This section is from the book "Materia Medica And Therapeutics - Vegetable Kingdom", by Charles D. F. Phillips. Also available from Amazon: Materia Medica And Therapeutics: Vegetable Kingdom.
Puerperal Convulsions form, perhaps, an exception: the high authority of Scanzoni may at all events be cited in favor of the beneficial influence of morphia in this affection. But it is probable that far better results may be obtained by the employment of chloroform, bromide of potassium, aconite, or hydrate of chloral.
In the Convulsions of Infancy, it is probable that opium, in the majority of cases, is not merely useless, but actively hurtful, unless given in extremely minute doses.
The Value of Opium in Inflammation was formerly one of the most disputed topics in therapeutic literature; but the observation of Brochet (1828) probably represents what is now the general opinion of experienced practitioners, viz., that the drug is far more useful in inflammations of membranous than of parenchymatous structures. In many cases of peritonitis, pleuritis, enteritis, and gastritis its use cannot be too highly extolled. In puerperal peritonitis it has undoubtedly often proved beneficial; but it is very much to be regretted that too many medical men employ it as a matter of routine in this disease, instead of selecting other remedies (aconite, for instance), which are decidedly more suited to individual cases. In diffuse inflammation of cellular tissue, especially where the periosteum is involved, opium, in tolerably full repeated doses, often exerts a most powerful antiphlogistic influence.
The employment of Opium in Insanity is at present regulated by very different principles from those which formerly prevailed. I have already alluded to the general tendency to abstain from the use of opium in acute delirium, and it may now be said that the old plan of attempting to narcotize acutely maniacal patients with this drug is very generally abandoned.
On the other hand, the great value of opium in insanity attended with depression, particularly in typical cases of melancholia, has been established beyond doubt, especially by the authority of Dr. Maudsley.1 It may be given in repeated and gradually increasing doses, several times daily; and the results of this treatment, if early adopted, are often strikingly beneficial. How far any employment of opium is ever justifiable in circumstances of blood-poisoning, where there is notable embarrassment of the excreting organs, must be considered very doubtful. On the whole, these conditions must be regarded as forming a prima facie and serious counter-indication.
Lastly may be mentioned, as a matter still under dispute, the question of the utility of opium in Diabetes. Very striking cases have been adduced in evidence of the power of full doses of opium to reduce the amount of sugar-elimination and diuresis, and to improve the general bodily condition; but, on the other hand, the drug has often been tried without the least good effect. The secret of this discrepancy very probably rests on differences between the causation of the disease in different cases; it is likely, in particular, that disease of the medulla oblongata in some instances counts for much, and in others for very little. The whole subject requires further investigation from the clinical, and also from the physiological and the pathological points of view.
Therapeutic Actions of Morphia. - There are important differences between the remedial action of morphia and that of opium, which depend partly on intrinsic qualities of the latter, owing to the presence of other ingredients, and partly on the superior facility of administration which distinguishes the former.
Under the first head we may establish the following comparative estimate: Morphia is more applicable to the relief of pain, and less potent in the mere production of sleep, than opium; it is less useful, also, than the latter in checking hypersecretion from mucous membranes. On the other hand, it can be much more effectively employed, especially in very small doses, for the relief of certain spasmodic affections. We may here especially mention whooping-cough, for which the treatment mentioned by Dr. Edward Smith,2 with doses of 1/24 grain, three or four times daily, is often extremely effective; and spasmodic asthma, in which small doses of morphia (especially if hypodermically injected) often afford a relief which would be sought in vain from opium.
1 See Practitioner, Jan., 1869.
2 Art "Whooping-cough:" Reynolds's System of Medicine, vol. i.
The most practically important advantages which morphia possesses over opium have been revealed by the modern practice of hypodermic injection. First adopted in 1857, by Dr. Alexander Wood, as a mere local remedy for pain, the hypodermic injection has since developed in the hands of Hunter, Eulenburg, Behier, Lewin, and many others, into a method of quite unexpected power and utility, and one adapted for the administration of many substances besides morphia. No drug, however, so fully illustrates the value of hypodermic injection, or the dangers that attend indiscriminate resort to it.
On the mechanical part of the process (instruments, mode of puncture, etc.), it is unnecessary to say anything, as these matters have been fully discussed in the well-known treatises of Hunter and Eulenburg, in the various papers in the Practitioner, and in the Report of the Royal Med-ico-Chirurgical Committee.1 As to the solution, it is probable that the acetate of morphia, live grains to the drachm, dissolved in plain distilled water, is the most convenient; and, as regards dose, it may be laid down as a general rule that the potency of injected morphia is at least three times as great as that of morphia swallowed.
The most striking effects of hypodermic injection of morphia are seen in its rapid relief of pain. In the treatment of neuralgias, especially, this remedy has proved most valuable; the severest pain being often quite relieved in a few minutes by the injection of 1/16 or 1/4 to 1/4 grain. Nor is the alleviation always merely temporary; in recent cases it is often possible, by injecting once or twice a day (according as the attacks recur), to completely efface the malady. It is of great consequence not to begin with too large doses, for if the patient be heavily stupefied we soon set up a severe craving for the repetition of the remedy, and a dangerous opium-habit may thus be engendered. The golden rule appears to be to employ just such doses, and no larger, as are sufficient to arrest the pain and produce either no narcotism (i. e., no stupor, no contraction of pupil, nor after-headache and constipation), or as little as may be possible.