As many lives are lost by this disease, its treatment must ever be one of intense interest, not only to physicians, but also to all humanity. Since non-alcoholic treatment has reduced the death-rate in typhoid to five per cent., the views regarding such treatment expressed by leading practitioners will doubtless be read with eagerness.
The following is a paper by Dr. N. S. Davis taken from the Medical Temperance Quarterly.
“Alleged Indications for the Use of Alcohol in the Treatment of Typhoid Fever:—On the first page of the first number of a new medical journal bearing date July, 1895, may be found the following statement: ‘The question of administering alcohol comes up in every case of typhoid fever. In mild cases, especially when the patient is young, healthy and temperate, stimulants are not needed so long as the disease follows the typical course. Here, as elsewhere, alcohol should be avoided when not absolutely demanded. There is, however, generally such a dangerous tendency toward nervous exhaustion, that in a majority of cases more or less alcohol is required. The indication which calls for its use is an inability to administer enough food. * * * * * Again, the existence of high temperature nearly always makes it necessary to stimulate the patient, as does threatened nervous exhaustion and heart failure, for immediate effect; likewise a weak, small, compressible, rapid pulse, with impaired cardiac impulse and systolic sound, is a frequent indication; other remedies may be required, but alcohol cannot be dispensed with.’ The next paragraph continues: ‘It is necessary to give alcohol in serious complications of typhoid fever, such as pneumonia, pleurisy, hemorrhage and severe bronchitis or diarrhœa. It is best to begin giving it early and in small quantities: two to six ounces is a moderate amount, eight to twelve ounces daily is not too much for adynamic or complicated cases.’
“The foregoing quotations purport to have been condensed from one of our recent authoritative works on practical medicine, and doubtless fairly represent the prevailing opinions concerning the use of alcohol in the treatment of typhoid and other fevers, both in and out of the profession. A careful reading will show that the whole is founded on the following four assumptions:
“1. That alcohol when taken into the living body acts as a general stimulant, and especially so to the cardiac and vasomotor functions. 2. That in mild, uncomplicated cases of typhoid fever in young and previously healthy subjects, stimulants are not required and no alcohol should be given. 3. That in a ‘majority of cases’ the tendency toward dangerous ‘nervous exhaustion’ and ‘heart failure’ is so great that the giving of ‘more or less alcohol is required.’ 4. The amount required may vary from two to twelve or more ounces per day.
“In the two preceding numbers of this journal, I have endeavored to show that the chief causes of nervous exhaustion and heart failure, in typhoid and other fevers were impairment of the hemoglobin and corpuscular elements of the blood, deficient reception and internal distribution of oxygen, and molecular degeneration of the muscular structures of the heart itself. These important pathological conditions are doubtless caused by the specific toxic agent or agents giving rise to the fever. Consequently the rational objects of treatment are to stop the further action of the specific cause, either by neutralization, or elimination, or both; to stop the further impairment of the hemoglobin and other elements of the blood; and to increase the reception and internal distribution of oxygen, by which we will most effectually prevent further fatty or granular degeneration of cardiac and other structures. The language of the paragraphs I have quoted, fairly assumes that alcohol is a stimulant capable of relieving nervous exhaustion and cardiac failures, regardless of the causes producing those pathological conditions, and consequently its use is necessary in the ‘majority of cases’ of typhoid fever.
“Can such an assumption be sustained by either established facts, or correct reasoning? Can nervous and cardiac exhaustion, induced by the presence of toxic agents in the blood, with deficiency of both hemoglobin and oxygen, be relieved by a simple stimulant, that neither neutralizes nor eliminates the toxic agents, nor increases either the hemoglobin or oxygen? That alcohol does not neutralize or destroy toxic ptomaines, or tox-albumins, is proved by abundant clinical experience, and also by the fact that chemists use it freely in the processes for separating these substances from other organic matters for experimental purposes. That its presence in the living body retards metabolic changes generally, and thereby aids in retaining instead of eliminating toxic agents of all kinds, has been so fully shown in the pages of preceding numbers of the Medical Temperance Quarterly, that the leading facts need not be repeated here. That its presence does not increase the hemoglobin, or favor oxy-hemoglobin or increased internal distribution of oxygen, but decidedly the reverse, has been equally well demonstrated by numerous and reliable experimental researches in this and other countries.
“Then it must be conceded that alcohol is not capable of fulfilling either of the important indications presented in the treatment of typhoid fever as stated above. Nevertheless, the advocates of its use apparently recognize but two ideas or factors in these cases, namely, the popularly inherited assumption that alcohol is a stimulant, and as the patient is in danger from nervous and cardiac weakness, therefore the alcohol must be given, pro re nata without the slightest regard to the existing causes of the weakness, or the modus operandi of the so-called stimulant.
“This is proved by the fact that they group together as stimulants, and give to the same patient in alternate doses, remedies of directly antagonistic action, as alcohol and strychnine, or digitalis, etc.
“The accepted definition of a stimulant in medical literature, is some agent capable of exciting or increasing vital activity as a whole, or the natural activity of some one structure or organ.