drawal of morphin in the treatment of habitués. These alkaloids, with gelseminin, should wholly replace morphin for general antispasmodic and narcotic effect.

Lobelia.

While lobelia may not be classed as an antispasmodic, per se, it does overcome spasm thru its great relaxing power. The regular school has given this drug but scant study in the past, but the eclectics have employed it, with reported good effect, over a period of several decades. This is one of the drugs which should be studied more thoroly, and it may be found that it will replace opium and her products in many instances. With the isolation of the alkaloid lobelin, we have a more reliable form of the drug with which to deal.

Bryonia.

Bryonia is another drug which the regulars have not given much of a reputation, but which, in the hands of the eclectics and homeopaths, has seemingly given good results in selected cases. It is employed by them in the presence of pains, tearing, stitching and stabbing in character, as that of pleurisy, made worse by motion and relieved by rest, and with good results, according to the reports of the eclectics. I have employed the glucosid, bryonin, in cases of pneumonia with associated pleurisy, and noted good results on several occasions. I have also employed the glucosid in muscular pains, increast on motion, and noted like good results. We of the regular school should undoubtedly give this agent closer study.

Rhus Tox.

Rhus tox is another drug which the eclectics employ with good results in the presence of pain, boring in character and relieved on motion. That school gives the following as specific indications: Sharp, boring pains (relieved by motion), with the quick pulse of irritation, localized burning pain in the frontal region of the orbit, with papillæ of the point of the tongue elevated and congested. It is also suggested in the treatment of sciatica and is said to have brought good results after all other remedies have failed. In this connection, alternation with colchicin adds to the effect.

Solanum.

Solanum is an agent which has come into prominence within recent years. The alkaloid has both an antispasmodic and mildly

In the above list cimicifuga was overlookt. This agent and its concentrations are of use in the treatment of muscular rheumatism, combined with bryonin. Macrotys is also useful in supprest or delayed menstruation, with shooting pains and bearing-down sensations, and to control "false" pains with tendency to abortion.

Law Will Reduce Opium Consumption.

With the numerous agents above enumerated, I cannot see why we should be obliged to resort to opium, or any of her various products, excepting in isolated cases. Even in emergency we can find antispasmodics and agents to relieve pain without resorting to the opiates, and these agents will give the desired effects without the ill ones incident to the use of morphin or other opium products.

We have in the past been too prone to employ morphin in the face of all emergencies. This has been done because of the fact that we have either not been taught

to employ or have not studied the possibilities of other agents. We have been tlamed, and truthfully, with the starting of many a soul on the track of the morphin habit, and it is little wonder that the parent government took steps, thru the Harrison bill, to overcome this tendency.

This new law is going to act as a check on every one of us. The doctor who orders morphin tablets by the tens of thousands is going to be investigated and he will have to show why he is using such large quantities of the drug, and rightly. It is going to make the hospitals likewise produce evidence as to their like large employment of this agent. It is going to make better doctors of every one of us, as it is going to make us study our materia medica to a greater extent, in that we may discover those drugs which will effectivly replace morphin, both in emergency and otherwise. This law, while requiring certain things of one who handles opium and coca products, is not going to work a hardship on anyone. It does not interfere with the dispenser in the least and he can go on with his practise as of yore, but he must be more careful, that is all. It is a good thing and we should co-operate in every way with those in charge of its execution.

GEORGE L. SERVOSS, M.D.

Gardnerville, Nev.

Some Manifestations of Nerve Wear. EDITOR MEDICAL WORLD:-In considering certain nervous manifestations, it is not our purpose to regard so-called "neuras

thenia" as a symptom of organic disease, but as a functional disturbance of the nervous system. Obviously the differentiation is difficult and in making the distinction we must depend upon a thoro physical and clinical examination, but more especially upon the lapse of time, which in many instances, alone enables us to make a diagnosis.

Symptoms of nerve wear may occur in all classes of individuals, but it is in the cultured, with their highly sensitiv nervous systems, that disturbances most frequently are observed. Increast susceptibility to nervous instability seems to be the concomitant of the elaboration of civilization, the price of intellectual and economic advance

ment.

In this strenuous age the individual with a well-balanced nervous system and a wide

margin of vital energy will stand the "wear and tear" of existence without evidence of nervous disorder, but another, less fortunate, with a neuropathic heredity or with an unstable nervous system as a result of previous illness, must husband his energy with care, lest some indiscretion or extra strain lead to symptoms of functional disturbance.

