3213. Observations On Their Use

1. The extent of the dose of a narcotic, especially in acute cases, should be regulated more by the effects which it produces, than by a regularly stated dose. "When a decided effect is desired, the dose should be large.

2. In most acute inflammations, depletion, local or general, should precede the exhibition of narcotics.

3. A patient habituated to their use requires a much larger dose than one unaccustomed to them.

4. Young Children Bear Narcotics Badly

5. The sanguine temperament is more susceptible to their action than the melancholic - women more so than men.

6. Given habitually to pregnant women, they are said to exercise an ill effect upon the foetus in utero.

* Cyc. Pract. Med., art. Narcotics. Mat. Med., p. 13.

7. Unless urgent circumstances require it, narcotics should be given in the evening, an hour or two before the usual hour of retiring to bed.

8. In debilitated subjects the dose should be small at first, and gradually increased, as the patient is able to bear it.

9. In congestion of the brain, and in the advanced stages of disease of the heart, narcotics require to be given with great caution, as they may depress the vital powers to a fatal extent.

10. Taken In Excessive Doses, They All Prove Powerfully Poisonous

11. "When one narcotic fails, another substituted for it will often be found effectual.

12. In pulmonary affections, attended with copious secretion, the use of narcotics requires great caution, as their ill-timed or excessive employment, observes Dr. Joy, might, by at once interfering with expectoration, and with freedom of inspiration, tend to augment pulmonary congestion, and prevent the due action of the air on the blood. (Further, see Obs. on the Use of Opium, sect. 1939.)

The diseases in which they are employed are very numerous; they are considered at length under each individual narcotic.

3214. Refrigerants are medicines employed to diminish the morbid heat of the body in disease, and to quench inordinate thirst. They are of two classes, Internal and External.

1. Internal Refrigerants comprise chiefly the acids and acidulous drinks, particularly solutions of Tartaric and Citric Acids, the Citrate of Soda, and the Nitrate of Potash. These require plentiful dilution in cold water, and may be drunk freely.

2. Of External Refrigerants, the most important is cold water, the efficacy of which is well known, when applied to the surface of the body in fevers, particularly in the exanthemata, when these exist uncomplicated with internal inflammations. If the latter, however, are present, external refrigerants are inadmissible. The addition of a portion of vinegar, and, in some cases, of Alcohol or Ether, to the water, increases its refrigerant effect. Sponging the body with tepid water, or vinegar and water, may be substituted in some instances with advantage.

The diseases in which they are employed are febrile and inflammatory affections, acute hAemorrhages, and all diseases where there exists morbid heat of the body.

3215. Spongio-piline is a fabric composed of sponge and wool felted together in three layers, and coated on one of its surfaces with caoutchouc, which renders it impermeable. It was invented in 1847 by Mr. A. Markwick, of London. "When the soft or inner surface is moistened with water, it forms a substitute for the ordinary cataplasm, warmth and moisture being thus secured, and its applications may be further extended by sprinkling the moistened surface with charcoal, yeast, &c, as may be required in each individual case. It may also be made a vehicle for lotions and liniments. Moistened with Liquor AmmoniAe, it is stated to raise a blister in four minutes, being more efficacious than any other vesicant now in use. In intertropical practice it is comparatively of little use, the outer or caoutchouc covering being destroyed by the heat of the climate.