It is a strange fact, but one in which all observers agree, that women who have never been accustomed to take alcohol, can stand considerable, and sometimes very large, quantities of it during convalescence after infectious diseases, such as pneumonia, etc. It is equally strange that in severe cases of diabetes, where previously opium had never been taken, very large doses of this drug may be used without any inconvenience. We have also observed that women suffering from severe diabetes, though unaccustomed to alcohol, could take large quantities of it—for instance, one or two tablespoonfuls of whiskey three times a day—without displaying any symptom of mental excitation or other signs of having taken liquor in a quantity which might provoke a state of excitation in persons not used to alcohol; in fact, the alcohol has been well tolerated and taken with pleasure.
In both these conditions—diabetes (Lorand) and infectious diseases—the thyroid gland plays an etiological rôle, as we have frequently indicated in this work. It is, therefore, justifiable now to discuss the point whether the thyroid has something to do with the apparent paradox that alcohol can be taken, without the display of any signs of intoxication, by women who are otherwise never in the habit of taking spirits.
That this is really so cannot be denied, a priori, for the reason that between the activity of the thyroid and the influence of alcohol a certain relationship exists. This is evidenced from the observation, mentioned previously, that alcohol acts upon the thyroid gland, at first causing hyperactivity, and later on exhaustion of it. As we have already mentioned, there is a certain analogy between the action of chloroform and that of alcohol on the thyroid gland. In fact, we think that it is permissible to assume that drunkenness is a consequence of the hyperactivity of the thyroid, for in such a condition there are observable a series of symptoms of thyroid hyperactivity; and it has been shown by Moebius[317] that in women suffering from Graves’s disease (hyperactivity of the thyroid) we may find a condition of intoxication similar to that seen in alcoholic intoxication, although such women had not taken even a drop of alcohol. This condition is provoked by the over-abundance of thyroid secretion in the blood. In other words, women suffering from this disease can be drunk without having taken any alcohol at all, simply because of the entering into their blood of the secretion of the thyroid in large, i.e., in toxic, quantity, this having produced such a condition.
According to several authors, whom we have already quoted (de Quervain,[318] Hertoghe[319]), alcohol has a great influence on the thyroid, and in chronic alcoholism the thyroid is found to be degenerated.
If it can be admitted that drunkenness is caused by the toxic products of the thyroid, due to the alcohol acting on the thyroid and causing its hypersecretion, we can also explain the mystery why persons bitten by poisonous snakes can also, in the same way, take very large quantities of alcohol without showing its effects, even when they have previously been quite unaccustomed to it. Snake poison, as do all poisons, creates a hyperactivity of the thyroid which results in the throwing off of a large amount of colloid substance. Exhaustion follows this hyperactivity, and in this condition, as in convalescence from infectious diseases, and in severe diabetes, where there is also a similar exhaustion of the thyroid after a previous hyperactivity, a large quantity of alcohol can be taken, merely because of the fact that when the thyroid is devoid of its colloid, a condition of hyperactivity, which is the cause of drunkenness, cannot easily be provoked, unless enormous doses are given. We must, therefore, in cases of snake poisoning give greatly increased doses of alcohol in order to again provoke an increased activity of the thyroid, and thus cause the eventual destruction of the harmful toxalbumins of the snake poison.
If women, in a state of convalescence after pneumonia, or with severe diabetes, and unaccustomed to taking spirits, can stand large quantities of alcohol without exhibiting any signs of excitation, it is very probably due to the circumstance that the thyroid has already thrown off its available amount of colloid, is exhausted, and the doses given are not yet sufficient to produce a fresh secretion, and thus the symptoms of drunkenness do not develop.
The result of these observations is that a degenerated thyroid cannot easily provoke a condition of drunkenness, which may also explain the curious coincidence that frequently chronic alcoholics, even after large quantities of alcohol, do not present typical symptoms of drunkenness; in fact, sometimes so few of such signs are visible that, if a crime is committed under such influences, it is difficult to prove they were really intoxicated at the time, as they present no visible signs of such a condition.
From the foregoing we shall, therefore, not be surprised to find that persons suffering from hypothyroidia or myxœdema can take large quantities of alcohol, and at the same time evince a great liking for the same; in fact, at times, they have a regular craving for it. Several things will explain why myxœdematous people like to take alcohol. They invariably feel cold, as the thyroid regulates the temperature of the body; they thus desire to obtain warmth from the spirit (which may excite the function, in a small degree, of such parts of the thyroid as are not yet degenerated), and thus produce symptoms of thyroid hyperactivity, by which warmth may be produced, though they do not realize that subsequently they will be all the colder. Such people are also generally of a dull apathetic disposition, never cheerful, but in a depressed mood, owing to the degenerated condition of the thyroid; and being thus despondent they are easily dejected by worries or disappointment. That such people should resort to drink is but natural, if we consider that they can take alcohol without visible effects. We must not forget that there are many degrees of hypothyroidia, from light cases with a simple insufficiency of the thyroid up to graver forms nearly approaching myxœdema; and all we have said on the above subject will apply in varying degrees to them.
