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of it should begin. I agree with the ancients, who
had a law on the subject that the whole female sex
would be vastly better without it, and that those
women bring up the healthiest children who never
touch it. I agree that a man in a good condition
of health is better without it. I have been to see
Carver shoot, and I am forced to the conclusion
that a glass of wine would almost of a certainty
spoil all his sport ; nay, to please you, which is al-
ways a satisfaction, I will honestly state that I do



12 AN INAUGURAL ADDRESS.

not believe any man who trusted in the least to al-
cohol could do what Carver does, with such almost
superhuman precision. I quite admit what you re-
late in one of your lectures, that in towns and com-
munities of abstainers, like Johnsburg, health, com-
fort, happiness, and wealth are all advanced far be-
yond what they would if the wine-god made his
entrance there. All these confessions I make, but
but still I can not join you."

My friend is a representative, I believe, of nearly
the whole profession of Medicine that thinks on this
question seriously. Strange it is that with such ad
vance of thought there should be so much of hesi
tation as to the logical course to pursue !

Another physician I could name has recently
read Dr. Cheyne's well-known essay on " Health
and Long Life," published in 1725, and thereby he
is sorely perplexed. Cheyne puts before this reader
some curious arguments. Cheyne says, " That no
man is afraid to forbear strong liquors in an acute
distemper, what quantity soever he might have
drunk in his health, and yet any sudden change in
his humours would not only be more dangerous
then than at any other time, but also would more
readily happen and come to pass in such critical
cases. But," he continues, " the matter of fact is
false and groundless; for I have known and ob-
served constant good effects from leaving off sud-
denly large quantities of wine, and flesh meats too,
by those long accustomed to both, and never ob-
served any ill consequences from it in any case
whatsoever. Those whose constitutions have been
quite broken and running into dissolution, have



THE MEDICAL PROFESSION AND ALCOHOL. 13

lived longer and been less pained in sickness by so
doing ; and those who have had a fund in nature to
last longer, have grown better, and attained their
end by it."

This experience of a very wise old father of
medicine perplexes my doubting modern friend
the more, because, to the letter, it represents his
own practice and his own experience. In all cases
of acute disease he has, from custom, forbidden, as
a first direction, wine and every other stimulant;
and in most cases of diseases of all kinds liver
cases, stomach cases, brain cases he has followed
the same plan. What is more, he has found it a
good plan, and, as Cheyne says, he never has seen
anything but ultimate good from it. And so he
asks himself if it be good to cut this agent off in
disease because the body is diseased ; and if it be
true, as all seem by consent to declare, that in
health the body does not require the agent, when
does the body require it, even from the point of
view of a doctor who, in spite of it all can not join
such a society as this?

Another of my brethren, who is, in like manner,
in doubt, communicates his view in equally striking
terms. He says, referring to one of my lectures:
" The best service you, I think, ever made was in
your pulling us all up on the question of the degree
to which alcohol should be carried in its adminis-
tration, and in insisting that it should never be
carried beyond the first stage or degree of its ac-
tion. I see " (he adds) " that one of the writers in
the Contemporary Review repeats the same lesson,
and layi it down as a rule that whenever alcohol is



14 AN INAUGURAL ADDRESS.

taken to the extent of doing more than causing
flushing of the face, and a little excitation of the
heart, and brain, it has been given or taken in such
sufficiency that to go further would be to go into
danger. I entirely agree with this advice some-
times, my friend, but the difficulty with me lies in
carrying it out in practice. How do I know what
quantities of different wines or spirits to order for
people of different ages and constitutions so as to
produce just this effect and no more ? The drinks
are varying quantities, the drinkers more varying
still. To carry out the rule, I must first make a
physical analysis of every drink I prescribe, and
then make a mental analysis of every person I pre-
scribe for. This is absurd. Again, I find that the
constitutions treated are like the movable feasts,
never twice alike. If I can produce the precise
tint of flushing to-day, in a man, by six ounces of
sherry, or three ounces of the finest whisky the
Encore whisky, for example, which is said to be
the purest I am told in a week or two that the
quantity had lost its effect, and that I must change
the drink or give a little more. Then I shake in
my shoes, lest by yielding I should encourage my
patient to rely on the drink, to increase it and be-
come a tippler. So," he concludes, " the question,
as I see it is surrounded with difficulties. The
theory is perfect, the practice an impossibility. I
do not want, certainly, to induce people to get into
the second stage of alcoholism any more than you
do, and would like to prescribe alcohol to cause a
given effect, as I prescribe chloroform, chloral,
mercury, iodide of potassium, or quinine; but the



