The Project Gutenberg EBook of Alcohol: A Dangerous and Unnecessary Medicine, How and Why, by Martha M. Allen This eBook is for the use of anyone anywhere at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at www.gutenberg.org Title: Alcohol: A Dangerous and Unnecessary Medicine, How and Why What Medical Writers Say Author: Martha M. Allen Release Date: October 4, 2008 [EBook #26774] Language: English Character set encoding: ISO-8859-1 *** START OF THIS PROJECT GUTENBERG EBOOK ALCOHOL *** Produced by Bryan Ness, Deirdre M., and the Online Distributed Proofreading Team at http://www.pgdp.net (This book was produced from scanned images of public domain material from the Google Print project.) * * * * * TRANSCRIBER'S NOTE: Every effort has been made to replicate this text as faithfully as possible; please see detailed list of printing issues at the end of the text. * * * * * ALCOHOL A DANGEROUS AND UNNECESSARY MEDICINE HOW AND WHY What Medical Writers Say BY MRS. MARTHA M. ALLEN Superintendent of the Department of Medical Temperance for the National Woman's Christian Temperance Union Published by the DEPARTMENT OF MEDICAL TEMPERANCE OF THE NATIONAL WOMAN'S CHRISTIAN TEMPERANCE UNION MARCELLUS, NEW YORK COPYRIGHT, 1900. * * * * * CONTENTS. INTRODUCTION 5 PREFACE TO SECOND EDITION 7 CHAPTER I. HISTORY OF THE STUDY OF ALCOHOL. Discovery of distillation--First American investigator of effects of alcohol--Medical Declarations--Sir B. W. Richardson's researches--Scientific Temperance Instruction in American Schools--Committee of Fifty 9 CHAPTER II. THE WOMAN'S CHRISTIAN TEMPERANCE UNION IN OPPOSITION TO ALCOHOL AS MEDICINE. How the Opposition began--Memorial to International Medical Congress--Origin of Medical Temperance Department--Objects of the department--Public agitation against patent medicines originated by the department--Laws of Georgia, Alabama and Kansas on Medical prescription of alcohol 21 CHAPTER III. ALCOHOL AS A PRODUCER OF DISEASE. Alcohol a poison--Sudden deaths from brandy--Changes in liver, kidneys, heart, blood-vessels and nerves caused by alcohol--Beer and wine as harmful as the stronger drinks--Alcohol causes indigestion--Other diseases caused by alcohol--Deaths from alcoholism in Switzerland 28 CHAPTER IV. TEMPERANCE HOSPITALS. The London Temperance Hospital--Methods of treatment--The Frances E. Willard Temperance Hospital, Chicago--"As a beverage" in the pledge--Address by Miss Frances E. Willard at opening of hospital--The Red Cross Hospital--Clara Barton and non-alcoholic medication--Reports of treatment in Red Cross Hospital--Use of Alcohol declining in other hospitals 37 CHAPTER V. THE EFFECTS OF ALCOHOL UPON THE HUMAN BODY. The body composed of cells--Effect of alcohol on cells--Alcohol and Digestion--Effects on the blood--The heart--The liver--The kidneys--Incipient Bright's disease recovered from by total abstinence--Retards oxidation and elimination of waste matters--Lengthens duration of sickness and increases mortality 58 CHAPTER VI. ALCOHOL AS MEDICINE. Medical use of alcohol a bulwark of the liquor traffic--Alcohol not a Food--Alcohol reduces temperature--Food principle of grains and fruits destroyed by fermentation--Alcohol not a Stimulant--Experiments proving this--Alcohol not a tonic--Professor Atwater on Alcohol as Food 96 CHAPTER VII. ALCOHOL IN PHARMACY. Strong tinctures rouse desire for drink in reformed inebriates--Glycerine and acetic acid to preserve drugs--Non-alcohol tinctures in use at London Temperance Hospital--Sale of liquor in drug-stores condemned by pharmacists 131 CHAPTER VIII. DISEASES, AND THEIR TREATMENT WITHOUT ALCOHOL. Alcoholic Craving--Anæmia--Apoplexy--Boils and Carbuncle--Catarrh--Hay-Fever--Colds--Colic--Cholera--Cholera Infantum--Consumption--Displacements--Debility--Diarrhoea-- Dysentery--Dyspepsia--Fainting--Fits--Flatulence--Headache-- Hemorrhage--Heart Disease--Heart Failure--Insomnia--La Grippe--Measles--Malaria--Neuralgia--Nausea--Pneumonia--Pain After Food--Snake-bite--Rheumatism--Spasms--Shock--Sudden Illness--Sunstroke--Typhoid Fever--Vomiting 140 CHAPTER IX. ALCOHOL AND NURSING MOTHERS. Beer not good for nursing mothers--Helpful diet--Opinions of medical men--Analysis of milk of a temperate woman--Of a drinking woman--Advice of Dr. James Edmunds, of the Lying-In Hospital, London--How to feed the baby--Case of a young mother who used beer--Nathan S. Davis on beer and gin 234 CHAPTER X. COMPARATIVE DEATH-RATES WITH AND WITHOUT THE USE OF ALCOHOL. Fewer deaths in smallpox hospitals without alcohol--200 cases of scarlet fever without alcohol--Non-alcoholic treatment of fevers with less than 5 per cent. death-rate--Report of cases in English and Scotch hospitals--340 cases of typhus--London Lancet articles on typhoid--Mercy Hospital, Chicago--Death-rates in pneumonia and typhoid in large hospitals--Sir B. W. Richardson's report of practice 247 CHAPTER XI. REASONS WHY ALCOHOL IS DANGEROUS AS MEDICINE. Researches of Abbott--Vital Resistance lowered by alcohol--Experiments upon Urinary Toxicity--Effect of alcohol upon the guardian-cells of the body--Dr. Sims Woodhead on immunity--Deléarde's experiments at the Pasteur Institute--Dr. A. Pearce Gould on alcohol and cancer--Delirium in illness caused by alcohol 262 CHAPTER XII. WHY DOCTORS STILL PRESCRIBE ALCOHOLICS. Public often demand it--Lack of knowledge of true nature of alcohol--Alcohol given undeserved credit for recoveries--Use of alcohol results from custom--Education of the people in teachings of non-alcoholic physicians necessary--Prescription of alcohol a matter of routine--Two examples 291 CHAPTER XIII. ALCOHOLIC PROPRIETARY OR "PATENT" MEDICINES. The Pure Food Law--The guarantee--Newspaper opposition to the law--Headache remedies--Fake testimonials--Dangers of soothing syrups and morphine cough syrups--Fraud orders issued by Post-Office Department--Internal Revenue Department and Patent Medicines--Proprietary "Foods" strongly alcoholic--Alcoholic Cod-Liver Oil preparations--Australia's Royal Commission on Patent Medicines--Committee on Pharmacy analyses--Malt extracts--Coca Wines--Advertising, the strength of the Nostrum business--An effectual remedy 299 CHAPTER XIV. DRUGGING. Drugs do not cure disease--Nature cures--Opinions of drug medication of prominent physicians--La grippe caused by drug taking--Coal-tar drugs--Quinine--Sir Frederick Treves on disuse of drugs--People demand drugs of physicians--Mothers make drug victims of their children--Habit-producing drugs--Causes of drug-taking--How to be well 335 CHAPTER XV. TESTIMONIES OF PHYSICIANS AGAINST ALCOHOLIC MEDICATION. No need for substitutes for alcohol--Alcohol hides symptoms of disease--Responsibility of physicians--Opinions of many teachers in medical colleges--Hot milk better than alcohol--_Journal of the American Medical Association_ on researches of Abbott and Laitinen--Resolution against alcohol of West Virginia Medical Society--Dr. Knox Bond on Scarlet Fever--Metchnikoff on white blood-cells--Kassowitz describes his treatment of fevers--Sims Woodhead's opinions--Opinions of German Physicians--Dr. Harvey blames medical profession for careless use of alcohol and opium--Use of Alcohol declining rapidly in medical practice 356 CHAPTER XVI. RECENT RESEARCHES UPON ALCOHOL. Experiments of Laitinen--Resistance of blood-cells to disease lowered by alcohol--International Congress on Alcoholism, London, 1909--Alcohol and Immunity--Effect of Alcohol Drinking on Human Off-spring--Researches of Kraepelin and Aschaffenberg--Economic losses by reduced work through beer and wine drinking--Researches of Dr. Reid Hunt--Mice given alcohol killed by small doses of poison--Difference in effect of alcohol and starch foods--Chittenden on food theory of alcohol--Researches of Dr. S. P. Beebe--Liver impaired by alcohol--Dr. Winfield S. Hall's interpretation of the researches of Beebe and Hunt--Oxidation of alcohol by liver a protective action--Researches show that alcohol is a poison, not a food 392 CHAPTER XVII. MISCELLANEOUS. Alcohol Baths--Beverages for the Sick--Tobacco and the Eyesight--Advertised "Cures" for Drunkenness--How to quit drinking--Dr. T. D. Crothers' remedy for drink crave--Alcohol and Children--Alcohol Tested--Beer-Drinking Injurious to Health--Drug Drinks--Special Directions for Women--Total Abstinence and Life Insurance--Opinions of Life Insurance Companies on drinkers as risks 410 INTRODUCTION. This book is the outcome of many years of study. With the exception of a few quotations, none of the material has ever before appeared in any book. The writer has been indebted for years past to many of the physicians mentioned in the following pages for copies of pamphlets and magazines, and for newspaper articles, bearing upon the medical study of alcohol. Indeed, had it not been for the kindly counsels and hearty co-operation of physicians, she could never have accomplished all that was laid upon her to do as a state and national superintendent of Medical Temperance for the Woman's Christian Temperance Union. She is also under obligation for helps received from the secretaries of several State Boards of Health, and from eminent chemists and pharmacists. The object of the book is to put into the hands of the people a statement of the views regarding the medical properties of alcohol held by those physicians who make little, or no use of this drug. In most cases their views are given in their own language, so that the book is, of necessity, largely a compilation. It is hoped that while the laity may be glad to peruse these pages because of the very useful and interesting information to be obtained from them, the medical profession, also, may be pleased to find, in brief form, the teachings of some of their most distinguished brethren upon a question now frequently up for discussion in society meetings. The writer does not presume to set forth her own opinions upon a question which is still a subject of dispute among the members of a learned profession; she simply culls from the writings of those members of that profession who, having made thorough examination of the claims of alcohol, have decided that this drug, as ordinarily used, is more harmful than beneficial, and that medical practice would be upon a higher plane, were it driven entirely from the pharmacopoeia. PREFACE TO SECOND EDITION. When the first edition of this book was published in 1900, there were only a few leading physicians either in Europe or America who were ready to condemn the medical use of alcohol. Sir Benjamin Ward Richardson, Sims Woodhead, and a few others in England; Forel, Kassowitz and one or two more on the Continent, and Nathan S. Davis, T. D. Crothers and J. H. Kellogg, in America, were about all that could be quoted largely as opposed to alcoholic liquors as remedies in disease. Whisky was then looked upon as necessary in the treatment of consumption and diphtheria. Ten years have brought about a great change. There are many American physicians now willing to admit that they have very little or no use for alcoholic liquors as remedial agents, and now, instead of recommending whisky for consumption anti-tuberculosis literature almost everywhere warns against the use of intoxicating drinks. The use of anti-toxin in diphtheria has driven out whisky treatment in that disease with markedly favorable results. Under the whisky treatment death-rates ran up to fifty-five and sixty per cent.; now the diphtheria death-rate is very low. Ten years ago many good authorities still ranked alcohol as a stimulant; now, almost all rank it as a depressant. In England, leading physicians and surgeons have spoken so strongly against alcohol in the last few years that the London _Times_, England's leading newspaper, said: "According to recent developments of scientific opinion, it is not impossible that a belief in the strengthening and supporting qualities of alcohol will eventually become as obsolete as a belief in witchcraft." So far as the writer can learn from replies sent to her inquiries by teachers of medicine, and by study of text-books on medicine, and articles in good medical journals, alcohol now has only a very limited use in medicine with the great majority of successful physicians. Some recommend wine in _diabetes mellitus_, saying that it acts less like a poison and more like a food in that disease than in any other. Some use alcoholic liquors in fevers as a food "to save the burning of tissue," but an article on "Therapeutics" in the _Journal of the American Medical Association_, for November 6, 1909, page 1564, says that sugar would probably have equal value in such case. The same article says that hot baths, with hot lemonade, and a quickly acting cathartic, will abort a cold without any need of recourse to alcohol. The writer wishes here to make grateful acknowledgment of courtesies received from busy physicians who have aided materially in her work by answering personal letters of inquiry, also letters published in the _Journal of the American Medical Association_, by kindness of the editor. Especially would she thank those professors of medicine and superintendents of large hospitals, who so courteously aided her in preparing a paper for the International Congress on Alcoholism, held in London, July, 1909, to which she was a delegate, representing the United States government. A few of the replies received at that time are given in this book. There was not room for all. She wishes also to acknowledge kindness and much help received from pharmacists and druggists in the fight against dangerous patent medicines and drug drinks sold at soda fountains. The _Druggists' Circular_, of New York, deserves special mention in this connection. It has been necessary to make many changes in this edition because of the changing views on alcohol and the publicity on patent medicines. Physicians will find Chapter XVI entirely new, and of great interest. M. M. A. * * * * * ALCOHOL. CHAPTER I. HISTORY OF THE STUDY OF ALCOHOL. The only intoxicating drinks known to the ancients were wines and beers. That these were used for medicinal as well as beverage purposes is evident from sacred and secular history. About the tenth century of the Christian era, an Arabian alchemist discovered the art of distillation, by which the active principle of fermented liquors could be drawn off and separated. To the spirit thus produced the name alcohol was given. A plausible reason cited for this name is that the Arabian for evil spirit is _Al ghole_, and the effects of the mysterious liquid upon men suggested demoniacal possession. Medical knowledge at this time was very limited: there was no accurate way of determining the real nature of the new substance, nor its action upon the human system. It could be judged only by its _seeming_ effects. As these were pleasing, it was supposed that a great medical discovery had been made. The alchemists had been seeking a panacea for all the ills to which flesh is heir, indeed for something which would enable men even to defy Death, and the subtle new spirit was eagerly proclaimed as the long-looked-for cure-all, if not the very _aqua vitæ_ itself. Physicians introduced it to their patients, and were lavish in their praises of its curative powers. The following is quoted from the writings of Theoricus, a prominent German of the sixteenth century, as an example of medical opinion of alcohol in his day:-- "It sloweth age, it strengtheneth youth, it helpeth digestion, it cutteth phlegme, it cureth the hydropsia, it healeth the strangurie, it pounces the stone, it expelleth gravel, it keepeth the head from whirling, the teeth from chattering, and the throat from rattling; it keepeth the weasen from stiffling, the stomach from wambling, and the heart from swelling; it keepeth the hands from shivering, the sinews from shrinking, the veins from crumbling, the bones from aching, and the marrow from soaking." Being a medicine, which very rapidly creates a craving for itself, the demand for it became enormous, and, as time advanced, people began prescribing it for themselves, until its use both as medicine and beverage became almost general. If the medical profession is responsible for the wide-spread belief that alcoholics are of service to mankind both as food and medicine, it should not be forgotten that it is to members of the same profession the world is indebted for the correction of these errors. All down through the centuries there have been physicians who doubted and opposed its claims to merit. It remained for the medical science of the latter half of the nineteenth century to clearly demonstrate with nicely adjusted chemical apparatus and appliances the wisdom of these doubts. The scientific study of the effects of alcohol upon the human body began about sixty years ago. The first American investigator was Dr. Nathan S. Davis, of Chicago, who was the founder of the American Medical Association. During the months of May, June, July, September and October, 1848, Dr. Davis published in the _Annalist_, a monthly medical journal of New York City, a series of articles controverting the universal opinion that alcoholic drinks are warming, strengthening and nourishing. In 1850 he executed an extensive series of experiments to determine the effects of a diet exclusively carbonaceous (starch), one exclusively nitrogenous (albumen), and alcohol (brandy and wine), on the temperature of the living body; on the quantity of carbonic acid exhaled; and on the circulation of the blood. The results of these investigations were embodied in a paper read before the American Medical Association in May, 1851. They showed that alcohol, instead of increasing animal heat, and promoting nutrition and strength, actually produced directly opposite effects, reducing temperature, the amount of carbonic acid exhaled, and the muscular strength. So opposed were these conclusions to the generally accepted teachings of the day that the Association did not refer the paper to the committee of publication. It was published later in the _Northwestern Medical and Surgical Journal_. In 1854 Dr. Davis published one of the most remarkable of the numerous works which have come from his prolific pen; it was entitled, "A Lecture on the Effects of Alcoholic Drinks on the Human System, and the Duty of Medical Men in Relation Thereto." This lecture was delivered in Rush Medical College, Chicago, on Christmas, 1854. An appendix to the work contained a full account of the series of original experiments which the author had been conducting in relation to the effect of alcohol upon respiration and animal heat, and gave the same conclusions as those presented before the A. M. A. several years previously. These experiments laid the foundation for the scientific study of the physiological effects of alcohol; and their bearing upon the study of the temperance question can even yet scarcely be appreciated. They were the first experiments which showed conclusively that the effect of alcohol is not that of a stimulant, but the opposite. In 1855 Prof. R. D. Mussey, of Vermont, read an able paper before the American Medical Association upon "The Effects of Alcohol in Health and Disease," in which he said, "So long as alcohol retains its place among sick patients, so long will there be drunkards." In England as early as 1802, Dr. Beddoes pointed out the dangers attendant upon the social and medical use of intoxicating drinks, laying stress upon "The enfeebling power of small portions of wine regularly drunk." In 1829 Dr. John Cheyne, Physician General to the forces in Ireland said:-- "The benefits which have been supposed from their liberal use in medicine, and especially in those diseases which are vulgarly supposed to depend upon mere weakness, have invested these agents with attributes to which they have no claim, and hence, as we physicians no longer employ them as we were wont to do, we ought not to rest satisfied with the mere acknowledgment of error, but we ought also to make every retribution in our power for having so long upheld one of the most fatal delusions that ever took possession of the human mind." Dr. Higginbotham, F. R. S., of Nottingham, a keen and able clinical practitioner, abandoned the prescription of alcohol in 1832, saying:-- "I have amply tried both ways. I gave alcohol in my practice for twenty years, and have now practiced without it for the last thirty years or more. My experience is, that acute disease is more readily cured without it, and chronic diseases much more manageable. I have not found a single patient injured by the disuse of alcohol, or a constitution requiring it; indeed, to find either, although I am in my seventy-seventh year, I would walk fifty miles to see such an unnatural phenomenon. If I ordered or allowed alcohol in any form, either as food or as medicine, to a patient, I should certainly do it with a felonious intent."--_Ipswich Tracts. No. 346._ In 1839 Dr. Julius Jeffreys drew up a medical declaration which was signed by seventy-eight leaders of medicine and surgery. This document declared the opinion to be erroneous that wine, beer or spirit was beneficial to health; that even in the most moderate doses, alcoholic drinks did no good. This, of course, dealt only with the beverage use of alcoholics. In 1847 a second declaration was originated, signed by over two thousand of the most eminent physicians and surgeons. This also referred only to liquor as a beverage. In 1871 a third declaration, signed by two hundred and sixty-nine of the leading members of the medical profession was published in the London _Times_. This declaration was in part as follows:-- "As it is believed that the inconsiderate prescription of large quantities of alcoholic liquids by medical men for their patients has given rise, in many instances, to the formation of intemperate habits, the undersigned, while unable to abandon the use of alcohol in the treatment of certain cases of disease, are yet of opinion that no medical practitioner should prescribe it without a sense of grave responsibility. "They are also of opinion that many people immensely exaggerate the value of alcohol as an article of diet, and they hold that every medical practitioner is bound to exert his utmost influence to inculcate habits of great moderation in the use of alcoholic liquids." In the same year the American Medical Association passed a resolution that "alcohol should be classed with other powerful drugs, and when prescribed medically, it should be done with conscientious caution, and a sense of great responsibility." The physicians of New York, Brooklyn and vicinity not long afterward published a declaration practically the same as that of the A. M. A., adding: "We are of opinion that the use of alcoholic liquor as a beverage is productive of a large amount of physical disease." The publication of these later declarations was the beginning of a marked change in the medical use of alcohol. In England the scientific temperance movement began with Dr. B. W. Richardson, afterwards knighted by Queen Victoria for his great services to humanity as a medical philanthropist. Dr. Richardson's success in bringing before physicians the remarkable medicinal agent known as nitrite of amyl, led to a request from the British Association for the Advancement of Science that he investigate other chemical substances. The result was that several years of study, beginning with 1863, were given to the physiological effects of various alcohols, ethylic alcohol, which is the active principle in wines, beers and other intoxicating drinks, receiving special attention. The following is taken from his "Results of Researches on Alcohol":-- "In my hands ethylic alcohol and other bodies of the same group; viz. methylic, propylic, butylic, and amylic alcohols were tested purely from the physiological point of view. They were tested exclusively as chemical substances apart from any question as to their general use and employment, and free from all bias for or against their influence on mankind for good or for evil. "The method of research that was pursued was the same that had been followed in respect to nitrite of amyl, chloroform, ether, and other chemical substances, and it was in the following order: First, the mode in which living bodies would take up or absorb the substance was considered. This settled, the quantity necessary to produce a decided physiological change was ascertained, and was estimated in relation to the weight of the living body on which the observation was made. After these facts were ascertained the special action of the agent was investigated on the blood, on the motion of the heart, on the respiration, on the minute circulation of the blood, on the digestive organs, on the secreting and excreting organs, on the nervous system and brain, on the animal temperature and on the muscular activity. By these processes of inquiry, each specially carried out, I was enabled to test fairly the action of the different chemical agents that came before me. * * * * * "The results of these researches were that I learned purely by experimental observation that, in its action on the living body, alcohol deranges the constitution of the blood; unduly excites the heart and respiration; paralyzes the minute blood-vessels; disturbs the regularity of nervous action; lowers the animal temperature, and lessens the muscular power. "Such, independent of any prejudice of party or influence of sentiment, are the unanswerable teachings of the sternest of all evidences, the evidences of experiment, of natural fact revealed to man by testing of natural phenomena." When Dr. Richardson reported to the Association for the Advancement of Science the results of his researches so at variance with commonly accepted ideas, the Association was as incredulous as the American Medical Association had been in 1851 when Dr. Davis gave a similar report, and Dr. Richardson's paper was returned to him for correction. It should be stated here that Dr. Richardson was not a total abstainer when he began his study of the effects of alcohol, but became an ardent and enthusiastic advocate of total abstinence, and later of non-alcoholic medication, because of what he learned by his experiments with this drug. He was the first to suggest that scientific temperance be taught in the public schools, and he prepared the first text-book ever published for this purpose. In 1874 he delivered his famous "Cantor Lectures on Alcohol," by request of the Society of Arts. This series of lectures created a sensation, being attended by crowds of people, as it was the first time that any physician of eminence had spoken from experimental evidence in favor of total abstinence. The agitation begotten in medical circles by the discussion of Dr. Richardson's researches upon alcohol led to extensive experimenting upon the same line by scientists of England, Continental Europe and America. The efforts of the National Woman's Christian Temperance Union of the United States, led by that intrepid woman, Mrs. Mary H. Hunt, to introduce scientific temperance instruction into public schools gave impetus to the study in this country. The call for text-books caused publishers to request professors in medical colleges to make minute research into the nature and effects of alcohol, that the demands of the new educational law might be met. The bitter opposition to these temperance education laws was a great stimulant to the scientific study of alcohol, for it was hoped by many that the teachings regarding the deleterious effects of alcohol might be proved incorrect. Unfortunately for the lovers of the bibulous, the proof was all the other way; great medical men could not be _bought_ by distillers or brewers to tell anything but the truth, and the truth of experimental research was all against alcohol. The text-books endorsed by Mrs. Hunt and her advisory committee being assailed again and again as containing erroneous teaching, were finally, in 1897, submitted to an examining committee of medical experts, nearly all of whom were connected with medical colleges. This committee consisted of Dr. N. S. Davis, Sr., of Chicago, Ill.; Dr. Leartus Connor, of Detroit, Michigan; Dr. Henry Q. Marcy, of Boston, Mass.; Dr. E. E. Montgomery, of Philadelphia, Pa.; Dr. Henry D. Holton, of Brattleboro, Vt.; and Dr. George F. Shrady, of New York City. From their reports upon the books the following is culled:-- "I find no errors in the teaching of any of them on this subject." "No statement was found at variance with the most reliable studies of especially competent investigators." "I was asked to point out any errors in these books which need correcting. I find no such errors." "I find their teaching completely in accordance with the facts determined through scientific experimentation and investigation." "I find them to be in substantial accord with the results of the latest scientific investigations." Dr. Baer, of Berlin, Germany, the foremost European specialist on the subject treated in these text-books, has recently subjected the books to rigid examination. He says in his report upon them:-- "On the basis of the examination I have made I can assert that the above mentioned school text-books, (the endorsed physiologies), in respect to their statements regarding alcoholic drinks contain no teachings which are not in harmony with the attitude of strict science." Still the opposers of the text-books were not satisfied, and a self constituted Committee of Fifty undertook an investigation. Men of unquestioned ability were chosen to make researches, but the result of their investigations was so different from what was looked for, that, with the exception of Professor Atwater's contention for the food value of alcohol, the report of the Committee of Fifty did not stir up much controversy. The school text-books deal exclusively with the effects of alcohol used as a beverage; for obvious reasons this is all they can do. But as intoxicating drinks have been generally supposed to contain great virtue as remedial agents, this phase of their nature and effects has not been overlooked by those pursuing inquiries concerning them. While full agreement has not yet been reached by experts as to the value of alcoholic liquids as medicines, it is noteworthy that some of the most eminent investigators were led to drop alcohol from their pharmaceutical outfit, and the remainder to admit that its sphere of usefulness is extremely limited. There are now medical colleges of high standing where students are advised against the use of alcohol as a remedy; hospitals are gradually using it less and less, some entirely discarding it; and many progressive physicians, while saying nothing as to their position upon the alcohol question, yet show their lack of faith in this drug by ignoring it unless patients or their friends desire it. CHAPTER II. THE WOMAN'S CHRISTIAN TEMPERANCE UNION IN OPPOSITION TO ALCOHOL AS MEDICINE. When the W. C. T. U. was first organized there was no thought among its members of antagonizing the use of alcohol in medicine. One almost immediate result of the organization, however, was that the women began to study the causes of inebriety, and prominent among the prevailing influences leading to drunkenness they found the medical use of alcoholics. The early efforts of these women were chiefly in rescue work through Gospel temperance meetings, and visitations of jails and poor-houses. By reason of this contact with the effects of inebriety they learned many sad tales of ruined lives, blighted homes and lost souls, through the appetite for strong drink created, or aroused, by alcoholic prescription. They saw, as time passed, that some of the drunkards reclaimed through their influence lapsed again into their evil habits because a little beer, or wine, "for the stomach's sake," or some other sake, had been advised them. Some of the workers had this trouble in their own homes, husband, son or other relative enslaved to alcohol through prescription in disease. Is it any wonder that women of the spirit of the Crusaders, having once had their attention thoroughly aroused to the danger of alcohol in medicine, should begin to examine this stronghold of the enemy to discover, if possible, whether or not, his fortress, the medicine-chest, was impregnable? Greatly to their joy they found that the medical profession was not a unit in commending alcoholics as remedial agencies, that all along since alcohol came into common use there have been physicians who distrusted, and opposed it. They learned, too, that some of the most distinguished physicians of America and of England were using little or no alcohol in their practice, and that a hospital had been established in London, England, which was clearly demonstrating the superiority of non-alcoholic medication by its small death-rate in comparison with hospitals using alcohol. This knowledge encouraged those possessing it so that they began to refuse alcoholics as remedies in their own households, and rarely did they find physicians unwilling or unable to supply another agent when asked to do so, and thousands of women can now testify to the fact of having recovered from ill health without the wine, beer or brandy they were advised to take. So the W. C. T. U. discovered several good reasons for opposing alcohol in medicine. 1. Its liability to create or revive an uncontrollable appetite. 2. A considerable number of the leading physicians of America and of Great Britain discard it from their list of remedies, considering it harmful rather than helpful. 3. The lessened mortality consequent upon its entire disuse demonstrated by the London Temperance Hospital. 4. By their own experience they knew that alcohol is not necessary to the restoration of health, nor to the upbuilding of strength. The first active work touching the medical use of alcohol was a memorial from the National W. C. T. U. to the International Medical Congress of 1876, which met in Washington, D. C. This memorial was suggested by Miss Frances E. Willard, and co-operated in by the National Temperance Society. It asked for a deliverance from the Congress upon alcohol as a food and as a medicine. The Congress was divided into sections for the more thorough discussion of the various topics. Upon the program was a paper on "The Therapeutic Value of Alcohol as Food, and as a Medicine," by Ezra M. Hunt, M. D., delegate from the New Jersey Medical Society. This paper was read before the "Section on Medicine," and, after earnest discussion, the conclusions of the author were adopted "quite unanimously" as the sentiments of the Section on Medicine. As such they were reported for acceptance to the General Congress, and by it ordered to be transmitted as a reply to the memorialists. The report was published in full by the National Temperance Society, and may be obtained from it in paper binding for twenty-five cents. As it makes a book of 137 pages the conclusions only will be quoted here. They are as follows:-- 1. "Alcohol is not shown to have a definite food value by any of the usual methods of chemical analysis or physiological investigation. 2. "Its use as a medicine is chiefly that of a cardiac stimulant, and often admits of substitution. 3. "As a medicine it is not well fitted for self-prescription by the laity, and the medical profession is not accountable for such administration, or for the enormous evil arising therefrom. 4. "The purity of alcoholic liquors is in general not as well assured as that of articles used for medicine should be. The various mixtures when used as medicine should have definite and known composition, and should not be interchanged promiscuously." It is matter for sincere regret that this deliverance was not, in some way, brought prominently before every physician in the land. There are, doubtless, thousands of physicians who never heard of it, and, consequently have never been influenced by it to doubt the utility of the popular brandy bottle. In 1883 Mrs. Mary Towne Burt, President of New York State W. C. T. U., in her annual address, suggested that a department of work be created to endeavor to induce physicians to not prescribe alcohol, unless in such cases as allowed of the use of no other agent. Mrs. (Rev.) J. Butler, of Fairport, was the first superintendent of this department, which was named, "Influencing Physicians to not Prescribe Alcoholics as Medicines." The National W. C. T. U. adopted the department in 1883, but soon dropped it. In 1895 it was reinstated and Mrs. Martha M. Allen, New York's superintendent, was made national superintendent. In 1905 the name of the department was changed from Non-Alcoholic Medication, which it had borne for fifteen years, to Medical Temperance. The objects of this department of work are: 1. To inform the public of the objections to the medical use of alcoholic drinks now held by many successful physicians. 2. To show the dangers in the home-prescription of alcohol and other powerful drugs. 3. To expose fraudulent and dangerous proprietary and "patent" medicines and liquid "foods," the main ingredients of which are alcohol and morphine. 4. To use persuasion with publishers of newspapers and magazines against fraudulent medical advertising. Also to seek legislation which shall hinder such advertising. 5. To endeavor to win the attention of physicians who prescribe alcoholic liquors to the teachings of great leaders in their profession who have abandoned such practice. 6. To bring to the attention of nurses the same teachings, and to seek their co-operation in education against the self-prescription of alcohol. 7. To work for legislation which shall correct the evils of the whisky drug-store, the whisky-prescribing doctor, and the dangerous "patent" medicine. 8. To gather the opinions upon alcohol of well-known physicians who do not use it, and publish them. This department originated the public agitation against injurious and fraudulent "patent" medicines which later was so ably carried on by _Collier's Weekly_, and the _Ladies' Home Journal_. That its early work in this direction was not better known to the general public was due to the fact that religious as well as secular papers were reaping large revenues from the advertising of these nostrums, and consequently refused to publish anything which might injure the trade. Indeed, in accepting some of this advertising, newspaper managers had to sign a contract that they would not publish any reading matter opposed to the nostrum business. The _Christian Advocate_ of New York city deserves special mention for having published in 1898 two articles written by Mrs. Allen under the caption, "The Danger and Harmfulness of Patent Medicines." These were in the fall of that year published in pamphlet form, and a copy sent to every local W. C. T. U. in the United States for study. Tens of thousands of copies of this and other leaflets on that theme were distributed within a few years, some local unions placing them in every home in their community. Medical journals took note of this work and commended it highly. When Mr. Bok began his campaign of education in the _Ladies' Home Journal_, for which he deserves lasting gratitude, the _American Druggist_ said he was "bowing to the clamor of the W. C. T. U." This department which began in weakness, and was for years regarded as fanatical even by many members of the W. C. T. U. has entered upon an era of victories. The National Pure Food Law requires the percentage of alcohol in patent medicines, and the presence of different dangerous drugs, to be stated upon the label. The prohibition law of Georgia forbids physicians to prescribe alcoholic beverages, absolute alcohol only being permitted. Kansas has amended her law so that whisky drug-stores are eliminated. If physicians prescribe alcohol the law forbids charge for it. Alabama forbids the sale of liquor for everything but the communion. The Internal Revenue Department has examined a large number of "patent" medicines and has listed them as intoxicating beverages. Two state medical societies and some county societies in 1908 passed resolutions to discourage the medical use of alcoholic liquors. Two national societies of druggists and pharmacists in 1908 passed resolutions against whiskey drug-stores. These are some of the results of Medical Temperance agitation. Much more may be expected in the next decade if the work is as faithfully and fearlessly carried on as in the past. This book contains much of the teachings of the department of Medical Temperance. When these views are generally accepted the liquor-problem will be well-nigh solved. CHAPTER III. ALCOHOL AS A PRODUCER OF DISEASE. That alcohol is a poison is attested by all chemists and other scientific men; taken undiluted it destroys the vitality of the tissues of the body with which it comes in contact as readily as creosote, or pure carbolic acid. The term _intoxicating_ applied to beverages containing it refers to its poisonous nature, the word being derived from the Greek _toxicon_, which signifies a _bow_ or an _arrow_; the barbarians poisoned their arrows, hence, _toxicum_ in Latin was used to signify poison; from this comes the English term _toxicology_, which is the science treating of _poisons_. Druggists in selling proof spirits usually label the bottle, "Poison." Apart from the testimony of science in regard to its poisonous nature, it is commonly known that large doses of brandy or whisky will speedily cause death, particularly in those unaccustomed to their use. The newspapers frequently contain items regarding the death of children who have had access to whisky, and drunk freely of it. Cases are reported, too, of men, habituated to drink, who after tossing off several glasses of brandy at the bar of a saloon have suddenly dropped dead. Dr. Mussey says:-- "A poison is that substance, in whatever form it may be, which, when applied to a living surface, disconcerts and disturbs life's healthy movements. It is altogether distinct from substances which are in their nature nutritious. It is not capable of being converted into food, and becoming a part of the living organs. We all know that proper food is wrought into our bodies; the action of animal life occasions a constant waste, and new matter has to be taken in, which, after digestion, is carried into the blood, and then changed; but poison is incapable of this. It may indeed be mixed with nutritious substances, but if it goes into the blood, it is thrown off as soon as the system can accomplish its deliverance, if it has not been too far enfeebled by the influence of the poison. Such a poison is alcohol--such in all its forms mix it with what you may." Dr. Nathan S. Davis said in an address given in 1891:-- "When largely diluted with water, as it is in all the varieties of fermented and distilled liquids, and taken into the stomach, it is rapidly imbibed, or taken up by the capillary vessels and carried into the venous blood, without having undergone any digestion or change in the stomach. With the blood it is carried to every part, and made to penetrate every tissue of the living body, where it has been detected by proper chemical tests as unchanged alcohol, until it has been removed through the natural process of elimination, or lost its identity by molecular combination with the albuminous elements of the blood and tissues, for which it has a strong affinity. "The most varied and painstaking experiments of chemists and physiologists, both in this country and Europe, have shown conclusively that the presence of alcohol in the blood diminishes the amount of oxygen taken up through the air-cells of the lungs; retards the molecular and metabolic changes of both nutrition and waste throughout the system and diminishes the sensibility and action of the nervous structures in direct proportion to the quantity of alcohol present. By its stronger affinity for water and albumen, with which it readily unites in all proportions, it so alters the hemaglobin of the blood as to lessen its power to take the oxygen from the air-cells of the lungs and carry it as oxyhemaglobia to all the tissues of the body; and by the same affinity it retards all atomic or molecular changes in the muscular, secretory and nervous structures; and in the same ratio it diminishes the elimination of carbon-dioxide, phosphates, heat and nerve force. In other words, its presence diminishes all the physical phenomena of life. "I say, then, that from the facts hitherto adduced, whether from accurate experimental investigations in different countries, from the pathological results developed in the most scientific societies, from the most reliable statistics of sickness and mortality, as influenced by occupations and social habits, or from the life insurance records kept on a uniform basis through periods of ten, twenty, thirty or even forty years, it is clearly shown that alcohol when taken into the human system not only acts upon the nervous system, perverting its sensibility, and, if increased in quantity, causing intoxication or insensibility, but it also, _even in small quantities_, lessens the oxygenation and decarbonization of the blood and retards the molecular changes in the structures of the body. When these effects are continued through months and years, as in the most temperate class of drinkers, _they lead to permanent structural changes, most prominently in the liver, kidneys, stomach, heart, blood-vessels and nerve structures, and lessen the natural duration of life in the aggregate from ten to fifteen years_. Consequently there is no greater, nor more destructive error existing in the public mind than the belief that the use of fermented and distilled drinks does no harm so long as they do not intoxicate. "Another popular error is the opinion that the substitution of the different varieties of beer and wine in the place of distilled liquors promotes temperance, and lessens the evil effects of alcohol on the health and morals of those who use them. Accurate investigations show that beer and wine drinkers generally consume more alcohol per man than the spirit drinkers; and while they are not as often intoxicated, they suffer fully as much from diseases and premature death as do those who use distilled spirits. Again, the beer drinker drinks more nearly every day, and thereby keeps some alcohol in his blood more constantly; while a large percentage of spirit drinkers drink only periodically, leaving considerable intervals of abstinence, during which the tissues regain nearly their natural condition. The more constant and persistent is the presence of alcohol in the blood and the tissues, even in moderate quantity, the more certainly does it lead to perverted and degenerative changes in the tissues, _ending in renal _(kidney)_ and hepatic _(liver)_ dropsies, cardiac _(heart)_ failures, gout, apoplexy and paralysis_." Sir B. W. Richardson says:-- "Alcohol produces many diseases; and it constantly happens that persons die of diseases which have their origin solely in the drinking of alcohol, while the cause itself is never for a moment suspected. A man may say quite truthfully that he never was tipsy in the whole course of his life; and yet it is quite possible that such a man may die of disease caused by the alcohol he has taken, and by no other cause whatever. This is one of the most dreadful evils of alcohol, that it kills insidiously, as if it were doing no harm, or as if it were doing good, while it is destroying life. Another great evil of it is that it assails so many different parts of the body. It hardly seems credible at first sight that the same agent can give rise to the many different kinds of diseases it does give rise to. In fact, the universality of its action has blinded even learned men as to its potency for destruction. "Step by step, however, we have now discovered that its modes of action are all very simple, and are all the same in character; and that the differences that have been and are seen in different persons under its influence are due mainly to the organs, or organ, which first give way under it. Thus, if the stomach gives way first, we say that the person has indigestion or dyspepsia, or failure of the stomach; if the brain gives way first, we say the person has paralysis, or apoplexy, or brain disease; if the liver gives way first, we say the man has liver disease, and so on. "All persons who indulge much in any form of alcoholic drink are troubled with indigestion. When they wake in the morning they find their mouth dry, their tongue coated, and their appetite bad. In course of time they become confirmed 'dyspeptics,' and as many of them find a temporary relief from the distress at the stomach, and the deficient appetite from which they suffer by taking more liquor, they increase the quantity taken, and so make matters much worse. * * * * * "There are a great number of diseases caused by alcohol, some of which are known by terms that do not convey to the mind what really has been the cause of the diseases." They are: (a) Diseases of the brain and nervous system: indicated by such names as apoplexy, epilepsy, paralysis, vertigo, softening of the brain, delirium tremens, loss of memory and that general failure of the mental power called dementia. (b) Diseases of the lungs: one form of consumption, congestion and subsequent bronchitis. (c) Diseases of the heart: irregular beat, feebleness of the muscular walls, dilation, disease of the valves. (d) Diseases of the blood: scurvy, dropsy, separation of fibrine. (e) Diseases of the stomach: feebleness of the stomach and indigestion, flatulency, irritation and sometimes inflammation. (f) Diseases of the bowels: relaxation or purging, irritation. (g) Diseases of the liver: congestion, hardening and shrinking cirrhosis. (h) Diseases of the kidneys: change of structure into fatty or waxy-like condition and other changes leading to dropsy. (i) Diseases of the muscles: fatty changes in the muscles, by which they lose their power for proper active contraction. (j) Diseases of the membranes of the body: thickening and loss of elasticity, by which the parts wrapped up in the membrane are impaired for use, and premature decay is induced. But it constantly happens that when deaths from these diseases are recorded and alcohol has been the primary cause, some other cause is believed to have been at work. While drinking parents by virtue of a strong constitution sometimes escape the penalty of their bibulous habit, it is not uncommon to see their children suffering from some disease or nervous weakness such as is caused by alcohol, "the sins of the father being visited upon the children." Erasmus Darwin says upon this point:-- "It is remarkable that all the diseases from drinking spirituous or fermented liquors are liable to become hereditary, even to the third generation, gradually increasing, if the cause be continued, till the family become extinct." Prof. Christison, of Edinburgh, in answer to inquiries from the Massachusetts State Board of Health, says of general diseases due to alcohol:-- "I recognize certain diseases which originate in the vice of drunkenness alone, which are _delirium tremens_, cirrhosis of the liver, many cases of Bright's disease of the kidneys, and dipsomania, or insane drunkenness. "Then I recognize many other diseases in regard to which excess in alcoholics acts as a powerful predisposing cause, such as gout, gravel, aneurism, paralysis, apoplexy, epilepsy, cystitis, premature incontinence of urine, erysipelas, spreading cellular inflammation, tendency of wounds and sores to gangrene, inability of the constitution to resist the attacks of epidemics. I have had a fearful amount of experience of continued fever in our infirmary during many epidemics, and in all my experience I have only once known an intemperate man of forty and upwards to recover." Professor Christison also claims that three-fourths, or even four-fifths, of Bright's disease in Scotland is produced by alcohol. Dr. C. Murchison, in speaking of alcohol as a preventive of disease, says:-- "There is no greater error than to imagine that a liberal allowance of alcoholic liquids fortifies the system against contagious diseases." In a paper read before the Royal Medical and Chirurgical Society, Oct. 22, 1872, Dr. W. Dickinson gave the following conclusions:-- "Alcohol causes fatty infiltration and fibrous encroachments; it engenders tubercles; encourages suppuration, and retards healing; it produces untimely atheroma (a form of fatty degeneration of the inner coats of the arteries), invites hemorrhage, and anticipates old age. The most constant fatty changes, replacement by oil of the material of epithelial cells and muscular fibres, though probably nearly universal, is most noticeable in the liver, the heart and the kidneys. _Drink causes tuberculosis_, which is evident not only in the lungs, but in every amenable organ." Dr. William Hargreaves says:-- "Brandy is not a prophylactic. To the temperate it is an active, exciting cause. It is well known that a single act of intemperance during the prevalence of cholera, will often produce a fatal attack. The sense of warmth and irritation (called stimulation) produced by alcoholic liquors, has led to the erroneous notion that they may prevent cholera. But the contrary we have seen is the truth, for the effects of alcoholics are to reduce the temperature of the body, and instead of stimulating, they narcotize, and reduce the life-forces, and predispose the system to all kinds of disease." The following testimonies are culled from the writings of eminent physicians:-- Sir Andrew Clark, M. D., F. R. C. P., London, Physician in Ordinary to the Queen, Senior Physician at the London Hospital: "As I looked at the hospital wards to-day, and saw that seven out of ten owed their diseases to alcohol, I could but lament that the teaching about this question is not more direct, more decisive and more home-thrusting. * * * * * Can I say to you any words stronger than these of the terrible effects of alcohol? When I think of this I am disposed to give up my profession, and go forth upon a holy crusade, preaching to all men--_Beware of this enemy of the race._" Sir William Gull, F. R. S. (late Physician to her Majesty): "I should say, from my experience, that alcohol is the most destructive agent that we are aware of in this country. I would like to say that a very large number of people in society are dying day by day, poisoned by alcohol, but not supposed to be poisoned by it." Dr. Abernethy: "If people will leave off drinking alcohol, live plainly, and take very little medicine they will find that many disorders will be relieved by this treatment alone." Dr. Forel, of the University of Zurich, Switzerland: "Life is considerably shortened by the use of alcohol in large quantities. But a moderate consumption of the same also shortens life by an average of five to six years. This is consistently and unequivocally seen in the statistics kept for thirty years by English insurance companies, with special sections for abstainers. They give a large discount, and still make more profit, as not nearly so many deaths occur as might be expected under the usual calculations. According to federal statistics in the fifteen largest towns of Switzerland, over ten per cent. of the men over twenty years of age die solely, or partly of alcoholism." Dr. J. H. Kellogg, Battle Creek, Mich.: "Every organ feels the effect of the abuse through indulgence in alcohol, and no function is left undisturbed. By degrees, disordered function, through long continuance of the disturbance, induces tissue change. The most common form of organic or structural disease due to alcohol is fatty degeneration, which may effect almost every organ in the body. * * * * * No class of persons are so subject to nervous diseases due to degeneration of nerves and nerve-centres as drinkers. Partial or general paralysis, locomotor ataxia, epilepsy and a host of other nervous disorders, are directly traceable to the use of alcohol." One of the visiting physicians of Bellevue Hospital, New York, states that at least two-thirds