In these days of medical knowledge, when so many merciful means for the alleviation of pain are known, it follows as a matter of course that great abuse of sleep-producing agents exists. We would therefore say a few words of caution as to the pernicious practice of people making use of chloral, chlorodyne, chloroform, and other kindred agents without medical advice. It is, we think, little known to how great an extent this evil exists. To come across a lady who is constantly more or less under the influence of chlorodyne, is by no means uncommon; every trifling ailment or passing malaise being an excuse for a few drops of that narcotic. Chloral is also extensively and improperly used; the more so because, unfortunately at the time of its first introduction as a sleep-producing agent, it was most erroneously stated to be perfectly harmless, and many are still under this impression.

The real truth is, that no narcotic of any kind whatever is harmless, but on the contrary, invariably pernicious when taken otherwise than by the advice and under the treatment of a medical man. True, sleeplessness is one of the most trying things a person can suffer from; but then there are other means of combating the enemy than by dosing one's self with chloral or any such agent; and thus making an infirmity chronic, which would in all probability have been only a temporary evil. Rely upon opiates for sleep, and sleep will not come without them. Thus a bad habit is formed; the bodily strength is undermined, the digestive powers enfeebled, the mind and intellect weakened and enervated, and the unfortunate sufferer becomes a slave, bound hand and foot to a habit that it is almost impossible to shake off. Sleeplessness often comes from want of sufficient fresh air and exercise, from over-mental work, mental distress, from too great a quantity of stimulants taken during the day, and from various other causes, which a little care as to diet and regimen would quickly overcome. Taking short naps during the day; too much tea and coffee drinking, especially shortly before bedtime—all these are apt to cause sleeplessness. In many cases a light and simple supper taken shortly before retiring to rest, and attention to the feet being thoroughly warm, will insure a good night's sleep when more energetic means have failed.

In those terrible abodes of suffering, our cancer hospitals, the method of all others most resorted to, and most efficacious for the alleviation of pain, is the sub-cutaneous (under-the-skin) injection of morphia. In sciatica, neuralgia, and other painful nervous affections, this remedy is often exceedingly beneficial, when used under competent medical advice and supervision; but like every other good thing it is open to great abuse, and often made use of merely as a soothing narcotic by the irritable, excitable, and discontented. A long train of evils follows; but with these we are not called upon to deal here. What we want now to lay before the reader is a plain statement as to the prompt treatment called for in a case of over-narcotism from too strong a dose of injected morphia. Coldness of the extremities, lividity of the countenance, profuse cold sweat, and loss of power over the limbs, insensibility, very deep breathing, and contraction of the pupils of the eyes to such an extent that they resemble a black pin-head, result.

What then is to be done? Time is precious, and perhaps half an hour or more may elapse before medical aid can be obtained. Taking it for granted that the patient is in a recumbent position, the first thing to be done is to raise the head, to sponge the face and chest copiously with fresh cold water, to rub the limbs steadily and strongly, to put hot-water applications to the feet and to the sides of the body, if it feel cold to the touch. Place strong smelling-salts to the nose; lay the head on one side with the mouth open, so that the tongue may not fall back and prevent respiration; give brandy-and-water, if the patient can possibly swallow it; but if the narcotism be severe, this will be impossible, and it is wisest to abstain from attempts which may result in fluid going the wrong way. In fact do everything to keep the body warm and the breathing unimpeded, and strive to rouse the unconscious faculties into action.

Supposing, however, that the narcotism be very excessive, and the breathing be slow, irregular, and low, then if medical aid be not forthcoming, it would be well to resort to artificial respiration; by no means a difficult matter to manage, if only any one present has a slight amount of knowledge on the subject. The following is Dr Sylvester's method, and is advantageous from its simplicity: 'Place the patient on the back, inclined a little upwards from the feet by raising and supporting the head on a cushion, placing support also under the shoulder-blades. Draw out the tongue and keep it forward, so as to leave the air-passages free. Remove all clothing from the neck, chest, and abdomen. Stand by the patient's head, take firm hold of the arms just above the elbows, and draw them gently and steadily upwards above the head, keeping them stretched upwards for two or three seconds. Then turn down the arms, and press them firmly and steadily against the sides of the chest for two or three seconds. Repeat these movements alternately, deliberately, and perseveringly, until a spontaneous effort at respiration is perceived; immediately upon which, proceed to try by every possible means to induce circulation and warmth.' However, should the case of narcotism be not a severe one, such extreme measures as artificial respiration will not be called for, and in all probability, after the use of those simpler remedies at first named, sickness will occur, and this may be taken as a sign that the worst of the evil is over.

