THE

BRITISH AND FOREIGN

MEDICO-CHIRURGICAL REVIEW.

JULY, 1876.

Analytical and Critical Reviews.

I. The Use of Alcohol.1

THE evil deeds of Alcohol against both the individual and society are so glaring and noisy, that orators and writers are sorely tempted to dwell on them with an exclusiveness which overshadows any inquiry into its possible virtues. In his 'Diseases of Modern Life,' Dr. Richardson piles up the usual heavy indictments against this article of diet, enumerating the various pathological conditions consequent on its excessive employment; but he does not allude to the diseases it may have warded off, the lives it may have lengthened, and the misery it may have lightened. The best he can say of it is that it is a "pleasant shroud," implying thereby that its shadow is as the shadow of death, a decent dress for a self-dug grave. We must decline to accept the unsavory association, and prefer to appropriate Sancho Panza's proverb to an use he would not condemn, "Blessed be the man who invented" alcohol, as well as

1 1. Diseases of Modern Life. By BENJAMIN W. RICHARDSON, M.D. London, 1876.

2. Les Alimens d'Epargne, Alcool, &c. Par le Dr. A. MARVAUD. Paris, 1874.

3. On the Issue of a Spirit Ration during the Ashanti Campaign of 1874. By E. A. PARKES, M.D., Professor of Military Hygiene in the Army Medical School, &c. London, 1875.

4. Observations on the Effect of Cuca, or Coca, the leaves of the Erythroxylon Coca. By Sir R. CHRISTISON, Bt., M.D. Brit. Med. Journal,' April 29, 1876. 5. The Non-Alcoholic Treatment of Disease. Notes of cases treated at the London Temperance Hospital, with introductory remarks and supplementary suggestions. London, 1876.

6. De l'Alcoolisme. Par le Dr. V. MAGNAN. Paris, 1874. 7. Alcoolisme. Par Dr. E. LANCEREAUX.

Médecine et de Chirurgie,' 1865.

115-LVIII.

'Dictionnaire Encyclopédique d

1

sleep; it wraps a man up like a cloak." Like a cloak it impedes the skill of the limbs, it smothers the voice, and its final consequence if used during exertion is increased weariness; like a cloak too it may by excess stifle us altogether, or lessen the vigour of our life. But also, like a cloak, it sweetens and renders more renewing our rest, it soothes the wear and tear of sorrow, pain, and ill humour, and after bodily or mental toil or sickness it may often make just the difference between good health and ill health, between life and death.

The most conspicuous of the primary actions of alcohol is a dynamic narcosis of the ultimate fibres of the nerves of sensation and vaso-motion-most conspicuous because exhibited in the cutaneous surface under our eyes. The sense of touch is rested by being relieved of its extreme acuteness, and the muscular tone of the capillaries is relaxed, so that they dilate, and weaken the current of blood, which congestion (like those from all other causes) is accompanied by increased frequency of cardiac contraction and of respiration. We are all familiar with the slight numbness of the upper lip and insensitiveness of the face to cold or heat quickly experienced by a temperate person after a glass of spirits, and the flushed skin and perceptible sharpness of the pulse following the narcosis.

The sluggishness of the blood-current has a corresponding effect on the mucous membranes; their endosmosis is arrested, and thus oxidation within the organism and nutrition are retarded in proportion to the dose of the agent. At the same time alcohol turns aside to its own profit and conversion some of the oxygen contained in the body, and thus spares the tissues from the destructive assimilation to which this oxygen would otherwise have subjected them. It may in this sense be fairly called a "saving food "-un aliment d'épargne.

As part of the alcohol disappears by oxidation in the body, it is in some sense partly a calorific agent; but then the increase of temperature so originated is not enough to outweigh the loss determined by that which remains unconverted in the blood; so that there is a decided tendency to lose animal heat evinced after the ingestion of distilled liquors; which indeed is very marked if the quantity be large, though the anesthesia prevents its being recognized by the sufferer.

Now, few probably will deny that there are circumstances, by no means of unfrequent occurrence, when it must contribute to the well being of the individual to modify the nutrition and other vital acts of the body in the directions indicated above. But a great many will dissent from the opinion that it is wise to employ the means thus placed at our disposal. They say you are paying too much for your whistle, that the retardation of the

blood-current and the relaxation of the capillaries necessarily tend to permanent organic lesions, latent indeed but insidious, and aggravated by each additional dose in proportion to its frequency. The risk that these histological changes should be permanent, or at least that each repetition of them should leave permanent deterioration behind it appears to them very great; it appears to Dr. Richardson so great, that he affirms the only way to avoid the probability of shortening one's life by alcohol is to abstain from alcohol wholly and entirely; to sacrifice altogether the blunting of pain, the calming of anxiety, the refreshment after toil, the softening of sleep, the renewal of the appetite, the gladdening of the heart, the smoothing of the temper, which the temperate man day after day puts to the credit of fermented drinks. The ease is a phantom profit; it vanishes like fairy gold and leaves an enhanced heap of pains behind. To render the sufferer insensible to this accumulating sorrow a larger and a larger dose is daily requisite, or else an amount of self-denial has to be exercised which is in itself a serious evil. Such is the serious allegation.

