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 Volinries of the Series. 
 
 EXERCISE AND TRAINING. 
 
 (Illustrated.) 
 ALCOHOL: Its Use and Abuse. 
 
 THE HOUSE AND ITS SUR- 
 ROUNDINGS. 
 
 PREMAIURE DEATH: Its Pro- 
 motion OR Prevention. 
 
 PERSONAL APPEARANCES IN 
 HEALTH AND DISEASE. 
 (Illustrated.) 
 
 BATHS AND BATHING. 
 
 THE HEART AND ITS FUNC 
 
 TIONS. 
 THE HEAD. 
 CLOTHING AND DRESS. 
 WATER. 
 
 THE SKIN AND ITS TROUBLES. 
 FATIGUE AND PAIN. 
 THE EAR AND HEARING. 
 THE EYE AIND VISION. 
 TEMPER.'\TURE IN HEALTH 
 
 AND DISEASE. 
 
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 HEALTH PRIMERS. 
 
 No. 2.
 
 HEALTH PRIMERS. 
 
 Vclum^s already published : 
 
 No. I. EXERCISE AND TRAINING. 
 " 2. ALCOHOL : ITS USE AND ABUSE. 
 " 3. THE HOUSE AND ITS SURROUNDINGS 
 " 4. PREMATURE DEATH : ITS PROMOTION 
 
 OR PREVENTION. 
 " 5. PERSONAL APPEARANCE IN HEALTH 
 
 AND DISEASE. 
 " 6. BATHS AND BATHING. 
 " 7. THE SKIN AND ITS TROUBLES. 
 " 8. THE HEART AND ITS FUNCTION. 
 " 9. THE NERVOUS SYSTEM. 
 
 Square i6mo. Cloth. Pric6t 40 cents each.
 
 HEAL TH PRIMERS. 
 
 1 r// 
 
 ALCOHOL: 
 
 ITS USE AND ABUSE. 
 
 BY 
 
 W. S. GREENFIELD, M. D. 
 
 NEW YORK: 
 
 D. APPLETON AND COMPANY, 
 
 I, 3, AND 5 BOND STREET. 
 
 1887.
 
 
 CONTENTS. 
 
 PACK 
 
 Introduction 5 
 
 Alcohol and Alcoholic Beverages 8 
 
 The Physiological Action of Alcohol i8 
 
 The Effect? of Alcohol when taken in Excess. . 32 
 
 The Uses of Alcohol and Alcoholic Beverages . 61 
 
 Alcohol in Ill-health and Disease 79 
 
 The Right Use of Alcohol ........ gi
 
 ALCOHOL: 
 
 ITS USE AND ABUSE. 
 
 INTRODUCTION. 
 
 The attempt to present in a popular form a subject on 
 which so much has been said, and written, on which so 
 great a variety of opinion exists, and by which such strong 
 feelings and prejudices are excited, as that of the use of 
 alcohol, may by many be considered a rash one. But 
 seeing how important the subject is to the general health 
 and welfare of the community, and how little real influ- 
 ence our store of medical and physiological knowledge 
 has had upon the habits of our countrymen, notwith- 
 standing the eminence and ability of those who have 
 written upon the subject, it seems to be a duty to endea- 
 vour to place the more important facts within the reach 
 of all in a simple form. 
 
 There is no subject relating to health which has a 
 greater practical importance, nor any on which more 
 misconceptions exist. In a perfect community, governed 
 by pure religion, morality, and intelligence, with no
 
 6 ALCOHOL : ITS USE AND ABUSE. 
 
 artificial habits, and no passions or vices, the use of 
 intoxicating Hquors would need no check; but in our 
 actual state, all experience shows the dangers which 
 may and do result from their abuse. But, as an ex- 
 ample of the many wrong ideas which exist as to what 
 excess is, there are few, except medical men, who know 
 what serious injury may be done by drinking which hardly 
 ever approaches intoxication, and which may be unre- 
 cognised by a man's nearest friends. AVe shall try to 
 show what is the evil of drinking, and how to avoid it, 
 what the good and how to gain it, without joining in a 
 universal condemnation of the use of alcohol. 
 
 In the limits of our space we can only touch on the 
 great questions involved ; we must leave for the medical 
 profession the study of the accumulated stores of scien- 
 tific observation on the use of alcohol and the results of 
 its abuse, from which we shall only draw such facts as 
 may seem to be most useful for our purpose ; nor can we 
 even refer more than cursorily to the views of those whose 
 scientific and moral eminence lends weight to their 
 opinion as to the usefulness or injuriousness of alcohol. 
 But we shall endeavour to give such reference to more 
 extensive works as may prove of service to those who 
 seek the higher fountainheads of information. 
 
 Nor let it be supposed that because we do not advocate 
 or condemn total abstinence, we are to be counted either 
 amongst its opponents or supporters, or that we are blind
 
 ALCOHOL : ITS USE AND ABUSE. 7 
 
 to the great moral importance of the teetotal question. 
 We believe that an intelligent comprehension of the 
 action of alcohol on the system will always have greater 
 influence with thoughtful men in promoting temperance 
 than any adhesion to a dogma. Moreover, we have no 
 doubt that the moral and social arguments for total absti- 
 nence, which are after all its strongest weapons, but which 
 lie beyond the province of our subject, will be strength- 
 ened by a calm consideration of what we know of the 
 effects of alcohol in health and disease. 
 
 It will be our endeavour to regard the subject mainly 
 from a scientific and practical point of view, to state 
 what is known of the effects of alcohol on the body, the 
 results of its abuse, and the right occasions and methods 
 of its use, and to draw only such conclusions as are 
 warranted by experience on the ground of preservation 
 of health, avoiding the numerous other topics which 
 arise in connexion with the subject of drinking. 
 
 Our subject being Alcohol : its use and abuse, we may 
 first ask what alcohol is, in what way it is usually taken, 
 and how much is contained in ordinary drinks. Then we 
 may examine its action on the healthy system, and see 
 what powers it possesses — its so-c3.\lQd/>/iysio/ogicala.ction. 
 Further, we shall see what is its effect when taken in 
 excess, either for a time or habitually. And, finally, 
 having seen what good it can effect and what mischief it 
 may do, we shall be in a position to study its use in
 
 8 ALCOHOL : ITS USE AND ABUSE. 
 
 health or disease, and draw such general inferences as 
 may guide us in our ordinary habits. 
 
 CHAPTER I. 
 
 ALCOHOL AND ALCOHOLIC BEVERAGES.^ 
 
 Nearly all the intoxicating drinks used by man depend 
 for their peculiar properties on the presence of a sub- 
 stance known to chemists as alcoJiol, This is associated 
 in many cases with other bodies called ethers^ which are 
 also intoxicating, and it is more or less largely diluted with 
 water, and combined or mixed with various substances 
 which give colour, taste, and smell, or which are nutri- 
 tious, such as sugar and starchy bodies, or which have 
 other chemical properties. The amount of alcohol in 
 drinks (to be more precisely stated later) varies from i 
 part in 70 (in small beer) to more than i in 2 (in strong 
 whisky) ; but it can equally be obtained from all by 
 distillation. 
 
 ^ Pure alcohol as obtained by the chemist is a colourless 
 volatile liquid, with a faint pleasant odour and but little 
 taste. It is lighter in weight than water, its specific 
 gravity being 796, boiling at 172° Fahr., and it is not 
 frozen by a cold of— 166° Fahr. If a few drops of it be 
 placed on the hand it evaporates, producing a sensation 
 of cold and slight tingling. It readily bums with a colour- 
 less flame. It has a strong attraction for water, so that,
 
 ALCOHOL : ITS USE AND ABUSE. 9 
 
 if in a moist atmosphere, it dilutes itself by combining 
 with water; and if cold pure alcohol and water are 
 mixed, slight warmth is produced by their combination. 
 On account of this property, and of preventing putre- 
 faction, strong spirit is used to preserve animal and 
 vegetable bodies and tissues, such as the various creatures 
 seen in museum jars, fruits for the housewife, &c. And 
 it very rapidly dries out the water from anything with 
 which it comes in contact. 
 
 Chemists tell us that this common or ''ethylic" alcohol 
 ^s made up of three elements, carbon, hydrogen, and 
 oxygen, and they represent its composition by the formula 
 CgHgO. i When burnt with air or oxygen, it produces 
 water "and a substance called carbonic acid, which is 
 identical with one of the gases constantly breathed out 
 from our lungs ; formed, too, by burning coal, gas, oil, or 
 wood, charcoal, or coke, &c., and which is the substance 
 in the air which makes it impure, unfit for breathing, and 
 necessitates ventilation.* 
 
 In whatever shape it is found naturally alcohol always 
 results from the process of fermentation of substances 
 containing sugar^j and though the chemist can, by com- 
 plicated processes, build it up in small quantities out of 
 its original elements, this need not enter into our calcu- 
 lations. To prepare pure alcohol from any of these fer- 
 mentation products repeated distillation and other means 
 * For other chemical details see works on Chemistiy.
 
 lo alcohol: its use and abuse. 
 
 of purification are necessary, to free it from other volatile 
 substances and also from water, which it holds with great 
 tenacity; but strong spirits (containing from 70 to 90 per 
 cent, of alcohol) can be obtained pretty readily. 
 
 For purposes of diet, alcohol is always used in combi- 
 nation, and the majority of liquors contain a considerable 
 number of other substances, held in solution by water ; 
 and the alcohol is probably combined more or less inti- 
 mately with these other ingredients. The more important 
 bodies are called " ethers " — bodies allied to alcohol, and 
 also formed in fermentation or by subsequent chemical 
 changes in the alcohol. It is to these that most of the 
 special odours and '* bouquet " of wines and spirits are 
 due ; and they give peculiar stimulating and intoxicating 
 powers to some wines, even when in small quantity. 
 Other " alcohols," differing in composition, but analogous 
 in nature to ethylic alcohol, ^'' vieihylicl' '''• aiitylic^' &c., 
 are produced in small quantity in some fermentations; 
 e.g., amylic alcohol is the '^ fusel oil" which constitutes 
 an impurity in whisky. They are all more deleterious 
 than ethylic alcohol, and have special poisonous 
 properties. 
 
 Besides these, the liquor contains usually colouring 
 matter, and more or less starchy and saccharine matter, 
 with various saline bodies, such as common salt, salt of 
 tartar, &c., and some essential oils. To give in any 
 detail the various constituents of each and their propor-
 
 ALCOHOL : ITS USE AND ABUSE. 
 
 II 
 
 tlon would much exceed our limits. In a general way 
 we may say that spirits, brandy, whisky, and gin, contain, 
 if pure, no starch and very little sugar; rum, more 
 sugar; wines, chiefly saccharine and saline bodies with 
 ethers and essential oils; ale, stout, and porter, much 
 starchy and " extractive " matter. 
 
 Amount of Alcohol in various Liquors. — This is the 
 most important practical point for our purpose. Later 
 we must consider the other ingredients and their action. 
 
 The following table gives the average percentage of 
 alcohol in some of the commoner beverages : — * 
 
 Whisky . . 
 
 . . 50 to 60 
 
 Claret- 
 
 
 Brandy , . 
 
 . . 50 to 60 
 
 Strongest Bordeau 
 
 X 17 
 
 Rum , . , 
 
 . . 60 to 77., 
 
 Mean . 
 
 • 15 
 
 Gin . . . 
 
 . 49 to 60 
 
 Vin ordinaire . 
 
 S or 9 
 
 Port Wine — 
 
 
 Champagne . . 
 
 . 5 to 13 
 
 Strongest . 
 Ordinary . 
 Weakest . 
 
 . • 25 
 . 23 
 . 16-5 
 
 Hock . . . . 
 Sauterne . 
 Cider .... 
 
 Ale- 
 
 9 to 12 
 14 
 5 to 10 
 
 Madeira . . 
 
 . . 16 to 22 
 
 Burton . . 
 
 9 
 
 
 
 Ordinary 
 
 3 to 5 
 
 Sherry — 
 
 
 Perry .... 
 
 7 
 
 Strongest . 
 
 • 25 
 
 Brown Stout . 
 
 6 to 7 
 
 Weakest . . 
 
 . 16 
 
 London Porter . 
 
 4-2 
 
 Burgundy 
 
 . 10 to 14 
 
 London Small Beer . 
 
 1-28 
 
 * The statements here are taken from the most recent and 
 Uiistworthy sources. There is a good deal of difference in the
 
 12 alcohol: its use and abuse. 
 
 It is only right to say that this table gives only approxi- 
 mate results, for the quantity of alcohol in wines or beers 
 of the same name differs very greatly ; there is no fixed 
 standard. Perhaps the most useful way of putting the 
 quantity of alcohol is to say how many ounces of the 
 beverage contain about one ounce of alcohol. The 
 largest quantity of alcohol which can be taken per 
 diem without evident ill effects is, according to Dr. 
 Parkes, ijoz. 
 
 From our table we see that i ounce v/ould be contained 
 in about 4 or 5 ounces of port or sherry, and from 6 to 
 10 ounces of claret or hock, and 12 to 20 of ale or stout. 
 The varying size of wine-glasses renders any certain state- 
 ment as to the number of glasses which make up this 
 amount impossible ; but two glasses of port or sherry, or 
 two or three glasses of claret, represent it pretty nearly. 
 Half a pint of Burton ale, or a pint of ordinary ale, would 
 nearly contain it. Some of the lighter ales and common 
 porter contain much less. Hence, for i ^ ounce of alcohol, 
 we may reckon three or four glasses of port or sherry ; 
 three to five of claret ; two glasses of Burton ale ; one and 
 
 figures given by different authorities. The amount is here given by 
 volufne, not by weight. It is idle to give decimals when the per- 
 centage is so variable. For other tables showing the analysis of a 
 large number of wines, &c., and for more accurate calculations, see 
 Thudichum and Dupre ('Origin, Nature, and Use of Wines,' i872)t
 
 alcohol: its use and abuse. 13 
 
 a half to two pints of common ale ; and perhaps two to 
 three pints of the very weakest ale. But we must bear 
 in mind that this is the outside hmit, and represents the 
 quantity which just fails to produce any obvious diminu- 
 tion of work in healthy men ; whether it does not cause 
 some deterioration of the organs is another question. 
 
 But it is not merely the amount of alcohol which is 
 important; its action is partly controlled by its state of 
 combination. A pint of brandy-and-water, of such 
 strength as to contain only as much alcohol as a pint of 
 beer, will yet act somewhat differently; and there are 
 other substances in beers and wines which variously in- 
 fluence both nutrition and digestion. 
 
 The composition and special properties of some of 
 these may with advantage be briefly reviewed. 
 
 Beer. — An average sample of beer contains in 20 ounces 
 (i pint)— 
 
 Alcohol I oz. 
 
 Extractives, dextrine, and sugar . . 1*2 ,, (524 grains) 
 
 Free acid (lactic, acetic, gallic, and 
 
 malic acid) 25 grains. 
 
 Salts (alkaline chlorides and phos- 
 phates) 13 ,» 
 
 Carbonic acid and volatile and essential 
 oils. 
 
 Porter contains caramel (burnt sugar), and usually more 
 dextrine and sugar than ale.
 
 14 ALCOHOL : ITS USE AND ABUSE. 
 
 Sj>edal action of Beers. — According to Dr. Parkes, the 
 special physiological action of beer is to lessen the excre- 
 tion (removal by the organs) of the products of tissue 
 change, both urea, the waste nitrogen product carried off 
 by the kidneys, and carbonic acid, the waste carbon pro- 
 duct given off from the lungs. This action is not due to 
 the alcohol contained, but to some other substance. 
 
