Analgesic

“ Actions.—Ether is anodyne, antispasmodic, diaphoretic, anthelmintic; a cardiac, respiratory and cerebral stimulant, an anesthetic and a narcotic poison; one of the best and quickest acting, diffusible, general stimulants, acting on the heart reflexly from the stomach. It is a powerful secretory stimulant, acting especially on the secretions of the stomach, salivary glands and pancreas. On the cerebrum and the motor and sensory nerves, its actions are similar to that of alcohol, but more prompt and less protracted; it is eliminated quickly, chiefly by the lungs. ”

“ Analgesia is the first stage of anesthesia—the "twilight zone" of approaching unconsciousness—in which the sense of pain is greatly dulled or entirely lost, while even that which is experienced is not remembered. It seems to the authors that "gas" is the ideal drug for producing this condition whenever it is necessary, as nitrous oxid is the most volatile of anaesthetics, acts most quickly, and its effects pass away most rapidly, while its administration is under the most perfect control—it may be administered with any desired proportion of oxygen—and may be discontinued on a moment's notice. ”

“ By the injection of a few drops of a medicated solution under the skin, at the point where the incision is to be made, we are now able to produce such complete local anæsthesia as to render the operation entirely painless without the administration of either chloroform or ether. This is an important consideration, as many are averse to taking chloroform or ether, and now that we are possessed of an agent that produces, locally, complete insensibility to pain, we are very glad to be able to dispense with their use in all such minor operations. ”

“ A complete analgesia affecting the whole body has been noticed to such an extent that there was absolute insensibility to burns or punctures; but it is usually confined to the right half of the body, and is especially intense in the right hand and wrist. ”

“ Though the patient may be convinced that he will suffer no pain, the mental attitude toward the local anesthesia, together with fear, may operate so strongly as to constitute a shock to the nervous system so great that a general anesthetic should be used and the local method abandoned, even were it apparently indicated.
Again, the injection of anesthetic drugs in cicatrical and inflamed tissues is quite difficult of accomplishment and because of the peculiarity of these tissues, diffusion throughout a given area is imperfect, hence insensibility is not complete. ”

“ In dysentery and other painful affections of the intestines, this is considered by the best medical authority to be a certain relief. Dr. Druit directs from one hundred to one hundred and twenty drops to be administered. A whole teaspoonful has been often used in severe cases. The less mucilage used, the more likely is the injection to remain in the rectum. An opiate injection for a child not over a year old may consist of two or three drops of laudanum mixed in three quarters of an ounce of mucilage. Opiate injections should not be administered often, without the advice of a physician. ”

“ Those having the stomach affected cannot take food, the least thing is rejected. It is best for such to remain quiet in bed, applying heat to the stomach and abdomen and to the feet until relief is experienced. Those suffering from headache should also remain quiet in bed. Some resort to anodynes and form the habit of using codeine, morphine. All these are bad and should be avoided. I have never found it necessary to give one dose of either to relieve pain at such times. Hot applications with the enema, vaginal douche, or [Pg 432] foot bath, has usually been all that was required. ”

“ The Injection of Alcohol into the Nerve.—The alcohol acts by destroying the nerve fibres, and must be brought into direct contact with them; if the nerve has been properly struck the injection is followed by complete anæsthesia in the distribution of the nerve. The relief may last for from six months to three years; if the pain returns, the injection may be repeated. The strength of the alcohol should be 85 per cent., and the amount injected about 2 c.c.; a general, or preferably a local, anæsthetic (novocain) should be employed (Schlösser) ”

“ We have sometimes found in the Shops of our Druggists, a certain Wood, which is there called Lignum Nephriticum, because the Inhabitants of the Country where it grows, are wont to use the Infusion of it made in fair Water against the Stone of the Kidneys, and indeed an Eminent Physician of our Acquaintance, who has very Particularly enquir'd into that Disease, assures me, that he has found such an Infusion one of the most effectual Remedyes, which he has ever tried against that formidable Disease. ”

“ False pains are from various causes, such as fatigue of any kind, especially too long standing, sudden and violent motions of the body, costiveness or diarrhœa, general feverishness, agitation of the mind, or a spasmodic action of the abdominal muscles. It is necessary to adopt the means used for the relief of the pains to the apparent cause, and generally to give an opiate proportioned to the degree of pain, or to repeat in small quantities at proper intervals till the patient shall be composed. ”

“ For, bear in mind that it is not usually the cause which can be at once destroyed by drugs, but only the bodily capacity to react to it in the fashion we call pain. Ether, chloroform, cocaine, and many other drugs enable us to-day to feel sure that the mass of real pain in the world is vastly less than it was. It is, indeed, possible to prevent all pain, and pain has no real value which we need respect and desire to preserve; at least this is so from the physician's stand-point. ”

“ Among the advantages, aside from the number of assistants required and the discomfort immediately following the administration of a general anesthesia, are the absence of remote ill effects of the invasion throughout the entire system of a noxious chemical substance and its direct deleterious effects on many large organs such as the lungs, heart, kidneys, and liver, and the assurance, when a proper drug, dosage, and technic are employed, that death cannot be ascribed to the anesthetic. ”

“ It should be given to the patient whether he calls for it or not, and it should be considered an important part of his treatment. When water is taken into the stomach and absorbed into the circulation, it throws into solution the ptomaines which have been absorbed from the intestines and are present in the circulation and tissues, and thereby puts them in a favorable condition for elimination. It increases the activity of the kidneys, and thus hastens and increases the elimination of the poisons in the system. ”

