The Secrets of Specialists/Chapter 26

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What are the factors which predispose certain individuals to the excessive use of liquor, while others do not care to use it at all? This is a question that has never been satisfactorily answered. I believe that certain individuals are born drunkards, just as I believe that others are born thieves, and there are children born every day cursed in their mother's womb by the dissipation of one or both parents. Bad company and poor literature contribute, perhaps, more toward the development of the drink habit than any other cause. A man with a timid disposition often thinks he is better able to combat with the world if he imbibes freely of the amber-colored liquid, while a man with an unevenly balanced mind believes he can be made more worldly if he flushes his stomach with the fiery fluid. A poor man feels rich if he is in a state of semi-intoxication, and especially so if he is in a glittering bar-room with company in a similar state. Finally, the intoxication increases, stupor comes on, and after this has worn off in the morning comes thirst, misery, headache, tremor and nervous irritability. Again he seeks relief by the usual "eye-opener," and again he keeps his jaded nervous system stimulated during the day until outraged nature rebels, and his stomach will no longer retain the poison, and the disordered brain and nervous system are on the border of collapse unless rest or medical aid will restore him to the normal, and compel him to leave alcoholic liquors alone for a few weeks or months. This is the history of the average periodical drinker.

There is another class of men whom we generally find in active business who do not intoxicate themselves to the extent just described, but who consume a large amount of liquor every ​day and keep it up for years, without much apparent injury, but by carefully watching these subjects, we find that they finally die from some disease for which alcohol is responsible. Possibly the heart may become exhausted or the liver or the kidneys give out, or the weakened blood vessels at some point of the brain will yield and apoplexy result.

There is still another class of men who may properly be called degenerates. These individuals are certainly physically and mentally weak, and, if allowed, will consume as much liquor as they can get their hands on. They wish to keep in a state of intoxication all the time, until they are finally taken to the prison or madhouse or wear out the lives of their most devoted friends.

From so high authority as Sir William Roberts we find in his excellent little work on "Diet and Digestion," that tea, coffee, tobacco and alcohol have been beneficial in strengthening both the muscles and the brains of Americans. He argues that this is one of the reasons why we have outstripped our eastern brethren in civilization and intellectual attainments. If such be the case, we have bought our civilization and our intelligence at an enormous expense.

There has been much discussion in medical literature as to whether the excessive use of alcohol is a disease or a habit. I am inclined to think that it is both, and that it may be either hereditary or acquired. If a man goes on an occasional spree and has no particular taste or craving for liquors, we may say that he has a habit. If he has an uncontrollable appetite for alcohol and feels that he cannot exist without the stimulant, we must admit that it is a disease, for there are certain pathological changes which take place in his nervous system.

Whether or not alcohol may be used without being abused is too broad a question to be discussed here, but we all know that it is a dangerous companion with which to associate, and we may live longer and better lives if we disinherit this king of many climes.

​It was Henry W. Grady who said that whisky had wasted more lives, dug more graves and sent more souls unshrived to judgment than all the pestilences and wars since God sent the plague into Egypt and Joshua stood before Jericho.

When a person applies for treatment for alcoholism he is generally in a state of intoxication; he wants sympathy and a friend. Possibly he has been called a drunken brute, which may be true in many instances, for there are many individuals who are correct impersonations of Dr. Jekyll and Mr. Hyde when under the influence of liquor. Men who have a kind, lovable and charitable disposition are transformed into perfect demons by its influence. A person not addicted to the liquor habit might think that it is not a difficult task to stop drinking, and we often find people who subject the drunkard to the most severe criticism, is a habitue of perhaps a milder stimulant or narcotic, i.e., tea, coffee, snuff or tobacco. I have seen as pronounced tea drunkards as I ever have whisky addicts.

Although Dr. Keeley and others who were among the first to classify alcoholism as a disease, were ridiculed by the Medical Profession, we are pleased to note at this writing that their views have been generally accepted, and by treating these conditions as disease, patients can be rapidly restored to their former manhood.

Any man of ordinary intelligence knows right from wrong, and by explaining to him the evil effects of his habits and how his dissipation has reflected upon himself and family; how he and his have been shunned by society; how his noble and faithful wife has patiently waited for the time to come when he would abandon the evil habit and become the same kind father, brother or son that he once was. She has, no doubt, many times knelt in prayer, and implored the Divine Giver of Life to shield her loved one from this terrible curse. Have your patient understand that he is able to live a different and a better life and that he has applied to you for the purpose of ​having you cure him of an uncontrollable disease, alcoholism, and when he has completed his treatment, he will return to his loved ones a much different man. But in order to be successful, he must avoid his former associates and places where liquor is sold, and in order that the treatment may be properly carried out, you must have his fullest co-operation.

There has been a diversity of opinion whether or not a physician in general practice, can treat alcoholism and the drug habits as successfully as they could be treated at habitue institutes. The principal and only advantage the institutes have they are genearlly equipped for treating such cases, and the psychic influence it has on the patient, of "leaving home for a vacation," which is generally their excuse. Alcoholic habitues dislike to admit their weakness and acknowledge that alcohol is their master. You often hear the most profound drunkard remark, "I can drink or let it alone," but they more often drink to show you they can drink than they do to abandon its use for demonstrative purposes.

There is rather a fraternity among drinking men, and while at an institute they discuss many experiences regarding the evil effects of alcohol, which often leads from the cradle to the prison or mad house. If the modern temperance lecturer is deficient for food for argument, his time will be well spent in visiting one of these institutes. There is no special class of men exempt from this evil, and we find inmates at these places who were clergymen, doctors, lawyers, etc., holding respective repentance with men of the lower classes, all congregated for one grand purpose of restoring manhood and placing themselves before the world once more, the same honorable, upright citizen they once were. They leave the institute with new resolutions and a brighter future before them.

A well equipped institute should possess everything which will be conductive to entertainment and health. For this purpose a small gymnasium is of special value, not only for amuse​ment, but as a strengthening process. Baths of every description offers the same advantages. I feel I cannot say too much regarding baths, as they offer us one of the best means of elimination obtainable, the Turkish bath mentioned on another page will answer the purpose, but the shower and other baths can be added to a good advantage. Patients should be required to take a Turkish bath, at least every other day throughout the treatment. Although the institutes have a few advantages, a physician in general practice can treat patients equally as successful as far as actual medication is concerned. The only equipment other than medicine is the bath outfit just mentioned. His first step toward success is to obtain the utmost confidence and co-operation of his patients and keep them under his observation and treatment for at least four weeks. At the end of the first week, he no doubt will abandon the use of liquor and by the judicious use of remedial measures, at the end of the remaining three weeks, he will leave your care with no further desire for alcoholic beverages.

