1990. In After-Tains, The Tincture Of Opium, In Doses Of Exv

- xx. in some aromatic water or Camphor julep, is generally effectual. Dr. Tyler Smith* advises an opiate liniment to be gently rubbed over the abdomen, but chiefly on the mammae. He states that, when thus applied, it acts by reflex action, and effectually allays excessive sensibility of the uterus.

1991. In Puerperal Convulsions

1. In convulsions, especially those of the hysterical form, occurring, as they do, more frequently during pregnancy than during labour, Opium is a valuable remedy. "This form of convulsions," observes Dr. Lever, "evidencing itself, as it does most frequently, during gestation, is readily recognised by the predisposition of the patient, often induced by mental anxiety, irregularity of diet, preceded by intolerance of noise, sleep short and interrupted, twitchings, startings, oppression of the chest, difficulty of breathing, &c, and when the convulsions manifest themselves, the larger muscles are more often affected than the smaller; here we find, after the paroxysm is over, that a mild opiate soothes the patient, allays the twitching, and procures sound and refreshing sleep." 2. In the anAemic form of Puerperal Convulsions, associated as it not unfrequently is with large losses of blood, where the face is pale, the eyes glassy, the features shrunken, the countenance betokening exhaustion, the skin cool, the breathing laboured, the pulse small, quick, and irritable, with noise in the ears, and pain and weight on the top of the head; where there is sleeplessness or restlessness, partial amaurosis, strabismus, and sometimes delirium; while close attention is paid to the position of the head and body, while stimulants are administered with judgment, while contraction of the uterus is secured, Opium will be found to act like a charm. 3. In genuine Puerperal Convulsions (eclampsia), where vascular excitement has been subdued, and relaxation of the soft parts has been accomplished by depletion, purgation, and tartarised Antimony, and where the repetition of the fits seems to depend upon irritation, Dr. Lever states that he has occasionally seen them checked by the administration of a full opiate. According, however, to the experience of Locock* and the best authorities, it proves injurious in convulsions occurring in plethoric subjects.

* Lancet, Nov. 25, 1S48.

1992. In Puerperal Insanity, after freeing the bowels by purgatives and enemas, a full dose of Opium (gr. ij. - iv.) may often be given at once with advantage; sometimes half a grain of the Hydrochlorate of Morphia may be preferable. Dr. Prichard 6ays that he has generally found Dover's Powder (gr. x.), repeated even' three or four hours, until sleep is induced, successful. It is contra-indicated, if there be heat of the scalp, flushings of the face, pains in the head, &c. When great debility exists, it may be combined with Carbonate of Ammonia and other stimulants. Dr. Mackenzie's observations on this point are deserving of careful attention. After remarking that the administration of Opium in these cases requires much caution and consideration, he observes, "Opium has a twofold action upon the economy, and each is distinct and dissimilar. Upon the functions of animal life, it operates as a sedative; upon those of organic life, as a stimulant; and thus, whilst, on the one hand, it lowers inordinate action of the brain and spinal cord, it tends, on the other, to exalt the activity of the vascular and organic functions. Hence its efficacy is greatest in those cases in which the sanguiferous system is most depleted, and the vital and organic functions are most depressed; and, conversely, its employment is least proper where there is a tendency to vascular fulness, whether general or local, and more especially of the encephalon. In proportion then as the pulse is rapid and weak, in proportion as organic debility prevails, and there is an absence of cerebral congestion or determination, - its use is indicated in this disease; and whatever may be the intensity of the mental excitement, in such cases it may be given fearlessly and freely. When, however, these conditions do not exist unequivocally, as will happen in the majority of instances, it must be had recourse to more guardedly, and its action modified according to the particular circumstances of each. "It is certainly impossible," he adds, "to lay down a rule applicable to all cases, for the administration of Opium in this disease; full doses at bedtime, with smaller during the day, answer well in some instances; and it is sometimes useful to alternate the use of one narcotic with that of another." Tranquillity and sleep are the great desiderata to be attained, and beyond this, it is not advisable to push the remedy.

* Cyc. Pract. Med., art. Convulsions.

Lib. of Med., vol. ii. p. 43.

Lond. Journ. of Med., June 1851.