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 cholera, opium is no less efficient. The ordinary bilious cholera, or cholera morbus, may be treated with it in the manner above recom-mended for bilious diarrhoea; the two diseases being, in fact, identical in character. Bat the dose should be more frequently repeated, as often as every half hour till relief is obtained; and, when the pains are very severe, and the discharges exhausting, the opiate should be considerably increased, and administered by enema if rejected from the stomach; calomel being at the same time moderately exhibited as before, to guard against a total suspension of the hepatic secretion. The discharges of bile in cholera morbus are no doubt intended to relieve a congestive irritation of the liver and whole portal circulation, which without this outlet might end in serious inflammation or fever. The use of calomel ensures a sufficient action of the liver to prevent ultimate evil, while the opium prevents immediate mischief by arresting the excessive discharge.
Epidemic cholera I believe to be a different affection from ordinary cholera morbus, and to depend on a different cause. Nevertheless,there is the same indication for the combined use of opium and calomel. In the stage of diarrhoea, or the joint discharge from the stomach and bowels called cholerine, which generally precedes the distinctive rice-water evacuations of the fully formed disease, opium is the remedy mainly to be relied on. With or without camphor and the aromatics. and in small doses frequently repeated, it almost always arrests the discbarges, and thus probably averts cholera itself. I have usually preferred the ordinary paregoric, or camphorated tincture of opium of the Pharmacopoeias, of which a fiuidrachm may be given three or four times a day if necessary. Should the evacuations from the bowels be destitute of bile, small d of calomel and opium should be employed as above advised. Sometimes it may be necessary to give the opiate more largely, and to combine with it an anodyne enema, and a sinapism over the abdomen. When the cholera is fully formed, opium is still, I think, the sheet-anchor in this disease. It should now be given in the dose of a grain or two at first, and afterwards repeated at intervals of half an hour or an hour, in one-quarter, or one-half the dose, till the discharges are arrested, and the pains relieved, or till some evidence of narcotism is produced. After this, it is of no use to push its effects further. Indeed, it can do only harm, by aggravating the general prostration through its secondary sedative effects. The great rule is not to allow it to render the patient stupid, or comatose; but. within this point, to continue its use, at longer or shorter intervals, so long as indicated by the spasms and the evacuations. But it should never be relied on exclusively. With the quantity of opium above mentioned, from two to four grains of acetate of lead, and a grain or two of calomel should be given, to be repeated afterwards along with it in proportionately diminished doses. At the same time, an anodyne enema should be exhibited, and a sinapism applied over the whole abdomen : warmth and rubefaction to the extremities being additionally used, if these should be cold and bloodless. In the collapse of cholera, opium is of little or no use. In the stage of reaction, its employment must be governed by the same principles as in low fevers and inflammations.
Cholera infantum does not offer equally strong indications for the use of opium. The head is so apt to suffer in infants, that anything which tends to congest the cerebral centres must be used with caution. Nevertheless, if the vomiting cannot be otherwise restrained, this remedy may be cautiously administered, and should be preferably used by injection: great care being taken to proportion the dose to the age. In the subsequent stages, when the affection has assumed rather the character of diarrhoea, and the indication exists for checking the evacuations, very small doses of opium, or one of its preparations, may be added to the cretaceous, astringent, or alterative medicines employed.
In excessive secretion of urine or diuresis, especially when connected with nervous disorder, or an irritable state of the system, opium is one of the most efficient remedies. In diabetes, strictly so called, it is an excellent palliative, diminishing frequently the amount of excretion, moderating the wear of the system, and greatly comforting the patient; but it is wholly inadequate to the cure. It should be used in this complaint, in full doses, and preferably at night. In small doses, frequently repeated, so as to produce its stimulant effects, I have often known it greatly to increase the secretion of urine.
In excessive mercurial salivation, opium is very useful, not only by checking the discharge, but by relieving pain, and diminishing nervous irritability.
In the excessive mucous secretion from the stomach, bladder, and bronchial tubes, called respectively gastrorrhoea, cystirrhoea, and bronchorrhoea. opium may be usefully employed as an adjuvant or corrective of other medicines; but cannot be relied on exclusively, or even as the chief remedy. Under this head may be mentioned the use of opium in combination with other medicines, where it may be desirable to prevent their operation upon the bowels. For this purpose, it is almost constantly given with calomel, and frequently with the blue mass, when the object is to obtain the peculiar effects of mercury on the system.
Hemorrhages constitute the second division of morbid discharges. In most of these opium is indicated, both from its effects upon the capillaries, and for its influence in quieting various attendant irritations, which often serve to aggravate the main affection. Thus, in hemorrhage from the lungs, or air-passages, it proves serviceable by allaying the irritative cough, which, by agitating the parts, tends to sustain the bleeding. In hemorrhage from the stomach, after the full evacuation of its contents, an irritated condition often remains, which provokes vomiting unnecessarily, and prevents the retention of medicines that may be indicated. Opium by the mouth or rectum, or endermically to the epigastrium, is very useful in such a condition. So also in hemorrhage from the bowels, bladder, and uterus, it tends to control the irritative movements, which, beyond what may be necessary for the mere evacuation of the effused blood, can act only disadvantageous!}- on the affection. For these purposes, it is usually sufficient to employ small doses, in conjunction with the other medicines indicated. For the direct influence of the opium on the bleeding vessels, it should be given in full doses, and combined with ipecacuanha; the patient being confined to bed, and well though not hotly covered, so as to favour the perspiration which is apt to be induced. But for this purpose, opium is not indicated in all the hemorrhages, nor in all conditions of any one of them. It should not be used when the pulse is full and strong, with a general febrile movement, and an active congestion of the bleeding organ. This condition should be removed by depletory and refrigerant methods, before recourse is had to opium. The remedy, in full dose, is of doubtful propriety in any case of haemoptysis, in consequence of its tending to check bronchial secretion, and thus rather to promote than relieve congestion of the vessels. Nor can it be given, as a genera] rule, in connection with ipecacuanha in haematemesis. But in intestinal, renal, and uterine hemorrhages, after a suitable preparation of the system, or in cases which have at no time presented any contraindication, it is often an excellent remedy. In menorrhagia it is especially useful, and. with rest, will often itself be quite adequate to the cure. In the purely passive hemorrhages, whether dependent on mechanical obstruction, or on that disorganized state of the blood which permits it to ooze out through the unresisting coats of the capillaries, opium can be of little service as a mere haemostatic. As a stimulant, it may be useful in the conditions of system attendant upon the state of the blood referred to.