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HEGEMAN'S

GENUINE COD-LIVER OIL.

Our Cod Liver Oil is warranted pure Newfoundland Oil. It has stood the test of twenty years experience, and can be relied on in every particular. Its superiority over that prepared on our own seashore is shown by the numerous cures performed by it when the inferior oils have been tried without effect. We make no claim to any secret mode of concentration or cold pressing, but warrant t pure Ol. Morrhua of the U. S. P.

The uniform good quality of our Oil has given it the pre.erence over the numerous brands in the market, and has elicited the highest commendation from eminent physicians.

The Most Perfect Iron Tonic.

BEGEMAN'S FERRATED ELIXIR OF BARK, OR ELIXIR OF CALISAYA BARK WITH PYROPHOSPHATE OF IRON.

The FERRATED ELIXIR OF BARK is a pleasant cordial, possessing the valuable properties of CALISAYA BARK deprived of its tannin and coloring matter, and contains eight grains of the PYROPHOSPHATE OF IRON in each fluid-ounce; and in all cases where a mild and efficacious Iron Tonic is desired, will be found a most valuable preparation. As a preventive to fever and ague, and as a tonic for patients recovering from fever or other sickness, it cannot be surpassed.

Directions. For an adult, a dessert spoonful to a table spoonful may be taken three times a day, before meals. Children in proportion to their age.

Hegeman's Cordial Elixir of Calisaya Bark

(Peruvian Bark).

The CALISAYA (or "King's Bark") is the most valuable of the numerous varieties of the Peruvian Bark, and in the Elixir is combined with other ingredients that increase its efficacy, and at the same time overcome the intensity of its bitterness, rendering it a most agreeable cordial.

For persons living in Fever and Ague Districts, it will be found invaluable as a preventivehalf a wine-glass taken night and morning rendering the system much less subject to the unhealthy influence of the atmosphere.

The above preparations are sold by Druggists throughout the United States.
Samples will be furnished on application to

HEGEMAN

&

со.,

Chemists and Druggists, New York. 2003

17

PRACTICAL MEDICINE,

&c., &c.

DISEASES AFFECTING THE SYSTEM GENERALLY.

1. ON THE LIMITS OF ALCOHOLIC STIMULATION IN ACUTE DISEASE.

By DR. W. T. GAIRDNER, Professor of Practice of Medicine in the University of Glasgow. [Dr. Gairdner considers that the assumption has been made unduly, without proof, to the effect that alcohol not only is a food in the ordinary sense of the term, but that it is the only food that can be relied on to support the system in many states of disease.]

The root of error, as I believe the opinion mainly responsible for the extreme lengths to which Dr. Todd and others have carried alcoholic stimulation-is to be found in the undue assumption that alcohol is not only a real food (which, hypothetically, I at least do not deny), but that it is the food, of all others, which is to be chiefly relied upon for supplying the material of repair in fevers; thus compensating the waste, and averting the functional exhaustion, characteristic of most acute diseases.

This doctrine I firmly believe to be erroneous; and if erroneous, it must not, in the great interests of humanity, be allowed indefinitely to shelter itself under the authority of great names, or to take refuge in the theoretical confusion which may be raised around it, in the present unsettled state of the physiological question. I shall venture, therefore, here to state the opposite doctrine in as precise terms as the nature of the case admits, viz. : that alcohol, per se (that is, apart from the other ingredients present in some stimulating liquors), is not in any sense a fitting material to be chiefly relied on for the repair of the textures in fever; that even admitting the doubtful hypothesis that alcohol may under certain circumstances act as a true reparative material, its practical utility in this direction is very strictly and even narrowly circumscribed by the stimulating or medicinal, narcotic, and ultimately poisonous, action which it always exerts upon the nervous system when given in sufficiently high doses; that in ordinary medical practice we cannot, as a rule, secure any considerable amount of the supposed feeding action of alcohol without a certain amount of this medicinal and poisonous action; and that the proper use of the stronger alcoholic liquors in acute disease is, therefore, therapeutic, and not properly dietetic.

Now, in order to bring the issue in the matter before us into the clearest possible shape, I shall maintain, as a doctrine based upon experience, that "alcoholic food," so called, is not only a bad and defective form of nourishment in most cases of fever, but (when used in quantity and continuously) a very positively injurious and disastrous one, inasmuch as it tends invariably, in the high doses prescribed by Dr. Todd and others, to destroy the susceptibility of the system for other and more natural food, to disturb the power of assimilation, to retard the elimination of effete matters from the blood, and by poisoning the nervous system, to render the patient more or less insensible to the natural wants of the exhausted body.

The whole drift of the argument of Dr. Todd's book is, that without such doses of alcohol as he describes it is impossible to pass safely through a fever of considerable intensity. Hence the alcohol (as he remarks elsewhere) must on no account be stopped, even though its use should appear to lead to flushing, or to increased delirium, or to coma; for it is more likely that the dose is too small than too large, and in any case, he remarks, "it is much better to err on the side of over-stimulation than not to give enough” (p. 130). Hence, also, the repeated cautions "against the morbid fear of over-stimulation, which leads many to adopt an opposite or vacillating course, and to allow their patients to die from exhaustion." I must tell you, in limine,” he writes, "that it is far more dangerous to diminish or withdraw alcohol than to give too much" (p. 484). Again-"I cannot too strongly impress upon you that, to do good with stimulants, you must use them early, with care and watchfulness, in very definite quantities, and not in a vacillating or timid manner. The harm which they do (in disease) is grossly and unfairly exaggerated, and always due to the slovenly administration of them" (p. 270).

