I I I I I I H I I 782 MAN'S PHYSICAL WELFARE for relief from pain and also a need for sleep, either a narcotic or a hypnotic and a non-narcotic analgesic is prescribed. A great variety of substances act as hypnotics. Among the simplest of these substances are the bromides of sodium and potassium. Bromides are mild sedatives; they should never be used except under the guidance of a competent physician. When sleep is interfered with by nervous disorders unaccompanied by pain, a sleep-producer (hypnotic) enables the patient to obtain the needed sleep. Hypnotics do not cure insomnia, but they do enable the patient to obtain sleep while Mother Nature or medical science is combating the causes of the insomnia. Hypnotics should never be used without a prescription by a competent physician, and they should never be allowed to take the place of needed medical treatment. In 1869 Liebreich introduced the use of chloral (chloral hydrate), which soon came to be known as "knockout drops." Chloral is habitforming and is injurious to the body in a number of ways. Chloramide is slower in action and safer to use than chloral. Chloral was soon superseded by urethane and sulfonal and finally by barbital, the most widely used hypnotic of today. A derivative of barbital, phenobarbital, is especially effective in treating epileptic seizures. Since 1920 a number of other barbital derivatives have been synthesized; among these are ipral, proponal, noctal, dial, neonal, amytal, phanoderm, and pentobarbital (nembutal). Pentobarbital is a quickacting, relatively nontoxic barbital derivative that is especially valuable in preparing patients for operations because it provides several hours of normal sleep and eliminates fear of operations. C0H5 0=S=0 O II CH 3—C S—C2H 6 CHs sulfonal II O C2H5 I o=s=o C2HB—C CH3 trional o II S—C2H6 II o o II C—N— (C2H5)2=C C=0 C—N— o barbital (veronal) NH, O II -C—O—C2H5 urethane
I I I I I I I C H H C H C H H RELIEF OF PAIN REVOLUTIONIZED SURGERY 783 O o II C—N— CH3 C—N—C2H5 \l I (C6H5)2=C C=0 c c=o ! I /I I C—N— C4H9 C—N— II O o phenobarbital pentobarbital (luminal) (nembutal) Used for prevention of epileptic fits CI H CI CHs CI H H I I I 1 I CI—C—C—OH CI—C—C—CH3 CI—C—C—N—C— CI OH CI OH CI OH O chloral chloretone chloramide OH O—CH3 OC2H5 I I . C C C / \ / \ / \ H— C— H C C— H C C— II H— C— H— \ C— H— \ C— \ / C I NHCOCH3 acetyl-p-aminophenol A weak antipyretic of high toxicity NHCOCH3 (methacetin) p-methoxyacetanilide A stronger antipyretic, but less toxic than acetylp-aminophenol H— H— H // \ C— II C— \ / C ! NHCOCHa (antifebrin) acetanilide About the same antipyretic action as phenacetin, but more toxic NHCOCH3 (phenacetin) p-ethoxyacetanilide About the same antipyretic action as methacetin, but less toxic Chloretone has a hypnotic action similar to that of chloral. It is used to prevent seasickness and is a useful bacteriostatic.