chemical condition of the most terrible ex-
plosives known.
When alcohol gets into the blood it does,
and must, "go to the head." Millions of
little cells at once undergo explosion, and
the result is that this complex organism, the
human body, is no longer under rational or
orderly control. The little nerves that hold
the gateways of the blood at the end of the
arteries let go their hold, for they are paral-
yzed ! The blood rushes to the face, and
flushes it ; the heart has a torrent of blood
poured upon it, and beats, and flutters ; the
limbs move without will or purpose ; the
tongue moves wildly, and incoherently, be-
cause mental order and control are lost.
Taken in small quantities there are some
who yet say alcohol may have some good
effects. When science discovered the true
nature of alcohol, as herewith explained, it
gave a decisive No ! to every question of
this kind. Drs. Benjamin W. Richardson,
Willard Parker, VV. H. Draper, and thou-
sands of other distinguished physicians,
express the true verdict when they say :
''^Alcohol is our 'worst enemy, always more
or less baleful in its efi"ects."
Alcohol is one of the most powerful an-
tagonists of life. When pure, it is a deadly
poison ; when diluted, its pernicious effects
are not so rapid, but it is ever injurious to
health. The able researches of Drs. E.
Smith, W. M.Lalleman, Duroy and Perrin,
have positively proved that alcohol is not a
food, and that it is neither transformed nor
destroyed within the organism. Alcohol
does not assimilate ; it passes out of the
stomach in precisely the same condition in
which it entered it. It shows itself in the
breath, in the perspiration, and in the evac-
uations. It is still alcohol. Part may be
retained in the blood, which it thins and
weakens.
That all of these effects are as stated is
known from experiments, and from the na-
ture of alcohol. It has been excreted from
an animal cell, as unable to assimilate with
it. It is matter that has already been burnt
up by vital process, and thrown out as so
much dead matter. It cannot be used in
any vital process any more than you could
build a fire by shoveling ashes into your
stove,
By putting this dead irritant into the
blood, every organ it touches is inflamed,
which is its effort to get it out of the sys-
tem, because it cannot be assimilated. The
old, and with some yet, still prevailing de-
lusion about alcohol is that this inflamma-
tion caused by poisonous irritation, is a
stimulation, an exhilaration, a warmer of
the blood, or a cause of some advantage in
some way. Nor is it strange that our feel-
ings should deceive us as to the irritation,
inflamipation and brain destruction which
alcohol causes in the human system. Our
feelings mistake the irritation for warmth ;
the fullness and puff of inflammation for
stimulation and food ; the irregular and
destructive action on the brain cells for ex-
hilaration. But the reverse of this is the
fact. The irritation reduces the warmth of
the body, and makes man less able to en-
dure the cold ; the inflammation is a swelling
resulting from obstructions which the tissues
are trying to remove ; the light-headedness
is not exhilaration, but an insanity and dis-
ease caused by a destruction of the brain
cells, so that the will is gone, and the mind
and reason are uncontrollable. You can
get food and warmth out of alcohol when
you can get fire by reburning your ashes.
It will give you real stimulation and exhil-
aration when the swelling of a sore, and
the destruction of the brain, will give them
to you.
Food, warmth, stimulation and exhilara-
tion only come from real nourishers, like
brain and nerve foods which assimilate in
the system, and thus rebuild and make it
strong, hearty and vigorous. Alcohol does
the reverse of nourishing, warming and
sustaining. It simply inflames and des-
troys. Alcohol is the one substance never
to be taken into the human system.
These results, stated in short in Zells'
Encyclopedia, have been proved over and
over again. Leading scientists in France,
Germany, England and America, though
working separately, have substantially
reached the same conclusions. For the de-
velopment and practical application of all
these discoveries, we are greatly indebted to
Dr. T. S. Lambert.
It may be asked why physicians and
scientists are not unanimous as to this ver-
dict. They are becoming so with reason-
able speed. It takes many years for those
who ought to have made a discovery, or
been first to accept it when made, to ac-
tually do so. The trouble is, that physi-
cians whose minds are full of old theories
cannot at once see and apply new chemical
facts.
