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 THE GIFT OF 
 
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 Alcohol: its action on the human organis 
 
 3 1924 024 830 212 
 
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 tlie Cornell University Library. 
 
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ALCOHOL : 
 
 ITS ACTION ON THE 
 HUMAN ORGANISM. 
 
 LONDON: 
 H.M. STATIONERY OFFICE. 
 
 igia. 
 
"IN Noveiii?jer, 1916, the Central Control Board (Liquor 
 TrafiRc), appointed an Advisory Committee "to consider 
 the conditions affecting the physiological action of alcohol, 
 and more particularly the effects on health and industrial 
 eflSciency produced by the Consumption of beverages of 
 various alcoholic strengths, with special reference to the 
 recent Orders of the Central Control Board, and further 
 to plan out and direct such investigations as may appear 
 desirable with a view to obtaining more exact data on 
 this and cognate questions." 
 
 The Members of the Committee were as follows : — 
 
 Lord D'Abernon, G.C.M.G. (Chairman). 
 
 Chairman of the Central Control Board (Liquor Traffic). 
 
 Sir George Newman, K.C.B., M.D. (Vice-Chairman). 
 Principal Medical Officer to the Board of Education. 
 Member of the Central Control Board (Liquor Traffic). 
 
 Professor A. R. Cushny, M.D., F.R.S., Professor of 
 Pharmacology at University College, London. 
 
 H. H. Dai<E, M.D., F.R.S., Head of the Department of 
 Bio-chemistry and Pharmacology under the Medical 
 Research Committee, National Health Insurance. 
 
 M. Greenwood, M.R.C.S., Statistician to the Lister 
 Institute of Preventive Medicine, and Reader in Medical 
 Statistics in the University of London. 
 
W. McDouGALi., M.B., F.R.S., Reader ill Mental Philosophy 
 in the University of Oxford, and Fellow of Corpus 
 Christi College, Oxford. 
 
 F. W. MoTT, M.D., F.R.S., Pathologist to the London 
 Connty Asylums ; Consulting Physician to Charing 
 Cross Hospital. 
 
 Professor C. S. Sherrington, M.D., F.R.S., Waynflete 
 Professor of Physiology in the University of Oxford, and 
 Fellow of Magdalen College, Oxford. 
 
 \V. C. Sui,i,iVAN, M.D., Medical Superintendent of the 
 Rampton State Asylum for Criminal Lunatics. 
 
 The Committee have now prepared ag a provisional 
 ba,sis for further research the following review of the 
 existing state of scientific knowledge regarding the 
 action of alcohol on the human organism. The con- 
 clusions represent the unanimous judgment ;0f the 
 Committee. 
 
 December^ 1 9 ' 7 ■ 
 
PREFACE 
 
 By L,OKD D'Abernon. 
 
 The part played by alcohol in social, industrial and 
 economic life is so considerable that knowledge of its 
 action on the.humau body might reasonably have been 
 expected to be full and precise. The total amount of 
 money devoted to the purchase of alcohol by the inhabi- 
 tants of these islands is nearly 50 per cent, greater than 
 the trafSc receipts of the whole railway system, including 
 both goods and passengers ; it is more than double the 
 expenditure on bread, and more than equal to the 
 expenditure on meat : before the war it was approxi- 
 mately equal to the total revenue of the State, and was 
 more than eight times the total amount required for 
 interest on the National Debt. Apart from the economic 
 aspect, it is admitted by all parties that the misuse of 
 alcohol exercises a considerable influence on health and 
 longevity, and it is contended by one large section of 
 opinion that it is a main cause of crime and poverty. 
 The ill effect on individual and national efficiency of 
 excessive indulgence in alcohol is not disputed. In 
 many other countries alcohol plays as great, and in some 
 a greater part. It is remarkable, therefore, that, through- 
 out the world, lack of exact knowledge still prevails 
 about the action of alcohol on the human system. No 
 authoritative scientific work gives or seeks to give the 
 required information ; on many important points, which 
 it is requisite to elucidate in order to regulate the proper 
 and legitimate use of alcoholic beverages, aqd also to 
 
IV 
 
 furnish practical guidance to the individual consumer, 
 little of substantial value has been published in a form 
 accessible to the general reader. 
 
 The absence of any authoritative work is perhaps 
 partly accounted for by the fact that many of the 
 essential data are not known even to science. A large 
 amount of laborious experiment has, indeed, been directed 
 to certain aspects of the action of alcohol ; but the choice 
 of questions for investigation has often been determined 
 by the ease with which they could be put to the test, or 
 by their bearing on some theoretical controversy, rather 
 than by their intrinsic and practical importance. There 
 are man}' points concerning the use of alcohol in daily 
 life on which research has been so inadequate that 
 knowledge with regard to them is both scanty and 
 imperfect. 
 
 It may facilitate the understanding of what is meant 
 by deficiencies, or lacunae, in scientific knowledge regard- 
 ing alcohol, if I state some of the points, many of 
 considerable importance, as to which no data, or only 
 very inadequate data, exist. I have adopted the interro- 
 gative form in order to give greater precision and 
 clearness.^ 
 
 (i.) In what way, and to what extent, if at all, do 
 solutions of ethyl alcohol in water, as commonly used 
 in laboratory experiments, differ in their action on the 
 nervous system from ordinary alcoholic beverages of 
 corresponding strength, such as beer, wines, or spirits ? 
 
 ' Experiments directed to answering the first five questions 
 in tlie above list have been carried out during the past year by 
 Dr. Edward Mellanby. 
 
 Some ver}- suggestive results have already been communi- 
 cated to the Committee while this book has been passing through 
 the press, but a final judgment as to their significance may be 
 reserved until the full Report of the research is readj- for 
 publication. 
 
(ii.) Are there any differences in inebriating action, 
 and if so what differences, between the several sorts of 
 alcoholic liquors when taken in doses of equivalent 
 alcoholic strength ? Does the drunkenness caused by 
 beer or wine differ in character from that caused bj- 
 spirits ? 
 
 (iii.) Is the effect on the nervous system of a given 
 dose of alcohol modified when it is administered in a 
 combination of alcoholic liquors ? Does mixing drinks 
 tend to produce drunkenness ? 
 
 (iv.) Does the greater or less degree of dilution in 
 which it is administered modify the immediate action 
 of a given dose of alcohol on the nervous system ? If 
 so, why and how ? 
 
 (v.) In what respect and through what mode of 
 influence, if at all, is the action of alcohol affected by 
 its administration with food ? To what extent does its 
 action vary with the particular foods taken, e.g. fats and 
 sugar ? Will a given dose of alcohol have a greater or 
 lesser effect on nervous functions when taken with a 
 meal than when taken on an empty stomach ? If there 
 is any difference, it is due to a difference in the rate 
 of absorption, or is it to be explained otherwise, and 
 if so, how ? 
 
 (vi.) Does the presence of fatigue modif j' the effect of 
 alcohol on the performance of skilled movements ? 
 
 (vii.) How does climate affect the amount of alcohol 
 that can be taken without injury to health ? Is alcohol 
 less injurious in moist climates than in dry climates ? 
 
 (viii.) To what extent is the development of chronic 
 alcoholism dependent on lesions of the stomach brought 
 about by the directly injurious action of the alcoholic 
 beverages on the mucous membrane ? 
 
 (ix.) Does, the feeling of increased cheerfulness induced 
 by aicoliol favour the resistance of the organism to 
 adverse physical influences, such as cold ? 
 
To none of these questions is it now possible to obtain 
 a precise and authoritative answer. Yet it is of vital 
 importance that knowledge regarding the points involved 
 should be full and accurate. There are many further 
 gaps in our knowledge. For instance, there is an almost 
 entire absence of reliable data regarding the psychology 
 of the drunkard, though adequate information on this 
 point is obviously essential to devising rational methods 
 for the treatment of the inebriate. l,ittle is known of 
 the progress of the drinker from occasional excess to 
 chronic alcoholism. Are the occasional drinker and the 
 habitual drunkard two distinct types, or is the former 
 an early stage of the latter ? 
 
 Further, there is a deplorable deficiency of reliable 
 statistical data concerning alcoholic disease and mortality. 
 This deficiency is due in part to the unsatisfactory 
 system of certifying the causes of death, and also in 
 some measure to absence of clinical investigation regard- 
 ing the extent of the influence of alcoholism in bringing 
 about the diseases associated with excessive drinking. 
 This explanation does not, however, cover all the facts, 
 for even in the case of diseases of unequivocally alcoholic 
 origin, such, for instance, as delirium tremens, no general 
 statistical records have hitherto been kept, save in isolated 
 localities. 
 
 The usual explanation given to account for this position 
 is that the subject is both difficult and ungrateful. It is 
 held to be difficult because its investigation has to 
 overcome obstacles even greater than those encountered 
 in all experimental research which seeks to derive guid- 
 ance as to the action of drugs in the human body from 
 the behaviour of the same drugs in the test-tube, or from 
 their effect on animals, and this for a simple reason. The 
 action of alcohol on the higher centres of the brain — the 
 action of special importance in relation to the ordinary use 
 of the alcoholic liquors — can only be elucidated by investi- 
 
v:i 
 
 gatioii in man, and the results of such investigations, even 
 when they can be objectively determined, are necessarily 
 of very doubtful interpretation, owing to the complexity 
 of the nervous functions in question, and the degree in 
 which they may be affected by the idea on the part of 
 the subject that a given result is desired, or by bias 
 felt by the subject as to the result of the experiment. 
 
 This special difficulty is enhanced by the fact that it is 
 extremely hard to disguise the presence of alcohol when 
 given in the doses necessary for experimental purposes, 
 and that it is no less hard to counterfeit it satisfactorily 
 in control doses. 
 
 Complication in arriving at the true effect of alcohol 
 on performance further arises from the fact that while 
 alcohol gives the drinker the impression that he has 
 performed the allotted task with unusual facility and 
 success, impartial and objective examination of the per- 
 formance shows — almost invariably in cases where the 
 higher faculties are concerned — that both accuracy and 
 regularity have fallen below the normal standard. Self 
 satisfaction has been increased, but neither skill nor 
 power. 
 
 The extreme caution which these considerations impose 
 upon students detracts from the brilliancy and certainty ot 
 any deduction from experiments, and tends therefore to 
 render research less attractive than in other directions. 
 
 The second alleged reason is that alcohol is an ungrate- 
 ful subject. The origin of this opinion may be traced 
 to the general belief that most people who are interested 
 in the subject are already partisans on the one side or the 
 other, and that no body of impartial opinion exists which 
 is ready to be guided by scientific inquiry. The majority 
 of those who would give any attention to original work 
 on the subject would do so, less to gain knowledge, than 
 to find arms and arguments to support their preconceived 
 opinion. 
 
VI 11 
 
 Whethet or not these reasons are a true and com- 
 plete explanation, there can be no doubt as to the fact 
 itself, viz. that knowledge on the subject of the action 
 of alcohol is inadeqiiate to the needs and importance 
 of the question. In view of this situation, the Central 
 Control Board appointed a special Committee to consider 
 the subject from a scientific point of view. Soon after it-s 
 appointment, this Committee came to the conclusion that 
 it was essential, as a starting point for further research, to 
 draw up a brief statement of the present position of 
 knowledge. It appeared that by this means research 
 would be most sureh' guided to those points which were 
 of practical importance and regarding which knowledge 
 was most urgent. 
 
 It also appeared certain that in view of the consider- 
 ations mentioned above, no impartial statement of the 
 case was likely to be made, unless it was drawn up by 
 some public body. We felt it therefore incumbent 
 upon us to enter upon the task, however invidious it 
 might be. 
 
 In substance, this book is the outcome of the decision 
 then arrived at. Its object is to separate what is know- 
 ledge from what is surmise, conjecture, or popular belief, 
 and, by this preliminary clarifying of the question, to 
 prepare the way for a further research. It may be claimed 
 for the book that it is impartial, not only in the sense 
 that the authors did not knowingly or of set purpose take 
 sides with any existing body of opinion, but also in the 
 further sense, that the writers have frankly admitted 
 doubt, when the evidence appeared insufficient to esta- 
 blish a definite conclusion, and have further indicated 
 with absolute sincerity the many points, some of them 
 of great importance, regarding which no precise and 
 scientific knowledge is available. 
 
 It will perhaps be urged that this attitude of mind mars 
 the authority with which the conclusions are put forward; 
 
IX 
 
 and that it would have been expedient to adopt a more 
 didactic tone. 
 
 But I believe that complete sincerity is the only sure 
 guide to the confidence of readers, and that the present 
 condition of knowledge does not justify any more positive 
 note. No subject has suffered more from over- statement, 
 and from excessive violence both of opinion and ofi 
 language, and on none, therefore, is caution in drawing 
 conclusions more necessary. 
 
 In the final section of the Report will be found a brief 
 summary of the principal conclusions to which the Com- 
 mittee have been led provisionally. 
 
 They are : — 
 
 (a) That the main action of alcohol (apart from 
 
 the effects of its continued excessive use) is 
 confined to the nervous system ; 
 
 (b) That alcohol is narcotic rather than stimulant 
 
 in action ; 
 
 (c) That its nutritional value is strictly limited ; 
 
 (d) That its habitual use as an aid to work is 
 
 physiologically unsound ; and 
 
 (e) That the ordinary use of alcohol should not 
 
 onh- be moderate, but should also be limited 
 
 to the consumption of beverages of adequate 
 
 dilution, taken at sufficient intervals of time 
 
 to prevent a persistent deleterious action on 
 
 the tissues. 
 
 It is, of course, common knowledge that grave and 
 
 widespread social evil follows in the train of excessive 
 
 consumption of alcoholic beverages. 
 
 The physiological findings contained in the present 
 Report have not been influenced by preoccupation re- 
 garding the social issues. But an increase of accurate 
 knowledge as to the physiological action of alcohol cannot 
 fail to be advantageous, both positively and negatively, 
 to those whose duty it may be to deal with those issues. 
 
Apart from afiording a summary of whatever knowledge 
 is available, it may be hoped that this work may to some 
 extent stimulate the habit of scientific inquiry into the 
 problems in which alcohol is concerned, and may make 
 the temper in which, they are discussed less passionate 
 and more serene. I believe that nothing more beneficial 
 could be imagined both as an aid to future State-action in 
 regulating drink control and as a guide to the individual 
 in confining the use of alcohol within proper and 
 legitimate limits. 
 
 Impartiality in investigation, caution in drawing con- 
 clusions, moderation in stating them, and a certain breadth 
 in framing and applying i"egulations, will probably prove 
 th^ best aids to eifective and durable progress. 
 
 Decembc,-, igjy. D'ABERNON. 
 
CONTENTS. 
 
 CHAPTER. Page. 
 
 I. Introductory ... ... ... ... ... i 
 
 II. Alcohol as a iood ... ... . ... 17 
 
 III. Mental Effects of Alcohol ... ... ... 30 
 
 IV. Alcohol and the Performance of Muscular 
 
 Acts... ... ... ... ... ... 41 
 
 V. Action of Alcohol on the Digestion ... 56 
 
 VI. Action of Alcohol on the Respiration and 
 
 on the Circulation of the Blood ... ... 63 
 
 VII. Influence of Alcohol on the Body Tempera- 
 
 ture ... ... ... ... ... ... 78 
 
 VIII. Poison Action of Alcohol 85 
 
 IX. Alcohol and Longevity ... ... ... 114 
 
 X. Conclusions ... ... ... ... ... 125 
 
 APPENDICES. 
 
 1. Consumption of alcoholic beverages in the 
 
 United Kingdom from 1897 to 191 7 
 
 2. Annual Death Rates from Alcoholic Disease 
 
 in England and Wales from 1891 to 1916. 
 
Mortality from Alcoholism in Occupational 
 Groups ... 
 
 Alcoholic strengths of several sorts of alco- 
 holic beverages 
 
 Amount of absolute alcohol in usual retail 
 measures of the ordinary alcoholic bever- 
 ages 
 
 Index • ... 
 
Alcohol: its Action on the 
 Human Organism. 
 
 CHAPTER I. 
 
 Introductory. 
 
 The object before us is to answer the question, " What 
 is known concerning the action of alcohol on the human 
 body ? " An attempt is to be made to review and appraise 
 all the evidence which is available concerning the action 
 of alcohol, regarded simply as a subject of phj'siological 
 and pathological investigation. It will appear that certain 
 facts concerning this action can be accepted as estab- 
 lished ; that there are many others which, though less 
 rigidly demonstrated, are supported by such evidence 
 that they may be accepted as a basis of practical opinion ; 
 and that there are numerous directions in which infor- 
 mation concerning the action of alcohol is still so vague 
 and unsatisfactory, that no conclusion is legitimate, 
 until further experiments have been made or more 
 numerous and accurate data collected. 
 
 Definition of certain terms. 
 
 One of the first necessities of scientific discussion is to 
 define, as precisely as possible, the meaning which is to 
 be attached to any words, concerning the significance of 
 which there can be any doubt or possibility of mis- 
 understanding. An endeavour will be made to define 
 and explain, as they occur, the principal scientific terms 
 which it may be necessary to employ in this book. The 
 need for accurate definition is especially felt, however, 
 in the case of familiar words, which are in frequent and 
 
every day use. The meaning which popular usage attaches 
 to such words is sometimes vague and illogical ; it fails to 
 cover the whole of what the word means when used in a 
 precise and scientific sense, and at the same time it 
 suggests ideas which the word does not properly imph'. 
 
 For example, a great deal of controversy has been 
 devoted to the question whether alcohol is or is 
 not a "food," and much of it has undoubtedly 
 been due to the fact that the disputants were using 
 the word " food " in different senses. In popular dis- 
 cussion the claim that alcohol is a "food" is frequentl)' 
 opposed by the production of evidence that it is a 
 " poison," the two statements being regarded as mutuallj' 
 exclusive. When we come to enquire what precise 
 meaning- can be attached to each of these words, it will 
 be clear that there is no reason why the properties 
 indicated by both should not be present in the same 
 substance ; so that the statements, that " alcohol is a 
 food," and that "alcohol is a poison," are not in- 
 consistent, and may both be true. 
 
 We shall find, in fact, that both are true, if the words 
 are used with the meanings which will here be defined. 
 There is, further, an important part of the effects of 
 alcohol, in many waj's the most important, in producing 
 which it cannot properly be said to act either as a food or 
 a poison. We shall speak of these effects as the "drug 
 action of alcohol. We have, therefore, to consider three 
 classes of effects produced by alcohol on the human body, 
 three aspects of its action, which we call the action of 
 alcohol "as a food," " as a drug," and "as a poison." 
 Our first duty is to define as exactly as possible what 
 is m.eant here by "alcohol," "food," "drug," and 
 "poison." 
 
 What is meant by " Alcohol." 
 
 The chemist recognises a very large oumber of 
 substances as "alcohols," applying the term to any 
 
substance haviiig a certain type of chemical constitution. 
 Glycerin, for example, is an " alcohol " in this sense, as 
 are many other substances to which the name would 
 never be applied in ordinary usage. When the word 
 alcohol is used by itself, without qualification, the sub- 
 stance referred to is what the chemist would call " ethylic 
 alcohol." This is the ingredient of the various beverages 
 known as " alcoholic drinks " or " alcoholic liquors " to 
 which their inebriating properties are almost entirely due. 
 The alcohol in these liquors is in all cases produced by 
 the fermenting action of yeast upon sugar; The sugar 
 may be that which naturally occurs in the juices of fruits, 
 as when wines are obtained by the fermentation of the 
 juice of grapes, or cider from that of apples. When 
 barley is malted, a ferment (diastase) is produced, which 
 in the process of brewing, converts the starch of the grain 
 into malt-sugar, and from this the alcohol of beer is 
 produced by fermentation with yeast. 
 
 Constituents of fermented liquors. 
 By the fermentation of these natural sugary solutions 
 liquors are obtained which contain only a relatively low 
 percentage of alcohol. The fermentation, moreover, pro- 
 duces many other substances besides ethylic alcohol, 
 though in much smaller proportions. Some of these are 
 other alcohols ; one in particular, called amylic alcohol by 
 the chemists, is the principal constituent of the product 
 known as "fusel oil." Others are members of other 
 chemical series, such as "aldehydes" and "ethers." 
 vSome of these are present in the fresh fermented liquor, 
 whilst others are formed during the process of maturation. 
 When a wine is matured in wood, some of the constituents 
 present in the raw new wine are slowly abstracted. 
 
 Distillation: substances fotmd in distilled spirit. 
 Ethylic alcohol and the majority of these other sub- 
 stances boil at a lower temperature than water and are said 
 
 16066 ^ 
 
to be more "volatile." When, therefore, a fermented liquor 
 is boiled down, the ethylic alcohol and other volatile 
 substances evaporate more readily than the water ; and 
 when the vapour produced during the earlier part of the 
 evaporation is condensed in a still, a fluid is obtained 
 containing a much higher proportion of ethylic alcohol 
 than the original liquor, with different but always verj' 
 small proportions of the other volatile constituents. This 
 was the old-fashioned method of obtaining the different 
 "distilled spirits," which resembled one another in 
 containing a high proportion of ethylic alcohol, and 
 diflfered from one another in the nature and proportion 
 of the other volatile constituents present, in addition to 
 water. Thus, true brandy owes its characteristic flavour 
 to traces of certain volatile constituents of wine ; true 
 whisky, prepared by the old-fashioned "pot-still," to those 
 formed in the fermentation of malted grain ; rum to 
 those formed in the fermentation of molasses. 
 
 It will be seen, therefore, that wines, beers, and dis- 
 tilled spirits prepared as above described, all contain 
 traces of other active substances besides alcohol. Some 
 of them, such as the mixture of less volatile alcohols 
 known as "fusel oil" (chiefly amylic alcohol), are 
 much more poisonous than ethylic alcohol if given in 
 equal doses. It has been thought that they may play 
 a part in producing the bad effects, which follow 
 habitual excess in the use of alcoholic liquors. The 
 suggestion is one which must be considered, but there is 
 very little evidence to support it. The other volatile 
 substances are present in such small traces that thej^ 
 cannot have much effect on any property of the spirit 
 except its flavour. Some of them appear to be abstracted 
 slowly when the spirit is " matured " in casks ; the spirit 
 acquires a more delicate flavour, and is less "fiery" to 
 the taste. Tradition regards spirits so treated as more 
 wholesome than the crude new product, and very 
 
probably they are so. At the same time we must not 
 lose sight of the fact that tradition and connoisseurship, 
 in this as in other matters, are bound up with a good 
 deal of convention and superstition. The modern 
 scientific apparatus known as the " patent still " makes 
 possible a much cleaner separation of the products of 
 distillation. By its use a practically pure ethylic alcohol 
 can be obtained, whatever thenature of the fermented liquor 
 treated. Many of the cheaper brands of the different 
 spirits consist of ethylic alcohol so obtained, diluted with 
 water and appropriately flavoured to represent whisky, 
 gin or rum, as the case may be. There is no reason to 
 suppose that such preparations are weaker in inebriating 
 action, or less permanently harmful if taken in habitual 
 excess than the products of the old-fashioned still. 
 They would probably be condemned by the educated 
 palate of the connoisseur. Nevertheless, there can be no 
 doubt that they present ethylic alcohol in a state of 
 purity, which no amount of maturing and blending 
 of " pot-still " whisky could achieve. 
 
 Ethylic alcohol the important constituent of the 
 alcoholic liquors. 
 
 Without denying the possibilit}" of a minor influence 
 to other constituents, we can quite safely assume 
 that ethylic alcohol is by far the most important 
 constituent of alcoholic liquors, from the point of view of 
 the actions which are here to be studied. This is the 
 substance which is responsible for practicably the whole 
 of that action of alcohol on the body, which distinguishes 
 these drinks from those called non-alcoholic, and which 
 is the main reason for their use. 
 
 We may, therefore, without an}- serious inaccuracy use 
 the simple word " alcohol " ^hen we are speaking of the 
 action of ethylic alcohol, whether it is taken as the 
 chemically pure Substance diluted with water, as in many 
 
of the experiments which we shall have to describe, or 
 ill the more complex fluids, such as beer, wine or brandy, 
 in which it is used in every-day life. This is the sense in 
 which the word " alcohol " will be used throughout this 
 book. 
 
 Definition of " Food." 
 
 Ill defining the meaning of the word "food," it 
 will be useless to try to frame a definition which shall 
 include everything which everybody admits to be a food, 
 and exclude everything which is not so recognised by all. 
 For there are some who maintain that alcohol is not a 
 food, and if we frame our definition so as to exclude it, 
 we decide in advance the question we have to discuss ; it 
 becomes a mere matter of words and definitions and has 
 no real meaning. If the question, whether alcohol is a 
 food, is to have anj' real significance, we must ask 
 ourselves, what are the properties implied when the 
 word " food " is used in its ordinary sense ? We must 
 define those properties in a precise and scientific manner. 
 The question can then be answered by a consideration of 
 the scientific evidence, as to whether alcohol has or has 
 not the properties so defined. 
 
 A food, in the first place, is something which we eat or drink, 
 ivlilch is useful for the normal life of the body and of its 
 constituent parts. But such a definition would include 
 substances like water and various salts, which are in- 
 dispensable constituents of the body, but are not usually 
 regarded as foods. If the " man in the street " is asked 
 why he does not regard water and salts as foods, he will 
 probably reply that they do not appease his hunger. 
 
 If this reply is put to the physiologist, he will agree, 
 and will proceed to explain why. He will explain 
 that water and salts are not used or altered by the 
 body. The body is constantly losing water by evapora- 
 tion from the lungs and the skin, and both water and 
 salts in the urine and the sweat. To replace these, and 
 
preserve the normal amount of water and salts in the 
 body, we need frequent fresh supplies ; but they pass 
 through the body without change. 
 
 Consider now the case of a substance such as sugar, 
 which everybody recognises as a food. If sugar be 
 eaten in any ordinary quantity it disappears completely 
 as sugar, and no more of it can be recovered than 
 if it is thrown into the fire and burned. And, indeed, 
 the changes undergone by sugar when it disappears 
 in the body are, in the end results, identical with those 
 which occur when it is burned in the fire. In both 
 cases it combines with the oxygen of the air, with 
 evolution of heat, and the substances resulting are 
 carbonic acid gas and water. The body gets rid of 
 these in the breath and the urine. 
 
 O.rvgen and oxidation : carbonic acid. 
 
 Oxygen is a gas which forms about one-fifth of the 
 air. When a substance burns in air it enters into 
 combination with the oxygen. Oxygen is likewise the 
 constituent of the air, which, when breathed, supports 
 life ; life is, indeed, essentially a slow combustion. 
 Sugar contains the elements carbon, hydrogen and 
 oxygen. When additional oxygen is supplied, and 
 the temperature is raised sufficiently high, combustion 
 takes place, the carbon of the sugar combining with 
 •oxygen to form carbon dioxide, and the hydrogen with 
 oxygen to form water. Carbon dioxide is the gas often 
 called carbonic acid, which causes the effervescence 
 of beer, &c., and " aerated waters " are artificially 
 impregnated with it. The process of combining with 
 oxygen is often spoken of as " oxidation." 
 
 How the body obtains energy from food. 
 
 There is another analogy between the burning of a 
 combustible substance, such as sugar, in air, and the 
 
oxidation or combustion which it undergoes in the body. 
 All are familiar with the fact that the heat which is 
 generated by burning such a substance can be made to 
 do work, b>- the use of an appropriate engine ; in the 
 language of Mechanics, part of the " energy," which is 
 liberated when a substance is burned, can be obtained in 
 the form of mechanical work, though with even the 
 most perfect engine a large part is dissipated in the 
 form of heat. The body, just as truly as a steam- 
 engine, obtains the energ>- for carrying out the work 
 performed by its different organs by the combustion or 
 oxidation of different materials ; like the engine, too, the 
 bodj^ obtains the liberated energj- parth- in the form of 
 mechanical work — the work performed by the muscles in 
 moving the body or lifting weights, and by the heart in 
 driving the blood in circulation — but parth- as heat, 
 which maintains the normal warmth of the body. Now 
 all the substances which we recognise as foods can thus 
 undergo combustion in the body, and supply the heat 
 and the power of doing work which distinguish the 
 living from the dead body. Water and salts on the 
 other hand, while essential to life, only supply the 
 conditions necessary for the use of other substances by 
 the body ; but they are not themselves consumed in 
 the process, cannot themselves furnish the energy 
 which the body requires, and therein differ from the 
 foods. 
 
 Accessory substances. 
 
 The same ma}' be said of the so-called " acce.ssoiy 
 substances," the importsfnce of which has been made 
 clear during recent 3ears. These are substances of 
 which the nature is still obscure, which must be present 
 in minute quantities in the diet if normal growth and the 
 health>- life of the body are to be maintained, but are not 
 themselves a source of the energy which the bod>' needs. 
 
Food as fuel : the several classes of foods. 
 
 We have advanced a step further, therefore, in our 
 definition of a food. A food is not merely soinethifig which 
 is useful for the normal life of the body ; it is a fuel which the 
 body can use as a source of energy. 
 
 Leaving the case of alcohol out of account for the 
 present, we find that all the important constituents of 
 our diet, which are capable of acting thus as true foods 
 or fuels to the body, fall into three classes : — 
 
 1. The carbohydrates, including starches, gums and 
 sugars. 
 
 2. The fats. 
 
 3. The proteins, or albuminous substances. 
 
 If we .make a chemical examination of the body, we find 
 that it contains substances belonging to all these three 
 classes, though not necessarily in any case the same 
 individual substances as the food contains. By the 
 processes which we call "digestion" the body breaks 
 down all the food-materials, when necessary, into simpler, 
 soluble substances. These are readily absorbed, and 
 from them the body builds up again its own carbohydrates, 
 fats and proteins. 
 
 Special position of the proteins. 
 
 The proteins are in a special position. They form an 
 essential constituent of every part of the body which is 
 living. The element nitrogen enters into their compo- 
 sition, but not into that of fats or carbohydrates. The 
 body, therefore, cannot form protein from fats or 
 carbohydrates ; to repair the waste of its tissues it must 
 have protein in the food. So that a certain quantity of 
 protein is, in a peculiar sense, an indispensable 
 constituent of a diet. 
 
 Carbohydrates and fats are not indispensable in the 
 same sense. If the food contains more protein than is 
 required for the repair of tissue, the body can form 
 
carbohydrate or fat from the remainder. But when 
 carbohydrates and fats are given as well, as in an ordinary 
 diet, the body requires very much less protein than if it 
 had to be maintained on protein alone. Excess of carbo- 
 hydrate can be stored in the body as a special carbohydrate 
 called " glycogen," a sort of animal starch ; or it can be 
 converted into fat and stored in that form. Excess of 
 fat in the diet can similarly be stored as body-fat. The 
 well-nourished body, therefore, always contains a good 
 reserve of these food-substances or fuels. If no food is 
 taken for a prolonged period, but only water, the body 
 draws on its own reserves of fuel to maintain the supply 
 of energy. It uses first the fat and carbohydrate, which 
 are stored for this purpose, and when these are exhausted 
 consumes the proteins of the less important tissues, such 
 as the muscles of the limbs and trunk, to maintain the 
 supply of energy for those which are more essential for 
 the continuance of life. 
 
 Ordinary food-stuffs used for tissue repair^ or can be 
 stored in the body. 
 
 We have, then, another property of all these three 
 classes of food-substances. They can not only serve as 
 fuel for the body's immediate requirements of energy, but 
 can furnish material for the repair of the natural waste 
 •jf the living tissues, or for replenishment of the fuel- 
 reserve which the body normally maintains. The body 
 not only can use them, but can store them for future 
 need. 
 
 Are we to regard this also as an essential character 
 of a "food," and refuse to apply that term to substances 
 which can be used as immediate fuel, but cannot be 
 changed by the body into glycogen or fat for storage ? 
 The question is a very important one for our present 
 purpose, because on the answer to it depends our con- 
 clusion as to whether alcohol is a " food " or not. On 
 
II 
 
 the whole it has appeared to us more logical to admit 
 that such immediate fuel-substances are " foods " also ; 
 for although they cannot themselves be stored, or changed 
 into something which can, by meeting the immediate 
 demand of the bodj' for fuel, they prevent the deple- 
 tion of the reserve. Their addition to a diet will, in 
 the same way, allow the body to use for replenishment of 
 its fuel-reserve carbohydrates and fats which it would 
 otherwise have to use immediately. So that such sub- 
 stances have, in fact, the same effect in a diet as an 
 additional supply of carbohydrates and fats ; they have, 
 to a limited extent, the same effect as substances which 
 are undoubtedly foods, though they do not produce it in 
 exactly the same way. 
 
 Physiological classification of food-substances] 
 
 We shall, therefore, adhere to our simple definition, that 
 a food is a fuel ivhich the body can use as a source of energy. 
 But we must further recognise that the question is not 
 a simple one : that there are degrees in the scale of 
 importance applicable to food substances, of which we 
 can distinguish three. 
 
