Chapter XII: Why Doctors Still Prescribe Alcoholics

Workers in the department of Medical Temperance of the Woman's Christian Temperance Union are told repeatedly by the better class of physicians that they would be glad often not to prescribe alcohol if patients and their friends would not insist upon its use. There is a deep-rooted prejudice in favor of alcohol as a remedy in the minds of the great multitude of people, and they are ready to distrust as fanatical, or incompetent, any physician who does not use it. Dr. Norman Kerr, a well-known physician of England, says, that during a ten years' residence in America, he found people unwilling to pay him as much for his services as they were willing to pay one who prescribed alcoholics. Even those who were abstainers from liquors as beverages distrusted him for not using these things as medicines. Indeed, this prejudice goes so far with many that they will refuse to employ a non-alcoholic physician, if they know him to be such. In consequence of this latter fact, there are great numbers of skilful physicians who say nothing about alcohol lest they be considered "faddists," and lose practice, but who never prescribe it unless it is asked for by the patient or his friends.

Again, consulting physicians will sometimes insist upon the use of alcohol, and thus seeds of distrust of the non-alcoholic physician will be sown.

Dr. J. J. Ridge says of medical prescriptions:--

"Hundreds of medical men order alcoholic liquors from habit,
from ignorance of their real effect, from fashion, or from a
desire to please, or not to offend, their patients. Port-wine is
constantly being ordered when persons are recovering from
various diseases; day by day they regain their strength, and the
port-wine gets all the credit of it, especially since each glass
seems to diffuse a comfortable glow over the whole body. They
forget that the process of recovery would have gone on without
the port, and that hundreds and thousands of people do get well
without it. They often ignore the fact that they are taking real
tonics in addition. They are misled by the sensations which the
alcohol causes; they do not know that it relaxes the
blood-vessels instead of improving their tone; that it exhausts
the heart by making it beat away more rapidly to no profit.
Hence the convalescence is actually more prolonged than it would
otherwise be. Gentle exercise, regulated baths, good food, balmy
sleep, these are the true restoratives of the exhausted system,
and no jugglery with sedatives, such as alcohol, can produce the
desired result.

"It is by its sedative action that alcohol has obtained its
position in public opinion. It will render persons insensible to
various uneasy sensations, and the majority prefer to continue
the bad habits which produce the uneasy sensations, and then to
take them away by a dose or two of some alcoholic liquor, or,
indeed, to take this before the uneasy sensations come on. In
this way they do themselves injury and make themselves
unconscious of it. Dr. Beaumont, who had the opportunity of
examining the interior of Alexis St. Martin's stomach, and of
seeing how digestion went on, was astonished to see how inflamed
the mucous membrane could be without any consciousness of it. He
observed, as a matter of fact, that alcoholic drinks of all
kinds hindered the process of digestion, and produced this
morbid condition of the mucous membrane. The relief, therefore,
which can be obtained by alcohol is delusive and dangerous.

"But some persons say they are afraid to abandon the use of
alcohol because they have been in the habit of taking it for a
long period. This fear is entirely groundless. The alcohol will
be missed for a time, just as a person who has been using
crutches would miss them if thrown away; but they will do better
without both after a little while. There is no kind of
constitution which renders a person unable to do without
alcohol. The prisoners in all our jails have to leave off their
drink at once, and altogether, on entering there, and no harm
ever ensues in consequence. But some say that this is because
their diet is so carefully arranged, and the hygienic condition
of the prison so perfect. Quite so. This shows us clearly that
when total abstainers become ill outside the prison, their
illness is to be attributed to some error in diet or hygiene, or
to some accidental circumstance. It is absurd to think that the
infraction of one law of health can be nullified by breaking
another; that if you eat too much, or too fast, or too often, or
what is not good for you, you can escape the consequences by
injuring yourself with alcohol."

Dr. N. S. Davis was for many years openly sneered at by many of his professional brethren as "a cold-water fanatic." Since his views are now being rapidly adopted by progressive medical men all over the civilized world, it may be that soon those physicians who cling to alcohol will deserve the soubriquet of "alcohol fanatics." Dr. Davis said:--

"If I am asked why the profession continues to prescribe these
drinks, I answer; simply from the force of habit and traditional
education, coupled with a reluctance to risk the experiment of
omitting them while the general popular notions sanction their
use. Nothing is easier than self-deception in this matter. A
patient is suddenly taken with syncope, or nervous weakness,
from which abundant experience has shown that a speedy recovery
would take place by simple rest and fresh air. But in the alarm
of friends something must be done. A little wine or brandy is
given, and as it is not sufficient to positively prevent, the
patient in due time revives just as would have been the case if
neither wine nor brandy had been used.

"Of course both doctor and friends will regard the so-called
stimulant as the cause of the recovery. So, too, when patients
are getting weak, in the advanced stage of fever, or some other
self-limited disease, an abundance of nourishment is regularly
administered, in the greater part of which is mixed some kind of
alcoholic drink. The latter will always occupy the chief
attention, and if, after a severe run, the fever, or disease,
finally disappears, it will be said that the patient was
sustained or 'kept alive' for over two or three weeks, as the
case may be, 'solely by the stimulants,' when, in fact, if the
same nourishment and care had been given without a drop of
alcohol, he would have convalesced sooner, and more perfectly,
as I have seen demonstrated a thousand times in my experience."

Dr. Casgrau, of Dublin, says that physicians who make personal use of alcohol are not able to give an unbiased opinion about its action, as one of its most marked effects is that of a narcotic to the mental powers; such physicians are not so acute to observe the action of this, or any drug.

