| 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 INFLUENCE OF THE DRINKING OF
ALCOHOLIC BEVERAGES ON THE
NATIONAL HEALTH
BY
ARTHUR NEWSHOLME, M.D., F.R.C.R., D.P.H. |
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267 |
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“ If I could destroy tomorrow the desire for strong drink in the people of England, what changes we should see. We should see our gaols and workhouses empty. We should see more lives saved in twelve months than are consumed in a century of bitter and savage war.”—Mr. Joseph Chamberlain, 1874.
“A universal cry of despair rises from the whole universe at the sight of the disasters caused by alcoholism . . . This invasion of alcoholism ought to be regarded by every one as a public danger, and the principle that the future of the world will be in the hands of the temperate ought to be inculcated into the masses as a truth that is incontestable.”—Speech of Prof. Brouardel at Congress on Tuberculosis, 1901.
“The latest and most authentic statistics show that over ten per cent of all mortality is due to the abuse of alcohol, and fully twenty per cent of all disease is traceable to this cause ; also, that over fifty per cent of insanity, idiocy, and pauperism springs from this source. All authorities agree that from seventy-five to ninety per cent of all criminality is caused by the abuse of alcohol. These and other well-authenticated facts indicate the necessity of a more exact medical study of alcohol and its effects and influence on society and the individual.”— By T. D. Crothers, M.D., Hartford, Conn., Superintendent Walnut Lodge Hospital, 1905. |
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268 |
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CHAPTER XVI
THE INFLUENCE OF THE DRINKING OF ALCOHOLIC BEVERAGES ON THE NATIONAL HEALTH 1
Standard of Life influenced by National Expenditure on Alcohol
The following figures will, it is hoped, enable some faint conception to be obtained of the national importance of the subject with which this book deals. Each year official returns are issued by the Board of Trade, which make it practicable to estimate for the United Kingdom the amount of alcoholic beverages which, on an average, each person annually drinks. During the year 1903, the amount of beer drunk per man, woman, and child was 29·7 gallons, which is more than the amount drunk in any other country except Belgium. In addition, each person drank close on a gallon of proof spirit and two-fifths of a gallon of wine during the same year. Now, of every 1000 persons in the general population, 576 are more than twenty years old. If we assume that all of this liquor is drunk by persons over twenty years of age, and that women drink as much as men, this means that each adult drinks annually 51·6 gallons of beer, 1·82 gallons of proof spirit, and 0·69 gallons of wine. Putting it another way, the average weekly consumption for each adult is about eight pints of beer, a third of a pint of proof spirit, and a tenth of a pint of wine. In actual fact, much larger quantities than these are taken by a much smaller number of persons.
Even this statement scarcely enables one to realise the significance of the figures quoted above. Let us consider what
1 By Arthur Newsholme, M.D., F.R.C.P.Lond., when Medical Officer of Health, Brighton, author of Elements of Vital Statistics, etc.
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270 ALCOHOL AND THE HUMAN BODY chap.
it means in money. This can be stated with some degree of exactitude, as official figures are published year by year. In 1904 the population of the United Kingdom was nearly forty-three millions, and this population spent 169 millions sterling on alcoholic drinks, an amount which was 5½ millions less than in the previous year. This means that on an average each person in the United Kingdom spent during 1904, £3 :19s. on alcoholic drinks. But as the consumption of alcoholic drinks is almost entirely confined to persons over twenty years of age, it follows that every person over twenty spends on an average £6 :17 : 2½ per annum on alcoholic drinks. The wage-earning classes form about four-fifths of the total population, and they probably spend about two-thirds of the total money devoted to the purchase of alcoholic drinks. On this assumption each adult of the working classes spends 2s. 2½d. a week on alcoholic beverages. There are usually two such adults, and often three, in each working-class family. It will be perfectly safe to say that at least 5s. on an average is spent on alcoholic drinks in each of these families. As some spend less or nothing at all in this direction, others must and do waste a much larger weekly amount on such expenditure. We will assume, however, that the amount is only 5s. a week. Con sider what this sum would do, if wisely spent. If placed as an insurance premium in the Post Office year by year, begin ning at the age of twenty-five, it would mean for the husband that he would have the sum of £422 at the age of fifty-five, or his wife would obtain this sum if her husband died at an earlier age. This .£422 invested in an annuity for the husband would furnish a yearly income of £32 : 10s., or 12s. 6d. a week; for the wife, if similarly invested, a slightly smaller income.
