# Popular Science Monthly/Volume 33/June 1888/The Effects of Moderate Drinking

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* THE EFFECTS OF MODERATE DRINKING.
By GEORGE HARLEY, M. D., F. R. S.
IT is because of there being at present such diverse views expressed regarding the influence moderate drinking has on the constitution, that I am tempted to contribute my mite of knowledge to the general stock, in the hope that what I relate may suggest new ideas in the minds of others who, like myself, are interested in the study of this intricate question. For I regret to find that, notwithstanding there has already been so much written, and well written, on the action of alcohol when taken in excess, no one appears as yet to have thought it worth his while fully to tackle the subject of moderate drinking. The reason of this, perhaps, is not far to seek, seeing that a little reflection reveals the fact that, although the majority of persons may truthfully be said to be moderate drinkers, and consequently medical men see far more patients belonging to this category than any other, they possess but very little opportunity of studying the effects of alcohol, when thus indulged in, upon the constitution, for the following reasons: 1. There
​are not only no tables of statistics as to its effects in existence, but there are no means of acquiring them; the statistics of the effects of drunkenness, of which there are abundance of greater or lesser value, being unfortunately of no service whatever in solving the problem of the effects of moderate drinking either on mind or body. 2. In no instance are the effects sufficiently marked to necessitate any special form of treatment in a public institution. 3. The deleterious influences on the bodily functions are so insidious as in the early stages either totally to escape detection, or, what is more common, to lead them to be attributed to some entirely different cause. 4. The effects of moderate drinking manifest themselves in such a variety of different forms, that, even when their true nature is recognized, the general practitioner has not the opportunity of seeing a sufficient number of any one of them to admit of his drawing conclusions from them. 5. The men who have most experience of the severer forms of functional disease directly traceable to the effects of moderate drinking are, in general, merely those who, like myself, make liver and kidney diseases a special study; the liver, kidneys, heart, and brain being those organs of the body most affected by alcohol when indulged in within the limits of what is called moderation. Notwithstanding this fact, it being impossible for me, or even any one else specially engaged in the treatment of liver and kidney diseases, to collect a sufficiently large number of telling cases from which to deduce crucial data of the deleterious effects of small quantities of alcoholic stimulants habitually indulged in by temperate men, I purpose adopting the plan of drawing conclusions from the statistical data of the effects of alcohol on the human constitution when it is taken in the form of what is called "nipping"—that is to say, small quantities only being taken at a time, but frequently in the course of the day. Of these, fortunately, the registrar-general's reports of our national mortality in different industries furnish us with something approaching to reliable data. So I shall make use of them, along with some German statistics of a similar character, in illustrating the probable pathological effects of moderate drinking on the human constitution. For when one can not get what he wants, it is good policy to make use of what he has got, on the principle that half a loaf is better than none. 6. Added to all these drawbacks to the formulation of reliable conclusions regarding both the direct and indirect effects of alcoholic stimulants, taken in small quantities at a time, upon the vital functions, there is yet the other of reconciling different minds with what is exactly meant by the term "moderate drinking," seeing that a quantity which one would call moderate is not at all unlikely to be by another designated immoderate ​drinking. Before attempting to define the intrinsic value of the two words, let me remind the reader that the mere use of the term "moderate," when applied to anything whatever—whether it be to walking exercise, or anything else—implies that it is merely a relative and consequently a fluctuating quantity, according to the capabilities of the individual and the circumstances of the case; for a moderate walk to a weak person is quite a different thing from a moderate walk to an athlete. So the term "moderate drinking," when applied to a girl in her teens, is something quite different from the term "moderate drinking" when applied to a robust man. Consequently its intrinsic value is not to be measured by quantity, but by the effects; and fortunately, as every thinking being is capable of doing this for himself, it is quite unnecessary for me to fix upon any given quantity, but merely to say that by moderate drinking I mean the indulging in alcoholic stimulants well within the margin of intoxication. I shall, for the present, confine my remarks on the effects of moderate drinking to those more particularly observed on the four important and indispensable organs of the body—namely, the liver, kidneys, heart, and brain.
