Opium

The dried milky juice from the green, half-ripe heads of the papaver somniferum, especially the large-headed white poppy, the papaver officinale.

A number of chemists have endeavored recently to analyze opium into morphine, narcotine, meconic acid, extractive matter, caoutchouc, opium-balm, fat oil, glutinous matter, resin, gum, volatile matter. Most of them, however, disagree both in regard to the mode which they adopt in separating opium into its constituent ingredients, and in regard to their chemical nature and relative power. Considering this difference of opinion, the probability is that not much can be expected from those alkaloids in the treatment of disease.

Homoeopathy uses the drug as nature gives it, and prepares it for medicinal purposes in such a manner as will make every constituent element of the original drug to enter into the prepared drug in the original proportions. The object of Homoeopathy being to save, not to destroy life, we have no occasion, in our art, for morphine, or indeed for any of those dangerous artificial preparations.

It is much more difficult to observe the effects of opium than those of any other drug.

We know of no medicine which is more capable of suppressing the lamentations of the patient more easily than opium. It is in this delusive power of opium that originates the great abuse which has been made of it.

If the use of opium were generally followed by as good effects as it frequently is, there would be no drug which would do as much good as opium. But the contrary is generally the case.

The power and speed with which it acts, make great caution and a careful knowledge of the circumstances where it ought to be administered, an indispensable condition of its being administered with benefit. This is not possible except when it acts homoeopathically to the symptoms.

In some rare cases where physicians dared to act contrary to the rule " contraria contrariis curentur," or when they made a mistake or acted numinis affiatu, by the inspiration of a god, wonderful cures have been effected by opium. Generally, however, opium has been used as a palliative, and no palliative is more capable of disguising morbid symptoms or smoothing them over, no palliative produces a more dangerous reaction and does more positive injury after its palliating effect has passed off, than opium.

Opium has been used as the principal remedy against all sorts of cough, diarrhoea, vomiting, sleeplessness, melancholy, spasms, nervous complaints, especially against all sorts of pains.

But very few of those ailments are primary effects of opium • most of them are the opposite of those primary effects ; this shows how little permanent good must have been accomplished by opium in the treatment of those affections, as is indeed abundantly confirmed by experience.

Opium has sometimes removed slight and recent cases of diarrhoea, vomiting, sleeplessness, trembling, etc., in a perfectly healthy body. A short cough which has been occasioned by a cold, a recent trembling occasioned by fright/ a diarrhoea which has been suddenly occasioned by fear, by a cold or other slight causes ; retching, which has come on in consequence of a moral emotion, loathing, etc., may yield to opium, and sometimes does yield suddenly, because all that opium requires to do in these affections, is, to suppress them for a short while, in order to enable the organism to remove in the meanwhile all disposition to those affections, and to effect its restoration to health by means of its own inherent recuperative power. (See Organon of the Healing Art, § 63. Note.)

The power which opium possesses, to palliate the above named trivial affections, should not lead one to suppose that opium really possesses the power to cure such affections permanently, under all circumstances ; those affections cannot be cured by opium if they are fragmentary symptoms of a more comprehensive affection to which opium is not homoeopathic, or after they have lasted for some time.

It is for this reason that opium has been employed in every country to the detriment of patients affected with old cough, chronic diarrhoea, chronic sleeplessness, chronic vomiting, habitual spasms, fits of anxiety and trembling. These ailments have never, in a single instance, been cured by opium, if they were either fragmentary symptoms of an affection to which opium was a mere antipathic, or after they had been in the organism for a certain length of time.

The greatest abuse which has been made of opium is as an anodyne against pains of any kind, no matter how old and inveterate they might have been.' The fact that opium should be used as an anodyne against all sorts of pain, appears of itself foolish to common sense. Physicians ought to consider that pains vary according to the nature of the disease, locality, time, the circumstances in which they originate, are excited again, increased or diminished, etc., and that this variety of pains requires a corresponding variety of remedies, inasmuch as every drug, being itself a finite substance, can only have a finite sphere of action. Opium is no true anodyne, does not cure pain. Among the primary symptoms of opium there is not one symptom of pain. Every other drug excites a particular kind of pain in the organism and is therefore capable of curing a similar pain, especially when all the other symptoms correspond. Opium is the only drug which is incapable of curing a single pain, for this reason, that it does not produce any kind of pain as a primary symptom, but on the contrary insensibility, which is necessarily followed by an increase of sensibility as a secondary effect and a corresponding increase of pain.

All the pains which have been palliated by opium, return as soon as the stupefying effect of opium has passed off, and return at least with all their former violence.*^ Generally the pains return with gi eater violence, and their farther suppress-

' Although I have condemned the practice of administering opium as an anodyne as late as twenty years ago fsee the first edition of the Organon, 1810); although I have shown tnat practice to be a sinful transgression of the just rights of the patient, nevertheless the practice ha continued as before without any intermission. The perpetrators of that practice have indignantly rejected my exhortations ; my exhortations, intruding upon their thoughtless routine, have roused their anger just as the impenitent sinner, whose conscience is struck by the sermon of the minister, growls at the latter instead of being dissatisfied with himself. But what does a man like me, who feels bound in his soul to teach important truths, and who has truth and nature on his side, care what those incorrigible spouters may say ?

He who feels strong enough to discover errors and to enlarge the boundaries of science, is obliged to do so, and the public ought to listen to him, although ti whole school, who thinks its authority so well founded that it does not think it worth while to appeal to nature, or who feels bound, at any rate to suppress the memory of the discoverer, should be offended by the new doctrine. — Fr. Casimir Mediais.

Chronic maladies are the touch-stone of true treatment, because they do not disappear of themselves ; slight aiUiients which come on of a sudden, pass off with or without medicines, by the recuperative power of the organism ; but if remedies do act as curatives in acute affections, these ought to disappear much more speedily than when no medicine is given.

