alcohol in the schools.
Dr. Atwater claims in his publishe
406
THE CHARLOTTE MEDICAL JOURNAL.
statements that the results of his experiment
prove that alcohol is a food, and that there-
fore the teaching of pulpit and schools that
it is not a food is an error, and should be
discontinued. The adherents of temperance
and of the present method of teaching in re-
gard to alcohol have replied in several letters
and finally by a pamphlet called "An Ap-
peal to Truth," stating that Dr. Atwater's
experiments do not prove that alcohol is a
food either in the common sense of the term,
as understood by people generally and used
in books of hygiene, or in the particular
sense in which the author uses it, as a food
entitled to rank as sugar, starch and fat,
and that, therefore,, his experiments should
have no effect upon the teaching.
The question in dispute in this case is not
the actual value of alcohol as a food, but is
solely whether or not the conclusions which
Dr. Atwater draws from his results are justi-
fied by these results.
These conclusions, stated in Circular No.
357, November 6, 1899 (U. S. Department
of Agriculture, Division of Publications),
are :
(i) That the alcohol was almost com-
pletely oxidized in the system.
(3) In the oxidation all of the potential
energy of the alcohol burned was transform-
ed into heat or muscular energy.
(3) That the alcohol protected the mate-
rial of the body from consumption just as
effectively as corresponding amounts of
sugar, starch or fat.
If we examine the experiments from
which these conclusions are deduced, con-
tained in Bulletin No. 69 (Office of Experi-
mental Station, Department of Agriculture)
in regard to each of the three conclusions
seperately, we find that conclusions Nos. i
and 2 are perfectly tenable and justifiable
on the basis of these experiments, but that
No. 3 is not justifiable.
The data given in the Bulletin show con-
clusively that alcohol is oxidized m the body
and that the potential energy of this alcohol
is transformed to heat or energy of some
other kind. It fails, however, to show that
the alcohol protects the body materials from
consumption equally with sugar or starch
or fat. In fact, this data shows an actual
loss of nitrogen in the experiments in which
alcohol was used, proving a consumption of
body material under these conditions. We
are thus forced to conclude from an exami-
nation of the facts that the authors of "An
Appeal to Truth" are correct in their claim
that Dr. Atwater's experiments do not justi-
fy his statement that alcohol is a food en-
titled to a rank as sugar, starch or fat in its
effect in protecting the body materials from
consumption. In fact, the experiments as
they stand prove the contrary.
Are they justified also in their claim that
his experiments fail to justify him in his
conclusion that alcohol is a food in the ordi-
nary sense of the term, a conclusion implied
in his statements in the report which refer
to alcohol "with other food materials".''
We think that they are so justified.
The two conclusions in regard to the me-
tabolism of alcohol which Dr. Atwater's
experiments did warrant, namely, that al-
cohol is oxidized. in the body, and that the
potential energy of the alcohol is there lib-
erated, do not by any means prove that al-
cohol is a food in the ordinarily accepted
sense of the term "food." To demonstrate
this fact, it must be proven that the sum
total of the effect of the ingested alcohol If
useful rather than harmful in the mainten-
ance of the animal economy. And this Dr.
Atwater has not proven. And it has not
yet, as far as we know, been demonstrated
by any experiments. In fact, the weight
of experimental evidence at the present
time is decidedly against such an assump-
tion. Thus the experiments made upon
large bodies of men under conditions of
sustained labor, as those conducted in the
English, German and American armies,
prove to us that the effects of the use of al-
cohol, in the amounts ordinarily spoken of
as "moderate," make the soldier less rather
than more fit for work, and decrease rather
than increase the amount of energy which he
can put forth under given conditions. That
the use of alcohol in large amounts is harm-
ful no one doubts.
It is possible that it may some day be
proven that the effect of very small amounts
of alcohol upon the economy is such as to
entitle it to be considered as a food. But
it has not yet been so proven. And until
it is, the advocates of the temperance edu-
cation are quite justified in any protest
which they may make against the assump-
tion that alcohol is a food.
As we have said, the whole truth in re-
gard to the action of alcohol in the body or
the question of its nutritive value is not
known. If it is at some future time proven
that small amounts have such a value, then
alcohol must be classed as a food.
