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REMARKS ON CERTAIN RECENT PAPERS ON THE

ACTION OF ALCOHOL.

BY DR. ANSTIE.

PART II.

THE influence of alcohol in reducing temperature is a fact so contrary to preconceived ideas that until within the last few years it was never even suspected. The first decided demonstration of it was given by Lichtenfels and Fröhlich in 1852. Their experiments were made with moderate doses upon healthy persons, and the reduction obtained amounted only to some fractions of a degree (Centigrade). In 1866 Tschechechin, and in 1867 Möller, experimented on animals with larger doses, and obtained more considerable reductions; and in the meantime Ringer and Rickards (1866) had independently carried out their well-known series of experiments upon healthy and also upon sick persons, fully demonstrating the general fact of the lowering of temperature, and going more into detail as to the varying results under different circumstances.1

The attention of Professor Binz was drawn to the subject while he was still unaware of the researches of Ringer and Rickards; and at his instigation M. Cuny Bouvier made a series of experiments, in the laboratory at Bonn, with very decided results. On healthy men and on animals alcohol in moderate doses produced a small, and in larger doses a considerable, reduction of heat. Moreover, a dog which had been thrown into a pyrexial state by the injection of pus into the subcutaneous tissue, had its abnormal temperature markedly reduced by three considerable doses (each about 1 drachm

1 Lancet, 1866, vol. ii.

absolute alcohol, with water), the lowering amounted to more than two degrees in all. The alcohol was then discontinued, the temperature rapidly rose again, and went on rising till death.

Since that time the subject has made great advances under the direction of Binz1 and his pupils, especially Bouvier, who in 1872 published a more extended work upon alcohol,2 in which the temperature question was again summed up. Finally, at the recent meeting of the British Association, Professor Binz, though necessarily in somewhat popular style, laid down, as the definite result of recent experimentation, that alcohol always reduces temperature, but that this effect was most readily perceptible in fevered persons, in whom the bodily heat was much above the normal line. In this respect, be it remarked, he differs from the conclusions of Ringer and Rickards, who did not find such marked reductions of heat in fevered as in healthy persons.

As the one notable exception, in its results, to all recent inquiries that have been made in a truly scientific manner, I must mention the inquiry of Dr. Parkes (1871). That eminent observer failed to find any constant reduction of temperature from the use of alcohol; indeed, on the whole, his results seemed to point rather the other way. We shall return to his papers presently; but I must mention that Parkes's experiments were made only upon a healthy man previously very temperate in the use of alcohol.

I cannot help pausing here to remark on the singular and even grotesque course which English popular medical opinion has taken upon this question of alcohol in pyrexia, since the death of Todd. His observations, which were doubtless inexact (for medical thermometry did not in his time exist), have been declaimed against in every variety of tone; but the special reproach against them has always been that they were "not truly scientific." Loud as this outcry has been, I am not aware that (before Ringer and Rickards) a single English medical

1 Ueber die antipyretische Wirkung von Chinin u. Alkohol. Virchow's Arch. B. 51, 1870.

2 Studien über Alkohol. Bonn, 1872.

3 Transactions Royal Society.

observer (one or two of Todd's pupils excepted) had ever put to the simple test of the thermometer Todd's main allegationthat alcohol reduces febrile temperature by its direct action. On the Continent, however, things have gone very differently. In France, the observations of Behier and of several of his most distinguished pupils, have affirmed the power of alcohol to reduce pyrexial temperature from clinical evidence; and Demarquay (as far back as 1859) had shown by physiological experiment that alcohol was on the whole a cooling agent. In Germany, as we have seen, there has been a catena of evidence to this effect, ever since 1852, and a great impulse was given to the inquiry by Todd's "empirical facts," as Binz calls them --which, it was felt, demanded an accurate sifting. The practical result is sufficiently remarkable. That very portion of Todd's practice which has excited the fiercest condemnation in this country, viz., his administration of very large doses of alcohol, in conditions of high pyrexia, turns out to agree best with the results of physiological investigation, and has in practice been endorsed by such eminent physicians as Liebermeister, Binz, Socin, and many others. The Franco-German war gave abundant occasion for testing this matter; and it was fortunate that Professor Binz received a high medical military post, and that such men as Socin and others, who also filled important medical posts in the war, were willing to carry out his plans with vigour. Those who are acquainted either personally or through his writings with Professor Socin, are aware that a more accomplished observer is not to be found in Europe; it need, therefore, hardly be said that his war-experiences of the treatment of pyæmia, erysipelas, &c., possess an uncommonly high value. It is therefore a matter of much importance that we find him stating that in the severe septicamic wound-fevers he not only employed quinine in the enormous daily quantity of 67 grammes (90 to 105 grains), but at the same time gave three bottles of wine every day. Under this treatment he saw many unexpected improvements and even recoveries; and he

See, especially, Godfrin, "De l'Alcohol," &c. Paris, 1869.

