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rubbed into the skin diminishes the pain of chronic rheumatism
and myalgia ; probably in this case the friction is more efficacious
than the opium. Locally applied to sores and ulcers, it may
soothe the pain due to them. The ointment of nutgall and opium
[B. P., powdered opium, 2 ; gall ointment, 27 ;] will often re-
lieve the pain of piles and anal fissures, especially if a mild laxa-
tive is given by the mouth. [The warm decoction of the white
poppy is used in England as an anodyne fomentation. Poppy
capsules (Papaveris Capsulae, B. P.) are obtained from the
Papaver somniferum (nat. ord. Papaveracece) which is cultivated
in England. A ten per cent, decoction made from these con-
tains but a small and uncertain amount of opium, and its bene-
ficial effects, if any, are doubtless due to its warmth.]



360 ORGANIC MATERIA MEDICA.

Internal. Stomach. Morphine is of great service for the
pain of gastric ulcer, cancer, or even for simple painful dyspep-
sia. A solution [of morphine in water, i in 480 ; dose, i fl.
dr. ; 4. c.c.] is preferable to opium, as that may aggravate the
indigestion. Morphine is frequently combined with preparations
of bismuth, and taken immediately before or after meals. Many
forms of vomiting are relieved by morphine, because it decreases
pain, peristalsis, and excessive secretion.

Intestines. Opium is invaluable for stopping many varieties
of diarrhoea. If they will yield to any treatment, opium is most
likely to be successful. Intestinal colic, being due to irregular,
excessive peristaltic action, is generally relieved by opium, and,
indeed, so is abdominal pain of all sorts. In all inflammatory
conditions of the peritoneum full doses of opium must be given,
the object being so to paralyze the intestinal movements as to
prevent the peritoneal surfaces rubbing against each other.
[This method is quite likely to result in extensive peritoneal
adhesions.] It is the great mainstay in perityphlitis, acute peri-
tonitis, and after operations or wounds in the abdomen. Opium
is far preferable to morphine for abdominal cases ; if they are
severe, it must be boldly pushed, the patient being kept just
drowsy, with slightly contracted pupils ; and it often does not
matter if the bowels are not open for a week, or even more.
[The more recent and better practice, however, is to keep the
bowels slightly open by the use of the salines.] Morphine should
be given sparingly, if an abdominal operation is impending, for
it masks the symptoms.

Heart. Much skill is required to give opium properly in
heart disease. The hypodermatic injection of morphine is, on
the whole, to be preferred to opium. The great indication for it
is when cardiac pain and distress keep the patient awake. Often
it acts like a charm, a quiet refreshing sleep being the result of a
single injection. No doubt it is a cardiac depressant, but we
have to set against this the exhaustion of pain and insomnia.
Still, if the patient is very ill, these two factors must be carefully
balanced. [It is quite probable that in small doses administered
hypodermatically morphine is a cardiac stimulant.] It likewise



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 361

often relieves the pain of aneurism and intra-thoracic growths.
Its depressant effect may be to some extent counterbalanced by
combining belladonna with it.

Vessels. Opium is an excellent haemostatic. It is probably
efficient after absorption, but its great value is in gastric and in-
testinal haemorrhage, when it acts- pirtly by stopping peristaltic
movements. An excellent form in which to give it is the
Pilula Plumbi cum Opio, [B. P., powdered opium, i ; lead
acetate, 6 ; dose, 2 to 4 gr. ; .12 to .25 gm.] It is also very
useful in haemoptysis, for it acts as a haemostatic, and relieves
cough.