 Class I. Substances which can serve as fuel, to supply 
 the energy required for the life of the body, and which 
 can also supply the material required for the repair of the 
 living structure. Theoretically the body could supply all 
 its needs from such substances, together with water, 
 salts, and the requisite traces of the " accessory sub- 
 stances" mentioned above (p. 8). 
 
 To this first class belong the proteins alone. 
 
 Class 2. Substances which can serve as fuel directly, 
 and can also be used to replenish the fuel-reserve of the 
 body. 
 
 To this class belong the carbohydrates and fats. 
 
 Class 3. Substances which can serve as fuel, but are 
 only available for immediate use. They cannot be used 
 to form new materials for the body's fuel-reserve ; but 
 
12 
 
 they can help to maintain that reserve bj- reducing the 
 need for drafts upon it, and by allowing substances of 
 Class 2 to be used for its replenishment. 
 
 Instead of asking the bare question, " Is alcohol a 
 food " ? we shall obtain information of much greater 
 importance and interest by asking, " Does alcohol belong 
 to any of the above classes of food-stuflfs, and if so, to 
 which " ? 
 
 Alcohol a fuel food which is only available for 
 immediate use. 
 
 We shall find that the evidence leads to the conclusion 
 that alcohol is a food of Class 3 ; indeed, it is the only 
 important constituent of an ordinary dietary belonging to 
 that class. We must make the position quite clear. If any- 
 one chooses to maintain that the word " food " should be 
 restricted to substances included above in Classes i and 2, 
 he is perfectly entitled to do so. He would then be 
 justified in stating that alcohol is not a food, provided 
 that he made perfectly clear the limited sense in which 
 he was using the word. We have chosen, for reasons 
 stated, to allow the word a more extended application. 
 We shall review the evidence which shows that alcohol 
 is a food in this wider sense, and indicates the 
 class of food-stufFs to which it belongs, and the limits 
 imposed on its value as a food by its other properties. 
 No one has the right to quote us as making the state- 
 ment that alcohol is a food, unless he defines, as we 
 do, the exact sense in which the word is used, and the 
 limits within which the statement is true. 
 
 Definition of metabolism. 
 
 In discussing the food-value of alcohol we shall 
 frequently have occasion to use the term " Meta- 
 bolism," and it will be convenient to define its meaning 
 now. The word metabolism is used by the physio- 
 logist to denote the sum-total of the chemical changes 
 
that take place in the bodJ^ The engineer who 
 wishes- to measure the efficiencj' of his engine, keeps 
 careful record of the fuel consumed, the mechanical 
 work done, and the amount of energy lost as heat. 
 Similarly the physiologist conducts on the living man or 
 animal what is called a " metabolism experiment," though 
 the measurements and analyses required are far more 
 numerous and elaborate than those which are needed for 
 the relatively simple mechanism of the steam-engine or 
 the petrol-motor. A man, or some other animal, is placed 
 in an observation chamber. Everything that he eats or 
 drinks, and the air that he breathes are measured and 
 analysed. All the products of metabolism, coming out 
 in the breath, through the kidneys or by the bowels, are 
 measured and analysed with the same care. The amount 
 of work performed and of heat lost are recorded, as well 
 as the weight of the subject at the beginning and end of 
 the observation. From all these elaborate data informa- 
 tion is obtained as to the mode of working of the body, 
 regarded as a machine, and a study can be made of the 
 effect of adding a particular substance, such as alcohol, 
 to the food. We shall see that by such means evidence 
 has been obtained which enables us to reply to the above 
 questions whether alcohol is a food, and to which 
 class of food-substances it belongs. 
 
 Definition of drug action. 
 
 Apart from serving as food-materials, in the manner 
 already indicated, substances can influence metabolism 
 in other ways. There are substances which, when 
 they are taken into the body, can accelerate, retard, 
 or otherwise modify the delicate action of various parts 
 of its mechanism, independently of any contribtition to 
 the supply of energy. Such action we propose in this 
 statement to term "drug-action," and to refer to such 
 substances as " drugs." 
 
14 
 
 IV/mt is meant bv the term ^^ drug.'' 
 The word "drug" is used in different senses by different 
 classes of people. In popular phraseology it often means 
 a substance of a deleterious nature. As we use it here, 
 it should not be taken to imply a necessarily harmful 
 action ; we use it simply to mean a substance which tem- 
 porarily modifies the activity of the bodily organs, includ- 
 ing, of course, the brain and nervous system, otherwise 
 than by increasing the supply of available energy. 
 As an example of a pure drug-action, in this sense, 
 we may take that of nitrous oxide — the anaesthetic gas 
 used by dentists. When this gas is breathed the 
 patient rapidly loses consciousness, the rate of his 
 breathing and of his heart-beat, the activitj^ of his 
 muscles, are all conspicuously modified. When admin- 
 istration of the gas is stopped, he rapidly rids himself 
 through his breath of all the nitrous oxide which he 
 had absorbed, and his brain and organs return to their 
 normal state of activity. The nitrous oxide has pro- 
 foundly modified the bodily functions without being 
 used up or in any way entering into the chemical 
 changes which we call metabolism. The effect of 
 another familiar anaesthetic, ether, differs from this, 
 not only in the fact that it is more prolonged, but 
 because a small proportion of the ether taken into the 
 body is burned ; so that ether to a very small extent 
 enters into metabolism, and to that extent its action 
 is that of a. food, in the sense mentioned above. Nobody 
 would think of describing ether as a food, or of 
 suggesting it as a constituent of a diet ; its food- 
 value is trivial, and its drug-action predominant. When 
 we come to consider alcohol, the case is different ; 
 but the difference is only one of degree. Alcohol is a 
 common article of diet, and its food-value has been the 
 subject of much controversy. But quite apart from any 
 conclusion we reach on that point, as the result of our 
 
examination of the evidence, we have to consider its 
 drug-action. We shall give reason for deeming this the 
 most important of the actions of alcohol, as taken by 
 the majority of those who use it. 
 
 Importance of drug action of alcohol. 
 For, though alcohol does, in the sense already indicated, 
 act as a food, it is seldom taken primarily for that reason. 
 It is to its drug properties and to the agreeable taste of 
 the fermented liquors that we must look for the origin 
 of the habit of using the drinks containing alcohol and of 
 their position in popular esteem. A large section Of our 
 statement will be concerned, therefore, with the details 
 of the action of alcohol as a drug. We shall discuss to 
 what extent this action is useful to the healthy and to 
 the sick, and to what extent it is harmful. It will be 
 clear also that a final estimate of the value of alcohol as 
 a food must involve consideration of the extent to which 
 its use is limited by the fact of its drug-action. 
 
 Definition of poison action. 
 
 Practicalli' every drug when used in excessive quan- 
 tities, or under exceptional conditions, becomes a 
 poison ; that is to say, it so greatly interferes with 
 the normal working of the bodily functions that it en- 
 dangers life. When life is endangered or terminated 
 bj' a single large dose of a drug, we speak of the effect 
 as " acute poisoning," and we shall have to discuss the 
 phenomena of acute poisoning which a single large dose 
 of alcohol will produce. On the other hand there are 
 many drugs which, when taken habitually for long periods, 
 produce structural and other changes of important 
 organs, which ultimately lead to permanent ill-health, 
 and may be the cause of death. We call such a condition 
 " chronic poisoning." It should be noted that the 
 chronic effects may have no relation whatever to the 
 symptoms of what we have called the " drug-action," or 
 
i6 
 
 of acute poisoning by the same substances. Each in- 
 dividual dose, from the succession of which the chronic 
 poisoning results, may be so small as to produce but 
 slight symptoms of drug-action, and those of an agreeable 
 and apparently favourable nature. 
 
 Short of dangerous illness or death, there are minor 
 defects and infirmities, affecting perhaps only some organ 
 or system which is not essential to the life of the 
 individual, which may result from chronic poisoning. 
 The body may, through the prolonged action of a 
 poison, acquire a weakness, a lessened resistance to 
 disease or injury, which is imperceptible in health, and 
 only becomes manifest when the subject is exposed to 
 infection or violence. We shall have to discuss the 
 possibility of the body being affected in any of these ways 
 by the habitual use of alcohol. 
 
17 
 
 CHAPTER II. 
 Alcohoi, as a Food. 
 
 Absorption of alcohol. 
 
 In considering the value of any substance as a food, it 
 is necessary to know in the first place, to what extent, 
 and with what rapidity it is absorbed from the stomach 
 and intestine ; for it is not until the substance has 
 passed into the blood, by the circulation of which it is 
 distributed to the tissues which can make use of it, 
 that the true action as a food begins. 
 
 However easily combustible a substance may be out- 
 side the body, unless it is soluble in the blood, or can 
 •be changed by digestion into something which is solu- 
 able, it cannot act as a food. A substance like paraffin, 
 for example, although it burns readily in air, is 
 completely insoluble in the fluids of the body, and when 
 it is taken into the stornach, it passes unchanged through 
 the intestine and does not act as a food at all. Alcohol, 
 on the other hand, is completely soluble in water, with 
 which it mixes perfectly in all proportions, so that it 
 does not need to be rendered soluble by digestion. 
 We should expect it, therefore, to be absorbed quickly 
 and completely ; experiment has shewn that this is the 
 case. 
 
 Analyses of the contents of the stomach and intestines, 
 made at different intervals after a dose of alcohol has been 
 swallowed, sl^ew that about one-fifth of it is absorbed 
 from the stomach. In the uppermost section of the 
 small intestine one tenth is absorbed, but the main 
 absorption, accounting for one half of the quantity 
 taken, occurs in the middle part of the small intes- 
 tine, the remaining one-fifth being absorbed in the third 
 and last section. By the time the alimentary contents 
 
i8 
 
 reach the large intestine, all the alcohol has been taken 
 up from them into the blood. 
 
 The absorption of alcohol is, therefore, complete, and, 
 in comparison with that of food-stuffs needing pre- 
 liminary digestion, such as meat, it is conspicuously 
 rapid. The actual speed of absorption seems to vary 
 with a number of conditions, such as the form in which 
 the alcohol is taken, the extent to which it is diluted, and 
 the time in relation to meals ; but the interaction of the 
 different factors is evidently very complicated, and there 
 is no evidence so clear as to warrant a definite statement 
 concerning the effect of an}- of these factors. 
 
 Excretion. 
 
 The second point on which information is required, in 
 estimating the food-value of a substance, is the extent 
 to which the body can use it after it has passed into the 
 circulation. We can obtain an indication of this by 
 determining to what extent it leaves the body again un- 
 changed. The processes by which the body discharges 
 materials which it does not use further are collectively 
 termed " excretion " by physiologists. 
 
 Mention has been made of the case of sugar, an}' 
 ordinary quantit}' of which is burned completelj' in the 
 body, so that, except in some diseased conditions such as 
 diabetes, no sugar can be found amongst the waste 
 materials in the uriue. Sugar, therefore, is used by the 
 body to its full value. We may contrast with this the 
 case of saccharin, a complex coal-tar derivative, which is 
 sometimes used in place of sugar, on account of its 
 intensely sweet taste. Saccharin, in ordinary quantities, 
 is absorbed completely from the stomach and bowel, but 
 the whole amount taken can be recovered unchanged in 
 the urine ; so that saccharin is not a food at all, and its 
 whole value is in its sweetness. 
 
 Alcohol, being a substance which readily evaporates. 
 
19 
 
 can leave the bod\- to some extent in the breath,^ as well 
 as in the urine, and both must be analysed in order to 
 determine the proportion of a dose of alcohol which is 
 excreted.^ 
 
 In all the experiments of this kind which have been 
 made this proportion has been found to be a small one, 
 though it is not constant. It is increased by anj^ 
 influence which quickens the absorption of alcohol from 
 the stomach and intestine, or the formation of urine by 
 the kidneys, or which augments the vigour of the 
 respiration. But under the conditions most favourable to 
 this loss of unchanged alcohol in the breath and urine, 
 it never amounts to more than one-tenth of the quantity 
 swallowed. Usually much less is lost in this manner — on 
 an average about one-fiftieth ; and in people who, be- 
 taking alcohol habitually, have acquired the power of 
 using it up more rapidly than those unaccustomed to it, 
 as little as one-hundredth part of a moderate dose of 
 alcohol may escape in the breath and the urine. 
 
 The quantit}' of alcohol excreted as such by the body 
 is always small, therefore, and may be trivial. What 
 
 ' It should be noted tljat the odour of the breath, associated 
 with the taking of alcoholic liquors, is mostly due to other 
 substances than alcohol, which has but a faint odour. 
 
 ^ There is no evidence that alcohol is ever eliminated in appre- 
 ciable amount in the sweat. Traces of the drug have been found 
 in the milk, in experiments in which large doses of alcohol were 
 given to cows and goats ; and some observers have also detected 
 its presence in the milk of women of alcoholic habits. It is 
 probable, however, that this occurs only when large quantities of 
 alcohol are taken, and that even then, the amount excreted is too 
 small to have any influence on the health of the infant. In this 
 connection it may further be mentioned that the available evidence 
 gives no support to the popular belief that alcoholic beverages, 
 and particularly malted liquors, promote the production of milk, 
 and are therefore to be recommended to nursing mothers. 
 Whether in the form of spirits or of beer, alcohol does not seem 
 to have any effect whatever on either the quantity or the quality 
 of this secretion. (R. Rosemann, in Pfliiger's Archiv, Vol. 78, 
 18S9). 
 
 16066 c 
 
20 
 
 "becomes of the remainder ? This question must be 
 answered before any conclusion can be drawn as to the 
 food-value of alcohol. 
 
 How the body uses alcohol. 
 
 Though little of the alcohol escapes as such in the urine 
 and breath, the residue does not remain long in the body. In 
 from fifteen to twenty-four hours after a dose of alcohol has 
 been taken, the whole of it has disappeared completely. 
 The destruction of the alcohol, indeed, begins as soon as it 
 reaches the blood. Samples of blood can be taken from a 
 man or other animal at intervals after a dose has been 
 swallowed, and the proportion of alcohol in each sample can 
 be determined by analysis. In this way it has been found 
 that for the first few hours the alcohol is passing into the 
 blood more rapidly than it is destroyed, so that the 
 concentration in successive samples rises. After an 
 interval, varying with the dose among other conditions, 
 the concentration reaches a maximum, and usually 
 remains at about that level for some time. This 
 maintenance of a level concentration does not mean that 
 the absorption has been completed, but that it has been 
 ■overtaken by the destruction, and that, for the time being, 
 the two processes practically balance one another. Then 
 the rate at which alcohol disappears becomes greater 
 than that at which it is entering the circulation, so that 
 the concentration in the blood declines, until after about 
 24 hours no more alcohol can be discovered anywhere in 
 the body. 
 
 The maximum concentration which alcohol reaches 
 in the blood bears a regular relation to the original 
 dose : thus, it was shewn by Grehant' that when an 
 animal had taken a dose of alcohol equivalent to 
 one - thousandth of its body weight {i.e. a dose of 
 I cubic centimetre per kilogram), the highest pro- 
 
 ' Gr^hant. — Comptes rendus de la Soci^td de Biologic, 1881, 
 .1896, and 1899. 
 
21 
 
 portion subsequentlj- found in the blood was about 
 I per thotisand ; with a dose of 2 cc. per kilogram 
 the blood contained about 2 per thousand, and so on. 
 This would, at first sight, appear to mean an equal dis- 
 tribution of the alcohol throughout the body. It does 
 not mean this, however ; for when the maximum concen- 
 tration is attained in the blood, some part of the dose has 
 already been destroyed, while some of it is still unabsorbed. 1 
 It so happens that the balance of absorption over destruc- 
 tion brings the maximum concentration in the blood to 
 the value which would be obtained by an immediate dis- 
 tribution of the whole dose through the whole of the 
 tissues of the body; but the correspondence is accidental. 
 
 Products of combustion of alcohol. 
 
 What has become of the alcohol ? Only a little of it can 
 be found passing out of the body ; and yet, after 24 hours 
 none can be found in the body. There being no evidence 
 of its change into some other substance which the body 
 can retain, the supposition is natural that it is completely 
 " oxidised " or burnt, producing, as when burnt in air, 
 carbon dioxide and water, which pass out in the breath 
 and urine. The method by which this supposition can 
 be put to the test of direct experiment, must now be 
 described. 
 
 All food- substances contain carbon and hydrogen, and 
 therefore yield carbon dioxide and water when they are 
 oxidised in the body. The carbon dioxide leaves the 
 body very quickh' in the breath, the rate and depth of 
 breathing being normally so adjusted as to keep the 
 amount of it in. the blood nearly constant (see p. 68). 
 
 The quantity of carbon dioxide and water formed, 
 and, therefore, the amount of carbon dioxide passing out 
 in the breath, varies from minute to minute, with changes 
 in the activity of the muscles and other organs. A mere 
 measurement of the rate at which carbon dioxide is 
 turned out in the breath, after alcohol has been taken. 
 
will not give much information as to the extent to which 
 alcohol is oxidised. For, even if variations due to the 
 activity of the muscles or other organs were excluded, 
 an increase in the production of carbon dioxide, following 
 a dose of alcohol, would not necessarily mean that the 
 alcohol was being burnt. It might mean merely that the 
 taking of alcohol caused the body to burn more fat, 
 carbohydrate or protein. Another measurement is needed 
 as well, namel>', the rate at which oxygen is used up in 
 the air which is breathed. 
 
 The Respiratory Quotient. 
 
 When a carbohydrate, such as sugar, is burnt in the air, 
 the volume of oxygen which disappears from the air is 
 exactlj' the same as the volume of carbon dioxide which 
 is formed. This is not true of any other food-substances ; 
 when fats or proteins are burnt, the volume of oxygen 
 used is always larger than that of the carbon dioxide 
 which is produced. And there is a difference of the 
 same kind, but greater, when alcohol is burnt. 
 
 Readers with a slight knowledge of chemistry will 
 readily understand the reason of this difference. Carbo- 
 hydrates, fats and alcohol are all composed of carbon, 
 hydrogen and oxygen. The amount of oxj^gen present 
 in a carbohydrate is just sufficient to combine with all 
 the hydrogen to form water, so that when a carbohydrate 
 is burnt onl\- sufficient extra oxygen is required to com- 
 bine with the carbon ; and when oxygen combines with 
 carbon, the \olume of carbon dioxide formed is equal to 
 that of the oxygen used. Substances like fat contain a 
 smaller proportion, of oxygen, insufficient to combine 
 with all their hydrogen, so that, when they are burnt, 
 they use up a volume of oxygen which is larger than 
 that of the carbon dioxide which is formed. The differ- 
 ence is still larger in the case of alcohol, which contains 
 a smaller proportion of oxygen than the fats. 
 
23 
 
 The same difference between carbohydrates aud other 
 food-substances appears when they are used in the body. 
 By analysing the air which is breathed in and that 
 which is breathed out by a man, or other animal, over a 
 long period, the amount of oxygen used and the amount 
 of carbon dioxide formed in the body are determined. 
 These are compared by making a fraction : — 
 Volume of carbon dioxide formed 
 
 Volume of oxygen used, 
 and this is called the " respiratory quotient." When the 
 two volumes are nearly equal, so that the value of the 
 fraction approaches unity, we know that the body is 
 using chiefly carbohydrates. When the volume of the 
 oxygen used is greater in proportion, so that the respira- 
 tory quotient becomes smaller, we know that some food- 
 substance other than carbohydrate is being burnt. The 
 respiratory quotient resulting from the oxidation of 
 alcohol would be lower than that corresponding to any 
 of the ordinary food-stuffs ; so that, if alcohol is oxidised 
 in the body, the addition of alcohol to the diet should be 
 followed by a fall of the respiratory quotient. 
 
 Degree to which alcohol is oxidised in body. 
 A series of elaborate and careful experiments of this 
 kind was carried out by Atwater and Benedict^ in America, 
 and their observations have been confirmed by other 
 workers. The results give definite proof that alcohol is 
 oxidised in the body as completely as the carbohydrates, 
 and rather more completely than the fats and proteins; 
 
 Alcohol a fuel food. 
 
 It has been suggested that the energy liberated by this 
 oxidation of alcohol cannot be used by the body, but is 
 lost in the form of superfluous heat. This possibility has 
 been examined and disproved. Atwater and Benedict 
 
 Physiological Aspects of the Liquor Problem, New York, 1903. 
 
24 
 
 were able to shew that the bodj' can derive up to oue- 
 fifth of the total energy it requires from the metabolism 
 of alcohol. There can be no doubt, therefore, that alcohol 
 is a " food," in the sense of a fuel that the body can use. 
 
 We have seen that alcohol is not stored b}- the body. 
 There remains to be considered the extent to which it 
 can replace each of the ordinary food-stuffs. 
 
 Hmv far alcohol can replace otdinary food-sUiffs : 
 (i) Carbohydrates. 
 
 Experiments of the kind described above have shewn 
 that, up to a certain point, carbohydrate can be replaced 
 by alcohol. A man was kept on a standard measured diet, 
 rich in carbohj'drates, and his respiratory quotient was 
 carefully determined. A ration of alcohol was then 
 added to the diet. The respiratory quotient fell promptly, 
 and to such an extent as to shew that, while the alcohol 
 was being oxidised, carbohydrate was being saved from 
 oxidation and added to the fuel reserve of the man's body. 
 (2) Fats. 
 
 All those who have made experiments on the point, agree 
 in finding that alcohol can take the place of part of the 
 fats in a diet. If a fixed diet, sufficient for maintenance, 
 is given, the addition of alcohol to it protects some fat 
 from oxidation, and allows more fat to be added to the 
 body's reserve supply. 
 
 (3) Proteins. 
 The case of the proteins is peculiar. They contain 
 nitrogen, and a small proportion of sulphur, in addition 
 to carbon, hydrogen, and oxygen, and, as stated above, the 
 animal bod)- can obtain the materials for repairing the 
 wear and tear of its proteins, only from proteins in 
 the food. Neither carbohydrates, nor fats, nor alcohol can 
 replace in the food the protein needed for this purpose. 
 But an ordinary diet contains protein much in excess of 
 this minimum needed for repair, and this excess is oxidised 
 
to furnish energj-. The amount of protein which is thus- 
 being burnt can be estimated by determining the sub- 
 stances containing nitrogen which leave the body in the 
 urine. 
 
 When protein alone is given as a food, the body destroys 
 such a large proportion of it, that a large amount 
 of it must be given ; otherwise, the body loses more 
 nitrogen in the urine than it receives in the food — an 
 indication that the natural wastage of the body's own 
 protein is not being made good. But if fat or carbo- 
 hydrate is given in addition, the proportion of the food 
 protein which is thus burnt is much reduced, so that a 
 larger proportion is available for repairing the waste of 
 the tissues, and a smaller ration of protein suffices. 
 
 The question which we have now to consider is whether 
 alcohol can also act in this way. And it will be clear 
 that we are not discussing whether alcohol can take 
 the place of protein, for nothing can trulj' do so ; the 
 question is whether alcohol can act like carboh5'drates 
 and fats in economising protein, by reducing to a 
 minimum the amount which the body requires. The 
 general result of experiments made to determine this- 
 point, shews that it can. 
 
 The method of experiment is to put the subject on a 
 mixed ration, containing known amounts of protein,, 
 carbohydrate and fat. A daily determination is made of 
 the nitrogen lost in the urine on this standard diet. The 
 diet is so adjusted to the needs of the subject that a 
 reduction of the carbohydrate or fat will lead to the 
 burning of more protein, which will be indicated by the 
 loss of more nitrogen in the urine. But instead of merely 
 reducing carbohydrate, the effect can be tried of sub- 
 stituting for it a chemically equivalent amount of alcohol. 
 For example, the original diet may contain a high pro- 
 portion of sugar; a large part of this can be dropped,, 
 and a corresponding ration of whisky given instead. If 
 
26 
 
 this change does not cause the appearance of more 
 nitrogen in the urine, we have evidence that the alcohol 
 is acting like the sugar as an economiser of protein. 
 
 Most observers who have used this method are agreed 
 that alcohol can act like a carbohydrate in this 
 respect also, the amount of protein burnt in the body 
 remaining just the same after the change from carbo- 
 hydrate to alcohol. Others have found evidence of an 
 increased destruction of protein when the change is made, 
 and have, therefore, maintained that alcohol has not the 
 same power as the carbohydrates have of saving protein. 
 There is good reason to believe, however, that this result 
 was due to the fact that the subjects of these experiments 
 were not accustomed to taking alcohol, and it seems to 
 be clearly established that, in those who are used to it, 
 alcohol in moderate quantity is as efficient as carbo- 
 hydrates or fats in reducing the amount of protein 
 required by the body to maintain itself, by saving the 
 proteins from being used merely as a source of energy. 
 
 Has alcohol a special action on nutntion ? 
 
 Reference has already been made to the presence in an 
 efficient diet of traces of so-called "accessory substances," 
 which are not themselves foods, but have a profound 
 influence on the power of the body to nourish itself on 
 the true food-stuffs. It is necessary to discuss whether 
 alcohol has, apart from its food-value in the sense 
 already defined, any such specific stimulant action on 
 nutrition. Medical opinion formerly attributed to alcohol 
 an effect of this kind ; certain wines and beers especially 
 were credited with special value in the " building up of 
 the constitution," and were widely prescribed in cases of 
 malnutrition, such as that due to tubercular infection. 
 This view is no longer widely held by medical men, but 
 appears still to be current as an article of popular belief. 
 
27 
 
 There are probably many who regard abstinence from 
 ■alcohol as incompatible with the development and pre- 
 ■servation of a robust and vigorous bodily habit. Accurate 
 •observations lend no support to such a belief. The food- 
 value of alcohol, within limits, is no less than that of a 
 ■corresponding quantity of sugar or lard ; but, on the 
 ■other hand, there is no evidence for its ever being 
 ■greater. If sufficient food is being taken in other forms, 
 the addition of alcohol to the diet may lead to the 
 accumulation of fat, but it will not improve the nutrition. 
 When wine or beer aids recovery after a wasting 
 disease, it does so because the food taken in ordinary 
 forms is not adequate. In such circumstances, the 
 alcohol is of some use in increasing the food-value of 
 the diet ; but its main effect is probably in making 
 the patient more comfortable and contented, and thereby 
 improving his appetite for ordinary foods. This is not a 
 •special action on nutrition, but a drug action, which will 
 be considered in a subsequent chapter. 
 
 Summary. 
 It will be useful now to summarise the conclusions 
 which seem to be justified by the evidence discussed in 
 this chapter, and to consider their practical bearings. 
 
 1. Alcohol is completely and rapidly absorbed from the 
 •stomach and intestine, and distributed by the circulating 
 blood to the different organs of the body. The rate of its 
 absorption is modified by conditions which still need 
 further investigation. 
 
 2. A variable but always small proportion of alcohol 
 escapes unchanged in the breath and urine. The rest 
 •disappears completely in about 24 hours after it has been 
 ■swallowed. 
 
 3. The concentration of alcohol in the blood rises for 
 a few hours after it has been swallowed, remains nearly 
 .constant for a few hours longer, and then steadily 
 
28 
 
 declines. The duration of these phases is modified by 
 conditions affecting either the rate of absorption or the 
 rate of disappearance ; but the evidence as to the nature 
 of these conditions is still very imperfect. There is, how- 
 ever, good evidence of an increased rate of disappearance 
 in subjects who have become habituated to taking alcohol 
 {vide chapter on " Poison Action," p. 85). 
 
 4. The disappearance of alcohol from the bod}', apart 
 from the small proportion escaping unchanged, is due to- 
 its being oxidised ( burnt). None of the alcohol is known 
 to be converted into any substance which the body can 
 retain. 
 
 5. The energy liberated by the combustion of a mode- 
 rate amount of alcohol can be used by the body to its full 
 value. 
 
 6. Alcohol can, within limits, replace an equivalent 
 amount of carbohydrate or fat in a diet, and has a similar 
 effect in economising proteins. 
 
 7. The whole food-value of alcohol is due to its use by 
 the body as a fuel. 
 
 Food-value of alcohol qualified by its drug action. 
 
 The conclusions thus summarised are concerned with 
 the purely scientific question, whether alcohol acts as 
 a food in the sense here defined. The question whether- 
 a substance is a desirable constituent of a diet, whether 
 its use is advisable, is a much wider one than this, 
 and involves many considerations other than that of the 
 body's ability to use it as a fuel. There are other 
 substances which the body oxidises as completely as it 
 does alcohol, such as citric or acetic acid (the acids- 
 contained in lemon juice and ^•inegar respectively). 
 Nobody would suggest that either of these substances 
 could be taken in such quantities as to make a material 
 contribution to the fuel required by the body. In 
 practice they are not so taken, being used only in small 
 
29 
 
 quantities, for their acid taste, and not for their food- 
 value. Their other properties make it impossible to- 
 take them in large quantities. Theoretically they are 
 foods ; practicall)" their use as such is negligible. 
 
 Similarly, in discussing the evidence for the action of 
 alcohol as a food, it has repeatedly been necessary to use 
 qualifying expressions such as ''within limits," "in mode- 
 rate quantities," etc. These limits are, of course, imposed, 
 by the other effects of alcohol, which will form the subject 
 of the ensuing, chapters. The question, as to how far 
 the theoretical value of alcohol as a food is in practice 
 restricted and counterbalanced by these other properties, 
 must be left till they have been considered. It is- 
 desirable here, however, to emphasise the fact that, for' 
 the normal man, alcohol has no advantage over an 
 ordinary food-substance like sugar, from the point of 
 view of its food-value alone. The question of its food- 
 value cannot, therefore, be allowed much weight in the 
 practical decision of the individual as to whether he 
 should or should not take alcohol. This question must 
 be decided rather by a balancing of the advantageous 
 features of what is here termed its "drug-action" against 
 those which are undesirable, and against the risk of the 
 wholly bad effects included under its action as a "poison." 
 
30 
 
 CHAPTER III. 
 
 Mentai, Effects of Alcohoi,. 
 
 Effect of environment on symptoms of drunkenness. 
 
 The aspect of drunkenness which has most impressed, 
 the popular mind is that of boisterous, disordeted 
 and even violent activity of mind and body which 
 not infrequently appears as one phase of the process, 
 of intoxication. But this phase commonh- appears 
 under social conditions which stimulate the emotions ; 
 alcohol undoubtedly diminishes the control of the 
 intellect and the will over the emotions, and it appears 
 not improbable that this passing phase of excitement 
 may be sufficiently accounted for by exciting influences 
 of the environment, the jovial company, the bright lights, 
 the unrestrained talk and song; the general sense of 
 festivity, which are the common setting of the feast. 
 The conclusion indicated by laboratory tests of mental 
 and bodily capacity is borne out by simple observation 
 of one's self or of other subjects, if one takes successive 
 doses of alcohol in the absence of all such exciting 
 influences. The first effect generally noticed is a slight 
 giddiness or " light-headedness ; " this is followed by an 
 increasing heaviness and disinclination for all effort, 
 soon passing into sleepiness; and this in turn, if not 
 counteracted by any excitement coming from within or 
 without, gives place to a heavy sleep which continues for 
 many hours. 
 
 Reeling of xvetl-bcing induced by alcohol. 
 
 We may notice at once that even under these condi- 
 tions alcohol produces to some degree that efi"ect which, 
 perhaps more than any other, is the secret of its 
 «harm, its well-nigh universal attraction for the human 
 
31 
 
 race, namely, a sense of careless well-being or bodily 
 and mental comfort. In so far as this sense of well- 
 being is of bodily origin, it is no doubt largely due to a 
 flushing of the skin with blood that abolishes all sense 
 of chill ; but it is due also in part to a blunting of the 
 sensibilitj' to the small aches and pains and a thousand 
 hardly distinguishable sense-impressions which, except 
 in those in perfect health, contribute to tip the balance 
 of bodily feeling-tone to the negative or unpleasant side. 
 In so far as this effect is primarily mental, it results 
 from the blunting of those higher mental faculties which 
 lead us to " look before and after and pine for what is 
 not " and harass us with care for the future and a too 
 sensitive self-consciousness for the present. 
 
 Appearance of excitement not due to any stimnlant action of 
 
 alcohol. 
 
 If on the other hand the drinker is subjected to the 
 stimulation that comes from social intercourse he usually 
 passes through a phase which may be justly called one 
 of excitement, the degree of excitement depending upon 
 the temperament of the drinker and the nature and 
 degree of the external stimuli. But careful observa- 
 tion of and reflexion upon the phenomena of this stage 
 shew clearly that they do not require for their explana- 
 tion the assumption that alcohol stimulates the nervous 
 system, whether directly or through the medium of other 
 bodily organs. 
 
 The drinker's conversation and actions become less 
 restrained ; all his emotional responses are freer and 
 fuller than in his normal state. He laughs and smiles 
 more readily, he grows more easily angry or tender, 
 elated or depressed, scornful or compassionate, according 
 to the appeal of the moment. Perhaps the various 
 emotional states into which fear enters as an element, 
 and which we denote by such names as anxiety, worry. 
 
