From The Medical Record.
WE had tolerated thirteen years of so-called prohibition during which the medical profession was hemmed in by countless restrictions in supplying much needed alcoholic medication to sick people while Congress, composed of untrained laymen, acted as a super-physician, and dictated to the medical profession how and when and in what dosage alcohol may be prescribed. Hypocritically they declared anything above one-half of 1 per cent. intoxicating while the majority were said to “vote dry and drink wet”.
One pint in ten days was all the liquor that the sickest of patients was supposed to need; while, on the other hand, the illicit liquor industry made millionaires out of gangsters, and the liquor they turned out caused untold deaths, blindness, and permanent damage to the gastro-intestinal tract, and probably to the liver and arterial system as well. Even the united States Pharmacopoeia, carried upon a wave of fanaticism, ignored the views of such eminent diagnosticians as Abraham Jacobi, Bastedo, Hare and others, and such eminent biochemists and physiologists as Chittenden, Mendel, Atwater, Benedict, and Yandell Henderson, all of whom attest its value either as a medication or an auxiliary restrictions set by Congress and felt that the health and even the lives of their patients were frequently jeopardized by such rulings, but nothing could be done.
Even the American Medical Association failed to protest. On the other hand, The Medical Record, in 1929, conducted a symposium upon the alcohol question, and several year prior to this, published several articles proving its efficacy and the opinion of hundreds of practising physicians attesting its usefulness.
The history of the use of alcohol is summarized by Hemmeter who states: “The ancients had no intimate knowledge of alcohol as such, although they consumed wine and beer. Distillation was first introduced by the alexandrines. In 950 Rhazes, mentioned a method of preparing alcohol. The Israelites preserved their wines in skin and jugs. The French, English, Italian, Latin and Greek words for wine are derived from the Hebrew yain. Wine was used with meals and for devotional purposes. There was no abuse, and hence Moses saw no necessity to formulate regulations in regard to its consumption”.
Dinner quotes Abraham Jacobi as stating: “I do not care to classify alcohol anywhere. I do not contest observations and experiments on either healthy or diseased men an don animals. One of the most profitable laboratories, however, is the hospital and the private bedside,” and there he found alcohol a valuable remedy.
Some of the uses of alcohol in medicine are as follows:.
As an appetizer its action is so obvious that all physicians and most laymen know it by their practical experience.
Mallory states: “TO describe the steps by which a sparkling glass or foaming mug stimulates the appetite would be pedantic. The increased flow of saliva and the swallowing movements induced by visual memory alone speak convincingly. The stimulation of the olfactory nerves by the aroma acts in a similar manner, all its qualms and accessory phenomena of lassitude, weakness, nervous irritability, and vasomotor instability without appetite even when hunger and need of food are present.
Under such conditions, a moderate dose of alcohol.. acts.. in such a manner that inhibition is realized, the emotions released, and there is a pleasant physical and mental relaxation with a feeling of ease and comfort during which inhibited appetite returns.”.
wilcox states: “In general, it may be stated that alcohol in moderate amounts and well diluted tends to favour the process of digestion through an increased secretion of gastric fluid, increased gastric movement, and increased absorption. Small amounts of diluted alcohol taken at meals, it would seem, therefore, may be of service in promotion digestion.
Rusby states: “the nutritive properties of alcohol being very similar to those of sugar, and the use of the two being largely interchangeable, alcoholic drinks are especially useful in recovery from exhausting illness such as typhoid or pneumonia.
Cabot states: “We may treat as established the following statements: 1. In healthy persons alcohol is capable of replacing satisfactorily the fats and carbohydrates of ordinary food. 2. It is not yet settled whether or not alcohol can replace the proteid of our customary diet. 3. The food value of alcohol as a substitute for carbohydrate and fat is perfectly consistent with its toxic properties”.
Chittenden states: “If we confine our attention to the results obtained by the more accurate method of recent days, especially the painstaking results reported by Prof. Atwater and his co- workers in this country, Rosemann and Rosenfeld in Germany, and many others, there seems to be no doubt that alcohol when taken in moderate doses can be oxidized in the body and its energy made available for the needs of the system.”.
Sollman states: “Over 98 per cent. of the ingested alcohol disappears in the body being completely oxidized to carbon dioxide and water (Atwater and Benedict, 1902). By the chemical, energy thus liberated.. alcohol can perfectly replace carbohydrates and fats in the diet, and is typical non- nitrogenous food. It is even superior to most other foods in one particular; viz., in that it does not require digestion. It spares carbohydrates in man even when large amounts of sugar are supplied (Toegel and co-workers, 1913). Mendel and Hilditch, 1910, found alcohol spared protein.”.
