THE EFFECTS 
OF THE 
ABUSE OF ALCOHOL 
ON THE 
Circulatory and Respiratory Organs, 
READ BEFORE THE MEETING OF THE 
American Institute of H OMCEOPATHY, 
Session of 1884, 
BY 
J. W. DOWLING, M.D., 
PROFESSOR OF PHYSICAL DIAGNOSIS AND DISEASES OF THE HEART AND 
LUNGS, NEW YORK HOMOEOPATHIC MEDICAL COLLEGE; LATE PRESIDENT 
OF THE AMERICAN INSTITUTE OF HOMOEOPATHY, AND DEAN OF 
THE NEW YORK HOMOEOPATHIC MEDICAL COLLEGE. 
REPRINT FROM THE TRANSACTIONS. 
PITTSBURGH: 
PRESS OF STEVENSON & FOSTER, No. 529 WOOD STREET. 
1884. ERRATA. 
On page 9, 20tli line, for “ diastole,” read “ systole.” 
On page 12, 15th line, for “ insiduous,” read “ insidious.” 
77t.8., 
S / <£ ev 
M^.. J'Jye Effects of tfye yibuse of on tf/e Pircu; 
latory and Respiratory Prgans. 
By J. W. Dowling, M.D., New York City, N. Y. 
With but few exceptions the exhilarating, the damaging in- 
gredient of all of the so-called stimulating drinks is alcohol. 
It matters not whether they be in the form of spirituous liquors, 
cordials, still wines of high and low grades, the most delicate 
champagnes, ales or beers. 
It is true that in some instances, either to add to the gains 
of the dealer, or to improve the flavor, or to impart peculiar 
stimulating or intoxicating properties, substances are added 
which are in themselves poisonous, in rare instances even more 
poisonous than alcohol itself. Thus, fusil oil is found added 
to some brandies, and gin, the favorite drink of the toper, the 
lining membrane of whose pharynx, oesophagus and stomach 
have become tanned, so to speak, is made fiery and at the same 
time smooth, by the addition of oil of vitriol, oil of juniper, 
alum, carbonate of soda, turpentine, etc., all helping to impart 
to the popular beverages their peculiar flavors and properties. 
But of all poisonous substances added to alcohol in the prepa- 
ration of palatable drinks, the essence of absinthium or worm- 
wood is the most injurious. In addition to its destructive 
effects upon the stomach, it has been known to produce in man, 
as it does in the lower animals, a species of epilepsy, the con- 
dition becoming lasting where the use of the poison is contin- 
ued. As is well known, wormwood, aside from alcohol, is the 
active ingredient of the popular cordial known as absinthe. 
But it is of the effects of the abuse of alcohol that we propose 
to treat, and enough can be truthfully said on the subject to 
satisfy every thinking man that the constantly working, and 
in health, never tiring heart, is invariably weakened in its 
action, and often, very often, permanently ruined by the con- 2 
THE EFFECTS OF THE ABUSE OF ALCOHOL 
stant use of stimulating beverages; and so, too, with those 
equally important and vital organs, the lungs and air passages. 
As in our heading we use the term “ abuse of alcohol,” it is 
but proper that we should have some understanding as to 
what constitutes abuse in this connection. 
It is undoubtedly true that some constitutions are far more 
susceptible to the action of alcohol than others. It is also true 
that in some, the effects are more marked on the nervous 
system, in others on the digestivo organs, in others on the kid- 
neys, and in others on the circulatory and respiratory organs. 
How often have we as physicians been called to treat diseases 
resulting from the habitual use of alcoholic beverages in 
patients who considered themselves temperate men or women, 
and who boasted that they were never under the influence of 
liquor in their lives, while at that very time they were dying 
of Bright’s disease, cirrhosis of the liver, chronic gastritis, 
brain or spinal disease, fatty degeneration of the heart, chronic 
bronchitis, with emphysema of the lungs, or even of pulmo- 
nary consumption, resulting alone from the long continued 
use of some of the many fascinating drinks containing alcohol. 
