On the use and abuse of alcoholic liquors, in health and disease

Front matter

S&t* oJ/

YALE MEDICAL LIBRARY

HISTORICAL LIBRARY

Chapter I. Page

What are the Effects, Corporeal and Mental, of Alcoholic

Liquors on the healthy Human System? 25

Sect. I. — Influence of Alcohol upon the Physical, Chemical and Vital Properties of the Animal Tissues and

Fluids 25

Corrugation of Tissues 25

Coagulation of Albumen 26

Impairment of solidifiability of Fibrine 27

Irritating action on Living Tissues 27

Temporary exaltation of Nervous Power 28

Change in red Corpuscles 29

Sect. II. — Immediate Consequences of the Excessive Use of

Alcoholic Liquors on the General System 30

Phenomena of Alcoholic Intoxication 30

Symptoms and Post-mortem appearances of Alcoholic poisoning 32

Pathology of Alcoholic Intoxication 34

Sect. III. — Remote consequences of the excessive Use of Alcoholic Liquors 38

Diseases of the Nervous System 88

Delirium Ebriosum 88

2 (xiii)

XIV CONTENTS.

PAGE

Delirium Tremens 39

Insanity 42

Oinomania 45

Mental Debility in the Offspring 48

Inflammatory Diseases of the Brain 60

Apoplexy 50

Paralysis and Epilepsy 52

Diseases of the Alimentary Canal 53

Irritation and Inflammation of the Mucous Membrane of the Stomach 54

Inflammatory Gastric Dyspepsia 57

Disorders of the Intestinal Mucous Membrane.. 58

Diseases of the Liver 59

Acute and Chronic Inflammation of the Liver... 59

Hypertrophy and Atrophy of the Liver GO

Diseases of the Kidneys Gl

Diseases of the Skin G2

General Disorders of Nutrition 63

Tendency to the Deposition of Fat 64

Diminished Power of Sustaining Injuries by

Disease or Accident 65

Liability to Epidemic Diseases 67

Gout and Rheumatism 68

Diseases of the Heart and Arteries G9

Spontaneous Combustion 69

Sect. IV. — General effect of the Excessive Use of Alcoholic

Liquors on the Duration of Life 71

Experience of Insurance Offices 72

Specially injurious influence of Excess in Warm Climates 73

Statistics of the Indian Army 75

CONTENTS. XV

Chapter II. Page

Does Physioloqy or Experience teach us that Alcoholic Liquors should form part of the ordinary sustenance of man, particularly under circumstances of exposure to severe labour, or to extremes of temperature ? or, on the other hand, is there reason for believing that such use of them is not sanctioned by the principles of science, or by

the results of practical observation? 81

Sect. I. — Endurance of Bodily Exertion 81

Sect. II. — Endurance of Mental Exertion 92

Sect. III. — Endurance of Cold 96

Sect. IV.— Endurance of Heat 108

Sect. V. — Resistance to Morbific Agencies 118

Sect. VI. — Consequence of the Habitual " Moderate " Use of

Alcoholic Liquors 123

Effect upon the Stomach 128

Effect upon the Nervous System 130

Effect upon the Circulation 132

Effect upon Nutrition 135

Chapter III

Are there any special modifications of the bodily or mental condition of man, short of actual disease, in which the occasional or habitual use of Alcoholic Liquors may be necessary or beneficial ? 138

Sect. I. — Demand for Extraordinary Exertion 138

Sect. II. — Deficiency of other Adequate Sustenance 142

Sect. III. — Deficiency of Constitutional Vigour 145

Pregnancy j. 150

Lactation 151

Childhood 154

Old Age 155

XVI CONTENTS.

Chapter IV

paob

Is the Employment op Alcoholic Liquors necessary in the Practice of Medicine? if so, in what diseases, or in what form and stages of disease, is the use op them necessary or

beneficial? 161

Sect. I. — Recovery from Shock 161

Sect. II. — Treatment of Acute Diseases 162

Resistance to the depressing influence of Morbific

Agents 162

Recovery from states of Prostration 164

Support under Exhausting Drains 160

Forms of Alcoholic Liquors most desirable 167

Sect. III. — Treatment of Chronic Diseases 168

Appendix A 172

PEEFACE,

The circumstances under which the following Essay is given to the Public, are sufficiently explained by the preceding Advertisement and Adjudication ; but the Author takes this opportunity of offering a short statement of the objects which he had especially in view in its composition.

