Part 17

Similarly Rüdin found the effects of a single dose of alcohol to persist, as regards some forms of mental disturbance, for twelve hours, for other forms twenty-four hours, and for yet others thirty-six hours and more. But Rüdin's experiments bring out another aspect of the subject, which no one who considers the alcohol question in any of its phases should overlook: the fact, namely, that individuals differ greatly in their response to a given quantity of the drug. Thus, of four healthy young students who formed the subjects of Rüdin's experiment, two showed very marked disturbance of the mental functions for more than forty-eight hours, whereas the third was influenced for a shorter time, and the fourth was scarcely affected at all. The student who was least affected was not, as might be supposed, one who had been accustomed to take alcoholics habitually, but, on the contrary, one who for six years had been a total abstainer.

Noting thus that the effects of a single dose of alcohol may persist for two or three days, one is led to inquire what the result will be if the dose is repeated day after day. Will there then be a cumulative effect, or will the system become tolerant of the drug and hence unresponsive? Some experiments of Smith, and others of Kürz and Kraepelin have been directed toward the solution of this all-important question. The results of the experiments show a piling up of the disturbing effects of the alcohol. Kürz and Kraepelin estimate that after giving eighty grams per day to an individual for twelve successive days, the working capacity of that individual's mind was lessened by from twenty-five to forty per cent. Smith found an impairment of the power to add, after twelve days, amounting to forty per cent.; the power to memorize was reduced by about seventy per cent.

Forty to eighty grams of alcohol, the amounts used in producing these astounding results, is no more than the quantity contained in one to two litres of beer or in a half-bottle to a bottle of ordinary wine. Professor Aschaffenburg, commenting on these experiments, points the obvious moral that the so-called moderate drinker, who consumes his bottle of wine as a matter of course each day with his dinner--and who doubtless would declare that he is never under the influence of liquor--is in reality never actually sober from one week's end to another. Neither in bodily nor in mental activity is he ever up to what should be his normal level.

That this fair inference from laboratory experiments may be demonstrated in a thoroughly practical field, has been shown by Professor Aschaffenburg himself, through a series of tests made on four professional typesetters. The tests were made with all the rigor of the psychological laboratory (the experimenter is a former pupil of Kraepelin), but they were conducted in a printing office, where the subjects worked at their ordinary desks, and in precisely the ordinary way, except that the copy from which the type was set was always printed, to secure perfect uniformity. The author summarizes the results of the experiment as follows:

_A Loss of Ten Per Cent. in Working Efficiency_

"The experiment extended over four days. The first and third days were observed as normal days, no alcohol being given. On the second and fourth days each worker received thirty-five grams (a little more than one ounce) of alcohol, in the form of Greek wine. A comparison of the results of work on normal and on alcoholic days showed, in the case of one of the workers, no difference. But the remaining three showed greater or less retardation of work, amounting in the most pronounced case to almost fourteen per cent. As typesetting is paid for by measure, such a worker would actually earn ten per cent. less on days when he consumed even this small quantity of alcohol."

In the light of such observations, a glass of beer or even the cheapest bottle of wine is seen to be an expensive luxury. To forfeit ten per cent. of one's working efficiency is no trifling matter in these days of strenuous competition. Perhaps it should be noted that the subjects of the experiment were all men habituated to the use of liquor, one of them being accustomed to take four glasses of beer each week day, and eight or ten on Sundays. This heaviest drinker was the one whose work was most influenced in the experiment just related. The one whose work was least influenced was the only one of the four who did not habitually drink beer every day; and he drank regularly on Sundays. It goes without saying that all abstained from beer during the experiment. We may note, further, that all the men admitted that they habitually found it more difficult to work on Mondays, after the over-indulgence of Sunday, than on other days, and that they made more mistakes on that day. Aside from that, however, the men were by no means disposed to admit, before the experiment, that their habitual use of beer interfered with their work. That it really did so could not well be doubted after the experiment.

_The Effect of Beer-drinking on German School-children_

Some doubly significant observations as to the practical effects of beer and wine in dulling the faculties were made by Bayer, who investigated the habits of 591 children in a public school in Vienna. These pupils were ranked by their teachers into three groups, denoting progress as "good," "fair," or "poor" respectively. Bayer found, on investigation, that 134 of these pupils took no alcoholic drink; that 164 drank alcoholics very seldom; but that 219 drank beer or wine once daily; 71 drank it twice daily; and three drank it with every meal. Of the total abstainers, 42 per cent. ranked in the school as "good," 49 per cent. as "fair," and 9 per cent. as "poor." Of the occasional drinkers, 34 per cent. ranked as "good," 57 per cent. as "fair," and 9 per cent. as "poor." Of the daily drinkers, 28 per cent. ranked as "good," 58 per cent. as "fair," and 14 per cent. as "poor." Those who drank twice daily ranked 25 per cent. "good," 58% "fair," and 18 per cent. "poor," Of the three who drank thrice daily, one ranked as "fair," and the other two as "poor." Statistics of this sort are rather tiresome; but these will repay a moment's examination. As Aschaffenburg, from whom I quote them, remarks, detailed comment is superfluous: the figures speak for themselves.

