RM 
 
 256 
 
 A6260
 
 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 LOS ANGELES
 
 r 
 
 ON THE 
 
 OSES OF WINES IN HEALTH 
 AND DISEASE. 
 
 FRANCIS E. ANSTIE, M.D., F.E.C.P., 
 
 Late Physician to the Westminster Hospital, and Editor of the "Practitioner. 
 
 REPRINTED FROM THE "PRACTITIONER? 
 
 MACMILLAN AND CO. 
 
 1877.
 
 f 
 
 LONDON I 
 Y, SONS AND TAYLOR, PRINTERS, 
 
 BREAD STREET HILL, 
 QUEEN VICTORIA STREET.
 
 RM 
 
 CONTENTS. 
 
 PAGE 
 PART I. ON THE PLACE OF WINES IN THE DIKT OF ORDINARY 
 
 LIFE 1 
 
 PART II. ON THE USES OF WINES IN DISCASE- 
 
 Section I. Wines in Acute Disease ....... 42 
 
 Section II. Wines in Chronic Disease . . 62 
 
 1086558
 
 ON THE USES OF WINES 
 
 IN 
 
 HEALTH AND DISEASE. 
 
 PAET I. 
 ON THE PLACE OF WINES IN THE DIET OF OKBINARY LIFE. 
 
 IN commencing a series of papers on the uses of 
 Wines in health and in disease, we must briefly define 
 the intended scope of our inquiry, in order to avoid 
 misunderstandings. In the first place, it is no part 
 of our object to discuss the question of the lawfulness - 
 or the advisability of using alcoholic liquors in general, 
 either as food or as medicine ; we shall take it as 
 established, both by wide-spread custom and by the 
 most recent physiological research, that alcohol as such, 
 has its legitimate place in the sustentation both of the 
 healthy and of the diseased organism. Nor shall we 
 occupy space with the re-assertion of the doctrine, 
 of the absolutely different effects respectively produced 
 by the moderate and by the excessive use of this 
 class of drinks. It is our intention to deal specially 
 with Wines as such ; to show that the whole group of 
 these beverages has common properties and uses that 
 
 * B
 
 2 ON THE USES OF WINES 
 
 separate it from other alcoholic liquids ; and further, that 
 among wines themselves there are very numerous 
 differences, of which many are probably not yet under- 
 stood either by the public or even by the majority of 
 medical men. We can hardly be mistaken in the 
 latter assertion, sweeping though it seems ; since not 
 only is it common to meet with invalids and others 
 who have received diametrically opposite directions as 
 to the choice of beverages from different practitioners 
 of equal standing, but we have observed after a pretty 
 close study of this subject, extending over more than 
 thirteen years, that hasty generalizations, which will 
 not bear sifting, are almost as common in the pages of 
 recent as of older writers on this topic. One part of 
 our knowledge has, indeed, of late made solid, though 
 limited advances viz., the chemistry of wines. But 
 the far wider question of their choice and practical 
 uses is still in the most uncertain state ; and it must be 
 confessed that recent literature on the subject, though 
 it may have cleared away some gross misconceptions, 
 has almost neutralized this benefit by fostering the 
 growth of new prejudices which are scarcely less 
 unfounded than the old ones. And there is one aspect 
 of the new discussions upon which, though we would 
 willingly ignore it, our duty compels us to animadvert 
 with plainness : we mean the influence of commercial 
 motives. We are not imputing conscious dishonesty to 
 the writers even of the most objectionable of the many 
 trade circulars which have been published under the 
 guise of scientific pamphlets on wine ; but it is only too 
 obvious to those who are at all behind the scenes that 
 commercial bias has in several instances assisted power- 
 fully in the development of exclusive dogmas which, 
 from a scientific standpoint, must be regarded as
 
 IN HEALTH. 3 
 
 capricious and absurd. It may perhaps be necessary 
 hereafter to illustrate this with some particularity ; at 
 present it will be enough to adduce an instance which 
 is so common that our criticism of it can scarcely 
 inflict the sting of personal reproach: we refer to 
 the clamour for the exclusive use of particular 
 " natural " or " unfortified " wines. Doubtless this cry 
 represents a natural, and on the whole a wise, reaction 
 from certain stupid and pernicious routine habits of 
 English life ; but it has been largely fostered and 
 exaggerated by traders, and by a certain class of 
 scientific men, in a manner which scarcely corresponds 
 with the idea of disinterestedness, unless we are to 
 suppose that their enthusiasm is strongly leavened with 
 ignorance. 
 
 To a medical writer on wines there are several induce- 
 ments to attack the subject first from the side of the 
 medicinal uses of these drinks ; the strongest reason being 
 that, from the nature of his daily experience, he is most 
 familiar with this aspect of the question. We prefer, 
 however, to start from the view of wine as a beverage 
 of ordinary life ; being persuaded that the subject can 
 only be fairly examined in this way. It is no doubt 
 true, on the one hand, that a complete statement of the 
 physiological action of wines cannot, in the present 
 state of science, be given ; and, on the other hand, it 
 may be urged that if empirical experience is to be our 
 guide, the circumstances of sickness offer a guarantee 
 for closer and more accurate observation of the pheno- 
 mena than can be expected when wines are used as a 
 mere beverage of the healthy. To this argument we< 
 believe there is one conclusive reply that there is no 
 such clear line between health and disease as is assumed 
 in common speech ; that the foreshadowings and faint 
 
 B 2
 
 4 ON THE USES OF WINES 
 
 images of disease are to be seen in sundry incidents of the 
 life of those who are conventionally regarded as healthy, 
 and that it is in the study of these " natural diseases " 
 (if we may use such a phrase), and their relations to 
 the dietary remedies which general custom, indepen- 
 dently of medical authority, has prescribed for them, 
 that we are most likely to discover a reasonable basis for 
 the use of these remedies in diseases which involve 
 extensive and obvious departures from the standard of 
 health. It need scarcely be said that alcoholic drinks, 
 rightly or wrongly, are the commonest of all household 
 remedies for a large number of paltry ailments ; and one 
 of the first things which we wish to demonstrate is the 
 prominent fitness of wines, above other alcoholic drinks, 
 for all legitimate purposes of this kind. Accordingly, 
 we shall in the first place very simply sum up the 
 composition of wines, as a class ; and also the main 
 distinctions between the principal kinds. 
 
 1. In the first place, we have to consider wines as 
 alcoholic fluids ; and we must remind our readers of the 
 elementary facts as to their relative strengths as com- 
 pared with each other, and with other kinds of alcoholic 
 drinks. It will be enough for the present to say that 
 the strong wines, including port, sherry, madeira, marsala, 
 and all that genus, contain on the average something 
 like 17 per cent, of absolute alcohol (the strongest ports 
 ranging as high as 23 per cent, or more), and that the 
 light wines, including claret, burgundy, champagne, 
 Ehine, and Moselle wines, Hungarian wines, &c., 
 average between 10 and 11 per cent, of absolute alcohol 
 (the lightest champagnes not containing more than 5 or 6 
 per cent.). Comparing wines with beers, we may note 
 that the poorest sorts of beer contain about 2 per cent, 
 of absolute alcohol ; ordinary table-ale, as drunk in most
 
 IN HEALTH. 5 
 
 middle-class households, about 3 per cent. ; ordinary 
 porter between 3 and 4 per cent. ; stout from 5 to 6 
 per cent. ; while the strongest kinds of malt liquors 
 range through various degrees up to even 10 per cent. ; 
 and a common strength for good bottled ale or stout 
 is about 7 per cent of absolute alcohol. On the other 
 hand, good brandies and rum average between 45 and 
 50 per cent. The above rough averages are only drawn 
 with a view to place before the reader a standard of 
 comparison by the help of which he may realise, some- 
 what more accurately than is usually done even by 
 medical men, the comparative alcoholic potency of 
 beverages which are so commonly recommended in an 
 off-hand and careless fashion. For instance, let us take 
 the very common case of a lady, not exactly ill, but 
 delicate, and "needing generous living," who takes 
 " three or four glasses of port wine a day." Now it 
 need hardly be said that wineglasses vary greatly in 
 size, and that of late years there has been a marked 
 tendency to make them larger than formerly ; but we 
 will take the moderate average of 2 ounces for a 
 port-glass : then four of these will contain 8 ounces of 
 wine, which, on the supposition that the liquor is of 
 a fair age and quality, will represent 1^ ounce of 
 absolute alcohol, or the alcoholic equivalent of 50 
 ounces (five large tumblers) of table-beer, or 3 ounces 
 of good brandy, or two-thirds of a bottle of a generous 
 claret or Ehine wine. Or to put the comparison in 
 another practical form (still avoiding the nuisance of a 
 dry tabular statement), we may say that a bottle of 
 twelve glasses of average port is equal in alcoholic 
 strength to rather less than half a bottle of brandy, or 
 two bottles of good claret or hock, or nearly a gallon 
 of table-beer or of light champagne. Now, it would be
 
 6 ON THE USES OF WINES 
 
 easy to make a somewhat sensational point, by showing 
 that the by no means unusual allowance for ladies who 
 are at all " delicate " of two glasses of port or sherry at 
 lunch, and the same quantity at dinner, daily, makes up 
 the alcoholic equivalent of a bottle of brandy every 
 week, which looks rather shocking on paper. But apart 
 from the question whether such an allowance is exces- 
 sive or not, we would insist on the value of this kind of 
 comparison, as tending to show very distinctly that the 
 place of the stronger wines is rather among the cordials, 
 to be used under express and careful medical sanction, 
 than among the beverages of common life, since it is 
 plain that a very little carelessness in their use may 
 lead to actual excess. The daily allowance above- 
 mentioned includes an amount of absolute alcohol 
 which our own experimental researches have shown to 
 be about the limit of what can be habitually taken by 
 persons leading a not very active life, without provoking 
 symptoms of chronic malaise indicative of actual 
 alcoholic poisoning. 
 
 It is otherwise with the class of light wines, speaking 
 in the broadest sense ; wines, namely, that average no 
 more than 10 per cent, of alcoholic strength. So far 
 as alcoholic strength is concerned, it may be said in 
 general terms that half a bottle a day of such wine for 
 a sedentary, and a bottle a day for a vigorous and 
 actively employed adult, affords a reasonable and 
 prudent allowance of alcohol; and this quantity of 
 wine, either aloue or with water, will be enough to 
 satisfy the needs of moderate persons for a beverage at 
 lunch and dinner, the only two meals at which alcohol 
 should, as a rule, be taken. 
 
 We have put this question of the absolute alcoholic 
 allowance for healthy adults in a somewhat crude and
 
 IN HEALTH. 7 
 
 abstract form, not undesignedly ; for we wish to compel 
 the upper and middle classes, and their medical advisers, 
 to look the facts of alcoholic consumption honestly in 
 the face. No one who is at all conversant with the 
 habits of the wine-drinking classes will deny that such 
 a daily allowance of alcohol as we have above mentioned 
 is distinctly within the average consumption of persons 
 of moderate habits as the ways of society go ; and indeed 
 we fear that a good many persons will characterise it as 
 Utopian in its standard of temperance. It is therefore 
 well to remember, that the same quantity of alcohol, 
 represented in beer, makes up between two and three 
 pints; and that a labouring man who exceeded this 
 daily allowance would certainly fall under the ban 
 of conventional moralists as " intemperate." It would 
 probably be a surprise to many worthy philanthropists, 
 if they chanced to read this paper, to find themselves 
 placed so nearly on a level with Hodge the carter, who 
 reprehensibly fuddles himself with " t'other pint." But 
 in fact the matter is stronger than this : and for once we 
 must beg leave to drop the conventional theory of 
 educated manners, and describe plain facts. It is true 
 that there has been a real advance towards temperance 
 of late years, and that intoxication has become a 
 monstrous exception, among the cultivated classes. But 
 we may appeal to any medical man with a knowledge 
 either of metropolitan or provincial society as to the 
 accuracy of the following computation. We shall admit, 
 in the first place, that there are many men, and very many 
 women, who drink almost no alcohol. But the greater 
 number of men, and a large number of women, of the 
 middle and upper ranks, habitually take a daily allowance 
 of alcohol far larger than that above indicated. We 
 purposely leave out of sight the reckless " fast " men who
 
 8 ON THE USES OF WINES 
 
 are perpetually "nipping" at bitters or absinthe, or 
 " setting themselves right " with just another " brandy- 
 and-soda," and also the miserable women whose 
 numbers none but the doctors even faintly suspect 
 who indulge in secret dram-drinking. Excluding all 
 such persons from our reckoning, let us merely consider 
 the case of the moderate diners-out, and the virtuous 
 dancing young ladies. The former will certainly take 
 on the average 8 ounces of strong wines, and 12 to 
 16 of light wines, daily; or he will make up the 
 equivalent of this with beer or with spirits : in fact, 
 he will take about 3 ounces of absolute alcohol, or the 
 equivalent of about a gallon of the puddle-beer that 
 labourers drink. And the young lady will not take 
 less than three-fourths of this quantity by the time she 
 has finished her last champagne-cup at the ball or rout. 
 If any one thinks this estimate excessive, we assure 
 him, that, were it discreet, we could produce accurate 
 notes of the performances of sundry terpsichorean and 
 otherwise athletic young ladies, of irreproachable 
 character, to which the foregoing facts are a trifle. 
 
 It is, in fact, a considerable puzzle to understand, at 
 first, how our respectable classes manage to consume 
 so much more alcohol, without reproach, than the un- 
 fortunate Wiltshire clodhopper, for example, can do. 
 Doubtless one reason is that their drinks are not muddled 
 with Cocculus indicus, &c., as his is. But no doubt 
 the truth is that the intoxicative, that is the visibly 
 poisonous, effects of alcohol are mainly kept at bay by 
 powerful exertion either of the muscular or of the nervous 
 system : and the wealthy classes to a large extent do task 
 either one or both of these systems far more heavily 
 than labourers, except those employed in some specially 
 fatiguing callings. Nevertheless, there is grave danger
 
 IN HEALTH. 9 
 
 of excess, were it merely from the multiplication of 
 alcoholic drinks which are taken by the richer classes ; 
 and it will be our aim to show that adherence to one 
 drink, and generally one wine, is almost a necessity 
 for the purposes of health. .s^__ 
 
 It has already been shown that there is a great 
 tendency in the customs of modern middle and upper 
 class society to introduce modes of wine-drinking which 
 would easily involve people in habits of alcoholic 
 excess, though such an idea might be far enough from 
 their wishes or intentions. 
 
 It is very obvious that the multiplication of alcoholic 
 drinks, with different flavours, each tempting in its 
 turn, must lead the sharer in convivial feasts to forget 
 how much he has already drunk ; more especially if (as 
 is usually the case) he has no accurate knowledge of the 
 alcoholic strength of the liquors which he takes. And 
 even in every-day life it cannot be easy for those who 
 adopt the common plan of drinking at least two, and 
 generally three, separate alcoholic liquors in the course 
 of the day, to regulate their allowance of alcohol with 
 anything like nicety. It is therefore much to be 
 desired that people may be educated in the direction of 
 using only one alcoholic drink ; at least for every-day 
 consumption. The choice of this one drink must in 
 each individual case depend upon a number of other 
 considerations besides mere alcoholic strength, and these 
 will be discussed further on ; at present we have to 
 point out those drinks which are suitable, in the single 
 matter of strength, to be selected as the only alcoholic 
 beverage. 
 
