I. First Degree of Operation.—" In small doses, such as from a quarter of a grain to one grain, opium generally acts as a stimulant, though in this respect the symptoms are not uniform. Usually the vascular system is somewhat excited, and a sensation of fulness is experienced about the heart. The excitement in the cerebral vascular system is accompanied by alterations in the condition of the nervous functions. The mind is exhilarated, the ideas flow more quickly, a pleasurable or comfortable condition of the whole system is expe rienced, which is difficult to describe ; there is a capability of greater exertion than usual. These symptoms are followed by a diminution of muscular power, and of susceptibility to the impression of external objects ; a desire of repose is experienced, with a tendency to sleep. While these effects are taking place, the mouth and throat become dry, and hunger is diminished, though the thirst is increased; and slight constipation usually follows.
" Such are the common effects of a small dose of opium on persons unaccustomed to its use ; but by repetition the influence of this agent becomes remarkably diminished, and those therefore who resort to it for the purpose of producing a pleasurable stimulus are obliged to increase the quantity in order to keep up an equal effect.
2. Second Degree of Operation.—" Given in a full medicinal dose, such as two or four grains, the stage of excitement is soon followed by that of depression. The pulse, which at first is increased in fulness and frequency, is afterwards reduced below the natural standard. The skin becomes hot, the mouth and throat dry, the appetite diminished, the thirst increased, and frequently nausea or even vomiting is induced. The symptoms of excitement soon pass away, and a state of torpor succeeds ; the individual feels indisposed to exertion, the muscular system appears enfeebled, the force of impressions on the organs of the senses is diminished, and the ideas become confused. This state is followed by an almost irresistible desire to sleep, which is frequently attended by dreams, sometimes of a pleasing, at others of a frightful nature.
" These effects are usually succeeded by constipation (which may continue for several days), by nausea, furred tongue, headache, and listlessness." 3. Third Degree of Operation ; Poisonous Effects of Opium, as given by Dr. Christison.—" The symptoms of poisoning with opium, when it is administered at once in a dangerous dose, begin with giddiness and stupor, generally without any previous stimulus. The stupor rapidly increasing, the person becomes motionless and insensible to external impression ; he breathes very slowly, generally lies quite still, with the eyes shut and the pupils contracted; and the whole expres sion 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 exceedingly relaxed, and, unless assistance is speedily procured, death ensues. If a person recovers, the stupor 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 quantity which can produce a fatal effect in a person unaccus tomed to its use is very small, even four grains ; and in children, owing to the large quantity of blood which naturally goes to the brain, and the great impressibility of their nervous system, a very minute portion of opium, or of its numerous preparations, open or disguised, can produce death. These facts constitute a strong reason for unskilful persons refraining from its employment, and also for avoiding in this place all details connected with its medical use. It is undoubtedly one of the most important means of alleviating human suffering when appropriately administered, and yet one of the greatest banes when abused. It is by the self-doctoring in general that the practice of opium-eating is acquired; and it is the more necessary to warn such persons against commencing the use of it, even for the legitimate pur pose of overcoming disease, as they may inadvertently Lapse into habits which they may never be able to shake oft'. Further, it should be
known by those who are disposed to adopt this practice, that the habitual consumers of this drug have recourse to it again and again, not so much for the sake of the pleasurable sensations it can excite, as to escape the misery, mental and bodily, which their previous indulgence has entailed upon them. (Dr. Oppenheines State of Medicine.) It is necessary to place this statement before the public, as there is reason to believe that the practice of taking opium is becoming com mon in this country, where other stimulants are relinquished. Besides the injury done to the moral faculties and the general health, the quantity required to procure the desired excitement becomes at last so great as to render it a most expensive, and, to the poor, a ruinous habit. It has been alleged, in cases connected with life-insurance, that this habit has no tendency to shorten life. But the instances adduced in support of this view are quite inadequate to warrant such a con clusion, and all those demonstrating the longevity of opium-smokers in the East are altogether inapplicable. The effects of opium-smoking are by no means so pernicious as those of opium-eating. The prepara tion which the opium undergoes seems to disarm it of much of its injurious property. The Chinese employ only the soluble part of the opium after it has been half roasted, which they term smokeable extract, or chandoo, of which 50 or 51 per cent. is obtainable from Patna opium, and 70 to 75 per cent. from Malwa opium. This extract retains all the bitterness of the opium, but has not in the least degree the virose and nauseous odour which characterises crude opium. The more it has a brown colour, the milder and more agreeable is the odour. If well prepared, it resembles the taste of hazel-nuts. It is not mixed with tobacco, as some writers assert, and is smoked out of a very different kind of pipe,—one made of a cane of bamboo with two joints to it. The smoke is held in the mouth as long as possible, and theta expelled through the nostrils. it is rarely swallowed, and If It abould reach the stomach It generally causes some temporary (Ratline awe of that organ. The Chines, use It both before and after meals, but if taken too soon after food it onuses sleknesa. It seems to excite the bodily power., but create. little derangement of the intellectual faculties, and does not ocemion drranu, as op ium.eating does. It appears to be an almost masonry stimulus in a climate where languor and listlesanem so commonly prevail. Enjoyed in moderation It has no had consequences. These statements are confirmed by the accounts of Dr. Burnes (' Narrative of a Visit to the Court of Snide; p. 230), and above all, by that of Botta (Froriep's Notizen,' xxvi.), who made trial during a period of twelve months on himself, and found his hodth in nowieeaffected. Strict philosophical inquiry must not by casual cireumstances, and least of all should it be blamed by the rash areertions of those who debate the question of the effects of opium with the violeuce of partisans or the partiality of interested dealers. (See ' Quarterly Review,' vol. Ims, March, 1840, ' On Chinese Affairs; written by Sir John Barrow.) Of the treatment of a case of poisoning with opium, little need be added to what has been sald under ANTIDOTES, and Nencortcs. The first object is to empty the stomach, and as emetie.a can scarcely be made to act, the stornach•pump should be assiduously used. The next object is to obeiste the disposition to sleep. This may be done by keeping the person walking about as much as possible, and also applying cold and hot water alternately, as recommended by Dr. Boismgon (' Medical Gazette,' March 7, 1840), perseverance in which will often rescue the patient from imminent danger. When all the opium is removed from the stomach, vinegar, or coffee boiled in vinegar, may be drank at short intervals. Moderato vcnesection (if the pulse be full) Is sometimes of service, and carrying on artificial respiration is a most beneficial measure. The subsequent constipation requires at tendon.