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EXAMINER IN PHYSIOLOGY IN THE UNIVERSITY OP LONDON, AND FROPESSOR OP MEDICAL JURISPRUDENCE IN UXn'ERSlTY COLLEGE. BOSTON : P U D L I 8 II E D FOR THE MASSACHUSETTS TEMPERANCE SOCIETY BY WM. CROSBY & II. P. NICHOLS, 111, Washington Street. 1851. l-:^.^xj^^,,^^. : BOSTON: PRINTED BY JOHN WILSON, No. 21, School-itreet W OFFICERS OiTTHB MASSACHUSETTS TEMPERANCE SOCIETY, 1860-61. w JOHN C. WARREN, M.D. . . HON. STEPHEN FAIRBANKS MOSES GRANT, Etq REV. ANDREW L. STONE . REV. JOSEPH BANVARD . RICHARD OIRDLER, E»q. . BENJAMIN P. RICHARDSON, . President. . Vice-President. , Secretary and Treasurer. Esq.. ' Councillors. u PREFACE TO THE BOSTON EDITION. Thb name of Dr. Carpenter has become well known in the United States by his valuable and beautiful work on the Principles of General and Comparative Physiology, by his Principles of Human Physiology, and by various other writings. The studies to wliich the production of tliese works led, qualified him to undertake an inves- tigation of the ejects of alcohol on the human body. When, therefore, it was announced that the prize of one hundred guineas, which the liberality of a gentleman in England had oflfered for the best Essay on the Use of Alcoholic Liquors in Health and Disease, had been ga'n vi by him, those who felt an interest in the subject lookc ! with eagerness for the results of his labors ; and, when they appeared, the highly wrought expectation was not disappointed. Accordingly, we were pleased to find that an edition was soon issued in this country by Messrs. Lea and Blanchard, of Philadelphia, and that physicians and others would be able to avail thousolves of the pro- ducts of Dr. Carpenter's talent and researches. n PREFACE TO TUB BOSTON EDITION. Many persons have thought that the work could bo rendered more generally UHoful by the insertion of expla- natory notes, which should make it intelligible to the mass of readers. This has been hero accomplished under the direction of the Massachusetts Temperance Society, — the word "Author" having been usually affixed to the notes of Dr. Carpenter, to distinguish them from those in the present edition. It has been intimated, that some medical men on the continent of Europe, highly distinguished for learning and benevolence, have not gone as far in the absolute and unexceptionable exclusion of alcoholic liquids as many temperance physicians and others in this country con- sider themselves justified in doing. We must admit that our experience is in favor of the expediency and safety of their unqualified prohibition at every period of life, excepting always their medicinal use under medical prescription. This exporiouco, somewhat extensive and protracted, among the young and the old, among the rich and the poor, including a krgo hospital observation, has not made known to us permanently unfavorable con- sequences from the sudden relinquishment of the use of spirituous and fermented liciuors ; provided, however, that the change lias boon accompanied by a judicious manage- ment of food, of medicinal tonics, and of the moral con- dition of the subject. In this remark wo do not mean to include intemperate persons who meet with great PREFACE TO THE BOSTON EDITION. YU accidents; for we know that, when compelled by a severe injury to intermit their bad habit, they often suf- fer greatly and fatally. DeUrium tremens, mortification, and the worst forms of inflammation, occurring under these circumstances, render abortive all the skill or inge- nuity of the surgeon and physician. Such conditions in an alcoholic patient often demand, as the indispensable remedy, a recurrence to the poison which has been the source of his suffering and danger. When it is thus used, we would recommend that the earliest opportunity should be employed for discontinuing the practice, and warning the patient against a return to it. We have adverted to the use of stimulant drinks in the latter part of life, and expressed an unfavorable opinion. This is quite contrary to the common belief, and will be thought injudicious and the result of over- heated zeal. " Vinum lac senum" is a favorite adage, and is too congenial to the tastes and wishes of most men to become unpopular. Instances, however, have constantly presented themselves to our notice of old men who complained that wine, which they had formerly taken as they thought with advantage, though still agree- able, had ceased to be salutary. Formerly, they ex- perienced from it no particular inconvenience ; but, at a later period of life, it caused acidity of stomach, heat about the head and hands, pain in the head, and other inconveniences. When the wine was abandoned, the till PRBPACB TO THB BOSTON BDITION. •ymptoms disappeared, and they were reluctantly brought to the oonolusion that they were better without it. Theae well-established facts are supported by an investigation into the physical changes of advanced life. Observation has shown, that the pulse, instead of becoming slower in proportion to age, as generally believed, does, ailer a certain period, begin to quicken, and continues to do so to the end of life. This disposition in the system to an increase of the heart's action is still farther excited by the use of stimulants ; and the condition which was favor- able to health, under the influence of natural powers, becomes morbid from the over-excitement of artificial stimulants. On the whole, we should recommend, aa a general rule, the sudden and total abandonment of the habit oi employing spirituous and fermented liquors, both by the young and the aged, the weak and the strong. The work of Dr. Carpenter we consider to be the most valuable contribution to the aid of temperance which it has received since the productions of L. M. Sargknt, Esq. ; and we heartily recommend its perusal to all classes of people, particularly to gentlemen of the medical profession. J. C. W. BosTOR, D«eeinber, 1840. TO HIS ROYAL HIGHNESS PRINCE ALBERT, €{)i0 €bu^ (by febmission) MOST RESPECTFULLY DEDICATED, At AW EXPRE8BI0N OP THE AUTHOR'S ADMIRATION OF HIS ROYAI. HIOHNESS'S ENDEAVORS TO ELEVATE THE SOCIAL CONDITION OP HIS ADOPTED COUNTRY, AND WITH THE FIRM BELIEF THAT THE PATRONAGE NOW SO ORACIOUSLT CONCEDED WILL AID IN CALLING THE ATTENTION OP THE PUBLIC TO THE SUBJECT OF THE PRESENT INQUIRY IN A DEGREE COMMENSURATE WITH ITS IMPORTANCE. 6« dr >I>VERTISEMENT ISSUED BT DIBBCTIOM OF THE DOKOB OP THB FBIZE. A PRIZE OF ONE HUNDRED GUINEAS WILL BE GIVEN rOR THB BEST ESSAY ON THB USB OF ALCOHOLIC LiaCOBS IN HEALTH AND DIBBA8B. The Essay must contain answers to the following questions : — 1. What are the effects, corporeal and mental, of alcoholic liquors on the healthy human system ? 2. Does physiology or experience teach us that alcoholic liquors should form part of the ordinary sustenance of man, par- ticularly under circumstances of exposure to severe labor, or to extremes of temperature ? Or, on the other hand, is there reason for believing that such use of them is not sanctioned by the principles of science, or the results of practical observation ? 3. Are there any special modifications of the bodily or mental condition of man, short of actual disease, in which the occasional or habitual use of alcoholic liquors may be necessary or beneficial ? 4. Is the employment of alcoholic liquors necessary in the practice of medicine ? If so, in what diseases, or in what forms and stages of disease, is the use of them necessary or beneficial i The Essay must be delivered to the undersigned ad- dress, on or before the 30th day of September, 1 849. xu ADVERTISEMENT AND ADJUDICATION. 1 Dr. John Forbes, F.R.S., Physician to the Queen's Household, Prince Albert, and the Duke of Cambridge ; Dr. G. L. RouPELL, F.R.S., Physician to St. Bartholo- mew's Hospital ; and Dr. W. A. Gut, M.B., Cantab., Professor of Forensic Medicine, King's College, London, have kindly consented to act as adjudicators, a.. Signed on behalf of the Donor, Chaeles Gilpin. Thomas Beogs. 6, Bishopsgate Street Without, London, April, 1848. ADJUDICATION. From the fifteen manuscript Essays on the Use and Abuse of Alcoholic Liquors, transmitted to us by Messrs. Beggs and Gilpin for adjudication, we have unanimously selected as the best the one bearing the motto, Mens sana in corpore sano. We accordingly adjudicate to its author the prize of one hundred guineas. We also think it due to the author of the Essay bear- ing the motto, Quot homines tot sententioe, to record our opinion of its great merits. We further deem it right to speak in terms of coiAmen- dation of the Essay having five mottoes, the first of which is, HotD use doth breed a habit in a man. • » (Signed) ' . ■ i ) London, December 6th, 1849. John Forbes, M.D. G. L. RoupELL, M.D. William A. Guy, M.B. PREFACE. The circumstances under which the following Essay is given to the public are suflSciently explained bj the pre- cedii^ Advertisem^it and Adjudication ; but the author takes this opportunity of offering a short statement of the objects whicK he had specially in view in its com- position. The questi(His set forth in the Advertisement having been evid^itly drawn up with great care, and having been obviously intended to bring the whole subject of the ordinary as well as the medical employment of alcoholic liquors under discussion, the author judged it advisable to follow the plan which they had marked out, by answerii^ each of them seriatim ; * although he was aware, that, by so doing, a certain amount of repetition would be almost necessarily involved. He found, as he proceeded, that it would be impossible to maintain such a continuity in his argument as would be desirable for its effectiveness; and he would therefore request his * Seriatim^ in order. XIV PREFACE. readers, in limine,* to keep the following issues in view, as those to which ho is desirous of leading them. In the first place, That, from a scientific examination of the modus operandi -f of alcohol upon the human hody, when taken in a poisonous dose, or to such an extent as to produce intoxication, wo may fairly draw inferences with regard to the specific effects which it is likely to produce, when repeatedly taken in excess, but not to an immediately fatal amount. Secondly, That the consequences of the excessive use of alcoholic liquors, as proved by the experience of the medical profession, and universally admitted by medical writers, being precisely such as the study yof its effects in poisonous and immediately &tal doses would lead us to anticipate, we are further justified in expecting that the habitual use of smaller quantities of these liquors, if sufficiently prolonged, will ultimately bo attended, in a large proportion of cases, with consequences prejudicial to the human system ; the morbid actions thus engen- dered being likely rather to be chronic X tlian acute || in their character. Thirdly, That, as such morbid actions are actually found to be among the most common disorders of persons * In limine, at the beginning. t Modus operandi, action. X Chronic, fixed, of long continuance. II Acute, transient. ' !T . » PREFACE. XV advanced in life, who have been in the habit of taking a " moderate" allowance of alcohohc liquors, there is very strong ground for regarding them as in great degree dependent upon the asserted cause, although the long postponement of their effects may render it impossible to demonstrate the existence of such a connection. Fourthly, That the preceding conclusion is fully ] orne out by the proved results of the " moderate " use of alco- hohc liquors, in producing a marked liability to the acute forms of similar diseases in hot climates, where their action is accelerated by other conditions ; and also by the analogous facts now universally admitted, in regard to the remotely injurious effects of slight excess in diet, imperfect aeration * of the blood, insuflScient repose, and other like violations of the laws of he;ilth, when habitu- ally practised through a long period of time. Fifthly, That the capacity of the healthy human sys- tem to sustain as much bodily or mental labor as it can be legitimately called upon to perform, and its power of resisting the extremes of heat and cold, as well as other depressing agencies, are not augmented by the use of alcoholic liquors ; but that, on the other hand, their use, under such circumstances, tends positively to the impair- ment of that capacity. Sixthly, That, where there is a deficiency of power, on the part of the system, to carry on its normal actions * Aeration, vitalizing by the action of air. m PRSFA<3a. i *. . with the energy and regularity which ooDstitute health, Buch power can rarely be imparted foy <^ habitual use of alcoholic liquors ; its deficiency being generally con- Bequeht upon some habitual departure firom tlie laws of health, for which the use of alcoholic liquors cannot compensate; and the employment of sudi liquors, although with the temporary effect of palliating the dis- order, having not merely a remotely injurious effect per sCf* but also tending to mask the action of other morbific cuuses, hy rendering the system more tolerant of them. Seventhly f That, consequently, it is the duty of the medical practitioner to discourage as much as possible the habitual use of alcoholic liquors, in however " mode- rate " a quantity, by all persons in ordinary healtii ; and to seek to remedy those slight departures from health which result from the "wear and tear" of active life, by the means which shall most directly remove or antagonize their causes, instead of by such as simply palliate their effects. Eighthly, That, whilst the habitual use of alcoholic liquors, even in the most "moderate" amount, is likely (except in a few rare instances) to be rather injurious than beneficial, great benefit may be derived, in the treatment of disease, from the medicinal use of alcohol in appropriate cases ; but that the same care should be employed in the discriminating selection of those cases, as would be taken by the conscientious practitioner in * Per ae, in itself. '■- 1 PHIFAOI. zm regard to tbe administrfttioii of any other powerful remedy which if poitonous in Urge doees. ^ ' ■5 ''-^ The foregoing appear to the author to be the conclu- sions legitimately deducible from the facts and arguments which he has brought forwards : it will be for his profes- sional readers to decide how &r the case which he has made out is sufficiently strong to lead them to the same results. This much, however, he would add ; that, when he first entered upon the investigation, some years ago, he had adopted no fbregone conclusion, and had, conse- quently, no temptation to make the facts square with preconceived views ; that he has constantly endeavored to treat the subject as one of purely scientific inquiry, and has avoided mixing up any other considerations with those which presented themselves to him as a physiolo- gist and a physician ; and that, for the sake of keeping himself free from even the appearance of partisanship, he has never allied himself with any one of the societies which have been tovmed to carry into practical e£fect the total-abstinence principle, but has preferred to follow a perfectly independent course. He ventures to hope, that on these grounds he may claim some right to being candidly heard by those to whom this Essay is more especially addressed. He cannot albw it to go forth, however, Vithout ex- pressing his conviction, that, wliilst there are adequate zvu PREFACE. medical reasons for abstinence from the habitual use of even a " moderate " quantity of alcoholic liquors, there are also strong moral grounds for abstinence from that occasional use of them which is too frequently thought to be requisite for social enjoyment, and to form an essential part of the rites of hospitality. The experience of every practitioner must bring the t^ ible results of intemperance frequently before his eyes ; but, "whilst he is thus rendered familiar with its consequences as regards individuals^ few, save those who have expressly inquired into the subject, have any idea of the extent of the social evils resulting from it, or of the degree in which they pYess upon every member of the community. The author believes that he is fully justified in the assertion, that, among those who have thus inquired, there is but one opinion as to the fact, that, of all the causes which are at present conspiring to degrade the physical, moral, and intellectual condition of the mass of the people, there is not one to be compared in potency with the (dfuse of alcoholic liquors ; and that, if this could be done away with, the removal of all the other causes would be im- measurably promoted. Every one who wishes well to his kind, therefore, must be interested in the inquiry how this monster-evil can be best eradicated. ^. Now, the author considers that the best answer to this inquiry has been found in the results of experience. A fair trial has been given, both in this country and in the PRBFACB. XIX United States, to societies which advocated the principle of temperance^ and which enlisted in their support a large numher of intelligent and influential men ; but it has been found that little or no good has been effected bj them, among the classes on whom it was most desirable that their influence should be exerted, except where those who were induced to join them really adopted the total-abstinence principle. Though he agrees fully with those who maintain, that, t/all the world would be really temperate^ there would be no need of total-abstinence societies, the author cannot adopt the inference, that those who desire to promote the temperance cause may legitimately rest satisfied with this measure of advocacy. For sad experience has shown, that a large proportion of mankind cannot^ partly for want of the self-restraint which proceeds from moral and religious culture, be temperate in the use of alcoholic liquors ; and that the reformation of those who have acquired habits of intem- perance cannot be accomplished by any means short of entire abstinence from fermented liquors. Further, experience has shovm, that, in the present dearth of effectual education among the masses, and with the ex- isting temptations to intemperance arising out of the force of example, the almost compulsory drinking-usages of numerous trades, and the encouragement which in various ways is given to the abuse of alcoholic liquors, nothing short of total abstinence can prevent the con- PMFAOli tintuuioe; in the riling generation, of the terrible evils which we have at present to deplore. And, lastly, ex- perience has also proved, that this reformation cannot be carried to its required extent, without the co>operation of the educated classes; and that their influence can only be effectually exerted by example. There is no case in which the superiority of example over mere precept is more decided and obvious than it is in this. " I practise total abstinence myself," is found to be worth a thousand exhortations ; and the lamentable failure of the advocates who cannot employ this argument should lead all those whose position calls upon them to exert their influence, to a serious consideration of the claims which their duty to society should set up, in opposition to their individual feelings of taste or comfort. Among the most common objections brought against the advocates of the total-abstinence principle, is the following: "That the abuse of a thing good in itself does not afford a valid argument against the right use of it" This objection has been so well met by the late Archdeacon Jeffreys of Bombay (in a letter to the Boni- bay Courier), that, as it is one peculiarly likely to occur to the mind of his medical readers, the author thinks it desirable to quote a part of his reply. '^ The truth is," he says, "that the adage is only true under certain general limitations ; and that out of these, so far from being true, it is utterly fiilso, and a mischievous fitllacy. ^-rrvaSPiavL^je!^^^ PBBFACB. ZXl And the limitations are these : If it be found by experi- ence, that, in the general practice of the times in which we live, the abuse is only the solitary exception, whereas the right use is the general rule, so that the whole amount of good resulting from its right use exceeds the whole amount of evil resulting from its partial abuse, then the article in question, whatever it be, is fully entitled to the benefit of the adage ; and it would not be the absolute and imperative duty of the Christian to give it up on account of its partial abuse. This is precisely the position in which stand all the gifts of Providence, and all the enjoyments of life ; for there is not one of them which the wickedness of man does not more or less abuse. But, on the other hand, if it be found by expe- rience that there is something so deceitful and ensnaring in the article itself, or something so peculiarly untoward connected with the use of it in the present age, that the whole amount of crime and misery and wretchedness connected with the abuse of it greatly exceeds the whole amount of benefit ai'ising from the right use of it, then the argument becomes a mischievous fallacy, the article in question is not entitled to the benefit of it, and it becomes the duty of every good man to get rid of it." After alluding to the evidence that this is pre-eminently the case with regard to alcoholic liquors, the archdeacon continues: ''We have, then, established our principle, in opposition to the philosophic adage ; taking the duty IZU PBBPAOB. ill of the citizen and the patriot, even on the lowest ground. But Christian self-denial and Christian love and charity go far beyond this. St. Paul accounted one single soul so precious, that he would on no account allow himself in any indulgence that tended to endanger a brother's soul : ' If meat make my brother to offend, I will eat no meat while the world standeth, lest I make my brother to offend.' ' It is good neither to eat flesh nor to drink wine, nor any thing whereby thy brother stumbleth, or is offended, or is made weak.' And we must bear in mind that flesh and wine are here men- tioned by Paul as ' good creatures of God ; ' they are not intended to designate things evil in themselves. This saying of St. Paul is the charter of teetotalism ; and will remain the charter of our noble cause, so long as the world endures, so long as there remains a single heart to love and revere this declaration of the holy, self-denying Paul." If, then, the author should succeed in convincing his readers that the ''moderate" habitual use of alcoholic liquors is not beneficial to the healthy human system, — still more, if they should be led to agree with him that it is likely to be injurious, he trusts that they will feel called upon, by the foregoing considerations, to advocate the principle of total abstinence, in whatever manner they may individually deem most likely to be effectual. He believes it to be in the power of the PRBFAOB. XXlll elerioal and medical professions combined so to influence the opinion and practice of the educated classes as to promote the spread of this principle among the "masses" to a degree which no other agency can effect. And he ventures to hope, that, whether or not he carries his readers with him to the full extent of his own conclu- sions, he will at any rate have succeeded in convincing them that so much is to be said on his side of the question, that it can no longer be a matter of indifference what view is to be taken of it ; and that, as " universal experience " has been put decidedly in the wrong with regard to many of the supposed virtues of alcohol, it is at any rate possible that its other attributes rest on no better foundation. In his general view of the case, he has the satisfaction of finding himself supported by the recorded opinion of a large body of his professional brethren; upwards of two thousand of whom, in all grades and degrees, — from the court-physicians and leading metropolitan surgeons, who are conversant with the wants of the upper ranks of society, to the humble country practitioner, who is familiar with the require- ments of the artisan in his workshop, and the laborer in the field, — have signed the following certificate : — •* We, the undersigned, are of opinion, — "1. That a very large proportion of human misery, including poverty, disease, and crime, is induced by the use of alcoholic or fermented liquors as beverages. ■'■■■' ^■\'i]\-trv:^rc^r' xay PRBFACB. ** 2. That the most perfect health is compatible with total abstinence from all such intoxicating beverages, whether in the form of ardent spirits, or as wine, beer, ale, porter, cider, &c. &c. "3. That persons accustomed to such drinks may, with perfect safety, discontinue them entirely, either at once, or gradually after a short time. \ *■ , " 4. That total and universal abstinence from alcoholic beverages of all sorts would greatly contribute to the health, the prosperity, the morality, and the happiness of the human race." Mo medical man, therefore, can any longer plead the singularity of the total-abstinence creed as an excuse for his non-recognition of it ; and although a certain amount of moral courage may be needed for the advo- cacy and the practice of it, yet this is an attribute in which the author cannot for a moment believe his bre- thren to be deficient. Judging from his own experience, indeed, ho may say, that he has found much less diffi- culty in the course he has taken than he anticipated when he determined on it ; and that he has met with a cordial recognition of its propriety, not merelj on the part of those who participated in his opinions but did not feel called upon to act up to them in their individual cases, but also among others who dissented strongly from his scientific conclusions, and who consequently had no more sympathy with his principles than with his practice. LoNiH)N, March, 1860. ■t/i^r ' <-v. TABLE OF CONTENTS. CHAPTER I. What abb the Effects, Cobforeal and Mental, of Aloo* HOLic Liquors on the Healthy Huican System? Page Sbot. I. — Influence of Alcohol upon the Physical, Che- mical, and Vital Properties of the Animal Tissues and Fluids 1 Corrugation of Tissues 1 Coagulation of Albumen 3 Impairment of Solidifiability of Fibrine . . 4 Irritating Action on Living Tissues . . 6 Temporary Exaltation of Nervous Power . 6 Change in Red Corpuscles .... 8 Sbot. II. — Immediate Consequences of the Excessive Use of Alcoholic Liquors on the General System 9 Phenomena of Alcoholic Intoxication . , 9 Symptoms and Post-mortem Appearances of Alcoholic Poisoning ..... 12 Pathology of Alcoholic Intoxication . . IS Sect. HI. — Remote Consequences of the Excessive Use of Alcoholic Liquors ..... 22 Diseases of the Nervous System ... 22 Delirium Ebriosum 23 ^* Delirium Tremens ...._2.4. Insanity 28 Oinomania 33 Mental Debility in the Oflspring . . 39 Inflammatory Diseases of the Brain . 42 ZXVl CONTENTS. Apoplexy Paralysis and Epilepsy Diseases of the Alimentary Canal . Irritation and Inflammation of the Mu coos Membrane of the Stomach . Inflammatory Gastric Dyspepsia Disorders of the Intestinal Mucous Mem brane Diseases of the Liver .... Acute and Chronic Inflammation of the Liver Hypertrophy and Atrophy of the Liver Diseases of the Kidneys .... Diseases of the Skin .... General Disorders of Nutrition Tendency to the Deposition of Fat . Diminished Power of Sustaining Injuries by Disease or Accident . Liability to Epidemic Diseases . . Gout and Rheumatism Diseases of the Heart and Arteries . Spontaneous Combustion . Sect. IV.— General Effect of the Excessive Use of Alco holic Liquors on the Duration of Life . Experience of Insurance Offices . . Specially Injurious Influence of Excess in Warm Climates Statistics of the Indian Army , , CHAPTER IL Dobs Physioloqt or Experienob teach us that Alco- holic LiciuoRS should form part of the ordinary sustenance of HAN, PARTICULARLY UNDER CIRCUMSTANCES OF EXPOSURE TO SEVERE LABOR, OR TO EXTREMES OF temperature ? OR, ON THE OTHER HAND, IS THERE REASON FOR BELIEVING THAT SUCH USE OF THEM IS NOT SANCTIONED BY THE PRINCIPLES OF SCIENCE, OR BY THB ftBSULTS OF FBACTICAI< OBSERVATION? . , . . Page 43 46 47 48 63 55 56 67 58 59 62 64 66 67 69 71 72 73 77 77 79 83 &2 CONTENTS. XXVll Page Sect. I.— Endurance of Bodily Exertion ... 92 Sect. II. — Endurance of Mental Exertion . . . Ill Sect. III. — Endurance of Cold 118 Sect. IV. — Endurance of Heat 138 Sect. Y. — Resistance to Morbific Agencies . . . 166 Sect. VI. — Consequence of the Habitual "Moderate" Use of Alcoholic Liquors 163 Effect upon the General System and Excretory- Organs 163 Effect upon the Stomach 171 Effect upon the Nervous System . . .176 Effect upon the Circulation . . . .178 Effect upon Nutrition 182 CHAPTER m. AUE THERE ANT SPECIAL MODIFICATIONS OF THE BODILY OR MENTAL CONDITION OF MAN, SHORT OF ACTUAL DIS- EASE, IN WHICH THE OCCASIONAL OB HABirUAL USB OF Alcoholic LiauoRS mat be necessary or benefi- cial? 187 Sect. I. — Demand for Extraordinary Exertion . . 187 Sect. II. — Deficiency of other Adequate Sustenance . 194 Sect. III. — Deficiency of Constitutional Vigor . . . 199 Pregnancy 208 Lactation 210 Childhood 214 Old Age 217 CHAPTER rV. Is the Employment op Alcoholic Liquors necessary in the Practice of Medicine? If so, in what diseases, or in what form and stages of disease, is the USB of them necessary or beneficial? .... 226 UVUl OONTBMTS. PMg* Sbot. I. — Recovery from Shook . • • • • 226 S^. II. — Trefttment of Acute DiseasM . . . .228 Resistance to the Deprewing Influence of Mor< hiflc Agents 228 Recovery from States of Prostration . . 232 Support under Exhausting Drains . . . 234 Forms of Alcoholic Liquors most desirable . 237 Sect. IIL—Treatment of Chronic Diseases . . .238 Appendix A 245 " B 260 « C 263 Remarks on the Use op Aioohol fob thb Pbepabation OF Medicines, by the Editor . . • . . . 267 Medical Cbbtifioatb ....... 202 Htt • • . 226 1 • . 228 ieeofMor< • . 228 • . 232 • . 234 •irable . 237 • . 238 • . 245 • . 250 ' f . 252 USE AND ABUSE OP ALCOHOLIC LIQUOES. BPABATIOir 257 282 CHAPTER I. WHAT ARE THE EFFECTS, CORPOREAL AND MEN- TAL, OF ALCOHOLIC LIQUORS ON THE HEALTHY SYSTEM ? 1. In replying to this question, it will be desirable to proceed as systematically as possible ; since the results of our inquiries upon the several points which it involves will have to form the groundwork of our further investi- gations. We shall commence, therefore, by examining the influence of alcohol upon the physical^ chemical^ and vital properties of the several components of the animal fabric ; from a knowledge of which we shall derive im- portant assistance in our appreciation of its effects upon the human system as a whole. I. INFLUENCE OF ALCOHOL UPON THE PHYSICAL, CHEMI- CAL, AND VITAL PROPERTIES OF THE ANIMAL TISSUES AND FLUIDS. 2. The most important physical change which the contact of alcohol effects in the softer animal tissues, is 1 i I 2 EFFECTS OF ALCOHOL. that of corrug-ation ; * which change is entirely due to the difference in the capillary attraction of the tissue for alcohol and for water respectively. If animal mem- branes, a mass of flesh, or coagulated fibrine,t be placed in alcohol in a fresh state (in which they are thoroughly charged with water), there are formed, at all points where water and alcohol meet, mixtures of the two ; and, as the animal texture absorbs much less of an alcohohc mixture than of pure water, a larger amount of water is of course expelled, than of alcohol taken up ; and the first result is a shrinking of the animal substance. *' Thus," says Professor Liebig, " 9-17 grammes of bladder, fresh, that is, saturated with water (in which are contained 6*95 gi-ammes of water and 2-22 of dry substance), when placed in forty cubic centimetres of alcohol, weigh at the end of twenty-four hours 4-73 grammes, and have con- sequently lost 4*44 grammes. For one volume of alco- hol, therefore, retained by the bladder, rather more than three volumes of water have been expelled from it." % 3. Tliis corrugating effect of alcohol will be usually increased by the coagulating influence which it will exert on whatever soluble albumen || the tissues may contain. Both these results will, of course, be proportioned in their degree to the state of concentration of the alcohol : bui some such physical change must always take place in thg walls of the stomach, whenever alcohohc fluids are introduced into it ; and in the soft tissues of the body at ♦ Corrugation, a paickering-up or contraction of ioft parts, t Fibrine, the substance of which muscular threads are com- posed. X On the Motion of the Animal Juices, p. 11. II Albumen, the white and nutritive portion of the blood. ON THE UEAtTUY SYSTEM. 8 large, wherever alcohol liiw found its way into the cur- rent of the circulation. And that such is actually the case is proved by the experiments of Dr. Percy,* who found tliat, when animals are poisoned by alcohol intro- duced into the stomach, the coats of that organ become so thoroughly imbued with it, throughout their whole thickness, that no washing or maceration can remove it. He found, also, tliat the tissues remote from the stomach become impregnated with alcohol, when it has passed into the current of the circulation ; but on this point we shall dwell more at length hereafter. — ("5» IT.) 4. The physical change just described must have an important influence upon the cltemical relations of the tissues ; since it is impossible that alcohol can be substi- tuted, in however small a proportion, for their constituent water, without producing a decided alteration in their chemical properties, which must disturb the normal series of changes involved in their nutritive operations. Among the most important of the chemical changes which alco- hol has the power of effecting is the coagulation -f of soluble albumen ; and although it will rarely, if ever, be introduced into the- mass of the blood, or into the serous fluids of the tissues, by any ordinary alcoholic potations, in a sufficiently concentrated state o effect this, yet we should anticipate tliat its presence, even in a very dilute form, must affect the chemical relations of albumen, and can scarcely do otherwise than retard that pecuhar trans- formation by which it is converted into the more vitalized substance, fibrine. That such is actually the case will be * Experimental Inquiry concerning the Presence of Alcohol in the Ventricles of the Uruln, p. 29. t Coar/ukttion, hardening of fluids, like the curdling of milk. 4 EFFECTS OF ALCOHOL rendered probable by the considerations to be presently adduced. 5. No considerable changes of a physical or chemical nature can take place in any of the animal tissues, with- out disordering their vital properties also ; and we have now to inquire into the mode in which these properties are affected by the contact of alcoholic liquids. In the first place, it would appear that the sohdifiabihty of the fibrine, which is its special vital endowment,* is im- paired by the introduction of alcohol into the fluid which contains it; for, when an animal has been killed by the injection of alcohol into the blood-vessels, the blood often remains fluid after death, or coagulates but imperfectly. (See the experiments of Dr. Percy, op. cit) Now, as it is probable that nearly all the organized tissues are developed at the expense of the fibrine, it is obvious that any thing which impairs its organizability must have an injurious influence upon the general nutritive operations ; and we shall hereafter find confirmation of this inference in that peculiar condition of the system which results from excessive habitual indulgence in alcoholic potations, and of which the imperfect elaboration of the fibrine is one of the special characteristics. — (§ 63.) But, sec- ondly, we find that, when alcoholic Uquids are applied to living tissues, especially to the vascular surface of the skin or mucous membrane, they induce redness, heat, and pain, indicating an increased determination of blood to the part. These symptoms vary in intensity, ♦ The coagulation of albumen and the fibrillation of fibrine are two entirely diflferent processes ; the former being a simply physical aggregation, the latter tending to produce an organized tissue, and being therefore of a vital nature. — Author. ON THE HEALTHY SYSTEM. 5 according to the state of concentration of the liquiil, anil the length of time during which it remains in contact with the surface ; and they may pass on from this con- dition of irritation to one of actual inflammation. 6. Our best knowledge, however, of the influence of alcohol upon the vital actions of the animal tissues, is derived from microscopic observations upon the circula- tion of blood in the web of the frog's foot. If alcohol be applied to this membrane in a veri/ dilute state, its first effect is to quicken the movement of blood through the vessels, which are at the same time rather contracted tlian dilated. But this state of things gradually gives place to the opposite ; for after a time, which varies with the degree of the dilution of the alcohol, the circulation becomes retarded, and the vessels dilated ; and a further time elapses before the original condition is recovered. If the alcohol have been applied at first, however, in a less dilute form, the first stage is not observed ; but a retardation of the flow of blood is immediately brought about, and a considerable dilatation of the vessels takes place. The retardation may be such as to amount, in p'>me parts, to a complete stagnation; and here it is noticed, that the red corpuscles * become crowded toge- ther, and that their normal form is lost ; their coloring matter also being diffused through the liquor sanguinis.! Around the parts in which the stagnation is witnessed, however, there is generally a border, in which the blood ^ows with increased rapidity. Now, this perverted state may gradually give place to the normal condition, $ if * Red corpuscles, red portion of the blood, t Liquor sanguinis, the blood. X Normal condition, healthy condition. 1* 6 EFFECTS OF ALCOHOL the Stimulus bo only applied for a short time ; the circu- lation being restored where it was deficient, and the vessels gradually contracting to their proper size. But, if the contact of concentrated alcohol be prolonged, it becomes obvious tlmt the tissue has been killed ; for the circulation is never re-established in it, and it is at last separated by gangrene.* We rarely witness, in cold- blooded animals, those consequences of the apphcation of irritants which proiHjrly constitute the inflammatory process ; but this process is liable to be excited in man, and in warm-blooded animals, by the contact of alcohohc fluids with living tissues, if the contact be suiRciently prolonged, and the alcohol sufficiently concentrated. 7. Now, the inference to bo drawn from the preceding details is these, — that alcohol, when applied to the hving tissues in a sufficiently dilute form, exalts for a time their vital activity ; but that this exaltation is temporally only, and is followed by a correspcnding depression. And further, that, when the alcohol is m a state of suffi- cient concentration to act more potentially, its exhausting or depressing effect is manifested, without any previous stage of excitement. This inference we shall hereafter find to be in precise accordance with that to which we shall be conducted by ol)servation of the effects of alcohol upon the system at large ; and we are justified, there- fore, in regarding alcohol as belonging to the class of stimulants, and as subject to the laws of their operation. It has been affirmed by some, that alcohol in small doses is tonic ; f but of this there is no adequate proof. The • Gangrene, death of the part. t Tonic. A tonic is whatovor increases the vigor of the diges- tive powers. ; the circu- it, and the size. But, rolonged, it ed ; for the it is at last Js, in cold- plication of lammatory 'd in man, 'f alcoholic 3uffic.'.ently 'aled. preceding ' the living or a time temporary spression. e of suffi- xhausting ■ previous hereafter which we )f alcohol d, there- class of peration, all doses ►f. The he digcs- ON THE HEALTHY SYSTEM. T property of tonic remedies is to increase the vital contrac- tility of the animal solids in general, hut more especially that of the walls of the blood-vessels. Now, although some shght effect of this kind is at first manifested, ttfter the application of very dilute alcohol to a living mem- brane, yet it is very transitory, and is succeeded by a much longer period of diminution of the tonic contrac- tiUty of the walls of the blood-vessels. And we shall hereafter see, that the supposed tonic properties of alco- hol in small doses (especially in the form of wine or malt liquor) are really but a manifestation of ita stimulant efiects. 8. Various other experiments confirm this view of the effects of alcohol on the animal tissues ; and those of Humboldt are particularly valuable, as regards its spe- cial capability of producing a temporary excitement of nervous power. " When the crural nerve," he says, " of a full-grown and lively frog was immersed in alco- hol, if the leg was already exhausted by galvanization, the alcohol evidently increased its excitability ; and this increase was lasting (i.e. for a time), when it was quickly removed from the stimulating fluid. If the nerve was left in it for some time, its excitability was completely exhausted. Its application e.^ liausted instantaneously the excitability of young animals, — birds, worms, and in- sects. If the tail of an earthworm or leech be dipped for only four seconds in alcohol, it becomes stiff and inexcitable as far as it is immersed; and, although in frogs and puppies this state of rigidity could sometimes be removed, in these animals it never could." * * Annals of Medicine, 1799, p. 265. i; '' EFFECTS OF ALCOHOL 9. There are some peculiar effects of alcohol upon the hlood, besides its influence on the coagulability of the fibrine, of which it is proper that special mention should be made. When alcohol is mingled with fresh arterial blood, it darkens its color, so as to give it more or less of the venous aspect. — (j^ 118.) And, when this admixture is made under the microscope, it is perceived that the red corpuscles shrink, and that a considerable part of their contents becomes mingled with the liquor sanguinis. Now, although the pecuUar functions of the red corpuscles have not yet been precisely determined by physiologists, there is no doubt whatever that they are among the most important constituents of the blood ; and there is strong reason to believe, that they are subser- vient on the one hand to the respiratory function, and on the other, either directly or indirectly, to the elaboration of the plasma or organizable material of the blood. It is highly improbable, then, that any considerable effect can be produced upon them, without seriously impairing the processes of aeration and nutrition ; both of which, as we shall hereafter see, are prejudicially influenced in other ways, by the presence of alcohol in the blood. Having thus considered the influence of alcohol upon the properties and actions of the component tissues of the animal fabric, we shall inquire into its effects upon the living system as a whole. ON TUE HEALTUY SYSTEM. II. IMMEDIATE CONSEQUEXCES OF THE EXCESSIVE USE OF ALCOHOLK LIQUORS ON TUE GENERAL SYSTEM. Phenomena of Alcoholic Intoxication. 10. The term Intoxication is sometimes employed in this country to designate that series of phenomena which results from the action of all such poisons as first produce stimulation, and then narcotism : of these, however, alco- hol is the tjipe ; and the term is commonly applied to alcohoUc intoxication alone. It is worthy of notice, however, that the designation is now given by French writers to the series of remote or constitutional effects consequent upon the introduction of ani/ poisonous agent into the blood : thus we meet with the terms " arsenical intoxication," "iodine intoxication," and even " purulent intoxication." In fact, it is there considered an equiva- lent (as its etymology denotes) of our word poisoning- ; and the fact that such a term should be in common use in this country, to designate the ordinary results of the in- gestion of alcoholic liquors, is not without its significance ; for, if the classical term " intoxication " be habitually employed as the equivalent of the Saxon " drunkenness," we are justified in turning that classical term into English again, and in asserting that the condition of drunkenness ^ in all its stages^ is one of poisoning. That such is indeed the case will become obvious from an examination of its symptoms, and from a comparison of them with those of the cases in which a fatal result has supervened upon excessive indulgence in alcoholic liquors. To such an examination we shall now proceed ; first, detailing the symptoms of the slighter forms of intoxication; then, 10 EFFECTS OF ALCOHOL those of the deeper ; and, lastly, those of the severest cases ; and afterwards inquiring into the pathological state from which those symptoms proceed, and the modus operandi * of the agent that has produced it. 11. Among the^rs^ effects of the ingestion f of alco- hohc liquors, in sufficient amount to produce their charac- teristic influence, are, in most persons, an increase in the force and rapidity of the heart's contractions ; producing a full, frequent, and strong pulse. With this, there seems to be a general exaltation of the organic functions ; the appetite and the digestive power being increased, and the secretions augmented, especially those of the skin and kidneys. But it is obvious that the encephalic % centres of the nervous system are specially acted on by the stimulus ; for we observe all the manifestations of an excited action in them, such as talkativeness, rapidity and variety of thought, exhilaration of the spirits, ani- mation of the features and gestures, flushed countenance, and suffusion of the eyes. During slight intoxication, the prevailing dispositions and pursuits are often made manifest ; and hence the saying, " In vino Veritas^ || The irritable and ill-tempered become quarrelsome ; the weak and silly are boisterous with laughter and mirth^ and profuse in offers of service ; and the sad and hypo- chondriacal readily burst into tears, and dwell on mourn- ful topics. It sometimes happens, however, that men habitually melancholy become highly mirthful, when they have drunk enough to excite them ; but this seems * Modiis operandi, mode of operation. t Ingestion, taking in or swallowing. X Encephalic, connected with the brain. II III vino Veritas, an inebriated person lets out the truth. /^ ON THE HEALTHY SYSTEM. 11 the severest pathological id the modus >n t of alco- their charac- 3rease in the ; producing this, there c functions ; 'reased, and >f the skin encephalic % cted on by itions of an s, rapidity pirits, ani- untenance, ^toxication, ften made ome; the nd mirth, ^nd hypo- >n mourn- that men ul, when lis seems f I truth. rather to be the case when the melancholy results from external depressing influences than when it is constitu- tional ; and hence it is that too many persons in circum- stances of distress or difficulty have recourse to the bottle for temporary solace from their cares. If no more liquor be taken than is sufficient to produce this condi- tion, it gradually subsides, and is followed by a state of the opposite character ; the appetite, the digestive power, and the organic functions in general, being lowered in activity, the skin dry, the secretions diminished, the spirits depressed, and the power of mental exertion for a time impaired. For this condition, sleep and absti- nence (not merely from a renewal of the stimulus, but from more food than the stomach really demands) are the most effectual remedies. 12. The state of mental excitement just described is very similar to the incipient stage of phrenitis or mania. It is not a uniform exaltation of the mental powers, but in some degree a perversion of them ; for that voluntary control over the current of thought, which is the distin- guishing character of the sane mind of man, is consider- ably weakened, so that the heightened imagination and enlivened fancy have more unrestricted exercise ; and, whilst ideas and images succeed each other in the mind with marvellous readiness, no single train of thought can be carried out with the same continuity as in the state of perfect sobriety. This weakening of the voluntary con- trol over the mental operations must be regarded, then, as an incipient stage of insanity. 13. If the first dose of alcohol bo such as to produce more potent effects, or if, as in ordinary intoxication, it be renewed after the first effects have already been mani- 12 EFFECTS OF ALCOHOL fested, the second stage is induced, in "which not merely the intellectual but the sensorial apparatus is disturbed. The voluntary control over the direction of the thoughts is completely lost, and the excitement has more the char- acter of delirium ; the ideas becoming confused, the reasoning powers disordered, and hallucinations some- times presenting themselves. At the same time, vertigo, double vision, tinnitus aurium,* and various other sensory illusions, occur ; the muscular movements become tremu- lous and unsteady, the voice thick, the eyes vacant, and the face commonly pale. Vomiting frequently occurs in this state ; and, when it does, the consecutive stage is usually either cut short, or is abated in intensity. The poisonous effects may proceed no further than this ; the drunkard falling into a heavy sleep, from wliich he awakes to feel the consequences of his transgression. These consequences differ in some degree with the pre- vious habits. Those unaccustomed to such excesses usually suffer from headache and feverishness, with a dry and furred tongue, complete anorexia,! Avith a par- ticular loathing for alcoholic drinks, inability for mental or bodily exertion, and depression of spirits ; and only recover from this condition after prolonged repose and abstinence. On the other hand, the man to whom it is habitual, although his general condition is nearly the same, craves for a further dose of his stimulant ; and, when he has obtained it, he is able to take food, and to proceed with his ordinary avocations. 14. In the third and most profound stage of intoxica- tion, there is extreme diminution or entire suspension of ♦ Tinnitus auritim, ringing in the ears. t Anorexia, loss of appetite, aversion to food. ON THE HEALTHY SYSTEM. 