( Reprinted from the Proceedings of flic Philadelphia < 'ounty Medical Society.] 
THE 1HJTV OF THE HOUR. 
Beino an Examination of tiie Relation of the Medical Profession 
to the General Use of Alcoholic Liquors. 
Read September 26, 1883. 
Member of the Society of Public Analysts of England. 
IIENltY LEFEMANN, M. H. 
IN his work on the descent of man, Mr. Charles Darwin, of 
blessed memory, remarks that he made in the course of his 
studies a large collection of the definitions which have been 
offered as expressing the distinctions between man and the lower 
animals. The primary object of this collection was to show the 
insufficiency of such definitions, but unfortunately the learned 
author abandoned his plan and the list wras never published. I 
have always regretted this because I wras anxious to sec if any one 
had been bold enough to sacrifice the honor of the race to its 
independence, in other words to define the human being as the 
only animal in which natural passions are abused and unnatural 
appetites developed. Though it may be a pessimistic view of 
human nature, yet we cannot avoid the conclusion that the defi- 
nition is substantially correct. The history of races and nations 
presents us invariably with a picture of unbridled passions, the 
fierceness of which is but slowdy and uncertainly assuaged by 
civilization, for in the modern as well as in the ancient world, it 
is in the centres of intellectual development that the greatest 
license has been seen. Legislators, both of the civil and ecclesi- 
astical order, have wrestled with these problems, and in some forms 
of excess have tried every expedient, from the most despotic 
repression to the most indulgent remonstrance, but with only 22 
nilLADELrillA COUNTY MEDICAL SOCIETY. 
partial advantage. Among the vices which appear to he charac- 
teristic of man under every climate and social condition, is the 
use of alcoholic liquors, and although the evils of this indulgence 
have been vividly presented to every one, yet a determined effort 
to obliterate the habit belongs only to our own time. 
In that almost exhaustive treatise on moral and religious polity, 
the Jewish and Christian Scriptures, we notice that the duty of 
total abstinence has not been inculcated either among Hebrews, 
although the daily duties of life were regulated with microscopic 
minuteness, or among the leaders of the new dispensation, 
although they founded a most extended system of asceticism and 
self-denial. We are concerned, however, with the present, not 
with the past. Around us is a social system of great complexity. 
Though progress is slow, yet we need have no fear of its general 
direction. Each year marks too slight a movement to permit us 
to distinguish the result, but each century gives us a definitely 
recognizable advance, and shows clearly the tendency of the race 
to a higher and purer life. It is the text of my discourse to-night 
that the basis of this higher morality is self-restraint, and the 
basis of self-restraint is the influence of example. In the con- 
sideration of total abstinence, and the relation of the medical 
profession to its encouragement, we must clearly distinguish 
between the use of alcohol as a beverage and as medicine. With 
the question of its therapeutic indication and contra-indications, 
we have absolutely nothing to do in this paper. As to the method 
and form of its clinical use, however, as will be shown later, very 
important questions arise. 
I think I may safely assume that the use of alcohol is not 
necessary to the maintenance of ordinary health. Its physio- 
logical effects have been extensively studied, and concordant 
results have not always been obtained. I need not stop to 
reconcile these differences, for the greater portion of the published 
results is not germane to my subject, nor will it be necessary to 
devote time to the presentation of statistics. One authority will 
be sufficient, because it is an authority in whom opportunities of 
observation and experiment are combined with sound common 
sense and accurate logic. Without desiring to slight the labors 
of other workers, I think we find in Parkes’ Hygiene the whole 
subject of alcohol so thoroughly discussed as to render other 
authority superfluous. In this work it is established beyond THE DUTY OF THE HOUR. 
23 
question that the use of alcohol is not beneficial, that it does not 
inctease the power of the system to resist extremes of heat, cold or 
fatigue, and that even in special cases in which stimulants appear 
to be needed to maintain the resisting powers, other substances 
may advantageously be used. It is certainly surprising to read 
that one of the most common opinions, L would rather say super- 
stitions, about alcohol, that it assists the body in resisting cold,is 
without foundation. Scarcely any of the minor causes of drinking 
are more general than this, yet the unanimous testimony of those 
who have been in charge of polar expeditions is against its bene- 
ficial action in such vicissitudes, and some of these leaders have 
after their first experiences declared that they would not take on 
any subsequent voyage any person addicted to the use of stimu- 
lants. As regards the general effect of the continual use of alcohol 
on persons in ordinary health I cannot do better than quote briefly 
from papers read by well-known clinicians, before this Society, 
two years ago. Dr. Wood says:* “Although I hold that the 
habitual use of alcohol is to well-fed persons not only unnecessary 
but positively harmful, it seems to me that in many cases of disease 
and in those periods of life when by reason of age the body waxes 
weak, alcohol is found of great value. Under sixty years of age 
the daily employment of wine may for most persons be very 
well discountenanced * * * . It is notorious that in America 
almost every one in reasonable health consumes much more food 
than the system needs, so that any alcohol taken is added to that 
which is already in excess.” Dr. Pepper holds j" that the quantity 
permissible is very small, not more than one and one-half ounces 
of absolute alcohol in twenty-four hours, taken much diluted and 
only at meals. A very large number of persons, either from sus- 
ceptible stomach or a gouty diathesis, cannot safely take alcohol 
at all. Dr. Bartholow says:+ “As a stomachic tonic alcohol is 
effective only in the case of those not habituated to its use 
* * * . That in time a catarrhal state of the mucous membrane 
is produced and a pathological secretion obtained shows the im- 
propriety of the long continued use of alcohol as a stomachic 
tonic.” Finally, although relating to the therapeutical use of 
* Is Alcohol a Food. Proceedings Phila. Co. Med. Society, vol. iii, p. 135. 