The questions set forth in the Advertisement having been evidently drawn up with great care, and having been obviously intended to bring the whole subject of the ordinary as well as the medical employment of Alcoholic Liquors under discussion, the Author judged it advisable to follow the plan which they had marked out, by answering each of them seriatim ; ' although he was aware that, by so doing, a certain amount of repetition would be almost necessarily involved. He found, as he proceeded, that it would be impossible to maintain such a continuity in his argument, as would be desirable for its effectiveness ; and he would therefore request his readers, in limine, 2 to keep the following issue in view, as those to which he is desirous of leading them.

In the first place, — That from a scientific examination of the modus operandi 3 of Alcohol upon the Human body, when taken in a poisonous dose, or to such an extent as to produce Intoxication, we may fairly draw inferences with regard to the specific' effects

1 Seriatim — in order. a In limine — at the outset.

* Modus operandi — the mode or way in which it acts. 4 Specific — peculiar. 2 * (xvii)

XV111 PREFACE.

which it is likely to produce, when repeatedly taken in excess, but not to an immediately-fatal amount.

Secondly, — That the consequences of the excessive use of Alcoholic liquors, as proved by the experience of the Medical Profession, and universally admitted by medical writers, being precisely such as the study of its effects in poisonous and immediately-fatal doses would lead us to anticipate, we are further justified in expecting that the habitual use of smaller quantities of these liquors, if sufficiently prolonged, will ultimately be attended, in a large proportion of cases, with consequences prejudicial to the human system, — the morbid actions thus engendered being likely rather to be chronic,' than acute, 2 in their character.

Thirdly, — That as such morbid actions are actually found to be among the most common disorders of persons advanced in life, who have been in the habit of taking a " moderate" allowance of alcoholic liquors, there is very strong ground for regarding them as in great degree dependent upon the asserted cause ; although the long postponement of their effects may render it impossible to demonstrate the existence of such a connexion.

Fourthly, — That the preceding conclusion is fully borne out by the proved results of the " moderate" use of Alcoholic liquors, in producing a marked liability to the acute forms of similar diseases in hot climates, where their action is accelerated by other conditions ; and also by the analogous facts now universally admitted, in regard to the remotely-injurious effects of slight excess in diet, imperfect aeration of the blood, 3 insufficient repose, and other like violations of the Laws of Health, when habitually practised through a long period of time.

Fifthly, — That the capacity of the healthy Human system to sustain as much bodily or mental labour as it can be legitimately called upon to perform, and its power of resisting the extremes of Heat and Cold, as well as other depressing agencies, are not augmented by the use of Alcoholic liquors ; but that, on the other

' Chronic — slow; of long continuance.

* Acute — rapid in progress.

3 Aeration of the blood — the change produced in the blood by its being brought in contact with the atmospheric air during its passage through the lungs.

PREFACE. XIX

hand, their use, under such circumstances, tends positively to the impairment of that capacity.

Sixthly, — That where there is a deficiency of power, on the part of the system, to carry on its normal 1 actions with the energy and regularity which constitute health, such power can rarely be imparted by the habitual use of Alcoholic liquors ; its deficiency being generally consequent upon some habitual departure from the laws of health, for which the use of Alcoholic liquors cannot compensate ; and the employment of such liquors, although with the temporary effect of palliating the disorder, having not merely a remotely-injurious effect per se, 2 but also tending to mask the action of other morbific 3 causes, by rendering the system more tolerant of them.

Seventhly, — That, consequently, it is the duty of the Medical Practitioner to discourage as much as possible the habitual use of Alcoholic liquors, in however " moderate" a quantity, by all persons in ordinary health ; and to seek to remedy those slight departures from health, which result from the "wear and tear" of active life, by the means which shall most directly remove or antagonize their causes, instead of by such as simply palliate their effects.

Eighthly, — That whilst the habitual use of Alcoholic liquors, even in the most "moderate" amount, is likely (except in a few rare instances) to be rather injurious than beneficial, great benefit may be derived in the treatment of Disease, from the medicinal use of Alcohol in appropriate cases ; but that the same care should be employed in the discriminating selection of those cases, as would be taken by the conscientious practitioner in regard to the administration of any other powerful remedy which is poisonous in large doses. —

The foregoing appear to the Author to be the conclusions legitimately deducible from the facts and arguments which he has brought forwards; it will be for his Professional readers to decide, how far the case which he has made out is sufficiently strong to lead them

