MODERN STIMULATION, ETC. 
BY 
T. j* W. FRAY, M. D. 
APPOINTED DEC., 1877, BY THE STRAFFORD DISTRICT MEDICAL 
SOCIETY TO READ THIS PAPER BEFORE THE NEW HAMP- 
SHIRE MEDICAL SOCIETY, IN JUNE, 1878. 
CONCORD: 
PRINTED BY THE REPUBLICAN PRESS ASSOCIATION. 
1878. THE REASONS EOR MODERN ALCOHOLIC 
STIMULATION EXAMINED. 
BY T. J. W. PRAY, M. D., DOVER, N. H. 
“ Tempora mutantur, et nos mutamur,” etc., is an old Latin 
maxim, and in nothing is this better exemplified than in the differ- 
ent means used for the cure and treatment of disease. Change 
here is the order of the day. How different the medication of to- 
day and a hundred years ago ! The recommendations of the fa- 
thers are nearly all ignored, and the speculations of the present 
have full sway. What they did was imperfect, to say the least; 
what we do, or theorize in, is progress,—advancement in science. 
And yet, in this desire for the novel, some truth which former 
ages recognized is often dressed up under a new guise and her- 
alded forth as discovery. Much of the knowledge of idiopathic 
fevers and their laws is the result of former research. There is 
no question but that a great part of what has been written about 
the etiology of disease is merely theory, having no foundation 
in fact; yet amid the rubbish of centuries, many a gem of truth 
gleams forth to enlighten and profit modern thought. Old 
medicines have been laid aside, and new ones have taken their 
place, perhaps no safer, nor of greater potency. We turn from 
the experience of other times with seeming distaste, so that we 
really have no medical literature in one department of our pro- 
fession. Books printed from thirty to fifty years ago are old : the 
recent author is eagerly sought after. System after system, 
theory upon theory, have yielded to this desire for something 
different to avert pathological activity or remove pathological 2 
stimulation. The labors of learned minds, which have woven 
into the tangled web of subtle thought many an ingenious treat- 
ise, and revolutionized medical opinion, are set at nought. We 
own no man master, and no thought worthy of credence can 
stand for a moment unless fortified by more than mere asser- 
tion. And yet, as a profession, we have not arrived at a state 
of perfection. Much of the practice of to-day will be consid- 
ered obsolete a hundred years hence. As long as disease can- 
not be cured, so long will different remedies be employed. We 
are not even independent actors. We are too much influenced 
by authority. We act in deference to the prejudices of others. 
Exigencies occur in the daily practice of the medical man, when 
he is controlled by the vague opinions of the non-medical world. 
Take, for instance, venesection. This remedy, although in use 
for over 2,000 years, has become unpopular, and is seldom em- 
ployed. But we are not so far removed in point of excellence 
from the errors of our fathers. We also have fallen into ex- 
tremes of practice, and follow after theories with like zeal. If 
they went beyond reason in the use of the lancet, we who live 
in glass houses should not throw stones. It has become the 
fashion—a fashion imported from Germany—to give enormous 
doses of quinine in typhoid fever to reduce the temperature of 
the body, as if this fever consisted only in the heightened heat 
of the system. Let 11s hope that its use in this manner may not 
lead to fatal complications. Along with this is the custom of 
giving alcoholic stimulants in large quantities, from the belief 
that disease is asthenic in character. When from eight to forty 
ounces of brandy, and even more, are prescribed in acute affec- 
tions every twenty-four hours, some reason should be shown 
for such a course. In health, we should pronounce such a pro- 
cedure to be pernicious and detrimental: why it is not so in dis- 
ease has not been sufficiently explained. The usual apology 
for such a course is in the belief that the type of disease is 
changed. This influences the action of the physician at the 
bedside. As he believes, so will his therapeutics, in a great 
measure, be. If he supposes that debility reigns, it will lead to 
stimulation. If, on the contrary, a sthenic state is dominant, no 
recourse is had to such remedies. Now, is there any founda- 
tion for the supposition that there is a change in the type of dis- 3 
ease? What is the opinion of medical men in this and other 
countries in regard to this question? 
Early in the present year, we addressed generally two in- 
quiries to a few practitioners of medicine in this country, who 
have had from thirty-five to sixty years of experience, to ascer- 
tain their views and to find out the result of their observations 
upon this question, and the requirement of stimulation in the 
treatment of cases under their supervision. The following are 
extracts from this correspondence. We place the opinions of 
those who think there is a difference in type first, arranging 
them in the order of reception. 