From this we shall now also understand why aged people can sometimes take much alcohol without exhibiting signs of drunkenness, which is probably the origin of the erroneous idea that “wine is the milk of the aged.” This can have very baneful results, for if small doses can undoubtedly produce—especially when light French wines are taken—a tonic and stimulating effect on the thyroid, after larger doses the hyperactivity may more readily be followed by exhaustion, in which case, in old age, the degeneration of the thyroid will be still more quickened.
If persons with a degenerated thyroid can take large quantities of alcohol without getting drunk, on the other hand, those with an overactive thyroid cannot stand alcohol so well; and that the latter is the case in Graves’s disease has been already shown by the fact such people can exhibit the symptoms of intoxication even when they have taken no alcohol at all. Young girls and women generally, except those past the climacteric age, are very sensitive to the effects of alcohol, and easily get intoxicated, owing to the fact that the thyroid is, with them, more active on account of the intimate connection between it and the ovaries. Thus, during thyroid treatment we have seen intoxication appear after a single glass of claret in persons who previously could drink much more without becoming so affected.
During treatment with thyroid tablets alcohol is not well borne, according to our observations.
It is probable that the sexual glands have also something in common with this question. We have observed that people with marked sexual inclinations are seldom habitual drunkards; in fact, we do not recall having ever come across an instance; also, among total abstainers men of strong sexual inclination are not infrequently met with, whereas alcoholics do not usually seem to care much for the fair sex, which should surprise us the less, in as much as among them impotency is very frequent, alcohol in large quantities always having a baneful effect on the sexual glands. In small quantities, to a certain extent, it may prove stimulating to these glands.
It is an interesting fact that in those with degenerated sexual glands there is always a greater liking for alcohol; thus women, after the menopause, have a greater predilection for spirits, and the greatest number of cases of drunkenness in women is to be observed among such. Eunuchs also have a greater inclination for intoxicating agents than have their more fortunate brethren who are still in possession of their sexual glands. We do not think that psychic impulses, consequent on such conditions, can be of sufficient influence to explain the craving for alcohol, except, perhaps, through the circumstance that persons deprived of the active sexual glands do not enjoy a high state of mental activity and are unable to judge of the fatal consequences of the drink habit. If women, after the menopause, exhibit a greater inclination to drink, we think it cannot be explained solely by their seeking to drown the sorrows of lost youth and by substituting for the pleasures of sexual life those of the bottle. This may certainly influence them to a certain degree, but in any case it is certain that without the possession of healthy sexual glands the desire for stimulants is greater; and it would seem also that in advanced age they can take alcohol more freely than in their prosperous younger days. Such persons have a partiality for strong sweet liqueurs. Happily such women are in a great minority. All we wish to point out is that it is among the older people that this craving exists, as in the younger ones alcohol cannot be so well borne.
From such observations on the greater frequency of the alcohol habit among persons suffering from degenerated conditions of the thyroid and sexual glands, and on its greater rarity in opposite conditions, we believe that some therapeutic hints may be gained. The best preventive against the alcohol habit (which is induced usually by the want of, and a real craving for, stimulants) will be the satisfying of this tendency by other means than alcohol. We can even prevent this craving if we can improve the state of their thyroid or sexual glands. For single persons marriage is an excellent stimulant, and a first-class psychic treatment as well. Treatment by means of thyroid gland can also give good results, as by this the mental condition will be improved and a cheerful disposition may be gained, which will enable them the better to withstand worry and depression after disappointment. At the same time the temperature of the body will be increased, a feeling of warmth produced, and fatigue much better borne. Thus no whip will be needed, and the craving for stimulants will be prevented. To women not only thyroid, but ovarian, extracts should be given. Both exercise a powerful influence on the mental condition, relieve depression, and remove the craving for constant stimulation. By these means we possess a basis for the rational treatment of alcoholism, besides the psychical and ethical one, on which we will not enter here. But we must emphatically remark that we must, in the first instance, get rid of the real cause of alcoholism, viz., the diseased condition of the thyroid and sexual glands which induces it, and by the removal of the cause we also remove the consequences. By merely forbidding the use of alcohol and doing nothing to cure the diseased condition which sets up such an insatiable craving for it, is like filling a barrel, which has a hole in it, with water, before we have tried to stop up the orifice.