1 I leave out of the question the treatment of external strangulated hernia; here the remedies are taxis, under chloroform, extraction of gas and fluids with the aspira-tor, and, failing these things, operation.

2 Second edit., edited, by Dr. Buzzard.

3The Antagonism of Therapeutic Agents, London, 1878.

In catarrhal irritation of the gastric mucous membrane opium sometimes proves valuable; but it is here a two-edged weapon, for its constipating effects may more than undo any momentary advantage which it produces. However, in chronic gastric catarrh, attended with much pyrosis, opium in small doses, perhaps combined with the mineral acids, is sometimes very useful: and constipation may be met by the use of mild aperient waters, such as Pullna or Friedrichshall, if necessary.

In catarrhal affections of the intestines, especially in autumnal diarrhoea, and in English cholera (early stage), the good effects of opium, combined or not, according to circumstances, either with mineral acids, or with chalk and aromatic confection, are well known. One-sixth to one-fourth or half a grain, or an equivalent dose of tincture, should be given every two, four, or six hours. In the early stages even of Asiatic cholera, notwithstanding all that has been said against it, the preponderating voice of those practitioners who have had the largest experience still declares that opium is one of the most decidedly valuable agents. But in the stage of collapse, and in that of reaction, it is worse than useless. In irritable conditions of the mucous membrane of the genito-urinary organs, small doses of opium are often most valuable; but it is necessary always to bear in mind the possible existence of kidney disease, which often renders the employment of opium very dangerous.

As a Sudorific, opium is occasionally very useful: its effect is greatly heightened when it is combined with ipecacuanha, as in Dover's powder; ten grains of the latter will often give the greatest relief in febrile catarrh, with hot dry skin, and in various inflammatory diseases.

In Conditions of Acute Delirium opium is occasionally very useful, but it requires to be employed with great circumspection. The use of it (formerly frequent) in acute mania and in delire aigu is nearly abandoned in favor of hydrate of chloral, combined with the careful and assiduous administration of food, and, in some cases, of stimulants.

In Delirium Tremens also, opium may be said to be practically superseded by chloral, and by bromide of potassium. In the delirium of zymotic fevers opium has always been regarded with suspicion and dislike by some of the best practical physicians. Graves and Billing, however, have endeavored to show that it may often be employed usefully in such cases, in combination with small doses of tartarized antimony; and even the danger of opium pure and simple (in typhus, for example) has probably been a good deal exaggerated. One caution it is absolutely necessary to remember; viz., if kidney complication be present, opium will probably increase the danger very seriously. (Prof. A. L. Loomis, of New York, has introduced the practice of administering morphia in acute uraemia. In an oral communication to the editor, he stated that he first used it in a case of unemic convulsions in 1868, with such satisfactory results, that ha has frequently employed it since. The commencing dose should be small, not exceeding ten minims of Magendie's Sol. In chronic uraemia, however, where there is danger of cedema of the brain, he believes that morphia should be used with very great caution.

Ulcers. - The use of opium in forwarding reparative processes in certain kinds of ulcers and wounds is one of the most interesting facts in therapeutics. First in importance under this head is its action when boldly and promptly given in the phagedenic ulcer; here its employment, in doses of a grain or two grains every three or four hours, has frequently exerted a surprising influence, not only in easing pain, but in arresting the destructive processes. Again, in the indolent ulcer, with large flabby granulations, the internal administration of opium (three to four grains daily), combined with the external use of opium in lotion or ointment, has often entirely changed the character of the sore, and induced rapid healing. The use of opium, locally in particular, is by no means so commendable in the so-called "irritable" ulcer, although here it might have been thought especially applicable; these ulcers on the contrary are often aggravated by opium, and are best treated in quite a different manner. (Skey was a prominent advocate of this practice, and the editor has frequently verified the above statements, though giving the opium in smaller doses, gr. j. - ij., daily.)

The above curative actions of opium are established on indisputable evidence; but there is much more difference of opinion among authorities respecting its value under the following circumstances.

In General Convulsions the action of opium is very uncertain, and the instances in which it is useful are rare, though sometimes striking.

It has been employed very largely in tetanus; and there was the more reason to hope for good results from its use because, in this disease, the system shows an extraordinary tolerance of large quantities of opium. The enormous daily quantum of 20 or 30 grains has not infrequently been given without producing any decided stupor, and with the simple result of relieving the spasms to a greater or less extent. At present, however, I believe I am justified in saying that no high authority regards opium as a remedy possessed of any considerable curative power in tetanus; it would seem rather that the cases which have recovered under its use belonged to the class, not inconsiderable in number, which recover spontaneously.

In Epilepsy the highest trust has, by some authorities, been reposed in opium, but the day has gone by for this kind of practice, and few believe that any effect, except a quite temporary one, can be thus produced. Indeed, there is the best reason to suppose that serious mischief would follow the use of opium in many such cases.