1 LIBRARY OF THE University of California. Class i -..\ ALCOHOLISM A CHAFIER IN SOCIAL PATHOLOGY W. C. SULLIVAN, M.D. MEDICAL OFFICER IN H.M. PRISON SERVICE ^ OF THE UNIVERSITY OF JAMES NISBET & CO., LIMITED 21 BERNERS STREET 1906 505° ^^;^ '^^'^iB.'^l. PRINTED BY ADLABD AND SON LONDON AND DOHKINQ. TO SIE EVELYN KUGGLES-BEISE, K.C.B., Chairman of th9 Prison Commission, UNDER WHOSE ENLIGHTENED ADMINISTRATION SCIENCE AND HUMANITY HAVE BECOME THE GUIDING PRINCIPLES OF THE ENGLISH PENAL SYSTEM, THIS WORK IS RESPECTFULLY DEDICATED. 304946 Digitized by the Internet Archive in 2007 with funding from IVIicrosoft Corporation http://www.archive.org/details/alcoholismchapteOOsullrich PREFACE ^HB object of the following essay is to give^ in as concise a form as is compatible with clearness and accuracy, a summary of the fundamental data of the drink question, having regard more particularly to the connection of alcoholism with industrial con- ditions. The predominant importance of this latter aspect of intemperance is, as a rule, very inadequately recognised in the discussion of the liquor problem in this country ; and in the practical schemes that most commend themselves to the temperance reformer little, if any, account is ever taken of it. In this fact lies the raison d'etre of the present volume, which, it need hardly be added, is designed merely to point out the omission, and has no pretension to repair it. In dealing with so vast a subject it would obviously be impossible, without burdening the text with notes, to give exact references to all the writers whose works have been laid under contribution. In most instances, however, where statements are made on the authority of individual observers, it will be found that the source of information has been indicated sufficiently to enable it to be readily traced in the ^ Bibliographie des Alkoholismus ' of Abderkalden VI (Berlin, 1904: Urban und Schwarzenberg), which is familiar to most students of inebriety. To that invaluable work, and to the treatises of Baer and of Grotjahn, I have to express my deep obliga- tions. For the material embodied in the historical sketch of alcoholism I have been chiefly indebted to Bertholot's 'Histoire de Chimie/ to Cunningham's * History of English Industry and Commerce/ and to Leck/s works. In the chapters on the physiological action of alcohol, on drunkenness, and on chronic alcoholism, the 'Psychologische Studien' of Kraepelin, Maudsley's 'Pathology of Mind,' and Lancereaux' articles in Raige-Delorme's ' Dictionnaire de Medecine ' have been of special assistance. And, of course,, in dealing with the social and industrial conditions of the labouring classes Mr. Charles Booth's monu- mental work has been constantly consulted. For valuable advice and assistance in revising the proofs I have to thank my friend and colleague, Dr. J. H. Parker Wilson. Finally, I have to express my special indebtedness to the Prison Commissioners, who have allowed me to make free use of the opportunities afforded by my official position. It is on the study of the human docu- ments of alcoholism which have thus been brought within my reach that this essay is mainly based. W. C. SULLIVAN. CONTENTS CHAPTER VAQE I. — Introductory and Historical ... 1 — II. — Physiological Action op Alcohol . . 15 :yIII. — Drunkenness 37 ^Y. — Chronic Alcoholism 45 V. — Social Causes of Intemperance . . 57 VI. — Industrial Drinking . ... 76 VII. — Factors of Industrial Drinking . . 113 Social Effects of Alcoholism . . 133 *VIII. — Alcoholism and Suicide . . . .137 ^IX. — Alcoholism and Crime . . . . 153 '- X. — Alcoholism and Insanity. . . .170 XI. — Alcoholism and Human Degeneration . 182 XII. — Conclusions 199 ALCOHOLISM : A CHAPTEE IN SOCIAL PATHOLOGY. CHAPTER I. INTRODUCTORY AND HISTORICAL. The word " alcoholism ^^ is used currently in two meanings : in the narrower sense, to indicate the intoxication of the individual organism by alcohol, being then further distinguished as acute or chronic ; and in a wider sense, without qualification, as a synonym of the drink question, to indicate the group of problems which depend on the prevalence of alcoholic excess in a community. The use of a single word to subserve these two meanings, though liable at times to cause some misunderstanding, has the very decided advantage that, as the original connection of the term is with individual pathology, it keeps constantly before the mind the close relationship of the individual to the social aspects of alcoholism. And this is, in the study of the drink question, a matter of the first importance ; for the beginning and the end of that 2 ALCOHOLISM. question, the causes which lead to alcoholic excess and the effects which follow from it, alike find their explanation in the state of organic function in the drinker. The origin of alcoholism is in the power that alcohol possesses of inducing certain modifica- ■ tions in that state ; and the social conditions which lead to the various forms of excess are operative in the long run through their influence in making such modifications desirable. And, as the immediate action of alcohol on the organism thus accounts for the causation of excess, so its more remote effects , shown in the tissue changes of chronic intoxication I are the source of those morbid impulses and those \ degradations of function which are the essential .' elements in the graver social results of intemper- ance. For this reason the study of alcohol and alcoholism in the individual is the proper and natural introduc- tion to the study of alcoholism as a problem of sociology. That is the plan which it is proposed to follow in this essay. The first portion will be devoted to an analysis of the physiological action of alcohol, and more especially of its influence on mental and muscular function, and to a discussion of the acute and chronic intoxications and their influence on conduct. The facts set out in this part of the inquiry will then be taken as a guide in the second and third parts of the book, the former dealing with the social and industrial causes of alcoholism, and the latter with its relation to the different social phenomena in whose origin it plays a more or less important part. INTRODUCTORY AND HISTORICAL. 