ADDRESS 
DELIVERED AT THE 
ANNUAL MEETING 
OF THE 
RHODE ISLAND MEDICAL SOCIETY, 
J une 1 1 th, 1 879, 
BY T IT K PRESIDENT, 
Edward T. Caswell, A. M„ M. D„ 
OF PROVIDENCE, R. I. 
PROVIDENCE: 
E. L. FREEMAN & CO., PRINTERS. 
1 8 80. ADDRESS 
DELIVERED AT THE 
ANNUAL MEETING 
OF THE 
RHODE ISLAND MEDICAL SOCIETY, 
J une 1 1 th, 1 879, 
IB Y THE Tit E S IDT'e N X, 
Edward t. Caswell, a. m„ m. d„ 
OF PROVIDENCE, II. I. 
PROVIDENCE: 
E. L . FREEMAN & CO., PRINTERS. 
1 8 8 0. ADDRESS. 
Gentlemen of the Society : — 
We are once more assembled to celebrate this, our annual 
festival, and it gives me pleasure to welcome so large a number 
of our own members, and the delegations from other similar 
societies, and from the distinguished association,* which is now 
holding its annual session in this city. Your Secretary has 
shown you that not a few of those, who have been accustomed 
to join with us in these gatherings, have during the past year 
been called to their final account. Among those was he, who 
a year ago to-day was the oldest member of our Society,! who 
for more than half a century had gone in and out among us ; 
who had held important offices in your organization, and dis- 
charged faithfully, for a long period of years, the responsible 
trusts committed to his charge. These vacant places admonish 
us all to emulate the virtues of those that have gone before us, — 
and lt to work while the day lasts.” 
In this connection I trust you will pardon me, if I seize 
the opportunity offered to state, in anticipation of the subject 
which I propose to bring before you, some points in connection 
with the management of our Society, in which I think there is 
room for improvement. I venture upon these suggestions in all 
* The American Association of Superintendents of Asylums for the 
Insane. 
f Dr. S. Augustus Arnold. 4 
modesty, and can only say that they have long been in my mind. 
Although I do not propose at the present time any special 
action, they may yet find a lodgment in your own thoughts, and 
at some later day bring forth fruit. 
Our Society is formed for the purposes of mutual improve- 
ment in our profession, and for social intercourse. It is the 
first of these objects that is ever dominant, and it seems to me 
that it is the one wherein we more especially fall short. There 
is not that readiness on the part of our members to contribute, 
each one in his turn, his own share to the general interest of 
our meetings. The experience of the past year has shown 
me that it is no easy matter for your presiding officer to 
provide papers and subjects for discussion for each quarterly 
meeting. Members are not sufficiently ready to respond to 
invitations to prepare papers; they do not come forward with 
alacrity to discuss those that are presented, nor do they bring 
enough of their own experience to the knowledge of their 
fellow-members. I trust you will not misunderstand my 
words, which are dictated by no captious spirit, but rather 
by the desire to arouse each and all of you to emulate 
each other in adding your own mite even, if no more, to the 
general spirit of our meetings. There is no one of us who 
cannot, from time to time, bring something that would in- 
terest and instruct us all. If we could free ourselves from 
the idea that the chief objects of our existence are to amend our 
By-Laws, though it must be allowed they sadly need it ; to 
discuss questions of ethics, all of which are summed up in the 
Golden Rule; and to deal with questions of parliamentary law; 
if we could give the time that has been allotted to these matters 
to scientific subjects, we should, I think, be greatly the gainers. 
Of course these subjects must occupy our attention to a degree, 
but I would have them restricted to the smallest possible limit. 
And this brings me to a second suggestion. 
It has for a long time been a source of great mortification to 
me, that at this, our annual meeting, when we expect to be 
honored with the presence of delegates from other societies, we 
have so little to offer in the way of intellectual entertainment. 5 
To have gentlemen come from Maine and New Jersey, and all 
of the states between, and sit here while we ballot for officers, 
and go through the long list of our reports of committees; to 
have them listen, as they have more than once been obliged to 
do, to our discussions of amendments to our By-Laws, and 
various matters of a purely local interest, and then to have them 
leave without hearing one single word on those matters which 
pertain to our profession, it is, as I say, mortifying. As matters 
now stand, it seems in a certain degree inevitable. , 
The machinery of this Society has now been running nearly 
seventy years, and we may well suppose that by this time some 
improvements have come to hand, or that some parts have been 
worn out and need to be replaced. When this Society was 
organized it numbered forty-nine members, and now we have 
one hundred and seventy-five. We have, I think, outgrown the 
modes and methods that served a good purpose in our infancy. 
It would probably be useless to suggest the idea of our annual 
meeting embracing two days, one for business and one for 
scientific papers. The State Societies which adopt this plan, 
have, I believe, but one meeting in the year, while we have 
quarterly meetings. I am not prepared, nor is this the fitting 
time to present any matured plan, but I have thought that if 
all the routine business of the Society, including the election of 
officers, could be delegated, as it is in Massachusetts, Con- 
necticut, and New Jersey, to a smaller body, as a committee, 
whose meeting should be in advance, and whose report should 
be final and accepted, it might be greatly to our advantage. 
And I say even this much with great diffidence, because I know 
how delicate a matter it is to deal with. I wish especially, how- 
ever, to draw your attention to the subject, and trust that it 
may dwell in your minds, until some wise and acceptable 
modification of our present system may commend itself to all 
of us. 
There is but one other point which I wish to bring to your 
notice and that is whether we could not with advantage change 
the clay of our annual meeting to the second Thursday in Juno 
instead of the second Wednesday. I know that we have had to 6 
submit to several changes hitherto in order to avoid the Com- 
mencement of Brown University on the one hand, and the 
meetings of the American Medical Association on the other. But 
now for a series of years we have held our meeting on the same 
day with our neighbors of the Massachusetts Medical Society. 