THE MEDICAL PROFESSION AND ALCOHOL. 15

thing is not to be done unless, like you and your
friends, I go over to total abstinence and use the
good gift as if it were a mere drug; a step which,
in my opinion, is just as intemperate as the intern-
Derate misuse of the gift." It is very strange in-
deed to hear these reasonings, reasonings against
reason ; and yet I rather greet th'em. They are
signs of an awakening conviction that at the bot-
tom of the argument some fanatical sentiment,
some ingrained looseness of principle, is felt and
almost repented of. By standing steadily together,
though we be but a hundred, we shall, I think, in
time easily conquer such objections as these.

It is a fact, openly confessed by those who are
not with us, that we are logical, and only too rigid
in our method. So we are charged.

Let us not at the same time, in pride of logical
status, contend that those who are not with us have
no other arguments save of the kind above quoted,
There are other arguments, and with one or two of
the best of them I propose, in all candor, to deal
for a few minutes of time.

There are some who say that if we are logically
right, we are losing ground by insisting too forcibly
even on our Tightness. This is a world of give and
take, and the wisest rules will be relaxed by the wis
est men. The old author of the work on " Health
and Long Life " helps his argument when he says,
" The reflection is not more common than just that
he who lives physically must live miserably." The
truth is that too great nicety and exactness about
every minute circumstance that may impair our
health is such a yoke and slavery as no man of a



l6 AN INAUGURAL ADDRESS.

free spirit would submit to. " 'Tis," as a poet ex-
presses it, " to die for fear of dying 1 . On the other
nand, to cut off our days by intemperance, to live
miserably for the sake of gratifying a sweet tooth,
is equally beneath the dignity of human nature."
Well, we all admit this to be true, and we would
relax our rigid rule about wine if we felt that to
take off wine were " to die for fear of dying." Our
contention is, that to leave it off is not to assume but
to cast away a yoke and a slavery which no man
of a free spirit would submit to. Our argument is
that the wine drinkers are the yoke bearers, we the
free men ; and that their indulgence, in this instance,
is beneath the dignity of their nature, while the cast-
ing off the yoke is for the happiness, not less than
the health, of all mankind whom it affects, now and
to come.

There are others who argue that the world itself
is not prepared to receive the truth from the pro-
fessors of medicine, even if the arguments against
the use of alcohol were all accepted. They say
that faith would be lost in them by their patients if
the luxury were too hastily forbidden ; they insist
that they could not live by practice expounding
such extreme views, and they assure us that free
will is one of the potent influences to be conciliated
even in matters of life and death. I admit at once
the speciousness of this argument. I have written
an essay dealing on free will in relation to physic.
I have a keen appreciation of the power of free
will, but I still see one other side, perhaps two,
even to this objection. First, if medical men were
united, free will in the many against them would



THE MEDICAL PROFESSION AND ALCOHOL. I?

nave little chance ; secondly, in this matter, if I
mistake not the signs of the times, the tide of free
will is going rather against them than with them
in opposition to the use of alcohol. At all events,
if popular free will has not set up in full tide against
alcohol, popular free doubt has, and that is next
thing to it ; so on this mere subject of expediency
(and it is nothing else) our society has no need to
do more than keep up its colors and stand by them
triumphantly.

