NOTES ON ALCOHOL
The influence of alcohol on longevity can be most satisfactorily
determined by the records of life insurance companies wherein the
death-rates among those abstaining from alcohol have been computed as
compared to those of the general class of insured lives. In considering
such figures it is well to bear in mind that the general or
non-abstaining class comprises only those who were accepted as standard
healthy risks and so far as could be determined were moderate in their
use of alcohol. Such experiences have been carefully compiled by the
following companies:
United Kingdom Temperance and General Provident Institution of
London;[1][K] The Sceptre Life;[2] The Scottish Temperance Life of
Glasgow;[3] The Abstainers and General Life of London;[4] The
Manufacturers' Life of Canada;[5] Security Mutual Life of Binghamton,
N. Y.[6]
[K] The notes ("[1]" etc.) refer to the publications listed at the close
of the section.
[Sidenote: Comparative Mortality Among Abstainers and Non-Abstainers]
The comparative mortality among abstainers and non-abstainers in several
of these companies is shown in the charts exhibited in this section.
It is probable that the heavier mortality among non-abstainers as
compared to abstainers is not wholly due to the chemical effect of
alcohol on the tissues, but in some degree to collateral excesses
(especially those resulting in infection from the diseases of vice) and
a more careless general manner of living engendered by alcoholic
indulgence; that, furthermore, those who indulge in so-called moderation
are open to greater temptation to increased indulgence and final excess
than those who abstain altogether.
It has often been alleged, however, that the lower mortality among
abstainers was due solely to a more conservative habit of living, and
that this class is largely composed of people in favorable or preferred
occupations, such as clergymen and teachers.
The experience of the Security Mutual of Binghamton, N. Y., does not
support such a postulate. During a twelve years' experience the
mortality among the abstainers was one-third that of the tabular
expectation, and their occupations were classified as follows:
Clergymen 4 per cent.
Farmers 19 " "
Clerks 15 " "
Miscellaneous (earning $15 to $25 per week) 62 " "
Mr. Roderick McKenzie Moore, Actuary of the United Kingdom Temperance
and General Provident Institution,[7] has this to say regarding the
abstainers' class in that company:
The total abstainer class was not "nursed" or favored to produce
a low mortality. So far as could be determined (and many of the
risks came in personal contact with the officers) they were of the
same general class as the non-abstainers. They were written by the
same group of agents, for the same kind of policies, for the same
average amounts, _and were in the same general walks of life_, and
of the same general financial condition. They were almost equal in
numbers to the general class and did not form a small high grade
section of the policyholding body. On the contrary, greater care was
exercised in the selection of the non-abstainers because of the less
favorable experience anticipated on them, and many borderline risks
were accepted in the abstaining class because of a feeling that
their abstinence would neutralize some unfavorable factor.
UNITED KINGDOM TEMPERANCE AND GENERAL PROVIDENT INSTITUTION OF LONDON
HEALTHY MALES--WHOLE LIFE POLICIES
1866-1910
[Illustration: graph]
EXPECTED MORTALITY________________________________________100%
NON-ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY........ 91%
[L]ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY--.--.--. 66%
MORTALITY AMONG NON-ABSTAINERS--STANDARD RISKS--37.7% HIGHER THAN AMONG
ABSTAINERS
[L] THAT IS, WHERE--ACCORDING TO THE MORTALITY TABLES UPON WHICH
PREMIUMS ARE BASED--100 WERE EXPECTED TO DIE, ONLY 66 ACTUALLY DIED.
* * * * *
SCEPTRE LIFE ASSOCIATION OF LONDON
WHOLE LIFE POLICIES
1884-1911
[Illustration: graph]
EXPECTED MORTALITY________________________________________100%
NON ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY........ 80%
ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY--.--.--.--. 52%
MORTALITY AMONG NON-ABSTAINERS--STANDARD RISKS--51.8% HIGHER THAN AMONG
ABSTAINERS
THE LIFE EXTENSION INSTITUTE, INC.