Although all persons who indulge in alcoholic stimulants well within the margin of actual drunkenness speak of themselves as "moderate drinkers," there are two special classes of them which bear no resemblance to each other, except in the one solitary circumstance that they never at any time take sufficient to intoxicate themselves. The one class is that which only partakes of stimulants while eating; the other indulges in them between meal-times. To the latter habit is applied in this country the title of "nipping," while in the East it is spoken of as "pegging." And this is the most pernicious of all forms of drinking, from the fact that stimulants taken without at the same time partaking of food, though only imbibed in small quantities at a time, have most deleterious effects on the internal organs. A man who habitually indulges in a single glass of sherry in the forenoon, a brandy-and-soda in the afternoon, and a glass of whisky-and-water in the course of the evening—for reasons presently to be explained—does far more injury to his constitution than one who partakes of a larger quantity of alcoholic stimulants at meal-times. That this is not a mere ideal opinion evolved from the realms of fancy, but one founded upon an indisputable basis, I shall show by reference to the tables of mortality furnished by the registrar-general in his annual reports. As there, unfortunately, exist no especial tables of mortality from this form of moderate drinking, I have adopted the plan of estimating its effects on health by comparing the ​death-rates given in the reports of persons who, in the course of their vocations, are exposed to the temptation of taking small quantities of alcoholic stimulants between meal-times, with the recorded death-rates of those, at the same ages, whose trades and modes of life do not so expose them. And the results are, I think, perfectly conclusive. For they not only furnish us with a comparative absolute average death-rate in the two sets of cases, but, in no ambiguous language, point out the exact organs of the body that are most affected by nipping, and give us the relative proportions of the deleterious influence it has upon each of them.
First, then, as regards the influence of "nipping" on the liver and kidneys—the two organs of the body not only more immediately affected, but most closely corelated, from the fact that when the one is diseased the other has to perform its functions, as best it can, vicariously. Seeing that the average proportion of drunkards is about the same in all industries, when it is considered on such a vast scale as over the whole nation's strength, I scarcely think any one will doubt the trustworthiness of the results as revealed in the subjoined tables:"Supplement to the Forty-fifth Annual Report," 1885, p. 82.
Death-Rate of Men between the Ages of 25 and 65.
| Men exposed to the temptations of "nipping." | Liver diseases. | Urinary diseases |
| Commercial travelers | 61 | 44 |
| Brewers | 96 | 55 |
| Innkeepers, publicans, vintners, barmen, and waiters | 240 | 83 |
The comparative death-rates of men of the same age engaged in other industries, not exposed to the temptation of "nipping," are, again, as follows:
| Death-rate of men not exposed to the temptations of "nipping." | Liver diseases. | Urinary diseases |
| Gardeners and nurserymen | 18 | 39 |
| Printers | 28 | 30 |
| Farmers and graziers | 41 | 31 |
| Drapers and warehousemen | 35 | 37 |
As an addendum to these most telling statistics, I think I can not do better than quote what Baer says regarding the probabilities of life in persons exposed to the temptations of "nipping" compared with that of those not liable to be so tempted. The following is extracted from his table of Prussian statistics, and I arrange them for the sake of easy comparison in two parallel columns, showing the probable duration of life calculated at different ages:
| AGE. | PROBABLE DURATION OF THE LIFE OF MEN. | PROBABLE DURATION OF THE LIFE OF MEN. |
| AGE. | In the liquor trade. | Not in the liquor trade. |
| 25 | 26·23 | 32·08 |
| 35 | 20·01 | 25·92 |
| 45 | 15·19 | 19·92 |
| 55 | 11·16 | 14·45 |
| 65 | 8·04 | 9·72 |
This, as is seen, is an equally instructive table.
