K"* oc£ SURGEON GENERAL'S OFFICE LIBRARY. Section,________________________ Xo. ^O■& A\T\J •JUrr■'■« W «r • • v£?• • * *r • ^ »••v n£{ •• \ *« l.*V •U 'ft * ,.?;,, -if ON THE ... / j? / 1 P3 USE AND ABUSE r /. / . , ALCOHOLIC LIQUORS, IN HEALTH AND DISEASE. •J By WILLIAM B. ^AKPENTER, M.D., F.K.S., F.G.S., XAMINER IN PHTSIOLOGY* IN THE UNIVERSITY OF LONDON, PROFESSOR OP MEDIC iL JURISPRUDENCE IN UNIVERSITY COLLEGE, AKD AUrHOR OF "PRINCIPLES OF HUMAN PHYSIOLOGY," KTC. ETO. HAMILTON: PRINTED AT " THE CANADIAN" OFFICE, FOR H. W. JACKSON, «. JJ. 1852 TO HIS ROYAL HIGHNESS PRINCE ALBERT, m (BY PERMISSION) MOST RESPECTFULLY DEDICATED; AS AK EXPRESSION OF 'BHB AUTHOR'S A B.HI K A "B I Q,S OF BIS ROYAL HIGHNESS^ ENDEAVORS TO E1EVATB THE SOCIAL CONDITION OF HIS ADOPTED COUNTRY; AND. \V«H THE FIRM BEI4EF THAT THE PATRONAGE NOW SO GRAOIOVSl.Y COXCEDEl', WILL AID IN CALLING THE ATTENTION OF THE PUBLIC TO THE BUBJECT OF THE PRESENT INQUIRY, IN A DEGREE COMMENSURATE WITH ITS IMPORTANCE ADVERTISEMENT ISSUED BY DIEECTION OF THE DONOR OF TIIE PRIZE A PRIZE OF ONE HUNDRED GUINEAS WILL BE GIVEN FOR TIIE BEST ESSAY ON THE USE OF ALCOHOLIC LIQUOP.s IN HEALTH AND DISEASE, The Essay must contain answers to the following ques- tions :— 1st.—What are the effects, corporeal and mental, of Alco- holic Liquors on the healthy human system ? 2nd.—Does Physiology or experience teach us that Alcholic Liquors should form part of the ordinary sustenance of man, particularly under circumstances of exposure to se- vere labor or to extremes of temperature ? Or, on the other hand, is there reason for believing that such use of them is not sanctioned by the principles of science, or the results of practical observation ? 3rd.—Are there any special modifications of the bodily or mental condition of man, short of actual disease, in which the occasional or habitual use of Alcoholic Liquors may be necessary or beneficial ? 4th.—Is the employment of Alcoholic Liquors riecessary in the practice of Medicine ? If so, in what diseases, or in what forms or stages of disease, is the use of them neces- sary or beneficial ? The Essay must be delivered to the undersigned address on or before the 30th day of September, 1849. Dr. John Forbes, F. R. S., Physician to the Queen's House- hold, Prince Albert, and the Duke of Cambridge ; Dr. G. L. Roupell, F. R. S., Physician to St. Bartholomew's Hospital; and Dr. W. A. Gut, M. B., Cantab., Professor of Forensic Medicine, King's College, London, have kindly consented to act as Adjudicators. Signed on behalf of the Donor, 5, Bishopsgate Street Without, Charles Gilpin, London, April, 1848. Thomas Beggs. A 2. tr AnVERTHSEMBW*. ADJUDICATION. From the fifteen M S. Essays on the Use and Abuse of Alco- holic Liquors, transmitted to us by Messrs. Beggs and Gilpin for adjudication, we have unanimously selected as the best, the one bearing the motto—Mens sana in corporc sano. We ac- cordingly adjudicate to its author the Prize of One Hundred Guineas. We also think it due to the Author of the Essay bearing the motto—Quot homines tot sententice, to record our opinion of its great merits. We further deem it right to speak in terms of commendation pf the Essay having five mottoes, the first of which is—How fise doth breed a habit in a man. John Forbes, M. D. (Signed) G. L. Roupell, M. D. William A. Guy, M. B, London, December 6th, 1849. PREFACE. The circumstances under which the following Essay is given to the Public are sufficiently explained by the preceding Ad- vertisement and Adjudication ; but the Author takes this op- portunity of offering a short statement of the objects which ho had specially in view in its composition. The questions set forth in the Advertisement having been evidently drawn up Avith great care, and having been obviously intended to bring the whole subject of the ordinary, as well as the medical employment of Alcoholic Liquors under discussion, the Author judged it advisable to follow the plan which they had marked out, by answering each of them seriatim ; although he was aware that, by so doing, a certain amount of repetition would be almost necessarily involved. He found, as he proceeded, that it would be impossible to maintain such a continuity in his argument as would be desirable for its effec- tiveness ; and he would therefore request his readers, in limine, to keep the following issues in view, as those to which he is desirous of leading them. In the first place. That, from a scientific examination of the modus operandi of Alcohol upon the human body, when taken in a poisonous dose, or to such an extent as to produce Intoxi- cation, we may fairly draw inferences with regard to the specific effects which it is likely to produce, when repeatedly taken in excess, but not to an immediately fatal amount. Secondly. That the consequences of the excessive use of Al- coholic liquors, as proved by the experience of the Medical pro- fession, and universally admitted by medical writers, being precisely such as the study of its effects in poisonous and im- mediately fatal doses would lead us to anticipate, we are further justified in expecting that the habitual use of smaller quanti- ties of these liquors, if sufficiently prolonged, will ultimately be attended, in a large proportion of cases, with consequences prejudicial to the human system,—the morbid actions thus engendered being likely rather to be chronic, than acute, in their character. Thirdly. That as such morbid actions are actually found to be among the most common disorders of persons advanced in life, who have been in the habit of taking a " moderate" A 8. Vi PREFACE. allowance of alcoholic liquors, there is very strong ground for regarding them as in great degree dependent upon the asserted cause; although the long postponement of their effects may render it impossible to demonstrate the existence of such a con- nection. Fourthly. That the preceding conclusion is fully borne out by the proved results of the "moderate" use of alcoholic liquors, in producing a marked liability to the acute forms of similar diseases in hot climates, where their action is accelerated by other conditions ; and also by the analogous facts now uni- versally admitted, in regard to the remotely injurious effects of slight excess in diet, imperfect aeration of the blood, insufficient repose, and other like violations of the laws of health, When habitually practised through a long period of time. Fifthly. That the capacity of the healthy human system to sustain as much bodily or mental labor as it can be legitimately called upon to perform, and its power of resisting the extremes of heat and cold, as well as other depressing agencies, are not augmented by the use of Alcoholic liquors ; but, that, on the other hand, their use, under such circumstances, tends positive- ly to the impairment of that capacity. Sixthly. That, where there is a deficiency of power, on the part of the system, to carry on its normal actions with the energy and regularity which constitute health, such power can rarely be imparted by the habitual use of Alcqholic liquors ; its deficiency being generally consequent upon some habitual departure from the laws of health, for which the use of Alco- holic liquors cannot compensate ; and the employment of such liquors, although with the temporary effect of palliating the disorder, having not merely a remotely injurious effector se, but also tending to mask the action of other morbific causes, by rendering the system more tolerant of them. Seventhly. That, consequently, it is the duty of the medical practitioner to discourage as much as possible the habitual use of Alcoholic liquors, in however " moderate " a quantity, by all persons in ordinary health ; and to seek to remedy those slight departures from health which result from the " wear and tear " of active life by the means which shall most directly remove or antagonize their causes, instead of by such as simply palliate their effects. Eigthly. That, whilst the habital use of Alcoholic liquors, even in the most " moderate" amount, is likely (except in a few rare instances) to be rather injurious than beneficial, great PREFACE. VU benefit may be derived, in the treatment of disease, from the medicinal use of Alcohol in appropriate cases; but that the same care should be employed in the discriminating selection of those cases, as would be taken by the conscientious practi- tioner in regard to the administration of aay other powerful rernedy which is poisonous in large dosesi The foregoing appear to the Author to be the conclusions legitimately deducible from the facts and arguments which he lias brought forward ; it will be for his professional readers to decide how far the case which he has made out is sufficiently strong to lead them to the same results. This much, however, he would add: that, when he first entered upon the investiga- tion, some years ago, he had adopted no foregone conclusion; and had, consequently, no temptation to make the facts square with preconceived views; that he has constantly endeavored to treat the subject as one of purely scientific inquiry, and has avoided mixing up any other considerations with those which presented themselves to him as a Pysiologist and a Physician ; and that for the sake of keeping himself free from even the ap- pearance of partisanship, he has never allied himself with any one of the Societies which have been formed to carry inid practical effect the Total Abstinence principle, but lias preferred to follow a perfectly independent course. He ventures to hope" that on these grounds he may claim some right to being can- didly heard by those to whom this Essay is more especially addressed. ne cannot allow it to go forth, however, without expressing his conviction that, whilst there are adequate medical reasons for abstinence from the habitual use of even a " moderate *' quantity of Alcoholic liquors, there are also strong moral grounds for abstinence from that occasional use of them which1 is too frequently thought to be requisite for social enjoyment, and to form an essential part of the rites of hospitality. The" experience of every Practitioner must bring the terrible results of Intemperance frequently before his eyes ; but, whilst he is thu» rendered familiar with its consequences as regards individuuts^ few, save those who have expressly inquired into the subject can have any idea of the extent of the social evils result- ing from it, or of the degree in which they press upon every member of the community. The Author believes that he' is folly justified in the assertion that, among those who" have thus inquired, there is but one opinion as to the fact that of all the causes which are at present conspiring to de- a4. Till PREFACE. made the physical, moral, and intellectual condition of the mass of the people, there is not one to be compared in potency with the abuse of Alcoholic liquors ; and that, if this could be done away with, the removal of all the other causes would be im- measurably promoted. Every one who wishes well to his kind, therefore, must be interested in the inquiry how this monster-evil can be best eradicated. Now the Author considers that the best answer to this inquii y has been found in the results of experience. A fair trial has been given, both in this country and in the United States, to societies which advocated the principle of Temper- ance, and which enlisted in their support a large number of intelligent and influential men; but it has been found that little or no good has been effected by them, amons: the classes on whom it was most desirable that their influence should be exerted, except where those who were induced to join them really adopted the Total Abstinence principle. Though he agrees fully with those who maintain that, if all the world would be really temperate, there would be no need of Total Abstinence Societies, the Author cannot adopt the inference that those who desire to promote the Temperance cause may legitimately rest satisfied with this measure of advocacy. For sad experience has shown that a large proportion of mankind cannot, partly for want of the self-restraint which proceeds from moral and religious culture, be temperate in the use of Alco- holic liquors; and that the reformation of those who have ac- quired habits of intemperance cannot be accomplished by any means short of entire abstinence from fermented liquors. Fur- ther, experience has shown that, in the present dearth of effectual education among the masses, and with the existing temptations to Intemperance arising out of the force of exam- ple, the almost compulsory drinking-usages of numerous trades, and the encouragement which in various ways is given to the abuse of Alcoholic liquors, nothing short of Total Abstinence can prevent the continuance, in the rising generation, of the terrible evils which we have at present to deplore. And lastly, experience has also proved that this reformation cannot be carried to its required extent, without the co-operation of the educated classes; and that their influence can only be effectually exerted by example. There is no case in which the superiority of example over mere precept is more decided and obvious than it is in this. " I practice total abstinence myself," is found to be worth a thousand exhortations; and the lamen- PREFACE. ix table failure of the advocates who cannot employ this argument should lead all tliose whose position calls upon them to exert their influence to a serious consideration of the claims which their duty to society should set up, in opposition to their individual feelings of taste or comfort. Among the most common objections brought against the advocates of the Total Abstinence principle, is the following— " That the abuse of a thing good in itself does not afford a valid argument against the right use of it." This objection has been so well met by the late Archdeacon Jeffreys of Bombay (in a letter to the Bombay Courier), that, as it is one peculiarly likely to occur to the mind of his Medical readers, the Author thinks it desirable to quote a part of his reply. " The truth is," he says, " that the adage is only true under certain general limitations; and that out of these, so far from being true, it is utterly false, and a mischievous fallacy. And the limitations are these : If it be found by experience, that, in the general practice of the times in which Ave live, the abuse is only the solitary exception, whereas the right use is the general rule, sc that the whole amount of good resulting from its right use exceeds the whole amount of evil resulting from its partial abuse, then the -article in question, whatever it be, is fully entitled to the benefit of the adage ; and it would not be the absolute and imperative duty of the Christian to give it up on account of its partial abuse. This is precisely the position in which stand all the gifts of Providence, and all the enjoyments of life; for there is not one of them which the wickedness of man does not more or less abuse. But, on the other hand, if it be found by experience that there is something so deceitful and ensnaring in the article itself, or something so peculiarly untoward connected with the use of it in the present age,that tne whole amount of crime, and misery, and wretchedness con- nected with the abuse of it greatly exceeds the whole amount of benefit arising from the right use of it, then the argument becomes a mischievous fallacy, the article in question is not entitled to the benefit of it, and it becomes the duty of every good man to get rid of it." After alluding to the evidence that this is pre-eminently the case with regard to Alcoholic liquors, the Archdeacon continues—" We have then established our principle, in opposition to the philosophic adage; taking the duty of the citizen and the patriot, even on the lowest ground. But Christian self-denial and Christian love and charity go far beyond this. St. Paul accounted one single soul a .5. X PREFACE* 80 precious, that he would on no account allow himself in any indulgence that tended to endanger a brother's soul. ' If hieat make my brother to offend, I will eat no meat while the world standeth, lest I make my brother to offend.' ' It is good neither to eat flesh nor to drink wine, nor anything whereby thy brother stumbleth, or is offended, or is made weak.' And we must bear in mind that flesh and wine are here mentioned by Paul as ' good creatures of God;' they are not intended to designate things evil in themselves. This saying of St. Paul is the Charter of Teetotalism; and will remain the charter of our noble cause so long as the world endures, so long as there remains a single heart to love and revere this declaration of the holy self-denying Paul." _ If, then, the author should succeed in convincing his readers that the "moderate" habitual use of Alcoholic liquors is not beneficial to the healthy Human system—still more, if they should be led to agree with him that it is likely to be injurious, he trusts that they will feel called upon, by the foregoing considerations, to advocate the principle of Total Abstinence in whatever manner they may individually deem most likely to be effectual. He believes it to be in the power of the Clerical and Medical Professions combined so to influence the opinion and practice of the educated classes as to promote the spread of this principle among the " masses " to a degree which ho other agency can effect. And he ventures to hope that, whether or not he carries his readers with him to the full ex- tent of his own conclusions, he will at any rate have succeeded in convincing them that so much is to be said on his side of the question, that it can no longer be a matter of indifference what view is to bo taken of it; and that, as "universal experience" has been put decidedly in the wrong with regard to many of the supposed virtues of Alcohol, it is at any rate possible that its other attributes rest on no better foundation- In his general view of the case, he has the satisfaction of find- ing himself supported by the recorded opinion of a large body of his Professional brethren; upwards of two thousand of whom, in all degrees and grades—from the court physicians and leading metropolitan surgeons, who are conversant with the wants of the upper ranks of society, to the humble country practitioner, who is familiar with the requirements of the artisan in his workshop, and the laborer in the field—have signed the following certificate:— " We, the undersigned, are of opinion— PREFACE. M " 1. That a very large proportion of human misery, including poverty, disease, and crime, is induced by the use of Alcoholic or fermented liquors as beverages. " 2. That the most perfect health is compatible with Total Abstinence from all such intoxicating beverages, whether in the form of ardent spirits, or as wine, beer, ale, porter, cider, &c, &c. "3. That persons accustomed to such drinks may, with perfect safety, discontinue them entirely, either at once, or gra- dually after a short time. "4. That Total and Universal Abstinence from Alcoholic beverages of all sorts would greatly contribute to the health, the prosperity, the morality, and the happiness of the human race." No medical man, therefore, can any longer plead the singularity of the Total Abstinence creed as an excuse for his non-recognition of it; and although a certain amount of moral courage may be needed for the advocacy and practice of it, yet this is an attribute in which the Author cannot for a moment believe his brethren to be deficient. Judging from his own experience, indeed, he may say that he has found much less difficulty in the course he has taken than he anticipated when he determined on it; and that he has met with a cordial recognition of its propriety, not merely on the part of those who participated in his opinions, but did not feel called upon to act up to them in their individual cases, but also among others who dissented strongly from his scientific conclusions, and who consequently had no more sympathy with his principles than with his practice. London, March, 1850. CHAPTER I. WHAT ARE THE EFFECTS, CORPOREAL AND MENTAL, OF ALCOHOLIC LIQUORS ON THE HEALTHY SYSTEM ? 1. In replying to this question, it will be desirable to proceed as systematically as possible ; since the results of our inquiries upon the several points which it involves, will have to form the v groundwork of our further investigations. We shall com- mence, therefore, by examining the influence of Alcohol upon the physical, chemical, and vital properties of the several com- ponents of the animal fabric; from a knowledge of which we shall derive important a--si-tance in our appreciation of its effects upon the human system as a whole. I. INFLUENCE OP ALCOHOL UPON THE PHYSICAL, CHEMICAL, AND VITAL PROPERTIES OF THE ANIMAL TISSUES AND FLUIDS. 2. The most important physical change which the contact of Alcohol effects in the softer animal tissues, is that of corru- gation ; which change is entirely due to the difference in the capillary attraction of the tissue for alcohol and for water re- spectively. If animal membranes, a mass of flesh, or coagulated fibrine, be placed in alcohol in a fresh state, (in which they are thoroughly charged with water,) there are formed, at all points where water and alcohol meet, mixtures of the two ; and as the A animal texture absorbs much less of an alcoholic mixture than of pure water, a larger amount of water is of course expelled, than of alcohol taken up ; and the first result is a shrinking of the animal substance. " Thus," says Professor Liebig, "9-17 grammes of bladder, fresh, that is, saturated with water, (in which are contained 6-95 grammes of water and 2*22 of dry substance,) when placed in forty cubic centimetres of alcohol, weigh at the end of twenty-four hours 4-73 grammes, and have consequently lost 4-44 grammes. For one volume of alcohol, therefore, retained by the bladder, rather more than three volumes of water have been expelled from it."* 3. This corrugating effect of alcohol will be usually increased by the coagulating influence which it will exert on whatever soluble albumen the tissues may contain. Both these results will, of course, be proportioned in their degree to the state of concentration of the alcohol; but some such physical change * On the Motion of Animal juicos, p. 11. 14 • EFFECTS OF ALCOHOL must always take place in the walls of the stomach, whenever alcoholic fluids are introduced into it; and in the soft tissues of the body at large, wherever alcohol has found its way into the current of the circulation. And that such is actually the case, is proved by the experiments of Dr. Percy,* who found that when animals are poisoned by alcohol introduced into the stomach, the coats of that organ becomes so thoroughly imbued with it, throughout their whole thickness, that no washing or maceration can remove it. He found, also, that the tissues remote from the stomach become impregnated with alcohol, when it has passed into the current of the circulation. But on this point we shall dwell more at length hereafter.—(§17.) 