182 THERAPEUTICS AND PHARMACOLOGY 



this and pain per se is one of the greatest evils that poor humanity 

 has to bear. The introduction of antiseptics has completely re- 

 volutionized the art of surgery because it allows operations to be 

 done with almost certain success which would in former days have 

 almost inevitably proved fatal from unconscious contamination 

 of the wound by disease-germs. But the greatest triumphs of sur- 

 gery have only been rendered possible by the discovery of anes- 

 thetics. Previous to the work of Long, Jackson, Wells, Warren, 

 and Simpson rapidity of operation was everything, and careful 

 but long-continued manipulation was impossible because the long- 

 continued pain of the operation would inevitably have killed the 

 patient. Even the minor pains of neuralgia, neuritis, and head- 

 ache, though not dangerous to life, are most distressing to the suf- 

 ferer. Formerly there was almost no drug to relieve these except- 

 ing opium, while now we have phenacetin, antipyrin, phenalgin, 

 and a host of others, and chemists are daily at work preparing new 

 and perhaps even better pain-killers. 



Hardly, if at all, less distressing than pain is sleeplessness, and 

 here again our powers of helping the patient have been enormously 

 increased of late years. When I was a student almost the only 

 hypnotics used were opium, henbane, and Indian hemp. The latter 

 two were very unsatisfactory and practically one pinned one's faith 

 on opium which had to be combined with tartar emetic in cases of 

 fever. Then came the introduction by Liebreich of chloral, which 

 was not only a great boon in itself but marked an epoch as one of 

 the first instances of rational therapeutics, the application of a 

 certain drug in disease because of its pharmacological action. Now 

 we have any number of hypnotics, some of which are useful be- 

 cause they act on the nervous system itself and produce sleep with- 

 out depressing the heart and can thus be given where the circula- 

 tion is already weak, while others, like chloral, not only act on the 

 cerebrum but lessen the force of the circulation, and by thus di- 

 minishing the flow of blood through the brain assist it to rest and 

 aid the onset of sleep. Formerly when the circulation was too 

 active the chief depressants were mercurial and other powerful 

 purgative medicines, bleeding, tartar emetic, vegetarian diet, or 

 partial starvation. Although these means may still be employed with 

 advantage in proper cases, yet we have in addition a new set of 

 remedies, viz., vaso-dilators, including nitrites, nitrates, and pos- 

 sibly a good many substances which dilate the vessels and lower 

 the tension in the arteries, a tension which may be dangerous on 

 the one side to an enfeebled heart and on the other to an athero- 

 matous artery in the brain. 



When the heart is failing we have a series of cardiac tonics and 

 stimulants. Foremost amongst these, perhaps, may be put strych- 