t Effects of the prolonged nse of Alcohol on the Nervous System and Organs of Special 
sense. Op. cit., p. 139. 
X Alcohol. Its therapeutical uses internally and externally. Op. cit., p. 127. 24 
PHILADELPHIA COUNTY MEDICAL SOCIETY. 
alcohol, I cannot avoid quoting some forcible and logical remarks 
made by I)r. Woodbury* in a discussion on the treatment of pul- 
monary consumption: “Nothing in clinical medicine is more 
certain than the continual use of alcohol in even moderate 
doses stimulates the development of connective tissue all over the 
body, nothing in pathology more evident than the fact that alcohol 
is a prolific source of pulmonary disease, nothing in toxicology 
better established than the observation of the action exerted by 
alcohol upon the respiratory centre. For this reason it is espe- 
cially dangerous in pulmonary consumption.” 
It is, unfortunately, too true that no quotations from authority 
or rehearsal of statistics are needed to show the moral and phys- 
ical injur}' done by alcohol. Directly and indirectly it is a prime 
factor in the promotion of disease and crime, and when we reflect 
upon the thousands of desolated homes and ruined prospects for 
which this agent is annually responsible, we cannot wonder at the 
sentiment which is slowly but surely developing in the community 
against all phases of industry or trade which have for their object 
the furtherance of the use of alcohol, nor can we doubt that to 
the success of the work of moral regeneration of our race the 
obliteration of these industries is essential. A powerful assistance 
in securing and maintaining sobriet}' would be to destroy the 
superstitious respect in which the various beverages are held. 
Non-medical persons are generally aware that physicians attribute 
particular values to particular liquors. In my own experience 1 
have found very few persons who are willing to admit that they 
use liquor merely because they like it. They generally find some 
other reason—the necessities of the system, the advice of some 
physician, either to themselves or to some friend. One person 
uses beer because it is a tonic ; another, because of its nutritious 
value, and so on—every reason but the real one, because they like 
it. Not a little of this popularity of liquor is due to the glamour 
of sentiment which attaches to it. Even the austere psalmist, 
who, with the exception of a single sin, “did that which is right 
in the sight of the Lord,” has praised the “wine that maketh glad 
the heart of man.” And for ages poets and prose-writers have 
extolled the qualities of stimulating beverages and the romance 
of their manufacture. In our time, however, these sentimental 
* Proceeding* Phila. Co. Med. Society, vol. iv, p. 175. TIIE DUTY OF THE HOUR. 
25 
features are but imaginary. Nothing in the present methods of 
producing liquors is of a character to make us respect them as 
types of poetic or convivial relations. The wine that stands on 
our tables no longer shows in its ruddy color the rainbow tints— 
“Caught where the morning sunbeams, stooping low, 
Have kissed Grenada’s plain.” 
Nor does its aroma repeat 
“The dainty perfumes of the East 
That Horace used to praise.” 
No, the suggestions that are now called up by those who know 
the facts, are the suggestions of the fourth floor of a Front street 
warehouse, where rectified spirit, animal charcoal, glycerine, 
saponified cottonseed oil, aniline red, burnt sugar, et hoc genus 
omne, are being mixed together and transferred to casks and 
bottles ornamented by lying labels. The foaming tankard of malt 
liquor no longer suggests the 
“ house where nut-brown draughts inspire,” 
but the images now appropriate are those of bloated workmen, 
aloes, quassia, and the hop substitutes, salicylic and boric acid, 
baking-soda, gum for preserving froth, and beer-pumps for pro- 
ducing it. in short, no romance belongs to our alcoholic bever- 
ages. They are the products of influences allied with the lowest 
levels of mercantile honor, and their touch is corrupting. 
