Chapter X

COMPARATIVE DEATH-RATES WITH AND WITHOUT THE USE OF ALCOHOL AS A REMEDY.

A study of statistics relating to the difference in results of the treatment of disease with and without the use of alcohol, cannot but be of great interest to all students of the alcohol question. The appended statistics are culled mainly from the _Medical Pioneer_ of England, now, _Medical Temperance Review_, the journal of the British Medical Temperance Association, and from the _Bulletin of the American Medical Temperance Association_.

A paragraph in the _British Medical Journal_, for Dec. 2, 1893, says:--

"An interesting fact has been noted by Dr. Claye Shaw, at the
London County Asylum, Banstead, for the Insane. Since the
withdrawal of _beer_ from the dietary, the rate of recovery has
gone up. During the past year, for example, the recoveries
reached 46.97 per cent. Nearly one half of the patients had thus
recovered during the period stated. The inmates take their food
better without the liquor, and they are thus taught that
intoxicants are not a necessity of ordinary health."

In the _Medical Pioneer_ for January, 1894, Dr. John Mois, medical superintendent of West Haven Infectious Diseases Hospital, states that prior to 1885 he had treated 2,148 cases of smallpox "in the usual routine method, with the use of alcohol when the heart's action seemed to indicate it;" resulting in a mortality of 17 per cent. But since 1885 he has treated 700 additional cases under similar circumstances except that the use of alcoholic preparations was entirely omitted, and the resulting mortality was only 11 per cent.

In the same journal, Dr. J. J. Ridge states that he had treated the 200 cases of scarlet fever admitted into the Enfield Isolation Hospital during the years 1892 and 1893, without alcohol in any form, with a mortality of only 2.5 per cent.; while the mortality in the hospitals under the Metropolitan Asylums Board in 1893, in which alcohol was used in accordance with the usual practice in scarlet fever, was 6.3 per cent.

Dr. J. J. Ridge says later:--

"In January, 1894, I published the result of the treatment of
the first 200 cases of scarlatina admitted into the temporary
wards of the Enfield Isolation Hospital during 1892 and 1893. I
stated that there had been five fatal cases, but that one was
dying when admitted and only lived a few hours. The mortality
was 2 per cent., or 2.5 if the later case is included.

"Since then 300 more cases have been admitted and discharged and
among these there have been 7 fatal. Hence there have been 14
deaths in 500 consecutive cases extending over a period of a
little more than four years. One of these ought to be excluded,
no time having been given for treatment. Hence the mortality
has been just 2.6 per cent. This, I think it will be admitted,
is a low mortality, although it is possible it may be even lower
when the cases are treated in a permanent hospital about to be
erected.

"It may be interesting to state that 4 of the cases died on the
third day after admission; 1 on the fourth; 1 on the sixth; 1 on
the tenth, with pneumonia; 1 on the thirteenth; 1 on the
fifteenth; 1 on the sixteenth; 1 on the eighteenth; 1 on the
thirty-sixth, with nephritis and pleuropneumonia; and 1 on the
forty-sixth, with otitis and meningitis.

"All the cases have been treated without alcohol either as food
or drug, although many have been of great severity with various
complications. It is certain that the absence of alcohol has not
been detrimental, since the mortality is less than three-fourths
of that of the mortality among all notified cases in England and
Wales. I am bound to say that it is my firm conviction that had
alcohol been given in the usual fashion, the death-rate would
have been higher. Cases have been admitted to which alcohol has
been given previous to admission, apparently with harm, as they
have improved without it. One case was particularly noticeable
in this respect. A child, aged 6, had had a good deal of whisky,
and was supposed to be dying when admitted on the fourth day of
the disease, so that the doctor who had seen it was surprised,
when he called the following day to inquire, to find it was
still alive. Without a drop of alcohol it began to improve and
made a good recovery. I may say that delirium is very rare, even
in the worst cases treated non-alcoholically."

Dr. Norman Kerr says:--

"In my paper on 'The Medical Administration of Alcohol,' read to
the section of medicine at the Sheffield meeting in 1876, I
cited several medical testimonies in favor of non-alcoholic
treatment of fevers, notably that of my friend, the late Dr.
Simon Nicolls, who had a mortality of less than 5 per cent. in
230 cases.

"The record of the results of a greatly lessened administration
of alcohol in the treatment of smallpox in the London hospital
ships, is of deep interest. Having been requested to inquire
into the effects of this diminished alcoholic stimulation on
mortality and convalescence, Dr. Birdwood stated that though the
gravity of the cases had increased, with a mortality of 15 per
100 in the metropolis, the ship's death-rate had remained at
less than 7 per 100. Convalescence had been more rapid, and
there had been fewer and less serious complications from
abscesses and inflammatory boils. Other causes had contributed
to this improvement, but the medical officers attributed a
considerable share in the amelioration to a greatly diminished
prescription of alcohol."

