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with spirit, or its elements. My first remark on seeing such a case is, that a man cannot live on alcohol; he must take some food or he will die. The correctness of such common-sense remarks is admitted, but qualified with the statement that no solids can be taken, and that if stimulants be omitted it is feared the patient will sink. It is assumed that the constant administration of brandy is necessary for the temporary maintenance of life, and

the idea never seems to have been conceived that the stimulation of the heart causes the weak, fluttering pulse, and stimulation of the stomach a subacute disease. Do you ask me what method I adopt? The simplest possible. I withdraw every drop of the stimulant, and in a few hours the irritated stomach is partly restored to its normal condition, the nervous excitement abates, the patient takes a little food and begins to mend. Do you ask, again, whether I do not fear any frightful results from the sudden withdrawal of the stimulus? I say, not the least; I have no fear of the consequences.

"That many cases of disease of various kinds would do far better without stimulants I am perfectly confident. But lately I have seen the case of a gentleman, about sixty years of age, who passed through a most severe attack on the lungs without the use of stimulants. He had been a tolerably free liver, and would not have been called a good subject; but having before me the case of another gentleman of the same age, who had just died of a similar attack, and who had taken a large quantity of brandy, I readily acquiesced in the patient's own view, that none should be given. It is very remarkable what extremes we have reached, and on how slight a scientific basis is founded the treatment of such diseases. many years ago the opposite method was adopted, including bleeding, antimony, calomel, &c.; then came the "let alone" method; and now we have the brandy treatment. What the need of this can be with Professor Hughes Bennett's statistics before us, I do not comprehend. My own opinion is (but of course this is only an opinion), that in any given number of cases a larger majority would recover under the old treatment than by

Not

the more modern method by brandy. As regards heart disease, the utmost discrimination is required in the use of stimulants. There are cases where an undoubted benefit is produced by them; but there are others, and these I have seen repeatedly, where alcohol has induced palpitation, fluttering, great distress, and constant sleepless nights, but where, on the other hand, the withdrawal of the spirit, and the substitution of a dose of medicine has been of the most essential service.

"Of course stimulants are often needed as medicines; but young persons with typhus and typhoid fevers are far better, I believe, without them. That they make good recoveries on simple milk diet is a fact, which my hospital cases prove, and which no arguments can gainsay; and, on the other hand, I have seen a marked improvement take place in some cases where a stimulus has been left off. It is also a fact that in bronchitis I have repeatedly seen improvement after stimulants have been omitted; and, as regards heart disease, I am convinced that the amount of mischief done by stimulants is immense. In the case of fever and bronchitis, the weak pulse is often but an indication of extreme capillary congestion, and a stimulus to the heart only aggravates the evil; and in the case of a diseased and weak heart, where repose is indicated, a constant stimulation by alcohol adds immensely to its trouble.

"Whatever may be thought of the remarks just made, there is one thing which I must insist uponthat is, when treating any malady, and the administration of alcohol is suggested to your mind, that you give the same grave consideration to its recommendation as you would to any other potent drug; not to sit down and give all your serious thoughts to the question of whether a grain of this or a grain of that drug should be ordered, perhaps twenty or thirty drops of either, and then at hap-hazard order any loose number of ounces of brandy. You observe, that I say nothing against the potency of alcohol in several states of disease; but I do speak strongly against its indiscriminate use without due consideration of its need or of its results. My arguments

S. VI.

would equally apply did I find that opium or any other drug were indiscriminately used as a universal medicine.' I should protest against the practice, whilst still possessing great faith in the virtue of the drug. If I can influence you to place alcohol in your list of drugs, so that you may administer it with the same caution as you do the several powerful drugs used as medicines, then the object of these remarks will be fully answered.”*