4. The physical change just described must have an import- ant influence upon the chemical relations of the tissues ; since it is impossible that Alcohol can be substituted, in however small a proportion, for their constituent water, without pro- ducing a decided alteration in their chemical properties, which must disturb the normal series of changes involved in their nutritive operations. Among the most important of the chemi- cal changes which Alcohol has the power of effecting, is the coagulation of soluble Albumen; and although it will rarely, if ever, be introduced into the mass of the blood, or into the serous fluids of the tissues, by any ordinary alcoholic potations, in a sufficiently concentrated state to effect this, yet we should anticipate that its presence even in a very dilute form, must affect the chemical relations of albumen, and can scarcely do otherwise than retard that peculiar transformation by which it is converted into the more vitalized substance, Fibrine. That such is actually the case will be rendered probable by the con- siderations to be presently adduced. 5. No considerable changes of a physical or chemical nature can take place in any of the animal tissues without disordering their vital properties also; and we have now to inquire into the mode in which these properties are affected by the contact ot J^o'jc liquids. In the first place it would appear that the solidifiability of the fibrine, which is its special vital endow- ment is impaired by the introduction of alcohol into the fluid * Experimental Inquiry concerning the Presence of Alcohol in the Ventricles of the Brain, p. 29. t The ™*W<^™ of albumen and the fibrillation of fibrine are two entirely different processes ; the former being a simply physical segre- gation, the latter tending to produce an organized tissue and fining therefore of a vital nature. ' "Klllh ON THE HEALTHT SYSTEM. 15 which contains it; for when an animal has been killed by the injection of alcohol into the blood-vessels, the blood often remains fluid after death, or coagulates but imperfectly. (See the experiments of Dr. Percy, op. cit.) Now, as it is probable that nearly all the organized tissues are developed at the ex- pense of the fibrine, it is obvious that anything which impairs its organizability must have an injurious influence upon the general nutritive operations; and we shall hereafter find con- firmation of this inference in that peculiar condition of the sys- tem which results from excessive habitual indulgence in alco- holic potations, and of which the imperfect elaboration of the fibrine is one of the special characteristics. (§63.)—But, secondly, we find that when alcoholic liquids are applied to living tissues, especially to the vascular surface of the skin or mucous membrane, they induce redness, heat, and pain, indi- cating an increased determination of blood to the part. These symptoms vary in intensity according to the state of concen- tration of the liquid, and the length of time during which it remains in contact with the surface ; and they may pass on from this condition of irritation to one of actual inflammation. 6. Our best knowledge, however, of the influence of alcohol upon the vital actions of the animal tissues, is derived from microscopic observations upon the circulation of blood in the web of the frog's foot. If alcohol be applied to this membrane in a very dilute state, its first effect is to quicken the movement of blood through the vessels, which are at the same time rather contracted than dilated. But this state of things gradually gives place to the opposite; for after a time, which varies with the degree of the dilution of the alcohol, the circulation be- comes retarded, and the vessels dilated; and a further tima elapses before the original condition is recovered. If the alco- hol had been applied at first, however, in a less dilute form, the first stage is not observed ; but a retardation of the flow of blood is immediately brought about, and a considerable dilatation of the vessels takes place. The retardation may be such as to amount in some parts to a complete stagnation; and here it is no- ticed that the red corpuscles become crowded together, and that their normal form is lost; their coloring matter also being diffused through the liquor sanguinis. Around the parts in which the stagnation is witnessed, however, there is generally a border, in which the blood flows with increased rapidity. Now this per- verted state may gradually give place to the normal condition, if the stimulus be only applied for a short time ; the circula 16 EFFECTS OF ALCOHOL tion being restored where it was deficient, and the vessels gradu- ally contracting to their proper size. But if the contact of concentrated alcohol be prolonged, it becomes obvious that the tissue has been killed ; for the circulation is never re-established in it, and it is at last separated by gangrene. We rarely wit- ness in-cold-blooded animals those consequences of the appli- cation of irritants which properly constitute the inflammatory process; but this process is liable to be excited in man, and in warm-blooded animals, by the contact of alcoholic fluids with living tissues, if the contact be sufficiently prolonged, and the alcohol sufficiently concentrated. 7. Now the inference to be drawn from the preceding de- tails is these ;—that alcohol, when applied to the living tissues in a sufficiently dilute form, exalts for a time their vital activity; but that this exaltation is temporary only, and is followed by a corresponding depression. And further, that when the alco- hol is in a state of sufficient concentration to act more poten- tially, its exhausting or depressing effect is manifested, without any previous stage of excitement. This inference we shall hereafter find to be in precise accordance with that to which we shall be conducted by observation of the effects of alcohol upon the system at large; and we are justified, therefore, in regarding alcohol as belonging to the class of stimulants, and as subject to the laws of their operation. It has been affirmed by some that alcohol in small doses is tonic ; but of this there is no adequate proof. The property of tonic remedies is to increase the vital contractility of the animal solids in general, but more especially that of the walls of the blood-vessels. Now although some slight effect of this kind is at first manifested after the application of very dilute alcohol to a living mem- brane, yet it is very transitory, and is succeeded by, a much longer period of diminution of the tonic contractility of the walls of the blood-vessels. And we shall hereafter see that the supposed tonic properties of alcohol in small doses (especially in the form of wine or malt liquor,) are really but a manifesta- tion of its stimulant effects. 8. Various other experiments confirm this view of the effects of alcohol on the animal tissues; and those of Humboldt are particularly valuable, as regards its special capability of pro- ducing a temporary excitement of nervous power. " When the crural nerve," he says, " of a full-grown and lively fro* wa. immersed in alcohol, if the leg was already exhausted by gal- vanization, the alcohol evidently increased its excitability ; and ON THE HEALTHY SYSTEM. 17 this increase was lasting (i e. for a time,) when it was quickly removed from the stimulating fluid. If the nerve was left in it for some time, its excitability was completely exhausted. Its application exhausted instantaneously the excitability of young animals—birds, worms, and insects. If the tail of an earth- worm or leech be dipped for only four seconds in alcohol, it becomes stiff and inexcitable as far as it is immersed ; and although in frogs and puppies this state of rigidity could some- times be removed, in these animals it never could."* 9. There are some peculiar effects of alcohol upon the blood, besides its influence on the coagulability of the fibrine, of which it is proper that special mention should be made. When alco- hol is mingled with fresh arterial blood, it darkens its color, so as to give it more or less of the venous aspect.—(§ 118.) And when this admixture is made under the microscope, it is perceived that the red corpuscles shrink, and that a consider- able part of their contents becomes mingled with the liquor sanguinis. Now, although the peculiar functions of the red corpuscles have not yet been precisely determined by physiolo- gists, there is no doubt whatever that they are among the most important constituents of the blood ; and there is strong reason to believe that they are subservient on the one hand to the respiratory function, and on the other, either, directly or indi- rectly, to the elaboration of the plasma or organizable material of the blood. It is highly improbable, then, that any consid- erable effeot can be produced upon them, without seriously impairing the processes of aeration and nutrition ; both of which, as we shall hereafter see, are prejudicially influenced in other ways, by the presence of alcohol in the blood. Having thus considered the influence of Alcohol upon the properties and actions of the component tissues of the animal fabric, we shall inquire into its effects upon the living system as a whole. II. IMMEDIATE CONSEQUENCES OF THE EXCESSIVE USE OF ALCO- HOLIC LIQUORS ON THE GENERAL SYSTEM. Phenomena of Alcoholic Intoxication. 10. The term Intoxication is sometimes employed in this country to designate that series of phenomena which results from the action of all such poisons as first produce stimulation, and then narcotism; of these, however, alcohol is the type ; * Annala of Medicine, 1799, p. 26S. 18 EFFECTS OF ALCOHOt and the term is commonly applied to alcoholic intoxication alone. ^ It is worthy of notice, however, that the designation is now given by French writers to the series of remote or consti- tutional effects consequent upon the introduction of any poi- sonous agent into the,blood; thus we meet with the terms " arsenical intoxication," " iodine intoxication," and even " puru- lent^ intoxication." In fact, it is there considered an equivalent (as its etymology denotes) of our word poisoning ; and the fact that such a term should be in common use in this country, to designate the ordinary results of the ingestion of alcoholic liquors, is not without its significance; for, if the classical term " intoxication" be habitually employed as the equivalent of the Saxon " drunkenness," we are justified in turning that classical term into English again, and in asserting that the condition of drunkenness, in all its stages, is one of poisoning. That such is indeed the case will become obvious from an examination of its symptoms, and from a comparison of them with those of the cases in which a fatal result has supervened upon excessive in- dulgence in alcoholic liquors. To such an examination we shall now proceed; first detailing the symptoms of the slighter forms of intoxication; then, those of the deeper; and, lastly, those of the severest cases ; and afterwards inquiring into the pathological state from which those symptoms proceed, and the modus operandi of the agent that has produced it. 11. Among the first effects of the ingestion of alcoholic liquors in sufficient amount to produce their characteristic influence, are, in most persons, an increase in the force and rapidity of the heart's contractions ; producing a full, frequent, and strong pulse. With this, there seems to^be a general ex- altation of the organic functions; the appetite and the digestive power being increased, and the secretions augmented, especially tliose of the skin and kidneys. But it is obvious that the en- cephalic centres of the nervous system are especially acted on by the stimulus, for we observe all the manifestations of an excited action in them, such as talkativeness, rapidity and var- iety of thought, exhilaration of the spirits, animation of the fea tures and gestures, flushed countenance, and suffusion of the eyes. During slight intoxication, tho prevailing dispositions and pursuits are often made manifest; and hence the saving "In vino vcritasr The irritable and ill-tempered become quarrelsome ; the weak and silly are boisterous with laughter and mirth, and profuse in offers of service; and the sad and hypochondriacal readily burst into tears, and dwell on mourn- ON TIIE HEALTHY SYSTEM. 10 ful topics. It sometimes happens, however, that men habitu- ally melancholy become highly mirthful, when they have drunk enough to excite them; but this seems rather to be the case when the melancholy results from external depressing influ- ences, than when it is constitutional; and hence it is that too many persons, in circumstances of distress or difficulty, have recourse to the bottle for temporary solace from their cares. If no more liquor be taken than is sufficient to produce this condition, it gradually subsides, and is followed by a state of the opposite character; the appetite, the digestive power, and the organic functions in general, being lowered in activity, the skin dry, the secretions diminished, the spirits depressed, and the power of mental exertion for a time impaired. For this condition, sleep and abstinence (not merely from a renewal of the stimulus, but from more food than the stomach really de- mands,) are the most effectual remedies. 12. The state of mental excitement just described is very similar to the incipient stage of Phrenitis or Mania. It is not a uniform exaltation of the mental powers, but in some degree a perversion of them ; for that voluntary control over the cur- rent of thought, Avhich is the distinguishing character of the sane mind of man, is considerably weakened, so that the height- ened imagination and enlivened fancy have more unrestricted exercise; and whilst ideas and images succeed each other in the mind with marvellous readiness, no single train of thought can be carried out with the same continuity as in the state of perfect sobriety. This weakening of the voluntary control over the mental operations must be regarded, then, as an incipient stage of Insanity. 13. If the first dose of alcohol be such as to produce more potent effects, or if (as in ordinary intoxication) it be renewed after the first effects have already been manifested, the second stage is induced, in which not merely the intellectual but the sensorial apparatus is disturbed. The voluntary control over the direction of the thoughts is completely lost, and the excite- ment has more the character of delirium; the ideas becoming confused, the reasoning powers disordered, and hallucinations sometimes presenting themselves. At the same time, vertigo, double vision, tinnitus aurium, and various other sensory illu- sions occur; the muscular movements become tremulous and unsteady, the voice thick, the eyes vacant, and the face com- monly pale. Vomiting frequently occurs in this state; and when it doos, the consecutive stage is usually either cut short, 20 EFFECTS OF ALCOHOL or is abated in intensity. The poisonous effects may proceed no further than this; the drunkard falling into a heavy sleep, from which he awakes to feel the consequences of his trans- gression. These consequences differ in some degree with the previous habits. Those unaccustomed to such excesses usually suffer from headache and feverishness, with a dry and furred tongue, complete anorexia, with a particular loathing for alco- holic drinks, inability for mental or bodily exertion, and depres- sion of spirits ; and only recover from this condition after pro- longed repose and abstinence. On the other hand, the man to whom it is habitual, although his general condition is nearly the same, craves for a further dose of his stimulant; and when he has obtained it, he is able to take food, and to proceed with his ordinary avocations. 14. In the third and most profound stage of intoxication, there is extreme diminution or entire suspension of cerebral and sensorial power; a state of coma supervening upon that last described. This state may vary in intensity, however, between one of deep ordinary sleep, from which the individual can be so far aroused as to give manifestations of sensibility, and a torpor as profound as that of apoplexy; and, when the latter manifests itself, it is an indication of danger, especially when the respiratory movements are impeded. According to the observ- ations of Dr. Ogston,* the face is sometimes pale, sometimes flushed ; the eyes vacant and suffused, sometimes glazed ; the pupils dilated, and contracting very imperfectly, or not at all, to light; the temperature of the head is generally above the natural standard, but that of the extremities and of the surface is in general considerably lowered, or but little affected in milder cases ; the pulse, which was at first quick and excited, becomes feeble, small, and ultimately slow, or even entirely wanting at the wrist, according to the intensity of the intoxica- tion ; the respiratory movements are less frequent than usual, and are imperfectly performed, exhibiting, in the severest cases, the convulsive character of those of persons suffering from asphyxia. Strabismus, general tetanic convulsions, or spasms of particular parts, sometimes supervene in the more ad- vanced states. When a fatal termination occurs, it is usually attributable, as in apoplexy, to the imperfect aeration of the blood ; the face becoming livid and tumid, the eyes prominent, and the lips blue. In some instances, the complete prostration * Edinburgh Medical and Surgical Journal, vol. xl. ON THE HEALTHY SYHTKM. 21 of the cerebral and sensorial powers comes on suddenly, with- out any previous stage of excitement; and in these cases, it i$ noticed that the pupil is usually contracted. 15. The unfavorable indications, in case of poisoning by large doses of alcohol, are profoundness of insensibility, insuffi- ciency of respiratory movement, with consequent failure of cir- culation and imperfect aeration of blood, the pupils either much dilated or contracted, coldness of the extremities, and the occurrence of strabismus or tetanic spasms. When these symp- toms do not appear, the ill effects pass off, in a great measure, within twenty-four hours; but it is usually much longer before the various functions regain their healthy tone. 16. In fatal cases,* the appearances usually resemble, more or less closely, those of Asphyxia ; the right side of the heart, the pulmonary arteries, and the systemic veins being loaded with blood ; whilst the left cavities and the arterial system are comparatively empty, the blood which they do contain being dark. The sinuses and the whole venous system of the brain are turgid with dark blood ; and serous effusion is usually found within the ventricles, or beneath the arachnoid; this, however, being variable in its amount. The substance of the brain is unusually white and firm, as if it had lain in alcohol for an hour or two. The fiver, spleen, and kidneys are loaded with venous blood ; and the air-passages of the lungs contain more or less of frothy mucus. The stomach usually exhibits but little departure from its normal condition, except in cases where drunkenness has been habitual, or where the fatal dose has been taken in a very concentrated form. In the former case, the mucous coat is usually found thicker, softer, and more vascular than usual; this change sometimes extending even throughout the entire length of the small intestines. In rarer instances, the coats of the stomach are remarkably thickened and hardened. Where death results from a very concentrated dose, the intense injection, almost amounting to black discolor- ation, of a powerful irritant poison, is met with. This, how- ever, has been rather noticed in experiments on animals, into whose stomachs rectified alcohol had been injected, than in human subjects, by whom alcohol is very rarely taken in such a form. Of the condition of the liver and kidneys found in habit- ual drunkards, an account will be given hereafter. The blood, * See Dr, Ogston, he. cit.; and Dr. Peters, in New York Journal of Medicine, vol. hi., No, 9. 22 EFFECTS OF ALCOHOL in most cases of alcoholic poisoning, according .to the observa- tions of Dr. Ogston upon drunkards, and the experiments of Dr. Percy upon animals, is either fluid or imperfectly coagulated. Pathology of Alcoholic Intoxication. 17. The pathological character of intoxication by alcohol, and the modus operandi of the poison, have been fully made out from the experiments and observations just referred to; and it is very important for our future inquiries that the results of these should be rightly understood. That alcoholic liquors, when introduced into the stomach, should undergo rapid ab- sorption into the sanguiferous system, is precisely what might be anticipated from our knowledge of the conditions under which that absorption takes place; and there is ample evidence that such is really the case. Thus Dr. Percy was always able to detect the alcohol in the blood of the animals which he had poisoned by injecting alcohol into their stomachs, provided they did not live too long afterwards; and MM. Bouchardat and Sandras have more recently determined its presence in the blood of the gastric veins. The rapidity with which this ab- sorption takes place may be judged of by the fact that, in one of Dr. Percy's experiments, in which the animal fell lifeless to the ground immediately that the injection of the alcohol into the stomach was completed (the respiratory movements and pulsations of the heart entirely ceasing within two minutes,) the stomach was found nearly void, whilst the blood was strongly impregnated with alcohol.* Hence, it may reason- ably be inferred, that in all cases of ordinary intoxication, and in the greater number of cases of death from the introduction of alcohol into the stomach, the effects are produced by the passage of the alcohol into the current of the circulation, so as to exert a direct action on the nervous centres. And this influ- ence is confirmed by the fact that Dr. Percy has demonstrated its presence, in considerable amount, in the substance of the brain ; thus confirming Dr. Ogston's assertion (\\ hich had been called in question by Dr. Christison and others,) as to its pre- sence in the fluid effused in the ventricles of the brain. 