Billeder på siden
PDF
ePub

man. From history we learn that the masses imitate the example set by those in authority over them. By placing none but sober, honest, competent men in positions of authority, trust and honor we should practically say to young men: "You see what kind of characters you must form if you would secure the confidence and respect of your fellow men." This kind of teaching will count.

Years ago it was the custom in India for mothers to cast their children into the Ganges as an act of worship. As was her duty, England stopped this barbarous practice. In our land there are thousands upon thousands of parents who starve their children to death by spending for intoxicants the money needed to supply their children with bread. Unquestionably it is the duty of the state to protect the lives of these helpless little ones. "What! go down into the slum of New York, Philadelphia and Boston to rescue those little ones, who with wan cheeks and sunken eyes are at this moment stretching forth their tiny, bony hands, piteously imploring the state to come to their rescue before they shall be sacrificed on the altar of their parents' unhallowed appetites?" Yes, most assuredly yes. I know the task is an herculean one, but it can be done and must be done.

There are thousands of men who day and night are robbing the wives which they solemnly swore to love, cherish and protect as long as they both should live, and no effort is made to protect these wives. Were a drunkard to rob and abuse any other woman as he robs and mistreats his wife the state would bring the culprit to justice. How long, O! ye sons of men, will we cling to that barbarism, which has been handed down to us through a hundred generations, that barbarism which deemed the wife a slave who had no rights which her husband, her lord and master, was bound to respect? It is a greater crime for a man to rob or mistreat his wife than to rob or mistreat another woman.

Whenever and wherever necessary the state should appoint a conservator to take

charge of the property and earnings of the man who is spending for liquor the money needed to supply his family with the necessaries of life and hold them for one year. If the man whose property and earnings are in the hands of a conservator shall refuse to work, give him nothing to eat until he shall be glad to work.

Treat the drunkard and his accomplice as they ought to be treated; then men will live sober lives, and saloons will be few and far between. No man will then pay for the privilege of selling intoxicants. S. HENRY.

Camp Point, Ill.

ALCOHOL, PROHIBITION LAWS AND THE DOCTOR

In reading various articles in the November CLINIC on the prohibition question, there are a few points seldom touched by the writers that come to my mind. I think physicians today recognize and their daily practice shows that spirituous liquors are seldom used by them for their patients. The laity by reason of knowing no substitutes think of and use liquor as a medicine much more than is needed, and have an idea that an irreparable injury would be done the practice of medicine, and them of course indirectly, by the total prohibition of liquor sales, and as a consequence they compromise with right and adopt a prohibitory liquor law with lots of loop-holes in it. They desire to interfere with their neighbors getting it, but not themselves.

When A wants liquor it is difficult for him to think that he does not need it, but as to B, why A is satisfied B does not need very much of it. So they close the saloon and Mr. Saloonkeeper hires a clerk (same salary, or less, as his license cost him before) and starts a drugstore, because A and B except from the prohibition law certain sales of liquor by drugstores.

Sometimes, as in the case of the Washington legislature of two years ago, they try to shift the responsibility on to the wrong ones, so that no drugstore can sell liquor except upon the prescription of a registered

physician; and what a farce such a law has been. Even Mr. Legislator knows that did he want (probably not need) a pint of whisky he would merely say to his family doctor, "Give me a prescription," and the doctor would not dare to refuse and lose the friendship and probably the patronage of this man.

Right is one thing and bread is another. The doctor has enough temptations now without loading the prohibition question's success on him. I do not think he wants it (the load) or will do his best for it, even though at heart he may wish liquor banished from the country. He does not care to be a buffer between a man's desires for liquor on the one side and the dispenser's desire for money on the other. Why will the legislatures not try something a little different, even a little radical if need by?

I would like to offer something by way of suggestion, testing the good faith of the users of liquor for medicine under prohibition. Say the law prohibits all sales of liquor except on prescriptions of registered physicians who shall state in the prescription whom the liquor is for and for what disease to be used. Let it be issued in original and duplicate, the original to be certified by the town clerk, whose duty so to do shall be mandatory; the clerk shall post the duplicate on a bulletin board on the wall of his waiting room or his office, this to remain there for fifteen days. Doctors shall file monthly statements with him as to the number issued, to whom, etc., and every druggist shall also make a monthly report of numbers filled, to whom, etc.

Now of course the law would have to release the doctor from responsibility for stating the disease for which this liquor is to be used, but as the uses for liquor in medicine are only in honorable diseases no great harm would be done to the patient. But it would have a deterring influence on the respectable "chronic," who has a great respect for his medicine-bottle of old rye, and many people would soon find out that they could get along without the liquor if they had to go through so much trouble, and the police authorities could be on the

watch for the man whose name appeared too often on the bulletin board. Of course the doctor should be allowed to prescribe only a nominal amount.

