Alcoholism

The term alcoholism is understood to include all the changes that may occur in the human organism after the ingestion of any form of alcohol. These changes vary from the merest transient exhilaration of the cerebral functions up to profound unconsciousness, ending in coma and perhaps in death. These variations depend upon the amount of alcohol taken, the form of alcohol used, the rapidity of its administration, and the habituation of the individual to its effects. A vast amount of literature has grown up around the apparently simple question of the amount of alcohol which can be oxidized or burnt up in the body and its energy made available for the needs of the system. The question as to whether alcohol is really a food has also aroused much discussion and considerable diversity of opinion. The more accurate methods of study in recent days and the careful work now being done in physiological chemistry make it certain that alcohol can be burned in the body, and that the system may derive energy therefrom, as in the oxidation of sugar or fat. But it must be clearly understood that this statement does not carry with it the idea that alcohol is to be recommended for its food value, or that prior to its oxidation it may not exert some physiological action the reverse of beneficial. As a matter of fact, its disadvantages so far outweigh its useful effects, when taken as a food or beverage, that its use in this way must be emphatically condemned, while the damage that the consumption of alcohol does to man's nervous apparatus, to his intellect and will, and to his moral sense furnishes additional reason why abstinence, during health at least, should be man's rule of life. To appreciate fully the facts upon which this statement is based we must consider what alcohol is, its chemical composition, the forms of alcohol in common use, its physiological action in the human body, and its poisonous effects in excessive, or in long continued doses.

Alcohol is a liquid composed of ninety-one per cent by weight (94 by volume) of ethylic alcohol and of 9 per cent by weight (6 by volume) of water. Its specific gravity is 0.820 at 60 F. It is a transparent, colourless, volatile, and inflammable substance, with a characteristic, rather pungent, taste and odour. Ethylic alcohol is the alcohol of brandy, whiskey, wine, and the various spirits and cordials. Its effects upon the system are less dangerous than those of other alcohols, such as amylic, methylic, or butylic. During distillation of grain, unless very carefully conducted, considerable amylic alcohol (fusel oil) will pass over with the ethylic, especially if the process be continued too long. By keeping whiskey stored for several years the amylic alcohol becomes changed into various ethers, which impart the flavour to the spirit. Therefore grain-spirit (whiskey) should be at least two years old, and the spirit from fermented grapes (brandy) at least four years old. Wine is made by fermentation without distillation; red wine by fermenting the juice of coloured grapes in the presence of their skins, and white wine by fermenting the unmodified juice of the grape, free from seeds, stems, and stones. Gin is obtained by adding juniper berries to dilute alcohol. Rum, or molasses spirit, by distillation from sugar or molasses which has undergone alcoholic fermentation. Malt liquors -- ale, beer, porter, etc. -- are produced by fermentation of malt and hops. Absolutely pure alcohol is rarely found, even in the laboratory of the chemist. Owing to its great affinity for water, it will abstract it even from the air. What is known as absolute alcohol of the shops usually contains about 2 per cent of water. In order to estimate the effects of different forms of alcoholic liquors the following comparative strength should be remembered: Brandy, whiskey, rum, gin, cordials, 30 to 50 per cent of absolute alcohol; Spanish and Italian sweet wines, 13 to 17 per cent; hock and claret, 8 to 11 per cent; ale, porter, stout or beer, 4 to 6 per cent; koumyss, 1 to 3 per cent. Champagne contains from 8 to 10 per cent, but the presence of carbonic acid gas makes it more "heady," that is to say, the cerebral stimulation is produced more quickly, and the carbonic acid acts as a sedative to the stomach, making champagne especially serviceable where prompt stimulation is required and the stomach is irritable, as in seasickness or in yellow fever. Besides the open and undisguised alcoholic preparations cited above, there is a host of patent medicines, proprietary foods, tonics, and other nostrums advertised as entirely harmless and as containing no alcohol, and recommended for inebriates, for convalescents, and for persons weakened by disease. Analysis of many of these has shown alcohol in quantities ranging from 7 to 47 per cent. The use of these substances is having a tremendous, but unrecognized, influence, physical, economical, and moral, upon society at the present day. Although it is unquestionably true that alcohol may take the place of some fat or carbohydrate in the food, it is an extraordinary food, to be used only under certain conditions when its ease of oxidation may be of great benefit, and on account of its peculiar toxic effect it should not be taken except when needed. It has been compared to the furniture of a ship, together with its decks and stanchions, which are undoubtedly fuel substances, yet which no sane captain would use for fuel purposes, except in the direst need. Physiologically, it is both unwise and incorrect to advise that the continued use of alcohol in moderate doses is harmless. Alcohol, like salt water in a steam boiler, should be used only in emergencies. To understand this, we must consider its physiological action in the human body.

