TRIONAL, 
The New Hypnotic. 
ITS USE IN NARCOTIC HABITUES. 
- BY - 
J. B. HATTISON, H. D., 
Medical Director, Brooklyn Home for Habitues. 
Read before the Brooklyn Neurological Society, 12 April, 1893. 
REPRINT: 
Medical News, 6 May, 1893. TRIONAb, THE NEW HYPNOTIC.* 
J. B. MATTISON, M.D., 
MEDICAL DIRECTOR OF THE BROOKLYN HOME FOR HABITUES. 
r I RIONAL is one of the latest additions to our soporific resources, 
JL and, along certain lines, there is reason to think it the greatest. 
First used in the Hamburg Hospital, reports of its value have come 
mainly from German sources, but I have given it one hundred times, 
with a measure of success that prompts me to make this report- 
the most extensive yet presented, in English. 
Trional, like sulfonal, depends, for its power, on the presence of 
ethyl groups, and in color and taste the two drugs are much alike. 
Trional can be given in fine powder on buttered bread or meat, in 
hot tea, soup, or milk ; or dry, on the tongue. It is sedative, but not 
analgesic. Pain prevents its hypnotic action. 
Boettiger, of Bonn, last year reported the results of an extensive 
therapeutic study of the drug, based on his use of it in seventy-five 
cases of insomnia, simple and primary, or due to pain or psychic 
excitation. In regard to ordinary agrypnia, his testimony is in 
accord with that of others-that trional is a prompt and effective 
soporific. In these cases, he gave doses of from i to 2 grams, which 
induced sleep in from 15 to 75 minutes, and lasting for from 6 to 9 
hours. The sleep was usually deep, quiet, dreamless, and unbroken. 
In the treatment of agrypnia associated with posterior spinal sclerosis, 
it failed. 
Schaefer also found trional useless when physical pain was pro- 
nounced. In cases of hysteria, deep sleep was produced by 1 gram. 
In 33 cases of insomnia attending mental disease, doses of from 1 to 2 
grams brought sleep within 90 minutes at longest, and lasting for 
from 6 to 10 hours. The drug failed in one case of paralysis and one 
of hallucinations attending senile marasmus. It proved effective in 
chronic alcoholic dementia, unattended by mania or hallucinations; 
but not in acute hallucinatory alcoholic delirium. 
In marked mental excitement, Schaefer describes his results as 
" astonishingly good." He cites a paralytic, restless, crying, and 
destructive, in whom it acted kindly after hyoscine had failed. In 
* Read before the Brooklyn Neurological Society, April 12, 1893. some cases good results followed the administration of i-gram doses 
several times daily. 
Among the 75 patients to whom trional was given, in only 7 was 
there no effect. In 20 cases the sleep was short and slight, and in 
most of these the failure was ascribed to the smallness of the dose, 
which varied from 1 to 4 grams, the maximum being 6 grams in 
twenty-four hours. In several cases, doses of from 1 to 2 grams were 
given repeatedly during the day. To secure sleep or quiet at night 
the drug was given between 8.30 and 9 p.m. 
The drug was given by the bowel 24 times in doses of 2 grams; it 
was rejected but once. The results were as good and as prompt as 
when given by the mouth. In 6 cases the effect continued through 
the forenoon after the day of administration. Two failures were due 
to physical pain and one to hysterical excitement. No irritant after- 
effects were noted. Changes in pulse and breathing were not observed. 
Anorexia, vomiting, and diarrhea were present in one case, after a 
dose of 4 grams. Six patients complained of vertigo and 10 of lassi- 
tude on the day after the administration. On several occasions it 
was found that 1 gram of trional proved as efficacious as 3 grams of 
chloralamid or amylen hydrate, while 2 grams had a much stronger 
action than 3 grams of either of the other remedies. Boettiger thinks 
3 grams the maximum dose. 
Brie, of the provincial Asylum, Bonn, in a paper published last 
December, reports a similar experience, which is confirmed by that of 
Schultze, Schaefer, Barth, Rumpel, Garnier, Ramoni, and Mariottini. 
Schultze gave 1000 grams to 76 different patients with such good 
results that he places it in the front rank of hypnotics. Schaefer gave 
it in 77 cases, both by the mouth and by the bowel, in doses of from 
| a gram to 4 grams, with such good effect that he thinks it leads the 
list of soporifics. 
Mariottini asserts, from his experience, that trional has double the 
power of sulfonal, and that it is much speedier in effect. He gave it 
in fine powder, in milk or tea, from 10 to 20 minutes before retiring, 
and secured from 6 to 7 hours of sleep. In only one case did he note the 
gait to become ataxic. No toxic effect was observed, and none upon 
temperature, circulation, respiration, stomach, or bowel. 