3 Before entering, however, on the proper matter of our inquiry, it will be desirable to recall very briefly something of the history of the subject, and more particularly to indicate the chief phases in the gradual development by which intemperance, from being little more than an expression of individual vice, and as such mainly interesting the moral teacher, has grown to the magnitude of the grave problem which to-day confronts society in every civilised country. A very summary account of the essential facts in this evolution will form the subject of the present chapter. Alcohol, by which ordinarily is meant ethylic alcohol, is the distinctive constituent of what are known as alcoholic drinks, and is a product of the fermentation of saccharine fluids. As may readily be imagined from the ease with which the process of fermentation can come about in nature, the preparation of intoxicating beverages from fruit juices is practised by most savage peoples, and its knowledge was one of the earliest acquire- ments of the race. " The palafits or Lake Dwellings of Clairvaux and of Switzerland show that during the neolithic epoch the inhabitants of central Europe possessed already a fermented drink prepared from raspberries and from mulberries. The investigation of the palafits of Bourget (Savoie) and of various stations round the Alps proves that the use of this raspberry or mulberry wine continued during the bronze age. On the southern slopes of the Alps the palafits intermediate between the prehistoric and the protohistoric show the use of another fermented liquor, dogberry wine. Finally, a little more to the 4 ALCOHOLISM. south in the terramares of the plain of the Po, going back to the first bronze age, we ascertain the exist- ence of the true wine of the grape '' (Gr. de Mortillet) . Whether the vine and the art of wine-making came from East to West, or, as more recent research seems rather to indicate, travelled from West to East, they are found at a very early period in the civilisations of antiquity, associated with legends suggestive of remote and Divine origin, as in the Hellenic myth which represents the vine as a gift of Zeus to Dionysus. In antiquity the use of wine, or of the artificial wines that replaced it where the culture of the grape was impracticable, seems to have been mainly con- vivial. In civilisations low in the scale of civilisa- tion there was then, as now, a strong tendency to excess, while in societies which had reached a higher level of refinement the virtue of moderation was at all events esteemed, if it was not always practised. Drunkenness, no doubt, appears to have been neither very rare nor very strongly reprobated even in the best times of Greek civilisation ; but its grosser forms were at least discouraged by tradition ; the drinking of undiluted wine was accounted a barbarism, and though intoxication was often a result of the sym- posium, it was not its aim. And to some extent, at all events, the Romans before the decadence followed the same traditions. The decline of the empire, however, and the dominance of the barbarians of the North brought coarser habits into vogue, and drunkenness of a bestial sort became the ideal of pleasure in wine. INTEODUCTORY AND HISTORICAL. 5 Evidences of this grossness of taste are to be found in abundance in the social records of Western Europe throughout the Middle Ages; and nowhere are they met with more frequently than in the history of this country. Already at the time of the Conquest the drunken habits of the Anglo-Saxons were noto- riouSj and the Norman invaders, though by contrast they gained a reputation for relative sobriety, do not appear, if we may judge from the references of con- temporary critics in the twelfth and thirteenth centuries, to have lagged very far behind the subject race in Bacchanalian prowess. But although in the writers of this time, both in England and elsewhere, we read very often of Gar- gantuan excesses, and may even in isolated cases be able to recognise descriptions of alcoholic disease, it appears clear that on the whole, at all events amongst the masses of the population, mediaeval drinking, as would accord with its purely convivial origin, must have been essentially of an intermittent and occasional character. And to this we may perhaps attribute, at least in part, the fact that despite the frequent and vehement rebukes which it drew from the moralists and religious writers of the period, this general intemperance did not apparently lead to any restrictive or penal measures. It is true, of course, that in a relatively rudimentary state of society and with a low standard of manners we should hardly look for any elaborate legislation to promote sobriety ; but it is, nevertheless, highly probable that had there been any wide de- velopment of alcoholism among the common people. 6 ALCOHOLISM. such as we meet with later in history, it would have been quickly recognised as an evil calling for legal repression. We may, accordingly, conclude with a fair measure of assurance that in this country up to the time of the Tudors occasional drunkenness was the main part of intemperance, and that the habitual use of intoxicants as an aid in labour, which is the chief ■ factor in modern alcoholism, had not yet come into vogue ; or, as we may express it by the aid of two terms, which are to some extent self-explanatory, and which, so far as they need definition, we shall have to discuss in detail later on, we may say that mediaeval drinking was purely convivial, and not industrial. "" It was not, in fact, until the break up of feudalism, and the reorganisation of society on the capitalistic basis, that the necessary conditions for this graver form of intemperance came into being. And it so happened that those latter changes coincided with an event which may very well have contributed to bring into prominence the attractions of alcohol as an industrial stimulant. This was the vulgarisation of the process of distilling spirits, which the Arabs, probably in the thirteenth century, dis- covered by applying to wine the methods and appa- ratus of the Grjeco-Egyptian alchemists. The striking properties of the aqua ardens led at once to enthusi- astic views of its value as a drug : Arnold, of Villanuova,in his treatise *^de Conservanda Juventute^ (ca. 1309) hails it metaphorically as the aqua vitas or elixir of life. INTRODUCTORY AND HISTORICAL. 