The idea that alcohol is necessary to enable men
to perform extra mental or physical work has so
utterly come to grief, it is really not necessary that
I should put it forward, even as a remnant of
superstition against us ; but it has been suggested,
leaving the present ground of history altogether,
giving up, in despair, all attempts to reply to those
unanswerable modern proofs against the old fal-
lacy, which Arctic explorers, men of great strength
and physical skill, incessant minds, and the most
laborious literary scholars so richly supply ; it has
been suggested, I repeat, that, in some inscrutable
manner, alcohol has been the feeding-mother of
great nations, that it has sustained racial tenacities
and vitalities, overcome mighty adversaries, and
been, in short, both a herald and a conqueror on
the side of civilization. For our parts we, who
dare to doubt this conclusion, want to know on
what facts the conclusion is based. We are will-
ing to learn, but we insist that those who preach
must prove. Who can say what any great and
mighty nation would have been to-day if wine had
never been ? By what evidence can the destinies



18 AN INAUGURAL ADDRESS.

of nations in favor of a good destiny be traced
through wine or strong drink ? We can see some
facts in history in relation to the effects of human
acts plainly enough. We can see, for instance, that
Constantine most probably destroyed the Roman
empire by moving the seat of government from its
old basis to a new city that should be marked by
his name. But where is there any corresponding
fact bearing on great events and making of nations,
wine being the factor? Suppose we turn to some
facts, such as they are, in history, and they point
circumstantially all the other way. Nations the
mightiest have risen while they were abstaining
nations ; have fallen when wine became their
luxury. Herodotus gives us the record of all-
powerful Cyrus receiving from a small Ethiopian
prince a bow, with this message ; " Tell Cyrus that
when he can bend this bow, which is mine, or find
a Persian to do it, he may come and conquer Ma-
crobia." And the historian relates, with evident
satisfaction, that these Macrobians, who were the
finest of men, so that they stood a head above the
Persians, and were a truly noble race, were dis-
tinguished from the Persians in (hat they drank no
fluid stronger than milk, while the Persians reveled
in wine. There is yet another bit of evidence
against a hypothesis of alcohol as the nursing-
mother of great nations. Through ail tribulations,
through all vicissitudes, through all persecutions,
what nation has maintained its vitality like the
Jewish nation ? Has alcohol been to this people
a nursing-mother? Baron Hallcr, dealing with
this topic in the last century, gave the secret



THE MEDICAL PROFESSION AND ALCOHOL. 19

of the cause of this vitality all in one word
sobrietas.

There is one other line of objection taken against
our work, which is the last I have space to refer to,
but which is first in its bearing- on our success.
The objection relates to the possibility of success-
fully treating disease in some forms of it without
the aid of alcohol. Opinion in the profession it-
self has greatly changed at various times on this
subject, independently altogether of the subject of
temperance. Before ever the temperance question
was dreamed of, medical men, and schools of medi-
cal men were in conflict from time to time on the
right and wrong in using alcohol in disease. The
Greek and Roman physicians were moderate in
their employmeut of wine. They used, it is true,
various kinds of wine ; they used salted wines ;
they used acid wines ; and in many ways they used
wines purely as medicines, not confounding the
general with the special use at all, and, as a rule,
proclaiming against their general use. The Middle
Age physicians were almost as cautious as their
predecessors, and although, after the time of Albu-
cases, in the eleventh century, they became ac-
quainted with the use of spirit of wine ardent
spirit they do not seem to have employed the
ardent spirit to any extent, if at all, for internal use
in the treatment of disease. They used the spirit
chiefly for tinctures and for dissolving resins and
gums. After the time of Stahl the doctrine of the
phlogistic theory, and of the antiphlogistic treat-
ment of disease led to the all but abandonment of
stimulants in the treatment of disease, so that dun



2O AN INAUGURAL ADDRESS.



last century we had man}' illustrious physi-
cians who, on theory, let stimulants stand aside;
while some others joined in the objection to the
use of those agents from more general and, I had
almost said, for more generous sentiments as to
their danger to mankind. The illustrious Haller,
Boerhave, Armstrong, 4 and particularly Erasmus
Darwin, were earnest in their support of what we
now call the principles of temperance, and the
illustrious representative of the name of Darwin to
this day maintains the principle in unbroken line.
Then, just about one hundred years ago, there oc-
curred for a time a revulsion of feeling, owing to
the attempted establishment in Edinburgh of what
was called the Brunonian system of medicine,
founded by one of the most erratic, generous, and
unhappy men and classical scholars medicine ever
possessed, John Benson Brown, who strove to in-
stitute a system of medicine based on the internal
administration of stimulants and narcotics chiefly
wine, or rum, and opium. In his physiology he
classed the stimulant and the narcotic together as
stimuli, and held up the practice of their free ad-
ministration, as the all but universal cure. Disease
was to him always a relaxation or loss of vital
power, and the cure of disease was by and through
the conserving elevating stimulant. In 1780, Brown
was for a second time elected president of the old
Medical Society of the Edinburgh University, and
to such fury did debate run there that a law was
passed for expelling students who challenged other
students to mortal combat. Cullen, and all the
leaders of the Edinburgh School, opposed Brown,



