The effects of opium continue for about eight hours, and if its action is to be maintained it should be repeated at intervals of that duration or somewhat less. The dose is to be governed solely by the relief afforded. Its effects are usually limited to relief of the pain, or of the sense of sinking for which it has been given, producing no other direct effect on the system in general. “It would seem,” says Sir Henry Holland, “that the medicine, expending all its specific power in quieting these disorders, loses at the time every other influence on the body. Even the sleep peculiar to opium appears in such instances to be wanting, or produced chiefly in effect of the release from suffering.”[60] Opium should always be given to the dying in its liquid forms--as the tincture, or the liquid extract--or as morphia, of which I know of no preparation of equal value to the solution of the bimeconate. So long as the air passages are not obstructed by secretion, so long as there is neither lividity nor even duskiness of face, opium, if indicated, may be given in aid of the Euthanasia; but if they are present, it is hazardous and might hasten death. Much care, too, is needed in the employment of opium, in cases where the heart is _greatly enfeebled_, and where the conditions, directly or indirectly induced by opiates, especially that of sleep, may be just enough to turn the balance against it. A contracted pupil is also a contra-indication to opium; it implies a state of the brain, which opium is likely to increase rather than relieve. And if food has been injudiciously pressed upon the patient, so that the stomach is distended with it, and the epigastrium is full and tense, opium given by the mouth is rarely found to act kindly, if at all. If, under such circumstances, the influence of opium is needed, we should resort to the hypodermic injection of morphia. Professor Paradys warns us of the confusion of the senses and of the mind that sometimes follows the administration of opium to the dying, and which to some persons is worse to bear than the sufferings for which it has been prescribed.[61] But this, in my experience, has been rare, and will be seldom observed if opium is restricted to the cases where, as I have stated above, it is specially called for,--namely, in relief of pain or of severe sinking. When, however, it does occur in these circumstances, it is probably due, either to an idiosyncrasy on the part of the patient, or to the inadequacy of the dose given, which has been enough to confuse and stupify the senses, but not to control the symptoms for which it was administered. “Si timide et nimis parce datum fuerit,” writes Dr. Gregory,[62] “longe alium effectum habebit, et iisdem ægrotis haud parum nocebit, quibus largius datum multum profuisset.” * * * * *