In an article read before this Society two years ago,* I put for- 
ward tire view, that when alcohol is to be used by physicians it 
should be used as such, and not in the form of special manufac- 
turers. I cannot express myself better than by my words on this 
occasion, as follows: 
“We know that liquors prepared by strictly natural methods 
are not constant in composition ; we know that under the exigen- 
cies of trade additional conditions of variations are produced, 
and even complete substitution brought about. I have for some 
time thought that the best way to secure entire constancy in the 
therapeutic use of alcohol would be to have the preparations made 
up by regular prescription, or by printed formula; in the Pharma- 
copoeia. The substances which exist in wine, beer or brandy are 
♦Medical Relations of the Commercial Adulterations of Wines and Liquors. Pro- 
ceedings Phila. Co. Med. Society, vol. iii, p. 132. 26 
PHILADELPHIA COUNTY MEDICAL SOCIETY. 
in accidental mixture—some are useful, others useless Why 
should we not have the useful articles properly combined by co n- 
petent hands, and the useless omitted. * * * And 
the physician, instead of ordering a special wine, will simply pre- 
scribe such preparations as may be necessary of alcohol, water, 
flavoring ethers, and astringent or bitter principles.” These pre- 
scriptions, like those containing other powerful ingredients, should 
be renewable only at the instance of the physician. 
I have lately learned with much pleasure that Dr. A.W. Miller, 
of this city, a gentleman well known to most of the members of 
the Society, as an experienced pharmacist, is about to publish a 
paper advocating a similar view. Dr. Miller indeed expressed 
such opinion publicly several years ago, although I was not aware 
of it then. His large experience in the manufacture of flavoring, 
coloring and other materials used in liquor imitation, gives him 
the right to speak with authority, and 1 find by my conversation 
with him that we are entirely in accord. In his paper he intends 
to call attention to the fact which 1 would not have time to con- 
sider, that, in wines and brandies, factitious articles are sold at high 
prices, and thus the practice of ordering such articles exposes 
patient to both deception and robbery. Not the least of the inju- 
ries which is done to the community by the laxity of physicians 
in reference to the use of liquors, is the encouragement which is 
thus given to the sale of quack medicines under the guise of bit- 
ters and tonics. No greater fraud is put upon the public than the 
preparations which are advertised under these names. The}- are 
alcoholic beverages in their most dangerous and insidious form. 
I have this week examined one of the most extensively advertised 
of the lot—Warner’s Safe Tonic—and I find it to contain a consid- 
erable amount of alcohol, in association with some vile combination 
of s}rrup and bitter extract. When it is remembered that the 
miserable stuff is bought at a price much above its value, and is 
used mostly by persons already somewhat out of health, we must 
see that the harm done is incalculable. Yet the popularity of 
these articles is largely due to the lact that they meet what most 
people believe to be a necessity in disease, an alcoholic tonic. 
During the last few years several eminent physicians and chemists 
in this country and abroad, have gone almost into spasms over a 
knowledge of such adulterations as the use of alum in baking- 
powders, glucose in candy, and oleomargarine in butter, all trifling THE DUTY OF THE HOUR.. 
27 
and non-injurious substitutions ; but we hear very little about the 
far more dangerous preparations of the class just alluded to. The 
most striking evidence of the profoundly misguided condition of 
the public mind on these topics, was well shown lately in New 
York, when the officers of the Business Men’s Moderation Society 
gravely condemned the use of the harmless glucose in beer, and 
then gave, inferentially at least, certificates of wholesomeness to 
beer containing between four and five per cent, of alcohol. The 
quack medicine mentioned above has with each bottle the official 
certificate of the Professor of Chemistry of the University of 
Rochester, stating that the preparation is free from deleterious 
ingredients. I feel sure that statements like this could not be 
made if medical authorities were true to their own knowledge on 
these questions. 
It is in view of the points which I have here enumerated, that 
I feel obliged to lay before this Society, and through its published 
proceedings before the world, the accusation that the medical 
profession is responsible for a very large portion of the misery 
which alcoholic beverages produce, and I declare that the time 
has now come when a stand should be taken in favor of absti- 
nence. I believe that it is established by the citations I have 
given, that alcohol is not needed by healthy persons. I know 
that many non-medical persons use liquor because of the general 
approval of it by the medical profession, and I think it can be 
demonstrated that although alcohol itself is a substance of great 
value, alcoholic beverages are entirely unnecessary. Of late years 
although physicians have assumed the right to speak broadly upon 
many questions affecting public health and public morals, they 
have been singularly conservative as regards the evil of moderate 
drinking. Yet it seems to me that sewer construction, registry 
laws, quinine pills, river pollution, ethical innovations, etc., on 
which topics so much energy has been expended recently, do not 
approach in magnitude the reform which is here urged. 
The pollution of a river water by organic matter before it 
reaches a city reservoir is rarely so serious in its effects as the 
pollution of it by alcohol after it leaves the hydrants, and the 
dangers of Rye Beach, of which we have heard so much, are trifling 
compared with the dangers of rye whisky or what is labeled as 
such. 