of all the diseases treated there originated in drink. Dr. W. A. Hammond: "It is of all causes most prolific in exciting derangements of the brain, the spinal cord, and the nerves." CHAPTER IV. TEMPERANCE HOSPITALS. THE LONDON TEMPERANCE HOSPITAL. In 1865 Dr. S. Nicholls, medical officer of the Longford Poor-law Union, published a report of the results of non-alcoholic treatment of disease as practiced by him for sixteen years in the institutions under his control. The figures for 1865 were:-- ADMITTED. RECOVERED. DIED. Fever, 142 135 7 Scarlatina, 33 30 3 Small-pox, 48 47 1 Measles, 8 8 0 --- --- --- 231 220 11 _The treatment was altogether without wines, spirits or alcohol in any form._ The death-rate reported by Dr. Nicholls was so small that some of the more observing and progressive physicians were led by it to begin similar experiments in the disuse of alcohol in other hospitals. Among these was Dr. James Edmunds, senior physician at the Lying-In Hospital, London. The experiments continued a year with a reduced death-rate among both mothers and children. But the great brewers of London, who contributed largely to the support of this hospital raised such a storm of opposition to the discontinuance of alcoholic liquors that the experiments had to be abandoned. The establishment of a temperance hospital was now suggested, and in October, 1873, a temporary institution was opened in Gower Street, accommodating only seventeen in-patients at one time. Later a fine site was secured on Hampstead Road, and in 1881 the east wing and centre were opened by the Lord Mayor of London. In 1885 the west wing was finished, and the opening ceremonies conducted by the Bishop of London. At the time of the launching of this enterprise, wine and spirits were literally "poured into" sick persons, with frightful results. Death-rates were enormous. The success of the Temperance Hospital has no doubt had much to do in modifying this abuse. Its death-rate, on an average, has been only 6 per cent. throughout the years since its beginning. This is lower than that of any other general hospital in London, and certainly proves conclusively that alcohol is not necessary in the treatment of disease. The physicians connected with it have been men of eminence in the profession, such as Dr. James Edmunds, Dr. J. J. Ridge and Sir B. W. Richardson. The visiting staff is not compelled to pledge disuse of alcohol, but is required to report if it is used. During all these years it has been given only seventeen times, then almost entirely in surgical cases, and in nearly all of these a fatal result proved it to be useless. The patients who are restored to health leave without having had aroused or implanted in them a desire for alcoholic liquors, neither have they been taught to regard them as valuable aids to the recovery of health and strength. On the contrary, there have been many who have come in, suffering from this delusion, who have had it thoroughly dispelled, both by their own experience and the experience of their fellow patients. Sir B. W. Richardson took charge of this hospital from 1892 until his death in 1897. In his report in 1893 he said:-- "I remember quite well when according to custom, I should have prescribed alcohol in all those cases that were not actually inflammatory (speaking of diseases of the alimentary system); but I never remember having seen such quick and sound recoveries as those which have followed the non-alcoholic method." The following selection showing points of practice in this hospital is taken from the same report: "For medicinal purposes, we are as free as possible from all complexity. We use glycerine for making what may be called our tinctures, and in my clinique I am introducing a series of 'waters'--aqua ferri, aqua chloroformi, aqua opii, aqua quinæ, and so on--to form the menstruums of other active drugs when they are called for. I also follow the plan of having the medicines administered with a free quantity of water, and with as accurate a dosage as can be obtained, for I agree with Mr. Spender's original proposition that the administration of medicines in comparatively small and frequent doses is more effective and useful than the more common plan of large doses given at long intervals. "I treat many cases by inhalation, and for this end I use oxygen in a new and, I hope, efficient manner. I make oxygen gas a medium for carrying other volatile substances that admit of being inhaled with it. The mode is very simple. * * * * * In the pneumonic and bronchial cases the treatment has been of the simple and sustaining kind. The medicines that have been given during the acute febrile stages have been chiefly liquor ammoniæ acetatis and carbonate of ammonia in small and frequently repeated doses. The patients have all been well and carefully fed on the milk and middle diet until convalescence was declared. In some of the more extreme instances, where there was fear of collapse from separation of fibrine in the heart or pulmonary artery, ammonia has been given freely according to the method I have for so many years inculcated. I have also in cases of depression under which fibrinous separation is so easily developed, lighted on a mode of administering ammonia which combines feeding with the medicine. I direct that a three or five-grain tabloid of bicarbonate of ammonia shall be dissolved in a cup of coffee or of coffee with milk, and be taken by the patient in that manner. The coffee can be sweetened with sugar if that is desired by the patient, and the ammonia can be so administered without any objectionable taste to the beverage. After what is called the crisis in acute pneumonia, I administer very little medicine of any kind; I trust rather to careful feeding with an occasional alterative or expectorant, as may be required. * * * * * I am satisfied that no aid I could have derived from alcoholic stimulants, as they are called, could have bettered my results. I feel sure any candid medical brother who will have the steady courage to put aside many old and unproven, though much-practiced, methods, based only on unquestioning and unquestioned experience, and to move into these new fields of observation and experience, will, in the end, find no fault with me for leaving a track which, though it be beaten very firmly and be very wide and smooth to traverse, may not, after all, be the surest and soundest path to the golden gate of cure." THE FRANCES E. WILLARD NATIONAL TEMPERANCE HOSPITAL. This hospital is situated at 343-349 South Lincoln Street, Chicago, in a handsome and well-equipped building. It is connected with a medical school. The history of its origin is best told in the words of the woman to whom the conception of such an institution first came, Dr. Mary Weeks Burnett, for several years the physician in charge:-- "In the fall of 1883 there came to a few of us the thought that there was a point of weakness in the temperance pledge. It reads, 'We promise to abstain from all liquors--_as a beverage_.' We had found in many instances in reform work that pledging to abstain from liquor 'as a beverage,' and leaving the victim to the unlimited use of it in physicians' prescriptions, was simply a skirmish with the devil's outposts, that the conflict, based upon these grounds, was short, and defeat almost sure; and the great fact remained that the innermost recesses of evil force and power were by this pledge still left unassailed. We found that this power of evil had largely entered the homes of our land through the family physicians, and that willingly or not, the physicians were being used to bring in even our innocent children as recruits to this unrighteous warfare. "Now, how could we hope to eliminate those three little words 'as a beverage' from our pledge? "In some way we must bring about an arrest of thought in the minds of 100,000 men and women physicians whose medical education warranted them in supposing that they knew that of alcohol which justified them in its full and free use in medical practice. Nothing short of a great national object lesson could ever convict and convert this broad constituency through which the power of darkness is doing his deadliest work. "In January, 1884, four of us met and organized under the name of the National Temperance Hospital. To have our sick properly cared for in our hospital we found that we should be obliged to train our own nurses. The nurse who has always been accustomed to administering alcohol under the physician's prescription at all times and under all circumstances, and to administering it herself at her own discretion if the physician is not at hand, is a terror to the temperance physician. So we included in our charter a Training School for Nurses. It is now open, and we expect, as the years go by, to send out armed with our training school diplomas, grand, noble women and men thoroughly trained in true temperance methods for relieving the sick. "Our organization lived on paper, and was sustained in purpose by prayer and planning for two years. In September, 1885, Mr. R. G. Peters, of Manistee, Michigan, signified to us his intention to give $50,000 toward our buildings whenever we had satisfactorily materialized. About the same time a good old gentleman in Michigan placed in his will for us $2,500. The dear man is still living, and we hope will live many years. Even the money when it comes can never be of greater service to us than was the knowledge at that time that the Lord was our leader and was raising up helpers in the work. "In January, 1886, we found, according to the law under which our charter was obtained, that we must commence active operations at once, or obtain a new charter. After a blessed season of prayer and counseling together in the board meeting held January 29, there being present only the members of the board at that time, Mrs. Plumb offered to advance $3,500, if necessary, toward the expenses for the first year. We accepted it with great thankfulness, rented a building the 15th of March, 1886, and formally opened the National Temperance Hospital on the 4th of May, 1886. "In April, 1886, we took a firm stand upon the alcohol question, and decided to eliminate it entirely from our list of therapeutics, as we had become convinced that there were better and more reliable remedies as stimulants and tonics. "In September, 1886, at our annual meeting, we reaffirmed this decision, and we now have the following as one of the articles of our constitution: 'All medicines used in the hospital must be prepared without alcohol, and all physicians accepting positions on the medical staff of the hospital or dispensary must pledge themselves not to administer alcohol in any form to any patient in hospital or dispensary, nor to call in counsel for such patients any physician who will advise the use of alcohol. "Any physician of pure character, and in good standing, who is a total abstainer from liquor and tobacco can, by subscribing to this pledge, become a member of our physicians' association, and if so desired, be placed upon the visiting and consulting staff of the hospital. "The cases treated in the hospital include many of the serious medical and surgical maladies. In no case has any particle of alcohol been used, and the usual inflammatory secondary symptoms resulting when alcohol is used have been entirely avoided. "Our course of building-up treatment is, we believe, unique in hospital practice. It consists of treatment by massage, heat, rest, passive exercise, etc., together with proper medication and a thoroughly nutritious diet adapted to the individual needs of the patient. "To alleviate, and, if possible, cure disease, is the design of all hospital treatment. In our hospital we seek to gain this result by means which the highest science of the day approves, and in addition to this we have especially at heart the advancement of the temperance reform. There are, we believe, thousands of temperance adherents, who do not yet fully apprehend the importance of this hospital to the permanent extension and progress of temperance principles. Although prohibition as a _principle_ has been accepted by many, yet in its _practical application_ in the home in serious illness, it is still feared by the immense majority of even our strongest prohibitionists. We are organized upon the basis _no alcohol in medicine_, and we are preparing to demonstrate fully and scientifically, so he who runs may read, that as in health, so in disease and accident, alcohol in any form works to the hindrance and injury of the vital forces, and prevents the establishment and advancement of health processes in the system." At the opening of the hospital, May 4, 1886, Miss Frances E. Willard, the president of the National W. C. T. U., gave the following address: "Nothing is changeless except change. The conservatives of one epoch are the madmen of the next, even as the radicals of to-day would have been the lunatics of yesterday. To prove this, just imagine the founders of this hospital declaring to my great-grandfather that because he had taken a cold was no reason why he should take a toddy; and _per contra_, imagine my great-grandfather's doctor marching into our presence here and now, with saddle-bags on arm, and after treating us each to a glass of grog for our stomach's sake, giving us a scientific disquisition on the sovereign virtues of the blue pill, and informing us that bleeding, cupping and starvation were the surest methods of cure! "That the story of Evolution is true I am by no means certain, but that 'We, Us, and Company,' are 'evoluting' with electric speed ourselves it is useless to deny. This very hospital is the latest mile-stone on the highway of progress in the American temperance reform. The conditions that have made its existence possible have developed in this country within about twelve years. "Public opinion, that mightiest of magicians, has within that time been educated up to this level and has said in its omnipotence: 'Hospital, be!' and, behold, the hospital _is_. "When I joined the ranks of temperance workers in 1874, a thought so adventurous as that alcoholics in relation to medicine were a curse and not a blessing had never lodged within my cranium. But, as in duty bound, I studied the subject from the practical, which is the nineteenth century standpoint. "I investigated the cause of inebriety, and found the medical use of alcoholic stimulants a prominent factor in this horrible result; I sought for expert testimony, and found Dr. N. S. Davis, ex-President American Medical Association, saying 'that in his ample clinical practice he had for over thirty years tested the medical uses of alcoholics, and had _found no case of disease and no emergency arising from accident that he could not treat more successfully without any form of fermented or distilled liquors than with_'; found Dr. James R. Nichols, of Boston, so long editor of _The Journal of Chemistry_, declaring as his deliberate scientific opinion that the entire banishment of these liquors 'would not deprive us of a single one of the indispensable agents which modern civilization demands'; found Dr. Green, of Boston, saying before the physicians of that city that it is upon the members of the medical profession and the exceptional laws which it has always demanded, that the whole liquor fraternity depends more than upon anything else to screen it from opprobrium and just punishment for the evils it entails, and that after thirty years of professional experience he felt assured that alcoholic stimulants are not required as medicines, and that many, if not a majority of the best physicians, now believe them _to be worse than useless_. Meanwhile I learned that across the sea such great physicians as Dr. Benjamin Ward Richardson, Sir Andrew Clark, Sir Henry Thompson and Sir William Gull held views which for their latitude were almost equally radical; and Dr. James Edmunds, founder of the London Temperance Hospital had demonstrated publicly and on a grand scale the more excellent way, his hospital having 4-1/2 per cent. fewer deaths than any other in London, taking the same run of cases, and that the Royal Infirmary at Manchester reported the medicinal use of alcohol fallen off 87 per cent. in recent years, with a decrease in its death-rate of over one-third. Besides all this, and independent of any such investigation, the 'intuitions' of our most earnest women were leading them out of the wilderness. As is their custom, they determined to put this matter to the test of that 'experience which one experiences when he experiences his own experience,' and a whole body of divinity upon the advantages of non-alcoholic treatment could be furnished from their evidence. I was not able personally to pursue this method, my own condition of good health having become chronic. Away back in 1875, in executive committee, one of our leading officers was stricken with _angina pectoris_. A physician was promptly summoned. 'Give her brandy,' he said, and insisted so stoutly upon it as vital to her recovery that we should probably have sent for it, but the dear woman gasped out faintly, 'I can die, but I can't touch brandy.' She is alive and flourishing to-day. Another national officer absolutely refused whisky for a violent attack of a very different character, the physician telling her that she could not live through the night without it; but she is still an active worker--a living witness that doctors are not infallible. Instances like these have multiplied by hundreds and thousands in our Woman's Christian Unions and Bands of Hope. 'No, mamma I can't touch liquor; I've signed the pledge,' is a protest 'familiar as household words.' Meanwhile, I beg you to contemplate something else that has happened. Behold, our own beloved beverage itself, 'Sparkling and bright, In its liquid light,' has come grandly to our rescue in this crusade against alcohol in the sick room. Water has become a favorite--nay, even a fashionable--medicine! The most conservative physicians freely prescribe it in the very cases where some form of alcohol was the specific so long. To be sure, they give it hot, but we do not object to that, since 'water hot ne'er made a sot,' and it cures dyspepsia and all forms of indigestion as whisky never did, but only made believe to; while its external use as a fomentation is banishing alcohol even for old folks' 'rheumatiz' where, as a remedy, it would be likely to make its final stand. "Farewell, thou cloven-foot, Alcohol! Thou canst no longer hide away in the home-like old camphor bottle, paregoric bottle, peppermint bottle or Jamaica-ginger bottle; and a tender good-by, Mrs. Winslow's Soothing Syrup, for be it known to you that the wonderful discovery stumbled over for six thousand years has in our day been made, namely, that hot water will soothe the baby's stomach-aches and the grown people's pains, and drive out a cold when all else fails. _Jubilate!_ Clear out the cupboard and top shelf of the closet now that the sideboard has gone. Let great Nature have a glance to 'mother up' humanity with the medicine, as well as the beverage, brewed in Heaven." THE RED CROSS HOSPITAL. A philanthropic young woman, Miss Bettina A. Hofker, entered Mount Sinai Training School for Nurses in 1891. Her desire was to fit herself as a nurse for the poor. After her graduation in 1893, she met Mrs. Charles A. Raymond, a benevolent lady, who offered her pecuniary assistance in her work. Miss Hofker suggested that she would like to institute a Red Cross Hospital and Training School for Nurses. Mrs. Raymond succeeded in interesting others in the proposition. The name of Red Cross however could not be used without permission of the officers of the society bearing that name, but after consultation with Miss Barton, permission was granted. Several years previous to this, Dr. A. Monæ Lesser, Dr. Thomas McNicholl and Dr. Gottlieb Steger had opened a small hospital under the name of St. John's Institute. This was now amalgamated with the Red Cross, and Dr. George F. Shrady and Dr. T. Gaillard Thomas, two of New York's leading physicians, were requested to act as consulting physicians. The hospital does not confine itself to service in its building alone, but sends its workers wherever called, to mansion or tenement. The "Sisters" are trained for field service or for any national calamity such as floods, earthquakes, forest fires, epidemics, etc. When neither war nor calamities require their presence, they devote themselves to the service of the needy poor, or wait upon the rich, if called. The heroic service rendered by the surgeons and nurses from this hospital in the Cuban War, brought their work into great prominence. At the suggestion of Miss Barton, the medical department of the hospital was commissioned to treat diseases without the use of alcoholic liquids. Dr. Lesser, the executive surgeon, is a German, and of German education, having received his medical education in the Universities of Berlin and Leipsic. In a conversation with a press representative, Dr. Lesser said some time ago:-- "We have been convinced that the use of alcohol can be entirely eliminated from our medical practice, and this has been practically accomplished at the Red Cross Hospital. We find that where stimulants are required, such remedies as caffeine, nitro-glycerine and kolafra take the place of alcohol, and are even more satisfactory. The main use of alcohol is to stimulate the action of the heart in various ailments. The blood is thus forced to the remote parts of the system, and poisonous substances carried away. But, besides serving this good purpose, the drug tears down and ultimately destroys the cellular tissues of the body. A relapse is certain to follow the application. The drugs that I have mentioned serve exactly the same purpose without the disastrous results. We are proving this every day at the Red Cross Hospital. "Only a few days ago a boy was brought in, apparently at the point of death. He was put into bed and watched by the nurse. After a little ammonia had been given to him as a stimulant, he unconsciously expressed himself to the effect that it was not the same as they gave him in another place, and gradually when it dawned upon him that no alcohol was administered by the Red Cross, he said, 'Gin has allers made me better.' The doctor in charge, who already suspected that the boy was pretending illness for the sake of the drink, was not surprised an hour or two afterwards to learn that he had demanded his clothes, dressed himself, and left the hospital most ungratefully, but apparently quite well." Dr. George F. Shrady, one of the consulting physicians, is famous as having been in attendance upon both President Garfield and President Grant. He is the editor of the _Medical Record_, one of the most important medical journals published in America. While not a non-alcoholic physician, he says of the medical use of intoxicants:-- "There is altogether too much looseness among physicians in prescribing alcohol. It is a dangerous drug. There is much more alcohol used by physicians than is necessary, and it does great harm. Whisky is not a preventive; it prevents no disease whatever, contrary to a current notion. Another thing, we physicians get blamed wrongfully in many cases. People who want to drink, and do drink, often lay it on to the physician who prescribed it. * * * * * I think that in most cases where alcohol is now used, other drugs with which we are familiar could be used with far better effect, and with no harmful results." Dr. Steger, another physician of the staff, says:-- "I don't use alcohol at all in my practice. I used to use it, but my observation has been that other drugs do the same work without the harmful results. Alcohol over-stimulates the heart, and tears down the cellular tissues of the system, besides causing other deleterious effects. The use of alcohol is simply a superstition among physicians. They have used it so long that they think they always must. I am not a total abstainer, but that only shows that I take better care of my patients than I do of myself. It is not good for a healthy man to drink, but sometimes folks like myself do things which had better be left undone. I have seen patients in hospitals made absolutely drunk by their physicians." The following interesting items in regard to practice in this hospital are culled from the report of 1897:-- "Temperature was never reduced by active drugs known as antipyretics. "Water was allowed freely after all kinds of surgical operations and in fevers. "Alcohol was never used as an internal medicine. "The free use of water in saline solutions directly injected into the tissues was found of great service. Quarts have been injected that way with most satisfactory results. "Antipyretics were altogether discarded as it is well known that their action diminishes the tone of the heart. Artificial reduction of temperature only deludes one into the belief that the drug has improved the condition of the patient, while in reality, it has no beneficial influence on the disease, and has reduced the vital resistance of the patient. In no case has high temperature harmed a patient and there was every evidence that in some instances a high temperature was preferable to a low one. "Special attention has been given to the use of alcohol in disease, not with any desire to approve or disapprove it, but solely for the purpose of discovering the truth, for nothing seems of greater public interest from a medical standpoint than the truth regarding a subject for which so many virtues are claimed on the one hand, and so many destructive elements proven on the other. * * * * * "We criticise the treatment of no institution, antagonize no school of medicine, claim no unusual or peculiar scientific virtue, but what we do maintain and insist upon is this: that the human body may be ever so afflicted, ever so reduced, the heart ever so feeble, and the spark of life ever so dim, the conscientious student of medicine can secure as good results without as with administration of antipyretics, sparkling wines, beers or liquors. "Experience teaches that true science does not antagonize nature. In surgical cases, in septicæmia, in pneumonia, or in any of the fevers, water freely administered has proven to be a real source of comfort, and an aid to recovery. It is amazing how favorably diseases terminate under this beneficent beverage. The withholding of food does not retard, but rather hastens convalescence. "In the conduct of our Red Cross patients, irrespective of their condition when admitted, it can be truly said that after treatment began, delirium has not been witnessed in a single instance, and as our hospital reports indicate, our mortality has been unusually small. "Alcohol has not figured as a life-saver in our institution. Cases of extreme collapse following major operations, cases of pneumonia, where the pulse ranged from 160 to 220, patients suffering from pernicious anæmia, septicæmia, pyæmia, cholera infantum and typhoid fever, some of whom when first seen were in the worst stages of delirium and collapse have without alcohol regained consciousness, overcome delirium and made excellent recoveries. "The following cases very forcibly illustrate the results of non-alcoholic treatment:-- "Case No. 1. A child, aged nine months, under treatment for six days for pneumonia, came under our notice on the seventh day. The temperature was 106 5-10; pulse was 220; respirations 90. Whisky, which had been given previously to the extent of two ounces daily, was stopped. Carbonate of ammonia, caffeine salicylate, nitro-glycerine and 1-10 of a drop of aconite were given internally; camphorated lard applied externally; with the result that on the ninth day temperature stood 99; pulse 100; respiration 20. The child made a complete recovery. "Case No. 2. L. was a child aged eight months, suffering from a very violent attack of entero-colitis. For three weeks previous to coming under our notice the patient received brandy, stimulating foods and alkaline mixtures. Fearfully emaciated, temperature 106, feeble pulse 182, frequent bloody discharges from the bowels, numbering as much as thirty in a day and constant vomiting, the child was considered beyond hope. Under these circumstances, and at this time we first saw her. Brandy and all foods were stopped; bowel flushings were given, 1-12 of a drop of tincture of aconite was administered every half hour and salicylate of caffeine every two hours. In twenty-four hours the temperature was 105 and the pulse 160. In two days, temperature was 102 and the pulse 140. In one week, temperature was 99 5-10, pulse 110. In three weeks, the patient was discharged cured. "Case No. 3. Mrs. C., aged forty-three, who had been under treatment for seven weeks for metrorrhagia, nietortes and peritonitis came under our notice. Brandy which had been previously given in large quantities had proved of no avail and the patient was considered beyond recovery. We found her completely prostrated, temperature 102, pulse 170, and unconscious. The heart very weak and irregular. The brandy was discontinued, salicylate of caffeine and nitrate of strychnia were given with the result that in a short time the patient was convalescent and finally recovered. "Each case in our hospital is an additional proof that whether found in wines, spirits or beers, alcohol can claim no right as an indispensable medicine." Dr. Lesser, who was Surgeon-General of the American Red Cross in the Cuban War said after his return from his first visit to Cuba that four out of six of his patients, to whom he allowed liquor to be given as a concession to the popular idea that it was necessary, died; while subsequently in treating absolutely without alcohol sixty-three similar cases, only one died, and he upon the day on which he was received at the hospital. ALCOHOL IN OTHER HOSPITALS. In the spring of 1909 a circular letter was sent to some of the best known hospitals throughout the country asking if the use of alcoholic liquors had decreased in those institutions during the past ten years. From the replies received the following statements are taken: Cook County Hospital, Chicago, sent figures for two years only, 1907, and 1908. With 28,932 patients treated in 1907, the bill for wines and liquors amounted to only $719.40. In 1908 with 31,202 patients the bill for liquors amounted to $970.65. This makes a _per capita_ expenditure for liquors for 1907 of .024 cents, and for 1908 a _per capita_ expenditure of .031 cents. The _per capita_ expenditure for liquors during the same years in Bellevue and Allied Hospitals of New York city, with from 30,000 to 40,000 patients treated was .0246 and .029. Two or three cents as the yearly _per capita_ expenditure for alcoholic liquors in the two largest hospitals in America is striking evidence that the physicians practicing there have not large faith in whisky, or other alcoholic liquors as remedial agents. Long Island, N. Y., State Hospital:--"We are not using more than half the amount of alcohol we used ten years ago." Manhattan State Hospital, Ward's Island, New York City:--"Our patient population has averaged nearly 4,500 the last four years, and we have had about 750 employees, many of whom are prescribed for by institution physicians. The _per capita_ cost of distilled liquors for the last fiscal year was .0273 at this hospital." Milwaukee City Hospital:--"No alcoholic liquors are used to any extent in this hospital, or prescribed by the staff. I know of no move against such use of liquors, but venture the assertion that the physicians believe they have more reliable agents at their command for most cases." Pennsylvania Hospital, Philadelphia:--"We are now using about one-third the amount of liquor that was used in the Pennsylvania Hospital ten years ago." The Presbyterian Hospital of Philadelphia sent figures for the years from 1900 to 1908. Those for 1900 show the cost of liquors to be $774.20 and for 1908 only $331.48. The number of patients was not given. Grady Hospital, Atlanta, Georgia:--"That less liquor is now used than formerly is a fact well known to all connected with the institution." Garfield Memorial, Washington, D. C., sent figures for ten years. For 1899 the cost of liquors was $490.08, with a steady decrease to 1908 when the cost was $274.58. Number of patients in 1899 was 1,171; in 1908, 1,898 patients. The _per capita_ for 1908 was .144 cents. University Hospital, Ann Arbor, Michigan:--"Very little alcohol is prescribed in this hospital." Maine General Hospital, Portland:--"Comparatively speaking, we use but little alcohol for the reason that we now have many remedies which, especially for continued use, are superior to alcohol, which twenty years ago we did not have. For the conditions or emergencies in which we think alcohol has a value it is used when required or deemed best." Buffalo, New York, State Hospital sent figures for six years which include cost of alcohol used in the manufacture of pharmaceutical preparations, which, of course, makes a very decided difference. _Per capita_ for 1903 was 22 cents; for 1908 it was 18 cents. Buffalo, New York, General Hospital:--"The use of alcohol as a drug in this hospital has diminished about one-third in the past ten years, but I wish to add in this connection that the use of all drugs has diminished in this hospital, and to the best of my knowledge in other institutions of a like character. The use of the microscope, and other studies have advanced the science of medicine the same as all other branches of learning, and other methods are coming to be used beside the use of drugs." Mount Sinai, New York City:--"The use of alcoholic beverages here for medical purposes is the exception rather than the rule. The majority of our cases are surgical cases, and in these alcoholic liquors are rarely prescribed for any purpose whatsoever." Massachusetts Homeopathic Hospital, Boston, sent figures for five years. For 1904 the cost of alcoholic liquors was $197.69 with 3,720 patients; for 1908, the cost was $69.82 with 4,543 patients. The _per capita_ cost for the five years is as follows: 1904, cost .0531 cents; 1905, cost .0474; 1906, cost .034; 1907, cost .0171; 1908, cost .0153. In the _Boston Medical and Surgical Journal_ of April 15, 1909, Dr. Richard C. Cabot gave a table showing the decrease in the use of alcoholic liquors, and of other drugs in Massachusetts General Hospital, Boston. The following is his table: 1898 1899 1900 1901 Ale and Beer $759.00 $793.90 $1,062.00 $723.00 Wines and liquors, 1,563.00 2,209.00 1,348.00 1,063.00 --------- --------- --------- --------- Total for alcoholic drinks, $2,321.00 $3,002.00 $2,410.00 $1,786.00 Total for other medicines, $8,424.00 $10,013.00 $10,132.00 $9,168.00 Number of patients, 5,005 5,203 5,012 5,495 Cost of alcohol per patient, $0.46 $0.57 $0.48 $0.32 Cost of medicine per patient, 1.68 1.92 2.02 1.66 1902 1903 1904 1905 Ale and beer, $605.00 $338.00 $431.00 $301.00 Wines and liquors, 799.00 688.00 904.00 144.00 --------- --------- --------- ------- Total for alcoholic drinks, $1,404.00 $1,026.00 $1,335.00 $445.00 Total for other medicines, $9,772.00 $7,815.00 $9,162.00 $7,018.00 Number of patients, 5,342 5,429 5,709 5,531 Cost of alcohol per patient, $0.26 $0.19 $0.23 $0.09 Cost of medicine per patient, 1.88 1.43 1.60 1.26 1906 1907 Ale and beer, $192.00 $203.00 Wines and liquors, 546.00 610.00 --------- --------- Total for alcoholic drinks, $738.00 $813.00 Total for other medicines, $5,981.00 $5,492.00 Number of patients, 5,513 5,966 Cost of alcohol per patient, $0.13 $0.13 Cost of medicine per patient, 1.00 0.92 Dr. Cabot says:-- "Since there has been no fall in the price of stimulants or medicine, the diminished expenditure corresponds to a diminution in the number of doses of medicine and stimulants, and indicates a rapid and striking change of view among the members of the staff of the hospital, especially in the past five years, when it has become generally known that alcohol is not a stimulant but a narcotic and that drugs can cure only about half a dozen of the diseases against which we are contending. "There has been during this period no increase in the proportion of surgical cases among the whole number treated, so that the decreased use of medicines and alcoholic beverages has not resulted from an increased resort to surgical remedies. On the other hand, there has been a great increase in the utilization of baths (hydrotherapeutics), of massage, of mechanical treatment and of psychical treatment, all of which accounts no doubt for part of the falling off in the use of alcohol and drugs." CHAPTER V. THE EFFECTS OF ALCOHOL UPON THE HUMAN BODY. The body is made up mainly of cells, fibres and fluids. The cell is the most important structure in the living body. Life resides in the cell, and every animal may be considered a mass of cells, each of which is alive, and each of which has its own work to accomplish in the building up of the body. The matter which forms the mass of a cell is called protoplasm, or bioplasm. It resembles somewhat the white of a raw egg, which is almost pure albumen. Cells make up the body, and do its work. Some are employed to construct the skeleton, others are used to form the organs which move the body; liver-cells secrete bile, and the cells in the kidneys separate poisonous matters from the blood in order that they may be expelled from the system. These cells, composing the mass of the body, being very delicate, are easily acted upon by substances coming into contact with them. If substances other than natural foods or drinks are introduced into the body, the cells are injuriously affected. Alcohol is especially injurious to cells, "retarding the changes in their interior, hindering their appropriation of food, and elimination of waste matters, and therefore preventing their proper development and growth." "Bioplasm is living matter; it is structureless, semi-fluid, transparent and colorless. It is the only matter that can grow, move, divide itself and multiply, the only matter that can take up pabulum (food) and convert it into its own substance; and is the only matter that can be nourished. The bioplasm in the cell gets its nourishment by drawing in of the pabulum through the cell wall, and in that way building up the formed material while it is being disintegrated on the outer surface. This process is continually being carried on, and is what is meant by nutrition. Disintegration of the formed material is as essential as the building up of it. All organic structure is the result of change taking place in bioplasm. These small cell-like bioplasts are the workmen of the organism. All wounds are repaired by them, all fractures are united, and all diseased tissues brought back to their normal and healthy condition, unless there is not vitality enough to overcome disease, or they have been injured or killed by poisonous material. The body is kept in repair by this living matter, and all the functions of the body are but the result of its action. We may examine, watch and study bioplasm under the microscope; we see it take up pabulum and convert that which is adapted to itself into its own substance, while all other substances are rejected. We take a solution of what we call a stimulant and immerse the bioplasm in it, and we find that it increases its activity, moves faster, takes up more pabulum, and divides more rapidly than in the unstimulated condition. We next add an astringent, and it begins to move more slowly, and soon contracts into a spherical shape and remains contracted, or may move slowly to a limited extent, depending on the strength of the solution. We next take a relaxant, and gradually the living matter begins to spread in all directions, in a laxy-like manner, and becomes so thin as to be almost undiscernible, and takes up very little, if any, pabulum. If sufficiently relaxed or astringed, the movements may entirely cease so as to appear lifeless, but when a stimulant is again added the same result is obtained as before--it begins to move, and acts as vigorous as ever, which shows that it was not injured in the least by the agents used. Alcohol is called a stimulant. We take a weak solution of alcohol and try it in the same way; but we find that almost instantly the living matter contracts into a ball-like mass. Now, we may through ignorance suppose that alcohol acts as an astringent, and so we try to stimulate it with the same harmless agent before used, but no impression is made on it; it does not move; it is dead matter. These are demonstrable facts, and lie at the foundation of physiology, pathology and the practice of medicine. Alcohol destroys the very life force that alone keeps the body in repair. For a more simple experiment as to the action of alcohol, take the white of an egg (which consists of albumen, and is very similar to bioplasm), put it into alcohol, and notice it turn white, coagulate and harden. The same experiment can be made with blood with the same result--killing the blood bioplasts. Raw meat will turn white and harden in alcohol. Alcohol acts the same on food in the stomach as it does on the same substances before introduced into the stomach, and acts just the same on blood and all the living tissues in the system as out of it; and this alone is enough to condemn its use as a medicine." From _Alcohol, Is It a Medicine?_ by W. F. Pechuman, M. D., of Detroit, Michigan. ALCOHOL AND STOMACH DIGESTION. The nitrogenous portions of the food are the only ones digested in the stomach. The oily and fatty, as well as the starchy portions, are digested in the small intestines. Very little was known about digestion until 1833, when Dr. Beaumont published the results of his investigations upon the stomach of Alexis St. Martin. St. Martin received a severe wound in the left side from a shot-gun. The wound in healing left an opening into the stomach about 4/5 of an inch in diameter, closed on the inside by a flap of mucous membrane. Through this opening the interior of the stomach could be thoroughly examined. Dr. Beaumont made hundreds of observations upon this young man, who was in his home several years. He says:-- "In a feverish condition, from whatever cause, obstructed perspiration, _excitement by alcoholic liquors_, overloading the stomach with food, fear, anger or whatever depresses or disturbs the nervous system, the lining of the stomach becomes somewhat red and dry, at other times pale and moist, and loses its smooth and healthy appearance, the secretions become vitiated, greatly diminished or entirely suppressed." One day after giving St. Martin a good wholesome dinner, digestion of which was going on in regular order, Dr. Beaumont gave him a glass of gin. The digestive process was at once arrested, and did not begin again until after the absorption of the spirit, after which it was slowly renewed, and tardily finished. Gluzinski made some conclusive experiments with a syphon. He drew off the contents of the stomach at various times with and without liquor. He concluded that alcohol entirely suspends the transformation of food while it remains in the stomach. Dr. Figg, of Edinburgh, fed two dogs with roast mutton; to one of them he gave 1-1/2 ounces of spirit. Three hours later he killed both dogs. The dog without liquor had digested the mutton; the other had not digested his at all. Similar experiments have been made repeatedly with like result. The elements of our food which the stomach can digest depend upon the pepsin of the gastric juice for their transformation. Alcohol diminishes the secretions of the gastric juice, unless given in very minute quantities, and kills and precipitates its pepsin. It also coagulates both albumen and fibrine, converting them into a solid substance, thus rendering them unfit for the action of the solvent principles of the gastric juice. Hence, any considerable quantity of alcohol taken into the stomach must for the time retard the function of digestion. Many experiments have been made with gastric juice in vials, one, having alcohol added, the other, not having alcohol. The meat in the vials without alcohol, in time dissolved till it bore the appearance of soup; in the vials to which alcohol was added the meat remained practically unchanged. In the latter a deposit of pepsin was found at the bottom, the alcohol having precipitated it. Dr. Henry Munroe, of England, one of the experimenters in this line of research, says:-- "Alcohol, even in a diluted form, has the peculiar power of interfering with the ordinary process of digestion. "As long as alcohol remains in the stomach in any degree of concentration, the process of digestion is arrested, and is not continued until enough gastric juice is thrown out to overcome its effects."--_Tracy's Physiology_, page 90. In _The Human Body_, Dr. Newell Martin says:-- "A vast number of persons suffer from alcoholic dyspepsia without knowing its cause; people who were never drunk in their lives and consider themselves very temperate. Abstinence from alcohol, the cause of the trouble, is the true remedy." Sir B. W. Richardson:-- "The common idea that alcohol acts as an aid to digestion is without foundation. Experiments on the artificial digestion of food, in which the natural process is closely imitated, show that the presence of alcohol in the solvents employed interferes with and weakens the efficacy of the solvents. It is also one of the most definite of facts that persons who indulge even in what is called the moderate use of alcohol suffer often from dyspepsia from this cause alone. In fact, it leads to the symptoms which, under the varied names of biliousness, nervousness, lassitude and indigestion, are so well and extensively known. "From the paralysis of the minute blood-vessels which is induced by alcohol, there occurs, when alcohol is introduced into the stomach, injection of the vessels and redness of the mucous lining of the stomach. This is attended by the subjective feeling of a warmth or glow within the body, and according to some, with an increased secretion of the gastric fluids. It is urged by the advocates of alcohol that this action of alcohol on the stomach is a reason for its employment as an aid to digestion, especially when the digestive powers are feeble. At best this argument suggests only an artificial aid, which it cannot be sound practice to make permanent in place of the natural process of digestion. In truth, the artificial stimulation, if it be resorted to even moderately, is in time deleterious. It excites a morbid habitual craving, and in the end leads to weakened contractile power of the vessels of the stomach, to consequent deficiency of control of those vessels over the current of blood, to organic impairment of function, and to confirmed indigestion. Lastly, it is a matter of experience with me, that in nine cases out of ten, the sense of the necessity, on which so much is urged, is removed in the readiest manner, by the simple plan of total abstinence, without any other remedy or method." In _Medicinal Drinking_, by John Kirk, M. D., this passage occurs:-- "Especially in the matter of support, it is essential to our inquiry to examine fully into alcoholic influence on the change by which food introduced into the stomach becomes capable of passing into the circulation and constituent elements of the living frame. It may be best to suppose a case for illustration. Here, then, is a child of, say, six or seven years of age. This child is of the slenderer sex and has been brought into a state of extreme weakness as the consequence of fever. The fury of the disease is expended, but it has, as nearly as may be, extinguished life. The medical man's one hope for saving this child is now concentrated in what he fancies to be 'support.' Beef-tea, arrowroot and _port wine_ are prescribed. Let it be kept in mind that the pure wine of the grape is discarded in favor of alcoholic wine. Our question is, What effect will the alcohol in this wine have on that process by which the food is to prove really nourishing, and so to be that support which is the only hope for this child? Will it help her? or will it so hinder the necessary change in the food as to kill her, unless she has sufficient strength left to get above its influence? These are surely important questions. Neither of them can be set at rest by the fact that she recovers; for she _may_ have strength enough, as many have had, to survive even a serious error in her treatment. "What light, then, does true science throw on these important questions? All who know anything on the subject are aware that alcohol, instead of dissolving _food_, or aiding in its dissolution, is one of the most powerful agents in preventing that dissolution. On what principle, then, is it possible that its being mixed with the materials of food, in this case, can aid in their dissolution, so that they may more easily be changed into the fresh blood required to sustain and recover life in this child?" He then refers to the experiments with gastric juice in vials, and proceeds:-- "Here, then, is indisputable evidence that alcohol effectually _prevents_ that process which is known as digestion, and which is essential to food's being of any use to support life in man. On what principle can the physician explain his introduction of it into the stomach of a child whose thread of life is attenuated to the slenderest hair? "We urge the chemical truth that the alcohol, given to promote support, is of such a nature as to prevent that which would nourish, from effecting the end so much to be desired, and for which true food is adapted." The pure, unfermented juice of the grape, free from chemical preservatives, is now used by many physicians where the miserable concoction of drugs and alcohol, known as port wine, was once considered essential. Unfermented grape juice contains all the nutriment of the grape, without any of the poison, alcohol. After being opened it should be kept in a cool place, or it will ferment and produce alcohol. Fruit juices are very grateful to a fever patient, and should not be withheld as they are in so many cases. Dr. J. H. Kellogg, and other non-alcoholic physicians, recommend them highly. They are better than milk, as milk frequently produces "feverishness," while fruit juices allay it. For those who think beer or ale an incentive to appetite, Dr. N. S. Davis, and others, recommend an infusion of hops, made fresh each day. It is the bitter which promotes appetite, not the alcohol. For the sake of the little bitter in beer, it is not wise to vitiate the tone of the stomach with the alcohol it contains, and which is its active principle. Many mothers have become drunkards, secret drunkards, possibly, through the use of beer as a fancied aid to digestion. Multitudes of men suffer untold horrors from dyspepsia, caused by the beer which they mistakenly suppose to be a friend to their stomach. EFFECTS OF ALCOHOL UPON THE BLOOD. "The blood is a thick, opaque fluid, varying in color in different parts of the body from a bright scarlet to a dark purple, or even almost black." If a drop of blood be placed under a microscope, immense numbers of small bodies will be seen. These are called blood-globules, or corpuscles, or discs. There are both red, and white or colorless, corpuscles. Each red corpuscle is soft and jelly-like. Its chief constituent, besides water, is a substance called hemoglobin, which has the power of combining with oxygen when in a place where that gas is plentiful, and of giving it off again in a region where oxygen is absent, or present only in small quantity. Hence, as the blood flows through the lungs, which are constantly supplied with fresh air, its corpuscles take up oxygen, which, as it flows on, is carried by them to distant parts of the body where oxygen is deficient, and there given up to the tissues. This oxygen-carrying is the function of the red corpuscles. Hemoglobin, as the coloring-matter of the blood is called, is dark purplish-red in color; combined with oxygen it is bright "scarlet red." Accordingly, the blood which flows to the lungs after giving up its oxygen is dark red in color, its dark color being due to the impurities it contains; and that which, having received a fresh supply of oxygen, flows away from the lungs is bright scarlet--having been cleansed of its impurities. The bright red blood is called _arterial_, and the dark red _venous_. The work assigned to the blood in the economy of the human system is: first, to pick up nutriment in its course through the walls of the alimentary canal, and oxygen, as it flows through the lungs, and convey these to all other parts of the body. Second, to act as a sort of sewage stream that drains off waste matter, and to carry this to the organs of excretion by which waste is expelled from the body. "The blood is the great circulating market of the body, in which all the things that are wanted by all parts, by the muscles, the brain, the skin, the lungs, liver and kidneys, are bought and sold. What the muscles want they buy from the blood; what they have done with, they sell back to the blood; and so with every other organ and part. As long as life lasts this buying and selling is forever going on, and this is why the blood is forever on the move, sweeping restlessly from place to place, bringing to each part the thing it wants, and carrying away those with which it has done. When the blood ceases to move, the market is blocked, the buying and selling cease, and all the organs die, starved for lack of the things they want, choked by the abundance of things for which they have no longer any need."