Alcohol: A Dangerous and Unnecessary Medicine, How and Why Part 22

"A consideration of the pathology of this disease does not properly come under this head, but we wish simply to call attention to the well-known fact that typhoid fever is a germ disease. The germ which causes this fever has generally been supposed to be the bacillus of Eberth. More recent bacteriological studies rather indicate that the bacillus coli may also cause the disease. These germs are usually carried into the body in food or drink, and, lodging in the small intestines, begin to grow and multiply, and by their life produce poisonous ptomaines which are absorbed and carried by the circulation to all the organs and tissues of the body.

"It is these ptomaines, thus carried to all parts of the body, that are largely the immediate cause of the pyrexia and attending symptoms. The organisms which produce these poisons for the most part remain in the intestines, although they have been found in the spleen.

"The indications for treatment are:--

"1. To remove or destroy the cause (to eliminate the germs and ptomaines from the body).

"2. To sustain the vital and resisting powers of the patient.

"If the patient is seen early in the disease, it has been my practice to immediately put him to bed and give a free dose of magnesium sulphate. This is preferably given in the morning or forenoon, and may be repeated once or twice on successive days.

Besides this the patient should have a large enema of water at a temperature of from 75 to 80 F.; and this may be repeated daily or even oftener, for some time, if necessary, to keep the bowels empty of the poisonous substances.

"The salines and enemas thus used carry out bodily a large number of germs and ptomaines that are present in the intestines; and further, the salines, by producing an increased secretion of the mucous membrane of the intestines, tend to disentangle and set free many of the germs that have found a lodging place in the walls of the intestines.

"For the elimination of the ptomaines which have been absorbed into the circulation and carried to the tissues, nothing is better than the internal use of water. From three to five pints should be drunk during every twenty-four hours. It should be taken in small quant.i.ties--six to eight ounces every hour or two during waking hours, except when food is taken. I will refer to this point more in detail later.

"A consideration of the general care of the patient properly comes under the second head of the indications for treatment as given above. The patient should be put to bed in a large, light, well-ventilated room. At least two sides of the room should communicate directly by windows with out-of-doors, in order that the room may be properly ventilated.

"All unnecessary articles of furniture, such as carpets, couches, upholstered chairs, pictures, etc. should be removed.

"The room should be thoroughly cleaned before the patient is put into it.

"There should be two beds in the room for the use of the patient. These should be, preferably, narrow and so placed in the room that there is a free approach to both sides of the bed, for the convenience of the nurse in giving treatment. Iron bedsteads are preferable to wooden. The bedding should be firm, yet soft and smoothly drawn. There should be just sufficient covering to protect the body. The patient should be changed from one bed to the other daily. This may be done by placing the two beds side by side and carefully moving the patient from one to the other. The sheets on the bed from which the patient has been taken should be washed and disinfected at each change of the beds, and all other bedding should be thoroughly aired and exposed to the sunlight daily.

"The patient should have the care of a thoroughly educated, careful and competent nurse, one who understands perfectly the various methods of using water in the treatment of fevers.

"There is no other single remedy that I consider so valuable in the treatment of fever as the internal use of water. As above stated, the patient should drink six or eight ounces every hour during the waking hours, except for about two hours after food is taken. The water should be thoroughly sterilized, and as a rule may be taken either cool or hot. Ice water is objectionable. Hot water is often preferable. This is a simple remedy, but nevertheless is efficacious. It should be given to the patient whether he calls for it or not, and it should be considered an important part of his treatment. When water is taken into the stomach and absorbed into the circulation, it throws into solution the ptomaines which have been absorbed from the intestines and are present in the circulation and tissues, and thereby puts them in a favorable condition for elimination.

It increases the activity of the kidneys, and thus hastens and increases the elimination of the poisons in the system.

"In the early stage of the fever, when the pulse is full, and the action of the heart increased, it is best to give the patient cool water. Later in the disease, when the action of the heart is weak, and the patient feeble, it is best to give the water hot.

