Practical Hints, &c.
[]A melancholly accident having, within theſe few days, taken place in this neigh⯑bourhood, from a quantity of Opium given to a young boy, by miſtake for a different medicine, which ſoon proved fatal, gave riſe to the following remarks. The Author hopes the public will receive them with candour, ſince they are laid before them to guard them in future, and prevent them from keeping in their houſes, as family medicines, drugs of violent operation, undiſtinguiſhed by proper labels from more innocent ſub⯑ſtances [4]of the Materia Medica: or ſhould the like again take place, that they may from theſe hints, be the better prepared to put in force the means of cure, he ſubmits to their conſideration, which on many ſuch occaſions, (for too many ſuch are on record) have been found effectual when they were had early recourſe to, and ſtrenuouſly applied.
THIS drug of high uſe, and deſerved eſ⯑timation in Medicine, like many others of the virulent Vegetable Poiſons, becomes, when incautiouſly exhibited by thoſe leſs acquainted with its powers, and when given thro' miſtake, ſpeedily deſtructive; chang⯑ing the regular motions of the living body into irregular and violent; inducing ſtupe⯑faction; convulſions; appoplexy &c. ſoon to be followed by a total deprivation of life.*
[5]WITHOUT entering into a diſſertation on the ſubject at large, or a detail of the various opinions, and hypotheſes that have lately, as well as heretofore, been advanced relative to its mode of operation as a medi⯑cine, this being foreign to my preſent pur⯑poſe, let me at once ſuppoſe ſuch a quan⯑tity received into the ſtomach, as muſt in a ſhort time induce death, ſhould attempts, (and theſe almoſt inſtantaneouſly) not be made to prevent its baneful effects; and indeed, admitting them made, it muſt be confeſſed, (ſo great may the force of the poiſon be) that its effects may be exerted even in a very ſhort time, altogether be⯑yond the poſſibility of obviating, notwith⯑ſtanding [6]the moſt diligent application of the moſt rational means.
THIS reflection, however, ſhould not ſlacken our endeavours or damp our ardour, but ought rather to ſtimulate us to a trial of all the methods that have been known to ſucceed.
THE firſt thing then to which we are to turn our attention, is the uſe of emetics: and let one be thrown down the moſt ſpeedy in its operation.—Powders of Ipecacuanha, Tartariſed Antimony, Vinegar of Squills, or, perhaps what may ſtill be more quick in exciting the action of the ſtomach, White Vitriol.—The contents of the ſtomach, ſuppoſe the operation ſucceeds, ſhould be examined to find whether any of the Opium has been evacuated; this will be eaſily diſ⯑covered by its ſmell, and will afford en⯑couragement [7]to purſue our firſt advantage, by continuing the vomiting till this organ be compleatly evacuated.
THE doſes uſed muſt be in proportion to the exigencies of the caſe, to the diminiſhed energy, and ſenſibility of the nervous ſyſtem in general, and the ſtomach in particular. If the Opium has begun to exert its effects, the more will be neceſſary; and as there is no time to looſe, and inevitable danger, per⯑haps death, awaiting, we muſt hazard the larger quantities in proportion to the ac⯑cuſtomed doſes, and perſiſt in their uſe.
To prevent ſtupefaction as far as in our power, and the conſequent train of bad ſymptoms, ſtrong agitation may be uſed, ſuch as walking, running, ſhaking, &c. this has been ſtrenuouſly recommended by ſeveral Authors. In one caſe, as I am [8]lately informed by a Medical Gentleman in this county, whoſe ſiſter was the ſubject of the trial, it appears to have had no ſmall ſhare in the cure. The gentleman when a child about ſix years of age, having ob⯑ſerved his mother take ſomething from a bottle in her cloſet, went afterwards and brought it to his ſiſter, a child about a year younger than himſelf, perſuading her to take of it, which he intended to do alſo, but his ſiſter after taking ſome complained it was bad taſted, on which he took none; ſhe ſoon became affected, the family were a⯑larmed, and their Apothecary was ſent for. Among other things he ordered the child to be walked about though in a ſtate of ſtupefaction, being held up between two ſervants, and kept in conſtant motion for ſeveral hours. She recovered with difficul⯑ty [...]
