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Occasionally a patient will have the delusion that he must take the drug to allay the pains of some imaginary disease, while in reality the discomforts endured are "morphin" pains, pure and simple, instead of the disease suspected.

There is necessity for consideration of the disease and its treatment. Will others add to knowledge on the subject? DR. C. E. PATTERSON.

Grand Rapids, Mich.

The Abuse of Opium.—A Clinical Picture. Editor MEDICAL WORLD:-It seems as tho the best remedies placed in our hands for good are the most abused. Opium, the great sheet-anchor in treating acute inflammatory diseases, in the hands of the thoughtless or unwise physician is proving a curse. The abuse of opium is modern. It is only about a quarter of a century that the opium-habit has made great inroads. upon the moral, physical and intellectual status of our nation. Hippocrates used it in the practice of medicine, and Galen alludes to it. It was not used however as an intoxicant until about the middle ages, when its use began to increase in Turkey and Persia; it was confined almost exclusively to those countries until after 1700, at about which time it began to be shipped to other countries and used as an intoxicant. India is now the great opium market of the world, and the habitual use of the drug has been increasing there in the last 40 years.

Wood, of Edinburg, devised the hypodermic mode of injection. This has been gradually perfected until within the last few years it has become almost the universal method of relieving pain. Opium was used in the form of gum or the alcoholic tincture previous to the invention of the syringe, except in oriental nations where it was smoked. Thirty years ago it was introduced in this form on the Pacific Coast, and is now being extensively smoked there, and this form of addiction is rapidly gaining a foothold in our large cities.

The busy doctor is in large degree responsible for the astounding and everincreasing army of habitues. The relief from pain and the ensuing comfort are so quick and satisfactory to the patient that the tablet of morphin and the syringe are out in a minute and the patient gets a shot. The pain is gone and the wonderful magic inserted by the needle is sure to be called for when the pain comes again.

If the patient be of a nervous or hysteric nature, the doctor will have to "forget"’ his syringe or make some valid excuse, and resort to other means for relief if he does not desire to assist in forming the opium-habit. If he be called to a case of sciatica and is very busy, the doctor often leaves his syringe and tablets and instructs the patient how to use them. It is not long, under these circumstances, until the patient is confirmed in the use of the drug.

When compelled to give morphin the doctor should never tell the patient what it is. It is a good idea to have it rubbed up with powdered hydrastis enuf to color it, then raise the patient's tongue, drop it under, and have the patient hold the tongue down until it is absorbed. This will take place almost as quickly as with the hypodermic mode of administering. If, however, the doctor has an habitue to deal with, his pathologic condition must be considered, since every organ has become so perverted that he is morally irresponsible and physically fast becoming a wreck.

The nerve-centers and cerebrospinal and sympathetic systems become affected. and the organs and parts supplied with nerves become more or less perverted. The gastro-intestinal tract and glandular system seem to suffer the most. The glands that secrete the digestive fluids in the stomach and intestines become atrophied, do not perform their function, and the food is only partially digested, owing to the paralyzed condition of the gastric glands. The testicles in the male and the ovaries in the female become atrophied, the sexual passions become dead, and if copulation is performed pregnancy rarely supervenes. If it does, miscarriage is a natural sequence owing to a lack of or deleterious condition of the vital fluids. There is an impairment of the function of all of the secretory organs.

Constipation from the general intestinal paralysis and lack of the secretory fluids obtains, and the patient has to be aided by cathartic enemas to obtain a passage from the bowels. The kidneys are overtaxt in relieving the poison from the system, as large quantities of urine are passt and at times traces of albumin are found.

Burlington, Ind. B. F. LANDES, M. D.

What have you learned about the treatment of phthisis? Let us have it for the benefit of others.

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Baptisia Tinctoria. Editor MEDICAL WORLD:-The more I see of the general neglect by the profession of the above remedy the more strongly I feel impelled to say something in its behalf.

Tho out of the ranks, practically and professionally speaking, my interest clings to all that concerns the interests of my professional brethren. I enjoy the society and meet a large number of the physicans of our State, and I find that comparatively few know anything about this grand remedy, clinically speaking. The skill of the pharmacist has achieved much in these latter days, and far be it from me to speak a disparaging word of them or their productions.

