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 c , 
 
 THE USE OF ALCOHOL 
 
 I N — 
 
 PNEUMONIA 
 
 BY — 
 
 L. COYTEUX PREVOST. M. D. V. 
 
 PHYSICIAN TO THK GENERAL HOSPITAL, OTTAWA. 
 
 Mead before the Ottawa Medico-Chirugical Society, April 1879. 
 
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 O TT AWA: ' 
 
 A. BUREAU, PRLNTER, 170^ SPARKS St. 
 
 1880. 
 

 
ox 
 THE USE OF ALCOHOL 
 
 IN PNEUMONIA. 
 
 Mr. President and CrENTiiEMEN. 
 
 Amono- the diseases that aliiic't poor humanity, inflammation ol 
 the lungs ma}' bo considered, without contradiction, one of the 
 most important, as much with regard to its frequency as to tho 
 <langers of the lesions and the gravity of its symptoms. 
 
 The sudden and solemn onset of this atJ'ection, the c^^^clic 
 course of the fever which accompanies it, the stitch in tlu' 
 side, the d^'spnea, the cough, the expectoration, the signs 
 I'evealed by the stethoscope, the anatomo-pathological parti- 
 culars, ever}'- thing, in short, indicates such an activity in the 
 process, that it is no wonder that this disease, more than any 
 other, has solicited the active and often meddlesome interference 
 of the physician. 
 
 It is not my intention to review all the modes of ireatr lent of 
 this disease: such a vast subject would not permit my keeping 
 withiti the bounds I have traced for myself, w nting mcrel}' to 
 otter you a few considerations, supported by personal obsej'- 
 vations, on a mode of treatment, which, although it has been 
 recommended for several years, may be considered still in its 
 infancy: I mean the treatment of acute inflammation of the lungs 
 by alcohol. 
 
 In constituting myself the defender of this method, I feci 
 that I may perhaps shock the preconceived idojis of some 
 among you, but while asking before hand 3'our pardon, I must 
 .sincerely confess that such is, to a certain extent, my object, 
 because it is often by the clashing of dift'erent opinions that wo 
 arrive at the truth. 
 
 The subject is exceedingly important and merits all our 
 attention. 
 
 It is to be deplored, that, in therapeutics, we are generally so 
 apathetic. Incessantly following beaten paths, an<l allowing 
 
 
 60535 
 
4 
 
 our8olvcH to i)0 led on hy Kiiponiimiuitcd tlioorios, wo Jiro too apt 
 to cunt JiHJ^lo as worthless, facts which hiivo no other claim to 
 our contempt than that thoy are the expression of new theories. 
 I admire and certaiidy profens profound i'esj)ect for the intel- 
 lectual conceptions of the immortal Hionssais whose doctrins 
 have been so favorable to the use of the lancet. 
 
 I reverence also the name of Haaori who entertained, for 
 emetics, an att'ection shai-ed by wo many thousands phywicianw. 
 Honor be to those men of genius ! IJut I refuse to constitute 
 myself as their slave, and what I wish before all, is to save the 
 life contided to mo : such is the true niission of the physician 
 an(* it nuittcrs but little what doctrin I adopt as long as 1 attain 
 ni}' object. 
 
 The applyance of alcohol to the cure of diseases, traces its 
 origin to a very remote time in the history of medicine. 
 
 In the thirteenth century, alcohol was considered as a 
 universal panacea and known under the name of " aqua vitoi. " 
 They attributed to it, the property of exciting the nervous 
 system and prolonging existence. 
 
 In 1(!62, Bruno Cibaldi wrote a complete treatise upon the 
 method of curing all diseases by the sole use of alcohol. 
 
 The observations on })ulmonary affections cured by spirits, 
 huve long occupied place in medicine. Hazard had given those 
 agents as a useful i-emedy, ])ractice confirmed their efficacy and 
 theory afterwai'ds came to explain their mrxle of action and 
 ^ierved us as a control to these empiric notions. 
 
 In 1()9(), Scheldamer relates tlie euro by tlie eau-de-vie of a 
 pneumonia which existed ei)idemically. 
 
 At the beginning of this century, owing to the almost univer- 
 sal domination of Broussais' antiphlogistic method wlio laid down 
 as a principle that •' irritants are the only morbific causes " the 
 use of alcohol and various spirituous liquors was ai 'indoned. 
 
 To Laennec is due the honor of having first reacted against 
 these too exclusive tendencies and recommended the use of this 
 agent in the acute thoracic attections. 
 
 Chomel, eminent clinical authority, whose name is still in 
 France, surrounded by a glorious halo, Chomel also powerfully 
 struggled against the tendencies of the teachings of the " Val- 
 de-Grace" and extolled the use of wine in adynamic forms of 
 acute diseases. 
 
 But it Avas an english physician, Eobert Bentley Todd, who. 
 relj^ing before all on facts, established in method the use of 
 alcohol and the preparations which are derived from it, in the 
 treatment of pulmonary phlegmasias. He clung to this idea and 
 succeeded so well to attract upon it the attention of learned 
 men that, to day, in clinic, Todd's medication is synonymous of 
 medication by alcohol. 
 
 I. •■ V . { , .< 
 
Behior, physician at tlio Ilotel-Dieii, luul tlio merit of intro- 
 «liicin«^ ill FniiK'O the thorapcutic method of the learned on/^lisli 
 physician, and alttsr a judicious examination of facts, lie came t(» 
 tlie conclusion th.it alcoholic ])rcparations, methodically em- 
 ployed, are of a use, a ^reat deal less dangerous, casici* and less 
 injurious than we are generally inclined to admit; that they arc 
 a })rocious tneans of raising and consolidating the strenght of 
 the economy, and, in short, that wo can employ thom in larger 
 <io8es than we ordinary do, provided tliese dosoH remain frac- 
 tional. 
 
