Alcohol: A Dangerous and Unnecessary Medicine, How and Why

“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. Deléarde, 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. Deléarde 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,1 staphylococcus2 and bacterium coli,3 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.

“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. Deléarde 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.4 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.

“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. Deléarde 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. Deléarde 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. Deléarde 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. Deléarde 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. Deléarde 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 amœbae, 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 Gréhant 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 Gréhant, 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 diarrhœa, somewhat resembling a mild grade of enteric typhoid fever.

“As she became much reduced in strength during the latter part of her diarrhœa, 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 diarrhœa 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 anæsthetic 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.

CHAPTER XII.

WHY DOCTORS STILL PRESCRIBE ALCOHOLICS

Workers in the department of Medical Temperance of the Woman’s Christian Temperance Union are told repeatedly by the better class of physicians that they would be glad often not to prescribe alcohol if patients and their friends would not insist upon its use. There is a deep-rooted prejudice in favor of alcohol as a remedy in the minds of the great multitude of people, and they are ready to distrust as fanatical, or incompetent, any physician who does not use it. Dr. Norman Kerr, a well-known physician of England, says, that during a ten years’ residence in America, he found people unwilling to pay him as much for his services as they were willing to pay one who prescribed alcoholics. Even those who were abstainers from liquors as beverages distrusted him for not using these things as medicines. Indeed, this prejudice goes so far with many that they will refuse to employ a non-alcoholic physician, if they know him to be such. In consequence of this latter fact, there are great numbers of skilful physicians who say nothing about alcohol lest they be considered “faddists,” and lose practice, but who never prescribe it unless it is asked for by the patient or his friends.

Again, consulting physicians will sometimes insist upon the use of alcohol, and thus seeds of distrust of the non-alcoholic physician will be sown.

Dr. J. J. Ridge says of medical prescriptions: —

“Hundreds of medical men order alcoholic liquors from habit, from ignorance of their real effect, from fashion, or from a desire to please, or not to offend, their patients. Port-wine is constantly being ordered when persons are recovering from various diseases; day by day they regain their strength, and the port-wine gets all the credit of it, especially since each glass seems to diffuse a comfortable glow over the whole body. They forget that the process of recovery would have gone on without the port, and that hundreds and thousands of people do get well without it. They often ignore the fact that they are taking real tonics in addition. They are misled by the sensations which the alcohol causes; they do not know that it relaxes the blood-vessels instead of improving their tone; that it exhausts the heart by making it beat away more rapidly to no profit. Hence the convalescence is actually more prolonged than it would otherwise be. Gentle exercise, regulated baths, good food, balmy sleep, these are the true restoratives of the exhausted system, and no jugglery with sedatives, such as alcohol, can produce the desired result.