-care, despondency, are exceptions to this rule. This 
 ■group of exceptions is readily explicable on the prin- 
 •ciple that we apply, namely, that alcohol successively 
 weakens and suspends the hierarchy of functions of 
 the brain, and therefore of the mind, in the order from 
 above downwards ; that is to say in the inverse order 
 of their development in the individual and in the race. 
 For the emotional dispositions or capacities are a very 
 ancient racial endowment and have their physiological 
 seats in the basal ganglia, the lowest levels of the great 
 brain, the part which alone is represented in the brains 
 of the lower vertebrates. The higher intellectual faculties 
 on the other hand are the latest acquired and are 
 connected with the anatomically highest and last 
 developed parts of the brain. Intermediate between 
 these come, in the order of development, the sensory 
 and skilled motor functions (and their nerve centres). 
 
 / Blunting of self-criticism by alcohol. 
 
 Now, of all the intellectual functions, that of self- 
 criticism is the highest and latest developed, for in it are 
 combined the functions of critical judgment and of self- 
 consciousness, that self-knowledge which is essential to 
 the supreme activity we call volition or the deliberative 
 will. It is the blunting of this critical side of self- 
 awareness by alcohol, and the consequent setting free of 
 the emotions and their instinctive impulses from its 
 habitual control, that give to the convivial drinker the 
 aspect and the reality of a general excitement. 
 
 In the mature well-developed mind, this interplay 
 of thought and emotion goes on under the checking 
 and moderating influence of self-criticism ; in social 
 intercourse especially, it is constantly checked by the 
 thought of the figure one cuts in the eyes of one's fellow 
 men. In proportion, then, as alcohol hampers this 
 mechanism of self-control, the liberation of intellectual 
 
33 
 
 -or emotional effects goes ou at a higher rate. Normally 
 the emotional states of anxiety, care and despondency 
 are maintained by self-consciousness, by the repeated 
 turning of the stream of thought to the self, its 
 difficulties, its embarrassments, the snares and dangers 
 that beset its course on every hand, and are far more 
 frequently imagined and foreseen than actually en- 
 countered. Hence, when imaginative .self - conscious- 
 ness is dimmed, the emotions of this class are pro- 
 portionately less liable to be touched to life, and in the 
 -absence of their restraining influence, the other emotions 
 run riot the more gaily. 
 
 Weakening of self-control evident in every stage of diunken- 
 ness ; most prominent feature of initial stage. 
 
 Both introspectively and objectively this lack of self- 
 control is clearly discernible in every stage of alcoholic 
 intoxication. It is' commonly counteracted in part by 
 the subject who becomes aware of it by means of a 
 deliberately increased effort of self-control: but, as the 
 influence of the alcohol increases, this effort ceases to be 
 continuously effective, and the drinker surprises the 
 observer (whether himself or another) by smiling or 
 laughing aloud at some very small joke, or by remarks 
 or other actions which betray the suspension of his 
 habitual self-control. And the weakening of his critical 
 self-awareness is especially revealed by the fact chat such 
 jovial remarks as he now utters seem to him to shine 
 with a lustre hardly perceptible to the normal mind ; 
 hence the tendency, perhaps the most characteristic and 
 constant feature of the first stage of drunkenness, to 
 flippant whimsical utterances, which, like the rest of the 
 subject's behaviour, betray the blunting of his critical 
 self-consciousness and of his sense of personal responsi- 
 bility. 
 
 The successive stages or phases of intoxication cannot 
 
34 
 
 be sharpl}' distinguished, and every case presents its 
 peculiar combination and succession of features, varying 
 with the temperament and disposition and character of 
 the individual and his circumstances of the moment. 
 But three main stages may be broadly distinguished 
 corresponding to the invasion by the narcotic of the three 
 principal levels of cerebral function mentioned above. 
 The first stage, that in which the highest or intellectual 
 brain level is alone distinctly affected, has been described 
 above. 
 
 Nei'votis functions involved in second stage of drimkenness. 
 
 The second stage is that in which the functions of the 
 intermediate level, sense - perception and skilled move- 
 ment, are invaded and disturbed. The drinker begins to 
 shew a certain clumsiness of behaviour. If he is self- 
 observant, he notices that he is liable to make ill-adjusted 
 movements ; on setting down his glass it makes a more 
 violent contact with the table than he had intended ; on 
 rising, he maj- stumble against a chair, perhaps upsetting 
 it ; on lighting a cigarette he may break the match which 
 he essays to strike ; in speaking he may slur a word or 
 drop an h. Each such little mishap will at first be 
 quickly rectified, for ^ap{,.^22^ i^^y evoke the power, 
 possessed in some degree by all and to a wonderful 
 degree by many men, of temporarily correcting by an 
 effort of concentration or self-control the paralysing 
 effects of the drug. 
 
 Emotional instability in second stage of drnnkenness. 
 
 At this stage also his perceptions are impaired. His 
 field of sense-observation is narrowed ; the several senses 
 work in relative isolation from one another ; the fineness 
 of his ear, of his taste, his touch, his vision is blunted ; 
 he may momentarily see objects doubled, and becomes 
 relatively indifferent to heat and cold, to the flavour of 
 
.15 
 
 his food and the aroma of his wine, to the glare of the 
 lights, the strains of the music, and the stridency of his 
 own or his neighbour's voice. The impairment of 
 his intellectual functions being further advanced than 
 in the first stage, and the functions of th^ third or 
 lowest cerebral level, that of the emotions and instinctive 
 impulses, being still relatively intact, h'e is apt to give way 
 to clumsy but violent displays of emotion characterised 
 by the exclusive dominance of each primary emotion in 
 turn ; and he passes quickly from anger to affection, 
 from boisterous merriment to tears, from elated boasting 
 to despondency, each unrestrained and unmodified by 
 that blending of other emotions which expresses the 
 reaction of the intellectual faculties upon them. 
 
 At this stage the drinker is apt to feel that his bodilyi 
 movements occur without his initiation or intention — 
 they escape from him rather than proceed from his will 
 — and, in so far as he remains self-conscious, he leads a 
 double life; his inner self, aTTietached observer with 
 folded hands, watches his bodily actions, not seldom 
 with surprise, consternation or amusement ; he may, e.g: 
 become aware of wearing facial expressions, of making 
 gestures, or of uttering remarks, which he did not intend 
 and cannot wholly repress, but which seem to him to be 
 executed by his members of their own initiative. 
 
 At this' stage the paralysis of the drinker's higher 
 mental functions reveals itself clearly also in the 
 increasing dependence of all mental and bodily activity 
 upon external stimulation ; he lives in and for the 
 present moment only, and, if he is deprived of the 
 stimulus of social intercourse, he quickly lapses into 
 dreamy somnolence or actual sleep. 
 
 Third stage nj drunkenness. 
 In the third stage, the intellectual processes of judgment 
 and self-criticism and control are virtually suspended ; 
 
 16066 D 
 
36 
 
 the functions of sense-perception and skilled movement 
 are grossly impaired, and the emotional tendencies 
 themselves are invaded and weakened, so that only 
 strong appeals to them suffice to evoke any response and, 
 in their absence, the drinker sinks inert and nerveless 
 into a hea\'y sleep, which lasts until the alcohol absorbed 
 by the nervous system has been oxidised or carried 
 away in the blood and consumed by other tissues. 
 
 Hypothesis that alcohol acts primarily on nerve-cell junc- 
 tions^ or synapses. 
 
 This succession of events constituting the normal 
 course of alcoholic intoxication as it appears to 
 common observation, can be explained in general 
 terms by an hypothesis as to the direct action of 
 alcohol on the nervous tissue, which is suggested and 
 supported by many physiological facts and analogies ; 
 the hypothesis, namely that alcohol acts primarily and 
 most powerfully not upon the nerve cells or fibres, but 
 upon the junctions between nerve-cells, technically 
 known as synapses. It is now pretty well established 
 that we may properly regard the nervous system as 
 consisting of a vast number of vital units, the nerve- 
 cells, each consisting of a central body and one or 
 more slender threads or fibres ; each cell having no 
 anatomical but only a functional continuity with others. 
 Their relations to one another may be likened to those 
 of a crowd of people, in which each person maintains 
 relations with his fellows and communicates with them 
 only by the touch of hands and feet. There is much 
 evidence to shew that these points of contact are the 
 weak points of the nervous pathways ; the points that 
 give way most readily under strain or shock and under 
 the influence of fatigue and of various paralysing 
 drugs. 
 
37 
 
 Why effects of alcohol are first shewn on higher functions. 
 
 Further, there is good reason to believe that in the 
 pathways of the lower levels of the brain, those which 
 subserve the functions first developed in the race and 
 in the individual, the points of junction are relatively 
 firm and open to the passage of the nervous current; 
 while those of higher and later developed levels are less 
 solidly organised, and that they therefore offer more 
 resistance to the passage of the nervous current, in 
 proportion as they stand high in the scale of function 
 and late in the order of development. If we accept 
 this view, and if we make the further simple assump- 
 tion that alcohol acts equally upon all such junctions 
 of nerve-cells (or synapses), we have the explanation 
 of the phenomena of drunkenness. For, by the terms of 
 the hypothesis, the alcohol, acting equally upon all cell- 
 junctions in the nervous system to increase their 
 resistance to the passage of the nervous current, will 
 first raise this resistance to the point of impermeability 
 in those junctions in which it is normally highest, 
 that is, in the latest developed paths of highest func- 
 tion ; and it will progressively effect a similar paralysis 
 of other nerve-paths in the descending order of 
 functional dignity and complexity. 
 
 Action of alcohol purely narcotic. 
 
 It may be added that a review of the many laborious 
 attempts made in recent years to determine by the 
 methods of the laboratory the effects of alcohol on the 
 mind and nervous system, shews that such observations 
 harmonise well with these general conclusions ; for, 
 although some of the earlier workers on these lines 
 belie;ved they had found evidence of an initial stimulating 
 effect of alcohol, this appeared in all cases to be of but 
 small extent and duration ; and later work throws doubt 
 upon the validity of this interpretation of the evidence 
 
38 
 
 and supports the conclusion that the direct effect of 
 alcohol upon the nervous system is, in all stages and upon 
 all parts of the system,' to depress or suspend its func- 
 tions, that it is, in short,^froni first to last a narcotic 
 drug. 
 
 Varieties of mental symptoms in dninkenness. 
 
 If we have truly stated the principle according to which 
 alcohol attacks the functions of the brain and of the 
 nervous system generally, it will be seen that mental 
 changes are naturally among the first of all the symptoms 
 of derangement to appear. With small doses of alcohol, 
 they may be the only symptoms which are noticeable ; 
 with larger, they are the earliest of the whole sympto- 
 matic train of changes. It is obvious that though 
 traceable by psychological analysis to one single source, 
 namely the blunting of that intellectual self-criticism 
 and control which the mind normally exerts, the detailed 
 forms which they assume will, under the manifold 
 ■\'arieties of individual circumstance and character, appear 
 disordered items of behaviour . almost Protean in 
 shape and kind. Yet of these, various as they are, 
 certain sub-types appear with such frequency, and have 
 been so accreditably documented in carefully conducted 
 test experiments,^ as to be worth .specific mention here, 
 since they can be regarded as established marks sympto- 
 matic of alcoholic effect. In this respect they ha^e 
 therefore some practical importance. They may be sub- 
 sumed briefly thus : (i) Uncritical self-satisfaction of 
 the subject with his own performances, (2) disregard 
 
 ' For a possible exception to this statement, in the case of the 
 nerve centres of respiration, see pp. 69-70. 
 
 ' Kraepelin. Dber die Beeinflussung einfacher psychischer 
 Vorgange dnrch einige Arzneimittel. Jena, . 1893. Rivers. 
 Influence of Alcohol and other Drugs on Fatigue. Ivondon, 
 1907. Partridge. Studies in the Psychology of Intemperance. 
 New York, 1912. 
 
39 
 
 of occurrences and conditions iiormall)- evoking caution 
 of act and word, (3) trespass of rules and conventions 
 previously respected, (4) impaired appreciation of the 
 passage of time, (5). loquacity and (6) an argumentative 
 frame of mind. 
 
 Early appearance of purely mental effects of alcoliol. 
 
 These changes of mentality actually observed in labora- 
 tory experiments directed toward' study of alcoholic 
 effect, are largely confirmed by general experience. As 
 laboratory experiments shew, they may occur when the 
 dose and degree of action of the alcohol are quite in- 
 sufficient to cripple manifestly and openly the power to 
 perform routine technical operations, such as adding 
 figures or typewriting by a person accustomed to perform 
 them. To attempt to specify the lower limit of dose 
 required to produce these symptoms is probably of little 
 value. Not only is there varying susceptibility to alcohol 
 from person to person, and not only does, in one and the 
 same person, the susceptibility differ according to circum- 
 stances, digestive and other, under the same dose, but 
 intellectual self-criticism and control are strong in one 
 person, weak in another, and, in the same person, while 
 strong in respect of certain kinds of acts, may be weak 
 in respect of certain others. With large doses these 
 slighter mental effects are part of the train of symptoms 
 passed through as profouhder degrees of intoxication are 
 approached. 
 
 Disturbance of higher mental functions in conditions falling 
 short of drunkenness. 
 But a point of greater practical importance is that, 
 without signs of intoxication in the full ordinary or in 
 the legal sense of the term, the bearing and individual 
 attitude of mind suffer temporary change as an effect of 
 the drug; and those in contact with the person so 
 affected have for the time being to deal with an altered 
 
40 
 
 individual, whose mind lacks temporarily- its normal 
 factor of judgment and conspicuous elements of its self- 
 control. 
 
 There is hardl}' any need to emphasise here the' obvious 
 fact that the directions which these alterations tend to 
 take commonly, even as instanced merely by the few sub- 
 types of deviation of judgment and behaviour just men- 
 tioned, are likely to be fraught with serious consequences 
 for the due discharge of responsibilities in all walks of 
 practical life. Accuracy, avoidance of accidents, tactful 
 handling of colleagues and subordinates, observance of 
 discipline, punctuality, reticence in matters of confidence, 
 are all obviously jeopardised; and an additional source of 
 friction is brought to complicate the relations between 
 the employer and the employed. 
 
41 
 
 CHAPTER I^^ 
 
 al,cohol and the performance of 
 Muscular Acts. 
 
 Complexity of muscular acts. 
 
 The effect produced by alcohol on the performance of 
 muscular work is not so readily determinable as might at 
 first sight appear. The performance of a muscular act 
 even of a simple kind involves a number of processes. 
 The actual contraction of the muscle is only the final step 
 in a series of events. The action of the muscle has 
 invariablj' to be called forth by recurrent nervous action, 
 and this nervous action includes, even in the simplest 
 voluntary act, a linked series of processes with which 
 many parts of the nervous system are concerned. 
 
 Influence of alcohol on their performance due to action on 
 nervous system, and not on muscles. 
 
 The muscle being the final executant of the act, a point 
 desirable of elucidation is how far the administration of 
 alcohol influences directly the functioning of the muscles 
 themselves. The muscles differ sufficiently from the 
 organs of the nervous system to make it probable that 
 the influence of alcohol on the two will not be the same, 
 at least not of the same magnitude. 
 
 The influence of alcohol upon muscles separated from 
 the nervous system has been examined, and it has 
 been found that when administered to them through 
 the blood in doses up to the equivalent of about 70 cubic 
 centimetres in man or nearly 5 oz. of whisky at proof 
 strength,^ alcohol produces no obvious effect upon the 
 contractile power or other functional properties of muscle. 
 
 'V. Furth and C. Schwarz, Pfliiger's Archiv, f. d. ges. Physio, 
 logie, Vol. 129, p. 525. 1909. 
 
42 
 
 We may infer then that any influence which alcohol, in 
 such doses as are met with in ordinary human consumption 
 of it, exerts upon the performance of muscular acts, must 
 be referred to its effects upon the nerve centres concerned 
 with activating the muscle. 
 
 Reflex acts and volitional acts. 
 
 In regard to the nervous processes which find their 
 expression in muscular acts, they are divisible into two 
 main kinds. Those of one kind are termed volitional, 
 because produced at the behest of the will ; of the other, 
 involuntary, because independent of the will. The 
 former, even at their simplest, are complex. The latter, 
 often spoken of as " reflexes," are less so. These latter 
 are for this reason more completely understood and 
 analysed ; the nervous events involved in them are 
 sufficiently known to serve as standards by -vvhich the 
 efiect of alcohol upon certain fundamental processes of 
 nervous activity can be gauged. The relative simplicity 
 of the reflexes has made it possible for medical study 
 to ascertain with exactitude what parts and elements 
 of the nervous system are required for their perfor- 
 mance and to judge from them whether those parts 
 are working well or ill. Changes in them give fairly 
 precise information as to the seat and manner of 
 any improvement or impairment they may shew. They 
 are of importance further since it is by means of the 
 nervous centres which the reflex acts use that volitional 
 nervous acts, initiated in the higher nervous centres, 
 exercise their effect upon their executant muscles. 
 Skilled movements of hand and arm, executed under 
 the mandate of the will, demand for their performance 
 the employing by the brain of those same lower centres 
 which the reflexes of the limb employ and test. The 
 brain centres bring the muscles into action through the 
 lower reflex centres. 
 
43 
 
 If for some part of the body, say leg or eye, these 
 latter are deranged, it is not to be expected that the 
 skilled execution, by that part, of acts under the behest 
 of the will can continue to be perfect or normal. 
 
 Inftuencc of alcohol on simple reflex adion. 
 (i) The knee jerk. 
 
 A simple reflex act, much used by the physician for 
 testing the healthy working condition of the spinal cord, is 
 the knee-jerk. A light tap is dealt to the front of the knee 
 just below the knee cap, on the tendon of the muscle that 
 straightens the knee. The tap is delivered at a time when 
 the limb is at rest, for instance when the knee is passively 
 resting crossed upon the other knee. This light blow 
 stretches slightly and briefly the muscle, and this slight 
 stretch excites nerve-fibres which pass from the muscle to 
 the nerve-centres in the spinal cord, and so excites these 
 centres. The centres in their turn excite the muscle by 
 means of the motor nerve passing from them to it. This 
 causes the jerk-like movement of the knee. This reaction 
 tests therefore, (/) the nerves passing from the muscle to 
 the spinal centres and from the latter to the muscle 
 (//) the spinal centres themselves ; and (/») the muscle. 
 It gives reliable indications not only of the healthy or 
 disordered condition of these parts but in several respects 
 also of the condition of the brain itself as influencing 
 that of the spinal cord. The indications it yields are the 
 more valuable because it is a reflex which lies beyond 
 the voluntary control of the person examined. It cannot 
 be quickened or slowed, increased or diminished at wil 
 by the person experimented on. 
 
 Elxperiment shews that a dose of 30 cubic centimetres 
 of alcohol, equivalent to a little over 2 oz. of whisky at 
 proof, or to about i^ pint of beer of average strength 
 {i.e., containing 4 per cent, of absolute alcohol), 
 administered an hour to an hour and a half earlier, 
 lessens the speed and amplitude of the movement of the 
 
44 
 
 knee-jerk in healthy persons. As an average obtained 
 from observations on six men, this dose of alcohol 
 reduced the speed of commencement of the responsive 
 movement bj' 9'6 per cent, and diminished the extent of 
 the movement by 48'9 per cent.^ A larger dose, 45 cubic 
 centimetres of alcohol, in the same persons impaired the 
 reaction speed and amplitude still more. 
 
 {it) The " eye-closing reflex." 
 
 Another reflex, somewhat less simple, is the "eye- 
 closing reflex." The movement is an involuntary blink 
 which occurs when some local danger imperils the eye, as 
 when grit enters it or a blow threatens it. It commonly 
 occurs also when some startling shock is received by 
 the body, or when a loud sudden unexpected noise is 
 heard. Although it is an involuntary act, repression 
 of it can by practice and training be acquired in regard 
 to circumstances which otherwise regularly evoke it. 
 Thus, as a response to a threatening by a blow or to a 
 sudden loud noise, those who are practised in boxing and 
 in the use of firearms learn to suppress it. 
 
 The effect of alcohol on this reflex has been examined^ 
 in the same six normal men whose knee-jerk was tested 
 as above. The dose of 30 cubic centimetres alcohol 
 retarded the reflex speed by 5'9 per cent., taking the 
 average from four of the men ; it decreased the eyelid 
 movement's extent by 107 per cent., taking the average 
 measure from five of the men. 45 cubic centimetres of 
 alcohol, equivalent to about 3 oz. of whisky at proof, or 
 to nearly 2 pints of beer, impaired the reflex still more. 
 In two of the men the smaller dose slightly increased the 
 reflex-speed, and in one of these two the larger dose also 
 increased it. The means used in these observations for 
 evoking the eye-blink reflex was the sudden production 
 
 ' Dodge & Benedict, Psychological Effects of Alcohol, Washington, 
 
 1915- 
 ' Dodge & Benedict, op. cit., 1915. 
 
45 
 
 of a loud urgent noise. Both of the men in whom the 
 dose of alcohol induced increase in the speed of the reflex 
 were found normally and apart from any dosage with 
 alcohol to exhibit unusually small blink-reflexes. The 
 observers concluded that the normal blink-reflex in these 
 two men was a partially restrained one, some degree of 
 inhibitory control over the reflex having been acquired 
 b^- them. One of them was practised in boxing and 
 one in revolver shooting. The observers concluded that 
 the quickening of the reflex produced in these two cases 
 by the alcohol was due to the alcohol weakening the 
 acquired inhibitory control. 
 
 Deprcssaul effect of alcohol on simple reflexes. 
 This dose of alcohol, therefore, depresses these simple 
 reflex reactions of the nervous system. Even in regard 
 to the somewhat greater frequency of the pulse-rate 
 which commonly follows the administration of a moderate 
 dose of alcohol, the cause seems to lie in a depressant 
 rather than a stimulant action of the drug. The accelera- 
 tion of pulse appears to be due to depression in degree of 
 the reflex cardio-inhibitory tone which normally restrains 
 the heart-beat.' The depression caused by the alcohol 
 in all these instances indicates a specific lowering of the 
 powers of the lower nervous centres, of a nature re- 
 sembling, though much less in intensity, that produced 
 by chloroform and drugs of that kind, tending towards 
 temporary paralysis. 
 Difficulty of analysing effect of alcohol on volitional acts. 
 Simple reflexes like the above form a suitable starting 
 point for inquiry into any influence which alcohol may 
 exert upon the nervous system in its performance of 
 muscular acts. But the step from such simple reflexes 
 to acts initiated and controlled by the will is a consider- 
 able one into a region of greater complexity. Besides the 
 
 ' Dodge & Benedict, op. cit., 1915. Vide also Chapter VI, p. 73. 
 
46 
 
 lower reflex centres through which the volitional processes 
 must ultimately play, the nerve-centres concerned in 
 calling forth and directing a muscular act at behest of the 
 will are many, some in the highest parts of the brain and 
 others in the lower, and some in the spinal cord itself. 
 It is impossible to track the influence of alcohol step by 
 step through such a maze. But it can be said with 
 certainty that the degree of action of the alcohol will not 
 appear equally in all the centres nor in all the phases of 
 their processes. The detailed nature of the normal inter- 
 action of the various centres, whence the willed muscular 
 act results, is far from being as yet sufficiently known to 
 justify here an attempt to analyse the influence of alcohol 
 in regard to the steps of the process taken piecemeal. 
 
 Effect of alcohol on efficiency of willed movements. 
 
 Experiments have however been made which, without 
 attempting to analyse the willed act, and accepting the 
 movement made as index of its success, indicate how its 
 efficiency changes with var5'ing conditions. Three main 
 directions in which the efficiency may varj' are (i) in 
 power, (2) in ability to withstand fatigue, and (3) in 
 nicety of adjustment for the object in view. The power 
 of a muscular act and its ability to withstand fatigue can 
 be examined by the ergograph. This instrument registers 
 the strength and extent of a particular willed movement 
 which can be easily repeated, the instrument continuing 
 its register throughout a series of repetitions of the act. 
 The movement arranged for is purposely kept a very 
 simple one, and therefore little scope is given in the 
 ergograph for examination of nicety of adjustment, or 
 other factors which constitute " skill." 
 
 Ergographic experiments on the effect of alcohol. 
 
 The influence of alcohol has been examined ergo- 
 graphically by many observers. Some of the observations 
 
47 
 
 appear, however, to be of small value for our purpose ; in 
 some the dose of alcohol is unstated ; in some the form of 
 ergograph was unsatisfactory ; in some too little heed 
 was paid to circumstances other than the giving of 
 alcohol likely to influence the muscular act under the 
 conditions of the experiment. The earlier obser- 
 vers, impressed with the simplicity of the actual 
 movement employed as an index, did not appre- 
 ciate fully the extent to which mental conditions 
 might affect it. Experience with ergographic records 
 has shewn that fleeting states of the mind, greater or 
 lesser concentration of attention, or greater or lessei" 
 interest in the repetition of the movement at one time 
 than at another, may influence quite distinctly a person's 
 performance of a movement even so simple as that chosen 
 for the ergograph. Mental "suggestion" has to be 
 excluded so far as possible i from disturbing the subject's 
 attitude toward the experiment, which should be a 
 neutral attitude. The mere knowing that he has or has 
 not received a dose of alcohol ma}- affect his performance 
 under the test and obscure or confuse any effect produced 
 by the alcohol itself. 
 
 The researches in which precautions have been taken 
 definitely to safeguard against these various sources of 
 error are still relatively few, and notable among them is 
 the investigation by Rivers. ^ Rivers found that single 
 doses of 5, of lo, and of 20 cubic centimetres of alcohol left 
 no indubitable trace upon the muscular act, as recorded 
 by the ergograph. His experiments were carried out upon 
 two persons. When the dose was increased to 40 cubic 
 centimetres, corresponding to over 2f oz. of whisky, or to 
 about 1 1 pint of beer, an effect was produced on one 
 of these. That person was habituallj- an abstainer from 
 alcohol. The effect produced on his ergograph record 
 
 Rivers. Influence of Alcohol and other Drugs on Fatigue. 
 London. 1907. 
 
4S 
 
 T.vas increase in the series of contractions performed, this 
 increase appearing about an hour and a half after the 
 administration of the dose. The increase was small. 
 •On the other person examined the dose of 40 cc. was 
 followed by slight decrease of the ergographic work, but 
 Rivers was not satisfied that in the case of this person 
 the dose produced any clearly indubitable effect. 
 
 The result stands in general conformity with results 
 obtained previously b}^ Oseretzkowsky and Kraepelin^ 
 who found no obvious evidence of an effect of alcohol 
 on the ergographic record after administration of a single 
 dose of 50 cubic centimetres {i.e., 3^ oz. of whisk>' or a 
 little over 2 pints of beer). 
 
 In the extensive series of ergographic experiments 
 by Hellsten^, the ergograph employed was of an 
 unusual type, the movement registered being executed 
 with both arms, and therefore not so limited and simple 
 as is generally preferred for ergographic examination. 
 Working with this type of ergograph, Hellsten tested the 
 influence of alcohol upon its records. The subject of 
 experiment was an athlete of 90 kilos (between 14 and 
 15 stone) weight. Single doses of 25 and of 50 cubic 
 centimetres of alcohol, given in appropriate dilution with 
 water 5-10 minutes before the ergographic record began, 
 produced no clear and unequivocal effect on the record. 
 When the dose was 80 cubic centimetres, corresponding 
 to between 5 and 6 ounces of whisky, or more than 
 3 pints of beer, there ensued, after a slight and brief- 
 lasting improvement in the record, a marked decrease in 
 the recorded muscular work. When this dose preceded 
 the test by half an hour, the decrease observed amounted 
 to 20 per cent, of the normal performance done without 
 
 ' Oseretzkowsky n. Kraepelin, in Psychologische Arbeiten, 
 Vol. 3, pt. 4, p. 587. 1901. 
 
 ' Hellsten. Skandinav. Archiv f. Physiologic. Vol. 16, p. 160. 
 1904. 
 
49 
 
 alcohol. The decrease was 17 per cent, when the dose 
 preceded the test by one hour, and was 1 1 per cent, when 
 it preceded the test by two hours. 
 
 Animal experiments to test effect of alcohol on work. 
 
 Comparable in some measure with the above experi- 
 ments are those carried out by Chauveau,i who examined 
 the influence of alcohol upon the output of work by a trained 
 dog turning a treadmill. The dog had a measured and 
 liberal daily ration of raw meat and cane-sugar. When qne- 
 third, namely 84 grammes, of the daily sugar ration was re- 
 placed by 50 cubic centimetres of alcohol the output fell by 
 about 22 per cent. Similar results were obtained whether 
 the alternation of the rations followed weekly or monthly. 
 The dog lost weight on the alcohol substitution ration and 
 maintained its weight on the ration without alcohol. 
 The actual weight of the dog is not stated, but the daily 
 amount of alcohol taken by it in the substituted ration 
 must have been equivalent to not less than 250 cubic 
 centimetres alcohol for a man, or not much short of a 
 pint of whisky. This animal is, however, less susceptible 
 to alcohol than is man! 
 
 Observations on effect of alcohol on efficiency in hill-climbing. 
 
 Comparable also to some extent with these observa- 
 tions on the dog are observations by Diirig^ upon man. 
 Diirig observed the effect of alcohol upon the muscular 
 exercise involved in walking to the top of a hill. The 
 ascent and the route taken and the time of day and other 
 conditions of the ascent were kept as far as practicable 
 the same for a number of successive repetitions, with the 
 exception that on some days 30 cubic centimetres alcohol 
 in 150 cubic centimetres of water, i.e., as much alcohol as 
 
 ' Chauveau Comptes rendus de I'Acad^mie des Sciences. Vol. 
 132, pp. 65 and no. 1901. 
 
 'Diirig. Pfiiiger's Archiv fiir die ges. Physiologic. Vol. 113, 
 p. 314. igo6. 
 
so 
 
 is contained in 2 oz. of whisky or ij pint of beer, was 
 taken in addition to the daily ration. This dose was taken 
 at breakfast just before starting. It was found that 
 although the walker, who was accustomed to moderate 
 use of alcohol, felt in himself no difference between his 
 condition on the alcohol and non-alcohol da}"s, the distance 
 and ascent per minute was on the alcohol da3's less bj' 
 12-14 per cent, than that on the non-alcohol daj's. This 
 was so, although the expenditure of energy by his body 
 was greater on the alcohol days than on the non-alcohol 
 days. Diirig inclined to attribute this deterioration in the 
 performance of the ascent to impairment of skill with 
 which movements are directed. He says that it was as if 
 the effect of pre-\-ious training in the act were teiiiporarily 
 lost. The experienced climber is reduced by the dose of 
 alcohol towards the level of a beginner at such work and 
 makes an unduly large number of badly directed or 
 ill-judged movements. In short, alcohol in a dose of 
 30 cc. tended to undo the effect of previous training. 
 The act here was of course much more complex and gave 
 much more scope for skill than the acts examined by the 
 ordinarj" ergograph. 
 
 Disiitrbin^ effect of alcohol on skilled- movements. 
 
 Rivers, in an appendix to the account of his ergographic 
 observations, notes that, although the ergographic records 
 shewed, even when the dose of alcohol was 40 cubic centi- 
 metres, slight evidence onlj^ of their being influenced by it, 
 there was from the experiments other evidence to the effect 
 that after that dose " the control of movement did not 
 appear to be so good," and that the execution of movements 
 tended to be slower than usual. His evidence for this is 
 as follows : — " In the normal condition," i.e. of the sub- 
 ject ejcperimented with, "the two minutes allowed him 
 betweeii successive ei'gograms for taking the customar}' 
 readings and for making necessai-y adjustments of the 
 
•ergograph were ample for his doing so ; but on the 
 40 cc. alcohol days the period of 2 minutes was hardly 
 long enough for him to do what was necessar\', although 
 the time it took him seemed to him no longer than usual. 
 This was so striking that the subject was at first inclined 
 to believe that his watch was in error, for it seemed to 
 him that he had been carrying out his usual task at 
 the normal speed." 
 
 "Several small accidents happened on days on which the 
 •dose of alcohol was 40 cc, and these were probabh' the 
 result of awkwai'dness in adjusting the apparatus. Some 
 of the intervals " (between the actual spells of exercise 
 at the ergograph) ''were occupied" (by the subject) "in 
 drawing lines for tabular purposes or in pasting 
 ergograms in a book, and these operations were found 
 afterwards to have been done roughh* or irregular!}- on 
 the 40 cc. alcohol days." 
 
 " Within half an hour of the taking of the 40 cc. alcohol 
 there came on," in this subject, " a subjective feeling of 
 lassitude and disinclination for activity either of body or 
 mind." " It was doubtful how far the state of lassitude 
 was preceded by one of exhilaration, but, if the latter 
 occurred, it was certainly of ver}^ brief duration." 
 " During the state of lassitude there was decided irrita- 
 bility ; and a fellow worker states that he was able to 
 recognise clearly the days on which the 40 cc. dose had 
 been taken by the general demeanour of the subject — 
 partly from his lassitude, partly from his very obvious 
 irritability." 
 
 Effect of alcohol on adjustment of eye- movements. 
 
