AGENTS EMPLOYED IN THE TREATMENT OF THE OPIUM AND MORPHINE HABITS.
Limited space forbids my illustrating each modification of treatment with
pertinent cases, and I content myself with discussing the various drugs
and agents used, and the indications calling for their employment. In this
way, too, the reader will become acquainted with the various symptoms that
arise in the course of rapid deprivation.
BATHS.
Baths of various kinds are the mainstay in the treatment of most cases of
this kind. They are used for four purposes: (_a_) To allay excitement.
(_b_) To relieve pain. (_c_) To equalize the circulation, and (_d_) To
procure sleep. They succeed when drugs fail.
On the third or fourth day of treatment it is usual to have, especially
in very nervous persons, considerable excitement, reflex nervous
irritability, not so great, however, as when the drug is suddenly taken
away. The violent delirium tremens spoken of by Levenstein I have never
seen, save in one case, which I treated according to his method. When
delirium occurs at all, it is usually of a low, muttering, harmless
kind. For its treatment and that of the severe nervous irritability and
restlessness sometimes seen, the hot bath, followed by the cold douche,
is an excellent remedy. If the patient is strong I let him remain in
it for twenty minutes; if weak, from five to fifteen minutes. A good
reaction is had and the quieting powers of the bath enhanced by pouring
one or two pails of cold water over the patient’s head and shoulders,
or directing upon him for a moment a number of fine jets of cold water,
with considerable force. The nozzle should be so arranged that from twenty
to forty jets may play at the same time. After this the body should be
thoroughly rubbed with a hair glove, until the surface is in a glow, and
the patient then be put to bed, where gentle perspiration usually follows,
with considerable relief to the pain in the limbs, shivering and sneezing;
oftentimes a quiet sleep, lasting from thirty minutes to two hours,
follows.
A rapid hot bath, followed by the douche or spray, and that by thorough
rubbing, I find an excellent measure in the after-treatment of these
cases, it hastening the breaking down of old and stimulating the growth of
new tissues, as also the different secretions.
The temperature of the bath should never be below 112° Fahr.
In some neuralgic patients, the cold douche sometimes causes pain
afterward. In these cases it should be omitted, the hair glove being used
freely in its stead.
Several baths may be given in the course of a day, but I rarely find it
necessary to give more than two or three in the worst cases.
The bath, too long continued or too often given, will sometimes greatly
weaken the patient. In debilitated subjects and those suffering from
pelvic pains I find the hot sitz bath, followed by thorough rubbing and
kneading of the whole body, often gives great relief.
For persistent insomnia I find the cold pack a most serviceable agent.
The patient is wholly undressed, a sheet is wrung out of cold water, and
he is wholly enveloped in it up to the chin. The sheet should be folded
under the feet and tucked in evenly and closely about the neck. He is
then closely wrapped in from four to six blankets, and in the majority of
instances will soon fall asleep, a gentle perspiration breaking out all
over him. He may be allowed to remain in this an hour or even two hours.
Excitement and nervousness are calmed by it, the restlessness and pain
disappear, and the sufferer often remarks how much good it is doing him.
In removing it, the whole matter should be done rapidly, under cover of a
heavy blanket, and the body be thoroughly rubbed with a sponge dipped in
whiskey and water.
ELECTRICITY.
This is also a valuable agent in the treatment of the pains, that are
usually distressing. Sometimes the interrupted, sometimes the continuous
current acts the best. As a rule, however, a powerful continued current
(from ten to forty cells) is the most serviceable. The electrodes should
be kept continuously moving up and down the limbs, and the current be
occasionally reversed.
Dr. William F. Hutchinson relates the following interesting case[41] of
cure by electricity: “About the first of January of the present year, I
was requested by Dr. O. C. Wiggin, of this city, to see with him a lady
supposed to be suffering with cerebral congestion in an advanced stage.
“A visit to Mrs. S. revealed the following history: Age thirty-nine;
married; one child, aged six; and has had one miscarriage; weight about
150 pounds; and general appearance of contour and skin good. Patient kept
up a low moaning, answering most of my questions intelligently, then
relapsing into a semi-unconscious condition. Pulse 100, compressible;
temperature 99°; no loss of control of evacuations; conjunctivæ congested
and pupils contracted closely; perspiration starts upon the smallest
exertion, which also causes pain in abdomen and excites vomiting, which
has lately become persistent, accompanied with intense thirst. Hands and
feet cold, with shriveled palms and plantar surfaces. No difference in
temperature of head and axilla.