"I speak the more positively on this sub-
ject, because for more than thirty years I
have faithfully tested the correctness of the
sentiments I have given you in relation to
the therapeutic effects and uses of alcoholic
liquids in an ample clinical experience, both
in hospital and private practice, and during
that time I have found no case of disease,
aud no etnergency arising from accidents^
352
THE CHARLOTTE MEDICAL JOURNAL.
that I could not treat more successfully
without any form of fermented and distilled
liquors than with." — N. S. Davis, Ex-
President of American Medical Association,
and author of the standard work, Principles
and Practice of Medicine.
"As a result of thirty years of experience
and practical observation, I feel assured that
alcoholic stimidaiifs arc not required as
medicine^ and believe that many, if not a
majority of physicians of to-day, of educa-
tion and experience, are satisfied that alco-
holic stimulants as medicines, are "Morse
ihan useless; and physicians generally have
only to overcome the force of habit and the
prevailing fashion in medicine, to find a
more excellent way, when they will look
back with wonderland surprise, that they,
as individuals, and as members of our hon-
ored profession, should have been so far
compromised." — Dr. Green's Address to
the Medical Association of Boston.
"Forty years ago the fathers of the very
men who now prescribe brardy, wine and
ale for almost all diseases, prescribed bleed-
ing, calomel and starving instead. They
did this conscientiously, too, no doubt, but
then as now, the tendency of their medi-
cines was to kill rather than to cure. In
the London Temperance Hospital the mor-
tality is four and a half per cent, lower
than in any other hospital taking the same
run of cases. Alcohol is almost never used
in the hospital ; is not employed in making
tinctures, a solution of one part of glyce-
rine to two of water being substituted at a
cost of one-fifth less than that of alcoholic
tinctures, and used in amputations or ty-
phoid fever, with results that demonstrate
the superiority of this method." — Dr. J,
Edmonds, London, Eng.
In the Manchester Royal Infirmary, Eng-
land, the medicinal use of alcohol has fallen
off in recent years eighty-seven per cent.,
and the death rate from about eleven to
about seven per cent.
"In no instance of disease in any form is
alcohol a medicine which might not be dis-
pensed with, and other agents substituted."
— Dr. J. B. Nichols, editor Boston Journal
of Chemistry.
"The sale of drink, is the sale of disease ;
the sale of drink, is the sale of poverty;
the sale of drink, is the sale of insanity;
the sale of drink, is the sale of crime; the
sale of drink, is the sale of death." — Sir
Benjamin Ward Richardson, M. D.
Mrs. Bangle. — They say half the world
doesn't know how the other half lives.
Bangle. — Then they don't read the patent
medicine testimonials.
Fracture of the Skull at the Vertex, with
a Series of Cases.*
By Clinton B. Ilerrick, M. D., Troy, N. Y.,
Clinical Professor of Surg-ery, Albany Medical
College, Surgeon Troy Hospital.
As a condition, per se, fracture of the
skull need not be considered in a serious
light, inasmuch as the damage done to the
bone does not interfere in any wise with
any of the functions or activities of the
body, and the replacing of the fragments,
or the care of the same, is reduced to the
manifestations of the primary attentions.
But as the skull is a box wherein lies the
brain, and any violence which is sufficient
to fracture the skull, is carried to and into
this intercranial organ, producing imme-
diate symptoms of greater or less severity,
or a material injury or destruction, the
latter coexisting condition becomes at once
the one demanding attention, relegating the
actual fracture to the position of being
treated entirely according to the demands
to be met with, to improve the intracranial
condition.
Fracture of the skull is usually classified
into various kinds, as simple, fissured, com-
pound, depressed, and combinations of
these, but the importance of this is entirely
lost sight of in the presence of the intra-
cranial condition produced in connection
with the fracture.
We have been taught, for years, that cer-
tain signs and symptoms accompanied with
intracranial conditions dependent upon a
fractured skull, and that they followed, to
a great extent, the severity of the external
condition.
Looking backward over the field of ex-
perience, we find that this teacher throws
quite a different light upon the subject, and
not only do we see that signs and symp-
toms are many times widely at variance
with the actual lesion, but that they too are
modified in many ways other than those
long looked upon as positive, and it is with
the object of noting these by illustrative
cases that this short paper has been pre-
pared.
Take those cases where from a blow upon
the head without any very marked external
evidence of wound, and therefore a presu-
mably intact or at most a slightly fissured
fracture of the skull where, from book-lore
we expect at most a short stage of come
and quick recovery from any or all symp-
tom of injury. Then again those cases
where with more or less extensive fracture,
with depression, we have always expected
'Read before the Medical Association of Troy.
