HYPNOTICS AND THEIR USES. " To the Editor of The Indian Medical Gazette.' with the uses Silt,?Before dealing of various hypnotics it is very essential for the student to know something about the. as it would Physiology of sleep help him a great deal in giving his discretion for the appropriate use of the drugs Physiology of sleep:?During sleep there is diminished irritability of entire nervous system, which is explicable onlv of in part through fatigue centripetal nerves, but is especially m a manner attributed peculiar to the central nervous the system. During deepest sleep psychic activities appear to be at so that the wholly rest, sleeping person maybe compared to a being with exterpated cerebral hemispheres is in the There reduction activity of the heart of the blond' in of the pressure the arteries amount of blood in the motor brain! of the irritability of cortical centres, of the artivitv nf and respiration, of gastric intestinal in of in the movement? generation heat, secretions indicates a lessening in the activities of cord. The spinal pupils during a e the smaller the the The ? deeper sleep. cause of sleep is the con sumption of potential energy in the nerves principally in the 236 THE INDIAN MEDICAL GAZETTE. [June, 1915.

Medinal is more rapid in action than snlphonal and acts central organs, which renders restitution necessary. Per- well in old people. It should be given about 30 minutes be- haps accumulations of decomposition product in the body fore retiring to bed. induce (? Lactates) sleep. Opium and Morphia g.1-8 to gr. J are given very The various g.|-g-2 Hypnotics and sedatives commonly used little choice now-a-days as hypnotics, in insane persons. are :? They are valuable as hypnotics, in neuralgias and surgical cases. 1. 9. & Paraldehyde. Opium Morphia. Adaline 10-?0 Somnal 30-40 2. Chloral 10. Adaline. g. ; Isopral g- 10-15; minims, Hydrate. dose 8-15 All these are used as 3. Bromides. 11. Hedonul, grs. drugs hypno Isopral. but are not much in nse. 4. 12. Somnal. tics, frequent Hyoscine Hydrobromate. Uralhane 20-10 is tasteless and is soluble. It 5. ^Sulphonal. 13. Hedonal. g. fairly pro- duces and can be to children. 6. Medinal. 14. Urathane. light sleep given dose 30 to 40 minims and Chloralose, 7. Trional. 15. Hydrate of Amylene. Amylene. dose '2 5 These are out of use novv- 8. Veronal. 16. Chloralose. grs. hypnotics practically a-days. are few other which are out of Paraldehyde is one of the best and safest hypnotic at the There hypnotics altogether disposal of alienist. It quickly absorbs and produces calm use and hence I have not dealt with them. refreshing sleep akin to natural slumber, without any after- SHYAMA SHANKER SHUKLA, effects and cardiac depression. However its use should be well considered as it would not suit all cases. It may be Sub-Asst. Surgeon, safely used in cases of insomnia due to cardiac or respiratory Central Lunatic Asylum, Agra. diseases, mania, hysterical excitement, melancholia and in the later stages of adynamic fever, etc. It is generally used in Asylum practice and is considered to be a valuable remedy. It should be given at bed time in 1 to 4 dram doses. Major A. O. Wright gives it in 2 to 3 dram doses when the pulse rate is rapid and the arterial tension is high, but where the arterial tension is low, he administers it in 10 to 15 minimum doses. The only drawback in the use of Paraldehyde is its nuseous taste and unpleasant ethereal odour, which it imparts during its elimination by the breaths. Its pungent disagreeable taste may be disguised by mixing it with Syrup or Tr. of orange and peppermint water. Large doses should be emulsified with compound Tragacanth powder. Dr. W. J. Corrindon of Lunatic Asylum, Agra, likes to add sufficient water to dissolve all the Paraldehyde. Chloral Hydrate also acts quickly and therefore should be given at bed time. Its cardiac and respiratory depression should be noted and therefore should not be given to old people with fatty heart or lung diseases or to delicate or cons- titutionally weak persons. Its action is very satisfactory in cases of alcholic insanity. In doses of 15 to 20 grains, it induces a refreshing sleep, which thus obtained not infre- quently leads to the repeated use of the drug and thereby induces the chloral-habit. It should be prescribed with Syrup Ginger, as it covers its pungent taste very nicely. It may be given by rectum or subcutaneously. Bromides of Potassium, Sodium or Ammonium are suitable for mild cases. Of these salts Pot. Bromide easily ranks first and should be given in 3ss?3ii doses, with camphor or chloroform water. Some people speak of better results when the three salts are combined. Of all the sedatives they are probably thf least harmful and can be administered for a longtime If given in full doses for a long time, they some- times tend towards dementia and derange digestion. Acute spots, etc., should be controlled by the admixture of 2 or 3 ms. of Liq. arsenicales. The Bromides are also usefully combined with other Soporofics such as Tr. Hyoscyami 3ss?3ii or Tr. Cannabis Indica 3ss?3ii or with Tr. Digitalis 3ss, which in such doses seems to have a calming effect on the central circula- tion. Pot Bro. with Liq. morphine acts as a very nice sedative and hypnotic after surgical operations. I have seen its use with marvellous results after surgical operations in 6 or 7 Sa.dar Hospitals of these Provinces. The Bromides also prolong and intensify the effect of Chloral Paraldehyde and Amylene Hydrate when prescribed with them. Bromides may be administered by the mouth, Rectum or hypodermicallv. Hyoscine, Hydrobromate or Sr.onolomine should be used hypodermically in doses of g. 1/100?g. 1/75. It is a powerful motor depressant which should only be used to emergency purposes and is then sometimes given with Morphia. In Asylum practice I have seen its wonderful calming effect in cases of violent maniacal excitement. Hyoscine g. 1/75 and Duboisine g. 1/100 have similar actions though less pronounced. is Sulphonal dose g. xx-xl is a tasteless powder and not very soluble and therefore should be given in hot milk or hot water about 4 hours before retiring to bed It has a cumulative action and keeps a patient quiet a next day and if repeated on the second night, its effects are more pro- nounced. It is a motor depressant and therefore it is very useful in mania. It suits old people well. Patients who are given this drug should however be induced to drink as much fluid as possible and the bowels should be kept open. Its combination with Potassium Bromide may be warmly commended 10 to 20 grains of sulphonal with 20 grains of Bromide in a cup of warm broth, milk or chocolate should be taken about 4 hours before bed time. Medinal. Triona and Veronal are fairlv tasteless powders and are all hypnotic in frequent use. They should be given in doses 5-10, 15-30, and 5-10 grains respectively.