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urious necessities of life and even alcohol, adminis- tered to us in the form of various confusing but de- lectable beverages, is not lacking for enthusiastic advocates. But it is not of these harmless or harm- ful stimulants that I wish to speak to-day, but of a vicious habit which is becoming so alarmingly prevalent even in our own fair city that a few words upon the subject may not seem out of place. I re- fer to morphinism and morphinomania — two varie- ties of the same afifection. We mav describe morphinism as the habit of tak- ing morphine in small doses for the relief of pain and achilles slot review without any appreciable increase in dosage ex- cept as necessity demands. Morphinomania, on the other hand, is a condition in which morphine is taken for pleasure or as a stimulant and in ever increasing doses. Statistics show that physicians, druggists, and nurses are the most frequent victims of this pernicious habit, and about ten per cent, of the cases occur among wives of physicians. Why should this disease occur so often among those to whom experience and example should act as the greatest deterrent? I think the reasons are sufficiently obvious. First, the ease of procuring the drug : secondly, the secrecy with which its use may be commenced ; thirdly, the false sense of security induced by association and knowledge ; and, lastly, the nervous strain incident to long hours, loss of sleep, and anxious and responsible duties. Self confidence and daring should never be meas- ured against a foe so subtle and treacherous, nor is •Read before the Graduate Nurses Alumnx Association of Ottawa, February 10, 191 1- it wise to give our love to one who offers in ex- change disease and death. In one hospital in Paris out of 650 cases of this achilles slot play for fun disease forty per cent, were physicians and ten per cent, wives of physicians, and in one of the German hospitals the ratio was about the same. This con- dition of affairs abroad should serve as a warning to us in the United States and Canada not only to protect our patients from the danger of forming a habit so devitalizing and so ineradicable but to look to ourselves that familiarity breed not contempt but a reasoning awe. ]\Iorphine contains all achilles video slot the potentialities for good or evil. We have no more obedient or useful serv- ant and no more tyrannical or dangerous master. It is the octopus of medicine, winding its great arms softly, subtly, soothingly about its victim ; its hor- rible fascination overcomes him, and he falls limp and unresisting until at last the cruel tentacles con- tract achilles slot machine with a firm, unyielding grasp and slowly but relentlessly crush him to death. It is startling to think that in this city (Ottawa) of less than one hundred thousand inhabitants there are probably several hundred morphine habitues — poor unfortunate creatures, egotistic and unreason- ing, who stalk about the city streets, sepulchral im- ages of their dead selves, human in outward sem- blance only — in reality lost to the common instincts and impulses of humanity. IMorphine not only robs its victim of his physical vitality but leads finally to his mental and moral degradation. Knowing as we do these facts it behooves us as the sanitary guards of the public to protect as far as lies in our power the future interests of our pa- tients by never administering an opiate unless there is the greatest necessity therefor, and particularly to avoid morphine where the chronicity of the dis- ease or the mental condition of the patient warns us that there is some danger of the formation of the habit. As a general rule the drug is first used to combat pain, real or fancied, or as a remedy for insomnia, although many cases have occurred in which it was first used from curiosity or through the example or advice of an habitue. Unfortunately there is a con- siderable immber of individuals in whom it produces even from the first a species of delirious pleasure akin to drunkenness, and to this type it is i^articu- larly dangerous. To plagiarize the expression of a former patient: "The achilles slots world is transformed into a paradise achilles casino night ct tout est couleur de rose." Morphinomaniacs almost invariably use the hy- podermic method. There are several reasons for this. There is a certain morbid fascination about the needle ; the transitory self inflicted pain followed so quickly by transcendent pleasure, the more rapid efl'ect. and the greater certainty than where other means are used. The hypodermic method is less subject to achilles slots of vegas variations in results and obviates to some extent the constipation following the use of opiates. A much smaller quantity will produce the desired effect than when the drug is administered />rr os. The morphinomaniac feverishly pursues an elusive myth which appears before his distorted imagina- tion. He seeks mental strength, exaltation, relief from ennui; the drowning of sorrow, and of the BELL: MORPHINISM AND MORPHINOMANIA. 68i sense of failure and hopeless despair. He seeks to annihilate the present and the achilles slot game future. To approach this result he must constantly increase his dose, and even then the best he can hope for is a temporary forgetfulness, a fleeting happiness soon followed by a corresponding play achilles slots depression — he succeeds only in obliterating his better self. After about six months use of the drug some of the characteristic symptoms develop. The memory becomes treacherous, the patient may be able to re- call events which have occurred years before and yet the immediate or quite recent past remains a blank, amnesia becomes marked. During a conver- sation words fail to come and embarrassment and confusion ensue. Insomnia gradually becomes more pronounced, for, contrary to what we might expect, the morphine habitue does not sleep well ; the nights are spent in restless tossing about or for want of a better occupation in reading. Or if by chance he should fall asleep he is obsessed by the most fright- ful nightmare ; grotesque and hideous objects flit be- fore his harassed imagination, he hears gruesome sounds and starts from his clammy pillow into wakefulness — only a degree less terrible than those phantoms of his dreams. When the morning breaks he is exhausted but sleepless, he is fatigued, stupid, and ill humored. A feeling of despondency op- presses him and this sensation predominates throughout the day or it is replaced at times by flashes of unwonted animation superinduced by the drug — a fleeting and transitory play achilles slots free brilliancy in which the ideas are exaggerated and unnatural — a light- ninglike illumination of the mind fast followed by impenetrable achilles casino darkness. There is a great tendency to fall asleep during the day time and at the most unseasonable hours and occasions, as for instance in the middle of a conversation. The will power is enfeebled, whole days are often spent in bed, the patient lacking the initiative necessary to arise and attend to pressing duties. The sense of responsibil- ity is obtunded. and is replaced by indifference and perfect egotism. An inability for consecutive men- tal work develops, and added to this we find a moral inertia ; he becomes untruthful, unreliable, and un-

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