very serious obstacle to its use is the liability of producing tetanus, which has, however, never been the case in my own experience, but has occurred in the hands of others, of which I will give a well-authenticated instance:

M. Arnold, a military surgeon at Constantia (Algeria), who had used quinine successfully in ague, warns the profession as to tetanus being induced by such injections, and mentions two cases a child and an adult, who both died of traumatic tetanus from hypodermic injection of sulphate of quinine dissolved in water and a little sulphuric acid. Both patients were suffering from ague. I would, therefore, recommend great caution in the indiscriminate use of this medicine hypodermically. There are, however, circumstances under which I would not hesitate to use it, and do use it. Where life is endangered by the recurrence of a congestive chill, and my patient will not tolerate quinine by the stomach or rectum, or can not swallow it, or refuses to do so, or I have not time to wait for its constitutional effects by the ordinary method of administration, then, I repeat, I would not hesitate to take the chances of ulceration or tetanus. The following is the solution of quinine I employ:

R.-Sulph. quinine, grains, xxx.
Sulph. acid, dilut., gtt., x.

Water, (boiling), 3as.

M.-Sig., inject from one-half to one drachm half hour before the paroxysm.

The preparations of opium and belladonna deserve special mention, because of their universal and almost unlimited use by the hypordermic method for the relief of pain and many of the distressing symptoms of disease, the effects of which are as satisfactory as they are astounding. While diseases differ from each other materially in cause, symptoms, and severity, there is one characteristic in common, which is pain, ever present and harassing at the bedside by day, unappeased by night, a phantom that walks by the side of the physician, ever ready to bar the door of the sick chamber against his entrance. In these

preparations we possess a therapeutic weapon that speedily overcomes and vanquishes this dread enemy. In my former article I recommended the use of the acetate of morphine, but now use, and prefer, the sulphate, because it is more soluble, and consequently less irritating.

The following is my solution:

R.-Sulph. morphia, grains, xviii.
Sulph. atropia, grain, i.
Carbolic acid, grain, .

Water, 3i.

M.—Sig., ten drops equal to one-half grain of morphine and one-thirty-sixth grain of atropia.

The carbolic acid produces a perfect solution without the further addition of other acids, and prevents the cryptogamic deposit or growth that you find in the ordinary solutions of morphine without it—thus enabling us to keep a larger quantity of the solution on hand, thongh it is best to use a fresh solution whenever practicable. The number of drops calculated for an ounce is three hundred and sixty (360), and not four hundred and eighty (480), as ordinarily supposed; the test of the drop being the amount that passes off as such from the point of the hypodermic needle. There ought to be a more reliable standard of the drop than now exists, and the needles of the syringe should always be the same size. Those manufactured by Lier and Charrier, of Paris, are of precisely the same size, and also those prepared by Tiemann & Co., of New York. I use the sulphate of atropia, because it is most soluble, and equally as efficacious. As will be perceived, I combine the atropia in this solution for obvious reasons. The question of antagonism between opium and belladonna and their preparations has excited considerable controversy during the past few years. I have not time to enter into a full discussion of this question, but will mention that it seems to be the result of extensive observation by learned men of the profession that morphine and atropine are naturally opposing poisons; but that while on the one hand atropine diminishes or removes the hurtful influence of morphine

on the brain without diminishing its sedative and pain-allaying power, yet on the other there is no complete antagonism between the two agents over the whole range of their action. In certain functions of the organism the antagonism is incomplete, in others it is wholly absent, and in respect of the urinary bladder, the effects of the two poisons are alike. It seems then that the evidence of antagnism is inconclusive, yet, in my opinion, the physician who does not administer the one in case of poisoning by the other, fails to do his duty. The success depends upon the prompt administration of a dose or amount adequate to the case in hand; and there can be no other rational guide to this than the quantity of poison taken and probably absorbed, as evinced by existing symptoms. The combination of the atropine in the morphine solution seems to be valuable then in many respects. The essential effects of opium are both intensified and prolonged by the concurrent action of belladonna. It prevents the nausea frequently that would otherwise follow the use of morphine. This combination, as a general diffusible stimulant, surpasses all other drugs, and is a most appropriate and hopeful therapeutic means in all diseases where there is failure of the heart's action, i. e., the depression of the sympathetic nerve-force. It must be borne in mind that an excessive dose will produce depression from over-stimulation. Given with a view of exciting or sustaining the heart's action, the dose will range from the 1-100th to the 1-60th of a grain of atropia, and should never exceed the 1-40th It is especially in cases of the neuralgias-of pain of every character, that the administration of this solution exhibits to most advantage.

