| 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. |
DEGENERATION AND DISEASE OF THE NERVOUS SYSTEM DUE TO ALCOHOL |
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’ ’ The vast increase of lunatics in this country demands the serious Consideration of every means which can legitimately be used to protect society from physical and mental degeneration.”—Sir Edward Fry (Lord Justice of Appeal), Evidence given before the Royal Commission on the Care of the Feeble-Minded, 1905.
“During the years 1861-5 there entered the asylums of France 14,983 insane persons. In the same space of time, twenty years later, there entered more than 57,000. . . . Dr. Serieux made researches, and found that of the relapsed cases 78 per cent were drinkers, while of violent lunatics 88 per cent were drinkers.”
“. . . We have too big a beam in our own eye to moralise on the state of France.”—The Lancet, May 1889.
“Alcoholic insanity steadily goes up. This year no less than 42·3 per cent of all our men and 18 per cent of our women—much the largest proportion we have ever had experience of—had excess in alcohol assigned as the cause of their insanity. In the five years, 1873-7, the percentage of alcohol cases was only 18·5 among the men, and 10·4 among the women admissions. It has steadily gone up, and now it has doubled. No explanation will account for this but the one that certain classes of our population are drinking to greater excess than they did, and in doing so are, many of them, destroying their sanity.”—Dr. Clouston, Report of the Morningside Asylum, 1903.
“It is certain that for every man in whom excessive drinking causes absolute insanity there are twenty in whom it injures the brain, blunts the moral sense, and lessens the capacity for work in lesser degrees.”
“It is most sad and discouraging that this preventable cause of the most terrible of all human diseases should thus continue to increase. It is a veritable plague spot in our social life.”—Ibid. |
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CHAPTER VI |
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DEGENERATION AND DISEASE OF THE NERVOUS SYSTEM DUE TO ALCOHOL
No account of the effect of alcohol upon the nervous system is at all adequate unless reference be made to the profound and too often permanent mental deterioration and instability which it induces, as a result of its depressing action upon the brain and spinal cord. By the general public little is, of course, known with regard to this painful subject, for the patients, although numerous, are, as far as possible, hidden away in private homes or asylums, and those of us who are at work in the world outside contrive to protect our own happiness by thinking little about the thousands of lonely and wretched men and women who inhabit these institutions ; in fact, the doctors who manage them are practically the only people who at all realise the ghastly waste of life and happiness that alcoholism entails.
The craving for alcohol, which leads to final disaster in the shape of social and intellectual downfall, may be either periodic or chronic.
Dipsomania is the general expression used to describe a condition of recurrent uncontrollable craving for alcohol. The attacks occur more or less periodically at intervals from six weeks to a year, in persons who at other times are perfectly free from the drink crave. Quite early in adult life these exhibit a tendency to drink to excess, and no consideration of disgrace or loss of income or of social standing can finally deter them. After ineffectual struggles the barriers of self-control break down, often towards night or during the night ; alcohol in some form is taken copiously, and the patient may then drink straight on, or be continuously drunk for a week or a
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112 ALCOHOL AND THE HUMAN BODY chap.
fortnight, the outbreak often culminating in an attack of delirium tremens. Even when the sufferer takes precautions against himself, and provides, by entering an asylum, that his craving shall not be indulged, the suffering during the attack and the subsequent prostration are usually great.
Insanity and Alcoholism
If a man, day by day, pours such an amount of alcohol into his blood that morbid stimulation and irritation of his brain cells results, that man is in danger either of actual insanity or of degenerative mental changes allied thereto. Only during recent years have scientific workers been able to point out and satisfactorily explain the intimate relationship that exists between insanity and intemperance, and today the inter dependence of these two conditions one upon the other still needs and is receiving careful investigation.
During the year 1908 the number of cases of lunacy admitted into the asylums1 of England and Wales is 10,630 males and 11,614 females.2 Of these annual admissions, ascertained personal intemperance in drink is stated by the Commissioners in Lunacy to be responsible for 23·3 per cent of the male cases and 8·9 per cent of the female cases.
Now these percentages do not include those cases in which the breakdown may be more or less traceable to alcoholism in the parents of the patients, nor do they include those cases in which it has been one factor out of several, and a factor about which accurate information is liable to be held back by the patient and his friends.
Where these elements in the causation are counted it is considered, generally speaking, that alcohol is accountable for fully 20 per cent of the cases under care in our asylums.
