Among the diseases of infancy, Convulsions occupy the most prominent place, as the cause of death. 889 boys, and 852 girls, perished from convulsions, chiefly in the three first months of life, and between the first and fourth year. Dentition proved fatal to 154 boys, and 161 girls; Measles to 120 boys, and 202 girls; Small-pox to 85 boys, and 35 girls; Croup to 77 boys, and 75 girls. Premature and Still-births amounted to 1246, of whom 682 were males, and 564 females; and the number of deaths in the first three months, from mere original weakness, was 513, of which 215 were males, and 298 females. A very striking circumstance here doveloped, and one which has been remarked before, is the much greater frequency of phthisis among females than among males. Taking phthisis and the corresponding disease after middle age, pulmonary catarrh, we find that for 1821 male deaths, there were among females 2377, which is nearly in the proportion of two to three.-Ib. .i. 32. On the difference of mean longevity between the rich and poor. (Annales d' Hygiene Publique et de Médecine-Légale, Avril, 1830.)— In the 20th volume of this Journal, (p. 212,) a notice has been introduced among the articles of Medical Intelligence, from the researches of M. Villermé, of Paris, on the relative mortality and longevity of the rich and poor orders of society in the French capital; and from that notice, it appears that in the arrondissements of Paris inhabited chiefly by the rich, the annual mortality is from one in 43 to one in 54, while in those inhabited chiefly by the poorer ranks, the mortality is so great as one in 24 or 25. This inquiry has been since taken up by M. Benoisten de Chateauneuf, who ar. rives at the same conclusion from different data. He restricts his researches to the very highest and the very poorest ranks. For data as to the mortality of the former, he takes the various princes of Europe-the great church dignitaries, comprehending the whole cardinals, and the archbishops and bishops of Francethe peers of France and England, and the lieutenant-generals, viceadmirals, presidents of the higher courts, directors general, ministers and councillors of state in France. These, at the beginning of 1820, formed a body of 1600 persons, whose ages extended from twenty to ninety-five; namely, 53 between twenty and thirty, 157 between thirty and forty, 370 between forty and fifty, 391 between fifty and sixty, 361 between sixty and seventy, 189 between seventy and eighty, 78 between eighty and ninety, and one above ninety. The number of each of these individuals who died in each of the ten years, ending with 1829, was 57, 47, 49, 56, 61, 61, 46, 51, 50, 44, which, taken together, form one third of the whole. The mortality at different ages was as follows: Of those between the ages of thirty and sixty, about three and a quarter per cent. died annually; between sixty and eighty, eleven and two thirds per cent.; above the age of eighty, thirteen and a quarter. The other term of comparison is procured by taking 2000 of the inhabitants of the 12th arrondissement of Paris, where the workmen belong almost entirely to laborious trades, and are so poor that at least three fourths of them die in the hospitals. Among these 2000 individuals, M. Benoisten de Chateauneuf found, that of persons between the ages of thirty and sixty, seven and a quarter per cent. die annually; between the ages of sixty and eighty, twenty-one and nine tenths; and above eighty, all died within one year. The relative mortality at shorter intervals of ages, will appear from the following table, where the first line indicates the intervals of age, the second the annual per centage of deaths in the richest order of society, and the third the annual per centage in the poor ranks. 30 to 40 50 60 - 70 80 90 Rich, 1.08 1.17 1.99 3.60 8.04 13.22 It appears from an important document, printed a few months ago by the Faculty of Advocates of Edinburgh, that in that body, consisting of individuals who enter it not younger than 21, and on an average at the age of 23 or 24, the expectation of life, or the number of years which they live one with another after their admission, is 40. 2-11ths nearly. This calculation is taken from the lives of 210 individuals, the whole of whom entered before the year 1765; and since then it is well known that the average duration of life has been considerably improved. Among the 210 individuals, 118 survived their entrance (at the age of 24) 40 years or upwards. Of these 118, 29 survived between forty and forty-five years; 25 between forty-five and fifty; 25 between fifty and fifty-five; 17 between fifty-five and sixty; 13 between sixty and sixty-five; 8 between sixty-five and seventy; and one survived 72 years.—Ibid. DOMESTIC INTELLIGENCE. 1. Remarks in relation to the use of the Trocar in paracentesis ab. domines. By JABEZ W. HEUSTIS, M. D., of Alabama.-Whoever has performed the operation of paracentesis of the abdomen with the trocar in ordinary use, must be aware of the degree of difficulty attending it. The operation is simple and unimportant in itself, but when the trocar is pushed against the parietes of the abdomen, considerable force is required to make it enter. This comes partly from the abrupt bluntness of the trocar, but principally from the resistance exerted by the canula; the surrounding parts closing upon and embracing the perforator, and thus refusing admission to the instrument without the use of considerable force. Having uniformly experienced these difficulties in the use of the trocar, of which I have used those of the best construction, I have for a considerable time laid this instrument entirely aside in all cases of ascites requiring puncturing. As a substitute, I make use of the common thumb lancet; in the distended state of the abdomen this is introduced without the least difficulty, and, contrary to what happens with the trocar, causes little or no pain. For a canula, to conduct the water, I make use of a quill, cut off at both ends. A silver canula, with one end closed, and a small opening on each side, would be more elegant, but not having an instrument of this description, I have found the quill answer every purpose. The superior advantage and facility of this mode of operating need only to be tried to be fully appreciated. I claim but little merit in the plan here described; presuming that others may have previously adopted the same: being a practice that would obviously suggest itself to every one who has had any share of experience in paracentesis abdominis. 2. Case in which a nail was swallowed by a child six years old. By J. W. HEUSTIS, M. D., of Alabama.