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certainly be classified as a foodstuff" under certain conditions. The
numerous theories advanced concerning its deleterious influences upon
the system are all worthless when compared with the actual results
following its use. The value of alcohol as a food and a preventive of
tissue waste was fully demonstrated during the polar expedition of



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The American PtacHtioner and News. 237

Peary and Greely. For days before the rescuing parties reached the
stranded survivors the latter subsisted on a small daily allowance of
alcohol and glycerine. It is certain that in this instance the vital spark
was kept alive by these agents, and most likely by the alcohol. The
chemical compositions of alcohol and glycerine are not so very materially
diflFerent as regards the primary elements that enter into their compo-
sition, both containing carbon, hydrogen, and oxygen. These are the
primary elements that go to make the great bulk of all of our food, as
starches, sugars, and fats, and while the arrangement of these primary
elements in the diflFerent foodstuflFs varies in quantity, they are split up
and form new compounds in the body, and in fact undergo an unlimited
number of changes — but in the final wind-up their purpose is served
by giving up to the tissues what is needful to them, and so it is with
alcohol — it gives up what is necessary to support life and prevent tissue
waste, and after all this is the only thing accomplished by any foodstuflf.

Dr. Mitchell Bruce, in his admirable work on materia medica and
therapeutics, in speaking of alcohol, says: '' It may now be accepted as
proven that, when taken in suflSciently small quantities, alcohol is
oxidized in the tissues; and that it only passes out of the body
unchanged through the lungs and kidneys, etc., when so freely given
that excretions occur before oxidation has had time to take place.
This decomposition of alcohol must necessarily develop vital force and
heat like the oxidation of sugar, fat, and albumen. Alcohol belongs
to that class of foods which do not become an integral part of living
cells or tissue proteids, as do much of the albumen salts, etc., but
remain in the plasma which bathes the cells, are oxidized there and
constitute their pabulum, the materials which thus supply the active
elements with much of their energy, the * circulating proteids,* carbo-
hydrates, etc. Thus it happens that alcohol can for a time sustain
life when no food (so-called) is taken, as in confirmed drunkards and
some cases of severe illness.

" Professor Binz, of Bonn, who has studied this question with great
industry and success, has calculated how much energy is contained in
a gramme of alcohol, and finds that two ounces of absolute alcohol
yield about the same amount of warmth to the body as is supplied by
an ounce and a half of cod-liver oil.'*

This is suflScient to show beyond all doubt that alcohol is a valuable
foodstuflF if properly used. Everybody knows that the excessive use
of alcohol is injurious and shortens life, but, taken in moderation in



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238 The American Practitioner and News.

the shape of good whisky, it will not materially injure the body and is
healthful to many. Three ounces of whisky in twenty- four hours, well
diluted, is within safe limits, if the " morning toddy " is avoided. No
whisky should be taken as a beverage before the noon hour or twelve
o'clock in the day. When taken before breakfast or on an empty stomach
it irritates that organ too much, and is taken directly into the liver and
general circulation, and must prove harmful in many cases if used in
this manner. At noon the morning meal has been disposed of to a
degree, but the liver at this time contains many things that are not
found in it after the long rest at night, and in addition the noonday
meal usually follows the use of whisky at this time ; if it does not, it
should do so, so that the liquor may be mixed with the food, as this
does much to counteract any harmful influences that it would be liable
to produce, as congestion of the stomach and liver.

Considering the relative evils of alcohol and other so-called unneces-
sary luxuries, it is safe to say that so far as the actual injury to the
physical body is concerned, alcohol in moderation is much less harmful
than tobacco. The common and extensive use of tobacco makes its
evil results less appreciated, but the country is full of wrecks as the
result of the excessive use of tobacco. Tobacco hearts are very common,
and as dangerous as they are common. The typhoid or pneumonic
patient with a tobacco heart has much less chance of recovery than if
he were free from the influence of tobacco.

Teetotalism can never be attained, and those good people who are
urging it had better ask for moderation in the use of alcohol drinks
instead of total abstinence, as there would be some chance of securing
this to a degree.



Hotes ox(^ Clueries*



The Tri-Statk Medical Society. — The eleventh annual meeting of
the Tri-State Medical Society will be held in Chattanooga, Tuesday, Wed-
nesday, and Thursday, October 24, 25, and 26, 1899. The railroads will
give reduced rates. The prospects for an excellent meeting were never
better. Many of the best men of the South will be in attendance.