With regard to the number of cases under detention at any one time for this preventable mental condition, Dr. Robert Jones has shown3 that out of the 116,000 cases of insanity detained in 1904 in our asylums, probably no less than 11,000 males and 6000 females owed their illness directly or indirectly to drink.
1 Excluding idiot establishments.
2 See Report of Commissioners in Lunacy, issued September 1909.
3 British Journal of Inebriety, July 1904. |
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VI DISEASE OF NERVOUS SYSTEM 113
And we must remember that large numbers of these patients are of an age when they should be active members of the com munity, instead of being the cause of much of the broken home-life and child misery which is our special disgrace as a nation, as well as being the occasion of much needless expense to the State.
In Ireland matters are little better. The Census Commis sioners show that whereas in 1851 there was one lunatic in every 657 of the population, in 1901 there was one lunatic in every 178 of the population.
The exact part played by alcohol, as one of several causes which has led to this untoward state of things, has yet to be determined, but the following facts are significant:—
The counties of Ireland have been arranged according to their “ Drunkenness rate,” i.e. the proportion of recorded cases of drunkenness to their population for the average of the years 1899-1903. In this list the county of Waterford stands first, one drunken person in every 28·5 of population being the proportion recorded.
This same county heads the list of counties arranged according to their “Lunacy Rate,” one in every 104 of the population being a lunatic1
The report of the Waterford Lunatic Asylum for 1903 states that “ the most frequent cause of the insanity of those admitted was intemperance ”—and on studying the records we find that 23 per cent of the cases admitted that year were attributed to alcohol, whereas in the same year hereditary predisposition was the cause of 16·2 per cent of the admissions. On taking the averages for this institution during three years (1903, 1904, 1905), hereditary predisposition accounts for 17·6 per cent of the admissions and alcohol for 19·6 per cent.
All these sets of figures, it must be remembered, represent only those patients who were ill enough to merit asylum treat ment, and do not, of course, include the very large number of cases of delirium tremens, epilepsy, and other conditions caused by alcohol, which occurred in that same year, but were treated for various reasons in their own homes, or in general hospitals and infirmaries.
1 “The Relation in Ireland between Lunacy and Drunkenness,” by W, Macvey. Medical Temperance Review, December 1906. |
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114 ALCOHOL AND THE HUMAN BODY chap.
Alcoholic Insanity
As Dr. Maudesley well points out :—
“ A drunken man notably exhibits the abstract and brief chronicle of insanity, going through its successive phases in a short space of time. First, a brisk flow of ideas, inflamed emotions, excited talk and action, aggressive address, unusual self-confidence, a condition of stimulated energy with weakened self-control, so like the sort of mental excitement which goes before an outbreak of mania that the one is sometimes mis taken for the other ; next, as in insanity, sensory and motor troubles, incoherent ideas and conversation, and increasing passion, which, accord ing to the previous temperament, is expansive, quarrelsome, melancholic, or maudlin, and which may sometimes, as in insanity owning no cause, go through these stages in succession in the same individual ; lastly, a state of stupidity or stupor, which might be called, and is essentially a temporary dementia.” 1
Cases of “ alcoholic insanity ” pure and simple may be divided into three main groups :—
1. Acute alcoholic mania.
2. Delirium tremens.
3. Chronic alcoholic dementia (including alcoholic delu
sional insanity).
Each of these three groups constitutes a definite clinical picture. In the first two, the alcohol acts as a powerful irritant to the brain cells of the motor centres, and the result shows itself in muscular excitement and violent uncontrolled movements, which often go on for days, and may even require the use of a padded room. This wild delirium is characterised by hallucinations both of hearing and of sight. The patient hears voices, which seem so clear and audible, that they often incite him to definite action, destructive or otherwise. The illusions of sight are frequently so extreme that the figures of well-known friends are not recognised, but are often thought to represent “fiends”; while a simple shadow under a bed may arouse an insane suspicion which it is impossible for the attendants to dispel. All such delusions of suspicion render the patient a source of serious danger to others.
1. Acute Alcoholic Mania.—In these cases of alcoholism the symptoms of drunkenness, instead of merely following the more usual form of quarrelsomeness or savage conduct, develop
1 Henry Maudesley, M. D., Pathology of Mind. |
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VI |
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into furious mania, and as a frequent consequence the patient requires admission into an asylum. It is unnecessary to enter into a detailed description of this condition ; it suffices to say that the whole brain is in a turmoil, and completely paralysed as regards all its normal powers of action and understanding. The patients are usually men in the prime of life, and the outbreak often follows a single recognised excess in the use of alcohol. “Recovery” is a slow process, in fact, a long time may elapse before a brain so violently disordered regains its equilibrium.