Such a provision would not exhaust the saving which would result from spending no money on alcoholic drinks. The improved health of parents would imply saving of money, and increase of efficiency in every direction. The general standard of life of the family would be raised. It is by this raising of the standard of life of the wage-earning classes, who form the majority of the population, that the prosperity of the nation can be most certainly promoted. The brewing trade pays in wages for every £100 value produced much less than the majority of trades, only about one-third or even only one-seventh of many of them. The diversion of the same amount |
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XVI INFLUENCE ON NATIONAL HEALTH 271
of money as is now spent in producing alcoholic drinks to increased food, rental, clothing, and other comforts, would react on nearly every trade in the community, and would greatly enhance our national prosperity. This statement allows nothing for the partial emptying of our prisons, work houses, and lunatic asylums, which would follow the abolition of alcoholism, and the releasing for more useful purposes of the money and energy which this economy would secure.
During the last twenty years the wages of the working classes have risen. Between 1881-5 and 1900 the average wages in this country rose 20 per cent. During the same period the cost of food to each family declined 25 per cent, and of clothing 5 per cent, rent rising 12 per cent. Taking all these items together, the total of the chief expenses of a working-man’s family fell over 14 per cent. This is an average statement, which, while it does not exclude the fact that among a section of the population, especially unskilled labourers, there is still a very low standard of life, shows that the majority of the wage-earning classes have greatly improved in their possibilities of social comfort and prosperity. It is clear, however, that as on the average the heads of the house hold of every wage-earning family spend at least five shillings a week each on alcoholic drinks, a large share of this increased prosperity is being wasted. It is lamentable that up to the present time the consumption of alcoholic drinks varies closely as national prosperity varies, and not in accordance with our increasing knowledge of the evils of drinking, even of so-called moderate drinking.
Our national expenditure on alcoholic drinks means more than wasted money. It implies an enormous mass of wasted health and of lost lives. It would form an interesting subject for speculation whether the amount of alcoholic drinks now consumed in the United Kingdom would do more harm in the aggregate if an equal amount were consumed by every adult, or if, as now happens, a very large number took little or no alcohol, and others indulged in amounts which every one agrees are excessive. So-called moderate doses of alcohol can be proved experimentally to inflict serious injury, and the experience of insurance offices points in the same direction.
Statistical Understatement of Number of Deaths due to Alcohol.—-The first class of statistics with which we have to |
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272 ALCOHOL AND THE HUMAN BODY chap. xvi
deal is those published by the Registrar-General, which state the number of deaths annually caused by alcoholism and certain diseases, like cirrhosis of the liver, which are known to be almost strictly confined to topers. For obvious reasons, the number of deaths registered under these heads is greatly under stated. The doctor in attendance hands the death-certificate to the nearest relative of the deceased, and he is careful not to hurt that relative’s feelings. Often, also, alcohol produces lesions which may be caused by other agents, and the disease named on the death-certificaté gives no clue as to which of these is operating. So far, therefore, as our national death-returns for the general population are concerned, statistics only tell a minute fraction of the total mischief done by alcohol. Thus, in England and Wales, during the year 1903, only 1475 deaths of males and 1075 of females were returned as caused by alcoholism and delirium tremens, and 2196 death of males and 1720 deaths of females were ascribed to cirrhosis of the liver, a disease known to be nearly always due to alcoholic indulgence.
