ALCOHOL IN ITS THERAPEUTIC RELATIONS AS A FOOD AND AS A MEDICINE.

BY

EZRA M. HUNT, M.D.,

OF METUCHEN, N. J.

WE propose to consider the subject of this paper1 by inquiring intoI. The value of alcohol as a food;

II. Its value as a medicine;

III. How far its value is modified by variability in the composition of spirituous liquors.

I. Any article, to rank as a food, must be convertible into tissue or force, in such a way as to contribute to healthy vitality and aid the body in the performance of its normal functions. This includes that energy which the body needs in the execution of its own processes of nutrition and repair, and that which must be generated to fit it for the expenditure of proper force in its contact with the world about it. So definite is the relation between the human system and the usual foods by which it is sustained and propelled, that in respect to most of them we are not left in doubt. If we take any one of the ordinary aliments, and subject it to chemical analysis, and then apply the same process of examination to human material, we are not slow to trace the correspondence of the two. Since chemistry has come to be more perfect in its methods of analysis, and physiological investigators have been careful to study relations, and test them by science and art combined, these adaptations are seen to be systematic and definite.

[The ascertainable qualities which constitute a food are, in the original paper, illustrated by a comparison of the various aliments with the organic constituents of the body. A description is given of the ascertained processes of their conversion into tissue and force. The testimony of Wanklyn, Fowne, Attfield, Bridges, Liebig, and Bernard is adduced as to the accuracy of our knowledge of foods, with allusions to the experiments and testimony of Voit, Bischoff, Wilson, Playfair, Lankester, Frankland, Haughton, Mapother, and others. It is shown that alcohol, as subjected to such tests, fails to establish itself as a food.]

There has been such unanimity of consent among those of divergent views in other regards, as to alcohol, that it is not a tissue-building food, that it is by quite common consent excluded from this class. We have never seen but a single suggestion that it could so act, and this a mere guess. One writer (Hammond) thinks it possible that alcohol may somehow enter into combination with the products of tissue decay, and "under certain circumstances might yield their nitrogen to the construction of new tissue." There is no parallel to this in Organic Chemistry, nor can any evidence be found in Animal Chemistry to surround this guess with the aureola of a possible hypothesis.

It has been conclusively proved, says Lionel Beale, that alcohol is not

1 [The entire paper being too voluminous for insertion, the author has furnished a synopsis for the Transactions, reserving the right to publish the whole in a separate form.-EDITOR.] 2 Med. Times, 1872.

a food, and does not directly nourish the tissues. "There is nothing in alcohol with which any part of the body can be nourished." "It is not demonstrable at present that alcohol undergoes conversion into tissue." Alcohol contains no nitrogen; it has none of the qualities of the structure-building foods; it is incapable of being transformed into any of them; it is therefore not a food in the sense of its being a constructive agent in the building up of the body. The food tables of Letheby, Frankland, E. Smith, etc., give no place to alcohol as a tissue-forming food, and only allude to ale and porter as containing some nutritious elements from the presence of other substances. The period of youth is that in which it should be used to give muscular development and structure-building power, if possessing these properties, but authors and experimenters with one accord exclude it from the diet of children.

In Comparative Histology we find the structure of animals, and the laws of growth, repair, and tissue-secretion, quite similar to those in man: yet none of the careful experiments as to foods, or the development of the animal kingdom, have ever given alcohol a place for the construction of tissue. This undoubted exclusion of alcohol from nitrogenous foods is all the more significant because recent investigations have shown that this class of foods not only makes cells, but that it has very impor tant correlation in heat producing processes.

[Why alcohol cannot be placed amid carbonaceous, or heat or force producing foods. It is now shown how uniform is the production of heat or force as the result of the union of oxygen with the carbons; how accurately it can be tested, and how alcohol fails in this test. The accuracy of experiments illustrated by those of Pettenkofer, Fowne, etc., with confirmatory quotations from Liebermeister, Edward Smith, Parkes, and H. C. Wood, Jr., showing why alcohol fails as a producer of heat and force.]