--FOSTER. This is one way of saying that the processes of repair and waste are constantly going on in the body. Every action of the body, every impulse of the mind uses up some cell-matter, which must then be passed from the body as waste. This is called tissue disintegration. New cells to repair tissue waste are built up from the nutriment which the blood carries from the alimentary canal after the process of food digestion is accomplished. This is called tissue construction, or the process of assimilation. Technically, these are the metabolic, or destructive and constructive processes. Both are essential to health and life. Any substance taken into the body, which will interfere with these processes of nutrition and waste is inimical to health, and in time of disease, dangerous to life. _Alcohol is such a substance._ The cells and tissues of the body which are touched by alcohol are more or less hardened and injured by it, hence are less perfectly nourished than they are when alcohol is not present in the blood. Even a teaspoonful of alcohol to a 1/2 gallon of water hinders natural growth. If liquor is given to puppies it keeps them small. Young growing-cells are most affected by it, because they are most tender. There are growing-cells in adults as well as in children, for people are growing and changing all through their lives. Hence, when alcohol is administered in sickness the cells are hindered in the full performance of their function of taking up food for the building up of tissue, and as a consequence, the patient's body is really robbed of nutriment by the agent which is supposed to be "keeping up his strength." Truly, "Wine is a _mocker_, strong drink is raging, and whosoever is _deceived_ thereby is not wise." That alcohol interferes with the passage of waste matter from the body is generally conceded. Indeed this is claimed by the advocates of its medicinal use as one of its virtues: the fact that less waste passes from the body being urged as evidence that there is less waste, that in some way alcohol preserves tissue from being used up in the natural way. Those who speak thus seem to think that they know better than the Creator how the body should be treated. He made the body so that in health, work, waste and repair should be equal to one another. Dr. Ezra M. Hunt says in _Alcohol as a Food and as a Medicine_:-- "We believe that any one who will candidly review the claims put forth for alcohol, in that it delays in any of these hypothetical ways, tissue-change, will conclude that it has no such power _in a salutary sense_, and that it is unwarrantably assumed that to retard tissue metamorphosis (change) is equivalent to tissue nutrition." Dr. N. S. Davis says:-- "It seems hardly possible that men of eminent attainments in the profession should so far forget one of the most fundamental and universally recognized laws of organic life as to promulgate the fallacy here stated. The fundamental law to which we refer is, that all vital phenomena are accompanied by, and dependent upon, molecular or atomic changes; and whatever retards these retards the phenomena of life; whatever suspends these suspends life. Hence, to say that an agent which retards tissue metamorphosis is in any sense a food, is simply to pervert and misapply terms." Non-alcoholic physicians unite in declaring that the retention of waste matter in the system, caused by alcohol, invites disease, and tends to inflammatory action; and in illness retards, and frequently prevents, recovery, for the germs of disease remain longer in the body than they would were it not for the delay in the passage of effete matter. _Alcohol not only hinders the blood in its work of tissue nutrition; it also prevents the full oxidation of the blood in the lungs._ "In order that a steam engine may work and keep warm it is not merely necessary that it have plenty of coal, but it must also have a draft of air through its furnace. Chemistry teaches us that the burning in this case consists in the combination of a gas called oxygen, taken from the air, with other things in the coals; when this combination takes place a great deal of heat is given off. The same thing is true of our bodies; in order that food matters may be burnt in them and enable us to work and keep warm, they must be supplied with oxygen; this they get from the air by breathing. We all know that if his supply of air be cut off a man will die in a few minutes. His food is no use to him unless he gets oxygen from the air to combine with it; while he usually has stored up in his body an excess of food matters which will keep him alive for some time if he gets a supply of oxygen, he has not stored up in him any reserve, or, if any, but a very small one, of oxygen, and so he dies very rapidly if his breathing be prevented. In ordinary language we do not call oxygen a food, but restrict that name to the solids and liquids which we swallow; but inasmuch as it is a material which we must take from the external universe into our bodies in order to keep us alive, oxygen is really a food as much as any of the other substances which we take into our bodies from outside, in order to keep them alive and at work. _Suffocation_, as death from deficient air supply is named, is really death from oxygen-starvation."--Martin's _Human Body_. Much of the food taken into the body is burned to supply energy and heat. This burning is called oxidation. When food is burned, or oxidized, either in the body, or out of it, three things are produced, carbon dioxide (_carbonic acid gas_), water and ashes. These are waste matters, and must be expelled from the body, or they will clog up the various organs, as the ashes and smoke of an engine would soon put its fire out if they were allowed to accumulate in the furnace. It is the duty of the lungs to pass the carbon dioxide out to the air. With every breath exhaled, this poison gas, generated in the body through the oxidation of food, passes from the system. With every breath inhaled the life-giving oxygen is taken into the body; providing that the person is not in a close room from which the fresh air is excluded. Any substance taken into the body which interferes with the reception of oxygen into the blood, and with the giving off of carbon dioxide from the same is a dangerous substance. _Alcohol is such a substance._ It has already been stated that it is the duty of the little red corpuscles in the blood to take up oxygen in the lungs, and carry it to every part of the body, and upon the return passage to the lungs to convey the _débris_, or used-up material, from the tissues, called carbon dioxide gas. A little vapor and ammonia accompany this gas. The action of alcohol upon these little corpuscles, or carriers of the blood, is to somewhat harden and shrivel them, so that they are unable to take up and carry as much oxygen as they can when no injurious substance is present in the blood. In consequence of this, the blood can never be so pure when alcohol is present, as it may be in the absence of this agent. The following is taken from _The Temperance Lesson Book_, by B. W. Richardson, M. D.:-- "When the blood in the veins is floating toward the right side of the heart, which communicates with the lungs, it carries with it the carbonic acid (_carbon dioxide_), and, as I have found by experiment, a great part of this gas is condensed in these little bodies, the corpuscles. Arrived at the lungs, the blood comes into such contact with the air we breathe, that the oxygen gas in the air is freely absorbed by the little corpuscles, while the carbonic acid is given up into the air-passages of the lungs, and is thrown off with every breath we throw out. In this process the blood changes in color. It comes into the lungs of a dark color; it goes out of them a bright red. * * * * * The parts of the blood on which alcohol acts injuriously are the corpuscles and the fibrine. The red corpuscles are most distinctly affected. They undergo a peculiar process of shrinking from extraction of water from them. They also lose some of their power to absorb oxygen from the air. In confirmed spirit-drinkers the face and hands are often seen of dark mottled color, and in very bad specimens of the kind, the face is sometimes seen to be quite dark. This is because the blood cannot take up the vital air in the natural degree. * * * * * "If anything whatever interferes with the proper reception of oxygen by the blood, the blood is not properly oxidized, the animal warmth is not sufficiently maintained, and life is reduced in activity. If for a brief interval of time the process of breathing is stopped in a living person, we see quickly developed the signs of difficulty, and we say the person is being suffocated. We observe that the face becomes dark, the lips blue, the surface cold. Should the process of arrest or stoppage of the breathing be long continued the person will become unconscious, will stagger and fall, and should relief not be at hand, he will in a very few minutes die. "I found by experiment that in presence of alcohol in blood the process of absorption of oxygen was directly checked, and that even so minute a quantity as one part of alcohol in five hundred of blood proved an obstacle to the perfect reception of oxygen by the blood. The corpuscles are reduced in size, when large quantities of alcohol are taken, and become irregular in shape." Dr. J. J. Ridge says in _Addresses on the Physiological Action of Alcohol_:-- "It has been found by experiment that, when alcohol is taken, less carbonic acid comes away in the breath than when it is not. This is partly because the blood-corpuscles cannot carry so much, and partly because so much is not produced, because there is less oxygen to join with the food and produce it. Just as burning paper smokes when it does not get enough oxygen, so other things are formed and get into the blood when there is not enough oxygen to make carbonic acid. These things make the blood impure, and cause extra work and trouble to get rid of them. This is why persons who drink alcohol are more liable to have gout and other diseases, than total abstainers." Dr. Alfred Carpenter, formerly president of the Council of the British Medical Association, says in _Alcoholic Drinks_:-- "A blood corpuscle cannot come into direct contact with an atom of alcohol, without the function of the former being spoiled, and not only is it spoiled, but the effete matter which it has within its capsule cannot be exchanged for the necessary oxygen. The breath of the drunken man does not give out the quantity of carbonic acid which that of the healthy man does, and the ammoniacal compounds are in a great measure absent. Some of the carbon and effete nitrogenous matter is kept back. The retention of these poisonous matters within the body is highly injurious. Let the drinker suffer from any wound or injury and this effete matter in his blood is ready at a moment's notice to prepare and set up actions called inflammatory or erysipelatous, or some other kind; by means of which too often the drinker is hurried into eternity, although, perhaps, he may have been regarded as a perfectly sober man, and have never been drunk in his life." In the light of these scientific facts, what can appear more utterly foolish than the swallowing of alcoholic patent medicines which are widely advertised as "Blood Purifiers"? That they will render the blood impure is only too evident in the light of scientific truth. Dr. Nathan S. Davis has written much in disapproval of the use of alcohol in fevers, pneumonia and diphtheria, putting stress upon the fact that these diseases, of themselves, interfere with the reception of oxygen into the blood, and hence the use of all remedies that notably diminish the internal distribution of oxygen, or impair the corpuscles of the blood, should be avoided. Not only is alcohol of such a nature, but all the coal-tar series of antipyretics also. Since the internal distribution of oxygen, and the processes of tissue change are essential to the repair of the body, and alcohol hinders the blood in the full performance of its duties in these respects, it certainly seems clear that those physicians, who are extremely cautious in the use of this drug, or who do not use it at all, are more likely to be successful in saving their patients than are those who use it freely. Death-rates, with and without alcohol, show conclusively the superiority of the latter treatment. ALCOHOL AND THE HEART. The organs of circulation are the heart and the blood-vessels. The blood-vessels are of three kinds, arteries, capillaries and veins. The arteries carry blood from the heart to the capillaries; the veins collect it from the capillaries and return it to the heart. There are two distinct sets of blood-vessels in the body, both connected with the heart; one set carries blood to, through and from the lungs, the other guides its flow through all the remaining organs; the former are known as the _pulmonary_, the latter as the _systemic_ blood-vessels. The smallest arteries pass into the _capillaries_, which have very thin walls, and form very close networks in nearly all parts of the body; their immense number compensating for their small size. It is while flowing in these delicate tubes that the blood does its nutritive work, the arteries being merely supply-tubes for the capillaries, through whose delicate walls liquid containing nourishment exudes from the blood to bathe the various tissues. The quantity of blood in any part of the body at any given time is dependent upon certain relations which exist between the blood-vessels and the nervous system. The walls of the arteries are abundantly supplied with involuntary muscular fibres, which have the power of contraction and relaxation. This power of contraction and relaxation is controlled by certain nerves called _vasomotor_ nerves, because they cause or control motion in the vessels to which they are attached. When arteries supplying blood to any particular part of the body contract, the supply of blood to that part will be diminished in proportion to the amount of contraction. If the nervous control be altogether withdrawn, the arterial walls will completely relax, and the amount of blood in the part affected will be increased correspondingly. Alcohol, even in moderate doses, paralyzes the _vasomotor_ nerves which control the minute blood-vessels, thus allowing these vessels to become dilated with the flowing blood. "With the disturbance of power in the extreme vessels, more disturbance is set up in other organs, and the first organ that shares in it is the heart. With each beat of the heart a certain degree of resistance is offered by the vessels when their nervous supply is perfect, and the stroke of the heart is moderate in respect both to tension and to time. But when the vessels are rendered relaxed, the resistance is removed, the heart begins to run quicker like a clock from which the pendulum has been removed, and the heart-stroke is greatly increased in frequency. It is easy to account in this manner for the quickened heart and pulse which accompany the first stage of deranged action from alcohol."--RICHARDSON. Dr. Parkes of England, assisted by Count Wollowicz, conducted inquiries upon the effects of alcohol upon the heart, with a young and healthy man. At first they made accurate count of the heart beats during periods when the young man drank water only; then of the beats during successive periods in which alcohol was taken in increasing quantities. Thus step by step they measured the precise action of alcohol on the heart, and thereby the precise primary influence induced by alcohol. Their results are stated by themselves as follows:-- "The average number of beats of the heart in 24 hours (as calculated from eight observations made in 14 hours), during the first, or water period, was 106,000; in the earlier alcoholic period it was 127,000, or about 21,000 more; and in the later period it was 131,000, or 25,000 more. "The highest of the daily means of the pulse observed during the first, or water period, was 77.5; but on this day two observations are deficient. The next highest daily mean was 77 beats. "If, instead of the mean of the eight days, or 73.57, we compare the mean of this one day; viz. 77 beats per minute, with the alcoholic days, so as to be sure not to over-estimate the action of the alcohol, we find:-- "On the 9th day, with one fluid ounce of alcohol, the heart beat 4,300 times more. On the 10th day, with two fluid ounces, 8,172 times more. On the 11th day, with four fluid ounces, 12,960 times more. On the 12th day, with six fluid ounces, 20,672 times more. On the 13th day, with eight fluid ounces, 23,904 times more. On the 14th day, with eight fluid ounces, 25,488 times more. But as there was ephemeral fever on the 12th day, it is right to make a deduction, and to estimate the number of beats in that day as midway between the 11th and 13th days, or 18,432. Adopting this, the mean daily excess of beats during the alcoholic days was 14,492, or an increase of rather more than 13 per cent. The first day of alcohol gave an excess of 4 per cent., and the last of 23 per cent.; and the mean of these two gives almost the same percentage of excess as the mean of the six days. Admitting that each beat of the heart was as strong during the alcoholic period as in the water period (and it was really more powerful), the heart on the last two days of alcohol was doing one-fifth more work. "Adopting the lowest estimate which has been given of the daily work of the heart; viz. as equal to 12.2 tons lifted one foot, the heart during the alcoholic period, did daily work excess equal to lifting 15.8 tons one foot, and in the last two days did extra work to the amount of 24 tons lifted as far. "The period of rest for the heart was shortened, though, perhaps, not to such an extent as would be inferred from the number of beats, for each contraction was sooner over. The heart, on the fifth and sixth days after alcohol was left off, and, apparently at the time when the last traces of alcohol were eliminated, showed in the sphygmographic tracing signs of unusual feebleness; and, perhaps, in consequence of this, when the brandy quickened the heart again, the tracings showed a more rapid contraction of the ventricles, but less power than in the alcoholic period. The brandy acted, in fact, on a heart whose nutrition had not been perfectly restored." Richardson quotes these experiments of Parkes and Wollowicz as if he agrees with them that increased heart-beat must of necessity mean increased work done by the heart. Dr. Nathan S. Davis, Dr. Newell Martin, Dr. A. B. Palmer, and some other investigators, show conclusively that mere increased frequency of beat above the natural standard is no evidence of increased force or efficiency in the circulation. "The more frequent beats under the influence of alcohol constitute no exception to the general rule, for while the heart beats more frequently, its influence on the vasomotor nerves causes dilatation of the peripheral and systemic blood-vessels, as proved by the pulse-line written by the sphygmograph, which more than counterbalances the supposed increased action of the heart. The truth is, that under the influence of alcohol in the blood the systolic action of the heart loses in sustained force in direct proportion to its increase in frequency, until, by simply increasing the proportion of alcohol, the heart stops in diastole, as perfectly paralyzed as are the coats of the smaller vessels throughout the system. This was clearly demonstrated by the experiments of Professor Martin of Johns Hopkins University, to determine the effects of different proportions of alcohol on the action of the heart of the dog; and those of Drs. Sidney Ringer and H. Sainsbury, to determine the relative strength of different alcohols as indicated by their influence on the heart of the frog. Professor Martin states that blood containing 1/4 per cent. by volume of absolute alcohol, almost invariably diminishes, within a minute, the work done by the heart." (This estimate would equal in an adult man an amount equal to the absolute alcohol in two or three ounces of whisky or brandy.) "These investigations of Professor Martin, being directly corroborated by those of Drs. Ringer and Sainsbury, complete the series of demonstrations needed to show the actual effects of alcohol on the cardiac, as well as on the vasomotor, and also on the direct contractability of the muscular structure, when supplied with blood containing all gradations in the relative proportion of alcohol, leaving no longer any basis for the idea, popular both in and out of the profession, that alcohol in any of its forms is capable of increasing, even temporarily the force or efficiency of the heart's action."--Dr. N. S. Davis in _Influence of Alcohol On the Human System_. The following letter will be of great interest to all students of the physiological effects of alcohol:-- "CHICAGO, ILL., March 3, 1899. "To MRS. MARTHA M. ALLEN, "Syracuse, N. Y., "MADAM: Your letter asking my attention to the apparent contradiction of authorities concerning the _work_ done by the heart when influenced by alcohol was received yesterday. "The explanation is not difficult. It depends entirely on the different views of what constitutes the _work_ of the heart. "One class of investigators, led by the original and valuable experiments of Parkes and Wollowicz base their estimate of the heart's work entirely on the _number of times it contracts or beats per minute_. Thus Dr. Parkes, finding that moderate doses of alcohol increased the number of contractions of the heart from three to six beats per minute more than natural, readily estimated the number of additional contractions that would occur in twenty-four hours, and thereby demonstrated a large amount of increased work done by the heart under the influence of alcohol. All writers who speak of 'stimulating' or increasing the action of the heart by alcohol follow this method of measuring the amount of _work_ done. They generally add that it is like applying 'the whip to a tired horse.' "The other class of investigators who claim that _alcohol_ diminishes the actual _work_ done by the heart base their estimates on the amount _of blood the heart passes through its cavities into the arteries in a given time_. This is the physiological function of the heart; i.e. to aid in circulating the blood. Professor Martin's experiments were admirably contrived to determine, not how frequently the heart beat, but the amount of blood it delivered per minute under the influence of alcohol and without alcohol. "He, and all others who take this basis of work, found that alcohol in any dose diminished the efficiency of the heart in circulating the blood in direct ratio to the quantity taken. "My own original experiments, made fifty years ago, uniformly showed that alcohol quickly increased the number of heart beats per minute, but at the same time diminished the efficiency of the circulation generally. Every experienced practitioner knows that the weaker the _heart_ becomes, the _faster_ it beats. Consequently, the number of times the heart contracts per minute is no measure of the efficiency of its work in circulating the blood. Indeed the mechanism of the heart is such that there must be sufficient time between each of its contractions for its _cavities_ to _fill_, or it is made to contract on an insufficient supply, and the efficiency of the circulation is diminished. "Yours respectfully, "N. S. DAVIS." The International Medical Congress of 1876 adopted as its reply to the Memorial of the National Temperance Society, and of the National Woman's Christian Temperance Union respecting "Alcohol as a Food and as a Medicine," the paper by Dr. Ezra M. Hunt, one conclusion of which was, "Its use as a medicine is chiefly that of a cardiac stimulant." As experiments conducted since that time show that it is not a cardiac stimulant, but a direct cardiac paralyzant, what excuse is there for using it as a medicine now? "Whenever the heart is compelled to more rapid contraction than is natural, it has less time to rest. Although it seems to be constantly at work, it really rests more than half the time, so that, although the periods of relaxation are very short, they are so numerous that the aggregate amount of rest in a day is very great. Now, if the rapidity of the contractions is increased materially and continuously, although the aggregate amount of time for rest may be the same as before, yet the waste caused by the contractions is greater, while the time for rest after each one is shorter. This lack of rest produces exhaustion of the heart-muscle, ending in partial change of the muscular tissue into fat. The heart then becomes flabby and weak and its walls become thinner, a condition known to physicians as a 'fatty heart,' often resulting in sudden death."--_Tracy's Physiology_, page 158. Dr. T. D. Crothers, of Hartford, Conn., has made many observations with the sphygmograph to learn the effects of alcohol upon the heart. He says:-- "On general principles, and clinically, the increased activity and subsequent diminution of the heart's action brings no medicinal aid or strength to combat disease. This is simply a reckless waste of force for which there is no compensation. Without any question or doubt the increased heart's action, extending over a long period, is dangerous. "The medicinal damage done by alcohol does not fall exclusively upon the heart, although this organ may show it more permanently than others."--_Transactions of Second Annual Meeting of A. M. T. A._ Dr. I. N. Quimby, of Jersey City, N. J., in an address before the American Medical Temperance Association, after describing two clinical cases which ended in death, made the following statement: "There was nothing so strange about the death of these two patients, although they both died unexpectedly to the physician and their friends, but the declaration I am about to make may be somewhat new and startling, namely: That neither of these patients, in my candid judgment, died from the effect of disease, but rather from vasomotor paralysis of the heart, _superinduced by the administration of the alcohol_, which brought on a sudden and unexpected collapse and death." Alcohol causes fatty degeneration of the heart and other muscular structures. Old age also causes these degenerations, hence alcohol is said to produce premature aging of the body. "In fatty degeneration the cells and fibres of the body become more or less changed into fat. If a muscular fibre undergoes fatty degeneration, the particles of which it is made disappear one by one, and particles of oil or fatty matter take their place, so that the degree or amount of degeneration varies according to the extent to which this change has gone on. When the fibres of which a muscle is composed have become thus altered by fatty degeneration they become softer according to the amount of it; they are more easily torn and may even tear across when the muscle is being used during life. The more a muscle is thus degenerated the weaker it is, because it contains less muscular substance and more fat. Not only do the heart and other voluntary muscles thus degenerate, but those of the arteries also. "Fatty degeneration is promoted by alcohol because alcohol prevents the proper removal of fat, which has been seen to accumulate in the blood; alcohol prevents the proper oxidation or burning up of waste matters; growing cells which are affected by the chemical influence of alcohol are not quite natural or healthy, so are more liable to degeneration; alcohol hinders the proper removal of waste matter from individual cells and tissues."--DR. J. J. RIDGE, London. Dr. Newell Martin says in _The Human Body_:-- "Although fatty degeneration of the heart may occur from other causes, alcoholic indulgence is the most frequent one. Fatty liver or fatty heart is rarely if ever curable; either will ultimately cause death." Dr. Ridge says these degenerations occur in the tissues of thin people as well as in those of stout persons. In thin people they are usually in the fibres only, not between them. It is because of this degeneration of the heart and other muscles caused by alcohol that athletes in training need to be so very careful to avoid the use of beer and other intoxicating drinks. Diseases such as fevers, diphtheria, and pneumonia which interfere with the reception, and internal distribution of oxygen, favor granular and fatty degeneration of the heart and other structures of the body. Hence non-alcoholic physicians urge that alcohol and such other drugs, as have like action in hindering full oxidation of the blood, and causing fatty degenerations should be studiously avoided. These physicians attribute many of the deaths from heart-failure in such diseases to the combined action of the disease and the alcohol in exhausting the heart, and weakening its structure. _Comparative death-rates with and without alcohol show conclusively the superiority of the latter treatment._ EFFECTS OF ALCOHOL UPON THE LIVER. The liver is a very large organ, the largest and heaviest in the body, weighing in a healthy adult from three to four pounds. It secretes the bile. Its cells also store up, "in the form of a kind of animal starch called glycogen," excess of starchy or sugary food absorbed from the intestine during the digestion of a meal. This it gradually doles out to the blood for general use by the organs of the body until the next meal is eaten. Dr. William Hargreaves says:-- "The office of the liver is to take up new substances having not yet become blood, as well as the portions of integrated matter that can be worked over, and brought again into use. It is in fact the economist of the system. It excretes bile, and liver-sugar, and _renews_ the _blood_. When the liver is disordered the whole body is more or less deranged and the proper nutrition of its parts arrested." Dr. Alfred Carpenter says:-- "The liver has to do several things; a considerable part of its duty is to purify the blood from _débris_ (waste matter), to filter out some things, to break up and alter others, and to expel them from the body in the form of bile. There are certain diseases in which the liver suddenly declines to do any more work. Acute atrophy of the liver is the name of this condition, and when it arises death rapidly results from suppression of the secretion of bile. It brings about a state of things called _acholia_; the patient is actually poisoned by the non-removal of those ingredients from the blood which it is the duty of the liver to remove. This corresponds in effect to the condition which alcohol can bring about by slow degrees." The liver is the first important organ, next to the stomach and bowels, to receive the poisonous influence of alcohol. "If alcohol is used habitually, though only in small quantities at a time, the liver may become the seat of serious changes. There may be a great increase of fat deposited in the cells, producing what is called 'fatty liver,' or it may lead to a great increase of connective tissue (membrane) between the cells, and surrounding the blood-vessels. This newly-developed connective tissue gradually contracts, and in so doing crushes the cells and obstructs the blood-vessels, making the organ much smaller than natural, and causing the surface to be covered with little projecting knobs, consisting of portions of liver-tissue that have been less compressed than the part that separates them. The pressure upon the liver-cells and the destruction of many of them, prevents the proper formation of bile and liver-sugar. The contraction of the newly-developed tissue, by obstructing the blood-vessels, interferes with the circulation. Malt liquors seem to produce fatty degeneration, while the stronger liquors cause the development of connective tissue."--_Tracy's Physiology._ Speaking of diseases of the liver, Dr. Trotter said in his _Essay on Drunkenness_:-- "The chronic species is not a painful disease; it is slow in its progress, and frequently gives no alarm, till some incurable affection is the consequence. Hence, the fallacy and danger of judging merely by the feelings of the beneficial effects of the use of intoxicating drinks; for the liver and stomach may be seriously diseased, while a man imagines himself in moderate health." Hardening of the liver, or "hob-nailed" liver, is said to be the result, largely, of taking liquor upon an empty stomach. Dr. E. Chenery, of Boston, in his excellent book, _Facts for the Millions_, tells of a patient of his who was well up to the evening before, when he went out and drank with some companions, taking the liquor on an empty stomach. That night, vomiting and pain in the right side came on, with high fever. Headache began and increased, followed by delirium and a general jaundiced condition. He died as a result. The disease was acute inflammation of the liver, brought on by the one broadside of alcohol poured "point blank" into the organ. Dr. Chenery says further on in the same book:-- "There is another disorder of a very serious nature which science is now laying at the doors of the liver--_diabetes mellitus_, or sugar in the urine. Till quite recently, this formidable affection has been regarded as having its seat in the kidneys; and it is so classified in medical writings. Later researches, however, show that the sugar has been formed in the economy before it reaches the kidneys, and that these organs act only as strainers with respect to it, removing it from the blood as they remove salt and various other substances. In seeking for the fountain-head of diabetic sugar, it is found that the liver is the great glycogenic, or sugar-originating factory of the body. In an ordinary state of health this substance is produced in just the proper amount for the uses for which it is intended, so that it is all disposed of in the organism, and does not pass off by the kidneys. If any cause interrupts the processes by which the sugar is consumed, while its manufacture goes on normally, there will come to be an over-supply of sugar in the blood, which, when it reaches 3 parts to 1,000 of the blood, will begin to pass off by the kidneys and appear in the urine. On the other hand, if an undue amount of it is formed, the consumption remaining normal, it will also accumulate in the circulation, and be eliminated by the kidneys. In either case we have diabetes, the sugar irritating and diseasing the kidneys as it passes." Dr. Harley, of the Royal Society of London, has made the subject of alcohol and diabetes matter for considerable study. He says a small quantity only of alcohol injected into the portal (liver) circulation of healthy animals will cause diabetic urine. "If any one doubt the truth of the assertion that alcohol causes diabetes, let him select a case of that form of the disease arising from excessive formation, and after having carefully estimated the daily amount of sugar eliminated by the patient, allow him to drink a few glasses of wine, and watch the result. He will soon find the ingestion of the liquor is followed by an increase of sugar. If alcoholics increase the amount of saccharine matter in the urine of the diabetic, we can easily understand how their excessive use may induce the disease in individuals _predisposed_ to it."--DR. HARLEY. Some physicians claim that in jaundice and certain other bilious disorders even medicines prepared in alcohol are decidedly prejudicial and aggravating. Dr. J. H. Kellogg, and other writers draw attention to the effects of alcohol in hindering the liver in its duty of destroying the toxic substances generated within the system of a sick person by the specific microbes to which the disease owes its origin, saying that the activity of the liver in destroying these poisons is one of the physiologic processes which stand between the patient and death. The more this question is studied the more apparent is it that, other things being equal, the sick person who is cared for by a non-alcoholic physician has a much better chance of recovery than the one dosed by "a brandy doctor." EFFECTS OF ALCOHOL UPON THE KIDNEYS. "The kidneys, being the chief organs for the excretion of nitrogen waste, are among the most important organs of the body. Any defect in their healthy activity leads to serious interference with the working of many organs, due to the accumulation in the body of nitrogenous waste products. If both kidneys be cut out of an animal, it dies in a few hours from blood-poisoning, due to the accumulation of waste poisonous substances which the kidneys should have got rid of. Serious kidney-disease amounts to pretty much the same thing as cutting out the organs, since they are of little use if not healthy. It is always fatal if not checked, and often kills in a short time. The things which most frequently cause kidney disease are undue exposure to cold, and indulgence in alcoholic drinks."--Martin's _Human Body_. "The kidneys are supplied with arterial blood, which, having given up water, urea, salt, and certain other substances, either secreted or simply strained from it, returns to the kidneys nearly as bright and fresh as when it entered them. While the lungs are concerned in removing carbonic acid--the ashes of the furnace--it is the peculiar province of the kidneys to remove the products of the wear and tear of the bodily machinery--the wasted nerve and muscle--in the form of urea, or other crystallizable substances, the presence of which in the economy for any considerable time is attended with disastrous results. "Now, nature has put these organs, charged with so important work, as far away as possible from any source of irritation. Could alcohol get as direct access to them as to the liver, there is no doubt that their function would be destroyed almost at once, since the change in arterial blood by alcohol is much more extensive and damaging than that wrought in such venous blood as the liver receives from the portal veins. Thus while the liver takes the alcohol immediately from the alimentary canal, the kidneys receive it only after it has passed through the liver, the heart, the lungs, and the heart again; by which time much of it has escaped, while the remainder has been greatly diluted by the blood of the general circulation; yet coming to the kidneys even so considerably diluted, it has power to congest, irritate, and excite them to the excretion of an unusual amount of the watery elements of the urine, as if to wash the irritant away. "But it is only the watery element that is increased, not the urea, which is the substance representing the waste of vital action, and is a poison to the system; this it is the special office of the kidneys to remove. Not only does alcohol not increase its elimination, but actually lessens the discharge. And should the irritation of the spirit continue, or be augmented in force, inflammation would follow, and the excretion of urea nearly or entirely cease and life be in the greatest jeopardy. Relief or death then must speedily follow."--Dr. E. Chenery, of Boston, in _Alcohol Inside Out_. "Alcohol causes kidney-disease in several ways. In the first place it unduly excites the activity of the organs. Next, by impeding oxidation it interferes with the proper preparation of nitrogen wastes: they are brought to the kidneys in an unfit state for removal, and injure those organs. Third, when more than a small quantity of alcohol is taken, some of it is passed out of the body unchanged, through the kidneys, and injures their substance. The kidney-disease most commonly produced by alcohol is one kind of "Bright's disease," so called from the physician who first described it. The connective tissue of the organ grows in excess, and the true excreting kidney-substance dwindles away. At last the organ becomes quite unable to do its work, and death results. "The three most common causes of Bright's disease are an acute illness, as scarlet fever, of which it is a frequent result; sudden exposure to cold when warm (this often drives blood in excessive quantity from the skin to internal organs, and leads to kidney-disease); and the habitual drinking of alcoholic liquids."--Dr. Newell Martin in _The Human Body_. "Every physician knows or should know, that the quantity and quality of the effete, or waste, material separated from the blood by the kidneys and voided in the urine, is such as to render a knowledge of the action of any remedy or drink on the function of these organs, of the greatest importance in the treatment of all diseases, and especially those of an acute febrile character. As was long since demonstrated by clinical observation, and more recently by patient and accurate experiments by Bouchard and others, the amount of toxic, or poisonous, material naturally separated from the blood by the kidneys and passed out in the urine is so great that if wholly retained by failure of the kidneys to act for two or three days, speedy death ensues. Equally familiar to every observing physician is the fact that in all the acute febrile and inflammatory diseases, not only is the quantity of the urine secreted generally diminished, but its quality or constituency is also changed to a greater degree than even its quantity. Thus, some of the more important constituents are increased, others diminished, and often new or foreign elements are found present, all resulting from the disordered metabolic processes taking place throughout the system during the progress of these diseases. "It is, therefore, hardly necessary to remind the physician that it is of the greatest importance to know as correctly as possible both the direct and the indirect influence of every medicine or drink on the action of the kidneys and all other eliminating organs and structures, lest he unwittingly allow the use of such as may not only retard the elimination of the specific causes of disease, but also favor auto-intoxication by retarding the elimination of the natural elements of excretion. "That the presence of alcohol in the living system positively lessens the reception and internal distribution of oxygen, and consequently retards the oxidation processes of disassimilation by which the various products for excretion are perfected and their elimination facilitated, is so fully demonstrated, both by observation and experiment, as no longer to admit of doubt. "As nearly all the toxic elements of urine are the results of these oxidation processes, the presence of alcohol in the system could hardly fail to interfere with them in a notable degree. "The direct and somewhat extensive series of experiments instituted by Glazer, as published in the _Deut. Med. Wochensch._, Leipsic, Oct. 22, 1891, demonstrated this, as shown by the following conclusions:--'Alcohol, in even relatively moderate quantities, irritates the kidneys, so that the exudation of leucocytes and the formation of cylindrical casts may occur. It also produces an unusual amount of uric acid crystals and oxalates, due to the modified tissue changes produced by the alcohol. The effect of a single act of over-indulgence in alcohol does not last more than thirty-six hours, but it is cumulative under continued use.' "Dr. Chittenden kept several dogs under the influence of alcohol eight or ten days, and found it to increase the amount of uric acid in their urine more than 100 per cent. above the normal proportion. "Mohilansky, house-physician to Manassein's clinic, in the conclusions drawn from his interesting experiments on fifteen young men to determine the effects of alcohol on the metabolic processes generally, stated that 'it does not possess any diuretic action: but rather tends to inhibit the elimination of water by the kidneys.' It is further stated that this result is owing to the coincident effect of diminished systemic oxidation and of blood pressure. "On the other hand, several observers have reported that the flow of urine was increased by the use of alcohol. From as full an examination of the subject as I have been able to make, it appears that the diverse results obtained have depended upon the previous habits of those experimented on, and the widely varying quantities of water drank with the alcohol. When the alcohol is taken with large quantities of water, as is usual with those who use beer and fermented drinks generally, the total amount of urine passed is usually increased, but not more than is found to result from taking the same quantity of water without any alcohol. When alcoholic drinks are taken by those already habituated to its use, it has less marked effect on the quantity and quality of the urine than when taken by those who had previously been total abstainers. This was illustrated by the experiments of Mohilansky on the fifteen men, some of whom were habitual drinkers, some occasional drinkers, and others total abstainers. When all were subjected to the same diet and drinks, with alcohol, in two the daily amount of urine voided remained unaltered, in five it was increased seven per cent., and in eight it decreased twelve per cent. But whatever may be the variations in the mere quantity of urine voided under the influence of alcohol, the alterations in quality pretty uniformly show an increase in the products of imperfect internal metamorphosis or oxidation, such as uric acid, oxalates, casts, leucocytes, albumen and potassium, with less of the normal products, as urea and salts of sodium. "During the past year I have met with three cases in which the regular daily use of alcoholic drinks for several months, in quantities not sufficient to produce intoxication, had so altered the blood, and the renal function, that the urine contained both casts and albumen, and some degree of oedema was observable in the face and extremities. These changes were so marked as to justify a diagnosis of incipient nephritis, or Bright's disease. Yet after totally abstaining from the use of alcoholic drinks and remedies, and taking such vasomotor tonics as strychnine and digitalis, with a regulated diet and fresh air, they completely recovered. "When it is remembered that in diphtheria, pneumonia and typhoid fever, the acute diseases in which a large part of the profession administer most freely alcoholic remedies, the function of the kidney is altered in almost the same direction as are found to take place under the influence of alcohol, it should certainly cause every practitioner to pause and critically review the pathological basis on which he has been prescribing. An anæsthetic, like alcohol, may certainly render a patient with diphtheria, pneumonia or typhoid fever more quiet, and cause him to say he feels better, but if it at the same time diminishes the internal distribution of oxygen, retards the oxidation and elimination of waste and toxic products through the kidneys and lungs, and lessens vasomotor force, it cannot fail to protract the duration of disease, and increase the ratio of mortality."--Dr. N. S. Davis, _A. M. T. A. Quarterly_, April, 1894. Dr. J. H. Kellogg, by a series of carefully executed experiments, conclusively demonstrated that alcohol hinders the elimination of poisonous matter by the kidneys. This property of alcohol is one of the objections which he sees to its use as a medicine. He says:-- "Water applied externally stimulates elimination by the pores of the skin, and employed freely internally by water drinking, and enemas to be retained for absorption, aids liver and kidney activity. If the patient dies it is because his liver and kidneys have failed to destroy and eliminate the poisons generated with sufficient rapidity to prevent their producing fatal mischief in the body." CHAPTER VI. ALCOHOL AS A MEDICINE. Although nearly all of the foremost scientific investigators of the effects of alcohol upon the body have lost faith in the old views of the usefulness of alcoholic liquors as remedial agencies a considerable proportion of the medical profession do not seem yet to have learned how to treat disease without recourse to the alcohol therapy. This is largely due to the fact that the new thought has not yet crystallized to any large extent in the medical text-books, and also to the widely variant views held by professors of medicine. The medical use of alcohol has been, and still is, the great bulwark of the liquor traffic. The user of alcoholics as beverages always excuses himself, if hard pressed by abstainers, upon the ground that they must be of service or doctors would not recommend them so frequently. In all prohibitory amendment, and no-license campaigns, the cry of "Useful as Medicine" has been the hardest for temperance workers to meet, for they have felt that they had to admit the statement as true, knowing nothing to the contrary. Indeed, thousands of those who advocate the prohibition of the sale of liquor as a beverage, use alcohol in some form quite freely as medicine, and are as determined and earnest in defence of their favorite "tipple" as any old toper could well be. Many use it in the guise of cordials, tonics, bitters, restoratives and the thousand and one nostrums guaranteed to cure all ills to which human flesh is heir. The wide-spread belief in the necessity and efficacy of alcoholics as remedies is the greatest hindrance to the success of the temperance cause. It is impossible to convince the mass of the people that what is life-giving as medicine can be death-dealing as beverage. The two stand, or fall, together. Hence there is no more important question before the medical profession, and the people generally, than that of the action of alcohol in disease, and, as a goodly number of the most distinguished and successful physicians of Europe and America declare it to be harmful rather than helpful, it behooves thoughtful people to carefully study the reasons they assign for holding such an opinion. Certainly it is true that if physicians and people would all adopt the views of the advocates of non-alcoholic medication the temperance problem would be solved, and the greatest source of disease, crime, pauperism, insanity and misery would be driven from the face of the earth. To understand the arguments advanced in favor of non-alcoholic medication it is needful to make some study of the effects of alcohol upon the body, and of the purposes for which alcoholics are prescribed medically. _Alcohol is used in sickness as a food, when solid foods cannot be assimilated, "to support" or sustain, the vitality; it is used as a stimulant, a tonic, a sedative or narcotic, an anti-spasmodic, an antiseptic and antipyretic; it is used in combination with other drugs, in tinctures and in pharmacy._ It is not wonderful that the people esteem it above all other drugs, for none other is so variously and so generally employed. Those who discard it as a remedy teach that only in human delusions is it a food or a stimulant, and for the other uses to which it is put, outside of pharmacy, there are different agents which may be more satisfactorily employed. IS ALCOHOL FOOD? So well agreed are all the scientific investigators that alcohol has no appreciable food value that it would seem foolish to spend time upon a discussion of alcohol as food were it not that the idea of its "supporting the vitality" in disease, in some mysterious way is deeply rooted in the professional, as well as the popular mind. _Foods are substances which, when taken into the body, undergo change by the process of digestion; they give strength and heat and force; they build up the tissues of the body, and make blood; and they induce healthy, normal action of all the bodily functions._ Alcohol does none of these. It undergoes no change in the stomach, but is rapidly absorbed and mixed with the blood, and has been discovered hours after its ingestion in the brain, blood and tissues, unchanged alcohol. In many of the experiments made with it upon animals, considerable quantities of the amount swallowed were recovered from the excretions of the body, without any change having taken place in its composition. This, of itself, is sufficient evidence to show that it is a substance which the body does not recognize as a food. _Foods build up the tissues of the body._ All physiologists are agreed that since alcohol contains no nitrogen it cannot be a tissue-forming food; there is no difference of opinion here. Dr. Lionel Beale, the eminent physiologist, says that alcohol is not a food and does not nourish the tissues. "There is nothing in alcohol with which any part of the body can be nourished."--Cameron's _Manual of Hygiene_. "Alcohol contains no nitrogen; it has none of the qualities of the structure-building foods; it is incapable of being transformed into any of them; it does not supply caseine, albumen, fibrine or any other of those substances which go to build up the muscles, nerves and other active organs."--SIR B. W. RICHARDSON. "It is not demonstrable that alcohol undergoes conversion into tissue."--DR. W. A. HAMMOND. If it is a food why do all writers and experimenters exclude it from the diet of children, and why is the caution always given people to not take it upon an empty stomach? Foods are supposed to be particularly suited to an empty stomach. _Foods induce healthy, normal action of all the bodily functions._ The chapter upon "Diseases Produced by Alcohol" is evidence that by this test alcohol shows up in its true nature as a poison, and not a food. Alcohol destroys healthy normal action of all the bodily functions, and builds up impure fat, fatty degeneration, instead of strong, firm muscle. Dr. Parkes, one of the most famous of English students of alcohol, says:-- "These alcoholic degenerations are certainly not confined to the notoriously intemperate. I have seen them in women accustomed to take wine in quantities not excessive, and who would have been shocked at the imputation that they were taking too much, although the result proved that for them it was excess." Dr. Ezra M. Hunt, late secretary of New Jersey State Board of Health, remarks:-- "The question of excess occurs in sickness as well as in health, and all the more because its determination is so difficult and the evil effects so indisputable. The dividing line in medicine, even between use and abuse, is so zigzag and invisible that common mortals, in groping for it, generally stumble beyond it, and the delicate perception of medical art too often fails in the recognition." All non-alcoholic writers assert that the continuous use of alcohol as a medicine is equally injurious to all the bodily functions as the employment of it as a beverage. Calling it medicine does not change its deadly nature, nor does the medical attendant possess any magical power by which a destructive poison may be converted into a restorative agent. Dr. Noble, writing recently to the _London Times_, said:-- "The internal use of alcohol in disease is as injurious as in health." Since foods induce healthy, normal action of all the bodily functions, and alcohol injures every organ of the body in direct proportion to the amount consumed, by this test it is proved to not be a food. _Foods give strength._ Alcohol weakens the body. This has been determined again and again by experiments upon gangs of workmen and regiments of soldiers. These experiments always resulted in showing that upon the days when the men were supplied with liquor they could neither use their muscles so powerfully, nor for so long a time, as on the days when they received no alcoholic drink. Of the results of such tests Sir Andrew Clark, late Physician to Queen Victoria, said:-- "It is capable of proof beyond all possibility of question that alcohol not only does not help work but is a serious hinderer of work." So satisfied are generals in the British army of the weakening effect of alcohol that its use is now forbidden to soldiers when any considerable call is to be made upon their strength. The latest example of this was in the recent Soudan campaign under Sir Herbert Kitchener. An order was issued by the War Department that not a drop of intoxicating liquor was to be allowed in camp save for hospital use. The army made phenomenal forced marches through the desert, under a burning sun and in a climate famous for its power to kill the unacclimated. It is said that never before was there a British campaign occasioning so little sickness and showing so much endurance. Some Greek merchants ran a large consignment of liquors through by the Berber-Suakim route, but Sir Herbert had them emptied upon the sand of the desert. A reporter telegraphed to England:-- "The men are in magnificent condition and in great spirits. They are as hard as nails, and in a recent desert march of fifteen miles, with manoeuvring instead of halts, the whole lasting for five continuous hours, not a single man fell out!" This was in decided contrast to the march in the African war some years before when, as they passed through a malarial district, and a dram was served, men fell out by dozens. Dr. Parkes, one of the medical officers, prevailed upon the commander-in-chief to not allow any more alcoholic drams while the troops were marching to Kumassi. Experiments in lifting weights have also been tried upon men by careful investigators. In every case it was found that even beer, and very dilute solutions of alcohol, would diminish the height to which the lifted weight could be raised. As an illustration of the deceptive power of alcohol upon people under its influence, it is said that persons experimented upon were under the impression, after the drink, that they could do more work, and do it more easily, although the testing-machine showed exactly the contrary to be true. Athletes and their trainers have learned by experience that alcohol does not give strength, but is, in reality, a destroyer of muscular power. No careful trainer will allow a candidate for athletic honors to drink even beer, not to speak of stronger liquors. When Sullivan, the once famous pugilist, was defeated by Corbett, he said in lamenting his lost championship, "It was the _booze_ did it"; meaning that he had violated training rules, and used liquor. University teams and crews have proved substantially that drinking men are absolutely no good in sports, or upon the water. Football and baseball teams, anxious to excel, are beginning to have a cast-iron temperance pledge for their members. So practical experience of those competing in tests of strength and endurance teach eloquently that alcohol does not give strength, but rather weakens the body, by rendering the muscles flabby. Sandow, the modern Samson, wrote his methods of training in one of the magazines a few years ago, and stated that he used no alcoholic beverages. The ancient Samson was not allowed to taste even wine from birth. A question worthy of serious consideration is: how are the sick to be strengthened and "supported" by drinks which athletes are warned to specially shun as weakening to the body? Either the sick are mistakenly advised, or the athletes are in error. Which seems the more likely? Dr. Richardson says in _Lectures on Alcohol_:-- "I would earnestly impress that the systematic administration of alcohol for the purpose of giving and sustaining strength is an entire delusion." In another place he says:-- "Never let this be forgotten in thinking of strong drink: that the drink is strong only to destroy; that it never by any possibility adds strength to those who drink it." Sir William Gull, late physician to the Prince of Wales, said before a Select Committee of the House of Lords on Intemperance:-- "There is a great feeling in society that strong wine and other strong drinks give strength. A large number of people have fallen into that error, and fall into it every day." Any unprejudiced person can readily see that experience and experiment unite in testifying that alcohol does not give strength, hence differs radically from most substances commonly classed as foods. Yet millions of dollars are spent annually by deluded people upon supposedly strength-giving drinks, and thousands of the sick are ignorantly, or carelessly, advised to take beer or wine to make them strong and to _support_ them when solid food cannot be assimilated. Truly, "My people is destroyed for lack of knowledge." _Foods give force to the body._ Dr. Richardson says:-- "We learn in respect to alcohol that the temporary excitement is produced at the expense of the animal matter and animal force, and that the ideas of the necessity of resorting to it as a food, to build up the body or to lift up the forces of the body, are ideas as solemnly false as they are widely disseminated." Dr. Benjamin Brodie says in _Physiological Inquiries_:-- "Stimulants do not create nerve power: they merely enable you, as it were, to use up that which is left." Dr. E. Smith:-- "There is no evidence that it increases nervous influence, while there is much evidence that it lessens nervous power." Dr. Wm. Hargreaves, of Philadelphia:-- "It is sometimes said by the advocates and defenders of alcohol, that by its use force is generated more abundantly. This it certainly cannot do, as it does not furnish anything to feed the blood or to store up nourishment to replenish the expenditure. For by their own theory, the increase of action must cause an increase of wear and tear; hence alcohol instead of sustaining life or vitality, must cause a direct waste or expenditure of _vital force_." Dr. Auguste Forel, of Switzerland:-- "All alcoholic liquors are poisons, and especially brain-poisons, and their use shortens life. They cannot therefore be regarded as sources of nourishment or force. They should be resisted as much as opium, morphia, cocaine, hashish and the like." Dr. W. F. Pechuman, of Detroit, in his valuable little treatise, _Alcohol--Is it a Medicine?