This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
In peritonitis opium and calomel are invaluable, when further depletion is out of the question, and in cases which will not admit of depletion at all. In the peritonitis from perforation of the bowels, opium is the only remedy upon which reliance can be placed. In the same affection, without perforation, occurring in the course of low febrile diseases. or attended from the beginning; with the same condition of system, the opiate plan with mercury should be commenced immediately after a thorough evacuation of the bowels; the opium being freely administered, and the bowels afterwards left undisturbed, except by the occasional exhibition of a cathartic enema, to evacuate the rectum and lower colon. Prof. A. Clark, of New York, has found large doses of opium the most effectual remedy in puerperal fever, when peritonitis is "a prominent element" in the disease. (New York Journ. of Med . March, 1855).
In hepatitis, opium should be used with more reserve, in consequence of its property of checking the secretion of bile. Still, if it be combined with calomel, this effect may be in a considerable degree obviated; and I should not hesitate to employ it, if necessary to procure sleep. It is, however, better adapted to those cases in which the investing membrane is affected. In the parenchymatous inflammation of the gland, it would be best, on the whole, not to use it; and as the pain is in this case less severe, there is not the same occasion for its use.
In inflammations of the internal urinary and genital organs, the general rule as to the use of opium holds good; but, as the stomach is very apt to be irritable in nephritis, it is often necessary to omit the ipecacuanha: and, in all these cases, the opiate is in general most efficaciously administered by enema.
All the inflammatory affections of the chest, whether of the inspiratory or circulatory organs, come under the general rule, with the exception of the different forms of acute bronchitis, in which opium should ordinarily not be given until secretion has been thoroughly established; as it tends to prevent this result, and thus to increase the pectoral oppression, and to aggravate the disease. But, when the acuteness of the inflammation has been subdued, and expectoration has become free, opium in moderate doses is often very useful, in connection with expectorants, in relieving the harassing cough, and enabling the patient to rest The same rule applies also to the chronic form of the complaint.
After what has been already stated, under the head of contraindica-tiona to the use of opium, it is scarcely necessary to repeat that it is altogether unsuitable to the treatment of acute inflammation of the bra in. and of very doubtful advantage even in the chronic; though cases sometimes occur, in which, from the particular seat of the affection, as,for example, when confined exclusively to the meninges, the indications for its use more than balance the contraindications. To procure rest is sometimes, under these circumstances, all-important; and opium may be cautiously used, when no symptoms of acuteness in the inflammation are present.
In erysipelatous inflammation of the skin, opium may be given when not forbidden by stupor or coma.
But of all the inflammatory affections there is no one to which it is better adapted than acute rheumatism. After two or three days given to depletory measures, opium and ipecacuanha, or the Dover's powder, may be used very freely: and, if associated with calomel, so as to affect the system in the course of the second week, will in general be found adequate to the cure. In subacute rheumatism, the remedy is indicated from the commencement; and, in the chronic form, a Dover's powder at bedtime may enter into almost every plan of treatment adopted in that complaint.
In acute gout, too, it is highly useful at bedtime, in relieving pain and enabling the patient to sleep, and, so far as I have seen, does no harm. It is, however, in this complaint better associated with colchicum; and the mercurial addition is not advisable unless merely to stimulate the liver when torpid.
In the suppurative stage of inflammation, opium, in moderate stimulant doses, is of great use in supporting the system, and comforting the patient; and should generally be given with the tonics and stimulants employed.
Ulceration, when painful, and indisposed to the healing process in con-sequence of an irritated condition, connected, it may be, with an irritable state of the system at large, may be advantageously treated with opium, both given internally, and applied topically. M. Rodet has derived great advantage from it in the phagedenic serpiginous ulcerations of syphilis, in which mercury is altogether contraindicated. (Med. Times and Gaz.. Aug. 1856, p. 176.) Mr. Skey, of St. Bartholomew's Hospital, London, considers no treatment equal to the opiate, in very old and obstinate ulcers of the limbs or other parts, in which it seems to act with a restorative power, wholly independent of its mere sedative influence. (Banking's Abstract, No. xxiii. p. 120).
When inflammation is attended with gangrene, opium is an invaluable remedy, relieving the pain often attendant on that affection, and supporting the nervous centres under its prostrating influence. Indeed, opium is indicated in mortification under almost any circumstances; and. in the last stage of acute inflammation of the alimentary canal, given in combination with oil of turpentine, it affords, in some instances, almost the only remaining chance for the patient
After all that has been stated above, 1 wish not to be understood as recommending opium in all cases of inflammation, when no positive contraindication may exist. In slight or even moderate cases, and in the chronic forms generally, it should be employed with great caution, from the fear of leading the patient into its habitual and excessive use.