THE CHARLOTTE MEDICAL JOURNAL,
353
to find an unconscious individual with many
positive signs of the intercranial cpndition,
and which case will awaken as from a feleep
the moment the depressed bone is elevated,
or at least be followed by amelioration of
all of the concomitant symptoms for a time ;
at least can we always expect that?
Case. — A young man received a -blow
from a stone thrown by some one, the same
striking on the parietal region and glancing
off leaving but a slight wound of the scalp.
Temporary dizziness, immediate travel on
cars for some distance, some headache fol-
lowing ; passed over as trifling. Months
subsequent, convulsions more frequent;
operation, exposure at site of blow; fissure
running into suture, no evidence of depres-
sion, fissure chiselled open allowing some
serum to escape ; drainage ; no marked im-
provement. Some time later another oper-
ation, trephining found cyst of dura and
spicula of bone. Reviezv. — Slight condition
with very serious outcome.
Case. — Child received bullet at short
range against skull, non-penetrating but
depressed outer table. Deep coma at once.
Trephining, no depression of internal table.
Coma lasted several days after operation ;
finally recovered. Review. — No lesion ;
deep and lasting coma.
Case. — Child under one year; kicked
by horse in parietal region ; slight external
wound ; bone so badly displaced as to almost
cut through scalp. Depression to a marked
degree; no symptoms whatever. Complete
recovery ; bones reshaping themselves to
some extent, but projection still prominent
and skull misshapen. Revic~v. — Apparent
extensive depression ; absolutely no symp-
toms.
Case. — Similar to above. Child fell off
wall striking on head. Decided depression
of small fragment. No symptoms. Re-
covery, without sequel£E.
Case. — Man struck by train in front
parietal region, causing a compound com-
minuted depressed fracture of a limited
area, constitutional symptoms all very
pronounced; stupor deep ; shallow, irregu-
lar respiration. Operation without anes-
thesia ; removal of all pieces ; brain very
slightly injured ; no laceration ; coma last-
ing several hours after operation for remo-
val. Reviexu. — All symptoms severe and
lasting with but slight injury actually in-
flicted upon the brain.
Case. — Man struck by guard of locomo-
tive ; blow received in front parietal re-
gion ; picked up unconscious. Showed ex-
ternal wound and fissure of skull, showing
depression of at least the external table of
an inch and a-half long 'by half inch broad.
Operation by trephining showed no depres-
sion of internal table. Recovery prompt.
Review. — Slight evidence of injury with
severe stupor for some time.
Now to cite opposite effects we will note
the following :
Case. — Man fell through a bridge strik-
ing on his head upon some stones or rock.
Picked himself up and walked for assis-
tance. No coma. Had an extensive de-
pressed fracture over fronto-occipito region
some several inches long by one broad ; in
fact it seemed the entire half of upper skull.
Removal of large loose segment. No con-
stitutional symptoms from first to last. Re-
covery. Rcvieiv. — Extensive injury with
no symptoms or coma. (In this case the
brain was not lacerated, but dura torn
badly).
Case. — Woman struck on head in frontal
region by some sharp object (said to be the
ash pan cover of a cook stove), having a
compound depressed fracture of skull as a
result with oozing of considerable brain
matter. Picking herself up from the floor
where she fell, she walked several blocks
on the street and remained entirely con-
scious ; no other symptoms. Operation,
removed bone, and large quantity of brain
matter followed. Coma appeared 48 hours
after, ending in death. Review. — Exten-
sive injury with laceration of brain, and no
primary symptoms (these appearing very
late) and really depending upon general in-
flammation rather than direct injury.
Now thes3 are a few cases, selected from
many, to typify the fact that many cases of
fracture of the skull are accompanied by
symptoms far different from what we might
be led to expect from the ordinarially con-
ceded relations between cause and effect, or
such as are laid down by the text-books as
certain to follow, and leads us to the lesson
these cases teach, that in diagnosing we
should be guarded, in prognosis reserved to
tardiness, and in treatment thorough.
What then are the signs and symptoms
associated with conditions of fracture of the
skull ; and what do they indicate to as the
actual condition present and upon which
we can base a diagnosis and prognosis?
Coma. — An unconscious state usually
present to a certain degree in any fracture
of the skull, should be given significance as
indicating injury to the brain according to
the profoundness and length of the same.