 What we have practically to consider is the possi- 
 bility of selecting some alcoholic fluid which shall be 
 weak enough either when taken neat, or with only so
 
 10 ON THE USES OF WINES 
 
 much water as will not make it distasteful to enable 
 us to drink so much of it as will satisfy all needs for 
 fluid at lunch and dinner (or dinner and supper with 
 folk of early habits), without producing any of the 
 injurious effects of alcohol. Weak beers would, of 
 course, very well fulfil these requirements ; for instance, 
 a sound light table-beer, containing about 3 per cent, of 
 absolute alcohol. But to a large number of persons 
 the quantity of such beer that would satisfy thirst, and 
 also prove sufficiently stimulant, would not be readily 
 digestible ; or, if it did not disorder primary digestion, 
 would cause disagreeable after-consequences. Especially 
 to persons of a gouty constitution, such a regimen would 
 be most unwholesome ; also to many persons with 
 rheumatic tendencies, on account of the sugar and 
 dextrine which some light beers contain. Beers, again, 
 cannot be mixed with water and retain their agreeable 
 flavour. 
 
 It is amongst the class of natural wines, averaging 
 not more than 10 per cent, of absolute alcohol, that 
 we must seek the type of a universal alcoholic beverage 
 for every- day life. If we turn to the most recent 
 analyses (the very careful work of Dr. A. Dupre, of the 
 Westminster Hospital), we find two kinds of wine 
 which, as far as alcoholic strength is concerned, meet 
 the ideal want viz., a Khine wine at 9| per cent, 
 alcohol, and a claret at SJ per cent. Such wines are 
 easily procurable, and we may say that we have, in 
 either of them, a beverage which, alone or diluted with 
 a certain amount of water, would at once satisfy all 
 needs for liquid with the principal meals, and all needs 
 for alcohol, in the most convenient and agreeable way. 
 A bottle a day of either of these wines for an actively 
 employed adult, and a proportionately less quantity for
 
 IN HEALTH. 11 
 
 those whose life is more sedentary, would very well 
 represent the allowance of alcohol which may be said 
 to suit best the standard of ordinary health. Un- 
 fortunately, however, for persons of moderate means 
 the German wines, in the present state of prices, are 
 practically out of the field as leverages. It is quite 
 possible (experto crede) to procure in London an admir- 
 ably sound ordinary Bordeaux for 12s. a dozen (alcoholic 
 strength 8 to 9 per cent.) ; but a German wine of any- 
 thing like equal merit would cost twice as much. The 
 same may be said respecting Hungarian, Burgundian, 
 and Greek wines, besides other objections to be noticed 
 hereafter. 
 
 Practically, then, those who wish to adopt the plan of 
 drinking all their alcohol in the shape of one wine, will 
 probably do best with Bordeaux, which is also par 
 excellence the wine which may be mixed with water (of 
 course we speak of the humbler growths) without 
 spoiling. We maintain that for the hard-working 
 student, politician, professional man, or busy merchant, 
 there is no better arrangement possible than that of 
 taking, as the regular daily allowance, a bottle of sound 
 ordinary wine of Bordeaux : and that the number of 
 persons with whom such a diet really disagrees is very 
 limited ; but on the latter point we shall have more to 
 say hereafter, in discussing the other ingredients of 
 wines. It may be added that no other wines which 
 the world produces are capable of yielding, day after 
 day, such unwearied pleasure to the palate as the 
 sound ordinary wines of Bordeaux and of the Ehine. 
 
 While, however, we vindicate, for the light natural 
 wines, the position of the best common alcoholic drink 
 for healthy adults, we have some remarks to make on 
 certain more limited and occasional uses of wines, which
 
 12 ON THE USES OF WINES 
 
 embody ideas not commonly received by the profession. 
 We refer to the employment of the stronger wines, such 
 as port, sherry, madeira, or marsala, all of which are 
 fortified by the addition of alcohol over and above that 
 produced by their own fermentation. 
 
 It is a common idea that the stronger wines are 
 particularly suited to healthy adult life, and especially 
 to middle age ; but we believe that this is a complete 
 mistake. The vigorous frame and perfect digestion of 
 a healthy young or middle-aged person requires but a 
 moderate daily allowance of alcohol to assist functional 
 activity; and as, nevertheless, the temptation to free 
 indulgence in the pleasures of the table is most in- 
 fluential in the middle period of life, it is of the 
 greatest consequence that the alcohol should be taken 
 in the most diluted forms : and we may add that this 
 is especially necessary for persons (particularly women) 
 who possess a nervous temperament, and are, therefore, 
 highly sensitive to strong and pleasing impressions on 
 the nervous system. It is otherwise with the two 
 extremes of life infancy and old age ; in both these 
 periods there are tendencies to a variety of afflictions 
 which scarcely appear to deserve the name of positive 
 disease, but which demand serious modifications of the 
 diet; these conditions may, we affirm, be far more 
 advantageously treated by the administration of the 
 stronger wines than by any other means whatever. "We 
 shall defer the full consideration of this subject till we 
 come to speak of the ethereal constituents of wine, 
 which count for at least an equal, if not a greater, value 
 than that of the alcohol in this particular use of the 
 stronger wines, more especially of sherry. 
 
 2. Sugar is the next ingredient of wines which 
 we have to consider in the selection of appropriate
 
 IN HEALTH. 13 
 
 beverages for persons in ordinary health; and here 
 we get a forcible illustration of the maxim that 
 " health " is not a constant and uniform thing, 
 capable of being separated by a sharp line from 
 "disease:" for there are the greatest possible differ- 
 ences between the respective capabilities of different 
 persons, equally healthy in appearance, to digest 
 saccharine wines. 
 
 The respective proportions in which the various 
 classes of wines contain sugar cannot, of course, be 
 stated in a summary manner, sugar being precisely the 
 most varying element. Given a wine made from a 
 certain grape, and under certain climatic conditions, 
 then, of course, the amount of sugar which it actually 
 contains when drunk will depend, (1) on the degree of 
 completeness to which fermentation was allowed to 
 proceed in the wine-making ; and (2) on the age of the 
 wine. Taking the matter broadly, it may be said that 
 the natural wines are the non-saccharine, and the 
 fortified wines are the saccharine ; though there are 
 important exceptions to this which must be specially 
 mentioned. Here are the results of Dr. Dupre's analyses 
 of four clarets (red Bordeaux), of the respective prices 
 of 12s., 15s., 30s., and 66s. per doz. ; the first contained 
 13'56 grains of sugar in the bottle, the second 15 '62 
 grains, the third 18'48 grains, and the fourth (an old 
 bottled wine) 11-40 grains. Contrast with this the same 
 chemist's analyses of four sherries, prices respectively 
 22s., 36s., "high" and "high," the two last being 
 wines of good vintage, and some years in bottle: the 
 quantities of sugar are, 307'8 grains, 217'2 grains,.' 356 '4 
 grains, and 421 '2 grains per bottle, respectively. Take 
 also the analyses of four ports (vintages 1864, 1851, 1851, 
 and 1842) ; the quantities of sugar per bottle are 51972
 
 14 ON THE USES OF WINES 
 
 grains, 46O80 grains, 190-20 grains, and 121*20 grains. 
 Two samples of marsala (old and good) contained 388'8 
 and 451'2 grains of sugar per bottle, respectively. The 
 natural wines of the Rhine, on the other hand, contain 
 even less sugar than clarets ; thus in four samples 
 examined by Dr. Dupre" (prices 15s., 20s., 36s., and 
 Y2s. per doz.), the sugar per bottle amounted to 1'44 
 grains and 8'64 grains, respectively, in the two cheapest, 
 and to a mere " trace " in the two others. Champagne 
 stands in a peculiar position, as it is intentionally 
 sweetened ; according to Bence Jones' analysis there 
 are about 500 grains of sugar per bottle in such varieties 
 as find most favour in this country (e.g. Moet and 
 Chandon, premiere qualiU] ; but some champagnes are 
 sweetened to a much higher pitch, while, on the contrary, 
 some English connoisseurs demand a champagne which 
 scarcely contains half this amount of sugar. Hungarian 
 natural wines contain but a small amount of sugar ; 
 they stand somewhat intermediate, as regards this 
 element, between Rhine wines and red Bordeaux. 
 
 One of the richest in sugar of all the natural wines 
 is Bordeaux-Sauterne, a white wine of great popularity, 
 from its fragrant bouquet and flavour. Bence Jones' 
 analysis of a sample of fine Sauterne (72s. per doz.) 
 gives 125 grains of sugar to the bottle ; and the taste of 
 this wine, until it has been many years in bottle, is 
 distinctly sweet, too much so, indeed, for the taste of 
 many wine-drinkers. On the other hand, among the 
 fortified wines we occasionally meet with sherries of 
 extreme " dryness," containing, in fact, almost no sugar 
 at all : such, for instance, as an amontillado (marked 
 " very good" in Bence Jones' tables). But such wines, 
 when genuine, are too expensive for common use. 
 
 The above brief summary of the proportion of sugar
 
 IN HEALTH. 15 
 
 in the principal varieties of wine will be sufficient for 
 the purposes of those who merely require some guidance 
 in the choice of an every-day "beverage. It is clear that 
 for those who wish to employ wine as a beverage, and to 
 avoid the use of a highly saccharine liquor, the safest 
 choice, in this respect, lies between the sound ordinary 
 wines of Bordeaux, the Ehine, and Hungary. It now 
 remains for us to inquire what are the facts as to the 
 wholesomeness or unwholesomeness of saccharine wines, 
 as such, to persons in ordinary health. 
 
 It must be remembered, in the first place, that we are 
 not dealing with the possible effects of very large 
 quantities of sugar in wine. The "dietetic use of 
 wines " does not practically include the employment of 
 any wine which would contain more than one ounce to 
 the bottle, and the facts already detailed as to alcoholic 
 strength will show that the wines (except champagne) 
 that contain anything like this percentage of sugar 
 port, sherry, madeira, marsala cannot (on the ground 
 of alcoholic strength) be safely taken in larger daily 
 quantities than one-third to one-half of a bottle. The 
 question then arises, whether and if so in what 
 circumstances the ingestion of from one-third to half 
 an ounce of sugar in their wine has a deleterious 
 influence upon persons in what would ordinarily be 
 called " health." 
 
 There are three classes of individuals enjoying fairly 
 good general health respecting whom there is a certain 
 amount of evidence that saccharine wines are apt to 
 unfavourably influence their bodily condition. (1.) 
 A considerable number of persons possess a marked 
 proclivity to excessive deposit of fat in the cellular 
 tissues ; and a good deal of evidence has been adduced 
 by various writers from Brillat-Savarin to Banting
 
 16 ON THE USES OF WINES 
 
 to show that the saccharine and sugar-making ingre- 
 dients of food aggravate this tendency. It is not 
 necessary, however, to dwell on this subject, as the 
 amount of sugar introduced into the body by anything 
 like a temperate consumption of saccharine wines would 
 obviously be trifling as compared with the supplies 
 furnished by ordinary food. (2.) The tendency to 
 gouty affections, which is hereditary, is widely diffused 
 among persons otherwise healthy, and a certain amount 
 of evidence exists to show that a considerable saccha- 
 rine ingredient perceptibly increases the well-known 
 tendency of alcoholic drinks to evoke the ten- 
 dency to gout which is latent in such constitutions. 
 Our own investigations lead us to entire concurrence 
 with the opinion of Garrod the greatest living 
 authority on gout that the saccharine element of 
 alcoholic liquors has never yet been proved to be the only 
 effective element in provoking the disease. Nevertheless, 
 the fact that the one common feature in all those classes 
 of drinks which really do seem convicted of a strong 
 gout-producing tendency malt liquors, strong wines, 
 champagnes, and sweet cider in their saccharine or 
 sugar-producing quality, does suggest an almost necessary 
 connection between saccharine beverages and gout. 
 Even if it be true, as Dr. Garrod maintains, that even 
 the " driest " sherry will often appear to excite gout 
 in a predisposed individual, we cannot believe that 
 the saccharine element of wines has not a powerful 
 influence in developing gouty manifestations. In truth, 
 however, we question the accuracy of this assertion ; at 
 least we greatly doubt whether really non-saccharine 
 sherry ever produced a first attack of gout ; but when 
 the tendency to the attacks has become very strong, a 
 trifling disturbance of digestion might be sufficient to
 
 IN HEALTH. 17 
 
 bring on a fit of gout, and even so innocent a fluid 
 as dry sherry might suffice for this purpose. Still, 
 there can be no question that for persons who are 
 born of gouty families, especially if they have them- 
 selves experienced warnings of gout, the safest course is 
 to avoid the whole class of fortified wines, and con- 
 fine themselves to sound light claret, or, in the rare cases 
 where this disagrees, to very weak cold spirits and 
 water, carefully bearing in mind that though, when used 
 in moderation, alcohol itself does not appear to be a 
 gout-producer, yet the depression of the nervous system 
 which inevitably follows excesses, even with plain gin, 
 is perfectly competent to induce gout in predisposed 
 persons. (3) Even more than to those persons who 
 are liable to well-pronounced gout, saccharine wines are 
 a danger for that class of dyspeptic patients who are 
 the victims of a latent gouty disposition. In subjects 
 of this temperament the effects of even a small 
 indulgence in this kind of liquor are often extremely 
 disastrous. We are acquainted with one lady whose 
 sensitiveness in this regard makes her stomach an 
 extraordinarily delicate tester of the sweetness of wines. 
 The least approach to high saccharine quality makes 
 wine, to her, a poison which infallibly provokes severe 
 vomiting or bilious diarrhoea, or both. It is a curious 
 circumstance, however, that this particular lady only 
 showed the tendency in question rather late in life, 
 previously to which period she had habitually, though 
 Very moderately, taken port wine of a decidedly saccha- 
 rine type ; and it was soon after her first development 
 of an incapacity to bear this wine that her first (very 
 slight) symptoms of articular gout appeared. The same 
 lady drinks very dry sherry with perfect impunity. 
 The peculiar form of dyspepsia which is found in 
 
 c
 
 18 ON THE USES OF WINES 
 
 persons of gouty habit is, however, by no means the 
 only dyspepsia with which the saccharine wines dis- 
 agree. It is one of the commonest medical observations 
 that a considerable number of persons can only maintain 
 a good and active state of the digestive powers by means 
 of a very strict limitation of their allowance of sugar, 
 and also of the starch-containing foods, which undergo 
 conversion into sugar at an early stage of the digestion. 
 Such persons are obliged to be extremely moderate, 
 for instance, in their consumption, not merely of pastry 
 and sweets, but even of bread and potatoes, under 
 penalty of severe dyspepsia if they transgress this rule. 
 To such individuals the saccharine wines are commonly 
 very unsuitable and disturbing. For some reason, not 
 clearly apparent in the present state of our knowledge 
 of the chemistry of digestion, the tendency of sugar to 
 " turn acid " on the stomach is very much heightened 
 when that substance is given in combination with 
 alcohol. This is the case even when it is taken with a 
 plain spirit like gin. But the mischief is still further 
 heightened in the case of wines, since all wines contain 
 a considerable proportion both of fixed and volatile 
 acids, as will be presently seen. The tendency of the 
 sugary wines to produce sour dyspepsia is, however, 
 altogether out of proportion to their chemical degree of 
 acidity. For instance, such a wine as one of the ports 
 analysed by Dr. Dupre" (vintage 1864), which contain 
 43-31 grains per 1,000 of sugar, and only 413 per 1,000 
 of total free acids, is far more likely to be mischievous 
 in this direction than a light natural wine like claret 
 of good quality, which may contain as much as six 
 grains of free acid per 1,000. 
 