Our proximity would naturally lead to something more than 
the formal representation, which now exists, but as it now stands 
they can neither come to us, nor can we go to them. I am sure 
that many of us covet the opportunity of attending those 
extremely interesting meetings, and many of the distinguished 
members of that Society have kindly expressed the wish that they 
might be present with us. I leave this suggestion therefore, 
with the others for your future consideration, and with the hope 
that you will not think that I have thereby transcended the 
privileges of my office, I turn from these matters and pass to 
the subject which I have selected for your consideration. 
There are at times waves of popular feeling, which passing 
over Society, stir it to its very depths. There are crises of public 
sentiment, which turn the tide of opinion, away from the deep 
worn channels, in which it has run for generations, into fresh 
broad openings, where it flows with ever-widening stream. Such 
seems to be at the present moment the movement towards total 
abstinence in England. There have been, from time to time, 
outbursts of energy on the part of those who have had these 
principles at heart. But at no time, I fancy, has there been any 
such united action pervading all classes of society, the rich, and 
the poor, ihe noble and the commoner, the professions and the 
tradesmen, as is seen at the present day. Canon Farrar recently 
stated that four millions were enrolled in England under the 
banner of total abstinence, and new additions are daily being 
made. The prominence which the subject takes has led to an 
expression of opinion on the part of . our own profession, and 
numerous articles by different medical men of an acknowledged 
position have appeared in the pages of the Contemporary, and 
other periodicals. At the same time two or three new works on 
the subject of alcoholism have been brought out, both in 
England and in Germany, presenting the subject from a strictly 7 
scientific point of view. I have thought, therefore, it might be 
well to take a survey of some of these various contributions, 
and see, if we can, what is really the most enlightened view of 
these subjects at the present day ; what there is that may so far 
commend itself to the sound common sense of this generation 
as to ensure its hold upon their life and conduct. I propose, 
therefore, to consider the present phase of the 
ALCOHOL QUESTION FROM A MEDICAL POINT OF VIEW. 
I do not, however, intend to read you a temperance lecture, 
nor to present myself as the avowed advocate of any theory. 
It is not my plan to depict the horrors and crimes that are laid 
at the door of alcohol. As professional men, we come in con- 
tact with it in all its phases, and we know perhaps, better than 
others, the extent of the direful woe which its abuse entails. 
Surely enough too, each one of us, I presume, can point to cases 
in our own ranks, where the most brilliant promise of success, 
the brightest talents, and golden opportunities have been lost for- 
ever by the curse of alcohol. With all the misery and crime that 
stares us in the face, it becomes us as scientific men, as members 
of the body politic, as friends of our race, to give the subject 
most earnest heed, to determine what shall be the rule of our pri- 
vate life, what shall be the course we recommend to our patients, 
and what the means are, by which the terrible evil of intem- 
perance— an evil which has grown amazingly in the last twenty 
years — may be opposed. It must be admitted, at the start, that 
there is no subject outside of theology, in which the holders 
of different opinions have been more violent in the defense of 
their own side, more virulent in denouncing their opponents. 
There is no subject in the discussion of which more contradic- 
tory statements have been made, all of which have been ap- 
parently supported by experiment. And there is none in which 
the rule for each individual is perhaps more potent. Let us 
endeavor to arrive at some conclusion as to the use of alcohol in 
health, and in disease, and to canvass some of the more recent 
views advanced by medical men. 
At the outset of this discussion, I need hardly remind you of 
the almost universal use of alcohol, in some form or other, to a 8 
greater or less degree, among nearly all the nations of the 
globe. Peoples, civilized and enlightened, semi-civilized and 
barbarous, beneath the equator and under either pole, all, with 
few exceptions, have recourse in one way or another, to alcohol 
in some form. The facility with which alcohol may be obtained 
from numerous cereals, legumes, and other vegetable products, 
renders capable the supply of this demand. From this wide- 
spread use some have drawn the conclusion that it was a neces- 
sity; that it supplied a want. Additional support for their 
views is found in the fact that those nations which do not use 
alcohol, as for instance the followers of Mahomet, have recourse 
to other substances, such as opium, hasheesh, and the like, to 
supply the want that is felt. 
I shall not undertake to describe alcohol to you, nor venture 
into the labyrinthine paths with which modern chemistry has 
hedged around its domain. It is sufficient for us to know that 
there are different alcohols known to science, varying in the 
combinations of carbon and hydrogen, and possessing poisonous 
properties in an ascending ratio, as the proportion of these 
elements increases. Common alcohol, known to the modern 
chemist as dentylic alcohol, but taught to us of an older day 
as ethylic or ethyl alcohol, enters in various proportions 
into the spirituous liquors, wines and ales, with which we are 
all familiar. If these are still further strengthened by the ad- 
dition of the stronger alcohols, then is their capacity for injury 
increased by so much, until they may rank with the deadly 
poisons. According to the latest tables published by Dr. Green- 
field and others, Brandy and Whiskey contain from 50-G0 per 
cent, of common alcohol ; Bum from GO-77 per cent, and Gin 
from 49-60 per cent. Of the wines, the heavier, as Port, 
Madeira, and Sherry contain from 1G-25 per cent, alcohol; 
Clarets from 8-17 per cent. ; Burgundy and Sauterne from 
10-14 percent.; Rhine Wines from 9-12 per cent., and Cham- 
pagnes from 5-13 per cent. Ales contain from 3-9 per cent., 
and Beers from 2-6 per cent. Dr. Parkes gives it as his 
opinion that an ounce and a half of alcohol is as much as can 
be taken daily without evident ill effects. This amount may 
be represented by two or three glasses of the heavier wines, or 
by a half-pint to a pint of the lighter wines, or of ale or beer. 9 
With these general statements with regard to alcohol itself, 
let ns proceed to a cursory consideration of the questions, how 
does alcohol behave when it is introduced into the system, and 
what becomes of it ? What are the effects of acute and chronic 
alcoholism ? When taken into the stomach, diluted with water, 
alcohol is absorbed, entering the veins and passing into the cir- 
culation. Its first effect is to quicken the action of the heart, 
and increase its force, at the same time diminishing its periods 
of rest, thus giving the heart more work to perform. With this 
action of the heart, which tends to increase the amount of 
blood sent forward, its effect upon the vascular system, through 
the vaso-motor system of nerves, is to dilate the capillaries, 
thus retarding the progress of the blood in its onward course, 
and causing the heart to exert still more force. Thus is ex- 
plained the flushed face which is characteristic of the earlier 
stages of alcoholic excitement; and Dr. Richardson says the 
same flush would be found in the brain, stomach, lungs, and all 
the organs of the body. If the dose of alcohol is frequently 
repeated, this continuous dilatation of the capillary system leads 
to a condition of paralysis of the walls, and produces effects 
which we shall shortly notice. 