13 h not merely is disturbed, the thoughts ore the char- onfused, the itions some- ime, vertigo, ther sensory Jome tremu- vacant, and ntlj occurs ive stage is 'sity. The this; the winch he nsgression. h the pre- h excesses 3s, with a ith a par- for mental and only 'pose and horn it is early the It; and, 1) and to intoxica- 'nsion of cerebral and sensorial power ; a state of coma * super- vening upon that hist described. This state may vary in intensity, however, between one of deep ordinary sleep, from Avhich the individual can be so far aroused as to give manifestations of sensibility, and a torpor a« profound as tliat of apoplexy ; and, when the latter manifests itself, it is an indication of danger, especially when the respiratory movements are impeded. Accord- ins to the observations of Dr. Ojj-ston.t the face is sometimes pale, sometimes fluslied ; the eyes vacant and suflfused, sometimes glazed : the pupils dilated, and con- tracting very imperfectly, or not at all, to light : the temperature of the head is generally above the natural standard, but that of the extremities and of the surface is in general considerably lowered, or but little affected in milder cases ; the pulse, which was at first (juick and excited; becomes feeble, small, and ultimately slow, or even entirely wanting at the wrist, according to the intensity of the intoxication : the respiratory movements are less freipient than usual, and are imperfectly per- formed, exhibiting, in the' severest cases, the convulsive character of those of persons suffering from aspliyxia. X Strabismus. || general tetanic •§> convulsions, or spasms of particular parts, sometimes supervene in the more advanced states. When a fatal termination occurs, it is usually attributable, as in apoplexy, to tlie imperfect aeration H of the blood ; the face becoming livid and * Coma, torpid sleep. t Edinburgli Medical and Surgical Journal, vol, xl. X AspJiijxia, suffocation. || Strabismus, squinting. § Tetanic, attended with rigid contractions. II Aeration, process by which the blood is acted upon by the air. 2 14 EFFEOTrf OF ALCOHOL tumid, the eyes prominent, and the lipH l>kic. In some instances, the complete prostration of the cerebral and sensorial powers comes on suddenly, without any previous stage of excitement ; and, in these ca»e8, it is noticed that the pupil is usually contracted. 15. The unfavorable indications, in ca.so of poisoning by large doses of alcohol, are profoundness of insensi- bihty, insufficiency of respiratory movement, with conse- quent failure of circulation and imi)erfect aeration of blood, the pupils either nmch dilated or contracted, coldness of the extremities, and the occurrence of stra- bismus or tetanic spasms. When these symptoms do not appear, the ill effects pass off, in a great measure, witliin four and twenty hours ; but it is usually much longer before the various functions regain their healthy tone. 16. In fatal cases,* the ap[)earance8 usually resemble, more or less closely, those of asphyxia ; the right side of the heart, the pulmonary arteries, and the systemic veins being loaded with blood : whilst the left cavities and the arterial system are comparatively empty, the blood which they do contain being dark. The sinuses f and the whole venous system of the brain are turgid with dark blood ; and serous effusion % is usujUly found within the ventricles.f or beneath the arachnoid ; f this, however, being variable in its amount. The substance of the brain is unusually white and firm, as if it had lain in alcohol * See Dr. Ogston, loc. clt. ; and Dr. Peters, in New York Jour- nal of Medicine, voL iii. No. 9. t Sinuses, ventricles, arachnoid, names of different portions of the brain. X Serous effusion, effusion of the watery portion of the blood. ON THE HEALTHY SYSTEM. 15 ^- In some cerebral and iiJiy previous noticed that ^f poisoning of insensi- Viith conse- aeration of contracted, ice of stra- mptoms do t measure, lally much Jir healthy f resemble, ?ht side of ;emic veins » and the ood wliich and the vith dark within the however, the brain 1 alcohol 'ork Jour- •ortions of ! blood. for an hour or two. The liver, spleen, and kidneys are loadeil with venous blood; and the air-pa.ssages of the lungs contain more or less of frothy mucus. The stom- ach usually exhibits but little departure from its normal con(liti<:)n, exee[)t in cases where drunkenness has been habitual, or where the fatal dose has been taken in a very concentrated form. In the former case, the nmcous coat is usually found thicker, softer, and more Viiscular than usual; this change sometimes extending even throughout the entire length of the small intestines. In rarer instances, the coats of the stomach are remarkably thickened and hardened. Where death results from a very concentrated dose, the intense injection, almost amounting to black discoloration, of a powerful irritant poison, is met with. This, however, has been rather noticed in experiments on animals, into whose stomachs rectified alcohol had been injected, than in human sub- jects, by whom alcohol is very rarely taken in such a form. Of the condition of the liver and kidneys found in habitual drunkards, an account Avill be given hereafter. The lilood, in most cases of alcoholic poisoning, — accord- ing to the observations of Dr. Ogston upon drunkards, and the experiments of Dr. Percy upon animals, — is either fluid or imperfectly coagulated. Patholog't/ of Alcoholic Intoxication. 17. The pathological character of intoxication by alcohol, and the modus operandi of the poison, have been fully made out from the experiments and observa- tions just referred to; and it is very important for our future impiiries, that the results of these should be right- ly understood. That alcoholic liquors, when introduced 16 EFFECTS OF ALCOHOL into the stomacli, sliould undergo rapid absorption into the sanguiferous system, is precisely what miglit be anticipated from our knowledge of the conditions under which that absorption takes place ; and there is ample evidence that such is really the case. Thus Dr. Percy was always able to detect the alcohol in the blood of the animals which he had poisoned by injecting alcohol into their stomachs, provided they did not live too long after- wards; and MM. Bouchardat and Sandras have more recently determined its presence in the blood of the gastric * veins. The rapidity with which this absorption takes place may be judged of by the ftujt, that in one of Dr. Percy's experiments, in which the animal fell lifeless to the ground immediately that the injection of the alco- hol into the stomach was completed (the respiratory movements and pulsations of the heart entirely ceasing within two minutes), the stomach was found nearly void, whilst the blood was strongly impregnated with alcohol, f Hence it may reasonably be inferred, that in all cases of ordinary intoxication, and in the greater number of cases of death from the introduction of alcohol into the stomach, the effects are produced by the passage of the alcohol into the current of the circulation, so as to exert a direct action on the nervous centres. And this influence is confirmed by the fact that Dr. Percy has demonstrated its presence, in considerable amount, in the substance of the In'aUi ; thus confirming Dr. Ogston's assertion (which had been called in question by Dr. Christison and others) as to its presence in the fluid eff"used in the ventricles of the brain. * Gastric, pertaining to the stomach. t Op. cit. p. 61. ox TIIK IIKAI/niY SY.STKM. 17 18, In some of tin; (j.vjjcrinicntH on alcoholic poisoning, however, nuwle by Dr. (.'hrintiMon and others, it would appear as if the total Iohh of innensibility and voluntary power so instanlanconshf followed the introduction of the poison into the Htoinaeh, — especially when it Avas introduced in a corKHjntrated form, — as not to admit the idea that absorption could have taken i)lace to a sufficient extent for the p)'odu(;tioii of the effect hy the direct action of the poison on the rKjrvous centres. In such instances, the fatsil result would Hcujtn rather due to the violent im- pression made ufxm the gastric nerves, especially those of the sympathetic systc^tti ; Avhcreby the heart's action is suspended, and e unfavorable to absorption, which takes place jrni(!h more readily when it is diluted with water, we are <'nabled rejixlily to account for this difference in its moduH opnuuidi. 19. The f^enrraf Htinmlant action, which is for a time exerted by alcohol introduced in small quantities, and diluted by admixture with the general mass of the blood, is easily explained uiKjn the ba«is of the observations * Syncope, complete and »U(ldcn low of sensation and motion. 2* 18 EFFECTS OF ALCOHOL fii-st detailed (*§> 17) ; but its special power of exciting the nervous centres to augmented activity can only be accounted for by the idea of some special relation between alcohol and nervous matter. And this idea is fully borne out by the fact, that Dr. Percy found alcohol to exist in the substance of the brains of the dogs poisoned by it, in considerably greater proportion than in an equivalent quantity of blood. {Op. cU. p. 103.) — This fact is one of fundamental importance, as showing us how directly and immediately the whole nutrition and vital axjtivity of the nervous system must be affected by the presence of alcohol in the blood ; the alcohol being thus specially drawn out of the circulating current by the nervous matter, and incorporated with its substance, in such a manner as even to change (when in sufficient amount) its physical as well as its chemical propesties. It is important also to observe, that this affinity is ob- viously such as will occasion the continual presence of alcohol in the blood, even in very minute proportion, to modify the nutrition of the nervous substance more than that of any other tissue ; for the alcohol will seek onf, as it were, the nervous matter, and will fasten itself upon it ; just as we see that other poisons, whose results become more obvious to our senses (although the poisons themselves may exist in such minute amount as not to be detectible hy the most refined analysis), Avill localize themselves in particular organs, or even in particular spots of the same organ. =* * See, for illustrations of this doctrine, now generally admittccl by physiologists, Dr. W. Budd's paper on Symmetrical Diseases, in Med.-Chir. Trans, vol. xxv. ; and Mr. Paget's Lectures on Nu- trition, in Medical Gazette, 1847. — Authoe. iii'irL(i.n>Mni*m ON THE HEALTHY SYSTEM. 19 20. The selective power of alcohol apiMjars to lead it in the fii*st instance to attack the cerebrum^* the intel- lectual powers being affected be** -^ any disorder of sen- sation or motion manifests itself; and to this it seems to be hmited in what has been here descrilx3d as the first stage of into.xication. But with the more complete jwr- version of the intellectual powers, which characterizes the second stage, we have also a distui-bed function of the sensory g'ang'/ia,'f upon which the cerebral hemispheres! are superposed ; this disturbance being indicated by the disorders of sensation, and also by the want of that con- trol over the muscular movements which require sensation for their guidance. In the third stage, the functions of the cerebrum and sensory ganglia appear to be completely suspended; and those of the medulla ob/ongataW ^^'^ spinal cord now begin to be affected, as we see to be indicated by the difficulty of respiration, the strabismus, the dilated pupil, and the tetanic spasms. As already stated, the sidmixture of alcohol with the blood has a tendency to give a venous character even to that of the arteries ; and, when this tendency is augmented by im- perfect respiration, the blood Avill become more and more venous, until its influence upon the medulla oblongata is so directly poisonous, that its functions are completely suspended, the respiratory movements are brought to a stand, and death takes phice by asphyxia, precisely as in narcotic poisoning by other substances. 21. This tendency, however, is more or less com- * Cerebrum, the brain, f Sensnrij ganglia, centres of sensation. X Cerebral hemispheres, the two halves of the brain. II Medulla oblongata, prolongation of the brain to the spinal marrow. EFFKCTH OF ALCOHOL pletely antagonizecl hy tlio oflTortH wliich the system makes (so to s[)cak) to get rid of tlio poison; which efforts, if successful, will carry it off in the course of a few hours, leaving nothing l)e]iitHl it but the disordered condition which it has prtMluced. Wo have seen that an increased secretion * takes phico by the kidneys and skin ; and the former of these is certainly a means of eliminating f the alcohol, which has been detected in the tirine by Dr. Percy {op. cit. \). 104), — contrary to the statements of many physiologists, who have denied that it ever finds its way into that secretion. It is indeed a general rule, that, when a medicinal or toxic agent X produces a special ved condition must be in the nervous pulp itself, I { it it must be of a kind to keep up morbid and irriiauve activity, at the same time that the tissue is incapable of exercising those reparative functions which are carried on in the healthy condition during the state of repose. 28. Although, in the vast majority of cases, delirium tremens is the immediate or the consecutive result of the excessive use of alcoholic hquors, yet it may occur inde- pendently of them ; but its other causes are such as resemble the excitement of alcohol, in producing exhaus- tion or depression of the nervous power, — such, for instance, as excessive depletion, the shock of severe injuries, or extreme cold. But in most of the cases in which one or other of these appears to be its exciting cause, a predisposition has been estabhshed by habitual intemperance ; and this has been especially remarked of the delirium traumaticum. EFFECTS OP ALCOHOL 29. It is important to remark, that a wli^hter form of this disorder, marked by tremors of the luiiids and feet, deficiency of nervous power, and occaaional illusions, will sometimes appear as a consequenco of habitual tippling, even without intoxication having been once produced. And a still slighter manifestation of the want of control over the muscular apparatus — the trembling of the hands in the execution of a voluntary movement — is familiar to every one as extremely frciquent among the habitually intemperate. We thus sec that the disease is at least as much dependent upon the dis- ordered state of nutrition^ consequent upon the habitual presence of alcohol in the blood, as it is UfKin that posi- tive exhaustion of nervous power consequent upon the violence of the excitement, which is the more immediate effect of the stimulus, v)^ 30. Insanity. — Such being the case, we have no difficulty invunderstanding how the liabitual use of alco- holic liquors in excess becomes one of the most frequent causes of insanity, properly so called, i,e. of settled mental derangement. Upon that point, all writers on the subject are agreed, however much they may diflfer in their appreciation of the relative frequency of this and of other causes. The proportion, in fact, will vary according to the character of the population on which the estimate has been formed, and also according to the mode in wliich it has been made. Thus, in Pauper Lunatic Asylums, the proportion of those who have become insane from intemperance is usually much larger than it is in asylums for the reception of lunatics from the higher classes, among whom intemi>eranco is less frequent, while causes of a purely moral and intellectual ON THE HEALTHY SYSTEM. nature operate upon thera with greater intensity. And again, if, in all cases in which habitual intemperance has been practised, it be set down as the cause of the mental disorder, the proportion be^-omes much larger than it will be if (as happens in many cases) some other cause have been in operation concurrently, and the disorder be set down as its result, no notice whatever being taken of the habit of intemperance. This omission must be particu- larly allowed for, when the relative proportion of intem- perance to other causes is being estimated in regard to the middle and higher classes ; on account of the strong desire which usually exists among the friends of the patient to conceal the nature of his previous habits, and to lay his disorder entirely to the account of the cause from which it has seemed immediately to proceed. 31. There can be no doubt, that those who have weak- ened and disordered the nutrition of the brain by habitual intemperance are far more liable than others to be strongly aflfected by those causes, moral or physical, to which the mental derangement is more immediately attributable ; so that the habit of intemperance has contributed, as a predisposing cause, at least as much towards its pro- duction as what is commonly termed the exciting cause has done. In ftict, of predisposing causes generally, it may be remarked that their action upon the system is that of slowly and imperceptibly modifying its nutritive operations, so as gradually to alter the chemical, physi- cal, and thereby the vital properties of the fabric ; and thus to prepare it for being acted on by causes which, in the healthy condition, produce no influence. And although that one of the conditions in previous opera- tion is often singled out as the cause, from which the 8« 80 EFFECTS OP ALCOHOL result may seem most directly to proceed, yet it fre- quently happens that it has really had a far smaller share in the production of the disorder than those re- moter causes whose operation has been more enduring and really more effectual.* 32. In the Statistical Tables, published by the Metro- politan Commissioners of Lunacy in 1844, comprehending the returns from ninety-eight asylums in England and Wales, we find that, out of 12,007 cases whose supposed causes were returned, 1,799, or nearly 15 per cent, are set down to the account of intemperance ; but, besides these, 551, or 4*6 per cent, are attributed to vice and sensuahty, in which excessive use of alcoholic liquors must have shared. Moreover, in every case in which hereditary predisposition was traceable, this was set down as the cause, notwithstanding the notorious fact that such predisposition frequently remains dormant until it is called forth by habitual intemperance. It is not more correct, therefore, to regard this as the cause of the dis- order, in all the cases in which it is traceable, than it would be to regard intemperance in that hght, in every case in which the patient had previously indulged in alcoholic excesses. Of the 2,526 cases, then, in which ^he disorder is attributed to hereditary predisposition, a considerable proportion might with equal justice be set down to the account of intemperance. And there can be no doubt, that the same practice had a great share in the production of the disease in the 3,187 cases set down to bodily disorder, and in the 2,969 for which moral causes are assigned. ♦ See Mr. J. S. Mill's Elements of Logic, vol. i. p. 398. ON THE HEALTHY SYSTEM. &1 83. If we turn from tl>i» general statement to the experience of individual aHylums, we fretjuently find the proportion much higher ; and curious variations are sometimes observable iKJtwecn the returns for successive years. Thus, in the Ghwgow Lunatic Asylum, accord- ing to the report of Dr. Ilutcheson, the following we:*e the proportions which i^tc^ -nnce bore to other causes during seven years : - Tmt. ptliMl*. Cmm ■tHtni ttw lUauM* «M t)ir»ttl»rt, k», 3 20 5i no 77 47 49 Ol«M wt»«T« th« 1 €tMi wh*re fn. known. | Ui« eauM. ! Proportion per wnt \ uf ihtemperanoe to other causes. 1840 1841 1842 1843 1844 1845 1846 149 1/57 109 327 390 304 414 34 44 20 38 41 38 62 20 30 46 31 63 90 105 13'4 19-1 23-1 9-4* 18-2 24-7 25-3 Total 2000 300 277 375 19-7 Of the great increase which presents itself in the number of cases attributoble to intemperance during * This marked diminution in the per centage of cases attri- butable to intompcrancti in chiefly due to the admission into the Glasgow ARylurn, during the year 1843, of a number of lunatics who had previouHly been conAned at Arran, for the most part, during several yearn. Of the origin of their insanity very little was known ; and they were chioiiy assigned to the head of " He- reditary and CouHtitutionnl Predisposition," thereby diminishing the per centage of the other causes. Among the recent cases admitted during the year, however, the per centage attributable to intemperance was decidedly less than usual ; which circum- stance is attributed by Dr. Ilutcheson to the improved condition of trade, which caused an nde(iuato demand for labor. On this point he makes the following remarks, in his report for 1842, p. 36 : " It may be said, that when wages are low, and occupation diffi- EFFECTS OF ALCOHOL II the last two years of this return, Dr. Hutcheson thus speaks in his report for 1846 : " This cause appears to have operated on patients of all ranks; and I am inclined to think, that this has been owing, in a great measure, to the excitement in which the community was kept by that universal spirit of gambling which seized on society like an epidemic mania. There is a great connection between general excitement and the craving for stimulants, as may be every day seen during con- tested elections, public dinners, races, &c. It is also a fact well known to those who have minutely studied the subject, that over-exertion of the brain leads to a desire for stimulants, which, however, are easily enough aban- doned when the brain is allowed to rest." For the reason already given, it is probable that the average proportion of 19'7 per cent does not by any means represent the entire number of cases in which intemperance was the principal cause of the disease, and that we should be within the truth in assigning to it at least a quarter of the whole number of cases. 34. In the report of the Aberdeen Lunatic Asylum for 1847, we find intemperance specified as the cause in cult to be obtained, men will have less money to spend, and con- sequently will drink less. A pretty extensive observation of the different grades of the working classes, for upwards of fifteen years, has convinced me that this opinion is erroneous ; for I have gen- erally found, that want and intemperance go hand in hand. Whenever a man falls below a certain point in physical comfort, he becomes reckless, and sensual enjoyment forms his only plea- sure. To this he will sacrifice every thing ; and habits of intem- perance are frequently acquired in seasons of distress, which the individual, in more favorable circumstances, finds it impossible to lay aside." — AuTuoit. ON THE HEALTHY SYSTEM. 33 seventeen cases out of ninety-three admitted; but, of these ninety-three, there were eight cases in which lie- reditary predisposition, and eleven in which predisposition from previous attacks, was assigned as the cause; and there can be no doubt that of these nineteen cases a con- siderable proportion might be set down, in part, to the account of intemperance. In the report of the Dundee Lunatic Asylum, we find that eight out of fifty-two cases admitted are set down to intemperance ; seven were hereditary; and in four the cause was unknown. In other asylums, the proportion of cases returned as due to intemperance is much greater than in those already referred to. Thus, in the Commissioner's report already cited, we find that, in nine provincial private asylums, the proportion which the cases assigned to intemperance alone bear to those assigned to other causes is no less than 32-62 per cent ; independently of 5-67 per cent, which are set down to the account of " vice and sen- suality." There is an asylum in the East of London, where the proportion of cases attributed to intemperance alone amounted to 41-07 per cent; and those arising out of this in combination with other vices, to 22 per cent of the whole number whose causes were assigned. And it is stated by Dr. Macnish {op. cit. p. 193), that, of 286 lunatics at that time in the Richmond Hospital, Dublin, one-half owed their madness to drinking. 35. Oinomunia. — There is one form of insanity which has so peculiar a relation to the use of alcoholic liquors as to call for particular consideration in this place ; and, in order that its characters may be presented in the most unexceptionable manner, the author avails himself of the excellent account of the disease which is EVVKCVa OF ALCOHOL given by Dr. IIutchcHoii in the rcfKirt of the Glawgow Lunatic Awyluin for 1842 (pp. 89 — 44) ; deeming its value sufficient to juHtify him in presenting it without abridgment. The ut he only derives a temporary satisfaction from the grati- fication of his insane impulse, or rather from freeing himself from the overwhelming misery which the non- gratification of his impulse inflicts on him. The disease appears in tliree forms, — the acute, the periodic, and the chronic. " The acute is the rarest of the three. I have seen it occur from hemorrhage in the puerperal stiite, in recovery from fevers, from excessive venereal indulgence, and in some forms of dyspepsia. When it proceeds from any of the first three causes, it is easily cured by restoring the strength of the patient. When it arises fiom the fourth cause mentioned, it- is not so easily removed, and is very apt to assume the chronic form. " The periodic or paroxysmal form is much more frequent than the acute. This is often observed in indi- viduals who have suffered from injuries of the head, females during pregnancy, at the catamenial periods, on the approach of the critical jKMiod and afterwards, and in men whose brains are overworked. When it occurs from injury of the head, the case is hopeless. In the other instances, it may be cured. In some cases, it occurs whenever the individual paiiakes of stimulants. In these, total abstinence is the only remedy. Like the form about to lie mentioned, it is frequently hereditary, being derived from a parent predisposed to insanity or addicted to intemperance. In such cases, the probability of cure is very small. The individual thus affected abstains for weeks or months from all stimulants, and frequently loathes them for the same period. But by degrees he becomes uneasy, listless, and depressed, feels 86 EFFECTS OF ALCOHOL incapable of application, and restless, and at last begins to tb-ink till he is intoxicated. He awakes from a rest- less sleep, seeks again a repetition of the intoxicating dose, and continues the same course for a week or longer. Then a stjite of apathy and depression follows, during which he feels a loathing for stimulants, is the prey of remorse, and regrets bitterly liis yielding to his malady. This is followed by fresh vigor, diligent application to l)Lisiness, and a determined resolution never again to give way. But, alas ! sooner or later the paroxysm recurs ; and the same scene is re-enacted, till ultimately, unless the disefise be checked, he falls a victim to the physical effects of intemperance, becomes maniacal or imbecile, or affected with the form of the disease next to be men- tioned. " Of all the forms of Oino7nania, the most common is the chronic. The causes of this are injuries of the head, diseases of the heart, hereditary predisposition, and intemperance. This is by far the most incurable form of the malady. The patient is incessantly under the most overAvheh^ing desire for stimulants. He will disregard every impediment, sacrifice comfort and reputa- tion, withstand the claims of affection, consign his family to misery and disgrace, and deny himself the common necessaries of life to gratify his insane propensity. In the morning, morose and fretful, disgusted with himself, and dissatisfied with all around him, weak and tremu- lous, incapable of any exertion either of mind or body, his first fechng is a desire for stimulants, with every fresh dose of which he recovers a certain degree of vigor both of body and mind, till he feels comparatively com- fortable. A few hours pass without the craving being ON THE HEALTHY SYSTEM. 87 so strong ; but it soon returns, and the patient drinks till intoxication is produced. Then succeed the restless sleep, tlie suffering, the comparative tmnc^uillity, the excitement, and the state of insensibility; and, unless absolutely secluded from all means of gratifying the propensity, the patient continues the same course till he dies, or becomes imbecile. This is that fearful state portrayed by Charles Lamb, in which resison revisits the mind only during the transient period of incipient intoxi- cation. " It must be remarked, that, in all these forms of the disease, the patient is perfectly incapable of self-control ; that he is impelled by an irresistible impulse to graiify his propensity ; that, while the paroxysm is on him, he is regardless of his health, his life, and all that can make life dear to him ; that he is prone to dissipate his pro- perty, and easily becomes the prey of the designing; and that, in many cases, he exhibits a propensity to commit homicide or suicide. He is thus dangerous to himself and others; and, however responsible he may have been for bringing the disease on himself, his respon- sibility ceases as soon as he comes under the influence of the malady. The disease, however, may not be brought on by the act of the individual ; and then it is clear at once, that neither directly nor indirectly c^s he be deemed responsible. But, suppose that it v\jre the result of his previous conduct, I repeat that, however culpable he may have been for that, he is not a respon- sible being while afflicted with the mala».iy ; for I can see no distinction between this form of the disease and any other which has been induced by the habits or acts of the individual. iOBii 38 EFFECTS OF ALCOHOL " The only cliance of cure or allevi.ation is from atten- tion to the health, and abstinence from intoxicating liquors. Neither can be secured so long as the patient is at large; and no amendment can be depended on, unless he has undergone a long course of discipline and probation. Considering, then, that the indi\adual is irresponsible and dangerous to himself and others ; that, if left uncontrolled, he will ruin his family ; and that his disease can be treated only in an asylum, — it is not only merciful to him and his relatives, but necessary for the security of the public, that he be deprived of the liberty which he abuses and perverts, and that he should be prevented from committing crimes instead of being punished, or, I should rather say, being the object of vindictive infliction after he has perpetrated them. So convinced are some, affected ■with the periodical form of the disease, of the necessity of being controlled, that, when the first symptoms of their paroxysm are felt, they voluntarily enter an asylum, and remain till the attack has passed off. These, however, are men of stronger minds, though, with all their strength, incapable of resisting the disease ; and, surely, what they feel to be their only refuge to avoid the impending evil, it cannot be unjust or harsh to force on others whose minds are more impaired. Such cases soon become rational in an asylum: and, when the individual can so far control himself as voluntarily to surrender his liberty on the first premonitory symptoms of the malady presenting themselves, he may be dismissed after a shorter proba- tion. It is otherwise with those who have not that self-control, or who fancy that they are unjustly inter- fered with when checked in their career. 7/hey require ON THE HEALTHY SYSTEM. 39 a much longer probation, which should be increased at each return of their malady. " Of the chronic form, I have seen only one case completely cured, and that after a seclusion of two years' duration. In general, it is not cured ; and no sooner is the patient liberated than he manifests all the symptoms of his disease. Paradoxical though the statement may appear to be, such individuals are sane only when con- fined in an asylum." The superintendent of the Dundee xVsylum. in remark- ing u ^on the frequent causation of insanity by intempe- rance, makes a very similar statement of the results of his observations, and regrets that there are not in this country such asylums as ai-e understood to exist in the United States, for the reception of those incorrigible drunkards in whom the power of self-control has been altogether destroyed by their repeated yielding to the craving for alcoholic stimulants. 36. Mental Debility in the Offspring: — It is scarcely necessary to accumulate further proof in sup- port of the assertion, that, of all the single causes of insanity, habitual intemperance is the most potent, and that it aggravates the operation of other causes. We have now to show that it has a special tendency to pro- duce idiocy, insanity, or mental debihty, in the offspring". Looking to the decided tendency to hereditary predis- position in the ordinary forms of insanity ; looking also to the fact, that any perverted or imperfect conditions of the nutritive functions established in the parent are also liable to manifest themselves in the offspring, as shown in the transmission of the gouty and tubercular diatheses ; * * Tubercular diathesis, scrofulous or consumptive condition of the body. 40 EFFECTS OF ALCOHOL. '« ■( we should expect to find that the offspring of habitual drunkards would share with those of lunatics in the pre- disposition to insanity, and that they would, moreover, be especially prone to intemperate habits. That such is the case is within the knowledge of all who have enjoyed exten- sive opportunities of observation ; and the fact has come down to us sanctioned by the experience of antiquity. Thus Plutarch cays, "One drunkard begets another;" and Aristotle remarks, that " drunken women bring forth children hke unto themselves." Dr. W. A. F. Browne, the resident physician of the Crichton Lunatic Asylum at Dumfries, makes the following statements : " The drunkard not only injures and enfeebles his own nervous system, but entails mental disease upon his family. His daughters are nervous and hysterical ; his sons are weak, wayward, eccentric, and sink insane under the pressure of excitement, of some unforeseen exigency, or of the ordinary calls of duty. At present, I have two patients who appear to inherit a tendency to unhealthy action of the brain, from mothers addicted to drinking ; and another, an idiot, whose father was a drunkaixl."* The author has learned from Dr. Hutche- son, that the results of his observations are precisely in accordance with the foregoing. On this point, however, the most striking fact that the writer has met with is contained in the Report on Idiocy lately made by Dr. Howe to the legi, 'nture of Massachusetts : " The habits of the parents of three hundred of the idiots were learned ; and a hundred and forty-five, or nearly one' half, are reported as ' known to be habitual drunkards. ' * Moral Statistics of Glasgow, by William Logan, 1849, p. 20. ON THE HEALTHY SYSTEM. 41 n Such parents, it is affirmed, give a weak and lax consti- tution to their children ; who are, consequently, ' deficient in bodily and vital energy,' and predisposed by their very organization to have cmvings for alcoholic stimulants : many of these children are feeble, and live irreguhirly. Having a lower vitality, they feel the want of some stimulation. If they pursue the course of their fathers, which they have more temptation to follow, and less power to avoid, than the children of the temperate, they add to their hereditary weakness, and increase the ten- dency to idiocy in their constitution ; and this they leave to their children after them. The parents of case No. 62 were drunkards, and had seven idiotic children."* 37. There is a prevalent impression that idiocy is par- ticularly liable to occur in the offspring of a procreation that has taken place when one or both of the parents were in a state of intoxication. A striking example of this kind is related in the Phrenological Journal (vol. vii. p. 471) : Both the parents were healthy and intelligent, and one at least habitually sober ; but both were partially intoxicated at the time of the intercourse, and the off- spring was completely idiotic. There is every reason to believe, that the monomania of inebriety not only acts upon, and renders more deleterious, whatever latent taint may exist, but vitiates or impairs the sources of health for several generations. That the effects of drunk- enness are highly inimical to a permanent healthy state of the brain is often proved at a great distance of time from tlie course of intemperance, and long after the adoption of regular habits. * American Journal of Medical Sciences, April, 1849, p. 437. 4.* 1 1 42 EFFECTS OF ALCOHOL 38. Injlammatory Diseases of the Brain. — All medical writers agree in regarding intemperance as one of the conditions which tend to produce injlammatory diseases of the encephalon, now distinguished as cere- britis * and 'meningitis ; f and this is precisely what might be anticipated, when it is considered how great must be the derangement of the circulating and nutritive operations occasioned by the presence of alcohol in the blood. An attack of acute encephaUtis not unfreciuently supervenes upon a debauch, which is then regarded as its exciting cause. | But it may occur quite independently of any special act of excess, in consequence of the predis- position ai-ising from the perversion of tlie normal functions, by the habitual use of alcoholic li(|Uors in quantities that may never produce actual intoxication. Perhaps, indeed, this is the more common occuiTcnce. We have seen that the state of excitement first produced in most persons by the ingestion of alcohol would pass into meningitis (or rather inflammation of the convohi' tions), if it were not to subside with the eliminntion of the alcohol from the blood. On the other liand, the •state of torpor of the mental functions wliieh alcohol pro- duces from the first in some individuals, and which comes on in sill if the intoxication be carried far enoudi, is indicative of that congestion of the substance of the brain which, if confirmed, and accompanied hy a cei-tain dis- turbance of the nutritive operations, would ])ecoi»ie cere- bi'itis. There can be no hesitation, therefore, in admit- * Cerebritis, inflammation of the brain. t Meningitis, inflammation of the membranos of the brain. % See, for example, a fatal case related by Dr. Percy, op. cif. p. 64. — AuTHoii. ON THE HEALTHY SYSTEM. 48 ting the relation of cause and effect, in cases in which it is so obviously established by the sequence of the pheno- mena. 39. There is another class of diseases of the brain, which are usually dependent upon structural changes that require a longer period for their development, yet whose frequent connection with habitual intemperance is established both by theory and observation. These are apoplexy, paralysis, and epilepsy. 40. Apoplexy. — The state of profound coma, cha- racteristic of the advanced stage of intoxication, may be considered to be identical with that of congestive apo- plexy, in every respect save the nature of its cause, and its duration.* A certain degree of tendency to apoplexy may be said to exist in the slighter form of intoxication ; the vessels of the brain being congested, as a consequence of increased action of the heart, and of obstruction to the encephalic circulation, such as is occasioned by imperfect discharge of the functions of the brain ; and tliis obstruc- tion being also favored by that partial stagnation of blood in the lungs which takes place whenever the respiratory movements are interfered with. This apoplectic tendency seems to render the intoxicated man peculiarly liable to suffer from causes wliich would not otherwise produce rupture of the vessels : thus, there are numerous in- stances on record in which blows received in pugilistic encounters, or other comparatively slight injuries, have i ctt. * Although, as we have already seen ({ 14), the phenomena are so nearly identical, the difference in the etiology involves an important difference in the treatment ; the comatose drunkard not requiring nor bearing the free depiction that is proper in a case of true congestive apoplexy. — Author. 44 EFFECTS OF ALCOHOL occasioned fatal hemorrhage within the cranium ; * the sufferer having been previously dosed with spirits in such quantity as oi itself to produce a state of congestion bor- dering on apoplexy. And it occasionally happens, though this is comparatively rare, that cerebral hemorrhage oc- curs without any external violence, after an excessive indulgence in spirituous potations. 41. But the influence of alcoholic liquors in the cau- sation of apoplexy is usually of a mi^ jli more gradual nature. A large proportion of the cases of apoplexy occurring in plethoric subjects, and not connected with disease of the heart or softening of the arterial coats, are traceable to intemperance in eating as well as in drink- ing ; the latter, however, being the chief cause, inasmuch as, without the habitual assistance of alcoholic liquors, continual excess in eating would generally soon correct itself. Hence, we find that such cases are rather apt to occur among those who take considerable quantities of wine or malt-liquor with full meals of sohd food, than among the drinkers of spirits, who are seldom great eaters. It is not difficult to see the reason of this. For, on the one hand, the habit of excess in eating and drinking has a tendency to produce that condition of plethora f wliich is most peculiarly prone to favor hemorrhagic effusions ; whilst, on the other, the ingestion of a large quantity of solid food, by causing pressure on the vessels of the abdominal viscera, % and by impeding the descent of the diaphragm, || tends to force an unusual quantity of blood * Homorrhage, bleeding ; cranium, skull. t Plethora, full habit. % Abdominal viscera, the bowels and digestive organs. II Diajihragm, dividing screen between the chest and the bowels. 1*1 ox THE HEALTHY SYSTEM. 45 into the cncepliulic vchhcIh, a« well as to obstruct its return from tliern. Such an ha)»itual derangement of the circuliition may well be supposed to occasion a pro- gressive weakening of the vessels of the brain ; and in this manner it hap|KniM, that, after a persistence for months or years in this course, ajK»plexy may supervene, and be its legitimate constMjuerice, without the attack being trace- able to any exti-aordinary indulgence.* 42. Of the strength of the general opinion of the medi- cal profession as to the tendency of alcoholic stimulants to produce the sthenic form f of apoplexy, it is impossi- ble to give a stronger prcwf than the rigidity of the rule of abstinence which is laid down for those in whom a disposition to it luis alrca/ly manifestc \ itself. Now, if it be necessary to lay down such rules to prevent the recurrence of the disciwe, is it not most obvious that we are justified in attributing to an habitual violation of them its first occurrence 'I And if habitual excess be so obviously a prc'§• 2, 3). It some- times happens, however, that, after the narcotic effects of the alcohol have passed off, another set of symptoms appears, indicative of inflammation of the alimentary canal; and, if these proceed to a fatal termination (as now and then occurs), the usual appearances indicative of that state are found in the gastro-intestinal * mucous membrane. In one example of this kind, cited by Dr. Christison, the whole villous coat of the stomach was in a gangrenous state, the colon was much inflamed, and the small intestines red along their whole length. 49. Our best information as to the effect of alcoholic liquors upon the condition of the gastric mucous mem- brane during life, is derived from the well-known ob- servations of Dr. Beaumont in the case of Alexis St. Martin. This man appears to have been habitually temperate and healthy; but to have occasionally in- dulged in excess both in eating and drinking, the results of which could be seen by direct observation through the fistulous opening in the parietes of his stomach. Thus, says Dr. Beaumont, under the date July 28th, 1833, * Gastro-intestinal, &c. inner lining of the stomach and bowels. ON THE HEALTHY SYSTEM. 61 " Stomach not healthy, some erythema, * and aphthous f patclies on the mucous surface. St. Martin has been (h'inking ardent spirits pretty freely, for eight or ten "days past; complains of no pain, nor shows symptoms of general inihsi)osition ; says he feels well, and has a good apj)etite. August 1st. Inner membrane of the stomach morbid ; considerable (irythema, and some aph- thous patches on the exposed surfjice ; secretions vitiated. August 3d. Inner membrane of Btomach uimsually morbid ; the erythematous appcjirance more extensive, and spots more livid than usual, from the surface of which exuded small drops of grumousj blood; the aphthous patches larger and more numerous ; the mu- cous covering thicker than common, and the secretions much more vitiated. The gastric fluids extracted tliis morning were mixed with a large proportion o^ thick, ropy mucus, and considerable muco-purulent || matter, shghtly tinged with blood, resembling the discharge from the bowels in some cases of chronic dysentery." Now, it is very important to remark, that all this disorder was proved by direct observation to be actually existing in the mucous coat of the stomach, without any such mani- festation of it by general or local symptoms as would by themselves have been thought indicative of its presence. " For," continues Dr. Beaumont, " St. Martin com- plains of no symptoms indicating any general derange- ment of the system, except an uneasy sensation, and a tenderness at the pit of the stomach, and some vertigo, ♦ Erythema, inflammation. t Aphthous, studded with minute ulcers. % Grumous, clotted, thick. II Mxico-ptirulent, diseased matter. 52 EFFECTS OF ALCOHOL with dimness and yellowness of vision on stooping down and rising again; has a thin, yellowish-brown coat on his tongue, and his countenance rather sallow; pulse uniform and regular, appetite good, rests quietly, and' sleeps as well as usual." By the 6th of August, the inner surface of the stomach had recovered its healthy appearance ;• the patient having in the meantime entirely abstained from all alcoholic liquors, and ha^^ng been con- fined to low diet. Dr. Beaumont further states, that "diseased appearances, similar to those mentioned above, have frequently presented themselves in the coui-se of my experiments and observations. They have generally, but not always, succeeded to some appreciable cause. Impro- per indulgence in eating and di'inking has been the most common precursor of these diseased conditions of the stomach. The free use of ardent spirits, ivine, beer, or any intoxicating liquor, ivhen continued for some days, has invariably produced these morbid changes. '''' 50. From the precise concurrence of these observa- tions with what theory would lead us to expect in regard to the action of alcoholic liquors on the mucous mem- brane of the stomach, it is obvious that we have no right to suppose that the peculiar condition of St. Martin gave him any peculiar hability to suffer in the manner above described. On the contrary, such disorders of the circu- lation, nutrition, and secretion, might be anticipated to occur in every case ; and it is only because they are not immediately indicated by pain and heat in the stomach, by loss of appetite, or by general febrile disturbance, that they are presumed not to exist. This presumption, however, has been shown to be altogether fallacious ; and we have adequate reason to believe, that some sucli con- ON THE HEALTHY SYSTEM. 58 dition must be tlic result of every excess in the use of alcoholic liquors, however little it may be indicated by the local or general symptoms. 51. hijlammatory Gastric Dyspepsia. — It might be anticipated, then, that habitual excess would convert this state of occasional and transient disorder, which only requires rest and abstinence for its cure, into one of a more persistent and obstinate character ; which, by unfit- ting the stomach for the discharge of its normal functions, would seriously impair the general nutritive operations. Such has been shown by experience to be the case ; a special form of dyspeptic disorder, termed injlammatory g-astric dyspepsia, being well known to practical men as common among those who have freely indulged in alco- hohc potations. Of this disorder, the follovring are the symptoms, as enumerated by Dr. Todd : * " Painful digestion,, sense of heat, tenderness, or pain at the epi- gastrium,! increased upon taking food, or on pressure ; thirst ; tongue more or less of a bright red color, some- times brownish red, sometimes dry, glossy, and adhe- sive ; taste saltish or alkaline, occasionally like that of blood; bowels generally confined; urine high-colored; skin dry, with occasionally profuse, partial sweats, chiefly in the direction of the extensor muscles ; temperature of the trunk increased, of the extremities diminished, except occasionally in the palms of the hands and soles of the feet, which, especially at night, are frequently hot, dry, and burning: aggravation of the symptoms under the use of stimulants or of irritating ingesta. t. " The vari- * Cyclopaedia of Practical Medicine, Art. IiuUgestion, t Epi(jastriumy region of the stomach. t Ingesta, -whatever is taken into the stomach. 6* 11 54 EFFECTS OF ALCOHOL :^ ous stages and degrees of the disease are cliaracterized by various modifications of these symptoms, many of them the consequences of the disturbance of the nutritive functions produced by the disorder of the stomach ; but of all such consequences it may be remarked, that they are probably aggravated by the previous disturbance of the nutritive and secretory operations consequent upon the habitual introduction of alcohol into the blood. Thus we find a special tendency to cutaneous eruptions, such as erysipelas, lichen, erythema, urticaria, psoriasis, and pityriasis ; to sluggish and imperfect action of the liver ; to scantiness in the secretion of the kidneys; and to depression of spirits, with inability for active mental ex- ertion, passing on, in the more confirmed states, to com- plete hypochondriasis. Although excess in eating may aid in the production of this wretched condition, jct, as Dr. Todd remarks, it is rather due to the stimulating quality of what is taken into the stomach, than to its quantity; and although it may occasionally arise from the habitual use of highly seasoned food without the proper dilution by bland liquids, yet it is much more frequently brought on by indulgence in alcoholic pota- tions; "it is the dyspepsia of the dram-drinker and opium-eater, and belongs altogether more to the drunkard than to the glutton." In the treatment of this disease, the complete disuse of stimulants is found to be of the greatest importance; notwithstanding that, in the more chronic forms of it, a temporary alleviation is sometimes obtained from small quantities of alcoholic licjuors. * Soo the observations of Sir Philip Crampton on this subject, in Dublin Hospital Reports, vol. i. p. 349. ON THE HEALTHY SYSTEM. 55 52. Disorders of the Intestinal Mucous Membrane. — The disordered state of the gastro-intestinal mucous membrane * is not limited, as we have seen, to the sto- mach, and it may extend itself along the whole coui-se of the alimentary canal, to parts with which the alc()h 41.) 