 3. The natural acidity of wines is the next item 
 which needs consideration in reference to their use as
 
 IN HEALTH. 19 
 
 beverages ; a more general diffusion of accurate know- 
 ledge on this subject is highly desirable, since the taste 
 of wines, by which people ordinarily judge of their 
 acidity, is often highly misleading. The following are 
 the figures given by Dr. Dupre* for the principal wines : 
 In four red Bordeaux (prices 12s., 15s., 30s., and 66s. per 
 doz.) the total quantities of free acid were 77'40 grs., 
 72-96 grs., 74*28 grs., and 65'76 grs. per bottle respec- 
 tively. In four samples of hock (prices 15s., 20s., 36s., 
 and 72s. per doz.) the total free acids were, 6744 grs., 
 57'60 grs., 70-32 grs., and 69'24 grs. per bottle. In 
 three samples of Hungarian wine (prices 21s., 34s., and 
 42s. per doz.) the total free acids were, 80 -16 grs., 85-92 
 grs., and 83'88 grs. per bottle. In four sherries (prices 
 22s., 36s., "high" and "high") the total free acids were 
 55-32 grs., 54'48 grs., 6116 grs., and 58'08 grs. per bottle. 
 In four ports (prices 32s., 50s., "high" and "high") the 
 total free acids were, 49'56 grs., 49'56 grs., 6216 grs., 
 and 58'08 grs. per bottle. In two marsalas ("old" and 
 "very old") the total free acids were 39*12 grs. and 
 46-76 grs. per bottle. 
 
 When we analyse further the free acid constituents of 
 wine, we find that they are made up of three principal 
 ingredients malic, tartaric, and acetic acids, and a 
 small proportion of several volatile acids closely akin 
 to the latter, which, however, have but a trifling influence 
 on the acidity of wines, though they are important 
 ingredients in flavour and bouquet. 
 
 Of the three principal acids, malic and tartaric are the 
 direct product of the grape-juice, the former prepon- 
 derating ; they are fixed, or non-volatile. The acetic, 
 and other volatile acids, are the consequence of fermen- 
 tation, and of the slower oxidizing processes which go 
 on after fermentation. Supposing the total amount of 
 
 c 2
 
 20 ON THE USES OF WINES 
 
 free acids to range (as it does in sound wines) between 
 4 and 6 per 1,000, the volatile acids should not exceed 
 one-fourth of this amount in the case of white, or one- 
 third in that of red wines. More than this indicates 
 that the wine is losing its vinous character and turning 
 to vinegar. 
 
 Now as regards the acidity of wines, it need hardly be 
 said here that a very popular prejudice in this country 
 regards the light natural wines as essentially sour, and 
 consequently, in that respect at least, inferior in whole - 
 someness to the port and sherry which are consecrated 
 by English drinking traditions. Of course if we judge 
 by mere taste this idea is correct ; a light claret, or still 
 more a light hock, will appear strikingly sour as com- 
 pared with a sherry of fair soundness : one would judge 
 that there was five or six times as much free acid in the 
 light wine as there is in the stronger. In truth, 
 however, if we turn to the analyses of Dr. Dupre, we 
 find that a light claret of 1865, costing only 155. a dozen, 
 contains but 6'08 per thousand of total free acids, as 
 against 518 per thousand in an expensive old bottled 
 sherry of 1860 vintage ; and that the proportion of 
 acetic to total free acid is much greater in the case of 
 the sherry than of the claret. There is, perhaps, even a 
 more settled prejudice against hock than against claret 
 on the score of supposed acidity ; yet if we turn again 
 to the tables we find hock at 15s. per dozen, containing 
 no more than 5'62 per thousand of free acids, of which, 
 again, a less proportion than in the case of the sherry 
 above mentioned is volatile acid. The explanation of 
 the common mistake is, of course, to be found in the 
 large quantity of sugar (29'70 per 1,000) which the 
 sherry contains, and which masks the acid; and it 
 therefore becomes an important question, whether the
 
 IN HEALTH. 21 
 
 mere masking of an acid taste in this way really renders 
 the wine more digestible. 
 
 For our own part we are totally opposed to such a 
 view, and indeed are strongly inclined to believe that, 
 as applied to wines, it is actually the reverse of the 
 truth. We believe that in reality the maximum of 
 injurious quality is reached when a wine of tolerably 
 high natural acidity contains also a considerable amount 
 of sugar. For (1) the dyspepsia, gout, and other 
 symptoms which (putting aside alcoholism) are supposed 
 to be the special results of indulgence in wine, are 
 comparatively uncommon among the European nations 
 who habitually consume the natural acid-tasting light 
 wines in large quantities. (2) We have personally 
 sought in vain for any instance where the moderate use 
 of a really non-saccharine sherry has produced gout; 
 and we strongly suspect that those persons who have 
 fancied that gout was provoked in them by the use of a 
 " dry " sherry were merely judging of the quality of the 
 liquor from its taste, and had really been drinking a 
 sherry the composition of which resembled that men- 
 tioned above. (3) Whatever may be ultimately shown 
 to be the true origin of the gouty and other allied forms 
 of dyspepsia, it can scarcely be doubted that one of their 
 most important phenomena is an interference with the 
 normally rapid rate of absorption of saccharine matters 
 from the stomach, or that the presence of alcohol 
 (especially alcohol of some strength) would increase this 
 delay of the sugar absorption. That under these 
 circumstances fermentative changes, with abnormal 
 formation of acid and irritant matters, would occur in 
 the stomach, seems highly probable. (4) It is very 
 difficult to believe that the trifling proportion of fixed 
 and volatile acids present in any drinkable wine would
 
 22 ON THE USES OF WINES 
 
 be sufficient to disturb digestion save in persons of 
 exceptional sensitiveness ; one lias only to remember the 
 quantities of malic and tartaric acid which every one 
 swallows during the fruit season, and the quantities of 
 acetic acid which even the most modest consumer of 
 pickles, sauces, and salads habitually takes, to perceive 
 how extremely improbable it is that a wine containing not 
 more than 6 per 1,000 total free acids should (from that 
 cause) disturb the digestion of any moderate drinker of it. 
 It is needless to say that throughout the above 
 remarks we are dealing with the case of wines which 
 are fair specimens of their respective classes, and not 
 with those which, whether from careless manufacture, 
 or fraudulent manipulation, depart widely from the 
 standard of sound wines. 
 
 We have spoken of the natural acidity of wines 
 chiefly from the point of view of indicating the limits 
 within which the presence of this quality is not a 
 mark of unwholesomeness in a beverage intended for 
 healthy adults. It would be a serious omission, how- 
 ever, did we not show that the free acids, provided that 
 they are present only in the several proportions which 
 have been already indicated, are far more than merely 
 harmless in their action. 
 
 It is a singular thing that while the tonic powers 
 of mineral acids, as used in medicine, have obtained 
 universal recognition, the no less remarkable tonic 
 qualities of the vegetable acids, which are essential 
 ingredients of a variety of foods which we consume 
 in ordinary life, should have been so slightly dwelt upon ; 
 one can only ascribe the fact to the vicious conventional 
 tradition which habitually separates the action of foods 
 from that of medicines. The value of acetic acid has,
 
 IN HEALTH. 23 
 
 indeed, been practically confessed in the popular use of 
 vinegar as a so- called condiment ; in plain language, 
 a tonic to the function of primary digestion ; and a 
 more profound and important action of this substance 
 on the organism is indicated by the empirical observa- 
 tion of numerous physicians and travellers, that vinegar 
 is an antidote of no mean power to scurvy. An equally 
 decided instinct to that which makes men crave for sour 
 pickles, makes them crave also for sour fruits ; and it is 
 certain that a moderate use of these things powerfully 
 aids primary digestion, more especially in the condition 
 of digestive languor which is apt to prevail during the 
 height of summer weather. Moreover it is probable 
 that malic and tartaric acids, which are the principal 
 representatives of vegetable acid in natural wines, are 
 able to exert a real influence on secondary assimilative 
 processes, since, like acetic and most other vegetable 
 acids, they are converted into carbonic acid in their 
 transit through the body; and the same holds good 
 of that further proportion of these acids which exists in 
 wines under the form of salts. On the whole, however, 
 it may be presumed that the useful functions of such 
 quantities of free acids as are found in natural wines 
 are limited to their tonic stimulant action upon stomach- 
 digestion. And that this must be a powerful action no 
 one will doubt who has systematically observed the 
 effects of acid (but otherwise sound) wine in restoring 
 appetite and digestion from the state of prostration in 
 which they are often left after an acute illness. 
 
 4. Closely connected in the minds of most persons 
 with acidity is the quality of astringeney ; and indeed 
 the latter might be plausibly regarded as a branch of the 
 former subject, since a vegetable acid, the tannic, is its 
 chief cause. But, in the first place, the astringeney of
 
 24 ON THE USES OF WINES 
 
 wines is essentially different from their mere acidity 
 in its effects upon primary digestion; and secondly, there 
 is the important physiological distinction, between tannic 
 and the other vegetable acids of wine, that it does not 
 undergo conversion to carbonic acid within the body. 
 
 To say the truth, tannic acid, with its peculiar so- 
 called astringency, is the real culprit in many cases 
 where a natural red wine of low alcoholic strength is 
 accused of "acidity." The impression of roughness on 
 the tongue is easily confounded with actual sourness. 
 Tannic acid in wines is almost exclusively the product of 
 grape-skins and stones, not of grape-juice. And hence 
 it is only in red wines that it exists in any high propor- 
 tion; the maximum is found in young dark-coloured 
 wines, for in process of time the tannin precipitates 
 along with an albuminoid matter, which is a notable 
 constituent of such wines, especially when they have 
 been only partially fermented. The colouring matter 
 also precipitates with the tannin, and hence an old port- 
 wine becomes " tawny." If any one wants to know 
 what the astringent element of wine is, at its worst, 
 he must taste some of the dark purple wines of the 
 Valais, or of North Italy, quite new. Generally 
 speaking, the tannin element of wine may be said to be 
 neutral as regards its influence on persons in ordi- 
 nary health. But there are wines to be met with, 
 here and there, which when young contain enough 
 tannin to set any ordinary teeth on edge, and to iipset 
 any ordinary digestion. We remember with horror 
 such a liquor which we once drank at a roadside station 
 in crossing the Simplon, and which produced the most 
 violent diarrhoea. This wine, which was a very cheap 
 sort, of a dark purple tint, rough-tasting, but not sour, 
 had probably been fermented not only with the grape-
 
 IN HEALTH. 25 
 
 skins and stones, but also with the fruit-stalks ; and as 
 it was very new, there had been no time for the tannin 
 to deposit. 
 
 On the other hand, the astringent qualities of red 
 wines may become very valuable in certain morbid 
 conditions. But this consideration does not come under 
 our present subject ; and we may take the opportunity 
 here of remarking that a great many erroneous state- 
 ments have been made in recommendation of the highly 
 tannic wines for a daily drink, on account of their 
 "bracing" qualities. It is only in certain limited 
 conditions of disease that the tannic element of wine 
 possesses any value : and it may be feared that doctors 
 have inflicted much useless misery on unoffending 
 persons, who were not ill, but merely delicate, by 
 recommending them to drink repulsive liquids, which 
 turn the tongue to leather, on account of an imaginary 
 " robustness " of the latter. There is no need for this. 
 
 5. "We pass now to the consideration of the salts of 
 wines. The importance of the saline constituents of 
 wine was recognised very early in the history of 
 chemistry ; in fact, the " tartar " of wine was regarded 
 with almost mystic reverence by physicians and chemists 
 from Paracelsus onward, and we see traces of this feeling 
 even in the pages of a sceptical, and for the times 
 enlightened, pamphlet published by " A Fellow of the 
 College," in 1724, and entitled, " The Juice of the Grape, 
 or Wine preferable to Water." Modern physiological 
 chemistry assures us that 'there is a sound basis for this 
 belief in the importance of wine-salts. The combina- 
 tions of alkalies (more especially of potash) with 
 vegetable acids, which every natural wine contains, are 
 of a dietetic value not to be easily overrated ; and in 
 the particular function of warding off scurvy and some
 
 26 ON THE USES OF WINES 
 
 allied diseases of malnutrition, they rise to the highest 
 importance. 
 
 It has been already said that tartaric acid is a pro- 
 minent ingredient in the majority of natural wines ; but 
 it is not only present as a free, acid, but largely also, in 
 combination, as acid tartrate of potash (cream of tartar), 
 and to a smaller amount, as tartrate of lime. There 
 are also chlorides of potassium and sodium, phosphate 
 of lime, and traces of silica and magnesia, besides other 
 occasional salts. The above is a list of the characteristic 
 saline ingredients of wines. 
 
 Among these various saline ingredients there is none 
 other so characteristic of natural and unadultered wine 
 as the acid tartrate of potash ; this is especially the 
 case with the wines of Bordeaux. For instance, of four 
 samples of Bordeaux wine already referred to in a 
 previous paper, we find the total ash (left after evapora- 
 tion, and incineration of the residue) amounted to 
 2-35, 2-08, 2-23, and 2'00 parts per 1,000 respectively; 
 of this total 0-45, 0'66, 0'41, and 0'38 respectively 
 consisted of carbonate of potash, the representative of 
 the tartrate in the wine. In Rhenish wines there is 
 also much tartaric acid, but a larger proportion of it is 
 in combination with lime than with potash. In port 
 wines, when new, there is a high proportion of tartrates, 
 which tend to deposit with age. But in sherries as sold, 
 even when new, there is a remarkable deficiency of 
 tartrates, which requires special comment, because it is 
 not a natural feature of the wine, but a result of a 
 special process of adulteration which is unfortunately 
 universal. Sulphate of lime (in the shape of plaster of 
 Paris) is employed in the manufacture of these wines 
 with a view to precipitate the tartaric acid and the albu- 
 minoid matters ; the result is strikingly manifest in the
 
 IN HEALTH. 27 
 
 character of the ash left by the wine after evaporation 
 and incineration. Of four sherries anatysed the total 
 ash was found to be as much as 4 - 50, 5'15, 5'50, and 
 5-13 per thousand parts respectively ; but of this large 
 ash, only 0'07, O'lO, 0'14, and 0'07 consisted of carbonate 
 of potash, the representative of tartrate in the wine. 
 That means that the wine is by the " plastering " strongly 
 impregnated with sulphate of potash, a serious evil, for 
 sulphate of potash is a very depressing salt, and its 
 effects might materially interfere with the stimulant 
 action of the wine, and doubtless does so, except in the 
 case of the old-bottled sherries, which have counter- 
 balancing virtues of their own, to be presently noticed. 
 It may be said, also, in general terms, that any attempt 
 to rob a young wine of its tartaric acid and tartrates 
 is a mistake of the most serious kind ; for the presence 
 of these substances really tends to keep the wine in 
 good condition, and their premature removal decreases 
 the chance of the liquor keeping well, not to mention 
 that it abstracts a valuable nutritious ingredient for 
 which, in its youth, the wine possesses no compensating 
 advantage. It is to be feared that the same objectionable 
 process of " plastering " is also followed in the case of 
 several Greek wines, since it is difficult, otherwise, to 
 account for the high percentage of sulphate of potash 
 in the ash of these wines, and the low percentage of 
 carbonates. 
 
