“Now, if you add something—alcohol in the case we are considering—which not only exerts a negative chemiotaxic action—i. e., which drives the leucocyte away—but which, as we have seen, also causes degeneration of nerve, muscle and epithelial cells, shall we not injure the infected patient both directly and indirectly by interfering with the return of the leucocytes driven away, by diminishing or altering the functional activity of these cells, and indirectly by interfering with the excretion of the poisons (owing, as we have seen, to a degenerated condition of the secretory epithelium)? Have we not, in fact, a cumulative action of two substances, either of which alone would do damage, but not in the same proportion as do the two when acting together.
“Now let us see what we may learn from a series of experiments carried out by Dr. Abbott, working in the Laboratory of Hygiene of the University of Pennsylvania, under the auspices of the committee of fifty, to investigate the Alcohol Question.
“These are his conclusions:—
1. “That the normal vital resistance of rabbits to infection by streptococcus pyogenes is markedly diminished through the influence of alcohol when given daily to the stage of acute intoxication. 2. That a similar, though by no means so conspicuous, diminution of resistance to infection and intoxication by the bacillus coli communis also occurs in rabbits subjected to the same influences.
“Throughout these experiments, with few exceptions, it will be seen that the alcoholized animals not only showed the effects of the inoculations earlier than did the non-alcoholized rabbits, but in the case of the streptococcus inoculations, the lesions produced (formation of miliary abscesses) were much more pronounced than are those that usually follow inoculations with this organism.
“With regard to the predisposing influence of the alcohol, one is constrained to believe that it is in most cases the result of structural alterations consequent upon its direct action on the tissues, though in a number of animals no such alterations could be made out by microscopic examinations. I am inclined, however, to the belief, in the light of the work of Berkley and Friedenwald, done under the direction of Professor Welch, in the pathological laboratory of the Johns Hopkins University, that a closer study of the tissues of these animals would have revealed in all of them structural changes of such a nature as to indicate disturbances of important vital functions of sufficient gravity fully to account for the loss of normal resistance.
“Following up Dr. Abbott’s experiments, Dr. Deléarde, working in Calmette’s laboratory in the Institut Pasteur at Lille, made a series of observations which are, from many points of view, of very great interest and importance as he attacks it from an entirely new standpoint, one that will, I hope, ere long, be taken up by those working in this country. It has already been demonstrated that ‘alcoholics’ suffer far more seriously from microbic affections than do those of sober life, and it is now accepted that amongst them the mortality from this class of disease is higher than amongst those who are not accustomed to take alcohol regularly or to excess.
“It is pointed out, as most of us have from time to time had the opportunity of observing, that, taking pneumonia as an example of this class of disease, there can be no doubt that the alcoholic patient has not merely an appreciably smaller chance for recovery, but an apparently slight attack becomes one in which the chances of recovery come to be against the patient rather than in his favor. I well remember when I was House Physician in the Royal Infirmary at Edinburgh that Dr. Muirhead, who almost invariably treated his pneumonic patients without alcohol, used to say that an ordinary case of acute pneumonia should always recover under careful treatment, but that cases of pneumonia in ‘alcoholics’ were always most anxious cases and in every way unsatisfactory. (Slides were shown on screen to illustrate the changes taking place in pneumonia, the conditions of leucocytosis, and the very important part which leucocytes play in the process of ‘clearing up’ during the course of the patient’s recovery). Dr. Deléarde in an admirable summary gives the principal features of pneumonia in alcoholics. He describes it as running a comparatively prolonged course, as being often accompanied by a violent delirium, following which is a period of prostration or of coma; even in those who recover, abscesses frequently occur in the liver, or in other organs. He also points out that there may be a similar chain of events in other infective conditions such as erysipelas and typhoid fever, but as he insists that, until Abbott’s experiments on the streptococcus,[A] staphylococcus[A] and bacterium coli,[A] in alcoholized and non-alcoholized animals, little attempt has been made to indicate the mechanism, or, at any rate, the process by which alcoholized individuals are rendered more susceptible to the invasion and action of micro-organisms.
[A] Microbes or bacteria of different kinds.
“As we have already seen, Abbott’s experiments prove beyond doubt that attenuated disease-producing organisms, which in healthy animals do not kill immediately, bring about a fatal result when the animal has previously been treated with alcohol. In order to determine which was the most important factor in the destruction or weakening of the resisting agents in the body, Dr. Deléarde conceived the idea of experimenting with those diseases in which it has been found possible to produce, artificially, as it were, and under controlled conditions, an immunity or insusceptibility in healthy animals. He carried out a series of experiments on rabbits, immunizing against and infecting with the virus of hydrophobia, tetanus and anthrax.[B] To these rabbits he first administered a quantity of alcohol, from 6 to 8 c.c. at first, and gradually rises to 10 c.c. doses per diem.