| MEDICAL INTRO |
| BOOKS ON OLD MEDICAL TREATMENTS AND REMEDIES |
THE PRACTICAL |
ALCOHOL AND THE HUMAN BODY In fact alcohol was known to be a poison, and considered quite dangerous. Something modern medicine now agrees with. This was known circa 1907. A very impressive scientific book on the subject. |
DISEASES OF THE SKIN is a massive book on skin diseases from 1914. Don't be feint hearted though, it's loaded with photos that I found disturbing. |
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ALCOHOL A DRUG
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“The baneful effects of the poison affect all communities.” — Von
ZIEMSSEN.
“Alcohol is a poison—so is strychnine; so is arsenic; so is opium. It ranks with these agents. Health is always in some way or other injured by it.”—The late Sir Andrew Clark, M.D., Physician to H.M. Queen Victoria.
“Through the accumulation of small injuries it is that constitutions are commonly undermined, and break down long before their time. And if we call to mind how far the average duration of life falls below the possible duration, we see how immense is the loss.”—Herbert Spencer, Education, p. 14.
“The old saying, ’Wine is the milk of old people,’ is entirely wrong ; that, on the contrary, milk is for old people, with rare exceptions, one of the best articles of food ; while the habitual use of alcohol, excepting in the smallest quantity, is to them even more injurious than to younger people in their full activity.”—Sir Hermann Weber, M.D., F.R.C.P., 1906, author of The Prolongation of Life.
The taberner in “ The Four Elements “—A Miracle Play :
“ For if ye drink a draught or two They will mak you, ere ye thence go By (Jupiter) stark mad.”
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2
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CHAPTER I
ALCOHOL A DRUG
Alcohol is a drug which, among others, is used by many nations as a beverage or as a medicine, very often without the least discrimination. And yet as a drug its effects are most marked, and therefore skilled knowledge is required in its use.
Complexity of Drug Action
Only those who make a life’s study of the action of drugs have any conception of the great complexity of the subject of their administration. In spite of this it is common enough to hear a patient inquire : “ What is the action of such and such a substance ? “ as if he thought the answer could be conveyed to him in a short sentence. Now the full reply to such a question is almost invariably difficult and intricate—for, although most drugs have a more or less selective effect, any single one probably exerts half-a-dozen actions on a similar number of the various tissues of the body, actions which a skilful physician requires to think out carefully, and balance fully, one against the other, before finally deciding on its use in a given case. Alcohol is a drug which is no exception to this rule, inasmuch as it has a very widespread influence on the different parts of the human frame, and consequently requires prescribing with as much care as any other remedy in the Pharmacopoeia.
Scientific Evidence causes Change in Medical Treatment
The scientific evidence now at the command of the medical profession regarding the action of alcohol may be divided into two groups :—
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4 ALCOHOL AND THE HUMAN BODY chap.
(1) Evidence indicating that alcohol does not aid the human economy in the way popularly supposed.
(2) Evidence proving the occurrence of actual damage to the structure and functions of the different organs.
Both classes of evidence have for some time been carefully studied and weighed by the profession, and as a result on all sides indications may be seen that the real position which alcohol holds among narcotic drugs is becoming better known. Moreover, the gradual and recent discovery of several valuable and reliable medicines renders frequent resort to the use of alcohol as needless as it is often unsatisfactory, and, as a matter of fact, its rôle is becoming more and more restricted.
The reason for this marked alteration in medical as well as surgical treatment is twofold. In the first place, modern physicians and surgeons are cautious in prescribing alcohol, now that its double-edged action, and many reasons for its disuse therapeutically, have been proven ; and, in the second place, as guardians of the public health they desire to limit and safeguard even the medical employment of a drug con cerning which they have daily evidence that its social or customary use is undermining the happiness and welfare of large numbers of the community.
The general trend of medical opinion upon this matter is shown in a striking way by the steady fall in the amount of alcohol used in hospitals during the last forty years.
In 1883 Charles J. Hare, M.D., F.R.C.P., published an analysis of the money expended by a number of the leading London Hospitals, during one year in each decade between the years 1832-82, upon alcohol and milk respectively; and, owing to the great courtesy of the Secretaries of these same institutions, we have been able to carry some of these statistics up to date. Taking those hospitals1 from which the returns are complete for the last forty years (1862-1902), we find that the figures stand as follows :—
1 Names of Hospitals from which the table is composed:—St. Bar tholomew’s, Guy’s, Middlesex, St. George’s, St. Mary’s, University College, Westminster.
For the expenditure on alcohol in the individual hospitals, see Burdett's Annual Report.
