinical Therapeutics, 1905, was written by Fred J. Petersen, M.D.