tal engine.

In the cases where the engine was used there was not the least shock, the only symptom noticable was a slight elevation of temperature. My method of procedure is first to have the head shaved closely and with aniline pencil, line on scalp Rolandic and Sylvian fissures, also outline strip of bone to be removed. With a small awl or drill I then puncture scalp at the ends of intended suture marking the skull beneath, the size and directions of strip to be excavated. The strip depends altogether upon the case and the surgeon's idea. It is usually made from 14 to 4 inch wide and from 4 to 8 inches in length. Some prefer Lannelongue's T, V or U shape. The flap is next made. This can be made with convexity upward or downward as is best suited to the case carrying it at least 4 of an inch anterior and posterior to the point where suture is to be made. The flap is then dissected up leaving the pericranium intact, which is removed with the bone thus preventing the gap from filling in.

The circular saw is next used. I used a % inch saw for longitudinal incisions and 1⁄2 inch saw for transverse sections. The saw is carried along with a steady motion, being held very firm to prevent jerking, cutting first one side then the other. The outer tablet being harder and

thicker than inner, more time will be expended in penetrating this portion of the brain case. When the diploae is reached blood will ooze from the cut. Care must be taken in cutting through the inner plate less the dura and brain substance be injured. As the saw nears the cavity the cutting sound becomes deeper, cavernous and if the sense of touch be educated as it should be in those who attempt such work it is easy to tell when the saw has passed through the bone. But this is not necessary. When the sound becomes very deep stop, make your transverse section at either end and the entire piece can be pryed up with an elevator, being careful to separate dura should it be adherent-the dura being more adherent in children than in adults.

Any rough edges that are left can now be clipped off with forceps. The wound is carefully cleansed removing all bone dust, and closed aseptically, provided there is no hæmorrhage. The external wound is then dressed and a thick compress placed over groove in skull and all bandaged tightly too prevent hernia. I do not think it advisable to operate on both sides at one operation. There are of course in these cases special dangers but these may be limited by restricting the operation both in time and extent.

PIUM is an extract, the milky

juice obtained after the flowering of the plant by making longitudinal incisions in the capsules and stalks of the poppy plant, Papaver

Read before the Missouri Institute of Homo-opathy.

somniferum.

It is commonly obtained from the Levant or India, where the poppy grows abundantly. Opium is of a heavy and slightly fetid olor; its taste is nauseous, bitter, acrid and warm; it is in flat

pieces; solid and tenacious; of a dark brown color, and yellowish when powdered. Opium contains a number of principles, of which Farrington enumerates twenty-eight, all having more or less narcotic principles akin to those of opium, but morphina and meconic acid (combined in the drng itself as meconate of morphina) are the most important, and by the reaction of those two substances the presence of opium is recognized. In addition to the many preparations of opium used in legitimate medicine, there are many patent remedies containing this drug or its alkaloid morphina, all of which may prove fatal, if given carelessly, such as blackdrop, Winslow's Soothing Syrup, Godfrey's cordial, Dalby's Carminative, etc. The white poppy heads grown in this country are also poisonous. It is said that threefourths of all murders or suicides are due to opium and two-thirds of these in children; caused largely by the pernicious opium habit and popular practice of taking cough mixtures and soothing syrups. It stunts the growth of children, makes them irritable and cross, and interferes sadly with the brain development. Hahneman says: "No medicine relieves suffering sooner than opium. It is this property that has induced physicians to employ it so largely-a source of innumerable evils. In short, nothing has caused more positive evil after apparent relief. All pains soothed for the moment by opium return after a short time, when the stupefying effect is passed, and very often are still more intense than before; so that at last they will only yield to stronger and larger doses, which create in return other serious diseases

new to the sufferer. The use of opium in confirmed pain is therefore empirical and deceptive to the patient, leading him to attribute to other diseases the mischievous consequences that are due to it alone."

