The habitual use of opium is most injurious. Dr. Oppenheim, in his
description of the state of medicine in Turkey, tells us that persons
seldom attain the age of forty who have begun the practice early. The
opium-eater may be known by his attenuated body, withered yellow
countenance, stooping posture, and glassy, sunken eyes. He has no
appetite, his bodily powers are destroyed, and he is obliged continually
to increase the dose of his “grief-assuaging remedy” to obtain the
wished-for effect.
_Post-mortem appearances._—The appearances in acute poisoning by opium
are not very characteristic. The most prominent are, great turgescence
of the vessels of the brain, with effusion of serum into the ventricles
and at the base. The turgid condition of the vessels often continues
down the spinal cord, &c. The lungs are usually gorged with fluid blood,
and the skin is of a livid hue.
_Treatment._—The first object is to remove all the poison from the
stomach, and this cannot be effected in any way so well as by the
stomach-pump. In the absence of this instrument, emetics of half a
drachm of sulphate of zinc, or a tablespoonful of mustard, must be
employed. The patient at the same time is to be prevented as far as
possible from going to sleep. When the stomach has been thoroughly
emptied, every means must be adopted to keep the patient roused. This is
to be effected by dashing cold water over his head and chest, walking
him up and down or shaking him between two attendants in the open air,
irritating his legs by flagellation with a wet towel, applying
electro-magnetic shocks to the spine, and administering strong coffee.
Bleeding has been recommended; but it is only to be used after the
poison has been removed from the stomach, and when from the coma and
full pulse we are sure that there is cerebral congestion. In extreme
cases artificial respiration must be tried.
The remedies recommended must be perseveringly used, remembering that as
long as life lasts hope of recovery is not to be banished. In the great
majority of cases the treatment is successful.
_Tests._—There are no direct means by which opium may be detected. We
endeavor therefore to obtain evidence of the presence of morphia and
meconic acid. The two substances may be separated from organic admixture
by the following process: The suspected matters should be well boiled
with distilled water, and spirit acidulated with acetic acid, and
strained. To the fluid which has passed through, acetate of lead is to
be added until precipitation ceases, and the whole, after standing, is
to be thrown on a filter. The insoluble meconate of lead remains on the
filter, the morphia passing through as acetate. To separate the meconic
acid the substance on the filter is to be diffused through water, and
sulphuretted hydrogen passed for a time. Sulphide of lead is thus thrown
down and may be separated by filtration, the meconic acid remaining in
solution. On concentration this should give the requisite reactions.
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