The victims of nerve wear are the business or professional man too much absorbed in his work to take a vacation; the housewife whose duties at home prevent her from having an occasional change of environment; the subject of a turbulent domestic life; the college student having a full schedule and earning his maintenance; the youth with neurotic heredity and with an ambition in excess of his nervous vitality; the easily worried; the individual unable to locate his niche in life; the disappointed lover; the chauffeur and the engineer; the operator of a rapidly moving machine; the magnifier, who sees in the slightest difficulty the unalterable source of future failure; and the individuals whose feelings run the gamut of emotion from the summit of ecstasy to the depths of abyssmal despair.

Physiologically, at the onset the manifestations of nerve wear are usually characterized by emphasis on the cortex, cord or autonomics, but later signs of general derangement of the nervous system appear. Cerebral.

Our cases with emphasized cerebral localization showed mental inaptitude, inability to concentrate, deficient memory, headache, disturbed sleep, irritability of temper, predisposition to worry, depression, obsessions, phobias, and emotional excitability.

No. 205, aged 50, a housewife, complained of "nervousness.' No history of neuropathic heredity. Menopause uneventful. The patient has enjoyed "fair" health, but "always worried a lot." Recently she noticed that she tired very easily.

She had a markt disproportionate conception of causation and result. Phobias were notable. To her, harmless family gossip was the basis of scandal; the failure of a member of the family to appear at the expected moment caused fear of his death by accident; each spark was to be the beginning of a conflagration; the slightest cloud, a sign of a devastating tornado; and each injury the source of cancer. She gloried in an unexcelled pessimism.

Change of environment and a hygienic régime were followed by great improvement, and at present, three years later, the patient reports, "I am well, but when I am tired I get nervous and worry.'

"

No. 200, aged 29, a student, complains of being "unable to concentrate, poor memory and abso

lutely inefficient." His mother has always been a "nervous woman" and "one brother is an inventiv genius who is peculiar and has to be watcht by mother."

The patient has had "nervous trouble off and on for eight years." He had been worried a long time on account of his poor efficiency, but recently he has developt mild ideas of persecution-"all of my instructors and associates are down on me, my girl has gone back on me, I am hopeless and helpless, and feel like ending all."

He was carrying a heavy schedule, working for his maintenance, getting insufficient sleep, taking no recreation, and living on a diet of low calorimetric value.

His physical examination was negativ. This seemed to afford him great hope and comfort, as he had been certain that he was a physical wreck, beyond repair.

He was given a program of eight hours' sleep, two hours' recreation, three regular full meals, and a slightly reduced schedule of study. This régime was followed by a gain of several pounds in weight, which made the patient optimistic concerning his recovery.

At vacation time he obtained a position in the work he specially liked, and eight months after having been first seen finds himself "never feeling so well in years."

This patient with a neuropathic heredity represents the type where a simple hygienic life, the avoidance of extra nerve strain, and a suitable occupation will do a great deal in making him a useful member of society.

No. 68, male, student, aged 23, has full schedule and earns his keep. He complains of fear of dying. No history of nervousness in his family. When 17 years old he was much worried over the financial condition of his family and "began to think how terrible it would be if I went blind." This fear possest him for three months, in spite of good eyesight. Gradually he began to realize there was no such danger and his fear disappeared. Two years later, during the time his work was especially hard at high school, he was worried by the thought of how serious it would be if he could not sleep. As the worry did not keep him awake at night, he concluded it was foolish and it disappeared.

On entering college in September, 1914, the anxiety over getting his course arranged and the procuring of a suitable position for maintenance was followed by a dread of death. Fortunately, he was well fixt and his necrophobia disappeared. At the end of the semester the extra tension accompanying approaching examinations caused the fear of death to reappear. His living schedule was rearranged so as to include eight hours' sleep, two hours' recreation, and he was assured that his standing as a student insured his passing. His fear of death has not annoyed him for the last six weeks.

The patient seems to be in excellent condition physically, but whenever under extra nerve strain phobias have appeared which disappear when the tension is relieved, to reappear when it is again increast.

Spinal.

The spinal manifestations of nerve wear are muscular weakness, vague pains, backache, hyperesthesia and priapism.

No. 215, female, teacher, age 25, complained of pain in chest and right arm. Her mother was a woman that worried over trifles and her father was considered a nervous man. The patient was a vigorous woman in good health. At the time of the attack she was teaching a difficult school under trying circumstances and was discouraged concerning her position.

The pain began suddenly in the region of the right sternal margin between the second and fifth ribs and radiated along the right arm into the right hand. It occurred intermittently, once or twice daily, disappearing at night, to recur the next day. The physical examination was negativ. The reflexes and sensation in the affected arm were negativ, but the grip of the right hand was slightly weaker than that of the left. The patient was ordered to take a rest and the pain and weakness disappeared during the first week of vacation.