-On the ninth of November I was sent for in haste to visit a child six years of age, who, I was told, had swallowed a shingle nail. Upon my arrival I found the child apparently well, complaining of no pain or uneasiness, though I learned that his throat had been considerably scratched by the passage of the nail, which was rusty, and a little crooked at the point. I remained all night; but no unfavorable symptoms occurring, I did not think proper to exhibit any medicine with the view of producing the expulsion of the nail, concluding that the more quiet the stomach and bowels could be kept, the greater probability would there be of its passing off without producing any injury. No unpleasant symptoms took place for about a week, when very early one morning the child was suddenly seized with pain and great sickness of the stomach, and in the effort of vomiting he threw up the nail he had swallowed, which had un·lergone little or no change from its lodgment in the stomach. The danger to be apprehended, was that by getting entangled in the mucous coat of the stomach or intestines, it might have brought on dangerous and fatal inflamation. And it would appear a little singular, that so rough a substance should have remained so long in contact with the delicate lining of the stomach without giving rise to any unfavorable symp. toms, or even occasioning any painful sensation. The probability is, that in attempting to pass into the duodenum, it met with some obstruction at the pyloric extremity of the stomach, and, producing irritation, gave rise to the effort of vomiting, which caused its expulsion. Had the stomach failed in this effort, which we might consider as very possible, we may readily suppose that dangerous symptoms would have speedily ensued. 3. Cases of DELIRIUM TREMENS, with Remarks. By LEWIS BELDEN, M. D., of New-York.-The two following cases, it is hoped, may serve, in some measure, to illustrate the utility of severe exercise or labor in Delirium Tremens. Before detailing the circumstances of the cases referred to, I would take occasion to observe, that the beneficial effects of healthy exercise and appropriate labor, have long been known and duly appreciated in certain kinds of mania. In Spain, for instance, we are told that experience and observation have established the maxim, that the poor generally may be expect. ed to recover from mania, but the rich never; inasmuch as the former are habituated to labor, from necessity, and can easily be prevailed upon to continue the salutary practice, even when affected with mental derangement; but the latter, from pride and long cherished aversion to all kinds of labor, can never be induced to Suumit to what is equally regarded by them, in a sane or insane state, as utterly degrading to their conceived opinions of what per tains to wealth and rank. But, however salutary certain kinds of exercise and labor may have been considered, in many of the va rious sorts of maniacal derangement, yet in the species denominated delirium tremens, I am not aware, as far as my knowledge and observation on the subject extend, that their usefulness, as remedial agents, has ever been suggested. But if this kind of maniacal affection consist, according to the generally received opinion, in de. rangement of the nervous system, and if, in connexion with this, we consider the admitted utility of certain kinds of exercise and labor in chronic and nervous complaints, I believe it might reasonably be inferred, à priori, that they would, at times, prove salutary also in the delirium tremens. And here, perhaps, it may not be amiss to remark, that the obvious effects of labor and exercise are to coun teract the excessive mobility of the nervous and muscular systems, inducing quiet and wholesome sleep; and, indeed, by favoring the healthy exercise of all the natural functions, to impart tone and energy to all parts of the body. It is, doubtless, from this cause, that the deleterious effects of intemperate drinking, in producing the disease under consideration, are much slower in manifesting themselves in the constitutions of those who take much exercise, or perform severe labor, than in the constitutions of the sedentary and indolent. Again, from the same cause we find that the morbid influence of intemperance, in certain instances of unusually good natural constitution, is resisted, sometimes, even to advanced age. The carefully observing and discriminating practitioner will, therefore, readily perceive, from this consideration, the propriety of advising those who have unfortunately contracted intemperate habits, to avoid sloth and indolence, and pursue active and laborious employments. Exercise and labor, then, I infer, are valuable prophylactic or preventive means, in obviating, in some degree, the morbid tendency of intemperate drinking. From the developement of this principle, therefore, if from no other consideration, I conceive the subjoined cases are deserving of record. In the treat. ment of this disease, special reference should be had to the promi. nent and leading circumstances and symptoms present. In plethoric habits, in some few instances, particularly when the disease in its incipient state is attended with much excitement, venesection may be regarded as a valuable remedy; but in a great majority of cases I believe it not only of doubtful efficacy, but of dangerous tendency. Again, where biliary and hepatic derangement prevails, evacuants and alteratives, more especially emetics, have been found useful. And again, in cases of great nervous irritation, and frequently in the more advanced stage of the disease, sedatives and anodynes are specially indicated. To these, most medical practitioners yield a decided preference in almost all cases and conditions of the disorder; and it is by a judicious selection and combination of these and other remedies, according to the several indications presented, that this interesting but formidable disease is to be successfully combated.* Having premised thus much, I now proceed to a brief detail of In a certain class of cases arising from protracted abstinence, or super. vening upon certain diseases occurring in the persons of the intemperate, or in the collapse of the disorder, some physicians advise, for arresting the progress of the disease, a free exhibition of alcoholic stimulants. These cases I believe would be best treated by the free use of opium, or by opium combined with tonics and stimulants of a different class. From the great variety and pecu. liarity of cases, doubtless much of necessity must be left to the good sense and discriminating judgment of practitioners. To presume, therefore, to recom. mend a single remedy, or a single unvarying mode of treatment, to the neglect or exclusion of all others, savors too much of empyricism; and from the va. riant nature of cases occurring, cannot therefore be deemed entirely consonant to reason and the most successful practice. But in the choice of remedies, other things being equal, a preference for obvious reasons should doubtless be given to those least obnoxious to abuse. |