The abject mental state of the patient calls for much firmness, gentleness, and tact on the part of the physician and attendants. Every effort should be made to inspire courage and hope. Neither the importance of the symptoms nor the intensity of the sufferings of the patient should be underrated; nevertheless, the ordeal is a limited one. In the majority of instances, to get rid of the opium means to get well, because opium, unlike alcohol, does not leave permanent structural lesions of any organ. The expectation of a radical cure must therefore be confidently presented to the patient as a consolation in his sufferings.
With the return of convalescence sexual power is restored and menstruation is re-established. Insomnia and muscular weakness usually persist into the convalescence for some weeks, and only gradually yield to careful regulation of the daily life of the patient, with abundant nutritious food, open-air exercise, and change of scene. The insomnia of this period constitutes a serious symptom, for the reason that it constantly subjects the patient to the temptation to return to the use of hypnotics. In the course of time, however, the normal physical and mental condition is regained, and the patient may be permitted to return to his former pursuits and associations.
The Treatment of the Chloral Habit.—That which has been said in the foregoing pages concerning the prophylaxis against the opium habit applies with equal force to chloral and other narcotics. The curative treatment of habitual addiction to chloral is attended neither by the difficulties nor the dangers which are encountered in the management of the opium habit. The symptoms attending the discontinuance of chloral are less severe and less persistent; in fact, individuals accustomed to the taking of large doses of chloral not infrequently voluntarily discontinue its use for considerable periods of time. As a rule, the treatment may be carried out at home, the patient, however, being isolated and cared for by a watchful attendant. The drug should be stopped at once. For the first few days alcoholic stimulants should be freely given. Systematic feeding, pepsin, full doses of quinine, followed after a time by strychnia, and, as soon as the condition of the digestive system will permit of it, by iron, fulfil the general indications. Cod-liver oil and malt extracts may be given with advantage. Cardiac failure, collapse, and delirium tremens are to be treated in the same manner as similar complications occurring in the treatment of the opium habit. Vomiting is much less likely to occur, and when present is less persistent and less difficult of management. Diarrhœa does not usually prove troublesome, the bowels, on the contrary, being constipated. The latter condition yields to mild laxatives or to simple enemata. Hemorrhages from the various mucous tracts may be controlled by fluid extract of ergot, the hypodermic injection of solution of ergotin, minute doses of wine of ipecac, or fluid extract of hamamelis. The conjunctivitis which is occasionally present usually subsides spontaneously upon the discontinuance of chloral. It may be treated by instillations of a 2 per cent. solution of cocaine and mild borax lotions (grs. v to fluidounce j). The after-treatment must be carefully carried out. Relapses are less frequent than after the opium habit.
The Treatment of Habitual Addiction to Paraldehyde, Cannabis indica, Ether, Chloroform, etc. must be based upon the general principles indicated in the foregoing pages. Cases of the habitual abuse of these drugs are comparatively infrequent on the one hand, and on the other do not often present the serious and progressive symptoms produced by excesses in opium and chloral; hence they come but rarely under the care of the physician, except in those unhappy individuals in whom the propensity to vicious narcotism is such that any drug capable of producing excitement and oblivion is made the means of gratification, and all are used by turns as the opportunity occurs.
CHRONIC LEAD-POISONING.
BY JAMES C. WILSON, M.D.
DEFINITION.—The term chronic lead-poisoning is used to designate the morbid phenomena induced by the gradual accumulation of lead in the organism.