This amount I divide into three equal doses--one to be administered
after each meal. By administering them after meals I give nutrition
the start of narcotism, prevent the violent action possessed by
stimulants and opiates on the naked stomach, and secure a slower, more
uniform distribution of the effects throughout the day. The position
of the third dcse after the 6 o'clock meal of the day is particularly
counselled by the fact that opium is only secondarily a narcotic, its
sedative effects following as a reaction upon its stimulant, and the
third dose accordingly begins to act soporifically just about
bed-time, when this action is especially required.
I keep a glass for each of my patients, upon which their "high-water
mark" is indicated by a slip of paper gummed on the outside. When
Mr. Edgerton, pursuant to our stipulation, comes to me for his dose, I
drop into the glass before his eyes a shot about the size of a small
pea--then fill the glass with Magendie's Solution up to the mark
indicated. (This shot varies in each case with the rapidity of
diminution I think safe to adopt. In some cases it is a buckshot or a
small pistol bullet.) Every day a new shot goes in--and if he bears
that rate of progress I may even drop one into the glass with each
alternate dose.
Midway between the doses of morphia I give Mr. E. a powder of bromide
of potassium, amounting to 30 or even 40 grains at a time, and an
average of about 100 grains per day. The value of this remedy has been
a matter of much controversy--some practitioners lauding it to the
skies as one of the most powerful agents of control in all disorders
of the nervous system, others pronouncing it entirely inert. Where it
has proved the latter it has probably been given in too small doses or
not persevered in for a sufficient length of time. (The timidity with
which it is often prescribed may be seen in the fact that one of the
principal druggists on Broadway lately warned a person to whom I had
given a prescription for 30 grain doses that he was running a very
dangerous risk in taking such a quantity!) Its operation is so
entirely different from that of the vegetable narcotics that people
looking for their instantaneous sedative effect can not fail to be
disappointed. It is very slowly cumulative in its action, seeming to
act upon the nervous system by a gradual constitutional change rather
thin any special impetus in a given direction. Because that is its
_modus operandi_, I begin to give it thus early; and it is of
peculiar value now, not only as making the daily diminution of the
opium more tolerable, but as preparing the system for the time when
the drug is to be abandoned altogether and the hardest part of the tug
comes.
Public-domain text, read in full here on John Shaqi.
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