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These statements are certainly entitled to the credit of being the fruit of a very strong and undoubting conviction. But are they well founded in fact? Is the large use of the stronger alcoholic liquors in acute disease so necessary? Are the dangers of their injudicious use to be found always, and alone, on the side of under-stimulation?

To both these inquiries I am led by experience to give a negative answer; and as, even apart from all theory, the statement of the facts is important, I shall ask your permission to place some of them before you in an extremely condensed form, referring to previous communications for the details of evidence.

As regards epidemic fever in the first place, I believe I have unassailably demonstrated that its treatment may be successfully conducted with allowances, even in the very worst causes, of stimulants far less in quantity, and far less continuously given, than those on which Dr. Todd was accustomed to insist from day to day (as above shown), in the face of quite apparent symptoms of alcoholic coma, under the mistaken idea that life could not be preserved without going to the very verge of "over-stimulation." In a rather minutely detailed narrative of two months' experience in the Glasgow Fever Hospital, I have accurately recorded 68 cases of febrile disease (chiefly typhus fever) in males and 58 cases in females, in the precise order in which they occurred, omitting no single case (even when sent to the hospital actually moribund) that crossed the threshold of the ward; and yet I have calculated that the whole of the 68 male cases consumed only 328 ounces of wine and 401 ounces of whiskey, being, in all probability, a less quantity of alcohol than was administered to the one young girl Copstock, whose case is mentioned above. The mortality of these 68 cases was only 6-i.e., less than one in eleven, one of the deaths being in a case of pneumonia, one in enteric fever, the rest in typhus. The number of these cases is of course quite too small for a statistical analysis of any value, and it is not my intention to insist upon this at present, further than to say that all the available evidence goes to show that the mortality was, as compared with almost any similarly and equally exactly observed series of cases, remarkably small, and that Dr. Todd's results, so far as they are known, were in fact very inferior to mine in respect of numerical success.

It must be stated that in 49 out of the 68 males, and 34 out of the 58 females, there were absolutely no stimulants administered; and in many of the remaining instances the quantities given were so small as to be purely experimental, but at the same time such as to show that I did not, from any preconceived theory, or to carry out a dogma, willingly omit any reasonable opportunity of observing if stimulation appeared to do good. The details of the fatal cases leave it, of course, open to be argued that some of them might possibly have been saved by a larger administration of stimulants; but, on the other hand, I was quite satisfied at the time, and am equally satisfied. now, that if on this side there was a possible error, there was also, to a

certain amount, an unnecessary, perhaps even injurious, administration of them to some of the patients who recovered. To those who recoil distrustfully from numerical arguments, I would recommend the study of these cases in detail. I believe that such a study of them will lead to the conviction that, under a habitual practice of high stimulation, the general result could scarcely have been better on the whole, while there is a good deal of reason to suppose that it might have been very much worse. Yet I should be sorry if any one drew the inference that I consider these cases as examples of a perfected or model treatment in all respects, or even that I look upon them as entirely conclusive with regard to the exact quantities of alcohol that may be most beneficially administered in fever. The only conclusion I wish to draw from them is, that the habitual, or continuous, or alimentary use of alcohol in fever is to be deprecated as at least unnecessary, and even to be suspected as possibly injurious.

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On commencing hospital practice in Glasgow in the end of 1862, I found another great epidemic of fever already in progress. Four physicians were very soon at work in the fever wards; and I became aware, through various suggestive hints, that the ratio of stimulation I had insensibly adopted, after so many years of varied experience, was considered unusual, and even doubtfully orthodox, by some of the most respected of my senior colleagues. On one occasion it was pointed out to me, from the wine and spirit rolls of the house, that in the other wards of the fever hospital, at a particular date, fully six times as much wine and whisky were administered per patient as in mine; or rather, to state the matter more exactly, the wards might be considered as equally divided between two physicians who adopted a system of pretty high stimulation, and two others who followed a practice of very great moderation in this respect. Under these circumstances it became a simple duty to inquire into results, and to secure, in so far as it could be done without invidious personal reflections, that the lessons of experience should be made as plain as the nature of the facts permitted. I accordingly gave the necessary instructions to my assistants, and I had the satisfaction of having them followed out with the most minute accuracy and faithfulness in detail. The result was a triple series of cases, amounting to 595 in all, which were analysed and commented on in the Lancet, March 12, 1864.

It is difficult to state here in a condensed form what I believe to be the just conclusions from this experiment, without laying them open to some more or less plausible objections; but the following facts are, I believe, unquestionable, and will serve to give an idea of the inferences fairly deducible from the whole.

In the year 1861 (commencement of the epidemic), before I had left Edinburgh, the recorded mortality of typhus over the whole of the Fever wards of the Glasgow Royal Infirmary was 18.86 per cent. In the year 1862 it was 16.72 per cent. In both these years the ratio of stimulation practised was rather high especially as regards the amount of wine; the proportion, however, cannot be exactly ascertained for the typhus cases separately, owing to the deficiency of data. In December, 1862, I became a physician of the Glasgow Royal Infirmary, but of course the statistics of that year can scarcely include any cases of mine treated to a termination.

In the years 1863 and 1864 the experiment above alluded to took place, and the number of cases biased towards a lower scale of stimulation amounted, I believe, to about one-half of those under treatment. The mortality of ty phus fever as officially rendered in the books for the whole hospital, was :

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In the succeeding years (under yet a different arrangement) the mortality was as follows:

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It has to be added that during the years 1863 and 1864, the mortality at

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