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cases, the vis medicatrix is all sufficient, as all the ex creting organs, more particularly the lungs, skin and kidneys, certainly materially aid in this direction.

In fact, Anstie claims "that there is some reason to think that as much as a fourth to a third of the dose taken, leaves the body in an unchanged condition within the course of forty-eight hours." Be this as it may, the probabilities seem conclusive that just in proportion to the functional activity, in different persons, of the various organs whose office consists in the elimination of excrementitious material will be the toxic or innocuous effects of the doses absorbed. It follows that in the absence of certain forms of disease, especially renal affections, the natural efforts will serve to eliminate the poison.

Then again we must recall the fact that alcohol in the quantities in which it is imbibed by the drunkard is in no sense a stimulant, but a powerful narcotic sedative, overwhelming the nervous system with each additional dose more and more, paralyzing the vaso motor nervous system, and thus superinducing fluxions or hyperemias of the central nervous system, especially the brain.

Cerebral congestion, the result of vaso-motor paral. ysis developed by the immediate action of the alcohol, is the underlying pathological condition in nearly all cases, which requires the most of our attention, and upon which we can not place too much stress.

Therefore, as alcohol is dangerous in proportion to its quantity, to say nothing of quality, which correspondingly increases its sedative or narcotic or paral Secondly. That the various forms of alcoholism do yzing effects; how absurd it seems to talk about the not depend, as was formerly taught, upon the sudden withdrawal of an accustomed stimulant being the allwithdrawal of the alcoholic potations, it seems hardly important factor in the superinduction of the phenecessary at the present day to discuss; but as some nomena of alcoholism, instead of the direct poisonous important features of treatment are inseparably connected with the truth of this proposition, I shall cursorily, advert to some essential facts.

and paralyzing effects of alcohol upon the nervous system. In the multitude of instances the acute attack merely exhibits in full development, symptoms which had been partially recognizable for a long time previously.

Clinical observation will prove incontestably that the patient is usually overwhelmed in the midst or height of his debauchery. Abstinence plays, in recently As a matter of fact it had frequently been observed recorded cases, no prominent feature in the history of that the sufferer from delirium tremens had ceased to the outbreak. The nervous centers in consequence of drink for one, two or three days before the access of their elective chemical affinity for the alcoholic poison his more acute symptoms, and the exhaustion caused by become more impregnated with it and consequently the loss of his ordinary stimulant was supposed to progrow more and more intolerant of its effects. Their duce these symptoms. Dr. Ware, of Boston (1831), functional activity becomes proportionately more and was one of the first writers who pointed out that this more hypercarbonized, their power for the appropriation statement includes a fallacy of observation. From an of oxygen becoming more and more reduced, a period analysis of one hundred cases, he proved that the cesof culmination consequent upon these conjoined dele-sation of drinking, where this occurs, is in fact proterious effects is attained, and the phenomena or duced by a feeling of revulsion to strong liquors, which symptomatic manifestations of alcoholism are devel- is a part of the early symptoms of the acute disease in oped. many cases; and, on the other hand, that very many patients do not leave off drinking at all, but the delirious attack supervenes in the midst of a debauch. This observation has been confirmed by Dr. Gardner, and many other excellent recent writers, and at present the classical theory of exhaustion from withdrawal of an accustomed stimulus bas but a few upholders.

This occurrence is not to be marvelled at when we take into consideration the effects of these increasingly toxic doses of such a powerful depressing agent. If, as Anstie claims, we dissect a nerve or a bundle of nerves, and then immerse it in strong alcohol, we shall find that after a certain period the nerve will no longer be a conductor of nerve force, but will become absolutely paralyzed. If, on the other hand, we take only a weak or diluted alcoholic solution, we shall not find the effects so deleterious, the paralytic phenomena which ensues will not become so completely developed.

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The expectant plan of treatment is therefore rational; the disease being a self-limiting one. In mild cases very little, if any special treatment is necessary. In severe cases my usual plan is to administer ten grains of calomel, which has the action of an eliminant, acting

also a soothing, calming effect upon the gastric disturbance, in the very beginning enabling the physician to administer nourishment and other remedies which would otherwise well nigh be impossible, owing to incessant vomiting. Careful nursing and systematic nourishment, constitute powerful auxillary measures in promoting the patient's comfort and cure.

