ALCOHOL.
Of the several individual factors, which are especially potent, as tending
to develop and perpetuate the Insane Diathesis, there are none which can
be regarded as more influential, either directly or indirectly, than
alcohol. Over-education of the brain, under-education, and heredity, all
may exert an influence which tends toward this result, and their victims
may be found in large numbers in all our asylums and hospitals; but the
effects of alcohol are so insidious, it has been so generally used in the
past, and its effects are so often transmitted to succeeding generations,
that probably the sum total of its effects are far greater than those of
either of the above-named agencies.
I therefore regard it as a happy omen for the future of society, that the
physiological effects of this substance, and its absolute uselessness and
positive injury to the human system, except as a medicine and under
exceptional circumstances, are beginning to be more clearly recognized by
the medical profession, and more generally understood by the educated
portion of society. And yet I fear we are far from the realization of any
millennial period, as to its use and abuse, in this or other countries.
Indeed, while probably there is much less of alcohol used as a beverage
among the more intelligent portion of the community at the present time
than there was fifty years ago, yet I think there is more used in that way
among the operative classes, and especially the young of large towns and
cities. The facilities of obtaining it are so much greater, that the
temptations to its use are greatly increased, and the habit of using lager
beer, ale, and wine, among those from fourteen to twenty-four or
twenty-six years of age, is certainly greatly increased, if the numbers of
this class who frequent and assist in sustaining the large number of
saloons and public-houses now so prevalent in cities, may be taken as an
indication of existing facts.
Granting, however, that actually less of alcohol is now consumed than
formerly, per capita, it by no means follows that the amount of its evil
effects is less. The conditions of life are so greatly different to-day
from those existing fifty years ago; populations reside to a so much
larger extent in-doors, so that alcohol would be much less freely and
easily eliminated from the system, than when exercising and breathing in
an out-of-door atmosphere; life is so much more intense in many of its
avocations which were then unknown, necessitating very much larger drafts
upon the brain and nervous system; the means with which to purchase and
use alcoholic beverages by the laboring classes are so much more abundant
and easily obtained now than formerly, and while living in places of
larger population than would be possible if residing in the country, or in
small villages,--all these conditions and others unite in rendering the
probability of its use greater, and its effects upon the nervous system
vastly more injurious than formerly. Under these conditions of modern
civilization a small quantity goes a long way. Besides, society is to-day
reaping the harvest of its abuse of this drug during a long period, in the
shape of a diathesis which manifests itself in various ways and under many
forms of disorder.
Some years since I had occasion to examine the history of admissions to
the Retreat, which at that time amounted to more than five thousand cases,
and it was found that in more than one tenth of these cases the cause of
insanity had been traced to the use of alcohol. This, however, did not
embrace those cases which had inherited an unstable condition of brain in
consequence of the use of alcohol by parents, and became insane for this
reason.
Of the sixteen hundred insane and imbecile or feeble-minded persons in
Connecticut at the present time, it is estimated that not less than one
fifth have become so either directly or indirectly through the influence
of alcohol. Some writers estimate the amount of insanity which is caused
through the influence of alcohol, on parents and their children, in
England, at a much higher proportion, than this. Statistics indicate that
a considerably larger amount of spirits, beer, and wine, per capita, is
used yearly in Great Britain than in the United States.
My present purpose, however, is to draw attention to the part it plays,
more particularly when used not immoderately as a beverage (if any use of
it as such can be so characterized), in creating a diathesis which renders
the brain liable to unstable and irregular action. And I may remark at the
outset that it does not so much signify in what form of beverage it may be
used. The _quantity_ taken is the important point--whether it be in the
form of beer or wine, brandy or whiskey. The alcohol contained in any or
all of these articles is _the_ thing sought for, and _its_ influence upon
the brain is that of paramount importance and consideration.
In order that we may more clearly understand the manner in which the use
of alcohol, in its various forms, as a beverage, tends to create an
unstable condition of the nervous system and irregular mental activity, it
becomes necessary to study, in some measure, its physiological effects
upon the system, as they have been demonstrated by means of experiments
conducted with scientific accuracy. This becomes the more necessary, as
there has always existed, and still exists, in the public mind a firm
belief that its effects are quite harmless, and may be even beneficial,
_if it is used in moderation only_.
