beneficial results, doubtless, for it can be said without fear of contradiction that no method of operating but is sometimes indicated and sometimes contraindicated. In general it is accepted that the more simply an operation is conducted the better, and that a wound in the mouth should not be complicated by a wound in the trachea unless absolutely necessary.

In a paper read before this Faculty some time since,* I called attention to the prone position as offering certain advantages, the patient's head being somewhat raised, facing a window. At that time I had had recourse to it upon two occasions when excising portions of the upper jaw; since the date mentioned I have had recourse to it several times, and see no reason to modify the favorable opinion then expressed. The advantage to be gained when operating upon the jaws by seminarcotizing the patient with opium or one of its alkaloids is very great, since sensation is abolished before profound unconsciousness is induced by ether or chloroform. In several instances I have been told by patients that they had suffered no pain during operative measures, although they had obeyed directions given in a loud tone of voice during the progress of the operation. Confirmative evidence to the above is seen by the quietude of patients during operation, when treated as suggested.

The opiate should be given a certain time before the anesthetic is inhaled, morphine hypodermically (not less than thirty minutes); a full dose is required, and that the patient have no idiosyncrasy, it is wise to give a tentative dose a day or two previously, especially in children.

The position to which I have referred as being advantageous is as follows: The patient having received a full dose of morphine, hypodermically, and subsequently anesthetized, is turned face down, the upper portion of the thorax extends beyond the table, being supported by an assistant at each shoulder-respiration is thus less labored. A third assistant supports the head, standing behind the shoulder carrier, so as to be out of the operator's way. The face being raised towards a window, light is obtained, while blood from incisions, etc. runs out of the mouth into some vessel placed conveniently. The operation upon the patient, now shown to the Faculty, was the most extensive in the position referred to that I have done. The portion of upper jaw removed extended from the left lateral incisor to the last right molar; both nares were opened, yet bleeding caused no anxiety, for it flowed from, not towards, the larynx and escaped externally.

*Trans. Med. and Chi. Fac., 1880, p. 207.

I venture to think that the prone position may permit the removal of an upper jaw or a pharyngeal tumor without a preliminary tracheotomy.

B

The case presented is as follows: Afemale, menstruation not yet present, aet. 15 years, has noticed swelling of right upper jaw during past two years, no cause known. Latterly increase in size has been marked, no pains or discomfort experienced. Examination shows a firm, elastic tumor of right upper jaw, entirely surrounded by bone, apparently about one inch and a quarter in diameter, encroaching on the intermaxillary suture. The right lateral incisor had erupted very late and was of imperfect development. Presumptively the tooth and tumor were connected.

B

Three weeks later Awas again seen; the tumor had increased decidedly, absorption of right palate process had taken place, and fluctuation at one part of growth was apparent. After a few days' preparatory treatment the tumor, together with adjacent bone, was removed, strong bone forceps being used as being more rapid in execution than a saw. The pliers were of different shapes, the blades being at an angle with the handles. The upper lip was split in the middle line to facilitate bone removal. The after treatment consisted of great cleanliness by means of warm carbolized water. Secondary hemorrhage from both nostrils occurred on the fourth day, requiring plugging. Afterwards all went well and the patient returned home in three weeks. The tumor was partly solid, partly cystic, and was connected with the fang of the immature lateral incisor. Microscopic examination showed it to be a spindle-celled sarcoma.

HYPNOTISM.

BY G. HALSTED BOYLAND, M. D., M. A.

Mr. President and Gentlemen: The large increase in the immoderate use of narcotics which is observable among the people of the United States is traceable to a variety of causes.

Probably the climate, with its high atmospheric pressure, its dryness, and its sudden and great meteorological changes, has during a long series of years produced no little effect. To a still greater extent, however, must the blame be laid on the rapid rate of living which characterizes the 19th century. This shows its influence even in the school-room by the pernicious system of "cramming," and, in later life, by the eager and restless desire to put the work of two days into one, as well as by the impatience which is everywhere manifested for immediate returns from labor or capital expended. The result of this is that the system, unable to maintain the severe strain put upon it, fails under the pressure, and "nervous break-down" ensues. In this condition stimulants and narcotics offer to the sufferer an apparently easy means to revive the drooping powers of mind and body, and recourse to them, at first occasional, often becomes habitual, till the habit is firmly established before the patient realizes his mistake.