“ For irritative pain on the surface Aconite is most efficacious. Belladonna comes next to it. In Gastrodynia Hydrocyanic Acid is to be preferred. But to counteract the pain of a surgical operation we require a medicine which shall be capable of producing a powerful effect on the whole system at once. Such medicines are Ether and Chloroform. It is found most convenient to bring the patient under their influence by causing him to inhale the vapour into his lungs. Being absorbed by the pulmonary mucous surface, and passing directly into the circulation, the medicine thus takes effect rapidly. ”

“ When such Fluxes appeared early attended with sharp Pain of the Bowels, and Signs of Inflammation; if the Patient [89] was strong, we began the Cure with opening a Vein, which the Patient bore easily, and it gave Relief; but when the Symptoms were mild, without any acute Pain, the Bleeding was omitted.—Commonly the Bowels were loaded with corrupted Humours, when this Symptom appeared; and, therefore, we found it of Advantage to give a Dose of the Salts with Manna and Oil, or some other gentle Purge, to carry them off; and in the Evening an Opiate to ease the Pain and procure the Patient Rest. ”

“ The same remedy may act in more than one way, e.g. alcohol, besides stimulating the secretory organs directly, is a stimulant to the circulation, and thus increases the pressure within the vessels. Diuretics are prescribed when the quantity of urine is much diminished, or when, although the quantity may be normal, it is wished to relieve some other organ or set of organs of part of their ordinary work, or to aid in carrying off some morbid product circulating in the blood, or to hasten the removal of inflammatory serous exudations, or of dropsical collections of fluid. ”

“ TREATMENT.—The management, when a diagnosis can be made, must be guided mainly by the etiological indications. The restoration of the functions of the heart, lungs, or liver when these organs are at fault, the abstinence from alcohol in the drunkard, and an energetic use of mercurials or iodide of potassium in syphilis, are of the first importance in arresting the disease. A persistent course of mild purgatives and of cathartic mineral waters is serviceable. Pain should be relieved by belladonna or opium. ”

“ According as we settle in our minds whether a given case of pain is an exaggeration or a lessening of the ordinary physiological condition, our treatment will logically be either narcotic or stimulant. ”

“ If you think it necessary to give medicines, you may safely purge upwards by hellebore, but none of those should be purged downwards. The most effectual mode of treatment is by the urine, sweats, and exercise; and use gentle friction so as not to harden the constitution; and if he be confined to bed let others rub him. When the pain is seated above the diaphragm, place him erect for the most part, and let him be as little reclined as possible; and when he is raised up let him be rubbed for a considerable time with plenty of hot oil. ”

“ Treatment for acute kind.—The first thing to do is to rest in bed and control the pain and acute symptoms. Hot applications help to relieve the suffering. Patient must be kept comfortably and constantly warm and quiet. Hot applications of lead water and laudanum.
Medicines.—It may be necessary to use morphine to control the pain. Remedies such as antipyrine or aspirin are often used. A physician must be called. When the disease is caused by arsenic and lead and alcohol, of course you must remove the cause before you can hope for any improvement. ”

“ Analgesia is a term applied to the loss of pain sensation. The patient may not be wholly or even partially unconscious—merely under the influence of some agent which dulls, deadens, or otherwise destroys the realization of pain. ”

“ The general line of treatment should consist in giving emetics promptly, washing out the stomach by means of the stomach tube, and administering large quantities of water, milk, or [292] gruel. Distressing symptoms should be treated as they arise; thus, if convulsions occur, large doses of chloral or potassium bromide should be given; if stupor or drowsiness comes on, the patient should be forced to take hot coffee, stimulants, etc., and made to walk about. If collapse supervenes, stimulants should be freely given, the patient wrapped in blankets, and hot bottles applied to the feet. ”

“ Absorbents are medicines which destroy acidities in the stomach and bowels, such as magnesia, prepared chalk, &c.
3014. Alteratives are medicines which restore health to the constitution, without producing any sensible effect, such as sarsaparilla, sulphur, &c.
3015. Analeptics are medicines that restore the strength which has been lost by sickness, such as gentian, bark, &c.
3016. Anodynes are medicines which relieve pain, and they are divided into three kinds, paregorics, hypnotics, and narcotics (see these terms) ; camphor is anodyne as well as narcotic. ”

“ Astringents with Narcotics, and Absorbents. It has been already observed, that in a Diarrhœa, depending upon the influx of acrid fluids into the intestines, there are three modes of treatment by which the malady may be obviated, viz. by a narcotic, diminishing the irritability of the intestines; by an astringent, restraining the serous excretion; and by an absorbent, neutralizing the acrid matter. As the modes of action are not incompatible with each other, they maybe simultaneously established with the greatest advantage. ”

“ If there is great pain, opiates may be necessary, but here, as in other surgical indications for anodynes, a minimum amount should only be given. Usually rest, elevation, and relief of tension will be of greater benefit than opiates. ”

“ In the aged, we know that it is not so much the operation itself as the broncho-pneumonia that often follows the anesthesia which deserves grave consideration. Chloroform, or a chloroform-ether combination, such as anaesthol, is undoubtedly, in such cases, preferable to pure ether, because it causes less bronchial 46irritation. In the morphine-anaesthol-ether sequence which I have tried to outline, chloroform and ether are blended in a way most adequate for anesthesia, and the system is so flexible that it readily adapts itself to an anomalous case. ”

“ If they conclude that drugs are wholesome, let them by all means be swallowed; but if they are proved to be injurious, deleterious and unnecessary, then away with them;—if opiates are innocuous let them be retained, but if they congest the liver, sicken [38] the stomach, and paralyze the actions of the vital organs, the sooner they are erased for ever from the Hygienic Pharmacopeia the better—let them gracefully retire before the improved system of hot stupes, fomentations, and the abdominal compress. ”