If opium seems to appease pain in acute diseases, it is because these diseases either became speedily fatal, or else disappear of themselves in a few days, together with the pain.

Opium cures pain indirectly when it is homoeopathic to the general affection, in which case the pain disappears together with the disease. Every case of dysentery, for instance, depends upon a retention of faeces in the upper part of the intestinal canal ; it is evident that some cases of dysentery which are accompanied with heat and stupor, may be cured by opium, for the simple reason that certain primary effects of opium correspond to those symptoms homoeopathically, and of course cover the accompanying pains which were occasioned by the spasmodic retention of the faeces.

Painful diseases, both acute and chronic, can only be cured by a remedy which is capable of producing in its primary action upon the organism a pain similar to the one which it is intended to cure ; when that remedy is administered, both the disease and the pain disappear at the same time.

Opium being given as an antipathic remedy to pains, it was

To counteract the coldness which was experienced as a secondary effect of opium, heating spices were added, and its constipating virtue was supposed to be counteracted by cathartics and salts. By dissolving it several times in water, by filtering and inspissating it, its crude, pretendedly useless and hurtful resin was supposed to be separated from it, and the pretendedly poisonous narcotic essence was supposed to be expelled by submitting the opium to digestive processes for months ; it was even thought that it might be refined and moderated by roasting, and that it might in this manner be converted into a precious and faultless panacea against all sorts of complaints, pains, sleeplessness, diarrhoea, etc.

In cases of poisoning by opium, the genuine primary effects of opium are not seen; but the incipient reactions just mentioned at once terminate in death. I have seen such cases, and Willis relates some in his Pharm. Rat., sect. VIL, can. I p. 292. ' F »

The oriental opium-eaters are constantly in a state of the secondary effects of opium, after the effects of opium have subsided ; Their mental powers are very much weakened by the frequent use of that drug ; chilly, pale, bloated, trembling, lowspirited, Aveak, stupid, and with an evident feeling of internal discomfort and anxiety does the opium-eater stagger to the opium shop in the morning to swallow his number of opiumpills, in order to accelerate the course and restore the warmth of the blood, to raise his sunken spirits, to animate his cold and barren imagination with a few ideas, and to rouse for a time the activity of his paralytic muscles.

My co-observers are, Cubitz, Gutmann, Schoenike, Staph

Head p. 8

Vertigo, when stooping, (a. 20 h.) Vertigo and stupefaction of the head. Violent vertigo obliges him to sit down.

5. Vertigo, as if everything were turning with him in a circle. He feels giddy, anxious ; his senses are confused. Vertigo and confusion of the mind. He staggered to and fro like one intoxicated. Intoxication.

10. A sort of intoxication which prevented her from keeping herself on her legs. Small doses of opium produce cheerfulness of mind, larger doses produce intoxication. Cloudiness of the head (immediately). Gloomy feeling of the head, with a feeling of dry heat in the eyes, and a disposition of the eyes to close, without, however, feeling drowsy, with sensation as if he had been awake the night before. The head feels heavy and as if intoxicated (for 12 hours).

15. Obtuse feeling of the head. Sensation in the head as if smoke were ascending into the brain. Stupefaction. Dullness of the understanding, as if he had a board before his head, accompanied with vertigo, which obliges him to lie down, followed by trembling of the body which lasts for some time. Violent stupefaction and intoxication (from smelling much opium).

20. Dull stupefaction, with faint eyes and extreme debility. Stupefaction and insensibility ; his answers, however, are appropriate. Sensation in the head as one experiences after waking from sleep consequent upon a violent intoxication with wine. Dullness of mind, short, anxious respiration, with heaving of the chest ; the eyes are full of water and half closed. Ideas crowd upon him ; he feels cheerful.

25. He feels more disposed to serious, important affairs. He is without sleep the whole night, but more disposed to elevated contemplations. After taking opium, the evening previous, he lost all inclination to sleep ; his imagination and memory became astonishingly strong, so that he was almost forced, as it were, to pass the night in the deepest meditations ; at daybreak he slumbered for a few hours, after which he was unable to recollect what he had been thinking during the night.' Slow thought, stupidity, absence of sense. Taciturn.

30. Weakness of mind. Disappearance of the mental faculties. Dullness of sense. Dullness of mind. Dullness of all the senses and mental faculties.

35. Indifference to pain or pleasure. Stupefaction, indifference. The head feels dull ; he has no clear notion of any thing ; when reading, he is unable to conceive the meaning of what he is reading. Dullness of sense, (a. 8, 12 h.) He does not recognize his nearest relatives, the most familiar objects.

40. His senses are dull, he is insensible, he is scarcely conscious of his existence ; his answers, however, were pretty appropriate. He is not conscious of himself Stupefaction and loss of rationality. Dullness of physical sensations, which sometimes disappear altogether. She was unconscious of what took place around her ; she seemed to be insensible ; the joints were flexible, and all the muscles were in a state of relaxation.

45. Cloudiness and weakness of the mind ; he deceives himself, as if his eyes were four times as large as they are, and as if his body had gigantic proportions. Sensation as if he were flying or hovering through the air, and as if every thing were turning with him. He sees and hears, but he has no taste, smell or tact ; however, he feels the coldness of his own body, (a. li h.) Stupidity. Stupidity, indifference to external objects.

50. Stupidity and imbecility. Opium-eaters are drowsy and almost stupid. Opium-eaters are always indolent and intoxicated. Want of memory. Loss of memory.

55. Weakness of memory (when using opium frequently). Loss of memory (for several weeks). Long-lasting loss of memory.' Wavering ideas.

