Papaver somniferum. Poppy. N.O.Papaveraceae. Opium is the dried milky juice of the green, half-ripe heads of the poppy. Tincture.
PATHOGENESIS.
OPIUM is a very complex substance and contains a large number of alkaloids, at least eighteen in number, combined with meconic, lactic and sulphuric acids, and various fatty substances, caoutchouc, mucilage resin, albumin, glucose, and salts of ammonia, calcium and mangnesium. The principal alkaloids are morphine, codeine, papaverine, narcotine and the baine. of these, by far the most important is morphine, which, on the average, is present in opium in the proportion of 10 per cent., but varies in different specimens from 2.7 to 22.8 per cent. To its presence the action of opium is mainly due. The action of morphine is, no doubt, modified by the presence of the other alkaloids and various different substances, but only to a slight extent. The baine is the alkaloid most antagonistic to morphine, as it is a convulsant, but it is never present in a larger proportion than 0.3 per cent., so that its action is overshadowed by that of the vastly larger amount of morphine, and is only displayed in exceptional circumstances, either of special exceptional circumstances, either of special susceptibility on the part of the patient or from the specimen of opium containing much less than the average amount of morphine.
Opium must be taken as a unit, as such it has been proved, and as such it is used homoeopathically in the treatment of disease. In view, however, of its sometimes rather puzzling and contradictory action, it is well to remember that it is a complex substance made up of many elements that are not present is definitely fixed proportions.
Opium acts principally on the central nervous system, but it also affects some peripheral organs, such as the alimentary tract. It acts as a depressant, but depression is, in most cases, preceded by a brief period of excitation. This has been notably observed in the higher faculties which in some people are exalted, especially the imagination. Images are more vivid than usual, and though seems more rapid, the reaction time to flashes of light and sound is shortened, fewer errors are made in the correct association of words and sentences, and in making arithmetical computations, but at the same time the powder of reasoning and of forming correct judgments is lessened, control of thought is in abeyance, leaving the imagination to run riot, and will-power is deficient. This state of exalted imagination is soon succeeded by depression of the highest centres, and sleep follows, which may be either full of dreams or dreamless. The depression of the next highest centres occurs and the patient ceases to respond to any sound, light, or cutaneous stimulation; he feels no pain. He can, however, be aroused from the sleep, but immediately returns to it. As the dose is increased sleep becomes torpor, and finally, coma, from which he cannot be awakened. During this stage respiration is very slow, the pulse regular and moderate in frequency, the pupils are contracted to a pin point, the mouth and throat are dry, the face is purple and congested, and the skin warm and moist. As respiration becomes more depressed the face acquires a livid hue, cold perspiration collects on the forehead, the pulse is smaller and quicker, and just before the final arrest of respiration the pupils dilate widely. The heart continues to beat feebly for a short time afterwards. Death occurs from paralysis of respiration, which is slowed from the beginning, and becomes progressively slower as the dose is increased; as the rate slows the depth increases, but not sufficiently to compensate for the slowing. In late stages of poisoning Cheyne-Stokes respiration may occur.
On awaking from sleep after a moderate dose some people feel quite well, but with most there is languor, with headache, nausea, and perhaps vomiting, and also trembling and marked depression. Itching of the skin and redness may occur while the effect of the drug is passing off.
Opium depresses the cerebral motor centres but not so completely as the intellectual; the chief depressing action falls on the respiratory centres and the paths by which pain stimuli reach the consciousness.
The motor cells of the spinal cord are at first slightly stimulated and reflex excitability is exaggerated, but they are soon depressed, and reflex movements are obtained with difficulty.
The circulatory centres in the medulla are but little affected. Blood-pressure remains high, the peripheral arteries are not altered in caliber, except those of the skin, and of the head and neck, the vessels of which are dilated, rendering the face flushed and hot, and, as asphyxia comes on, purple or cyanotic. General perspiration is often observed, which on the head and body is usually warm, on the extremities cold.
