While a successful outcome is not always to be expected, much can be accomplished by persistent effort in these cases. They are not hopeless by any means.

Therapeutics. - In a general way the medical uses of opium are - 1, to relieve pain; 2, to produce sleep; 3, to lessen reflex irritation; 4, to diminish secretion; 5, to support the system; 6, to act as a sudorific.

Opium is the most important and useful drug known to medicine, as well as the most remarkable in its multifarious applications. It would, therefore, be idle - indeed, well-nigh impossible - to enumerate all the maladies and abnormal conditions for which this invaluable remedy has been employed. It perhaps best represents the typical symptom medicine, being used almost invariably for the relief of one or more symptoms of disease, rather than for its specific or direct curative action upon the disease itself. Unless some special contraindication exists, it may be employed when any of the above medical uses are desired.

Externally and Locally. - It is used to relieve pain, either in the form of an ointment, a liniment, or a suppository, the most popular form, perhaps, being the lead-and-opium lotion.

Internally. - Pain. - Either opium or morphine may be used for the relief of pain, regardless of the seat or cause. Pain of moderate intensity may often be allayed by other analgesics, such as anti-pyrine, acetanilid, etc.; but when it is severe or excruciating, it is useless to experiment with other drugs when so potent an agent of relief as opium is obtainable. As a general principle, it should be borne in mind that opium should, if possible, be avoided in all pains of an essentially chronic nature, if the habit is not to be acquired. One is justified, however, in the employment of opium or morphine indefinitely for the relief of pain or insomnia in incurable cases.

Sleep. - It is not recommended for ordinary use to produce sleep, because of its seductive, insidious action, and the danger of creating in the patient a tendency toward the opium habit. When, however, sleeplessness is occasioned by pain, and in the insomnia of delirium tremens or acute delirium, opium or some one of its preparations is often an indispensable remedy.

Spasm. - Spasmodic conditions of involuntary muscles, as in cases of asthma, the convulsions of tetanus, uremia, hydrophobia, frequently call for a drug as powerful as opium.

When given in proper doses in peritonitis, opium reduces peristalsis and removes the pain, promoting the patient's comfort and supporting his vital powers. It diverts the blood from the congested peritoneum by dilating the cutaneous blood-vessels. Furthermore, it possesses the peculiar property of causing the irritation in the inflamed area to contract reflexly the local blood-vessels, thus diminishing the blood-supply to the diseased part.

It is manifestly of little service beyond its pain-relieving effects in the peritonitides of septic appendicitis or of other acute bacterial peritonitides. If its use tends to mask the symptom of pain in appendicitis, thus rendering diagnosis more difficult, it is to be avoided.

Secretion. - In dysentery, cholera morbus, and cholera, it has been used with excellent results, having also been employed in many cases of excessive secretion in other portions of the body.

Opium is frequently given in bronchitis with profuse secretion and irritable cough, in which condition it acts favorably through depression of the reflexes and power to allay irritation and check secretion. In these cases, however, small doses only should be administered, and the condition of the patient carefully watched, especially that of the aged, lest the respiratory apparatus be so depressed that expulsion of the accumulated viscid mucus be impossible and danger of death from suffocation ensue.

Metabolism. - As a supporter of the system when the vital forces are weakened by acute or chronic disease or injury there are few drugs as efficacious as opium. It calms and strengthens the debilitated heart, and secures the patient refreshing sleep, soothing and invigorating his system by means of the much-needed rest. If pain be persistent, wearing seriously upon the sufferer's vitality, opium by its anodyne influence enables him to recuperate during the interval of relief.

In shock from severe injury, opium, by benumbing sensation and depressing the reflex mechanism, lessens the danger of cardiac and respiratory failure.

In pleurisy it is the most efficient remedy, relieving congestion as in peritonitis, besides reducing the respirations, and consequently the friction of the inflamed pleural surfaces, as well as allaying the pain accompanying each respiration.

Dover's powder is a common and valuable agent in acute coryza, it also being one of the most efficient diaphoretics.

Opium is considered the most efficacious remedy in puerperal septicemia. It has also been advocated for hemorrhage, both active and passive, its greatest utility being manifested in the latter condition. It is particularly valuable in the hemoptysis of phthisis, and useful in hemorrhage in typhoid.

Although frequently used in continued fevers of various kinds, it is indicated, as a rule, only during their course - or, rather, after the fever is well established or during its decline - to mitigate its violence or conserve the strength and relieve the nervous manifestations foreboding exhaustion. Clinical experience has demonstrated its inutility, ordinarily, at the onset or climax of such fevers. Even in exanthematous fevers opium has proved valuable when the eruption is delayed. The presence of narcotine is said to be of assistance in the treatment of malaria.

As already intimated, the space allotted to this drug will scarcely permit an enumeration of the many disorders for which this remedy has been successfully administered. The independent and thoughtful physician, knowing the chief indications for its use, will find no difficulty in employing opium alike to the relief of the patient and his own satisfaction.