60. He is insensible to shame and refined feelings. The power of volition was overcome by the least cause. Opium-eaters are said to be inconstant ; they frequently promise what they afterwards refuse to fulfil, (every body is on his guard against them ; does not want to have any thing to do with them). Rush of blood to the brain. (The vessels of the brain were distended with blood.)

65. Pulsations of the arteries of the head. He hears the arterial blood rise to the brain. Painful headache, in the occiput. Headache on one side of the forehead, with pressure from within outward, increased by external pressure. Headache, as if there were pressure in the forehead from within outward.

70. Tearing and beating in the forehead, sour eructations, sour vomiting ; she had to he down, after which she began to perspire. Single twitchings in the temporal muscles. Sort of pressure in the forehead, which seemed to extend as far as the eyes and nose. Sensation of tightness in the head. Headache.

75. Violent headache. Pain in the head as if all the contents were torn, with sensation as if every part in the body were turning wrong side up, with a feeling of angriness and uncomfortableness. Heaviness of the head. Heaviness of the head for several days ; theocciput feels like lead, the head falling backward constantly ; it was impossible to keep it erect.

80. He is unable to keep his head erect ; it totters to and fro.

Face p. 10

Sunken, pale countenance. Pale countenance. Frequent alternation of redness and paleness of the countenance. Pale countenance and nausea, with sensation of drowsiness and diminution of all the secretions, frequently'- even of exhalation.

85. Pale face and forehead, and glassy eyes. Claycolored countenance. Clay-colored, pale countenance, faint eyes filled with tears ; he slumbers with his eyes half open, does not heed any thing, gives vague answers, passes his stool involuntarily, sinks into his knees, and falls, and has a short, anxious respiration. Bluish, clay-colored face. He looks in his face as if he had not slept enough, or as if he had been revelling the whole night, with sunken, winking eyes.

90. All the muscles of his face look relaxed, which gives the face a stupid expression ; the lower lip feels inclined to hang down relaxed, the nostrils are wide open, and it is only with great difficulty that he can raise the upper eyelid. Red spots on either cheek. Bloated countenance. Bloated countenance, hot and dry skin, white tongue, hoarseness, oppressed breathing, spitting of blood. Dark-red countenance.

95. The face is entirely red. Red, bloated, swollen countenance. The face is cherry-brown. The veins of the face are distended. The face is red and puffed, and the veins of the head are distended.

100. The face and eyes are red. The face is uncommonly red, and the lips are swollen. The face is not only red, but looks inflamed. The face is entirely red, and the eyes look wild, red, and protrude from their sockets.

105. Disfigured countenance, taciturnity, staring eyes. Spasms of the facial muscles. Spasmodic movements of the facial muscles, (a. 7 days.) Convulsive trembling of the facial muscles, lips and tongue.

Eyes p. 10

Glistening, sparkling eyes.

110. Staring and glistening eyes. Glassy, protruded, immoveable eyes, which do not see any thing, like those of a dying man. The pupils are immoveable to the light. Dilated pupils (the first hour). The pupils dilate easily.

115. Contracted pupils. The eye is only half closed, and the pupils are dilated without possessing any irritability. Open eyes with the pupils turned upward. Sensation in the eyes as if they were too large for their cavities. He stares at those who are present with watery eyes, but he does not know what is taking place, and he is unable to recognize those persons.

120. Scintillations before the eyes. Dimsightedness, as if he were looking through a gauze. His eyes see black ; he is giddy. Although he has his full understanding, yet he complains that his eyes are obscured, and that he is getting blind, (a. 4 h.) Swelling of the lower eyelids.

125. The eyelids hang down as if paralyzed. The eyelids are trembling, they cover the globe only half.

Ears p. 11

Dull roaring in the ears, after dinner (in four hours). Humming in the cars (very soon). Ringing in the ears.

Mouth and teeth p. 11

130. The lower lip is painful when touching it with the upper teeth or with the fingers. Distortion of the mouth. Locked jaw. Violent pains in the lower jaw (after 7 days). Force had to be used in opening her mouth, and pouring a few tablespoonfuls of soup down her throat.

135. Pain of the upper jaw. (a. 8 h.) Toothache. Vacillation of the teeth. Fine, corrosive pain in the nerves of the tooth, (a. 8 h.) Hanging down of the lower jaw.

140. Paralysis of the tongue. Speech becomes feeble when he begins to talk ; he has to make an effort in talking loud. He is unable to talk, although his mouth is open. He stutters. White tongue.

145. Black tongue. Ptyalism. Profuse Ptyalism. Ptyalism as if occasioned by mercury.

150. Suppresses the secretions from the salivary glands, the Schneiderian membrane and glands of the larynx. Inspissated the saliva, the nasal mucus, the mucus of the trachea, and makes the tongue dry. Dryness of the tongue, palate and fauces, without inclination to drink. Feeling of dryness of the anterior part of the tongue, without thirst, early in the morning. Dryness in the mouth, without any desire for drink, with chilliness over the abdomen,

155. Dryness over the whole mouth, with little thirst. Dryness in the back part of the throat. Dryness in the throat and on the tongue. The mouth is so dry that he is scarcely able to utter a word. Violent thirst, especially a desire for small beer.

160. Causes little ulcers in the mouth and on the top of the tongue.' Occasions ulcers in the palate and on the tongue. When chewed, it burns the mouth and

' From tasting opium. tongue, and inflames the throat. Excites an intolerable, biting burning on the tongue, as of pepper.'

165. The veins of the neck are distended, and the arteries pulsate violently. Difficult deglutition. Inability to swallow. Bitter mouth. Flat, almost no taste.

170. Sour taste. Bitter taste in the mouth, next morning. Loss of appetite. Takes away the appetite immediately (when taken in a somewhat large quantity).