Do Women Bear Abdominai. Operations Better than Men ?— This
is pre-eminently the age of statistics. Of late years so much care, ingenuity,
and industry have been devoted to the compilation of tabular statements
afiecting pretty nearly every subject under the sun that averages alone have



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The American Practitioner and News. 239

come to be esteemed as worthy of notice, the salient instances by which
public opinion used formerly to be in a great measure formed and guided
being now regarded as of no more value than any other of the similar but
obscure items in the same category. It would be diflScult to find a subject
in either medicine or surgery which has not been exposed to the test of
figures, and especially is this the case with regard to operations. Among
other points all more or less noteworthy the influence exercised on the
results of surgical interference by age,. temperament, nationality, latitude*
season, the experience of the operator, etc., has been statistically recorded
with much advantage, while incidentally these investigations have likewise
been by no means barren. For some considerable time the supposition
that grave surgical operations were better supported by women than by
men was rather extensively entertained, but it was not until totals had been
systematically tabulated that we were afibrded reliable grounds for believing
that members of the so-called feebler sex could endure the knile with
greater advantage than those of the sex which is inured to labor and hard-
ship. The following figures, supplied by Haberkant and quoted by Pro-
fessor Tarnier in a lecture last summer, would certainly seem to afibrd
prima facie evidence of the exactitude of the proposition. In 1 17 cases of
gastro-enterostomy in the male there was a mortality equal to 54 per cent,
while in 96 similar cases in the female it was only equal to 35 per cent, a
difference of very nearly one fifth. In pylorectomy the discrepancy was
not quite so prominent, the mortality after 70 operations in the male and
140 in the female being at the rate respectively of 64.3 and 52.8 per cent, an
advantage in favor of the latter of only 1 1.5 per cent. As may be supposed,
a great many theories have been advanced in explanation of this sexual
peculiarity. In the opinion of one profound observer who has actually
been bold enough to place his lucubration on record in print women suffer
less than men after capital abdominal operations because it js especially
characteristic of this sex to enjoy this comparative immunity. As Profes-
sor Tarnier did not fail to remark, this intelligent explanation reminded
him of the well-known character in Moliere, who so strenuously maintained
that opium caused somnolence because it was endowed with soporific prop-
erties ! According to Dr. Marcel Baudouin, however, it is not impossible
to furnish reasons which at all events are plausible for the fact that females
support operations better than males. In the first place, pregnancy makes
the abdominal parieties thin and flaccid, thus enormously favoring examina-
tion and consequently helping to an accurate diagnosis. Secondly, women
are more prone to complain than men, especially in connection with any
thing that concerns their reproductive systems. In this way their cases
come under observation at an early stage when surgical interference is less
of a pis aller. Thirdly, men as a rule hate confinement, whereas women
are accustomed to an indoor life. Fourthly, women do not smoke or drink,
and nature, consequently, can exert her recuperative qualities more effect-
ually. — Lancet,



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240 The American Practtitoner and News.



Special notices.



Sanmetto Airways Rbuablb in Strength. — I have one word of praise to say
for Sanmetto, viz., that the last bottle gives the same results as the previous one, or in
other words, Sanmetto is always reliable in strength. Mark C. Meyers, M. D.

Kansas City, Mo.

The Treatment op Indigestion op In pants. — For several years we have used
Lactopeptine in the indigestion of infants; in fact, it is much of a routine treatment
and the results have always been highly satisfactory. Infants need it when indigestion
is more or less chronic, and it will do valiant service in correcting the difficulties of
digestion here encountered. In addition to medical care, much attention must be
given to the hygienic surroundings of the child, its bath, its outdoor life, its exercise,
the water it drinks, and the quality and quantity of food taken.— ^. P, Norbury^ M. D.,
in Medical Fortnightly.