“Ophthalmoscopic examination gave retinal and choroidal congestion, with
venous enlargement, slight optic neuritis and choked disk.
“There was constant pain, and sense of fullness in frontal region.
“The only family history that could be obtained bearing upon the case was
the death of one sister, a year ago, from acute brain inflammation, the
remainder of the immediate family being still living and in good health;
and the present condition appeared to be the culmination of six years of
almost constant pain and general nerve exhaustion, following the birth of
a child, and aggravated by a subsequent miscarriage.
“At this visit no suspicion was entertained by me of any opium habit, and
the case was diagnosed as passive cerebral congestion, dependent upon
general neurasthenia.
“The next day Dr. Wiggin called and gave me the following additional
items, which at once placed the case in its proper light and gave the key
to many of the symptoms before cited. After her confinement, which was a
long and painful one, she suffered severely from wandering pains in back
and hips, for which her attending physician at the time ordered tincture
of opium applied externally, giving at the same time ten drops by the
mouth, and the ground was broken for the building of the habit. The dose
steadily increased until she came under the charge of Dr. Wiggin, some
six months previous to my seeing her, when she was taking four ounces of
laudanum daily, internally, besides continuing external applications as
before. Attempts were made to stop the pernicious habit, but it was too
late for wise counsel to avail, and the usual cunning of opium eaters
procured for her the drug in spite of every effort of both husband and
physician.
“All forms of concurrent medication had been faithfully tried, but nothing
was of use except the opium, to which it became absolutely necessary
to resort occasionally, as without it the poor lady would arouse the
neighborhood with agonizing screams and cries.
“At this juncture, as a forlorn hope, it was decided to essay galvanism,
hoping that its great vitalizing power might aid in restoring tone to the
exhausted nerve centres. At my suggestion, Collis Brown’s chlorodyne was
given in place of laudanum, and produced the same effect with an ounce per
diem that the four ounces of the former had done.
“Central galvanism was applied, with a twenty-four cell Bartlett battery,
using six cells from the cilio-spinal centre to the forehead, with a
downward current; then from the cervical vertebræ to the solar plexus,
with an ascending current, each lasting six minutes, or until the skin was
thoroughly reddened under the negative carbon point. For the first few
days applications were made morning and night. In a week the vomiting had
ceased and consciousness returned, and the evening sitting was omitted.
After a month the dose of anodyne was gradually decreased, but with every
diminution the nausea returned, and nothing but a return to the old dose
would avail. But her condition was very much improved. She slept better,
the eyes were normal as to color and the palms were no longer dry. At the
close of the second month she was able to sit up, and the dose of anodyne
was steadily cut down without the patient’s knowledge, by adding to the
chlorodyne a sufficient quantity of flavored treacle to replace each dose
taken, until at that time an ounce would last three days.
“Her general condition was greatly improved, and she began to take
interest in her surroundings. In two months more she commenced to go
out, and came to my office for treatment, when I changed the current to
the Siemens and Halske cabinet cell, which, with its low tension and
perfect capability of control, I regard as the ideal battery for central
galvanism. There was no further trouble, and to-day, June 21st, the lady
is quite well, attending to all her household duties, not having tasted
opium in any form for seven weeks, and expressing unbounded delight at
being free from the terrible habit which had so long been her master.
“The _rationale_ of the action of galvanism in this case is difficult to
understand. When the circuit was closed over the superior sympathetic
ganglion, Dr. Wiggin and myself distinctly observed a sudden wave-like
contraction of the distended retinal veins, which resumed their size in
a few moments after the stimulus was removed. But, after some weeks’
treatment, these veins became normal, and the intraocular congestion had
disappeared _pari passu_ with the cerebral symptom, and having repeatedly
witnessed the same phenomenon in other cases, I am led to believe that the
galvanic current has a direct tonic influence upon the vaso-motor system,
which accounts for the occasional surprising results obtained in cases of
cerebral congestion. With the advent of increased nerve circulation came
an absolute horror for the drug, and it is not easy to know to what to
attribute the increase of strength of will up to the point of totally
dispensing with it of her own accord, unless it be to some change in
mental power, due to increased nerve tone, the direct result of what I
have before termed the vitalizing power of the galvanic current. Faradism
was not at any time employed.