 On the whole, we are inclined to believe that of all the 
 saline ingredients of wine, the only ones which seriously 
 influence the organism, and possess a real dietetic value, 
 are the tartrates of potash and of lime, and possibly the 
 phosphates of lime. In regard to the phosphates 
 generally, there is one popular delusion much fostered 
 by certain wine-dealers, and unfortunately abetted by
 
 28 ON THE USES OF WINES 
 
 some hasty and ill-considered statements of a chemist 
 of European celebrity, that the presence of these salts 
 gives to wine an exceptional value as a nervine tonic. 
 In reality there is not the least support, in the facts 
 either of physiological chemistry or of clinical medicine, 
 for the theory that salts of phosphoric acid influence 
 the nervous system except in the most indirect manner. 
 It is true that phosphorus is a constituent of the 
 nervous system, and it is probable that phosphates in 
 the excretions are partly due to disintegration of 
 nervous tissue, but there is no proof that phosphates, 
 administered as such, will nourish the nervous tissues ; 
 and, on the other hand, there is a great deal of evidence 
 tending to show that their action is limited to certain 
 changes in the relative proportions of the alkaline 
 constituents of the blood, and in the alkaline consti- 
 tuents of the wine. The phosphate of lime stands on 
 a different footing from the other phosphates; and 
 although the question of its functions within the 
 body is far too elaborate to be discussed here, there 
 is some reason to think that even in small quantities, 
 such as are present in wine, it may prove a valuable 
 agent in assisting the processes of cell-growth in young 
 tissues or in tissues that are undergoing rapid repair after 
 disease or injury. 
 
 Upon a general review of the question of saline 
 constituents of the various wines, there can be little 
 doubt that, in this respect, the varieties which possess 
 the highest merits are, successively, the wines of 
 Bordeaux, Burgundy, the Ehine, and Hungary ; that is 
 to say, among natural wines, which must be the 
 principal subject of our consideration in regard to the 
 use of wines as a daily beverage. 
 
 6. We come now to what is by far the most difficult
 
 IN HEALTH. 29 
 
 and obscure part of the discussion upon wines : the 
 estimate, namely, of the value of their highly charac- 
 teristic secondary elements, which are formed during the 
 period of storage. The chemistry of the subject is only 
 in its infancy, and so much of it as is already made 
 out is by no means easy to explain in brief outline. 
 But the difficulty of application of such chemical facts 
 as are known to the practical selection of wines for 
 dietetic purposes is aggravated by the fact that the 
 question becomes immediately complicated by secondary 
 considerations. In dealing with those elements of wine 
 which have already been discussed, the task was simple, 
 for the very first of these topics that of alcoholic 
 strength introduced considerations which showed that 
 if wine is to be used as a beverage, both temperance 
 and economy most strongly argue that the bulk of the 
 community should limit themselves to the class of 
 natural wines produced under such conditions as enable 
 the cheaper varieties to be relied on as sound, wholesome, 
 and palatable. We have now to deal with properties 
 of wine which can only be legitimately developed by 
 age and careful handling, and must, therefore, involve 
 increased costliness; but which, when developed, 
 have the most valuable effects, not merely in increasing 
 delicacy of flavour, but in fitting the wine to supply, 
 in a very important manner, certain special needs of 
 life. We must, therefore, comparatively disregard 
 questions of economy, and deal with wines from the 
 point of view of a refined, yet not unwholesome luxury 
 on the one hand, and of a cordial, for special emer- 
 gencies, on the other. This greatly widens the field 
 which we have to survey, for without meddling with 
 the strictly medicinal uses of wines at all, we are 
 bound to examine the properties of a variety of wines
 
 30 ON THE USES OF WINES 
 
 especially the fortified kinds), which, as beverages of 
 daily life for healthy adults, we deliberately disap- 
 prove of, or set aside as too expensive for consumers 
 whose income is but moderate. 
 
 These substances of secondary formation are the 
 compound ethers, to which wine of a certain age owes 
 the greater part of its flavour and bouquet, and which 
 have a scarcely less important influence in heightening 
 the quality of the liquor as a stimulant of vital functions. 
 The first of these results is well recognised by connois- 
 seurs, though the most accomplished amateurs are often 
 singularly ignorant of some important features of wine 
 flavour ; the second is most perversely ignored or mis- 
 understood by the majority of medical men in their 
 capacity of instructors of the public. 
 
 When the primary process of fermentation of wine 
 has been brought to a standstill, whether because there 
 is no more sugar to be destroyed, or because there is no 
 more available 1 ferment to carry on the process, there 
 remain in the liquid two kinds of substances alcohol 
 and acid, or rather several alcohols and several acids, 
 which must react upon each other, producing, more or 
 less rapidly and completely, a substitution of compound 
 ethers for the alcohol generated by the primary fermen- 
 tation. The compound ethers are of two kinds, fixed 
 and volatile, and there is a great difference between the 
 importance of the two classes ; according to Dr. Dupre', 
 the fixed ethers have probably scarcely any value 
 beyond the indirect one of neutralizing a part of the 
 acid and facilitating the formation of volatile ethers. 2 
 
 1 We say available, because the albuminoid substance may be only 
 temporarily locked up by other natural constituents of the wine, or by 
 alcohol artificially added. 
 
 * This is probably true from a chemical point of view, but is too 
 absolute a statement, I think, if it be applied to physiological action.
 
 IN HEALTH. 31 
 
 It is the great merit of Dr. Dupre's investigations into 
 the constitution of wines, that he has enabled us to 
 take the first important steps in the appreciation of the 
 relative proportions, as well as the relative merits, of 
 these two classes of compound ethers, and has opened 
 the way for a large amount of promising inquiry into 
 the more obscure questions as to the physiological 
 action of wines. 
 
 If we glance down the tables already referred to, 
 bearing in mind the explanatory directions which 
 accompany them, we note the following capital facts 
 as regards the ethers of the principal European wines. 
 Among the natural wines we find the Hungarian 
 predominant, on the average, in the important merit 
 of excess of volatile over fixed ethers ; but inferior 
 to Ehine and Bordeaux wines in the total amount of 
 ethers. Bordeaux comes next, on the average, in the 
 excess of volatile over fixed ethers, but is somewhat 
 inferior, on the average, to Ehine wine, in total ethers. 
 One specimen of expensive hock (72s. per doz., vintage 
 1862) exceeds any single Bordeaux or Hungarian wine 
 quoted, both in total ethers and in the excess of the 
 volatile over the fixed ; the general composition of this 
 wine is typical of a Jhigh-class. natural white wine 
 thoroughly fermented, and possessing all the best quali- 
 ties of a bottled wine. It is interesting to contrast 
 Greek wine with Hungarian in respect of the ethers ; 
 e.g., in a white Hungarian at 34s. and a Greek at 36s. 
 per dozen, from Dr. Dupre's tables, we observe that the 
 total ethers are about equal, but that whereas in the 
 Hungarian the volatile ethers are largely in excess of 
 the fixed, in the Greek the relative proportions are 
 reversed. The low proportion of volatile ethers in the 
 three samples of Greek wine quoted in these tables
 
 32 ON THE USES OF WINES 
 
 must be considered a not unimportant defect ; and we 
 must here mention another fault of these wines which 
 should have been referred to previously, viz., the 
 high proportion of volatile to fixed acids. We will 
 also notify a further indictment of Dr. Dupre^s against 
 Greek wines, viz., that they frequently contain an 
 appreciable amount of aldehyde, an oxide of alcohol, 
 which, so far as known, is rarely or never present in 
 any wine except when it is about to turn into vinegar. 
 On the other hand, we are bound in fairness to mention 
 that a very distinguished chemist, Dr. Williamson, has 
 recently referred to the presence of aldehyde in these 
 wines as a positive merit. Personally, we must disagree 
 with this verdict, on the double ground that the flavour 
 of aldehyde is, we think, extremely disagreeable, and 
 that this substance is more likely, from what we know, 
 to be injurious than useful as a physiological agent. 
 Without pretending to give a final judgment, or one 
 intended to be universally applicable to Greek wines, 
 we may certainly say that supposing the analyses given 
 in Dr. Dupre's tables to represent at all fairly the 
 average composition of these wines, it would appear 
 that as a class they are rich in promise rather than in 
 performance as yet achieved : since the concurrence of 
 the several peculiarities which have now been named 
 points with much force to the conclusion that, from 
 some reason, the capacity for keeping sound in bottle 
 is defective. On the other hand, we must say that 
 from a recent careful tasting of a number of these 
 wines, we have recognised unmistakable natural vinous 
 quality of a high order in several which are quoted at 
 moderate prices, and we are inclined to believe that as 
 medicinal agents they will be found very valuable. 
 We also rather believe that the defects in keeping power
 
 IN HEALTH. 33 
 
 which seem to be indicated by the peculiarities above 
 mentioned depend solely on imperfections in the present 
 mode of manufacture, and we venture to doubt whether 
 Dr. Dupre's anticipation, that the climate of Greece will 
 not admit of the perfection of wine-making, is just. It 
 would be a thousand pities if a country so rich in 
 capacity for the production of full-bodied and rich- 
 ilavoured natural wines, with an alcoholic strength 
 conveniently intermediate between the wines of France 
 and Germany and the fortified liquors of Spain 
 and Portugal, should prove unable to bring its pro- 
 ducts into the European markets in a state of 
 perfect soundness. At any rate, there is no reason 
 to believe that the experiment has been fairly tried 
 as yet, and we may hope that the same energy 
 which has -done so much to introduce Greek wines 
 to general notice will be successful in perfecting their 
 preparation. 
 
 We turn now to the ethereal constituents of the 
 fortified wines, taking port, sherry, madeira, and 
 marsala as sufficient examples for practical purposes. 
 We at once notice the fact that these wines, as a rule, 
 only very slowly develop any considerable quantity of 
 volatile ethers. From the quantity of alcohol and of 
 acids present in the wine from the first, one would 
 suppose that a large quantity both of fixed and volatile 
 ethers must be formed, but, as a matter of fact, one finds 
 in a port two years in bottle (price 32s.) only 0430 per 
 thousand total ethers as against 0415 per thousand in a 
 thin 12s. claret of the same age ; and, on the other hand, 
 the claret has altogether the advantage as regards volatile 
 ethers, which it contains in the proportion of 0'235 to 
 O'lSO fixed, while the port has 0'302 fixed and only 
 0128 volatile per thousand. The dosing with alcohol 
 
 D
 
 34 ON THE USES OF WINES 
 
 which port undergoes, not merely arrests the primary 
 fermentation processes, but delays indefinitely the vitally 
 important processes of etherifi cation. Even so old and, 
 in many respects, splendid a wine as the port of 1851 
 does not contain quite so much volatile as fixed ether, 
 though the total amount of ethers is high. The wine of 
 1842, on the other hand, yields a very high total per- 
 centage of ethers, of which a rather larger part is volatile 
 than fixed. This is a magnificent wine as regards 
 every item of its composition, and where it has been 
 judiciously kept is still in first-rate order. The alcoholic 
 strength is only 18 per cent., and there are but 
 130 grains of sugar to the bottle; the wine also 
 still contains a high proportion of tartrates, as is 
 evident from the ash. The wine of 1851 is yet 
 more moderate in alcoholic strength (15 per cent.), 
 contains also a high proportion of tartrates, but 
 has the advantage, or disadvantage, according as 
 we take it, of containing more sugar, viz. 235 grains 
 to the bottle quite enough to make this delicious 
 drink a gout-provoker for predisposed persons ; in- 
 deed even the '42 wine will sometimes act in that way. 
 
 On.e has been accustomed, of late years, to hear port- 
 wine abused with indiscriminate vehemence, and there 
 can be little doubt that in its young and rough state it 
 is a barbarous drink, however much its most objection- 
 able features may be disguised by the presence of 
 sugar and spirit. Put aside the question of expense, 
 however, and it is simply dishonest to deny that port- 
 wine can be procured which represents nearly all the 
 elements of a fine wine at their best ; and for certain 
 special purposes to be named presently it is as singularly 
 useful as it is undoubtedly agreeable to a refined palate. 
 
 Marsala, which is easily and cheaply procured in
 
 IN HEALTH. 35 
 
 sound condition, is a really fine wine in many ways. 
 A very old wine of this sort was found to contain a 
 high total percentage of ether, of which, however, the 
 fixed were still in excess of the volatile. Marsala is free 
 from the defects of " plastered " wines. 
 
 The case of sherry is singular among fortified wines, 
 and affords a good instance of the way in which a 
 popular cry confounds things which are utterly distinct 
 in one condemnation. At the present moment there are 
 hundreds of persons who imagine that all sherry is, 
 from first to last, a coarse sophisticated drink, of the 
 same general character and strength as port, and like it 
 to be utterly repudiated by reformers in wine. Doubt- 
 less sherry has the fault of being universally fortified ; 
 and it is also mischievously affected by the "plastering" 
 already mentioned. But, on the other hand, it is 
 remarkable that in sherries, from an early period, a 
 high proportion of volatile ethers is developed; and 
 an expensive bottled sherry of the 1857 vintage men- 
 tioned in Dupre's tables presents about the highest de- 
 velopment of this quality which it is possible to find in 
 any wine. There is no reason, then, that even a young 
 sherry (two years in bottle), if genuine, should not 
 present the most important characteristics of a well- 
 made wine; while, as regards the older specimens, 
 analysis fully confirms the opinion which, personally, 
 we have long entertained that of all the strong wines 
 there is none to compare, either in generous character 
 or in delicacy of flavour, with a really fine old bottled 
 sherry. We shall revert to this point when we speak of 
 the employment of the stronger wines in the treatment 
 of disease ; at present we must introduce some remarks 
 on special dietetic uses to which the more potent wines 
 are particularly adapted. 
 
 D 2
 
 36 ON THE USES OF WINES 
 
 And first, as regards the infancy of delicate children. 
 Of all the subjects on which conventional morality 
 has talked pernicious nonsense, there is none upon 
 which, in a small way, it has done more decided 
 mischief. The worthy teetotallers have easily enlisted 
 the sympathies of persons whose experience of the 
 management of children was limited, when they have 
 declaimed against the practice of " rearing drunkards 
 from the cradle," &c. &c. ; and it is, of course, quite 
 possible to do even so dreadful a thing as this. But 
 the judicious use of wine as a part of the diet even of 
 quite young children (of course always under medical 
 sanction) is entirely free from such dangers, and, on the 
 other hand, may do positive good of a very visible kind. 
 The cases in which it is useful (we are now talking of 
 children not absolutely diseased) are, (1) those where a 
 tendency to wasting is very marked, i.e. where children 
 are very apt, without positively seeming ill, to run 
 down suddenly in flesh, with or without simultaneous 
 failure of appetite ; and (2) those where trifling 
 catarrhal affections are very easily caught, and very 
 slowly shaken off. We are firmly convinced that 
 multitudes of such children have been allowed to slide 
 into confirmed ill-health, and then into organic disease, 
 who would have done perfectly well had such symptoms 
 as the above been attended to by the administration of 
 wine. Now the right way to deal with children about 
 wine is precisely the reverse of the plan which is 
 appropriate for adults. The latter should be advised to 
 take wine only with their meals, and the problem, 
 therefore, is to find for them a light natural wine which 
 may safely be used as a beverage. With children, on 
 the contrary, it is much better to give wine at separate 
 hours, as if it were strictly a medicine ; and the potent
 
 IN HEALTH. 37 
 
 wines, disguised and made somewhat disagreeable by 
 the addition of bitters, are much the best : for example, 
 a teaspoonful of sherry or port made up to a tablespoon- 
 ful with strong infusion of gentian, which might be 
 given three times a day to a child of three or four years 
 old; or even double this quantity may sometimes be 
 advantageously given. But the point which we wish 
 to dwell on more particularly here is the superiority of 
 sherries to all except the most recherche kinds of port 
 for this kind of purpose. The improvement of appetite 
 and nutrition, which is sometimes marvellous in young 
 children who have been put on an allowance of wine, is 
 never observed in so striking a degree as after the 
 administration of wine containing a high proportion of 
 volatile ethers. Even a common 30s. sherry, such as 
 any respectable wine-merchant will supply, is more 
 highly gifted in this particular respect than any port 
 which is within the reach of ordinary purchasers. It is 
 therefore a point of much consequence that in pre- 
 scribing wine as supplementary food for children whose 
 parents are not wealthy we should recommend sherry 
 rather than port. Sherry is also markedly superior to 
 marsala for this purpose. 
 
