TEMPERANCE COLUMN.

Otago Witness, Issue 3889, 25 September 1928, Page 6

TEMPERANCE COLUMN.

(Published by Arrangement with the United Temperance Reform Council.) ALCOHOL AS A CARDIAC STIMULANT. In a paper opening a discussion upon the treatment of lobar pneumonia at Edinburgh, the subject of alcohol as a cardiac stimulant was dealt with as follows by Professor John Hay, M.D., Liverpool University:-— The general public still has implicitfaith alcohol as the cardiac stimulant, and it is evident there are some members u ° Ur P ro^e ® s * on who even now believe that alcohol, in some peculiar way—in its specific action—increases the efficiency of the heart. In a recent text book dealing with pneumonia, I find the following:—“ Alcohol is often useful; it should not be given too early in the attack, but where there are indications of incipent cardiac "weakness 4oz to 6oz daily may be given, and this even to alcoholics.” Four of alcohol in 24 hours is no mean dose. So far, no scientific evidence had been advanced in favour of the view that alcohol in its specific action is a direct cardiac stimulant, and I am convinced that the prognosis in any particular patient is rendered graver by repeated doses of alcohol administered to prevent or counteract cardiac failure. Like -most other medical men of my age, I was trained to prescribe alcohol freely at the first indication of cardiac weakness, and it was not for some years that, as the result of clinical observation, I began to question the value of-this line of treatment. In the years 1899 to 1901, while R.M.O. in a large Union infirmary, I made a cereful and serious attempt to determine whether pneumonia patients did better with or without the administration of alcohol, and careful notes were kept of .150 cases. Forty-seven were treated without alcohol: 103 received alcohol when the ordinarily accepted indications for its use arose.

lhe patients in each section were of the same tvne, and they were drawn from the same districts of the citv.

On certain days of the week every case of pneumonia passed into the first group. On the remaining days the pneumonias were drafted into the other group. In this way, _if there was a variation in the severity of the prevailing infection, both groups were affected equally. The results were remarkable. They leit no doubt—in my mind —that alcohol, 5 1 o GI j 10 * ortif y an d strengthen the heart, failed in its purpose, and. instead of Helping the patient to fight his infection, materially diminished his chances of recovery. In section 1, treated without alconol, oi the 47 patients 14 died—a mortality of 29J per cent. In section 2. of the 103 patients, 47 died—a- mortality of 45J per cent., a difference of 16 per cent. The average age in each group was 35 years. I thought that this remarkable difference in mortality might tie due to a relatively greater number of moribund patients being admitted into the second section, and in order to eliminate that factor I deleted all these who had died within 24 hours of admission. I found that five moribund eases were included in section 1 and 16 in section 2. The revised figures, after deducting these patients moribund on admission are as follows:— Section 1: 42 cases, with nine deaths—- - mortality of 21.4 per cent. Average age 34 years. Section 2: 87 cases, with 31 deaths—a mortality of 36.8 per cent. Average age 32.8 years (on the whole a younger group). We find a difference of 15 per cent, in the mortality remaining after the elimination of those moribund, the two sections having—for all practical purposes—r the same average age. T do not wish to stress unduly the actual figures. There were possibly some unrecognised factors responsible, in part, for the lowered mortality in section 1, but in view of the fact that the only material difference in the treatment of the two groups was in the administration or the withholding of alcohol, I consider it reasonable to dssume that this was, at any rate, the dominant factor Further experience has convinced me that alcohol is only of use to pneumonic patients under certain well defined conditions, and that it is not only futile, hut detrimental, when administered in repeated doses to help a failing heart. It may be of service either alone or in combination with other sedatives in procuring rest and sleep during the acute stage of the disease. It may be comforting. given in a hot drink during the initial rigor, and no objection could be taken on therapeutic grounds if alcohol in some palatable form were ordered during convalescence. But to give alcohol in the belief that it is a cardiac tonic or stimulent is opposed to scientific teachinp and clinical experience. One most important action of alcohol in the blood-stream and an action generally overlooked, is its effect on the immunising response of the body. _ Recovery, in pneumonia, depends on the production of antibodies, and alcohol has been proved to inhibit this vital activity on the part of the organism. Professor Wynn sums up this aspect of treatment tersely when he says: “No proof has yet been advanced that alcohol is of service in cardiac failure, and to give under the guise of a stimulant a depressing drug, which, moreover, inhibits the immunising process, to patients who are unable to neutralise its effect, cannot be sound treatment.” With this I agree.