53. Where, in place of excessive indulgence, v.hai is commonly considered a moderate use has beci raxiio of alcoholic licpiors, we caimot, with the same confidence, attribute to it any decided departure froi.i the healiij/ condition of the stomach ; and it is cert-nn that the mu- cous mem1)rano becomes in time so habituated to its pre- sence, that its contact no longer produces the same effects as it does on a membrane unaccustomed to it. But we shall hereafter (§ 160 — 162) find reason to believe, thai; * Gasf.ro- intrsfinal mucous membrane, the inner coat of the sto- mach, bowels, &c. t Plasticity, adhesiveness. 56 EFFECTS OF ALCOHOL ill such habitual use is not without itH consequences, al- though these may be very remote ; the continual over- excitement of the vital activity of the gjwtric mucous membrane being probably one of the causes of tliat pre- mature loss of functional power which is observable in a great number of those who have accustomed themselves to the use of alcohohc liquors. This cause, however, will seldom act alone ; being usually combined Avith ex- cess in diet, and with "wear and tear" of the general system, as will be shown in its proper place ; so that its operation is very liable to be overlooked. Diseases of the Liver. 54. That habitual excess in the use of alcoholic liquors must have a direct tendency to produce; certain diseases of the liver, will be questioned by no one who considers their mode of introduction into the system, and their influence on the condition of the blood. The blood which returns from the gastric veins charged with alcohol is immediately transmitted through the liver : nnd it stimu- lates this gland for a time to increased activity, one effect of which is to eliminate a portion of the alcoliol from the blood, — this substance, according to Dr. Pei'cy's obser- vations, being detectible in the bile of anlirjuls poisoned by alcohol. Hence, the liver, like the stomach, is sub- ject to habitual over-stimulation from tlie direct contact of alcohol with its substance. But we have seen tliat the presence of alcohol in the blood prevents It from ac(|uiring its proper arterial character by passages througli the lungs ; and we shall hereafter find that it causes the undue re- tention in it of hydro-carbonaceous matt 51), which seem to be rather .MTjuent upon the disorder of the digestive aj)paratii idu.ed by the habitual free use of alcoholic Tupiors. due to the direct agency of the alcohol upon its tissue. There is a disease, however, noticed by Dr. Darwin under the name of psora ebriormn, A^hich may be attributed with great probability to a chronic though slight perversion of the nutritive operations of the skin, in consecpienee of the pre- sence of alcohol in the blood. Of this disease, Dr. Dar- win says : " Elderly people who have been much a '^/^'l^ >^ .'^ Photographic Sdences Corporation n WEST MAIN STREET WEBSTER, N.Y. MSSO (716)872-4503 '^^^^ "^^^ ■^ '^^ > u EFFECTS OF ALCOHOL General Disorders of NiUrition. 60. Having thus considered the principal forms of disease which the intemperate employment of alcoholic liquors has a tendency to induce in the several parts of the excretory apparatus, to which they seem to give a special determination, we have now to consider those general chsorders of nutrition which are traeerble to the same cause, and wliich manifest themselves either as substantive diseases, as modifying the course of other diseases, or as giving a special habihty to the action of other morbific causes. We have already spoken of the deteriorating effect of the admixture of alcohol with the blood ; how it lowers the plasticity of the fibrine, tends to empty the red corpuscles, and in various ways impedes the process of aeration ; and another less direct, but not less important, source of deterioration is to be found in the imperfect elimination * of the constituents of the bile and urine, which must be the consequence of functional inactivity, still more of structural degeneration,! of the liver and kidneys. Hence it would seem impossible, that by such a pabulum the formation of the sohd tissues can be normally sustained ; and we should expect to find, that the nutritive processes are not performed with the same energy and completeness in the habitually intem- perate, that they are in the habitually abstinent. Not- withstanding some appearances to the contrary, there is abundant evidence that such is the case. Although a high degree of bodily vigor seems to be exhiliited by certain classes of men, who consume large quantities of fermented liquors, yet this is extremely deceptive, as the Elimination, separation. t Degeneration, diaense. ON THE HEALTHY SYSTEM. 65 facts to be presently stated will clearly indicate ; and the general result is evidently on the other side. 61. Tendency to the Deposition of Fat. — The im- mediate eflFects of alcoholic liquors upon the general appearance of the body, especially as regards the deposi- tion of fat, vary with their nature, and with the circum- stances under which they are habitually used. Thus it is generally to be noticed, that those who indulge largely in malt liquors become fat, and often exceedingly corpu- lent ; the large consumers of wine commonly share the same tendency ; but the spirit-drinker is more commonly lean, and even emaciated. This difference may partly depend upon the constitution of the liquors; thus ale, beer, &c. .wntain a considerable amount of saccharine matter, which is either consumed in respiration, leaving the fatty matters of the blood to be deposited as fat, or is itself converted into fat ; in wine, again, there is more or less of sohd matter, which furnishes materials for combustion ; whilst, in distilled spirits, there is scarcely any thing save the alcohol. But it also depends in part upon the amount of solid food habitually taken with the drink ; thus, the beer-drinker, if he be leading a life of gi-eat muscular exertion, may find his appetite but little impaired by his excess; the wine-drinker also usually feeds high ; whilst the spirit-drinker, especially among the poorer classes, takes his dram instead of solid food, for which he has neither appetite nor pecuniary means. The corpulence of the beer and wine-drinker, however, seldom continues to old age ; and the parts which first begin to shrink are the legs, after which the shoulders generally give way, and the whole body becomes loose, flabby, and inelastic ; the abdomen alone retaining its 6* 66 EFFECTS OF ALCOHOL. protuberance, in consequence of the large deposition of fat in the omentum,* which is rarely absorbed. Such a deposition of fat is almost invariably found in the omen- tum of confirmed spirit-drinkers,! notwithstanding its absence elsewhere. 62. A general corpulence of the body, however, can by no means be admitted as an indication of healthy nutrition : indeed, it must be regarded as very much the reverse. No animal in a state of nature exhildts any considerable deposit of fat, except for some special pur- pose (as in the case of cetacea and other warm-blooded animals inhabiting the water, where the coating of fat serves as a non-conductor ; or in the case of hybernating mammals, | as also of many birds, whose autumnal accu- mulation of fat is destined to make up for the deprivation or deficiency of food in the winter) : and when, by a change of habits, the deposition of fat is artificially pro- moted, it is obvious that the muscular vigor and general " hardiness " of the system are much im|)aired ; the ani- mal becoming liable to many disorders from which it was previously exempt, and requiring much more careful treatment to keep it in good condition. When, indeed, we find a tendency to the deposition of fat, not in addition to, but instead of, the normal tissues, the case is one of " fatty degeneration," and must be regarded as a positive disease ; involving, as it does, a general fr tional in- activity. II * Omenhim, fatty membrane covering the bowels, ■^ t Dr. Peters, foe. cit. % IlybernatiiKj mammals, quadrupeds which become torpid in ■winter. II The following interesting case is recorded by Dr. Robertson ON THE HEALTHY SYSTEM. 07 we to, of tive in- 63. Diminished Power of Sustaining' Injuries by Disease or Accident. — The classes of men among whom there is an appearance of remarkable bodily ^^gor, notwithstanding habitual excess in the use of alcohohc liquors, are those who are continually undergoing great muscular exertion, and who not only drink largely, but eat heartily. Of this class, the London coal-heavers, ballasters, and brewers' draymen, are remarkal)lc exam- ples : many of them drink from two to three gallons of porter daily, and even spirits besides ; they are for the most part large, gross, unwieldy men, and are capable of great bodily exertion, — so long,, at least, as their labor is carried on in the open air.* But it does not hence follow that they are in a condition of real vigor ; for the constitutions of such men break down before they are far advanced in years, even if they do not earlier fall victims (as a large proportion of them do) to the results of disease or injury, which were at first apparently of the most trifling character. It is well known to those who have observed the practice of the London hospitals, that, when such men suffer from inflammatory attacks (Treatise on Diet, fourth edition, vol. i. p. 272). The subject of it was a very young man, who died thus early from the intemperate nse of spirits. For several months before his death, ho had been unable to oat more than a very small quantity of food, and his powers -were almost exclusively maintained by frequent dram- drinking. The immediate cause of death was cerebral " ramol- lissemcnt ; " but, although the body was mucli attenuated, the muscular fibre of the system much wasted, and the subcutaneous fat of the extremities had almost disappeared, on cutting through the abdominal walls to examine the condition of the liver, at least three times the usual thickness of fat had to be divided. — AurHou. :son See Appendix A. 68 EFFECTS OF ALCOHOL or from local injuries, these are peculiarly disposed to run on to a fatal termination ; in consequence, it is evi- dent, of the deficient plasticity of the blood, of the low assimilative power of the solids, and of the general depression of the whole vital energy, resulting from habitual over-excitement. The want of plasticity of the blood gives to the inflammatory processes an asthenic * instead of a sthenic f character ; there is no limitation by pkstic effusion, but they spread far and wide through the tissues; depletion cannot be borne; and the only hope of success lies in the use of opium and stimulants with nutritious diet, to sustain, so far as possible, the prostrated energy. Thus we see that in such men the slightest scratch or bruise will not unfrequently give rise to a fatal attack of erysipelas ; and that internal organs affected with inflammation rapidly become infil- trated with pus, X or pass into a gangrenous state. Henco the surgeon is very unwilling to perform severe operations upon them, knowing that their chance of recovery is but small. The condition of these men, in regard to recovery from injuries, is in remarkable contrast to that of men who have been " trained " to pugilistic encounters; the latter having been brought to a condition of- lae highest possible health, by active exercise, abundance of nutritious food, occasional mild purgation, and either entire abstinence from fermented liquore, or by the very sparing use of them. Men thus "trained" recover with remarkable rapidity from the severe bruises which they are liable to receive. * Asthenic, wanting strength. f Sthenic, vigorous. X Pus, matter, as from sores. ON THE HEALTHY SYSTEM. 69 64. Although there are now few men who habitually take winn to a corresponding extent, or who maintain by active exercise in the open air any thing like the same muscular vigor, yet such examples are occasionally met with among the fox-hunting country sf^uires, who spend their whole days on horseback, and pass their evenings in drinking port- wine. Of these, also, the same remark may be made; that, notwithstanding their appearance of vigor, they are bad subjects for medical or surgical treatment, owing to the imperfect condition of their nutritive functions. Among the spirit-drinkers of our large towns, it is notorious that .the nutritive and re- parative powers are low; and of this fact we have a remarkable illustration in the frequency, among the intemperate, of a certain form of phagedenic ulceration, whose origin is suflSciently indicated by the term " Ge- neva ulcer," by which it is commonly known at Guy's and other metropohtan hospitals. This ulcer, usually commencing on the leg, begins as a red, angi*y, and painful spot, which passes into an open sore ; and this increases rapidly, both in depth and breadth, so as even to involve the whole surface of the calf, laying bare the muscles, tendons, and nerves. It is not confined, how- ever, to gin-drinkers, but is occasionally met with in the bloated, plethoric, red-faced wine-bibber. 65. Liability to Epidemic Diseases, — Another most important indication of the disordered state of nutrition, consequent upon habitual excess in the use of intoxicat- ing hquoi"s, is the liability of the intemperate to suffer from various other morbific causes, especially those of an epidemic or pestilential nature. On this last point there is, the writer beheves, no difference of opinion amongst / / 70 EFFECTS OF ALCOHOL medical practitioners in any part of the world ; all being agreed that the habitual drunkard is fay more likely to suffer from such agencies than the h^bitujilly sober or temperate man. Whether hahitnal /hbsti7ie)}ce is still safer than habitual moderation, is gr point which cannot be so easily ascertained : some considerations on this subject, however, will be offered hereafter (*§> 144 — 150). The peculiar liability of the habitually intemperate to suffer from the cholera-poison is well known. The fol- lowing circumstance, which occurred during the fonner epidemic of cholera, is very significant on this point; especially showing that the state of depression which follows excitement is the one in which the system is most readily affected. The nurses in the Cholera Hospital at Manchester were at first worked six hours, and allowed to go home the other six; and the mortality was so great amongst them that there were fears of the failure of the supply. It was found, however, that they were much given to alcoholic potations (with the idea, proba- bly, of increasing their power of resisting the malady) during their leisure hours ; and they were therefore confined to the hospital, and debarred from obtaining more than a small allowance of alcoholic drink; after which, not a single fresh case occurred among them. During the present epidemic, the writer has learned from various sources, that a considerable proportion of those invwhom the liability to the disease was not evi- dently produced by the condition of the locality in which they resided, might be considered as deriving a pre- disposition to it from habitual intemperance, — many establishments having lost those men, and those only, who had been accustomed to free indulgence in the use ON THE HEALTHY SYSTEM. 71 of alcoholic liquors. The general connection between the intemperate habits of a population, and its high rate of mortality from various causes, will \)e shown here- after ; and a high rate of mortalily is always indicative of a large amount of sickness, although the ratio between the two is by no means constant. 66. Gout and Rheumatism. — Among the general disorders of nutrition, to wliich the intemperate use of alcoholic liquors certainly predisposes, although it may not of itself cause them, are gout and rheumatism. The former is most common among those who have been accustomed both to eat and to drink freely ; and it is favored by such a use of alcoholic liquors as stinmlates the stomach to digest more azotized * aliment than the system can appropriate. This may be regarded as the fundamental cause of the disease, when it occurs in its sthenic form. Of the ulterior stages of it, we yet know too little to enable us to trace with certainty the effect of alcohol upon each of them ; but tliis much is pretty cer- tain, — that an impaired condition of the nutritive ope- rations will be favorable to the production of the mater ies morbi,-f whatever be its nature ; that tliis will be further promoted by any impediment to the due oxidation of the constituents of the blood, such as the admixture of alcohol has been shown to occasion ; and that the ehmination of this morbid matter will be obstructed by that torpid condition of the liver and kidneys, to wliich these organs are especially liable in those who have habitually over- excited them in earlier life (•§» 58). In the production of rheumatism, also, we may clearly trace the aggravat- - * Azotized, containing much, nitrogen, as in animal food, t Materiea morbi, material of disease. 72 EFFECTS OF ALCOHOL ing influonco of habitual excfcL'8 in the use of alcoholic liquors, especially if the materies morbi be, as many- suppose, lactic acid, * or one of its compounds. For, whilst the disordered condition of the assimilative and nutritive operations will give a special tendency to the production of this substance, the impediment to its oxy- genation t presented by the presence of alcohol in the blood will cause it to be retained and to accumulate there, instead of being burned oflf (which it ought to be, as fast as formed) and escaping from the lungs in the condition of carbonic acid and Avatcr.^ Here, again, the torpor of the liver and kidneys, and the disordered action of the skin, in the habitually intemperate, will present an additional obstacle to the proper elimination of the morbific mat- ter ; and in rheumatism, as in gout, the intensity of the inflammation can scarcely but be augmented by the dia- thesis II induced by the habitual presence of alcohol in the blood. All these predictions are verified by the experience of every practical man. 67. Diseases of the Heart and Arteries. — Closely connected with the gouty and rheumatic diatheses are diseases of the heart and arteries ; of which some obvi- ously arise out of these constitutional states, and are * Lactic acid, acid found in milk. t Oxijgonation, process by which oxygen is supplied. % This idea of the influence of alcohol in conducing to the retention of lactic acid, and thereby favoring the i-heumatic diathe- sis, is confirmed by the success of Dr. G. O. Ilees's method of treating rheumatism by lemon juice ; the rationale of which seems to be, that the citric acid aiFords a large and ready supply of oxy- gen, whereby the lactic acid (or materies morbi, whatever it be) is burned off. — Author. II Diathesis, condition of body. ON THE HEALTHY SYSTEM. 78 thus imiirectly favored hy tlie alnisc of ulcoliulic liiiuors ; wliilst otliers seem to be more tlirectly tlepeiKloiit upon the introUiiction of alcohol into the blood. The continual but irregular excitement of the contractile action of the heart and arteries, Avhich is the result of the habitual use of stimulants, must of itself predispose their tissues to disease ; and tliis predisposition will, of course, be in- creased by the contact of blood charged with alcohol with their lining membrane, as Avell as by the general disordered condition of the nutritive operations. Now, attacks of acute arteritis* seem not unfrecjuently traceable to alcohohc intoxication ; and it cannot, therefore, be regarded as improbable, that those more chronic disorders of their walls, which give rise to aneurism, f softening, fatty degeneration, and other structural changes, and wliich thereby predispose to hemorrhage, should be favored, if not absolutely produced, by the habitual presence of alcohol in the circulating current. Accord- ingly, we find the intemperate use of alcoholic liquors, specified by authors on the diseases of arteries, as among the most important of their predisposing causes. 68. Spontaneous Combustion, — Although the phe- nomenon termed "spontaneous combustion" of the human body is one of such rarity that it might seem scarcely to deserve to be ranked among the ordinary re- sults of habitual excess in the use of alcoholic liquors, yet it should not be passed by in any inquiry into the consequences of such excess ; more especially since it may be regai-ded, with much probability, as resulting from the same kind of perverted nutrition, carried to an extreme * Arteritis, disease of the arteries, t Aneurism, tumor of the arteries. I 74 EFFECTS OF ALCOHOL degree, as that to which wc have ah'cady traced various other consefjuences. It would be more correct to speak of these cases as instances of unusual combustibility of the body, than of really spontaneous combustion ; since, in scarcely any of them, perhaps in none, does there seem adequate evidence that the combustion originated without the contact of external flame ; their real pecu- liarity consisting in this, — that, whereas an ordinary human body requires a largo amount of wood, coal, or other inflammable material, for its combustion, the body in the subjects of this accident takes fire very readily, and bums as if it Avcre itself highly inflammable. In some instances, it has appeared as if a very inflammable gas were given off" from the body ; a flame having darted towards it from some distance. In all, or nearly all, the cases in which the previous habits of the individuals were known, they had been intemperate; and it is re- markable that the greater number of recorded instances occurred among fat old people who had been spirit- drinkers. The chief source of this peculiar combustibility is probably to be found in the impregnation of the fluids and solids of the body with phosphorus, which is per- haps united with hydrogen, so as to form some highly inflammable compound. This may be conceived to result from the habitual ingestion of alcohol, in the following way : The normal mode in which the phosphorus, set free by the waste or disintegration of nervous matter, is extricated from the system, is through the urine, after having been converted by oxidation into phosphoric acid. Now, if there be not oxygen enough in the blood to eflFect this conversion, it is to be expected that the phos- phorus would be retained in the fluids, and possibly depo- \ r ON THE HEALTHY SYSTEM. 75 sited again in tlio solids ; and, since we have seen that the continual presence of alcohol in the circulation gives even to arterial hWl a venous character, it is not difTi- cult to understand how such a retention of the phosphorus destined for excretion should l)e favored hy hahitual in- temjKJrance. It is a reniarkuble confirmation of this view, that the breath of drunkards luia been sometimes observed to bo luminous, an if it contained the vajwr of phosphorus or of some of its compounds ; and that it hag been found by experiments upon dogs, that, if phosphorus be mixed with oil and injected into the blood-vessels, it escapes unburned from the lungs, if time be not given it to unite with the oxygen of the blood.* The foregoing are the principal disorders, local and constitutional, in the production of wliich we can trace the operation of the habitually excessive use of alcohohc stimulants, with tolerable directness. It would be easy to extend this catalogue by the inclusion of other dis- eases which are manifestly aggravated by intemperate habits ; but this, in fact, would require the enumeration of almost every disease to which the human body is subject, more especially if inflammation participate in it. But the writer thinks it preferable to limit his state- ments to the cases in which the chain of causation is most continuously and obviously traceable. It has been his object throughout to show what consequences might ♦ See Casper's Wochenschrift, 1849, No. 15. The luminosity observed by Sir Henry Marsh in the faces of two phthisical patients was probably due to the same cause, — the imperfect oxidation of phosphorus within the body, and its consequent extrication from the skin in a vaporous condition. — Author. 76 EFFECTS OF ALCOHOL !l be expected to arise from habitual " intemperance ; " regard being had to the facts which have been fully ascertained, with respect to the modus operandi of al- cohol on the system at large, and on special organs. It has been shown, that a variety of disorders of the nervous system, of the digestive apparatus, of the secret- ing organs, of the skin, of the heart and arteries, and of the organic fluids and solids in general, might be thus anticipated; and that such anticipations are all com- pletely verified by the results of practical observation. We might now push the investigation further, and inquire what evidence we have in regard to the con- sequences of the habitually "moderate" use of alcoholic liquors on the human system. It must be freely ad- mitted, however, that we have not the same data for the determination of this question, as of that on which we have been hitherto engaged ; and this on two accounts : first, that the consequences will be naturally remote, and will be often such as appear fairly attributable, in great part, if not entirely, to other causes; and, second, that the very general prevalence of the " moderate " or " tem- perate" use of alcohohc liquors, and the shortness of the time during which total abstinence has been hitherto practised by any large number of individuals, render it difiicult, if not impossible, to draw any valid inference, as yet, from comparative observation. But the writer would argue, that, if we have such a complete accord- ance between the predictions of theory and the results of observation, in regard to the consequences of habitual "excess," as establishes the relation of cause and effect beyond dispute, Ave have a strong case in favor of such a relation, when, the cause being in less active operation, / M ON THE HEALTHY SYSTEM. 77 . " the predicted effects do occur, even though at a period so remote as apparently to disconnect them from its influence. For various reasons, however, he deems it advisable to carry out this inquiry under the second head, where it will be more conveniently discussed. IV. GENERAL EFFECT OF THE EXCESSIVE USE OF ALCO- HOLIC LIQUORS ON THE DURATION OF LIFE. 69. We shall close this part of the inquiry by examin- ing into the general tendency of the excessive use of alcohoUc hquors to shorten life ; either by themselves giving rise to the diseases above enumerated, or by in- creasing the susceptibihty of the system to other morbific causes. That such a tendency exists cannot for a moment be questioned. No life-insurance office will accept an insurance on an individual whose habits are known to be intemperate ; and if it be discovered after his death that he has been accustomed to the excessive use of alcoholic liquors, contrary to his statement in his proposal for insurance, the jjolicy is declared void. And it is, doubtless, owing in part to the superior sobriety of the great bulk of insurers over that of the average of the population, that a lower rate of mortality presents itself amongst them, than that which might be expected ac- cording to the calculations founded on the entire mor- tality of the country, — to the great profit of the office. Thus, at the age of 40 years, the annual rate of mortality among the whole population of England is about 13 per 1000 ; whilst, among the lives insured in life offices, it is about 11 per lOQO ; and in those insured in friendly societies, it is about 10 per 1000. Now, the average mor- tality for all ages between 15 and 70 years is about 20 7* T8 EFFECTS OF ALCOHOL per 1000 ; whereas, in the Temperance Provident Institu- tion, after an experience of eight years, and with several lives above 70 years of age, the average mortality has been only G per 1000, up to the present season, in which it has undergone a slight increase from the cholera epi- demic. It is worthy of remark, however, that, altliough many of the insurers in this office are of the poorer class, whose condition and employments expose them much more than the middling classes gener.ally to the endemic causes of cholera, no more than eight have died of this disease, out of the total of about 3,500 insurers. As a means of further comparison, the following table may be subjoined, in Avhich the mortahty of the insurers in the Temperance Provident Institution, for the first five years, is compared with that of the insurers in other offices during the corresponding period of their exist- ence : — Life Piilicies. Deaths. A issued 914, and had 14; being equal to 13 per thou'and. B „ 1901, „ 27; „ 11 C ,, 838, „ 11 ; „ 13 „ D „ 2170, „ 65; „ 26 TPI„ lo96, „ 12; „ 7i M During the sixth year of its existence, only iivo deaths occurred out of the whole number of insurers in the Tem- perance I*rovidcnt Institution, l)y which its annual aver- age of mortality Avas reduced still lower. 70. Such comparisons, however, must not be regarded as demonstrating that the usual rate of mortality among " moderate" or ''temperate"' men is reduced to half its amount by "total abstinence; " since other causes have dou])tless concuired to keep down the mortality in the Temperance Provident Listitution, — such as a more ■IT ON THE HEALTHY SYSTEM. 79 Idcatlis Tem- sivcr- ^ardcd imong tilf its have 5n the more healthful condition of the class which has furnished most of the insurers, or a more favorable distribution of ages. But it will be seen to be impossible, that either of these separately, or both conjointly, should have occa- sioned the whole of the difference above pointed out; the annual average, G per 1000, being no higher than that of the age of le5, which is more favorable than that of any other period of life. And we appear fully justi- fied, therefore, in attributing a part of the result to the abslinent system practised by the insurers in the Tem- perance Provident Office. 71. The influence of excess in the use of alcoholic liquors in directly producing sickness and mortality, or in predisposing to it, is most remarkable in tropical cli- mates, and especially in such as are otherAvisc unhealthy. It would seem, indeed, that the more unhealthy the station, the more freely do the residents at it indulge in the use of alcoholic stimulants ; either from the mistaken idea that they enable them to withstand the effects of the chmate, or from the desire that their life, if short, shall be a merry one. Some years since, the writer, being himself in the Island of St. Vincent in the "West Indies, met Avith a gentleman resident in Tobago, who informed him that the average annual mortality amonirst the Eu- ropeans of that island was about oie in fJircc. Upon inquiry into the halnts of the residents, it was found that intemperance prevailed to a most fearful extent among them ; few getting up in the morning witliout their glass of sangaree (wine and water), and the strength of their beverage gradually increasing during the day. until it arrived at neat brandy at night. He further sp<^ke of it as no uncommon occurrence for a party of friends who 80 EFFECTS OF ALCOHOL had met at a drinking-bout, to be summoned, within two or three days, to the funeral of one or two of their number. This gentleman was himself apparently quite indisposed to recognize between these occurrences any relation of cause and effect ; being obviously under the belief, that, if it were not for the protecting influence of good wine and brandy, his life would be worth a yet shorter purchase. We shall be led, however, by the evidence about to be adduced, to a different conclusion. 72. The writer has on various occasions sought for information from those who had preserved their health during a long residence in tropical climates, as to their habits in the use of alcoholic liquors ; and has almost invariably found that they had practised extreme modera- tion, if not total abstinence. 73. At the Statistical Section of the British Associa- tion, in the year 1848, a paper by INIr. Balfour having been read on the " Means of maintaining the Health of Troops in India," — in which paper the author attempted to show that intemperance would be found to add but a small proportion to the deaths from chmatorial diseases, but that the special liability of Europeans to the diseases of hot climates arises from their unsuitability of consti- tution to any climate widely different from that of their own country, — an important discussion took place, in the course of which some valuable facts were cstaT)lished by the testimony of several officers present (medical and otherwise), who had served in India and elsewhere. The returns contained in the paper showed a marked differ- ence in rate of morality between the ordinary soldiers and the officers ; a difference which was greater accord- ing to the unhealthiness of the station. Now, a certain ON THE UEALTHY SYSTEM. 81 part of this difference must be admitted to be due to the superior character of the officer's lodging, and to his partial exemption from the fatigue and the exposure to which the soldier is lialjlo. But the difference is chiefly to be accounted for by the difference in the manner of living between the soldiers and the officers ; the former being allowed a regular ration of spirits, and many of them getting as much more as they can ; whilst the latter are now comparatively abstemious, drinking wine or beer in place of ; »ivits, and this to a mach less extent than formerly. With regard to the Indian service, it was specially asserted by Lieutenant-Colonel Sykes, who has paid great attention to the statistics of the Indian army, that, since it has become the custom among the officers to drink bitter ale in place of wines or spirits, the rate of mortality among them is so greatly dimin- ished, that promotion is no longer expected to take place more rapidly in the Indian army than in other depart- ments of the service. In illustration of the extreme injury done by intemperance to the Indian troops, a medical officer stated, that, within a month after the arrival of the order for the discontinuance of temperance societies,* he had/or^// cases of delirium tremens in his own regiment. 74. That the haljility to chmatorial disease is by no means inevitable, and that it is especially to be avoided by the adoption of the habits in regard to diet, &c.^of the * The authorities at the Horse Guards, -vvho have taken the ex- traordinary step of putting down temperance societies in the army, on the ground that every organization but the regimental is con- trary to the discipline of the service, can scarcely be supposed cognizant of what they have to answer for. — Author. 82 EFFECTS OF ALCOHOL native population, where that is healthy, is the testimony of all those who have had most extensive opportunities of forming a judgment on the subject. The two following citations from diflferent publications — the one by Lieute- nant-Colonel Sykes, who was himself long resident in India ; the other by Dr. Daniell, assistant-surgeon to the forces, who has had the superintendence for a consider- able time of some of the most unhealthy stations on the western cost of Africa — will carry with them great weight. " I never followed a farinaceous or vegetable regiment myself in India," says Colonel S. " nor do I recommend it to others ; but I ate moderately and drank little, and I have a strong conviction that much of Euro- pean disease in India is traceable to over-stimulus, and that the mortality among the European troops will not be lessened until the European soldier is improved in his habits ; until he is made to understand that temper- ance is for the benefit of his body, libraries for the benefit of his mind, exercise for the benefit of his health, and savings' banks for the benefit of his purse. The climate of India is less to blame than individuals ; for^ in case foreigners find the people in a country healthy, they sliould, to a certain extent, conform to the habits of the natives to be healthy also." * So with regard to Africa, Dr. Daniell says, "It is a well-known fact that the notorious insalubrity of Africa has frequently served as the scape-goat on which the blame of those evil conse- quences (resulting from the reprehensible indulgence of dissipated courses) might be unreservedly thrown, without * Vital Statistics of the Indian Army, in Journal of the Statis- tical Society, vol. x. p. 184. ON THE HEALTHY SYSTEM. 88 the risk of their being disputed or questioned."* And again, when describing the Bight of Benin, one of the most pestilential localities on the surface of the globe, he says : " And yet, amid these regions so rife with disease and death, I have known Europeans reside for a number of years in the enjoyment of good health, from the simple secret of moderately conforming to the habits of the natives as regards their diet, exercise, and attention to the due perforaiance of the cutaneous functions."f 75. The evidence of statistics, however, is more valua- ble on this point than the mere aflfinnation of individuals, however trustworthy ; and to this, as set before us by Colonel Sykes, we shall now proceed. The per centage annual mortality from sickness of the three armies of Bengal, Bombay, and Madras, for the last twenty years, has averaged as follows : — Bengal. Native 1-79 European 7*38 This table presents some very remarkable features. In the first place, the striking contrast between the rate of mortality of the European and of the native troops, serving together, and exposed to the same morbific causes. Secondly, the great difference between the mortality of the troops serving in the difierent presidencies. And, thirdly, the circumstance that in the Madras Presidency the rate of mortality is highest amongst the native troops, and lowest among the Europeans. 76. Now, on the first point, Colonel Sykes remarks : * Sketches of the Medical Topography and Native Diseases of the Gulf of Guinea, Western Africa, p. 13. t Op. cit. p. 61. Bombay. Madras, 1-291 2-095 6-071 3-846 84 EFFECTS OF ALCOHOL " I -svill not say that the (|uestion is absolutely solved by the reply, ' Habits of life ; ' but I will say, reasoning from analogy, that the reply goes a great way to solve it. The European soldier in India is over-stimidated by food, over-stimulated by drink, and under-stimulated in mind and body. The European soldier eats a quantity of animal food every day of his life ; he drinks a quan- tity of alcohol every day of his life to the amount of a bottle of spirits in every five days, two drams being served out to him daily ; and he has not any mental and httle bodily exercise. Happily the pernicious practice has been recently discontinued ; but time was when the European soldier Avas compelled to take liis drjim by eight o'clock in the morning, with the thermometer varying from 70^ to 90° or more, at different seasons of the year, leaving him in a state of nervous irritation and thirst, which could only be relieved, as ho thought, by further potations : indeed, I have been assured, within the last few days, by a pensioned artillery staff-sergeant, vjho never drank in India, and ivas only in hospital five days during" tiserdy-onc years' service, that he has known, out of a detachment of one hundred artillery men, no less than eight men in strait jackets at one time, absolutely mad from drink. Now, animal food, with the assistance of such an auxiliary, and combined with mental vacuity, go far to account for the excess of mor- tahty amongst Europeans." 77. The question next arises, why the mortality of the European troops in the IMadras Presidency should be so much less than that of the others, being about three- fourths that of the Bombay troops, and but little more than half that of the Bengal army ; whilst, on thje other ON THE HEALTHY SYSTEM. 85 hand, the mortality of the native troops in the Bombay army is but liltle more than two-thirds of that of the Bengal army, and less than two-thirds that of the Madras army. There does not seem to be any such diflference in the climatorial diseases, or in the character of the military stations, of the three presidencies, as are by any means sufficient to account for this discrepancy ; and, if there were, Ave should expect them to manifest themselves ahke in the native and in the European army. That the reverae is the case must be admitted to be a cogent argument, if not a complete proof, in favor of the insufficiency of any such account of the discrepancy. The following are the causes assigned by Colonel Sykes : The Bengal European array has no supply of porter, but is furnished with rum, a spirit not so wholesome as arrack. On the other hand, the Ma- dras army consume large quantities of porter, and drink comparatively little spirit ; what they do consume being arrack. The Bombay troops have only recently com- menced the consumption of porter ; and the spirit they drink is understood to be more wholesome than rum, and less so than arrack. "These results," says Colonel Sykes, " are certainly not conclusive ; but I cannot help associating the increased consumption of malt-liquor by the Madras Europeans with their comparative healthi- ness ; and the gradations of the moi*tality in the Bengal and Bombay European troops as partly influenced by the quality (no doubt much more by the quantity) of the spirits they respectively consume."' 78. On the other hand, the excess of mortahty in the native army of Madras above that of the Bengal and Bombay troops is equally attributable to a diffijrence in the habits of the individuals composing it. " Of the 86 EFFECTS OF ALCOHOL Bombay army," says Colonel Sykes, " six-eighths con- sist of Hindoos, and considerably more than half of the whole army are Hindostanees. These men never taste meat, fish, or spirituous liquors, but live, I may from personal observation venture to say, almost exclusively upon unleavened cakes of wheat or other cerealia, baked upon an iron dish, and eaten as soon as cooked. The great majority of the Bengal army consists of a similar class of men. The Madras army, in its constituents, is the reverse of the other two. In the cavalry there are from six to seven Mussulmans to one Hindoo, and in the infantry there is one Mussulman to every 1^ or If Hindoos ; but amongst the latter there is a con- siderable number of low castes, without prejudices about food, and unrestrained by the prejudices of caste : there- fore the majority of the native troops of the Madras army can eat and drink like Europeans." Thus, then, we see that, whereas in the Madras army, in which the European and native habits most closely assimilate, the mortality of the former is less than double (about 38 to 21) that of the latter, the mortality of the Bengal Europeans is nearly six times (about 74 to 13) that of the Bombay natives ; this difiFererice bearing such a rela- tion to the greater abstemiousness of the native soldiers, and the larger consumption of spirits by the Europeans, that it is scarcely possible to avoid the inference that they must be connected in the relation of effect and cause. 79. The following returns are of value, as showing the proportion of sickness between the members of Tem- perance Societies * in the European regiments serving * In these societies, the pledge simply held the members to abstinence from distilled spirits, and from excess in the uae of any fermented liquor. — Author. ON THE HEALTHY SYSTEM. 87 ; they in India, and the soldiers not members of these societies ; the average daily number of men in hospital of each class being staterftnoe BocietiM. Htrrngth of remmin class of substances in its * Albuminotis, nutritious. The white of egg is albumen. t This term is here used to designate what are commonly known as the protein compounds ; late researches ha^Hng tended to show the incorrectness of the basis on which that appellation was founded. — Author. X Pabulum, food, nourishing matter. II It is usually stated, on the authority of Fremy, that the fatty acids of the nervous substance contain nitrogen. This, however, is probably an error, arising from the substance of the brain or nerves being submitted to analysis en masse ; for this substance consists not merely of the fatty contents of the cells and tubes, but of their albuminous walls ; and, thus regarded chemically, it is a mixture of oleaginous with a small quantity of albuminous matter, which last, when included in the analysis, would give to the former ingredient the appearance of containing azote. (See Valentin's Lehrbuch der Physiologic, Band i. p. 174.) — Author. § Oleaffinous, oily, fatty. 96 SUPPOSED USES OF ALCOHOL ! chemical relations. But there are two circumstances which render it highly improbable that alcohol can ever be converted into nervous matter. In the first place, we have no other example of an organic compound being found applicable to the nutrition of the animal tissues, which is the product of incipient decay or decomposi- tion ; yet this may be affirmed to be the case with alco- hol, since the alcoholic fermentation is the first of a series of degrading changes, which, if allowed to con- tinue unchecked, terminates in the putrefactive process ; and we can scarcely imagine, therefore, that it can be an appropriate material fo/ the formation of the most ac- tive and important part of the whole animal mechanism. Again, we have no other example of the application of an organic compound to the nutrition of the animal tis- sues, which exerts upon any of them such a decidedly poisonous influence in large doses, as we have seen to be exerted by alcohol (§§ 13 — 16). The materials which constitute the pabula for the several tissues are perfectly innocuous whilst they retain their normal constitution ; and their pretrence in the blood, in larger amount than usual, though it may in various modes be a source of functional derangement, never exercises any special dele- terious influence upon the vital properties of the nervous, muscular, or any other tissue. On these grounds, then, it may be almost positively affirmed, that, notwithstand- ing the chemical relation which alcohol bears to nervous matter, it cannot serve, either in its original condition or under any other guise, as a pabulum for the generation of nervous tissue. 87. We seem justified by the laws of physiology, therefore, in assuming that alcoholic hquors cannot sup- IN SUSTAINING THE VITAL POWERS. 97 Qstances jan ever )lace, we id being tissues, jomposi- ith alco- rst of a to con- process ; an be an most ac- chanism. cation of imal tis- lecidedly sen to be Is which perfectly titution ; mt than ource of ;ial dele- nervous, ds, then, ithstand- nervous dition or neration jrsiology, inqt sup- ply the first of the requisites already enumerated for the development of the physical power of the nervous and muscular apparatus ; and we have next to consider what is its capacity in regard to the second. It may be safely affirmed, that the introduction of alcohol into the blood cannot stand in the place of the oxygen which is essen- tial to the functional activity of the nervous and mus- cular systems : on the contrary, its presence in the blood would rather tend to impede the oxidation of their organic components, both by the more cogent demand for oxygen which it will itself set up, and also by the preventive influence which it is well known to exercise over the oxidation of other organic substances {^'^ 117, 118). In both these modes, it will not only interfere with that action of the oxygen of the blood upon the nervous and muscular substances, which is essential to their functional activity ; but it will also tend to check the removal, by oxygenation, of those products of de- composition whose continuance in the blood is attended with most serious injury to the system. In so far, in fact, as the presence of alcohol in the circulating current tends to give to arterial blood a venous character, it must thereby impair its power of serving as the e citing fluid (for so we may term it) of the nervous and muscular battery. And this it does, in the first instance, by obstructing the ehmination of carbonic acid, as will be shown hereafter (<§» 118) ; but more remotely by that interference with the proper functional activity of the liver and kidneys, which we have seen to be among the most ordinary consequences of the free and liabitual use of alcoholic liquors (§*§• 54 — 58). 88. But, although we are led by the preceding con- 08 SUPPOSED USES OF ALCOHOL t siderations to regard the regular employment of alco- holic liquors as rather a detriment than an aid to the development of nervo-muscular power, there is a third point towards which we have to direct our inquiry ; namely, whether the peculiar stimulating effect of alco- hol, which is especially exerted upon the nervous system, may not enable a greater amount of nervous energy to be produced, and a greater amount of muscular power to be thereby called forth, than could be generated without its aid. In considering this question, it is most important to keep in view the difference between a tem- porary and a sustained effort. We have seen that the usual effect of a moderate dose of alcohol is, in the first instance, an increase in the force and rapidity of the circulation, and in the activity and energy of the functions of the nervous system ; and both these condi- tions will be favorable to the development of muscular power, so long as they continue. But such a state cannot long endure. We may increase the amount of nervous power developed in a given time, by the influ- ence of alcoholic stimulants ; or we may prolong its generation by the same kind of assistance, when it would otherwise have failed. But as every exertion of nervous power, like that of muscular, involves the death and decay of a certain amount of the tissue by which it is evolved, there is a limit to the possibility of its genera- tion ; so that we find the continuance, or even the in- crease, of the stimulus ceasing after a while to produce any effect ; and the exhausted power can only be recov- ered by a lengthened period of repose, which shall allow time and opportunity for the regenerating processes to he performed, at the expense of nutrient material drawn IN SUSTAINING THE VITAL I'OWEIIS. 99 from the blood. Until this has been cfFectually accom- plished, the nervous power is at least as much below par as it previously was above it ; so that the loss is cer- tainly equivalent to the gain. And the more the nervous system has been forced, by the influence of alcoholic stimulants, to give forth its powers beyond their natural limit, whether as to duration or intensity, the greater will be the degree and duration of that subsequent de- pression which speaks so unmistakably of the need of rest and reparation. 