Many patients arc found to be the victims of both opiates and alcoholic stimulants. If the physician should succeed in weaning them off their opium, he will probably find it will be only to receive the credit of having made them inebriates.
In those cases where for any special reasons removal to a nursing institution is impossible, a trial may be made at home of reducing the daily amount of the narcotic; but if such be attempted at all the diminu tion must be most gradual, the reduction being accomplished by small fractional proportions. Failure generally results in chronic cases by the physician's haste or anxiety to make progress, and sometimes the patient is also to blame, being tempted to curtail to an extent beyond his power of endurance. Moral treatment, in such instances, is of the greatest value for a time, and every change in the patient's environment may he a benefit, such as the selection of new companions and occupation, and change of scene and habits. Alcohol is especially dangerous, and on no account should chloral be prescribed. The greatest difficulty will be from insomnia, and Trional or Paraldehyde combined with a diminished dose of the opiate at bed-time is the best remedy. In cases treated at home J ennings's plan of reduction may be tried, whilst the patient is permitted to carry on his usual avocation, the period of treatment extending over 3 months. He takes the case of a patient injecting zo grs. morphia daily. The syringe is given up, and an initial drop of 3 to 5 grs. is made, and a daily drop of r gr. for some days till this becomes irksome, then L I, and finally gr. is daily dropped. The real difficulty begins when the daily amount injected is lessened to about 2 grs. After
this period, far every 4 gr. suppressed he gives twice as much by the mouth or rectum till in about 12 days the injections are reduced to zero, after which the dose by the mouth is gradually diminished to nothing, and if the " progression " is properly carried out the cure is effected with only a night or two of restlessness requiring hypnotics. No suffering need ever occur. Sparteine hypodermically or Digitalis by the mouth forms an essential part of the routine, and must be commenced as soon as the heart becomes feeble or sluggish.
Whatever form of treatment is selected, supervision should be carried out for a period of several months, as the weakened will-power of the patient requires a long time for recuperation, during which he cannot be trusted.
Certain symptoms arc liable to occur during the early days of the treatment; the most important of these have been already dealt with. Next to the insomnia and cardiac weakness the most frequent is nausea and vomiting; these are best met by large doses of effervescing waters, which, if not retained, will aid in washing out the stomach. A copious draught of tepid water containing a teaspoonful of Bicarbonate of Soda may be occasionally administered for the same purpose, and this is also believed to diminish the craving by keeping the stomach contents alkaline.
The Cocaine Habit is to be treated upon the same principles as mor phinism, and the same details may be applied and carried out as if the patient had been addicted to opium-eating; unfortunately, both vices are not infrequently met with in the same individual, and when associated with alcoholism the case may well he regarded as hopeless.