18. In some of the experiments on alcoholic poisoning, how- ever, made by Dr. Christison and others, it would appear as if the total loss of insensibility and voluntary power, so instanta- neously; followed the introduction of the poison into the stom- * Op. cit. p. 61, OX THE HEALTHY SYSTEM. £3 ach—especially when it was introduced in a concentrated form —as not to admit the idea that absorption could have taken place to a sufficient extent for the production of the effect by the direct action of the poison on the nervous centres. In such instances, the fatal result would seem rather due to the violent impression made upon the gastric nerves, especially those of the sympathetic system; whereby the heart's action is sus- pended, and death takes place by syncope rather than by as- phyxia. This is the case with many other poisons, when administered in large quantity and in concentrated form, espe- cially with such as exert a chemical action upon the animal tissues; the effect which they produce (through the nervous system) upon the heart, closely resembling that of blows upon the epigastrium, or extensive burns of the cutaneous surface. Now as the concentration of the alcohol will, on the one hand, favor its physical and chemical action upon the tissues, whilst pn the other it will be unfavorable to absorption, which takes place much more readily when it is diluted with water, we are enabled readily to account for this difference in its modus oper- andi. 19. The general stimulant action, which is for a time exerted by alcohol introduced in small quantities, and diluted by ad- mixture with the general mass of the blood, is easily explained Upon the basis of the observations first detailed (§17) ; but its special power of exciting the nervous centres to augmented activity can only be accounted for by the idea of some special relation between alcohol and nervous matter. And this idea is fully borne out by the fact that Dr. Percy found alcohol to exist in the substance of the brains of the dogs poisoned by it, in considerably greater proportion than in an equivalent quan- tity of blood. (Op. cit. p. 103.) This fact is one of funda- mental importance, as showing us how directly and immedi- ately the whole nutrition and vital activity of the nervous sys- tem must be affected by the presence of alcohol in the blood ; the alpohol being thus specially drawn out of the circulating current by the nervous matter, and incorporated with its sub- stance, in such a manner as even to change, (when in sufficient amount) its physical as well as its chemical properties. It is important also to observe that this affinity is obviously such as will occasion the continual presence of alcohol in the blood, even in very minute proportion, to modity the nutrition of the nervous substance more than that of any other tissue ; for the alcohol will seek out (as it were) the nervous matter, and will 34 JfrFFBOTB OF ALCOHOL fasten itself upon it—just as we see that other poisons, whose results become more obvious to our senses, (although the poi- sons themselves may exist in such minute amount as not to be detectible by the most refined analysis) will localize themselves in particular organs, or even in particular spots of the same organ.* 20. The selective power of alcohol appears to lead it in the first instance to attack the cerebrum, the intellectual powers being affected before any disorder of sensation or motion man- ifests itself; and to this it seems to be limited in what has been here described as the first stage of intoxication. But with the more complete perversion of the intellectual powers, which characterizes the second stage, we have also a disturbed function of the sensory ganglia, upon which the cerebral hemispheres are superposed; this disturbance being indicated by the disor- ders of sensation, and also by the want of that control over the muscular movements which require sensation for their guid- ance. In the third stage, the functions of the cerebrum and sensory ganglia appear to be completely suspended; and those of the medulla oblongata and spinal cord now begin to be affected, as we see to be indicated by the difficulty of respira- tion, the strabismus, the dilated pupil, and the tetanic spasms. As already stated, the admixture of alcohol with the blood has a tendency to give a venous character even to that of the ar- teries ; and when this tendency is augmented by imperfect respiration, the blood will become more and more venous, until its influence upon the medulla oblongata is so directly poison- ous, that its functions are completely suspended, the respiratory movements are brought to a stand, and death takes place by asphyxia, precisely as in narcotic poisoning by other sub- stances. 21. This tendency, however,- is more or less completely an- tagonized by the efforts which the system makes (so to speak) to get rid of the poison; which efforts, if successful, will carry it off in the course of a few hours, leaving nothing behind it but the disordered condition which it has produced. We have seen that an increased secretion takes place by the kidneys and skin; and the former of these is certainly a means of elimi- nating the alcohol, which has been detected in the urine bv Dr. Percy (op. cit, p. 104,)-contrary to the statements of * See, for illustrations of this doctrine now crA.lc,.»ii~ a •„ J V" Medical Gar.cttr, 1847. g6U L<,ct»rM ™ Nutrition, in OS THE HEALTHY SYSTEM. 25 many physiologists, who have denied that it ever finds its way into that secretion. It is indeed a general rule, that when a medicinal or toxic agent produces a special determination to some particular gland, that determination is the means of eli- minating it from the blood; as is seen in the diuretic action of the neutral salts. And it would not seem improbable, there- fore, that the skin also should be concerned in the exhalation of the alcohol ;* more especially since an alcoholic odor may often be observed, not merely in the breath, but proceeding from the person generally. Dr. Percy has also shown that alcohol may be detected in the bile of animals poisoned by it. The alco- holic odor of the .breath is a sufficient indication that alcoholic vapor is exhaled from the lungs in the act of respiration ; but the quantity of this is probably small in comparison with that which is carried off in another way, namely, by the combustive process, which takes place in the blood at the expense of the oxygen it contains, and which converts the alcohol into car- bonic acid and water; both of which are set free by exhalation from the lungs. The readiness with which alcohol is thus oxi- dized, in fact, is probably one cause of its influence in giving a venous aspect to arterial blood; since it will withdraw the oxy- gen from other substances, which are waiting to be eliminated by the combustive process, and the accumulation of which will deteriorate the character of the fluid. 22. By all these channels, then, the alcohol is rapidly car- ried out of the system; so that recovery may be certainly expected, if life can be sufficiently prolonged by warmth to the surface by artificial respiration, by the administration of am- monia, and by other such measures. The depressing character of the influence of alcohol, when carried to this extent, is suffi- ciently indicated by the fact that copious depletion cannot be borne; and it is, on this account, very important to distinguish between alcoholic poisoning and congestive apoplexy, tor which it may be easily mistaken if its cause be not known. It would be easy to extend the foregoing description by a more particular account of the varieties of the modus operandi of alcohol presented by different individuals; but it has not been thought necessary to do so, the great general facts pre- sented by its ordinary operation, being-those of prime unport- * Dr Macnish states (Anaiumy of Drunkenness, p. 175.) that he has met witli two instances the one in a claret the other m a port drinkTr, in which tho cutaneous pc.-.piratio.i after a debauch nad the hue of the liquor th-y had drunk. b 1. 26 EFFECTS OF ALCOHOL ance in our further investigations. We have now to inquire into the various forms of disease, the production of which may be assigned, with more or less probability, to the prolonged or repeated action of alcohol on the human system. III. REMOTE CONSEQUENCES OF THE EXCESSIVE USE OF ALCO- HOLIC LIQUORS. Diseases of the Nervous System. 23. From the peculiar tendency which the alcohol in the blood has to disorder the functions of the nervous system, it might be expected that the habitual ingestion of alcoholic liquors in excess would bring about a more permanent de- rangement of this apparatus, and more particularly of its ence- phalic portion; which seems to be singled out by alcohol, almost to the exclusion of the spinal cord, just as the spinal cord is affected by strychnine, almost to the exclusion of the encephalon. This we shall find to be the case. There are, in fact, scarcely any diseases of the encephalon, except such as are of a purely constitutional nature, (such as tubercular or cancerous affections,) which are not so much more frequent among the habitually intemperate than among the habitually sober, as to justify us in regarding the excessive use of alco- holic liquors as among the most efficacious of the conditions of their production. It will be proper, therefore, to pass the principal diseases in review before us, and to inquire into the mode in which habitual excess in the use of alcoholic drinks tends to produce each of them. 24. Delirium Fbriosum.—Considering that the state of intoxication is itself, strictly speaking, a transient paroxysm of insanity, it can excite no surprise that a confirmed state of mental derangement should frequently result from the repeti- tion of the cause which produces the single paroxysm. There are, in fact, some individuals in whom a fit of positive mad- ness, persisting for some little time after the immediate effects of the stimulus have subsided, is brought on by every excess in drinking. The head becomes extremely hot, the face flushed, the pulse very frequent, full, and hard ; the temper is exces- sively violent, the individual sometimes attacking every one who comes in his way, and being always prone to ferocity against any one who opposes him; and all sense j>f danger being lost, he is not deterred from violence by the fear of per- sonal injury, but rushes madly upon what may prove his do- ON THE 1IEALTIIV SYSTEM. 27 struction. This condition, the delirium ebriosum of Darwin, is obviously an exaggeration of one of the ordinary forms of ex- citement in common intoxication ; and it usually subsides in a day or two, if the individual be simply restrained from doing mischief to himself or others. It is sometimes accompanied, however, with tremors, even in the midst of violent excitement; and this form constitutes the transition to the disorder next to be noticed. The frequent repetition of this paroxysm, of which, as of ordinary drunkenness, the stimulating action of alcohol on the nervous centres must be regarded as the immediate cause, is almost certain, like the recurrence of regular maniacal paroxysms, to end in some settled form of Insanity. 25. Delirium Tremens.—The habitual drunkard, who has exhausted his nervous power by continual over-excitement, is liable to another form of disordered action of his brain, which is commonly known from one of its most marked symp- toms—the peculiar tremor of the limbs—as delirium tremens. This state is in many respects the opposite of the preceding. There is little or no heat of the head or flushing of the face, the skin is cool and humid, and even chilly; the pulse, though frequent, is small and weak; and the temper, though very irri- table, is not violent—the prominent disposition, indeed, being an- xiety and apprehension of injury or danger. There is an almost entire want of sleep ; and even if repose be obtained, it is very imperfect, being interrupted by frightful dreams. On the other hand, the waking state is frequently so disturbed by il- lusions of a frightful or disagreeable nature, that it differs but little from that of sleep, save in the partial consciousness of external things. The following is the vivid picture of this condition, given by one wdio has himself experienced it:* " For three days I endured more agony than pen could de- scribe, even were it guided by the hand of a Dante. Who can tell the horrors of that horrible malady, aggravated as it is by the almost ever-abiding consciousness that it is self- sought. Hideous faces appeared on the walls, and on the ceiling, and on the floors; foul things crept along the bed- clothes, and glaring eyes peered into mine. I was at one time surrounded by millions of monstrous spiders, who crawled slow- ly, slowly over every limb ; whilst beaded drops of perspiration would start to my brow, and my limbs would shiver until the bed rattled again. Strange lights would dance before my eyes, * Autobiotrraphv of J. B. Gough, p. 70. " B 2. 28 EFFECTS OF ALCOHOL and then suddenly the very blackness of darkness would appal me by its dense gloom. All at once, whilst gazing at a fright- ful creation of my distempered mind, I seemed struck with sudden blindness. I knew a candle was burning in the room, but I could not see it. All was so pitchy dark. I lost the sense of feeling, too, for I endeavored to grasp my arm in one hand, but consciousness was gone. I put my hand to my side, my head, but felt nothing, and still I knew, my limbs and frame were there. And then the scene wrould change. I was falling—falling swiftly as an arrow far down into some terrible abyss; and so like reality Avas it, that as I fell I could see the rocky sides of the horrible shaft, where mocking, gibing, mowing, fiend-like forms were perched ; and I could feel the air rushing past me, making my hair stream out by the force of the unwholesome blast. Then the paroxysm Sometimes ceased for a few moments, and I wrould sink back on my pallet drenched with perspiration, utterly exhausted, and feeling a dreadful certainty of the renewal of my torments." 26. With this disturbed condition of the brain, a more or less disordered state of the digestive apparatus is commonly associated. The tongue is furred, the stomach unable to bear food without vomiting or a sense of oppression; the bowels are usually constipated, or, if they be relaxed, the stools are dark and offensive, and the urine is scanty. Sometimes the disease proceeds to a fatal termination, which is generally preceded by contracted pupil, occasionally strabismus, incessant low delirium, increase in the muscular tremor almost amount- ing to subsultus tendinum, and other indications of nervous exhaustion ; the pulse becomes thready, and at the same time more rapid, so that it sometimes can scarcely be counted ; cold sweats break out upon the skin, and the chilliness of the sur- face increases, proceeding from the extremities to the trunk. Sometimes a calm supervenes shortly before death ; whilst in other instances the patient is carried off* in a convulsion. On the other hand, the bad symptoms may gradually abate, and the supervention of profound sleep give to the exhausted energies of the nervous system the means of restoration. Sometimes, however, the recovery is never complete, but the patient remains in a state of Melancholia, with more or less of deficiency of intellectual power; and this more especially happens after repeated attacks of the disease. 27. Between the Delirium Embriosum and the proper Delirium Tremens, there are several intermediate conditions; QS THE HEALTHY SYSTEM. the former, indeed, being very apt to pass into the latter, if depleting measures be imprudently adopted. The latter may present itself, like the former, as the direct and immediate consequence of the excessive use of Alcoholic liquors; but there is this important difference—that, while the former is but an exalted manifestation of the primary excitement ordi- narily produced by alcohol, the latter, supervening at the end of a prolonged debauch, is the consequence of exhaustion produced by continued excitement. Delirium Tremens more frequently occurs, however, when the accustomed stimulus is withheld; and it is then no less obviously the result of the previously exhausted condition of the nervous system, which nothing save the renewal of the potent stimulus can excite to anything like regular action. In fact, this terrible state is the manifestation of the disordered condition to which the brain has been brought by habitual excess, and plainly exhibits^ the complete perversion of its functional power and of its nutritive operations. In fatal cases, no morbid appearances are found that in the least indicate turgescence of the vessels or inflam- matory excitement, unless the delirium have partaken of the characters of that which directly arises out of intoxication. And it is manifest, therefore, that the disordered condition must be in the nervous pulp itself, and that it must be of a kind to keep up morbid and irritative activity, at the same time that the tissue is incapable of exercising tliose reparative functions which are earned on in the healthy condition during the state of repose. 28. Although, in the vast majority of cases, Delirium Tre- mens is the immediate or the consecutive result of the excessive use of Alcoholic liquors, yet it may occur independently of them ; but its other causes are such as resemble the excitement of alcohol, in producing exhaustion or depression of the nervous power—such, for instance, as excessive depletion, the shock of severe injuries, or extreme cold. But in most of the cases in which one or other of these appears to be its exciting cause, a predisposition has been established by habitual intemperance; and this has been especially remarked of the delirium trau- maticum. 29. It is important to remark that a slighter form of this disorder, marked by tremors of the hands and feet, deficiency of nervous power, and occasional illusions, will sometimes appear as a consequence of habitual tippling, even without intoxication having been once produced. And a still slighter d8. 3U EFFECTS OF ALCOHOL manifestation of the want of control over the muscular appa- ratus—the trembling of the hands in the execution of a volun- tary movement—is familiar to every one as extremely frequent among the habitually intemperate. We thus see that the disease is, at least, as much dependent upon the disordered state of nu- trition, consequent upon the habitual presence of alcohol in the blood, as it is upon that positive exhaustion of nervous power consequent upon the violence of the excitement, Avhich is the more immediate effect of the stimulus. 30. Insanity.—Such being the case, we have no difficulty in understanding how the habitual use of Alcoholic liquors in excess becomes one of the most frequent causes of Insanity, properly so called, i. e. of settled Mental Derangement. Upon that point, all writers on the subject are agreed, however much they may differ in their appreciation of the relative frequency of this and of other causes. The proportion, in fact, will vary according to the character of the population on which the estimate has been formed ; and also according to the mode in which it has been made. Thus, in Pauper Lunatic Asylums, the proportion of those who have become insane from Intem- perance is usually much larger than it is in Asylums for the reception of Lunatics from the higher classes, among whom intemperance is less frequent, while causes of a purely moral and intellectual nature operate- upon them wdth greater in- tensity. And again, if, in all cases in which habitual intem- perance has been practised, it be set down as the cause of the mental disorder, the proportion becomes much larger than it will be if (as happens in many cases), some other cause have been in operation concurrently, and the disorder be set down as its result, no notice wdiatever being taken of the habit of intemperance. This omission must be particularly allowed for, when the relative proportion of intemperance to other causes is being estimated in regard to the middle and higher classes; on account of the strong desire which usually exists among the friends of the patient to conceal the nature of his pre- vious habits, and to lay his disorder entirely to the account of the cause from which it has seemed immediately to proceed. 31. There can be no doubt that those who have weakened and disordered the nutrition of the brain by habitual Intem- perance, are far more liable than others to be strongly affected by those causes, moral or physical, to which the Mental Derangement is more immediately attributable; so that the habit of intemperance has contributed, as a predisposing cause, ON THE HEALTHY SYSTEM. 81 at least as much towards its production as what is commonly termed the exciting cause has done. In fact, of predisposing causes generally, it may be remarked that their action upon the system is that of slowly and imperceptibly modifying its nutritive operations, so as gradually to alter the chemical, physical, and thereby the vital properties of the fabric; and thus to prepare it for being acted on by causes which, in the healthy condition, produce no influence. And although that one of the conditions in previous operation is often singled out as the cause, from which the result may seem most directly to proceed, yet it frequently happens that it has really had a far smaller share in the production of the disorder than those remoter causes whose operation has been more enduring and really more effectual.* 32. In the Statistical Tables, published by the Metropolitan Commissioners of Lunacy, in 1844, comprehending the returns from 98 Asylums in England and Wales, we find that, out of 12,007 cases whose supposed causes were returned, 1799, or nearly 15 per cent., are set down to the account of Intem- perance; but besides these, 551 or 4-6 per cent, are attributed to vice and sensuality, in which excessive use of alcoholic liquors must have shared. Moreover, in every case in which Hereditary Predisposition was traceable, this was set down as the cause ; notwithstanding the notorious fact that such predis- position frequently remains dormant until it is called forth by habitual intemperance. It is not more correct, therefore, to regard this as the cause of the disorder, in all the cases in which it is traceable, than it would be to regard intemperance in that light, in every case in which the patient had previously indulged in alcoholic excesses. Of the 2526 cases, then, in which the disorder is attributed to hereditary predisposition, a a considerable proportion might with equal justice be set down to the account of intemperance. And there can be no doubt that the same practice had a great share in the production of the disease in the 3187 cases set down to bodily disorder,, and in the 2969 for which moral causes are assigned. 33. If we turn from this general statement to the experience of individual asylums, we frequently find the proportion much higher; and curious variations are sometimes observable be- tween the returns for successive years. Thus, in the Glasgow Lunatic Asylum, according to the report of Dr. Hutvheson, the * Sec Mr. J. S. Mill's Elements of Logic, vol. i., p. 898. n 4, i 82 EFFECTS OF ALCOHOL following were the proportions which intemperance bore to other causes during seven years:— Year. Total number of< patients. Cases where the disease was heredita-ry, *''■ Cases where the cause was unknown. Cases where intemperance whs the cause. Proportion per cent, of intemperance to other 1840 1841 1842 1843 1844 1845 1846 149 • 157 199 321 390 364 414 3 20 54 116 77 47 49 34 44 20 38 41 38 62 20 30 46 31 53 90 105 13-4 19-1 23-1 9-4* 18-2 24-7 25-3 Total. 