The preliminary treatment for alcoholism depends somewhat upon the condition of the patient when he presents himself for treatment. He may be perfectly sober, or, on the other extreme; he may be brought to you in a state of total collapse, or suffering with delirium tremens, or manifesting symptoms bordering upon this condition, as a result of a recent debauch; the former condition will require no special treatment, while the latter demands the physician's immediate attention. The patient's stomach may be in such a state that he cannot tolerate solid foods; in such cases we find hot broths, milk and invalid foods are the best diet. If the patient is not able to take this nourishment by the mouth, it can be given by the rectum. Many drunkards eat and sleep very little while on a debauch, and it is owing to this deficiency of rest and diet which have a tendency to induce collapse and delirium tremens, by overtaxing their already shattered nervous system.

​It has often been observed that alcoholics who eat and sleep well never manifest delirious symptoms. We therefore find that the most important factors as a preliminary restorative treatment will be to sustain nourishment, quiet the nervous system and induce nature's sweet restorative—sleep—and eliminate all the poisonous elements from the body. The patient should be encouraged to eat, the congested liver and portal system should be relieved by a full dose of calomel followed by a saline purgative or the continuous use of phosphate of soda. The congested kidneys should also be relieved with an active diuretic, through diaphoresis should be obtained by means of the Turkish bath given in the bath cabint illustrated on another page and followed by a hot plunge bath for a few minutes in water of 110 degrees F.

These baths are indispensable as a means of elimination, and should produce sleep. If the baths should fail to produce sleep, the patient can be given a full dose of bromidia, sulphonal, trional, veronal paraldehyd, or any other suitable hypnotic, which will be discussed later in what is known as the "Rest Cure."

Patients have been educated by the former founders of the so-called "gold-cure" institutes to believe they can have all the liquor they desire. Thus we often find it necessary to carry out our treatment on the same plan, or the patient may think our treatment an inferior one. If the patient is very weak he should only be allowed sufficient liquor to support him. There is no remedy in existence which will support an irritable heart or calm the nerves of the whisky habitue as quickly as whisky. This should only be allowed in moderate doses, however, for a few days, until nature has an opportunity of recuperating from other sources. If the patient is a moderate drinker and in a state of intoxication or semi-intoxication, he may be allowed a four ounce bottle of whisky and advised to see how long he can make that last. All patients should be emphatically forbidden to enter any place where liquors are sold, or drink any intoxicating liquor other than that which he receives from you.

​In order that the reader may become familiar with the different methods of treatment, I will first give the treatment I used while in charge of an institute and which I have since used in private practice with excellent results for the treatment of alcoholism and the drug habits. I will also outline many secret cures and systems, sold to the profession at different prices according to territorial right, etc. By the judicious use of these treatments you will be prepared to treat and cure alcoholism and the drug habits as successfully as they can be treated elsewhere.

Some institutes have what is known as the "Rest Cure," which in detail is very much like the preliminary treatment just described. This treatment is of special value as a preliminary treatment for patients who are nervous or present themselves in a state bordering on collapse, or manifest symptoms of delirium tremens. The patient is given a hot water bath or a hot blanket bath, which consists of wrapping the patient in woolen blankets taken from water with the temperature 140 degrees F. These baths are frequently repeated to keep up free diaphoresis. Nourishment is given in small amounts as the patient awakens. The patient is allowed as little whisky as is necessary to support him and is kept in a hypnotic or semi-hypnotic state from two to four days, until the effect of the alcoholic poison wears off.

The remedies used for the purpose of producing "rest" (hypnosis) are hyoscine, trional, veronal and paraldehyd.

Dr. J. Collins, in writing regarding the relative value of the three last named remedies, says:

The reliance which we place upon them, apparently, judging from the frequency with which they are used, is indicated by the order in which they are enumerated. Although veronal, one of the most recently introduced hypnotics, has something to be said in its favor, and particularly that it produces a hypnosis more profound than that caused by trional, there are disagreeable features attendant upon its use which compel ​us to admit that trional is the more suitable hypnotic. My experience with veronal, which I have used upward of a year in a great many cases of insomnia of manifold causation, is that it causes quite the ideal artificial sleep, it sometimes produces motor inco-ordination, especially of the lower extremities, erythematous eruption, neuralgia, and it diminishes the solids and urin. Although trional will do all of these, I have not noticed any of them with anything like the frequency that I have after giving veronal. Nevertheless, veronal is an excellent hypnotic, and the sleep-producing effects are greater than those of trional, given in from ten-grain to fifteen-grain doses It usually produces sleep after the second or third dose in patients with delirium, whereas trional must be given oftentimes in twice or in three times this quantity before any considerable hypnosis results. We have the best results from the administration of trional when we give it in ten-grain doses every hour and with large draughts of hot water. After from four to six doses have been taken, the patient usually secures a more or less protracted sleep.

Paraldehyd is the most reliable of all hypnotics. Every one who has much experience in nervous and mental diseases will concede that this is a fact. It is never a pleasant medicine to take, and if given frequently it is sure to disorder the digestion. In delirium tremens the subacute or chronic gastroducdenal catarrh is almost invariably present, and paraldehyd tends to increase it and exaggerate it; for this reason we never give it in the City Hospital as a routine measure, but when other hypnotics fail we rely upon its administration in producing sleep and are rarely disappointed.

The rest cure is only given to patients who are delirious or extremely nervous and irritable and have muscular tremor, etc., and require rest. If the patient places himself in your charge in a reasonable state of sobriety, the rest treatment is omitted, with the exception of a hypnotic at bedtime, otherwise the patient is placed at once upon the following general tonic and reconstructive treatment:

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The first treatment I ever used was that known as the Dunlap Cure, which was approximately the same treatment, somewhat modified, as that used by Dr. Gray, the formulae of which were made public through the efforts of Dr. Andrews, of Chicago; and it is my belief that this treatment is quite as good as any in use at the present time, if used according to the following revised formulae:

I commence giving the patient hypodermically:

Gold and sodium chloride	4	gr.
Aqua. dis.	1	oz.

