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 half an hour, since some of the opium is excreted into the stomach after its absorption into the blood. If apomorphine is obtainable, both of these measures may be employed. Potassium permanganate decomposes morphine by oxidation, the action being facilitated by the addition of a small quantity of mineral acid to the solution. The physiological as well as the chemical antidotes must be employed. The chief of these are coffee or caffeine and atropine. A pint of hot strong coffee may be introduced into the rectum, and caffeine in large doses—ten or twenty grains of the carbonate—may be given by the mouth. A twentieth, even a tenth of a grain of atropine sulphate should be injected subcutaneously, the drug being a direct stimulant of the respiratory centre. Every means must be taken to keep the patient awake. He must be walked about, have smelling salts constantly applied to the nose, or be stimulated by the faradic battery. But the final resort in cases of opium poisoning is artificial respiration, which should be persevered with as long as the heart continues to beat. It has, indeed, been asserted that, if relays of trained assistants are at hand, no one need die of opium poisoning, even if artificial respiration has to be continued for hours or days.

Opium-eating.—Opium, like many other poisons, produces after a time a less effect if frequently administered as a medicine, so that the dose has to be constantly increased to produce the same result on those who take it habitually. When it is used to relieve pain or diarrhoea, if the dose be not taken at the usual time the symptoms of the disease recur with such violence that the remedy is speedily resorted to as the only means of relief, and thus the habit is exceedingly difficult to break off. Opium-eating is chiefly practised in Asia Minor, Persia and India. Opinions differ widely as to the injurious effect of the habit; the weight of evidence appears, however, to indicate that it is much more deleterious than opium-smoking.

The following statistics collected by Vincent Richards regarding Balasor in Orissa throw some light on the influence of this practice on the health. He estimates that 1 in every 12 or 14 of the population uses the drug, and that the habit is increasing. Of the 613 opium-eaters examined by him he found that the average age at which the habit was commenced was 20 to 26 years for men and 24 to 30 years for women. Of this number 143 had taken the drug for from 10 to 20 years, 62 for from 20 to 30 years and 38 for more than 30 years. The majority took their opium twice daily, morning and evening, the quantity taken varying from 2 to 46 grains daily, large doses being the exception, and the average 5 to 7 grains daily. The dose, when large, had been increased from the beginning; when small, there had usually been no increase at all. The causes which first led to the increase of the drug were disease, example and a belief in its aphrodisiac powers. The diseases for which it was chiefly taken were malarial fever, dysentery, diarrhoea, spitting of blood, rheumatism and elephantiasis. A number began to take it in the famine year, 1866, as it enabled them to exist on less food and mitigated their sufferings; others used it to enable them to undergo fatigue and to make long journeys. Richards concludes that the excessive use of opium by the agricultural classes, who are the chief consumers in Orissa, is very rare indeed. Its moderate use may be and is indulged in for years without producing any decided or appreciable ill effect except weakening the reproductive powers, the average number of the children of opium-eaters being 1·11 after 11 years of married life. It compares favourably as regards crime and insanity with intoxicating drinks, the inhabitants of Balasor being a particularly law-abiding race, and the insane forming only 0·0069% of the population. Dr W. Dymock of Bombay, speaking of western India, concurs in Richards’s opinion regarding the moderate use of the drug. He believes that excessive indulgence in it is confined to a comparatively small number of the wealthier classes of the community. Dr Moore’s experience of Rajputana strongly supports the same views. It seems probable that violent physical exercise may counteract in great measure the deleterious effect of opium and prevent it from retarding the respiration, and that in such cases the beneficial effects are obtained without the noxious results which would accrue from its use to those engaged in sedentary pursuits. There is no doubt that the spread of the practice is connected with the ban imposed in Mohammedan countries on the use of alcoholic beverages, and to some extent with the long religious fasts of the Buddhists, Hindus and Moslems, in which opium is used to allay hunger.

To break off the habit of opium-eating is exceedingly difficult, and can be effected only by actual external restraint, or the strongest effort of a powerful will, especially if the dose has been gradually increased.

Opium-smoking.—This is chiefly practised by the inhabitants of China and the islands of the Indian Archipelago, and in countries where Chinese are largely employed. Opium-smoking began in China in the 17th century. Foreign opium was first imported by the Portuguese (early 18th century). In 1906 it was estimated that 13,455,699 of Chinese smoked opium, or 27% of adult males; but during 1908–1910 the consumption of opium is believed to have diminished by about one-third.