175. Want of appetite either for solid or liquid food. He has an aversion to all things. Aversion to food, for a long while. Excessive aversion to food, with extreme debility. Extreme aversion to meat, with impure tongue.— 1 80. He asks for food, but as soon as he has swallowed a morsel he does not care any for the remainder. Increase of appetite. Canine hunger in frequent paroxysms, sometimes accompanied with a flat taste in the mouth, (a. 3 and several hoin-s.) Canine hunger, with puffiness and oppression of the stomach after a meal.

185. Excessive hunger with great debility. Canine hunger with aversion to food.

Gastric symptoms p. 12

Nausea. Inclination to vomit. Frequent nausea and vomiting.

190. Violent retching. Vomiting, (after a {ew minutes.) Inclination to vomit, during exercise. Vomiting after a meal.

195. Disposition to vomit ; hsematemesis. Pain in the stomach and convulsive motions, during which she vomits. Continual vomiting. Green vomiting.

200. The stomach is insensible to emetics. Eructations, (a. 5. h.)

Stomach p. 12

Repletion of the stomach. Oppression of the stomach. Continued hiccough, with short intermissions.

205. Violent pressure at the stomach (immediately). Weakness of the stomach. Oppression of the stomach as if a stone were lying in it. (a. 2 h.) Violent pressure in the region of the stomach, immediately after dinner, diminishing during a walk. Painful distention of the stomach.

210. Troublesome pressure across the stomach, after dinner, as if he had eaten too much, or as if the food had been too hard ; this pressure is relieved by walking in the open air. Violent pain in the stomach. Sudden pressure at the stomach and compression of the diaphragm. Constrictive pain in the stomach, intolerable and giving one a deadly anguish.^ Weakens the stomach.

215. Retards digestion and diminishes the appetite. Slow digestion. Disturbs digestion, occasions a feeling of heaviness, and compression in the stomach, and an indescribable trouble in the pit of the stomach. Painful distention of the pit of the stomach.

' When taken into the mouth in a certain quantity.

« From opium being taken immediately after dmner.

Abdomen p. 13

Distention of the abdomen, especially in the umbilical region.

220. Sensation of distention of the abdomen and especially the stomach. Accumulation of fialnlence in the stomach and intestines. Distended abdomen. The abdomen is distended and painful. Pain in the abdomen, as if one had taken a cathartic, (a. g h.)

225. Colic, as from a cold. Simple pain in the abdomen, as if bruised. (a. 2 h.) Oppression of the abdomen, and a pressing puffiness of the abdomen, as if it would burst ; the pressure decreased by moving the body, but it returned when sitting down. (a. 2 li.) Constant formation of flatulence. Frequent emission of flatulence.

230. Sensation as if the abdomen were oppressed by a weight in the umbilical region, with anxiety ; a feeling of flying internal heat and stupefaction of the head. (a. J h.) Beating in the abdomen. Aching and tensive pain in the abdomen, (a. 24 h.) Stitches in the left side of the abdomen, also between the inspirations, (a. 3 h.) Colic, before and after stool.

235. Oppression and heaviness in the abdomen, as of a stone. Drawing colic. Pain in the abdomen, as if the intestines were cut to pieces.

Stciul : Sluggishness of the peristaltic motion, retention of stool. Paralysis of the intestines.

240. (.""costiveness. Retention of stool and urine.

245. Constipation for ten days, terminating in death. Hard stool, preceded by pinching pain in the abdomen, and flatulence. Sensation, when making an effort at stool, as if the passage into the rectum v/eie closed. Hard stool for six days, he has to make an efioit every time he goes to stool. Costiveness for 6, 8 weeks, with loss of appetite ; no stool was passed except by an injection ; even in this case nothing but small, hard balls were passed. — ;^50. Costiveness for several months. Opium sometimes causes diarrhoea (secondary effect). Papescent stool (immediately or in ^ hour).

255. Fetid stool, (a. 20 h.) Increase of stool. Watery diarrhoea.' Discharge of a black substance by the rectum. (a. 24 h.) Liquid, frothy stools, with itching, burning in the region of the anus, and a violent tenesmus.

260. Fetid diarrhoea. Violent, painful movement of the fetus, frequently intermitting for hours, but afterwards returning with so much more violence. The uterus had become soft. Excessive, laborlike pains in the uterus, obliging her to bend double, with anxious, but almost ineffectual desire for stool, (a. i h.) Excessive pain in the rectum, with distensive pressure (between 4 and 6 hours).

Whenever she uses opium for her tooth-ache.

Urinary organs p. 14

Lemon-colored urine, with a good deal of sediment. Dark-colored urine. Dark urine and dry tongue. The mine is dark-red, and deposits a sediment. Hematuria.

270. Scanty, but red urine, without clouds. The urine has a brick-colored sediment. When making an effort to urinate, he feels as if the passage into the urethra were closed. Spontaneous interruption of the stream when urinating. He is not able to emit urine, except after great efforts.

275. He emits but little urine of a very dark-red color, with cutting pains during micturition. Suppression of urine. Retention of urine.

280. Retention of urine with dry mouth, and increased thirst. Weakens the contractile power of the urinary bladder. Opium sometimes suppresses, sometimes excites the urine. Excites the urine.

Genital organs p. 14

Erections during sleep, and impotence after waking. Excessive erection. Excitation of the sexual instinct, erection, emission, and lascivious dreams.

290. Excitation of the sexual desire, erection for 24 hours, lascivious dreams, emission. Emission (1 night). Nightly amorous visions, emissions. Excessive excitation of the sexual desire.

295. In some the sexual desire is excited, in others diminished. Slow, sexual desire. Opium is supposed to diminish the sexual powers. Excites the sexual desire. Impotence.

