The digestive tract and the heart demand special attention.
Gastro-intestinal disorders may be prevented by the use of bicarbonate of soda (2-6 grams daily), and cardiac failure by heart stimulants, such as caffein, strophanthus, or digitalis.
A morphine addict cannot be considered cured until a long time has elapsed after the suppression of the drug. The return to normal life is for him a critical moment; for this reason isolation in an institution should be continued for at least several weeks after the last injection.
This prolonged detention is further justifiable by the grave complications, notably fatal epileptiform attacks, which may occur long after complete demorphinization.
1 Sollier. La demorphinization. Presse medicale, April 23 and July 6, 1898.
3 Joffroy. Traitement de la morphinomanic. Gaz. hebd. de Med. et de Chirurgie, 1899 and 1900.
In spite of all these precautions permanent cures are the exception and relapses the rule.
Cocaine addiction differs but little in its general aspect from either morphine or heroin addiction. In the course of it, however, arises occasionally a special variety of delirium.
It is a delirium of a painful character associated with delusional interpretations; its main features consist in psycho-sensory disorders which, in spite of their extraordinary distinctness, are coexistent with perfect lucidity. The illusions and hallucinations may affect all the senses, but especially vision, touch, and the muscular sense.
Objects change their shapes and are constantly moving. A patient of Saury's l felt himself assailed by a swarm of bees which he could see and feel. Patients feel worms creeping over their bodies or coming out of their flesh; they see them, seize them with their fingers, and crush them under their feet. Many also perceive imaginary movements; the ground shakes beneath them, their bed is upset, or the house they are in, swept by a flood, floats upon the waves. Hallucinations of hearing, taste, and smell, though not rare, occur less frequently than the preceding and present no special characteristics.
Sometimes the delusions assume the form of morbid jealousy, as in alcoholic psychoses.
The reactions of the patient are governed by the delusions and are often violent.
The duration of the attack is brief, several weeks at the longest, and in some cases but a few days. We have seen a typical case of cocaine delirium terminate in forty-eight hours.
The treatment consists in suppression of the drug, which can in the great majority of cases be accomplished by the rapid method without serious inconvenience.
1 Saury. Cocalnomanie. Ann. med. psych., 1889.