REASONS WHY ALCOHOL IS DANGEROUS AS MEDICINE.
In the chapter upon "The Effects of Alcohol upon the Human Body" are
cited some of the reasons assigned by scientific investigators for their
disuse of alcohol as a remedy in disease. In this chapter the same may
be briefly hinted at, while others, some the results of quite recent
research, will be added.
In the _Bulletin of the A. M. T. A._, for January 1898, Dr. N. S. Davis
says:--
"The supposed effects of alcohol as a medicine were originally
based solely on the sensations and actions of the patients
taking it. The first appreciable effect of the alcohol after
entering the blood is that of an anaesthetic; that is, it
diminishes the sensibility of the brain and nerve structures, in
the same direction as ether and chloroform. And, as the brain is
the material seat of man's consciousness, the alcohol renders
him less conscious of cold or heat, of weariness or pain, and
less conscious of his own weight or of any external resistance.
Consequently, when under the influence of small doses, he feels
lighter and less conscious of any external impressions, and
thinks he could do more than without it. It was these effects
that led both the patient and his physician to regard the
alcohol as a general stimulant or tonic, notwithstanding the
fact that by simply increasing the doses of alcohol the
sensibility soon became entirely suspended, and the patient
helpless and altogether unconscious. * * * * *
"Simple increased frequency of the heart action is no evidence
of either increased force or efficiency in promoting the
circulation of the blood. Indeed, it may be stated as a
physiological law, that the more frequent the heart action above
the normal standard, the less efficiently does it promote the
circulation and strength of the living system. But the effect of
a moderate dose of alcohol in increasing the frequency of the
heart-beat and of blood pressure is so temporary that the doses
must be repeated so often that the alcohol accumulates in the
blood and tissues, and extends its paralyzing effects to all the
vasomotor, cardiac and respiratory nerves. Indeed, all the
investigators agree that alcohol in any dose capable of
producing an appreciable effect, diminishes the function of the
lungs in direct proportion to the quantity taken; and as the
lungs are the only channel through which free oxygen reaches the
blood, and such oxygen is the natural exciter of all vital
activities in the living body, it is not possible to explain how
alcohol, or any other drug that diminishes the function of the
lungs can, at the same time, act as a cardiac, or any other kind
of tonic.
"The truth is that all intelligent physicians and writers on
therapeutics of the present day agree in stating that alcohol in
large doses directly diminishes all the vital processes in the
living body, and in still larger doses suspends the life of the
individual by paralyzing the cerebral, vasomotor, respiratory
and cardiac functions, generally in the order named. If large
doses produce such effects, we must logically claim that small
doses act in the same direction, but in less degree. In other
words, alcohol is as truly and exclusively an anaesthetic as is
ether or chloroform, and, like them, is to be used as a medicine
only temporarily to relieve pain, or suspend nerve sensibility.
But as for these purposes it is less efficient than either ether
or chloroform, and other narcotics, there is no necessity for
using it as a remedy in the treatment of disease. And in health
its use in any dose can be productive of nothing but injury. The
only legitimate fields for the uses of alcohol are in chemistry,
pharmacy and the arts."
In another issue of the same magazine, Dr. Davis writes of the
investigations pursued by M. Robin of France in regard to the chemistry
of respiration. These investigations, he says, afford conclusive proof
that the acts of oxidation are defensive processes of the organism in
its struggle with bacteria, and therefore that the physician should
favor in every possible way the absorption of oxygen in every infection,
especially when there are typhoid complications.
He then speaks of the researches of other scientists in the same line,
concluding thus:--
"If we add to the foregoing investigations the results obtained
by Dr. A. C. Abbott, demonstrating that the presence of alcohol
directly diminished the vital resistance to infections, we
cannot fail to see that the administration of alcohol in
diphtheria, typhoid fever, pneumonia and other infectious
diseases, is directly contraindicated. If, as shown by M. Robin,
'the acts of oxidation are defensive processes' against
bacterial infections, then certainly the administration of
alcohol to patients with such infections is in the highest
degree illogical and injurious. The oxygen being obtained for
oxidation purposes in the blood and tissues, through the
respiratory process, it would be equally absurd to administer
alcohol in all cases in which it is desirable to increase the
processes of oxidation, as a long series of experiments has
shown that the presence of alcohol diminishes the efficiency of
the respiratory process in direct proportion to the quantity
used.
"How much longer will practical writers continue to recommend
for the same patient on the same day, fresh air, sponge baths,
and vasomotor and respiratory tonics to increase the absorption
of oxygen and oxidation processes, and alcohol in the form of
wine, whisky and brandy to directly diminish the respiratory
function and all the oxidations of the living system?"
In his address before the Medical Congress for the Study of Alcohol,
held at Prohibition Park, Staten Island, July 15, 1891, Dr. Davis
said:--
"If the foregoing views regarding the effects of alcoholic
liquids on the human system in health, are correct, what can we
say concerning their value as remedies for the treatment of
disease? If it be true that the alcohol they contain acts
directly upon the corpuscular elements of the blood, and so far
diminishes the metabolic processes of nutrition and
disintegration as to lessen nerve sensibility and heat
production, and favor tissue degenerations, their rational
application in the treatment of any form of disease must be very
limited. And yet the same errors and delusions concerning their
use in the treatment of diseases and accidents are entertained
and daily acted upon by a large majority of medical men as are
entertained by the non-professional part of the public.
