(C.) - Alcohol. - Leading Article from the "Lancet," January 1st, 1870.

After a great many fluctuations, professional opinion upon the question of alcoholic stimulation in disease appears to have recently achieved some real progress towards the establishment of satisfactory principles. There are still very wide divergencies between different authorities, and we fear that there is still a good deal of extreme and irrational practice, both in the direction of excessive stimulation, and of the opposite fault of an unreasonable fear of the remedy. But it seems to us that the outlines of a greatly improved knowledge, both of the therapeutic powers, and the capacity for mischief which alcohol possesses, may now be discerned.

In the first place, as regards acute diseases attended with febrile phenomena, three things are tolerably plain. The first is, that alcohol, when it acts well, acts as an antiphlogistic stimulant; that is to say, it lowers abnormally high temperature, it reduces the frequency of the pulse, and, while raising nervous power, it calms those disturbances of the nervous system which attend, if they are not caused by, the elevated temperature of the blood in pyrexia. The second great fact is, that there are the utmost differences between different pyrexial patients as to their capacity for receiving benefit in this way; that a large number of persons, especially among the young and previously robust, do best without any alcohol; and that among those to whom it is beneficial, there are some for whom three ounces of wine per diem is fully the physiological and therapeutical equivalent of twenty-four ounces given to another and smaller class of patients; and that nothing but careful tentative use of the remedy can tell, in any particular case, whether it is needed, and, if so, in what quantities. In short, that all generalisations to the effect that you must, or must not, give wine by ounces, or by bottles, in fevers or in inflammations generally, are worthless and misleading. The third settled fact is this, that it is often in those cases where alcohol used (on purely theoretical grounds) to be thought most dangerous - viz., in cases with very high temperature and flushed face - that it produces its best effects; and that to pour large quantities of stimulants into a fever patient simply because he is pale, and has a small pulse, is an unwarrantable proceeding.

The above are certainties and the following are probabilities.

It is probable that alcohol owes part of its influence in fevers to an antiseptic agency, by which it destroys the activity of certain bodies - call them organisms, or not, as you please - by means of which the contagium sets up the febrile disturbance within the blood. In the case of inflammation, it is probable that alcohol, when it acts well, does so in part because it stimulates the sympathetic and contracts the arterioles, and in part interferes with the migration of blood-corpuscles through the vascular walls, as Binz and his pupils have shown that quinine can also do. It is probable that so far as alcohol can be applied to these purposes within the organism, it is of unmixed benefit. And there is much reason to believe that the singular differences between different individuals, as to the quantity of alcohol they can bear, depend on some unexplained difference in the respective rapidity with which alcohol is oxidised in the blood in different persons. For it is now known with certainty, on the one hand, that nearly the whole, even of a poisonous dose, is always oxidised in the body, and on the other hand, that the presence of large quantities of unchanged alcohol for any length of time in the blood, inevitably poisons the nervous system. The antiseptic action, and the influence on the migrative tendency of the corpuscles, are most likely produced immediately that the alcohol mingles with the blood; it probably depends on the subsequent progress of oxidation whether the general effect on the patient will be good or bad. One thing is certain; if signs of narcotism - i.e., paralysis of the nervous system - are produced, the alcohol is doing harm and must be immediately diminished or stopped.

As regards chronic diseases, we are sorry to observe that there is very much less of intelligent progress in medical opinion than in the case of acute diseases. It is much to be regretted that a large number, even of highly-educated practitioners, will persist in acting on the assumption that in non-febrile diseases the amount of alcohol to be administered ought to be measured by the degree of debility, merely as such. The direct and very mischievous corollary of this is the practice, unfortunately daily increasing, of prescribing stimulants with lavish profusion in those numerous nervous affections to which weakly persons (more especially women) are prone. It is our duty, as medical journalists, to raise our voices to the utmost against this tendency. We are no bigots against alcohol; and we are heartily sick of the unthinking abuse which has been lavished on what it is the fashion to call 'indiscriminate stimulation in acute disease.' We declare our belief that the real mischief lies at the door of those who are indiscriminate (because they are unthinking and illogical) in their prescription of alcohol for debility, merely as such. It is no figure of speech, but the literal truth, when we say that hundreds of neuralgic, hysteric, and epileptic patients have been driven into drunkenness or lunacy, or both, by the careless folly of advisers, who had no better reason for the prescription of large doses of alcohol than the fact that these diseases are attended with nervous weakness, as they undoubtedly are. The assumption involved - that so much ingested alcohol is necessarily so much added nervous strength - is so gross a fallacy that no one would assent to it if expressed in plain words. Yet we constantly see it acted upon. We repeat with all the energy of which we are capable, that it is a grave scandal and mischief that medical men should endanger in this serious way the powers of moral resistance of women and other weak persons, while basing their practice upon ideas that are illogical and untenable; and we trust that a reform in this respect will immediately be commenced."