In Acute Nephritis, Opium is a remedy of great value. Dr. Christison states that he has seen the disease at once arrested, by following up blood-letting by a full opiate. "For the efficacy of this practice," he observes, "it is essential that venisection be pushed so far as to induce faintness, and to subdue pain; and that the opiate be given in a full dose (gr. ij. - iij. of solid Opium, or exxx. - xl. of T. Opii) immediately after the faintness passes off." Where Opium must be given frequently, or where it fails to give relief, when administered by the mouth, it is often signally useful in the form of clyster or suppository.
1977. In Nephralgia caused by the Passage of Calculi down the Ureters, Opium given in full doses is the remedy most calculated to afford relief. The hip-bath and anodyne enemas prove most serviceable when employed at the same time.
Whatever may be the character of the calculus, whenever much pain and constitutional irritation are present, Opium proves signally beneficial. It may be given by mouth; also in the form of enema or suppository; or it may be applied externally as a plaster. Some patients derive more benefit from one preparation of Opium than from another. Solid Opium, Liq. Opii Sed., or Dover's Powder, are the most generally useful forms. Morphia and its salts do not seem to exercise the same beneficial influence as Opium itself. It may be given in full doses (gr. j. - ij.), and repeated until relief is obtained; large doses will generally be borne without inconvenience. Dr. Watson * expresses his belief that no single drug has so much power in rendering alkaline urine acid as Opium.
* Clin. Lect., vol. ii. p. 277.
Ranking's Abstract, xxxvii. p. 275, 1863 Lib. of Med., vol. iv. p. 277.
Local abstraction of blood by leeches or cupping, from the hypogas-trium or perineum, hot fomentations, and Opium, either by mouth or in the form of enema (T. Opii exl. - lx. in Aq. fl. oz. ij. - fl. oz. iij.), should form the main treatment. Mr. Liston advised a suppository, composed of Opium gr. ij. - v., with gr. x. - xv. of Extract of Hyoscyamus. ''Its effects," he adds, " are almost instantaneous; all pain goes off; the patient becomes quiet, loses all recollection of his former sufferings, and often remains in a state of enviable comfort for twelve or sixteen hours. The suppository may be repeated as need be; the preferable time for its exhibition is the hour of sleep." Copious mucilaginous diluents should also be given. In irritable states of the Bladder, the above treatment, modified according to the urgency of the case, may be had recourse to with advantage. It proves in many instances essentially useful in alleviating the severe pain occasioned by the presence of Calculus in the Bladder. In such cases it is best administered in the form of enema or suppository.
1980. In retention of Urine from Spasmodic Stricture, Opium is one of the most efficacious medicines which can be employed. Sir B. Brodie relies chiefly upon it, when mechanical means fail. He advises f 3ss. - f3j. of T. Opii to be given in a glyster in fij. - fiij. of thin starch. If this should not succeed, he gives Opium in a full dose by the mouth; and the dose may be repeated every hour, if necessary, until the patient can pass urine. He adds, that, according to his experience, the cases in which the stricture does not become relaxed under the use of Opium freely administered are very rare. In retention following an indulgence in spirituous liquors, a saline aperient draught may be given advantageously, before the opiate.
1981. In Diabetes Mellitus, Opium is a valuable resource, diminishing the nervous irritability of the system, and at the same time exercising a decidedly sedative influence on the urinary secretion. The quantity of the discharged fluid is always found to be diminished after its administration, and the saccharine quality moderated or removed. It is, however, to be regarded solely as a palliative; for when the medicine is discontinued, all the symptoms of the disease return, with their original violence. Drs. Elliotson,* Warren, and others, employed it in large doses (gr. vj., twice daily); but Dr. Prout, who entertained a high opinion of its value, observes that all the beneficial effects to be really expected from Opium may, in most instances, be obtained by moderate doses only; and when thus judiciously exhibited, and when no peculiarity of constitution forbids its use, it will be found one of the most powerful remedies that we possess in the disease. He advises it in the form of Dover's Powder, combined with full doses of the Peroxide of Iron. It may be remarked, finally, that whatever mode of treatment is adopted, Opium will be found an efficient adjunct. According to the observations of Dr. Basham,§ Opium is only a palliative of certain symptoms; the daily average amount of sugar is not materially lessened, and the physical condition of the patient not improved.
* Lectures, vol. ii. p. 586. Elements of Surgery, part iii p. 105.
On Diseases of the Urinary Organs, 3rd Ed., p. 3S.
1982. In Diabetes Insipidus, Opium must be given regularly as a calmative and anodyne, and is perhaps the principal remedy. (Christison.)
1983. In Cancer of the Uterus, Opium stands first in the list of palliatives, being greatly superior to all other narcotics for efficiency and uniformity of action. It requires to be given in large and repeated doses, increasing the quantity almost daily; but it is sometimes necessary to omit or diminish it if haemorrhage supervene. It may be given internally, as a means of quieting constitutional irritation; and may be used, at the same time, as a local anodyne in the form of enema or vaginal injection. Camphor is said to increase its efficacy. Care is necessary in selecting the form of Opium to be administered. With some persons solid Opium, with others T. Opii or Battley's Sedative Solution, agrees; whilst in others, the Acetate or Hydrochlorate of Morphia is productive of most benefit. When one form fails, another should be had recourse to, until it is ascertained which affords the greatest amount of ease and sleep. When vomiting occurs in the advanced stages. Opium requires to be combined with Hydrocyanic Acid or Spt. Aether. Sulph. Co.
1984. In Irritable Uterus, Opium is chiefly to be relied upon; but previous to its employment, it should be ascertained whether inflammation exist: if there be any, it should be subdued by local bleeding, by leeches, cold lotions, and other antiphlogistic measures. An instructive case is related by Gooch, in which Opium entirely failed; but all the symptoms yielded to the application of a few leeches. When the pain and irritation continue after the use of these measures, Opium, as advised in the last section, proves in the highest degree serviceable. An opiate plaster to the loins affords much relief. Dr. Ferguson advises an injection of a solution of the Acetate of Morphia (gr. ij. - iv. ad Aq. fj.). In Painful Affections of the Uterus, M. Aran * advises the application of Laudanum (gutt. xxx. - 1.) in contact with the os uteri and upper part of the vagina, to be kept in situ by a magma produced by means of some inert powder, e. g. Magnesia. It may be repeated every day or every other day, the patient in the interval carefully washing out the previously applied magma. It is said to be most efficacious. It requires to be applied by means of a speculum. A similar mode of treatment, substituting Morphia for Laudanum, is advocated by Dr. Tilt. In Uterine Inflammation, Dr. Tilt considers that the local application of opiates is far more effectual than their internal administration. He advises Opium to be given by the rectum, either in suppositories or in one or two ounces of warm milk. "Thus given, opiates generally quell pain without narcotising the patient; and what is given merely for the relief of pain often accelerates the cure of disease."
* Med. Trans., vol. iv. Enquiry into the Nature of Diabetes, &c
On Stomach and Renal Diseases, p. 50. § Lancet, Jan. 28, 1854.
1985. In Dysmenorrha, when the pain and irritation are great, a full dose of Opium may be given with decided benefit. Prof. Simpson§ found a mixture of T. Opii and Tartar Emetic, in minute doses, frequently repeated, of signal benefit. Employed as directed in the next section, it has been found to afford decided relief.