504 MATER i A ME DIG A AND THERAPEUTICS. 



be relieved, under different circumstances, by any of the local 

 measures just enumerated, or by such diverse general remedies 

 as purgatives, Quinia, Iron, Iodides, and Alcohol, quite inde- 

 pendently of the direct anodynes which we may consider it 

 necessary to apply. 



b. Local Anodynes. When treatment directed to the cause 

 of the pain fails or is insufficient, we must next attempt to reduce 

 the irritability of the nerves by local means. Direct local anodynes 

 may now be rationally employed. Thus in neuralgia, constitu- 

 tional treatment must be combined with the application of a 

 local anodyne sufficiently powerful to interfere with the recep- 

 tion and conduction of impressions. We therefore employ 

 Aconite, Belladonna, Opium, the confined vapour of Chloro- 

 form, Alcohol, or Ether, the Volatile Oils, Carbolic Acid, 

 Creasote, heat (which must often be extreme), extreme cold, the 

 continuous current, or local nervous irritants. Most of the 

 drugs mentioned are applied in the form of liniments, lotions, 

 or ointments. Opium may be administered by the endermic or 

 hypodermic method, the former being now almost entirely 

 superseded by the latter, which is by far the most valuable 

 of all anodyne measures, from the readiness with which it 

 can be given, and the rapidity and completeness of its action. 

 Alcohol or Chloroform may be poured on lint, and evaporation 

 prevented, or rubbed on the part and covered. 



c. General Anodynes. When pain is very severe, sleep 

 impossible, and the whole system distressed and disordered, di- 

 rect general anodynes are demanded. The most useful is Opium 

 or Morphia, which may be given in a great variety of forms, 

 and by several channels, the most ready and powerful of all 

 being the hypodermic method. Chloral, Butyl-chloral, and 

 Cannabis Indica, are other general anodynes in use, but are 

 greatly inferior to opium. The narcotic or hypnotic effect of 

 these anodynes is taken advantage of, as a rule, by prescribing 

 them at the usual hour of sleep. 



Where the pain is unbearable, and relief must be not only 

 complete but instant, even these powerful anodynes may be 

 unavailing. In such cases general anesthetics must be 

 employed : the patient must be , put under the influence of 

 Chloroform or Ether. Such are the pains of labour, or of the 

 passage of calculus, the pain attending the reduction of a dis- 

 location or a severe surgical operation. Consciousness is quickly 

 abolished, kept in abeyance, and allowed to return when the 

 cause of the pain has ceased. The necessity for such powerful 

 remedies in some instances of pain will impress on the student 

 the importance of sparing the nervous system, and the viscera 

 which are reflexly depressed along with it, in every case of pain. 