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ALCOHOL A DRUG 5
Table showing Total Number of Beds in the Seven Hospitals together with their total expenditure on alcohol and Milk for each Year indicated.
(The totals as to expenditure include both “ Staff” and “ Patients.”)
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The facts are represented graphically upon the accompany ing chart, which shows that alcohol and milk have practically changed places as regards the extensiveness of their use. (Fig. 1.)
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Fig. 1.—Diagram in continuation of Dr. Hare s Table showing the gradual diminu tion during the past forty years in the administration of Alcohol and the increase in the use of Milk during the same period. The figures are summarised from the stat istics of seven large London Hospitals.
The following statistics of the expenditure on alcohol and milk in Salisbury Infirmary for the years 1865 to 1905 are useful as substantiating our statement as to the increasing disuse of alcohol in medical treatment. The figures are taken from the annual report of the Salisbury Infirmary :—
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6 ALCOHOL AND THE HUMAN BODY chap.
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Equally striking are the figures of the Infirmary of the Wandsworth Union, London :—
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Although the number of beds in the above-mentioned seven London Hospitals happens to have but slightly increased, the actual number of patients treated each year is much larger, because since the introduction of aseptic surgery the recovery after operations is far more rapid than formerly, and beds are therefore vacated more quickly.
Disuse of Alcohol in Surgery
The introduction by Lord Lister of his inestimable boon to humanity, antiseptic surgery, swept away—with the septic diseases, blood poisonings, gangrenes, etc—any necessity for the treatment of operation cases with alcohol. In fact, the only surgical condition in which alcohol is still thought by some to
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I ALCOHOL A DRUG 7
be of use is “shock,” and even in this respect it is now giving place to other and more scientifically administered measures.
Some of the present-day rapid recoveries are also due to the fact that after operation the patients are no longer dosed with alcohol under the mistaken idea that it hastens recovery, and possibly also to the* fact that they are increasingly encouraged to abstain from alcohol before the surgeon operates. Consequently, apart from the greater question of antiseptic improvements, the processes of repair and of healing proceed more quickly than in former times.
The change is of course obvious, in both the medical and surgical aspects of treatment.1
Disuse of Alcohol in Medical Cases To what an extent this has now reached, one example, viz. that of the treatment of “Fever,” will suffice to show. We are much indebted to the Clerk and Medical Superintendents of the Metropolitan Asylums Board for most courteously providing us with the following statistics on this point:—
METROPOLITAN ASYLUMS BOARD
Return of Patients treated in, and of Cost of Alcohol consumed in, the Board Hospitals
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(See Fig. 2.)
1 See particularly the Presidential Address by Dr. Handcock, President Bradford Medical Chirurgical Society, Oct. 17, 1905, “On the Demerits of Alcohol as a Therapeutic Agent,” The Medical Temperance Review, Dec. 1905.
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8 ALCOHOL AND THE HUMAN BODY chap.
The immediate deduction from these figures is, that whereas up to ten years ago alcohol was extensively used in the treat ment of fevers, it is now recognised that the disadvantages attendant on its employment often outweigh any prospective advantage to be obtained from its routine application. Even
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Fig. 2.—Metropolitan Asylums Board Statistics. Diagram showing expenditure in pounds on stimulants consumed per thousand patients under treatment.
in the treatment of enteric fever its supposed value is under going searching criticism, as instanced by the following words of Dr. Ford Caiger, Medical Superintendent of the South western Fever Hospital, M.A.B. :—
“ I rank myself with those who hold that in most cases of enteric fever not only is alcohol not required, but that its employment is occasionally
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1 ALCOHOL A DRUG 9
distinctly harmful, even when given in quantities which would not be considered excessive.” 1
Another authority, Sir James Barr, M.D., writing about typhoid, says :—
“Pneumonia and typhoid fever are the two principal diseases in which alcohol has been largely prescribed . . . but in the latter disease it is even more useless than in the former ; there is scarcely an indication for its use, while the protracted nature of the disease allows this medicament more time to work mischief.” 2
Disuse of Alcohol in the Treatment of Insanity
The office of the Asylums Committee of the County of London has placed at our disposal the following valuable facts, which show the complete revolution that has taken place during the last twenty years as regards the use of alcohol in the treatment of insanity. This, of course, was practically inevitable as soon as the true scientific effect of this drug upon the nervous system had been worked out and was understood in the medical world.
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LONDON COUNTY ASYLUMS
Comparative Consumption of Spirits, Wine, and Malt Liquor, 1889 and 1905-1906
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1 Bradshaw Lecture on “The Treatment of Enteric Fever,” Brit. Med. Journ. Nov. 26, 1904.