As to what becomes of the alcohol when taken into the sys- 
tem, many conflicting views have been entertained. Baer, in his 
recent exhaustive and extremely interesting volume on alco- 
holism, after summing up the evidence, says that in small doses 
it is transformed in the system into carbonic acid and water, 
while in very large doses, when the blood becomes overloaded 
with alcohol, it is in part oxidized, and in part eliminated in an 
unaltered form, by the lungs, kidneys, and skin ; the elimina- 
tion or the oxidation being in excess, according to certain 
circumstances. And Richardson says : “ We are landed then, 
at last; on this basis of knowledge. An agent that will burn, 
and give forth heat, and product of combustion outside of the 
body, and which is obviously decomposed within the body, re- 
duces the animal temperature, and prevents the yield of so 
much product of combustion, as is actually natural to the 
organic life.” And he adds, “ What is the inference? The 
inference is that the alcohol is not burned after the manner of a 10 
food, which supports animal combustion, but that it is decom- 
posed into secondary products by oxidation, at the expense of 
oxygen, which ought to be applied for the natural heating 
of the body.” Hence we see that alcohol is not in itself a 
food, a nutriment; it does not of itself add anything to the 
vital economy. We see, too, one of its most marked effects is 
to use up the oxygen, which as Dr. Richardson says, “ought to 
be applied for the natural heating of the body,” that is, it 
diminishes the temperature of the body. It is true that the 
immediate effect of alcohol is to send a glow through the system, 
but this is succeeded by a reduction of temperature. So marked 
is this characteristic that in cases of deep stupor, if no other 
means of diagnosis were available, the thermometer would 
furnish, I might almost say, an unfailing guide to the true con- 
dition of the case. If a man falls down in an apoplectic stupor, 
the thermometer will show possibly a normal, but probably an 
increased temperature, depending upon the length of time that 
has elapsed. On the contrary, if the stupor is that from alco- 
holism, the temperature will ordinarily be found to be below the 
normal standard. Indeed, so much confidence is reposed in 
this test, that one writer suggests that policemen should be 
instructed in this use of the thermometer, in order that they 
may rightly distinguish these cases. There is something in this 
suggestion, and if it were adopted, we should be spared the 
recital of an experience, which is not altogether single, of a man 
with apoplexy being carried to the station house, and dumped 
into a drunkard’s cell to die. 
I have spoken of the primary effects of alcohol upon the cir- 
culation, showing that it is a stimulant to the heart’s action. 
It affects the brain and the nervous system in a similar man- 
ner. The quickened thought, the ready flow of language, the 
heightened enjoyment, the genial sympathy with all our kind, 
all these familiar phenomena attend the first effects of alcohol 
upon tire brain. It is the over-stimulus of the brain and spinal 
cord, which follows successive doses of alcohol, that produces 
injury of these organs, and, as Baer says, in acute alcoholism it 
is the cerebro-spinal system that especially suffers. 
Again the primary effect of alcohol upon the digestive 
organs is to stimulate their activity. The mucous membrane 11 
of the stomach, “ like the skin of the cheek, is flushed with 
blood,’’ the secretory glands are excited to activity, and the gas- 
tric juice is poured forth in increased quantity, thus aiding the 
digestion if food has been taken. Such, in a word, are the 
primary effects of alcohol. It acts as a stimulant, and diminishes 
the temperature. 
If we now consider the effect upon the body of continued 
and excessive doses of alcohol, we have to bring before us an 
entirely different series of phenomena ; we have to consider 
effects of the most permanent nature upon all the organs of the 
body. The countenance of the toper is stamped, indelibly as it 
were, with the proof of the spirit he has imbibed. The leaden 
hue of the face has been the result of the prolonged and con- 
tinuous dilatation of the capillaries, which have at last become 
paralyzed, and refuse to contract. 