It must be pointed out, however, that
even such a result would not entitle it to
be classed as a desirable or hygienic food,
which is the sense in which people in gen-
eral understand the meaning of the term
"food." Against such inclusion there are
many weighty arguments, as, for example,
the fact that the tendency to the formation
of the alcohol habit from taking these small
amounts is so great that the danger of its
THE CHARLOTTE MEDICAL JOURNAL.
407
use far exceeds any possible benefits which
may be derived from it.
These remarks are not intended as a
justification of all the teaching upon the
subject of alcohol which has up to the pre-
sent lime been advocated or employed by
the agents of temperance education in the
schools. We wish merely to point out
that, in regard to the teaching upon this
particular question, as to whether or not
alcohol is a food, their position has not yet
been successfully controverted by scientific
evidence. Whether the present teaching
upon this point is the widest under present
conditions of knowledge is another ques-
tion.
It is our personal opinion that the wisest
course at present would be to base the
prohibition of alcohol advocated in the
teaching upon the fact that alcohol is an
undesirable substance, the use of which in
any capacity in health is quite unjustifiable
under the laws of hygiene, rather than
upon the statement that it is not a food or
the unqualified statement that it is a poison.
For while the latter statements in unqualifi-
ed form have, at the present time, the pre-
ponderance of .scientific evidence in their
favor, still our knowledge in this regard is
not complete. The former statement, how-
ever, is based upon facts and arguments so
established that it may be regarded as true
beyond the shadow of a doubt.
The Ideal Physician.
According to the Denver Medical Times
the ideal physician is a lover of humanity
and a benefactor of his race — not in any
mawkish or sentimental sense, but in an en-
lightened appreciation of the needs of hu-
manity and the resources of science. The
ideal physician is an enthusiast in regard to
his profession. Science is, indeed, his mis-
tress ; and to relieve pain, to cure disease or
to assist nature in any imperfect action, or
arrested development, gives him as keen a
delight as the artist finds in completing a
beautiful picture, or the sculptor finds in
carving a noble statue. The ideal physician
has positively no personal vanity. The
foolish smiles of motiveless women suggest
to him nothing more sentimental than the
play of certain facial muscles. The bland-
ishments of the artful intriguante are to him
a mere waste of time, if not suggestive of
grave physical disorders that medicine can-
not always reach. Being devoted to his
profession, the ideal physician is superior to
false pretenses or hollow make-beliefs. He
does not clothe himself with mystery as
with a garment and refuse to give any hint
concerning the nature of his remidies ; he
has no fear that his entire stock in tadecan
be stolen in a single prescription. He is as
frank and honest in dealing with his patients
as good business men are in giving the right
change when a purchase is made. In com-
plicated nervous disorders, requioing time,
patience, good nursing, proper feeding,
abundant resting and mental diversion, more
than medicine, the ideal physician states the
case frankly to those having the patient in
charge ; he does not assume the office of
nurse, nor contract a bill for bread-pills
when no medicine is required ; he has
enough to do that is necessary and remuner-
ative without making a pretense of doing
that which is not required, for a financial
consideration. His manner is grave, sym-
pathetic, frank; yet, withal, full of digni-
fied reserve. What he says has weight, be-
cause he does not speak unnecessarily or ir-
relevantly. He has no time to waste with
mere whims — no leisure for trifling with
feminine affections or frivolous coquetries;
yet a case of real distress never fails to
awaken his sympathies and elicit his assist-
ance. Hence it is that when he enters a
sick room, or confronts a patient, he inspires
confidence, and this restful mental attitude
on the part of the patient gives a sense of
relief even before any medicine is taken.
A pure and lofty nature brings healing even
with its presence, and the ideal physician
holds as sacred and potent an influence in
the hearts of his patients as that accorded
to priest or prophet.
Women no less than men frequently ex-
periment with their fellow creatures from a
morbid curiosity to find out how much
strength or weakness belongs to the charac-
ter they seek to explore, yet even these poor
skeptics of human goodness are forced to
honor the man or woman whose uncom-
promising rectitude rebukes their foolish
search for that which is unworthy.