2000 366 277 375 19-7 Of the great increase which presents itself in the number of cases attributable to intemperance during the last two years of this return, Dr. Hutcheson thus speaks in his report for 1846: " This cause appears to have operated on patients of all ranks; and I am inclined to think that this has been owing, in a great measure, to the excitement in which the community was kept by that universal spirit of gambling which seized on society like an epidemic mania. There is a great connection between * This marked diminution in the per centage of cases attributable to Intemperance is chiefly due to the admission into the Glasgow Asy- lum, during the year 1843, of a number of lunatics who had previously been confined at Arran, for the most part, during several years. Of the origin of their Insanity very little was known ; and they were chiefly assigned to the head of "Hereditary and Constitutional Pre- disposition," thereby diminishing the per centage of the other causes. Amoug the recent cases admitted during the year, however, the per centage attributable to intemperance Mas decidedly less than usual; which circumstance is attributed by Dr. Ilutcheson to the improved condition of trade, which caused an adequate demand for labor. On this point he makes the following remarks, in his report for 1842, p. 36: "It n.ay be said, that when wages are low, and occupation diffi- cult to be obtained, men will have less money to spend, and conse- quently will drink' less. A pretty extensive obsei \ntion of the different grades of the working classes, for upwards of fifteen years, has convinced me that this opinion is erroneous, for I have generally found that want and intemperance go hand in hand. Whenever a man falls below a certain point in physical comfort, he becomes reckless, and sensual enjoyment forms his onlv pleasure. To this he will sacrifice everything; and habits of intemperance are frequentlv acquired in seasons of distress, which the individual, in more favorable circumstances, finds it impossible to lay aside." ON THE HEALTHY SYSTEM. 33 general excitement and the craving for stimulants, as may be every day seen during contested elections, public dinners, races, &c. It is also a fact well known to those who have minutely studied the subject, that over-exertion of the brain leads to a desire for stimulants, which, however, are easily enough aban- doned when the brain is allowed to rest." For .the reason al- ready given, it is probable that the average proportion of 19-7 per cent, does not by any means represent the entire number of cases in which intemperance was the principal cause of the disease; and that we should be within the truth in assigning to it at least a quarter of the whole number of cases. 34. In the report of the Aberdeen Lunatic Asylum for 1847, we find intemperance specified as the cause in 17 cases out of 93 admitted; but of these 93, there were 8 cases in which hereditary predisposition, and 11 in which predisposition from previous attacks, was assigned as the cause ; and there can be no doubt that of these 19 cases a considerable proportion might be set down, in part, to the account of intemperance. In the report of the Dundee Lunatic Asylum, we find that 8 out of 52 cases admitted are set down to intemperance ; 7 were here- ditary ; and in 4 the cause was unknown. In other asylums, the proportion of cases returned as due to Intemperance is much greater than in those already referred to. Thus, in the Commissioner's report already cited, we find that in nine pro- vincial private asylums, the proportion which the cases assigned to intemperance alone bear to those assigned to other causes, is no less than 32'62 per cent.; independently of 5-67 per cent- which are set down to the account of " Vice and Sensuality." There is an asylum in the East of London, where the propor- tion of cases attributed to intemperance alone amounted to 41-07 per cent.; and those arising out of this in combination with other vices, to 22 per cent, of the whole number whose causes were assigned. And it is stated by Dr. Macnish (op. cit., p. 193), that of 286 lunatics at that time in the Richmond Hospital, Dublin, one-half owed their madness to drinking. 35. Oinomania.—There is one form of Insanity which has so peculiar a relation to the use of alcoholic liquors as to call for particular consideration in this place ; and in order that its characters may be presented in the most unexceptionable manner, the author avails himself of the excellent account of the disease which is given by Dr. Hutcheson in the report of the Glasgow Lunatic Asylum for 1842 (pp. 39-44); deeming ks value sufficient to justify him in presenting it without b 5. 34 EFFECTS OF ALCOHOL abridgment. The designation Oinomania, he would remark, has been substituted by Dr. H. for the less appropriate term Dipso- mania, used by other authors. " This form of mania," he ob- serves, " is quite different from drunkenness, which, however, may lead to it; the diagnostic mark of the disease being the irresistible propensity to swallow stimulants in enormous doses, whenever and wherever they can be procured. There are indi- viduals who, at the festive board, invariably become excited, if not intoxicated, but who are otherwise habitually sober, and in the course of the year drink much less than others who never appear to be under the influence of stimulants. Others indulge in their potations in a regular manner, and daily consume a larger quantity of liquor than is consistent with good health or sobriety. All these, however, possess self-control, and can, at ;any time, refrain from stimulants ; but those affected with the disease cannot do so, however convinced they may be of the impropriety of yielding to their propensity, or however desirous they may be to subdue it. I repeat that the disease does not consist in the mere act or habit of becoming intoxicated; but in the irresistible impulse which drives the unhappy being to do that which he knows to be pernicious and wrong, and which, in the intervals of his paroxysms, he views with loathing and disgust. He derives no pleasure from taste, for he gulps down the liquor, of whatever kind it may be; or from society, for he generally avoids society ; but he only derives a temporary satis- faction from the gratification of his insane impulse, or rather from freeing himself from the overwhelming misery which the non-gratification of his impulse inflicts on him. The disease appears in three forms—the acute, the periodic, and the chronic. " The Acute is the rarest of the three. I have seen it occur from hemorrhage in the puerperal state, in recovery from fevers, from excessive venereal indulgence, and in some forms of dys- pepsia. When it proceeds from any of the first three causes, it is easily cured by restoring the strengrh of the patient. When it arises from the fourth cause mentioned, it is not so easily re- moved, and is very apt to assume the chronic form. " The Periodic or paroxysmal form is much more frequent than the acute. This is often observed in individuals who have suffered from injuries of the head, females during pregnancy, at the catamenial periods, on thu approach of the critical period and afterwards, and in men whose brains are overworked. When it occurs from injur)- of the head, the case is hopeless. ON TUU HEALTHY SYSTEM. 35 In the other instances, it may bo cured. In some cases, it oc- curs whenever the individual partakes of stimulants. In these, total abstinence is the only remedy. Like the form about to be mentioned, it is frequently hereditary, being derived from a parent predisposed to insanity or addicted to intemperance. In such cases, the probability of cure is very small. The indi- vidual thus affected abstains for weeks or months from all stimulants, and frequently loathes them for the same period. But by degrees he becomes uneasy, listless, and depressed, feela incapable of application, and restless, and at last begins to drink till he is intoxicated. He awakes from a restless sleep, seeks again a repetition of the intoxicating dose, and continues the same course for a week or longer. Then a stage of apathy and depression follows, during which he feels a loathing for stimu- lants, is the prey of remorse, and regrets bitterly his yielding to his malady. This is followed by fresh vigor, diligent appli- cation to business, and a determined resolution never again to give way. But, alas! sooner or later the paroxysm recurs, and the same scene is re-enacted, till ultimately, unless the disease be checked, he falls a victim to the physical effects of intempe- rance, becomes maniacal, or imbecile, or affected with the form of the disease next to be mentioned. "Of all the forms of Oinomania the most common is the chronic. The causes of this are injuries of the head, diseases of the heart, hereditary predisposition, and intemperance. This is by far the most incurable form of the malady. The patient is incessantly under the most overwhelming desire for stimu- lants. He will disregard every impediment, sacrifice comfort and reputation, withstand the claims of affection, consign his family to misery and disgrace, and deny himself the common necessaries of life to gratify his insane propensity. In the morn- ing, morose and fretful, disgusted with himself, and dissatisfied with all around him, weak and tremulous, incapable of any ex- ertion either of mind or body, his first feeling is a desire for stimulants, with every fresh dose of which he recovers a certain degree of vigor both of body and mind, till he feels compara- tively comfortable. A few hours pass without the craving being so strong; but it soon returns, and the patient drinks till in- toxication is produced. Then succeed the restless sleep, the suffering, the comparative tranquillity, the excitement, and the state of insensibility; and, unless absolutely secluded from all means of gratifying the propensity, the patient continues the same course till he dies, or becomes imbecile. This is that u o. 80 EFFECTS OF ALCOHOi fearfnl state portrayed by Charles Lamb, in which reason re- visits the mind only during the transient period of incipient in- toxication. " It must be remarked that, in all these forms of the disease, the patient is perfectly incapable of self-control; that he is im- pelled by an irresistible impulse to gratify his propensity; that, while the paroxysm is on him, he is regardless of his health, his life, and all that can make life dear to him ; that he is prone to dissipate his property, and easily becomes the prey of the designing ; and that in many cases he exhibits a propensity to commit homicide or suicide. He is thus dangerous to himself and others, and however responsible he may have been for bringing the disease on himself, his responsibility ceases as soon as he comes under the influence of the malady. The disease, however, may not be brought on by the act of the individual; and then it is clear at once that neither directly nor indirectly can he be deemed responsible. But suppose that it were the result of his previous conduct, I repeat that, however culpable he may have been for that, he is not a responsible being while afflicted with the malady ; for I can see no distinction between this form of the disease and any other which has been induced by the habits or acts of the individual. "The only chance of cure or alleviation is from attention to the health, and abstinence from intoxicating liquors. Neither can be secured so long as the patient is at large; and no amend- ment can be depended on, unless he has undergone a long course of discipline and probation. Considering, then, that the individual is irresponsible and dangerous to himself and others —that, if left uncontrolled, he will ruin his family—and that his disease can be treated only in an Asylum, it is not only merciful to him and his relatives, but necessary for the securitv of the public that he be deprived of the liberty which he abuse's and perverts, and that he should be prevented from committing crimes instead of being punished, or, I should rather say, being the object of vindictive infliction after he has perpetrated them. feo convinced are some, affected with the periodical form of the disease, of the necessity of being controlled, that, when the first symptoms of their paroxysm are felt, they voluntarily enter an Asylum, and remain till the attack has passed off. These how- hT.wLf °f St-°Dgf minds' thouSh>wilh a» their strength, obethL. T8tVng the disease ; and' surel7> what they fee x> be their only refuge to avoid the impending evil it can unjust or harsh to force on others whL min^ds a e more ON THE HEALTHY SYSTEM. 37 pared. Such cases soon become rational in an Asylum ; and when the individual can so far control himself as voluntarily to surrender his liberty on the first premonitory symptoms of the malady presenting themselves, he may be dismissed after a shorter probation. It is otherwise with those who have not that Self-control, or who fancy that they are unjustly interfered with when checked in their career. They require a much longer pro- bation, which should be increased at each return of their malady. " Of the chronic form, I have seen only one case completely cured, and that after a seclusion of two years' duration. In general it is not cured | aud no sooner is the patient liberated than he manifests all the symptoms of his disease. Paradoxical though the statement may appear to be, 6uch individuals are sane only when confined in an Asylum." The Superintendent of the Dundee Asylum, in remarking upon the frequent causation of Insanity by Intemperance, makes a very similar statement of the results of his observations ; and regrets that there are not in this country such Asylums as are understood to exist in the United States, for the reception of those incorrigible drunkards in whom the power of self-control has been altogether destroyed by their repeated yielding to the craving for Alcoholic stimulants. 36. Mental Debility in the Offspring.—It is scarcely neces- sary to accumulate further proof in support of the assertion that, of all the single causes of Insanity, habitual Intemperance is the most potent, and that it aggravates the operation of other causes. We have now to show that it has a special tendency to produce Idiocy, Insanity, or Mental Debility, in the offspring. Looking to the decided tendency to hereditary predisposition in the ordinary forms of Insanity ; looking also to the fact that any perverted or imperfect conditions of the nutritive functions established in the parent, are also liable to manifest themselves in the offspring (as shown in the transmission of the gouty and tubercular diatheses); we should expect to find that the off- spring of habitual drunkards would share with those of lunatics in the predisposition to insanity, and that they would, more- over, be especially prone to intemperate habits. That such is the case is within the knowledge of all who have enjoyed ex- tensive opportunities of observation ; and the fact has come down to us sanctioned by the experience of antiquity. Thus Plutarch says, " One drunkard begets another;" and Aristotle remarks that "drunken women bring forth children like unto themselves." Dr. W. A. F. Browne, the resident Physician of 38 EFFECTS OS" AACOHOJ. the Crichton Lunatic Asylum at Dumfries, makes the following statements : "The drunkard not only injures and enfeebles his own nervous system, but entails mental disease upon his family. His daughters are nervous and hysterical ; his sons are weak, wayward, eccentric, and sink insane under the pressure of ex- citement, of some unforeseen exigency, or of the ordinary calls of duty. At present, I have two patients who appear to inherit a tendency to unhealthy action of the brain, from mothers ad- dicted to drinking ; and another, an idiot, whose father was a drunkard."* The author has learned from Dr. Hutcheson that the results of his observations are precisely in accordance with the foregoing.—On this point, however, the most striking fact that the writer has met with is contained in the Report on Idiocy lately made by Dr. Howe to the legislature of Mas- sachusetts. "The habits of the parents of 300 of the Idiot* were learned ; and 145, or nearly one-half, are reported as ' known to be habitual drunkards.' Such parents, it is affirmed, give a weak and lax constitution to their children ; who are, consequently, 'deficient in bodily and vital energy,' and predis- posed by their very organization to have cravings for alcoholic stimulants ; many of these children are feeble, and live irregu- larly. Having a lower vitality, they feel the want of some stimulation. If they pursue the course of their fathers, which they have more temptation to follow, and less power to avoid, than the children of the temperate, they add to their hereditary weakness, and increase the tendency to idiocy in their constitu- tion ; and this they leave to their children after them. The parents of case No. 62 were drunkards, and had seven idiotic children."! 37. There is a prevalent impression that idiocy is particularly liable to occurr in the offspring of a procreation that has taken place when one or both of the parents were in a state of intoxi- cation. A striking example of this kind is related in the Phrenological Journal (vol. vii. p. 471); both the parents were healthy and intelligent, and one at least habitually sober ; but both were partially intoxicated at the time of the intercourse, and the offspring was completely idiotic. There is every reason to believe that the monomania of inebriety not only acts upon, and renders more deleterious, whatever latent taint may exist; but vitiates or impairs the sources of health for several genera- * Moral Statistics of Glasgow, by William Logan, 1849, p. 20. f American Journal of Medical Sciences, April, 1849, p. 4«7. OX THE HEALTHY SYSTEM. 30 tions. That the effects of drunkenness are highly inimical to a permanent healthy state of the brain is often proved at a great distance of time from the course of intemperance, and long after the adoption of regular habits. 38. Inflammatory Diseases of the Brain. — All medical writers agree in regarding Intemperance as one of the con- ditions which tend to produce Inflammatory diseases of the Encephalon, now distinguished as Cerehritis and Meningitis ; and this is precisely what might be anticipated, when it is con- sidered how great must be the derangement of the circulating and nutritive operations, occasioned by the presence of alcohol in the blood. An attack of acute Encephalitis not unfrequently supervenes upon a debauch, which is then regarded as its ex- citing cause.* But it may occur quite independently of any special act of access, in consequence of the predisposition arising from the perversion of the normal functions, by the habitual use of alcoholic liquors in quantities that may never produce actual intoxication. Perhaps, indeed, this is the more common occurrence. We have seen that the state of excitement first produced in most persons by the ingestion of alcohol, would pass into Meningitis (or rather inflammation of the convolutions) if it were not to subside with the elimination of the alcohol from the blood. On the other hand, the state of torpor of the mental functions, which alcohol produces from the first in some individuals, and which comes on in all if the intoxication be carried far enough, is indicative of that congestion of the sub- stance of the brain which, if confirmed, and accompanied by a certain disturbance of the nutritive operations, would become Cerebritis. There can be no hesitation, therefore, in admitting the relation of cause and effect, in cases in which it is so ob- viously established by the sequence of the phenomena. 39. There is another class of "diseases of the Brain, which are usually dependent upon structural changes that require a longer period for their development; yet whose frequent con- nection with habitual intemperance is established both by theory and observation. These are Apoplexy, Paralysis, and Epilepsy. 40. Apophxy.—The state of profound Coma, characteristic of the advanced stage of intoxication, may be considered to be identical with that of congestive apoplexy, in every respect save the nature of its cause, and its duration.f A certain degree of * See, for example, a fatal case related by Dr. Percy, op. tit., p. 5- f Although, as we have already seen (§ 14), the phenomena are 40 EFFECTS OF ALOOflOL tendency to Apoplexy maybe said to exist in the slighter form of intoxication ; the vessels of the Brain being congested, as a consequence of increased action of the heart, and of obstruction to the encephalic circulation, such as is occasioned by imperfect discharge of the functions of the brain; and this obstruction being also favored by that partial stagnation of blood in the lungs, which takes place whenever the respiratory movements are interfered with. This apoplectic tendency seems to render the intoxicated man peculiarly liable to suffer from causes which would not otherwise produce rupture of the vessels; thus, there are numerous instances on record, in which blows received in pugilistic encounters, or other comparatively slight injuries, have occasioned fatal hemorrhage within the cranium; the sufferer having been previously dosed with spirits in such quan- tity as of itself to produce a state of congestion bordering on apoplexy. And it occasionally happens, though this is com- paratively rare, that cerebral hemorrhage occurs without any external violence, after an excessive indulgence in spirituous potations. 41. But the influence of Alcoholic Liquors in the causation of Apoplexy is usually of a much more gradual nature. A large proportion of the cases of Apoplexy occurring in plethoric subjects, and not connected with disease of the heart or soften- ing of the arterial coats, are traceable to intemperance in eating as well as in drinking; the latter, however, being the chief cause, inasmuch as, without the habitual assistance of alcoholic liquors, continual excess in eating would generally soon correct itself. Hence, we find that such cases are rather apt to occur among those, who take considerable quantities of wine or malt- liquor with full meals of solid food, than among the drinkers of spirits, who are seldom great eaters. It is not difficult to see the reason of this. For, on the one hand, the habit of excess in eating and drinking has a tendency to produce that condition of Plethora which is most peculiarly prone to favor hemor- rhagic effusions; whilst, on the other, the ingestion of a large quantity of solid food, by causing pressure on the vessels of the abdominal viscera, and by impeding the descent of the diaph- ragm, tends to force an unusual quantity of blood into the en- cephalic vessels, as well as to obstruct its return from them. nearly identical, the difference in the etiology involves an important difference in the treatment; the comatose drunkard not requiring, nor bearing the free depletion that is proper in a case of true conges- tive apoplexy. ON TOE HEALTHY SYSTEM. 41 Such an habitual derangement of the circulation may well be supposed to occasion a progressive weakening of the vessels of the brain; and in this manner it happens that, after a persis- tence for months or years in this course, Apoplexy may super- vene, and be its legitimate consequence, without the attack being traceable to any extraordinary indulgence.* 42. Of the strength of the general opinion of the Medical Profession as to the tendency of Alcoholic stimulants to pro- duce the sthenic form of Apoplexy, it is impossible to give a stronger proof than the rigidity of the rule of abstinence which is laid down for those in whom a disposition to it has already manifested itself.. Now if it be necessary to lay down such rules to prevent the recurrence of the disease, is it not most ob- vious that we are justified in attributing to an habitual violation of them its first occurrence ? And if habitual excess be so ob- viously a predisposing cause, can we reasonably deny that the long-continued even " moderate" use of stimulants is likeiy to exert a slow, but in the end a decided, influence ? It is surely in vain here to reply that, as food is wholesome in moderation, but is hurtful in excess, so may alcohol be also; for alcohol (as will be more fully shown hereafter) can never properly act as food, save when other alimentary matters are deficient; and even in the smallest and most diluted doses, alcohol exerts an influence on the vital properties of the tissues with which it is brought into contact, that is never manifested by proper ali- mentary matters. 