The primary result of weak and moderate doses, during whose action the organism is affected in a passive manner appears to be to excite the imagination and the courage, but also to deaden and stupefy the feelings, the sensibility and presence of mind. If now the dose is increased, either in quantity or by frequent repetition, there follows a sleepy state varying from a pleasant feeling of easy drowsiness to the most profound stupor, the result of increased circulation of blood in the brain ard the interference with its return to the heart. The face becomes deep red and swollen from the distention of the blood vessels. The more profound the stupor the darker red the face. The pupils become contracted and do not react to light. The pulse is full, round and slow, showing you that the heart is acting with the ful! volume of blood but not with its usual speed. Respiration is deep and as the stupor grows in intensity, it becomes heavier and finally stertorous. This stertor means that as the poisonous effects of opium increase, a paretic and finally a paralytic condition of the muscles of the mouth and cheeks appears. These parts, thus being thoroughly relaxed, flap back and forth with each respiration. As the case goes on from hour to hour, you find a picture of complete paralysis developed. The sphincters lose their control so that there is involuntary escape of urine and faeces. The lower jaw drops

and death claims its victim. At first the patient can be roused by a loud noise, but at a later stage he is kept awake with the greatest difficulty, and at last he becomes completely comatose, with stertor, pallor and ghastly countenance. Death may take place from apoplexy, collapse, apnoea, convulsions, or paralysis, but it is usually tranquil. In rare cases there are vomiting, diarrhoea, delirium, tetanoid spasms, dilated pupils, and it has happened that the usual narcotic symptoms have been absent, and death has occurred suddenly. When the stomach is full, the action of the poison is more rapid than when the organ is empty, and it is more active when taken in a liquid form than when in a solid state, or when the patient remains still than when he moves about. The smallest quantity on record as having destroyed life is about four grains, but enormous quantities have been taken without ill effects. Very small doses have proved fatal in young children, and some persons are peculiarly susceptible to the influence of opium, others just the re

verse.

drunkenness, the insensibility not being complete, the patient can be aroused, and the smell of alcohol may be detected in the breath.

TREATMENT.

Get rid of the poison as quickly as possible. Empty the stomach. The stomach pump may be used, an infusion of green tea, coffee, or powdered charcoal in water being em

ployed to wash out the stomach.

Vomiting should be encouraged by emetics: A tablespoonful of mustard; common salt; tickling the fauces with a feather; twenty grains of sulphate of zinc; followed by a free purge after emetic has acted. Do not let the patient go to sleep, throw cold water on face and neck, give strong coffee or tea at short intervals. In case of a child alternate warm and cold baths. The new antidote by Dr. William Moor, a saturated solution of permanganate of potassium hypedermically, has been verified in a number of cases and will doubtless soon supplant all others.

TESTS.

Nitric acid added to dry morphina develops a rich color, dissolving the morphina with

effervesence, and

vigor, severe neuralgic pains, premature old age, and early death. Death may take place within one half of an hour, the average being from seven to twelve hours. If the case survives twelve hours, there is good chance for recovery.

Post-mortem appearances are not constant, the most frequent being a congested state of the cerebral vessels, especially the veins but never any extravasation. In

with the production of ruddy fumes. If the acid is added to a solution of

PERCHLORIDE OF IRON.

This reagent, which should be neutral, gives a rich indigo blue with powered morphina turning to green if added in excess. With a solution of morphine the color produced is greenish blue. For meconic acid the latter test is used. Starch and iodic acid, Sulphuric acid and bichromate are also used, but the first two are the more common.

TWENTY-THREE years ago Drs.

Cutter and Kimball operated upon a case of fibroid tumor of the uterus by passing a galvanic current through portions of the morbid growth, using insulated needles as electrodes. Ten years ago Dr. Apostoli published the results of his method of electrical treatment of uterine fibroids. In Great Britain a number of distinguished gynecologists, among whom are Keith and Playfair, have adopted Apostoli's method. Apostoli claims that 95 per cent. of the cases treated by him were benefitted, the symptoms alleviated or entirely removed though the tumor had not disappeared. It is claimed by some that this relief is only temporary, but if this was true, it is better than doing nothing, or as is the case with some gynecologists of surgical tendencies doing too much. Dr. Thomas Keith, of London, published a paper in the British Medical Journal of June 8th, 1889. He closes his paper as follows:

"The only treatment not surgical worth speaking about that I have seen do any good, and which at the same time is one free from danger to life, if the treatment be undertaken by one who has respect for a strong electrical current, is that brought before us by Dr. Apostoli. If any one

*Oration delivered by Dr. Wm. T. Woodley, of Charlotte, N. C., to the Alumni Association of the Medical College of Virginia, and the public, Richmond, Va., Tuesday, April 2, 1896.

should have held on firmly to hysterectomy it is myself, for my results. after it are better than any other. I have, however, thrown over all surgical operations for this new treatment, and the longer I follow it the more am I satisfied. To the surgeon, no doubt, hysterectomy is the good and simple plan. He may have his bad quarter of an hour at the operation, but then he is practically done with the case, and he gets his results quickly, sometimes more quickly than he cares for. If the patient recovers there is pleasure all around; if things go badly, and the patient dies, he bewails his bad luck, as it is called, waits a little, and then, though rather unwillingly, does another. He resents any other treatment than that by the knife. He especially resents Apostoli's treatment of fibroids by electricity, for the result is long in coming; it is a slow treatment requiring great patience, great tenderness of manipulation, and much thinking. But with pa

tience the result is certain.

There is no mutilation, a thing abhorrent to most women. It puts a woman with a fibrous tumor, who suffers much, into the position of a woman with a fibrous tumor who does not suffer, or may be even unaware of its presence. It does not bring about the disappearance of the tumor, or it does so very rarely, but the size is lessened more or less, onehalf, one-third, two-thirds.

Tension is taken off everywhere, all around, and bladder irritability from pressure, a common cause of distress, is relieved. In a word, the woman is made well; her whole life is changed. All this can be done without danger to life, and if there is pain during the time the current passes the fault is in the operator. What more does a reasonable woman who has suffered much desire or need? What have those to offer in place of all this who have so bitterly opposed this treatment; who with unlimited material stand aside and will not take the trouble to investigate the matter for themselves, but wait until some one else does it for them; who make only an outcry if by chance they hear of an accident during the progress of the treatment of any case, and who go frantic over the rumor of a death, or, worse still, who proclaim they know of deaths that never happen. These men have nothing whatever to offer in the bad cases, and only hysterectomy in such tumors that will come out more or less easily, so as to be treated by the extra-peritoneal method of operating. I have seen not a few cases of bad bleeding fibroids . since I came to London. Almost every one had consulted one or other surgical authority on the subject of operation. These were invariably told that nothing would do them any good but the removal of the tumor, but in their special case the local difficulties were too great, or they had let their strength go down too far for such an operation. The very feeble and bad cases, with masses of tumor blocking the pelvfs, with absence of cervix, and opened out broad ligaments, would seem to be let alone. "Hysterectomy then, at best, would

appear to be a most doubtful remedy for a certain number of cases, and those not of the worst sort. On the other hand, the worse the case, the more feeble the patient, the greater the loss of blood, the more marked is the result of electrical treatment. Given a woman with a large bleeding fibroid, blanched almost to death from years of hemorrhage, and then see her some months after this treatment is completed, you would scarcely recognize her, the improvement is so great.

"The old spirit that at one time would have no abdominal surgery still unfortunately lingers among us. Electricity in any form, when applied to the cure of disease, is set down as pure quackery by many medical men, simply because they know nothing about it, and won't take the trouble to learn for themselves what to many is rather a hard study. What I now plead for is that, for a time, all bloody operations for uterine fibroids should cease, and that Dr. Apostoli's treatment, as practiced by him, should have a fair trial. Those who have hitherto most resisted the introduction of electricity are surgeons who are the best competent to carry it out. They are accustomed to manipulate in the female pelvis, and they will not make mistakes in diagnosis, or make them as seldom as it is possible to do. Hysterectomy, remember, which is performed every day for a complaint that rarely of itself shortens life, kills every fourth or fifth woman who is subject to it. This mortality must cease; it is not a question of surgery-it is a question of humanity. Every time that any disease can be cured without resorting to a bloody operation, such as