* * * * *
THE SCOTTISH TEMPERANCE LIFE ASSURANCE CO. OF GLASGOW
HEALTHY MALES--WHOLE LIFE POLICIES
1883-1912
[Illustration: graph]
EXPECTED MORTALITY________________________________________100%
NON-ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY........ 66%
ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY--.--.--.--. 48%
MORTALITY AMONG NON-ABSTAINERS--STANDARD RISKS--43.5% HIGHER THAN AMONG
ABSTAINERS
* * * * *
COMPARATIVE MORTALITY AMONG USES OF ALCOHOL 43 AMERICAN LIFE INSURANCE
COMPANIES 1885-1908
DEATH RATE AMONG INSURED LIVES GENERALLY--MEDICO ACTUARIAL TABLE
100 |||||||||||||||||||||||||
DEATH RATE AMONG POLICYHOLDERS USING 2 GLASSES OF BEER OR 1 GLASS OF
WHISKEY DAILY
118 ||||||||||||||||||||||||||||||
DEATH RATE AMONG POLICYHOLDERS GIVING HISTORY OF PAST INTEMPERANCE, BUT
APPARENTLY CURED
150 ||||||||||||||||||||||||||||||||||||||
DEATH RATE AMONG POLICYHOLDERS USING MORE THAN 2 GLASSES OF BEER OR
1 GLASS OF WHISKEY DAILY, BUT, REGARDED AS TEMPERATE & STANDARD RISKS
186 |||||||||||||||||||||||||||||||||||||||||||||||
* * * * *
Now that accurate laboratory evidence is available regarding the
physiological effect of alcohol in so-called moderate doses the
insurance experience seems consistent, and the higher mortality among
so-called moderate drinkers is only what we would naturally expect to
find in the light of the most recent knowledge regarding its effects
upon the human organism, not only in the direct causation of disease,
but in lowering the defense to disease and increasing the liability to
accident, and the tendency to careless living.
[Sidenote: Medico-Actuarial Mortality Investigation]
In the recent medico-actuarial investigation[8], including forty-three
American life insurance companies, the combined experience on users of
alcohol has been compiled, with very interesting results. It may be
subdivided as follows:
First: Those who were accepted as standard risks but who gave a history
of occasional alcoholic excess in the past. The mortality in this group
was 50 per cent. in excess of the mortality of insured lives in general,
equivalent to a reduction of over four years in the average lifetime of
the group.
Second: Individuals who took two glasses of beer, or a glass of whisky,
or their alcoholic equivalent, each day. In this group the mortality
was 18 per cent. in excess of the average.
Third: Men who indulge more freely than the preceding group, but who
were considered acceptable as standard insurance risks. In this group
the mortality was _86 per cent._ in excess of the average. In short, we
find the following increase of mortality over the average death rate
among insured risks generally:
Steady moderate drinkers but accepted
as standard risks 86 per cent.
Having past excesses 50 " "
Very moderate drinkers 18 " "
This means that steady drinkers who exceed two glasses of beer or one
glass of whisky daily are not, on the evidence, entitled to standard
insurance, but should be charged a heavy extra premium.
In these groups, the death rates from Bright's disease, pneumonia and
suicide were higher than the normal.
[Sidenote: Consumption of Alcohol]
The per capita consumption of alcohol has greatly increased in the
United States in recent years, while in the United Kingdom it has
materially decreased, as shown in the following table. This factor must
be considered in assigning a cause for the increasing mortality from
degenerative diseases in this country as compared to a decreasing
mortality from these maladies in Great Britain.
ANNUAL PER CAPITA CONSUMPTION (IMPERIAL GALS.) OF ALCOHOL IN VARIOUS
COUNTRIES[9] 1896-1912
--------+------------------------------+--------------------------------
| 1896-1900. | 1908-1912.
+------+------+--------+-------+------+------+--------+---------
| Beer.| Wine.|Spirits.| Total.| Beer.| Wine.|Spirits.| Total.
--------+------+------+--------+-------+------+------+--------+---------
Germany | 25.4 | 1.37| 1.66 | 28.43 | 22.4 | 1.09| 1.29 | 24.78
U. K. | 31.6 | .39| 1.05 | 33.04 | 26.65| .26| .71 | 27.62
France | 5.5 | 19.9 | 1.7 | 27.1 | 8.6 | 24.7 | 1.42 | 34.72
U. S. | 13.01| .30 | .81 | 14.12 | 16.62| .52| 1.02 | 18.16
--------+------+------+--------+-------+------+------+--------+---------
#Laboratory and Clinical Evidence Relating to the Physiological Effects
of Alcohol#
To interpret correctly the mortality statistics relating to moderate
drinkers and total abstainers, one must have some knowledge of the
physiological effects of alcohol in so-called moderate doses, a
knowledge which is often lacking in those who assume to interpret such
statistics.
