guaiac in doses of a teaspoonful three or four times a day, or the resin of guaiac, in lozenges, frequently repeated, are of considerable value. But I have derived the most benefit from the extract of phytolacca and salol, combined with a laxative, and sometimes with the iodide of potassium or with the bromide of potassium for its sedative effects. I give the extract of phytolacca in doses of from 2 to 4 grains, and salol in the same dose, or sometimes in doses of 10 grains. Tincture of bryonia and of cimicifuga have been claimed to be valuable remedies in the treatment of rheumatism. I have used them both, apparently with slight benefit in some instances, but the obstinate cases have done better under the phytolacca and salol, with the occasional use of the other remedies already suggested.

I have records of over fifty well-marked cases of this disease observed during the past four or five years, from which I deduced what I have said in this paper regarding the symptomatology, prognosis and

treatment.

THE ELECTRICAL TREATMENT OF FIBROIDS.

BY DR. GEORGES APOSTOLI, PARIS, FRANCE.

The Nashville Journal of Medicine and Surgery says: Apostoli attacked the method particularized by MM. Championniere and Davion at the meeting of the French Congress of Surgery. Their method is based on the employment of currents of moderate intensity, the extra-uterine action and the reversed action.

Their

He claims the inferiority of this method for various reasons. statements are based on seven months experience and eleven cases, while the method of Apostoli has been established seven years, has received the approval of all who have used it, and includes several thousand observations in France and other countries. They remain surgeons and continue to perform castrations and hysterotomies. They select their cases, using the current in aged women or those but little sick, and operating on the young women. They admit of failures, which legitimize their surgical intervention. Their method remains vaginal and extrauterine, preventing all cure of the accompanying endometritis. With them, the relapses are constant if the treatment is not continued. do not affirm as to the disposition of the inflammatory deposits. foncion des eaux chloruees sodiques" which they praise, sees that their method is at fault. They have not proved the evident anatomical reduction of the fibroma.

They
La

Apostoli asserts the efficaciousness of his method: Because it has the pretension to suffice in itself, and in most cases to supplant surgery in the treatment of fibroma. It does not require the selection of cases,

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Because failure is the ex

and all cases are ameliorated, young and old. ception in all cases of simple fibroid tumors, not fibro-cystic, which are not complicated by ascites, and without puerperal lesions of the annexes. Because there is utilized the action of vaginal galvano punctures, either singly or in conjunction with the intra-uterine action, which is necessary for the endometric lesions. Because relapses are the exception, and the greater part of the results remain constant if the treatment has been sufficiently prolonged. Because it embraces within its sphere of action under formulæ of intensity and diverse localization, the treatment of fibroma, that of endometritis and metritis, and of a great number of cases. of ovaro-salpingitis. Because it can do without an additional treatment, even that of les eaux chloruees solique. Because there has been observed an anatomical reduction of the fibroma not total but partial. His method is inoffensive and always supportable if the rules are conformed with, the very rare cases of death are due in great measure to errors in diagnosis, tumors of the appendages mistaken for fibroma and electrically treated.

Apostoli claims the priority and paternity of all medical electrical applications exceeding fifty milliampères. For two years he has exclusively employed intensities from forty to seventy milliampères; since that time he has considered it necessary to increase, not in an exclusive and blind manner as has been stated, but by a rational and progressive method, according to the cases.

The intensity should be moderate in cases of uterine intolerance or peri-uterine affections; the intensity should be increased in all the grave forms complicated by endometritis or by hæmorrhage.

Aimé Martin and Cheron were the first ones to particularize (1879) the action extra-uterine, either on the neck or on the vagina, and were the first to use the reversals, or the interruptions of the galvanic current. Moutz Bendick, of Vienna, had also applied reversed galvanic current before MM. Championniere and Davion.

TREATMENT OF MORPHINE HABIT.

BY EMORY LANPHEAR, M. D., KANSAS CITY, MO.
Surgeon to East Side Dispensary.

In the Journal of the American Medical Association the author says: By the introduction of new remedies considerable change has taken place within the past three years in the management of cases of the morphine habit. My present method of treating is, briefly, this: Upon admission to the hospital the patient is introduced to his special nurse who is to be his constant companion during the succeeding six weeks, and after being made comfortable is given an initiatory bath. He is then requested to give up his instruments and morphine, as the physi

cian henceforth is to attend to the administration of the drug; he does this willingly and makes no attempt at concealment if he be in earnest about undergoing treatment-if he be not, cure were better left unattempted. Under no circumstances is the patient humiliated by searching the clothing and trunk, as advised by many authors; it is the key-note of dissatisfaction, and discord can be the only result; in other words, the subject is made to feel that confidence between patient and physician is mutual.

WITHDRAWAL.

After these preliminary steps an assurance is given the patient that he is to be made as comfortable as possible, and that the pain will be reduced to the minimum. He is then left to become accustomed to his surroundings, and at the proper hours the hypodermic syringe is brought into use by the attendant who opportunely makes his appearance just as the patient begins to be uneasy. No attempt is made at reduction the first day in hospital; this encourages the subject, causing him to feel confident of the truthfulness of the doctor in the statement that there will be little suffering. Upon the second day but little reduction is made except at the urgent solicitation of the patient, which is not at all uncommon. On the third day the amount is diminished one-half (provided a large quantity is being used-less than one-half if only a few grains are being taken daily); on the fourth day a reduction of one-half; the fifth the same, and so on. Thus, if sixty grains be the amount taken, on the second day perhaps fifty grains may be injected; on the third day thirty, on the fourth fifteen, on the fifth eight, on the sixth four, on the seventh two, on the eighth one, on the ninth one-half, and on the tenth Frequently the diminution can be carried on much more rapidly than this; more than once I have run the scale from sixty grains, taken hypodermatically, to nothing within a period of four or five days, but most cases require from seven to ten days for complete withdrawal. Each case case must be a law unto itself. Alarming symptoms may demand slowness; happy symptoms prompt haste. Undue prolongation of withdrawal is to be studiously avoided, as it is even more cruel than the abrupt discontinuance of the Levenstein method.

