SOLUTIONS  OF  MORPHIA  AND  CAFFEIN  IN  CHLOROFORM.  253 
plied  to  the  gums  near  the  affected  tooth  rather  than  to  the  de- 
nuded pulp  itself.  A  wad  of  cotton  saturated  with  the  com- 
pound and  introduced  into  the  ear,  though  at  first  causing  pain- 
ful sensations,  assists  in  removing  the  pain.  The  latter  means 
is  also  serviceable  in  painful  affections  of  the  internal  ear. 
Sometimes  the  author  also  used  it  as  a  mouthwash,,  diluted  with 
much  water. 
In  using  this  remedy  internally,  it  was  observed  that  the  fre- 
quent disagreeable  concomitant  effects  of  morphia,  especially 
nausea  and  vomiting,  were  prevented  by  the  chloroform.  Hence 
the  combination  exerts  a  peculiarly  favorable  influence  upon 
painful  affections  of  the  stomach  and  bowels,  in  the  dose  of 
twenty  or  thirty  drops,  taken  on  sugar  or  in  some  tea. 
Besides  the  quieting  and  anaesthetic  effect  (which  has  been 
found  to  take  place  in  still  other  affections  besides  the  above 
named,  more  rapidly  and  more  completely  than  by  morphia 
alone),  the  tendency  to  sleep  which  this  remedy  induces  is  unde- 
niable, and  the  latter  approaches  more  nearly  to  the  character  of 
natural  'sleep  than  of  narcosis. 
Although  caffein  cannot,  strictly  speaking,  be  regarded  as  an 
anaesthetic,  but,  judging  from  its  physiological  action,  should 
rather  be  considered  as  a  means  of  giving  impulse  to  the  motor 
apparatus,  yet  it  cannot  be  denied  that  it  has  proven  useful  in 
many  cases  of  neuralgic  affection.  In  certain  forms  of  nervous 
cephalalgia,  especially,  it  has  not  alone  been  palliative,  but  even 
effected  radical  cures.  Koschlakoff's  investigations  (  Virchow's 
Archiv.,  1864)  have  shown  that  caffein  increases  the  heart's  ac- 
tion and  the  pressure  in  the  arteries,  and  that  its  diuretic  effect 
is  based  upon  the  increased  arterial  pressure.  The  author  is 
disposed  to  regard  hemicrania  as  a  vasomotor  neurosis,  and,  ac- 
cording to  this  view,  does  not  find  it  difficult  to  explain  the  effi- 
cacy of  caffein  in  this  disease  in  harmony  with  its  known  physi- 
ological action.  Upon  the  sensory  nerves  caffein  seems  to  ex- 
ert no  direct  influence ;  indirectly,  by  reflex  action,  it  may  in- 
deed cause  hyperesthesia.  The  combination  of  chloroform  with 
it  in  an  equivalent  dose  might  therefore  aid  its  offects  in  the  in- 
tended direction  without  interfering  with  the  physiological  pow- 
ers of  the  caffein. 
