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ethical. Criticism of all kinds is resented. Tlis self sufficiency recognizes no other authority. He shuns society or acts in a strange incomprehensible man- ner when in company. One patient whose attention I attracted to the fact that he often left my ques- tions unanswered replied that although he heard distinctly he saw no good reason why he should use the necessary mental effort to answer them. This almost incredible indifference to the opinions and feelings of others is characteristic of the disease, and the morphine habitue is bound sooner or later to become a social outcast. Morphinomania is by no means confined to the ignorant or illiterate. As a general rule we find that quite the reverse aladdin's wishes slot is the case, some of our best states- men and "litterateurs" having been addicted to the drug. But while some use this as an illustration that morphine does not injure the mentality and even excuse their vice by pointing to these men, we must admit that this is the exception rather than the rule and that even these men in time degenerate. One has only to read the writings of Edgar .-Mian Poe to see the ramblings of a morbid though thrilling imagination distorted by morphine. Nor do we find that the mental and moral health are alone in the process of degeneration ; perhaps the physical health deteriorates to an even greater ex- tent. We find in most cases fatty degeneration "of the heart and liver, an anjemia which soon is mani- fested by the ashy or leaden pallor so well known to most of us. Xutrition suffers and the patients become thin or flabby. The pupils are small and react slowly to light. There is thirst, loss of appe- tite, or an appetite only stimulated by an ante cibmn hypodermic of morphine. Systemic disorders supervene and we find tre- mors, gastric disorders, generalized pains, cough, and diarrhoea, all these symptoms being. relieved by resorting to 'the drug. As a matter of fact all the functions of the body which normally take place in a painless i:ianner have become so subdued by the opiate that when it is temporarily discontinued these l^hysiological actions become a source of positive discomfort, if not of actual pain. We may divide the effects into three stages: First, before the system becomes demoralized we have the stage of exaltation, when none but an acute observer might notice an appreciable change in the patient ; secondly, the stage of intoxication where the phy- sical and mental changes commence to manifest themselves, and, thirdly, the stage of cachexia with progressive weakness, emaciation, and a shrivelled parchmentlike skin, cedema of the extremities, and nephritis. The disposition becomes morose and sullen, and the patient is scarcely conscious of his environment. If the drug is suddenly withdrawn we find the most violent symptoms of reaction ; restlessness, sleeplessness, pain, vomiting, diarrhoea, coryza. yawning, sneezing, coughing, palpitation of the heart, sweating, great prostration, dilated pupils, tremors, collapse, and even death. If the pulse becomes weak, slow, and irregular, the face pallid and shrunken, watch for collapse and administer, not strychnine or other so called cardiac stimulants, but morphine in small doses. In these cases it acts as a much better and quicker stimulant than any other drug. And what shall we say of the prognosis of this dread disease? In no other aiTection is there as great a lendenc\- to relapse. Various writers have estimated the percentage of relapses as seventy-five or eighty, but to me this seems rather under than over the mark, for in a fairly large experience with these cases I cannot recollect more than ten per cent, of permanent cures. In one hospital where thirty-two physicians were treated twenty-six aladdin's wishes online slot were known to have returned to the drug — and this per- centage among those who should offer aladdin's wishes slot game the greatest hope of permanent results ! Many morphine habitues have no desire to be cured and resist all the efforts and good wishes of their friends in their behalf. It is not surprising to find that there are hun- dreds of morphine habitues among the criminals and paupers of our country and I think we may speak with reasonable assurance when we say that the use of opiates is largely responsible for many of the crimes of the present day. To aladdin's wishes free slots return to the prognosis, we may say that the best hope for recovery may be held out in those cases in which the drug has been used for some dis- 682 CORRESPONDENCE. eased condition which has been removed by play aladdin's wishes opera- tion or treatment during the period of withdrawal. The treatment of this dread disease is necessarily very varied, and must take into consideration the stage of the affection, the quantity of the drug used, and the physical condition of the patient. The patients should be treated either in a hospital or sanatorium or w'ith absolute isolation from friends and acquaintances, for there is no more cunning and resourceful individual than the morphine habitue; he will resort to all forms of trickery to gain access to the drug. We need too a clear minded and firm nurse, one who can assert her authority and who will keep the patient under the strictest surveillance; she must have good judgment and experience, for often collapse will occur so suddenly that there is no time to send for the physician or other help. Although there are many who advise immediate discontinuance of the drug, this plan has so fre- quently been followed by temporary insanity or col- lapse that it seems to be more advisable to adopt the system of rapid withdrawal in all but those cases in which there aladdin's wishes casino is great debility, when it will have to be done very gradually. Rapid withdrawal has this advantage over the slower method, that while it may cause severe suffering for a few days it does not pro- long the agony until one's patient is fairly distract- ed. Most patients will be found to be taking from ten to fifteen grains a day, although I recollect one woman who stated that she had taken sixty grains of morphine and twenty grains of cocaine in the twenty-fotir hours. We are fairly safe in cutting the maximum in half the first day of treatment be- cause it will be found that most habitues are taking almost double the quantity necessary for comfort, the surplus apparently remaining inert. We may cut this quantity in half the following day and so •day by aladdin's wishes slot review day until none at all is being used, excepting when symptoms of collapse supervene and we are forced to use a small quantity temporarily. At the same time we must use other sedatives such as the bromides, hyoscine, and best of all cannabis indie;; in order to keep our patient in what one might term endurable discomfort, for this is the best we can hope for in the first couple of weeks. At night it may be necessary to resort to such harmless hyp- notics as paraldehyde, trional, or veronal, being careful to change the hypnotic continually so that no new habit may replace the one we are trying to cure, for these patients are prone to contract new habits with uncanny readiness. Above all discontinue the use of the hypodermic syringe as soon as possible and if it is necessary to give opiates at all give them by the mouth. ' One word of caution about hyoscine hydrobro- mide, one of our best and most powerful nervous

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