| 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. |
THE EFFECT OF ALCOHOL UPON THE HEART AND THE CIRCULATION |
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199 |
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“A falsehood which dies hard is the idea that stimulants of whatever kind actually give strength and are necessary for the maintenance of health and vigour. Such is not the case, and the well-worn comparison that they are the whip and spur and not the corn and grass is strictly accurate. Anything accomplished under the influence of stimulants is done at the expense of blood and tissue, and, if frequently repeated, at the expense of the constitution.”—The late Sir W. Broadbent, M.D., K.C.V.O., LL.D., etc.
“Besides chloroform, alcohol may be mentioned as another drug which, while it renders the systolic output incomplete, increases the diastolic pressure and the dilatation of the heart.”—Leonard Hill. M.B., Text-Book of Physiology, edited by E. A. Schäfer, LL.D., F.R.S.. 1900.
“It has been shown, as well by experiments on animals as by observation on man during life and after death, that alcohol weakens the heart, causes hypertrophy and dilatation and fatty degeneration of the muscular fibres, and that it thus increases the natural tendency to failure of the heart which is usual in old age. Alcohol, by augmenting this tendency, adds to the danger arising from acute diseases, such as influenza and pneumonia, since persons with weak hearts much more readily succumb to such diseases than persons with strong hearts.”— Sir Hermann Weber, M.D., F.R.C.P., Alcohol and Old Age, 1906.
“Alcohol has a somewhat similar effect on the heart to that produced by the typhoid toxin.”—Sir Jas. Barr, M.D., etc. |
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200 |
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CHAPTER XII |
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THE EFFECT OF ALCOHOL UPON THE HEART AND THE CIRCULATION
By the circulation we understand the driving of the fluid blood, round and round the body, through the blood-vessels, such driving being maintained by the pumping power of the heart, which is practically a hollow muscle.
In consequence of this pumping power of the heart, the blood in the vessels is under considerable pressure, which is naturally increased if the blood-vessel be narrowed or con tracted, and diminished if the blood-vessel be expanded or dilated.
When studying the action of alcohol on the circulation, we have therefore, first, to consider its effect upon the action of the heart, and, secondly, its effect upon the blood-vessels of the body.
I. Effect of Alcohol upon the Pumping Power of the Heart
Popularly, alcohol is supposed to strengthen the pumping force of the heart ; in fact, great faith was placed in it on this account, until more recently, when the matter has undergone scientific revision and criticism. The question whether or not alcohol strengthens the force of the heart’s beat is one of great practical importance, and with the improved methods of research at the disposal of scientific men, observations have been made with the view of ascertaining its real effect upon that organ. These investigations are too long and complex to describe here in detail, but we may state that experiments have shown that blood containing only one-quarter per cent
201 |
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202 ALCOHOL AND THE HUMAN BODY chap.
of alcohol diminished within a single minute the work done by the heart ; and that blood containing one-half per cent so seriously affected its working power that it was scarcely able to drive a sufficient amount of blood to supply its own nutrient arteries. This enfeebled condition rapidly leads on to dilata tion of the heart, whereby “ the heart pumps around less blood.” 1
The conclusions arrived at with regard to this local action of alcohol upon heart-muscle may be summed up in the words of the writers of a recent and comprehensive review of the problem :—“ It has yet to be proved that the heart-muscle can be stimulated by alcohol.” 2
This greatly debated question has been approached by investigators by different methods, and probably to this variation is due some of the opposition of results. Thus clear distinction must be drawn between the results observed to follow the action of alcohol on the heart when that organ is part of an intact animal, subject both to the nervous system and to the mechanical conditions produced by the varying states of the peripheral circulation, i.e. blood-vessels, and those following the administration of alcohol to the isolated living heart removed from the body and the influences of other structures.
The most positive effects observed in support of the adjuvant action of alcohol are those recorded by Dixon3 upon the isolated heart, i.e. removed from the body and kept in activity by an artificial flow through its cavities of nutrient and oxygenated fluid to which alcohol in known quantity was added.
