Alcohol: A Dangerous and Unnecessary Medicine, How and Why Part 37

SIMS WOODHEAD, of London.

In an address upon the London Temperance Hospital delivered shortly before his death, Sir B. W. Richardson gave a brief review of the influences which led him to abandon the medical use of alcohol. The following is taken from that address as reported in the _Medical Pioneer_:--

"I was a member of the Vestry of St. Marylebone, and we had in our parish a very serious outbreak of small-pox, attended with a considerable mortality. In his report to us Dr. Whitmore stated that in his treatment of earlier cases of the confluent and hemorrhagic, and malignant forms of disease, stimulants of wine and brandy were freely administered without any apparent benefit; and, that after consultation with Mr. Cross, the resident surgeon, they resolved to subst.i.tute simple nutriments, such as milk, eggs and beef-tea, at frequent intervals, with discontinuance of stimulants altogether. The result of the change was most satisfactory, and many bad cases did well, which under the stimulant plan they believed would have terminated fatally. Again I was struck very much by a report made by Mr. Cadbury, in which that gentleman showed the course that was going on in various hospitals. The amount of alcohol in twelve hospitals in London, taken by the inpatients, varied in ounces from 37,531 in one establishment to 300,094 in another during the year 1878. I also found, from the same author, that the whole cost in St. George's Union Infirmary for the year 1878 was 8. 3s. 6d., amongst 2,496 patients, while the cost of the same number at the average of the twelve hospitals was 124. About this same time I also remarked that in many of the public inst.i.tutions of England there was a reduction something similar in kind, if not to the same extent, and that the number of persons who suffered seemed to make better recoveries than those who were taking the free amount of stimulant. The effect of these observations chimed in very remarkably with the physiological experiments it had been my duty to carry out, and which tended to show in a most striking manner that the action of alcohol in the body very much differed from the ordinary opinion that had been held upon it, and thereupon, in my own practice, I abandoned the use of alcohol, and began to give instead small quant.i.ties of simple, nourishing, dietic food, a course I pursued up to the present time with the most satisfactory results, results I have never felt any occasion to regret. By these steps, learned in the first place from the study of alcohol in its action on man, I was led to become a believer that alcohol is of no more service in disease than it is in health, and a lengthened experience in this matter has really confirmed the correctness of the idea."

In his last report as physician to the Temperance Hospital Dr.

Richardson made some remarkable statements upon the fallacy of the general ideas of stimulation. So interesting are his views that they are incorporated here:--