Neither in England nor America, fortunately, would it be possible to gather statistics comparable to these as to the effects of alcohol on growing children; for the Anglo-Saxon does not believe in alcohol for the child, whatever his view as to its utility for adults. The effects of alcohol upon the growing organism have, however, been studied here with the aid of subjects drawn from lower orders of the animal kingdom. Professor C. F. Hodge, of Clark University, gave alcohol to two kittens, with very striking results. "In beginning the experiment," he says, "it was remarkable how quickly and completely all the higher psychic characteristics of both the kittens dropped out. Playfulness, purring, cleanliness and care of coat, interest in mice, fear of dogs, while normally developed before the experiment began, all disappeared so suddenly that it could hardly be explained otherwise than as a direct influence of the alcohol upon the higher centers of the brain. The kittens simply ate and slept, and could scarcely have been less active had the greater part of their cerebral hemisphere been removed by the knife."

_The Development of Fear in Alcoholized Dogs_

Professor Hodge's experiments extended also to dogs. He found that the alcoholized dogs in his kennel were lacking in spontaneous activity and in alertness in retrieving a ball. These defects must be in part explained by lack of cerebral energy, in part by weakening of the muscular system. Various other symptoms were presented that showed the lowered tone of the entire organism under the influence of alcohol; but perhaps the most interesting phenomenon was the development of extreme timidity on the part of all the alcoholized dogs. The least thing out of the ordinary caused them to exhibit fear, while their kennel companions exhibited only curiosity or interest. "Whistles and bells, in the distance, never ceased to throw them into a panic in which they howled and yelped while the normal dogs simply barked." One of the dogs even had "paroxysms of causeless fear with some evidence of hallucination. He would apparently start at some imaginary object, and go into fits of howling."

The characteristic timidity of the alcoholized dogs did not altogether disappear even when they no longer received alcohol in their diet. Timidity had become with them a "habit of life." As Professor Hodge suggests, we are here apparently dealing with "one of the profound physiological causes of fear, having wide application to its phenomena in man. Fear is commonly recognized as a characteristic feature in alcoholic insanity, and delirium tremens is the most terrible form of fear psychosis known," The development of the same psychosis, in a modified degree, through the continued use of small quantities of alcohol, emphasizes the causal relation between the use of alcohol and the genesis of timidity. It shows how pathetically mistaken is the popular notion that alcohol inspires courage; and, to anyone who clearly appreciates the share courage plays in the battle of life, it suggests yet another lamentable way in which alcohol handicaps its devotees.

_Is Alcohol A Poison?_

It is perhaps hardly necessary to cite further experiments directly showing the depressing effects of alcohol, even in small quantities, upon the mental activities, Whoever examines the evidence in its entirety will scarcely avoid the conclusion reached by Smith, as the result of his experiments already referred to, which Dr. Abel summarizes thus: "One half to one bottle of wine, or two to four glasses of beer a day, not only counteract the beneficial effects of 'practice' in any given occupation, but also depress every form of intellectual activity; therefore every man, who, according to his own notions, is only a moderate drinker places himself by this indulgence on a lower intellectual level and opposes the full and complete utilization of his intellectual powers." I content myself with repeating that, to the thoughtful man, the beer and the wine must seem dear at such a price.

To any one who may reply that he is willing to pay this price for the sake of the pleasurable emotions and passions that are sometimes permitted to hold sway in the absence of those higher faculties of reason which alcohol tends to banish, I would suggest that there is still another aspect of the account which we have not as yet examined. We have seen that alcohol may be a potent disturber of the functions of digestion, of muscular activity, and of mental energizing. But we have spoken all along of function and not of structure. We have not even raised a question as to what might be the tangible effects of this disturber of functions upon the physical organism through which these functions are manifested. We must complete our inquiry by asking whether alcohol, in disturbing digestion, may not leave its mark upon the digestive apparatus; whether in disturbing the circulation it may not put its stamp upon heart and blood vessels; whether in disturbing the mind it may not leave some indelible record on the tissues of the brain.

Stated otherwise, the question is this: Is alcohol a poison to the animal organism? A poison being, in the ordinary acceptance of the word, an agent that may injuriously affect the tissues of the body, and tend to shorten life.