Rdw. L. H. Barry, jr., M. D., Jerseyville, 111., says: I have used Aletris Cordial
with excellent results in the following: Miss R., nineteen years of age, brunette, well
developed, but troubled with dysmenorrhea, called at my office and after explaining
her affliction, said : " Doctor, if there is any thing you can prescribe to relieve my
suffering do so, for life is a burden to me now." I thought of the Aletris Cordial at
once, and gave her a six-ounce bottle, directing her to take a teaspoon ful three times
a day, commencing four or five days before the regular period. Several weeks after-
ward she returned with the empty bottle, remarking : **rve come back for more of
that medicine, for it's the only thing I ever had to give me relief." I can cheerfully
recommend Aletris Cordial to the profession.

A Positive Corrective op Uric Acid and Lithemia. — In these days when from
sedentary habits or abuses of diet the kidneys and bladder are special suflferers in the
general cachexia, the physician is often puzzled in his diagnosis by a variety of symp-
toms in the patient over the exact cause or causes of the trouble. Usually there is
but little difficulty in determining if the trouble is of a nephritic* character. The
sympathetic nexus between disturbances in the kidneys and bladder is such that any
abnormal condition of one is reflected in the irritated condition of the other. Whether
the patient is suffering from excess of uric acid or lithial deposits in the bladder, or
surplus of albuminuria, the symptoms are much the same.

The difficulty just here lies with the making of a correct prognosis of the disease,
whether simple and confined to one organ or complicated and involving more than
one. It is a positive relief to the busy physician to know at such times that there are
remedies which may come most beneficially into action in some, if not all, of the dis-
eased conditions, and prove an immediate corrective of the leading troubles. In
nearly all forms of kidney and bladder disease decided and permanent relief has been
obtained from the free use of Granulated Effervescent Alkalithia. a preparation that
is coming into general use for lithemic kidney and the uric acid diathesis.

Its action in eliminating the urates of rheumatism has given special satisfaction
in cases where the other well-known remedies have failed, while the rapidity with
which it dissolves lithial deposits renders it a boon to those who suffer from lithemia.
The pleasant semi- saline taste and the refreshing effervescence of the preparation ren-
der it a very acceptable remedy to the patient. The portability and convenience in
form of this true lithial preparation in contrast to all so-called " Lithia Waters " will
also strongly recommend it both to the profession and to the public.



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THE



American Practitioner and News.



'NEC TENUL PENS A."



Vol. XXVIII. Louisville, Ky., October i, 1899. No. 7.



Certainly it is excellent discipline for an author to feel that he must say all he has to say in the
fevnat possible words, or his reader is sure to skip them ; and in the plainest possible words, or his
reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain
'way ; and we want downright facts at present more than any thing else.— Ruskin.



Original CIrticIes*



PLACENTA PREVIA.*

BY THOMAS H. BAKER, M. D.

To the obstetrician or to the general practitioner of medicine there
are few more fruitful themes of discussion than placenta previa, and
the very great importance of the subject justifies the attention and
earnest study that have been devoted to it.

The definition given by Rigby more than one hundred years ago
has not been improved upon : " A previa is fixed to that part of the womb
which always dilates during labor," and, clinically speaking, a placenta
is previa when it has an attachment in the lower zone of the uterus,
and partially or entirely covers the os.

Placenta previa is met with nearly eight times as frequently in mul-
tiparse as compared to primiparse, and is also of more frequent occur-
rence in hard-working women. The sudden and appalling hemorrhages
constitute the only dangerous element, and there is no obstetric com-
plication so alarming or requiring more energetic and scientific treat-
ment.

The source of the hemorrhage has been a much-discussed and much-
disputed proposition, but it is now generally conceded that this comes
from the torn and lacerated uterine vessels, and not to any great extent
at least from the placenta itself. Although the placenta must occupy its
abnormal site from the beginning of utero-gestation, it rarely gives rise

* Read before the Louisville Medico-Chirurgical Society, July 14, 1899. Per discussion see page 257.

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242 The American Practitioner and News.

to appreciable symptoms till within the last three months of pregnancy ;
because hemorrhage, which is the first suspicious indication, rarely
occurs till after the sixth month of gestation, and a uterine hemorrhage
occurring after that time is due almost invariably to an abnormal inser-
tion of the placenta. When the implantation is central, hemorrhage
will occur earlier than with a marginal insertion.