89. Hence, therefore, we should anticipate, that, al- though the use of alcoholic stimulants may enable a greater amount of physical force to be put forth within a given time than could otherwise be generated, they can be of no assistance in the suslentation of nervo- muscular power ; and, if the previous considerations be also taken into the account, we should be led to expect, that, in the long-run, severe bodily labor will be better borne without alcoholic stimulants than with them, — provided always that the digestive apparatus be in good working ord'^r, and be adequate to prepare that amount of alimentary material which is required for the regen- eration of the tissues disintegi'ated by use. 90. We have now to inquire how far the results of practical experience are coincident with these theoretical views; and whether it is found, on actual trial, that complete abstinence from alcoholic liquors is favorable, or the reverse, to the endurance of severe bodily labor. It cannot be denied, that the ideas current, among the laboring classes more especially, as to the teachings f»f experience on this point, are opposed to our theoretical deductions. But there are many circumstances whicli 100 SUPPOSED USES OF ALCOHOL should lead us to mistrust the popular voice on such a question, and to seek for proofs of a kind that may be more firmly relied on. The "universal experience" of former generations might be quoted in favor of a multi- tude of absurd notions, which we now treat as simply ridiculous ; and when there is this additional complica- tion, that the liking for alcoholic liquors is such as very readily to make " the wish father to the thought," we find an additional ground for suspicion. But the chief cause of our mistrust is this, — that there is no appreciation, in the popular mind, of the connection between the immediate and the remote effects of alcoholic stimulants. A glass of malt-liquor, or a small quantity of spirits, repeated three or four times a day, is found to increase the bodily vigor for a time; and this increase is set down as so much positive gain, no account being taken of the sub- sequent depression, which is considered as ordinary fa- tigue. Evidence of this kind is therefore of little or no value ; and the only facts that can be admitted as having any weight are those which bring into comparison the total amount of labor executed with and without the aid of fermented hquors, during lengthened periods of severe toil; these being the indications; not of the amount of force which may be temporarily set forth, but of that which can be habitually exerted ; and therefore of the general vigor of the system, rather than of its power in a state of excitement. 91. It would be easy to cite several modern testi- monies to the superiority of the abstinence principle (to 8iiy nothing of the ancient ones), from Benjamin Franklin down to Dr. Forbes ; —the former of whom tells us, in his Autobiography, that he was accustomed, when working IN SU8TAININ(1 THE VITAL POWERS. 101 >) of as a pressman in a London printing-house, an 87), it seems in the highest degi-ee improbable that they can be of the 112 SUPPOSED USES OF ALCOHOL i ! least advantage to it. The latter cannot in any degree be improved, but must be rather impaired, by the use of fermented hquors ; which, as already stated, tends to deteriornte the quality of the blood, and to obstruct its oxygen' *ion. 104. That the use of alcoholic stimulants, however, is attended in most persons with a te7}iporary excitation of mental activity, lighting up the scintillations of genius into a brilliant flame, or assisting in the prolongation of mental effort when the powers of the nervous system would otherwise be exhausted, may be freely conceded ; and it is upon such evidence as this that the common idea is based, that it supports the system under the endurance of mentul labor. This idea, however, is pro- bably as erroneous as the no less prevalent fallacy of regarding alcohohc liquors as capable of increasing the power of physical exertion. No physiological fact is better estabhshed than that of the depression of the men- tal energy consequent upon the undue excitement of it, by whatever causes that excitement may have been occa- sioned ; and the rapid and brilliant flow of thought which may have been called forth by the alcohohc stimulants gives place, usually after a few hours, to the oj^posite state of languor and despondency. 105. The influence of alcoholic stimulants seems to be chiefly exerted in exciting the activity of the creating and combining powers ; such as gives rise to poetical imaginations, to artistic conceptions, or to the sallies of wit or humor. It is not to be wondered at, then, that men possessing such powers should have recourse to alcoholic stimulants as a means of procuring a temporary exalta- tion of them, and of escaping from the fits of depi-ession IN SUSTAINING THE VITAL POWERi?. 113 to which most persons are subject in whom the imagina- tive and emotional tendencies are predominant. Nor is it to be denied that many of those mental productions which are most strongly marked by the inspiration of genius have been thrown off under the stimulating influence of alcoholic liquors. But, on the other hand, it cannot be doubted that the depression consequent upon the high degree of mental excitement which is thus produced is pecuharly great in such individuals, completely destroy- ing for a time the power of mental effort ; and hence it does not at all follow, that either the authors of the pro- ductions in question, or the world at large, have really benefited thereby. Moreover, it is the testimony of general experience, that, where men of genius have habit- ually had recourse to alcoholic stimulants for the excite- ment of their powers, they have died at an early age, as if in consequence of the premature exhaustion of their nervous energy : Mozart, Burns, and Byron may be cited as remarkable examples of this result. Hence, although their light may have burned with a brighter glow, like a combustible substance in an atmosphere of oxygen, the consumption of material is more rapid; and, though it may have shone with a soberer lustre without such aid, we cannot but believe that it would have been steadier, and less prematurely quenched. 106. We do not usually find, that the men most distin- guished for that combination of intellectual powers which is known as talent are disposed to make such use of alcoholic stimulants for the purpose of augmenting their mental powers ; for that spontaneous activity of the mind itself, which it is the tendency of alcohol to excite, is not favoraljle to the exercise of the observing and purely 10* 1 114 SUPrOSED USES OF ALCOHOL reasoning faculties, or to the steady devotemcnt of con- centrated attention to any subject which it is desired to investigate profoundly. Of this we have a remarkable illustration in the habits of practised gamblers ; who, when about to engage in contests requiring the keenest observation and the most sagacious calculations, and in- volving an important stake, always " keep themselves cool," either by entire abstinence from fermented liquors, or by the use of those of the weakest kind in very small quantities. And we find that the greatest part of that intellectual labor which has most extended the domain of human knowledge has been performed by men of re- markable sobriety of habit, many of them having been constant water-drinkers. Under this last category, it is said,* may be ranked Demosthenes and Ilaller ; Dr. Johnson, in the latter part of his life, took nothing stronger than tea, while Voltaire and Fontenelle used coffee ; and NcAvton and Hobbes were accustomed to solace, not to excite, themselves with the fumes of tobacco. In recrard to Locke, whose lonj; life was devoted to constant intellectual labor, and who appears, independently of his eminence in his special objects of pursuit, to have been one of the best-informed men of his time, the following very explicit and remarkable testi- mony is borne by one who knew him well: "His diet was the same as other people's, except that he usually drank notliinn; l)ut water: and he thoudit that his absti- nence in this respect had preserved his life so long, although his constitution vras so Aveak." | * Macnish's Anatomy of Drunkenness, p. 36. t Life by Lord King, vol. ii. p. 60. IN SUSTAINING THE VITAL POWERS. 115 107. Having, for several years past, been himself performing an amount of steady mental labor, wliich to most persons would appear excessive, the writer may be allowed to refer to his own experience, which is alto- gether in favor of total abstinence from alcoholic liquors, as a means of sustaining the power of perfijrming it. Having been brought up as a water-drinker, he never accustomed liimself to the habitual use of alcoholic liquors ; scarcely ever tasting them, except wlicn occa- sionally led to do so by social influences, or Avhen he believed that a small amount of stimulus would improve the "tone" of his system, which is liable to a peculiar relaxation in certain states of the atmosphere. On determining, about four years since, to give up the oc- casional use of wine, o,c. as a social indulgence, he still held himself free to employ it when he might think it likely to increase the general powers of his system ; and for some time he continued to have occasional recourse to alcoholic stimulants (never exceeding a single gjass of wine, or lialf a tumbler of bitter ale), when he felt him- self suffering under the peculiar depression just referred to. He gradually, however, found reason to doubt the utility of tlic remedy, and has for the last two years entirely given it up. During these two years, he has gone tlnonu'h a larger amount of mental labor than he ever did Ix'fore in the same period of time ; and he does not hesitate to say, that he has performed i^ with more ease to liiiuH^elf than on his former system, and that he has been iiioro free than ever from tliosc states of depres- sion of mental energy which he Avas accustomed to regfird as indicating the need of a temporary support to antago- nize tlic depressing cause. In fact, he now finds, that, 116 SUPPOSED USES OF ALCOHOL when these do occur, the use of alcoholic stimulants, taken even in very small amount, is decidedly injurious to him ; diminishing rather than increasing his power of mental exertion at the time, and leaving him still less disposed for it after their effect has gone off. He attri- butes this change to his entire disuse of alcoholic liquors under all other circumstances ; and he cannot but beheve, that the results which ho now experiences, and which have led him to relinquish these stimulants altogether, are the natural effect of them upon the healthy system ; and that the benefit which some persons consider them- selves as deriving from their use, arises from their simply removing for a time the depression which results (at a long interval, it may be) from tlieir previous employ- ment. 108. Two remarkable cases have recently fallen within the author's knowledge, in which individuals leading a hfe of considerable intellectual exertion, and long habitu- ated to the moderate use of stimulants, have derived considerable benefit from their relinquishment. In one of these cases, a pint of ale was the usual daily allow- ance ; to which a little spirits and water at night was occasionally added. The relinquishment was commenced as an experiment, and without any intention of perse- vering should it not succeed ; but the benefit has been so great that the abstinence has been subsequently con- tinued as a settled practice. This gentleman not only finds his general health improved, but declares that his power of intellectual exertion is much greater than formerly ; and, in particular, that he finds himself quite fresh and ready for work in the morning, instead of losing time, as formerly, in bringing himself up to the IN SUSTAINING THE VITAL POWiiUH. 117 point at wliicli ho left off the night hefor j. In the other instance, the usual daily allowance was from two to four glasses of wine ; and this was affirmed to l)e necessary to keep dotrn a state of mental excitement to which the individual was sulyect, and to hracc the mind to steady exertion. Failing health, however, having occasioned a recourse for a time to the hydropathic treatment, this gentleman, on returning in a state of renewed vigor to his usual avocations, wisely determined to persevere in the disuse of stimulants ; and he has since continued to pmctise the abstinent system, with great benefit to his bodily and mental health. 109. Even if we admit, however, that a certain amount of mental laljor may be performed with more facility in a limited time under the moderate use of alcoholic stimu- lants, it is still questionable, whether we do not, on the whole, rather lose than gain by their employment. For, if they cannot afford pabulum* for the fomiation of nervous matter, and if their influence is exerted rather in producing its disintegration than its growth, its de- struction rather than its construction, it follows that every excess of exertion performed under their influence must be followed by a corresp;">ndingly long period of incapacity, during which the regenerating processes have to be performed, and the brain again fitted for the dis- charge of its duties ; and, if it should be forced into acti- vity before this renovation has been duly performed, the amount of stimulus required to bring it up to the working point will be greater, and all the consequent evils in- creased. These theoretical predictions are, it is believed, ♦ Pabulum, food, material of growth. 118 SUPPOSED USES OF ALCOHOL II in full accordance with what observation teaches with respect to the results of rehance upon alcoholic stimu- lants for support during mental labor ; although, for obvious reasons, it is not possible to obtain the same pointed and decisive evidence on this topic a« in regjird to the endurance of physical exertion, or of extremes of temperature. But it is frequently urged, that although the use of alcoholic liquors to produce a stimulating action upon the brain is injurious, yet that bencifit is derived from the employment of a quantity sufficient to stimulate the stomach to the proper discharge of its duties, by digesting that amount of food which the system requires, but which the exhaustion of nervous power prevents it from duly appropriating. This doc- trine, which equally applies to the state of imperfect indigestion resulting from other causes, will be better considered when we have inquired into the reputed effi- ciency of alcoholic liquors in supporting the system under exposure to the extremes of cold and heat, to which question we have next to proceed. III. ENDURANCE OF COLD. 110. The power of alcoholic liquors to enable the kxly to resist the depressing influence of external cold, is per- haps the best established of all its attributes, not merely in the estimation of the uninformed public, but in the opinion of those who have scientifically considered the question. This is by no means surprising. The genial warmth which is experienced for a time, when a glass of spirits is taken on a cold day, appears to affijrd uimiis- takable evidence of its heat-producing power ; and* the IN SUSTAINING THE VITAL POWERS. 119 chemical properties of alcohol would seem to indicate, that, under such circumstances, it does not merely act as a stimulant, increasing the activity of the circulation, and augmenting the nervous energy, but that it also affords the material for that combustive process by which the heat of the body is sustained in a form peculiarly suita- ble for rapid and energetic appropriation to this purpose. The authority of Liebig is continually quoted in support of this view ; but more has been built upon his state- ments than they legitimately support. For his argu- ments are rather directed to prove that alcohol cannot become a pabulum for the tissues, and that its sole use, therefore, must be in maintaining the temperature of the body by the combustive process, than to show that it is superior to other materials, to whose employment, as they exert no stimulating influence, the objection raised against alcohol cannot apply. That we may place this question upon its proper basis, it will be necessary to consider the circumstances under which the combustive process is usually carried on. 111. That the maintenance of animal heat is chiefly, at least, dependent upon the union of the carbon and hydrogen of certain materials contained in the blood, with oxygen taken in by the lungs ; and that the non- azotized* ingredients of the food are specially appro- priated to this purpose, — are positions in which there is now such a general agreement amongst physiologists, that they may be assumed as a basis for our further inquiries. The non-azotized ingredients of ordinary food may be grouped under two heads, — the saccharine -f and the * Non-azotized, containing no nitrogen, t Saccharine, sweet, sugary. 120 SUPPOSED USES OF ALCOHOL oleag'inoiis ; the former including all those farinaceous matters which can be converted into sugar, and the latter consisting of oil and fat in every form. The former may be considered as hydrates of carbon ; * their proportion- als of oxygen and hydrogen being such as to form water ; so that in combustion they will only consume as much oxygen as will convert their carbon into carbonic acid. On the other hand, the proportion of oxygen in the latter is comparatively small ; so that in combustion they re- quire as much as will not only convert their carbon into carbonic acid, but will also unite with that part of the hydrogen for which no equivalents of oxygen previously exist in the compound. Thus, an equivalent of starch consists of 12 carbon, 9 hydrogen, and 9 oxygen ; whilst an equivalent of stearine, the basis of the soUd fats, consists of 136 carbon, 132 hydrogen, and 10 oxygen. Multiply- ing the numbers of the former by llf, so as to bring them better into comparison with the latter, f we find that — lis equiv. of starch = 140 carbon, 105 hydrogen, 105 oxygen. 1 equiv. of stearine =136 carbon, 132 hydrogen, 10 oxygon. Now, in the former case, the number of equivalents of oxygen necessary for the conversion of the starch into * Hydrates of carbon, compounds of carbon with hydrogen. t We thus make the sum total of the weights of carbon and hydrogen very nearly the same in the two cases ; for 140 equiv. of carbon (140 X 6) = 840 and 105 equiv. of hydrogen (105 X 1) = 105 whilst 136 equiv. of carbon (136 X 6) and 132 equiv. of hydrogen (132 X 1) [AUTHOK.] 945 816 132 948' IN SUSTAINING THE VITAL POWERS. 121 laceous e latter er may )ortion- water ; ; much ic acid, le latter hey re- jon into of the iviously r starch whilst consists iultiply- ng them hat — 5 oxygen. oxygon. alents of Tch into ogen. irbon and 3 5 carbonic acid and water will be no more than that required for the change of its carbon into carbonic acid, namely (140 X 2 =) 280 ; but, in the latter case, the number required will not be merely that which will convert the 136 eq. of carbon into carbonic acid, namely (136 X 2 =) 272 ; but also that required for combination Avith those 122 equivalents of hydrogen, for which no equivalent of oxygen exists in the compound, making in all (272 -|- 122 =) 394. A much more energetic combustive pro- cess is required, therefore, for the conversion of stearine into carbonic acid and water, than for effecting the same conversion upo" starch; for not only is the quantity of free oxygen "o xoaeA much larger, but the amount of heat generated j- e much greater; since much more heat is produced by the combustion of hydrogen thin by that of carbon. 112. Now, the atomic composition of alcohol being 4 equivalents carbon, 6 eq. hydrogen, and 2 eq. oxygen, it is intermediate, in regard to its proportion of oxygen, between the farinaceous and the oleaginous substances; bearing, however, a strong resemblance to the latter, in regard to the large proportion of hydrogen for which it does not contain an equivalent of oxygen. This will be best seen by multiplying the equivalent of alcohol by 31| , which will bring the total weight of its carbon and hy- drogen exactly to the same figure with that of 11 1 of starch.* 314 equiv. of alcohol = 126 carbon, 189 hydrogen, 63 oxygon. * For 126 equivalents of carbon (126 X 6) and 189 equivalents of hydrogen 11 [Author.] 7o6 189 no 122 SUPPOSED USES OF ALCOHOL Thus, then, in the combustion of this amount of alcohol, there will not merely be required (126 X 2 =) 252 equiv. of oxygen, for the conversion of its carbon into carbonic acid; but as (189 — 63) 126 equivalents of hydrogen exist in the compound without any equivalent of oxygen, that number of equivalents of oxygen will be required to convert all the hydrogen into water, making in all (252 + 126 =) 378. This amount is not far from that required by an equivalent quantity of ^tearine ; and, as a much larger proportion of it is consumed by the hydrogen, it is obvious that the heat produced must be greater than that evolved by the combustion of an equal weight of hydro-carbon contained in the latter. 113. Considered, therefore, merely in the light of /we/, alcohol is superior to oleaginous substances, whilst it is of far higher value than any substance of the saccharine group ; and of this the chemist is practically aware, for he finds that a spirit-lamp gives more heat than an oil- lamp. Were the human body simply a lamp or a fur- nace, therefore, we should have no room for doubt as to the efiiciency of alcohol in maintaining its heat ; and it is because the influence of alcohol upon the vital functions is too much disregarded, its share in the mere chemical process of combustion being too exclusively kept in view, that notions are entertained of its value, which are con- tradicted by lengthened and extended experience. This will be best understood, if we examine, in the first instance, into the circumstances under which other non- azotized substances taken in as food are made to contri- bute to the maintenance of heat. 114. Of such substances, a certain amount is usuallv circulating in the blood. All analyses indicate the ex- IN SUSTAINING THE VITAL POWERS. 12a istence of fatty mattei*s in that fluid : their proportion, however, varies considerably, being much greater after a full meal, of which oleaginous matters have formed a part. Although the amount is usually not too large to be held in solution l)y the alkali of the blood, yet the serum of blood, drawn within a few hours after such a meal, is usually found to be rendered opa(j[ue or milky, by the presence of an unusual quantity of oleaginous particles suspended in it, in a siate of very fine division. These, however, gradually diminish in amount; and, in a few hours more, the serum becomes clear again, indicating that these particles have been in some way disposed of. This, we can scarcely doubt, is the consequence of their having been "burned off" by the respiratory process, which is every hour carrying away at least one-third of an ounce of carbon from the blood. The evidence that the saccharine elements of the food are used up in the respiratory process with equal rapidity is not quite so distinct ; since these elements appear to be usually intro- duced into the blood in the condition of lactic acid,* the detection of which is attended with some uncertainty. But it has been sufficiently proved, that, when the sac- charine ingredients of the food are unusually abundant, they enter as such into the blood, where they may be detected shortly after a meal, especially if that meal have been preceded by a long fast. Like the superfluous fiitty matters, however, they soon disappear ; being carried oft", there can be little doubt, by the respiratory process. 115. In this manner, then, the heat-producing mate- rials are usually supplied to the system from meal to * Lactic acid, acid of milk. 124 SUPPOSED USES OF ALCOHOL meal ; the greater part of them being destined for ehmi- nation from the blood within a short time after their admission into it ; and the power of sustaining heat exist- ing in its greatest vigor, only whilst some of them remain unconsumed. This inference is confirmed by ordinary experience ; for every one knows how much more severely cold is felt after a fast of some hours' duration than after a full meal. We are accustomed to refer the difference to the condition of the stomach ; but the stomach may have been emptied by the completion of the digestive pro- cess long before the increased susceptibility to cold com- mences ; so that it would be more correct to refer this increase to the exhaustion of the supply of combustive material last introduced into the blood, than to the vacuity of the stomach. That an increase in the power of main- taining heat should be almost immediately produced after the ingestion of food into the stomach, is to be accounted for, not merely by that augmented activity and energy of the general circulation which accompanies the digestive process, but also by the rapidity with which nutrient matters find their way into the blood ; the turbidity of the serum, consequent upon the introduction of fatty sub- stances, having been observed as early as half an hour after the meal of which they have formed part.* 116. The admission of these matters into the current of the circulation cannot be discovered to produce any effect upon the system in general, otherwise than by sustaining the temperature of the body. In fact, they seem to be the legitimate pabulum for the combustive * See, for the oxperimonts on which several of the foregoing statements aro founded, the paper of Drs. Buchanan and II. I). Thomson in the Medical Gazette, Oct. 10, 1845. IN SUSTAINING THE VITAL POWERS. 125 process, just as albuminous matters constitute the pabu- lum for the formative processes whereby the tissues are generated. When they are present in excess, the superfluity is withdrawn by the production of adiix)se * tissue, which stores up the fatty mat+^^rs for future use. When, on the other hand, th j^.^ 's not c(iuivaleiit to the consumption required for the maintenance of the heat of the body, the fatty matters which are among the normal constituents of the blood are first drawn upon; and, as the proportion of these is diminished, it is supplied from the contents of the cells of adipose tissue. In this manner, the animial temperature is kept up nearly to its usual standard, even in spite of the total deprivation of food, so long as unconsumed fatty matter remains in the body ; but death then speedily takes place, in consequence of the coohng of the body, unless the temperature be sustained by external warmth. And death may result also from the subjection of the body to a very low temperature, whilst there is still much fatty matter left in the tissues ; as if this matter could not be re-introduced into the circulating current with sufficient rapidity to supply the demand for an extraordinary quantity of heat-producing pabulum. Further, when the store of fatty matter has been entirely exhausted, and the animal has nothing whatever to fall back upon, it is requisite that the supplies of new material intro- duced into the system should suffer no intermission ; for, immediately that they are exhausted, the temperature of the body begins to fall, and death speedily supervenes unless a fresh supply be aflforded.f * Adipose, fatty, t For the experiments on which the foregoing statements arc 11* 126 SUPPOSED USES or ALCOHOL 117. We are now prepared, then, to inquire into the question, how far alcohol may be advantageously em- ployed habitually as a heat-producing material ; and whether there are any peculiar or extraordinary circum- stances under which it is to be preferred to others. And, as one means of arriving at the truth on this point, we must examine more particularly into the influence of the introduction of alcohol into the blood, upon the respira- tory process. For our knowledge upon this point, we are chiefly indebted to the experiments of Br. Prout and to Vierordt. The former states,* that alcohol, and all liquors containing it, which he had tried, have the remarkable power of diminishing the quantity of car- bonic acid gas f in the expired air much more than any thing else which he had made the subject of experiment ; this effect being most decided when the liquor was taken upon an empty stomach. The latter | fully confirms Dr. Front's observations ; having found, that, in four experiments, tlie per centage of carbonic acid fell, after from half to a whole bottle of wine had been taken, from 4'54 to 401 ; and that this effect lasted between one and two hours. He fiirther found, that, when he drank wine with his diimer, the usual increase in the per centage of carbonic acid expired after a full meal did not take place. 118. These facts are of great importance. For, al- though it may be very possible, that, as suggested by founded, see the work of M. Cho8sat, entitled «• Rechcrches sur rinanition." * Annals of Philosophy, vols. ii. and iv. t Carbonic acid gas, composed of carbon united with oxygen. X Physiologic des Athmens, &c I I IN SUSTAINING THE VITAL POWERS. 127 Liebig, the increased formation of water, which Avill occur when alcohol is the combustivc material, compen- sates for the diminution in the amount of carbonic acid expired, and thus the normal amount of heat may be generated; yet there are clear indications, tliat, when thus present in the blood, with other materials which ought to be excreted, alcohol exerts an injurious influ- ence, by retarding their combustion. This it will do in two ways : first, by taking their place as the more readily combustible material ; and, secondly, in virtue of the antiseptic * influence which it exerts upon other sub- stances, preventing or retarding chemical changes in them. That such is the case appears from the experi- mei^.ts of Bouchardat ; who found, that, when alcohol is introduced into the system in excess, the blood in the arteries presents the aspect of venous blood, showing that it has been prevented from undergoing the proper oxygenating f process. J And the* experiments of Dr. Prout aflford additional support to this conclusion ; for he observed, that no sooner had the effects of the alcohol passed off || (which they did in his case with frequent yawnings, and a sensation as if he had just awoke from sleep), than the amount of carbonic acid exhaled rises * Antiseptic, preventing putrefaction. t Oxi/ffenatinff, supplying with oxygen, vit.alizing. J This result has been also noticed as a consequence of the inhalation of the vapors of ether and of chloroform, which are ^ied to alcohol in composition and properties ; and, in cases in wnlch the state of anaisthesia has been very profound, the tem- perature of the body has undergone a considerable depression. — AUTHOK. II Sailors can generally tell when the " grog is out of them." — Author. 128 SUPPOSED USES OF ALCOHOL 7nitch above the natural standard ; thus giving, it would seem, unequivocal evidence of the previous abnormal retention of carbonaceous matter in the system. 119. From the foregoing considerations, then, we may conclude, that the effects of alcohol, as a heat-producing material, will only be advantageously experienced, when the blood does not contain a supply of other matters waiting for removal by the respiratory pro^oss ; and this, we believe, will be found entirely conformable to expe- rience ; the greatest assistance being derived from it, when the body is exposed for a time to severe cold, after a long previous fast, and when, for the reasons already given, the heat-producing power is much less than usual, even although there should be no lack of material stored up in the body. Tliis is well illustrated by the follow- ing incident, which Dr. Macnish relates of himself: * " I was travelling on the top of the Caledonian Coach, during an intensely cold day, towards the end of Novem- ber, 1821. We left Inverness at five in the morning, when it was nearly pitch dark, and when the thermome- ter probably stood at 18° Fahr. I was disappointed of an inside seat, and was obliged to take one on the top, where there were nine outside passengers besides myself, mostly sportsmen returning from their campaigns in the moors. From being obliged to get up so early, and without having taken any refreshment, the cold was truly dreadful, and set fear-noughts, fur-caps, and ho- siery alike at defiance. So situated, and whn-ling along at the rate of nearly nine miles an hour, with a keen east wind blowing upon us from the snow-covered hills, I do * Anatomy of Drunkenness, p. 307. IN SUSTAINING THE VITAL POWERS. 120 not exaggerate when I say, that some of us, at least, oweil our lives to ardent spirits. The cold was so insuf- ferable, that, on arriving at the first stage, we were nearly frozen to death. Our feet were jterfectly be- numbed ; and our hands, fortified as they were with warm gloves, little better. Under such circumstjmces, we all instinctively called for spirits, antl took a glass each of raw whiskey and a little bread. The effect wiis perfectly magical : heat diffused itself over the system, and we continued comparatively warm and comfortable till our arrival at Aviemore Inn, Avhere we breakfasted. This practice was repeated several times during the journey, and always Avith the same good effect. When at any time the cold became excessive, we had recourse to our dram, Avhich insured us warmth and comfort for the next twelve or fourteen miles, without on any occa- sion producing the slightest feeling of intoxication. Nor had the spirits which we took any bad effects either upon the other passengers or myself. On the contrary, we were all, so far as I could learn, much the better for it ; nor can there be a doubt, that, without spirits or some other stimulating liquor, the consequences of sueh severe weather would have been highly prejudicijd to most of us." ' This last statement cannot be admitted without an im- portant reservation, sufficient to invalidate any inference drawn from this or similar cases as to the iiecessity for alcoholic liquors for the maintenance of the animal heat under exposure to severe cold. For it will be observed, that the party started on their journey after a fast of several hours, no food having been iaken that morning ; and there is every reason to believe, that, if Dr. Mac- nish and his companions had breakfasted heartily before 130 SUPPOSED USES OF ALCOHOL the commencement of their journey, they would not have found it necessary to have had such frequent recourse to the spirit-bottle ; easily digested solid food, es[)ecially such as includes oleaginous matter, taken in conjunction with hot liquids (especially coffee), being at least as efficacious, as a heat-producing material, as alcoholic liquors can be. In proof of this assertion, we shall noAv cite a series of facts which are, we conceive, quite ade- quate to demonstrate it. 120. In the first place, the author may relate his own experience of a journey performed on the outside of a stage-coach from Exeter to Bristol, on the 20th of Ja- nuary, 1838 ; a day memorable for the severity of its temperature, and for that remarkable prediction of the occurrence which gave a temporary celebrity to " Mur- phy's Almanac." The traveller, as in the preceding case, was " whirled along at the rate of nearly nine miles an hour" (which, in these days of railroad speed, must be accounted but a snail's : ace) ; and, though not ex- posed to " a keen east wind from the snow-covered hills," was subjected to a much lower atmospheric temperature, the thermometer having stood during the day at 8°, or twenty-four degrees below freezing point. Having forti- fied himself with a hearty breakfast, however, and having been in some measure previously inured to the cold by a severe frost of a fortnight's duration, he did not suffer from it to any extraordinary degree ; and, with the aid of a fresh supply of food at dinner, he arrived at his jour- ney's end without any greater degree of numbness of the extremities than a short exposure to the genial warmth of a good fire subsequently removed. No fermented liquor was taken by the writer on this journey ; and he cannot \ IN SUSTAINING THE VITAL POWERS. 131 )t have ursc to K3cially anction iast as coholic ill now te atle- lis own le of a of Ja- ' ' of its of the " Mur- eceding le miles 1, must not ex- hills," ^rature, ; 8°, or ig forti- having Id by a t suffer e aid of is jour- s of the rmth of d liquor J cannot tliink that he could have derived any other benefit from it than that, by accelerating the general circulation, it might have possibly kept up a more rnpid flow of blood through the surface and extremities. But this would have been a doubtful benefit, if, at the same time, the combustion of the materials supplied by the food had been retarded by the presence of alcohol in the blood. 121. The writer has heard many of the now almost extinct race of stage-coachmen — who had been induced to give up their former habit of imbibing a glass of ale or brandy-and-water at every stage, and to substitute an occasional cup of hot coffee and a rasher of toasted bacon — speak so decidedly in favor of the sui)erior efficacy of the latter system, that he doubts if any man who had the resolution to adopt it ever returned to his old habits, except from the love of liquor. 121. Experience on a much larger scale, and under a greater severity of cold, leads to the same conclusions. The Esquimaux, Greenlander, or Canadian relies upon his solid aliment, which contains a considerable amount of oleaginous matter, for his power of resisting cold ; and, when amply supplied with food, does not dread the ex- posure of his person to cold of the greatest severity. Thus, Captain Parry mentions with surprise that he saAV an Esquimaux female uncover her bosom, and give her child suck, in the open air, when its temperature was forty degrees be/oiv zero. And Sir J. Richardson, in a letter to the writer, states that "plenty of food and sound digestion are the best sources of heat ; " and that a ' ' Canadian, with seven or eight pounds of good beef or venison in his stomach, will resist the greatest degree of natural cold, in the open air, and thinly clad, if there be 1; 132 SUPPOSED USES OF ALCOHOL i i I i not a strong wind." The inhabitants of Arctic regions appear to have a natural relish for the very oleaginous food which nature has provided for them, in the wliales, seals, bears, and other animals upon which they chiefly subsist ; and this taste is acquired by Europeans when exposed to the same conditions. Thus, Dr. King, who accompanied Sir George Back in his overland expedi- tion in search of Sir John Ross, informed the author, that, whereas he had been previously accustomed to reject every particle of fat, owing to the dislike he felt for it, he found himself able, during his Arctic journey, to eat any amount of it with rehsh, and even experienced a positive craving for it ; and his experience led him to consider himself as far better fortified against the cold by the use of an oleaginous diet than by that of fermented liquors. Testimony to the same eflFcct is given by Dr. J. D. Hooker, who was one of the medical oflScers in the Antarctic expedition under the command of Sir James Ross. He says, in a letter to the author : " Several of the men on board our ship, and amongst them some of the best, never touched grog during one or more of the Antarctic cruises. They were iiot one whit the worse for their abstinence, but enjoyed the same perfect health that all the crew did throughout the four years' voyage. Many of our men laid in large stocks of coffee, and, when prac- ticable, had it made for them after the watch on deck. These men, I believe, would wiUingly have given up their spirits in exchange for coffee ; but we could not insure them the latter on the requisite occasions." 122. The foregoing statements appear sufiicicnt to prove, that a sufiicient supply of heat-producing food effects all that can be attributed to alcoholic liquors in IN SUSTAINING THE VITAL POWERS. 133 sustaining the heat of the body ; but we shall now go further, and endeavor to establish the position, that the use of alcoholic liquors is positively injurious when the exposure to cold is prolonged, and especially when mus- cular exertion is required. Thus, Dr. Hooker says, in the communication just cited: "I do think that the use of spirits in cold weather is generally prejudicial. I speak from my OAvn experience. It is very pleasant. The glass of grc -r warms the mouth, the throat, and the abdomen ; and tiiis, when one is wet and cold, with no fire, and just before turning into damp blankets, is very enticing. But it never did me one atom of good ; the extremities are not warmed by it ; and, when a continu- ance of exertion or endurance is called for, the spirit does harm, for then yon are colder or more fatigued a quarter or half an hour after it, than you ivould have been without it.'''' The testimony of othera who have been subjected to still more trying exposure is to the same eflFect. Thus Sir J. Richardson states, as the result of liis most scycre experience : " I am quite satis- fied that spirituous liquors, though they give a tem- porary stimulus, diminish the power of resisting cold. We found, on our northern journey, that tea was much more refreshing than wine or spirits, which we soon ceased to care for, while the craving for the tea increased. Liebig, I believe, considers that spirits are necessary to northern nations to diminish the waste of the solids of the body, and that tea is less useful ; but my experience leads me to a contrary conclusion." Dr. King's testi- mony was piecisely to the same effect. In fiict, it would appear that a very general concurrence exists on this point among all those qualified to form an unprejudiced 12 Illili. 134 SUPPOSED USES OF ALCOHOL judgment in regard to it ; since we find, that, in all the recent overland Arctic expeditions sent out by the Brit- ish government, it has been expressly provided that no fermented liquors shall be ased by the parties who pro- ceed upon them ; and that the Hudson's Bay Company have for many yearc C'^+irely excluded spirits from the fur-countries to the north, over which they have exclusive control, "to the great improvement," as Sir J. Richard- son states, " of the health and morals of their Canadian servants and of the Indian tribes." * 123. That puch are the teachings of sufficiently pro- longed experience, not merely in the frigid zone, but wherever the same conditions present themselves, will ap- pear from the two following statements. It is mentioned by Dr. Forbes, f as the result of his personal inquiries from the guides at Chamouni, that, when they are out upon their winter expeditions among the Alpine snows, they never find it advantageous to take any thing stronger ♦ To the above testimony, the author may add the following, "with -which Mr. Eaton has favored him : The Rev. Richard Knill, for many years a missionary at Petersburg, stated in a public meeting, in regard to the delusion which prompted people to use ardent spirits *• to keep out the cold," that the Russians had long since found out the injurious effects of taking them in very cold weather. When a regiment was about to march, orders were issued over night that no spiiits were to be taken on the foUoAving morning ; and, to ascertain as far as possible that the order had been complied with, it was the practice of their officials, answering to our corporals, carefully to smell the breath of every man when assembled in the morning before marching, and those who were found to have taken spirits were forthwith ordered out of the ranks, and prevented from marching on tliat day ; it having been found that such men were peculiarly subject to be '• frost-bitten," and otherwise injured. — Auriioii. t Physician's Holiday, p. 26, note. ' IN SUSTAINING THE VITAL POWERS. 135 than the weak wines of the country ; considering the use of spirits to be decidedly inimical to their power of sustaining exertion in an atmosphere of very low tem- perature. The writer had the opportunity, about a twelvemonth since, of conversing with a very intelligent man of above seventy years of age, residing at Wareham in Dorsetshire, who had spent more than fifty winters as a fowler, in which vocation he had been exposed to the utmost severity of the winter's cold ; since it can, of course, be most profitably pursued when the largest number of birds are driven southwards by the intensity of the frost in their northern residence. He stated that he had frequently been out for a fortnight at a time, without lying down, save in his little boat, and scarcely ever obtaining warmth from a fire during that period ; and, notwithstanding such severe trials, he was a re- markably hale and vigorous man for his years. Being himself the proprietor of a small public house, he cannot be supposed to have any prejudice against the use of fermented hquors, in which he indulges in moderation ; but his testimony to the writer was most explicit to the following effect : that, although the use of ale or brandy might seem beneficial in causing the cold to be less felt at first (so that, when out for no more than a day or two, he did not think it necessary to abstain from it), the case was quite reversed when the duration of the exposure was prolonged ; the cold being then more severely felt, the'larger was the proportion of fermented liquors taken. And he further stated, that all the fowlers of his ac- quaintance, who had been accustomed to employ brandy with any freedom, whilst out on prolonged expeditions, hiul died early ; he and his brother (who had practised 136 SUPPOSED USES OF ALCOHOL the same abstinence as himself) having outhved nearly all their contemporaries. 124. Hence it may be argued upon scientific princi- ples, that, whilst the use of alcohohc hquors may for a time aflford assistance in maintaining the heat of the body, so as the better to enable it to resist the influence of severe cold, they have no such advantage over olea- ginous matter, in affording a jmbuliim for the respiratory process, as sufficiently compensates for their injurious effect in preventing or retarding the oxygenation of those ingredients of venous blood which ought to be continually eliminated by the respiratory process. Consequently, looking at the chemical influence of alcohol merely, we might expect the prolonged employment of alcoholic liquors to induce such a vitiation of the blood as will impair its fitness for the manifold purposes which it is destined to answer. No such result will follow the in- gestion of heat-sustaining food ; since this waits its time for the combustive operation, without interfering with the oxygenation of other matters ; and, if not itself consumed, it is stored up within the body until the time of need. But again, although the stimulating effect of alcoholic liquors is less during the exposure to cold than it is under ordinary circumstances, yet it cannot be altogether prevented by the more rapid combustion which the alco- hol undergoes; and it might be anticipated, therefore, from what we know of the general action of stimulants, that the depression which follows upon their use would render the body peculiarly obnoxious to the influence of cold ; so that, although they may help to keep up the temperature of the body for a time, by imparting in- creased energy to the circulation, yet when that energy I IN SUSTAINING THE VITAL TOWERS. 137 is succeeded (as it must bo sooner or later) by the opposite condition, the cold will be felt with |];reater intensity. 125. The predictions thus based on physiological principles are found, as we have seen, to be in most perfect harmony with experience. For this teaches, in the first place, that, although alcoholic liquors may af- ford advantages equal or even superior, regarded simply as material for the combustive process, to those derivable from sohd food, those advantages are not of long dura- tion ; so that, for enabhng the body to resist the continued influence of severe cold, alcoholic liquors are far inferior in potency to sohd food. And, secondly, that, although the increase in the energy of the circulation, resulting from the stimulating effect of alcohohc liquors, may pre- vent the depressing influence of the cold from having its ordinary action upon the system, provided that it be exerted only whilst that effect lasts ; yet that, after it has subsided, the cold is felt Avith augmented severity, and its action upon the system is proportionately injurious.* * The author has proferrccl basing his conclusions upon infor- mation which he has obtained by his personal inquiries. He might easily have brought together a considerable amount of published tes- timony to the same effect. The following statements, contained in the work entitled " Bacchus," are in complete harmony with those which he has himself adduced : " In 1619, the cre-srof a Danish ship of sixty men, well supplied with provision and ardent spirit, attempted to pass the winter at Hudson's Bay ; but fifty-eight of them died before the spring : while in the case of an English crew of twenty-two men, in the same circumstances, but destitute of distilled spirit, only two died. In another instance of eight Eng- lishmen, also without spirituous liquors, who wintered in the same bay, the whole survived, and returned to England ; and four Rus- sians, left without ardent spirits or provisions in Spitzbergen, lived 12* 138 SUPPOSED USES OF ALCOHOL 126. The question .rhether there are any circum- stances under which the use of alcoholic liquors can be positively advantageous for the purpose of enabling the body to resist cold, will be considered in the succeeding chapter (^§ 182—187). IV. ENDURANCE OF HEAT. 126. Having thus concluded our inquiry how far the use of alcoholic hquors is necessary or desirable for arming the body against the depressing effects of cold, we shall consider their agency in supporting the system under the enervating influence of extreme heat. The belief in the existence of such an agency is scarcely less strongly or generally entertained than that of their pro- tective power against cold; but it must be manifestly due, if it exist, to some modus operandi different from for a period of six years, and were at length restored to their coun- try. In the winter of 1796, a vessel was wrecked on an island off the coast of Massachusetts ; there were seven persons on board ; it was night ; five of them resolved to quit the wreck, and seek shelter on shore. To prepare for the attempt, four of them drank freely of spirits ; the fifth would drink none. They all leaped into the water ; one was drowned before he reached the shore ; the other four came to land, and, in a deep snow and piercing cold, directed their course to a distant light. All that drank spirits failed, and stopped, and froze, one after another ; the man that drank none reached the house, and about two years ago was still alive." — (p. 374.) The evidence of Captain (now the llev. Dr.) Scoresby, who was for many years the captain of a whaling ship, is precisely to the same effect with that of the Arctic travellers whose testi- mony has been already cited. He gives it as his decided opinion, that spirits are injurious in cold climates ; and speaks of the re- action as especially pernicious, in diminishing the power of sus- taining cold, as well as that of muscular exertion. — Author. ' IN SUSTAINING THE VITAL POWERS. 