It will be difficult for us to give an intelligible idea of what 
constitutes abuse, or rather what may be considered the mod- 
erate use of alcohol. My own opinion accords with that of the 
great investigator, hygienist and physician, Benjamin W. Rich- 
ardson, M.D., F.R.S., whom I shall have occasion to quote in 
this article as authority for statements made. He says: 
“This chemical substance, alcohol, an artificial product de- 
signed by man, for his purposes, and in many things that lie 
outside his organism a useful substance, is neither food, nor a 
drink, suitable for his natural demands. Its application as an 
agent that shall enter the living organism is properly limited 
by the learning and skill possessed by the physician, a learn- 
ing that itself admits of being recast and revised in many im- 
portant details and perhaps in principles.” 
“ If this agent do really for the moment cheer the weary, 
and impart a flush of transient pleasure to the unwearied who 
crave for mirth, its influence (doubtful even in these modest 
and moderate degrees) is an infinitesimal advantage by the 
side of an infinity of evil for which there is no compensation 3 
ON THE CIRCULATORY AND RESPIRATORY ORGANS. 
and no human cure.” Still we occasionally have evidence 
presented to us that the daily moderate use of alcoholic prepa- 
rations may be continued for many years with no apparent 
injury in some individuals, and very frequently equally strong 
evidence that the same moderate use will produce in others 
serious, and in many cases fatal, chronic diseases. It is true 
that permanent injurious results rarely follow the occasional 
use or even abuse of stimulants, for if the patient be of healthy 
constitution the system has opportunity to entirely recover 
from the toxicological effects before the indiscretion is repeated. 
This will explain why so many periodic drinkers live to a good 
old age and die from natural causes. 
As an answer to the question: What constitutes abuse in 
the use of alcohol ? I most unhesitatingly assert that habitual 
use is abuse, even if the quantity be small. It is no argument 
against the truth of this statement that men have lived to be 
eight)' or ninety years of age in tolerable health, who have 
used alcohol in moderation the greater portion of their lives. 
Perhaps if they had abstained entirely they would have lived 
to be ninety or one hundred, and enjoyed still better health. 
Certain it is that alcohol is a poison. That but a small 
portion of what is taken into the system is eliminated as 
alcohol. That, to a certain point, what remains is decom- 
posed. That in this process of decomposition or oxidation it 
does not supply nutriment to the body, neither does it sup- 
ply muscular strength or animal warmth, for this oxidation 
is “ at the expense of the oxygen which ought to be applied 
to the natural heating of the body.” That the product of its 
decomposition is a poisonous substance which, circulating as 
it does, through every portion of the body, injures the deli- 
cate texture of the various organs, and interferes with their 
functions to a greater or less extent, according to the amount 
present or the susceptibility of the organs to its action. That 
even the accumulation of fat which sometimes follows the con- 
tinued use of certain alcoholic beverages, if it results at all 
from the alcohol contained in them, is produced by “ indirect 
and injurious interference with the natural processes.” 
But to the subject of our paper, “ The Effects of the Abuse of 
Alcohol on the Circulatory and Respiratory Organs.” At the 4 
THE EFFECTS OF THE ABUSE OF ALCOHOL 
present day all are familiar with the physiological action of 
Nitrite of amyl. We know that it has a paralyzing effect on 
the vaso-motor nerves, and that the muscular fibres of the ar- 
terioles throughout the entire body lose their power of contrac- 
tion, the vessels become dilated, not on the surface alone but 
everywhere. The heart, which has been kept in check by the 
tension of their walls, is relieved of a portion of its labor, and 
as a locomotive increases its speed rapidly on the breaking of 
the coupling which attaches it to the train behind, so the 
heart’s action is increased in frequency. This fact, in connec- 
tion with the action of Nitrite of amyl, has been taken advan- 
tage of by physicians throughout the civilized world to relieve 
the arterial spasm which causes the overloading and distend- 
ing of the heart in that dreadful condition known as angina 
pectoris. The drug, like alcohol, has its uses, but it is, never- 
theless, a poison. To a less extent alcohol acts in precisely the 
same way, paralysing the vaso-motor nerves, dilating the 
arterioles, increasing the frequency of the heart’s action. 