Frequently on again resorting to alcohol these cases have a “relapse,” and require re-admission to an asylum, thus again becoming a misery to themselves and an expense to the State or their friends.
Dr. Mott has shown that—
“ A large proportion of the recoverable cases admitted to the London County Asylums consists of pure drink cases, and of these 50 per cent are discharged within three weeks to six months of admission. They often return again in a short time, and some cases, termed ’ recurrent mania ’ and ‘recurrent melancholia,’ are discharged and readmitted many times, thus fictitiously raising the recovery rate. Many of these people would not come to the asylum were they not subject to the temptation of drink, for which they have an inborn or acquired intolerance.”1
2. Delirium tremens occurs as the result of repeated debauch. The feeling of elevation that the inebriate experi ences is sometimes present in the first attack, but when these become repeated it is the headache, the sleeplessness, the dis torted vision, and the sense of acute misery and impending disaster that predominate, and that obviously outbalance any so-called “ jollity” that alcohol may have seemed originally to provide.
Before this delirium actually occurs, the profound depression under which the nervous system is labouring may be seen in the nightmares and the gloominess and timidity of the patient, in his inability to think or to make simple decisions, in the tremor of his muscles, in his shivering, his vomiting, and weakened heart action. The hallucinatory condition is due to the fact that the sense centres of the cerebrum are suffering from constant perverted stimulation, and consequently their action is entirely faulty. Thus a tiny spot on the wall is
1 Alcohol and Insanity, by F. W. Mott, M.D., F.R.S. |
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116 ALCOHOL AND THE HUMAN BODY chap.
thought to be a creeping beetle, ordinary shades and shadows in a room are interpreted by the brain as ghosts and evil beasts, and the faces of friends seem one weird array of mocking demons.
Moreover, the higher centres of the brain associated with the manifestation of judgment, reason, and decision are also poisoned, and hence the “pluck” which an ordinary man would exhibit is wanting, and the wretched patient cowers and cringes before terrors that are merely the fabrication of his wrongly acting brain. The motor centres are similarly upset, so that the wildly excited and temporarily insane person struggles with tremulous weakness against those who control him. In this state the heart and respiration may collapse.
3. Chronic alcoholic dementia is a condition that usually comes on slowly as a result of repeated indulgence in spirit drinking. We have already described (under the heading of Subacute Alcoholism, p. 66) some of the early signs which accompany the onset of this condition of dementia, especially the mental deterioration which shows itself in lack of ability to comprehend and deal with the facts of life in a sensible way. Frequently it is this mental inability which accounts for the failure on the part of the patient to appreciate rightly his own condition, thereby leading him to disregard advice which might have saved him from further drifting into alcoholism.
“ Many habitual inebriates are as incapable of estimating the gravity of their condition as are persons legally insane. Very few are willing to acknowledge themselves to be inebriates at all. “ 1
After a certain time the habitual use of alcohol is liable to cause a kind of perpetual excitement of the nerve centres, due to a severe chronic alcoholic “ inflammation “ of the brain known as cerebritis. This excitement is shown to the outside world by a restlessness and irritability of body and mind. The habitual drinker is easily offended, is subject to insane delusions, and is very suspicious and jealous. A passing phase of alcoholic jealousy often leads to unfounded allegations being made against others. For instance, not infrequently a wife is made to suffer great mental distress on account of false charges
1 Dr. Branthwaite, Evidence given before the Royal Commission on the Feeble-Minded, 1908. |
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VI DISEASE OF NERVOUS SYSTEM 117
circulated by a husband who, when sober, fails even to remember that he said anything unusual. Jealous mania is responsible for quite a number of the crimes of drinkers in whom outbreaks of anger, followed by periods of depression, are frequent and violent, and occur without sufficient motive.
These emotional outbursts, due to the loss of higher intel lectual control, may for some time be the chief signs of mental obliquity. They are accompanied by muscular weakness and digestive derangements. Slowly and insidiously the symptoms of premature senility of mind appear. One of the most com monly observed alterations occurs in connection with the moral sense ; the drinker’s conscience soon becomes blunted, he becomes morally indifferent ; an antisocial feeling is de veloped ; his affections disappear, and, as a consequence, he keeps away from his family. Often the increasing demoralisa tion shows itself in selfish, brutish, and indecent acts, and he becomes a source of great anxiety to his friends. Regarding the purely intellectual faculties, a parallel downfall takes place. Judgment becomes more impaired, memory becomes more slow and uncertain, and imagination most deceptive. If the indi vidual in this condition undergoes treatment, his mental vigour and his moral sense may to a considerable extent be gradually restored, but unless abstinence is carried out, a progressive weakening and disappearance of the faculties occur, he becomes increasingly weak-minded, vacant, and listless, and finally reaches a stage of dementia, in which condition of mental ruin it is not possible to recognise his original character.
