tinder Insomnia the reader will see all the various drugs mentioned, any one of which he may try which does not contain opium or morphia.
The writer has tried almost all of them in the condition under notice, and he finds that either Paraldehyde, Trional or Sulphonal is the best. It is a good plan to abstain from chloral and Indian hemp, as there is much danger of a habit being established by the use of these drugs, and the administration of trional and paraldehyde upon alternate nights is free from any objections. gr. Hyoscine and Hydrate of Amylene (6o mins.) have given excellent results. Mattison gives gradually in creasing doses of bromides till 90 grs. daily are taken, when the morphia is entirely stopped, after which 3o grs. Trional are given nightly for seven days, the dose being then diminished to )5 grs. nightly for another week, after which Paraldehyde and Chloral in small doses may be given.
Macleod gives 2 drs. Sodium Bromide every two hours during two days, and i dr. during the third day. 3 oz. suffice, and the sleep lasts several days, from which the patient may awake with the craving greatly diminished, and some physicians induce this deep bromide sleep and keep it up for several days at intervals as a routine method of treatment for doing away with the use of morphia.
Many drugs have been recommended as substitutes for the opium during the day-time, but, speaking generally, there is little advantage in replacing one vice by another. The exception which may be made in the case of alcohol will be presently referred to. Some authorities sub stitute Heroin for the morphia or opium from the start; thus Ahlborn systematically commences with a gr. heroin by the mouth for each grain of morphia which the patient had been in the habit of indulging in, and in 4 weeks he states that he has found the craving to have disappeared, after which the drug is gradually diminished. It has, however, been proved that heroin is as dangerous a drug as morphia is in establishing a craving, and there appears to he little if any advantage in employing it as a routine treatment for morphinism.
Cocaine has been recommended and tried, but the cocaine habit being a more serious vice than morphinism this drug should never be employed as a routine. Occasionally, however, a full dose of the Liquid Extract
of Coca may be administered when the collapse and restlessness are extreme.
Lott's method of substituting Hyoscine for the opium or morphine is one of the best routine treatments. It consists in the hypodermic administration of the Hydrobromide of Hyoscine, commencing with a single dose of gr. and following it up with half of this amount every hour for 24 hours till a marked degree of hyoscine poisoning has become established, as seen in mild delirium, hallucinations, dilatation of the pupils, dryness of the mouth and skin, &c. These effects are kept up for 12 or 24 hours more by graduated doses sufficient to prolong without intensifying the intoxication, Strychnine being combined with the hyoscine should any sign of cardiac exhaustion appear. After the patient has regained his normal mental condition, Pilocarpine is adminis tered hypodermically every hour in doses of 8 gr. till copious sweating and elimination of the hyoscine occurs. During this latter stage of the treatment the condition of the heart will require careful watching, and a full dose of Strychnine hypodermically must be administered promptly should cardiac failure threaten. Diarrhoea, which is liable to follow the action of pilocarpine, should be controlled by appropriate astringents combined with Bismuth.
Carlisle's method consists in the hypodermic administration of T6 gr. with a gr. Morphine, which is repeated every 6 hours during the first day. On the second day the injection is given every 8 hours, and on the third day at intervals of 12 hours, the last dose being ad ministered at bed hour on the fourth day along with is grs. Trional by the mouth, active purgation being kept up all the time.
In one case with very exceptional environments the writer substituted large doses of Alcohol which kept the patient in a state of mild intoxica tion for several days, hut such a plan obviously cannot be recommended as a routine owing to the danger of establishing the alcohol habit.