Throughout the greater part of our medical literature they are
represented as stimulating and restorative, capable of
increasing the force and efficiency of the circulation, and of
conserving the normal living tissues by diminishing their waste;
and hence they are the first to be resorted to in all cases of
sudden exhaustion, faintness or shock; the last to be given to
the dying; and the most constant remedies through the most
important and protracted acute general diseases. Indeed, it is
this position and practice of the profession that constitutes,
at the present time, the strongest influence in support of all
the popular though erroneous and destructive drinking customs of
the people.
"The same anaesthetic properties of the alcohol that render the
laboring man less _conscious_ of the cold or heat or weariness,
also render the sick man less conscious of suffering, either
mental or physical, and thereby deceive both him and his
physician by the appearance, temporarily, of more comfort. But
if administered during the progress of fevers or acute general
disease, while it thus quiets the patient's restlessness and
lessens his consciousness of suffering, it also directly
diminishes the vasomotor and excito-motor nerve forces with
slight reduction of temperature, and steadily diminishes both
the tissue metabolism and the excretory products, thereby
favoring the retention in the system of both the specific causes
of disease and the natural excretory materials which should have
been eliminated through the skin, lungs, kidneys and other
glandular organs. Although the immediate effect of the remedy is
thus to give the patient an appearance of more comfort, the
continued dulling or anaesthetic effect on the nervous centres,
the diminished oxygenation of the blood, and the continued
retention of morbitic and excretory products, all serve to
protract the disease, increase molecular degeneration, and add
to the number of fatal results.
"I am well aware that the foregoing views, founded on the
results of numerous and varied experimental researches and
well-known physiological laws, and corroborated by a wide
clinical experience, are in direct conflict with the very
generally accepted doctrine that alcohol is a cardiac tonic,
capable of increasing the force and efficiency of the
circulation, and therefore of great value in the treatment of
the lower grades of general fevers. But there have been many
generally accepted doctrines in the history of medicine that
have been proved fallacious. And the more recent experiments of
Professors Martin, Sidney Ringer, and Sainsbury, Reichert, H. C.
Wood and others, have clearly demonstrated that the presence of
alcohol in the blood as certainly diminishes the sensibility of
the vasomotor and cardiac nerves in proportion to its quantity
until the heart stops, paralyzed, as that two and two make
four.
"After an ample clinical field of observation in both hospital
and private practice for more than fifty years, and a continuous
study of our medical literature, I am prepared to maintain the
position that the ratio of mortality from all the acute general
diseases has increased in direct proportion to the quantity of
alcoholic remedies administered during their treatment. How can
we reasonably expect any other result from the use of an agent
that so directly and uniformly diminishes the cerebral
respiratory, cardiac and metabolic functions of the living human
body?"
The _Medical Pioneer_ of January, 1896, contained a very interesting
article by Dr. J. H. Kellogg upon "The Influence of Alcohol upon Urinary
Toxicity, and its Relation to the Medical Use of Alcohol." He gives the
results of many of his own experiments to determine the effects of
alcohol in hindering the elimination of poisonous matter by the kidneys.
The subject of one experiment was a healthy man of 30 years, weighing 66
kilos. For fifty days prior to the experiment he had taken a carefully
regulated diet, and the urotoxic coefficient had remained very nearly
uniform. The urine carefully collected for the first eight hours after
the administration of 8 ounces of brandy diluted with water, showed an
enormous diminution in the urotoxic coefficient, which was, in fact,
scarcely more than half the normal coefficient for the individual in
question. The urine collected for the second period of eight hours
showed an increase of toxicity, and that for the third period of eight
hours showed still further increase of toxicity, the coefficient having
nearly returned to its normal standard.
Of this Dr. Kellogg says:--
"The bearing of this experiment upon the use of alcohol in
pneumonia, typhoid fever, erysipelas, cholera and other
infectious diseases, will be clearly seen. In all the maladies
named, and in nearly all other infectious diseases, which
include the greater number of acute maladies, the symptoms which
give the patient the greatest inconvenience, and those which
have a fatal termination, when such is the result, are directly
attributable to the influence of the toxic substances generated
within the system of the patient as the result of the specific
microbes to which the disease owes its origin. The activity of
the liver in destroying these poisons, and of the kidneys in
eliminating them, are the physiologic processes which stand
between the patient and death. In a very grave case of
infectious disease, without this destructive and eliminative
activity the accumulation of poison within the system would
quickly reach a fatal point. The symptoms of the patient vary
for better or worse in relation to the augmentation or
diminution of the quantity of toxic substances within the body.
"In view of these facts, is it not a pertinent question to ask
how alcohol can be of service in the treatment of such disorders
as pneumonia, typhoid fever, cholera, erysipelas and other
infections, since it acts in such a decided and powerful manner
in diminishing urinary toxicity--in other words, in lessening
the ability of the kidney to eliminate toxic substances? In
infectious diseases of every sort, the body is struggling under
the influence of toxic agents, the result of the action of
microbes. Alcohol is another toxic agent of precisely the same
origin. Like other toxins resulting from like processes of
bacterial growth, its influence upon the human organism is
unfriendly; it disturbs the vital processes; it disturbs every
vital function, and, as we have shown, in a most marked degree
diminishes the efficiency of the kidneys in the removal of the
toxins which constitute the most active factor in the diseases
named, and in others of analogous character. If a patient is
struggling under the influence of the pneumococcus, Eberth's
bacillus, Koch's cholera microbe or the pus-producing germs
which give rise to erysipelatous inflammation, his kidneys
laboring to undo, so far as possible, the mischief done by the
invading parasites, by eliminating the poisons formed by them,
what good could possibly be accomplished by the administration
of a drug, one of the characteristic effects of which is to
diminish renal activity, thereby diminishing also the quantity
of poisons eliminated through this channel? Is not such a course
in the highest degree calculated to add fuel to the flame? Is it
not placing obstacles in the way of the vital forces which are
already hampered in their work by the powerfully toxic agents to
the influence of which they are subjected?
