He had always been restless, uneasy, found it almost impossible to sit still anywhere; was not a good sleeper; general health good. Graduated from the high school of one of Ohio's county seats, then at nineteen came to Columbus, where he was employed in a plumbing establishment. He was sent out by his employers to do some work at a wholesale liquor store, where by invitation he took his first drink. It was old whisky, which he was told was perfectly harmless. He became intoxicated to the point of insensibility, and yet the pleasurable sensation that preceded insensibility was of such a character that he soon drank again and became a confirmed drunkard.

In the language of Defendorf, "defective heredity is the most etiological factor and' is manifested by a diminished power of resistance." Some observers claim defective heredity exists in eighty per cent. of all alcoholics. Let this introduce us to a brief study of the acquired characteristics of the alcoholic. Primarily, there is an exaggeration of the predisposing characteristics, the unstable nervous system is more unstable, a restless, dissatisfied nature is intensified; power of resistance is increasingly diminished; power of mental application gradually fails: irritability and unjust criticism of his best friends is common: a desire to shift the responsibility for his unfortunate condition upon his wife or immediate family is frequent; the impairment of memory exists, and more disastrous than all, are the inroads upon the moral sensibilities and the failure to appreciate the seriousness of the situation. am frequently led to believe that no alcoholic has a full comprehension of the gravity of his malady. Do not confound this statement with the transient penitence that immediately follows a drinking bout. This only means that he feels miserably uncomfortable, and for the time being, thinks, and possibly states, that he has taken his last drink. This has no significance, and is forgotten in a day. An extreme case comes to my mind: An old soldier of sixty-two had lost his property, his wife had deserted him, he had had delirium tremens, neuritis, an advanced arterial sclerosis, a myocardial degeneration, urine with low specific gravity, and a trace of albumin, a picture of physical wreckage. After the acute effects of alcohol had subsided, I asked him if he did not think this was a very serious matter, hesitatingly, he said he "did not know but what it was rather bad"; I said, "if you had boys would you want them to drink in view of your experience?"

He replied that if they could drink moderately, he thought it would be all right, and in fact, a pretty nice thing. The memory of the pleasurable sensations he had experienced with moderate indulgence overshadowed the disastrous condition which his diseased sensorium was unable to comprehend.

The alcoholic is eminently plastic; he is easily moulded by his environment; he is swerved this way and that by every extraneous force; there is no power of determinism, no fixedness of purpose; he is an excellent subject for hypnotism; he easily places himself in a passive state, and by suggestion, rapidly passes into the first stage of hypnosis, and often to complete somnambulism; he is frequently egotistical, having an exalted idea of his own importance; indeed, he approaches the expansive ideas of a paretic. He is a hale fellow. well met, and you admire him, but he sorely disappoints you. The advanced dypsomaniac needs protection against himself, and the state needs protection against him. What shall be done with him is not a question before us today. Why do some drink moderately and others drink to excess? First, the moderate drinker of today is the immoderate drinker of tomorrow; as the taking of alcohol creates a demand for more alcohol. Second, one person has a pleasurable sensation from a small quantity and a larger amount renders him uncomfortable. Others do not reach the point of exhilaration until comparatively large quantities are taken. A recent patient said to me he would never drink if he had to be confined to one or two drinks. It is an interesting fact that Jews become intoxicated very unusually, yet most of them are moderate drinkers. I have never treated a Jew for alcoholism or any drug addiction, and I have never heard of one being treated. The Scotch are not abstainers, but generally do not drink to excess. enness was formerly more common than now. his "Wealth of Nations," observed that the French of the winegrowing districts were much more temperate than their northern compatriots. Savage tribes like the Indians are extremely susceptible to the action of alcohol. They take to firewater with astonishing avidity. Most Germans drink beer, a very great many do not drink to excess: Why? The English committee to which I referred say that races that have long been exposed to the action of alcohol, have grown more and more temperate, explaining it

In Greece, drunk-
Adam Smuth, in

upon the theory of the survival of the fittest. By the process of evolution, the weak and unresisting having fallen by the way, the strong and unsusceptible surviving as progenitor of races. This is an hypothesis that seems to be well founded, though no one can say with assurance that it is true. Fluctuations in the percentage of drinkers, as counted from day to day, or from decade to decade, would not militate against this theory. The steps of evolution must be measured during the sweep of ages. Want of time forbids me to differentiate between the ordinary alcoholic and the dypsomaniac. Neither have I entered into the comparative merits of heredity and environment. The discussion of these questions would prolong this paper to too great length. Just a moment to the consideration of the opium habitue.

