In fevers typhoid, typhus, and eruptive fevers—opium was formerly much more frequently prescribed than at present. The cold baths, antipyretics, and more favorable hygienic influences, have lessened the violence and diminished the mortality from fevers. The maniacal excitement and the low, muttering delirium are not so frequently observed now as formerly, and hence the use of opium in these affections has greatly declined. The discovery of chloral has also diminished the use of opium as an hypnotic. Nevertheless, when there is much restlessness, wakefulness, subsultus, and delirium, opium may render important service. When the delirium is of the low, muttering kind, a small quantity of morphine (one eighth to one sixth of a grain) may suffice to procure quiet and refreshing sleep. When the delirium is violent, combination of tartar-emetic with opium, on the plan of Graves, may have a very happy effect. Or opium may be combined with belladonna, or chloral—the former when the condition is one of great depression, the latter when the delirium and wakefulness are excited in character. In measles and scarlet fever, when there is a condition of profound depression, the eruption being tardy in making its appearance, and is dusky in hue and ill-defined, beneficial results are experienced from the use of opium, especially when combined with camphor.

A threatened paroxysm of intermittent fever may be aborted by the hypodermatic injection of morphine (one fourth of a grain). This practice has a high degree of importance in the pernicious intermittents, when time is not afforded for an effective use of quinine. The febrile heat of intermittent and remittent fevers may be diminished, and the sweating stage induced earlier, by the use of opium in moderate doses (ten minims of the deodorized tincture every two, three, or four hours). The addition of morphine to quinine enables the latter to be better borne by the stomach, counteracts some of its unpleasant effects on the brain, and increases its therapeutical power. When no contraindication to the use of morphine exists, it is good practice to combine it with quinine in the treatment of intermittent and remittent fevers.

Narcotine has decided antiperiodic power, and may be given as a substitute for quinine when reasons exist to prevent the use of the latter. From five to ten grains of pure narcotine may be administered. As an antiperiodic it ranks after arsenic, salicine, and even apiol.

As an hypnotic opium is very frequently used in affections of the nervous system. The stimulant properties of crude opium, or its official preparations, render it less serviceable than morphine in the group of cases generally requiring an hypnotic. There can be no doubt that remarkable curative results have followed the hypodermatic injection of morphine in acute mania. The following are the indications for the use of morphine in mental disorders: prolonged wakefulness, maniacal excitement, persistent refusal of food, drink, or medicine, destructive and suicidal tendencies. As respects individual subjects, the state of the arterial tension furnishes a guide to the use of morphine. If the tension of the arterial system is low, a small dose is required. When the pulse is quick, and the arterial tension high, a large dose of morphine, by over-excitation, causes paresis of the sympathetic, and thus reduces action, an indication for the full influence of the agent. Large doses of morphine, when given subcutaneously, require the utmost circumspection in maniacal cases, especially in obese and aged subjects. Besides acute mania, excellent results have followed from the use of morphine in lypemania (Krafft-Ebing, Voi-sin), in chronic mania, and melancholia. Probably the best effects have been witnessed from opium in melancholia. In this mental disorder, which is a condition of depression, the best form for the administration of opium is the tincture, and the dose required is the stimulant and not the narcotic dose. The author is impelled to add the caution so well expressed in the following words by Maudsley: "It will be well to have in mind that neither opium by the mouth, nor morphine hypodermically injected, will always quench the fury of acute mania, and that successive injections of morphine, followed by brief snatches of fitful sleep, have been followed also by fatal collapse."

It was formerly held that large and increasing doses of opium were necessary for the cure of delirium tremens, the theory being entertained that to procure sleep was to insure recovery. It is now known that to re-establish digestion and to support the powers of life by suitable nutrients are in a large proportion of cases the only means needed to quiet delirium and to cause sleep. Opium, if used at all, must be given cautiously. Chloral has to a large extent taken its place as an hypnotic in this disease, but cases are not infrequently met with in which morphine agrees better, and is more effective in inducing quiet.

Some cases of sunstroke, coup de soleil, or "thermic fever," are rapidly cured by the hypodermatic injection of morphine. When the patient is able to swallow, good effects follow the conjoined administration of tincture of opium and brandy. The cases benefited by this treatment are characterized by pallor of the face and weakness of the heart—heat exhaustion.

Epilepsy and epileptiform seizures may be sometimes prevented by the timely administration of morphine hypodermatically. This treat ment is best adapted to epilepsy, the attacks of which occur at night, to petit mal, and to convulsive tic. It is improper in epileptoid seizures due to tumor or other coarse organic lesion of the brain. In suitable cases, this treatment procures most decided amelioration in the condition of the patient, but may induce the opium habit.

The remarkable fact has been demonstrated by Loomis, of New York, that we have in the hypodermatic injection of morphine the most important agent for the cure of uraemic convulsions, puerperal and non-puerperal. It is true this mode of treatment had been originally practiced by Scanzoni, but Loomis has, more especially, drawn attention to its real power and utility. "The most uniform effect of morphine so administered is, first, to arrest muscular spasms by counteracting the effect of the uraemic poison on the nerve-centers; second, to establish profuse diaphoresis; third, to facilitate the action of cathartics and diuretics, especially the diuretic action of digitalis."