Autonomic.

The symptoms of disturbance in the domain of the autonomics are flushing, vertigo, palpitation, nausea, flatulence, loss of appetite, sweating, and swelling of the hands and feet.

No. 125, aged 21, a bookkeeper, complained of sweating and swelling of the hands and feet. His family history was unimportant and he has always been well. Recently he has been troubled with sweating and swelling of the hands and feet, which became worse when he had had a hard day. Physical examination revealed a markt dermographia, hyperidrosis and borborygmus. Urin negativ. Rest and diet were followed by a disappearance of his trouble.

No. 146, aged 22, female, student, complains of "fevers." Her mother is a "nervous woman and is easily excited." The patient has always enjoyed good health, but has never been able to take vigorous exercise without disturbances of menstruation.

She had been well until entering college. She arranged a heavy schedule of work, and urged on by an ambition out of proportion to her strength, she studied very late at night, got no recreation, and frequently "skipt breakfast."

Examination showed a poorly nourisht, slender dermographia, flushings, tachycardia, and hypergirl with a normal temperature, muscle twitchings, activ reflexes. Proper rest and a tonic of iron, arsenic, strychnin and quinin cured the "fevers."

Preventiv Treatment.

The methods of treating nerve fatigue have cured and benefited many individuals, but they fail to reduce the number of unfortunates that are produced yearly as a result of neuropathic heredity and the strenuousness of the times. The great effort in dealing with nerve wear should be directed, not toward providing more retreats for the

worn out, but in the prevention of the wearing.

In adults prophylaxis is relativly simple. The symptoms of nerve wear are uncommon in those who do not take themselves too seriously, have a pleasant home, suitable employment, proper rest, and observe the laws of hygiene.

Prevention may also be obtained by so controlling the soil that it cannot form the source of a future subnormal nervous system. This is the mission of eugenics and cannot become effectiv until the general pub

lic has been so educated in the laws of heredity that its principles shall influence social relations.

The most hopeful means of prevention

is the early detection of the child with the abnormal nervous system that in later life will show manifestations of nerve wear under tension that would not cause symptoms in a normal individual. This obviously is difficult, but we should expect results with our methods for determining the mentality of children and with careful observation of them with special reference to their nervous states.

The discovery of children with abnormal nervous systems, the instruction of teachers in the manifestations of abnormality, and the advice of parents as to the education and management of such children should be as much the duty of the medical inspector of schools as his opinion concerning the removal of adenoids.

Proper co-operation of the medical examiner, the teacher and parents would save many abnormal children from shipwreck at adolescence, and would make useful members of society of individuals otherwise doomed to an institutional life or a mental semi-invalidism-a disappointment to their families and an economic loss to their communities.

J. HOWARD BEARD, A.M., M.D.
Urbana, Ill.

EDITOR MEDICAL WORLD:-My, oh! Time flies! I think I have taken THE WORLD Over thirty years. hope I will be able to take it another thirty years. We sleep out, every night, winter and summer, on sleeping porch, not because we are either of us sickly; we are not. No lung difficulty either side of the house. Back several generations parents on both sides of house lived to a good old age. My grandfather was a physician. My father was in activ

practise fifty years. The only brother he had was a physician. I have been in practise about thirty-five years. Have a brother younger in practise, I think twenty-eight years. All have taken THE WORLD; all like it. Therefore inclosed find check again for another year. Don't want to lose out on January. Monmouth, Ill. R. M. C. BALL, M.D. [Doctor, think what you would have saved if you had sent $3 for each four years instead of $1 every year. ED.]

Sinusoidal Current for Spinal Lesions. EDITOR MEDICAL WORLD:-I report it just about as it occurred:

"But, Doctor, I am not sick; I'm not the patient; why are you asking me those questions? Ask Sister, she is the patient; not me. I am not sick," are the words of a neurasthenic whom the sister had induced to come to the office by asking for company, while she, the sister, askt for help.

The patient, Mrs. F., English, aged 40, one child, stillborn, at 26, had the usual history of the "rounder" plus

Tired all the time; cannot rest; cannot think; mind cannot grasp things quickly, sleeps heavy (?) and as tired in the morning

as when she went to bed.

No appetite, acid stomach, breath bad, tongue coated gray brown; saliva seems to be sour; mouth and throat sour; nuts, of which she is fond, make her tongue sore. Dull headache all the time, occipital-top

-or frontal, at same time pain in lumbar region-dull-all the time; eyes achethrobbing-feel large and cold, as if too large for sockets.

Ears feel full-muffled.