THE MEDICAL PROFESSION AND ALCOHOL. 21

who, in time, came to London, where he died, in
his fifty-second year, of apoplexy, after having
taken a large dose of opium, to which stimulant
narcotic he was accustomed. That he exerted an
influence in favor of the stimulating method of
treating disease is without any doubt ; it suggested
a bad idea which ministered in its badness to one
of the weaknesses of mankind, and he himself, no
doubt, with all his genius, fell upon his own sword.
In the early part of the present century the debate
as to the value of wine in disease continued, the
practice at least lapsing into a compromise, the
rule of which still continuing I am myself able to
remember. The rule was that, in acute disease,
phlogistic disease, the remedies to be used were to
be strictly antiphlogistic or depressing, by which
rule all stimulants were rigorously excluded ; but
when the fury of the phlogistic attack had been
subdued, and the sick man, by bleeding, tartar
emetic, and purgatives, had been reduced to
death's door, then it was the thing to bring him up
again by gently pouring in wine or other stimulants
with an improved dietary. In the profession of
medicine these were halcyon days ; for the people
they were rather too systematic to be advantage-
ous, and they met their end by the hand of Dr.
Todd, who, seeing the evil done by the depressing
system, and not the evil by the recruiting system,
pushed his theories to the extent, practically, of
saying that all disease was depression of itself, and
therefore, required to be treated boldly, and, from
the outset, with a stimulant. I, for my part, im-
bued in early life by the lessons of a venerable



22 AN INAUGURAL ADDRESS.

practitioner of medicine of the antiphlogistic
school, was never led away by the enthusiasm of
Todd, whom I knew very well, and who was al-
ways most kindly interested in my experimental
work. But I have always felt that Todd did great
service in dispelling the old dogma of the violent
antiphlogistic line, and only erred in not stopping
at that point. His revulsion backtoBrunonianism
was for a time, no doubt, a serious disaster ; but the
very mischiefs it wrought were, in the end, a gain
to the cause of temperance. By exaggerating the
tendencies of mankind to intemperance, it struck a
note of alarm in the hearts of conscientious physi-
cians, and made them anxious (as the eminent Dr.
Fothergill in his latter days expressed) whether, in
curing the sick by wine, the physician might not
be giving him the first lessons in fatal inebriation.

Since the time of Todd the tone of the profes-
sion has been one of conflict and sobering down,
in these last days, to the idea that stimulants are
only temporary necessities in disease, and that men
in good health require none. The old antiphlo-
gistic mania -has departed, and its Brunonian se-
quence is following the same course.

With this improved mode of thought the pro-
fession, no doubt, is lending itself to the spirit of
the age. What we want is that it should do more.
Confessedly in the march of those simple and
grand men who, in their noble simplicity and
greatness of nature, led the way to the redemption
of the drunkard from drink, the profession has lost
the lead. We may regret this ; but, as it is too
true, regrets were vain. It has not, in this respect,



THE MEDICAL PROFESSION AND ALCOHOL. 23

been worse than its learned friends. The Church
of all banners lost its lead ; the law has not yet
moved in a single form of organization into the
ranks of the veterans. But, at last, the Church of
all banners has taken up its place, and we are or-
ganized to go with it. Our aim now should be to
cast off all things that so easily beset us, and step
boldly into the van. We are held back mainly by
one conservative feeling I do not say that in
derision, for medicine, to be sound, must always
be conservative ; we are held back by the idea that
alcohol is a necessity, not for health nor for the
healthy, but for our work in the treatment of dis-
ease. We are none of us in this society out of
sympathy with this sentiment, though it be but a
sentiment. We all claim the right to use alcohol
if, in our hearts, we believe we save life by it, sa.ve
suffering, or lessen affliction. We merely contend
and this is the point we want our fellow-laborers
to recognize that it must be used secundum artem.

