From all that has now been said on the subject of epilepsy as a disease which imitates many varieties of narcotic poisoning, the medical jurist will probably arrive at the conclusion, that, although a diagnosis cannot always be drawn with certainty, yet in numerous cases the consideration of the symptoms and appearances after death will enable him to say positively that poisoning is out of the question, and in many others that poisoning is highly probable.
Inflammation of the inner membranes of the brain, which constitutes the acute hydrocephalus or acute meningitis of authors, is not in general apt to cause much ambiguity; for its progress is commonly gradual, well-marked and less rapid than most cases of narcotic poisoning: and the appearances in the dead body, such as effusion of serum, lymph or pus on the outer surface of the brain or in the ventricles, are for the most part obvious.
Dr. Abercrombie, however, has described a form of it occurring among children during the existence of other diseases, particularly of the chest, which might be the cause of perplexity; for its course is sometimes finished within a day, its symptoms are delirium, convulsions and coma intermingled, and the only morbid appearance is congestion of vessels on the surface and in the substance of the brain.[1658] The affection now alluded to imitates closely, both in its progress and in its signs after death, some varieties of poisoning with the vegetable narcotico-acrids, such as belladonna, stramonium, and hemlock. But the latter cases, when they prove fatal, seldom last nearly so long as a day, while the instances of meningitis under consideration rarely cause death within twenty-four hours. Dr. Abercrombie also notices a parallel disease occurring among adults; but it is in them always marked by a considerably longer, though often more obscure course.[1659]
Dr. Bright takes notice of a similar affection under the title of “Arachnitis with excessive irritability” occurring chiefly among very intemperate people, but independently of previous disease. In general the disorder has a well-marked course of at least several days’ duration. But in two of the instances he has given the early stage was very obscure, the only symptoms having been headache and sickness of no great severity for four or five days; after which delirium came suddenly on, and was followed by coma, and by death within thirty-six or forty hours. The sole appearances found within the head were some serous effusion and vascularity on the surface of the brain and in the ventricles.[1660] To these illustrations may be added the heads of a remarkable case which occurred here in the person of an eminent lawyer, and for the particulars of which I am indebted to Dr. Maclagan. For three days there had been occasional headache, not great enough to prevent him pursuing his ordinary avocations, yet becoming so troublesome on the morning of the third day as to induce him to have leeches applied. But next morning he was seized rather suddenly with quickly increasing coma, and in forty hours more he expired. In this instance the whole surface of the arachnoid membrane, both over the hemisphere and in the ventricles, was found lined with soft, yellowish-green lymph.
In such cases it is apparent that an inspection after death will often unfold their real nature, where the history of the symptoms may leave it in doubt. But even without an inspection it is not likely that a careful physician could mistake them for narcotic poisoning; for independently of other considerations, the severe symptoms are ushered in by a precursory stage of ill health, commonly indicating an obscure affection of the head, and such as no one but a careless observer could fail to discover and appreciate.
It is not improbable, however, that acute meningitis may seem to prove suddenly fatal, in consequence of its course being in a great measure latent. The following case reported by Mr. Davies of Somers Town, seems of this nature. A woman, who had previously complained only of slight headache, was attacked after breakfast with violent vomiting for half an hour, when she fell down, and immediately expired. After death there was found great gorging of the vessels of the cerebral membranes, with opacity and thickening of the pia mater and arachnoid coats, and an effusion of nearly five ounces of bloody serum under the dura mater.[1661] Such a case might give rise to great perplexity in a charge of poisoning, until the examination of the body unfolded its true nature.
I should scarcely have thought it necessary to mention chronic meningitis among the diseases apt to imitate the effects of narcotic poisons, because it is commonly marked by a long and distinct course. But the following case, for which I am indebted to Dr. Arnoldi of Montreal, will show that, like other diseases of the head, chronic meningitis may be latent in its early stage, and may, after developing itself, terminate in a day, and then in some measure imitate poisoning with narcotics. A middle-aged female, subject for a twelvemonth to a purulent discharge from the left ear, and occasional headache, which was supposed to be rheumatic, was seized one morning with acute pain in the head, followed in a few hours by convulsions and tendency to coma; under which symptoms she died within twenty hours, although treated actively from the commencement. On dissection, the brain and pia mater were found healthy, except at the part corresponding with the petrous portion of the left temporal bone, where the brain was a little softened. The corresponding part of the temporal bone and the adjacent part of the occipital were completely denuded and covered with pus, which had established a passage for itself into the cavity of the ear.
Inflammation of the brain itself, the ramollissement of French writers, occasionally excites symptoms not unlike those produced by some narcotic poisons; and in a few instances its course has appeared to be equally short. It requires particular notice, because the appearances left in the dead body are sometimes apt to escape observation.
This disease in its well-marked form has been noticed by various authors from Morgagni downwards. But the first regular accounts of it were given in 1818 by Dr. Abercrombie,[1662] and in 1819 by M. Rostan[1663] of Paris, and Professor Lallemand[1664] of Montpellier. Its symptoms are allied to those of apoplexy and epilepsy. But the comatose state is generally preceded by delirium or imperfect palsy, and often by a febrile state of the circulation. Contraction of the voluntary muscles, once supposed to be a distinguishing sign of this disease, is neither essential nor peculiar to it. In the dead body it is recognized by the presence either of an abscess in the brain,—or more commonly of a nucleus of disorganized cerebral tissue surrounded by unnatural redness or softness,—or sometimes of a clot of blood surrounded by similar softening. Occasionally, when the disease kills in its early stage, nothing is found but redness of a part of the brain, and slight softening of the tissue, recognizable only by scraping it with the edge of the scalpel.