Menses regular, painful-flow is clotted, greenish at times at others dark red; sticky, stains napkins dark; spasmodic pain 24 hours before and continuing during period, sick headache afterward for 24

hours, when she vomits bile and is sick at stomach.

Genital organs heavy-seem to fall down and out; hips and back ache; leucorrhea thick, white or yellow.

Constipated all the time, "and, Doctor, it is no use to give me anything; I have taken all the cathartics and salts, etc., that there are on the market, and they do no good, and I have taken tonics galore."

me

Such was her history as told. What did I see? A widow of 40, corners of mouth drooping, putting on a bold front and trying to make the best of things, but a poorly nourisht body, pain-lined face and a lot of blood where it should not be.

"Applied Anatomy," by Gwilym G. Davis, page 482, last lines: "and the appearing of bed or pressure sores without ample cause is presumptiv evidence of a spinal lesion of the segments supplying the part." And I saw a pressure sore from the stomach to the rectum, inclusiv.

She had whipt the flagging forces with tonics galore, she had cleaned out with all

the oils and cathartics, and was trying to keep clean with salts, water and will-power, and it was affecting her mind, and the sister feared insanity or me ancholia-a cousin.

The lesion in the back, was located and we selected the sinusoidal electric current as our best friend with which to help, applied over the sixth and seventh dorsal vertebras, current entering one side and leaving the other, for ten to twenty minutes each day.

Thirty treatments during six months, when we missed her for four months and she blew into the office a very much different lady, cheeks red, smiling, happy, satisfied, and all her old condition gone, bowels moving naturally, and eats and sleeps normal.

"So glad Sister made me come. Mother is coming to see what can be done for her." Remedies used-nux vom., 3x, and sabina, 30x. DR. J. F. ROEMER.

Waukegan, Ill.

Versions and Flexions of Uterus.

EDITOR MEDICAL WORLD:-Recently having lookt up some of the old authors on diseases of women, and remembering, as I can, also teachings by the professors while in college, I compare those accepted beliefs with the enlightenment made in my mind by experiences with thousands of laparotomies. I am fully convinced that the beliefs held by those early teachers were erroneous. To me there is no such condition as versions or flexions of the uterus. How such errors could have crept into the thoughts of enlightened surgeons is hardly conceivable, and yet what may be still more wonderful is to see men of moderately good judgment still cling tenaciously to such fallacies.

The Conditions Present.

If this article serves no other purpose and convinces no one quickly, I do hope it will have a tendency to make men of thought sit up and think, and if any of them in their work can find a retroverted or anteverted uterus, not to say anything about a retroflext or anteflext condition, I would be very pleased to have them let me know. There is no such condition as constipation. resulting or an irritable bladder induced by these conditions. Such dogmatism as I am manifesting would not be evinced by me only "I am from Missouri" and have never yet been shown.

When we have irritable bladders and bowels that are constipated, the cause is abscess resulting from an infected Fallopian tube or vermiform appendix, a fibroid tumor, a cystic tumor, cancer of the bowel or some such extraneous cause. Formerly we used an old-time intra-uterin sound, which, having been placed "in situ," might decipher a tortuous canal, which most of us presumed was on account of the position the uterus held in the pelvis. If any one of you would take the pains to investigate one of these cases, most times you will find it to be the result of some irregularity in the uterin wall, often due to myoma, and probably a myomectomy would correct the route.

If there ever was a case which would excuse our early preceptors for teaching us the rot that we were taught, it is that the womb had been drawn forward or backward the same as a tree is sometimes bent over by its load of fruit or ice in the springtime. Remove the fruit or ice and see how quickly your tree will replace itself and spring back into position. Such is a good example of what will happen to the uterus after you have taken off a fibroid tumor from its muscular walls.

Pelvic cellulitis accompanied by accumulation of serum or pus relieved by a colpotomy will also cure a so-called flexion or version. Procidentia will invariably be present if there is any such condition leading us to believe that the uterus may have turned, and if such be the case correct your procidentia by a ventral fixation or an Alexander operation, and away goes your "retro" or "ante." In place of the timidity which most men presuming to benefit womankind generally practise, temerity should supersede. After the intelligent man has entered the pelvic cavity thru the abdominal route it will not take him long to become convinced of the truthfulness of my saying, and he will not thereafter be propping up a delusion with a vaginal pessary or requiring a lady to be coming to his office every second or third day for a local treatment consisting of a swabbing with iodin or a piece of lamb's wool or cotton in which he has decanted a measure of boroglycerid or ichthyol. Attach a string to this, and instruct your patient to remove it the next morning, and you will have a typical object, which might, in the nomenclature of an up-to-date observer, be called a modern-day fallacy. The doctor, especially the lady doctor, who makes the prac