 The pupils of Bohier, in Franco and those of Todd in Knglaud. 
 continued the study of treatment hy alcohol. 
 
 Aiistie, Murchison, Lyons, Marvaud, are the authors who 
 moi-e especially applied themselves to it. 
 
 This medication is a real therapeutic revolution and to show 
 how in a short space opinions may changed, f hog to recall that, 
 alcohol as well as the other exciting medicaments, were consi- 
 dered by modern therapeutists, as liable to determine that com- 
 bination of circumstances that we agree to call " e))hemeral 
 inflammatory favor " and which is caracterized by an increase oi' 
 energy in the impulsion of the heart, the frequency of the beat- 
 ings and by the augmentation of the heat of the slcin. 
 
 It i8,*to day, a general notion in medical practice, that this 
 medicament, which formerl}- was considered as incendiary, 
 diminishes fever, and that it is especially in feverish individual> 
 it produces the greatest lowering of tomperatui'o. 
 
 It is certainly on subjects atl'ected with pneumonia, that the 
 medication by alcohol lias been the most widely experimented, 
 and the facts recorded b}' Todd and Behier are veiy numerous. 
 
 At all times, alcoholics have been administered in acute 
 diseases, where there existed agreat depj'ossion of strength : biii 
 no person before Todd had thought of systematizing the meili- 
 cation. A profound study of physiological properties of alcohol 
 in medicinal doses, added to new ideas on the essence of acute 
 diseases in general and pneumonia in particular, such were 
 the causes which led to bannish from the treatment of inflamma- 
 tion of the lungs all kind of depressing modes of treatment, such 
 as bleeding, emetics, to replace it by a stimulating and reparating 
 one. 
 
 But before going any furthei", permit me to lay before you a 
 short sketch of the acquirements that modern science has given 
 us, with regard to the physiological properties of alcohol in 
 medicinal doses. 
 
 According to Todd, alcohol is an aliment. This opinion, 
 shared b\' Liebig and contended with by MM. Lallemand, Perrin 
 and Duroy, was victoriously supported by the so scientific 
 researches of Dupre, in " Proceedings of Royal Society 18Y2," 
 and Anstie in "Practitioner 1874." 
 
Tlio>o now rt'!s<'!irclio.soslaMisli the fact that ulcoliol croinplotoly 
 coiisuinos itself, that vvo cannot rotind it in jicrspiration and in 
 very .small (|uanlity in tho Mood, thu expired <^a.s(>H, and the 
 iirino, on condition that (ho dos(\s had hoon sniall and divided, 
 
 Jjiehi^ eonsidoi's it as a i'esj)ii'at(>i*y aliment, and according to 
 Albertoni and liUHana, aeortain (|uanli(y ineorporatiis itself'in the 
 tissues and contrihulos to tho formation of lu*; and some other 
 suhstancoH of or/^anism. 
 
 Alcohol, always administered in moderate (h)seM, is a stimulan* 
 of circulation and produces a icreater amplidule of ])ulsations 
 and also the diminution of vaseuhir tension hy an action that 
 AiiHtio attributes to the intermediate of the vaso-motoi-s. 
 
 It is also a stimulant of noi'vous system, which is phiinly 
 shown by the exj)eriments of CI : Bernai'd. It acts njmn tlic 
 intellectind, motive and sensitive functions. This action is 
 attributed bv Oi'tila, Brodie and Marcet to a reflex a(dion on 
 the brain due to an excitation of llie terminations of the pnou- 
 inogastric by alcohol, in the stoma(di. 
 
 In our country, where, during six long months, wo are 
 exposed to the low tem))eraturo of winter, it is commonly 
 acknowledged that a good glass of whislccy or Biandy warms 
 one up. Is it through imagination or conlidcnco that we experience 
 this agreable sensation of warmth? [ do not know, but what I 
 am aware of, is that the exj)erimental lesults ai'o entirely 
 opposed to this conclusion. 
 
 MM. Dumeril and Dumanjuay (rilris 184S) by expokiments 
 made on animals, Sidney Ringer ajid W. Richards (Lancet 
 18()()) by experiments ma(te on healthy as well as on feverish 
 subjects, E. Smith (Lancet ISdl) Maurice Perrin, Marvaud, 
 Magnan, (Paris 1871) and lately several other authors verified 
 the fact : all arc unanimous on this point that alcohol lowers 
 tempo raturc. 
 
 Gentlemen, 1 have Just laid boforo you a brief outline of the 
 physiological pro])orties of alcohol on healthy subjects, but I must 
 not pass silently the action of this mt licamenton feverish indivi- 
 duals. Here, you may perhaps accuse mo to emit statements ot* 
 a paradoxical nature in attributing contradictory properties to 
 the same agent. To this. I answer that I am partisan of no 
 theory and that I bow to facts the evidence of which rendei-s 
 them indisputable. 
 
 Alcohol reduces febi'ile heat a great deal more than it does 
 normal heat. This is the result of the observations made by 
 Todd, Behier and Binz. 
 
 On the other hand, alcohol tends to raise the temperature 
 when it falls below normal. 
 
 Whatever theory we may adopt to explain animal heat, it is 
 certain that the latter regulates itself constantly in persons 
 affected with fever as well as in healthy individuals \ the only 
 
ditl'croncc is tlial in iicallliy snhjocls, rcijuliit.on uiil tiiko place 
 al»()iit 5>S (U^i^reon Kai'onlicit, wlieroas on a fcvi'i'isli oiu*, it will 
 1)0 alwmt lOli or 104, tho saino way as in uroinia it will occur at 
 ali<>iit !Mi. 
 