In the form in which it is commonly seen, and as described by Rostan and Lallemand from a great number of cases, it can hardly be confounded with the effects of narcotic poisons; for its course is much slower, being seldom less than several days when it proves fatal.[1665] Yet in some instances it may prove fatal instantly. Lancisi notices the case of an Italian nobleman, who after an apoplectic fit became liable to frequent attacks of lethargy,—who at length died quite suddenly more than a year afterwards,—and in whose brain an organized clot was found, with extensive suppuration of the brain around it.[1666] An unequivocal case of the same kind has been related by Mr. Dickson, a navy-surgeon. An elderly sailor, who for months before had done duty, eaten his rations, and drunk his grog as usual, suddenly dropped down while in the act of pulling his oar, and died at once; and after death there was found in the middle lobes of the brain an extensive abscess, which had made its way to the surface.[1667] Such cases might, in certain circumstances, be mistaken for the effects of large doses of hydrocyanic acid; but the morbid appearances are of course quite characteristic. M. Louis has related an instance like the last two, but where the disease was altogether latent. His patient after a long illness died of diseased heart, the ventricles of which communicated together. He never had a symptom of disorder of the head; yet on dissection an extensive recent softening was found in the right corpus striatum and another in the right thalamus.[1668]
None of the treatises I have seen on the subject make mention of a variety of this disease intermediate between suddenly fatal cases and those which last several days,—a form in which the patient’s illness endures for a few hours only, and which, both in the special symptoms and in their course, imitates exactly the effects of some narcotics. Two such cases have come under my notice, both of them judicial, poisoning having been suspected. One of them proved fatal in an hour and a half, the individual having previously been in excellent health; and the only appearance of disease was softening of a considerable part of the surface of the brain where it lies over the left orbit. The other was more remarkable in its circumstances. In November, 1822, a man, who had previously enjoyed excellent health, was found one morning in a low lodging-house in the Lawnmarket comatose, and convulsed; and he died seven hours afterwards. The neighbours spread a report, that the woman of the house had poisoned him, with the view of selling the body; and by an odd coincidence the police, when they went to apprehend the woman, found an anatomist hid in a closet. The body was judicially examined by Sir W. Newbigging and myself; and we found an ulcer on the forepart of the left hemisphere of the brain, and a small patch of softening on each middle lobe.
It is only in cases like the last two that the disease is likely to be mistaken for the effects of poison; and the morbid appearances will at once distinguish them. But it is requisite to remember that softening of the brain when not far advanced is apt to escape notice, as it is not necessarily attended with a change in the colour of the diseased part. In the first of the two cases I have related, the cause of death was very nearly assumed to have been simple apoplexy, when at length the true disorder was unexpectedly noticed. I presume, indeed, that strictly speaking, both of the cases which came under my notice ought to be considered as simple apoplexy excited by pre-existing ramollissement.
This disease is not here mentioned, because its symptoms and progress resemble very closely those of poisoning with the narcotics; for it causes epileptic symptoms, which, besides that they are preceded for some time by other head affections, very seldom prove fatal in less than three days. But some notice of it is necessary, because the disease is rare and of recent discovery, so that the appearances left by it in the dead body may escape observation. Besides, the physician is at present imperfectly acquainted with it, and therefore, when a more extensive collection of cases shall have been made, it may be found to prove at times fatal so rapidly as to admit of being confounded with narcotic poisoning. Hypertrophy of the brain, it is true, is always a chronic or slow disease, but, like other diseases of the brain, its early stages may possibly be so completely latent that the patient may appear to die of a few hours’ illness. This, however, must be left to the determination of future experience. The most rapid case yet published proved fatal twenty-four hours after the first appearance of symptoms.
The appearances left in the body are increased density and firmness of the whole brain or a part of it,—flattening of the convolutions on their outer surface, so that their grooves are almost obliterated and the investing membrane uncommonly dry,—unusual emptiness of the blood-vessels of the brain and its membranes,—and a protrusion of the brain upwards on removal of the skull-cap, as if the organ were too large for its containing cavity.[1669]
Some pathologists doubt the existence of hypertrophy of the brain as a distinct disease, and conceive that the appearance of flattening of the convolutions is produced by serum effused between the dura mater and arachnoid membrane. But this explanation will not account for those cases in which it is expressly stated that little or no fluid was to be found in any part of the brain or in the base of the skull.
It is not necessary to say much on the acute diseases of the spinal cord, which are apt to be confounded with the effects of narcotic poisons. The diseases are extravasation of blood into the spinal canal, inflammation of the membranes, and inflammation [ramollissement] of the cord itself. These disorders are commonly marked by obvious and characteristic symptoms, as well as a much slower course than that of the affections induced by narcotic poisons. But occasionally they approach closely the characters of some of the slow cases of narcotic poisoning,—palsy being absent, the leading symptoms consisting of delirium, convulsions, and coma, and the fatal event occurring within the third day. Dr. Abercrombie and M. Ollivier have related examples of the kind arising from extravasation of blood,[1670] serous effusion,[1671] and softening of the cord.[1672] Such cases are exceedingly rare; but the possibility of their occurrence should impose on the medical jurist the necessity of examining the spine with care in all judicial cases of alleged narcotic poisoning, especially when death has not been rapid.
The only other natural disease requiring notice under the present head is the Asphyxia Idiopathica of the late Mr. Chevallier. It may be the cause of embarrassment in questions regarding narcotic poisoning, when the course of the symptoms to their fatal termination is rapid, and was not witnessed by any person; for it causes death with equal rapidity, and its signs in the dead body are very obscure. It has been observed chiefly among women in the latter months of pregnancy, or soon after delivery; but it has also been known to attack the male sex. It generally commences during a state of perfect health, and is seldom preceded by any warning of danger. The person suddenly complains of slight sickness, giddiness, and excessive faintness, immediately seems to sleep or swoon away, and expires gently without a struggle. The only appearance of note found in the dead body is unusual flaccidity and emptiness of the heart.[1673] But even these slight appearances are not constant; for in a case related by Rochoux of a woman who, while in a state of perfect health, suddenly grew pale, slipped off her chair, and died on the spot, the auricles of the heart contained a great deal of blood.[1674] This singular disorder appears to consist of nothing else than a mortal tendency to fainting; and it may prove fatal either in the first fit of syncope, or after an hour and a half.—Under the same head are probably to be arranged the cases of sudden death described by M. Devergie under the title of Death by Syncope. He has given scarcely any account of the circumstances attending death; but it may be inferred from his classification of the cases that fainting immediately preceded it. In all of them he found blood in both sides of the heart; and the blood, contrary to what happens in other kinds of sudden death, had separated into clear serum, and fibrin free of colouring matter.[1675]—Under the same head also may be noticed a denomination of cases, which, though alluded to before by various pathologists, were first distinctly characterized by M. Ollivier, where death is caused on a sudden, apparently by the disengagement of a large quantity of aëriform fluid from the blood in the heart and great vessels. Among the instances described by Ollivier, it appears that death repeatedly occurred quite suddenly while the individuals enjoyed sound health; and the only appearances of any note found in the body were tympanitic distension of the heart, absence of blood there and in the great vessels, and the existence of a gaseous fluid in numerous globules throughout the blood-vessels of the brain. The circumstances of death and the appearances in the dead body are much the same with those observed from the admission of air into the veins during surgical operations. A case of this kind, owing to its suddenness, might be confounded with the effects of the more active narcotic poisons, such as hydrocyanic acid, especially as its characters in the dead body might escape notice.[1676]
Death often takes place from sudden syncope in organic diseases of the heart. Such cases may be confounded with the most rapid variety of poisoning with hydrocyanic acid; and if the duration of the symptoms preceding death is unknown, they may give rise to a suspicion of poisoning generally. But they are at once distinguished by the morbid appearances. A trivial organic derangement may be the occasion of instant death.