300. Impotence. Diminution of the sexual desire. Increased menstrual discharge, (a. 2 h.) Opium left the menstrual functions undisturbed, even in a case where it had been used for thirty years every day, in doses of four grains and more, causing very painful, spasmodic paroxysms.

Coryza and respiratory organs p. 14

Obstruction of the nose, like dry coryza, in the warm room, after walking in the open air.

305. Hoarseness. Hoarseness, with dry mouth and white tongue. Excessive hoarseness. Hoarseness as if occasioned by mucus in the trachea. When swallowing liquids she coughed.

310. The cough is worse after a meal. Hollow, dry cough (immediately after taking the drug) ; it passes off again very speedily. Paroxysms of a violent dry cough • followed by yawning and a sudden loud cry. (a. 36 h.) His face becomes suddenly bine, and he wants to cough, but the breathing is arrested ; after this he falls into a deep sleep, his body being covered with a cold sweat, (a. 30 h.) Cough during deglutition.

315. He coughs up a frothy mucus.

Chest p. 14

Spitting of blood. Expectoration of a thick, sanguineous mucus. Suppression of the sanguineous expectoration and stool, quick respiration.

320. Quick, oppressed, anxious respiration. Accelerated, difficult respiration. The breathing is shorter and shorter. Slow respiration. Difficult, oppressed respiration, especially at night.

325. At times single, deep inspirations ; at times the breathing is suppressed for minutes. The inspirations are long and sighing. Short, snoring breathing, which is from time to time arrested for half a minute. Short attacks of anxiety, with short, oppressed breathing and trembling of the arms and hands.

330. Difficult respiration and anxiety. Anxiety, with contraction and tightness of the chest. Constriction of the chest, as if it were stut; difficult respiration. Asthma, as if he would be attacked with pleurisy, accompanied with tension in the region of the scapula. Spasmodic asthma.

335. Oppressed and difficult respiration, and anxiety about the heart. Diminished breathing; asthma. Difficult, impeded respiration. Deep, snoring breathing. Difficult, deep breathing.

340. Panting, loud breathing. Excessively difficult and anxious breathing, with open mouth. The breathing was at times snoring and loud, at times difficult and feeble. Loud, painful, ruhng respiration.

345. Moaning, slow respiration, (a 4 h,) Moaning, suppressed breathing. The breathing is imperceptible ; sometimes accompanied with a little noise,

350. Irregular, suffocative breathing. Oppressed, difficult and irregular breathing. The breathing stops for a few minutes, after which it returns with a sigh. The breathing was arrested ; for five minutes he was like one dead ; after this the inspirations became short and sudden, as if hiccough were about to set in. The breathing was interrupted by progressively increasing intervals, until death set in.

355. Excessive aching pain in the right side of the chest, also between the acts of inspiration, with stitches in that side during an inspiration (a. 1 h.) Drawing tearing pain in the side of the chest. Contractive (clawing) pain in the sternum and back, which is felt during motion. He feels hot in the chest. Burning in the heart, as of glowing coal ; she thinks she will die with it, — 360, Pain in the hypochondria, especially the right. Tension in the infra-costal region ; it is very painful to the touch, (a. 4 h.) Tensive pain below the short ribs, along the attachment of the diaphragm, during an inspiration.

Upper limbs p. 15

Single twitchings in the arms.

365. Convulsive motion to and fro in one or the other arm. Paroxysmal trembling in the left arm, (a. 3 h.) Tingling sensation in the fingers, increasing when seizing any thing. Itching of the arms and shoulders. Trembling of the hands.

370. The arm is paralyzed, (a, 48 h,) Disagreeable creeping in hands and feet, passing over into a frightful rolling.

Lower extremities p. 16

The lower limb is almost insensible. Violent itching of the lower limbs, in the evening. Weakness of the lower limbs

375. Sensation as if the blood-vessels were alternately traversed b)?^ sudden torrents of fire and by icy cold water. Drawing-tearing pain in the back. He strikes his foot convulsively up and down, with a sudden, loud cry. Numbness of the foot. The foot feels stiff, and is so sensitive that he can neither tread upon it, nor use it in walking. 380. — Swelling of the foot. Heaviness of the feet after a meal, (a. 2 h.)

General symptoms p. 16

Horrid pains, penetrating the marrow of the bones. Emaciation of the whole body. Dropsical condition of the body,

385. He cannot bear the open air, and feels as if he would catch cold. Pale, bluish color of the skin. The skin of the body, especially that of the genital organs is blue. Blue spots on the body, here and there. The whole body is red.

390. Burning pain and sometimes itching of the skin. Burning and itching of the skin, and rising of the epidermis in pustules.' Stinging itching in the skin here and there. Itching, especially of the upper parts of the body, commencing at the chest and extending over the face, especially the nose. Troublesome itching.

395. Redness and itching of the skin. Itching of the whole body; after scratching, red blotches make their appearance, itching a good deal, but soon disappearing again. Cutaneous eruptions, and sometimes itching. Sweat is frequently followed by cutaneous eruptions and a smarting itching in the skin.

400. Small red itching spots on the skin here and there. Itching and creeping in all the limbs, (a. 5 h.) Sensibility is diminished first, afterwards irritability. The limbs are numb and insensible. The limbs are numb and insensible, the whole body being cold. (a. 2 h.)

Fits, spasms p. 16

405. Cold, stiff body. Tetanus. Incipient opisthotonus. Sort of opislhotonic spasm of the nape of the neck. (a. 1 h.) The back is stiff and straight (a sort of tetanus, between the first and second hour).

410. The trunk is curved in the form of an arch, owing to the violent tremor in the limbs, which causes a sensation in the nerves as if they would be pulled to pieces. Rigor of the whole body. (a. 1 h.) Tetanus and epileptic convulsions.'^ Convulsions.^ Spasmodic motions, accompanied by cries.

