2005. In Gout, Opium, internally and locally to the affected part, was employed to mitigate the severity of the paroxysm, by many of the older physicians. At the present day, it is rarely exhibited alone, although it may be advantageously combined with other remedies, Purgatives should in every case precede the internal use of Opium in this disease. "In weakly habits," observes Dr. Copland,* "or where there seems to be a state of asthenic or irritative action in the fit, and particularly if the external affection shifts its seat, the opiate should be combined with Camphor, in doses proportioned to the urgency of the nervous symptoms, or of vital depression. This combination will promote the cutaneous excretion; the Camphor preventing any tendency to the retrocession or suppression of the paroxysm that may exist, or that the Opium may occasion." I have found heated Laudanum, applied to the painful parts, on pieces of linen, afford marked relief, when other remedies had failed in producing any alleviation.
* Dub. Joum., Nov. 1839. Clin, Lect, Med. Gaz., Oct. 4, 1848.
British Med. Journ., Nov. 21, and Dec. 5, 1858. § Clin. Lect., vol. ii. p. 238.
Graves observes that, in addition to the frequent application of leeches and the use of anodyne ointments, we should employ large doses of Opium internally. Some patients, he adds, if the bowels be regulated, will bear from gr. iv. - v. or even gr. vj. of Opium in the day, when the disease has advanced to the second stage. Mild mercurials may be employed at the same time.
2008. In Ptyalism, Opium has been given internally with the view of arresting the excessive discharge. Dr. Graves quotes a case in his practice, in which its influence was very marked. The patient was profusely salivated, every means had failed to diminish the flow of saliva, until Opium (gr. j every four hours) was ordered. An almost immediate cessation of the discharge ensued.
2009. In Cancer, Opium, in large and increasing doses, has been employed with the view of alleviating the patient's sufferings. Dr. Copland§ believes that, when combined with suitable remedies, it is otherwise productive of benefit.
2010. In Mortification, Opium is an invaluable remedy when administered in proper cases. It soothes the pain, and diminishes the restlessness and irritability with which mortification is so often accompanied, and frequently procures sleep. It is espe-cially indicated, when spasms or convulsions arise in the progress of the disease. In sloughing phagedenic Ulcerations, Dr. Tweedie states that he has seen the most astonishing results from large doses of Opium; and I can bear witness, in my own practice, to its value in these cases. In Chronic Ulcerations, especially of the lower extremities, Mr. Skey || speaks highly of the value of the internal use of Opium. He considers no treatment as comparable to it. It is an adjunct which should never be neglected in these cases.
* Dict. Pract. Med., vol. ii. p. 50. Clin. Lect., vol. ii. p. 293. Ibid., vol. i. p. 478.
§ Dict. Pract. Med., vol. i. p. 288. || Lancet, Jan. 26, 1856.
2011. In Tetanus, Opium was formerly much relied on as an anodyne and anti-spasmodic; but, in the experience of Founder, Pescay, Rush, M'Grigor, and others, it proved valueless. Almost any amount of Opium may be given in some instances, without producing any impression on the disease; this is partially attributable to the impaired state of the digestive functions; thus Mr. Abernethy found 3xxx. of solid Opium undissolved in the stomach of a man who died of Tetanus; but a more satisfactory explanation is suggested by Dr. Todd: * the chief object in the treatment of Tetanus, he observes, is to reduce the polarity of the spinal cord. Now Opium is not a sedative of the spinal cord. In cold-blooded animals, it exalts and stimulates that part, and it is not impossible that in warm-blooded animals it may have a similar tendency; it is, therefore, a remedy of little value in Tetanus, save as a sudorific, and in large doses it may be of an injurious tendency. In mild idiopathic Tetanus, partaking of an hysterical character, it has occasionally been found serviceable. When employed, it should be in the form of tincture, f3j. or more, every three or four hours. At the same time it may be employed in the form of enemas, liniments, and baths. To obviate costiveness, Ol. Terebinth, f3ij., in emulsion, may be employed. It is inferior in efficacy to Chloroform, Aconite, Ice, or Cannabis.