If accompanied with wound, inspection of
the structures will associate the severity of
the lesion with this state. If no wound
exists, the profoundness of coma is diag-
nostic, not necessarily prognostic. Relap-
sing coma, or the state coming on late in
the case increases the gravity of the same
many fold.
354
THE CHARLOTTE MEDICAL JOURNAL.
Consciousness, on the other hand, does
not improve the prognosis where the brain
is seen to have suffered mucli damage.
Cotivulsions — seldom seen at first injury
— when occurring later is diagnostic of irri-
tation to dura or brain through spicule ;
and prognostic in lending gravity.
Menial Aberration — Only appearing, if
at all, in the conscious condition, is diag-
nostic of laceration of frontal convolution
of cerebrum ; and prognostic only when
viewed in conjunction with other signs and
symptoms, always weighing the balance on
the side of gravity.
Other symptoms that are to be noted
directly after the primary ones, or during
the course of the case are equally important
as both diagnostic aud prognostic, but
especially prognostic in the case, are.
Pupillary Disturbance which is no longer
considered of any value whatever, diagnos-
tic or prognostic, as variations of all kinds
are noted in cases parallel and opposite.
Circulatory Disturbance is likewise of
but little value and only prognostic when,
on the one hand, full regular and soft, and
on the other, weak, rapid and irregular.
Respiratory Disturbance is of value in a
prognostic sense, as the more gradual and
regular the same diminishes in frequency,
the graver the case. Stertorous and puffy
respiration is at times seen where pressure
is present, but the relief of the latter is not
followed promptly by a regularity in this
breathing, so as a sign it is of but little value
other than to associate it with a coming
fatal case.
A sign which has been lately brought
into prominence by Dr. Phelps, of New
York, as one of great significance is that of
Temperature. — In laceration of the brain,
no matter what the external lesion is or is
not, the temperature, dropping at first to
subnormal as the direct result of the blow
rapidly rises and does so according to the
amount of laceration, and consequently the
gravity of the case. A steady high rise is
considered of positive prognostic value in
marking the case as fatal.
Paralysis, which is overlooked or masked
in the early history of fracture of the skull,
becomes, if it appears later, a diagnostic
point relating directly to the region of the
intracranial lesion, and becomes prognostic
in direct relation to the extent and severity
of the same, not necessarily fatal, but one
that seldom recovers to the fullest normal
extent.
That the treatment of fracture of the skull
should be as thorough as the case will jus-
tify is unnecessary to state. A shaving of
the entire scalp ; removal of all loose bone,
spiculse and offending matter ; free drain-
age from beneath the dura, if that be broken,
otherwise leaving it undisturbed ; daily
dressings; complete rest, mental and phys-
ical, and careful watching for the unex-
pected or the possible, constitute the main
features of treatment. .
A'Remarkable Case of Superfoetation.
On the evening of February 21st, 1900, I
was called to see Mrs. J , aged 41, mul-
tipara, the mother of nine children. Found
her suffering greatly with severe pains in
pelvic region, in no wise expulsive. It was
plain that labor would soon set in. Exam-
ination revealed an abnormal state of affairs.
The OS was partly dilated, the waters had
escaped, and I feared I had to deal with a
cross presentation. After several hours,
true labor pains came on, and with some
difficulty I removed a foetus, apparently
three months old. It was seemingly healthy,
not at all offensive. This occurred about 3
A. M. February 33d. At 11 A. m., after an
entirely normal labor, my patient gave birth
to a well developed living child, weighing
II pounds.
There was one large, and a separate small
placenta. Superfoetation, or the possibility
of impregnating a female already pregnant
(except at a very early period), is generally
denied. In this instance we have an ap-
parent impregnation after six months.
During an experience of forty years, I
have not encountered or known of a similar
case.
If any other physician has ever had a
similar case I would be glad to hear from
him through the Journal in regard to same.
John P. Nicholson, M. D.
Salem, N. C.
According to a Vienna correspondent of
the Medical Record, a blackmailing case
with a humorous aspect has been occupying
the attention of the criminal courts at Gratz,
An elderly lady of great wealth one day re-
ceived a letter saying that if she did not
send the sum of 10.000 florins in small bank
notas the writer would work a fearful re-
venge by opening in her room a bottle con-
taining the bacilli of various infectious dis-
eases, which would certainly cause her
death. The lady appealed to the police,
who discovered the would-be blackmailer.