INSOMNIA.

Nothing is given to produce sleep the first night-nothing is needed; the second night the patient is given his last dose of morphine at ten o'clock upon retiring, and this suffices. At eight o'clock on the third night twenty grains of sulfonal are given; the patient then is allowed his second bath, and at half-past nine the sulfonal is repeated, and an hour later the morphine. During this night the patient will be somewhat uneasy, but will sleep fairly well; the next will be a troublesome one, so at 6 P. M. he is given four grains of monobromide of camphor, and the dose is repeated at seven, eight and nine o'clock; at ten recourse is again had to the scruple of sulfonal, and at eleven the same amount is

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administered simultaneously with the last injection of morphine, the number of injections having now been reduced to two per diem—one as late in the day as the patient will permit, the other at bedtime. The next night and the next the same procedure is carried out and, with possibly one night of sleeplessness, from four to eight hours' sleep will be secured each night. The amount of monobromide of camphor is rapidly decreased after three or four nights, and as soon as possible the sulfonal is superseded by ammonium bromide, which is also nightly reduced in quantity until nothing is taken. This is usually about the fourteenth or fifteenth day.

DELIRIUM.

Delirium, if it arise, as is frequently the case if withdrawal has been rapid, is met by the hypodermatic injection of one-sixtieth (1-60) grain. of hyoscin hydrobromate, repeated in one hour if necessary. A third dose is never given inside of eight hours. In one case (of abrupt withdrawal) where maniacal symptoms arose, the same quantity of hyoscyamine sulphate acted kindly, but the other hyosciamic alkloid has proven eminently satisfactory in my hands. A brief period of excitement follows its injection, succeeded by a feeling of calmness-even tranquillity -which persists from four to twelve hours. I have never had a dangerous symptom from its use, and in only one case have I found it devoid of efficacy.

DIARRHOEA.

Under this mode of treatment diarrhoea has not proven the distressing feature that it has in former cases-why, I do not pretend to say—I simply record it as a clinical observation. Salicylate of bismuth has given fairly good results when tried, but most reliance is placed in a mixture of bismuth subnitrate, tannic acid and aromatic syrup of rhubarb in quantities sufficient to control the number of discharges. If there be great pain and tenesmus, codeine sulphate added to the bismuth mixture acts charmingly, far better than opium or morphine, and with less harm. The "sinking feeling" at the pit of the stomach is generally amenable to hot fomentations or a belladonna plaster; vomiting, which also sometimes accompanies the diarrhoea, often yields to half-grain doses of carbolic acid in peppermint water, though it usually is not of sufficient importance to demand attention unless it occur after each effort to take nourishment.

PAIN.

One of the most distressing features is "cramps" in the muscles of the leg and thigh, and neuralgic pains-particularly sciatica. For this, fifteen grains of methozin (antipyrin) is dissolved in sixty minims of distilled water, and a half injected over the seat of the greatest pain, the other half close by. A sharp, stinging sensation follows, persisting for a half minute, succeeded by a complete subsidence of the pain. My experience corroborates that of Germain Sée: that in methozin, injected be

neath the skin, we have an agent even more powerful than morphine for the relief of nervous pain.

DISTURBANCES OF CIRCULATION.

For remedying this important group of symptoms I have found nothing superior to the well-known lines: food, alcohol, recumbent posture, warmth, friction of the extremities, etc. Milk punch usually meets all the requirements, and cannot be improved upon. Here hot sponge baths, once daily, are useful, and give a sense of comfort. In weak heart digitaline has proven utterly valueless in my practice; atropine is better.

NERVOUS SYMPTOMS.

For the nervous symptoms other than delirium and sleeplessness, i. e., for the general uneasiness and anxiety, I often prescribe :

When convalescence is established, tincture of nux vomica affords much satisfaction-five to ten drops in half a glass of water before meals, and an iron tonic is of service one hour after meals.

CONCLUSION.

In conclusion I would say:

I. With these new remedies we pass the "ordeal" of withdrawal far more satisfactorily than heretofore.

2. Many baths are avoided, because too weakening.

The physician gives each dose himself, so that for a day or two after complete suspension of the pure drug water may be injected to relieve the patient's mind.

4. Complete cure (permanent) can be effected much more frequently than authors would lead us to suppose.

5. With competent, trustworthy nurses and hospital confinement it is not a difficult disease to treat.

6. During convalescence the patient is constantly assured of the permanency of the cure-a sort of non-hypnotic "suggestion."

7. Before discharge, ample explanation is made regarding the necessity for carefully avoiding the use of the drug for any disease within a period of at least two years.

8. Not the least important element of success is attention to the daily life of the recuperating invalid: nutritious food, abundant exercise, proper sleep, freedom from worry, and, to end all, a pleasure trip if possible.

No. 8 East Ninth street.