And here let us once more emphatically state that in this and all other cases we assume that a medical man is sent for, and that our suggestions only refer to what is to be done until he appears upon the scene. Nothing is so annoying and so productive of harm as for a non-professional person to be constantly making this and that suggestion as to the treatment of a sufferer, when a medical man is giving his best thought and skill to the case; but on the other hand it is well for people—more especially women—to know what to do when thrown upon their own resources.

Cases of poisoning from over-doses of opiates are of course only one class of such-like accidents; and the accidental swallowing of irritant poisons, embrocations, &c. often occur, and call for the utmost promptitude of action and presence of mind on the part of those present.

In the less densely populated parts of the country, it is a positive necessity that people should be able to rely upon themselves in cases of emergency, for if a doctor is many miles distant, and it takes several hours to fetch him, one might almost as well be without him, where sharp practice is called for. To produce vomiting, one of the best emetics we happen to know of is an American one. It consists of a table-spoonful of common treacle (molasses it is called across the water) and as much powdered alum stirred into it as the sticky compound can be made to contain. Now alum is such a valuable drug in many ways that it ought to be kept in every household medicine-chest; and treacle is not usually hard to get. We have never seen this remedy tried in a case of poisoning, but we have seen its effect in croup; and anything more decided and imperious in its action it would be difficult to imagine. Such a dose might freely be given in any case of poisoning; and after the emetic has acted freely, we would give some soothing mixture, such as thickened milk. There are various things which have the power to a certain extent of protecting the coats of the stomach from the action of irritant poisons; if the poison be an acid, the scrapings off a white-washed wall or chalk and milk are good. Milk almost stiffened with common brown sugar is one of them; sweet oil taken to nauseation is another.

In all cases of poisoning, loss of time is the one great thing to be avoided; and the nearest remedy at hand is the best one to make use of. Mustard and water, strong and plenty of it, is a capital emetic. Of croup, that enemy of juvenile humanity, we must now speak a few words; and we know of no better remedy than the American one above described, combined with a hot bath and a hot blanket to roll the child well up in afterwards.

The ignorance of the poor as to the treatment and still more the prevention of the diseases of children is something appalling, and there can be no doubt that thousands of little lives are annually sacrificed to this Moloch.

'I can't tell what ails my child, ma'am,' said a labourer's wife to the writer of this, one bitter day last winter, 'he's carrying on so strange: crowing like a cock, and turning his-self almost black in the face every nows and again.'

The infant in question was comfortably seated on a nice cold door-step, and breathing as if he had swallowed a baby's rattle by mistake. 'Your child has the croup,' I said, picking up the unfortunate little creature and carrying it to the fireside; 'and if you don't do something for him at once, he'll very likely die.'

However something was done for him, and he didn't die; but he had a kick for his life all the same, and very little more door-step would have finished him. Yet this poor woman was not an unloving mother; she was only ignorant, and in her ignorance, assisting her child into the grave she would have shed such bitter tears over.

From croup to diphtheria is a natural progression, and we would wish to say a few, a very few words on this terrible disease; not as to its treatment by the amateur nurse, for it is of the greatest importance that such cases should have close medical care. It is then on the subject of the operation called tracheotomy—that is, the making an outward incision in the windpipe below the seat of the disease, and inserting a tube for the purpose of respiration, that we would speak—not to discuss it in its medical aspect, but simply to say a word or two to nervous mothers who would shrink from the idea of the surgeon's knife touching a sick child under any circumstances whatever. Surely there can be no more pitiful sight to look upon than a child dying of diphtheria—the eyes wild with fear, looking appealingly for help from one troubled face to another; the little hand thrust into the mouth in helpless, useless effort to dislodge the terrible leather-like substance that is clogging up the throat, and making each breath a sound so painful that for days and weeks to come it will not cease to sound in our ears. What more agonising sight can the sick-room give us to gaze upon? And yet doctors have told us of cases in which a mother has had such an overpowering dread of the surgeon's knife, that even when things come to such a state as this, she has positively refused to allow of any attempt at alleviation of her child's agony by a simple operation!

Now it is on this head we wish to say a few words of encouragement and counsel. Tracheotomy is in the first place a chance—a very slight chance in most cases—but still a chance for life; but if it does not save life, it spares the child a death of awful suffering. The pain of the operation itself is so momentary as not to be worth considering, and relief is instantaneous. We are not speaking of recovery, but simply of the difference between such a death as that described above and the quiet 'falling asleep' of the child upon whom tracheotomy has been performed; and this is what the writer saw—the frightened appealing eyes; the pitiful effort at self-help; and then the instant relief given by firm and skilful hands; and four-and-twenty hours later, the quiet painless death; the boy smiling up into our faces as the pure spirit fled to that place of rest and peace where 'there shall be no more pain.' It was not a thing to be seen and forgotten.