139 that which renders them serviceable in the opposite con- dition. For it cannot be imagined, that they can be of any service by affording pabulum for the combustive process, Avhen that process is already generating more heat than the body, exposed to a high external tempera- ture, can possibly need. Nor can it be supposed, that the loss of the watery portion of the blood, by the per- spiratory process, can be in any degree I'cpaired by the ingestion of alcoholic liquids. It must be presumed, then, that whatever energy their use may communicate to the body must be derived from their stimulating properties, and must be subject to those disadvantages which are inseparable from the habitual employment of stimulants. Each of these points, however, requires a fuller examination. 127. It is well known to the physiologist, that the respiratory process in warm-blooded animals is much less energetic at high temperatures than at low ; the sys- tem having in itself the power of regulating the amount of matter which it shall burn off, in order that its heat may be kept up to the proper standard. Thus it was ascertained by the experiments of Letellier,* that the amount of carbonic acid set free by birds, when they are breathing in an atmosphere of from 86° to 106* Fahr. is scarcely more than one-third of that which they gene- rate in an atmosphere of 32° ; and, by similar experi- ments upon small mammalia,! it was ascertained that they only give off, between 86° and 106°, about half as much carbonic acid, and between 59° and 68° about * Comptes Rendus, torn. xx. p. 795 ; and Ann. de Chim. et de Phys., torn. xiii. p. 478. t Mammalia, animals which suckle their young ; the first class. .1 J ,!| 140 SUPPOSED USES OF ALCOHOL two-thirds as much, as they generate at 32*. The experiments of Vierordt * upon his own person lead to a similar conclusion in regard to man, although the difFer- ence is not so great. For he states that the average amount of carbonic acid exhaled by him p. v minute, between the temperatures of 24® and 47" Fahr., was 18 J cubic inches ; whilst the average between the temperatures of 66® and 92* was but 15| cubic inches. It is obvi- ous, then, that the demand for combustive material at high temperatures must be comparatively small ; and that the residents in hot countries cannot require the same supply of heat-producing aliment as is needed by the inhabitants of the frigid zone. We see this indicated in the quality of the non-azotized material which nature has provided for their use ; for, whilst the dwellers amid the Arctic and Anfcirctic Seas derive their chief suste- nance from those oleaginous articles which have the greatest heat-producing power, the vast population of the Equatorial region derives its principal support from those farinaceous f vegetable products whose non-azotized portion, belonging to the saccharine class, has the lowest calorific agency (§111). 128. It is very necessary, however, to bear in mind that the respiratory process is not one of simple calori- fication ; for it is one of the most important of all those excretory operations whereby the waste or eifete % matter of the system is eliminated from the blood. This, in fact, may be regarded as the essential part of the func- tion, which is common to all animals ; the combustion of * Op. cit. §§ 73—82. t Farinaceous, formed from grain, as meal or flour. X Effete, used up, refuse. IN SUSTAINING THE VITAL POWERS. 141 an additional amount of hydro-carlx>naceous matter, for the purpose of maintaining the temperature of the body at a fixed standard, being peculiar to the warm-blooded classes. It is evident, then, that from the diminution of the total quantity of carbonic acid exhaled at high temperatures, the excretory part of the respiratory func- tion will be more liable, than at low or moderate tempera- tures, to interference from any agency wliich still further checks the oxygenation of the combustible matter of the blood. 129. Now, as we have found, that, under exposure to severo cold, the stimulating effects of alcoholic hquors (especially when taken at intervals, in small quantities at a time) are but little felt, the alcohol being burned oflF before it can accumulate so as to exert any considerable influence on the nervous system; so might we expect, that, under the influence of external heat, when the com- bustive process is greatly reduced in activity, the stimu- lant effects of alcohol should be more rapidly produced and more powerfully exerted. And further, if the views formerly stated be correct as to the efiects of the absorp- tion of alcohol into the blood, in preventing the elimi- nation of matters which ought to be carried off by the respiratory process, we should expect that the use of alcoholic liquors in warm climates would exert this obstructive influence in a peculiar degree. Both these anticipations are confirmed by ample experience, which thus bears testimony to the soundness of our principles. 'For it is well known that a far smaller quantity of alco- holic liquor suffices to produce intoxication beneath a burning sun than in a frosty atmosphere ; so that indi- viduals who are not aware of this fact sometimes become 142 SUPPOSED USES OF ALCOHOL intoxicattHl, without having exceeded the allowance which they beheved to bo perfectly compatible with sobriety. Again, it has been continually observed, that, when alco- holic liquors are taken during the performance of severe labor in an extremely high temperature, their temporary stimulation is followed by a very rapid and decided fail- ure both of nervous and muscular power ; so that men who drink largely of such liquors in the intervals of their work are obliged to abstain from them whilst their labor is in progress. This result appears fairly attributable to vitiation of the circulating blood, consequent upon the retention of matters destined for excretion ; the removal of which, by the oxygenating process, has been obstructed by the presence of alcohol. And the same inference appears legitimately deducible from the peculiar tenden- cy (already referred to, §*§» 54, 55), which the habitual use of alcoholic liquors in warm climates has to engender diseases of the liver ; the duty of separating those hydro- carbonaceous * products of the waste of the system, which are poisonous if retained in the blood, being unduly thrown upon the liver, when their elimination by the lungs is interfered with. 130. That the use of alcohol is especially necessary to support the system under its excessive loss by perspira- tion at high temperatures, is an idea so commonly held, that it demands a serious refutation ; although the fallacy of the notion, that, because ivater is drawn off from the blood through the pores of the skin, alcohol must be taken into the stomach to replace it, would appear self- evident. The fundamental error seems to lie in the notiOi-, that copious perspiration in itself really weakens * Ifj/dro-carbonaceous, composed of hydrogen and carbon. IN SUSTAINING THE VITAL POWEUS. 143 tho system; whilst it is, in fact, notliing else than the means by which the external warmth is prevented from raising tho heat of tho body above its normal standard. Tho determination of the blood to tho skin, wliich that heat excites, appears to cause an unusual transudation * of the watery part of the blood through the thin- walled capillaries f of the sweat-glands ; just as certain diuretic J medicines increase tho quantity of water in the urine, by causing an increased determination of blood to the kid- neys ; but, with this large amount of watery fluid, very little solid matter passes off", — none, in fact, but what is purely excrementitious. 131. That perspiration, however abundant, has in itself no weakening eflfect, — except by diminishing the quantity of water in the blood (which is readily supplied by absorption from the stomach), — appears from the fact, that, if persons exposed to a very high temperature make no bodily exertion, they do not experience any loss of vigor, if copiously supplied with cold water. In fact, such exposure may be made to conduce vt-ry decidedly to the invigoration of the system. All travellers who have tried the Russian baths speak of the feelings of renova- tion wliich the copious perspiration, and the subsequent plunge into cold water, produce in the wearied frame. And those who have given a fair trial to the hydropathic || treatment, in appropriate cases, are unanimous in the same testimony. The writer has himself been in a stove- room, in which delicate females were accustomed to * Transudation, passing out by sweat. t Capillaries, very minute vessels. X Diuretics, substances which increase the ui-ine. II Hydropathy, water-practice. J!- 1 %i\ 144 SUPPOSED USES OF ALCOHOL remain for half an hour or more, when it was heated to a temperature of from 140° to 170° Fahr. ; their wrap- pings becoming saturated by copious perspiration, the material for which was supplied by the water administered to them internally from time to time ; and he has had ample assurance to the effect, that this process, when fol- lowed by the cold plunge, had usually an invigorating influence, which quite sets aside the idea that the act of perepiration is in itself exhausting, or that it removes from the system any thing which it can be requisite for alcohol to supply. 132. The peculiar fatigue which usually results from muscular exertion at a high temperature is generally set down as the consequence of the excessive perspiration ; although the fact is, that the fatigue is chiefly to be attri- buted to the interference with the vaporous or "insensi- ble " transpiration, which is produced by the accumulation of liquid or " sensible " perspiration on the surface of the skin, and by the saturation of the garments in contact with it. For the same fatigue is experienced when the atmosphere is loaded with dampness, even at a low tem- perature ; and it has been the uniform result of the attempt to use any muscular effort, when the body has been clothed in water-proof garments made after the fashion of ordinary clothes, so as not only to keep out the rain, but to keep in the insensible perspiration. In either case the effect is the same, — the due vaporization of fluid at the surface of the skin is checked ; the cooling influence of the perspiration is not exerted ; and the heat of the body itself is injuriously augmented.* And as * Thus it was found by MM. Delaroche and Berger, that, -when animals were exposed to the temperature of 120% their bodies IN SUSTAININQ THE VITAL POWERS. 145 an augmentation of from 11* to 13* in the temperature of a warm-blooded animal produces an invariably /a/a/ result, so can it bo readily understood that an increase of 2* or 3* nmst be attended with injurious consequences,, so long as it lasts. 133. Among these consequences, we may probably rank a still further diminution in the quantity of carbonic acid exhaled from the lungs ; as well as an obstruction to the cutaneous respiration,* which, although its propor- tional amount has not yet been satisfactorily ascertained, is certainly of no mean importance in the depuration f of the blood. Hence, an accumulation of excremcntitious matters will take place in the circulating fluid, such as affords quite a sufficient explanation of the peculiar fatigue which is experienced when muscular exertion is called for in a heated atmosphere already charged with moisture. And we should expect, that such exertion could be per- formed with much less feeling of exhaustion in an atmo- sphere of dry air, though of very high temperature, — such as that of glass-houses, gas-works, or foundries, — than in the less heated atmosphere of tropical coun- tries, which usually contains a considerable amount of watery vapor. This is undoubtedly the fact ; and, as a being enveloped in close boxes, whilst tlieir heads were free, a thermometer placed in the mouth showed an increase of 6" in the heat of the body, in the com-se of seventeen minutes ; this eleva- tion being obviously due to the obstruction to the transpiration from the surface of the body. When, by continued exposure to a heated atmosphere saturated with moisture, the temperature of the body was raised from 11" to 13° above the natural standard, the animals uniformly died. — Authok. * Cutaneous respiration^ perspiration, t Depuration, purifying. 13 1 X > hi 1 1 i'i li 146 SUPPOSED USES OF ALCOHOL far larger amount of liquid will be carried off by insensi- ble transpiration * in the former case than in the latter, it proves the correctness of our position, that it is not the loss of liquid from the skin which is the cause of the peculiar exhaustion that results from muscular exertion in a heated atmosphere ; f and that we are to look for the source of that exhaustion in the elevation of the tem- perature of the body itself, which will be produced with peculiar facihty in a damp and heated atmosphere ; and in the accumulation of excrementitious matters in the blood, which will be especially hkely to take place when their elimination % through the lungs is being checked, at the same time that an increased amount is being gene- rated by the waste of the muscular tissues. 134. If, then, our fundamental positions have been just, and our argument correct, we should infer, that, putting aside their peculiar influence upon the ner\'0U8 system, the use of alcoholic liquors during muscular exertion in a heated atmosphere, and especially when that atmosphere is charged with moisture, can be nothing else than injurious; as tending to interfere still more with that elimination of excrementitious || matters from the blood which is peculiarly required when a continual production of such matters is taking place through the disintegration of the nervous and muscular tissues conse- quent upon their functional activity, and wliich is already * Insensible transpiration, continued imperceptible sweat. f "We are of conrse supposing, throughout, that water is freely supplied in both cases. The exhaustion produced by the undue diminution of the fluids of the body, indicated by excessive thii'St. is of qtiite a different character. — Authou. X Elimitiation, separation, escape. 1} Excrcmcntitiotis, refuse. IN SUSTAINING THE VITAL POWERS. 147 retarded by the diminution in the activity of respiration. We shall presently find that experience is here also in accordance with theory ; the result of many trials having shown that severe and long-continued exertion in tropical climates can be better sustained without alcoholic liquors than ivith their habitual use. 135. The stimulative effects, from which alcoholic liquors derive their reputation as supportera of bodily vigor, during habitual exposure to a heated atmosphere, are exerted in two ways : in the first place, by giv- ing temporary assistance to the digestive process ; and, secondly, by increasing, for a time, the nervous and mus- cular power. It is commonly supposed, that the diminu- tion of appetite which is experienced by most pei-sons who change their residence from a temperate country to a hot one is the result of the enervating influence of the climate ; whereas the fact is evident to those who take into account the proportionally smaller amount of car- bonic acid exhaled as the external temperature rises, that the diminished appetite chiefly results from diminution in the demand for combustive material; and that it ought, therefore, to be taken as an indication of the pro- priety of lessening the amount of food ingested, rather than of forcing the stomach to augmented activity for the purpose of disposing of the superfluity which it has taken in. All medical authorities on the diseases of tropical climates are in accord upon this point, — that, next to the injury derived from the abuse of fermented liquoi*s, excess in diet is one of the most fertile of those sources of disease which arise out of the personal habits of the individual ; and such excess is in great degree due to the use of alcoholic stimulants as an artificial provocative 148 SUPPOSED USES OF ALCOHOL I li I to the appetite, whereby the blood becomes charged with more ahmentary material than it can rightly dispose of; so that the diminution in the activity of the respiratory process throws the elimination of this superfluity upon the liver, which organ consequently becomes pecuharly liable to functional disorder. 136. We have continual opportunities of noticing the same sequence of phenomena in our own country, though in a less marked degree. A (hminution in the appetite is experienced by most persons during the heat of summer ; and, if the Avarning be not lost, the amount of food ingested is proportioned to the demand. But those who from habit continue to take in their usual supply are extremely liable to be warned of the impropriety of such a course by hepatic derangement ; and the bihous diarrhoea which is so common in the latter part of summer, and which is connected in the popular mind with the " plum season " (although it frequently affects persons who have alto- gether abstained from fruit), seems to find a rational explanation in the accumulation of excrementitious mat- ter, which must be the consequence of habitual excess in diet, especially when the stomach is stimulated by alco- holic hquors to digest more than could be appropriated without such artificial aid. 137. There is no reason whatever to believe, that (with the exception of the difference in regard to amount, which has been already remarked upon, § 129) the stimulating influence of alcoholic liquors upon the ner- vous system, whereby it is enabled to put forth increased power so long as this influence lasts, is exerted in any other mode, when the body is habitually exposed to a high temperature, than that in which it operates under IN SUSTAINING THE VITAL POWERS. 149 ordinary circumstances. That the excitement must Ije followed by subsequent depression is as true in India as in England ; and that this excitement, if habitually had recourse to, will be followed in hot climates hj conse- quences even more injurious than in cold or temperate regions, might be inferred from all that has been already stated in regard to its peculiar unsuitableness when the activity of the respiratory process is diminished. 138. We shall now proceed to inquire, therefore, how far the experience, both of individuals and of large bodies of men, supports the idea that abstinence from alcoholic stimulants, or at most the very sparing use of them, is fa- vorable to the endurance of extreme heat, especially when great bodily exertion is required. And we shall first cite the evidence of the late Mr. Gardner,* a well-educated surgeon, who spent several years of most active exertion in the exploration of the botany of Brazil, into which country he penetrated further than any scientific Euro- pean had previously done. During thiee years' travelhng in that climate, he tells us,f under constant fatigue and exposure to \dcissitudes of weather and irregularity of living, his only beverage, besides water, was tea, of wbioh he had laid in a large stock previously to his departure from Pernambuco. He was told when he arrived at Bra- zil, that he would find it necessary to mix either wine or * The author has been informed by an intimate friend of this gentleman, that his lamented death, •which took place from a coup de soldi, X whilst holding the appointment of Superintendent of the Botanic Garden at Ceylon, was entirely due to the injudicious and almost foolhardy exposure to which his confidence in his vigor led him to subject himself. — Autiiok. t Travels in Brazil, p. 402. X Coup de soleil, stroke of the sun. 150 SUPPOSED USES OF ALCOHOL r M li I ■ t 1 , r. ■ J 1; '•I 'it brandy with the water which he drank ; but a very short experience convinced him, not only that they are unneces- sary, but that they are decidedly hurtful to those whose occupations lead them much into the sun. " Whoever drinks stimulating liquors," he says, " ai^d travels day after day in the sun, will cei-tainly suffer from headache ; and, in countries where miasmata prevail, he will be far more likely to be attacked by the diseases which are there endemic." 139. Equally explicit testimony is borne by Sir James Brooke, the enterprising and skilful colonizer of Borneo ; who speaks in his "Journal" of habitual abstinence from alcoholic liquors as decidedly conducive to the maintenance of health, and of the power of sustained exertion, in the equatorial regions in which he had es- tablished himself So, again, Mr. Waterton, the well- known traveller, speaks of himself as confident that the preservation of his vigor, during many years of toil and •exposure in tropical climates, is mainly due to his total abstinence from fermented liquors. And the writer has been assured by Dr. Daniell, who was for a long time stationed as medical officer in the equatorial portions of Western Africa, that he found the use of the ordinary alcoholic liquors decidedly inimical to the power of exer- .tion ; the strongest beverage which could be habitually made use of without injury being the "palm- wine" of those countries, which is very little, if at all, more alco- holic than our ginger-beer. The following testimony, given by Dr. Mosely in his work on Tropical Diseases, ■maybe added to the foregoing: "I have ever found," he says, "from my own knowledge and custom, a^ well as from the custom and observation of others, that those IN SUSTAINING THE VITAL POWERS. 151 exer- ?j of who drink nothing but water, or make it their principal drink, are but little affected by the chmate, and can undergo the greatest fatigue without inconvenience." Many other individual testimonies might be cited to the same effect ; but, as these are open to the objection of being influenced by pecuharities of individual constitu- tion, it will be preferable to have recourse to cases in wliich large bodies of men are included. 140. The following statement, which the writer has received from an oflScer in the regiment to which it refers, proves that our English soldiers in India not only do not suffer from, but are absolutely benefited by, abstinence from alcoholic liquors during a continuance of unusually severe exertion: " In the early part of the year 1847, the 84th regiment marched by wings from Madras to Secunderabad, a distance of between four and five hun- dred miles. They were forty-seven days on the road; and, during this period, the men were, practically speaking, teetotalers. Previously to leaving Madras, subscriptions were made among the men, and a coffee-establishment was organized. Every morning, when the tents were struck, a pint of hot coffee and a biscuit were ready for each man, instead of the daily morning dram which sol- diers on the march in India almost invariably take. Half-way on the day's march, the regiment halted, and another pint of coffee was ready for any man who wished it. The regimental canteen was opened only at ten and twelve o'clock for a short time, but the men did not frequent it ; and the daily consumption of arrack for our wing was only two gallons and a few drams per diem, instead of twenty-seven gallons, which was the daily government-allowance. The conmianding ofiicer em- H 152 SUPPOSED USES OF ALCOHOL i y ■ i ployed the most judicious precautions to prevent the men from obtaining arrack in the villages on the route ; and his exertions were eflFectively seconded by the zeal- ous co-operation of the other officers, and by the admira- ble conduct of the majority of the men, who were fully persuaded of the noxious influence of ardent spirits during exercise in the sun. The results of tliis water-system were -shortly these : Although the road is proverbial fov cholt ?'.) and dysentery, and passes through several un- healthy and marshy districts, the men were free from Juiciness to an extent absolutely unprecedented in our maiv^^- ill India; they had no cholera and no fever; and ohi V two men were lost by dysentery, both of whom were old chronic cases taken out of hodpital at Madras. With these exceptions, there was scarcely a serious case of sickness during the whole march. The officers were surprised, that the men marched infinitely better, with less fatigue and with fewer stragglers, than they had ever before known ; and it was noticed by every one, that the men were unusually cheerful and contented. During the whole march, the regiment had not a single prisoner for drunkenness." A considerable proportion of the men (the writer has learned from his informant) abstained entirely from arrack : and the consumption of those who occasionally took it v-as tar below their usual allowance. Those who entire >j abstained were certainly in no respect inferior, either in power of sustaining exertion or in freedom from sickness, to those who occa- casionally took small quantities of spirits : on the con- trary, they rather seemed to have the advantiige. That this remarkable result was not dae to any peculiar liealthfulness of the season, or other modifying circum- IN SUSTAINING THE VITAL POWERS. 153 stance, is shown by the fact, that the 63d regiment, which performed the same march ^ at the very same time, though in the opposite direction, lost several nier out of a strength f f four hundred ; and that it had so maiiy sick, that, when it met the 84th on its mnrch, it was obliged to borrow the spare " dhoolies " (or palanquins for the sick) belonging to the latter.* 141. The foregoing account fully accords with that given by Sir James (then Mr.) M'Grigor, of the march in Egypt of a division of the British army sent from Hindustan to aid the main army in opposing the French under Bonaparte. After the Great Desert had been crossed, in July, 1801, no spirits were issued to the troops in Upper Egypt, owing to a diificulty in procuring carriage for them. At this time there was much fa- tigue-duty to be performed, which, for want of followers, was done by the soldiers themselves ; the other duties were severe upon them ; they were frequently exercised, and were much in the sun ; the heat was excessive, the thermometer standing at 113* or 114° Fahr. in the sol- diers' tents, in the middle of the day ; bxit at no time xvas the Indian army more healthy, \ * The marked contrast between the rate of morteility in the 63d and 84th regiments, during their respective residences at Secunderabad during two consecutive years, has been already noticed (§§ 81, 82) ; but it may be as well hfere to remind the reader, that the former lost seventy-three men in nine months, which was at the rate of 78*8 per 1,000 of average strength for the entire yea** ; whilst the latter lost but thirty-nine men in the whole twelve months, being at the rate of 34'2 of average strength. — Author. t Medical Sketches of the Expedition from India to Egypt, page 86, ii i.i I'll '<. lii .■I • s . . Ii 154 SUPPOSED USES OF ALCOHOL I'M: lii;} ti# \m I'M' 11 142. The intimate acciuaintance of Sir Charles Na- pier with the habits and wants of the Indian soldier can be doubted by no one ; and the following is his testimony in favor of the abstinence system (delivered in his own characteristic manner), as contained in his address to the 96th regiment, when he reviewed it at Calcutta, on the 11th of May, 1849: "Let me give you a bit of advice : that is, don't drink. I know young men do not think much about advice from old men. They put their tongue in their cheek, and think that they know a good deal better than the old cove that is giving them advice. But let me tell you, that you are come to a country where, if you drink, you're dead men. If you be sober and steady, you'll get on well; but, if you drink, you're done for. You will be either invalided or die. I knew two regiments in this country ; one drank, the other didn't drink. The one that didn't drink is one of the finest regiments, and has got on as well as any regiment in existence. The one that did drink has been all but destroyed. For any regiment for which I have a respect (and there is not one of the British regiments that I don't respect), I should always try and persuade them to keep from drinking. I know there are some men who will drink in spite of the devil and their officers ; but such men will soon be in hospital ; and very few that go in, in this country, ever come out again." 143. Whatever temporary advantage, then, is derived, or supposed to be derived, from the stimulating powers of alcoholic liquors, when they are used witli a view of sustaining the power of exertion in tropical climates, is dearly purchased by the increased liability to disease, which not only theoretically^ but, according to all compe- IN SUSTAINING THE VITAL POWERS. 155 tent evidence, actually results from their habitual use. And thus theory and practice are again completely agreed in affording a decisive contradiction to the usually received idea, that alcoholic liquors assist the body in the endurance of heat. V. RESISTANCE TO MORBIFIC AGENCIES. 144. It is a common idea, and one apparently sup- ported by adequate evidence, that such a use of fermented liquors as aids in keeping the body in "high condition" renders it less susceptible of the influence of pestilential miasmata,* of cold and damp, or of other morbific agen- cies ; and this belief is entertained by many who deprecate the habitual use of fermented liquors under other circum- stances. Thus, says Dr. Macnish, "I am persuaded that while, in the tropics, stimulating liquors are highly prejudicial, and often occasion, while they never prevent, disease, they are frequently of great service in accomplish- ing the latter object in damp, foggy countries ; especially when fatigue, poor diet, agues, dysenteries, and other diseases of debility, arc to be contended against." — "In countries subject to intermittents, it is very well known, that those who indulge moderately in spirits are much less subject to these diseases than the strictly absti- nent." t These assertions he endeavors to justify by the two following statements : "At Walcheren, it was re- marked that those officers and soldiers who took schnaps, alias brandy drams, in the morning, and smoked, escaped the fever which was so destructive to the British troops ; * Miasmata, seeds of disease. t Anatomy of Drunkenness, pp. 277, 279. !'.i f\ t] I] 156 SUPPOSED USES OF ALCOHOL and the natives generally insisted upon doing so before going out in the moniir<^." * ;\.gain, " A British regi- ment quartered on the Niagara frontier of Upper Canada, in the year 1813, was prevented by some accident from receiving the usual supply of spirits ; and, in a very short time, more than two-thirds of the men were on the sick-list from ague and dysentery ; while the very next year, on the same ground, and in almost every respect under the same circumstances, except that the men had their usual allowance of spirits, the sickness was ex- tremely trifling. Every person acquainted with the circumstances believed that the diminution of the sick, during the latter period, was attributable to the men having received the quantity of spirits to which they had been habituated." f 145. Now, it is obvious that neither of these facts proves that exposure to the morbific agencies in question renders an allowance of spirits necessary, or even bene- ficial, for those who have not been accustomed to make use of it under ordinary circumstances. On the con- trary, the second instance is a valuable testimony to the disadvantage of habitual dependence upon alc^I^clic sti- mulants ; inasmuch as it is evident, that, when they were withheld from the troops, the constitution of the men was rendered peculiarly susceptible to the causes of dis- ease indigenous $ to their locality. All that it proves is, that an unduly depressed state of the system is favorable to attacks of ague and dysentery (of wliich every medical practitioner is aware) ; and that, in persons who have * Glasgow Medical Journal, No. xv. t Op. cit. X Indigenous, belonging to the place. IN SUSTAINING TUE VITAL POWERS. 157 habituated themselves to the use of spirits, such depres- sion is hal)le to supervene when the allowance is with- held, and may be for a time kept off by its restoration. And even the first exaniplc cannot be said to prove more than this ; for it simply gives us the experience of indi- viduals who took an early dose of spirits, as conippr* '^' with that of the individuals who abstained from 'big liabit; without telling us that tlie latter ado])ted ;i! of those substitutes which prudential experience W(m,. , dictate. 146. The writer is strongly impressed with the belief, that the result, in this and in many similar cases, is to be attributed to the neglect of such precautions. It is well known, that, in losalities where zymotic * poisons are indigenous, no condition of the healthy system is so obnoxious to their influence as that which is natural to it on first rising in the morninor, when the stomach is empty, the pulse comparatively feeble, and the heat- producing power nearly at its minimum. The nutritive actions which have been talvin!^; ])l:ieo daring!; i-Mv.se have ox Ox. prepared the nervous and muscular apparatus for renewed activity ; but this has been accomplished at the expense of the blood, from which there has been a continual drain, both for the regeneration of the tissues, and for the maintenance of the animal heat. It is within the expe- rience of most persons that nervous and muscular exertion is loss efficiently sustained,! and external cold less fully u * Zymotic, produced by fermentation. t The -writer can speak feelingly on this subject, being himself unable to walk a couple of miles upon the empty stomach of early morning, without extreme languor almost amounting to syncope, although four or five times that amount would usually be per- 14 .^''^. IMAGE EVALUATION TEST TARGET (MT-3) ^ ,<*\^ 1.0 I.I l^|18 |2.5 lis IS o i:£ liJIlM im 11.25 ill 1.4 III 1.6 V] r 7. em f c "^ o' y^ Photographic Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 .> A^* 158 SUPPOSED USES OF ALCOHOL resisted, at this period than at any other ; and the re- commendation of experience to " take something to keep the cold out of the stomach-" is here fully justified upon physiological principles. But it does not hence follow, that alcoholic stimulants constitute the best means of protecting the system against the influence of morbific agencies : on the contrary, we shall find strong reason to believe that other means, properly employed, would be as efficacious at the time, and would have a more perma- nently beneficial effect. 147. A man, previously in the enjoyment of vigorous health, and not accustomed to depend upon alcoholic stimulants, will derive all the protection he can require from taking his first solid meal before he exposes himself to the cold, damp, or pestilential miasmata whose influ- ence is to be resisted ; and the moderate use of hot tea. coffee, or cocoa will help to diffuse a genial warmth through his body, which is more enduring than that which results from the ingestion of spirituous liquors. In this way, the stomach will bo wholesomely employed, new material will be supplied to the blood, the circulation will be quickened without being excited, the firmness of the pulse will be increased, and the heat-producing power will be augmented ; and all this in a manner strictly accordant with the normal economy of the bodily system. On the other hand, although the use of spirits, by pro- ducing a temporary excitement of the circulation, will probably render the system less obnoxious to morbific agencies than if it be exposed to them before ita dormant energies have been in any way aroused, yet we can formed by him after breakfast with scarcely an approach to fatigue. — Author. IN SUSTAINING TUE VITAL POWERS. lo9 the re- : to keep ied upon e follow, leans of morbific eason to lid be as perma- vigorous dcoholic I require himself 30 influ- hot tea. warmth that liquors. iployed, culation oness of g power strictly system. by pro- on, will morbific lormant we can > fatigue. scarcely anticipate that they can be as favorable to the sustenance of its energy (a previously healthy and vigor- ous condition being supposed) as persistence in the regu- lar habits to wliich it has been accustomed. For it has been already shown, that the continued endurance of cold is not favored by the use of alcoholic hquors, but on the contrary is impaired by it ; and where cold, therefore, acts concurrently with zymotic poisons, and favors their operation by the depression of the vital powers which it induces, we should feel certain that those means would be most conducive to the resisting power of the system which are most eflScient in maintaining its standard warmth. 148. So far as we are acquainted with the bearings of experience on this question, they are decidedly favorable to the view here advocated ; namely, that, where a healthy state of the system has been previously maintained with- out the assistance of alcoholic liquors, the operation of morbific agents will be more efficiently warded off by a continuance of the abstinent plan than by recourse to stimulants ; provided that the same precaution be exer- cised by the disciple of abstinence as by the spirit-drinker, in not exposing himself to the morning air without a for- tification of " the inner man." For we do not see that the circumstances of tropical or those of cold or temperate chmates differ as regards the susceptibility of the system to zymotic poisons, in any other particular than their .temperature ; but this will act in more than one way ; for whilst, on the one hand, the depressing influence of cold upon the body will tend to increase its susceptibility, the agency of heat, on the other, will augment the potency of the poison. Now, that abstinence from spirits dimin- ishes, instead of increasing, the hability of the body to U 160 SUPPOSED USES OF ALCOUOL the influence of pestilential miasms in warm climates, provided that other precautions be duly taken, we have not merely the individual experience of Mr. Gardner, Mr. Waterton, and others {§§ 138, 139), in addition to the testimony of many medical observers, but the important evidence derived from the march of the 84th regiment along a road "proverbial for cholera and dysentery," without a single fresh attack of these complaints (§ 140). Here the " pint of hot coffee and biscuit " were cei-tainly to the full as efficacious as " the daily morning dram, which soldiers on the march in India almost invariably take ; " and there is no adequate reason why the coflFee should not have an equal value in colder countries, when employed with the larger allowance of heat-producing food which will be there required, 149. When the remote effects of the two systems are contrasted, there can be little hesitation in assigning the preference to the abstinent plan. For, the object being to sustain the utmost equability of health, and especially to avoid that depressed condition which sooner or later supervenes upon states of undue excitement, it is obvious that, when all the nutritive functions are regularly and vigorously discharged, it is unwise to interfere with their performance by the use of alcoholic hquors, which, if sufficient to produce either general stimulat* or excite- ment of any one function, must involve as i. nsequence a corresponding diminution of the normal activity at some subsequent period. It is quite true that tliis may not manifest itself at once ; so that for weeks, months, and years, the vigor of the system may seem to be efficiently maintained, and morbific agencies to be perfectly kept at bay, by the habitual use of a small quantity of alcoWic IN SUSTAINING THE VITAL POWERS. IGl stimulus ; to which the beneficial result will then be pro- bably attributed. But the trial is not completed in weeks, months, or years ; it must last for the w^hole of life ; and if it be true, as we shall presently endeavor to show, that the continued employment, however moderate, of small quan- tities of alcoholic liquors favors, if it does not necessarily induce, an early exhaustion of the vital powers, it cannot be questioned that the system will then be left in a state of peculiar susceptibility to the influence of zymotic poi- sons and other morbific agencies. It is well known that persons of regular habits and good ordinary health, who have long resided in countries where intermittent fevei*s prevail, are frequently attacked by them when their vital powers begin to dechne with advancing years ; and, if that dechne be hastened by the previous over-excitement of alcohohc liquors, the influence of these morbific causes will be earlier and more powerfully e> erted. 150. These theoretical deductions are not merely sanctioned by such results of experience as can be brought to bear directly upon them ; for they are in complete harmony with the fiicts universally admitted regard to the peculiar susceptibility of habitually m intemperate persons, and especially of those whose con- stitutions have been broken down by the combined influence of intemperance and advancing years, to attacks of fever, cholera, and other pestilential disorders {'^ 65). For, we again repeat, if the cause, when acting with its greatest potency, is attended with a result which no one can hesitate in accepting, it is but reasonable to attribute *to the same cause, acting with diminished intensity, but over a longer period of time, a result of a similar nature ; even though this may be so long postponed, that its I If 162 SUPPOSED rSES OF ALCOHOL dependence on that cause is in danger of being over- looked. 151. We have abundant evidence, then, not merely in the experience of individuals, but in that of large bodies of men, that the most vigorous health may be maintained, under circumstances usually regarded as most trying to the power of bodily and mental endu- rance, without the assistance of alcoholic stimulants. Such evidence is afforded by the numerous ships that are travelling every part of the wide ocean, whose crews, pledged to the total-abstinence principle, maintain a degree of health and vigor which cannot bo surpassed ; by the many workshops of every kind, in which the severest labof is endured with a constancy at least equal to that of the drinkers of alcoholic beverages ; by troops executing toilsome marches in the sultry heat of the torrid zone, and through the pestilential atmosphere of tropical marshes, who find the "cup of cold water" more refreshing and sustaining than the spirituous drinks which hurry so many of their comrades to an early grave ; and by numbers of men and women, in every rank of life, in every variety of condition, and subjected to every kind of mental and bodily exertion, who luivc given the principle of total abstinence a fair trial, and have lx)me their willing testimony to its beneficial results. And, where such is the case, there can scarcely be a question that this system is preferable to the habitual use, how- ever moderate, of fermented liquors. For, if the appetite prompt to the use of an adequate amount of nourishment to repair the waste of the system ; if the stomach perform its action with due energy, and supply to the absorbent IN SUSTAINING THE VITAL POWERS. 163 vessels the material for fresh blood in a state of clue preparation; if the circulation be carried on with that equable regularity which is most favorable to the actions to which it is subservient ; if the various tissues draw from the current of nutritious fluid the materials which they severally require, and apply these materials to their own maintenance and regeneration ; if the lungs freely exhale the carbonic acid which is evolved by their exer- cise, and introduce the oxygen which is needed for a renewal of the effort ; and if the liver, kidneys, and skin, by the constant discharge of their respective offices, eli- minate from the blood the other products of the waste of the system, and thus keep it in the state of purity most favorable to the discharge of its multitudinous functions ; in a word, if all the actions concerned in the maintenance of the fabric be already discharged with that vigor and uniformity which constitutes health, — why should we attempt to alter them by means of agents, which, if they produce any efiect whatever on the system, can only operate by producing a departure from that perfect bal- ance of the several parts of the nutritive functions which it is so desirable to maintain, and so difficult to restore when perverted? Let us examine these questions in more detail. VI. CONSEQUENCES OF THE HABITUAL "MODERATE ■ USE OF ALCOHOLIC LIQUORS. 152. Effect vpon the General System and Excretory Organs, — If the natural appetite be already good enough to give a rehsh to the food which the system requires, can the artificial production of an increased 164 SUPPOSED USES OF ALCOHOL appetite be necessary or desirable ? And, if the stomach be abeady capable of digesting and preparing as much nutriment as is required to keep up the solids of the blood to their proper amount, can any but prejudicial conse- quences result from forcing it to dispose of more 7 Two classes of evils may be expected to proceed from such a system : in the first place, the habitual introduction of more alimentary material into the circulating current than the nutritive functions can appropriate, must pre- dispose to disorder of the system in general ; and, secondly, by constant reliance upon an artificial stimu- lus, the natural powers of the stomach itself must be in danger of becoming gi-adually impaired. 153. The efiect upon the system at large of an habi- tual introduction of more alimentary material than the nutritive functions can appropriate seems to vary with the temperament. In some individuals, they are converted into blood, so that the normal amount of that liquid undergoes an augmentation ; thereby inducing a state of plethora,* which is favorable to local congestions and inflammatory diseases of various organs, and which espe- cially predisposes to hemorrhage, — this being an efibrt of nature to relieve the undue turgescence. But, in other constitutions, the superfluous aliment would seem to be never so far vitalized and assimilated, but is from the first destined to excretion; the lungs, the liver, the kidney, and the skin are thus called upon to remove, not merely the products of the normal waste or disintegration of the system, but also the superfluous non-assimilated matter ; and hence they are brought into a state of undue func- tional activity, which cannot but render them peculiarly * Plethora, repletion, too great fulness. IN SUSTAINING THE VITAL POWERS. 165 susceptible of derangement. The excretory action of the lungs, however, is chiefly regulated (as already shown, »§> 127) by the temperature ; so that, when it is dimin- ished by external warmth, more remains to be accom- plished by the other depurating organs; and hence any excess in diet is more likely to have a prejudicial eflfect upon the latter in warm climates, and during the summer, than in a colder atmosphere. 154. This is precisely what experience teaches. From habitual excess in diet, in temperate climates, in persons not of the sanguineous temperament, disorders both of the liver and kidney are very apt to arise ; those being most liable to the former who have not the power of generating fatty tissue at the expense of the surplus of non-azotized food ; and those being most liable to the latter, in whom the too free use of alcoholic liquors occa- sions an undue determination of blood to the kidneys. On the other hand, habitual excess of food in warm climates usually manifests itself first in disorders of the liver ; since the diminished excretion of carbon by the lungs causes the blood to proceed to the liver more highly charged with that element, whilst at the same time the consumption of that part of the biliary secretion which should be normally oxygenated and carried off through the lungs is interfered with. On the other hand, the skin, whose functions are greatly increased in activity, comes to the assistance of the kidneys in disposing of the superfluity of azotized ahment ; a considerable amount of urea * being daily excreted through the former channel, f * Urea, the substance of urine. t See the experiments of Dr. Landerer, of Athens, in Brit, and For. Med.-Chir. Review, vol. i. p. 341. 1i li 166 SUPPOSED USES OF ALCOHOL This result of what is accounted the " moderate " use of alcohohc liquors in warm climates, for the purpose of in- creasing the appetite and stimulating the digestive powers of the stomach, is much dwelt upon by writers ou tropical diseases ; who represent it as, in the long-run, not less hurtful than that excess which produces effects more immediately and obviously pernicious. In this point of view, it ranks with high-seasoned dishes, and those other seducing provocatives to the diminished appetite and lessened digestive powers of the residents in such cli- mates, wliich, by occasioning the habitual ingestion of more food than the system requires, are among the most fertile sources of tropical disease. 155. Now, as already remarked, almost every cause of disease acts on the human system with greater potency in tropical than in temperate regions ; and we have op- portunities, therefore, in the study of tropical diseases, of perceiving the agency of causes whose tardiness of operation under other circumstances interferes with our recognition of their real results. It cannot, then, be imagined that even a small habitual excess in diet, induced by the stimulating action of fermented liquors, can be without its remote consequences upon the general sys- tem, even though it may be for a time sufficiently com- pensated by increased activity of the excreting organs.* And the disorders of the liver and kidneys, which are so frequent among those who have been accustomed to this mode of living for many years, without (as they believe) any injurious consequences, are as surely to be set down to it as are those congestive and inflammatory diseases * Ejocreting orgam, those which separate the refuse matter. IN SUSTAINING THE VITAL POWERS. 167 of the abdominnl viscera which so much more speedily follow upon habitual excess in warm climates. For the excreting organs cannot be always kept in a condition of excessive activity ; like other parts of the system, they suffer sooner or later from too great an exaltation of their function ; and if this should not pass, as it often docs, into an inflammatory condition, it is almost cerluin to be remotely followed by a state of depressed activity, in which the nutrition of the organ becomes impaired, so that it is left, during the remainder of life, in a state by no means equal to the performance of its regular duties. 