Dr. Hayes, the veteran editor of the American Journal of 
Medical Science, says,—“ Since my entrance into the profes- 
sion, now nearly sixty years, there has been a marked change 
in the type of disease from the sthenic to the asthenic. I have 
repeatedly, in the Medical News and Library, expressed this 
conviction.” 
Dr. E. T. Leonard, of Massachusetts: “ I think for the last 
few years diseases are more asthenic, and require more stimu- 
lants and nourishment than formerly.” 
Prof. A. Smith, of this state (in a letter of Jan. 17, 1878), 
writes,—“ I am very conscious of the change that has taken 
place in the type of disease, and if we would, the lancet could 
never be used again as in my earlier days. I began practice in 
1833” 
Dr. Wight, of this state: “ I must answer, confidently, that 
there has been a change. Zymotic diseases are much more 
common than formerly ; or, in other words, in my opinion, four 
fifths of the maladies we are (failed to treat at the present 
day, although having the external appearance of being inflam- 
matory, are really asthenic in form. I believe the treatment in 
vogue fifty years ago would kill more patients now than it did 
then.” 
Dr. Dugas, of Augusta, Ga., writes,—“ I must answer in the 
affirmative, that the type of disease has changed. As long ago 
as 1846 I observed a marked change in pneumonia, which pre- 
vailed epidemically in different parts of this state, and called 
the attention of my colleagues to it. Prior to this I had treated 
this disease by bleeding, tart, antimony, and other antiphlogis- 4 
tics ; but now I found the type so changed that I could not 
bleed. I had to rely almost entirely upon quinine and opiates. 
In 1854 dysentery prevailed epidemically in different parts of 
the country, and the treatment by quinine was equally success- 
ful.” 
Dr. Woodward of Connecticut: “I do not hesitate to say 
that the type of disease has changed. Depleting remedies do 
not seem to be indicated as formerly.” 
Dr. Warner, of Connecticut: “ I believe it is the general 
opinion of the older physicians, that diseases of the present 
time are of quite different type from those of thirty years ago. 
My impression is, that this is the universal opinion among the 
older practitioners.” 
Dr. Alfred C. Post, of New York city : “ I have a very 
strong impression that active inflammatory diseases, charac- 
terized with a vigorous circulation, with a bounding, hard, 
and incompressible pulse, and requiring active depletion for 
their relief, are much less frequent than they were when I be- 
gan my professional life ; but I think the abandonment of deple- 
tion in the treatment of inflammation has been carried too far, 
and that there are still many cases of acute inflammatory dis- 
eases which can be controlled more efficiently, more speedily, 
and more safely by blood-letting and other depressive agents, 
than by the means which are now generally resorted to.” 
Dr. S. P. Smith, of Alabama, says,—“ In 1837, when I com- 
menced practice, all fevers were highly inflammatory, requiring 
blood-letting; but since 1849 fevers have changed, and require 
stimulants and feeding.” 
The following are the opinions of physicians who think there 
is no change in the human constitution or in the type of dis- 
ease : 
Dr. Ballou, of Rhode Island, writes,—“ During my pupilage 
in medicine, and some few years afterwards, I regarded the 
fevers, and other diseases which fell under my observation, as 
far more sthenic than those which now, and for many years 
since, I have been called to treat. Fevers and other diseases, 
which occurred from 1828 to 1835, were more successfully 
treated by venesection, tarter-emetic, &c., than by tonics, stim- 
ulants, and what is now called a sustaining regimen.” 5 
Dr. Willard Parker, of New York city, says,—44 It is now 
nearly fifty years since the profession began to talk of a change 
in the type of disease. Dr. Gallup, in Vermont, regarded every 
disease as sthenic, and requiring the lancet and tartarized anti- 
mony, while Drs. Miner and Tully, residing in Connecticut, 
believed every disease as asthenic, and relied on stimulants and 
opium. They were both representatives of extremes,—both 
right and both wrong,—Gallup’s practice being safer in the 
country. I have failed to discover any change of type in dis- 
sease: it is not an entity, but an action, and the action is mod- 
ified by the patient’s system.” 