Mabon,* of the Utica State Hospital, gave trional 35 times to 10 
lunatics, with good results ; in most cases in doses of 1 gram, in hot 
milk, at bedtime, which were followed in from 15 to 45 minutes 
(though sometimes not for two hours) by from 6 to 9 hours of dream- 
less sleep. Schultze found trional active in 75 per cent, of his cases, 
Schaefer in 86 per cent., and Boettiger in 89 per cent. 
I have, since last December, given trional 100 times, with success 
in 90. All the patients were, or had been, opium, chloral, or cocaine 
* American Journal of Insanity, vol. xlix. No, 4, p. 579. habitues-certain conditions of which test strongly the power of any 
hypnotic. The drug was given dry on the tongue. The initial doses 
were full-40 grains for males, 30 grains for females-and were 
usually given at 7 p.m. I have known sleep to come in half an 
hour after the administration of the drug, but in most cases it was 
delayed, as with sulfonal, for three or four hours. The sleep was 
sound and refreshing, and lasted for from 4 to 11 hours. 
The maximum amount of slumber occurred in a morphine-cocaine 
case of some years' standing, kindly brought to me by Dr. Hedges* 
house-physician of the Presbyterian Hospital. In this case trional 
acted surprisingly well, the first dose of 40 grains being followed by 
11 hours slumber; other doses, of from 30 to 40 grains, giving 8, 
9, and 10 hours sleep. In five weeks the man left, with normal 
sleep and free from drugs. 
In a case of ten years' chloral taking, reaching a maximum of 120 
grains nightly, trional served an excellent purpose, no chloral being 
given after the first night. The initial dose was 40 grains, which was 
gradually reduced, during three weeks, to 15 grains, when all hyp- 
notics-save a psychic soporific-were withdrawn. Five weeks later 
the man was dismissed, cured. 
In a twelve years' case of morphinism, notable from the fact that 
the woman, on coming to me, was taking only of a grain subcu- 
taneously daily-a condition quite exceptional and largely due to the 
drug not being self-given-trional, in doses of from 20 to 30 grains, 
was the only soporific used. It worked well. The lady recovered. 
In several other cases the drug acted satisfactorily. No ill effect 
on pulse or breathing was observed. In one man and in two women 
vertigo was noted, and in two male morphine-cocaine cases the gait 
was decidedly "groggy " the day after. In one woman a dose of 30 
grains seemed to cause a sharp but short attack of gastric cramp, 
which subsided without treatment and did not recur. 
In another case, a morphine habitue, a dose of 40 grains caused 
severe epigastric pain and repeated vomiting. Another trial gave a 
like result. This case was not a fair test, as the man was more 
largely burdened with idiosyncrasies than any one ever under my care 
-chloral, sulfonal, and paraldehyde each causing gastro-intestinal 
derangement, without sleep, which was finally secured by two doses 
of 5 and 10 grains of extract of cannabis indica at an interval of two 
hours. 
In several cases the sedative and hypnotic effect was prolonged to 
the day after the administration, and in some till the second day-the 
drug in this respect resembling sulfonal. This prolonged sedative 
effect was marked in one woman, who slept all night after a dose of 
30 grains, and was quite free from nervous unrest on the following 
day, this symptom returning when the trional was omitted. In another more recent case of morphinism the patient had 8 
hours of unbroken sleep after taking 30 grains; he felt calm on the 
following day, and slept well again at night without the drug. This 
patient, a physician, declared that the effect was more profound than 
he had ever experienced from sulfonal, chloral, or paraldehyde. He 
also asserted that a marked psychic effect was produced, closely akin 
to that caused by morphine-so much so as to suggest a decided risk 
of tolerance if the drug were long continued. 
In all cases of failure with trional that I have noted, other than 
the one case of gastro-intestinal disorder, there is reason to think it 
mainly due to the under dose. 
Careful comparative observations were made as to the effects of 
equal doses of trional and sulfonal. The result was always in favor 
of the former. 
There is a consensus of opinion as to the hypnotic power of 
sulfonal in the early abstinence-time of narcotic inebriety-a time 
when chloral and paraldehyde fail to do good-but I think sulfonal 
is surpassed in this condition by trional. It has been along this line 
entirely, with one exception, that my trials with trional have been 
made, and I am bound to say that I regard it of special and superior 
value in this condition. The agrypnia of this period is usually so 
profound that full doses of any soporific are essential, and I commend 
one maximum rather than two medium doses.-For details of its use 
in these cases, see "The Mattison Method in Morphinism reprint 
at command. 
In simple insomnia doses of from 20 to 30 grains will suffice. In 
marked cases from 30 to 40 grains are best. Trionalism is possible. 
I have found the effect of trional more certain, pronounced, and 
prolonged than that of sulfonal, and my experience, with that of 
foreign physicians, warrants me in thinking it, in some conditions, 
the most powerful hypnotic we now possess.