c. General Anodynes.-When pain is very severe, sleep impossible, and the whole system distressed and disordered, direct 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 anaesthetics 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 dislocation 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.

Food and stimulants are, as a rule, urgently indicated in protracted pain.

2. Loss Of Common Sensibility

Loss Of Common Sensibility. Neither this nor the allied condition of loss of touch {anesthesia) very often [calls for treatment, and the large number of nerve irritants which we possess in the Acids, Metallic Salts, Mustard, etc., are seldom used for this purpose. Pyrethrum is sometimes given in anaesthesia of the mouth.

3. Paralysis

Paralysis. The rational treatment of paralysis will depend entirely on its nature, and the seat of its cause; and this, as in the case of pain, must he ascertained as accurately as possible. If the lesion be cerebral, general remedies must be directed to relieve the pathological state, such as Mercury in syphilis, cardiac measures in vascular rupture, and so on. Rest of the mind, e.g. by Bromides, will be all important. There is no indication, as a rule, to increase the activity of the damaged centres, except after a time by the use of the will; on the contrary, all cerebral stimulants, such as alcohol, are better to be avoided. In paralysis from disease of the cord, the same general system of treatment is to be followed, but Strychnia may be tried as a direct stimulant of the affected part, sometimes with success. In paralysis due to injury or disease of the nerve trunks or peripheral nerves, the cause must be carefully searched for and if possible removed, e.g. tumours. The local injection of Strychnia appears to benefit some cases. In every kind of paralysis, local treatment must be carried on along with general, and consists chiefly in exercise of the terminal nerves and muscles by electricity, friction, and passive movements, with the view of sustaining the local circulation and nutrition until the centres shall have been restored.

4. Excessive Motor Activity-in the form of spasm, tremors, and convulsions-being generally due to peripheral irritation reflected through the centres, is rationally treated by removal of the cause. The convulsions of children, for instance, are generally to be treated by stomachics and purgatives; the spasms of adults by carminatives. But in many cases it may be necessary also to employ remedies which depress the reflective centres, such as the Bromides and Opium. When the cerebrum is believed to be the seat of disorder or disease attended by these symptoms, e.g. epilepsy, the Bromides are of great service, whilst tetanus, hydrophobia, and other spasmodic diseases with better defined organic causes in the cord and medulla, may be rationally treated by Physostigma and Chloral. It cannot be said, however, that much success rewards such treatment, possibly because employed, as a rule, too late. When the spasm appears to be due to purely local causes, Belladonna and Conium are often of use, e.g. in chordee, spasmodic asthma, and laryngismus. The continuous battery current and counter-irritants relieve painful spasm of the voluntary muscles. Lastly, Opium again is a most powerful antispasmodic for general use.

5. Consciousness may he said to demand temporary removal, in anticipation of the excessive pain and anxiety attending operations. The general anaesthetics in common use are Ether and Chloroform, the selection and use of which are fully described under their special therapeutics. Conditions of excitement, such as delirium and mania, are to he met by two sets of remedies, which must always he combined-viz. first, cerebral depressants, such as Opium, Chloral, Hyoscyamus, Bromides, and, if necessary, Chloroform; and secondly, general nutrients and stimulants, chiefly in the form of abundant food, and possibly a certain amount of alcohol. Judicious moral treatment is an indispensable accompaniment.

6. Loss of consciousness appears to require and receive treatment in cases of fainting, drowning, accidents to the head, etc., but the great centres of respiration and circulation are the real objects of our anxiety. They have been depressed along with the convolutions, and must be restored to activity if life is to be preserved. Restorative measures include the re-establishment of the general and cerebral circulation by the recumbent posture and cardiac stimulants, and of respiration by artificial chest movements and abundance of fresh air. Local nervous irritants such as cold affusion, flagellation, or mustard applied to sensitive parts, powerful odours, and Ammonia, must each or all be employed.

7. Disorders, of Sleep will be rationally treated by pursuing the course suggested by our previous considerations. Insomnia may be met by the many indirect and direct hypnotics. In every instance full advantage must be taken of the indirect group. Bromides are indicated when the cerebral circulation is excited by overwork; and Chloral may be combined with it. When pain is present Opium only will induce sleep. When there is much mental distress Opium is again necessary, and Alcohol at bedtime may be invaluable. In every instance the time of administration of hypnotics must be carefully ordered. Further, it must never be forgotten that the narcotics, including Opium, Morphia, and Chloral, are all powerful depressants of the respiration, circulation, and excretions, and may produce disastrous results, whilst they afford the temporary advantage of sleep.