Alcoholic dementia, as compared with other forms of dementia, has a greater tendency to terminate rapidly in death. This is not surprising, seeing that alcohol affects every region of the body, including the large abdominal and thoracic organs.
Coincidently with this disorganisation of the mental powers, there exist both sensory and motor failure.
“ In regard to the skin there are false sensations, pricking and itching, which the patient compared to the sensation produced by thousands of ants creeping over the skin (formication). These false sensations, exagger ated like all alcoholic pseudæsthesiæ during the night and by the warmth of the bed, affect chiefly the lower limbs. They are very troublesome, last a long time, and are apt to cause insomnia. They are precursors of more serious symptoms, and indicate that material lesions are commencing in the nervous centres. . . . The sensory derangements involve also the |
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118 ALCOHOL AND THE HUMAN BODY chap.
special senses, especially that of sight. Illusions of this sense are frequent. Acuteness of vision is also weakened ; the use of the eyes becomes fatiguing, and objects become confused (alcoholic amblyopia).
Motor derangements are very characteristic. The most frequent is tremor. . . . The muscular excitability sometimes shows itself by more lasting and extremely painful contractions of the whole of certain muscles (cramps) ; they are especially noticeable in the lower limbs, in the calves of the legs, and occur preferably by night.” 1
Association between Melancholia and Alcoholism.—Un fortunately the foregoing large groups of insanity do not by any means include all the cases of mental illness in which alcohol plays a part. In addition, there are to be found in our lunatic asylums large numbers of patients whose breakdown is due to several contributory causes, one of these being alcohol.
“ The blood is liable to be poisoned by all sorts of things, from bacteria to alcohol,” and it is easy to see that several of these poisons may act hand in hand and reinforce one another. Moreover, an unstable nervous system is often a factor of im portance, which, when associated with such conditions as over-work and alcohol, may result in a downfall.
It is characteristic of the derangements of intellect caused by alcohol that they are of a painful nature, and it is therefore not surprising that, in the case of an already exhausted brain, the taking of this drug should increase any latent tendency to melancholia that may exist, or should even bring on an attack.
“ Undoubtedly in alcoholic depression we see exhibited to the full its power to cause prolonged poverty of action of the nervous system, in consequence of which all thoughts are sad, and all actions seem to require a great effort before they can be accomplished.” With regard to melancholia, it is well to remember that no mere bodily diseases can compare with the indescribable feelings of hopelessness and misery that are the lot of those suffering from serious depression ; and that, as compared with the other insanities, a melancholic patient is acutely conscious of his feelings, and thus is often more wretched than the sufferers from some other forms of mental breakdown.
Temporary Outbreaks of Mental Unsoundness.—On this
1 Dictionary of Psychological Medicine, art. on “ Chronic Alcoholism, ” by Dr. Legrain. |
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VI DISEASE OF NERVOUS SYSTEM 119
subject, which is one upon which the community is absurdly indifferent, we prefer to quote a London alienist of experience :—
“ In addition to the actual numbers who are sufficiently poisoned by alcohol to be certified as insane, there are large numbers of individuals who are from time to time dangerously unsound, it may be for a few hours or a few days, who are the terror of their relatives, form a large proportion of the cases at police-courts, and ruin themselves in health and fortune. And those who have had charge of the insane will agree with me that the cases of mental disorder due to alcohol are among the most difficult to manage, the most hostile and litigious, and after recovery very often the most ungrateful of any patients with whom we have to do. No doubt in many cases the alcoholic is a person who starts life with an unstable nervous system ; he has either alcoholic or insane or neurotic inheritance, and to a certain extent he is defective ab initio in self-control, and goes without much resistance into the paths of chronic alcoholism, but at present the Legislature has given him no assistance. The facilities for drinking are enormous.” 1
Loss of Memory.—Sometimes the depressive effect of alcohol acts specially on certain functions, such as the power of memory, persons who use large amounts of spirits being liable to curious brain conditions (such as exist in epileptics), during which actions and crimes are committed of which the agent has not the slightest recollection. Side by side with this only recently recognised brain-state we may place those everyday lapses of memory in the chronic alcoholic which are the cause of so much perplexity to his friends. The condition termed “ paramnesia,” i.e. a failure of memory for recent events, is especially character istic of alcohol poisoning. Not only is there forgetfulness of recent occurrences, but imaginary or long past events seem to take their place, and so confused and “ lost ” does the person become that his statements are absolutely contradictory. This failure of memory leads alike to forgetfulness of promises and of duties. The sense of time and space are lost, and there is an inability to distinguish between past and present. From a brain so poisoned that its functions are in this state of confusion it is useless to expect the least accuracy of statement ; in fact, it may be almost predicated beforehand that the truth will be distorted.