Respiration. It will be remembered that opium depresses
the respiratory centre ; therefore, by diminishing the activity
of the centre for the reflex act of coughing, it will often alleviate
the distressing symptoms, but it is only justifiable to give it when
the irritation which reflexly sets up a cough is irremovable, as in
intra-thoracic growth or aneurism, or when there is little or no
lividity and yet the cough is violent, as is often the case in pleu-
risy. The liability to lividity and asphyxia in many diseases
attended with cough must never be forgotten. Thus opium is
quite inadmissible in the last stages of bronchitis and pneumonia,
and, as a rule, in even the earlier stages of these diseases other
means of relieving the cough should be tried first ; and if opium
is given, it must be administered with great caution and judg-
ment. But in pneumonia without lividity it is very useful, les-
sening cough and pain, and promoting sleep. A "linctus
opiatus," a favorite remedy, is often given at night when a
cough keeps the patient awake. It may consist of tincture of
opium, i ; diluted sulphuric acid, i ; treacle, 15 ; water to [30
parts] . The object of the treacle is to soothe the pharynx
locally. Opium must also be given cautiously for [the relief of
the symptom] asthma, as there is in this disease a great liability
to the growth of a permanent opium habit. [Codeine is prefer-
able to all other preparations and alkaloids of opium for relief
of cough in pulmonary diseases.] An insufflation of one-half
grain [.03 gm.] of morphine acetate with 5 gr. [.30 gm.] of
starch is of great use when blown on to a larynx painful from



362 ORGANIC MATER1A MEDICA.

organic disease. A grain [.06 gm.] of boric acid or of iodo-
form is often added to each insufflation.

Nervous system Brain. It is in its action on this organ
that the marvellous value of opium is seen, its great function
being to relieve pain and to produce sleep when that is prevented
by pain. For these purposes it is best given hypodermatically
as morphine, for that acts more quickly, more certainly, and is
less liable to produce indigestion and excitement than opium.
Many [prefer] to inject a solution containing ^ gr. [.0013 gm.]
of atropine sulphate to each ^ gr. [.03 gm.] of morphine salt,
for by so doing the liability of morphine to upset the stomach
and bowels is diminished and its efficacy as an anodyne is not
sensibly lessened. It would be a long list to give all the diseases
the pain of which can be relieved by morphine ; cancer and
fractures are typical instances. Morphine is very valuable for
the insomnia of acute diseases ; but it should never be prescribed
for habitual sleeplessness, for fear the patient should contract the
habit of opium taking unless the disease causing the insomnia
is incurable, when the use of opium is quite justifiable. It
should not be given in gout, for that is often accompanied by
granular kidneys ; nor for hysteria, for often it does not relieve
hysterical pains, and an opium habit may be formed. It is es-
pecially useful in renal and biliary colic, and for the after-
pains of a confinement. In these cases it relieves the pain partly
from its power as an anodyne, and also because by its paralyzing
effect on unstriped muscle it relaxes the muscular contraction.
This property also makes it valuable in some cases of spasmodic
stricture of the urethra. It may be given as a sedative in de-
lirium tremens and some forms of mania, but often such large
doses are required that its use is not justifiable. Patients suffer-
ing great pain can take enormous doses without any symptoms
of poisoning.

Spinal cord. It has been used for pains of locomotor ataxia
and occasionally in convulsive diseases, but without much success.

Kidneys. It should always be remembered that morphine is
excreted with difficulty, if the kidneys are diseased. There are
several cases recorded in which persons suffering from Bright's



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 363

disease have been killed by quite small doses of opium. But it
often so markedly relieves uraemic dyspnoea, uraemic insomnia,
the cardiac dyspnoea which may complicate Bright' s disease, and
even uraemic convulsions, that it may be justifiable to inject ^
of a grain [.01 gm.] of a morphine salt subcutaneously into a
patient suffering from one of these conditions and run the slight
risk there is of poisoning him. But it is clear that this treatment
must be adopted very cautiously.

Skin. Combined with ipecacuanha [as in] Dover's powder,
opium is commonly given as a mild diaphoretic, in cases of slight
inflammatory disorder, such as a common cold.

