An Essay on the Effects of Opium. Considered as a Poison

Doctor Jones mentions Acids in a secondary Degree, recommending the fixed and unfermented to be used, "when the Resin is not at Stomach," as he phrases it. That is, in other Words (as he places the whole noxious Power inherent in the Resin) when the Patient is not in Danger.

Nervous and cardiac Medicines have a known Property of comforting the Stomach; the former, by a soft balsamic Power, sheathing the Acrimony, such are Valerian and Castor; and the other, by a warm stimulating Nature, including Volatiles and Aromatics – The Antients were very industrious in the Use of Simples, and attributed many Cures to certain specific Properties of Individuals, which saved them much Trouble in Ratiocination of Time, Place, and other accidental Circumstances, that might arise; of these there are numerous Instances, and among the Number, some are distinguished as Specifics, for the Cure of those poisoned with Opium; the best of which, are Camphire, Castor, and Coffee; the former two are recommended by many Authors; the latter, by Doctor Willis, as is the Semen Elephantiasis by Pliny.

I think, according to what has been said of the Action of Opium on the Stomach and nervous System, that the Evacuations by Vomit, Sweat, and Stool, with the Use of Acids and Cardiacs, become indispensably necessary to expel the Virus, and prevent an after Relaxation. Can any one nervous Principle produce all these combined Effects? I think neither of the abovementioned can; Nor do I know of any other that is singly capable of it. The strong Power of Castor upon the Womb is so well known, especially where the Party is pregnant, (which is generally, I presume, the Case, when Women take this Poison) that the Use of it ought to be rejected; and I may almost venture to affirm, that, where a person recovers by taking one kind of Medicine only, the Cure cannot rationally be accounted for, but through the native Strength of the Constitution; and, whoever depends upon that alone, must often fail of Success.

By the Method laid down for the Cure of the milder Effects of this Poison, the rational Means of treating the most inveterate is discovered, it being requisite only to encrease the Strength of the Medicines, in proportion to the opposing Power of the Poison, the Constitution of the Party, or other concomitant Circumstances.

These being premised; in the second Degree of Symptoms, and in the most violent, I cannot do better (as I have happily experienced Success in both) than recite the manner of Cure, as Circumstances occurred to me.

In the second Degree, viz. Convulsive Twitchings, Madness, Suppression of Breath, florid Complexion, fixt Eye, and faultering Speech – The Party had taken one Ounce of Laudanum, in different Proportions, with small Punch, in the Space of an Hour, and this upon an empty Stomach; being thus taken at Intervals, the Vellications in the Stomach were not so immediately violent, as to make it be rejected; the Party conscious of his Error, and fearful of the Consequences, when the Poison began its Operation (he being possessed of a strong Constitution) endeavoured to counteract the Power of it by violent and incessant Walking, till Nature, overcome by the Conflict, was no longer able to support herself. The sleeping Power of the Opium being withstood, the Operation upon the animal Spirits produced a Delirium; the Eyes were distorted, the Speech inarticulate, notwithstanding, his Pulse moved slowly, but with great Distention of the Vessel; I found also a cold, flaccid Moisture of the extream Parts, with convulsive Twitchings, and a violent Tremor, arising from excessive Exercise, and the Effect of the Poison upon the whole nervous System; and from the Length of Time the Poison had been taken, an almost immediate Solution was to be apprehended, after the Manner observed by Doctor Willis, quoted in a former Page.

I gave him a vomiting Potion, which, by the Help of a Quantity of Gruel, soon operated; and presently after (the Vomiting being ended) a nervous cordial Draught, of the same Nature of that already described, encreasing the Quantity of Acid with Castor, (being a more powerful Antispasmodic) instead of Valerian. He was placed upright in Bed, and being covered warm, through the Assistance of the Medicines, in a short Time, fell into a profuse Sweat; he drank plentifully and frequently of warm Whey; Blisters were soon after applied to the Arms: The first four Draughts were taken within the Space of two Hours: His Pulse thereupon grew full, and regular, and the extream Parts warm. AS I perceived he laboured under an Astringency of Body, and the Virulence of the Poison being now, in some Degree, carried off by Sweat, I gave him, of the Powder of Jalap, one Scruple, properly corrected as before; which performed its desired Office. The Virus thus subdued, I reduced the Quantity of Acid in each Draught, and repeated them Night and Morning for some few Days, with a Cordial Julep to take of, at Intervals, when oppressed with a Languor of Spirits. By this Process the Patient perfectly recovered his Health.

Doctor Jones has observed, that when Opium causes a Purging, the Patient generally recovers; but is an Evacuation that rarely happens, without Art. A Constipation or bound State of Body is the general Consequence that ensues the taking this Poison; which to remove, requires the Aid of brisk Purges, and those, for the most Part, in encreased Doses.

In the most extream and violent Degree, when a large Quantity of this Poison has been taken, and gained its full Power of Action, the Symptoms are, an Inclination, but Inability, to vomit, from the great Inflammation of the Parts, Hickupings, heavy and dead Sleeps, unequal Pulse, Convulsions, Contraction of the Jaw, profuse and cold Sweats, with a total Relaxation of the extream Parts. In this State, I found a Patient, who had taken the Poison upwards of an Hour; she was lying on the Bed, in a profound Stupor, interrupted only with Convulsions. – She did not exceed the Age of Eighteen, of a slender and delicate Constitution. I ordered her immediately to be raised to a sitting Posture in Bed, supported by Attendants on each Side; and then gave the following Powder, mixed with warm Water, in a Spoon; as that was the readiest Way the Medicine could be got down, some Force being requisite, and half of it, even then, was lost, by running out at the Sides of the Mouth; yet the Stimulus of the remaining Quantity, which reached the Oesophagus, or Mouth of the Stomach, was sufficient to cause an immediate Inclination to vomit, and gave Opportunity for pouring down Fluids.