To return for a moment to the part played by the so-called moderate use of alcoholic stimulants in the production of fatal forms of liver-disease. As it is, I think, impossible that we as medical men can know too much regarding the probable deleterious effects of mere "nipping," I here subjoin an extract from the registrar-general's tables of the comparative mortality from liver-diseases in different industries, between the ages of twenty-five and sixty-five, in the years 1880-'82, which exhibits the matter in a stronger light than any words of mine can possibly do:
| Bookbinders | 3 | Butchers | 21 |
| Booksellers | 4 | Fishermen | 22 |
| Hatters | 9 | Brewers | 42 |
| Tobacconists | 10 | Innkeepers, publicans, vintners, wait- | 197 |
| Druggists and printers | 18 | ers, and barmen | 197 |
| Gardeners and miners | 19 | | |
The result here shown is so startling that the registrar-general not inappropriately designates it as "appalling," seeing that the proportion of deaths from liver diseases is in reality six times greater among men exposed to the temptations of "nipping" than in that of all the other industries combined—the actual figures being: For brewers, 1,361; for vintners and other salesmen of wines, spirits, and beers, 1,521; and for waiters and barmen (those most exposed to temptation), no less than 2,305: whereas, for maltsters, who are only concerned with the materials from which intoxicants are manufactured, and not with the intoxicating liquids themselves, the death-rate is only 830. Nothing could be more conclusive of the deleterious effects of so-called moderate drinking on the human constitution than this; for, as all different effects in this world originating in identical causes are but relative, it is readily seen how a lesser proportion of "nipping," though giving rise to lesser results, must nevertheless cause a proportionate amount of cases of disease in the liver and kidneys to those given in the above tables.
Notwithstanding the familiarity of medical men with the fact that many cases of hepatitis, chronically enlarged liver, and cirrhosis are directly traceable to inebriety, few, I fancy, can have ​been prepared, without some special acquaintance with, the subject, for the information furnished, by the foregoing mortality tables of the potent action of alcohol on the liver, when only taken in small quantities at a time. And, although it may at first sight appear strange that the liver of all the organs of the body should be most potently affected by moderate drinking, I think one can scarcely be surprised at this if he is acquainted with the peculiar action of alcohol introduced into the liver by the portal vein. For it requires, I think, but a small amount of reflection on the part of those acquainted with the mechanism of digestion to understand how alcohol, when taken into the stomach, even in small quantities at a time, is a powerful agent in the production of hepatic disease. Seeing that most of the liquid products of our food are carried directly from the intestines to the liver by the portal vein, it consequently follows that almost every drop of the alcohol, be it small or be it great, taken into the stomach must be directly conveyed by the portal vein to the liver, and compelled to filter through its tissues before it can possibly get into the general circulation and reach any of the other organs of the body. The knowledge of the fact that all the imbibed alcohol is directly conveyed to the liver by the portal circulation not only gives a clew to why alcoholic stimulants are so prone to induce hepatitis, as well as to increase the formation of sugar and aggravate diabetes, but to bring about an attack of gout; seeing that the liver is regarded as the main source of both sugar and uric acid—the supposed gout-forming material. In addition to which, the direct conveyance of alcohol to the liver affords us a reasonable explanation of why alcohol taken along with the food is so much less detrimental to the constitution than when it is taken on an empty stomach. Moreover, it is now a well-known fact that the continuous excitement of the liver, kept up by habitual "nipping," is far more injurious to its functions than an occasional outburst of drunkenness followed by intervals of strict sobriety. It equally accounts for the fact that the liver is not alone the first organ of the body that becomes affected, but is at the same time the one most seriously disordered by moderate drinking.
The effects on the kidneys of moderate drinking are far less apparent than upon the liver; nevertheless, they are sufficiently marked to merit attention. The reason why the kidneys suffer so much less from the imbibed alcohol when it is taken in only small quantities at a time is sufficiently obvious, seeing that a large quantity of what passes through the liver never reaches the kidneys at all, from a considerable part of it having been eliminated by the breath during its passage in the blood through the lungs. That intemperance is a fruitful source of Bright's ​disease has long been known, and the reason of this is not far to seek, seeing that it is the special duty of the kidneys to eliminate alcohol from the general circulation—as they do all other foreign materials. And the more work that is thrown upon an organ, the more prone are its tissues to become degenerated. Not only, however, do we know that the kidneys eliminate the imbibed alcohol (from its being met with in urine), but we likewise know that alcohol, as alcohol, saturates the renal tissue to such an extent that I and others have been able to obtain pure alcohol from the kidneys of persons who have died intoxicated by the simple process of distillation. Besides all this, however, there is a special reason why the kidneys should become diseased in so called moderate drinking; and that is on account of the circulation being incessantly increased in them, as it is elsewhere, from the accelerated heart's action induced by the repeated imbibition of stimulants in small quantities. For no doubt the diameter of the renal blood-vessels is augmented by their engorgement, and consequently they exert a deleterious pressure on the intervascular tissues, which will interfere with their proper nourishment. While, further, this engorgement of the renal vessels will render the kidneys more liable to the injurious effects of chills; and chills are, as is well known, the most fruitful cause of kidney disease. This view of the case appears to me to give not only the clew to the reason why Bright's disease is so particularly common among the inebriate, but likewise why transient attacks of albuminuria are so frequently met with in moderate drinkers, among both men and women. Spirit-drinking is said to be mainly instrumental in inducing the variety of renal disease named granular kidney; while beer-drinking is, on the other hand, thought to be most potent in bringing about fatty degeneration of the renal tissues. Be that as it may, I well know, from a long experience of urinary affections, that even small quantities of alcohol habitually indulged in sometimes bring on most troublesome forms of albuminuria, without there being any well marked symptoms of the existence of either granular or fatty degeneration of the tissues of the kidneys.