415. Convulsive movements. Epilepsy. Epileptic fits, with violent delirium. Foam at the

' From the frequent use of opium.

' Shortly before death.

' From large doses. mouth. Uneasiness in the sound Hnibs, which cannot remain quiet a moment.

420. Tremor of the whole body, as if he had become frightened, accompanied with single jerks in the body and twitchings in the limbs, the flexor muscles whereof are the only muscles in a state of activity, the outer parts of the body being cold. Convulsive trembling of the limbs. Spasmodic trembling of the limbs. Tremulous motion in all the limbs, causing every nerve to be pulled upon. Staggering.

425. He is unable to walk without staggering. Agreeable weariness, as if occasioned by intoxication. Slow, vacillating gait. Invincible weariness. Indolence.

430. Great inclination to lean against every thing, to stretch the feet carelessly, and to support the head upon one arm. He feels strong. DebiUty. (a. 8, 12 h.) Laxness, indolence.

435. Debilitated; every thing is disagreeable to him ; he is drowsy, dizzy, stupefied, sad, and he loses his memory.' Opium suppresses the mobility of the voluntary muscles, diminishes the sensibility, and therefore causes sleep. In strong persons opium diminishes the power of the voluntary muscles, makes the head feel heavy, and causes great debility.*^ Grows soon old.

440. Opium causes a sensible diminution of strength, and takes away the tone and the mobility of the solids. Relaxation of the limbs and debility. The mobility of the muscles decreases. Heaviness of the limbs, (a. I h.) Debility.^

445. Opium frequently causes apoplexy.^ Is unable to do any thing, feels faint and weak. He is scarcely able to stir his feet, or to make a step forward, even when obliged by force.

450. Debility, and inability to move. He became excessively debilitated. Difficulty of moving the muscles. Increased inability of moving the limbs. Laxness of the muscles, occasioning a sort of paralysis.

455. Laxness of all the muscles. Paralysis.^ The limbs were immoveable, and remained in the position in which they were placed. Great debility and sinking of the vital forces.® Uncomfortableness, both of the body and mind. (a. 8, 12 h.)

460. Fainting fits. Fainting fit every quarter of an hour ; he closes his eyes, hangs his head, with weak breathing, without consciousness, the pulse remaining unaltered ; this is followed by a few spasmodic concussions of the body, a few minutes after which the paroxysm terminates in a sigh ; afterwards anxiety.' Hemorrhage from a vein which had been opened a little while ago (until the person died). Her strength feeling increased, she attempted to rise from her bed, but she fainted immediately, and felt giddy ; after lying down her consciousness and strength returned, inclination to lie down.

Sleep p. 18

Yawning for many hours, with pain in the articulations of the jaws, as if they would break. Drowsiness. Great inclination to sleep. Falls asleep suddenly. Coma vigil.

470. Unintelligible talk during the sopor. A sort of sopor, the eyelids being half open, the eyeballs being turned upwards below the upper eyelid, the mouth being more or less open, and the breathing being snoring. Drowsiness, sopor, stupor. Sopor. Produces a morbid slumber in place of a sound sleep.

475. Continuous sopor in the night, with increase of thirst, clean tongue with dark-red edges, and dry, parched lips. The opium-sleep passed over into an unusual stupor. The stupor was so intense that it was impossible to get an answer out of him.

480. Sound sleep, with raling breathing, as after an apoplectic fit. (a. 6 h.) Almost constant slumbering, the eyelids being half closed, accompanied with constant grasping at flocks, and moving of the hands over the bed-cover. Stupor, without consciousness, and raling in the chest. Sleep with consciousness. He hears every thing that is said, but is unable to wake himself; he wakes after the lapse of two hours. By shaking the patient and talking to her, it was possible to wake her. When awake she complained and wished to die soon.

485. Sopor and insensibility, with natural warmth, and a natural pulse and respiration. Unconquerable sleep, during which he feels pain, however, and opens his eyes when pinched. Irresistible sleep (immediately after taking two and more grains), which was however disturbed with dreams, and at the termination of which he felt nauseated instead of refreshed. Unrefreshing sleep with general sweat. Weariness after a sleep produced by opium.

490. He feels faint-hearted when waking. Inclination to vomit when waking. On waking from his opium-sleep he feels faint, his head feels heavy and the throat feels dry. Erection

' From the tincture of opium mixed with spirits ot hartshorn. during sleep, and impotence after waking. Stuttering on waiting from his opium-sleep.

495. Difficulty of moving the tongue, after waking. The head feels gloomy after waking. He starts in his sleep ; on waking he is Hke one drunk and half crazy. Intoxication and vertigo after the sleep. He feels still more exhausted after waking, owing to restless dreams in the night.

500. A man who had not had any dreams for a long time past, dreamed after taking opium. The whole night he was haunted by a multitude of visions and fancies. Opium-sleep is always disturbed with dreams and gesticulations. Merry dreams.

505. His dreams are at times pleasant, at times sad, at times anxious and terrible. The opium-sleep is disturbed with dreams which are at times pleasant, at times frightful ; it either degenerates into sopor or into an apoplectic death, with convulsions. Deep, sound sleep, with rattling breathing, as if she had had an apoplectic fit. Snoring.

510. Snoring during an expiration, while asleep. Moaning while asleep, (a. 2 h.) Lamenting cries during sleep. Restless sleep, full of moaning and groaning. Anxious sleep, full of dreams, (a. 7 h.)

515. Anxious sleep, disturbed with- the saddest dreams ; he seems to be in constant delirium while he is in his sopor. Suffocative fit during sleep (night-mare). Sleep full of terrible fancies and fearful dreams.

