quiescent and external sensory impressions are in abeyance, when it is in a state of contemplative abstraction and relaxation and content pervades all feeling, then an outside will may make the imagination captive and lead it or drive it by means of suggestions; it will then, provided all the necessary factors are working harmoniously, control bodily functions, at least some of them, at the command of this outside will and so can be made of use in the fight against disease and ill health.

In conclusion I wish to say that in gathering this little bouquet of facts and fancies I have plucked flowers from many gardens, and it will be useless to ticket each one with its place of growth; the theory advanced here of the relation between suggestibility and the mental state of content, making the former active through disinclination to individual thinking and motion, I do not remember ever having seen advanced before, and it is offered for what it may be worth. It is undeniably true that content is sentient nature's state of passivity, a natural state of rest in which thought and will are held captive by a feeling of delicious inactivity and the imagination gracefully yields to the dictates of outside impressions insufficient to interfere with this feeling of safety and satisfaction. The deepening of this state of passivity in a natural and therefore harmless manner into a condition where individual effort is not only undesirable but impossible means simply so many stages of hypnosis, and the deeper the passivity the greater the ability to assimilate acceptable suggestions.

DISCUSSION OF PAPER BY DR. ROSE.

Dr. Hull: The doctor brings to the attention of the Association that there is one class of cases in which suggestive therapeutics are very effective. I remember onecase of a young lady who had been petted all her life, until she developed into a good case of hysteria. She was taken:

sick, and after ten days was brought to Atlanta with these symptoms: she was blind, partially deaf, paralyzed below the waist, and having eight (8) convulsions every day, and had been this way for a week. Where drugs had failed, mental therapeutics succeeded. I obtained her confidence and replaced the auto-suggestions by contrary suggestions, and that was the only treatment used. She was well in ten days, and has been teaching school ever since.

Dr. Rose (in closing): I did not quite finish reading the paper, as I had already taken up more than my share of your time. It is true, as has just been pointed out by Dr. Hull, that in cases cases where hypnotic suggestion is to be attempted, it is of the first importance to gain the patient's confidence so that he or she will reach the point where belief is easy, and unless this is accomplished it is often impossible to successfully eradicate unpleasant or undesirable conditions in the patient. The paper just read, however, does not deal directly with the question of "how" or "when" or "why" to hypnotize, but tries to show rather why hypnotic suggestions "stick"; I simply tried, in my feeble way, to remove that idea of mystery and occultism frequently connected with these phenomena by placing them on a foundation that may make individual investigation less difficult and more satisfactory to patient and doctor.

THE HYPODERMIC ADMINISTRATION

MAGNESIUM SULPHATE.

By J. K. GARNER, M.D., ATLANTA,

OF

When administered by the mouth, magnesium sulphate very greatly increases the secretion of fluids in the intestines and seems to retard the reabsorption of this fluid until it has formed a five or six per cent. solution of the drug, when a copious watery evacuation is produced. This is probably due to peristalsis, impetus to which has been given by the increased bulk and weight of the intestinal contents, and not to any direct irritation, produced by the drug itself, upon the muscular coats of the intestines. Acting upon the blood and the urine, Epsom salts, like other salts of magnesia, increases the alkalinity of the blood to a slight degree, thus holding uric acid in solution, and is a mild diuretic, but it is too slowly absorbed and too feeble in its action to be of any import.

Although the hypodermic administration of this drug has received but slight attention, it merits a far greater consideration; while the ease with which a sterilized solution can be obtained, together with its ready solubility and the excellent results following when given in this way, renders the method a most valuable agency for good and speedy results.

Stevens (Modern Materia Medica and Therapeutics, 1903, page 209) states that the action of Epsom salts' appears to be a purely local one, and that this view is supported by the fact that it does not produce catharsis when injected intravenously; while according to Hay it is intense

24 mt

ly toxic when introduced into the circulation, paralyzing both the heart and respiration.

For nearly two years I have used magnesium sulphate hypodermically and have always obtained a free and satisfactory catharsis, while I have not seen any untoward symptoms manifested, not even having had an abcess formation at the seat of the injection.

Its mode of action when administered in this manner is rather obscure but, at least in a large measure, the drug seems to be thrown into the intestinal canal where its local action and final results become the same as when given by mouth.

Given hypodermically, the dosage must, of course, be small (five to eight grains) and consequently frequent repetitions will be necessary in order that the percentage of the salt in the intestinal fluids may be brought to the strength required to produce purgation. It is my custom to use a solution of four drachms to the ounce of boiled water, of which fifteen minims (seven and one half grains) are injected every one half or one hour, until a copious evacuation is obtained; then if it is desired that the movements continue, an injection may be given every hour or two, as the necessity of the case demands, two or three injections, after peristalsis has been started, usually being followed by a free action.

There are many cases where a speedy saline purge is indicated, but the stomach is not retentive, particularly of Epsom salts, which of itself is nauseous, and enemas do not reach high enough to produce the desired effect. It is in such cases as these that the most happy results will follow the hypodermic administration of magnesium sulphate as above described.

Such cases as ileus, acute appendicitis, accompanied by nausea and requiring active and immediate purgation, excessive flatulence, especially post-operative, and the in

testinal paresis, either primary or that which often follows abdominal operations, during the performance of which much handling and bruising of the intestines has been necessitated, are the ones in which the most marked good may be obtained by the method in question.

In making the injection there is no point of predilection, though it is best that it be made into some fleshy portion of the body and deep into the tissues, as the amount of the injection, together with the irritant properties of the salts produce considerable pain and soreness when only made subcutaneously. For the same reasons it is best to vary the location, in the same individual at each dosage.

Reviewing a few cases treated by the hypodermic administration of Epsom salt will best illustrate the usefulness and importance of the measure.

Case 1.—Mrs. J. W. N., age thirty-eight. Operation for pyosalpingitis. Upon opening the abdomen many adhesions were found binding the Fallopian tube firmly to the intestine, much handling of which was necessitated in breaking up the adhesions. Upon the second day there was so much flatulence as to cause the patient much suffering and to endanger the wound. Magnesium sulphate was given by the mouth, producing immediate emesis, and a second dose produced a like result. Fifteen minim doses of the solution of magnesium sulphate (four dr. to the oz.) were then given hypodermically every hour for eight doses. After the fourth dose there was a slight movement accompanied by considerable flatus, and with the eighth dose free purgation was produced and nearly all the distention passed away, the patient becoming comfortable. After the stomach became retentive salts were given by the mouth in half ounce doses daily as necessity required, the patient making an uneventful recovery.

Case 2.—Mr. C. L. B., age twenty-three. Acute appendicitis. Magnesium sulphate given by the mouth produced