Metabolism. Opium is administered to persons suffering from
diabetes, and the amount of sugar in the urine certainly dimin-
ishes and the patient's general health improves [but, however,
codeine is preferable.] Opium can, in the opinion of many,
control all varieties of inflammation, therefore it is given for a
cold in the head, for cystitis, pleurisy, etc. Occasionally per-
sons taking [morphine] suffer from retention of urine. We have
indicated the occasions on which opium and morphine are re-
spectively preferable.

[Heroine (not official) is morphine diacetic ester, which as a
hydrochlorate is freely soluble in water and alcohol. It gener-
ally produces no disagreeable symptoms, beyond headache, and
is said not to give rise to habituation. It occasionally produces
violent and uncontrollable vomiting. Since it diminishes the
sensitiveness of the respiratory centres to an excess of carbon
dioxide in the blood (Wood) it is useful in some forms of dysp-
noea. It is of great value in quieting cough. The dose is -fa to
gr.; .003 to .012 gm.

Dionine (not official) is morphine mono-ethyl ester hydro-
chlorate, which is readily soluble in water. It is somewhat
hypnotic, and like heroine is useful to allay cough. It is
said to check night sweats. The dose is ^ to ^ gr.; .01 to
.015 gm.

Peronine (not official) is morphine benzylic ester hydro-
chlorate, soluble in water. This is hypnotic, producing sound
sleep without previous excitement, and is useful in allaying the



364 ORGANIC MATERIA MEDICA.

cough of pulmonary tuberculosis, chronic bronchitis and pertus-
sis. Dose, T5S gr. ; .0004 gm. in pill.]

TOXICOLOGY.

Acute poisoning. There may be slight preliminary excitability ; but soon
drowsiness sets in. This is followed by incapacity for exertion, sleep, and
finally deep coma. The pupils are minutely contracted. At first the patient
can be roused ; but soon no stimulation will do this. Reflex action is abol-
ished. The skin is cold, the face and lips are livid, and toward the end
bathed in sweat. The pulse is weak and slow. The respiration becomes
slower and more irregular ; and last it is stertorous, and the patient dies from
asphyxia.

Diagnosis of poisoning by Opium. I. From Alcoholic poisoning. Often
very difficult, especially if, as commonly happens, the man poisoned with
opium has taken alcohol or had it given to him. The pupils are more con-
tracted in opium poisoning. The patient is more easily roused in alcohol
poisoning. Examine the urine for morphine and alcohol. Get a careful his-
tory. 2. From cerebral hemorrhage. If this is in the pons Varolii, the
pupils may be very contracted and the diagnosis difficult, but look carefully
for local paralysis. Usually cerebral haemorrhage takes place into the internal
capsule, and then the face and the limbs on the opposite side are paralyzed.
If the haemorrhage is a small one, and especially if it is in the pons, the tem-
perature may be raised ; if it is a very large one, the temperature falls for the
first few hours, but may rise subsequently. If the pupils are unequal, the
case is one of cerebral haemorrhage. 3. From Carbolic Acid poisoning, in
which there may be coma and contracted pupils. The acid produces white
patches in the mouth, and the odor is characteristic. 4. From Chloroform
and Ether poisoning, by the odor of the breath and of the vomited matters.
5. From uraemia, by the signs of Bright' s disease, especially albuminuria. 6.
From diabetic coma, by the smell of the breath and the glycosuria. 7. From
the comatose stage of an epileptic fit, by the history, the dilatation of the pupils,
and the fact that the lividity does not deepen. 8. From the same stage of a
Jit in general paralysis of the insane and other nervous diseases, by the same
symptoms.

Post-mortem. The appearances after death from Opium poisoning are
those always found after fatal asphyxia.