“Dr. Wiggin gives full credit to the special treatment for the cure of the
case.”
DRUGS.
The _bromides_ I have found to be very valuable, especially where there
is a hysterical tendency. The bromide of sodium is said to disorder the
stomach less than any of the others. To be of any service they must be
given in large doses. Dr. J. B. Mattison gives sixty grains, three times
a day. I have given as high as three hundred and thirty grains in one
hour and a half, and often in one hundred grain doses, and have never
yet seen the least harm result, but very decided good. Wyeth’s elixir of
the bromide of potassium is an elegant preparation. Its strength may be
increased at will. Where there is too decided irritation of the stomach
I give the drug by the rectum, in milk. Occasionally a large dose of the
bromide will quiet persistent nausea. It certainly modifies the excitement
and reflex irritability, as also the headache and salivation.
_Coca_ I have tried in several cases, but cannot agree with Prof. Palmer
as to its peculiar adaptability to these cases. As a nerve tonic it is a
valuable adjunct to other treatment, but beyond that nothing.
_Strychnia_, _capsicum_ and _belladonna_ I use in large doses, or small
doses often repeated. They are all heart stimulants, and the two former
decided nerve tonics, aside from their action on the stomach. I vary the
quantity of each ingredient to suit each case. The use of capsicum was
first suggested by its successful employment in delirium tremens. A
nervous tonic may at the same time be a sedative to nervous irritability.
I gradually increase the dose as the symptoms are wont to increase, during
three or four days, and the drugs thus given seem to have a better effect.
If the nervous irritability is extreme, especially if there are hysterical
symptoms or twitching of muscles, or spasm of the rectal or vesical
sphincter, I add _lobelia_ and _stramonium_, which, besides relieving
these symptoms, are excellent in allaying the nausea and vomiting.
_Cannabis indica_ is an excellent agent to cause tranquillity and destroy
hallucinations. It seems to take the place of the morphine to a certain
extent. It, too, must be given in large doses.
_Hyoscyamus_ and _hyoscyamia_ I have tried, and never derived much
advantage from them. The former usually increases or produces diarrhœa. My
failure to obtain good results has not been due to using too small doses.
_Chloral_, except in small doses, is a dangerous remedy, and one with
which, if a good effect is had, the patient is apt to fall in love. It is
not of much service as a sleep producer, save in dangerously large doses.
Levenstein found that in some cases it produced violent excitement. I have
seen a ten-grain dose produce urticaria that tormented the patient for
several days.
_Hydrocyanic acid_ was first recommended in the treatment of this
affection by W. C. Blalock.[42] He claims that it supplies the place of
morphine or opium. It does not do so. His formula reads as follows—
℞. Acidi hydrocyanici dil., gtt. xlviij
Syr. simplicis, ℥ ij
Aquæ, ℥ j. M.
SIG.—A teaspoonful at 7 A.M., 12 and 8 P.M.
As a quieter of gastric irritation and nausea, and as a nerve stimulant,
it is an excellent adjuvant in certain cases.
_Lupulin_ and _Lactucarium_. I have not had sufficient opportunity to test
these drugs fully, but in one case, which I have under treatment now, they
seem to take the place of morphine with excellent results, the patient
going twenty-four hours with but a small amount of discomfort on a minimum
amount of morphine and large amounts of these drugs. In three days I have
been enabled, by their use, to reduce the amount of morphine from twelve
grains to half a grain, in the twenty-four hours, the patient being up and
about. Whether the effect will hold, and whether these drugs can be easily
abandoned, remains to be seen. It is in drugs of this class that we must
look for a substitute for opium and its alkaloid. With other treatment we
merely combat the symptoms that arise.
The fluid extract of lupulin may be used in from one to four drachm doses,
by the mouth, or from thirty to sixty drops hypodermically. Lactucarium is
best given in powder, in half drachm doses.
I have also used the extract of lettuce (English) in ten-grain doses,
every two hours.
DIET AND STIMULANTS.
In the management of these cases diet is as important as medication. With
the plan which I am now pursuing I rarely have nausea lasting longer than
a few hours, a very important point, both as regards the comfort of the
patient and the possibility of full nutrition. Diarrhœa, too, so common in
Levenstein’s plan, rarely proves troublesome, is often entirely absent,
and I am occasionally obliged to use laxative medicine. If there is any
tendency to relaxation of the bowels I interdict the use of fruit, of
which these patients are very fond, and give subnitrate of bismuth, in
large doses.
