1 88 MATERIA MEDIC A AND THERAPEUTICS. 



irritation of the nerves, but sensibility is quickly reduced, 

 hunger and pain relieved or removed ; appetite, gastric secre- 

 tion, and digestive activity diminished; and the afferent im- 

 pressions which give rise to vomiting arrested, so that direct 

 emetics will no longer act. Anorexia, nausea, and sickness 

 may occur as sequelce of the same or larger doses. 



These effects of opium on the stomach have a double 

 bearing in therapeutics. First, they indicate that it has a 

 constant tendency to derange digestion. Secondly, it is a 

 powerful means of relieving gastric pain and vomiting, what- 

 ever their cause, but especially in the acute catarrh which 

 remains as the effect of irritant food, alcohol, or poison, after 

 these have been removed ; in ulcer, "chronic," or malignant; 

 and in reflex sickness, due to disease, irritation, or operation, in 

 some other part of the abdomen. In chronic dyspeptic pain it 

 is manifestly contra-indicated. 



The action of opium on the intestine is distinctly sedative, 

 although very brief primary stimulation may sometimes be 

 recognised. Both the sensible and insensible impressions from 

 the mucous membrane are diminished or arrested by medicinal 

 doses. Pain is prevented or relieved, the secretions are less 

 abundant, and peristalsis is more feeble or arrested ; the total 

 result being anodyne and astringent. Opium is therefore a 

 most valuable remedy for unnatural frequency of the bowels, 

 as in simple diarrhoea, dysentery, the first stage of cholera, 

 the ulceration of typhoid fever and tuberculosis, and irritant 

 poisoning. In all such cases, however, it must be employed 

 with the cautions to be afterwards insisted on, and in most 

 instances it is best prescribed as an addition to other astrin- 

 gents such as chalk, lead, and tannic acid in its many forms ; 

 the amount of opium being a minimum, but still sufficient to 

 assist the less powerful drugs. It has the further advantage of 

 relieving abdominal pain. Even infants (see cautions, page 197) 

 may thus be treated for diarrhoea with the greatest benefit. 



Opium is of still greater service in paralysing the bowels 

 in hernia, intestinal obstruction, peritonitis, and visceral per- 

 t'oi-itions, ruptures, and wounds. The drug must be freely and 

 continuously given in such cases, until nature or art can afford 

 relief. 



Given by the rectum, as the enema or suppository, opium 

 relieves local pain, diarrhoea, dysentery, and spasm of the 

 rectum or neighbouring parts, sets the pelvic organs at rest 

 after operations, and prevents irritability of the rectum by 

 nutrient enemata. The dose of opium by the rectum should be 

 half as much more as by the mouth. A trace of morphia ia 

 excreted unabsorbcd in the faeces. 