Professor of Surgery in Basle.

3 Kriegschirurgische Erfahrungen gesammelt in Carlsruhe, 1870 and 1871. Leipzig (Vogel), p. 27.

declares that the wine not only increased the lowering effect of the quinine on the temperature, but that it also much moderated the toxic effects, i.e. the "cinchonism."

Erysipelas was also a disease that came very largely under Socin's observations at Carlsruhe; and he speaks here in a different manner. He especially remarks that quinine had but little or no effect in reducing temperature, and all remedies appear to have been unavailing to reduce the temperature very markedly. Nevertheless, the patients supported the high temperature particularly well; and he attributes this, at least in part, to the administration of three to four bottles, daily, of champagne and sherry mixed.1

I think it is not too much to say that such experience, related by a man like Professor Socin, of the treatment of diseases like erysipelas occurring in wounded men of previously healthy life, is sufficient to render completely worthless the whole mass of criticism which was levelled at Todd for his supposed enormities in the way of dose. Here are certainly all the conditions of a so-called "sthenic" febrile disease; yet they were habitually and successfully treated with enormous doses of alcohol-such, indeed, as Todd never, or almost never, gave. I do not at all say that it decides the controversy as to the treatment of fevers by alcohol. But it certainly, in my opinion, sweeps the arena of discussion perfectly clear of the à priori arguments which have been urged by the so-called "moderates" during the reaction since Todd's death, and leaves it open for a perfectly new discussion of the subject.

To return, however, to the subject of the cooling influence of alcohol in pyrexia. The researches of Binz have gone far to prove that this is not exerted through the heat-regulating centres. In his papers in Virchow's Archiv. (1870) will be found the record of experiments in which the possible interference of such a cause was elaborately provided against. And the general result of his inquiries is to reinforce, more strongly than any other researches have done for a long time, the opinion that alcohol, while itself oxidised within the blood with great

1 Op. cit. p. 85. "In Carlsruhe. . . . liessen wir solche Fiebernde, mit dem besten Erfolg, 3-4 Flaschen eines Gemisches von Sherry und Champagner täglich zu nehmen."

rapidity, hinders the oxidation of the tissues. Hence it can be easily understood that the effect of alcohol in lowering temperature would be seen most plainly in the febrile diseases, where the tissues are being violently consumed, while the supplies of ordinary nutriment are necessarily very small. Such, in fact, proves to be the case, and Dr. Binz has recently informed me (last August) that whereas in smaller doses, e.g. one ounce of wine or half an ounce of brandy, it is usually not possible to obtain a reduction of more than a few decimal parts of a degree, and the dose must be frequently renewed to maintain the effect, he has found that the influence of a very large dose has sufficed to produce a reduction amounting to several degrees. Whether this be, on the whole, the best method of relieving pyrexia by means of alcohol, is a question which will be found more fully investigated in my new researches, which will shortly. be published.

6. Another question of great moment which also requires the attention of the profession, is whether alcohol reduces the excretion of urea, and the special relation which this reduction bears to the existence of the fevered state. The experiments of Dr. Parkes in 1871 have, since that time, constantly been cited as evidence against the possession, by alcohol, of any power to diminish the urea. It is therefore very necessary that we should remember accurately what these experiments proved. The subject of them was a very healthy soldier of unusually temperate habits. He was submitted to two successive investigations, the first being made with alcohol diluted with water, and with brandy; the second being made with Bordeaux wine: but as the results appear to have been substantially the same in both series of trials, we may take the first, in which the effects of alcohol and of brandy were successively tested. The result may be simply stated as altogether negative: no reduction of urea elimination was observed. So far, then, as the observations go-and I need scarcely say that all Dr. Parkes's work of this kind has deservedly the highest possible reputation for conscientious care and accuracy-all one can say is, that they stand in marked opposition with the results obtained by a number of very eminent authorities. But what are the facts really shown? Merely, that in a man who was in good health, and was taking a normal

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