Physiologists now universally believe that the cell is the scene of all vital processes. The essential processes of nutrition are the metabolic changes which take place within the cells of the body, all other steps of nutrition being either antecedent or succedent accessories. The antecedent accessories of nutrition are the preparation of the food, its mastication, its deglutition, its digestion, its absorption, its distribution by the circulatory system, and its selection by the individual cells from the capillaries direct or from the tissue plasma. Physiologists and biologists believe that all foods are built up into protoplasm; that is, they are selected and made part of the living cell. A food must therefore satisfy the following conditions: First, it must be digestible and absorbable by the organism which it is to nourish; second, it must be assimilable by the living cells of the organism, in order to build up new tissue; third, after assimilation it must be capable of catabolic changes accompanied by oxidation, in order to liberate energy; fourth, the energy must be liberated at such a time and place as to be advantageous and beneficial to the organism. It is not enough to prove that potential chemical energy is changed into kinetic energy. The oxidation must take place at the right time and place, before the energy liberated can be useful in function. All food is tissue-building in its assimilation; all food is energy-yielding in its catabolism. The only points alcohol possesses in common with the foods are two: first, it is oxidized within the body; secondly, it diminishes carbonaceous and perhaps proteid catabolism -- the so-called "sparing" action of alcohol. This "sparing" is accompanied by an accumulation of the carbonaceous materials of the body and an actual deposit of fat. But this condition is brought about by reducing the activity of the cell by the narcotic effect of the alcohol, and is not in any sense to be compared with the increased demand for food by the cell, resulting from proper mental and physical exercise and all conditions which favour vigorous nutrition. Yet the advocates of alcohol as a food in health base upon their physiological misconceptions a superstructure of fallacious reasoning.

A detailed consideration of the effects of alcohol upon the individual organs and tissues will perhaps elucidate the foregoing statements. Applied to the skin, alcohol excites a sense of heat and superficial inflammation if evaporation be prevented. It coagulates the albumen and hardens the animal textures. If evaporation is not prevented, the surface temperature is reduced. The lining of the mouth is corrugated by it -- a result due to the abstraction of water and condensation of the albumen. In the stomach it causes a sensation of warmth which is diffused over the abdomen and quickly followed by a general glow of the body. In moderate quantity, it induces an increased blood-supply which enables the mucous follicles and gastric glands to produce a more abundant secretion of stomach juices. When habitually taken, a gastric catarrh is established with the production of a fluid abnormal both in quantity and quality. The increased blood supply also sets up irritation of the structural framework (connective tissue) of the stomach, resulting in its overgrowth, with the crowding out of the working-cells, which gradually shrink. Alcohol also affects directly the chemistry of the gastric secretion by precipitating the pepsin -- a necessary ferment to the digestion of albuminoid food. The abnormal mucus, which is elaborated in great quantity, sets up pathological fermentation in the starchy saccharrine and fatty elements of the food, giving rise to acidity, heartburn, regurgitation of food, and a peculiar retching in the morning.