43. Paralysis and Epilepsy.—As the conditions upon which the cerebral forms of Paralysis depend are so nearly the same with those which induce Apoplexy, we cannot doubt that the continual intemperate use of Alcoholic liquors must predispose to this disease, especially when it accompanies intemperance in eating ; and should expect, too, that an attack of it may some- times be traced to some particular excess, as its exciting cause. All medical writers accord in stating that such is the result of actual observation ; and here, again, we find in the rules of treatment laid down, an additional evidence of the general con- viction of the tendency of alcoholic liquors, even in small quan- tities, to induce a recurrence of paralytic attacks. The writer has had opportunities of noticing this in the case of two gentle- * There is evidence that habitually excessive use of Alcoholic liquors has a tendency to produce hemorrhages elsewhere, probably by diminishing the plasticity of the blood, and by impairing the nutrition of the walls of the blood-vessels.—(See §§ 52 and G8.) 4'Z EFFECTS OF ALCOHOL men advanced in life, each of whom suffered from repeated at- tacks of paralysis, which" almost invariably supervened upon a violation of the habitual rule of abstinence from fermented liquors, and of extreme moderation in diet.—Precisely the same, too, may be said of Epilepsy, which disease is now gene- rally attributed to a disordered state of nutrition of the brain, of which the paroxysm is the manifestation. Of this disordered state of nutrition, intemperance in eating and drinking is among the most frequent of the predisposing causes, especially when the disease occurs in persons advanced in life ; whilst in those who are already predisposed from these or other causes, the excessive use of fermented liquors is frequently the immediate or exciting cause of the paroxysm. 44. Besides these positive diseases, a premature exhaustion of Nervous power, manifested in the decline of mental vigor, and of nervo-muscular energy, is ranked by common consent among the consequences of habitual excess in the use of Alco- holic liquors ; and reasons will be given hereafter for the belief that it is occasionally the direct, but more frequently the in- direct, consequence of the habitual employment of what is con- sidered a very moderate allowance.—(See §§ 177,178.) 45. In regard to all the forms of Encephalic disorder which result from the long-continued action of causes that impair its nutrition, it is to be observed that the habitual use of Alcoholic liquors has—in addition to its direct action upon'the functions of circulation and nutrition—an important indirect agency ; in- asmuch as, by the temporary support it affords, it sustains the nervous apparatus under a degree of exertion that is in the end most injurious to it, and renders the whole system more tolerant of morbific causes of various kinds ; the manifestation of whose action, however, is only postponed, and becomes more severe in the end, in proportion to the duration of the agency. This in- direct operation of alcoholic liquors, however, will be more fitly considered at a future period.—(§ 198.) Diseases of the Alimentary Canal. 46. The disorders of the Nervous System, whose symptoms are among the most obvious and characteristic results* of Alco- holic Intoxication, having been now considered, we proceed to examine the influence of Alcoholic liquors on the production of diseases of the Digestive Apparatus. This influence is exerted in two ways: First, by the direct irritating action of the fluid upon the mucous lining of the Alimentary Canal; and second UN THE HEALTHY SYSTEM. 43 by the general deterioration of the nutritive processes, resulting in various ways from the entrance of Alcohol into the Blood. 47. Irritation and Inflamation of the Mucous Membrane of the Stomach.—That irritation would be produced in the very vasculor mucous meuibrane of the Stomach, by the direct con- tact of Alcoholic liquors, and that this would vary in its inten- sity with the amount, concentration, and duration of the ap- plication of the irritant, is precisely what we should anticipate, from what has been already shown by observation to be the re- sult of the application of Alcohol to a living membrane. A small quantity of Alcoholic liquor, diluted by the fluids already in the stomach, appears to produce only the first effect, namely, a quickening of the circulation, and a temporary exhaltation of the functional activity of the organ, as shown in the increase of the appetite and of the digestive power. But when a larger quantity is introduced, and especially when successive doses are taken so as to keep up the irritation, or when the alcohol is in a state of high concentration, and the stomach contains but little other fluid, all the effects of an irritant are produced, vary- ing from moderate congestion with diminished functional ac- tivity, to intense congestion passing into inflamation, and even into a gangrenous state. The more severe effects, however, are not often seen ; in consequence, it may be surmised, of the rapidity with which the alcohol has been absorbed (§ 18), and the brevity of the duration of its contact with the membrane, shielded as this is with its coat of mucous. Hence a repetition of the dose seems more likely to produce a state of high irrita- tion, or of inflammation, than any single dose, unless this have been too great to be quickly absorbed. 48. The morbid appearances found in the Stomachs of men or animals killed by narcotic poisoning, and attributable at first sight to the direct influence of the irritant, can seldom be fair- ly regarded in that light; since they are for the most part such as are producible by the Asphyxia which has been the immediate cause of death. When we find general injection of the mucous membrane, local patches of extreme congestion, numerous minute extravasations, or hemorrhagic patches of large extent, these are more likely to have been the result of the stagnation of the pulmonary circulation, acting backwards upon the whole venous system, than to have been the immediate re- sult of the contact of alcohol; since appearances precisely sim- ilar are found when death has taken place from suffocation in other modes, e. g. in criminals executed by hanging. In the 44 EFFECTS OF ALOOHOl ease of animals poisoned by Alcohol, it frequently happens that scarcely any positively morbid appearances are discernable in the stomach ;" and the departures from the healthy charac- ter which are noticed in the stomach of the human subject af- ter death from alcoholic poisoning, are most frequently such as indicate an altered state of its nutrition, consequent upon ha- bitual irritation. Of these departures, a thickened state of the mucous membrane seems to be the most constant; the mem- brane being sometimes softened (as stated by Dr. Ogston); sometimes unusually firm, corrugated, and pale, (as obser- ved by Dr. Peters). These last appearances seem to have been most common, when a quantity of undiluted Spirits had been taken shortly before death, and to have resulted from that physical action exerted by them upon the membrane, to which reference has already been made (§§ 2, 3). It some- times happens, however, that after the narcotic effects of the Alcohol have passed off, another set of symptoms appear, in- dicative of inflammation of the Alimentary Canal; and if these proceed to a fatal termination (as now and then occurrs), the usual appearances indicative of that state are found in the gas- trointestinal mucous membrane. In one example of this kind cited by Dr. Christison, the whole villous coat of the stomach was in a gangrenous state, the colon was much inflamed, and the small intestines red along their whole length. 49. Our best information as to the effect of Alcoholic li- quors upon the condition of the Gastric mucous membrane dur- ing life, is derived from the well-known observations of Dr. Beaumont in the case of Alexis St. Martin. This man appears to have been habitually temperate and healthy ; but to have occasionally indulged in excess both in eating and drinking, the results of which could be seen by direct observation through the fistulous opening in the parieths of his stomach. "Thus," says Dr. Beaumont,"under the date July 28th, 1833, " Stomach not healthy, some erythema, and aphthous patches on the mucous surface. St. Martin has been drinking ardent spirits pretty freely, for eight or ten days past, complains of no pain, nor shows symptoms of general* indisposition—says he feels well, and has a good appetite. August 1st. Inner mem- brane of the Stomach morbid ; considerable erythema, and some aphthous patdhes on the exposed surface"; secretions vitiated. August 3d. Inner membrane of Stomach unusually morbid ; the erythematous appearance more extensive and spots more livid than usual, from the surface of which exuded ON THE HEALTHY SYSTEM. 46 small drops of grumous blood ; the aphthous patches larger and more numerous ; the mucous covering thicker than com- mon, and the secretions much more vitiated. The gastric fluids extracted this morning were mixed with a large propor- tion of thick, ropy mucus, and considerable muco-purulent matter, slightly tinged with blood, resembling the discharge from the bowels in some cases of chronic dysentery." Now, it is very important to remark that all this disorder was proved by direct observation to be actually existing in the mucous coat of the stomach, without any such manifestation of it by gen- eral or local symptoms as would by themselves have been thought indicative of its presence. " For," continues Dr. Beau- mont, "St. Martin complains of no symptoms indicating any general derangement of the system, except an uneasy sensation, and a tenderness at the pit of the stomach, and some vertigo, with dimness and yellowness of vision on stooping down and rising again ; has a thin yellowish-brown coat on his tongue, and his countenance rather sallow ; pulse uniform and regular, appetite good, rests quietly, and sleeps as well as usual." By the 6 th of August, the inner surface of the stomach had reco- vered its healthy appearance ; the patient having in the mean time entirely abstained from all alcoholic liquors, and having been confined to low diet. Dr. Beaumont further states that "diseased appearances, similar to those mentioned above, have frequently presented themselves in the course of my experi- ments and observations. They have generally, but not always, succeeded to some appreciable cause. Improper indulgence in eating and drinking has been the most common precursor of these diseased conditions of the stomach. The free use of ar- dent Spirits, [Vine, Beer, or any intoxicating liquor, when con- tinued for some days, has invariably produced these morbid changes." 50. From the precise concurrence of these Observations with what Theory would lead us to expect, in regard to the action of Alcoholic liquors on the Mucous membrane of the stomach, it is obvious that we have no right to suppose that the peculiar condition of St. Martin gave him any peculiar liability to suffer in the manner above described. On the contrary, such dis- orders of the circulation, nutrition, and secretion, might be anticipated to occur in every case ; and it is only because they are not immediately indicated by pain and heat in the stomach, by loss of appetite, or by general febrile disturbance, that they are presumed not to exist. This presumption, however, has 46 EFFECTS OF ALCOHOL been shown to be altogether fallacious ; and we have adequate reason to believe that some such condition must be the result of every excess in the use of alcoholic liquors, however little it may be indicated by the local or general symptoms. 51. Inflammatory Gastric Dyspepsia.—It might be antici- pated, then, that habitual excess would convert this state of occasional and transient disorder, which only requires rest and abstinence for its cure, into one of a more persisted and obsti- nate character; which, by unfitting the stomach for the discharge of its normal functions, Avould seriously impair the general nutritive operations. Such has been shown by experience to be the case ; a special form of dyspeptic disorder, termed Inflam- matory Gastric Dyspepsia, being well known to practical men as common among those who have freely indulged in alcoholic potations; Of this disorder, the following are the symptoms, as enumerated by Dr. Todd :* " Painful digestion, sense of heat, tenderness, or pain at the epigastrium, increased upon taking food, or on pressure ; thirst; tongue more or less of a bright red color, sometimes brownish red, sometimes dry, glossy, and adhesive ; taste saltish, or alkaline, occasionally like that of blood ; bowels generally confined ; urine high-colored ; skin dry, with occasionally profuse, partial sweats, chiefly in the direction of the extensor muscles ; temperature of the trunk in- creased, of the extremities diminished, except occasionally in the palms of the hands and soles of the feet, which, especially at night, are frequently hot, dry, and burning ; aggravation of the symptoms under the use of stimulants, or of irritating in- gesta." The various stages and degrees of the disease" are characterized by various modifications of these symptoms, many of them the consequences of the disturbance of the nutritive functions produced by the disorder of the stomach ; but of all such consequences it may be remarked that they are probably aggravated by the previous disturbance of the nutritive and secretory operations consequent upon the habitual introduction of alcohol into the blood. Tims, we find a special tendency to cutaneous eruptions, such as Erysipelas, Lichen, Erythema, Urticaria, Psoriasis, and Pityriasis ; to sluggish and imperfect action of the Liver ; to scantiness in the secretion of the Kid- neys; and to depression of spirits, with inability for active mental exertion, passing on, in the more confirmed states, to complete Hypochondriasis. Although excess in eating may * Cyclopedia of Practical Medicine, Art. Tndigestl ON THE HEALTHY SYSTEM. 47 aid in the production of this wretched condition, yet, as Dr. Todd remarks, it is rather due to the stimulating quahty of what is taken into the stomach, than to its quantity ; and al- though it may occasionally arise from the habitual use of highly-seasoned food without the proper dilution by bland liquids, yet it is much more frequently brought on by indul- gence in alcoholic potations ; " it is the dyspepsia of the Dram Drinker and Opium Eater, and belongs altogether more to the Drunkard than to the Glutton." In the treatment of this disease, the complete disuse of stimulants is found to be of the greatest importance ; notwithstanding that, in the more chronic forms of it, a temporary alleviation is sometimes obtained from small quantities of alcoholic liquors.* 52. Disorders of the Intestinal Mucous Membrane.—The disordered state of the gastro-intestinal mucous membrane is not limited, as we have seen, to the stomach, and it may extend itself along the whole course of the Alimentary Canal, to parts with which the Alcoholic liquors themselves have not come in contact; so as to be attributable rather to the general imper- fection of the nutritive operations than to the local effects of the stimulant. Thus, we find that habitually intemperate per- sons are subject to soreness, redness, and ulceration of the membrane of the nose, and of that of the lower part of the in- testinal canal; and hemorrhages from various parts of this membrane, as well as from the mouth itself, are of no unfre- quent occurrence—the escape of blood being obviously depen- dent in part on its own insufficient plasticity, and in part upon the softened condition of the walls of the vessels. It is impor- tant to bear this in mind, as increasing the probability of the same cause being concerned in the production of a similar softening elsewhere; as, for example, in the vessels of the Brain.—(See § 41.) 53. Where, in place of excessive indulgence, what is com- monly considered a moderate use has been made of Alcoholic liquors, we cannot, with the same confidence, attribute to it any decided departure from the healthy condition of the stomach; and it is certain that the mucous membrane becomes in time so habituated to its presence, that its contact no longer pro- duces the same effects as it does on a membrane unaccustomed to it. But we shall hereafter (§§ 160-162) find reason to be- * See the observations of Sir Philip Crampton on this subject, in Dublin Hospital Reports, vol. i. p. 319. 48 EFFECTS OF ALCOHOL lievo that such habitual use is not without its consequences, although these may be very remote; the continual over-excite- ment of the vital activity of the gastric mucous membrane being probably one of the causes of that premature loss of functional power which is observable in a great number of those who have accustomed themselves to the use of alcoholic liquors. This cause, however, will seldom act alone; bein^ usually combined with excess in diet, and with " wear and tear" of the general system, as will be shown in its proper place ; so that its operation is very liable to be overlooked. Diseases of the Liver. 54. That habitual excess in the use of Alcoholic liquors must have a direct tendency to produce certain diseases of the Liver, will be questioned by no one who considers their mode of introduction into the system, and their influence on the condition of the blood. The blood which returns from the gastric veins charged with Alcohol is immediately transmitted through the Liver; and it stimulates this gland for a time to increased activity, one effect of which is to eliminate a portion of the alcohol from the blood—this substance, according to Dr. Percy's observations, being detectible in the bile of animals poisoned by alcohol. Hence the Liver, like the stomach, is subject to habitual over-stimulation from the direct contact of alcohol with its substance. But we have seen that the presence of alcohol in the blood prevents it from acquiring its proper arterial character by passage through the lungs ; and we shall hereafter find that it causes the undue retention in it of hydro- carbonaceous matters, which ought to be removed by the res- piratory process. Hence, an undue amount of labor is thrown upon the Liver—one of the functions of this Gland being, to separate from the blood such hydro-carbonaceous matters as are not carried oft" by the respiratory organs; and this continual overwork must predispose it to various disorders. 55. Acute and Chronic Inflammation of the Z/ivr.—In tropical climates, acute inflammatory diseases of the Liver are among the most common of these disorders; and they are dis- tinctly traceable, in a large proportion of cases, to that excess, both in eating and drinking, to which Europeans are unfortu- nately but too prone, being rarc among the Natives, and al- mannefo1f^ivT "T^, •'" Eurol"'an* "ho *i°pt the native mannei of hvmg. In tins count, v, such' acute diseases are comparatively rare; but there are certain remote coi^ueil ON THE HEALTHY SYSTEM. 49 which are no less clearly traceable to chronic inflammation and degeneration, resulting from the excessive use of fermented liquors, especially when these are taken in the form of dis- tilled spirits. The following is the account of the state of the Liver given by Dr. Peters (loc. cit), as presented in the seventy cases which he had an opportunity of examining: "In 'moderate drinkers,' the liver was generally found to be some- what larger than usual, its texture softened, and its outer surface spotted, with patches of fatty infiltration extending two or three lines into the parenchymatous substance; the rest of the viscus retaining its natural color, and its edges their normal sharpness. In those who had been more addicted to the use of spirits, the liver was still larger, its edges were more obtuse, and the patches of fat on its surface were larger ai:d more numerous. In old drunkards the liver was very large, weighing at least six or eight pounds, often from ten to twelve j the edges were very thick and much rounded ; the parenchyma almost white with fat, soft, fragile, and the peritoneal covering could be torn off with ease." It is evident that in all these oases the Liver was the subject of various degrees of fatty degeneration, which takes place, on the one hand, as the result of deficient functional activity of the Gland, whilst, on the other, it is indicative of an excess of fatty matter in the system. 56. The peculiar conditiens of the Liver known as "granu- lar liver," and "hob-nailed liver," or "gin liver," were comparatively rare in Doctor Peter's experience, being ob- served only in four or five cases; but they seem to be much more common in this country; and its greater prevalence may possibly be due to a difference in the character of the spirit usually employed by drinkers among the lower classes, Gin being here the most common, Rum and Brandy in the United States. These conditions appear to be dependent upon atrophy of the proper hepatic substance, with hypertrophy of the connecting areolar tissue; the former being apparently the result of the exhaustion of the functional power of the liver by over-excitement; and the latter to continual attacks of chronic inflammation, which produce the false membranes, adhesions, puckerings, &c, that give rise to the second of the designations just cited. Between the state of contraction (in which the Liver is frequently not more than half its usual size), and the state of enlargement just described, there is not that opposition which might at first sight appear; for in both c 1. 60 EFFECTS OF ALCOHOL is there diminished functional and nutritive activity of the proper substance of the gland; and the state of enlargement, which is simply dependent upon the accumulation of fatty matter, not unfrequently gives place to one of contraction. In fact, it would not seem improbable that each state may have a relation to the general disposition to the development of fat, hi the individual; for Avhilst in many habitual drunkards there is a great tendency to the production of fat, and to its deposition in various parts of the body (§ 61,) there is an equal tendency in others to a leanness which no fattening process will over- come.—Certain it is, however, that the habitual use of Alco- holic liquors has a tendency first to excite and then to diminish the functional activity of the Liver; and thus predisposes in the first instance to inflammatory diseases of the organ, whilst its more remote operation is to induce atrophy or degeneration. This will be especially the case in tropical climates; where several causes concur (as will be shown hereafter) to augment the injurious influence of Alcohol upon the Liver, and conse- quently to increase the amount and severity of the diseases of that organ induced by its habitual use.