Alcohol, when taken in small quantity, is in general said to act as a direct cardiac stimulant, and its stimulating effect is supposed to be due to its possessing the faculty of increasing the muscular power of the heart. I take an entirely different view of the matter, and shall now endeavor to show how the increase in the force of the heart's movements, the quickening of the pulse, the flushing of the face, the congestion of the retinal blood-vessels, as well as all the other visible appearances of accelerated cardiac functional activity, are in reality in no wise due to the stimulating action of alcohol, either on the heart's ​muscular tissue or the nerves supplying it, but actually to the very reverse—namely, its paralyzing effects on the cardiac nerve mechanism. This may appear a strange idea to those unfamiliar with the advanced theories regarding the accelerating and restraining heart's nerve-forces. Nevertheless, it is quite consonant with the results of modern physiological investigations, which go far to prove that every function of organic life—no matter whether it be the expulsion of the urine, the peristaltic movements of the intestines, the throbbings of the heart, or involuntary respiration—acts under the immediate influence of a bifold nerve mechanism. For example, the human heart is endowed with two entirely different and opposing centers of nerve-force, and so retroactive are their respective functions that the sole duty of the one appears to be to regulate and control the functions of the other. To the former has been given the name of inhibitory or restraining mechanism; to the latter that of the exciting or accelerating nerve agency. Destroy or paralyze the inhibitory nerve-center, or arrest its power of communicating with the heart by dividing the vagus, and instantly its controlling effect on the cardio-motor mechanism is lost, and the accelerating agent, being no longer under its normal restraint, runs riot. The heart's action is increased, the pulse is quickened, an excess of blood is forced into the vessels, and from their becoming engorged and dilated the face gets flushed and the retina congested—all the usual concomitants of a general engorgement of the circulation being the result. Instead of paralyzing the vagus by section, and thereby arresting its inhibitory cardiac nerve-power; paralyze it through the instrumentality of a toxic agent, and precisely the same chain of phenomena will of necessity be the result. The most powerful paralyzer of the vagus we at present know of is atropia; and what happens when it is given in a full dose? Nothing more or less than the effects we have here attributed to the section of the vagus—tumultuous heart's action, quickened pulse, congested face and eyes, etc. Alcohol acts on the heart, I believe, in precisely the same manner as atropia does, although less strongly; that is to say, it quickens the heart's action, as well as apparently increases its power, by paralyzing its restraining or inhibitory nerve mechanism. This, however, is only the primary action of alcohol on the cardiac organ, for no sooner is the quantity administered sufficiently increased than all its at first apparently stimulating effects vanish. From its now possessing adequate power to paralyze the accelerating as well as the retarding cardiac nerve mechanism, the heart's action, therefore, now becomes diminished pari passu with the amount of the paralyzing agent employed, until at length (if a sufficiency be given) the cardiac ​movements are totally arrested, and death closes the scene. Effects on the human organism being, when properly interpreted, like effects in the inorganic world—exactly proportionate to cause—the at first sight apparently stimulating and consequently salutary action of alcohol on the heart, when taken in moderation, is as much due to the alcohol's paralyzing power as the destruction of all vital action is its result when it is taken in poisonous quantities. From this, however, it is not to be inferred that its incipient paralyzing power over the inhibitory cardiac nerve mechanism must necessarily be in all cases detrimental. On the contrary, it may actually in many instances be beneficial. Just in the same way as atropia, strophantus, digitalis, and daturine—which are all cardiac inhibitory nerve paralyzers—prove exceedingly useful medicinal agents when they are judiciously employed in appropriate cases. So alcohol, by the doctor's skill, may in like manner be so used as to paralyze to cure, and not to kill.