The genera comprehended in the class of narcotics are opium, henbane, lettuce-opium, solanum, hydrocyanic acid, and the deleterious gases. Of these genera the last is by no means a pure one, for it includes many gases which act as irritants only; but it is more convenient to consider them together, than to distribute them into separate classes. Some other vegetable substances besides henbane, lettuce-opium, and solanum, possess nearly the same properties; but as they likewise cause irritation, they are arranged more appropriately in the next class, the narcotico-acrids.
Most narcotic vegetables owe their poisonous properties to a peculiar principle, probably of an alkaline nature, and slightly different in each. This discovery was made with regard to opium in 1812; and the discovery of the active principle in that drug has been followed by the detection of analogous principles in most narcotics, as well as in many narcotico-acrids.
These principles are generally crystalline, soluble in alcohol and the acids, little soluble in water, free from mineral admixture, and entirely destructible by heat. When purified with the greatest care, they still retain decided alkaline properties; but on account of their number and the low power of neutralization their alkaline nature was long denied; and they have been conventionally styled alkaloids.
In their natural state they exist in combination with various ternary acids, some of which are peculiar; and they are likewise intimately blended, or more probably united chemically, with other inert principles of the vegetable kingdom, particularly resinous and extractive matters, to which they adhere with great obstinacy.
They are all highly energetic, and generally concentrate in themselves the leading properties of the substance from which they are obtained.
The experiments, which have led to the conclusion, that the narcotic poisons act on the brain by entering the blood-vessels, have been repeated with their alkaloids, and have yielded similar results. But the alkaloids are in equal quantities much more energetic than the crude poisons. Their effects indeed are truly formidable, and some well authenticated instances of their action appear hardly less marvellous than the most extravagant notions entertained in ancient times of the operation of poisons. One of them, the principle of nux vomica, which, however, does not belong to the present class, is so active that in all probability a man might be killed with the third part of a grain in less than fifteen minutes.
It is very difficult to detect some of the vegetable alkaloids; and it is fortunate, therefore, that they are rare, and not to be procured but by complex processes.
Chemical analysis does not by any means supply so good evidence of poisoning with the narcotics as it does of poisoning with the irritants. Their chemical properties are not very characteristic, and they are not well developed unless with a larger quantity of the poison than will usually be met with in medico-legal investigations. This remark, however, does not apply universally; and it is probable, that, as organic analysis goes on improving, better and more delicate processes will be discovered.
To the medical jurist opium is one of the most important of poisons; since there is hardly any other whose effects come more frequently under his cognizance. It is the poison most generally resorted to by the timid to accomplish self-destruction, for which purpose it is peculiarly well adapted on account of the gentleness of its operation. It has also been often the source of fatal accidents, which naturally arise from its extensive employment in medicine. It has likewise been long very improperly employed to create amusement. And in recent times it has been made use of to commit murder, and to induce stupor previous to the commission of robbery. Mr. Burnett, in his work on Criminal Law, has mentioned a trial for murder in 1800, in which the prisoners were accused of having committed the crime by poisoning with opium; and although a verdict of not proven was returned, there is little doubt that the deceased, an adult, was poisoned in the way supposed. A few years ago, a remarkable trial took place at Paris, where poisoning was alleged to have been effected by means of the alkaloid principle of opium; and the prisoner, a young physician of the name of Castaing, was condemned and executed.
In several parts of Britain during the last fifteen years many persons have been brought into great danger by opium having been administered as a narcotic to facilitate robbery; and some have actually been killed. In December, 1828, a conviction was obtained in the Judiciary Court of Edinburgh for this crime, in which instance the persons who had taken the opium recovered. A fatal case, which was strongly suspected to be of the same nature, was submitted to me by the sheriff of this county in 1828; but sufficient evidence could not be procured. In July, 1829, a man Stewart and his wife were condemned, and subsequently executed for the same crime, the person to whom they gave the opium having been killed by it. And about a year afterwards a similar instance occurred at Glasgow, for which a man Byers and his wife were condemned at the Autumn Circuit of 1831.
Opium is the inspissated juice of the capsules of the Papaver somniferum. It has a reddish-brown colour, and a glimmering lustre on a fresh surface. It is soft and plastic when recent; but if pure, may be dried so as to become brittle. Its smell is strong and quite peculiar. It has a very bitter and most peculiar taste. In consequence of this taste one would suppose it no easy matter to administer opium secretly. The plan resorted to by thieves and robbers seems to be, to deaden the sense of taste by strong spirits, and then to ply the person with porter or ale drugged with laudanum, or the black drop, which possesses less odour.
The following account of the chemical history of opium will be confined in a great measure to the leading properties of the principles, in which its active qualities are concentrated, or which are likely by their chemical characters to supply proof of its presence.
The common solvents act readily on opium. Water dissolves its active principles even at low temperatures. So does alcohol. So particularly do the mineral and vegetable acids when much diluted. Ether removes from it little else than one of its active principles, narcotine. By the action of these agents are procured various preparations in common use. Laudanum is a spirituous infusion, and contains the active ingredients of a twelfth part of its weight of opium. Scotch Paregoric Elixir, a solution in ammoniated spirit, is only one-fifth of the strength of laudanum; and English Paregoric, tincture of opium and camphor for its chief ingredients, is four times weaker still. Wine of opium contains the soluble part of a sixteenth of its weight. The black drop and Battley’s sedative liquor are believed to be solutions of opium in vegetable acids, and to possess, the former four, the latter three times the strength of laudanum. But their strength has been greatly exaggerated; neither of them, according to my own experience, being above half what is supposed. The juice and infusion of the garden poppy are also powerfully narcotic, so as even to have caused death both when given by the mouth and in the way of injection.[1677] Many other pharmaceutic preparations contain opium.
If opium be infused in successive portions of cold water, the water dissolves all its poisonous principles, and also a peculiar acid possessing characteristic chemical properties. These principles are separated by means of the alkalis, the alkaline carbonates, or the alkaline earths. The most important of them are morphia, the chief alkaloid of opium,—narcotine, a feeble poison, not an alkaloid,—a peculiar acid, termed meconic acid,—and a resinoid substance. Other crystalline principles also exist in opium, though apparently in too small proportion either to affect its action or to be available in medico-legal analysis as the means of detecting the drug. These are codeïa, meconine, narceïne, paramorphia, and porphyroxine.
