Poppy, Papaver Somniferum, universally official. Poppy Capsules official in twelve standards, Poppy Leaves in France, Poppy Seed in Germany and Russia, and Poppyseed Oil in France. Red Poppy Petals, Papaver Rhoeas, official and used as a coloring matter in eight countries. Opium is derived from the unripe poppy capsules. The capsules are used in the form of a decoction and a syrup in some countries. The leaves are popularly supposed to be anodyne applied externally, which is doubtful. The seeds contain no narcotic alkaloids and supply a fixed oil to commerce, and it is used by painters and for burning purposes. It has also been used as an adulterant in olive oil.

California Poppy, Eschscholtzia Californica, is one of about a dozen Papaveraceae growing in the United States. It contains an acrid substance, a bitter principle, succinic acid, and, possibly, san-guinarine. Schmidt claimed it contains protopine. one of the opium alkaloids. The alcoholic extract has been used and is said to produce calm sleep.

I have experimented with this plant, finding little activity in the seed capsules; but the root, when freshly dug in my garden in Pennsylvania, exudes a yellow juice much resembling that of sanguinaria. I have taken it in fairly large doses, without nausea being induced or any marked narcotism. From limited experience, the root of this plant impresses me as possessing to some degree the properties of hydrastis, as well as slight narcotic properties. It had no such action as has sanguinaria in my tests of it. A tincture is not at all high colored. I very much doubt if it contains any appreciable amount of sanguinarine, as I do not get its characteristic action; but the addition of a trace of nitric acid to the tincture develops a high color, though it does not cause a precipitate. So there may be a trace of sanguinarine in the root.

Pharmacology Of Opium

There are about twenty alkaloids in opium, morphine, codeine, and ihebaine being the principal ones of the phenanthrene group, and papaverine, narcotine, narcein, laudosa-nine, laudanine, cotarnine, and hydrocotarnine being the principal ones of the iso-quinoline group.

There are two classes of actions also, a depressant action on the higher cells, and a convulsant action on the cord. Morphine is the most depressant, and laudanine the most convulsant. Scaled relatively as between the two extremes, the principal alkaloids are active as follows:

Depressant - Morphine, papaverine, codeine, nar-cotine, thebaine, laudanine - Convulsant. (Read backward and forward to understand.)

Morphine is the principal and dominating alkaloid, but differences exist between morphine and opium. The table expresses the main differences:

Function

Opium

Morphine

Absorption

Slow

Rapid

Digestion

Interferes with;

Constipates

Causes nausea but less constipation

Diaphoresis

Marked

Slight

Narcotism

Slowly induced

Rapid and certain

Convulsant

Slightly

No convulsant action of note

Sphincters

Little effect

Considerable effect

Pruritus

Causes little

Causes more than opium

Excretion

Not rapid

More rapid than opium

Pharmacology Of Morphine

A short stage of excitement is followed by depression of the higher cerebral centers, with gradual extinguishment of the faculties and then sleep. There is lack of sensibility to pain; then the medullary centers are depressed, and, in toxic doses, death results from paralysis of the respiratory center.

The cardiac center is little influenced. There is slight diaphoresis. The pupil is contracted from central stimuli. Peristalsis is checked. Metabolism is decreased. Secretion is lessened except as regards urine. There is no anodyne action upon the unbroken skin, but there is on mucous membrane. The excretion of urine is little affected. Peripheral muscles and nerves are little, if any, influenced.

Therapeutics

Externally upon unbroken skin opium is of no value as an anodyne, despite current belief to the contrary.

Gastro-Intestinal Disease

The pain of ulcer and cancer relieved, preferably by morphine. In acute gastritis laudanum is to be preferred. In vomiting which persists give morphine. Opium checks persistent diarrhea. If morphine is used give in repeated small doses. Opium is indicated in intestinal colic. In peritonitis opiates are to be used with discrimination, if at all. Don't obscure the symptoms of appendicitis or other abdominal lesion until sure of your ground. In biliary and renal calculi morphine relaxes the spasm.

Heart

Morphine may be used cautiously in cardiac dyspnea, given hypodermatically. The pain of aortic aneurism is relieved by morphine and atropine. Before general anesthesia, a hypodermatic dose of morphine may be given to diminish the danger of cardiac paralysis.

Respiratory Disease

Don't forget that morphine depresses the respiratory center. Dover's powder is, however, useful in the early stages of many cases of bronchitis, pleurisy, and pneumonia, and small doses of opiates to allay cough are often indicated, as well as larger doses in severe pain. Never use in the last stages of pneumonia and bronchitis.