No man has it in his power to do more
good in the world than the sympathetic,
skillful and conscientious physician. He is
admitted to the inner sanctuary of domestic
life ; he can heal or widen the breach be-
tween husband and wife that disordered
nerves, financial trouble, or mental obliquity
may often induce even among those who
have the best intentions. He knows that
when a woman's nerves have reached a cer-
tain tension her husband is a "fiend incar-
nate," He knows that when a man's im-
moralities have exhausted his life-forces,
clouded his brain, and hardened his heart,
this man's wife becomes of all women most
unattractive, and the neglect or abuse which
she must endure reduces her to a physical
condition which the physician is expected
to remedy with medicine. He must hear
THE CHARLOTTE MEDICAL JOURNAL.
the complaints of both with the'patience of
Job and the wisdom of Solomon ; he must
do what he can do and decline to pretend
to do what he cannot do. He must distin-
guish between a temporary mood and a per-
manent condition on the part of both and
govern himself accordingly.
Lastly, and above all things, the ideal
physician never reveals by any sign or token
the secrets confided to his professional hon-
or. Hence it is that he receives not only the
confidence and respect, but the friendship
and devotion of those to whom he has min-
istered.
The Surgical Treatment of Gail-Stones.
The extraordinary success which has at-
tended surgical intervention for the relief
of symptoms dependent upon gall-stones,
before these latter have produced wide-
spread inflammatory changes, saAjs the
Therapeutic Gazette, is scarcely realized by
the profession because the majority of these
cases are not reported, and because it has
been the habit of doctors to believe that
gall-stones are peculiarly amenable to med-
ical treatment.
Naunyn's statistics on this point are
scarcely reassuring, since he reports that of
150 cases of all kinds which he has treated,
not more than forty per cent were cured ;
and that in many of these, symptoms per-
sisted which led him to believe that the
cure was not a complete one.
Two notable papers upon this subject
have recently appeared — one by Mayo
(Annals of Surgery, October, 1899), the
other by Kehr (Archiv fur Klin. Chir., 58
Band, 3 Heft).
Mayo, briefly summarizing the results of
his experience, states that during the past
eight years he has performed 105 operations
on the gall-bladder and bile-ducts.
In seven cases the exploratory incision
was negative, no gall-stones being present ;
in two of these a diseased appendix was
found to be the source of trouble ; in one a
movable kidney ; in four no cause could be
discovered. Of the remaining ninety-eight
operations and explorations for non-malig-
nant disease, but two perished; for gall-
stones of the bladder or cystic duct, or
both, cholecystectomy was performed sixty-
four times with one death ; in eight cases
cholecystectomy was performed for the relief
of infection of the gall-bladder, and in four
of these stones were present ; cholecystenter-
ostomy was performed four times success-
fully. In the eleven cases of choledocho-
tomy performed for the removal of stones
from the common duct, all recovered ; in
five of these the gall-bladder also contained
stones ; in three cases the liberation of adhe-
sions relieved pain.
Kehr has performed in all 408 operations
for the relief of gall-stones. Of these forty-
nine, or twelve per cent, perished, a mor-
tality much larger than Mayo's. Of the
202 laparotomies performed in the last two
and two-thirds years, thirty-two died — that
is, sixteen per cent ; whilst in 206 opera-
tions performed in the seven years preced-
ing, seventeen died — a mortality of eight
per cent. Eliminating those cases of death
due to a preexisting and lethal lesion (such
as wide-spread carcinoma or suppurative
cholangioitis, or profound sepsis) and those
in which the liver operation was not re-
sponsible for the lethal ending (such ones,
for instance, as required enterostomy or
resection of the pylorus), there remain of
the cases recently operated on 177, with
seven fatalities, or 3.9 per cent ; and of the
earlier cases 196, with seven fatalities, or
3.6 per cent.
The author states that an early operation
for the relief of stone in the gall-bladder or
cystic duct is absolutely safe, though his
tabulation does not seem to prove this. Of
fifty-five patients subjected to cholecystec-
tomy (the procedure which he strongly re-
commends when the gall-bladder is chron-
ically diseased and sunken), but two died;
of twenty-nine patients subjected to cho-
lecystotomy and drainage of the liver, four
died ; and of thirty-five patients subjected
to complicated operations, twenty-three
died.