Sir B. W. Richardson, M. D., in an address upon the reasons why physicians still prescribe alcoholics, says that the magnetism of public opinion has great weight with professional men.

"All professions are under that subtle influence. All
professions whatever their duties, whatever their learning may
be, are sensitive and obedient to that influence. In their pride
they think they lead public opinion; it is a mistake, they
always follow it on every question in which the people, at
large, have a voice. They can assist in influencing the public
voice, and sometimes, to quote the words of Abbe Purcelle,
spoken in the dawn of the great French Revolution, they may
prove that 'respect for sovereign power sometimes consists in
transgressing its orders,' but as a general rule not merely the
orders but the inclinations are obeyed. We have to wait on, and
for, public opinion, and in nothing so much as on the subject of
alcohol. The use of alcoholic beverages rests not on argument
but on habit, custom. To those whom it affects personally it is
an absolute monarch. It makes its own empire. By the very action
which it has upon the body of those who receive it into
themselves it rules and governs. The joke of the inebriate man
that when he had taken his potation he was quite another man and
that then he felt it his duty to treat that other man, is
literally true, a terse and faithful expression of a natural
fact. The man or woman born and bred under the influence of
alcohol is of the race of alcohol, and as distinct a person as
any racial peculiarity can supply. The reason, the judgment, the
temper, the senses are attuned by it. It is loved by its lovers
like life. The grape to them is no longer a luscious fruit; it
is 'the mother of mighty wine,' and he who is bold enough to
disown that motherhood must stand apart. How can a profession
however strong, march all at once against such an overwhelming
influence? Itself born, perchance, under the influence bred
under it, how shall it immediately be transformed? Why disobey
the influence? It is in the _interest_ of the doctor to obey, in
a worldly sense of view; but more--it is in his _nature_ to
obey. The strong bands of nature and interest go hand in hand.
Is it wonderful that the genius of a professional man so
situated should, according to the quality of his genius, uphold,
root and branch, the role of his nativity? On the contrary the
wonder is that he has ever done anything else. It is most
natural that he should be amongst the last to take up what
revolutionizes all the manners, and customs, and faiths, of
society. A lady will ask her physician the question, May I take
wine, Sir? As much as you like Madam; it is very bad for you and
I take none, but that is your business entirely. Henceforth that
gentleman is said to be one who prescribes alcohol in any
quantity. In fact, he never prescribes it, for although when
forbidding is hopeless, there is all the difference in the world
between prescribing and permitting, permitting goes down as if
it were prescribing. Often a patient will try to compromise. On
an ocean of whisky and water, brandy and soda, or other
poisonous mixture, he is floating into fatal paralysis. You tell
him so faithfully, and he says he knows it and will drop down to
claret. If you assent, he tells his friends you have changed his
brandy or whisky to wine; if you dissent, he says you have left
your duty as a doctor undone, in order to become an advocate for
abstaining temperance, about which he is as competent a judge as
you are, and he won't pay fees for that advice. He pays to be
cured of his disease, not to be dragooned into a system peculiar
in its tenets. In an alcoholic world there is a strong argument
in this decision. It rolls splendidly, especially down hill."

After speaking of non-alcoholic physicians, and their opinions of the harmfulness of alcohol, he adds:--

"On the other side, there are practitioners who, under the
magnetism of public opinion, as earnestly believe the opposite
in relation to alcohol, who declare they could not,
conscientiously, practice their profession if they were
debarred the use of alcohol, and who look on the advance and the
growth of scientific abstaining principles--which they cannot
avoid recognizing--with positive dread. The extremists on this
side are indeed extreme in their fanaticism. They shut their
eyes to the most obvious facts, and do not hesitate in their
blindness to misrepresent the most obvious truths. They affirm
that under the influence of total abstinence and, by inference,
because of total abstinence, the yearly decreasing death-rate of
the population is accompanied by reduction of vitality; that
people who live long are more enfeebled than those who live
short lives and merry; that under abstinence from alcohol
fearful diseases are being developed; that the total abstainers
have less power for resisting disease than the moderate
temperate; and that under the current system of advance towards
total abstinence, a very small advance yet by the way, diseases
of a low type have developed and extended their ravages."

It is only physicians of large conscientiousness, or of great independence of character, who will dare to go counter to the prejudices of the people.

Consequently, it is necessary to educate _the people_ in the teachings of those physicians, whose eminence in the profession has permitted them, or whose conscientiousness has driven them, to expose the delusions concerning the medical value of alcoholic beverages. When the people cease to believe in alcoholic remedies, physicians will no longer prescribe them. But while the majority desire the "physicians' prescription" as a cover for indulgence, there will be found physicians willing to give such prescriptions.

That the prescription of alcohol by physicians is largely a matter of routine may be seen from the following two cases, reported to the writer by county superintendents of the department of Medical Temperance.

In the first case, the physician said to the nurse, "If the patient's heart becomes weak, you might give a little brandy or whisky." Seeing reluctance expressed upon the nurse's countenance, he added hastily, "Or coffee, strong coffee will do just as well." The nurse in reporting this to the writer, said, "Why couldn't he have ordered coffee in the first place if he thought it equally good?"

The second case was that of an aged woman whose physician ordered whisky as a tonic. Her granddaughter ventured to ask, "Would not whisky have a narcotic rather than a tonic effect?" He replied thoughtfully, "Well, tell the truth, I suppose it would."