The non oxidation of the tissues acts as another particularly upon the portal circulation, and possesses powerful factor in the development of the symptoms. The red corpuscles diminish, the hydro-carbon of the alcohol appropriates for its own use the free oxygen of the system to a large extent, the blood becomes surcharged with fatty and effete materials, and the deleterious effects of the excessive retrograde metamorphosis, with the constructive efforts reduced to a minimum, sooner or later explode, the nervous system bears the principal brunt of the storm, and the phenomena of alcoholism supervene.

Lime water and milk, and beef essence highly surcharged with capsicum, are valuable agents. The capsicum possesses decided advantages. It quiets the

erethism of the patient, promotes digestion and sleep. and are those regarding the British troops at different Its action is obscure, it possibly has a reflex influence stations. upon the pneumogastric. I prefer its administration systematically with fluid nourishment, although in a case treated at St. Vincent's, my friend, Dr. Hodgen, administered it in bolus, which was productive of an equally happy effect.

It is rare that I administer bismuth, hydrocyanic acid and other stomachic sedatives, the habitual dose of ten grains of calomel rendering such measures useless. The bromides are given, of course, systematically, generally three times a day, to prevent alcoholic eclampsia, one of the greatest dangers in these cases, to reduce reflex excitability to the minimum, and last, but not least, to obviate vaso-motor paralysis with its consequent attending cerebral hyperemia, one of the most common causes of death, whether directly resulting in cerebral or pulmonary fluxions. At night, sulphonal or trional are administered in moderate doses of 10 to 15 grains; sometimes in severe cases of insomnia, sulphonal is combined with hyocyamine. The nurse is ordered never to administer over two doses. In other words, sleep is never forced, If the patient is reported in the morning as not having slept, I do not feel uneasy or anxious to press the hypnotic remedies the following night In all forms of acute alcoholism it is a rule admitting of no exception, to at once withhold alcohol in ever form and all doses. Large doses of digitalis, formerly employed, are not advisable. Tyson recommends in mania a protu alcohol may be withdrawn at once. If necessary to stimulate, gave ammonol, aromatic spirits of ammonia, digitalis and strychnia.

Recollecting the self-limiting tendency of a disease, of which insomnia is only a symptom, we feel assured that like all other symptoms, it will yield as the case progresses favorably. In other words, it does not con stitute the crisis of the older authorities on this subject, nor is it the field upon which the battle is to be fought and lost, or won. Like the harassing cough of pneumonia or the angina of scarlatina, or the diarrhea of typhoid fever, it will yield with the arrestation of the pathological conditions which predetermine its exist

ence.

We believe our very low mortality of 14 deaths in 1,129 cases, or one death in 80 cases, or a mortality of a little over 14 per cent, is attributable almost directly to this practice of not forcing sleep, and to carefully avoiding the opium treatment.

Dr. Wood in his work on "Practice of Medicine"

The late Sir Alexander Tulloch, in his report for 1853, gives the following percentages of mortality among them:

....

Great Britain infantry.. Great Britain cavalry. Bermuda...

Canada..
Gibraltar.
Malta....

Nova Scotia.....

176

13.8

15.0

7.94

136

8.8

9.1

When a student of medicine, my preceptor taught that two grains of powdered opium was to be administered in such cases every two hours. I concluded forever to abandon the opium treatment, for the following reasons:

The idea that patients in delirium tremens require to be narcotized into a state of repose, may now be said to be abandoned by those best qualified to speak on the subject.

Large and successive doses of opium are dagerous because "it has often happened that the patient without even sleeping at all, has passed into a condition of coma vigil, next to stertorous breathing, and at last sunk, fairly poisoned with opium."

Then again the depressing action of opium upon "the visceral nerves is well known, impairing and impeding, as it does, digestion, and rapidly tending to paralize the action of the heart."

Dr. Anstie contends that, "in truth, the condition of the brain requires that sort of treatment which shall fortify and stimulate its funtions.

*

*

*

"The typical member of the group of stimulants is simple, easily digested food, food is the best of all stimulants, and the successful treatment of delirium tremens, in nine cases out of ten, depend on the regular and continuous supply of suitable nourishment, whereby the functions of the nervous system are supported dur ing the struggle toward recovery." In addition to the objections already urged to the use of opium, we would add that it constipates and seals up to a great extent the excrementitious channels, thereby checking elimination, upon which, to a great extent, the safety of the patient depends in the earlier stages, and which is so largely luded to, which I never fail to administer, at least once, contributed to by the large dose of calomel already alearly in the case.