"Winternitz, many years ago, demonstrated that hot water taken into the stomach acts as a cardiac stimulant, and the increased heart's action is immediate, or at least before the water has time to absorb, which indicates that the water in the stomach acts reflexly as a cardiac stimulant. The water after absorption also increases the circulation by filling the blood-vessels, and increasing arterial pressure. The writer has frequently noticed a decided increase in the fullness, and rapidity of the pulse, after a patient has drunk a gla.s.sful of hot water.

"The external use of water also forms an important part of the treatment. The patient should be sponged off with tepid water every hour or two when the temperature is 103, or above. When the temperature is less than this, it is not necessary to sponge the body so frequently. Sometimes a hot sponge bath is more efficacious in reducing the temperature than the tepid or cool bath. The sponge bath reduces the temperature, relieves many of the distressing nervous symptoms, is refres.h.i.+ng to the patient, and promotes sleep. The temperature of the body may also be reduced by the use of cool compresses placed over the abdomen, and changed frequently.

"The matter of diet is an important factor in the treatment of typhoid fever. The diet should be aseptic, easily digested, and should contain the necessary food elements. Probably no one article of diet meets all these requirements as well as sterilized milk. The patient should take from two to three pints daily. The milk is best taken four times during the day at intervals of four hours, taking eight to ten ounces at a time.

Should the patient become tired of the milk, gluten gruel may be subst.i.tuted for the milk.

"The diarrhoea and bowel symptoms, when present, may be relieved by the application of hot fomentations to the abdomen, warm or hot enemas and twenty grains of subnitrate of bis.m.u.th given every four hours.

"The patient should be kept as quiet as possible, and should be turned in bed at intervals, to prevent hypostatic congestion and the formation of bed-sores. The bony prominences which are apt to become eroded should be sponged frequently with a solution of tannic acid in equal parts of alcohol and water; a dram of the tannic acid to a pint of alcohol and water, is about the proper strength to use.

"By the methods briefly outlined above--that is by the free use of water internally and externally, by keeping the intestines thoroughly emptied of poisonous material by the free and frequent use of enemas, by proper feeding and the careful attention of a good nurse to the patient and his surroundings--the duration of the fever may be shortened and the severity of the disease lessened; heart failure, and other complications will seldom occur, and the patient will in nearly every instance make a good recovery. The best method to pursue to prevent heart failure is to keep the poisons which are generated in the bowels and absorbed into the body, and which are the direct cause of the heart failure, eliminated from the body. Should the heart become weak, it may be effectually stimulated by giving hot water to drink, applying heat to the heart in the form of a fomentation, and the application of fomentations to the upper spine.

"In the treatment of a large number of cases of typhoid fever, extending over several years' practice, the writer has never made use of alcohol internally to support the action of the heart, or for any other purpose.

"The number of cases of death from typhoid fever coming under the writer's observation, where the method of treatment pursued has been similar to that briefly indicated above, have been very few, a much smaller per cent. than in practice where alcohol has been used as a 'cardiac stimulant.' I believe that the use of alcohol in the treatment of typhoid fever is not only useless, but absolutely harmful."

Dr. Kate Lindsay, of Battle Creek Sanitarium and Hospital, contributed an article upon Typhoid Fever to the _Bulletin of the A. M. T. A._ for January, 1896, from which a few notes are here taken:--

"The chief toxic centre is evidently the intestinal tract, especially the termination of the ileum. The ulcerations, necroses, perforations and hemorrhages are most frequently found in the last twelve inches of the small intestine, and may extend into the large intestine. The ulcerated surface and open vessels increase the facility with which the poison finds entrance into the circulation. The microbes, blood clots, necrosed tissue and pus, furnish abundant supplies of toxic matter, which, saturating the system, over-power and stop the activity of the functions of all the organs of the body, causing degeneration of tissues. Death is said to take place from heart, lung or brain failure, but the failure involves every other organ as well.

