upon inebriety was studied by an experimental trial in twenty-five cases, in the firm belief that this was the active element in Keeley's cases. The results were published. Though averse to having any seeming connection with Keeley's methods, yet of its possessing an action above any suggestive one, there seems to me to be no doubt. That the suggestive element must be relied on to carry on the effect, however, there is also not much doubt, as the drug action is only a temporary one. That it can

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... be asserted to be logically the best drug for the purpose is, however, in my opinion very probable. Our opinion as to the value of hypodermic injections of strychnin in combating the craving for alcohol, was practically re-affirmed two years later by Dr. Breed, (Philadelphia Medical News, April 7, 1894) who outlines in a similar manner its direct value above that of a suggestive one, in annulling the appetite of the inebriate, "and that without the least effort on his part." Its strong tonic action is also dwelt upon. Dr. Breed, however, was a little too near to the first enthusiasm of the immediate effect of the hypodermics to judge conservatively of their permanent value. He assumes inferentially, moreover, that the drug effect is a permanent one which seems to me a great error. Suggestions, fear and moral effects . must keep up the waning influence of the drug. (I have often wondered if the administration of the drug could be kept up either in small doses or in an intermittent way, so as to insure permanent effect.) Dr. Breed also speaks of the hypodermics of strychnin .as if new, whereas during the past two years it has been frequently mentioned, and our own idea two years ago was gotten partly from the references to " : the records of Russian and Italian physicians, the experience of whom I believe goes back as far as 1880, . and from whom I suspect Keeley to have adopted and developed the idea. Partly also my incentive was from Dr. Gray, who claimed to be using it in his Sanitarium at La Porte, Indiana, and whose methods rather than Keeley's were the ones that I adopted. We used here the nitrate of strychnin, especially prepared by Eli Lilly, for such treatment. . Partial or modified responsibility. This somewhat philosophical subject, running out on theoretical grounds, yet being of far-reaching practical value, the "partial" or "modified" responsibility of some people, was strongly advocated as needing a recognized standing in an article before the State Medical Society this year. The connection of Bright's disease with insanity, strongly and ably advocated by E. D. Bondurant of the Tuscaloosa Asylum, stimulated us to an extra effort to see if we could justly admit ourselves to have overlooked such fact. Aside from the consideration of any theory of connection, however, we could not find any such facts of albumiuria and casts as he detailed. We found even after some selection of cases, only about 13 per cent, of cases; and probably we would average not over 5 per cent, of the admissions; whereas he found about 85 per cent, in consecutive examinations, some 50 per cent, having both albumin and casts. and others have all studied the subject with varying results. Landon Carter Gray's recent article also falls in the same line. Treatment of Choking.-In connection with Training School work, there has originated a peculiarly useful mode of treatment in cases of choking which, -9so far as I have noted, is not mentioned in any textbook on nursing. In one case of choking by meat, when the finger could not reach the morsel, and the man was becoming comatose before my eyes, it suddenly occurred to me to reach with thumb and finger deep down behind the sternum, to pinch the windpipe and strip it upward ; thus carrying the contents up into the throat. It was easily and promptly executed; the meat taken from the mouth, after which three minutes of artificial respiration brought him to life. So simple and fairly sure is this procedure that I should now think that one of our nurses was neglectful of duty who did not try it in any similar case. Hypodermics of Nitro-Glycerin in Epilepsy.-In last year's literature several references were found as to the value of hypodermics of nitro-glycerin in checking the convulsions of epilepsy. Upon having a case of status-epilepticus in a young girl, in whom a comatose condition had been present for over twenty-four hours, in whom the temperature had reached 104 degrees and who was considered as surely going to die,the idea of trying these hypodermics was considered. The very first one was followed by a reviving effect, and a continuation brought her from the coma and fever to her usual condition in, approximately, about four days. She has been as usual since. This seems to me a quite noteworthy and unexpected effect. The hypodermics were tried later in the case preceding trephining, as outlined elsewhere, and with good results. This is the last case of status-epilepticus which we have had here. We have tried the remedy on the mental confusion of an epileptic state with somewhat of temporary benefit, and are trying it now on various other epileptic temporary conditions that come up from time to time. Its permanent benefit must as yet be considered very doubtful. Massage.-This was first introduced systematically last year. The very first case taken by the members of the class in massage, a case of "post-operative" exhaustion or shock, progressed so steadily and logically toward health that it acted as a great incentive to the class to continued work. The case was one of confusional state of mild melancholia, and the Wier-Mitchell treatment of rest, massage and electricity was very effectual. Contagious diseases have been very rare in the hospital. During the last two years, however, we had several cases of measles and several of mumps; in all but two cases, however, among the employes. We had three cases of typhoid fever, all sent to us from the cities. We had no dysentery except in isolated cases during that period. The chronic inebriate appears most frequently in the lower courts charged with crime against persons, and also minor grades of crime against property. He is commonly a continuous drinker, taking spirits daily, and to excess, when he has the means to procure it, and the conditions are favorable; or a periodic drinker with distinct drink paroxysms, at uncertain or definite free intervals. The paroxysms Downloaded From: http://jama.jamanetwork.com/ by a Oakland University User on 06/02/2015