Of the various principles now indicated it is necessary to notice here only morphia, narcotine, codeïa, porphyroxine and meconic acid. They require mention either as being active poisons, or because a knowledge of their leading characters may be useful in conducting a medico-legal analysis in a case of poisoning with opium.
Meconic acid, as procured by evaporation, is usually in little scales of a pale brown or yellowish tint, being rendered so by adhering resin or extractive matter; but when nearly colourless, it forms long, extremely delicate tabular crystals, which in mass have a fine silky appearance like spermaceti. 1. When heated in a tube, it is partly decomposed, and partly sublimed; and the sublimate condenses in filamentous, radiated crystals. 2. When dissolved even in a very large quantity of water, the solution acquires an intense cherry-red colour with the perchloride of iron. The sublimed crystals have the same property. Only one other acid is so affected, namely, the sulpho-cyanic, a very rare substance. It has been repeatedly stated,[1678] that the redness produced by meconic acid may be distinguished by the effect of an alkali, which is said to bleach the colour produced by sulpho-cyanic acid, but to deepen the cherry-red tint occasioned by the meconic. This is not correct; an alkali added to the red solution of meconate of iron precipitates oxide of iron and renders the liquid colourless. The best distinction yet proposed is the following which has been suggested by Dr. Percy. Acidulate the red fluid with sulphuric acid, drop in a bit of pure zinc, and suspend at the mouth of the tube a bit of paper moistened with solution of acetate of lead: If the redness be caused by sulpho-cyanic acid, hydrosulphuric acid gas is evolved, and blackens the paper; but no such effect ensues, it the redness be owing to meconic acid.[1679]—According to Dr. Pereira, solutions of the acetates, an infusion of white mustard, decoctions of Iceland moss, and of the Gigantina helminthocorton, besides other more rare substances, are reddened, like solution of meconic acid, by the salts of peroxide of iron.[1680] 3. The solution of meconic acid gives a pale-green precipitate with the sulphate of copper, and, if the precipitate is not too abundant, it is dissolved by boiling, but reappears on cooling.
Of the Tests for Morphia and its Salts.—Morphia, when pure, is in small, beautiful, white crystals. Various forms have been ascribed to it; but in the numerous crystallizations I have made, it has always assumed when pure the form of a slightly flattened hexangular prism. It has a bitter taste, but no smell.
A gentle heat melts it, and if the fluid mass is then allowed to cool, a crystalline radiated substance is formed. A stronger heat reddens and then chars the fused mass, white fumes of a peculiar odour are disengaged, and at last the mass kindles and burns brightly.—Morphia is very little soluble in water. It is more soluble, yet still sparingly so, in ether. But its proper solvents are alcohol, or the diluted acids, mineral as well as vegetable. All its solutions are intensely bitter, and that in alcohol has an alkaline reaction.—From its solutions in the acids crystallizable salts may be procured; and morphia may be separated by the superior affinity of any of the inorganic alkalis; but it is easily redissolved by an excess of potash.—Morphia when treated with nitric acid is dissolved with effervescence, and becomes instantly orange-red, which, if too much acid be used, changes quickly to yellow. The coloration of morphia by nitric acid is a characteristic property; which, however, it possesses in common with some other alkaloids, such as brucia, and also strychnia when not quite pure. The change of colour is said by some chemists to depend on adhering resinoid matter, and not to be possessed by perfectly pure morphia; but this is a mistake. It is probable that some other vegetable substances besides the three alkaloids, morphia, brucia, and strychnia, may be turned orange-red by nitric acid. Dr. Pereira says that oil of pimento undergoes the same change.[1681]—When suspended in water, in the form of fine powder and then treated with a drop or two of perchloride of iron containing little or no free hydrochloric acid, it is dissolved and forms a deep blue solution, the tint of which is more purely blue, the stronger the solution, and the purer the morphia. This is a property even more characteristic than the former, since no such effect is produced on any other known alkaloid. Like the effect of nitric acid, it is said not to be essential to morphia, but to depend on adhering resinoid matter; yet the blue colour is always strongly produced with powdered morphia of snowy-whiteness.—Another property by which morphia maybe also distinguished is the decomposition of iodic acid. A solution of iodic acid is turned brown either by morphia or its salts, owing to the formation of iodine; and the test is so delicate that it affects a solution containing a 7000th of morphia.[1682] So many other substances, however, possess the property of disengaging iodine from iodic acid, that little importance can be attached to this criterion.
Acetate of Morphia is in some countries the common medicinal form for administering morphia; but it has been almost entirely superseded in this city by the hydrochlorate, since Dr. W. Gregory pointed out a cheap mode of procuring that salt in a state of purity.[1683] The acetate is in confused crystals, often of a brownish colour from impurities. The stronger acids disengage acetic acid. The alkalis throw down morphia from its solution in water. Nitric acid and perchloride of iron act on it as on morphia itself.
Hydrochlorate of Morphia.—The muriate or hydrochlorate must be carefully attended to by the medical jurist, because it is extensively used in medical practice instead of opium. As now prepared, it is snowy-white and apparently pulverulent, but is in reality a congeries of filiform crystals. It decrepitates slightly when heated, then melts, and at the same time chars, exhaling a strong odour somewhat like that of truffles. Nitric acid and perchloride of iron act on it as on morphia. Boiling water dissolves fully its own weight, and very easily three-fourths of its weight of hydrochlorate of morphia; and on cooling down to 60° F. it retains seven parts per cent., and deposits the rest in tufts of beautiful filiform crystals. The solution commonly employed in medicine contains one per cent. of the salt. Nitric acid turns the solution yellow, acting distinctly enough when the water contains a hundredth, and perceptibly when it contains only a two-hundredth of its weight. Perchloride of iron strikes a deep blue with a solution containing a hundredth of its weight, very distinctly when the proportion is a two-hundredth, and even perceptibly when it is only a five-hundredth. A solution much more diluted than even the last has a strong bitter taste. When moderately concentrated, morphia is precipitated from it by the alkalis.
Of the preceding properties of morphia and its salts, those which constitute the most characteristic tests are the effects of perchloride of iron and of nitric acid on all of them, the effect of heat on morphia, and the effect of an alkali on its solutions in acids.
