This section is from the book "A Practitioner's Handbook Of Materia Medica And Therapeutics", by Thos. S. Blair. Also available from Amazon: A Practitioner's handbook of Materia Medica and Therapeutics.
Opium. This drug is so ably treated in the writings of all schools of medicine and is so well known that little need be said here. Its preparations are so numerous that we will not detail them.
The employment of the alkaloids derived from opium is more marked by abuse than by use, both in and outside of the medical profession, and the hypodermic syringe has become a public menace. This little book has been written in the intervals between patients, during office hours, and the notes were stained by drugs and soiled by wet fingers many a time, but no "dope" has left its stain there, and the too ready "hypo." of the laboratory and library therapeutist has never been a paperweight or. bookmark during its preparation. In sixteen years' fairly active practice, the present author has not given fifty hypodermic injections of morphine aside from surgical cases and emergency work. Any physician who takes the trouble to learn the therapeutics of pain need use morphine and enslaving drugs very little indeed, but the therapeutic nihilist and the blind searcher for mere symptoms and the would-be surgeon who makes a bluff at therapeutics until he can make surgery pay, all incline to use too much morphine, because they really do not know what else to do. On the other hand, opium itself is a most useful drug in a host of cases, and we need to learn how to handle it in large and small doses as intelligently as we do digitalis, ergot, or ipecac, and not become imbued with the idea that its alkaloids are alone of use. When we do use the alkaloids, it is well to remember that a hypodermic tablet dissolved in a tablespoonful of hot water and given by mouth is usually better practice than the hypodermic injection of the same thing; that codeine is vastly safer than heroin or dionin and usually more effective; that apomorphine should never be given to children under any circumstances; that large doses should not be given to a nursing mother; that very young babes should rarely have these alkaloids in any dose; that we should be careful and not obscure important symptoms necessary to recognize in time to save life, since these alkaloids are very liable to obscure them; that they have well-marked contraindications, and that a patient with flushed face, contracted pupils, a dry and hot skin, a coated tongue and inactive excretion seldom tolerates them in large dose; that they have no place in cough mixtures for young children; that drug habits are readily formed, and that we have no right to give these agents to others in conditions in which we would not administer them to our own dear and near ones.
Opium in large doses (1 1/2 to 2 gr.; tr., I0 to 20 I.; Dover's powder, 15 gr.) is indicated in spasmodic pain of bowels, bladder, uterus, common bile duct, ureters, and urethra when pain is not too acute, or to follow an initial dose of morphine when acute; in cholera morbus, laudanum, or opium per rectum; peritonitis, until sharp pain is relieved; to check excessive secretion in diarrhea, and in many surgical conditions. When sleeplessness is due to pain, opium in grain doses is indicated, and 2 gr. doses may frequently be required.
Morphine in large doses (1/4 gr. hypodermically or by mouth, as indicated by conditions or urgency) is indicated in wakefulness, with excessive muscular action in acute spasmodic diseases, such as chorea and epidemic cerebrospinal meningitis. In traumatic tetanus it should be injected into the muscles. Spasmodic asthma demands fairly large doses at times, as do violent cramps. Acute neuralgic and sciatic pain and the pain and shock of traumatism demand full doses, often hypodermically. Puerperal convulsions may demand doses as high as 10 gr. Opium in moderate doses (1/2 to 1 gr.; tr., 5 to I0 I. ;
Dover's Powder, 5 to 8 gr.) is indicated in many cases of diarrhea and for a diaphoretic effect. The moderate dose, especially of Dover's Powder, is indicated. Moderate doses in suppositories are applicable in painful pelvic, rectal, and genito-urinary troubles.
Morphine in moderate doses (1/8 gr.) is applicable in the less acute indications noted under large doses, and in cardiac dyspnea and angina pectoris, as well as in rectal tenesmus and threatened miscarriage.
Opium in small doses (1/4 to 1-3 gr.; tr., 2 to 4 I.) is a stimulant to the nervous system and tends to prevent exhaustion, and is quite useful in typhoid fever with nervous exhaustion. Give by rectum. Similarly used in pneumonia and pleurisy, it frequently does good. There are a good many cases of spasmodic contraction of the intestines that result in constipation. Small doses of opium following oil or a saline relieve promptly.
Morphine in small doses (1-20 gr.) is of value in reflex vomiting and in dry, spasmodic cough. Codeine is frequently to be preferred in cough, but in doses of .1/4 gr. or more. These small doses of morphine hypodermically are of value in melancholia marked by loss of appetite and muscular weakness.
Opium in minute doses, as employed in the 3x by homeopaths, is indicated in sluggish conditions of the nervous system with stupid sleep, stertorous breathing, relaxed jaw, and dark, suffused face. There is no doubt that the stimulating effects of opium could be secured by these minute doses if very frequently repeated, but it impresses me that such symptoms involve a study of the underlying pathology and the use of very much more direct remedies to meet the state of the case. (Do not forget the difference between the drop and minim of Tr. Opii.)