"The theory advanced by Dr. Lauder Brunton in relation to death from chloroform poisoning, is that the patient does not die directly from the influence of chloroform upon the nerve centres, but that death is due to the influence of chloroform upon the kidneys, whereby the elimination of the ptomaines and leucomaines naturally produced within the body, ceases, their destruction by the liver also ceasing, so that the system is suddenly overwhelmed by a great quantity of poison, and succumbs to its influence, its power of resistance being lessened by the inhalation of the chloroform.

"The affinity between alcohol and chloroform is very great. Both are anaesthetics. Both chloroform and alcohol are simply different compounds of the same radical, and the results of our experiment certainly suggest the same thought as that expressed by Dr. Brunton. How absurd, then, is the administration of alcohol in conditions in which the highest degree of kidney activity is required for the elimination of toxic agents!

"In a certain proportion of chronic cases there is a tendency to tissue degeneration. Modern investigations have given good ground for the belief that these degenerations are the result of the influence of ptomaines, leucomaines and other poisons produced within the body, upon the tissues. It is well known that many of these toxic agents, even in very small quantity give rise to degenerations of the kidney. It is this fact which explains the occurrence of nephritis in connection with diphtheria, scarlet fever and other infectious maladies. Dana has called attention to the probable role played by ptomaines produced in the alimentary canal in the development of organic disease of the central nervous system.

"It is thus apparent that the integrity of the renal functions is a matter of as great importance in chronic as in acute disease, hence any agent which diminishes the efficiency of these organs in ridding the system of poisons, either those normally and regularly produced, or those of an accidental or unusual character, must be pernicious and dangerous in use."

Among the more recent findings of science in regard to the effects of alcohol are the action of this drug upon the leucocytes or "guardian cells" of the body. Leucocytes are defined to be "minute, nucleated, colorless masses of protoplasm, capable of ameboid movements, found swimming freely in blood and lymph, in the reticulum of lymphatic glands, and in bone-marrow and other connective tissue." The white corpuscles of the blood are leucocytes. "The work of these cells is to prey upon and take into their substance bacteria and other micro-organisms within the blood and tissues. This destruction of bacteria, and other noxious organisms, has the biological name of phagocytosis."

Dr. Alonzo Brown in Physician and Surgeon says of phagocytosis:—

"Recently a brilliant theory has been projected into the histological world. It is the principle of phagocytosis. The beauty of it is so great that we are attracted by it, and its reasonings have riveted general attention. It is said that certain cells have the power to absorb and so destroy other cells. This is phagocytosis. It is said that 'the cells which are known to possess phagocytocic properties are the leucocytes, mucous corpuscles, connective tissue cells, endothelia of blood vessels and lymphatic vessels, alveolar eypithelium of the lungs, and the cells of the spleen, bone, marrow and lymphatic glands.' (Senn). This is a very significant array of colloid matter; and it has been repeatedly affirmed by the highest authorities that alcohol is poisonous to the colloid element.

"Now, among the most important of the phagocytes just enumerated are the leucocytes. They embrace and enfold the pathogenic germs with which they come in contact by what is known as an ameboid force. They enclose, disintegrate and absorb the enemy. It is well known that the moment the leucocytes are submitted to an alcoholic solution, their ameboid movements cease, and their function is arrested. It is plain that their phagocytocic power is immediately destroyed. It is possible, also, that the fixed tissue-cells are likewise impaired or killed by alcoholic imbibition. How deleterious, and even deadly, must the internal administration of alcoholic liquors then be in the treatment of diphtheria, and of other diseases having a germinal origin? It therefore follows, to my mind, that all the diseases which are the result of germinal infection, are most badly treated when alcohol is used in their therapy.

"With extreme brevity I advert to another view in the field. It is that of adynamic disease. It has been conclusively proven that alcohol decreases the muscular power. It decreases (from the minimum dose to the maximum) the power of the heart as well as that of all other muscles. I say this has been absolutely demonstrated by Richardson and others. In death from adynamia it is through failure of muscle, that is, of the heart, of the scaleni and intercostals, of the diaphragm, and of the laryngeal muscles, et cetera. All of the muscles may gradually fail, become wearied unto death. How pernicious then must alcohol be in adding its influence to bring about the tragic end!

"It is my belief that it is in diphtheria that the most dire results are to be observed. In that disease the vast majority of cases die by asthenia, or else by sudden failure of the heart. To what is this sudden cardiac paralysis due? The elucidation is as follows. In the grave cases there is almost invariably a subnormal temperature, together with great muscular prostration. Also it is a physiological fact that a decrease of the temperature slows nervous conduction. As the system is made colder, the nervous force flows slower and slower. In diphtheria the heart muscle is very weak, the temperature falls, the lessened nervous energy but feebly animates the muscular fibres, and so actual paralysis ensues, death closing the scene almost instantaneously. Now, in such a state of imminent danger, brought about by such causes, what could be worse than to administer an agent which notably reduces temperature, and at the same time enfeebles muscular power? May I add, what could be the remedy in such a condition? and I answer, External heat freely applied to the whole surface of the body. This will prevent the cardiac paralysis whenever it is preventable."

The Medical Pioneer of Dec., 1892, contained an editorial article upon "The Toxine Alcohol," which deals with leucocytes and their functions. The following is the article:—

"Dr. Broadbent's introductory address at the opening of the session at Owen's College, Manchester, deserves more attention than most of these formal deliveries. He dwelt on the intellectual interest which attaches to the study of medical science, and illustrated it, among other ways, by the interest excited by recent observations on the action of bacilli and the combat which goes on between these invading hosts and the guardian cells or leucocytes of the living body. Inflammation surrounding a wound is regarded as caused by the influx and multiplication of leucocytes to engulf and destroy septic bacilli which have gained entrance from the air, a 'local war' of defence. The issue of this pitched battle will depend on the relative number and activity of the respective hosts. Inflammation round a poisoned wound is an evidence of vital power and a means of protecting the system at large from invasion and devastation. If this first line of defence is broken through, the bacilli pass through the lymphatic spaces and ducts to the glands, and another battle ensues which produces glandular swelling and inflammation and possibly abscess. This second line of defence may be insufficient and then we get general septicaemia. It is now well proven that the injury is done, not by the bacilli themselves but by the toxines which they secrete or excrete. Dr. Broadbent very properly points out that the action of the bacilli of fever in the body is strictly comparable to the action of yeast in a fermentable liquid. The yeast cells grow and multiply at the expense of the sugar, in destroying which they produce alcohol, carbonic dioxide and other substances. When the alcohol amounts to some 17 per cent. of the liquid the process is stopped by the poisonous action of the alcohol on the yeast cells. In just the same way the toxines produced by the bacilli at length stop their further multiplication and put an end to the disease. Alcohol is in fact, the toxine produced by yeast, and, like many other toxines, it is not only poisonous to cells which produce it, but to any animal into whose veins it may happen to get.

"There can be little doubt that the state of immunity which one attack of certain fevers confers against future attacks depends partly upon what is called the phagocytic action of leucocytes. These have been actually observed to draw into their interior and destroy bacilli which would otherwise have multiplied and produced their special effects. There can be little doubt, either, that we are continually taking into our systems bacilli of all sorts, and that, again, disease is averted by the activity of the germ-devouring leucocytes. Dr. Broadbent describes an experiment which proves that power of resisting disease is largely dependent on the activity of these cells. A rabbit, having had a certain quantity of bacilli injected under its skin, suffers from inflammation at the spot, and perhaps abscess, but recovers. At the same time, another rabbit is treated in precisely the same way, but, simultaneously, a dose of chloral is injected into another part of the body. The chloral, circulating in the blood, is known to paralyze leucocytes, and, as a result of this, they do not collect and wage war on the bacilli injected under the skin; there is very little local reaction, the bacilli get free course into the lymph and blood, and the animal dies. But, in the words of Dr. Broadbent, 'alcohol in excess has a similar action on the leucocytes, and this, as well as the deteriorating influence of chronic alcoholism on the tissues, predisposes to septic infection. A single debauch, therefore, may open the door to fever or erysipelas.' A similar experiment of Doyen confirms this. He found that guinea pigs can be killed by the cholera microbe, when introduced by the mouth, if a dose of alcohol has been previously administered. It has been the general testimony of observers in cholera epidemics that those addicted to much alcohol are far more liable to fatal attacks. But while large doses of alcohol are, of course, more obviously injurious, it would be absurd to imagine that lesser quantities are entirely without influence in the same direction. It has, indeed, been shown by Dr. Ridge, that even infinitesimal quantities of alcohol, such as one part in 5,000, cause a more rapid multiplication of the bacillus subtilis and other bacilli of decomposition, while, by the same quantities, the growth of both animal and vegetable protoplasm is retarded. Hence there can be no longer any question that alcohol renders the body more liable to conquest by invading microbes, less able to resist and destroy them. Alcohol, a toxine injurious to living cells, is destroyed or removed from the body as fast as nature can effect it, but while it remains, and while able to affect the cells at all, its action is detrimental to healthy growth and healthy life, and the less we take of such an agent the better for us. This is a dictum which it becomes the profession to enunciate far and wide. 'The less, the better' is a watchword which all may use, and the wise will interpret it in a way which will infallibly preserve them altogether from all possible danger from such a source."