Of the Tests for Narcotine.—Narcotine is rather distinguished by negative than by positive chemical properties. When pure, it is in transparent colourless pearly crystals, which, as formed from alcohol, may be either very flat, oblique, six-sided prisms, or oblong four-sided tables obliquely bevelled on their sides. But when crystallized from sulphuric ether the crystals are prisms with a rhombic base. They fuse with heat, and concrete on cooling into a resinous-like mass. They are soluble in ether, and fixed oil, less so in alcohol, insoluble in water or the alkalis, very soluble in the diluted acids, but without effecting neutralization; and if perfectly pure, they do not undergo the changes produced on morphia by perchloride of iron or nitric acid. Few specimens of narcotic, however, are so pure as not to render nitric acid yellow. Care must be taken not to confound narcotine with morphia. When crystallized together from alcohol and not quite pure, narcotine forms tufts of pearly thin tabular crystals, while morphia is in short, thick, sparkling prisms.
Of Codeïa.—This substance is, like morphia, an alkaloid, capable of combining with acids. It differs from morphia and narcotine in being moderately soluble in water; and from this solution it may be crystallized in large crystals affecting the octaedral form. It is unnecessary to detail its chemical properties.
Of the Tests for Porphyroxine.—This principle is a neutral crystalline body, insoluble in water, soluble in alcohol and ether, and also soluble in weak acids, which part with it unchanged on the addition of an alkali. When heated with hydrochloric acid, a fine purple or rose-red solution is produced; whence its name. It is supposed that this property may be of use in medico-legal researches; and the following mode of developing it has been proposed by Dr. Merck, its discoverer.[1684] Decompose the suspected fluid with caustic potash; agitate the mixture with sulphuric ether; dip a bit of white filtering paper repeatedly in the etherial solution, drying it after each immersion; then wet the paper with hydrochloric acid, and expose it to the vapour of boiling water; upon which the paper will become more or less acid.
Having stated these particulars of the chemical history of opium and its chief component ingredients, I shall now describe what has appeared to me the most delicate and satisfactory method of detecting it in a mixed state.
1. If there be any solid matter, it is to be cut into small fragments, water is to be added if necessary, then a little acetic acid sufficient to render the mixture acidulous, and when the whole mass has been well stirred, and has stood a few minutes, it is to be filtered, and evaporated at a temperature somewhat below ebullition to the consistence of a moderately thick syrup. To this extract strong alcohol is to be gradually added, care being taken to break down any coagulum which may be formed: and after ebullition and cooling, the alcoholic solution is to be filtered. The solution must then be evaporated to the consistence of a thin syrup, and the residue dissolved in distilled water and filtered anew.
2. Add now the solution of acetate of lead as long as it causes precipitation, filter and wash. The filtered fluid contains acetate of morphia, and the precipitate on the filter contains meconic acid united with the oxide of lead.
3. The fluid part is to be treated with hydrosulphuric acid gas, to throw down any lead which may remain in solution. It is then to be filtered while cold, and evaporated sufficiently in a vapour-bath. The solution in this state will sometimes be sufficiently pure for the application of the tests for morphia; but in most cases it is necessary, and in all advisable, to purify it still farther. For this purpose the morphia is to be precipitated with carbonate of soda; and the precipitate having been collected, washed, and drained on a filter, the precipitate and portion of the filter to which it adheres are to be boiled in a little pure alcohol. The alcoholic solution,—filtered, if necessary,—will give by evaporation a crystalline residue of morphia, which becomes orange-red with nitric acid, and blue with perchloride of iron. The latter property I have sometimes been unable to develope when the former was presented characteristically.
4. It is useful, however, to separate the meconic acid also; because, as its properties are more delicate, I have repeatedly been able to detect it satisfactorily, when I did not feel satisfied with the result of the search for morphia. Dr. Ure made the same remark in his evidence on the trial of Stewart and his wife. He detected the meconic acid, but could not separate the morphia. It may be detected in one of two ways,—by means of hydrosulphuric acid, or by sulphuric acid.
If the former method be chosen, suspend in a little water the precipitate caused by the acetate of lead (par. 2); transmit hydrosulphuric acid gas till the whole precipitate is blackened; filter immediately without boiling; then boil, and if necessary filter a second time. A great part of the impurities thrown down by the acetate of lead will be separated with the sulphuret of lead; and the meconic acid is dissolved. But it requires in general farther purification, which is best attained by again throwing it down with acetate of lead, and repeating the steps of the present paragraph. The fluid is now to be concentrated by evaporation at a temperature not exceeding 180° F., and subjected to the tests for meconic acid, more particularly to the action of perchloride of iron, when the quantity is small. If there is evidently a considerable quantity of acid, a portion should be evaporated till it yields crystalline scales; and these are to be heated in a tube to procure the arborescent crystalline sublimate formerly described. About a sixth of a grain of meconic acid, however, is required to try the latter test conveniently.
If the method of separating meconic acid by means of sulphuric acid be preferred, the precipitate formed by acetate of lead is to be treated with weak sulphuric acid, which forms insoluble sulphate of lead, and disengages the meconic acid. The liquid obtained by filtration is then to be evaporated as above, to obtain crystals, which are to be examined by the tests for meconic acid. Orfila thinks this method more delicate than the mode by hydrosulphuric acid gas. I am inclined from my own experiments to doubt his statement.
5. If there be a sufficiency of the original material, Merck’s process for detecting porphyroxin may be tried [see p. 534]. But I doubt whether this process is sufficiently delicate for medico-legal purposes.