Students of pathology answer this question with no uncertain voice. The matter is presented in a nutshell by the Professor of Pathology at Johns Hopkins University, Dr. William H. Welch, when he says: "Alcohol in sufficient quantities is a poison to all living organisms, both animal and vegetable." To that unequivocal pronouncement there is, I believe, no dissenting voice, except that a word-quibble was at one time raised over the claim that alcohol in exceedingly small doses might be harmless. The obvious answer is that the same thing is true of any and every poison whatsoever. Arsenic and strychnine, in appropriate doses, are recognized by all physicians as admirable tonics; but no one argues in consequence that they are not virulent poisons.

Open any work on the practice of medicine quite at random, and whether you chance to read of diseased stomach or heart or blood-vessels or liver or kidneys or muscles or connective tissues or nerves or brain--it is all one: in any case you will learn that alcohol may be an active factor in the causation, and a retarding factor in the cure, of some, at least, of the important diseases of the organ or set of organs about which you are reading. You will rise with the conviction that alcohol is not merely a poison, but the most subtle, the most far-reaching, and, judged by its ultimate effects, incomparably the most virulent of all poisons.

_Alcohol and Disease_

Here are a few corroborative facts, stated baldly, almost at random: Rauber found that a ten per cent. solution of alcohol "acted as a definite protoplasmic poison to all forms of cell life with which he experimented--including the hydra, tapeworms, earthworms, leeches, crayfish, various species of fish, Mexican axolotl, and mammals, including the human subject." Berkely found, in four rabbits out of five in which he had induced chronic alcohol poisoning, fatty degeneration of the heart muscle. This condition, he says, "seems to be present in all animals subject to a continual administration of alcohol in which sufficient time between the doses is not allowed for complete elimination." Cowan finds that alcoholic cases "bear acute diseases badly, failure of the heart always ensuing at an earlier period than one would anticipate." Bollinger found the beer-drinkers of Munich so subject to hypertrophied or dilated hearts as to justify Liebe in declaring that "one man in sixteen in Munich drinks himself to death."

Dr. Sims Woodhead, Professor of Pathology in the University of Cambridge, says of the effect of alcohol on the heart: "In addition to the fatty degeneration of the heart that is so frequently met with in chronic alcoholics, there appears in some cases to be an increase of fibrous tissue between the muscle fibers, accompanied by wasting of these tissues.... Heart failure, one of the most frequent causes of death in people of adult and advanced years, is often due to fatty degeneration, and a patient who suffers from alcoholic degeneration necessarily runs a much greater risk of heart failure during the course of acute fevers or from overwork, exhaustion, and an overloaded stomach, and the like, than does the man with a strong, healthy heart unaffected by alcohol or similar poisons."

It must be obvious that these words give a clue to the agency of alcohol in shortening the lives of tens of thousands of persons with whose decease the name of alcohol is never associated in the minds of their friends or in the death certificates.

Dr. Woodhead has this to say about the blood-vessels: "In chronic alcoholism in which the poison is acting continuously, over a long period, a peculiar fibrous condition of the vessels is met with; this, apparently, is the result of a slight irritation of the connective tissue of the walls of these vessels. The wall of the vessel may become thickened throughout its whole extent or irregularly, and the muscular coat may waste away as a new fibrous or scar-like tissue is formed. The wasting muscles may undergo fatty degeneration, and, in these, lime salts may be deposited; the rigid, brittle, so-called pipestem vessels are the result." Referring to these degenerated arteries, Dr. Welch says: "In this way alcoholic excess may stand in a causative relation to cerebral disorders, such as apoplexy and paralysis, and also the diseases of the heart and kidneys."

From our present standpoint it is particularly worthy of remark that Professor Woodhead states that this calcification of the blood-vessels is likely to occur in persons who have never been either habitual or occasional drunkards, but who have taken only "what they are pleased to call 'moderate' quantities of alcohol." Similarly, Dr. Welch declares that "alcoholic diseases are certainly not limited to persons recognized as drunkards. Instances have been recorded in increasing number in recent years of the occurrence of diseases of the circulatory, renal, and nervous systems, reasonably or positively attributable to the use of alcoholic liquors, in persons who never became really intoxicated and were regarded by themselves and by others as 'moderate drinkers.'"

"It is well established," adds Dr. Welch, "that the general mortality from diseases of the liver, kidney, heart, blood-vessels, and nervous system is much higher in those following occupations which expose them to the temptation of drinking than in others." Strumpell declares that chronic inflammation of the stomach and bowels is almost exclusively of alcoholic origin; and that when a man in the prime of life dies of certain chronic kidney affections, one may safely infer that he has been a lover of beer and other alcoholic drinks. Similarly, cirrhosis of the liver is universally recognized as being, nine times in ten, of alcoholic origin. The nervous affections of like origin are numerous and important, implicating both brain cells and peripheral fibres.