These figures deal only with his last series
of cases. Kehr advises medical treatment,
particularly a Carlsbad cure, in cases of
gall-stone accompanied by acute obstruc-
tion of the common duct, unless this is un-
duly persistent and accompanied by fever
or marked weakening of the pulse ; in cases
of inflammatory processes in the gall-blad-
der, with or without jaundice, when they
recur seldom ; in cases of frequent cholecys-
titis, followed by the discharge of stone
with the excreta ; in very fat, gouty, diabe-
tic, or otherwise diseased patients, in whom
narcosis would be dangerous. In patients
who have been subjected to operation Kehr
states that such should undergo a careful
Carlsbad course. He believes that opera-
tion should be advised in acute seropurulent
cholecystitis and pericystitis ; in adhesions
resulting from these conditions and causing
symptoms such as are painful or obstructive ;
in chronic obstruction of the common duct;
in chronic obstruction of the cystic duct ; in M
all cases of cholelithiasis, which begin with
moderate symptoms and steadily become
more severe until the patient is crippled ; in
suppurative cholangioitis and liver abscess ;
THE CHARLOTTE MEDICAL JOURNAL.
409
in perforation and peritionitis ; in morphin-
ism due to gall-stones. In cases of doubt,
operation should be performed. He holds
that all anastomosis between the gall-blad-
der or ducts and the intestine or stomach
should be avoided if possible, and implies
in his paper (if he does not actually state it)
that were physicians fully alive to the much
greater surety and safety of cure afforded by
the surgeon, in Germany alone there would
come to the operating table (suffering from
large stones irremediable by any other
means) yearly 34,000 patients. Riedel
places this number at 90,000.
The admirable results shown by these two
papers should encourage physicians to refer
their cases of gall-stones to the surgeon at
an early stage, when the cure is likely to
be as certain and safe as that which attends
the modern treatment of stone in the blad-
der.
MISCELLANEOUS.
Anopheles and Malaria.
A valuable paper by Professor Celli, the
Director of the Institute of Hygiene in
Rome, has appeared in a recent issue of the
British Medical Journal. The following
comments are made editorially :
"The older observers had noted, what is
indeed a part of the folk-lore of malarial
districts of Europe, that malaria was most
likely to be contracted about sunset and at
night. Anopheles lies hid by day and is-
sues forth in quest of human blood at sun-
set, and pursues its search through the night.
Again, the older observers noted that the ma-
larial 'miasm' was often very limited, and
did not extend to any great elevation, so
that residence on top of a rock or in the
highest story of a lofty house was some pro-
tection. It is known that the mosquito
does not fly far from its birthplace, or
mount high in the air. Again, the older
observers knew that the malarial 'miasm'
was not carried by high winds, and it is
notorious that the mosquito does not fly on
stormy nights.
"Professor Celli thus traces the cycle, for
the maintenance of which, in Italy at least,
man is essential. Beginning with the great
multiplication of mosquitoes at the end of
June or the early part of July, it is found
that some of these are infected by the ma-
larial parasite. They convey the infection
to man, thus bringing about the great in-
crease in the number of attacks of malaria
observed in July and August, but some-
times continuing into the fourth quarter of
the year. During the first and second quar-
ters of the following year the malarious
cases met with are generally recurrence of
the infections contracted in the third or
fourth quarters of the preceding year, and
it is by these recurrent cases occurring even
as late as June, when the mosquito once
more becomes active, that the infection is
again transmitted to the insect, and a new
epidemic started.
"Professor Celli observes incidentally that
in Italy children are more affected by ma-
laria than adults, and Professor Koch lays
great stress upon this point, making it in-
deed the test of the extent to which ma-
larial prevails in a population, since he finds
evidence that adults in a malarial district
having survived the infection in early youth
have acquired a more or less complete im-
munity. This observation Koch believes
may be of great importance in prophy-
laxsis.
"Both Celli and Koch lay great stress on
the part which the cultivation of rice plays
in favoring the multiplication of mosqui-
toes. 'The more rice fields,' Koch reports,
'there are in the neighborhood of a place,
and the nearer they are, the greater the
abundance of mosquitoes' ; and Celli ob-
serves that it is well known that 'the for-
mation of rice fields causes the reappear-
ance of malaria where it had become ex-
tinct, and where it already exists they are
a very active focus of production.' Rice
is best cultivated on low lands subject to
occasional inundation, but where inunda-
tion cannot be depended upon very copious
artificial irrigation is resorted to. — Boston
Medical and Surgical yournal.