For example: If it could be shown that small doses of alcohol produce no
ascertainable ill effects upon the human organism, the higher mortality
among the moderate drinkers as compared to total abstainers might have
to be explained as due to some as yet unrecognized cause or causes
other than alcohol. But if laboratory and clinical evidence shows that
alcohol in so-called moderate quantities (social moderation) produces
definite ill effects, such as lowering the resistance to disease,
increasing the liability to accident and interfering with the efficiency
of mind and body and thus lessening the chances for success in life, to
say nothing of any toxic degenerative effect upon liver, kidneys, brain
and other organs, the excess mortality that unquestionably obtains among
moderate drinkers as compared to total abstainers must be ascribed
chiefly to alcohol.
It is not possible here to give all the evidence, but the following
items will serve to clarify these questions.
[Sidenote: Effect on Brain and Nervous System]
Kraepelin[10] and his pupils have contributed most extensively to our
knowledge on this subject. According to such authorities, a half to a
whole liter of beer is sufficient to lower intellectual power, to impair
memory, and to retard simple mental processes, such as the addition of
simple figures. Habitual association of ideas, and free association of
ideas are interfered with.
As far back as 1895, Smith demonstrated the influence of small doses of
alcohol in impairing memory, and these results have been confirmed by
Kraepelin and quite recently by Vogt[11] in experiments on his own
person--15 cc. (about 4 teaspoonfuls) of whisky on an empty stomach, or
25 cc. with food, being sufficient to distinctly impair the power to
memorize.
Careful and exact experiments have shown the influence of moderate doses
of alcohol in lessening the amount of work performed by printing
compositors. There has also been shown a disturbance in the sequence of
ideas. The time that elapses between an irritation and the beginning of
a responsive movement can be measured within one one-thousandth of a
second. According to Aschaffenburg,[12] under the influence of even very
small doses of alcohol this reaction period is disturbed and shortened.
It is below the normal, the acceleration being attained at the expense
of precision and reliability. Indeed, the reaction is often premature,
and constitutes a false reaction--"the judgment of the reason comes
limping along after the hasty action."
It is now conceded that alcohol is not a real brain stimulant, but acts
by narrowing the field of consciousness. By gradually overcoming the
higher brain elements the activities of the lower ones are released,
hence the so-called stimulation and the lack of judgment and common
sense often shown by those even slightly under the influence of alcohol.
The man who wakes up under alcohol is really going to sleep, as far as
his judgment and reason are concerned. Complete abolition of
consciousness is brought about by sufficient doses as when ether or
chloroform is taken.
Under moderate doses, muscular efficiency is at first increased a little
and then lowered, the total effect being a loss in working power, as
shown by the experiments of Dubois, Schnyder,[13] Hellsten,[14] and
others.
[Sidenote: Influence on Bodily Resistance to Disease]
Muller, Wirgin and others[15] have shown that alcohol restricts the
formation of antibodies (the function of which is to resist infection in
the blood) in rabbits, and Laitinen[16] has shown that the prolonged
administration of small doses in men (15 cc.) is sufficient to lower
vital resistance, especially to typhoid fever.
Rubin[17] has demonstrated that alcohol, ether and chloroform, injected
under the skin, render rabbits more vulnerable to streptococcus (blood
poison) and pneumnococcus infection (pneumonia); Stewart,[18] that small
amounts lower the resistance to tuberculosis and streptococcus
infection; Craig and Nichols,[19] that moderate doses of whisky were
sufficient to cause a negative Wassermann reaction in syphilitic
subjects; Fillinger[20] found the resistance of red blood cells much
reduced after the administration of champagne to healthy human subjects.
Similar results were found in dogs and rabbits.
Weinburg[21] confirmed these results by the same methods, showing that
20 per cent. of the red cells lose their resistance after the
administration of 450 cc. of champagne.
Parkinson,[22] in a series of careful tests, failed to establish any
influence on phagocytosis (capacity of the white blood cells to destroy
bacteria), except when large doses or continuous moderate doses were
taken.
[Sidenote: Effect on Circulation]
On the heart and circulation, alcohol acts as a depressant, increasing
the rate, but not the force, of the pulse. It causes depression of the
nerve center controlling the blood vessels and thus lowers blood
pressure. Large doses cause paralysis of these nerves and of the heart.