Comparative Mortality for Various Trades and Occupa tions.—We must turn to the Registrar-General’s statistics for special occupations to obtain a clearer insight into the havoc wrought by alcohol. This authority gives “comparative mortality figures,” showing the relative number dying in different occupations out of a given number living in those occupations at the same ages. Thus, if the comparative mortality figure for all men equals 1000, an equal number of gardeners would only have 568 deaths, teachers 571, grocers 664, doctors 957 ; while at the other end of the scale are brewers 1407, innkeepers and inn-servants 1665, and filemakers 1791.1 The practical importance of these facts, and of similar facts which are well known, is shown by the practice adopted by insurance societies, as contained in the following extract from Allbutt’s standard System of Medicine :—
It is customary to add 50 per cent extra for such dangerous occupations
1 The above figures relate to the years 1890-92. These statistics are only published by the Registrar-General once in ten years. More recent returns (to be found in Dr. Tatham’s Supplement (1908) to the Registrar-General’s Sixty-fifth Report) give the comparative figures for 1900-1902 as follows :— Gardeners 527, teachers 599, grocers 670, doctors 952, brewers 1324, inn keepers 1669, filemakers 1682. Their teachi remains the same as before. |
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Fig. 32—Relative mortality figures of adult males, publicans, and abstainers. The two first are derived from the Regis trar-General’s returns, the last from the experience of the Independent Order of Rechabites for the years 1878-87, the figures being stated in each case in terms of a “ standard population.” |
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274 ALCOHOL AND THE HUMAN BODY chap.
as the drink trade, even if classed as A 1 by the medical examiner ; but it is probably wiser to follow the rule of the more cautious offices, and absolutely to decline to accept proposals in such cases.
Why is it that a publican’s chance of premature death is three times greater than that of a gardener, and that it is nearly as risky to be engaged in a public-house as in the extremely dangerous industry of file-making? The reason must be sought in a further examination of the diseases to which those engaged in selling alcoholic drinks are subject. Comparing employees in inns (inn-servants) with all occupied males, we find that out of a given number in each group, among inn-servants 8 times as many die from alcoholism, 51/2 times as many from gout, l3/10 times as many from diseases of the nervous system, 14/5 times as many from suicide, 21/2 times as many from consumption, and so on. (1890-92 statistics.)
Consumption and Cancer.—Consumption and cancer are two of the most dreaded diseases, and they are two of the most common causes of death. Out of every 1000 deaths in England 78 are caused by consumption, and at least 56 by cancer. Both these diseases are more frequent among those who indulge in alcoholic drinks than among abstainers.
Consumption is due to infection by a microbe, the tubercle bacillus, which is discharged with the expectoration or spit of persons suffering from the same disease. The infection is commonly inhaled by others in the form of dust, which consists in such cases largely of dried expectoration, resulting from careless spitting by consumptives on floors of rooms, etc. But why do those working in public-houses and those who frequent public-houses suffer much more from consumption than others 1 Doubtless much of the mischief is caused by direct infection at the bars of public-houses. It is well known that, as a rule, frequent doses of infection are required before active con sumption is produced. To frequent a public-house is one of the most certain ways of receiving these frequent and large doses of infection. But this is not all that indulgence in alcoholic drinks implies. If so, infection might be avoided by drinking at home. It has been shown, however, that alcohol lowers the resistance to infection ; in other words, it opens the door to infection ; it prepares the soil on which the seed of infection grows. This is well known to be true not only for consumption but also for such diseases as pneumonia, typhoid |
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XVI INFLUENCE ON NATIONAL HEALTH 275
fever, erysipelas, blood-poisoning, etc. A great French physi cian, Dr. Brouardel, has well stated the matter in the following words : “ Alcoholism is in effect the most powerful factor in the propagation of tuberculosis. The most vigorous man who becomes alcoholic is without resistance before it.”
