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THE CLINICAL USE OF ALCOHOL

(From an address by H. A. Hare, M.D., Professor of Therapeutics and Diagnosis, Jefferson Medical College of Philadelphia. Read before the Philadelphia County Medical Society, April 14, 1915.)

". . . The view has been brought forward, although held by certain investigators for many years, that alcohol in moderate amounts is burnt up in the body and in the process of this combustion gives force to the organism, and in certain instances, because of its easy combustion or oxidation, distinctly aids in the conservation of tissue. Not only does it do this by giving force but it saves the tissues, in that it is burnt up so readily that the less easily burnt-up tissues escape.

"This being the case it is not difficult to reach the conclusion that alcohol, properly used, has a very definite position in the materia medica list, and can be used with advantage in certain cases of diseases which are characterized by great tissue wastes, notably diabetes mellitus, typhoid fever, and certain cases of tuberculosis, and in certain stages of other maladies. I believe that it may be fairly stated that these are facts, and that those who are sweeping in their condemnation of alcohol as a remedial agent are, at this time, unable to present any evidence which can satisfactorily controvert these views; always bearing in mind, however, that this drug, like others, must be administered in doses which suit the needs of the patient in the particular stage of the disease, and the particular time of the day when he needs the drug. All drugs are given too much by routine and too little by careful adjustment to daily or hourly need, and alcohol does not escape from this abuse any more than its sister remedies. To make the bald statement that alcohol is useful in diabetes or valuable in the treatment of typhoid fever is almost as much of an error as to state that it is useless in these diseases. Such positive statements must be qualified by the additional information that it is useful if the proper

kind of alcoholic fluid is selected, if the proper dose as to size is given, and if the proper time of administration is chosen.

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". . . There are at least two other phases of the action of alcohol which should be carefully considered from the clinical standpoint. I have already dealt with the fact that it gives energy and saves tissue. The other points deal with its influence upon the circulation, as we understand it in these more modern days, and its power in combating infection aside from any mere increase in vital resistance by energizing the body. Instead of believing that alcohol acts as a stimulant, increasing the force, vigor, and blood-pressure of the circulation, we now believe that the value of alcohol, so far as the circulation is concerned, lies in its ability to adjust the circulation, so to speak, or, to use another term, its power to equalize the circulation. There can be no doubt that the influence of alcohol in re-establishing circulatory equilibrium is one of its advantages, and its circulatory effect is one which brings benefit to the patient in the congested areas of the deeply situated portions of the body, while the peripheral tissues which have been poorly supplied with blood are freely flushed with this fluid.

". . . I would like to emphasize once more that alcohol does a great amount of good in many cases of prolonged fever by this method of establishing circulatory equilibrium. There are only two drugs which approach it in value for this purpose, possibly three, namely, atropine, camphor, and the nitrites. The nitrites are apt to act too suddenly and forcefully and are too fleeting; atropine stops the secretions which the alcohol often increases. The exact value of camphor is hard to determine.

"Finally, let me bring forward the view that alcohol enables the man sick from a severe infection to combat that infection not only by providing him with a readily oxidized food, but that it in some manner as yet unknown seems to increase the phagocytic power of the blood and still more surely increases bacteriolysis. A number of years ago I carried out a series of experiments in cases of typhoid fever and tuberculosis in which I proved, at least to my own satisfaction, that alcohol distinctly increases the bacteriologic power of the blood serum, and presented the results of my investigation to the Association of American Physicians. Unfortunately, I was called away before the discussion was completed,

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THIS MOONSHINE STILL WAS SEIZED BY THE REVENUE OFFICERS.

and in the discussion Dr. Welch raised the question as to whether there were not certain elements of fault in the technique. The technique, it happened, was suggested or directed by Dr. Flexner, who was then in Philadelphia, and was actually carried out by some one who had no conception as to the character of the research I was following; did not know that alcohol was being used; did not know that the blood was taken from a patient receiving alcohol; or when it was taken from a patient who was not receiving alcohol. ". . . This discussion is designed not to loudly sing the praises of alcohol; it is intended to emphasize the point that he who utterly casts it aside deprives himself of a valuable tool at certain times; that he who uses it in excess does harm; but that he who prescribes it in proper form and in proper dose and at the proper time may consider alcohol one of his standard remedies just as he considers any other drug possessing activity capable of doing good."

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