The use of opiates in asthma is not to be commended, as habit may be induced. Codeine is effective in the relief of cough.

Nervous System

Analgesics and hypnotics are to be used with the utmost of reserve in diseases of the nervous system; but there are many acute conditions - too many to detail - in which its use may be imperative for a short period.

The emergencies of surgery are many in which morphine must be resorted to - pain, spasm, shock, hemorrhage, severe burns, fractures, etc.

Codeine is less constipating and narcotic than morphine. Especially useful in irritable cough and some cases of diabetes. Average dose, 1/2 grain; phosphate and sulphate the same. Eucodin is a methyl-codeine bromide, the average dose being 1 grain.

Dionin is ethyl-morphine hydrochloride, as listed in the U. S. P. IX. It is used in doses of 1/4 to 1 grain. Stands intermediate between morphine and codeine. Used in ophthalmology to secure the removal of old inflammatory products from the cornea or conjunctiva.

Heroin is diacetyl-morphine, as listed in the U. S. P. After several frights with heroin, I have wholly abandoned its use and consider it less effective and far more dangerous than morphine. Dose, from 1-60 to 1-12 grain. See comments in "New and Nonofficial Remedies," 1916 edition. Heroin is a habit-inducing drug I believe we should drop wholly.

Papaverine, an alkaloid from opium and of the iso-quinoline group. Not a morphine derivative. It relaxes smooth muscle. A very effective drug in hypertonic conditions. Does not interfere with normal intestinal action. A feeble central analgesic and a local anesthetic. Not habit-inducing to any degree, and is but slightly toxic. Used in intestinal spasm, for the diagnosis of pyloric spasm, in biliary colic, and in bronchial spasm. Useful in some cases of angina pectoris, acute uremia, and in eclampsia. Its local anesthetic action, with vasodilatation, makes it useful in rhino-asthma and to mitigate the pain of irritant injections. Recently applied, through urethroscope, to the mouth of the ureter in ureteral calculus. Oral and hypodermic dose, 1/2 to 1 1/4 grain. Hydrochloride and sulphate same dose.

Pantopon, a mixture of the hydrochlorides of the alkaloids of opium (50% morphine). Action same as opium but is adapted to hypodermic administration. Dose, 1-6 to 1-3 grain for adults.

Dosage of U. S. P. Products. - Opium, 1 grain; powdered opium, 1 grain; deodorized opium, 1 grain; granulated opium, 1 grain; extract of opium, 1/2 grain; tincture opium (laudanum), 8 minims; camphorated tincture opium (paregoric), 1 flui-drachm; deodorized tincture opium, 8 minims; wine of opium (U. S. P. VIII), 8 minims; Dover's powder, 8 grains; Tully's powder (U. S. P. VIII), 7 1/2 grains; morphine, 1-8 grain; morphine acetate, 1-8 grain; morphine sulphate, 1-8 grain. These were stated as 1/4 grain in the U. S. P. VIII.

For Children give morphine salts in the following doses: At one month, 1-1000 grain; at three months, 1-600 grain; at one year, 1-200 grain; at five years, 1-30 to 1-20 grain. Repeat no oftener than every 2 hours. Hypodermic doses should be smaller (Holt).

Antidotes

Repeatedly wash out the stomach. Give emetics and potassium permanganate well diluted and then wash out again. Caffeine (strong black coffee) and tannin should be used. In the emergency ward in my hospital service I have seen really remarkable effects from the persistent use of the faradic current after respiration had nearly ceased. These patients were kept warm and given hypodermic injections of ether and inhalations of oxygen. Atropine is a physiologic antidote to be used only with the greatest care, it at all.

Apomorphine Hydrochloride is the hydrochloride of an alkaloid prepared from morphine by the abstraction of one molecule of water. Stimulates the medullary centers and produces, in sufficient dosage, immediate vomiting. Smaller doses are expectorant, nauseating, and depressing. Look out for collapse, especially in infants. Apomorphine is most too convenient as an emetic; hence it is too often used. Don't use it in narcotic poisoning. The emetic dose is 1-12 grain for the adult hypo-dermically, and 1-6 grain by mouth; expectorant, 1-20 grain. Usually given by hypodermic injection for its emetic action. In my opinion, this drug should never be used as an expectorant, and certainly not in the U. S. P. dose, and rarely as an emetic. It is a highly dangerous drug when given to children.

Apocodeine has been prepared; but it is not emetic, though powerfully expectorant. It has been employed as a hypodermic purgative. It is, thus far, purely on an experimental basis.

There are a number of less defined products of, and derivatives from, opium, some of them being on a scientific but clinically untried basis, while one or two are fraudulent. Also see "Cotarnine."