2 Alcohol as a Therapeutic Agent, Brit. Med. Journ, July 1, 1905.
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10 ALCOHOL AND THE HUMAN BODY chap.
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255.000,GALLONS MALT LIQUORS
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and 1900 GALLONS, SPIRITS AND WINE
consumed by
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8000 Patients and Hospital Staff
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in
1889.
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Fig. 3.—Diagram showing consumption of alcoholic liquors by 8107 Patients and Staff in 1889.
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ALCOHOL A DRUG 11
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1000 GALLONS, MALT LIQUORS
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250 GALLONS, SPIRITS AND WINE
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consumed by
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19,000 Patients and Hospital Staff
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in 1905.
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Similar diagram for the year 1905—showing increase in Patients and Staff and decrease in use of alcoholic liquors.
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12 ALCOHOL AND THE HUMAN BODY chap.
Thus, although during the last sixteen years the number of patients taken over by the London County Asylums more than doubled, the total amount of spirits and wine consumed dropped from 15,000 to 2000 pints, and the amount of beer fell from 255,000 to 1000 gallons per annum. This change is shown diagrammatically in Fig. 3.
Place of Alcohol in Pharmacology
Alcohol belongs to the class of medicines known as narcotics, the class which also includes chloroform and ether—drugs which have a twofold action, being : (1) temporarily exhilarant, for a short time; (2) depressant, for a much longer time. The temporary stage of exhilaration is followed, more or less rapidly according to the amount taken, by a stage of sleepiness or actual insensibility which lasts longer than the stage of excitement.
For instance, if only a small quantity of ether or chloroform be inhaled, there is a pleasant feeling of warmth and sensation of vigour,1 followed later by drowsiness and a desire to sleep.
In patients who are given these drugs in larger quantity, there is a short stage of exhilaration, garrulity, and loss of complete mental control, followed by the lowering of bodily temperature and a stage of deep sleep and loss of power to move or feel. Alcohol acts in precisely the same way. Its anæsthetic action (in vapour) was, in fact, made use of in 1839, in which year Dr. Collier performed a surgical operation on a negro who was rendered insensible by breathing the fumes of alcohol. This was the first published case in which an anæsthetic was used. Ether and chloroform were discovered later.
Alcohol a Poison
Drugs are usually classified according to a quasi-scientific estimate of the degree of poisonous activity they exhibit when introduced into the body. It is interesting to note that alcohol is always included among the “poisons,” and in the pharmacological classification of “poisons” it is invariably placed side by side with chloroform and ether and described as a narcotic poison. This is the position assigned to alcohol by the pharmacologists of all countries.
1 This subjective sensation of increased vigour is, of course, delusive.
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For instance, the celebrated physician and clinician, von Ziemssen, describes the action of alcohol in the following words :—
“ The outward symptoms are like those induced by other narcotics. . . . The nerve centres have their function stimulated at first . . . then their activity is gradually abolished for the time . . . modified by the quantity of the poison taken, and by the time the poison is working— so that we see a variety of phenomena—sometimes only the stage of excitement, sometimes the paralytic. . . . The baneful eff’ects of the poison aff’ect all communities.”
Without doubt it is scientifically correct to speak of alcohol as a poison, but as this statement has been questioned in the past, we cannot close this paragraph better than by quoting the following forcible sentence from the physiologist, Professor Fick :—
“ It is a daily occurrence to find persons unaccustomed to the use of alcoholic liquors after drinking a small glass of wine (3 oz.) complain of dizziness, etc., indicating a circulatory disturbance. During these few moments it is hardly possible that more than one-third of the teaspoonful and a half of alcohol contained in the three ounces of wine could be absorbed and find its way into the blood. The amount of alcohol in the blood is thus less than one-half volume in a thousand, as the total amount of blood in the body is equal to about five quarts : and yet this almost inappreciable amount of alcohol in the blood causes a very decided dis turbance ’in the action of the nervous system. Hence, there is no reason for being in doubt as to the justice of calling this substance a poison.”
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Cumulative Action
Like the other members of its class, alcohol has a cumulative action. Moreover, it is also to be borne in mind that the residual consequences or effects of even small quantities habitually taken, accumulate, and, as will be more fully dis cussed, gradually affect the efficiency and well-being of the individual.
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The immediate action of any given drug is liable to vary somewhat in intensity according to the varying circumstances and conditions of the body into which it is introduced, and we must now devote a brief space to the discussion of this subject.