On the sixteenth of December, 1897, Dr. Sims Woodhead, president of the British Medical Temperance Association, gave a masterly address in London upon "Recent Researches on the Action of Alcohol." The lecture was illustrated by lantern slides. From the report given in The Medical Temperance Review of Jan., 1898, the following is culled:—

"In a series of drawings of kidney you will notice first that there is a condition known as cloudy swelling; this is one of the first changes that can be observed. Notice the characteristic features of this cloudy swelling in the cells of all these specimens. The large swollen cells are granular, and very frequently there is a granular mass in the lumen of the tubule. In some cases the cells are so much swollen that the lumen of the tubule is represented merely by a 'star-shaped' radiating chink. The nucleus is usually somewhat obscured, that this alcoholic cloudy swelling (similar to that met with as the result of the administration of certain poisons) is the first change observed in the parenchymatous cells of the organs of animals that have died of acute alcoholic poisoning. This condition, unless the cause is removed, goes on to a condition of fatty-degeneration, as shown in the next specimen in which we have, in addition to the granular appearance of the protoplasm of the cell, a deposition of masses of fat in and at the expense of this protoplasm.

"There is another series of changes to which I wish to draw your attention. In the tubules of the kidney we have, in addition to the granular appearance of the protoplasm of the cells, an increase in the number of leucocytes, and connective tissue cells between the tubules around the glomeruli and along the course of the blood-vessels. This condition of small cell infiltration, we know, is constantly associated with inflammatory conditions of the kidney as in other organs. Here then are the changes in the epithelium plus increase in the number of leucocytes.

"I show you too a specimen of heart muscle, in which the granular degeneration, or cloudy swelling is well marked whilst here and there the process is going on to fatty degeneration, similar to that seen in the kidney. Here again, then, the active elements of the organ are becoming broken down, or, at any rate, losing their normal structure and affording evidence of fundamental changes in these cells. Such changes are set up, not by any one poison alone, or by any single disease toxin, but by members of many groups of poisons, by alcohols, ethers, etc. indeed by very various poisons—animal, vegetable and mineral.

"Now, it is a peculiar fact, as shown by Massart, Bordet and others, in researches on chemiotaxis, that nearly all these poisons have the power of repelling leucocytes, and of seriously interfering with them in the performance of their functions, and this power assumes a special significance in connection with our subject this afternoon.

"Now, two of the great functions of leucocytes under ordinary conditions are those of policing and scavenging. Massart and Bordet showed, under the action of certain substances, alcohol amongst others, these functions are lost, but following up Metchnikoff and others they observed that after a time these same leucocytes became accustomed to the presence of these poisons, gradually becoming 'acclimatized' as it were. At first paralyzed or repelled, they after a time pluck up courage to attack the invading substances and carry on or renew their accustomed work of scavenging; they try to get rid of both poisons and poison-producers, and even acquire the power of forming substances (anti-toxins) which can neutralize the poison and allow the cells to devote their energy to doing their own proper work.

"Here are drawings of minute abscesses that have formed in the wall of the heart. We see at once the part that the leucocytes play in attacking micro-organisms, and of localizing their action. Look at the blood-vessel in the wall of the heart with its plug of micro-organism (staphylococci) in the centre of a clear space; here the leucocytes are not numerous, indeed they are very sparsely scattered, and appear to have been driven back by the organisms or their toxics. Then a little distance away from the toxin and toxin-forming organisms, the leucocytes are coming up in large numbers, forming a sort of protecting army, as it were. This is known as leucocytosis. In the small patent vessels around this commencing abscess numerous leucocytes, far in excess of the usual proportion, may be seen—the nearer the abscess, the more numerous they become. Thus the leucocytes make their way to what is to become the wall of the abscess, and form a layer around a mass of micro-organisms, localizing, or attempting to localize, such mass. So long as the leucocytes can make their way to this mass, and shut it off from the surrounding tissue, so long we shall have no extension of the abscess.

"Now, if you add something—alcohol in the case we are considering—which not only exerts a negative chemiotaxic action—i. e., which drives the leucocyte away—but which, as we have seen, also causes degeneration of nerve, muscle and epithelial cells, shall we not injure the infected patient both directly and indirectly by interfering with the return of the leucocytes driven away, by diminishing or altering the functional activity of these cells, and indirectly by interfering with the excretion of the poisons (owing, as we have seen, to a degenerated condition of the secretory epithelium)? Have we not, in fact, a cumulative action of two substances, either of which alone would do damage, but not in the same proportion as do the two when acting together.

"Now let us see what we may learn from a series of experiments carried out by Dr. Abbott, working in the Laboratory of Hygiene of the University of Pennsylvania, under the auspices of the committee of fifty, to investigate the Alcohol Question.

"These are his conclusions:—

1. "That the normal vital resistance of rabbits to infection by streptococcus pyogenes is markedly diminished through the influence of alcohol when given daily to the stage of acute intoxication. 2. That a similar, though by no means so conspicuous, diminution of resistance to infection and intoxication by the bacillus coli communis also occurs in rabbits subjected to the same influences.

"Throughout these experiments, with few exceptions, it will be seen that the alcoholized animals not only showed the effects of the inoculations earlier than did the non-alcoholized rabbits, but in the case of the streptococcus inoculations, the lesions produced (formation of miliary abscesses) were much more pronounced than are those that usually follow inoculations with this organism.

"With regard to the predisposing influence of the alcohol, one is constrained to believe that it is in most cases the result of structural alterations consequent upon its direct action on the tissues, though in a number of animals no such alterations could be made out by microscopic examinations. I am inclined, however, to the belief, in the light of the work of Berkley and Friedenwald, done under the direction of Professor Welch, in the pathological laboratory of the Johns Hopkins University, that a closer study of the tissues of these animals would have revealed in all of them structural changes of such a nature as to indicate disturbances of important vital functions of sufficient gravity fully to account for the loss of normal resistance.

"Following up Dr. Abbott's experiments, Dr. Delearde, working in Calmette's laboratory in the Institut Pasteur at Lille, made a series of observations which are, from many points of view, of very great interest and importance as he attacks it from an entirely new standpoint, one that will, I hope, ere long, be taken up by those working in this country. It has already been demonstrated that 'alcoholics' suffer far more seriously from microbic affections than do those of sober life, and it is now accepted that amongst them the mortality from this class of disease is higher than amongst those who are not accustomed to take alcohol regularly or to excess.

"It is pointed out, as most of us have from time to time had the opportunity of observing, that, taking pneumonia as an example of this class of disease, there can be no doubt that the alcoholic patient has not merely an appreciably smaller chance for recovery, but an apparently slight attack becomes one in which the chances of recovery come to be against the patient rather than in his favor. I well remember when I was House Physician in the Royal Infirmary at Edinburgh that Dr. Muirhead, who almost invariably treated his pneumonic patients without alcohol, used to say that an ordinary case of acute pneumonia should always recover under careful treatment, but that cases of pneumonia in 'alcoholics' were always most anxious cases and in every way unsatisfactory. (Slides were shown on screen to illustrate the changes taking place in pneumonia, the conditions of leucocytosis, and the very important part which leucocytes play in the process of 'clearing up' during the course of the patient's recovery). Dr. Delearde in an admirable summary gives the principal features of pneumonia in alcoholics. He describes it as running a comparatively prolonged course, as being often accompanied by a violent delirium, following which is a period of prostration or of coma; even in those who recover, abscesses frequently occur in the liver, or in other organs. He also points out that there may be a similar chain of events in other infective conditions such as erysipelas and typhoid fever, but as he insists that, until Abbott's experiments on the streptococcus,[A] staphylococcus[A] and bacterium coli,[A] in alcoholized and non-alcoholized animals, little attempt has been made to indicate the mechanism, or, at any rate, the process by which alcoholized individuals are rendered more susceptible to the invasion and action of micro-organisms.

[Footnote A: Microbes or bacteria of different kinds.]