M. Sig. Inject five to ten minims at seven and eleven-thirty a. m., and at five and nine p. m. Each ten minims represents one-twentieth grain of the chloride of gold and sodium. I also give the following internally:

Atropine	¼	gr.
Strychnine nitrate	1	gr.
Tinet. Capsicum	2	dr.
F. E. erythroxylon cocal	1	oz.
F. E. avena sativa	1	oz.
F. E. chionanthus virg.	1	oz.
Compound F. E. cinchona	3	oz.
Simple elixir	1	oz.

Mix. Sig. A teaspoonful every two hours while awake.

In briefly resuming the therapeutic value of the above medication, I may add that it is the belief of many physicians that the only important part gold has in the treatment of alcoholism is the gold coin which passes from the hand of the patient to the pocket of the doctor. This is a great mistake, although the term "gold cure" has been extensively advertised for commercial purposes and sounds well and looks well. The therapeutic value of the chloride of gold and sodium is strongly indicated to antagonize the evil effects of alcohol. By referring to all modern literature upon the subject and accepting the views of the most competent clinicians, we find that the salts of gold are alteratives of the highest order and seem to ​exercise their best efforts upon organs and tissues destroyed by the poisonous effects of alcohol.

It is a remedy par-excellence for sclerosis of the internal organs, especially the liver and kidneys, drunkards dyspepsia, characterized by red glazed tongue, relaxation of the bowels, catarrh of the bile-ducts, duodenum, jaundice, etc. It has been highly commended for suicidal mania, melancholia and a tonic for low spirited people, and many other conditions which are associated in a direct or indirect way with chronic alcoholism; thus we find that the use of gold is not as empiric as we are often led to believe, and is one of the principal remedies used at many successful institutes. Atropine has been judiciously added to the preparation as a means of relieving cerebral congestion and headache, which is nearly always present after a debauch. It is also especially useful as a cardiac and respiratory stimulent. Strychnine is also a valuable adjunct in the treatment of alcoholism and the drug habits as a stomachic tonic and a stimulant to the heart respiratory, muscular and nervous system. Erythroxylan, avena sativa and the cinchona compound have been added for their respective tonic properties. Chionanthus in passive doses, as given here, is a cholagogue and mild diuretic and promotes activity of the liver and kidneys, and assists elimination. There is no remedy which replaces the fiery taste of whisky better than capsicum. Whisky drinkers are accustomed to hot drinks and this remedy supplies this desire. This can be omitted in many cases, however, and should always be gradually reduced within a few days, or it can be administered separately if desired.

After the patient has taken this treatment for a few days, he generally loses his desire for liquor and discontinues its use, but the treatment should be continued for a period of three or four weeks. On the other hand, we occasionally find a patient who thinks he is overly-wise and can "beat the cure." These patients are generally of the lower classes and will drink, drink, and drink, until compelled to stop. They are easily managed, however, and it is rather amusing to see how quickly ​you can relieve their minds of these erroneous ideas. After a patient has been taking the treatment a few days and you feel that he is fighting the treatment, when the time comes for the hypodermic injection, give him an extra large drink of whisky. Have him secure it at the drug store, if you wish, so that he will not think you have doctored it, and instead of the regular injection, give him one-tenth grain of apomorphine. This, of course, will make him sick at his stomach and vomit. In nine cases out of ten you cannot get him to touch liquor any more, but once in a while a patient will attempt to drink again. I remember once giving a patient seventeen of these injections before I could conquer him.

Apomorphine and the "sickening process" have always formed one of the "trade secrets" of the different gold-cure institutes, and I believe that apomorphine is one of the most valuable drugs we have as an emergency treatment in the cure of alcoholism, as it makes you master of the situation, and at the same time, impresses the patient with the fact that the treatment you are giving is a complete antidote to alcohol, and that the two can not be taken at the same time. You will also find that some patients before quitting the treatment wish to see if they can take a drink of liquor, to learn whether or not the cure has been complete. In many cases I have requested them to drink and then given them an injection of apomorphine at the same time. This satisfies them in the extreme. This might be condemned by some as an unprincipled and injudicious practice, but, such as it is, it is effective and curative and I believe that there is a larger percentage of cures in those who have undergone the sickening process at least once while taking treatment than in those who have not. The mental impression the patient receives (and alcoholism is conceded to be partially a mental disease, hence the term "dipsomania") is lasting in its results. After this treatment the patient is thoroughly disgusted with his favorite beverage. I have often seen patients become sick at their stomach by watching others drink, several days after taking the apomorphine.

​This is what is known at most gold-cure institutes as the "barber pole shot." They have three solutions for injecting, labeled number one, two and three. Number one is white and contains a solution of nitrate of strychnine; number two contains gold and sodium and is colored red; number three contains the apomorphine, which if mixed with water will turn a bluish green, hence, by taking medicine from each bottle, we get the red, white and blue.

There is no special advantage of treating alcoholism by hypodermic medication, other than you have the patient under your immediate control. You can absolutely compel him to stop drinking by the use of apomorphine and having him report regularly for his hypodermic treatment; you can keep him constantly under your observation and control and witness the progress of your treatment. The hypodermic injections also have a wonderful psychic effect. Many patients have never received a hypodermic injection before and they imagine that this method of treatment is much more certain and curative in its effects than the ordinary treatment given by the mouth.

Although the apomorphine treatment is not required in all cases, it would be almost impossible to cure some cases without its use, and this method of producing emesis is far better than to give an emetic in whisky, and is not nearly so easily detected.

The combined treatment which I have just outlined is the one I prefer for the general class of patients and it will establish as great a number of cures as any treatment in present use. It can be used in either private or a sanitarium practice with equal success.

There are several different types of drug habitues and several different methods of treatment to cure them, each method having its enthusiastic advocate. The treatment of drug habits differs from alcoholism inasmuch as nearly every ​case presents different individual characteristics and requires special attention and skill on the part of the physician to meet the emergencies. While we find alcoholic patients desire companionship and enjoy social functions, opium and other drug habitues are generally secretive in their disposition, and the physician who treats them should lose no time in securing the confidence and co-operation of his patients. They are wedded to their drug and believe that it is part of their existence; therefore they should have the assurance that they can have all of the drug their system requires during the treatment, but that they are to take only that which they receive from you.

To illustrate the cautiousness of many patients, I remember one lady who applied for treatment who had three drachm bottles of morphine and a hypodermic syringe secreted in her clothing. She did not tell me this until after she had completed the treatment, when she handed them to me and confessed her actions, stating that she had heard so much about the torture received in curing the morphine habit, that she came prepared not to suffer. She was placed upon the gradual reduction treatment and made a splendid recovery.