Beefsteak, beef broth, chicken soup, mutton broth, wine jelly, eggs and
plenty of milk are called for. With the milk a little lime water should
be used. If the digestion is slow and labored, from ten to twenty grains
of pepsine should be given after each meal. If there seems to be decided
gastric catarrh nothing acts so well as pills composed of—
℞. Argent. nitrat., gr. 1/6
Creasote, gr. ss.
One, one hour before meals.
If there are symptoms of collapse, although this is unusual, wine should
be given freely, or whiskey hypodermically, three or four syringefuls at
a time. Milk punch is an excellent stimulant and food, and egg-nog good,
when well borne by the stomach, which is not always the case.
The best wine for these patients is sherry, and it should be better
than that found in drug stores and bar rooms. Port is usually largely
adulterated. Claret causes acidity. As a rapid stimulant the best
champagne is excellent. There comes a little apparatus that can be screwed
through the cork of the bottle, and by turning a faucet as much or as
little can be drawn as is wanted. It saves wine and keeps it from staling.
Bottled beer is of service in some cases. The purest only should be used.
It may be kept from staling in the same manner as the champagne.
_Alcoholic stimulants should be continued only so long as is absolutely
necessary_, which is never more than ten days. This is very important, for
it must be borne in mind that these patients are prone to go to excess
with stimulants, as well as narcotics.
AFTER TREATMENT.
_The thorough cure of an opium or morphine habituè does not consist alone
in stopping the use of the drug._ This is certainly a very important step,
but there yet remains much to be done, especially in those cases where the
person became habituated to the use of the drug through its employment in
some extremely painful neuralgic affection. This disease may still persist
or return in full force on the withdrawal of the drug.
The use of the drug being discontinued, attention should be at once
directed to the treatment of the original affection _or of any disease
that may lead the patient to again return to the use of the drug_.
There are, too, certain troublesome symptoms, about some of which I have
already spoken, that come on a few days after the opium or morphine is
stopped. The most troublesome of these is “soreness of the throat,”
consisting in congestion of the pharynx, tonsils, larynx and vocal cords.
There is a sensation of tickling and a short, dry, annoying cough, that
comes on in paroxysms and is especially troublesome at night. It is best
treated by the local application of nitrate of silver (twenty to forty
grs. to the ounce) and five-drop doses of benzoic acid given several times
daily.
The insomnia is usually relieved by exercise better than by drugs,
although I have often found bromide of potassium and hyoscyamus of
service. On no account use chloral hydrate, or give stimulants at bedtime.
Exercise is by far the best remedy. Walking, running, making garden, etc.,
sufficient to tire the patient out thoroughly, is an almost certain sleep
producer, appetizer and hastener of tissue metamorphosis. The cold pack or
a hot bath at bedtime often proves of service.
The appetite usually needs no stimulation by drugs. It is, as a rule,
ravenous for the first few weeks after the morphine is stopped, so much so
that ten-grain doses of pepsine will often be found necessary after each
meal, the patients usually over eating. As a rule, I give the following
mixture, as much for its effect on the nervous system as for the appetite:—
℞. Strychniæ sulph., gr. ss. _vel_ gr. j
Tinct. gentian co.,
Tinct. cinchona co., āā ℥ ij. M.
SIG.—One drachm half an hour before meals.
If anæmic, nothing acts so well as the muriated tincture of iron, which
usually contains a trifle of arsenic, in from fifteen to forty-drop doses,
three times a day, _after meals_. It should be given in half a goblet of
water. Cod-liver oil is also of great benefit, especially if there is
combined with it minute doses of the iodide of arsenic.
Seminal emissions and priapism in males will right themselves.
Females who suffered from leucorrhœa before they commenced using opium
or morphine, and who stopped during the time they were taking it, as,
also, those who have never had such a discharge, are usually troubled
with a white, ropy matter passing away from them in large amount. This
is sometimes accompanied by severe, labor-like pains. Vaginal injections
of a strong infusion of white oak bark are called for, to be followed by
the use of the following on the top of pads made of borated or absorbent
cotton:—
℞. Tinct. iodin comp., ℥ ss
Glycerin, ℥ ij. M.
These pads are made a little larger than a lemon, with a pedicle twisted
with fine cord. They are medicated on the top, the sides smeared with
vaseline, and are then pushed up against the mouth of the womb. A small
piece of cord is left hanging, so that they can be easily removed. They
are to be introduced in the morning, and removed at night.