 A daily excess of beer, as all know, leads to a state of 
 fulness and plethora, and a great accumulation of fat. 
 This is partly due to a check in the proper nutritive 
 changes in the tissues, partly to increased supply of fat- 
 forming substances. The waste products are imperfectly 
 burnt off, and accumulate in the system, giving rise to 
 gouty and bilious disorders. 
 
 The use of beer in moderation answers several pur- 
 poses besides the action of the alcohol : it supplies sub- 
 stances which are nutrient and fat-forming, and lessens 
 the destruction of fat, and thus increases the weight of 
 the body. The free acids and the bitter extractive 
 matters, which are chiefly derived from the hops, are 
 useful as stomachic tonics and serve to promote di- 
 gestion. The salts also assist in nutrition, though in 
 what manner we do not know. In moderation, there- 
 fore, beer is undoubtedly useful to many. 
 
 Wines. — Wines, as we have said, vary very greatly in 
 their composition, and so widely, that we could not give
 
 ALCOHOL : ITS USE AND ABUSE. 1 5 
 
 even the average composition of any one sort of wine to 
 serve any useful purpose. 
 
 Wines alter much by keeping ; they undergo important 
 chemical changes. Red wines contain a good deal of 
 tannin, derived from the grape-skins ; this is in great part 
 precipitated with some colouring matter ; and tartrate of 
 potash is also gradually precipitated. Some of the sui^ar 
 undergoes complex chemical changes, and with the 
 alcohol forms ethers, which give bouquet to the wine; 
 part also of the alcohol is lost by gradual evaporation. 
 Hence old wine is much less rich in sugar and alcohol, 
 and contains less astringent and saline matter than young 
 and fruity wine, but more ethers. Hence the properties 
 of any given wine alter very much with age. 
 
 Although the chemical constitution of the alcohol con- 
 tained in wines is the same as that in spirits, there can 
 be no doubt that the action is very different from that of 
 spirits, as we have already said. Tissue degeneration is 
 much less readily produced when the alcohol is thus 
 taken. 
 
 The vegetable salts contained in wine, especially in 
 the natural light red wines, serve in some cases a very 
 useful purpose. According to Dr. Parkes they are highly 
 " anti-scorbutic," that is, they prevent the occurrence of 
 scurvy. Scurvy is produced by the want of vegetable 
 salts, which, either by fresh vegetables or juice of fruits
 
 l6 ALCOHOL : ITS USE AND ABUSE. 
 
 (e.g., lime-juice), must be supplied to the body. " In a 
 campaign the issue of red wines should never be omitted." 
 (Parkes.) 
 
 The ethers have peculiar rapid stimulant qualities, and 
 they are believed to promote the absorption of fat by 
 exciting the secretion of the J^ancrcas, one of the organs 
 which manufactures a digestive fluid which especially 
 acts upon fat. According to the late Dr. Anstie, the 
 ethers are of especial value as stimulants in diseases of 
 children, and to aged persons. 
 
 A great deal of the difference in digestibility of wines 
 depends upon the quantity of sugar and free acids and 
 acid salts. The tannin also has a peculiar astringent 
 effect, which in some cases aids, in others deranges 
 digestion. 
 
 It would be easy to say a great deal about the effects 
 popularly attributed to various liquors, and with some 
 show of reason. Science certainly lags behind experi- 
 ence in this matter, as in many others. We know more of 
 the effects of liquor upon disease and in producing disease 
 than of some other actions. Gin and whisky have a 
 peculiar action upon the kidneys and skin, because they 
 contain certain substances in addition to alcohol which 
 act upon those organs ; pale brandy is more beneficial in 
 allaying sickness than is rum ; rum fattens more than gin, 
 and the like. We can at least give plausible reasons for
 
 alcohol: its use and abuse. 17 
 
 these facts. Absinthe hqueur gives rise to a peculiar 
 form of mania, and to epilepsy, which are accounted for 
 by the direct action of the absinthe. But why is it that, 
 as is asserted and maintained, not only by popular belief 
 but by statistics, that in countries and districts in which 
 white wine is produced and drunk there are far more 
 crimes of violence under the influence of liquor than 
 where red wine is habitually taken ; that natural white 
 wines have so different an action from red of equal 
 alcoholic strength? And whence arises the belief, sup- 
 ported we believe by experience, that white wine is more 
 *' heating " than red ? * 
 
 Nor have we space to do more than mention the varied 
 mental effects produced by drinking different liquors. It 
 is a popular belief that authors who take wine or spirits 
 to promote the flow of thought and invention, and stimu- 
 late them in their work, have the mental product coloured 
 by the kind of stimulant they take. Poets have from 
 early ages been charged with the failing of drawing 
 
 * Those who make Alpine ascents will have noticed that steady- 
 guides usually take red wine to dr nk whilst on the climb, reserving 
 a bottle of white wine to drink when the summit has been reached, 
 and the party is resting exposed to cold air. They maintain that 
 for warmth only is white wine to be taken. Those interested in 
 practical experience should question some of the best Swiss guides 
 as to the different action of wines and spirits. We have had some 
 very interesting chats on the subject above the snow line.
 
 l8 ALCOHOL : ITS USE AND ABUSE. 
 
 inspiration from wine ; and even the divine Homer has 
 been called "Vinosus Homerus."* A hke charge has 
 been made against many poets since ; in some cases, it 
 must be feared with too m^ach truth, in the cases of Byron, 
 Campbell, and Edgar Allan Poe, for example. But we 
 have no exact knowledge of the relative mental effects of 
 different stimulants ; we point it out only as a subject 
 worthy of inquiry. 
 
 We may postpone the consideration of the choice of a 
 beverage until we have further discussed the action of 
 alcohol. 
 
 CHAPTER n. 
 
 THE PHYSIOLOGICAL ACTION OF ALCOHOL. 
 
 By this we mean its action on the body in a state of 
 health — how it modifies the natural actions of life, such 
 as the circulation, the power of feeling, movement, and 
 
 * ... Si credis, . . . 
 
 Nulla placere diu, nee vivere carmina possunt, 
 Quae scribuntur aquae potoiibus. . . . 
 
 Laudibus arguitur vini vinosus Homerus : 
 Ennius ipse pater nunquam nisi potus ad arma 
 Prosiluit dicenda. 
 
 Horace, Epist. lib. i., xix. 1-9.
 
 alcohol: its ,use and abuse. 19 
 
 «o on. And here we must only very briefly speak of some 
 of the more important effects which are observed by ex- 
 periment. Let any one who knows how many and various 
 are the natural actions which go on in the body, consider 
 what a multitude of effects such an agent as alcohol might 
 produce in different doses, and he will see how complex 
 the subject is. And we shall have to mention a great 
 many of these effects again from time to time, so need 
 not so fully discuss them here. 
 
 The effect of alcohol differs as it is given in a small 
 dose, a repetition of small doses, or a large dose at once. 
 The most important direct actions are upon the circulation 
 of the blood, and upon the nervous system. 
 
 Absorption of Alcohol. — When alcohol is taken in any 
 form into the stomach, it is taken up by the minute, 
 so-called capillary, or hair-like blood-vessels which 
 ramify in ifs~sfructure ; from them it gets into the larger 
 , vessels or veins, and is conveyed to the heart. The 
 "heart, as most people know, is the hollow muscular organ 
 which propels the blood through the body. It is divided 
 into two halves, and each of these again consists of two 
 cavities or chambers, one of which, the auricle^ first re- 
 ceives the blood, which then passes into the Dentride^ 
 which propels it into the arteries. The blood which 
 comes from the veins of the body goes into the right 
 auricle, and is sent on by the right ventricle into the
 
 to alcohol: its use and abuse. 
 
 lungs, where It passes through a network of capillary 
 vessels in contact with the air, and is so purified, then it 
 goes back to the left side of the heart, which sends it 
 into the arteries of the body to do its work again. But 
 all the blood which goes from the stomach passes first 
 to the liver, which is interposed as a sort of sieve be- 
 tween the stomach and the heart. The minute vessels 
 of the stomach unite into one large trunk, or vein, 
 which joins the veins from the bowels ; and when it 
 reaches the liver breaks up again into an infinity of small 
 branches, which ramify through the liver, and join again 
 into one large trunk vessel, which carries the blood to the 
 right side of the heart. 
 
 So tteij^rjl the alcohol which we drink, after becoming 
 diluted with water, is absorbed by the blood, carried to 
 the liver, thence to the heart, then the lungs, back to the 
 heart again, and is distributed from it to all parts of the 
 body. If the alcohol is injected into the veins, it makes 
 its way straight to the right side of the heart without going 
 through the liver ; if inhaled into the lungs as vapour, it is 
 carried straight to the left side of the heart. But even 
 when it takes the roundabout course through the liver to 
 heart and lungs before it gets into the general blood-stream, 
 it passes through in a very short time — not more than a 
 minute or two — and its general effects are very rapidly 
 produced. The absorption from the stomach continues
 
 alcohol: its use and abuse. 21 
 
 as long as any more alcohol is present there, and its rate 
 of absorption is modified by various conditions. 
 
 Alcohol, as such, cannot be taken up directly by the 
 vessels, but must first be diluted with water in order to 
 pass through their walls. Now when we take anything, 
 especially solid food, into the stomach, one of the first 
 effects is to produce a fulness of the blood-vessels of the 
 lining or " mucous membrane" of that organ, and then from 
 it is poured out fluid which mixes with the food taken, 
 and "digests" it, that is, fits it for absorption. The 
 mucous membrane is provided with many organs called 
 glands, which make various substances which act chemi- 
 cally upon the food, and are mingled with the watery 
 fluid poured out by the vessels. The quantity and quality 
 of these constituents of the " gastric juice," or digesting 
 fluid, are beautifully regulated in their supply by the 
 nature of the substance taken into the stomach. If 
 nothing but a liquid, such as wine or brandy, is taken, 
 very little but water is poured out, the effect being much 
 like that of touching the eye and making it water ; this 
 mixes with the wine, and when properly diluted, the 
 combined fluid is taken up by the blood-vessels. 
 
 But if we take wine with food, the solid food is 
 mixed with it, and, moreover, a much larger quantity of 
 fluid is poured out by the stomach wall into its own 
 cavity, owing to the presence of the food, so that
 
 82 ALCOHOL : ITS USE AND ABUSE. 
 
 the absorption of the wine is more gradual and it 
 becomes more diluted. 
 
 If we could look into the stomach just after taking a 
 glass of wine, we should see that its inner surface became 
 bright red where the wine touched it — in fact, blushed 
 as it were. The same would be the case if a piece of 
 meat were taken, but the colour would probably be less 
 intense, and less rapidly produced. We shall see that 
 this effect of alcohol is one which is widespread and very 
 important. So far it acts merely as an irritant, by 
 coming in contact with the mucous membrane, just as, if 
 we dropped it into the eye, it would make it red and 
 watery j but when it gets into the blood, it produces a 
 similar effect in a different way. 
 
 The mixture with food, then, makes the absorption 
 slower, and so does mixture with water ; for clearly, there 
 is a greater quantity of fluid to be taken up, and it needs 
 a longer time, and less is taken up in a given time. The 
 combination of the alcohol also makes a considerable 
 difference ; in the form of spirits and water it is most 
 readily diffused into the blood, and acts most rapidly ; 
 next as wine, and slowest as malt liquor. One apparent 
 exception must be noticed. If raw spirits are taken in 
 any considerable quantity, no effect whatever may be 
 observed for some little time. Many cases are on record 
 where men for a wager, or in a drunken frolic, have drunk
 
 alcohol: its use and abuse. 23 
 
 a bottle of spirits. The effect may be, often is, sudden 
 death ; but it may be that for a quarter or half ?.n liour 
 nothing happens; then sudden unconsciousness, going 
 on to a condition of stupor, sets in, and speedy death 
 occurs. This peculiar effect seems to be due to a sort of 
 paralysis of the stomach, which takes some liitle time to 
 recover its natural function of absorption. 
 / Effect on the Circulation. — If any sufficient quantity of 
 
 ... Yialcohol is taken, we see a more marked effect. The 
 / face flushes, the skin seems warmer ; there is a sense of 
 
 ^ — being warmer.)) How is this explained? We know that 
 all parts of the body are abundantly supplied with 
 blood-vessels, the smallest of which, called capillaries, 
 make up a great part of the textures. Every beat of 
 the heart drives blood through these networks of minute 
 vessels, and the quantity thus supplied depends, of 
 course, partly upon the force of the heart and the fre- 
 quency of the pulse. But the arteries, or vessels which 
 carry the blood from the heart to the capillaries, are not 
 rigid tubes ; they are elastic, and they also are muscular, 
 and can alter their size in accordance with the needs of 
 the part they supply. We regulate the quantity of gas 
 we burn in several ways : we may control it either at the 
 metre, or on its way to the lamp, or at the lamp itself by 
 the tap ; and the Gas Company, too, can give it greater 
 or less pressure, or check our supply at the main. Now,
 
 84 ALCOHOL : ITS USE AND ABUSE. 
 
 if instead of thus having several taps or stop-cocks at inter- 
 vals along onr system of gas-pipes, we could arrange for the 
 pipes to be narrowed at pleasure in their whole length, so 
 as to make the channel smaller when we wanted less 
 gas, and to dilate and get larger when we wanted more, 
 we should have the same arrangement which is found in 
 the blood-vessels. Suppose, too, that for the words " ner- 
 vous system " we substituted "gas-engineer"; for "heart," 
 "central gas-works," and for "arteries," "gas-pipes," 
 and understood that the gas-engineer could, by means of 
 electric wires, control the size of our gas-pipes, we should 
 have a rough simile of the arrangement of our vessels. 
 We must imagine also that the householder has the power 
 of controlling his gas-pipes as well as the engineer. The 
 arteries, even to their most minute branches, or arterioles^ 
 have this property of contracting and dilating, and they 
 do this either in response to a central order conveyed by 
 nerves, or in consequence of a local action upon their 
 nerves, or their muscular coats. Alcohol has a very marked 
 power of thus causing the vessels to dilate whenever it is 
 contained in the blood, so that these minute vessels be- 
 come turgid, and the tissue redder. At the same time it 
 acts upon the heart also. The contraction of the heart 
 has to overcome the resistance of the vessels, and to keep 
 them full of blood. When the vessels dilate, they offer 
 less resistance to the heart, and moreover, the whole mass
 
 ALCOHOL : ITS USE AND ABUSE. 25 
 
 of blood in them in the part is of necessity greater. To 
 keep them full the heart must send more blood at a time 
 in each pulse, or the pulses must more quickly follow 
 one another. 
 
 But alcohol acts also on the heart itself, and makes it 
 / beat faster, and propel more blood in a given time. 
 "/" Thus we see that the one early result of alcohol is to 
 ( produce dilatation of the blood-vessels, both local and 
 general, to quicken the action of the heart, and make it 
 do more work in a given time. This latter action has 
 been carefully studied by experiment. We may quote 
 here the remarks of the late Dr. Parkes, who made many 
 careful observations on this pointj^ 'f^AIcohol in healthy 
 persons at first increases the force and quickness of the 
 heart's action^/ In a healthy man I found that brandy 
 augmented the rapidity of the pulse 13 per cent., and the 
 force was also increased ; taking the usual estimate of 
 the heart's work, its daily excess of work with 4*8 fluid 
 ounces of absolute alcohol was equal to 15*8 tons lifted 
 one foot. With claret the results were almost identical." 
 Dr. Parkes adds the important statement : " the period 
 of rest of the heart was shortened, and its nutrition must 
 therefore have been interfered with." But in smaller 
 quantities it seems that the action of the heart may be 
 increased, and yet its nutrition be maintained. 
 