"Regarding the intestinal tract as any other abscess at this time, the physician should seek for methods of treatment or remedies which will remove the morbid matters, and destroy, or at least inhibit their action, thus decreasing the fever and stimulating the circulation. Secondary toxic centres often develop in the course of this disease, notably in the glands, lungs and dependent organs, the hypostatic congestion resulting from lying in one position, causing stasis of blood, death and necrosis of tissue, both of the external and internal organs.

All vessels connected with the dying tissues carry toxins to other parts of the body. Suppurating glands, and phlebitis of the femoral veins are examples of this secondary infection, and are accountable for the heart failure and collapse so often fatal during the second, third and fourth weeks of typhoid fever. * * * * *

"The old idea that in peristaltic action lay the great danger of increase of the hemorrhage and perforation of the bowels, is giving way to the more rational view that gaseous distention and septic absorption, are what bring about fatal results from these complications, and that the moderate peristalsis of the intestinal walls lessens these dangers by closing the gaping ends of the injured vessels, and expelling the septic matter and foul gases. To meet these indications I have found lavage of the bowels, even during hemorrhage, with water of 105 to 110 F. or even hotter, given in moderate quant.i.ty of from one pint to three, to give great relief by freeing the large intestines of blood clots, fecal matter and other morbid matter. It also increases peristaltic action in the small intestines, thus favoring the expulsion of gas. The heat stimulates the circulation in the peripheral vessels of the intestines, and overcomes the tendency to blood stasis.

"In the cases cited, ice-bags, alternated with fomentations, were used over the abdomen externally, and heat, or hot and cold, to spine. The extremities were kept warm. From ten to thirty minims of turpentine, in an ounce of gum acacia or starch water, increased the efficiency of the enemata, and aided in expelling the gas and checking hemorrhage.

"The tendency to hypostatic congestion and bed-sores, was prevented by frequent change of position, and the use of hot and cold to the spine by fomentations and compresses, or better still, hot fine spraying, or the alternate hot and cold spray.

In one grave case, spraying was kept up for about twelve hours, with only short intermissions. The heart was stimulated by heat applied over it, whenever depression and collapse threatened, and by hot and cold sponging of the spine."

Dr. n.o.ble said some time ago in the _London Times_:--

"Although it is true that alcohol is an antipyretic, yet its exhibition neither shortens nor modifies (favorably) the diseases of which the fever is but a symptom. The paralysis of the brain which is so frequent a cause of death in typhoid fever, is more often brought about by alcohol than any other cause, and more than one woman suffering from puerperal fever has been done to death by the administration of this substance, which, not being _convenienter naturae, is contra naturam_."

J. S. Cain, M. D., in an able paper, read at the Nashville Academy of Medicine, on "Rational Suggestions in the Treatment of Typhoid Fever,"

dissents from the practice, which still obtains largely in the medical profession, of administering alcoholic liquors, in the belief that they are "stimulants, conservators of force and even nutrients," and says:--

"After a careful and thoughtful study of this subject, I have reluctantly, and against firm early convictions, been forced to the conclusion that these theories with regard to the beneficial effects of alcohol in disease are wholly fallacious. The only rational conclusion at which I can arrive is that the agent is ever, and under all circ.u.mstances, a depressor of temperature; that it arrests the physiological interchange of carbonic acid gas and oxygen in the tissues, as well as in the air vesicles of the lungs; that it impedes the elimination of tissue waste, and causes the acc.u.mulation of this refuse in the system; that it is lethal anaesthetic in all quant.i.ties; that it is not stimulant in the true sense, and never exerts that influence; and that it supplies no element to the diseased and vitiated system calculated to antagonize disease, repair waste, or invigorate lowered vital forces, and therefore for these purposes is not called for in the rational treatment of typhoid fever."

