1946. Diseases Of The Head

In Insanity, Opium, if given judiciously, is a remedy of great value; but great discrimination in its use is necessary. "A most important resource," observes Dr. Prichard, "for tranquillizing the system, and bringing back the healthy condition of the brain, is the use of Opium. There are few disorders in which so much benefit is derived from this remedy as in cases of insanity. While the skin is hot and dry, and the pulse full and hard, it is injurious; but when relaxation has been induced by blood-letting, Antimony, the cold douche, &c, Opium may be safely given. Sometimes a large dose (gr. ij. - iij.) given at once, will answer the end of procuring sound and refreshing sleep. A better method is to prescribe gr. x. of Dover's Powder, with or without Tartar Emetic, every three or four hours, until sleep is induced. After sound sleep thus induced, it is often found that the disease is almost cured." In Puerperal Insanity, the treatment by Opium is very successful. (See Puerperal States, infra.)

1947. In Delirium Tremens, Opium is the sheet-anchor, but discrimination is necessary in adjusting the dose, combination, &c. In ordinary cases, unattended with any great depression or inflammatory action, Opium, in doses of gr. j - ij., may be given every three or four hours, until sleep is indueed. When, however, much, depression or debility is present, when the patient is old, and has been subject to several previous attacks, it should be given in combination with the Sesquicarbonate of Ammonia (gr. v. - x.); and when the excitement is very great, when inflammatory action is apparently impending, and Opium, given alone, has failed to produce amelioration, it should be given with Tartar Emetic, in the form advised by Dr. Graves: -1946 Diseases Of The Head 159 Ant. Potas. Tart. gr. iv., T. Opii 3ij., Mist. Camph. Oss., M. Of this, two tablespoonfuls should be given every hour or two hours, until an impression is produced. I have, on several occasions, witnessed striking benefit from this formula. It is inadmissible if the pupil is strongly contracted. Depressing aperients should be avoided, and it is rarely advisable to withdraw altogether the stimulus to which the patient has been accustomed. Camphor may often be advantageously combined with the Opium, as it appears to increase the sedative effect of the latter. When there is much depression, a combination with Quinine is often attended with excellent results. A draught containing T. Opii ex. - xxx., Quinine gr. j. - ij., repeated every four, six, or eight hours, is strongly advised by Dr. Todd. * Opium is inadmissible where there is a great tendency to coma. Some very judicious remarks on the use of Opium in this disease have been published by Dr. Laycock,t which may be consulted with advantage.

* Cyc. Pract. Med., vol. ii. p. 226. Lancet, June 28, 1862.

Lib. of Med, p. 134.

1948. In Delirium occasioned by inflammatory action of the Brain or its Membranes, particularly when it assumes a maniacal or violent character, and after depletions have been carried as far as may be thought prudent, and the bowels have been freely evacuated, Dr. Copland X states that he has frequently seen a full dose of Opium, or Hyoscyamus, given either alone, or with Antimony and Camphor, produce the happiest effects. Any unpleasant symptoms which may result, either from too large doses of these narcotics, or from their inappropriate use, will readily be removed by the cold or tepid affusion on the head. Opium, combined with antimonials and Camphor, also proves serviceable in Delirium attended by exhausted nervous and vital influence, and in that characterised by depressed vital power and morbidly excited vascular action.

1949. In Epilepsy, opiates have been employed from the earliest ages; Avicenna, Aetius, and others, placing much confidence in them. In more modern times, they have been used by Fother-gill§; and Cullen.|| Opium is, however, a remedy far from being generally applicable; and, if. employed injudiciously, may be productive of much mischief It can only prove serviceable in purely asthenic cases, when the disease arises from moral causes, as fright, or is connected with much nervous excitement. If given during a paroxysm, it may prove injurious. Morphia is generally to he preferred to the solid Opium.

* Med. Gaz , 1850, p. 1077.

Edin. Med. Journ., Oct. 1858.