 Rivers, therefore, although he found no clear evidence of 
 influence of alcohol upon the performance of the muscular 
 act examined by his ergograph until the single dose had 
 reached 40 cubic centimetres and sometimes not then, con- 
 cluded that that dose did in one of his two subjects impair 
 
 ]6o66 E 
 
the execution of some skilled niovenieiits incidental tO' 
 those experiments but not recorded b>- the ergograph. This- 
 stands in harmony with observations b\- Guilleryi on the 
 influence of alcohol on certain movements of the eyes. 
 
 (Guillery tested the ability of the eyes to follow clearly, an 
 object brought nearer and. nearer to the person observing 
 it, that is to keep both eyes focussed on it as it approached. 
 This requires a convergent movement of the eyeballs, the 
 convergence increasing in degree as the object is brought 
 closer. At a certain closeness further convergence be- 
 comes impossible and fixation is lost, the object no longer 
 appearing single. He found that the degree of conver- 
 gence possible for the person was not affected, either in 
 the direction of improvement or impairment, b)' a dose of 
 20 cubic centimetres alcohol, equivalent to nearly I5 oz. 
 of whisky, or to over f of a pint of beer, but that by a dose 
 of 40 cubic centimetres it was very distinctly impaired. The 
 impairment took the form of weakening and of slowing of 
 the movement. The impairment was first detectible about 
 20 minutes after the taking of the dose ; normal speed and 
 
 ' power were regained about 40 minutes later. With 60 cubic 
 centimetres alcohol the impairment was greater, came on 
 about 10-15 niinutes after the dose and lasted for an hour 
 and a half. The opposite movement of " divergence " was 
 impaired even more, and other eye movements similarly 
 examined were found also to be impaired. Guillery re- 
 marked that under no grade of dose of alcohol and at no 
 time under any dose were the eyeball movements found to 
 be strengthened or rendered quicker. 
 
 Similarly, Dodge and Benedict found that a dose of 
 45 cubic centimetres of alcohol measurably impaired the 
 -speedpf starting the movement of turning of theeyes toward 
 a fresh object : in short, the speed of directing the gaze. 
 The whole movement is one of considerable complexity 
 
 ' Guillery. Pfluger's .\rchiv fiir die ges. Pliysiologie. Vol. 79. 
 v.- 597' 1899- 
 
53 
 
 of nervous adjustment. The twelve muscles of the 
 eyeballs have all of them to act appropriately together, 
 that j^is to say, some have to be made to contract more 
 than they were contracting, others have to be relaxed, 
 from contraction, and these changes have to be made in 
 each muscle with harmonious rate and degree. To 
 CKecute the movement the nerve centres must not only 
 have perfect control of the necessary motor powers but 
 must be aware of the posture the eyeballs start from and 
 of the direction toward which they have to be moved. 
 These latter requisites demand the alertness of sensory 
 nerve-centres, information from which is a factor in the 
 guidance and alertness of the motor centres themselves. 
 
 The act is, of course, one of extremely frequent execu- 
 tion throughout the waking day, and from an early period 
 of infant life onward. It is indeed in many respects 
 a reflex act; and it is under many circumstances 
 impossible, and under still more very difficult, of 
 repression by the will ; it tends to occur " in spite of 
 ourselves." A form, however, in which we meet its use in 
 a highly practised technical act is that trained movement 
 learned in reading which enables the eyes to follow the 
 words across a page and then return correctly to the first 
 word in the line immediately below. Like all other acts 
 of the kind a slight delay attends its starting, a delay 
 which though it is not long is yet considerably longer 
 than the delay attending such simpler reflexes as the 
 knee-jerk. The influence of alcohol on this delay has 
 been tested and on the same persons as those forming 
 the subjects of the experiments on the simpler reflexes. 
 
 A' dose of 45 cubic centimetres alcohol was found an 
 hour and a half after it had been taken to increase the 
 delay (average of all six men) by 15 per cent. The 
 accuracy of the movement, that is, the degree of truth 
 with which the eyeballs when moved hit the required 
 direction, was not tested. 
 
54 
 Effect of alcohol on speed of to ami fro movement of linger. 
 
 The same observers designed an experiment testing the 
 performance of an act relatively simple in character yet 
 one which is not naturally regularly practised, namely a 
 rapid to and fro movement of a finger, the person being 
 told to move the finger thus as rapidly as possible. 
 The index of success taken was the speed with whjch 
 the movement could be alternated, the rate at which the 
 to and fro movements could be made to follow each other. 
 \Vhile requiring the action of relatively lower nervous 
 centres the exercise demands therefore in addition some 
 effort of the higher centres in controlling and urging the 
 former. It involves activity of the will and, though not 
 to a high degree, demands that kind of effort which is 
 necessary for acquiring facility in a novel manoeuvre 
 which habituation has not as yet made easy. It is there- 
 fore to this extent a test of skill, skill taking effect in 
 speed. It tests, though very simply, just that type of 
 nervous process which is involved in the first steps of 
 learning to use a new tool or attaining dexterity in a new 
 manual process. 
 
 The effect of alcohol as thus tested was examined in the 
 same .six men employed for the " turning of the gaze " 
 test. The dose of 45 cubic centimetres of alcohol taken 
 an hour and a half previously reduced the rapidity with 
 which the movement could be performed by 8"8 per cent, 
 {average of the six persons). 
 
 Conclusions. 
 
 It will be seen that experiments suitable for yielding 
 inferences for the present purpose are not numerous ; 
 and that, if for that i-eason alone, caution is necessarj- 
 in making deductions from them. Yet, they agree in 
 indicating that a single dose of less than 40 cubic centi- 
 metres of alcohol, or as much as would be taken in about, 
 2| oz. of whisky at proof, or in ij pint of beer, in an 
 
adult accustomed to moderate use of alcohol, exerts little 
 or no appreciable influence on the performance by him 
 of a muscular act of simple character not demanding 
 precision. For acts requiring skill the inference from 
 the experiments, so far as they go, seems, however, to be 
 that their performance tends to be temporarily impaired 
 after a dose of alcohol of even less than 40 cubic centi- 
 metres, e.g. 30 cubic centimetres; especially in diminished 
 speed and nicety of the required act's performance. It 
 seems therefore permissible to suppose that the greater 
 the precisional delicacy and alertness demanded in a 
 muscular act and the greater its degree of difficulty, e.g. 
 by reason of novelty to the performer, the more liable will 
 that act be to shew impairment under the influence of 
 alcohol, and, within limits, the smaller will be the dose of 
 alcohol which may impair the act. Reliable evidence that 
 alcohol improves, in normal circumstances, the efficient 
 performance of any muscular act, unskilled or skilled, 
 seems at present to be altogether lacking. 
 
56 
 
 CHAPTER V. 
 
 Action of Alcohol on the Digestion. 
 
 Factors in digestion ivhich ina\ he influenced by alcohol. 
 
 The process of digestion is ver>' complex and it is 
 convenient to distinguish the following factors each of 
 ■which might be modified by alcohol. 
 
 (i) The secretion, or outpouring, of the digestive juices, 
 saliva, gastric juice,- pancreatic juice and bile, which 
 may be altered either, directly, by some action upon the 
 glands which form the juices, or indirectly, through 
 nerves which convey impulses leading to alterations of 
 quality or quantity in the juices poured out. 
 
 (2) The churning movements of the digestive organs, 
 particularly the stomach, movements which normally aid 
 ■digestion but, when abnormal in kind or degree, hinder 
 it and often cause pain. 
 
 (3) The actual digestion or chemical transformation of 
 such food-stulFs as undergo it and their subsequent 
 absorption after they have been more or less profoundl)- 
 changed by the action of the digestive juices. 
 
 Effect iif alcohol on secretion of digestive juices. 
 
 Beginning with (i) we may first inquire in general 
 terms whether alcohol does, or does not, cause a flow of 
 •digestive juices, and if so, how. So far as the saliva is 
 concerned, there is no doubt that alcohol taken into the 
 mouth does, like anj- other sapid fluid, or indeed, like the 
 act of chewing inert substances such as india-rubber, 
 cause a flow of saliva. This action is not of much 
 importance. So far as the gastric juice is concerned, the 
 question is more important and the answer less simple. 
 Thus, alcohol might cause a flow indirectly, by acting 
 upon nerves of taste or smell ; any agreeable taste in the 
 
57 
 
 •mouth is well known to do this; but we cannot say that 
 this is peculiar to alcohol, and the onlj- direct observation 
 (upon a woman who had an artificial opening in her 
 giillet and another in her stomach) did not afford anj- 
 decisive information. 
 
 When alcohol reaches the stomach, it certainly arouses 
 a considerable secretion of a juice, partly, perhaps, by 
 directly irritating the wall of the stomach but largely 
 through a specific action on the cells which manufacture 
 the digestive juices. This has been proved by man\' 
 •experiments on animals and also by observations upon 
 men who, in consequence of disease or injurj', had had 
 artificial openings made into their stomachs through 
 which alcohol could be introduced, often without the 
 patients knowing what had been given. In animals, a 
 part of the stomach separated from the main stomach 
 :secreted actively when alcohol was given by the mouth. 
 
 The gastric juice which is secreted owing to the action 
 of alcohol is not, however, of a normal kind. It contains 
 the usual amount of h5'^drochloric acid but very little 
 pepsin — the ferment which is concerned in the digestion 
 ■of albuminous substances by the stomach. In fact, all 
 the pepsin which the juice contains has been merely 
 washed out of the cells; no fresh supply is formed in 
 Tesponse to the action of alcohol. It accordingly follows 
 that this increased amount of gastric juice is of little or 
 no value in the process of digestion, although there is no 
 reason to suppose that it is in any way injurious. So 
 far as the amount of secretion is concerned, the increase, 
 in dogs, is greatest when small doses of alcohol, producing 
 in the stomach a concentration not higher than lo per 
 cent., are given. As the amount and its concentration 
 increase, the rate of secretion falls off and there is a 
 tendency to form much slimy substance (mucus). The 
 greater the amount and the concentration, the greater 
 the formation of mucus. When the alcohol was 
 
5« 
 
 repeatedly given, even in dilute form, the iuucu> 
 secretion became more marked and the increase of total 
 juice smaller. It is said that the [xvicrcntic secretion is 
 also increased by alcohol, given by the stomach or by 
 injection through the anus into the large bowel. This, 
 together with the alleged increase in the secretion of bile,. 
 may in part be due to some action on the stomach, for an 
 increase of gastric secretion often leads to an increase in 
 the activit}' of the pancreas. 
 
 Action of alcohol oil inovciiiciits of stomach. 
 
 Passing to (2), the churning movements of the stomach 
 are a natural part of the digestive process — they aid' 
 digestion. They aid it, not only by promoting digestion 
 in the stomach itself, but also b_\- duh' passing on partially 
 digested food from the stomach into the intestine, for the 
 completion of its digestion there. It is commonly stated 
 that alcohol promotes the movements of the stomach, but 
 the experimental methods by which it has been sought to 
 establish this conclusion were not altogether satisfactory. 
 Chittenden', for instance, did not find that the sta>' of 
 food in the stomach of a dog was materialh- altered by 
 the presence of alcohol. Carlson-, who investigated the 
 movements of the stomach in a man with an artificial 
 opening (fistula) into that organ, found that diluted 
 alcohol, brandy and various wines introduced directly 
 through the fi.stula, arrested the rhythmical movements 
 and the bracing of the muscular coats (tonus) which are 
 associated with hunger, but saw no increase of movement.. 
 50-100 cubic centimetres (2-3 ounces) of 10 per cent., 
 alcohol were enough to do away with the hunger con- 
 tractions for two hours, and 200 cubic centimetres (half a' 
 
 ' Chittenden, in Physiological Aspects of Liquor Problem, Vol. I., 
 p. 294 ; Boston, 1903, 
 
 ^ Carlson, .\nierican Journal of Physiology. Vol. 32, p. 252, 1913.. 
 
59 
 
 pint) of beer had this effect for from half an hour to an "hour. 
 So far indeed as the evidence goes, it would seem that there 
 is no reason to believe that gastric movement is increased 
 by alcohol while some forms of contraction are arrested. 
 This lessened movement of the stomach, a so-called 
 carminative action, is produced b}' many other volatile 
 substances, and maj' explain the relief of discomfort and 
 colic-like pains which svich substances, including alcohol,, 
 may afford. 
 
 Eifcct of alcohol on activity of digestive ferments. 
 
 Finally, under (3), we take first the chemical process 
 of digestion. It has already been said that the gastric 
 ferment pepsin is not increased in amount hy alcohol, 
 but its activity might be. This is a matter which has 
 engaged the attention of manj- investigators and their 
 general results are concordant. The possible action in 
 this way can be measured by ascertaining the amountof 
 change which gastric juice is able to effect in food with 
 which it is mixed in test tubes containing different small 
 amounts of alcohol. It j has been shown that while 
 1-2 per cent, of pure alcohol has little effect upon the 
 activity of the juice, in the presence of from 5-10 per 
 cent., digestion is slightly retarded, while a concentration 
 of more than 10 per cent. ver>- definitely diminishes the 
 rate of digestion. 
 
 If the gastric juice used contains but little ferment, 
 the retardation induced by even 10 per cent, alcohol is 
 considerable. (Such a concentration can rarely if ever 
 be present in the stomach of a living man for more than' 
 a few seconds.) 
 
 Ordinary forms of spirits act on gastric digestion merely 
 in proportion to the amount of alcohol they contain, but 
 wines, especially red wines, and sherry, retard digestion 
 much more than can be explained by the alcohol they 
 contain, evidently owing to the activity of some other 
 
6o 
 
 constituents. The same is true of the beers, although 
 these in small quantities have no pronounced effect. The 
 above general statement applies equallj- to the- salivarj- 
 ferment, viz., little or no action when the proportion is 
 low, retardation when the alcohol is stronger than lo 
 per cent. Here, again, wines and beers have a retarding 
 effect out of proportion to their content of alcohol, an 
 additional, and more powerful, factor here being the 
 acidity of some wines. 
 
 Although some authorities have belie^•ed that the action 
 of alcohol upon pancreatic digestion was less un- 
 favourable than upon gastric digestion, one even stating 
 that the digestion of fats is accelerated by it, there is no , 
 doubt that some of the ferments themselves when 
 examined in test tubes, are more sensitive to the action 
 of alcohol than are those of the stomach. The digestion 
 of albuminous substances may be delayed by so little as 
 2-3 per cent, concentrations. Spirits are here more 
 deleterious than can be explained by their alcohol, while 
 the acid reactions of wines and beers are unfavourable to 
 the digestion. 
 
 In practice it is probable that alcohol reaches the intes- 
 tine in such comparatively small quantities and such dilute 
 .solution, while it is also so quickly absorbed there, that 
 its action on pancreatic digestion is of small importance. 
 To sum up these results, we may say that moderate 
 quantities of alcohol, .particularly when mixed with other 
 foods, have no serious effect, good or bad, upon the 
 chemical processes of gastric or pancreatic digestion, and 
 this is true both of persons who are moderate users of 
 alcohol and of total abstainers. 
 
 Psychic effect of alcohol in irlaiion to digestion. 
 
 It has been suggested that the action of alcohol upon 
 the central nervous system, the brain and spinal cord, 
 may help digestion by distracting the subject's attention 
 
6i 
 
 from worries and promoting a more cheerful outlook 
 upon life, because of the interaction of the nervous system 
 with other organs of the body. Whether this is or is not 
 the case cannot be determined by laborator>' experiment. 
 Jt is a matter of common knowledge that many people 
 «at, they say, with more appetite, if alcohol is drunk 
 with or before the meal, but there is no reason to think 
 that the actual transformation of food into substances fit 
 to be absorbed is increased, although one may derive 
 more pleasure from a meal at which alcohol is taken. 
 Alcohol and the absorption of food. 
 
 With respect to absorption itself, that is the passage of 
 the digested food-stufis into the blood, while there is 
 no doubt that some drugs, for instance chloral and 
 strychnine, are readily absorbed when given in alcohol, 
 more so than when taken in water, and there is some 
 reason to think that small quantities of alcohol in 
 the 'intestine promote the absorption of food-stufFs, there 
 is no reliable evidence leading to the conclusion that 
 moderate doses have an}'^ serious effect, one way or the 
 other, upon the process of absorption of food. 
 
 The possibility that alcohol may promote the absorption 
 of harmful bodies which would not otherwise make their 
 way into the blood, is considered elsewhere.^ 
 
 Excessive doses of alcohol are liable to cause vomiting, 
 partly through local irritant action in the stomach but 
 mainly indirectly through disturbances in the nervous 
 mechanisms. 
 
 The whole subject of this section can be epitomised in 
 the following terms. 
 
 Conclusions. 
 
 Moderate doses have never been shown to affect appre- 
 ciably the digestive organs apart from their taste and 
 their tendency to increase the secretion of fluid and 
 mucus from the walls of the stomach. 
 ' See p. 95. 
 
62 
 
 On the other haud, there is a consensus of opinion 
 that some of the alcoholic beverages may be more 
 deleterious than others ; wines which do not notice- 
 ably interfere with the digestion of one man may 
 cause trouble to another.^ The alcohol present in these 
 wines cannot be regarded as responsible, for the 
 effects are not observed when the same quantity 
 and concentration of alcohol is taken in another form. 
 The solid non-volatile bodies in the wines have usually 
 been blamed for the dyspepsia sometimes associated with 
 the use of them, and possibly with justice. But it is 
 not possible to dismiss the volatile bouquet substances 
 from consideration, as similar differences are observed in 
 the use of different forms of spirits where the non- 
 volatile substances are present in but very small quantities 
 and appear to be harmless. In these spirits, the higher 
 alcohols (fusel oil) and the ethers are popularly credited 
 with the action on the stomach, and there is some ground 
 for believing them more disturbing to the digestion than 
 pure alcohol. The changes induced by these bodies are, 
 however, quite unknown, and may be different in character 
 from those due to alcohol itself. 
 
 ' Roberts. Collected Contributions on Digestion and Diet, 
 1891. Chittenden, in Physiological Aspects of Iviquor Problem, 
 Vol. I, 1903. 
 
CHAPTER VI. 
 
 Action of Alcohol on the Respiration and on 
 THE Circulation of the Blood. 
 
 This chapter is concerned with some of the minor effects 
 which follow the use of alcohol in moderate doses : effects 
 so small that they are easih' overlooked altogether, and 
 have no real importance in the ordinary use of alcohol 
 by normal persons. 
 
 In the literature devoted to the action of alcohol these 
 effects have received an amount of attention which seems 
 ■out of proportion to their real significance.' There are 
 two reasons for the importance which has been attributed 
 to them. 
 
 In the first place it must be realised that a large part of 
 the reputation which alcohol has enjoyed as a medicine, 
 is attributable to the belief that it stimulates a feeble 
 heart or failing respiration. With medical men, until 
 comparatively recent years, alcohol was the favourite 
 " respiratory and cardiac stimulant," and, indeed, practi- 
 -cally the only one available. It is still the most popular 
 domestic remedy for the temporary failure of the heart, and 
 secondarily of the respiration, which is known as " faint- 
 ing." It is clearly of importance, therefore, to know 
 whether alcohol really possesses the stimulating action on 
 these vital functions, with which it has been generally 
 ■credited. 
 
 A second reason for the amount of investigation which 
 has been devoted to these effects, is that the discussion of 
 their nature formed part of a wider controversy, concern- 
 ing the action of alcohol on the body generally, and 
 
 ' For a general review of the literature, except for recent years, 
 see Abel, in "Physiological Aspects of the Liquor Problem," 
 Vol. II, Boston, 1903. 
 
64 
 
 especiallj- on the brain and nervous system. In the 
 chapter dealing with the mental action, we have 
 seen that one school of opinion has maintained that 
 moderate doses of alcohol have a truly stimulant action, 
 while another school has regarded the appearance of 
 increased mental activity as misleading, and has supported 
 the view that alcohol, even in the smallest dose having 
 any perceptible effect, is always depressant or paralysing in 
 its action. The effects on the respiration and the pul^e 
 are such as can easily be measured and recorded, and this 
 partisans of the one theory were accordingly eager to 
 demonstrate that alcohol had a genuine stimulant action 
 in these cases, however small it might be ; while their 
 opponents showed a corresponding anxiety to prove , that 
 any appearance of such a stimulant action could be 
 explained in other ways. 
 
 Sub-Chapter I. 
 The Action of Alcohol on Respiration. 
 
 Normal working of respiratory mechanism. 
 
 I The movements of respiration, by which air is rhythmi- 
 cally drawn into and expelled from the lungs, show wide; 
 variations both of depth and rhythm, even under normal 
 conditions of active life. These movements are initiateti 
 by the activity of a nervous centre, called the " respira' 
 tory centre,' which is situated in the hindmost part o^ 
 the brain, just above the level where it becomes continuoiis 
 with the spinal cord. The activity of the centre is nor- 
 mally called forth by the presence of carbon dioxide in the 
 blood carried to it by the circulation. If the blood-is 
 deprived of carbon dioxide completelj-, the breathing 
 stops altogether. If the quantity of carbon dioxide in the 
 blood becomes abnormally great, the respiration becomes 
 rapid and laboured ; as when we find ourselves ," out of 
 
65 
 
 breath" after runiiiiig up a flight of stairs. The action 
 of the centre is also modified by the activity of other parts 
 of the brain and nervous system. The respiration is to 
 a large extent controllable by the will, and is affected by 
 every emotion ; we " gasp with astonishment,'' " hold the 
 breath with anxiety," or " pant with eagerness." It is 
 also subject to " reflex " effects from the stimulation of 
 sensory nerves ; a sudden pain, a dash of cold water on 
 the skin, makes us gasp or pant for breath. 
 
 Indirect effects of alcoJiol on respimforv actwitx. 
 
 Since the rhythm of breathing is normally subject 
 to such wide variations, it is clear that a small effect . 
 of a drug will be difficult to detect with certaintj', 
 unless special precautions are taken. Under ordinary 
 conditions a dose of alcohol will produce, in nian\- 
 persons, a condition of excitement, talkativeness, and 
 restless muscular activity. The fact that this is accom- 
 panied by quicker and deeper breathing cannot be taken 
 to represent an action of alcohol on respiration ; for a 
 similar access of respiratory activity can be seen in 
 persons of excitable temperament if, without having 
 taken alcohol, they become engaged in animated discus- 
 sion and gesticulate freely. 
 
 Earlier nbsoi'aiions : difficulties in their interpretation. 
 
 Many competent observers formerly stated, however, 
 that the taking of a moderate dose of alcohol, by a subject 
 kept in repose and carefully protected from disturbing 
 influences, was followed by a small but definite increase 
 of respiratory activity. All forms of increase in activity 
 were recorded : a quicker rate, with deeper, unaltered, 
 or shallower individual respirations, or even a deepening 
 of each breath without alteration of the rate. The uett 
 result was, however, in general an increase in the 
 volume of air breathed in a given time. One observer 
 
66 
 
 stated that the effect was more pronounced with a wiiie 
 •of fine bouquet than with pure alcohol, and noted its 
 special prominence in subjects suffering from fatigue. 
 A long and vigorous discussion arose as to the nature 
 of this effect. It would be unprofitable to follow this 
 into all its detail, and it will sufiice to indicate the 
 main lines of the argument. Those who believed that 
 alcohol never stimulates the brain, and who were there- 
 fore unwilling to admit that it would stimulate the 
 respirator}' centre, attributed the effect to an irritant 
 action on the mucous membrane of the stomach. The 
 similar effects seen in experiments on animals, when the 
 alcohol was inhaled as vapour, or injected under the 
 skin, were similarly attributed to irritation of the 
 lining of the wind-pipe and the lungs, or the nerves in 
 the subcutaneous tissue. Other irritant substances, such 
 as mustard,^were said to cause a similar increase of 
 respiratory movement, when they were introduced into 
 the stomach.^ 
 
 On the other hand, the adherents of the " stimulant " 
 theory of the action of alcohol, claimed the effect on 
 respiration as supporting their view. They pointed 
 out that the effect was apparently not diminished by 
 diluting the alcohol freeh- with water before it was 
 swallowed ; whereas the irritant action of strong spirit 
 would be greatly reduced by such dilution.^ They 
 laid much stress also on the fact that the injection 
 of suitably diluted alcohol directly into the vein of an 
 animal was followed by an increase of respiratory 
 activity ; and under such conditions, there was no 
 possibility of local irritative action, affecting the 
 respiratory centre indirectly.'' 
 
 ' Jaquet — Archives Internationales <le Pharniacod3'nainie, Vol. 2, 
 
 p. 107. 1896. 
 - Wilmanns — Pfliiger's Archiv. fiir die jjesanimte Phj'siologie, 
 
 Vol. 66, p. 167. 1897. 
 ^ Binz — Centralblatt fiir innere Medizin, p. i. 1891. 
 
67 
 
 Experiments to test the ejj-ect of alcohol on the excitability 
 of the respiratory centre. 
 
 In the light of more modern information, concern- 
 ing the normal activity of the respirator)- centre, and 
 the manner of its control, much of this discussion 
 seems irrelevant. We have seen that the respiratory 
 centre does not work automatically, but only in 
 response to the stimulating action of carbon dioxide in 
 the blood. When it is suggested, therefore, that a 
 drug like alcohol has a " stimulant " action on the 
 respiratory centre, this can onh' mean that it makes 
 the centre more readily responsive to carbon dioxide. 
 The excitability of the centre can be tested, by 
 measuring the effect produced on the breathing, when 
 a definite proportion of carbon dioxide is added to the 
 air which is breathed. Such a measurement, before and 
 after a dose of alcohol, was indeed made maliy years ago.^ 
 
 Two subjects were chosen for the experiments, one 
 accustomed to taking alcohol, the other not. Each was 
 given, on separate occasions, a dose>of 35 cubic centi- 
 metres and another of 60 cubic centimetres of alcohol. 
 The quantities of whisky at proof containing these 
 amounts of alcohol would be 2| ounces and rather less 
 than 4J ounces respectively. Only in one case was an 
 increase in the excitability of the respiratory centre 
 detected, namely, when the larger dose was given to the 
 person who was not used to taking alcohol. 
 
 Proportion of carbon dioxide in " alveolar air" as a measure 
 of the excitability of the respiratory centre. 
 
 Another method of measuring the excitabilitj- of the 
 respiratory centre has been used in more recent experi- 
 ments. The activity of the centre so adjusts itself to 
 the need of the body to get rid of carbon dioxide, 
 that the proportion of carbon dioxide in the blood 
 
 ' tioewy — Pfliiger's Arcliiv. fur die gesammte Physiologie, Vol. 47, 
 p. 601. 1890. 
 
 16066 F 
 
68 
 
 filling the arteries is kept practically constant. The 
 gases held by this blood are in equilibrium with the 
 air in the deepest recesses of the lungs — the so-called 
 "alveolar air." Samples of this air can easily be 
 obtained, and analysed, and it has been found that the 
 proportion of carbon dioxide in it remains very constant 
 in the same individual under similar conditions. When 
 the rate at which carbon dioxide is being formed in the 
 body increases, the respiratory centre is stirred to 
 greater activity, and the more active breathing quickly 
 readjusts the proportion of carbon dioxide in the alveolar 
 air to its normal level. 
 
 Now it will be clear that, if the normally constant pro- 
 portion of carbon dioxide undergoes a change and takes 
 up a new level, this must indicate a change in the excita- 
 bility of the respiratory centre. If more carbon dioxide 
 accumulates in the air in the lungs, we know that the 
 excitability of the centre has become less; for othenvise 
 the tendency to such accumulation would have excited 
 the centre to greater activity, and the more vigorous 
 breathing would have swept carbon dioxide out of the 
 lungs more rapidly, so as to maintain the normal propor- 
 tion. If, on the contrary, the proportion of carbon 
 dioxide in the alveolar air becomes less, we know that 
 this indicates an increase in the excitability of the centre; 
 for otherwise the tendency to diminution of the amount 
 of carbon dioxide would have resulted in smaller activity 
 of the centre, and the slower and shallower breathing 
 would have allowed the normal proportion of carbon 
 dioxide to remain. More active breathing may, there- 
 fore, be brought about either by an increase in the 
 excitability of the respiratory centre to the normal pro- 
 portion of carbon dioxide, or by a more rapid production 
 of carbon dioxide by the body. In the former case, a 
 decrease in the proportion of carbon dioxide in the 
 alveolar air would be detected, in the latter it would not 
 
69 
 
 ■change perceptibly. The two influences may work in 
 opposition — e.g., an increase in the excitability of the 
 centre may be accompanied by diminished production of 
 carbon dioxide; and in such a case there may be no 
 change, or even a decrease of respiratory activity, although 
 the excitability of the centre has risen. 
 
 Experiments to determine the effect of alcohol on the proportion 
 of carbon dioxide in the ''^ alveolar air. ^'' 
 
 It will be clear that the interpretation of an apparent 
 effect of alcohol on breathing is a much more complicated 
 matter than the earlier investigators supposed. Quite 
 recently the changes in all the difl^erent factors have 
 been carefully investigated in a series of men.' Seven 
 subjects were chosen for the experiments, whose ex- 
 perience of alcohol included all variations from habitual 
 abstinence to daily use. In each test two doses were 
 used, 30 cubic centimetres and 45 cubic centimetres of 
 pure alcohol, suitably diluted with a flavouring mixture ; 
 the equivalents in alcohol of whisky at proof would be 
 rather more than 2 ounces and 3 ounces respectively. 
 The doses were large enough to produce distinct 
 physiological effects — feelings of comfortable warmth and 
 drowsiness, and in some cases talkativeness and mental 
 excitement ; on the other hand, they were not enough to 
 cause definite inebriation. The patients were kept care- 
 fully at rest, and under constant observation, and each 
 alcohol experiment was controlled by one iij which the sub- 
 ject took the same flavouring mixture without the alcohol. 
 
 In a certain proportion of the experiments there was an 
 indication of a slight' increase in the excitability of the 
 respiratory centre, the proportion of carbon dioxide in 
 the alveolar air undergoing a small reduction after 
 alcohol had been taken. This effect, however, was 
 counterbalanced by a diminished production of carbon 
 
 ' Higgins — Journal of Pharmacology and Experimental Thera- 
 peutics, Vol. 9, p. 441. 1917. 
 
70 
 
 dioxide by the body. Tlie nett result on the breathing 
 was that the volume of air breathed per minute was 
 either unchanged or slightly diminished. 
 
 Conclusions regarding the action of alcohol on respiration. 
 
 There need be no hesitation in accepting these experi- 
 ments, made by the most recent methods, as giving a 
 true account of the action, or want of action of alcohol 
 itself on the respiration. The fact that a definite, though 
 small increase, in the volume of air breathed, was so 
 consistently observed by the earlier workers to follow the 
 taking of alcohol, may be explained in one of two ways. 
 Pother (i) their precautions against an increase of 
 muscular activity following the taking of alcohol were 
 imperfect, so that the effect they obser\'ed was in part the 
 indirect result of more rapid formation of carbon dioxide; 
 or (2) the wines, brandy, etc., used in some of the earlier 
 experiments contained, among their ethereal bouquet- 
 substances, some which had more action on the respira- 
 torj'' centre than alcohol. Only further experiment, by 
 modern methods, could decide between these possibilities. 
 For our present purpose it is sufficient to have reached 
 the conclusion that alcohol, in moderate doses, has no 
 effect on the respiration of practical importance, either 
 for its use by normal persons, or for its medicinal use. 
 The onh' important effect of alcohol on respiration is the 
 paralysis of the respirator}- centre bj' large doses, which, as 
 another chapter shows,^ is the cause of death in poisoning.^ 
 
 > Chapter VIII, p. 86. 
 
 '' Since this section was sent to the printers an interesting note 
 has been published by Hooker (Journ. of Pharmacology and Exp. 
 Therapeutics, vol. X., 1917, p. 121), who, by an ingenious method 
 of artificial perfusion, has tested the direct action of alcohol on 
 the respiratory centre, isolated from the general circulation. His 
 results confirm the stimulant action of low concentrations of 
 alcohol on the centre ; but the conditions are so abnormal, that 
 no deduction can be made as to the importance of the action 
 under normal conditions, and no revision seems necessary of our 
 conclusions as to the trivial nature of the effect on respiration of 
 alcohol as taken b%' man. 
 
71 
 
 Sub-Chapter II. 
 
 Action of Alcohol in the Circulation of the Blood. 
 
 In what ways a drug max influence the Circulation. 
 