"As we have already seen, Abbott's experiments prove beyond doubt that attenuated disease-producing organisms, which in healthy animals do not kill immediately, bring about a fatal result when the animal has previously been treated with alcohol. In order to determine which was the most important factor in the destruction or weakening of the resisting agents in the body, Dr. Delearde conceived the idea of experimenting with those diseases in which it has been found possible to produce, artificially, as it were, and under controlled conditions, an immunity or insusceptibility in healthy animals. He carried out a series of experiments on rabbits, immunizing against and infecting with the virus of hydrophobia, tetanus and anthrax.[B] To these rabbits he first administered a quantity of alcohol, from 6 to 8 c.c. at first, and gradually rises to 10 c.c. doses per diem.

[Footnote B: Carbuncle.]

"There is in the first instance a slight falling off in weight of the animal, but after a time this ceases, and the animal may again become heavier, until the original weight is reached. He then took a series of animals and vaccinated them against hydrophobia. In one set the animals were afterwards alcoholized and then injected with a considerable quantity of virulent rabic cord. It was here found that immunity against rabies had not been lost.

"In a second set the vaccination and alcoholization were carried on simultaneously, a fatal dose (as proved by control experiment) of rabic cord was then injected, when it was found that little or no immunity had been acquired. In a third series the alcohol was stopped before the immunizing process was commenced. In this case marked immunity was acquired.

"As regards rabies, then, acute alcoholism, especially when continued for comparatively short periods, simply has the effect of preventing the acquisition of immunity when alcohol is administered during the period when the immunizing process ought to be going on. This indicates that the action of the alcohol in acute alcoholism is direct, and that although its administration prevents the acquisition of immunity it does not alter the cells so materially that they cannot regain some of their original powers, whilst once the immunity has been gained by the cells, alcohol cannot, immediately, so fundamentally alter them that they lose the immunity they have already acquired. When we come to the consideration of the case of tetanus, however, we are carried a step further. Dr. Delearde repeating his immunizing and alcoholizing experiments, but now working with tetanus virus in place of rabic virus, found—and, perhaps, here it may be as well to give his own words:—

(1) "'That animals vaccinated against tetanus and afterwards alcoholized lose their immunity against tetanus;

(2) "'That animals vaccinated against tetanus and at the same time alcoholized do not readily acquire immunity;

(3) "'That animals first alcoholized and then vaccinated may acquire immunity against tetanus if alcohol is suppressed from the commencement of the process of vaccination.'

"In the case of anthrax too, as we gather from another series of experiments, it is almost impossible to confer immunity, if the animal is alcoholized during the time that it is being vaccinated, and although the animals, first alcoholized and then vaccinated, may acquire a certain amount of immunity, they rapidly lose condition and are certainly more ill than non-alcoholized animals vaccinated simultaneously.

"We have already mentioned that Massart and Bordet some years ago pointed out that alcohol, even in very dilute solutions, exerts a very active negative chemiotaxis, i. e., it appears to have properties by which leucocytes are repelled or driven away from its neighborhood and actions. Alcohol thus prevents the cells from attacking invading bodies or of reacting in the presence of the toxins which also, as is well known, exert a more or less marked negative chemiotaxis, i.e., the cells appear to be paralyzed. In all diseases, then, in which the leucocytes help to remove an invading organism or in which they have the power of reacting or of carrying on their functions in the presence of a toxin, we should expect that alcohol would to a certain extent deprive them of this power or interfere with their capacity for acquiring a greater resisting power or of reinforcing the powers of resistance. It appears indeed to reinforce the poison formed by pathogenic organisms. Dr. Delearde maintains moreover that chronic alcoholism increases enormously the difficulty of rendering an animal immune to anthrax, whilst as those who have had any experience of cases of anthrax know full well alcoholics, whether acute or chronic, manifest a remarkable susceptibility both as regards attacks of anthrax and the fatality of the disease when once contracted. Further as clinical proof of the correctness of another of these sets of experiments, Dr. Delearde instances two cases of rabies which have come under observation in the Institut Pasteur—one, a man of 30 years of age, of intemperate habits who after a complete treatment of 18 days after a bite in the hand died of hydrophobia; the other, a child of 13 years who was bitten on the face by the same dog that had attacked the other patient, and on the same day—who underwent the same treatment remained perfectly well. In this case the more severe bite (the face being the most serious position in which a person can be bitten) was received by the child; indeed the intemperate habits of the man, who even took alcohol during treatment, appear to have been the only more serious factor in his case as compared with that of the child.

"From all this Dr. Delearde draws the practical conclusion that patients who have been bitten by a mad dog should as far as possible abstain from the use of alcohol not only during the process of treatment, but also for some time afterwards, even for a period of eight months, during which period, apparently, increase of immunity may be going on. Beyond this he maintains that doctors often commit a grave error in administering strong doses of alcohol to patients suffering from certain infectious diseases such as pneumonia, or from certain intoxications such as those produced by snake-bite, during which an increase in the number of leucocytes appear to be a necessary part of any process that leads to the cure of the patient. Finally, he points out how necessary it is that we should respect the integrity of the leucocytes in the presence of microbic infections or intoxications. We may accept these statements all the more readily as Dr. Delearde states that 'although we must recognize that small doses of dilute alcoholic beverages are indicated in certain cases where it is necessary to stimulate the nervous system, one must guard oneself against an abuse which may certainly be prejudicial to the putting into operation of the mechanism of defence against the organisms of disease.'

"In so far as these conclusions rest on a series of exact experiments we are justified in accepting them as being a most valuable contribution to the question; where there is no experimental basis, we must exercise our own judgment. To show the very strong impression that exists that there is some connection between severe cases of pneumonia and alcohol I may mention that the other day I heard a gentleman (not a medical man) say, 'It is well known that most men (of a certain profession) die from alcoholism.' When asked to explain he said, 'They all die from cirrhosis or pneumonia, and if those conditions are not due to alcoholism, what is?'

"There can be no doubt that in addition to its specific action, alcohol has a general action—the mal-nutrition, which is usually associated with the use of alcohol, especially as a result of its action on the mucous membranes of the stomach, etc."

That the "guardian cells" of the body play a part in a considerable number of diseases was illustrated by Dr. Woodhead by drawings and photographs, shown on the lantern screen. The photographs included cells containing anthrax, typhoid and tubercle bacilli, the spirilla of relapsing fever, specimens from cases of anthrax. Specimens were shown in which the cells were actually ingesting and digesting the specific micro-organisms. In a case of typhoid, showing large masses of typhoid bacilli in one of Peyer's patches, there were seen certain of the cells which contained the typhoid bacilli, some of them undergoing degenerative changes, and showing unequal standing.

Of the researches made by Dr. Abbott referred to in the foregoing lecture Dr. N. S. Davis says:—

"Thus we have another and direct positive demonstration of the fact that the presence of alcohol in living bodies not only impairs all the physiological processes, but also impairs their vital resistance to the effects of all other poisons. It was hardly necessary, however, to trouble the rabbits to obtain proof of this; for such evidence may be found in abundance by examining the vital statistics of every civilized country. The late Frank H. Hamilton, in his valuable work on military hygiene, gives an interesting account of an experiment executed, not on a few rabbits, but on whole regiments of human beings, who were being exposed to the inhibition, not of the streptococcus pyogenes, but to the infections of malarial and typho-malaria fever. And, as many were attacked with sickness, it was thought by some of those in authority that if the soldiers were given a specified ration of alcoholic liquor two or three times a day, it might enable them to resist the morbid influences to which they were exposed. The proposed ration was accordingly ordered, and Dr. Hamilton informs us that the soldiers taking the liquor ration succumbed to the morbific influences surrounding them so much more rapidly than before, that in less than sixty days the order was countermanded, and the liquor ration stopped. And that eminent surgeon and sanitarian added, with peculiar emphasis, that he wished never to see the same experiment tried again."

Dr. J. J. Ridge, of London, has learned through his experiments that alcohol not only hinders the leucocytes in their war upon disease germs, but also tends to the multiplication of germs. Of this he says:—

"The antagonism of alcohol to the fundamental functions of life is further exhibited by its action on the cellular elements of living tissues and the free cells or leucocytes of the blood. Dr. Lionel Beale long ago pointed out how it affected the protoplasm of cells, and diminished the movements of amoebae, to which leucocytes are apparently analogous.