 Without tryin<i^ to aHcortain tlio neat of this ivi^ulatini!; ])owor 
 or to localize it in a small s|)ot of tho hnll>, or to show that it is 
 shiirod hy tho ^cnoralty of tho vai'ioiis j)arts of tho central ner- 
 vous Hystoni, wo can ostahlish its existence and pronounce tho 
 following i^oneral law : " Alcohol ^ivon in medicinal dosos 
 maintains to its ))hysiolon;i('al rate the rii^uiatini^ power of 
 animal heat or tenda to restore it to its nornjal state, wiion it 
 <ioviates from it." 
 
 Jn otiior terms, alcoliol tends to reduce the temperature when 
 it is increase*!, it tends to increase it when it is diminished and 
 neither docs it inci'oaso or reduce it when it is normal. 
 
 The action of alcoliol on the respiration and circulation of 
 Kuhjects J t'fected with fovor is not less interesting. In this case 
 also, it acts a« u regulator ; if the heart heats too fast, alcoliol 
 makes it slower and if too hIow, quiclvons it; In fact, it is a 
 heart tonic. 
 
 The functions of tiie hrain seem to be suhmittod to the same 
 law ; alcohol having a tendency to bring them back to the nor- 
 mal level from which they have departed, calms delirium et 
 dissipates tupor. 
 
 (irentlemen, what I have stated is by no moans arbitrary and 
 is sujiported by clinical and experimental facts recoi'dod in 
 works of indisputable autliorit3\ Theories naturally abounded 
 to explain those interesting phenomena. J regret that time and 
 space do not allow me to devote a i'aw moments to the study of 
 those hypothesis, I would yield perhaps then to the desire 1 
 experience to apprize you of the admiration 1 feel for tho doc- 
 trin of the tine old Brown who proclaimed " asthenia" the prime 
 cause ol'tho morbid processes of the economy. 
 
 Is this doctrin of times that are gone by, true in its essence, 
 or, is it but the expression of a truth applying itself to certain 
 medical constitutions, and particularly the one we are presently 
 traversing ? 
 
 Be it as it may, I cannot help declaring that the general im- 
 pression that has been made upon me by tho few years 1 have 
 spent at the bedside of patients, is that we find ourselves a groat 
 deal oftener obliged to add rather than to take away in the 
 indications olfered to us by the diseases, temperaments and 
 constitutions we have to deal with. 
 
 But I do not want to abuse ..f your kindness and I hasten to 
 pass on to the few considerations I wish to lay before you, witli 
 regard to the nature of Pneumonia. 
 
Pneumonia 1r an aciito inflanimntory (liHoaso, which, liko all 
 other inrtammutions, must ahsoiiitoly i^o through all its sta^UN 
 without hoin^ checked hy any treatment whatever. 
 
 There is a very important juacticai consenuence tiiat (!irectl\ • 
 proceeds from the study of anatomical evolution of the inflammii 
 tory process, namely: " When the living tissue has answered^ 
 the irritative provocation which it has undei'ijone, that is ti ' 
 say, when inflammation is definitely estahlishod, resolution is tiit^ 
 (piickest terjnination that can he ohtained ; hut, however rapi( 
 this ending may be, it cannot take place hefore the j>haso ot* 
 nutritive irritation has accomplished its natural evolution,' 
 (Jaceoud.) Now the progress of histolo^^y and the admirahli^ 
 works of Wichow and his ])Uj)ils, show that this evolution 
 includes several ojxM'ations, su(;}i as vascular exosmosis, formation^ 
 of exsudation, which recjuire necessarily a certain time, and* 
 teach us besides with luminous evidence, that inflammation cannoi . 
 be checked in its (jourse, that therefore, there are no modes oi) 
 treatn)ont that can cut short the local hy])ei'nutrition and that' 
 resolution is before all a matter of time. ^ 
 
 Pneumonia, as an inflammation, is submitted to the same law ^ 
 
 Here are, moreover, the conclusion that Todd haa come to, in 
 therapeutics, and which Professor Behier has resumed ii ^ 
 *' Dictionnaire Fincyclopedique " as follows: j, 
 
 Ist. The idea so loniij prevailing in schools, that aji aculi a 
 disease could be prevented or cured by means which depress <- 
 and reduce vital and nervous strouifth is altoi^elher fallacious. I 
 
 2nd. An acute disease cannot be cured by the direct influence t 
 of any mode of treatment or any known therapeutical agent. f 
 
 3rd. The disease gets cured by a natural evolution, for tht^' 
 complete developement of which the vital power must be sus f< 
 tained. Eemedios, either as medicaments producing a specia © 
 physiological action in the system, or otherwiLe, are useful ii n 
 as much as they can excite, assist or provoke this natural o 
 cur.ative evolution. 
 
 Clinical observation, besides, is in perfect harmony with the 
 above pathological statements. The studies of Wunderlich con 
 firmed b}' those of many other authorities, teach us that thi T 
 course of temperature in pneumonia is invariably the same, ol ' 
 a rog"Iarity similar to that of all essential fever and therefon ^ 
 undei es the influence of no medication whatever. For thi . 
 first 2-k or 48 hours, the thermometer indicates from 102 to 104 I' 
 degrees. This elevation of temperature persits, with few 
 morning remissions, until the fifth, seventh or ninth day K 
 when a sudden defervescence termed '' crisis," takes place an( 
 brings. back the temperature to its normal state ending th( 
 febrile cycle. The disease then enters the phase of reparation 
 which is complete after five or six daj^s, the whole duration ot 
 
' 9 
 
 1 tl»o (liHoiise being from 14 to 15 duyn in cuhos free from compli- 
 cn lions. 
 
