By the nice Sense of the Palate, we are able to judge in general, what is, and what is not essential to the Nutriment of the Body; which Nutriment the Stomach, for the most Part, rejects when noxious. Some Things, indeed, are almost void of Smell or Taste, therefore not seemingly injurious to the external Senses, and thus may be accidentally taken into the Stomach; or when those Senses are depraved; as Hemlock has been often mistaken, and eat for Parsley; but when a Poison is taken, the nocent Power is put into Action by the internal Heat, and proves a Stimulus on the nervous Coat of the Stomach. "Porro hujus tunicæ altior in Ventriculum insertio, intimum ac Citissimum illud inter Stomachum & Gulam Commercium facit; ita ut, si pars alter utra in Vomitionem cieatur, mox altera in σύμπραξιν adducatur: cumque eadem tunica, palatum aliasque Oris partes investiat, etiam hæ cum illis circa Vomitionem mutuo consensu afficiuntur. Willis Pharmac. Rationalis, Sec. 2. Page 5. Primarum Viarum Descriptio." Upon this Stimulus, Nature immediately takes the Alarm, and sickens, which Sickness increases with the Vellications, till the offending Power is discharged, or by sudden and violent Inflammation, the Stomach is withheld from discharging the Virus, when the human Mechanism suffers an universal Convulsion. If therefore, by such powerful Efforts of the nervous System, the grosser Parts of the Poison received, cannot be disengaged by proper and timely Assistance, the Nerves lose their Power; the Muscles can no more be brought into Action, but remain in a State of Relaxation, and the whole Body must sink under the Calamity.
Thus the Actions of most Poisons, especially the Vegetable, when taken into the Stomach, are nearly the same; all vellicating and inflaming the first Passages, yet the Analysis of them is materially necessary to discover the acting Principles wherewith they are compounded, that we may more exactly point out their separate Cures. Dr. Mead describes the Effects of Poisons in the Primæ Viæ, in so accurate and concise a Manner, that I cannot do better than transcribe his own Words.
"Upon the Sense of a violent Irritation and Pain, the Fluid of the Nerves is presently, and in large Quantities determined to the Part affected; and this, if the Stimulus be not over-great, will only be to such a Degree as is sufficient, by contracting the Fibres of the Stomach, and Muscles of the Abdomen, to throw off the Cause of the disagreeable Sensation; but the uneasy Twitching being too terrible to be borne, the Mind, by a Kind of Surprize, does with Haste and Fury as it were, command the Spirits thither; thus the Business is overdone, and the Action of the Fibres becomes so strong, that the Orifices of the Stomach are quite closed; so that, instead of discharging the noxious Matter, the Torment is made greater, and the whole Oeconomy put into Confusion."
The Proportions of the volatile Parts of Opium are so very great, that when received into the Stomach, they presently enter into Action, which Parts, being of an innate soporiferous, and stupefactive Quality, peculiar to this Poison, make some Progress before Nature is materially excited to reject them, and is the Reason why the afflicted Person has Symptoms, at first, common only to Ebriety.
The combined Powers of Opium, consisting of Salts and Sulphurs, must be corrosive to a certain Degree; on this Account it is reckoned a Depilatory; and when expanded in the Stomach, the innate active Principle, or volatile Salt, must necessarily inflame the Coats of it, as much as any other Poison of equal Power. To this Quality are owing all the dreadful Symptoms of Vertigoes, Vomitings, Madness, Sopors, Convulsions, &c. On the same Principles, the pleasing Sensations of a moderate Dose may be explained; for, when taken into the Stomach, in so small a Quantity as may be requisite only to procure Rest or ease Pain, the Divisibility of it, especially in a fluid State, is almost immediate, the volatile Salts are presently brought into Action by the Heat of the Stomach, which, by their Rarefaction, cause an agreeable Plenitude, and in a much more eminent Degree, than the Effects produced by an hearty Meal, and arise from that grateful Sense of a moderate Fullness of the Stomach, which so frequently inclines us to sleep; the corrosive Power being so broke likewise, and expanded, cannot do more than stupify the Part, and thereby induce the Subject meerly to rest, without any consequent Misfortune.