Dixon found that the mammalian heart under those cir cumstances exhibited at first an increase of power which soon became followed by a diminution or depression.
To Dixon’s results are opposed those of Backmann4 and other workers, but perhaps the most important practical outcome of all this investigation is Dixon’s observation that
1 Martin and Stevens, Studies from the Biological Laboratory of Johns Hopkins University, 1889.
2 Alcohol and the Cardio-Vascular System, by Dr. Munro, Physician to Glasgow Royal Infirmary and Professor of Medicine in St. Mungo’s College ; and Dr. J. W. Findlay, Assistant Physician to Glasgow Royal Infirmary.
3 Journal of Physiology, 1906, p. 346.
4 Skand. Archiv. fur Physiologic, 1906. |
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xii EFFECT ON HEART AND CIRCULATION 203
alcohol produces its well-known depressant action on the heart soon, and all workers are agreed that so soon as the small quantity of ·5 per cent of alcohol in the blood is reached a rapidly developed weakening of the heart’s action ensues. Martin found the same effect from ·25 per cent.
Thus direct experiment upon the whole heart shows that alcohol has not the augmenting power formerly attributed to it, but that, on the contrary, it slowly depresses the action of the heart-muscle, and ultimately partly paralyses not the muscle only but also the delicate nerves which are present in the wall of the heart.
This paralysis of the cardiac nerves largely accounts for the acute dilatation of the heart and the fatal failure of that organ, which often occur when people have drunk large doses of alcoholic liquids.
Faintness
An objection may be raised that alcohol is used with success in the restoration of those who have fainted ; and this matter may now be conveniently dealt with.
It must be borne in mind, in the giving of all remedies by mouth, that the mere act of swallowing or sipping accelerates the action of the heart, causing it to beat more quickly. Whether it be water or alcohol or simply saliva is immaterial as regards the value of this act of swallowing, which reflexly tends to relieve the heart. Therefore our first effort with a fainting or exhausted person is to induce them to swallow or sip something—and if possible a liquid that is warm.
Alcohol, when given, acts as an irritant (so-called stimulant) to the nerves of the mouth and stomach, causing a preliminary excitation of the nervous system, and it is to this that the apparent revival is due. Other substances have this power of stimulating the nerves in the same way, for instance, a burnt feather, ammonia, ether. A side issue in the case is the fact that alcohol causes dilatation of the blood-vessels of the body owing to its depressant action on the nerves that control these blood-vessels (see Chap. VII.), and this relaxation induced by alcohol permits the passage of blood to occur more readily than normal, and, therefore, for the moment the heart turgidity may be relieved and its work be accomplished with less effort. Thus far alcohol may indirectly be of a little value, but, as we |
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204 ALCOHOL AND THE HUMAN BODY chap.
have stated above, the proofs of actual heart stimulation are wanting.
[The best thing to do in a case of fainting is to lay the patient flat near open windows, to loosen all clothing, and to raise the feet if recovery be slow. Sips of water, preferably hot, should be given, and as the patient revives hot milk should be sipped, as this will be found to be both stimulating and nourishing.]
These facts are in undoubted opposition to the almost invariable practice of giving alcohol, in the belief that it improves the tone of the heart and its circulation—but, as has just been shown, the ideas on which such use of alcohol is based have now been found to be incorrect.
This notable development of clinical opinion is strikingly exemplified by the extraordinary reduction of the amount of alcohol given in hospitals, and by the successful issue of cases treated entirely without it.
A glance at the chart on p. 5 will at once indicate the way in which medical treatment has completely altered in regard to the prescribing of alcohol. It is no longer given by physicians and surgeons as a routine and serviceable remedy required to help the heart and digestion, although some practitioners still permit a certain amount to be taken when patients state that they are dependent upon its habitual use.