Here, beyond all question, lies the main matter to be decided by the physiologist. Is the risk a real risk? Are the chemical changes in the flesh and blood wrought by alcohol permanent or dynamic? With those who hold that dynamic or functional acts do not exist, this is not the place to argue-they may fairly demand more space than is possible here to have their doubts dealt with. But conceding that there are certain processes which affect the body, especially the nervous system, for a time, and then leave it exactly in the same state it was before, with the same expectation of life, so far as the said process is concerned, then the initial phenomena produced by alcohol may reasonably be classed among such processes. Experience seems to prove that its action may prevent the destructive agencies of a rugged life from paining and injuring the body for a time, and that during the respite thus obtained the tissues may be renewed by rest more completely than had no alcohol been taken. Appetite and vigour are restored, and the langour due to the exhaustion of labour is not felt. The reactionary langour which certainly follows excess is never consequent on moderate doses. The blessing does its quiet duty, and nothing more is known of it. A vast army of respectable working men of all classes, from the peer to the peasant, take their allowance of alcohol at one or two principal meals daily from youth up to extreme old age, without the slightest wish ever to increase its quantity or strength.

Everybody knows too well that there are also many to whom moderation is a distasteful state, and to whom the only beauty

of alcohol lies in its abuse. To them Dr. Richardson's is truly a sage warning, and we sincerely hope that the sadly true picture he draws in burning words of the fatal effects of increasing the dose of alcohol in obedience to the morbid craving of a vitiated taste, will be read by all who have ever experienced this temptation. Let each one strictly examine his own conscience, and if he finds that the more he drinks the more he wants to drink, if the memory of the moments of intoxication is attractive to him, let him forswear for ever the use of alcohol, for he will not be able to shun the abuse. But do not let him insist upon his example being followed by others, whose self-restraint allows them freely to enjoy the gifts of nature without risk. And let him not denounce as traitors to the cause of temperance those who try by observation to find out and define what are the essential qualities which have so long caused alcohol to be valued by the human race, and have caused it to be valued in spite of its acknowledged evils.

An opportunity of rare value for obtaining answers to physiological and social questions is often afforded by that concentration of healthy men under strict discipline and observation which we find in an army on active service. Such an opportunity has been seized by the Professor (alas! we must say the late Professor) of Military Hygiene at Netley, in the report which he made for the War Office on the experience of those who marched through the dashing Ashanti campaign, concerning the effects of the spirituous liquors issued to them. The report is grounded on the evidence of all sorts of men, old and young surgeons who like their glass, surgeons who are habitually total abstainers, soldiers selected from the same mixed classes, sergeants from the hospital corps, and combatants from the ranks. The agreement of evidence is very remarkable, the variations being almost entirely in the degree of the effects stated to be produced.

The experiment was made on the daily consumption of rum in moderate doses, not exceeding half a gill (two and a half fluid ounces), and generally diluted as punch or put into tea. The results are as follows:

1. Entire absence from alcohol did not make the men who abstained more sickly as a whole, or more disposed to malarious fever, nor did it diminish the average marching powers of those who had used themselves to it.

2. The evidence is against the usefulness of alcohol during physical exertion. If rum is taken during a march its invigorating effects rapidly go off, and are succeeded by a languor greater than that relieved by it. The evidence for this point is

taken from Indian experience, compared with that derived from the Ashanti campaign.

3. Taken after the physical exertion is over, at the end of the day's march, alcohol is equally reviving as if it were taken earlier. And it is equally reviving to those unaccustomed to its use as to its habitual employers.

4. If this revival is followed by sleep no reactionary languor is perceived, and the refreshment is more complete. Some of the men thought they marched better the morning after rum had been issued than when it had been withheld by accident the evening before.

5. The digestion and appetite are perceptibly improved by this moderate use of spirits.

6. Alcohol is more useful in a hot moist atmosphere than in a dry cold one. The experience of Sir Garnet Wolseley's famous Red River expedition was that hardships were best borne, or at least equally well borne, without alcohol; and many of the officers went out to the Gold Coast with this impression. But they returned with their faith much shaken. It seemed to many as if alcohol were the only thing which could enable them to do their work, and that the instinctive craving for it experienced by Europeans after labour in a tropicalclimate is justified by reason.

This demand for alcohol arises probably not so much from the heat of the sun as from the saturation of the air with moisture. On the coast the mean difference between the dry and wet bulb is only 2.5°, and in the interior the air is often quite saturated. Consequently the perspiration from the surface of the body is not carried off. On the slightest exertion the skin is bathed in sweat, not because more is formed, but because less is evaporated. The total temperature, therefore, rises, and a depression is felt like that which accompanies over-heated blood in fever, in sunstroke, in hyperpyrexia, and rheumatism. As in fever, so here, cooling and relief are obtained by the use of spirituous liquors, and memory suggests a recurrence to the same relief on similar occasions.

In this series of observations we have traced out two of the uses of alcohol in active life-one analogous to the use of sleep, namely, to stay the continuity of the destructive assimilation set on foot by labour, to rest the tissues from over-rapid life, and to give them time to lay up fresh force; the other defensive against the depressing influences of cosmic agents, by blunting the nervous system to them. Both of these uses are in health preventives of disease, and in disease are curative in a more conspicuous manner, inasmuch as the deleterious dis