In the Lancet of March 12, 1864, there was an article on "Facts and Conclusions as to the use of Alcoholic Stimulants in Typhus Fever," by W. T. Gairdner, M.D., Physician to the Royal Infirmary, and Professor of the Practice of Physic in the University, Glasgow. Dr. Gairdner shewed that the mortality from typhus fever might be greatly reduced by reducing the quantity of alcoholic stimulants usually given; that this reduction in mortality may take place at all ages, but in a marked degree among the young; that the young and temperate persons may be advantageously treated, with a diminished mortality, without one drop of wine or spirit being given from beginning to end of the fever, except in the rarest casualties. The reduced mortality under Dr. Gairdner's mode of treatment is highly encouraging. It appears that in 595 cases of all ages treated by Dr. Gairdner, the mortality from typhus was only 11.9 per cent.; whilst under the liberal use of stimulants the mortality for all ages was 17 per cent. These results are extraordinary, as the average mortality from typhus in the hospitals of England is little less than 18 per cent. It is well known that typhus fever is not so fatal to the young as to adults, and we see that in 189 unselected cases among the young treated by Dr. Gairdner without stimulants the mortality was less than 1 per cent. Dr. Gairdner says—“ I confess I am strongly persuaded that, to the young, in typhus, and very probably in most other fevers, stimulants are not less actively poisonous and destructive, unless administered with the most extreme caution, and in the

A Lecture on Alcoholic Stimulants in Disease. By Samuel Wilks, M.D., Physician to Guy's Hospital, and Examiner in the Practice of Medicine at the University of London.

most special and critical circumstances." He further shews that, had the 189 young persons formerly mentioned been in the hands of the late Dr. Todd, under a routine of such extreme stimulation as is indicated in Dr. Todd's book on Acute Diseases, it seems probable that instead of one death in the 189 cases, there must have been no fewer than thirty to thirty-five.

Many medical men will confess that by ordering the use of stimulants in sickness, they have unintentionally sown the first seeds of drunkenness. Too many of their patients, relying on medical advice, have begun the habit of drinking, which has not ceased when they have left off the other medicines prescribed, but has continued, increasing almost daily in the amount taken, until the habit has become confirmed, and their lives sacrificed at an early age. Here is the testimony of

one*

"I believe I have made many drunkards, not willingly, not purposely, but I have recommended the drink. It makes my heart ache, even now, to see the mischief that I have made in years gone by, mischief never to be remedied by any act of mine. But in this respect at least I do not sin now, and have not done so for the last ten years. I do not take intoxicating drink myself, I do not have it in my house, and I do not give it to anybody else."-Rev. J. Ridgway.

HÆMORRHAGE; OR, LOSS OF BLOOD.

THE escape of blood from its vessels into the surrounding tissues is named extravasation; if into one of the cavities of the body, or externally, it is named hæmorrhage. The loss of from four to six pounds of blood, from one or more of the great vessels, will generally prove fatal to an adult, but if the bleeding be slower, much larger quantities may be drawn from the bloodvessels without a directly fatal issue.

Death from sudden hæmorrhage, is caused by the want of sufficient blood to supply the nervous centres, * Henry Munroe, M.D., F.L.S.

so that fatal syncope (i.e., fainting), takes place. When death occurs from prolonged hæmorrhage, it is not from a defective supply of nutriment to the tissues generally, but from a slow exhaustion of the nervous and muscular power, affecting the brain, spinal cord, and heart, due to a deficient supply of nutriment and of oxygen to them, in consequence of the diminution in the number of the red corpuscles.

Everyone should be acquainted with the various forms of accidental bleeding, and their immediate treatment. If it be general oozing from small vessels, which is easily recognized, and if it proceed from a part to which pressure can be applied, a handkerchief closely folded into the form of a pad, and firmly bound over the spot by another handkerchief, will generally suffice to staunch the bleeding for a time; the part should then be kept elevated and at rest. In hæmorrhage from a vein the blood is dark, and the stream flows continuously, welling up over the surface. Moreover, pressure with the finger on the side of the wound further from the heart will almost entirely arrest the bleeding; whilst if pressure be applied on the side of the wound next to the heart, the flow of blood becomes more copious. To arrest bleeding from the veins, a small thick pad should be applied upon the wound, so as to extend a little to the side further from the heart; this should be firmly secured by a handkerchief or bandage; the chief pressure must be made on the side of the wound away from the heart, because that is the direction from which the blood flows. Arterial hæmorrhage is known by the blood being bright, and projected in a jet from the wound, sometimes to a considerable distance, usually by jerks; though, if the artery be very small, there are merely slight intermissions in the force of the jet, and, in wounds of very minute arteries, the jet is continuous. Moreover, pressure, on the side of the wound further from the heart, has no effect on the strean; but pressure on the side nearer the heart stops it. To stop arterial bleeding from a small artery, therefore, a pad of suitable size should be applied upon the wound, and

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