[Reprinted from the American Gynaecological and Obstetrical Journal 
for February, 1895.] 
OPIUM IN GYNAECOLOGY.* 
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The medical profession has always been responsible for the opium 
habit of patients or the laity. The reckless and indiscriminate use 
of anodynes and narcotics, generally used for the treatment of symp- 
toms—rarely does the routine practitioner make a precise diagno- 
sis, before giving opium if pain is present. Opiates are commonly 
used without a clear recognition of an indication except that of pain. 
The opium habit is rarely acquired, except it be antedated by pain 
or an illness for which some doctor has given morphine or some 
preparation of opium. There is scarcely a remedy in the Pharmaco- 
poeia used so recklessly and ignorantly and none doing more general 
mischief—it has always done thrice more harm than good. In the 
general practice of medicine some of the preparations of opium are to 
be found in about every prescription. The hypodermic syringe has 
made thousands of morphine habituates, either with the syringe or 
without it with the powder. The abuse of the drug is much more 
common in some States than in others. The influence or impress of 
certain teachers of therapeutics, has been wide in certain sections. 
The very common remark of teachers, “Gentlemen it is your mission 
to relieve pain and suffering,” has done a world of mischief. Many 
of them spend days talking over the numerous preparations of opium 
without an allusion to the importance of an accurate knowledge of 
pathology and diagnosis. The growth of the poppy in North Carolina 
is to be lamented, it will do just what it has done for China—deci- 
mated a great people. 
While a student of medicine we were taught the use of opium 
throughout the treatment of about every disease. In many of 
the hospitals Dover’s powders were dubbed “dozing powders” and 
begged for nightly. Many patients purchased hypodermics immedi- 
ately on their discharge from the hospital. The abuse of morphine 
with the hypodermic, has resulted in two great evils, an habituate, 
Joseph Price, M. D. 
* Read before the Philadelphia Obstetrical Society, January 3, 1895. 2 
Joseph Price, M. D. 
and the mercenary use of the drug, the unfortunate patient the prey. 
Now daily at eight o’clock I see a physician drive to a house to give 
a hypodermic, the visit is made twice or thrice daily at fixed hours, 
to repeat the injections, not for malignancy. It is a common thing 
for physicians to visit patients regularly for the specific purpose of 
giving a hypodermic. Again without an effort to determine the na- 
ture of the trouble, or cure the patient with well-applied treatment. 
It is in surgery and nervous distuibances that opium and patients have 
been most abused. But few physicians re-educate themselves, the 
few that have successfully tried it, realize the great importance of 
deviating from the routine methods of practice, still commonly taught. 
It is to be hoped that the more scientific schools of the day, will rec- 
ognize the great evil. 
The comfort of patients throughout their convalescence in abdom- 
inal surgery has been so gratifying and pleasing without the use of 
opiates in any form that I constantly take pleasure in exhibiting pa- 
tients to visitors and pupils and directing their attention to the total 
absence of all the uncomfortable symptoms following its use. 
The management of all surgical cases is easy and the convalescence 
more satisfactory and speedy when opium preparations are not used. 
I am satisfied that the use of opium in some form, either by injection 
suppository or solution, has been largely responsible for much of the 
high mortality in abdominal suigery. I rejoice I have never used it 
in abdominal work except where cancer existed. I have watched the 
work of others and compared the mortality of the operators who use 
it with that of those who reject it—all that condemn it head the list 
with a low mortality. It is simply cruel and unkind to use opium in 
abdominal surgery. The use and abuse of it before painful troubles 
are removed obscures symptoms, impairs nutrition and greatly com- 
plicates the management of the patient. Without opiates the patient 
co-operates, the pain lasts only a few hours in all abdominal and 
pelvic operations. 
The numerous uncomfortable conditions favored by opium are 
wholly absent without it. 
The surgical profession should make an earnest effort to withhold 
opiates before discussing this subject. 
We can justly speak of the opium or morphine habit as that of the 
profession, not of the patient. 
The following report of four instructive cases will illustrate most 
beautifully the successful management of four typical cases of acute 
angry and general peritonitis, a painful trouble, one always treated by Opium in Gyncecology. 
3 
opiates and rarely successful, quite universally admitted a fatal 
disease : 
Case I. October 13, 1894.—Mrs. A. F., aged twenty-five years, 
acute general peritonitis, persistent nausea, distention, general adhe- 
sions, bloody serum, lymph and muddy fluid throughout the peritoneal 
cavity. Freeing of all adhesions, irrigation and glass drainage, fol- 
lowed by speedy recovery. 
Case 11. October 13, 1894.—Mrs. M. B., aged twenty-three, acute 
double pyosalpinx with acute general peritonitis. Section irrigation, 
glass drainage, speedy recovery. 
Case III. October 17, 1894.—Mrs. I. C., aged twenty-one years. 
Acute double pyosalpinx, with general peritonitis. Section removal 
of suppurating tubes and ovaries, irrigation and drainage, freeing of 
all adhesions, recovery. 
Case IV. October 25, 1894.—Miss J. R., aged twenty years. Acute 
pyosalpinx, general adhesion and peritonitis. Removal of suppurating 
tubes and ovaries, unraveling of all adhesions, thorough flushing, 
glass drainage, recovery. 
This was a very angry and ill group of patients. The treatment 
was rather simple, rapid and thorough. Section, irrigation, drainage, 
and rest quiet and position, without opium. All varieties of peri- 
tonitis have been uniformly and successfully managed by the simple 
treatment suggested.