The _Medical Pioneer_ says:--

"In 1872 there appeared in the _Saturday Review_ an article in
which the medical practitioners of this country were accused of
inciting their patients to free drinking, and in the discussion
which this article called forth, Dr. Gairdner, of Glasgow, said
that fever patients in that city, when treated with milk and
without alcohol, did much better than those reported as having
been treated by Dr. Todd with large doses of alcohol; the latter
resulting in a mortality of about 25 per cent., while those
treated by Dr. Gairdner with milk had had a death-rate of only
12 per cent. About this time the British Medical Temperance
Association was founded, owing to the exertions of Dr. Ridge, of
Enfield, and in 1876 it was enrolled, under the presidency of
Sir B. W. Richardson. It now contains 269 members in England and
Wales, 53 in Scotland and 80 in Ireland, or more than 400
altogether, all professional men and women. This, I think, is
but a sign of the change of opinion on the use of alcoholic
fluids in medical practice, for all who remember what medical
practice was in London thirty years ago know that the use of
wine and brandy in hospital practice was so common that it was
quite a rarity in some hospitals to find a patient who was not
ordered, by some of the staff, from three to four ounces of
brandy or six to eight fluid ounces of wine. The expense caused
to the hospitals by this practice was, of course, great, and
increased notably between 1852 and 1872, owing to the prevalence
of the views of Liebig and his follower, Dr. Todd. The writings
of Parkes, Gairdner, Dr. Norman Kerr and of Sir B. Ward
Richardson, Dr. Morton and others, gradually lessened this
predilection for treating diseases by alcohol, and accordingly
between 1872 and 1882 a great change came over the practice of
London hospitals. Thus the sum paid for milk in 1852 in Saint
Bartholomew's Hospital was L684, and in 1882 it was L2,012;
whilst alcohol in that hospital cost in 1852, L406; in 1862,
L1,446; in 1872, L1,446; and in 1882 only L653. Westminster
Hospital in 1882 spent L137 on alcohol and L500 on milk. One
hospital, St. George's, long continued to use large quantities
of alcohol. That hospital in 1872 had the high mortality among
its typhoid fever patients of 24 per cent., which was twice as
high as that noted by Dr. Gairdner as occurring in Glasgow, when
alcohol was abandoned and milk used instead. Dr. Meyer, who
reported these cases of typhoid treated in Saint George's
Hospital at that time, mentioned that alcohol in large doses was
given to 87 per cent. of the patients. Three-fifths of these
patients took daily eight ounces of brandy when there was danger
of sinking from failure of the heart's action. One-fourth of the
number took sixteen fluid ounces of brandy in the 24 hours."

"In 230 typhoid cases in St. Mary's Hospital, Dr. Chambers
reduced the ratio of deaths from 1 in 5 with alcohol to 1 in 40
without it. Dr. Perry, of Glasgow, found that of 534 cases
treated with alcohol, 138 died, while of 491 treated without
alcohol, only 9 died."

In a recent text-book on medicine occurs the following:--

"English physicians use spirits in fevers, and all experience
sustains the conviction that no substitute has been found for
them."

In a late number of the _Temperance Record_, Dr. Smith gives a different view of the experience of English physicians:--

"When Bentley Todd was at King's College, and leading his
profession, brandy was the rule in febrile cases. Then the
mortality varied from twenty-five to thirty-five per cent. That
the treatment was as fatal as the disease, experience
demonstrates:--

"1. Professor W. T. Gairdner, of Glasgow, writing to the Lancet
(1864), gave his experience as follows:--

Fever cases Average of
treated. wine and spirits. Mortality.

1,829 34 oz. to each 17.69 per cent.
595 2-1/2 oz. to each 11.93 per cent.
212 none 1 death only.
(young lives)

"These were mostly typhus cases, but the rationale, so far as
alcohol is concerned, is the same as in typhoid.

"2. At the British Medical Association in 1879, Professor H.
MacNaughton Jones gave particulars of 340 cases of typhus,
typhoid and simple fever. I append a summary:--

Cases. Deaths. Mortality
per cent.

Given brandy 58 19 32.7
Given claret 51 2 3.8
Given no alcohol 231 4 1.7

"3. Dr. J. C. Pearson writes to the _Lancet_ (Dec. 5 and 26,
1891), giving his experience of typhoid. He had treated several
hundreds of cases without a single death, and never prescribed
stimulants in any shape or form in the disease.