Prof. Flint, of New York : “ I have seen no reason to change 
the views, in relation to the matter of your inquiry, which I 
have expressed in my work on Practice: 4 With a professional 
experience of nearly forty years, I do not hesitate to express the 
conviction that acute inflammations are essentially the same.’ 
The opinion held by some, that such alterations (change of 
type) have occurred within the memory of those now living, 
does not rest on any solid basis.” 
Dr. Alonzo Clark, of New York: “I do not think there is 
any change in type. Such a change could only result from con- 
stitutional changes in all persons. That this has not occurred 
is evident in the fact that puerperal and accidental bleedings 
are just as well borne as they ever were ; and I believe that 
to-day the bleedings of Rush would do no more mischief than 
they did in his time.” 
Dr. C. Ellis, of Boston : 441 have seen no change in the type 
of disease. I have never hesitated to feed and stimulate pa- 
tients when they bore nourishment well and seemed feeble.” 
Prof. S. D. Gross, of Philadelphia: “From all I have seen 
of men, in health and disease, I have no reason to believe that 
the human constitution is at all different now from what it was 
when I entered the profession fifty years ago. I do not believe 
in a change of type in disease ; nor do I think that there is any 
more necessity for the use of stimulants in diseases and acci- 
dent than there was formerly. If there is any change,—and I 
am sorry to say there is,—it is not in our patients, but in our 
modes of treatment, too often influenced by the authority of 
some great name or fashion in medicine.” 6 
Dr. H. I. Bowditch, of Boston : “ I do not see anymaterial 
difference in the type of disease as seen now and for- 
merly.” 
Prof. N. S. Davis, of Chicago : “ I do not think there has 
been any permanent change in the special type of diseases dur- 
ing the last half century, as supposed by many. Diseases of an 
epidemic and endemic character vary in severity, but no gen- 
eral change has been noted during the forty years I have been 
in practice.” 
Dr. T. H. Jewett, of South Berwick, Maine: “I have my 
doubts as to much change, as is generally stated, as to fevers, 
from the sthenic to the asthenic.” 
Prof. A. B. Palmer, of Ann Ai'bor, Michigan : “ I do not 
think any general wide-spread change from the sthenic to the 
asthenic type of disease has occurred during the forty years I 
have been in the practice of medicine, and I do not believe 
stimulants are more required or better borne than forty years 
ago.” 
Dr. Phelps, of Windsor, Vt.: “To-day our fevers make a 
show of sthenicity quite formidable in the outset, but soon this 
condition gives way to asthenia, but on this account I am not 
prepared to say, pathologically speaking, that the type is 
changed.” 
Dr. William Perry, of Exeter, N. H., who has been in prac- 
tice sixty-four years : “ I have no doubt that there is ‘ change ’ 
in the character of diseases, but there is quite as much differ- 
ence in the brains of those who treat them. This is quite ob- 
vious from the starting-point, in regard to the nature of disease. 
Formerly any ache or pain had for its cause an inflammation, 
or, in the language of the day, a change of action, and the cure 
was in breaking it up. Neuralgia was hardly known, except- 
ing the famous tic-douloureux. Bleeding does not often kill, and 
so it was constantly resorted to, to prepare the wa}r for other 
remedies,—to change the action. This practice will often effect 
the object very promptly, and the doctor get credit for his skill. 
Now change the belief in the nature of disease, and believe it to 
depend on imperfect nervous influence, and we shall have as- 
thenic form to perfection, which is not to be considered curable 
by venesection. Now these are somewhat the outlines to ex- 7 
plain the change of sthenic to asthenic in the form of disease 
formerly and at the present time.” 
Dr. R. C. Hewitt, of Louisville, Ky.: “I have not observed 
nor do I believe any such change (from sthenic to asthenic) has 
taken place. The general characteristics of diseases now are 
just the same as they appeared to me thirty-four years ago. I 
do not believe stimulants are more necessary now than they 
were formerly.” 
Dr. Spofford, of Groveland, Mass., who has practised more 
than sixty-five years: “ I do not think there is much change 
in the human constitution, but more in the manner of treatment 
of disease. I do not believe that bleeding can be laid aside to 
the extent it is, without costing some lives. In my early prac- 
tice, at Hampstead, N. H., during a severe visitation of fever, 
stimulants were used freely with good results. In later years I 
have used less.” 