The two chief predisposing factors are an unstable nervous organization and an unwillingness to bear pain. There is an intimate relationship between the alcoholic and the opium user. Very frequently a double addiction exists. I do not recall a morphine patient who did not use alcohol as well. It is much to be regretted that the family physician is the initiative factor in very many cases. We will hail with delight the new-born day when physicians will dispense alcohol and opium with extreme caution. Alcohol is constantly prescribed without any consideration of its physiological action, and the lazy physician is of easy access who uses his hypodermic with unwonted frequency rather than take the time to patiently investigate the cause of pain and, if possible, remove it. There are infinitely worse things than pain and one of these is the opium habit. Lydston paraphrases Shakespeare as follows:

"The patient better bear the colic that he has, than to fly to dangers that he knows not of."

In addition to the authorities named in the paper I have found valuable material in Reid's Text on Alcoholism.

PUERPERAL ECLAMPSIA.*

BY THOMAS L. COOKSEY, M. D.,

Secretary Clinton County Medical Society, Wilmington, Ohio.

It is with some degree of timidity we appear before this wellknown medical society in our first effort at writing a paper. We cannot hope to present to you anything new or modern, but only to call forth from the archives of your memory some old things for discussion in regard to puerperal eclampsia.

This is a disease of very rare occurrence, many practitioners having passed years of service without seeing a case (very fortunate indeed). They have no regrets.

My first case of obstetrics after leaving the tender care of the venerable W. H. Taylor was a spina bifida. We were somewhat dazed at the double-headed monstrosity as it presented, and after delivery informed the family that this was unfortunate and rare and would advise them further at my next visit. I lost no time in posting up so that I could tell them what we had. Imagine my feelings with my second case of obstetrics when I called and found the patient in a violent attack of spasm. Some one has said there is a time in every one's life when they wish they hadn't been born: that was my time." However, we remembered the injunction of our professor, deliver at once, so we proceeded to diolate the uterus, applied the forceps and delivered the woman of a dead baby. The mother had three spasms before delivery and one following, and then went on with an uninterrupted recovery.

We have had three cases since in our eight years' practice. with about the same history.

As to the cause of puerperal eclampsia there are many theories advanced and yet the limit seems to have not been reached. One author claims it is due to a sudden entrance of toxines into the circulation, provoking convulsions and analogous to chills in pyemia, and in answer to the question why infectious processes in other parts of the body do not give rise to eclamptic attacks, he says the sudden and rapid entrance into the circulation of toxines is only possible in a part where the absorptive power is as great as it is in the placental site. It has always been a question with me.

* Read before the Miami Valley Medical Society, October 10, 1905.

what part a pathological placenta played in the course of the disease. Is the change there a cause of other changes in circulatory system or is it the result of changes somewhere else. The later theory seems more pleasurable to me that a diseased placenta is a result and not a cause. If the theory that eclampsia is due to a latent microbic endometritis during pregnancy we can understand how the placenta may become the center of the field of toxemia. We have in all these cases a renal insufficiency associated with albuminuria as a rule and contracted arterioles of the kidney as a cause of renal insufficiency and albuminuria a secondary result.

We believe that the first cause for all changes in other organs comes from uterine irritation and transmitted through the sympathetic nerves to the kidneys with results as stated, hence a contracted empty uterus is a safe one and frees patient from further danger. The diagnosis of these cases are as rule easy, first, from epilepsy by the previous history and the frequency of attacks, eclampsia being oftener; second, from hysteria as in these total loss of consciousness does not occur and if during attack the pupil reacts to light, then you are sure you have a hysterical case, as they do not react in either of the others.

You are warned of appending danger, the patient complains of swelling under eyes and of limbs and feet, also change in quantity of urine passed, also headache, disturbances of vision, spots before the eyes, etc. Any of which symptoms justify an examination of urine, followed by corrected diet, preferably milk, and an eliminative treatment, through the bowels, kidneys and skin.

Remedies in post-partum eclampsia are often useless, in that occurring toward the end of pregnancy. Morphine will usually abort an attack of eclampsia for the time being, but nothing gained. Veratrum viride, while not a specific, certainly is one of our best remedies. I prefer Norwood tincture, ten drops hypodermically every thirty minutes to one hour as patient can take

same.

When I am called to a case of eclampsia and patient has had more than one spasm, I have but one rule and insist upon it: Proceed to bring about labor, it matters not at what period of pregnancy. It's the only safe plan for the mother, and only hope for the delivery of a live baby. Multiple attacks mean a dead baby and endangers more and more the life of the mother.