Baer describes minutely the effects of chronic alcoholism. He 
says the blood itself is affected in two ways, physiologically and 
chemically. It contains more serum and less fibrin. There is a 
diminution in the number of blood corpuscles, and in the solid 
constituents, and a large increase of fat cells. Among the 
earliest changes, especially in drinkers of whisky and brandy, is 
catarrh of the stomach ; and one of the most frequent and im- 
portant results of the abuse of alcohol, is ulceration of the 
stomach. The liver suffers most and earliest of the organs, and 
the more in drinkers of brandy and whiskey, than in those habit- 
uated to beer and wine. Next to the liver no organ suffers so 
much as the central nervous system. Fatty degeneration of the 
liver, kidneys and heart, follow in succession, and a large pro- 
portion of all the cases of the so-called Bright’s disease, occur 
among the subjects of chronic alcoholism. No better picture can 
be drawn of the effects of the abuse of alcohol upon the whole 
economy, than has been given by Dr. Moxon. “When,” he says, 
“the sot has descended through his chosen course of imbecility or 
of dropsy to the dead house, Morbid Anatomy is ready to receive 
him, knows him well. At the post mortem she would say, 
‘Liver hard and nodulated, brain dense and small ; its covering 
thick.’ And if you would listen to her unattractive but in- 
teresting tale, she would trace throughout the sot’s body a 12 
series of changes, which leave unaltered no part of him worth 
speaking of. She would tell you that the once delicate, filmy 
texture, which when he was young had surrounded, Jikc a 
pure atmosphere, every fibre and tube of his mechanism, 
making him lithe and supple, has now become rather a dense 
fog than a pure atmosphere ; dense stuff’, which instead of lubri- 
cating has closed in upon and crushed out of existence more 
and more of the fibres and tubes, especially in the brain and 
liver, whence the imbecility and dropsy.” 
With this brief sketch of the physiological and pathological 
effects of alcohol, I proceed to consider its use in disease and 
in health. As a medicine alcohol can lay claim to the highest 
rank. Whatever may be said against its use in this respect, no 
one will deny its potency. The most rigid adherents to the 
party of extremists, would not dispute the power of alcohol. 
From what we have already stated, it will be seen what these 
powers are. 
It is a stimulant of the first order; its effect in small doses 
upon a depressed heart is to increase its action, to carry the 
patient over an impending collapse ; to avert paralysis of the 
heart and brain. By its capacity for absorbing the oxygen of 
the tissues, in large doses, it diminishes the amount of heat in 
the body ; and also by the increased amount of blood which it 
drives to the surface, it promotes the radiation of heat, and it 
also retards the metamorphosis of the tissues. Hence we find 
its use indicated in low conditions, as in protracted illness, to 
support the system, in cases of injury and shock, to stimulate 
and revive the failing powers ; in fevers to reduce the tempera- 
ture ; in cases of gangrenous inflammation to preserve the 
integrity of the tissues. Its use as an anodyne, to woo the fitful 
sleep that hovers around the wearied brain without embracing it, 
in many cases cannot be doubted ; but perhaps there is less to 
be said in its favor as a remedy, in this connection than in 
any other. 
The history of the medical use of alcohol presents one of the 
most striking instances of the changes that come over the gen- 
eral practice of the profession. When, forty years ago, Dr. 
Todd introduced to the profession the alcoholic treatment of 13 
fevers, he was as much alone, as are those who now propose to 
do away with it entirely. Since that day the spectacle has been 
presented of the constant and indiscriminate use of alcohol in 
all forms of disease. And to such an extent has this been 
carried that a large body of distinguished practitioners in Eng- 
land have felt called upon to issue a circular denouncing this 
indiscriminate use, and demanding a much greater restriction 
in its application. Let us see therefore what are some or the 
more recent statements upon this point. 
Dr. Murchison, whose name I cannot mention without ex- 
pressing the profound loss which his recent untimely death has 
brought to the science of medicine, whose vast and laborious 
researches have made him an authority throughout the known 
world, Dr. Murchison says that “ Alcohol is useful in the course 
of most acute diseases, when the organs of circulation begin to 
fail as they are apt to do. A moderate quantity usually suffices. 
In convalescence from acute diseases, or from other weakening 
ailments, when the circulation remains feeble, and the tempera- 
ture is often subnormal; alcohol is also useful in promoting the 
circulation, and assisting digestion.” “All other conditions of 
the system marked by Aveakness of the muscular wall of the 
heart, whether permanent or transient, are usually benefitted by 
alcohol.” This same author is however quoted by Baer as 
claiming a smaller mortality without alcohol in the treatment 
of Typhus and Typhoid fevers. Gairdner coincides with this 
opinion, and especially claims that it is not necessary in the 
young. Chambers says that alcohol is not necessary in the 
treatment of Typhoid fever, and Bennett makes the same state- 
ment with regard to Pneumonia. 
Against this array of names we find that in Germany, Lieber- 
meister considers alcohol next to quinine, and cold baths, as the 
most important means of preserving the heart in Typhoid, and 
Jurgensen says that it is a sine qua non in Pneumonia, that 
every patient should have a variable proportion of Bordeaux. 
In England, Graily Hewitt advises the methodical administration 
of alcohol in cases of Puerperal Fever, in mild cases, from six to 
eight ounces daily; in severe cases two ounces every two hours. 
Breitsky and Conrad, of Berne, after numerous experiments in 14 
the treatment of Puerperal Fever, came to the following conclu- 
sions as stated by Baer: In mild as well as in severe cases of 
Puerperal Fever, alcohol has a positive antipyretic effect, even in 
doses which produce no intoxication. In most cases the decline 
of fever is gained by small doses frequently repeated, (a tea- 
spoonful every half-hour) sometimes more profitably by larger 
single doses. Larger single doses act more quickly and thor- 
oughly than oft repeated small doses ; the effects of the former 
may be seen within the first few hours, of the latter sometimes 
within the same period, sometimes not until after the lapse of 
twenty-four or forty-eight hours. Among those habituated to 
the use of alcoholic drinks, their usual limit must be passed, if 
the goal is to be reached. They consider rum as the best form 
for administration. In the course of four years out of thirty 
cases thus treated, Breitsky found that twenty-six pursued an 
immediately favorable course. 
