Opium very materially assists the bark in curing inter-mittents, and prevents it from running off by the bowels. When given at the approach of the paroxysm, it sometimes checks its attack, or shortens and renders it milder, and abates the violence of the hot stage, by determining to the surface, and inducing sleep. In acute rheumatism, opium is advantageously 'given united with calomel and antimonials3 after bleeding: it is, also, usefully combined with nitre, and always relieves when it determines to the surface; but in order to afford permanent relief it is requisite, at the same time, to purge very freely. In the other phlegmasia4, opium cannot with propriety be used in the early stages; but after the in-

1 Nouveaux Elemens de Therapeutique, etc. 4th edit, tome xi. p. 76.

2 Medical Reports on the Use of Cold and Warm Water, i. 290.

3 I know of no remedy which so effectually relieves the excruciating pain of acute rheumatism, which generally makes its attack at night, as the following combination, after the application of leeches to the painful joint: Calomelanos, gr. j. Antimonii tartarizati, gr. 1/4. Opii gr. jss. Fiat pilula, hora decumbentis sumenda.

4 Were it allowable in this work to criticise nosological arrangements, we might justly question the propriety of placing rheumatism among the phlegmasia?.

flammatory action is subdued, it is useful in quieting cough, allaying pain, and procuring sleep. In eruptive diseases, particularly small-pox, the liberal use of opium is found to be highly beneficial, when convulsions precede the appearance of the eruption, or if the accompanying fever assume the typhoid type. It is injurious in some other of the exanthemata, especially in the diarrhoea which succeeds measles: in malignant scarlatina and in pemphigus it is equally valuable; but its use is contra-indicated in the delirium of scarlatina, and altogether in this class of diseases when the fever is inflam-matory. In the haemorrhagiae it is useful when the discharge arises chiefly from an increased degree of irritability, and where the pulse, instead of being strong and full, is small, quick, and intermitting. Hence its efficacy in the floodings of weakened habits after abortions, and in phthisical haemoptysis. In uterine haemorrhages the dose should be large, not less than sixty minims of the tincture.

It has been recommended also after blood-letting, in the haemoptysis and haematemesis of the latter months of pregnancy.

Although opiates are hurtful at first, and check expectoration in bronchitis, yet, when the cough remains obstinate, their good effects are undoubted; and in the contagious catarrh or influenza, an opiate at bed-time is requisite for quieting the cough in every stage of the disorder. In dysentery, also, the benefit to be derived from opium depends very much on the bowels having been previously well cleared, in which case it allays the tormina and tenesmus: and maintains the advantages obtained, when its use is continued in combination with castor oil; and the same remark applies to diarrhoea. In dysentery it is most useful when combined with calomel, in which case it appears to act by retaining the mercurial in the duodenum.

The spasmodic and convulsive diseases are those in which opium is most evidently useful. In tetanus, although it does not always succeed, even when given in the largest doses, yet many cases have occurred in which the continued exhibition of large doses has overcome the spasm, and cured the disease; particularly when it has been judiciously combined with cathartics: often, however, very large quantities of the remedy have been taken without any sensible effect on the state of the habit, and without relieving the disorder; and the same is the case in hydrophobia, in which 180 grains of solid opium have been taken in the space of twelve hours, without producing any apparent effect. It has been found beneficial in chorea; but, as in tetanus, it is necessary to precede its use by strong cathartics, or at least to give it in combination with these.1 In epilepsy not connected with organic lesions it proves useful when given in combination with musk; and it has been recommended by highly respectable authority 2 in eclampsia; but its efficacy in this complaint is rather doubtful.

In spasmodic asthma it shortens the paroxysms: it abates the violence of the cough in pertussis, when given after the primary fever subsides; and it is more especially useful in pyrosis and cholera than any other medicine. Solid opium, either alone or united with camphor, is the most effectual remedy for checking obstinate vomiting, proceeding from a morbid irritability of the stomach. In colic and ileus it is given in combination with laxatives, and allays the spasm and pain; nor is it less efficacious in flatulent colic with hernia. As a remedy in lues venerea, opium is still relied on by some foreign practitioners, but the idea of its anti-venereal powers has been justly exploded in this country; and it is properly regarded chiefly as an useful adjunct to mercury in this disease : "by diminishing the sensibility of the stomach and bowels, it prevents many of those inconveniences which this mineral is apt to excite in the primae viae, and allows it to be more easily introduced into the system."3 In short, in all cases where the irritability is morbidly increased, and where it is of importance to lessen pain, and procure sleep, opium is undoubtedly the most valuable article of the Materia Medica.

Opium is contra-indicated in all morbid states of the body, where a strong inflammatory diathesis exists; in pulmonary affections, when the cough is dry and hard, and the expectoration difficult and scanty; and if not hurtful, its use is at least doubtful in mania, in which it generally occasions restlessness instead of procuring sleep.

Externally used, opium is almost as efficacious as when it is taken into the stomach, and produces its narcotic effects without affecting the head or producing nausea. It is applied in the form of frictions, either combined with oil, or with the camphor liniment, or in the form of tincture : and thus applied it may be used in all the diseases above enumerated. We have often seen its good effects in colic; and have also witnessed its singular efficacy in symptomatic trismus, when rubbed on the jaw, and applied to the scrobiculus cordis by means of pledgets soaked in the tincture combined with the oil of turpentine. A piece of solid opium stuffed into a carious tooth relieves the pain of toothache; and introduced into the rectum, either in the solid form, or dissolved in water as an enema, it affords relief in tenesmus, in painful affections of the prostate gland, and in spasmodic strictures. A weak, watery solution of it, also, is an useful adjunct to injections in gonorrhoea, and to collyria in ophthalmia; and the vinous tincture dropped into the eye removes ecchymosis, and the suffusion which often remains in that disease after the inflammation has been subdued; and restores the tone of the diseased organ.