_ says clearly:-- "When alcohol or any other irritant poison is put into the system, the conservative vital force, recognizing it as an enemy, at once makes an effort through the living matter to rid the system of the offender;--the heart increases in action and new strength seems to appear. Now, right here is where the great mass of people and a large number of physicians are deluded. They mistake the extra effort of the vital force to preserve the body against harmful agencies for an actual increase in strength as the result of the agent given; we wonder that they can be so blind as not to see the reaction which invariably occurs soon after the administration of their so-called stimulant." Dr. F. R. Lees, of England:-- "All poisons lessen vitality and deteriorate the ultimate tissue in which force is reposited. Alcohol is an agent, the sole, perpetual and inevitable effects of which are to avert blood development, to retain waste matter, to irritate mucous and other tissues, to thicken normal juices, to impede digestion, to deaden nervous sensibility, to lower animal heat, to kill molecular life, _and to waste, through the excitement it creates in heart and head, the grand controlling forces of the nerves and brain_." If alcohol is a destroyer of bodily force, as any ordinary observer of drinking men can readily see, it is a problem beyond solving, how it is going to give force to, or sustain vitality in, the patient hovering between life and death. Too often has it been the means of hastening into eternity those who, but for its mistaken use, might have recovered from the illness affecting them. _Food gives heat to the body._ Alcohol does not, but really robs the body of its natural warmth. This finding of science was received with the utmost incredulity when first presented to the medical world, but the invention of the clinical thermometer settled it beyond controversy. It is now believed by all but a very few of those who have knowledge of the physiological effects of alcohol. While Dr. N. S. Davis, of Chicago, was the first to demonstrate this fact, it was Dr. B. W. Richardson, of England, who succeeded in putting it prominently before the attention of physicians. The normal temperature of the human body is a little over 98 degrees by Fahrenheit's thermometer. If the temperature is found to be much above or below 98 degrees the person is considered out of health; indeed by this condition alone physicians are able to detect serious forms of disease. By the use of the clinical thermometer, placed under the tongue, it is easy to determine what agents acting upon the body will cause the temperature to vary from the natural standard. When alcohol is swallowed there is at first a decided feeling of warmth induced; if the temperature be taken now it will be found that in a person unaccustomed to alcohol the warmth may be raised half a degree; in one accustomed to alcohol the warmth may be raised a full degree, or even a degree and a half beyond the natural standard. But this warmth is only temporary, and is soon succeeded by chilliness. Dr. Richardson says in his _Temperance Lesson Book_:-- "The sense of warmth occurs in the following way: When the alcohol enters the body, and by the blood-vessels is conveyed to all parts of the body, it reduces the nervous power of the small blood-vessels which are spread out through the whole of the surface of the skin. In their weakened state these vessels are unable duly to resist the course of blood which is coming into them from the heart under its stroke. The result is that an excess of warm blood fresh from the heart is thrown into these fine vessels, which causes the skin to become flushed and red as it is seen to be after wine or other strong drink has been swallowed and sent through the body. So, as there is now more warm blood in the skin than is natural to it, a sense of increased warmth is felt. The skin of the body is the most sensitive of substances and the sense of warmth through, or over the whole surface of the skin is conveyed from it to the brain and nervous centres of the body, by which we are enabled to feel. "The warmth of surface which seems to be imparted by alcohol, only _seems_ to be imparted. Positively the warmth is not imparted by the alcohol, but is set free by it. "In a short time the sense of warmth is succeeded by a feeling of slight chilliness. Unless the person is in a very warm room, or has recently partaken of food, the thermometer will now show a decided decrease in temperature, reaching often to a degree. Should the person go out into a cold air, and especially should he go into a cold air while badly supplied with food, the fall of temperature may reach to two degrees below the natural standard of bodily heat. In this state he easily takes cold, and in frosty weather readily contracts congestion of the lungs, and that disease which is known as bronchitis. If the person drinks to drunkenness his temperature will be found to be from two and a half to three degrees below the natural standard. It takes from two to three days, under the most favorable circumstances, for the animal warmth to become steadily re-established after a drunken spree. "The excitement of the mind in the early stages of drunkenness is not natural; it is exhaustive of the bodily powers, and exhaustive for no useful purpose whatever. * * * * * "As nothing has been supplied by the alcohol to keep up the supply of heat the vital energy is rapidly exhausted, and if the person is exposed to cold, the exhaustion becomes extreme, sometimes fatal. All great consumers of alcohol are chillier during winter than are abstainers, and as they labor under the delusion that they must take wine or ale or spirits to keep them warm, they keep on making matters worse by constantly resorting to their enemy for relief." Dr. Newell Martin makes this very clear in his physiology, _The Human Body_. "Our feeling of being warm depends on the nerves of the skin. We have no nerves which tell us whether heart or muscles or brain, are warmer or cooler. These inside parts are always hotter than the skin, and if blood which has been made hot in them flows in large quantity to the skin, we feel warmer because the skin is heated. As alcoholic drinks make more blood flow through the skin, they often make a man feel warmer. But their actual effect upon the temperature of the whole body is to lower it. The more blood that flows through the skin, the more heat is given off from the body to the air, and the more blood, so cooled, is sent back to the internal organs. The consequence is that alcohol, in proportion to the amount taken, cools the body as a whole, though it may for a time heat the skin." If other evidence that alcohol is not heat-producing in the body were necessary it could be found in the fact that the products of combustion are decreased when it is present in the body. The quantity of carbonic acid exhaled by the breath is proportionately diminished with the decline of animal heat. Arctic explorers learned by experience what science discovered by experiment. Dr. Hayes, the explorer, says:-- "While fresh animal food, and especially fat, is absolutely essential to the inhabitants and travelers in Arctic countries, alcohol, in almost any shape, is not only completely useless, but positively injurious." Lieutenant Johnson, who accompanied Nansen upon his northern expedition, said, when interviewed by a reporter of the London _Daily News_:-- "The common opinion that alcohol becomes in some way a necessity in cold countries is entirely a mistaken one. This has been conclusively proved by the expedition. In making up his list of the _Fram's_ equipments, Nansen did not include any spirits, with the exception of some spirits of wine for lamps and stoves." In the list of stores taken upon the long sledging expedition after leaving the _Fram_ no liquors are mentioned. See _Farthest North_, by Nansen. The omission of spirits was not because of any "temperance fanaticism," but because the experience of former Arctic expeditions had shown clearly that men freeze more readily after partaking of alcohol than when they totally abstain from it. That wine is not a fuel-food was shown conclusively in the Franco-Prussian war during the siege of Paris. Food was scarce in the French Army, and wine was liberally supplied. The men complained bitterly of the extreme chilliness which affected them. Dr. Klein, a French staff surgeon, was reported in the _Medical Temperance Journal_ of England, October 1873, as saying of this:-- "We found most decidedly that alcohol was no substitute for bread and meat. We also found that it was no substitute for coals. We of the army had to sleep outside Paris on the frozen ground. We had plenty of alcohol, but it did not make us warm. Let me tell you there is nothing that will make you feel the cold more, nothing which will make you feel the dreadful sense of hunger more, than alcohol." There is no evidence against alcohol stronger than that which shows it to be not heat-producing, as commonly believed, but a reducer of heat in the body. Indeed, this question of bodily temperature is used in recent times to decide whether a man who has fallen upon the street is troubled by apoplexy, or influenced by alcoholism. If the clinical thermometer shows the temperature to be above normal, it is apoplexy; if below normal, it is alcoholism. "Alcohol is clearly proved to be not a fuel-food, for if it were it would enable the body to resist cold, instead of making it colder; and in the extreme degrees of cold it would go on burning like other fuel-foods, and would maintain, instead of helping to destroy, life."--Richardson's _Lesson Book_. Yet because it creates a glow of warmth in the skin immediately after drinking it, thousands of people will discredit all evidence that it is a reducer of bodily heat. Clinical thermometers, and after-sensations of chilliness, are unheeded, for "Wine is a mocker," and multitudes are willing to be deceived by it. So, also, with the conclusions against it as a strengthening agent; because it dulls the sense of hunger and of fatigue, those who crave it will declare in the face of all scientific testimony that it strengthens them, and takes the place of food. They will cite, too, the cases of people who "lived upon whisky" during an illness of greater or less duration. Of the sustaining of life upon alcohol only, Dr. N. S. Davis has said:-- "The falsity of all such stories is made apparent by the fact that nineteen-twentieths of all the alcoholic drinks given to the sick are given in connection with sugar, milk, eggs or meat-broths, which furnish the nutriment, and would support the patients better if given with the same perseverance without the alcohol than with it. While we have quite a number of examples of men living on nothing but water forty or fifty days, I have never seen or learned of a well-authenticated case of a man's taking or receiving into his system nothing but alcohol for half of that length of time, without becoming sick with either gastro-duodenitis, nephritis, or delirium tremens." _Some of the defenders of the medicinal use of alcohol claim that since it has been shown to reduce tissue waste it should be classed as an indirect food, a conserver of tissue._ Of this claim, Dr. N. S. Davis says in the _Bulletin of the A. M. T. A._, November, 1895:-- "A careful study of the conditions and processes necessary for both tissue building or nutrition, and tissue waste or disintegration, in all the higher order of animals, will show that neither process can be materially retarded without retarding or preventing the other. Both processes take place only in bioplasm or vitalized matter, supplied with oxygen, water and heat. Neither the assimilation of new material food, nor its use in tissue building can be effected without the presence of free oxygen and nuclein, or corpuscular elements of the blood. And without the presence of the same elements we can have no natural tissue disintegration and removal of the waste. The processes of tissue building and tissue disintegration, are therefore, so intimately related, and dependent upon the same materials and forces, that neither can be hastened or retarded from day to day without influencing the other. When alcohol or any other substance, introduced into the blood, retards the tissue waste, as shown by the diminished amount of excretory products, it must do so by either diminishing the amount of free oxygen in the blood, by impairing the vasomotor and trophic nerve functions or by direct impairment of the properties of the nuclein or protogen elements of the blood and tissues. The popular idea, both in and out of the profession is, that the alcohol, by further oxidation in the blood, lessens the amount of oxygen to act on the tissues, and generates heat or 'some kind of force.' Those who advocate this theory of saving the tissues by combining the oxygen with alcohol seem to forget that in doing so they are diverting and using up the only agent, oxygen, capable of combining with, and promoting the elimination of, all natural waste products as well as the various toxic elements causing disease. "But the theory that alcohol directly combines with the oxygen of the blood by which it would be converted into carbonic acid and water with evolution of heat is completely refuted by the well-known fact that its presence in the blood diminishes both temperature and elimination of carbonic acid as already stated. Physiologists of the present day very generally agree that the capacity of the blood to receive oxygen from the lungs, and convey it to the systemic capillaries and various tissues, depends chiefly on its hemoglobin (red coloring matter), protein, or albuminous and saline elements. "Both experimental and clinical facts in abundance show that alcohol at all ordinary temperatures displays a much stronger affinity for these elements of the blood and tissues, than it does for oxygen. And when present in the blood, it rapidly attracts both water and hemoglobin from the corpuscular and albuminoid elements of that fluid, and thereby diminishes its reception and distribution of oxygen. We are thus enabled to see clearly how the alcohol diminishes the oxygenation and decarbonization of the blood, and retards all tissue changes both of nutrition and waste without itself undergoing oxidation with evolution of heat. Consequently, instead of acting as a shield or conservator of the tissues by simply combining with the oxygen, the alcohol directly impairs the properties and functions of the most highly vitalized elements of the blood itself, and thereby not only retards tissue waste but also equally retards the highest grades of nutrition, and favors only sclerotic, fatty and molecular degenerations, as we see everywhere resulting from its continued use. Can an agent displaying such properties and effects be called a _food_, either direct or indirect, without a total disregard for the proper meaning of words?" In another place he says:-- "This lessening of the elimination of tissue waste is simply an evidence of the accumulation of poisonous substances within the body, through the lessened activity of liver and kidneys and the impairment of the blood." Dr. Ezra M. Hunt says in _Alcohol as Food and as Medicine_, page 37:-- "It sounds conservative of health to say of a substance that it delays the breaking down of tissue, but the physiologist does not allow a substance which occasions such delay, to possess, because of that, either dietetic or remedial value. To increase weight by prolonged constipation is not a physiological process." Dalton says:-- "The importance of tissue change to the maintenance of life is readily shown by the injurious effects which follow upon its disturbance. If the discharge of the excrementitious substances be in any way impeded or suspended, these substances accumulate either in the blood or tissues, or both. In consequence of this retention and accumulation they become poisonous, and rapidly produce a derangement of the vital functions. Their influence is principally exerted upon the nervous system, through which they produce most frequent irritability, disturbance of the special senses, delirium, insensibility, coma, and finally, death." The power to retard the passage of waste matter from the system is one of the gravest objections to the use of alcohol in sickness, as the germs of disease are thereby caused to remain longer in the body than they would, were no alcohol or drug of similar action, used. Thus recovery is delayed, if not effectually hindered. The preponderance of scientific evidence is all against alcohol as possessing food qualities. It contains no elements capable of entering into the composition of any part of the body, hence cannot give strength; it is not a fuel-food as it does not supply heat to the body, but decreases temperature; and its classification as indirect food because it retards the passage of waste matter is shown to be utterly unscientific, as any agent which interferes with the natural processes of assimilation and disintegration is a dangerous agent, a poison rather than a food. The question naturally arises:-- If these drinks are not liquid food, as we have been taught to believe, how is it, since they are made from food, as barley, corn, grapes, potatoes, etc? These drinks are not food, although made from food, because in the process of manufacturing them the food principle is destroyed. The grain is malted to change starch into sugar--loss of food principle begins here--then the malted grain is soaked in water to extract the saccharine matter. When the sugar is all in the water the grain goes to feed cattle or hogs, and the sweetened water is fermented. The fermentation changes the sugar into alcohol. Analyses of beer by eminent chemists show an average of 90 per cent. water, 4 per cent. alcohol, and 6 per cent. malt extract. The malt extract consists of gum, sugar, various acids, salts and hop extract. Starch and sugar are all of these capable of digestion, and the amount of them would be equal to 39 ounces to the barrel of beer. Liebig, the great German chemist, said:-- "If a man drinks daily 8 or 10 quarts of the best Bavarian beer, in a year he will have taken into his system the nutritive constituents contained in a 5 pound loaf of bread." Eight quarts a day for a year would be 2,920 quarts, or a little more than 23 barrels. If sold to the consumer at the low rate of five cents a pint, it would cost him $292; a high price for as much nourishment as in a 5 pound loaf! Analyses of wine by reliable chemists show that the consumer must pay $500 for the equivalent in nourishment of a 5 pound loaf of bread, wine being higher priced than beer. Wines average 80 per cent. water, about 15 per cent. alcohol, and 5 per cent. residue. This residue is composed of sugar, tartaric, acetic and carbonic acids, salts of potassium and sodium, tannic acid, and traces of an ethereal substance which gives the peculiar or distinguishing flavor. The only one of these ingredients possessing food value is sugar; this exists chiefly in what are called sweet wines. Yet how many thousands of people spend money they can ill afford for wines and beers to build up the failing strength of some loved one! A costly delusion, and too often a fatal one! "Distilled liquors, if unadulterated, contain literally nothing but water and alcohol, except traces of juniper in gin, and the flavor of the fermented material from which they have been distilled."--_Influence of Alcohol_, by N. S. Davis, M. D. It is the solemn duty of those to whom the people look for instruction in matters of health to undeceive the toiling masses as to the food-value of alcoholic liquids. Some of the medical profession are faithful in this regard, but too many others are themselves deceived, or care not for the destruction of the people. IS ALCOHOL A STIMULANT? A lady asked her family physician several years ago what he thought of the views of those medical writers who class alcohol as a narcotic, and not a stimulant. He answered with some heat, "Any one who says alcohol is not a stimulant is either a fool or a knave!" He could not have been aware that some of the most distinguished professors in American medical colleges teach that alcohol is not, properly speaking, a stimulant, but a narcotic. The accepted definition of a stimulant in medical literature is some agent capable of exciting or increasing _vital activity_ as a whole, or the natural activity of some one structure or organ. Dr. N. S. Davis has said repeatedly that both clinical and experimental observations show that alcohol directly diminishes the functional activity of all nerve structures, pre-eminently those of respiration and circulation, thus decreasing the internal distribution of oxygen, which is nature's own special exciter of all vital action. "Consequently it is antagonistic to all true stimulants or remedies capable of increasing vital activity. Instead, therefore, of meriting the name of _stimulant_, alcohol should be designated and used only as an anæsthetic and sedative, or depressor of vital activity." The following is taken from an editorial article in the _American Medical Temperance Quarterly_ for January, 1894:-- "Drs. Sidney Ringer and H. Sainsbury in a carefully executed series of experiments on the isolated heart of the frog, found that all the alcohol when mixed with the blood circulating through the heart, uniformly diminished the action of that organ in direct proportion to the quantity of alcohol used, until complete paralysis was induced. In closing their report in regard to the action of different alcohols, they say that 'by their direct action on the cardiac tissue these drugs are clearly _paralyzant_, and that this appears to be the case from the outset, _no stage of increased force of contraction preceding_.' "Professor Martin, while in connection with the Johns Hopkins University, performed an equally careful series of experiments in regard to the action of ethylic, or ordinary alcohol, directly on the cardiac structures of the dog, and with the same results. He makes the following explicit statement of the results obtained by him. 'Blood containing one-fourth per cent. by volume, that is two and a half parts per 1000 of absolute alcohol, almost invariably diminishes, within a minute, the work done by the heart; blood containing one-half per cent. always diminishes it, and may even bring the amount pumped out by the left ventricle to so small a quantity that it is not sufficient to supply the coronary arteries.' "In 1883, R. Dubois, by direct experimenting upon animals, found that the presence of alcohol in the blood much intensified the action of chloroform and thereby rendered a much less dose fatal. "Prof. H. C. Wood of the University of Pennsylvania, in an address upon Anæsthesia to the Tenth International Medical Congress, of Berlin, in 1890, said: 'In my own experiments with alcohol, an eighty per cent. fluid was used largely diluted with water. The amount injected into the jugular vein varied in the different experiments from 5 to 20 c. c.; and in no case have I been able to detect any increase in the size of the pulse or in the arterial pressure produced by alcohol, when the heart was failing during advanced chloroform anæsthesia. On the other hand, on several occasions, the larger amounts of alcohol apparently greatly increased the rapidity of the fall of arterial pressure, and aided materially in extinguishing the pulse. "Sir Henry Thompson says: 'That alcohol is an anæsthetic and paralyzant is a fact too well established to be questioned or contradicted.' "Dr. J. J. Ridge, of London, has published elaborate tables, showing that even small doses of alcohol, averaging one tablespoonful of spirits--not quite half a wineglass of claret or champagne, and not quite a quarter of a pint of ale--impair vision, feeling, and sensibility to weight, without the subject's being conscious of any alteration. Dr. Scougal, of New York, has repeated and confirmed these experiments, and also demonstrated that the hearing was similarly affected. "Drs. Nichol and Mossop, of Edinburgh, conducted a series of experiments on each other, examining the eye by means of the ophthalmoscope while the system was under the influence of various drugs. They found that the nerves controlling the delicate blood-vessels of the retina were paralyzed by a dose of about a tablespoonful of brandy. "Dr. T. D. Crothers, of Hartford, Conn., has deduced some valuable facts from his experiments with the sphygmograph, upon the action of the heart. He has found by repeated experiments that while alcohol apparently increases the force and volume of the heart's action, the irregular tracings of the sphygmograph show that the real vital force is diminished, and hence its apparent stimulating power is deceptive."--Extract from the Annual Address before the Medical Temperance Association at San Francisco, Cal., June 8, 1894, by Dr. I. N. Quimby, of Jersey City, N. J. Dr. J. H. Kellogg, of Battle Creek, Mich., has made extensive experiments as to the effects of alcohol. In summing up the results of these he says:-- "It would seem that no further evidence could be required that alcohol is a narcotic and an anæsthetic, rather than a stimulant, and that its use as a supporting and tonic remedy is a practice without foundation in either scientific theory or natural clinical experience." Sir B. W. Richardson at a medical breakfast in London in 1895, stated that though alcohol produced an increase in the motion of the heart it was ultimately weaker in its action, so he resolved to give up using such an agent. Dr. A. B. Palmer of the University of Michigan prepared a "Report" upon alcohol in 1885 for the Michigan State Medical Society in which he cited experiments showing that the opinion that alcohol stimulates the heart by an increase of real force, is an error. It creates a flutter, but decreases power. "Increased frequency of pulsation is often the strongest evidence of diminished power--as the fluttering pulse of extreme weakness." He classes alcohol with chloroform. "If chloroform is a narcotic, alcohol is a narcotic. If chloroform is an anæsthetic, alcohol is an anæsthetic. If one is essentially a depressing agent, so is the other. Their strong resemblance no one can question. The chief difference is that the alcoholic narcosis is longer continued, and its secondary effects are more severe." In closing his summary of the changes in scientific knowledge of this drug he says:-- "We said it was a direct heart exciter. We now know it is a direct heart depressor. We said, and nearly all the text-books still say, it is a direct cardiac stimulant. We know from most conclusive experiments it is a direct _cardiac paralyzant_." The following is taken from one of the many excellent papers upon alcohol written by that Nestor among physicians, Dr. N. S. Davis:-- "Alcoholics are very generally prescribed in that weakness of the heart sometimes met with in low forms of fever and in the advanced stage of other acute diseases. It is claimed that these agents are capable of strengthening and sustaining the action of the heart under the circumstances just named, and also under the first depressing influence of severe shock. "There is nothing in the ascertained physiological action of alcohol on the human system, as developed by a wide range of experimental investigation, to sustain this claim. I have used the sphygmograph and every other available means for testing experimentally the effects of alcohol upon the action of the heart and blood-vessels generally, but have failed in every instance to get proof of any increased force of cardiac action. "The first and very transient effect is generally increased frequency of beat, followed immediately by dilatation of the peripheral vessels from impaired vasomotor sensibility, and the same unsteady or wavy sphygmographic tracing as is given in typhoid fever, and which is usually regarded as evidence of cardiac debility. Turning from the field of experimentation to the sick-room, my search for evidences of the power of alcohol to sustain the force of the heart, or in any way to strengthen the patient has been equally unsuccessful. I was educated and entered upon the practice of medicine at a time when alcoholic drinks were universally regarded as stimulating and beat-producing, and commenced their use without prejudice or preconceived notions. But the first ten years of direct clinical or practical observation satisfied me fully of the incorrectness of those views, and very nearly banished the use of these agents from my list of remedies. While it is true that during the last thirty years I have not prescribed for internal use the aggregate amount of one quart of any kind of fermented or distilled drinks, either in private or hospital practice, yet I have continued to have abundant opportunity for observing the effects of these agents as given by others with whom I have been in council; and simple truth compels me to say that I have never yet seen a case in which the use of alcoholic drinks either increased the force of the heart's action or strengthened the patient beyond the first thirty minutes after it was swallowed. * * * * * "Nothing is easier than self-deception in this matter. A patient is suddenly taken with syncope, or nervous weakness, from which abundant experience has shown that a speedy recovery would take place by simple rest and fresh air. But in the alarm of patient and friends something must be done. A little wine or brandy is given, and, as it is not sufficient to positively prevent, the patient in due time revives just as would have been the case if neither wine nor brandy had been used." In the _Medical Pioneer_ of November, 1895, Prof. E. MacDowel Cosgrave, Professor of Biology, Royal College of Surgeons in Ireland, says:-- "The result of all recent investigation is to show that the use of alcohol when a stimulant effect is desired, is an error; and that, from first to last alcohol acts as a narcotic." Dr. Edmunds, of London, said in an address given in Manchester:-- "By giving alcohol as a stimulant in exhausting diseases, I believe we always do as we should in giving a dose of opium and brandy and water to comfort a half suffocated patient; i. e., increase his danger. If that be so, we reduce alcohol not only from the position of food medicine, but we reduce it from the position of a goad; and we say that the supposititious stimulating or goading influence of alcohol is a mere delusion; that in fact alcohol always lessens the power of the patients, and always damages their chance of recovery, when it is a question of their getting through exhausting diseases." Many more such quotations might be adduced. Enough are given to show that the popular use of alcohol, when a stimulant is required, is considered a grave error by those who have most thoroughly studied the effects of this drug. ALCOHOL AS A TONIC. Dr. J. J. Ridge, of London, says:-- "The action of alcohol in relaxing unstriped muscular fibre, which entitles it to be called an anti-spasmodic, robs it of all claim to give tone. The sense of exhilaration which follows small doses of alcohol has been mistaken for real strength and increase of vitality. It is well known that relaxation of the blood-vessels throughout the body is one of the first effects of alcohol. The arteries of the retina have been observed to dilate after very small doses of alcohol. The diminution of tone is well seen in the tracings of the pulse under the influence of alcohol. If one needs a tonic, therefore, alcohol is one of the things to be shunned altogether. "But alcoholic beverages contain other things beside alcohol. Beer contains infusion of hops, or other bitter stomachics. Some wines contain tannin. These ingredients, by creating or stimulating the appetite, increase the strength and vital power in certain cases. But we have a large number of drugs which will do the same without the disadvantages arising from the presence of alcohol, and, if the flavor be objected to, many of them can be taken in the form of coated pills. "The external use of cold, either by a dripping sheet, cold sponging, or a shower-bath, according to the power of reaction, is a valuable means of giving real tone. "Wine is frequently prescribed for those young persons who are growing rapidly, and whose strength does not seem to keep pace with their growth. It is important to know that alcohol is not desirable in such circumstances. There is often found in such cases a defective appetite, perhaps even sub-acute gastric catarrh, which may be due to imperfect mastication through bad teeth, or aggravated by it. There are other causes, such as late hours, bad habits, improper food or irregular meals. In such cases those means must be resorted to which are so effectual in improving the condition and strengthening the heart of athletes. Regular and regulated meals, exercise in the fresh air, a good amount of rest and sleep--these will do more than anything else to invigorate the bodily health." Dr. N. S. Davis says:-- "Although I was taught, like all others, to use alcohol as a tonic when patients were sick, to hasten their recovery and promote their strength, yet it did not take me very long to find out that here and there was one already a teetotaler who would not take wine long, nor any kind of alcoholic drink unless prescribed, just as castor-oil, dose by dose, but who, when he got beyond the necessity of having it as a medicine, took no more. What was the comparison? My patients who refused, or did not take alcohol, got strong quicker and had less tendency to relapse than those who continued its use. Here was the first step in progress, and consequently I came soon to cease the recommending it merely to hasten recovery of strength. As a tonic, I found it of no value." Dr. James Miller, of Edinburgh, says in _Alcohol, Its Place and Power_, written many years ago:-- "It may be well here to correct an important error, yet very current, in regard to the medicinal use of alcohol. People regard it as a simple and common tonic; and are ready to accept its supposed help as such in every form of weakness and general disorder of health. But it is ordinarily, no true tonic." Dr. Ernest Hart, editor of the _British Medical Journal_, stated some years ago at a meeting of the British Medical Temperance Association that "the medical profession were nearly all agreed that alcohol is neither a food nor a tonic." Many drunkards have been made, especially among women, by the delusion that alcohol has tonic effect. As a sample of these sad cases the following is given, taken from a recent number of _The National Advocate_:-- "There is in the jail at Elizabeth, N. J., a woman who was arrested while participating in wild drunken orgies with a gang of tramps in the woods near the town. She appears nothing but a besotted hag, but was only a short time ago a dutiful wife of a respectable man, and the mother of three beautiful children. Her father, who is said to be living in a village in New York State, is a highly respected minister of the Methodist Episcopal Church. Her children are in an asylum, and her husband is a wanderer in the West. The cause of her ruin was beer, prescribed for her by the family physician as a tonic. At first she refused to take it, having always been a teetotaler, but persuaded to obey the physician, she soon acquired a taste for the drink that speedily developed into the overmastering appetite, which has brought her and hers to this sad condition." ALCOHOL AS A SEDATIVE. Dr. J. J. Ridge says in the _Medical Pioneer_, April, 1893:-- "Alcohol, chiefly in the form of spirits, is often given to procure sleep and to relieve pain, such as that of neuralgia, dyspepsia, colic and diarrhoea. It is as a sedative that alcohol is so insidious and seductive in cases of chronic disease, as, if frequently resorted to, the drink craving is almost certainly developed. Hence the importance in many cases of rather bearing the ills we have than of flying to others that we know not of. It is clear that other narcotics, such as opium, morphia, chorodyne, chloral, are open to the same objection, and the victims of these drugs are terribly numerous. * * * * * In many instances some form of dyspepsia is the cause of the sleeplessness, palpitation or other uneasy feeling for which a sedative is desired, and when this is cured the symptoms vanish." A prominent minister in a large American city was afflicted with insomnia a few years ago, and, after trying various remedies, was advised by a physician to try whisky "night-caps." He became a hopeless drunkard. A young medical student in New York appealed to one of his professors for aid in overcoming aggravated insomnia. The professor advised whisky and morphine! The advice led to the ruin of the young man. ALCOHOL AS AN ANTIPYRETIC. "By the power of alcohol to retard the evolution of heat in retarding molecular changes in the tissues, the liquids containing it may be used as antipyretics when the temperature is too high, and to retard the processes of waste when these are too rapid. But the antipyretic influence of alcohol is so feeble in comparison with the proper application of water to the surface, or with the internal administration of sulphate of quinia, salicylic acid, digitalis, etc. that no one thinks of using it for antipyretic purposes."--Dr. N. S. Davis in _Principles and Practice of Medicine_. PROFESSOR ATWATER'S CONCLUSIONS UPON ALCOHOL AS A FUEL-FOOD. In 1899 a decided sensation was caused by the announcement that Prof. Atwater, of Middletown, Conn., had proved that alcohol is a fuel-food equal in value to carbohydrates and fats. The study later of Prof. Atwater's report of his investigations led to prolonged discussions among medical men interested in the alcohol question, and his theory that alcohol is a food because it is oxidized in the body was vigorously opposed by many scientists of high standing. Professor Abel, of Johns Hopkins University, Baltimore, an investigator of alcohol who worked with the Committee of Fifty, said on this point:-- "Oxidizability cannot be made the measure of usefulness in regard to this substance." Professor Gruber, president of the Royal Institute of Hygiene, Munich, said:-- "Does alcohol truly deserve to be called a food substance? Obviously, only such substances can be called food material, or be employed for food, as, like albumen, fat, and sugar, exert non-poisonous influence in the amounts in which they reach the blood and must circulate in it in order to nourish * * * * Although alcohol contributes energy it diminishes working ability. We are not able to find that its energy is turned to account for nerve and muscle work. Very small amounts, whose food value is insignificant, show an injurious effect upon the nervous system." Sir Victor Horsley, the well-known London surgeon, said:-- "We know that alcohol lowers the temperature of the body. It can only do that by diminishing the activity of the vital processes. It also diminishes very greatly the power of the muscles, and it diminishes the intellectual power of the nervous system. To call an agent that causes such diminution of activity throughout the whole body a food is ridiculous." An editorial in the _Journal of the American Medical Association_ said: "The fallacy of the reasoning which would place alcohol among the foods is very apparent when we put it in the form of a syllogism: All foods are oxidized in the body; alcohol is oxidized in the body; therefore alcohol is food. As logically we might say: 'All birds are bilaterally symmetrical; the earthworm is bilaterally symmetrical; therefore the earthworm is a bird.' Oxidation within the body is simply one of several important properties of food, as bilateral symmetry is one of several important characteristics of a bird." Schafer's Physiology says:-- "It cannot be doubted that any small production of energy resulting from the oxidation of alcohol is more than counterbalanced by its deleterious influences as a drug upon the tissue elements, and especially upon those of the nervous system." The _Bulletin_ of the A. M. T. A. for July, 1899, contained an article upon Prof. Atwater by Dr. J. H. Kellogg, from which the following is taken:-- "Starch, sugar and fats become foods or fuels only through their assimilation. Abundant physiological evidence attests that no substance can act as a food, or as a true source of energy, unless it has first entered into the composition of the body. It must be assimilated. The forces manifested by the body, the muscular forces, or nervous energy, are the result of the breaking down of organized structure into simpler forms. For example, in the case of nervous energy, material from which nerve energy is derived is stored up in the nerve cell, and can be seen with the microscope in the form of minute granules, which disappear as the cell energy is expended, leaving the cell blank and shriveled when in a state of extreme fatigue from overwork. The same is essentially true of the muscle cell. The source of muscular energy is glycogen, an organized substance which becomes a part of the muscle tissue in a well-nourished muscle in a state of rest. "Experiments have clearly shown that fat, sugar and starch must all alike be converted into the form of glycogen and enter into the muscle structure before they can become a source of energy. "Professor Atwater tells us that alcohol can not form tissue, hence the query is pertinent, How can it be a source of vital energy? The body does not burn food as a stove does fuel. Food can be called fuel only in a highly figurative sense. The oxidation of food in the body does not take place directly. Food is assimilated, becoming a part of the tissue. Oxygen is also assimilated, entering into the composition of the tissue along with the food elements under the action of special organic ferments brought into play by nervous impulses received from the central ganglia. "The molecules of these residual tissues which form the storehouse of energy in the body are rearranged in simpler forms, thereby giving up a portion of the energy which holds them together in the state in which they exist in the tissues, and this energy thus set free appears as muscle force, mental activity, glandular work and various other forms of functional activity." CHAPTER VII. ALCOHOL IN PHARMACY. In the _Journal of the American Medical Association_ for November 13, 1897, Dr. T. D. Crothers, editor of the _Journal of Inebriety_, says in a paper upon "Concealed Alcohol in Drugs":-- "A very important question has been repeatedly raised, and answered differently by persons who claim to have some expert knowledge. The question is, can strong tinctures of common drugs be given in all cases with safety; tinctures of the various bitters which contain from 10 to 40 per cent. of alcohol, and are used very freely by neurotic and debilitated persons? It is asserted with the most positive convictions that such tinctures are more sought for the narcotic effect of the alcohol than for the drugs themselves. "In my experience a large number of inebriates who are restored, relapse from the use of these tinctures given for their medicinal effects. * * * * * "The question is asked, how much alcohol can be used as a solvent in drugs without adding a new force more potent than that which is brought out by the alcohol? Opinions of experts differ. One writer thinks 10 per cent. of alcohol in any drug will, if given any length of time, develop the physiologic effect of alcohol in addition to that of the drug. An English writer says that in some cases a 5 per cent. tincture is dangerous from the alcohol which it contains. "There is some doubt expressed by many authorities as to the potency of a drug which is covered up in a strong tincture. It is clear that the value of a drug is not enhanced, and it is certain that a new force-producing, or exploding agency, has been added to the body. "In experience, any drug which contains alcohol can not be given to persons who have previously used it without rousing up the old desire for drink, or at least producing a degree of irritation and excitement that clearly comes from this source. It is also the experience of persons who are very susceptible to alcohol, that any strong tincture is followed by headache and other symptoms that refer to disturbed nerve centres. "In many studies I have been surprised at the increased action of drugs when given in other forms than the tincture. Gum and powdered opium, have far more pronounced narcotic action than the tincture. Yet the tincture is followed by a more rapid narcotism, but of shorter duration, and attended with more nerve disturbance at the onset. "I am convinced that a more exact knowledge of the physiologic action of alcohol on the organism will show that its use in drugs as tinctures is dangerous and will be abandoned. "There are many reasons for believing that its use in proprietary drugs will be punished in the future under what is called the poison act." Dr. J. J. Ridge published in May, 1893, in the _Medical Pioneer_, the following statement of the pharmacy of the London Temperance Hospital:-- "When the Temperance Hospital was first opened, it became a question of practical importance, what should be done with regard to the alcohol so largely employed as a vehicle and drug excipient. Not that the principle of the treatment of disease without the ordinary administration of alcoholic beverages precludes the employment of alcoholic tinctures, but it was felt that in such a test case as this it was important to obviate the objection that while withholding alcohol as a beverage, it was given in the medicine. As a matter of fact, it is surprising, when one looks into it, how much alcohol is often given merely as a vehicle for other drugs, and without the special action of alcohol being required or desired. In prescriptions which are to be seen in many text-books, it is not uncommon to find from one to two or three, or even four drachms of rectified spirit in the form of tinctures or spirits. This is very undesirable. If alcohol is needed it should be given in proper measured dose. But if it is not indicated, then it is not well to administer it in this indirect manner. "Experiments were therefore made, partly at the hospital and specially by Messrs. Southall Bros. & Barclay, of Birmingham, with the result that new non-alcoholic tinctures were made replacing the following alcoholic tinctures and wines:-- Tinct. Aloes. " Arnicæ. " Aurantii. " Belladonnæ. " Buchu. " Calumbæ. " Camph. Co. " Capsici. " Cascarillæ. " Catechu. " Chiratæ. " Cinchonæ Co. " " Flav. " Cinnamomæ. " Colchici Sem. " Conii. " Digitalis. " Ferri Acet. " Ferri Perchlor. " Gentiani Co. " Hyosciami. " Kino. " Krameriæ. " Limonis. " Lobeliæ. " Nucis Vomicæ. " Opii. " Quassiæ. " Rhei. " Scillæ. " Serpentariæ. " Stramonii. " Valerianæ. " " Ammon. Vin. Aloes. " Colchici Rad. " " Sim. " Ipecac. " Opii. " Rhei. "These were made by extracting the principles of the drugs in the usual way except that instead of alcohol a mixture of glycerine and water was used in the proportion of one-fourth to one-third part of glycerine, and about five per cent. of acetic acid. These made very elegant preparations, and in the majority of cases appeared to have just the same, and just as great physiological action. Subsequently the ordinary tinctures were distilled, and the extracts thus obtained dissolved in the above menstruum, as far as was possible, in most cases the residuum being found to be inert. "Gum resins and essential oils were found to be insoluble in this menstruum, and hence such drugs have been given in the form of pill, powder or mixture. Such tinctures are those of assafoetida, benzoin, cannabis indica, cantharides, castor, cubebs, lavender, myrrh, pyrethrum, sumbul, tolu and ginger. Out of 62 tinctures it was found that 46 made good preparations, and 16 did not. "These were employed for several years. But for some time past, somewhat more reliable preparations have been made for us which contain _all_ the constituents of the alcoholic tinctures without the alcohol. They are for the most part made by taking standardized tinctures, mixing with them sugar of milk, and distilling off the alcohol. The alcoholic extract remains behind in a finely divided condition mingled with sugar of milk. This is broken up, pulverized and compressed into tabloids of a definite dose, which can be taken either in that form or rubbed up and dissolved or suspended in gum water. "The following have been made up in this form: aconite, belladonna, camph. co., cannabis indica, capsicum, cinchon. co., and cinchon. simpl., digitalis, gelseminum, hyosciamus, nux vomica, opium, strophanthus, ginger and Warburg. Other tinctures will be gradually added to this list. "As external liniments those commonly used are the linimentum terebinthinæ and the linimentum terebinthinæ aceticum, which do not contain alcohol. A strong solution of iodine is made with iodide of potassium. "The spiritus ammoniæ aromaticus is made without the spirit, the aromatic oils being emulsionized by means of rubbing up with fine sand, but most of these subsequently rise to the surface. The spiritus etheris nitrosi is impossible without alcohol, but nitrite of amyl, and nitrites of potash or soda can be substituted. The spiritus chloroformi is replaced by aqua chloroformi, or as a sweetening agent by solution of saccharin. Thus a favorite expectorant mixture contains carbonate of ammonia five grains, acetum ipecac, ten minims, and solution of saccharin in each dose. "As a special stimulant a subcutaneous injection of a drachm of pure ether has been given in a few cases; in others digitalis, or caffeine or ammonia in some form, such as the carbonate dissolved in a cup of hot coffee; or hot solution of Liebig's extract, or rectal injections of hot water." It may be objected by some that glycerine belongs to the family of alcohols, hence hospitals using glycerine tinctures are not, strictly speaking, non-alcoholic. To this the answer is, that while glycerine certainly is classed in the family of alcohols, it is of a very different nature from ethyl alcohol, which is used for beverage purposes. Ethyl alcohol, the alcohol in all intoxicating beverages in common use, and the alcohol generally used in medicine, creates a fatal craving for itself, and is injurious to the body. Glycerine does not create any craving for itself, and has not been demonstrated to have injurious properties, and is not used for beverage purposes. At the annual meeting of the New York State Medical Society, held in New York City, in October, 1898, a discussion was held upon the use of alcohol as medicine. Dr. E. R. Squibb, a leading pharmacist of Brooklyn, stated that during the last two or three years much had been accomplished in retiring alcohol as a menstruum for exhausting drugs. Of the other menstrua experimented with up to the present time, that which had given the best results was acetic acid, in various strengths. It had been discovered that a ten per cent. solution of acetic acid was almost universal in its exhausting powers. There were now in use in veterinary practice, and in some hospitals, extracts made with acetic acid. They were made according to the requirements of the pharmacopoeia, except that acetic acid was substituted for alcohol. Acetic acid, when used with alkaloids gives the physician some advantages in prescribing, owing to there being fewer incompatibles. In small doses, the percentage of acetic acid in the extract is so small as to be hardly appreciable, and when larger doses are required, the acetic acid can be neutralized by the addition of potash or soda. Dr. Noble said, in article to _London Times_ before referred to:-- "Modern science has shown that those drugs which are soluble in alcohol only, are, in all probability, more hurtful than useful." The following from Dr. Jas. R. Nichols, editor Boston _Journal of Chemistry_, is too good to be omitted, although it should be familiar to temperance students:-- "The facetious Dr. Holmes has said, that if the contents of our drug-stores were taken out upon the ocean and thrown overboard, it would be better for the human race, but worse for the fishes. This statement may be a little sweeping; but it is true that all the showy bottles in drug-stores which contain alcoholic decoctions and tinctures might be submerged in the ocean, and invalids would suffer no detriment. Since the active alkaloidal and resinoidal principles of roots, barks and gums have been isolated and put in better and more convenient forms, there is no longer need of alcoholic tinctures and elixirs. Laudanum, which is a tincture of opium, might be banished from the shelves of every apothecary, as it is not needed. It is now known that the valuable narcotic and hypnotic principles of opium are contained in certain crystalline bodies, which can be isolated, and used in minute and convenient forms, and that they can be held in aqueous solutions. Alcohol is no longer needed to hold the active principles of opium, Peruvian bark or other indispensable drugs. As regards the vegetable tonics so called, the best among them is the columbo (Radix columbo) and this readily yields its bitter principle to water, as does quassia, gentian, senna, rhubarb and most other valuable substances. A careful survey of the contents of a well-appointed modern pharmacy leads to the conclusion that there is no one indispensable medicinal preparation which requires alcohol as a free constituent. "The catalogue of modern remedies is almost endless, and many of them hold alcohol in some form; but every intelligent physician knows that 90 per cent. of these alleged remedies have little or no intrinsic value. The nostrums of the quack, the bitters, elixirs, cordials, extracts, etc. nearly all contain alcohol, and this is the ingredient which aids their sale. The whole unclean list might, with advantage to mankind, be thrown to the fishes. "The chemist, more particularly the pharmaceutical chemist, may inquire how he is to conduct his processes without alcohol. It is from the pharmaceutical laboratory we derive some of the most important substances used in medicines and the arts. Among them may be named ether, chloroform and chloral hydrate, three of the most indispensable agents known to science, and the employment of alcohol is essential to their production. Alcohol is a laboratory product; it is a chemical agent which belongs to the laboratory; it is the handmaid of the chemist, and, so long as it exists, should be retained within the walls of the laboratory. In the manufacture of most of the important products in which alcohol is either directly or indirectly used, its production may be made simultaneous with the production of the agent desired. In the manufacture of ether and chloroform, the apparatus for alcohol may be made a part of the devices from which the ultimate agents, ether and chloroform, result. Fermentation and distillation may be conducted at one end, and the anæsthetics received at the other. It is true that in a chemical laboratory alcohol is an agent very convenient in a thousand ways. But, if it were banished utterly, what would result? There are other methods of fabricating the useful products named, and many others, without the use of alcohol, but the processes would be rather inconvenient and more costly. The banishment of alcohol would not deprive us of a single one of the indispensable agents which modern civilization demands, and neither would chemical science be retarded by its loss." "It must be remembered that modern science has given us glycerine, naptha, bisulphide of carbon, pyroligneous products, carbolic acid and a hundred other agents which are capable of taking the place of alcohol in a very large number of appliances and processes." The sale of liquor in drug-stores is beginning to be deplored by the more respectable pharmacists. At the annual meeting of the Massachusetts State Pharmacists' Association in 1895 the president said in his address:-- "One thing that every pharmacist, who has the best interests of his calling at heart, must bear in mind is that the liquor part of their business is being, and must be, slowly crowded out. Public sentiment has changed greatly in the last few years, and instead of all being classed alike, the line has been sharply drawn, and the stores that sell the least amount of liquor that they possibly can are gaining the confidence and esteem of the public, and consequently their business is growing from year to year, while the others are losing ground and dropping lower and lower." The _Evening Record_ of Boston contained the following in its issue of March 7, 1896:-- "The number of flagrant offences on the part of druggists in certain no-license towns--offences not only against the liquor laws, but also against the laws of decency and humanity--brought before the board of pharmacy, would appall the public if they were known. The Looker-On has seen the record of several of these druggists as transcribed from the police courts and they are very black records. One druggist after selling liquor over and over again to one customer, and several times getting him completely intoxicated, finally deposited him one night in a snowbank, in a state of frozen stupor, where he would have frozen to death had not the wife of the druggist's clerk threatened to complain to the police unless he was rescued. "The story is told of one of the druggists of a neighboring no-license town. A man came in and asked for a pint of whisky. He was asked what he wanted it for. His reply was that he wanted it to soak some roots in. He got it, and as he went out he dryly remarked, 'I should have told you that it was the roots of me tongue that I want to soak.'" CHAPTER VIII. DISEASES, AND THEIR TREATMENT WITHOUT ALCOHOL. The question, "What shall I take instead of wine, beer or brandy?" is frequently asked by those who have been trained to think some form of alcohol really necessary to the cure of disease, but, who, from principle would prefer other agents, if they knew of any equal in effect. This chapter deals somewhat with the answer to that question. ALCOHOLIC CRAVING:--The craving for alcohol may be present for a time after a person has commenced to abstain from all beverages containing it. Or, it may occur periodically, as a sort of irresistible impulse. For the periodical craving Dr. Higginbotham, of England, recommends that a half drachm of ipecacuanha be taken so as to produce full vomiting. He says the desire for intoxicating drinks will be immediately removed. The craving is caused by vitiated secretions of the stomach; the vomiting removes these. Dr. Higginbotham says:-- "If a patient can be persuaded to follow the emetic plan for a few times when the periodical attacks come on, he will be effectually cured." Some men in trying to abstain have found the use of fresh fruit, especially apples, very helpful. Nourishing and digestible food should be taken somewhat frequently. A cup of hot milk or hot coffee taken at the right moment has saved some. ANÆMIA:--In this complaint there is a deficiency of the red corpuscles of the blood. It may be the result of some fever or exhausting illness; it may accompany dyspepsia, and is then due to imperfect digestion and assimilation of the food. The poverty of the blood produces shortness of breath, and often palpitation of the heart also, especially on a little exertion. There is generally more or less weariness, languor and debility, sometimes also giddiness, sickness, fainting and neuralgia. "In the treatment of anæmia, port wine and other alcoholic liquors are worse than useless."