 If this action on the heart and blood-vessels is only
 
 26 alcohol: its use and abuse. 
 
 temporary the effects are probably not permanent ; but if 
 kept up day after day, year after year, they lead to changes 
 in the structure and action of the system, of which we 
 shall speak later. 
 
 On the Nerzwiis Systcfji. — Alcohol acts on the brain, 
 the spinal cord, and the nerves when conveyed to them 
 by the blood. It not only affects their function by pro- 
 ducing quickened circulation through them, but it acts 
 also upon their own proper structural elements. . Its 
 main action seems to be to lower the proper activity of 
 the nervous matter. This is composed of cells and 
 fibres ; the former, which are chiefly in the brain and 
 spinal cord, originate and receive nervous impulses ; the 
 latter convey them to and fro. Alcohol appears to 
 have a special affinity for the substance composing these 
 cells and fibres, and endowed widi these peculiar 
 nervous properties, and its effect is to diminish their 
 activity, so that the cells originate and receive im- 
 pulses more sluggishly, and the fibres conduct them less 
 perfectly.* 
 
 ♦ This, at least, is the view which our present knowledj^'e indi- 
 cates. According to some, the action of alcohol at first, or in moderate 
 quantities, "is simply to augment the generation of nervous power. 
 When this increased action of the nervous system is kept within 
 certain limits the effect of the alcohol is beneficial ; but when carried 
 beyond a certain point the action is injurious and deteriorating, the 
 sf irit at length impairing and ultimately destroying the nutrition of
 
 alcohol: its use and abuse. 27 
 
 How is this effected? It used to be stated that 
 alcohol was especially absorbed and retained by the 
 brain substance, and could be found in combination 
 with it in drinkers after it had been removed from 
 the rest of the body; but this is now shown to be an I 
 error. But whether we suppose that it actually combines 
 with the nervous matter, or only acts upon it by its 
 presence as a sort of damper, we can have no doubt 
 about its action. When we come to mention the effects 
 of alcohol, as shown by the various mental and nervous 
 symptoms which result from its misuse, we shall see a 
 combination of the effects of vascular excitement and 
 nervous weakening, and shall be able to trace a regular 
 course in them. We shall find that at first there is for a 
 time apparent overaction or excitement of the brain and * 
 nervous system, due, in part, to increased blood-supply^ 
 and rapid circulation ; in part, it may be, to direct stimu- 
 lation of the nerve cells. Then as the effect is main- 
 tained or increased we shall see diminished activity. The 
 higher functions of thought, will, and consciousness be- 
 come impaired ; the power of action, especially of con- 
 trolled and balanced action, lessened ; sense and feeling 
 
 the nervous matter" (Todd). But it is a question whether more 
 force is generated or is only set free at first, the latter being the 
 view now more commonly held.
 
 28 ALCOHOL : ITS USE AND ABUSE. 
 
 are diminished; and, at last, unconsciousness and inaction 
 results. We might trace all these out in detail, and 
 see how the alcohol acting upon the brain in its various 
 parts, upon the spinal marrow and upon the nerves, 
 produces these varied effects, which all result from 
 diminished action due to the presence of alcohol. If 
 consciousness is the faculty of the part of the nervous 
 system affected, this gives place first to lessened and 
 then to lost consciousness ; if feeling, it is first deadened, 
 then lost ; if motion, it is first irregular, then defective, 
 then more or less entirely lost. 
 
 As a general rule, in man at any rate, these powers 
 or functions of the nervous system are affected in a 
 definite order, first the higher powers of the brain and 
 then the spinal centres ; but the extent to which they 
 are affected varies in different cases, and as both are 
 affected together, the continued action may show itself 
 most clearly first on one or the other. That is to say, 
 some men will continue pretty clear-headed even when 
 their gait has become unsteady ; whilst others will become 
 drowsy or half unconscious before they show any marked 
 want of equilibrium. In animals the casfe is rather dif- 
 ferent, and the effect of a large dose of alcohol on dogs is 
 nearly always to produce at first paralysis of the hind legs, 
 showing that the spinal cord towards its lower part is ia 
 them the first to give way.
 
 ALCOHOL : ITS USE AND ABUSE. 29 
 
 The influence, not only of habit and constitution, but 
 of disease or idiosyncracy, may also greatly determine 
 the part of the nervous system which is chiefly affected. 
 Great pain may keep up such a condition of excitement 
 of the brain that the power of alcohol in producing un- 
 consciousness is nearly lost. So, too, may mental excite- 
 ment or emotion, or mental derangement ; and it is from 
 this cause that the great danger of alcohol to some 
 persons arises. They can take a large quantity of alcohol 
 for some time with little perceptible effect upon the brain. 
 Then comes a time when the power of resistance is gone, 
 and the brain suddenly gives way, delirium tremens, in 
 some of the fiercest and strangest forms, resulting. So 
 that this production of unconsciousness, which is so great 
 a safeguard against dangerous results, cannot always be 
 relied upon. We have seen cases of men who showed none 
 of the ordinary signs of excess in drink, or at least so slight 
 as to be almost imperceptible, or perhaps slightly tremu- 
 lous and unable to walk, suddenly burst out into the most 
 violent raving delirium with fury. In two such cases we 
 have seen hospital patients who for two days had been 
 in hospital and not taken any spirits, and had been 
 admitted for indigestion with weakness in the legs, who 
 were apparently perfectly rational and calm, go off sud- 
 denly into this violent frenzied delirium ; and it was not 
 till afterwards that the discovery was made that in both
 
 30 alcohol: its use and abuse. 
 
 cases a long and deep debauch had immediately preceded 
 the symptoms for which they sought admission to the 
 hospital. Here the alcohol had been acting, but held in 
 check; the deranged working of the nervous centres, 
 produced by the opposing actions, resulted in the violent 
 explosion of the pent-up forces. 
 
 Weakening, deranged action and paralysis of volition, 
 sensation and motion, are thus seen to be the results of 
 alcohol acting upon the nervous system. 
 
 These effects of alcohol on the circulatory and nervous 
 systems are the most important for our present purpose, 
 and they explain many of the other effects to which we 
 cannot here allude, but which depend on disturbed action 
 of various organs. Probably all tissues which have vital 
 properties may be more or less affected by alcohol, and 
 the changes connected with their nutrition and functions 
 impaired ; but the experiments hitherto made on these 
 points are conflicting. 
 
 So also are the results as to the prevention of waste of 
 the tissues, and the accumulation of fat, by the use of 
 alcohol. Strong ground is afforded by what we see in 
 the use of alcohol in disease for the belief that it has 
 some such action, but how it acts we hardly know as yet ; 
 and such an action in health has been doubted, so that 
 we will only mention this without discussing it. 
 
 It has been affirmed by some, and denied by others,
 
 alcohol: its use and abuse. 31 
 
 that alcohol lowers the temperature of the body. In 
 moderate quantities it scarcely seems to affect it; in 
 larger doses, it lowers it slightly in some cases ; in 
 poisonous doses the body is greatly cooled. We shall 
 speak of this later. 
 
 What becomes of the alcoliol taken into the body? 
 Some have believed that it all enters into combination 
 with the tissues, and after a time is all carried away out 
 of the body by the natural channels. This is no doubt 
 an error. Only a small portion gets out of the body as 
 alcohol ; the greater part, and nearly all if the quantity is 
 not excessive, is used up — burnt, so to speak — in the 
 body, and thus gives some small amount of nutriment, 
 A very small quantity is carried off by the lungs and 
 kidneys, unless a larger amount is taken than can be used 
 up, when the excess is thus discharged. 
 
 We shall see presently that the fact that alcohol is 
 eliminated by the kidneys is important as explaining its 
 special effect in producing disease of those organs ; just 
 as the passage of all the alcohol from the stomach 
 through the liver explains the frequent disease of the 
 latter organ in drinkers. 
 
 We cannot go further into detail upon this subject ; 
 indeed, there is yet much obscurity upon the action of 
 alcohol in the system. We have said enough to serve as 
 a guide to what we have to sa^ as to its use.
 
 32 ALCOHOL : ITS USE AND ABUSE. 
 
 CHAPTER III. 
 
 THE EFFECTS OF ALCOHOL WHEN TAKEN IN EXCESS. 
 
 We have seen that the first tangible result of taking any 
 form of alcoholic beverage, so far as it reveals itself to 
 our consciousness, is a slight stimulant effect. A glow of 
 warmth is diffused over the body ; there is a sensation of 
 pleasure, which takes its special colour from the surround- 
 ings of the moment, showing itself in relief from discom- 
 fort, whether mental or physical, in increased enjoyment 
 of the flow of conversation, in a freer current of thought 
 and social intercourse, or any of the other subtle harmo- 
 nies of life. It may be objected that such is not always 
 the effect ; that it is largely modified by habit, by the 
 condition of digestion, the drink taken, and the special 
 temperament and constitution of the individual ; and we 
 fully admit this objection. But, allowing for all such dif- 
 ferences in degree, such is the most common sensible 
 effect of the " wine which maketh glad the heart of man." 
 But if more than a certain quantity is taken, further 
 results rapidly ensue. The point of stimulation only 
 may be reached by a continuance of repeated small 
 doses ; as, for example, in a long after-dinner talk, only 
 just enough being taken to keep up this stage : but it is 
 easy to go beyond this point, when other effects appear.
 
 alcohol: its use and abuse. 33 
 
 Thought no longer only flows more freely and conver- 
 sation more pleasantly ; there is some loss of control of 
 thought, the ideas fleet rapidly, but are not steadily re- 
 tained, the too rapid stream overflows its banks, and is 
 broken into eddies and currents in its course, so that there 
 arise confusion of thought, want of clearness of apprehen- 
 sion, and inability to reason soundly and consecutively. 
 Nor is the intellect alone perturbed ; the emotions are 
 less under control : mirth gives way to hilarity, and this 
 to boisterous merriment, which may subside into the 
 opposite of sullennoss, or go on to wild excitement ; 
 moral control is lost, and the actions are the result of 
 fitful caprice, or the outcome of baser passions. The 
 voluntary and involuntary motions of the body show a 
 like want of control ; the more delicate movements, those 
 which require long-trained and adjusted co-operation of 
 nerve centres and groups of muscles, cannot be per- 
 formed ; even those which are so far habitual and auto- 
 matic that we can perform them without conscious 
 efl"ort, and may even do them during sleep, become 
 difficult or are done imperfectly. It is well known that 
 many actions, such as walking, are done almost without 
 volition when the power has been acquired, so that we 
 only will to go to such-and-such a place, or to walk 
 about, and our attention, so long as all goes well, is no 
 longer needful. We balance the body, throw out one
 
 34 ALCOHOL : ITS USE AND ABUSE. 
 
 foot, poise ourselves on the other, plant the foot, and 
 so on, without the least consciousness that we are doing 
 so ; though, should any accident derange some part of 
 the mechanism, we are painfully alive to the various 
 movements. Other habitual actions require a greater 
 control and attention, yet may become almost equally 
 automatic as walking. There are many men who write 
 constantly or much, who become equally facile ; there 
 is to them no conscious pause or thought between the 
 volition to write, and the appearance of the word on 
 the paper ; and so established is the connexion of thought 
 and word, that for each idea there is a sign which 
 they place upon paper, and the sign may be one which 
 they have adopted for brevity of expression, but which 
 they use as their token for the thought or word quite 
 unconsciously, and require great effort not to use. We 
 might thus instance also other acquired movements, such 
 as playing musical instruments, knitting, and working 
 various machines, which by habit become capable of 
 execution almost unconsciously. It is these movements 
 Which first show that disorder which results from loss of 
 control. There may be perfect consciousness of the 
 right method of doing them, and an endeavour to do 
 them, but they are less delicately combined, need greater 
 effort for their performance, and when a certain point 
 of intoxication has been reached, they are either im-
 
 ALCOHOL : ITS USE AND ABUSE. 35 
 
 possible if very complex, or are done clumsily and ir- 
 regularly. It is thus the movements which are acquired 
 with most pains, such as writing and mechanical move- 
 ments, which are first disordered; then those which, 
 though complex, like walking, are not the outcome of 
 great training and effort, yet require regularly co-ordinated 
 action for their performance. On a rather different level 
 we may place the act of speech, one of the most 
 thoroughly acquired yet most complex of our actions. 
 It would be interesting to study in detail the mode in 
 which this is affected, and to show how the derange- 
 ments of the several groups of nervous centres cause a 
 variety of changes in its performance. We must only 
 just mention them in passing. To speak a word, we 
 must first in some way have the idea of the word in 
 the mind, or rather a word-idea is our mental cheque 
 or telegraph-form for the word. This word-idea must 
 pass to the nerve-centre which controls the expression, 
 from which again all the orders, or stimuli, to the 
 centres which control each part of the speaking of the 
 word must pass ; and these orders, in the transmission, 
 must be harmonised so that they may produce not 
 merely the sounds needed, but the sounds in their due 
 order, force, and inflection. There are required for each 
 word which we speak, special movements of the tongue, 
 mouth, palate, and throat, organised and united into
 
 36 ALCOHOL : ITS USE AND ABUSE. 
 
 one, and all controlled by separate and numerous 
 centres, and the defective adjustment of any one of 
 these deranges and spoils the speaking of the word. 
 But in speech it is not one word, but a continuous 
 flow of words that we employ, all separate, yet all 
 harmonised and succeeding each other with a rapidity 
 which seems to leave no time for special arranging of 
 the organs. When, therefore, control is less active, the 
 reins slackened so to speak, words may be wrongly 
 spoken through the wrong word-idea being chos"en ; or 
 they may be omitted, or curtailed, or misplaced ; or 
 they may be imperfectly made up, lacking some parts, 
 or jumbled together in confused expression ; and the dis- 
 order of the uttering organs of speech may cause them 
 to be dipt at the ends, stammered, or mouthed, or " thick " 
 from defective action of the tongue. Thus we might 
 see how the loss of control of idea at the one terminal, 
 causes confusion of thought and wrong choice of words, 
 and at the other, how the organs of expression fail 
 from maladaptation, and we might try to show how all 
 the degrees of speech-affection are indices of stages of 
 intoxication. 
 
 In a yet further stage of intoxication, we find that 
 movements which are naturally combined in harmony, 
 and which we cannot derange without voluntary effort, 
 become deranged ; this especially in the case of actions
 
 ALCOHOL : ITS USE AND ABUSE. 37 
 
 which, hke those of the eyes, are symmetrical for two 
 corresponding organs. In healthy eyes, the muscles which 
 move the eyeballs, so as to direct them towards any given 
 object, or to concentrate them upon a nearer or further 
 point, act automatically, so that the images in the two 
 retinae fall on corresponding points, and are organised 
 into one image in the brain. When, from injury or 
 disease, one of the muscles is but slightly deranged, or 
 when we squint voluntarily, the image in one eye falls 
 upon a point in the retina which does not correspond 
 with that of the other image, and thus two images are 
 seen.* Now this derangement occurs under the influence} 
 of drinking — the eyes do not move in harmony, hence the ,5 
 man " sees double." (We do not mean to say that this 
 is the only way in which intoxication causes double 
 vision, for others may and do occur, and two images and 
 more may be seen with one eye ; but to understand the 
 mechanism of these, a njuch more elaborate account 
 of the structure and actions of the eye would be needed.) 
 We may here pause to note that the rapidity with 
 which these effects are produced, as well as their cha- 
 racter, varies immensely with the person, with the kind of 
 drink, the rate at which it is taken, and many other cir- 
 cumstances. Moreover, many of them may be absent, 
 
 * For further details on this interesting subject see the work in 
 this series on ' The Eye.'
 