We could have extended these inquiries had we been better 
acquainted witli the older physicians of the United States. Of 
course many letters have been unanswered, owing to sickness, 
and failure to reach those addressed. 
In Europe, such men as Dr. Stokes, Sir Robert Christison, 
Allison, Graves, and others, affirm that there has been a change 
in the type of disease. Dr. Stokes speaks thus : 
“ Since the delivery of my address on ‘ Change of Type in 
Disease,’ before the British Medical Association, at Leaming- 
ton, in the year 1865, I have received numerous letters on the 
subject from leading physicians in England and Ireland. The 
testimony of these gentlemen has been of the strongest charac- 
ter, of the occurrence of an asthenic type of local inflammatory 
disease within forty years.”* 
This gentleman thinks the fathers of British medicine were 
correct; that men, in forming their opinions, could not possibly 
have fallen into the practice of bleeding so largely, in the treat- 
ment of their patients, unless the maladies themselves called 
for such action ; that Sydenham, Haygarth, Fothergill, Heber- 
den, Fordyce, Gregory, Cullen, Cheyne, and others, were men 
of giant minds, and could not have failed in their observations 
as to the true character of disease ; that their description of 
* See Stokes’s Lectures on Fever. 8 
fevers is so different from what prevails now, as not to suppose 
that, in the early part of this century, they were sthenic in char- 
acter ; that from his own knowledge, and of frequent occur- 
rence, he noticed, in the epidemics of 1822 and 1828, the vehe- 
ment action of the heart, the incompressibility of the pulse, the 
vivid redness of the venous blood, and the “ force with which 
it spouted almost per saltum from the orifice of the vein.” 
There was no call for stimulants then, but now, since asthenia 
reigns, they are required. 
Of course this is high authority, and great respect must be 
shown to such opinions. Dr. Stokes, however, is not supported 
in his belief by all the leading minds of England. Prof. Ben- 
nett, Dr. Markham, and others, hold that the doctrine of the 
change of type is untenable. 
Such is the state of medical opinion in this country and Eng- 
land upon this question. In the United States, many of the 
distinguished men of our profession, those who form med- 
ical opinion in the lecture-room, are unquestionably of the be- 
lief that there is no change in disease. While they maintain 
that venesection is called for now, in many cases, still it is re- 
quired but occasionally, and should not be abused, as in the 
days of Rush. 
Between these two conflicting views, which is the right one? 
Perhaps a solution to this question lies partly in considering 
what has been done in medicine for the last half century. 
There has been steady progress. New truths of vital impor- 
tance have been discovered ; hygienic conditions are daily in- 
vestigated ; physiology has become a more exact science ; chem- 
istry has revealed valuable curatives, and made as clear as the 
light of noonday the great changes which disease produces in 
the body. The investigations going on in the domain of ma- 
teria medica are revealing new properties to numerous medic- 
inal agents. Pathological anatomy has familiarized us with 
the results of disease, which our fathers could only guess at. 
Our progress in this respect has been wonderful. A higher 
tribute is paid to the vis medicatrix natures. Less medicine is 
given, not because less is required, but in consequence of a bet- 
ter comprehension of its effects upon the system. The philo- 
sophical treatises of Dr. J. Bigelow of Boston, and Dr. Forbes 9 
of London, upon the efforts of nature in the sick-room, have 
solved many of its perplexities, and banished many false no- 
tions of what medicine can accomplish. For the last fifty years 
our treatment of disease has been greatly simplified, because we 
are sure that many diseases, as typhoid fever, rubeola, scarla- 
tina, variola, etc., are self-limited, and not to be materially 
shortened in their course by any mode of treatment. The sick 
are often cured through nature’s restorative powers, while the 
mind of the patient is quieted by the millionth part of a drop or 
grain of medicine. 
If we treat diseased action differently from Sydenham, Cul- 
len, and others, it is no disparagement to them to say that 
we, their sons, know as much, and ought (to keep up with 
the constant progress in every department of science) to be 
better informed as to the exact nature of sickness, and con- 
sequently treat it differently. It would be a reflection upon 
our profession, if disease were not less fatal and its progress less 
violent. 