Mr. Brudenell Carter says, “It is interesting to note that 
nearly every practitioner finds it to be of especial value in that 
particular department of the healing art, in which he himself 
has the largest and the most constant experience. The physician 
describes its efficacy in certain forms of internal inflammation 
and of fever; the surgeon describes its efficacy in conditions 
consequent upon injury.” He then goes on to say that “per- 
haps the most remarkable testimony ever borne to its usefulness 
is that of a distinguished ophthalmic surgeon, Dr. Gustav 
Braun, of Moscow, who a few years ago was accustomed to lose 
no less than forty-five per cent, of the eyes on which he operated 
for cataract in his hospital, that is to say among badly nourished 
Russian peasants.” After trying a number of experiments, he 
“administered a dose of brandy or of sherry to every patient, 
immediately, and repeated it twice a day for two or three days. 
The result of this plan was after a year’s trial, to reduce the 
number of cases, in which the eye was totally lost, from forty- 
five to six per cent., with an additional three per cent, of im- 
perfect recoveries. Nothing was altered in the mode of opera- 
ting or in the other treatment; and Dr. Braun reports that 
the improvement was attributable to the alcohol alone.” 
Baer claims that it is of the greatest benefit in cases where 
great prostration is caused by the disease, where the type, is 15 
adynamic. So it is of the utmost value in Erysipelas, and dis- 
eases of a putrescent nature, as Diphtheria, Gangrene, etc. In 
all these the effect of alcohol is, as Binz says, to reduce tempera- 
ture* diminish the gangrenous processes, and increase the action 
of the heart. Large and frequent doses of alcohol are therefore 
indicated in order to maintain a lower temperature, in all cases 
where it is important to oppose the weakness of the heart, where 
quinine has failed. It is of the greatest use in cases of appar- 
ently unimportant disease, in those who are poorly nourished, 
and whose blood is impoverished, and who are mentally de- 
pressed. He thinks that in all cases of drunkeness, alcohol 
must be administered in order to avoid threatening symptoms 
on the part of the brain, and the heart, if the accustomed 
stimulus is withheld. This view is, however, the subject of 
much discussion at the present day. 
Even Dr. Richardson, that most zealous advocate of total 
abstinence, claims the right to use alcohol as a medicine, and 
although he decidedly prefers to treat fevers without it, yet he 
admits that there are many cases where its administration is 
attended with decided benefit, but he maintains that its effects 
should be carefully watched, and insists upon the point that it 
should always be given pur et simple, like any other medicine. 
For his patients there shall be no brandy, nor whiskey, nor 
champagne, nor claret, but simply proof spirit in water ! 
I have thus given you a limited view of the opinions ad- 
vanced at the present day with regard to the use of alcohol in 
disease. If we come to weigh the testimony, and to add to it 
that of our own individual experience, I think we shall be forced 
to the conclusion, that alcohol is one of the most valuable aids 
to the physician that we possess. For one I know not how we 
could do our duty by our patients, how we could satisfy the 
known and acknowledged demands of science without its use. 
In infancy, in mature life, in old age there are innumerable 
cases, where to my mind, the slender thread of life has been 
kept from breaking by the judicious and persistent use of 
alcohol alone. 
If now we turn to consider the use of alcohol in health, we 
find ourselves on very different ground ; we enter at once upon 16 
one of the most vexed questions of the day, one which it seems 
can hardly be approached without feeling the bias of individual 
habit and education ; one which has called forth on either side 
an unusual degree of rancor, and one which in its ultimate 
effects is of the most vital importance. Volumes have been 
written in support of the theory of total abstinence, and much 
that is in favor of the judicious use of alcoholic stimulants. 
Both have recently been canvassed pretty extensively by medical 
men, and it is the diversity of opinion in our own ranks, which 
has thus been divulged, that led me to bring the subject before 
you. I propose then, to consider the question : Is alcohol bene- 
ficial in a state of health, or in other words is its habitual use 
to be recommended ? Is- temperance or total abstinence the 
wisest course to be pursued, and to be recommended ? I say 
temperance, for intemperance is not a point that I propose to 
consider in this connection. It is true that what may be tem- 
perance for one is intemperance for another ; that for some the 
only temperance is total abstinence. Nor do I propose to con- 
sider whether, in a certain class of persons, intemperance is a 
vice or a crime; whether it is the result of heredity, or of 
acquired habit; whether it renders them responsible or not, for 
the deeds committed while under its influence. All these ex- 
tremely interesting and suggestive points, I leave one side, as 
foreign to our present purpose and limit myself to the simple 
issue : Is the moderate use of alcohol serviceable in the ordinary 
pursuits of life ? 
We have seen that alcohol is a stimulant ; that it excites the 
brain and nervous system ; increasing the muscular action of the 
heart, and in the same way, according to some, enabling the 
muscles of volition to exert a greater power. It also serves as an 
aid to digestion. These are the phenomena attendant upon the 
earlier stage of alcoholic excitement, upon the use of small 
amounts, and these are the effects which are sought for. In 
some of its forms especially, as ale and beer, it has been sup- 
posed to increase the amount of superficial fat, and the appear- 
ance of those who use these beverages to excess, leaves but little 
room to doubt that such is their effect. This result is, however, 
due not to the alcohol, but to the other ingredients which enter 17 
into the beer. Aside from these uses of alcohol, we have to 
meet it as an element of social life, as a means of adding to our 
enjoyment. 
We have in the first place to consider the fact that much of 
the evil, which is ascribed to alcohol, is due to the adulterations 
which are introduced into alcoholic drinks, many of which 
are poisonous in their effects. These are added on various 
grounds, partly for the sake of increasing the gain of the dis- 
tiller, partly to give to the resulting liquor certain qualities of 
taste or color, body, or bouquet, which have been demanded by 
the buyer. The extent to which this adulteration of wines and 
liquors is carried, is so well known, that it hardly needs mention. 
We, however, cannot fail to emphasize the fact that in general 
these adulterations are of a positively injurious nature. 
