Opii, or an equivalent dose of some other opiate, given with a warm diluent at bedtime, and followed in the morning by whatever laxative may be required, will often arrest altogether a complaint, which the later use of purgatives, antimonials, and salines would only tardily remove. (Dr. Holland.)
Graves states that he has employed Opium with favourable results. Having used antiphlogistics for a day or two, he advises the following mixture: - Mist. Amygdalae f vj., Potas. Nit. 3j., MorphiAe Hydrochlor. gr. ss , M. In some cases, the Tinct. Camphor. cum Opio may be substituted with advantage.
1956. In Hooping Cough, Opium has been prescribed with a view of allaying spasmodic action. It has been given variously combined, by De Haen, Lettsom, Willan, and others. Of the various preparations and combinations of Opium, however, as observed by Dr. Copland, * the Tincture of Camphor with Opium is indisputably the best, given with an alkaline subcarbonate, in almond or mucilaginous emulsion. In the chronic form of the disease, I have repeatedly seen benefit from the use of opiate frictions along the course of the spine. Dr. Muller, of Berlin, speaks highly of the value of Morphia in minute doses in this disease. He states that, in very young children, he has commenced with gr. 1/60th, and has increased the dose to gr. 1/40th or even gr. 1/36th, until a slight degree of narcotism has been manifested; and that he has persevered in it, in the same doses, until the whoop has quite ceased.
* Essay on Hydrocephalus, 8vo, 1843, Lond.
Med. Notes and Reflections. Clin. Lect., vol. i. p. 445.
Graves states that he has seen great benefit from directing the part to be well steeped, and then rubbed with warm Laudanum. This will often procure immediate relief.
By its judicious use, we may in a measure relieve the cough, lessen the amount of expectoration, check the diarrhoea, and afford a great degree of sensible comfort. It may be given by mouth, or in the form of enema; and in such doses as the patient can bear without producing deep sleep, or any inconvenience. It is a valuable' resource, often available when other expedients fail.
1959. Chronic Coughs are sometimes much benefited by the application of an opiate plaster to the chest.
1960. In Endocarditis and Pericarditis, occurring in the course of Rheumatic Fever, the use of Opium in full and repeated doses has been advocated by Dr. Sibson. Dr. Walshe§ also recommends it in full doses in these diseases, if agitation and disquietude be at all marked. If the surface has been blistered, Morphia may be used endermically.
Of its value in Peritonitis, Enteritis, Gastro-Enteritis, and Hepatitis, when given in combination with Calomel, I have spoken in considering the latter article. (See sect. 1403.)
1962. In Peritonitis, when depletion is inadmissible, Opium is alone sufficient to effect a cure. Dr. Stokes|| has specified the following cases in which it may be thus employed: - 1. Peritonitis arising from the escape of faecal matter into the peritonseal cavity, through a perforating ulcer of the intestine. 2. That arising from the bursting of an abscess into the serous cavity, or from rupture of the intestine, induced by external violence. 3. That occurring after the operation of paracentesis in delicate subjects. 4. Low typhoid Peritonitis after delivery. In all these cases, depletion is decidedly contra-indicated; and the indication clearly is to support and strengthen the patient. With this view, and with that also of preventing further mischief, Dr. Stokes advises Opium in large doses, gr. j. every hour, until a decided impression is effected. It is extraordinary the large doses which will be borne without inconvenience; in one of Dr. Stokes' cases, the man took 105 grains of Opium, in eight days, without the slightest cerebral disturbance. Dr. Stokes relates several instances in which the above treatment was eminently successful. Mr. Stanley* relates a highly instructive case of Peritonitis from injury, which yielded to the persevering use of Opium. The patient, a boy of five years old, took exxij. of T. Opii per diem for ten days, without any unpleasant symptoms, or any unusual amount of sleep. Purgatives were strictly prohibited (this is a point also enjoined by Dr. Stokes), although the bowels were not open for nine days.
* Dict. Pract. Med., vol. ii. p. 249. Ranking's Abstract, 1859, vol. xxix. p. 45. Op. cit, vol. ii. p. 538.
§ Diseases of the Lungs and Heart, Ed. 1854, p. 604.
|| Cyc. of Pract. Med., vol. iii. p. 315.