Severe or traumatic iritis of an exudative nature sometimes follows extraction of senile cataract. It usually comes on about the fourth day after operation, manifested by great redness of the eyeball, pain of severe nature, lacrymation, discoloration of the iris, contraction of the pupil, or the throwing out of the exudate that blocks the pupil, and may cause numerous morbid unions that entirely close the pupil.

In such cases the dressings are changed several times in a day, and moist, hot compresses applied, leeches to the temple, strong atropin solution (2 or 3 per cent.) instilled, diaphoretics, inunctions of the oleate of mercury and free catharsis used. It is said that about 65 per cent. or more of the cases of exudative iritis follow syphilis.

Sympathetic inflammation of the fellow eye may follow extraction of senile cataract, and when the inflammation is due to traumatism is known as sympathetic ophthalmia or sympathetic iridochoroiditis. It is a very serious disease and the sight of the affected eye is usually destroyed. It follows most frequently an iridocyclitis, which has been produced in the injured eye by a penetrating wound of the ciliary region, or by foreign bodies in the eye. It may appear as early as the second week after injury, but usually not till the sixth week after the injury of the sympathetically injured eye, and the inflammation of the injured eye is at its height. It has sometimes appeared years after the injury, when foreign bodies have been lodged in the eye. Wounds of the ciliary region or foreign bodies may therefore set up sympathetic inflammation in the fellow eye at any time, even years after the injury.

Failure of the power of accommodation in the sympathizing eye is one of the first signs of disease; next the eye becomes sensitive to light, or painful, and then there is lacrymation and redness.

Unless this condition be relieved, it de

marked by circumcorneal injection, contraction of the pupil, clouding of the aqueous humor, pain, photophobia, and retraction of the iris in severe cases. This condition may last several weeks and then subside, but is oftener repeated again and again, until the sight is lost. Sometimes it eventually happens that the injured eye may retain a little of its vision, and the sight of the sympathizing eye be totally lost.

Enucleation of the injured eye is often the surest way of saving the sight in the uninjured eye, if done before or during the primary inflammation of the uninjured eye. In the treatment of sympathetic inflammation, atropin in a 1 to 3 per cent. solution is often instilled every five minutes for a period of thirty minutes. If the pupil does not dilate easily, a drop of 1 per cent. cocain solution should be used along with the atropin, or a few drops of adrenalin chlorid, 1-1,000, supplemented. When such topical applications as atropin are used in the eyes, the nurse should press with her fingers on the lacrymal sac for two or three minutes after, to prevent the drug going into the nose, where it is likely to be rapidly absorbed, and may cause irritation and symptoms of poisoning.

Leeches or artificial leeches applied to the temple, hot baths, hypodermic injections of muriate of pilocarpin (1-10 or 1-5 grain), often aid in dilating the pupil. After instillation of the eyedrops, hot fomentations are usually employed for thirty minutes out of every two hours during the day, and half as often during the night. Both eyes should be shaded from light, or the room should be. darkened. After the pupil is once dilated atropin should be used twice daily to keep it dilated. The bowels should be kept open, light diet given, and if much pain exists the patient kept in bed.

Spastic entropion, or turning inward of the lower lid, occasionally follows operations. The treatment generally consists in painting

T

HE morphin habit, in fact all forms

of the opium habit, present some points in common with the smoking habit. First, employing the drug in any form must be accompanied by a gradual increase in the dose in order to procure the desired effect. Second, the pleasurable symptoms that at first appear soon disappear. Third, the mental and physical effects are similar in many respects. Last, the evil symptoms attendant upon abstinence are identical.

As to the question of physical injury, which includes both rapidity of action and permanency of effect, the different forms of opium and the manner of employing them have been arranged in this order:

1. Morphin injected hypodermically. 2. Morphin either by mouth or by rectum. 3. The use of alcoholic preparations of opium (laudanum, etc.) by mouth.

4. The use of gum-opium by mouth. 5. Opium smoking (inhalation of the extract of opium).

Opium smoking occupies the last place in the list, because, as we are informed: first, it takes longer to form a real habit; second, it causes less injury, both physical and mental, when once formed; last, the opium smoking is much easier to cure than the others.

But from the standpoint of moral degradation and financial ruin, habitual smoking should head the list. The moral question is not difficult to understand when we are assured that opium smoking, unlike other forms of the opium habit, is, most likely in the vast majority of instances, indulged in among the lewd companions of vile "joints."

As to the financial aspect, the following figures will show it to be rather an expensive

-even a very expensive-indulgence; it costs. a smoker about 50 cents to $3.00 a day to appease his appetite, this difference depending not alone on the amounts consumed, but upon the quality of the drug, etc. Besides this, must be taken into consideration the valuable time wasted, which is an especially important item when affecting business interests.

An account is given of one victim who, on a wager, smoked pretty steadily for thirty hours, consuming 3 ounces, or 1,560 grains, costing (at that time) over $5.00. An authenticated record shows that out of 1,000 Chinamen, the vast majority smoked between 16 and 128 grains in one day; many more smoke as high as 320 grains, while over one hundred smokers consumed from 480 to 1,600 grains! How long such daily quantities were kept up is not given; but as high as 360 grains is the regular daily allowance for some, and even 720 grains in one instance. One hundred grains a day is considered a fair average for an American smoker, while only 60 grains or thereabout will satisfy a Chinese habitué. Such an amount as 100 grains seems less surprising when we are told that about 33 per cent. of it becomes ash, still rich in morphin; only a small portion of the active principle passes into the lungs with the smoke.

