Opium
is one of the most complicated substances in the materia medica. Besides mucilage, albumen,
fat, sugar, and salts of Ammonia, Calcium, and Magnesia, it contains "seventeen or eighteen alkaloids, and
two neutral substances, as well as a peculiar acid─meconic acid"
(Brunton). Among the alkaloids of Opium, Apomorphinum, Codeinum,
Morphinum have their several places in the homœopathic materia medica. As the
prince of pain-killing palliatives Opium has played a
very prominent part in old-school therapeutics, and by its seductive properties has reduced
many who have sought its help to become its slaves. The effects observed in persons brought
under its influence in this way, in opium-smokers and in persons poisoned with massive
doses, have produced a large part of the pathogenesis; provings and clinical observations
have added the rest. The effects of a poisonous dose of Opium
are scarcely to be distinguished from a fully developed attack of apoplexy─absolute
unconsciousness; complete muscular relaxation; pupils contracted to a pin-point aperture;
turgid, bloated, very red, or bluish face; stertorous breathing; pulse slow and full. Death
takes place by asphyxia, the heart continuing to beat after breathing has ceased. Minor
degrees of the Opium influence give: Deep sleep;
pleasant, fantastic, or frightful dreams; delirium like delirium tremens. On waking from
this stage there is severe headache, nausea, furred tongue, loss of appetite. In still
smaller doses (or in the large doses of Opium habituées)
there is: (1) Excitement of circulation, pulse fuller
and quicker, surface warm and flushed; increased power of directing energies. If he wishes
to sleep, "an agreeable languor followed by sleep comes on. He can be easily aroused
from this sleep; and after a few hours the effect passes off, leaving, however, slight
headache and languor, with dryness of mouth and slight nausea. If, on the other hand, he
wishes to work, he can do this with increased energy; or if he desires to exert the mind, he
will find his imagination more vivid, his thoughts more brilliant, and his power of
expression, greater" (Christison, quoted by Brunton). In my student days I had the good
fortune to be in the skilful hands of Dr. Angus Macdonald through a severe attack of
peritonitis (apparently induced by a chill one very severe winter). The treatment was: Opium, in pills, two or three times a day; the object being to
keep the intestines inactive till such time as the inflammation should subside, and at the
same time to relieve me of the pains. The treatment was on perfectly rational grounds, and
was completely successful. The inconveniences of it were persistent vomiting, distressing
dreams, a state of irritability almost of the Chamomilla
type, and constipation. This last was the feature which gave me more anxiety than anything
else, and, in spite of my doctor's assurances, I could not help fearing that obstruction had
taken place. It lasted long after the Opium was
discontinued, and at last, without any medicinal help, ended, to my great astonishment, in
diarrhœa. There had been neither stool nor flatulence pass for many days. Flatus began to
pass before the diarrhœa set in. Hahnemann (M. M. P.)
sums up the action of Opium thus: "In the primary
action of small and moderate doses, in which the organism passively, as it were, lets itself
be affected by the medicine, it appears to exalt the irritability and activity of the
voluntary muscles for a short time, but to diminish those of the involuntary muscles for a
longer period; and while it exalts the fancy and courage in its primary action, it appears
at the same time to dull and stupefy the external senses, general sensibility and
consciousness. Therefore the living organism in its active counteraction produces the
opposite of this in the secondary action: Diminished irritability and inactivity of the
voluntary and morbidly exalted excitability of the involuntary muscles, and loss of ideas
and obtuseness of the fancy, with faintheartedness along with over-sensitiveness of the
general sensibility." It is right to say that Hahnemann prefaces the above with the
remark that, "It is more difficult to estimate the action of Opium
than of almost any other drug." This is quite true if we conceive it necessary to
divide the effects of the drug into primary and secondary. For my part I have never yet been
able to turn to practical account this division into primary and secondary in respect of any
drug; and, except for the occasional purpose of arranging the actions of a drug in
rememberable form I do not attempt it. I find that whether an Action is "primary"
or "secondary" depends on the prover or the patient. I know some people who are
made absolutely sleepless by Opium in all sorts of
doses; and Op. 30 has helped me in case of sleeplessness
as often as Coffea. My experience goes to show that
whether the drug-effect is primary or secondary, it is a drug-effect and is good for
prescribing on. Hahnemann describes as a rare and transient effect of Opium in excitable subjects, occurring primarily but really a
sort of reflexion of the secondary state: "Deathly paleness, coldness of the limbs and
whole body, cold perspiration, timorous anxiety, trembling and despair, mucous stools,
transient vomiting and short cough, and very rarely certain kinds of pain." The last
remark is to be taken in connection with a previous one to the effect that Opium "does not cause in its primary action one single
pain." Here again Hahnemann's negative must be taken with caution. No doubt abnormal painlessness is a grand keynote for Opium;
but in the pathogenesis many acute pains will be found, and among them this recorded by
Hahnemann himself: "Horrible labour-like pains in uterus, which compelled her to bend
the abdomen double, with anxious, almost ineffectual urging to stool." Whether this be
"primary" or "secondary" I know not; but in one of the worst cases of
painful menstruation I have ever had to treat Op. 30
gave greater and more lasting relief than any other remedy. In one patient to whom I gave Op. 30 for constipation, it caused with the onset of the next
period "sharp pain which caused vomiting and a desire to sit doubled up and keep
warm." J. P. Willard (H. W., xxxii. 168) has
repeatedly given permanent relief in cases of suffering with Op.