Yet we know these elegant preparations sometimes fail us, and we look about us to see "where we are at." Here we have a remedy evolved in Nature's laboratory and adapted to a wide range of application. We can use it internally, externally, and I had almost said eternally. It is non-irritating, antiseptic, alterative, and it certainly possesses some sedative properties, for I have applied it to some very sensitive surfaces. Some very judicious physicians are using it as an internal antiseptic and alterative. My experience with the drug has been confined entirely to its local use.

I have had grand results with it in cases where the stinking iodoform failed. Did space permit, would like to particularize cases. I have cured those intractable ulcerations resulting from burns as well as the so-called "irritable ulcers" of the books. It is a grand remedy where gangrene is impending. I was called to attend an old lady early in my professional experience, who, like the woman mentioned in the good book, "suffered much of many physicians." A large ulcerated surface of the left calf, and her being upwards of seventy-five years of age, made the case a very unpromising one. iodoform she had been using was discontinued, and absorbent cotton saturated with a strong decoction of baptisia was applied, and renewed three or four times. a day. This treatment was continued for four or five days, and then followed by the application of a roller bandage and a simple ointment, which completed a permanent cure.

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In conclusion, knowing the virtues of the remedy as I do, I would say when your routine treatment of such cases is

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Concerning Fever-Real and Ephemeral. Editor MEDICAL WORLD:-Having a few leisure moments, will write a line on fever, real and simulative. By fever, real, Í mean where Nature brings on complete reaction to any cause producing increast temperature. If fever is real the pulse rises on pressure and seems to order the fingers out of the way. If the fever is simulative the pulse falls on pressure or seems to stop. When called to see a patient this pulse-reaction is the first thing I ascertain. If the pulse rises on pressure I know I have a case that is easily cured, for I have always believed that real fever is an effort of Nature to cure. If the pulse falls or stops I know the case will be stubborn and hard to cure.

A great many doctors think that when the pulse is quick and fast that the patient has high fever, but, acccording to my judgment, the quickest pulse is caused from congestion, and is deceptive.

If my patient has real fever my plan of treatment is to try to assist the process till Nature throws off the disease, or rather its cause. Therefore, I always give my patients quinin and stimulants while the fever is up, and do not wait for the fever to lessen. I was recently called to see a child in consultation. The attending doctor said he had tried for three days to lower the fever, but had failed. I found the patient with full and rebounding pulse with an occasional lost beat. On examination, I found a string tied round one of the fingers of the left hand tight enuf to stop the circulation. I did not wonder that calomel and spirits of niter had failed to stop the fever. We cut the string and the fever soon lessened, and the child was up next day.

I was called to see a gentleman in haste, the statement being made that he was about to go into convulsions from fever. On arriving, I found him with a thready pulse, so quick I could hardly count it. The wife informed me she had given paregoric but had no fever-drops to lessen his fever. I ascertained he had come in late in evening from hunting, and had gorged himself on meat and half-cooked peas. About dark he was seized with cramps and vomiting. His wife gave the paregoric, as

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An Amendment That Needs Amending. Editor MEDICAL WORLD:- -An announcement is going the rounds of the secular press, stating that Governor Roosevelt has signed an amendment to the civil code of New York State, prohibiting physicians from disclosing any and all information regarding their patients, before or after death. The object of the law is all right in the main, but like most good rules, needs an exception for certain cases, viz.: A member of the itinerant class of workmen, among other experiences contracts a specific contagious disease, and, as frequently happens, secures employment in some rural community, and there first realizes that he has some annoying disease. If he has sense enuf to consult a physician, he will learn the serious nature of the trouble, and the physician should impress on his mind the danger of transmitting the disease to other persons, from the mucous patches that are generally present in the mouth and throat.

But that is all the control the physician has over this unfortunate and frequently obstreperous individual. With a bountiful stock of stories of his extensive travels, one of these fellows soon ingratiates himself with the family of some farmer, and, in many instances, the farmer or some of the boys contract the disease from the hired man, who has traveled so much. One farmer in Wayne county, Pa., that I know of contracted syphilis from the hired man by trading pipes with him.

