1963. In Perforating Ulcer Of The Stomach, Opium Is The Sheet-Anchor

Drs. Stokes and Graves successfully employed it as advised in the last section; and Dr. Ogier Ward§; testifies to its value. When given in large doses, frequently repeated, it checks the vermicular motion of the bowels, while it supports the powers of nature until an exudation of lymph takes place, which glues the ulcer to the adjoining tissues, preventing the further escape of the contents of the stomach, and isolating the seat of inflammation from the remainder of the peritonaeal surface. The horizontal position should be insisted upon, and the food should be of an easily-digestible kind, and in the smallest possible quantities. Beef-tea enemas may be advantageously given. (Ward.)

1964. In Dysentery, Opium is a remedy of the highest value, and it possesses the peculiarity of being applicable more or less to every stage and almost to every form of the disease. The condemnation of it by Mr. Twining|| led in a great measure to its falling into disuse, but the writings of Drs. K. Mackinnon,¶ Taylor,** Blecker, Morehead, &c. have served to restore it to its proper place in the treatment of tropical dysentery; whilst Drs. Christison,§§ Cheyne,|||| &c, have proved its utility in the dysentery of temperate climates. Dr. Christison indeed regarded it as capable of effecting a cure uncombined with other remedies, when administered early and boldly; and although it must be admitted that when given alone its remedial powers are great, yet it appears to gain additional value when given with other remedies, as Ipecacuanha, &c. The tolerance of the drug in these cases is very remarkable, and the dose may be gradually raised from gr. j. to gr. iij. - iv. three or four times daily, not only without inconvenience, but with marked benefit. Nausea or vomiting, tympanitic distension of the abdomen, and scanty stools are signs that the remedy has been carried as far as it can be consistently with safety. Some writers prefer Morphia; thus Dr. Blecker observes: "Muriate of Morphia is, even in the early stage, one of the best remedies. It diminishes the otherwise unbearable pain, moderates the peristaltic motion of the intestines, removes the dryness of the skin, promotes a free and copious perspiration, and procures wholesome sleep. It may be given in doses of gr. 1/4 twice or oftener during the day." For the relief of Tormina and Tenesmus, Opium, in the form of enemata or suppositories, is one of the most generally useful remedial measures.

* Lancet, Oct. 5, 1850. Op. cit. Clin. Lect.

§ Med. Times, June 22,1850. || Diseases of Bengal. ¶ Ibid., &c, 1848, p. 331.

** Indian Annals of Med. Science, April 1S54, p. 420. Ibid., Oct. 1853, p. 1. Dis. of India, p. 302. §§ Edin. Monthly Journal, No. ii. |||| Dublin Med. Reports, vol. iii.

1965. In Cholera, Opium, either alone or in combination with Calomel, stimulants, or anti-spasmodics, was formerly regarded as indispensable in the treatment of this disease. This idea is now generally considered as erroneous; and on reference to the table showing the comparative rate of mortality under various modes of treatment (see Calomelas, sect. Cholera), it will be observed that a very high rate of mortality followed all those cases in which Opium formed a prominent part of the treatment. "It has been given," observes Mr. Ross,* "with a view of relieving the cramps and spasms; but the internal congestion which it produces has undoubtedly proved injurious. The use of opiates has been carried too far; they have locked up the biliary secretion, choked the capillaries of the brain with black blood, and overpowered and deadened the nervous sensibility, which ought to be sustained by every effort and appliance, as the only means left us, in the states of collapse, for rallying the declining powers of the patient." Mr. A. Blacklock regards it as a poison in this disease; Mr. W. J. Cox, as quite powerless to check the vomiting or purging, or to relieve the cramps, and as totally inadmissible in any stage or in any dose. The last opinion is perhaps too sweeping; as, in minute doses as employed by Dr. Ayre, it appears to have a beneficial effect (see Calomelas); but that it has not unfrequently proved injurious in large doses, either alone or in combination, is a fact that few will be inclined to doubt, after the experience of the last epidemics. Nevertheless, Opium, in combination with Chalk and other astringents, has been found valuable in the treatment of the premonitory diarrhoea of Cholera.

lera, 1848.

* Lectures on Cholera, Med. Times, vol. xix. p. 107, et seq.

The Leading Phenomena of Cho-

The Cholera, What has it taught us? 1850.