Stomach-pain, whether simply neuralgic {gastralgia), or excited by the presence of food (irritative dyspepsia), or due to ulcer or cancer, is relieved by opium. The preparations of morphine are better than the crude drug, as a rule, in these cases. The endermic application is an excellent mode of procuring relief. The subcutaneous injection, practiced in the epigastric region, is still more effective. Morphine is frequently combined with bismuth, or zinc, or silver salts, in painful stomach diseases. Rx Bismuthi subcarb., vel subnitrat., 3 iij; morphinae sulph., gr. j—grs. ij; pulv. aromat., 3 j. M., ft. pulv. no. xij. Sig.: A powder in milk before each meal. The following formula is also useful, notwithstanding its unchemical relations: Rx Zinci oxidi, 3 ss; morphinae sulph., gr. j—grs. ij. M., ft. pil. no. x. Sig.: One pill, three times a day, before each meal. A half-grain of the oxide of silver may be substituted for the oxide of zinc in the above formula.

Inflammatory pain, due to corrosive poisons, to peritonitis, etc., requires opium. When the stomach is irritable, and the symptoms urgent, the best mode of using the remedy is the hypodermatic injection of morphine. Many kinds of nausea and vomiting, stomachal or reflex in origin, are arrested by opium preparations. In vomiting of cerebral origin, or produced by uraemia, or caused by cirrhosis, the use of opium is contraindicated. When vomiting is caused by irritant matters, opium is prescribed after the stomach is emptied. The vomiting which accompanies the passage of biliary or renal calculi, dys-menorrhoea, etc., is best relieved by opium. Very severe cases of sea-sickness, and of the vomiting of pregnancy, may be sometimes arrested when all other means fail, by the subcutaneous use of a minute quantity of morphine (one twentieth to one twelfth of a grain).

Nothing is more common than the prescription of opium in diarrhoeal diseases, but it is often used without a just appreciation of the conditions requiring it. In acute diarrhoea, caused by irritating aliments, such astringent laxatives as rhubarb, or mild salines, should precede the use of opium. When the evacuations are watery, the best results are obtained by a combination of opium with mineral acids, or acetate of lead. In acute dysentery opium is a very important remedy, but it is often injudiciously employed. If there be fever, much tenesmus, and the stools consist of mucus and blood, the exhibition of opium should be postponed until salines have emptied the intestinal canal of its contents, and have depleted the distended vessels. An excellent method of administration, especially when the dysenteric inflammation occupies the rectum, is an enema of starch or milk, or a suppository, containing opium in some soluble form. In chronic dysentery opium is indispensable. It is usually combined with arsenic, or with the salts of silver, copper, or zinc. In the chronic dysentery of malarial origin, the best results are obtained by a combination of arsenic and opium, according to a formula already given; in that form which succeeds to the acute disease, opium and sulphate of copper, or zinc, or nitrate of silver, or vegetable astringents.

Nothing can be more satisfactory than the treatment of choleramorbus by the hypodermatic injection of morphine. It is always desirable to secure the expulsion of irritating matters before resorting to opiates. For an ordinary case of cholera-morbus from one twelfth to one sixth of a grain of morphine suffices. In true cholera the utility of opium is most evident in the preliminary diarrhoea, but is entirely without avail in the stage of collapse. Mischief not infre-quently results from its use, for patients emerging from the condition of collapse are either directly narcotized by the opium which had lain unabsorbed in the stomach, or the cerebral symptoms of the secondary fever are greatly intensified by it. In cholera infantum opium must be used with caution, if not avoided. The subjects of this malady are easily narcotized, and the nervous system—an unknown morbid state of which bears some close relation to the gastro-intestinal disorder—is rendered so irritable by opium that the symptoms are aggravated by it.

The following formula embodies a truth of great practical importance: As a rule, opium does harm in all gastro-intestinal maladies in which there is a deficiency in the proper secretion, or a suspension of the functions, of the liver and kidneys.