The first and most powerful Action of Opium being in the Stomach, the Cure is to be begun by evacuating and blunting the Acrimony of it as quickly as possible.
This Poison acts differently upon different Bodies, in Proportion to the Strength or Weakness of the Subject, the Time it has been taken, whether upon a full or empty Stomach, before or after plentiful Eating or Drinking; and indeed, through these Circumstances, the Power of it is so much varied, that they cannot be too particularly attended to. The Quantity taken should be known, as nearly as possible, if in a solid or liquid State, and whether the Party ever was habituated to the Use of this Drug.
These Particulars are often difficult to be ascertained, owing either to the Ignorance or Fright of the Bystanders; and it rarely happens that the Patient is in a Condition to inform you himself; notwithstanding, Nature in this, as in many other Cases, indicates a Cure. She must first be assisted in disengaging herself from the Poison, by Vomit; though this, if the Stimulus should be very violent, will encrease, rather than diminish, the Inflammation of the Stomach; yet even an Excess in that Particular is better than to hazard the Opium remaining any Length of Time undisturbed, which would more endanger the Life of the Patient, unless of a very strong Constitution. – The Symptoms therefore, as before mentioned, alone can direct us, namely, whether in the first Degree they are similar to those of Ebriety, in the second and more violent, consisting of a heavy unnatural Stupor, &c. or third, and most extream, in Vertigoes, Convulsions, cold Sweats, &c.
Doctor Jones attributes the Sensations from, and indeed the whole Action of this Poison, to so close an Adhesion of the resinous Parts to the internal Coats of the Stomach, that though the Stimulus thereby occasions frequent Vomitings, they cannot be disengaged from it, but must necessarily be dissolved and digested, and therefore, where the Patient recovers, are carried off by Stool.
Now, that the Poison cannot be attributed to the Resin it contains, as this Author asserts throughout his Treatise, appears to me manifest; for upon an Analysis, the Power of Action consists in a volatile Salt, minutely blended with a corrosive Oil; which being expanded over the whole Stomach, villicates and inflames the nervous Membrane thereof, communicating her Affects to the Brain, even to the Destruction of Life; unless overcome by Art. – Were it the Resin only which occasioned the Mischief, the Resin of any other Vegetable would probably perform the same; but a Person may take a Quantity of any common Resin, which is a vegetable Production from the Pine, without these violent and dangerous Effects, therefore we cannot advise, with Dr. Jones, the taking of highly sulphurous and rectified Spirits, in order to dissolve the Resin in the Stomach, lest, by such an additional Corrosiveness, the Stimulus and Contraction, instead of being diminished, should become more violent. Nor can I more approve his recommending the Use of Lixivial or Alkaline Salts, unless formed into a saponaceous Body, with Water and Oil.
We certainly know, that Lixivial and Alkali Salts will disunite and dissolve resinous Bodies, but not so expeditiously as these Cases must require; nor are we ignorant, that such Salts are greatly corrosive; as we experience in the Composition of Cauteries; must they not therefore further encrease the Abrasion of the Vessels? We have read likewise, and indeed Experience confirms, that lixivial Bodies augment the Power of Volatiles; in that Sense, what can be expected from their Use, but Expansion, and an Encrease of the corrosive Power? Should we not rather endeavour to check the Activity of those Principles, by clogging and weakening their Powers, and to strengthen the fibrous Coats of the Stomach, against the repeated Attacks of such an active Enemy?
As the Author before us, has been very minute and prolix upon this Subject, it may be necessary to examine his Principles, relative to the Cure, somewhat further. The first Thing he judges most proper, and to be given with all possible Speed, is Salt of Tartar one Scruple, in a Spoonful or two of Brandy, or some other hot cordial Spirit, if Spirit of Wine be too hot. Herein we find, lest the Corrosiveness of the fixt Salt should not prove sufficient, if given separately, their Powers are to be united; and thus to be repeated even to every two Minutes. There is something whimsical in his directing the Person to be placed in the very same Position as he was when he took the Opium, that the Spirit, or rather combined Solvent, should fall immediately upon the Resin, and thus instantaneously, as he expresses himself, dissolve and disengage it from the Coats of the Stomach.