It being well known that intemperance is a most fruitful cause, not only of all the various forms of heart-disease, but likewise of the degenerations of the coats of the blood-vessels, all I at present require to do is to prove that even what is called moderate drinking has a much greater share than is generally supposed, in not only greatly increasing heart-diseases, in cases where they already exist, but also in inducing their development in the constitutionally and hereditarily predisposed to become affected by them. The reason why moderate drinking should induce not only hypertrophy and dilatation, but likewise valvular disease of the heart, is not far to seek—from its being a recognized fact that every increase in a muscle's activity is associated with an increase in its development, as well as its tension on the parts with which it is connected. The truth of the foregoing statements will, by a little reflection, be gleaned from the results of drinking small quantities of alcohol frequently during the day, as manifested by the figures in the subjoined table of mortality I have drawn up from the registrar-general's reports, of the relative frequency of diseases of the circulatory system among men between the ages of twenty-five and sixty-five employed in different industries. For it not only shows the effects of so-called moderate drinking per se, but likewise the still more pernicious effects of it when it is associated with intermittent muscular strain—that is to say, when the stimulus of alcohol upon the heart has superadded to it an increase in the heart's activity necessitated by oft-repeated sudden muscular ​efforts; for while it shows that all exposed to the partaking of alcoholic stimulants in small quantities at a time are much more frequently affected with the fatal forms of cardiac diseases than others, it in an equally unmistakable way shows that men who, like brewers, require in the course of their trades to tax their muscular strength, and thereby throw additional work upon their hearts, are far more often attacked with the fatal forms of diseases affecting the circulatory system than men equally addicted to imbibe alcoholic stimulants, but who are not called upon to make similar kinds of straining muscular efforts.
The relative proportions of deaths from diseases of the circulatory system in the different classes are:
| Those not exposed to the temptation of drinking. | Those not exposed to the temptation of drinking. | Those exposed by their vocations to the temptation of drinking. | Those exposed by their vocations to the temptation of drinking. |
| Drapers and warehousemen | 75 | Commercial travelers | 100 |
| Gardeners and nurserymen | 82 | Vintners, waiters, and barmen | 146 |
| Printers | 93 | Brewers | 165 |
Moreover, it is equally known that intemperance is a most active agent in the induction of atheromatous (fatty granular) degenerations in the coats of the arterial system, and as such a fruitful source not only of death by cardiac syncope, but likewise by apoplexy, from the cerebral vessels being quite as frequently and as severely affected with the degeneration as those of the heart itself, and the coats of the one set being as liable to sudden rupture as those of the other, if not, indeed, even more so, from the less solid nature of the brain surroundings. I wish now to call special attention to what I believe to be a fact—namely, that what is termed "moderate drinking" is a far more general cause of atheromatous degeneration of the coats of the blood-vessels than is usually supposed.
It is, I believe, next to impossible to overrate the desirability of impressing patients laboring under heart-disease, as well as atheromatous degenerations of the blood-vessels, with the absolute necessity of being extremely temperate in the use of alcoholic stimulants, if they wish either to live long or to ameliorate the disease of the circulatory system under which they labor. For alcohol taken in the form of spirits—brandy, whisky, gin, or rum—even in teaspoonful doses, by increasing the heart's action has quite as pernicious an effect on the organic structural disease, be its form what it may, as belladonna itself. And I fancy all who have much experience with cardiac diseases know well the intrinsic significance of this remark.
In the early stages of organic disease of the heart or blood-vessels judicious regimen is quite as essential to the well-being of the patient as wise treatment: for, if the case be skillfully handled, it is not only possible for death to be long averted, but ​even the effects of the organic changes reduced, and, like the cracked jug which goes often to the well, the life of the patient may be prolonged for years; while, on the other hand, if the true nature of the case fail to be early recognized, and the patient goes on living as if there were nothing the matter with him, the disease rapidly advances, and ere long the time arrives when it is utterly beyond human power to avert a more or less suddenly fatal ending.