Opium gives a degree and kind of relief in hepatic, renal, and saturnine colic, which no other remedy or combination of remedies affords. The most prompt and effective form in which the remedy can be administered is the hypodermatic injection of morphine. This relieves the pain, and relaxes the spasm of the affected tube, and at the same time checks the depressing vomiting which attends these cases. The quantity of morphine required will vary from one fourth to one half a grain. As the effect is immediate, the most prudent practice consists in the administration of a small quantity (one sixth to one eighth of a grain) for the first dose, in order to test the physiological capabilities of the patient, and following this in fifteen minutes with a dose of similar size if the first is well borne and the pain persist.

Opium, in small doses, is a valuable tonic to a weak and dilated heart. When administered simultaneously with digitalis, it obviates one of the dangers which may be caused by that agent. In the so-called passive haemorrhages, in which not only is the blood altered in quality but the tension is low, small doses of opium sustain the powers of life, and by increasing the arterial tension lessen the transudation through the vessel-walls. Under these circumstances, the dose of opium should not as a rule exceed five minims of the tinctures, and it should generally be given in combination with ergot, digitalis, tannic and gallic acids, acetate of lead, etc.

The important observation was made by Bernard, and afterward illustrated and confirmed by Nussbaum, that the hypodermatic injection of morphine, administered before the inhalation begins, prolongs the stage of chloroform narcosis with a less quantity of the anaesthetic, diminishes the danger of cardiac paralysis, and prevents the after-nausea and depression.

Opium is the most important agent which we possess in the treatment of various inflammations. Its efficacy depends upon several factors: it relieves pain, quiets restlessness, and thus removes from the inflammatory process one of its most important elements, viz., an irritable and paretic state of the nerves of the affected part. Besides these effects, opium raises the tonicity of the vessels, helps to maintain the continuity of the blood-current, and hinders the migration of the white corpuscles of the blood. It is especially in inflammations of the serous membranes that its highest utility is manifest, e. g., pleuritis, peritonitis, arachnitis. Good reasons exist for believing that the hypodermatic injection of morphine will sometimes cut short (jugulate) these maladies, if administered just at their onset. If the period for obtaining such a fortunate result has passed, the course and duration of these diseases can be greatly modified by the judicious use of opium. The quantity of opium required will be determined by the effect; the pain should be relieved, the pupils somewhat contracted. A full dose should be administered at the beginning of treatment (two to three grains of opium—a half grain of morphine), and a given physiological effect be maintained by the regular use of smaller doses. Pain is probably the surest guide, for the existence of pain indicates that decided opium narcosis has not been attained.

In peritonitis, whether puerperal, traumatic, or the extension of intestinal inflammation, no fact of therapeutics is better established than the curative power of opium. Besides its immediate influence over the inflammatory process, its indirect action, in maintaining the necessary quietude of the intestines, is of the greatest service. In arachnitis, pachymeningitis, basilar meningitis, there are clinical facts which tend to show that small doses of some opiate preparation really accomplish more than any other remedies. The author is convinced that we possess no means of treatment of cerebrospinal meningitis so effective as the opiate treatment. The same rule as to the quantity required, as that given for peritonitis, should be observed: that quantity of opium should be administered which will relieve the pains and rigidity. The best results are obtained by the hypodermatic injection of morphine. When effusion takes place, and stupor and coma ensue, the utility of opium is ended.

In parenchymatous inflammations, experience has shown, opium is much less useful. When pain is a prominent symptom, it can be employed to relieve it; in small, stimulant doses, it may be given to maintain the action of the heart. In pneumonia opium is a remedy of very doubtful utility. Its narcotic action certainly disposes to pulmonary congestion, although it may be cautiously used to allay pain and moderate cough. Although this was the general professional opinion, and is now largely held, there are those who entertain very different views regarding the utility of opium in pneumonia. Thus, Prof. A. L. Loomis, of New York, maintains that the disease may be aborted, or at least decidedly modified in severity, by the subcutaneous injection of morphine in the first stage (congestion) of this disease.