In everyday life we are exposed to worry and disappointment; and also, as many of us easily tire after work, we frequently feel an inclination to take something to cheer us up and to incite us to further exertions; thus we take stimulants, such as alcohol, tea, coffee, tobacco, etc.
We may fairly compare these stimulants to a whip with which we urge on a horse. A short reflection, however, will teach us that rest would be the best stimulant for a tired horse; but, unfortunately, physiological thinking is not yet the commonsense view of all.
A willing horse requires no whip, and many of us are able to attain a good old age without requiring any stimulants. The grandfather of the author of this work has attained the age of 105 without taking any stimulants.
As our numerous friends, both in America and England, know, we do not take any alcohol, not from principle, but because we find no pleasure in so doing. Still we don’t feel inclined to follow the anti-alcohol fanatics in their crusade, because we detest fanaticism of any kind, whether displayed by Chinese, by Mohammedans in Bochara or Morocco, or by Christians in England or America. We also do not uphold such narrow-mindedness as prohibiting even the smallest amount of alcohol to those who only take it in the greatest moderation, solely on the ground that there are some good-for-nothings who can never take it without getting drunk. With equal justice might we take away the fortune from a man who has gained it by his labor, on the ground that there are others starving because they will not work. We are not prepared, either, to accept the dictum of the anti-alcoholics that alcohol is a poison even in small quantities. We do not deny that there are many among them who cannot stand even small quantities, which is a probable reason why they are so clamorous against it; but they do not possess normal health, physically or mentally; and the supposition is not unjustified that there is in some of them a lessened tolerance for alcohol owing to their previous immoderate libations.
The truth is, as shown by many physiologists, such as Atwater and Benedict, and also by Professor Tigersted,[309] even at the Anti-Alcoholic Congress at Stockholm, that alcohol may be regarded, but in small doses only, as a precious gift, for by it we may preserve important parts of the bodily tissues—carbohydrate and fatty substances, which may be economized by the use of certain quantities of alcohol. The nourishing effect can be attained only if not too much be taken, for in over-abundance a decomposition of albuminous substances can be produced as a toxic effect.
Alcohol in small doses is unquestionably an excellent stimulant for the nervous system and the circulatory apparatus. There are many people who are able to do more work, especially of a physical nature, when they take a certain amount of alcohol; and at the same time they have a better appetite for food. Alcohol, however, is of more benefit in this respect if we take wine; and of all alcoholic drinks, except beer, wine contains the least percentage of alcohol, especially French wines, which normally contain only 9 per cent. But this stimulating effect only holds good when we do not take large amounts, for in the latter case the quality of work is impaired, especially mental labor.
In a given quantity, and preferably in the shape of red wine, alcohol is able to cheer us up, and to a certain extent diminish grief and sorrow; but after taking large quantities we feel more depressed.
Beer is more nourishing than wine, but has a more sluggish effect. English and some kinds of American beer often contain nearly as much alcohol as some kinds of wine, sometimes more than light Tyrolean or Italian wines.
The most beneficial form of alcohol is a light wine, and, as a medical stimulant, the older vintages of French wines. Beer may, to some extent, assist digestion, owing to its bitter constituents. It is true that it contains the least percentage of alcohol of all beverages of this nature, but it has the disadvantage that it is taken in larger quantities as one gets accustomed to it, and thus more alcohol and a larger amount of liquid may be introduced, the result of which may be injurious to the circulatory system (see “Hygiene of the Food”).
Observation proves that many old people thrive well on a small amount of claret or other red wine taken daily at meal times. In such cases it may be regarded as a harmless tonic, if taken only in small quantities, and if their health be otherwise normal except for the debility attributable to old age. Dr. Savile, of London, has also found salutary effects from moderate and exactly regulated quantities of alcohol in the aged inmates of the workhouse infirmary.
In our judgment we shall be best guided by the way in which our regular patients tolerate alcohol. When, having been accustomed to it all their life, they ask for wine or whiskey, and they can tolerate it well, we admit that small amounts act as a kind of tonic for them; but it should never be given if there is an incompatibility for it, for then it is distinctly harmful and should be avoided.
Brandy is the most dangerous form of alcohol,[310] but whiskey in small doses may be reckoned much less harmful; but the least injurious of all are light wines and the still lighter kinds of beer, which contain only some 3 per cent. of alcohol.
That wine may be taken without harm, even to considerable old age, can be illustrated by a series of examples, of which we have mentioned some already, where persons have reached 100 years of age in spite of drinking wine every day. They might, perhaps, have lived longer had they taken no alcohol, for, as a rule, such persons come from long-lived families, and, as we have said previously, such people may permit for themselves greater license in this respect; but this must be distinctly regarded as the exception, for, as the statistics of the United Temperance Association in England show, total abstainers have a much greater chance for a long life than have others. According to Neisson’s investigation of 6111 persons from 16 to 90 years of age who were taking alcohol, the ratio of mortality among them was three times greater than for the whole population of England.