Hemorrhage usually appears suddenly without previous symptoms^
often during the night when the patient is asleep or perfectly quiet.
Blood may have either a venous or arterial hue, and has a marked ten-
dency to coagulate. The flow may cease as suddenly as it appeared^
and may not return for eight to fifteen days, or even longer; then
another hemorrhage occurs without appreciable cause, as in the first
instance, but more profuse and continuous than before. These phe-
nomena may be repeated until labor begins, when the bleeding becomes
so extensive as to seriously jeopardize the patient's life.

Treaimeftt. Dr. William T. Lusk insists that the time to act is at
the occurrence of the first hemorrhage, because delay in the interest of
the child means too often the sacrifice of both lives. As we have before
indicated, the first hemorrhage from placenta previa occurs after the
sixth month. In case the seventh month has not been attained, delay
should be counseled only in cases where the patient can be under the
immediate and constant care of a competent medical attendant. At or
after the seventh month, when the child is viable, there can be no
reason for further delay.

Opium tends to diminish the uterine contractions, and, therefore,,
does more harm than good. Ergot is a remedy which is almost cer-
tainly fatal to the child and dangerous to the mother, and is most dis-
tinctly contra-indicated. Cold or astringent injections are not suffi-
ciently powerful. Active, rapid, energetic, and effective measures are
indicated, and temporizing methods are to be condemned, because we
are certainly playing with two lives when we postpone active inter-
ference.

Induce labor, and do so at once. If the cervix is closed, disinfect
the vagina, and then thoroughly tampon it as the most efficient means
of exciting uterine contractions. In from eight to twenty-four hours
the tampon should be removed, and then the cervix will be found in
most cases to be dilated sufficiently to permit the introduction of one
or two fingers. With this degree of dilatation, version should be per-
formed by the Braxton-Hicks method, and an extremity of the child



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The American Practitioner and News. 243

brought down into the vagina. The rest can be safely left to nature,
if the pains are good. If the pains are defective, slight traction on the
leg of the child will not only induce pains, but will allay any hemor-
rhage which may have persisted.

It has been my good, or bad, fortune during a comparatively brief
medical life to have met with five cases of placenta previa, occurring in
four women. In these cases the maternal mortality is nily but the fetal
mortality is seventy-five per cent. While the infantile mortality is
large, yet I feel that I have no reason to be other than pleased with the
results as regards the mothers.

Case i. Mrs. N. W. G., aged thirty. Multipara. About sixth month
of pregnancy ; began with rather severe hemorrhage, which was con-
trolled by tampon. At the expiration of six hours labor pains set in ;
tampon removed and a dead child delivered by version.

Case 2. Mrs. J. B. V., aged twenty-four. Primipara. At about the
eighth month of pregnancy. Was awakened in the night by a pool of
blood in her bed. When I reached the house the patient was almost
pulseless, complaining of great thirst ; sighing respiration, cold sweat,
and such an amount of blood lost as to completely saturate the mat-
tress and soak through on to the floor. Hasty examination disclosed
a vertex presentation, and also a margin of the placenta presenting
through a well-dilated os. Forceps were quickly applied and delivery
of a child effected. Had not my entire time been required by the
mother the child could probably have been resuscitated, but by the
time the mother's condition had improved the child was beyond human
aid. The patient's convalescence was long, stormy, and tedious. In
addition to puerperal fever of rather mild form, phlegmasia alba dolens
of the left extremity occurred on the ninth day, and two weeks later
the same trouble made its appearance in the right leg.

Case 3. Mrs. W. L., aged thirty-one. Primipara. This case was
to me of a most extremely unique nature. Profuse and repeated hem-
orrhages occurred in sixth month of pregnancy. Examination was
unsatisfactory, but absolute rest in bed was prescribed, and the patient
apparently recovered. Between the eighth and ninth months she was
attacked with severe labor pains, accompanied with profuse hemor-
rhage. Chloroform was administered, the hand introduced with some
difiiculty into the vagina ; membranes ruptured, and then the discovery
was made that there were two children. Delivery of the first child was
quickly effected, but the second one, and, as subsequent developments



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244 ^^^ American Practitioner and News.

showed, much the larger child, presented by the shoulder dorso-ante-
riorly, the head being to the left. Version was performed and the body
quickly born, yet partly by reason of the lack of uterine contractions
and partly by reason of the large size of the head, I was unable to
deliver, even when the forceps were applied, before the child was
asphyxiated. The first child delivered is living to-day, and the mother
made a slow but uneventful recovery.

