Formula

(C17H19No3)2.H2So4+5H2O.

Derivation

Sulphate of Morphine is obtained by dissolving morphine in boiling alcohol, and saturating it while hot with sulphuric acid, the coloring matter being removed by animal charcoal ; it is then boiled and filtered while at the boiling temperature. Upon cooling the sulphate is deposited in the form of white, feathery, acicular crystals, of a silky lustre, odorless, with a bitter taste and a neutral reaction. It is soluble in water and alcohol.

Medical Properties And Action Of The Salts Of Morphine

The salts of morphine possess anodyne, hypnotic and antispasmodic properties, and are less stimulating, less convulsant, and more hypnotic and anodyne than opium, and they also produce less constipation, and less diaphoretic action than opium. After the administration or insertion of the ordinary dose, which is one-sixth to one-fourth of a grain, there is experienced a sense of heat and flushing of the face, which may be preceded by some pallor, a fulness of the head, giddiness, noise in the ears, and frequently nausea, sometimes epigastric pain. The vertigo may cause a staggering walk and inability to maintain an upright position. Injection of the conjunctiva and contraction of the pupils occur at the same time that the cerebral effects are felt. The lips have a bluish appearance, the mouth and tongue dry, deglutition is painful and the voice becomes husky. During these symptoms the anodyne effects are manifested by the relief of pain and spasm, with perfect calmness of mind and tranquillity. While the effect is generally hypnotic, yet in some cases there is extreme wakefulness, with great mental activity, and when sleep occurs, instead of its being calm, the respirations are slow, noisy and labored, the patient being disturbed by dreams and visions. While the action of the heart is diminished in frequency, there is a considerable rise in the arterial tension. When a hypodermic injection of morphine has been made, there is experienced an itching of the nose, which may extend to the entire cutaneous surface. The skin, which is at first dry, becomes moist, from diaphoresis, which is sometimes profuse. The secretions of the mucous surface are also arrested as a primary effect.

If morphine is administered after a full meal, its effect is to suspend digestion for some time, and also to temporarily arrest the intestinal movements and diminish the urinal discharge, and make its emission difficult on account of the temporary loss of contractile power of the bladder and of the ejaculatory muscles.

When the narcotic effects of morphine decline, there is generally experienced headache, confusion of mind, anorexia and nausea. When a poisonous dose is administered, a profound state of narcotism quickly ensues, the pulse becomes slow and feeble, the respiration slow and indistinct, the skin cold and covered with perspiration, the face pale, blue and ghastly, the conjunctiva deeply injected, the pupils greatly contracted, the reflex movements entirely destroyed. Half a grain of morphia is the smallest dose which has proved fatal to an adult, but other cases are recorded where one grain destroyed life. It chiefly affects the cerebro-spinal functions, and causes death by paralyzing the respiratory muscles.

The antidotes in cases of poisoning are the stomach pump, emetics, cold effusions, counter-irritation, strong coffee, active stimulants, atropine by hypodermic injection, electro-magnetism and artificial respiration.

Therapeutic Uses

The salts of morphine are employed in all neuralgic affections, for the relief of pain from whatever cause, and to induce sleep; also in diseases of the heart, chronic gastritis, delirium tremens, tetanus, colic, spasms, dysentery, cholera, cough of pulmonary affections, cerebro-spinal meningitis, puer-pural fever, convulsive diseases, vomiting, colica pictonum, diarrhoea, diabetes, gangrene, etc., etc. For hypodermic injection, the acetate of morphine is supposed to possess some advantages over the other salts, such as the sulphate and muriate, one of which is its greater solubility. Morphine is contra-indicated where there is a tendency to apoplexy and coma.

Dose

Of the salts of morphine, gr. 1/6 to grain 1/4. One-sixth of a grain of either of the salts of morphine is equivalent to a grain of opium, or twenty-five drops of the tincture of opium (laudanum).

For hypodermic injections the dose of salts of morphia is gr. 1/8 to 1/6. The use of morphine hypodermically frequently leads to the morphine habit, which, once formed, is rarely abandoned ; and which, independent of its fatal systemic effects, has very injurious effects upon the teeth - the enamel and dentine becoming thoroughly disintegrated, owing to the presence of erosive acids.

For endermic application, gr. 1/2 to j of morphine may be sprinkled on a surface (which has been blistered to remove the cuticle), over the seat of pain; but the hypodermic method is the most effectual.

Dental Uses

For dental use the acetate of morphine and the muriate of morphine are preferable to the sulphate, on account of their greater solubility and greater chemical affinity with the tissues on which they are to act. The acetate of morphine is also preferred to the other salts as an ingredient of nerve paste for destroying the vitality of the pulps of teeth, on account of its chemical and mechanical compatibility with the pulp tissue, giving relief as an anodyne when the sulphate would irritate. Concerning the action of morphine when combined with arsenious acid, its effect is anodyne, modifying the irritant action of the arsenic, and preventing to a considerable degree the intense pain which follows its application to vitalized structures. Besides its use in devitalizing mixtures and as an obtunder of sensitive dentine, morphine is employed for the temporary relief of odontalgia, for such a purpose being combined with carbolic acid, sweet spirits of nitre, oil of cloves and other anodyne agents.

A paste made of acetate of morphine and creasote (or carbolic acid) is much used for obtunding the sensitiveness of dentine. A thin paste, made of acetate of morphine rubbed up with oil of cloves, is an excellent application for exposed pulps; also a mixture of acetate of morphine, grs. v; oil of cajeput, f3j; applied on a pledget of cotton. The latter is also effective for the pain following tooth extraction; it is applied on cotton in the alveolar cavity.

For internal administration in facial and other neuralgias, morphine is combined with atropine in the proportion of atropine, gr. 1/120 to 1/100, morphine, gr. 1/6 to 1/4; hypodermically injected. Morphine in combination with carbolic acid is also employed to relieve the pain of an exposed and painful pulp.

Dental Formulae

For Odontalgia.

White. Morphinae acetatis . .gr.xx Olei caryophylli, Spiritus aetheris nitrosi.......aa

Signa

Apply on a pellet of cotton.

Signa 1215Signa 1216

For Odontalgia.

Morphinae acetatis . . gr.xx Creasoti (vel acidi carbolici).......

Signa

Apply to carious cavity on a pellet of cotton.

Signa 1217Signa 1218

For Devitalizing Pulps of Teeth.

Morphinae acetatis . . gr.j Acidi arseniosi .... gr.ij

Creasoti.......q.s. M.

Fiat Massa, Signa

Apply a sufficient quantity to exposed surface of pulp, on cotton. (For other devitalizing mixtures see Arsenious Acid.)

Fiat Massa Signa 1219

For Itching of Inflamed Surfaces.

Morphinae sulph. . . . gr.vj Sodii boratis ....

Aquae rosae.....

Signa

To be used as a lotion.

Signa 1220Signa 1221

For Abraded Surfaces of Teeth.

Dr. A. C. Hugenschmidt.

To prevent pain of friction. Morphinae murias . . . gr.ij

Mur. cocaini.....gr.ij

Sodii boras......

Mellis........

To Relieve the Pain Following Extraction of Teeth, and a Local Anaes-thetic.

Morphinae.....gr.vj

Tincturae aconiti, Chloroformi,

Alcoholis.....

Signa

Apply on cotton, or with an applicator, as a local anaesthetic. (See Formulas under Arsenious Acid.)

Signa 1222Signa 1223Signa 1224Signa 1225