Richardson, in referring to this, says: “If you attend a large 
dinner party, you will observe after the first few courses when 
the wine is beginning to circulate, a progressive change in 
some of those about you who have taken wine. The face 
begins to get flushed, the eye brightens, and the murmur of 
conversation becomes loud. What is the reason of that flush- 
ing of the countenance? It is the same as the flush from 
blushing, or from the reaction of cold, or from the Nitrite of 
amyl. It is the dilatation of vessels following upon the reduc- 
tion of nervous control, which reduction has been induced by 
the alcohol. In a word, the first stage, the stage of vascular 
excitement from alcohol has been established.” 
As was before stated, if the indiscretion stop here, provided 
the subject be a healthy one, the paralyzing effect of the alcohol 
soon passes away. The walls of the vessels regain their tone, 
the vessels resume their former calibre, the old obstacle is 
offered to the too free emptying of the heart, and the undue 
frequency of action disappears ; but if the indiscretion be soon 
repeated again and again, by and by, a condition of permanent 
vaso-motor paralysis is established. The vessels become per- 
manently dilated, the heart’s action permanently increased in 
frequency. ON THE CIRCULATORY AND RESPIRATORY ORGANS. 
5 
If this was the only effect of alcohol, it is easy to prove 
that from this, and this alone, serious injury, permanent injury, 
injury calculated to shorten life, would result to the circula- 
tory and respiratory organs. But its action does not stop here. 
The poison generated by the combustion of alcohol in the 
system produces cellular changes everywhere; by its contact 
with the blood-discs, changes are produced in them; by its mix- 
ing with the serum of the blood, changes, injurious changes, 
are produced here, the character of the blood is changed, the 
heart, the arterial walls, the elastic lung tissue, the muscular 
fibre of the bronchial tubes, the mucous membrane lining 
them and the upper air passages, the muscles concerned in 
respiration, all receive impure, poisoned blood and are damaged 
accordingly. The immediate action of alcohol on the nervous 
system, the digestive organs and kidneys, will be considered 
by my associates in the bureau. 
What is the result, so far as the circulatory and respiratory 
organs are concerned, of this dilatation of the blood-vessels, 
of this increased frequency of the heart’s action, of this poisoned, 
this pathologically changed blood ? 
As a certain number of years are allotted for the life of man, 
so a certain number of heart strokes, of respiratory movements, 
are allotted. If the life of a healthy man should extend three 
score and ten, or four score years, with the heart beating after 
maturity at the rate of seventy a minute, and with eighteen 
respiratory movements in the same length of time; with a 
heart beating at eighty and with twenty-one respirations to the 
minute, his life from the time of commencement of the excess 
would be shortened by about one-seventh. This, in itself, 
would seem to many a serious and unfortunate result, but this 
is not all. The life, in by far the greater majority of cases 
owing to the discomfort produced, is rendered miserable, and 
in some instances death, to the individual, and frequently to 
his relatives and friends, is a welcome visitor. From overwork 
alone the heart would be prematurely worn out. 
The diseases resulting immediately or secondarily from the 
abuse of alcohol, so far as these organs are concerned, may be 
enumerated as follows : 
Dilatation of the heart. Hypertrophy of the heart. 6 
THE EFFECTS OF THE ABUSE OF ALCOHOL 
Endocarditis. Pericarditis. Valvular disease cf the heart. 
Fatty deposit on the heart and infiltration of the walls of 
the heart with fat. Fatty degeneration of the heart. 
Aneurism of the walls of the heart, and rupture of the heart. 
Fibroid disease of the walls of the arteries. 
Fatty and calcareous degeneration of the walls of the arteries. 
Aneurisms of the arteries. 
Nasal, pharyngeal, laryngeal and bronchial catarrh. 
Pulmonary emphysema. Asthma. Pneumonia. 
Pulmonary phthisis. Pleuritis. 
We will now attempt briefly to state how these conditions 
can be produced by the continued use of alcohol, and the 
results arising from them. 
DILATATION OF THE HEART. 