"Sir B. W. Richardson, M. D., who was unable to be present, communicated (through the secretary) his annual report as physician to the hospital. After twelve months further trial of the treatment of all kinds of disease in this inst.i.tution without the a.s.sistance of alcohol, either as a diet or a medicine, he (Sir B. W. Richardson) was fully sustained in the belief that the plan pursued had been attended with every possible advantage. About 500 cases had come under his observation and treatment as in previous years, and these cases had been of the most varied kind, including all patients who were not directly suffering from contagious disease. In not one instance had alcohol been administered, nor had anything like it been used in the way of a subst.i.tute, and there had not been a single case in which he could conceive that it was ever called for, while the success which had attended the treatment generally had been superior to anything he had ever seen following upon the administration of alcoholic stimulants. One great truth which had forced itself upon him had reference to the doctrine of stimulation generally. It had been one of the grand ideas in medicine that there came times when sick people were benefited by being stimulated. It was argued that they were low, and in order that they might be raised and brought nearer to the natural life they required something like alcohol to quicken the circulation, quicken the secretion, and help to preserve the vitality. But the experience which was learned here tended to show in the most distinct manner that that very old and apparently rational idea was fallacious. Such stimulation only tended ultimately to wear out the powers of the body, as well as change the physical conditions under which the body worked. True lowness meant practical over-fatigue, and when the body was spurred on, or stimulated, over-fatigue was simply intensified and increased. What, therefore, was wanted was not stimulation, but repose. The sufferer was placed in the best position to gain entire rest, and all the surroundings or environments were employed which tended to prevent waste. The air was kept at the proper temperature, the body of the patient kept warm, and the simplest and most easily digested foods were used; the patient's condition then swung round to a natural state, and he began to get well. In other cases where the sick were brought under observation suffering already from excitable condition of the senses, with congestions here and there of the circulatory or nervous systems, with imperfect condition of the brain, and with the elements of what was usually denominated inflammatory or febrile state--the stimulant was already present (was, indeed the cause of the symptoms) and did not want in any degree to be enforced further by the acts of treatment. Here, therefore, they were on the safest grounds as regarded methods of administration, for they calmed as well as they possibly could both mind and body and left nature to do the rest, which she did with the best and most tranquilizing effect. On both sides, therefore, in the treatment of disease, they did good, and that was the reason, he believed, why their returns were so satisfactory. It often happened in an inst.i.tution where some particular plan was carried out that the old ideas in which they had been bred were without intention refined or suppressed. For example, he had been taught, and believed for a number of years, that some medicament of a particular kind was needful for some particular train of symptoms, be the surrounding conditions what they might. There was no doubt that this same feeling had given rise to the persistent use of alcohol; but, greatly to his own surprise, he discovered that when the surroundings were all good, the rule that applied to alcohol constantly applied to other substances that were called remedies, with the result that recovery was often just as good without the particular remedies as with them, so that a revision came quite simply with regard to stimulating agents and their properties, and also with regard to every medicine that might at earlier times have been employed. He had seen many cases in this hospital recover without any other aid than that of the environments, which cases he would have said could not possibly have gone on well, or towards complete recovery, unless some special recipe had been followed. He believed the day would come when others, learning this same truth as he had been obliged to learn it, would act on such simple principles that the books of remedies would have to be vastly curtailed. It would be seen that there was such a tendency of disease to get well of itself, or by virtue of natural processes, of which people had at present but a very poor idea, that the art of physic would pa.s.s into directions how to live rather than into dogmatic a.s.sertions that particular means must be employed in addition to the common details of life for the process of cure. If therefore they learned in this hospital by their reduced death-rates the true lesson, the inst.i.tution would have performed a double duty, and become one of the test objects in medicine, and in the field of disease.

They made no attempt by selection, or by any side action, to exaggerate their results. The cases were taken indiscriminately, except that they gave admission to the worst cases first; that was to say, they never caused patients to come under their treatment if they saw they were only slightly affected, and were bound to get well."--_Medical Pioneer._

Dr. Landmann, of Boppard-on-the-Rhine, Germany, says:--

"The members of the a.s.sociation of Abstaining Physicians, reject the use of spirituous liquors in every form, and particularly declare the use of alcohol at the sick-bed a scientific error of the saddest kind. In order to war against this abuse, they earnestly appeal to the officers having charge of funds for the sick, henceforth, under no circ.u.mstances, any longer to permit the prescription of wine, whisky and brandy for sick members; but to resist to the utmost, according to the right given them by the laws insuring the sick, the taking of spirituous liquors, under the false pretext that they have a curative and strengthening effect."

Dr. Bleuler, Rheineau, Switzerland, says:--

"The treatment of chronic diseases with alcohol is contrary to our knowledge of the physiological effects of alcohol. There is no probability that its use will be beneficial, certainly its benefits have not been established. Often an injurious result is proved.

"It is not implied that there may not be some benefit in the use of alcohol in cases of sudden weakness with or without fever.

But even in such cases the benefit is not demonstrated. At any rate, other remedies can with advantage be subst.i.tuted for alcohol.

"The essential thing in the treatment of all alcoholic diseases, delirium tremens included, is total abstinence.

"The physiological effect of alcohol is that of a poison, whose use is to be limited to the utmost. Even the moderate use as now practiced is injurious.