There are several things to be considered in carrying out a treatment for the drug habits. We have to combat the physical and mental disturbances, which are sure to follow the withdrawal of the drug. We have to relieve the patient from the craving of the drug, that we may enable him to permanently discontinue its use. We have to restore his mental and physical condition so that he will not depend upon the drug for support. These are problems which often confuse the minds of the most skillful physicians, but they can be solved by the appropriate therapeutic measure.

Among the patients applying to you for treatment, you will find first, the young vigorous patients, who have not taken the drug long enough to produce any marked pathological changes in their anatomy. Second, the one who has used the drug for several years without its seemingly producing any ill effects. Third, the one who uses the drugs for the relief ​of pain of some co-existing disease, such as cancer, chronic sores, hepatic and renal calculi, etc. Fourth, the old and feeble who have existed upon the drugs for years and have brought about pathological changes which are beyond repair.

As the digestive and assimilative organs are practically paralyzed; the secretions of the stomach, liver and bowels are checked. They become emaciated and live upon their reserve of former years.

The first and second class will generally yield to proper treatment. The third class may also be cured, providing you can establish a cure for the painful disease, but as a rule, the fourth class is beyond all medical aid and the patients should be allowed to use the drug as long as they live. The preliminary treatment for drug addicts should be very much the same as that for alcohol. If in your judgment, you think the case is a curable one, for a few days previous to the treatment you adopt, the patient should take hot air and water baths and open the pores of the skin. The alimentary tract should be cleaned out by the use of calomel and phosphate of soda. Acetate of potassium will be found a good remedy to stimulate the secretions of the kidneys. The patient will then be ready for the regular routine treatment. There are several ways in which the drug habit may be treated, viz:—the gradual reduction method; the rapid reduction method, and the immediate withdrawal method, etc.

This is one of the most satisfactory methods of treatment in present use for curing morphine and other drug habits and has the advantage that it can be used in private practice nearly as well as at a sanitarium or institute. With full co-operation of the patient this method of treatment offers the following advantages, viz.: It is not attended with any marked discomfort to the patient, no weakness or profuse perspiration, generally no pain or diarrhoea or extreme nervousness, collapse, etc., often accompanying other treatments. With this treat​ment there is no fixed amount of the drug reduced each day, but the patient is requested to take as little of the drug as possible, and still remain comfortable.

The principal point to be observed is to build up the patient's general constitution and prepare him for the reduction previous to withdrawing his drug supply, and allow him as minimum amount of the drug as is compensative with health and comfort, and to withdraw the amount so gradual that it will not be noticeable to the patient. Most patients take much larger amounts of the drug they are using than is generally necessary to keep them comfortable. If a patient is taking 30 grains of morphine a day it can be reduced to at least one-half that amount, or even less, the first few days, and hardly be noticed, and the patient always feels better for its removal. It is always a good rule to commence the first day's treatment by reducing the amount of the drug at least one-half; if you are satisfied that the patient is absolutely in need of more you may allow it. If he has passed the first day successfully and in comparatively a comfortable manner, the drug may be reduced as much as you think he will stand the next day; finally you will reach the minimum amount which will support him without distress, and this should be your starting point. Remember, however, that you should never allow the patient to suffer for the want of the drug; on the other hand, they often imagine they want the drug when they really do not require it; in such instances a hypodermic injection of water will often pacify them. After you have found the minimum amount he can stand, the reduction should be made from now on in such small amounts each day that the patient will not be able to detect the reduction. As soon as you commence to reduce the drug the functions of the body, which have been chained down, will awaken to new life and activity, the appetite will usually increase, the secretions will be more profuse, the bowels will become more regular, although the patient may be somewhat restless at night. What sleep he does procure will be more profound and refreshing. If he should suffer too much from ​insomnia, a suitable hypnotic may be given when he awakens. The heart may become irritable, weak, fast or irregular, requiring a hypodermic injection of strychnine.

With this method there is no stated time promised to effect a cure; it might require one month, or it may require ten weeks; this depends somewhat upon the physical condition of the patient, which is always to be supported in advance or in proportion to the amount of the drug withdrawn, always watching the condition of the appetite, bowels, kidneys and heart, and see that the skin is active with hot air and water baths, which assist the eliminative process. If the patient has weak recuperative powers, it will take longer to effect a cure than it will where the functions of the body are more active. During the reduction the patient will require a good thorough tonic and eliminative treatment. The following offers one of the best hypodermic medications to support the heart's action and nervous system:

Strychnine nitrate	½	dr.
Spartein sulph.	6	gr.
Aqua	1	oz.

Mix. Sig. Inject ten minims with the amount of morphine you find necessary to support the patient; each ten minims represents strychnine, one ninety-sixth grain, and spartein one-eighth grain. The best time to make the hypodermic injections is about fifteen minutes before meal time and just before going to bed. The stimulating effect allows the patient to eat and sleep better if given at these times, and it is absolutely necessary that he should maintain a good appetite and rest to have the treatment progressive and accomplish results. The patient should also take internal treatment. The following formula has given excellent satisfaction:

F. E. avena sativa	1	oz.
F. E. passiflora incarnata	1½	oz.
F. E. Cinchona comp.	2	oz.
Bromidia	1½	oz. ​
Spts. ammonia aromatic	2	oz.
Syr. lactucarium virosa	2	oz.

M. Sig. A teaspoonful every two hours while awake.

To illustrate the use of this method of treatment, we will say that the patient is in the habit of taking forty grains of morphine; we know that he can exist in perfect comfort with twenty grains, we therefore commence our first day's treatment with twenty grains. If the day is passed comfortably, the next day we make a still further reduction of two grains. This reduction is made from one to two grains a day until we have reached the minimum amount which will support him comfortably. If this should require twelve grains we will commence from this amount as a starting point and from now on we will make the reduction so gradual that the patient will not be aware of it. I have the following solution prepared:

Morphine sulphate	96	gr.
Aqua	1	oz.

