There are eases in which immediate cessation of the drug occasions com paratively little distress, and is suc cessful, but these have been, so far as I have seen, exceptional. I generally spread the period of gradual diminution of the dose till entire discontinuance of the drug over four or five weeks. The length of this tapering-oft process, how ever, depends chiefly on the daily amount of opium or morphine used, while taking the idiosyncrasy of the narcotee and the effect of the poison on the individual constitution into account. Occasionally three week-s suffice, but the duration sometimes extends over eight weeks.
The following method of treating chronic morphinism is simple, safe, and satisfaetory. A mixture containing 5 grains of bromide of sodium to a drachm is ordered, and a drachm of the mixture is given every three hours; the dose is increased by a drachm every day. By the time the patient is taking the 'A drachm doses of In•omide every three hours for a (lay or two he will probably bc able to do without his morphine. If the drowsiness by this time is profound, the bromide may be stopped; if it is not very deep the dose can be diminished by 5 grains every day until no more is re quired. J. C. Vero) (Australasian Med. Gaz., Mar. 20, '90).
No remedy for any disease fills an in dication more perfectly or gives better results than does hyoseine in the treat ment of morphinism. The gradual re duction method of treating, morphinism should be discarded as useless and even hurtful; the sudden withdrawal, with out some agent to relieve the patient's suffering, is inhumane and dangerous. This leaves the rapid reduction as the only one of the old methods worthy of consideration, but in this the patient suffers so intensely and the result is so seldom a mire that it certainly cannot be regarded as a. satisfactory or suc cessful treatment.
The painful symptoms attendant upon the abrupt withdrawal of morphine have a natural limit of a few days' duration. By the use of hyoseine these days may be passed in comfort, and the patient enabled to escape the nerve-strain and shock that would necessarily have at tended such an ordeal of suffering. In the opinion of the author, hyoseine not only occupies, but 1111s, when properly used, as important a place in thc treat ment of morphinisin as does chloroform or ether in the practice of surgery. Its office is very similar to theirs. It saves the patient from indescribable suffering and renders the unsafe, impracticable, and difficult, safe. practicable, and easy.
In a series of nearly 400 cases in which the writer has used this remedy he states that only in two or three cases has delirium or delusions of any kind been present as long as forty-eight hours after the last dose. Probably, in
one case out of ten. such symptoms con tinue twenty-four hours after the last dose, but in fully 90 per cent. of the cases the mind was perfectly clear by the twelfth hour or earlier, and re mained so thereafter. In many eaSei the delirium subsides by the fourth to sixth hour after the last dose. G. E. Pettey (Medical NOWS, Fel). 2S, 1903).
Potassium and sodium bromides are generally indicated to subdue thc ex treme nervous irritability, with henbane and cannabis Indica. The quantities ad ministered must vary with the individ uality of the case. Bearing this in inind, the formula appended may be taken as a anide:— b Potass. bromid., gr. xx.
Sodii bromid., gr. xx.
Tr. cannabis Indic. fl., m. xv. Tr. hyoscyami fl., m. xv.
Sp. ammon. aromat. fl., xx.
Tinct. cardamom. co. fl., m. xx. Aq. destillat., ad fl. oz.
When the patient can bear the im mediate or almost immediate withdrawal of the drug, a much smaller dose of this mixture, repeated once or twice, will be ample. After a day or two tonic treat ment can be begun.
Personal method of treatment of mor phinism. First, sulphate of magnesia (salts) is given; then the patient is placed in bed. His hypodermic syringe and all opiates removed and concentrated tincture of hyoscyamus, concentrated tincture avena sativa (B. & Co.), equal parts, 12 or 15 drops given every hour or two, as the symptoms indicate. W. S. Robinson (Med. Brief, Oet., '9S).
Dionin, a hydrochlorate of morphine ethyl ether, is valuable as a substitute for morphine. 'The morphine is grad ually NNitlidrzuNn. the amount of morphine taken daily has been reduced to 1/., or 'A grain, it is well to stop it altogether and substitute the (Bonin. One grain may be sufficient to quiet the untoward symptoms, but more may lie required. The drug is quite soluble in water. A small dose given in the la• ginning of the restlessness 1\ ill give re lief, while a much larger dose may be without effect if one waits until the access becomes violent. Fromm!, tiler liner klin. \Voch., Apr. 3, '99).
Dionin as Ihe most valuable of all llie morphine sub,titutes in the treatment of the morphine hahit. In fact, its po‘‘er to relieve the morphine habil is its most valuable proiaPi (y. So far as the dose is eoneei tied, ahout one third more is re quired than when morphine is given, but the exhilaration folbming the injection is not nearly Fio great as that. follim ing morphine. A slight ilehing of the skin is usually observed a few minutes after the exhibition of the dionin, which, how ever, disappears in at most len minutes, ' " it to tie rap I .I1 d 1'.11 idly VIIIIIi11:11Cd.
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