A smart purge should be given before beginning the opiate treatment, and if the physician suspects that the remedy is not being absorbed, he may give a corresponding amount by the hypodermic needle when the next dose falls due in 4 hours.
Wood states that the combination of chloral and morphia far exceeds in efficiency and general applicability all other hypnotics, though some physicians believe that this combination is more dangerous than full doses of either drug.
A 90-min. dose of Paraldehyde is the safest of all hypnotics; Sulphonal and trional, in 3o-gr. doses, have been used to great advantage, and many physicians are content to treat all cases with one or other of these drugs; they are, moreover, perfectly safe in the above-mentioned doses. When the delirium has been fierce and exhaustive, Hyoscine hypo dermically (, gr.) has been tried as a hypnotic, and has given splendid results.
After an investigation of over r,000 cases, Ranson and Scott state that Veronal (Barbitone) was the only hypnotic drug which did not increase the mortality of the disease. They found that in the early restless stage it often cut short the attack, and that in the delirious stage it alone of all hypnotics should be selected. In the early stage the veronal was given with ergot and whiskey at regular intervals. tcl grs. may be accepted as a full dose, but owing to its insolubility there should be long intervals between the doses .
Digitalis has been advocated in very large doses, and it is rather surprising to find that a heavier mortality has not been reported after 240 mins. of the tincture every 4 hours. These heroic doses have unfortunately been followed however in some cases by dangerous symptoms.
Strychnine acts much more quickly than digitalis when symptoms of cardiac failure show themselves, and it has an antagonistic action to Alcohol. (See under Alcoholism.) The Tincture of Nux Vomica may )0 given in doses of mins. every 4 hours with ro mins. of Tincture of Digitalis, and, where cardiac failure threatens seriously to cut off the ?atient, in addition to the free use of whiskey with Ammonia, as already mentioned, it is a good practice to give a large hypodermic dose of strychnine gr.), which may be repeated in 3 hours. Hot Mustard
?oultices to the cardiac region and spine should be used at the same time.
Leonard treats serious cases by Spinal Puncture and injecting a Pravaz syringeful of a 25 per cent. Magnesium Sulphate solution into the ;pinal canal.
The following is a good formula for use when the restless delirium is severe and the heart is showing signs of failure: yoscrno- 11 ydrolirom. gr. ,',. Lignor. Strycliniuce Ilyd. 5j.
;;i:s.
rind. Card. Co. ,;iss.
Aqua- ad isce.
El. iniq. horis.
in 2.o-gr. doses, has been advocated as a hypnotic; it is un reliable and may produce gastritis, though some employ it in the presence of acute gastric disturbance.
Convulsions occur from renal disease; they should not he mistaken for epileptic seizures, which also often occur. A convulsion coming on, accompanied by a large amount of albumin in the urine,should be promptly treated by Saline purgatives and a lint Mustard pack, Alorphia being only used with great circumspection.
Where symptoms of Acidosis supervene, the intravenous injection of Sodium Ilicarbonatc with normal Saline should be resorted to.
Pneumonia is especially serious, and complications, as they arise, must he treated upon the general principles mentioned under the head of each. As a rule, they are an indication for stimulants.
Delirium Tremens following an injury or accident in intemperate and irregularly living subjects generally turns out a grave affection. It may conic on with alarming rapidity, and it is the writer's experience that the delirium in these cases is often of a more active and dangerous kind, and free stimulation is much more frequently indicated in this group of case, than in the ordinary medical varieties of the disorder; this is especially true when erysipelas or other septic condition complicates the accident.