Mix. Each five minims of the above solution represents one grain of morphine; of this he receives four injections the first day by taking ten minims (two grains of morphine) of this solution and ten minims of the spartein in strychnine solution at about 6:45 and 11:45 a. m., and 5:45 and 9:30 p. m. He is also allowed two powders of one-half grain each triturated with ten grains of sugar of milk, to be taken if absolutely necessary between the injections, allowing him to have only one powder at a time. We will now attempt to reduce the morphine one grain a day for five days. After about two weeks, under judicious management, we will find we have reduced the drug from forty to about six grains a day without much discomfort to the patient. The reductions from now on will have to be made in much smaller amounts. A new solution should be prepared containing one grain to every ten minims and from this solution you can commence by using twelve minims with one-half grain powders if necessary. At the end of another week the patient can be well supported by three grains. By reducing the drug in very small amounts for about three or ​four weeks longer it can be gradually withdrawn altogether without the patients knowledge. During the last three weeks if you have not abandoned the internal powder, it is well to substitute quinine, which has a similar bitterness and cannot be detected by the patient. Of course, you will find there are many complications arising from this treatment the same as there are with others, but by carefully watching the patient and with his co-operation, you can effect a cure in fully eighty-five or ninety percent, of all cases. If the patient is weak and nervous, endeavor to build him up physically and mentally in proportion to the amount of the drug you withdraw. Do not attempt to be in too great a hurry and cause the patient discomfort, for it is better to have the patient in a peaceful state of mind than otherwise, even if it takes longer.

Complete recoveries can be made by this treatment in six weeks in many cases, while in others it will require three months. Although this treatment is condemned by enthusiastic advocates of other treatments, I believe it to be the best medication for the average patient and it is particularly advantageous in the aged and persons with low vitality. If we fail to get the full co-operation of the patient by the gradual reduction method, there is only one alternative, which is the rapid reduction method.

There are two ways generally practiced of reducing drugs rapidly; one is known as the Intermediate Withdrawal Method and the other as the Radical Withdrawal Method; both require much discipline on the part of the physician, and some distress and will power on the part of the patient, for a few days after the drug has been entirely abandoned. The latter can be greatly overcome, however, by appropriate medication. Both of these methods have been largely used at institutes where the patient only had a limited time to receive treatment. Many patients start on this treatment and terminate with the Immediate Withdrawal Method, as will be discussed later.

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The drug can be reduced by this method by either hypodermic or internal medication. I prefer the internal treatment in powder form, triturating the drug with sugar of milk. If you are treating the patient for the morphine habit, duplicate quinine for the morphine as you withdraw the latter. This will give the powder a bitter taste so that it will not be noticed by the patient that you are using less morphine each day, and at the same time you get the tonic effect from the quinine.

The amount by which the morphine is reduced each day will depend upon the amount consumed. To illustrate, if the patient is in the habit of consuming fifteen grains of morphine in twenty-four hours, it should be prepared with sugar of milk as follows:

Morphine sulphate	15	gr.
Sugar of milk	45	gr.

Triturate and divide in as many powders as the patient wishes. He can take these powders at the same intervals as was his former custom. The next day we will make a reductino of two grains and add quinine as follows:

Quinine sulphate	2	gr.
Morphine sulphate	13	gr.
Sugar of milk	45	gr.

Triturate and divide in powders as required.

We will attempt to reduce the morphine two grains a day for the first five days and add two grains of quinine each day, then one grain a day for three days, then half a grain a day for four days. After this, the drug should not be given at all, if possible. Now we commence to reduce the quinine as we did the morphine until the patient requires none of the powders. This is the general plan of treatment by the simple reduction method, but oftentimes we have to deviate from this, and not reduce the drug so rapidly, also giving an extra dose of morphine to allay the nervousness. But this method of treatment should be adhered to as nearly as possible, and be ​sure that the patient gets a smaller quantity of the drug each day. The tonic treatment may be kept up for some time after the powders are abandoned, but it should be taken in smaller doses each day and withdrawn altogether a week or two after the quinine is stopped.

The amount of the drug is much more rapidly reduced by this method than it is by the gradual reduction or intermediate treatments previously given. The patient is allowed the drug to which he is addicted for about seven to twelve days and then it is given up altogether. The method of reduction is to reduce the drug by one-half each day. To illustrate, if the patient should take thirty-two grains of morphine each day, the second day's treatment he receives sixteen grains, the third day eight grains, and so on until the end of the tenth day, when he receives one-sixteenth grain; then it is used no longer. From the time he is allowed less than two grains a day for about ten days or two weeks, he will suffer considerable mental and physical distress, but by successfully bridging him over this critical period by the use of judicious therepeutic measures, he will reach the crisis successfully.

Aside from the hypodermic and tonic treatment he receives during the critical period, a suitable hypnotic and baths should be given to induce sleep. It might be necessary to confine the patient to his bed for a few days and keep him in a semihypnotic condition, by alternating hyoscine with other suitable hypnotics. This method of treatment is rather a severe one and is only a modification of the Levinstein treatment. It can be used successfully, however, in many cases where time is limited and the patient has sufficient courage and vitality to withstand its application. It is this and similar treatments, however, which give institutes a bad reputation, as having a torture process connected with their treatment. It is best never to use this treatment without first explaining the details of the treatment before commencing its use. Patients who ​have taken this treatment are not liable to give the method a very hearty commendation, which often reacts to a disadvantage to the physician's reputation.

A few months ago there was a Dr. Swain located in this city, who afterwards established a sanitarium in Cleveland and advertised quite extensively what was known as the "Three Day Cure." This and similar quick cure treatments used at institutes are described as the "Immediate Withdrawal Method, which is approximately the treatment I wish to outline here. This treatment can be adopted to a good advantage in the young, vigorous, and in new cases. The patient is prepared for this treatment the same as for other treatments, by giving hot air and water baths a few days. Before commencing the treatment remove all foreign matter from the bowels by cathartic remedies; the kidneys should also have diuretic treatment. In the meantime the drug should be reduced to a minimum. After giving these preliminary measures the attention they require and the day comes to commence the treatment proper, the patient is requested to abstain from the use of the drug to which he is addicted until he can no longer resist the craving. Then he may be given a hypodermic injection of five minims of the following formula:

Hyoscine hydrobromide	½	gr.
Tincture rhus tox	5	min.
Tincture apis mellifica	5	min.
Solution boracic acid (2 per cent.)	1	oz.

Mix. Sig. Use hypodermically. Maximum dose ten minims; minimum dose five minims; use according to the directions which follow:

​At the end of fifteen minutes, give him five minims more, and in a half hour he can take ten minims more. The patient will now tell you that his throat is very dry, and he will fall asleep; his sleep will probably last four or five hours. If he should become sleepy after the second dose, five minims will be sufficient for the last injection.

When the patient awakens he will complain of being dizzy; his pupils will be dilated and his face flushed. If he has been asleep four or five hours, he should have another injection of ten minims.