1 Normal — appropriate; proper; healthy. 'Per se — by or of themselves. 1 Morbific — disease-producing.

XX PREFACE.

to the same results. This much, however, he would add; that when he first eitered upon the investigation, some years ago, he had adopted r» foregone conclusion, and had, consequently, no temptation to make the facts square with preconceived views ; that he has constantly endeavoured to treat the subject as one of purely scientific inquiry, and has avoided mixing up any other considerations with those which presented themselves to him as a Physiologist and a Physician ; and that, for the sake of keeping himself free from even the appearance of partizanship, he has never allied himself with any one of the Societies, which have been formed to carry into practical effect the Total Abstinence principle, but has preferred to follow a perfectly independent course. He ventures to hope that on these grounds he may claim some right to being candidly heard, by those to whom this Essay is more especially addressed.

He cannot allow it to go forth, however, without expressing his conviction, that, whilst there are adequate Medical reasons for Abstinence from the hahilual use of even a " moderate " quantity of Alcoholic liquors, there are also strong Moral grounds for Abstinence from that occasional use of them, which is too frequently thought to be requisite for social enjoyment, and to form an essential part of the rites of hospitality. The experience of every Practitioner must bring the terrible results of Intemperance frequently before his eyes ; but whilst he is thus rendered familiar with its consequences as regards individuals, few, save those who have expressly enquired into the subject, have any idea of the extent of the social evils resulting from it, or of the degree in which they press upon every member of the community. The Author believes that he is justified in the assertion, that among those who have thus enquired, there is but one opinion as to the fact, that, of all the causes which are at present conspiring to degrade the physical, moral, and intellectual condition of the mass of the people, there is not one to be compared in potency with the Abuse of Alcoholic liquors; and that, if this could be done away with, the removal of all other causes would be immeasurably promoted. Every one who wishes well to his kind, therefore, must be interested in the enquiry how this monster-evil can be best eradicated.

Now the Author considers, that the best answer to this enquiry has been found in the results of experience. A fair trial has been

PREFACE. XXI

given, both in this country and in the United States, to societies which advocated the principle of Temperance, and which enlisted in their support a large number of intelligent and influential men ; but it has been found that little or no good has been effected by them, among the classes on whom it was most desirable that their influence should be exerted, except where those who were induced to join them really adopted the Total Abstinence principle. Though he agrees fully with those who maintain, that if all the world would be really temperate, there would be no need of Total Abstinence Societies, the Author cannot adopt the inference that those who desire to promote the Temperance cause may legitimately rest satisfied with this measure of advocacy. For sad experience has shown, that a large proportion of mankind cannot, partly for want of the self-restraint which proceeds from moral and religious culture, be temperate in the use of Alcoholic liquors ; and that the reformation of those who have acquired habits of intemperance cannot be accomplished by any means short of entire Abstinence from fermented liquors. Further, experience has shown that, in the present dearth of effectual education among the masses, and with the existing temptations to Intemperance arising out of the force of example, the almost compulsory drinking-usages of numerous trades, and the encouragement which in various ways is given to the abuse of Alcoholic liquors, nothing short of Total Abstinence can prevent the continuance, in the rising generation, of the terrible evils which we have at present to deplore. And lastly, experience has also proved that this reformation cannot be carried to its required extent, without the co-operation of the educated classes ; and that their influence can only be effectually exerted by example. There is no case in which the superiority of example over mere precept is more decided and obvious, that it is in this. "I practise total abstinence myself," is found to be worth a thousand exhortations; and the lamentable failure of the advocates who cannot employ this argument, should lead all those whose position calls upon them to exert their influence, to a serious consideration of the claims which their duty to society should set up, in opposition to their individual feelings of taste or comfort.

Among the most common objections brought against the advocates of the Total Abstinence principle, is the following, —''That

XXJi PREFACE.