As with consumption so with cancer, there is a great excess of disease in persons employed in those occupations in which alcoholic indulgence is common. According to the Registrar-General’s figures,1 the same number as would furnish 44 deaths from cancer among all occupied males, 35 among clergymen, and 43 among doctors, would furnish 63 deaths from cancer among commercial travellers, 70 among London innkeepers, and 70 among brewers. In an investigation which I made as to the persons insured in the United Kingdom Temperance and General Provident Institution, I found that the same number living at the same ages which gave 100 deaths from cancer among the non-abstainers, only gave 71 deaths among the abstainers. This is not surprising when we remember that one of the factors producing cancer is the influence of chronic irritation, and alcohol causes irritation of the tissues with which it comes into contact.
Comparative Death-Rates of Abstainers and Non-Abstainers
We have seen that the statistics of persons engaged in different occupations give us a better insight into the ravages of alcoholism than do the statistics for the whole community. Happily there are now exact statistics available comparing, in a manner free from fallacy, the relative experience of abstainers and non-abstainers on a large scale.
Thus the incidence of sickness and mortality among abstainers from alcohol and non- abstainers is very clearly demonstrated by the statistics of the friendly societies.
From the Report of the Public Actuary of South Australia, Mr. H. Dillon Gouge, F.S.S., we extract the following facts :— |
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1 For 1890-92.
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276 ALCOHOL AND THE HUMAN BODY chap.
So, too, the contrast between the percentage death-rate among the members actually sick, and the average weeks of sickness suffered by the two classes is striking :— |
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To this must be added the statement that many of the members of the “non-abstainers’” societies, i.e. Foresters and Odd fellows, are, in fact, abstainers. The contrast would have been even stronger had they been truly all non-abstainers.
The net result approaches two to one in favour of the abstainer, who thus lives longer and more healthfully than his non-abstain-ing friends. And, finally, when he is sick he makes a more speedy recovery.
The insurance office already named has, among others, col lected its experience for a long series of years. During this time over 14,000 deaths occurred, and as these and the total lives in sured throughout have been kept in separate groups of abstainers and non-abstainers, and as trans fers from one class to the other have been excluded from both classes, we have a body of evidence
Fig. 33.—To show the facts derived from insurance statistics, which demonstrate that the drinkers of alcohol make calls upon their sick fund for many more weeks than do the total abstainers. |
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XVI INFLUENCE ON NATIONAL HEALTH 277
which gives irrefutable proof of the longer life enjoyed by the abstainers. Up to the age of 55 the death-rate of non-abstainers at any age is never less than 45 per cent higher than that of abstainers, and at some ages 94 per cent higher than the latter. Between 60 and 64 it is 32 per cent higher ; between 65 and 69 it is 20 per cent higher ; between 70 and 74 it is 16 per cent higher than that of abstainers, so that the superiority of the latter persists at nearly every age. Expressed in another way, every abstainer 30 years of age has an average prospect of living 31/10 years longer than a non-abstainer. Comparing with more general experience, out of every 100,000, starting at the age of 20, among the abstainers 53,044 reach the age of 70, while only 42,109 reach this age in
Of every 100,000 Non-abstainers |
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Of every 100,000 Total Abstainers |
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Fig. 34.—Comparison between the duration of life of total abstainers and non-abstainers. (From a paper read by Mr. R. M. Moore before the Institute of Actuaries 30.11.03.)
the general experience of a large number of life offices of Great Britain.
It is not necessary to multiply similar figures. All point to the same conclusion. The prospects of long life, like the prospects of good health, are very seriously diminished by alcoholic indulgence. Of course the non-abstainers in the statistics quoted above comprise a certain proportion of drunkards, and it may be urged that it is the latter who cause this enormous difference in life prospects between abstainers and non-abstainers. There must have been a large number of drunkards, if they alone caused the experienced difference, and this is contrary to the known facts. We are compelled to conclude that what is commonly described as moderate drinking has a most injurious influence on health and life, and that the best practice, both in the interests of health and morality, consists in the avoidance of all alcoholic drinks as a beverage. |
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