Looking over the more recent publications on this subject, 
we find certain points on which all seem to agree, and these 
are it seems to me, well taken. The first is that alcoholic drinks 
are not necessary to the young, to those of immature age ; to say 
that because they are not necessary they are therefore injurious, 
may not follow as a logical sequence, but it is better to act as 
if it was. The young should not be allowed to use them in 
any form. Again there is a general agreement in the view that 
brandy and whiskey, and the alcoholic liquors, are positively 
injurious, and cannot be habitually taken, even in small quan- 
ties, without producing permanent and decided injury, in the 
first place upon the stomach, and then upon the liver and ner- 
vous system. Whatever may be said of wines and beers as a 
beverage, brandy and whiskey, and liquors should be utterly 
tabooed. Again it is conceded by nearly all these writers, that 
alcoholic drinks should not be taken upon an empty stomach, 
but either with the food or after a meal. As Dr. Wilks quaintly 
says : “ I always suspect people who require something about 
eleven in the morning. Indeed the man or woman who has an 
acute consciousness of the hour of eleven, is a being both physi- 
cally and morally lost.” 
I for one am an entire disbeliever in the idea that more work 
or better work, whether physical or intellectual, can be done by 
the direct aid of alcohol. If a man is in an ordinarily healthy 18 
condition, I do not think he ought to require that spur, and I 
am a little suspicious of the surgeon who requires to be fortified 
before he can perform an operation, or of the writer who depends 
upon a stimulant to elaborate his thoughts. That there may be 
positive benefit in the use of a stimulant after the effort has been 
made, to revive and recuperate the worn-out system, I am free 
to acknowledge. But I cannot think that work of any kind, 
which is done under constantly recurring doses of alcohol, will 
be as well done, as it would be without its aid. For there is this 
peculiarity about the use of alcohol, that to the period of in- 
creased activity, there succeeds a period in which the energies 
flag, and again require the whip. Thus the pernicious habit 
grows, and saps the vital powers, while the labor accomplished 
diminishes in quantity and quality. The experience of both 
branches of the government service has proved the truth of 
these statements. The abolition of the grog ration in the navy 
was because it was found that the men did their work better 
without it; and in the war of the rebellion it was found that 
the soldiers would make forced marches better upon hot coffee 
than upon whiskey. Dr. Frank Hamilton says : “From ex- 
perience and observation we have arrived at the firm conclusion, 
that the common use of alcohol is under no circumstances use- 
ful to healthy persons. We make no exceptions as to cold, heat, 
rain, or even previous habits, so long as they are soldiers.” And 
in this connection I cannot fail to draw your attention to the 
degree of health attendant upon forced abstinence, in the case 
of the inmates of our prisons, many of whom have thus ex- 
perienced a sudden and entire change of their habits in this 
respect. 
Let me present to you some of the more recent views on 
these points. Baer quotes Moleschott as calling brandy the 
savings-box of the tissues, and saying that he who eats little 
and drinks moderately, preserves as much in the blood and 
in the tissues, as he who under corresponding conditions eat 
more, without drinking beer, wine or brandy. To this Donders 
replies: “ It is indeed a savings-box, but one which costs too 
dear. If the necessity for nourishing food is limited by the 
use of alcohol, so is the vital activity sunk, and the individual, 19 
as a physical and psychical being, placed upon a lower plat- 
form.” And Baer himself says : “ Brandy is not a material 
ont of which the laborer gains strength for his task, which 
makes him capable of continued exertion, and least of all more 
capable than any other nutriment. The power gained from 
brandy is dearly paid for, as in every other non-nitrogenous nu- 
triment * * * and, as a daily and frequent diet for the 
laborer, is a slow and effective poison, which robs the laborer of 
his bodily and mental validity, and this the sooner, the more it 
takes the place of other nourishment.” So too he says of mental 
labor, “ although it excites the brain, and gives rise to new ideas 
and images, and has been praised by poets and geniuses ; still 
what genius does, and what it demands for its excitement, and 
for its creative activity, cannot furnish the rule or the copy for 
imitation to the ordinary mind. Quiet thought, calm judgment, 
critical views and decisions, the cool observation of facts, and 
the recognition of their dependence, these mental operations, and 
to them humanity owes the entire treasure-house of positive 
knowledge drawn from the great circle of natural science, tech- 
nical and industrial, these mental operations certainly cannot be 
promoted by alcohol. The functions of the brain in their ca- 
pacity for continuance, are not promoted by the influence of 
alcohol; for quiet, continuous mental labor, alcohol is no nutri- 
tive element.” 
These views expressed by the learned German author with such 
directness and force, and in such eloquent terms as find but a 
feeble counterpart in my own reproduction, must commend 
themselves to our judgment as in the highest degree sound. 
And if they are true for Germany, how much more force do 
they have in this country, where the use of alcoholic liquors is 
so much more common. Without wishing to yield to a mawkish 
sentiment, or join in the unqualified tirade of those who have 
leagued themselves for the battle, I cannot forbear the expres- 
sion that for us in this country, and at this time, whiskey is a 
curse from which we suffer in all ranks of society, in all stations 
of life. When we think of the abilities that are shrouded in 
darkness ; of the powers for planning and executing that are 
dwarfed and stunted ; of the God-given talents of the most 20 
transcendent brilliancy that are dulled, and in eternal eclipse 
from the daily and constant nse of alcoholic liquors; when wo 
think of these, can we fail to ask ourselves what remedy there 
may be, what position we shall assume, what course we shall 
recommend ? 
In entering upon the consideration of this question, is total 
abstinence or moderation the course to be recommended, there is 
one broad fact to which I have referred, that stares us in the 
face, and that is the almost universal use of some kind of stimu- 
lant, alcoholic or otherwise. All the world over, from the pole 
to the equator, and from the equator to the pole, a need is felt, 
and it is supplied. This universal craving of our nature is 
gratified in different ways. I need not name the list with which 
we are all familiar. The point to be made is: does alcohol 
supply this want better than the other substances used, and is 
its use in moderate quantities injurious or beneficial ? 
