therapeutics describe at great length the value of morphine in medicine, but say little of the possible dangers from its use. In nearly all medical colleges, little or no instruction and seldom any warning is given the recent graduate concerning the danger of addiction to morphia. The moral theory of vice and wilful giving way to the impulse for relief from morphia is prominent in both medical and lay circles, and the victim who has become an habitué is regarded as one who might have done otherwise by the exercise of his will. A prominent physician recently wrote that the mania for morphine by the needle was more a moral lapse than a physical one. Another writer of eminence in this country talks at great length of the moral treatment of morphinism, conveying the same idea. Physicians believing these theories would naturally use morphia by the needle with great indifference. It is urged by some writers that in all conditions of pain, it is justifiable to use morphine by the needle. Some physicians when called to an obscure case, give morphia at once, before making a diagnosis, believing that after a certain narcotism of the pain centers the symptoms of the disease can be more easily determined or they reason, that the effect from cessation of pain by the needle will create confidence in the mind of the patient that will be followed by more successful after treatment. Other physicians use morphine in the most routine way, giving it in nearly all cases either alone or combined with other drugs, varying with the amount of pain present. In neurotic and rheumatic cases where the use of morphia brings rapid relief it not infrequently happens that the physician instructs the patient in the use of the needle, and trusts his judgment when and how to use it. Instances are not uncommon in which the physician has given morphia daily for weeks. When it dawns on the mind of the patient that he is contracting an addiction, the physician is discharged but the drug is continued in some form or another.

Where the physician has concealed the drug from the patient, a change of physicians is almost sure to reveal the fact and show the inability of the patient to get along without a narcotic. Many very excellent physicians have thoughtlessly given morphia until its poison effects were marked and the patient was unable to bear its withdrawal. In that case, the patient usually drifts away from the doctor, falls into the hands of quacks, and soon becomes an incurable. A second class of medical men, who are very active in promoting morphinism and other narcomanias, are spirit and drug takers themselves. They are physicians who believe in the food, tonic and stimulant qualities of alcohol and use it in socalled moderation, socially and at meals or upon any occasion of strain or overwork as a stimulant. Morphia is used in the same way. If suffering from insomia or overwork, morphine by the needle is used for relief. These physicians believe implicitly in the stimulant value of morphia and do not hesitate to use it on all occasions. The morphia-taking physician will combine this drug in nearly all his prescriptions whenever pain suggests its use. To him there is no possibility of an addiction, and should it follow, it is ascribed to other than the real cause. In one instance, a physician of this kind was known to have made or assisted in promoting morphinism in, at least, six different persons. A third class who are active in promoting narcomanias are druggists and manufacturers of proprietory medicines. The former soon discover the magic effect of prescribing doses of morphia for pain and the latter teach the person how to use the needle, the druggist profiting by the sale of the drug. Many druggists change inebriates to morphomaniacs by couter-prescribing some of the forms of opium or morphia. Physicians may start these cases, then the druggist helps on the addiction, and continues to sell the drug as long as the habitué can pay for it. The patent medicine proprietors use large quantities of opium, mor

phine and cocaine in the pain-killers and nerve remedies. In one of these widely advertised drugs, an eighth of a grain of morphia was found in every teaspoonful. Many of the brain and nerve remedies contain cocain in addition to some form of opium. The popularity of such com pounds often depends largely on the narcotics they contain. After their use a few months, the druggist substi tutes for them a similar compound containing morphine. The patient is then a narcomanie. Not infrequently the history of the case begins with proprietary medicine first. The effect of morphia is then realized, although the drug is unknown. The physician is called in and he discovers morphinism in the abstinent symptoms, when the proprietary drug is stopped. After an ineffectual struggle, he continues the morphia concealed in some other drug and from this down the course is rapid. The patient drifts from one physician to another, each one discov ering the addiction and unable to check it allows the case to drift into other hands. Sometimes the case be gins with the druggist who prepares a mixture of morphine concealed in some flavoring substance which is used for a time, then the patient drifts away to a physician and finally becomes a morphine taker. There are in every community neuroties and psychopaths who are continuously seeking relief from states of exhaustion and depression. Indigestion, excitement, overwork and under work are followed by general emotional disturbances for which drugs are taken. Such persons are hunters for panaceas and specifics. When morphine is given, the narcotism is so perfect as to be a revelation of a new world of comfort and peace, and this is repeated with eagerness and reckless disregard of consequences. Should the drug produce nausea and after a short period of quietness and rest be followed by still greater depression, it is not usually used again. It is one of the unmistakable signs of danger when the morphine brings complete abolition of pain with quiet, restful slumber

and no after depression. Such cases are sure to become morphomaniacs with very little temptation. In one instance, a physician found two members of a neurotic family peculiarly susceptible to the narcotic action of morphia, given by the needle. Fearing that this would lead to a serious addiction later, he gave large doses of apomorphia which produced intense nausea and disgust, breaking up the mental fascination for morphia. Neuropathics, seeking relief from both physical and psychical pain should never be given morphia by the needle except for some special purpose, and then only when concealed. In these cases there is often a needle mania or an intense desire to get instantaneous effects from the drug, and feel the prick of the skin and see the raised surface into which the fluid is forced. This needle mania is serious and persistent, requiring great skill on the part of the physician to break up. Hyper-sensitive men and women insist on having drugs given this way, and when nothing but hot water is used, are satisfied. The danger of addiction to morphia, by using it indiscriminately and on all occasions, while always a serious one, is by no means the most important. The physiologic action of morphia on the nerve centers is first a slight stimulant or irritant and then a narcotic. This narcosis falls most heavily on the sensory brain centers, and while checking pain symptoms and depressing functional activities, reacts on nutrient centers and the metabolic processes. Narcotism of these higher centers disturbs elimination and when continued increases the growth of toxins, which still farther depress and derange the equilibrium of the nerve centers. The physiological effect of morphia, first causing irritation, increasing the heart's action, then depressing nerve activity and consciousness to a degree of coma and sleep after which reaction in nausea and depression follow, are certainly very serious interferences with the normal physiological processes of the body. Recently several eminent surgeons have

sharply condemned the custom of giving morphia after operations, asserting that the narcotism following still farther depresses the nerve centers, deepening the shock from the operation and depressing the vitality. Some English surgeons have recently protested very emphatically against the common use of morphia, giving as a reason the diminished secretions and changed metabolism which always follows. Dr Price, of Philadelphia, believes that opium in any form increases the mortality from abdominal operations and sustains his argument with strong clinical proof. Other authorities condemn the use of morphia by the needle, reasoning that the sudden introduction into the blood of a toxic agent lowering the nervous activity and concentrating its power on the sensory centers is a far more dangerous and serious interference with the vital processes than if used by the stomach. There seem to be good reasons for believing that chemical interference from suddenly changing the hyperesthetic sensory centers is followed by other and more serious states. The mere cessation of pain may be an interfering with and a prolonging of the cause, of which pain is a symptom. Morphia used to quiet pain is simply trating symptoms while the causes remain. Dr. Barrett has shown conclusively that water may be used in the place of morphia as a narcotic in nearly every instance where pain is to be overcome. Dr. Cowles concludes that the continued use of morphia favors the growth of intestinal toxins, absorption of which still farther poisons and deranges the vital processes. Opium, as a as a fluid or solid, has far more pronounced narcotic action and when given by the stomach is followed by more prolonged after ef fects. The alkaloids, morphia, heroin and other new combinations are more intense and brief in their action and all of them seem to fall more heavily on the higher brain. Another source of danger is apparent in many of the common cases which come under daily observa