The effects of a few drops of this solution in a case of facial neuralgia or hepatic colic, for instance, injected beneath the skin of the forearm into the areolar tissue, are sometimes almost marvellous; usually within ten minutes the patient is quite free from pain. The effect of one such dose is startling to any one who has not had some experience in these cases-the beneficial influence continuing for several hours, and in ordinary cases not arising from organic disease, effecting a cure. It is remarkable

that morphine thus used has a more permanent effect in allaying pain than when given in any other way. After a fracture has been reduced and the limb placed in a proper position, a small dose injected into the areolar tissue of the limb is of great value in preventing muscular spasm, and, I think, ought never to be neglected. In the distressing vomiting from sea-sickness, which sometimes imperils life, I imagine this solution injected over the region of the stomach would produce charming relief, as it certainly does in other vomitings. I have seen hiccough complicating pneumonia, which had resisted for days various treatment and strongly threatened death, instantly relieved by injecting six drops of this solution into the intercostal region. Puerperal convulsions after labor are almost always relieved by the injecting of ten drops in the arm. In the distressing paroxysms of asthma, I have never found any remedy so efficacious. In obstetric practice I find the subcutaneous injection of this solution very useful under the following circumstances and conditions, viz.

I

1st. During painful dilatation and expulsory periods, especially in primiparæ and in norrow pelves. 2d. In spasmodic pains. 3d. In painful complications of the process of labor in general. 4th. In severe after-pains. It is in the first category of cases that I have especially employed it, injecting one or both thighs. might go on and occupy pages, enumerating the conditions andcircumstances where these drugs have been employed with complete satisfaction. I will only further state that wherever pain is present, which no human being ever willingly endured for a single moment, always use the hypodermic syringe. In children and delicate females I employ the compound liquor of opium, prepared by Dr. Edward R. Squibb, in doses from five to fifteen. drops, or more, always beginning with a minimum and gradually going to a maximum dose. There is no risk whatever in using it on children, even infants. In small children, I usually introduce the medicine under the skin at the back of the neck. The pain inflicted is of no consequence, and there is much less annoyance than pouring it down their throats. The tolerance

of the human system to the preparations of opium, administered hypodermically, is very surprising, and I shall briefly allude to it. There are several cases on record, well authenticated, of employing it to such an extent that the body was perfectly covered by the points of puncture. There is a young man in this city, who, during the past three years, has had the instrument used upon himself about four thousand times. He had scarlatina when a child, and the inflammation, extending from the tonsils and fauces to the eustachian tube, resulted in disease and ulceration of the bones of the ear, causing most violent paroxysms of pain. He could not take any of the preparations of opium by the stomach without the greatest distress, and nothing else seemed to give him any relief. The hypodermic syringe was called into requisition and Squibb's compound liquor of opium in twenty-drop doses first used with immediate and marked relief whenever the attacks came on. He visited and consulted the most eminent medical men in the United States, and permanent relief was pronounced by them impossible. After various medication, it was decided to direct remedies alone to the relief of these paroxysms of pain, not supposing the unfortunate young man could much longer survive. Thus he has gone on, using the hypodermic injections daily, generally five or six times in twenty-four hours, for about three years, occasionally increasing the dose, until now it only requires about one grain of morphine and 1-30th grain of atropine at each injection. He does not seem any worse now than two years since, except some loss of flesh and a weakening of his intellectual sensibilities, together with an impairment of vision, requiring the use of glasses in reading, produced by the atropine. He carries about his person constantly, wherever he goes, a hypodermic syringe and solution of morphine and atropine, to be used whenever an attack comes on, and so common is it in the city that any one who first gets to him uses the instrument-even a negro servant, who often accompanies him. He carries a little blank-book in his pocket, properly ruled, where the time of day and number of drops of the solution are recorded, and referred to each time