Effect of Alcohol in conditions of “Shock”
A most striking proof that alcohol is not only of no service in the restoration of the heart’s action, but that it is distinctly depressant, is exemplified by the treatment of cases of “shock.” Crile 1 has shown by direct experiment on the state known as “shock” that alcohol only aggravates the conditions resulting therefrom ; and wider experience has demonstrated that hypo dermic injections of strychnine and atropine, and the use of other substances,2 are far better calculated to bring the patient out of danger than the alcohol, so often given as a routine, while other far more valuable remedies are omitted.
As regards this change in medical practice, it must be remembered that our forefathers had not discovered the value
1 Blood Pressure in Surgery, by George W. Crile, A.M., M.D.
2 Notably the subcutaneous injection of large amounts of water. |
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XII EFFECT ON HEART AND CIRCULATION 205
of hypodermic injections, and their remarkably rapid and certain effect. In modern methods of treatment reliance is always placed upon the above-named drugs in cases of danger, few dreaming of depending on alcohol.
Alcohol and Chronic Disease
Similarly in chronic disease alcohol has been shown to be of no real benefit in the way of stimulating the heart—its action |
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Fig. 29.—Two drawings of muscle-fibres from the heart and magnified 375 diameters. The regularly striated muscle-fibres on the left hand are healthy. The fibres on the right have almost entirely lost their striation, and their substance is infiltrated with droplets of fat which have been stained black. Thus the fibres are in an active state of fatty degeneration. This diseased specimen is taken from a patient suffering from chronic alcoholism.
under such circumstances being more that of a narcotic and sedative. Not a few persons, especially the aged, suffering from some chronic ailment, have been rendered bedridden, and have lost all disposition and ability to move about, as a result of this mistaken use of alcohol.
In fact, alcohol acts as a direct poison on the protoplasm of heart-muscle just in the same way as chloroform and diphtheria, and as a result there occurs slight swelling and cloudiness of the muscle-fibre, and later on the actual deposition of droplets |
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206 ALCOHOL AND THE HUMAN BODY chap.
of fat in the fibre itself. Fig. 29 shows the difference between a normal fibre and that rendered flabby by containing deposits of fat. A heart thus weakened tends to dilate, and this common and serious condition we must now consider.
Dilatation of the Heart
Dilatation of the heart due to alcoholism may be either :
(1) Gradual in its occurrence,—or,
(2) Sudden and fatal.
1. Gradual dilatation or stretching of the relaxed muscle is a very common condition, and the part played by alcohol in its causation may be explained as follows :—
The depressing effect of alcohol upon the nerves which control the action of the heart, the hampering effect of deposits of fat on and between the muscles, and finally the impaired power of contraction possessed by the muscle-fibres themselves when they are beginning to undergo fatty degeneration, unite in causing a weakened power of contraction of the heart, which consequently fails to empty itself completely when it strives to pump forward its contents. Such a languid and ineffectual method of contraction leads gradually to a slight stretching of the heart, this being for the moment the most ready way of accommodating itself to the increased internal pressure caused by over-fulness. From this point matters tend to become worse, unless the factors which encourage dilatation are removed from the patient’s life. For not only does a dilated heart fail to empty itself properly, and hence become increasingly hampered by its own over-fulness, but the whole circulation through the body is hindered, to the great detriment of all the organs. This condition is one of extreme importance, because owing to the special situation of the abdominal organs and the arrangement of their circulation, the liver, spleen, stomach, etc., become venously congested directly the heart flags in its duty of keeping the circulation active. There is, in fact, an accumulative or back-flow effect, which tells immediately and primarily on the liver. But this is not all : for any marked weakening of the force and strength of the heart leads at once to a slowing of the circulation, and thus to a partial stagnation of the blood all over the body. Consequently the tissues are deprived of the rapidly changing supply of nourishing blood |
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xii EFFECT ON HEART AND CIRCULATION 207
which they need ; and as a result of this semistarvation they naturally deteriorate.
This partial starvation occurs also in the tissues of the heart itself, and is a most serious thing, considered in the light of the stupendous task which that organ has to perform throughout life, a task which it can only accomplish satis factorily as long as its blood supply is perfect and its muscles nourished.