 A drug can influence the circulation of the blood by 
 causing either a change in the rate or strength of the 
 heart's beating, or a change in the state of contraction of 
 the blood-vessels, especially of the smaller arteries. The 
 heart is a muscular pump, which at each beat drives a 
 spurt of blood into the great arteries, causing a wave of 
 pressure, the pulse-wave, to travel down them. Where 
 the large arteries divide into small ones, and these again 
 open into the net-work of capillary blood-vessels, the flow 
 of blood encounters a pronounced resistance. As a result 
 of this resistance, and of the elasticity of the larger 
 arteries, a head of pressure is built up in these, by which 
 the blood is driven on through the capillaries into the 
 veins in a steady stream. The maintenance of this 
 ■"arterial blood-pressure," which is one of the essential 
 factors of an efiicient circulation, depends on the rate and 
 volume of the heart-beat, and on the state of contraction 
 of the small arteries. The arterial pressure rises when the 
 heart-beats follow one another more rapidly, or when the 
 volume of blood expelled at each beat increases ; and it 
 rises also when the walls of the small arteries contract, 
 and increase the resistance to the flow of blood out of the 
 arteries. If the heart-beat becomes slower or weaker, 
 or if a general relaxation of the small arteries occurs, the 
 arterial blood-pressure falls. But the arteries of the 
 whole body need not, and do not usually contract or relax 
 together. The arteries in the skin, for example, may 
 contract, while those of internal organs relax ; and the 
 result may be that, while the pressure in the large arteries 
 is unchanged, a larger proportion of the blood goes to 
 the internal organs, and less to the skin than before. 
 
72 
 
 In discussing the effect of alcohol on the circulation of 
 the blood, the main points on which information are 
 required are, therefore, its effect on the rate and strength 
 of the heart-beat or the pulse, and its effect on the state 
 of contraction of the smaller arteries ; and we further 
 have to inquire whether, as the result of the effects on 
 the heart and arteries, any change occurs in the pressure 
 of the blood in the larger arteries. 
 
 Effect of alcohol on the superficial blood-vessels. 
 
 There are only two features of the action of moderate 
 doses of alcohol on the circulation concerning which there 
 is anything like a general agreement. All who have studied 
 the matter are agpreed as to the general relaxation of the 
 small arteries carrying blood to the skin. This causes a 
 slight general flushing of the surface and accounts for 
 the comfortable feeling of bodily warmth which the taking 
 of alcohol produces. It is more important for its effect 
 on the body temperature, which is dealt with in the 
 following chapter, than for its effect on the general 
 circulation of the blood. But it will be clear, from what 
 has been said above, that such a dilatation of the skin 
 vessels will be attended by some fall of the arterial blood - 
 pressure, unless it is compensated either by a constriction 
 of arteries carrying blood to internal organs, or by an 
 increase in the activity of the heart. 
 
 Effect of alcohol on the piUse-rate. 
 
 The majority of observers are further agreed in stating 
 that the swallowing of a moderate dose of alcohol is 
 followed by an increase in the rapidity of the heart-beat, 
 which lasts for about half an hour. There are some who 
 have failed to detect this action, and others even who 
 observed that the pulse became slower after alcohol was 
 taken. The rate of the pulse is not a matter concerning 
 which there can be a difference of opinion, and it can only 
 
73 
 
 be concluded that different subjects react differently to 
 alcohol in this respect, while dose and dilution have 
 probably some infltience on the effect. There seems to be 
 no doubt that a slight quickening of the pulse commonly 
 occurs. In the most recent series of experiments on the 
 effect of alcohol on respiration, described in the foregoing 
 section, records of the pulse-rate were taken. These 
 showed a small acceleration, following the taking of 
 alcohol, in about half the experiments. In the others no 
 change was detected.^ 
 
 Quickening of the pulse iindcr alcohol is probably brought 
 about indirectly. 
 
 There is very good reason, however, for believing that 
 this effect, weak and inconstant as it is, is not due to a 
 direct action of alcohol on the heart. It has been 
 seen to occur when alcohol of sufficient concentration 
 (50 per cent.) was simply taken into the mouth and 
 rejected without being swallowed. In this case, the 
 quickening of the pulse only lasted for a few minutes, 
 whereas, if the dose was swallowed, the quickening lasted 
 for half an hour or so.^ It seems reasonable to attribute 
 at least a part of the result to the continuance in the 
 stomach of the irritating action of alcohol on mucous 
 membranes, which must be the immediate cause of the 
 effect seen when alcohol is held in the mouth. 
 
 The heart-beat, though automatic, is under the constant 
 controlling influence of the nervous system. Under 
 normal conditions, the heart is held in check by impulses 
 from an " inhibitory centre," so that the rate is less than 
 that at which the heart would beat if freed from such 
 control. This restraint can be weakened by various 
 causes. The quickening of the heart in response to the 
 irritation of mucous membranes by alcohol is probably an 
 
 ' Higgius — loc. cit. 
 
 ^ Dixon— Journal of Physiology, Vol. 35, p. 346. 1907. 
 
74 
 
 example of a reflex weakening of this control. A quick- 
 ening of the heart, largely due to a similar action, 
 regularly accompanies muscular activity ; and it is not 
 unlikely that the tendency to restless movement, which 
 follows the taking of alcohol, also plays its part as an 
 indirect cause of the quickened pulse. That the effect is, 
 in the main, an indirect one, has been shown by experi- 
 ments, conducted by a number of observers, on the action 
 of alcohol on the heart isolated from the body. 
 
 Experiment to test the action of alcohol on the isolated 
 
 heart. 
 
 The heart of a recently killed animal, if blood or a suit- 
 able nutritive fluid is made to flow through its blood- 
 vessels, can be kept beating for hours or days outside 
 the body. Under such conditions its action is uncom- 
 plicated by changes in the rest of the circulator3' 
 system, and is free from all nervous control. Alcohol 
 in accurately measured proportion can be added to the 
 fluid perfusing the heart, and the direct and uncom- 
 plicated effect of such addition on the beat of the 
 heart can thus be studied. 
 
 Most of those who have made such experiments have 
 failed to detect any quickening or strengthening of the 
 heart-beat under the influence of alcohol of any con- 
 centration. ^ Such observers found that, in concentrations 
 up to about o'l per cent., alcohol was without effect. 
 Others have observed some strengthening of the beat 
 as the result of such low concentrations of alcohol. - 
 This, however, appears to have been due to the fact 
 that the heart, during the long perfusion, had used up 
 much of its reserve supply of food-material, needed 
 for producing the energy of its beat, and that, under 
 
 ' See Backman — Skandinavisches Archiv fur Physiologic, Vol. i8 
 (1906), p. 323, who gives full references to earlier work on these 
 lines. 
 
 ' Dixon — loc. cit. 
 
75 
 
 such conditions, it was able to use alcohol as a fuel, 
 just as it can use glucose (grape-sugar) added to the 
 perfusion fluid. So that there was no evidence that 
 alcohol, in these concentrations, had a specific stimu- 
 lating action on the activity of the heart; on the 
 other hand, it was harmless. 
 
 Direct effect on the heart only obsemed with large doses, 
 and then of depressant character. 
 All are agreed that in greater concentrations alcohol 
 is directly harmful to the heart. The investigators 
 differ as to the concentrations at which the harmful effect 
 Tjegins to be manifest. Those who used a pure saline 
 fluid for perfusion through the vessels of the heart 
 observed a depressant action as soon as the proportion 
 of alcohol rose above ci per cent. On the other hand, 
 in experiments in which blood was perfused, even -5 
 per cent, of alcohol was found by one observer to have 
 no definitely harmful action. ^ It will be seen later 
 (Chapter VIII) that when, in man, the concentration- 
 of alcohol in the circulating blood rises above ci per 
 cent., the condition of the subject becomes one of definite 
 inebriation, while at a concentration of o'5 per cent., we 
 are approaching the fatal limit. There seems no good 
 reason, therefore, for ascribing to direct stimulation of 
 the heart any favourable effect which a small dose of 
 alcohol may appear to produce, or to direct depression 
 of the heart, a large share in the danger to life produced 
 by poisonous doses. The effect in either case, whether 
 of quickening or depression, must be mainly the indirect 
 result of the other actions of alcohol. 
 
 Effect of alcohol on arterial blood-pressure. 
 
 The effects of alcohol on the arterial blood-pressure 
 
 are similarly small and indefinite. Some observers have 
 
 ' Loeb — ^Archiv fur experimentelle Pathologic und Pharma- 
 kologie, Vol. 52, p. 451. 1906. 
 
76 
 
 described a relativelj' small rise of the arterial pressure, 
 as the result of injecting small doses of alcohol directly 
 into the circulation. ^ Others have failed to detect any 
 definite effect, or have observed a small decline of 
 arterial pressure ; while one found that the pressure 
 fell if alcohol was injected into a vein or under the 
 skin, but rose to a small extent, for a few minutes, if 
 the same dose of alcohol was swallowed. - 
 
 Conchtstons. 
 The action of alcohol on the heart and circulation has 
 theoretical interest for the pharmacologist, and has 
 accordingly been the subject of much investigation and 
 discussion. But no scientific ground has been discovered 
 for any claim made on behalf of alcohol to practical 
 value as a direct stimulant of the heart in cases of 
 threatened failure of the beat. When it appears to pro- 
 mote recovery from fainting, it probably acts simply by 
 virtue of its irritant action on the mucous membrane of 
 the mouth and throat. The fact that the beneficial effect 
 appears almost immediately, and long before any signi- 
 ficant amount of alcohol can have been absorbed and 
 carried to the heart, is evidence for this local and indirect 
 nature of the action. Its use in these circumstances is, 
 therefore, comparable with that of smelling salts, or the 
 irritating fumes of burnt feathers, traditionally employed 
 for the same purpose. When, in conditions of more pro- 
 tracted weakness of the heart, the administration of 
 alcohol has a beneficial effect, this must be attributed 
 mainly to its mildly narcotic and sedative action. 
 
 ' Dixon — Loc. cit. 
 Kochmann — Archives Internal, de Pliarmacody nu . \'ol. 13, 
 
 p. 329. 1904. 
 Bachem — Archives Internal, de Pharmacodyn. Vol. 14, p. 437. 
 
 1.905- 
 Brooks — Journal of the American Medical Association. Vol. 30^ 
 
 p. 373. 1910. 
 
77 
 
 relieving the centres, which modifj' the action of the 
 heart, from the disturbing influence of pain and anxiety. 
 The promotion of a patient's comfort, the relief of mental 
 strain, may be an essential element in the treatment of 
 disease, and an important factor in recovery. It does not, 
 however, justify the description of alcohol as a " stimu- 
 lant" of the heart. In this direction, as in others, the 
 popular idea that it is a " stimulant " proves on examina- 
 tion to be scientifically untenable. 
 
78 
 
 CHAPTER VII. 
 
 The Influencf of Alcohol on the Body 
 
 Temperature. 
 
 Distinction between surface tempciatitre and deep temperature. 
 
 In speaking of body temperature we must carefully 
 distinguish between the surface temperature, i.e., the 
 temperature of the surface of the skin, and the deep 
 temperature, which is that of the underlying parts and 
 the internal organs. 
 
 The surface temperature is in general lower than the 
 deep temperature, but the most important difference 
 between the two is that, whereas the surface temperature 
 varies widely, not only at different times but on different 
 areas of the skin at the same time, the deep temperature 
 is, in health, remarkably constant. If one hand is plunged 
 into hot water (at 45 degrees Centigrade, i.e., 113 degrees 
 Fahrenheit, for example) and the other into melting 
 snow, the surface temperature of the former rises higher 
 than the deep temperature, while that of the latter falls 
 far below it. If the temperature on the surface of the 
 body be taken immediately on rising from bed on a 
 winter's morning, and again immediateh* after a cold 
 bath, it will be found to have fallen through a long range. 
 Through all these changes, howe^-er, the deep temperature 
 will have remained practically unaltered, as may be 
 verified by taking the temperature under the tongue, 
 with the lips closed, before and after the cold bath. 
 
 This maintenance of the deep temperature at a practi- 
 cally constant le\el, with but small fluctuations from its 
 normal average of 37 degrees Centigrade ^ (or 98*6 degrees 
 
 ' Normally the temperature curve exhibits a regular diurnal 
 cycle, reaching a maximum between 4 p.m. and 8 p.m. and a 
 minimum between 2 a.m. and 6 a.m. The extreme range is 
 between i and 2 degrees Fahrenheit, and the cycle is related to 
 ■variations in the activity of metabolism. 
 
79 
 
 Fahrenheit) is an essential condition of health ; for it is 
 only at this temperature that the chemical and physical 
 changes of the living tissues proceed at their normal rate. 
 This constancy of the deep temperature gives to the 
 clinical thermometer its value as an instrument for 
 detecting the onset of illness, and for measuring its 
 progress. 
 
 Hoiv the deep temperature is maintained at its normal level 
 
 in health. 
 
 We have seen that the chemical changes of the bodj', 
 \'iewed as a whole, are in effect a combustion, and are 
 accompanied by the evolution of heat. This constant 
 production of heat renders the body warmer than the air 
 and most of its surroundings. Heat is, therefore, always 
 being generated in the body, and always being lost at its 
 surface to the air. The maintenance of the deep 
 temperature at its normal level involves a continual 
 adjustment of these two processes, so that the amount of 
 heat lost at the surface just balances the amount that is 
 evolved within. The rate at which heat is produced in 
 the body is always varying, with changes in the acti^-ity 
 of the muscles and of the glandular organs. The rate at 
 which heat is lost from the body is likewise subject to 
 continual variations, with changes in the temperature 
 and moisture of the air, in the degree to which the skin 
 is exposed to it, and in the rate at which winds and 
 currents keep the cool air moving over the surface of the 
 body. 
 
 The heat-regulating centre. 
 
 The adjustment of processes by which heat is produced 
 and lost by the body so that an accurate balance is 
 maintained, is under the control of a nervous centre in 
 the brain, the unconscious action of which suffices for 
 moderate changes of the external or internal conditionsr 
 We may confine our attention to the manner in which the 
 
8o 
 
 ■ body protects itself against a/w// of the deep temperature, 
 since this is of the greatest importance in connection with 
 the action of alcohol. 
 
 Auiomaiic adjustment of body tetnperature in exposure 
 to cold. 
 
 When the body, by exposure to cold, is threatened with 
 
 a loss of heat at a rate exceeding that of its production, 
 
 the first means of readjustment is a change in the 
 
 distribution of the circulating blood as between the skin, 
 
 where heat is lost, and the internal organs, where it is 
 
 evolved. The nerves of the skin, excited by the surface 
 
 cooling", ca:ll into action the nerve centre regulating the 
 
 body temperature ; this, through the nerve-centre which 
 
 controls the contraction of the small arteries, causes a 
 
 narrowing of the channels through which blood is 
 
 conveyed to the skin. Less of the blood streams through 
 
 the cold skin, and more through the heat-producing 
 
 organs in the interior. The result is a further fall of 
 
 temperature of the skin ; but the all-important deep 
 
 temperature is maintained. If the exposure to cold is 
 
 more severe or prolonged, the narrowing of the blood 
 
 vessels in the skin is inadequate to protect the body 
 
 against excessive loss of heat, and the deep temperature 
 
 begins to fall. This fall also affects the heat-regulating 
 
 centre, through which the heat-producing organs, such as 
 
 the muscles, are stimulated to activity, so that a more 
 
 rapid evolution of heat takes place. We become 
 
 conscious of the uncontrollable rhythmic contraction of 
 
 the muscles and call it " shivering." 
 
 How conscious effort instinctively assists automatic 
 mechanism. 
 
 So far we have dealt with the automatic, involuntary 
 mechanism for maintaining the deep temperature of the 
 body at a constant level. In the normally alert and 
 
8i 
 
 sensitive person this automatic regulation is assisted by 
 conscious effort. Before the stage of shivering is reached 
 we become conscious of a definite, unpleasant sensation, 
 which we describe as " feeling cold." This is due to 
 the fall in the temperature of the skin, accelerated, as we 
 have seen, by the diversion of the blood to the interior of 
 the body. Of a fall in the deep temperature we are not 
 directly conscious, and are made aware of it only through 
 the reaction of shivering. The feeling of discomfort and 
 misery thus engendered is a naturalwarning of impending 
 injury by cold, a signal that the deep temperature is 
 beginning to fall, and that the balance bfetween production 
 and loss of heat can no longer be upheld by the 
 unconscious reflex mechanism. The desire to reinforce 
 the automatic adjustment by conscious effort becomes 
 urgent. We find ourselves impelled to accelerate the 
 production of heat by vigorous muscular activity and to 
 restrict still further the rate of its loss from the surface 
 by putting on more clothes. If the excessive surface 
 cooling, which is the cause of discomfort, is confined to a 
 small part, such as a hand, we may endeavour to 
 alleviate it by beating and chafing the part affected, and 
 thus restoring in it a freer circulation of blood. 
 
 Alcohol causes loss of heat through flushing of surface. 
 
 Turning now to the action of alcohol, it will be re- 
 membered that, in the previous chapter (p. 72), mention 
 was made of a general flushing of the skin surface, a 
 widening of the small arteries carrying blood to the skin, 
 as one of its effects on the circulation of the blood. We 
 saw, indeed, that this was the only one of its effects on 
 the circulation concerning which there was no doubt or 
 difference of opinion. 
 
 In considering the bearing of this effect on the regulation 
 of the body temperature, we must note, in the first place, 
 that such flushing of the skin has, as a necessary result, 
 
82 
 
 an accelerated loss of heat from the surface of the body. 
 The question arises whether this is balanced by an 
 increase in the production of heat by the internal organs. 
 There is no evidence to indicate that alcohol directly 
 affects the rate at which heat is formed in the body. 
 Indirectl}', indeed, it may increase the rate of heat 
 production, by weakening the control of the brain, and 
 thereby favouring a restless muscular activity. In a 
 resting subject it does not increase the production of 
 heat, and the result of its effect on the circulation through 
 the skin is a fall of the deep temperature. 
 
 Alcohol hlttnts the ivarning sensation of cold. 
 
 So far as the unconscious reaction to external cold is 
 concerned, therefore, the effect of alcohol is to weaken 
 the action of the heat-regulating centre, so that the 
 protective constriction of the vessels carrying blood to 
 the skin is relaxed. What of the conscious instinctive 
 reaction ? The flushing of the skin relieves the un- 
 pleasant sensation of " feeling cold," and replaces it by a 
 comfortable glow of warmth. We have seen that under 
 conditions of exposure to cold the unpleasant sensation 
 is a valuable warning, which assists the maintenance of 
 the deep temperature by creating an impulse towards 
 muscular exertion, so that the production of heat is 
 accelerated. This warning sensation alcohol blunts or 
 annuls, and thereby tends to preclude the instinctive 
 protective action, which the warning should call forth. 
 It impairs or annuls, therefore, the conscious instinctive 
 reaction, as well as the automatic, reflex mechanism of 
 adjustment. From the point of view of maintaining the 
 deep temperature, the influence of alcohol is evidently 
 wholly bad. Its popular reputation as a means of 
 " warding-off cold " is due to the relief which it affords 
 from the warning discomfort. 
 
83 
 
 Practical conclusions regarding use of alcohol by persons 
 exposed to cold. 
 
 If the practical question is asked, therefore, whether a 
 person who feels cold can take alcohol with advantage, the 
 answer must depend on a balance between discomfort and 
 danger. Whereas it maj' well be considered legitimate to 
 incur a trivial danger in order to avoid a considerable 
 discomfort, even serious discomfort is not worthy of 
 consideration if the alternative is danger to life itself. 
 
 It may be safely stated that, under the conditions of 
 ordinary life indoors, or in the open when the tempera- 
 ture of the air is mild, the effect of a moderate dose of 
 alcohol on the body temperature has no importance. In 
 circumstances of brief exposure to cold, with the body as 
 a whole well clad, the discomfort due to a chilling of the 
 face and extremities maj' be mitigated bj' the use of 
 alcohol without likelihood of producing a dangerous fall 
 of internal temperature. The mental depression which 
 accompanies the feeling of being " miserably cold," the 
 discomfort of numbed hands, can be alleviated by a small 
 dose of alcohol ; and the relief, though short-lived, reacts 
 favourably for the timebeing on the complexion of the mind. 
 The cheerfulness and sense of energy, which thus replace 
 dejection and apathy, will not improbabh' awaken a desire 
 for muscular activity ; so that the temporary and, in itself, 
 illusory relief, provided by alcohol, may pave the way to 
 the more genuine, natural and permanent remedy. 
 
 Such uses of slcohol, for the relief of the feeling of cold, 
 are suited only to a very brief emergency, created by 
 exposure to a degree of cold which is merely unpleasant. 
 The taking of alcohol during, or as a preliminarj^ to, pro- 
 longed or severe exposure to cold, is on every ground to 
 be condemned. Any sensation of warmth which it pro- 
 duces, under such conditions, is an illusion fraught witB 
 danger ; its effect is to render the subject indifferent to a 
 peril, which is in fact seriously increased by its use. 
 
 16066 G 
 
84 
 
 When, on the otheir hand, the exposure to cold is at an 
 end, and the victim has been placed under conditions 
 promoting warmth, the use of alcohol may have real 
 value. If, for example, the surface of the bod} has 
 become chilled and the deep temperature has been 
 lowered by prolonged immersion in cold water, when 
 once the patient has been wrapped in hot blankets and 
 surrounded with hot bottles, the administration of 
 alcohol can assist the restorative measures by promoting 
 the return of blood to the superficial tissues, to ^vhich 
 the external heat is applied. 
 
«.s 
 
 CHAPTER VIII. 
 Poison Action of Alcohol. 
 Drug action and poison action differ onlv in degree. 
 
 In the case of alcohol, as in the case of other drugs, it is 
 impossible to draw any hard and fast line between drug 
 action and poison action. Drug action, when, with 
 increase of dose, it becomes excessive, passes into poison 
 action ; but there is no absolute criterion of excess, and 
 an action which under one set of circumstances and from 
 one point of view may be regarded as excessive and 
 harmful, may under other circumstances come within 
 the denomination of a drug action. For instance, a 
 person who drinks such a quantity of ether that he 
 becomes unconscious would certainly be considered to 
 be suffering from poisoning, and yet we do not ordinarily 
 speak or think of poisoning in the case of a patient under 
 an anaesthetic, though his condition may represent a 
 more intense and dangerous action of the same drug. 
 In reference to alcohol, then, it will be sufficient if, 
 without trying to be too precise, we take it that a 
 drinker really begins to suffer from acute poisoning as 
 soon as he shows such immediate effects of the drug as 
 interfere with his normal capacity for taking care of 
 himself. 
 
 The symptoms of ordinary drunkenness have been fully 
 •described in Chapter III, where it was pointed out that 
 they result from a progressive impairment of the 
 functional activity of the nervous centres in the order 
 from the highest to the lowest, that is to say, beginning 
 with the centres of the brain that have to do with 
 complex mental processes, such as those involved in 
 critical judgment and self-control, and subsequently, 
 
86 
 
 with deepening intoxication, affecting lower levels untit 
 finally a state of stupor is reached. 
 
 In this final stage of intoxication, when the drinker, in 
 common parlance, is " dead drunk " or " paralytic drunk," 
 the nervous centres which control such vital activities 
 as the movements of the respirator}- muscles are more 
 or less interfered with, as shown, for instance, by the 
 snoring or " stertorous " breathing which accompanies 
 the unconsciousness of drunkenness. Ordinarily, this, 
 condition passes gradually into a state of deep sleep, 
 after which the patient returns to the normal. In some 
 cases, however, when the quantity of alcohol taken has 
 been verj' large, these vital centres are so gravely 
 affected that the drunkard may die from failure of 
 respiration. 
 
 Svmptonis due altogether tfi action on central nervous svstem.- 
 
 All the symptoms of drunkenness, then, are due- 
 essentially to the action of alcohol on the brain and the 
 rest of the nervous system. Even when it kills by acute 
 poisoning it kills through its action on that system, and 
 not by directly injuring any other bodih' organ. This, 
 indeed, we are already prepared to find, for, as we saw when 
 dealing with the action of alcohol on the other functions 
 of the body, it is ov\y when very large doses of the drug 
 are taken that it can produce an immediate effect of anj- 
 significance on these functions : thus, for instance, to^ 
 depress the action of the heart to an appreciable degree 
 by directly influencing that organ, we saw (Chapter VI, 
 p. 75) that alcohol must be present in the blood in a. 
 proportion of about "5 per cent. — a proportion which 
 would imply an original dose, for a man of 10 stone 
 weight, of nearly twelve ounces of absolute alcohol, or 
 well over a pint of whisky at proof strength. With such 
 a dose, of course, in an ordinarj- individual the direct, 
 effect on other organs would be negligible in presence of 
 
87 
 
 the symptoms of profound and dangerous intoxication 
 ■of the central nervous system. 
 
 Relation of symptoms tn amount of alcohol in blood. 
 The next point which we have to consider is how 
 ■drunkenness is related to the amount of alcohol taken, 
 and to the particular sort or sorts of alcoholic beverage 
 ■drunk. We shall deal first with the question of dose. 
 Alcohol gets to the central nervous system by passing 
 from the blood into the fluid — the cerebro- spinal fluid, 
 to give it its technical name — which bathes the brain and 
 the spinal cord as they lie within their lining membranes 
 in the skull and the spine ; and the amount of the drug 
 which enters this cerebro-spinal fluid is strictly pro- 
 portional to the amount contained in the blood. From 
 -experiments on animals and from observations on man, 
 it has been found that the onset and the intensity of the 
 symptoms of intoxication are roughh' dependent on the 
 •quantitj^ of alcohol present in the circulation. Thus 
 in experiments on dogs and horses it was ascertained 
 that the animals began to be slightly affected when the 
 proportion of alcohol in the blood reached the level 
 ■of "12 per cent., that with higher proportions the 
 symptoms became more marked, and that profound 
 stupor frequently ending in death, ensued when the 
 alcohol content rose to 72 per cent.^ Similarly in cases 
 ■of drunkenness in man, the blood has been found to 
 contain, in one observation '153 per cent, of alcohol, and 
 in another instance, when the intoxication was more 
 pronounced, "227 per cent.^ ; and it is generally accepted 
 that with a blood content of over "6 per cent., there is a 
 •considerable likelihood of death.' 
 
 ' Quoted in Kobert, Lehrbuch der Intoxikationen, Vol. 2, 
 p. 986. Stuttgart, 1906. 
 
 - Schweisheimer, Deutsches Arcliiv f. Klin. Medizin, Vol. 109, 
 p. 271. 1913. 
 
 'As qualifying this statement, see under "Tolerance," p. 91. 
 
These figures, however, do not convey much meaning 
 until we have translated them into terms of doses as 
 drunk. This we can easilj" do if we refer back to 
 what was said in Chapter II concerning the absorption of 
 alcohol into the blood and its subsequent fate in the 
 body. It was explained in that chapter (p. 20) that 
 alcohol passes rapidly from the stomach and bowel into 
 the circulation, and that, owing to the slowness with 
 which it is burned or excreted, the amount present in 
 the blood soon reaches a maximum level, bearing a 
 pretty constant relation to the dose originally drunk. So- 
 that, knowing the quantity of absolute alcohol taken and 
 the body weight of the drinker, we can at once give an 
 approximate estimate of the maximum proportion of 
 the drug which will be found in the circulation ; and 
 conversely, we can say what amount of alcohol must 
 be administered to give any particular percentage in 
 the blood. Thus, taking the figures which we have 
 quoted, the proportion of '15 per cent, which was found 
 in the blood in the less pronounced case of intoxication, 
 would correspond to an original dose of i'5 cubic centi- 
 metres of absolute alcohol for each kilogramme of body 
 weight, and this amount, expressed in English measure, 
 would be roughly equivalent, in the case of a man 
 weighing xo stone, to a total dose of 3^ ounces of 
 absolute alcohol, that is to say, nearly a gill and a 
 half of whisky at proof, or rather more than 4 pints of 
 beer of average strength (i.e. containing 4 per cenL 
 absolute alcohol). 
 
 Lctlial dose of alcohol. 
 
 Again, if we accept '6 per cent, as being approximately 
 the alcohol content of the blood in dangerous poisoning, 
 we shall put the fatal dose of the drug, for a man of the 
 weight given above, at about 14 ounces of absolute 
 alcohol, or nearly a pint and a half of proof spirit. The 
 quantity of beer which would contain this amount of 
 
alcohol would be over two gallons, so that it is easy to 
 understand that fatal cases of acute alcoholic poisoning 
 are not likely to occur from the drinking of a beverage 
 of this dilution. 
 
 Effect of diltitioii on intoxicating action of alcohol. 
 
 So far we have been considering the factor of dilution, 
 in its relation to drunkenness, simply as affecting the 
 quantity of alcohol which the drinker consumes, and 
 this, no doubt, is its most important aspect. It has been 
 suggested, indeed, that it may have a wider influence, 
 and that the inebriating action of a given dose of the drug 
 may differ to some extent according as it is taken in a 
 weak or strong solution, but the available evidence gives 
 little support to this view. Any such influence would 
 probably be due largely, if not entirely, to the effect of 
 dilution on the rate at which alcohol is absorbed into the 
 blood, and on the degree — in any case, as we have seen, 
 a ver\' limited degree — to which it is eliminated 
 unchanged from the body. 
 
 But the most recent experiments^ go to shew that dilu- 
 tion does not appreciably affect the rate of absorption, and 
 though it is true that a free action of the kidneys, which 
 would be promoted by the taking of a large bulk of fluid, 
 may lead to a slightly increased excretion of unchanged 
 alcohol in the urine, this increase is hardly sufficient to 
 have anj' real effect on the concentration of the dug in, 
 the blood. The question, however, is certainly one to 
 which further research might usefully be directed.^ 
 
 Inebriating action of different alcoholic beverages. 
 And a similar remark may be made with reference to the 
 supposed influence of the various bodies which are asso- 
 ciated with ethylic alcohol in wines and beers and spirits. 
 
 'Widmark. Skandinav. Archiv f . Physiologie. Vol.33 p. 85. I916. 
 ^ See footnote to Preface, p. vi. 
 
go 
 
 We are practically quite ignorant as to whether any of 
 these other substances modify the inebriating action 
 of alcohol, either by accelerating or retarding absorp- 
 tion, or in other ways. We do not know, for instance, 
 whether, as is popularly supposed, the drunkenness due to 
 beer differs in type from that due to whisky when doses 
 of equivalent alcoholic strength are given in both cases, 
 and, if there be any difference, we do not know on what it 
 may depend. It has been asserted that the alcohol of beer 
 may be absorbed more slowly owing to the amount of 
 gummy, or " colloid " matters contained in that liquor, 
 but such experimental evidence as exists does not support 
 this view. 
 
 Mixing of liquors. 
 
 Similarly we do not know whether there is any 
 foundation in fact for the popular belief that ''mixing 
 liquors," and, more particularly, the combination of 
 spirits with beer, is more likely to cause drunkenness 
 than the taking of an equivalent amount of alcohol in 
 one or other of these drinks alone. Another point on 
 which we need more exact knowledge is with regard to 
 the inebriating effect of the impurities met with in some 
 of the alcoholic beverages, and especially in badly recti- 
 fied spirits. 
 
 Practical conclusions regarding advantages of the more 
 dilute alcoholic beverages. 
 
 As our practical conclusion, then, from the evidence at 
 present available, we may say that an)' form of alcoholic 
 liquor can cause drunkenness, if such a quantity of it is 
 taken, at once or within , a short time, as will lead to the 
 presence of the drug in the blood above a certain pro- 
 portion, which in the case of the average healthy adult, 
 may be put provisionally at from '15 to '2 per cent. From 
 the point of view of the prevention of drunkenness, the 
 superiority of the more dilute beverages, such as the 
 lighter beers and natural wines, is therefore mainly due 
 
9i 
 
 to the fact that the bulk of the fluid makes it difficult for 
 the drinker to consume a very large dose of alcohol with- 
 in a moderate period. This, as we saw when referring 
 to the question of fatal intoxication, is an extremely 
 important superiority. 
 
 Differences in susceptibility to alcohol. 
 In the preceding remarks we have had in view the aver- 
 age normal drinker — the person who is neither specially 
 susceptible nor specially resistant to the inebriating 
 action of alcohol. But it is notorious that departures 
 from this average standard are very frequent : some 
 people are so constituted that they are affected by quite 
 small quantities of the drug, while others can take large 
 doses without showing any signs of intoxication. 
 
 Tolerance. 
 
 Moreover, as a result of continued use, some degree of 
 tolerance can be acquired, so that the habitual drinker is 
 often able to consume, without becoming obviously 
 intoxicated, quantities of liquor which would cause well- 
 marked drunkenness in a person unaccustomed to the 
 drug. Thus, instances have been known where steady 
 drinkers have been in the habit of taking alcohol in daily 
 doses exceeding lo cubic centimetres per kilogramme of 
 body weight, that is to say, for a man of lo stone weight, 
 no less than 23 ounces of absolute alcohol, or well over 
 two pints of whisky at proof, more than enough to kill 
 a neophyte. 
 
 We know very little as yet about the bodily changes 
 that accompany the development of tolerance. One 
 factor may be the increased capacity of the tissues to 
 burn alcohol, for it has been shewn that when the system 
 has become accustomed to the drug, it can oxidise it 
 much more rapidly, so that after a given dose, the 
 amount present in the blood does not rise to the same 
 level in an habitual drinker, as it would reach in the 
 
92 
 
 case of a person who had not acquired tolerance. That 
 this, however, can only be a contributory element is 
 evident from the fact, proved by experiment, that a 
 tolerant animal may show few or no signs of intoxi- 
 cation even when its blood contains enough alcohol 
 to cause well-marked symptoms in an unaccustomed 
 animal.^ It is obvious, .therefore, that when tolerance has 
 become established, either the access of alcohol to the 
 nervous centres is in some way impeded, or, as is more 
 likely, the nerve cells react less readily to its presence; 
 but we do not know anything of the conditions on which 
 this change depends. 
 