156.' In asserting that to the ordinary use of fermented liquors in " moderate " quantity, during early and middle life, and to the habitual excess in diet (however slight) to which they prompt, we are to attribute many of the chronic disorders of the excreting organs which are amongst the most common ailments of advancing years, we may seem to go beyond the positive teachings of ex- perience. The consequences are so remote, that wc may not appear to be justified in attributing them to the causes we have assigned. But let it be remembered, that we have multitudes of other cases, in which the long- continujed agency of morbific causes of comparatively low intensity has been proved to be in the end not less potent than the administration of a poison in a dose large enough to produce its obviously and immediately injurious effects. Thus a man who would be rapidly suffocated by immer- sion in an atmosphere of carbonic acid may hve for weeks, months, or years, in an atmosphere shghtly con- taminated by it, without experiencing any evil effects which he can distinctly connect with its influence ; and, 168 SUPPOSED USES OF ALCOHOL yet who will now deny that the constant action of this minute dose of aerial poison is insidiously undei*mining his vital powers, and preparing him to become the easy prey of the destroying pestilence? So, again, we see that a brief exposure to the pestilential atmosphere of the swamps of the Guinea coast is often sufficient to induce an attack of the most rapidly fatal forms of tropical fever ; but the dweller among the marshy lands of temperate climates, inhaling the paludal * poison in its less concen- trated form, becomes after a time afflicted Avith inter- mittent fever; and no one has any hesitation in here recognizing the connection of cause and effect. On the other hand, the resident in a town where the insufficiency of the drainage causes the surface-moisture to be imper- fectly carried off, and to be not merely charged with the malaria of vegetable decomposition, but with the mias- matic emanations of animal putrescence, may long be free from serious disorder, if the cause do not operate in sufficient intensity ; yet he becomes liable in a greatly increased degree to the operation of .olmost every mor- bific agent, and especially of the various forms of fever- poison ; and no one who has paid even a slight degree of attention to the results of the sanitary inquiries which have now been carried on for many years past hesitates in admitting the relation of cause and effect between insufficiency of drainage and the higher rate of mortality in undraincd localities, although not only days and weeks, but months and years, may be required for the operation of the cause upon the animal system. 157. Should we not, then, be running counter to all * Paludal, mai'shy. / i IN SUSTAINING THE VITAL POWERS. 1G9 analogy, if wo do not hold ourselves ready to admit, that such an habitual excess in diet as is favored by the moderate use of alcohoho stimulants, and a consefi[uent habitual over-exertion of the excretory organs, must bo likely to have remotely injurious results 7 — and are we not justified in assuming a relation of cause and effect to exist, when we find such results occurring precisely as we should predict 1 If the medical man has no hesitation in regarding those severer derangements of the excretory organs which are so common amongst those who commit habitual excesses in eating and drinking as the conse- quence of those excesses, why should he refrain from attributing the milder but more protracted disorders of the same organs to the less violent but more enduring operation of the same cause? "The little I take does me no harm "is the common defence of those who are indisposed to abandon an agreeable habit, and who cannot plead a positive benefit derived from it ; but, before such a statement can be justified, the individual who makes it ought to be endowed with the gift of prophecy, and to be able to have present to his mind the whole future history of his bodily fabric, and to show that, by reducing the amount of his excess to a measure which produces no immediately injurious results, he has not merely post- poned its evil consequences to a remote period, but has kept himself free from them altogether. The onus pro- bandi* lies with those who assume the absence of a connection which is indicated by every fact with which we are acquainted. 158. Although we have hitherto been considering the • Onus probandi, burden of proof. 15 170 SUPPOSED USES OF ALCOHOL effects of the "moderate" use of alcoholic stimulants upon the excretory organs, as consisting simply in aug- menting the amount of labor they are called upon to perform, by favoring the reception of too large an amount of alimentary matter into the system, yet there is another point of view iinder which it will be convenient here to examine its results ; namely, the direct influence of the alcoholic stimulus upon the organs themselves. This in- fluence may for a time be corrective of the other, and may thus aid in concealing and retarding its evil consequences. For we have seen (§ 57) that the introduction of a small quantity of alcohol into the circulation has a direct action > upon the kidney, increasing the determination of blood to that organ, and tending to augment its secretion ; and it is highly probable that it has a similar effect upon the liver, more especially as the blood which has received the alcohol by the absorbent action of the gastric veins * passes through that organ before proceeding to any other part of the system. In this manner, the call for increased action of these two depurating! organs being met by augmented functional activity on their part, a system of compensation is maintained, whereby the effects of excess are neutralized for a time, — but only for a time ; for, as surely as any organ is habitually exerted in an ex- cessive degree, so surely must its vital powers be prema- turely exhausted, the remoteness of the period at which the flagging of its power begins to manifest itself being inversely to the degree of habitual over-excitement. Hence we have additional reason for imputing a con- siderable proportion of those chronic disorders of the * Gastric veins, veins of the stomach, t Depurating, separating refuse matter. IN SUSTAINING THE VITAL POWERS. 171 ' i excretory organs, to wliich reference has been more especially made, to the habitual employment of alcoholic liquors in what is ordinarily considered to be a " moder- ate " amount, and regarded as perfectly consistent with health, if not rec^uircd to maintain it. 159. It would be absurd, however, to affirm that such diseases always proceed from this cause ; since those who practise total abstinence from alcoholic hquors arc by no means proof against other errors in dietetics ; and, in so far as they habitually take in more food than their sys- tem needs, they will be liable to suffer from disorder of the organs whose duty it is to eliminate the waste. But they will be much sooner warned of the excess they ha\re committed, if the stomach refuses to digest the superfluity, instead of being forced by artificial stimula- tion to an undue exertion of its power ; and an attack of indigestion, by early giving a salutary check to the prac- tice, may ward off its remoter consequences. It is the freedom from such checks, up to a certain time of life, which encourages in those who habitually use fermented liquors in "moderation," and who at the same time practise habitual though slight excess in the amount of sohd food which they consume, the delusive behef that in neither case are they doing themselves any harm. 160. Effect upon the Stomach. — Such, then, are the consequences to the system at largo, which theory and experience join to indicate, as resulting from such an habitual use of alcoholic liquors as stimulates the appe- tite to desire, and the stomach to digest, a larger amount of food than is necessary to supply the wants of the body ; and we have next to inquire into the effects it pro- duces upon the stomach itself. We have already described 172 SUPPOSED USES OP ALCOHOL the admitted results of what is commonly regarded as *' excess; " and we shall therefore at present limit our- selves to the inquiry, whether the "moderate" use of alcoholic liquors is likely to be productive of any injurious consequences, as regards this important organ. All our knowledge of the action of stimulants would lead to the conclusion, that, when once the habit of employing them has been established, and the stomach is come to rely (as it were) upon the extraneous aid which they afford, its power of performing its duty without such aid must be impaired. The case is very similar to that of sleep. A person in health, and not subjected to any unfavorable influences, is naturally disposed to pass as much time in repose as his system needs for its renovation ; but, if he were long to accustom himself to the use of a narcotic, he would find himself completely unable to sleep without it. And experience shows, in like manner, that those who have long been habituated to the moderate use of alcoholic beverages with their meals are seldom able to discontinue them without a temporary loss of appetite and of digestive power, unless, indeed, their place be supplied by the more wholesome excitement of fresh air and exercise. 161. With many persons, the evil, so far as the stomach is concerned, may seem to be confined to the induction of this state of reliance on artificial aid. Year after year passes away, without any indication that its powers have been overtasked, or that any unhealthy change has taken place in its circulation or nutrition; and the usual dose of the alcoholic stimulant appears still to produce its wonted effect. But this does not show that the practice is really innocuous. We have seen Ihat, IN SUSTAINING THE VITAL POWERS. 173 whilst a potent dose of a poison speedily manifests its action by the violence of its effects, the repeated intro- duction of minute doses is not really inoperative, although the effects are not speedily apparent. If the stomach be not an exception to the general law of the action of sti- mulants upon the animal body, we should expect that, by the habitual over-excitement of its function, in however trifling a degree, its vital energy will undergo a prema- ture depression ; and that the result of the moderate use of alcohohc stimulants will manifest itself, sooner or later, in diminution of the digestive power. The earhest indi- cation of this, in most instances, is the demand for the augmentation of the stimulus to produce the same result ; the amount which was at first sufficient to whet the appe- tite, and increase the digestive power, being no longer found adequate. If the demand be yielded to, and the quantity of the stimulus be augmented, the original bene- fit seems for a time to be derived from it ; but, after the stomach has become tolerant of the liquor, that which at first excited it to increased functional activity does so no longer, and a further increase is called for ; until what began in "moderation" ends in positive excess, with all its consequent evils. But, supposing this demand not to be felt, or not to be yielded to, the same "moderate" allowance being indulged in for a long course of years, we should anticipate that injurious consequences, though perhaps long postponed, must ultimately show themselves; and that such is the case is unfortunately the experience of a vast number who suffer by that "loss of tone" of the stomach which is so common an attendant of advancing years, for the too great activity to which the organ has been previously forced, during the long period of early 16* 174 SUPPOSED USES OF ALCOHOL and middle life. And although the common idea, that alcoholic liquors, when taken in small quantities, have a ionic * property, may render it difficult for some to coin- cide in the conclusion that the real effect of the habitual use of even this small quantity must be of the opposite kind, — exhaustive instead of tonic, — yet, as this idea has no other foundation than the temporary assistance derived from the stimulating powers of alcohol, it ought not to prevent our recognition of the consequences which might be theoretically expected to proceed from its long- continued action. 162. It is not here maintained, however, that the habitual employment of alcoholic stimulants in small quantity, even when coupled with habitual excess in the amount of food ingested, uniformly stands, to the loss of appetite and digestive power so frequent with the advance of years, in the relation of cause and effect ; for there can be no doubt that the habit may be persevered in by some individuals throughout a long life, without the mani- festation of any injurious results; whilst, on the other hand, it cannot but be admitted that the disorder in ques- tion may be induced in other ways. But the existence of exceptional cases by no means invalidates the argu- ment based upon general experience, any more than our occasionally meeting with individuals who have daily con- sumed a bottle of spirits, and have yet enjoyed a hearty old age, warrants us in rejecting the evidence which indi- cates that such a consumption wottWr have, in by far the larger proportion of mankind, a decided tendency to shorten life. Nor does it follow, that, because the loss * Tonic, strengthening. IN SUSTAINING THE VITAL POWERS. 175 of digestive power may be justly attributed to other causes when this one has been wanting, it has been inope- rative when present. In fact, there can be little doubt, that, amongst the class of men who are engaged in active mental occupation, and who justify a moderate use of alcohohc liquors on the ground that it keeps them "up to their work," the expenditure of nervous power, conse- quent upon that undue exertion of the cerebral functions which has been aided 1>;'^ the continual over-stimulation, has a large share in the result. 163. Effect upon the Nervous System. — Every medical man is familiar with cases in which the "wear and tear" of an over-active life has been sustained with little apparent loss of power for perhaps a long series of years ; but in which there is a sudden failure both of mental and bodily vigor, as manifested in deficiency of power of continued mental exertion, depression of spirits, want of appetite, enfeebled digestion, and the whole train of disordered actions which is consequent upon this con- dition. It is not to be denied that such a state mav arise quite independently of the agency, direct or indirect, of ha- bitual stimulation; one instance, in particular, is strongly present to the writer's recollection, in which it supervened on a long course of excessive mental exertion, in an indi- vidual who was most moderate in every thing but the labor of his brain, and who rarely or never sought for artificial support from alcoholic stimulants. But the most common case is that in which two sets of causes are in action together. An habitual system of over-exertion of the nervous system may be maintained for a longer time by many persons, with the assistance of alcoholic stimu- lants, than without them ; and thus the delusion -is kept I mm 176 SUPPOSED USES OF ALCOHOL up, that the strength is not reallj overtasked : when the fact is, on the contrary, that the prolongation of the term of over-exertion, by the repeated application of the sti- mulus, is really expending more and more of the powers of the nervous system, and preparing for a more com- plete prostration at a later period. 164. The temporary advantage, then, which is thus gained is very dearly purchased. The man who ha- bitually abstains, not merely from alcoholic liquors, but from other artificial provocatives (misnamed supports) to the endurance of mental activity, is early warned by the failure of his intellectual energy and cheerful tone of spirits, that he is overtasking his brain ; whilst his stomach tells the same tale in another way, — the failure of power to digest that which the fabric really needs for its regeneration, being indicative of an exhaustion of nervous energy. A short period of rest and change, in such a condition, is usually sufficient for the renovation of the system, and for the recovery of the mental and bodily vigor. But the case is very different when the effort has been sustained, for a lengthened series of years, by means of the delusive support afforded by alcoholic liquors; for, as the excessive expenditure of nervous power has been greater, so is the exhaustion more com- plete ; and, as the stomach has been longer over-excited and overtasked, its tone is the more seriously injured, not merely by the depression consequent upon its own overwork, but by the impairment of the nervous power which is required for its due activity. Thus, then, although the consequences of habitual over-exertion of the brain may be less speedily felt when the stomach is kept up by alcoholic stimulants to a state of extraordinary IN SUSTAINING THE VITAL POWERS. 177 activity of supply ; and although, in like manner, the habitual use of alcoholic stimulants may cause the sto- mach to be less susceptible of the loss of the accustomed energy, — yet, when the crisis does come, each condition aggravates the other; the effects of undue disintegration of the nervous matter being more difficult to repair, when the nutritive apparatus is depressed in functional power ; and the restoration of the tone of the stomach being impeded by the deficiency of nervous energy, when this has been lowered by excessive action of the brain. The length of time then required for the cure is proportional to the duration of the causes which have induced the malady ; and tedious and difficult is the process of restoration, as every medical man well knows. We shall hereafter have occasion {§§ 227, 228) to consider the best methods of medical and hygienic * treatment for this condition, and shall show that the measures which experience now proves to be the most efficacious means of restoring the vigor of the system are precisely such as the physio- logist would recommend, under the guidance of the preceding views of the causation of the morbid state in question. 165. We have thus been led to consider the remote influences of the prolonged and habitual use of fermented liquors, in however " moderate" a quantity, upon the digestive apparatus, the excretory organs, and the ner- vous system ; and we have found that we may, with the highest probability, if not with absolute certainty, attri- bute many of the chronic disorders which affect these organs in advancing life — especially that loss of func- Ilygienic, health-producing. 178 SUPPOSED rSES OF ALCOHOL tional power which is frequently the earliest stage of such disorders, and which, if appropriately treated in the first instance, might not proceed further — to the excessive action to which they have been subjected, under the stimulating influence of alcoholic beverages. In so far, therefore, as the use of these beverages causes or favors such excessive action, it must in the end be hurt- ful, rather than beneficial, to the general health, — not- withstanding that its temporary efiect may appear to be wholesome and exhilarating, — or at any rate, if negative for good, to be also negative for evil. But we have further to consider, whether this inference is borne out by the effects of alcoholic liquoi-s, taken habitually in small quantities, upon the functions of circulation and nutrition. 166. Effect upon the Circulation. — It may be diffi- cult to prove, that the ingestion of a small quantity of alcoholic liquor, taken in conjunction with food, has any decidedly stimulating influence upon the general circula- tion; since a certain acceleration of the pulse, and an increase in its fulness, normally occur during digestion ; and the augmentation produced by the alcohol may be so trifling as to be scarcely detectible. Such augmentation, however, is certainly produced by the imbibition of a quantity usually accounted "moderate;" and we have now to inquire, whether it can recur habitually, through a long series of years, without producing injurious re- sults. There cannot be a doubt, that, in a healthy person, the rate of the circulation is proportioned to the amount of functional activity of the principal organs of the body. We find that it depends, in great degree, upon muscular exertion, as put forth in the maintenance IN SUSTAINING THE VITAL POWERS. 179 of the erect posture, and still more in active exercise ; but it may be accelerated also by exalted activity of the nervous system, which sets up an unusual demand for blood in the brain ; and its increase of rate, during the digestive process, appears to be connected with the large supply of blood then transmitted to the chylopoietic viscera,* and required for the due performance of their several offices. Now, whenever the circulation under- goes any considerable acceleration, there is a tendency to a recurrence of local congestions, arising from the want of power, on the part of the vessels of some particular organ, to allow their current to pass at the same rate with the rest. Of this we have a familiar example in that accumulation of blood in the pulmonary arteries which is liable to take place in most persoiis during violent muscular exertion, producing the feeling of being " out of breath," and which is particularly marked in those in whom there exists some disordered condition of the lungs that obstructs the passage of blood through their capillaries. 167. There are few persons, however, in whom there is not some tendency to an irregularity of the circula- tion, which manifests itself in a torpor in some parts, and an undue activity in others. One of the most com- mon forms of this, especially among individuals who work their brains more than their muscles, is a torpor of the current in the extremities, and an undue activity in the cephalic circulation ; so that the head is habitually heated, whilst the hands and feet are cold. Now, where such is the case, we find that even the normal accelera- * Chylopoietic viscera, organs which form chyle. 180 SUPPOSED USES OF ALCOHOL tion produced by the ingestion of food aggravates this disordered condition; so that the face becomes more flushed, and the head more hot, after meals, than at any other time.* Precisely the same result is observable in such persons, after the use of even a small quantity of alcohoUc stimulant ; and the habitual production of it can- not but be injurious, as tending to establish that inequality which it should be our endeavor to counteract. 168. Similar inequalities exist in di£ferent individuals, in regard to other organs. Thus it very frequently happens, that the liver is the part in wliich a disposition to torpidity of circulation exists ; and congestion of its portal system of vessels must stagnate the whole of the circulation through the chylopoietio viscera, from which the blood of that system is derived. Any such disposi- tion to local congestion must operate with increased force in producing general irregularity of the circulation, when the rate of movement is unduly accelerated ; just as the outlets to a theatre, which suffice to discharge the entire audience in a few minutes, when the pressure towards them is uniform and regular, are speedily blocked up, and produce a stagnation of the entire current ; whilst, under the influence of an alarm of fire, every one is rushing toward them with undue haste. And, as we have seen that hepatic and abdominal congestions are among the ordinary results of excess in the use of alco- holic liquors ('J 155), it cannot be doubted that even * The acceleration produced by muscular exercise 'will, of course, be unattended by this result ; the cause of the acceleration being such as to divert the current from the brain to the limbs, and to make it pass through them with energy and rapidity. — AUTHOB. IN SUSTAINING THE VITAL I'OWEIIS. 181 their moderate employment must aggravate any tendency to such derangement of the circulation, when it already exists. No such derangement can be habitual, and bo thus continually liable to aggravation, without laying a foundation for other more serious disorders. So, again, as we have seen that habitual excess in alcoholic liquors has a tendency to produce determination of blood towards the kidneys, and thereby to favor the development of many serious diseases in those organs (*§»•§> 54 — 58), we can scarcely refuse to admit, that, where the least ten- dency to disordered action already exists in them, it must be aggravated by the habitual recurrence of such a slight increase in the afflux of blood to them as would of itself attract no attention. 169. If it be said, that, in thus reasoning upon proba- bihties, we are going further than experience warrants us in doing, we must again take leave to refer to the argument from analogy on which we have already dwelt (^ 156), as a justification of our somewhat theoretical propositions. The whole tendency of modem pathologi- cal research has been to show, that the human frame, if endowed with an ordinary amount of inherent vigor, is no otherwise incident to disease than as it is in various ways subjected to the agency of causes which produce a departure from the normal play of its functions ; and that, although old age and decay are inevitable, diseases are not, being preventible in the precise proportion in which we are able to discover and eradicate their causes. And when we can clearly trace a relation of cause and eflFect between obvious and flagrant violations of the rules of health and the occurrence of certain forms of acute disease, we seem justified in assuming, that minor but 16 182 SUPPOSED USES OF ALCOHOL habitual violations of the same kind must be allowed to participate, at any rate, in the production of chronic diseases of the same order. The very nature of chronic dibcaso implies a prolonged action of the causes in which it arises ; for no such determinate alteration of the nor- mal functions as it involves can be at all accounted for by any temporary causes of perversion ; these either inducing a transitory disorder, or, if acting with suflS- cient intensity, exciting an attack of acute disease. In chronic diseases, we find that the organ has, so to speak, groivn to its perverted action ; so that no curative measure is permanently beneficial which does not first act by withdrawing the cause of the original departure from the healthy state, and by placing the organ in the best condition for its recovery. We are fully justified, therefore, by all that we know of the causes of disease, in asserting that the habitual use of alcoholic hquors by healthy individuals, even in small quantities, is likely, when sufficiently protracted, to favor the development of such chronic disorders as originally depend upon an irregularity in the movement of the circulating current, or are liable to be augmented by it. 170. Effect upon Nutrition. — There appears, more- over, to be an adequate amount of evidence, that the practice in question has an unfavorable influence upon the nutritive operations, by which the alimentary ma- terials first converted into blood are applied to the rfcgeneration of the living tissues. This influence is not so clearly manifested in the ordinary course of these operations — which indeed is not demonstrably affected by it — as in the extraordinary demand which is made upon the regenerative powers for the repair of injuries IN SUSTAINING THE VITAL POWEKS. 183 occasioned by accident or disease. It in well known to surgeons, that the most desirable of all nio (53), it can scarcely be denied, that, where a minor departure from the normal condition shows itself, and the same cause has been in action in less intensity, that departure may be reasonably consid- ered, in part at least, as its eftect. And this conclusion is remarkably confirmed by the surgical cxijcrience of the late campaigns in India, on occasions on which there had been, from accidental causes, an interruption in the usual supply of spirits. Thus, ^Er. llavelock^ in his " Narrative," in reference to the wounded, after the vic- tories in India, observes : " The medical officers of this army have distinctly attributed to their previous ab- stinence from strong drink the rapid recovery of the wounded at Ghuznee." And Mr. Atkinson, in his work on Affghanistan, is more explicit, stating that ''all the 16» 180 SUPPOSED USES OF ALCOHOL. ETC. \i n ti swortl-cuts, which were very numerous, and many of them very deep, united in the most satisfactory manner ; which we decidedly attributed to the men having been without rum for the previous six weeks. In consequence, there was no inflammatory action to produce fever, and interrupt the adhesion of the parts." 173. From the foregoing considerations, then, we seem entitled to draw the general conclusion, that, in the " average man," the habitual use of alcoholic liquors, in moderate or even in small quantities, is not merely unnecessary for the maintenance of bodily and mental vigor, but is even unfavorable to the permanent enjoy- ment of health, even though it may for a time appear to contribute to it. For, as it is justly remarked by Dr. Robertson, " that man only is in good health who recovers rapidly from the simple accidents incidental to his occu- pation, and from the simple disorders incidental to his humanity and to the climate he lives in, and who can bear the treatment that those accidents or those disorders demand ; " and, if such be not the case, we may feel confident, that, however great the temporary power of exertion may be, such power is destined to give way at a period much earlier than that of its normal duration. And if it be true, as we have endeavored to show, that the effect of the habit is not merely to induce certain predispositions to disease by its own agency, but also to favor almost any of those which may already exist in a latent form, we have an additional right to aflSrm, that even the most moderate habitual use of alcoholic liquors becomes to the "average man" positively injurious, if protracted for a sufiicient length of time to allow of the development of its effects. 187 CHAPTER III. ARE THERE ANY SPECIAL MODIFICATIONS OF IHE BODILY OR MENTAL CONDITION OF MAN, SHORT OF ACTUAL DISEASE, IN WHICH THE OCCASIONAL OR HABITUAL USE OF ALCOHOLIC LIQUORS MAY BE NECESSARY OR BENEFICIAL? 174. There appear to be three classes of cases in which recourse may be had with temporary advantage to the use of alcoholic liquors : those, in the first place, in which there is a demand for some extraordinary exer- tion of the animal powers, and in which the occurrence of subsequent depression may not be an adequate objec- tion to the employment of a stimulus that enables the system to meet it ; those, in the second place, in which there is a deficiency of the proper sustenance, and in which alcohol serves as a heat-producing article of food ; and those, in the third place, in which there is a want of sufiicient vigor on the part of the system itself to digest and assimilate the aliment which it really needs for its support. I. DEMAND FOR EXTRAORDINARY EXERTION. 175. Of the first class, the following appropriate example may be extracted from the letter of Dr. J. D. Hooker, alreailv cited : "I know of only (mo occasion," wtmmmmmmfmk 188 USE OF ALCOHOL i I he says, " on which the use of spirits appeared indispen- sable ; and that was when a httle more exertion at the crowning of a mighty and long-continued effort was demanded. Thus the ship, when saihng in the paek- ice, is sometimes beset, or falls to leeward into the lee-ice. This takes two or three minutes — but, if there is much wind, it takes many hours — to get her out. Not being in command, the sails are of no use ; and the ice prevents her from moving in any way but with it to leeward. Under these circumstances, the only way to get her out is by fastening ropes from the ship to the larger masses of ice, and Avarping her out by main force against the wind. Now, I have seen every officer and man in the ship straining at the capstan for hours together, through snow and sleet, with the perspiration running down our faces and bodies like water. Towards the end of such a struggle, at the mighty crowning effort, I have seen a little grog work wonders. I could not have drunk hot coffee without stopping to cool ; nor, if I had, do I think it would have supplied the temporary amount of strength which was called for on the spot under cir- cumstances hke this. These, however, are extreme cases, which do not affect the sailor in his ordinary condition, and which any ship might be well prepared for." 176. It must be within the experience of most persons, that a very small quantity of alcoholic stimulus has been of similar efficacy in sustaining the nervo-muscular energy under some temporary effort, wliich circumstances called for, and to which the system, exhausted by previous fatigue, would not otherwise have been equal. And the writer can speak from his own knowledge of its corre- sponding effect in quickening and freshening the mental IN EXCEPTIONAL CASES. 189 pspen- It the was pack- the there T out. dthe it to way to the force and ether, power, during a brief period, through which it could not otherwise have been sustained. Of course, in every such case, a corresponding depression is subsequently felt; but this depression is rather traceable to the fatigue of over-exertion than to the re-action consequent upon over- excitement. For, in the cases alluded to, the eflfect of the alcoholic liquor is not to quicken the circulation, or to exalt any of the functions above their normal activity, but merely to keep them up to par ; and its use for such a purpose is therefore free from many of the objections which have been urged against its habitual employ- ment. 177. But it must not hence be supposed, that recourse to alcoholic liquors can habitually be had with impunity for purposes of this kind. Every kind of ' ' forcing ' ' must be in the end injurious to the vital powers, and more espe- cially to those of the nervous system; and the more frequently and violently it is practised, the more speedily may we expect that functional derangement will manifest itself Extreme overtasking of its poAvers is often so immediately followed by apoplexy, paralysis, epilepsy, mental derangement, or fatuity, that no one has any hesitation in regarding these as the natural results of the previous immoderate exertion ; and we appear equally justified in attributing similar results to similar causes, however remote the results may be, where causes less potent have been in continual or frequently repeated operation. For every such irregularity tends to derange the nutrition of the system; and, if a renewal of the irregularity should take place before the effects of the preceding derangement have been recovered from, they are, of course, aggravated ; and thus a cumulative 11 •MMMMana 190 USE OF ALCOHOL result is produced, and a permanently disordered state of nutrition established, which manifests itself at last in some serious and settled form of cerebral disease. 178. The case resembles that of the racer, excited to put forth his utmost speed, or the jaded roadster goaded to a temporary improvement of his pace by the applica- tion of the spur. The spur gives no strength ; but, like the dram to the sailor toiling at the capstan, or the glass of wine to the public speaker wearied with his previous exertions, it calls forth the most vigorous exercise of the remaining strength. The racer may fall dead on the spot ; the roadster may sink from exhaustion ; but the spur has only been the indirect means of bringing about this catastrophe, the real cause of it being the undue exertion which it has called forth. And in like manner, when recourse has been had to alcoholic liquors for the maintenance of the power to meet some extraor- dinary demand upon the bodily or mental energy, and the amount used has been merely such as to meet that demand, we ought to attribute the subsequent exhaus- tion rather to the violence of the effort which has been put forth, than to the stimulus, trifling in itself, by which the system was rendered capable of making it. The occasional dram or glass of wine would of itself have produced but little mischief in comparison ; and its con- sequences might have been manifested in some other way . But the frequent over-exertion of the vital powers, especially those of the nervous system, must ultimately tell upon the fabric, under whatever kind of excitement it is called forth. 179. However desirable, then, it may be to avoid the necessity for such immoderate exertion, it can scarcely IN EXCEPTIONAL CASES. 191 ite in ' be denied, that occasions will arise in the experience of some persons, in which the temporary assistance derived from alcohohc liquors could scarcely be replaced by any other. When the choice lies between the easy and satisfactory performance of the prescribed duty, and the discharge of it as a task which must be got through at all hazards by the most determined bracing up of the powers for its execution, there can scarcely be a doubt, in the opinion of the writer, that, if the former can be procured by the use of such a small dose of alcohol as shall merely raise the vital powers for a time to their usual energy, it will be followed by less of subsequent exhaustion than the latter. But again, he would repeat, — and he cannot do so too often, or too earnestly, — that the habitual recourse to such a practice is fraught with the greatest prospective danger ; since it encourages the delusive idea, that the exertion which is thus for a time sustained is really doing no injury to the system ; besides which, it is next to impossible that the frequent use of alcoholic liquora, however moderate, can be per- severed in, for any length of time, without favoring the production of that disordered state of nutrition of the brain which the irregular activity of the nervo'S system has of itself so marked a tendency to generate. It should rather be the aim of those who have accustomed them- selves to such assistance to avoid the necessity (so far as may be possible) for such extra-exertion, and to prepare themselves to meet it, when it is indispensable, by care- ful and constant attention to all the rules of health. The most beneficial results from such a use of stimulants are to be experienced by those who are habitually absti- nent ; since the quantity of alcohohc liquor which they MMWi 192 USE OF ALCOHOL require for the purpose is extremely small ; and whatever injurious effects it may produce will be more likely to be dissipated, when a considerable interval elapses before it is again resorted to. When alcohohc liquor is employed as an ordinary beverage, the quantity required to give the desired aid, on the occasions in question, is such as must of itself exert a prejudicial influence on the system. 180. Nearly allied to the preceding cases, are those in which the use of alcoholic liquors may be found beneficial in assisting to fortify the system against a temporary exposure to cold or damp, separately, or in combination. We have already examined into the reputed efficacy of alcoholic liquors in favoring the resistance to cold, and have found reason to adopt the conclusion that this re- putation is altogether fallacious as regards the power of continued endurance. There can scarcely be a question, however, that although, considered simply as a heat- producing material, alcohol is inferior in some important particulars to such oleaginous matters as can be readily introduced into the current of blood, it has for a time the power of keeping off the chilling influence of severe external cold, in virtue of the augmented rapidity of the circulation which it induces, and particularly of the de- termination of blood which it favors towards the vessels of the skin. And this effect seems to be exerted Avith still greater benefit when cold and damp are acting together; their depressing influence being kept at bay for a time by the moderate use of alcoholic stimulants, so that no injurious result is subsequently felt from an exposure which might otherwise have been followed by a severe "cold," an attack of rheumatism, or some* other IN EXCEPTIONAL CAPES. 193 it )d ve 3h le malady, as determined by tlic idiosyncrasy * of the indi- vidual. 181. It is not here argued, however, that alcoholic liquors afford the best means of resisting such influences. On the contrary, it is within the experience of most per- sons, that muscular exertion, where it can be employed, is a far better means of keeping up that vigor of the circulation which shall resist the influence of the external chill, than the use of any stimulants whatever in a state of bodily inactivity. But, where circumstances prevent a resort to the former, and the choice lies among the best internal means of protection, — as in the case of a traveller exposed to cold and wet on the top of a coach, — we seem justified in believing, that, if the chilling influ- ence is powerful and likely to be of short duration, it may be betler resisted by a stimulating dose of alcoholic liquor than in any other way. But, if the resisting power is to be prolonged, such a course is most un- desirable ; for the system is never so obnoxious to the depressing influence of cold and damp as when it is already in a buite of depression resulting from previous over-stimulation ; and the use of coffee, cocoa, and other hot beverages, with solid food, which shall aid in per- manently sustaining the heat of the system, is then unquestionably to be preferred. Here, again, we would remark, that the habitu[il abstainer has decidedly the advantage, since a very small amount of the stimulus is sufficient, as in the former case, to produce the desired result ; and that, if recoui-se be too frequently had to it, the remote consequences of alcoholic excitement may be expected to manifest themselves. 17 * Idiosyncrasy, peculiarity of constitution. 194 USE OF ALCOHOL II. DEFICIENCY OF OTHER ADEQUATE SUSTENANCE. 182. The second class of cases in which the use of a small amount of alcoholic liquors seems beneficial, or at any rate justifiable, is that in which there is a deficiency of the proper sustenance, so that the alcohol supplies the means of maintaining the animal heat, for which the ani- mal tissues would otherwise be attacked. Under such circumstances, too, the temporary elevation of the ha- bitually depressed state of the animal power seems rather beneficial than injurious. Of this we have a remark- able example in the well-known case of the mutiny of the Bounty, from Captain Bligh's Narrative, of which the following passages are extracted: "At daybreak I served to every person a teaspoonful of rum, our limbs being so much cramped that we could scarcely move them." Further on : " Being unusually wet and cold, I served to the people a teaspoonful of rum each, to enable them to bear with their distressing situation." And again: " Our situation was miserable ; always wet, and sufiering extreme cold in the night, without the least shelter from the weather. The little rum we had was of the greatest service : when our nights were particularly distressing, I generally served a teaspoonful or two to each person, and it was always joyful tidings when they heard of my intention." Now, however decidedly we may give the preference to hot tea, coflfee, or cocoa, with plenty of nourishing food, over alcoholic liquors, in, facK, litating the endurance of such an exposure, it can scarcely be questioned, that, in circumstances such as those of Captain Bligh's crew, the administration of the few drops of spirit was of the most important service, both Us sup- IN EXCEPTIONAL CASES. lOo ^E. plying com])U3tible muterial, and as enabling the poweix of their system, already seriously depressed, from being fatally reduced by the privations to which the party was subjectefl. 183. The beneficial influence of a small quantity of alcoholic stimulus, in contributing to the endurance of bodily labor under circumstances peculiarly trying, and under the disadvantage of a deficient allowance of animal food, hiis been demonstrated on an extensive scale by the hygienic* experience of the large prison at Nismes, called the "Maison Centrale," of which an ac- count has been recently published by the chief physician, M. Boileau Castelnau, Avho has been connected with the prison for the last twenty-five years.f Of this account an abridgment will be here given, as the facts are considered by the writer as of very great importance, in disprov- ing, by the experience of a large number of individuals, the position of those who assert that under no circum- stances can the habitual use of alcoholic liquors be otherwise than injurious. This prison usually contains a population of 1,200 convicts, most of them adults, the minimum age being eleven. Its wards have been habitu- ally over-crowded and ill-ventilated, and insufficiently heated in winter ; and the food of the prisoners has been coarse and innutritions, whilst more labor has been ex- tracted from them than their strength has been adequate to perform. The prisoners, moreover, have been sub- jected to the tyranny of brutal keepers, frequently loaded with irons, and occasionally severely whipped. Under these circumstances, it is not surprising that the rate of * Hygienic, health-producing. t See the Annalcs d'llygienc Publique, Jan. 1819. 196 USE OF ALCOHOL mortality in the prison has been always high, varying from one in 23 88 to one in 7*85, whilst the average rate of mortality amongst the inhal^itanta of the town of Nismcs, of the same ago and sex, amounted to one in 49'9. The rate of mortality in the prison underwent considerable variations in different years ; and for these variations some definite cause could generally be assigned. Thus the winters of 1828-9, and of 1829-30, were unusually severe and prolonged ; and the rate of mor- tahty for 1829 was one in 940, whilst for 1830 it was one in 8 50 ; clearly proving the fatal influence of a low temperature upon systems debihtated by insufficient food, impure air, and work disproportioned to their strength. With the exception of the year 1833, in which the mor- tality was again great, the rate was much less for several subsequent years, varying between one in 11*35, and one in 1562 ; but in 1839 it suddenly rose from one in 12-32 to one in 7*85. The cause of this terrible augmentation (from 102 deaths to 162) seems to have lain in a mini- sterial ordinance issued on the 10th of May, 1839, limiting the alimentary articles allowed to be sold at the canteen to potatoes, cheese, and butter. Previously to th at time, the convicts had had it in their power to lay ou t a portion of their earnings, wliich was at their own d isposal, in the purchase of wine and tobacco, in addition to the articles just named ; but these were now prohibited. 184. " In order fully to appreciate," says Dr. J. Coxe (by whom this case is cited in the ninth edition of Dr. A. Combe's Physiology of Digestion), "the amount of misery thus entailed upon the prisoners, the reader mus t be aware, that, in the south of France, wine is con- idered an absolute necessary of life. It is drunk 'by the s IX EXCEPTION AT, CASES. 197 poorest of the people, and ap|)cais essential to enahlo them to digest their coarse, unstitnulating fixxl. Within the town of Nismes, it costs about a penny the litre (1| pint) ; and without the wall, where it is free from duty, the laborer may drink it at a penny the hour. Po- tatoes, butter, and cheese could not replace its stimulus ; and besides, the south of France containing no pastures, the butter was bad and dear, and the cheese also dear. Hence, the pittance at the disposal of the prisoners wa.s more than ever insufficient to supply the deficiency of nutriment." 185. The rate of mortality was somewhat diminished in the following year, the diet being increased, and the prisoners receiving small supplies of wine and to1)acco at exorbitant rates, principally through the connivance of the officials : still, however, it remained very high ; the number of deaths in 1840 being 135 out of 1,216 pri- soners, or one in 9*07. Attention being now attracted to the condition of the prisoners, an attempt was made to ameliorate it ; the old keepers being removed, and their places being supplied by the " Freres des ecoles chre- tiennes,"* who substituted moral persuasion for physical force ; and the diet being improved both in quantity and quality. In consequence of these measures, the mortality again began to diminish, and reached its lowest point in 1844, when the number of deaths was only fifty-six out of 1,290 prisoners, or one in 23-88. The " Freres," how- ever, being disgusted at the continual obstructions which their measures received, gave up their charge ; the old system of hard work and cruel punishments was again * Freres, &c. an order of friars. 17* 198 USE OF ALCOHOL introduced ; aiid the pittance at the disposal of the pri- soners was diminished to a mere fraction. The effect of this change speedily showed itself in the increased mor- tality, the avei-age of deaths progi-essively increasing, in the years 1845, 1846, and 1847, to one in 19-63, one in 16 -52, and one in 1357. One of the first acts, how- ever, of the revolutionary government of February, 1848, was to put a stop to the system of convict-labor, as it was then carried on, and the result of this change was speedily apparent in the diminished mortality ; for, whilst the number of deaths during the seven months ending October 31, 1847, had been forty-four, only sixteen deaths took place during the corresponding months of 1848. 186. Now, the principal lesson taught by this fearful history is the dependence of the vital powers upon food, and the fatal effects of the exaction of severe labor from men insufficiently supplied with aliment, especially when they are subjected to the additionally injurious influences of a low temperature, foul air, and ill treatment. But it seems obvious, from the large increase in the r.ate of mortality which ensued upon the prohibition of icine^ no extraordinary depression of temperature having existed to account for it, that its deprivation exerted a positively injurious effect. If an adequate measure of nutritious food had been supplied in its stead, the change would doubtless have been for the better ; but the support given by the wine, which was probably too weak and poor to have any decided stimulating effect in moderate quantities, had become so necessary to the debilitated systems of these men, that its withdrawal was fatal to many among them. IN EXCEPTIONAL CASES. 199 187. From these two cases, then, and from others which miglit be cited to the same effect, we seem justified in concluding that the use of alcoholic liquors in small quantity may assist in sustaining the powers of the sys- tem, when these have undergone an extreme depression from the combined influence of exposure or exertion, and of want of food ; so that under such circumstances the alcohol docs decidedly more good than harm, and should therefore bo employed when accessible. And this we may freely admit, without having in the least degree to qualify the doctrine previously advanced, that continual exposure and protracted exertion may be better sustained Avithout the use of alcohohc liquors than with it, when an adequate supply of wholesome food is to be had, and the stomach is capable of digesting it. III. DEFICIENCY OF CONSTITUTIONAL VIGOR. 