"But while alcohol is thus injurious to living protoplasm, or constructive protoplasm as it may be called, that which builds up, and forms all kinds of structures, and living beings of all higher types, I accidentally discovered that in minute quantities, under about one per cent., and even in such almost incredible amounts as 1 part in 100,000, (1/10 millilitre in 10 litres) it favors the growth and multiplication of many microbes whose function is antagonistic to the protoplasm of organized beings, and which may therefore be called destructive protoplasm. We know that these microbes are kept at bay by the vitality of the tissues; if this vitality is lowered they may prevail: as soon as life departs they set to work, and decomposition is the result. It is, therefore, not very surprising that an agent, like alcohol, which, we have seen, lowers the vitality of constructive protoplasm, should, on the other hand increase the vitality of destructive protoplasm. At any rate such is the fact. In the presence of these minute quantities of alcohol, decomposition goes on more rapidly, and the micrococci and bacilli, thrive and swarm more abundantly. This is easily demonstrable by the more rapid, and thicker, cloudiness of any clear decomposable liquor in the course of a day or two, or in a few days, according to circumstances. But I have demonstrated the more rapid multiplication of some forms by means of plate cultivations, of which I show specimens. It is true of the bacteria of decomposition, of the streptococci, and staphylococci of pus, and of diphtheria. Time alone has been wanting to demonstrate this in other cases, which I hope to do."

The Medical Week some time ago contained this paragraph:—

"Dr. Viala, in collaboration with Dr. Charrin, says: 'I have carried out a series of researches on the toxicity of various alcoholic beverages in common use, such as wines and brandies of all brands, from those which are reputed the best to those of very inferior quality. All these products have been analyzed with the greatest care. Our experiments were carried out on fifty animals. Intravenous injections confirm Dr. Daremberg's statement that liquors considered as the best are the most toxic, more particularly as regards their immediate effects.'"

Although the foregoing statement directs the reader's attention to the comparative effects of different alcoholic liquors, it also plainly implies several facts of great importance. The first is, that all alcoholic liquors, fermented or distilled, are toxic or poisonous; and the more pure alcohol they contain, the more poisonous are they, the qualities of liquor differing only in the rapidity of their injurious effects.

In the same number of the Medical Week, Professor Grehant states that after injecting a quantity of alcohol into the venous circulation of a dog equal to one twenty-fifth, or four per cent., of the estimated weight of the blood of the animal, he found by several analyses at different times that it required "a little over twenty-three hours for complete elimination of the alcohol from the blood." If we consider these results obtained by Viala, Charrin, Daremberg and Grehant, with those obtained by Dr. A. C. Abbott, showing the direct effect of alcohol in diminishing the normal vital resistance of the living body to infection, we see excellent reasons why the liberal use of alcohol in the treatment of such infectious diseases as diphtheria, typhoid fever and pneumonia, under the supposition that it was a cardiac tonic, has resulted in so great a mortality as from thirty to sixty per cent.

Dr. A. Pearce Gould, a London hospital surgeon of the first rank, has made special study of the surgery of the blood-vessels, and of the chest. He was one of the earliest to practice and advocate the careful removal of the axillary glands in all operations for cancer of the breast.

He is a strong believer in the value of total abstinence as promoting robust health of body and mind. He regards the value of alcohol in disease as exceedingly small, and prescribes it only very rarely. He thinks that alcohol increases the activity of cancer and other malignant growths, an opinion which is of great importance from one with such exceptional opportunities for observation in these complaints.

Dr. N. S. Davis in the American Medical Temperance Quarterly of January, 1895, gives reports of cases which came under his observation as a consulting physician, where the use of alcoholics throughout an extended illness favored the continuance of delirium, or mild mental disorder, after convalescence was established. In each case the withdrawal of the alcohol was followed by a cessation of the mental delusion.

One of these cases may be taken as an example:—

"The third case was that of a woman over sixty years of age, who had suffered from a mild grade of fever and protracted diarrhoea, somewhat resembling a mild grade of enteric typhoid fever.

"As she became much reduced in strength during the latter part of her diarrhoea, her friends began to give her wine, and sometimes stronger alcoholic drink, under the popular delusion that these could strengthen her. Her mind soon became wandering, and she was troubled with illusions, which were attributed to her weakness, and the so-called stimulants were increased. But the mental disorder increased also, and continued after the fever and diarrhoea had ceased, until the question was raised concerning the propriety of her removal to an asylum for the insane.

"Being consulted at that time, and listening to an accurate history of the case, I suggested that the anaesthetic effect of the alcohol on the cerebral hemispheres, in connection with its effect on the hemoglobin, and other elements of the blood, in lessening the reception and internal distribution of oxygen, might be the cause of both the perpetuation of her weakness, and her mental disorder. I advised a trial of its entire omission, and the giving of only simple nourishment, and moderate doses of strychnine and digitalis, as nerve tonics. My advice was followed, though not without much hesitation on the part of her friends. The result, however, was entire recovery from the mental disorder, and some improvement in her general health."

Puerperal mania resulted in one case cited, from the use of a moderate amount of wine at mealtimes; when the wine was abandoned the mania subsided.



CHAPTER XII.

WHY DOCTORS STILL PRESCRIBE ALCOHOLICS.

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

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

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

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

"It is by its sedative action that alcohol has obtained its position in public opinion. It will render persons insensible to various uneasy sensations, and the majority prefer to continue the bad habits which produce the uneasy sensations, and then to take them away by a dose or two of some alcoholic liquor, or, indeed, to take this before the uneasy sensations come on. In this way they do themselves injury and make themselves unconscious of it. Dr. Beaumont, who had the opportunity of examining the interior of Alexis St. Martin's stomach, and of seeing how digestion went on, was astonished to see how inflamed the mucous membrane could be without any consciousness of it. He observed, as a matter of fact, that alcoholic drinks of all kinds hindered the process of digestion, and produced this morbid condition of the mucous membrane. The relief, therefore, which can be obtained by alcohol is delusive and dangerous.

"But some persons say they are afraid to abandon the use of alcohol because they have been in the habit of taking it for a long period. This fear is entirely groundless. The alcohol will be missed for a time, just as a person who has been using crutches would miss them if thrown away; but they will do better without both after a little while. There is no kind of constitution which renders a person unable to do without alcohol. The prisoners in all our jails have to leave off their drink at once, and altogether, on entering there, and no harm ever ensues in consequence. But some say that this is because their diet is so carefully arranged, and the hygienic condition of the prison so perfect. Quite so. This shows us clearly that when total abstainers become ill outside the prison, their illness is to be attributed to some error in diet or hygiene, or to some accidental circumstance. It is absurd to think that the infraction of one law of health can be nullified by breaking another; that if you eat too much, or too fast, or too often, or what is not good for you, you can escape the consequences by injuring yourself with alcohol."

Dr. N. S. Davis was for many years openly sneered at by many of his professional brethren as "a cold-water fanatic." Since his views are now being rapidly adopted by progressive medical men all over the civilized world, it may be that soon those physicians who cling to alcohol will deserve the soubriquet of "alcohol fanatics." Dr. Davis said:—

"If I am asked why the profession continues to prescribe these drinks, I answer; simply from the force of habit and traditional education, coupled with a reluctance to risk the experiment of omitting them while the general popular notions sanction their use. 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 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.

"Of course both doctor and friends will regard the so-called stimulant as the cause of the recovery. So, too, when patients are getting weak, in the advanced stage of fever, or some other self-limited disease, an abundance of nourishment is regularly administered, in the greater part of which is mixed some kind of alcoholic drink. The latter will always occupy the chief attention, and if, after a severe run, the fever, or disease, finally disappears, it will be said that the patient was sustained or 'kept alive' for over two or three weeks, as the case may be, 'solely by the stimulants,' when, in fact, if the same nourishment and care had been given without a drop of alcohol, he would have convalesced sooner, and more perfectly, as I have seen demonstrated a thousand times in my experience."

Dr. Casgrau, of Dublin, says that physicians who make personal use of alcohol are not able to give an unbiased opinion about its action, as one of its most marked effects is that of a narcotic to the mental powers; such physicians are not so acute to observe the action of this, or any drug.

Sir B. W. Richardson, M. D., in an address upon the reasons why physicians still prescribe alcoholics, says that the magnetism of public opinion has great weight with professional men.