[9]To theſe ſhould be added Stimulants of all kinds, as Volatile Salts to the noſe, Bliſters to the ſkin, &c. If epiſpaſtics are applied, they ſhould be placed on the moſt ſenſible parts, or joints, as the ancles, arms, inſide of the legs, and ſoles of the feet, and wherever the body is thinneſt of fleſh, and the nervous fibrillae moſt numerous.
IT may be objected to the uſe of bliſters, that they will act too ſlowly in a caſe of this nature, where expedition is ſo requiſite. But without attempting formally to remove this objection, which we think might be eaſily done, as it is not their evacuant, but their ſtimulant effects for which we con⯑ſider them expedient, we ſhall only ſay, that their application even in that caſe, can do no harm by interrupting other means; and on this ground alone, I would not have them omitted.
[10]IF we can rouſe the mind ſo far that it will feel pain, ſo far one point is thereby gained, which adds ſomewhat to our hopes of ſucceſs, and ſhould quicken our exertions.
I know not how far Electricity might in this ſenſe be advantageous. As it is acknow⯑ledged, however, one of the moſt powerful, though tranſient ſtimulants, and as it may be applied to the human body, even for a length of time, and frequency with the utmoſt ſafety, we can run no great hazard in giving it a trial, eſpecially as machines for its commodious application are now in almoſt every body's poſſeſſion. The poiſon being of the higheſt ſedative nature, the ſtrongeſt ſtimulants would ſeem obviouſly indicated as its antidote.
IN the caſes of drowned perſons, and thoſe ſuffocated by the fumes of charcoal [11]&c. the analogy thus far holds good, that in this as in thoſe there is a ſuſpenſion of the functions from a deprivation of ſenſibility in the ſyſtem. In thoſe Electricity is ſtrongly recommended.
THE writer of theſe hints will not enter here into that part of the Pathology which ſuppoſes the operation of the Opium to be by augmenting, or rarefying the volume of the blood in the ſanguiferous ſyſtem in general, and the head in particular, where⯑by a turgeſcence, and over-diſtention of the Veſſels of this organ are ſaid to be parti⯑cuarly preſent, and from which the ſymp⯑toms of apoplexy are argued to ariſe. Of this opinion among others was the celebra⯑ted Mead. He affirms that it enflames the Stomach, and rarefies the blood to ſuch a degree, that the Veſſels cannot again reco⯑ver [12]their tone, whereupon apoplectic ſymp⯑toms, &c. will enſue; to prove which he relates an experiment which he made with it on a Dog.
PERHAPS all ſtimulants, (and it appears to me, by the bye, that all ſubſtances taken into the ſtomach exert firſt a ſtimulant power, whatever their after action may be,) have the effect leſs or more of ſending a greater quantity of blood to the head, at leaſt quickening the circulation by which the face becomes fluſhed; but ſurely ſtimu⯑lants, for this reaſon alone, are not here to be omitted. The ſtimulant power of the Opium ſeems tranſitory, the ſedative ſoon follows. And now, if we can rouſe the powers of the heart to exert their wonted action, and renew the motion of the blood flowing at preſent languidly, we need the leſs dread this ſuppoſed plethora, as the conſequence [13]muſt be a more equitable circulation, and diſtribution of the blood. I know no proof, however, that this fluid is augmenting in its volume, but that it is in a ſtate almoſt of ſtagnation is evident.
Dr. Alſton, in the preſence, and with the aſſiſtance of Mr. Fullarton, a gentleman ſkilled in microſcopical obſervations, in Auguſt 1733, conveyed into the ſtomach of a frog ſome Opium diſſolved in water, and after putting it into a glaſs cylinder, they adapted the microſcope to the membrane between the toes, in ſuch a manner, that they had a diſtinct view of the circulation of the blood in this part. The Dr. had found before that Opium killed theſe ani⯑mals, and his deſign now was to obſerve its effects on the circulation; no change, however, took place either in the colour or [14]conſiſtence of the blood; but the diminu⯑tion of its velocity was extremely evident, ‘"for it did not move half ſo ſwiftly as it uſed to do in theſe creatures."’ This obſervation was repeatedly made; and as the effects of the Opium went off, the blood became gradually quicker in its motion. When the frog had entirely recovered its vigour, they forced more Opium into its ſtomach, and obſerving again, ſaw again the ſame diminution of the blood's velocity.
