Trional has largely taken the place of sulphonal as a pure and unob jectionable hypnotic, being less cumulative and more rapid in its action and not likely to cause prolonged drowsiness, headache or other nervous symptoms. It may be given in doses of 20 to 30 grs. just before retiring to rest, and it is very suitable for children. Upon the whole it maintains its position as the safest of all the newer hypnotics, though occasionally neuritis has been observed after its prolonged use, and very occasion ally limmatoporphyrinuria has been noticed. Tetronal, another allied sulphonal compound, acts like trional, but it is cumulative and less reliable than either sulphonal or trional when given in its usual dose of 15 to 20 grs.
Veronal is now official under the name of Barbitone. It should never be given in larger doses than io grs.; 7i grs. in any hot liquid at bed-time should seldom be exceeded. It is decidedly in the writer's opinion a less safe and reliable hypnotic than trional, and many deaths have already been caused by its use when the drug was not prescribed by the physician.
Paraldehyde must be pronounced to be the most valuable of all simple hypnotics, as it is undoubtedly the safest and has the largest range of usefulness. It is the drug which the physician should always employ in the insomnia of patients whose hearts are in any way damaged, whilst in mania, melancholia and other mental states it is as rapid in its action as chloral, and without any of the drawbacks which follow the use of that drug. The sleep rapidly induced by paraldehyde is sound and refreshing, and seldom followed by headache, malaise or gastric disturbance. The
ordinary dose is i dr., but treble this amount can be given with safety; it may be administered in a little whiskey, and given in this way it is by far the best routine hypnotic in delirium tremens. In very intractable cases of insomnia it may be given upon the second night after sulphonal ad ministration, when a small dose will greatly intensify the prolonged deferred action of that drug. The only contra-indication of its use is pain, as it possesses no analgesic action.
It may be prescribed in the following draught, which is very suitable in those cases of insomnia where the patient is liable to fall soundly asleep on lying down, but may awaken in an hour or two and remain awake during the rest of the night. The draught may be reserved for such emergencies.
It. Paraldehydi 5iss.
Tr. Aurantii 3iij.
Aquae Cinnamomi Misce.
Fiat haustus Nora somni sumendus p.p.a.
Amylene-Chloral or Dormiol is given in doses of 20 to 45 mins. in capsule and has been much praised in mania, melancholia, hypochondriasis, and functional neurosis. It combines the properties of both chloral and paraldehyde. Amylenc hydrate produces reliable hypnotic effects in doses of about r dr. It is best given in capsules or in claret or any weak wine, and it appears to act like chloral, without exerting dangerous depressant action upon the heart in ordinary doses and it acts very rapidly.
Hypnotism has been resorted to when all measures have failed to induce sleep in neurotic individuals, but it is a remedy which should only be employed by those who have made a close study of its operations.