I. That the primary physiological effects of alcohol upon the nervous
system are such as to cause, either directly or indirectly, a large
increase of some of the functional activities of the body, has always been
so well known, that alcohol has long been regarded as one of the most
active stimulants. Hence its so general use in medicine. And yet, to how
great an extent it acts as such, and how much is physiologically signified
by its effects as a stimulant, especially upon the primary tissues of the
body, has not been so well understood. That this may be rendered more
clear in the mind of the reader, I shall now introduce some of the results
of experiments conducted by Dr. Parkes and Count Wollowicz. These
experiments were upon the person of a strong and healthy young man, and
were intended to be as accurate as possible. They extended over two
periods: the _water period_ and the _alcohol period_, and were continued
many days in succession. During the first period, the person used no other
fluid than water, and the action of the heart was registered at regular
intervals, a mean of the several registrations being taken as a basis for
computation.
The same plan was followed during the alcohol period, and during the days
while increased amounts of alcohol were administered. I herewith give the
results in the words of their own report:
"The highest of the daily means of the pulse observed during the first, or
water, period, was 77.5; but on this day two observations were deficient.
The next highest daily mean was 77 beats.
"If, instead of the mean of the eight days, or 73.57, we compare the mean
of this one day, viz., 77 beats per minute, with the alcoholic days, so as
to be sure not to over-estimate the action of the alcohol, we find:
"On the 9th day, with one fluid ounce of alcohol, the heart beat 430 times
more.
"On the 10th day, with two fluid ounces, 1,872 times more.
"On the 11th day, with four fluid ounces, 12,960 times more.
"On the 12th day, with six fluid ounces, 30,672 times more.
"On the 13th day, with eight fluid ounces, 23,904 times more.
"On the 14th day, with eight fluid ounces, 25,488 times more.
"But as there was ephemeral fever on the 12th day, it is right to make a
deduction, and to estimate the number of beats on that day as midway
between the 11th and 13th days, or 18,432. Adopting this, the mean daily
excess of beats during the alcoholic days was 14,492, or an increase of
rather more than 13 per cent.
"The first day of alcohol gave an excess of 4 per cent., and the last of
23 per cent.; and the mean of these two gives almost the same percentage
of excess as the mean of the six days.
"Admitting that each beat of the heart was as strong during the alcoholic
period as in the water period (and it was really more powerful), the heart
on the last two days of alcohol was doing one fifth more work.
"Adopting the lowest estimate which has been given of the daily work done
by the heart, viz., as equal to 122 tons lifted one foot, the heart,
during the alcoholic period, did daily work in excess equal to lifting
15.8 tons one foot, and in the last two days did extra work to the amount
of 24 tons lifted as far.
"The period of rest for the heart was shortened, though, perhaps, not to
such an extent as would be inferred from the number of beats; for each
contraction was sooner over. The heart, on the fifth and sixth days after
alcohol was left off, and apparently at the time when the last traces of
alcohol were eliminated, showed, in the sphygmographic tracings, signs of
unusual fulness; and, perhaps, in consequence of this, when the brandy
quickened the heart again, the tracings showed a more rapid contraction of
the ventricles, but less power than in the alcoholic period. The brandy
acted, in fact, on a heart whose nutrition had not been perfectly
restored."[16]
In reference to the result of the above experiments, it will be observed
that no special notes are made except in relation to the action of the
heart. The primary effect of alcohol is upon this organ, through its
influence upon the nervous system. It, however, by no means ends here, but
through it extends to all other portions of the body.
Now, the heart (and all other organs of the system) may be said to have a
unit of power--so much, and no more inherent strength of action; so much
capacity of function. If, therefore, under the influence of alcohol or any
other drug, an organ is made to do two hours' work in one, or in any
measure an increase of its normal activity is secured, a draft is made
upon its _reserve_ power, and, that it may regain this, there must
necessarily afterward occur a period of so much less than normal activity.
In other words, what has been gained in action under the effect of
stimulus, must be lost on its withdrawal, and there must ensue a period of
feeble and imperfect action, which is radiated to all other portions of
the system, and is manifest in none more fully than in the brain. Indeed,
upon the action of the heart as to frequency and regularity, depends the
action of the brain as to continuity and strength of thought; and this, in
even a greater measure than in relation to the functions of other parts.
The brain at all times contains a much larger portion of the blood than
any other organ, and this quantity is imperatively necessary to its normal
action as to thought. To such an extent is this so, that consciousness at
once fades into darkness, and all thought ceases instantaneously, upon the
check of its circulation, even in certain limited areas of its surface.