188. Wo have now to inquire into the third class of cases, in which a temporarily beneficial result appears to be derived from the occasional, or even (for a time at least) the habitual, use of alcoholic liquors ; — those, namely, in which there is a want of sufficient vigor on the part of the system itself to digest and assimilate the aliment which it really needs. Such cases present them- selves in all ranks of life. In the higher, they too fre- quently result from heated rooms and late hours, from the want of regular exercise of mind and body, and from habits of self-indulgence and '• coddling," which foster, especially in females, what may have been an hereditary weakness of digestive power. In the middle classes, it is usually traceable to the " wear and tear " of 200 USE OF ALCOHOL professional or commercial avocations ; to undue cerebral labor, carried on, as this frequently is, in ill-ventilated apartments ; and to the anxieties incident to the consci- entious discharge of the duties of a profession, or to the fluctuations of business. Among the lower classes, on the other hand, it is traceable rather to the condition of their dweUings, workshops, and persons ; to the want of ventilation of the buildings in which they dwell or labor, to the miasmatic atmosphere of their ill-drained streets, and to the foulness of their skins and garments. 189. Now, in the first of these groups, it is obvious that the want of appetite is a natural result of the reduc- tion of demand for aliment to its lowest point ; for where neither the muscular nor the nervous systems are ade- quately exercised, and where the body is habitually kept in a temperature not far below its own, there can be very little " waste " to be repaired, and a very small amount of combustive action can be needed to keep up the heat of the body to its proper standard. But the digestive powers are very liable, when their natural use is too little called for, to sink beloiv the level at which the demands of the system should keep them ; and thus an almost total want of appetite, and extreme debility of the stomach, are the result, which of course tends to aug- ment the habits of self-indulgence, and to foster the whole system of " coddling." In such cases, an appa- rent benefit is derived from the habitual employment of a glass or two of wine, or a tumbler of bitter ale : but tliis merely facilitates the persistence in a wrong course ; and every judicious practitioner would now assent to the truthfulness of the advice, given by Abernethy in a case of this kind, to " live on a shilling a day, and earn it." IN EXCEPTIONAL CASES. 201 •al ed It is utterly impossible that alcoholic licjuors can coun- teract the influence of heated rooms and late hours ; that they can stand in the place of healthful exercise of mind and body ; or that they can neutrahze the evil results which are sure to proceed from the habitual direction of the attention to self All that they can beneficially do is to create for a time that appetite which ought to be naturally felt, and to urge the unwilling stomach to di- gest that food which the body really requires. But this they can only eflfect by their stimulating properties; and, as the usual dose almost invariably ceases after a time to exert its original influence, it requires a gradual increase, until the evil effects of its habitual use in such a state of the system are unmistakably manifested. 190. The true cure for conditions of this kind lies in such an entire change of habits as shall place the system in the condition most favorable to the recovery of its vigor, or to the acquirement of that which it has never enjoyed ; — the substitution of fresh air and bracing breezes for heated and ill- ventilated rooms ; of early and regular hours for the system of turning night into day, and day into night ; of plain but wholesome fare for seasoned dishes and refined cookery ; of the use of even a weakly pair of limbs for that of a carriage and horses ; and of labor in behalf of others for the weariness of ennui, or continual thought of one's self, 191. Nevertheless, it may happen, that, after all these means have had a fair trial, and considerable improve- ment may have been produced, the stomach may not bo equal to its work; and this is liable to be the case more particularly with those to whom weak digestive powers have been transmitted from their parents (generally in ..,Ji 202 USB OF ALCOHOL consequence of their own unhealthful habits), or in whom they have been fixed (so to speak) by an erroneous sys- tem of bodily and mental training, and especially by the habitual use of stimulants during childhood and youth. In such cases, the writer believes that the habitual use of a small quantity of alcoholic stimulant, especially when combined with a bitter tonic, may be of more service than any other form of medicine ; and, if care be taken not to employ it to such an extent as to produce an artificial appetite, or to force the stomach to digest more than the system really needs, it does not appear likely to have the same permanently injurious effects as it exerts in most other cases. It will generally be found to be an indication of its beneficial use, that the dose does not require increase ; the small quantity originally taken continuing to exert its good effects ; and this benefit will be more hkely to be persistent, if the use of the alcoholic stimulant be intermitted whenever the digestive powers seem adequate to the support of the sys- tem without it. 192. The want of appetite and feebleness of digestive power, so common among individuals in the middle classes, who go through an undue amount of cerebral labor, frequently under circumstances which are of them- selves prejudicial to health, has been already adverted to under another head (§§ 163, 164) ; and it has been shown, that the use of alcoholic liquors cannot in gen- eral be regarded as likely to be permanently beneficial in such a condition, although temporary benefit may doubtless be derived from it. It is impossible that alco- hol can supply the place of mental repose to the man whose intellect is overtasked, and whose anxieties ' are IN EXCEPTIONAL CASES. 203 unduly excited for himself or for others ; or that it can be an efficient substitute for muscular exercise to the man of sedentary habits, or for fresh air to him who is habitually exercising his brain in a close, ill-ventilated apartment. All that it can do is, as in the former case, to restore the appetite which ought to be felt, and to force the digestive powers to the discharge of the duty which they are indisposed to perform of their own accord. And here, too, we find that, when stimulants are habit- ually employed for such a purpose, they gradually lose their power ; and the wearied stomach, like the jaded roadster, at last breaks down, under the combined influ- ence of the withdrawal of nervous agency consequent upon cerebral exhaustion, and of the depression of its own energies consequent upon the habitual over-excite- ment to which it has itself been subjected. 193. Here, then, it is obvious that the use of alcohol- ic stimulants can only serve as a palliative, and that the true remedy can only be found in such a change of habits as shall bring back the system as nearly as possible to the natural state. The intellectual labor must be moderated ; the mind must be prevented from dwelling on its own sources of anxiety by the healthful influences of social and domestic intercourse, of variety of occupation, and of objects that shall interest without exciting it; and the body must be placed, by regular exercise, fresh air, and adequate repose, in the most favorable condition for the endurance of mental labor. Such measures, steadily pursued, with an occasional complete intermission from the ordinary occupations, and an entire change of scene with the accompaniment of fresh objects of interest (for ennui is to be especially i i 1 I 204 USE OF ALCOHOL Ill avoided), more especially when a bracing air and aug- mented muscular exercise tend still further to the bodily invigoration, will usually be found sufficient, when em- ployed in time, for sustaining the appetite and digestive powers under that amount of mental lalwr to which the system is really equal ; and recourse should be had to all such natural means of procuring and sustaining the vigor of health, before the artificial and delusive aid of alcoholic stimulants is invoked. It is, indeed, among the most injurious results of their habitual use, that it is found possible, through their means, to prolong the health- destroying system, and thereby, like the trader who lx>lsters up his failing credit with accommodation-bills, to carry onwards, from page to page of the book of life, a heavy balance which must be accounted for at some subsequent period. 194. Still, the writer is by no moans disposed to deny, that, after all other practicable means have been taken for the invigoration of the system, the habitual use of a small or moderate quantity of alcoholic liquors may be found beneficial in some individuals of the class referred to ; enabling them to digest that food which the system really needs, and thus contributing to sustjiin their powers under an amount of exertion to which they would not otherwise be equal. And this will be especially the case (as with the class first treated of), where, from heredi- tary predisposition or the habits of early life, there is a fixed constitutional debility of the digestive powers. In such instances, the stimulating effects of the alcohol do not manifest themselves ; it is not found requisite to in- crease the dose ; and the practice is continued with appa- rent benefit through the whole of life. A characteristic IN EXCEPTIONAL CASES. 205 example of the results of experience in this respect is afforded by the case of the late Dr. Joseph Clarke, of Dublin, who lived to the age of seventy-six years, and who discharged the duties of a laborious profes- sion, with scarcely any intermission, to the end of his life.* 195. The craving which is felt for alcoholic liquor among the classes whose labor is rather physical than mental, and the benefit which in many cases appears to be derived from it, proceed from a different cause. No- thing can be conceived in itself more likely to whet the appetite, and invigorate the digestive powers, than regu- lar but not excessive muscular toil, with that moderate occupation of mind which the execution of the labor involves; but, in order that this may exert its proper effect, it must be carried on under circumstances other- wise favorable to health, and more especially in a pure atmosphere of moderate temperature. If, in place of this, the air be already loaded with carbonic acid, an obstruction is created to the unusually rapid exhalation of that gas which muscular exertion involves, and the labor cannot be borne without the assistance of stimu- lants. And, if the atmosphere of the dwelling be charged with the noxious emanations resulting from animal or vegetable putrefaction, the appetite and the digestive powers fail, the aliment which the system really needs for the regeneration of its " wasted " material is no longer prepared and supplied to the circulating current, and the strength consequently flags. Under such cir- ! ' 41 ♦ See the Sketch of Dr. Clarke's Life and Writings, by his nephew, Dr. Collins, p. 81. 18 206 USE OF ALCOHOL oumstances, recourse is had, with apparent benefit, to the use of alcoholic liquors ; for they spur on the stomach to its work, and cause it, for a time at least, to furnish what is needed for the maintenance of the various func- tions of tlie body; the whole train of which depends, more or less directly, upon the due performance of the digestive operation. 196. Now, it is a remarkable characteristic of this condition, that the stimulus which was at first found sufficient very speedily ceases to produce its usual efiect ; and that the feeling of necessity for it increases, the more it is used. Of this we have an example — which, though an extreme case, teaches the lesson with the force that extreme cases alone can do — in the conditicm of the journeymen tailors employed in the large London workshops, as disclosed by the inquiries whose results are published in the first " Sanitary Beport" (1842). The heat and closeness of the workshops were stated by the witnesses to be such, that, on the coldest nights of winter, large thick tallow candles melted and fell over with the heat, and fresh hands from the country fainted away. In order to get the strength up for the day's work, and to Create an appetite for breakfast, it was customary to take a glass of gin at seven o'clock in the morning ; and this was repeated three or four times in the subsequent ten hours. Now, the utter inability of the alcoholic stimulus to afibrd more than a tempo- rary power of endurance under such a state of things, and the cumulative eflfect of the noxious atmosphere on the one hand, and of the habitual use of spirits on the other, are fearfully shown in the excessive mortality among this class of men, especially from consiunption ; IN EXCEPTIONAL CASES. 207 their average age not being above thirty-two, and a man of fifty being considered a& superannuated. "* 197. Nothing can be more absurd, then, than to maintain that any real benefit is derived from alcoholic liquors in such cases, or that it can in the least degree supply the place of pure air, or enable the body to resist the influence of excessive heat. Nor can it be more potent in preventing the morbific influence of putrescent miasmata; nor, again, can it make up for the want of personal cleanliness. These agencies can only be reme- died by their proper antagonistic measures, — hot and foul air by proper ventilation ; noxious emanations from the soil by efficient sewerage ; filthiness of the skin and garments by the use of baths and wash-houses ; and, if they be allowed to continue, they must exert their influ- ence on the bodily system, all the alcohol in the world notwithstanding. When, on the other hand, they are removed, — the artisan's labor being prosecuted in pure air, and his home and garments being kept clean and fresh, so that his skin and lungs are allowed their due exercise, — it will be seldom, if ever, that any thing else will be required to sharpen his appetite, and invigorate his digestive powers, for the consumption of as much food as his system may require. 198. On the whole, then, we may conclude, that, in by far the greater number of cases falling under one or other of the above categories, the influence of the habitual use of alcoholic liquors, while it may seem temporarily ♦ The •writer has been informed, that these workshops have been greatly improved of late years, especially in regard to ventilation ; and that the craving for spirits, on the part of those employed in them, has gradually ceased to manifest itself. 208 USE OF ALCOHOL I i 4- G^- beneficial, is in the end rather pernicious than otherwise ; and this not so much, in the cases now under considera- tion, by their own specific effects on the system, as by causing the individual io feel less need of the very change which is needed for the restoration of the body to its wonted vigor. The insensibility to the efiects of various morbific causes, which the habitual use of these stimu- lants induces, and the toleration of them which it thus permits, may be regarded, indeed, as one of its most injurious results. Those who are prevented from feel- ing the immediate consequences of their improper course flatter themselves that they are uninfluenced by them, and give to their wine, their spirits, or their beer, the credit of the escape. But this is far from being the case. The enemy is only baffled, not dispersed ; and, although he lies concealed for a time, he only waits until his onslaught may be more efiectually made. Any systema- tic departure from the laws of health — all experience teaches — must exert its influence on the system, sooner or later ; the sooner it does so, the more readily may the mischief usually be corrected ; whilst the postponement of its efiects tends to render the process of cure as pro- tracted as the operation of the causes has been. It is one of the greatest benefits of the abstinent system, then, that, by making the evils of such a departure less endu- rable, it sooner prompts the sufierer to seek a remedy. 198. Pregnancy. — Among the modifications of the bodily condition, short of actual disease, in which the occasional and even the habitual use of fr.i uiwffifd ')jap9m seems desirable in some instances, are the states of pregnancy and lactation. The state of pregnancy frequently occasions a peculiar irritability of the stomach \ IN EXCEPTIONAL CASES. 209 (fr jr|n i " iil lj' ' f t w jn i nlj ii i i ni ;i a rh ni mrtrr ), which indis- poses it to retain the nutriment really required by the system, or which prevents 14 from' properly digesting and preparing It w^en retkinM: This irritabihty is occasion- ally so aggravated as to become the bubject of medical treatment; and the most powerful sedative "^ medicines are sometimes required to subdue it sufficiently for the retention of even small quantities of food.^ Sometimes even these are ineffectual ; and more rehef is obtainable from small quantities of wine, frequently repeated, than from any thing elseJJ T^ ^Hg°j ^^ Philidnlphia, mentions a case in which nothing could be borne but ■vibaiBpagiie. J.n milder cases of the same kind, it often happens that a small quantity of fermented liquor, taken with the principal meai, seems to establish a tolerance of it in the stomach, and to promote its digestion, in a way which no ordinary sedative or tonic medicine can effect ; and it certainly seems a less evil to employ this, even habitually, during the period of pregnancy, than to allow the system both of mother and foetus to be suffering for want of the aliment which this condition so peculiarly requires. ( And, ae^the source of irritation is temporary, there"is less danger than in other circumstances, lest the demand should be rendered permanent by the habituation, of the stomach to the stimulus. 199. But the evils attending its habitual use, even under such circumstances, can only be reduce ^. to their minimum by very careful attention to all the other con- ditions favorable to health during the pregnant state, — especially fresh air, moderate exercise, early hours, ade- li * Sedative, composing, sleep-producing. 18* 210 USE OF ALCOHOL 'i* quate repose, and the avoidance of all sources of excite- ment ; and also by the strict hmitation of the quantity of the alcoholic liquor to that which is suflScient to produce the desired result. The writer has known cases in which, under such watchful regulation, great benefit appeared to be derived from the very moderate use of alcoholic liquors (especially of those in which the bitter and sedative properties of the hop are combined), without any corresponding disadvantage ; the stomach being there- by enabled, so long as the pregnant state lasted, to receive and digest the food which the system really needed ; and the requirement not being felt after its termination. But it must not be forgotten, that the habit of indulgence in fermented liquors, once established, is often felt by females, as well as by men, to be very diflScult of rehn- quishment ; and where there is reason to believe that the individual does not possess self-command sufiBcient to break through the habit at the proper time, it might be advisable to endeavor to substitute a medicine for a beverage^ giving to the alcoholic compound such a form as may render it not peculiarly palatable or inviting. 200. Lactatio7i. — The benefit derivable from the use of alcoholic liquors to support the system during lacta- tion * is more doubtful. Certainly it may be aflSrmed, that, in every case in which the appetite is good and the general system healthy, the habitual use of these stimu- lants is no more called for than at any other time ; and that they are likely to produce the same injurious efiects as when unnecessarily given under ordinary circumstances. The regular administration of alcohol, with the professed * Lactation^ the condition of nursing, or giving milk. I IN EXCEPTIONAL CASES. 211 I object of supporting tho system under the demand occa- sioned by Ihc flow of milk, is "a mockery, a delusion, and a snare." For alcohol affords no single clement of the secretion, and is much more likely to impair than to improve the quality of the milk. G'he only mode in which it can contribute, even indirectly, to increase the amount of solid aliment which tho secretion may contain, is by affording a supply of combustivo material, the consumption of which may leave more oleaginous and saccharine matter to pass into the milk. But. where the appetite already prompts to the ingeation, and the stomach is equal to the dige&iion, of an adequate amount of solid food, no such benefit can be looked for ; and, al- though it cannot be certainly affirmed that the character of the milk is always impaired by the habitual use of moderate (quantities of alcoholic liquors, yet there can be little doubt that such is usually the case. For it is unquestionable that their excessive employment is highly prejudicial to the quality of the milk, and thereby to the health of i:he child ; having a special tendency to occasion derangements of the digestive organs, Jvnd convulsive complaints.* This, indeed, might be fully expected ; since all that we know of the mode in which substances taken into the blood affect the mamma '."y secretion would lead us to expect, that alcohol, if introduced into the circula- tion more rjipidly than it can be consumed, would pass into the railk, and would consequently produce the same effects upon the child as if directly given to it, besides deranging by its presence the act of secretion itself, in ♦ Dr. North says (Practical Observations on the Convulsions of Infants), that he has seen these almost instantly removed by the transference of the child to a temperate woman. — Author. 212 USB OF ALCOHOL i? ii' virtue of its tendency to pr'oduce coagulation of albu- minous matters. And the fact, that multitudes of women of good constitutions, whose general habits are conducive to health, go through the period of lactation without any feeling of debility, simply finding their appetite increased during its continuance, is a sufficient proof that this con- dition is not one which in itself occasions a demand for alcoholic liquors. 201. But there are cases in which, notwithstanding all that can be done to promote the general health, the stomach does not seem capable of retaining and digesting the requisite amount of nutriment, except under the artificial assistance afibrded by alcoholic liquors ; and in which it appears more desirable, for the welfare alike of mother and child, that such assistance should be affijrded, than that lactation should be carried on without it. In one case of this kind that fell particularly under the writer's notice, in which the mother was most anxious to avoid the assistance of fermented liquors, and began to nurse without their support, the milk was obviously too poor in quality, and not sufficient in quantity, for the nutrition of the infant ; and the use of a single glass of wine, or a tumbler of porter, per day, was followed by a speedy and marked improvement in the condition of both mother and child; and this small allowance did not require to be increased during the continuance of the lactation, and was relinfjuished without difficulty soon after the weaning of the infant. In such cases, the alcoholic liquor seems to have no other operation than that of enabling the stomach to digest the amount of solid aliment required by the system ; whilst the small- ness of the quantity of alcohol introduced at any one IN EXCEPTIONAL CASES. 213 i] time prevents it from either itself passing into the milk, or exerting any injurious influence on the secreting pra- cess. But it may be questioned whether the practice is in the end desirable ; or whether it is not, like the same practice under other circumstances already adverted to, really detrimental, by causing lactation to be persevered in, without apparent injury at the time, by females whose bodily vigor is not adequate to sustain it. Such certainly appeared to be the case in the instance just referred to ; for the system remained in a very depressed state for some tim3 after the conclusion of the first lacta- tion; and on subsequent occasions it has been found absolutely necessary to discontinue nursing at a very early period of the infant's hfe, owing to the inadequacy of the milk for its nutrition, and the obvious inabihty of the mother to bear the drain. Hence it may be affirmed, with tolerable certainty, that the first lactation, although not prolonged beyond the usual period, and although apparently well sustained by the mother, was really injurious to her ; and the inabihty to furnish what was required, without the stimulus of alcoholic liquors, was nature's warning, wliich ought not to have been disre- garded. 202. Considering, then, that lactation (unlike preg- nancy) may bo put an end to at any period, should it prove injurious to the mother, the writer is disposed to give his full assent to the dictum of Dr. Macnish ; that, " if a woman cannot afford the necessary supply without these indulgences, she should give over the infant to some one who can, and drop nursing altogether." — " The only cases," continues Dr. M. "in which a moderate portion of malt liquor is justifiable, are when the milk is deficient, 214 USE OF ALCOHOL and the nurse averse or unable to put another in her place. Here, of two evils, we choose the least, and rather give the infant milk of an inferior quahty than endanger its health by weaning it prematurely, or stint- ing it of its accustomed nourishment." * Now, upon this, the writer would remark, that a judicious system of feeding, gradually introduced from a very early period in the life of a child, will generally be preferable to an imperfect supply of poor milk from the mother ; f and that, if the mother be so foolish as to persevere in nurs- ing her infant, when nature has warned her of her incapacity for doing so, it is the duty of the medical man to set before her, as strongly as possible, the risk, — the almost absolute certainty — of future prejudice to herself. The evils which proceed from lactation, pro- tracted beyond the ability of the system to sustain it, may be to a certain degree kept in check by the use of alcoholic stimulants ; but the writer is convinced, from observation of the above and similar cases, that its mani- festation is only postponed. Under no circumstances, therefore, can he consider that the habitual or even occa- sional use of alcoholic liquors during lactation is necessary or beneficial. 203. Childhood. — It has been maintained by some, that there are certain states of the constitution in child- hood in which benefit is derived from the habitual use of * Anatomy of Drunkenness, p. 301. t The author has found, in his own experience, that good cow's milk, somewhat diluted with water, and sweetened with a small quantity of sugar (so as to be brought nearly to the composition of human milk), has answered extremely well even for very young infants. IN EXCEPTIONAL CASES. 215 small quantities of fermented liquors ; and this especially in those who inherit the scrofulous diathesis, and in whom the nutritive functions are altogether imperfectly performed. Experience, it is said, demonstrates the benefit which is derivable from the judicious employment of stimulants, in exciting the digestive and assimilative processes to augmented activity, and in thus improving the general tone of the system. It is not denied, that temporary benefit may be derived from such a course ; but this will be obtained at the risk of prospective evil, extending through the whole of hfe. For, if the habit be begun thus early, it will seldom be found possible to discontinue it ; t =« stomach is rendered dependent upon artificial suppo^ , a d the improvement which this ap- pears to produce will probably render the parent less anxious to avail himself of other means of invigorating the system, and of promoting a more active and complete performance of the nutritive actions, which are more permanent in their character, because they act more naturally on the system. Every measure of this kind, therefore, — such as unlimited exposure to fresh air (avoiding damp and cold), plenty of exercise, warm but not too impervious clothing, the copious use of cold water with the addition of salt, sea-bathing, and other adjumenta,* — ought to have a complete trial, before recourse be had to the completely artificial support yielded by alcoholic liquors. 204. There cannot be any reasonable doubt, that the habitual use of alcoholic liquors by children in average health is in every way injurious.! In no period of life * Armenia, assisting remedies. t In illustration of the injurious effects of the habitual use of 216 USE OF ALCOHOL are the nutritive functions more energetically carried on, if the child be only placed in circumstances favorable to health ; and at no period of life is there such a disposi- tion to take just that amount of exercise of the nervo- muscular apparatus which is beneficial to the system, without exceeding it. The motives which stimulate the adult to over-exertion in his battle with the world do not operate upon the child : unless forced by the zeal of injudicious instructors, he will seldom be disposed to carry his mental exertions beyond the stage at which they may be best intermitted; and, whilst naturally prone to muscular exercise, he readily complains of fa- tigue, and is indisposed to persevere after this warning of the failure of his powers. The chief thing to be watched for and avoided, therefore, is the excess in diet to which children are sometimes prone, more especially if their palates be tempted by articles of which they are fond ; and if this be duly restrained, and every natural means for the preservation and improvement of health fermented liquors upon healthy children, Dr. Macnish (Anatomy of Drunkenness, p. 302) relates the following experiment made by Dr. Hunter upon two of his children, both of them having been previously unused to wine. To one, a child of five years of age, he gave every day a full glass of sherry ; to the other, a child of nearly the same age, he gave an orange. In the course of a week, a very marked difference was perceptible in the pulse, urine, and evacuations from the bowels of the two children. The pulse of the first child was raised, the urine high-colored, and the eva- cuations destitute of their usual quantity of bile. In the other child, no change whatever was produced. He then reversed the experiment ; giving to the first the orange, and to. the second the wine, and the results corresponded : the child who had the orange continued well, and the system of the other got straight- way into disorder, as in the first experiment. — Authob. ' IN EXCEPTIONAL CASES. 217 l)e judiciously and perseveringly employed, it is believed by the writer that more good will in the end bo done than will be accomplished by the assistance of alcoholic liquors. And, in support of this belief, he can appeal to the large numbers of families now growing up, in this country and in America, in the enjoyment of vigorous health, among whom no alcoholic liquor is ever con- sumed ; and he can point to numerous cases within his personal knovvledge, in which the apparent debility of constitution having been such as in the opinion of some to call for the assistance of fermented liquors, the advice was resisted, and those other means adopted wliich have been already adverted to, with the effect of rearing to vigor and endurance children that originally appeared very unlikely to possess either. 205. Old Age. — It has been maintained, again, by some of those who fully admit the undcsirablencss of the habitual use of alcoholic liquors during the vigor of early and middle hfe, that they are requisite or useful for the support of old age. Now, upon this point, also, the writer believes that much misconception is prevalent, arising out of a disregard to the dictates of nature on the subject. During the most active period of life, the "waste" of the body is considerable; and the demand for food, and the power of thgesting it. nrc both adequate, in the healthy state, to supply that waste. But with the advance of years, the power of activity diminishes; the body (so to speak) lives much more slowly, as is proved by the lessened exhalation of carbonic .acid and the diminished excretion of ur'^a ; and, the waste l)cing thus lessened, the demand for food, and the power of digest- in<' it, ore proportionably diminished. Now, this abatc- 19 218 USE OF ALCOHOL I:- ^ ment of the appetite and digestive power (like that -which is felt by those who go from cold or temperate climates to reside in tropical regions) is a natural warning that a smaller amount of food should be taken in ; and if it be so received, and no more nutriment be habitually ingested than the appetite legitimately prompts, the digestive powers will be found as adequate as in a state of gi-eater activity to provide for the wants of the system. But this abatement is very commonly regarded Jis an indication of the failure of the powers of the stomach ; and recourse is had to alcoholic hquors, with the view of re-exciting these. Now, although from such a practice, when very moderately resorted to, less prospective evil may be anti- cipated, as regards merely the eflfects of the continual ingestion of alcohol upon the stomach, than it is liable to occasion when commenced earlier in life ; yet it is very much to be deprecated on another account, — namely, that it forces admission into the syskm (so to speak) for a larger amount of alimentary matter than it can appro- priate ; and as all the organs which are set apart for the ehmination of the superfluity (the kidneys, the liver, the skin, and the glandulae of the intestinal canal) are less easily stimulated to increased activity in the dechne of life than at an earlier period, it follows that habitual excess in diet, even though to no great amount, is yet more likely to be followed by the disorders Avhich it tends to produce. And hence it is, more especially, that we find the lithic acid diathesis * so prone to manifest itself in advanced life, and requiring such careful dietetic management for its correction. • Lithic acid diathesis, stute of tlio system which tcnds^ to form stone. IN EXCEPTIONAL CASES. 219 206. The author would not take upon him to deny, that cases may present themselves in which the habitual use of a small quantity of alcoholic liquors may be bene- ficial to persons advanced in life and not suffering under any positive ailment, but experienc'^^g absolute deficiency of digestive power heyoTim ai '^h is in conformit / with the general dechne of activity. In such cases, the benefit to be expected from their employment is, that the stomach should be assisted in the digestion of the food which the system really requires ; and, in so far as their use is carried beyond that point, it is hurtful in every way. Such cases may be expected to be rare among those who have habitually observed the laws of health, and who have not prematurely exhausted the powers of their digestive apparatus by habitual excess in diet or in mental labor, or by the continual use of stimulants. Those, on the other hand, who have adopted the habit, early in life, of relying upon the aid of alcoholic liquors for the performance of the digestive operation ; or who have overtasked their nervous systems, and thus deprived the stomach of the nervous power which it requires ; or who have impaired their vigor by breathing a foul atmo- sphere, by irregularity and insufiiciency in regard to the periods of repose, or by various other departures from the ordinances of nature, — are more likely to suffer in advanced life from a loss of digestive power, which no treatment, medical or hygienic, can ever completely repair. 207. But here, as in all other instances, if the pro- longation of life and the restoration of vigor be the paramount objects of consideration, recourse should at first be had to all those measures of general hygiene 220 USE OP ALCOHOL /■ which prudential experience would recommend ; and the assistance of alcoholic liquors should be avoided, with a jealous apprehension of their prospective evils, until it shall appear that no other more natural means can bring about the desired result. Those who have been in the habit of employing them during the whole of life are certainly those who are least likely to feel able to dis- pense with them in old age ; yet experience has demon- strated, even here, that, where the evil results of their continued use have begun to manifest themselves, decided and permanent benefit has followed their aban- donment; and, where it was believed by the individual that he could not possibly dispense with their use, the stomach has recovered its healthy tone (.specially under the copious external and internal use of cold water, and the influence of an invigorating atmosphere), so as to be able to discharge its duties for the remainder of life with greater ease than it ever previously had done.* 208. For the results of experience on this and other points, any statements of which should be based rather on a wide and general survey than on induction from a comparatively limited number of instances, the author has thought it safest to rely on the assurances of medical practitioners in the New England States ; since the entire disuse of fermented liquora has been now practised as a habit, for some years, by a large proportion of the popu- lation of those States, including those who are most subject to those influences (the " wear and tear" of social hfe) which are usually regarded as most powerfully con- * For two remarkable cases of this kind, see Appendix C. IN EXCEPTIONAL CASES. 221 spiring to render the assistance of stimulants desirable. The following statements on this subject have l)cen recently put forth by the Massachusetts Temperance Society, under the sanction of their distinguished presi- dent, Dr. Warren : * — 209. " In regard to the habitual use of wine, it is probable that the change of opinion is greater here than in Europe. A vast number of persons on this side of the Atlantic have wholly abandoned the use of wine, cider, and malt liquors; and many of those who con- tinue to employ them have great!}/ diminished the quan- tity. Wine is no longer thought necessary in the convalescent stage of fever. Cider, formerly one of the household provisions of almost every family in the North, is rarely seen; and the very trees which pro- duced it are either cut down for fuel, or converted to the production of fruits for food. The stronger beers are quite disused, except among emigi-ants ; and even the milder are employed only in some very light and unstimu- lating form to allay thirst, principally in the hot season. The apprehension that a sudden disuse of fermented liquors might be injurious has been dispelled by a vast number of cases, in which, after long-continued employ- ment, a sudden and total abandonment has taken place, not only without impairing health and comfort, but with positive improvement in strength, activity, and agreeable sensations. How common is it amongst us to see per- sons who in former times used wine freely, and who have now given it up, present an appearance of mental and bodily vigor they had not exhibited before! The ♦ Preface to the reprint of an Essay on the Physiological Effects of Alcoholic Drinks, from Dr. Forbes's Review, Boston, N.E. 1848, 19* 222 USE OF ALCOHOL influence of such a change of habit in the wealthier classes has been great beyond calculation, in leading the mass of society to abandon the use of spirits, and to repeat an experiment already made by those whom they are accustomed to respect and follow. Such having been the consequences of the disuse of wine, how desirable is it that all those who have not abandoned it, who wish well to their fellow-men, and are willing to show that they are capable of making the sacrifices they advise, should submit to a privation which they have sufficient reason to beheve will be most salutary to tuemselves and others ! " 210. The extent of change of habit, in this respect, among the middle and higher classes of society in Bos- ton, and other great towns of New England, may be judged of from the fact that many of those pubUc festi- vities at which the assistance of alcoholic liquors is con- sidered indispensable in this country are there conducted without any such artificial excitement. " Of late years" (we quote the same authority), " we have had the grati- fication of witnessing so many exceptions to the former praxjtice, that it appears very probable the rule will be reversed, and the exceptions change to the opposite side. The great festivals on the anniversary of National Independence are in many places celebrated without other stimulus than that of patriotic feeling. The annual ceremonies of our literary institutions, too often stained by lavish draughts of the juice of the grape, are now purified hy the effusions of chastened wit, and elevated by the flights of an unclouded imagination. Most of the universities, and particularly the oldest, and we may perhaps venture to say the most distinguished, have IN EXCEPTIONAL CASES. 228 unshackled themselves from the chains of ancient habit. Under the influence of a maatT-spirit (President Everett) the great annual festival of Commencement at Cambridge University has been accomplished without the aid of wine ; and the oldest of our literary fraternities, the Phi Beta Kappa Society, has enjoyed the excitement of a social meeting without the consequent depression fi-om artificial stimulus. Wine is no longer admitted at the yearly convocation of the clergy, or the assemblage of the medical profession of this State. The great associ- ation of mechanics of the metropolis hold a brilliant triennial feast, from which every kind of alcoholic, fer- mented, vinous, and other stimulating liquid is wholly excluded."* i" 211. On the whole, then, the writer thinks that phy- siology and experience alike sanction the conclusion, that, although there are states of the stomach in which the diminished appetite and digestive poAver prevent the recep- tion of an adequate supply of aliment into the system, and in which the assistance of alcoholic liquors is tempo- rarily beneficial, that assistance is rather a palliative may have * " In order to give a mora exact idea of the importance of the celebrations alluded to above, we have thought it well to state the number of persons that attended them, as nearly as can be ascertained : — Fourth of July Celebration in Faneuil Hall 1000 Commencement at Cambridge University 300 Festival of Phi Beta Kappa 150 Festival of the Clergy 200 Festival of the Massachusetts Medical Society .... 300 Festival of the Massachusetts Mechanics' Association . . 600 " 224 USE OF ALCOHOL than a cure of the condition which calls for it ; and, if perseveringly had recourse to, is likely to induce a train of evils of its own; whilst, at the same time, by the apparent support which it gives, and by rendering the system more tolerant of the unfavorable influences from which its depression of power may have proceeded, it renders the individual less disposed to seek, in a change of habit, the remedies which will be really effectual. " Thus," as an American physician has remarked to the writer, " where you (the English practitioner) recom- mend to a man losing his digestive power, from the fatigue and confinement of a city life, to take wine, porter, or bitter alp, with his dinner, we order him out of town, to get fresh air, and the refreshment of idleness in the country." No man of observation can doubt which of these two systems is likely to be most beneficial in the long-run. 212. But, again, the writer believes that there are exceptional cases, arising chiefly from peculiarity of ori- ginal constitution, in which the want of digestive power is more completely and permanently supplied by the habitual use of a small quantity of alcoholic hquors than it can be by any other means within the power of the individual. It may be impossible to predicate, in any individual instance, whether this shall be the case or not ; but the results of observation appear sufficient to prove, that it would be erroneous to assert dogmatically that it never can be. Still, the evils resulting from the unne- cessary employment of stimulants are so great that recourse should never be had to them, until every other more natural method of sustaining the vital powers has been tried without success. They should never be em- IN EXCEPTIONAL CASES. 225 ployed to repliice any hygienic rofiuiremcnt, such as fresh air, mental repose, muscular exercise, &o. ; and they should be disused whenever it may appear that the necessity for them no longer exists. 226 CHAPTER IV. < } IS THE EMPLOYMENT OF ALCOHOLIC LIQUORS NE- CESSARY IN THE PRACTICE OF MEDICINE? IF SO, IN WHAT DISEASES, OR IN WHAT FORMS AND STAGES OF DISEASE, IS THE USE OF THEM NECESSARY OR BENEFICIAL? U u 213. Those who maintain that alcoholic liquors are not requisite for the ordinary sustenance of man, or even that they are likely to be rather prejudicial than other- wise when habitually taken in small quantities, — that, in fact, alcohol is to almost every one a true poison, slower or more rapid in its operation, according to the rate at which it is taken, — may still maintain, with perfect consistency, that (like many other poisons) it may be a most valuable remedy, when administered, with caution and discrimination, in various forms of disease. In re- plying to the above question, we shall first look at the inferences which we may draw from the physiological action of alcohol in regard to the conditions of the system in which it is most likely to be useful. I i I. RECOVERY FROM SHOCK. V\ 213. We have seen that alcohol, when introduced into the circulation, acts as a stimulant in augmenting the force and rapidity of the heart's contractions, and that it USE OF ALCOHOL, ETC. 227 w also increases the excitability of the nervous system ; we have found, moreover, that it supplies the means of keeping up the animal heat, which may be advantage- ously employed when other means are deficient. Hence we should say, that alcoholic liquors may be advantage- ously employed to assist in rousing the system from the effects of agencies of various kinds, which threaten for a time to produce a fatal depression of the vital powers ; such, for exar pie, as severe injuries that produce a violent shock, under the primary effect of which the sys- tem appears likely to sink. But great caution must be used in their administration, and they should not be given unless there appears to be a positive necessity for doing so (J. e. unless the patient appears Ukely to sink without them) ; for it is as certain that re-actionary excitement will follow a primary depression as it is that depression will be consequent upon primary excitement ; and, if stimulants have been unnecessarily employed, the difficulty of controlhng the re-action will be increased. This caution is more aspecially necessary where the Orain is the part to which the injury has occurred ; since the special determination of alcohol to this organ will increase the violence of the re-action in a most dangerous man- ner. 214. There is no class of cases, perhaps, in which the good effects of stimulants in maintaining the heart's action, and in keeping up the nervous excitability, are more manifest than in those severe and extensive burns of the trunk of the body to which the children of the lower classes are peculiarly liable, from their clothes taking fire tlirough carelessness or negligence. The shock given by this injury to the deUcate and im- 228 USE OF ALCOHOL Y pressibie system of the child is often rapidly fatal ; the heart's action being extremely depressed, the nervous power reduced, and the body gradually cooling, until its temperature falls to a degree incompatible with the main- tenance of life. The writer has witnessed many such cases, in which hfe oociiicd to be kept in the body by the frequent administration of a spoonful of cordial, but in which death supervened upon a short intermission of the stimulus ; the nurses in hospitals being generally pos- sessed with the belief that the little patients viust die, and being too frequently careless in the employment of the only means by which hfe can be sustained. II. TREATMENT OF ACUTE DISEASES. 215. Resistance to the Depressing Influence of Mor- bific * Agents. — In the class of cases to which reference has just been made, the shock is temporary ; and, if the patient can be kept ahve until the system has recovered from its immediate consequences, a great point is gained. There is another class of cases in which the depression is produced by a morbific agency, and in which it is of equal importance to keep up the vital powers for a tune ; since, if they can be sustained for a few hours or days, the patient has a fair cl ance for recovery. Of such we have examples in many forms of fever ; especially in those which run a tolerably determinate course, and which exert their noxious influence rather in producing a general depression of the vital powers than in occasioning any decided local lesion. No two epidemics of fever are Morbific, that which produces disease. IN THE TREATMENT OF DISEASE. 229 precisely alike ; and the treatment which is of service in one may be found injurious in the other, notwithstanding that the general type may be the same. A severe epidemic of typhoid fever, which the writer witnessed in Edinburgh in the years 1836-7, aflforded him an opportunity of seeing the decided efficacy of alcoholie stimulants in one form at least of this fever ; the oppo- site methods of treatment, followed by two physicians whose practice he watched, being attended with such different results, that, as the cases were of the same class, and the other conditions identical, there was no other way of accounting for the difference. By neither physician were any active measures taken during the early stages of the fever, for none seemed called for : but, in one set of cases, the same expectant practice was continued to the end ; whilst, in the other, the adminis- tration of wine and spirit was commenced, as soon as the weakness of the pulse, and the coldness of the extremi- ties, indicated the incipient failure of the circulating and calorifying * powers. The quantity was increased as the necessities of the patient seemed to require ; and, in one case (that of a woman whose habits had been previously intemperate, and on whom a more potent stimulus was therefore needed to make an impression), a bottle of sherry with twelve ounces of whiskey was the daily allowance for a week or more, — the patient ultimately recovering. Now, the result of this wine- treatment was, that the mortality was not above a third of that of the simple expectant treatment; the patients dying under the latter from actual exhaustion and &ilure of oalori- Calorifying, producing heat. 20 280 USB OF ALCOHOL 'l\ ^ying power, and no local lesion* being detectible on post-mortem examination. 