orders of their sex, for which solace is found in the anæsthetic and paralyzing effects of alcohol-an effect that with startling and sorrowful frequency ends in the toxic disease.

Inebriety from a fondness for alcohol per se-vicious indulgence-obtains less often in women. Why this is so goes without saying, and so this neurosis in them presents the strongest possible proof that its origin lies in perturbed physical conditions; in fine, that it is a disease; no mere moral obliquity, as many-well meaning, but mistaken-would have us believe.

The consequence of alcoholism in women is less promptly patent than in men. Albeit none the less sure, it obtains more slowly. This from varied causes that act over larger area and with greater energy in men. In the earlier stages of inebriety in those cases in which volition is not entirely ended, a peculiar shrinking from publicity protects some women against the objective symptoms noted among men at a like period of their disease; but with increase of toxic power due to constant or recurrent taking this protective shield gives way, and a well marked consensus of symptoms, psychical and somatic, lays bare the varied ravages of the disease. Among them the latter lead, and early and often those along gastric lines. To detail is not needed; but-so well masked may be the true status-in every case of marked disorder in this regard, if not yielding to the usual remedies, the doctor should mske bold to question the patient, direct, as to rum being a factor for ill.

With progress of the toxic force widespread disturbance of functions presents-scarcely any escape-and as the disorder deepens into structural change the signs of health infraction become more prononunced and prolonged.

On ovulation the alcoholic impress is one of deranged rather than, as in opium inebriety, suspended action, and so it comes to pass unfortunately that the average female alcoholist is not sterile. Just the reverse obtains with the woman morphinist, and it is one of the mysteries of a divine economy that this beneficent law does not extend the same wholesome result in her alcoholic sister, and so shut off in large measure a diseased, depraved progeny that tends to curse every community with a physical and moral blight, the extent of which is beyond compute, and with which no other agent for ill can compare.

Sequelling visceral disturbance comes psychical derangement, ranging from slightly erratic outbreaks to furious maniacal outbursts, or a more or less steadily stupid condition. The latter is less frequent than in men, the inebriety of women more often being periodic. While the signs of psychical ill-health may be less gross than in men, they just as surely show the fell power of this poison to distort and destroy along higher lines of life, and transform many a winsome woman into one far removed from her gentle self and deserving the largest measure of sympathy and relief.

The prognosis of alcoholism in women eligible for treatment is better than in men. Barring advanced cases, the outlook for recovery is hopeful to an extent that warrants placing every patient under proper care. The betterment gained by well directed treatment in some cases is surprising, and were this fact well known, would, it is safe to say, lead to a larger optimism among medical men as to cure. Risk that the disease will recur is large. This, however, by persistent treatment, favoring environment, and watchful care, may be brought largely to a minimum. and many a life seemingly given over to a rum bondage till death can be reclaimed.

The treatment of alcoholism in women to be most effective, must be twofold-curative and preventive. Touching the former, modern medicine has made such advances as places present treatment much in the van of everything that has been. As a valued psychical adjunct, the doctor must be firmly impressed with a belief in his power to help, and the impress of this opinion must be made on the patient to full if the maximum of good would be gained. A supreme confidence along this line is an immense factor in reaching the goal desired, and so far as concerns non-coercive care is almost a sine qua non.

The remedical agents of greatest worth in warring on this disease are strychnine, arsenic, electricity, and hypnotism. But before any of them can be made of most service certain untoward conditions claim attention. The gastroalvine status must be righted, and nothing will better do this than a mild nightly mercurial and a morning aperient water. Uterine luxations should be reduced, ovarian discomfort must be ended, and, unless removal be called for, galvanism holds out the largest promise for good.

The question of abrupt or gradual rum quitting will be present. Case conditions must decide. If possible, the former should obtain. As a rule, fear of ill result is unfounded, and the effect on the patient's morale will be good. If sudden stopping be deemed unwise, let the usual stimulant be discarded, and alcohol in like amount be giveu with milk, to be ended as soon as possible; or, better still, the compound tincture of cinchona combined with nux vomica and tincture of gentian, or the mineral acids.

The way for the main treatment having been paved, strychnine leads the iist. There have been such a consensus of opinion and such a volume of fact to this effect as cannot be gainsaid or set aside. It is best given subcutaneously, in the form of nitrate, one-thirtieth to one-twentieth of a grain thrice daily. As a rule, it will be best not to exceed the latter dose, and if strychninism presents a decrease is in order. The average alcoholic is very tolerant of this drug; this fact should not be forgotten. These full doses may be given a month, if well borne; after that, one-sixtieth to onefortieth of a grain will suffice, and with or without arsenic should be given for months.