FROM Mr. Ramſay's experiment (made in April 1755) on a dog, we have a fur⯑ther proof of the pulſe becoming ſlower. The heart of this animal in its natural ſtate beat* 150 times in a minute. Four minutes after the injection of the Opium into the cavity of the abdomen, he fell down ſenſe⯑leſs. Mr. R. opened the thorax, which ſeemed to give the Dog no pain, and he felt [15]plainly the motion of the heart thro' the pleura. It beat now only 76 times in a minute, and became ſlower. Immediately after counting the pulſe, he cut the ribs on each ſide of the ſternum in the common way, and laid them back, by which the heart was brought into view. It appeared quite turgid.
FROM Dr. Whytt's experiments, we have likewiſe ample proof of the leſſened motion of the blood, after the application of Opium, "the veins," he ſays, "after a large doſe of Opium eſpecially thoſe of the brain become much ſwelled, whence it has been thought, that Opium produces its effects in the bodies of animals partly at leaſt, by rarefying the blood, and com⯑preſſing the brain; but this diſtention of the veins ſeems to be no more than a con⯑ſequence of a very ſlow motion of the blood [16]thro' the heart, on account of the inſenſi⯑bility with which this organ is affected." The Author tells us that in frogs, into whoſe ſtomach, and inteſtines he had in⯑jected Opium, he not only found the heart's auricle, but the great viens leading to it much diſtended with blood. From all this it muſt follow, that the heart and arterial ſyſtem being ſo reduced in their irritability cannot propel the blood with ſufficient force thro' the larger veſſels near, much leſs thro' the extreme ones, and leſs ſtill thro' the Veins.
Dr. Leigh gave two grs. of the reſin of Opium to a healthy man, of 30 years of age, his pulſe was then at 60 ſtrokes in a minute, half an hour after it roſe to 72; this proves what we have already hinted, that the firſt operation of this, as well as other drugs, is that of a ſtimulus; but be⯑hold! [17]in a ſhort time it fell down to 55. was full and ſtrong; and now head-ach, vertigo, and drowſineſs ſucceeded.
THE ſame gentleman gave three grs. of the gummy part of Opium to a young woman. In ten minutes her pulſe fell 13 ſtrokes; became alſo full and ſtrong.
To a third perſon alſo, he gave Opium, pulſe roſe ſix ſtrokes in a minute, but in a quarter of an hour it fell 15, and became extremely full.
ON the ſuppoſition, however, of rare⯑faction of this fluid, as well as inflam⯑mation, which has been contended was produced. Geoffroy, and others of the antient* phyſicians recommended, and [18]practiſed, V. S. without duly conſidering, we apprehend, that it is a moſt powerfully debilitating means, leſſening the vigour of thoſe functions which are already become too debile; and without reflecting, that as the ſtomach is the place of action, the part firſt affected, relief can only be ra⯑tionally ſought for by applications chiefly to this organ. Should evacuations, how⯑ever, by blood letting be at all practiſed, ſcarifications on the head, or opening the jugular veins, or temporal artery would appear preferable to general V. Section.
FROM an experiment of the celebrated Dr. Mead on a dog, which he killed by Opium, this practice would ſeem to re⯑ceive ſome countenance, for on diſſection he found the blood veſſels of the brain very full, and took a large grume of concreted blood from the upper part of it, as he cut [19]into the ſinus longitudinalis.—No extra⯑vaſated ſerum was found either in the ven⯑tricles, or any of the membranes. The ſtomach was wonderfully diſtended, though empty of every thing but ſome water and Opium; parcels of frothy mucus ſwam in it, and its inſide was as clean as if ſcraped and waſhed from all the ſlime of the glands; ſome redneſs was diſcovered here and there, as if in the beginning of an inflammation; the pylorus was found contracted.
BUT even under theſe circumſtances, I ſhould be inclined to defer opening theſe veſſels till ſymptoms of apoplexy had com⯑menced, and other means, better adapted to the cure, had been purſued ineffectually.
