In my third book (I call it Renting Silence, but the publisher has yet to weigh in on that), I use Veronal to, ahem, rid myself of some shady characters. Veronal was an over-the-counter sleeping potion that was occasionally misused for suicide. I needed to know how much it would take to kill someone and how long it would take to work, so I asked my favorite pharmacist, Dr. Mark Pugh, and found this information (red highlights are mine):
This from JAMA, 1925, an abstract of a longer article.
The use of barbital (veronal), or diethylbarbituric acid, as a hypnotic has constantly increased since its discovery in 1903. It is an effective drug with a considerable margin of safety, may be obtained in most localities without a physician’s prescription, and the possibility of its producing a habit is not generally appreciated. These reasons have been partly responsible for its popularity with both the laity and the profession. Medical literature, however, particularly in Germany and England, contains many reports of severe poisoning and fatal results from its use in excessive doses or in long continued administration. Its action is quite rapid, ordinarily producing sleep in from one-half to one hour, and in moderate doses is seldom followed by distressing after-effects. From 70 to 90 per cent, of the ingested drug is eventually eliminated in the urine; but its excretion is slow and is often extended over a period of from
This from the British Medical Journal of March 28, 1925.
SIR,-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 bedtime,
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,
MARCH – 8, I9251 CORRESPONDENCE. TEEBRmsw 631
he went home, anld subsequently had difficulty in clearing
himself from a charge of drunikenness before the club committee.
” Veronal is no good; it has not the smallest effect
on me,” he declared. On a later occasion, when ignorant
of thc remedy applied, he was given 5 grains in the early
evening. He described himself as, getting ” a heavenly
niight,” but as being too sleepy in the morning. Thereupon
he was given 21 grains, also in the evening. Now he had
perfectly natural sleep ” with no apparent 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
broken, which 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 individuals
It seems evident that, apart from deliberate suicide,
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. I am, etc.,
Soutlisea, March 23rd. G. ARCHDALL REID.
This from the California State Journal of Medicine, March 1914:
A CASE OF VERONAL POISONING.*
By EDWARD SWIFT, M. D., Los Angeles.
The patient was a woman of 42 years. She had
always been in good health, but was of a highly
neurotic temperament. At 11 a. m. I was called to
sef her, though I had seen her the night before
when she was apparently in perfect health but
somewhat worried over some domestic troubles.
I received the telephonie call from her brother, who
informed me that though his sister had gone to bed
the previous night at 10 o’clock, she had as yet
shown no evidence of awakening.
On examination I found the patient in coma from
which it was impossible to awaken her; no response
from pressure over supraorbital nerve. There was
no cyanosis; pulse 60 and of good quality; tempera ture
normal; respirations 22. I immediately washed
out her stomach with warm water, after which six
ounces of black coffee and one egg was administered
through the tube. Normal salt was given per
rectum by the drop method (two quarts at this
time). When I saw her a few hours later she was
in the same condition, though her respirations were
slightly deeper. About 4 a. m. the following morning
she became cyanotic, her breathing, which had
gradually been getting deeper, became stertorous,
her pulse weak and irregular, being intermittent at
times. Her temperature still remained normal.
Caffeine sodium benzoate in doses of gr. i and camphor
and ether in doses of m. x were given for cardiac
stimulation. This treatment only improved the
pulse temporarily. Her respirations gradually be came
more and more stertorous, and by three in the
afternoon she developed signs of pulmonary congestion.
This gradually increased until there were
signs of well marked edema of the lungs.
Her cyanosis gradually increased in spite of oxygen
inhalations and hypodermic injections of atropine.
Adrenalin was given without benefit. At 4-
p. m. her stomach was washed out and the return
consisted of brown fluid with a decided fecal odor,.
and containing some particles of fecal matter.
There seemed to be a loss of tone of the intestinal
tract, for enemas given were not expelled.
The patient died at 5 p. m. Just before death hertemperature
gradually increased to 105°, respirations
developed into the Cheyne-Stokes type. Her
pulse became weaker and weaker until it was im–
perceptible at the wrist. The function of the kid neys
was lessened and in the last twenty-four hours.
of her life only two ounces of urine were to be obtained
by catheter. Altogether she received one
gallon of normal salt by the drop method, but this
seemed to have no effect upon the secretion of
urine. Hot packs and dry cups over the lungs w’ereused,
but nothing seemed to be of any avail.
On investigation it was found that she had taken
one hundred (100) grains of veronal just prior to.
retiring for the night.
The following references may be of interest:
Sterling in the Australian Medical Journal, May-
17, 1913, reports a case in which one hundred and
twenty-five (125) grains were taken with recovery.
Patient was found a few hours after taking.
* Read before the Los Angeles County Medical Society.
January 15, 1914.