"All professions are under that subtle influence. All professions whatever their duties, whatever their learning may be, are sensitive and obedient to that influence. In their pride they think they lead public opinion; it is a mistake, they always follow it on every question in which the people, at large, have a voice. They can assist in influencing the public voice, and sometimes, to quote the words of Abbe Purcelle, spoken in the dawn of the great French Revolution, they may prove that 'respect for sovereign power sometimes consists in transgressing its orders,' but as a general rule not merely the orders but the inclinations are obeyed. We have to wait on, and for, public opinion, and in nothing so much as on the subject of alcohol. The use of alcoholic beverages rests not on argument but on habit, custom. To those whom it affects personally it is an absolute monarch. It makes its own empire. By the very action which it has upon the body of those who receive it into themselves it rules and governs. The joke of the inebriate man that when he had taken his potation he was quite another man and that then he felt it his duty to treat that other man, is literally true, a terse and faithful expression of a natural fact. The man or woman born and bred under the influence of alcohol is of the race of alcohol, and as distinct a person as any racial peculiarity can supply. The reason, the judgment, the temper, the senses are attuned by it. It is loved by its lovers like life. The grape to them is no longer a luscious fruit; it is 'the mother of mighty wine,' and he who is bold enough to disown that motherhood must stand apart. How can a profession however strong, march all at once against such an overwhelming influence? Itself born, perchance, under the influence bred under it, how shall it immediately be transformed? Why disobey the influence? It is in the interest of the doctor to obey, in a worldly sense of view; but more—it is in his nature to obey. The strong bands of nature and interest go hand in hand. Is it wonderful that the genius of a professional man so situated should, according to the quality of his genius, uphold, root and branch, the role of his nativity? On the contrary the wonder is that he has ever done anything else. It is most natural that he should be amongst the last to take up what revolutionizes all the manners, and customs, and faiths, of society. A lady will ask her physician the question, May I take wine, Sir? As much as you like Madam; it is very bad for you and I take none, but that is your business entirely. Henceforth that gentleman is said to be one who prescribes alcohol in any quantity. In fact, he never prescribes it, for although when forbidding is hopeless, there is all the difference in the world between prescribing and permitting, permitting goes down as if it were prescribing. Often a patient will try to compromise. On an ocean of whisky and water, brandy and soda, or other poisonous mixture, he is floating into fatal paralysis. You tell him so faithfully, and he says he knows it and will drop down to claret. If you assent, he tells his friends you have changed his brandy or whisky to wine; if you dissent, he says you have left your duty as a doctor undone, in order to become an advocate for abstaining temperance, about which he is as competent a judge as you are, and he won't pay fees for that advice. He pays to be cured of his disease, not to be dragooned into a system peculiar in its tenets. In an alcoholic world there is a strong argument in this decision. It rolls splendidly, especially down hill."

After speaking of non-alcoholic physicians, and their opinions of the harmfulness of alcohol, he adds:—

"On the other side, there are practitioners who, under the magnetism of public opinion, as earnestly believe the opposite in relation to alcohol, who declare they could not, conscientiously, practice their profession if they were debarred the use of alcohol, and who look on the advance and the growth of scientific abstaining principles—which they cannot avoid recognizing—with positive dread. The extremists on this side are indeed extreme in their fanaticism. They shut their eyes to the most obvious facts, and do not hesitate in their blindness to misrepresent the most obvious truths. They affirm that under the influence of total abstinence and, by inference, because of total abstinence, the yearly decreasing death-rate of the population is accompanied by reduction of vitality; that people who live long are more enfeebled than those who live short lives and merry; that under abstinence from alcohol fearful diseases are being developed; that the total abstainers have less power for resisting disease than the moderate temperate; and that under the current system of advance towards total abstinence, a very small advance yet by the way, diseases of a low type have developed and extended their ravages."

It is only physicians of large conscientiousness, or of great independence of character, who will dare to go counter to the prejudices of the people.

Consequently, it is necessary to educate the people in the teachings of those physicians, whose eminence in the profession has permitted them, or whose conscientiousness has driven them, to expose the delusions concerning the medical value of alcoholic beverages. When the people cease to believe in alcoholic remedies, physicians will no longer prescribe them. But while the majority desire the "physicians' prescription" as a cover for indulgence, there will be found physicians willing to give such prescriptions.

That the prescription of alcohol by physicians is largely a matter of routine may be seen from the following two cases, reported to the writer by county superintendents of the department of Medical Temperance.

In the first case, the physician said to the nurse, "If the patient's heart becomes weak, you might give a little brandy or whisky." Seeing reluctance expressed upon the nurse's countenance, he added hastily, "Or coffee, strong coffee will do just as well." The nurse in reporting this to the writer, said, "Why couldn't he have ordered coffee in the first place if he thought it equally good?"

The second case was that of an aged woman whose physician ordered whisky as a tonic. Her granddaughter ventured to ask, "Would not whisky have a narcotic rather than a tonic effect?" He replied thoughtfully, "Well, tell the truth, I suppose it would."



CHAPTER XIII.

ALCOHOLIC PROPRIETARY OR 'PATENT' MEDICINES.

America has been called the Paradise of Quacks, and with good reason. For years patent medicine manufacturers had such complete control of the American press, both secular and religious, that it was almost impossible to reach the public with information as to the real nature of these concoctions. Consequently the people accepted with amazing credulity the startling claims to miraculous cures of various pills and potions as set forth under glaring headlines in the daily papers. The publicity of the last few years has hurt the traffic seriously, but it still has a great hold upon the ignorant and credulous part of the population, and there is still a very large number of these preparations upon the market. Many persons think that the Pure Food Law guarantees every drug preparation now sold to be perfectly safe for use. This is a great error. The guarantee means simply that the manufacturer guarantees that his preparation is as he states upon the label; the government guarantees nothing concerning the matter. That the guarantee of the manufacturer is not always truthful has been shown by analyses of some preparations made by state and national chemists. All the advantage that the public has through the Pure Food Law, so far as drug preparations are concerned, is that the percentage of alcohol must be printed upon the label, and the presence of certain dangerous drugs, such as morphine, cocaine, and acetanilid must be indicated. Thus persons intelligent as to the nature of these drugs will avoid medicines which the label says contains them. The ignorant are not protected. It was difficult to secure even this small restriction upon the sale of proprietary medicines because of the opposition of a large number of newspaper publishers who were sharing the ill-gotten gains of the medical fakirs.

A careful compilation of manufacturers' announcements list 1,806 so-called patent medicines sold in open markets, in which alcohol, opium or other toxic drugs form constituent parts. 675 of the preparations are known as "bitters," stomachics, or cordials, and alcohol enters into their composition in quantities varying from fifteen to fifty per cent.; 390 are recommended for coughs and colds, nearly all of which contain opium. Sixty remedies are sold for the relief of pain, and no other purpose. 120 are for nervous troubles, and of this number, sixty-five have entering into their composition coca leaves, or kola nut, or both, or are represented by their respective active principles, cocaine or caffeine. 129 are offered for headaches, and kindred ailments, and usually with a guarantee to give immediate relief. In these are generally compounded phenacetine, caffeine, antipyrine, acetanilid, or morphine, diluted with soda, or sugar of milk. Dysentery, diarrhoea, cholera morbus, cramp in bowels, etc., have 185 quick reliefs or "cures" to their credit, nearly all of which contain opium, many of them in addition, alcohol, ginger, capsicum or myrrh in various combinations, and there are numerous cases on record where children and adults have been narcotized by their excessive use. Some manufacturers print on the labels covering these goods, words of caution limiting the amount to be taken. Forty-eight compounds for asthma contain caffeine and morphine. Sufferers from toothache have their choice from thirty-eight remedies, and thirty-six soothing, or teething, syrups are provided for infants.

Many people have ignorantly and innocently formed an alcohol, morphine, or cocaine habit through the use of patent medicines. Many deaths have occurred from headache powders of which acetanilid is the chief ingredient. Dr. Harvey W. Wiley, chief of the Bureau of Chemistry, says of these headache powders:—

"A woman has a headache and she uses one of these remedies. It relieves the pain. When she has another attack she uses it again and again with the same result. After a while she finds the usual amount of the remedy does not cure the pain. She uses two portions, and so the habit is formed until absolute danger is confronted. For one thing must not be forgotten: these remedies are powerful, for if they were not they would be of no effect. They are in certain doses deadly; they depress the nervous system; they disturb the digestion; they interfere with natural sleep; they require to be used in increasingly larger quantities as the system becomes accustomed to their use; they are almost without exception excreted by the kidneys, thus adding an additional burden to organs already badly overworked. They produce a habit of gaining relief which becomes an obsession and incapable of being resisted."

It may be asked, "How is it if these mixtures are harmful only, that so many people profess to have received benefit from them?" There are different reasons for this.

1. The nature of such drugs as alcohol, opium and cocaine is to benumb sensation, so that pain is stilled, and the pain, or functional disturbance forgotten for the time, because the nerves are drugged into insensibility. The person feels better while under the influence of the drug, so thinks it is benefiting him.

2. There are people who imagine they have diseases which they do not have; since trained physicians occasionally err in diagnosis, it is not strange if the laity should do likewise. Such persons are always ready to aver that a certain medicine "cured" them.

A ludicrous example of this is a woman out West, whose picture graces the advertisements of a certain nostrum, accompanied by a testimonial that said nostrum cured her of a "polypus"! Upon being written to as to how such a preparation could effect such a cure, she answered that, after giving the testimonial, she found that she had not had a polypus!