I wish I could add my testimony to the opinion, expressed on a remarkable occasion by Professor Chaussier, in favour of the delicacy of the tests for morphia and its compounds, that they might be detected “jusqu’à une molécule.”[1685] In one sense this statement may be correct. Morphia, separated from the complex mixture of principles with which it is combined in opium, may be detected in extremely small quantities. Accordingly, M. Lassaigne has supplied, for the discovery of acetate of morphia in mixed fluids, an excellent process, whence the chief part of the three first paragraphs of the preceding method for opium are borrowed; and from the facts stated by him in his paper,[1686] as well as from the experimental testimony of Professor Orfila,[1687] it appears that Lassaigne’s process will furnish strong indications, if not absolute proof of the presence of that salt, in the proportion of two grains to eight ounces of the most complex mixtures. Hence the search for acetate of morphia in a suspected case is by no means hopeless. But the detection of acetate of morphia is an object of small moment, compared with the detection of morphia in its natural state of combination in opium. Now my own observations lead me to entertain serious doubts, whether the best method of operating hitherto known could be successfully applied to the detection of the equivalent opium in complex mixtures. By the process I have recommended it is easy to procure, from an infusion of ten grains of opium in four ounces of water, satisfactory proof of the presence of morphia by the action of ammonia, perchloride of iron and nitric acid, and equally distinct proof of the presence of meconic acid by perchloride of iron, as well as sulphate of copper. But on proceeding to apply the process to organic mixtures, I have found that when the soluble part of ten grains of opium was mixed with four ounces of porter or milk, I could develope no property of morphia but its bitterness, and no indication of meconic acid but the action of perchloride of iron. MM. Larocque and Thibierge, it is right to add, have in similar circumstances found the process somewhat more delicate.[1688]
It is of great consequence, however, to remark, that in cases of poisoning with opium, the medical jurist will seldom have the good fortune to operate even upon so large a proportion of the poison as in my experiments; because the greater part of it disappears from the stomach before death. This will not happen always, as may be seen from various cases mentioned afterwards in the section on the morbid appearances caused by opium. But, according to my own observations, the poison will often disappear in a short time, so far as to render an analysis abortive. Thus in the case of a young woman who died five hours after taking not less than two ounces of laudanum, I could apply to the fluid, procured from the contents of the stomach, by paragraphs 1, 2, and 3 of my process, only the test of its taste, which had the bitterness of morphia. In the case of another young woman, whose stomach was emptied by the stomach-pump four hours after she took two ounces of laudanum, I could obtain from the evacuated fluid, when properly prepared, only the indications of the presence of morphia supplied by its bitterness and the imperfect action of nitric acid,—and the indication of the presence of meconic acid supplied by the imperfect action of perchloride of iron. In a third case, where the stomach was evacuated two hours after seven drachms of laudanum had been swallowed, even the first portions of fluid withdrawn had not any opiate odour, and did not yield any indication of the presence even of meconic acid. Now, on the one hand, the quantity taken in these instances is rarely exceeded in cases of poisoning with laudanum; and, on the other hand, the interval during which it remained in the stomach subject to vital operations is considerably less than the average in medico-legal, and above all in fatal cases. It may be laid down, therefore, as a general rule, that in poisoning with opium the medical jurist, by the best methods of analysis yet known, will often fail in procuring satisfactory evidence, and sometimes fail to obtain any evidence at all, of the existence of the poison in the contents of the stomach. In a case published by Dr. Bright from the experience of Mr. Walne of London, it is stated that the matter removed from the stomach only half an hour after an ounce and a half of laudanum had been taken, while the stomach was empty, did not smell of opium.[1689] This case is quoted to put the reader on his guard. But at the same time it does appear extremely improbable that the whole opium had disappeared from the stomach in so short a time, and much more likely that it might have been found by analysis in the matter first withdrawn.
I have taken some pains to establish the proposition laid down above, because in a matter of such importance it is always essential, that the medical inspector know the real extent of his resources; and it has appeared to me that, greatly as the hand of the chemist has been strengthened by late discoveries in vegetable analysis, his power has been overrated both by his scientific brethren, and by the medical profession generally. I am happy to find, since the first publication of these remarks, that they coincide with the experience and opinion of so eminent an authority as Professor Buchner; who has observed that a chemical analysis must often fail to detect opium where there could be no doubt of its having been administered in large quantity.[1690]
It is of moment to add, that in two of the instances mentioned above the odour of laudanum was perceived in the subject of analysis,—faintly, however, and only for a few hours after it was removed from the stomach. Although the peculiar odour of opium is a delicate criterion of its presence, it does not follow that it should be preferred to an elaborate chemical analysis. For it is a test of extreme uncertainty. There is in the contents of the stomach such a complication of odours, that with a rather delicate sense of smell, I have sometimes been unable to satisfy myself of the presence of the opiate odour where others were sure it existed. At the same time the medical jurist should not neglect it as a subsidiary test. It is always strongest and most characteristic, first, when the stomach is just opened, or the contents just withdrawn, and again, when the fluid, in the course of preparation, as directed in paragraph 1 (p. 535), is just reaching the point of ebullition. The latter odour is somewhat different from the former, yet quite peculiar, and such as every chemist must have remarked on boiling an infusion of opium. It is further to be observed, that although the odour of opium is a very delicate test of its presence even in complex organic mixtures, chemical analysis may be successful, where this character fails. Dr. Morehead of the Bombay service, in applying my process to the fluid withdrawn by the stomach-pump, detected morphia both by nitric acid and perchloride of iron, although he could not detect any odour of opium in the fluid.[1691]
So much for the delicacy of the process. As to its precision,—from what I have myself witnessed, as well as from the experience of Dr. Ure, it will often happen in actual practice, that the only indication of opium to be procured by the process consists in the deep red colour struck by perchloride of iron with the meconic acid. Now, will this alone constitute sufficient proof of the presence of opium? On the whole, I am inclined to reply in the affirmative. Sulpho-cyanic acid, it is true, has the same effect, and this acid has been proved by Professors Gmelin and Tiedemann to exist in the human saliva,[1692]—a fact which was called in question by Dr. Ure in his evidence on the trial of the Stuarts, but which at the time I had verified, and which Dr. Ure has since been compelled by experiments of his own to admit.[1693] But it must be very seldom possible to procure a distinct blood-red coloration from the saliva, after it has been mixed with the complex contents of the stomach, and subjected to the process of analysis detailed above;[1694] and the check proposed by Dr. Percy (p. 532) will distinguish it.
The symptoms and mode of action of opium have been long made the subject of dispute, both among physicians and toxicologists; and in some particulars our knowledge is still vague and insufficient.
Under the head of general poisoning, some experiments were related, from which it might be inferred that opium has the power of stupefying or suspending the irritability of the parts to which it is immediately applied. The most unequivocal of these facts, which occurred to Dr. Wilson Philip, was instant paralysis of the intestines of a dog, when an infusion of opium was applied to their mucous coat;[1695] another hardly less decisive was palsy of the hind-legs of a frog, observed by Dr. Monro Secundus, when opium was injected between the skin and the muscles;[1696] and a third, which has been remarked by several experimentalists, is immediate cessation of the contractions of the frog’s heart when opium is applied to its inner surface.[1697]
The poison has also powerful constitutional or remote effects, which are chiefly produced on the brain. Much discussion has arisen on the question, whether these constitutional effects are owing to the conveyance of the local torpor along the nerves to the brain, or to the poison being absorbed, and so acting on the brain through the blood. The question is not yet settled. It appears pretty certain, however, that the poison cannot act constitutionally without entering the blood-vessels; although it is not so clear, that after it has entered them, it acts by being carried with the blood to the brain. The newest doctrine supposes that it enters the blood-vessels, and produces on their inner coat an impression which is conveyed along the nerves.
According to the experiments of Professor Orfila, it is more energetic when applied to the surface of a wound than when introduced into the stomach, and most energetic of all when injected into a vein.[1698] The inference generally drawn from these and other analogous experiments[1699] is, that the blood transmits the poison in substance to the brain. They certainly, however, do not prove more than that the poison must enter the blood before it acts.