--DR. J. J. RIDGE, London. "The common prescription of wine or some form of spirits for states of general exhaustion and anæmia, is a serious mistake. It assumes that the temporary increase in the action of the heart is renewed vigor, and that some power is added to the failing energies. This theory rests solely on the statement of the patient that he feels better. In reality the exhaustion is intensified, though covered up."--_Medical Pioneer._ "Deficiency of nutrition, of light and of pure air may be mentioned as common causes of anæmia. * * * * * It is evident that the first step in the treatment of this disease is to remove the cause. If the cause is dyspepsia, this must receive attention; if intestinal parasites, they must be dislodged; if prolonged nursing, nursing must be interdicted; if too little food, a larger quantity of nourishing, wholesome food must be employed. Such simple and easily digested foods as eggs, poached or boiled, boiled milk, kumyzoon, good buttermilk, purée of peas, beans or lentils, boiled rice, well-cooked gruels and other preparations of grains are suitable. Beef tea and extracts are worthless. * * * * * "A careful course of physical training is essential to securing perfect recovery in cases of chronic anæmia due to indigestion, or any other serious disturbance of the nutritive processes."--DR. J. H. KELLOGG. APPETITE, LOSS OF:--"There is often disinclination for food because _it is not required_. Many cannot eat much breakfast, because they have had a hearty supper. Or having had both a hearty breakfast and luncheon, they feel but little desire for a dinner of four or five courses. Generally the stomach is right and the habits wrong. What is to be done then, for such lack of appetite? Simply go without food until appetite comes. "When ale or beer is taken regularly with meals the stomach learns to expect them, and the food is not relished without them. The appetizing power of beer and bitter ales is chiefly due to the hop or other bitter ingredients which they contain. When it seems necessary to assist the appetite temporarily, a small quantity of simple infusion of hops may be taken. "Sometimes appetite fails because of exhaustion of body and mind. This may be nature's warning against overwork, and cannot be neglected with impunity. Life will inevitably be shortened if it is found necessary to rely upon the aid of alcohol in any form in order to do a day's work. "Bouillon, or beef soup, at the beginning of a meal are incentives to appetite. Change of scene, and life in the open air are the very best aids to appetite, when aids are really required." APOPLEXY:--"There is a popular idea that whenever a person is taken ill with giddiness, fainting or insensibility, brandy should be at once procured and poured down his throat. Nothing can be more dangerous in apoplexy. This disease is due to the bursting of some blood-vessel in the head, and the poured-out blood presses on the brain and leads to more or less insensibility. If fainting occurs, it may possibly save the patient's life, because then the blood-vessels contract, and the flow of blood ceases immediately; time is thus given for the ruptured blood-vessel to became sealed up by a clot, which will prevent further loss of blood. If brandy is given, there is, first, great risk of choking the patient; if that danger is escaped and the brandy is swallowed and absorbed, the vessels become relaxed and the heart recovers its force; hence the ruptured vessel, if not sufficiently sealed by clot, may be started again, and fatal hemorrhage result. "The only _treatment_ which unskilled hands can adopt is to lay the patient on his back on the floor or sofa with the head and shoulders somewhat raised; to loosen all the dress round the neck and body; to apply cold to the head and hot flannels or a hot bottle to the feet and hands, or to soak them in hot mustard and water, and to gently rub the arms and legs."--DR. J. J. RIDGE. Dr. Alfred Smee, surgeon to the Bank of England, says:-- "Give nothing by the mouth. Apply a stream of cold water to the head. If the feet are cold apply warm cloths. If relief is not soon obtained, apply hot fomentations to the abdomen, keeping the head erect." BED-SORES:--Some object to using alcohol even as an outward application. Dr. Ridge recommends that when a patient is confined to bed the parts pressed on be well washed every day with strong salt and water or alum water, and carefully dried. _Glycerine of Tannin_ may then be applied. If any redness appears, especially if any dusky patch is formed, _collodion_ may be applied with a brush, and all pressure should be taken off the part by a circular air-pillow or by a cushion; or small bran or sand-bags may be made and carefully arranged. If the skin is broken, _zinc_ or _resin ointment_ may be applied. Some recommend finely powdered iodoform sprinkled over the surface of the sore. BOILS AND CARBUNCLE:--"In many cases these troubles result from an overloaded condition of the system, which is the result of taking too much food, or some error in diet. The boils are an effort of nature to be rid of offending matter. In some cases they are due to the use of impure water, or the presence of sewer gas in the house. In others, overwork, or other debilitating causes, may have produced the state of the digestive organs which usually causes the boils. Carbuncle is, essentially, an extensive boil. "Apply iodine early or a piece of belladonna plaster. The diet should be plain and unstimulating, condiments being avoided and plenty of fresh vegetables taken, if possible. Fresh-air, exercise and proper rest should be obtained, and late hours avoided. "Medical advice is requisite in carbuncle. The popular notion that port wine is absolutely necessary is both erroneous and mischievous."--RIDGE. CATARRH:--Among the causes are repeated colds; errors in diet, especially excess in the use of fats and sugar, and an inactive state of the liver. Cut off from your bill of fare all salted foods, avoid fats and condiments; drink freely of pure water; live in the open-air and sunshine as much as possible, taking much out-door exercise. Take a cold sponge or towel bath every morning, beginning at the face and finishing by plunging the feet into a foot-tub. Follow with vigorous rubbing with a crash or Turkish towel. Those subject to sore throat should hold the head over a basin of cold water and lave the neck with the water for about two minutes. The writer was formerly subject to frequent sore throats, but has had none for over two years, as she believes, because of the adoption of this measure, together with the towel bath every morning, summer and winter. Care should be taken to avoid exposure to draughts, or any other means which will produce liability to cold. Care in diet, good ventilation and the morning cold bath are essential if a radical cure is desired. Local measures, while giving relief, will not remove the predisposing causes. Dr. Kellogg recommends saline solutions in the form of the nasal douche, a teaspoonful of salt to a pint of soft water, adding twenty to thirty drops of carbolic acid, if there is offensive odor, as a relief measure. Sleeping in a poorly ventilated room is said to be one cause of catarrh. _Hay Fever_ is a form of catarrh. The vapor bath is recommended as very helpful in this trouble. _Nature Cure_ says that two vapor baths and a two or three days' fast will cure any case of hay fever. The use of pork and other clogging foods should be avoided by those afflicted with this trouble. The bowels should be kept in good condition. If constipated, the use of prunes, figs, grapes, apples and other such fruits will be very beneficial; walking, and massage of the bowels, being added if the fruits are not sufficient. No one able to walk should depend upon drugs to relieve a constipated condition. COLDS:--"If the bowels are constipated, the skin over-burdened and clogged with bilious matter, and the lungs weak, it is as easy to take cold as to roll off a log. If, on the contrary, the lungs are well developed, and the respiratory power large, providing abundant oxygen to keep bright the internal fires, the colon clean, the skin daily washed, and the system hardened by the cold bath, taking cold is next to impossible. "The first remedial agent for a cold should be a copious enema. Then open the pores of the skin by a hot bath; take a glass of hot lemonade and go to bed."--_The New Hygiene._ CHILLS:--For chill, take a hot foot and hand bath, with mustard in the water, 1/4 pound to a gallon; then go to bed in a well ventilated room. Drink freely of hot lemonade or hot water. Catarrh, colds and hay fever may all be effectually relieved by hot baths. Relief may be gained also from inhaling the vapor from pine needles or hemlock leaves. Put them in a bowl, pour boiling water over them, hold the face down over the bowl, the head being covered, and inhale the vapor well up into the nostrils and head. A few drops of hemlock oil in the hot water will do as well. COUGHS AND HOARSENESS:--Boil flaxseed in 1 pint water, strain, add two teaspoons honey, 1 ounce rock candy, and juice 3 lemons. Drink hot. Also; roast a lemon till hot, cut, and squeeze on 3 ounces powdered sugar. COLIC:--This may arise from cold, or from error in diet. If the latter it is desirable to induce vomiting. For the pain, apply hot flannels or fomentations; drink hot water. In severe cases, sprinkle a little turpentine on flannel, wrung from hot water, and apply to abdomen. Colic resulting from the accumulation of fecal matter should be treated with hot enemas until relieved. A hot hip-bath is sometimes necessary to relief. The colic of children and infants should never be treated with alcoholics. In infants it generally arises from excessive or improper feeding; care should be taken that the milk provided them is not sour. In severe cases the babe should be immersed in warm water, keeping the head above water, of course. This is also the best remedy in convulsions. The hot bath, with a copious enema of warm water, has saved the lives of many babes. For adults, hot water, with a pinch of red pepper added, will do all that brandy can do, and more. CHOLERA:--Brandy has been considered by many a really necessary medicine in cholera. The following is a discussion upon Alcohol in Cholera which was held at the annual meeting of the British Medical Temperance Association, in May, 1893, and is taken from the _Medical Pioneer_ of June, 1893:-- "Dr. Richardson opened a discussion on Cholera in relation to Alcohol. He said he would bring forward five points on the subject. 1. The negligence among the people at large produced by alcohol in the presence of a cholera epidemic. There was no doubt on the part of any who had seen an epidemic of cholera as to the mischief done by alcohol, apart from its action as a remedy. People rush to the public houses and take it to ward off the danger, or to relieve them when they begin to feel ill, and the result is very bad morally. He had seen this in different epidemics. Or people got in spirits to face the danger, and many became intoxicated and less able to resist. 2. Its misuse by those affected. It was often given to cheer them up and remove their fear and nervousness. In his opinion it invariably produced mischief. 3. He was unable to find any physiological reason for giving it. There was a constant drain of fluid, causing spasms and cramp, both of the muscles and blood-vessels, and difficult circulation through the lungs. Spasm may be relaxed by alcohol, but, on the other hand, alcohol is exceedingly greedy of water, and so increases the flux. But it also reduces animal temperature, which is a strong feature of cholera, so much so that he could almost diagnose cholera blindfold in the stage of collapse, by the icy coldness. 4. Its uselessness as a remedy during the acute stage. He had seen a great deal of cholera and never saw alcohol do any good whatever. There was a temporary glow which passed away in a few minutes, and then the evil it does in other ways was brought out. Water was far better, even if cold. The College of Physicians had given some instructions and ordered great care in the administration of alcohol; this was not far enough, but good as far as it went. The recoveries were best where the treatment was simplest, such as external warmth with plenty of diluents. He had given creasote largely. 5. Its injuriousness during the stage of reaction. The reactive fever following collapse caused a great number of deaths. In this stage alcohol was absolutely poisonous. He could recall many such cases in which he had given alcohol through ignorance, and always with disaster. "Brigade-Surgeon Pringle said that when he went out to India he thought alcohol was something to stand by, but he had soon found out his mistake; he had himself suffered from it. He could confirm what Dr. Richardson had said as to the demoralization produced by alcohol to which men resort to keep up their spirits, and men seized under these circumstances were in the greatest danger. Nature effects a cure in many cases without assistance, and often with wonderful rapidity. People apparently dead and about to be buried, he had known to get up and recover. When alcohol is given during collapse there is often no absorption until reaction occurs, and then the quantity accumulated speedily produces intoxication. It was the same with opium: he had found pills unchanged in the stomach for hours. He recommended hot drinks; he had tried every kind of medicine and had little faith in it. The nursing was very important, and it was important that the nurses should abstain. "Dr. Morton said it was easy to see that on physiological grounds alone, alcohol, with its strong affinity for water and its tendency to lower temperature, could not be a useful drug in the treatment of cholera collapse, and with its powers of paralyzing vascular inhibition and checking elimination of effete matter, could not be otherwise than harmful in the stage of reaction. As these conclusions were corroborated by practical experience he did not think members would hesitate to banish it from their equipment against cholera. "Dr. Ridge said it should be remembered that Doyen had made experiments on guinea-pigs and had found they were proof against cholera, unless they had previously had a dose of alcohol. This explained why drunkards and hard drinkers were so much more liable to have cholera, and have it badly as all observers declared to be the case. Another reason might be that small quantities of alcohol, such as would be found circulating in the blood, favored the growth and multiplication of bacteria, certainly those of decomposition, and probably those of cholera. Hence, other things being equal, the abstainer had a great advantage. "Dr. Norman Kerr said that he had observed both in America and Glasgow that not only notorious drunkards but free drinkers suffered; abstainers were less liable unless they took contaminated water, and the less liquid taken the less chance of taking cholera; beer-drinkers often took more than abstainers. The alcohol-drinker uses up more water from his blood and so has less to flush out the system. Alcohol, given to a patient, disguised his condition so that he might seem better though really worse. Hence it is better and safer not to give any. The doctors and nurses ought to be abstainers. A doctor after dinner was more likely to take a roseate view of a case, looking at it through an alcoholic pair of spectacles. Alcohol was not really a stimulant, but a depressant, and this is a very depressing disease; it was important to have our vital resisting power as vigorous as possible. Hot water both relaxes and stimulates, and the whole cry of the sufferer is for water. Many persons who died in cholera did not die of the disease, but of the drugs such as alcohol and opium. Acid drinks should be given, as the bacilli could not live in acid mixtures. Cholera might come, but he believed we were better prepared to meet it and to treat it. "Surgeon-General Francis sent a communication which was read by the Honorable Secretary. He said: 'Having had many opportunities of treating cholera in various parts of India and amongst all classes, I have no hesitation in affirming that alcohol in any shape is one of the very worst remedies. Life is, so to speak, paralyzed, and we give a remedy which, apparently stimulating, is in reality, a paralyzer and therefore mischievous; the death-rate might be considerably reduced provided alcohol were rigidly excluded.'" Dr. Norman Kerr in a valuable paper upon Cholera says:-- "The first thing is to get rid of the poison. How? By assisting it out; but alcohol keeps it in by blocking the doors, just as the doors were blocked in the terrible calamity at Sunderland not long ago. The alcohol makes the heart and circulation labor more. Alcohol not only retains the cholera poison, but retards the action of the heart. Brandy and opium used to be employed, but the records show that if the object had been to make cholera as fatal as possible, that object was achieved by the indiscriminate administration of brandy and opium. Better leave the victim alone, and his chances of recovery will be greater than if he have a thousand doctors, and as many nurses, administering to him brandy and opium. Alcohol is especially dangerous in the third stage, that of reactive fever, because it adds to the fever. Then, alcohol is not only unsafe in the three stages of genuine cholera, but especially unsafe in the premonitory diarrhoea stage, which gives nearly every one warning before they are attacked by genuine cholera. Brandy is taken simply because it puts away the pain. If there are only the pain and slight diarrhoea, speaking medically, it is all right, but if there is anything behind the pain, it is all wrong. After the alcohol, the mischief is going on, only the patient does not know it, and valuable time is lost. All the alcohol does is to deaden sensation. * * * * * Here I can thoroughly recommend ice and iced water. I have always treated cholera patients with these. Let them drink iced water to their hearts' content; they can never drink too much; and this opinion is fortified by that of Professor Maclean, of Netley. There is no need of a substitute for brandy in cholera, because in ordinary circumstances in that disease the action of a stimulant is bad. Flushing of the blood is required, and water will do it. Milk will not do it, because it is too thick--nothing but pure, cold water, all the better if iced." In 1893 Dr. Ernest Hart, editor of the _British Medical Journal_, read an able paper upon Cholera before the American Medical Association. His argument was that the introduction of such a substance as alcohol, itself being a product of germ action, into a system already suffering from the toxic influence of a ptomaine, could not be otherwise than pernicious. CHOLERA MORBUS:--Dr. Kellogg says: "The stomach should be washed by means of the stomach-tube when possible. A large hot enema should be given after each evacuation of the bowels. The addition of tannin, one drachm to a quart of water, is serviceable. When the vomited matter no longer shows signs of food, efforts should be made to stop the vomiting. Give the patient bits of ice the size of a bean to swallow every few minutes. At the same time apply hot fomentations over the stomach and bowels. If the patient suffer much from cramp, put him into a warm bath. The first food taken should be farinaceous. Oatmeal gruel, well boiled and strained, is useful." CHOLERA INFANTUM:--"Iced water may be given in very small quantities every few minutes. Give the stomach entire rest for at least twenty-four hours. There will be no suffering for want of food as long as the stomach is in such a condition. Withhold milk until nature has had time to rid the alimentary canal of the poison-producing germs. White of egg dissolved in water is an excellent preparation in these cases. Egg enemata may also be advantageously used. "Warm baths, the hot blanket pack when the surface is cold, and the hot enema are all useful. Keep the child wrapped warmly. "Great care should be taken in returning to the milk diet. The milk should be thoroughly sterilized by boiling for half an hour, and should be mixed with some barley water so as to avoid the formation of large curds in the stomach. Cream, diluted with water, may be used instead of milk." CONSUMPTION. Dr. Koch, the celebrated German microscopist, pronounces consumption contagious, because during its progress a very minute bacterium is developed which may be transmitted from one person to another. It is said that a person with healthy lungs might daily breathe millions of tubercle bacilli without any danger, and that the best preventive of this disease is to live much in the open air, or if this is impossible to spend ten or fifteen minutes a day in deep breathing exercises in the open air. "Fresh-air and disease-germs are antagonistic." Alcohol, chiefly in the form of whisky, was for many years considered of great value in the treatment of consumption of the lungs. Indeed, it was looked upon not only as a curative, but also as a prophylactic, or preventive, of great service to those predisposed to this disease by reason of narrow chest and weak lungs. Sir Benjamin Ward Richardson was the first medical scientist who showed plainly that alcohol, instead of being a preventive of consumption, is really the sole cause of one type of this disease, the type now classed under the head of "alcoholic phthisis." For this kind of phthisis there is no hope of cure. French physicians some years ago came to the conclusion that alcohol was a prolific cause of tuberculosis and that the administration of alcoholic liquors in tubercular troubles was a great error, and in the International Anti-Tuberculosis Congress held in Paris in 1905, about 2000 medical scientists being present, they presented the following resolution, which was adopted: "In view of the close connection between alcoholism and tuberculosis, this Congress strongly emphasizes the importance of combining the fight against tuberculosis with the struggle against alcoholism." Since that time a great crusade against tuberculosis has been carried on by means of exhibits and lectures, and in connection with these, almost invariably the people are warned against intemperance. For example, a pamphlet sent out by the Boston Association for the Relief and Control of Tuberculosis says: "Do not spend money for beer or other liquors, or for quack medicines or 'cures.' Self-indulgence and intemperance are very bad. Vice which weakens the strong kills the weak." The New York State Charities Aid Association, working with the State Board of Health, says in a pamphlet: "Patent medicines do not cure consumption. They are usually alcoholic drinks in disguise, and the use of alcoholic drinks is dangerous to the consumptive." At the great exhibit in Washington in September, 1908, in connection with the International Anti-Tuberculosis Congress different warnings against alcohol were upon the walls. Among these was a large poster of white cloth on which was printed the opinions on alcohol, in brief, of some of the best-known authorities on consumption. The opinions as given on that poster are given here, with others, in order to show the great change of sentiment regarding alcohol and consumption which has come about within a few years:-- "Alcohol has never cured and never will cure tuberculosis. It will either prevent or retard recovery. It is like a two-edged weapon; on one side it poisons the system, and on the other it ruins the stomach and thus prevents this organ from properly digesting the necessary food."--S. A. KNOPF, M. D., New York, Honorary Vice-President of the British Congress on Tuberculosis. Dr. Knopf in his prize essay on "Tuberculosis and How to Combat It," says in several places: "Avoid all alcoholic beverages." He says also, "Alcohol should never be given to children even in the smallest quantities." "It is a recognized fact in the medical profession that the habitual use of alcoholic drinks predisposes to tubercular infection. It is also recognized, I think, by most physicians that alcohol as a medicine is harmful to the tubercular invalid."--FRANK BILLINGS, M. D., Chicago, Ill., Former President American Medical Association. "Alcoholic liquors are of damage to consumptives because they tend to impair nutrition, disturb the action of the stomach, and give a false strength to the invalid on which he is sure to presume. Besides, we know that in countries where drinking prevails most, the ravages of tuberculosis are most marked."--EDWARD L. TRUDEAU, M. D., Adirondacks Sanitarium for Consumptives, Saranac Lake, N. Y. "In my judgment whisky should not be used by people who have consumption, and in my practice I prohibit its use absolutely. At the White Haven Sanitarium and Henry Phipps Institute we do not use alcohol in any form in the treatment of our patients."--LAWRENCE F. FLICK, M. D., Vice-President of the National Association for the Study and Prevention of Tuberculosis, Philadelphia, Pa. "I do not feel that I can emphasize strongly enough the harm that can be done by the use of alcohol in tuberculosis, and the indiscriminate use of it certainly borders on the criminal. I do not believe that any legitimate reason can be given for the routine employment of alcohol in the treatment of tuberculosis. I furthermore know of no emergency in which it is indispensable. My experience with patients who have been accustomed to the use of alcohol, especially moderately, is very unsatisfactory. They seem to show an abnormally low resisting power to the tubercle bacillus. The fact has been established that alcoholism is a very potent factor in the causation of tuberculosis. I find it not only unnecessary in treatment but believe it to be contraindicated."--F. M. POTTENGER, M. D., Superintendent the Pottenger Sanitarium for Diseases of the Lungs and Throat, Monrovia, California. "I have met with a small class of consumptive patients who could take alcoholic liquors freely for a length of time, without deranging either the stomach or the brain, and with a decided amelioration of the pulmonary symptoms, and an arrest of the emaciation. Some of these have actually increased in _embonpoint_, and for three to six months were highly elated with the hope that they were recovering. But truth compels me to say that I have never seen a case in which this apparent improvement under the influence of alcoholic drink was permanent. On the contrary, even in those cases in which the emaciation seems at first arrested, and the general symptoms ameliorated, the physical signs do not undergo a corresponding improvement; and after a few months the digestive function becomes impaired; the emaciation begins to increase rapidly; and in a short time the patient is fatally prostrated."--DR. NATHAN S. DAVIS, SR., of Chicago. "The use of whisky in this disease positively interferes with digestion which must under all circumstances be kept as perfect as possible in order that the patient may assimilate the food which is so necessary to the upbuilding of the system and to gain strength to fight the onslaught of the disease. "Its constant use would not only interfere with digestion but would have a tendency to create disease in other organs of the body so that we therefore consider the use of whisky in tuberculosis positively contraindicated. "Wishing you success in your laudable campaign."--DR. M. COLLINS, Superintendent National Jewish Hospital for Consumptives, Denver, Colorado. "It is difficult for many people to adapt themselves to a methodical plan of life long enough to establish a permanent cure in consumption. I have known many a young fellow with only a slight trouble in his lungs to die in the Adirondacks more from the effects of whisky than from the disease itself."--DR. HENRY P. LOOMIS, of New York City, in a Lecture on Consumption. (See page 232, of Handbook, on the Prevention of Tuberculosis.) "The majority of our patients receive no medication whatsoever. The stomach is rarely in condition to bear excessive medication, and the promiscuous use of creosote and similar preparations is to be condemned. Milk and raw eggs are the best articles of diet in addition to a regular diet of simple food."--JAMES ALEXANDER MILLER, M. D., of the Vanderbilt Clinic, New York. (From Medical Record.) "In my specialty, the treatment of pulmonary diseases, I rarely prescribe alcohol in any form, and in the sanitaria with which I have been connected it is the exception where alcohol in any form is prescribed. I have advised against its use where such has been the custom, believing that as a rule alcoholic liquors do more harm than good in the treatment of this disease."--PROF. VINCENT Y. BOWDITCH, M. D., Harvard Medical School, Boston. "From personal experience in handling pulmonary tuberculosis, not only at the Nordrach Ranch Sanitorium, for the past five years, but in an active practice of thirteen years, I am more than convinced that whisky and liquor, in any form, are absolutely poisonous to the consumptive. "Whenever we admit a patient to the Nordrach Ranch Sanitorium, we ascertain whether the individual is an alcoholic or not; and we invariably find that such an individual is lacking in vitality enough to combat the disease. They may look fat and strong, pulmonary tuberculosis usually makes quick work of them. "It is also a noticeable fact, proven by various statistics, that a very large percentage of alcoholics become tubercular; and if we ever stamp out tuberculosis, we will also have to stamp out intemperance. "Trying to cure consumption with whisky is like trying to put out a fire with kerosene. This is very easy to understand when we stop to consider the nature of this disease. In the first place, we have a very rapid heart's action, dating from the very earliest manifestations of the disease. The pulse is often in excess of 100, even in incipient cases, and if the stimulation of alcohol is added, we have what might be called a 'runaway heart'; and if there is one thing needed in the long combat against tuberculosis, it is a good heart."--JOHN E. WHITE, M. D., Medical Director Nordrach Ranch Sanitorium, Colorado Springs, Colorado. "You ask me my opinion as to the use of whisky in the treatment of consumption. In reply permit me to say that I regard its use in this disease as most universally pernicious."--PROF. CHARLES G. STOCKTON, M. D., Buffalo Medical College, Buffalo, N. Y. "It was formerly thought that alcohol was in some way antagonistic to tuberculous disease, but the observations of late years indicate clearly that the reverse is the case, and that chronic drinkers are more liable to both acute and pulmonary tuberculosis. It is probably altogether a question of altered tissue soil, the alcohol lowering the vitality and enabling the bacilli more readily to develop and grow."--DR. OSLER, formerly Professor of Medicine in Johns Hopkins University, Baltimore, Md., now of Oxford University, England. "Upon investigation I found 38 per cent. of our male tubercular patients were excessive users of alcohol, 56 per cent. moderate users. From my study of the cases I am led to believe that in a vast majority of these cases drink has been a large factor in producing the disease, by exposure, lowering of vitality, etc. I believe that alcohol has no place in the treatment of tuberculosis. Many patients are deceived by the false strength it gives them."--O. C. WILLHITE, M. D., Superintendent of Cook County Hospital for Consumptives, Dunning, Ill. "In tuberculosis there is a state of over-stimulation of the circulatory system due to the toxins. The use of alcoholics simply makes the condition worse. It reduces resistance and makes the person more susceptible to the disease."--H. J. BLANKMEYER, M. D., Sanatorium Gabriels, in the Adirondacks, N. Y. "The practice of taking alcoholics of any sort, and in any quantity, over a considerable length of time, is certain to produce more or less injury to a tubercular patient, and their use by tubercular people cannot be too strongly condemned."--H. S. GOODALL, M. D., Lake Kushaqua, N. Y. Most of these opinions were written for the author of this book in response to letters of inquiry. Are they not indicative of a day when the medical profession will lay aside alcoholic liquors in the treatment of all diseases? It is acknowledged that the past usage of giving whisky and cod-liver oil to consumptives was an error; some day, it may be not far distant, a larger acknowledgment may be made, and the medical use of alcoholic liquors will be entirely a thing of the past. Rev. J. M. Buckley, D.D., editor of _The Christian Advocate_, was in early manhood considered an incurable consumptive. Being a man of great will power and indomitable perseverance, he resolved to try the open-air cure, together with the use of an inspirator. The result was perfect restoration to health, so that, as is well known, he can be easily heard by audiences of thousands at Chautauqua and other places where he is greatly in request for lectures. He has written a pamphlet giving a full history of his case. It can be obtained from Eaton & Mains, 150 Fifth Avenue, New York, for fifty cents, and should be read by all consumptives who have any "grit" in their composition. Dr. Forrest, a hygienic physician, says:-- "What is to be done if the germs have already obtained lodgement in the lungs? Increase the general nutrition of the body in every way, and then the lungs can resist the inroads of the disease. The first thing necessary to improve the nutrition of the body is to stimulate the digestive and absorbent functions of the stomach and intestines. Naturally then, you must throw the so-called cough medicines out of the window. The drugs used to stop a cough are sedatives. Now, no sedative or nauseant is known that does not lock up the natural secretions and thus lessen the digestive powers. The cough is nature's method of expelling offending matter from the lungs and bronchial tubes. It is infinitely better to have this stuff thrown out of the lungs than retained there." Keep the bowels clean is this physician's next recommendation. Sweet cream is preferable to cod-liver oil as it is not so likely to derange the stomach. Easily digested food is necessary, as the organs of digestion are in weakened condition. Again Dr. Forrest says:-- "The consumptive should live as much as possible in the open air. "Dr. Trudeau inoculated twelve rabbits with tubercle or consumptive germs. Six of these he turned loose on an island where they ran wild. The other six were kept confined in hutches such as rabbits are usually kept in. Results--All the six rabbits in the open air recovered from the inoculation and remained well. Five of the confined rabbits died of tubercles in the lungs and different parts of the body. The sixth was still lingering, badly diseased, when the experiment was brought to a close. Fresh air and exercise enabled the first six to overcome the disease germs. Confinement gave full play to the disease in the others. "Now, you house lovers, sleepers in close bedrooms, people afraid of cold air, you are the rabbits in the hutches. Beware, lest the verdict be in your case, 'Died of tubercles in the lungs.' If you are not able to leave your home, live with open windows, day and night, summer and winter. "Exercise systematically, especially those exercises, accompanied by deep breathing, that open and strengthen the lungs--exercises without fatigue. "If you are hoping that some wonderful, mysterious drug has been or will be discovered, a drug that will cure consumption without your help, you are hoping against hope. Improved nutrition is your salvation, and that must come through exercise, diet and fresh air." Dr. J. H. Kellogg, in his _Home Hand-Book of Hygiene and Medicine_, recommends a salt sponge bath upon retiring, to arrest night sweats, or sponging with hot water. He adds:-- "It is important that patients should know that the sweats are greatly aggravated by opium in any form, and hence are increased by cough mixtures of any sort which contain this drug. Very simple remedies are often effective to relieve the most distressing cough, such as gargling of water in the throat, holding bits of ice in the mouth, taking occasional sips of strong lemonade, and similar remedies. As a general rule, patients run down and the disease progresses much more rapidly, after beginning the use of opium in any form. Sometimes it is best that the cough should be encouraged instead of being repressed. When the patient expectorates very freely, the cough is a necessary means of relieving the chest of matters which would seriously interfere with the functions of the lungs if retained, by filling up the bronchial tubes and air-cells. The kind of cough needing relief is an irritable, ineffective cough, unaccompanied by any considerable degree of expectoration. Loaf sugar, honey or a mixture of honey and lemon juice, and other simple, familiar remedies are often effective in relieving such a cough. * * * * * "It is perhaps needless to add that the numerous quack remedies for consumption advertised in the newspapers are wholly without merit. There is no known drug which will cure this disease, or in any certain degree influence its progress. Numerous remedies have been recommended as curative, but not one has thus far stood the test of experience." DISPLACEMENTS OF THE UTERUS:--These conditions are not among those for which alcoholic liquors are likely to be advised by a physician, but women frequently resort to Lydia Pinkham's Compound and other alcoholic preparations in the vain hope of finding the relief so positively promised in the nostrum advertisements. Women are sometimes seriously injured by using the nostrums specially advised for uterine weaknesses, for this reason: a drug which may be of service in an anæmic condition of the womb may do much damage in an inflamed or engorged condition, yet the nostrum vendors advise their preparations for all alike, without a word of warning as to possible dangers. Ordinary displacements may be recovered from by cleanliness of the parts and by exercises which strengthen the muscles in the pelvic region. The writer has known a considerable number of women who have been restored to health by exercises after months, in some cases, and several years in others, of weakness and misery. One of these women was a close relative of a celebrated specialist in women's diseases. He said he could not do any more for her, and gave permission for her to try the exercises, which were given her by a well-equipped teacher of physical training. There are three kinds of displacements: anteversion, retroversion, and prolapsus. The causes of these troubles are various; lack of proper care in child-bearing, miscarriages, heavy lifting, a hard fall, jumping out of a carriage, straining, too violent exercise in gymnasium work, and tight-lacing, also gradual weakening of the ligaments which sustain the uterus in position. An abdominal supporter should be worn constantly during the day for a year or so, then left off gradually an hour or two at a time. It should be worn during the second year whenever any extra work is to be done. There is a supporter sold by the Battle Creek Sanitarium which is highly recommended, but any physician can get one for a patient. Perfect cleanliness is necessary. For this purpose a hot vaginal douche should be taken two or three times a day. This douche should be made astringent by adding to a pint of water a quarter ounce of alum or tannin. The hot astringent injections tone up the lower supports of the uterus, and cleanse the passage. The patient should remain in a recumbent position for some hours after the douche if possible. Considerable rest hastens a cure. Take the rest in the fresh air when weather permits. Persistent use of sitz baths will be found helpful. For prolapsus the simplest form of internal supporter is a small roll of cotton. After the organ is carefully put into position this supporter should be pressed up against the mouth of the womb, the patient meanwhile lying upon her back. The ball of absorbent cotton should be large enough to be retained in position, and should be saturated with a weak solution of glycerine and alum or glycerine and tannin before being applied. A piece of white cord should be tied firmly around the centre of this tampon by which it may be removed. Remove before taking the douche. Persons who feel unable to purchase an elastic or other abdominal supporter can make a substitute (not so good, but of considerable service) from unbleached muslin made in the shape of the letter T, and having the cloth double. It should go up to the waist and be made to fit over the hips, then should be fastened firmly in front with safety-pins, and the cross-piece be drawn up from the back and fastened securely in front. The daily exercises are the most important part of the treatment. They must be begun gradually, and taken at greater length as strength is gained. Those for prolapsus will be given first:-- The patient should lie upon a rug, or on a firm long sofa or couch. The feet should be drawn up as close to the body as possible. Now lift the lower part of the body so that the hips and lower portion of the trunk will have no support but what comes from the feet and shoulders. Hold this position for a minute or two (longer when able without much fatigue). After a few minutes' rest repeat. This exercise may be continued from twenty to thirty minutes, according to patient's strength. The elevation of the hips in this exercise aids in the restoration of the organ to its natural position. This exercise should be continued daily, the number of times being increased as strength increases. A second exercise which is very helpful in prolapsus is to support the body on the toes and elbows with the face downward, and the hips raised as high as possible. Another exercise may be taken with an assistant; the patient should lie face downward, supporting the body by the chest, and keeping the limbs rigid while the assistant lifts the feet as high as possible without hurting. These movements strengthen the abdominal muscles and draw fresh blood to the weakened parts, and cause quickened circulation in addition to restoring the displaced organ to natural position. They should be taken at night just before retiring after a hot douche. The bowels should be kept open by the free use of fruit. The patient should sleep with the hips elevated as much as can be endured without real discomfort and sit with the feet on a stool. When strength sufficient is acquired the exercises for anteversion will be found useful, and any other exercises which strengthen the abdominal muscles, such as bending backward and forward, and sideways. Kneading and percussing the abdomen by an osteopath or masseur strengthens, and also relieves constipation. Rest during the day should be taken with the feet higher than the head. Prolapsus due to laceration in child-birth may require a surgical operation. In case of antiflexions the first exercise given for prolapsus should be taken daily. (The advice for the prolapsus treatment and the exercises are taken from the writings of Dr. J. H. Kellogg, superintendent of the Battle Creek Sanitarium.). ANTEVERSION:--Persons suffering from anteversion or retroversion should sleep without pillows under the head, and lie flat upon the back; they should sit with the feet as high as convenient and avoid high seats which hinder the feet from touching the floor. They should discard corsets and tight stocking supporters which push or hold down the organs which need to be replaced. Stocking supporters should be fastened over the hips and comfort waists can be bought in place of corsets. It is well to have an attendant to prepare weak patients for first exercises in all uterine troubles by the use of towels wrung from hot water applied to the back and abdomen for a few minutes to relax the muscles, or a hot water bottle, or hot salt bag may be used. Then, with the patient lying with head low, the attendant should give the abdomen and small of the back a thorough rubbing or kneading for ten minutes or less according to strength of patient. Olive oil can be used on the hand in the rubbing. FIRST EXERCISE FOR ANTEVERSION:--Lie on bed or rug; fold arms on chest; hold trunk of body still; stretch legs, and hold the position about half a minute, then relax at the knee and ankle. Then point the toes down and stretch upper leg muscles; relax; then stretch under leg muscles by stretching heel out. The patient will feel the exercise as far as the shoulders, and should be careful not to lift the body from the floor at first. When patient can hold stretching exercise for a minute then lift first the right, then the left leg, and take same exercise until the person can give a quick little kick for, say, twelve times, as the leg is straightened. SECOND EXERCISE:--Lying on the back, stretch to full length; move the left leg out at the side, then up and back to position, forming a semi-circle, keeping muscles tense throughout. Then move right leg out at the side--left--stretch toes long--relax--stretch heel--, lift a little higher and bring back to place in a circle and rest. Same with left leg and then both together. Few people can do this easily at first, the weight of the legs is too much for the weak muscles at the back; but some one can hold the foot at first. When the patient can do this easily without bringing on any pain or ache, she may sit in a low chair and take arm lifting exercises. Raise both arms out at the sides, then slowly raise them up close to the head and consciously lift all the organs of the body up, relax, and lower arms down front and repeat slowly, six or ten times at first, until for five minutes the patient can do this sitting. Then take it standing for ten minutes or more. Stand with feet wide apart. Dr. Anderson says, "A woman who will do this twenty times each day can never have anteversion, if she dresses properly, for it lifts the organs in place each time." It lifts the chest and abdomen up, and brings a feeling of exhilaration if done in the open air. After the patient has taken exercises for five or six weeks she may lie flat on the back, fold arms and raise body up to sitting position without unfolding arms. Then turn on right side and do the same, then on left side and do the same. This is fine for back and abdomen muscles. Anteversion needs the Rest Cure, and resting with the body in a position in which nature can right things is an important thing to remember. Rest always after exercise, either with a pillow under the knees or with the legs hanging over a low foot-board, or lying on a couch with the feet higher than the head. Exercise will relax the muscles and call for blood which will revitalize and stimulate the weakened conditions. A woman with this trouble should be careful about bending quickly over, or climbing stairs, until she gains strength. RETROVERSION:--Place the patient with face downward on bed or mat and with a small pillow under the lower part of the abdomen. Relax the muscles by applying a hot towel, hot salt bag or hot water-bottle just below the small of the back, and lower part of the abdomen for ten or fifteen minutes. (Hot salt bags are most effective and are easy to handle.) Then rub the back briskly with a circular movement; if tender in front, do not rub the abdomen. The circulation will gradually carry away any inflammation as soon as the muscles reach a normal condition, though kneading of back and abdomen, using sweet oil on the hand, is helpful if the patient can bear it. The patient must remember that these conditions have been months in coming and only painstaking work and time can restore the weakened organs. The manner of dress is very important; loose, comfortable clothing must be worn. Sleep with the face down as much as possible; nature will correct itself, if allowed, many times. FIRST EXERCISE:--Fold arms under forehead and draw right knee up close to body and hold two minutes (unless painful) and slowly straighten, and stretch very slowly. Do the same with the left leg until the patient can repeat the exercise twelve times with each leg and hold five minutes instead of two, with the knee close to the body. It will probably take two weeks to gain strength for this. After that time raise the body up on hands, and move legs just as a baby does when creeping, except that the patient only follows the movement and does not move along. SECOND EXERCISE:--Patient take sitting position on floor and clasp hands under knees, and bring knees up, so that chin and knees meet and hold. Then straighten legs, slide hands toward the heels as far as hands can reach, (stretch hands toward heels); make a continuous movement of this. THIRD EXERCISE:--Sit on floor. Place the hands on floor at sides, legs straight out in front, lift the body from the floor with the arms, up and down. This is a fine exercise for raising up the misplaced organs. FOURTH EXERCISE:--Place the patient flat on back and push the body up to sitting position with hands quite far back and palms down, recline again, up and down until arms and back are very tired. Then sit up, legs straight in front, raise the body from the floor, (an inch) and move backward, resting weight on hands, then move over on knees as at first exercise and creep, then sit up and move backward again. These will take a month to perfect. Begin by exercising five minutes and gradually work up to half an hour, rest between, always. The patient must have the right mental attitude, must think that she is trying to replace the uterus by lifting it to its natural position. The exercises must not be lazily done. Sitting in a tub of hot water is most helpful where there is much tenderness, or inflammation. Witch-hazel in hot water douches or a weak solution of hot salt water is a wonderful tonic in some cases. EXERCISE FOR REPLACING UTERUS TO BE TAKEN JUST BEFORE RETIRING:--Kneel on the bed; bend forward until the chest is touching the bed and the hips are elevated as high as possible. The inlet of the vagina should then be opened so as to admit air. As soon as the air enters the womb falls into position. Lie down at once and give nature a chance to regain strength while you sleep. The tampon soaked in glycerine and alum, and the douches of hot water, in which a little alum is dissolved, are both of great service in controlling the flooding which so frequently accompanies change of life and miscarriages. (Exercises for anteversion and retroversion supplied by a successful teacher of such work.) The writer of this book asked a well-known medical writer why physicians do not advise exercises for the cure of displacements instead of operations. He said it is because women are not willing to do anything to help themselves. They expect the physician to cure them, and the only way a physician can "cure" is to operate. Sensible women, however, will be glad to practice helpful exercises. DEBILITY:--"The debility of convalescence requires fresh air, easily digested food, the avoidance of over-exertion, with a gradually increasing amount of exercise. Such debility is only aggravated by alcohol, though it may for a time be partially masked thereby. Milk, eggs, fresh fruit and farinaceous articles are the best foods. General debility without obvious cause, may be treated by cold or tepid bathing. Salt added to the bath is helpful. Change of air is a good tonic. Port wine and other alcoholics while giving a false sensation of increased vigor, really _reduce the tone of the pulse_, and therefore tend to enfeeble the system. Alcohol is a relaxant, _not a tonic_." DEPRESSION OF SPIRITS:--"Learn the Delsarte exercise for the 'blues,' and practice them daily. Hot air baths. Avoid rich food. Take out-door exercise." DIARRHOEA:--"This is a symptom of the presence of an irritant of which the stomach is trying to be rid. Do not arrest it prematurely, but assist it. If it persists, arrowroot, or corn starch, or flour, mixed with cold water to the consistency of cream may be taken, a tablespoonful at a time. 2. Bread charcoal with cold milk. 3. A tablespoonful of cinnamon water with a teaspoonful of lime water, mixed, every one, two or three hours. Smaller dose for a child. Diet should be confined to toast, milk toast, milk, cold or boiled. Tea, broth, meat, etc., are sure to renew the trouble. Diarrhoea in infants is generally due to errors in feeding, either over-feeding or the use of improper kinds of food. Boiled milk thickened with flour is a simple remedy in light cases. Alcoholics are utterly unnecessary in diarrhoea, and to order them for young children is quite wrong. A full enema of water, as hot as can be borne, will remove offending substances from the bowels. "Beware of diarrhoea medicines containing opium in any form. They are unnecessary and dangerous, particularly for young children." DYSENTERY:--"At the beginning of the disease the stomach should be relieved by the use of a large warm-water emetic. The quantity of food should be restricted to the smallest amount compatible with comfort. Ripe fruits, especially grapes, and most stewed fruits, may be used in abundance to keep the bowels regular. Salads, spices and other condiments, fats and fried foods should be strictly avoided, together with tea, coffee, alcoholics and all other narcotics. "The diet should consist chiefly of simple soups, well boiled oatmeal gruel, egg beaten with water or milk, and similar foods. In many cases regulation of the diet is sufficient. Either the hot or the cold enema may be employed. "The use of opium, which is exceedingly common in this disease, is not advisable, as it produces a feverish condition of the system, decidedly prejudicial to recovery. Herroner, an eminent German physician, very strongly discourages the use of opium in this disease."