"4. Dr. Knox Bond writes to the _Lancet_ (Nov. 25, 1893), giving
his experience of typhoid at the Liverpool Fever Hospital. He
says: 'As a resident for some years in the fever hospitals, my
views of the value of alcohol in fever underwent, solely as a
result of the experience there gained, entire modification. The
conviction became forced upon my mind that in no case in which
it was used did benefit to the patient ensue; that in a
proportion of cases its use was distinctly hurtful; and that in
a small but appreciable number of cases the resultant harm was
sufficient to tilt the balance as against the recovery of the
patient.'

"In plain terms, alcohol tended to the destruction of the
patients. Dr. Bond's figures are:--

No. of cases. No. of deaths.

Given alcohol 71 18
Given no alcohol 309 15
--- ---
380 33

In May, 1890, Dr. Nathan S. Davis, read a paper before the American Medical Association upon the use of certain drugs in disease. Among the drugs mentioned was alcohol, and comparative death-rates were given in typhoid fever and pneumonia, between Mercy Hospital, Chicago, during a term of years when no alcohol was used in the medical wards, Dr. Davis being in charge of them, and some of the large metropolitan hospitals using alcohol. In Mercy Hospital without alcohol, the death-rate in typhoid fever was only five per cent.; in pneumonia only twelve per cent.

"Of 161 cases of typhoid fever treated in Cook County Hospital
during 1889, 27 died, or one in six--nearly 17 per cent.

"According to the annual report of the Cincinnati Hospital for
1886, 47 cases of typhoid fever were treated during that year,
with seven deaths, a mortality rate of 16 per cent.

"The Garfield Memorial Hospital, at Washington, reported for the
year 1889, 22 cases of typhoid fever, with 5 deaths--or 22 per
cent.

"In the Pennsylvania Hospital the mortality rate in pneumonia
for the years 1884-1886, was 34 per cent.

"The mortality of pneumonia in the Massachusetts General
Hospital, between the years 1822 and 1889, comprising 1,000
cases, was 25 per cent.; but a gradual increase in mortality had
been noted from 10 per cent. in the first decade of the seventy
years represented by this report, to 28 per cent. in the last
decade.

"According to the report of the Supervising Surgeon General of
the U.S. Marine Hospital Service for 1888, the number of cases
of pneumonia treated between 1880 and 1887 was 1,649, with 311
deaths--nearly 19 per cent.

"The Cincinnati Hospital reported for 1886 a mortality rate in
pneumonia of 38 per cent.

"The mortality rate in the Cook County Hospital, Chicago, for
1889, according to Dr. Heltoin, relating to 80 cases of
pneumonia, was 36 per cent."

Only a five per cent. death-rate in typhoid fever without alcohol, and from sixteen to twenty-two per cent. with alcohol; only a twelve per cent. death-rate in pneumonia without alcohol, and from 19 to as high as 38 per cent. with alcohol. Such are the comparative death-rates given by Dr. Davis. They should be committed to memory by every opposer of the use of alcohol, as they show clearly that people have many more chances for recovery, other things being equal, in the diseases mentioned, if alcohol is not used than if it is.

It is worthy of mention in this connection that Cook County Hospital contains in its report for 1897 the following items: Number of patients 19,536; cost of liquors $80.00; per cent. of deaths from all causes, 5.7. The cost of liquors is only .004 for each patient. This shows a decided advance in the disuse of alcohol, when so very little is used in a great hospital, with so large a number of patients.

Dr. A. L. Loomis, in the treatment of 600 typhus fever cases on Blackwell's Island in 1864, excluded alcoholics, with the result of reducing the mortality rate to only six per cent. whereas it had previously been twenty-two per cent., in Bellevue Hospital from which the patients had been removed.

In Battle Creek Sanitarium no alcohol is used in any disease, simply because the management believe better results are obtained by the use of other agencies. In the October, (1893) number of the _American Medical Temperance Quarterly_ now _Bulletin of the A. M. T. A._, Dr. J. H. Kellogg gives statistics of deaths from various diseases in the Battle Creek Sanitarium. The total of these statistics is as follows: la grippe, 827 cases, 4 deaths--or two per cent.; scarlet fever, 83 cases, 2 deaths--less than three per cent.; 333 cases of typhoid fever, 9 deaths--or 2.7 per cent.; 82 cases of pneumonia, 4 deaths--or 4.9 per cent. These exceptional results are not attributed solely to the non-use of alcohol. The nursing and surroundings were of the best. But these results certainly show that the use of alcohol as a remedy in acute diseases is not necessary, and that patients have a much better chance for life, other things being equal, where alcohol is not used than where it is.

