Di-acetyl morphine, or heroine, of which the hydrochloride, soluble in alcohol and water, is in use, is somewhat like codeine, its powers to diminish pain and to promote sleep being less than those of morphine, while its tendency to produce reflex excitability is greater. It is excreted partly by the kidneys and partly by the intestines.

In Heinz's rabbit experiments, 1/65 grain (0.001 gm.) caused a reduction of the respirations from 120 to 18 in forty minutes and reduced the volume of air inspired from 880 c.c. per minute to 240 c.c. Hence the individual inspirations are increased in depth, but the respiration is so slowed that the intake of air is considerably reduced. It is about five times as depressing to the respiration as morphine, and Heinz says that it is about thirty times as depressing as codeine; while Gottlieb and Magnus state that even very small doses may show a dangerous effect upon the respiratory center. Worth Hale reports it as depressing to the circulation.

In over 100 cases of pulmonary tuberculosis the author made a clinical comparison of its action with that of codeine, giving each drug many times to the same patient. One-twelfth grain (0.005 gm.) of heroine hydrochloride was compared with 1/4 grain (0.0015 gm.) of pure codeine, or 1/6 grain (0.01 gm.) of heroine hydrochloride with 1/2 grain (0.003 gm.) of codeine. The codeine proved superior in its power to allay cough, to overcome pain, and to promote sleep. In several cases the heroine produced nausea and constipation, and in one woman who was regularly excited by morphine, heroine produced the same excitement, while codeine did not. Heroine would seem, therefore, to possess some of the undesirable properties of morphine. Its chief employment is to check cough.

The heroine habit. Like morphine, heroine is the cause of a "vicious" habit that in a very few years has become wide-spread. It is usually taken by mouth or hypodermatically or by snuffing. By the last method it causes nasal congestion followed by atrophy.

1 have one old patient who for several years obtained his heroine in certain proprietary cough remedies; he was easily switched to codeine and then broken of the habit. Brooks and Mixsell report

2 cases, one taking 6 ounces (150 c.c.) of "gly co-heroine," a proprietary remedy, and the other 10 to 15 grains (0.7-1 gm.) of heroine per day. Both were cured through the substitution of codeine. In some instances the habit is very difficult to cure. Wholey reports a case using hypodermatically one hundred 1/6 grain (0.01 gm.) tablets a day. The symptoms after withdrawal are pains in shins and legs, coarse tremor of hands and fingers, nervousness, headache, insomnia, and stomach discomforts. The treatment is the same as that for the morphine habit. In experiments with dogs it has been shown that tolerance, similar to that from morphine, is readily established.