11. As A Diaphoretic, Opium Is Best Combined With Ipecacuanha

The cutaneous and the mammary secretions are the only ones not sensibly decreased by Opium; the former, it increases. On this point, Dr. Holland * observes, " Of the various internal means of obtaining diaphoresis, I believe Opium, in one or other of its forms, is the most uniformly certain and beneficial. Its action appears to depend upon its power of allaying inordinate circulation, or other excitement of the system." Its power as an antiphlogistic is considered in sect. Inflammation.

12. The researches of Anderson, Bell, and others have established the fact of a therapeutic and physiological antagonism between Opium and Belladonna. This fact has been turned to practical account, each having been successfully employed as an antidote to the other in cases of poisoning. They should not be prescribed in combination. A similar antagonism exists between Opium and Stramonium.

13. An Antagonism Between Opium And Quinine Was First Pointed Out By

Dr. Gubler. Dr. Nivison, who has examined the subject, maintains that this antagonism is only partial, influencing or modifying only the bad effects of these agents, enabling us to prescribe them simultaneously with advantage, when they could not otherwise be given.

1940. Opium is either contra-indicated, or should be given with caution, in the following states: - 1. In cerebral affections occurring in persons of a plethoric habit, and where congestion of the vessels of the brain is suspected. 2. In acute sthenic inflammation in plethoric subjects, previous to the employment of depletion. 3. In pulmonary affections, when the cough is dry and hard, and the expectoration is difficult and scanty. 4. In affections of mucous membranes of the air-passages, attended with copious secretion. In such conditions the narcotizing influence of Opium, by diminishing the respiratory function, has often proved fatal. 5. In morbid states of the body, where venous congestion is evident. 6. Whilst the urine is scanty and high-coloured. Alkalies should, in such a case, be generally administered first: but if the symptoms be urgent, and Opium is imperatively called for, it should be given in combination with alkalies. 7. During pregnancy. Dr. Denman § states that he is persuaded that the frequent use of opiates by pregnant women is prejudicial to the foetus. 8. In fevers and other morbid states, accompanied by contraction of the pupils.

* Med. Notes and Reflections, p. 61. Gaz. des Hopitaux, May 29,1858.

See further Amer. Journ. of Med. Sciences, July 1861. § Midwifery, p. 235.

1941. Therapeutic Uses

In Inflammation, Opium has been recommended as a powerful antiphlogistic. It has been objected to, on the ground that the primary stimulant effect of Opium tends to aggravate the original disease, and to increase the febrile action; and also that, by subsequently deadening the pain, which is generally a very fair index, taken in connection with other circumstances, of the extent and progress of inflammatory action, we involve the disease in obscurity; leading the practitioner, particularly an inexperienced one, into the belief that the inflammation is subdued, whilst in reality only one symptom is relieved. In some inflammations, Opium may be had recourse to, not only with safety, but with benefit; premising that, in the great majority of instances, local or general depletion has been previously employed. Dr. Watson* has ably drawn the line of distinction in these cases. " As a general rule," he observes, " you must be very careful how you give Opium in inflammatory diseases, that tend to produce death by coma or apna. If there be any unnatural duskiness of the face, if ever so slight a tinge of purple mingle itself with the colour of the lips, this is an appearance which should warn you against Opium. It shows that the blood is imperfectly arterialized; and imperfect arterialization of the blood either results from, or conduces to, a state of coma. On the other hand, it is, cAeteris paribus, in cases where the tendency is towards death by asthenia, that the use of Opium, as a remedy for inflammation, is most serviceable; thus it has a capital effect often, after depletory measures, in cases of Peritonitis and of Enteritis." Dr. Stokes. of Dublin, has drawn the following conclusions on this subject: - 1. That in cases of recent inflammation of serous and mucous membranes, where depletion by blood-letting and other antiphlogistic measures are inadmissible, and the system is in a state of collapse, the exhibition of Opium has a powerful effect in controlling the disease. 2. That, under these circumstances, the remedy may be given with great benefit and safety. 3. That its effect then is to raise the powers of life, and to remove the disease. 4. That the poisonous effects of Opium are rarely observed in these cases; the collapse and debility of the patient appearing to cause a tolerance of the remedy. In some cases of acute inflammation, when the pain is excessive, and forms the prominent symptom, and when this is accompanied with much nervous irritation, Opium, after local or general depletion, may be given, not only with safety, but with benefit. A full dose (gr. ij.) may be given, and repeated until there is a mitigation of the pain. Opium is contra-indicated in acute inflammation of the brain (which tends to produce death by coma), and in acute inflammation of the lungs, in Laryngitis and Bronchitis, all of which tend to produce death by apnoea. There are, however, occasional exceptions to this rule; as, for instance, in Inflammation of the Brain, in which Dr. Griffin* states that Opium, given in combination with Tartar Emetic, a formula for which the thanks of the profession are due to Prof. Graves, exerts an extraordinary power in allaying nervous irritation, quieting increased action in the capillaries, and inducing sound and refreshing sleep. It should, however, be employed with extreme caution, and only by one whose experience in this class of diseases gives him a title to depart from what is generally regarded as safe practice. In corroboration of Dr. "Watson's opinion, stated above, we may refer to Prof. Alison, who states that the value of Opium as an antiphlogistic is nearly confined to inflammation of the intestines, Enteritis and Dysentery (both of which produce death by asthenia), and that in these diseases, after depletion, the feelings are relieved, vomiting allayed, sleep procured, and the pulse is found to rise in strength. The preceding remarks do not apply to the combination of Calomel and Opium. (See Calomelas.)

• Lectures, vol. i. p. 240.

Dub. Med. Journ., No. 1.