3. Some of the cures attributed to drugs, are doubtless due to Nature. It is estimated that from 30 to 90 per cent. of ailments are cured by Nature, unassisted, and often in spite of, the drugs swallowed. Many of the books advertising these remedies (?) give excellent rules of health, which, if followed, would restore persons to vigor more speedily without the accompanying medicine, than they can be restored while the system has the poisonous drugs to throw off. It may be reasonably assumed that a goodly number of recoveries ascribed to drug treatments are due, in reality, to the resisting force of a good constitution, or to obedience to the laws of health given in the circular.

4. It is not uncommon for people suffering from certain diseases to have temporary remissions in the course of the disease. No doubt, some of the cases reported as cures are such spontaneous remissions, which are followed, after the testimonials have been written, by relapse. The majority of people are ignorant of the natural course of diseases—of what happens when no treatment is taken. They do not know that a great many affections are characterized by periods of apparent recovery. For instance in some varieties of paralysis, as well as in consumption, the sufferer may to appearance recover completely for a few months or longer; if a remedy was being used at the time, it would naturally get the credit of causing the favorable change.

However, all of the glowing testimonials of wonderful benefits accruing from patent medicines are not what they seem to be. Dr. J. H. Kellogg says in his Monitor of Health:—

"The average manufacturer of patent medicines regularly employs a person of some literary attainment whose duty it is to invent vigorous testimonials of sufferings relieved by Dr. Charlatan's universal panacea. In many instances persons are hired to give testimonials, and answer letters of inquiry in such a way as to encourage business. The shameless dishonesty and ingenious villainy exhibited are beyond description."

Recently an advertisement of one of these nostrums stated in the headlines that said nostrum was used in the Frances Willard Temperance Hospital, Chicago. The testimonial appended purported to be from a nurse in that hospital, but the testimonial did not state, as did the headlines, that the preparation was ever used in that hospital. The president of the hospital board of trustees states that the nurse positively denies having given any testimonial to the company thus advertising. She did give one to another patent medicine concern, but not to this, and never said either was used in the hospital, nor have they been. Suit could be brought for damages, but unfortunately the patent medicine people have unlimited money, and the hospital has not.

Early in the present year there appeared in many daily papers a large advertising picture of a man whose name was appended as a professional nurse of a western city.

The following testimonial accompanied the picture:—

"Mr. —— of ——, who is a professional nurse of experience, writes,—'My friend is improving, thanks to ——, and you. I am called on to nurse the sick of all classes. I recommend —— to such an extent that I am nicknamed —— (giving name of nostrum) by nearly everybody.'"

As the writer of this book was acquainted with a physician residing in the small city mentioned in the advertisement, she wrote to him, requesting that he investigate this testimonial.

He replied that he found the chief part of the advertisement, namely, that Mr. —— was a professional nurse, false; "First, by his own statement as he told me this morning that he never claimed to be a professional nurse. And my personal acquaintance with him, as well as that of a number of other physicians in our little city, and reliable men and women of this community who are acquainted with him, all testify to the same thing, namely; that he is not a professional nurse, neither is he a nurse, or even a reliable man. He is an innocent, ignorant man, very close to the pauper class. He told me when I read the commendation to which his name is affixed, that it was all true except the professional nurse part, and that was entirely false, as stated above."

As the picture was of a fine-looking, intelligent-appearing man it probably was as genuine as the testimonial.

The following was clipped from a copy of Merck's Report, April, 1899, a druggists' paper published in New York city:—

MANY DRUGGISTS INDIGNANT.

A PATENT-MEDICINE ADVERTISEMENT CONTAINS UNAUTHORIZED ENDORSEMENTS.

"Fully a score of East-side druggists are up in arms over the unauthorized use of their names in a full-page newspaper advertisement of a widely-known specific. This advertisement appeared recently in certain New York daily papers, and retail druggists who have made it a rule of their business never to recommend any particular proprietary article, found themselves quoted in unqualified laudation of the article so liberally advertised. The names and addresses of the druggists were given in full, and when several of the men quoted conferred together they found that the most barefaced misrepresentation had been resorted to.

"One of the pharmacists thus misrepresented, happened to be Sidney Faber, the secretary of the Board of Pharmacy. He was not selling this particular specific, and had never said a word for or against it, nevertheless, six or eight lines of endorsement of the article were directly attributed to him. He called on some of his druggist neighbors whose names he saw in the advertisement, and ascertained that they, too, had been falsely and unwarrantably quoted. Mr. Faber promptly wrote to the proprietors of the specific in question, and denounced the published endorsements bearing his name, as a forgery. His indignation was by no means appeased when he received a letter from the proprietary concern, couched in the following language: 'We regret to learn that you have been annoyed by any statements that have appeared in New York city papers. We will forward your letter to them.'

"Within the past few days several of the druggists whose names were used in this advertisement without authority, have been considering the advisability of taking legal proceedings in order to ascertain their rights in the matter. It is contrary to pharmaceutical ethics for a pharmacist to specially endorse any proprietary article, or patent medicine. Some of the offended druggists propose to contribute to a fund for the purpose of publicly, and widely, advertising this unwarranted use of their names."

When patent medicine advertisers would dare to resort to such a wholesale fraud as this, what may they be expected to refrain from?

As an illustration of how commendations from notable persons are sometimes obtained, the following is cited: In the winter of 1899, appeared an advertising picture of the lovely Christian lady from Denmark, the Countess Schimmelmann, who was spending some time in Chicago. Below her picture were the words:—

"Adeline, Countess Schimmelmann, whose portrait is here given, in a recent letter to the —— company, (mentioning proprietors of nostrum) speaks of friends of hers who have been benefited by —— (mentioning nostrum), and who first advised her to recommend it to her sick friends.

"The Countess, as is well known, is a prominent member of the Danish court. Her coming to this country has been much talked of. Her real object is one of charity. She is stopping in Chicago, and from there writes her straightforward endorsement of —— (mentioning nostrum)."

The italics are the writer's. The picture and the testimonial were cut from the paper, and sent to the countess, asking if she had so spoken of this medicine, and, if so, did she, a strong total abstinence woman, know that this mixture contains a large percentage of alcohol.

She responded as follows:—

"Thank you for asking me about the enclosed. A white-ribbon lady came and asked me if I would do her the great kindness to recommend —— compound (made up of the juice of celery). I said I could not personally recommend it as I neither use, nor want, medicine. But some very reliable friends of mine (temperance people, and true Christians) told me I would do a good thing in recommending it as they used it, and found it excellent. Then I wrote the following: 'I myself cannot recommend —— compound as I do not suffer from any of the ailments it is said to be good for, but reliable friends of mine tell me that it is excellent, and I would do a good thing in recommending it to my friends. Adeline, Countess Schimmelmann.'

"I will only consent to the publishing of this letter if you publish the whole letter, and no extract from it, as the white-ribbon lady did for the —— compound."

If a white-ribboner played this mean trick upon this distinguished Christian worker she is unworthy of membership in the Woman's Christian Temperance Union. It is more than likely that the "white-ribbon lady," was a paid advertising agent of the patent medicine manufacturer, and wore a white-ribbon to gain the confidence of the Countess.

Whether patent medicine manufacturers know how to doctor all ills to which human flesh is heir may be doubted, but that their advertising agents are skilful "doctors" of testimonials is very evident to any one acquainted with the facts.

The Department of Public Charities of New York city in a "Report on the use of so-called Proprietary Medicines as Therapeutic Agents," says:—

"In connection with this subject it might be mentioned that, for years past, the name of Bellevue Hospital has been taken in vain by a number of persons and firms, without any authority whatever. It is a common occurrence that samples of proprietary medicines, foods, mineral waters, plasters, etc., etc. are sent to the hospital, or to members of the house-staff for 'trial,' whereupon the subsequent advertisements of the articles in question often assert that the latter are 'used in Bellevue Hospital,' leaving the impression upon the mind of the reader that the article, or articles, have been used with the sanction of some member of the Medical Board. It is probably impossible to find a remedy for this evil, from which many other institutions of repute likewise suffer. To publish a denial of such false assertions would only aggravate the evil. The utmost that can be done appears to be, to caution the medical staff against any entanglements with, or encouragement of, the agents of the interested parties."

This report, which was adopted by the Medical Board of Bellevue Hospital, classifies proprietary preparations as "Objectionable" or "Unobjectionable" according to the following rules:—

"Unobjectionable preparations are those, the origin and composition of which is not kept secret, and which are known to serve a useful and legitimate purpose. Malted Milk is an example. Objectionable proprietary preparations, by far the largest group of the whole class, comprise all those which are aimed at under the medical code of ethics under the term 'secret nostrum,' which term may be more closely defined thus:

"A secret nostrum is a preparation, the origin or composition of which is kept secret, the therapeutic claims for which are unreasonable or unscientific, or which is not intended for a legitimate purpose.