 This course of the tomporntiiro is tho cxteninl nmnifcstatioii 
 of the j)atliol()<^ical procosH cvolvin;^ in tlio niidHt of the in- 
 '!ainnK'(l tisMio of the \\iu^. Tiio ascenHion of temperature 
 lOorrespoiids to the period of evsiidation, the stasis to its coagu- 
 lation, the decline to its liquefaction and tiio yielding of all tiie 
 symptoms. 
 
 I I i(»peat it, gentlemen, this cyclic course of pneumonia, is 
 |invariable, and the natural evolution of the lesion can neither 
 bo Hhorlened by venesection, calomel, emetics, nor any 
 .other means or modes of troatment. 
 
 I This course, this regular evolnti(>n of pneumonia was unknown 
 I to our forefathers armed with the lancet and deprived of the 
 I thermometer. 
 
 I if is to the school of expectation that we owe this knowledge, 
 
 I it is expectation that demonstrated that pneumonia behaves 
 
 , itself according to the I'egular cycle above mentioned, even 
 
 abandoned to itself, outside of all theraj)eutic action, running its 
 
 course with the same precision as an eruptive or a typhoid 
 
 fever. 
 
 ' 1 shall, in the same time, avail myself of this occasion to 
 
 'protest against the erroneous ideas of certain physicians who 
 
 refuse to acknowledge the utility of thermometer, in clinics, 
 
 I and who consider this pi-ocious instrument as a more object 
 
 sC luxury, by no means superior to their " t actus eruditus.'' 
 
 Is it tho abhorrence of innovation, or tho ignorance in which 
 
 t the}' are of the ])rogress realised by this new application of 
 
 phys'cal means to diagnosis and prognosis, that makes them treat 
 
 , it with such a contempt? I do not know, but it does not detract 
 
 from known science that, although we must avoid granting 
 
 exaggerated utility to this instrument, we must consider ther- 
 
 I mometer as a safe and necessary guide in the greatest number 
 
 j of diseases tho physician has to treat. 
 
 I beg your pardon, gentlemen, for the digression and hasten 
 J to return to the discussion of my subjeot. 
 
 Pneumonia has not been considered by all the authors, as a 
 ^merely local att'ection, similar to other phlegmasias, producing 
 J like the latter, general symptoms, consequences of the primitive 
 ^ organic trouble. 
 
 ^ According to Iluxham, Borsieri, Todd, Hoffman, pneumonia 
 
 I is a disease essentially ganeral at the tirst onset, having its 
 
 ^ local expression in the lungs. According to them " Febris 
 
 peripneuvionica,'' is but the expression of a morbid principle, 
 
 diffused in the organism, producing the inflammation of the lungs 
 
 as the rheumatic fever produces arthritis and ague the enlarge- 
 
 ' ment of the spleen and the liver. Sucii is also the opinion 
 
 I supported at all times by tho school of Montpellier. 
 
10 
 
 Of late, ail iindisguiBod rotuni took place lOwartlH tliis fonner 
 conception of ^^ Febris peripneurnonica." JurgcnMcn, Frietlrick, 
 Conhoin, KlebH in (rcrmany ; Marrotlc, Parrot. Bornhein in 
 France ; llardwich in Knglund, coiiHtituted thomsolvea the 
 defenderw of these renewed ideas. 
 
 According to Bernhein, pneumonia meauH also a pneumonic 
 fever : " By the way it begins, he says, pneumonia often behaves 
 itself like a pyr(3xia, a fever. That regular cyclic course ot 
 temperature, such as you will tind it in ])yrexiaH, eruptive 
 fevers, ei-ysi]»elas ; that ra])id crisis in a tixed day, the amend- 
 ment of the genei'al state invariably ])receding the resolution 
 of the local, the history of the diseat^,^ almost figured by the 
 graphic curve of the fever, does not all that give the impression 
 of a general disease localized in the lung, of a pneumonic fever 
 and nc a pneumonia''* " 
 
 Klebs goes further still and describes a protorganism the 
 '^ monas pulmonaUs.'' iho inocuhition of which in animals would 
 artificially bring on the disease. 
 
 llardwich of Sheffield relates several observations of pneu- 
 monia, tnuismitted by contagion : " A priest is att'ected with 
 pneumonia, one of his relatives calls upon him and takes the 
 same disease and a third person gets it through the latter. In 
 an other locality, an old man stricken by pneumonia summons 
 to him several friends and every one of them are soon after 
 afflicted with the same disease. Lastly, in a third series of facts, 
 we sPiC, after the apparition of a case of adynamic pneumonia 
 in a village where this disease was not previously prevalent, six 
 similar cases showing themselves in subjects who had been in 
 relation with the subject at first att'ected or with each other. 
 
 Jurgensen, denying the contagiousness of pneumonia, says 
 it belongs to the class of infectious diseases. lie says that pneu- 
 monia is no longer an atfection which developes itself in the 
 same condition as the phlegmasias a frigore, but rather under the 
 influence of causes similar to those which engender typhoid 
 fever, such as overcrowding and certain telluric conditions. 
 Anatomically, pneumonia differs with all other pulmonary 
 phlegmasias, and just as it is impossible, by an irritant what- 
 ever, to provoke in the intestines the characteristic lesion 
 of Peyer's patches of typhoid fever, so also we would try in vain 
 to produce experimentally the lesions of acute pneumonia. 
 
