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Medical Men and the Temperance Cause.

By John Blackmer, M.D.

The Temperance reform is the great event of the nineteenth century. It is so fraught with the hopes and the destinies of our people and the race, that its importance can scarcely be overestimated.

No man can escape a degree of responsibility for the advance and success of this reform. But there are those whose position and relations to the community are such as to make their responsibilities great and their action especially important.

This is emphatically true of medical men. They are supposed to know what the system needs; what will prove a benefit, and what an injury; what will strengthen and what will weaken; what will build it up and what will break it down. They should, therefore, keep constantly in mind the fact that by frequently prescribing alcoholics, they are not only creating and feeding an individual appetite which, in very many instances, will prove too strong for its possessor to overcome; but they are also nourishing and strengthening the popular notion that some form of alcoholic is adapted to almost every ill to which the human flesh is heir.

The physician thus becomes a most potent educator of public sentiment in favour of alcoholics, a most valuable ally to the liquor dealer, and one of the greatest impediments to the progress of the temperance reform.

If this position is a necessity of his profession, he should accept it regretfully, and do his best in other fields to atone for the wrongs done in this; but if the use of alcoholics, now so alarmingly common among medical men, is largely the result, of routine practice, or a matter of convenience, or a yielding to the tastes and wishes of patients and friends; and especially if, after careful investigation and patient study, it shall appear that the free or the ordinary use of these articles is inconsistent with the soundest principles of medical science, then, certainly, his own self-respect, his regard for his patient, for his profession, and for the community, as well as the claims of the temperance cause, should prompt a radical change of position and practice.

We do not, at present, purpose to notice that small class of practitioners who, without any regard to hygienic law or pathological condition, are inclined to prescribe alcoholic remedies as Barnum would use water, viz. "externally, internally, and eternally," in every conceivable case.

The majority of intelligent physicians who prescribe intoxicants at all, do so first in low forms of disease, especially in the latter stages of typhoid fever and other disorders where the vital powers seem to be failing. These are almost invariably employed in such cases on the theory that they act as diffusible stimulants, and thus help to revive and restore the waning powers. But recent investigations have given us new light upon the modus operandi of these agents; and it now seems to be pretty clearly established that the prime as well as the secondary effect of alcohol is to deaden the sensibility of the nervous system, or rather that it is, from the first, narcotic in its action, and not stimulant. It is true that the pulse is accelerated and page 60 the heart's action quickened, but this is due to the paralyzing action of the alcohol upon the terminal nerve fibres, thus allowing the capillaries to be engorged, and a portion of the resistance to the heart's action being by this means removed, its rapidity is, of course, increased, not by the addition of new force, but by a diminution of the resisting power.

Alcohol, then, must be regarded as a narcotic first, last, and always; and when a real stimulant is desired it must be sought elsewhere.

But if the advocate of alcohol still declares that this partial narcotism lessens the sensibilities and abridges the waste of tissues—results frequently most desirable—we think he must also concede that all this can be as promptly accomplished with other remedies that are not open to the same objections.

The author of this article has been in active practice more than twenty years. During the first decade he was in the habit of prescribing alcoholics under the circumstances alluded to, as almost all physicians then did, but he began to doubt the wisdom and propriety of the course, and during the last decade he has rarely made a prescription of this kind; and although unable to furnish statistics, he is quite certain that the percentage of recoveries during the last ten years will not fall short of the preceding.

The British Medical Journal of 1865 says: "We feel bound to say that on the face of it, the teetotallers have, from a scientific point of view, the best of the argument; it is certain that our greatest and most esteemed authors have come to the conclusion that it (alcohol) is not assimilated, that it does not undergo decomposition in the body, but on the contrary, is eliminated as alcohol from the body." But, in addition to the established theories and settled convictions of eminent medical men who have given this subject careful thought, we confidently invite attention to the actual experience of men in all ages of the world's history: from the day that Daniel stood before king Nebuchadnezzar and demonstrated in himself and his associates the superiority of cold water and pulse over wine and the king's meats, down to the latest encounters of modern times, where muscle or brain, physical or mental superiority, has been demanded, the entire written and unwritten testimony of human experience is that alcoholics are not only not required, but are decidedly pernicious if the object is to strengthen or build up the human system. Is it not, then, quite time that Old Plantation Bitters and that entire class of so-called remedies were entirely confined to empires and completely excluded from the materia medica of the regular profession?