Treatment. Wash out the stomach. [This should be repeated at fre-
quent intervals, because the morphine, which has been absorbed, is excreted
into the stomach.] Give prompt emetics (see p. 139), as apomorphine [hydro-
chlorate] subcutaneously. Always arouse the patient by walking him about,
flapping him with a towel, pinching him, applying the faradic current, and
putting ammonia to the nose; a pint [500. c.c. ] of strong coffee should be
injected into the rectum, 2 ' ff gr. [.003 gm.] of atropine sulphate given subcu-
taneously, or 30 minims, [2. c.c.] of tincture of belladonna by the mouth, re-



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 365

peated every quarter of an hour. [Instances of recovery from opium poisoning
followed by death from the belladonna or atropine, used as an antidote, have
been observed. Great caution must be exercised if this antidote be used,
if indeed it should be employed at all.] If the breathing is very difficult, arti-
ficial respiration should be employed. Oxygen or amyl nitrite inhalations may
be used. The treatment must be kept upjbr several hours if necessary. [Po-
tassium permanganate, well diluted, has been successfully used in an amount
equal to that of the alkaloid ingested ; it almost immediately destroys the
latter, through its chemical action. It is claimed that it can act upon the
poison when in the blood so that a hypodermatic injection of it even for some
hours after its ingestion may afford relief. Wood, however, has found that its
hypodermatic injection does no good in morphine poisoning. The reports
have been so generally favorable that potassium permanganate should be used
immediately] .

Chronic Morphine poisoning. As many persons administer this drug sub-
cutaneously to themselves, chronic poisoning is very common. The symptoms
are that the patient loses all sense of right and wrong, he will lie and thieve
in the most degrading way, especially if his desire is to obtain the drug, and
absolutely no statement that he makes can be trusted. He neglects his work,
and lets his business go to ruin. He wastes and becomes anaemic, he suffers
from loss of appetite, indigestion, dry mouth, sluggish bowels, and a foul
tongue. The nails are brittle, the skin is dry, the hair turns gray early, and
falls out. There is sexual impotence, no erections take place, no semen is
secreted, there is amenorrhcea, and the flow of milk is stopped, but there is
polyuria. The pupils are small, there is loss of muscular power, slight ataxia
and tremor in severe cases. The arm, [leg, or portions of the body] are
scarred with marks of the [needle]. Even 20 gr. [1.20 gm.] of morphine
may be taken each day.

[Treatment. ]The patient must be isolated and carefully watched [so]
that he gets no morphine (he often eludes or bribes his nurse) ; it should be
diminished gradually, so that at the end of a fortnight he is taking none. If
it is stopped suddenly there may be serious collapse and wild delirium.
Relapses are very common, and a complete cure after a relapse is very rare.
[No reliance can be placed upon any of the advertised cures for the morphine
habit ; most contain morphine and the remainder are useless. The patient on
entering an institution for his cure must be most thoroughly and carefully
searched so that he shall not be possessed of a supply sufficient to keep him
comfortable during his treatment.

ANTAGONISM.

Atropine, Atropine [see p. 373] is a valuable antidote to morphine,
because it powerfully stimulates the respiratory centre. It also stimulates the
cerebral convolutions and intestinal peristalsis, both depressed by morphine.
It appears to be antagonistic to opium in other particulars, but is not really so.
Thus, although it prevents perspiration and dilates the pupil, these effects are



366 ORGANIC MATERIA MEDICA.

due to action on the peripheral nerve terminations, while morphine produces
contrary results by acting on the central nervous system. Still it has been
found that some of the undesirable effects that may follow the subcutaneous
injection of morphine, such as indigestion, constipation and cardiac depression,
may be avoided if T ff to T ^ gr. ; [.0004 to .0006 gm.] of atropine sulphate is
injected at the same time.

CODEINA. Codeine. An alkaloid obtained from Opium. C 18 H 21
NO 3 -f-HjO=[3i6.3i. Synonym. Methyl Morphine.

SOURCE. Obtained by evaporating the ammoniacal liquids, remaining
. after the precipitation of Morphine by Ammonia in the preparation of the
Hydrochlorate, treating the residue with water, precipitation with Caustic Pot-
ash, and purifying by dissolving in Ether and letting the Codeine crystallize
out on spontaneous evaporation.