7 Its preparation soon ceased to be a secret of the laboratory ; and by the end of the fifteenth century the manufacture of brandy had become an important branch of industry in the wine countries. In the following century improvements in the technical methods, and more particularly the utilisation of fermented grain as a source of alcohol — a discovery of the German Libavius — caused a rapid extension of the trade ; and as spirits could now be produced at a cost that brought them within the reach of the common people, their employment as a stimulant in labour quickly came into vogue^. • In the middle of the fifteenth century, indeed, brandy was supplied for this purpose to the workers in the Hungarian mines ; and some years later we hear of its distri- bution to the English troops serving in the Low Countries. This latter fact is of special interest from our present point of view; for it is to the drinking tradition brought home by these soldiers that Camden attributes the growth of intemperance which was a prominent characteristic of the closing years of the sixteenth and the early part of the seventeenth century in England. Presumably, however, their example, if it had any real influence, must have acted mainly as a stimulus to the national beer- drinking, for it seems improbable that they introduced any extensive use of spirits; English distilleries, according to Lecky, were insignificant until the time of the Revolution, and French brandies were, of course, too highly priced for popular consumption. In any case, however, it is unnecessary to assume that 8 ALCOHOLISM. this extraneous influence had anything like the im- portance which Camden assigns to it ; it seems much more likely that the increase of intemperance to which he refers was connected with the natural growth of industrial drinking consequent on the new economic conditions which^ as contemporary legislation shows us, were emerging at this time. Already, earlier in the century, as we learn from an enactment of 1555, the weaving industry was passing into the capitalistic phase, and complaints were being made of evil clothiers "engrossing the looms into their hands and possession, and letting them out at such exorbitant rents that the poor artificers are not able to maintain themselves." And in other trades the same transforming influences were at work. These signs of the coming of the modern industrial system were accompanied also by a very significant change in the legal attitude towards intemperance, which was now treated for the first time as a serious social evil. The Licensing Law of Edward VI (1551), ushering in the long series of similar enact- ments which stretches down to our own day, was designed, according to its preamble, to remove '^ the intolerable hurts and troubles to the Commonwealth of this realm which do daily grow and increase through such abuses and disorders as are had and used in common ale-houses and . . . tippling houses." We know, however, that convivial drunkenness was a fairly common trait in the manners of the people long before this date ; and that though it was often severely censured by the moralists, it had not been found necessary to make it the object of restrictive INTRODUCTORY AND HISTORICAL. 9 legislation in an age that was by no means chary of interference with liberty. It seems reasonable, there- fore, to suspect that the new attitude betokened by this and other subsequent laws must have been determined by some considerable change in the circumstances or the character of the national in- temperance, whereby its possibilities as a source of danger to the community were either increased or at all events rendered more conspicuous. And such a change might naturally be looked for in the growth of the labouring class — whose discontents are so prominent a feature in the history of the' sixteenth century ; the conditions under which this class lived were of a kind peculiarly apt, on the one hand, to further the substitution of industrial drinking for piire convivial excess ; and, on the other, to aggravate the more obvious consequences, direct and indirect, /^ of the increasing intemperance. And the subsequent ^ course of events fully confirms this view. Thus throughout the seventeenth century, with the de- velopment and extension of the capitalistic system, the evidences of a widespread alcoholism become increasingly frequent and pronounced. And the in- dustrial origin of this growing intemperance is strikingly indicated by the fact that the classes of the population in which the habits of excess reached their highest degree were exactly, as at the present \ "^ time, the unskilled labourers of the sea-ports. The worst oifenders, for instance, in the way of drunken- ness and disorderly conduct dealt with by the summary jurisdiction of the Commissioners of Revenue under the Commonwealth were the Thames watermen 10 ALCOHOLISM. and the porters and carmen of the quays, whose representatives to-day are the class most addicted to alcoholism in the labouring population of London. The practice of industrial drinking was not, however, confined to the manual workers, for even the Puritan divines of the time were said to assign "the great pains they were to take or had taken in preaching^' as an excuse for their liberal potations in the vestry. Towards the end of this century a further im- pulse was given to the national intemperance by the liquor policy of the Government of the Whig Revolution, which made distillation practically free, and so led to the partial substitution of spirits for ale as the ordinary beverage of the people. This change was followed by an enormous increase of alcoholism ; and in the first half of the eighteenth century the results of intemperance, in disease, crime, and pau- perism, were appallingly evident in London and in smaller towns. According to Smollett^s well-known description, the gin-shops in the Metropolis hung out painted boards inviting people to get drunk for a penny, and dead drunk for twopence, and offering them straw for nothing. There were computed to be 20,000 of these shops within the Bills of Mor- tality; and it was said that 100,000 persons in London lived on practically nothing but liquor. It seems probable, however, that the intemper- ance of this period, though owing its wild excesses to the special opportunities offered by the free trade in spirits, was essentially no more than an aggra- vation of a regular practice of industrial drinking. This may be inferred from the fact that its evil INTRODUCTOKY AND HISTORICAL. 