2. Acute dilatation occurs not infrequently in those whose heart-muscle has been for years somewhat undermined by alcohol and other indulgences. A fatty and dilated heart requires but little stress (such, for instance, as a mild attack of illness or an attack of indigestion) to make it dilate suddenly and even fatally.
Gradual Deterioration in Heart Power a Cause of Premature Death
One of the early indications that the foregoing changes may be occurring in a heart is a sense of fatigue and breathlessness on slight exertion, or a feeling of disinclination for normal effort.
For instance, those who have taken alcohol in small quantities for years often notice in themselves an absence of energy, and their vigour and freshness return only after a few months of total abstinence, during which time the heart gradually regains its tone. It is probably not realised by many that very small doses, constantly taken, ultimately cause an effect on the heart. The result of such depression of the efficiency of the heart with many is that when they are attacked by some disease they succumb to heart failure, instead of being able to hold their own and recover from the illness. This probably accounts for the great number of deaths in men between forty and sixty years of age, men who ought to live to a good old age, but who are heavily handi capped when a disease such as influenza or pneumonia comes upon them, their hearts being below par. Their loss to the community is incalculable. So serious is it, and so needless, that in considering matters of national physical efficiency it ought not to be ignored. A man of forty to sixty should be of real value to his country, whether as a work producer or a |
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208 ALCOHOL AND THE HUMAN BODY chap. xii
teacher or thinker—his powers of body and mind being at their best. Too often are these powers impaired, and the normal resistance to disease and death lessened, by what is often regarded as an ordinary dietetic use of alcohol. When the death of a man in the prime of life is announced, the first thought ought to be : “ Need he have died ? ” In the large majority of these cases, a little investigation will show that what should have been a normally resisting heart has been weakened by daily habits and social customs.
On the other hand, it is happily an everyday experience to hear of a patient recovering from a severe illness mainly because of his temperate life. In other words, his organs, especially his heart, are in a healthy state, and thus are enabled to combat disease successfully.
Beer-Drinker’s Heart.—This term is one well known to the physicians of our large hospitals, and indicates a special condition of unhealthy enlargement of the heart due to dilatation, accompanied by some increase of tissue and of fat. Doctors Bauer and Bollinger found that in Munich one in every sixteen of the hospital patients died from this disorder. It is common in Germany—the land of beer-drinking—and proves incontestably that the habit of drinking even such a mild alcoholic beverage as “lager beer” is one that is un desirable and unwise. (See Fig. 30.)
II. Effect of Alcohol on the Blood Vessels
1. Chronic Congestion.—When alcohol is swallowed it produces, as we have seen, a local effect on the blood-vessels of the stomach (p. 146), and almost simultaneously causes dilatation of the blood-vessels of the liver, which organ becomes turgid and swollen. The same condition obtains (as soon as alcohol reaches them) in the other organs of the body, their vessels becoming dilated—whether by local or reflex action is not determined, but probably by both agencies.
Repeated doses of alcohol, of course, render this dilatation of vessels more and more permanent, and as the flow of blood through the widened channels is necessarily slower (especially in view of the impaired action of the heart), a condition of stagnation, or what is called chronic congestion, ensues.
The bluish appearances of skin in people who take much alcohol is thus produced ; and it is not surprising that before |
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(1) Normal Heart (2) Fatty Alcoholic Heart |
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Fig. 30.—Two drawings of the human heart. The smaller one on the left (No. 1) is a healthy specimen, the larger on the right (No. 2) is a fatty and dilated heart from a beer-drinker. These are taken from excellent coloured drawings by Dr. C. Henning from preparations by Professor Weichselbaum, and are reproduced by kind permission of the Austrian Anti-Alcohol Society. The muscular substance of the beer-drinker’s heart is not only itself fattily degenerated, but it is greatly overlaid and hampered by the overgrowth of fat which, as is well shown in the figure, is but a gross exaggeration of what exists to a moderate degree in health. Note that the ordinary muscle is hardly to be seen. |
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210 ALCOHOL AND THE HUMAN BODY chap.
actual disease of the kidneys and other organs sets in, this chronic congestion leads (for example) to such a condition as albuminuria—that is to say, to the escape of the extremely important albuminous constituents of the blood into the water which passes away from the kidneys.