2x without producing any narcotic effect. Opium can
cause cramps and even tetanus as well as the opposite state, the tetanic properties chiefly
existing in the alkaloid Thebain. Opium causes tetanus in frogs but has no effect whatever on
birds. The grand characteristic of Opium is the
drowsiness, inertia, torpor, absence of sensation, absence of reaction, which appears is its
general effects. In all complaints with great sopor; painlessness; complaining of nothing
and wanting nothing, Opium may be required. I remember
reading of the cure of an ulcer of the leg. There were no
sensations on which a remedy could be diagnosed, but the absence
of sensations indicated Opium, and Opium cured. "Want of susceptibility, trembling," is
another feature of the same state; lack of vital reaction. Inertia of the intestines results
in constipation; of the bladder, in retention; of the uterus, in suspension of the menses.
Generally speaking, all secretions are checked except that of the skin, which is excited.
This arrest of action seems to explain the sensation of obstruction which occurs in inner
parts; and in intestinal obstruction Opium has won many
triumphs. It was part of Owen Thomas's treatment of intestinal obstruction to give drop
doses of Op. Ø, and feed the patient on meat soups only─no
milk, farinaceous foods, or solids. His idea was to keep the intestines quiet, but the
action was clearly homœopathic. In ileus and strangulated hernia it has been given with
success and reversed peristalsis and fæcal vomiting are leading indications here. It is
equally indicated in the involuntary and unconscious passage of urine and fæces from
paralysis of sphincters. Also in uterine inertia during labour Opium
is often needed. On the other hand, Opium, which is a
very dangerous remedy to give to children, has this effect on the fœtus in utero, that
instead of making it quieter it makes it more lively; hence Opium
is one of the chief remedies for fœtal movements when they become excessive. Opium also follows Acon. as a
remedy in the asphyxia of the new-born, and in puerperal convulsions. In the cerebral
complaints calling for Opium there is generally the deep
red face, the stertor, and stupor to guide. These are found in apoplexy; in insensibility,
and partial or complete paralysis resulting from fright, the fear still remaining; from
charcoal vapour; from inhaling gas; from alcohol. The apoplexy of drunkards is accurately
pictured in Opium poisoning. The spasms of children
occur at the approach of strangers, from nursing after the mother has had a fright; from
crying; eyes half open and upturned. Screaming before and during a spasm. Epileptic attacks
occurring during sleep. Sleep follows the convulsions. Loud snoring. The delirium of Opium is marked by: Great loquacity; visions of animals starting
out of various parts of the room. Delirium tremens of old sinners; very little drink is
sufficient to bring on an attack. The face has a constant expression of fright. If he sleeps
the sleep is stertorous. On the other side of the sleep picture, partly mixed up with sleep
phenomena, is the exalted sensitiveness and timidity; sensitiveness to fright and other
emotions. Sleepy but cannot sleep, sleepless with acuteness of hearing disturbed by sounds
ordinarily not heard at all. Twitching trembling of head, hands, and arms. In tetanus Opium is called for when the spasms are ushered in with a loud
shriek. Nervous and irritable, tendency to start. Opium
is a great fever remedy. The Opium habit is very common among inhabitants of the fen districts of Lincolnshire, possibly contracted to
palliate the debility and depression left by ague. Sweat as a concomitant is a
characteristic of Opium─complaints
appearing with perspiration. The skin is hot and damp. An opium-eater's face glistens with
fine perspiration. "Very hot, sweltering perspiration." Another condition is
described by Guernsey thus: "Patient may not feel cold all day, but may have only a
little chill, and at night, when in bed, complain that the sheets
feel so very hot." T. F. Allen (H. R.,
xiv. 481) remarks that Opium fever may be closely allied
to that of Aco. (The Ranunculaceæ are not far removed
from the Papaveraceæ.) The Opium fever may have high
temperature without distinct inflammatory process. It is characterised by intense thirst and
great sleepiness, and is without the anguish, fear, and restlessness of the Aco. fever. The Opium fever
may be periodic─intermittent or remittent. Gels. fever is like Opium fever but without thirst.