The learned professions are potent influences in moral reform, 28 
PHILADELPHIA COUNTY MEDICAL SOCIETY. 
and for many centuries law and divinity have exercised much 
more control over the race than has medical authority. This 
relation is now rapidly changing. The questions of civilization 
are regarded as practical problems, largely medical in character, 
and the direction of education is passing into the control of the 
scientist and physician. Both the lawyer and divine have recog- 
nized alcohol as a foe to public and private virtue, for courts now 
frequently regard intoxication as an aggravation rather than as 
an excuse for crime, and the almost unanimous temper of church- 
men is against any form of indulgence in stimidants; even the 
time-honored employment of wine in Communion is not sufficient 
to maintain its use, and unfermented wine is now a familiar 
article of commerce. Let us then begin at once to discharge 
our duties, and ally ourselves openly with the laity, who, though 
lacking in scientific knowledge, have the good of the community 
at heart. Let us recognize that while many evils claim our atten- 
tion, the importance of a firm stand in favor of total abstinence 
is urgent and is indeed the “ duty of the hour.” 
DISCUSSION ON THE RELATION OF THE MEDICAL PROFESSION TO THE 
GENERAL USE OF ALCOHOLIC LIQUORS. 
The President stated that the points presented for discussion were : 
1. That the use of alcohol in any form and in any amount l>y persons in 
ordinary health is deleterious. 
2. That the medical profession, by its lax attitude on this question, is 
responsible for much of the prevailing abuse of alcoholic liquors. 
8. That if alcohol is to be used at all, it should be given as such, and 
the prescription should be made non-renewable, as with other powerful 
medicines. 
Dr. J. T. Eskridge, in opening the discussion by request of the President, 
said : I like the practical and novel way in which the subject has been 
treated. It will attract attention, and, I hope, serve to make the members 
of this Society, and of the medical profession in general, consider their own 
responsibility for the abuse of alcohol. 
One of the conclusions at which the writer of the paper has arrived, is 
“That the use of alcohol in any form and in any quantity by persons in 
ordinary health is deleterious.’’ This is a broad and sweeping statement, 
and, while in the main it is correct, circumstances may arise when alcohol 
may be administered to persons in health with benefit. 
Dr. Percy’s experiments showed that the free use of alcohol tends to 
prevent the solidifiability of fibrin, and thus renders wounds difficult to 
heal; and those of Yierodt and Prout, that less carbonic acid is given oil' The duty of the hour. 
29 
in the exhalations by the breath under similar conditions. Boucliardat 
tirst pointed out that alcohol darkens arterial blood. These results were 
obtained by experimenting upon subjects whose stomachs had been over- 
charged with alcohol, or into whose veins the spirit had been directly 
injected. They show the poisonous effects of alcohol, and reasoning from 
these, it by no means follows that the administration of small quantities 
well diluted is injurious to health. But observations are not wanting to 
prove the evil effects of alcohol on healthy persons when taken in small 
quantities for a considerable length of time. 
Prof. W. B. Carpenter, a strong advocate of temperance, in his admirable 
prize essay on the, “ Use of Alcoholic Liquors iu Health and Disease,” 
after describing the baneful effects of alcohol on mind and body, when 
taken in small quantities several times daily for a length of time, frankly 
admits that its temporary administration to persons in health, on certain 
extraordinary occasions, is attended with decided benefit. Prof. Miller, of 
Glasgow, in an excellent review of the subject, entitled “Alcohol : Its 
Place and Power,” arrives at conclusions almost identical with those 
reached by Prof. Carpenter. 
I am satisfied that persons in health, under ordinary circumstances, do 
not need an alcoholic stimulus, and that if its administration is attended 
by no good results, evil only follows the use of alcohol at such times ; but 
on the other hand, I am convinced that’ circumstances do arise when, if 
alcohol is properly administered to persons in health, its good effects far 
outweigh its evil ; and that there are conditions, short of what we are 
accustomed to call disease, which are improved by the temporary and 
judicious employment of alcohol. 
Bodily and mental labor that cannot be endured without resorting to 
artificial stimulants had better be left off; but times come in the history 
of many persons, when they are not their own task-masters. A great 
deal may depend upon a few hours’ work. Tea and coffee may not be 
sufficient stimuli, and a little alcohol taken at these times will allow an 
extra strain being made upon the system. The use of alcohol must not be 
often repeated for the purpose of increasing the power of endurance. It 
must be remembered that a stimulus in these cases acts the part of the 
spur to the tired horse. It probably does not directly add force to the indi- 
vidual, but it enables him to call more upon his latent powers, and, of 
course, the exhaustion which follows is all the more profound by the reason 
of the extra strain upon the vital forces, made possible by the use of alcohol. 