The idea that alcohol is a heat-producing food, and so, like calorific foods, is consumed in the system according to the usual law of disintegration, has been so far accepted that Anstie, speaking of its anti-pyretic effect, as now admitted, says, "Until within the last few years it was never even suspected." In his advocacy, while claiming that somehow alcohol must be oxidized and converted into force, he then says "this. force cannot be heat." In other words, the most remarkable exception in all the laws of energy must be assumed to exist in order to make tenable the view that alcohol undergoes oxidation, so as somehow to elaborate life force. Yet as H. C. Wood, Jr., in his recent work on Materia Medica, expresses it: "No one has been able to detect in the blood any of the ordinary products of its oxidation."

[Examination as to whether alcohol increases the excretion of carbonic acid (carbondioxide), which is a leading proof of the food value of the hydrocarbons, of oils, and of such liquids as in their change impart vital force. It is shown that "the quantity of carbondioxide and water produced" in vital processes is as accurately determined as in inorganic analysis. Testimony of the leading experimenters examined and compared. The "weight of evidence is that it diminishes the elimination of carbonic acid" (H. C. Wood, Jr.). So far from combining in any way so as to form water, alcohol is the great parcher of tissue. It is inquired next "Is not the formation of fat a result which proves a nutritive process, and is it not secured by the use of alcohol?" Whatever may have been the results from malt liquors, or from sugary or other mixtures containing alcohol, it is shown that alcohol neither contains any fat material, nor is any conversion of it into fat, such as takes place with some foods, ascertainable. Explanation of cases of increase of fat while liquors are used. Remarks as to how imperfect a test of healthy nutrition, is mere increase of fat. Examination of facts as to the reappearance of alcohol in the secretions, and how far its quantitative

Cameron, Manual of Hygiene, p. 282.

3 Richardson on Alcohol, p. 21.

5 Op. cit., p. 107.

2 Hammond, Tribune Lecture, May, 1874. Practitioner, vol. ii., 1873, p. 422.

absence is a test of its appropriation as a food. The imperfection of the evidence as shown by a survey of the experiments and views of Anstie, Ford, Parkes, Thudichum and Dupré, Richardson, Duroy and Massing, Ringer, etc.]

Parkes says, in reply to Anstie,1" Even if complete destruction within certain limits were quite clear, this fact alone would not guide us to the dietetic use of alcohol. We have first to trace the effect of the destruction, and learn whether it is for good or for evil. You seem to think that the destruction must give rise to useful force, but I cannot think that this is necessarily so." When an article appears to a considerable extent in the excretions, it seems to indicate at least that it is not readily assimilated. If under experiments absolutely complete, instead of very defective, alcohol could not all be found, we would look for such results of disintegration as the laws of animal chemistry would indicate, and see how the changed products had been made available as food. Finding none of those products which are derived from alcohol as consumed out of the system, nor such as occur when foods are appropriated in the system, we would be quite excusable for asking some evidence of food-value beyond the fact that the exact quantity imbibed could not be recovered from the excretions.

We can find no chemical law or practical excretory result which defines alcohol as a food. "The mode of destruction is in fact unknown."2 We search in vain for products of oxidation, except a slight change perhaps of a portion into acetic acid, in the stomach, and, in the case of the imbibition of large quantities, the acidity of the urine which is found slightly increased. Yet in animals poisoned with alcohol, Buckheim and Massing could find no acetic acid in the blood." No one has as yet been able to show a method of consumption such as ought to be manifested if this article acts as a food. If decomposed at all, it is, says Richardson, probably "at the expense of the oxygen which ought to be applied for the natural heating of the body."

But if those who would defend alcohol as a food are unable to identify it as such by any of those tests which indicate nutritive or energizing foods, may we not assign it a place in what are called accessory or auxiliary foods?