 Used under the precautions above given, not merely 
 is there no danger of wine corrupting children's tastes, 
 but the services it renders to health are more important 
 than those of any medicine with which we are ac- 
 quainted ; indeed, it is just in the cases where medi- 
 cines would disorder the stomach and aggravate the 
 child's malaise that wine plays the most remarkable 
 dietetic role. 
 
 As a dietetic aid in the debility of old age the more 
 potent wines are even more remarkably useful than in 
 infancy and childhood. More particularly in the
 
 38 ON THE USES OF WINES 
 
 condition of sleeplessness, attended often with slow and 
 inefficient digestion, and a tendency to stomach cramps, 
 a generous and potent wine is often of great value. It 
 is not desirable for such persons to include a large 
 allowance of fluid in their daily diet, and their alcohol 
 may well be taken in the more concentrated forms. 
 Moreover, the fine volatile ethers which develop in well- 
 kept old bottled port and sherry have an extraordinary 
 influence in heightening the stimulant and tonic influence 
 of alcohol. But in this category sherry^is to be reckoned 
 as a much more convenient agent than port, because we 
 are able to get the specific effects of the volatile ethers 
 at a much more reasonable price in the case of the 
 former than of the latter wine. 
 
 One very important effect of the highly etherized 
 wines, which are at the same time of rather high 
 alcoholic strength, is their power to produce tranquil 
 and prolonged sleep in aged persons. Supposing that 
 we allow an aged person eight ounces (four glasses) of 
 sound sherry for total daily alcoholic allowance, then we 
 shall afford him the maximum of comfort by ordering 
 that half this quantity shall be taken, with some light 
 food, at his supper hour. Considering how simple 
 a prescription this is, it is surprising how often its value 
 is ignored by medical men, though the popular custom 
 of a "night-cap" of toddy for old people, even when 
 they have been little accustomed to alcohol in their 
 younger days., shows the existence of a need for some 
 agent of this kind. Plain alcohol is, however, a much 
 less efficient hypnotic, unless taken in objectionable 
 quantities, than the highly etherized wines; and no 
 spirit, except the finest and most expensive old cognac 
 or rum, approaches good sherry in this kind of value. 
 In all probability it is precisely the ethereal constituents
 
 IN HEALTH. . 39 
 
 of such old bottled spirits which give them their 
 hypnotic and calmative power over the nervous systems 
 of the aged. 
 
 We here conclude what we had to say about the 
 dietetic use of wines by healthy persons. It was never 
 our intention to dwell in detail upon the merits and 
 demerits of individual wines, except as they fall into 
 main groups which illustrate leading dietetic rules. It 
 was our object to lay down certain great principles 
 which ought to govern the selection of wines for daily 
 use, and especially to show how wine might be made 
 the wholesome beverage of ordinary life rather than 
 a dangerously seductive luxury, leading easily to mis- 
 chievous excess. We have purposely abstained from 
 dwelling upon such wines as fall merely within the 
 category of luxuries for occasional indulgence; but 
 some of them, which are either too expensive, or in 
 other ways objectionable for daily consumption, will 
 find an important place in the remarks which we shall 
 have to make in Part II. on the use of wines in disease. 
 For the present we may be content with the following 
 summary of the points we desire to insist upon : 
 
 1. Wines for daily use by healthy adults should not 
 on the average contain more than 10 per cent, absolute 
 alcohol : 8 or 9 per cent, is better. 
 
 2. If wine be used as the daily drink, it is best, as far 
 as may be, to use only one kind at a time, and no other 
 form of alcoholic liquid. 
 
 3. Sound natural wines are to be obtained at the best 
 economic advantage from the Bordeaux district; the 
 red wines are to be preferred. 
 
 4. Ehine wines (white) are equally excellent, but 
 more expensive.
 
 40 ON THE USES OF WIXES 
 
 5. Hungarian wines are also, in many instances, 
 excellent, but are at present too dear for daily use 
 except by the rich. They are also unequal in quality, 
 owing to defects of manufacture. 
 
 6. Greek wines labour under the same defects : under 
 the latter, especially, in an aggravated degree. 
 
 7. The fortified wines, as a class, develop no proper 
 vinous qualities till they have been for some years in 
 bottle. Sherry, however, is greatly superior to the other 
 wines of this class in the rapidity with which it 
 develops the volatile ethers. 
 
 8. Fortified wines in small quantities, especially 
 sherry for the reason just named, are the appropriate 
 stimuli of certain kinds of infantile and youthful 
 debility, and of the enfeebled nervous system of old 
 persons. 
 
 Finally, we may add a few words in correction of a 
 statement which by ambiguity of phraseology, may lead 
 to misunderstanding. We did not intend, when recom- 
 mending the "hard-working student" to allow himself a 
 bottle per diem of weak Bordeaux wine, to give that 
 recommendation to young lads. We were thinking of 
 "hard-working students" of middle age; and we would 
 state our very firm conviction, that for youths (say 
 ' under 25) whose bodily frame is as yet not fully 
 consolidated, the proper rule is, either no alcohol or very 
 little indeed. 
 
 From the time of puberty onwards, there arises a 
 much greater susceptibility to the injurious influences 
 of alcohol upon the emotions and the character; and 
 between the date of puberty and the age of 25, or even 
 30, it would be better, in ordinary cases, either to 
 abstain altogether, or to limit the allowance to one-
 
 IN HEALTH. 41 
 
 third or one-half the amount above named. Still, there 
 can be no question that to many rapidly-growing 
 lads an amount of alcohol (preferably as beer) strictly 
 limited to these latter quantities, is not only harmless 
 but most actively useful.
 
 PAET II. 
 
 ON THE USES OF WINES IN DISEASE. 
 
 SECTION I. WINES IN ACUTE DISEASES. 
 
 THE questions which we have to discuss, in consider- 
 ing the uses of wines in disease, are much more nume- 
 rous and difficult than those which we dealt with in 
 speaking of wine as a beverage in health ; and if we 
 expend comparatively fewer words in discussing them, 
 this will arise from the fact that our knowledge is here 
 very much less extensive and accurate, so that we can 
 but present an imperfect outline of the subject. We 
 believe, however, that some important principles, which 
 have never as yet been expressly laid down, may be 
 gathered from a systematic study and arrangement of 
 the facts already known to practical physicians. 
 
 We propose first to deal with what is by far the 
 most important portion of the therapeutics of wines ; 
 the use, namely, of these liquors in acute diseases. 
 A few preliminary words are necessary, in order to 
 define the class of maladies which we include under 
 this title. 
 
 Acute diseases, as we understand the word, are 
 affections in which danger to life, or notable damage 
 to tissue, is rapidly produced ; or in which, at any
 
 ON THE USES OF WINES IN DISEASE. 43 
 
 rate, marked and characteristic trains of symptoms are 
 quickly set up. They are divisible into two chief 
 groups, as regards their relation to alcoholic treatment, 
 viz. the febrile and the non-febrile. 
 
 1. The febrile acute diseases include the exanthemata 
 and the other epidemic fevers, and also the acute 
 inflammations, whether primary or supervening on in- 
 jury or surgical operation, or complicating a previously 
 existing disease. 
 
 In commencing the discussion of the use of wines in 
 febrile acute disease, it is necessary to say a few pre- 
 liminary words as to the circumstances which induce 
 us to prescribe alcohol at all in such maladies. Not 
 to occupy space with unnecessary detail, we may say 
 broadly that the combination of high temperature, 
 especially when persistent, with delirium or other 
 evidences of nervous prostration, great rapidity with a 
 high degree of dicrotism of the pulse, and especially a 
 tendency of the latter to become unrhythmical in such 
 a manner as to show rapid and irregular changes in the 
 force, of the heart-beats all these strongly indicate the 
 use of alcohol, and when they manifestly diminish 
 under the influence of our first experimental doses we 
 are confirmed in our opinion. Again, there is a class 
 of inflammatory affections, chiefly represented by pneu- 
 monia and bronchitis of the aged, in which all the other 
 symptoms above mentioned may be present without the 
 high temperature ; in these cases also alcohol is strongly 
 indicated. The safest guide beyond comparison to the 
 use of alcohol in all acute diseases is the condition of 
 the pulse ; the existence of marked dicrotism with great 
 rapidity, especially when combined with any irregularity, 
 is a far truer indication than any consideration derived 
 from the stage at which the illness has arrived.
 
 44 ON THE USES OF WINES 
 
 With regard to most of tlie acute febrile diseases, it 
 may be said that alcoholic liquids are to be prescribed 
 primarily, if not only, for the sake of the alcohol which 
 they contain ; the only other points of consequence 
 being that the other ingredients of the liquor shall be 
 harmless to digestion. For the most part, then, we 
 shall simplify matters by ordering plain spirit properly 
 diluted with water in these cases ; and the use of wines 
 is unnecessary. This is especially the case where the 
 febrile temperature runs high persistently during seve- 
 ral days ; and, generally speaking, in the early stages of 
 severe pyrexia which is to last for some time. The 
 distinctive uses of wine in acute febrile disease are of a 
 different order, and may be divided under two heads. 
 The ethereal constituents of wine have a special value 
 in the later stages of severe febrile disease with great 
 exhaustion of the heart, especially when combined 
 with sleeplessness. On the other hand, a low alcoholic 
 strength of wine, together with the presence of carbonic 
 acid, as in the finer effervescing wines, is particularly 
 useful in cases where the violence of the fever, the 
 nervous prostration, and the derangement of digestion 
 are out of proportion to the gravity of the case as 
 regards danger to life and continuous destruction of 
 tissue. 
 
 (1.) A most important and too little recognised 
 distinctive indication for the highly ethereal wines is 
 to be found in the condition of cerebral and cardiac 
 exhaustion which is so well seen, for instance, in the 
 third and fourth weeks of a severe case of typhoid fever. 
 Here the chief danger unquestionably arises from the 
 weakness both of the nervous and muscular forces 
 of the heart. The special combustive processes have 
 for the most part spent their force; the danger is
 
 IN DISEASE. 45 
 
 from the failure of the heart. Under these circum- 
 stances we shall, I believe, do best by throwing aside 
 brandy, unless we can procure the most recherchd kinds, 
 which are rich in ethers, and betaking ourselves to the 
 use of the finest old port or sherry, or to some of the 
 more excellent qualities of Bhenish or Hungarian wines. 
 From six to twelve ounces per diem of fine old sherry, 
 or from eighteen to twenty-four ounces of the Hungarian 
 wine known as dry Euster, given in divided doses at 
 intervals of half-an-hour, affords the ideal stimulant 
 required under the circumstances ; it is surprising how 
 rapidly this treatment at the same time restores strength 
 and regularity to the heart's action, and calms the 
 nervous system, so as to allow of sweet and restorative 
 sleep. It is useless here to think about cost ; the very 
 finest wine that can be procured for money is just that 
 which will procure the effect we desire with the least 
 possible delay. The physicians of the Westminster 
 Hospital have had abundant opportunities of observing 
 the effects in such circumstances of a very splendid old 
 sherry, of which the late Duke of Northumberland 
 presented a large quantity to the hospital ; and for our 
 own part we are convinced that the influence of such a 
 liquor is something entirely distinct from that of its 
 mere alcohol. 
 
 Another instance of acute disease in which profound 
 exhaustion threatens a disastrous failure of the heart, is 
 that form of insanity known as acute delirium. We 
 can hardly express too strongly our sense of the supe- 
 riority of highly etherized wines to merely potent 
 alcoholic liquids in these cases. We have been informed 
 by alienist physicians, whose larger experience only 
 confirms our own, that the calming and reviving in- 
 fluence of such wines as we have just referred to is of
 
 46 ON THE USES OF WINES 
 
 inestimable value. In such cases there is commonly no 
 very great elevation of temperature ; but every one who 
 has seen much of this terrible form of disease must be 
 aware with what alarming rapidity the nervous system and 
 the heart succumb. It is by no means always necessary 
 to give large quantities of the stimulant. Sometimes a 
 very few glasses will suffice to restore the patient to a 
 condition in which he becomes willing to take those 
 supplies of food which are of the first importance for 
 his safety ; and, above all, the efficacy of this treatment 
 in inducing sleep is of the utmost consequence to the 
 patient. In short, though alcohol as such seems to have 
 little influence over the progress of these cases, it is 
 quite different with the effect of wines of the highly 
 etherized class. It is not asserted for a moment that 
 their effect is specific; like everything else, they will 
 often fail to do good ; but it may safely be said that, 
 with the exception of food, chloral, and occasionally of 
 bromide of potassium, nothing offers so good a prospect 
 of success. 
 
 The general result to which the best observation we 
 have been enabled to give to this subject during a good 
 many years of special study has led us, is as follows : 
 We believe that the administration of potent alcoholic 
 liquids is especially appropriate to the period of severe 
 and persistent febrile disturbance in fact, to the early, 
 or at any rate the middle period of acute febrile disease ; 
 and that if this treatment be judiciously adopted, the 
 ultimate stage of cardiac exhaustion is often mitigated 
 or entirely prevented. But if once this stage of ex- 
 haustion be reached, we believe that the largest doses of 
 alcohol as such will be unable to restore the flagging 
 power of the heart; whereas a wine of comparatively 
 feeble alcoholic strength, but rich in volatile ethers, will
 
 IN DISEASE. 47 
 
 often prove marvellously efficacious in sustaining the 
 nervous power of the heart till its enfeebled muscular 
 tissue shall have had time to repair itself. 
 
 (2.) There is a very different set of circumstances in 
 which febrile symptoms may call for the administration 
 of wine ; viz. the catarrhal inflammations, the ephemeral 
 form of catarrhal fever, and the true contagious influenza : 
 in all these wine is not unfrequently useful, but we are 
 convinced that the week effervescing kinds are the really 
 valuable form, while the more strongly alcoholised 
 varieties as often do harm as good. 
 
 To take first the case of catarrhal inflammations : it 
 is possible, we believe, to establish an ascending scale 
 of suitability for wine treatment. Catarrhal inflam- 
 mations of the stomach rarely either call for, or tolerate, 
 alcohol in any shape : but occasionally when they occur 
 as part of a general catarrhal affection which involves a 
 considerable amount of prostration, a moderate quantity 
 of sparkling wine may be given with advantage. 
 
 Somewhat more frequently is this kind of wine useful 
 in the catarrhal diarrhoea the acute intestinal catarrh 
 of summer and autumn. In the majority of such 
 cases no alcohol is required ; the patient needs only to 
 limit himself for a short time to a system of eating very 
 small quantities of food (not necessarily mere slops) at 
 short intervals, and preserving rigidly the recumbent 
 posture. If any irritating food requires removal from 
 the bowels a mild rhubarb purge will be useful ; and 
 if any further medication by drugs be found necessary, 
 opium, with or without mineral acids, will commonly 
 do best. But if the diarrhoea obstinately continues for 
 several days, as is especially apt to occur when the 
 patient cannot keep the recumbent posture, but must 
 move about more or less, then the greatest benefit will
 
 48 ON THE USES OF WINES 
 
 often result from putting him upon a ration of ten or 
 twelve ounces of champagne daily, discontinuing all 
 medicines. If the patient can afford it, some good 
 turtle-soup is an excellent addition to this fare. 
 