Dr. Kellogg says of the surgical cases:--

"In a hospital of 100 beds, connected with the institution, more
than 3,000 surgical cases have been treated, to whom alcohol has
never been administered except in connection with chloroform
anaesthesia; my uniform custom being to administer an ounce of
brandy or whisky five minutes before beginning the
administration of the anaesthetic, when chloroform is used.

"The surgical cases include more than 300 cases of ovariotomy,
and over 300 other cases involving the peritoneal cavity, such
as operations for strangulated hernia, the radical cure of
hernia, etc. The statistics of death and recoveries are
certainly as good as can be produced by any hospital in the
world, dealing with the same class of cases. The total mortality
from the operation of ovariotomy, including nearly 300 cases, is
less than three per cent., and for the last few years, in which
the antiseptic measures have been perfected, the record is still
better, showing a succession of 172 cases of laparotomy for the
removal of ovarian tumors, or diseased uterus and ovaries,
without a death. These cases include a number of hysterectomies,
and many cases so desperate that those who trust in alcohol as a
heart stimulant, and as a means of supporting the vital
energies, would certainly have considered it necessary to resort
to the use of this drug. Nevertheless, it was not administered
in a single case, and I have seen no reason to regret its
non-use in a single instance."

Dr. T. D. Crothers, of Hartford, Conn., tells the following:--

"In a large hospital a study of the mortality of pneumonia
indicated a greater fatality at intervals of six months. There
were five per cent. more deaths during periods of two months at
a time, twice during the year. This extended back for two years,
and was finally narrowed down to the service of an eminent
physician who gave spirits freely in all cases of pneumonia from
their entrance to the hospital. The other visiting physicians
gave very little spirits, and only in the later stages. The
physician was skeptical of these statistics, but finally
consented to test them by giving up spirits practically in all
cases of pneumonia. This was continued for a year, and the
mortality went back to the average statistics. That physician
has abandoned alcohol as a food and a medicine, only in very
limited degree. He writes, 'My stupidity in accepting theories
and statements of others, concerning spirits, which I could have
tested personally, is a source of deep sorrow, and I do not know
but it could be called criminal. I certainly feel that
punishment would be just.'"

Brandy has been considered the great necessity in cholera, yet the use of it and other alcoholics are known to expose people to greater danger when this disease prevails.

The _Bulletin of the A. M. T. A._ is authority for the following:--

"During the epidemic of 1832, Dr. Bronson said: 'In Montreal
1,000 persons have died of cholera, only two of whom were
teetotalers.' A Montreal paper said: 'Not a drunkard who has
been attacked has recovered from the disease, and almost all the
victims have been at least moderate drinkers.'

"In Albany, N. Y., the same year, cholera carried off 366
persons above sixteen years of age, all but four of whom
belonged to the drinking classes. Packer, Prentice & Co., large
furriers in Albany, employed 400 persons, none of whom used
ardent spirits, and there were only two cases of cholera among
them. Mr. Delevan, a contractor, said: 'I was engaged at the
time in erecting a large block of buildings. The laborers were
much alarmed, and were on the point of abandoning the work. They
were advised to stay and give up strong drink. They all
remained, and all quit the use of strong drink except one, and
he fell a victim to the disease.' He says also: 'I had a gang of
diggers in a clay bank, to whom the same proposition was made;
they all agreed to it, and not one died. On the opposite side of
the same clay bank were other diggers who continued their
regular rations of whisky, and one third of them died.'

"In New York City there were 204 cases in the park, only six of
whom were temperate, and these recovered, while 122 of the
others died. In many parts of the city the saloon keepers saw
and acknowledged the terrible connection between their business
and the spread of the disease, and, becoming alarmed for their
own safety, shut up their saloons and fled, saying: 'The way
from the saloon to hell is too short.'

"In Washington the Board of Health was so impressed with the
terrible facts that they declared the grog shops nuisances,
ordered them closed, and they remained closed for three months.

"A prominent physician of Glasgow reported: 'Only nineteen per
cent. of the temperate perished, while ninety-one and two-tenths
per cent. of the intemperate died.' One extensive liquor dealer
of Glasgow, said, 'Cholera has carried off half of my
customers.'

"In Warsaw ninety per cent. of those who died from cholera were
wine drinkers.

"At Tifels, Prussia, a town of 20,000 inhabitants, every
drunkard died of cholera."