A bottle found in his possession really con-
tained bacilli, which the culprit, who is a
medical student, had stolen from his pro-
fessor's lecture-room. A sentence of eigh-
teen months' hard labor will doubtless pre-
vent this promising youth from further
blackmailing enterprises. — Medical Age.
THE CHARLOTTE MEDICAL JOURNAL.
355
THE
Charlotte Medical Journal.
Editorial Department.
E. C. REGISTER, M. 0. J. C. MONTGOMERY, M D
Editors and Publishers.
No. 36 South Tryon Street, - - - -
Charlotte, N. C.
SUBSCRIPTION. $2-50 PER YEAR,
MAY 22d, 1900.
The Medical Society of the State of North
Carolina will meet in Tarboro, Tuesday,
May 22d, 1900. The Board of Medical
Examiners will meet the Wednesday before,
being the i6th of May.
Through the courtesy of Mr. W. H.
Fitzgerald the following rates will be in
force on the railroads :
Round trip rates, from
Blacksburg, .113,20 Gastonia, $12.00
Charlotte, 11.20 Goldsboro, 3.00
Danville, 9.85 Greensboro, 8,05
Durham, 5.50 Henderson, 5.50
Fayetteville, 5.05 Hickory, 11.80
Forest City, 13.80 Lattimore, 13.35
Marion, 13-40 Raleigh, 4.50
Maxton, 6.70 Rural Hall, 9.70
Mooresboro, 13.50 Sanford, 6.75
Newton, 11.40 Selma, 3.00
Norfolk, 4.85 SuflFolk, 4.05
Pembroke, 6.20 Weldon, 2.75
Winston-Salem, 9.30 Wilmington, 5.15
Rutherfordton, i3'95
Tickets will be on sale May 15th and
i6th for the meeting of the Board, and
May 2ist and 22d for the Society meeting,
all having a final limit May 26th. Con-
tinuous passage in each direction.
The above rates apply to junctional points
as named ; if you do not live near a junc-
tional point see your local ticket agent at
once and he can have you a ticket ready.
The reduction will apply to all the main
lines in the State, the Southern, Seaboard,
Atlantic Coast Line, and the S, C, and G,
Extension.
The meeting promises to be one of excep-
tional interest from a scientific standpoint.
If all will contribute it will equal a post-
graduate course, and the busier the doctor
the less he can afford to miss it.
The Local Committee promise ample ac-
commodation to all, hotel rates will be from
$1,00 to $2,00 per day.
Dr. Julian M. Baker, of Tarboro, is
Chairman of the Local Committee of Ar-
rangements, and first-class display room
can be secured from him by exhibitors.
Let all the members remember the An-
nual Discussion on "The Continued Fevers
of North Carolina," and come prepared to
make it profitable.
CONVALESCENCE.
In some diseases relapses are more com-
mon than in others and they are likely to
occur during convalescence.
The average doctor is usually sufficiently
solicitous about his patients during the ac-
tive stage of the disease, but his interest is
liable to cool off too suddenly as the patient
begins to sit up and all seeming danger is
past.
But in this weakened, run-down condi-
tion of the system, there is often serious
danger.
There are people dead who might have
been living now if the same proportionate
care had been taken during convalescence
as were manifested during the acme of the
disease.
It is not that we should hang on to our
patients until they are strong and hearty
after some lingering disease. It is not meant
that we should see them twice a day or
oftener, but that we should continue our
over-sight and management throughout
convalescence. This is the harvest time
for quacks and frauds of all kinds, and it is
so because the phvsician does not consider
the condition worthy of his attention,
A middle aged lady is treated for pneu-
monia, and for several days her life hangs
in a balance. The attending physician is
almost constant in his ministry and help-
fulness, but the temperature slowly comes
down, the pulse strikes 100, the breathing
is easy and the patient passes into conva-
lescence.
After the temperature has been normal
for some time, the patient sitting up and
appetite good, she is dismissed though there
is a lingering cough and some expectoration.
The patient left to herself reads the news-
papers, and as time drags heavy, even the
advertisements. The post-graduate course
in medicine, which is thrown in with every
year's subscription to the daily paper is
taken in full and she decides that "Dr,
Nocum's specific" is the very thing for her
complete restoration. Takes five bottles in
four months and finds herself well again.
The doctor is forgotten, but Dr, Nocum is
talked about to all her friends and she sends
a two inch testimonial to the manufacturers
356
THE CHARLOTTE MEDICAL JOURNAlx