"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 quant.i.ty 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 ca.n.a.l 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 ma.s.ses 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 ill.u.s.trated 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 pa.s.s through the lymphatic s.p.a.ces 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 quant.i.ty 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 quant.i.ties are entirely without influence in the same direction. It has, indeed, been shown by Dr. Ridge, that even infinitesimal quant.i.ties 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 quant.i.ties, the growth of both animal and vegetable protoplasm is r.e.t.a.r.ded. 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 a.s.sociation, gave a masterly address in London upon "Recent Researches on the Action of Alcohol." The lecture was ill.u.s.trated 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 ma.s.s 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 c.h.i.n.k. 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 ma.s.ses 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 a.s.sociated 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 Ma.s.sart, 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 a.s.sumes 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. Ma.s.sart 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 s.p.a.ce; here the leucocytes are not numerous, indeed they are very spa.r.s.ely 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 ma.s.s of micro-organisms, localizing, or attempting to localize, such ma.s.s. So long as the leucocytes can make their way to this ma.s.s, 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 c.u.mulative 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 p.r.o.nounced 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 _Inst.i.tut 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 cla.s.s 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 cla.s.s 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 ill.u.s.trate 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 princ.i.p.al 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, teta.n.u.s and anthrax.[B]

To these rabbits he first administered a quant.i.ty 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 quant.i.ty 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 teta.n.u.s, however, we are carried a step further. Dr. Delearde repeating his immunizing and alcoholizing experiments, but now working with teta.n.u.s 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 teta.n.u.s and afterwards alcoholized lose their immunity against teta.n.u.s;

(2) "'That animals vaccinated against teta.n.u.s and at the same time alcoholized do not readily acquire immunity;

(3) "'That animals first alcoholized and then vaccinated may acquire immunity against teta.n.u.s 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 Ma.s.sart 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 Inst.i.tut 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 a.s.sociated 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 ill.u.s.trated 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 ma.s.ses 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.