A young fellow came to me a few months ago with the loathsome eruption nearly all over his body. After informing him of the nature of the trouble, what small hopes of a complete cure, the time it would take, and the care he should exercise, so as not to transmit the disease to any other person, I furnisht him medicine, and urged him to make it the business of his life for the next two years to get cured of the trouble. He returned to me three times during the first two months, in which time the annoying symptoms of the malady

were relieved. I saw no more of him for two months, when, on responding to a call to the house of a farmer some six miles away, I found my unfortunate patient very comfortably situated as a member of the farmer's family. At the time he was leisurely smoking an old pipe, a little girl of four years and a boy of ten playing on his lap and about him in a very affectionate manner. My first impulse was to snatch the children away from him, for I felt sure he had at that moment mucous patches of the disease in his mouth, which I found two or three weeks later to be the fact, As I entered the house and found him there, I was hardly able to control a frown from gathering on my face. I think the fellow discerned my feelings, for he came to me three weeks later for more medicine, but he had no idea of foregoing the good fortune that fell to him at the farmer's. Nor will the present law allow a physician to inform the farmer of the danger he and his family are in by entertaining the much-traveled hired

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Consumption and Open Air.

Editor MEDICAL WORLD:-Two months ago I was called to see a patient whom I found suffering with consumption. The weather was cold, but the room was heated with a small, red-hot stove. The mercury stood at about 90° F., and the air was reeking with impurity.

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The history was that of a cough of two years' duration, which had been treated with syrups and cough-mixtures nauseam, but had gradually grown worse, until now the bed had been taken to and appeared that it would be the only resting place for the patient. Appetite, sleep, rest and comfort seemed forever gone. Large quantities of greenish and yellow purulent sputum were being brought up, and the temperature was 103° F.

Upon inquiry, I found that the former medical attendant had askt that an abundance of fresh air be supplied to the patient, had prescribed somebody's emulsion of cod liver oil with hypophosphites, and given the case up, it being consumption and therefore hopeless. Tho

"hope springs eternal in the human breast," it had almost departed in this case. The diagnosis was unmistakable and the microscope revealed myriads of bacilli.

Opium Poisoning—Strychnia Poisoning. Editor MEDICAL WORLD:-The longer we are in practice the less medicine we give, and the more we depend on fresh air,

I had the patient moved into an adjoin- plenty of pure water and good hygienics.

ing room and had the window lowered from the top, and gave direction that the opening should be increast or diminisht in proportion to the change of outdoor temperature, a scale of which was furnisht. The window in the room where the stove was should be slightly opened at the top but wider at the bottom, governed by a similar scale of temperature-range.

The complete arrangement was such that an even state of mildest perflation was and has been since, constantly maintained. The crisp, dry, cool air produced an amelioration of the patient's suffering in twelve hours that was astonishing alike to patient and friends, who declared change of rooms and so much air would be fatal. Since the patient has been practically living outdoors the cough has almost ceast, the appetite is good, the strength has improved and, greatest of all, the weight has increast. The patient is up and able to walk about the house and yard and visit nearby neighbors. No medicine worth mentioning has been given, for but little has been needed, except it had been something of a specific nature, which unfortunately we have only in part.

The history and partly suggested management of this case could be multiplied many times. The appreciation of the open-air treatment of consumption is a small matter with the profession generally, compared to the importance it will finally assume. It is one of, if not the most valuable of all remedies. Of itself it often cures; without it all methods of treatment are absolute failures.

The weather seldom gets too cold and never too wet for patients under my care to have their living or bed-room doors or windows open, and results are the surest criteria.

The constant aim is that the patient shall be under a roof that protects from precipitation with a wall always to windward, for as important as the outside air is, the patient must avoid draughts. If the patient gets too cool, put on additional wraps, increase the heat if it can be done without befouling the incoming air. Do anything, if it must be, but do not close the outside door or window.

Danville, Va. LOUIS F. HIGH, M. D.

Opium poisoning: CASE 1. Called about twenty minutes after patient had taken about half an ounce of laudanum. Gave a glassful of milk and followed with onetenth grain of apomorphia hypodermically. I dissolved one grain of permanganate of potash in about three drams of water and filled the syringe with about thirty minims of this solution, and injected in the arm. After the first vomiting, I dissolved another grain of the permanganate in a halfglass of water and gave it per oram. five minutes, another hypodermic. Pupils, pulse and respiration improved. Gave a cup of hot coffee. Patient recovered.