Dict. Pract. Med., vol. i. p. 296.

§ Med. Observations and Inquiries, vol. vi. p. 272. II Mat. Med., vol. ii p. 217.

1950. In Sleeplessness, Opium is the sheet-anchor, but its mode of administration requires much attention. Dr. Graves'* observations on this subject are very important. " In cases of sleeplessness," he observes, "particularly in that observed towards the termination of acute diseases, and where you have administered an opiate with success, be careful to follow it up for some time, and do not rest satisfied with having given a momentary check to the current of morbid action. To arrest it completely, you must persevere in the same plan of treatment for a few days, until the tendency to sleep at a fixed hour. becomes decidedly established. It should be given for five or 'six nights in succession, and, in obstinate cases, it must be employed for a longer period, and in undiminished doses. You need not be afraid," he adds, "of giving successive opiates, lest the patient should be accustomed to them, and a bad habit be generated; for the rapid convalescence and renewed health, which are wonderfully promoted by securing a sound and refreshing sleep, will soon enable him to dispense with the use of opiates." The Sleeplessness of Delirium Tremens is most successfully treated by the use of a combination of Tartar Emetic and Opium. (See Delirium Tremens.) In Sleeplessness arising from Neuralgia, in that of Delirium Traumaticum, &c, Dr. Graves states that the results of his experience tend strongly to confirm Dupuytren's observation, that a certain quantity of Opium, when prescribed in the form of enema, will act with more decided effect in allaying nervous excitement, than the same, or even a larger quantity, when taken by the mouth. Dr. Graves, also, states that he has seen excellent results from the external application of Opium, in some forms of sleeplessness. He directs the scalp to be well steeped, and subsequently the following plaster to be applied: -1946 Diseases Of The Head 160Pulv. Opii ij., Camphor. 3ss., Emp. Picis, Emp. Plumb, aa q. s. ft. emplastrum.

1951. In Hydrocephalus, Opium has sometimes been employed in the second and third stages, to lessen the acute pain in the head, convulsions, and irritability of the stomach and intestines; and may be given with this view, at an early period, when the disease depends on exhaustion and debility, uncomplicated with inflammation. " It has often succeeded," observes Dr. Bennett, "in effecting this without in any way interfering with the action of other remedies, or inducing constipation when moderately employed." At the early part of the second stage, it may be given with Calomel, James's Powder, or Tartar Emetic, in doses varying from gr. 1/8 to 1/4, every four hours. If there is much irritability of the bowels, it is best administered in the form of Dover's Powder, combined with Hyd. c. Creta,. According to Crampton and Cheyne, contraction of the pupils following the exhibition of this remedy indicates that it has been pushed sufficiently far. Dr. Risdon Bennett* has since stated, that, avoiding its use when the pupil is contracted (which he regards as a contra-indication of its use), he has employed Opium with the best effect, and has sometimes saved an apparently hopeless case. For a child one year old, one drop of T. Opii is a sufficient dose, and this may be repeated in three or four hours, if no unpleasant symptoms present themselves.

* Clin. Lect. vol. ii. pp. 526,529. 538.

Lib. of Med., vol. ii. p. 79.

1952. In Diseases of the Lungs and Heart, Opium, uncombined with other remedies, is perhaps of less value than in affections of most other parts. Most of this class of diseases tend to produce death by apna; and therefore, as explained in the sect. Inflammation, are those in which Opium is the least applicable and the most likely to prove injurious. Combined with Calomel or Antimony, however, it sometimes is productive of the best effects. (See Calomelas and Antim. Tart.)

1953. In purely Spasmodic Asthma, or in that connected with Hysteria, a full dose of Opium (gr. ij.) will often at once allay the violence of the spasm, and shorten the paroxysm. It is in this form only that it proves useful; in all others, particularly in that arising from inflammation or irritation of the bronchial membrane, and in catarrhal Asthma, it proves highly injurious. Great caution is necessary in its use.