Arsenic in inebriety is not given the credit it deserves. It is a multum-in-parvo remedy-a general tonic, a non-neuralgic, an anti-malarial, a nutrition promoter; in fine, an allround roborant, admirably adapted to the cure of this disease. Fowler's solution is best-four to eight drops after each meal. It may sequel the strychnine giving, and not be pushed beyond slight face puffing. It should be long continued-in this is its chief value-four to twelve months.

Electricity is another remedy, the worth of which in the treatment of inebriety is much more than the average doctor will admit. Ignorance of its value comes from inexperience. Study and practice of this valued aid must be had if one would be well equipped- There are few facts in medicine better fixed than the power of galvanism to raise the lowered nerve tone and relieve the varied neuralgias so common to this disease. Constant-current seances, ten to twenty minutes each, may be given daily for weeks, and a specially opportune time, when sleep is impaired, is at night. When used for neuralgia, each of the attacks, be they frequent or few, must be met promptly. The faradic current, while less widely useful than the constant, may be given daily,

twenty-minute seances, general faradization, as a tonic and to remove the peculiar unrest "fidgets"-noted in some

cases.

Hypnotism acts best in periodic cases. Seances should be had between drinking-bouts. No case should be deemed unyielding till several attempts have proved futile. The condition of each case must govern as to time and extent of seances. To a minor degree most women can be brought under hypnotic influence if, as we have urged, the physician be largely optimistic as to treatment and will stamp the impress of that optimism on the patient. In every case effort to this end should be made. Despite adverse opinion, hypnotism is sometimes an immense power for good.

We have noted the biggest guns in the battle with this disease. Minor ones are of value. Full feeding ranks first; generous diet, with cod-liver oil and malt if need be, must be given. If patients be pallid or heart action weak, steel and strophanthus should be used. The Turkish bath fills an important role as sedative, eliminant, and soporific. A morning cold shower is a capital tonic. If a hypnotic be needed, trional outranks all others; dose, fifteen to thirty grains, dry on the tongue, at 7 P.M., or in hot milk or bouillon at bedtime.

The pain peculiar to chronic alcoholism can often be eased by cannabis and quinine. If not, coal-tar products may succeed. All failing, an opiate can be given, but it must not be morphine; that is unsafe; it is snareful, chronic alcoholics take to it too kindly. Codeine may be given. This drug-for the greatly increased use of which in America during the last six years the profession is mainly indebted to Dr. J. B. Mattison-one-half to two grains of the phosphate or sulphate by skin or mouth, is an efficient anodyne, and the risk of tolerence is vastly less than with morphine.

One remedy, radical and a dernier rassort, remains to be noted. Granting the woman has been given treatment, proper, persistent, and prolonged, without avail. she should be asexualized. This, whether maid or matron-for many a former would not have the courage of conviction equal to that of a young woman brought to my notice, who refused an alluring offer of marriage solely because she was a periodic alcoholic. It might be curative, it surely would be preventive; and better by far unsex the woman than have her beget a brood tainted with this curse of the world.

Special stress must be laid on the need for treatment long continued. Lack of this is the largest factor in failure. It is absurd to suppose that a system, bruised and battered by alcoholic excess for years, can be brought back to health in a few weeks or months. The good work must go on, if need be, for years. True, much may be done in some cases by less-protracted care, but as a rule the risk of recurrence makes the longer treatment of greater worth. The skillful doctor repairs or retards the ravages of renal or cardiac disease by care years continued, and the same wise effort along alcoholic lines must obtain if the largest measure of good would be gained: There is great incentive to such effort. Even now, from thirty to fifty per cent. of alcoholic inebriates properly treated recover, and, with a clearer insight of causative conditions and a more extended remedial regime, there is full warrant to think this good result will be greater. No case should be deemed beyond hope till every aid that scientific treatment can now surely extend, under willing or coercive care, and continued if need be for years, shall prove of no avail.

So much as a present spur. When we face the future, and realize the fact that in the new century, so near, the question of the effects of alcoholism on the physical weal of human. kind will be the question out-ranking all others, phthisis not excepted, to engage attention of scientist and sanitarian: when we give due thought to the fact that alcoholism is not only a curable but a preventable disease-we must be profoundly impressed by the immensity of its importance; and let our every effort array against it, for it compasses not only the welfare of a present host, but that of millions yet to be.

PYOMETRA-REPORT OF CASE.

By Lillian G. Towslee, M. D., Cleveland.

Assistant to the Chair of Gynecology in the College of Physicians and Surgeons: Gynecologist to the Cleveland General Hospital Dispensary. N the text-books on Gynecology if pyometra is mentioned at all, it is simply defined. It is rarely met with and more rarely diagnosed. There are probably many interesting cases that have never come to light. It may very easily mislead one and be mistaken for cancer, as it so closely resembles