At the annual meeting of the American Medical a.s.sociation held in Atlanta, Georgia, in 1896, Dr. G. B. Garber, of Dunkirk, Ind., read a paper upon "Alcohol in Typhoid Fever" from which a few points are here taken:--

"The fact that the mortality from typhoid fever seems to be gradually lowering is no doubt due in great measure to the non-use of alcohol in the treatment of the disease. Hardly a week pa.s.ses that some of our journals do not report a series of cases treated without the aid of alcohol in any form. I used alcohol in the treatment of the disease until two years ago, when I became alarmed at the mortality; so I changed my plan, and in 1894 I treated thirty-seven well marked cases of varying degrees of intensity. I had two fatal cases, and in both of them I had used alcohol. In 1895 I treated thirty cases of about the same type, with no death. I only used alcohol in one of them, and it caused me more trouble than any of the others. As this case was in the family of a saloon-keeper, I could not control the matter, as they would give it during my absence. On my return I would find the face flushed, the temperature high, the pulse rapid and the patient nervous. By close inquiry I would find that some of the family had given 'just a little good whisky' which had been in the house for twenty years.

"In closing, I wish to state that I am well convinced that in the treatment of typhoid fever our patients will do better and stand a greater chance of recovery, if we abstain entirely from the use of alcohol in the treatment of the disease."

Prof. J. Burney Yeo, of London, in a paper read before the International Medical Congress held at Rome, Italy, said:--

"In order to maintain the intestinal antisepsis which forms an essential part of this method of treatment, I insist on the necessity of scrupulous attention and caution in feeding patients suffering from enteric fever, great danger arising from a failure to note the extremely limited digestive and absorptive capacity exhibited by such patients.

"In conclusion, the use of alcoholic stimulants, and the common employment of depressing antipyretic agents, must be condemned."

In a report of the treatment of typhoid fever by seventy-two physicians of Connecticut, thirty-eight declared that they did not use alcohol in any stage of this disease. The remainder used it sparingly in the last stages, and only two considered it valuable from the beginning of the disease.

In a discussion of typhoid fever by a medical society meeting in Rochester, N. Y., recently, sixty physicians being present, only three spoke in favor of using alcohol in this disease.

Hygienic physicians all insist upon a rigid fast as long as the high temperature continues, or until the patient is sufficiently hungry to eat a piece of plain, stale, graham bread, "dry upon the tongue." Dr.

Charles E. Page of Boston says there would be very few relapses if this plan were carefully carried out. He contends that the whisky and milk diet, together with the not over-fresh air of the average sick room is enough to produce fever in a healthy person, hence is not likely to be conducive to recovery in one already infected with the disease.

In an article in the _Arena_ of September, 1892, Dr. Page says:--

"In my fever practice I have frequently observed the effect of fasts of six, eight, ten and twelve days to be in the highest degree productive of the health and comfort of patients, as, on the other hand I have, during the past twenty years observed the deplorable effects of the almost universal plan of constant feeding. In some of the most distressing cases that have happened to be thrown in my way, when all hope in the minds of friends had been abandoned, I have found that withdrawal of food, drugs and stimulants, and the subst.i.tution of simple, fresh, soft water, has produced results that seemed almost miraculous."

Fruit juices are now permitted by many physicians in fever, a few drops of lemon or orange juice, being a grateful addition to the water. Grape juice, unfermented, is highly recommended by some.

A young minister of great promise died recently of typhoid fever. His young wife, only one year married, is in settled melancholy, because she cannot understand why "G.o.d took her husband." Inquiry developed the fact that the physician in attendance was a believer in alcohol as a remedy, and used it in this case. In view of the better chances of recovery under non-alcoholic treatment shown by comparative death-rates, may it not be that the alcohol was responsible for the young man's death, instead of its being "G.o.d's will to take him?" The Author of all good has too frequently been held responsible for the errors of physicians, and the carelessness of nurses.