--DR. J. H. KELLOGG. DYSPEPSIA:--"It is commonly supposed that a little good whisky or brandy aids digestion, while on the contrary it has been proved conclusively by observing the processes of digestion upon persons who have fistula of the stomach, or by evacuating the contents of the stomach by means of a stomach-pump about an hour after taking a meal--in one instance after taking an ounce of alcohol, and in another where no alcohol was taken--that alcohol coagulates the albuminoids, throws down the pepsin, decreases the acidity (the combined chlorin and free hydrochloric acid), and increases the fixed chlorids. Any one can make the observation upon himself, that a meal taken without alcohol is more quickly followed by hunger than one with it. "Blumenau says: 'On the whole, alcohol manifests a decidedly unfavorable influence on the course of normal digestion even when ingested in relatively small quantities, and impairs the normal digestive functions.' "Dr. Chittenden, professor of physiologic chemistry in Yale College, as a result of some investigations made by himself and Dr. Mendel, states in the _American Journal of Medical Sciences_, that he finds that as small a quantity as three per cent. of sherry, porter, or beer lessens the activity of the digestive powers."--_Bulletin of A. M. T. A._ "It should be observed that doses of alcohol which have no appreciable effect in delaying digestion, are so small as to be practically useless for any beneficial action."--_Medical Pioneer._ One doctor writes:-- "What makes dyspepsia so hard to cure? This very alcohol taking. The best cure is to refuse all alcoholic drinks, at meals and all other times, and drink nothing but water." The causes of dyspepsia are various; errors of diet being the most common. Others are mental worry, care and anxiety, and the use of drugs. An eminent writer upon this disease says: "My main object in the treatment is to prevent the sufferers from resorting to drugs, which in such cases, not only produce their own morbid conditions, but also confirm those already existing. "The extensive and often habitual use of alkalies for acidity, of purgatives for constipation, nervines and opiates for sleeplessness, and after-dinner pills to goad into action the lagging stomach, has been a potent factor in the production of a large class of most inveterate dyspepsias." Underdone bread, cake, and pie, are unfit for any stomach, yet are seen upon many tables. "Breakfast foods," cooked for ten or twenty minutes, are also dyspepsia producers. All breads, cakes, pies and cereals, require thorough cooking to fit them for digestion. Most cereals are better for supper than for breakfast, as they should be cooked in a double boiler for several hours. A young man, troubled with dyspepsia, learned to his amazement that the oatmeal, which he supposed was his best food, had much to do with the giddiness which often overcame him. He was advised to use dry foods, such as toast, zwieback and shredded wheat. This diet, together with the abandonment of nostrums, led to a cure. Zwieback is bread sliced, and dried in a moderate oven until light brown. Whole wheat bread is best. It is very delicious and is quite easily digested. In the case of the young man, it is probable that the difficulty with the oatmeal was the lack of sufficient cooking. Oatmeal made into gruel, well cooked, and diluted with a large quantity of scalded milk is easy of digestion. Eating between meals, and excess in eating, lead to stomach derangement. "The best remedy for acidity of the stomach is hot-water drinking. Two or three glasses should be taken as hot as can be sipped, one hour before each meal, and half an hour before going to bed. The effect of the hot water is to wash out the stomach, and so remove any fermenting remains of the previous meal. Heartburn may be treated the same as acidity." Persons troubled with slow digestion are better to eat only two meals a day. The writer has personal knowledge of a goodly number of women who have been benefited wonderfully by adopting the two meal a day plan. Some persons, much troubled with dyspepsia, have adopted the plan of prolonged fasting advocated by Dr. Dewey, and testify to a cure by this method. While heroic, it is certainly more rational than drug treatment. For acute dyspepsia a fast is requisite. All that alcoholics can do for dyspepsia is to allay the uneasy sensations for a time, while adding to the trouble. It has been abundantly proved that alcohol must pass from the stomach before digestion can begin. Dr. Ridge says:-- "Many cases which seem to be relieved by the use of beer are really benefited by the hop, or other bitter, which the ale or beer contains. _Hop tea_ is a useful stomachic, and a quarter of a pint, or half that quantity, may be taken cold. It is made in the same way as tea, using a handful of hops to a pint of boiling water. Make fresh every day." Dr. Kellogg says:-- "In cases of chronic dyspepsia the use of alcohol seems to be particularly deleterious, although not infrequently prescribed, if not in the form of alcohol or ordinary alcoholic liquors, in the form of some so-called 'bitters,' 'elixir' or 'cordial.' Nothing could be further removed from the truth than the popular notion that alcohol, at least in the form of certain wines, is helpful to digestion. Roberts showed, years ago, that alcohol even in small doses, diminishes the activity of the stomach in the digestion of proteids. Gluzinski showed, ten years ago, that alcohol causes an arrest in the secretion of pepsin, and also of its action upon food. Wolff showed that the habitual use of alcohol produces disorder of the stomach to such a degree as to render it incapable of responding to the normal excitation of the food. Hugounencq found that all wines, without exception, prevent the action of pepsin upon proteids. The most harmful are those which contain large quantities of alcohol, cream of tartar or coloring matter. Wines often contain coloring matters which at once completely arrest digestion, such as methylin blue and fuchsin. "A few years ago I made a series of experiments in which I administered alcohol in various forms with a test meal, noting the effect upon the stomach fluid as determined by the accurate chemic examination of the method of Hayem and Winter. The result of these experiments I reported at the 1893 meeting of the American Medical Temperance Association. The subject of experiment was a healthy young man whose stomach was doing a slight excess of work, the amount of combined chlorin being nearly fifty per cent. above normal, although the amount of free hydrochloric acid was normal in quantity. Four ounces of claret with the ordinary test meal reduced the free hydrochloric acid from 28 milligrams per 100 c. c. of stomach fluid to zero, and the combined chlorin from .270 to .125. In the same case the administration of two ounces of brandy with the ordinary test meal reduced the combined chlorin to .035, scarcely more than one eighth of the original amount, the free hydrochloric acid remaining at zero. Thus it appears that four ounces of claret produced marked hypopepsia in a case of moderate hyperpepsia, whereas two ounces of brandy produced practically apepsia." FAINTING OR SYNCOPE:--The following letter from the late Sir B. W. Richardson was addressed to a lady who had sought the great physician's advice on the subject:-- "25 Manchester Square, W., July 18, 1896. "DEAR MADAM: There is no substance which acts as a substitute for alcohol, nor is anything like it wanted. The human body is a water engine, as I have often described it, and alcohol plays no part in its natural motion. The idea that when it begins to fail, a stimulant has to be called for, springs merely from habit, and if, whenever any of the symptoms of fainting you speak of occur, the person merely lies down on the side or back and drinks a glass of hot water, or hot milk and water, all that can be done is done. In the London Temperance Hospital I have been treating the sick for diseases of all kinds and during all stages, and have never administered a minim of alcohol, or any substitute for it, and we have got on better than when I--feeling it at all times at command--made use of it in the ordinary way. "I am, dear Madam, faithfully yours, "B. W. RICHARDSON." TREATMENT:--"Lay the patient down in a current of air with the feet raised higher than the head, preferably on one side in case of sickness occurring, or bend the head down to the knees, to restore the flow of blood to the brain. Loosen all clothing. Rub the limbs, chest and over the heart with the hand or a rough towel. Sprinkle cold water on the head and face. Smell ammonia, strong vinegar, smelling salts or any pungent odor. Put hot bottles to the feet, and in severe cases a mustard plaster over the heart. Sip hot milk, hot water, hot tea, hot black coffee, beef tea or a meat essence. Crowding round the patient and all excitement should be avoided. In 999 cases out of 1,000, no medicine is necessary. "Faintness often proceeds from indigestion, flatulence inducing pressure on the heart." FAINTNESS, WEAKNESS, EXHAUSTION, FATIGUE:--"The truth is that for simple weakness, faintness, exhaustion, fatigue, cold or wet, the best remedies are simple fresh air, pure water, digestible food and rest. These are nature's restoratives, and the sooner both physicians and people learn to rely upon them instead of upon drugs the better it will be for all parties. And as the effect of alcoholic liquors are directly depressing to the strength and activity of all the natural functions and processes of life, as shown by the most varied and scientific investigations, it is important that this fact be taught to both doctors and people everywhere."--DR. N. S. DAVIS. FITS:--"Whether the fit be apoplexy or epilepsy all alcoholics are extremely bad, both at the time and afterwards. Alcohol, the 'genius of degeneration,' is the chief cause of apoplexy, and also a cause of epilepsy, especially when taken in the form of beer. It diminishes the tone of the arteries and blood-vessels, and thus tends to cause, aggravate and maintain a congested state of the capillaries throughout the whole body. In the treatment of epilepsy, therefore, neither alcohol nor any so-called substitute should be given. * * * * * "In the convulsions of children alcohol is equally injurious."--DR. RIDGE. FLATULENCE:--"Many uneasy sensations or pains, even in distant parts of the body, are due to wind in the bowels, resulting from indigestion. Asthma, cramps, depression of spirits, faintness, giddiness, hiccough, prostration, sinking sensations and sleeplessness, are all frequently due to the same cause. The diet needs careful attention where there is much flatulence; tea is often a cause. Charcoal biscuits are useful in some cases; lemon juice in others. Fluid Magnesia may be taken. Watch for the cause and remove it." HEADACHE:--_The New Hygiene_ says: "This is the manifestation of a deeper-seated trouble, usually in the stomach. The use of stimulants is a sure promoter of headache. All users of alcoholic liquors are, I believe, subject to headache, and it is also a sure result of overindulgence in tea and coffee. "To prevent the attacks, live regularly, avoid late hours and excessive brain work; avoid tea, coffee and alcoholic beverages, also sweets of all kinds, including sauces and pastries, and anything fried in fat. Eat plenty of good, plain food, including fruit, especially oranges. Eat none late at night. Exercise regularly in such a way as to bring all the muscles into play, at least once a day. "To relieve an attack flush the colon. "Headaches, which so largely result from the retention of impure matter in the body, will be cured if a good quantity, say two or three glasses, of hot water be drank in the morning or at night, and then the next regular meal omitted, so that an interval of house-cleaning can be had before other material is moved in."--_Life and Health._ "Avoid pills and powders. Persons suffering from headache need to be warned against taking remedies that contain opium and alcohol, and also against the use of a recent popular remedy, usually called a 'white powder' or 'white tablet.' They take the latter readily because the druggist or physician says it contains no opium. This is true, but it is one of the lately discovered coal tar preparations (anti-febrine, acetanilid, etc.) and is very depressing to the human system. Headache is usually a symptom of trouble somewhere else, often in the alimentary canal, an overloaded stomach, constipation, or tight clothing. Learn the cause and remove that, and the headache will disappear."--DR. H. J. HALL, Franklin, Ind. "Gentle massage is helpful and the use of cold compresses. Lack of sufficient sleep will cause headache. Women often bring on nervous headache by overwork and worry." HEMORRHAGE:--"Never give alcohol in a case of profuse hemorrhage. The faint feeling, or irresistible inclination to lie down is nature's own method of circumventing the danger, by quieting the circulation and lessening the expulsive force of the heart, thus favoring the formation of clot at the site of the injury."--_Clinique._ "For uterine hemorrhage an emetic to induce vomiting is the best cure."--Dr. Higginbotham in _British Medical Journal_. "If the faint is dispelled too quickly, and the blood-vessels are relaxed by alcohol, or the heart aroused to energetic action by any remedy, the hemorrhage may recommence, and may prove fatal. Quiet, the application of cold, pressure, the elevation of the wound where possible, and the absence of stimulants, are the cardinal points of treatment in most cases."--DR. RIDGE. "If then, it seems absolutely necessary to rouse a person out of a dead faint, what can be done? Swallowing is out of the question, lest the patient choke. The head must be laid low, and the face and chest flapped with a cold wet cloth, or alternately with hot wet cloths; smelling salts (not too strong) may be applied to the nose. "When the faint has been recovered from, but the hemorrhage continues so much that it is feared another faint may occur, and, perhaps, be fatal, it may be warded off by drinking any hot liquid; if Liebig's extract of meat, or strong beef tea, is at hand and can be given hot, there is nothing better." HEART DISEASE:--Dr. Ridge says: "I trench here on a delicate subject, because, when there is real disease of the heart, medical advice will of course have been obtained, and very probably a doctor may have said that some alcoholic liquor is essential. There are, also, several different forms of heart disease which require altogether different treatment, and only a physician can tell the difference, or appreciate the necessity for the particular treatment required. But it may be pointed out that alcohol is utterly unable to 'strengthen' the heart, or give tone to the blood-vessels, or to the system at large. "The alteration in the pulse due to alcohol is chiefly owing to its paralyzing action on the blood-vessels, and when they are too contracted, and thereby cause the weakened heart to labor too much, the alcohol will give relief for the time. But we have in nitrite of amyl, a fluid which will act more quickly and more powerfully; but this must not be employed without medical direction. It is very useful in cases of _angina pectoris_, or _breast pang_, but is rarely required in the majority of cases in which the valves of the heart are diseased. The paralyzing action of alcohol is not generally produced by less than half a wine-glassful of brandy or whisky, or twice that quantity of wine, and often much more is required. The relief to uneasy sensations which much smaller quantities sometimes produce is due to their anæsthetic or benumbing action, by which the nerves of the patient are rendered less sensible, although the danger is by no means diminished. * * * * "The only sensible way to avert the evil consequences of heart disease is to strengthen the heart, and that is to be done by strengthening the body generally. The amount of exercise, the kind of baths, etc., which should be taken, have to be modified in accordance with the nature of the case. If these natural health-giving measures cannot be employed nothing is an effectual substitute. "_Weak_ or _feeble heart_ is a common complaint, and is as ordinary an excuse for resorting to alcoholic liquors as 'Timothy's stomach.' If there is no organic disease; if the valves of the heart are healthy and act properly, all anxiety on this point may be entirely banished. The slow pulse, the feeble pulse, the cold feet, the want of energy, these are not to be got rid of by such a mere temporary agent as alcohol, even if relief can be thus obtained from day to day. The constant application of alcohol to the tissues of the body alters them gradually by its chemical action. In addition to this, the balance of the nervous system is altered, an unnatural condition is produced, and the unhappy patient becomes more liable to disease and more easily succumbs when attacked. "Many of these 'feeble hearts' mean too little exercise, very often also, too much or improper food and drink. "The best remedies are cold sponging (according to the season); avoidance of coddling; plain, wholesome food; abstinence from tea, hot drinks and condiments; regular out-of-doors exercise and all similar true _tonic_ measures." Dr. Kellogg says:-- "Persons subject to attacks of _angina pectoris_ should carry with them a small bottle containing a sponge saturated with nitrite of amyl, and place it to the nose when necessary. "Sympathetic palpitation may be relieved by bending the head downward, allowing the arms to hang down. The effect of this measure is increased by holding the breath a few seconds while bending over. Another ready means of relief is to press strongly upon the large arteries on either side of the neck. "Palpitation of the heart is often mistaken for real organic disease of the organ. * * * * * A careful regulation of the diet is in most cases all that is necessary to effect a cure." Dr. Edmunds, of London, was asked during a medical discussion what he thought of the use of alcohol in heart disease. His answer is embodied in the following:-- "With regard to the use of brandy in cases of heart disease, he was convinced it was a mistake to use it in such cases. There were many forms of heart disease, but the most common kind arose from the heart being too fat. Excess of fat debilitated the heart and injured its working, just as a piece of wax attached to a tuning fork would impair its usefulness. In such cases he dieted his patients in order to reduce their weight. Every dose of brandy taken for heart disease increased the evil. The moment brandy was taken for heart disease, or any other chronic complaint of a similar kind, the disease was increased. If doctors recommended alcohol to their patients, he had been asked what abstainers should do. In such cases, as had been suggested, he thought the patients might ask what the alcohol was to do for them, and if the reply was not satisfactory, they should get another doctor." Dr. T. D. Crothers, of Hartford, Conn., has deduced some valuable facts from his experiments with the sphygmograph, upon the action of the heart. He has found by repeated experiments that while alcohol apparently increases the force and volume of the heart's action, the irregular tracings of the sphygmograph show that the real vital force is diminished, and hence its apparent stimulating power is deceptive. Dr. C. W. Chapman, of the National Hospital for Diseases of the Heart, wrote in the _Lancet_:-- "The very thing (alcohol) which they supposed had kept their heart going was responsible for many of its difficulties." Of cases of palpitation and irregularity caused by business anxieties or indigestion, he said:-- "To give alcohol is only to add fuel to the fire." HEART FAILURE:--"In cases of cardiac weakness, the thing needed is not simply an increased rate of movement of the heart, or an increased volume of the pulse, but an increased movement of the blood current throughout the entire system. In the application of any agent for the purpose of affording relief in a condition of this kind, the peripheral heart as well as the central organ must be taken into consideration. In fact, the whole circulatory system must be regarded as one. The heart and the arteries are composed of essentially the same kind of tissue, and have practically the same functions. The arteries as well as the heart are capable of contracting. "Both the heart and the arteries are controlled by excitory and inhibitory nerves. These two classes of nerves are kindred in structure and in origin, the vagus and the vasodilators being medullated, while the accelerators of the heart and the vasoconstrictors of the arteries are non-medullated and pass through the sympathetic ganglia on the way to their distribution. "Winternitz and other therapeutists have frequently called attention to the value of cold as a cardiac stimulant or tonic. The tonic effect of this agent is greater than that of any medicinal agent which can be administered. The cold compress applied over the cardiac area of the chest may well replace alcohol as a heart tonic. The thing necessary to encourage the heart's action is not merely relaxation of the peripheral vessels, but, as Winternitz has shown, increased activity of the peripheral circulation in the skin, muscles and elsewhere. Alcohol paralyzes the vasoconstrictors, and so dilates the small vessels and lessens the resistance of the heart action; but at the same time it lessens the activity of the nerve centres which control the heart, diminishes the power of the heart muscle, and lessens that rhythmical activity of the small vessels whereby the circulation is so efficiently aided at that portion of the blood circuit most remote from the heart. A continuous cold application applied to that portion of the chest overlying the heart stimulates the nerves controlling the walls of the vessels, and at the same time energizes the corresponding cardiac nerves. It is wise to remember that the vasoconstrictor nerves are one in kind with the excitor nerves of the heart, while the vasodilators are in like manner associated with the vagus. With this in mind, it is clear that while alcohol paralyzes the vasoconstrictors, it at the same time weakens the nerves which initiate and maintain the activity of the heart; while, on the other hand, cold excites to activity those nerves which produce the opposite effect. "The apparent increase of strength which follows the administration of alcohol in cases of cardiac weakness is delusive. There is increased volume of the pulse for the reason that the small arteries and capillaries are dilated, but this apparent improvement in cardiac action is very evanescent. This is a natural result of the fact that while the heart is relieved momentarily by sudden dilation of the peripheral vessels, the accumulation of the blood in the venous system, through the loss of the normal activity of the peripheral heart, gradually raises the resistance by increasing the amount of blood which has to be pushed along in the venous system. This loss of the action of the peripheral heart more than counterbalances the temporary relief secured by the paralysis of the vasoconstrictors. "Thermic applications, general and local, may safely be affirmed to be the true physiological heart tonic. In the employment of the cold pericardial compress as a heart tonic, the application should generally be continued not more than half an hour at a time, and its use may be alternated with general cold applications to the surface. A cold towel rub, or the cold trunk pack is the best form for application if the patient is very feeble. "The cold towel rub is applied thus: wring a towel as dry as possible out of very cold water, and spread it quickly and evenly over the surface; rub vigorously outside until the skin begins to feel warm; then remove, dry the moistened surface, rub until it glows, and make the same application to another part; and so on until the whole surface of the body has been gone over. The procedure should be rapid and vigorous. "If the cold trunk pack is employed, a sheet of not more than one thickness should be wrung as dry as possible out of very cold water, and wrapped quickly about the body, after first dipping the hands in water, and rubbing the trunk vigorously. In cases of extreme cardiac weakness, very cold and very hot applications may be alternately applied over the region of the heart. The duration of the hot and cold applications should be about fifteen seconds each. "Any one who has ever witnessed the marvelous effects of applications of this sort in reviving a flagging heart will never doubt their efficacy, and will have no occasion to resort to alcohol, or any other intoxicant, to stimulate a flagging heart. The writer has employed these measures for stimulating the heart for more than twenty years, and might cite hundreds of instances in which their efficiency has been demonstrated. They are applicable not only to the cardiac depression encountered in the adynamic stage of typhoid and other fevers, but in cases of heart failure from hemorrhage, of surgical shock, collapse under chloroform or ether, opium poisoning, coal gas asphyxia, drowning, etc."--Dr. J. H. Kellogg, in _Bulletin of the A. M. T. A._, Jan., 1899. Dr. N. S. Davis tells of a case of threatened collapse where he was called in consultation. Patient was in a small, unventilated room. "It was easy to see that what she needed was fresh air in her lungs. Instead of giving alcohol in any form she was moved into a large, well-ventilated room. All symptoms of 'heart failure' disappeared. Had she begun to take whisky or brandy, physician and friends would have attributed her recovery to that, when in fact it would have retarded recovery by hindering oxygenation of the blood." "It would also be a very great mistake to suppose that when reaction follows collapse, in cases in which alcohol has been given, this result is always due to the alcohol. I have seen so many cases of severe collapse recover without alcohol that I cannot but be skeptical as to its necessity, and even as to its value. I was much struck many years ago by a case of post partum hemorrhage which was so severe that convulsions set in. I should then have given brandy if there had been any to give, but there was none in the house and none to be got. I administered teaspoonfuls of hot water and the patient revived and recovered; next day, except for anæmia, she was as well as ever, with no reactionary fever or other disturbance, as would almost certainly have been the case if brandy had been given. "In collapse from hemorrhage, we have learned the value of injections of warm saline water, either into the veins, the skin or the rectum, and the same treatment is available in other cases of collapse with contracted vessels. "Another measure which has proved most efficacious is the _inhalation of oxygen_ gas. This is especially useful in cases in which alcohol is decidedly injurious, namely, those in which there is increasing congestion of the lungs, which the heart, though doing its utmost, is unable to overcome. Alcohol only increases the congestion, and the heart is already over-exerted and nearly exhausted. The effect of the oxygen is apparent in a few seconds, and cases have been rescued in which death appeared to be inevitable and imminent."--DR. RIDGE. HEART STIMULANTS:--"The advantage of beef extract over alcohol as a stimulant was demonstrated on a large scale in the Ashantee war."--DR. RIDGE, London. For those who must have a drug: aqua ammonia, 8 drops to 1/2 cup of hot water, or 20 grains carbonate ammonia to 1/2 cup water. Hot water alone is a useful stimulant; also water, hot or cold, with a few grains of Cayenne pepper added. The latter is good, not only to start the heart's action in collapse, but also to relieve violent pain. Hot milk is a most valuable stimulant. Many persons to whom hot milk has been given during the extreme weakness of acute disease have testified afterward to its good effects in comparison with the wine formerly administered. The wine caused an after-feeling of chilliness and weakness, while the milk gave warmth and added strength. INSOMNIA OR SLEEPLESSNESS:--"A person who suffers from sleeplessness should avoid the use of tea and coffee, tobacco, alcoholic liquors and all other disturbers of the nervous system. Eating immediately before retiring has been recommended, but the ultimate result may be an aggravation of the difficulty instead of relief. If a person suffers from 'all gone feelings' so that he cannot sleep, he should take a few sips of cold water or a glass of lemonade. As complete relief will generally be obtained as from eating, and the stomach will be saved work when it should be resting. A warm bath just before retiring, a wet-hand rub, a cool sponge bath, gentle rubbing of the body with the dry hand, a moist bandage worn about the abdomen during the night, are all useful measures. When the feet are cold, they should be thoroughly warmed by a hot foot or leg bath, and thorough rubbing. When the head is congested, these measures should be supplemented by the application of cold to the head, as the cold compress or the ice-cap." A walk in the evening, or gentle calisthenics, may help those of sedentary habits. Bicycle riding and horse-back riding in the evening have helped many. The practice of long deep breathing will often put persons to sleep when all other devices fail. The lungs should be filled to their utmost capacity, and then emptied with equal slowness, repeating the respiration about ten times a minute, instead of eighteen or twenty, the natural rate. Those who fall asleep upon first going to bed, and after a few hours awake, and are unable to sleep again, may find relief by getting out of bed, and rubbing the surface of the body with the dry hand. Or walk about the room a few minutes, exposing the skin to the air, go back to bed and try the deep breathing. "The use of drugs for the purpose of inducing sleep should be avoided as much as possible. Opium is especially harmful. Sleep obtained by the use of opiates is not a substitute for natural sleep. The condition is one of insensibility, but not of natural refreshing recuperation. Three or four hours of natural sleep will be more than equivalent to double that amount of sleep obtained by the use of narcotics. When a person once becomes dependent upon drugs of any kind for producing sleep, it is almost impossible for him to dispense with them. It is often dangerous to resort to their temporary use, on account of the great tendency to the formation of the habit of continuous use. The use of opiates for securing sleep is one of the most prolific means by which the great army of opium-eaters is annually recruited. Chloral, bromide of potash, whisky and other drugs are to be condemned almost as strongly as opium."--DR. KELLOGG. Dr. Furer, of Heidelberg, Germany, in a paper before the International Congress against alcohol, held in Basle, Switzerland, in Sept., 1895, said:-- "The sleep from alcohol does not act as a mental tonic, but leaves the mind weaker next day." Some noble specimens of manhood have become wrecks through accepting the advice to try "whisky night-caps." Edison recommends manual labor, instead of going to rest, for aggravated insomnia. He says sleep will soon come naturally. LA GRIPPE:--"Alcohol has no place in the treatment of _la grippe_; on the contrary it is because of the too frequent use of this, and other narcotics, that epidemics make such fearful headway in our land, and such must be the rule until the people study the laws of health and obey them. Profuse sweating, followed by a careful bathing of the body in tepid water, gradually cooling it to a normal temperature, and avoiding unnecessary exposure, will relieve. The patient should sleep in pure air and eat as little as possible, and that only when hungry. * * * * * Quinine is essentially a nerve poison, and capable of producing a profound disturbance of the nervous centres. A drug of such potency for evil should be employed with the greatest care, and never when a milder agency will secure the result. Exceedingly pernicious is the habit of dosing children with this drug."--DR. CHARLES H. SHEPARD, Brooklyn, N. Y. "A late surgeon of the gold coast of Africa wrote the following to the London _Lancet_ of Jan. 2, 1890: 'Some of the worst cases of this disease, the grippe, remind me of an epidemic I saw among the natives of the swamps of the Niger. * * * * * Irrespective of disinfectants and inhalations there is a simple, effective and ready remedy, the juice of oranges in large quantities, not of two or three, but of dozens. The first unpleasant symptoms disappear, and the acid citrate of potash of the juice, by a simple chemic action decreases the amount of fibrine in the blood to an extent which prevents the development of pneumonia.'" The Syracuse (N. Y.) _Post-Standard_ contained the following during the epidemic of 1899:-- "Dr. George D. Whedon declared to a _Post-Standard_ reporter yesterday that there is practically no subsiding of the grippe in this city. Dr. Whedon said that the weather conditions have little, if anything, to do with the disease, and that it is impossible to define the conditions which produce it. It is some morbific agency, the influence of which, Dr. Whedon said, is exerted upon the pneumogastric nerve. "_Dr. Whedon was emphatic in denouncing treatment by means of alcoholic stimulants, and coal tar derivatives._ In discussing the subject at some length he said:-- 'I find that infants and young children are practically exempt from the disease, and the liability increases with age. In my own experience, which has since 1889 amounted to an aggregate of 3,000 cases, alcoholic stimulants have appeared to be usually of little or no value; their usual stimulating effect does not seem to be realized in this condition. Unless malarial complications exist quinine appears of no benefit, and then should not be used in larger than two grain doses. Large doses depress the weakened heart, and in all cases increase the terrible confusion and headache constantly present in severe cases. 'From the views I entertain of its pathology, and from the terrible fatality which has attended the extensive use of the coal tar derivatives in treatment of _la grippe_, I argue that the manner in which they have been prescribed in the beginning of the disease, to reduce fever, and relieve the often intense suffering, lowers the heart's action, which is already sufficiently incapacitated by the toxic agent producing the disease. 'The intention is usually to stimulate later, but later is in many cases unfortunately too late. The heart being overwhelmed by the poison, and by the added depression of all coal tar preparations, cannot keep up the pulmonary circulation. The swelling of the lungs increases, and the result is fatal. 'I am aware of the weight of authority for their administration and of the relief they afford, but am just as well assured that were their use discontinued, the greatly increased death-rate from _la grippe_ would cease to appear. 'These coal tar remedies are being used everywhere, and the medical journals recommend them despite the fatal results. They are being used every hour in the day in Syracuse, and, as a result, are knocking out good people. Among the most popular coal tar derivatives I might mention anti-kamnia, salol-phenacetine, anti-pyrine and salicylate of soda. 'Prognosis is favorable at all ages. Patients should be kept warm, and perfectly quiet in bed, and supplied with such nutritious and easily digested food, at frequent intervals, as the partially paralyzed stomach can take care of. All nourishment must be fluid and warm rather than cold.'" The _Journal of Inebriety_ for April, 1889, says:-- "The present epidemic of influenza has proved to be very fatal in cases of moderate and excessive alcoholic drinkers. "Pneumonia is the most common sequel, breaking out suddenly, and terminating fatally in a few days. Heart failure and profound exhaustion, is another fatal termination. One case was reported to me of an inebriate, who, after a full outbreak of all the usual symptoms, drank freely of whisky and became stupid and died. It was uncertain whether cerebral hemorrhage had taken place, or the narcotism of the alcohol had combined with the disease and caused death. "A physician appeared to have unusual fatality in the cases of this class under his care. "It was found that he gave some form of alcohol freely, on the old theory of stimulation. Another physician gave all drinking cases with this disease alcohol, on the same theory, and had equally fatal results. It has been asserted that alcohol, as an antiseptic, was useful in these bacterial epidemics, but its use has been followed by greater depression, and many new and complex symptoms. The frequent half domestic and professional remedy, hot rum and whisky, has been followed by more serious symptoms, and a protracted convalescence. Many facts have been reported showing the danger of alcohol as a remedy, also the fatality in cases of inebriates who were affected with this disease. "The first most common symptom seems to be heart exhaustion and feebleness, then from the catarrhal and bronchial irritation, pneumonia often follows." The vapor or Turkish bath is the best means of "breaking up" this disease, together with hot lemonade and rest in bed for a day or two. The inhalation of hot steam should be tried when there is much bronchial irritation. LIFE-SAVING STATIONS, THE USE OF ALCOHOL IN:--"There is no possible useful place for alcoholic liquors in connection with a life-saving station. Applied externally the rapid evaporation of alcohol reduces the temperature; taken internally it diminishes the efficiency of both respiration and circulation, and by increasing congestion of the kidneys it directly increases the danger of secondary bad effects from exposures of any kind. To restore warmth and circulation to the surface, light, rapid friction and the wrapping with dry flannel is the safest, cheapest and most efficient, while free breathing of fresh air, and frequent small doses of milk, beef-tea, ordinary tea or coffee, or even simple water, will afford the greatest amount of strength and endurance, and leave the least secondary bad consequences. It is just as easy to keep at hand a jug or flask of any one of the articles named as it is to keep a flask of whisky or brandy. There is no need of keeping them hot, as they act well at any temperature at which they can be drunk."--DR. N. S. DAVIS, Chicago. MEASLES:--"In mild cases, very little treatment is required, except such as is necessary to make the patient comfortable. Good nursing is much more important than medical attendance. If the eruption is slow in making its appearance, or is repelled after having appeared, the patient should be given a warm blanket pack. "The old-fashioned plan of keeping the patient smothered beneath heavy blankets, and constantly in a state of perspiration is wholly unnecessary. The irritation of the skin, as well as the sensitiveness to cold, may be relieved by rubbing the skin gently two or three times a day with vaseline or sweet oil. There is no danger from the application of cold water to the surface except in the last stages of the disease, after the eruption has disappeared. "The patient should be allowed cooling drinks as much as desired. During the disease a simple but nutritious diet should be allowed, but _stimulants of all kinds should be prohibited_." "It is wholly unnecessary, and dangerous as well, to give whisky to bring out the eruption."--DR. I. N. QUIMBY, Jersey City. "Any hot drink, such as ginger tea or hot lemonade, may be used to hasten the eruption, if delayed." MALARIA:--Observers of this disease in such regions as the gold coast of Africa have noted the fact that malarial attacks are generally preceded by impaired digestion. The disease is said to be due to animal parasites. These parasites are supposed to generate in the soil of certain regions, and thence, through the drinking water, or otherwise, find entrance to the human body. "A healthy stomach is able to destroy germs of all sorts, hence the best protection from malaria is the boiling of all drinking water, and the maintenance of sound digestion and purity of blood by an aseptic dietary." Dr. J. H. Kellogg says in _The Voice_:-- "It must be understood, however, that fruit in malarial regions, especially watermelons, may be thickly covered with malarial parasites and the parasites may sometimes find entrance to the fruit when it becomes over-ripe, so that the skin is broken. It is evident, then, that care must be taken to disinfect such fruit by thorough washing, or by dipping in hot water, which is the safer plan. The same remark applies to cucumbers, lettuce, celery, cabbage and other green vegetables which are commonly served without cooking. Not only malarial parasites but small insects of various kinds are often found clinging to such food substances, their development being encouraged by the free use of top dressing on the soil, a process common with market gardeners. "The treatment of malarial disease is too large and intricate a subject for proper treatment in these columns. We will say briefly, however, at the risk of being considered very unorthodox, that the majority of cases of malarial poisoning can be cured without the use of drugs of any sort. In fact, in the most obstinate cases of chronic malarial poisoning, drugs are of almost no use whatever. Quinine, however, is certainly of value as a curative agent in these cases, either in destroying the parasites, or in preventing their development; but as it does not remove the cause, its curative effect is likely to be very transient. The practice of habitually taking quinine as a preventive of malarial disease is a most injurious one, as quinine is itself a non-usable substance in the system, and therefore must be looked upon as a mild poison, to be dealt with by the liver and kidneys the same as other poisons. By habitual use it may itself become a cause of disease. One or two periodical doses of quinine often prove of great service in interrupting the paroxysms of an intermittent fever, but other treatment must also be employed to develop the bodily resistance, and fortify the system against disease. The morning cold bath, followed by vigorous rubbing, is a most excellent measure for this purpose, but the old-fashioned German wet-sheet pack is one of the best remedies known. The paroxysm itself can generally be avoided by means of the dry pack, begun before the chill makes its appearance; but this requires the services of an expert nurse. In not a few cases it is wise for a person who suffers frequently from malarial disease to seek a change of climate to some non-malarial region. "Col. T. W. Higginson of the First South Carolina Volunteers, in 1862, said of Dr. Seth Rogers, an eminent Southern physician, who was surgeon of the regiment: 'Fortunately for us, he was one of that minority of army surgeons who did not believe in whisky, so that we never had it issued in the regiment while he was with us, and got on better, in a highly malarial district, than those regiments which used it.'" MATERNITY:--Dr. Ridge says:--"It is one of the greatest mistakes to make use of alcoholic beverages to 'keep up the strength' during labor. It is, of course, impossible to predict at the commencement how long the labor will last; if then brandy, or other similar drink, is resorted to early, it acts most injuriously. The desire for food is often entirely removed; the demand of the system being therefore unperceived, and so not supplied, a state of weakness and prostration is in time produced, if the labor should be protracted, which may be really serious. The nervous system becomes exhausted by the repeated action of the alcohol. If a fatal result is not occasioned, yet the prostration of body and mind after delivery is aggravated, and convalescence thereby retarded. Alcoholic drinks produce paralysis and congestion of the blood-vessels, and in this way largely increase the liability to flooding after the labor is over. Alcohol also increases the liability to a feverish condition. "It is necessary to take small quantities of plain, nourishing food at regular intervals, and nothing is of greater value than well-cooked oatmeal: other farinaceous food may be substituted, if preferred. If there is much prostration, meat extracts or beef tea are of great value. Tea tends to produce flatulence and to prevent sleep. "After the labor is over, the best restorative is a cup of hot beef tea or an egg beaten up in warm milk or a cup of warm gruel. Rest, and absence of excitement and worry are essential and alcohol is specially injurious." MENSTRUATION, PAINFUL:--Young girls often resort to the use of brandy during the monthly period, and parents ask anxiously, "What can they use instead of the brandy?" The very best thing that can be done is to go to bed, wrapped in flannels, with a hot-water bottle or other hot application to the abdomen, and to the feet. Take hot ginger tea, or pepper tea. A warm hip-bath taken at the beginning may give relief, or a large hot enema retained for half an hour or so. Rest is necessary. For those who must go to work, Dr. Ridge recommends five drops of oil of juniper, to be taken on sugar. NEURALGIA:--"The principal cause of neuralgia is defective nutrition of the nerves. Disorders of digestion are very often accompanied by neuralgia in various parts of the body. It may also result from taking cold, from loss of sleep, from dissipation, and also from the use of tobacco, alcohol, tea and coffee. "The patient's general health must be improved by a wholesome, simple diet, and the employment of tonic baths, as a daily sponge bath, and massage in feeble cases. Sun-baths and exercise in the open air are of first importance. Ordinary neuralgia may almost always be relieved by either moist or dry heat. In some cases, cold applications give more relief than hot. As a rule, abnormal heat requires cold, and unnatural cold requires hot applications. In many cases it is necessary to give the patient a warm bath of some kind. Electricity often succeeds when all other remedies fail. "For facial neuralgia apply hot fomentations, together with the use of sitz baths, or hot foot baths. The head may be steamed by holding it over hot water, adding pieces of hot brick occasionally to keep water steaming, head being covered. "There is no complaint, perhaps, in the treatment of which the use of port wine will be more strongly urged by kind friends, with the assurance that it is impossible to get well without it. This is quite untrue, as thousands can testify."--DR. RIDGE. "Avoid opiates of all sorts. 'It is better to bear the ills we have than fly to others that we know not of.' The pangs of neuralgia are as nothing to endure compared with the sufferings of an opium wreck. Build up the general health, and the neuralgia will disappear." NAUSEA.--"A feeling of sickness is not uncommonly due to indigestion. If it is caused by rich food take a pinch of bicarbonate of soda in a little water, or a teaspoonful of fluid magnesia. The acidity of the food will thus be neutralized, and this course is far preferable to benumbing the stomach with brandy. If indigestion is the cause, it is often salutary to miss one or two meals, so as to allow the stomach to recover. "When due to pregnancy, a little aërated water, or soda water is useful; sometimes a small wafer or a crust, eaten before rising in the morning, will check it. An early morning walk, if the weather is pleasant, is helpful. "The moist abdominal bandage is a very excellent means of relieving nausea during pregnancy. It should be worn constantly for a week or two, and then omitted during the night. Daily sitz baths are also of great advantage. In many cases electricity relieves this symptom very promptly. In very urgent cases in which the vomiting cannot be repressed, and the life of the patient is threatened, the stomach should be given entire rest, the patient being nourished by nutritive injections. Fomentations over the stomach, and swallowing small bits of ice, are sometimes effective when other measures fail."