11 effects were chiefly observed in the proletariat of the towns. The petition of the Middlesex magis- trates, for example, in support of the Gin Act of 1736 expressly singles out journeymen and appren- tices as the classes particularly addicted to this sort of excess. And from other references in contemporary writers it is sufficiently clear that even at that early stage of the modern industrial system the use of alcohol, whether in the form of beer or spirits, as a stimulant for muscular work, was firmly established. Frank- lin's account, for instance, of the habits of the Lon- don printers about 1724 is a perfect epitome of the theory and practice of industrial drinking {vide Chap. YI, p. 102). On the essential causes of this form of alcoholism none of the many changes in liquor taxation or in the Licensing Laws, which were made in the course of the century, could be expected to have very much effect. The worst evils of the earlier Hanoverian period were, it is true, abated in a considerable de- gree by the legislation of the Pelham ministry, and the overt intemperance of the country was doubt- less thereby brought back to something nearer its old level ; but, despite this improvement in manners, the tradition of industrial drinking, in which lay the danger of the future, persisted unchanged, and its fostering conditions continued to develop. Up to this period, however, these conditions were absolutely and relatively very limited in their force and in their extension. In 1740 the population of the whole country was only a little over 6,000,000, 12 ALCOHOLISM. and it had reached this figure at a comparatively slow rate of progress. The people were for the most part engaged in rural occupations, and the chief industries were mainly domestic in character and primitive in method. Roads were bad, canals did not exist, industrialism was still in its infancy. The second half of the century saw a total trans- formation of this state of things. A rapid succession of discoveries in science and industry revolutionised the conditions of work. Machinery drove out manual skill, and around the centres of motor power grew up big manufacturing towns, where the workers were gathered into factories for the long hours of their monotonous labour, and herded for the rest of the time in vile slums to sleep, feed, and procreate. By the end of the Napoleonic wars the population had risen under these conditions to over 10,000,000; in 1821 it amounted to 14,300,000. In the large centres of industry in the north, and in the great seaports of the north-west the increase was enormous. This development of the factory system, reinforced by the conditions of slum life, naturally brought about a rapid extension of industrial drinking, which was the more serious in its results in that it affected both sexes and all ages. Of its character and degree we find ample evidence in the first half of the last century. Thus Dr. Kay, writing of the state of the cotton operatives in Manchester in 1832, after re- ferring to their bad and insufficient diet, in which potatoes formed a large element, adds that it was a frequent practice for these workers to use spirits in tea as a stimulant during the hours of labour. And INTRODUCTORY AND HISTORICAL. 13 another observer at about the same date, Mr. R. Gregg, describing this class, states that " the per- nicious practice of mixing a large proportion of spirits in every cup they take prevails to an incon- ceivable extent among the manufacturing popula- tion at every age and in both sexes." And he adds that opium was also largely used as a stimulant in the same conditions. The overworked and brutally used children in the factories adopted the same habits, and it was said that gin was dealt out to them at the drinking shops in special measures suited to their tender years. With this abuse of alcohol as an industrial stimu- lant there went, of course, a corresponding develop- ment of convivial excess, and such leisure as the brutalised labourer enjoyed he spent, not unnaturally, in getting drunk as often and as profoundly as his means would allow him. It is from this time that we may date the full growth of the tradition of industrial drinking amongst the English working classes, which, as we shall see later in this essay, is still dominant in most of the forms of skilled and unskilled labour at the present day. And here, accordingly, on the threshold of our own times, we may bring to a close this brief review of the history of the drink question in England. The social and economic changes which have since occurred, numerous and far-reaching as they doubt- less are, have not altered the fundamental factors of the problem with which we have to deal. The circumstances of the manual worker are, it is true, vastly better in our time than in the palmy days of 14 ALCOHOLISM. the industrial revolution, and his alcoholic tendencies have no doubt shown some corresponding modifi- cation. The higher wages, the cheaper food, the shorter hours of work under better sanitary con- ditions, the restrictions on female and juvenile labour, the increased stringency of the Employers' Liability Acts, and other influences of the same kind, which have wrought so marked an improvement in the status of the working classes, have necessarily weakened in some measure the forces that make for industrial alcoholism. In their essential character, however, these forces have undergone but little change. The drinking habits created by their more vigorous operation in the past can still find a sanction for their persistence in the attenuated activity of the same causes in the present. And it is, in fact, as we hope to show in the course of this inquiry, through the constant in- fluence of these causes in keeping alive the drinking traditions that industrial alcoholism has maintained its hold on this country, and that despite the general progress in manners and in national prosperity, despite the efforts of legislation and of moral and religious enthusiasm, the national intemperance is still in the position of a grave and urgent social problem. CHAPTER II. THE PHYSIOLOGICAL ACTION OF ALCOHOL. Ethylic alcoliol is the essential constituent of all the alcoholic beverages, and for our present purposes may be regarded as the sole important agent in the production of their immediate and remote effects on the organism. Of course, in the various forms of liquor this alcohol is associated with numerous other bodies, many of which have distinctive modes of action ; but for the most part the proportions in which these bodies are present are so small that their influence may be treated as practically negligeable. There are, it is true, some exceptions to this general rule ; it is notorious, for example, that the deleterious effects of absinthe are due even more to the con- vulsive poison of the essential oil of wormwood than to the alcohol which is its vehicle; and a similar remark would apply to other aperitifs^ such as vermouth and bitter. Again, when the rectification of trade spirit has been imperfectly carried out, it is quite possible that the amount of the heavier alcohols which remain may be so large as to modify considerably the type of the intoxication. 