Only by some such a course can you get a law that will be a success. To prohibit the saloon only is a farce and degrades the druggist's calling. To trust to the doctors to make a success of the law would be a total failure. They just can not afford it. What do you think, Mr. Editor and reader? The legislative season is at hand and prohibition is in the air. How far do the doctors owe it to the state to enforce the laws?

Krupp, Wash.

H. E. AYARS.

[We put it up to the doctors.-Ed.]

A FREAK OF NATURE

On May 30, 1908, I received a hurry telephone call six miles in the country, and after arriving at the the house I found Mrs. L., age 34, in the first stage of labor. After making some examinations, I found the membranes ruptured and fluid escaped, with very little other change. This was at 10 o'clock in the morning, and I departed, charging the family to call me later when the need appeared.

At 7:30 in the evening I was again called, but on arriving at the place I found much the same condition. At about 11 p. m. her pains began in earnest but with very slow progress. At 12 o'clock I gave an anesthetic and found the head presenting normally and well engaged, so I assured the husband and family that everything was all right. The pains kept up very strong but nothing doing. At about 1:30 I applied forceps and with a hard struggle delivered the head. After this was delivered I could not get any farther nor could I tell why. At this time I became greatly alarmed as the mother was getting very low and my bottle of chloroform well exhausted. Being one mile from a telephone and no medical assistance near, I concluded to give her the hypodermic anesthetic. This accomplished,

[blocks in formation]

Are you certain of any proposition in medicine? To illustrate. Calomel is considered a purgative, but are you sure that (in safe doses) it will purge the next patient to whom you give it? You have seen cases in which it did not purge. So you see that when you say that calomel is a purgative you mean that it frequent y acts as a purgative.

Why all this uncertainty? (1) You do not know that you are giving calomel at all. (2) You do not know calomel when you see it. (3) You can not demonstrate

that calomel is calomel because you do not know how. The average doctor (and this is my audience) is not an analytical chemist. And all the average doctor knows about calomel (as such) is what the chemist has told him. His (the doctor's) knowledge is only hearsay. And this kind of testimony does not go in the count of inquiry as to what you know.

In a world of ignorant prejudice and spite there is demand for something better than war in our ranks. If the J. A. M. A. would attend to its legitimate work, the promotion of the prosperity and unity of the profession, while the alkaloid-man continues in his claim that alkaloids are more reliable than galenicals, there would be no excuse for this warfare. If the war continues, all the Smiths, Joneses and Browns will take a hand, and no good will result. Peace, gentlemen, peace, if you please. Let us have peace.

[graphic]

Charleston, Mo.

W. C. HOWLE.

[Amen! By all means let us have peace. All we ask is to be allowed to attend to our duties. But how can we detect the differences between the finest râles and pleuritic friction while a little imp is sticking pins into our legs? Just take the youngster up, reverse him over your knee, arrange his wardrobe conveniently, and counterirritate energetically, while we take advantage of the lull to attend to our work.

Your argument about calomel is a strong one in favor of the doctor doing his own dispensing. ED.]

A CASE OF UREMIC POISONING

Whether uremia be due to renal inadequacy, hepatic insufficiency, or both combined with general intoxication, the question of importance to the patient as well as the physician is the prevention of the climax, since, in the language of Croftan, "The treatment of the acute uremic attack is always an ungrateful task: for it is immaterial whether we are dealing with a disorder that is primarily or in its ultimate con

sequence due to renal, hepatic or general metabolic insufficiency, in any case we are dealing with a terminal syndrome that is due to the crumbling of the whole cellular edifice. To arrest this collapse essentially means to revive a dying organism. That this may occasionally be done for the time being cannot be denied: and as the recuperative powers of the human body border on the phenomenal, no effort should be spared to bring an acutely uremic patient back to life."

The case, the history of which I shall briefly give, illustrates the marvelous recuperative powers possessed by some individuals, and it may encourage us to be hope ful in the presence of conditions that seem to be desperate.

Mrs. G., age 24, married. For several years previous to her marriage she was a domestic. She does not remember that she ever, since childhood, was kept in bed because of illness. During her pregnancy she did her housework even to the day of her confinement, consulting her physician during. this time only for nausea. April 16, 1908, she was confined, the labor being normal and the progress of the patient satisfactory. She left her bed in about ten days and lay on the couch, but her physician directed her to return to bed for a few days longer, after which time she gradually took up her usual duties.

May 5 there was pain in the right side, for which her physician was called. May 9 she was better and doing her work. From the 5th to the 14th she was taking diuretics. May 26 the doctor was again called, and he found her legs swollen and pains in the stomach. May 27 urine was nearly solid with albumen; sp. gr. 1025. May 29 laboratory examination of urine showed sp. gr. 1012; urea 1.9 percent, albumin, indican, blood-corpuscles, hyaline and granular casts. June 1 she seemed better.