216. It is bj no means difficult to give a satisfactory rationale ^ of this beneficial action. The immediate cause of death in such cases appears to be a failure of the power of the heart, the contractions of which, in the advanced stage of typhus and typhoid fevers, become progressively feebler and more rapid ; and it has been noticed by Drs. Stokes and Graves, as the best indica- tion for the use of wine, that the impulse is greatly diminished, and that the first sound becomes very feeble, or is entirely extinguished. Now, the efiect of wine, where it acts beneficially, is to render the heart's action more vigorous, and at the same time slower. Again, with this state of the circulation we generally have a low muttering and restless delirium, with an approach to Bubsultus tendinum ; % and, if the wine acts beneficially, it renders the patient more tranquil, and disposes him to sleep. Under the influence of wine, too, in suitable cases, the skin and tongue become moister, and the breathing more deep and slow ; but, if the wine be acting injuriously, the skin and tongue become drier, and the respiratory movements more hurried. Concurrently with the failure of the heart's action, there seems often to be a deficiency of heat-producing material ; all that was pre- viously contained in the body having been burned off during the earlier period of the fever, and little or none having been taken in from without. Day by day, the fiitty matter of the body is used up by the respiratory • Lesion, injury. t Rationale, explanation. X SubauItuB tentUnumf twitching of the tendons, spasms. ill m THE TREATMENT OF DISEASE. 231 process ; and thus, as in cases of simple starvation, the patient must die of coldf unless some means be provided for the sustenance of the heat. In such a condition of the system, no farinaceous or oleaginous matters could be digested or absorbed in sujBficient quantity ; whereas alcohol is taken into the current of the circulation by simple endosmose,* without any preparation whatever, and can be immediately applied to the production of heat. 217. Now, in the cases in which the alcohol is thus useful, there is an entire absence of stimulaling' ef- fects. This is probably due in part to the fact, that the alcohol is burned off nearly aa fast as it is introduced (the general rule in such cases being to give a small quantity at a time, but to repeat this frequently); but it would ako appear to result in part from this, — that the stimulating' power of the alcohol is expended in neu- tralizing (so to speak) the depressing" influence of the fever-poison already in the system, and that it simply tends, therefore, to restore both the heart and the brain to their condition of normal activity. Where the habits of the patient have been previously intemperate, the ordinary doses of alcoholic stimulants have no percepti- ble effect ; and it is necessary to go on increasing them, until some marked influence is exerted by them, as in the case just now cited. 218. It is not only in the idiopathic typhoid and typhus fevers that alcohol thus becomes the most important re- medy which the physician has at his command ; for it is equally so in the typhoid states of other diseases, especially Endosmose, suction. ^82 USB OF ALCOHOL erysipelaa and the exj'nthemata ; * and it ia in the typhoid form of erysipelas, which so often presents itself in men of the bad habit of body resulting from habitual intem- perance (*§> 63), that the largest quantities of alcohoUc stimulants may be given, without any other perceptible effect than that most beneficial one, — the support of the system whilst the disease runs its course. 219. Recovery from States of Prostr alien. — During the stage of convalescence from fevers and acute inflam- matory diseases, in which the vital powers have been greatly depressed, it will frequently happen that the use of alcoholic liquors will be decidedly beneficial ; and this apparently in two ways, — by raising the nervous system jfrom that low irritative state which is the conseq -jnce of depressed vital power, and by increasing the digestive power of the stomach and the general nutritive activity of the system, so that the reparative processes take place more rapidly, and the general vigor is more speedily restored. Every practical man must have perceived, that the state of debihty in which the patient is left after the termination of an acute disease is extremely different from the state of exhaustion consec^uent upon a long- continued course of over-excitement. The former par- takes of the nature of shock ; the vital powers are not so much exhausted as depressed ; and recovery is best pro- moted by arousing the system, so far as possible, to the due performance of its functions. If alcoholic stimulants are really beneficial under such circumstances, they make their utility apparent in the same way as in the advanced stage of typhoid fever ; that is, by reducing tho rapidity * Exanthemata, eruptiTO fevers. IN THE TREATMENT OF DISEASE. 233 of the heart's action at the same time that its strength increases, and by cakning the mind instead of exciting it. Dr. A. Combe mentions the case of a delicate lady, who, during recovery from fever, took to the extent of a bottle of Madeira in twenty-four hours, with these obviously beneficial results. It is well known that much depends, in this condition, on procuring as speedy a renewal as possible of the normal actions of nutrition ; es))ecially where either the disease, or the treatment it has required, has caused them to be greatly lowered, or almost entirely suspended ; for there is great danger lest the convalescent should pass into a cachectic condition, "^ and a foundation be laid for tubercular f or other forms of disease depend- ent upon the imperfect performance of the nutritive pro- cesses. Hence, if, when these operations are just being renewed, a little increased energy can be artificially imparted to them, we have a better hope of escape from these evil consequences. As a general rule, no alcoholic stimulants should be employed, until after the complete subsidence of the inflammatory processes : but this rule is not invariable ; for a stnte of chronic inflammation is often kept up by the low and imperfect state of the general nutritive operations, and hence (as Professor Alison was wont to teach and to practise with great success), however contradictory it may at fii-st appear, we may frequently combine a general tonic or somewhat stimulant regimen with local depletion or counter-irritation. % 220. When alcoholic stimulants are employed for these purposes, the greatest care and watchfulness * Cachectic condition, state of permanent and general disease, t Tubercular, consumptive, scrofulous. % Counter-irritation, blistering or irritating the skin. 20* 234 USB OF ALCOHOL Bhould be used in their administration, both to avoid doing positive mischief by an over-dose, and also to avoid bringing the system into a habit of dependence upon them, and thereby predisposing it to the various remoter evils formerly described. There is no doubt that a course of over-indulgence in alcoholic liquors haa frequently commenced with the therapeutic* use of thein; and it is extremely desirable, therefore, that the medical practitioner should enforce the diminution of the dose, and the final discontinuance of the remedy, at the earliest possible period, — substituting, if he should think it necessary, a small quantity of alcohol in some medici- nal form, — in order that the patient may have as little motive as possible for continuing its use, after the time for its really beneficial action has passed. 221. Support under Exhausting' Drains. — There is another class of cases, in which the stimulating action of alcoholic hquors may be occasionally had recourse to with advantage ; those, namely, in which there is great drain upon the nutritive material, owing to some dis- ordered action which at the same time lowers the vital powers of the system, — such, especially, as an extensive suppurating f surface. Now, here the general rule, that the appetite and the digestive power are proportionate to the demand for nutriment in the body, does not hold good ; since the depressing influence of the disease lowers the functional activity of the digestive apparatus to such a degree that it cannot supply what is needed ; and thus there is a progressive diminution of the nutritive solids of the blood, which still further depresses the vital * Therapeutic, medicinal. . ' t Suppwratmgt discharging matter as from « sore. IN THE TREATMENT OF DISEASE. 285 powers of the system. We should therefore anticipate a beneficial result from such an employment of alcoholio Btimulants as would for a time augment the digestive power of the stomach, and would thus enable it to appro- priate and prepare the amount of nutritive matter which the system really needs, whilst at the same time its gene- ral powers are sustained under the depressing influence of the disease. Experience shows that such is the case ; and that, under such circumstances, alcoholic liquors may be beneficially employed, not so much to stimulate the heart, or the nervous system, nor to take the place of "^olid food ; but, by stimulating the stomach, to augment the quantity of solid material which it can advantageously receive. 222. Allusion has already been made to the unfavor- able course which febrile and inflammatory diseases are disposed to run in the habitually intemperate ; this being chiefly dependent upon the imperfect elaboration * of plastic t material, which predisposes to suppurative ac- tivhat benefit they are capable of conferring will be obtained by their improvement of the digestive power, and of the processes of primary assimilation.* But it is very doubtful whether the temporary improvement which can sometimes be thus obtained is not really fal- lacious, — like that which we see in the burning of a lamp, just after the raising of the wick, when there is a deficiency of oil ; since it is procured, not by the re- animation of power which exists in the body, but has previously lain dormant, but by the more rapid con- sumption of the small stock of power left. And the question of their benefit or injury will often depend upon whether, by this more rapid consumption, new vigor can be infused into the system by the introduction of new material. 226. The use of alcoholic stimulants in such cases has been hitherto so customary with medical men, that it may seem to be running in the face of the established results of experience to deny or even to doubt their eflScacy. But we have seen reason, within a recent period, to deny or doubt the efficacy of many systems of treatment of chronic diseases which long-continued ex- perience appeared to have sanctioned, and to believe that the vis medicatrix\ of the system is often itself the great restorer, when time is given for its operation, and other circumstances concur to favor it. And it is espe- cially important, in judging of the action of all remedies which must be persevered in for some time in order to * Auimilaiion, converaion of food into living substance, t V%» medicatrix, inherent healing power. 240 USE OF ALCOHOL produce any decided result, to take their remote conse- quences fully into account, and to consider how far these are, or are not, favorable to our object. Now, the writer has endeavored to show, that the remote consequences of the continued use oi alcoholic liquors, even in small quantity, are all of them so unfavorable to health, that, if the immediate invigoration of the digestive power and of the assimilative processes, which seems to be their (mly beneficial eflfect under such circumstances, can be obtained in some other way, it will be most desirable to avoid their use. 227. This will be more particularly the case, when the causes of the disordered state have been such as to exhaust the vital energy of the stomach itself; such as long-continued excess in diet, and habitual indulgence in a moderate allowance of fermented liquors, especially when accompanied by exhaustion of the nervous power by over-exertion or anxiety of mind. It is quite absurd to expect, that any change or variety of direct stimulation can re-invigorate the digestive apparatus under such circumstances. We may keep our patient in town at his usual occupations, practise all kinds of experiments upon his stomach, recommend fat bacon or lean chops, prescribe blue pill and senna-draught, or quinine and calumbo, and ring the changes upon all the wines, spirits, and malt-liquors which the cellar can furnish, without effecting any permanent benefit. Whereas, if he can be induced to give himself a complete holiday ; to betake himself to some agreeable spot, where there is suflficient to interest, but nothing to excite ; to inhale the fresh and invigorating breezes of a mountaanous coun- try, in place of the close and deteriorated atmosphere of IN THB TREATMENT OF DISEASE. 241 a town ; to promote the copious action of his skin by exercise, sweating, and free ablution ; to wash out his inside, ff.nd increase the tonic power of his stomach with occasional (but not excessive) draughts of cold water ; and to trust to the natural call of appetite alone, in preference to artificial provocatives, — we shall be giving him the best possible chance of permanent restoration to health. 228. There is perhaps no class of cases in which the benefits of the hydropathic treatment are so strikingly displayed, especially when it is carried on in a spot where all other aids concur to make it most effectual ; and, reasoning from analogy, the writer is strongly in- clined to believe, that it would be of similar efficacy in re-invigorating the system exhausted by other forms of chronic disease, and would in most cases be preferable to any form of alcoholic stimulants for procuring an increase of digestive and assimilative power. So far as the writer is acquainted with the results of comparative experience, they are decidedly in favor of the hydro- pathic treatment, moderately and judiciously applied, especially in cases of chrcmic gout and rheumati3m ; but he would not be dogmatic enough to assert, that there are not individual instances in which (as in the class formerly adverted to, f» 194) the loug-continued or even the habitual use of alcoholic liquors will promote recovery from chronic diseases by their influence on the digestive and assimilative apparatus. He does not see the possi- bility, however, of laying down any general rules by which such canes can be distinguished ; and it will be only from the results of an extended experience of the com- paiative advantages and disadvantages of different modes 21 242 USE OF ALCOHOL of treatment, and of the immediate and remote conse- quences of the employment of alcoholic stimulants, as compared with those of the abstinent system, that any really valuable inferences can be drawn. Until these shall have been obtained, he believes that abstinence will in most cases be the safer plan ; except where the pros- tration of the vital powers has proceeded to such an extent as to require temporary stimulation for the per- formance of any of the nutritive and regenerative opera- tions. , 229. It may not be amiss to remark, in conclusion, that it is through the medium of the water contained in the animal body that all its vital functions are carried on. No other liquid than water can act as the solvent for the various articles of food which are taken into the St; -ach. It is water alone which forms all the fluid portion of the blood, and thus serves to convey the nutri- tive material through the minutest capillary * pores into the substance of the solid tissues. It is water which, when mingled in various proportions with the solid com- ponents of the various textures, gives to them the con- sistence which they severally require. And it is water which takes up the products of their decay, and conveys them, by a most complicated and wonderful system of sewerage, altogether out of the system. It would seem most improbable, then, that the habitual admixture of any other fluid — especially of one which, like alcohol, possesses so marked a physical, chemical, and vital in- fluence upon the other components of the animal body — CapiUaiy, very minute, hair vessels. IN THE TREATMENT OP DISEASE. 243 can be otherwise than injurious in the great majority of cases ; and, where a benefit is derivable from it, this will depend upon the fact that the abnormal condition of the system renders some one or more of the special actions of alcohol remedial instead of noxious, so that the balance becomes on the whole in favor of its use. APPENDIX A, p. 67. Some very remarkable details regarding the condition of the ballasters and coal-whipperft employed on the Thames, have lately been ascertained by the inquiries of the " Com- missioner " employed by the Morning Chronicle^ and have been made public in the columns of that newspaper. The drinking habits of these men have been in part engen- dered by the system under which they have worked ; which has involved, as the necessary condition of their employment, the expenditure of a large part of their earn- ings at the public-house. This system was done away with, a few years since, as regards the coal-whippers ; but it still remains in force with respect to the ballasters. Several of the former class are now total abstainers ; while others, who adop'od the abstinence system for a time, have returned to their former habits. The inquiries of Mr. Mayhew, the ** Commissioner," were specially directed to the experience of both these classes ; and we shall first quote the statement of one of the latter, by way of show- ing the extreme severity of the labor undergone by these men, and the circumstances under which the assistance of alcoholic liquors is sought by them : " I was a strict tee- totaler for many years, and I wish I could be so now. All that time I was a coal-whipper, at the heaviest work ; and I have made one of a gang that has done as much as one hundred and eighty tons in one day. I drank no fer- 21* 246 APPENDIX. 1 1: hi mented liquors the whole of the time. I had only ginger- beer and milk, and that cost mo Is. 6d. It was in the summer-time. I didn't ♦buff it* that day; that is, I didn't take my shirt off. Did this work at Regent's Canal, and there was a little milk-shop close on shore, and I used to run there when I was dry. I had about two quarts of milk and five bottles of ginger-beer, or about thre'' quarts of fluid altogether. I found that amount of drink necessary. I perspired very violently ; my shirt was wet through, and my flannels wringing wet with the perspi'-ation over the work. The rule among us is, that Vi e do twenty-eight tons on deck, and twenty-eight tons filing in the ship's hold. "We go on in that way through- out the day, spelling at every twenty eight tons. The perspiration in the summer streams down our foreheads so rapidly, that it will often get into our eyes before we have time to wipe it off. This makes the eyes very sore. At night, when we get home, we cannot bear to sit with a candle. The perspiration is of a very briny nature ; for I •often taste it as it runs down my lips. We are often so heated over our work, that the perspiration runs into the -shoes; and often, from the dust and heat, jumping up and down, and the feet being galled with the small dust, I have had my shoes full of blood. The thirst produced -by our work is very excessive. It is completely as if you had a fever upon you. The dust gets into the throat, and very nearly suffocates you. Yiu taa scrape the coal-dust K)ff the tongue with the teeth i. and, do whrf. you will, it is impossible to get the lea.«r- spittle into the mouth. I have known the coal-dust to be that thick in a ship's hold, that I have been unable to see my mate, though he was only two feet from me. Your legs totter under you. Both before and after I was a teetotcler, I was on( of the strongest men in the business. I was able to carry seven APPENDIX. 247 hundred weight on my back for fifty yards, and I could lift nine half-hundreds with my right arm. After finish- ing my day's work, I was like a child with weakness." Tc the foregoing account, the following may be added from another witness by way of finish to the picture : — " Then there's the coals on your back to be carried up a nasty ladder, or some such contrivance, perhaps twenty feet — and a sack full of coals weighs two cwt. and a stone at least ; the sack itself 's heavy and thick. Isn't that a strain on a man ? No horse could stand it long. Then, when you get fairly out of the ship, you go along planks to the wagon, and must look sharp, 'specially in slippery or wet weather, or you'll topple over, and there's the hospital or workhouse for you. Last week we carried along planks bixty feet, at least. There's nothing extra allowed for distance, but there ought to be. I've sweat to that degree in summer, that I've been tempted to jump into the Thames just to cool myself. The sweat's run into my boots, and I've felt it running down me for hours as I had to trudge along. It makes men bleed at the nose and mouth, this work does. Sometimes we put a bit of coal in our mouths to prevent us biting our tongues." Now it cannot be questioned, that such labor is greater than any man should be called on to perform ; and that, oven if it should be proved that assistance is derived in it'j execution from the use of alcoholic liquors, the fact would not be in the least degree in their favor. For we might fairly anticipate, that, under this artificial stimula- tion, more work being got out of the frame than it is naturally capable of discharging, its powers would be ex- hausted at an earlier period than that to which they would be preserved under a system of less excessive labor, per- formed without artificial support. And that such is the !>,>.»; 248 APPBNDIX. case is abundantly proved by the fact, that sucb of these men as survive the attacks of acute disease, or are not thd subjects of accident, become prematurely old ; and that, among the whole class, there are few who have passed the age of fifty years. The amount of alcoholic liquor habitually consumed by them may be judged of from the following statements made to Mr. Mayhew by two men who have remained firm to the total-abstinence principle* " Before I was a teetotaler, I principally drank ale. I judged that the more I gave for my drink, the better it was. Upon an average I used to drink from three to four pints of ale per day. I used to drink a good drop of gin too. The coal-porters are very partial to dog's-nose — that is, half a pint of ale with a pennyworth of gin in it ; and, when they have got the money, they go up to what they term the * lucky-shop ' for it. The coal-porters take this every morning through the week, when they can afford it. After my work, I used to drink more than when I was at it. I used to sit as long as the house would let me have any. Upon an average, I should say, I used to take three or four pints more of an evening ; so that altogether I think I may fairly say I drank my foar pots of ale regularly every day, and about half a pint of dog's-nose. I reckon my drink used to cost me 13s. a week when I was in work. At times I was a noisy, drunken gentleman then." Another coal-porter, who has been a teetotaler ten years on the 25th of last August, told Mr. M. that before he took the pledge he used to drink a great deal after he had done his work, but while he was at his work he could not stand it. '* I don't think I used to drink more than three pints and a half and a pennyworth of gin in the day- time," said this man. " Of an evening, I used to stop at the public^honse generally till I was drunk, and Unfit to 111 APPENDIX. 249 work in the morning. I will vouch for it, I used to take about three pots a day after I had done work. My reck- oning used to come to about Is. 8d. per day, or, including Sundays, about 10s. 6d. per week. At that time I could average all the year round 30s. a week, and I used to drink away ten of it regularly ! I did indeed, sir, more to my shame.*' It seems a legitimate inference, from the early decay of the physical powers of these men, that no real support is given them by alcoholic liquors, in the performance of their arduous labor ; and it is a remarkable point in the state- ments just quoted, that both agree in the assertion that the principal part of the liquor consumed is taken in the evening, after the day'« toil is over, as they '* could not stand it " whilst at work. Thus it appears that the amount which can be effectively employed as a stimulus to nervo- xnuscular exertion is really small ; and it is further evident that there is an entire absence of proof that any thing is in the end gained by their use ; a conclusion which is in perfect harmony with the statements made in the Essay (§§ S^ — 102), as to the incapacity of alcoholic liquors for maintaining the physical powers of the human system. That some of tiiose who have tried the total-absti- nence system have gone back to their former habits, from a feeling of the necessity of support, is capable of being accounted for, not merely by the excessive amount of labor they are called on to perform, but also by the want of ade- quate sustenance from solid food. A due allowance of this is unquestionably essential to the maintenance of the strength ; and it appears from the testimony of other indi- viduals similarly employed (given in the next Appendix), thai, where this course has been followed, the labor has been performed with more ease, and that the power of endurance has been increased. 260 APPENDIX B, p. 102. I The recent inquiries of the " Commissioner" of the Morning Chronicle not only reveal the circumstances under which a vast amount of excessive drinking takes place among men engaged in laborious employments, but also confirm all that is stated in the text as to the possi- bility of performing the severest labor without such assist- ance, provided due support be obtained from solid food. The follov.'ing is the statement made to Mr. Mayhew by a coal-whipper, who had been a teetotaler of eight years' standing : " It's food only that can give real strength to the frame. I have iune more work since I have been a teetotaler in my eigbc years, than I did in ten or twelve years before. I have felt stronger. I don't say that I do my work better ; but this I will say, without fear of suc- cessful contradiction, that I do my work with more ease to myself, and with more satisfaction to my employer, since I have given over intoxicating drinks. I scaiv.^.!/ know what thiist is. Before I took the pledge, I was always dry ; and the more shadow of the pot-boy was quite sufficient to convince me that I wanted something. I cer- tainly havn't felt weaker since I have left off malt-liquor. I have eaten more and drank less. I live as well now as any of the publicans do ; and who has a better right to do so than the man who works ? I have backed as many as sixty tons in a day since I took the pledge, and have done it without any intoxicating drink with perfect ease to myself, and walked five miles to a temperance .meeting afterwards. But, before I became a teetotaler, after the APPENDIX. 251 of the stances ; takes Its, but i possi- 1 assist- id food, ew by a t years' strength ire been twelve lat I do of suc- ease to ', since ■ know always I quite I cer- •liquor. now as ight to s many d have ease to eeting tor the same amount of work I should scarcely have been able to crawl home. I should have been certain to have lost the next day's work at least; but now I can back that quan- tity of coals week after week without losing a day. I've got a family of six children under twelve years rC ^e. My wife 's a tectoaler, and has suckled four childr( ipon the principle of total abstinence. Teetotalism ha ide my home quite happy, aiid what I get goes twice Where I work now, four of us out of five are teetotalers. I am quite satisfied that the heaviest work that a man can possibly do may be done without a drop of fermented liquor. I say so from my own experience. All kinds of intoxicating drinks is quite a delusion. We teetotalers can do the work better, that is, with more ease to our- selves, than the drinkers can. Many teetotalers have backed coals out of the hold, and I have heard them say over and over again that they did their work with more comfort and ease than they did when they drank intoxi- cating drink. Coal-backing from the ship's hold is the hardest work that it is possible for a man to do. Going up a ladder sixteen feet high, with 238 lbs. weight upon a man's back, is sufficient to kill any one ; indeed, it does kill the men in a few years — they're soon old men at that work." It appears from the statement of this man, — 1st, That he could do more work in the time, on the total-abstinence system, than on his previous system ; 2d, That he could do it with more ease and comfort to himself ; 3d, That at the end of his day's labor he was not too much fatigued to prevent hira from voluntarily walking five miles to a temperance meeting ; whilst (like the first witness cited in the preceding Appendix, who spoke of himself as " like a child with weakness " when his toil was over) he was previously scarce able to crawl home. IMAGE EVALUATION TEST TARGET (MT-3) &^ '^o {./ /.^ ,*> K 1.0 I.I u 2.0 1.8 1.25 JjU ,,.6 < 6" ► V 'Z ^ c*m. ' ^. ''\y '? s> Photographic Sdences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 7 252 APPENDIX C, p. 220. On the Effect of Water-drinking in the Owe of Gout, Ey John Bostock, M.D., FJR.B. •^Cotnmunleated to the Medico- Chirurgical Society. «i The case to -which I propose to direct the attention of the Society is that of a gentleman seventy years of age, ■who had been, from a very early period of his life, subject to very frequent attacks of gout, the predisposition to which complaint is inherited from his parents. Connected with this, he has been a constant sufferer from stomach- affections of various kinds ; acidity, flatulence, heart- bum, irregularity of the bowels, and, in short, from every one of the affections which are enumerated in CuUen's well-known definition of dyspepsia. His mode of life was regular and moderately active ; and his diet, what might be styled temperate, although not abstemious. He had, indeed, been advised by his medical friends to take wine in moderate quantity ; he had occasionally employed ale, porter, and brandy-and-water, but never in what could be considered an excessive quantity. In this way he had passed about forty years, seldom actually confined by indisposition, but almost always subject to a Sttcceseion of ailments, which rendered it necessary to have recourse to medicines of various kinds, and, more especially, to alkalies, which were taken in large quantity, and, as the symptoms appeared to indicate, to purgatives' or to seda- APPENDIX. 253 tives, and to a variety of tonics and stimulants. During this period, the renal secretion was seldom in what could he considered a perfectly healthy state ; it was sometimes loaded with deposits, and of high specific gravity ; some- times of low specific gravity, limpid and aqueous ; sometimes very copious, at other times scanty ; while itf« chemical constitution was most variable both as to the nature and the proportion of its saline contents. '* About four years ago, in consequence of the accession of certain alarming symptoms of a new description, which were supposed to require the antiphlogistic treatment, the patient was ordered by his medical attendants to reduce his system of diet, and more especially to abstain entirely from fermented liquor or distilled spirits of any description. By this restriction, and by other appropriate remedies, the threatened disease was averted. And, be- sides this fortunate result, the patient found his general state of health and feelings so much improved by the change of diet, that the abstinence from all kinds of liquors has been strictly adhered to up to the present period. The effect has been, that he has lost all the dys- peptic symptoms to which he had been subject for upwards of forty years ; and, what I am more particularly desirous of pointing out to the society, the renal secretion has been now, for a long period, in a perfectly natural state : it is nearly uniform in its specific gravity, and is totally free from all the morbid deposits which were before seldom absent from it. And there is a circumstance connected with it, which I conceive to be particularly deserving of attention ; that, although of an average specific gravity, and containing the proper proportion of urea and saline ingredients, it is uniformly increased in quantity, so that there has been now, for several months, considerably more of these substances discharged from the system than was 22 254 APPEKDIX. formerly the case. It would appear, therefore, that the abstraction of alcohol has produced a more healthy state of the digestive and secreting functions ; so that the func- tions of the kidney are more actively and effectively performed." — Medical Gazette, Feb. 23, 1844. To this interesting case, which is understood to be that of Dr. Bostock himself, may be added the following, from the Bristol Temperance Herald : — " Rebecca Griffiths, the individual referred to, resided in this city (Bristol) the larger portion of her long life, and until her eighty-ninth year had daily taken as a beverage some kind of intoxicating drink. Beer, and occasionally gin and water, had been commonly used ; but, for a few years before practising total abstinence, she took daily a small portion of the best Madeira wine; having, perhaps, both as regarded the quantity and quality of the liquor, every advantage that any one could possess in using a stimulating drink. This practice she relin- quished all at once in the eighty-ninth year of her age. For a time, it was feared her health would suffer ; but it was soon manifest that those fears were groundless : her appetite improved with the change of diet, and occasional interruptions by a disordered stomach were much less fre- quent ; she would at times observe that she could eat, drink, and sleep, as well as at almost any period of her life ; nor did her spirits appen* to suffer even temporarily. For nearly fifteen years, she been tried with a sore in one of her legs, which was troublesome, and at times appeared to be dangerous ; after practising teetotalism for about a year and a half, this sore began to diminish, and was soon perfectly healed. At the expiration of two years, she had a rather violent attack of influenza, which brought her so low that her medical attendant recom- APPENDIX. 255 mended wine, to which she had recourse for about six months, when the wound in her leg again opened^ and became troublesome : the wine was, consequently, discon- tinued, and, after the lapse of a few months, the sore again healed up! Her health also improved yet more decidedly than after her first trial of total abstinence ; and she continued, until within a few days of her decease (which took place in the spring of 1843), in the enjoy- ment of excellent health and spirits, and the full posses- sion of nearly all her faculties, although ninety-three years old." THB USE OF ALCOHOL POE THE PREPARATION OF MEDICINES, BY THE EDITOB. In i^ nmnber of the States in this country, laws have been passed prohibiting the sale of alcohol, except for medicine ^nd the arts. In these States the apothecaries have be- come its only regular venders, and some of them have availed themselves of the opportunity thus afforded to retail it to the tippler. This practice partially defeats the operation of the law, and thus threatens to be a public nuisance. The question has naturally arisen. Whether alcohol is a necessary article of the Materia Medica ; and, if 80, to what extent ? Whether, for example, it is not employed in many cases where other articles might be substituted with propriety, and even with advantage ? The principal uses for which alcohol is employed in medicine are, Jtrst^ As a Stimulant ; second^ As a Men- struum ; thirds As an Antiseptic. As a stimulant, it is not so necessary as might at first view appear. When it is employed, for example, to revive a person who is much exhausted, the distilled aro- matic herbs, or a mixture of the essential oils, would answer. Peppermint-water, and the other aromatic waters, by increasing the proportion of the essential o\\m, 22* 268 USB OF ALCOHOL / mty be mado as strong a stimulant as can be swallowed without excoriating the throat. These may often, there- fore, be very properly substituted for brandy. For some other cases, the preparations of ammonia are more proper. Their action is more rapid ; they possess greater stimulant powers ; and the quantity required is therefore less. Second, as a menstruum, alcohol is employed for ex- tracting the virtues of medicinal plants, and dissolving medidnul resins. The substance, being infused in alcohol A certain time, imparts its properties, or a portion of them, to the liquid ; which is then administered, sometimes in a pure state, and sometimes diluted with water. Many people are not aware, that, when they take a glass of elixir proprietatis or of tincture of rhubarb, they swallow two ounces of strong rum. Yet delicate females, and even children, are made to take these daily, and thus become habituated to the use of alcoholic stimulants. The danger arising from such practices in some inflamma- tory complaints must bo very great. The medicinal resins for which alcohol is used as a sol- vent are aloes, myrrh, guaiacum, dec. The tincture formed by the combination of alcohol and the first two of these is the famous " Elixir Pro." which, in former times, every good mother thought herself obliged to prepare and keep for the benefit of her young family. Many an unconscious mother has brought on symptoms of violent fever by intoxicating her offspring with these insidious articles. Now, for these there are substitutes, which may be employed in the greater number of instances. An infu- •ion of rhubarb in water, with some aromatic, is a better medicine than the alcoholic preparation in three cases out of fourt Aloes may be used as an extract in pills, and may be employed in the simpler state of powder, and even in decoction ; so that there are, in fact, very few, if any, FOR THE PREPARATION OF MEDICINES. 259 cases where the spirituous preparation is required. It is a common opinion, indeed, that tincture of aloes and myrrh, or elixir proprietatis, is an excellent remedy for colic. If it be used in a colic from indigestion, the astrin- gent property of the alcohol may, by contracting the stomach on undigested food, increase the pain ; and the same is true of brandy, gin, and other forms of alco- hol. If, again, it be used for w'nd-colic, or pain from flatulence, drinks actually hot, as hot peppermint- water, or even simple hot water, are preferable. Tincture of cinchona, or " tincture of bark," as it was formerly called, contains less tonic power* than may be found in the pre- parations of quinine ; and the same may be said of most of the bitter tinctures, as calumba and cascarilla. Tinc- ture of red lavender poured upon loaf-sugar has been a favorite cordial with young ladies who wish to fortify their stomachs against any particular emergency, and it is notorious that this indulgence has been a very frequent origin of tippling. If, instead of taking lavender to re- lieve the stomach, they omitted the use of sugar-plums and bon hons, they might experience neither the disposi- tion for, nor the ill consequences arising from, alcoholic articles. Stoughton's elixir, which is the same ac ;l.o tincture of gentian, was regularly introduced into the draw- ing-room during the last generation to give keenness to the appetite for an approaching feast. But at last it was discovered, that, by overstimulating the empty and unpro- tected organ, and producing a sense of satiety before any food was taken, instead of quickening the appetite or aiding the digestion, it blunted the one and enfeebled the other. Our epicures, having sagaciously observed these disagreeable effects, have proposed to tickle and awaken the stomach by the introduction of a large cold oyster or two. The best substitute for both of these will 260 US£ OF ALCOHOIi / be found in half a glass of water, fresh as it comes from the spring, and not spoiled by ice. The cases above mentioned will perhaps be thought sufficient to show how easy it often is to find substitutes for alcoholic medicines. There is a class of preparations, revealed by science, which promises great advantages as a substitute for the tinctures. In the number of the ** Boston Medical and Surgical Journal" for September 5, 1849, will be found an account of a mode of producing a fermentation, by which is generated a substance containing the properties of medicinal articles in a convenient state for administra- tion and preservation. By adding to an infusion of senna a due proportion of sugar, a fermentation is generated which produces a vinous fluid, so weak as not to possess any important stimulant properties, and yet strong enough to prevent decomposition. This preparation we have tried, and find elegant, convenient, and safe. It cannot be used for the purposes of intoxication, on account of its weak- ness and medicinal effect. Various preparations — as, for example, aloes, opium, gentian, rhubarb, and many others most necessary in medical practice — may be made in the same way. Perhaps it will be thought that they are no better than tinctures ; but, in fact, they have not the strength of tinctures. No extraneous alcohol is intro- duced. We recommend to the enterprising apothecary the preparation of these products of fermentation as pro- mising much advantage to the medical practitioner, and a valuable improvement in economy to the apothecary himself. A third use of alcohol is to prevent decomposition. For this purpose it is added to some infusions, decoctions, and syrups. The two former of these should always be prepared recently and without alcohol; and the last, if properly made, do not require it. '. r, FOR THB PREPARATION OF MEDICINES. 261 Physicians have been among the most forward, perse- vering, and able advocates of temperance. Without their aid, the temperance reformation could never have pro- ceeded as far as it has. But it appears there is an evil existing under their eyes, and, in a measure, maintained by their prescriptions, which has become formidable to the public morals. If they would take the matter into con- sideration, and satisfy their own minds when alcoholic preparations are really required, their prescriptions would undoubtedly be much more restricted than they now are in the employment of the tinctures. The facts so briefly stated above will probably be sufficient to convince them, that they might, with a very little sacrifice of convenience, employ substitutes more beneficial to the patient, and less objectionable on the ground of temperance ; and they would have the satisfaction of believing, that they have removed from the reach of their patients an article which might, by slow and insidious steps, have ultimately led to their ruin. Note. -^ Some of the Pharmaeopceias direct that spirit should be added to infusions to prevent decomposition, when they are to be kept any length of time. This may be accomplished without alcohol, by placing the infusion, while hot, in a closely stopped bottle, and keeping it in a cool place. 262 MEDICAL CERTIHCATE. Thtt 4fMMM(, ifwkieh a copy u given at page xxiii. has already bten mbierUii ty MlMiut flOOO MeUieul PractUwMers, among toAum are the fultvwing i — A4»mii, M«%. Maxwell, M.n. ProfeMor, A4(llM»n, T. M.o. Senior PliyRiriBn to Uuf*t HiMiplliil AM^Htn, Win. m.d. r.ii.i. k,c. London AtkmMn, dou burgeon, Ea«t Linton, Ilii4din||l4in)«hlr« AllMtN, W. P. M.D. ProfeiMr of the frtMUlcn of Pliyitic and Clinical Me- iieim in the Unlvenily of Edin- burgh, ind Phyiicinn to the auoen AlMl«r»on, Ales. Burgeon, Tranent, llMidingtonnliIre Amslt, i. MoncrlefT, r.ii.i. Vice-Presi- 4«Ht of the Riiynl College of Sur- |«Mii of England, Ilc. 'x. Arnott, Neil, m.d. r.n.: Physician £«('. to the Queen ) Author of " £le- in«Ht« of Pliyitlc))," Ijondun Bftlilngton, Dun. Guy, m.d. r.iki. Pby- •i«lNfl to Guy's Hospital illy, WllllHtn, M.D. r. R.». Physician to th« Mill-lmnk Prison, London BftrtMr, iohn, M.n.o.s. Aldborough, iilfliflk PmUIo, Wlllliim. M.D. Edinburgh and Londott, Pliyslcian Extraordinary to hiu iMto Mnjesty William IV. &c. &c. liONdon DtwutHOfit, Thos. Surgeon, Bradford, Yorkshire B«ll, L'liM. W. M.D. Physician to the Mflnehester Hoynl Inflrmnry Billlflg, A. M.o r.R.s. late Senior Phy- Mieintt to the London Hospital Bo«(o«k, John, m.d. r.H.s. Bowiimti, W, r.R.a. Professor of Phy- «k*iogy In King's (College, London Bright, ttiehard, m.d. r.a.s. Physician £«lr. to the Queen, Consulting Phy- •tolUtt to Ouy's Hospital Brodie, Sir Ren. C. Bart r.a.s. Ser- geant-Surgeon to the Queen Buchanan, M. S. m.d. Professor of Anatomy in the Andersonian Uni- versity, Glasgow Budd,0. M.D. r.R.i. Physician to King's College Hospital, London Burn, J. M.D. Edinburgh Burnett, Sir W. m.u. r.>.t. Phyitetan- General to the Navy, itc. &c Burrows, Geo. m d p.r.i. Physician t* St. Uartholumew's Hospital Carmichael R. r.R.t. M.a.i.*. Dublin Carpenter, W. B. m.d. r.a.s. &e. ttt. London Chalmers, Wm. m d. late Physician to the Royal Infirmary of Glaagow, Croydon, Surrey Chambers, Wni. F. m.d. f.r.s. Phyal- cian to the Queen and to the Queen Dowager Clark, Sir James, Bnrt. m.o. F.R.i. Phy- sician in Ordinary to the Queen and his Royal Highness Prince Albert riay, Chas. m.d. Editor of the •' Bri- tish Record of Obstetric Medicine '* Clanny,Wm- R. m.d. f.r.i. Edinburgh, Consulting Physiciun to the Sunder- land Inflrmnry Cluley, Wm. h.r.c.s. Ashton-under- Lyne, Lancashire Collenette, B. m.r.u.8. Guernsey Collet, H. J. M.R.c.s. Worthing, Sussex Combe, And. m.d. Physician in Ordi- nary to the Queen for Scotland Cooke, Wm. m.d. h.r.c.8. tec. London Copland, James, m d. f.r §. Author of " Dictionary of Practical Medicine " Couper, John, m.d. Professor of Mat»- ria Medica in the University of Glaa- gow MEDICAL CERTIFIOATB. 268 Courtney, A. m.r.o.i. late Surgeon, R.N. RnmKgale Cnimptun, Sir Philip, Rort. m.d. r.iut. Burgeon-Uunural lu the FurccH, Ire- land Crl«p, Edwards, m.d. m.iuc.*. London Crlap, Fred. A. n.ii.ct. Walwortb, Surrey Currle, Claud, Surg.-Oeneral, Madraii Daviei, J. B. m.d. Senior Physician to Queen's ilogpital, UirininKham Duncan, Robt. m.d. m.k.c.i. Tunbridgo Well* Ed!!n, T. M.n.c.a. Liverpool Eyre, Sir Jaa. m.d. h.r.c.i. I^ndon Farre, Arthur, m.o. r.iut. Profu88ur of Midwifery in Kiiig'd College, I. Professor of General Pittliology in the University of Edinburgh Ilick.'t, U. SuriS'f'n, London lligginbottom, John, f.r.c.i. Author of " Alcohol as a Medicine," he Not- tingham HilU, Geo. M.n.o.s. Arundel, Sussei Hingriton, Andrew, M.a.e.s. Llskeard, Cornwall Hinffston, Richard, Surgeon, Cornwall Hofmunn, A. VV. ProfcHHur to the Royal College of t'h'Mnistry, London Holland, G. C. m.d. Physician Extr. to tlie Sheffield General Infirmary Holland, Henry, m.d. p.R.t. Physician Extraordinary to the Queen ; Author of" Medical Notes and Reflections" Hue, C. M.D. r.ii.c.p. Senior Physician tu St. nartiiultiiiii w'd IIo:ipital Hume, Joiseph, m.d. and M.r. Hunter, Robert, M.D. F.a.c.p. Cdin. and Lecturer on Anatomy, Glasgow Jeffreys, Julius, f.h.s. f.o.s. he. he London Judd, W. H. F.R.C.B. Surgeon in Ordi- nary to II. R. II. Prince Albert Key, C. Aston, f.r.s. Senior Surgeon to Guy'ii Hoi^pital Kiernnn, Fran. F,R.a. f.r c.s. he. he, London Kirk, James R. m o. Glasgow Latliam, P. M. m.d. Physician Extraor- dinary to the Queen, late Physician to St. Uartholomcw'ii Hospital Lnurie, James A. m.d. Surgeon to the Glasgow Royal Infirmary Little, W. J. M.D. Physician to the London Hospital 264 MEDICAL CBBTIFICATB. / Lonsdale, H. k.d. r.iuo.r. Edinburgh, Physician to the Cumlwrland Infir- mary, Carliala MKSregor, Sir James, Bait if.o. r.B.i. Director-General of the Army Medi- cal Department H'Kenzie, Wm. m.d. Surgeon-Octtlist to her M^iJeflty, Glasgow Mantel!, G. A. uuo. r.a.i. r.ii.o.t. Lon- don Marsh, Sir H. Bart if.D. Physician to the Queen, Dublin Moore, G. if.D. Author of " Man and his Motives," &c Tunbridge Wells Mudge, H. if.K.c.1. Burgeon to the Hos- pital and Dispensary, Boduiin, Corn- wall Munro, Sir Alex. ii.d. late Professor of Anatomy in the University of Edin. Newth, Geo. Elisha, m R.c.f. Edin- burgh, Assistant-Accoucheur to St Thomas's Hospital, London Oxley, W. 1I.D. Hackney, Middlesex Paris, J. A. h.d. f.r.s. President of the Boyal College of Physicians, Lond. Percy, John, if.o. f.r.s. Professor of Chemistry, Queen's College, Bir- mingham Pereira, Jonathan, ii.d. r.>.s. Assistant- Physician to the Lond. Hospital, &c. Peny, Uobt m.d. Physician to the Glas- gow Eoyal Infirmary Pettigrew, 1'. J. f.b.i. r.iuc.s. &c. &c. London Prout, Wm. if.D. r.B.s. Author of *' Sto- mach and Renal Diseases," &c. Reid, John, m.d. Professor of Anatomy in the University of St. Andrews Roget, P. M. M.D. r.ius. London Roupell, G. L. M.D. F.B.S. Physician to St. Bartholomew's Hospital Eoyle, J. F. m.d. f.r.s. Prof, of Materia Medica in King's College, London Sladen, Ramsay, Phys.-Gen. Madras Sleman, R. m.iuc.s. Tavistock, Devon Smith, A. M.D. Deputy-Inspector of Army Hospitals Snow, John, m.o. Vice-President of the Westminster Medical Society, Lond. Syme, J. m.d. Professor of Clinical Surgery in the University of Edin- burgh, and Surgeon to thejQueea for Scotland Tatum, T. F.i.o.t. Surgeon to Bt George's Hospital Taylor, Alfred S. F.i.i. Professor of Medical Jurisprudence and Chemb- try in Guy's Hospital Taylor, John, m.d. Professor of Natu- ral Philosophy in the Andersonian University, Glasgow Thomson, John, m.d. Hamilton, La* narkshire Thomson, Robt. Dundas, k.d. Profes* Bor of Chemistry in the University of Glasgow Toone, John, H.a.c.s. Salisbury Toynbee, Joseph, f.b.s. f.b.o.s. Lond. Tweedie, A. m.d. f.r.*. Physician to the Fever and to the Foundling Hos- pital, London Ure, And. m.d. F.i.i. London Ure, Alexander, f.k.c.s. London Watson, James, U. m.o. Tranent, Had- dingtonshire Watson, Thomas, h.d. f.i.c.f. Con- sulting Physician to King's College Hospital, London Webster, G. h.d. M.ii.o.i. Edinburgh, Dulwicb, Surrey Whitfeld, H. m.iuc.s. Ashford, Kent Whittle, Edward John, Surgeon, Lam- berhurst, Sussex Wilkins, Ignatius, m.i.o.s. Wade> bridge, Cornwall Williams, C. J. B. m.d. f.b.s. Pro£ of Medicine in the University of Lond. Wilson, Erasmus, F.s.i. f.b.o.s. &e. &.C. London Winslow, Forbes, h.d. m.b.o.s. Editor of the "Journal of Psychological Medicine and Mental Pathology," London Wood, Andrew, h.d. f.i.o.s. Edin. Wright, Samuel, m.d. vuo. Physician to Queen's College, Birmingham Young, J. Forbes, m.d. Kennington, Surrey.