Sir Isambard Owen shows, by a careful analysis of the results of the Collective Investigation Returns, comprising 4287 persons, that the average duration of life is greatest among total abstainers and very moderate drinkers, and that but few addicted to much alcohol were among the long lived; those in the latter condition can only expect a shortening of life, which proves conclusively that alcohol is very deleterious to the organism.
As post-mortem examinations show, all the organs of the body suffer degeneration after coming in contact with large quantities of alcohol. It would be impossible to dilate here upon all these different changes. We will, therefore, only mention the effects of alcohol on the most important organs—for example, the heart and blood-vessels.
As is well known, alcohol, if taken in large quantities, degenerates the heart muscles and also produces the condition of arteriosclerosis. Its effects on the brain are particularly deleterious. If taken once only, but in large measure, it is sufficient to cause intoxication, with changes in the mental faculty. Taken habitually, as by chronic alcoholics, these mental changes may develop into a permanent character, and thus insanity may follow. According to the official statistics of the Kingdom of Württemburg, about 60 per cent. of the inmates of lunatic asylums were alcoholics. Out of 579 lunatics of the Provincial Insane Asylum, in Vienna, in 1899, there were 40 per cent. alcoholics.
As we have shown in our address at a special meeting of the Philadelphia Medical Jurisprudence Society, insanity and crime stand in very close relationship, and, in fact, crime may be regarded as a nervous disease. We should, therefore, not be surprised to find so many criminals among alcoholics. According to statistics prepared in Germany, some 63 per cent. of cases of injury to the person, 69 per cent. of robbery and murder, and 77 per cent. of sexual crimes were committed by persons under the influence of alcohol; and according to Dr. Scharffenberg, of Christiania, if there were no alcoholics crime would be diminished by one-half.
A person committing a crime while under the influence of alcohol is no more responsible than a person who does the same thing while in a state of delirium caused by some infectious disease, or while under the influence of such a poison as muscarin or atropin, which produces an intoxication similar to that of alcohol.
Of the other organs which are injured by alcohol we must put in the front rank the various ductless glands, which are of special importance to us.
The frequency of impotency in chronic alcoholism proves how injurious to the sexual glands are large quantities of alcohol. The same applies to the adrenals, as shown by the frequency of arteriosclerosis in alcoholics. From one dose of alcohol we can often see an increase in blood-pressure. It has been shown by Dr. Sajous that alcohol acts in a very deleterious way upon the pituitary body when taken in anything but small quantities or well diluted as in beer or light wines; he illustrates this fact in a very instructive microscopic specimen.[311]
In the same way the bad effects of alcohol on the kidneys and liver are amply demonstrated in the handbooks of clinical medicine and pathological anatomy, with which we are all well acquainted; and the constant occurrence of cirrhosis of the liver and interstitial nephritis in alcoholics plainly show this.
A matter of grave importance to us is also the degeneration of the thyroid in alcoholics, as found by the researches of de Quervain[312] and Sarbach[313] and the clinical observations of Hertoghe.[314]
These degenerating effects of alcohol on the ductless glands will explain why premature old age is so often found in alcoholics, especially when brandy and liqueurs are taken; but still worse consequences than this also arise, viz.: the diminution of the powers of resistance to infection or intoxication, in consequence of the lack of those important protective elements which, as we see in Chapter III, are derived from the ductless glands, a fact which various epidemics amply prove. My friend, Dr. MacMeans, told me during a stay in Monterey, Mexico, that in an epidemic of yellow fever, he observed that alcoholics were among the first to contract it.
We know the great frequency of tuberculosis in alcoholics, and the great mortality in such persons from pneumonia. They are unable to withstand the high fever and cannot combat the infection, and the heart soon fails; and also, as a general rule, in all cases of infectious diseases their chances are much worse than are those of other people.
We note in Chapter VI that heredity depends on the condition of the ductless glands of the parents. This is also the case with alcoholics, and it is a fact that the descendants of such are heavily handicapped; and, as also mentioned in Chapter VI, congenital myxœdema and scrofulosis is prevalent among them, and their chances for a long youth discounted. Nervous diseases are also of constant occurrence among these, such as idiocy, epilepsy, etc., very interesting data as to which are given by Legrain. A certain alcoholic was eight times in the insane asylum for delirium tremens. He had nine children; three died at birth from general debility, one died of convulsions within the first year, and the other five suffered from trembling in the extremities. The father of this person was also a drunkard, who hanged himself; the mother, a brother, and a sister were also dipsomaniacs.