We can more easily control diseased action, lessen the sever- 
ity of its onset, and make it milder throughout its course. In 
many instances certainty takes the place of doubt. A want has 
been filled, which had long been felt in practice, by such rem- 
edies as aconite, veratrum viride, potassium compounds, chlo- 
ral, etc. To-day, if we would, we could not deal out the rem- 
edies as they did of “ olden time.” Study and research have 
given us advanced ideas ; and we stand upon a more elevated 
plane, with more means at our command to battle with disease. 
Some ailments known to the ancients have been driven oft' the 
earth. It is not too much to expect that many others now seen, 
will, in the future, be heard of only in history. 
Disease, then, has been modified by the intelligent action of 
our profession ; but to say there is change in its type, implies 
that there are constitutional changes in all persons. It cannot 
be affirmed that we have deteriorated in any respect as a people 
in bodily force. In the war of the rebellion, soldiers, North and 
South, performed marches, suffered deprivations, and endured 
hardships, that would have thrown into the shade those of Caa- 
sar, Hannibal, and Napoleon Bonaparte. Fatigue was not 
a prominent complaint. The farmer, mechanic, and day-la- 10 
borer, in city, town, and country, are just as capable of meeting 
their wonted tasks as those of a century ago. Our young men 
and old are not bowed down by feebleness, nor by the entail- 
ment of constitutional weakness. The cares of business, the 
constant wear and tear of body and mind, do not make greater 
inroads upon the health. Besides puerperal and accidental 
hemorrhages, capital operations in surgery are just as well 
borne to-day as they ever were. We are not a nation of inva- 
lids. We have as strong men, healthy men, as ever walked the 
earth ; and there is no evidence of decay in muscular power or 
endurance. Sickness has not increased ;—in fact, the average 
length of life h as lengthened. 
If there is a change in type, when, and in what diseases is it 
found ? Small-pox, typhus fever, dysentery, measles, diphtheria, 
and the like, always remain the same as to their essential char- 
acters, only qualified by depraved conditions of the system. 
Certainly this change is not in phthisis pulmonalis, for this is 
no more virulent: its subjects live as long and bear up as well 
against its insidious encroachments. There is no asthenic con- 
dition of the system here more than formerly, and the disease 
has not been on the increase. Nor do the diseases of the ner- 
vous system predominate over former years ;—and yet the asser- 
tion is confidently made, that there has been a progression in 
the number of these diseases. Statistics do not sustain this 
view. To the question put to Dr. Roberts Bartholow, in a 
paper read before the International Medical Congress in 1877, 
Do conditions of modern life favor specially the development 
of nervous diseases? he was forced to reply in the negative. 
Dr. Althaus, of London, says the rate of deaths from these dis- 
eases does not appear to vary perceptibly from time to time, 
being about twelve per cent, of the entire mortality from all 
diseases ; and he further says, that “nervous diseases are not, as 
is commonly asserted, more frequent, but on the contrary less 
numerous, in large towns than in the country.” He gives the 
following statement in support of this: that the death-rate of 
London from nervous diseases was 10.66 per cent., wThile in 
southern England it was 11.20 per cent., and in Wales, 15.38 
per cent. 
But it is maintained, that in fevers there is much less force in the circulatory system, and more debility generally, than were 
described by authors fifty years ago ; that patients could not now 
bear venesection, and would sink into a hopeless condition un- 
der such treatment. No one doubts that bleeding was abused 
formerly by nearly every medical man. Then old men of eighty 
years, and even infants of not more than two months, were 
bled. It was used remorselessly in almost every complaint,— 
in hemorrhages, in puerperal fevers, in injuries, even in erup- 
tive fevers and anaemia. Immense quantities of blood were 
drawn, and the operation repeated frequently a dozen times, 
until the blood ceased to flow. The champions of this prac- 
tice acted under a theory. It was the fashion for all to bleed. 
Hardly any one stopped to question its utility. That it was 
demanded in many instances, we have no reason to question : 
that it could be borne even now, as recklessly employed as then, 
there is not much doubt. Patients sank then, and they would 
at the present time. Death followed too often the path of such 
notions. All the excuse for such action lies in the supposition 
that, in their limited acquaintance with therapeutical agents, 
they had not means vigorously to combat otherwise inflamma- 
tory action. It was the excess in bleeding which was repre- 
hensible, and brought it into disfavor. There were times then, 
as now, when its employment offered such relief as nothing else 
could. The recent testimony of Prof. Clark, Drs. Post, Flint, 
and Parker, together with Fordyce and Barker of New York, 
and Gross of Philadelphia, with many goes to 
show that the modern abandonment of venesection has been 
fraught with evil and the sacrifice of life ; that it is a rem- 
edy where aconite, veratrum viride, and other vital depress- 
ants, cannot meet the conditions of many acute and chronic 
diseases. 