I answer unhesitatingly, No.

There remains but one more question to discuss, which gives the following mortality: "Of 1,241 cases of deli-we shall summarily dispose of as our convictions are very rium tremens in all its forms and stages, and of intem- decided in this connection. Should alcohol be adminis. perance, expected to end in delirium, admitted to the tered during the attacks of acute alcoholism? Philadelphia Hospital, and subjected to a variety of treatment; 121 cases proved fatal, or somewhat less than one in ten." Dr. Aitkin, "Science and Practice of the patient, and the physician is not called upon to agMedicine, Vol. I, article, "Delirium Tremens," says: gravate morbid states present by giving additional "Calmeil states the mortality at 5 per cent; Bougard, at quantities of the poison which has already produced the 19 per cent. The most accurate records to be got at, pathological conditions he is called upon to remove.

The mischief is effected when we are called to visit

3. The expectant plan of treatment is the most rational.

4. Opiates are dangerous because they additionally derange digestion, and acting as powerful cardiac seda. tives, tend to paralize the heart and, finally, because they check elimination, interfere with the normal secretions and digestion.

With the moral features of the question, we have no interest in this paper, as we are simply viewing the question in its medical aspect. There are many cases where we are compelled to administer alcohol in mod erate and judicious quantities, because the patient, not being absolutely under our control, will not submit to a total withdrawal of alcohol, and the prejudices of his friends and relatives favor his determination. Under 5. Sleep is never to be attained at risk or hazard to such circumstances administer the minimum amount the patient, but is to be expected as one of the harbin. possible. As regards the objection that the sudden gers of a convalescence not be forced.

withdrawal in injudicious, it is always in our power to 6. In acute alcoholism, as in many other acute disrecommence should violent asthenic or adynamic symp.eases, the vis medicatrix is fully adequate in most cases toms demand its employment. Its use, in suitable to produce the happiest results.

u. Gynak., 1898, Vol. XXXIX, No. 3; La Presse Med.) in this paper makes a plea in favor of the treatment of uterine cancer by abdominal section.

doses, as a stimulant and not in sedative doses, will soon compensate for any obviously injurious symptoms produced by its withdrawal in the early periods. Its Complete Abdominal Hysterectomy for use when not needed is permanently injurious and its Uterine Cancer.-Funke (Zeitschrift f. Geburtsh. withdrawal later, will hardly compensate for mischief produced. At any rate, in all cases, we again urge Anstie's advice, who says: "I wish to express the decided opinion that complete abstinence may always be carried out without any immediate danger to life or health, if proper care be taken to substitute a substan tially nourishing diet." In very few, nay, most excep tional cases will we have to resort to its administration, once we have boldly withheld it from the very earliest commencement of our medical treatment.

"In every case, however, I think it is our duty to ab stain as long as possible from the use of alcohol and, before resorting to a treatment of such doubtful propriety, we ought to try less harmless narcotic stimu lants."

INEBRIATES TREATED IN ST. VINCENT'S ASYLUM.

YEAR.

1880....

1881...

1882...

1883...

1884...

1885...

1886...

1887...

1888...

Total....

Deaths.....

ADMISSION.

130

162

136

98

150

132

111

110

100

1,129
14

At the instigation of Freund (of Strassburg) he attemps to demonstrate that abdominal hysterectomy is to be preferred to vaginal hysterectomy in all cases of malignant neoplasms of the uterus; the advantages of this method are the following:

1. The ability of the operator to appreciate the entire extent of the disease and to refrain from operating in cases that are truly inoperable.

2. The very much greater facility for going beyond the limits of the infiltrated tissues (ablation of the broad ligaments, etc.).

3. The possibility also of removing the ganglions corresponding to the lympathics of the uterus, this is of especial importance as regards the possibility of its re

turn.

In this article Funke reports ten cases of uterine cancer operated on by this method in the service of Freund. Seven of these cases had cancer of the cervix; two others had cancer of the body of the uterus; in the last one the neoplasm ocupied both the cervix and the body of the womb.

Two of these operated upon, died, one from acute septicemia (the one with cancer of the body and cervix), the other from a slow infection. This last patient had had both the ureters included within the ligatures of the unterine arteries, compelling the operator to reopen the abdomen and resect both of the ducts, intro

Death rate 14 per cent. On the whole, four deaths ducing one into the bladder and transplanting the other

in 500 cases.