Miller and Brooks[23] found from small doses (6 to 12 cc. absolute
alcohol) an increase in blood pressure in conscious (unanesthetized)
animals, contrary to the findings of Crile,[24] Cabot,[25] Dennig,[26]
Hindelang and Gruenbaum, Alexandroff[27] and others, _in man_; but the
amounts were small and variable, according to individual susceptibility,
_thus showing the drug to be, even on such evidence, uncertain and
unserviceable as a heart stimulant_.
[Sidenote: Food Value]
Atwater and Benedict,[28] and Beebe[29] and Mendel,[30] have shown that
alcohol is a "protein sparer," and can, to some extent, take the place
of fats and carbohydrates. This is what is meant by calling alcohol a
"food." Always, however, it fails to pass some test by which true foods
are measured. Apart from its effect on the nervous system, among which
must be figured its action on the blood vessels which causes a _loss of
body heat_, Mendel has shown that in moderate doses (96 cc. daily) it
increases the output of uric acid and allied (purin) bodies derived from
the tissues, a fact which distinguishes it from all other foods. These
poisonous or drug effects must always be considered, together with any
alleged nourishing effects. Alcohol is still used by some as a rapidly
available fuel-food in fevers, and when ordinary foods cannot be readily
digested and made available. But this is done to a much less degree than
formerly, now that its narcotic and poisonous effects are more fully
understood. Sugar and water often serve quite as useful a purpose.
It seems reasonable, on the evidence herein presented, to class alcohol
among the narcotic or "deadening" drugs, such as ether or chloroform.
Indeed, Aschaffenburg[31] has recently called attention to the growth of
the ether habit in eastern Germany, where this drug is used as a
so-called stimulant, while in reality the effects are well known to be
narcotic, or deadening.
The laboratory and the life insurance records simply give exact
expression to what has long been a matter of common knowledge to the
employer of labor and to leaders and commanders of men; to wit, that the
influence of alcohol on any large group of men, whether they be artisans
or soldiers, is harmful and lowers the efficiency of the group.
Individual susceptibility varies, but the man who thinks he is an
exception and can indulge with safety may find that he is mistaken only
after serious damage to the body has been done and perhaps a definite
loss sustained in happiness and achievement.
[Sidenote: Effect on Offspring]
Stockard,[32] in his experiments on animals, has demonstrated
conclusively that the germ cells of males can be so injured by allowing
the subjects to inhale the fumes of alcohol that they give rise to
defective offspring, although mated with vigorous untreated females. The
offspring of those so treated when reaching maturity are usually nervous
and slightly undersize. These effects are apparently conveyed through
the descendants for at least three generations. Such evidence
establishes at least the probability of the transmission of serious ill
effects to human offspring through alcoholic indulgence of the male
parent.
Much of the statistical evidence that has been produced on both sides of
this question of the transmissibility of the effect of alcohol is
misleading unless very critically analyzed, but the results of exact
laboratory experiments can hardly be gainsaid.
Those who trifle with alcohol should at least take the precaution to be
periodically examined in order to detect the earliest signs of
ill-effect. One's own feelings are not safe guides, and may fail to
warn of danger until serious damage has been done.
In 1914, at the annual meeting of the National Council of Safety, at
which there were present representatives from several hundred large
industries, the members unanimously voted to abolish liquor from their
plants. It has been well stated by Quensel[33] that "work and alcohol do
not belong together, especially when the work demands wideawakeness,
attention, exactness and endurance."
The restrictive and prohibitive measures of the French and Russian
governments, the well known opposition of the Kaiser to alcohol and the
warnings uttered by Lord Kitchener and leading British statesmen, are
sufficient evidence that the condemnation of alcohol represents the
deliberate judgment of the world's strong men.
_REFERENCES_
[1] United Kingdom Temperance and General Provident Institution of
London, Annual Report, 1910.
[2] Sceptre Life Association, Annual Report, 1912.
[3] Scottish Temperance Life Assurance Company, Annual Report, 1912.
[4] The Abstainers and General Insurance Company, Ltd., Annual Report,
1912.
