Extracted from the 
TRANSACTIONS OF THE COLLEGE OF PHYSICIANS OF 
PHILADELPHIA. 
THIRD SERIES, VOLUME VIII. A PLEA FOR THE MEDICINAL USE OF PURE ALCOHOL 
AND ALCOHOLIC MIXTURES OF KNOWN COM- 
POSITION IN PREFERENCE TO ORDI- 
NARY FERMENTED LIQUIDS. 
By 
HENRY LEFFMANN, M I) 
[Read June 3, 1885.] 
I present to the College this evening, with some 
misgivings I confess, a topic which can scarcely yet be 
considered a “live issue” in clinical medicine, but which 
is destined, I am certain, to become one. At the present 
time the profession does not take kindly to suggestions 
having in view material modifications of its policy in 
reference to alcoholic liquors. The majority of physicians 
regard those who preach or practise total abstinence, or 
throw doubt on the indispensability of alcohol as a thera- 
peutic agent, as entitled to little respect or tolerance. 
In presenting the view that we should abandon in clini- 
cal medicine the uke of the natural wines and liquors, 
and resort to mixtures confessedly fictitious, we must 
expect to encounter all the force of the conservative 
spirit. Many centuries of constant use have developed 
in the race a feeling that fermented drinks, particularly 
those that, like wines and malt liquors, have suffered no 
modification by distillation or admixture, are bounties 
of nature wisely given for our use. The traditions of 
the past associate the first preparation of liquor with 168 
LEFFMANN, 
the gtxls, and in all ages poetry and prose have com- 
bined to increase the reverence for these natural pro- 
ducts. Yet all this feeling is nothing but a superstition. 
Fermentation is now known to be a process occurring 
under the influence of micro-organisms, and it allies 
itself with ordinary putrefaction. The reverence which 
we have for “ nature’s laboratory ” is born of ignorance, 
and there is no progress in chemistry more gratifying 
in its results, than that which deals with dispelling the 
illusions which have surrounded its application to medi- 
cine. 
Whatever ulterior relations the plan advocated here 
may have to the questions of total abstinence are not 
presented for discussion; I merely offer it as a contribu- 
tion to the methods of exactness and certainty in clinical 
work. 
In the medicinal and dietetic use of fermented liquors, 
it is the effect of the ethyl alcohol which is sought to 
be obtained. It is true that those who prescribe liquors 
a great deal are in the habit of saying that the accessory 
ingredients, compound ethers, astringents, or bitter prin- 
ciples, etc., are also efficacious, but if we closely ob- 
serve the customs of such prescribers, it will be found 
not only that the effect expected from the alcohol out- 
weighs that to be obtained from any other ingredient, 
but also that in the majority of cases the accessory 
ingredients are either not known or recognized. 
This fact is then taken as a starting point, that an 
agent universally recognized as one of powerful physio- 
logical activity should be used only in the most definite 
condition. 
The forms of fermented liquors are numerous, and 
each form is subject to minor variations, depending on MEDICINAL USE OF PUKE ALCOHOL. 
169 
on locality and season. The demand exceeds the supply, 
and hence the strong temptation to dilute and substi- 
tute. Within the past few months further notice has 
been given of the communications by American consuls 
abroad to the effect that the wines and brandies ex- 
ported from France and Portugal are fictitious articles, 
in the majority of cases, and it needs but a little inquiry 
to show that a very large trade in liquors, more or less 
spurious, is carried on over the entire world. 
Chemical analysis still has much to accomplish in the 
study of fermented liquors, but enough is known to 
enable us to imitate their essential features. The tabular 
statement of composition gives us a long list of mineral 
ingredients, but we are reasonably certain that, be- 
sides the ethyl alcohol, the only ingredients that need 
attention are the traces of fusel oil, compound ethers, 
astringent and bitter principles, and the effect even of 
their accessories is often more on the mind than on the 
body. 
I suggest first, then, that in all cases in which the 
general physiological effect of ethyl alcohol is desired, 
it should be given by prescription, in the form of a rec- 
tified spirit of standard strength. My friend Dr. A. W. 