"The customary beneficial results unquestionably depend chiefly on suggestion, and by making the patient believe falsely that the momentary subjective better feeling means actual improvement.

"Physicians share the blame of the present flood of alcoholism.

They are, therefore, morally bound to remedy the evil. Only by means of personal abstinence can this be done."

Dr. A. Frick, professor in Zurich, is a careful student and an influential writer on alcohol. His statements are weighty. This is his testimony:--

"In larger doses, alcohol is absolutely injurious in the treatment of acute fevers, especially in case of pneumonia, typhus and erysipelas. They first of all injure the general state of the patient, they cause delirium, or increase it if already existing, and, secondly, they injure most seriously the organs of digestion and interfere with proper nourishment; thus they have a weakening effect, instead of preventing weakness, which they are usually supposed to do. In case no alcohol is used, the convalescence is much more rapid. In no case has the benefit of treatment with alcohol been established. According to the view of the most eminent pharmacologists, the stimulating effect of alcohol consists simply in a local irritation of the mucous membrane of the stomach, similar to that produced by a mustard plaster."

The following selection from the excellent address of Dr. Harvey, president of the Virginia State Medical Society, at a recent meeting, is a most timely caution:--

"Our prisons, asylums and homes are filled with the victims of the careless and indiscriminate use by the medical profession of those twin demons, alcohol and opium, which, save tuberculosis, are doing more to debase and destroy the human race than all the other diseases together. I most earnestly beseech you, young men, who are just starting out in life, to stay your hand in the use of these agents in your own persons, and in your daily work, and to beware of the seductive needle, and the cup that inebriates. Make it an invariable rule, never to prescribe alcohol, nor one of the solinaceus or narcotic drugs, if you can possibly avoid it. The use of alcohol and opium debases the minds and morals of habitues, predisposes especially to Bright's disease and insanity, and lays the foundation in the offspring for the majority of the neuroses and degenerations of modern civilized life. The physical fatigue of long working hours, loss of sleep, mental strain, worry and hunger, invite the tired physician, especially, to their seductive use. To totally abstain from them is always business, and very often character, and even life itself. I feel free to speak to you on this subject very earnestly, my younger brothers, for, having prescribed alcohol for over thirty years, I am familiar with its tendencies and its dangers."

Dr. T. D. Crothers of Hartford, Conn., in an article upon "The Decline of Alcohol as a Medicine," says:--

"Thoughtful observers recognize that alcohol as a medicine is rapidly becoming a thing of the past. Ten years ago leading medical men and text-books spoke of stimulants as essentials of many diseases, and defended their use with warmth and positiveness. To-day this is changed. Medical men seldom refer to spirits as remedies, and when they do, express great conservatism and caution. The text-books show the same changes, although some dogmatic authors refuse to recognize the change of practice, and still cling to the idea of the food value of spirits.

"Druggists who supply spirits to the profession recognize a tremendous dropping off in the demand. A distiller who, ten years ago, sold many thousand gallons of choice whiskies, almost exclusively to medical men, has lost his trade altogether, and gone out of business. Wine men, too, recognize this change, and are making every effort to have wine used in the place of spirits in the sick-room. Proprietary medicine dealers are putting all sorts of compounds of wine with iron, bark, etc., on the market with the same idea. It is doubtful if any of these will be able to secure any permanent place in therapeutics.

"The fact is, alcohol is pa.s.sing out of practical therapeutics because its real action is becoming known. Facts are acc.u.mulating in the laboratory, in the autopsy room, at the bedside, and in the work of experimental psychologists, which show that alcohol is a depressant and a narcotic; that it cannot build up tissue, but always acts as a degenerative power; and that its apparent effects of raising the heart's action and quickening functional activities are misleading and erroneous.

"French and German specialists have denounced spirits both as a beverage and a medicine, and shown by actual demonstration that alcohol is a poison and a depressant, and that any therapeutic action it is a.s.sumed to have is open to question.

