Studies on the Action of Alcohol in Disease, Especially upon the Circulation

RICHARD C. CABOT
1903 Boston Medical and Surgical Journal  
Perhaps no subject has been more frequently or 'bore heatedly discussed during the last few years than the action and value of alcohol. We have 'lad two interesting symposia upon the subject in »OBlon within a year, und many similar discussions j^e reported in domestic and foreign journals, "e might think, therefore, that the subject was ftbout threshed out and that nothing new could be Silid about it, but ¡is one looks over the reports of »hese discussions one fact is very striking, and that
more » ... the scarcity of experimental evidence regarding 'ue action of alcohol in diseased human beings. lu the discussions to which 1 have referred, the "'Sputante have usually ranged themselves in two Parties, those favoring the use of alcohol on one Bide ¡uid those opposed to its use on the other. Pilose who favor its use usually do so on the ground°* their general impression that it has done good 1,1 cases under their observation. Those opposed 0 the use of alcohol usually refer to a number of B3EPeriment8, for the most part not very recent°> ies, upon the action of the drug in the lower :ninii:ds. Hut very rarely has any one anything to 8ay about experiments or measurements of the action of the drug upon any of the functions of the diseased human being. The " advocates of aloo-J°l" say that it does good, but if you ask them : "hat good does it do? Does it decrease temperature? Docs it improve sleep? Does it slow or U'engthen the heart's action, and if so how much ? -J1' l ey have rarely anything to answer. On the other 'and, if you ask the "opponents of alcohol" what ua,'in it does they will point to the effect produced°u a dog or a rabbit by doses of alcohol which voitl(I correspond to giving a man a quart of Whiskey at a drink, or they will refer you to experiments on healthy soldiers or typesetters. The use such evidence assumes that alcohol acts in the j£ffle way in all animals; whereas we know well . 'ut its action in mammals is very different from ls action in birds, and have by no means proved "at is true of its action in dogs or rabbits is true . 'ts use in man. Another common assumption 8 that the effects of alcohol in disease are similar 0 'ts effects in health. But this is a totally "Proved assumption, and there is, 1 think, a good°! d of evidence that it is not true. *t seems to me, therefore, that there is a real ., ed for exact experimental evidence regarding 0 action of alcohol in sickness, and it is to this ' "Wem that I have addressed myself. I have not , "ght to show that alcohol does good or that it ((00s harm. I have rather tried to find out what it 1 s) what its effect is upon temperature, upon the Wt and pulse, upon the rapidity of the respiration, •°" the amount of urine, upon the sweat, upon _~L aPpearanoe of the tongue, upon the appetite 8|°P .on tlle cerehral condition of the patient as°W l> in the amount he sleeps, in the effect of the drug uiioii delirium, and upon his spirits so far as could be ascertained by talking with him. I will not deny that I have approached the subject with a marked bias, but I hasten to add that I have done all I could to prevent this bias from influencing my observations. That I have succeeded, at least to some extent, is evidenced, I think, by the fact that my results have not come out at all as I expected and indeed hoped that they would. In order to counteract so far ¡is possible the bad effects of my prejudices, I have recorded each of my observations on separate slips of paper without allowing myself to refer to the chart in which they were later recorded. As I could not retain in memory the records of the individual patients, and did not allow myself to be reminded of them by looking at the chart, 1 was thus unable to influence the readings in the direction of my expectations, as I previously found it very tempting to do. In the study of the effects of alcohol on temperature, appetite, sleep, etc., I have circumvented my bias by getting nurses, who had no idea of what I had in mind, to record the data for me on blanks provided for the purpose. I have said that there was a dearth of experimental evidence regarding the action of alcohol in diseased persons, but this hick is much more striking in certain directions than in others. Certain points have, I think, been pretty well cleared up, while others are still obscure. Hence it may not be out of place to sum up what may be regarded as relatively settled, in order that the unexplored regions may be made more evident by contrast. About the food value and the digestive action of alcohol, about its effect on temperature, respiration, the secretions and the susceptibility of the lower animals to infection, there is a good deal that we may consider settled. On the other hand, there are very few experiments upon its action on the circulation of the sick, or upon the protective powers of the human blood against infection. These two problems, then, confront us : (1) What effect has alcohol upon the circulation in sick persons? (2) What is its effect on the power of man's blood to protect his organism against infection? The first of these two questions I have tried to answer in the present lecture. The second I hope to attack later. Before presenting the results of my own experiments I will endeavor to summarize what seems to me established as the result of work previous to my own. We may treat as established the following statements : I. ALCOHOL AX» METABOLISM. (1) In healthy persons alcohol is capable of replacing satisfactorily the fats and carbohydrates of ordinary food. (2) It is not yet settled whether or not alcohol can replace the protcids of our customary diet. (3) The food value of alcohol ¡is a substitute for carbohydrates and fat is perfectly consistent with its toxic properties. It is beyond doubt both a food and a poison.
doi:10.1056/nejm190307231490402 fatcat:aakubzprxff7nakvspurwnf4dq