If we take the writings of those who have joined hands with 
Total Abstinence, we find that alcohol may be easily supplanted 
by tea, or beef-tea, or a little oat-meal mingled with beef-tea, to 
say nothing of the now famous dried raisins, with which one 
eminent physician recuperates his wearied powers, or the six 
brandied cherries upon which another regales, when wearied by 
over-work. Even the late fashionable devices of a cup of warm 
water in the morning, or the use of aerated waters, may be 
added to the list of stimulants, which are supposed by these 
authorities to make good the place of alcohol. 
The claim is made by these writers, that the bodily condition 
is improved in every respect, digestion is rendered more sound 
and regular, the circulation more equable, the muscles more 
capable and under better control, the mind more calm and 
serene. Dr. Richardson, who has written ably and enthusias- 
tically from this point of view, experimented upon himself, and 
found that in each series of experiments in which he abstained 
from alcohol entirely, bis bodily health was better than when he 
used it in entire moderation. Of the two courses he thinks that 
total abstinence is in every respect the best, and the conclusions 
which he has reached, are to his own mind as satisfactorily dem- 
onstrated, as those of the study of any natural phenomenon. If 21 
this could be as satisfactorily proved to all of us, if we all were 
as sure as is he, that total abstainers as a class, present far 
healthier records and are in much better condition than other 
men, we would not hesitate to yield ourselves to this view. But 
this has not yet been done. No sufficiently reliable statistics, 
covering any sufficient number of facts, have yet been presented 
to show this point. Dr. Richardson finds in water a resource for 
every emergency a supply for every need of the healthy man. 
Without going to the same length as the writer just named, 
Sir William Gull believes that alcohol is of no benefit in the 
performance of intellectual or bodily labor, and that many of 
the most intractable forms of disease proceed from the constant 
and moderate use of alcohol. And in the same vein Dr. Mur- 
chison says the moderate use of alcohol is the cause of a large 
number of the ailments, which render life miserable, and bring 
it to an untimely close. He says that if a man in average health 
eats well and sleeps well, his judgment will be clearer, and his 
mental capacity greater, when he takes no alcohol, than when 
he indulges in its habitual use. His belief is that though its 
occasional use may do no harm, its habitual use, even in mode- 
ration, does induce disease gradually. 
Now the views of these gentlemen are entitled to careful 
consideration, from the high degree of eminence they have 
attained in our profession. They have been the result of their 
own experience, and are not the expression of hastily conceived 
opinions. There is still here, however, the lack of proof of the 
assertion. How are we to know that these diseases to which 
reference is made, proceed from this moderate use of alcohol ? 
Mr. Brudenell Carter is an entire sceptic as to the deductions 
from physiological facts or quasi-facts, in this respect. And his 
description of the now prevailing method of research is quite 
amusing, and has as I think, several grains of truth. He says, 
“a number of otherwise unemployed and unappropriated per- 
sons set themselves to work with microscopes and test tubes, 
and fancy that they are making discoveries. The laborious 
trifling of six months is then described as a research ; and the 
conclusions of the great unknown, who makes it, are regarded 
as part of the general stock of knowledge for the six months 22 
longer, which may possibly elapse, before these conclusions arc 
overthrown by somebody else; * * * * and the common 
people, who are not scientific, are expected to worship at each 
shrine, as long as it endures.” We can all of us, I doubt not, 
supply, from our own observation of the course of medical 
science, other illustrations of Mr. Carter’s remarks. Here, as 
elsewhere, I suppose, “ the survival of the fittest,” will find .its 
application. 
But aside from the question of the scientific accuracy of the 
statements I have quoted, there comes up to my mind in connec- 
tion with the application of total abstinence to intellectual 
labor, the experience of those countries, where alcohol is univer- 
sally used, and, I may add, generally in moderation. What 
becomes of all that intellectual life and activity, with which 
Germany and France are swarming, if the habitual use of 
alcohol in moderation is at last so subversive of all mental 
effort? Where can we find a larger number of men whose brains 
are more vigorously employed than among those nations, and 
among them all, how many can be found who practico total 
abstinence? What contributions to our medical literature are 
more eagerly sought for than those that proceed from both of 
these nations ? And can wo in the face of these facts agree 
with the view that alcohol in moderation stunts and dwarfs 
the mental faculties ? And as to the question of longevity, it 
strikes me the average age of the individual in those countries 
is as great as elsewhere. 
There are some other considerations in connection with the 
total abstinence view, which, as they have no medical relation 
to the subject, would be out of place in this connection. 1 
refer to the alleged duty we owe our fallen brother, to abstain 
from all use of alcohol, as a means of elevating him ; to the 
economy of total abstinence, and to the impossibility of estab- 
lishing it by legal acts. These points so interesting to discuss, 
upon which so much may, and has been said on either side, are 
foreign to the purpose of this address. 
I now pass to the consideration of the use of alcoholic drinks 
in moderation. I include under this head the habitual use in 
small quantities, and the occasional use in somewhat larger 23 
measure. This is what is commonly considered their use in 
moderation. What that measure is, is a question for each one 
to decide for himself, taking care that the error, if any there be, 
shall be upon the side of the minimum quantity. This use of 
alcohol precludes of necessity, all tippling; it is to be supposed 
that, as a habit, it is used at dinner, and it limits the use to 
beers, ales, and light wines. It is possible that the daily use of 
the heavier wines, as Sherry, Port, and Madeira, might not 
prove injurious to many, but the boundary of injury is with 
these much more easily passed. The occasional use of these 
heavier wines, in small quantities, 1 hold to be consistent with 
the moderate use of alcohol. This it seems to me is the true 
idea of temperance. If, as I have said before, a man cannot 
follow this use, then the rule for him is total abstinence. But 
to my mind “the discipline of temperance” as Sir James Paget 
says, “is better than the discipline of total abstinence.” 