"All this is not the result of agitation and wild condemnation by persons who feel deeply the sad consequences of the abuse of spirits. It is simply the outcome of the gradual acc.u.mulation of facts that have been proven within the observation of every thoughtful person. The exact or approximate facts relating to alcohol can now be tested by instruments of precision. We can weigh and measure the effects, and it is not essential to theorize or speculate; we can test and prove with reasonable certainty what was before a matter of doubt.

"Medical men who doubt the value of spirits are no more considered fanatics or extremists, but as leaders along new and wider lines of research. Alcohol in medicine, except as a narcotic and anaesthetic, is rapidly falling into disfavor, and will soon be put aside and forgotten."

CHAPTER XVI.

RECENT RESEARCHES UPON ALCOHOL.

In the year 1900 Prof. Taav Laitinen, of the University of Helsingfors, Finland, published an account of experiments made upon 342 animals--dogs, rabbits, guinea pigs, fowls and pigeons--to determine the effects of alcohol upon the resistance of the body to infectious diseases. He used as infecting agents, anthrax bacilli, tubercle bacilli, and diphtheria bacilli. The doses of alcohol given varied with the animal. For his "small dose" experiments he used the quant.i.ty of alcohol given as a food or as a medicine, or both, in a neighboring sanitorium. The alcohol employed was, as a rule, a 25 per cent. solution of ethyl alcohol in water. It was given either by esophageal catheter, or by dropping it into the mouth from a pipette. It was administered in several ways, and for varying times; sometimes in single large doses, at others in gradually increasing doses for months at a time, in order to produce here an acute, and there a chronic poisoning; in fact, he produced the conditions consequent upon steady, moderate drinking.

His first conclusion from these experiments, most carefully carried out, is that alcohol, however given, induces in the animal body a markedly increased susceptibility to infectious diseases; and he maintains that his experiments indicate that the use of alcohol, at least in the treatment of anthrax, tuberculosis, and diphtheria, is not only useless but probably injurious. From a number of other experiments carried out with scrupulous care he comes to the same conclusion as Abbott, Welch, and others that the predisposing to disease of alcohol must be explained by its action in producing abnormal conditions--pathological changes in the alimentary ca.n.a.l, liver, kidneys, heart, and nervous system. He found that the alkalinity of the blood was slightly diminished, and the number of leucocytes somewhat decreased. He also draws attention to the fact that his experiments prove that pregnant animals and their offspring are markedly affected by the continued use of small doses of alcohol. He shows, too, that the temporary lowering of the body temperature by alcohol produces the most favorable condition for the invasion of disease germs.

Since the publication of these experiments, and of others similar to them, the use of alcohol in diphtheria and tuberculosis has very largely ceased. Boards of health and charity organizations unite in warning against indulgence in alcoholic drinks as conducive to tuberculosis.

At the International Congress on Alcoholism, held in London in July, 1909, Professor Laitinen delivered two lectures. The first was upon "The Influence of Alcohol on Immunity." The following is taken from this lecture:--

"Modern researches have done much to explain the extent and nature of the protective powers by which the organism endeavors to defend itself against the attacks of all kinds of injurious agencies, and especially against invasion by the germs of infective diseases. It is now a well-established fact that alcohol weakens the normal resisting power of the body against the above-named disease-producing influences. In the hope of contributing something to the explanation of the way in which alcohol weakens the organism, I have made a number of experiments bearing upon the question of the influence of alcohol on immunity.

"Early in this century careful experiments went to show that alcohol certainly had some influence upon immunity. Two Americans, Abbott and Bergey, were the first to discover that this agent produces a diminution of the haemolytic complement in the blood-serum of certain animals which were tested. They showed also that the formation of specific haemolytic receptors (immune bodies) may be r.e.t.a.r.ded by the action of alcohol.