The _St. Paul Medical Journal_, of September, 1899, gives the following report of a railway surgeon, Dr. Kane:--

"From June 1, 1898, to June 1, 1899, the author performed a few
more than four hundred operations. Forty-nine abdominal
sections, fifty odd more operations of a graver sort, one
hundred miscellaneous of less gravity than above, over one
hundred operations upon female perineum and uterus. Of the four
hundred, more than three hundred demanded anaesthesia. There were
but three deaths, making the mortality a little less than one
per cent.

"The author does not claim a phenomenally low mortality, nor
does he claim specially brilliant results. He has to contend
with unreasoning fear on the part of the patients for hospital
surgeons, and also most of his cases had been in the hands of
quacks, and had subjected themselves to remedies prescribed by
old women. Many cases came after the family physician had
exhausted his resources. He thinks his results are considerably
better than the average in hospitals and in country districts.
Alcohol medication was dispensed with entirely after the
patients came under his care, and to this he attributes much of
his success. He does not believe that alcohol is a stimulant, or
a tonic. On the contrary, he believes that it retards digestion,
arrests secretion, and hinders excretion. The courage and
fortitude of his patients were lessened instead of increased by
the use of alcoholic medication.

"Pain is better borne, endured longer and more patiently when
alcohol is not used.

"He urges the practical surgeon to carefully weigh the subject
of alcohol, and verify for himself the expediency of its use."

Dr. B. W. Richardson in the report of his practice for 1895 in the London Temperance Hospital refers to non-alcoholic treatment of rheumatism. He said:--

"Out of seventy-one cases of acute or subacute rheumatism--the
large majority acute, and attended with temperatures moving up
to 104 deg. F.--sixty-nine recovered, and two, although they were
discharged without being put on the recovery list, were so far
relieved that a few days' change in country air seemed all that
was required to induce full restoration. Comparing the
experience of the treatment of acute rheumatic disease without
alcohol with that which I have previously observed with alcohol,
I can have no hesitation in declaring that it is of the greatest
advantage to follow total abstinence absolutely in this disease.
The pain and swelling of joints is more quickly relieved under
abstinence, the fever falls more rapidly, there is less frequent
relapse, and there is quicker recovery. In brief, the experience
of treatment of rheumatic fever minus alcohol, presents to me as
much novelty as it does pleasure, and I am convinced that if any
candid member of the profession could have witnessed what I have
witnessed in this matter, he would agree with me that alcohol in
rheumatic fever, however acute, is altogether out of place. I am
also under the conviction, though I express it with great
reserve, that in acute rheumatism, treated without alcohol, the
cardiac complications, endocardial and pericardial, are much
less frequently developed than where alcohol is supplied."

Dr. Pechuman in _Alcohol--Is It a Medicine_, published in 1891, says:--

"There is no disputing that many deaths occur each day as the
result of the administration of alcohol in acute diseases, to
say nothing of the deaths caused by its habitual use; and those
who give it ignore the very fundamental principles of physiology
and the many published statistics. The Boston Hospital report
tells a sad story in this connection; it shows that out of 1,042
cases treated with alcoholics 386 died, while out of the same
number treated without alcohol only 81 died. Using plain English
305 were actually killed by it."

Dr. T. D. Crothers, in the January, 1899, _Bulletin of the American Medical Temperance Association_, gave the following Hospital Statistics, showing a decline in the use of spirits in hospitals:--

"Evidently a great change is going on in the use of alcohol as a
remedy in large hospitals. The annual reports of ten hospitals
in the New England and the Middle States show the following
widely varying figures. The spirits used include beers, wines,
whiskies and brandies, and vary from eleven to sixty-one cents a
person for all the cases treated. These hospitals treat from
eighty to seven hundred cases a year, both surgical and medical,
and the medical staff are the leading physicians of the towns
and cities where they are located. The hospital where the
largest amount of spirits was used is not different from others,
nor is the one where the lowest amount is reported. The
conclusion is that this difference is due entirely to the
judgment of the medical men. The lowest rate (eleven cents each)
was in a hospital where one hundred and twenty-one cases had
been under treatment. The highest rate (sixty-one cents) was in
a hospital of five hundred and forty cases. The mortality from
typhoid fever and pneumonia was eight per cent. higher in this
hospital than in the one where only eleven cents a head had been
expended for spirits. The general mortality did not vary greatly
in any of these hospitals, and the records of one year could not
be expected to show this. In the remaining hospitals the
mortality of the fever and the septic cases was about the same.
The free use of spirits did not show any improvement, but rather
an increase of the death-rate, while the same amount of spirits
used showed but little change, and that in the line of
improvement of death-rate. These are only the figures of one
year, but they indicate a change of practice, and show the
passing of alcohol as a remedy."