Contraindications. - If avoidable, opium should not be given to children under five years of age. Should the necessity of administration under that age be deemed advisable in the judgment of the physician, it should be remembered that the drug acts with greatly disproportionate power upon the nervous systems of the young, 1 minim (0.06 Gm.) of tincture of opium having caused the death of a child one day old, and a few drops of camphorated tincture of opium having proved fatal to an infant of nine months. The death of a nursing babe is even recorded; the mother having taken a medicinal dose of laudanum.

Opium is contraindicated in excessive bronchial secretion of the aged, during the second stage of pneumonia, in cerebral congestion, and in alcoholism.

Administration. - As has been stated under Poisoning, there are many circumstances which modify the action of opium, the young and the old requiring smaller doses and great care in administration. For children the best preparation is paregoric. Females, moreover, need smaller doses than males, since they are more readily affected by the drug and more subject to untoward manifestations, such as nausea, headache, etc.

Caution should be exercised in administering opium to those who have an idiosyncrasy against it. On the other hand, persons addicted to the opium habit require enormous doses to make a medicinal impression.

Agonizing pain seems to antagonize the drug, so that in peritonitis or during the passage of biliary or renal calculi, in severe neuralgia, tic doloureux, etc., opium is well borne, doses which under other conditions might produce dangerous symptoms having little effect save to deaden the pain, frequently not even inducing sleep.

In other cases, such as nephritis, very small doses may be followed by serious and alarming consequences, continued administration resulting in an accumulation of the drug in the system, owing to defective elimination. Should prolonged administration be desirable, it is necessary to increase the dose gradually in order to produce the requisite effect, because of the growing tolerance to the drug.

Certain preparations are preferable in given conditions. Thus, if it be necessary to produce diaphoresis, Dover's powder or some other combination with ipecac is advisable. When relief of pain, unless it be intense, is desired, small doses of morphine or tincture of opium will usually be sufficient, full doses being required to produce sleep.

The deodorized tincture of opium causes less disagreeable symptoms than the plain preparation, which contains narcotine. Potassium bromide is said to prevent untoward after-effects.

When opium is demanded for its astringent action, it should be given in small or stimulant doses or combined with chalk or with some of the astringents. The camphorated tincture, owing to the camphor it contains, is probably the most astringent liquid preparation of opium, and is therefore preferable in cases of diarrhea, as it is the favorable form as an adjunct to cough-mixtures.

When the prolonged sedative and astringent effect of opium is desired, as in intestinal hemorrhage, diarrhea, nausea, and certain diseases of the stomach, an old, dry opium pill or pill of opium and lead is better than any liquid preparation of morphine, owing to its tardy solution.

In diseases of the rectum requiring opium a suppository containing the extracts of opium and belladonna is perhaps the best combination to use.

Ovarian and pelvic pain more readily succumbs to the anodyne action of codeine than distress in other parts of the body.

When opium is used as a soporific, it is best to combine it with chloral, a small dose only of each being necessary. These unite in their action upon the brain, depressing the heart less than if chloral alone had been given, and are attended by less serious aftereffects than had morphine been the sole agent employed.

Opium prolongs the narcotic effect of chloroform, and in certain operations it is good practice to administer a dose of the drug, following it soon with a few inhalations of the anesthetic.

The hypodermic injection of morphine is usually preferable to the internal administration of opium in cases of severe pain, since a smaller dose is required and a much more rapid effect produced, with less danger of affecting the appetite and bowels.

The many circumstances influencing the action of the drug appear to confirm the statement that "there is no dose of opium," its conduct being wholly dependent upon the age, sex, idiosyncrasies, and condition of the patient. The amounts given under the different preparations are such as experience has shown to be safe ordinarily as the initial ones for adults, succeeding doses being adjusted according to the indications of the individual case.