 Clinically, he says, pneumonia has a typical course, a .^.yclic 
 evolution, which no other local phlegmasia presents in the 
 same degree. Infectious diseases alone, such as fevers, otter 
 ^'uch a regular type. In short, the following, are the conclu- 
 sions which this author arrived at : 
 
 " Croupous pneumonia is a constitutional disease, and is not 
 ^' dependant upon a local cause. The pulmonary inflammation 
 " is merely the chief symptom, and th^ morbid phenomena 
 
11 
 
 " are not due to the local aft'ection. The hypothesis of a 
 " morbitic cauHo is indispensable. CroiipouH pneumonia belongs 
 
 '* to the group of infectious diseases It cannot be 
 
 " produced by any of the usual causes of inflammation, however 
 " strong or weak their action ; as in typhoid fever, there must 
 " be a special exciting cause. Croupous pneumonia is a disease 
 " which runs a typical course. No affection which arises from 
 " a local lesion presents a career so definitely limited in point 
 " of time as is the case with " croupous pneumonia." 
 
 If then, inste.'id of considering Pneumonia as a mere acute 
 inflammation submitted to the rules laid down by Todd and 
 Behier, we sooner accept the opinion of those who believe in 
 the essentialty of this aft'ection considered as a fever, wo must 
 admit our inability to stop the course of this disease, just as 
 much as by any known therapeutical agent whatever wo can 
 break or directly cure a scarlatina, a measles or a typhoid fever. 
 
 Therefore, Gentlemen, since we have to deal with a disease 
 which, whatever we may do, cannot be checked in its course 
 and must absolutely go through all its stages ; since this 
 ttifection posesses a depressive action on the economy and tends 
 to put in danger its victim, on account of the length of its evo- 
 lution ; let us not loose our time trying to cut it short by a 
 depressing treatment, but, on the contraxy, lot us endeavour to 
 put the patient in a condition that will enable him to await and 
 assist the normal completion of the pathological working; let 
 us stimulate and strengthen the organism which has a tendency 
 to faint, in order that it may advantageously struggle with the 
 disease . let us try, as much as possible, to bring back the tem- 
 perature and circulation towards their respective normal stan- 
 dard. All these indications are, as nearly as possible, fulfilled 
 by alcohol owing to its properties upon which I already dwelt. 
 
 Now that we have examined the theoretical side of the ques- 
 tion, let us see, if you please, (rentlemen, the practical results 
 already obtained by the treatment of pneumonia by alcohol. 
 Allow me, at first, to cite the statistics that I gathered from 
 Dujardin — Beaumetz himself in Paris, in the various modes of 
 treatment used in acute inflammation of the lungs : 
 
 The cases treated by bleeding gave a mortality of 27 per cent. 
 
 By Emetics 21 per cent. 
 
 By Expectation ..7 " 
 
 By alcohol 3 '' 
 
 At the Edinburgh Eoyal Infirmary, from 1839 to 1848, out of ^ 
 648 patients treated by venesection, mortality has been of 34 
 per cent. 
 
 iiasori, by venesection and tartar emetic had a mortality of 
 22 pel cent. 
 2 
 
li 
 
 Bennett, of 129 caseR submitted to the alcoholic treatment 
 and tonics, lost only four patients, being a mortality of only 
 3 per cent. 
 
 GrisoUe himself, in spite of his evident antipathy to the use 
 of alcohol is compelled to state in some of the pages of hi.s trea- 
 tise, the good effects of that medication. '* Forty Hve patients, 
 he says, drank hot sugared wine,, the greater part of them 
 drank it during 7, 8, 9 and 10 days, successively, the quantity 
 varying between 8 and 60 ounces. Of these 45 patients, five 
 only died, that is a mortality of 1 1 per cent. 
 
 Flint declares himself entii'ely in favour of alcohol and uses 
 wine, brand}', whiskey, giving in average one ounce of Brandy 
 «(very two hours to his patients. 
 
 In 1871, Peter, physician at I'llopital de la Pitie, in Paris, of 
 18 patients affected with pneumonia had only one death. Of 
 these 18 pneumonias, two were bilateral and seven affected the 
 apex of the lung. 
 
 About the same time, Danet, of CO cases that he had under 
 his care, treated 20 of them by venesection and blisters and 
 had 16 deaths ; 20 were treated bj' digitalis and blisters, 12 
 died ; the 20 others were submitted to alcohol, and four only died. 
 
 Out of 36 cases treated bj' alcohol, Behier obtained 29 cures 
 in the Hospital. Among these 29 cases, the grave ataxo- 
 adynamic forms were observed 11 times and on others, all the 
 signs of the mere inflammatory form; it was in non-alcoholic 
 subjects from 20 to 30 years of age. 
 
 If you permit me now. Gentlemen, to join to th'^«e statistics 
 the humble result of my own experience, I shall say, that, 
 within the last five years I had to treat 26 cases of pneumonia 
 divided as follows : 
 
 On children from 6 to 15 years of age : 8 cases 
 On adults of both sexes : 17 cases. 
 On an old woman : 1 case. 
 
 Of these 26 patients, three died. But I hasten to say that on 
 one, death occurred almost suddenly, during convalescence and 
 must have been due to a lesion extraneous to the inflammation 
 of the lung. Another one, the old woman, died most likely, 
 from the results of an accidental poisonning by morphine. 
 
 The mixture I used in the treatment of those cases, is nearly 
 the classical Todd's mixture, employed in France by Behier 
 and composed as follows : 
 
 E. Brandy from...... 3 to 6 ounces. 
 
 Tr Cinnamon 4 drachms. 
 