Alcohol enters the blood with great facility, and probably almost all taken into the stomach passes into the blood from this organ, and goes directly to the liver by way of the portal vein. In the liver, it increases at first the functional activity of the working-cells, and a more abundant production of bile is the result. Frequent stimulation and consequent overaction result in impairment or loss of the proper function of the part, as is the universal law. The liver cells shrink, the structural framework increases in size at first but subsequently contracts, producing the small, nodular, hard liver, to which the term cirrhosis has been applied. Alcohol also diminishes the normal storage of glycogen, leaving less to draw upon when needed by the system during stress. In small doses alcohol increases the action of the heart and the cutaneous circulation; a slight rise of temperature is observed, and all the functions are for the time being more energetically performed. On the nervous system its first effect is to increase the functional activity of the brain; the ideas flow more easily, the senses are more acute, the muscular movements more active. With increased action of the alcohol, the excitement becomes disorderly, the ideas incoherent and rambling, the muscular movements uncontrolled and inco-ordinated. With an excessive quantity, the functions of the cerebrum are suspended, and complete unconsciousness results. By an extension of the poisonous influence to the nervous centres governing respiration and circulation, these functions may cease, and death result. Alcohol has a special affinity for nervous tissue, and as a result chiefly of its direct contact, but partly from its effects on the blood current, the working cells of the brain shrink, the supporting structure hardens, the cerebrospinal fluid, which should act as a protective water-jacket, increases in quantity and exerts injurious pressure. giving the familiar picture of "wet brain" so common in the autopsy room of hospitals caring for large numbers of habitual drunkards. Existing in a less degree, these brain changes are objectively shown in the impaired mental power, the muscular trembling, the shambling gait, and the lack of moral sense of the chronic drinker. Delirium tremens is a variety of alcoholism occurring in some subjects from sudden excess of a periodical kind, in others from a failure of the stomach to dispose, not only of food, but of the accustomed stimulus, and in another group -- common in hospitals and jails -- to sudden deprivation of liquor in steady drinkers when under confinement for injury or crime. Idiosyncrasy is an important factor in the causation of delirium tremens, as is also the use of alcoholic beverages rich in fusel oil -- like the cheaper whiskeys. The long-continued action of alcohol on the nervous system produces many other chronic disorders. Loss of sensation, epilepsy, motor-paralysis, and blindness often result from alcoholic excess. It is probable that if alcohol could be stamped out for a century insanity would shrink in prevalence seventy-five per cent. The best and latest authorities all agree that the action of alcohol upon the nervous system is always that of a narcotic, whether the dose be large or small. On the bodily temperature there is no longer any doubt that alcohol produces a reduction, after the primary and transient sensation of heat has passed away. All northern explorers know that the use of alcohol endangers life through cooling of the body. It is useful, in the form of hot drink, to revive a person who has been exposed to cold, but only after the exposure has ceased. Dr. Parkes, in the Ashantee campaign, found that the fatigue of marching in the tropics is better borne without the aid of a spirit ration. The power of alcohol to diminish muscular work and agility is so well known that athletes rigorously abstain during training, and the records of the prize-ring demonstrate that only the pugilist who has no alliance with alcohol is able to remain in the game.

There is no difference of opinion among physiologists regarding the facts of the action of alcohol in the human body. They differ strenuously regarding the conclusions to be drawn from these facts, some contending that alcohol is a "partial food when taken in moderate quantities". Modern knowledge justifies the belief that in health it is never a food in any sense, be the quantity large or small, but always a poison, biologically or physiologically speaking; in disease it is neither a food nor a poison, but may be a suitable and helpful drug. It should be rightly called what it rightly is, a drug, and not a drink; a narcotic, and not a tonic. Its use as a drug will then be rightly restricted, as in the case of other drugs, to the intelligent direction of men upon whom the State imposes, at the present day, rigid restrictions as to preliminary education, supplemented by study of the technical knowledge of the profession of medicine. Its uses in disease are many, but their consideration does not come within the scope of this article. There are cases of typhoid fever, pneumonia, and diphtheria in which alcohol is a most valuable help, and in some other conditions its use may be advisable. Careful observations of its effects, in private practice and in extensive hospital experience, compel the writer to subscribe to this conclusion: "Alcohol in health is often a curse; alcohol in disease is mostly a blessing." From a sociological standpoint, we are compelled by incontrovertible evidence to acknowledge that it is of all causes the most frequent source of poverty, unhappiness, divorce, suicide, immorality, crime, insanity, disease, and death.

CHITTENDEN (Yale). Medical News, 22 April, 1905; SHOEMAKER, Materia Medica and Therapeutics (Philadelphia, 1894); BEEBE, New York Medical Journal (15 April. 1905); FOSTER, Textbook of Physiology (London, 1898); FLINT, Handbook of Physiology (New York, 1905); BARTHOLOW, Materia Medica and Therapeutics (New York 1903); HALL, Journal of the American Medical Association (14 July, 1900); ATWATER, Physiological Aspects of the Liquor Problem (Boston, 1903); WELCH, Physiological Aspects of the Liquor Problem (Boston, 1903); BUNGE, Physiologische und Pathologische Chemic (1894), 124; NAMMACK, Alcohol in Typhoid Fever in Medical Record (28 April, 1906); PEABODY, Alcohol in Disease, in Medical News (22 April, 1905); O'GORMAN, Scientific Valuation of Alcohol in Health (London, 1900).

CHARLES EDWARD NAMMACK