After having so forcibly pointed out the baneful effects of even small quantities of stimulants in diseases affecting the heart and blood-vessels, I think it is time for me to show that in these cases the laws of therapeutics are not, like those of the Medes and Persians, unalterable. This arises from the fact that even the same forms of organic disease affecting the circulatory system occasionally differ very materially in their characters as well as in their course, not only from the special constitutional peculiarity of the patient, but likewise in a marked degree from the different circumstances under which he is placed; so that stimulants may be employed in one case as a useful adjunct to other treatment, in spite of their being absolutely forbidden in another. In all cases, however, their employment can only be sanctioned under medical advice, for, from its being always much easier to put a thing wrong than to set a thing right, therapeutical combined with pathological knowledge can alone be safely intrusted to decide whether or not alcohol can be given with either advantage or with safety in any given case of cardiac disease. Even here, however, some general rules for alcoholic treatment can be notified; for there is no doubt whatever that, in all cases of cardiac syncope, spirits, in the shape of brandy, rum, whisky, or gin, are potent heart revivers, especially when there exists no actual organic disease of the organ. And even in certain cases where there are valvular derangements alcoholic stimulants may be had recourse to with marked benefit. Moreover, from the fact of alcohol being a powerful anti-flatulent, there is scarcely a single case of organic disease of the heart in which it may not sometimes be administered in small quantities at a time with marked advantage.
Finally, I think it may be said that the various facts adduced appear to prove—1. That alcohol, when indulged in, even well within the limits of intemperance, has a most prejudicial effect on heart-disease. 2. That sudden spurts of muscular exertion act most deleteriously on all forms of organic cardiac affections. 3. That mental excitement is a cause of rupture of atheromatous blood-vessels. 4. That a mere extra-distension of a stomach by wind may suffice to fatally arrest a diseased heart's action. The knowledge of these facts has for some years past led me to make ​it an invariable rule to impress upon all patients laboring under diseases of the circulatory system, who desire to minimize the effects of their complaints and ward off as long as is possible the inevitably fatal termination, to pay strict attention to what I call the following three golden rules: 1. Take exercise, without fatigue; 2, nutrition, without stimulation; and, 3, amusement, without excitement.
As the consideration of the effects of alcohol on the brain, when taken in excess, lies entirely outside of the scope and purport of this essay, I at once proceed to call attention to the as yet but imperfectly known subject of the influence of small quantities of alcohol on brain-diseases. And it being my desire to make the effects of moderate drinking as strikingly apparent as is possible, as there are no statistics of the effects of it forthcoming, I fall back upon the data furnished in the registrar-general's reports regarding the comparative ratio of mortality from diseases of the nervous system occurring among men between the ages of twenty-five and sixty-five in different industries. For they tell so startling a tale of the baneful effects of taking small quantities of alcoholic stimulants frequently during the day, that no one accustomed to analyze results deducible from collateral evidence can fail to appreciate their intrinsic value in the elucidation of the point in hand. The registrar-general's reporttells us that the relative mortality is as follows:
| Men exposed to the temptations of "nipping." | Diseases of the nervous system. |
| Commercial travelers | 139 |
| Brewers | 144 |
| Innkeepers, publicans, wine, spirit, and beer dealers | 200 |
| Men exposed to the temptations of "nipping." | Diseases of the nervous system. |
| Gardeners and nurserymen | 63 |
| Farmers and graziers | 81 |
| Printers | 90 |
| Drapers and warehousemen | 109 |
The above figures speak to the reflecting mind in no ambiguous language, so that I need make no comment upon them save to call special attention to the fact of diseases of the nervous system being so much more common among drapers and warehousemen than among the equally indoor occupation of printers: the only tentative explanation which I dare venture to adduce from this fact Toeing that, as it is worry, little fidgeting mental worries, that conduce more than mental work (not excessive) to shatter the nerves, the high percentage of diseases of the nervous system met with among drapers and warehousemen is possibly due to their being more liable to be mentally harassed in the ​course of their daily vocations than printers, who are as a rule not subjected to anything like a similar class of petty annoyances during their work, no matter how arduous it may be.
That after the liver and the heart the brain should be the next organ of the body which suffers most from the injurious effects of alcohol when taken in small quantities at a time is no more than what might be expected. Indeed, I think it is even less, seeing that alcohol acts injuriously upon nerve-tissues in three distinctly different ways: First, through its chemical action upon the blood; second, by disordering the liver's functions and causing the bile to accumulate in the circulation, and thereby poison the brain and nerves; and, third, by its accelerating the heart's action, and thus sending an increased supply of blood to the brain—every increase in an organ's blood-supply being associated with a corresponding increase in the functional activity of the organ.