16 ALCOHOLISM. Under existing circumstances, however, at all events in this country, such exceptional cases are relatively few, so that in a general survey of the question they may be left out of account without risk of material error, and it may be assumed that we have to do with ethylic alcohol alone, and that the only difference between the several alcoholic beverages is a difference in dilution. It is for the sake of the ethylic alcohol which they contain that these beverages are taken, and all the main effects of their use and abuse can be got from ethylic alcohol in its purest form. There are only a few points on which this assumption needs to be qualified, and these it will be more convenient to discuss incidentally later on. The present chapter, therefore, will deal ex- clusively with the action of ethylic alcohol, and more particularly with its influence on nervous and mus- cular function, and, in relation to the latter, with its value as a food. Its effects on other functions are, from our point of view, of subordinate interest, and concern us only or chiefly in so far as they are connected with and enter into its action on the brain. Its stimulation of the heart, for instance, is im- portant, not so much in itself, as because it is one element in the general exaltation of motor and secretory function which alcohol produces, and which is, indeed, the physical counterpart of the characteristic sense of well-being that is the most notable and familiar effect of drinking. And this applies also in a large measure to its influence in promoting the muscular and secretory activity of PHYSIOLOGICAL ACTION OF ALCOHOL. 17 the stomach, though in this case the direct value that alcohol thereby acquires as a condiment also plays an important role in determining its habitual use by the classes of the population who have to live mainly on unpalatable or insufficient food. Broadly speaking, however, it is only with its action on the nervous system and with its influence on volitional muscular work that we need occupy our- selves when considering the physiological basis of alcoholism. On these questions a good deal of light has been thrown within recent years by the application to their study of exact experimental methods, and the new material so acquired will form the chief part of the data for this discussion. Of course, it will be readily understood that the conclusions to which this sort of evidence can lead are for the most part merely probable. The questions at issue are of such complexity that it is very difficult to devise experi- ments for their solution that will not be open to many and grave fallacies ; the effects of slight dif- ferences in technique or of peculiarities in indi- vidual reaction are likely to show on an exaggerated scale, and hence to produce discordant results ; and even when the results are agreed on their inter- pretation will still depend on physiological principles regarding which the sharpest and most radical differences of opinion prevail. None the less, when due allowance has been made for these difficulties, the experimental evidence to which we refer does permit us to formulate fairly positive views on some points ; on others it enables us 2 Y 18 ALCOHOLISM. at least to establish with a moderate degree of assur- ance the balance of probabilities ; while even on the most obscure questions it is of considerable value in helping to define the issues. And its importance in all these ways will, no doubt, be decidedly increased when wider experience shall have fixed the best tech- nical methods, and when, above all, by the multiplica- tion of experiments, we are enabled to form some idea of the range and character of individual variation in susceptibility to alcohol. This is a point of the first importance, for nothing has been better established by these investigations — in agreement, indeed, with common experience — than the fact that the amount, direction, and duration of the influence that alcohol exerts on the several functions differs enormously in different persons. For that reason we cannot be very sure of our position until further research has shown us, not only what is beyond doubt the dominant type of reaction to the drug in respect of^ each mode of function, but also what is the relative importance numerically of the different groups which exhibit a departure from that type. Pending the fulfilment of these conditions, which will obviously demand much time and labour, we have to bear in mind that many of our conclusions must retain some- thing of a provisional character. Having said this much by way of preface, we may now pass to the consideration of the experimental evidence, and we shall first deal with that which relates to the action of alcohol on the simple mental processes. This question has been investigated more particularly by Professor Kraepelin and his pupils of PHYSIOLOGICAL ACTION OF ALCOHOL. 19 the Heidelberg school, and their results have very generally been confirmed by observers elsewhere. The methods employed in these experiments are those customary in psycho-physical research, and are fully described in the special treatises of ex- perimental psychology. Essentially the mode of procedure consists in ascertaining the speed and character of various mental exercises, and then observing how far they are modified by the admi- nistration to the subject under examination of various doses of alcohol. The operations include the measurement of reaction time — i. e. the length of time between the application of a sensory stimulus to the individual under examination and his reply by a preconcerted signal ; the estimation of the acuteness of perception, as shown, for instance, by the recognition of letters, syllables, or figures pre- sented to the sight for very brief periods of time ; the determination of the rapidity and accuracy dis- played in such exercises as reading aloud, adding rows of figures, committing figures to memory, and so forth. By these researches certain facts of alcoholic action seem to have been clearly established, which we may summarise in the following propositions : (1) Below a minimal dose, which varies within wide limits in different individuals, and possibly to some extent in the same individual under different circumstances, alcohol has no effect on psychic processes. (2) Above this minimal dose its effects vary in kind and degree with the amount of alcohol taken, 20 ALCOHOLISM. (3) The most constant effect of moderate doses is a stimulation of psycho-motor function, so that voluntary movements are easier and quicker (Krae- pelin, Eiidin) . For this reason simple reaction-time is generally shortened, the greater rapidity of its motor part overbalancing the prolongation of its sensory period ; motor images predominate in the association of ideas, so that words are connected by similarity of speech processes rather than by simila- rity of sense ; and exercises, such as reading and writing, are done with increased speed. In resistant subjects this psycho-motor stimulation may be the only perceptible effect after even fairly large doses of alcohol. Riidin, for instance, in four individuals who served as subjects for his experiments, found one on whom a dose equivalent to 90—100 grammes of abso- lute alcohol (as much as would be contained in four pints of ale) produced no result beyond a quickening of the motor speech associations. (4) This psycho-motor excitation lasts only a short time, and is succeeded by depression. Kraepelin with doses of 50 grms. absolute alcohol found that the phase of stimulation lasted about half an hour. With larger doses the duration of the phase is shorter, the paralytic effect of the drug showing itself earlier. On the other hand, at all events in some instances, small doses seem capable of causing stimulation with no appreciable degree of subsequent depression. (5) The motor stimulation is directly perceived by the individual, and is felt as a sense of increased energy. This feeling is the origin of the common belief in the strengthening action of alcohol, and is PHYSIOLOGICAL ACTION OF ALCOHOL. 