 Still more marked is the good effect of light effer- 
 vescing wine in that form of epidemic catarrh which is 
 accompanied with low inflammation and ulceration of 
 the throat, and which is apt to assume an epidemic 
 type. The patient cannot bear to swallow solid food : 
 yet he often gets low and depressed under even the 
 most continuous feeding with milk, beef-tea, &c. ; while 
 on the other hand strong wine or brandy frequently 
 proves heating, and increases his discomfort. Here 
 champagne to the extent of a pint bottle per diem often 
 most materially assists recovery, and, what is scarcely 
 less important, it greatly relieves the sense of depression 
 and misery. 
 
 There is a form of ephemeral catarrhal fever which 
 may attack any one, but to which certain individuals 
 are especially liable ; it may be induced, apparently, by 
 almost anything which greatly depresses the nervous 
 system, but its access is commonly precipitated by 
 catching a chill, though the latter may be very slight. 
 In such persons the attack is often attended for a day, 
 or for two or three days, with such a considerable febrile 
 heat as to alarm the bystanders, and to suggest the idea 
 that one of the more serious fevers or inflammations is 
 about to declare itself. The writer has had considerable 
 experience of the treatment of this affection, and can 
 assert, with much confidence, that it may be very 
 effectively dealt with by a treatment consisting simply 
 of, (a) perfect rest in bed, (&) a diet exclusively of milk, 
 which may be drunk ad libitum, and (c) an allowance 
 of a pint of light champagne in the twenty -four hours ;
 
 IN DISEASE. 49 
 
 and this is the plan we would generally recommend. 
 A single dose of opium at the very outset of the 
 symptoms may sometimes arrest the attack altogether ; 
 but if this fails it is best to dispense with medicine 
 altogether, and simply follow the above directions. 
 
 Not less effective is this kind of treatment in many 
 cases of true contagious influenza ; but where the disease 
 is very severe, and threatening to life from acute chest 
 complications, it may be necessary to feed generously 
 with soup, and to allow eggs and brandy freely. 
 
 We desire to call attention to what seems a very 
 important distinction between the kind of pyrexia which 
 distinguishes the severe contagious fevers and the severe 
 tissue-inflammations, and that which attends a large 
 number of catarrhal affections. We believe that, where- 
 as in the former group of cases the elevated axillary 
 temperature, the flushed face, and sensibly burning skin 
 are a true index of greatly heightened combustion-pro- 
 cesses within the body, in the latter they are commonly 
 in great part due to an altered temperature distribution, 
 owing to more or less generalised paralytic dilatation of 
 the peripheral arterioles and capillaries. If this be true, 
 it has a most important bearing on the question of the 
 administration of alcohol. Large amounts of the potent 
 alcoholic liquids are, we believe, only required in those 
 cases where there is evidently an amount and kind of 
 pyrexia which can only be due to greatly increased 
 processes of tissue-waste, or enormous cell-formation, or 
 both. We do not mean to say that even here we would 
 counsel any routine employment of alcoholisation : here 
 as elsewhere, we would make the quality of the pulse, 
 and its behaviour under experimental doses, and above 
 all, the appearance or non-appearance of unchanged 
 alcohol in the urine, the true guide to practice. But in 
 
 E
 
 50 ON THE USES OF WINES 
 
 the catarrhal fevers and inflammations, where we believe 
 that the apparent elevation of temperature is so often 
 deceptive, we recommend the use of alcohol, when it 
 needs to be used at all, only in such small quantities 
 and such a diluted form as to act mainly as a modifier 
 of sensation and brain-function, relieving the tendency 
 to cerebral stupor, and the painful aching of limbs, &c., 
 which are so common ; and for this purpose the effer- 
 vescing form is especially adapted. 
 
 It is quite otherwise, again, in the true tissue inflam- 
 mations, which tend to the formation of lymph and of 
 pus within the substance of organs. Here, also, there 
 is no routine principle for or against the use of alcoholic 
 liquids ; each case must stand upon its individuality : 
 but the cases that do call for these liquids demand them, 
 we believe, fort he sake of their alcohol; and conse- 
 quently there is no advantage in the use of wine over 
 tiiat of spirits, but rather the reverse, at any rate in the 
 acute stages. According to the most recent information 
 we must at least provisionally believe that alcohol 
 subserves a double purpose in acute inflammations 
 (a) that it tends to check excessive combustion of tissues, 
 and (6) that (as Binz shows) it checks the migration of 
 blood-corpuscles through the vascular walls. It is only 
 in the latter and exhaustive stages of inflammations, 
 especially of such as tell heavily upon the heart, that 
 we find an indication for the highly ethereal wines : we 
 may especially mention rheumatic pericarditis in this 
 category. We shall not easily forget the remarkable 
 effects which we saw in one particular case of this kind 
 from the administration of a fine old Ehenish wine, 
 highly charged with ether, and of magnificent odour; 
 the feeble rapidly-flickering heart came back to a 
 comparatively strong and steady beat, and the irrit-
 
 IN DISEASE. 51 
 
 ability of intense nervous prostration was wonderfully 
 calmed. It is needless to say that for such a purpose 
 as this no crude or unduly acetous wine can be toler- 
 ated; it would be the worst economy not to give the 
 best that money can procure. 
 
 Before we conclude this present paper we must add a 
 few words that should have been said above, respecting 
 the administration of champagne in the catarrhal fevers 
 and inflammations. The wine itself should be chosen 
 with great care : it should have not above 6 or 7 per 
 cent, of absolute alcohol, and at the same time be very 
 dry ; the presence of any considerable amount of sugar 
 makes champagne quite unfit for the stomach of a 
 fevered patient. One " pint " bottle will contain about 
 6 drachms absolute alcohol in such a wine as we are 
 now recommending. We recommend that not more 
 than half a champagne-glassful be given at once ; but 
 if the patient likes to fill up the glass with seltzer-water, 
 and sip it more slowly, he can do so. It is a decided 
 mistake to over-ice the champagne, but it should be 
 moderately iced in summer weather. In temperate 
 weather it should not be iced at all, but simply kept in 
 a cool place, in water. 
 
 2. We come now to the subject of wine-treatment in 
 the non-febrile acute affections. In this group we in- 
 clude (1) the occurrence, from any cause, of haemorrhage 
 to such an extent as to constitute of itself a rapid 
 danger to life ; (2) the acute neuroses ; (3) the condition 
 of shock-collapse, whether from extreme emotion, from 
 violence, or from severe surgical proceedings. 
 
 (1.) Before we discuss the relations of wine to in- 
 dividual varieties of haemorrhage, let us try to lay down 
 certain broad principles as to the indications and contra- 
 indications of alcoholic liquids generally, in cases of 
 
 E 2
 
 52 ON THE USES OF WINES 
 
 dangerous bleeding. Now there are two objects with 
 which we may give alcohol in dangerous haemorrhage 
 either we may desire to stimulate a heart which is in 
 danger of stopping from syncope induced by excessive 
 aneemiation of the nervous centres, or we may hope to 
 produce contraction of the relaxed peripheral vessels, 
 and thus directly assist the efforts of nature to arrest the 
 bleeding. And there are likewise two corresponding 
 dangers in the use of wine ; for on the one hand v/e may 
 over-irritate the heart and cause such an increase of the 
 force and rapidity of the circulation as may increase or 
 renew a bleeding which tended to spontaneous arrest, or 
 on the other we may overshoot the intended effect upon 
 the peripheral vessels, and induce paralytic dilatation 
 instead of contraction of the latter. To take first the 
 case of threatened syncope, it may be at once admitted 
 that a certain amount of severity of this symptom forms 
 a positive indication for alcohol which over-rides every 
 theoretic objection, because the danger is not merely 
 that of suddenly fatal heart-stoppage, but also of a more 
 gradual and more deadly arrest of the cardiac pulsations 
 by the formation of coagnla within the pulmonary 
 artery a peril which reaches its maximum in subjects 
 whose blood, from any cause, is hyper-fibrinous. Putting 
 aside the case of great syncopal tendency, however, it 
 may be said that on the whole the balance is heavily 
 against the use of alcoholic stimulation in acute haemor- 
 rhages generally. And further, it may be laid down as 
 a general principle that the danger from exciting too 
 violent cardiac action is greatest in cases where the 
 haemorrhage either comes from organs like the lungs 
 which are anatomically near to the pulsating centre, 
 or from a large artery in any part of the body, especially 
 if there be reason to think that the vessel is diseased.
 
 IN DISEASE. 53 
 
 There remains, however, a not inconsiderable class of 
 cases in which the tendency to haemorrhage is mainly 
 due to, or its dangerous continuance is mainly kept up 
 by, a relaxed and atonic condition of the smaller arteries 
 and the capillaries ; a condition which is perhaps most 
 frequent and most prominent in the menorrhagic dis- 
 charges of women of lax fibre, and in the intestinal 
 haemorrhages of typhoid patients of a similar con- 
 stitutional type. 
 
 In considering the special uses of wines in acute 
 haemorrhage, we must keep in mind the distinction 
 between (a) effects intended to be produced on the 
 heart, and (b) effects intended to be exerted on the 
 peripheral vessels. 
 
 (a) In regard to the heart, there are two kinds of 
 indications which may decide us in the first instance to 
 give alcohol, and then to select certain wines as the 
 appropriate form. 
 
 In the first kind there is so large a loss of blood, 
 either absolutely or relatively to what the patient can 
 afford to lose, that the nervous centres are drained of 
 blood and force to a degree that immediately threatens 
 life. Here, though wines may be useful, it is chiefly on 
 account of their alcohol, and only the more potent kinds, 
 in large dose, can avail to meet the danger. We need 
 hardly mention the case of enormous postpartura 
 haemorrhage, which is so familiar; there is scarcely a 
 practitioner who has not once or twice in his life seen, 
 with amazement, women of temperate habits swallow as 
 much as half-a-pint or a pint of brandy or a 
 bottle of port under such circumstances, without the 
 least intoxication, and with the sole result of a resur- 
 rection from almost absolute death. It is difficult to 
 explain these remarable effects on any other theory than
 
 54 ON THE USES OF WINES 
 
 that of an enormously rapid oxidation of the alcohol, 
 and consequent development of nervous and muscular 
 force available for the desperate needs of the organism. 
 
 A second variety of quasi-syncopal cases is, we believe, 
 essentially different in its indications, as it certainly is 
 in many outward features. Everyone has seen and 
 recognised the above mentioned cases of extreme and 
 sudden ansemiation, with dead greyness of the face, faint 
 indigo coloration of the lips, restless jactitation of the 
 limbs, and slow flickering pulse collapsing at the lightest 
 finger-touch. There are fewer, perhaps, who have 
 adequately recognised another group of hsemorrhagic 
 cases, in which the heart is also deeply involved, but in 
 another manner. In these patients, of whom much the 
 greater number are women, both pulse and countenance 
 might readily deceive a careless observer as to the 
 source of mischief, for the complexion is not steadily 
 pale, but changes from red to white, or even, in some 
 cases, scarcely suggests the idea of pallor at all. The 
 peculiarity of the case is, however, best marked by the 
 state of the pulse, which is very rapid, and apparently 
 still of considerable volume. It has occurred to our- 
 selves to hear such a pulse described as " bounding ; ' 
 but strict attention (even without the use of the 
 sphygmograph) will detect that the beats are more or 
 less unrhythmical, and that the artery is easily com- 
 pressible. Now the tendency of these cases, we venture 
 to believe, is very different from that of the last 
 mentioned kind ; and the danger is not so much of 
 positive arrest of the heart's action, as of serious 
 occurrences on the side of the nervous system. Instead 
 of the generally diffused exhaustion of the nervous 
 centres which is indicated in the more ordinary cases of 
 acute haemorrhage, by simultaneous disturbance of
 
 IN DISEASE. 55 
 
 consciousness (without insensibility), and a tendency to 
 general "jactitation" (slight clonic convulsions), there 
 is here a tendency to convulsions of an epileptoid 
 character, sometimes so like true epilepsy as to be 
 undistinguishabie from it. Before we discuss the 
 pathology of these cases, which is a doubtful matter, 
 we will say, with more confidence, what is their appro- 
 priate treatment; for upon this point there are con- 
 siderable grounds for forming a distinct opinion. We 
 believe that any large doses of alcohol, especially in the 
 more concentrated forms, are likely to be productive of 
 nothing but mischief. Unlike the case of true epilepsy, 
 where a stiff glass of spirit and water (though a most 
 unadvisable remedy) has nevertheless indubitable power 
 to stop or modify an impending fit, these semi-hysterical 
 cases are seriously complicated by narcotic inebriation, 
 and in every way made worse, by the adoption of any 
 such treatment. It is quite otherwise, however, with 
 the effect of such a stimulant as a glass of light cham- 
 pagne; the reviving effect of this upon the nervous 
 system at once exerts a remarkable steadying influence 
 on the circulation, calming and at the same time 
 fortifying the heart's action. It must be understood 
 that we do not recommend this treatment for hysterical 
 states, with rapid and irregular pulse, which are twt 
 dependent on haemorrhage; the cases are essentially 
 different. What is the real pathological import, then, 
 of the cases we have just been considering ? We can 
 make no more than a strong guess, and it is this : that 
 the patients whom we have now described are for some 
 reasons probably of inherent constitution more 
 liable than others to break-down of the functions of the 
 medulla oblongata, and that the phenomena observed 
 are in fact the result of the influence of haemorrhage
 
 56 ON THE USES OF WINES 
 
 upon the vagus and vaso-motorial centres which the 
 medulla contains, the rest of the nervous centres 
 remaining comparatively unaffected. It is but a specu- 
 lation, certainly, but at present we can suggest no other 
 explanation of the facts; and on the other hand, the 
 effect of a slight but rapidly-acting stimulant like 
 champagne upon the vagus and vaso-motor centres 
 might well be expected to exercise the calmative and 
 regulating influence on the circulation which it appears 
 actually to produce ; and at the same time to avert the 
 tendency to epileptoid convulsion. 
 
 (&) In what regards the possibility of producing a 
 beneficial increase of tone in the peripheral vessels, by 
 means of the use of wine, and so helping the natural 
 arrest of passive haemorrhage, we are able to say but 
 little in the way of exact indications. It is doubtful, 
 even, whether the peculiar ingredients of wine offer 
 any additional advantage, in this respect, over merely 
 alcoholic liquids. The most remarkable instances of 
 this kind are shown in the occasional effect of stimulants 
 in checking menorrhagia which is not dependent on 
 positive organic disease, but rather on want of tone of 
 the uterine vessels, and it is well to note a broad and 
 decided distinction between the proper method of admin- 
 istering stimulants in these cases, and that which obtains 
 in the case, which might at first sight seem analogous, 
 of post-parturn haemorrhage. The principal machinery 
 of arresting bleeding in the latter case is contraction of 
 the uterine walls, and very large quantities of alcohol 
 may be useful, and even absolutely necessary, for this 
 purpose. It is otherwise with the passive haemorrhage of 
 the non-impregnated uterus ; here we apply the stimulus 
 rather to the vessels themselves ; and it behoves us to 
 be careful that we do not overshoot the mark, and
 
 IN DISEASE. 57 
 
 produce narcotic dilatation, instead of tonic contraction 
 of the arterioles and capillaries ; nor is it common to 
 find that large doses are of any advantage on the 
 contrary, they usually do harm. In such cases the 
 remedy should be used in a careful and tentative man- 
 ner, and the sphygmograph might be advantageously 
 employed to test its effects upon arterial tone. If the 
 signs of increased tension coincide with diminution of 
 the haemorrhagic tendency we have the happiest evidence 
 that the alcohol is doing good. It is advisable, in such 
 cases, to employ the more potent wines, in small doses 
 (half an ounce), five or six times a day. 
 