Dr. Alſton* makes a curious obſerva⯑tion, which may be mentioned here; [20]while he viewed the ſlow motion in the foot of the frog, as above related, he took notice that the frequency of the pulſe was as uſual, but the heart was weak, and had not power to propel the fluid with its wonted force to the extremities. "One thing," ſays he, "was obſervable all along, that notwithſtanding the diminiſhed velocity of the blood, there was no ſen⯑ſible dimunition in the frequency of the pulſe; yet, when there was no circulation, or progreſſive motion of the blood, in this part, (the foot) the pulſe was viſible by an undulatory motion; that is, the blood returned as far back at every diaſtole of the heart, as it was protruded by the preceding ſyſtole; this continued till the frog was quite dead."—He opened it, and "found nothing in its ſtomach but a clear mucus, like a jelly, a little coloured with the Opium. Every thing elſe ſeemed perfectly natural: this experiment we often re⯑peated." [21]He adds, "and it had always the ſame appearance and event."
AFTER the uſe of the emetics, the next practice, that I would recommend, is that of cathartics, they ſeem to hold the ſecond place; nay, both emetics and cathartics may be conveniently exhibited at the ſame time. Theſe, for the ſame reaſons we gave in the uſe of emetics, ſhould be powerful, and of a ſufficiently ſtimulating nature. Aloetics, with others, from the tribe of re⯑ſinous purges have been recommended; the powder of jalap, ſcammony, and calomel, are all active; yet vinegar of ſquills may be perhaps conveniently added to the number; and in ſome reſpects, at leaſt, it may be found preferable, as it both vomits and purges, if adminiſtered to any extent.
NEUTRAL ſalts, and eſpecially Glau⯑ber's, have been likewiſe recommended:— [22]while we uſe theſe we are not to omit gliſ⯑ters: and theſe may be made of ſalt and water, or ſtrong brine, to which may be added purgative ingredients, as may beſt ſute the preſcriber's intention: they ſhould be thrown up as warm as convenient.
Mr. Ramſay injected into the inteſtinum rectum of a ſmall dog, a ſolution of two ſcruples of Opium, in an ounce of water, blood warm, to which he added a drachm of T. Opii. in about a minute his hind legs became convulſed, and in a few mi⯑mutes more their ſenſibility was ſo de⯑ſtroyed, that when pinced, they ſeemed in⯑ſenſible to pain; in ten minutes more he became quite ſtupid; fell into a "profound ſleep," and was convulſed. On obſerving this, a ſtrong ſolution of ſea ſalt, in water, was injected into his guts; this purged him ſeverely, and occaſioned a prolopſus [23]ani. Soon after he awoke from his ſleep, and gradually recovered the uſe of his hind legs. In a few hours he ſeemed well in every reſpect, but could take no food for ſome time.
BEFORE the enema be injected, I would recommend the uſe of a ſuppoſitory, this may be prepared in an inſtant, with ſome paper twiſted up, of a proper thickneſs, well covered with oil or hogs lard, and introduced per anum. It will at once bring away the faeces that are hardened, and filling up that part, and thus give room for the enema to penetrate farther into the inteſtine.
Dr. Dobſon's patient, at Liverpool, was cured by the uſe of Glauber's ſalts and emetics. He had ſwallowed, in the ſpace of 24 hours, 26 grains of ſolid Opium, [24]in the ſhop compoſition, called pil. ſapo⯑nac. By miſtake for pil. aloetic. an ounce. The Doctor juſtly concluded, that in all probability, this would have proved fatal, but for the following favourable circum⯑ſtances: Firſt, That the Opium was in a ſolid form: Secondly, That a ſtrong eme⯑tic was ordered, and repeated till it pro⯑duced the deſired effects: And Thirdly, That a free diſcharge by ſtool was ob⯑tained, by perſiſting in the uſe of Glau⯑ber's ſalts. He obſerves what is worthy of remark, that the neutral ſalts gave relief even before they had occaſioned any eva⯑cuation. The ſalts were continued, at proper intervals, for three days after.
HAVING ſtrengthened our hopes, by evacuations, per os & anum, the next to be thought of is that by the perſpirable pores. To aſſiſt our endeavours here, the pa⯑tient [25]ſhould be immerſed in warm water, and I ſhould prefer that of a ſtimulant to that of a relaxing heat; or, the water ſhould be ſomewhat above the tepid tem⯑perature moſt commonly uſed, when the warm bath is applied.