Once more, there are probably very few, even in the ranks of the medical profession, who are aware to what an extent alcoholics are prescribed from mere routine. It is so easy to fall into ruts that many do so, and continue therein, without even discovering the fact. There are very few physicians who do not have what are known as favourite remedies which they prescribe, not in a single class of cases alone, but in a great variety of cases that do not present positive and distinctive features. It is said that when a famous physician of Philadelphia was in the height of his fame, he would, ere a patient had half told his story, dash down his prescription—"ten, ten," which his favourite apothecary understood to be ten grains of calomel and ten of jalap.

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Not a thousand miles from Boston, a physician of some celebrity was attending to his morning callers by rotation, when a country physician who had come in with a patient and was waiting his turn, noticed the recommendations of the celebrity in some half a dozen very dissimilar cases, and observing that whisky formed an ingredient in each instance, ventured to inquire what feature in those diverse cases called for the same remedy; when the prescriber was somewhat surprised to learn that he had actually recommended the same remedy in cases so very unlike.

There are very few intelligent physicians at the present day who believe that alcoholics are a panacea for all the ills of humanity, and yet there are many whose daily prescriptions would seem to indicate that such was their view.

If the imperfections of human nature are such that some degree of routine practice muse be expected, the physician should, at least have a care to fall into that which is harmless; and he should recognize the fact that the alcoholic routine is most dangerous and destructive, because even if the real article were valuable, there is no other class of remedies where adulterations are so common, where sham is the rule and not the exception, and where when a prescription is made so slight, an idea can be formed of what the patient is swallowing; there is no other class of remedies where the patient is so apt to cling to the remedy after the necessity for medication has passed and there is no other that leaves in its train such a fearful catalogue of results.

It is to be feared that there is yet another class of cases in which intoxicating liquors are prescribed by not a few physicians. I refer to those instances in which the patient makes his own prescription, or if that is stating it too strongly, I will say those cases where prescriptions are made to suit the desires or tastes of the patient. Alcoholics are far more agreeable to most men than other remedies. The taste is pleasant to many, and the exhilarating effects are pleasant to still others. The physician, of course, likes to please his patient; and if he believes that his directions on regimen will prove effectual in spite of the so-called remedy, he is inclined to yield to the patient's wishes. The latter comes with the inquiry whether a little wine or gin or brandy will not be advisable. The physician is not so obtuse as not to perceive what he wants, and he frequently yields to the suggestion when he does not doubt that some other remedy would be far preferable. He is not besieged in this way respecting any other remedy. No one comes to inquire whether it would be best for him to go on to a course of belladonna or strychnia, but this fishing for an alcoholic prescription is of almost daily occurrence, and is far too frequently successful.

No one who has studied the alcoholic problem can doubt that the medical man holds the key to the position to-day. Remove the medical prop from the alcoholic structure, and you destroy its main support.

We want, then, in the temperance reform to-day, the vigorous and consistent support of medical men, not a support that is inconsistent with the duties of their profession, but one that is perfectly in accord therewith.

We could to-day dispense with whisky, brandy, wine, and gin without serious loss to our medical armory. In the present state of page 62 science we need pure alcohol in preparing our tinctures, essences, and extracts, but the other intoxicants might all be wiped out without impairing our ability to meet and successfully treat disease.

If the profession, with united voice, would make this declaration and abide by it in practice, the way would be fairly opened for the complete prohibition of the manufacture and importation of all intoxicants save alcohol; and this accomplished, although many a hopeless sot would continue his potations on this fiery beverage alone, there would be no beginners, and the coming generation would be saved.

We earnestly appeal to our medical brethren to consider well their position and responsibilities, and act with a view to the advance of true medical science, and in the interests of humanity.