The old doctrine, that the blood-vessels have no concern with its action, and that it acts only by conveyance along the nerves of a peculiar local torpor arising from its direct application to their sentient extremities, has been long abandoned by most physiologists as untenable. But some have adopted a late modification of this doctrine, by supposing that opium may act both by being carried with the blood to the brain, and by the transmission of local torpor along the nerves. They believe, in fact, that opium possesses a double mode of action,—through sympathy as well as through absorption. It would be fruitless to inquire into the grounds that exist for adopting or rejecting this doctrine, because sufficient facts are still wanting to decide the controversy. So far as they go, however, they appear adverse to the supposition of a conveyance of impressions along the nerves, without the previous entrance of the poison within the blood-vessels. The difficulties, in the way of the theory of the sympathetic action of opium, would be removed by the doctrine of Messrs. Morgan and Addison. According to their views, the experiments, which appear at first sight to prove that this substance operates by being carried with the blood to the part on which it acts, are easily explained by considering that the opium makes a peculiar impression on the inside of the vessels, which impression subsequently passes along the nerves to the brain.[1700] But, as stated in the introductory chapter on the physiology of poisoning, this theory requires support.
The effects of opium, through whatever channel it may produce them, are exerted chiefly on the brain and nervous system. This appears from the experiments of a crowd of physiologists, as well as from the symptoms observed a thousand times in man. In animals the symptoms are different from those remarked in man. Some experimentalists have indeed witnessed in the higher orders of animals, as in the human subject, pure lethargy and coma. But the latest researches, among the rest those of M. Orfila, show that much more generally it causes in animals hurried pulse, giddiness, palsy of the hind-legs, convulsions of various degrees of intensity, from simple tremors to violent tetanus, and a peculiar slumber, in the midst of which a slight excitement rouses the animal and renews the convulsions. These symptoms are produced in whatever way the poison enters the body, whether by the stomach, or by a wound, or by direct injection into a vein, or by the rectum. In man, convulsions are sometimes excited; but much more commonly simple sopor and coma.
According to the inquiries of M. Charret, which were extended to every class of the lower animals, opium produces three leading effects. It acts on the brain, causing congestion, and consequently sopor; on the general nervous centre as an irritant, exciting convulsions; and on the muscles as a direct sedative. It is poisonous to all animals,—man, carnivorous quadrupeds, the rodentia, birds, reptiles, amphibious animals, fishes, insects, and the mollusca. But of its three leading effects some are not produced in certain classes or orders of animals. In the mammalia, with the exception of man, there is no cerebral congestion induced, and death takes place amidst convulsions. In birds there is some cerebral congestion towards the close; but still the two other phenomena are the most prominent.[1701]
It has been rendered probable, by what is stated above, that opium enters the blood. The question, therefore, naturally arises, whether its presence there can be proved by chemical analysis? But considering the imperfection of the processes for detecting it when mixed with organic substances, no disappointment ought to be felt if this proof should fail in regard to so complex a fluid as the blood. The only person who has represented himself successful in the search is M. Barruel of Paris. He examined the urine and blood of a man under the influence of a poisonous dose of laudanum, amounting to an ounce and a half; and procured indications of morphia in both. When three ounces of urine were boiled with magnesia, and the insoluble matter was collected, washed, dried, and boiled, in alcohol, the residue of the alcoholic solution formed a white stain, which became deep orange-red on the addition of nitric acid. The blood was subjected to a more complex operation. One pound and ten ounces of it were bruised in a mortar, diluted with two pounds of water, strongly acidulated with sulphuric acid, boiled, filtered, and washed. The filtered fluid was saturated with chalk, and the excess of carbonic acid driven off by heat. The fluid was then filtered again, and after being washed with water, was acted on by diluted acetic acid. The acetic solution left on evaporation a residue which was repeatedly acted on by alcohol; and the residue of the alcoholic solutions was treated with pure alcohol and carbonate of lime. The new solution when filtered and evaporated left several small white stains, which became orange-red with nitric acid.[1702] These results have been since contradicted by M. Dublanc. He in vain sought for morphia in the blood and urine of people who were taking acetate medicinally, or of animals that were killed by it.[1703] Barruel’s results are also at variance with some pointed experiments of M. Lassaigne, who could not detect any acetate of morphia even in blood drawn from a dog twelve hours after thirty-six grains were injected into the crural vein;[1704] nor any in the liver or venous blood of a dog poisoned with eight ounces of Sydenham’s laudanum.[1705]
In investigating the effects of opium and its principles on man, the natural order of procedure is to consider in the first place those of opium itself in its various forms.
The effect of a small dose seems to be generally in the first instance stimulating: the action of the heart and arteries is increased, and a slight sense of fulness is caused in the head. This stimulus differs much in different individuals. In most persons it is quite insignificant. In its highest degree it is well exemplified by Dr. Leigh in his Experimental Inquiry, as they occurred to a friend of his who repeatedly made the experiment. If in the evening when he felt sleepy, he took thirty drops of laudanum, he was enlivened so that he could resume his studies; and if, when the usual drowsiness approached, which it did in two hours, he took a hundred drops more, he soon became so much exhilarated, that he was compelled to laugh and sing and dance. The pulse meanwhile was full and strong, and the temporal arteries throbbed forcibly. In no long time the customary torpor ensued. The stimulant effect of opium given during a state of exhaustion is also well illustrated by Dr. Burnes in his account of Cutch. “On one occasion,” says he, “I had made a very fatiguing night march with a Cutchee horseman. In the morning, after having travelled above thirty miles, I was obliged to assent to his proposal of haulting for a few minutes, which he employed in sharing a quantity of about two drachms of opium between himself and his jaded horse. The effect of the dose was soon evident on both, for the horse finished a journey of forty miles with great apparent facility, and the rider absolutely became more active and intelligent.”[1706]
By repeating small doses frequently, the stimulus may be kept up for a considerable time in some people. In this way are produced the remarkable effects said to be experienced by opium-eaters in the east. These effects seem to be in the first instance stimulant, the imagination being rendered brilliant, the passions exalted, and the muscular force increased; and this state endures for a considerable time before the usual stage of collapse supervenes. A very poetical, but I believe also a faithful, picture of the phenomena now alluded to is given in the Confessions of an English Opium-eater,—a work well known to be founded on the personal experience of the writer. It is singular that our profession should have observed these phenomena so little, as to be accused by him of having wholly misrepresented the action of the most common drug in medical practice. In reply to this charge the physician may simply observe, that he seldom administers opium in the way practised by the opium-eater; that when given in the usual therapeutic mode it rarely causes material excitement; that some professional people prefer giving it in frequent small doses, with the view of procuring its sedative effect, and undoubtedly do succeed in attaining their object; that in both of these medicinal ways of administering it, excitement is occasionally produced to a great degree and of a disagreeable kind; that the latter phenomena have been clearly traced to idiosyncrasy; and therefore that the effects on opium-eaters are probably owing either to the same cause, or to the modifying power of habit. This much at all events is certain,—that in persons unaccustomed to opium it seldom produces material excitement in a single small dose, and does not always cause continuous excitement when taken after the manner of the opium-eater. The effect of a full medicinal dose of two or three grains of solid opium, or forty or sixty grains of the tincture, is to produce in general a transient excitement and fulness of the pulse, but in a short time afterwards torpor and sleep, commonly succeeded in six, eight, or ten hours by headache, nausea, and dry tongue.