We therefore perceive how even more important than for other organs it is,
that the circulation of the brain, the tissue of which is the most
delicate and sensitive, should remain unaffected by over-stimulation of
the heart's action, which, in reality and effect, is the controlling power
of the system, and may be likened to an engine, by means of which is kept
in operation the force requisite to move the machinery of all other
portions of the system, and maintain them in harmonious activity.
But, let us study this physiological effect of alcohol a little further,
that we may more fully understand how much is signified by it.
Every heart-beat causes a certain amount of blood to pass through the
larger arteries to the brain, and thence through its minute vessels or
capillaries. It is by means of the capillary circulation that the brain,
its cells, connective tissues, and all membranes, are supplied with the
requisite material for life and activity. So important is the _regularity_
of this supply to the brain in the discharge of its functions, that a
special arrangement of blood-vessels is provided, or rather the number of
arteries is larger and their distribution more complicated and various
than for any other organ. If now this supply of blood is increased by one
fourth or one sixth, or in any other degree, through the action of the
heart, there must result a relative increase of it to the brain-cells and
tissues, together with a corresponding increase of function.
The anatomy of the brain teaches us that every fibre, brain-cell, and even
nucleus, is enclosed with an exceedingly thin covering, through which its
contents may be nourished, and also through which, when its constituents
are no longer of any use, they may be eliminated and removed from the
body. These coverings, or membranes, as they are called, in turn, derive
their materials for growth and function from the minute capillary
blood-vessels which, in almost infinite number, supply them, while all
portions of brain tissue are together dependent upon the _regularity_ of
the heart's supply of blood to enable them to discharge their functions
in a normal manner.
Now, physiological experiments have shown that the effect of alcohol upon
that portion of the nervous system--the vaso-motor--which presides over
and supplies power of action to these capillaries, and also regulates the
action of the heart, is that of a narcotic. Its effect is to partially
paralyze this nerve, and leave the heart to act more freely and rapidly
under the influence of the motor nerve; in consequence of this partial
paralysis of the coats of the capillary vessels, when the blood passes
through them so much more rapidly than when in their normal state, they
fail to absorb from the blood the material requisite to nourish them, and
also fail to remove material which has already been used.
One of the most important of their functions however, is the removal of
this used-up material of the brain-cell, connective tissues, and fibres.
If this is imperfectly performed, and some portion of this secondary
metamorphosis of material is left unremoved, there must result at least
two not very remote effects.
1. A less sensitive and delicate condition of these several constituent
portions of brain-substance, and they will become correspondingly less
responsive to both objective and subjective impressions or influences.
There must result, therefore, a less perfect discharge of thought-function
in its various manifestations, both moral and intellectual.
2. This imperfect removal of material which has once discharged its
function, and is consequently useless, will ultimately cause a thickening
of the coverings of these cells and fibres of the brain, which, in process
of time, must render the discharge of their function more difficult and
imperfect.
II. So far, it will be observed, we have referred only to the indirect
effect of alcohol upon the brain, which results from its influence upon
the heart-action. I wish now to refer, in a few words, to its direct
physiological effect upon the mind, when used as a beverage. Its primary
effect is to cause a more rapid flow of thought. It is, as if that portion
of a watch which holds its spring and prevents its too rapid uncoiling
should be removed; the result would be a quickening of movement, and its
power of action would be greatly increased for a little time. So it is
with the mind under the primary influence of alcohol; as the blood flows
through the brain more freely, thought becomes more accelerated, and there
is an excitement of utterance and imagination. This period, however, soon
passes by, and before long the mind becomes less clear and accurate in its
perceptions; it is partially clouded; it loses the nicety of its moral
sense; it does not perceive the moral side of conduct so clearly and
definitely as formerly; it does not judge so accurately in reference to
the claims of friends and society; and there is not that sense of
propriety as to personal conduct which formerly existed. Moreover, the
rapidity of impressions becomes lessened, and consecutiveness of thought
is impaired, so that the mind fails to carry through a train of thought,
or conduct a course of reasoning, as it would do when free from the
influence of alcohol. This effect may continue under the repeated
influences of alcohol until impressions, both objective and subjective,
become less and less vivid and more circumscribed, and ultimately there
may result partial paralysis of the power of thought. It becomes more and
more liable to irregularity, confusion and weakness; the will loses its
power of control in a large degree over mental operations, and insanity in
some of its forms not infrequently ensues.