Again, the appetites of some persons have been rendered capricious by 
the process of coddling, and those of others lessened, and the power of 
digestion weakened by worry and over-mental exertion, so that the simplest 
articles of food cannot be digested properly. To such the administration 
of a little wine, with a bitter tonic, before meals, for a week or two, and 
subsequently a bitter tonic given before meals, and wine during or imme- 
diately after the ingestion of food, is followed by admirable results. In all 
these cases the use of alcohol must be cautious and temporary, and not 30 
PHILADELPHIA COUNTY MEDICAL SOCIETY. 
allowed to be coutined longer than is absolutely necessary. I agree with 
the statement made by the reader of the paper, to-night, that below sixty 
years of age a person is generally not benefited by the use of alcohol in 
health. I know, indeed, of a case in which it did not become necessary 
to resort to it before the ninetieth year. 
In regard to the use of alcohol in phthisis, to which a casual reference 
has been made, I have very strong convictions of its value when properly 
employed. In this disease, when pulse is rapid and temperature con- 
siderably elevated, alcohol is contra-indicated, but in the more chronic 
cases, when respiration is difficult, and pulse and temperature nearly 
normal, its beneficial effects in prolonging life are evident to every one 
who has given it a fair trial. Prof. Flint speaks in the highest terms of 
alcohol in phthisis. 
As a preventive of phthisis, alcoholic stimuli have their place and power. 
It is well known that in the same family, several children, whose parents 
have suffered from phthisis, may die from this disease at about the same 
age. For these persons, if alcohol is occasionally employed judiciously, 
whenever vital force falls below its normal in them, I have no doubt that 
in many instances the fatal disease might be prevented. 
To the second proposition I may say that I do not know of any case in 
which the use of alcohol in disease, under direction of a physician, gave 
rise to drunkenness. Some time ago Dr. Hamilton, in a discussion before 
this Society, mentioned a case in which a patient became a drunkard in 
consequence of the use of alcohol in typhoid fever, but it appeared on 
further inquiry that the man was a habitual drinker before the disease 
occurred. Lax prescribing, however, may easily become a serious error. 
It is important that if alcohol is ordered, the quantity, form and time of 
taking should be indicated. It should be taken only at meals. This 
periodic and formal use of it will make the patient willing to stop when 
required. I admit that if. we consider that alcohol is injurious in health, 
we must regard its use in social gatherings, and especially in those com- 
posed of medical men, as wrong. 
In reference to the last points, I cannot speak from experience. If the 
adulteration is as extensive as pointed out in the paper, then the author’s 
view, that alcohol should be used as mentioned, is correct. I however, 
doubt that we can make, extemporaneously, mixtures which will take the 
place of natural liquors. 
Dr. Mills said : I would not wish to be regarded as an advocate of any- 
thing else but temperance in the best use of the word, but the question of 
the influence of the moderate use of alcohol upon intellectuality and the 
longevity of intellectual workers, is one of considerable interest, from 
what might be termed a biographical point of view. During the Inter- 
national Medical Congress of 1876, one of the English delegates expressed 
the opinion, in words which I do not exactly recall, that the intellectual 
productions of men who did not use alcohol at all were not of a character 
to indicate the value of abstinence. Many distinguished men who have THE DUTY OF THE HOUR. 
31 
lived to a comparatively advanced age—the English Lord Chancellors, 
German thinkers, and well-known American statesmen, for instance—used 
alcohol in moderation throughout their lives. I simply introduce this point 
for discussion. About the evils of the abuse of alcohol no doubt can exist. 
Ur. Wood : I consider the first proposition advanced by the author of 
the paper to be untrue ; it is entirely too sweeping. To say alcohol is 
deleterious in any form and in any quantity in health, is to say that one 
would be injured by simply smelling a bottle of whisky. I am fully con- 
vinced that we do not need alcohol in health, hut indulgence in it moder- 
ately, on occasions, is probably no more hurtful than over-eating. 1 have 
seen, at social gatherings, total abstainers, who, while standing apart from 
the general company and congratulating themselves upon their superior 
virtue in not indulging in stimulants, gorge themselves beyond repletion 
with the food set before them, much to their stomachs’ distress. 
The moral question involved is the old one of use and abuse, and whether 
I must forego the use of a thing because some one else abuses it. 
* Are we to abstain from a certain amount of pleasurable indulgence 
because of the example which that indulgence offers to others? I do not 
believe in attempting to force total abstinence, because I do not believe 
that the movement will accomplish the desired result. Not long ago I was 
traveling in Kansas and I met a prominent prohibitionist, a member of the 
Central Committee of the State, whom I questioned about the success of 
the prohibition movement, asking, inter alia, if they had destroyed the 
grape industry, as the law directed, in the wine-making districts. He 
replied that they did not expect to do this in those places. Here was an 
admission of the weakness of the cause, for where the manufacture and 
use of wine were now most active was the least hope of abolishing it. In 
the same car was a traveling salesman on the verge of delirium tremens, 
and l asked him as to the effect of the liquor laws in Kansas. He replied, 
“I can get a drink of whisky anywhere in Kansas for fifteen cents.” 