"In his address before the American Medical Association at
Milwaukee, Dr. Ernest Hart, editor of the _British Medical
Journal_, very aptly suggested in relation to the treatment of
cholera, the inutility of alcohol, basing his suggestion upon
the fact that in a case of cholera, the system of the patient is
combating the specific poison which is the product of the
microbe of this disease, and hence is not likely to be aided by
the introduction of a poison produced by another microbe;
namely, alcohol. This logic seems very sound, and the facts in
relation to the influence of alcohol upon urinary toxicity or
renal activity, which are elucidated by our experiment, fully
sustain this observation of Mr. Hart.
"In a recent number of the _British Medical Journal_, Dr. Lauder
Brunton, the eminent English physiologist and neurologist, in
mentioning the fact that death from chloroform anaesthesia rarely
occurs in India, but is not infrequent in England, attributed
the fact to the meat-eating habits of the English people, the
natives of India being almost strictly vegetarian in diet,
partly from force of circumstances doubtless, but largely also,
no doubt, as the result of their religious belief, the larger
proportion of the population being more or less strict adherents
to the doctrines of Buddha, which strictly prohibit the use of
flesh foods.
"The theory advanced by Dr. Lauder Brunton in relation to death
from chloroform poisoning, is that the patient does not die
directly from the influence of chloroform upon the nerve
centres, but that death is due to the influence of chloroform
upon the kidneys, whereby the elimination of the ptomaines and
leucomaines naturally produced within the body, ceases, their
destruction by the liver also ceasing, so that the system is
suddenly overwhelmed by a great quantity of poison, and succumbs
to its influence, its power of resistance being lessened by the
inhalation of the chloroform.
"The affinity between alcohol and chloroform is very great. Both
are anaesthetics. Both chloroform and alcohol are simply
different compounds of the same radical, and the results of our
experiment certainly suggest the same thought as that expressed
by Dr. Brunton. How absurd, then, is the administration of
alcohol in conditions in which the highest degree of kidney
activity is required for the elimination of toxic agents!
"In a certain proportion of chronic cases there is a tendency to
tissue degeneration. Modern investigations have given good
ground for the belief that these degenerations are the result of
the influence of ptomaines, leucomaines and other poisons
produced within the body, upon the tissues. It is well known
that many of these toxic agents, even in very small quantity
give rise to degenerations of the kidney. It is this fact which
explains the occurrence of nephritis in connection with
diphtheria, scarlet fever and other infectious maladies. Dana
has called attention to the probable role played by ptomaines
produced in the alimentary canal in the development of organic
disease of the central nervous system.
"It is thus apparent that the integrity of the renal functions
is a matter of as great importance in chronic as in acute
disease, hence any agent which diminishes the efficiency of
these organs in ridding the system of poisons, either those
normally and regularly produced, or those of an accidental or
unusual character, must be pernicious and dangerous in use."
Among the more recent findings of science in regard to the effects of
alcohol are the action of this drug upon the leucocytes or "guardian
cells" of the body. Leucocytes are defined to be "minute, nucleated,
colorless masses of protoplasm, capable of ameboid movements, found
swimming freely in blood and lymph, in the reticulum of lymphatic
glands, and in bone-marrow and other connective tissue." The white
corpuscles of the blood are leucocytes. "The work of these cells is to
prey upon and take into their substance bacteria and other
micro-organisms within the blood and tissues. This destruction of
bacteria, and other noxious organisms, has the biological name of
phagocytosis."
Dr. Alonzo Brown in _Physician and Surgeon_ says of phagocytosis:--
"Recently a brilliant theory has been projected into the
histological world. It is the principle of phagocytosis. The
beauty of it is so great that we are attracted by it, and its
reasonings have riveted general attention. It is said that
certain cells have the power to absorb and so destroy other
cells. This is phagocytosis. It is said that 'the cells which
are known to possess phagocytocic properties are the leucocytes,
mucous corpuscles, connective tissue cells, endothelia of blood
vessels and lymphatic vessels, alveolar eypithelium of the
lungs, and the cells of the spleen, bone, marrow and lymphatic
glands.' (Senn). This is a very significant array of colloid
matter; and it has been repeatedly affirmed by the highest
authorities that alcohol is poisonous to the colloid element.
"Now, among the most important of the phagocytes just enumerated
are the leucocytes. They embrace and enfold the pathogenic germs
with which they come in contact by what is known as an ameboid
force. They enclose, disintegrate and absorb the enemy. It is
well known that the moment the leucocytes are submitted to an
alcoholic solution, their ameboid movements cease, and their
function is arrested. It is plain that their phagocytocic power
is immediately destroyed. It is possible, also, that the fixed
tissue-cells are likewise impaired or killed by alcoholic
imbibition. How deleterious, and even deadly, must the internal
administration of alcoholic liquors then be in the treatment of
diphtheria, and of other diseases having a germinal origin? It
therefore follows, to my mind, that all the diseases which are
the result of germinal infection, are most badly treated when
alcohol is used in their therapy.
"With extreme brevity I advert to another view in the field. It
is that of adynamic disease. It has been conclusively proven
that alcohol decreases the muscular power. It decreases (from
the minimum dose to the maximum) the power of the heart as well
as that of all other muscles. I say this has been absolutely
demonstrated by Richardson and others. In death from adynamia it
is through failure of muscle, that is, of the heart, of the
scaleni and intercostals, of the diaphragm, and of the laryngeal
muscles, et cetera. All of the muscles may gradually fail,
become wearied unto death. How pernicious then must alcohol be
in adding its influence to bring about the tragic end!