Digestion.-Secretory glands are rendered less active by opium, with the exception of the sweat glands; we have consequently dry mouth and diminished gastric, intestinal and pancreatic secretions. General metabolism is slightly decreased. There are violent thirst, canine hunger without appetite, nausea and vomiting, with heaviness and pressure, and, may be, pain in the stomach. The depressing action of opium on the sympathetic nervous system causes peristalsis to be lessened or abolished, and there is obstinate constipation from torpor of the intestines. Desire for defecation is absent. Faeces and flatus accumulate in the bowels and cause great distension of the abdomen. The stools are hard, black balls, which frequently have to be extracted by the finger. Sometimes there is violent colic, with at the same time spasmodic stricture of the anus; this is probably a secondary reaction, as is also the diarrhoea which may follow recovery from a large dose, and which is common in opium smokers who are chronically poisoned by the drug.
Twitching of muscles and trembling are frequently seen in cases of chronic poisoning.
The temperature centre in the brain is less sensitive from the taking of opium, with the result that the patient’s body is not accommodated to changes of temperature so well as usual.
Skin.-Opium may produce an erythematous eruption on the skin and much itching, more noticeable with morphine than with opium. Continued use of opium leads to toleration, when sometimes enormous doses are necessary to produce any effect.
The peculiarity of the action of opium is the slightness of the stage of stimulation and the predominance of that of depression. The main influence is exerted on the highest, or latest evolved, portion of the nervous system. In man this will involve the intellectual faculties; in other mammals the excito- motor areas are chiefly affected, and in them the initial period of excitation may be accompanied by convulsive movements; in frogs the stress falls upon the spinal cord, and violent convulsions occur. In some men and in children the stage of excitation is more evident than in the average individual, and delirium, sleeplessness, muscular twitchings and even convulsive actions may be produced. Children are easily poisoned by it, and women are more easily affected than men.
Opium is excreted by the bowel, a small quantity appears in the urine and milk, and the remainder is oxidized in the liver.
THERAPEUTICS.
Opium has for centuries been used to relieve pain and to induce sleep, especially when sleeplessness has been due to pain, and to allay excessive cough and the paroxysms of asthma. It should not be used in chest diseases when there is excessive expectoration, as its sedative effect lessens cough and leads to accumulation of mucus in the bronchial tubes, which might end in asphyxia.
Opium is used to lessen the movements of the bowels in obstruction, peritonitis, perforation, haemorrhage and other intestinal disorders, to antagonize the spasm of the intestines that occurs in lead colic and to check diarrhoea. Old cases of malaria and diabetes have been thought to benefit from its administration. It is often given either as opium or by hypodermic injection as morphia as a preliminary to general anesthesia, and when given in association with scopolamine it has been used in labour (twilight sleep), and also as an anesthetic in operations. For this latter purpose, one-sixth of a grain of morphine with one two-hundredth of a grain of scopolamine is injected one and a half hours and half an hour before an operation. Morphine is also used with scopolamine for the induction of spinal anesthesia. Combined with ipecacuanha in Dover’s powder it is used as a diaphoretic.
These are the conditions in which opium is daily administered by the orthodox school. This treatment is not homoeopathic; the results are obtained by making use of the direct action of the drug in abolishing the sensation of pain and diminishing reflex action. Its employment is from a homoeopathic point of view justifiable only to tide over an emergency, as, for example, in a case of perforation of the bowel, or in chronic cases to allay pain or produce sleep when recovery is hopeless. But in any ordinary case of pain or sleeplessness, resort to opium on the part of the physician indicates that his knowledge of homoeopathy is deficient, as these troubles can always be overcome by removing the cause, if it can be found, and by administering the similarly acting drug. The use of opium in chronic disease will very likely induce the opium habit, for the increasing tolerance of the drug demands ever increasing doses to produce the desired effect, and in addition many evils result, such as diminished appetite, impaired digestion, nausea and vomiting, constipated bowels, a general mental and moral deterioration, increased sensitiveness to pain, and, last, but not least, a masking of symptoms that renders diagnosis of the true condition of the patient more difficult.
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,