CONCERNING MORPHIN ADDICTION AND ITS TREATMENT.
Authors: C. B. BURR
Journal: JAMA (1902)

plumbi 3ii, spts.rectificati §iii to aquae q. s. §viii).When the disease has become chronic with hypertrophy, salicylic acid grs.xx, ung.diachyli §ii.In place of the diachylon ointment, mercury or tar may be used in ointment form.In all eases the hands should be pro- tected by wearing leather gloves, and when practicable a change of climate affords the most certain means of immediate relief, although it does not eradicate the tendency to the disease. DISCUSSION.Dr. W. S. Gottheit», New York-The cases described belong to a class not unknown in the east, though we are accustomed to give them a different name, and do not recognize the rela- tionship to erythema that the essayist ascribes to them.Pre- cisely similar cases in our clinics are called myeotic eczemas; they are recognized as eczematous, and are called mycotie on account of their peculiar margins, course, etc.That they get worse in late autumn and early spring has also been noted.Dr. M. L. Heidingsfelo, Cincinnati-I have long been im- pressed with the frequency with which these cases occur, and with the large rôle they play in dermatologie practice in Cin- cinnati.I am also impressed with what Dr. Gottheil remarks on, and the clinical manifestations have lead me also to believe that there is some parasitic nature to this affection, though histologie and bactériologie proof is still lacking.The same predisposing influences which Dr. Corlett mentions exist in Cincinnati.Personally speaking, these cases, in previous years, have proved to be very obstinate and rebellious to thera- peutic measures, and during the past year I have found the ¡r-rays to be a very valuable and efficient measure for their treatment.As far as my personal experience permits me to state, I believe that the results from the oe-ray are not only prompt, convenient and effective in the treatment of this affec- tion, but also permanent.De. M. B. Hartzell, Philadelphia-I think we have all seen cases of this kind, and it seems to me that what they should be called depends largely on their etiology.I am sure I have seen cases like these which have resulted from external irri- tants.In some instances the irritant was discoverable, but in most it was unknown.If I understood the writer of the paper correctly, the histology differed from that of eczema.As to whether we shall call this affection dermatitis hiemalis or eczema will depend somewhat on our definitions of dermatitis and eczema.I would deprecate qualifying the disease as mycotie.That seems utterly without reason.No one has ever discovered a micro-organism in these cases, and the pres- ence of a sharp margin is not a sufficient reason for calling them mycotie.Dr. F. H. Montgomery, Chicago-Dr.Corlett has given a very clear demonstration of a fairly distinct local type of a larger class of disorders to which Dr. Hyde called attention some fifteen years ago.By comparing, month by month dur- ing a period of three years, the number of eases treated with the temperature chart of the weather bureau, he demonstrated that these conditions were exaggerated and largely due, not so much to cold as to sudden temperature changes; a sudden change from cold to warm weather being effective, though less so than an equally sudden change in the opposite direc- tion.I would like to ask Dr. Corlett whether he has recognized this influence of a sudden change in temperature on the cases which he has described to us.Dr. Corlett-I am loath even to attempt to add to the al- ready long list of skin diseases, but I have a fixed impression that the cases herein detailed represent a distinct clinical entity, while from a pathologic standpoint no distinct picture may be drawn.As I have said, my observations are based on clinical experience.In regard to Dr. Montgomery's question, in my paper read in London I gave a table of the climatal changes occurring on the south shore of Lake Erie for a certain period of time, and in that table I called attention to the fact that these der- matoses were apparently dependent on a rapid change in tem- perature, but that my observations were always on the same altitude.