The fact being established that the first effect of alcohol is 
to quicken the heart’s action, it can readily be understood how 
the walls of the heart may become hypertrophied by this con- 
tinual over-action, for the muscular fibres of the heart, like 
those of other muscles, are thickened by over-exertion, provided 
the nutrition of the organ is good, and, too, it has been estab- 
lished, that new muscular fibres are formed in the walls of a 
heart that has an excessive amount of work to do, and under 
such circumstances we do not look on this hypertrophy as a 
disease, but as nature’s method of compensating for the amount 
of extra labor to be performed. But in habitual drinkers of 
alcohol the nutrition of the heart is not good, and particu- 
larly if there be inherent weakness from other causes; instead 
of the walls becoming hypertrophied from increased growth of 
old muscular fibres and the development of new, the muscu- 
lar fibres atrophy, and the heart walls during systole are no 
longer able to empty the chambers of the organ, which being 
partially filled during the diastole, instead of being empty as 
they should be, the incoming blood from the veins to the 
auricles, and from the auricles to the ventricles, stretches the 
relaxed muscular fibres, [and the heart walls become dilated 
enlarging the capacity of the chambers. If on the first evi- 
dences of heart failure from dilatation of its walls the excesses ON THE CIRCULATORY AND RESPIRATORY ORGANS. 
7 
be suspended, provided the subject be free from complicating 
diseases, the muscular fibres will regain their former strength 
and return to their normal condition, but if the excess is con- 
tinued the well-known consequences of dilatation follow. 
Pulmonary engorgement, over-distension of the systemic veins, 
percolation of serum through their walls, general dropsy and 
finally death. 
HYPERTROPHY OF THE HEART. 
We have just alluded to the manner in which the heart 
walls may become hypertrophied from too rapid action as a 
result of the paralysis of the walls of the arterioles, accompany- 
ing the early stages of alcoholism, but, as we shall learn later, 
there is another stage in which, notwithstanding the paralyzed 
condition of the vaso-motor nerves, the lumen of these vessels 
is actually diminished, then comes resistance to the emptying 
of the heart, and if the nutrition of the organ be fairly good, 
compensating hypertrophy gradually takes place, and the 
heart in its strengthened condition does good work for a long 
period of time, till death comes from the rupture of an atherom- 
atous cerebral artery, from the rupture of an aneurismal sac, 
from ursemic poisoning, as a result of kidney changes, or from 
heart degeneration with pulmonary oedema, the pathological 
conditions mentioned, as will be seen further on, being but a 
portion of a general disease process resulting from the abuse 
under consideration. 
It is well known that acute inflammation of the endocardium 
is a frequent complication of articular rheumatism, and it is 
well established that this complication is owing to the presence 
of lactic acid in the blood in this disease. Endocarditis is also 
a complication of other diseases, characterized by the presence 
of acids of a different nature in the blood. It is often found 
as a complication of so-called Bright’s disease, but there is a 
doubt in my mind as to the endocarditis being the result of 
the changed condition of the kidneys; rather is it the result of 
the poisoned state of the blood which has itself really given 
rise to the kidney degeneration. Lithsemic subjects suffer from 
fibroid and granular degeneration of the kidneys arising un- 
ENDOCARDITIS. 8 
THE EFFECTS OF THE ABUSE OF ALCOHOL 
doubtedly from the changes which first commence in the walls 
of the arterioles of those organs owing to the excess of waste 
material (uric acid) in the blood. The endocardium is sensi- 
tive to the action of acid poisons, and how common is it for 
the blood of persons addicted to the use of alcohol to be loaded 
with lithic acid and other poisons, resulting from the oxida- 
tion of the alcohol taken into the system. Is it surprising 
then that acute endocarditis should result directly from the 
abuse of alcoholic beverages ? That it does there is no doubt, 
for post-mortem examinations in cases of death from acute 
acohol poisoning have proved it. The consequences of endo- 
cardial inflammation, whether it arise from this or other causes, 
are too well known to require mention. In the majority of 
cases changes take place in the edges of the valves which 
progress and cripple the heart for life. 
Pericarditis. 
Acute inflammation of the pericardium is almost as common 
a complication of rheumatism as endocarditis, but it is not so 
easy to surmise the cause as in endocarditis. So is it a com- 
plication of lithsemia, and as lithsemia is one of the most direct 
and common results of the excessive and prolonged use of 
alcohol, we can assert without fear of contradiction that peri- 
carditis results directly from the presence in the blood of waste 
material and poisonous substances which would not be there 
were it not for the excess referred to. In this disease, as well 
as in endocarditis, there is probably generally an exciting 
cause for its development, but a cause which would be inoper- 
ative were it not for the predisposition resulting from the 
alcoholic dyscrasia. Although pericarditis is not generally 
fatal in its results, adhesions of the two layers almost invaria- 
bly follow the absorbtion of the exudation, and the heart is 
hampered in its action through life. 