Miller, who is familiar with this topic, both from the 
point of view of the pharmacist and physician, has sug- 
gested that such a standard, pure spirit be made officinal 
under the title sjnritus maydis rectificatus. Such a sug- 
gestion is in the interest of clinical accuracy and safety 
to the patient, if the medical profession have any con- 
cern in the protection of the health and morals of the 
community—and it would certainly appear that it has 
great concern—no better opportunity is offered for good 
work than in reforming the widespread errors in refer- 170 
LEFFMANN, 
ence to the use of alcoholic liquors. Where is the 
physician who would say to a patient, take a little 
laudanum or chloral every day, and leave to the patient 
or the druggist the duty of determining the dose, or the 
duration of the treatment? Yet every day physicians 
give similar recommendations in regard to liquors. The 
use of rectified spirits in prescriptions is to be recom- 
mended on the same ground that we give potassium 
bromide and iodide in accurate dosage, instead of the 
sea-water which contains them, or morphia and quinine 
instead of opium and Peruvian bark. Incidental to the 
therapeutic accuracy and moral safety which are in- 
volved in such practice, is the not unimportant question 
of cheapness. Many liquors command prices far above 
the actual commercial value of the ingredients they 
contain. A pure French brandy, for instance, costs $12 
per gallon. Its place can be taken by a spirit of much 
less cost. 
Several objections may be made to the plan of using 
the plain spirit. I cannot stop to consider the one 
which arises from a belief in the superiority of a natural 
product, from a view that that which arises from a nat- 
ural process will be necessarily superior to anything 
artificial; this, as I have said before, is a superstition; 
but there are some suggestions which are really im- 
portant. It may be that the accessory ingredients have 
some therapeutic value, and it has been said to me that 
while pure alcohol may easily be used during acute 
disease and in hospital practice, that in, long-continued 
treatment, and as a dietetic, patients cannot be made to 
take it. In these cases the method to be pursued is 
plain. Let the alcohol be mixed with suitable accessory 
ingredients. If a combination of bitter tonic, sedative, 171 
MEDICINAL USE OF PURE ALCOHOL. 
and stimulant is wanted, it can be prescribed, and so 
on. There need be no difficulty in the matter, because 
modern art in the preparation of fictitious liquors has 
reached such perfection that excellent imitations of the 
natural liquors are made, and these have the advantage 
of definite and known composition and greater cheapness. 
It is not uninteresting to note here the general nature 
of this work. I have the samples to illustrate it. In 
the preparation of fictitious liquors threQ methods may 
be employed. 1st. The genuine liquor may be diluted 
with a suitable strength of pure spirit. This will give us 
a liquor differing but little from the original. 2d. The 
liquor may be imitated by adding to pure spirit coloring 
and flavoring ingredients. In many cases this will give 
a liquor substantially identical with the original. 3d. 
The liquor may be made up weak, and then taste and 
appearance of alcoholic strength be given by means of 
pepper and bead oil. The latter method is reprehen- 
sible, but the two former methods are, I hold, not inju- 
rious, and should be recognized. 
In order to make the present state of the art more clear 
to the members, I submit herewith samples of artificial 
liquors, cordials, and flavors, kindly furnished me by Dr. 
A. W. Miller, of this city. 
[Samples of rectified spirit, whiskey, brandy, Holland gin, chartreuse, and 
curacoa, were exhibited, also a number of concentrated flavors and color- 
ing matters.] MILLER, MEDICINAL USE OF PURE ALCOHOL. 
173 
[After the reading of the preceding paper:—] 
Dr. A. W. Miller said : I have listened with much pleasure to the 
reading of this paper, for the subject is one in which I have taken con- 
siderable interest for a number of years, and I have myself written 
several papers on it. I doubt whether Dr. Leffmann is entirely correct 
in speaking of these liquors as being made by art. It is simply 
following a well-known law of commerce and bringing those products 
from countries where they are abundant to those countries where they 
are scarce. In making whiskey we use alcohol produced by fermenta- 
tion of corn, which is the cheapest article from which it can be made 
in this country. This is passed through percolators containing char- 
coal, sometimes animal and sometimes vegetable, which absorbs all the 
fusel oil and coloring matters. When this process is carefully per- 
formed, we have an absolutely pure spirit, which is made of such 
strength as to contain fifty per cent, of alcohol by volume. To flavor 
this we import from Germany, where rye whiskey is one of the cheapest 
forms, the oil of rye, which is there a waste product in the rectification 
of rye whiskey. When this is diluted to a proper strength, it can be 
used as a flavoring material. 