Martin found in 60 out of 83 female epileptics, alcoholism in the parents. Demme examined 57 children among such, and found only 10 who were normal, physically and mentally.
A terrible genealogy is that traced by Dr. Klausner concerning a woman named Ada Take, born in 1740, who was a dipsomaniac. She had 709 descendants, among whom were 100 illegitimate children, 181 prostitutes, 142 beggars, 46 workhouse inmates, 76 criminals, and the remainder were more or less habitual drunkards. This one family cost the country or prison authorities for their support over three million florins ($1,200,000).
In tropical climates the effects of alcohol are most pernicious. According to Dr. Hueppe, it is the greatest enemy to the European. From the official report of the British Commissioner General for Central Africa, in 1894, “the use of beer, wine, and spirits is more destructive to our tropical colonies than all the bacilli and plasmodia;” and according to the great African explorer, Emin Pasha, the tropics offer no dangers to the health of such as can abstain from large amounts of stimulants. It is very likely that what atrocities have been credited to Europeans in Africa were due to alcohol.
From the foregoing facts it is clear that large quantities of alcohol are most injurious, but there is no scientific evidence to prove, with exactitude, that small doses are harmful.
Some experiments in this direction have been made by Laitinen,[315] but they were performed on rabbits and guinea-pigs, to which he gave very small doses (only 0.1 centimeter per kilo bodyweight). He found that the hæmolytic ability of the blood was impaired, and that there was a greater mortality among their young than among the young of those kept on water. Laitinen, himself, did not dare to draw conclusions from these experiments; nor can we, for there is a great difference between a man and a rabbit. But if an inference may be deduced from such, we can apply it to children, for, as is well known, the effects of drugs on small animals offer better comparisons for children than for adults. For this purpose, however, we need not refer to the experiments of Laitinen, for Dr. Maurice Kende has lately experimented on 20 children between 6 and 15 years of age, who, after very small quantities of wine, exhibited an impairment of their mental faculties.
Dr. Hercod has also shown that out of 591 Viennese school children, the best certificates for scholarship were gained by those who took no alcoholic drinks; instructional results were not quite so satisfactory in those who occasionally did so; but the worst scholars of all were those who took alcohol two or three times a day. According to Viennese life, beer is generally meant by the term “alcohol,” and, in a much less degree, wine.
That children are susceptible to alcohol, as to all poisons in general, has been already mentioned in Chapter X; so it is not surprising if only small quantities should unfavorably affect their mental faculties. We have also previously insisted upon the necessity of considering it a crime, meriting a heavy punishment, to give alcohol to children. But we again repeat that there is not sufficient strictly scientific evidence, as yet, to prove that small quantities of alcohol (especially beer or wine, and possibly whiskey) are deleterious to the majority of adults; those who cannot stand even small quantities will be best without any; but we fail to see why a working man, when he comes from his daily labor, should be forbidden to take his glass of beer. It is certainly not the temperate users of stimulants, the hard workers, that should be persecuted by anti-alcoholics, but the intemperate users, who are a real curse to humanity. If those fanatics will limit their action in this useful direction only, every physician will be only too anxious to support them; but instead of this, like Don Quixote against the windmills, they forbid the use of alcohol entirely to persons who simply cannot exist without it; in fact, they might just as reasonably forbid them to eat, drink, or sleep!
We firmly believe that the best course is to discover the cause which compels such people to drink so much that they cannot discontinue the habit, and by finding the cause we shall ascertain the origin of the disease and can then treat it rationally, as we will endeavor to show in the succeeding chapter. Physicians, and not clergymen, are best qualified to fight the alcoholic habit, just as they are best qualified to fight all other diseases. That alcohol in small quantities cannot be such a poison as claimed by these faddists, is also shown by the great number of moderate drinkers who live to be much above 100 years old. At the present time there are also within our knowledge several persons over 100 years old who take every day a certain amount of alcohol. Thus an old general in Berlin, who reached his 103d birthday last December, is accustomed to go, every day, to a beer house to have his glass of beer. Mrs. Andie Campbell, of Springburn, near Glasgow, who attained her 103d birthday in January, 1908, attributes, as the newspapers stated, her old age to the moderate use of whiskey, which she has been accustomed to drink all her life. According to the report of the Collective Investigation Committee of the British Medical Association, most of the 51 centenarians, whose cases were investigated, were total abstainers, but 5 were very fond of alcohol. One of them, Peggy Walsh, who is said to have attained 127 years, was in the habit of taking daily before dinner an ounce of whiskey in water.[316] Thus it seems conclusive that the use of moderate quantities of alcohol does not seriously impair our chances for living to a good old age.