This section is from the book "Materia Medica And Therapeutics: An Introduction to the National Treatment of Disease", by John Mitchell Bruce. Also available from Amazon: The pharmacology and therapeutics of the materia medica.
2. Superficial pain may be met by local applications such as the Plaster, Liniment, or fomentations made with laudanum or other fluid preparation; but, as we saw, the value of the drug itself in all these applications is very doubtful.
3. As a hypnotic, the best forms are the Tincture, the Liquid Extract, the Solution of Morphia, and the Soap and Opium Pill; the particular preparation and the dose being regulated by the degree of sleeplessness and of the pain which may accompany it. Dover's Powder is an excellent hypnotic in the restlessness at the commencement of feverish attacks.
4. As a sedative to the stomach, various preparations may be tried, such as the Solutions of Morphia in effervescing mixtures, morphia endermically or hypodermically over the epigastrium; sometimes solid opium or the Extract in the form of a small pill. Dover's Powder is of great value in painful ulceration and acute dyspepsia, combined with bismuth or soda.
5. As a sedative and astringent to the bowels, Laudanum, either by the mouth or as the Enema, may be given in urgent cases attended by much pain. When there is less urgency, we may prescribe one of the powders - Compound Opium Powder, Chalk and Opium, Kino and Opium, or Dover's Powder. Acetate of morphia with acetate of lead and acetic acid, or the Lead and Opium Pill may be demanded in severe diarrhoea, especially if haemorrhage threaten. Solid opium, alone or combined with calomel, is the best form of astringent when the bowel must be paralysed, as in hernia, peritonitis, and intestinal obstruction.
6 As a sedative to the rectum, bladder, pelvic organs, and urethra, we possess the various Suppositories of opium and morphia, and the Enema.
8. Diaphoresis is generally accomplished with Dover's Powder.
The uses of the other preparations are obvious. The Con-fection is a pleasant form of the compound powder.
Influences modifying the action and uses of opium. - Dangers: Cautions. - Age modifies greatly the effects of opium, children being particularly susceptible of its influence on the convolutions and medulla. An infant of one year should not be given more than half a minim of the tincture for an ordinary dose, and suckling women should be ordered opium with special pre-cautions. Females are more easily affected than males. Certain individuals have peculiar idiosyncrasies as regards opium, some resisting its action, others being excited by it, others again very readily narcotised; whilst more frequently some persons suffer from a species of shock after the hypodermic injection of morphia, becoming sick, faint, and even alarmingly collapsed. The effect of habit is extremely marked in opium, the necessary dose steadily rising, until large quantities may be safely taken. Disease, especially pain, affords great resistant power to the action of opium, which appears to expend its action on the morbid process. The quality of the opium, the particular pre-paration, and the combinations used, also modify its action. On the contrary, opium and morphia act more powerfully in the subjects of kidney disease, as we have already seen. Morphia and opium are contra-indicated, because dangerous, or are to be used with special care, in diseases of the respiratory organs, the heart, and the kidneys; in congestive conditions and hyper-aemia of the brain; and in alcoholic intoxication.
Opium and Belladonna: Combinations and Antagonism of Morphia and Atropia. - In several respects the action of morphia is opposed to that of atropia, the important principle of belladonna. The antagonism between the two substances is in part real, such as their respective effects on the convolutions, respiratory centre, and intestines; in part apparent only. Thus, the contraction of the pupil caused by morphia occurs through the basal ganglia; the dilatation caused by atropia is referable to paralysis of the ciliary branches of the third nerve. Morphia is a diaphoretic through the centres: atropia an anhidrotic through the terminal nerves of the glands. Both depress the heart and reduce the blood pressure, in poisonous doses. Thus, morphia and atropia are not true antagonists, but the one may prevent or relieve certain effects of the other, and may therefore be combined with the other for particular medicinal purposes, or given in the treatment of poisoning by the other under particular circumstances. Combinations of atropia and morphia are now extensively used for hypodermic injection (1/100, 1/50, or even 1/25 gr. of sulphate of atropia to 1 gr. of morphia), to prevent certain unpleasant effects of the latter. It is found that the immediate sickness and depression, and the subsequent dyspepsia and constipation, may thus be avoided, and a more natural sleep induced. The combination is preferable when morphia is given as a hypnotic or anodyne; in conditions of cardiac depression and disease of the lungs; in obstruction of the bowels; and to relieve spasms in general. The atropia should be avoided in cerebral excitement, especially mania.
Use as mutual antidotes. - Sulphate of atropia, in doses of 1/100 gr., may be injected subcutaneously every quarter of an hour in opium poisoning, the pulse and respiration being carefully watched. Three or four doses may thus be given; but the ordinary means of resuscitation, especially artificial respiration, must not be for a moment interrupted.
In poisoning by belladonna, morphia should be given subcutaneously, with the same precautions, in doses of 1/4 of a grain.