Why a fixed Salt is to be given in a spirituous Body, I cannot comprehend; the Salt being, in such a Liquid, indissoluble, and certainly more corrosive. I fear too, that if it should immediately dissolve the Resin (which is a very improbable Supposition) it would only encrease the Corrosiveness and Expansion of the Poison, whereby the Stimulus would become excessive, and would inflame and contract the Orifices of the Stomach so powerfully, as to prevent the Benefit that might arise from Vomiting, and so throw the Party into an immediate Convulsion; for this same Reason, I think his subsequent Direction, to take the Alkali Salt and Spirit after every Vomiting, lest it should return from the Stomach without any Effect, very unnecessary; for the Inflammation of the Oesophagus and Larynx would undoubtedly prevent such a Kind of Remedy being administered very often.
The taking the Yolk of an Egg, to sheath the Salts of the Opium, and confine their Power, and the Sapo Tartareus, stand both recommended by Dr. Jones; the Egg particularly, with this additional Assertion, "That it will be found by Experience (which is yet much wanted, because it has not been used) "to be the very best Help in these Cases."
Notwithstanding this conjectural Opinion of his, he again recommends Lixivial Salts and Spirit; and that their Use might not be neglected, tells you, if you should not have Salt of Tartar at hand, other Alkaline Salts will serve the Purpose; as of Wormwood, &c. but these being of a weaker Nature, their Quantity is to be encreased, at least, one third; and in great Urgency, from a Deficiency of them, their Ashes, or those of any Vegetable, may be taken; provided they are joined with Brandy, or old Wine; and that the Roughness of the Ashes will contribute not a little to wear off the Resin.
Geoffroy informs us, that the first Thing necessary to remedy this Poison, is to empty the Vessels by copious Bleeding, if Strength will admit.
Though this is a Practice I do not condemn, yet, as not having experienced the Use, I cannot recommend it; for instead of relieving Nature thereby, I should fear a Relaxation might be hurried on, which ought to be prevented as much as possible. – In Fact, the Stomach is the Place of Action, and present Relief can only be obtained, rationally, by immediate Applications to that Part.
The Effect of Opium upon the Venous Fluid, is not immediate, but secondary; for when injected into a Vein, it will neither encrease the Motion of the Blood, nor coagulate it. Sir Christopher Wren gives us an Instance of this, by transfusing a Solution of Opium into the Blood of a Dog, which, he observed, had no Effect upon the Animal, until it had Time to reach his Brain, when the Dog became drowsy, and staggered; from which he was relieved, by being forced into Motion, and in a short Time afterwards grew fat. This, I think, proves, that the violent Effects of Opium are on the Nerves, and not upon the Blood, which, by a Consent of Parts, it can only rarify, and make more fluid. By diminishing the Quantity of Blood in the Veins, the Secretions of Sweat and Urine are interrupted, and the Relaxation, so much to be dreaded, is forwarded. – The great Boyle, and Dr. Willis, likewise mention Experiments of this Kind, made upon a Dog, but differ in their Accounts; Willis asserting, that a Dog can bear a large Quantity of Opium, and overcome the Poison: He gives an Account of one that had received, by Transfusion, three Ounces of liquid Laudanum into his Veins, and without any very violent Symptoms, or other Help, than the Exercise of a Whip, to keep the Dog in Motion, he perfectly recovered. The Effect which followed Laudanum, being poured into a Dog's Stomach, as Dr. Mead experimented, is very different from that by Transfusion, for it presently convulsed and killed him; and upon Dissection, he found that the Poison had not only inflamed the Coats of the Stomach, but abraded the finer Vessels of the Brain.