By this time he is getting the characteristic physiological effects of the hyoscine. He will imagine and do all sorts of things. He may cry, sing or imagine he sees funny people; he will pick at the bed clothes, etc. This should not cause you to be alarmed, as all these symptoms are due to the denarcotizing effects of the hyoscine. The patient should be given hypodermic injections at intervals of four or five hours until he has been kept in this condition for a period of twenty-four hours; then discontinue their use and allow the patient to resume his normal mind. He may ask for more of his accustomed drug or he may say that he has no desire for it whatever. If he should still crave the drug, he should be kept under the influence of hyoscine for a period of twelve hours longer then stop the treatment again until he is rational. If he still has a craving, you may again produce the semi-intoxicated condition with the hypodermic injections for a few hours longer, but if he states he has no further use for the drug, and is free from the craving, you should discontinue the hypodermic injections and at once commence giving him the following:

Hyoscine hydrobromide	⅛	gr.
Strychnine nitrate	1	gr.
Nitro-glycerine	¼	gr. ​
F. E. avena sativa	2	oz.
Simple elixir, q.s. ad.	6	oz.

Mix. One teaspoonful every four to six hours.

During the time you are giving the hypodermic injections, the patient may manifest a variety of symptoms. His heart action generally remains about normal, but if it should become weak, give him a hypodermic injection of 1-40 grain strychnine nitrate or 1-100 grain nitro glycerine, if his body is cold. The patient will almost always vomit freely and feel much better afterwards. He may also have fetid breath, dry tongue and free salivation. None of these symptoms should cause you alarm.

Respiration may be accelerated, but this is of little concern. If it should become labored, one-fourth or one-half grain of morphine may be given, which will give immediate relief without retarding the treatment. During the treatment, the patient should have all the water he wants and nutrition should be kept up as much as possible with milk or some one of the prepared invalid foods.

After the patient tells you he has no desire for his accustomed drug, he should commence taking a teaspoonful every four hours of formula No. 2. This should be continued for a few days, according to the needs of the patient, when it should be gradually withdrawn.

The most common complaint of one who has taken the opium cure is insomnia, and it is always best to omit hypnotics. If possible, try to induce sleep by having the patient take hot or cold baths, but, if it is absolutely necessary, you may give from seven to fifteen grains each of hydrate of chloral and bromide of potassium.

A patient undergoing this treatment should be undressed and confined to his room, and have the constant attention of a nurse, who should watch the patient very closely and see that he has a hot or cold bath every day. This has a remarkable soothing effect. Allow the patient to sit up or lie down as he prefers. The bowels should move at least every other day, ​but, if diarrhoea should exist, it should be checked by appropriate treatment.

This method of treatment may be considered rather heroic, but it is not dangerous in selected cases. The patient should never be told beforehand the effects of the treatment, but you can inform his friends if you wish. This is a very successful treatment and will produce remarkable results in curable cases, but I prefer the gradual reduction method when it can be applied.

It becomes necessary at times to change from one treatment to another; this is particularly so if you do not succeed in getting the full co-operation of the patient. You might commence the gradual reduction method and find the patient is taking his drug on the sly, which, of course, detains the progress of the treatment. In such cases the immediate withdrawal of the drug and the use of hyoscine bears the same relation to the opium habit as the apomorphine does to the alcohol habit; it rather compels them to abandon the drug. It can also be used to a good advantage in many cases, where for various reasons, the patient has only a limited time to complete his treatment. I have seen beautiful results from commencing treatment with either the Gradual, Immediate or Rapid Withdrawal Treatment, and when the point has been reached where the patient craves more of the drug than you are supplying him, to place him at once upon the Immediate Withdrawal Treatment and terminate the cure. While on the other hand there are a few selected cases where the Immediate Withdrawal Treatment has been used first and the Gradual Reduction Treatment completed a cure.

As I have previously stated, there can be no stereotyped rule, treatment or medication which can be applied in all cases alike. Although you will find that there are several compli​cations, idiosyncrasies and personal characteristics which may confront you and require your immediate attention as they present themselves during the course of any treatment you deem best suited for any particular case. These complications should be readily met with proper therapeutic measures. The condition of the appetite, heart, kidneys, liver and bowels should always be watched. Endeavor to keep them in as normal state as possible. The heart may become weak and require a stimulant, of which we find strychnine, spartein or nitroglycerine acceptable. The sudden withdrawal of morphine may cause diarrhoea, which may require the use of salol, bismuth, the sulpho-carbolates, etc. Excessive perspiration and night sweats may be checked with atropine. Sickness at the stomach and hyperacidity often require the physician's attention. A morphine addict who has existed upon the drug a long time, pain will be a prominent symptom when the drug is withdrawn; this may be either real or imaginary. Rest, hot air and water baths, accompanied by hypnotics, are the best means of relief. If the patient should manifest symptoms of delirium, some one of the hypnotics mentioned in the "Rest Cure" will be servicable. The treatment of alcoholism and the drug habits in general require remedies thoroughly classed as a heart stimulant, nerve tonics, sedatives, reconstructives, hypnotics, etc. Elimination is the foundation of all curative measures and is well expressed by Dr. Waugh in his favorite quotation "Wash up clean out and keep clean," cannot be used in any disease to a better advantage than in eliminating poisonous drugs, which have found a lodging place in the bodies of habitues for years.

Every accessible source we have in promoting elimination should be utilized. The most important of these is hot air and water baths; these baths have as important a relation in the treatment of alcoholism and the drug habits as quinine does in malaria, or mercury in syphilis. Baths are the one indispensable agent in assisting nature to eliminate the poisonous elements. They should be taken at least as often as every ​other day from the commencement of the treatment and continued for several months afterwards. Baths are not only important as an eliminating process, but they will often relieve pain and induce rest and sleep when other treatments fail.

When the patient has successfully completed his treatment, It is always a good plan to provide him with remedies which will stimulate the secretions of the kidneys and liver and regulate the bowels.

There are many remedies and emergency treatments which might be mentioned here, but every physician is familiar with the therapeutic value of the drugs required, and by carefully observing the condition of the patient during the process of the treatment, he will be able to meet the demands of the different complications and successfully bridge him over the critical period to a successful crisis.

It may seem rather unreasonable to state that the tobacco habit is one of the most difficult to conquer, but such is the case, and in order to effect a cure, the patient has to exercise his will-power to its fullest extent. In this habit we have what may be termed a mechanical as well as a physical and mental condition to overcome.