21 thus one of the chief causes of the general use of alcoholic liquors. (6) On sensory functions the action of alcohol is depressant. This has been shown clearly with regard / to simple tactile, visual, and auditory impressions and is apparent also in the case of muscular sensations in the diminished accuracy of fine motor adjustments. (7) The intellectual processes which can be tested show a similar reaction. Very moderate doses of al- f cohol decrease speed and accuracy in adding figures, in / committing numbers to memory, in logically associat- ing ideas, and so forth. (8) The depression of sensory and intellectual function seems generally to last a considerable time, probably as long as twenty-four hours in some in- dividuals (Wlassek, Riidin). In more resistant sub- jects it is inuch briefer (Partridge). In cases where the effect of the drug is fairly persistent there is, with daily doses, a summation of the depressant action, which will then be perceptible even some days after its use has been discontinued. (9) The subjects are not conscious of the impair- ment of sensation and reasoning, but, on the contrary, believe that their mental keenness is increased. (10) Owing to the dulling of sensation, disagree- able impressions are less felt, and this fact contributes, with the stimulation of motor and secretory activity, to give rise to that feeling of well-being which is the most signal and constant effect of alcohol*-<=:r/ The excitant action of alcohol on psycho-motor function, which is one of the salient results brought out by the investigations we have just discussed, is, 22 ALCOHOLISM. of course, one, and, as we shall see later on, probably the most important element in its influence on muscular work. This influence, however, is so com- plex, and the several modes of alcoholic action that go to form it are so intimately connected, that it is more convenient to deal with the question as a whole, and in most of the experimental work on the matter this method has, in fact, been followed. The bulk of the work to which we refer has been done with one of the many forms of ergograph, an instrument invented by Mosso for the study of fatiofue. In this instrument the arm and hand of the subject under examination are encased in a rigid frame, so that no portion of the limb can be moved except the middle finger, to which a weight is sus- pended. A pen attached to the tip of the finger is put in contact with a recording cylinder revolving at a regular known speed, and the subject contracts the finger at a fixed rhythm, each contraction being accordingly registered on the cylinder by a corre- sponding elevation in the tracing. It is found that when the contractions succeed one another at a shorter interval than ten seconds they decrease regularly in range until a point of exhaustion is reached where the finger ceases altogether to move; a complete tracing of this kind is termed an '' ergogram.^' Now, the characters of this ergographic tracing, which are fairly constant in the same individual under the same conditions, show certain modifications when these conditions are altered, as they are notably by the administration of various drugs. By giving, therefore, various doses of alcohol and observing the PHYSIOLOGICAL ACTION OF ALCOHOL. 23 resulting alterations in the amount and character of the work done as shown in the ergographic tracing, it is possible to gain some notion of the extent and manner in which the drug influences muscular effort. Of course, as in other psycho-physical inquiries, diversity of method and the personal equation of the subject act as disturbing factors, so that on several points there are conflicts of evidence which it is difficult to reconcile. On the main facts, however, there is a very fair measure of agreement, or, at all events, a sufficient preponderance of testimony to warrant a definite conclusion. This will be clearly seen in the following summary of the more important investigations dealing with the matter : One of the first of these inquiries was carried out by Lombard Warren, who found that a dose of 32 c.c. of whisky, or its alcoholic equivalent in the form of claret, increased the power to do volitional muscular work. This effect came on within a few minutes, lasted sometimes as long as an hour and a half, and was not followed by any depression. When the electric current was substituted for the stimulus of volition there was no gain in energy with alcohol. A more detailed investigation was made by Frey, who arrived at the conclusion that the action of alcohol differed according to the condition of the muscle, that it had a depressing effect on unfatigued muscle, lowering considerably the force of the indi- vidual contractions, while it stimulated fatigued muscle, as was shown by its prolonging the duration of the working period. These results Frey explained 24 ALCOHOLISM. by supposing that in unfatigued muscle alcohol acted purely by depressing the peripheral excitability of the nervous system, while in the case of fatigued muscle it was used up as food, its combustion fur- nishing the muscle with fresh energy. In Frey^s experiments only very small quantities of alcohol were used, 5 to 10 grms. of absolute alcohol di- luted with water, or equivalent amounts of beer or wine. Such a dose, it will be noted, would correspond to very much less than half a pint of beer of the strength of 4 per cent., or to a little more than half a nip of rum or spirits. Frey did not find that the stimulant effect was succeeded by any reactive weakness. In a later paper on the question, published in reply to some adverse criticisms of his earlier work, Frey to some extent abandons his first view as to the different effect of alcohol on fatigued and un- fatigued muscle, but adheres to his position that the stimulant action of alcohol is not followed by any phase of depression. He asserts further that the favourable effect on working capacity persists for as long as two or three hours. One of the critics of Frey's first paper, Destree, repeating his experiments with similar doses, found that alcohol increased the power of muscular work whether the muscle was fatigued or not, but that the stimulation was very brief, and Avas succeeded by a fall in working capacity which far outbalanced the initial gain. Rossi observed that 80 grms. of rum caused an increase in energy followed by a decrease. With PHYSIOLOGICAL ACTION OF ALCOHOL. 