The Scandinavian method of dealing with the temperance question seems 
to me more practicable. In Sweden and Norway the country is divided 
into distiict-, in each one of which only one tavern is allowed. The 
licenses are sold at public auc.ion. The temperance people have combined 
and bought up the licenses. They are obliged to open the tavern, but 
they can adopt such regulations as will prevent, the excessive use of alcohol 
by those who frequent the place, and also employ all moral means to 
persuade men not to drink at all. I do not think that the adulterations 
of liquor are as harmful as has been stated by the lecturer. Liquors and 
wine are artificial products always. 
I think that good liquoiS cau be easily obtained. I do not agree with the 
proposition that medical men are responsible for the habit of drinking to 
excess ; on tin? contrary, the example and teaching of the medical profession 
have done much to diminish the evils of intemperance. 
Dr. O’Hara : In reference to the remarks of the last speaker, let me read 
the following from Richardson, “Induced Diseases of Modern Life,” page 32 
PHILADELPHIA COUNTY MEDICAL SOCIETY. 
232 : “ Speaking lionestly I cannot, by any arguments yet presented to me, 
admit the alcohols by any sign that should distinguish them from other 
chemical substances of the paralyzing narcotic class.” 
If this view be correct, we can have no doubt that alcohol is injurious in 
health, and that it does not serve as food. We are too much under the 
ideas of Liebig in this matter. For my part I cannot see that the total 
abstinence movement is a failure, or that the views advanced in the paper 
are erroneous. They are the views which have been advocated by high 
authority, in the International Medical Congress in 1876, and other scien- 
tific bodies, for instance. The medical profession may be responsible 
indirectly for much of the excessive drinking, through the idea scattered, 
but now passing away, that it was food. 
I have myself learned by experience the evils of too much confidence in 
alcohol, when I thought it wras food, and now watch it closely as a medicine. 
As to the cases narrated by Dr. Eskridge, they cannot be regarded as cases 
of healthy persons, and the use of alcohol in treatment of them is a ques- 
tion of therapeutics, not of hygiene. 
Medical men may certainly accomplish a good deal by the teaching 
influence of example. 
I recall an instance in which brandy was used for dyspepsia ; the patient, 
it is true, got rid of the dyspepsia, but he complained frequently until the 
day of his death, which was superinduced by liquor, that he made a bad 
swap and would rather have held on to his dyspepsia. 
The conclusions of Dr. Hunt’s paper were adopted by the International 
Medical Congxess, 1876, and ordered to be transmitted to the 
Tempeiance Society, the Women’s National Christian Temperance Union, 
and the Friends’ Temperance Union of New York. They were : 
1. Alcohol is not shown to have a definite food value by any of the 
methods of chemical analysis or physiological investigation. 
2. Its use as a medicine is chiefly that of a cardiac stimulant, and often 
admits of substitution. 
3. As a medicine, it is not well fitted for self-prescription by the laity, 
and the medical profession is not accountable for sucb administration or 
for the enormous evils arising therefrom. 
4. The purity of alcoholic liquors is, in general, not as well assured as 
that of articles used for medicines should be. The various mixtures when 
used as medicines should have a definite and known composition, and 
should not be interchanged promiscuously. 
Dr. Tyson: This question is one very difficult to discuss ; both parties ai’e 
apt to go to extremes. Dr. O’Hara’s remarks are a case in point, for the 
injurious effects to which he alludes are the effects of the use of alcohol in 
excess and not in moderation. It must have been the experience of all 
practicing physicians to see many cases which are benefited by the 
moderate use of alcohol, especially at meals, while in many aged persons 
its use is very appropriate and even necessary. I am not prepared to deny 
altogether the correctness of the second proposition offered in the paper. TIIE DUTY OF T1IE HOUR. 
33 
I think there may be some ground for it, yet I do not know a single case 
in which the recommendation of the use of alcohol in disease has resulted 
in establishing a habit of drinking. I recall a case in which a gentleman 
was advised by a non-medical friend to use whisky for dyspepsia. It was 
tried, and finding good results from it he continued using it in small 
amounts daily; the use was kept up until one day the patient found the 
bottle empty. He missed his usual dose so greatly that he was forced to 
realize that he had been drinking, and never used the liquor again. It may 
be laid down as a rule that it is not safe for physicians to advise the regular 
use of alcohol for dyspepsia; it may lead to a habitual use of stimulants. As 
to the third point, I think that in view of the fact that it is still possible to 
get pure wines, especially if we are satisfied with domestic wines, the fiavor 
and other properties which made them more acceptable to the patient, 
justified their continued use ; but I for one am willing to try the effect 
of pure alcohol properly diluted in cases where alcohol only is indicated. 
Dr. Hamilton : Moderate drinking, it must be remembered, is very 
often the road to immoderate drinking, and therefore the physician, 
whose influence in this connection is paramount, should sedulously avoid the 
too frequent and too liberal use of liquor, especially in young subjects. 