520. Sleep full of fright; when closing his eyes, he feels as if he had lost his understanding. Vivid, vexatious dreams, he does not succeed in any thing. Frightful dreams. Sweet, pleasant slumber, from which he is suddenly waked by frightful jerks in his limbs.

625. Restless, sleepless nights. He is very drowsy; nevertheless he is unable to fall asleep ; the pulse being slow. The soporific power of opium is very much diminished by great pain or great grief Sleepless nights with delirium.

530. Sleeplessness, full of imperfect images, and full of fancies which were altogether distinct from the surrounding objects, as in crazy persons. Between the waking and the sleeping states he had dreams and fancies about dragons, skeletons, and horrid ghosts and masks. Resdess nights, sopor alternating with waking, delirium, hot skin, stupor ; he is lying coiled up in one heap. Sleep and redness of face.

Fever p. 19

The pulse sank from one hundred and eight to seventy-two beats ; accompanied with chilliness and shuddering, diminished cheerfulness, great debility, and increase of appetite.

535. Diminishes the beats of the pulse and the inspirations. The pulse decreases by fourteen beats (the first four hours) ; after the lapse of ten hours the pulse increases by thirty beats.' The pulse diminishes one half.*^ The heart beats four times more slowly. ^ Great, slow pulse, the respiration being slow, heavy and snoring.

540. Great, slow pulse, with slow, heavy and snoring breathing. Slow pulse. The pulse is stronger. The pulse is at first slow and full, afterwards weak. Slow pulse, with moaning, slow breathing, red, puffed face, and profuse sweat, with convulsions.^

545. Full, equal, slow pulse, with deep, snoring breathing. Faint, suppressed, slow, small pulse. He complains of feeling chilly. Inclination to shudder. Diminution of animal heat.

550. Chilliness in the back, with suppressed, scarcely perceptible pulse. Cold extremities. Thirst during the chilliness. Fever : first chilliness, afterwards flushes of heat in the face (with white tongue and sweat before midnight).

555. Fever : first chills, afterwards heat with sleep, during which he sweats a good deal. (Fever : he falls asleep during the chilly stage ; no thirst during the chilliness ; thirst during the hot stage, accompanied with a profuse, general sweat. Chilliness as soon as she gets into bed in the evening; as soon as she falls asleep she begins to perspire, especially about the head. (Fever : trembling chilliness with thirst, afterwards increased heat of the whole body, with inclination to uncover herself, with strong, full pulse, dryness of the fauces without thirst, and vividness of ideas and memory.) (a. 1 h.) Coldness of the extremities.

560. Coldness with stupefaction. Diminution of animal heat, followed by increase of exhalation from the skin. Strong, quick pulse, which finally becomes weak and intermittent (a. 8^ hours, shortly before death).^ Gtuick and unusually weak pulse, with quick, oppressed, anxious respiration (after several hours). Quick pulse with headache.

565. Q,nick, violent, rather hard pulse, with [a dark-red countenance. Congestion of blood to the brain. Violent, quick, hard pulse, with heavy, impeded respiration. Accelerated circulation, with sensation of heat.

570. The blood-vessels are distended with blood. Increased heat. Alternation of moderate warmth and coldness. Great redness of the face with burning heat of the body, for eight hours ; afterwards convulsive beating with the right arm and foot, with loud cries, heavy breathing and coldness of the face and hands, which are

' From rubbing in eight grains of opium, after fifty minutes.

'^ Alston saw this through the microscope in the foot of a frog, to which he had given some drops of the tincture of opium.

^ In a frog, to which opium had been given.

* From opium mixed with the spirits of hartshorn.

5 From one scruple. covered with drops of sweat (shortly before taking the drug).

575. Burning heat in the face, and a sensation of heat, especially in the eyes, without thirst, for six evenings in succession. Heat with thirst. Increases the heat of the whole body, and occasions dryness of the mouth, and thirst. The skin is sometimes dry and hot, sometimes a slight sweat breaks out. Heat of the body, with great anxiety.

580. Intolerable heat with great anxiety. Acute fever, with delirium making its appearance after a short sleep, and lasting twelve hours ; after the fever he became very weak, and was attacked with fits of nausea, the pulse being weak ; in three hours the delirium recurred, lasting forty-eight hours, with a strong, full pulse ; after this he fell into a sleep of eight hours. Restlessness, oppression, confusion of ideas and scintillations, during which a burning, disagreeable heat ascends to the head, and afterwards spreads over the whole body. Drops of sweat about the head, afterwards over the whole body, and sleep. Increased exhalation from the skin.

585. Sweat all over. Early in the morning during sleep, a sweat breaks out over the whole body, and he shows a disposition to uncover himself, (a. 12, 36 h.) Cold sweat on the forehead. Sweat, especially on the upper parts of the body, the lower parts being hot and dry.

590. Profuse sweat. Strong sweat (for twelve hours). General sweat, (a. 8 h.) Violent sweat, during a pretty quiet sleep.

595. Profuse sweat, causing an itching in the skin, and bringing out an eruption, all the senses, taste, sight, smell, becoming in the mean while insensible. Sweat and eruption of a red rash, with itching. General sweat over the hot body with great thirst, full, strong pulse, vivid eyes and bright mind.

Moral symptoms p. 21

Contentment. Alternation of sullen mood, without care, and of cheerfulness.

600. Taciturnity (after the smallest dose). Calm indifference to the things of this earth, owing to the ecstatic excitement of the fancy. Constant contentment, as if they were in heaven. He remained the whole night without pain, in great contentment.^ Extremely delightful feeling, with contentment of mind and forgetfulness of all his ailments.

605. She was unable to obtain peace and happiness except by taking opium. He had no sleep, but he became quiet and contented, as if he were in heaven.^ Sweet, delightful fancies, than which nothing can be

' In the evening he had taken a grain of opium for a most troublesome pain.