[5] McMahon, T. F.: _The Use of Alcohol and the Life Insurance Risk._
Proceedings of the Association of the Life Insurance Medical Directors
of America, 1911, Twenty-second Annual Meeting, p. 473; Medical Record,
LXXX, p. 1121.
[6] Lounsberry, R. L.: Proceedings of the Life Assurance Medical
Directors. October, 1913.
[7] Moore, Roderick McKenzie: _On the Comparative Mortality Among
Assured Lives of Abstainers and Non-Abstainers from Alcoholic
Beverages._ Transactions of the Institute of Actuaries, 1913, XXXVIII,
pp. 248-272.
[8] Report of Medico-Actuarial Mortality Investigation, IV, pp. 11-13.
[9] Statistical Abstract for the United Kingdom, Sixty-first Number,
1809-1913 (Wyman & Sons), London, 1914, p. 173; Statistical Abstract for
the Principal and Other Foreign Countries, 1901-1912, Thirty-ninth
Number, pp. 505, 506, 507; Statistical Abstract of the United States,
Thirty-sixth Number, 1913, p. 516.
[10] Kraepelin, Emil: _Ueber die Beeinflussung einfacher psychischer
Vorgaenge durch einige Arzneimittel_, Verlag von Gustav Fisher, Jena,
1892; Aschaffenburg, Gustav: _Praktische Arbeit unter Alkoholwirkung,
Psychologische Arbeiten_, 1896, I, pp. 608-626; Kurz, Ernest, and
Kraepelin, Emil: _Ueber die Beeinflussung psychischer Vorgaenge durch
regelmaessigen Alkoholgenuss, Psychologische Arbeiten_, 1901, III,
pp. 417-457; Mayer, Martin: _Ueber die Beeinflussung der Schrift durch
den Alkohol, Psychologische Arbeiten_, 1901, III, pp. 535-586; Rudin,
Ernst: _Ueber die Dauer der psychischen Alkoholwirkung, Psychologische
Arbeiten_, IV, pp. 1-44.
[11] Vogt, R.: _Om virkningen af 15-50 cm3 koncentrert spiritus paa
erindringsevnen_, Norsk. Mag. f. Laegevidensh., 1910, LXXI, pp. 605-626;
The Lancet (London), 1910, II, p. 1040.
[12] Aschaffenburg, Gustav: _Crime and Its Repression_, Little, Brown &
Company, Boston, 1913, p. 84.
[13] Schnyder, L.: _Alkohol und Muskelkraft_, Archiv fuer
Physiologie, 1902-3, XCIII, p. 451.
[14] Hellsten, A. F.: _Ueber den Einfluss von Alkohol, Zucker und Thee
auf die Leistungsfaehigkeit des Muskels_, Munchen Med. Wchnschr., 1914,
LI, pp. 18-94.
[15] Bastedo, Walter A.: _Materia Medica Pharmacology and Therapeutics_,
W. B. Saunders Company, Philadelphia and London, 1913, p. 333.
[16] Laitinen, T.: The Norman Kerr Lecture on _The Influence of Alcohol
on Immunity_, Med. Rec., LXXVI, 1909, pp. 445-446. Read before the
Twelfth International Anti-Alcoholic Congress, held in London, July,
1909; _Uber die Einwirkung der kleinsten Alkoholengen auf die
Widerstandsfaehigkeit des tierischen Organismus mit besonderer
Beruecksichtigung der Nachkommenschaft_, _Ztschr. f. Hyg. u.
Infections-krankheiten_, LVIII, 1907-8, p. 139.
[17] Rubin, George: _The Influence of Alcohol, Ether, and Chloroform on
Natural Immunity in its Relation to Leucocytosis and Phagocytosis_,
Jour. Infct. Dis., 1904, I, pp. 425-444.
[18] Stewart, Chas. E.: _The Influence of Alcohol on the Opsonic Power
of the Blood_, Mod. Med., 1907, XVI, pp. 241-246. Read before the
American Society for the Study of Alcohol and Drug Neuroses, Atlantic
City, June 4, 1907, and published in the Jour. of Inebriety.
[19] Craig, Chas. F., and Nichols, Henry J.: _The Effect of the
Ingestion of Alcohol on the Result of the Complement Fixation Test in
Syphilis_, Jour. A. M. A., 1911, LVII, pp. 474-76.