 (2.) The acute neuroses frequently call for the admin- 
 istration of alcohol, and in a good many cases wine is 
 preferable to any other form. Of these the most con- 
 spicuous example is unquestionably afforded by severe 
 infantile convulsions. It is needless to say that in the 
 majority of such affections some source of peripheral 
 irritation forms an important factor in the malady, and 
 that the removal of this, when possible, above all things 
 demands our attention. Sometimes, indeed, the mere 
 removal of the irritation at once subdues the convulsions ; 
 this is most frequently seen where gastric or intestinal 
 irritation is present. But we must remember two things : 
 first, that convulsion does not follow peripheral irri- 
 tations, unless these are very severe, except in subjects 
 whose nervous system is in a state of morbid irritable 
 debility; and secondly, that the continuance of con- 
 vulsion may produce irreparable mischief before we can 
 thoroughly remove the peripheral irritation. In the 
 convulsions of dental irritation, for instance, we are 
 now aware that such local remedies as gum-lancing are 
 seldom of any avail, the real source of mischief being 
 the compression of the trigeminal nerve-fibres by the
 
 58 ON THE USES OF WINES 
 
 tight packing of the growing teeth in the jaw. Under 
 these circumstances our true resource is in brain stimu- 
 lation; and incomparably the most effective stimulant 
 for the purpose is a tolerably potent wine which is also 
 rich in volatile ethers. No medicine can effect half as 
 much good as port or sherry of good age and keeping ; 
 the latter is the more accessible, and our own experience 
 leads us to rely upon it with implicit confidence. For 
 infants under one year, half teaspoonful doses should be 
 prescribed every half hour till the symptoms begin to 
 decline ; and it is seldom indeed that this result is not 
 produced in a short time if the treatment be steadily 
 pushed. Still more necessary is this kind of stimulation 
 when from improper feeding the infant has been 
 practically starved, and the irritability of the nervous 
 system thereby indefinitely heightened. 
 
 Another case of acute neurosis in which the value of 
 the potent and also highly etherised wines can hardly 
 be over-rated, is the acute form of chorea which threatens 
 life, and which in so many instances actually does prove 
 fatal. Here there is very often a tolerance for large 
 doses which is extraordinary, and so long as we keep 
 below the line of narcotism, and administer the stimu- 
 lant with regularity and watchfulness, there is no need 
 for timidity as to quantity ; the danger is pressing, and 
 a very large total daily allowance may be absolutely 
 necessary. Unquestionably, however, a vigilant dis- 
 crimination must be made between different patients, 
 for whereas the naturally feeble and anaemic patients, 
 especially when the attack has been precipitated by 
 severe emotional shock, almost universally require the 
 free use of wine, there is a smaller group in whom 
 constitutional and nervous debility has a much smaller, 
 and some functional irritation a much larger share;
 
 IN DISEASE. 59 
 
 and these are often more amenable to the influence 
 of bromide of potassium than to that of wine. The 
 occasionally severe chorea of pregnancy is an example 
 of this class, and also the acute chorea sometimes 
 produced by excessive masturbation. 
 
 As regards tetanus, the question of alcohol treatment 
 may be said to be in a transitional state. The free use 
 of alcoholic stimulation might have been fairly said, 
 ten years ago, to offer by far the best chance to the 
 patient, and in fact many recoveries took place under 
 this treatment. Certainly it was far better than the 
 unlimited use of opium, or of chloroform, which were 
 much the commonest methods. At the present moment, 
 however, several new remedies are putting forward higli 
 claims to confidence in tetanus : of these Calabar bean, 
 nicotine, and ourara are supported by a mass of import- 
 ant testimony, and a certain amount of evidence exists 
 in favour of chloral. Personally, we are inclined to 
 believe most strongly in nicotine, and next to this in 
 Calabar bean, and at the present moment we should 
 certainly try one or other of these, in preference to 
 alcoholic stimulants. 
 
 The case of delirium tremens may be mentioned here 
 only to repeat the emphatic protest which we have 
 always made against the employment of alcohol at all, 
 except in rare instances of thoroughly broken-down 
 old drinkers. We are not at all sure that even this 
 qualification will not soon be rendered altogether un- 
 necessary. 
 
 Very acute neuralgia may sometimes appear to 
 demand the use of alcohol ; and the power of alcoholic 
 stimulants, especially of good sherry, to relieve such 
 pain is an unquestionable fact. But there are the 
 gravest moral objections to such an employment of
 
 60 ON THE USES OF WINES 
 
 alcohol, and in fact the only case in which we should 
 be inclined to recommend its use is that of angina 
 pectoris threatening life. Even here sulphuric ether or 
 nitrite of arnyl are far better remedies. If wines are 
 used, they should be of the highly ethereal kinds. 
 
 To conclude what we had to say on the use of wines 
 in acute neuroses, let us insist for a moment on the 
 distinction between their case and that of the chronic 
 neuroses. Alcohol, whether as wine or in any other 
 form, is employed in the former case to save life, or for 
 some other grave emergency. In chronic nervous 
 diseases this excuse does not exist ; and on the other 
 hand, as we formerly attempted to show, 1 the tempta- 
 tions to alcoholic abuse are exceptionally great. 
 
 (3.) We have next to consider the state of nervous 
 shock-collapse in relation to the use of wine ; the 
 condition in question may be caused either by violence, 
 by some surgical operations, or by extreme emotion ; in 
 either case its essential features are the same. The 
 pulse is small and also soft, and is usually irregular in 
 force .or in rhythm, or both ; the skin is cold, the pupils, 
 more frequently than not, dilated, and always markedly 
 inactive. Consciousness may be variously affected, up 
 to entire insensibility, and down to a mere apathetic 
 condition, with scarcely any loss of intelligence. We 
 would draw attention to the fact that this state is 
 decidedly different from another with which it is often 
 confounded, and which is perhaps the most ordinary 
 result of mental shock ; in the latter there is first of all a 
 condition of distinct rigor, followed by palpitation, flush- 
 ing of the face, violent and irregular pulse. The two con- 
 ditions are not only physiologically but therapeutically 
 
 1 Vide Practitioner, July, 1869, "Indiscriminate Stimulation in 
 Chronic Disease."
 
 IN DISEASE. 61 
 
 distinct ; and although the depression may seem equally 
 in the last case as in the first, we must not allow our- 
 selves to be deceived. In the case of true shock-collapse 
 the great object must be to rouse the attention of the 
 brain, so to speak ; and for this purpose the strongest 
 stimulants, in concentrated form, are the best. Brandy 
 diluted with only an equal quantity of water is the most 
 suitable remedy ; and if it cannot be swallowed it should 
 be given in the shape of enema ; but even here it would 
 be a great mistake to suppose that enormous quantities 
 of alcohol would be beneficial. On the contrary, in 
 common with the two other great members of the 
 anaesthetic group of narcotics chloroform and ether 
 alcohol in decidedly narcotic doses is singularly de- 
 pressing in shock-collapse, 1 though less so than either of 
 the other two; and we may here remark that there 
 is then no such insensibility to its narcotic influence as 
 in the depression produced by haemorrhage only. In 
 shock-collapse it is best to give an ounce dose of half- 
 and-half brandy and water every fifteen minutes, and a 
 very few doses are all that are useful ; the rest of the 
 work must be done by such stimulations as surface-heat, 
 friction, &c., and advantage must be taken of the earliest 
 opportunity to administer food, if the patient be in a 
 state of fast. 
 
 It is quite otherwise with the state of shock-depression 
 that commences with a sudden rigor, followed by quasi- 
 hysteric reaction. However alarming the depression may 
 seem, alcohol is not the best remedy. Sulphuric ether 
 given by the stomach if it can be borne, or in extreme 
 cases injected into the rectum, is at once more effective, 
 
 1 We have elsewhere expressed our belief that this state is the 
 only condition which truly centra-indicates chloroform anaesthesia in 
 patients who are at all fit to bear an operation.
 
 62 ON THE USES OF WINES 
 
 and greatly less objectionable than alcohol; it is at 
 once a stimulant and a regulator of cardiac action, and 
 in milder degree of the whole cerebro-spinal nervous 
 system. 
 
 Forty-minim doses may be given by the mouth (in 2 
 oz. of acacia mixture), or 60 minims may be injected per 
 anum, suspended in 3 ounces of mucilage. Camphor, in 
 5-grain doses, is the next best remedy for this state. 
 
 SECTION II. WINES IN CHRONIC DISEASE. 
 
 THE final section of our subject concerns the employ- 
 ment of wines in chronic diseases a theme so extensive 
 that it is difficult to select the points which may be 
 most advantageously brought together within the 
 compass of a paper of moderate length. The best 
 division of the subject that suggests itself to our mind 
 is the following: 
 
 1. Wine in debility, produced by failure of primary 
 digestion. 2. Wine in defective conditions of the blood 
 such as anaemia, chlorosis, hydrsemia, &c., not yet com- 
 plicated with tissue-change. 3. Wine in phthisis, and 
 in the wasting diseases of childhood. 4. Wine in 
 chronic neuroses of the aged. 5. Wine in exhausting 
 mucous discharges. 6. Wine in chronic suppuration. 
 
 1. In a large number of persons debility is mainly 
 caused by a failure of primary digestion: the first starting- 
 point may have been either of several occurrences, but 
 the main fact is that the patient does not digest, even if 
 he still swallows, a sufficient quantity of nutriment ; very
 
 IN DISEASE. 63 
 
 commonly, too, the evil reacts upon itself, and persistent 
 under-nutrition brings about a notable impairment of 
 appetite, or even a positive disgust for all food. 
 
 It must be understood that cases of the class 
 we refer to are not always distinguished, in the first 
 instance, by loss of appetite; indeed there are some 
 patients who from first to last take a fair quantity of 
 food, though they fail to make use of it in the organism. 
 And on the other hand there are plenty of cases 
 of failure of primary digestion, where anorexia is from 
 the first a conspicuous symptom, but in which the ad- 
 ministration of alcohol in any shape would be a grave 
 mistake. Among these we may, perhaps, include the 
 majority of chronic catarrhal affections, but of course 
 most especially that variety of gastric catarrh which has 
 itself been provoked by alcoholic excess : here no treat- 
 ment will be anything but mischievous which does not 
 include a complete abstinence from alcohol. On the 
 other hand, the absence of well-marked catarrhal 
 physical signs (e.g. in the appearance of the tongue) by 
 no means certainly contradicts the notion of alcohol as 
 perhaps the cause of dyspepsia : we occasionally see a 
 drunkard with a perfectly clean tongue. 
 
 Chronic gastric catarrh, arising as an apparently inde- 
 pendent affection, and not linked (as it often is) to 
 chronic diseases of some other viscus, is probably always 
 caused by improper food or drink, or else by the same 
 kind of exposure to weather, &c., which might produce 
 an ordinary chronic nasal or bronchial catarrh. It is 
 consequently but very rarely a fit subject for alcoholic 
 treatment : but if ever such treatment be found abso- 
 lutely necessary from the general state of health, a 
 very light effervescing wine, free from sugar, or ex- 
 tremely weak brandy and soda-water, is the only form
 
 64 ON THE USES OF WINES 
 
 which should be allowed. A single glass of strong 
 wine or spirit may undo the work of months of 
 treatment. 
 
 There are, however, a considerable number of cases 
 of dyspepsia, to which there is a tendency, at present, to 
 give the title of catarrhal, simply on the ground that 
 the dyspepsia and want of appetite are accompanied by 
 a certain amount of apparent enlargement of the tongue, 
 and exhaustion of its epithelium, with perhaps a few 
 red points near the tip ; but in which the original cause 
 of the mischief is, in truth, nothing but nervous depres- 
 sion. For such cases as these a fixed moderate allowance 
 of a generous wine is very helpful. When we can 
 distinctly make out from the history that the patient 
 has not exposed himself to the effects of improper 
 food or drink (very often such people have been too 
 abstemious in every way), or other ordinary causes of 
 stomach catarrh, we may very properly employ a wine of 
 good body and medium alcoholic strength. For an adult 
 man, six to eight ounces per diem of a Beaune (Burgundy) 
 of about 14 per cent, absolute alcohol, or four ounces for 
 an adult female, will be very useful : and for the same 
 purpose we may recommend several of the stronger red 
 Hungarian wines, and the Greek wine known as red 
 Kafesia. The chief requisites in wine, for this purpose, 
 seem to be (a) medium alcoholic strength, and (&) good 
 original vinous flavour ; and it does not appear requisite 
 that the qualities of very old wine should be present. 
 A moderate amount of astringency perhaps may increase 
 somewhat the good effects of such wines upon the 
 appetite ; but anything like a highly tannic wine 
 will rather disgust, and may also cause troublesome 
 constipation. 
 
 "While maintaining however, that many such dyspeptic
 
 IN DISEASE. 65 
 
 patients, with pseudo-irritant symptoms, are really 
 benefited by wine, we must insist that the quantity be 
 strictly restrained to the limits above mentioned, and 
 also that it is very necessary to inquire whether the 
 original depression did not arise mainly from neglect of 
 ordinary food. Dr. Blandford has recently pointed out * 
 the great mischief that is often done to the nervous 
 system by the bad custom of many hard-working 
 merchants to pass a long day from breakfast to late 
 dinner without food ; and we may lay it down as very 
 certain that the dyspepsia, which is a prominent feature 
 in such cases, should be encountered, in the first place, 
 rather by increased quantities of suitable food than by 
 alcohol. 
 
 (2.) The use of wines in conditions of blood which, 
 whether in the form of simple anaemia, chlorosis, or 
 general hydraemia, indicate above all things a deficiency 
 of the all-important red corpuscles, is by no means a 
 simple matter. Practically we may clear the ground 
 somewhat by laying down, as a fact, demonstrable from 
 large and general empiric experience, that anaemia 
 resulting from haemorrhage nearly always does require 
 and is immediately benefited by the use of alcohol ; 
 and that this is much best given in the form of full- 
 flavoured and potent wine. For such purposes, full- 
 bodied port wine of moderate age, but retaining much 
 of the richness of its original flavour, is decidedly the 
 best agent : and we may venture to administer it 
 with considerable freedom (e.g. 12 to 16 oz., or 6 to 
 8 small port glasses, for an adult), on the condition that 
 we never produce symptoms of narcosis. It will 
 be found that these quantities are often well borne at 
 
 1 " On the Value of a large Supply of Food in certain Nervous 
 Diseases ; " Practitioner, July, 1870.
 
 66 OX THE USES OF WINES 
 
 first, but they must be rapidly and steadily reduced as 
 the patient's condition improves, and as he becomes 
 more sensitive to the action of alcohol. 
 
 It is much more difficult to say whether, or how 
 much alcohol ought to be given in cases of anaemia 
 which verge towards the chlorotic type. As a general 
 rule we strongly object to its use in this form of blood- 
 weakness, for we have found it complicate matters by 
 increasing the headache and distaste for food, without 
 really advancing the blood-regeneration in the slightest 
 degree; moreover wine has a tendency to make this 
 class of patients more hysterical and self-indulgent than 
 they otherwise would be. Exception, however, must be 
 made for the case of rapidly advancing chlorosis of a 
 dangerous type, with profound melancholy : here the 
 use of stimulants, and especially of generous port wine, 
 is often our most valuable resource; although it can 
 only divert the course of disease, and give breathing 
 time to allow of the effectual use of tonics, food, and 
 hygiene. 
 