the abuse of a thing good in itself does not afford a valid argument against the right use of it." This objection has been so well met by the late Archdeacon Jeffreys of Bombay, (in a letter to the Bombay Courier,) that, as it is one peculiarly likely to occur to the mind of his Medical readers, the Author thinks it desirable to quote a part of his reply. — "The truth is," he says, "that the adage is ODly true under certain general limitations ; and that out of these, so far from being true, it is utterly false, and a mischievous fallacy. And the limitations are these : — If it be found by experience, that, in the general practice of the times in which we live, the abuse is only the solitary exception, whereas the right use is the general rule, so that the whole amount of good resulting from its right use exceeds the whole amount of evil resulting from its partial abuse, then the article in question, whatever it bo, is fully entitled to the benefit of the adage ; and it would not be the absolute and imperative duty of the Christian to give it up on account of its partial abuse. This is precisely the position in which stand all the gifts of Providence, and all the enjoyments of life ; for there is not one of them which the wickedness of man does not more or less abuse. But, on the other hand, if it be found by experience that there is something so deceitful and ensnaring in the article itself, or something so peculiarly untoward connected with the use of it in the present age, that the whole amount of crime, and misery, and wretchedness connected with the abuse of it greatly exceeds the whole amount of benefit arising from the right use of it; then the argument becomes a mischievous fallacy, the article in question is not entitled to the benefit of it, and it becomes the duty of every good man to get rid of it." After alluding to the evidence that this is pre-eminently the case with regard to Alcoholic liquors, the Archdeacon continues, — " We have then established our principle, in opposition to the philosophic adage ; taking the duty of the citizen and the patriot, even on the lowest ground. But Christian self-denial and Christian love and charity, go far beyond this. St. Paul accounted one single soul so precious, that he would on no account allow himself any indulgence that tended to endanger a brother's soul. ' If meat make my brother to offend, I will eat no meat while the world standeth, lest I make my brother

PREFACE. XXU1

to offend.' — ' It is good neither to eat flesh nor to drink wine, nor anything whereby thy brother stumbleth, or is offended, or is made weak.' And we must bear in mind that flesh and wine are here mentioned by Paul as 'good creatures of God;' they are not intended to designate things evil in themselves. This saying of St. Paul is the Charter of Teetotalism ; and will remain the charter of our noble cause so long as the world endures, so long as there remains a single heart to love and revere this declaration of the holy self-denying Paul."

If, then, the Author should succeed in convincing his readers, that the " moderate" habitual use of Alcoholic liquors is not beneficial to the healthy Human system, — still more, if they should be led to agree with him that it is likely to be injurious, he trusts that they will feel called upon by the foregoing considerations, to advocate the principle of Total Abstinence, in whatever manner they may individually deem most likely to be effectual. He believes it to be in the power of the Clerical and Medical Professions combined, so to influence the opinion and practice of the educated classes, as to promote the spread of this principle among the "masses," to a degree which no other agency can effect. And he ventures to hope that, whether or not he carries his readers with him to the full extent of his own conclusions, he will at any rate have succeeded in convincing them that so much is to be said on his side of the question, that it can no longer be a matter of indifference what view is to be taken of it ; and that as " universal experience" has been put decidedly in the wrong with regard to many of the supposed virtues of Alcohol, it is at any rate possible, that its other attributes rest on no better foundation. In his general view of the case, he has the satisfaction of finding himself supported by the recorded opinion of a large body of his Professional brethren; upwards of two thousand of whom, in all grades and degrees, — from the court physicians and leading metropolitan surgeons, who are conversant with the wants of the upper ranks of society, to the humble country practitioner, who is familiar with the requirements of the artizan in his workshop, and the labourer in the field, — have signed the following certificate : —

Xxiv PREFACE.

" We, the undersigned, are of opinion —

" 1. That a very large proportion of human misery, including poverty, disease, and crime, is induced by the use of Alcoholic or fermented liquors as beverages.

" 2. That the most perfect health is compatible with Total Abstinence from all such intoxicating beverages, whether in the form of ardent spirits, or as wine, beer, ale, porter, cider, &c, &c.

" 3. That persons accustomed to such drinks may, with perfect safety, discontinue them entirely, either at once, or gradually after a short time.

" 4. That Total and Universal Abstinence from Alcoholic beverages of all sorts would greatly contribute to the health, the prosperity, the morality, and the happiness of the human race."

No medical man, therefore, can any longer plead the singularity of the Total Abstinence creed, as an excuse for his non-recognition of it; and although a certain amount of Vnoral courage may be needed for the advocacy and the practice of it, yet this is an attribute in which the Author cannot for a moment believe his brethren to be deficient. Judging from his own experience, indeed, he may say that he has found much less difficulty in the course he has taken, than he anticipated when he determined on it ; and that he has met with a cordial recognition of its propriety, not merely on the part of those who participated in his opinions but did not feel called upon to act up to them in their individual cases, but also among others who dissented strongly from his scientific conclusions, and who consequently had no more sympathy with his principles than with his practice.

London, March, 1850.

ON ALCOHOLIC LiaUORS.