June 3, 7 a. m., the husband came to my office and asked me if I would see his wife as their physician was out of town. He said she had suffered intense pain in her head all night and nothing they had done gave any relief. I called at once and gave

her a hypodermic, and left. At 9 a. m. a phone message came asking me to come again at once, that she was dying. On my arrival a few minutes later I found her in convulsions, and during that day and the following night she had more than twenty attacks. At noon I saw her with a consultant and the latter expressed the opinion that there was no hope for her recovery. She was in profound coma, with short intervals between convulsions. During the afternoon there was no special change in her condition. At midnight the convulsions were severe but less frequent, stertorous breathing, and pulse so rapid and weak that I could hardly count it. I advised the friends that in my opinion she would live. only a few hours and that I could do nothing more for her.

The next morning (June 4) another physician was called. He gave the same opinion and left without doing anything. However, at 9 a. m. the husband called at my office, said his wife was still living, and asked if I would see her. At this visit the only change observed was that she appeared to be nearer death's door, in fact already upon the threshold. I returned home expecting soon to be notified of her death. At 1:30 p. m. the husband came once more, requesting that I see her again. She was still living, and he thought she was improved. He had been at her bedside through the hours of that day and night, part of the time alone with her, holding the stock between her teeth during those horrible convulsions, giving the chloroform and expecting to see her go out from him any moment. Arriving, I found no marked change, but renewed my efforts to save her life, and I was rewarded that supervening night in her partial return to consciousness. At 3:30 o'clock a. m., June 5, the pulse ran 135, and she now could answer questions.

From this time on there was a slight improvement each day until the afternoon of the 8th, when she complained of headache, and in the evening she had three convulsions. She was unconscious during the night, but regained consciousness in the morning. She again began to improve, though slowly, and

at times there was a great deal of tympanites. The temperature ranged from 99°F. in the morning to 102° F. in the afternoon, pulse 120 to 135.

The first week or her illness, after June 3, the urine was black and abundant, a little later it was very bright-red, nearly one-third albumin in bulk, blood-corpuscles and casts present. Up to the second week she had lost all memory of having had a babe, though she could remember some things intervening between the birth and her illness. The swelling entirely left the feet and legs, and only a little remained in the face. June 17 the left foot was badly swollen, the right one less. By the 23rd the edema had again disappeared from the feet, and altogether the patient felt more comfortable.

About a week after I first saw the patient I consulted Dr. Garber of Muskegon, and from the history and her condition as nearly as I could describe it he gave an unfavorable prognosis, which was in harmony with my opinion, for while the patient had shown improvement I did not believe it would be permanent.

June 24 her temperature was 99°F., and pulse 108. She was sleeping well, appetite was good. Her bowels now were moving three to five times each day, and she voided one to two quarts of urine per day. The night of the 28th she was nervous, did not sleep well and vomited twice. On the 29th, II a. m., temperature was 99°F., pulse 110. On the 30th, 7 p. m., temperature was 98.5°F., pulse 135. At this time I submitted the history of the case to Dr. Boise of Grand Rapids, and his opinion was that without doubt she would die. July 1, 6 a. m., pulse 140. She did not sleep any during the night. At 8:30 p. m. pulse very weak and bowels distended with gas. During the day she coughed almost incessantly and spit up a large quantity of bright-red blood. The patient was conscious, very restless, coughing and spitting blood. Her face was pale and haggard, and symptom pointing to a speedy dissolution. I am free to admit that I had not the faintest hope that she would live till morning and so advised the friends.

She had been restless for three nights and the husband was desirous that I should do something to quiet her. I replied that I could put her to sleep but that it was probable that she would not awaken. He asked me to give her rest even if she did not regain consciousness, as he could not endure another night like the previous one. I gave her a hypodermic and requested the husband to inform me if the end came before morning.

July 2, 7:30 a. m. Patient had slept well; pulse 123. I might have stated that the day I first saw the patient she was stricken with blindness before the first convulsion. In a few days her sight had returned but was not normal, while after the relapse of July 1 her vision was less clear.

During the day of July 2 she vomited a great deal, not being able to keep anything in her stomach. July 3, 9 a. m. Pulse 120. She did not sleep any during the night but rested well. Urine scanty; coughing and spitting blood; vomiting some. July 4, 9 a. m. Temperature 98°F., pulse 108. Slept well, no vomiting, no coughing of blood.

[ocr errors]

From this time the improvement was continuous though slow. For two weeks the pulse kept above 100 degrees, and the patient could not assume an upright position without dizziness and great weakness. strength gradually increased and August 1 she took her first meal with the family.

Her

[blocks in formation]
« ForrigeFortsæt »