The symptoms of poisoning with opium, administered at once in a dangerous dose, begin with giddiness and stupor, generally without any previous stimulus. The stupor rapidly increasing, the person soon becomes motionless and insensible to external impressions; he breathes slowly; generally lies still, with the eyes shut and the pupils contracted; and the whole expression of the countenance is that of deep and perfect repose. As the poisoning advances, the features become ghastly, the pulse feeble and imperceptible, the muscles excessively relaxed, and, unless assistance speedily arrive, death ensues. If recovery take place, the sopor is succeeded by prolonged sleep, which commonly ends in twenty-four or thirty-six hours, and is followed by nausea, vomiting, giddiness, and loathing of food.
The period which elapses between the taking of the poison and the commencement of the symptoms is various. A large quantity, taken in the form of tincture, on an empty stomach, may begin to act in a few minutes; but for obvious reasons it is not easy to learn the precise fact as to this particular. Dr. Meyer, late medical inspector at Berlin, has related a case of poisoning with six ounces of the saffron tincture of opium, where the person was found in a hopeless state of coma in half an hour,[1707] and M. Ollivier has described another instance of a man who was found completely soporose at the same distance of time after taking an ounce and a half of laudanum.[1708] In these cases, the symptoms must have begun in ten or fifteen minutes at farthest. In a case noticed by M. Desruelles the sopor was fairly formed in fifteen minutes after two drachms of solid opium were taken.[1709] For the most part, however, opium, taken in the solid form, does not begin to act for half an hour or even almost a whole hour,—that period being required to allow its poisonous principles to be separated and absorbed by the bibulous vessels. It is singular that an interval of an hour was remarked in a case where the largest quantity was taken which has yet been recorded. The patient swallowed eight ounces of crude opium; but in an hour her physician found her able to tell connectedly all she had done; and she recovered.[1710] In some rare cases the sopor is put off for a longer period: thus, in a case mentioned in Corvisart’s Journal, there seems to have been no material stupor till considerably more than an hour after the person took two ounces and a half of the tincture with a drachm of the extract.[1711]
The result of almost universal observation, however, is, that in pure poisoning with opium the commencement of the symptoms is not put off much beyond an hour. Such being the fact, it is extremely difficult to account for the following extraordinary case, which was communicated to me by Dr. Heude, of the East India Company’s service. A man swallowed an ounce and a half of laudanum, and in an hour half as much more, and then lay down in bed. Some excitement followed, and also numbness of the arms and legs. But he continued so sensible and lively seven hours after the first dose was taken, that a medical gentleman, who saw him at that time and got from him a confession of what he had done, very naturally did not believe his story. It was not till at least the eighteenth hour that stupor set in; but two hours later, when Dr. Heude first saw him, he laboured under all the characteristic symptoms of poisoning with opium in an aggravated degree. The stomach-pump brought away a fluid quite free of the odour of opium. In seven hours more, under assiduous treatment, after having been in an almost hopeless state of insensibility, he had recovered so far as to be safely left in charge of a friend; and eventually he got quite well. No particular cause could be discovered for the long apparent suspension of the usual effects of opium.
Although the symptoms are very rarely postponed beyond an hour in pure poisoning with this substance, there is some reason for thinking that the interval may be much longer, if at the time of taking the opium the person be excited by intoxication from previously drinking spirits. Mr. Shearmen has related a striking case of an habitual drunkard, who took two ounces of laudanum while intoxicated to excitement with beer and spirits, and had no material stupor for five hours, during which period vomiting could not be induced. Five hours afterwards, he was found insensible, and he eventually died under symptoms of poisoning with opium.[1712]
The most remarkable symptom in the generality of cases of poisoning with opium is the peculiar sopor. This state differs from coma, in as much as the patient continues long capable of being roused. It may be difficult to rouse him; but unless death is at hand, this may be commonly accomplished by brisk agitation, tickling the nostrils, loud speaking, or the injection of water into the ear. The state of restored consciousness is always imperfect, and is speedily followed again by lethargy when the exciting power is withheld.—It has been already remarked, that the possibility of thus interrupting the lethargy caused by opium is in general a good criterion for distinguishing the effects of this poison from apoplexy and epilepsy.
It was observed, in describing the mode of action of opium, that convulsions, although very frequently produced by it in animals, are rarely caused in man. It is not easy to account for this difference. Orfila has endeavoured to explain it, by supposing that convulsions are produced only by very large doses; but there are many facts incompatible with that supposition.
While convulsions are certainly not common in the human subject, yet when they do occur they are sometimes violent. Tralles mentions that he had himself several times seen convulsions excited in children by moderate doses.[1713] The Journal Universel contains the case of a soldier who took two drachms of solid opium, and died in six hours and a half, after being affected with locked-jaw and dreadful spasms.[1714] A case is related in the Medical and Physical Journal of a young man, who, three hours after swallowing an ounce of laudanum, was found insensible, with the mouth distorted, the jaws fixed, and the hands clenched; and who, soon after the insensibility was lessened by proper remedies, was seized with spasms of the back, neck, and extremities, so violent as to resemble opisthotonos.[1715] Another good case of the kind is related by Mr. M’Kechnie, where the voluntary muscles were violently convulsed in frequent paroxysms, and affected in the intervals with subsultus, for three hours before the sopor came on.[1716] Two instances of convulsions alternating with sopor are shortly related by Dr. Bright.[1717] The convulsions sometimes assume the form of permanent spasm, which may affect the whole muscles of the body, as in a case related in Corvisart’s Journal.[1718]—Another rare symptom of poisoning with opium is delirium. It appears to occur occasionally along with convulsions, as happened in Mr. M’Kechnie’s case, and in one related by M. Ollivier.[1719]