"It is my belief that it is in diphtheria that the most dire
results are to be observed. In that disease the vast majority of
cases die by asthenia, or else by sudden failure of the heart.
To what is this sudden cardiac paralysis due? The elucidation is
as follows. In the grave cases there is almost invariably a
subnormal temperature, together with great muscular
prostration. Also it is a physiological fact that a decrease of
the temperature slows nervous conduction. As the system is made
colder, the nervous force flows slower and slower. In diphtheria
the heart muscle is very weak, the temperature falls, the
lessened nervous energy but feebly animates the muscular fibres,
and so actual paralysis ensues, death closing the scene almost
instantaneously. Now, in such a state of imminent danger,
brought about by such causes, what could be worse than to
administer an agent which notably reduces temperature, and at
the same time enfeebles muscular power? May I add, what could be
the remedy in such a condition? and I answer, _External heat
freely applied to the whole surface of the body_. This will
prevent the cardiac paralysis whenever it is preventable."
The _Medical Pioneer_ of Dec., 1892, contained an editorial article upon
"The Toxine Alcohol," which deals with leucocytes and their functions.
The following is the article:--
"Dr. Broadbent's introductory address at the opening of the
session at Owen's College, Manchester, deserves more attention
than most of these formal deliveries. He dwelt on the
intellectual interest which attaches to the study of medical
science, and illustrated it, among other ways, by the interest
excited by recent observations on the action of bacilli and the
combat which goes on between these invading hosts and the
guardian cells or leucocytes of the living body. Inflammation
surrounding a wound is regarded as caused by the influx and
multiplication of leucocytes to engulf and destroy septic
bacilli which have gained entrance from the air, a 'local war'
of defence. The issue of this pitched battle will depend on the
relative number and activity of the respective hosts.
Inflammation round a poisoned wound is an evidence of vital
power and a means of protecting the system at large from
invasion and devastation. If this first line of defence is
broken through, the bacilli pass through the lymphatic spaces
and ducts to the glands, and another battle ensues which
produces glandular swelling and inflammation and possibly
abscess. This second line of defence may be insufficient and
then we get general septicaemia. It is now well proven that the
injury is done, not by the bacilli themselves but by the toxines
which they secrete or excrete. Dr. Broadbent very properly
points out that the action of the bacilli of fever in the body
is strictly comparable to the action of yeast in a fermentable
liquid. The yeast cells grow and multiply at the expense of the
sugar, in destroying which they produce alcohol, carbonic
dioxide and other substances. When the alcohol amounts to some
17 per cent. of the liquid the process is stopped by the
poisonous action of the alcohol on the yeast cells. In just the
same way the toxines produced by the bacilli at length stop
their further multiplication and put an end to the disease.
Alcohol is in fact, the toxine produced by yeast, and, like many
other toxines, it is not only poisonous to cells which produce
it, but to any animal into whose veins it may happen to get.
"There can be little doubt that the state of immunity which one
attack of certain fevers confers against future attacks depends
partly upon what is called the phagocytic action of leucocytes.
These have been actually observed to draw into their interior
and destroy bacilli which would otherwise have multiplied and
produced their special effects. There can be little doubt,
either, that we are continually taking into our systems bacilli
of all sorts, and that, again, disease is averted by the
activity of the germ-devouring leucocytes. Dr. Broadbent
describes an experiment which proves that power of resisting
disease is largely dependent on the activity of these cells. A
rabbit, having had a certain quantity of bacilli injected under
its skin, suffers from inflammation at the spot, and perhaps
abscess, but recovers. At the same time, another rabbit is
treated in precisely the same way, but, simultaneously, a dose
of chloral is injected into another part of the body. The
chloral, circulating in the blood, is known to paralyze
leucocytes, and, as a result of this, they do not collect and
wage war on the bacilli injected under the skin; there is very
little local reaction, the bacilli get free course into the
lymph and blood, and the animal dies. But, in the words of Dr.
Broadbent, 'alcohol in excess has a similar action on the
leucocytes, and this, as well as the deteriorating influence of
chronic alcoholism on the tissues, predisposes to septic
infection. A single debauch, therefore, may open the door to
fever or erysipelas.' A similar experiment of Doyen confirms
this. He found that guinea pigs can be killed by the cholera
microbe, when introduced by the mouth, if a dose of alcohol has
been previously administered. It has been the general testimony
of observers in cholera epidemics that those addicted to much
alcohol are far more liable to fatal attacks. But while large
doses of alcohol are, of course, more obviously injurious, it
would be absurd to imagine that lesser quantities are entirely
without influence in the same direction. It has, indeed, been
shown by Dr. Ridge, that even infinitesimal quantities of
alcohol, such as one part in 5,000, cause a more rapid
multiplication of the _bacillus subtilis_ and other bacilli of
decomposition, while, by the same quantities, the growth of both
animal and vegetable protoplasm is retarded. Hence there can be
no longer any question that alcohol renders the body more liable
to conquest by invading microbes, less able to resist and
destroy them. Alcohol, a toxine injurious to living cells, is
destroyed or removed from the body as fast as nature can effect
it, but while it remains, and while able to affect the cells at
all, its action is detrimental to healthy growth and healthy
life, and the less we take of such an agent the better for us.
This is a dictum which it becomes the profession to enunciate
far and wide. 'The less, the better' is a watchword which all
may use, and the wise will interpret it in a way which will
infallibly preserve them altogether from all possible danger
from such a source."
