Clinical Lecture on Alcoholism
Authors: S. Wilks
Journal: BMJ (1876)

THERE is no room for a lecture on t'Ois subject in the usual courses, except, perhaps, in that of Materia MIedica and Therapeutics, and therefore I take this opportunity of bringing it before you.The special interest in our case is that, in addition to the ordinary symptoms of chronic alcoholism, the patient has spinal paralysis.It is not uncommon for the cerebro-spinal system to be involved, yet it is not so sufficiently recognised as it should be, and tlherefore it is that I draw your attention more particularly to this case.I do not know of any subject that is of greater importance to consider, both with reference to diet and medicine, than that of alcohol.You must be well acquainted with the evil effects of drinking in this great city, whether you look in the medical wards and see the patients brought there through it; in the surgical wards, and notice the number of accidents resulting from it; in the prisons ; in the workhouses, where some of their wretched occupants owe their downfall from superior stations to it; or in the lunatic asylums, where 12 to 15 per cent. of the inmates have been broken down by it.The subject, therefore, must be one of the greatest importance.WNThat al e the physiological effects of alcohol?It is very remarkable how little we know of them, when it is considered what an enormous quantity of spirits is con- sumed.I believe twenty-five millions of gallons, at least, are made in this country every year.It is still disputed whether it acts as a food or not.A few years ago, it was said that it all passed out of the system as alcohol, or as some of its products of decomposition.These authorities, French chemists, said that it was eliminated by the skin, urine, breath, etc.They used chromate of potash, which is turned green by alcohol, as their test for it.I have read lately of a test in the French papers, where, to detect alcohol in the brain, this was boiled with benzoic chloride, and, if alcohol were present, it was changed into benzoic ether and recognised by its smell.But the amount of alcohol excreted in this way is so infinitesimal that the remainder must be in the body, and there can be no doubt that it is oxidised; and this supports Liebig's theory that it is a food for the lungs.Although it may not be directly a food, yet indirectly it might be so; for, if two men be taken, and one have nothing whatever to eat, and the other have alcohol given him, I presume the latter will re- main alive the longer.It must certainly be oxidised ; and persons who take a large quantity of spirits grow fat, as we shall pre- sently see.If, however, we do not understand its physiological workings, yet we can see the effects of it on the system for all practical and clinical pur- poses.In the first place, does alcohol appear to be a necessary food ?There can be but one answer.There are many nations who do not take it, and some whose religion forbids its use.Is it necessary for us?WVell, you know many in this country who do not take any.It is not a necessity then; it is for this we have to contend, and, if I can im- press this on you, the hour will not be wasted.English people are, however, too often brought up with the idea that it is a necessary article of diet.Patients will take their wine and spirits even when they are doing themselves harm, and, if you object, will ask, " What must they do?"You tell them to do without them ; to which they will reply that they must take something.I want you to get it tho- roughly out of your minds that there is any must in it, and start afresh with the idea of its non-necessity.Let children always live and grow up without alcohol: in after years, when we pass an artificial life, there may be reasons for taking it; but remember, even then it is not an absolute necessity.Start with this principle ; let your patient, even an adult, try to do without it, and then, and if circumstances seem to suggest it, let him have his glass of wine.I do not say that a number of persons can do entirely with- out any in our present mode of living, but let us regard alcohol in its true light, as a luxury, as we do tea, tobacco, etc.If we do this, we are safe.I cannot recommend you to live entirely by rules and natural laws, and give up all the conventional luxuries of life, for then * Reported by Mr. Alfred Pain.