Brandy is made in nearly the same way. The flavoring material is 
obtained by distilling the refuse of the grapes, from which the wine 
is made, with sulphuric acid. There is only one pound of this obtained 
from a ton of the so-called mark. When this is properly reduced, it 
may be used as a flavoring ingredient. These are not the only ingredi- 
ents used in flavoring, but they are all harmless in the small proportions 
used. Another of these flavors is acetic ether. This is also present in 
the natural product. The peculiar bouquet of high-priced wines 
is probably due to the presence of acetates, and to the products of oxi- 
dation of fusel oil, producing valerianic acid and subsequently valerian- 
ates of ethyl and amyl. These are present in an infinitely small 
proportion. Artificial rye whiskey contains only one part of amylic 
alcohol in ten thousand parts. Brandy only one in fifty thousand. In 
addition to acetic ether, there is formic ether in brandy, and also 
butyric ether. All these things are used by confectioners in flavoring 
candies, and, as far as I know, no one has suffered from their use, 
although they are used in larger quantities. There is another point, 
namely, that liquor-dealers insist upon having a wholesome article, 
while confectioners are not so particular. 174 
MILLER, GRAHAM, LUDLOW, 
The cordials which have been shown are made from the rectified 
spirit with the addition of aromatics and syrups. 
The curacoa is almost an exact representative of the simple elixir 
of the pharmacopoeia. This is a very useful manner of administering 
a mild form of alcoholic beverage, and is to be preferred on account 
of having the sanction of the pharmacopoeia, and on account of having 
a definite strength. This is another point in favor of the use of arti- 
ficial liquors. The rectified spirit always contains fifty per cent, of 
alcohol. The natural liquors vary greatly, sometimes falling to forty 
per cent., and sometimes, as in rum, reaching seventy-five or eighty 
per cent. 
I might say here that the unpleasant taste of ordinary diluted 
alcohol is probably due to the amylic alcohol, which is more soluble 
in strong than in dilute alcohol. Not being thoroughly combined, it 
causes a disagreeable taste and odor. 
The economical value of these substitutes has been referred to. The 
rectified spirit can be bought for $1.25 per gallon, and its therapeutic 
value is equal to that of brandy at $10 per gallon. 
I have proposed the name spiritus maydis rectificatus, because it 
designates the particular kind of grain from which this alcohol is de- 
rived, and prevents it from being confounded with the spiritus fru- 
menti, which is now officinal. 
Dr. John Graham : At the Franklin Reformatory Home, some 
three hundred cases of alcoholism are treated annually. For the last 
two years none of the ordinary alcoholic drinks have been used, but 
we have employed rectified spirits variously medicated. In the mild 
cases, alcohol is not used, but in the severe cases it is. The results 
have been equally as good as when the ordinary liquors have been 
used. In devising these substitutes for ordinary liquors, we must be 
careful that we do not injure instead of aid the temperance cause by 
the introduction of new drinks. In regard to dose, we consider 
one teaspoonful of rectified spirits to equal two teaspoonfuls of brandy. 
Dr. J. L. Ludlow" : I would like to ask to what the term oil of cognac 
is applied ? Also whether Dr. Miller has noticed any difference be- 
tween the so-called California brandy and so-called French brandy ? I 
have tried the California brandy and it struck me as though red pepper 
had been added to it. MEDICINAL USE OF PURE ALCOHOL. 
175 
Dr. Miller : There are different varieties of oil of cognac. The 
best is that which is obtained by acting with sulphuric acid on the 
residue of the grapes after pressing out the juice. As I have said, 
there is only about one pound obtained from a ton of residue. It is a 
complicated compound of the higher ethers. Some artificial oils of 
cognac are made by the action of nitric acid on oil of rue, others by 
the saponification of castor oil or cocoanut oil and the subsequent 
decomposition of the soap thus formed by sulphuric acid. 
As far as my experience goes, California wines and brandies are 
perfectly pure. Their low price offers no incentive to adulteration. 
It is well known that brandies from different localities have different 
flavors. The California brandy also probably never reaches the age 
of the French brandy. 
Dr. William Hunt : I have frequently made the observation that 
in low forms of disease where alcohol is called for, the odor cannot be 
detected in the breath as long as the patient is not getting too much.