Whether the cause of the nervous prostration be found in overwork of any kind or in undue indulgence of the appetites, the rational means for cure is to be found in regular hours, less work, or even cessation of it for the time being, more relaxation and attention to diet, which has usually been much neglected; in short, physiological rest, till the system has regained its tone. But this process, even when aided by proper medication, is slow, and delay is not readily brooked. Too often we find individuals of all classes having recourse to more seductive remedies, such as laudanum, hydrate of chloral, bromide of potash, morphia or opium, with which they may have become acquainted through physicians or druggists who have prescribed them in some case of bronchial irritation or severe pain. As there is no State nor municipal law restricting the sale of

hypnotics, the public are at liberty to purchase any quantity they please of these drugs; for if the druggist refuses, the desired amount of laudanum may be had at the grocery store; thus the habit spreads without check.

ness.

That the general use of such drugs is largely on the increase there can be no question and I have been able to trace many cases of Bright's disease, paralysis agitans, chronic nervous exhaustion, cerebral anaemia and irritability that have come under my own observation, directly to their use. Patients addicted to them often alternate them with alcoholic drinks, and after their debauch employ bromide of potash, hydrate of chloral or morphia to allay the tremor and general nervousWomen seek in their use quiet and tone to the shattered nervous system, after late hours, dancing or worry. This object is, of course, never attained, for the greater the quantity of the drug used, and the oftener repeated, the worse the condition of the patient, until at last the utterly wrecked system is invaded by some organic disease of the brain, lungs, heart, liver or kidneys. Now that the moment has arrived for their exhibition upon therapeutical grounds, their effect is gone, or such large quantities must be prescribed as to endanger the heart. The danger of failure of cardiac power in the morphia habitué is always present.

The formation of the habit increases by insidious degrees. The quantity taken at first is in doses that seem to be perfectly harmless. But the effect of small doses is soon lost, and the amount has to be increased until it becomes enormous, and a habit has been formed which is the most difficult of all habits to break. Even where such a result is not reached, grave effects upon the general health are often entailed, and it is a grave question how far the ill-health and dyspepsia from which so many of our youth suffer may not be traceable to the indiscriminate use of patent medicines and nostrums given during childhood; for none of these, so far as analysis has gone, are free from some hypnotic-usually opium, or one of its preparations.

To return; in one case to which I was called not long ago, the patient was seen to take 10 grains of the sulphate of morphia in powder without producing anything more than cold extremities, contracted pupils and a general appearance of intoxication; strong black coffee was the antidote used. In another laudanum was preferred, and he would pour it out without measuring, and toss it off as he would whiskey. Both of these patients were subject to hypnotism and alcoholism alternately.

Perhaps the largest quantity on record was given during the last year, when 120 drops of Magendie's solution were administered hypodermically in the top of the head in a case of osteo-sarcoma of the sphenoid and superior maxillary bones. As even this did very little toward alleviating the pain, another 90 drops were given at the end of the next hour and a quarter. Still the pain was intense, and at the end of the second hour and a quarter 120 drops were again injected hypodermically, making in all 330 drops of Magendie's solution or 11 grains of morphia in two and a half hours. After a few hours 125 drops were administered hypodermically, the heaviest single injection known to me. The quantity was then reduced 10 drops at a time down to 90 every four hours. This patient had been accustomed to morphia for nearly two years, beginning with the equivalent of one-quarter of a grain of Magendie's solution. It was therefore deemed advisable to continue the 90 drops, which had the happy effect of steadying the circulation, allaying nervousness and giving tone to the general system.

In the case of a lady that I treated for malaria with quinine and calomel followed by the elix. pyrophos. iron, quinine and strychnia, it afterwards came out that the sallow tint and puffiness about the face and eyes, the contracted pupils and general cachectic appearance, were the result of the habitual use of morphia, of which she would take quantities, pouring it in the palm of the hand and approximating her quantum by a guess. Whilst under my treatment, which lasted about one month, it is impossible to say whether she continued the use of morphia or not; though it is probable that, with the usual slyness which characterizes habitués, she did. She left Baltimore, however, much improved. In several instances, patients to whom I had reluctantly given a hypodermic injection have asked me to leave my syringe with their attendants, which was of course refused.

Belladonna does not seem to be a favorite means of producing hypnotism among those addicted to the use of narcotics. In one of my cases the patient was in the habit of taking the alkaloid, sulphate of atropia, with each injection of morphia-claiming that he thus got the antidotal effect of the atropia, which not only increased the agreeable influence of the morphia, but overcame the unpleasant after effects. Nothing, however, would relieve the intense burning in the throat, which he experienced after using this combination, which was of course due to the atropia.

In belladonna we have a cerebral excitant of the most powerful