Case 4. Same patient as Case 2. Was seized with rather severe
hemorrhage while attending to her housework. In my absence a
neighbor physician was called, who, without making an examination,
prescribed ergot and rest. On my return home, some hours later, I
was called to see her and found her condition most desperate, and death
apparently imminent. Dr. Stafford was hastily summoned to my assist-
ance. Under chloroform, examination showed clots in the vagina;
cervix well dilated, the placenta centrally implanted, through which a
vertex presentation could be defined. Pushing the placenta hurriedly
and not very carefully aside, forceps were applied hastily and stillborn
child, placenta, membranes and all delivered en masse. Patient dis-
charged well in about three weeks.

Case 5. Mrs. F. S., aged thirty-five. Multipara. Was seized with
hemorrhage at eight and a half months of utero-gestation. In this case
the OS admitted two fingers. Manual dilatation was made ; the mem-
branes and a foot brought down. Hemorrhage ceasing and the patient's
condition being fairly satisfactory, I made no attempt to finish the
labor, but waited upon nature. Labor finally ended with the birth of a
living child two hours thereafter, but the child, which appeared well at
the time of birth, died a few hours after.

I.OUISVII*l.E.



VITAL AND MORTUARY STATISTICS OF KENTUCKY FOR 1898.
PRORATED FROM THE NATIONAL CENSUS OF 1890.

BY T. B. GREENI.EY, M. D.

In the first place I will speak of the population of the United States
and its decennial increase since 1790. In that year the population was
3,929,214. In 1800 it was 5,308,483; increase 35.10 per cent. In 1810
it was 7,239,881; increase 36.38 per cent. In 1820 it was 9,633,822;
increase 33.07 per cent. In 1830 it was 12,866,020; increase 33.55 per

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The American Practitioner and News. 245

cent. In 1840 it was 17,069,453; increase 32.67 per cent. In 1850 it
was 23,191,876; increase 35.87 per cent In i860 it was 31,443,321;
increase 35.58 per cent. In 1870 it was 38,558,371 ; increase 22.63 per
cent. In 1880 it was 50,155,783; increase 30.08 per cent In 1890 it
was 62,622,250; increase 24.86 per cent. In the census of 1890 there
were males 32,067,880, and females 30,554,370. Whites, 54,983,870;
colored, 7,638,038. Death-rate of the whole population, 12.85 per
1,000 — whites 12.20 and colored 14.24.

It will be seen that there has been a pretty regular decennial increase
in the population of the country except the periods included in the
wars of 1812 and 1861, when, of course, there was a- diminution of
increase due to natural causes. There was also a falling oflF in the
regular increase during the period from 1880 to 1890; but no doubt
this was due to the fault of the census takers in omitting a large num-
ber of the population, as we had no wars or epidemic diseases to pro-
duce such a result.

When I come to speak of the population of Kentucky I shall endeavor
to show a great defect in this particular.

The number of children born during the last census year, 1890, was
1,670,821; deaths under five years, 307,562 ; stillborn, 34,102. Deaths
among all classes, 875,521 ; males, 464,320; females, 411,191. Death-
rate: Whites, 13.98; colored, 15.30. Principal diseases causing death:
Typhoid fever, 27,058; malarial fever, 18,594; diphtheria, 27,815;
diarrheal diseases, 74,711; consumption, 102,199; pneumonia, 76,496;
cancer and tumors, 20,984 ; heart disease and dropsy, 55,029 ; diseases
of the nervous system, 89,974; diseases of the urinary organs, 23,652
old age, 16,591 ; all other diseases, 250,080.

Population of Kentucky in 1890 was 1,858,635; white, 1,590,462;
colored, 268,173. Births in 1890, 52,015. Deaths under one year,
3,231 ; under five years, 5,802. Deaths of all ages, 23,897 ; whites,
19,398; and colored, 4,479. Ratio per 1,000: White, 12.20; colored,
16.70. Principal causes of death: Scarlet fever, 105 cases; typhoid
fever, 375 ; malarial fever, 400 ; croup, 259 ; diphtheria, 385 ; diarrheal
diseases, 948 ; measles, 207 ; whooping-cough, 207 ; cancer and tumors,



Online LibraryUniversidad de Buenos Aires. Facultad de Derecho yThe American practitioner → online text (page 82 of 109)