 38 alcohol: its use and abuse. 
 
 and the process may cease at any point if the drinking 
 be suspended. 
 
 Before going further, we may inquire what is the mode 
 of action of alcohol by which these results are produced. 
 We have spoken of excitement, followed by confusion of 
 intellect, emotion and action ; and we shall see that a yet 
 further stage may be reached in which all the powers are 
 in abeyance and dormant, and a living death, or mere 
 vegetative life, remains. But all these maybe summed up 
 in the words, loss of control. The higher intellectual 
 centres cease to control the thought, the moral control is 
 lost over the emotions, the centres which govern and direct 
 combined action no longer guide the lower and subor- 
 dinate ones, and they in turn hold less in check and tone 
 the muscles and their nerves. It would be easy to show 
 that it is not only the higher powers which are affected, 
 that the lower centres, too, are directly acted upon. And 
 as we have already seen in speaking of the physio- 
 logical action of alcohol, the earliest glow of warmth, 
 flush of face, and quickened beat of heart, are alike due 
 to a check of control, so that the minute blood-vessels 
 dilate owing to loss of moderating force. 
 
 For the present we need not carry into further detail 
 the picture of the state of the drunken, with which we 
 are all too familiar, as it appears to outward observation ; 
 and the drunkard has himself no farther consciousness
 
 ALCOHOL : ITS USE AND ABUSE. 39 
 
 when he has reached the stage which we have indicated, 
 so that he cannot tell what he feels or experiences. We 
 have touched upon this state in speaking of physiological 
 action. " The worst estate of man is that wherein he 
 loses the knowledge and government of himself." 
 
 If we wrote only for those who, whether rarely or often, 
 drink to such excess as this, we should waste our labour, 
 for no such a.dvice as we could give, grounded on general 
 considerations of health, would serve to deter them from 
 indulging their habits. We might paint ruin staring them 
 in the face — ruin of body, mind, and soul, or ply them 
 with exhortations to virtue and temperance ; but to show 
 them their state from a scientific point of view, would be 
 like putting a tissue-paper barrier to stop a waterfall, the 
 fragments would soon dance in the eddies. 
 
 But it is a melancholy fact that ?, very large number of 
 those who are permanently injured by drinking are of 
 those who rarely or never drink beyond the stage of slight 
 excitement, or even halt before that point. For one man 
 who is injured by being drunk often, there are twenty or 
 more who are more seriously injured by drinking and 
 never approaching the verge of intoxication. A man may 
 drink in such a way as never to feel consciously excited 
 or embarrassed, yet ruin his health, and cut short his 
 days more speedily and surely than the man who is dead- 
 drunk every Saturday night.
 
 40 ALCOHOL : ITS USE AND ABUSE. 
 
 ^, 
 
 We may here add a little to what we have already said 
 on physiological action, action, that is to say, on the 
 working of the system. 
 
 Every time a machine is set a-going it consumes material 
 whicli sets it at work, whether coal or gas ; it does some 
 work, if only in wasted movement, and it wears itself 
 out a little. It has waste products in the shape of ashes 
 from the coal or coke, and it may be also of the material 
 on which it acts, and if it wear itself rapidly, as a grind- 
 stone, for instance, there will be the products of its wear. 
 With one most important qualification the human body 
 may be likened to a machine, for it is constantly at work; 
 its boilers need replenishing, its stokehole filling ; it has 
 waste products both of the fuel and of its own wear ; it 
 does work of all sorts, and tends to wear out. The dif- 
 ference is that the machine itself is a living machine and 
 constantly repairs and renews itself, though at last its 
 power of self-repair fails, and it falls into decay. 
 
 Now it is easy to see that, by putting certain fuel into 
 a machine, >ve may do several things. The fuel may 
 make too ho't a fird, and so over-heat the boilers, dry up 
 the oil of the bi^ringSj crack the metal, spoil the varnish, 
 or make the machine go at a dangerous speed. Or it 
 may be corrosive, and erode and spoil the furnace and 
 boilers, and perhaps other parts. Or if the machine be 
 a self-repairing one, it maybe hindered from proper repair,
 
 alcohol: its use and abuse. 41 
 
 whether by want of clue supply, want of time, or spoiling 
 of the several parts. 
 
 Alcohol may act in all these ways when taken in excess, 
 or in an improper manner, and the results are seen in the 
 various diseases which result from its use. Even to men- 
 tion all these diseases by name would require too much 
 space, nor, without a description of all the organs, could 
 we give any adequate idea of them. The most useful 
 plan, we think, will be to classify them under three or 
 four heads ; to describe so much of the more common as 
 will be of practical use, and to mention only some of the 
 rest, which come under the more special knowledge of 
 the doctor, as follows : — • 
 
 I. Comparatively slight disorders due to use of excess 
 
 of alcohol, or its use at improper times. 
 II. The effects of large repeated doses in producing 
 
 simple intoxication, or the peculiar forms of 
 
 alcohol poisoning known as delirinm tremens^ &r.c. 
 III. Diseases resulting from the continued use of 
 
 alcohol. 
 
 1. General deterioration. 
 
 2. Destruction of special organs of the body. 
 I. Slight disorders due to excessive or improper use. 
 
 ■ — Returning to our machine, we see that if we use the 
 wrong fuel even once, we may choke the flues, corrode 
 the pipes, and so on, and leave a certain result which will
 
 42 ALCOHOL : ITS USE AND ABUSE. 
 
 last only for a time, if we have it repaired, and cease to 
 use the fuel. If we use it again and again, we shall run 
 the greater risk of damaging our machine irreparably, so 
 that it will always go a little wrong or shakily, though it 
 may go for a long time ; or it may be so damaged as to 
 break down altogether. 
 
 So we see that wine or spirits, taken at wrong times or 
 in excess, cause disordered digestion, constipation, general 
 malaise, inability to work, nervousness, shakiness of the 
 hands, and so on, with no greater result if discontinued ; 
 that if taken once or repeatedly in large quantities, it may 
 cause drunkenness or deliidujn t7'emens ; that if taken for 
 months or years in any excess, however slight, it may 
 cause degeneration or destruction, for all practical pur- 
 poses, of certain parts of the body, or a deterioration of 
 the whole. It is mainly the slighter forms that we have 
 now to consider. 
 
 Alcoholic Indigestion. — One of the commonest, least 
 recognised, and most insidious results of slight excess is 
 the derangement of digestion known as '''"alcoholic dys- 
 pepsia'' A multitude of well-to-do and respectable people 
 suffer from it without either knowing its cause, or being 
 aware that it is preventible, and it is one of the com- 
 monest and most troublesome of the complaints which 
 bring patients to the " out-patient " rooms of our hospitals 
 (especially ''chest" hospitals). The symptoms vary, but
 
 alcohol: its use and abuse. 43 
 
 when slight are something like these : A man (or woman 
 either) complains of slight loss of appetite, especially in 
 the morning for breakfast ; feels languid either on rising 
 or early in the day ; retches a little in the morning, and 
 perhaps brings up a little phlegm only, or may actually 
 vomit ; or may be able to take breakfast, but feels sick 
 after it. Towards the middle of the morning he is 
 heavy and languid, perhaps, and does not feel easy till he 
 has had a glass of sherry or some spirits, then gets on 
 pretty well, and can eat lunch or dinner. Or if worse, 
 the appetite for both is defective, and there is undue 
 weight and discomfort after m.eals ; and with this there 
 is often some slight soreness of the throat, tickling sensa- 
 tions, and tendency to a little cough, especially in the 
 morning. Not uncommonly there is also a tendency to 
 constipation, and a feeling of discomfort and weight in 
 the right side. 
 
 Now all these symptoms may be due to other causes ; 
 but when taken together — and especially when the loss of 
 appetite for breakfast is most marked — they are by far 
 most commonly due to alcohol, taken in excess or at 
 wrong times. They are, of course, worst in those who 
 drink in large excess, and there is often then a tremulous 
 condition of the hands and tongue, and other disorders. 
 But many people get into this state, either occasionally or 
 habitually, by taking a glass or two of wine or spirits on
 
 44 alcohol: its use and abuse. 
 
 an empty stomach late at night; and during the day,- 
 whilst taking their ordinary stimulant at meal-times, in- 
 dulging also in a glass or two of sherry in the middle of 
 the morning, and perhaps, too, at other times. And we 
 must emphasise the statement that such effects are often 
 seen in persons who are abstemious through the day, and 
 moderate at dinner, but who take wine or spirits before 
 going to bed, in order to rid them of mental excitement 
 and enable them to sleep. So slight are the other general 
 effects, that were it not that this condition has a dangerous 
 tendency to cause fresh recourse to drink for its temporary 
 relief, and that there can be no doubt that, in the long- 
 run, the constant recurrence of slight poisoning tends to 
 set up organic disease, we might say less about this 
 result of alcohol. 
 
 Amongst the labouring classes, and in certain trades, 
 especially those involving long hours and night-work, as 
 well as in many of the more educated classes, spirits are 
 especially taken ; and when taken undiluted or with a 
 little water, are especially liable to cause these symptoms. 
 And this is one of the reasons why the " morning nip " 
 before breakfast, or before work, is so often indulged in 
 and is so dangerous ; for while it relieves for a time the 
 tremor and the discomfort, it only aggravates the condi- 
 tion which produces them. 
 
 Tremhlmg. — Another condition which we have just
 
 ALCOHOL : ITS USE AND ABUSE. 45 
 
 mentioned, one of the special results of alcohol, is tremor^ 
 shakiness of the hands, so that they are unsteady when 
 at rest, or if the hand is held out it is seen to vibrate 
 slightly ; or in the more advanced condition, " shakes 
 like an aspen leaf." We have seen this in a spirit-drinkei 
 as almost the only symptom ; he was a barber, working 
 early and late in shaving, and to " steady his hand " took 
 constantly raw spirits, at first to relieve fatigue, then 
 because he found that if he discontinued, his hand was too 
 shaky to use the razor. Complete abstinence from 
 alcohol, anci strong coffee, quite removed his tremors and 
 his desire for spirits. And this is only a sample of a 
 class, though few, it"'- may be feared, have so much self- 
 control as to relinquish the habit, or so honest a purpose 
 in drinking. This tremor has its highest expression 
 during the condition of mental derangement known as 
 delirium tre?nens. We need not dwell upon the other 
 slight effects mentioned above. 
 
 II. The effects of large repeated doses in causing 
 drunkenness and, later, delirium treinens. — It would be 
 outside our purpose to speak much of these. We have 
 just described some of the stages of intoxication, and 
 others will appear from the description of the physiological 
 action of alcohol. The evils of drunkenness are so obvious 
 to all in their social, moral, and physical aspects, and so 
 wide a field of discussion would be opened, that we may
 
 46 alcohol: its use and abuse. 
 
 leave this for others ; we have already said that it is a 
 great mistake to believe that those who never become 
 intoxicated do not injure themselves and others by 
 drinking. 
 
 The condition known as delirium tremens may be, and 
 perhaps most frequently is, produced without actual drunk- 
 enness in the common use of the word. Those who drink 
 hard but keep from actual loss of consciousness, especially 
 those engaged in hard mental work, or subjected to great 
 moral strain or shock ; and, too, those of certain tempera- 
 ments, are peculiarly liable to it. It is preceded usually 
 by loss of sleep, ideas of persecution or of injury with no 
 foundation in fact, and slight hallucinations, especially at 
 night, the man the while in the day looking anxious, 
 slightly exeited, nervous and tremulous, and perhaps nar- 
 rating, as actual occurrences, the hallucinations of the 
 preceding night. Then the senses are partly lost, he sees 
 spectres, horrible and foul creatures about him, has all 
 sorts of painful terrifying visions (whence the common 
 name of " the horrors "), is extremely tremulous, and 
 either excited or lies prostrate, trembling violently on 
 movement, sleepless, anxious, and a prey to spectres and 
 terrors of the imagination. But we need follow him no 
 further to recovery or death, but leave the study of his 
 condition to the doctor and the moralist. 
 
 Another condition often and wrongly confounded with
 
 alcohol: its use and abuse. 47 
 
 this is that known as dipsomania. It has m common 
 with it the fact that those who are a prey to it do get 
 deUrium tremens by their drinking ; but it is a name 
 properly appHed only to a disease, usually associated 
 with mental disease or inherited tendency, in which there 
 occurs, periodically, an irresistible craving for drink, not 
 always limited to alcoholic drinks ; and during the con- 
 tinuance of this craving everything is drunk which can be 
 got hold of. The attack over, whether by intoxication 
 or by restraint, the patient (for such he should be) is free 
 for a time, often a long time, from any tendency to drink. 
 This is, and should be, regarded and treated as a mental 
 disease, and has no resemblance to the commoner forms 
 of excess in drinking. But we must add that drinking 
 itself induces a strong craving for alcohol, so that some- 
 times it may be hard to say whether a man is only 
 suffering from his bad habits or from a mental disease. 
 The chief point of difference is that in the true dipso- 
 maniac the attacks are periodical, and there is often a 
 family tendency to insanity or to other nervous diseases. 
 
 III. The diseases which result from the continued 
 excess in alcohol are very numerous, often combined in 
 the same person, and, as is the case with nearly all 
 diseases of one part, leading to further changes in other 
 parts. 
 
 I. We may speak first o( gmcral conditions, affecting all 
 4
 
 48 ALCOHOL : ITS USE AND ABUSE. 
 
 parts of the body. And here we cannot even attempt to 
 mention all those slighter general states which are so 
 commonly seen in those who drink. The moral tone is 
 lowered, there is often a coarseness of look and manner 
 which mark the general deterioration ; the memory is 
 less clear and retentive, the grasp of the intellect is 
 enfeebled, there is less power of mental work, and loss 
 of that self-control and self-respect which gain the confi- 
 dence of others. Often there is a peculiar suspicion 
 shown in the look, a suspicion of being suspected ; or a 
 restless wandering look which betrays to the careful 
 observer a consciousness of deterioration. Then the 
 face assumes a slightly puffy look, due at first to want 
 of " tone " of the muscles of expression, and later to 
 actual degeneration, and to the accumulation of fat over 
 them. Or, in rarer instances, there is instead a pinched, 
 wasted look, conjoined with a similar condition of the 
 body. 
 