--DR. J. H. KELLOGG. OUTGROWING THE STRENGTH:--"There is sometimes debility or weakness in rapidly growing boys and girls which is attributed to this cause. It is popularly supposed that port wine or beer, is the great remedy; but nothing can be worse. It is true that gin given continuously to puppies will keep them small, but no one would advocate the amount of spirit required in proportion by a lad or girl to produce the same effect. If the growth could be checked by chemicals it would be most injurious to do so. "In the treatment of such cases fresh air by day and night is essential; cold sponging, followed by friction with a rough towel, and exercise are desirable." PNEUMONIA. Dr. Julius Poheman says in _Medical News_:-- "The effect of alcohol upon nearly all the organs of the body has been carefully investigated. But, strange to say, literature contains only a few straggling hints upon the action of alcohol on the pulmonary tissue. It has long been known that the abuse of alcohol is a predisposing cause of death when the drinker is attacked with pneumonia. No experimental evidence has been published of the action of alcohol in producing pathological conditions in the lungs. In order to determine this action, a series of experiments was made upon dogs in the winters of 1890-1891 and 1892-1893. The dogs were a mixed lot of mongrels gathered in by the city dog catchers. They varied in weight from fifteen to twenty-five pounds, and were apparently in good health. In all, thirty animals were experimented on. "The experiments were performed as follows:--A carefully etherized animal had injected into his trachea just below the larynx a quantity of commercial alcohol varying from one dram to one ounce in amount. The effects of equal amounts of alcohol upon animals of the same weight varies greatly. Two dogs, weighing twenty-five pounds each, were injected with two drams of alcohol. One died in one hour, and the other in six hours after the injection. Four other dogs, two weighing twenty-four pounds each, another eighteen pounds, and the fourth fifteen pounds, were all injected with the same amount, two drams. All four survived, and were as well as usual in four weeks. Another dog of eighteen pounds died five minutes after an injection of two drams, while another of fifteen pounds took one ounce and recovered. "The symptoms in the dogs were all alike, dyspnea, increasing as the inflammation increased, until the accessory muscles of respiration were called into play. The stethoscope showed that air had great difficulty in entering the bronchi and air vesicles, and showed also the tumultuous beating of the heart in pumping blood through the lung. It was impossible to take the temperatures. Post-mortem examinations showed the lungs dark, congested and solid in some places. The air passages were filled with frothy, bloody mucus, even in the dog that died in five minutes. On section, the lungs were dark, congested, and full of bloody mucus. This shows how acutely sensitive the respiratory passages are to the action of alcohol. On microscopic examination of the lungs, the air tubes and vesicles were found filled with immense numbers of red and white corpuscles and much mucus. The same picture was presented as in a slide from the lungs of a broncho-pneumonic child. "The striking similarity between the two is enough to prove that the pathological condition is the same, and that alcohol has produced a lesion very closely resembling, if not absolutely like, that of broncho-pneumonia in the human subject. This to some extent explains why drunkards attacked by pneumonia succumb more readily than the temperate. The sensitive lung tissue is enveloped in alcohol--flowing through the capillaries of the lung on one side, and exhaled, filling the air vesicles and tubes on the other. The condition must create a state of semi-engorgement or of mild inflammation, similar to the drunkard's red nose, or his engorged gastric mucous membrane. Such a state will reduce the vitality of the pulmonary tissue, and its power of resistance to external influences. Add to this an inflammation such as a pneumonia, and the lungs find themselves unable to stand the pressure." As previous chapters contain much showing the reasons why alcohol is dangerous in pneumonia, space need not be taken here to do more than indicate briefly some points of non-alcoholic treatment. Pneumonia is generally supposed to result from a cold; it is ushered in by the symptoms of a chill, followed by fever, headache, shortness of breath, pain in chest, etc. It sometimes occurs as a complication of typhoid fever and other acute diseases. "It is not a very fatal disease in young and healthy subjects, but in weak children, old persons and habitual drinkers, it is a very fatal malady." _Nature Cure_ recommends a vapor bath immediately upon the appearance of the first symptoms, together with copious drinking of hot lemonade, and a good supply of pure fresh air in the room, together with the application of alternating hot and cold compresses, _and no drugs_. Dr. Kellogg says:-- "Cool compresses or ice-bags, alternated every three hours by hot fomentations for ten minutes, should be applied to the chest, particularly to the affected side, the seat of pain. The hot fomentations relieve the pain, and the cold compresses check the diseased process. The compresses should be wrung out of cold water, and changed every five to eight minutes, or as often as they become warm. Although the cool compresses are not usually liked by the patient, they will soon give relief if their use is continued, and they do much towards shortening the course of the disease. Care should be taken to keep the patient's body from being wet except where the treatment is applied. The cold compress is much used in the large hospitals of Germany. When the pulse becomes as rapid as 95 to 110 or more, cool sponging, the wet-sheet pack, the cool full bath or the cool enema should be employed. When much chilliness is produced by the contact of water with the skin, the cold enema is a most admirably useful measure. The amount of water required is from half a pint to a pint. The temperature may be 40 to 60 degrees. The apartment should be kept as cool as possible without discomfort, and an abundance of fresh air should be continually supplied. "The diet of the patient should consist of milk, oatmeal gruel, ripe fruit, and similar easily digested food. No meat, eggs or other stimulating food should be allowed. "Discontinue the cold treatment after the first twenty-four to forty-eight hours. If the surface is cold, apply hot sponging or a hot pack. Avoid causing chilliness." PRE-NATAL INFLUENCE OF ALCOHOL:--"The use of beer as a medicine during pregnancy is without doubt perilous to the health and vigor of the offspring. Children born under such conditions are sickly and feeble, and suffer from disease more severely than others, or die early. Alcoholic prescriptions to pregnant women are, from all present knowledge of the facts, both dangerous and reprehensible in the highest degree."--DR. T. D. CROTHERS, Hartford, Conn. "M. Fere, an eminent French physician, recently reported to the Biological Society of Paris the results of experiments which he had been conducting for the purpose of throwing light upon this question. These experiments demonstrate that the exposure of hen's eggs to the influence of the vapor of alcohol, previous to incubation, retards the development of the embryo, and favors the production of malformations. It is evident from these experiments that alcohol may act directly upon the embryo when there is no marked influence of alcoholism in the parent." PAIN AFTER FOOD:--"This may occur in acute or chronic gastric catarrh, or in a neuralgic or oversensitive condition of the stomach, or in ulcer or cancer of that organ. In all these it comes on soon after food has been swallowed; but, if occurring a long time after a meal, it is probably due to atonic dyspepsia. Alcohol will undoubtedly sometimes relieve this kind of pain by deadening the nerves of the stomach so that the pain is not felt so much; but this effect soon passes off, and if the cause of the malady is not removed by other means, increasing quantities of alcohol will be required to give relief. Many cases of drink-craving have originated in this way. Medical aid will generally be required. A small mustard poultice over the pit of the stomach is often useful, especially in inflammatory cases, or any other outward application of heat. Food should be fluid, or semi-fluid, and digestible. Ginger tea, or peppermint water, may serve to disperse gas." POISON, ANIMAL. The following by Dr. Chas. H. Shepard, of Brooklyn, who introduced the Turkish bath into America, is taken from the _Journal of the A. M. A._, for Nov. 13, 1897:-- "Animal poison is by no means uncommon, and so quick and mysterious is its action that a prompt remedy is a vital necessity. There is good reason to believe that the numerous remedies that have been recommended from earliest times as antidotes for animal poison are worthless, as they have not the properties commonly ascribed to them. The paucity of remedies is so great that alcohol is the one which comes most quickly to the mind of those who have been taught in the traditions of the past, and who are not fully aware of its action on the human system. We shall endeavor to show that the action of alcohol is not helpful, but on the contrary is really detrimental; and also that there is a better way out of the difficulty. "If we get a splinter in the body, vital energy is aroused to get rid of the offending substance, inflammation is set up, and sloughing goes on until the splinter is voided. If the splinter is covered with acrid material, the same process is intensified, and nature endeavors to eliminate the offending substance through the natural excretions. Upon the peculiarity of the material depends the direction of this elimination. "It is well known that some poisons are thrown off by the kidneys, some by the lungs, while others again are attacked by all the emunctories. The difference in the power of the system to absorb different substances, appropriate whatever can be utilized, and throw off whatever can not be used, is sometimes called idiosyncrasy, but more properly it may be called vital resistance, and upon the integrity of this power rests the ability to combat disease in all its forms, whether it be the absorption of any animal virus or the poison resulting from undigested food. This ability is in proportion to the integrity and soundness of every tissue and organ of the body. This may be illustrated by the fact that with a person suffering from kidney disease, which necessarily impedes elimination, the ordinary effects of a poison are intensified; therefore whatever aids in the promotion of good health, or in other words, the normal action of all the functions, will contribute to the safety of the individual in any and every emergency. "When a person dies from the effect of poisoning, it is simply because the system was unable to eliminate the offending substance and was exhausted in the effort. There is a tolerance of some substances which frequently results in chronic disease, and again it is shown in what is called the cumulative effect or acute disease. "Those who would hold that a substance is at one time a medicament, and at another time a poison, have much trouble in drawing the line between the beneficial and the poisonous effect. The idea that poisonous substances act on the system is responsible for many grave mistakes, whereas always, and under all circumstances, it is the system that does all the action. "There might be some excuse for the idea that disease is an entity, from the facts that have been brought to light by the germ theory, but this theory is of recent date, while the entity theory is as old as superstition. "Snake poison, which may be cited as a type of other animal poisons, takes effect through the circulation, and acts by paralyzing the nerve centres, and by altering the condition of the blood. In ordinary cases death seems to take place by arrest of respiration, from paralysis of the nerves of motion. The poison also acts septically, producing at a later period sloughing and hemorrhage. "Dr. Calmette, a noted French scientist, claims that what is poisonous in the snake's bite, is not the venom absorbed into the blood, but a principle which the blood itself has developed out of the poison. This would necessitate very quick action when the poison is inserted in one of the large veins, as that is followed by instant death. "The following cases fairly represent some of the tragedies that are occurring in our everyday life. "A man 60 years old falls and dislocates his finger, he goes to the hospital, where in a short time he dies from blood poisoning. * * * * * Another man 48 years old, many years a wine merchant, whose great toe was severely crushed by a heavy man stepping on it, was taken with blood-poisoning and in spite of all treatment, even to the amputation of the leg, he soon succumbed to the disease. * * * * * A young woman 24 years old, picks a pimple on her chin and at once her face begins to swell. In vain was all medical treatment, for in a few days she died in terrible agony. * * * * * About a year ago there died in Brooklyn, N. Y., a physician in his 38th year, who six days previously received a slight scratch in his hand while performing a post-mortem examination. All that medical science could suggest was done to no avail. * * * * * In the summer of 1896 a young woman 22 years of age was bitten on the leg by an insect. Several physicians were called in but their treatment gave no relief; blood-poisoning set in; it was decided to amputate the leg, but before it could be done she died. * * * * * In July, 1896, a veterinary surgeon 34 years of age, while removing a cancer from a horse pricked his finger with his knife. The wound was so slight that he forgot all about it. A few days later blood-poisoning set in and in a short time his end came. * * * * * Some forty years ago a man named Whitney was teasing a rattlesnake in a Broadway barroom, was bitten by it, and, though whisky was poured down his throat by the quart, he soon died. "Such results seem entirely unnecessary were the proper course pursued, and at the same time they are a fearful commentary on the medical resources of the day. "The latest researches in regard to alcohol reveal it as a poison to the human system in whatever way it may be diluted or disguised. Its effect is always the same in proportion to the amount taken. It is impossible to habitually use it in any form, even in small quantities, without disease and degeneration resulting therefrom. When taken into the stomach the action is the same as with any other narcotic; the meaning of this word is _to become torpid_. It benumbs the nerves of sensation, and thus the vital resistance to any offending material is reduced, and while the patient _feels_ less of any disturbance the real harm goes on with accumulated force because of the lack of vitality and non-resistance of the nervous system. "When the body is in the throes of a vital struggle with a virulent poison it would seem, to any unprejudiced mind, the height of folly to further weaken the vital resistance by the administration of any narcotic, and especially alcohol. "The eminent German, Professor Bunge, says: 'All the results which on superficial observation appear to show that alcohol possesses stimulant properties, can be explained on the ground that they were due to paralysis.' * * * * * Professors S. Weir Mitchell and E. T. Reichert, in _Researches on Serpent Poison_, make this notable statement: 'Despite the popular creed, it is now pretty sure that many men have been killed by the alcohol given to relieve them from the effects of snake bite, and it is a matter of record that men dead drunk with whiskey and then bitten, have died of the bite.' "As a great contrast to the weakness of the mass of our people who are drug-takers and alcohol-consumers, and who are liable to almost any epidemic that comes along, and quickly succumb to a serious injury, may be mentioned the Turkish soldiers of to-day, who know nothing of drugs as we use them and never use alcohol in any form. During the late controversy with the Greeks, one of them who was reported as having been shot in the stomach, remained in the ranks, and afterward walked ten miles. Another one who was wounded twice in the legs and once in the shoulder, continued attending to his duties for twenty-four hours, until an officer noticed his condition and ordered him to the hospital. The heat was tremendous, but the troops endured it without complaint, and the doctors were astonished at the wonderful vitality of the wounded Turks, who recovered with remarkable rapidity. This, with good reason, is attributed to their abstemious lives. "It has been stated that the Moqui Indians handle the rattlesnake with impunity, and are not inconvenienced by its occasional bite. "The rational treatment of animal poison is to endeavor to prevent the entry of the virus into the circulation and to neutralize it in the wound before it is absorbed; but when it has entered the system everything should be done for its elimination. "The most powerful aid to the human system, and the most perfect eliminator known to man is heat. It is used with much advantage, and great success by means of water, both internally and externally, but above all is its use by hot air, as in the Turkish bath, which works in harmony with every natural function, promoting the action of all the secretions, and more particularly the excretions. By this means will the system unload itself of an accumulation of impurities in an incredibly short space of time, while the heat aids in destroying whatever there may be of virus therein. "Calmette, whom we have previously quoted, has shown that whatever be the source of snake venom, its active principle is destroyed by being submitted to a temperature of about 212 degrees for a variable length of time. "In the not remote future thousands of human beings will owe to the Turkish bath not only an immunity from disease in general, but also an escape from the horrors of a premature death from hydrophobia, the poison of snake bite, or the slower action of infectious disease. "The mass of testimony that has been accumulating for over thirty years past is more than sufficient to convince any reasonable mind that is willing to examine the facts. "The medical profession has searched the world over and under for the means of controlling disease, while within the human body itself lies the vital power which needs only to be cultivated and exalted to its true function to banish the mass of disease from the land." Dr. Shepard states in another article that Turkish baths are now used in London and Paris for the cure of hydrophobia. Dr. J. H. Kellogg says:-- "A great number of remedies have acquired the reputation of being cures for snake bites. The partisans of each one of these have been able to produce a large number of cases, which apparently supported their claims; the uniform testimony of all scientific authorities upon this subject, however, is that all these so-called antidotes are worthless. Prof. W. Watson Cheyne, M. B., F. R. C. S., surgeon of Kings College Hospital, London, England, states, in the _International Encyclopedia of Surgery_, that 'there is no known antidote by which the venom can be neutralized, nor any prophylactic.' This eminent authority also remarks further: 'Hence medication with this view is to be avoided altogether, and the aim of treatment should be to prevent the poison from gaining access to the general circulation, and to avoid its prostrating effects if its entrance has already taken place.' The same writer asserts that the only aim of the constitutional treatment should be 'to sustain the strength until the poison shall have been eliminated.' The idea that the saturation of the body with whisky to the point of intoxication, if possible, is beneficial in these cases, is in the highest degree erroneous. Whisky intoxication, according to Dr. Cheyne, actually 'favors the injurious effect of the poison. What is required is to keep the patient alive until the poison has been eliminated.' Whisky will not do this, but actually aids the poison in its fatal work by lessening the resistance of the patient, and hence lessening his chances for recovery. "The reputation of whisky as a remedy in these cases is due to the fact that on an average only one person in eight who is bitten by a rattlesnake is really poisoned; the reasons for this were fully explained in an interesting paper on 'Rattlesnakes,' by the eminent Dr. S. Weir Mitchell, and published in the Smithsonian Contributions to _Knowledge_ for 1860. If the snake strikes several times before inflicting a wound, the sacs containing the venom may be emptied, so that the succeeding bite will introduce only the most minute quantity of poison--not enough to produce serious, or fatal results. If the part bitten is covered by clothing, the poison may be absorbed by the clothing, so that but very little enters the circulation. In various other ways the snake is prevented from inflicting a fatal wound. The popular idea, that every bite of a rattlesnake is necessarily poisonous, is thus shown to be erroneous. It is not at all probable that the administration of whisky has ever in any case contributed to the long life of a person bitten by a rattlesnake. "Whisky is often recommended by physicians with the idea that it will sustain the energies of the patient, or will stimulate the heart, etc.; but it has been clearly shown that alcohol in all forms is not only useless for these purposes, but does actual damage, since it lessens the resistance of the patient, weakens the heart, and helps along the prostration which is the characteristic effect of the rattlesnake venom. Alcohol has, for many years, been used as an antidote for collapse under an anæsthetic administered for surgical purposes, but no intelligent physician nowadays thinks of using alcohol for such a purpose; instead, alcohol is given before the anæsthetic for the purpose of facilitating its effect. Errors of this sort which have once become established are very hard to uproot. Probably some physicians will continue to use alcohol for shock, exhaustion, general debility and similar conditions as well as for rattlesnake poisoning for another quarter of a century, but such use of alcohol does not belong to the domain of rational medicine and is not supported by scientific facts." "Under the Pasteur method, a man who did not take alcohol was much more likely to recover from the bite of a mad dog than one bitten under the same conditions, who used that drug; while in lock-jaw there was absolute failure to secure immunity if the patient had taken alcohol. In India it used to be given in large quantities for snake bite, but it was found that it had a direct effect in interfering with the processes of repair, and so is being abandoned."--DR. SIMS WOODHEAD, of the Royal College of Physicians and Surgeons, London, Eng. "Nothing could be more irrational and dangerous than the popular notion concerning the antagonism of whisky and snake-bites, and Willson reports that several of the fatalities in his series were directly due to alcohol rather than to the bite."--_Editorial, Journal of the American Medical Ass'n._ RHEUMATISM:--"Unquestionably, the most active cause of rheumatism, as well as of migraine, sick-headache, Bright's disease, neurasthenia and a number of other kindred diseases, is the general use of flesh food, tea and coffee, and alcoholic liquors. As regards remedies, there are no medicinal agents which are of any permanent value in the treatment of chronic rheumatism. The disease can be remedied only by regimen,--that is, by diet and training. A simple dietary, consisting of fruits, grains, and nuts, and particularly the free use of fruits, must be placed in the first rank among the radical curative measures. Water, if taken in abundance, is also a means of washing out the accumulated poisons. "An individual afflicted with rheumatism in any form should live, so far as possible, an out-of-door life, taking daily a sufficient amount of exercise to induce vigorous perspiration. A cool morning sponge bath, followed by vigorous rubbing, and a moist pack to the joints most seriously affected, at night, are measures which are worthy of a faithful trial. Every person who is suffering from this disease should give the matter immediate attention, as it is a malady which is progressive, and is one of the most potent causes of premature old age, and general physical deterioration. American nervousness is probably more often due to uric acid, or to the poisons which it represents, than to any other one cause."--_Good Health._ "Alcohol favors the development of rheumatism. It does this by preventing waste matter from leaving the system. Beer and wine, because they contain lime and salts, are said to cause rheumatism, or at least to aid in its development. These salts are absorbed into the system, unite with the uric acid, and form an insoluble urate of lime, which is deposited around the joints, thus causing them to become enlarged and stiff. * * * * * "The success of the Turkish bath treatment has been phenomenal. Of over 3,000 cases treated here at least 95 per cent. have been entirely relieved, or greatly helped. Some who were treated over twenty years ago have stated that they have not had a twinge of rheumatism since. Very few have persevered in the use of the bath without experiencing permanent relief."--DR. CHARLES H. SHEPARD, Brooklyn. "Those having a bath cabinet can have a good substitute at home for the Turkish bath. Remember that if tobacco and alcohol are indulged in, there can be no permanent relief." _The New Hygiene_ says:-- "Under no circumstances take any of the thousand and one nostrums advertised as sure cures for this disease. Pure unadulterated blood is the only remedy. This can only be produced by cleansing the system of impurities, and giving it the right kind of material out of which to make it. Keep out the poisonous physic, clean out the colon, strengthen the lungs, and feed the system with proper food, and this disease will vanish like a fog before the rising sun." The same book in advocating the use of the Turkish bath for rheumatism, says:-- "The fact, which is well attested, that when a person enters the bath the urine may be strongly acid, but, on leaving the bath, after half an hour, it is markedly alkaline, shows that the bath has a strong effect upon the system." Dr. Ridge says of _rheumatic fever_:-- "I would urge most strongly the desirability of avoiding every form of alcoholic liquor, from the very commencement of the disease, as affording the best chance for a speedy and safe recovery. The highest authorities are agreed on this point, but there is a lingering practice which makes reference necessary in order to confirm the wavering." In Mt. Sinai Hospital, New York, the hot blanket pack is used in acute rheumatism, almost to the exclusion of other methods. The pack should be continued two to four hours at least, and may be repeated two or three times within the twenty-four hours with advantage. _Nature Cure_ says that thorough massage, and half a dozen cups of hot lemonade will cure a severe case of sciatica:-- "The massage should be commenced moderately, and increased as the patient can bear it. Rubbing and slapping of the muscles with bare hands will hasten a cure, and be agreeable to the patient. One to two hours treatment, if _vigorous_, will effect a cure." SEA-SICKNESS:--Brandy is a common resort in this trouble, many taking it under such circumstances who would under no other. Yet it frequently adds to the sickness, instead of relieving it. "Be sparing in diet for two or three days before the expected voyage. If very sensitive, take to your berth as soon as you go on board, or lie down on deck; get near the centre of the vessel, and lie with your feet to the stern. Go to sleep if possible. Iced water may be sipped, but nothing solid should be taken at first; after a while a cracker or wafer may be taken." It is said upon good authority that if two or three apples are eaten shortly before going on board, or before rough water is encountered, sea-sickness is entirely averted. It will be well to partake of no other food for some hours previous to the voyage when trying this. _Good Health_ says:-- "If any of our readers have occasion to cross the ocean in the stormy season, we recommend three things; keep horizontal, with the head low; put an ice-bag to the back of the neck, keep the stomach clean, free from greasy foods and meats, and eat nothing till there is an appetite for food. A habitually clean dietary before going on board is doubtless a good preparation for such a voyage, as well as for any other nerve strain, or test of endurance. It pays to be good--to your stomach, as well as in other ways." The following is guaranteed by a Russian physician to be an effective cure and a means of avoiding sea-sickness when the symptoms first make their appearance. Take long and deep inspirations. About twenty breaths should be taken every minute, and they should be as deep as possible. After thirty or forty inspirations the symptoms will be found to abate. This is recommended for dyspepsia also. SORE NIPPLES:--"Alum water, or tannin, used for several months in advance will harden as effectually as brandy. If there is soreness on commencing to nurse, put a pinch of alum into milk, and apply the curd to the nipple." SPASMS:--"These are caused by flatulence, as a result of indigestion. A little hot ginger tea, or capsicum tea, may do all that is required. If these are not at hand, loosen every tight band, rub well the region of the heart and stomach, slap the face with the corner of a wet towel, and give sips of cold water." SHOCK:--"In shock, or collapse, the state is similar in some respects to that which is present in fainting. Every function is almost at a standstill; absorption from the stomach and elsewhere is at its lowest point, because the circulation of the blood is so much interfered with. Hence much of the brandy which is so often given, and to such a wonderful amount, with very little apparent effect of intoxication, is really not absorbed at all, and is very often rejected from the stomach by vomiting, when reaction does occur, if not before. "The patient should be wrapped up warmly, and put to bed as soon as possible. The limbs may be rubbed with hot flannels, and hot water bottles put to hands and feet. In some cases, also, towels wrung out of hot water may be wrapped around the head. Hot milk and water, hot water slightly sweetened, or with a little peppermint water in it, should be given as soon as the patient can swallow. Hot beverages will warm the skin more rapidly and powerfully than any alcoholic liquor. "If the patient cannot swallow, an enema of hot water, or hot, thin gruel, should be administered, and may be of use in addition to hot drinks. Beef extract may be added to the hot water with advantage. "In the vast majority of cases there need be no anxiety so far as the shock is concerned; reaction will occur in due time if ordinary care be taken, and will be more natural and steady if the system is not embarrassed by the presence of the narcotic alcohol. In the state of collapse the voluntary nervous system is depressed; alcohol diminishes the power and activity of the nervous centres of the brain, hence its action is undesirable in shock or collapse."--DR. J. J. RIDGE, London. "No procedure could be more senseless than the administering alcohol in shock. A stimulant of some kind is necessary in such cases, and alcohol, instead of being a stimulant is a narcotic. * * * * * Alcohol causes a decrease of temperature, the very thing to be avoided in cases of shock."--DR. J. H. KELLOGG. "I am perfectly sure that a large dose of alcohol in shock puts a nail in the coffin of the patient."--DR. H. C. WOOD of the University of Pennsylvania. SINKING SENSATIONS:--Many women have a feeling of weakness or "goneness" at about eleven o'clock in the morning, and are led by it to the injurious practice of eating between meals. It is often due to indigestion, or to the use of beer or wine. A few sips of hot milk, of fruit juice, or even of cold water will often relieve it, especially if total abstinence is persevered in. SUDDEN ILLNESS:--"Those taken suddenly ill are likely to fare best if placed in a recumbent position, with head slightly elevated, all tightness of garments about the neck or waist relieved, and a little cold water given in case of ability to swallow. A mustard plaster on the back of the neck, or over the stomach, and hot water or hot bottles to the feet, are never out of place, while vinegar, or smelling salts, or dilute ammonia to the nostrils is reviving."--EZRA M. HUNT, M. D., late secretary of New Jersey State Board of Health. "Both the popular and professional beliefs in the efficacy of alcoholic liquids for relieving exhaustion, faintness, shock, etc. are equally fallacious. All these conditions are temporary, and rapidly recovered from by simply the recumbent position, and free access to fresh air. Ninety-nine out of every hundred of such cases pass the crisis before the attendants have time to apply any remedies, and when they do, the sprinkling of cold water on the face, and the vapor of camphor or carbonate of ammonia to the nostrils, are the most efficacious remedies, and leave none of the secondary evil effects of brandy, whisky or wine."--DR. N. S. DAVIS. SUNSTROKE:--"There has lately been a correspondence in the _Morning Post_ on the subject of 'Sunstroke and Alcohol.' We quite agree with the statement that 'nothing predisposes people to sunstroke so much as this pernicious habit of taking stimulants (so-called) during the hot weather.' As far as this country is concerned, nearly every case of sunstroke might be more appropriately designated 'beerstroke.' One effect of alcohol is to paralyze the heat-regulating mechanism; the blood becomes overloaded with waste material, and the narcotism, and vasomotor paralysis, produced by the alcohol, is added to that produced by the heat. Abstainers, other things being equal, can always endure extremes of temperature better than consumers of alcohol."--_Medical Pioneer_, England. "During the month of January, 1896, there occurred over three hundred deaths from sunstroke in Australia. When called upon to offer suggestions relative to its prevention, the medical board promptly informed the Colonial government that, of all the predisposing causes, none were so potent as indulgence in intoxicating liquors, and in its treatment nothing seemed to have a more disastrous effect than the administration of alcoholic stimulants."--_Medical News._ The _Bulletin of the A. M. T. A._ for August, 1896, contained the following:-- "Recently a leading medical man, a teacher in a college, warned his student audience against the anti-alcoholic theories urged by extremists and persons whose zeal was greater than their intelligence. He affirmed positively that the value of alcohol was well known in medicine, and established by long years of experience. "Not long afterward a man was brought into his office in a state of collapse from sunstroke, and this physician and teacher ordered large quantities of brandy to be administered; the patient died soon after." Dr. T. D. Crothers tells of a case where alcohol was administered to a child for partial sunstroke, and says, "there were many reasons for believing that the profound poisoning from alcohol gave a permanent bias and tendency that developed into inebriety later." "When a person falls with sunstroke (or heatstroke) he should at once be carried to a cool, shady place. His clothing should be removed, and cold applications made to the head, and over the whole body. Pieces of ice may be packed around the head, or cold water may be poured upon the body. Cold enema may also be employed. In case the face is pale, hot applications should be made to the head and over the heart and the body should be rubbed vigorously."--DR. J. H. KELLOGG. TYPHOID FEVER. As many lives are lost by this disease, its treatment must ever be one of intense interest, not only to physicians, but also to all humanity. Since non-alcoholic treatment has reduced the death-rate in typhoid to five per cent., the views regarding such treatment expressed by leading practitioners will doubtless be read with eagerness. The following is a paper by Dr. N. S. Davis taken from the _Medical Temperance Quarterly_. "ALLEGED INDICATIONS FOR THE USE OF ALCOHOL IN THE TREATMENT OF TYPHOID FEVER:--On the first page of the first number of a new medical journal bearing date July, 1895, may be found the following statement: 'The question of administering alcohol comes up in every case of typhoid fever. In mild cases, especially when the patient is young, healthy and temperate, stimulants are not needed so long as the disease follows the typical course. Here, as elsewhere, alcohol should be avoided when not absolutely demanded. There is, however, generally such a dangerous tendency toward nervous exhaustion, that in a majority of cases more or less alcohol is required. The indication which calls for its use is an inability to administer enough food. * * * * * Again, the existence of high temperature nearly always makes it necessary to stimulate the patient, as does threatened nervous exhaustion and heart failure, for immediate effect; likewise a weak, small, compressible, rapid pulse, with impaired cardiac impulse and systolic sound, is a frequent indication; other remedies may be required, but alcohol cannot be dispensed with.' The next paragraph continues: 'It is necessary to give alcohol in serious complications of typhoid fever, such as pneumonia, pleurisy, hemorrhage and severe bronchitis or diarrhoea. It is best to begin giving it early and in small quantities: two to six ounces is a moderate amount, eight to twelve ounces daily is not too much for adynamic or complicated cases.' "The foregoing quotations purport to have been condensed from one of our recent authoritative works on practical medicine, and doubtless fairly represent the prevailing opinions concerning the use of alcohol in the treatment of typhoid and other fevers, both in and out of the profession. A careful reading will show that the whole is founded on the following four assumptions: "1. That alcohol when taken into the living body acts as a general stimulant, and especially so to the cardiac and vasomotor functions. 2. That in mild, uncomplicated cases of typhoid fever in young and previously healthy subjects, stimulants are not required and no alcohol should be given. 3. That in a 'majority of cases' the tendency toward dangerous 'nervous exhaustion' and 'heart failure' is so great that the giving of 'more or less alcohol is required.' 4. The amount required may vary from two to twelve or more ounces per day. "In the two preceding numbers of this journal, I have endeavored to show that the chief causes of nervous exhaustion and heart failure, in typhoid and other fevers were impairment of the hemoglobin and corpuscular elements of the blood, deficient reception and internal distribution of oxygen, and molecular degeneration of the muscular structures of the heart itself. These important pathological conditions are doubtless caused by the specific toxic agent or agents giving rise to the fever. Consequently the rational objects of treatment are to stop the further action of the specific cause, either by neutralization, or elimination, or both; to stop the further impairment of the hemoglobin and other elements of the blood; and to increase the reception and internal distribution of oxygen, by which we will most effectually prevent further fatty or granular degeneration of cardiac and other structures. The language of the paragraphs I have quoted, fairly assumes that alcohol is a _stimulant_ capable of relieving nervous exhaustion and cardiac failures, regardless of the causes producing those pathological conditions, and consequently its use is necessary in the 'majority of cases' of typhoid fever. "Can such an assumption be sustained by either established facts, or correct reasoning? Can nervous and cardiac exhaustion, induced by the presence of toxic agents in the blood, with deficiency of both hemoglobin and oxygen, be relieved by a simple _stimulant_, that neither neutralizes nor eliminates the toxic agents, nor increases either the hemoglobin or oxygen? That alcohol does not neutralize or destroy toxic ptomaines, or tox-albumins, is proved by abundant clinical experience, and also by the fact that chemists use it freely in the processes for separating these substances from other organic matters for experimental purposes. That its presence in the living body retards metabolic changes generally, and thereby aids in retaining instead of eliminating toxic agents of all kinds, has been so fully shown in the pages of preceding numbers of the _Medical Temperance Quarterly_, that the leading facts need not be repeated here. That its presence does not increase the hemoglobin, or favor oxy-hemoglobin or increased internal distribution of oxygen, but decidedly the reverse, has been equally well demonstrated by numerous and reliable experimental researches in this and other countries. "Then it must be conceded that alcohol is not capable of fulfilling either of the important indications presented in the treatment of typhoid fever as stated above. Nevertheless, the advocates of its use apparently recognize but two ideas or factors in these cases, namely, the popularly inherited assumption that alcohol is a _stimulant_, and as the patient is in danger from nervous and cardiac weakness, therefore the alcohol must be given, _pro re nata_ without the slightest regard to the existing causes of the weakness, or the _modus operandi_ of the so-called stimulant. "This is proved by the fact that they group together as stimulants, and give to the same patient in alternate doses, remedies of directly antagonistic action, as alcohol and strychnine, or digitalis, etc. "The accepted definition of a stimulant in medical literature, is some agent capable of exciting or increasing _vital activity_ as a whole, or the natural activity of some one structure or organ. "For instance, both clinical and experimental observations show that strychnine directly increases the functional activity of the respiratory, cardiac and vasomotor nervous systems, and thereby increases the internal distribution of oxygen, which is nature's own special exciter of all vital action. Therefore it is properly a direct respiratory, cardiac and vasomotor stimulant and indirectly a stimulator of all vital processes. But the same kind of clinical and experimental observations show that alcohol directly diminishes the functional activity of all nerve structures, pre-eminently those of respiration and circulation, and also of all metabolic processes, whether respirative, disintegrative or secretory. Consequently it not only acts as directly antagonistic to strychnine, but equally so to all true stimulants or remedies capable of increasing vital activity. Instead, therefore, of meriting the name of _stimulant_, alcohol should be designated and used only as an anæsthetic and sedative, or depressor of vital activity. "And a thorough and impartial investigation will show that its use in the treatment of typhoid and other fevers, while deceiving both physician and patient, by its anæsthetic effect in diminishing restlessness, both prolongs the duration and increases the ratio of mortality of the disease, by its impairment of vital activity in the organizable elements of both blood and tissues." Equally interesting is the following outline of treatment pursued by Dr. W. H. Riley, of the Battle Creek Sanitarium. "The purpose of the present paper is to give briefly an outline of the method of treatment of typhoid fever as used by the writer in a considerable number of cases. "A consideration of the pathology of this disease does not properly come under this head, but we wish simply to call attention to the well-known fact that typhoid fever is a germ disease. The germ which causes this fever has generally been supposed to be the bacillus of Eberth. More recent bacteriological studies rather indicate that the bacillus coli may also cause the disease. These germs are usually carried into the body in food or drink, and, lodging in the small intestines, begin to grow and multiply, and by their life produce poisonous ptomaines which are absorbed and carried by the circulation to all the organs and tissues of the body. "It is these ptomaines, thus carried to all parts of the body, that are largely the immediate cause of the pyrexia and attending symptoms. The organisms which produce these poisons for the most part remain in the intestines, although they have been found in the spleen. "The indications for treatment are:-- "1. To remove or destroy the cause (to eliminate the germs and ptomaines from the body). "2. To sustain the vital and resisting powers of the patient. "If the patient is seen early in the disease, it has been my practice to immediately put him to bed and give a free dose of magnesium sulphate. This is preferably given in the morning or forenoon, and may be repeated once or twice on successive days. Besides this the patient should have a large enema of water at a temperature of from 75° to 80° F.; and this may be repeated daily or even oftener, for some time, if necessary, to keep the bowels empty of the poisonous substances. "The salines and enemas thus used carry out bodily a large number of germs and ptomaines that are present in the intestines; and further, the salines, by producing an increased secretion of the mucous membrane of the intestines, tend to disentangle and set free many of the germs that have found a lodging place in the walls of the intestines. "For the elimination of the ptomaines which have been absorbed into the circulation and carried to the tissues, nothing is better than the internal use of water. From three to five pints should be drunk during every twenty-four hours. It should be taken in small quantities--six to eight ounces every hour or two during waking hours, except when food is taken. I will refer to this point more in detail later. "A consideration of the general care of the patient properly comes under the second head of the indications for treatment as given above. The patient should be put to bed in a large, light, well-ventilated room. At least two sides of the room should communicate directly by windows with out-of-doors, in order that the room may be properly ventilated. "All unnecessary articles of furniture, such as carpets, couches, upholstered chairs, pictures, etc. should be removed. "The room should be thoroughly cleaned before the patient is put into it. "There should be two beds in the room for the use of the patient. These should be, preferably, narrow and so placed in the room that there is a free approach to both sides of the bed, for the convenience of the nurse in giving treatment. Iron bedsteads are preferable to wooden. The bedding should be firm, yet soft and smoothly drawn. There should be just sufficient covering to protect the body. The patient should be changed from one bed to the other daily. This may be done by placing the two beds side by side and carefully moving the patient from one to the other. The sheets on the bed from which the patient has been taken should be washed and disinfected at each change of the beds, and all other bedding should be thoroughly aired and exposed to the sunlight daily. "The patient should have the care of a thoroughly educated, careful and competent nurse, one who understands perfectly the various methods of using water in the treatment of fevers. "There is no other single remedy that I consider so valuable in the treatment of fever as the internal use of water. As above stated, the patient should drink six or eight ounces every hour during the waking hours, except for about two hours after food is taken. The water should be thoroughly sterilized, and as a rule may be taken either cool or hot. Ice water is objectionable. Hot water is often preferable. This is a simple remedy, but nevertheless is efficacious. It should be given to the patient whether he calls for it or not, and it should be considered an important part of his treatment. When water is taken into the stomach and absorbed into the circulation, it throws into solution the ptomaines which have been absorbed from the intestines and are present in the circulation and tissues, and thereby puts them in a favorable condition for elimination. It increases the activity of the kidneys, and thus hastens and increases the elimination of the poisons in the system. "In the early stage of the fever, when the pulse is full, and the action of the heart increased, it is best to give the patient cool water. Later in the disease, when the action of the heart is weak, and the patient feeble, it is best to give the water hot. "Winternitz, many years ago, demonstrated that hot water taken into the stomach acts as a cardiac stimulant, and the increased heart's action is immediate, or at least before the water has time to absorb, which indicates that the water in the stomach acts reflexly as a cardiac stimulant. The water after absorption also increases the circulation by filling the blood-vessels, and increasing arterial pressure. The writer has frequently noticed a decided increase in the fullness, and rapidity of the pulse, after a patient has drunk a glassful of hot water. "The external use of water also forms an important part of the treatment. The patient should be sponged off with tepid water every hour or two when the temperature is 103°, or above. When the temperature is less than this, it is not necessary to sponge the body so frequently. Sometimes a hot sponge bath is more efficacious in reducing the temperature than the tepid or cool bath. The sponge bath reduces the temperature, relieves many of the distressing nervous symptoms, is refreshing to the patient, and promotes sleep. The temperature of the body may also be reduced by the use of cool compresses placed over the abdomen, and changed frequently. "The matter of diet is an important factor in the treatment of typhoid fever. The diet should be aseptic, easily digested, and should contain the necessary food elements. Probably no one article of diet meets all these requirements as well as sterilized milk. The patient should take from two to three pints daily. The milk is best taken four times during the day at intervals of four hours, taking eight to ten ounces at a time. Should the patient become tired of the milk, gluten gruel may be substituted for the milk. "The diarrhoea and bowel symptoms, when present, may be relieved by the application of hot fomentations to the abdomen, warm or hot enemas and twenty grains of subnitrate of bismuth given every four hours. "The patient should be kept as quiet as possible, and should be turned in bed at intervals, to prevent hypostatic congestion and the formation of bed-sores. The bony prominences which are apt to become eroded should be sponged frequently with a solution of tannic acid in equal parts of alcohol and water; a dram of the tannic acid to a pint of alcohol and water, is about the proper strength to use. "By the methods briefly outlined above--that is by the free use of water internally and externally, by keeping the intestines thoroughly emptied of poisonous material by the free and frequent use of enemas, by proper feeding and the careful attention of a good nurse to the patient and his surroundings--the duration of the fever may be shortened and the severity of the disease lessened; heart failure, and other complications will seldom occur, and the patient will in nearly every instance make a good recovery. The best method to pursue to prevent heart failure is to keep the poisons which are generated in the bowels and absorbed into the body, and which are the direct cause of the heart failure, eliminated from the body. Should the heart become weak, it may be effectually stimulated by giving hot water to drink, applying heat to the heart in the form of a fomentation, and the application of fomentations to the upper spine. "In the treatment of a large number of cases of typhoid fever, extending over several years' practice, the writer has never made use of alcohol internally to support the action of the heart, or for any other purpose. "The number of cases of death from typhoid fever coming under the writer's observation, where the method of treatment pursued has been similar to that briefly indicated above, have been very few, a much smaller per cent. than in practice where alcohol has been used as a 'cardiac stimulant.' I believe that the use of alcohol in the treatment of typhoid fever is not only useless, but absolutely harmful." Dr. Kate Lindsay, of Battle Creek Sanitarium and Hospital, contributed an article upon Typhoid Fever to the _Bulletin of the A. M. T. A._ for January, 1896, from which a few notes are here taken:-- "The chief toxic centre is evidently the intestinal tract, especially the termination of the ileum. The ulcerations, necroses, perforations and hemorrhages are most frequently found in the last twelve inches of the small intestine, and may extend into the large intestine. The ulcerated surface and open vessels increase the facility with which the poison finds entrance into the circulation. The microbes, blood clots, necrosed tissue and pus, furnish abundant supplies of toxic matter, which, saturating the system, over-power and stop the activity of the functions of all the organs of the body, causing degeneration of tissues. Death is said to take place from heart, lung or brain failure, but the failure involves every other organ as well. "Regarding the intestinal tract as any other abscess at this time, the physician should seek for methods of treatment or remedies which will remove the morbid matters, and destroy, or at least inhibit their action, thus decreasing the fever and stimulating the circulation. Secondary toxic centres often develop in the course of this disease, notably in the glands, lungs and dependent organs, the hypostatic congestion resulting from lying in one position, causing stasis of blood, death and necrosis of tissue, both of the external and internal organs. All vessels connected with the dying tissues carry toxins to other parts of the body. Suppurating glands, and phlebitis of the femoral veins are examples of this secondary infection, and are accountable for the heart failure and collapse so often fatal during the second, third and fourth weeks of typhoid fever. * * * * * "The old idea that in peristaltic action lay the great danger of increase of the hemorrhage and perforation of the bowels, is giving way to the more rational view that gaseous distention and septic absorption, are what bring about fatal results from these complications, and that the moderate peristalsis of the intestinal walls lessens these dangers by closing the gaping ends of the injured vessels, and expelling the septic matter and foul gases. To meet these indications I have found lavage of the bowels, even during hemorrhage, with water of 105° to 110° F. or even hotter, given in moderate quantity of from one pint to three, to give great relief by freeing the large intestines of blood clots, fecal matter and other morbid matter. It also increases peristaltic action in the small intestines, thus favoring the expulsion of gas. The heat stimulates the circulation in the peripheral vessels of the intestines, and overcomes the tendency to blood stasis. "In the cases cited, ice-bags, alternated with fomentations, were used over the abdomen externally, and heat, or hot and cold, to spine. The extremities were kept warm. From ten to thirty minims of turpentine, in an ounce of gum acacia or starch water, increased the efficiency of the enemata, and aided in expelling the gas and checking hemorrhage. "The tendency to hypostatic congestion and bed-sores, was prevented by frequent change of position, and the use of hot and cold to the spine by fomentations and compresses, or better still, hot fine spraying, or the alternate hot and cold spray. In one grave case, spraying was kept up for about twelve hours, with only short intermissions. The heart was stimulated by heat applied over it, whenever depression and collapse threatened, and by hot and cold sponging of the spine." Dr. Noble said some time ago in the _London Times_:-- "Although it is true that alcohol is an antipyretic, yet its exhibition neither shortens nor modifies (favorably) the diseases of which the fever is but a symptom. The paralysis of the brain which is so frequent a cause of death in typhoid fever, is more often brought about by alcohol than any other cause, and more than one woman suffering from puerperal fever has been done to death by the administration of this substance, which, not being _convenienter naturæ, is contra naturam_." J. S. Cain, M. D., in an able paper, read at the Nashville Academy of Medicine, on "Rational Suggestions in the Treatment of Typhoid Fever," dissents from the practice, which still obtains largely in the medical profession, of administering alcoholic liquors, in the belief that they are "stimulants, conservators of force and even nutrients," and says:-- "After a careful and thoughtful study of this subject, I have reluctantly, and against firm early convictions, been forced to the conclusion that these theories with regard to the beneficial effects of alcohol in disease are wholly fallacious. The only rational conclusion at which I can arrive is that the agent is ever, and under all circumstances, a depressor of temperature; that it arrests the physiological interchange of carbonic acid gas and oxygen in the tissues, as well as in the air vesicles of the lungs; that it impedes the elimination of tissue waste, and causes the accumulation of this refuse in the system; that it is lethal anæsthetic in all quantities; that it is not stimulant in the true sense, and never exerts that influence; and that it supplies no element to the diseased and vitiated system calculated to antagonize disease, repair waste, or invigorate lowered vital forces, and therefore for these purposes is not called for in the rational treatment of typhoid fever." At the annual meeting of the American Medical Association held in Atlanta, Georgia, in 1896, Dr. G. B. Garber, of Dunkirk, Ind., read a paper upon "Alcohol in Typhoid Fever" from which a few points are here taken:-- "The fact that the mortality from typhoid fever seems to be gradually lowering is no doubt due in great measure to the non-use of alcohol in the treatment of the disease. Hardly a week passes that some of our journals do not report a series of cases treated without the aid of alcohol in any form. I used alcohol in the treatment of the disease until two years ago, when I became alarmed at the mortality; so I changed my plan, and in 1894 I treated thirty-seven well marked cases of varying degrees of intensity. I had two fatal cases, and in both of them I had used alcohol. In 1895 I treated thirty cases of about the same type, with no death. I only used alcohol in one of them, and it caused me more trouble than any of the others. As this case was in the family of a saloon-keeper, I could not control the matter, as they would give it during my absence. On my return I would find the face flushed, the temperature high, the pulse rapid and the patient nervous. By close inquiry I would find that some of the family had given 'just a little good whisky' which had been in the house for twenty years. "In closing, I wish to state that I am well convinced that in the treatment of typhoid fever our patients will do better and stand a greater chance of recovery, if we abstain entirely from the use of alcohol in the treatment of the disease." Prof. J. Burney Yeo, of London, in a paper read before the International Medical Congress held at Rome, Italy, said:-- "In order to maintain the intestinal antisepsis which forms an essential part of this method of treatment, I insist on the necessity of scrupulous attention and caution in feeding patients suffering from enteric fever, great danger arising from a failure to note the extremely limited digestive and absorptive capacity exhibited by such patients. "In conclusion, the use of alcoholic stimulants, and the common employment of depressing antipyretic agents, must be condemned." In a report of the treatment of typhoid fever by seventy-two physicians of Connecticut, thirty-eight declared that they did not use alcohol in any stage of this disease. The remainder used it sparingly in the last stages, and only two considered it valuable from the beginning of the disease. In a discussion of typhoid fever by a medical society meeting in Rochester, N. Y., recently, sixty physicians being present, only three spoke in favor of using alcohol in this disease. Hygienic physicians all insist upon a rigid fast as long as the high temperature continues, or until the patient is sufficiently hungry to eat a piece of plain, stale, graham bread, "dry upon the tongue." Dr. Charles E. Page of Boston says there would be very few relapses if this plan were carefully carried out. He contends that the whisky and milk diet, together with the not over-fresh air of the average sick room is enough to produce fever in a healthy person, hence is not likely to be conducive to recovery in one already infected with the disease. In an article in the _Arena_ of September, 1892, Dr. Page says:-- "In my fever practice I have frequently observed the effect of fasts of six, eight, ten and twelve days to be in the highest degree productive of the health and comfort of patients, as, on the other hand I have, during the past twenty years observed the deplorable effects of the almost universal plan of constant feeding. In some of the most distressing cases that have happened to be thrown in my way, when all hope in the minds of friends had been abandoned, I have found that withdrawal of food, drugs and stimulants, and the substitution of simple, fresh, soft water, has produced results that seemed almost miraculous." Fruit juices are now permitted by many physicians in fever, a few drops of lemon or orange juice, being a grateful addition to the water. Grape juice, unfermented, is highly recommended by some. A young minister of great promise died recently of typhoid fever. His young wife, only one year married, is in settled melancholy, because she cannot understand why "God took her husband." Inquiry developed the fact that the physician in attendance was a believer in alcohol as a remedy, and used it in this case. In view of the better chances of recovery under non-alcoholic treatment shown by comparative death-rates, may it not be that the alcohol was responsible for the young man's death, instead of its being "God's will to take him?" The Author of all good has too frequently been held responsible for the errors of physicians, and the carelessness of nurses. VOMITING:--"If the vomiting is due to undigested food, and the sickness can be traced to excess, or to improper diet, draughts of hot water should be taken in order to be rid of offending matter in the stomach. After the stomach is empty bits of ice may be sucked, or cold water sipped. A quarter of a Seidlitz powder may be taken. A flannel, folded to four thicknesses, dipped in hot water, and wrung dry in a towel, may be applied to the pit of the stomach. Cover the flannel with a hot plate, being careful to have the flannel large enough to prevent the plate's burning the skin. Pin a dry towel over all, around the body. This may be renewed every half-hour or hour, as required. Sometimes a cold wet compress on the pit of the stomach, covered with a dry towel is more efficacious, heat developing by reaction. Fluid magnesia is often helpful."