III. There is reason to believe that there results a further action of
alcohol upon the electrical currents of the body, which originate in and
proceed from the brain. Dr. Mulvaney, Staff Surgeon of the Royal Navy of
England, conducted some experiments upon the effects of alcohol on these
electrical currents, with the following results: "He discovered that an
ounce of brandy, equal to about half an ounce of alcohol, taken by a
healthy man, raised the galvanometer in a few minutes, in one case
twenty-five degrees, and in another case forty-five degrees. He concluded
that the thermo-electric currents of the system were strongly excited by
small doses of alcohol, and that this excitement may be profitably
employed when there is 'clear evidence of derangement of function
springing from enfeeblement of the organic system of nerves'; but that 'in
health, when function, nutrition, and blood and nerve influence are
harmonized by structural integrity,' such artificially excited currents,
by tending to abstract an undue amount of water from the brain-cells,
'must interfere with their normal working.'"[17]
It appears, then, that there are three well-recognized and clearly
pronounced effects upon the elements of brain-structure which must result
from the use of alcohol even in small doses. It will be observed that
nothing has been said as to its physiological effects upon membranes in
other portions of the body. I hardly need enter upon this branch of the
subject in order to establish proof of its very great effect as an agent
in producing a changed and unstable condition of brain-action. And yet we
need to bear in mind how greatly its effects on the nervous system in
general are increased by its affinity for water; and how it absorbs this
from all portions of the body with which it may come in contact, thus
tending to leave them in a shrivelled and dry condition,--one unfavorable
to discharge of function.
That this may be more clearly understood in relation to the membranes of
other portions of the system, as well as those of the brain, I quote from
Dr. Richardson[18] a few sentences:
"Upon all these membraneous structures alcohol exerts a direct perverting
power of action. It produces in them a thickening, a shrinking, and an
inactivity that reduces their functional power. That they may work rapidly
and equally, the membranes require to be at all times properly charged
with water. If into contact with them any agent is brought that deprives
them of water, then is their work interfered with; they cease to separate
the saline constituents correctly; and if the evil that is thus started be
allowed to continue, they contract upon their contained matter, in
whatever organ it may be situated, and condense it.
"By its effects upon these membranes, envelopes, and coverings, alcohol
becomes one of the most extreme causes of modification of animal function,
and one of the greatest sources of structural degeneration."
In the consideration of the subject as above, reference has been made to
the effect of alcohol upon the adult system. But there can be no question
that it is vastly greater and more ruinous in its effects upon the brain,
when used during the period of youth and early manhood. At this time, the
whole system is much more susceptible to unfavorable influences of all
kinds, and especially is this the case with the brain, and that portion of
it which is concerned in mentality.
The more highly sensitive and delicately organized any portion, or the
substance of any part of the system may be, the more easily and rapidly
are impressions and changes of a permanent character made upon it. The
brain, being more highly organized than any other organ or portion of the
body, and the metamorphosis of its tissues being more rapid during the
earlier periods of life, becomes greatly more susceptible to the bad
effects of alcohol, and a diathesis is more rapidly created. And, it may
be added, that, when this diathesis has once become developed during early
life, there exists almost no hope of eradicating it, or of again rendering
the brain healthy.
Improvement may take place while abstinence from alcohol continues and the
person is under restraint, but when once again the unfortunate victim is
thrown upon his own resources, and left to his self-control, he always
falls, and returns again to his cups, as a sow to her wallowing in the
mire.
In the preceding chapter upon Heredity in its relation to the Insane
Diathesis, it was shown that the effects of alcohol are such, that they
are most surely transmitted from parent to child; and that its effects,
both moral and physical, are of the most serious character.
We have now seen how it comes to pass that such is the nature of its
effects. By its too frequent use there results a changed condition of the
coats of the blood-vessels, and an abnormal state of the brain-cells and
fibres. In accordance with the laws of heredity, a tendency to this
condition is transmitted from parent to child, to the third or fourth
generation, unless it be sooner eliminated, and may manifest itself in any
one of the many forms mentioned, all of which are of a serious nature and
generally exist through life. The importance therefore of abstinence from
the use of alcoholic beverages by all parents, and especially by the young
of both sexes in its relation to the subject of healthy brain action, can
hardly be overestimated. No one change in the customs of society and the
habits of individuals could occur, which would exert a larger influence
toward the prevention of insanity.