Morphine

Morphine, the chief alkaloid of opium, to which the medicinal action of the former is mainly due. It is not used itself in medicine owing to its insolubility in water and ether. The preparations of morphine are incompatible with salts of iron, copper and mercury, also with lime water and alkaline earths and substances containing tannin. With ferric chloride it forms a deep red colour.

The preparations of morphine in the British Pharmacopoeia are as follow: from Morphinae Hydrochloridum are made five subpreparations: (1) Liquor Morphinae Hydrochloridi, strength 1% or about 44 grs. of the hydrochloride to the fl. oz.; (2) Suppositoria Morphinae, made with a basis of oil of theobroma, strength 4 gr. of morphine hydrochloride in each; (3) Tinctura Chloroformi et Morphinae, strength gr. in io minims; (4) Trochiscus Mor- phinae, gr. in each; (5) Trochiscus Morphinae et Ipecacuanhae, strength hgr. of morphine hydrochloride and gr. ipecacuanha in each. From Morphinae Acetas, a white soluble amorphous powder, is made Liquor Morphinae Acetatis, strength 1% or 44 grs. of the acetate to i fl. oz. From Morphinae Tartras, a white crystalline powder, are prepared, Injectio Morphinae Hypodermica, containing 5% of morphine tartrate, and Liquor Morphinae Tartratis. Morphinae Sulphatis is not official in the British Pharmacopeia but is official in the United States, the U.S.P. Trochisci Morphinae et Ipecacuanhae and Pulvis Morphinae Cornpositus  (Tully's powder) being made from it. Hypodermic tabloids of morphine sulphate either alone or combined with atropine are much in use. Various non-official preparations of morphine are in use, such as dionin, heroin, glycaphorm and peronin.

## Therapeutics

Morphine is an analgesic and hypnotic, relieving pain and producing deep sleep. As contrasted with opium it differs in being less astringent and constipating. Morphine is the greatest anodyne we possess, and no drug yet discovered equals it in pain-relieving power. The most frequent mode of administration is the hypodermic method, on account of the extreme rapidity with which it is absorbed. In pain due to violent sciatica relief and even permanent cure has been obtained by the injection of morphine directly into the muscle of the affected part, and in the treatment of renal and hepatic colic morphine given subcutaneously will relieve the acute pain consequent on the passage of biliary and urinary calculi. A violent paroxysm of asthma may be arrested by the administration of morphine subcutaneously, but the practice should not be continued, as there is great danger in a chronic disease that the patient may become the victim of morphinism. Morphine is recognized as one of the most useful drugs in the treatment of eclampsia, early injection often arresting the fits. In the cough of phthisis minute doses are of service, but in this particular disease morphine is frequently better replaced by codeine or by heroin, which checks irritable coughs without the narcotism following upon the administration of morphine. In bronchitis with profuse expectoration the use of morphine is particularly dangerous, as it is likely to check the cough so necessary for getting rid of the secretion, but in the converse condition it usefully allays the harassing cough by diminishing the excitability of the respiratory centre. In the dyspnoea of advanced valvular disease of the heart morphine relieves the distress and restlessness, and induces sleep. It should however be withheld if the heart has undergone fatty degeneration. Morphine is a sheet anchor in the later stages of cancer and other painful diseases, rendering the life of the patient one of comparative comfort. If given in excess the drug is eliminated by way of the intestines and kidneys. It is also excreted in the milk; hence the danger in the administration of large doses of morphine to nursing mothers.

Morphine-scopolamine anaesthesia was introduced in 1902 by Steinbiickel. It has been used by some surgeons for the production of anaesthesia previous to the administration of ether or chloroform, but the use of the method is now more usually relegated to obstetric practice.

Morphinism (Morphinomania).-Chronic morphine poisoning is very common, as morphine taken constantly creates a habit. Once acquired the habitue depends on the drug for a comfortable existence, and as the organism becomes quickly tolerant of the alkaloid the original dose no longer suffices. The total amount of morphine indulged in by the habitual morphinist may reach an astonishing figure; 15 grs. a day is said to be common, and some medical writers record quantities such as 60 to 70 grs. in the 24 hours in extreme cases. The early stages of morphinism are marked by moral degeneration; the patient seems to lose all sense of right and wrong, and will lie most plausibly and even thieve to obtain the drug; personal disorderliness, disregard of time, neglect of business and decline of family affection become soon evident. Physical symptoms also appear; the face assumes an earthy colour, the body wastes, constipation is usually present to an extreme degree, the secretions become arrested, loss of appetite and indigestion follow and the mouth is parched. The nails become brittle and the skin dry, sterility shows itself in women and sexual impotence in men. While not directly causing death, morphinism so lowers the bodily powers that the patient is easily carried off by some intercurrent malady. The sudden withdrawal of the drug from a morphine habitue is followed by a train of alarming symptoms. As the time approaches for the usual dose there is marked restlessness, followed by excitement and later by chills, pallor, sinking, nausea, with perhaps vomiting and diarrhoea. Horrible mental depression and melancholia are present, and there may be hallucinations of vision and hearing passing into violent delirium. At this stage collapse may set in, the patient become faint, the limbs twitch, the radical pulse become imperceptible, and unconsciousness supervene. The condition may even go on to a fatal result should morphine be continuously withheld, but injection of even a small quantity of morphine causes these symptoms to cease abruptly. The sudden withdrawal of morphine should therefore never be practised with takers of large quantities of the drug, but gradually diminishing doses given by the physician should be substituted. For the successf ul treatment of morphinism, complete isolation of the patient is necessary in a place where he is supervised so that he can obtain no morphine. Isolation in a home is far the best, as friends may give way to entreaties and servants be bribed. The "tapering off" of the dose is the best method. Absence from home and strict supervision lasting over a long period, usually a year, are necessary to prevent relapse. The lowered bodily health requires to be built up, and a long sea voyage under adequate supervision is usually recommended.