--DR. RIDGE. CHAPTER IX. ALCOHOL AND NURSING MOTHERS. It frequently happens that the nursing mother is unable by reason of defective digestive apparatus, or imperfect assimilative powers, to supply sufficient nourishment for her babe. In such case she is often advised to drink ale or beer. It is true that these liquors will excite the secretions of the mammary gland, but it is increase in quantity, not in quality, for the milk is impoverished by the added water and alcohol, taken in the beer. Milkmen sometimes salt cows heavily so that they will drink largely of water, and thus give more milk, but one quart of good, rich milk is worth three quarts of the poor, thin stuff resulting from such method. It is proper feeding, and care, that ensure good milk. When women complain that they are unable to nurse their babies the cause is often an error in diet. Too great reliance is put upon meat as strength-giving. While meat, used in moderation, may be valuable to many persons, the nursing mother should not depend upon it to any great extent. She will find farinaceous foods, with plenty of warm milk, what she most requires. At bedtime she should have a bowl of well-cooked oatmeal gruel, diluted with rich milk, and sweetened, if she prefer it so. The milk should be added to the gruel while it is boiling, as it digests more readily if scalded. People who cannot, or think they cannot, take milk of itself, often find it easy to digest it, after it is scalded in the gruel. Anything that a mother can do in the way of nourishing her babe will be done upon such a diet, that is, farinaceous foods and milk. Sweet fruits are of course valuable also, as tending to keep the system in good order. It is well to bear in mind that it is not the quantity of food eaten, but that which is digested, and assimilated, that goes to build up the tissues of the body. So the habit of eating between meals is pernicious, as it disturbs the digestive processes, and robs the stomach of much-needed rest. This habit is the cause, in many cases, of the falling off in the milk after the first month or two. As nourishment for both mother and babe can come from food only, good appetite, and good digestion are essential to health and strength. The very best help towards gaining a good appetite is exercise in the open air. All mothers recognize the need of keeping their little ones out of doors a while every day, but all do not see the necessity of the same mode of life for themselves. Dr. Nathan S. Davis has said: "I have persuaded thousands of mothers to try fresh air, instead of wine or beer, with gratifying results." The mother who takes her babe out, herself, for its daily airing, is laying up stores of health and vitality, to aid her in providing for the needs of the little one, dependent upon her. Good digestion is as essential as good appetite. Alcohol, whether in beer, wine, whisky, or any other form, is injurious to the stomach, and a hinderer of digestion, hence must do harm, rather than good, to the mother in search of added nourishment for her babe. Dr. Condi says:-- "The only drink of the nurse should be water or milk. All fermented and distilled liquors, as well as strong tea and coffee, she should strictly abstain from. Never was there a more absurd or pernicious notion than that wine, ale or porter is necessary to a nursing mother in order to keep up her strength, or to increase the quantity, and improve the properties of her milk. So far from producing these effects, such drinks, when taken in any quantity, invariably disturb more or less the health of the stomach, and tend to impair the quality, and diminish the quantity, of nourishment furnished by her to her infant." Dr. William Hargreaves says:-- "Every farmer knows that all a healthy cow requires to give good milk and butter is, to give her good feed, and pure water; and he also knows that the way to make a cow give poor watery milk, which they might churn until doomsday without obtaining butter, is to feed her on distillery slops, or grains from the brewery. It is also well known that cheese cannot be made from such milk, it being deficient in curd, or casein. "Alcohol is not only useless but injurious; for children whose mothers try to keep themselves upon beer, etc., very frequently suffer from vomiting and diarrhoea, and often from convulsions. Sometimes a single glass of whisky, taken by the mother, will produce sickness and indigestion in the child, for twenty-four hours after. "In the milk of a healthy woman the water ranges from 879 to 905 parts in 1,000. The oily substance ranges from 25 to 42; casein from 15 to 39; sugar of milk from 31 to 45, and the salts from 1 to 4 parts in 1,000. "Alcoholic drinks materially alter these proportions, for, on the analysis of the milk of the same woman, a few hours before and after the use of a pint of beer, it was found that the alcohol increases the proportion of the water, and diminishes that of casein; and that alcohol is very perceptible in it." "The only rational way to be adopted by mothers to increase the supply of nutrition for their infants, is to secure plenty of suitable nutritious food, prepared in the way that will most fit it for digestion, while they at the same time, avoid as far as possible all fatigue, and mental excitement. It is impossible that alcoholic beverages can add anything to the nutrition of either the infant or mother."--Dr. Bussey, in _Stimulants for Nursing Mothers_. Dr. E. G. Figg, in _The Physiological Operation of Alcohol_, gives the analyses of the milk of a temperate woman in good health, and of a drinking woman as follows:-- Milk of temperate mother. Milk of drinking mother. Salts, " " 8.50 Salts, " " 5.50 Casein, " " 3.0 Casein, " " 2.0 Oil, " " 7.50 Oil, " " 6.5 Water, " " 81.0 Water, " " 84.0 Alcohol, " " 2.0 ------ ------ 100.00 100.00 Dr. Edward Smith says in his _Practical Dietary_:-- "Alcoholics are largely used by many women in the belief that they support the system, and maintain the supply of milk for the infant; but I am convinced that this is a serious error, and is not an infrequent cause of fits and emaciation in the child." Dr. James Edmunds, of the Lying-In Hospital, London, Eng., says in _Diet for Nursing Mothers_:-- "The nursing mother is peculiarly placed, in that she has to provide a supply of nutriment for the child which is dependent upon her, as well as for the ordinary requirements of her own system. The nutrition of the child is to be provided for upon the same principles, and by the same food-elements, as is the nutrition of the mother, the only difference being that the young child is possessed of less perfect masticatory and digestive powers, and therefore requires food to be presented to it in a state more simple, uniform, and readily assimilable than the adult, who is furnished with strong teeth, and possessed of a fully-grown stomach. The mastication, digestion, and primary assimilation of the nursing infant's food is thrown upon the mother's organs; but the tissues of the child are nourished precisely as are the tissues of the mother, and a nursing mother requires simply to digest a larger supply of wholesome, and appropriate food. As a matter of course mothers with imperfect teeth, or weak stomachs, cannot perform the digestion of extra food for the infant so well as those mothers who have an abundance of reserve power in their digestive apparatus; and with such patients, the question arises, how are they to make up for the deficiency which they soon experience in the supply of milk? Such mothers appeal to their medical advisers to prescribe some stimulant which will enable them to overcome the difficulty which they experience, and often are greatly dissatisfied if informed that there is no drug in the _materia medica_ which will make up for structural weakness in the organs which masticate, digest or assimilate the food. The proper course for such women to adopt is a simple and rational one. They should assist their digestive apparatus as much as possible by securing an abundance of suitable and nutritious food, prepared in the best way, and as is most digestible, while they should lessen the demands of their own system by the avoidance of bodily fatigue, and mental excitement. These means, aided by that philosophical hygiene which is at all times essential to the preservation of pure and perfect health, will enable them to supply a maximum quantity of pure and wholesome milk; and further calls by the child require proper artificial food. Unfortunately such advice fails to satisfy many anxious mothers who refuse to admit, or believe, that they are less robust, or less capable, than other ladies of their acquaintance, and such mothers fall easy victims to circulars vaunting the nourishing properties of 'Hoare's Stout,' 'Tanqueray's Gin,' or Gilbey's 'strengthening Port,' circulars which are always backed up by the example, and advice, of lady friends, who themselves have acquired the habit of using these liquors, and who view as a reproach to themselves the practice of any other lady who may not keep them in countenance, as the perfection of all moral and physical propriety. Unfortunately the pressure of such lady friends is often so persistent as to paralyse the influence of a conscientious and thoughtful medical adviser, while the appetites and beliefs of such friends often throw them into active antagonism to any medical adviser, who may not endorse the habits in which, as they believe, and no doubt conscientiously, duty to their child requires them to indulge. The only course that a medical practitioner, whose family is dependent upon his practice, can safely take with veteran mothers on this question, is to let them have their own way without reiterated admonition. When once they have acquired the habit of depending upon large quantities of beer for nursing their children, they become perfectly infatuated, and are practically incapable of passing through the probationary fortnight which takes place before the digestive apparatus can work under its natural, but to them strange, conditions, while the temporary longing for beer, and the sudden lessening of the quantity of milk afforded by their strained and impoverished systems, are at once set down as clear proofs that their medical adviser is a crochetty, and dangerous person, who must be superseded at the first convenient opportunity. Facts and arguments have no more influence on such mothers than they have upon opium-eaters, drunkards, or inveterate consumers of tobacco; while the extreme propriety of conduct which these ladies manifest, and the encouragement they receive from other medical men, make the convictions based upon their own personal sensations incontrovertible, and their position practically unassailable. I think I might fairly say that among the comfortable middle classes of society the views at present held on this question are so deplorable that a large proportion of children are never sober from the first moment of their existence until they have been weaned; while often after a few years the use of alcohol is again introduced to the children as a 'medical comfort,' as a part of their regular diet, or as an invariable accompaniment of all their juvenile visitation, and company-keeping. Under such circumstances, it is not surprising that temperance reformers appeal in vain on this question, and that their facts and arguments are viewed with plausible indifference, or insidious opposition, by persons whose appetites and instincts have been undergoing debasement, and perversion from the very dawn of their lives. My own deliberate conviction is that nothing but harm comes to nursing mothers, and to the infants who are dependent upon them, by the ordinary use of alcoholic beverages of any kind. "Infants nursed by mothers who drink much beer also become fatter than usual, and to an untrained eye sometimes appear as 'magnificent children.' But the fatness of such children is not a recommendation to the more knowing observer; they are extremely prone to die of inflammation of the chest (bronchitis) after a few days' illness from an ordinary cold. They die, very much more frequently than other children, of convulsions and diarrhoea, while cutting their teeth, and they are very liable to die of scrofulous inflammation of the membranes of the brain, commonly called 'water on the brain,' while their childhood often presents a painful contrast--in the way of crooked legs, and stunted or ill-shapen figure--to the 'magnificent,' and promising appearance of their infancy. "Those ladies who adopt the general views I have thus expressed in relation to the nursing of their children, will want to know what is the 'proper artificial food' with which to supplement their milk when it is deficient in quantity. With some patients the milk will fall off in quantity at the end of two or three months. With others, although the quantity may not fall off, the child seems unsatisfied; and there is a third class with whom a profusion of milk is supplied, and the child thrives exceedingly, but the mother gets flabby, weak, nervous, pale and exhausted. In the last case, the mother is simply goaded on by susceptibility of her nervous system, or by inordinate activity of the breasts to yield an amount of milk which her digestive powers are not equal to providing for. The treatment of such cases should be simply repressive. The mother should separate herself somewhat more from the child, and make a rule of only nursing it from five to eight times in the twenty-four hours, while the neck of the mother should be kept cool in regard to dress, and cold sponging may be practiced carefully night and morning. Her attention should be diverted by outdoor exercise on foot, and additionally in a carriage if necessary. When the mother's milk, though apparently not deficient in quantity, proves unsatisfying to the child, great attention should be paid to varying the diet of the mother, while such staple foods should be taken as are most easily and thoroughly assimilated into milk. The unsatisfying quality of the milk will generally be remedied by taking a more varied diet, together with three or four half pints of milk in the course of the day, accompanied with farinaceous matter, as in the shape of well-made milk gruel; and in case these measures fail, the only alternative is to supplement the mother's milk by obtaining a wet-nurse to suckle the child three or four times a day alternately with the mother, or by feeding the child with proper artificial food. The same measures may be resorted to where the milk, though satisfying in character, is deficient in quantity; and in preparing artificial food for the child it must always be remembered that the food requires to be adapted to the stage of development which is manifested by a young infant's digestive organs. The infant's digestive apparatus is, in fact, designed to digest milk, and to digest nothing else, but when the teeth are cut farinaceous matter of a more or less solid character should be gradually mixed with the milk. Almost all the illnesses of infants under twelve months of age are caused by some gross impropriety of diet, or otherwise, on the part of the mother, for which the child suffers through the medium of the milk, or they are caused by feeding the child with improper artificial food. Thick sop, and many other articles often given as food are as indigestible to an infant of three months old as beefsteaks would be to a horse; and, until the child has cut its teeth, it should have nothing but food resembling the mother's milk as closely as possible. "The proper way to feed an infant of three months old, whose mother is only able to partially support it, is as follows: When the child wakes in the morning it should not go to the mother, but should be taken away by the nurse, and immediately fed from the bottle, sucking its milk through a suitable teat. After the mother has breakfasted the child may go to the breast, and during the day it should be alternately fed from the bottle, and nursed by the mother. At six o'clock the baby should invariably be placed in its crib, by the side of the mother's bed, and fed just before going to sleep, and the habit of going to bed at six o'clock should be strictly and invariably enforced. If once the child be allowed to come down to the family circle after dark, the habit of going to sleep will be broken, and the child will continuously cry to come down. In the course of the evening the mother may nurse the child once, and at ten or eleven o'clock, when the mother goes to bed, the child should be again fed from the bottle, and the mother should have a basin of well-made milk-gruel; and by her bedside should be placed, at the last moment, as much gruel as she is likely to drink with relish during the night. Whenever the child is restless it should be taken out of its crib, gently, by the mother, and nursed, say two or three times during the night, and put back again into its crib, the child never being allowed to sleep with the mother. When the night is fairly over, and the child awakens, it should be fetched by the nurse, and have its first morning meal from the bottle. This plan of feeding should be persisted in continuously until the child has cut its teeth; and it is only when every means have been taken to ensure the sweetness, freshness and niceness, not only of the milk and water, but of the bottle and of the teat, and the child still fails to get on, that, in rare cases, I advise the admixture of a little farinaceous matter, in the way of food containing one part milk, and two parts of properly sweetened barley-water. As the milk teeth come through, other farinaceous matter may be gradually blended with the milk, and there is nothing better than to begin at about eight months with a teaspoonful of baked flour, well boiled in a pint of milk and water, or in the water, to be afterwards cooled with milk. Oftentimes a little salt, as well as sugar, will materially help its digestion. The child will do well on that food--the quantity being duly increased--until it has cut almost all its milk teeth, when it may eat bread and butter, rice, and egg puddings, and occasionally eat a boiled egg once a day. I believe that it is a great mistake to give red flesh meat to children in their early years, unless there be some very special reason for it, and then it should only be temporarily used; but nice potatoes, flavored with fresh gravy from a joint, may be given at dinner, as the child becomes able to feed itself. * * * * * "Bear in mind that when you take wine, beer or brandy, you are distilling that wine, beer or brandy into your child's body. Probably nothing could be worse than to have the very fabric of the child's tissues laid down from alcoholized blood." Another English physician deplores "the pernicious habit of drinking large quantities of ale or stout by nursing mothers, under the idea that they thereby increase and improve the secretion of milk, whereas they are in reality deteriorating the quality of that upon which the infant must depend for health and life." Dr. Edis says:-- "Infant mortality is mainly due to two causes, the substitution of farinaceous food for milk, and the delusion that ale or beer is necessary as an article of diet for nursing mothers. * * * * * Countless disorders among infants are due simply and solely to the popular fallacy, that the nursing mother cannot properly fulfil her duties, unless she resorts to the aid of alcoholics." Dr. N. S. Davis says:-- "The opinion prevails quite extensively among certain classes of people, and with some physicians, that a liberal use of beer is beneficial to women while nursing their children. They drink it under the impression that it will both strengthen them and make their milk more abundant. But I have never seen a case in which it had been used regularly for any considerable period of time, where it did not result in more or less indigestion from gastric irritation and disordered secretions, and an early failure in the secretion of milk. It probably never increases the flow of milk any more than would the drinking of the same quantity of pure water; while the alcohol it contains, by daily repetition, induces congestion of the gastric mucous membrane, with disordered gastric and hepatic secretions. "A case strikingly illustrating these results was examined by me to-day. The patient was a young married woman who was nursing her first child, now nine months old. At the time of her confinement she was in fair health, rather nervous temperament, weight 120 pounds. During the first few days her milk did not flow very freely, and she says her physician advised her to drink beer. Consequently she commenced to drink a glass of beer at each mealtime, and a bottle during the night. During the first six months she had sufficient milk for her baby; but before the end of that time she had begun to suffer from flatulency, constipation, gaseous and acid eructations, what she calls 'heart-burn,' and sometimes vomiting. During the last three months she has suffered, in addition to the preceding symptoms, one or two attacks each week of extreme pain, from the lower point of the sternum to the back between the scapula, accompanied by retching, or severe efforts to vomit. To relieve these attacks she has taken liberal doses of gin, in addition to her regular supply of beer. Now at the end of nine months, her milk has nearly ceased to flow, her bowels are costive, her stomach tolerates only small quantities of the simplest nourishment, her flesh and strength are very much reduced, her weight being only 96 pounds; and yet she thinks both the beer and gin make her feel better every time she takes them. Such is the delusive power of the anæsthetic effect of alcohol. A persistence in the same management would probably terminate fatally in from six to twelve months more, from chronic gastritis, and inanition. But if she will rigidly abstain from all alcoholic remedies, and take only the most bland, unirritating nourishment, aided by mildly soothing and antiseptic remedies, and fresh air, she will slowly recover." In a clinical lecture delivered before the Senior Class in the Northwestern University Medical School, Dr. Davis told of a case similar to the preceding:-- "The flow of milk in her breasts has also diminished to such a degree that she does not have half enough for her baby. Yet she says the _beer_ makes her feel better after each drink, and that the _gin_ helps to relieve the severe attacks of pain, and consequently she thinks she could not do without them. It is undoubtedly true that the patient feels temporary relief from the anæsthetic effect of the alcohol in her beer and gin, just as she would from any anæsthetic or narcotic. And it is equally true that so long as the alcohol is present in her blood it so modifies the hemoglobin and albuminous constituents, as to diminish the reception and internal distribution of oxygen, and thereby retards metabolic changes. But the combined influence of the alcohol in retarding the internal distribution of oxygen and the drain upon the nutritive elements of her blood, in furnishing milk for her baby, led to rapid impoverishment of the blood and tissues, and the early establishment of a sufficient grade of gastritis to cause indigestion, frequent vomiting, and, later, paroxysms of severe gastralgia, with general emaciation, and loss of strength. "In accordance with the present popular ideas, both in and out of the profession, this patient tells me she has tried a great variety of foods, peptonized, sterilized, and predigested, but all to no purpose. And why?--Simply because her troubles are not in the kind of food she takes, but in the morbid condition of her blood, and of the mucous membrane and nerves of her stomach. Consequently the rational indications for treatment are: (_a_) to get her stomach and blood free from the alcohol of beer and gin; (_b_) to encourage the reception and internal distribution of oxygen by plenty of fresh air; (_c_) to give her the most bland, or unirritating food in small, and frequently repeated doses, of which good milk with lime-water, and milk and wheat-flour gruel are the best; (_d_) such medicines as possess sufficient antiseptic, and anodyne properties to allay the irritability of the gastric mucous membrane, and lessen fermentation." CHAPTER X. COMPARATIVE DEATH-RATES WITH AND WITHOUT THE USE OF ALCOHOL AS A REMEDY. A study of statistics relating to the difference in results of the treatment of disease with and without the use of alcohol, cannot but be of great interest to all students of the alcohol question. The appended statistics are culled mainly from the _Medical Pioneer_ of England, now, _Medical Temperance Review_, the journal of the British Medical Temperance Association, and from the _Bulletin of the American Medical Temperance Association_. A paragraph in the _British Medical Journal_, for Dec. 2, 1893, says:-- "An interesting fact has been noted by Dr. Claye Shaw, at the London County Asylum, Banstead, for the Insane. Since the withdrawal of _beer_ from the dietary, the rate of recovery has gone up. During the past year, for example, the recoveries reached 46.97 per cent. Nearly one half of the patients had thus recovered during the period stated. The inmates take their food better without the liquor, and they are thus taught that intoxicants are not a necessity of ordinary health." In the _Medical Pioneer_ for January, 1894, Dr. John Mois, medical superintendent of West Haven Infectious Diseases Hospital, states that prior to 1885 he had treated 2,148 cases of smallpox "in the usual routine method, with the use of alcohol when the heart's action seemed to indicate it;" resulting in a mortality of 17 per cent. But since 1885 he has treated 700 additional cases under similar circumstances except that the use of alcoholic preparations was entirely omitted, and the resulting mortality was only 11 per cent. In the same journal, Dr. J. J. Ridge states that he had treated the 200 cases of scarlet fever admitted into the Enfield Isolation Hospital during the years 1892 and 1893, without alcohol in any form, with a mortality of only 2.5 per cent.; while the mortality in the hospitals under the Metropolitan Asylums Board in 1893, in which alcohol was used in accordance with the usual practice in scarlet fever, was 6.3 per cent. Dr. J. J. Ridge says later:-- "In January, 1894, I published the result of the treatment of the first 200 cases of scarlatina admitted into the temporary wards of the Enfield Isolation Hospital during 1892 and 1893. I stated that there had been five fatal cases, but that one was dying when admitted and only lived a few hours. The mortality was 2 per cent., or 2.5 if the later case is included. "Since then 300 more cases have been admitted and discharged and among these there have been 7 fatal. Hence there have been 14 deaths in 500 consecutive cases extending over a period of a little more than four years. One of these ought to be excluded, no time having been given for treatment. Hence the mortality has been just 2.6 per cent. This, I think it will be admitted, is a low mortality, although it is possible it may be even lower when the cases are treated in a permanent hospital about to be erected. "It may be interesting to state that 4 of the cases died on the third day after admission; 1 on the fourth; 1 on the sixth; 1 on the tenth, with pneumonia; 1 on the thirteenth; 1 on the fifteenth; 1 on the sixteenth; 1 on the eighteenth; 1 on the thirty-sixth, with nephritis and pleuropneumonia; and 1 on the forty-sixth, with otitis and meningitis. "All the cases have been treated without alcohol either as food or drug, although many have been of great severity with various complications. It is certain that the absence of alcohol has not been detrimental, since the mortality is less than three-fourths of that of the mortality among all notified cases in England and Wales. I am bound to say that it is my firm conviction that had alcohol been given in the usual fashion, the death-rate would have been higher. Cases have been admitted to which alcohol has been given previous to admission, apparently with harm, as they have improved without it. One case was particularly noticeable in this respect. A child, aged 6, had had a good deal of whisky, and was supposed to be dying when admitted on the fourth day of the disease, so that the doctor who had seen it was surprised, when he called the following day to inquire, to find it was still alive. Without a drop of alcohol it began to improve and made a good recovery. I may say that delirium is very rare, even in the worst cases treated non-alcoholically." Dr. Norman Kerr says:-- "In my paper on 'The Medical Administration of Alcohol,' read to the section of medicine at the Sheffield meeting in 1876, I cited several medical testimonies in favor of non-alcoholic treatment of fevers, notably that of my friend, the late Dr. Simon Nicolls, who had a mortality of less than 5 per cent. in 230 cases. "The record of the results of a greatly lessened administration of alcohol in the treatment of smallpox in the London hospital ships, is of deep interest. Having been requested to inquire into the effects of this diminished alcoholic stimulation on mortality and convalescence, Dr. Birdwood stated that though the gravity of the cases had increased, with a mortality of 15 per 100 in the metropolis, the ship's death-rate had remained at less than 7 per 100. Convalescence had been more rapid, and there had been fewer and less serious complications from abscesses and inflammatory boils. Other causes had contributed to this improvement, but the medical officers attributed a considerable share in the amelioration to a greatly diminished prescription of alcohol." The _Medical Pioneer_ says:-- "In 1872 there appeared in the _Saturday Review_ an article in which the medical practitioners of this country were accused of inciting their patients to free drinking, and in the discussion which this article called forth, Dr. Gairdner, of Glasgow, said that fever patients in that city, when treated with milk and without alcohol, did much better than those reported as having been treated by Dr. Todd with large doses of alcohol; the latter resulting in a mortality of about 25 per cent., while those treated by Dr. Gairdner with milk had had a death-rate of only 12 per cent. About this time the British Medical Temperance Association was founded, owing to the exertions of Dr. Ridge, of Enfield, and in 1876 it was enrolled, under the presidency of Sir B. W. Richardson. It now contains 269 members in England and Wales, 53 in Scotland and 80 in Ireland, or more than 400 altogether, all professional men and women. This, I think, is but a sign of the change of opinion on the use of alcoholic fluids in medical practice, for all who remember what medical practice was in London thirty years ago know that the use of wine and brandy in hospital practice was so common that it was quite a rarity in some hospitals to find a patient who was not ordered, by some of the staff, from three to four ounces of brandy or six to eight fluid ounces of wine. The expense caused to the hospitals by this practice was, of course, great, and increased notably between 1852 and 1872, owing to the prevalence of the views of Liebig and his follower, Dr. Todd. The writings of Parkes, Gairdner, Dr. Norman Kerr and of Sir B. Ward Richardson, Dr. Morton and others, gradually lessened this predilection for treating diseases by alcohol, and accordingly between 1872 and 1882 a great change came over the practice of London hospitals. Thus the sum paid for milk in 1852 in Saint Bartholomew's Hospital was £684, and in 1882 it was £2,012; whilst alcohol in that hospital cost in 1852, £406; in 1862, £1,446; in 1872, £1,446; and in 1882 only £653. Westminster Hospital in 1882 spent £137 on alcohol and £500 on milk. One hospital, St. George's, long continued to use large quantities of alcohol. That hospital in 1872 had the high mortality among its typhoid fever patients of 24 per cent., which was twice as high as that noted by Dr. Gairdner as occurring in Glasgow, when alcohol was abandoned and milk used instead. Dr. Meyer, who reported these cases of typhoid treated in Saint George's Hospital at that time, mentioned that alcohol in large doses was given to 87 per cent. of the patients. Three-fifths of these patients took daily eight ounces of brandy when there was danger of sinking from failure of the heart's action. One-fourth of the number took sixteen fluid ounces of brandy in the 24 hours." "In 230 typhoid cases in St. Mary's Hospital, Dr. Chambers reduced the ratio of deaths from 1 in 5 with alcohol to 1 in 40 without it. Dr. Perry, of Glasgow, found that of 534 cases treated with alcohol, 138 died, while of 491 treated without alcohol, only 9 died." In a recent text-book on medicine occurs the following:-- "English physicians use spirits in fevers, and all experience sustains the conviction that no substitute has been found for them." In a late number of the _Temperance Record_, Dr. Smith gives a different view of the experience of English physicians:-- "When Bentley Todd was at King's College, and leading his profession, brandy was the rule in febrile cases. Then the mortality varied from twenty-five to thirty-five per cent. That the treatment was as fatal as the disease, experience demonstrates:-- "1. Professor W. T. Gairdner, of Glasgow, writing to the Lancet (1864), gave his experience as follows:-- Fever cases Average of treated. wine and spirits. Mortality. 1,829 34 oz. to each 17.69 per cent. 595 2-1/2 oz. to each 11.93 per cent. 212 none 1 death only. (young lives) "These were mostly typhus cases, but the rationale, so far as alcohol is concerned, is the same as in typhoid. "2. At the British Medical Association in 1879, Professor H. MacNaughton Jones gave particulars of 340 cases of typhus, typhoid and simple fever. I append a summary:-- Cases. Deaths. Mortality per cent. Given brandy 58 19 32.7 Given claret 51 2 3.8 Given no alcohol 231 4 1.7 "3. Dr. J. C. Pearson writes to the _Lancet_ (Dec. 5 and 26, 1891), giving his experience of typhoid. He had treated several hundreds of cases without a single death, and never prescribed stimulants in any shape or form in the disease. "4. Dr. Knox Bond writes to the _Lancet_ (Nov. 25, 1893), giving his experience of typhoid at the Liverpool Fever Hospital. He says: 'As a resident for some years in the fever hospitals, my views of the value of alcohol in fever underwent, solely as a result of the experience there gained, entire modification. The conviction became forced upon my mind that in no case in which it was used did benefit to the patient ensue; that in a proportion of cases its use was distinctly hurtful; and that in a small but appreciable number of cases the resultant harm was sufficient to tilt the balance as against the recovery of the patient.' "In plain terms, alcohol tended to the destruction of the patients. Dr. Bond's figures are:-- No. of cases. No. of deaths. Given alcohol 71 18 Given no alcohol 309 15 --- --- 380 33 In May, 1890, Dr. Nathan S. Davis, read a paper before the American Medical Association upon the use of certain drugs in disease. Among the drugs mentioned was alcohol, and comparative death-rates were given in typhoid fever and pneumonia, between Mercy Hospital, Chicago, during a term of years when no alcohol was used in the medical wards, Dr. Davis being in charge of them, and some of the large metropolitan hospitals using alcohol. In Mercy Hospital without alcohol, the death-rate in typhoid fever was only five per cent.; in pneumonia only twelve per cent. "Of 161 cases of typhoid fever treated in Cook County Hospital during 1889, 27 died, or one in six--nearly 17 per cent. "According to the annual report of the Cincinnati Hospital for 1886, 47 cases of typhoid fever were treated during that year, with seven deaths, a mortality rate of 16 per cent. "The Garfield Memorial Hospital, at Washington, reported for the year 1889, 22 cases of typhoid fever, with 5 deaths--or 22 per cent. "In the Pennsylvania Hospital the mortality rate in pneumonia for the years 1884-1886, was 34 per cent. "The mortality of pneumonia in the Massachusetts General Hospital, between the years 1822 and 1889, comprising 1,000 cases, was 25 per cent.; but a gradual increase in mortality had been noted from 10 per cent. in the first decade of the seventy years represented by this report, to 28 per cent. in the last decade. "According to the report of the Supervising Surgeon General of the U.S. Marine Hospital Service for 1888, the number of cases of pneumonia treated between 1880 and 1887 was 1,649, with 311 deaths--nearly 19 per cent. "The Cincinnati Hospital reported for 1886 a mortality rate in pneumonia of 38 per cent. "The mortality rate in the Cook County Hospital, Chicago, for 1889, according to Dr. Heltoin, relating to 80 cases of pneumonia, was 36 per cent." Only a five per cent. death-rate in typhoid fever without alcohol, and from sixteen to twenty-two per cent. with alcohol; only a twelve per cent. death-rate in pneumonia without alcohol, and from 19 to as high as 38 per cent. with alcohol. Such are the comparative death-rates given by Dr. Davis. They should be committed to memory by every opposer of the use of alcohol, as they show clearly that people have many more chances for recovery, other things being equal, in the diseases mentioned, if alcohol is not used than if it is. It is worthy of mention in this connection that Cook County Hospital contains in its report for 1897 the following items: Number of patients 19,536; cost of liquors $80.00; per cent. of deaths from all causes, 5.7. The cost of liquors is only .004 for each patient. This shows a decided advance in the disuse of alcohol, when so very little is used in a great hospital, with so large a number of patients. Dr. A. L. Loomis, in the treatment of 600 typhus fever cases on Blackwell's Island in 1864, excluded alcoholics, with the result of reducing the mortality rate to only six per cent. whereas it had previously been twenty-two per cent., in Bellevue Hospital from which the patients had been removed. In Battle Creek Sanitarium no alcohol is used in any disease, simply because the management believe better results are obtained by the use of other agencies. In the October, (1893) number of the _American Medical Temperance Quarterly_ now _Bulletin of the A. M. T. A._, Dr. J. H. Kellogg gives statistics of deaths from various diseases in the Battle Creek Sanitarium. The total of these statistics is as follows: la grippe, 827 cases, 4 deaths--or two per cent.; scarlet fever, 83 cases, 2 deaths--less than three per cent.; 333 cases of typhoid fever, 9 deaths--or 2.7 per cent.; 82 cases of pneumonia, 4 deaths--or 4.9 per cent. These exceptional results are not attributed solely to the non-use of alcohol. The nursing and surroundings were of the best. But these results certainly show that the use of alcohol as a remedy in acute diseases is not necessary, and that patients have a much better chance for life, other things being equal, where alcohol is not used than where it is. Dr. Kellogg says of the surgical cases:-- "In a hospital of 100 beds, connected with the institution, more than 3,000 surgical cases have been treated, to whom alcohol has never been administered except in connection with chloroform anæsthesia; my uniform custom being to administer an ounce of brandy or whisky five minutes before beginning the administration of the anæsthetic, when chloroform is used. "The surgical cases include more than 300 cases of ovariotomy, and over 300 other cases involving the peritoneal cavity, such as operations for strangulated hernia, the radical cure of hernia, etc. The statistics of death and recoveries are certainly as good as can be produced by any hospital in the world, dealing with the same class of cases. The total mortality from the operation of ovariotomy, including nearly 300 cases, is less than three per cent., and for the last few years, in which the antiseptic measures have been perfected, the record is still better, showing a succession of 172 cases of laparotomy for the removal of ovarian tumors, or diseased uterus and ovaries, without a death. These cases include a number of hysterectomies, and many cases so desperate that those who trust in alcohol as a heart stimulant, and as a means of supporting the vital energies, would certainly have considered it necessary to resort to the use of this drug. Nevertheless, it was not administered in a single case, and I have seen no reason to regret its non-use in a single instance." Dr. T. D. Crothers, of Hartford, Conn., tells the following:-- "In a large hospital a study of the mortality of pneumonia indicated a greater fatality at intervals of six months. There were five per cent. more deaths during periods of two months at a time, twice during the year. This extended back for two years, and was finally narrowed down to the service of an eminent physician who gave spirits freely in all cases of pneumonia from their entrance to the hospital. The other visiting physicians gave very little spirits, and only in the later stages. The physician was skeptical of these statistics, but finally consented to test them by giving up spirits practically in all cases of pneumonia. This was continued for a year, and the mortality went back to the average statistics. That physician has abandoned alcohol as a food and a medicine, only in very limited degree. He writes, 'My stupidity in accepting theories and statements of others, concerning spirits, which I could have tested personally, is a source of deep sorrow, and I do not know but it could be called criminal. I certainly feel that punishment would be just.'" Brandy has been considered the great necessity in cholera, yet the use of it and other alcoholics are known to expose people to greater danger when this disease prevails. The _Bulletin of the A. M. T. A._ is authority for the following:-- "During the epidemic of 1832, Dr. Bronson said: 'In Montreal 1,000 persons have died of cholera, only two of whom were teetotalers.' A Montreal paper said: 'Not a drunkard who has been attacked has recovered from the disease, and almost all the victims have been at least moderate drinkers.' "In Albany, N. Y., the same year, cholera carried off 366 persons above sixteen years of age, all but four of whom belonged to the drinking classes. Packer, Prentice & Co., large furriers in Albany, employed 400 persons, none of whom used ardent spirits, and there were only two cases of cholera among them. Mr. Delevan, a contractor, said: 'I was engaged at the time in erecting a large block of buildings. The laborers were much alarmed, and were on the point of abandoning the work. They were advised to stay and give up strong drink. They all remained, and all quit the use of strong drink except one, and he fell a victim to the disease.' He says also: 'I had a gang of diggers in a clay bank, to whom the same proposition was made; they all agreed to it, and not one died. On the opposite side of the same clay bank were other diggers who continued their regular rations of whisky, and one third of them died.' "In New York City there were 204 cases in the park, only six of whom were temperate, and these recovered, while 122 of the others died. In many parts of the city the saloon keepers saw and acknowledged the terrible connection between their business and the spread of the disease, and, becoming alarmed for their own safety, shut up their saloons and fled, saying: 'The way from the saloon to hell is too short.' "In Washington the Board of Health was so impressed with the terrible facts that they declared the grog shops nuisances, ordered them closed, and they remained closed for three months. "A prominent physician of Glasgow reported: 'Only nineteen per cent. of the temperate perished, while ninety-one and two-tenths per cent. of the intemperate died.' One extensive liquor dealer of Glasgow, said, 'Cholera has carried off half of my customers.' "In Warsaw ninety per cent. of those who died from cholera were wine drinkers. "At Tifels, Prussia, a town of 20,000 inhabitants, every drunkard died of cholera." The _St. Paul Medical Journal_, of September, 1899, gives the following report of a railway surgeon, Dr. Kane:-- "From June 1, 1898, to June 1, 1899, the author performed a few more than four hundred operations. Forty-nine abdominal sections, fifty odd more operations of a graver sort, one hundred miscellaneous of less gravity than above, over one hundred operations upon female perineum and uterus. Of the four hundred, more than three hundred demanded anæsthesia. There were but three deaths, making the mortality a little less than one per cent. "The author does not claim a phenomenally low mortality, nor does he claim specially brilliant results. He has to contend with unreasoning fear on the part of the patients for hospital surgeons, and also most of his cases had been in the hands of quacks, and had subjected themselves to remedies prescribed by old women. Many cases came after the family physician had exhausted his resources. He thinks his results are considerably better than the average in hospitals and in country districts. Alcohol medication was dispensed with entirely after the patients came under his care, and to this he attributes much of his success. He does not believe that alcohol is a stimulant, or a tonic. On the contrary, he believes that it retards digestion, arrests secretion, and hinders excretion. The courage and fortitude of his patients were lessened instead of increased by the use of alcoholic medication. "Pain is better borne, endured longer and more patiently when alcohol is not used. "He urges the practical surgeon to carefully weigh the subject of alcohol, and verify for himself the expediency of its use." Dr. B. W. Richardson in the report of his practice for 1895 in the London Temperance Hospital refers to non-alcoholic treatment of rheumatism. He said:-- "Out of seventy-one cases of acute or subacute rheumatism--the large majority acute, and attended with temperatures moving up to 104° F.--sixty-nine recovered, and two, although they were discharged without being put on the recovery list, were so far relieved that a few days' change in country air seemed all that was required to induce full restoration. Comparing the experience of the treatment of acute rheumatic disease without alcohol with that which I have previously observed with alcohol, I can have no hesitation in declaring that it is of the greatest advantage to follow total abstinence absolutely in this disease. The pain and swelling of joints is more quickly relieved under abstinence, the fever falls more rapidly, there is less frequent relapse, and there is quicker recovery. In brief, the experience of treatment of rheumatic fever minus alcohol, presents to me as much novelty as it does pleasure, and I am convinced that if any candid member of the profession could have witnessed what I have witnessed in this matter, he would agree with me that alcohol in rheumatic fever, however acute, is altogether out of place. I am also under the conviction, though I express it with great reserve, that in acute rheumatism, treated without alcohol, the cardiac complications, endocardial and pericardial, are much less frequently developed than where alcohol is supplied." Dr. Pechuman in _Alcohol--Is It a Medicine_, published in 1891, says:-- "There is no disputing that many deaths occur each day as the result of the administration of alcohol in acute diseases, to say nothing of the deaths caused by its habitual use; and those who give it ignore the very fundamental principles of physiology and the many published statistics. The Boston Hospital report tells a sad story in this connection; it shows that out of 1,042 cases treated with alcoholics 386 died, while out of the same number treated without alcohol only 81 died. Using plain English 305 were actually killed by it." Dr. T. D. Crothers, in the January, 1899, _Bulletin of the American Medical Temperance Association_, gave the following Hospital Statistics, showing a decline in the use of spirits in hospitals:-- "Evidently a great change is going on in the use of alcohol as a remedy in large hospitals. The annual reports of ten hospitals in the New England and the Middle States show the following widely varying figures. The spirits used include beers, wines, whiskies and brandies, and vary from eleven to sixty-one cents a person for all the cases treated. These hospitals treat from eighty to seven hundred cases a year, both surgical and medical, and the medical staff are the leading physicians of the towns and cities where they are located. The hospital where the largest amount of spirits was used is not different from others, nor is the one where the lowest amount is reported. The conclusion is that this difference is due entirely to the judgment of the medical men. The lowest rate (eleven cents each) was in a hospital where one hundred and twenty-one cases had been under treatment. The highest rate (sixty-one cents) was in a hospital of five hundred and forty cases. The mortality from typhoid fever and pneumonia was eight per cent. higher in this hospital than in the one where only eleven cents a head had been expended for spirits. The general mortality did not vary greatly in any of these hospitals, and the records of one year could not be expected to show this. In the remaining hospitals the mortality of the fever and the septic cases was about the same. The free use of spirits did not show any improvement, but rather an increase of the death-rate, while the same amount of spirits used showed but little change, and that in the line of improvement of death-rate. These are only the figures of one year, but they indicate a change of practice, and show the passing of alcohol as a remedy." CHAPTER XI. 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 anæsthetic; 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 anæsthetic 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 anæsthetic 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 anæsthetic 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 anæsthesia 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 anæsthetics. 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 septicæmia. 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. 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 th