We have alluded to valvular deformity as a result of the 
endocarditis complicating alcoholism. As it is secondary to 
endocardial inflammation, so is it late in life a result of the 
arterial changes arising from alcoholism which will be de- 
VALVULAR DISEASE OF THE HEART. ON THE CIRCULATORY AND RESPIRATORY ORGANS. 
9 
scribed further on. Atheromatous degeneration of the aorta 
near its root readily extends to and involves the segments of 
the semilunar valve at the aortic orifice, as a result, deformities 
from fibroid growth and calcareous degeneration result. Fre- 
quently too, from the narrowing of the lumen of the arterioles 
owing to the thickening of their walls to be described later, the 
recoil against the aortic valves during diastole and the strain 
of the mitral during the systole of the ventricle are so great 
that a chronic inflammation results with fibroid thickening, 
the newly developed tissue subsequently contracting produc- 
ing deformities resulting in insufficiency or constriction or 
both. In some instances the valves yield to the pressure 
which they are called on to sustain, and are lacerated. In- 
flammation follows and by its consequences adds to the valv- 
ular derangement. 
The result of valvular deformity in every instance, whether 
it constricts the orifice or permits regurgitation, is to obstruct 
the blood-current at the orifice involved. As a consequence 
there is imperfect emptying of the chamber back of this orifice 
during the diastole of its w’alls and dilatation follows; if the 
nutrition be fairly good, compensating hypertrophy gradually 
takes place, and, to a certain extent, the injury is overcome, 
but the patient is crippled for life. 
FATTY DEPOSIT ON THE HEART AND INFILTRATION OF THE WALLS 
OF THE HEART WITH FAT. 
Although it has been asserted in this article that alcohol in 
itself does not form fat in the body, it is notorious that many 
habitual drinkers—and, too, including some who partake of 
but little food, owing to the catarrhal conditions of the stom- 
ach resulting from their habits—accumulate fat rapidly ; par- 
ticularly is this true in reference to ale and beer drinkers. 
Richardson, in discussing this fatty tendency on the part of 
habitual drinkers, says: “ The fattening may not be due to the 
alcohol itself, but to the sugar or the starchy material that is 
taken with it. As a matter of general experience on which I 
have tried to arrive at the truth, I am led to the conclusion 
that pure spirit drinkers among men, I mean those who do 
not mix sugar with the spirit, and who dislike spirit which is 10 
THE EFFECTS OF THE ABUSE OF ALCOHOL 
artificially sweetened, are not fattened by the spirit they take. 
This tallies also with the observations on the action of abso- 
lute alcohol on inferior animals, for they certainly, under that 
influence if they are allowed liberty to move freely, do not 
fatten. Alcohol when it is largely taken, unless the will of 
the imbiber be very powerful, is wont to induce desire for un- 
due sleep or, at least, desire for physical repose; under such 
conditions there is an interference with the ordinary nutrition 
processes. The wasted products of nutrition are imperfectly 
eliminated, the respiration becomes slower and less effective, 
and there is set up a series of changes leading, independently 
of the alcohol as a direct producer of fat, to the development 
and deposit of fatty tissue in the body/’ 
In the obese, fat is not alone deposited on the surface of the 
body. It is with man, as with animals fattened for market— 
the appearance of prize beef is famili ar to all—fat nearly every- 
where, between the muscles, in and between the muscular 
fibres, on the heart, beneath the pericardium, along the edges 
of the lungs. 
Certain it is that habitual drinkers, particularly those who 
confine themselves mainly to malt liquors, grow fat and die 
many years before the allotted time of man. Such are found 
post-mortem to have fatty hearts. 
This condition of a few ounces of fat deposited on the organ 
to a certain extent hampers its action; it has a greater daily 
amount of work to do, and fails earlier than would otherwise 
be the case. It is not supposed that the muscular fibres them- 
selves are weakened by the mere presence of fat around them, 
so long as there is no actual fatty degeneration of tissue. 
FATTY DEGENERATION OF THE HEART. 
Although fatty degeneration of the muscular fibres of the 
heart frequently co-exists with fatty deposit, it is quite as often 
found where there is no undue deposit of fat on the heart, 
and it is even said to be rare as an accompaniment of fatty 
infiltration. 
