a. Some persons are very intolerant to the action of Opium; in these even the smallest dose produces great nervous excitement, violent headache, and vomiting. When this peculiarity is known to exist, the drug should be avoided.
b. Infants and young children bear Opium badly; cases are on record in which three drops of Laudanum have proved fatal to infants. Still, there are diseases of childhood in which it proves valuable, but in these it should not be given except under professional advice or superintendence.
c. It should be avoided as far as possible during pregnancy. Recent experience seems to show that its frequent or habitual use exercises a prejudicial effect on the fœtus.
d. The previous habits of the patient materially influence the effects of this medicine. A confirmed Opium-taker requires a far larger dose to produce a given effect, than one not habituated to it.
e. When the use of Opium is clearly indicated, and the patient from any cause is unable to swallow, it may be given in an enema; in this case a larger dose, a third or even a half larger, is required than when given by mouth.
f. Whenever in doubt as to the advisability of giving Opium, take the safer course and—avoid it!
For treatment of poisoning by Opium, see Index.
283. There are many diseases as Rheumatism, Tumours of different kinds, Cancer, Carbuncles (Rajah Boils), Abscesses, and Ulcers connected either with Leprosy, Syphilis or Scrofula, in which the pain, especially at night, effectually banishes sleep; here Opium is invaluable. An adult may commence with one grain pill or fifteen drops of Laudanum, taken about an hour before the usual bedtime: if this succeeds in procuring sleep it may safely be repeated nightly; if not, the dose may be doubled the second night, and trebled the third night; but it is not advisable to go beyond this quantity except under professional advice. Even these quantities after a week or two's use lose much of their power, and may require to be cautiously increased. When the pains are lessened and the patient is improving, the quantity of Opium should be decreased gradually, rather than the whole supply left off at once. To control the Sleeplessness and Restlessness of Delirium Tremens, Opium given as above may be necessary, but each dose should be combined with four or five grains of Camphor in the form of pill; in fact, Camphor alone in doses of 2 to 3 grains every three or four hours, exercises a most soothing influence, and when this treatment is adopted, the Opium at bedtime may be given alone.
284. In Spasmodic Affections of the Bowels, violent Colic, and the Passage of Gall Stones, and when the pain is violent, a full dose of Opium, e.g., 20 to 25 drops of Laudanum in a wineglassful of Omum water, or Infusion of Sweet Flag root (12), often affords speedy relief; should it not do so, however, in half an hour the dose may be repeated, and a third dose after an hour, should the pain continue unabated. At the same time, hot water fomentations, a turpentine stupe, or a mustard poultice, should be applied externally. When the pain has subsided a dose of Castor Oil is advisable, especially when there is reason to suspect that the attack has arisen from the use of crude or indigestible articles of food.
285. In Cholera the practice of giving Opium in large and repeated doses, especially in the solid form, in all stages of the disease, is fraught with danger. Administered judiciously at the proper time, and in proper cases, it is capable of doing much good, but its indiscriminate use often produces the worst effects. At the outset of an attack, few remedies are more useful when combined with Acetate of Lead. (See Index.) Again, it is a valuable adjunct to the "Calomel treatment" of Dr. Ayre, which consists in giving one or two grains of Calomel, with from one to five drops of Laudanum, every five, ten, or fifteen minutes, according to the urgency of the symptoms, till the quantity of Laudanum has reached altogether 60 or 80 drops, when it should be discontinued. An essential part of this treatment, which has sometimes proved very effectual, is the free use of cold water as a drink.