[20] Fillinger, F. V.: _Weitere Mitteilungen ueber Resistenzverminderung
der Erythrozyten nach Alkoholgenuss_, Deutsch. Med. Wchnschr., 1912,
XXXVIII, p. 999.
[21] Weinburg, W. W.: _The Lowering of Stability of Erythrocytes in
Alcoholic Intoxication_, Russky Vratch, 1912, II, p. 1324; New York Med.
Jour., 1912, XCVI, p. 1040.
[22] Parkinson, P. R.: _The Relation of Alcohol to Immunity_, The Lancet
(London), 1909, VII, pp. 1580-82.
[23] Brooks, Clyde: _The Action of Alcohol on the Normal Intact
Unanesthetized Animal_, Jour. A. M. A., 1910, LV, pp. 372-73. Read in
the Section on Pathology and Physiology of the A. M. A. at the
Sixty-first Session, St. Louis, June, 1910.
[24] Crile, George W.: _Blood Pressure in Surgery_, J. B. Lippincott
Company, Philadelphia, 1903. Cartwright Prize of the Alumni Ass'n of the
College of Physicians and Surgeons, New York City.
[25] Cabot, Richard C.: _Studies of the Action of Alcohol in Disease,
Especially upon the Circulation_, Med. News, LXXXIII, 1903, pp. 145-153.
Read before the Association of American Physicians, May 13, 1903.
[26] Dennig, Hindelang und Gruenbaum: _Uber den Einfluss des
Alkohols auf den Blutdruck und die Herzarbeit in pathologischen
Zustaenden_, Namentlich beim Fieber, Deutsch. Arch. f. klin. Med., 1909,
XCVI, pp. 153-162.
[27] Alexandroff, Emilie: _Ueber die analeptische Wirkung des Alkohols
bei pathologischen Zustaenden_, Cor. Bl. f. schweiz. Aerzte., 1910, XL,
pp. 465-475; Action of Alcohol During Febrile and other Pathologic
Conditions, Jour. A. M. A., 1910, LV, p. 174.
[28] Atwater, W. A., and Benedict, F. G.: _An Experimental Inquiry
Regarding the Nutritive Value of Alcohol_, National Academy of Science,
1902, Sixth Memoir.
[29] Beebe, L. B.: _The Effect of Alcohol and Alcoholic Fluids Upon the
Excretion of Uric Acid in Man_, Amer. Jour. Physiol., 1904, XII,
pp. 13-37.
[30] Mendel, L. B., and Hilditch, Warren W.: _The Influence of Alcohol
Upon Nitrogenous Metabolism in Men and Animals_, Amer. Jour. Physiol.,
1910, XXVII, pp. 1-23.
[31] Aschaffenburg, _Ibid._
[32] Stockard, C. R.: _A Study of Further Generations of Mammals from
Ancestors Treated with Alcohol_, Proc. Soc. Exper. Biol. and Med., 1914,
XI, p. 136.
[33] Quensel, Ulrik: _The Alcohol Question from a Medical
Viewpoint--Studies in the Pathology of Alcoholism_, Year Book, United
States Brewers' Association, 1914, p. 168.
* * * * *
Bastedo, Walter A.: _Materiel Medico, Pharmacology and Therapeutics_,
W. B. Saunders Company, Philadelphia and London, 1913, p. 318.
Bertillon, Jacques: _On Mortality and the Causes of Death According to
Occupations_, Proceedings of the Fifteenth International Congress on
Hygiene and Demography, Washington, 1912, I, p. 345.
Boos, William F.: _The Relation of Alcohol to Industrial Accidents and
to Occupational Diseases_, Proceedings of the Fifteenth International
Congress on Hygiene and Demography, Washington, 1912, I, p. 829.
Cabot, Richard C.: _The Consumption of Alcohol and of Other Medicines at
the Massachusetts General Hospital_, Boston Med. Jour., CLX, 1909,
pp. 480-81.
Dixon, W. E.: _Alcohol in Relation to Life_, The Nineteenth Century,
1910, LXVII, pp. 516, 523.
"Ethyl Alcohol," _The Dispensatory of the United States of America_,
J. B. Lippincott & Company, Philadelphia, 19th edition, p. 102.
Ewald: _Alcohol in Relation to Infectious Diseases_, Med. Rec., 1913,
LXXXIV, p. 75. Read before the Fourth National Congress on
Physiotherapy, Berlin, March 26, 1913.