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14 ALCOHOL AND THE HUMAN BODY chap.
Conditions which modify the Action of a Drug such as Alcohol
Pharmacologists, whose duty it is to study the actions of drugs, have found that such actions are modified in many ways, e.g. by :
(1) Age.
(2) Muscular exercise.
(3) Personal idiosyncrasy : craving for “ repetition,“ etc
(4) Habit.
We will study these conditions separately.
1. Age
In the matter of age it is, in the first place, needless to point out at length how especially injurious alcohol is to the growing structures of young children. This is universally recognised. We shall later on devote a chapter (Chap. XIV.) to the question of the direct action of the drug on young tissues generally, and, therefore, shall only now discuss the statement that there is no age of life in which alcohol can be unconditionally said to be actively useful.
For instance, the popular idea that alcohol is of benefit in old age is far from being true. By leading to delayed excretion (see Chap. XIII.), and by gradually weakening the circulation (see Chap. XII.), it frequently causes a lowering of vitality, even when only given in small doses.
“Wine is not, as is supposed, ’the milk of the aged’; it tends to produce cardiac weakness, muscular and rheumatoid pains, and deteriora tion of the fine arterioles and blood-vessels. Alcohol is also responsible for much insanity and mental disorder.”1
At first alcohol often acts in the aged as a narcotic, and because it assists thus in inducing sleep, it is often regarded, not unnaturally, as a useful drug—but, as a matter of fact, it at the same time increases the senile decay. Nothing is more striking than the marked improvement seen in cases of acute mental depression in elderly people, when the giving of alcohol is stopped and the eliminative powers of the patient are aided by medical treatment.
1 Sir Thomas Barlow, M.D., K.C.V.O., British Medical Journal, April 1, 1905.
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2. Exercise
The amount of exercise taken markedly affects the elimina tion of any poison, such as alcohol. A man walking about all day in the fresh air of the country excretes effectively, and is able, therefore, to get rid of the drug out of his system faster than a man who lives in a town. This is one of the reasons why the inhabitants of towns succumb more quickly to the action of alcohol than do those who live in the country.
3. Personal Idiosyncrasy
Personal idiosyncrasy with regard to drugs is a factor which, though very difficult to estimate accurately, is always present. In the case of alcohol, there are in our midst far more people than is generally realised who are “ very susceptible “ ; persons, namely, in whom quite a small dose will produce marked symptoms of deterioration, and even occasionally intoxication. This is especially the case when there is any hereditary alcoholic taint, or where there is any family tendency to insanity or organic disease of the nervous system. Many such persons are adversely influenced by a dose that does not to ordinary observation affect others.
Moreover, there are always considerable differences in normal human beings as to the way in which they tolerate drugs, and this is especially true of alcohol. For instance, patients who have suffered from head injuries or from sunstroke frequently find that they cannot take the smallest dose of alcohol without being gravely affected. In other words, the natural sensitiveness of the body to the action of this powerful drug is notably increased in such cases. It is easy to under stand, in these instances in which the circulation has already been affected by an accident to the head, that the alcohol probably acts by causing rapid flushing, i.e. physiological congestion by dilating the blood-vessels of the brain (see Chap. VII.); but there are, in addition, many persons in the community who have inherited an unstable nervous system and who have a lessened tolerance for alcohol, in whom the susceptibility is probably due to the abnormal state of their nerve-cells and tissues generally.
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ALCOHOL AND THE HUMAN BODY
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CHAP,
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Apparent Toleration shown by some Persons to Alcohol
Frequent attempts have been made to ascertain whether there exists a minimum dose of alcohol which a man can take without being affected in any disadvantageous way—and, in accordance with the steady advance of scientific opinion on this matter, smaller and smaller amounts have been suggested as permissible. In reality we have no proof that a minimum and permissible dose exists at all.
The fact that certain men seem able to assimilate alcohol without obvious evil effect, simply means that they happen to be strong and stable in health, and so are able to withstand, without immediate signs of injury, the effect of doses which are disastrous to many highly strung, sensitive persons. After a military campaign there are always some men who return alive and not apparently injured ; but this does not alter the fact that a large proportion of the soldiers are either killed, disabled, or overstrained by the war.
Indeed, this apparent toleration of alcohol is, in the majority of cases, only a deception; for, when illness comes to a man of this type, it is found that his tissues show signs of being unduly disposed to inflammatory conditions, and that invading microbes and germs create undue havoc in spite of his naturally strong body and originally good endowments in the way of health. Moreover, the real condition of an apparently very strong and robust man who habitually takes large quantities of alcohol will be often demonstrated by the decadence of his children and grandchildren, who are frequently epileptic, mentally defective or vicious, and of impaired vitality.