25 smaller doses — 25 grms. — this secondary decrease did not always occur. In Tavernari's experiments, made on two indi- viduals who were first fatigued by walking exercise before the ergographic seance, it appeared that 50 grms. of Marsala (equivalent to 10 grms. of absolute alcohol) was followed by a distinct gain in working capacity, shown chiefly in an increase in the number of contractions. In one of the subjects 400 grms. of Graz beer (equal to 18 or 20 grms. of alcohol) had practically the same effect as the Marsala ; in the other individual it produced hardly any influence on the curve. Tavernari found, in contradiction with Warren and most other observers, that the stimulant effect of alcohol was equally distinct with electrical excitation. Scheffer in his experiments did not take complete ergographic curves, but measured the amount of work done in successive series, each consisting of a definite number of contractions. He found that 10 c.c. of absolute alcohol diluted with water increased the working capacity if given within fifteen minutes of commencing work, but caused a decrease if administered earlier. This result he referred to the onset of a secondary paralysing action of the drug. Scheffer further investigated the effect of alcohol on muscle in the frog deprived of its brain, and found that small doses caused an increase in energy as long as the muscle nerve-endings were intact, but that this effect disappeared when they were paralysed with curare. Partridge experimented on himself and on another 26 ALCOHOLISM. subject with an improvised ergograph^ using a method similar to that of Scheffer^ viz. measurement of the work done in series each made up of a fixed number of contractions. He found that in his own case 45 grms. of an alcohol of 33*3 per cent, strength had practically no effect, and that 90 grms. caused an increase in energy during the first half- hour of work, followed by a decrease in the succeed- ing half-hour. On his companion 60 grms. had a purely depressing effect, causing a decided fall in the output of work. Oseretzkowsky and Kraepelin, whose study of the question is the most careful and exhaustive that has /yet appeared, have cleared up some of the points left in obscurity in the earlier investigations. They found that with doses ranging from 15 to 50 grms. of alcohol there was a notable gain in working capacity, which on analysis was seen to depend almost entirely on an increase in the number of con- tractions in the ergogram. The force of the indi- vidual contractions, on the other hand, showed at most a slight initial rise followed by a regular fall. The stimulant effect thus apparent in the prolonga- tion of the working period lasted about forty minutes, and was then succeeded by a phase of depression. Fere in several series of experiments obtained similar results — that is to say, a decided increase in working capacity, lasting a short time and followed by a decrease in energy which more than com- pensated the initial gain. And he further found that this stimulant action was distinctly greater, and PHYSIOLOGICAL ACTION OF ALCOHOL. 27 the subsequent depression less, when the alcohol, instead of being swallowed, was merely retained in the mouth during the experiment. From this he inferred that the increase in energy was due to a reflex stimulation through the nerves of taste. It is clear, then, from the foregoing review, that the majority of observers are agreed that alcohol in small doses increases the output of muscular work as measured by the ergograph, and further that it does this mainly by prolonging the working period. This effect is evidently due to the influence of the nervous system, since, according to nearly all the experiments (except Tavernari^s),it is not perceptible when the muscles are excited by electricity. While the number of contractions is thus increased by alcohol, the force of the individual contraction is either unaffected or is at most momentarily increased. As to the time during which the stimulant effect of the drug is perceptible, it seems generally admitted that, though probably varying within pretty wide limits, it is in all cases relatively short. And it may also be taken as clearly established by the greater weight of evidence that the phase of stimulation is usually followed by a period of depression which more than counterbalances the initial gain in energy. As to the interpretation of this stimulant effect there is some difference of opinion. Kraepelin apparently regards it as a result of a direct exci- tation of the psycho-motor cells of the brain ; others, on the contrary, attribute it to a lowering of the activity of the higher centres which ordinarily con- trol the motor area, and see in it, therefore, merely 28 ALCOHOLISM. an initial stage of the essentially paralysing action of alcohol ; while, as we pointed out above, the experiments of Fere suggest that, though of the nature of a true stimulation, it depends, not on the direct action of the drug on the brain cells, but on its reflex influence through the sensory nerves of the mouth and stomach. In ordinary work, of course, in addition to the amount of muscular effort, we have to take into con- sideration the sensory element involved in the varying degree of accuracy of perception and movement that the particular task may demand ; and as we have seen that these sensory functions are generally de- pressed by alcohol, it is obvious that such advantage as may be derived from the motor stimulation will in these circumstances be proportionately discounted. Experiments to test the effect of alcohol from this practical point of view have been made, the most re- markable being those carried out by Aschaffenburg on a group of four compositors working at their trade. The working time on four successive days of the ex- periment was divided into quarter-hour periods, and at the close of the first of these periods on the second and fourth days 200 grms. of a Greek wine con- taining about 18 per cent, of alcohol were adminis- tered. On the other days no alcohol was taken. On contrasting the work actually done with the amount which, allowing for the probable gain through practice, it was calculated ought to have been done, it was found that in all cases alcohol seemed to have lessened the performance — that is to say that the in- terference with the sensory element in this skilled PHYSIOLOGICAL ACTION OF ALCOHOL. 