 Syrup aurantii 1 ounce. 
 
 Aq : Purae 6 ounces. 
 
 Sig : One tablespoonful every hour. 
 
18 
 
 tf the stitch in the side is the object of a speciul indication, ] 
 ^'ive hindanum internally or hypodermic injections of morphine. 
 
 In all cases I could observe the particular and interestijjg 
 course of the temperature which T have above spoken of. Every 
 (me of them had almost the same duration. During the 7 or S 
 first days, fever was intense and otfej-ed all the classical 
 characters of inflammatory fever. About the seventh, eighth 
 or ninth day, a sudden lowering of temperature would take 
 jjlacc corresponding to tlie resolution of the disease evidenced 
 by 'lumerous rales, diminution of the blowing and greater facility 
 of expectoration ; convalescence wa.s then established and about 
 the 14th or tbe 15th day the patient could be considered as 
 completely cured. 
 
 Several of the cases which ended favorably presented the 
 most alarming symptoms, such as delirium, intense fever, &c.. 
 as you may judge yourselves by the following observations : 
 
 " Case 1st. — L.N , Laborer, aet 53. — Often exposed by 
 
 his occupations to cold, dampness and misery. For a long 
 time, he com])lains of rheumatic pains in the joints, especially 
 at the approach of bad weather. Old chronic bronchitis accom- 
 [)anied with light cough and expectoration. At the latter end 
 of April 7G, ho C(mi plained of uneasiness, loss of ap])etite and 
 on the 29th in the morning was suddenly seized by a severe 
 v\n\\ which lasted all the forenoon. To this chill succeeded 
 very profuse perspiration with considsrable delirium ; the 
 rough increased and towards the end of the afternoon the sputa 
 appeared thick, tinged with blood and became in the course 
 of the night as if completely composed of pure bloo<l. Com- 
 ))lete anorexia, emesis. Between six and seven o'clock he passes 
 two involuntary stools in his bed. Intense headache, great 
 thirst, very acute pain in the right mammary region. 
 
 I saw him on the 1st of May, that is, three days after the 
 onset of the above symptoms. I noticed dorsal decubitus, 
 lostlesncss, and incoherent mutterings ; he is a prey to halluci- 
 nations. Quickened respiration, considerable dyspnea. Pro- 
 fuse diarrhoea. The pulse is strong, frequent, full and resisting. 
 The pain exists in the right side between the 6th and Tth rib. 
 
 On percussion, at the left apex there seems to be a deficiency 
 of pulmonary tone, the respiration there takes place by jerks. 
 On the right, in the mammary region, dulness does not seem to 
 be as considerable as might induce to suppose a strong blowing 
 accompanied with bronchophony without anj" rales. Temperatui-e 
 is 39.8 centigrades, that is very near 104 Farenheit. 
 
 I prescribed, one drachm of Brandy in linseed tea every two 
 hours. 
 
 May 2nd. — Deliriam all night, diarrhoea. Temp : 40, 5, P. 108. 
 Viscous sputa intimately mixed with blood. 
 
 i^ 
 
u 
 
 Better in the evening ; delirium diminished ; headache gone. 
 Stitch always painful ; physical wigns the same. 
 
 Todd's mixture every hour, that is 3 ounces of Brandy within 
 the 24 hours. 
 
 May 3rd. — Morning, T. 39.7. Pulse intermittent : 04. Spent 
 abetter night, delirium almost all gone; quieter. Yellowish 
 stools, more consistent. Less blood in expectoration. Blowing 
 still intense, filling the ear. Few rales perceptible after fits of 
 coughing. White and coated tongue. 
 Evening, T. 39.5 P. 95. 
 
 May 4th, — The mixture has not been given last night, until 
 this morning. lie was restless all night. Pulse 100, intermit- 
 tent, more delirium. Respiration 44. T. 39.5. Blowing seems 
 to gain the posterior part of the lung. Stitch still painful, 
 Blister. Todd's mixture containing 6 ounces of Brandy in the 
 24 hours. 
 
 May 5th. — P. 100 T. 38. Less delirium. Does not try any 
 more to leave his bed, as he used to do. Blowing greatly dimi- 
 nished in front, but spreads towards the axilla and posterior 
 part of the lung, no rales. Sputa continues red. Stitch not 
 relieved by blister. 
 
 May 6th— Delirium persists. Pulse weak, intermittent: 94. 
 T. 38.4 Pain in the side easier. Respiration 42. Sputa hardly 
 contains any more blood. No more blowing in front ; dulness 
 and bronchophony in the axillary line. Behind, subcrepitanl 
 rales at both the inspiration and expiration. 
 
 8 o'clock P. M. Mutters all the ti'ue. Sputa again bloody. 
 Cough looser. Pulse extremely irregular. Considerable weak- 
 ness. Blowing diminished in the side. T. 39.4. Resp. 45. 
 
 Pres : 15 grains Bromide of Potassium, same treatment besides. 
 
 May 7th. — Good deal quieter. Slept now and then last night. 
 Pulse : 80 weak and intermittent. T. 38.4. Numerous rales are 
 heard all around the chest. R. 36. Nine o'clock P. M. T. 37.3 
 Moderate expectoration of white sputa. 
 
 May 8th. — P. 70, stronger, regular. T. 36.9 delirium com- 
 pletely gone. Slept well last night. Resp. 23. Wishes to eat. 
 
 May 9th. — Improving rapidly. Cough decreasing. Appetite 
 good. 
 