One conclusion emerges from the recent investigation of the whole alcohol question, namely, that it is quite impossible to state that any given minimal amount of the drug is harmless to our tissues. A man who desires to use his entire force on behalf of himself or his fellow-men can do so best and longest by entirely avoiding alcohol.
Drugs that induce a Craving for Repetition
A point always to be remembered in the giving of any medicine is, that not a few drugs have a curious tendency to induce a craving for their repetition.
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1 ALCOHOL A DRUG 17
This being so, we need hardly say that a careful physician exercises the greatest thought before prescribing any medicine of this character. Unfortunately, although alcohol is one of these drugs, and creates in many of those who take it a strong craving, its use by the public generally is so common that it is not regarded as it should be, viz. as always a possible danger. We shall consider this perilously Utopian view of alcohol more fully in Chapter IX.
It is very instructive to note that alcohol behaves in the same manner as morphia when it is taken for the first time. Thus at first it is often vomited. The exquisitely delicate lining of the stomach, as we shall see later on, is irritated, and the stomach proceeds to eject the irritant. Subsequently, however, a tolerance is established, and the body becomes accustomed to the intruder, and even feels its withdrawal. We are such “creatures of habit” that we readily become accustomed to any routine, and a few weeks (“ six “ according to the psychologist, Professor William James) afford sufficient time wherein to form the foundation of a deeply rooted habit. Unfortunately, in the case of alcohol its withdrawal usually means that a “ craving “ follows, and this is a condition to be dreaded, unless we are possessed of a very strong power of self-control. Dr. Clouston, Medical Superintendent of the large Morningside Lunatic Asylum, near Edinburgh, has well said that “it always implies less expenditure of energy to crave than to control.” In this trite sentence lies the gist of much of the trouble with regard to alcohol and the drug habit in general. He points out that very many people entirely lack this high faculty of “ control.” To “ crave “ is easy, to ’’control” is difficult; therefore, the wiser course is to avoid those things which tend to create a craving.
“The moment we have a craving for something that, if attained, would be hurtful to the organism, then we have something that is contrary to Nature’s law, and is more or less of the nature of disease. It is one most prominent characteristic of our modern civilisation, that it exerts itself to create ' artificial ’ needs in all directions, physical and mental, and each one of those enlarges the area of human desire. Such needs and desires soon become hereditary. We feel them because our fathers created them.” 1
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1 Dr. Clouston.
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ALCOHOL AND THE HUMAN BODY
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4. Habit
The effect of habit upon ourselves, and its hereditary influence upon our children, are matters that no person of thought and intelligence can ignore. When taken as a daily drink, alcohol causes sensations and effects which are soon imagined to be a necessary part of life. The stomach becomes dependent on the daily dose and disinclined to work without it When this physiological dependence occurs it is time to recognise both the true facts of the case, and our bondage to the habit, rather than falsely to regard alcohol as a “ food,” because it induces certain sensations to which we have become accustomed.
It is, indeed, not a matter of mere personal import but of national concern that we should reckon with this factor of “ habit ” before encouraging ourselves or others to do or take what may prove to be injurious both to the individual and to the future generations of our race.
It would be interesting, as Professor Cushny has suggestively pointed out,1 could alcohol be considered as a new drug on its own merits, and its advantages and disadvantages weighed without prejudice. Judging from recent experience in the case of cocaine, and the alarm with which its employment is regarded on account of some comparatively few instances of consequent cocainism, a trial of this nature of the drug alcohol could have but one result. Cases of alcoholism with full descriptions of its various manifestations and terrible social effects would come in from practitioners in all parts of the country, and its use would certainly be considered unjustifiable, excepting in cases of extreme rarity and where the prescription of some alternative narcotic was for special reasons impossible.
It is most unfortunate that the force of custom has so dulled observation in this direction that the results of practice in this particular are rarely either followed up or commented on, and that the public consequently regard alcohol as the universal and safe domestic remedy.
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After this preliminary view of the special nature of alcohol as a drug, we propose in the succeeding chapters to show how
1 Address by Prof. Cushny, M.D., at the debate of the British Association (1907) on Alcohol.
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this substance acts upon the various tissues and systems of the body, prefacing the discussion of these effects with a chapter on what alcohol is from a chemical point of view, and conclud ing with a chapter kindly contributed by Dr. Newsholme, showing the gross social and vital effects it produces on com munities or groups of individuals.
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