The Powder was of Ipecacuanha, and Russia Castor, each half a Drachm in fine Powder, mix them for one Dose. In the Space of ten Minutes I might get down, I suppose, about one half of this Powder, and the warm Water, which we forced into her at the last, in some Quantity, occasioned her to vomit plentifully five or six different Times; her Senses yet were in no Degree returned; her Head falling upon the Shoulder, as if lifeless; the Convulsions, however, ceased, and she grew warm. I caused her then to be roused as much as possible, by a continual Movement of her Arms and Body; but to little Purpose. The following Medicines were then given:

Take of the Powder of Russia Castor, Mountain Valerian Root, each half a Scruple, Aromatic Species, five Grains; and with a sufficient Quantity of Sir Walter Raleigh's Cordial, mix them into a Bolus, to be taken directly, and repeated every half Hour, or oftener, as the Urgency of the Case might require.

Take of simple Spear-Mint Water six Ounces; strong Cinnamon Water, distilled Vinegar, each one Ounce; Syrup of Clove Gilly-Flowers six Drams; mix them together into a Julep, of which give the Patient four Spoonfuls with each of the above Bolusses, and between whiles, when faint.

Assafœtida Drops were used likewise to her Nostrils and Temples, and Blisters applied to the Arms as expeditiously as possible.

These Bolusses being given as directed, and the Julep, or Wine Whey, (every two or three Minutes) she went into a profuse Sweat; and, in little more than an Hour from the Time I first saw her, recovered her Senses and Speech. These, however, were imperfect; then ensued Stools, and an universal Relaxation, with frequent, and almost continual Faintings; she was relieved from these by quick Repetitions of the Julep, which had been some little time neglected by those about her. She continued the Use of the Bolus, leaving out the Castor, and encreasing the Quantity of the Valerian to a Scruple, with the Julep, for some Days; and in a Week was free from every bad Consequence. The Vertigo and Tremor had entirely left her, and no Remains of the Disorder apparent, but in the sallow Look of her Skin, and that continued some time. She was with Child, and did not miscarry, notwithstanding the Quantity of Laudanum taken was one Ounce.

In these Cases, when the Virus of the Poison is weakened, it would be wrong immediately to omit the use of Medicines, since the future Illness that would probably arise, might be prevented by the Power and Quantity of them being gradually decreased; for which Reason I shall lay down no Rule, but leave to the Discretion of the Gentleman employed to act, as the Weakness, or other consequent Symptoms attending the Patient, may direct.

I shall recite yet another Case of a Child, about eighteen Months old.

The Reader may very naturally doubt, how it was possible for a Child, so young as this, to be poisoned with Laudanum. Sorry am I to say, nothing is so easy; the Practice among Nurses to give to their Children the Syrup of the Sleeping Poppy, or other quieting Medicines, is too common; and particularly, one that goes by the Name of Godfrey's Cordial; which is a Composition very binding, has Opium in it, and was never designed by the Author for such Purposes; but was calculated principally for the Cure of Fluxes. By the Administration of such Things, a Nursery may be kept quiet, which is Inducement enough to some Nurses, as they will be enabled thereby to pursue their various Employments without Interruption, which could not be done with the same Ease, were the Child waking.

A Girl, at the Age of eighteen Months, had the Whooping Cough; to remedy which, her Mother was advised to get of a sleeping Medicine, called Elixir Paregoricum, and to give the Child a certain Quantity of it every Night. What that Quantity was, or how much was given, I cannot positively say; but am certain, that it was sufficient to be in Effect very violent; for a Struggle of Nature immediately ensued the swallowing of the Medicine to overcome Strangulation, caused by the Heat and confining Power of it; presently after, the Child sunk into a heavy Sleep, which continued near twenty-four Hours; and she bore, during that Time, all the progressive Symptoms of the Power of Opium, which encreased, as usual, to Convulsions.

The Use of Acid in this Case was, in a manner, forbid me, from the natural Tendency of the Humours in young Children to such Ferments; I therefore avoided it, till obliged by the Violence of the Effects (acting after Harris de Morbis acutis Infantum, p. 102. Quod ad convulsiones spectat, ab Acrimonia Materiæ Morbificæ propaginem Nervosam Extimulante ut plurimum pendentes, Testacea nostra, et maxime, si Castoreum iis adjiciatur, &c.

As my Patient had the nocent Dose given her at Night, the Effect was not perceived until the next Morning, when they found her, with her Eyes closed, and insensible to the taking of Aliment and Drinks, in consequence of which, I was called to her, and ordered as follows:

Take of Castor Water, one Ounce and a half; Crabs Claws and Cordial Confection, each one Scruple; Syrup of Saffron, two Drachms; Tincture of Castor, twenty Drops; mix them, and give a large Spoonful often.

A Blister was applied to the Back, notwithstanding which, the Convulsions encreased, with short Intervals of a total Relaxation, to which Infants are very liable in most Illnesses, owing to the natural Moisture of their Bodies; I then gave the following:

Take of simple Pennyroyal Water, two Drachms; the Cordial Confection, half a Scruple; Powder of Russia Castor, three Grains; strong Cinnamon Water and distilled Vinegar, each half a Drachm; mix them for a Draught, to be given as soon as possible.

Soon after taking this Medicine, my little Patient recovered from her Convulsions, opened her Eyes, and cried.

I then gave her a Powder of Rhubarb and Jalap corrected, which, in the Course of the Day, produced several Stools, that smelt inexpressibly strong; the Fits left the Child that Evening, and, in a few Days, she was entirely recovered.