During the first years of his career as an
actor, Colonel W. F. Cody had in one of his
thearrical companies a Westerner named
"Brocho Bill." There were Indians in the
troupe, and a certain missionary had joined
the aggregation to look after the morals of
the Indians. Thinking that Broncho Bill
would bear a little looking after also, the
good man secured a seat by his side at the
dinner table, and remarked pleasantly,
"This is Mr. Brohcho Bill, is it not?"
"Yaas."
"Where were you born.'"'
"Near Kit Bullard's mill on Big Pigeon."
"Religious parents, I suppose.'"'
"Yaas."
"What is your denomination?"
"My what?"
"Your denomination !"
"O — ah — yaas. 44 Smith and Wesson."
— Argonaut.
Absolute permanent baldness following
the administration of a quarter of a grain of
thallium is reported by Jeanselme.
410
THE CHARLOTTE MEDICAL JOURNAL.
The Doctor's Dream.
Last evening I was talking
With a doctor, aged and gray,
Who told me of a dream he had,
I think 'twas Christmas day.
While snoozing in his office,
The vision came to view,
For he saw an angel enter.
Dressed in garments white and new.
Said the angel, "I'm from heaven,
The Lord just sent me down,
And bring you up to glory,
And put on your golden crown.
"You've been a friend to everyone.
And worked hard night and day.
You have doctored many thousands.
And from few received your pay.
"So we want you up in glory.
For you have labored hard.
And the good Lord is preparing
Your eternal, just reward.
Then the angel and the doctor
Started up toward glory's gate.
But when passing close to hades.
The angel murmured, "Wait.
"I have a place to show you;
It's the hottest place in hell.
Where the ones who never paid you
In torment always dwell."
And, behold, the doctor saw there
His old patients by the score.
And grabbing up a chair and fan.
He wished for nothing more :
But was bound to sit and watch them.
As they'd sizzle, singe and burn,
And his eyes would rest'on debtors
Whichever way they'd turn.
Said the angel, "Come on, doctor.
There's the pearly gates I see ;"
But the doctor only murmured,
"This is heaven enough for me."
He refused to go on further.
But preferred to sit and gaze
At that crowd of rank old deadheads.
As they lay in the blaze.
But just then the doctor's office clock
Cuckood the hour of seven.
And he awoke to find himself
In neither hell nor heaven.
— Woody ard Kindlings in the Franklin^
Pa., Evening News.
In burns about the neighborhood of the
joints, keep the limb flexed if the burn is
on the extensor side, and extended if the
flexed side is affected.
Crcosotal in Acute Pulmonary Diseases.
The action of creosotal in acute diseases
of the lungs, such as pneumonia, broncho-
pneumonia, grip pneumonia, &c., Dr. F.
Hoelscher says (Tagebl. Kongr. z. Bek. d.
Tuberkulose) is even more remarkable than
in chronic cases, as is shown by the re-
searches which have just been published
by Cassoute and Corgier from the hospitals
of Marseilles. Pneumonia is cut short by
the early administration of large doses of
creosotal, and the course of the disease is
noticeably shortened when the drug is
administered later on in the disease. The
typical fall of temperature occurs in twenty-
four hours after the administration of the
drug. The afebrile condition is a perman-
ent one if the exhibition of the creosotal is
persisted in. The temperature rises, how-
ever, if the administration of the remedy is
discontinued before the ausculatory signs
have completely disappeared. The sequelae
that so frequently occur, and more especi-
ally tuberculosis, are completely avoided
by the creosotal treatment of acute diseases
of the lungs.
New Method of Treatment of Wounds.
Schleich, in his book on the treatment of
wounds, which has recently appeared, has
attempted to simplify the methods of minor
surgery so as to make the general practi-
tioner independent of what he calls the
monopolization and centralization of sur-
gery. He disputes the assertion that bac-
teria are the chief source of infection. He
looks upon them as the accompaniments of
uncleanliness, of which their presence is
sufficient proof, but he rejects the idea that
they are the cause of sepsis and pyaemia,
for the reason that these diseases occur in
the presence of very different forms of
bacteria. He supports his ideas by the
citation of other illustrations. For example,
characteristic fevers follows the ingestion of
spoiled meat and fish, although under these
circumstances only small numbers of the
ordinary streptococci and staphylocci can
be shown to be present. Schleich insists
that the operator should disinfect himself
immediately after contact with infectious