Those who use tobacco are accustomed to having something in their mouth and they miss this as much or more than they do the narcotic effect of the tobacco. I once treated a patient for the tobacco habit, who used at least three ounces of fine-cut every day, and after the cure was completed, he stated that he had no desire for tobacco, but he must have something in his mouth; he, therefore, chewed wheat. He was still keeping up this practice when I saw him last, four years after taking the treatment. Others want gum, while cigarette, cigar and pipe smokers often like to hold a lead-pencil in their mouth.

The following formula has proved that it meets the demands in curing the tobacco habit in many cases in my practice:

​

Atropine sulphate	⅛	gr.
Tr. nux vomica	½	dr.
Tr. humulus	1	oz.
Tr. quassia	1½	oz.
Tr. gentian	1½	oz.
Tr. cinchona comp.	2	oz.

M. Sig. A teaspoonful every two or three hours while awake.

For the chewing tobacco habit the patient should be allowed a small amount for a few days; he should use fine-cut and use a piece no larger than a bean.

This may be used every three hours for the first day; every five hours the second day; the third day it may be used twice; and the fourth day it should be given up altogether; but every time the patient thinks he wants a chew from this time on he should take a few drops of medicine on his tongue. This will stop his craving.

If the patient smokes, he should be instructed to smoke a pipe instead of cigars or cigarettes. He may have a short smoke of not more than a quarter of a pipe full at a time every three hours the first day, and every five hours the second day; twice the third day, and none the fourth day. The same plan of treatment of taking a few drops of medicine on the tongue will apply to smoking the same as it does for chewing. From now on he need not take a teaspoonful of the treatment every three hours, as the medicine he takes when he has a desire to use tobacco will be sufficient to cure him. The treatment should be kept up for a month or more.

The physician in charge of institutes or sanitariums where these habits are exclusively treated, differ greatly as to the percentage of cures, some claiming ninety-five per cent. and others as low as fifty per cent. These different percentages of success naturally lead us to inquire what may be considered a cure.

​I believe that if we can succeed by proper treatment in placing a patient in a condition in which he does not require or crave any alcohol, morphine or other drug to which he is addicted, for a period of six months, he may be considered cured, and, if he has any strength of character, he can let it alone from that time on. There are always periods after a patient has taken treatment when he has a feeling of loneliness or absent-mindedness steal over him. This cannot be termed a craving, but he cannot help realizing the delightful sensations that were present when he was full of his once accustomed poison. It is therefore many times beneficial to give a good tonic preparation after the regular treatment is abandoned and to tell him that if he should ever have a desire for his liquor or drug to take this preparation for a day or so. This in many cases will carry him through.

Patients of this kind should have their minds occupied either with work, amusement, travel or change of scene, or some other diversion.

If we consider a term of six months a sufficient length of time to pronounce a case cured, the percentage of cures will be much larger than they would if we accept only those cases which are permanently cured. Of the first fourteen cases I treated for alcoholism, the first to relapse was at seven months. From this time up to two years, eight went back to their former habits, one died six months after taking treatment, of pneumonia. Some of these eight took the treatment again, however, and did not drink again for many months. The last time I heard from the remaining five, they were still total abstainers. I have had occasion to note patients who have taken the Keeley and other treatments, and I found that the percentage of cures are about the same. Owing to the lack of association, I believe that the percentage of cures in drug habits is greater. We will always notice that those who drink alcohol want associates, while those who indulge in drugs want secretiveness.

​Even if the percentage of permanent cures may be considered small, this treatment has been instrumental in doing more good than any other temperance cause ever instituted. If its only field of importance were to make homes happy for a period of six months or a year, it would be a worthy practice, but we find, on the other hand, a certain percentage of permanent cures, which bring with them new manhood and happy families. In the foregoing pages I have endeavored to give the details of the different methods of treatment generally used at gold cure institutes, private sanitariums and in private practice. Although the treatment may vary in many instances it is practically all founded upon the methods already outlined. There have been several other methods and secret systems used which have come under my observation, and in order that the physician may broaden his knowledge as much as possible upon the subject, I will append the formulæ and details of several of these secret and non-secret systems.

This method is also often spoken of as the English Method, due to its first being introduced in England by the above author. This treatment consists of placing the patient in a padded cell and suddenly withdrawing all morphine. He is constantly watched by a medical attendant and provided with stimulants or other medication he may require to meet the emergencies as they present themselves. The patient raves and fights until he is often in a state of collapse; at the end of from four to six days his struggle is over, and with appropriate tonic treatment he reaches a successful crisis.

This barbarous treatment needs no mention other than its condemnation, as it requires an extra amount of courage for both physician and patient, although it is successful in many cases. There have been many sudden deaths, and the mortality is much greater than in the use of other treatments.

In opposition to the English method, Dr. Mattison, of ​Brooklyn, has published what he calls the American Method, which is an intervening method of treatment from the cruel method of sudden withdrawal without supporting the nervous system, as practised by Levinstein and avoids the long delay of reaching the crisis by the use of the gradual reduction method. The treatment used by this noted specialist, in brief, is as follows: The morphine is gradually reduced in from ten to twelve days, and as the reduction is taking place the nervous system is supported with increasing doses of bromides. The bromide of sodium is preferred, as it is attended with the least cutanious eruption and is more agreeable and acceptable by the stomach. The sodium is administered twice a day, at ten a. m. and ten p. m.

To illustrate, the patient states he generally uses about thirty grains of morphine each day; we find this about one-third more of the drug than is necessary to support him comfortably. We therefore commence the first day's treatment with twenty grains of morphine; from now on we reduce two or more grains a day until at the end of ten days the drug is entirely withdrawn.

To support the nervous system and produce sedation the bromide of sodium is given in increasing doses, as the morphine is withdrawn. The first day the morphine is reduced three grains and the patient receives ten grains of the bromide of sodium twice daily; the next day the morphine is likewise reduced and the sodium increased to twenty grains twice a day; the third day another reduction is made with the morphine, and the patient receives thirty grains of the sodium each morning and evening, thus the decrease of morphine and the increase of sodium is kept up until the morphine is entirely withdrawn and the patient is taking the maximum dose of sodium bromide, which might reach to seventy-five or one hundred grains daily. The object of this treatment is to produce sedation and conquer all nervous manifestations by large doses of the bromide.