The causes of fatty degeneration are faulty nutrition of the 
organ from a deteriorated or poisoned condition of the blood, 
or from improper blood supply resulting from obstruction to ON THE CIRCULATORY AND RESPIRATORY ORGANS. 
11 
the current through the coronary arteries. The former is 
found where the blood is loaded with waste material resulting 
from improper oxidation of effete tissue, and in amemia re- 
sulting from a diminished supply of red blood-corpuscles with 
excess of white, and in the same condition resulting from 
pathologically changed blood-discs; the latter where there is 
insufficiency of the aortic valves with the consequent regur- 
gitation during the diastole of the ventricles, and where the 
coronary arteries are tortuous and atheromatous. 
Each of these pathological states results directly from the 
continued use of alcoholic beverages; consequently, as the 
effect follows the cause, we are safe in asserting that fatty de- 
generation of the heart is not an uncommon result of pro- 
longed excess in this direction. 
Although it is a mooted question as to whether it is possible 
for new muscular fibres to take the place of the old ones which 
have become converted into fatty debris (necrosed), all agree 
that a heart which has become degenerated to any extent is 
in by far the greater majoriy of cases permanently disabled, 
and that owing to its enfeebled condition venous engorgement 
of the various organs of the body may result, and to such an 
extent as to disturb their function sufficiently to be incom- 
patible with life itself; or that acute oedema of the lungs, as a 
direct result of weakened heart’s action, may destroy the life 
of the patient; or that the heart may suddenly fail during its 
diastole, owing to shock, or sudden change from the recum- 
bent to the upright position, the result of course being instant 
death. Several cases of death from fatty degeneration of the 
heart, from each of the above causes, have come under the 
writer’s immediate observation. 
ANEURISM OF THE HEART AND RUPTURE OF THE HEART WALLS. 
In rare instances fatty degeneration of the heart exists to 
but a limited extent. In small areas there is obstruction of 
the minute branches of the coronary artery. The part involved 
not being properly nourished degenerates, and of course becomes 
weakened, and as during the systole of the heart the pressure 
is equal in all parts of the ventricle the weakened portion 
yields and bulges, as does a weakened portion of the aorta 
during systole of the ventricle, it is readily seen that quite a 12 
THE EFFECTS OF THE ABUSE OF ALCOHOL 
large aneurism may result which eventually ruptures, or the 
degenerated portion may rupture on the first extra violent 
systole of the ventricle from any cause. Of course death under 
such circumstances is the inevitable result. Although these 
conditions may not be considered the immediate results of 
alcoholism, they are the immediate results of the degenerative 
process which can be and frequently is caused by the abuse of 
alcoholic drinks. 
We now come to the consideration of the most interesting 
pathological changes w'hich may result from the long continued 
use of alcoholic beverages, viz.: Fibroid disease of the walls 
of the arteries, from which some of the conditions already 
described are the immediate result. It would carry us too far 
were we to attempt to go fully into the consideration of this 
insiduous disease which, in by far the greater number of cases 
where it exists, results directly from the abuse, the effects of 
which we are considering. Hypertrophy of the left ventricle 
of the heart which is a constant accompaniment of the form of 
Bright’s disease known as contracted kidney, was till recently 
supposed to arise from the obstruction the blood met with in 
its passage through the kidneys, owing to their cirrhotic state, 
and the narrowing of the lumen of their arterioles and capil- 
laries. It was conceded by all that this condition was a frequent 
result of the prolonged use of alcoholic drinks. Recent inves- 
tigations have proved that in the disease mentioned, this con- 
dition of the arterioles is not confined to the kidneys, and that 
the walls of these vessels throughout the entire body are 
involved in a general vascular lesion, viz.: hypertrophy of their 
longitudinal and circular muscular fibres with hyperplasia of 
fibrous tissue cells, the latter involving the capillaries as well, 
the connective tissue resulting, subsequently contracting, in 
accordance with the general law governing newly developed 
connective tissue and narrowing the calibre of the vessels, the 
hypertrophy of the heart being nature’s method of compensat- 
ing the obstruction to the blood current thus produced. Why 
is this contraction of the kidneys, this change in the walls of 
the smaller arteries and the capillaries, this hypertrophy of 
the left ventricle of the heart so frequently found in those who 
have been habitual drinkers of alcoholic beverages? ON THE CIRCULATORY AND RESPIRATORY ORGANS. 