[Accessory and auxiliary foods defined, and the terms shown not to be an indefinite escapement for failures of evidence. How as a so-called accessory or auxiliary food alcohol fails to find for itself such a place as is assigned to water, chloride of sodium, condiments, fruits, etc. It is shown how modern chemistry has made even those which we once called accessory foods to have a definable place.]

Alcohol not only does not merit a place as an accessory food, according to any known laws of such foods, but it is very well known to induce deterioration of tissue, and to disturb the relation between the nitroge nous foods and water. In appropriating the water so as to dry the tissue, as already noted, it thickens membranes intended for that vital transmission of fluids known as endosmose. Thus local" sclerosis or a hardeuing of nerve tissues is one of its frequent manifestations."4

[Special examination of the attempt to define alcohol as an accessory food by saying that it delays metamorphosis of tissue. The whole subject of progressive and retrogres sive metamorphosis of tissue examined. Their importance as physiological processes shown to be such that delay of metamorphosis is in itself, as a rule, a disturbing and invaliding process. It is so exceptionally beneficial that it must be directly shown, in the case of any special medicament, that it is conservative of health, and how it is. Quotations from

Practitioner, p. 85.

3 Ibid.

2 Parkes, p. 272.

4 Hammond.

Pappenheim, Cameron, Beale, Hammond, and others, showing the inconclusiveness of this kind of evidence. Full examination of this argument as attempted to be substantiated by diminution or change in excretions, and by its impeding of corpuscle and other bloodchanges.

Examination of the claim that alcohol belongs to the catalytic substances, and modifies metamorphosis by the "action of presence."

Next, does alcohol show a food value by the tests of dietetic and sanitary experience? Examination of the cases of Anstie and Inman, and rebutting evidence. It is concluded that alcohol is not shown to have a definite food value by any of the methods of chemical analysis or physiological investigation.]

II. We next propose to discuss the place of alcohol in the Materia Medica, and its therapeutic action. "There is," says Lionel Beale, “no more important question in medicine to be determined than the action of alcohol in disease." As we come to inquire into the value of alcohol as a medicine, after having found its reputation as a food unsustained, it is well to remember that the terms food and medicine are often more nearly allied than the mention of the words is apt to indicate. A medicine is that which helps to heal or repair, for that is both the etymological meaning of the word and the practical design of the article used. The process of restoration or repair is often but an application of the process of natural nutrition. Amid the progressive changes of food into tissue, and the retrogressive disintegration which all life implies, we must not deceive ourselves by terms. Much of the discussion, therefore, as to the value of alcohol as a medicine, is in reality to be determined by what it can do toward repairing the waste of tissue which occurs in disease. What it can do in this regard depends largely upon the determination of its food value. This we have seen to be so small and indeterminate, that it will not do to push it forward as a valuable medicine. in those respects in which medicine chiefly concerns nutrition and the production of animal heat.

When we find that alcohol has no nitrogen with which to nourish; that it does not respond to the laws by which animal heat is usually evolved; that it at best undergoes such imperfect change in the system. that much of it is found unchanged in the secretions, excretions, and tissues; that the products of its primary or secondary change cannot be identified; that it is not settled whether it diminishes the carbonic acid, or urea, or other excreta, or whether such diminution would be reparative, we may well hesitate to assign this drug a place in the category of medicinal agents. When it has eluded the ingenuities of science, the persuasions of art, and the astute diligence of interest, to extemporize it into a food, it must be remembered that it has made a signal failure to vindicate its position as a medicine in any one of the particulars in regard to which it is most frequently urged as of value.

[Next to the consideration of the place of alcohol as a medicine, we come to inquire how far the variability in the composition of spirituous liquors and their unreliability modify their therapeutic value.]

III.—If we are to consider any article therapeutically, we ought to be able to know that it is the article which it professes to be. The clinician who claims uniformity of result, and a declared therapeutic effect, from a given article, has reason to question whether the effect was a result of the conceived cause, when he finds that the alleged cause was necessarily inoperative by reason of absence or admixture. If the article used was not tested either as to quality or quantity, if the general rule in respect