On the sixteenth of December, 1897, Dr. Sims Woodhead, president of the
British Medical Temperance Association, gave a masterly address in
London upon "Recent Researches on the Action of Alcohol." The lecture
was illustrated by lantern slides. From the report given in _The Medical
Temperance Review_ of Jan., 1898, the following is culled:--
"In a series of drawings of kidney you will notice first that
there is a condition known as cloudy swelling; this is one of
the first changes that can be observed. Notice the
characteristic features of this cloudy swelling in the cells of
all these specimens. The large swollen cells are granular, and
very frequently there is a granular mass in the lumen of the
tubule. In some cases the cells are so much swollen that the
lumen of the tubule is represented merely by a 'star-shaped'
radiating chink. The nucleus is usually somewhat obscured, that
this alcoholic cloudy swelling (similar to that met with as the
result of the administration of certain poisons) is the first
change observed in the parenchymatous cells of the organs of
animals that have died of acute alcoholic poisoning. This
condition, unless the cause is removed, goes on to a condition
of fatty-degeneration, as shown in the next specimen in which we
have, in addition to the granular appearance of the protoplasm
of the cell, a deposition of masses of fat in and at the expense
of this protoplasm.
"There is another series of changes to which I wish to draw your
attention. In the tubules of the kidney we have, in addition to
the granular appearance of the protoplasm of the cells, an
increase in the number of leucocytes, and connective tissue
cells between the tubules around the glomeruli and along the
course of the blood-vessels. This condition of small cell
infiltration, we know, is constantly associated with
inflammatory conditions of the kidney as in other organs. Here
then are the changes in the epithelium plus increase in the
number of leucocytes.
"I show you too a specimen of heart muscle, in which the
granular degeneration, or cloudy swelling is well marked whilst
here and there the process is going on to fatty degeneration,
similar to that seen in the kidney. Here again, then, the active
elements of the organ are becoming broken down, or, at any rate,
losing their normal structure and affording evidence of
fundamental changes in these cells. Such changes are set up, not
by any one poison alone, or by any single disease toxin, but by
members of many groups of poisons, by alcohols, ethers, etc.
indeed by very various poisons--animal, vegetable and mineral.
"Now, it is a peculiar fact, as shown by Massart, Bordet and
others, in researches on chemiotaxis, that nearly all these
poisons have the power of repelling leucocytes, and of seriously
interfering with them in the performance of their functions, and
this power assumes a special significance in connection with our
subject this afternoon.
"Now, two of the great functions of leucocytes under ordinary
conditions are those of policing and scavenging. Massart and
Bordet showed, under the action of certain substances, alcohol
amongst others, these functions are lost, but following up
Metchnikoff and others they observed that after a time these
same leucocytes became accustomed to the presence of these
poisons, gradually becoming 'acclimatized' as it were. At first
paralyzed or repelled, they after a time pluck up courage to
attack the invading substances and carry on or renew their
accustomed work of scavenging; they try to get rid of both
poisons and poison-producers, and even acquire the power of
forming substances (anti-toxins) which can neutralize the poison
and allow the cells to devote their energy to doing their own
proper work.
"Here are drawings of minute abscesses that have formed in the
wall of the heart. We see at once the part that the leucocytes
play in attacking micro-organisms, and of localizing their
action. Look at the blood-vessel in the wall of the heart with
its plug of micro-organism (staphylococci) in the centre of a
clear space; here the leucocytes are not numerous, indeed they
are very sparsely scattered, and appear to have been driven back
by the organisms or their toxics. Then a little distance away
from the toxin and toxin-forming organisms, the leucocytes are
coming up in large numbers, forming a sort of protecting army,
as it were. This is known as leucocytosis. In the small patent
vessels around this commencing abscess numerous leucocytes, far
in excess of the usual proportion, may be seen--the nearer the
abscess, the more numerous they become. Thus the leucocytes make
their way to what is to become the wall of the abscess, and form
a layer around a mass of micro-organisms, localizing, or
attempting to localize, such mass. So long as the leucocytes can
make their way to this mass, and shut it off from the
surrounding tissue, so long we shall have no extension of the
abscess.
"Now, if you add something--alcohol in the case we are
considering--which not only exerts a negative chemiotaxic
action--i. e., which drives the leucocyte away--but which, as we
have seen, also causes degeneration of nerve, muscle and
epithelial cells, shall we not injure the infected patient both
directly and indirectly by interfering with the return of the
leucocytes driven away, by diminishing or altering the
functional activity of these cells, and indirectly by
interfering with the excretion of the poisons (owing, as we have
seen, to a degenerated condition of the secretory epithelium)?
Have we not, in fact, a cumulative action of two substances,
either of which alone would do damage, but not in the same
proportion as do the two when acting together.
"Now let us see what we may learn from a series of experiments
carried out by Dr. Abbott, working in the Laboratory of Hygiene
of the University of Pennsylvania, under the auspices of the
committee of fifty, to investigate the Alcohol Question.
"These are his conclusions:--
1. "That the normal vital resistance of rabbits to infection by
streptococcus pyogenes is markedly diminished through the
influence of alcohol when given daily to the stage of acute
intoxication. 2. That a similar, though by no means so
conspicuous, diminution of resistance to infection and
intoxication by the bacillus coli communis also occurs in
rabbits subjected to the same influences.
"Throughout these experiments, with few exceptions, it will be
seen that the alcoholized animals not only showed the effects of
the inoculations earlier than did the non-alcoholized rabbits,
but in the case of the streptococcus inoculations, the lesions
produced (formation of miliary abscesses) were much more
pronounced than are those that usually follow inoculations with
this organism.