IRECOMMEND this, though at the ſame time I am well aware, that too great a degree of heat is unfavourable to perſpi⯑ration; but we are to keep in view the want of due ſenſibility; and that ſince, for this reaſon, we were obliged to aug⯑ment the doſes of emetics and purgatives, ſo muſt we now make uſe of a higher de⯑gree of heat to produce the ſame effect. Thoſe who contend for a rarefaction of the blood, and the preſence of ſanguinous apoplexy, will, no doubt, think this part of our practice unfavourable to the end we have in view, the recovery of the patient, [26]as it will have a tendency to encreaſe the rarefaction of the ſanguiferous ſyſtem, and the fluids in general: but they will remem⯑ber that we thought it more than probable, ſuch a ſtate of the fluids did not exiſt.
To aſſiſt us in opening the perſpirable pores, diluents and diaphoretics muſt be conjoined; for without a due proportion of diluents we cannot ſo eaſily force a ſweat. The principle on which I go, by adviſing ſweating, is from a ſuppoſition that the lymphatic ſyſtem has abſorbed part of the Opium, and that it is by this means mixed with the fluids in the ge⯑neral habit. And as our chief view is to evacuate it as compleatly as poſſible, that part of it which has been abſorbed, and which creates a great ſhare of the ſymp⯑toms, cannot be evacuated by means more effectual than by ſudorifics.
[27]I NEED not quote the experiments of profeſſor Monro on this part of my ſubject. He is clear that it is taken up by this ſyſtem of veſſels, becauſe, among other proofs, both urine and ſweat ſmell of it. The heart is a muſcle very irritable. When the Opium is abſorbed, the nerves of its inner ſurface muſt be affected, becauſe it is then applied immediately to them, as well as to the nerves of the inſide of the arteries; and through this medium, as well as through the nerves of the ſtomach, it muſt induce its peculiar ſymptoms. The diaphoretics, that have been gene⯑rally uſed, were of the warm kind, ſuch as confect. aromatic. miſtur. camphe⯑rat. &c.—
A MAN who ſwallowed an ounce of L. Laud. within the ſpace of an hour, in ſmall punch, recovered by vomits, purg⯑ing, [28]bliſters, and ſweating. And a lady, eighteen years of age, who took the ſame quantity, was cured by much the ſame means.
A CHILD, of eighteen months old, la⯑bouring under the hooping cough, had a doſe of elix. paregor. given, with the in⯑tention of moderating the cough; the quan⯑tity uncertain. It was adminiſtered at night, and the ſymptoms were not no⯑ticed till next morning, when deep ſleep and convulſions were obſerved: recovery was here brought about by ſtrong cor⯑dials. The quantity of the elix. appears not to have been ſo large as to induce thoſe ſymptoms that end in ſpeedy death.
Dr. Clark's patient, who in July 1766, ſwallowed a drachm of ſolid Opium, was alſo cured by vomits, purges, gliſters, and ſweating. The patient was an adult; [29]he took half a drachm, and repeated the doſe at a ſhort interval; in the ſpace of 20 minutes it began to operate.
THERE is reaſon, I preſume, to ſuppoſe that ſudorifics, ſome ſudorifics, at leaſt, blunt the action of Opium. It is well known, that when emetics, neutral ſalts, and Opium are united, a much larger doſe of the Opium may be adminiſtered with ſafety and ſucceſs, as a medicine, than when given alone; its action by this ad⯑dition being modified.
A PROOF of this we have in the com⯑poſition, commonly known by the name of Dover's ſweating powder. This is an union of Opium, ipecac: and vitriolated tartar. To aſſiſt then both in modifying the action of the Opium and procuring ſweat, either ipecac. in powder, or an [30]antimonial may be employed in warm water, to which a ſmall quantitiy of a neutral ſalt may be added; the Opium, being, as we preſume, already in the ſto⯑mach, will form a ſtrong ſudorific, and thus, part at leaſt of the offending matter be converted into an antidote to deſtroy its own noxious quality, by hurrying it through the circulating fluids, and expel⯑ling it by the pores of the ſkin.