"Examples: The various 'Soothing Syrups,' 'Female Regulators,' 'Blood Purifiers,' and thousands of others."

Dr. A. Emil Hiss, Ph. G., says of the secrecy of these preparations:—

"A secret compound with a meaningless title is presumptively a fraud. Why a secret if not to permit extravagant, or fraudulent, claims as to therapeutic merit? * * * * * The ruling motive of the secret being essentially false and dishonest, its employment in the interest of any remedy is clearly a sufficient cause for its condemnation and ostracism."

Mothers sometimes wonder why their boys take so readily to cigarettes, or their daughters to cocaine, never thinking that the soothing syrup, or cough mixture given freely by themselves to their children developed a craving for something stronger later on. Mrs. Winslow's Soothing Syrup, advertised for years in church as well as secular papers as "invaluable for children," is cited in the report for 1888 of the Massachusetts State Board of Health as containing opium; also Ayer's Cherry Pectoral, Dr. Bull's Cough Syrup, Jayne's Expectorant, Hooker's Cough and Croup Syrup, Moore's Essence of Life, Mother Bailey's Quieting Syrup, and others too numerous to mention. The report says:—

"The sale of soothing syrups, and all medicines designed for the use of children, which contain opium and its preparations should be prohibited. Many would be deterred from using a preparation known to contain opium, who would use without question a soothing syrup recommended for teething children."

Again, on page 149 the following is quoted from a prominent physician:—

"Among infants, and in the early years of life, soothing syrups are the cause of untold misery; for seeds are doubtlessly sown in infancy only to bear the most pernicious fruit in adult life. It is said that one of the best known soothing syrups contains from one to three grains of morphia to the ounce of syrup. I believe that stringent legal measures should immediately be taken to stop the sale of so-called soothing syrups containing opium, morphia or codeine."

The writer has known mothers so ignorant of the nature of these soothing syrups as to deliberately put the baby to sleep upon them in order to insure relief from care for some hours.

Prof. J. Redding, M. D., says on this point:—

"While it may be true that an adult, of his own free will, and without incentive, or predisposing causes, does occasionally become a drunkard, I am convinced that nine hundred and ninety-nine out of every one thousand individuals who become drunkards are made so in embryo, infancy, or childhood, by the use of alcoholic decoctions, soothing syrups, opiates, calomel, etc. which are given as medicines to allay pain, obtund nerve sensibility, to cure the little sufferer of his vital manifestations, of his mental discomforts, but leave the actual disease and its, perhaps, putrid causation to time and debilitated vitality to remove."

Of the danger and harmfulness of patent cough mixtures The American Therapist says:—

"Cough mixtures as a rule, do more harm than good. Nine times out of ten the principal ingredient is opium. It is true that opium may lessen the tendency to cough, but it does great damage by arresting the normal secretions, and the system becomes affected by the poisons from the kidneys, skin, stomach, intestines and the mucous membrane lining the upper air passages. Not only do these mixtures arrest every secretion in the body, but they also show their deteriorating and degrading effect through the stomach. They contain substances which tend to disorder and derange digestion."

Several years ago the Post-Office Department at Washington was led to take an interest in the question of fraudulent "patent" medicines, and an examination of many of these nostrums was undertaken by government chemists. Fraud orders were issued against some of the most flagrant offenders, forbidding them the use of the mails. This has not done away with the evil, however, for they usually move to another city, and begin business again under another name.

The examinations made for the Post Office Department revealed the fact that a great many of the so-called medicines on the market were intoxicating beverages in disguise. The Internal Revenue Department then took up the matter and a long list of these beverage medicines was sent out to internal revenue agents with instructions that these must not be sold henceforth unless by persons paying a special tax for the sale of alcoholic beverages.

Some of the manufacturers of these nostrums availed themselves of opportunity given to add a recognized medicinal agent to their flavored alcohol and water and such preparations were stricken from the list of those requiring a whisky license for their sale. Peruna and Hostetter's Bitters were the best-known of these. Peruna had been up to this time what government chemists called "a cheap cocktail." The report of the pure food commissioner of North Dakota for 1906 gives on page 157 an analysis of it as now upon the market: "Alcohol by volume, 21.25 per cent.; total solids, 3.846 per cent.; ash, .158 per cent." The report says:—

"The only thing of a medicinal nature that we could find in this preparation appeared to be a small amount of senna combined with a bitters of some kind."

Proprietary "Foods" have not escaped attention from chemists. Dr. Charles Harrington, for several years secretary of Massachusetts Board of Health, was the first to publish an analysis of these preparations showing their alcoholic strength and their small nutritive content. He lists "foods" examined by him as follows:—

"Liquid Peptonoids 23.03 alcohol; maximum amount recommended will yield less than one ounce of nutriment per day, and the equivalent of 3.50 oz. of whisky. Hemapeptone 10.60 alcohol; Hemaboloids 15.81 alcohol; the maximum dose recommended yields about 1/4 oz. of nutriment, and the equivalent of about 1-1/2 oz. of whisky daily. Tonic Beef 15.58 alcohol; doses recommended yield about 1/2 oz. nutriment daily, and the equivalent of one ounce of whiskey. Mulford's Predigested Beef 19.72 alcohol; doses recommended yield about 1-1/4 oz. nutriment daily, and the alcoholic equivalent of about 6 oz. of whisky. There were "Foods" for the sick examined which were non-alcoholic, but their nutritive value was about nothing in comparison to their cost."

The Committee on Pharmacy of the American Medical Association reports on the following foods thus:—

Carpanutrine 17.3 alcohol; Liquid Peptones (Lilly & Co.) 22.0; Nutrient Wine of Beef Peptone (Armour) 21.5; Nutritive Liquid Peptone 23.0; Panopepton 18.5; Peptonic Elixir 18.8; Tonic Beef 16.1. The report on these says: "There are no fatty substances present in these products; their food value from this point of view is, therefore, nil."

A prominent physician of Philadelphia said of these "Foods" in the Journal of the A. M. A.:—

"I have long been convinced that many a patient has suffered severely when preparations such as these were being used, and that not a few of them have died, chiefly of starvation. * * * A very important disadvantage of these foods is their alcoholic content. Even in the small doses customarily used, the quantity of alcohol is often irritating to the stomach, and may be disadvantageous in other ways."

The Committee on Pharmacy also reported on cod-liver oil preparations. They said: "A preparation claiming to represent cod-liver oil which does not contain oil in some form is fraudulent. Waterbury's Metabolized Cod-Liver Oil and Hagee's Cordial of Cod-Liver Oil are cited as examples. It is claimed by the manufacturers that the latter represents 33 per cent. of pure Norwegian cod-liver oil, but in neither of these preparations did the tests made by the committee show any oil. Analysis revealed sugar, alcohol, and glycerine, none of which is contained in cod-liver oil."

Vinol is advertised as Wine of Cod-Liver Oil, but is admittedly without oil, and according to analysis contains 18.8 per cent. alcohol. Wampole's Tasteless Preparation of Cod-Liver Oil showed 20.05 per cent. of alcohol.

Cod-Liver Oil is considerably out of date now as a prescribed remedy because physicians have found that it impairs appetite. Cream and fresh butter and olive oil are advised instead.

Australia has been such a harvest field for patent medicine manufacturers that a government commission was appointed to study the subject. This commission presented a voluminous report to the parliament of 1907. This report gives an analysis of most of the extensively advertised medicines. Doan's Backache Kidney Pills are said to be made of oil of juniper 1 drop, hemlock pitch 10 grains, potassium nitrate 5 grains, powdered fenugreek (Greek hay) 4 grains, wheat flour 4 grains, maize starch 2 grains. The report says: "The stuff is the cheapest kind of skin-plaster made up into pills." The seeds of fenugreek are used mainly for poultices. Doan's Dinner Pills contain two drastic purgatives, podophyllin and aloin. Both of these are dangerous drugs. Aloin frequently produces hemorrhoids (piles). The British Medical Journal says that the material in forty of the Kidney Pills and four Dinner Pills would cost one English halfpenny (one cent).

Vitae-Ore is given as consisting of ordinary sulphate of iron (green vitriol) to which a little Epsom salts has been added. Munyon's Kidney Cure, which claims to cure Bright's disease, gravel, and all urinary diseases, is given as composed entirely of sugar. Dr. Williams' Pink Pills are said to be an iron pill much the same as the ordinary Blaud's Pills which are sold in drug-stores for half, or less than half, the price of the proprietary article. (Iron is said by recent investigators to be very injurious to the stomach.)