—Of course, every dis- turbance of the function of the Liver must be an additional source of disorder in the digestive operations, in which the action of this gland has so important a share. Diseases of the Kidneys. 57. We have seen that a special determination of blood to the Kidneys takes place as one of the results of the reception of Alcoholic liquors into the blood; and these organs are thereby excited to augmented action, one of the purposes of which would seem to be the removal of the alcohol from the current of the circulation. As the blood of the Kidneys is derived from the arterial system, in which the alcohol becomes diluted by the whole mass of sanguineous fluid; and as the alteration in the constituents of the blood which it tends to produce, has less relation to the function of the kidneys than , to that of the liver, it might be expected that excess in alco- holic liquors should not have the same tendency to produce acute inflammatory attacks in this organ as in the other, although it may act as the exciting cause of such attacks (as hlTrilvb fTTUt1^ thG CaSeranCe to the India troops a Medical Officer stated that within a month after th^arri- val of the order for the discontinuance of Temperance So- ON THE HEALTHY SYSTEM. 65 cieties,* he had forty cases of Delirium Tremens in his own Regiment. 74. That the liability to climatorial disease is by no means inevitable, and that it is especially to be avoided by the adopt- ion of the habits in regard to diet, &c, of the native population, Avhere that is healthy, is the testimony of all those Avho have had most extensiAre opportunities of forming a judgment on the subject. The two folloAving citations from different publica- tions, the one by Lieutenant-Colonel Sykes, who Avas himself long resident in India, the other by Dr. Daniel], Assistant Sur- geon to the Forces, avIio has had the superintendence for a considerable time of some of the most unhealthy stations on theWestern Coast of Africa, Avill carry AAdth them great weight. " I never followed a farinaceous or vegetable regimen myseif in India," says Colonel S., " nor do I recommend it to others ; but I ate moderately and drank little, and I have a strong convic- tion that much of European disease in India is traceable to over-stimulus, and that the mortality among the European troops will not be lessened until the European Soldier is impro- ved in his habits; until he is made to understand that temper- ance is for the benefit of his body, libraries for the benefit of his mind, exercise for the benefit of his health, and Savings' Banks for the benefit of his purse. The climate of India is less to blame than individuals; for, in case Foreigners find the people in a country healthy, they should, to a certain extent, con- form to the habits of the Natives to be healthy also"\ So with regard to Africa, Dr. Daniell says, " It is a well- known fact that the notorious insalubrity of Africa has frequently served as the scape-goat on which the blame of those evil consequences (re- sulting from the reprehensible indulgence of dissipated courses) might be unreservedly thrown, Avithout the risk of their being disputed or questioned.''^ And again, when describing the Bight of Benin, one of the most pestilential localities on the surface of the globe, he says, " And yet, amid these regions so * The Authorities at the Horse Guards, who have taken the extra- ordinary step of putting down Temperance Societies in the Army, on the ground that every organization but the regimental is contrary to the discipline of the service, can scarcely be supposed cognizant of what they have to answer for. f Vital Statistics of the Indian Army, in Journal of the Statistical Society, vol. x. p. 184. \ Sketches of the Medical Topography and Native Diseases of the Gulf of Guinea, Western Africa, p. 13. oe EFFECTS OF ALCOHOL rife Avith disease and death, I have known Europeans reside for a number of years in the enjoyment of good health, from the Bimple secret of moderately conforming to the habits of the natives as regards their diet, exercise, and attention to the due performance of the cutaneous functions."* 75. The evidence of statistics, hoAvever, is more valuable on this point, than the mere affirmation of individuals, however trustworthy ; and to this, as set before us by Colonel Sykes, we shall now proceed. The per centage annual mortality from sickness of the three armies of Bengal, Bombay, and Madras for the last twenty years, has averaged as follows:— Bengal. Bombay. Madras. Native - - - 1-79 1291 2.095 European - - 7 38 5071 3846 This Table presents some very remarkable features. In the first place, the striking contrast betAveen the rate of mortality of the European and of the native Troops, serving together, and exposed to the same morbific causes. Secondly, the great dif- ference between the mortality of the Troops serving in the dif- ferent Presidencies. And, thirdly, the circumstance that in the Madras Presidency the rate of mortality is highest among the Native Troops, and lowest among the Europeans. 76. Now, on the first point, Colonel Skyes remarks: "I will not say that the question is absolutelv solved by the reply, 'Habits of Life ;' but I will sav, reasoning from analogy, that the reply goes a great way to solve it. The European soldier m India is over-stimulated by food, over-stimulated by drink, and under-stimulated in mind and body. The European sol- dier eats a quantity of animal food every day of his life ; he drinks a quantity of alcohol every day of his life to the amount ot a bottle of spirits in every five days, two drams being served out to him daily ; and he has not any mental and little bodily exercise. Happily the pernicious practice has been recently rZT^n??\Ylmie™S when the European soldier was Still takGb]S dramby e^ht oVloc&n the morning, JerentselZZT^ ^T'8 fr°m l0° to 90° or more, at dif- tatbn and thlst ? -Jf'' ^^ him in a state of nervous irri- oTi^^k^f\^ rh^ebreelieved'as,he -W last few day* by a V^I^^^^wlZet * Op. cit., p. 61. " ON TnE HEALTHY SYSTEM. 67 twenty-one years'1 service, that he has known, out of a detach- ment of 100 Artillery men, no less than eight men in strait jackets at one time, absolutely mad from drink. Noav animal food, with the assistance of sueh an auxiliary, and combined Avith mental vacuity, go far to account for the excess of mortal- ity amongst Europeans." 77. The question next arises, why the mortality of the Euro- pean troops in the Madras Presidency should be so much less than that of the others, being about three-fourths that of the Bombay troops, and but little more than /<«(/" that of the Ben- gal army ; whilst, on the other hand, the mortality of the NatiA-e troops in the Bombay army is but little more than two- thirds of that of the Bengal army, and less than two-thirds that of the Madras army. There does not seem to be any sueh dif- ference in the climatorial diseases, or in the character of the mili- tary stations, of the three Presidencies, as are, by any means sufficient to account for this discrepancy ; and if there were, we should expect them to manifest themselves alike in the Native and in the European army. That the reverse is the case, must be admitted to be a cogent argument, if not a complete proof, in favor of the insufficiency of any such account of the discre- pancy. The following are the causes assigned by Colonel Sykes : The Bengal European army has no supply of porter, but is fur- nished Avith rum, a spirit not so AvholesDme as arrack. On the other hand, the Madras army consume large quantities of porter, and drink comparatively little spirit, Avhat they do con- sume being arrack. The Bombay troops have only recently commenced the*consumption of porter, and the spirit they drink is understood to be more AAdiolesome than rum, and less so than arrack. " These results," says Colonel Sykes, " are certainly not conclusive ; but I cannot help associating the increased con- sumption of malt liquor by the Madras Europeans Avith their comparative healthiness ; and the gradations of the mortality in the Bengal and Bombay European troops as partly influenced by the quality (no doubt much more by the quantity) of the spirits they respectively consume." 78. On the other hand, the excess of mortality in the Native army of Madras above that of the Bengal and Bombay troops is equally attributable to a difference in the habits of the in- dividuals composing it. "Of the Bombay army," says Colonel Sykes, "six-eighths consist of Hindoos, and considerably more than half of the Avhole army are Hindostanees. These men never taste meat, fi>li, or spirituous liquors, but live, I may from 68 EFFECTS OF ALCOHOL personal observation venture to say, almost exclusively upon unleavened cakes of wheat or other cerealia, baked upon an iron dish, aud eaten as soon as cooked. The great majority of the Bengal army consists of a similar class of men. The Mad- ras army in its constituents is the reverse of the other two.— In the cavalry there are from 6 to 7 Mussulmen to 1 Hindoo, and in the infantry there is 1 Mussulman to every l£ or If Hindoos ; but amongst the latter there is a considerable num- ber of low castes, without prejudices about food, and unrestrained by the prejudices of caste ; therefore the majority of the Native troops of the Madras army can eat and drink like Europeans." Thus then we see, that whereas in the Madras army, in which the European and Native habits most closely assimilate, the mortality of the former is less than double (about 38 to 21) that of the latter ; the mortality of the Bengal Europeans is nearly six times (about 74 to 13) that of the Bombay Natives; this difference bearing such a relation to the greater abstemious- ness of the Native soldiers, and the larger consumption of spirits by the Europeans, that it is scarcely possible to avoid the in- ference that they must be connected in the relation of effect and cause. 79. The following returns are of value, as showing the pro- portion of sickness betAveen the members of Temperance Societies* in the European regiments serving in India, and the soldiers not members of these Societies ; the average daily number of men in hospital of each class being stated, for each of the first six months of 1838, and the per centage being calculated with reference to the strength of each division. Months. Strength of the Tem-perance Societies. Strength of Remainder of Regiment. Relative proportions admitted to Strength, Average daily per centage of Men in Hospital. Temperance Society. * Remainder of Regiment. Tempe-Society. Remain-der of Regiment. January February March April May June 1953 1840 1542 1359 1282 1364 25G9 2639 2879 3081 3161 3075 1 in 18-77 1 in 20-10 1 in 14-44 1 in 109 1 in 18-44 1 in 19-53 1 in 9-22 1 in 9-24 1 in7-14 1 in 526 1 in 6 35 1 in 6-37 2-54 2-27 2-94 5-47 5-24 4-55 8-15 8-27 8 66 10-28 10 66 10-35 Total 9340 17,354 1 in 1647 1 in 7*28 365 1020 * In these Societies, the pledge simply held the members to absti- nence from distilled splits, and from excess in the use of any fermen- ted liquor. J ON THE HEALTHY SYSTEM. 69 Thus it appears that, on the whole, the daily per centage of invalids among the members of the Temperance Societies was but 3-65, vhilst in the remainder of the troops it was 10-20, or nearly three times as great.—The Cameronian Regiment, sta- tioned in Fort William in the years 1837 and 1838, lost only twenty-six men in the first of these years, and twenty-two in the second; whereas the average mortality in Fort William, for a period of fourteen years previously, had been nearly seventy-two. The proportion of the regiment which belonged to the Temperance Society.was continually varying; but the general result of its operation was, that since the arrival of the reo-iment in India, its annual consumption of spirits diminished from 10,000, 12,000, and even 14,000 gallons, to 2516; the amount drunk in 1837 having been 9673 gallons less, and in 1838, 8242 gallons less, than the regiment was entitled to draw.' On the other hand, a considerable amount of beer and wine had been drunk; but these beverages are far less injurious to health, especially in India, than distilled spirits. 80. Having learned that the 84th Regiment of Her Majesty's Foot has for some time enjoyed the reputation of being one of the most temperate and well-conducted regiments in the Euro- pean portion of the Indian army, the writer has consulted the Army Medical Returns, for the purpose of ascertaining whether its rate of mortality has differed in any marked degree from the average given above ; more especially since it has been quar- tered at Secunderabad, which lies under the bad repute of being one of the most unhealthy stations in the Madras Presidency. That this bad repute is well deserved, is shown by the fact that the annual mortality, for an average of fifteen years previously to 1846-7, has been 7-5 per cent. ; nearly double the average of the whole Presidency, and more than double the average of the other stations. The evil seems traceable to the insufficient barrack accommodation rather than to the condition of the sur- rounding country ; for one-third of the men are obliged to sleep in the verandahs, and the remainder have by no means a due allowance of fresh air ; whilst the officers of the regiment quar- tered there, and the Artillery company, who are better lodged, have not shown any excess of mortality above the average. 81. Now in the hear 1846-7, the average strength of H.M. troops in the Madras Presidency was 5963, and the number of deaths was 251, or 4-21 per cent.; which is rather above the average mortality in this Presidency, calculated by Colonel Sykes from the returns of twenty years. During the first eight 70 EFFECTS OF ALCOHOL months of this period, the 84th Regiment was quartered at Fort St. George, Madras, which is considered a healthy station; it then performed a march of between four and five hundred miles to Secunderabad, in an unusually wet season, the roads (such as they were) being in some parts knee-deep in water ;* and it took up its quarters at Secunderabad, about two months previously to the date of the return (April 1st, 1847). The medical return of the regiment for this year presents us with the almost unprecedentedly low number of thirteen deaths in an average strength of 1072 men ; the mortality being thus at the rate of only 1-21 per cent. Now during the same period, the 63rd Regiment, which was quartered at Secunderabad up to February 1st, 1847 (or nine months out of the twelve), lost seventy-three men, which was at the rate of 7-88 per cent, for the entire year ; whilst the mortality for all the other stations in the Madras command was only 3-02 per cent, for the same year. Hence we see that the mortality of the 84th Regiment for the year 1846-7 was only two-fifths of that of the average of the healthier Stations in the Madras Presidency, which average its own very low rate contributed to reduce. 82. During the year 1847-8, the total mortality in the Madras Presidency was 22 7 to 6040 of average strength, or 3-76 per cent.; but this reduction from the preceding year was not dtie to any considerable difference in the rate of mortality at the other stations, being almost entirely consequent upon the" diminution in the number of deaths at Secunderabad. For the 84th Regiment, which remained at that station during the whole year, lost in that time no more than thirty-nine men out of an average strength of 1139, so that its per centage mortality was only 3-42 ; which was below the general average of the Presidency, and less than half the average rate at Secunderabad for fifteen years previously. It seems impossible to attribute these remarkable results to anything but the abstinent habits of # the soldiers of this regiment ; a large proportion of them being total abstainers, and those who were not so being very moderate in their consumption of alcoholic liquors. 83. The comparison of the returns of this regiment with those of others less remarkable for sobriety affords a full confirmation of the deductions drawn from the statistics of crime in this country, as well as from individual observation, in regard to * Of this march a more particular account will be given further on ON THE HEALTHY SYSTEM. 71 the influence of habitual Intemperance upon the moral conduct. That a large proportion of offences amenable to punishment, both in the civil population and in the military and naval services, are committed under the direct excitement of alcoholic liquors, there can be no kind of doubt ; and the comparison of the insubordination and criminality of a drinking regiment with the orderly and reputable conduct of an abstinent one, circum- stanced in other respects almost precisely the same, adds to the confidence with which we may assert that Intemperance is the chief cause of Crime. For, besides the immediate provocation which alcoholic excitement may induce, it is indubitable that habitual excess has a tendency to debase the moral tone and to weaken the controlling power of the will ; an effect for wdiich the statements already made as to its action on the mind, through its organ the brain, leave us at no loss to account.* * The author is happy to be able to add the testimony of Colonel Reid, who was for some years Governor of the Bermudas, and subse- quently of the Windward Islands, in favor of the beneficial effects of Total Abstinence, in improving the physical condition, and in promot- ing the general welfare, of a tropical population composed of a mix- ture of Europeans with colored people. To Colonial Reid belongs the high credit of being one of the few individuals, occupying situations of high official responsibility, who have employed their influence in pro- moting this great measure of social reform. The author is informed by him that the habit of Total Abstinence now prevails in the Bermudas to such an extent, that in some parishes there are no public houses; the feeling of the people being so much againt these, that no one will come forward to give the collateral security which is required from those who seek licenses for them. In the Annual Reports of the Gov- ernors of Colonies which are laid before Parliament, and published, Colonel Reid speaks as follows, with reference to Barbadoes: "I en- deavored, on my first arrival here, to revive a Temperance Society which had been before unsuccessfully attempted. This Society has now taken root in the midst of Distilleries ; and promises to effect a great social revolution in West Indian habits." 72 SUPPOSED USES OF ALCOHOL CHAPTER H. DOES PHYSIOLOGY OR EXPERIENCE TEACH US THAT AL- COHOLIC LIQUORS SHOULD FORM PART OF THE ORDI- NARY SUSTENANCE OF MAN, PARTICULARLY UNDER CIRCUMSTANCES OF EXPOSURE TO SEVERE LABOR, OB TO EXTREMES OF TEMPERATURE ? OR, ON THE OTHER HAND, IS THERE REASON FOR BELIEVING THAT SUCH USE OF THEM IS NOT SANCTIONED BY THE PRINCIPLE OF SCIENCE, OR BY THE RESULTS OF PRACTICAL OB- SERVATIONS ? The reply to this question will be best furnished, in the op- inion of the writer, by considering seriatim how far science and experience lead to the belief, that the use of Alcoholic Liquors is advantageous, as fitting the system for the better endurance —1st, Of severe bodily exertion;—2d, Of severe mental ex- ertion;—3d, Of extreme cold;—4th, Of extreme heat;—5th, Of morbific agencies. From the results of these inquiries it will be found not difficult to draw deductions as to the propriety, or otherwise, of making Alcoholic Liquors form part of the sus- tenance of Man under ordinary circumstances. I. ENDURANCE OF BODILY EXERTION. 84. All bodily exertion is performed by the instrumentality of the muscular apparatus, which is called into play by the agency of the nervous system. It is requisite, therefore, that we should begin by inquiring into the conditions under which their powers are respectively put forth ; and the following may be stated as fundamental positions, in which all the most emi- nent physiologists are now agreed. I. Both the Nervous and Muscular systems require, for the energetic development and due maintenance of their respective powers, that then- tissues shall be adequately supplied with the ^T^U?-^*^"*^'™; -tLbfthey shall he heir riti?endo ^ °f thG losS which e™7 Zeroise of heir vital endowments involves; and also to develop new tissue, to meetmcreasmgdemands upon then- functional activ^ IN SUSTAINING THE VITAL POWERS. 7# II. The functional activity, both of the Nervous and Muscu- lar systems, involves the disintegration of a certain amount of their component tissues, by the agency of Oxygen : the evolu- tion of their peculiar forces being apparently dependent upon the return of the living tissue to the condition of dead matter, and upon the union of this matter with the oxygen supplied by the blood ; whereby new compounds are formed, the retention of which in the circulating current would be detrimental to the vivifying qualities of the blood, and the continual elimination of which, therefore, is especially provided for.—Both these sys- tems consequently require", as the condition of their highest ac- tivity, that they shall receive an adequate supply of blood, charged with Oxygen, and purified from the contaminating matters which it has taken up in the course of its circulation through the system. III. For the fullest evolution of physical power, it is requisite that the Muscular system should receive an adequate excitation from the Nervous; and the amount of muscular force put forth on any occasion depends, ceteris paribus, on the degree of ner- vous power which is caused to operate on the muscles—a strong Emotional excitement, for example, being sometimes effectual in accomplishing that which the will could not effect. 85. If the Nerves and Muscles be inadequately nourished, it is impossible that their normal power can be developed, except under the influence of stimulants, and then only for a short time. If, on the other hand, tho blood be imperfectly charged with Oxygen, it cannot supply a sufficient amount of that ele- ment for the performance of those chemical changes which are involved in every action of the muscular and nervous apparatus. And if, besides being deficient in (>xygen, the blood be charged with carbonic acid, biliary matter, urea, or other products of the disintegration of the body, the functional power of the ner- vous and muscular systems must undergo a marked diminution, in consequence of the deleterious influence which such matters exert upon their tissues. 8G. Now it may be accepted as an indubitable fact in Or- ganic Chemistry, that there is not the slightest relation of com- position between Alcohol and Muscular tissue; and all our present knowledge of the subject tends to prove that the albu- minous* matters of the blood, which constitute the pabulum of * This term is here used to designate what are commonly known as the protein compounds ; late researches having tended to show the in- correctness of the basis on which that appellation was founded. D 1 74 SUPPOSED LSE6 OF ALCOHOL that tissue, cannot be generated within the body of man, or of anv other animal, but are derived immediately from the food. "We cannot regard Alcoholic liquors, then, as contributing to the nutrition of Muscular tissue ; except in so far as they may contain albuminous matters in addition to the Alcohol, which is especially the case Avith " malt-liquors." But these matters would have the same nutrient power, if they were taken in the form of solid food. 87. We cannot speak with the same confidence in regard to the im2)osslbillty of any assistance being afforded by Alcohol to the nutrition of the Nervous system ; since Nervous matter is essentially composed of fatty substances, which, though peculiar as containing a large quantity of phosphorus, do not seem to contain nitrogen •* and since Alcohol is regarded by the Chemist as approximating the oleaginous class of substances in its chemical relations.