 The most common general condition is that which is 
 known as " fatty degeneration," which consists of two 
 quite distinct parts. All over the body, beneath the 
 skin, where it is thicker in some parts than others, and 
 also in all the chinks and spaces around and between 
 the chief organs (except the brain and spinal cord), there 
 •s in the healthy state what is known as fatty or adipose 
 tissue, which is made up of minute cells filled with oil,
 
 alcohol: its use and abuse. 49 
 
 closely packed together. In addition to this, some organs, 
 especially the liver, contain some oil, which is burnt 
 as fuel when needed, as we see in hybernating animals, 
 who are said to store up a large quantity before the winter. 
 The use of the fat or oil is to form, as it were, pads, and 
 to lubricate the muscles, to keep in the warmth, and to be 
 burnt up or used up when wanted. One common effect of 
 alcohol is to cause an increase of this fat, so that in some 
 cases it becomes very excessive, especially in the liver 
 and in other internal parts where only a small quantity 
 ought to be present. 
 
 Another change, much more serious and important, 
 but which goes by the same name, is a change of other 
 tissues into fat. All the important organs of the body 
 are composed of various forms of " albuminoid " matter, 
 and are of " protoplasmic " nature ; that is, they are 
 highly complex organic bodies, having some relation to 
 albumen, and endowed with living powers, which vary 
 with the different tissues they constitute. Thus we have 
 muscle, made up of minute filaments which have the 
 power of contracting ; nerves, formed by delicate cords, 
 which convey nerve-impulses of whatever nature * cells, 
 some of which make ferments, &c., to digest food, some 
 prepare it for use, and so on, but all go to make up 
 what we call organs, and have special work of some kind, 
 and a peculiar power of doing it. Now when one of
 
 50 ALCOHOL : ITS USE AND ABUSE. 
 
 these elements dies or slowly decays, the albuminous or 
 protoplasmic substance of which it is made first loses 
 its peculiar vital properties, then breaks up into minute 
 granules, and these granules are further altered till they 
 become oil globules, in which state they are carried off 
 by the blood to be burnt up. We cannot follow all the 
 steps of the process chemically, but we know that the 
 protoplasm loses its nitrogen, oil containing none, and 
 when the stage of oil drops is reached, we know that 
 the part of the organism is for all work and use 
 dead. 
 
 It is this form of " fatty degeneration " which alcohol 
 especially produces and which makes its results so dan- 
 gerous. We see it most in the heart and liver, but an 
 analogous process occurs in the blood-vessels, in the 
 nerves, and indeed in all vital organs. It means simply 
 living decay of parts of our most important organs, piece- 
 meal death going on in the live body. And when alcohol 
 is taken in large repeated doses continuously, this change 
 may become very advanced in but a short time. Other 
 poisons produce it more rapidly, especially phosphorus. 
 
 There is another general deterioration, which is of 
 almost equal importance. All organs contain a material 
 which forms their skeleton or framework, holds the more 
 special vital parts together, and forms coverings for 
 them. This is called " connective " or fibrous tissue,
 
 ALCOHOL: ITS USE AND ABUSE. 5 1 
 
 Now this, when in proper quantity and arrangement, is 
 essential, but when it grows beyond normal limits it dis- 
 places and destroys the more important vital elements, 
 so that its overgrowth in any organ causes to an equal 
 degree undergrowth or destruction of those more im- 
 portant parts. Nor is this all ; for this tissue grows from 
 cells which are soft and elastic, but gradually these are 
 joined together into fibres, and these into thicker fibres, 
 and as they grow and get stronger and denser, they con- 
 tract and get shorter, so that they crush the softer and 
 more yielding tissues which they surround and divide. 
 Now a scaffolding or framework is very useful in proper 
 limits ; but if we use growing trees and their branches 
 for our timbers and joists, and they can, and do, still grow 
 and flourish, our house will not be likely to be YQry per- 
 manent ; nor does this simile give more than a very feeble 
 idea of what happens in the case of a contracting tissue 
 in an organ. 
 
 It is from this overgrowth or fibrous change that many 
 of the most serious internal diseases result ; and it pro- 
 duces especially the diseases of the liver and kidneys 
 which are so fatal to chronic drinkers. 
 
 But there are other general constitutional conditions 
 which are produced by over-indulgence in drinking, even 
 when the habit is never carried to excess of visible amount. 
 It is far more difficult to classify and accurately describe
 
 52 alcohol: its use and abuse. 
 
 these general states of the system. They probably depend 
 on an early stage of functional derangement, caused by 
 the organic diseases of which we are about to speak, 
 before they have reached any perceptible degree. A 
 tendency to gout, some forms of rheumatism, stone and 
 the like, are now very commonly believed to result from 
 habitual slight excess in alcohol. Very strong opinions to 
 this etfect have of late years been expressed by some 
 eminent surgeons and physicians whose large experience 
 in these particular diseases entitles their opinion to 
 respect. But we must not forget that it is not merely 
 the direct effect of alcohol itself with which we have to 
 do — over-indulgence in wine or beer means, commonly, 
 excess in eating, bad habits as to rest, exercise, and air, 
 and many other evil habits which combine to produce 
 the results mentioned. They are, however, indirectly 
 attributable to the use of alcohol. 
 
 2. The destruction of particular organs is rather in the 
 province of the physician than suited to a popular essay. 
 The whole system may be involved, or only certain organs, 
 especially the heart, stomach, liver, kidneys, and brain ; 
 but there is also a peculiar tendency to some chronic 
 forms of lung-disease, and to fatal results in accidental 
 diseases, such as erysipelas, inflammation of the lungs, 
 &c. The organ affected, and the form of disease, depend 
 in part upon the form of alcohol and its degree of dilu
 
 ALCOHOL : ITS USE AND ABUSE. 53 
 
 tion, upon the idiosyncracy of the person, and upon his 
 general temperament and habits. 
 
 The stomach may be damaged by the direct action of 
 strong alcohol, by repeated derangement, or by changes 
 like those of other organs. We have seen that one of the 
 effects of alcohol, especially in the form of wine or 
 spirits, is at first to stimulate the secretion of the 
 stomach, and possibly also the movements on which the 
 digestion partly depends. We found, too, that the local 
 effect is to dilate the blood-vessels. This over-action 
 when excessive or needless is followed by a perturbed 
 condition, partly due to an exhaustion from the over- 
 action, partly to the direct damaging effect of the 
 alcohol ; and the derangement of the liver adds also to 
 the disturbance. Now when this irritation is repeated 
 day by day, week by week, and year by year, we need 
 not be surprised that the stomach gets altered in its 
 structure, even if the temporary derangement is only 
 slight at any given time. Gtifta cavat lapidem^ and a 
 " drop too much " is not needed to wear out the stomach. 
 But although we do find various diseases in the stomach, 
 and see the effects of deranged digestion as a result of 
 drinking, there is a marvellous power both of resistance 
 and recovery on the part of the stomach, so that some 
 long-standing topers maintain their digestion and have 
 healthy stomachs to the last. The evil is bad enough, we
 
 54 ALCOHOL : ITS USE AND ABUSE. 
 
 need not exaggerate it by the absurd and impossible 
 pictures of the stomach with which teetotal lecturers 
 delight to terrify their credulous audiences. 
 
 The worst form of stomach disease occurs in those who 
 take spirits on an empty stomach, and particularly in the 
 morning with " bitters," " absinthe," and the like, which 
 also help to irritate the stomach coats. 
 
 The liver is peculiarly liable to disease, for all, or nearly 
 all, the alcohol taken into the stomach goes into the 
 blood-vessels wiiich lead to the liver, and all the blood 
 from the stomach circulates through the minute blood- 
 vessels of the liver before it goes on to the heart. Hence 
 the evil effects of which we have spoken are usually 
 most strongly marked in the liver. 
 
 The changes in the heart are especially due to over- 
 excitement and consequent hypertrophy, combined with 
 the slow deterioration or fatty degeneration of its muscle- 
 fibres, and accumulation of fat on its surface also. And 
 other more complex derangements also occur. 
 
 The kidneys receive from the blood all the materials 
 of tissue destruction or waste which are not burnt off the 
 lungs or excreted by the skhi, as well as the greater part 
 of excess of water in the blood. Alcohol has a peculiar 
 property of exciting the kidneys to over-action by tem- 
 porary dilatation of the blood-vessels, which produce a 
 condition like that seen on the skin in blushing. It
 
 ALCOHOL : ITS USE AND ABUSE. 55 
 
 probably also acts as an irritant on the glandular cells 
 of the organ, causing them, if only slightly stimulated, 
 to excrete more organic material than before. Hence the 
 first and direct action is irritation, slight and transient, 
 but capable of repetition. 
 
 But a part of the action is more complex, and is pro- 
 bably due to the effects upon other tissues and on the 
 blood. We have said that the kidneys excrete or remove 
 from the body the waste products of tissue-combus- 
 tion, and waste, and many other bodies, such as salts of 
 various kinds which only get into the blood by accident 
 or design, and stay only a short time in the body. But 
 before the waste tissue products are removed by the 
 kidneys, they are usually in great part converted into 
 the form of a salt called urea, which is readily soluble in 
 water. It is now believed by many physiologists that the 
 liver plays a great part in this transformation ; and it is 
 also at least known that retarded oxidation of tissue waste 
 prevents the proper reduction into urea. Now, by what- 
 ever mechanism, whether by its action on the liver, 
 or on the blood, or by its power of retarding oxidation, 
 alcohol does prevent in some degree the proper changes 
 in the tissue waste, so that a larger part of it than usual 
 passes out in the form of uric acid, urates and other sub- 
 stances, which are less soluble, more irritant, and defec- 
 tively oxidized.
 
 56 ALi:OHOL : ITS USE AND ABUSE. 
 
 And whether from this cause, or from repeated conges- 
 tion and irritation, alcohol leads at last to widespread 
 disease of the kidneys in a large number of cases ; in 
 most to the fibrous form of degeneration ; but in a few 
 more rapidly to other forms. 
 
 We have already pointed out that the nervous system^ 
 in which term are included not only the nervous centres, 
 such as the brain and spinal cord, but also all the ganglia, 
 nerve fibres, and their terminations, undergo various 
 changes as the result of drinking, and that these changes, 
 whether transient or permanent, show themselves by 
 altered function and by diminished or deranged power. 
 The study of all these conditions would be a too technical 
 and too prolonged one for its introduction here, we must 
 therefore leave it, mentioning only some of the more 
 obvious results. 
 
 The very important question of the effect of drinking 
 in causing the loss of mental power must detain us a 
 moment. Many would ascribe moral deterioration also 
 to an organic change in the brain, but we cannot fully 
 agree with this view. Moral character is very largely in- 
 fluenced by habit, by the acquired control of the highest 
 cerebral centres over the lower ; and hence the continual 
 paralysis of that control, and the constant abolition of all 
 power of self-restraint must, of course, aid largely in 
 moral deterioration. But we cannot go further than this,
 
 ALCOHOL : ITS USE AND ABUSE. 57 
 
 the habitual drunkard is morally defective from the outset, 
 and his habits give full play to the action of all the baser 
 tendencies of his nature. Drunkenness is more a vice 
 than a disease. 
 
 But does the constant use of alcohol in moderate or 
 not greatly excessive quantity cause moral deterioration ? 
 No more important question could be proposed than this, 
 nor easily one more difhcult of answer. We believe the 
 true reply to be that whatever quantity causes any tempo- 
 rary loss of moral control does, if repeated, lead to moral 
 deterioration, but that short of this no such result is pro- 
 duced. But we must say that of those who habitually 
 use alcohol, even in what is regarded as moderation, a 
 very large number do from time to time exceed the limit 
 of safety, and weaken moral control. 
 
 The effect of the use of alcohol on the mental powers, 
 observation, memory, and judgment, &c., is exceedingly 
 variable. There are some whose nervous system is espe- 
 cially prone to be affected by alcohol ; others who resist 
 its action, even in large doses, for a very long time. The 
 results of habitual excess are seen in many cases in a de- 
 cline of intellectual power, loss of memory, &c., but this 
 chiefly when there is great excess with defective power of 
 resistance. We are speaking now only of the permanent 
 effects. No one can doubt the constant effect so long as 
 alcohol is being taken in excess. And we have no doubt
 
 58 ALCOHOL : ITS USE AND ABUSE. 
 
 that a large part of the mental deterioration which we see in 
 chronic drinkers is simply the resultant of long-continued 
 want of exercise of the mental powers, which for their 
 proper action require continued exercise and habit. Be- 
 yond this, there is actual decay of nerve tissue, partly from 
 disuse, partly the consequent of changes of nutritive 
 action and of vascular supply. 
 
 We are here again met with the inquiry whether the 
 habitual use of alcohol in anything short of excess causes 
 diminution of mental power. And we must again reply 
 that we know of no evidence that any such diminution is 
 produced, so long as there is no ejccess, in the proper 
 meaning of the term, but that there is great chance of 
 reduction of mental power with far less than is commonly 
 regarded as excess. And even when there is no per- 
 manent injury, however slight, the amount of mental work 
 which can be done without the effect is certainly dimin- 
 ished by very slight excess. On the other hand, we shall 
 * show that a moderate use of alcohol is in many cases a 
 safeguard against the over-exertion of the mind to the 
 injury of the brain. 
 
 Of other permanent nerve disorders caused by alcohol 
 we need say htde here. The various forms of paralysis, 
 convulsions, and mental derangement as the result of 
 great excess, form a very important study for the phy- 
 sician, but never result from any slight degree of drinking,
 
 ALCOHOL : ITS USE AND ABUSEw 59 
 
 find are beyond our province here. The researches of late 
 years have shown that excess in alcohol can and does pro- 
 duce nervous disorders which very closely resemble those 
 due to organic disease j the important practical point for 
 those who are not doctors is never to supply stimulants 
 to persons with paralysis and the like without the doctors 
 orders. We have known two patients killed in this way, 
 by secretly supplying them with spirits ; they were suffer- 
 ing from paralysis actually caused by alcohol, and their 
 friends thought they had serious disease, and wanted 
 *' keeping up," to which they had been used ; the doctor's 
 orders of strict abstinence were regarded as his " fad," 
 and the patients were " kept up " into fatal delirium 
 tremens. 
 
 We see, then, that intemperance is a most fruitful cause 
 of disease ; and this is true not only of the individual, but of 
 the population taken as a whole. For not more surely 
 does decay and degeneration of the body of the individual 
 occur, as the result of excessive drinking, than an injury 
 to the body corporate ; for the disease is propagated 
 in the offspring, and tells upon the com-munity. The 
 children of parents addicted to drink, even if not decrepit 
 and deformed, have the tendency to degeneration in some 
 one or other way implanted in their constitution, and 
 like a birth-mark, or a mole, or the colour of hair and 
 eyes, it may be handed down to posterity. There is
 
 5o ALCOHOL : ITS USE AND ABUSE. 
 
 no more wonderful problem in nature than this handing 
 down of tendencies, and even instincts and emotions, 
 from parents to children. Account for it as we may, we 
 must accept the fact that acquired tendencies to disease 
 are so propagated, and that especially the children of 
 parents whose brains are injured by alcohol are more 
 prone than others to mental disease, and to those widely 
 varied diseases which we call " nervous." We might 
 enlarge much upon this branch of our subject, and trace 
 out the effects of physical, mental, and moral deteriora- 
 tion of parents upon their offspring ; but this has already 
 been frequently done by others. There is good reason 
 to believe that a propensity to drinking is often hereditary, 
 that propensity having been in the first instance acquired. 
 But it must be remembered that we speak here of the 
 results of excess, and not of moderation and temperance. 
 In concluding this part of our subject we must say a 
 word or two upon the treatment of excess in alcohol. 
 The value of restraint and seclusion, and the ways in 
 which they should be enforced, we cannot here discuss. 
 But many men who desire to give up drinking find it 
 hard to do so. One great necessity is the substitution 
 of something to replace the alcohol. Bitter aromatic 
 tonics best serve this purpose, and may be taken at the 
 limes when spirits and water would otherwise be drunk. 
 Those wlio have acquired the habit of taking wine or
 
 ALCOHOL : ITS USE AND ABUSE. 6 1 
 
 spirits at night or in the morning, will often find that a 
 glass of milk will serve their purpose better. In all 
 confirmed cases total abstinence and medical treatment 
 are advisable. 
 