The Committee on Pharmacy of the American Medical Association has analyzed many proprietary medicines; from their reports the following analyses are taken. "Health Grains," which are claimed to be a remedy for "Dyspepsia, Indigestion, Nervousness, etc.," were found to consist of 87.50 per cent. of coarse quartz sand, and 12.50 per cent. of rock candy and syrup.

"Hoff's Consumption Cure consists essentially of sodium cinnamate and extract of opium, a mixture at one time suggested for the treatment of tuberculosis, but which has been discarded by physicians. A medicine which depends on opium for whatever therapeutic effect it may have is, when sold indiscriminately to the laity, inherently vicious."

Sartoin Skin Food for "sunburn, and all skin blemishes" was made of Epsom salts colored with a pink dye. The government prosecuted the company sending out Epsom salts as a "food," and they were fined $20 for thus seeking to dupe silly women.

Malt extracts are very extensively used at the present time, under the popular notion that they are an aid to starch digestion. That they are a product of the brewery has caused them to be looked upon with suspicion by cautious people, but the multitude has apparently given no thought, or care, as to whether or not they may be alcoholic. Dr. Charles Harrington presented the results of an examination of these preparations at a meeting of the Boston Society of Medical Sciences, held Nov. 17, 1896. The following is quoted from the journal of the society for November, 1896:—

"Twenty-one different brands of liquid malt extract were obtained and analyzed. That they were not true malt extracts is shown by the fact that in no one was there the slightest diastatic power; all were alcoholic, some being stronger than beer, ale, or even porter. In a number of specimens a large amount of salicylic acid was detected."

Dr. J. H. Kellogg, in commenting upon this report, said in the Dec., 1896, Bulletin of the A. M. T. A.:—

"In the light of these facts, it is apparent that ale or lager beer might as well be prescribed for a patient as these so-called malt extracts, which are practically nothing more than concentrated ale or lager."

There are malt extracts, made up like honey, or syrup, in consistency, which are valuable.

The following list of malt extracts, with accompanying letter from Prof. Sharples, is taken from a paper published by Hon. Henry H. Faxon, of Quincy, Mass.:—

"Boston, Mass., March 20, 1897.

"I enclose a list of the malt extracts examined in this office during the past year or two. These samples were all in original packages, obtained by officers in various parts of Eastern Massachusetts. They probably very fairly represent the various malt extracts on the market. I have added two samples of Porter and one of Old Brown Stout for purposes of comparison.

"Yours respectfully, "S. P. SHARPLES. "State Assayer."

Name. Solids. Alcohol.

5193 English Malt Extract 9.70 5.63 5214 Old Grist Mill Malt Extract 10.57 5.54 5418 Old Grist Mill Malt Extract 9.98 5.63 5490 Old Grist Mill Malt Extract 12.28 5.86 5626 Old Grist Mill Malt Extract 9.63 5.00 5207 Liquid Food, a Malt Extract 10.47 4.27 5225 Pure Malt, a Liquid Food, a Tonic 9.71 5.00 5416 Pure Malt, a Liquid Food, a Tonic 10.76 6.32 5619 King's Pure Malt[C] 9.52 6.60 [Footnote C: The label on King's Malt states that for a strong, healthy person, with a good appetite, a pint with each meal and another on retiring at night will not be too much.] 5421 A Nutritious Tonic, Pure Malt Extract 10.88 6.24 5226 Noris' Extract of Malt 11.57 5.94 5258 Noris' Extract of Malt 9.31 6.55 5397 Noris' Extract of Malt 10.63 6.24 5485 Noris' Extract of Malt 10.50 6.63 5620 Noris' Extract of Malt 12.55 5.90 5229 Pabst Malt Extract, The Best Tonic 10.43 5.16 5230 Hoff's Malt Extract (Tarrant's) 11.33 8.88 5489 Hoff's Malt Extract (Tarrant's) 12.25 7.17 5231 Johann Hoff'sches Malz-Extract, Gesundheit's Beir 11.31 4.34 5491 Johann Hoff'sches Malz-Extract, Gesundheit's Beir 11.02 4.85 5621 Johann Hoff'sches Malz-Extract, Gesundheit's Beir 10.49 4.50 5408 Johann Hoff'sches Malz-Extract, Gesundheit's Beir 11.47 4.78 5340 Haffenreffer & Co. Malt Wine 11.02 6.65 5423 Haffenreffer & Co. Malt Wine 11.71 5.63 Liquid Bread, A Pure Extract of Malt 6.78 6.63 5395 Durgin's Malt, Liquid Extract of Malt 7.12 5.94 5433 Durgin's Liquid Extract of Malt 6.49 5.55 5396 Wyeth's Liquid Malt Extract 14.80 3.35 5488 Wyeth's Liquid Malt Extract 15.50 2.86 5622 Wyeth's Liquid Malt Extract 15.73 2.35 5406 Wampole's Concentrated Extract of Malt 9.84 9.86 5407 Anheuser-Busch's Malt Nutrine 15.98 3.00 5600 Anheuser-Busch's Malt Nutrine 15.82 2.25 5417 Malt Extract (Sterilized), John L. Gleeson 7.97 4.71 5422 Malt Extract (Sterilized), Charles C. Hearn 8.58 5.00 5436 Burkhart Brewing Co.'s Malt Extract 10.73 7.01 5486 Menzel's Extract of Malt 5.90 5.24 5625 Menzel's Extract of Malt 6.75 4.35 5623 King of Malt Tonics, Lion Tonic 10.95 7.05 5624 Teutonic, "A concentrated Extract of Malt and Hops" 9.95 7.45 5409 Van Nostrand's Old Stout Porter, "a pure malt extract" 7.97 6.55 5233 Philadelphia Porter 5.34 6.63 5232 Burke's Guiness Stout 6.66 7.17

The alcohol in the above table represents the cubic centimeters of alcohol in a 100 cubic centimeters of the liquid. The solids are the number of grams of solid extract in each 100 centimeters of the liquid.

S. P. SHARPLES.

The British Medical Journal, and the British Medical Temperance Review have been calling attention to the danger in coca wines. Intemperance among invalids is said to be greatly on the increase from the use of these wines. In every case the basis of these preparations is strongly alcoholic wine, ranging from 18 to 20 per cent. The coca added is either the leaves, or liquid extract of coca, or hydrochlorate of cocaine.

Dr. Frederic Coley says in the British Medical Journal:—

"Coca, and its chief alkaloid, cocaine, are drugs which possess some power of removing the sense of fatigue, just as analgesics remove the consciousness of pain. But they no more remove the physical condition of muscles, and nerve centres, of which the sense of pain gives us warning, than a dose of morphine, which removes the pain of toothache, removes the offending tooth, or even arrests the caries in it. The truth of this will be obvious to any one who remembers enough of physiology to know what fatigue really means. A muscle which is tired out is different chemically from the same muscle in its more normal condition, when it is ready to respond vigorously to ordinary stimuli. It has lost something, and is, besides, overcharged (poisoned, in fact) with the products of its own activity, and it can only be restored by a fresh supply of the material which it requires, and the carrying away of the poisonous waste products. Fatigue of nerve centres is no doubt strictly analogous to fatigue of muscles.

"It is practically impossible for us, by voluntary exertion, to reach the degree of absolute fatigue, which the physiologist produces by electric stimulation of a nerve-muscle preparation. The sense of fatigue becomes so intense that voluntary effort cannot overcome it. So no man can produce asphyxia by simply holding his breath, because the besoin de respirer becomes irresistible; but it is quite possible for a narcotic to so dull the sensory part of the respiratory reflex mechanism as to permit asphyxia to take place.

"The sense of fatigue, and the besoin de respirer are both Nature's danger signals. Drugs which hide such signals from us are a more than doubtful benefit. If it were possible for us to suppose that a fraction of a grain of cocaine could afford to exhausted nerve centres, and muscles, the nutriment which they require for their restoration, and at the same time eliminate the poisonous waste products, then it would be reasonable to prescribe the drug for use by all who are overworked, and perhaps suffering from the malnutrition consequent upon, 'nervous dyspepsia,' as well as mere want of rest.

"In this go-ahead century it is no wonder that many are but too ready to experiment with a drug which professes to be able to remove fatigue, and to enable a man to go on working when, without its aid, weariness had become unendurable. Cocaine claims all this; and it is most dangerous just because, for a time, it seems able to keep its promise. That is how victims to cocainism are made. Let us be honest with our overworked patients, who want us to help them with drugs; let us tell them that rest is the only safe remedy for weariness.