For smoking the Chinese use an extract of opium known as prepared opium or chandoo, and a cheaper preparation is made from 60% used opium known as “opium dross” and 40% native opium. This latter is chiefly used by the poorer classes.

The process of preparation is thus described by Hugh M‘Callum, government analyst at Hong-Kong:—

“The opium is removed from its covering of leaves, &c., moistened with a little water, and allowed to stand for about fourteen hours; it is then divided into pans, 2 balls of opium and about 10 pints of water going to each pan; it is now boiled and stirred occasionally until a uniform mixture having the consistence of a thin paste is obtained. This operation takes from five to six hours. The paste is at once transferred to a larger pan and cold water added to about 3 gallons, covered and allowed to stand for from fourteen to fifteen hours. A bunch of ‘tang sani’ (lamp-wick, the pith of Eriocaulon or Scirpus) is then inserted well into the mass, and the pan slightly canted, when a rich, clear, brown fluid is thus drawn off, and filtered through ‘chi mui’ (paper made from bamboo fibre). The residue is removed to a calico filter and thoroughly washed with boiling water, the wash water being reboiled and used time after time. The last washing is done with pure water; these washings are used in the next day’s boiling.

“The residues on the calico filters are transferred to a large one of the same material and well pressed. This insoluble residue, called ‘nai chai’ (opium dirt), is the perquisite of the head boiling coolie, who finds a ready market for it in Canton, where it is used for adulterating, or rather in manufacturing, the moist inferior kinds of prepared opium. The filtrate or opium solution is concentrated by evaporation at the boiling point, with occasional stirring until of a proper consistence, the time required being from three to four hours; it is then removed from the fire and stirred with great vigour till cold, the cooling being accelerated by coolies with large fans. When quite cold it is taken to the hong and kept there for some months before it is considered in prime condition for smoking, As thus prepared it has the consistence of a thin treacly extract, and is called boiled or prepared opium. In this state it is largely exported from China to America, Australia, &c., being carefully sealed up in small pots having the name of the maker (i.e. hong) on each.

“The Chinese recognize the following grades of opium: (1) ‘raw opium,’ as imported from India; (2) ‘prepared opium,’ opium made as above; (3) ‘opium dross,’ the scrapings from the opium pipe; this is reboiled and manufactured as a second-class prepared opium; a Chinese doctor stated lately at a coroner’s inquest on a case of poisoning that it was more poisonous than the ordinary prepared opium; (4) ‘nai chai’ (opium dirt), the insoluble residue left on exhausting the raw opium thoroughly with water. The opium is sent every day from the hong (i.e. shop or firm) to the boiling-house, the previous day’s boiling being then returned to the hong. The average quantity boiled each day is from six to eight chests of Patna opium, this being the only kind used.”

By this process of preparation a considerable portion of the narcotine, caoutchouc, resin, oil or fatty and insoluble matters are removed, and the prolonged boiling, evaporating and baking over a naked fire tend to lessen the amount of alkaloids present in the extract. The only alkaloids likely to remain in the prepared opium, and capable of producing well-marked physiological results, are morphine, codeine and narceine. Morphine, in the pure state, can be sublimed, but codeine and narceine are said not to give a sublimate. Even if sublimed in smoking opium, morphine would, in M‘Callum’s opinion, probably be deposited in the pipe before it reached the mouth of the smoker. The bitter taste of morphine is not noticeable when smoking opium, and it is therefore possible that the pleasure derived from smoking the drug is due to some product formed during combustion. This supposition is rendered probable by the fact that the opiums most prized by smokers are not those containing most morphine, and that the quality is judged by the amount of soluble matter in the opium, by its tenacity or “touch,” and by peculiarities of aroma—the Indian opium, especially the Patna kind, bearing much the same relation to the Chinese and Persian drug that champagne does to vin ordinaire. Opium-smoking is thus described by Theo. Sampson of Canton:—

“The smoker, lying on his side, with his face towards the tray and his head resting on a high hard pillow (sometimes made of earthenware, but more frequently of bamboo covered with leather), takes the pipe in his hand; with the other hand he takes a dipper and puts the sharp end of it into the opium, which is of a treacly consistency. Twisting it round and round he gets a large drop of the fluid to adhere to the dipper; still twisting it round to prevent it falling he brings the drop over the flame of the lamp, and twirling it round and round he roasts it; all this is done with acquired dexterity. The opium must not be burnt or made too dry, but roasted gently till it looks like burnt worsted; every now and then he takes it away from the flame and rolls it (still on the end of the