 Tolerance not acquired by all cells. 
 In the case of some other narcotics, as, for instance, 
 morphine, it has been proved that while certain nerve 
 cells acquire tolerance after long use of the drug, others 
 remain as susceptible as at the beginning. This has not 
 been shown to occur in alcohol tolerance, in which it is 
 probable that all nerve cells lose their reaction to the 
 drug in nearly equal measure. But it is certain that, while 
 the nerve Cells of the habitual drinker become tolerant to 
 the presence of alcohol, other body cells are less able to 
 accommodate themselves to it, with the result that tfaey 
 are very liable to be injuriously affected, if the develop- 
 ment of tolerance in the nervous system leads, as it 
 naturally tends to lead, to the taking of larger doses of 
 the drug. That is why drinkers who have, as they 
 would say, strong heads for liquor and who can con^tihie 
 a great deal Of alcohol without becoming drunk, are very 
 likely to suffer in the long run from some of those bodih- 
 disorders we shall presentlj- have to consider in dealing 
 with the subject of chronic alcoholism. And, on the 
 other hand, people who are specialh" susceptible to the 
 intoxicating action of alcohol are to a great extent 
 
 ' Pringsheim. Biochemisclie Zeitschrift, Vol. 12, pts. i & 
 1908. 
 
93 
 
 protected from excess by that very f^ct. Just because 
 they are so easily made drunk, they escape the more 
 serious evils of chronic poisoning. Hence, from the 
 point of view of general health, the acquisition of toler- 
 ance really implies the removal of a protective mechanism 
 — it allows the drinker to use the drug in doses which he 
 could not have taken if his brain cells had retained their 
 normal power of reacting to it. 
 
 Special susceptibility to alcohol ; pathological 
 drtuikenness. 
 
 A further point which should be noted before we leave 
 this question of drunkenness is that under certain con- 
 ditions, as, for instance, after an injur}' to the head or, 
 after an attack of mental disease, a special susceptibility 
 to alcohol may be developed in persons whose reaction 
 to the drug had previously been normal. And this 
 change may also come about in the later stages of chroniq 
 poisoning, especially after an attack of delirium tremens, 
 so that the habitual drunkard, from being more resistant 
 to the influence of alcohol, may become very much less 
 resistant. It is a fact of some importance that this 
 special susceptibility to alcohol, and notably the suscepti: 
 bility which results from injury, or appears in an advanced 
 stage of chronic alcholism, is shown not merely in the 
 readiness with which small doses give rise to mental 
 symptoms, but is also very often manifested in the 
 character of these symptoms, Which may differ more or 
 less widely from the symptoms of ordinary drunketiness. 
 Very usually, for instance, there is in these conditions of 
 " pathological drunkenness," as it is called, a special 
 degree of in^ohement of the highest nei'vous centres— thfe 
 parts of the brain whose activity is related to our conscious 
 life — so that prolonged phases of mental confusion with 
 excitement and impulsiveness are more likely to occut 
 than in the intoxication of normal individuals. For this 
 reason the pathological drunkard, especiallj- when his 
 
94 
 
 morbid predisposition is due to chronic alcoholism, is 
 very apt to commit acts of a seriously criminal character. 
 
 Chronic Alcnholistn. 
 
 Having said this much about acute poisoning by alcohol, 
 we now pass to consider the question of chronic intoxica- 
 tion. As was pointed out in the introductory section, 
 there may be no relation between the acute symptoms 
 set up by a single excessive dose of a drug, and the 
 chronic disorders that result from slower poisoning by 
 repeated and usually smaller doses of the same drug ; 
 and this is conspicuously the case with alcohol. The 
 symptoms of drunkenness are due to the immediate action 
 of alcohol in the body, an action, the effect of which, as 
 we have seen, is mainly apparent in disturbance of the 
 functions of the brain ; when the drug is eliminated from 
 the system, all trace of this action disappears and the 
 patient returns to his normal state. 
 
 It is quite otherwise in chronic alcoholism. Here 
 we have to do with changes in the drinker's tissues 
 which may be of a permanent character, and which at all 
 events persist long after the alcohol has been entirely 
 removed from the system ; and these changes are not 
 limited to the nervous centres, but may affect in one way 
 or another most of the organs of the body. 
 
 Chronic alcoholism due to a generalised devitalising action : 
 its associatiott with other deleterious influences. 
 It would be beyond the scope of this book to give 
 any detailed account of the disorders which are collec- 
 tively described under the term chronic alcoholism. 
 Briefly, it maj- be said that they represent the results of 
 a general devitalising action on the tissues, and that 
 they vary from a relatively moderate impairment of the 
 normal state of the organs to gross morbid changes 
 which ultimately cause death. Of course, the habitual 
 drunkard is exposed during his life to many other 
 
95 
 
 deleterious influences besides that of alcoholic excess ; 
 and several of these influences resemble alcohol more or 
 less closely in their mode of action ; so that it may be a 
 matter of considerable difficulty to assess the due im- 
 portance of the alcoholic factor in the causation of the 
 diseased conditions which are found in specially frequent 
 association with intemperance. This fact has not always 
 been adequately recognised in the past, with the result 
 that many morbid effects have been set down to the 
 account of alcoholism which are really due, wholly 
 or in far greater measure, to other causes. The 
 responsibilit}- of syphilis in particular has often 
 escaped recognition in this way, and diseases, such, 
 for instance, as general paralysis of the insane, which 
 we now know to be invariably dependent on syphi- 
 litic infection, were long regarded as capable of 
 being brought about by alcoholic excess. Such con- 
 fusion can occur the more readily because, as pointed 
 out in the recent Report of the Royal Commission on 
 Venereal Diseases, the intemperate drinker, by reason of 
 his lessened power of self-control, is specially prone to 
 expose himself to the risk of contracting these diseases, 
 and, owing to his lowered vitality, is liable to suffer from 
 them in aggravated form. 
 
 Moreover, the waj- in which alcohol acts in chronic 
 intoxication is complex : its injurious effects are only 
 partially the direct result of the drug entering the 
 system ; they are largely brought about through it.'; 
 detrimental action on the lining membrane of the 
 stomach and bowel, causing chronic catarrh and failure 
 in the action of the digestive juices, and so promoting 
 the absorption from the alimentary canal of poisonous 
 matters (digestive and microbial toxins, as they are 
 termed), which, in health}- conditions of the mucous 
 membrane would be formed in lesser amount, if at all, 
 and would certainly not be allowed to pass so freely into 
 
96 
 
 the system. It is, indeed, a question whether many of 
 the morbid changes which occur in other organs in the 
 course of chronic alcoholism may not really be secondary 
 to these local disorders in the gastro-intestinal tract ; for 
 it has been found in some recent experimental inquiries 
 that when alcohol was administered to guinea-pigs, not 
 by the mouth but by inhalation, no visible alterations 
 were produced in the animal's tissues, even when the 
 intoxication was kept up for periods as long as three 
 years — that is to say, during half the average life of an 
 animal of this species — and although its effects were 
 thought to be shown by the frequent occurrence of 
 abnormalities of development in the oiffspring.^ 
 Experimental alcoholism. 
 When these considerations are borne in mind, it will 
 be readily understood that it is very difiRcult to define the 
 limits of chronic alcoholism, and to distinguish its effects 
 from those of the other morbid influences which ma}- be 
 mixed up with it. Efforts have been made to overcome 
 this difiSculty by having recourse to the experimental 
 method ; and numerous investigations have been made 
 to determine whether the continued administration of the 
 drug to rabbits, guinea-pigs and other animals will 
 produce in their tissues morbid changes similar to those 
 found in chronic alcoholism in man. There are, it is true, 
 obvious limitations to this method : its conditions are 
 necessarily very artificial, and moreover, the differences 
 between man and other animals, especially in regard to 
 the development of the brain — the organ on which 
 alcohol exercises its most important action — are enormous, ' 
 so that it is only with considerable reserve that con- 
 clusions drawn from animal experiment can be applied 
 to human beings. Despite such drawbacks, however, 
 these researches have given certain positive results of 
 
 ' Stockard. American Naturalist, Vol. 47. 1913. Proc. 
 Society of Bxper. Biology and Medicine, Vol. 11. 1914. 
 
97 
 
 unquestionable value, particularly with regard to the 
 effect of chronic poisoning on the liver and on the 
 reproductive glands. The bearing of the facts will be 
 best brought out if they are considered in relation with 
 the data derived from the observation of alcoholic 
 diseases in man. 
 
 Individual variations in stisccptibilitv to chronic intoxication. 
 
 The first important point to be noted is that the results 
 of laboratory experiment are in full agreement with medical 
 experience in proving the existence of wide individual 
 variations in susceptibility to the injurious effects of 
 alcohol. Just as instances are occasionally met with 
 where persons have drunk what would be generally 
 regarded as dangerously excessive quantities of alcohol 
 for years, and have yet shown no signs of being the 
 worse in health, so likewise in experimental ,1,'esearches it 
 has been found that some animals do not appear to suffer 
 fi'om daily intoxication over long periods of time, while 
 others of the same species succumb after a few weeks. 
 Individuals, whether experimental animals or men, differ 
 also very widely in the susceptibilit}- of the several 
 tissues and organs to the action of the poison ; in one 
 subject, the liver may be specially attacked, in another 
 the nervous system, and so on. 
 
 Mental disorders in chronic alcoholism , relation af 
 alcoholism to insanitv. 
 Some affection of mind is usually present in chronic 
 alcoholism, but it is commonly moderate in degree, and 
 may be shewn only in weakened will-power and failure 
 of memory. More intense but transitory disorders 
 occur in delirium tremens^ and in an allied condition of 
 mental confusion associated with wide-spread nerve-in- 
 flammation. And in relatively rare instances, alcoholism 
 seems to be responsible for a chronic insanity with 
 persistent delusions, usually of persecution and jealousy. 
 
98 
 
 In general, however, the part which alcoholic excess 
 plays in the causation of the ordinary forms of mental 
 disease is of secondary importance : it has been shewn 
 that when the two facts are associated, intemperance is 
 more usually a symptom of insanity than its cause.^ This 
 is conspicuoush- seen in certain cases of periodical (or 
 manic-depressive) insanity, in which, or in one phase of 
 which, the most obtrusive symptom of mental disorder 
 is an intense and overpowering impulse to alcoholic 
 excess. In these relatively infrequent cases, to which 
 the name dipsomania is sometimes given, the patient 
 drinks heavily for a period varying in different cases 
 but usually pretty constant for the same case, and then, 
 when the attack ceases or passes into another phase, he 
 returns to sobriety — a fact, it may be noted incidentally, 
 which goes to shew that alcohol has no very strong habit- 
 forming influence. 
 
 Morbid cliangcs in nci-vous system in chronic alcoholism. 
 
 The morbid changes in the nervous system which are 
 found in chronic alcoholism are very variable in character 
 and degree : most commonly there is some thickening of 
 the membranes, with wasting of the nervous tissues, 
 notably in those parts of the brain which are supposed 
 to be specially related to the higher mental activities. 
 These appearances, however, are not distinctive oi 
 alcoholism, nor is it possible to see in them an explana- 
 tion of the nervous disorders of chronic intoxication any 
 more than we can discover, with our present modes of 
 examination, any morbid changes in the brain tissues of 
 the insane which can account for the symptoms of 
 insanitj-. As bearing on this point, it may be noted that 
 the diseased conditions seen in the brain of patients dead 
 of delirium tremens are quite similar to those just 
 referred to as occurring in cases of alcoholism without 
 
 ' Mott. Archives of Neurology, Vol. 3, p. 424. 1907. 
 
99 
 
 such active disorder, and, as in these cases, are neither 
 constant nor very definite. It is evident, therefore, that 
 in chronic intoxication the nervous tissues may be 
 damaged in ways which, while profoundly affecting their 
 intimate constitution and their healthy functioning, are 
 not revealed in any visible structural change. We have 
 already had an intimation of this fact in the development 
 of tolerance, which is also probably dependent on some 
 obscure alteration in the vital activity of the nerve cells. 
 In the affection of the nerves, especially the nerves of the 
 limbs, which occurs occasionally as a result of chronic 
 alcoholic poisoning, more particularly amongst women, 
 and which is technically known as alcoholic peripheral 
 neuritis^ degenerative changes are found in the nerve- 
 fibres, and also not infrequently in the related cells of the 
 spinal cord. In animals, after prolonged intoxication 
 with alcohol, some observers have found alterations in 
 the nervous system, affecting both the nervous, tissues 
 proper and the smaller blood-vessels ; but the meaning 
 of these changes and their dependence on the chronic 
 poisoning are uncertain. 
 
 Disorders of the digestive system in chronic alcoholism. 
 
 It is well known that a frequent cause of death in the 
 subjects of chronic alcoholism is cirrhosis of the liver 
 with dropsy. An organ is said to undergo cirrhosis 
 when the fibrous connective tissue is increased and there 
 is an associated degeneration of the cells upon which the 
 functions of the organ depend. 
 
 Chronic inflammation of the stomach {gastritis) is met 
 with in heavy drinkers, especially in those who indulge 
 in large quantities of spirits. It precedes and is, in a 
 great measure, responsible for the disease of the liver. 
 The chronic irritation and subsequent inflammation of 
 the mucous lining of the stomach sets up degenerative 
 changes in the cells which secrete the gastric juice ; and 
 
 16066 H 
 
lOO 
 
 the hydrochloric acid, essential for digestion and the 
 prevention of bacterial fermentation may be completely 
 absent. 
 
 The blood circulating in the blood vessels of the 
 stomach and intestines is returned into the general 
 circulation via the portal vein of the liver, so that the 
 blood in this organ contains poisons absorbed from the 
 alimentary canal to a greater degree than other organs, 
 e.g. the kidneys. The continuous circulation of these 
 poisons in the liver gives rise to prolonged irritation of 
 the connective tissue supporting the portal vein, its 
 branches and remote ramifications throughout the organ. 
 A chronic inflammation is thus brought about in this 
 tissue, accompanied by a degeneration of the intrinsic cells 
 of the liver, vsrhich at farst is enlarged. This enlarge- 
 ment in many cases persists until fatal dropsy sets in, or 
 the more complete conversion of the chronic inflamma- 
 tory tissue into fibrous tissue may eventually cause such 
 a shrinkage of the organ, that it becomes much smaller 
 than natural, and its surface is so irregular and nodular 
 as to be termed " hobnailed." 
 
 In experiments on animals a catarrhal inflammation of 
 the mucous membrane has been set up, similar to that 
 which is seen in the stomach of the habitual drunkard. 
 And some recent researches have shewn that changes 
 in the liver corresponding to those of cirrhosis in man, 
 can also be produced in animals hy long-continued 
 intoxication with alcohol.^ 
 
 Other bodily disorders m chronic intoxication. 
 
 It is also generally recognized that chronic alcoholism 
 is an important cause of disease in other organs, that it 
 contributes, for instance, to the development of Bright's 
 
 Kyrle and Schopper. Virchow's Archiv f. patholog. Anatomie, 
 Vol. 215, pp. 309 and 321. 1914. 
 
lOI 
 
 disease of the kidneys, that it helps to bring about the 
 degeneration of the blood-vessels which leads to 
 apoplexy, and that it tends to promote fatty degenera- 
 tion of the heart, as well as being a very important 
 cause of fatty deposit on the surface of that organ. All 
 these diseased conditions, however, are met with also 
 very often in persons who never take alcohol : they 
 may be brought about by many deleterious agencies, 
 operating singly or in combination, and alcoholism is 
 merely one of these agencies. 
 
 Alcohol and resistance to infective disease. 
 
 The relation of alcohol to infective disease is of a 
 somewhat similar kind : the chronic poisoning, by 
 devitalising the tissues, lowers the defences of the 
 body against microbial invasion ; consequently, specific 
 germs, such as those which cause pneumonia and 
 tuberculosis, as well as the ordinary microbes of septic 
 inflammation and blood-poisoning, find a suitable soil. 
 A slight general depressing influence — a chill or a local 
 injury — which would have no harmful effect upon a 
 healthy individual, even if micro-organisms were 
 present, because the vital reaction of the living tissue 
 would prevent a general infection, may be most dan- 
 gerous to a chronic alcoholic. 
 
 It has also been suggested that resistance to infective 
 disease may be prejudicially affected by alcohol when 
 taken in even moderate and occasional doses ; but the 
 experimental researches by which it has been sought 
 to establish this view have not given any clear results. 
 On the other hand there is no evidence for the popular 
 belief which attributes to such doses of alcohol a pro- 
 tective value in cases of exposure to infection. 
 
 Action of alcohol on the reproductive cells. 
 In the foregoing remarks we have been considering 
 alcoholism merely as affecting the individual : we have 
 
I02 
 
 now to refer to the wider influence which it may exert 
 on the stock through its action on the reproductive cells. 
 The earlier inquiries regarding the reality and extent of 
 this influence were mainly directed to determining, from 
 statistical material, whether conditions of defective 
 development are or are not specially frequent in the 
 ofi'spring of alcoholic parents. Evidence of this sort, 
 however, even if its accuracy were unquestionable and 
 its indications positive and clear — and this can rarely be 
 said of any of the statistical data used in this controversy 
 — would obviously be open to serious criticism, inasmuch 
 as any excessive incidence of defect in the children of 
 habitual drunkards might be due, not to the influence 
 of parental alcoholism, but to the presence of a syphilitic 
 taint or to an original faultiness in the stock. On this 
 account it is preferable to approach the question from 
 another point of view, and to rely mainly on such 
 data as are obtainable from the s}'stematic examination 
 of the genital glands in alcoholic subjects, and from 
 breeding experiments on animals. Researches in both 
 these directions ha\e been recently carried out, and have 
 given results which, as far as they go, are definite and 
 concordant. 
 
 The state of the reproductive glands in habitual drunk- 
 ards has been investigated by two independent observers,^ 
 who have shewn that a condition of wasting of the testicles 
 with absence or scanty production of the fertilising cells 
 or spermatozoa, is to be found in the majority of male 
 alcoholics d)ing in the prime of life, while in the female. 
 alterations of a similar character may be discovered in 
 
 ' Bertholet. L'lnfluence de I'alcoolisnie chronique sur les. 
 organes de rhomtiie, et sur les glandes reprodiictrices eu particu- 
 lier. Ivausanne, 1913. Also comiiiunications by the same author 
 to the luteruatioual Congresses on Alcoholism at I/Ondon (1909), 
 and at The Hague (1911). 
 
 Weichselbaum. Verhandl. der deutsch. pathol. Gesellschaft, 
 Jena, 1910. 
 
X03 
 
 the ovaries. Further, it has been shewn by experiments 
 •on rabbits that, by the continued administration of the 
 drug, morbid changes can be produced in the genital 
 glands of these animals of the same type as those which 
 have been observed in chronic alcoholism in human 
 beings. 
 
 Effect of parental alcoholism, on offspring. 
 
 The fact that these glands are so frequently and so 
 markedly affected in conditions of chronic intoxication 
 gives some indirect support to the view that parental 
 alcoholism may react injuriously on the vitality and 
 normal development of the offspring. And recent re- 
 search has furnished very important direct evidence to 
 the same effect. It has been shewn by Stockard,i in a 
 series of experiments in which alcohol was administered 
 to guinea-pigs by inhalation, that the offspring of the 
 alcoholised animals, in comparison with the young of 
 control animals of the same stock, were conspicuously 
 inferior in strength and vitality, and in many instances 
 presented gross abnormalities of organisation. These 
 bad effects were transmitted through several generations, 
 and were, indeed, more pronounced in the later genera- 
 tions, than in the immediate offspring of the alco- 
 holised subjects. An important point brought out by 
 Stockard is that the injurious influence of the intoxica- 
 tion may be manifest in the offspring even when the 
 genital glands appear to be quite healthy, thus shewing 
 that, although there are no visible structural changes in 
 the germ cells, they have been modified to an extent 
 suf&cient to cause them to give rise to defective embryos 
 ■or weakened individuals who die shortly after birth. 
 
 These observations and experiments would thus appear 
 to indicate that parental alcoholism may have a seriously 
 
 ' Stockard, loc. at. 
 Stockard and Papanicolaou, American Naturalist, Vol. 50, 1916. 
 
104 
 
 detrimental influence on the stock ; and if the results are 
 confirmed by further investigation, it will be reasonable 
 to conclude that this is probably one of the most 
 important modes in which intemperance threatens the 
 health and well-being of the community. But, in view of 
 the extreme importance of this conclusion, it is clearly 
 desirable to suspend judgment until the work has been 
 controlled by other inquirers. 
 
 Causation of chronic alcoholism. 
 After this brief review of the disorders of chronic 
 alcoholism, the next question to be considered is, under 
 what conditions do these disorders come about? What 
 mode and degree of excess are liable to lead to chronic 
 poisoning ? In endeavouring to answer this question 
 we have not at our disposal any direct evidence 
 comparable to what we had when discussing drunken- 
 ness ; and we must, therefore, be content, at all events 
 for the moment, with such indirect indications as can be 
 gathered from a general survey- of the facts. 
 
 Continuity of action and excess of dose nccessaty factors. 
 
 The main conclusion that we arrive at in this way is, 
 that there are two essential factors in the causation of 
 chronic alcoholism : first, the drug must be taken in 
 sufiicient quantity to exercise an injurious action on the 
 tissues, and second, that action must be more or less 
 continuous. Excess of dose without continuity of action 
 does not give rise to persistent tissue changes ; as we 
 have already seen, an isolated bout of drunkenness does 
 not leave any lasting after-effects. Again, the regular 
 use of alcoholic beverages does not induce chronic 
 poisoning so long as only moderate doses are drunk ; 
 this is a matter of common experience, and we can see 
 evidence of it on a large scale in the absence, or extreme 
 rarity, of chronic alcoholism in communities where, as 
 
I05 
 
 in the non-industrial populations of Southern France, 
 Spain, and Italy, alcohol is part of the ordinary dietary, 
 but is drunk in moderation and in the form of natural 
 wines of low strength. 
 
 Conditions which promote chronic alcoholism. 
 
 In the absence of exact data, we cannot safely go beyond 
 these general propositions, and we shall not, therefore, 
 attempt to make any estimate as to how much alcohol 
 there must be in the blood, and how long its action 
 must be kept up, to exercise a detrimental effect on the 
 vitality of the tissues. For practical purposes it will 
 be sufficient if we endeavour to distinguish the 
 conditions which cause alcoholic beverages to be taken 
 in such excess, with regard to amount and frequency of 
 dose, as appears from actual experience to involve more 
 or less injury to the drinker's health. In a general view, 
 we may summarise the more important of these con- 
 ditions as follows. 
 
 (i) Use of the stronger alcoholic beverages. — When liquors 
 of high alcoholic strength are drunk, there is an ante- 
 cedent probabilitj' that an excessive dose of alcohol may 
 be more readily taken. The man who drinks a light 
 beer must consume some pints of fluid before he gets as 
 much alcohol into his blood as the spirit drinker would 
 absorb from a glass of neat whisky at proof. And that, 
 no doubt, is one reason why drunkenness appears to be 
 relatively more frequent in spirit drinkers than in beer 
 drinkers, though the difference is probably less pro- 
 nounced than is commonly supposed. In a recent inquiry 
 directed to this point, it was ascertained that amongst 
 1,505 persons (1,032 males and 473 females) charged with 
 drunkenness, in I,ondon and 14 other large cities in 
 England during a period of three weeks, intoxication 
 
io6 
 
 was attributed to beer alone in 45*4 per cent, of the cases 
 occurring in men, to spirits alone in 42^0 per cent., and 
 to beer and spirits together in io"8 per cent., whilst 
 amongst women the proportions were, beer alone, 
 37'6 per cent., spirits alone, 49*0 per cent., and beer 
 and spirits together, 8"6 per cent. Inasmuch as the 
 amount of alcohol taken in the form of spirits in the 
 whole United Kingdom is only one-third to one-quarter 
 that which is consumed in beer, it is legitimate to 
 conclude from these figures, drawn from the predo- 
 minantly beer-drinking part of the country South of 
 the Tweed, that there is in fact a greater likelihood 
 of immediate excess when the stronger alcoholic bever- 
 ages are used. The statistical information with regard 
 to the relative importance of the several sorts of liquor 
 in the causation of chronic alcoholism is very scanty, 
 but, as far as it goes, it points even more clearly 
 in the same direction, and is thus confirmatory of the 
 general medical belief that spirit drinking is specially 
 liable to induce alcoholic disease. 
 
 Apart from the greater risk of excess of dose when 
 highly alcoholic beverages are drunk, the use of these 
 more concentrated liquors tends, as we have already 
 seen, to promote chronic poisoning, on account of the 
 damage done to the lining membrance of the stomach 
 by the direct action of alcohol in strong solution. 
 
 (ii) Frequent repetition nf dose. — It takes some hours 
 before even a moderate dose of alcohol is completely 
 eliminated from the system ; so that if a fresh quantity 
 of liquor is drunk during this period when the blood 
 still contains a significant percentage of the original dose, 
 the alcohol level in the circulation will rise again. And 
 if further doses continvie to be taken at similar intervals, 
 the action of the drug in the body will be kept up 
 persistently. This is what happens, for instance, in the 
 case of industrial workers who have frequent recourse to 
 
I07 
 
 alcohol during the hours of labour, as, e.g.^ dock labourers, 
 butchers, etc. : owing to this frequent repetition of doses, 
 which, taken individually, may be quite moderate, but 
 which by their addition maintain a considerable con- 
 centration of the drug in the blood, drinkers of this class, 
 industrial drinkers as we may term them for brevity's 
 sake, are peculiarly apt to suffer from the chronic effects 
 of alcohol. In this respect, they contrast very strikingly 
 with men engaged in such occupations as coal-mining. 
 The miner's task involves muscular effort which in its 
 character and degree might appear a priori to be equally 
 favourable to the use of alcoholic beverages as an element 
 in the working diet. The conditions, however, under 
 which the work is carried on are such as preclude 
 altogether the possibility of taking alcohol during the 
 hours of labour ; and amongst coal-miners, accordingly, 
 industrial drinking is practically unknown, and alcoholic 
 disease is exceptionally infrequent. Thus, if we refer to 
 the statistics of occupational mortality published by the 
 Registrar-General (vide appendix 3), we see that, while in 
 the case of dock labourers the "comparative mortality 
 figure " for alcoholism is more than three times that for 
 the general male population, the corresponding figure for 
 coal-miners is less than half the same standard, and is, 
 in fact, one of the lowest on the list. There is no reason 
 to suppose that this contrast is due to any difference in 
 general sobriety between the two groups in question — the 
 incidence of drunkenness is very similar upon mining 
 districts and upon seaports — so that it seems more 
 reasonable to attribute it mainly to the prevalence of 
 continuous or quasi-continuous drinking amongst dock 
 labourers, and to the absence of that type of drinking 
 amongst the coal-miners. 
 
 The inference to be drawn from these facts is, there- 
 fore, that, in order to prevent the development of 
 chronic intoxication, it is essential that alcohol should 
 
io8 
 
 not be taken in such frequentl}' repeated doses as will 
 keep up a constant excessive action in the system- — 
 that is to say, that intervals should elapse between the 
 times when alcoholic liquors are drunk, such that the 
 average concentration of the drug in the blood remains 
 well below the point at which there is any risk of 
 injury to the tissues. 
 
 (iii) Dtinking zvithou food. — Food, when taken with 
 alcohol, dilutes it, and so decreases the irritant action 
 of strong alcoholic beverages upon the lining membrane 
 of the stomach ; the lack of this protective influence 
 is probably an important factor in the greater suscep- 
 tibility of the industrial drinker, who commonly 
 takes much of his alcohol on an empty stomach, par- 
 ticularly the early morning dram, or " livener," with 
 which it is customary in some districts to start the day's 
 work, 
 
 (iv) Sedentary Occupation. — It is popularly supposed 
 that intemperate persons of sedentary habits are more 
 liable to suffer from the effects of alcoholic excess 
 than drinkers engaged in active outdoor accupations. 
 And to a certain, though very limited extent, this 
 view is supported by what we know of the conditions 
 which may modify the oxidation and elimination of 
 the drug. Thus we have seen that vigorous muscular 
 exertion causes alcohol to be burned rather more 
 quickly in the body, and also increases the proportion 
 which passes out unchanged in the breath. The effect 
 produced in either of these ways is not, however, so 
 considerable that it can to an important degree protect 
 the drinker from the injurious results of the habitual use 
 of the drug in excessive and frequently repeated doses ; and, 
 in fact, as shewn by the statistics of occupational mortality 
 already referred to, the death-rate from presumably alco- 
 holic disease is specially high in several of these industries 
 
log 
 
 which involve hard muscular labour in the open air. 
 Thus the theoretical advantage which this active sort of 
 work confers on the drinker, in accelerating the removal 
 of alcohol from his system, is in practice much more than 
 counterbalanced by the tendency, which such work 
 creates, to the continued and excessive use of the drug as 
 a supposed aid to labour. 
 
 And from this point of view the risk of chronic 
 intoxication is in some sort enhanced by what would 
 appear prima facie to be a desirable quality in alcohol, 
 viz., its food value. As we have already seen, it can 
 be used to furnish as much as one-fifth of the total 
 amount of the energy required by the body, so that the 
 industrial drinker, over and above the relief from the 
 sensations of fatigue which the drug gives him, obtains 
 in his alcoholic liquor a supply of fuel food which enables 
 him to reduce substantially his consumption of other 
 forms of nutriment. The fact, therefore, that alcohol 
 has a high fuel value, tends in an important measure 
 to promote its habitual use as a food for very laborious 
 work in substitution for other foods, and as, unlike 
 these other foods, it is not stored in inert form in the 
 body, but remains unaltered in the tissues, it can 
 exercise for some time a deleterious influence on their 
 vitality. 
 
 Habit-forming influence of alcohol. 
 
 To complete this examination of the factors which 
 contribute to the development of chronic intoxication, it 
 is necessary to say something of habit in relation to 
 alcohol. A number of drugs, especially drugs of narcotic 
 action, when they have been taken repeatedly for a 
 sufficient length of time, tend to create in the subject a 
 need or "craving" for their continued use; such drugs 
 are described as habit-forming, and the condition existing 
 when the need or " craving " has become established, is 
 called the drug-habit. It is to^be noted that a drug- habit. 
 
no 
 
 in this special sense of the term, means a good deal more 
 than the habit of taking a particular drug : thus, for 
 example, a person who suffers from some chronic or 
 frequently recurring disorder which is relieved by a 
 specific medicine, will be likely to use that medicine 
 regularly, but he will not be considered, on that account 
 alone, to have contracted a drug-habit ; his need of the 
 drug is due to the persistence of the cause which 
 Jed him to resort to its use in the first instance, it 
 has not been created by the action of the drug on his 
 system. Neither can we properly bring into the category 
 of drug-habits, in the narrower meaning in which the 
 term is here employed, those instances where the con- 
 tinued use of a drug has given rise to a sense of need, 
 solely through that general characteristic of our nervous 
 organisation in accordance with which we tend to repeat 
 actions that we have become accustomed to perfoini. 
 It is true that this influence does enter to some extent 
 into the formation of true drug-habits, as it necessarily 
 must in the case of all behaviour which has become 
 ■customary and agreeable ; but it is obviously a factor of 
 different nature from the specific disposition which is 
 ■created by the continued action of the drug, and which 
 gives to the drug craving its distinctive character. 
 
 Factors which may contribute to the formation of the alcohol 
 
 habit. 
 
 In the development of the alcohol habit, all these 
 factors play their parts. The habitual drinker takes 
 alcohol primarily for the sake of the agreeable effects 
 produced through the nervous system, because he finds 
 that it relieves the sensations of fatigue, and because he 
 believes that it gives him increased energy for his work ; 
 and the return or persistence of these motives un- 
 doubtedly contributes to the regular use of alcohol. 
 Similarly, some persons are said to " fly to drink" when 
 
Ill 
 
 they are worried or in pain. In these instances alcohol 
 is taken with the definite object of obtaining relief from 
 some disability. In other instances the chief factor in 
 drinking seems to be an attitude of mind which is 
 comparable with that induced by the continued repetition 
 of any other act which becomes habitual in the ordinary 
 sense. Such is the case of the drunkard who cannot pass 
 his usual public-house or meet his ordinary boon com- 
 panions without having a glass ; his conduct may be 
 largely an instance of habit, and his difficulty in breaking 
 it off may be scarcely greater than that of the loafer in 
 deserting his usual street corner. But while these 
 factors undoubtedly play an important part in the 
 development of habitual drinking, there can be no 
 question that the continued abuse of alcohol leads in 
 many instances to changes in the mental and bodily 
 functions which create a need or craving for alcohol. 
 The depression which is present during the recovery from 
 one drinking bout may be relieved by further indulgence 
 and thus lead to the continued use of the drug. The 
 most striking examples of craving are seen in secret 
 drinkers, in whom the abuse of alcohol is somewhat 
 similar to that of morphine in morphine-takers. 
 