Alcohol and Hysteria.—To an alcoholic taint in parents or grandparents may often be traced the condition known as
1 Percy Smith, M.D., F.R.C.P., Presidential Address before the Section of Psychology of the British Medical Association, 1900. |
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120 ALCOHOL AND THE HUMAN BODY chap.
hysteria, in which the miserable possessor of an unstable nervous system evinces all varieties of nerve storms and ex plosions, in a way unaccountable to both himself and his friends. A further cause of this lack of nerve control may be found in the personal habits of the patient with regard to alcohol, the power of which to induce abnormal psychic conditions in certain persons being very marked, especially when these latter already suffer from the handicap of an imperfect heredity of one kind or another.
Alcohol and Epilepsy.—The disease known as epilepsy is characterised by convulsive seizures, which are due to varying forms of brain excitation. Consequently it is produced by different causes. Thus certain drugs, especially absinthe and alcohol, are particularly excitants of the cerebral cortex, and produce epileptic fits. Some individuals who possess congeni-tally an unstable brain exhibit a marked intolerance of alcohol, which causes them to have convulsive seizures on taking even small doses of this drug. Tanzi 1 alluded to such cases, and according to him all epileptics have their disease intensified by taking alcohol. Chronic alcoholic patients frequently become epileptic. Nor is this to be wondered at.
When we remember how many persons are born into the world with more or less cerebral deficiency, it is not surprising that the irritant action of alcohol should serve as a final factor in disturbing the government of the “ motor ” centres, and thereby bring on muscular movements of an abnormal and uncontrolled type (convulsions), accompanied by loss of consciousness.
This is forcibly pointed out by Dr. Mott, who says :
“Alcohol, even in comparatively small quantities, may convert the potential lunatic into a raving maniac, and it is specially dangerous to the epileptic and feeble-minded, leading in the former to the production of motor and mental fits, and making him irresponsible and antisocial and sometimes very dangerous to himself and others. . . . The quantity of alcohol which is daily consumed by the pillars of society is quite sufficient to convert an epileptic or potential lunatic, or certain feeble-minded individuals, into criminals or certifiable lunatics.”2
Convulsive Attacks in Children.—These undoubtedly are
1 Trattato delle malattie neutrali. 2 Alcohol and Insanity, 1906. |
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VI DISEASE OF NERVOUS SYSTEM 121
often more or less directly connected with alcohol, as just explained.
Later on we shall draw attention to the occurrence of convulsions in breast-fed infants whose mothers take alcohol, and to the cessation of these attacks when the mothers are persuaded to abstain.
Sunstroke.—The fact that sunstroke attacks alcohol-takers rather than total abstainers is well known. It is, however, so striking an example of the disadvantage to the circulation of the brain caused by moderate drinking, that some con sideration of the facts may be in place here.
The authors of the most recent manual on tropical medicine 1 say concerning “sunstroke” that “ of all predisposing causes, alcohol is probably the most important.” Under the heading of “ Heat Exhaustion “ they state that “ alcohol is by far the most important predisposing cause, and accounts for the difference in mortality of expeditions in which soldiers are allowed to drink it and those in which they are not.”
Dr. W. R. Phillips,2 of Washington, records 841 cases of sunstroke. Nothing was known of the personal habits regarding the use of alcohol in 376 of the cases. Of the remaining 465, the following were the facts :—
Alcohol was used to excess by . . . . 140 (or 30 per cent). ,, ,, moderately by . . . . 230 (,, 50 ,, ). ,, not used at all by . . . 95 (,, 20 ,, ).
Death resulted in 140 of the 841 cases ; and in the 70 about whom facts could be learned, these were as follows :—
Excessive indulgers in alcohol . . . . 41 (or 60 per cent). Moderate ,, ,, . . . . 22(,,30 ,, ). Total abstainers. . . . . . . 7(,, 10 ,, ).