"The extent of the evil effects upon the human body resulting from the consumption of alcoholic liquors is as yet far from being fully known, and stands in need of scientific verification. Many other injurious influences such as unsanitary dwellings, bad feeding, excessive toil, and toxic agents like nicotine, etc., may produce somewhat similar morbid effects. It is therefore necessary, in the scientific study of the question, to take these possibilities into consideration. In my investigations, the results of which I am now to lay before you, I have endeavored to select as subjects for my experiments both abstainers from alcohol, and those who indulge more or less in its use, in such a way that their conditions of life and their habits in other respects should be as nearly as possible the same. All persons, for instance, suffering from any acute or chronic disease were rejected, and very few of the persons selected were smokers. The subject of this research has been human blood, and especially its two princ.i.p.al components, namely, red blood-corpuscles and blood-serum, both of which up to the present time have been very little studied in relation to the question under discussion. I have gone into these matters chiefly because the modern theoretical study of immunity during the last few years has, in general, attracted greater attention to the blood, and shown the important role which the different parts, properties, and capacities of the blood play in defending the organism against internal and external injurious agencies.

Further, the subtle methods employed in the study of immunity (such as organic reactions, and reactions between greatly attenuated organic liquids) would also seem to be available for our purpose, as they allow of the detection of the minutest differences which alcohol may produce in any part of the organism in question.

"During the course of this research, which has lasted over a period of three years, I sought to investigate the action of alcohol on the resistive power of human red blood-corpuscles. I wished to ascertain whether the resistivity of the red blood-corpuscles in a healthy man could be lowered by the consumption of alcohol. * * *

"It may be well for me here to explain that in this lecture I mean by the term 'drinker' a person who has taken alcohol in any quant.i.ty whatever. Many of these 'drinkers,' therefore, were in fact most moderate consumers of alcohol. By the term 'abstainer'

I mean a person who has never taken alcohol in any quant.i.ty worth mentioning. In the course of my investigations I have examined blood from two hundred and twenty-three persons. They were of different cla.s.ses and ages. There were professors of medicine and other physicians, University fellows, students of both s.e.xes, hospital nurses, school-teachers, waiters, and other men and women belonging to the working-cla.s.ses."

The rest of the lecture as given here is an abstract made by Professor Laitinen:--

"My studies have been directed to an investigation of the following points:

"1. I sought to ascertain whether the resistance of human red blood-corpuscles against a heterogeneous normal serum, or an immune serum, can be diminished by the use of alcohol.

"2. I have studied the action of alcohol in drinking and abstaining persons on the haemolytic power of blood-serum over heterogeneous red blood-corpuscles (rabbits). I have studied not only the haemolytic power of the human blood-serum, but also its power of precipitation in the presence of rabbit-serum, with a view to ascertain if the reaction between a known dilution of rabbit-serum and a certain dilution of serum of alcohol-users and non-drinking persons is different or not, and if the reaction is more apparent with the former or with the latter.

"3. The resisting power of serum obtained both from alcohol-drinking and from non-drinking persons was further tested by human blood, with the object of discovering whether any difference in reaction existed between the same immune serum and the two kinds of human sera above mentioned.

"4. I have studied the problem as to whether the haemolytic complement in the blood-serum of alcohol-drinking and non-drinking persons is altered in any way by alcohol.

"5. The bactericidal power of blood-serum from both alcohol-drinking and non-drinking persons was determined by some experiments.

"The above experiments have given the following results:

"1. The normal resistance of human red blood-corpuscles appears to be somewhat diminished against a heterogeneous normal serum or an immune serum by the consumption of alcohol, provided that tolerably large equal, or nearly equal, numbers of drinkers and abstainers of both s.e.xes be examined, and the average of resistance be taken on both sides: this last-named precaution being necessary because the resistance of red blood-corpuscles from different human beings varies largely. The difference is often greater when using weaker solutions than when using stronger dilutions of lysin.