MAY 2I, 19IO.] A DRASTIC TREATMENT FOR ALCOHOLISM. r NDZALTuu EJOUNA I249249 A DRASTIC TREATMENT FOR ALCOHOLISM. symptoms produced by the withdrawal of the narcotic will DR. ALBXANDER LAMBERT published last autumn in the he states, come out in full force; at this time an ox-gall Journal of the American Medical A88ociation an article enema is sometimes of assistance. After the bowels have with the title, "The Obliteration of the Craving for acted, but not before, one-third or half of the original dose Narcotics."1I It opened with the statement that if the of the narcotic may be given; it makes the patient comfort- writer, who is Visiting Physician to the Bellevue Hos- able and contented, and ready for the final stage. This pital, New York, and Professor of Clinical Medicine in begins twelve hours later by the administration of four Cornell University, had been told some years ago that it compound cathartic pills andfour to six vegetable cathar- was possible to take away the desire for morphine, cocaine, tic pills, with 5 grains of blue mass; six hours later this is or alcohol in less than five days with a minimum amount followed by an ounce or more of castor oil in coffee of suffering and discomfort to the patient, he would have or orange juice. Nervousness and discomfort occurring felt justified in treating the statement with polite before the castor oil acts should be met by a dose of scepticism. The treatment he has now adopted was 2 to 5 grains of codeine phosphate, given hypodermically. brought to his notice by Mr. Charles B. Towns, of New The castor oil ought to produce a characteristic stool York, not a member of the medical p'rofessiont who has showing that the treatment may cease. It is a liquid since commanicated details to Dr. Lambert. The pre- green stool composed of mucus and bile, and its passage scriptions he uses are as follows: is usually followed by the disappearance of discomfort. The Compound Tincture. After the patient has been under treatment for thirty 4 Tinctae belladonnae ............ .. .. 5i hours a cardiac stimulant, strychnine j to grain every Fluid extract of xanthoxylum .. 3 three hours, or digitalis or strophanthus, should be given, Fluid extract of hyoseyamus ... ... alone or in combination. During the treatment the patient Initial dose vi-viii1 . should have a regular diet of easily digested food, such as Compound Cathartic Pill. eggs, cereals, bread-and-butter, and vegetables; coffee or ] Extracti colocynthidis compositi ... ... gr. j tea may be given if desired by the patient. The appetite Hydrargyri chloridi mitis... .. gr. j often becomes voracious, and during the first week care CambOgie ........ ... ... ... gr.1 Reiala&1pse ...... ... .. ... gr. A must be taken that the patient does not over-eat himself. Vegetable Cathartic Pill. In the treatment of alcoholics the same plan is followed, I Extracti colocynthidis compositi ... ... gr. j but it does not usually need to be continued so long. Much Extracti hyoscyami ) closer observation is necessary to recognize the early Extracti jalapae . .- .. aa gr. ss symptoms of belladonna poisoning, an alcoholic being Extracti leptandrae ) sensitive to that drug. Dr. Lambert considers that bella- Extracti resinae podophyllij 1-a gr. l Olei menthae .. ... n donna delirium is less ferocious and less pugnacious than piperitae ... that produced by alcohol, and that the patients are more The second prescription is the compound cathartic pill, persistent and insistent in their ideas and more incisive in the third the vegetable cathartic pill, U.S.P. To the their statements concerning their hallucinations. Halluci- vegetable cathartic pills he adds oleo-resin of capsicum 2, nations produced by alcohol are usually those of an ginger gr. -, croton oil A Pi. He also found it desirable to occupation delirium, those of belladonna are not; further, have the pill mass freshly made, or to have it enclosed in the belladonna delirium is apt to be confined to one or two capsules, as ordinary stock preparations were too dry to ideas, whereas the hallucinations of alcohol follow each act efficiently. other so quickly, that the patient is busily engaged in Xanthoxylum, or powdered bark of prickly ash, is official in observing them one after another. When an, alcoholic is the United States Pharmacopoeia, and is described as a stimulant admitted "in the midst of his spree or at the end of it," producing when swallowed a sense of heat in the stomach, with more or less general arterial excitement and a tendency to the first thing to do is to put him to sleep, and a hypnotic diaphoresis. It seems to have been used chiefly as a cure for is given after the first four compound cathartic pills; the chronic rheumatism. hypnotic which Dr. Lambert states has given him the best By tincture of belladonna in the above prescription Dr. results is the following: Lambert means " the old 15 per cent. tincture of belladonna, .. .. U.S.P."; and Mr. Martindale informs us that 6 to 8 minims of Chloral. hydrat. ........ ... gr.xv the above tincture would contain 3 to 4 minims of the Morphinae ... ... gr. I compound Tincturae hyoseyami .. ... ... 5ss tincture of belladonna, B.P. Dr. Lambert also had blue mass ... ... (strength 33 per cent. as compared with the blue pill, B.P., Tincturae zingiberis -...... nl X strength 40 per up in capsules containing 5 grains. Tincturae capsici .... ... nt v cent.) put Aquam ... ... ... ... ad 5 ss There is therefore nothing very novel about the drugs, and we do not understand that Dr. Lambert claims any This dose can be repeated in an hour, with or without novelty on this head; the novelty would appear to be the 1 or 2 drachms of paraldehyd. use of the compound tincture as part of a course of treat- If these are not effective within two hours, or even less, ment in which catharsis is an important element. Appa- and the patient's delirium is of the furious, thrashing, rently the cases have been treated in the ordinary hospital motor type, a hypodermic injection of the following will wards, and we gather that in most of the cases of alco- almost invariably quiet him: holism the patient has been admitted, to use Dr. Lambert's Strychninae sulphatis ... ... ... gr. f phrase, "in the midst of his spree or at the end of it." Hyoseyamin. sulphatis .. .. ... gr. TAU. Dr. Lambert first describes the treatment of cases of Apomorphinae hydrochloridi ... ... gr. IYu morphine or cocaine addiction as follows: He begins by If sleep is difficult to obtain, the patient is allowed to giving four compound cathartic pills and 5 grains of blue sleep until he wakes; but if he goes to sleep easily, he is mass, and at the same time an enema of soap suds; when awakened every hour for a dose of the compound tincture. the bowels have begun to act he begins to give the com- Save in the young robust alcoholic Dr. Lambert considers pound tincture; at first he gives 6 to 8 minims every hour, it wise to give most alcoholic patients iV to -3S of a grain increasing the quantity by 2 minims every six hours, of strychnine every' four hours. Fourteen hours after until 14 or 16 minims are being taken every hour. If signs beginning the compound tincture the patient should of belladonna poisoning are noticed, the compound tincture again be given a cathartic, either the same dose of four must be stopped until they have subsided, when it should compound cathartic pills, or one half that quantity with be given again in 8 minim doses. At the beginning of 5 grains of blue mass. At this stage the young, full- the treatment with the compound tincture he gives, in blooded alcoholic may need a farther dose of hypnotic, three doses, at half-hour intervals, from half to two-thirds but need not be given alcohol; the older alcoholics of the total daily dose of opium, morphine, or cocaine usually and those in a weak and poor physical condition should taken by the patient; fourteen hours after the first dose of have 1 to 2 oz. of whisky about four times a day with milk the compound tincture he gives four compound cathartic during the first twenty-four hours, during the second pills and 5 grains of blue mass, and again, six hours twenty-four hours two doses will probably suffice. After later, four compound cathartic pills and four to six the second dose of cathartics has acted, if the patient vegetable cathartic pills. If catharsis is not produced begins to show the characteristic green, mucous stools, he within three or four hours the pills must be repeated with should be given an ounce of castor oil, and from this dose 5 to 10 grains of blue mass. If this be not done the the characteristic stool, as.describedc under morphine, will patients are liable to begin to vomit, and the distressing appear and the treatment may cease. If, however, the 1 Vol. liii,.P. 985. I green stool does not begin to appear at this time, further TIM 1250 JuI THE DEATH OF KING EDWARD. [MAY 2 190. -compound cathartic pills should be given, and as soon as Royal College of Phys8icianh, Edinburgh. the green stools begin to appear the castor oil should be The following addresses were proposed by the President given. (Dr. Allan Jamieson) and unanimously agreed to by the The treatment, Dr. Lambert says, establishes a patient's Fellows of the College, upstanding, at an Extraordinary self-reliance to go on without alcohol; it will do all that Meeting of the College held on May 12th, 1910.