In the Swedish investigation already alluded to (p. 107), the effect of alcohol on the men when marching could be studied during the manoeuvres. Some companies were given small quantities of alcohol : others were kept without. It was clearly shown that drinking predisposed to sunstroke, indeed heatstroke was noticed only amongst the “ drinking ” companies. Since these facts have been ascertained, the
1 Castellani and Chalmers, 1910.
2 “Meteorological Conditions of Sunstroke,” Dr. W. R. Phillips, International Medical Magazine, August 1897. |
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122 ALCOHOL AND THE HUMAN BODY chap.
Austrian soldier is not allowed to carry brandy when on march, except during severe winter weather and in the baggage of the ambulance corps.
Alcoholic Insomnia
Alcohol, though often used in small quantities as a narcotic on those who are not accustomed to its effects, has, like other drugs of the same class, a very different result when taken in excess. Dr. Hare describes as follows the production of insomnia by alcohol:—
“ The term alcoholic insomnia is applied to cases in which insomnia clearly results from inebriety. The trouble ceases with the cessation of the alcoholic habit, and can be depended upon not to recur so long as abstinence is maintained.
“The type of alcoholism which frequently leads to insomnia presents the following distinctive features. It is chronic and continuous, rarely intermittent, ... the patient has arrived at the stage at which large quantities of spirits are consumed without overt signs of intoxication ; and very often he has, until quite recently, continued to manage his business with tolerable, though of course decreasing efficiency. . . .
“Rarely has the patient experienced any difficulty in going to sleep, doubtless because he has never attempted to do so without taking several ’nightcaps.’ But for years he has awoke early in the morning, and this tendency has been steadily increasing. It may be that he has long resisted the temptation to drink before breakfast; but eventually he has found it impossible to touch food before taking a little alcohol. As time passes, his initial sleep—the sleep into which he falls on going to bed—becomes shorter and shorter ; he is driven to take alcohol in the night in order to have any chance of returning to sleep. Finally he finds himself with a bottle beside him, taking alcohol every few hours throughout the night. And it may be that even now he has never been frankly intoxicated.
“Such a patient is in imminent danger of delirium tremens.”1
the influence of alcohol on the nerves of the Body
Passing from the diseases of the central nervous system caused by alcohol, we must now describe its influence upon the peripheral nerves of the body, i.e. those rising in the trunk and limbs. These often suffer in conjunction with the brain, whilst at other times the chief force of the alcohol seems to be directed against the nerves and spinal cord, rather than the central nervous system.
1 Dr. Francis Hare, Norwood Sanatorium Report, 1909. |
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VI DISEASE OF NERVOUS SYSTEM 123
Neuritis (Alcoholic Neuritis)
This is a painful neuralgic affection of the nerves of the body, often accompanied by loss of power in the limbs— especially in the legs. Frequently the pains are thought by the patient to be rheumatic, whereas in reality they are due to an inflamed state of the sheaths of the nerves, which inflammation rapidly begins to subside as soon as the taking of alcohol is stopped.
Young people and people in middle age are much more commonly affected with this alcoholic form of neuritis than are old people, and for various reasons this condition is more common in women than in men. Frequently the friends of the patient have no idea of the true nature of this very common complaint, and sometimes even the medical attendant fails to suspect the cause of the illness, until the pains (often very severe) have existed for some time and the loss of power has become marked. Occasionally the taking of alcohol medicinally (as it used to be given in a prolonged illness like typhoid) leads to this disorder, which requires total abstinence as the first factor in its cure. But in this matter of cure it is not merely a question of a few days or weeks being required in order to get rid of the poison : prolonged abstinence and suitable treatment are really essential so that the damaged structures may become repaired and resuscitated and rendered fit for their work.
Alcoholic paralysis is the general term for a more pro nounced degree of the same condition. It is usual for the legs and feet to be more affected than the hands.
Structural Degeneration and Disease, Changes in the Nervous System caused by Alcohol
At this stage it is necessary that we should present the evidence that alcohol not only causes the severe disorders of nerve function just described, but definitely injures the structure of the nervous system. The microscope shows that grave alterations take place in the protoplasm of both the nerve-cell and fibre, under the action of alcohol, after this has been freely taken for some time. With regard to smaller doses, or to sudden intoxication in persons unaccustomed to alcohol, the findings of the microscope are naturally not so |
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Fig. 15.— In this drawing nerve cells or corpuscles (magnified 750 diameters) are shown stained with methylene blue to reveal their structure and the degenerative changes produced in them by alcohol. No. 1 is a normal cell. No. 2 shows the disappearance of the colouring matter, and that the nucleus is passing from the centre to the side of the cell. Nos. 3, 4, 5, and 6 show varying degrees of the breaking up of the corpuscles. |
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chap. vi DISEASE OF NERVOUS SYSTEM 125
definite. But this is in no way surprising, for the function of the cells of the body is gravely disturbed by drugs long before these latter can alter the physical nature of the cell protoplasm so definitely that changes can be detected by the present methods of fixing and staining and the best means of micro scopical investigation now known.
