THERE are various points in Opium which are very interesting and which make a striking contrast with Nux vomica. It has very many of the symptoms which one associates with Nux-for instance, the severe morning headache, the nausea, the loss of appetite and the dislike of getting up. Occasionally these are indications for Opium in people who have had a really bad debauch and have been completely “blotted out” the night before. It is a more extreme stage than the ordinary gastric upset from an indiscretion which one associates with Nux.
These, however, are not the conditions for which one ordinarily thinks of opium in digestive disturbances. The outstanding feature is complete, or almost complete, obstruction somewhere in the digestive canal, usually in the bowel. There are very clear indications in different pathological conditions associated with obstruction and obstructive vomiting.
The condition which most commonly calls for Opium is paralytic ileus after an abdominal section. There is a loop of bowel which is completely paralysed, accompanied by reversed peristalsis and the pumping of bile back into the stomach. The patient vomits violently, bringing up masses of bile-stained, rather foul smelling vomit, and has an extreme sensation of abdominal distension. This is the commonest condition in which Opium is most useful.
It is very interesting to note that in the majority of cases of a paralytic ileus, there is a history that opium, or one of its derivatives, has been given before or after the operation.
Another condition frequently indicating Opium is intussusception in children. Again, there is intestinal obstruction with spasmodic intestinal contractions, colicky attacks, extreme urging, and the passage of nothing but a little blood-stained mucus. Later, there is vomiting, first of bile and then of faecal material. In these cases, when seen early enough, I have known all the signs of intussusception entirely disappear after being given Opium and without any operation at all.
There are strong indications for Opium in intestinal – obstruction cases of mechanical obstruction, such as strangulated hernia, volvulus, etc. Again there are the same group of symptoms-violent colicky pains with the sensation as though an attempt were being made to force something through a narrow passage which was completely blocked, the development of reverse peristalsis and, later, typical faecal vomiting.
In all these cases, there is the same clinical picture : the feeling of acute abdominal distension, a sensation as though the abdomen were nearly bursting, and that if some flatus could be passed they would be better, but nothing is passed per rectum except, possibly, a little blood-stained mucus.
From the homoeopathic prescribing point of view, there are several typical features which have to be present in order to individualise the Opium case. The first is the incessant nausea. The patients, as a rule, have no appetite at all, and reject any suggestion of food. There is an exception-in a certain number of cases of paralytic ileus there is horrid, empty, sinking sensation which may be described as hunger, but from which eating brings no relief.
These patients complain of intense thirst and a persistently dry mouth which nothing will relieve. In cases of paralytic ileus with the patient vomiting pints of fluid, it is not surprising that he should be as dry as a bone. Also with this condition there is frequently a very dry, furred tongue. It may be simply a white coating to the tongue or, if the condition has progressed, a thick brownish-black coating. But it is the intense dryness of the tongue that is the outstanding feature.
Another pointer to Opium is that all these patients are worse after they have been asleep. You are often told that the patient was moderately comfortable and fell asleep, he slept for a period of twenty minutes or half an hour and then began to twitch a little-his arms twitched, his legs twitched-and finally he woke up complaining of very severe headache. Immediately on beginning to move, he felt violently sick and brought up pints of this bile-stained fluid. During these attacks, the abdomen becomes extremely sensitive to touch and to pressure.
Quite frequently, there is the history that these patients get very much worried at night, they tend to become delirious and have extreme night terrors, of horrible, terrifying visions.
In appearance, when at rest these patients tend to look horribly drawn and almost withered. With the acute attack of colic they flush up and may become actually cyanosed; they also tend to become sweaty, the skin feeling very hot and moist.
In the acute attacks of pain, the pupils become contracted. When the attack is over, there is an appearance of extreme exhaustion and the patient is hardly able to keep his eyes open. During the night terrors these patients sometimes have widely- open, staring eyes, but without the contracted pupils normally associated with Opium.
Complicating their thirst, these patients often complain of a spasmodic feeling in the oesophagus on swallowing; they may have actual difficulty in getting fluids down, and the attempt may make them sick.
I remember seeing one man with a paralytic ileus in whom this symptom was very marked. He was simply parched with thirst, his tongue was as dry as a parrot’s; but if he took a few sips of water, up it came-followed immediately by the best part of a pint of green bilious vomit. He responded at once to a few doses of Opium and made and excellent recovery.
A striking point about the Opium pains is manner in which the patient describe them, saying that they actually feel that they have an obstruction. The man I mentioned said he felt as if his stomach contracted and tried to force the contents through a narrow outlet which seemed to be blocked; the whole process was then reversed, the contents swished back into the other end of the stomach and came up his throat, he could not control it and the fluid simply poured out.
After he became convalescent, this patient had a recurrence of a similar sensation in his pyloric region. He described this as though there were a tight band narrowing his pylorus, and as though his food could not get through it, and he insisted on having another X-ray (which was negative) to see if he had not got adhesions tying down his duodenum and obstructing the passage. Opium entirely cleared up this symptom and he had no recurrence. This is the commonest description of Opium that will be given.
Another description of the discomfort of Opium is that there is a hard lump-almost like a stone-in the abdomen, which obstructs the passage of the intestinal contents.
The colic of Opium is very bit as violent as that of Colocynth: the patients have such intense pain that it feels as if their bowels were being cut to pieces. (That description may be met with in any obstructive condition.)
Occasionally there are indications for Opium in cases of organic – that is to say, carcinomatous-stricture of the bowel where there are definite obstructive symptoms and acute colicky pains, with a horrid obstructed sensation and the involuntary passage of small quantities of rather offensive diarrhoeic stool.
One ordinarily associates the Opium picture with the hot- blooded, flushed, cyanotic, somewhat apoplectic patient. But in these abdominal cases, there is likely to be a sensation of heat and general congestion tending to be confined to the head and neck, very often with a cold, clammy sweat over the rest of the body, particularly the extremities.
It is obvious that though the sphere of action of Opium may be a little limited, it is a very important emergency drug. One should know it well for when called for it is of immense value.