29 work was sufficient to outweigh the stimulant action on the motor side. There was a good deal of differ- ence in the effect on the several men, the actual loss in work appearing rather more evident in one indi- vidual whose drinking was ordinarily confined to occasional bouts of convivial excess. This latter detail is of some interest, for it illustrates a point to which we shall have occasion to refer later on, namely the bearing of the individual reaction to alcohol on the custom of industrial drinking. We shall find that in trades where that custom is in vogue there are very usually a certain number of workmen who, in con- trast with their fellows, are pure convivial drinkers, and never try to work on liquor. And on inquiry it is generally ascertained that, like this compositor and like the second subject in Partridge^s experiments, these men are exceptional ii^ their reaction to alcohol, and derive no stimulation from it, or are so unfavour- ably affected in their sensory functions that they find its net influence decidedly detrimental. So far we have dealt almost entirely with the effect of alcohol on the nervous element in muscular work, and have only referred incidentally to its direct relation to muscular energy. This latter question in a great measure belongs to the larger problem of the food value of alcohol, and can, there- fore, hardly be regarded as admitting of any final answer in the present state of physiological knowledge. All that the available facts enable us to do is to limit the number of possible solutions, and perhaps to indicate, though rather uncertainly, their relative degrees of probability. 30 ALCOHOLISM. Of these facts the best ascertained is that alcohol, when taken in moderate doses, is entirely consumed in the body. In the latest investigation of this point, that carried out by Atwater, it was found that 98 per cent, of the amount administered could be so accounted for. It is only when an excessive quantity is taken that any portion of it passes out of the body unchanged and can be recovered from the excretions. From the fact that it is oxidised in the system, it has sometimes been rather hastily inferred that alcohol, quite apart from the question whether it is also a poison, must certainly be a food, and more particularly a source of muscular energy. Such a conclusion, however, is not by any means of certain validity. It is, on the contrary, quite conceivable that a substance, though readily oxidisable in the body, might lack other essential attributes of a true food, and that its potential energy might not be available for muscular function. And there is, in fact, a good deal of experimental evidence which suggests that such substances do exist, and further, that alcohol is one of them. It has been shown, for instance, that malic and other fruit acids, which are absorbed as such into the circulation, and are oxidised in the economy without being integrated in the living tissues, though they yield heat, fail to replace the food stuffs which are so assimilated by the organism, and that when they are substituted for such food stuffs they do not maintain the body weight. These substances are what, in the language of one school of physiology, are termed pure thermogens, as dis- PHYSIOLOGICAL ACTION OF ALCOHOL. 31 tinguished from true foods or bio-thermogens, such as fats, carbohydrates, and proteids, which become incorporated in the anatomical elements and supply their vital needs. Now, alcohol seems to occupy a similar position to that of the pure thermogens. Except to an inappreci- able extent — about one tenth according to the experi- ments of Lallemand and Perrin — it does not become fixed in the tissues, but circulates in the blood. And it appears also to have the characteristic of the pure thermogens that, unlike fats and carbohydrates, it does not protect proteid — that is to say that when it is substituted in equivalent amount for part of the carbohydrate in the ordinary diet, there is an increase in the nitrogenous waste, indicating the using up of some of the proteid of the body. On this point, however, the evidence is not entirely accordant. On the one hand the careful researches of Miura, which are in essential agreement with the earlier results of Stamm- reich, would support the view expressed above ; they showed that when a portion of the carbohydrate in the regular diet was replaced by an isodynamic quantity of alcohol — a quantity, that is to say, of equivalent combustion value — there was an increase of nitrogenous excretion which was even greater than that which ensued when the carbohydrate was simply reduced to the same extent without any addition of alcohol. This latter result Miura attributed to the direct disintegrating influence of alcohol as a protoplasmic poison. On the other hand, the experi- ments of Atwater show that in some cases, though not invariably, there is no increase in nitrogenous 32 ALCOHOLISM. waste on a partially alcoholic diet, and since this occurs when the subject of the experiment is doing hard work, as well as when he is at rest, Atwater believes that under the circumstances it is probable that the alcohol has really served as a food, and has furnished the energy for muscular effort. In this con- nection, however, we have to remember that such an absence of nitrogenous waste, when it does occur, may be due, not to the alcohol replacing the carbo- hydrate as food, but to the narcotic influence which the drug exercises on some of the organic activities. The probability of this being the true explanation is strengthened by the fact, to which Kassowitz has drawn attention, that a similar effect can be produced by the administration of other narcotics, such as opium, in quantities so minute — e. g. a milligramme of morphia — that the value of their combustion can- not possibly be a factor in the result. Moreover, the presumption that alcohol is a pure thermogen and that it does not serve as a source of muscular energy is supported by evidence of another sort which has been brought forward by Chauveau. This observer proceeds from the fact, obvious to anyone who looks at their chemical formulas, that the combustion of alcohol (CgHgO), as compared with that of an ordinary carbohydrate such as starch (P\ci,{^