"With regard to the predisposing influence of the alcohol, one
is constrained to believe that it is in most cases the result of
structural alterations consequent upon its direct action on the
tissues, though in a number of animals no such alterations could
be made out by microscopic examinations. I am inclined, however,
to the belief, in the light of the work of Berkley and
Friedenwald, done under the direction of Professor Welch, in the
pathological laboratory of the Johns Hopkins University, that a
closer study of the tissues of these animals would have revealed
in all of them structural changes of such a nature as to
indicate disturbances of important vital functions of sufficient
gravity fully to account for the loss of normal resistance.
"Following up Dr. Abbott's experiments, Dr. Delearde, working in
Calmette's laboratory in the _Institut Pasteur_ at Lille, made a
series of observations which are, from many points of view, of
very great interest and importance as he attacks it from an
entirely new standpoint, one that will, I hope, ere long, be
taken up by those working in this country. It has already been
demonstrated that 'alcoholics' suffer far more seriously from
microbic affections than do those of sober life, and it is now
accepted that amongst them the mortality from this class of
disease is higher than amongst those who are not accustomed to
take alcohol regularly or to excess.
"It is pointed out, as most of us have from time to time had the
opportunity of observing, that, taking pneumonia as an example
of this class of disease, there can be no doubt that the
alcoholic patient has not merely an appreciably smaller chance
for recovery, but an apparently slight attack becomes one in
which the chances of recovery come to be against the patient
rather than in his favor. I well remember when I was House
Physician in the Royal Infirmary at Edinburgh that Dr. Muirhead,
who almost invariably treated his pneumonic patients without
alcohol, used to say that an ordinary case of acute pneumonia
should always recover under careful treatment, but that cases of
pneumonia in 'alcoholics' were always most anxious cases and in
every way unsatisfactory. (Slides were shown on screen to
illustrate the changes taking place in pneumonia, the conditions
of leucocytosis, and the very important part which leucocytes
play in the process of 'clearing up' during the course of the
patient's recovery). Dr. Delearde in an admirable summary gives
the principal features of pneumonia in alcoholics. He describes
it as running a comparatively prolonged course, as being often
accompanied by a violent delirium, following which is a period
of prostration or of coma; even in those who recover, abscesses
frequently occur in the liver, or in other organs. He also
points out that there may be a similar chain of events in other
infective conditions such as erysipelas and typhoid fever, but
as he insists that, until Abbott's experiments on the
streptococcus,[A] staphylococcus[A] and bacterium coli,[A] in
alcoholized and non-alcoholized animals, little attempt has
been made to indicate the mechanism, or, at any rate, the
process by which alcoholized individuals are rendered more
susceptible to the invasion and action of micro-organisms.
[Footnote A: Microbes or bacteria of different kinds.]
"As we have already seen, Abbott's experiments prove beyond
doubt that attenuated disease-producing organisms, which in
healthy animals do not kill immediately, bring about a fatal
result when the animal has previously been treated with alcohol.
In order to determine which was the most important factor in the
destruction or weakening of the resisting agents in the body,
Dr. Delearde conceived the idea of experimenting with those
diseases in which it has been found possible to produce,
artificially, as it were, and under controlled conditions, an
immunity or insusceptibility in healthy animals. He carried out
a series of experiments on rabbits, immunizing against and
infecting with the virus of hydrophobia, tetanus and anthrax.[B]
To these rabbits he first administered a quantity of alcohol,
from 6 to 8 c.c. at first, and gradually rises to 10 c.c. doses
per diem.
[Footnote B: Carbuncle.]
"There is in the first instance a slight falling off in weight
of the animal, but after a time this ceases, and the animal may
again become heavier, until the original weight is reached. He
then took a series of animals and vaccinated them against
hydrophobia. In one set the animals were afterwards alcoholized
and then injected with a considerable quantity of virulent rabic
cord. It was here found that immunity against rabies had not
been lost.
"In a second set the vaccination and alcoholization were carried
on simultaneously, a fatal dose (as proved by control
experiment) of rabic cord was then injected, when it was found
that little or no immunity had been acquired. In a third series
the alcohol was stopped before the immunizing process was
commenced. In this case marked immunity was acquired.
"As regards rabies, then, acute alcoholism, especially when
continued for comparatively short periods, simply has the
effect of preventing the acquisition of immunity when alcohol is
administered during the period when the immunizing process ought
to be going on. This indicates that the action of the alcohol in
acute alcoholism is direct, and that although its administration
prevents the acquisition of immunity it does not alter the cells
so materially that they cannot regain some of their original
powers, whilst once the immunity has been gained by the cells,
alcohol cannot, immediately, so fundamentally alter them that
they lose the immunity they have already acquired. When we come
to the consideration of the case of tetanus, however, we are
carried a step further. Dr. Delearde repeating his immunizing
and alcoholizing experiments, but now working with tetanus virus
in place of rabic virus, found--and, perhaps, here it may be as
well to give his own words:--
(1) "'That animals vaccinated against tetanus and afterwards
alcoholized lose their immunity against tetanus;
(2) "'That animals vaccinated against tetanus and at the same
time alcoholized do not readily acquire immunity;
(3) "'That animals first alcoholized and then vaccinated may
acquire immunity against tetanus if alcohol is suppressed from
the commencement of the process of vaccination.'
"In the case of anthrax too, as we gather from another series of
experiments, it is almost impossible to confer immunity, if the
animal is alcoholized during the time that it is being
vaccinated, and although the animals, first alcoholized and then
vaccinated, may acquire a certain amount of immunity, they
rapidly lose condition and are certainly more ill than
non-alcoholized animals vaccinated simultaneously.
