WASHINGTON NOTES. AT the meeting of the board of directors of the Emergency Hospital, Dr. W. P. Carr was elected to the chair of surgery formerly held by Dr. James Kerr. Dr. Turner will succeed Dr. Lawrence as resident physician, and Drs. Baker and Juemman were promoted from the subordinate staff. The second mark of honor erected in memory of medical men of the United States is the monumental memorial to Dr. Samuel Gross which was unveiled with appropriate ceremonies May 7. A large delegation of Philadelphia physicians were in attendance, particularly of the Jefferson Medical College. Book Reviews. THE DISEASES OF INFANCY AND CHILDHOOD; for Use of Students and Practitioners of Medicine. By L. Emmett Holt, A. M., M. D., Professor of Diseases of Children in the New York Polyclinic; Attending Physician to the Nursery and Child's and the Babies' Hospitals, New York; Consulting Physician to the New York Infant Asylum and to the Hospital for the Ruptured and Crippled. With Two Hundred Illustrations, including Seven Colored Plates. New York: D. Appleton & Co. 1897. Price, $6.00. The drift towards extreme specialism in medicine is shown in many ways just now, and, although there are some signs of a healthy reaction, the efforts in certain quarters to specialize pediatrics may be taken as an indication of the former tendency. While in past years there were few standard works upon diseases of children, one has now an increasingly large number from which to choose. The present work even limits itself to diseases of infants and very young children in a treatise of over 1000 pages. The first part of the book, including the hygiene and general care of infants and young children, growth and development of the body and peculiarities of disease in children, forms the best part of the work. The section on therapeutics places in a clear light the effect and method of administration of various agencies such as poultices, counterirritants, cold applications to the nose and throat, inhalations, stomach-washing, irrigation of the bowel, etc., also a consideration of the dosage and action of various drugs, antipyretics, anodynes, tonics and stimulants. The author believes in the free administration of alcohol to infants when stimulation is indicated, apparently not sharing the misgivings of some modern observers in reference to this subject. The diseases of the newly-born are treated briefly, but all the facts are stated. Exception might be taken to the effort to make an entity under the somewhat shadowy term, "inanition fever." It appears to us to be a good example of unnecessary differentiation. The chapters devoted to nutrition are well written and this important subject is discussed in all its aspects. A certain unevenness is to be noted in the space devoted to various classes of disease throughout the book. Thus, under diseases of the digestive system, gangrenous stomatitis, to which, pathologically, so much interest attaches, is passed over in a little more than two pages. Diseases of the respiratory organs are thoroughly considered. Pseudo-membranous laryingitis is discussed clinically in this section, although the etiology, lesions, pathological relations and bac terial diagnosis are considered in the chapter devoted to diphtheria. The author states at the outset that pseudomembranous inflammation of the larynx is almost invariably due to the Löffler bacillus and hence the confusion that might otherwise ensue in the mind of the reader from this arrangement is to a certain extent avoided. Strong ground is taken in favor of intubation when operative interference is necessary. The author is heartily in favor of antitoxine administration in diphtheria, in connection with generous feeding and free stimulation. So great is his faith in the serum treatment that the various drugs commonly recommended in diphtheria are given only a few lines. As in all modern works, the distinction between diphtheria and pseudo-diphtheria is sharply drawn. The section devoted to diseases of the blood, lymph nodes and bones is not as extensive as one would expect from the amount of work recently done in connection with these subjects. Taking it in all, this work expresses very fairly the advances that have been made in pediatrics during the past decade. Although it does not contain a great deal that is new, whatever the enquirer wishes to know in reference to the subjects discussed will be found stated with plainness and positiveness in the pages of the volume. Current Editorial Comment. MEDICAL PATERNITY. Medical Summary. WHO fathers all these absurd and ridiculous statements that appear in the medical press? It is fortunate for the