Neuralgic pains in the limbs and body are best removed by the hot bath and
massage.
The menses may come on irregularly, that is to say, not at the period
at which they usually came before addiction to the habit caused their
suppression. Pain in the pelvic region, fullness of the abdomen, and a
general sensation of puffiness, indicate their coming. On the appearance
of these symptoms I give the following until the bowels are freely moved,
at about which time the menses usually appear:—
℞. Ferri sulphatis, gr. ij
Pulv. alöes soc.,
Pulv. canella, āā gr. iv. M.
In capsule every night or morning, or the pills of Oppolzer.[43]
The period is finally established at its proper time by coming on a few
days sooner each month until the normal date is reached, after which there
is rarely any change. The second and third menstruation is much more
abundant and less painful than the first.
Dyspepsia and “biliousness,” which are sometimes present, are best
overcome by pepsine, and the following, every third night, to be followed
in the morning by some laxative mineral water:—
℞. Mass hydrargyri,
Ext. colocynth, co., āā gr. iij. M.
It may be made in pill form or be put in a capsule.
Finally, _plenty of exercise and fresh air_, baths, regular habits of
life, and treatment directed to those complaints, real or imaginary, if
still existing, for the relief of which the patient first took the drug.
The rapid way in which these patients gain flesh is sometimes astonishing.
A gain of fifty pounds in a month’s time is not unusual.
PROGNOSIS.
The prognosis is, in the majority of cases, good. A cure can be effected
in any case, provided the directions followed are faithfully carried out,
especially in a private institution, where absolute control of patient and
nurse is possible, and where the number of patients is limited.
Levenstein says:—
“To treat morbid craving for morphia with success, it is necessary to
decide the principal question, namely, whether each individual patient
does or does not suffer from pathological complaints or chronic disorders
requiring narcotics for their relief. If he does, it is only necessary for
the doctor to deprive the patient of the morphia syringe and to inject
personally, if his time permits of so doing, a dose which he thinks
sufficient, or else to give the narcotic internally.
“Furthermore, we exclude from the treatment all patients weak or exhausted
through bodily or mental affliction. It is all the same whether the
prostration is caused by night duty, distress, illness, childbed, want of
proper food, flooding, etc.; only those conditions of weakness following
upon the poisoning with morphia constitute no counter-indication, as
they disappear in consequence of the deprivation. Only such individuals,
therefore, are suited for the treatment who have continued the injections
while in perfect health, the former morbid appearances for which they at
first administered them having disappeared.”
From these statements I must heartily dissent. No organic disease, no
affection of the general system, save those that are sure to prove fatal,
as cancer and the like, justify continuance in this habit. In almost every
instance the accompanying ill effects will be found to be due more to the
abuse of morphine than to the disease itself. Indeed, its continuance may
place the patient in a condition that will preclude the possibility of
recovery.
Patients with one foot apparently in the grave, when deprived of their
morphine, take a decided turn for the better, and regain fair, if
not perfect health. A fatal ending sometimes follows the waiting and
attempting to build up the health before commencing the treatment of the
habit.
As to the advisability of treating debilitated and exsanguinated patients
by the method of sudden deprivation, I fully agree with him, for the trial
is as much as a robust and healthy individual can bear. By substitution
and gradual deprivation, however, it can be accomplished safely and
satisfactorily.
The danger of a return to this habit decreases with each year, each
month, each day of abstinence. It is greater in neurasthenic patients and
those who have taken large amounts, or who have not received proper after
treatment.
Under no circumstances should these people be given opiates in any form
or for any complaint, _save when life can be saved in no other way_, for
a relapse is almost certain to occur if this is done. Witness the case of
the literary gentleman already referred to. _A single dose may undo the
work of years._
In conclusion, I feel that I am warranted in again insisting upon the
growing evil of indiscriminate and careless use of the hypodermic syringe.
The following, from my work upon the hypodermic use of morphia, well
expresses my feelings in this matter.
“Some of my correspondents, men of ability and in large practice, express
themselves as very skeptical of the truth of the statement that the
morphia habit has ever been formed by the use of the drug hypodermically.
