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Abstract
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As surmised in an annotation in tlle BRITISH MEDICAL JOURNAL of March 21st (p. 570), it is likelv that death from veronal poisoning is more common than statistics indicate. May I suggest a probable cause for the mortality, and a possible remedy? We have four salient facts-at least, judging from my own experience, they seem facts to me. (1) The drug is so potent that, given properly and in ordinary insomnia, it is rarely necessary to prescribe more than 5 grains, and usually 21 grains is sufficient. (2) There is no clear evidenoe of habituation; its victims merely desire drowsiness, not other sensations as well (as in the case of alcohol, opium, and cocaine); given natural sleep it is not desired; no more, and no less, than procures sleep is desired; as time passes there is no augmented craving, and the same dose continues to produce the same effect. (3) The action is delayed-four, five, or six hours. (4) Apart from deliberate suicide, in every case of death the victim has tried to procure immediate sleep.
The case of a London clubman is instructive and typical. During an attack of insomnia he took 10 grains at bed- time, which in his case was late. He was wakeful that night, but " deadly drowsy " next day, a circumstance which he attributed to lack of sleep. The following niight he took 15 grains. Again he was wakeful; but in the after- noon slumbered so profoundly at his club that the attendants had difficulty in rousing him. Manifestly heavy and stupid, he went homiie, and subsequently had difficulty in clearing himself from a charge of drunikenness before the club committee. " Veronal is nio good; it has not the smallest effect on me," lie declared. On a later occasion, when ignorant of thc remiiedy applied, he was giveii 5 grains in the early evening. He described himself az, get;ting " a heavenly niight," but as being too sleepy in t'he mor.-iing. Thereupon he was given 21 grains, also in the f-vering. Now he had perfectly natur-al sleep " with no apparenit drowsiness till he went to bed, and none after he rose. He was then told the facts and informied that the fit of insomnia was probably brokeni, whicll proved to be the case. He still takes veronal, but rarely, and never in more than 21-grain doses. I could quote many similar instances. But doubtless tndividtials vary.
It seems evident tlhat, apart from deliberate muicide, excessive. doses are taken only because the victim, ignorant of the delayed action, makes more and more strenuous efforts to procure immediate sleep. I suggest that patients shall always be informed of the delay, anid that a label shall be affixed to every packet affirming the uselessness of veronal as a quick remedy for wakefulness |