The length of time required to carry out this treatment ​and the amount of morphine reduced each day and the quantity of bromide required to produce sedation, will depend largely upon the condition of the patient and the judgment of the physician. The patient should not have any stated amount of the bromide, but sufficient to produce complete sedation at all times. After the patient has taken this treatment a few days, he will appear to be drowsy and want to sleep: he may also manifest symptoms due to the increased amount of bromides he has taken, i.e., acne, fetid breath, etc. All these symptoms may be absent if the bromide of sodium causes an increased action of the kidneys, as it often does. After the patient takes his last dose of morphine he may require a few injections of codeine to carry him through the critical stage. Insomnia is often present and is treated with trional. For pain and restlessness he gives large doses of fluid extract cannabis indica. thirty to forty minims.

Dy Marrison has devoted many years of his life as a socialist in drug addictions and has been remarkably successful with this method, of which he is the originator.

A physician who was in charge of one of the Keeley Institutes and who afterwards conducted a sanitarium of his own, for the cure of alcohol, drug habits and nervous and mental diseases, published a little booklet giving the methods of treatment which he used and which he claims were identical with the methods used at the Keeley Institute. This booklet was sold to physicians for $25,(illegible text) and had many purchasers, and I believe the treatment he gives is reasonably correct, as I have met several physicians who had charge of similar institutes and are willing to vouch for its accuracy. Space will not allow me to publish the entire article, which to a certain extent would be only a repetition of what has been said, but I will give the formulæ of some of the preparations used, and the reader can judge for himself as to their value.

​

Boracic acid	4	gr.
Strychnine nitrate	½	gr.
Aqua dest.	1	oz.
Tr. cudbear	q. s. color

Sig. Dose five to ten minims, four times a day.

Atropine sulphate	½	gr.
Boracic acid	20	gr.
Aqua dest.	1	oz.

Mix. Sig. Dose five to eight minims.

Apomorphine	4	gr.
Boracic acid	20	gr.
Aqua dest.	1	oz.

Mix. Sig. Dose six to ten minims.

Thein. mur.	8	gr.
Boracic acid	20	gr.
Aqua dest.	1	oz.

Sig. Dose five to ten minims.

Pilocarpine mur.	8	gr.
Boracic acid	20	gr.
Aqua dest.	1	oz.

Mix. Sig. Dose five to six minims.

Morphine sulph.	8	gr.
Aqua dest.	1	oz.

Mix. Sig. Dose fifteen to thirty minims.

It will be noticed that the name of the solution is an abbreviation of the active ingredient contained. To illustrate, "Solution "A" is atropine, "S" is strychnine, etc.

​

When the patient enters the institute he is given a mixture containing the following:

Gold and sodium chloride	30 gr.
Strychnine nitrate	4 gr.
Atropine sulphate	1 gr.
Glycerine	2 oz.
Fl. ext. cinchona comp.	q. s. ad.	16 oz.

Mix. Sig. One teaspoonful in water three times a day.

In addition to the internal remedy, the patient is also given hypodermic injections from the solutions that the physician deems the patient requires. The atropine solution is generally pushed, until patients get the full physiological effect of the drug. The apomorphine is used when it is desired to produce the sickening process. You will notice that the solutions are colored conveniently for the "barber pole shot." After the desire for liquor has been conquered the patient is given hypodermic injections from Solution "S", and the following internal remedies throughout the balance of the treatment:

Ext. cinchona solid	40	gr.
Grd. gentian root	2	oz.
Powd. capsicum	20	gr.
Grd. bitter orange peel	½	oz.
Glycerine	3	oz.
Aqua	2	qts.
Caramel	q. s. to color

Mix the first four drugs in the water and boil twenty minutes; remove and filter; then add the glycerine and caramel.

Sig. One teaspoonful every two hours in water.

Pepsin sacch.	1 dr.
Bismuth subnit.	1 dr.
Powd. capsicum	20 gr.

Mix. Ft. powders XXX. Sig. A powder every three or four hours.

​

Tr. cinchona rub.	2	oz.
F. E. kola	2	oz.
F. E. scutellaria	1	oz.
Elix. aromatic	q. s. ad.	6 oz.

Mix. Sig. One teaspoonful in water four times a day.

F. E. calumba	½	oz.
Tr. quassia	½	oz.
Alcohol	½	oz.
Aqua	q. s. ad.	4 oz.

The hypodermic treatment consists of injections from Solution "T" four times a day, and an occasional injection from Solution "P," or if the "sickening process" is required, from Solution "A P."

Dr. J. L. Gray, of Indiana, was among the first to use the so-called "Gold-cure" for the alcohol habit, and his method was made publicly known through Prof. Edmond Andrews, of Chicago, who published an article on it in one of the Chicago papers. The treatment given was as follows: On entering the institute the patient was given a hypodermic injection four times a day, containing one-tenth grain of chloride of gold and sodium, and one-fortieth of a grain of nitrate of strychnine. He also received a mixture to be taken by the mouth composed as follows:

Chloride of gold and sodium	12	gr.
Muriate of ammonium	6	gr.
Nitrate of strychnine	1	gr.
Atropine	¼	gr.
Comp. fl. ex, of cinchona.	8	oz.
Fl. ex. of coca	1	oz.
Glycerine	1	oz.
Aqua des.	1	oz.

Mix. Sig. Take a teaspoonful every two hours when awake.

​I have used this treatment on several cases and find it is an excellent one, but do not believe that it is necessary to give such large doses of gold and sodium and strychnine, as they cause the muscles to twitch and an eruption to break out on the skin in many cases.

Since the first edition of this publication I have received many letters from physicians wishing to sell secret formulæ, of which this is an illustration: This treatment came from Dr. J. E. Clark of Hiattsville, Kansas, who claims it was formerly obtained from a Dr. Williamson, who was the attending physician at the Anti-Narcotin Institute, of St. Louis, Mo. Although it offers no special advantage over other treatments already given, it illustrates the simplicity of another "great cure," for which I gave approximately $10.50.

Hyoseine hydrobromate	1-100 gr.
Pilocarpine	1-100 gr.
Strychnine nitrate	1-100 gr.
Atropine	1-600 gr.

The above medication is given hypodermically every three hours, missing the treatment at twelve and three at night, during which time the patient generally sleeps. The directions for using, which came with the treatment, are as follows: On the evening before commencing the treatment the patient should be given a full cathartic and remove all foreign substance from the bowels; on the morning of the first day's treatment, the patient is allowed his usual quantity of morphine, and about two hours afterwards the above treatment is commenced and given at regular intervals.