journals that they are not responsible, else they would suffer; it is doubly fortunate for the profession that the great body of medical men are SO well grounded in medicine that the inane suggestions of would-be instructors are passed by with a smile, yet undoubtedly some are influenced to try the measures advocated. STATE EXAMINATIONS. Philadelphia Polyclinic. THE regulations, in many States, by which those connected with medical teaching are ineligible to appointment on the examining boards, interfere with the selection of persons who would be especially qualified, in so ne respects, at least, to conduct proper examinations. We do not quarrel with the principle, however; there are good reasons why those connected with colleges should be excluded, but the examiners should make careful study of the methods in vogue in college examinations and endeavor to follow the general trend of these. Especially is it important that all questions should be explicit in language, so that they may be understood in the same way by all. MEDICINE AND LAW. Baltimore American. now No profession is making more rapid progress than that of medicine. Young men study now under the best instructors, and with all the latest advantages science has been able to command, so that a young doctor starts out now much better equipped to make a success of his business than did his father or grandfather. In many respects the practice of medicine has been almost completely revolutionized within twenty-five years. Operations, for instance, are performed with ease, and with a high percentage of success, that less than thirty years ago would have been regarded as desperate to undertake. The ambitious, industrious young doctor is generally abreast of the age. He has been able, owing to the progress of science, to discard much that was useless. His brother, the lawyer, is still largely handicapped by clinging too closely to old forms and practices, which are to a great extent out of harmony with the age. Society Meetings. BALTIMORE. BALTIMORE MEDICAL ASSOCIATION, 847 N. Eutaw St. JAS. E. GIBBONS, M. D., President. E. L. CRUTCHFIELD, M.D., Secretary. Meets 2d and 4th Mondays of each month. BALTIMORE NEUROLOGICAL SOCIETY. Meets 3d Wednesday each month. SAMUEL J. FORT, M. D., Secretary. BOOK AND JOURNAL CLUB OF THE FACULTY. Meets at call of President. CLINICAL SOCIETY, 847 N. Eutaw St. Meets 1st and 3d Fridays-October to June-8.30 P. M. S. K. MERRICK, M. D., President. H. O. REIK, M. D., Secretary. GYNECOLOGICAL AND OBSTETRICAL SOCIETY OF BALTIMORE, 847 N. Eutaw St. Meets 2d Tuesday of each month-October to May (inclusive)-8.30 P. M. WILMER BRINTON, M. D., President. W. W. RUSSELL, M. D., Secretary. MEDICAL AND SURGICAL SOCIETY OF BALTIMORE, 847 N. Eutaw St. Meets 2d and 4th Thursdays of each month-October to June8.30 P. M. J. B. SCHWATKA, M. D., President. S. T. ROEDER, M. D., Corresponding Sec'y. MEDICAL JOURNAL CLUB. Every other Saturday, 8 P. M. 847 N. Eutaw St. THE JOHNS HOPKINS HOSPITAL HISTORICAL CLUB. 2d Mondays of each month, 8 P.M. THE JOHNS HOPKINS HOSPITAL MEDICAL SOCIETY. Meets 1st and 3d Mondays, 8 P.M. THE JOHNS HOPKINS HOSPITAL JOURNAL CLUB. Meets 4th Monday, at 8.15 P. M. MEDICAL SOCIETY OF WOMAN'S MEDICAL COLLEGE. SUE RADCLIFF, M. D., President. LOUISE ERICH, M. D., Corresponding Secretary. Meets 1st Tuesday in the Month. UNIVERSITY OF MARYLAND MEDICAL SOCIETY. Meets 3d Tuesday in each month, 8.30 P. M. HIRAM WOODS, JR., M. D., President, dent. E. E. GIBBONS, M. D., Secretary. WASHINGTON. CLINICO-PATHOLOGICAL SOCIETY. Meets at MARYLAND MEDICAL JOURNAL A Weekly Journal of Medicine and Surgery. VOL. XXXVII.-No. 6. BALTIMORE, MAY 22, 1897. WHOLE NO. 843 Original Articles. ALCOHOLIC INSANITY AND EXCESS, WITH A REFERENCE TO THE OPIUM HABIT. By A. L. Hodgdon, M. D., Dispensary Physician to the Department of Nervous Diseases, College of Physicians and Surgeons, Baltimore. READ AT THE NINETY-NINTH ANNUAL MEETING OF THE MEDICAL AND CHIRURGICAL FACULTY of AMONG the many conditions which This is decidedly an illusory insanity and numbers among its many phantasmal creations legions of weird and elfinlike spectra, the hallucinations of an over-stimulated brain. It is interesting in this connection to consider the myriads of phantoms which pass in long procession before the bewildered eyes of the victim of mania a potu and also the general character which they assume. Out of twenty-one cases selected at random from the many alcoholic cases which visit the nervous department of the College of Physicians and Surgeons dispensary, about eleven cases suffered from illusions. One sees frogs jumping over the floor, another sees horses kicking and