It may sometimes be necessary, when the pain has become so maddening
and been so protracted, to save the brain from the delirium of
exhaustion (or even as I have known to happen, _death_) by
procuring sleep for half an hour at any cost save that of a
return. The most interesting patient and noble man whose sufferings
compose the text and prompted the writing of my _Harper's
Magazine_ article, died just as it was going to press through the
exhaustion of a brain that had no true sleep for months. To avoid such
a termination, sleep must be had at any cost, and even the danger
attending chloroform or ether must be risked, though I need not point
out the necessity of pre-eminent wisdom, and the constant personal
presence and watchfulness of symptoms, in the physician during the
time that the anaesthetic is inhaled. Of ether as much as three or
four ounces may be inhaled during a single evening without much
danger, if the precaution of alternating the inspirations from a
saturated handkerchief with those of pure atmospheric air be carefully
attended to. Chloroform is much more risky, and almost always tends
to derange the stomach for several days after its use, still its
action is certain in some cases where ether fails even to obscure
sensation, and must be resorted to. A single ounce per evening,
inhaled with rather longer intervals between whiffs, need not be a
perilous dose, and in my experience has often conferred magical
relief. Nitrous oxide is too transient to be of much use, but to the
extent of twenty or thirty gallons may be used with pleasant effect
and about five minutes of alleviation.
Very different from these powerful agents is the humble,
much-neglected _scutellaria_. It has been repeatedly pronounced
inert, but is beyond all question a minor sedative of charmingly
soothing properties, giving sleep, as I have sometimes witnessed, out
of the very midst of intolerable rythmical neuralgic suffering--in one
case the first sleep the patient had enjoyed since leaving off
opium. It may be given with impunity in much larger doses, but on
those constitutions with which it has any effect at all a
table-spoonful is usually efficacious about ten minutes after its
exhibition in the form of fluid extract. Lupulin, valerian,
valerianate of zinc, and hyoscyamus (or with a much less tendency to
derange the stomach, _hyoscyamin_ in 1/10 grain doses) all have
their value in the less violent cases or toward the close of the
struggle. Capsicum, in the five grain doses earlier mentioned, may
often be relied on to counteract the tendency to frightful dreams
arising from the exquisitely irritable state of the stomach in which
the opium-habit leaves its victims.
Public-domain text, read in full here on John Shaqi.
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