But it is asserted that modern forms of sickness are 
quite often asthenic. This is no doubt the truth. It has 
always been thus. The same diseases change from year to 
year in mildness and severity. Epidemic and endemic com- 
plaints vary in the degree and course of their sthenic and 
asthenic character, and differ in one locality from another ac- 
cording to the difference in the local sanitary conditions. This 
has been recognized by every careful observer. It is the 12 
law of disease. Sydenham, in his day, remarked upon this 
phenomenon. Diseases mild and severe go and return, bearing 
all the characteristics of former years, only qualified by certain 
surrounding influences. Typhoid fever often loses its typical 
symptoms. The brown tongue, sordes, epistaxis, and numer- 
ous other concomitants of this affection, are seen and not seen, 
and yet the disease is typhoid in character and continuance. 
These varying appearances may be due to the exciting cause 
being less violent, to hereditary tendency in the constitution, to 
life in populated places, to season, climate, earliness of treat- 
ment, stage, extent of disease, and to the artificial habits of 
society. The man of the country, inured to toil, with thg ro- 
bustness gained in the invigorating atmosphere of New Eng- 
land, is more likely to have disease sthenic in form, and conse- 
quently bear a more vigorous treatment, than the one environed 
by the effeminate influences and impure atmosphere of city life. 
Let the two exchange situations, and a change at once occurs. 
Then there is difference in constitution. No two examples will 
exhibit the same characteristics throughout, and they will not 
admit of precisely the same remedies. What will do for one 
patient may not work well for another. We shall never find a 
universal panacea that will apply to any one disease. There is 
scarcely a malady which does not admit of a variety of man- 
agement. Hufeland has indicated the true way of meeting the 
requirements of the sick-room, namely, “ to generalize the dis- 
ease and individualize the patient.” Even the trusting to statis- 
tics, valuable as they are, will rob each case of its true individ- 
uality. He who follows stimulation as an invariable line of 
treatment is a routinist, and prescribes for a mere name, and 
not for the case he is called to treat. 
Dr. Todd, of England, and his followers, believe that disease 
has become asthenic. Accordingly excessive stimulation is 
recommended in almost every case. This system admits of no 
half-way measures : if patients are not held up by alcoholic 
preparations, they will certainly die. Now this is a mere theory, 
as much so as Brown’s, or Brousais’. It conceives of condi- 
tions not occurring in actual life. It makes assumptions that 
do not warrant its entire reliability if carried into operation. 
It is not the truth, that stimulants will do most for the sick. 13 
Take, for instance, pneumonia, as a representative disease. It 
has been variously treated. There is the expectant plan, which 
gives little or no medicine : here, one in three die. Homoeop- 
athy gives like fatality. In Dr. Todd’s stimulant method, one 
in nine dies; in the restorative course of Dr. Bennett and 
others, one in thirty-two dies. Doubtless the same results would 
be found if statistics were examined as to other diseases. Now 
no one can question the ability of Dr. Todd as a writer and 
clinical lecturer, but either he met with patients not usually 
observed in ordinary practice, or he was wedded to wrong no- 
tions of what is actually occurring in the human constitution. 
Dr. Gross remarks upon this point,—“Dr. Todd was an able 
man, but that he was a profound thinker I doubt; and it is well 
to bear in mind that the patients at King’s College Hospital, 
London, of which he had charge, were persons in the lowest 
walks of life, broken down by privation and various forms of 
intemperance, and therefore unable to bear depleting remedies. 
Such patients as Dr. Todd had are to be found in the wards of 
every elemosynary institution of Europe, arid this country. It 
was from the study of this class of cases that he deduced the 
doctrine of change in the character of disease.” From the 
spread of his writings and opinions we have lost sight of much 
judicious treatment. Alterative medicines are quite often dis- 
carded. Cathartics weaken too much, in the judgment of this 
class of thinkers. Nervines, depressor motors, and sitmulants 
constitute the great bulk of their recommendations for the sick. 