Moreover, as soon as a state of chronic congestion is estab lished in any part, the delicate chemical changes between the blood and the tissues nourished by it are so seriously interfered with that the tissue begins to undergo the first stages of fatty degeneration.
2. Alteration in the Walls of the Blood-Vessels.—Dilata tion of vessels and consequent congestion is not the only alteration induced by alcohol in the thousands of blood-vessels which penetrate every part of the body. A most important change takes place in the actual walls of the blood-vessels, i.e. a degeneration of these walls which occurs as the direct result of the constant taking of alcohol.
For many years it has been known that a thickening occurs in the walls of the blood-vessels of many persons. Microscopi cally this change is shown to be due to an increase of the normal fibrous tissue existing in this position, and in some cases there is found to be accompanying it a condition of fatty degeneration, and also even of calcification of the vessel-wall (pipe-stem vessels).
Recent observations have convinced most thoughtful observers that this condition of vessel-wall, “ in certain cases at any rate, can be attributed to nothing but the use of alcohol, and not always or necessarily in very large doses.” 1
This fibroid thickening leads to a lack of elasticity and contractility in the vessel-walls, and therefore to a delay in the blood-current, and to a stagnation or stasis of circulation.
In consequence of this a much greater amount of work is thrown upon the heart, which therefore is obliged to use up its reserve power and energy.
Interference with Nutrition.—It must be remembered that all the nutritive action of the blood depends on its power of filtering rapidly through the walls of the blood-vessels to the tissues,—and, conversely, its power of drawing off the waste products of the tissue depends on the facility and readiness with which such products can penetrate the walls of these vessels. 1 Professor Sims Woodhead, The Practioner, November 1902. |
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xii EFFECT ON HEART AND CIRCULATION 211
As soon as degeneracy sets in the walls of all the vessels tend to become thickened, and the active transference of liquid through them being more or less prevented, the nutrition of the body is gravely hampered.
This process of thickening in some people is very slow, in others it is rapid. As it advances, the vessels become not only less able to adjust themselves to the constant variation of the pressure of the blood within them, but finally unable to withstand that pressure. They therefore frequently rupture and produce hæmorrhages and apoplexies, which, when occurring in the brain, cause paralysis and mental decay.
Middle Life.—In middle life all tissue activity tends to become lessened, and notably so the pace at which oxidation occurs, by means of which we get rid of our waste matter, poisons, etc
If a man has been in the habit of taking alcoholic drinks in the days when his power of oxidising poisons was at its best, it is important for him to realise that he cannot with impunity continue long upon these lines, for middle life brings with it a lessened capacity for effecting oxidation, and consequently, as Professor Sims Woodhead points out, if he continue to take alcohol, instead of living to eighty or ninety years, as he should, he is liable to die at fifty or sixty from degeneration of the blood-vessels and failure of the heart, the result of
(1) The alcohol imbibed in young adult life,
(2) The continuation of the habit in middle life.
Of course a similar degeneration takes place not infrequently in old people, but the immediate point is that many persons, instead of waiting until old age comes to them, deliberately bring upon themselves this change in their blood-vessels, with its consequent risk of apoplexy and early loss of brain vigour (to say nothing of the early failure of other organs), by taking alcohol in what is often termed “ moderation.”
“Professor Baeumler further directs attention to the fact that persons consuming large quantities of beer mechanically overtax their blood-vessels by keeping them in a state of distension, which gradually leads to the disease of the small arteries and, later on also, of the heart, the work of which becomes additionally more and more increased by the morbid state of blood-vessels. My own experience amply corroborates Baeumler’s view.”—Sir Hermann Weber, M.D., On Means for the Prolongation of Life. |
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