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CASE 2. Dose Dose of opium not known. Came about forty minutes after taking the poison. More serious than the first case. No apomorphia. Gave of the permanganate solution about five or six hypodermics (one grain of the salt to three drams of water) within fifteen minutes. At intervals, gave grain j. of salt in half-glass of water, and twice a rectal injection of grain j. of salt in eight ounces of water. Patient recovered.

CASE 3. Called in to a friend of minemy neighbor physician-who suffered from sciatica. His druggist gave him a hypodermic of morphia, half a grain. The dose of morphia was measured by sight, not by weight, as the druggist depended on his thirty years' practice. The doctor had an injection of a half a grain of morphia (by weight) a few days before, without any bad results. Consequently, being seriously poisoned by the druggist's injection, we think that the dose was not less than three-quarters of a grain of morphia, and perhaps one grain.

Treatment: Half a grain of potassium permanganate, hypodermically; in ten minutes, one-sixtieth grain atropia, hypodermically; in twenty minutes, one grain of permanganate in half a glass of water, per oram; in fifteen minutes, one-quarter grain of salt, hypodermically. Respiration, pulse and pupils better. Anodynes and sedatives to quiet the irritability of stomach, which nearly exhausted him. Recovery after being with him for five hours.

Five years ago, before THE MEDICAL WORLD (the practical teacher), brought to my knowledge Dr. Moor's antidote for

opium poisoning, I was called to a young lady who had taken one ounce of laudanum. Reasoning out that one ounce of laudanum contains about one grain of morphin and one-twentieth of a grain of atropin will neutralize one grain of morphin, I filled my hypodermic with onetwentieth grain (!!) atropin and injected. Strange to say, she recovered.

A father with his child four years old came in my office. "Doctor," he said, "there is something the matter with my child; she complains of pain at the pit of her stomach. I wanted to give her some water, but she could not open her mouth. I was told she took five pills from this box." He gave me the box, on the label of which were the following directions: "One pill after each meal". I gave the child one teaspoonful of syrup of ipecac in my office, told him to take the child home at once, and that I would find out in the drugstore what the pills were. In ten minutes I was with the patient, administering in teaspoonful doses warm melted lard. The pills were one-sixtieth grain of strychnia each. The child vomited after The child vomited after three spoonfuls were given; the rest of the lard, about three-quarters of a pound, was retained. I was with the child one hour. Child recovered.

I gave a hypodermic of one-thirtieth grain of strychnia to a child three years old, which seemingly expired after two severe convulsions. Child recovered. No bad effects from strychnia.

In connection with the article on page 173, April WORLD, I will say that I have frequently been called to patients whom I have found in a state of collapse from the use of headache powders. Philadelphia.

DR. S. SEILIKOVITCH.

Puerperal Eclampsia With Hematemesis. Editor MEDICAL WORLD:-In reply to your questions (April WORLD, page 162), I will state that there was no post-mortem. There was no analysis of urine, as it was impossible to get a specimen. The skin was very dark and had the appearance of a patient suffering with hemorrhagic jaundice. The conjunctivæ were very yellow. There was no trace of blood in the vomited matter. As to the diet, nothing had been taken to produce such symptoms. It is a difficult matter to get the poorer class of white people to understand or see the necessity of having their general health or system prepared for the expected confinement. With all the theory as to sepsis

and antiseptically preparing the patient for delivery, nine-tenths make good recoveries without such preparation, tho I am an advocate of such theory. It is almost impossible for us doctors, who do a country practice, to have our patients to realize the importance of having everything ready, and have the abnormal actions of the kidneys corrected, and have the bowels to act regularly, and not be suffering from constipation; but that is never thought of by the majority of patients until the day of confinement. Success to THE WORLD. Lyon, Miss. W. T. MILSTEAD, M. D.

A Homeopathic Contribution.

Editor MEDICAL WORLD:-I have been using ferrum picricum the past six months for the cure of warts, and in some cases have been surprised at the rapidity with which the warts have disappeared. I gave the 3.x. and 4.x. trituration from one to three grains four times a day. A stray copy of your journal chanced to come to my office-hence the above.

I have read some of the articles on the treatment of pneumonia, and if the doctors carry out the treatment which they advise others to adopt, I do not wonder that they have to report that in some epidemics the most of their cases prove fatal. The question remains: Was it pneumonia or drugs that did the work?

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