In chorea Trousseau has carried the administration of morphine to an extraordinary extent. He restricts its use to severe cases, which appear to have a singular insusceptibility to the action of opium even in enormous doses. When the jactitations are incessant, preventing sleep, or persisting in spite of sleep, the utility of morphine is very great. It is most effective when combined with chloral. In these severe cases of chorea, the only limit to the quantity of morphine is the effect produced. It is evident, from the experiences of Trousseau, that very large doses are required, and that curative effects are thus obtained to which small doses are entirely inadequate. The subcutaneous method is more efficient than the stomach administration.

In tetanus and hydrophobia the use of morphine has been chiefly palliative. M. Demarquay has, however, applied morphine, by deep injection into the tetanized muscles, with greater success than heretofore. He carries the needle deeply into the tetanized muscles, and, if possible, to the point of entrance of the nerves. He injects in this way the masseters, the sterno-cleido -mastoid, the neck and sacro-lum-bar muscles, etc. The relaxation of the muscles of mastication thus induced permitted the nourishment of the patients. Of three cases thus treated during the siege of Paris two recovered and one died, but the death was due to pyaemia and not to tetanus.

The most important uses of opium and its various preparations are in the relief of pain. In surgical practice its administration is indispensable to prevent or mitigate shock, to quiet pain, and to check inflammation. To particularize on these points would require an epitome of surgery for illustration. Before the administration of chloroform, morphine should be injected hypodermatically, to diminish the dangers of the inhalation and to secure relief to the after-pain of the surgical operation. Nothing is more universal in surgical practice than the administration of an opiate after an operation of any magnitude, for the objects above named.

The most signal service is rendered by opium and its preparations in the various neuralgiae. The most effective mode of administration is by subcutaneous injection, and the remedy should be inserted in the neighborhood of the affected nerve, notwithstanding that relief is afforded by the injection at any point. In tie-douloureux, brachialgia, cardialgia, gastralgia, hepatalgia, nephralgia, sciatica, and pelvic neuralgiae, immediate relief is afforded by this remedy, and the relief is not temporary and palliative merely, but curative in numerous instances. It appears to be especially curative in sciatica. It is a remarkable fact that morphine inserted under the skin, and especially in the neighborhood of affected nerves, exerts a curative power which it does not at all have when administered by the stomach. An efficient method of using morphine in the treatment of neuralgiae, according to Brown-Séquard, consists in applying it in a finely-divided state to the derma, denuded by a blister. Lafargue proposed the method of inoculation, which consists in inserting morphine into the skin by means of a lancet-puncture. These clumsy and painful processes are by no means equal to the hypodermatic method.

The enchanting sense of relief to suffering wrought by opiates, and especially by the subcutaneous use of morphine, leads to the morphine habit. It is a singular fact that in these cases the pains which were cured by the remedy return when it is withdrawn, and other painful sensations appear of an even more distressing kind. In practicing the hypodermatic method for a long period in severe cases of neuralgia, the utmost care should be used to avoid the morphine-habit.

In the neuroses of the respiratory organs, great relief is often afforded by the use of opium in some of its forms. No remedial agent will so quickly cut short a paroxysm of asthma as the hypodermatic use of morphine. The paroxysms of difficult breathing which occur in emphysema are also readily relieved in the same way. But there is great danger of establishing the opium-habit in these chronic cases. In an allied disease—hay-fever, hay-asthma, or autumnal catarrh— the hypodermatic use of morphine is quite as effective as in spasmodic asthma. An incipient catarrh may be aborted by a full dose of Dover's powder, taken at the very outset of the inflammation. Morphine and quinine combined are rather more effective than Dover's powder in these cases. Opium, or some of its preparations, enter into the composition of expectorant mixtures to allay cough.

The hypodermatic injection of morphine has been shown to possess a high degree of utility in cases of dilated heart with difficult breathing, and general oedema. The eighth to the sixth of a grain suffices for this purpose. The effect it has is to quiet and regulate the action of the heart, to allay the distress of breathing, and to permit rest and sleep in the recumbent position. An occasional dose only is necessary (two or three times a week).

Opium is a very important addition to our resources in the treatment of diabetes. It must be given in considerable doses, as Pavy has shown. From six to twelve grains a day are necessary, in order to produce a decided impression. It checks the bulimia—the inordinate appetite—allays thirst, diminishes the flow of urine and the excretion of sugar, and, probably, arrests or prevents the changes in the nervous system which accompany or are causative of this disease. Although many cases are decidedly ameliorated, it can not be said that any have been cured by opium. Codeine, an alkaloid of opium, seems to be more effective in this disease than the crude opium or any of its preparations. It must be given in full doses. Besides checking the waste, it apparently exercises an influence over the central nerve-changes, and thus has a curative action as well as merely palliative.