To recapitulate the conclusions of this paper, then, we may assert that practical observation upon the treatment, prove that,

1. Acute alcoholism is a self limiting affection.

2. Acute alcoholism results not from sudden with drawal, but from excess and abuse of alcoholic, "so called stimulants," better called sedatives and narcotics in the doses in which they are taken.

into the abdominal wall.

In this paper, Funke states that the ten patients operated upon, constitute the second half of a series of twenty cases of uterine cancer treated by complete abdominal hysterectomy; the series of the first ten women include also two deaths, giving a total of four in twenty, that were operated upon (or a mortality of 20 per cent), figure that are relatively small if compared with the previous statistics of Kaltenbach, and even with those of Freund himself.

organized March 31, at a meeting held at the Southern

MEDICAL REVIEW. Hotel. The object of the club is to be, in the first place,

L. T. RIESMEYER, M.D., Editor.

Department Editors:

Dr. F. J. LUTZ, General Surgery. Dr. E. C. RUNGE, General Medicine.
Dr. W. B. DORSETT, Gynecology and Obstetrics.

Published Under the Auspices of the
MEDICAL REVIEW ASSOCIATION,
By O. H. DREYER.

Yearly Subscription, $3.50. Single Copies, 10 Cents.

To Contributors and Correspondents.

All letters, whether intended for publication or not, must contain the writer's name and address, not necessarily for publication. No attention will be paid to anonymous communications.

Secretaries of medical societies will confer a favor by keeping us informed of the dates of the meetings of their respective societies,

and of officers elected.

Members of the profession, who send us information on matters of general interest to our readers, will be considered as doing them and us a favor, and we shall take pleasure in inserting the substance of such communications.

Communications, Medical Books (for review), and all letters containing business communications or referring to the publication, subscription or advertising department of the MEDICAL REVIEW, must be addressed to 0. H. DREYER, Publisher, 112 N. Fourth Street, St. Louis, Mo.

Entered at the St. Louis Postoffice as Second-Class Matter.

ST. LOUIS, MO.: APRIL 8, 1899.

EDITORIALS

Missouri State Medical Association.

The annual meeting of the Missouri State Medical Association will be held in Joplin, Mo., on Tuesday, Wednesday and Thursday, May 16, 17 and 18, 1899 All members of the profession are cordially invited, and a large attendance is anticipated. The programme for the meeting contains a large number of papers and the subjects which will be discussed are of an important and interesting nature. Whoever can be present should attend the Joplin meeting.

to aid in giving the greatest possible publicity to the projected St. Louis World's Fair, and in the second place, to encourage mutual co operation with regard to all matters pertaining to the interests of medical journalism. The almost positive certainty that a World's Fair will be held in St. Louis as a centennial celebration of the purchase of Louisiana is the incentive of this organization which, being principally organized for the purpose of enhancing the interests of the common weal, deserves to be encouraged by every medical journal in this sec tion of the country. The next meeting of the press club will be held at the Southern Hotel, St. Louis, Friday, April 21, at 8 P M.

United We Stand, Divided We Fall.

The centennial celebration of the Louisiana purchase by a World's Fair to be held in St. Louis in 1903 is not only ardently welcomed by the entire business world of St. Louis, but also by the members of the various pro fessions. The medical profession is becoming more conscious of the fact that its reputable members should unite in an harmonious effort to enhance its interests by mutual support and co operation. There is no better opportunity for such an effort than the prominence and distinction which the holding of the World's Fair will give to this city. The solidity and prominence of St. Louis in the world of commerce, its population, and its central location, together with the important event in the history of the United States whose celebration will be most appropriately located in the hospitable precincts of St. Louis, entitle this city to the honor and distinction which would be conferred upon it by a World's Fair. As already intimated, the interests of the medical profession will also be affected by the real. ization of this project and this great event should be an In the last three weeks there has been a steady and incentive to renewed efforts on the part of its members marked increase in the death rate of this city. The to further its scientific interests. Without unity and week's advance in mortality was from 231 to 240, against mutual co operation the medical profession of this city 171 deaths for the week ending April 2, 1898. The death rate for the week ending April 1, 1899, was 20.8 per 1,000 on an estimated population of 600,000.