The effects of this pernicious habit are, first of all, mental. The novice and commencing habitué experience pleasant exhilaration, followed by a feeling of perfect rest. A little further on, true exhilaration lessens, and there is more of the waking dream. In from three months to a year the amount of opium must be greatly increased to lure pleasurable sensations. Gradually, the pleasurable sensa

tions cease, and the surprised and disgusted victim abandons his pipe. Abstinence lasts but a short time, unfortunately, for when the time draws round for the customary smoke he finds himself no longer merely seduced by it, but he is compelled to return to it. The chains that he has carelessly bound upon himself now refuse to be loosed, and he finds himself riveted to a habit that he despises. There are weakening of the will-power, indecision and impaired memory. Gloomy thoughts haunt the mind, which can only be dispelled by further recourse to the enemy; a fear of going to sleep lest a dread accident happen. Should sleep come, it is the reverse of refreshing, being filled with horrible phantasmagoria. While what might be called a moral insanity is met with, a true intellectual insanity is rare. There may result a despondency ending in suicide. Delirium tremens is probably unknown among smokers, but is said to be not at all uncommon among morphin-takers.

Smokers are very nervous, as evidenced by the unsteady hand or tongue; but the nervous system does not suffer quite so much as under other forms of the habit.

The pupils of the eyes are evenly contracted as a rule. After effect of the last dose has worn off, the pupils may be found widely dilated. The eyes burn, the tears flow, and dark circles appear beneath. Habitués complain of being near-sighted.

The pulse, temporarily accelerated after excessive smoking, falls below the normal rate, though in some the pulse-rate may deviate very little. In the novice, the pulse is affected to a greater degree.

In the novice, after a few pipes, the face is flushed and profuse perspiration occurs. In the habitué the face becomes sallow and corpse-like.

Morphia in varying quantities is always found in the urine. In women there is irritability of the bladder. In some menstruation ceases, not to return as long as the

smoking-habit continues; in others, it is rendered scanty and irregular; while in many it is not interfered with at all. In this it differs materially from the morphia habit, particularly that by hypodermic injection. In males, urination is apt to be difficult, due to spasm.

The digestive apparatus suffers, though in a less degree than when the drug is swallowed or injected. There is loss of appetite, with some gastric catarrh and constipation. Hemorrhoids are not uncommon. The secretions are, as a rule, checked. Sometimes the constipation is succeeded by a chronic diarrhea for months. Frequently there is a craving for sweets.

In some cases there is easy vomiting; in others, so violent as to end in the raising of blood and bile-tinged mucus. Nausea and vomiting may persist every time the victim. smokes, for even six months.

Concerning the effects upon the respiratory tract, symptoms of bronchitis usually follow prolonged smoking; there may be catarrh of throat and nose.

The perspiration emits an odor of opium; and will stain body and bed linen. Many complain of intense itching, which is aggravated by the warmth of the bed.

The mind is dazed, causing irregularity in walking, etc.

The sudden abandonment of smoking is attended with precisely the same set of symptoms as would be consequent upon abstinence after any other form of the opium habit. The only difference is one of degree as regards the suffering and the period of suffering. On account of the smoke having come into contact with the respiratory organs and the eyes, these parts are especially badly affected. The intestinal colic presents different characteristics, also.

Among the initial symptoms are yawning, sneezing, discharging eyes and nose, irregularity of the pupils, noises in the ears, then restlessness, vomiting and purging. Vomiting may be almost constant; and there may

be even forty evacuations from the bowels in twenty-four hours. Chilly feelings along the spine are followed by hot flashes and profuse perspiration. A peculiar dry, drawing, burning pain in the throat causes great misery; and most distressing tearing pains are experienced in other parts of the body. Severe cases, when not treated, gradually quiet down, the face becomes pale, the eyes sunken; then come collapse and death.

In cases not so grave, or when proper treatment has been instituted, the evil symptoms abate one by one, the person slowly returning to the normal condition, though insomnia usually persists for a long time.

Those why try to break themselves of the smoking habit rarely succeed; while, under rational treatment, there is said to be no great suffering. A prime reason for one's inability to break himself of the habit is on account of the almost unendurable thirst and burning sensation in the throat, which he knows that recourse to the pipe will remove.

The moral aspect of such victims is pitiable and disgusting. They appear to exist for nothing else than the gratification of their diseased appetite. They will falsify without apparent reason for so doing. They will go to any extremes to obtain the drug, pawning the necessities of life to procure money for its purchase; or they will steal it. Perhaps they will scrape the bowl for its ash, which they will eat in lieu of the pure drug. To such it has been said that heaven is equivalent to plenty of opium, hell to abstinence from it. No wonder that legislation cannot cope with it.

There are some few, we are informed, who, having been cured, can smoke occasionally without again forming the habit; but such instances are rare; for, like other forms of the opium habit, a single indulgence afterward will, in nearly all cases, cause a relapse.

If such are the horrors of opium smoking, to what terrible depths are plunged the miserable victims of morphin-injecting.

Normal salt solution used under given. specifications is probably the most effective intestinal evacuant we have. The directions

are:

One pint in quantity in the morning on an absolutely empty stomach, no food or drink to follow for half an hour. It simply sluices out the bowels without a cramp or pain and in several loose watery movements. Conditions in which it fails are: If made too strong or too weak, if the bowels are so full as to absorb the solution or as to resist its force, or the recumbent position. It seems to need the assistance of gravity or motion. One medium teaspoonful table salt in a pint of

water only hot enough to drink rapidly. It seldom fails to act. It is a most desirable dose to give preliminary to surgical operation to such patients, who might be allowed to sit up a half-hour following administration, as it does not in the least degree exhaust the patient. Some persons find it hard to drink the quantity of solution; some vomit it up. It may be administered by means of the stoamch-tube, just as is done in washing out the stomach. At the present time most of my patients with chronic constipation substitute this salt solution for their old dose of physic or enema.-Dr. Leiser, in American Medicine.