As a therapeutical agent, I have never excluded
alcohol from my practice. But this is what I have
done for nine years past : I have, whenever I
thought I wanted its assistance, prescribed it pure-
ly as a chemical medicinal substance, in its pure
form, in precise doses, in definite order of time;
as I have prescribed amyl nitrite, or chloroform, or
ether, so I have prescribed alcohol.

By this method I have an absolute experience of
the clinical use of alcohol, which, I think I may
safely say, does not belong to many other prescrib-
ing physicians. There are thousands of physicians
who, in the same time, have probably prescribed



24 AN INAUGURAL ADDRESS.

alcoholic fluids a hundred times to my single time;
but if they were to be asked the precise doses they
have ordered, the actual purity of the substances
they have ordered, they would be -quite unable, in
most cases, to answer at all. So many ounces of
wine, so many ounces of brandy or whisky, really
means nothing at all that is reliable. Therefore an
absolute experience of alcohol, and that only, is a
novelty. When I order alcohol, I prescribe so
much of it as I think or know will produce the de-
sired effect, directing the specific gravity of the
fluid to be '830, which is not absolute alcohol, ab-
solute alcohol being 795, but which is sufficiently
near to be reliable. This is the alcohol commonly
retailed as absolute alcohol, and is made without
the expense and trouble of removing the last por-
tion of water.

Used medicinally in this manner, the therapeuti-
cal action of alcohol may be soon reduced to a
positive method. There is no ambiguity of ac-
tion about it at all. It is as easily manageable as
chloroform, and is as definite in result as mercury,
or iodide of potassium. The differences of state-
ments as to its influence in disease are, in fact, one
and all due to the unscientific and utterly fallacious
mode of ordering it as wine, or spirit, or beer, with-
out regard to quantity, quality, or admixture ; for
when it is ordered in that way the percentage of
alcohol is unknown, the fact that there is no other
alcohol save the ethylic is unproven, and the other
disturbing agents that may be present, in the way
of ethers and acids, are not calculated for, though
they may be very important



THE MEDICAL PROFESSION AND ALCOHOL. 25

From the simple method and scientific course
pursued, I may say that when alcohol is prescribed
for the sick in a positive mode in relation to quanti-
ty, quality, and purity, so that nothing but the ac-
tion of ethylic alcohol is brought under observation
after the administration, the phenomena which fol-
low are singularly corroborative of the physiologi-
cal facts which have of late years been made known
as to its action on healthy bodies. It is probable
indeed that the influence of no other medicine in
the pharmacopoeia can be more correctly read by
the light of physiological learning than alcohol.
The chief difficulty that attends the administration
for securing positive results lies in the circumstance
that so many persons have accustomed themselves
to the use of it in varying quantities, there is no
standard dose applicable to the community at large
for ensuring the precise degree of action that may
be desired. We are often in the same condition in
respect to this drug as we are in respect to opium,
when on rare occasions we have to treat a person
who is addicted to the daily use of opium.

When, however, we have under treatment those
who are not accustomed to alcohol, the results are
regular and decisive. Then the dose of half a fluid
ounce, by measure, of '830 ethylic alcohol adminis-
tered to an adult is, as a rule, sufficient to produce
a brief temporary action. The action commences
within ten minutes after the fluid is taken, and the
first sign of its action is detectable in the circulation.
The action of the heart is quickened, the rate of
quickening being distinct even when the pulsation
is previously quickened from disea.se. The rate of



26 AN INAUGURAL ADDRESS.

increase runs, as a rule, from five to seven pulsa-
tions per minute, and even in cases of permanently
slow pulse the rule is maintained, as I found in the
instance of a member of my own profession, who
has a permanently slow pulse of thirty-five. With
this rise in the pulse there follows the temporary
elevation of surface warmth, and all the other signs
and subsequent effects of that ephemeral fever from
alcohol with which we are so well conversant; a
fever which, in some respects, resembles a mild
ague, and in other respects a hectic. By the use
of alcohol in this pure form we learn with much
accuracy its effects when it is administered in miner


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Online LibraryBenjamin Ward RichardsonTen lectures on alcohol → online text (page 19 of 23)