SHOULD the patient have loſt the power of deglution, for this has ſometimes hap⯑pened; theſe, and the other medicines we have recommended, muſt be forced into the ſtomach by a ſmall tube. A woman was killed, as Dr. Alſton relates, by taking a quantity of liniment for the haemorrhoides compoſed of Opium and Myrrh, by miſtake for a purge. When the miſtake was diſ⯑covered, a vomit was given, but though [31]this was not above three quarters of an hour after the bolus had been taken, ſhe was ſo convulſed as to have loſt the power of deglution. She died in ſome hours after. Pulſe large, full, and not very fre⯑quent. When her phyſician firſt ſaw her, there appeared a pale livor on her cheek, and in other reſpects ſhe was like a per⯑ſon drunk.
THERE are few ſurgeons without hol⯑low bougees; provided nothing more con⯑venient be at hand, one of theſe may be employed to convey the medicines down, eſpecially for children, where the aeſo⯑phagus is ſhorter than in the adult.
IF the tube be long enough to paſs be⯑yond the epgilottis, or the paſſage into the lungs, it is all that is requiſite; the liquid, of courſe, muſt drop into the ſtomach; [32]and this is no great length, as is well known to thoſe who have uſed the probang, in puſhing down, &c. ſubſtances accident⯑ly ſticking in the throat; or who will take the trouble to examine the diſtance be⯑tween the lower jaw and the top of the ſternum, where the trachaea and aeſophagus dip under it.
SEVERAL authors have ſpoken highly in favour of acids, both among the an⯑tients and moderns, for their power of modifying the noxious effects of Opium; among theſe, alſo, have been men of much celebrity.*
To acids Dr. Mead adviſes alkaline ſalts to be added. Dr. Cullen embraces the opinion that acids poſſeſs this power, and he ſpeaks of his having found them ſo [33]from his own experience*. We wiſh the Doctor had mentioned the inſtances to which he alludes, and the other means which he purſued at the ſame time, as we would then have been more able to deter⯑mine what ſhare they exerted, and what might be, at the ſame time, attributed to the other methods he purſued. He does not, however, pretend that it changes the nature of this drug; for when it is given thus in union with Opium, in a large enough quantity, he allows it to have all the ſame effects as Opium alone.
Doctor Webſter, an eminent medical teacher, at Edinburgh, and whom I have the honour to rank as one of my pre⯑ceptors in this ſcience, has the following [34]obſervation, which may be found in his Syllabus. "Acids render the ſtomach leſs capable of being acted on by other matters, as ſpirits, ale, &c." In the courſe of his lectures, the Doctor enlarges on the obſervation, by ſaying, that "the action of Hemlock, Opium, and Ipeca⯑cuanha, are moderated much by the ad⯑dition of an acid."
AN ingenious phyſician, who has not long ſince made many experiments on this article of the Mat. Med. denies that any ſuch effects follow. He affirms that acids render the ſtomach leſs ſenſible of the operation of Opium, if given previous to it; but ſhould the Opium be firſt admi⯑niſtered, and its effects have began, in any degree, to appear, the acid then cannot leſſen them.
[35]HE gave to a boy, of twelve years of age, an ounce of common vinegar; a quarter of an hour after 40 gutts of L. Laud.; in half an hour it produced a ſe⯑vere ſickneſs at his ſtomach, but no vo⯑miting. His head now began to be a little affected, but this did not continue long; the pulſe remained ſteady, except when the nauſea appeared; theſe ſymptoms ſoon went off, and the boy was reſtored to his uſual ſituation.
To a healthy young man he gave two ounces of the common vegetable acid, and in a quarter of an hour after 80 gutts of T. Opii.; two hours after taking it he complained of a little nauſea and head⯑ach; theſe ſymptoms continued only a ſhort time, when he felt himſelf as uſual, except a little ſickneſs about the ſtomach. The Doctor could diſcover no change in [36]the pulſe whatſover: he made ſimilar ex⯑periments both on dogs and rabbits, and concludes, by ſaying, "that the Opium ſeldom had much effect, if an acid was previouſly given."
HE inſtituted other experiments both on frogs and dogs; to ſatisfy himſelf farther, how far the acid would act if the Opi⯑um was given, and had begun to exert its effects before the other was exhi⯑bited. His concluſion is this,—"That the acid, if given after the Opium began to operate, had not the ſmalleſt power of correcting its dangerous tendency." Hence it it is plain, if we put any credit in the experiments of this ingenious gentleman, that the ſuppoſition of acids correcting the deleterious effects of Opium, like many other of the antient theories, has no ex⯑iſtence in reality, and that, we muſt not, [37]therefore, place our dependance in their uſe when the patient is in danger from the noxious powers of Opium, though a different doctrine be ſupported by great names, both among the antient and modern phyſicians.