CHARACTERS. White, or nearly translucent, orthorhombic prisms, or octa-
hedral crystals, having a faintly bitter taste, and slightly efflorescent in warm
air. Solubility. In 80 parts of water ; in 3 of Alcohol.]

Dose, X to 2 T - i [- OI 5 to - 12 S m -]

ACTION AND THERAPEUTICS OF CODEINE.

Codeine may produce tremors because it excites the cord more,
and depresses the higher faculties less, than morphine, and in man
its physiological action is in all respects much less than that of
morphine. It often relieves the hacking cough of phthisis. It
is also used for ovarian pain and to diminish the glycosuria in
diabetes [which it does more effectually than opium itself and as
an analgesic. It is an excellent substitute for morphine as an
ingredient of cough mixture. For diabetes it is usually given as
a pill, or in a syrup.] The phosphate (not official) has the ad-
vantage of being much more soluble than codeine.

[The following non-official alkaloids are sometimes used :

Thebaine. Synonym. Paramorphine. It is contained in Opium, 0.15 to
I per cent. It occurs in silvery scales or hard prisms, odorless and having a
bitterish taste ; soluble in Ether, Alcohol and Chloroform. ] This produces
powerful convulsions as the result of its action on the cord. Its subsequent
depressant action is very slight.

\_Narceine. It is contained in Opium o. I to 0.7 per cent., and occurs in
long quadrangular prisms, or white, silky needles, sparingly soluble in Alcohol,
and in water. It closely resembles morphine in its action, but is probably more
hypnotic and not so likely to be followed by disagreeable after-effects.]

Anarcotine. This is also known as narcotine, which is an [improper]



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 367

name, for the drug does not cause sleep. [It is contained in opium 1.3 to 10.
per cent., the amount varying greatly according to the source] ; it is the chief
constituent of Indian opium. [It exists in a free state in Opium from which it is
left behind when the drug is treated with water. It crystallizes in white, silky,
flexible needles which are tasteless and odorless. It is antiperiodic in its action
and is valuable not only as a preventive, but as well cures malarial fevers.]

APOMORPHIN^E HYDROCHLORAS. Apomorphine Hydro-
chlorate. C 17 H 17 NO 2 HC1[=302. 79.]

SOURCE. It is the hydrochlorate of an [artificial] Alkaloid obtained by
heating Morphine*in sealed tubes with an excess of Hydrochloric Acid. The
Morphine loses one molecule of water thus : Cj 7 H 19 NO 3 =:C 17 H 17 NO 2 -|-H 2 O.

CHARACTERS. [Minute, grayish- white, shining, acicular crystals, hav
ing a faintly bitter taste, and acquiring a greenish tint on exposure to light and
air. Solubility. In 45 parts of water ; in about 45 parts of Alcohol.]

Dose, ^ to \ gr. ; [.0027 to .01 gm.] hypodermatically, ^ to ^ gr. ;
[.003 to .006 gm.] by the mouth.

ACTION OF APOMORPHINE HYDROCHLORATE.

External. None.

Internal. Gastro-intestinal tract. Apomorphine is the
most powerful emetic we possess. It does not act locally on the
stomach, but solely on the vomiting centre in the medulla. It
is therefore an indirect emetic. This is shown by the fact that
when the drug is injected subcutaneously it produces violent vom-
iting if the vessels are so tied that none can reach the stomach,
but not if they are so tied that it cannot reach the medulla.

Circulation. Therapeutic doses have no effect beyond the de-
pressing action which may be attributed to the vomiting. Large
doses cause a rise in the rate of the pulse, probably from stimula-
tion of the accelerator nerves, and with fatal doses the pulse-rate
falls, because the drug directly paralyzes the cardiac muscle.

Respiration. This is at first stimulated by the act of vomit-
ing. The effect of poisonous doses is doubtful ; probably they
depress respiration. [Physiological experiments show that it
produces a watery discharge from the blood-vessels of the respir-
atory mucous membrane, which is found to be paler after the
administration of this remedy, as well as less oedematous. This
effect is produced within a half hour after ingestion, and it is not
in any respect the first stages of emesis.]