 CHAPTER IV. 
 
 THE USES ar ALCOHOL AND ALCOHOLIC BEVERAGES. 
 
 Alcoholic drinks have their uses in health and in 
 disease : we may consider the former first. It may be 
 laid down as an axiom that a man of good constitution 
 and in good health, with healthy surroundings of food, 
 air, and exercise, requires no alcohol. But so numerous 
 are the departures from the typical standard of health 
 and of good health conditions that a need of alcohol 
 sometimes arises. 
 
 Age exerts an important influence. Children under 
 lo years of age ought never to take alcohol unless during 
 illness or under medical advice ; and in the large majority 
 of cases, more harm than good is done by taking wine 
 or beer between the ages of 14 and 25, especially at the 
 period of adolescence.* But between the age of 9 or 10, 
 
 * "Plato forbids children wine till eighteen years of age, and 
 being drunk till forty." — Montaigne.
 
 62 ALCOHOL : ITS USE AND ABUSE. 
 
 and 14 or 15, there is often a rapid growth and a great 
 strain both on the mental and physical capacities, and if 
 this cannot be met by abundant rest, exercise, air, and 
 food, there is often good from a moderate allowance of 
 alcohol. But in this, as in other matters of the kind, 
 there is great variety in the age at which it is needed, 
 and the amount required. From 25 to 35 or 40, if there 
 is good health, alcohol is certainly not needed, provided 
 always that the surroundings be healthy. And it is 
 especially between 20 and 30 that the use of alcohol 
 habitually in any excess has the most deleterious influ- 
 ence both upon body and mind. After 35 or 40 the uses 
 of alcohol, in moderation, are most perceptible, and from 
 40 to 60 it is most needed. Later, many who have been 
 in the habit of using wine or spirits, find it necessary to 
 restrict the quantity, and to take it in a different form. 
 
 But after all, such rules as these are subject to great 
 modification in individual cases, and hence are of little 
 value in practice ; and it wdll be well to inquire what 
 alcohol can do to promote health, and in what ways it 
 may be usefully employed. 
 
 Alcohol has been supposed to aid digestion, and itself 
 also to act as a food ; to promote nutrition ; to be a 
 stimulant and a sedative, and to give warmth to the body. 
 We may inquire how far it really possesses these quahties, 
 and to what degree they may be utilised : they are so
 
 ALCOHOL : ITS USE AND ABUSE. 63 
 
 much involved in each other that we cannot absolutely 
 separate tliem. . 
 
 On Digestion. — Whether alcohol is a food or nq^it un- 
 questionably aids in the digestion and assimilation of 
 food in some cases, where without it food is not properly 
 digested. We will not now discuss the various theories 
 of its action. It may be, by its action directly on the 
 stomach, promoting the flow of blood ; by permitting of 
 that rest of nervous energy which is one of the main aids 
 to healthy digestion; by increasing secretion, or what 
 not — all of which might be amply discussed in a work on 
 medicine ; but the fact remains that, in a large number 
 of cases, a moderate allowance of alcohol taken with food 
 does aid digestion and thus promote nutrition. Even in 
 infancy, in some states of wasting, alcohol is of great 
 value. Wine is the form in which the alcohol is most 
 often useful for this purpose. In rapidly growing and 
 unhealthy children, who take their food badly, and are 
 not nourished by it — indeed in many conditions of con- 
 tinued ill-health in childhood and early youth — a small 
 daily allowance of wine, port or sherry, diluted with water 
 and taken at meals, is extremely beneficial. 
 
 In early manhood and womanhood, if the habits are 
 properly regulated, there is more rarely the actual necessity 
 for stimulants to aid digestion. More often their dis- 
 continuance would restore it. Young women, especially 
 5
 
 64 alcohol: its use and abuse. 
 
 of sedentary habits and keeping late hours, or neglect- 
 ing to take exercise, with no special duties requiring 
 thought and energy, very often suffer from capricious 
 appetite, some symptoms of indigestion, languor, and 
 debility, for which they are often advised to take, or do 
 take, wine, both at and between meals, and in the multi- 
 tude of instances only keep up and aggravate the very 
 symptoms of which they complain. And we might say 
 the same of many others — especially young men who 
 take wine or beer in the morning or at mid-day, or who 
 fast all day, and are exhausted and void of appetite at 
 dinner-time. Alcohol is not here the remedy ; light food 
 at mid-day, with chocolate or milk, and, if need be, a cup 
 of tea or coffee an hour before dinner, are far better 
 treatment. In a great number of cases, proper food taken 
 at proper times would make the use of alcohol for this 
 purpose unnecessary. 
 
 A very large number of middle-aged and elderly people 
 do, however, find that some wine or beer at dinner aids 
 them in digestion. We might provide them with a 
 number of theories as to the way in which this occurs ; 
 we prefer to point out the fact, and to caution them 
 against converting a right use into a misuse. Nor must 
 the effect of habit in creating necessities be forgotten. 
 
 We may here say a word for one mode of action of 
 alcohol which is too often left out of sight by strictly
 
 ALCOHOL : ITS USE AND ABUSE. 65 
 
 scientific people. Emotions, such as pleasure, happiness, 
 discontent, and the like, are too evanescent and im- 
 ponderable quantities to gain the notice of the physi- 
 ologist and chemist. It is true that the modern vitalist 
 looks upon them as an indication of the state of the 
 brain-cells which may be of interest and value, but the 
 truly scientific man is too much engrossed with physical 
 properties to care for the existence of such mere feehngs 
 in other people. He can see that alcohol causes the 
 blood-vessels to dilate, the gastric follicles to secrete; 
 that in excess it flushes the face, makes the gait un- 
 steady, and so on, and condemn this action as needless 
 and wasteful. But the effect even of slight and almost 
 unconscious states of feeHng upon all these processes 
 seem to escape his notice. The sight of green trees, 
 the sound of the sea, the smell of flowers, may give 
 energy and appetite to the invalid in such a way as to be 
 perceptible. The healthy man may be less conscious of 
 such emotion, but it may strongly influence him. Appe- 
 tite and digestion, and many other functions, are very 
 greatly under the control of feeling. Some cannot eat 
 heartily in company, nor others alone ; a smell, a slight 
 taste, will destroy the appetite and digestion. Perhaps 
 more than anything else, great mental preoccupation, 
 such as business cares and worries, may completely check 
 digestion. Now alcohol in some of the liquors which
 
 66 alcohol: its use and abuse. 
 
 contain but a very small quantity, such as light ales or 
 wines (we would especially mention light dry effervescing 
 wines), and even a small amount of these, do check in 
 many cases the current of these thoughts and cares for 
 a time, and the slight degree of pleasure thus excited 
 serves to set the digestive process in action. This is not 
 only a lawful use of alcohol, it is one which is in many 
 cases very beneficial, and to neglect it would be wrong. 
 Because ninety-nine persons out of a hundred misuse it, 
 it none the less remains true that it has a right use. Let 
 no one, however, mistake our meaning. Strong wine is 
 not nearly so well calculated to produce this effect as 
 light wine diluted with water, and where a light heart 
 and cheerful company make this needless, it is an abuse 
 of alcohol to take it. 
 
 To speak of the danger of producing such slight ex- 
 citement of the heart's action as this, to regard it as 
 shortening the life and producing physical and mental 
 decay, is an abuse of science; if it were true, every 
 exertion, every pleasing emotion, nay, all activity of 
 every sort, would tend to shorten our days, and they 
 alone would be wise and happy who existed in torpor, 
 with only such food as they could get with the least 
 possible exertion, and that only sufficient to keep body 
 and soul together. Science will never gain a proper 
 influence over the actions of intelligent men so long as
 
 ALCOHOL : ITS USE AND ABUSE. 6^ 
 
 her assertions are contrary to the common-sense and 
 inteUigence of rational beings. 
 
 Alcohol as a Food. — The question whether alcohol is a 
 food is one which has been obscured by numerous mis- 
 statements and fallacies. It has been discussed on 
 chemical and physiological grounds, and by the light 
 of experience. Chemically, it is a fact that alcohol 
 contains no nitrogen ; the body requires nitrogen for its 
 nutrition, hence it is stated that alcohol cannot support 
 life alone. But this is also true of starch and oil, two 
 of our chief food ingredients. If alcohol is burnt up 
 in the body it does act to some extent as a food. 
 Some physiologists have stated that all the alcohol 
 taken passes out of the body again unchanged. This, if 
 true, would show that it is not a food ; but further ex- 
 periments have shown that only a very small quantity of 
 the alcohol does pass out unaltered, the greater part is 
 burnt up in the body. Certain observations on persons 
 in old age or disease show that Hfe can be supported for 
 a long time on a diet which contains little but pure 
 spirits and water ; in these exceptional cases the alcohol 
 evidently acting as a food. 
 
 But all these results of experiment and observation 
 only refer to very exceptional conditions, and are not of 
 much value for our purpose. For no one would think 
 of taking, as a food, in health, an amount of alcohol
 
 68 ALCOHOL : ITS USE AND ABUSE. 
 
 sufficient to be an important ingredient in his diet. Four 
 glasses of sherry would supply at the outside only an 
 infinitesimal part of the carbon daily needed by a healthy 
 man, that is to say, from the alcohol itself. It is scarcely 
 necessary, then, to consider this question ; it is one of 
 little practical moment. 
 
 The more important question is, if an allowance of 
 alcohol is taken with food of ordinary kinds, is more 
 work done in the system than if no alcohol is taken. 
 Many experiments have been made to decide this. Like 
 all such experiments they are very difficult to conduct 
 accurately; and the quantity of alcohol given has ex- 
 ceeded that which could be called moderate. According 
 to the late Dr. Parkes, one of the greatest authorities on 
 the subject, the effect on bodily labour is that a small 
 quantity of alcohol does not produce much effect, but 
 that more than two fluid ounces daily manifestly lessens 
 the power of sustained and strong muscular work. Even 
 when the quantity is not excessive it seems doubtful 
 whether alcohol is beneficial, for it increases the action 
 of the heart beyond the necessary degree ; hence it 
 should only be used when an excessive effort is to be 
 made, which must be made without giving the heart 
 proper time for rest 
 
 The effect on mental work is more doubtful. When 
 mind and body are exhausted by over-work and want
 
 ALCOHOL : ITS USE AND ABUSE. 69 
 
 of food, alcohol no doubt restores the power of free 
 thought, and removes mental preoccupation. This it 
 does in the way which we have already described, by 
 quickening the circulation in the brain, and by its slight 
 narcotic and deliriant properties. When taken with 
 food it is not easy to decide how much of the effect is 
 due to the food alone. But whilst there is no doubt that 
 in many conditions alcohol does for a time promote the 
 flow of thought and idea, it diminishes the power of clear 
 and consecutive reasoning, and its use is nearly always 
 followed by greater exhaustion and less power of appli- 
 cation. One may perhaps make an exception in the 
 case of public speaking for some length of time, where 
 there is, in addition to thought, a physical strain and 
 some excitement ; alcohol does, in some cases of this 
 kind, enable great mental efforts to be performed. 
 
 The conclusion is, then, that in ordinary life, only so 
 much alcohol as is of use to insure mental rest and good 
 digestion should be taken. Where these are suflficient 
 without alcohol, none should be taken. 
 
 Under exceptional circumstances, such as exposure to 
 cold or heat, or extraordinary exertion, is alcohol bene- 
 ficial? Perhaps the best possible test is afforded by 
 experience in the army. It is the almost unanimous 
 experience of those who have given special attention to 
 the question, that so far from being an aid to great exer-
 
 ;o ALCOHOL : ITS USE AND ABUSE. 
 
 tion, and to the resistance of extremes of temperature, 
 alcohol acts injuriously; and that such conditions are 
 far better supported without it.* 
 
 The behef that alcohol produces warmth, and is there- 
 fore to be used on all occasions when there is a liability 
 to chill, is one of the most common of popular errors, or, 
 at least, is so regarded by scientific men. For experi- 
 ments have shown that the principal action of alcohol is 
 to lower the temperature of the body, in proportion to 
 the quantity taken. It is a well-known fact that the human 
 body (hke that of all animals) has a certain temperature, 
 which it maintains, with very slight variations, under the 
 varied conditions of external temperature. Thus it has 
 been shown that in the tropics and in the extremest cold 
 there is a scarcely perceptible difference in the heat of 
 the body, so long as health is maintained. This tempera- 
 
 * For further details on this interesting subject, which space 
 forbids us from entering into, see the following : — Parkes on 
 * Hygiene,' fourth edition, p. 281 ; 'Medical Sketches of the Expe- 
 dition to Egypt,' by Sir James M'Gregor, p, 86; Hamilton's 
 'Military Surgery,' p. 61 : Sir John Hall, * Medical History of the 
 War in the Crimea,' vol. i. p. 504; 'Journal of the United Service 
 Institution,' 1871, vol. xv. p. 74; Captain Huyshe's 'Account of 
 the Red River Expedition '; 'Blackwood's Magazine,' Jan. 1871, 
 p. 64 ; * The Soldier's Pocket Book,' by Sir Garnet Wolseley, 
 second edition, 1871, p. 172; Dr. W. B. Carpenter on 'The 
 Physiology of Temperance and Total Abstinence,' 1870.
 
 ALCOHOL : ITS USE AND ABUSE. 7 1 
 
 turc is about 98^° Fahrenheit ; slightly lower in hot than 
 in cold climates, owing to greater cooling by evaporation. 
 This uniform heat of the body is essential for the healthy 
 maintenance of nutrition, and appears to be regulated by 
 the nervous system ; that is, the various processes which 
 go on in the body to produce heat, or to get rid of it, are 
 under nervous control. A large number of diseases cause 
 this regular heat to be deranged, and the body becomes 
 too hot or too cool ; and alcohol, like several other drugs, 
 has the power of lowering the temperature, as will also 
 the external application of cold to such an extent as to 
 overcome the power of heat production in the body. 
 
 Alcohol, in a dose of any amount, has also the power 
 of lowering considerably the general heat of the body 
 below the natural standard, and in drunken persons very 
 low temperatures indeed have been found. We do not 
 yet know exactly how this effect is produced ; some think 
 it is by an action upon the central controlling part of the 
 nervous system, just as we may derange the regulated 
 filling of a cistern by holding up the ball-cock, or the 
 rate of a steam-engine by checking the governor-balls. 
 Others believe that it acts as a damper, preventing the 
 proper burning of the substance which is found in the 
 liver, and produces heat by combustion in the lungs. 
 Whichever is the true view, there is no doubt about the 
 action. But this is not quite the whole truth, for careful
 
 72 ALCOHOL : ITS USE AND ABUSE. 
 
 observation has shown that quite at first, when only a 
 moderate dose of alcohol is taken, there is a slight rise in 
 the body-temperature to the amount of i*^ to ij° Fahr., 
 which lasts for a short time. 
 
