192 MATERIA MEDIC A AND THERAPEUTICS. 



sleeplessness due to pain ; in the insomnia of exhaustion, over- 

 work, fever, or insanity ; and in the restlessness and anxiety 

 of visceral disease ; the quantity, combinations, and time of 

 administration being carefully arranged. In delirium chloral 

 is often preferred, especially in delirium tremens ; but opium 

 is more suitable in the delirium of mania, and in the later 

 stages of fevers, when the temperature is falling and the 

 respiration and circulation are not oppressed. It has been 

 recommended, however, in heat-pyrexia, combined with quinia. 



There are but few kinds of pain that cannot be relieved by 

 opium ; but whether it be wise to administer it in every instance 

 is another question. The unbearable pains attending the passage 

 of renal and biliary calculi, the pains of neuralgia, acute rheu- 

 matism, and cancer ; of fractures, dislocation, and other in- 

 juries, are a few examples of conditions in which opium is essen- 

 tial. In all cases when pain is urgent, and its seat accessible, 

 the hypodermic method should be chosen. In gout it is to be 

 used only when the pain is excessive, as it tends to aggravate the 

 cause. In hysterical pain it is less valuable. Other local 

 visceral pains will be noticed presently. The pain and shock 

 of operations are constantly treated with a full dose of opium. 



No use is made of the action of opium on the iris and 

 ciliary nerves. 



As an an ti spasmodic, opium is less employed for various 

 reasons, e.g. in epilepsy and other convulsive diseases ; but it 

 relieves some cases of spasmodic asthma, whooping-cough, and 

 spasmodic stricture of the urethra. 



The violent spasms and pains of certain diseases of the 

 cord may yield to no other form of treatment than morphia 

 injected hypodermically. 



From its action on the medulla, opium has been recom- 

 mended as an antidote to belladonna, which is so far its physio- 

 logical antagonist, as we shall see (page 198) ; but it must 

 always be used with great caution, and only in the stage of 

 excitement. 



The practical points connected with the vital centres will be 

 noticed under the heart, vessels, and respiration. 



In disease of the heart, opium is of great value to relieve 

 pain, anxiety, and distress, whilst, as we have seen, it is a 

 dangerous cardiac depressant. Towards the end of most cases 

 of cardiac disease, the greatest discrimination is called for as to 

 when opium may or may not be given. The safe rule is to 

 trust to other anodynes entirely, such as belladonna, direct and 

 indirect stimulants, and measures for relieving the circulation; 

 but it is equally true that in some cases of heart disease un- 

 jq ! 'likable relief and permanent benefit may be obtained by the 