V^



368 ORGANIC MATERIA MEDICA.

Nervous system. The first result of toxic doses is to cause
delirium. Finally there is paralysis of the motor nerves, and
consequently of the muscles.

THERAPEUTICS OF APOMORPHINE HYDROCHLORATE.

Internal. Vomiting action. The advantages of apomor-
phine over the other emetics are that it is certain, prompt, and
powerful ; it can be given when emetics introduced directly into
the stomach would not act, and it does not irritate the stomach.
It is largely used in cases of poisoning. It is usually given hypo-
dermatically, [dissolved in camphor water ; i in 50. Dose, 4 to
8 minims ; .25 to .50 c.c. This must be prepared extemporane-
ously, as it will not keep.]

Expectorant action. It is, when given by the mouth, a valu-
able expectorant for bronchitis. [In an adult ^ gr., .002 gm.,
or i dr., 4. c.c., of the syrup (see below) will produce a watery
expectoration within the time above stated, and this effect will
last from two to three hours. It is particularly useful in the
early stages of acute bronchitis, in chronic dry bronchitis, in
chronic catarrhal pneumonia, and in old tuberculous patients who
are harassed by an unproductive cough.

Soporific action. Recently it has been claimed that when
given hypodermatically at bedtime, in dose just short of pro-
ducing emesis, sleep, closely approaching the normal, ensues.
This is not always the case, and its hypnotic action may be due
to contamination with other alkaloids.]

The British Pharmaceutical Conference recommends the fol-
lowing Syrup of Apomorphine : Mix Rectified Spirit, 84 ; with
the same amount of water ; dissolve in this Apomorphine Hy-
drochlorate, i ; add Diluted Hydrochloric Acid, 24 ; and finally
Syrup, 1728 parts. Dose, ^ to i fl. dr. [2. to 4. c.c.] The
drug may also be given as a lozenge.

HUMULUS.

HOPS. [The strobiles of Humulus Z/W.f Linne (nat. ord. Urticaced).
Habitat. Northern temperate zone ; cultivated.

CHARACTERS. Ovate, about 3 cm. long, consisting of a thin, hairy, undu-
lated axis, and many obliquely ovate, membranous scales, in the upper part



DRUGS ACTING CHIEFLY ON THE NERVOUS SYSTEM. 369

reticulately-veined, and towards the base parallel-veined, glandular, and sur-
rounding a subglobular achene ; color of the scales greenish, free from red-
dish or brownish spots ; odor, aromatic ; taste, bitter, aromatic and slightly
astringent.]

COMPOSITION. The chief constituents are (i) Lupulin. (2) Lupu-
linic Acid, II per cent., a bitter crystalline principle. (3) Valerol, i per
cent., an aromatic volatile oil giving the odor. (4) Resin, 9 to 18 per cent.
(5) Tannic acid, 3 to 4 per cent.

[^COMPATIBLES. Mineral acids, and metallic salts.

Preparation.

Tinctura Humuli. Tincture of Hops. Hops, 200 ; by macer-
ation and percolation with Diluted Alcohol to looo.
Dose, i to 2 fl. dr. ; 4. to 8. c.c.-]

LUPULINUM. Lupulin. A glandular powder, separated from the
strobiles of Humulus Lupulus Linn6 (nat. ord. Urticacetz).

[CHARACTERS. Bright, brownish-yellow, becoming yellowish-brown, res-
inous, consisting of minute granules, which, as seen under the microscope,
are subglobular, or rather hood-shaped, and reticulate ; aromatic and bitter.]

Dose, 5 to 30 gr. ; [.30 to 2.00 gm.]

Preparations.

i. Extractum Lupulini Fluidum. Fluid Extract of Lupulin.
Lupulin, 1000 ; by maceration and percolation with Alcohol, evapora-
tion and solution to looo parts.



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