—But there p.re two circumstances, which render it highly improbable that Alcohol can ever be converted into Nervous matter. In the first place, we have no other ex- ample of an organic compound being found applicable to the nutrition of the animal tissues, which is the product of incipient decay or decomposition : yet this may be affirmed to be the case with Alcohol, since the Alcoholic fermentation is the first of a series of degrading changes, which, if allowed to continue unchecked, terminates in the putrefactive process; and we can scarcely imagine, therefore, that it can be an appropriate ma- terial for the formation of the most active and important part of the whole animal mechanism. Again, we have no other ex- ample of the application of an organic compound to the nutri- tion of the animal tissues, which exerts upon any of them such a decidedly poisonous influence in large doses, as we have seen to be exeited by Alcohol (g§ 13-1G). The materials which constitute the pabula for the several tissues are perfectly in- nocuous Avhilst they retain their normal constitution; and their presence in the blood, in larger amount than usual, though it * It is usually stated, on the authority of Fremy, that the fatty acids of the nervous substance contain nitrogen ;" this, however, is probably an error; arising from the substance of the brain or nerves feeing submitted to analysis en masse ; for this substance consists not merely of the fatty contents of the cells and tubes, but of their albu- nv.uous walls; and thus regarded chemical]}', it is a mixture of oleagi- nous with a small quantity of albuminous matter, which last when included in the analysis, would give to the former ingredient the ap- pearance of containing azote.—(SceA'alentin's Lchrbuch der Physiolo- gic, Band. I. p. 174.) J I.N STTSTAJNINC* TUH VITAk POWERS. 76 may in various modes be a source of functional derangement, never exercises any special deleterious influence upon the vital properties of the nervous, muscular, or any other tissue. On these grounds, then, it may be almost positively affirmed that, notwithstanding the chemical relation which Alcohol bears to Nervous matter, it cannot serve, either in its original condition, or under any other guise, as a pabulum for the generation of nervous tissue. 87. We seem justified by the laws of Physiology, therefore, in assuming that Alcoholic liquors cannot supply the first of the requisites alijeady enumerated .for the development of the physical power of the nervous and muscular apparatus; and we have next to consider what is its capacity in regard to the second. It may be safely affirmed that the introduction of Al- cohol into the blood cannot stand in the place of the Oxygen which is essential to the functional activity of the nervous and muscular systems; on the contrary, its presence in the blood would rather tend to impede the oxidation of their organic components, both by the more cogent demand for oxygen which it will itself set up, and also by the preventive influence which it is well known to exercise over the oxidation of other organic substances (§§ 117, 118). In both these modes, it will not only interfere with that action of the Oxygen of the blood upon the Nervous and Muscular substances, which is essential to their functional activity ; but it will also tend to check the re- moval, by oxygenation, of those products of decomposition whose continuance in the blood is attended with most senous injury to the system. In so far, in fact, as the presence of al- cohol in the circulating current tends to give to arterial blood a venous character, it must thereby impair its power of serving as the excising fluid (for so we may term it) of the nervous and muscular battery. And this it does, in the first instance, by obstructing the elimination of Carbonic Acid, as will be shown hereafter (§ 118); but more remotely, by that interference with the proper functional activity of the Liver and Kidneys, which we have seen to be among the most ordinary con- sequences of the free and habitual use of Alcoholic liquors (§§ 54-58). 88. But although we are led by the preceding considerations to regard the regular employment of Alcoholic liquors as rather a detriment than an aid to the development of nervo-muscular power, there is a third point-towards which we have to direct our inquiry : nainelv, whether the peculiar stimulating effect d 2. 76 SUPPOSED USES OP ALCOHOL of Alcohol, which is especially exerted upon the Nervous system, may not enable a greater amount of nervous energy to be pro- duced, and a greater amount of muscular power to be thereby called forth, than could be generated without its aid. In con- sidering this question, it is most important to keep in view the difference between a temporary and a sustained effort. "We have seen that the usual effect of a moderate dose of Alcohol is, in the first instance, an increase in the forge and rapidity of the Circulation, and in the activity and energy of the functions of the Nervous system ; and both these conditions will be favor- able to the development of Muscular power, so long as they continue. But such a state cannot long endure. AVe may in- crease the amount of Nervous power developed in a given time, by the influence of Alcoholic stimulants ; or we may prolong its generation by the same kind of a-^i.-tanee, when it would otherwise have failed. But as every exertion of Nervous power, like that of Muscular, involves the death and decay of a certain amount of the tissue by which it is evolved, there is a limit to the possibility of its generation ; so that we find the continu- ance, or even the increase, of the stimulus ceasing after a while to produce any effect; and the exhausted power can only be recovered by a lengthened period of repose, which shall allow time and opportunity for the regenerating processes to be per- formed, at the expense of nutrient material drawn from the blood. Until this has been effectually accomplished, the Ner- vous power is at least as much below par as it previously was above it; so that the loss is certainly equivalent to the gain. And the more the Nervous system has been forced, by .the in- fluence of Alcoholic stimulants, to give forth its powers beyond their natura> limit, whether as to duration or intensitv, the greater will be the degree and duration of that subsequent de- pression which speaks so umuistakeably of the need of rest and reparation. 89. Hence, therefore, we should anticipate that, although the use of Alcoholic stimulants may enable a greater amount of physical force to be put forth within a given time, than could otherwise be generated, they can be of no assistance in the sus- tentation of nervo-muscular power ; and if the previous con- siderations be also taken into the account, we should be led to expect that, in the long run, severe bodily labor will be better borne without alcoholic stimulants than with them—provided always that the digestive apparatus be in good working order, and be adequate to prepare that amount of alimentary material IN SUSTAINING THE VITAL POWERS. "77 which is required for the regeneration of the tissues disin- tegrated by use. 90. We have now to inquire how far the results of practical experience are coincident with these theoretical views; and whether it is found, on actual trial, that complete abstinence from Alcoholic liquors is favorable, or the reverse, to the en- durance of severe bodily labor. It cannot be denied that the ideas current, among the laboring classes more especially, as to the teachings of experience on this point, are opposed to our theoretical deductions. But there are many circumstances which should lead us to mistrust the popular voice on such a question, and to seek for proofs of a kind that may be more firmly relied on. The " universal experience" of former gene- rations might be quoted in favor of a multitude of absurd no- tions, which we now treat as simply ridiculous; and when there is this additional complication, that the liking for alco- holic liquors is such as very readily to make " the wish father to the thought," we find an additional ground for suspicion. But the chief cause of our mistrust is this—that there is no ap- preciation in the popular mind, of the connection between the immediate and the remote effects of Alcoholic stimulants. A glass of malt liquor, or a small quantity of spirits, repeated three or four times a day, is found to increase the bodily vigor for a time; and this increase is set down as so much positive gain, no account being taken of the subsequent depression, which is considered as ordinary fatigue. Evidence of this kind is therefore of little or no value; and the only facts that can be admitted as having any weight, are those which bring into comparison the total amount of labor executed with and with- out the aid of fermented liquors, during lengthened periods of severe toil; these being the indications, not of the amount of force which may be temporarily set forth, but of that which can be habitually exerted; and therefore of the general vigor of the system, rather than of its power in a state of excitement, 91. It would be easy to cite several modern testimonies to the superiority of the Abstinence principle (to say nothing of the ancient ones,) from Benjamin Franklin down to Dr. Forbes ; —the former of whom tells us, in his Autobiography, that he was accustomed, when workiug as a Pressman in a London printing-house, and taking only bread and water instead of the porter which his companions drank (as they said) to acquire strength for their work, to carry a large form of letters in each hand up and down stairs, to the astonishment of his porter- 3 n. 78 SUPPOSED USES OP ALCOHOL drinking companions, who found one of them a sufficient load ; —whilst the latter assures us that in a recent excursion amidst the mountains and valleys of Switzerland, which were chiefly traversed on foot, he found his own " sexagenarian" vigor, sus- tained by cold water only, quite on a par with that of his younger companions, who indulged in a moderate allowance of wine.* Such examples, however, might be regarded as excep- tional, because individual; and as affording no contradiction of the supposed general result of experience. They prove, how- ever, that there is nothing positively incompatible in the habit of total abstinence from alcoholic liquors with the sustenauce of a high degree of nervo-muscular power. And it may be well to fortify this position with a few additional testimonies, relating to cases in which the power of endurance was very severely tried. 92. Thus, a nail-maker at (rlasgow assured the writer that, after five years experience of the* abstinence system, he " found hard work easier, and long hours more readily to be endured;" and that, being a member of the Fire Brigade, he was on one occasion called upon for continuous exertion for seventy-three hours, which he endured, with no other beverage than coffee and ginger-beer, while all his comrades were '• beat and fell away." The following statement, forwarded to the writer from Leeds, was signed by thirty-four men engaged in labor- ious employments ; out of whom twelve belonged to the class whose occupations are commonly regarded as peculiarly try- ing, seven of them being furnace-men at foundries and gas- works, two of them sawyers, one a whitesmith, one a glass- blower, and the last a railway guard. " We, the undersigned, having practised the principles of total abstinence from all in- toxicating liquors during periods ranging from one to ten years, and having, during that time, been engaged in very la- borious occupations, voluntarily testify that we are able toper- form our toil with greater ease and satisfaction to ourselves (and, we believe, more to the satisfaction of our employers also) than when we drank moderately of these liquors; our general health and circumstances have also been considerably im- proved."! With regard to harvest-work, again, which is extremely trying to the strength, both from the continuity of - the exertion required, and the "heat of the weather at the time of its performance, there is ample testimony that those who go * "Physician's Holiday," p. 26 and passim. f See Appendix B. in si'ST.uyixo run vital power-. 79 through it upon tho abstinence principle are better able fco sustain it than those who endeavor to support their strength upon fermented liquors; and that, if an adequate supply of nutritious food be provided for them, the former will even increase in weight, whilst going through this severe toil. In some parts of the county of Cornwall, where the i; abstinence system" is more extensively practiced than in any other county in England, it is the general practice to get in the harvests without any allowance of fermented liquors; many laborers who are habitually moderate drinkers feeling the benefit of tho " abstinence system" at such times. 93. The following example, drawn from another source, is of peculiar value, as showing the comparative effect of the two systems upon the same individuals. The writer was acquainted, some years since, with a gentleman wdio had been for some years at sea in the Merchant service, ami who not long pre- viously had commanded a vessel during a voyage from New South AY ales to England. After passing the Cape of Good Hope, the ship had sprung so bad a leak as to require the continued labor, not merely of the crew, but also of the officers and passengers, to keep her afloat during the remainder of her voyage, a period of nearly three months. At first, the men were greatly fatigued, at the termination of their " spell"'at the pumps; and, after drinking their allowance of grog, would " turn in," without taking a proper supply of nourishment. Tho consequence was, that their vigor was decidedly diminish- ing, and their feeling of fatigue increasing, as might be ex- pected on the principles already laid down. By the directions of their Commander (who, although very moderate in his own habits, at the time of the writer's acquaintance with him, was by no means a disciple of the Total Abstinence School, which renders his testimony more valuable), the allowance of grog was discontinued, and coffee and cocoa were substituted for it; a hot " mess " of these beverages being provided, with the bis- cuit and meat, at the conclusion of. every watch. It was then found that the men felt inclined for a good meal of the latter, when the more direct but less effective refreshment of the alcoholic, liquor was withdrawn; their vigor returned; their fatigue diminished; and, after twelve weeks of incessant and severe labor (with no interval longer than four hours), the ship was brought into port with all on board of her in as good condition as they ever were in their lives. 94. Numerous examples might be cited of comparative triah d 4. 80 SUPPOSED C6E9 OP ALCOnCL between two sets of laborers, as nearly as possible alike in other respects, but the one practicing Total Abstinence, whilst the other , has relied upon the assistance of Alcoholic liquors. So far as the writer is aware, all these contests have given results in favor of the abstinence system, when the period of the experi- ment has been sufficiently protracted to give its merits a fair trial; and, although it may be asserted that such results are one-sided, as having been made known to the public by the professed advocates of a system, yet, considering the very large interests involved in the maintenance of the existing state of things in regard to the usj of fermented liquors, it might be reasonably expected that their upholders would make known to the world any results of an opposite description, had they . really occurred. The following statement, furnished to the writer by a gentleman at Uxbridge, has the advantage of being the comparative return of the regular labor of a whole year, performed by two sets of men, the one working on the " abstinent," the other on the " moderate" system, but not pitted against each other in a contest for vietory. It relates to brick-making, which is commonly accounted one of the most laborious of all out-door employments. " Out of upwards of twenty-three millions of bricks made in 1841, by the largest maker in the neighborhood, the a\ erage per man made by the beer-drinkers in the season was 7GO.JO9; whilst the average for the teetotalers was 795,400, which is 35,131, in favor of the later. The highest number made by a beer-drinker was 880,000; the highest number made by a teetotaler was 890,000; leaving 10,000 in favor of the teetotaler. The lowest number made by a beer-drinker was 659,500; the lowest number made by a teetotaler was 746,000 ; leaving 87,000 in favor of the teetotaler. Satisfactory as the account appears, I believe it would have been much more so, if the tee- totalers could have obtained the whole ' gang' of abstainers ; as they were very frequently hindered by the drinking of some of the gang; and when the order is thus broken, the work cannot go on." 95. The experience of large bodies of men, which becomes matter of public notoriety, is in many respects preferable, as demonstrationg (to say the least) the perfect compatibility of Abstinence from alcoholic liquors with the highest deo-ree of physical vigor, and with the greatest power of endurance of bodily labor. Thus, almost every traveller who has visited Constantinople has been struck with the remarkable muscular IN SUSTAINING THH VITAL POWERS. 81 powers of the men engaged in the laborious out-door employ- ments of that city. Mr. W. Fairbaim, an eminent machine- maker at Manchester, remarked that " the boatmen or rowers to the caiques, who are perhaps the first rowers in the world, drink nothing but water; and they drink profusely during the hot months of summer. The boatmen aud water-carriers of Constantinople are decidedly, in my opinion, the finest men in Europe as regards their physical development, and they are all water-drinkers." * And several other observers bear testimony to the extraordinary strength of the porters of Constantinople, who are accustomed to carry loads far heavier than English porters would undertake, even under the stimulus of alcoholic beverages; yet these Turkish porters never drink anything stronger than coffee. 96. The following statement, made upon the authority of Mr. Tremenhere, one of the Commissioners employed to report on the state of the Mining population, shows how completely the doctrines of the reputedly u universal experience," in re- gard to the support afforded by Alcoholic liquors to the labo- rious artisan, are negatived by the results of a change of habit, forced upon those most unwilling to adopt it. " A remarkable and most satisfactory instance," says Mr. T., "of a successful attempt to put a check upon the indulgence of ardent spirits, has occurred at the iron-works of Messrs. Houldsworth of Coltness, employing about eight hundred colliers, miners, fur- nace-men, &c. Much loss and annoyance had frequently been occasioned by the negligence or wilful misconduct of workmen under the influence of this habit; and the Messrs. Houldsworth, having in vain endeavored to put an end to it by persuasion and advice, resolved to do what they could by removing the temptation. They accordingly, about three years ago, forbade the sale of spirits at the store, and at the inn at their works, and ordered that the furnace-men should not be allowed to drink spirits during their hours of labour. These men had been accustomed to drink four or five glasses of whisky during each 'shift,' in addition to what they chose to drink at their own homes. They remonstrated strongly, and affirmed that it was impossible for them to do their work without this quantity of whisky. They were not long, however, before they found their error; they now drink nothing but water during their work, and tea and coffee at their m,eals; what they spent on * Sanitary Report, 1840, p. 252. n 5 . 82 StKTOSED fSES OP ALCOHOL whisky they now spend in wholesome or nutritious food; they allow that they do their work better, and that the change has been a great blessing to themselves and their families; and that it is the best thing that ever happened to them. 1 was after- wards informed that, among the colliers and miners, there was a marked improvement from the same cause. " 97. The experiment has now been carried on upon a still larger scale, for many years, amongst the seamen of the Aler- chant service, both of this country and the United States; and .the result has been, with few exceptions, so favourable to the Abstinence principle, that it is now adopted by a very large proportion of American trading vessels ; to whose general supe- riority in equipment and management over the mercantile ma- rine of this country, in the greater part of which the employ- ment of alcoholic liquors is still continued, a large body of evi- dence was recently given before a Committee of the House of Commons. The exceptions just alluded to relate to the reput- ed liability of "temperance" seamen to suffer from endemic or malarious diseases. Into this point we shall enquire under a subsequent head; and the writer thinks that it will there ap- pear that this liability, if it really exist, results from the defici- ency of any measures that shall serve as a substitute for the alcoholic stimulus, in rendering the system less obnoxious to the influence of the poisonous emanations to which it is exposed. (§§ 145-147.) 98. The writer has had the opportunity of ascertaining from Ship-owners who have adopted the "temperance" system (which on board ship, is equivalent to "total abstinence"—no other alcoholic liquor being substituted for spirits.) that they have found no difficulty in obtaining the services of excellent seamen, when a fair compensation is made in the superior qua- lity of the provisions and allowances, or in the rate of wa^es, for the "stopping of the grog." In fact, such ships are in po- sitiverequest among seamen of the best character; proving that in spite of the well-known attachment of their class to spirituous liquors, they are sensible of the advantages of ha- bitual abstinence from them. The writer, having himself made a voyage to the West Indies and back, some years since, in a " temperance ship," had the opportunity of remarking' that, during a heavy gale of nearly three davs' duration, which was continually taxing to the uttermost the strength of a crew far too small for the size of the ship, the men were at least as ready for the renewal of their exertions as they would have IN BUSTAtNlNG THE VITAL POWERS. 