 May 10th. — Getting stronger, feels better and better. Rales in 
 the lung disappearing gradually. 
 
 The following days, he leaves his bed and walks about in the 
 house. There is hardly any cough, he eats well." 
 
 " Case 2nd- — P. L...., aet. 18. — Strong, robust, never was sick- 
 in his life. Coming back from a dancing party in winter, catches 
 cold and is taken in the evening of the 19th of January 187*> 
 with chill, fever, headache, cough and pain in the side. His 
 mother puts a blister on the side aifected. I saw him for the 
 
u 
 
 first time two days after the bepfinning of the disease.. The 
 
 Fulse is strong, full, beats 100. Temp. 40.2. On percussion, 
 notice at the inferior angle of the scapula of the right side a 
 well marked dulness. Auscultation reveals at the same spot 
 superficial bronchial breathing and bronchophcmy. No rales 
 perceptible. The cough i« jnoderate ; rusty expectoration. 
 
 I prescribed : Rest, broth, milk and Brandy, a dessertspoonful 
 jin water every two hours. 
 
 Jan. 22nd. — Headache gone. Spent a good night. Pulse : 18. 
 [T. 'S\i.1 cough troublesome, increasing the pain in the side. Sputa 
 |reddish-brown. Diarrhea, tongue red, wet, no coating. 
 Opium : 1 grain at bed-time, same treatment besides. 
 Jan. 23rd. — Pulse: 90. Temp. 41.3, coughs less. Stitch in 
 the side very painful. Tongue a little furred. Cupping in the side. 
 Jan. 24th. — Pain greatly relieved by cupping last night, but 
 [is as bad to day. Pulse beats : 90 Temp. 40. Difficult expecto- 
 jration of completely bloody sputa. Headache. Same physical 
 {signs. Blowing ; dulness and no rales. 
 15 drops of laudanum to relieve the pain. 
 Jan. 25th.— T. 37.3 P 75. Great deal better. Spent a good 
 lighi. Does not feel the stitch any more. Headache gone. 
 Expectoration easier and not sc red. Large bubbles of subcre- 
 pitant rales are heard during the respiration. 
 
 Jan. 26'th. — P. 68. Temp. 37.5. Good sleep. No more blood 
 in the expectoration ; viscid and aerated sputa. Feels the want 
 of eating. Blowing getting weaker and covered with rales. 
 Same diet and same mixture. 
 
 Jan. 28th. — His faiher comes and informs me that he his up, 
 hardlj"^ coughs and feels well. 
 
 Jan. 30th. — I call and see hira. He is sitting up. Went out 
 the day before ; eats well, coughs a little yet. 1 examined hie 
 chest and noticed nothing but a weakening of respiration in the 
 right side." 
 
 "Case 3rd. — A. L , aet. 23. — No previous sickness; 
 
 Shanty-man, coughs sinco a few days, has a cold in his head. On 
 the 20th February 1876, after been out late, is taken during the 
 night with an exceedingly intense chill, followed by delirium 
 and profuse perspiration. In the morning, vomits a great quan- 
 tity of bile. The cough increases and the expectoration in 
 tinged with blood. He complains also of a sharp nain on a level 
 with the xyphoid appendix, radiating to the rignt towards the 
 false ribs. Complete anorexia. When I called to see him, he 
 did not seem to be suffering greatly. The skin is hot and dry. 
 The tongue is covered with a yellow coating and the right con- 
 junctiva offers a light subicteroid appearance. Pulse regular, 
 strong : 94. Temp. 40.5. 
 
u 
 
 Tho apex of the heart beats tumultnottsly between the 5tli 
 and the 6th iil> where a soft murmur masks the first sound On 
 percussion and auscultation, I find nothing abnormal in the 
 lungS; neither behind nor in front. But considering the symp- 
 toms mentioned above, namely: chill, headache, pain in the 
 side, cough, rusty expectoration, high temperature, and all thii- 
 after exposure to cold and in a time where pneumonia exists I 
 may say epidemically, I cannot help thinking of this affection 
 in spite of the total absence of physical sym2)toma perceptible 
 by percussion and siuscultatior,. 
 
 Have I not to deal, in this ' ase, with a central pneumonia of 
 the right lung? The reunior) of these symptoms is too intense, 
 especially the elevation of temperature on the 2nd day to make 
 me think of an acute endocarditis that might be betrayed by 
 the murmur alluded to. I suspend my diagnosis and pi'cscribc 
 a mild purgative with caiomel and rhubarb, followed by the 
 administration of Brandy by dessertspoonsful diluted in linseed 
 tea. every two hours. 
 
 Feb. 23rd. — Sleeplessness. However less delirium. Several 
 vomitings since yesterday. Tongue not so yellow. Head- 
 ache. Pain when he coughs, always felt in the same place. 
 tSputa is viscid, occasionnally rusty, in short pathognomonic ; 
 notwithstanding, auscultation and percussion fail to reveal 
 anything yet : no rales, no bronchophony, no dulness. Pulse 
 full, strong: 84. T. 40.7. 
 
 Feb. 24th. — Pulse 100. T. 41,3. aerated and rusty expectoration 
 R. 32. 
 
 Feb. 25th.— Pulse 100 T. 41.2 R. 36. At last, crepitant rales, 
 and bronchial breathing behind, middle of the right lung. 
 
 Feb. 26th. — Restlesness, delirium. Headache relieved, P. 98, 
 R. 33, T. 40.5, bronchophon)^. I prescribe 15 drops of Lau- 
 danum to relieve the cough and the stitch. A dessertspoonful 
 of Brandy every hour. 
 