running away, still another views snakes and rats, and a fourth has a similar illusion as the second, that of seeing a horse kicking and jumping; a fifth has seen something like a dog mashed up, and then it would appear to approach him; a sixth saw a horse the other night with red stockings on, and saw all kinds of things gaping at him, and voices singing out, also voices saying: "There he is now; go for him.” A seventh imagines he sees a man outside of the window and has a feeling that he himself is going to have convulsions; an eighth imagines he sees cats and rats and spirits running around the yard; a ninth sees men who appear to laugh at him when he closes his eyes; a tenth, a colored man, imagines he sees snakes, scorpions and black men, with knives, running around the room; and another, though not suffering from illusions, feels all the time like falling when working on a scaffold. Eighteen suffered from insomnia, partial or complete. There was morning vomiting in thirteen cases, and anorexia more or less complete in twenty cases. Eleven cases had no suspicion whatever of heredity; there were six who had excessive drinkers for fathers; one who claimed a relative on his mother's side was a drunkard; two had only one uncle who drank to excess, while one had several uncles who drank excessively. It is hardly worth while to dwell upon the destructive tendencies brought about through chronic alcoholism on the delicate structures of the brain and nervous system; the degenerations and their sequelae are all too common and well-known to us all, and furthermore these and many other matters connected with excessive drinking would fill a large volume and could hardly be brought within the scope of a paper so thoroughly abridged. What I would like to enunciate very forcibly is that although heredity may play its part in the production of many cases of this class, yet heredity should no longer be considered the scape-goat for the chronic inebriate. That a certain underlying constitution is inherited whereby the victim through mistaken ideas as to the social function of treating and being treated over the bar ad infinitum à la perpendiculaire, and of following this up day after day with many an orgie, remaining almost continually in a state of inebriation, just for the need of that volitional impulse to say "No" when quantum sufficit has been imbibed, and he really desires not a drop more, this lack of will-power I will concede is in many cases inherited, but would not the same class abuse opium, cannabis, chloral or any other narcotic or stimulant or any social function, in the event of it becoming popularized just on account of this very innervation of the inhibitory centers in the brain? Is there any prophylaxis? Yes! There are two laws which could be framed, either of which if enforced would reduce drunkenness to a minimum, would not limit to any extent freedom of conduct, and would work no hardship to any class of the community. One of the laws might prohibit treating in any public place, and the other law would be to impose a fine on the saloon keeper where the person found intoxicated took his last drink; neither of these statutes would entail a loss to the vender, as it would only render him more careful whilst dispensing his beverages in trying to prevent individuals from overstepping the bounds of sobriety. In passing I will barely touch upon the opium habit. De Quincy depicts its terrors in flaming colors but whether his work has served as a warning to others in the way of keeping away from dangerous. territory, or inspired many with a morbid curiosity to try it for themselves and realize all that he has described, is an enigma which I believe no statistician could solve. However the subtle influence of this enamoring drug should be guarded against, even when administered medically, as even in doses exhibited for medicinal purposes, at the time the drug is finally withdrawn, the sensations of sinking due to the withdrawal of its stimulant action are truly of a most distressing character; so great indeed is the ordeal, although a patient may be willing and very anxious to give up the drug, that even after firmly resolving to abandon the habit, the ordeal through which he is required to pass is such a trying one, that even the firmest resolutions are often shaken. I have known a patient after engaging me to treat her and try to bring about a cure in her case, when placed upon trial her fears were so great as to her powers of endurance, that before undertaking the treatment, after having given me her hypodermic syringe, she secreted some morphia in an inaccessible place and indulged in its use