 Tolerance and abstinence symptoms in driig--habits. 
 In the case of some habit-forming drugs, the drug 
 gradually loses its power and no longer induces the 
 action which followed its first administration. The best 
 example of this is offered by morphine, the most active 
 ingredient of opium. The morphine taker, or morphino- 
 maniac, through the habitual use of the drug, becomes 
 less and less susceptible to its immediate eff'ects, that 
 is to say, he acquires tolerance with regard to it, and, 
 by reason of this tolerance, he tends constantly to in- 
 crease his regular dose. Further, when he is deprived 
 of his usual allowance, he experiences acute discomfort, 
 
and, if the drug is suddenly and completely cut oft, he 
 sometimes presents symptoms of serious collapse which 
 may even end fatally if morphine is not administered 
 to him. 
 
 Tolerance and abstinence symptoms in drinkers. 
 The development of tolerance, then, and liabilit}' to 
 abstinence symptoms are often the accompaniments of 
 the true drug-habit. The degree, however, to which 
 they may be present varies very widely in the case of 
 difierent drugs. How does the matter stand with regard to 
 alcohol ? As we have already seen, the continued use of 
 alcohol produces tolerance, though never to the extent 
 that may be reached in the morphine habit. And alcohol 
 also may induce such a condition in the drinker that its 
 complete and sudden withdrawal will give rise to a feeling 
 of urgent need, or " craving," for the drug, which is 
 usually regarded as, and probably is, at least in part, a 
 genuine abstinence symptom. Though very lurid ac- 
 counts of this craving are sometimes given by neurotic 
 drinkers, it would appear that ordinarily the feeling, in 
 so far as it really is such a symptom, is vers- much 
 weaker than the craving which habitual users of other 
 drugs experience as a result of abstinence. Thus, 
 drunkards in prisons and other institutions where liquor 
 is not obtainable, complain much less of discomfort 
 from the lack of alcohol than from that due to the 
 prohibition of smoking. 
 
 Delirium Tremens not due to abstinence. 
 It has also been suggested that abstinence symptoms of 
 a more definite and graver sort may occur in alcoholic 
 subjects, and, more particularly, that the abrupt cutting 
 off of the drug in the case of a heavy drinker, may 
 precipitate an attack of delirium tremens. This has 
 been disputed, however, by many authorities, and several 
 arguments have been brought against it. Thus, delirium 
 
^^3 
 
 tremens is of very rare occurrence in institutions where, 
 as in the majority of inebriate retreats, it is the regular 
 practice to stop all alcoholic liquor immediately on 
 the patient's admission. Further, when the disease has 
 developed, its course is not affected by the administration 
 of alcohol, whereas the abstinence symptoms resulting 
 from the suppression of other diug-habits, as, e.g., the 
 morphine habit, are relieved at once when a dose of the 
 drug is given. Finally, recent investigation has shewn 
 that in many cases of delirium tremens, the fluid which 
 bathes the brain and spinal cord — the cerebro-spinal 
 fluid — contains appreciable amounts of alcohol, so that 
 evidently its presence in the nervous system does not 
 prevent the onset of an attack^. 
 
 Relatively slight habit-forming tendency of alcohol. 
 Alcohol thus diff'ers from such habit-forming drugs as 
 opium and morphine in the fact that its sudden with- 
 drawal causes less severe symptoms, and that no high 
 degree of tolerance is acquired by its prolonged use. 
 But these are diff'erences in degree rather than in kind. 
 And it is to be added that our experience of morphine- 
 takers in this country is limited to severe cases com- 
 parable to the confirmed drunkard. In each case the 
 habit of abuse may in part arise from the persistence or 
 recurrence of the conditions and circumstances which 
 originally led to recourse to the drug. But the habit of 
 excess once formed tends to become stronger through 
 the enfeeblement of the will which results from the 
 continued action on the central nervous system and 
 lessens the power to resist the invitation of the narcotic. 
 
 ' Demole. I/'Eiicephale, January, 1914. 
 
"4 
 
 CHAPTER IX. 
 
 Alcohol and Longevity. 
 
 Does " moderate " drinking affect the average duration ot 
 
 life ? 
 
 Thus far we have examined the subject in the light 
 of direct experimental, pathological or clinical researches, 
 and our task has not differed in kind from that of any 
 writers on physiological or medical questions. But a 
 discussion of the properties of alcohol is more or less 
 intimately related to that of various sociological and 
 economic problems the elements of which can rarely be 
 subjected to the process of isolation and intensive study 
 which is the essence of experimental science. Hence 
 arises the appeal to other kinds of evidence. In popular 
 discussions a good deal of use has, for instance, been 
 made of statistics. A proportion of such statistics refers 
 to matters which do not come within the scope of our 
 inquiry, such for instance as alcohol and crime ; but 
 something remains which we are called upon to examine. 
 To see how this happens, we may recur to a point made 
 in our introduction, viz., the existence of loosely defined 
 or undefined notions respecting the value of alcohol as 
 an habitual beverage. Many people think that a daily 
 glass of beer, wine or spirits "does them good" ; others 
 are not less confident that the use of such substances 
 does harm. Some of the implications of these statements 
 have already been noticed, but one remains for individual 
 attention. This is the belief that "moderate" drinking 
 shortens (or lengthens) life on the average. 
 
 Every reader of these pages must have seen a para- 
 graph describing an interview with some aged man (by 
 preference a centenarian) where the person interviewed 
 attributes his length of days to (a) total abstinence from 
 alcohol or tobacco, or (b) absolute regularity in the 
 
115 
 
 daily consumption of — say — one pint of beer and one 
 pipe of tobacco. . Again, beyond this anecdotal substitute 
 for scientific evidence, one finds statements describing 
 the heavy mortality suffered by, let us say, publicans and 
 inn servants ; the inference, whether expressed or 
 implied, being that they have shortened their lives by 
 the abuse of alcohol; or, on the other hand, we see 
 quoted the low death rates of the clergy, it again being 
 suggested that the large proportion of total abstainers 
 from alcohol to be found in this class is responsible for 
 the advantage enjoyed. The wide currenc)' of such 
 statements and implications makes it incumbent upon us 
 to inquire whether there really exists any evidence upon 
 which scientific conclusions can be founded with 
 reference to the relation between a habit of consuming 
 moderate quantities of alcohol and longevity. 
 
 Nature of available evidence. 
 
 The extreme difiiculty of the subject can be best 
 displayed by considering the kind of data that v/ould 
 need to be provided for a solution on the experimental 
 lines of the work used as a basis for the earlier chapters 
 of this book. 
 
 In effect we should require to have at our disposal a 
 number of men or women of like ages, similar ancestry, 
 occupations and civil condition. We should divide 
 them at random into two groups, the members of one 
 group would receive a fixed quantity of alcohol daily, and 
 the fates of all would be recorded from the time of 
 beginning the experiment until everyone was dead. 
 Naturally no such experiment has been carried out, and 
 we are obliged to fall back upon such partial substitutes 
 as the ordinary chances of society have placed at our 
 disposal. We shall not weary the reader with a 
 description of various admittedly imperfect or quite 
 unsuccessful attempts that have been made to find such 
 
 i6o66 I 
 
ii6 
 
 substitutes, but pass at once to the efforts which may at 
 kast be regarded as partially successful. Among siich, 
 certain statistics of insurance companies deserve mention. 
 As everybody knows, nearly all insurance companies 
 take special pains to learn the state of health and habits 
 of persons whose proposals are entertained, while there 
 are some which classify separately policy holders who are 
 or are not total abstainers from alcohol. An important, 
 example is the United Kihgdom Temperance and 
 General Provident Institution, and its experience has 
 been often quoted in the present connection. The 
 scientific papers dealing with this special case are cited 
 in the footnote and must be examined by a reader who 
 wishes to master the somewhat technical problems which 
 can here only be sketched in outline.^ 
 
 Experience of the United Kingdom Temperance and General 
 Provident Institution. 
 
 This office accepts, at the same premium, abstainers 
 from alcohol and non-abstainers, but, after acceptance, the 
 records of the two classes are kept apart, bonuses being 
 declared separately for each class in accordance with its 
 mortality experience. This is to say, that no immediate 
 inducement is held out to entrants who are abstainers ; 
 if they do derive any advantage in the long run, it will be 
 because their average longevity is greater, so that their 
 section of the office earns larger bonuses. 
 
 Now among males insured by this company (whole life 
 policies) it was found that 26-4 per cent, fewer deaths 
 occurred among the abstainers than would have taken 
 place had they died at the rate observed in the class of 
 non-abstainers. This great difference does not mean that 
 the non -abstainers were bad lives ; as a matter of fact, 
 
 ' Moore, Journ. Institute of Actuaries, XXXVIII, 213. 
 Lidstone, ibid. p. 273, 1904. Andrae, Berichte d. sten. Inter- 
 nationale!] Kongresses f. Versicherungs-Wissenschaft, p. 491, 1906. 
 
ir/ 
 
 their mortality was almost the same as experienced by 
 the clients of the 23 British Offices whose pooled 
 experience over the years 1 863-1 893 formed the basis of 
 a widely used table of mortality for insurance purposes 
 (that is, a table shewing the chance of a person dying at 
 various ages). To use a statistical average which is, 
 possibly, more vivid than a mere comparison of per- 
 centages of deaths, we may take the expectation of life 
 at age 30, that is, the average number of years lived by 
 persons after the thirtieth birthday. According to the 
 experience of the total abstainers, this is, on the average, 
 a little more than 39 years, while for the non-abstainers 
 it is some 35 years less ; indeed only one life office, viz., 
 the Clergy Mutual, has recorded an expectation of life 
 superior to that of the Total Abstainers of the United 
 Kingdom Temperance and General Office. 
 
 Thus far we have considered only males having ordinary 
 whole life policies. The experience of the office with 
 women was not so extensive and the difference between 
 the two classes, abstainers and non-abstainers, although 
 in favour of the former, was not significantly so ; they had 
 only 3 per. cent, fewer deaths than their fellows (all these 
 comparisons naturallj- allow for differences of age). The 
 data for Endowment Policies (the popular modern form 
 of insurance in which the sum assured is paj'able at a 
 •certain age or at death, whichever conies first) shewed a 
 great advantage among the abstainers (i8'2 per cent, 
 fewer deaths than expected) but not so great an ad- 
 vantage as seen in the whole life policies. 
 
 Difficulties in interpretation of the experience of the United 
 Kingdom Tempei'ance Institution. 
 
 There is evidently no reasonable doubt that the 
 abstainers insured in this office do, on the average, live 
 longer than the non-abstainers, but it would not be 
 scientific to attribute the result solely to the fact of 
 
ii8 
 
 abstinence from alcohol without further analysis. In- 
 surance statistics have to be interpreted with great care, 
 owing to the influence of selection and collateral social 
 conditions. Thus, it has been pointed out that the 
 number of policies in force in the abstainers' section of 
 this office increased by 29 per cent, between 1882 and 
 1902, while the number of non-abstainers' policies 
 diminished in the same time by 23 per cent. The con- 
 sequence was that the experience of the abstainers was 
 necessarily somewhat more favourable than that of the 
 non-abstainers from an assurance standpoint, for two 
 reasons : (i) It contained a larger proportion of recentlj' 
 selected lives, i.e. persons who had been more recently 
 medically examined ; (2) these persons lived during a 
 period of lower general mortality, viz., after rather than 
 before 1882. It is of course obvious that a man aged 35 
 is more likely to die within a year if he had insured 
 when 25 than if he had been accepted by the insurance 
 doctor when 34 years old, since he has had time to fall 
 a victim to a disease which the doctor will detect at his 
 examination, but could not predict several years earlier. 
 Again, we know that the expectation of life for all classes 
 has improved with time, in consequence of new medical 
 discoveries which benefit all, and of our modern higher 
 standards of public and personal hygiene. 
 
 It is not possible to measure the effect of this difference, 
 but it is proper to state that when the statistics 
 were limited to the period ending in 1882 (the whole 
 data published relate to the years from 1848 to 1901), the 
 abstainers still had an advantage, although for that 
 period, the above mentioned factors should rather tell 
 against them, because during the first eight years of its 
 existence the office only accepted abstainers, so that 
 there would have been proportionally more new policies 
 among the nou-abstainers. 
 
 Another criticism from the insurance standpoint is 
 
119 
 
 directed to two peculiarities in the experience of this 
 oflSce. The first is that the ratio of death rates, of males 
 to death rate of females (abstainers) is altogether unlike 
 that found in other offices, the female mortality, being 
 proportionally, much too high. The second is that the 
 mortality experience of the abstainers holding endow- 
 ment policies was not appreciably better than that of the 
 abstainers holding whole life policies. Both these facts 
 have suggested to a well-known continental actuary 
 (Andrae) that the abstainers were, at the time they 
 insured, " select " lives.. Thus, the proportion subsisting 
 between male and female rates of mortality must be 
 chiefly due to the differences of liability to certain 
 diseases and accidents dependent upon sex itself and to 
 secondary sexual consequences, such as occupation, 
 general habits, etc. It is not easy to see why this 
 •proportion should be changed if both men and women 
 abstain from alcohol. Again, all other offices have 
 found that persons who take endowment policies die at 
 lower rates, on the average, than do those who take life- 
 long policies. The usual explanation given is that 
 self selection is important. Anyone who thinks either 
 because many of his relations died young, or perhaps 
 because of some private habits or intentions which do 
 not come within the scope of an insurance company's 
 inquiries, that he will not live long, is not likely to pay 
 the higher premium required for an endowment policy, 
 so that the endowment policy holders are twice selected. 
 Naturally we cannot think that abstainers have less 
 powers of self selection than non-abstainers, so, in the 
 opinion of the critic, we must conclude that the whole 
 life policy holders were already a select class when they 
 insured, and that their lower rate of mortality may not 
 have had anything to do with their lifelong abstinence 
 from alcohol. 
 
 It would be exceeding the limits we have assigned to 
 
120 
 
 this statement were we to discuss the theoretical argu- 
 ments in support or in rebuttal of this criticism. It 
 does not seem practicable to apply any objective test 
 which could give a decisive answer, and therefore we 
 cannot regard the experience of the office as conclusive. 
 
 Possibility that " non- abstaining " group may include some 
 heavy drinkers. 
 
 There are two other criticisms the force of which can- 
 not be fully estimated. There is no doubt at all that 
 excessive indulgence in alcohol does very greatly shorten 
 life. But in any large group of persons who are not 
 total abstainers there must needs be found, in the long 
 run, a proportion, perhaps a very small proportion, but 
 still some, giving way to circumstances and becoming 
 seriously intemperate. Such persons will, on the 
 average, die below the normal age, and their unfavour- 
 able mortality experience must go to swell the balance 
 of deaths in the general section. It is, of course, 
 impossible to measure the significance of this fact, but 
 in the present state of knowledge, we cannot neglect it 
 without begging the question which we really wish to 
 answer, viz., whether moderate drinking shortens life 
 or not ? 
 
 Risks of venereal disease and accident in non-abstainers. 
 
 Also we must bear in mind the conclusion of the Royal 
 Commission on Venereal Diseases, that the abuse of 
 alcohol pla)s an important role in the spread of venereal 
 disease. A single lapse due to the loss of self-control 
 consequent upon convivial excess may lead to infection 
 with disease which shortens life greatly, and such cases 
 would also help to explain the difference between life 
 prospects of abstainers and moderate drinkers. A like 
 remark applies to various forms of violent death, as in 
 street accidents. 
 
121 
 
 Mortality of persons engaged in the liquor trade. 
 
 We have now examined the evidence available as to the 
 mortality experience of total abstainers compared with 
 ordinary life office experience, and must say a few words, 
 of those whose employment brings them into close 
 contact with alcohol. It is, however, unnecessary for us 
 to devote much space to this, because most readers will 
 be acquainted with the figures of the Registrar- General, 
 often quoted in the press, shewing the heavy mortality 
 experienced in the liquor trades.^ According to the 
 published statistics of a large insurance company (the 
 Prudential) the expectation of life of insured persons 
 belonging to the liquor trades is at age 30 as much as 
 15 years less than that of the abstainers noticed above, 
 and, indeed, many years short of the average for all 
 males as computed in the Registrar-General's life tables 
 for England and Wales.^ The data of the Actuarial 
 Society of America' also shew that persons employed in 
 liquor saloons die at very high rates. It was found 
 that proprietors, managers and superintendents of 
 liquor establishments who did not attend the bar, 
 experienced a mortality which was 135 per cent, of the 
 standard rate ; when they did attend the bar, the per- 
 centage rose to 178 per cent., while the death rate from 
 cirrhosis of the liver was sixfold the normal rate. 
 
 These figures, of course, confirm the view, which per- 
 haps hardly needed statistical confirmation, that excessive 
 opportunities for indulgence, on the principle "how oft 
 the sight of means to do ill deeds makes ill deeds 
 done," will be attended on the average with special 
 risks to life and health. But the statistics do not tell 
 
 ' See Appendix 3. 
 
 * McDonald, Berichte d. 5 ten. Intern. Kong. f. Versicherungs- 
 Wissenschaft, p. 517. 1906. 
 
 ' Medico-Actuarial Investigation of Association of Life Assur- 
 ance Medical Directors and the Actuarial Society of America. 
 3 Vols. New York, 1912-13. 
 
122 
 
 US much more ; we cannot infer from them that a 
 publican who drinks moderately will die sooner than 
 another man of the same age ; indeed, even if we 
 could infer this, we should still have to consider 
 whether the unhygienic surroundings, poor accommoda- 
 tion and excessive hours of labour of many liquor estab- 
 lishments rather than the drinking of alcohol might 
 not chiefly contribute to the result 
 
 Sickness and mortality of abstainers and non-abstainers ^" 
 certain Friendly Societies. 
 We next turn to the statistical experience of certain 
 large Friendly Societies, reported upon nearly 30 years 
 ago by Mr. F. G. P. Neison.i Comparing the Rechabites 
 {a society of total abstainers) with the Oddfellows and 
 Foresters, a difference very similar to that found in 
 the experience of the United Kingdom Temperance 
 and General Provident Institution is seen. The Rech- 
 abites had only 69 per cent, of the deaths calculated 
 on the basis of the Foresters' experience, and their 
 expectation of life at age 30 was more than 4 years 
 longer than that of the Foresters. This comparison, 
 however, probably overstates the advantage, as the 
 Rechabites' statistics cover the period 1878-1888, while 
 the Foresters' data were for 1871-5 and the Odd- 
 fellows' 1866-70. With regard to sickness, the aver- 
 age weeks of sickness claim per member were higher 
 among the Rechabites up to age groups 40-50, but 
 lower for ages 50-60 and 60-70 than in the non- 
 abstaining societies. The average numbers of weeks 
 of sickness, not per member, but per member sick, 
 were about the same among Foresters and Rech- 
 abites, and the actuary concluded that the higher 
 
 ' F. G. P. Neison. — The Rates of Mortality and Sickness accord- 
 ing to the experience for the ten years 1878-87 of the Independent 
 Order of Rechabites (Salford Unity) Friendly Society. Lon- 
 don, 1889, 
 
:general rates at earlier ages among the Rechabites 
 were due to less perfect medical examination at 
 ■entrance, his reason being that new entrants shewed a 
 much higher percentage of sickness claims than members 
 of the same age but longer standing in the society. 
 This, which is contrary to the usual experience of 
 Friendly Societies, pointed, in his opinion, to less 
 ■careful selection of entrants. 
 
 As a whole these results concord with the life office 
 experience detailed above. The obvious criticisms to 
 which they are subject are (i) the Rechabites were a very 
 much smaller society than either of the non-abstaining 
 societies ; both the Oddfellows and the Foresters' sta- 
 tistics covered in each case more than ten times as man)- 
 years of life and more than fifteen times as many deaths, 
 as the Rechabites, while the comparison does not relate 
 to the same calendar years. (2) Both occupational and 
 geographical distribution may be important factors of 
 mortality, especially in industrial populations, and neither 
 could be analysed. 
 
 Conclusions. 
 
 The observations we have offered and the illustrations 
 -quoted indicate the necessity of being cautious in draw- 
 ing deductions in respect of the relation obtaining 
 between the consumption of alcoholic beverages and 
 longevity. We think, however, that it is legitimate to 
 •conclude : — 
 
 (i.) That the death-rate is lower and the expectation 
 of life longer in the section of an Insurance 
 Society admitting only total abstainers from 
 alcohol than in the section admitting those who 
 are not abstainers from alcohol. 
 (ii.) That the statistics of mortality are more favour- 
 able for abstainers than are the returns for other 
 Societies making no such distinctions, and 
 
124 
 
 which issue policies chiefly to persons of a 
 
 more prosperous social class.^ 
 (iii.) That Friendly Society data are concordant with 
 
 those of the I^ife Insurance Offices in thisrespect. 
 (iv.) That the official statistics issued by the 
 
 Registrar - General indicate an exceptionally 
 
 heavy mortality among persons occupied in the 
 
 liquor trade. 
 It should be added that it does not follow from these 
 conclusions that a consistently moderate use of alcoholic 
 beverages shortens life, since we cannot sort out from the 
 data brought into comparison those instances in which 
 the habitual abuse of alcohol produces disease or deaths 
 or in which accidental abuse has a like consequence, nor 
 can we exclude many other social factors operating for 
 or against longevity. 
 
 Our duty is merely to assess the value of the evidence 
 dispassionately. Anyone is entitled to argue as follows : 
 Since it is admittedly proved that in a comparison 
 extending over many years and embracing different social 
 classes, non-abstainers do not live as long on the average 
 as abstainers, therefore, for the practical conduct of life a 
 person desiring to live more than the average term of 
 years will do well to become a total abstainer. This is 
 quite possibly a sound rule of conduct, but what the 
 impartial student has to keep in mind is that the con- 
 nection between the postulated "cause," taking or not- 
 taking alcohol, and the supposed " effect," an average 
 longer or shorter life, has not been displayed with the 
 clearness and freedom from disturbing complex social 
 or personal factors, in addition to the consumption of 
 alcohol, which would entitle it to rank as a scientifically 
 established conclusion. 
 
 ' The validity of the argument has been impugned on technical 
 grounds, the practical importance of which cannot be determined.. 
 
125 
 
 CHAPTER X. 
 
 Conclusions. 
 
 We have now completed our survey of the present 
 state of scientific knowledge regarding alcohol, considered 
 in its several aspects as a food, a drug and a poison. It 
 remains to sum up in this final chapter the main facts 
 which we have ascertained, and to draw from them such 
 inferences as have a practical bearing on the use of 
 alcoholic beverages under the conditions of everyday life. 
 
 Main action of alcohol confined to nervous system. 
 The first conclusion to which this review of the 
 evidence leads us is, that, apart from the results of its 
 continued excessive use, the main effects of alcohol that 
 have any real significance are due to its action on the 
 nervous system. As we have seen in the chapters deal- 
 ing with these several points, the result of scientific 
 research concerning the action of alcohol on the respi- 
 ration, the circulation, the digestion, the muscular system, 
 is to shew that, so far as direct action is concerned, 
 alcohol, when administered in moderate doses, in dilute 
 form and at sufficient intervals, has no efiect of anj- 
 serious and practical account. 
 
 Action of alcohol narcotic and not stimulant. 
 -- A further conclusion of capital importance which 
 emerges with equal clearness is that the action of alcohol 
 on the nervous system is essentially sedative, and — 
 with the possible exception of its direct influence on the 
 respiratory centre — is not truly stimulant. The popular 
 belief in the stimulatiug properties of alcohol, as regards 
 nervous and other functions, seems to be of purely sub- 
 jective origin and illusory; it is in the main, if not wholly, 
 an effect of the narcotic influence of the drug, for, as we 
 
126 
 
 have seen, it dulls the drinker's perception of unpleasant 
 •conditions in himself and his surroundings, and may 
 make him feel better, more efficient and stronger than he 
 really is. 
 
 Effects which are apparently of a different character — 
 ■effects such as the increased loquacity and freer gesticu- 
 lation produced by alcohol — which are usually interpreted 
 by the drinker, if not by those about him, as evidences of 
 stimulation, are really narcotic effects ; they result from 
 the removal of the control exercised by the higher nervous 
 centres, a control which enables the individual to weigh 
 his words and acts, and renders him self-critical and 
 solicitous as to the impression he is making on other 
 people. The removal of this control and the decrease of 
 critical self-consciousness are, in fact, the most constant 
 and characteristic effects of alcohol, whether in the moder- 
 ate dose which diminishes restraint and imparts courage 
 to the diffident speaker or in the excessive dose which 
 gives rise to the verbose diffuseness of drunkenness. 
 
 We may see a further illustration of the true nature of 
 the drug action of alcohol in its seemingly contradictory 
 effects on persons of different temperament ■^hen com- 
 peting in games of skill in which temperament is an 
 important factor. The cool and self -controlled player will 
 generally find that even a small or moderate amount of 
 alcohol will impair the accuracy of his play, while, on 
 the other hand, it may improve the performance of the 
 excessively nervous player by decreasing his over-anxiety 
 and self-consciousness. 
 
 Objective effects of drug on nervous system. 
 
 In reality, so far as the effects of the drug on the 
 nervous system are objectively perceptible, they are 
 always manifested in a lowering of functional activity. 
 We have seen that this effect is appreciable in the case 
 of the simplest reflex actions, but that it acquires increasing 
 
127 
 
 prominence with increasing complexit}- of the response 
 chosen for the test; so that a dose which produces no 
 obvious change in the performance of a simple act, 
 involving no skill or exact adjustment of movement, will 
 definitely impair the precision of an act demanding a 
 greater delicacy of control and co-ordination. 
 
 When nmxotic action may be useful. 
 
 The conclusion indicated by our review of the scientific 
 evidence, that alcohol is essentially a narcotic, does not 
 imply an adverse judgment as to its value in all circum- 
 stances. There is nothing intrinsically good about a 
 stimulant, and nothing intrinsically bad about a narcotic. 
 Each has its proper utility under given conditions. But 
 these conditions are diflferent for each, and on that account 
 it is important that there should be no confusion as to 
 whether a drug belongs to one category or the other. 
 When stimulation of nervous function is really needed — 
 when the individual has to meet an emergency which 
 calls for the exercise of his highest powers of perception 
 and judgment — alcohol is not merely useless, it is 
 certainly and unequivocally detrimental. On the other 
 hand, there are emergencies where, though the individual 
 may also imagine that he needs to be braced up nervously, 
 he would in fact be assisted far more by a relaxation than 
 by an increase of tension, and here the sedative action of 
 alcohol, so far as the immediate effect is concerned, may 
 be advantageous. The value widely attributed to the 
 rum ration, under the conditions of acute discomfort, cold 
 and nervous strain inseparable from trench warfare, may 
 be explained in this way. It is in this way too that alcohol 
 helps the timid speaker to overcome his difiSdence, and to 
 free himself from the inhibitions that prevent him from 
 finding his words. Similarly, an exhausting and worrying 
 day may leave a condition of tension and irritability which 
 
128 
 
 interferes with appetite and digestion ; and in such a con- 
 <iition, and in some persons, it may be that wine or other 
 dilute form of alcohol taken with the evening meal, will 
 assist the assimilation of food. Again, persons who have 
 •overworked to such an extent that they have become too 
 tired to rest, may be enabled to sleep when they have 
 taken a small amount of alcohol — a fact which in itself 
 illustrates the narcotic properties of the drug. It is to 
 these properties, too, that alcohol mainly owes its 
 reputation as a restorative in emergencies, as, for 
 instance, in fainting from pain or fright: its value in 
 such conditions is due, not to any direct stimulation of 
 the nervous system or the heart by the drug, but to its 
 weakening of the excessive check on the heart's action 
 exercised by the nervous centres, and to its sedative 
 influence on the higher levels of the brain, relieving pain 
 and anxiety and increasing the general comfort of the 
 patient. 
 
 Litnitaiions to value of alcohol as a food. 
 Somewhat analogous considerations apply to the use 
 of alcohol as a food. As we have seen, it undoubtedly 
 has a food value, when regarded exclusively from the 
 point of view of its capacity to act as a fuel in the body. 
 Moreover, alcohol is absorbed very rapidly, and unlike 
 ordinary food-stuffs, it does not require to undergo 
 digestion before it can make its way into the blood. It 
 may, therefore, be useful as a constituent of the diet in 
 conditions of emergency, as in acute diseases, when the 
 assimilation of ordinary foods is more or less interfered 
 with. But these advantages are accompanied by draw- 
 backs which, though they may be disregarded in the 
 special and transitory circumstances of an acute illness, 
 are ampl)' sufficient to condemn the use of alcohol as an 
 ordinary source from which to supply the energy required 
 by the body in health. In the first place, alcohol is 
 
129 
 
 unsuited for the latter purpose because of its immediate 
 drug action, which, as pointed out above, involves, even 
 with small doses, some impairment of the higher nervous 
 functions, so that efficiency is lowered in all forms of 
 work that demand the exercise of these functions. But 
 quite apart from this immediately detrimental influence 
 of alcohol on the higher activities of the brain, there is a 
 second serious limitation of its utility as a food. To 
 understand this limitation, we must again refer to what 
 we have already indicated as an important point of' 
 difference between alcohol and other foods — namely, to 
 the fact that, while these latter foods are stored in the 
 body, in altered form, to be drawn upon as required by 
 the muscles and other parts of our mechanism, alcohol 
 cannot be so stored ; it remains as alcohol in the blood, 
 and the organs generally, until it is destroyed by 
 combustion. As that process is gradual, the drug, when 
 in sufficient amount, can exercise a seriously injurious 
 effect upon the tissues of the body. If it is taken 
 frequently, so that a new dose enters the circulation 
 before the previous one has been eliminated, the tissues 
 are seldom free from this harmful influence, and the 
 oathological changes and disorders follow which we have 
 described under the heading of chronic alcoholism. 
 
 Thus, with regard to the use of alcohol as a food, we 
 reach conclusions which, from a practical point of view, 
 are substantially consonant with those to which we were led 
 by our consideration of its utility as a narcotic drug. It 
 unquestionably is a food, in the sense that it can be used 
 to supply a considerable proportion of the fuel needs of 
 the body, and it has even special properties, due to the 
 readiness with which it can be absorbed into the system, 
 that may give it an added value in some conditions of 
 disease and convalescence ; but it is a food suitable only 
 for such emergencies. To use it, as it is very commonly 
 used by people who do not appreciate its limitations and 
 
I30 
 
 drawbacks, as a staple food for muscular work, is to 
 run a grave risk of damage to health and efficiency — 
 how grave we have seen when discussing the alcoholic 
 mortality of industrial drinkers. 
 
 Nutritional value of beer, as compared with other alcoholic 
 
 liquors. 
 But in the ordinary alcoholic beverages there are other 
 constituents besides ethyl alcohol : does their presence 
 qualify this conclusion regarding the disadvantages of 
 alcohol as a food for work ? In this countr j-, the question 
 arises mainly in relation to beer, which contains, in 
 addition to alcohol, an appreciable amount of other sub- 
 stances possessing nutritive value, notably dextrin and 
 other carbohydrate bodies. It is generally estimated 
 that a pint of beer, of original gravity 1055, owes rather 
 more than half its food value to its contained alcohol ; 
 so that, regarded as foods, malted liquors, at all events 
 when brewed at the gravity we have named, are open, 
 though in a smaller measure, to the objections which 
 we have seen to apply to the stronger alcoholic bever- 
 ages ; they cannot be used as a large element in the 
 working diet without danger of inducing such bodily 
 disorders as may be incurred through the constant ex- 
 posure of the tissues to the action of alcohol. It is 
 obvious that, as alcoholic strength diminishes, the danger 
 indicated becomes less. 
 
 Use of alcohol as an aid to work physiologically unsound. 
 
 So far we have considered alcohol mainly in relation 
 to its influence on the working efficiency of the drinker, 
 this being, in fact, the relation we ordinarily have in 
 mind when we speak of the food value of alcohol, or of 
 what are erroneously regarded as its "stimulant" 
 properties. And we have found ample reason to conclude 
 that the taking of alcoholic beverages to promote such 
 
131 
 
 efficiency- is not only useless or even detrimental in 
 immediate effect, but is also likely to be, in its ultimate 
 results, seriously injurious to health. In the light of our 
 knowledge of how alcohol acts in the body, there can be 
 no question that its habitual use by the worker as a 
 substitute for food or in the belief that it gives a fillip 
 to energy, is physiologically unsound. 
 
 Conditions wider which use of alcoholic hei'erages may he 
 physiologically permissible. 
 