The chemical processes of the body are so complex that it requires extremely little to upset the balance. In the case of people who suffer from gout, certain individuals will tell you perfectly truly that if they take a small quantity of a particular kind of alcoholic drink, champagne, for example, it will invariably produce an attack, whereas they can take another kind of alcohol with apparent impunity. This shows, of course, that the chemical processes in their bodies may be upset by an astonish ingly small quantity of the chemical reagent, and the eff’ect, therefore, of so small a quantity of alcohol as suffices, for instance, to influence the rapidity with which the nerve corpuscle is able to subserve the process of thought, could not possibly be expected to be demonstrable by any appreciable structural alteration.
So, too, the chemical processes in the body are so delicate that an infinitesimal dose of poison (snake poison, for instance) can fatally arrest them without causing any changes of structure in the corpuscles which even the highest microscopical magnification can detect.
The changes wrought by chronic alcoholism, we shall see directly, are those of disorganisation of the actual particles of the cells themselves.
The explanation of these profound structural changes appears to be that alcohol is a powerful protoplasmic poison, having a special selective affinity for the delicate cells of the nervous system, with whose function and capacity it interferes even at a very early stage, finally causing permanent gross alterations in the tissue, which are demonstrable to both the naked eye and through the microscope. We are indebted to Dr. Mott for the accompanying drawings, which illustrate this part of our subject. Those representing damaged tissue are taken from cases which died at Claybury Asylum.
Fig. 15, No. 1, shows a normal cell from the spinal cord, with its central nucleus and other parts, as described in Chapter IV.
Fig. 15, Nos. 2, 3, 4, 5, 6, represent the degenerative changes through which a nerve-cell passes, and each cell may well be compared with the normal, No. 1. The diseased cell becomes swollen (Nos. 2, 6), the nucleus gradually is pushed from the centre towards the margin ; the spindle-shaped bodies |
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Giant nerve
Corpuscle
degenerated. |
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Giant nerve
corpuscle. |
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Glia cells. |
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No. 1. No. 2.
Fig. 16.—No. 1. Vertical section of the grey surface or cortex of the cerebrum ; from the sensori-“motor” area of a normal human brain. The nerve corpuscles are of all sizes, from the large cell marked “giant” to the very small ones near the surface. The wavy thin line at the top of the drawing is the free surface of the hemisphere covered with the thin arachnoid—pia mater membrane. The whole depth of the figure represents the depth of the cortex, which in its natural size amounts to about 1/8 th of an inch. It must be understood that the same cortex is pervaded throughout by fibres, which not being stained like the nerve corpuscles are not shown. These fibres convey nerve impulses to and from the nerve corpuscles.
No. 2, Section of the ‘ motor “ cortex of chronic alcoholic dementia to contrast with the normal brain section in No. 1. The nerve cells are extraordinarily reduced in number, having degenerated and wasted away. Of those that remain very few exhibit a normal outline. The large majority are shrunken and hopelessly damaged. Further, the glia cells, as displayed by their dot-like nuclei, are greatly increased. |
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CHAP. VI DISEASE OF NERVOUS SYSTEM 127
swell up, and their outline becomes indistinct, and they gradually lose the power of taking on stains, the processes shrivel and disappear, empty spaces occur in the protoplasm (see No. 6), and finally the cell ceases to stain and cannot be seen.
A cell damaged in this way never recovers, and so far as we know is never replaced. Even the most casual observer can see the difference between the beautiful normal cell with its central nucleus and vigorous processes, and the swollen deteri orated cells taken from the spinal cord of the patient who died after a lingering and painful illness brought on by alcohol. The general effect when large numbers of cells are grouped together may be studied in Fig. 16.
Next, as regards the effect of alcohol on the brain itself. Fig. 16 represents a small portion of normal brain tissue taken from the “ motor ” area of the cerebral hemisphere. It shows a large number of cells of proper shape and size, whose protoplasm stains well, the depth of staining being partly a measure of their vitality. With this must be compared Fig. 2, which represents the same’ part of the brain in a case of chronic alcoholic dementia, and shows :—
(1) A diminution of the number of cells.