The increase of the cerebral circulation consequent upon the increase in the heart's action from the imbibition of small quantities of alcohol acts prejudicially, however, upon the brain in yet another way—namely, by its causing an engorgement and dilatation of the cerebral arteries. For, seeing that Nicol and Mossop found that so small a quantity as two teaspoonfuls of absolute alcohol caused marked congestion of the retinal blood vessels—which derive their blood-supply from the same source as the cerebral vessels—it is natural to infer that even the small quantity of two teaspoonfuls of alcohol will induce the same amount of congestion in the branches of the blood-vessels within the cranium as it does in those immediately outside of it; and if so, seeing that the organ is confined within a limited space and surrounded on all sides by unexpansible ridged walls, by their engorgement and dilatation they must of necessity press injuriously upon the brain-substance. The pressure thus exerted on the nerve-cells and fibers will not only prevent their performing their functions properly, but at the same time interfere with their nourishment, and consequently lead to a degeneration of their constituents. The deleterious effects of congestion of the intercranial blood-vessels are rendered apparent to us in yet another way—namely, by the feelings of fullness or tightness of the head experienced by many persons after partaking of alcoholic stimulants. Moreover, it appears to me that the facts just alluded to afford a reasonable explanation of why it so often happens that persons who indulge in small quantities of spirits while engaged in arduous mental labor frequently suffer from a sudden mental breakdown, notwithstanding that the immediate effect of the stimulants had appeared to be beneficial to them by increasing their brain-power. My explanation of the cause of ​the mental collapse is, that the brain, like every other organ of the body, while in a state of functional activity, draws to it a super-supply of blood, and consequently, when alcohol is taken, it adds to the already existing engorgement of the cerebral vessels arising directly from the brain's activity, by accelerating the heart's action, and thereby augmenting its deleterious effects by still further increasing the pressure exerted on the nerve-cells and fibers by the already dilated and engorged vessels.
We shall now for a moment glance at the injurious effects of small quantities of alcohol exerted on the brain through the intermedium of the hepatic derangements that stimulants induce.
The very large number of nerve affections, more especially in the form of intellectual disturbances, which come under the notice of liver specialists, are in a great measure attributable to the disorder of the biliary functions brought about by the habitual indulgence in small quantities of alcohol between mealtimes; for, as is well known, scarcely a more formidable cerebral poison than bile exists.
Sometimes one learns from a patient a great deal which he may turn to account in the treatment of others; and one of the things a patient taught me was the marvelously depressing after-effects that a single glass of spirits will occasionally produce in a bilious subject. A leading member of our own profession, who is a martyr to biliousness, made a number of experiments upon himself regarding the depressing after-effects of alcoholic stimulants, and he tells me that he has repeatedly found that a single glass of gin, whisky, or brandy, taken diluted with water, either at dinner-time or in the evening, when he is bilious, and feels exhausted after his day's work, will be followed in from five to fifteen hours with such a morbid depression of spirits that he scarcely knows what to do with himself; yet the primary effect of the stimulant is, he says, not only refreshing but exhilarating. This, although an exceptional case in so far as its severity is concerned, is but the type of many others that have come under my notice; for some have said that a single tablespoonful of brandy, whisky, or gin, will induce depressing aftereffects when their livers are out of order.
The only way in which I can account for this depressing aftereffect of small quantities of alcohol, when taken by bilious persons, is by imagining that the small amount has the power to exert a more than usual deleterious influence on the cerebral tissues in consequence of their having been already materially weakened by the direct poisonous effects exerted on the nerve tissues by the bile in the circulation. I am led to this opinion from noticing how much less the depressing after-effects of spirits become so soon as the liver's functions are put to rights. ​The brain and liver disorders induced by alcohol thus appear to be as closely correlated as those of liver and kidney. The mere fact of a splitting headache following upon a debauch in the case of a strong, healthy man, and a frontal or an occipital pain succeeding the drinking of a single glass of sherry in a nervously weak one, may be regarded, I think, as proof positive of the detrimental effects of alcohol on the nerve-tissues, as well as lead us to suppose that it is most probably due to the compression of the nerve-cells and fibers, which, as I have above tried to explain, may probably arise from the alcohol accelerating the heart's action, and thereby increasing the circulation in the intercranial vessels.