_How the Poison Works_

Without going into further details as to the precise changes that alcohol may effect in the various organs of the body, we may note that these pathological changes are everywhere of the same general type. There is an ever-present tendency to destroy the higher form of cells--those that are directly concerned with the vital processes--and to replace them with useless or harmful connective tissue. "Whether this scar tissue formation goes on in the heart, in the kidneys, in the liver, in the blood-vessels, or in the nerves," says Woodhead, "the process is essentially the same, and it must be associated with the accumulation of poisonous or waste products in the lymph spaces through which the nutrient fluids pass to the tissues. The contracting scar tissue of a wound has its exact homologue in the contracting scar tissue that is met with in the liver, in the kidney, and in the brain."

It is not altogether pleasant to think that one's bodily tissues--from the brain to the remotest nerve fibril, from the heart to the minutest arteriole--may perhaps be undergoing day by day such changes as these. Yet that is the possibility which every habitual drinker of alcoholic beverages--"moderate drinker" though he be--must face. This is an added toll that does not appear in the first price of the glass of beer or bottle of wine, but it is a toll that may refuse to be overlooked in the final accounting.

_Alcohol and Acute Infections_

In connection with experiments in rendering animals and men immune from certain contagious diseases through inoculation with specific serums, Deléarde, working in Calmette's laboratory in Lille, showed that alcoholized rabbits are not protected by inoculation, as normal ones are, against hydrophobia. Moreover, he reports the case of an intemperate man, bitten by a mad dog, who died notwithstanding anti-rabic treatment, whereas a boy of thirteen, much more severely bitten by the same dog on the same day, recovered under treatment. Deléarde strongly advises any one bitten by a mad dog to abstain from alcohol, not only during the anti-rabic treatment but for some months thereafter, lest the alcohol counteract the effects of the protective serum.

Similar laboratory experiments have been made by Laitenan, who became fully convinced that alcohol increases the susceptibility of animals to splenic fever, tuberculosis, and diphtheria. Dr. A. C. Abbott, of the University of Pennsylvania, made an elaborate series of experiments to test the susceptibility of rabbits to various micro-organisms causing pus-formation and blood poisoning. He found that the normal resistance of rabbits to infection from this source was in most cases "markedly diminished through the influence of alcohol when given daily to a stage of acute intoxication." "It is interesting to note," Dr. Abbott adds, "that the results of inoculation of the alcoholized rabbits with the erysipelas coccus correspond in a way with clinical observations on human beings addicted to the excessive use of alcohol when infected by this organism."

Additional confirmation of the deleterious effects of alcohol in this connection was furnished by the cats and dogs of Professor Hodge's experiments, already referred to. All of these showed peculiar susceptibility to infectious diseases, not only being attacked earlier than their normal companions, but also suffering more severely, This accords with numerous observations on the human subject; for example, with the claim made some years ago by McCleod and Milles that Europeans in Shanghai who used alcohol showed increased susceptibility to Asiatic cholera, and suffered from a more virulent type of the disease. Professor Woodhead points out that many of the foremost authorities now concede the justice of this view, and unreservedly condemn the giving of alcohol, even in medicinal doses, to patients suffering from cholera or from various other acute diseases and intoxications, including diphtheria, tetanus, snake-bite, and pneumonia, as being not merely useless but positively harmful. Even when the patient has advanced far toward recovery from an acute infectious disease, it is held still to be highly unwise to administer alcohol, since this may interfere with the beneficent action of the anti-toxins that have developed in the tissues of the body, and in virtue of which the disease has been overcome.

_The Ally of Tuberculosis_

Not many physicians, perhaps, will go so far as Dr. Muirhead of Edinburgh, who at one time claimed that he had scarcely known of a death in a case of pneumonia uncomplicated by alcoholism; but almost every physician will admit that he contemplates with increased solicitude every case of pneumonia thus complicated. Equally potent, seemingly, is alcohol in complicating that other ever-menacing lung disease, tuberculosis. Dr. Crothers long ago asserted that inebriety and tuberculosis are practically interconvertible conditions; a view that may be interpreted in the words of Dr. Dickinson's Baillie Lecture: "We may conclude, and that confidently, that alcohol promotes tubercle, not because it begets the bacilli, but because it impairs the tissues, and makes them ready to yield to the attacks of the parasites." Dr. Brouardel, at the Congress for the Study of Tuberculosis, in London, was equally emphatic as to the influence of alcohol in preparing the way for tuberculosis, and increasing its virulence; and this view has now become general--curiously reversing the popular impression, once held by the medical profession as well, that alcohol is antagonistic to consumption.