Increase in Death Rate in St. Louis.

The Organization of a Medical Press Club.

A medical press club, whose members are to be recruited from the editors and publishers of the medical journals of Missouri and the neighboring States, was

is bound to be side-tracked when it comes to a proper and unbiased recognition of its merits as a center of medical education and research. The prospective con. solidation of the Missouri Medical College with the St. Louis Medical College is a most auspicious beginning in the direction of a general unification. United as one body who is constantly watchful of its interests as a whole by furthering the just interests of each individual member, the prominence of the medical profession of

this city could be much enhanced. There is much good clientel. His investigations had not passed the stage of and original work done in this section of the country doubt as to the correctness of his hypothesis and it which does not receive the recognition which it justly would have been appropriate for the author to strictly deserves and which by united efforts would be more confine his communications to the medical profession generally recognized.

A Warning Example.

the medical profession and, if a discovery has stood the test of adverse as well as confirmatory criticism, it is time enough to inform the laity. By such a course the reputation which, as in Schenk's case, it may have taken many years to establish, is permanent and not lost, as is otherwise often the case, as the prize of momentary notoriety and gain. Schenk's rebuke at the hands of

and his investigations to clinical and hospital practice until more light and certainty could be gathered on the question and until his assertions could be verified by other investigators. Instead of this it is claimed that Few discoveries have stirred up so much comment as Schenk has done everything to induce the aristocracy Schenk's alleged discovery of the determination of sex. of the various European countries to become subjects The senate of the Vienna University has investigated his of his experiment, while the stage of doubt and contra. claims and has censured severely his methods of pro. diction in his researches had not been passed. How mulgating his so-called discovery.. To the unbiased much this may have been a fault of his, or of more or observer it would seem that the only wrong that Schenk less uncontrollable circumstances, we do not know; but committed consists in the method employed in placing the matter has been considered of sufficient importance before the laity his results of investigation which, as he to his colleagues to institute an investigation with the himself states in his book, are by no means based upon above-mentioned result. Schenk's example should be a a solid scientific basis. Schenk has only taken up the warning to all who prematurely choose to place alleged subject where others had left off, and his research re- discoveries before the public at large. The safer plan garding sex determination was simply a side-issue in is always to first appeal to criticism within the ranks of his occupation as an investigator upon the scientific exactness of which he did not, as he states in his work, lay any stress whatever. He contends that if the sex of a human embryo can be influenced at all it can only be done along the line of furnishing the ovum adequate nutrition. It is a proven fact that in certain animal species the sex can be influenced by influencing the nutrition of the embryo and upon this observation the Vienna University senate is a lesson which should Schenk's theory is based. Schenk undoubtedly was too sanguine when he made the statement in his work that if the metabolism of an individual can be so influenced by appropriate diet that the process of oxidation is so physiologically perfect that no sugar can be detected in the urine by the phenylhydrazine test, the tendency of the offspring tends toward the male sex. Schenk, nevertheless, makes some allowance for other influences and, as already stated, makes no pretensions as to scientific exactness. He only takes the most scientific ground in the matter that probably can be taken at this . stage of development of the question. He has merely selected the most plausible hypothesis and elaborated and improved upon it without laying any claim to thor. oughness of investigation. Schenk's book in itself then is by no means to be condemned. Too sanguine state cumstances and this course can not be better indicated ments occur frequently under similar conditions when than by that reliable guide-the American Code of such a relatively intricate problem is concerned. But while Schenk is not so much to be blamed as far as his investigations in this direction, his theories, and his book are concerned, he certainly deserves severe censure with regard to the methods employed in securing

be written with indelible ink into all the medical jour nals of the land and preached to medical students before they start out in the laborious and often thorny field of practice. Since the investigation by the senate it seems that the numerous disappointed aristocratic patients who have been, as they express it, “starved" by Schenk's method of treatment, are now up in arms and are in no small measure the instruments to make the Professor's disgrace complete. Let us hope that the history of the meteor-like rise and downfall of Schenk be a warning example to those members in the medical profession whose natural tendencies are to appeal to the laity rather than to secure above all the confidence and respect of their colleagues and fellow workers. The latter course is the safest under all cir

But Ethics.

Death of Dr. James O. Murray.-Dr. James O. Murray, Dean of Princeton University, died March 27, after an illness of several weeks.

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