ALCOHOL IN DISEASE.
Diabetes. Joslin states: “In no disease is the employment of alcohol more useful or more justifiable. It furnishes an agreeable form of food in a diet which is often disagreeable, and the quantity of nutriment which it contains is by no means negligible. Authorities agree that the patient can take large quantities of fat more readily in conjunction with alcohol.. 30 c.c. of alcohol are equivalent to (30×7)=210 calories. Few of my patients ever take as much alcohol as this, but half the quantity will replace about 5 per cent. of the total diet, and allow the omission of 12 gm. of fat”.
Chills and after exposure. Sollman states. “If taken after the exposure, the dilatation of the cutaneous vessels favours the absorption of external heat, and also prevents the tendency to congestion of internal organs and thereby the tendency to catch cold”.
Cardiovascular disease. Lintz states: “Contrary to the usual impression, alcohol doses not raise blood-pressure, but lowers it considerably, which effect lasts about three to four hours before it rises to its previous level. There is a momentary rise of blood-pressure and then a considerable fall. Half an ounce of whisky will produce a drop of 60 to 70 mm. in the systolic, and 10 to 20 mm. in the diastolic pressure, and the patients feel much better on account of the conspicuous effects of the alcohol”.
Brown states: “High blood-pressure is often due to irritability of the sympathetic nervous system, and in such cases the strain and drive of life may be reduced by the leisurely non-competitive consumption of moderate quantities of alcohol”.
Bishop states: “The great fundamental cause of premature arteriosclerosis in the overworked business man is undoubtedly often founded on the reflex action of worry upon metabolism, and it is more than likely that the moderate use of alcohol at the proper time of day and in proper quantity, removing as it does this nervous and mental tension and abolishing worry for the time being, may be indeed a preventive of arteriosclerosis.
I have never found it desirable or necessary to prohibit the moderate use of alcohol in people suffering to prohibit the moderate use of alcohol in people suffering from heart disease or arteriosclerosis. In this I find myself in agreement with English authorities, and only out of touch with those of the profession who for some reason or other have been led to believe that alcohol was the cause of organic disease. Alcohol was the cause of organic disease. Alcohol has often proved a convenience in angina pectoris or physical collapse because it was ordinarily available”.
Shock, syncope or collapse. The effects of alcohol in the form or whisky or brandy in restoring the circulatory failure are too well known to require comment. Sajous regards alcohol as having a specific action in stimulating the adrenals in shock.
Septic conditions. In malignant diphtheria, streptococcus, infections, typhoid fever, and other septic conditions, its action is frequently truly miraculous, and it has undoubtedly saved many lives.
Jacobi described a case of malignant diphtheria in a boy with far advanced membranes, and who was semicomatose, cyanotic, suffering from complete anuria, and barely alive. An undertaker had been called to measure him for a coffin. Jacobi saved his life by giving him a teaspoonful of whisky every fifteen minutes, and made the following statements: “No amount of whisky will lead to intoxication when its effect is wanted to combat sepsis. My cases of thorough sepsis relieved or cured by alcohol extend over more than half a century.
My cases have not all been cured. But I have seen what was considered hopeless take a favourable turn. There are diphtheria cases which are not influenced by antitoxin in small or big doses. I cannot tell the cause of the antiseptic action of alcoholic beverages in sufficient doses. I merely refer to occurrences and observations extending over half a century. Let somebody else explain. Meanwhile take the hint”.
As a hypnotic. alcohol has proved its value as a hypnotic. Sollman states: “alcohol, especially in the form of beer, taken at night, and in the absence of excitement, is a fairly efficient hypnotic, producing less derangement than most other hypnotics”.
Vomiting. Hare recommends brandy on cracked ice for vomiting. Bastedo while simultaneously acting as a food.
Old age. In the aged its excellent effects are too well known to require much comment. Solis-Cohen states: “In persons of more advanced years, however, as in those who do hard manual or mental labour, life is apparently not so well sustained in its total absence; and this is true beyond doubt of the majority of adults who suffer from cardiac debility, with diabetes, with blood dyscrasias, with cancer and other chronic affections of depressing and wasting type.
Space does not permit me to give further details as to the manifold uses of alcohol in medicine. suffice it to say that a remedy bearing the endorsement of such eminent authorities as those quoted, even if not approved by a small minority of physicians who disapprove of this useful drug because it is occasionally abused, must be judged in an unbiased manner, and its true usefulness conceded.
Gluttony in drinking is not more excusable than gluttony in eating. One drink of an alcoholic liquor is undoubtedly helpful while twelve drinks in succession are harmful-but no more harmful than twelve pork chops in succession. Both must be taken within reasonable limits to prove useful.