Horsley, Sir Victor: _Discussion on Alcohol in Therapeutics_, Med. Rec.,
1912, LXXI, p. 951. Read before the Hunterian Society.
Hunter, Arthur: _Can Insurance Experience be Applied to Lengthen Life?_
Proceedings of the Association of Life Insurance Presidents, Eighth
Annual Meeting, 1914, pp. 27-37.
Kelynak, T. M.: _The Drink Problem_, London, Methuen & Company, 1907.
Landau, Anastazy: _Beitrage zur hehre vom Purinstoffwechsel und zur
Frage ueber den Alkoholeinfluss auf die Harnsaureausscheidung_, Deutsch.
Arch. f. klin. Med., XCV, 1908-9, pp. 280-328.
Miller, Joseph L.: _The Physiologic Action, Uses and Abuses of Alcohol
in the Circulatory Disturbance of the Acute Infection_, Jour. A. M. A.,
1910, LV, pp. 2034-2037. Read in the joint session of the Sections of
Practice of Medicine and Pharmacology and Therapeutics of the A. M. A.,
Sixty-first Annual Session, held at St. Louis, June, 1910.
Neff, Irwin H.: _The Problem of Drunkenness_, Proceedings of the
Fifteenth International Congress on Hygiene and Demography, Washington,
1912, IV, p. 510.
Phelps, Edward Bunnell: _The Mortality from Alcohol in the United
States_, Proceedings of the Fifteenth International Congress on Hygiene
and Demography, Washington, 1912, Vol. I, p. 813.
Proceedings: Association of Life Insurance Medical Directors, October,
1911.
Report of the Committee of Fifty on: Physiological Aspects of the Liquor
Problem, Houghton, Mifflin & Company, two volumes, 1903.
Togel, O., Brezina, E., and Durig, A.: _Ueber die kohlenhydratsparende
Wirkung des Alkohols_, Biochem. Ztschr., 1913, I, 296; Editorial, Jour.
A. M. A., 1913, LXI, p. 967.
Williams, Henry Smith: _Alcohol, How it Affects the Individual, the
Community and the Race_, The Century Company, New York, 1909.
Woods, Robert A.: _The Prevention of Inebriety: Community Action_,
Proceedings of the Fifteenth International Congress on Hygiene and
Demography, Washington, 1912, IV, p. 517.
#Additional Notes on Alcohol#
[Sidenote: Nutrition Laboratory Experiments]
There has lately been undertaken at the Nutrition Laboratory of the
Carnegie Institution at Washington a very broad and comprehensive study
of the effect of moderate doses of alcohol on the healthy and normal
human body. The immense scope of the investigation planned may be judged
by the fact that under the physiological division of the research, as
laid out by Professors Raymond Dodge and E. C. Benedict, there are seven
main sections and one hundred and sixty subdivisions. The program has
been arranged after conferences, either in person or by letter, with the
leading physiologists of the world, and may take ten years to complete.
[Sidenote: Psychological Effects]
The psychological program, carried out with the co-operation of Dr. F.
Lyman Wells, has already been completed and the results recently
published.[34] These results must be accepted as the testimony of pure
science, free from all bias or even remote suggestion of propaganda.
They were based upon experiments with moderate doses of alcohol
(30 cubic centimeters, or about 8 teaspoonfuls, and 45 cubic
centimeters) upon ten normal subjects, very moderate users of alcohol,
and may be summarized as follows:
[Sidenote: Lower Levels Spinal Cord]
A very simple reflex act, the "knee-jerk," a nervous mechanism
controlled by a center at the lower level of the spinal cord, was
markedly depressed, the time of response being increased 10 per cent.
and the thickening of the muscles concerned in the act decreased
45 per cent. In some subjects the larger dose, 45 cubic centimeters,
practically abolished the knee-jerk.
The eye-lid reflex, elicited by a sudden noise, showed the next largest
effect, the time of response being increased 7 per cent. and the degree
of movement decreased 19 per cent.
[Sidenote: Higher Levels]
Other nervous mechanisms, or reflex arcs, at the higher levels of the
cord, were next investigated: (1) eye-reaction to suddenly appearing
stimulus, and (2) speech reaction to visual word stimuli. Dose A
(30 cubic centimeters), accelerated the eye-reaction, while dose B
(45 cubic centimeters) positively depressed it, agreeing with the simple
reaction experiments of Kraepelin. This was the only instance of
acceleration of movement of the voluntary muscles through alcohol, all
the other tests showing it to be a consistent depressant. The speech
reaction showed a positive depressant effect of 3 per cent.