 We must understand, however, that the temperature 
 of all parts of the body is not the same, for different 
 parts are more exposed to external cooling agencies. 
 The skin of the arms and legs is always colder, usually 
 many degrees colder, than the blood, and the parts 
 immediately beneath the skin are cooler than the deeper 
 parts. In fact, the temperature of any given part will 
 depend on the free circulation of the warm blood from 
 the interior of the body, and the absence of external 
 cooling agencies. We can freeze the foot or hand by a 
 freezing mixture, or warm it by exercise or rubbing, which 
 make the circulation more active in it. In fact, we may 
 regard it as one of the very important functions of the 
 blood to act like a system of hot-water pipes, and keep 
 all parts of our bodily house warm. The longer the warm 
 blood stays at the parts most exposed the m.ore is it 
 cooled ; the faster it is changed for fresh v/arm blood the 
 better it keeps up its heat. 
 
 Now this is what alcohol really does in the body, and 
 in many cases what we want it especially for. It widens 
 the channels through which the blood flows, and thus 
 lets the blood course more freely through them, and it
 
 alcohol: its use and abuse. 73 
 
 quickens the beat of the heart, and sends more blood 
 through in a given time. Moreover, cold of itself con- 
 tracts the vessels, and makes them resist the passage of 
 the blood ; so that we see that alcohol directly counteracts 
 the local effects of cold. 
 
 Now, what is the effect of a chill, such as from riding in the 
 cold, getting wet feet, &c.? The danger seems to he in this, 
 that the blood-vessels of some part of the body, especially 
 of some internal organ, owing to the impression made by 
 the cold upon the surface, become affected, and thus a 
 congestion and inflammation is set up. (The complete 
 explanation is too technical to introduce here.) Now, 
 although the effect of alcohol in any large quantity may 
 be injurious, it is quite possible and probable that in a 
 moderate one it may for a time do good, for it not only 
 acts upon the vessels of the part chilled, but upon those 
 of the internal organs, and thus makes the circulation 
 everywhere more rapid and easy. For the evil effect of 
 a chill is not in the lowering of the general temperature 
 so much as in the local result, and its secondary effects 
 on other parts. 
 
 When, however, we have to do with exposure to a cold 
 climate or a very hot one, the question is very different. 
 The habitual use of alcohol lowers the power of resistance 
 to cold or heat, that is, it interferes with the central con« 
 trolling authority, and so works mischief.
 
 74 ALCOHOL : ITS USE AND ABUSE. 
 
 Old people who suffer from a languid circulation, cold 
 feet and hands, and the like, are often benefited by 
 alcohol, for example, spirits and water at night ; because 
 the blood-vessels have become degenerated and rigid, the 
 heart weakened and unable to overcome the resistance in 
 the vessels. Alcohol both aids in dilating the small 
 vessels and quickening and invigorating the heart's action, 
 and thus equalises the circulation, and allows the warm 
 blood to flow freely in all parts of the body, so that the 
 warmth of the more distant parts is maintained. 
 
 We may, then, use alcohol for this purpose of equalising 
 heat and circulation in some cases, both for a time under 
 exceptional circumstances, and habitually in moderate 
 doses, where, either from defective action of the heart or 
 a degenerated condition of the vessels, we cannot keep up 
 the due balance of action. But we must remember that 
 there are dangers attending the use of alcohol which 
 should make us always prefer other means for attaining 
 these ends, and that the dose must be strictly regulated 
 by the necessity of the case. It is better that a man 
 should suffer from cold feet than that by putting alcohol 
 into him we should make the heart act so forcibly as to 
 burst a vessel in his brain ; and better that he should 
 have a rather languid circulation, than that he should set 
 up disease of his vessels and organs by constant use of 
 alcohol. We may work a new and sound boiler at high
 
 alcohol: its use and abuse. 75 
 
 pressure, but we must be careful how we increase the 
 pressure when the boiler is rusty and the pipes furred. 
 In many such cases of languid circulation, rest in a re- 
 cumbent posture does all the good which alcohol could 
 do, without its attendant dangers. Sufficiently frequent 
 feeding and proper clothing must also be attended to. 
 
 Alcohol as a Stimulant. — Before we ask whether alcohol 
 is a stimulant, we ought to inquire what we mean by the 
 word. A stimulus is something which acts as a spur or 
 whip, and rouses up some flagging energy. Does alcohol 
 do this ? Many people have said that it does not — that 
 it only paralyses the higher controlling centres and lets 
 the lower act. But whatever theory we may adopt, no 
 one can doubt that somehow, under some conditions, a 
 glass of wine does revive the energies, that it quickens 
 the heart's action and the sluggish circulation, at any rate 
 for a time. 
 
 No doubt, in many cases, even, perhaps, in most, this 
 over-action is followed by corresponding depression ; 
 there is drowsiness, confusion of thought, languor, sluggish 
 alimentary action, especially if the stimulation is at all 
 more than absolutely necessary. So that some say that, 
 on the whole, the stimulant effect adds nothing to the 
 total income ; it only temporarily overdraws the account 
 at the banker's, and the deficit must be made up. But 
 we do not think this to be absolutely true. Both for a
 
 76 alcohol: its use- and abuse. 
 
 time, in some healthy persons, and constantly in many who 
 have no actual evident disease but a defective vital action, 
 the use of alcohol is justifiable and desirable ; so long as 
 only so much is taken as to give the needed stimulus and 
 no more. Chronic diseases require chronic remedies, 
 and so do chronic defects of action. 
 
 The effects produced by alcohol in certain diseases 
 show beyond a doubt that it has a certain action upon 
 the nervous system, which we can only call stimulant or 
 tonic. Especially is this seen in some cases of delirium 
 in fever, and in failure of the heart's action in some acute 
 diseases. In such cases alcohol is sometimes used in very 
 large and repeated doses with only a good effect, and 
 without any subsequent depression. It is idle to ignore 
 the results of experience in disease ; they are, so to speak, 
 only the same on a very large and visible scale as those 
 which occur in a less tangible form in the lesser 
 derangements of health. 
 
 As a sedative^ i.e. to promote rest and quiet, or sleep. — 
 This, as we have seen, is the sequel of the former effect, 
 and is produced mainly by the action upon the higher 
 nervous centres, which can be temporarily paralysed by 
 alcohol. In ordinary life, however, such a use of alcohol 
 would be highly mischievous ; even in disease, the result 
 can better be attained by other means. The use of wine 
 or spirits to relieve pain, headache, neuralgia, and the
 
 alcohol: its use and abuse. 77 
 
 like, is one of the greatest danger ; and when from long 
 continuance of the cause of pain the habit becomes 
 constant, the diseases caused by alcohol are most cer- 
 tainly produced. Very often the pain is really caused 
 by the use of the alcohol, and ceases on its withdrawal. 
 
 Yet there are exceptional conditions in which the seda- 
 tive effect of alcohol in a moderate degree is of great 
 value. This is especially the case where over-mental 
 activity or excitement prevent sleep or hinder digestion. 
 The over-exhausted brain is incapable of taking rest; 
 sleep is obtained with difficulty owing to continual active 
 yet useless thought; there is much dreaming and the 
 sleep is broken ; in the daytime there is drowsiness and 
 languor ; the appetite is gone. Now all these may result 
 from the use of alcohol, but they may also arise when 
 no alcohol is used, simply from mental exhaustion, and 
 then a small quantity of alcohol taken regularly gives 
 great rehef. In a similar way, as we have said, by 
 removing mental preoccupation, appetite and digestion 
 may be improved. 
 
 In elderly persons the use of wine or spirits and water 
 as a " nightcap " is very common, and in many cases 
 beneficial ; but very often some light food would have an 
 equally good effect, and we believe that in most cases 
 where it is really needed, some food should be taken 
 with it.
 
 ;8 ALCOHOL : its use and abuse. 
 
 It must, however, always be remembered, that in using 
 alcohol as a stimulant or sedative, that is, distinctly for 
 either of those objects, we are entering upon a course 
 which is more or less pernicious. For the action is only 
 temporary, and needs repetition, and there is no habit 
 more likely to cause its own repetition than the taking of 
 alcohol. We step in and interfere with nature, and if 
 nature replies by reckoning upon our interference, we 
 are perhaps in a worse case than before. If we accustom 
 ourselves to boots and clothing, nature does not give us 
 hard hoofs and a dense hairy covering. Our acquired 
 habits are some of the strongest parts of ourselves. 
 
 Moreover, there is no doubt that we can do work 
 beyond our right measure and standard for a time under 
 the influence of alcohol; and although the limit as 
 regards bodily work is soon reached, and less work is 
 done, it is not so certainly the case with mental, and we 
 may readily go beyond the point of safety, with con- 
 sequent weakening of our powers. 
 
 One word with regard to the diminution of alcohol or 
 its entire cessation after it has been used as a stimulant 
 or sedative. Can it be done with safety ? Unquestion- 
 ably, if in a person in ordinary health, it may be with- 
 drawn at once and entirely ; in diseased or in old persons 
 it must be done more gradually and cautiously. The 
 cessation is often attended with great discomfort, great
 
 ALCOHOL : ITS USE AND ABUSE, 79 
 
 craving for a return to it; but this is no indication of 
 injury by the withdrawal, it shows only a morbid condition 
 created by drinking. We may say, indeed, that such a 
 craving is of itself an indication that more had been 
 taken than was needed. Persons who take only a mode- 
 rate quantity usually suffer no discomfort or inconve- 
 nience from going without for a few days, though they 
 may feel the better for returning to their habitual 
 allowance. 
 
 CHAPTER V. 
 
 ALCOHOL IN ILL-HEALTH AND DISEASE. 
 
 We have said a good deal about the effects of alcohol in 
 various conditions of slight ill-health, and it may be 
 gathered from what we have already said that the habitual 
 use of alcohol is necessary only when there is some depar- 
 ture from health. If it is only the daily friction of mental 
 worry or bodily fatigue which is relieved by the daily 
 use of a small quantity with food, just as grease relieves 
 the friction of the wheels of a carriage, it is the slight 
 degree of overwear or friction of the system which makes 
 us need it. Now there are many conditions of ill-health 
 in which alcohol is supposed to be beneficial, and it is
 
 So ALCOHOL : ITS USE AND ABUSE. 
 
 one of the most difficult tasks of the doctor, and of those 
 who wish to be guided by reason alone, to decide whether 
 in such or such a case alcohol shall be taken, and in 
 what form. 
 
 It would be waste of time to go into all these various 
 conditions, and to try to suggest the appropriate modicum 
 for each. Patients generally expect the doctor to tell 
 them exactly how much stimulant, of what kind, and at 
 what time, they are to take. Some follow blindly and 
 exactly the instructions given, and this veiy wisely; 
 others hedge a good deal, they take less or more as their 
 inclination tends. If people would deal fairly and 
 honestly with themselves, they could often judge far 
 better than the doctor what is good for them. People 
 often ask the doctor such a question as this : " Do you 
 think three or four glasses of sherry a day would do me 
 harm ?" If he says, " Yes, take only two," the chances 
 are that they will still take as much as before ; if he says 
 " No," they will take it too, though all the while knowing 
 that it does harm them. In a large majority of cases the 
 truest answer is, " You can judge far better yourself, both 
 what form agrees with you best, and how much you 
 really need ; take that form which you can digest, and as 
 little of it as possible." Men are too willing to leave 
 others to judge for them, especially when the advice 
 jumps with their own inclination, and they need to be
 
 alcohol: its use and abuse. 8i 
 
 brought honestly to use their own reason and act on 
 their own responsibihty. 
 
 Knowledge of the individual and his habits, of the 
 tendencies of certain states of constitution, and the like, 
 do, however, often enable the doctor to form an accurate 
 judgment as to what is best. 
 
 Certain constitutions do not tolerate certain forms of 
 stimulants, and some are always injured by alcohol. 
 Every one knows that gouty people should not take 
 young port, or sweet wines ; that many dyspeptics cannot 
 take ale or stout ; that elderly persons often cannot take 
 claret, and so on. Some of these difficulties are due to 
 the other bodies, such as sugar, salts, &c., contained in 
 the various liquors. But we could not go into all these 
 points in a work like the present, and no one but a 
 doctor could be expected fully to appreciate the minute 
 shades of difference if we did. If one man finds that 
 beer gives him dyspepsia or headache, and claret does 
 not — if port flushes his face and makes him feel stupid, 
 and champagne does not — if, in fact, one thing suits him 
 and the other does not, he does not want a doctor to tell 
 him which to take, so long as he possesses any amount 
 of his reasoning faculties ; but he may need to be told 
 that he would be far better without any at all. 
 
 We must rather try to indicate what states of health 
 show that alcohol as such is injurious or beneficial.
 
 82 ALCOHOL : ITS LSE AND ABUSE. 
 
 " Indigestion" is one of the common complaints for 
 which alcohol is used. " Take a little wine for thy 
 stomach's sake " is a very old prescription, but wanting 
 in explicity both as to the quantity and nature of the 
 wine. There are many forms of indigestion — one of the 
 commonest in some classes is actually caused by alcohol, 
 as we have already said. For this the remedy is entire 
 abstention. So, too, when the water is high-coloured 
 and loaded in the morning, the tongue coated, much 
 thirst, drowsiness and heaviness during the day, the 
 bowels sluggish, dull aching in the right side, &c., we 
 may strongly suspect over-indulgence in the pleasures of 
 the table, both in meat and drink, and counsel abstinence 
 in both, and more exercise. But when there is loss of 
 appetite, with a pale clean tongue, slight pain after food, 
 capricious likings and loathings, and other symptoms 
 showing difficulty in digestion in a person not in the 
 habit of taking alcohol, it may often be given with food 
 with very great advantage. We come back, however, to 
 our starting-point, that every case must be judged on its 
 own merits, that other treatment should in most cases be 
 employed, and that the kind and quantity of stimulant is 
 to be regulated by the doctor's advice and the person's 
 own experience. "Indigestion" is only a name for a 
 condition varying widely in its causes and symptoms. It 
 may easily be aggravated by the use of alcohol, or by use
 
 alcohol: its use and abuse. 83 
 
 of it in the wrong form, or at wrong times, or it may 
 be greatly relieved by it, and we should lead into error 
 if we tried to go too much into detail. Experience is 
 after all the best guide in any individual case, but an 
 honest trial of total abstinence is always well worth 
 making. 
 
 We may lay it down as a universal rule that if alcohol 
 is to benefit digestion it must be taken with or soon after 
 meals, that only a moderate quantity such as we have 
 already indicated must be taken, and that the form must 
 be regulated by experience. Beyond these general 
 maxims we cannot here afford space to lay down any 
 fixed rules. 
 
 Neuralgia in all its varied forms, and nerve pains of 
 whatever kind, are generally supposed to demand the use 
 of alcohol. It is here that the narcotic effect of alcohol 
 is most frequently sought. If we go through the whole 
 series of pains and aches to which our human frame is 
 subject we shall find hardly one in which alcohol has 
 not been recommended as a specific. Toothache, tic- 
 douloureux, headache, &c., are often treated with large 
 doses of brandy or port wine, and in many cases with 
 great benefit, at least for a time. Alcohol has in such 
 cases a double action ; it makes the sensation of pain less 
 by deadening the sensibility of the brain, and probably 
 also it acts upon the vessels of the affected part, changes
 
 84 ALCOHOL : ITS USE AND ABUSE. 
 
 the relations of the vessels and nerves, and so alters and 
 possibly relieves the pain. But in many cases, though it 
 gives relief for a time, the pain returns with renewed 
 vigour^ and more alcohol must be taken, and so on. It is the 
 nature of all nerve pains to come and go, and to be aggra- 
 vated by diseased or unhealthy conditions of the general 
 system,and unless there be some serious direct irritation of 
 the nerve, to last only for a certain time and then go away. 
 When pain is very severe and agonising, it is on all 
 accounts desirable to relieve it, for nothing is more 
 wearying to the human frame than severe pain. And for 
 this we may use alcohol if we have no better means of 
 relief, but we ought fully to understand why we use it. 
 It is not to cure, and we may have to reckon with the 
 possibility of the general state which causes the pain 
 being made worse. 
 