 Again, there is a class of anaemic cases in which the 
 true source of mischief is nothing more than neglect of 
 bed, coupled or not with anxiety and worry of mind. If 
 this neglect of rest be inevitable, from the press ot 
 necessary work, then, imperfect as the remedy may be, 
 we believe that alcohol must be allowed, and that pretty 
 freely. It must never be forgotten that rest, and not 
 alcohol is the true remedy. Nevertheless we are quite 
 certain that it is an error to suppose that alcohol does 
 nothing more than enable such persons to use up their 
 brain tissue faster, and thus get more work out of them- 
 selves for the moment : we cannot doubt that it affords 
 substantial assistance, whether by the production of 
 brain-force, or possibly by aiding the nutrition of nervous
 
 IN DISEASE. 67 
 
 tissue. Only it must always be remembered that the 
 repair of all tissues is far more effectually provided for 
 by periods of rest from strenuous exertion, allowing time 
 for the more slowly convertible elements of food to have 
 their full effect. 
 
 As regards the condition of hydrsemia, general 
 poorness of blood in all solid ingredients, which is so 
 strikingly seen in sundry chronic visceral diseases, we 
 believe that no absolute rule as to the use of alcohol 
 can be laid down, some such patients appearing to bear 
 stimulation very badly. In the great majority of such 
 cases, however, it is quite necessary, and the main 
 point is to employ it in that form which will exert the 
 maximum good influence upon appetite and digestion. 
 For this purpose we have always found the greatest 
 effectiveness in port or sherry, or marsala ; and it is 
 desirable to choose a wine not so old as to have lost 
 its original flavour. Sherry of moderate age contains 
 this last qualification with a fair development of the 
 volatile ethereal ingredients ; and these are a very useful 
 element, more especially when the patient is restless and 
 sleepless. 
 
 (3.) The question of alcohol in phthisis of adults is 
 hotly disputed : on the one hand, many authorities 
 maintain that it is an unmixed evil ; on the other hand, 
 the treatment possesses numerous advocates, and we 
 even meet with records (by Flint and others) of patients 
 almost exclusively nourished upon an alcoholic diet for 
 prolonged periods, with apparently very beneficial effect. 
 This subject has engaged our particular attention, and 
 without expressing a very confident opinion, we have 
 good grounds for believing that the following is a near 
 approach to the truth. There are two classes of cases 
 in which alcohol appears to play an important part in 
 
 F 2
 
 68 ON THE USES OF WINES 
 
 the arrest of phthisis. In a class of patients who have 
 delicate skins and perspire very freely, and with whom, 
 at the same time, oil and fatty matters habitually disagree 
 (a not very common combination of conditions, but 
 one which is seen in a certain number of instances), we 
 have more than once seen remarkable effects produced 
 by the entire abandonment of all medication, and the 
 employment of large doses of spirit whisky or rum ; 
 \and a singular point in these cases was the tolerance of 
 alcohol that was shown, even from the first. It is a 
 singular sight to observe a delicate and habitually 
 abstemious person taking ten or twelve ounces of rum a 
 day as coolly as if it were the most customary thing ; 
 yet that was the allowance consumed by a patient of my 
 own, and with the exception of a fair amount of milk 
 it was almost his sole nutrition during many months, in 
 the course of which the most threatening symptoms of 
 the disease, especially the signs of commencing softening 
 had entirely disappeared. 
 
 Even where the patient, however, is not affected in 
 the peculiar way above indicated, and where he is able 
 to take a fair amount of fatty and other nutrient matters, 
 there is an important use for alcohol in certain contin- 
 gencies, though we believe that it should be excluded from 
 the routine of his daily life. We refer to the occurrence 
 of hectic and other symptoms of acute softening : and 
 we hold that there is a great want of discrimination in 
 the way in which wine treatment is often recommended, 
 or forbidden, by authorities in these cases. Our own 
 experience has led us to believe that the question must 
 here be judged, just as we have proposed that it should be 
 judged in cases of acute disease, experimentally. In 
 each case the effects of experimental doses upon the 
 form of the pulse-wave, and on the temperature, and
 
 IN DISEASE. 69 
 
 the elimination of alcohol by the kidneys, should be 
 carefully tested ; and according to what we have noted 
 in observing a large number of cases, we are justified in 
 believing that when alcohol reduces temperature, and 
 the dicrotions of the pulse, and fails to pass away in 
 notable quantity by the kidney, it always does good ; but 
 that the slightest degree of narcotic action of alcohol 
 is decidedly harmful. We do not doubt that it is to the 
 results of such narcotic action that some physicians 
 refer, when they say, as a very able physician said to us 
 the other day, that " alcohol was murder in phthisis." 
 As regards the form of alcohol to be employed, we 
 believe that the main thing to be considered is the 
 patient's fancy, as this will very generally indicate the 
 proper forms of stimulant. Only, we ought to be careful 
 to know the alcoholic strength of the liquor, whatever 
 it be, and we ought to be sure that the wine is free from 
 acetous decomposition. 
 
 Among the wasting diseases of childhood there are 
 a variety of conditions in which the judicious use of 
 alcohol is invaluable ; and here the stronger wines are 
 invariably to be preferred, especially sherry. We have 
 already referred to the use of small quantities of sherry 
 in the case of children who, without manifesting any 
 signs of positive disease, show a marked tendency from 
 time to time to run down suddenly in flesh. But wine 
 has a much more positive value in infantile wasting 
 which is the expression of a serious constitutional vice. 
 Among the conditions of this kind we may especially 
 notice the scrofulous and the rickety forms of disease, 
 and beyond all, well-pronounced tabes mesenterica. It 
 is rather remarkable that the evident superiority of steel 
 wine to other ferruginous preparations, in the majority 
 of these cases, has not led to a more general consideration
 
 70 ON THE USES OF WINES 
 
 of the probability that the vinous part of the medicine 
 goes for much in its effect upon the organism. Our 
 own attention was principally called to the use of wine 
 in infantile marasmus by the pre-eminent efficacy of 
 the vinum ferri ; and since that time we have very often 
 made the experiment of relying on wine without the iron. 
 The results have been excellent ; and in studying the 
 matter as closely as we could, we have been led to the 
 conviction that it is principally by fortifying the functions 
 of primary digestion that the remedy produces its good 
 effects. It is now our invariable custom to commence 
 the treatment of all cases of tabes by prescribing a fixed 
 allowance of sherry (given as medicine preferably, with 
 the addition of a vegetable bitter) at the rate of from 
 one to two ounces per diem. Nor does it make any 
 difference whether the case be complicated with diarrhoea 
 or not, only in the latter instance there is nearly always 
 additional reason for strengthening the function of 
 primary digestion, and wine is especially useful ; though 
 it is needless to say that careful avoidance of food that 
 is difficult of digestion is an essential condition of 
 success. In rickets, again, a diet composed entirely of 
 cream, milk, and bread, with the addition of some 
 phosphate of lime, and the allowance of sherry just 
 mentioned, affords, probably, all the assistance that 
 nature can receive from art in rectifying the faulty 
 nutrition of the body, except in the way of general 
 hygienic regulations. But it is especially in warding off 
 true tuberculosis from children that the value of wine is 
 conspicuous ; and were this more generally recognised* 
 we believe that phthisis of children, instead of being so 
 fatal a disease as it is, would rarely develop in a fatal 
 form at all; of course supposing that all proper hygienic 
 precautions were adopted, and especially a liberal supply
 
 IN DISEASE. 71 
 
 of simple and nutritious food. But we repeat here 
 what we said in another place : wine should always be 
 given to young children in the form of medicine, and 
 not as a beverage at meals : since it is important not 
 to set up a liking for it which, when the child arrives at 
 the critical period of puberty, might have an unfortunate 
 influence on the further development of the emotional 
 and sensual part of his nature. 
 
 (4.) Certain chronic neuroses of the latter part of life 
 present special aspects in which wine becomes an im- 
 portant consideration. We refer especially to that 
 exceedingly severe and intractable form of neuralgia 
 (most commonly facial) which is rarely or never developed 
 until after the age of forty ; and which, once developed, 
 resists remedies with such pertinacity. We are not 
 quite so helpless against this terrible malady, it is true, 
 as we formerly were; in particular it may be said that 
 galvanism now appears to offer great chances of sub- 
 stantial relief. Still the misery which these neuralgias 
 inflict, and the extent to which they shatter the system, 
 is deplorable under the best of circumstances ; and we 
 need eveiy helpful adjunct we can get. The reflex 
 irritation which the disease sets up is often fatal at 
 once to appetite and to sleep ; and wine is. the true 
 remedy for this part of the mischief. In elderly persons 
 we have not to apprehend the same mischief to character 
 which is so great a danger when alcohol is prescribed 
 with freedom for the chronic ailments of those who have 
 not yet passed the "grand climacteric;" and we have 
 personally seen cases in which, when the stomach would 
 retain scarcely anything else, it was quieted, and the 
 patient's strength was admirably husbanded and fortified, 
 by an almost exclusively alcoholic diet twelve to 
 eighteen ounces of sherry per diem continued for several
 
 72 ON THE USES OF WINES 
 
 days. The older the wine, the more endowed with 
 ethereal ingredients, the more effective is it for this 
 purpose. Still we have seen patients greatly benefited 
 by large doses of spirit which was practically little more 
 than alcohol. 
 
 (5.) The employment of alcoholic drinks in cases of 
 chronic mucous discharges e.g. chronic catarrh of 
 bronchial or nasal mucous membrane, chronic leucor- 
 rhcea, &c., is a very doubtful matter. That they frequently 
 relieve the sensations of depression and discomfort 
 which these affections cause is unquestionable, and in 
 the case of the chronic bronchial catarrh of the aged it 
 may be that they are indispensable. As regards the 
 commonest of all chronic mucous discharges leucor- 
 rhcea we have long been learning, with increasing 
 strength, to believe that the treatment is almost un- 
 mixedly mischievous; at any rate that alcohol ought 
 never to be prescribed, whatever the apparent degree 
 of depression, save in very small quantities of wine, 
 preferably claret, Hungarian Carlowitz, or some of the 
 rough red Greek wines, taken with meals to assist 
 appetite and stimulate primary digestion. The true 
 remedies are local astringents and the free application 
 of cold water, combined with the most persevering use 
 of exercise in the open air. And alcohol offers the 
 most serious temptations to women suffering from the 
 deadly languor often associated with profuse leucorrhcea, 
 temptations which they would do well never to face. 
 
 There is a particular use of alcohol, however, in one 
 form of chronic catarrh, viz., the chronic pseudo-dysentery 
 of young children, which is really of high value. 
 Directly astringent medicines are of almost no use in 
 these complaints; and the only drugs that should be 
 employed are ipecacuanha, with or without very small
 
 IN DISEASE. 73 
 
 quantities of opium. But a slightly astringent red 
 wine of fair alcoholic strength often is very useful. And 
 here we have much pleasure in saying that some of the 
 Greek wines, of which we have been rather sparing of 
 praise in other relations, fill an important place. They 
 have the requisite body, they have a useful degree 
 of astringency, and they have an alcoholic strength 
 conveniently intermediate between the lighter natural 
 wines and the strongly fortified ports, sherries, and 
 marsalas. Three table-spoonfuls a day, for a child of 
 three years old, is a fair allowance. 
 
 We hasten to conclude this imperfect sketch of the 
 use of wines in chronic diseases by a few words on what 
 is perhaps the most important part of the subject, viz., 
 wine in the treatment of chronic suppuration. There 
 are at least two objects which alcohol can achieve in this 
 state, and they are of so great consequence that the judi- 
 cious use of this remedy is frequently decisive in averting 
 serious and even fatal results. In the first place, there is 
 every reason to think that the free (but non-narcotic) em- ^ 
 ployment of alcohol checks both the migration of white 
 corpuscles and all the subsequent movements which go 
 to the formation of pus; and if it be true, as some 
 suppose, that pus cells are also formed from the division 
 of the elementary tissues, there can be little doubt that 
 this process also would be checked by the treatment. 
 On the other hand, alcohol, especially when given in 
 the form of stout or port-wine, marvellously sustains 
 and fortifies the appetite and the primary digestion. 
 The prompt limitation of chronic suppurative processes 
 is by no means to be thought of with our present 
 knowledge as a mere beneficial check upon the morbid 
 action which is directly exhausting the bodily forces. 
 It is all-important, because we have to dread absorptive
 
 74 ON THE USES OF WINES IN DISEASE. 
 
 infections, and the appearance of the true and almost 
 necessarily fatal tuberculosis. How powerfully this 
 argument ought to weigh with us is sufficiently apparent 
 if we consider the case of chronic empyema, and the 
 miserable frequency with which it is followed by fatal 
 phthisis. The prompt evacuation of the pus, even in 
 cases of large chronic abscess, if it were supplemented 
 by proper local measures for cleansing the cavity, and 
 excluding fermentative processes, would far more 
 frequently be followed by cure than is now the case, 
 if it were associated with the intelligent use of alcohol. 
 The copious, and even reckless, administration of stimu- 
 lants is perhaps common enough ; but this is often mere 
 waste. The patients will bear and require more alcohol 
 than in health : but there is no need for any great 
 excess. The simultaneous use of alcohol and of quinine, 
 according to the principles laid down by Binz, offers the 
 true solution of the matter. From three to six wine- 
 glasses per diem of port, each glass containing one 
 grain of quinine, is, we believe, incomparably the best 
 form of administration to employ in all these cases. 
 But even here we must insist that it is absolutely 
 necessary to judge by results, and to scrupulously reduce 
 the allowance of wine the moment that even the 
 slightest symptoms of narcosis present themselves. 
 
 LONLlON: R. CLAY, SONS, AND TAYLOR, PRINTERS
 
 THE 
 
 CALIFORNIA WINE COMPANY, 
 
 OFFICE, No. 68, WATER STREET, 
 
 ONE DOOR BELOW CONGRESS STREET, 
 
 BOSTON. 
 
 CELLARS IN WAVERLEY BLOCK, CHARLESTOWN DISTRICT. 
 
 T. S. MITCHELL, Agent. 
 
 J^titi fag |j*nmssion 10 
 
 BENJAMIN F. STEVENS, President, New England Mutual U 
 Insurance Co., Boston. 
 
 THEODORE METCALF, Druggist, 39, Tremont Street, Boston. 
 . WM. B. MACKIE, M.D., 675, Tremont Street, Bostvn. 
 JOHN G. WEBSTER ( Webster and Co.), Boston. 
 
 WINE LIST. 
 
 HOCK. 
 
 'GOLDEN GATE." 
 SANTA ROSA." 
 
 YO SEMITE." 
 ' YOUNTVILLE." 
 
 SWEET WINES. 
 
 "ASTORIA." 
 "SIERRA NEVADA." 
 MUSCAT ALEXANDRIA 
 " MIRROR LAKE." 
 RIESLING. 
 
 CLAKET 
 
 MUSCATEL. "HENRIQUITA." 
 
 TOKAY. j "ST. HELENA." 
 
 BRANDY 
 
 wines are selected express 
 quality 
 
 . 
 
 Our wines are selected expressly for those who require a genuine article of good 
 uality, and are supplied us by a leading wine grower in Napa County, California, 
 ho acquired a thorough knowledge of the business on the Rhine. They have good 
 
 e, delicate bouquet and flavour, and are considered by connoisseurs equal in all 
 espects to the finest imported wints. We particularly recommend them to 
 
 ysicians who, more than any other class, know both the importance of such 
 
 ine and the difficulty of obtaining it, and invite them to call and examine the 
 me. 
 
 Our Brandy is strictly genuine, distilled from wine, of good sge and fine quality. 
 H of which we offer low both in wood and glass.
 
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