This statement necessitates the making of another—namely, that atheromatous degenerations of both the cardiac and cerebral blood-vessels are particularly common among men of great muscular and mental activity, who are in general spoken of as "good livers."
I have now to call attention to what appears to be a reverse kind of preliminary alcoholic effect on the nervous system—namely, that which is observed in the incipient stage of intoxication, and is almost invariably spoken of as a pleasant instead of a disagreeable sensation. Although I imagine that when a small quantity of an alcoholic stimulant is taken, the pleasurable feelings experienced may be probably entirely due to its increasing the cerebral circulation, I nevertheless think that when the amount taken is sufficient to be ultimately able to lead to complete unconsciousness, the preliminary stage of the intoxication, which has been described by some as one of sweet sans souci, is simply the offspring of a blunting of nerve sensibility—in fact, merely a partial or incipient stage of cerebro-spinal paralysis; precisely in the same way as feelings of a pleasing calm are oftentimes felt to precede the total unconsciousness of refreshing sleep, and soothing sensations of agreeable beatitude have been described as their feelings by persons who after a lingering illness have quietly and peacefully slipped away into eternity. In all of these cases the pleasurable sensations experienced are merely, I believe, due to the gradually increasing negation of nerve-sensibility.
Lastly, as regards the deleterious influence that small quantities of alcoholic stimulants exert upon the brain-tissues through the power they possess of so acting on the nerve-pabulum in the blood as to prevent its taking up oxygen and exhaling carbonic acid, and thereby becoming fitted for the purposes of brain nutrition. Alcohol does this exactly in the same way, though to a somewhat lesser extent, as opium. This is well shown by the results obtained from a series of experiments I performed on the ​subject some years ago, a full account of which, was laid before the Royal Society, and published in its "Transactions" in 1864, under the title of "The Action of Physical and Chemical Agents upon the Blood, with Special Reference to the Respiratory Process."
The relative effects of alcohol and opium were found to be as follows:
| IN 100 PARTS OF AIR. | Oxygen. | Carbonic acid. | Nitrogen. | Vol. at 0° C. and 1 metre pressure. |
| Composition of employed air | 20·9 | 0·002 | 79·038 | 20·96 |
| With pure ox-blood | 10·58 | 3·330 | 86·00 | 14·91 |
| With pure ox-blood + 5 per cent of alcohol | 16·59 | 2·380 | 81·03 | 18·97 |
| With pure calf's-blood | 6·64 | 3·47 | 89·89 | 10·11 |
| With pure calf's-blood + ·005 grm. of morphia | 17·17 | 1·00 | 81·83 | 18·17 |
A glance at this table suffices to show that alcohol, even in the small proportion of five per cent, exerts a powerful chemical effect on blood, so powerful as to entirely derange one of its most important functions—namely, the function of respiration. The alcohol seems to have acted like an asphyxiant, inasmuch as it has not alone diminished the power of the red corpuscles to absorb oxygen, but to exhale carbonic acid, and that too in the same way, though to a somewhat lesser extent than morphia does. This peculiar chemical action of the alcohol on the blood nerve-pabulum may be thought to give a reasonable explanation of the paralyzing action of alcohol upon the nervous system, seeing that oxidation is the motor power of all vital action, and in direct proportion to its activity are the manifestations of life accelerated or retarded. Every breath we draw, every movement we perform, every thought . we think, is but the outcome of the transformation of matter under the influence of oxygen. If, then, it be true, as above shown, that alcohol possesses the power of preventing the constituents of the blood from being properly oxidized, and thereby fitted for the purposes of nutrition, it is easy to account for its producing a chain of more or less well-marked neurotic symptoms terminating at last in coma and death.—Abridged from the London Lancet.
* ↑ "Deutsche med. Wochenschrift," January 20, 1887.
* ↑ Supplement to the forty-fifth Annual Report, 1885, which takes in the whole previous ten years' death-rates, and may consequently be accepted as yielding a reliable average.
* ↑ Supplement to the forty-fifth Annual Report, 1885.