The London practice of physick, or, The whole practical part of Physick contained in the works of Dr. Willis faithfully made English, and printed together for the publick good.

Of the evil Effects of Opium, with cautions concern∣ing its Ʋse.

WE have found, by sad experience in many, the Use of Opi∣um to be sometime hurtful and destructive; for that some presently after taking it, have fallen into a perpetual sleep, and others by taking a Dose of it too great, or unseasonably, have either shortn'd their Lives, or by injuring their principal facul∣ties, have rendered it afterwards uneasie and burthensome. I have known some, who upon taking a Pill of Laudanum, have fallen presently into so profound a sleep, that they could never be rais'd from it, they liv'd indeed for three or four days, and as to their Pulse, Respiration, and Heat were pretty well, but could never be brought again to sense, and waking, by any Remedies or tor∣tures. I have observ'd others, who after taking Opium, have slept but moderately, nay sometimes little or scarce at all; but as to their Pulse, Respiration, and Heat presently grew worse; so that incontinently after the Medicine, they began to have a failing of strength, and then, growing short and thick Breath'd, to de∣cay more and more, nor could their vigour be renew'd by any Cordials, but fainting by degrees they died. I have elsewhere related a story of a robust man kill'd by Opium, who had no sleep at all after it, till his last and mortal sleep, viz. Death it self fol∣lowing it; this Man presently after he had taken the Medicine, complained of a great heaviness upon his Stomack, and of Cold, then he was taken with a great Languor, and a Consternation of all his Spirits, with a coldness of his extream parts, and within some hours complaining that his Eyes grew dim, and at length that he was quite blind, he died.

I shall now relate what evils from the improper, or unseason∣able use of Opium, sometimes happen in the Head, what in the Brest, and what in the Belly.

As to the first, it's well known that the principal functions of the Soul, viz. the Memory, the Reason, and the Acuteness of the understanding are very often extreamly injur'd by Narcoticks. A frequent use of them weakens the Memory in many persons; I knew a person, who by taking a great Dose of it in a Feaver,

wholly lost the use of that faculty, and after some weeks, when the use of it began to return, he remembred only things done within a peculiar tract of time, and nothing of those that were done before or after. I have known some that have grown dull and stu∣pid by this Medicine, and others that have grown mad. And it's observ'd, that those Turks that eat much Opium, though they seem to be well, and not injur'd by it, yet they are rendred more cold, and their functions become worse; they appear always as though they were drunk and besotted, and are affected with a Coma, or a continual inclination to sleep, being stupid and uncon∣stant, sometimes affirming a thing, and sometimes denying it, so that they are unfit to deal or converse with men.

Secondly, We find that Opiats are sometimes hurtful to the Precordia and Brest, because they depress and lessen the Pulse and Breathing, sometimes also (as we have said before) they make them faulter, and by degrees wholly to cease: Wherefore in Fea∣vers, when the Blood being mightily deprav'd, seems to admit of no Crisis, or not a good one, and that at the same time it fur∣nishes but very few and weak Spirits to the Animal Oeconomy. Narcoticks are in a manner always destructive, and as it were poysons: For though in the Plague and Malign Feavers, whilst the Pulse and Respiration are strong, Treacle, Mithridate, and Di∣ascordium, nay and Laudanum are often given with good effect, yet if at any time in those Diseases, and in other Feavers that do not carry so much malignity, the vital faculty languishes, those famous Antidotes must be us'd but very sparingly, and the stron∣ger Opiats not at all. Moreover in a violent Cough, the Phthisick, Plurisy, Empyema, and other Diseases of the Brest, viz. in what ills soever nature is stirr'd up to discharge it self on a sudden of that which is offensive, and oppresses the Brest, and lifts at it with its greatest effort, and at the same time the Organs of Respirati∣on being destitute of a sufficient plenty of Spirits, faulter and per∣form their work with great pain and difficulty; we must in such a case forbear Opium no less than poyson, for then Narcoticks increase and fix the weight to be remov'd, and lessen the strength of the parts that labour to throw it off.

Thirdly, As to the parts within the Belly, we find that Narco∣ticks often taken, proved sometimes very injurious to the princi∣pal faculty, viz. the appetite of food (on which all nutrition, and the Root of Life depends) because they very much blunt it, and often wholly destroy it: For when the Spirits residing in the in∣teriour Coat of the Ventricle are stupified, or destroyed by the Particles of the Opiat; so that those Nervous Fibres though em∣ptied, no longer are corrugated, then all hunger ceases, and there is no appetite to food, nay the same being then offer'd to the

Stomack, proving rather troublesome than delightful to it, is presently thrown up again. Moreover, for the same reason the concoctive force of the Ventricle is weakn'd, and the excretory motions as well of this, as of the Intestines grow tardy; for it's a common observation, that a slowness of concoction, and a tar∣diness of going to stool, are the familiar effects of an Opiatick Medicine.

From what is said, it will not be difficult to draw Physical Precepts and cautions concerning the right use of Opiats, which we may do by observing the four following things, viz. before a Narcotick Medicine be given, we must consider, First, What kind of constitution the Patient is of. Secondly, What kind of Disease it is he labours under. Thirdly, In what state the Ani∣mal Spirits are, in respect both of the Animal and Vital functi∣ons. Fourthly, In what condition the Blood and other humours are.