"We have already mentioned that Massart and Bordet some years
ago pointed out that alcohol, even in very dilute solutions,
exerts a very active negative chemiotaxis, i. e., it appears to
have properties by which leucocytes are repelled or driven away
from its neighborhood and actions. Alcohol thus prevents the
cells from attacking invading bodies or of reacting in the
presence of the toxins which also, as is well known, exert a
more or less marked negative chemiotaxis, i.e., the cells appear
to be paralyzed. In all diseases, then, in which the leucocytes
help to remove an invading organism or in which they have the
power of reacting or of carrying on their functions in the
presence of a toxin, we should expect that alcohol would to a
certain extent deprive them of this power or interfere with
their capacity for acquiring a greater resisting power or of
reinforcing the powers of resistance. It appears indeed to
reinforce the poison formed by pathogenic organisms. Dr.
Delearde maintains moreover that chronic alcoholism increases
enormously the difficulty of rendering an animal immune to
anthrax, whilst as those who have had any experience of cases of
anthrax know full well alcoholics, whether acute or chronic,
manifest a remarkable susceptibility both as regards attacks of
anthrax and the fatality of the disease when once contracted.
Further as clinical proof of the correctness of another of these
sets of experiments, Dr. Delearde instances two cases of rabies
which have come under observation in the Institut Pasteur--one,
a man of 30 years of age, of intemperate habits who after a
complete treatment of 18 days after a bite in the hand died of
hydrophobia; the other, a child of 13 years who was bitten on
the face by the same dog that had attacked the other patient,
and on the same day--who underwent the same treatment remained
perfectly well. In this case the more severe bite (the face
being the most serious position in which a person can be bitten)
was received by the child; indeed the intemperate habits of the
man, who even took alcohol during treatment, appear to have been
the only more serious factor in his case as compared with that
of the child.
"From all this Dr. Delearde draws the practical conclusion that
patients who have been bitten by a mad dog should as far as
possible abstain from the use of alcohol not only during the
process of treatment, but also for some time afterwards, even
for a period of eight months, during which period, apparently,
increase of immunity may be going on. Beyond this he maintains
that doctors often commit a grave error in administering strong
doses of alcohol to patients suffering from certain infectious
diseases such as pneumonia, or from certain intoxications such
as those produced by snake-bite, during which an increase in the
number of leucocytes appear to be a necessary part of any
process that leads to the cure of the patient. Finally, he
points out how necessary it is that we should respect the
integrity of the leucocytes in the presence of microbic
infections or intoxications. We may accept these statements all
the more readily as Dr. Delearde states that 'although we must
recognize that small doses of dilute alcoholic beverages are
indicated in certain cases where it is necessary to stimulate
the nervous system, one must guard oneself against an abuse
which may certainly be prejudicial to the putting into operation
of the mechanism of defence against the organisms of disease.'
"In so far as these conclusions rest on a series of exact
experiments we are justified in accepting them as being a most
valuable contribution to the question; where there is no
experimental basis, we must exercise our own judgment. To show
the very strong impression that exists that there is some
connection between severe cases of pneumonia and alcohol I may
mention that the other day I heard a gentleman (not a medical
man) say, 'It is well known that most men (of a certain
profession) die from alcoholism.' When asked to explain he said,
'They all die from cirrhosis or pneumonia, and if those
conditions are not due to alcoholism, what is?'
"There can be no doubt that in addition to its specific action,
alcohol has a general action--the mal-nutrition, which is
usually associated with the use of alcohol, especially as a
result of its action on the mucous membranes of the stomach,
etc."
That the "guardian cells" of the body play a part in a considerable
number of diseases was illustrated by Dr. Woodhead by drawings and
photographs, shown on the lantern screen. The photographs included cells
containing anthrax, typhoid and tubercle bacilli, the spirilla of
relapsing fever, specimens from cases of anthrax. Specimens were shown
in which the cells were actually ingesting and digesting the specific
micro-organisms. In a case of typhoid, showing large masses of typhoid
bacilli in one of Peyer's patches, there were seen certain of the cells
which contained the typhoid bacilli, some of them undergoing
degenerative changes, and showing unequal standing.
Of the researches made by Dr. Abbott referred to in the foregoing
lecture Dr. N. S. Davis says:--
"Thus we have another and direct positive demonstration of the
fact that the presence of alcohol in living bodies not only
impairs all the physiological processes, but also impairs their
vital resistance to the effects of all other poisons. It was
hardly necessary, however, to trouble the rabbits to obtain
proof of this; for such evidence may be found in abundance by
examining the vital statistics of every civilized country. The
late Frank H. Hamilton, in his valuable work on military
hygiene, gives an interesting account of an experiment executed,
not on a few rabbits, but on whole regiments of human beings,
who were being exposed to the inhibition, not of the
streptococcus pyogenes, but to the infections of malarial and
typho-malaria fever. And, as many were attacked with sickness,
it was thought by some of those in authority that if the
soldiers were given a specified ration of alcoholic liquor two
or three times a day, it might enable them to resist the morbid
influences to which they were exposed. The proposed ration was
accordingly ordered, and Dr. Hamilton informs us that the
soldiers taking the liquor ration succumbed to the morbific
influences surrounding them so much more rapidly than before,
that in less than sixty days the order was countermanded, and
the liquor ration stopped. And that eminent surgeon and
sanitarian added, with peculiar emphasis, that he wished never
to see the same experiment tried again."
Dr. J. J. Ridge, of London, has learned through his experiments that
alcohol not only hinders the leucocytes in their war upon disease germs,
but also tends to the multiplication of germs. Of this he says:--
"The antagonism of alcohol to the fundamental functions of life
is further exhibited by its action on the cellular elements of
living tissues and the free cells or leucocytes of the blood.