Iu the low forms of fever, or in chronic, wasting disease, such for instance, 
as pulmonary consumption, to which allusion has been made, it is often of 
great advantage, and in the latter disease, where expectoration is profuse, 
but unaccompanied with much fever or difficulty in breathing, it may 
prolong life for an indefinite period. The custom of drinking in the 
wealthy and fashionable circles may still be said to prevail with tyrannic 
power, and in ordinary social reunions the same practice is common. The 
influence of wealth and fashion is dominant, and until some amelioration 
in this connection is manifest, no general temperance reformation need be 
looked for in the people at large. 
The allusion to the adulteration of wines and stronger liquors was 
deservedly made, but it occurs, doubtless, much more frequently in regard 
to the finer and more costly than to the cheaper liquors, and the perfection 
to which this adulteration has attained is simply notorious. 
Dr. James C, Wilson : I am much pleased to see this subject before the 
Society. It is a subject which ought to be agitated, because the agitation 
will bring out the truth. I think that the propositions rather overstate the 
case, and somewhat weaken the points advanced. Independently of law, 
church influence and local politics, a widespread, popular sentiment is 
developing in favor of temperance, but not of total abstinence. A feeling 
against excessive indulgence is growing steadily in the community. It is 
now considered “bad form” to drink to excess at social gatherings, and 
young men especially are much more restricted than formerly. The three- 
bottle men of earlier days are now unknown. It is, however, going to an 
extreme to put the proposition that the use of alcohol in any form, and to 
any extent, is deleterious. Many persons can use alcohol in moderation, 
and derive comfort from it without injury. I do not agree with the second 34 
PHILADELPHIA COUNTY MEDICAL SOCIETY. 
proposition. Respectable medical men are not lax in their attitude on 
this question, but are accustomed to caution their patients in regard to the 
dangers of the use of alcohol. Most of them direct the amount to be taken 
and fix a time for discontinuing the use, just as they do with other powerful 
drugs. As regards the suggestion to use alcohol alone, it appears to be 
open to some objections. It is not possible to imitate the different wines. 
No formula of the pharmacopoeia or prescription could produce the perfect 
mixture which we see in natural wines, which are often so specifically 
beneficial. 
Dr. Frank Woodbury said : I have been much interested while listening 
to the paper, and, in the main, sympathize with its teachings. I think 
that the propositions submitted for consideration were puiposely framed 
so as to excite discussion, since they are not logical deductions from the 
paper, and indeed have not been presented as such. The alcohol question 
is a complex one —it is a great social and moral problem, as well as a 
scientific and medical one. The subject as presented this evening has at 
least three aspects : the use of alcohol in any quantity in health —this is a 
physiological question ; its employment by physicians—a medical question ; 
and the right of physicians to prescribe it—which is a moral question. 
This moral question is really the principal one of the paper, as is shown by 
its title, “The Duty of the Hour.” With regard to the question as to its 
injurious effect when used in health in any quantity, I would ask, first, 
what is meant by a state of health? If a physiological definition is 
accepted, then no person living under the artificial conditions of civiliza- 
tion can be in a state of perfect health. Ordinary health is merely an 
approximation towards physiological health ; and if the utility of alcohol 
is acknowledged in the condition of disease (which is merely any departure 
from the healthy standard), then the first proposition is answered by the 
lecturer himself in the negative. Then again, concerning the use of 
alcohol “in any quantity,” I think it worth while to recall the fact that 
not only is it without injurious effect in very small doses, but tliat in 
reality the organism cannot escape from imbibing alcohol ; it is omni- 
present—it is in fresh bread and in ripe fruits, and even traces have been 
found in the air we breathe, provided there exist a certain amount of organic 
matter and the conditions of temperature and moisture necessary to fer- 
mentation. Even in the muscular tissue and urine of total abstainers, a 
substance is present chemically indistinguishable from alcohol. In large 
doses every one admits that is capable of destroying life by its own prop- 
erties when taken into the system, and it is therefore a poison. Its use in 
much smaller doses, it must be admitted, may not prove incompatible with 
the enjoyment of long life and ordinary health ; but in many cases its 
constant use directly induces disease and tends to shorten life. The fact 
that a substance is a poison, however, is not sufficient in itself to forbid 
its use in disease, provided that it be given in accordance with the teach- 
ings of science and experience. The physician with the longest experience 
of any present has just expressed his deliberate opinion that it is useful 
in low conditions of vitality and in slow convalescence. TIIE DUTY OF TIIE HOUR. 
35 
With regard to the right of the physician to prescribe alcoholic liquors, 
the moral aspect of the subject, I hesitate to express an opinion, for fear 
of being misunderstood. I would suggest, at the outset, that in reality 
the treatment is not so entirely under the control of the physician as is 
implied by the question. Is it not the fact that it is the patient who 
employs the medical attendant, and if he is not treated in accordance with 
his ideas he becomes dissatisfied, loses condfience in his physician and 
engages another ? 