Testimony from all parts of the civilized world settles this matter beyond
question. Bartholow, from whose excellent little work I have so often
quoted, says:[44]
“‘The introduction of the hypodermic syringe has placed in the hands of
man a means of intoxication more seductive than any which has heretofore
contributed to his craving for narcotic stimulation. So common now are the
instances of its habitual use, and so enslaving is the habit when indulged
in by this mode, that a lover of his kind must regard the future of
society with no little apprehension. It may well be questioned whether the
world has been the gainer or the loser by the discovery of subcutaneous
medication. For every remote village has its slave, and not unfrequently
several, to the hypodermic syringe, and in the larger cities, men in
business and in the professions, women condemned to a life of constant
invalidism, and ladies immersed in the gayeties of social life, are alike
bound to a habit which they loathe, but whose bonds they are powerless
to break. Lamentable examples are daily encountered, of men and women,
regardful only of the morphia intoxication, and indifferent to all the
duties and obligations of life, reduced to a state of mental and moral
weakness most pitiful to behold.
“‘Usually the habit is formed in consequence of the legitimate use of
the hypodermic syringe in the treatment of disease. Employed in chronic
painful maladies for a long period, it is discovered, when an attempt
is made to discontinue the injections, that the patient cannot or will
not bear the disagreeable, even painful, sensations which now occur.
More frequently, when the injections are to be used for a long time, the
patient is unwisely intrusted with the instrument, and taught all the
mysteries of the solutions and the mode of administration.’
“A study of the opinions and cases that I have collected and presented
in the preceding chapters furnishes abundant food for thought; the more
so, as nearly every physician in the world is using a hypodermic syringe
with more or less frequency. Many are unquestionably using this instrument
too often; are using it in cases where the same, or other remedies, by
the mouth, would be equally efficacious, and certainly safer. Far be
it from me to condemn the use of an instrument the employment of which
has brought both temporary and permanent relief, sometimes cure, to
thousands suffering the most intense agony. Its value in cases especially
suited to it cannot be over-estimated; its use in cases unsuited to it,
or where other means would answer as well, cannot be too strongly and
heartily condemned. Death, syncope, alarming narcotism, and, perhaps, more
important than all, that living death—the morphia habit—bids us choose our
cases well, and continue its use for only so long a time as is absolutely
necessary.
“It would seem, from a study of the cases related under the latter head,
and from many of the interesting letters for which I cannot find space,
and, therefore, give at second-hand, that so long as the drug is used
carefully, and with discrimination, by the physician, the morphia habit
is little apt to result, and that it may be broken off when once formed,
although the amount of morphia used is large. But, nevertheless, even when
these results are attained, persons, especially those of the neurasthenic
type, will often procure a hypodermic syringe surreptitiously, and
continue, commence or re-commence the practice anew. For this the
physician is certainly not to blame, but the fact still stands, and the
question arises whether relief by other means, though less prompt and less
permanent, would not have been more preferable to the deplorable mental,
moral and physical condition that almost uniformly obtains when the habit
is once established.
“When Wood first gave his idea to the world, and when that idea was
practically developed and extended in point of applicability by Hunter
and others, it was thought to be glory enough to have found a weapon
sufficiently powerful to cope with severe and obstinate neuralgia and
diseases that would not yield to other treatment. To-day, as seen from
its journal literature, the subcutaneous method of giving morphine has
become almost universal, and it is employed for complaints of the most
trivial character. Aside from the immediate and remote danger of thus
needlessly extending this practice, there is another reason why this
instrument should not be so commonly employed—there is apt to be slurring
of diagnosis and a blind treatment of the most prominent symptom. This
is especially the case with the younger members of the profession.
Having relieved the pain, they fail to study the minor symptoms, to look
at patient’s family and personal history, to be observing of skin, and
tongue, and pulse. It may be urged that the patient often recovers without
any other treatment. True! But many do not, and the lack of study of every
point in the successful cases bears its fruit of slovenly diagnosis and
unscientific treatment in many succeeding cases.
“Finally, let it be distinctly understood that I consider the hypodermic
use of morphia a very decided therapeutic advance, and of incalculable
benefit in allaying pain and curing disease in cases where other modes
of treatment utterly fail. In calling attention to the dangers sometimes
attending the use of the drug in this way, I do it not from a one-sided
view of the question, not with a desire to condemn it, simply to point out
what _may_ occur, endeavor to show how best to avoid it, and, if possible,
restrict its use to those cases in which it is proper.”
The physician should never entrust a syringe or the solution to patients
or their friends. _He should use it himself._
THE CHLORAL HABIT.