 The matters summarised in the preceding paragraphs 
 have necessarily bulked largely in this report, and bulk 
 even more largely in popular discussions concerning 
 alcohol. It must, however, be said that among the 
 causes that have contributed to the world-wide habit of 
 taking alcohol, its action as a food, as an aid to digestion, 
 or as a supposed cardiac and respiratory stimulant, are 
 of secondary importance. In truth, men in general do 
 not drink alcoholic beverages because the}- regard them 
 as " foods," nor do those who abstain from these drinks 
 do so mereb' because they doubt their food-value. The 
 use of alcohol is dictated by the fact that, to tuc majority, 
 the taste of alcoholic beverages and the immediate effects 
 of alcohol are agreeable, and that the pleasure derived 
 therefrom outweighs their estimate of remoter harm, if, 
 indeed, they give ulterior considerations any thought at 
 all. To the abstainer either the taste or the immediate 
 effects are not agreeable, or the remoter ill, whether 
 real or imaginary, seems more important. Each class 
 manufactures arguments in favour of its own line of 
 conduct. 
 
 So far as these arguments have to do with the social 
 evils which result from the excessive use of alcoholic 
 liquors, they lie outside the scope of the present dis- 
 cussion : the moral problems which they raise cannot be 
 solved by directly scientific methods. We deal here 
 
 16066 i< 
 
132 
 
 solely with the physiological aspect of the alcohol 
 question, and our consideration of this aspect leads us to 
 recognise that the agreeable effects which the majority of 
 people experience from the use of alcoholic beverages 
 can be produced by doses of alcohol — moderate in 
 quantity and taken in adequate dilution and at sufficient 
 intervals — which will not, in normally constituted 
 persons, be attended with appreciable risk to physical or 
 mental health. It is foreign to the aim of the present 
 statement to inquire whether the pleasures associated 
 with the moderate use of alcohol by the many are 
 inseparably connected with, or lead inevitably to, the 
 evils arising from its abuse by the few, nor is it relevant 
 for us to examine the effect of the alcoholic habit on 
 social efficiency or national expenditure. 
 
 The present statement is not concerned with the 
 social evils arising from the excessive consumption of 
 alcohol as a beverage ; nor is it concerned with ethics, 
 administration, or national economy. We are dealing 
 solely with the physiological facts so far as it is possible 
 to ascertain them in the present position of knowledge, 
 and within the prescribed limitation we can only say that 
 the moderate use of alcoholic beverages is physiologicall)' 
 permissible only so long as it conforms to the special 
 conditions which we have seen to be necessary in order 
 to avoid the poison action of the drug. The risks of this 
 poison action that have to be guarded against and the 
 precautions to meet these risks may be summed up for 
 practical purposes in the following propositions: — 
 
 (i.) To avoid a continued action on the tissues, such an 
 interval should elapse between the times when alcoholic 
 beverages are drunk as will prevent the persistent presence 
 of a deleterious amount of the drug in the body. 
 
 (ii.) To avoid direct injury to the mucous membrane of 
 the stomach, alcohol should not be taken in concentrated 
 form and without food. 
 
133 
 
 The temperate consumption of alcoholic liquors in 
 accordance with these rules of practice may be considered 
 to be physiologically harmless in the case of the large 
 majority of normal adults; and this conclusion, it may be 
 added, is fully borne out by the massive experience of 
 mankind in wine-drinking and beer-drinking countries. 
 On the other hand, it is certainly true that alcoholic 
 beverages are in no way necessary for healthy life ; that 
 they are harmful or dangerous if the above-mentioned 
 precautions are not observed ; and further, that they arfe 
 definitely injurious for children and for most persons of 
 unstable nervous system, notably for those who have had 
 severe injuries of the head or who have suffered from' 
 attacks of mental disorder, or from nervous shock, 
 
 (Signed) D'AbERNON (Chairman'). 
 
 Georgk Newman (Vice-Chairman'). 
 
 A. R. CUSHNY. 
 H. H. Dai,E. 
 M. Greenwood. 
 
 W. MCDOUGALI,, 
 
 F. W. MoTT. 
 
 C. S. Sherrington. 
 
 W. C. SUI<I,IVAN. 
 
 December, 1977. 
 
APPENDIX 1 
 
 Total Consumption, an'd Consumption per head of Estimated 
 Population, of Beer, Spirits, and Wine in the United Kingdom 
 IN each Financial Year from 1897 to 1917. 
 
 
 Total. 
 
 Per Head 
 
 OF 
 
 Year 
 
 
 Population. 
 
 end- 
 
 
 
 
 
 
 
 ing 
 
 Beer. 
 
 Spirits. 
 
 Wine. 
 
 Beer. 
 
 Spirits. 
 
 Wine. 
 
 31st 
 
 
 
 
 
 
 
 Mar. 
 
 Standard 
 Barrels.1 
 
 Proof 
 Gallons." 
 
 47,927,000 
 
 Gallons.' 
 
 Galls.i 
 
 Proof 
 Galls.- 
 
 1-20 
 
 Galls.' 
 
 1897 
 
 33,581,000 
 
 15,810,000 
 
 30-23 
 
 -40 
 
 1898 
 
 35,083,000 
 
 48,279,0jO 
 
 16,004,000 
 
 31-28 
 
 1-20 
 
 ■40 
 
 1899 
 
 35,853,000 
 
 48,550,000 
 
 16,862,000 
 
 31^66 
 
 1-19 
 
 •41 
 
 1900 
 
 36,625,000 
 
 50,126,000 
 
 17,147,000 
 
 32^04 
 
 1-22 
 
 •42 
 
 1901 
 
 36,045,000 
 
 45,403,000 
 
 15,088,000 
 
 31^24 
 
 1-09 
 
 •36 
 
 1902 
 
 35,442,000 
 
 42,088,000 
 
 14,865,000 
 
 30-46 
 
 1-00 
 
 •35 
 
 1903 
 
 35,425,000 
 
 43,354,000 
 
 15,399,000 
 
 30-18 
 
 1-03 
 
 •36 
 
 1904 
 
 34,791,000 
 
 42,205,000 
 
 13,442,000 
 
 29-39 
 
 -99 
 
 •32 
 
 190.5 
 
 33,862,000 
 
 40,109,000 
 
 11,913,000 
 
 28-36 ' 
 
 -93 
 
 •28 
 
 1906 
 
 33,559,000 
 
 39,259,000 
 
 11,784,000 
 
 27-70 
 
 •90 
 
 •27 
 
 1907 
 
 33,789,000 
 
 39,847,000 
 
 12,347,000 
 
 27-81 ' 
 
 •91 
 
 •28 
 
 1908 
 
 33,904,000 
 
 39,697,000 
 
 12,124,000 
 
 27-66 
 
 •90 
 
 •27 
 
 1909 
 
 32,806.000 
 
 38,940,000 
 
 11,393,000 
 
 26-53 
 
 •87 
 
 •26 
 
 1910 
 
 32,390,000 
 
 26,008,000 
 
 11,446,000 
 
 25-96 
 
 -58 
 
 -25 
 
 1911 
 
 33,085,000 
 
 30,888,000 
 
 12,529,000 
 
 26-27 
 
 -68 
 
 -28 
 
 1912 
 
 34,362,000 
 
 30,887,000 
 
 11,104,000 
 
 27-18 
 
 -68 
 
 -24 
 
 191B 
 
 34,099,000 
 
 30.736,000 
 
 11,167,000 
 
 26-86 
 
 -67 
 
 •24 
 
 1914 
 
 35,446,000 
 
 32,596,000 
 
 11,637,000 
 
 27-69 
 
 •71 
 
 •25 
 
 1915 
 
 32,575,(^0 
 
 34,345,000 
 
 10,078,000 
 
 25-60 
 
 •75 
 
 •22 
 
 1916 
 
 29,646,000 
 
 35,597,000 
 
 11.138,000 
 
 23-66 
 
 -77 
 
 •25 
 
 11'17 
 
 25,923,000 
 
 23.996,000 
 
 8,929,000 
 
 21-49 
 
 -.52 
 
 •20 
 
 ' A -'standard barrel " represents 36 gallons of beer of an "original 
 gravity " of 1055 (water taken as 1000) and is the unit on which taxa- 
 tion is based. By " original gravity " is meant the specific gravity of 
 the worts, before fermentation, from which beer is brewed. As beer 
 is brewed on the average lighter than the standard, the number of 
 actual "bulk" or "liquid barrels" annually consumed is higher 
 than the corresponding number of standard barrels given in the 
 Excise returns. In column 5, a "gallon" of beer means ^V of a 
 standard barrel. 
 
 2 A " Proof gallon " is a gallon of " Proof Spirit," in terms of which 
 the strength of distilled spirits is usually expressed in this counti^y. 
 Proof Spirit is a mixture of alcohol and water having, at a tempera- 
 ture of 60° F., a specific gravity of -91976, compared with water taken 
 3.S unity. The mixture contains 49-28% of alcohol by weight and 
 57^10% by volume. 
 
 ' The figures referring to the consumption of wine indicate gallons 
 irrespective of alcoholic strength, which, of course, varies very widely 
 in the case of different wines. 
 
APPENDIX 2. 
 
 Annual Death Rates (England and Wales), 
 
 PROM (a) Alcoholism, and (b) Cirrhosis of the Liver at 
 
 all Ages to a Million Living from 1891 to 1916. 
 
 
 Alcoholism. 
 
 Cirrhosis of the Liver. 
 
 Years. 
 
 
 
 
 
 
 Males and 
 Females. 
 
 Males. 
 
 'Females. 
 
 Males and 
 Females. 
 
 Males. 
 
 Females. 
 
 1891 
 
 71 
 
 94 ' 
 
 49 
 
 125 
 
 148 
 
 104 
 
 1892 
 
 67 
 
 86 
 
 49 
 
 122 
 
 142 
 
 104 
 
 1893 
 
 73 
 
 93 
 
 55 
 
 120 
 
 139 
 
 103 
 
 1894 
 
 61 
 
 76 
 
 47 
 
 115 
 
 136 
 
 96 
 
 1S95 
 
 67 
 
 84 
 
 51 
 
 118 
 
 133 
 
 104 
 
 1896 
 
 71 
 
 91 
 
 52 
 
 122 
 
 140 
 
 106 
 
 1897 
 
 77 
 
 97 
 
 58 
 
 133 
 
 151 
 
 115 
 
 1898 
 
 78 
 
 98 
 
 59 
 
 132 
 
 152 
 
 112 
 
 1899 
 
 90 
 
 113 
 
 69 
 
 142 
 
 167 
 
 119 
 
 1900 
 
 113 
 
 132 
 
 95 
 
 144 
 
 162 
 
 127 
 
 1901 
 
 96 
 
 113 
 
 80 
 
 132 
 
 151 
 
 115 
 
 1902 
 
 84 
 
 105 
 
 65 
 
 123 
 
 144 
 
 104 
 
 1903" 
 
 77 
 
 92 
 
 63 
 
 118 
 
 136 
 
 100 
 
 1904 
 
 70 
 
 86 
 
 55 
 
 118 
 
 135 
 
 101 
 
 1905 
 
 65 
 
 79 
 
 52 
 
 118 
 
 132 
 
 105 
 
 1906 
 
 66 
 
 81 
 
 53 
 
 112 
 
 127 
 
 98 
 
 1907 
 
 63 
 
 79 
 
 49 
 
 112 
 
 123 
 
 102 
 
 1908 
 
 55 
 
 65 
 
 45 
 
 104 
 
 121 
 
 89 
 
 1909 
 
 47 
 
 68 
 
 37 
 
 100 
 
 120 
 
 81 
 
 1910 
 
 42 
 
 50 
 
 34 
 
 90 
 
 106 
 
 75 
 
 1911 
 
 45 
 
 57 
 
 34 
 
 91 
 
 105 78 
 
 1912 
 
 45 
 
 55 
 
 36 
 
 93 
 
 108 79 
 
 1913 
 
 52 
 
 62 
 
 42 
 
 97 
 
 115 80 
 
 1914 
 
 53 
 
 64 
 
 43 
 
 99 
 
 117 
 
 82 
 
 1915' 
 
 43 
 
 53 
 
 35 
 
 93 
 
 120 
 
 70 
 
 19161 
 
 29 
 
 40 21 
 
 79 
 
 111 
 
 54 
 
 1 
 
 The material for this Table has been obtained from the Annual 
 Reports of the Registrar General, and from information supplied 
 by Dr. T. H. C. Stevenson, Superintendent of Statistics at Somerset 
 House. 
 
 • Based upon Civil deaths and Civil population. 
 
APPENDIX ^. 
 
 Comparative Mortality of Males Aged 25-65 Years in the 
 
 Chief Occupational Groups (England and Wales) (a) from 
 
 Alcoholism, (b) from Alcoholism and Liver Diseases taken 
 
 together, and (c) from All Causes, in the Period 1910-1912. 
 
 NOTE. — The ''comparative mortality" figure from any given 
 disease in any given occupation indicates the number of deaths from 
 that disease which would occur in a population corresponding in 
 numbers and in age constitution with the standard population, but 
 composed solely of persons engaged in the particular occupation in 
 question. In this table the " standard population " is the population of 
 males, aged from 25 to 65 years, which in the period 1900-1902 
 furnished 1000 deaths from all causes. 
 
 
 
 [1910-1912.) 
 
 
 Gkoup. 
 
 
 
 
 
 Alcoholism. 
 
 Alcoholism & 
 Liver Diseases. 
 
 All 
 causes. 
 
 All Males 
 
 7 
 
 23 
 
 790 
 
 Clergyman, Priest & Minister' 
 
 2 
 
 11 
 
 443 
 
 Railway Engine Driver. 
 
 2 
 
 11 
 
 586 
 
 Guard, Porter, etc. 
 
 
 
 
 Platelayer, Railway Labourer 
 
 2 
 
 11 
 
 623 
 
 Agriculturists 
 
 3 
 
 11 
 
 474 
 
 Coal Miner 
 
 3 
 
 13 
 
 727 
 
 Shipbuilding 
 
 5 
 
 12 
 
 633 
 
 Printers 
 
 5 
 
 11 
 
 773 
 
 Building Trade 
 
 5 
 
 17 
 
 726 
 
 Metal Workers 
 
 5 
 
 19 
 
 804 
 
 Shoemaker 
 
 li 
 
 17 
 
 82U 
 
 Textile Manufacturer 
 
 6 
 
 19 
 
 799 
 
 Commercial Clerk, Insurance 
 
 6 
 
 22 
 
 802 
 
 Agent. 
 
 
 
 
 Tailor 
 
 6 
 
 22 
 
 799 
 
 Baker 
 
 "T 
 
 19 
 
 664 
 
 Carmen, Carriers 
 
 7 
 
 21 
 
 900 
 
 Shopkeepers 
 
 8 
 
 27 
 
 683 
 
 Commercial Traveller 
 
 9 
 
 32 
 
 724 
 
 Medical Profession' 
 
 9 
 
 38 
 
 693 
 
 Coach, Cab, Bus 
 
 12 
 
 29 
 
 921 
 
 Messenger, Porter 
 
 13 
 
 33 
 
 1,137 
 
 Barrister. Solicitor' 
 
 13 
 
 39 
 
 627 
 
 Seaman and Merchant Service 
 
 IS 
 
 S-t 
 
 1,485 
 
 Butcher 
 
 18 
 
 5li 
 
 885 
 
 General Labourer 
 
 20 
 
 50 
 
 2,301 
 
 Dock Labourer, 
 
 26 
 
 43 
 
 1,127 
 
 Costers, Hawkers 
 
 30 
 
 52 
 
 1,507 
 
 Publican, Innkeeper, etc. 
 
 50 
 
 152 
 
 1,265 
 
 For the above Table the Advisory Committee are indebted to Dr. 
 T. H. C. Stevenson, Superintendent of Statistics at Somerset House. 
 ' Based on relatively small numbers. 
 
APPENDIX 4. 
 
 Perckntage of 
 
 Proof Spirit and of 
 
 Absolute Alcohol 
 
 
 IN Variou 
 
 s Beverages. 
 
 
 
 Original 
 
 Percentage 
 of Proof 
 Spirit. 
 
 Percentage 
 of Absolute 
 
 Percentage 
 of Absolute 
 
 
 Gravity.! 
 
 Alcohol" 
 
 jUcohol" 
 
 
 
 (by weight). 
 
 fby volume). 
 
 Spirits— 
 
 
 
 
 
 At 25° u.p. 
 
 — 
 
 75-0 
 
 H5-9 
 
 42-8 
 
 At 30° up. 
 
 — 
 
 70-0 
 
 33-3 
 
 40-0 
 
 At 35° u.p. 
 
 .:— 
 
 65-0 
 
 30-8 
 
 37-1 
 
 At 4(1° u.p. 
 
 — ' 
 
 60-0 
 
 28-3 
 
 34-3 
 
 At 60° u.p. 
 
 — 
 
 50-0 
 
 23-4 
 
 28-6 
 
 Wines— 
 
 
 
 
 
 Port 
 
 — 
 
 35-3 
 
 16-4 
 
 20-2 
 
 Sherry 
 
 — 
 
 29-5 
 
 13-7 
 
 16-9 
 
 Madeira 
 
 — 
 
 28-9 
 
 13-4 
 
 16-5 
 
 Tarragona 
 
 — 
 
 27-2 
 
 12-6 
 
 15-5 
 
 Australian Bur- 
 
 — 
 
 24-8 
 
 11-5 
 
 14-2 
 
 gundy 
 
 
 
 
 
 Italian Red Wine 
 
 — 
 
 23-9 
 
 11-1 
 
 13-7 
 
 Champagne 
 
 — 
 
 23-6 
 
 10-9 
 
 13 5 
 
 French Burgundy 
 
 — 
 
 22-1 
 
 10-2 
 
 12-6 
 
 (red) 
 
 
 
 
 
 Californian Bur- 
 
 — 
 
 20-8 
 
 9-6 
 
 11-9 
 
 gundy 
 
 
 
 
 
 Italian WhiteWine 
 
 — 
 
 20-6 
 
 9-5 
 
 11-8 
 
 French Burgundy 
 
 — 
 
 20-2 
 
 9-3 
 
 11-6 
 
 (white) 
 
 
 
 
 
 Bordeau.x (white) 
 
 ■ — 
 
 19-9 
 
 9-1 
 
 11-4 
 
 (red) 
 
 — 
 
 17-0 
 
 7-8 
 
 9-7 
 
 Cider (bottled) ... 
 
 — 
 
 7-4 
 
 3-4 
 
 4-2 
 
 Beers (English) — 
 
 
 
 
 
 Pale or Bitter Ale 
 
 ]0(;o-2 
 
 11-1 
 
 5-1 
 
 64 
 
 London Stout ... 
 
 1064-6 
 
 9-7 
 
 4-4 
 
 5-5 
 
 Burton Ale 
 
 1053-2 
 
 9-4 
 
 4-3 
 
 5-4 
 
 Light Pale Ale ... 
 
 1042-6 
 
 7-9 
 
 3-6 
 
 1-5 
 
 Mild Ale (No. 1) 
 
 1037-8 
 
 5-8 
 
 2-6 
 
 3-3 
 
 Porter 
 
 1041-5 
 
 4-3 
 
 1-9 
 
 2-4 
 
 Mild Ale (No. 2) 
 
 1016-5 
 
 2-8 
 
 1-3 
 
 1-6 
 
 Beers (Import) — 
 
 
 
 
 
 Dutch (1916) ... 
 
 1053-5 
 
 9-8 
 
 i-n 
 
 5-6 
 
 Danish (1916) ... 
 
 1057-6 
 
 8-8 
 
 40 
 
 .5-0 
 
 Norwegian (191 6) 
 
 1042-4 
 
 6-8 
 
 3-1 
 
 3-9 
 
 Pilsener Lager 
 
 1054-0 
 
 9-4 
 
 4-3 
 
 5-4 
 
 (Pre-war) 
 
 
 
 
 
 Munich Lager 
 
 1057-0 
 
 8-8 
 
 4-0 
 
 5-0 
 
 (Pre-war) 
 
 
 
 
 
 The determination of the alcoholic strengths of wines, beers and 
 cider for the purpose of this Table has been made at the Government 
 Laboratory under the direction of Mr. E. Grant Hooper, F.I.C., the 
 Deputy Government Chemist, from samples of the several beverages 
 purchased in London. The wines represent the cheaper brands 
 retailed by grocers. As regards the strength of English beers, it 
 should be remembered that the examples given above represent pur- 
 chases made at the end of 1917. Before the war current strengths 
 were appreciably higher. 
 
 ' See footnote to Appendix 1. 
 " From Thorpe's Alcoholometric Tables ; London, 1915. 
 
APPENDIX 5. 
 
 Amount of Proof Spirit and of Absolute Alcohol (by volume) 
 
 i\ USUAL Retail Measures of the ordinary Alcoholic 
 
 Beverages. 
 
 Note on Retail Measures. — Beer, wine or spirits sold by the 
 
 ■' glass " may be supplied in any unstamped vessel, and there is no legal 
 
 obligation as to the quantity of flilid which a glass of any of these 
 
 beverages should contain. In practice a glass of beer usually contains 
 
 1 of a quart, i.e. a little, less than J pint, and it may contain only 
 
 If quart. In the case of spirits, a " glass " of whisky, more often 
 
 described in the South as a "large whisky," contains generally from 
 
 ■I to i gill ; a small glass contains l gill, or sometimes as little as 
 
 i gill. 
 
 The '■ glass " of wine is also a very variable quantity, ranging from 
 ^ of a gill to about | gill ; the latter being the average capacity of the 
 dock glass in which port is ordinarily sold at the bar. 
 
 
 
 Absolute Alcohol. 
 
 
 Proof Spirit. 
 Fluid ounces. 
 
 
 
 
 Fluid 
 
 Cubic 
 
 
 
 ounces. 
 
 Centimetres 
 
 BEERS. 
 
 
 
 
 Light Pale Ale 
 
 
 
 
 (original gravity 
 
 
 
 
 1042^6) 
 
 
 
 
 1 pint 
 
 \-oS 
 
 ■90 
 
 25^6 
 
 i pint 
 
 ■79 
 
 ■45 
 
 12^8 
 
 glass CJ pint) 
 
 ■63 
 
 ■36 
 
 10-2 
 
 Mild Ale 
 
 
 
 
 (original gravity 
 
 
 
 
 1037^8) 
 
 
 
 
 1 pint 
 
 l^lfi 
 
 ■66 
 
 18-6 - 
 
 i pint 
 
 ■58 
 
 ■33 
 
 9^3 
 
 glass (1 pint) 
 
 ■46 
 
 ■26 
 
 7^4 
 
 WINES. 
 
 
 
 
 Claret, J pint 
 
 • 1-70 
 
 •97 
 
 27-6 
 
 Sherry, glass (i gill) 
 
 ■74 
 
 ■42 
 
 11^9 
 
 Port, dock glass (i gill) ... 
 
 r32 
 
 ■75 
 
 21^3 
 
 SPIRITS— 
 
 
 
 
 at 30° u.p. 
 
 
 
 
 Large glass (i gill) 
 
 1-75 
 
 VOO 
 
 - .28 
 
 Small glass (i gill) 
 
 •70 
 
 ■40 
 
 !!• 
 
 at 50° u.p. 
 
 
 
 
 Large glass (i gill) 
 
 1^25 
 
 ■71 
 
 20^1 
 
 Small glass (1 gill) ^ 
 
 •50 
 
 ■28 
 
 8^0 
 
INDEX. 
 
 Page 
 
 Absorption of alcohol from alimentary canal 17 
 
 „ of food 61 
 
 Abstinence, delirium tremens not due to 112 
 
 „ symptoms in drunkards 112 
 
 „ „ in morphine takers 112 
 
 Accessory substances t' 
 
 Alcohol, definition of '. 2 
 
 „ not stored in body in altered form 12,21 
 
 Alcoholic beverages, alleged differences in effects of several ... S9 
 , „ consumption of, statistics of Appendix 1 
 
 ,, ,, impurities in ... ... ... ... ... 4 
 
 retail measures of Appendix 5 
 
 , ,, strength of Appendix 4 
 
 ,. poisoning, amount of fatal dose in 88 
 
 „ „ cause of death in 70, 8S 
 
 Alcoholism, chronic 94 
 
 ,. „ causation of 104 
 
 „ experimental 96 
 
 „ parental, effects of 103 
 
 Alveolar air 68 
 
 Arterial blood-pressure 71 
 
 ,, „ „ effect of alcohol on 75 
 
 Atwater and Benedict 23 
 
 Beer, nutritional value of 
 
 „ strength of 
 
 Benedict, see Atwater and Dodge. 
 
 Bile 
 
 Blood, concentration of alcohol in 
 
 „ vessels, superficial, dilated by alcohol 
 
 Carbohydrates ... 
 
 „ substitution of alcohol for ., 
 
 Carminative action of alcohol 
 
 Circulation of blood 
 
 Carlson 
 
 Carbon dioxide 
 
 „ „ in alveolar air 
 
 „ ,, stimulates respiratory centre 
 
 130 
 
 Appendix 4 
 
 20, 
 
 .. 58 
 87, 88 
 72, 81 
 
 9 
 
 .. 24 
 59 
 
 .. 71 
 
 .. 58 
 7 
 
 .. 68 
 67 
 
Page 
 Carbonic acid, see Carbon dioxide. 
 
 Chauveau 49 
 
 Chittenden 58 
 
 Cirrhosis of liver 99 
 
 Cold, effect of exposure to 80 
 
 „ ,, „ on circulation 80 
 
 „ sensation of, dulled by alcohol 82 
 
 ,, use of alcohol in exposure to 83 
 
 Concentrated alcoholicliquors, dangers of... 99,106 
 
 Consumption of alcoholic beverages, statistics of ... Appendix 1 
 
 Craving, alcoholic 109 
 
 Delirium tremens 97 
 
 ,, „ not an abstinence symptom 112 
 
 Digestion, action of alcohol on 56 
 
 „ effects of different alcoholic beverages on ... 59,62 
 
 ,, effect of mental state on .• 60,128 
 
 „ factors in process of 56 
 
 Digestive system in chronic alcoholism 99 
 
 Dilution, advantages of 90 
 
 „ effect of, on action of alcohol 89 
 
 Dipsomania 98 
 
 Distillation 3 
 
 Dock labourers, mortality of, from alcoholism 107 
 
 Dodge and Benedict ... ... ... 44, 45, 52 
 
 Drug, definition of 13 
 
 „ action not necessarily harmful 14 
 
 „ habit 109 
 
 Drunkenness, emotional instability in 34 
 
 ,, loss of control in 35 
 
 ,, pathological ... 93 
 
 „ alcohol content of blood in 87 
 
 ,, stages of 34 
 
 „ variety of mental symptoms in 38 
 
 Diirig 49 
 
 Energy of body, how obtained 7 
 
 Ergograph, experiments with ... 46 
 
 Ethers, in wines and spirits Hi 
 
 Eye-closing reflex, influence of alcohol on h + 
 
 Eye movements, effect of alcohol on accuracy of 51 
 
 Excretion, definition of... 18 
 
 ,, of alcohol, conditions affecting 19 
 
 „ „ „ in breath and urine ... 10 
 
 ,, „ in sweat in 
 
iFaihting, use of alcohol in 
 
 Fats 
 
 „ replacement of by alcohol 
 
 fermentation 
 
 Fermented liquors, constituents of 
 
 (Ferments, digestive 
 
 Food, definition of 
 
 Foods, several classes of 
 
 „ use of , to repair body tissue ... 
 J^ood-stuffs, physiological classification of ... 
 
 „ „ replacement of, by alcohol 
 Food-value of alcohol 
 
 „ ,, „ „ limitations on 
 
 Food, disadvantages of alcohol as a 
 
 Friendly Societies, sickness rates of ... 
 Fusel oil 
 
 Glycogen 
 
 Grehant 
 
 •Guillery 
 
 Habit-forming influence of alcohol 
 
 Heart, action of, controlled by nervous system 
 
 ,, „ „ depressed by large doses of alcohol 
 ,, „ „ indirectly excited by alcohol 
 „ isolated, action of alcohol on 
 
 Heat-regulating centre 
 
 Hellsten 
 
 Hill-climbing, effect of alcohol in 
 
 Infective disease, decreased resistance of alcoholics to 
 
 Insanity, relation of alcoholism to 
 
 .Intervals between drinking, importance of 
 
 Jf nee-jerk, influence of alcohol on 
 
 Kraepelin 
 
 Page 
 
 128 
 
 9 
 
 24 
 
 3 
 
 3 
 
 59 
 
 10 
 
 11 
 
 24 
 
 23 
 
 28 
 
 128 
 
 122 
 
 3 
 
 10 
 20 
 52 
 
 98, 109 
 73 
 75 
 76 
 74 
 79 
 48 
 49 
 
 101 
 97 
 108, 132 
 
 ... 45 
 38, 48 
 
 iactation, see Milk. 
 
 Life Insurance statistics 
 
 Liquor Trade, mortality of persons engaged in 
 JLiver, cirrhosis of 
 
 „ „ mortality from 
 
 -Longevity of abstainers 
 
 Mental effects of alcohol 
 
 MetaboUsm, definition of 
 
 116 
 
 121, 124 
 99 
 
 Appendix 2 
 
 m; 
 
 30 
 
 12 
 
Page 
 
 Milk, effect of alcohol on secretion of 19' 
 
 ., excretion of alcohol in ... Id 
 
 Miners, low alcoholic mortality of 107 
 
 Mixing of liquors 90 
 
 Morphine, tolerance of 92 111 
 
 habit Ill 
 
 „ „ abstinence symptoms in IIS 
 
 Mortality from alcoholic disease Appendices 2 and 3 
 
 Movements, skilled, effect of alcohol on 40,50' 
 
 „ of stomach, effect of alcohol on 58 
 
 Muscles not directly affected by alcohol 41 
 
 Muscular acts, action of alcohol on ... 41 
 
 Narcotic, alcohol a US, 12."> 
 
 ., action, when beneficial ... ... ... ... ... 127 
 
 Nervous system in chronic alcoholism 98 
 
 Nervous system, action of alcohol mainly on 12.") 
 
 Nutrition, no special action of alcohol on 26 
 
 Occupation, in relation to use of alcohol 108 
 
 Occupational groups, mortality from alcoholism in Appendix 3 
 
 Oseretzkowsky 48 
 
 Oxidation, definition of 7 
 
 „ of alcohol in body 21 
 
 Pancreatic secretion ... ... ... ... ... ... 58 
 
 „ ferment 60- 
 
 Poison action, defined 15 
 
 „ „ of alcohol ..'. 85 
 
 Poisoning, acute and chronic 15, 85 
 
 Precautions in use of alcoholic beverages 132 
 
 Proof spirit, definition of Appendix 1 
 
 Proteins ... 9 
 
 „ sparing of, by alcohol 24 
 
 Pulse, effect of alcohol on 72 
 
 ,, reflex quickening of 73 
 
 Refiexacts ... 42 
 
 „ „ effect of alcohol on 43- 
 
 Reproductive cells, action of alcohol on 101 
 
 Respiration 64 
 
 Respiratory activity, indirect effect of alcohol on 65 
 
 „ centre 64 
 
 „ „ alleged stimulation of, by alcohol 67 
 
 ,, ., paralysis of, in alcoholic poisoning ... 70, 86 
 
Kespiratory Quotient 
 
 Rivers 
 
 Rum ration in Army 
 
 Saccharin, excreted unchanged 
 
 Saliva 
 
 Self-criticism, blunted by alcohol 
 
 Shivering 
 
 Spirit-drinking, in relation to chronic alcoholism 
 „ „ „ drunkenness ... 
 
 Stimulant, alcohol not a 
 
 Stockard 
 
 Stomach, catarrh of, in drunkards 
 
 Susceptibility to alcohol, differences in 
 
 „ ,, „ in animals 
 ,, „ morbid , 
 
 Synapses, probable action of alcohol on 
 
 Temperature of body 
 
 how maintained 
 effect of alcohol on 
 regulation of ... 
 
 Tolerance of alcohol 
 
 „ „ not acquired by all body cells 
 
 Venereal disease, in relation to alcohol 
 Volitional acts, complexity of ... 
 
 Well-being, feeling of, induced by alcohol ... 
 
 Will, enfeeblement of, in alcoholics 
 
 Wines, effect of, on digestive ferments 
 
 „ strength of 
 
 Work, alcohol unsuitable as food for 
 
 „ skilled, effect of alcohol on 
 
 
 
 Page 
 
 
 
 22 
 
 
 47, 50, 51 
 
 
 
 127 
 
 
 
 18 
 
 
 
 56 
 
 ... ... 
 
 
 33 
 
 .• ..• 
 
 
 80 
 
 
 
 
 106 
 
 ... 
 
 
 105 
 
 31 
 
 37, 77, 
 
 125 
 
 103 
 
 99 
 
 91 
 97 
 93 
 36 
 
 78 
 79 
 81 
 80 
 91 
 92 
 
 95 
 
 46 
 
 30 
 113 
 
 59 
 
 ... Appendix 4 
 
 
 ... 
 
 
 129 
 
 
 126 
 
 129 
 
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 His Majesty's Stationery OfBce 
 
 by 
 
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LONDON : 
 
 Published by 
 
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 and to be purchased through anj' Boolcseller or 
 
 directly from H.M. Stationery Oflice, London, S.W. 
 
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