OPIUM. - 193 



hypodermic injection of morphia. This subject must be studied 

 in books on the practice of medicine. 



From its soothing effect upon the vessels and circulation 

 generally, opium is a haemostatic of the first order, but requires 

 to be used with judgment. In haemoptysis, it is given in small 

 doses, to relieve cough, to depress the circulation slightly by 

 slowing and weakening the heart and dilating the vessels, and 

 to relieve the mind of the anxiety which aggravates the bleed- 

 ing. In intestinal haemorrhage it is of great value, arresting, 

 as it also does, the movements of the bowel. It is best given 

 combined with lead or preparations containing tannic acid. 



The soothing influence of opium on the bronchi, lungs, the 

 afferent nerves, and the centre of respiration, accounts for its 

 extensive employment in cough, pain, dyspnoea, and other dis- 

 tressing symptoms in the chest. Its power here is unquestion- 

 able ; but for this very reason the danger of it is great. Cough 

 and dyspnoea are frequently beneficial acts, and are not to be 

 arrested in a routine fashion by sedatives, but, if possible, by 

 the removal of their cause. When cough is due to some irre- 

 movable condition, such as growth in the lung or bronchi, 

 pressure, or a remote (reflex) irritation, or to excessive irrita- 

 bility of the nerves and centre, opium is indicated, and may be 

 given with benefit. On the other hand, in cough and respira- 

 tory distress with abundant secretion, as in the bronchitis of 

 the old and infirm or of the very young and feeble, opium 

 leads to retention and inspissation of the products, aggravation 

 of the cause, and asphyxia, and is on no account to be given. 

 Between these extremes lies every variety of case in which 

 opium may suggest itself, e.g. in phthisis and recurrent 

 bronchial catarrh. The rule here should be on no account to 

 prescribe opium unless other means have failed, such as the 

 many expectorants, and attention to food, warmth, etc.; and 

 that, when given, opium must be ordered in small doses com- 

 bined with expectorants, such as ammonia and ipecacuanha, 

 which will prevent dangerous depression of the local nerves 

 and centres. In acute inflammation of the pleura, or pleuro- 

 pneumonia, it may be necessary to relieve severe pain in the 

 chest, harassing cough, sleeplessness, and mental distress by 

 morphia hypodermically. For asthma, opium must be ordered 

 with the greatest hesitation, as the opium habit is readily 

 acquired in this disease. Its employment in haemoptysis has 

 been already noticed. 



With respect to the liver and metabolism, opium is by far the 



most powerful drug known in reducing or removing sugar 



from the urine in diabetes, and therewith ameliorating the 



condition of the patient in most respects. Very large doses of 



if 8 