2 After having taken a moderate dose of opium, on account of violent pain from stone. more pleasant, especially after having been tortured by pain. He feels as if in heaven, vivid, delightful fancies hovering before his mind, which keep off sleep.

010. The cheerfulness produced by opium is like a dream without sleep. A female who was in the habit of indulging sad thoughts, was relieved of her sadness for some time in a most wonderful degree.' Opium causes forgetfulness of the sufferings of ihe soul, and produces a feeling of bliss in their stead.

615. The opiumeaters, who are generally sad and stupid, become cheerful ; they revel, sing amorous songs, laugh, and indulge all sorts of comic manners ; this pleasant exaltation of the mind lasts about an hour, at the termination of which they become angry and raving, and finally relapse into a state of sadness, and then fall asleep. Cheerfulness, contentment, disposition to work, fearlessness, courage.

620. Boldness, magnanimity ; he feels as if he would carry out any thing in spite of obstacles, with a feeling of bliss; this sensation only lasts a few minutes, after which his head feels gloomy (after a quarter of an hour). Boldness in danger. Opium gives those who dread a surgical operation courage and boldness. Criminals (in India) lose the fear of death, and march boldly to the gallows.*^ — 625, Audacious, daring. Opium makes one wild and cruel, like a ferocious beast,^ Rage, frenzy, and mania. Frenzy and distortion of the mouth (from applying opium upon the temples).

630. Mental derangement. Delirium. The patient is haunted with visions, Fearfulness and tendency to start. Want of courage.

635. Fear, (a, 8, 12 h.) Frightful visions. During her delirium she saw ghosts, devils, and masks around her bed, which tormented her very much.^ He said a great many incoherent things, and pointed to persons with masks, whom he pretended he saw approaching to him ; now he broke out into a loud laughter, now he started on account of imaginary fencing-masters, who might stab him ; he became angry when one tried to persuade him that he was indulging foolish fancies ; nevertheless he blamed himself in his delirium for indulging them.' In his delirium he talks about all sorts of things with open eyes, and afterwards he only remembers his talk as a dream.

640. She was hot, anxious, and intoxicated, talked all sorts of things, retracted what she had said, at times she started, at times she seized the hand of those around her with great anger. '^ He acts absurdly. His cheerfulness and mental bliss increase until they become irrational.^ Violent mania, with redness of countenance, glistening eyes, and increased animation of the body. He rolls about the floor like a maniac, threatening and burning with anger ; he does not recognize his friends, his head and face are swollen, the lips are reddish-blue and swollen, and the eyes are inflamed and protruded.

645. Ecstasy, followed by sadness and despondency. Hopeless and peevish mood. (a. 8, 12 h.) Lamentations and howling (first hours). She is put out with a pain until she cries.

650. Distrust. Sullen mood. Melancholy. Anxiety. Excessive anguish.

655. Anguish about the heart and restlessness, (a. 2 h.^)

Burning pain and irritation of the skin. Blisters on the skin. Great heat and pain of the skin, it draws a blister, corrodes the skin, and occasions mortification. Corrodes the skin, causing the hair to fall off, and occasioning itching.

660. When applied directly to the nerve it increases its sensibility and pain. When applied to the muscles, opium very soon destroys their irritability.

Notes

VOL. IV. 2 ' Smelling of a pellet of the 30th potency of opium, removes the effects of recent frights, were they ever so violent, almost instantaneous- 'ly, but only when the smelling is resorted to immediately after the fright; if used too late, the opium does mischief,

2 Opium is a specific for certain kinds of the most obstinate constit- nations, and for acute fevers characterized by a sopor bordering upon stupor and by absence of without any complaint, snoring with the mouth open, half jerking of the limbs, burning heat of the perspiring body, and for some other morbid conditions to which opium is homoeopathic. ' The mental and moral symptoms of opium are less easily distin- guished from one another than in any other drug ; in opium they are generally united. When opium is used palliatively for the purpose of suppressing pain, spasms, or a mental or moral condition contrary to that which opium is capable of producing (as in 619, 25. 612, 613, 611, 605, 614), or for the purpose of suppressing the natural night-sleep, it generally coca- sions in the place of those symptoms a sort of mental or moral ecstasy, which is a suddenly passing primary effect. This ecstasy is very much like the state of clairvoyance.

1 Note to symptoms 48, 49, 50. 51, 52, 53, 54, 55, 56, 57, 58. When these conditions have become continuous, and have been made perm- kent by eating opium for a long time, they denote a certain paralysis of the organs of the mind, which it is probably impossible to cure. (From

53-58 are secondary effects.) ' After the primary effect has passed off.

2 This diminution of the power, and even paralysis of the voluntary muscles is a secondary effect of opium ; the primary effect of opium is to excite the power of the voluntary muscles : if the primary effect is interrupted by stupefaction and stupor, one or the other limb continues to jerk nevertheless.

3 From the daily use of opium.

* From large doses.

5 From taking too frequent and too strong doses of opium.

* Even until death ensued. VOL. IV. 3 ' The opium acting as a palliative, she was obliged to increase the dose as she continued the use of the drug, until she took an ounce and a half after the lapse of one week.

2 The last nine symptoms are palliative effects of opium in persons who were desponding. ^ In persons who are weak and without courage, opium produces boldness, anger, and rage, palliatively. This palliative effect gives the Turks an almost irresistible power and desire for battle, as long as that effect lasts, but in a few hours it passes off, and the soldiers become stupid and cowardly, and are more easily beaten than any other army.

■* This happened whenever her ailments, palpitation of the heart, vomiting, hiccough, cardialgia, colic, tremor, and convulsive movements, were palliated by opium.