1. As to the first, when a Hypnotick is indicated, see that the temperament, habit of Body, or Indisposition, Custom, or man∣ner of Life of the Patient do not indicate the contrary. For ex∣ample, those that are of a mean stature, have a strong, well-set, and square Body, with a hot Blood, and a lively or quick aspect are wont to bear this Medicine best, and most commonly re∣ceive benefit thereby; which also they may much more securely adventure upon, if they have been us'd to it before; on the contrary it does not agree with, nay sometimes it proves very prejudicial to those who are too corpulent or very thin; also to those who being of a subtle texture of Body, have their Spirits easily dissipable, or being of a cold temperament, have their Flesh soft and flaggy, and being of a sluggish and intractable Nature, are of themselves dull and sleepy; to which this thing may be ad∣ded, and it augments the weight of the rest, if they never made a Trial of that Medicine before.

The nature of the Disease is sometimes of great moment for, or against the use of Opiats. None but flattering Physicians will make use of them in slight affects. Moreover in some great Di∣stempers they are either forbidden, or their use is much suspect∣ed: In the Palsy, Vertigo, Incubus, Apoplexy, Orthopnaea, the Dropsy of the Brest, or of the Abdomen in the numbness and trembling of the Limbs, in very malign Feavers, and in the fits of intermitting Feavers, or in the Crisis of others, Narcoticks are most common∣ly forbidden. Again, in a Cough with much and thick Spittle, the Asthma, and in any other affects of the Brest, with an oppres∣sion of the Lungs, and in Hysterick and other Convulsive Passi∣ons, they are to be given but rarely, and not without caution, and the advice of some prudent Physician: But in a violent Head∣ach,

Catarrhs, the Colick, Plurisy, ordinary Feavers, in Vomiting, the Bloody Flux, in Nephritick Fits, or fits of the Gout, and in any pains whatsoever, Opiats are not only allow'd, but we have re∣course to them as to a Divine Panacaea.

3. But as often as an Opiat is propos'd, or comes to be deli∣berated on, we must farther consider in what state the Ani∣mal Spirits presiding in each faculty are, for if they are but few, or being opprest, flag already, and do not sufficiently display them∣selves, certainly they must by no means be farther lessen'd, or put in a consternation by a Medicine: Wherefore whilst the Animal faculties do not appear quick, nor with sufficient vigour exert themselves as to sense or reason; or when the Pulse and Respi∣ration have the courses of their Reciprocations but weak, also more quick or slow than usually, or disturb'd, and inequal: And lastly, if a stupor and enervation with an unwonted Languor has seiz'd the Members and Parts for Motion, we must wholly forbear Hypnotick Medicines; but we may be free to use the same, if at any time they are Indicated by reason of some great affects, and that the Animal Spirits at the same time are strong enough, ac∣cording to these and the other respects, or also if they are too much expanded, or grown too raging and unruly.

4. In the mean time the state of the Blood and humours is not to be neglected, for sometimes the uneven, or ill condition of these wholly forbids Opiats, or permits them to be taken but spa∣ringly, and with some restriction. The Blood Indicates against their use when it is amiss either in its quantity, or in its quality, or Crasis: As to the former, the bloody Latex either abounds, or is deficient, and in both respects it excludes Narcotick Medicines. For first, if at any time the Blood grown turgid through its plenty, and withal boiling in a Feaver, so exceedingly extends the Vessels as to make them strout forth; and therefore the precordia mighti∣ly labour to circulate it as quick as possible, by most swiftly repeat∣ed turns of the Systoles, lest it somewhere stagnates or overflows; then certainly to give a Narcotick, whereby that labour and last effort of the Heart, so necessary for preserving Life, would be hindred, were rather the Office of a Poysoner, than of a Physici∣an. Wherefore in an over fullness of Blood, Phlebotomy ought always to precede the use of Opiats. Secondly, No less damage is threatn'd from Narcoticks, if given when there is a want or scar∣city of Blood, as after great Haemorrhagies, long Fastings, or long sicknesses: For when the current of the Blood is very slender, and by reason of its smallness scarcely continued, the Heart being mov'd with as quick a beat as may be, endeavours (as it were with redoubled efforts) to give it a most quick Circulation, lest its course be interrupted, and consequently ceases: Hence it is ob∣vious

to conceive how greatly prejudicial Opiats are, which put a stay, or lett to this endeavour of the Heart, so very necessary in such a juncture. And indeed it seems to be for this reason, that we forbid sleep to Women presently after Child-birth, when the Lochia flow in abundance, and to all others when a conside∣rable quantity of Blood has been taken from them, and in great Hemorrhagies, to wit, lest the Heart be deserted by the Spirits during sleep, with which it swiftly circulates the lessen'd current of the Blood. Moreover sometimes the Blood being faulty in its quality, or (to speak more properly) in its Crasis, Indicates a∣gainst the use of Opiats; for when in a Cacochymia, or Feaver, the Blood being mightily fill'd with drossy Excrements, ought to be agitated with a greater effort of the Heart, and be more swift∣ly circulated, to wit, that the Heterogeneous Particles may be subdued, and soon evaporate; the Operation of a Narcotick in∣tervening, puts a stop to these endeavours of the Praecordia, and consequently retards the Purification of the Blood, and sometimes disappoints it.

As to other Excrementitious humours usually heap'd together in the Ventricle, or the Intestines, these also must be purg'd forth by Vomit or Seige before an Opiat be given: For other∣wise being there fixt, they will stick more pertinaciously: For the Fibres of those parts being stupified by the Medicine, are not irritated as before; nor do they readily set upon excretory Con∣vulsions for expelling those drossy superfluities, or perform it with any vigour. Wherefore according to the ancient Precept; If any thing be to be Evacuated, let it be done before a Narcotick be given.