for the first few days of her treatment. A word of warning at this point as to the general doling out of morphine to patients, particularly its administration by the hypodermic method. Let us give morphia for pain, but it is well not to allow susceptible patients to know what they are taking. Those persons' nervous systems lack that resistance to the engrafting upon the system of the habitual use of this drug. Particularly should we be careful about the administration of morphine hypodermically, as by this method a maximum of voluptu ous sensations are produced and a minimum of the disagreeable sequelae, such as nausea and vomiting. Indeed there is but little doubt that the advent of the hypodermic syringe, although a great blessing, has been responsible for many cases of morphomania and the opium habit. The opium habitué who has taken his first dose of this entrancing potion and experiences the initial enrapturing dreams little knows the deep and awful abyss into which he may have to plunge, flung as by a catapult through space, down, and still further down, to well-nigh unfathomable depths, the ragged precipices, along whose narrow brink he may wearily in abject terror have to crawl, the fearful denizens of an antediluvian world which may confront him with their awful visages, aglow with fiery hatred, and nether jaw dropped, not hastening to consume him, only to make the ordeal still more terrible and replete with fearful fancies. As' to the treatment of these affections, what is to be done? If possible, secure a good trained nurse, if necessary, one for night and the other for day. I do not consider it in any way essential to remove them to an institution, if nurses can be supplied, even in the form of friends, whose sympathies are not too easily enlisted in behalf of the patient when tempted to supply the stimulant desired. In regard to the treatment to be pursued in this class of cases, one point of primary importance is the question of nourishment, and the abrupt withdrawal of all alcohol and opium at the inception of treatment, or the gradual lessening of the doses as the course of surveillance draws to a close. As a rule, I believe the conservative plan to be the better; as the most imperceptible lessening of the dose, although lengthening the period of suffering, yet does not cause such a profound shock to the whole nervous system as the abrupt withdrawal of the stimulant. In case alcohol is used in any form, I think that its combination with various foods is to be highly recommended. At the City Hospital Dispensary I generally advise the alcoholic patients to discontinue their potations immediately, as these cases come in and go out, their actions being in no way under your control in the interim and when once they decide to discontinue the alcohol they usually remain firm in the resolution, whereas if a regular allowance of spirits were permitted they might lapse into their former condition. I also give a solution of beef and bread in the finest Spanish wine, which I find very effective. The majority of cases of alcoholism receive the following: Sodium bromide, a half drachm every four hours; tincture of nux vomica, fifteen minims three times a day, with directions that hot beef tea well seasoned with cayenne pepper be kept simmering on the stove to be imbibed freely day and night. In case of great sleeplessness, I gave them a prescription of chloral hydrate, five grains every two hours until sleep is produced, or four doses have been taken. It must assuredly be an obstinate case in which this treatment will not prove efficacious. In some of the cases the administration of the bromide of sodium (which I exhibit because less of an irritant to the stomach) in dose of a half drachm, three times a day instead of every four hours, seems to answer the purpose. Hydrobromate of hyoscin may be used, or other hypnotics. In the treatment of the opium habit the bromide may be used, but I have found the following formulae very good during the process of abandoning both the opium habit and alcohol excess: R. Ex. Cannabis Indic.(Hering)grs. iv Caffein (Alkaloidal) grs. xxxii Quiniae Sulphat. 3j M. et divid. in pil. xxxii. One pill about every four hours if required, carefully watching its effect.. Apropos to all this is an article on "Wine" in Stillé and Maisch's Dispensatory, which says: "In France drunkenness as it is known in this country and in the North of Europe was comparatively rare as long as wine and cider were the only alcoholic beverages in general use; but the vice has greatly extended of late years and its increase has been mainly in the cider drinking department where alcohol distilled |