 It cannot be too clearly understood that most neu- 
 ralgias have a general as well as a local cause. How 
 many people do we see who suffer agonies from toothache 
 or earache whenever they get overworked or out of 
 health. Their teeth may be as rotten as touchwood, but 
 so long as they are in good health they feel nothing 
 amiss ; give them a few days' overwork, want of sleep, or 
 anxiety, and they hurry to the dentist to have their teeth 
 drawn. Now in very many such cases the amount of 
 alcohol which relieves pain gives rise to dyspepsia, or
 
 alcohol: its use and abuse. 85 
 
 to subsequent debility, and so indirectly aggravates the 
 suffering. 
 
 We are not speaking here of the local use of alcohol in 
 the form of brandy or rum, which sometimes has a very 
 good effect in the relief of pain, e.g., in a tooth, or apphed 
 to the face in neuralgia. This use is a harmless one, too 
 well known as a homely remedy to need recommen- 
 dation here. 
 
 What we have said of the use of alcohol in severe 
 acute neuralgia applies with greater force to its employ- 
 ment in long-standing or recurrent pain, and indeed 
 nearly all chronic nervous diseases. In no condition is 
 the use of alcohol so likely to become dangerous, and to 
 make the mind and body slaves to it. This is equally 
 true of the real bodily pains and discomforts to which 
 so many are subject, and those mental pains which, like 
 dank vapours, arise from the body and becloud the mind 
 and soul. For those who really suffer pain of body find 
 that drinking for a time relieves their sense of misery, 
 but only so long as the alcohol is acting; when it has 
 ceased they are as bad as, or worse than, ever, so that 
 they again seek the bottle. By degrees they find that 
 they need more frequent and larger doses to relieve their 
 pain and discomfort, nor can they be for any length of 
 time without it ; and so from occasional small doses they 
 slide into constant tipphng. Soon they find that when
 
 86 ALCOHOL : ITS USE AND ABUSE. 
 
 they are not drinking they have not only their original 
 pain but the malaise and wretchedness which result from 
 alcohol itself, and they must take more to remove their 
 sense of complicated misery. Thus from moderate 
 drinkers, using alcohol in a strictly medicinal way, they 
 become by degrees habitual drunkards, and ruin their 
 health, constitution, and entire well-being, physical and 
 moral. 
 
 Hypochondriacal and *' nervous " people, who are 
 readily " hipped," whose lives are made wretched by a 
 sense of misery which has no external or evident cause, 
 are often led into drinking. But they only aggravate 
 and extend their wretchedness, and may say — 
 
 *' Sad once were we 
 In the sweet air made gladsome by the sun ; 
 Now in these murky settlings are we sad." 
 
 They had to start with too little control over their 
 sensations and feelings, and what they had they lose; 
 find thus the soul 
 
 *' Yields her body to a fiend, 
 
 Who after moves and governs it at will, 
 
 'Till all its time be rounded." 
 
 Whatever benefit there may be in the use of alcohol to 
 " one that is of sorrowful heart " for a time, there is the 
 greatest danger in it to those who are so by nature and
 
 ALCOHOL : ITS USE AND ABUSE. 87 
 
 habit ; when once they begin to use it they become 
 gradually enslaved, and the craving for drink is the 
 tangible fomi which their longing for some relief takes 
 on. They may, it is true, in like manner become slaves 
 to opium or other narcotics, but it is rarely that they do 
 not take spirits too, either at the same time or alternately 
 with opium or morphia. 
 
 At some periods of life there is an especial tendency 
 to drinking, owing to abnormal or morbid sensations 
 caused by altered functional states. One of the most 
 dangerous of these is the change of life in women, and it 
 is at this period that many previously sober and moral 
 women become addicted to drinking, often in secret at 
 first, and lay the foundation of habits which shorten the 
 life and degrade the character. No doubt this tendency 
 is encouraged by custom and the influence of bad advice, 
 but, in many cases, there is a very strong incHnation 
 towards drinking which needs nothing but the possi- 
 bility of secret gratification to cause it to be indulged 
 in. Those who have not had the opportunities which 
 doctors unfortunately enjoy of hearing the sad revelations 
 which are sometimes made on this subject, would be 
 astonished at the amount of secret drinking amongst 
 apparently respectable and sober middle-aged women. 
 
 In the state of maternity and childbirth the same is 
 true to an enormous extent. The amount of drinking
 
 88 ALCOHOL : ITS USE AND ABUSE. 
 
 which is carried on, both at these times and by nursing 
 mothers, under a wrong idea of the necessity for alcohol, 
 and an entire misconception of its true action, is almost 
 beyond belief. On no subject connected with drinking 
 is it more necessary to speak emphatically, for the 
 direct and indirect effects of such a misuse are evils of 
 incalculable extent. It seems to have become one of the 
 doctrines and tenets of the female world that alcohol is 
 essential to women who are nursing, and that it is not 
 only a benefit to them, but their duty to take a considerable 
 quantity. If this error were confined to the lower classes 
 we might not be surprised, but unfortunately it is equally 
 common in the higher. Monthly nurses are probably more 
 chargeable with spreading drunkenness among married 
 women than any other class. Their position and supposed 
 experience as " wise women " enable them to insinuate the 
 temptation and propagate the error, in spite of all the 
 efforts of doctors and moralists. Young mothers especially 
 are led by their advice as if they were bound hand and 
 foot ; and, in spite of their better judgment, they give way 
 to their leaders in a hitherto unknown land, and blindly 
 follow their blind guides. 
 
 The evil thus brought upon young married women is 
 enormous, and the result in physical and moral deteriora- 
 tion is most saddening. But this is not by any means 
 the sole evil effect, for the habit tells upon the offspring
 
 alcohol: its use and abuse. 89 
 
 whom it is intended to benefit. We are not speaking of 
 the effect of drunkenness in the mother, which has ter- 
 rible results in infant mortality or life-long disease, but 
 the result of drinking more than is habitual or moderate, 
 the effect of which, though less in degree, is of the same 
 kind ; and there is the strongest probability that the 
 moral and mental character of children is influenced by 
 the action of alcohol in the mother, and greater misery 
 thus caused than even by crippling or fatal disease. 
 
 There is no evidence that alcohol is more necessary 
 or beneficial to mothers, as such, and all experience 
 points strongly in the opposite direction ; so that those 
 who wish to preserve their own health, and the hfe and 
 health of their children, should resist the bad advice so 
 often pressed upon them, and avoid alcohol as much as 
 possible. 
 
 Alcohol in Disease. — It may be thought that we have 
 said very little as to the use of alcohol in disease. Most 
 people, at any rate doctors, admit that alcohol is a most 
 valuable drug, and those who have had to deal much 
 with severe disease know of what immense value it is in 
 many cases. We have mentioned some of the slighter 
 ailments in which 't is useful, but beyond this we must 
 not go here. For whilst alcohol may be used with great 
 benefit, and in very large doses in some diseases, the 
 knowledge of how and when to use it with profit is one
 
 QO ALCOHOL : ITS USE AND ABUSE. 
 
 of these points which require all the special skill and 
 experience of the physician, and the indications for its 
 use require technical knowledge which we could not here 
 impart. It is especially in acute diseases and fevers, and 
 in some diseases of the nervous system and heart, that it 
 finds its greatest use ; but in such cases it should always 
 be given as a medicine in carefully measured doses, and 
 at stated times, and never left to the discretion either of 
 the nurse or the patient. Nor let it be imagined that 
 caprice or educational bias is the guide of the doctor in 
 giving or withholding alcohol ; there is no drug the effects 
 of which in disease have been more minutely and scien- 
 tifically investigated of late years than alcohol, and a 
 great mass of accurate knowledge as to its effects is the 
 result; so that he who pretends that giving alcohol is 
 merely a matter of conjecture or routine is either an 
 ignoramus or a quack. 
 
 And, lastly, the common use of brandy in all sorts of 
 ailments, as a specific, cannot be too earnestly deprecated. 
 It is quite true that in many slight ailments it gives 
 relief, and in some is very useful when no other remedy 
 is at hand ; for example, in colic or diarrhoea, in ex- 
 haustion or fainting, in shock from accident, and the 
 like. We have purposely avoided discussing its use 
 under these circumstances, because we are convinced 
 that there is no need to mention all the conditions which
 
 alcohol: its use and abuse. 91 
 
 may call, for it, and that what needs to be said is more 
 in the way of caution than advice. For in a very large 
 number of cases, the giving of brandy actually does harm, 
 in many others it does no good, and obscures the true 
 nature of the case when the doctor is called in. A man 
 is seen to reel and stagger in the street ; the bystanders 
 gather round him ; he complains of being sick and faint, 
 perhaps falls and becomes partially unconscious. The 
 two things which kind neighbours or good Samaritans do 
 are, first to try to help him to stand up, and then to 
 fetch him some brandy, or to support him to the nearest 
 public-house to get some, and then pour down a large 
 quantity. And thus many a case of commencing apoplexy 
 has been aggravated and made fatal ; or a man with heart 
 or brain disease taken to a police-cell as drunk, and died 
 there. AVe believe that in by far the majority of cases 
 the rough-and-ready treatment of ignorant persons has 
 thus been absolutely injurious ; in very few beneficial. 
 
 The use of spirits has often been supposed to aid in 
 preventing the attacks of fever, ague, and other infectious 
 and malarial diseases. The experience on this point 
 derived from army statistics seems to show that alcohol 
 has no effect in warding off malarial fever, cholera, or 
 dysentery. Nor does its presence promote attack. Yellow 
 fever is peculiarly fatal to intemperate persons. With 
 regard to other fevers, we have no evidence that they are
 
 92 ALCOHOL : ITS USE AND ABUSE, 
 
 at all prevented by alcohol, and they are certainly, like 
 nearly all other diseases, more fatal in persons who have 
 indulired to excess than in others. 
 
 CHAPTER VI. 
 
 THE RIGHT USE OF ALCOHOL. 
 
 We have thus briefly discussed the various uses and 
 abuses of alcohol ; and from what we have said, it is evi- 
 dent that alcohol has a right use, as an article of diet and 
 as a medicine ; but that it may be easily misused through 
 ignorance of its action, as well as from w^ilful indulgence 
 
 Upon the dietetic use of alcohol we cannot do better 
 than quote the words of the late lamentexLDr..Parkes^, 
 which will meet with the concurrence of all right-thinking 
 men. 
 
 " The dietetic value of alcohol has been much over- 
 rated. It does not appear to me possible at present to 
 condemn altogether alcohol as an article of diet in health ; 
 or to prove that it is invariably hurtful, as some have at- 
 tempted to do. It produces effects which are often useful 
 in disease, and sometimes desirable i-n health ; but in 
 health it is certainly not a necessity, and many persons 
 are much better without it. As now used by mankind it 
 is infinitely more powerful for evil than good."
 
 ALCOHOL : ITS USE AND ABUSE. 93 
 
 It is only needful now briefly to gather together some 
 hints as to the mode in which alcohol should be used, if 
 at all. 
 
 Choice of a Beverage. — First in order comes the choice 
 of a beverage. We cannot attempt to prescribe the right 
 kind of alcoholic stimulant for each individual. We have 
 shown that each has its own peculiar properties ; that the 
 most healthful and least injurious forms are those which 
 contain alcohol in the smallest quantity, and in the most 
 combined form. Spirits are directly injurious to the 
 tissues with which they come in contact, and cause de- 
 struction of other organs most rapidly ; hence their habi- 
 tual use is only to be permitted when necessitated by 
 disease, or when there is absolute incapacity to tolerate 
 any other form. Wines have their especial use in relation 
 to digestion and nutrition ; the stronger wines form a 
 class quite distinct from the lighter in this respect. For 
 ordinary use the lighter wines alone should be taken, 
 those having less than lo per cent, of alcohol being pre- 
 ferable, and ale or stout being still more advantageous, 
 as affording nutriment, and tonic and digestive principles 
 in addition. 
 
 Beyond these general principles, the selection must be 
 determined by individual constitution. 
 
 Quantity of Alcohol. — The quantity daily should not 
 exceed half-an-ounce of absolute alcohol^ and even this is
 
 94 alcohol: its use and abuse. 
 
 a limit which should not be reached if less can be taken. 
 To take one ounce daily is to reach nearly the limit of 
 diminished power, and it goes beyond the bounds of 
 safe stimulation. We must here refer to what we have 
 already said (see p. 12) as to the quantity of various 
 liquors which contain this amount. 
 
 Summary of Conclusions. 
 
 1. In health the use of alcohol is unnecessary, and its 
 habitual employment is liable to produce disease, hence 
 total abstinence is the safest course. 
 
 2. When the habitual use of alcoholic beverages in 
 some form is found necessary, the following rules are to 
 be observed : — 
 
 The quantity must be the least possible, and usually 
 not more than that containing half-an-ounce of absolute 
 alcohol per diem. 
 
 Th^form should always be dilute, and the alcohol in 
 a state of intimate combination. Wines containing more 
 than 10 per cent, of alcohol should not be drunk undi- 
 luted. 
 
 The time should be always with meals, preferably only 
 with dinner ; never in the morning or between meals. 
 
 3. In very many cases where alcoholic beverages may 
 be used temporarily with advantage no definite rules can
 
 ALCOHOL : ITS USE AND ABUSE. 95 
 
 be laid down other than those given in the preceding 
 pages. But let the dangers, moral, social, and physical, 
 of excess in drinking always be borne in mind, and con- 
 trol the action in this matter. 
 
 4. In disease alcohol should be used only as a medi- 
 cine, and the quantity, quality, and time strictly regulated 
 by the doctor's orders. 
 
 If these rules, and the principles upon which they are 
 grounded were observed, we should not have to lament 
 the ruin of health and constitution, and the increase of 
 vice and crime which now result from excessive drinking. 
 
 W. S. GREENFIELD. 
 
 List of Principal Authorities for Reference. 
 
 Anstie, Dr. F. E. Ou Stimulants and Narcotics. London, 1864. 
 , On the Use of Wines in Health and Disease. London, 
 
 1877. 
 Carpenter, Dr. W. B., F.R. S. Ihe Physiology of Temperance 
 
 and Total Abstinence. London, 1870. 
 Huss-Magnus. Alcoholismus Chronicus. 
 
 Magnan, Dr. V. On Alcoholism. (Translation.) London, 1876. 
 Parkes, Dr. E. A., F.R.S. On Hygiene. Fourth edition, 1873, 
 
 p. 279 et seq. 
 
 . Personal Care of Health. 
 
 Richardson, Dr. B. W., F.R.S. On Alcohol. 
 
 Report of Committee of Convocation of Canterbury on In 
 
 temperance. 
 Report of the Committee of the House of Lords on Intemperance. 
 7
 
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