13 
We have made the assertion that alcohol is itself a poison. 
Entering the blood it produces pathological changes here, the 
blood-discs are changed in shape, they are made to adhere to 
each other, in some instances clogging the capillaries, their 
function as oxygen bearers is impaired. It produces by its 
toxic effects cellular changes in every portion of the body, 
particularly is this seen in the stomach, the duodenum, the 
liver and the endothelial lining of the arteries, the arterioles, 
the capillaries and the veins. Thus by its presence alone seri- 
ous injuries result, but in addition it interferes with the proper 
elimination of waste material, “ and directly leads to the forma- 
tion of excess of uric acid in the blood, more than can be 
eliminated or destroyed in the system,” by disturbing the 
action of the digestive organs, and by interfering with the 
functions of the liver and kidneys, and by developing indo- 
lent and lazy habits so far as physical exertion is concerned, 
all combining to induce excess of waste material in the blood, 
and to prevent its proper elimination. A condition of chronic 
lithiasis results, precisely similar to that found in gouty sub- 
jects who have acquired the disease by inheritance, or by the 
excessive eating of nitrogenous food. Gout is frequently at- 
tributed to these latter causes, but it will generally be found 
on inquiry that in addition, the habitual use of alcoholic bev- 
erages has been common with such subjects. 
This excess of uric and other acids in the blood acts as a 
local irritant to the endothelial lining of the blood-vessels, 
finally bringing about the condition mentioned. Degenerative 
processes are liable to take place in this newly formed tissue, 
first fatty, later possibly calcareous degeneration. What is the 
result? As was before stated, the heart suffers through want 
of proper food supply, and the conditions already enumerated 
follow, for its tortuous and atheromatous blood-vessels cannot 
carry and supply the normal amount of blood to its muscular 
walls. The walls of the blood-vessels throughout the system 
generally are weakened owing to degenerative changes—conse- 
quently with an hypertrophied heart back of them pumping 
at times with great force, they sometimes yield and aneurisms 
result, or during excitement or violent physical effort a vessel 
may rupture, particularly is this common in the spleen, in the 14 
THE EFFECTS OF THE ABUSE OF ALCOHOL 
lungs and in the brain, for in these localities the walls of the 
vessels are not well sustained by support from the surround- 
ing tissues. If in the spleen or lungs haemorrhagic infarction 
results; if in the brain apoplexy, in fact the latter condition 
is the most common cause of death in lithaemic subjects who 
die in the prime of manhood ; later, unless they die of some 
disease contracted accidentally, and which, owing to their 
lack of resisting power, they have not the strength to withstand, 
they succumb to fatty degeneration of the heart, granular 
kidneys, abscess of the kidneys, resulting from calculi, stone in 
the bladder, cirrhosis of the liver, chronic catarrh of the 
stomach, intestines or bladder, or all combined, prostatitis, 
chronic bronchitis, pneumonia or pulmonary phthisis, result- 
ing directly from the abuse of alcohol. 
EFFECT ON THE RESPIRATORY ORGANS. 
We have already extended our paper so far that we shall 
necessarily be brief in what we have to say of the effects of 
the abuse of alcohol on the respiratory organs. We beg to 
call your attention again to our definition of abuse, viz., habit- 
ual use. 
Niemeyer says, and truthfully, “ Whenever there is hyper- 
semia of mucous membrane, active or passive, the condition 
known as catarrh is also more or less distinctly observable/' 
and every physician in active practice will confirm the state- 
ment of this great pathologist, that “habitual topers almost 
always have catarrh of the pharynx in which the laryn- 
geal mucous membrane takes a part.” 
The paralyzing effect of alcohol on the vaso-motor nerves 
and the resulting dilatation of the arterioles and capilla- 
ries which is general, of course extends to the mucous mem- 
brane lining the air passages. We, therefore, have the hy- 
persemia, which is always accompanied to a greater or less 
extent by the condition known as catarrh; but there seems to 
be an inherent predisposition in some from the same exciting 
cause, to catarrh of the pharynx and nasal passages; in others 
to catarrh of the larynx and trachea, and in others to bron- 
chial catarrh. In some all of these mucous surfaces are ON THE CIRCULATORY AND RESPIRATORY ORGANS. 