[Sidenote: Memory]
Free association of ideas and memory tests were also made, and showed
practically no effect from alcohol, but, unfortunately, the smaller dose
only was used in these tests.
The sensitiveness to electrical stimulation was decreased 14 per cent.
Motor co-ordination, as evidenced by eye-movements in fixating seen
objects, was next investigated. The velocity of these movements was
decreased 11 per cent. Finger-movements, measured in an exceedingly
delicate way, were reduced in speed 9 per cent.
[Sidenote: Heart and Pulse]
The effect on the pulse while these tests were made was observed, and
electrocardiograms taken. The pulse was found to be accelerated, but not
increased in force, that is, the "brake" was taken off the heart, but no
driving force supplied by alcohol. The condition of the circulation was
impaired by the narcotic effect of alcohol on the cardio-inhibitory
center which holds the heart action in check.
[Sidenote: Decreases Organic Efficiency]
According to the investigators, the effect is to "decrease organic
efficiency." This should shut off such little debate as still persists
with respect to alcohol having any value as a heart stimulant.
[Sidenote: Always a Depressant]
While these investigations only confirm in part the contention of the
Kraepelin school that alcohol first acts by depressing the higher
centers, and tend to show that its first and most profound effect is on
the lower levels of the spinal cord and the simpler nervous mechanisms,
it confirms the view of these and other investigators, that the total
effect of alcohol is that of a narcotic, depressing drug, even in the
smallest doses usually taken as a beverage.
[Sidenote: Resistance of Higher Brain Function]
The possible reactions are more complex than those supposed by
Kraepelin, and there is evident in the higher centers (the effect on
highest brain functions, were not measured by Dodge and Benedict) a
power of "autogenic reinforcement," which is well exemplified by the
ability of a half-intoxicated person to sober up under some shock or
strong incentive. When social conditions do not stimulate this
reinforcement, but, on the contrary, dull and retard it, as in convivial
company, there is reinforcement of the lower, more animal mechanisms of
the nervous system, and we have exhibited revolting and foolish
reactions to alcohol, which are consistent with these findings.
[Sidenote: Explanation of Memory Effects]
The slight effect on memory and free association is explained partly by
the methods used in the laboratory (difference in time of recognizing
words suddenly exposed a second time), which are more in the nature of
"short cuts" and perhaps not so accurate a reproduction of normal
memorizing as those employed by Kraepelin and Vogt (memorizing numbers
and verse), and partly by the power of "autogenic reinforcement," which
it is difficult to eliminate in a laboratory test.
This, the latest contribution of science to the study of alcohol, gives
added proof that the higher mortality among so-called moderate users of
alcohol is largely due to the unfavorable effect on the protective
mechanism of the body.
[Sidenote: Lower Resistance]
This has been further emphasized by the studies of Reich[35] at the
University of Munich, who found that the resistance of blood cells to
salt solution and to typhoid bacilli was less among alcohol users than
among total abstainers.
Konradi[36] has found that comparatively few antibodies against cholera
germs develop in persons who consume alcohol daily in fairly large
quantities and who had been inoculated against cholera. Pampoukis[37]
has observed that alcoholics are not favorable subjects for inoculation
against rabies. The Pasteur Institute in Budapest has made similar
observations, based on twenty-five years' experience.
#Additional References#
[34] Benedict, E. C.: _The Psychological Effects of Alcohol_, The
Carnegie Institution, Washington, D. C., 1916.
Benedict, E. C.: _The Psychologic Effect of Alcohol on Man_, The Journal
A. M. A., 1916, lxvi, p. 1424.
[35] Reich, H. W.: _Ueber den Einfluss des Alkoholgenusses auf
Bakterizidie, Phagozytose und Resistenz der Erythrocyten, beim
Menschen_, Arch. f. Hyg., 1916, lxxxiv, 337.
[36] Konradi: _Ueber den Wert der Choleraschutzimpfungen_, Centralbl. f.
Bakteriol., I. O., 1916, lxxvii, 339.
[37] Alcohol and Immunity, Jour. A. M. A., 1916, lxvi, p. 962, p. 1122.