A rough illustration may be given : When a Chinaman falls sick, he, as 
a rule, will, if possible, secure the services of the kind of physician that 
his parents and friends approve of. A sick Indian in the same way pre- 
fers the treatment of his medicine man to that of the most scientific post 
physician. Is it not also true, that in more cultivated communities, the 
physician who is called upon in the hour < f sickness is the one whose 
thoughts and prejudices best agree with those of his patients? Patients 
certainly should not be allowed to dictate in the details of treatment, but 
their unrelinquished l ight to approve or reject the general plan of treat- 
ment cannot be disputed. It may seem like a humiliating admission, but 
it is true that in a community where the taverns far exceed the bakeries, 
total abstinence physicians will have more opponents than clients. 
I hope that nothing that I have said will convey the impression that I 
approve of the use of alcoholic liquors in disease, given merely with a 
view to gratify the patient ; if ordered at all they should be given to obtain 
the physiological action of ethylic alcohol, which, on account of variation 
of strength and adulteration in ordinary liquors, may be best given in the 
form of dilute alcohol in order to secure both purity and exact dosage. 
This, I have learned, has been largely employed in Bellevue Hospital, where 
it was introduced by Dr. Gillette ; by its use the medical effects of the 
drug are obtained, and the danger of encouraging the use of ordinary 
liquors is to a large extent obviated. In conclusion, I wish to express the 
opinion that the second proposition .should be reversed, and it should read: 
“ Physicians deserve great credit for inculcating more correct and scientific 
ideas with regard to the use of alcoholic liquors by the community.” The 
great advance in the cause of temperance, in my opinion, is very largely 
due to the teachings of certain prominent physicians and the precepts and 
example of the great body of the profession. 
Dr. Leffmann, in closing the discussion, said : I am dissatisfied with the 
direction the debate has taken, for too much time has been given to the 
discussion of the value of alcohol as a remedy, a point which I expressly 
excluded. While the propositions which I laid down are my convictions, 
and I believe they will all be ultimately recognized as ti ue, yet I purposely 
worded them in an extreme form to make the debate more definite. No 
one, however, is justified in giving to the first proposition the strained 
meaning that Dr. Wood put upon it, namely, that smelling a bottle of 
whisky would be held as injurious. The language should be judged 
according to its intention. The remark quoted by Dr. Mills, in regard to 36 
I’]IrLADELPIIIA COUNTY MEDICAL SOCIETY. 
the literary abilities of total abstainers, is also unworthy of the dignity of 
the question and is not argument! Dr. Woodbury’s suggestion that alcohol 
must be used because patients expect its use is surely not the true principle 
of medical practice.' Patients are not to be the judge of anything in treat- 
ment. The success of homoeopathy and kindred delusions is largely due to 
the erroneous and absurd view that patients may elect the system of medi- 
cine on which they are to be treated. Neither can one regard the fact 
of the occasional existence of alcohol or alcohol-like bodies in organic 
matter, in urine or in muscular tissue, or in fresh bread (which latter I 
doubt very much), as any argument for its use in health as a beverage. 
Several of the speakers have apparently regarded the paper as declaring 
the adulteration of liquors to be harmful, but this was not the ground 
taken. On the contrary, in two papers on alcohol previously read before 
this Society, and papers read elsewhere, I have pointed out that the adul- 
terations are cheats rather than poisons. It is the uncertainty and deception 
to which I call attention. 
Although objection has been made to the third proposition on the ground 
that alcohol alone or simply diluted will not answer, yet we have these 
objections well refuted by the fact just stated by Dr. Woodbury, that in 
one of the New York hospitals such a preparation is regularly and success- 
fully used. 
The second proposition has been misunderstood. It has been taken to 
mean that the use of alcohol in disease under medical advice has resulted 
in drunkenness, but this is not the meaning. It is the habit of moderate 
drinking in health that makes drunkards, and it is to the indifference of the 
medical profession to this habit that the second proposition relates. 
The whole question, it seems to me, is a most important one. The 
terrible effects of alcohol are seen in all directions, and if the restriction of 
it is needed —and I do not see how any one can doubt that fact —such restric- 
tion must only come by active assistance of those who know the facts best. 
It will never do to temporize with vice. No method will answer with any 
form of crime or vice, except continuous, unrelenting opposition. It is a 
mistake to suppose that widespread and deep-rooted habits are unconquer- 
able. Did time permit, it could be shown that traits of human character, 
as vicious and deep-rooted as the tendency to drinking, have been eradicated 
by persistent effort, and what has thus been done can be done again. 
I am fully of the opinion that the tavern finds its best support in the idea 
so general in the community that physicians consider the regular use of a 
little alcohol not injurious. When the medical profession is true to itself, 
and teaches that alcohol should never be used except for a specific purpose 
and under continued medical advice, the tavern will lose its best hold on 
the community. 
The statement of Dr. Wood that he is fully convinced that we do not 
need alcohol in health, and that indulgence in it moderately on occasion 
is no more hurtful than over-eating, certainly leans in favor of my first 
proposition.