(2) Their disintegration as indicated by their imperfect staining and irregular outline.
(3) An increase of the tiny supporting (glia) cells, which take the place of the real nerve-cells, and are perhaps of no value as regards mental action.
It is, of course, useless to expect mental integrity or ordinary sense to emanate from a brain in such a condition. Moreover, even the mechanical muscular movements can scarcely be performed, the patient sitting in an inert heap and requiring attendance as if he were a little child.
Fig. 17 shows a group of degenerated spinal ganglion cells from a case of alcoholic neuritis and paralysis, in which the patient suffered from marked sensory disturbances, local anæsthesia, and pain. Notice the shrinkage of the cells, the crumbling appearance of their edges, and the marginal position of the nucleus. As the cells degenerate, shrink, and disappear, their place is taken, to a considerable extent, by the supporting connective tissue of the nervous system, which (as just shown) has no direct functional value and may be compared to the cotton wool in which jewels are packed. |
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Fig. 17.—The nerve cells (magnified 375 diameters) in a (sympathetic) ganglion from a case of alcoholic paralysis. A normal corpuscle is shown at A in the corner square. Observe the shrunken, crumbling appearance of the alcoholised cells. In only two does anything resembling a complete nucleus remain, and in each of these it has moved to the side of the cell. |
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Arachnoid and pia mater. |
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cell. |
Tangential fibres. |
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Fig. 18.—Microscopic section of the superficial layer of the cortex of the cerebrum (magnified 310 diameters), from a normal brain, showing healthy membrane (arachnoid and pia mater) and the normal number of fine tangential fibres. |
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 |
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Greatly
thickened
arachnoid
and pia
mater.
Spaces
filled with
fluid.
Matted
thickening
of glia.
Tangential fibre.
Glia cell. |
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Fig. 19.—Microscopic section to contrast with Fig. 18 of the superficial layer of the cortex of the cerebrum (magnified 310 diameters), from a case of chronic alcoholic dementia, showing excessive (inflammatory) thickening of the membranes and also increase of the glia cells and tissue, with a corresponding loss (from wasting) of the tangential fibres.
K |
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130 ALCOHOL AND THE HUMAN BODY chap.
Fig. 18 shows the normal depth of the covering membrane of the brain (pia mater) and the normal number of tangential fibres, with a few tiny packing cells in between. Compare this with Fig. 19, from a case of alcoholic dementia showing :—
(1) Marked thickening of the covering membrane.
(2) A space beneath this which is due to shrinkage of the brain substance and in which fluid tends to collect.
(3) A decrease in the tangential fibres, the real nervous elements, with a corresponding increase of the supporting (“glia”) cells.
Fig. 20a shows normal nerve fibres, each of which consists |
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Fig. 20a.—Normal nerve fibres moderately magnified. Compare with Fig. 20b in which fibres degenerated by alcohol are shown.
of a delicate strand of protoplasm covered with a sheath.
With this compare Fig. 206, which shows nerve fibres that |
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Fig. 20b.—Nerve fibres degenerated by alcohol from a patient suffering with neuritis. These fibres have been prepared and stained in the same way as those in Fig. 20a. The fatty sheaths of the fibres (stained black) are seen to be broken up into droplets.
have undergone degenerative changes due to alcohol. These consist in alteration of the sheaths, so that when stained black by suitable reagents the continuity of the (insulating ?) material of the sheath is found to be broken and the substance collected in droplets.
We may sum up, then, the chronic changes produced by alcohol on the nervous system as follows :—In the first place |
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VI DISEASE OF NERVOUS SYSTEM 131
there is a degeneration and ultimate destruction of the nerve-cells and their processes. In the second place there is an increase in the supporting tissue which replaces the nerve-cells, and which is entirely useless from the point of view of nerve action. This is merely another example of the increase which occurs in the supporting connective tissue of all organs, especially in the case of the liver and kidneys, generally under the influence of alcohol, and which, as has already been stated, tends to come on as age advances.
Here, again, we have impressed upon us the fact that alcohol tends to shorten life both by causing widespread degeneration and also by bringing on prematurely the special changes of old age. These changes in the case of the nervous system are, of course, especially to be dreaded because of the accompanying mental deterioration—a deterioration which frequently makes life a misery, and which, at the very least, renders it useless and ineffective. |
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