HOW far diuretics may conduce to the cure I dare not determine. As our great and chief buſineſs is to evacuate the Opium from the habit, and as the urine is found to contain it, which is indicated by its ſmell, I am inclined to think they may, in their turn, be advantageouſly had recourſe to. The diſcharges by the ſkin are generally obſerved to leſſen that by the kidnies; but both, I am perſuaded, may be forwarded to a certain degree at the ſame time. Di⯑luents was recommended to keep up a ſweat; diluents, in plenty, will excite the urinary diſcharges: to theſe may be added [38]medicines more directly ſtimulating the urinary organs. Parſley tea may be drank; ſp. aether. nitros. has been generally conſider⯑ed as having ſpecific effects on the kidnies.
OTHER methods more effectually for eli⯑minating this poiſon from the human body, I know of none; and I fully believe, where the circumſtances are ſuch, that hopes can be entertained, none other are neceſſary. Let me again recommend, however, expedi⯑tion and diligence in their application. Dr. Willis informs us of a robuſt man, who, after taking a large doſe of laudanum, was dead in ſo ſhort a time as four hours. Others have died in ten, twelve, and ſix⯑teen.
Dr. Leigh gave only five grains to a wo⯑man, and it threw her into violent con⯑vulſions; he gave her a few grains of ipe⯑cucuanha [39]to remove it, and afterwards 60 gutts of aether; ſhe was not well, how⯑ever, for two days after. The ſame gen⯑tleman gave to a dog, for an experiment, an ounce diſſolved in water. In a very ſhort time it threw him into convulſions, and killed him. We may remark, by the bye, that his ſtomach was immediately laid open, and the coats attentively examined, but not the ſmalleſt marks of inflammation were perceivable; a much leſs quantity would moſt undoubtedly have killed him. Dr. Mead gave a quarter of an ounce to a dog, and in ſo ſhort a time as a quarter of an hour he began to ſleep; then was con⯑vulſed; fell into univerſal tremblings; breathed ſhort and laborious; loſt the uſe of both his fore and hind legs; and then, as the Doctor expreſſes it, "his limbs on a ſudden grew limber, and he inſtantly expired."
[40]WHEN, unhappily, this drug has been ſwallowed to this quantity, our firſt enqui⯑ry ſhould be, how long it has been in the ſtomach, and in what form it was admi⯑niſtered? whether in a liquid, or ſolid form? whether united with other ſubſtances, and what theſe ſubſtances were? In a liquid form it is found to exert its effects much ſooner than when taken in a ſolid; and according to the experiments of the Abbe Fontana, in conjunction with ſpirits, it is the more powerfully deleterious.
Mr. Henderſon, the comedian, it has been ſaid, died in a ſhort time, by ſome miſtake in taking Opium; and the ſame has been aſſerted of the late Dr. Brown, who in a ſtate, it ſeems, of intoxication, took up⯑wards of 500 gutts of laudanum, and was found dead next morning. If this be true, it was a new way of taking off the effects [41]of intoxication; if he took it with this intention, it was like adding oil to extin⯑guiſh flame; for Opium and ſpirituous liquors, in their effects, are very analogous to each other, and the means, in general, that cures the one will cure the other; with this conſideration, that dilution is even more neceſſary, where ſpirits have been drank to a dangerous exceſs, than when Opium has been taken to the ſame extent.
To ſum up the whole; if we do not ſpeedily have recourſe to emetics and the other means already mentioned; all other efforts, when ſtrong convulſions and apo⯑plectic ſymptoms have taken place, afford but little hopes that life can be ſaved. If the doſe be ſwallowed from even 15 mi⯑nutes to 30 minutes, to an hour, accord⯑ing to the ſtrength and age of the perſon, and the quantity taken, its operation may [42]have already gone ſuch lengths, and ex⯑erted its baneful powers ſo far on the ge⯑neral ſyſtem, as to render every ſucceeding attempt to ſave life altogether abortive, even under the management of the moſt active phyſicians of ſteady perſeverance, and ready thought.
Ipſwich, July 1, 1790.