This was a patient of one of the best known physicians in the South. Her ovaries had been removed, cervix and perineum repaired, but the operative procedures had only aggravated the neurotic symptoms that they were intended to relieve. In addition to the aggravated nervous symptoms, she had a pain in one side, which had appeared as a result of adhesions, and to relieve this the administration of morphin had been instituted and continued for several months or more. The pain had subsided, but the demand for the continued use of morphin was imperative - at least from this lady's point of view. Five or six months had elapsed since the beginning of the habit, which was now well fixed. The patient lived forty miles distant, and was ordered to come into the city. Her physician explained to her that I had a treatment which would relieve her of the morphin habit without inconvenience, and both she and her husband consented to co-operate with our plans. She was given the following dose as the first of four doses:

R

Calomel ......................

1 grain

Resinous podophyllin .......................

1/2 grain

Extract of nux vomica ...................

1/2 grain

Powdered extract of cascara sagrada.......

1 grain

Aloin ...........................

1/2 grain

Misce Et Fiat Capsula No. I

This dose was given in a capsule every two hours for four doses, beginning at two o'clock in the afternoon, and the patient was allowed to have her usual hypodermic of 1 grain of morphin that evening.

The following morning she was given two drams of rochelle salts every hour until copious watery evacuations were produced, and this was directed to be given without regard to the action of the purgative dose administered the previous day.

Thorough elimination of the by-products of morphin must be secured as well as the getting rid of all retained excreta due to the continued use of morphin. At 11 o'clock the next day a warm bath was ordered, warm enough to secure thorough relaxation, and the drinking of copious draughts of water was also insisted upon for eliminative purposes.

No more morphin was allowed after the dose the day previous. When thorough elimination is secured in this way, morphin can be abruptly withdrawn without any inconvenience to the heart's action; in fact, the patient is less apt to die without the morphia than with it, provided the nervous element in the case is cared for, and this can be controlled by suggestion.

At noon on the second day, after copious actions of the purgative given the day previous and a saline had been given, and a warm bath had been administered, the patient was hypnotized and allowed to sleep for three hours. It was suggested that her nerves were steady, and quiet, and strong, and that her heart would beat strongly and regularly; that every minute and hour after that her nerves would get steadier, and quieter, and stronger; that she would enjoy her meals, feel hopeful, optimistic, and cheerful, and after that would have an antipathy for morphin or any form of opium; that she would breathe deeply, drink water freely, and take an interest in the affairs of life as she had not done in many months. It was suggested that at bedtime she would take three drops of a placebo prescription and go sound asleep, and sleep soundly all night, and awaken every morning feeling refreshed and well rested.

After three hours' sleep she was awakened and ate a lunch of milk, bread, and butter, and at once took the train for home, forty miles away. Five days afterward I went to this lady's home town, where her husband had gotten the physicians interested in my class work, and instructed a class of physicians at that place, allowing the husband of the patient to be present. She was then sleeping, eating, and doing well in every way.

Twenty-seven days after the withdrawal of the morphin, in response to a letter of inquiry, I learned that the patient had experienced no more inconvenience, had slept well, enjoyed eating, gained in weight, and was happier and better in every way. "But," said he, "yesterday my wife overexerted herself and I used a hypodermic of 1/4 grain of morphin last night, the first that she had taken in twenty-seven days." The only thing left for me to do was to write to him and express my regret that he had acted so unwisely, and urged him to use reason, castor oil, epsom salts, hot poultices, bromids, or do anything else except to deliberately start her on morphin with an already acquired predisposition for the drug.

To educate an individual in the principles of psychotherapy is one thing, but to get him to exercise the force of character sufficient to apply these principles is something else.