15 
equally susceptible. Certain it is that nearly all habitual 
users of alcoholic beverages suffer to a greater or less extent 
from catarrh of one or all of these mucous membranes. Long 
continued hypersemia of a part produces cellular hyperplasia, 
consequently in time the mucous membrane is thickened— 
hypertrophic catarrh—and still later owing to the contraction 
of the newly formed fibrous tissue, we may have the condi- 
tion known as atrophic catarrh, in which the membrane is so 
pathologically changed that its function is permanently de- 
stroyed. 
In the larger air passages, aside from disturbance of func- 
tion, no serious consequences result, unless there be a predis-, 
position to tubercular troubles or a syphilitic complication. 
Not so in the smaller air passages; their lumen is diminished, 
not only by the hyper-secretion, but by the increase of tissue. 
Inspiration being an active process, in which many powerful 
muscles are concerned, air can readily find its way through 
these constricted air passages to the air vesicles; but as it is 
expelled from these by the elasticity of the lung fibres alone, 
it is readily seen that they will become over-filled and dis- 
tended; and later, owing to the pressure of the air on the two 
sides of the walls of the vesicles, their blood supply is inter- 
fered with, and they atrophy and finally break down, and sev- 
eral vesicles are merged into one large air sack, and a condi- 
tion of permanent pulmonary emphysema is established. 
The results of this condition are too well known to require 
but mere mention; permanently diminished vital capacity; 
dyspnoea on the slightest exertion ; obstruction to the free 
emptying of the right heart with consequent dilitation, and 
if the nutrition be good, subsequent hypertrophy; but until 
this hypertrophy is established, venous engorgement of every 
organ of the body, the brain, liver, stomach and intestinal 
canal, kidneys, etc., with pronounced disturbance of their 
functions. As a direct result, too, even without hereditary 
predisposition, owing to nervous irritation resulting from the 
bronchitis and emphysema, we have in some, severe attacks of 
asthma. 
We are all familiar with the aetiology of lobular, broncho or 
catarrhal pneumonia, we know that in every instance an at- 16 
THE EFFECTS OF THE ABUSE OF ALCOHOL. 
tack is preceded by a bronchial catarrh, and that this bron- 
chial catarrh is the direct cause of the difficulty, aided in some 
instances by a predisposing cause, none greater, aside 
from a phthisical tendency, than alcoholism, this form of pneu- 
monia differing materially from croupous or lobar pneumonia, 
the aetiology of which is not settled, and which never attacks 
a single or a few lobules, but always an entire lobe, and which 
is not preceded by a bronchial catarrh, but which is primarily 
a lung inflammation. 
The latter disease rarely leaves any sequelae behind ; in 
nearly every instance it terminates in entire restoration to 
health, or death, while lobular pneumonia frequently develops 
pulmonary ulceration—necrosis of lung tissue—which is noth- 
ing more or less than pulmonary phthisis. If the factors are 
present, the result may be tubercular phthisis. 
Pleurisy the last condition under our heading, which we have 
enumerated as a result of the abuse of alcohol, is always an 
accompaniment of chronic interstitial pneumonia (fibroid 
phthisis of some authors), which results directly from bron- 
chitis, involving the deeper structures of the bronchial tubes 
(peri-bronchitis). It is also a constant accompaniment of 
pulmonary phthisis, where that portion of the lung covered 
by the pleura is involved; but in addition we may have pleu- 
ritis primarily as a direct result of the abuse of alcohol. 
This latter assertion has been proven by 'post-mortem, examina- 
tions in patients who have died from acute alcoholism. 
In the writing of this paper, which has been after careful 
study of my subject, I have not exaggerated the effects of this 
poison. Every statement 1 have made can be substantiated. 
And although I have always been fond of the pleasures of the 
table, with all that the term implies, and have suffered from 
sundry attacks of gout, which I cannot trace to hereditary 
predisposition, and which gave me opportunities for much 
needed rest from the arduous duties of my profession, my 
investigations have almost converted me to total abstinence. 
The half has not been told by me.