In regard to the almost universal use of Opium or its
alkaloids in cases of cancer in old-school practice, Snow contends that it has a certain
degree of power over the cancer process. From what we know of its botanical relatives, Sang. and Chel., this may be
true.─Villers cured with Op. 200 a
case of hystero-epilepsy having these characters: Attack preceded by sensation of swelling
of body. Veins protrude; face bluish red. Complete unconsciousness. C. N. Payne (Med. Adv., xxv. 198) relates the case of a little girl, aged two,
who had never slept properly since birth. She went to sleep at usual time and slept till 10
p.m., when she waked moaning, crying, and tossing about; seems frightened; almost falls
asleep again but wakens with a start, screaming and keeping in motion one arm and one leg
after waking. Seems sleepy but cannot sleep. Usual naps during day. Nux,
Bell., Cham. were given in succession in vain. It then transpired that before the
baby was twelve hours old it had had four different medicines put into its stomach, one of
them being Paregoric, which had also been given since,
as well as "quieting medicine." During the early months it had colic, with
constipation, stools in dark, hard, round balls. Clearly, it was a proving of Opium. Op. 200 was given. The
first night she slept much better, and rapid improvement and cure followed. Seward (Med. Adv., xxviii. 367) relates the case of a man who had been
given an allopathic dose of Opium for diarrhœa, with
the result that it made him "raving, fighting crazy, with red face, glistening
eyes." He struck out to hit the men who, he said, were after him to kill him, one of
them being a butcher with a cleaver. It took two men to hold him on the bed. He did not
recognise those about him. Camph. was given in repeated
doses, and he soon became quieter and would talk and laugh in a very lively manner. He said,
"Didn't I give it to them?" He soon after fell asleep, and slept all night,
remembering nothing of what had happened when he awoke next morning. Among the Camph. symptoms indicating it in the case are: "Great
excitement almost amounting to frenzy"; "most furious delirium, being with
difficulty restrained in bed by two men." Peculiar sensations
are: As if from smoke on the brain. As if flying or hovering in air. As if drunk. As if eyes
too large for orbits. As if sand or dust in eyes. As if eyelids paralysed. As of a band
round chest. As if intestines would be cut to pieces. As of a stone in abdomen. As if
something was forced through a narrow space in abdomen. Rolling as of a hard body in right
hypochondrium. As though anus closed. As if lower limbs severed from body. Opium is specially suited to:
persons of light hair, lax muscles and want of bodily irritability; persons insensitive to
well-chosen remedies. Childhood and old persons (first and second childhood). Drinkers. J.
B. S. King (Med. Adv., xxvii. 112) noticed that in seven
Opium-eaters (all that had come under his observation),
there was marked arching of the back, especially of the upper part of the back. In as many Morphia takers he had not met with a single case of arched back.
The symptoms are: < During and after sleep. < While perspiring. <
From stimulants. < From anxiety and fear; reproaches.
< During respiration. <
On moving. < During pregnancy. Touch < (bed feels hard); abdomen sensitive. There is great
susceptibility to cold air, but > uncovering head.
Laboured breathing > by cold air. Bed feels hot, > by cold, < from heat.
Symptoms reappear or are < on becoming heated.
Drinking water > dryness and cough. Getting cold = bronchitis. > Constant
walking.