Dr. Lionel Beale long ago pointed out how it affected the
protoplasm of cells, and diminished the movements of amoebae,
to which leucocytes are apparently analogous.
"But while alcohol is thus injurious to living protoplasm, or
_constructive protoplasm_ as it may be called, that which builds
up, and forms all kinds of structures, and living beings of all
higher types, I accidentally discovered that in minute
quantities, under about one per cent., and even in such almost
incredible amounts as 1 part in 100,000, (1/10 millilitre in 10
litres) it favors the growth and multiplication of many microbes
whose function is antagonistic to the protoplasm of organized
beings, and which may therefore be called _destructive
protoplasm_. We know that these microbes are kept at bay by the
vitality of the tissues; if this vitality is lowered they may
prevail: as soon as life departs they set to work, and
decomposition is the result. It is, therefore, not very
surprising that an agent, like alcohol, which, we have seen,
lowers the vitality of constructive protoplasm, should, on the
other hand increase the vitality of destructive protoplasm. At
any rate such is the fact. In the presence of these minute
quantities of alcohol, decomposition goes on more rapidly, and
the micrococci and bacilli, thrive and swarm more abundantly.
This is easily demonstrable by the more rapid, and thicker,
cloudiness of any clear decomposable liquor in the course of a
day or two, or in a few days, according to circumstances. But I
have demonstrated the more rapid multiplication of some forms by
means of plate cultivations, of which I show specimens. It is
true of the bacteria of decomposition, of the streptococci, and
staphylococci of pus, and of diphtheria. Time alone has been
wanting to demonstrate this in other cases, which I hope to do."
The _Medical Week_ some time ago contained this paragraph:--
"Dr. Viala, in collaboration with Dr. Charrin, says: 'I have
carried out a series of researches on the toxicity of various
alcoholic beverages in common use, such as wines and brandies of
all brands, from those which are reputed the best to those of
very inferior quality. All these products have been analyzed
with the greatest care. Our experiments were carried out on
fifty animals. Intravenous injections confirm Dr. Daremberg's
statement that liquors considered as the best are the most
toxic, more particularly as regards their immediate effects.'"
Although the foregoing statement directs the reader's attention to the
comparative effects of different alcoholic liquors, it also plainly
implies several facts of great importance. The first is, that all
alcoholic liquors, fermented or distilled, are toxic or poisonous; and
the more pure alcohol they contain, the more poisonous are they, the
qualities of liquor differing only in the rapidity of their injurious
effects.
In the same number of the _Medical Week_, Professor Grehant states that
after injecting a quantity of alcohol into the venous circulation of a
dog equal to one twenty-fifth, or four per cent., of the estimated
weight of the blood of the animal, he found by several analyses at
different times that it required "a little over twenty-three hours for
complete elimination of the alcohol from the blood." If we consider
these results obtained by Viala, Charrin, Daremberg and Grehant, with
those obtained by Dr. A. C. Abbott, showing the direct effect of alcohol
in diminishing the normal vital resistance of the living body to
infection, we see excellent reasons why the liberal use of alcohol in
the treatment of such infectious diseases as diphtheria, typhoid fever
and pneumonia, under the supposition that it was a cardiac tonic, has
resulted in so great a mortality as from thirty to sixty per cent.
Dr. A. Pearce Gould, a London hospital surgeon of the first rank, has
made special study of the surgery of the blood-vessels, and of the
chest. He was one of the earliest to practice and advocate the careful
removal of the axillary glands in all operations for cancer of the
breast.
He is a strong believer in the value of total abstinence as promoting
robust health of body and mind. He regards the value of alcohol in
disease as exceedingly small, and prescribes it only very rarely. He
thinks that alcohol increases the activity of cancer and other malignant
growths, an opinion which is of great importance from one with such
exceptional opportunities for observation in these complaints.
Dr. N. S. Davis in the _American Medical Temperance Quarterly_ of
January, 1895, gives reports of cases which came under his observation
as a consulting physician, where the use of alcoholics throughout an
extended illness favored the continuance of delirium, or mild mental
disorder, after convalescence was established. In each case the
withdrawal of the alcohol was followed by a cessation of the mental
delusion.
One of these cases may be taken as an example:--
"The third case was that of a woman over sixty years of age, who
had suffered from a mild grade of fever and protracted
diarrhoea, somewhat resembling a mild grade of enteric typhoid
fever.
"As she became much reduced in strength during the latter part
of her diarrhoea, her friends began to give her wine, and
sometimes stronger alcoholic drink, under the popular delusion
that these could strengthen her. Her mind soon became wandering,
and she was troubled with illusions, which were attributed to
her weakness, and the so-called stimulants were increased. But
the mental disorder increased also, and continued after the
fever and diarrhoea had ceased, until the question was raised
concerning the propriety of her removal to an asylum for the
insane.
"Being consulted at that time, and listening to an accurate
history of the case, I suggested that the anaesthetic effect of
the alcohol on the cerebral hemispheres, in connection with its
effect on the hemoglobin, and other elements of the blood, in
lessening the reception and internal distribution of oxygen,
might be the cause of both the perpetuation of her weakness, and
her mental disorder. I advised a trial of its entire omission,
and the giving of only simple nourishment, and moderate doses of
strychnine and digitalis, as nerve tonics. My advice was
followed, though not without much hesitation on the part of her
friends. The result, however, was entire recovery from the
mental disorder, and some improvement in her general health."
Puerperal mania resulted in one case cited, from the use of a moderate
amount of wine at mealtimes; when the wine was abandoned the mania
subsided.