 Feb. 27th. — Although the cough and other pain are relieved, 
 the laudanum seems to have increased the delirium. P. 90. 
 R. 31, T. 39.5. Sputa thinner, no more headache. Subcrepiiant 
 rales behind when he coughs. 
 
 Feb. 28th. — Delirium. Bad expression. Lingering answers; 
 feels weak, P. 64, T. 37, R. 40. Profuse perspiration last night, 
 
 Tr. Bark one drachm every four hours. Same treatment 
 besides. 
 
 Feb. 29th. — Better. Good sleep. No more delirium, no more 
 pains. Cough diminished ; difficult expectoration of white 
 sputa. P. 53, T. 36.9, R. 29. Blowing weaker, as well as bron- 
 chophony. Feels his appetite returning. ^ 
 
 March Ist. — Improves rapidly. Bowels opened. Tongue 
 cleaner. Expectoration white, easy. P. 60, T. 36.9. The lung 
 has partly recovered its normal tone on percussion. Few rales 
 
17 
 
 and weak bronchial breathing. The murmur at the apex of the 
 heart does not neem ho well marked as at the ho;^i lining. 
 
 Todd's mixture every two hours, more nutritious food. 
 
 Marcii iU'd. — Excellent appetite. Gaining strength rapidly ; 
 little cough. Feels well. 
 
 1 could multiply the number of those observations; but 
 several of them having been taken about the same time, that is, 
 in a time where acute pneumonia seemed to be prevalent as if 
 epidemically, they otter many points of analogy which would 
 render their relation somewhat tedious. I was only anxious to 
 give you an outline of the few cases I have JList related and of 
 which I possess several examples, to show that delirium, on one 
 hand, and vigour of the constitution, on the other, does not cons- 
 titute an impediment to the medication by alcohol but that, on 
 ■;he contrary, the course of the disease in these cases, had lost 
 nothing or its regularity; the crisis takiug place at the time 
 indicated by experience and observation. 
 
 Now, Gentlemen, is it expedient to employ indiscriminately 
 in all cases the treatment by alcohol in inflammation of the 
 lun .^s ? 
 
 It is, at this point, that I expect to meet with diff'erence of 
 opinion between us. " In strong and plethoric subjects that we 
 meet in the country, shall you say, in those vigorous and robust 
 farmers that nothing can overcome, it is dangerous to have 
 recourse to stimulants ; we must, on the conti-ary, wrestle with 
 the disease and remove from the economy the excess of vitality 
 developed by inflammation." 
 
 To these objections, 1 shall answer, that the cases which are 
 personal to me and to which I have already alluded, have been 
 observed in patients born and living in the country and all 
 submitted to the same treatment. Some were young, strong and 
 vigorous, others more enfeebled by age, their constitution or 
 other previous diseases ; the result has nearly always been the 
 same. 
 
 Besides, consult your memory and say, whether by vene- 
 section, emetic, calomel or otherwise you ever succeeded in 
 shortening the duration of inflammation of the lungs? Perhaps 
 you momentarily obtained a remission of the symptoms, but 
 few hours suflSced to make them regain their primitive inten- 
 sity. A new bleeding would cause an other amelioration and 
 so on until, at last, the resolution would take place spontaneous- 
 ly by itself, fortunate when a sudden collapse produced by 
 these repeated ^abstractions of blood, did not abruptly end the 
 scene • . . * . '.**.♦ • t • ' s . • 
 
 NevertKeUs»,'14<} Wt ^ivish la aV.oW 'rtiyself a greater partisan 
 of alcohol ,tluan. Xlie. .promotors, of the, .method. Todd himself; 
 did not iooijL.Vg^^rtlilG mtedica'tjon as .indispensable in all and 
 every catee* of ^D«Juftionia although he considers it as always 
 
 I 
 
 :^., 
 
18 
 
 liHoful, but the indications of this mode of treatment moi'o ospo 
 oially present themselves : 
 
 Ist. Each time that exist symptoms of ataxia or adynamia. 
 These symptoms : delirium, coma, stupor amend rapidly under 
 the influence of this medication. To»ld considers delirium an 
 the symptom of a viciated and enfeebled nutrition of the brain ; 
 we observe it in all debllitatin/ij diseases or accompanied with 
 high temperature ; therefore it is amenable to the same treat- 
 ment directed against adynamia. 
 
 2o. When the intensity of the fever indicated by thermometer 
 is considerable. Here, perhaps alcohol will not act as a direct 
 antipyretic but in stimulating, strengthening, feeding the 
 organism, it tends to make it recover the normal level of phy- 
 siological temperature raised by the disease. 
 
 3o. When the subjects are alcoholic or weakened by any 
 previous disease. 
 
 The mode of administration of alcohol is the capital point of 
 the treatment. The fractioning of doses is the indispensaWc 
 condition of success. It is not so much a day, we musi order, 
 but so much every half hour, every hour, every two hours, 
 Todd ga^^e half an ounce of brandy diluted in water, every two 
 or three hours, when cases of moderate severity, and every half 
 hour, every hour, when danger was pressing. 
 
 In France, they did not reach such high doses and Behier 
 does not seem to have given beyond 8 or 9 ounces within 24 
 hours, prescribing usually from 4 to 8 ounces of Brandy or Rum 
 diluted in the same quantity of water or linseed tea by table 
 spoonsful every one or two hours. 
 
 In all the cases confided to my care, I very seldom prescribed 
 more than one to two teaspoonsful of Brandy, given every hour 
 without interruption, during the whole duration of the disease 
 and more or less diluted according to the susceptibility of the 
 patient. 
 
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