Now none can deny that stimulation in many acute inflamma- 
tions is positively hurtful. It does not control, but, rather, in- 
creases the severity of symptoms. Whenever taken into the 
stomach, alcohol increases its vascularity, and tends after a 
short time to weaken its tone. If it be desirable to sustain the 
strength of the patient, then our aim should be not to injure the 
vitality of this organ. Large quantities of alcoholic mixtures 
produce catarrah of the stomach, upset its normal action, and 
interfere with the digestive process. Why, then, are such large 
quantities given? To keep up the heart’s action, say some: to 
maintain the strength, say others : to prepare the patient to 
pass over a crisis ; to conserve the vital powers, and prevent 
too much waste of the body ; to lessen the heat; to quiet the 14 
nervous system by its anodyne qualities; and as a food or a se- 
dative, say many. These are some of the reasons why stimu- 
lants are given, and yet almost every one of these suppositive 
properties are questioned. For a majority of them we have 
medicines of undisputed action, that will as surely meet these 
various conditions. Besides, many think that the administra- 
tion of stimulants tends to injurious results in disease. Dr. 
Gross says that “ whiskey and brandy kill as many people at 
the present day, as the lancet and tartar-emetic did in former 
times.” Dr. Hewitt writes,—“ I feel sure that the free use of 
stimulants in disease, which prevails now, results in the aggre- 
gate in vastly more injury than good.” Prof. Palmer writes,— 
“ I would retain it [alcohol] in the materia medica, but its util- 
ity is far more restricted than most of our medical literature 
seems to indicate, and its evils as a medicine strictly are far 
greater. Its use, with persons in health or in the ordinary con- 
ditions of debility, is more than an absurdity. It is, as Napo- 
leon would have said, worse than a crime ; it is a blunder.” Dr. 
Alonzo Clark, in his recent lectures on typhoid fevers, says,— 
“As a matter of fact, two thirds of the patients sick with this 
malady do better without than with alcoholic stimulants.” Dr. 
Willard Parker believes in the stimulant effects of alcohol as an 
effort of nature to throw oft' an offending substance. He re- 
gards it as an irritant,—as much so as a grain of sand forced 
into the eye. 
We would, then, class the wholesale manner of giving bran- 
dy, etc., to the sick, as it is often done, in the same catagory of 
extreme and radical measures as the use of the lancet sixty 
years ago ; as the tartar-emetic treatment of Rasori, or the blue 
pill of Abernethy. It is a one-idea medication, not broad, or 
comprehensive. 
But let us not be understood as discarding the use of alcohol 
altogether. Its abuse we deprecate. If resort be had to it, it 
should be given in conjunction with food, with milk or farina- 
ceous preparations, so that assimilation in debilitated condi- 
tions of the stomach maybe secured. “It is necessary to in- 
sist on this point,” says Ringer, “as it is common with both 
medical men and the laity to trust to alcohol alone, forgetting 
that while it benefits by stimulating the heart, it also effectually 15 
aids the digestive process, and this supports the patient in the 
best and most natural manner.” 
The rules laid down by Dr. Armstrong for the use of alco- 
holic mixtures are,—If the tongue becomes moist, the pulse 
slower, the skin not dry, the breathing tranquil, or if they 
produce sleep, then they do good. If, on the contrary, the 
tongue becomes dry and baked, the pulse quickens, the skin 
hot and parched, and the breathing hurried, they do harm. 
Dr. Stokes would administer them when the first sound and im- 
pulse of the heart over the left ventricle are enfeebled, and the 
first sound over the right ventricle is diminished, together with 
the marks of a depressed condition of the system. Dr. Bow- 
ditch says,—“I never prescribe whiskey or brandy, save with a 
limit as to the time of their use. I think physicians have done 
an immense injury by neglect of this obvious rule.” 
After all, our judgment is, if a patient is feeble, we have 
means far better than alcohol, and vastly more beneficial to the 
patient, and that is, in keeping up the strength of the patient 
by proper nourishment, judicious feeding, and suitable tonics. 
This gives satisfaction to physician and patient. In passing 
through the convalescent wards of the hospital over which Dr. 
Graves of England presided, some one remarked upon the 
healthy appearance of the convalescents. He replied,—“ This 
is all owing to our good feeding. Will you, when the time 
comes, write my epitaph, and let it be, ‘ He fed fevers’?”