Let us recur for an instant to the effects of alcohol. Accord- 
ing to Dr. Richardson, the effects of alcohol may be divided 
into four stages. There is a first stage of excitement merely, 
“a second stage of excitement with some failure of muscular 
direction, and with some mental confusion ; a third stage of 
distinct muscular failure, both in direction and power, with 
much mental confusion; and a fourth stage of complete mus- 
cular failure, both in direction and power, with entire mental 
insensibility.” Now of course the moderate use of alcohol can 
only include the first stage of simple excitement, and indeed we 
might with justice claim that, if used according to the suggestions 
I have made, even that stage would, in the majority of cases, 
be hardly reached. The effects of alcohol thus used are slightly 
stimulating to the circulation, to the action of the brain, to the 
digestive organs, and a general feeling of comfort is engendered. 
Dr. Bennett says, “you are no longer moderate if what you 
have taken excites you or stultifies you, or has any other effect 
upon you beyond that of balancing, calming, comforting you.” 
These effects may be gained in one by a single glass of claret, 
and in another by two or at the most three, and this may be 
repeated daily. That such use of alcohol is productive of posi- 
tive injury by accumulated force, I do not believe, and this is 24 
the point that is made by the advocates of total abstinence. 
Aside from the valid argument which they may and do advance 
with great force, that even this use may at any time like a slum- 
bering lion, break forth into an uncontrollable desire ; they also 
claim that the repeated and daily use of even small quantities 
will leave its mark for permanent injury upon the system. 
Therein, I think, they are in error, and injure their own cause, 
and in the absence of any statistical evidence wo must return 
the Scotch verdict of “not proven.” And the main difficulty 
seems to be that they never can acquire statistics. Men that use 
alcohol in this- moderate manner, of course, pay the debt of 
nature in the same way as their fellows who have practised total 
abstinence. And the autopsy cannot, in our present state of 
knowledge, reveal the fact that this man drank water during his 
whole life, and that one took a half-pint of claret every day at 
dinner. What there may be for us in the future, who can tell ? 
But at present, I fancy, such statistical evidence will not be 
forthcoming. 
And on the other hand, if this use cannot be proved to be 
injurious, it can, I think, in a large number of instances be 
shown to be of advantage. It may perhaps be said with truth, 
that if a man is healthy he does not need alcohol. But who is 
iu a perfect state of health ? The wear and tear of life at the 
present day, makes unusual demands upon the vital powers of 
the men, who drive with all their force the mental and bodily 
engines committed to their control. Our climate with its ex- 
hilarating tendencies calls for additional drafts of nerve force, 
and in no way to my mind, does it seem that these demands can 
be better satisfied, than by the judicious use of minimum doses 
of alcohol, as I have suggested. If one does not feel the need 
of such aid, if a cup of cold water supplies all that his system 
demands, he certainly need not have recourse to even this 
limited use of alcohol. But it seems to me that in our climate, 
and with our life, the majority of men who approach or have 
passed middle life, and certainly those who are on the downward 
slope, find a positive benefit in this use of alcohol. 
In support of this moderate use of alcohol, Sir James Paget 
says the large majority of physicians concur, and looking at the 25 
different nations of the globe, he claims that “as to working 
power, whether bodily or mental, there can be no question that 
the advantage is on the side of those who use alcoholic drinks.” 
Mr. Brudenell Carter advocates the use of alcohol, in the manner 
I have referred to, “ on purely empirical grounds,” and these he 
claims are the only grounds which are tenable. lie says that 
“we may assure ourselves by common observation that the- 
moderate consumption of alcohol is useful to many persons, and 
that it does not produce, at least necessarily, or in any but 
exceptional cases, the dire effects which have been ascribed to 
it.” And Dr. Garrod lays down the proposition that “ the ma- 
jority of adults can take a moderate quantity of alcohol in 
some form or other, not only with impunity, but often with 
advantage” 
There remains but one point, which I propose to bring for- 
ward, and that is the influence which the more general use of 
light wines and beer would have upon the suppression of intem- 
perance. Believing, as I do, that the universal practice of total 
abstinence is a thing never to be attained in the world as at 
present constituted, and recognizing, as we must, the universal 
demand for some stimulant, I believe that the general use of these 
lighter alcoholic beverages would materially tend to supplant the 
dangerous and fatal effects of alcohol in its stronger forms. I 
agree fully with Dr. Bowditch in his estimate of their agency in 
this respect, and in his recommendation that more attention 
should be paid in this country to the growth of native wines. 
Baer, too, from whom I have had frequent occasion to quote, 
considers beer as the strongest enemy of brandy-drinking, and the 
best weapon against its power. If native wines, and light and 
pure beers could be made to take the place of our Bourbon, and 
our Rye, I think we should have made a great advance in the 
right direction ; and if in addition to this, men could be taught 
to use even these in moderation, much of the danger that 
threatens us would be averted. 
I have thus, gentlemen, canvassed the views of alcohol in its 
relations to health and disease, and before I close I must give ex- 
pression to the hope 1 indulge, that not one word that I have 
uttered should inure in any way to the injury of the cause of total 26 
abstinence. A movement which at the present day is drawing 
to itself such pure and noble men, such eloquent and devoted 
adherents as it does, both from the clergy and from the ranks 
of our own profession, deserves to be regarded with the most 
profound respect, and to be judged most conscientiously. I 
accord to these gentlemen the fullest measure of esteem, and 
withhold from them my most earnest cooperation only on the 
grounds which I have presented to you. And so I leave the 
subject with you, as one which each individual must decide 
for himself, but in the full light of his own conscience, and 
with a just and overpowering sense of all the issues that are 
involved.