81 b^een if supported by alcoholic stimulants; whilst in various rowing-matches which took place between tiiem and the crews of other ships, whilst lying in port, they were generally the victors. This last fact is not cited as proving ihe superiority of the abstinence svst* m, since the difference might be attributed to the superior physical power of the crew ; but it sufficiently indicates that there is in the " abstinence system" nothing un- favorable to the maintenance of that power during the vicissi- tudes of a seaman's life. 99. The following extract from a private letter from a Cap- tain in the Merchant service, contained in the "Adviser" for October, 1849, gives a valuable testimony in favor of this con- clusion : "I harbored in Newfoundland on the 23d of Decem- ber last, the coldest day that had been registered there for the last six years, the thermometer on shore indicating twenty de- grees below Zero. I can honestly say, it was the most severe frost I ever was in on the water, during the twenty-nine years that I have been employed in the Newfoundland trade. I re- mained on shore from the time mentioned above until the 2d of March, and then embarked for Brazil, where, in April, we had the thermometer ranging from 80° to 87°, and remained in that climate till the middle of July. All that time, the whole of my crew, with two exceptions, were strictly teetotal, and all able to eat their allowance, and do their share of hard work, in the sun and out of it, taking in and out cargo. The two ex- ceptions did, in one solitary instance, infringe the law ; and they paid the penalty in severe headache and debility for some days." 100. It is rare for any occasion to present itself, during the march of an army, of testing the power of sustaining this kind of prolonged exertion, without the supposed assistance derived from the use of alcoholic liquors ; but opportunities of this kind have occurred, the abstinence having been in some instances voluntary, whilst in others it was compulsory ; and the results have in both cases been most completely confirmatory of the principles formerly laid down. Two of the most striking ex- amples of this kind within the writer's knowdcdge, will be men- tioned hereafter under the head of " Endurance of Heat " (££ 140, 141); these marches having been performed under an elevation of temperature which - rendered them peculiarly trying. And he will here confine himself to the mention of the fact that, during Sir John Moor's retreat to Corunna, the army was found to improve in health and vigor, as soon as ths n 6. 84 aCPPOSED USES op aloohol usual allowance of spirits was unattainable. This fact is the more remarkable, as the circumstances under which this march was performed must have been peculiarly depressing to the feel- ings of the men, and could not but have operated unfavorably (according to the invariable experience of retreating armies) upon their physicial powers. 101. The experience of whole nations, previously to the in- troduction ' of Alcoholic liquors amongst them, is equally in favor of the assertion, that prolonged and severe muscular ex- ertion may be at least as well borne without their assistance as with it. Where, for example, shall we meet with greater power of endurance of toil than was displayed by the North American Indians in "following a trail," before their race became deter- iorated by European vices ? 102. The question, it may again be remarked in conclusion, is not to be decided by the amount of strength which may be put forth at a single effort. It may be freely admitted that when the body is exhausted by fatigue, an Alcoholic stimulus, which excites the Nervous system to increased exertion, may impart a temporary strength, which shall enable the next effort to be successful in doing that which could not have been accom- plished without it. But there is reason to believe that the power of sustained exertion is thereby impaired ; and that those who have habitual recourse to this stimulus are really doing themselves more harm than good. This will be most assuredly the case, when they allow it to take the place of the solid food, which their nervous and muscular systems require for their re- generation ; and the tendency of the habitual employment of alcoholic liquors, when the body has been fatigued with severe and prolonged muscular exertion, is generally to diminish rather than to increase the desire for solid aliment, as the ex- amples above quoted clearly indicate. And as it is the latter alone that can afford real and permanent support, it is obvious that any habit which diminishes the natural disposition to profit by it, must be positively injurious in its influence upon the bodily vigor. II. endurance of mental exertion. 103. All that has been said of the influence of Alcoholic liquors on the development and sustentation of Physicial force, will equally apply to Mental power ; since, whatever may be our views as tc the relation between Mind and Matter it is not now questioned by any Physiologist, that the Brain is the instru- ment by which all mental power is exercised, in Man's present hm 6UB1A1jni.no TUB VITAL POWERS. 86 state ef existence, and that tho continued development of this power is consequently dependent upon those conditions which are favorable to the maintenance of the functional activity of the Nervous system in general. These conditions we have seen to be (I)—The healthy nutrition of the nervous substance ; and (II)—The due supply of highly oxygenated and depurated blood. The former process is certainly not dependent upon the assistance of alcoholic liquors ; and from the considerations already urged (§87), it seems in the highest degree improbable that they can be of the least advantage to it. The latter can- not, in any degree, be improved, but must be rather impaired, by the use of fermented liquors ; which, as already stated, tends to deteriorate the quality of the blood, and to obstruct its oxygenation. 104. That the use of Alcoholic stimulants, however, is atten- ded in most persons with a temporary excitation of mental ac- tivity, lighting up the scintillations of genius into a brilliant flame, or assisting in the prolongation of mental effort when the powers of the nervous system would otherwise be exhausted, may be freely conceded ; and it is upon such evidence as this that the common idea is based, that it supports the system un- der the endurance of mental labor. This idea, however, is probably as erroneous as the no less prevalent fallacy of regar- ding alcoholic liquors as capable of increasing the power of physical exertion. No physiological fact is better established than that of the depression of the mental energy consequent upon the undue excitement of it, by whatever causes that ex- citement may have been occasioned; and the rapid and brilliant flow of thought which may have been called forth by the alco- holic stimulants gives place, usually after a few hours, to the opposite state of languor and despondency. 105. The influence of Alcoholic stimulants seems to be chiefly exerted in exciting the activity of the creating and combining lowers ; such as gives rise to poetical imaginations, to artistic conceptions, or to the sallies of w it or humor. It is not to be wondered at, then, that men possessing such powers should have recourse to alcoholic stimulants as a means of procuring a tem- Dorary exaltation of them ; and of escaping from the fits of de- pression to which most persons are subject in whom the imagi- native and emotional tendencies are predominant. Nor is it to be denied that many of those mental productions which are most strongly marked by the inspiration of genius have ken thrown off under the stimulating influence of alcoholic liquors. 86 suiToeE'D uses o* a&ooifo*. But, on tho other hand, it cannot be doubted that the depression consequent upon the high degree of mental excitement which is* thus produced, is peculiarly great in such individuals, complete- ly destroying for a time the power of mental effort; and hence it does not at all follow that either the authors of the produc- tions in question, or the world at large, have really benefitted thereby. Moreover, it is the testimony of general experience, that where men of genius have habitually had recourse to alco- holic stimulants for the excitement of their powers, they have died at an" early age, as if in consequence of the premature ex: haustion of their nervous energy ; Mozart, Burns, and Byron may be cited as remarkable examples of this result. Hence, although their light may have burned with a brighter glow, like a combustible substance in an atmosphere of Oxygen, the consumption of material is more rapid; and though it may have shone with a soberer lustre without such aid, we cannot but believe that it would have been steadier and less premature- ly quenched. 106. We do not usually find that the men most distinguished for that combination of intellectual powers wdiieh is known as talent, are disposed to make use of Alcoholic stimulants for the purpose of augmenting their mental powers; for that sponta- neous activity of the mind itself, which it is the tendency of alcohol to excite, is not favorable to the exercise of the observing and purely reasoning faculties, or to the steady devoteiner.t cf concentrated attention to any subject which it is desired to in- vestigate profoundly. Of this we have a remarkable illustration in the habits of practiced gamblers; who, when about to en- gage in contests requiring the keenest observation and the most sagacious calculations, and involving an important stake, always "keep themselves cool," either by entire abstinence from fer- mented liquors, or by the use of tliose of the weakest kind in very small quantities. And we find that the greatest part of that intellectual labour which has most extended the domain of human knowledge, has been performed by men of remarkable sobriety of habit, many of them having been constant water- drinkers. Under this last category, it is said,* mav be ranked Demosthenes and Haller; Dr. Johnson, in the latter part of his life, took nothing stronger than tea, while Voltaire -and Fontenelle used coffee ; and Newton and Hobbes were ac- customed to solace, not to excite, themselves with the fumes of * Macnish's Anatomy of Drunkenness, p. 86. IN SUSTAINING TOE VITAL POWERS. 87 tobacco. In regard to Locke, whose long life was devoted to constant intellectual labor, and who appears, independently of his eminence in his special objects of pursuit, to have been one of the best-informed men of his time, the following very explicit and remarkable testimony is borne by one who knew him well. " His diet was the same as other people's, except that he usually drank nothing but water ; and he thought that his abstinence in this respect had preserved his life so long, although his constitution was so weak."* 107. Having, for several years past, been himself performing an amount of steady mental labor, which to most persons would appear excessive, the writer may be allowed to refer to his own experience, which is altogether in favor of Total Abstinence from alcoholic liquors, as a means 3 blood in the condition of lactio acid, the detection of which is attended with some uncertainty. But it has been sufficiently proved that when the saccharine ingredients of the food are unusually abundant, they enter as such into the blood, where they may be detected shortly after a meal, especially if that meal have been preceded by a long fast. Like the superfluous fatty matters, however, they soon disappear ; being.carried off, there can be little doubt, by the respiratory process. 115. In this manner, then, the Heat-producing materials are usually supplied to the system from meal to meal; the greater part of them being destined for elimination from the blood within a short time after their admission into it; and the powrer of sustaining heat existing in its greatest vigor, only wdiilst some of them remain unconsumed. This inference is confirmed by ordinary experience; for every one knows how much more severely Cold is felt after a fast of some hours' duration, than after a full meal. "We are accustomed to refer the difference to the condition of the stomach; but the stomach may have been emptied by the completion of the digestive process long before the increasd susceptibility to cold commences; so that it would be more correct to refer this increase to the exhaustion of the supply of combustive material last introduced into the blood, than to the vacuity of the stomach. That an increase in the power of maintaining heat should be almost immediately produced after the ingestion of food iuto the stomach, is to be accounted for, not merely by that augmented activity and energy of the general circulation which accompany the digestive process, but also by the rapidity with which nutrient matters find their way into the blood, the turbidity of the serum, con- sequent upon the introduction of fatty substances, having been observed as early as half an hour after the meal of which they have formed part.* 110. The admission of these matters into the current of the circulation cannot be discovered to produce any effect upon the system in general, otherwise than by sustaining the tempera- ture of the body. In fact, they seem to be the legitimate pabulum for the combustive process^ust as albuminous matters constitute the pabulum for the formative processes whereby the tissues are generated. When they are present in excess, the tuperfluity is withdrawn by the production of adipose tissue ; * See, for the experiments on which several of the foregoing state- ments are founded, ths pa; . r of J>::-. Buchanan and R. D. Thompson, in the Medical Gazette, Oct. 10th, 1815. 94 surroeuu lwks of alcohol which stores up the fatty matters for future use. When, on the other hand, the supply is not equivalent to the consumption required for the maintenance of the heat of the body, the fatty matters which are among the-normal constituents of the blood are first drawn upon ; and as the proportion of these is dhnh). ished, it is supplied from the contents of the cells of adipose tissue. In this manner, the animal temperature is kept up nearly to its usual standard, even in spite of the total depriva- tion of food, so long as unconsumed fatty matter remains in the body; but death then speedily takes place in consequence of the cooling of the body, unless the temperature be sustainedby external warmth. And death may result also from the sub- jection of the body to a very low temperature, whilst there is still much fatty matter left in the tissues ; as if this matter could not be re-introduced into the circulating current with suf- ficient rapidity to supply the demand for an extraordinary quan- tity of heat-producing pabulum. Further, when the store of fatty matter has been entirely exhausted, and the animal has nothing whatever to fall back upon, it is requisite that the sup- plies of new material introduced into the system should suffer no intermission; for, immediately that they are exhausted, the temperature of the body begins to fall, and death speedily su- pervenes unless a fresh supply be afforded.* 117. We are now prepared, then, to inquire into the ques- tion, how far alcohol may be advantageously employed habitually as a hea,t-producing material ; and whether there are any pecu- liar or extraordinary circumstances under which it is to be pre- ferred to others. And as one means of arriving at the truth on this point, we must examine more particularly into the in- fluence of the introduction of alcohol into the blood, upon the respiratory process. For our knowledge upon this point, we are chiefly indebted to the experiments of Dr. Prout and to Vierordt. The former states, t that Alcohol, and all- liquors containing it, which he had tried, have the remarkable power of diminishing the quantity of carbonic acid gas in the expired air much more than anything else which he had made the sub- ject of experiment ; this effect being most decided when the liquor was taken upon an empty stomach. The latter J fully *For the experiments on which the foregoing statements ar'e founded, see the work of M. Chossat, entitled " Recherches sur J Inanition. f Annals of Philosophy, vols. ii. and iv. X Phyeiologfe dee Athmens, hmen, also without spirituous liquors, who wintered in the same bay, the whole sur\'ived and returned to Eng- land ; and four Russians left without ardent spirits or provisions, in Spitzbergen, lived for a period of six years, and were at length restored to their country. In the winter of 1796, a \-essil was wrecked on an island off the coast of Massachusetts; there were seven persons on board; it was night; five of them resolved to quit the wreck, and Beek shelter on shore. To prepare for the attempt, four of them drank freely of spirits; the fifth Avould drink none. They all leaped into the water; one was drowned before he reached the shore; the other four came to land, and in a deep snow and piercing cold, directed their course to a distant light. All that drank spirits failed, and stop ped, and froze, one after another; the man that drank none reached the house and about two years ago was still alive"—(p. 374.) The evidence of Captain (now the Rev. Dr.) Scoresby, who was for many £Tnf tCl ? °! a wJ}alinS shiP-is Precisely to the same effect with TT *JL* * tit* a*^el!?r8 whose t^^ony has been already cited. dimSVa^d ^fcfe^^SXl "" ^^ M jjjjg*. power of sustaiSrcoH l^JTSXTT^Z IN SUSTAINING THE VITAL POAVEKS. 103 tageous for the purpose of enabling the body to resist Cold, will be considered in the succeeding chapter (§§ 182-18*7). IV. ENDURANCE OF HEAT. 12*7. Having thus concluded our inquiry how far the use of" Alcoholic liquors is necessary or desirable for aiming the body against the depressing effects of cold, we shall consider their agency in supporting the system under the enervating influence of extreme Heat The belief in the existence of such an agency is scarcely less strongly or generally entertained than that of their protective power against cold; but it must be manifestly due, if it exist, to some modus operandi different from that which renders them serviceable in the opposite condition. For it cannot be imagined that they can be of any service by afford- ing pabulum for the combustive process, when that process is already generating more heat than the body, exposed to a high external temperature, can possibly need. Nor can it be sup- posed that the loss of the watery portion of the blood, by the perspiratory process, can be in any degree repaired by the in- gestion of alcoholic liquids. It must be presumed, then, that whatever energy their use may communicate to the body, must be derived from their stimulating properties; and must be subject to those disadvantages Avhich are inseparable from the habitual employment of stimulants. Each of these points, however, re- quires a fuller examination. It is well knoAvn to the Phy- siologist, that the Respiratory process in Avarm-blooded ani- mals is much less energetic at high temperatures than at low; the system having in itself the power of regulating the amount of matter which it shall burn off, in order that its heat may be kept up the proper standard. Thus it was ascertained by the experiments of Letellier,* that jthe amount of carbonic acid set free by Birds, when they are breathing in an atmosphere of from 86 ° to 106 ° Fahr., is scarcely naore than one-third of that which they generate in an atmosphere of 32°; and by similar experiments upon small, Mammalia, it Avas ascertained that they only give off, between 86 e and 10.6 °, about half as much carbonic acid, and between 59 ° and 68 ° about two-thirds as much, as they generate at 32 °. The experiments of Vierordtf upon his own person lead * Comntes Rendus, torn. xx. p. 795 ; and Ann. de Chim. et de Phye. torn. xiii. p. 478. f Op. cit, §§ 73-82. E 4. 104 SUPPOSED USES OF ALCOHOL to a similar conclusion in regard to Man ; although the differ- ence is not so great. For he states that the average amount of carbonic acid exhaled by him per minute, between the tempera- tures of 24 ° and 47 ° Fahr., Avas 18| cubic inches ; Avhilst the average between the temperatures of 66 ° and 92 ° Avas but i.of cubic inches. It is obvious, then, that the demand for combustive material at high temperatures must be compar- atively small ; and that the residents in hot countries cannot require the same supply of heat-producing aliment as is needed by the inhabitants of the frigid zone. We see this indicated in the quality of the non-azotized material Avhich Nature has pro- vided for their use ; for, Avhilst the dwellers axiid the Arctic and Antarctic seas derive their chief sustenance from those oleaginous articles which have the greatest heat-producing power, the vast population of the Equatorial region derives its princi- pal support from those farinaceous vegetable products whose non-azotized portion, belonging to the saccharine class, has the lowest calorific agency (§111). 128. It is very necessary, however, to bear in mind that the Respiratory process is not of simple calorification ; for it is one of the most important of all those excretory operations Avhere- by the waste or effete matter of the system is eliminated from the blood. This, in fact, may be regarded as the essential par- of the function, which is common to all animals ; the combus- tion of an additional amount of hydrocarbonaceous matter, for the purpose of maintaining the temperature of the body at a fixed standard, being peculiar to the warm-blooded classes. It is evident, then, that from the diminution of the total quantity of carbonic acid exhaled at bight temperatures, the excretory part of the respiratory function will be more liable, than at low or moderate temperatures, to interference from any agency 'which still further checks, the oxygenation of the combustible matter of the blood. 129. Noav, as we have found that, under exposure to sew re Cold, the stimulating effects of Alcoholic liquors (especially when taken at intervals, in small quantities at a time), are but little felt, the alcohol being burned off before it can accumulate so as to exert any considerable influence on the Nervous sa's- tem ;—so might we expect that, under the influence of external Heat, Avhen the combustive process is greatly reduced in activity, the stimulant effects of alcohol should be n.ore rapidly produced and more powerfully exerted. And further, if the views formerly stated be correct, as to the effects of the absorption IN SUSTAINING TIIE VITAL TOWERS. 105 of alcohol into the blood in preventing the elimination of mat- ters which ought to be carried off by the respiratory process, Ave should expect that the use of alcoholic liquors in warm cli- mates Avould exert this obstructive influence in a peculiar de- gree.—Both these anticipations are confirmed by ample expe- rience, Avhich thus bears testimony to the soundness of our prin- ciples ; for it is Avell knoAvn that a for smaller quantity of alcoholic liquor suffices to produce intoxication beneath a burning sun than in a frosty atmosphere ; so that individuals Avho are not aware of this fact sometimes become intoxicated, Avithont having exceeded the allowance A\diich they believe to be perfectly com- patible with sobriety. Again, it has been continually observed that, Avhen Alcoholic liquors are taken during the performance of severe labor in an extremely high temperature, their tempor- ary stimulation is followed by a very rapid and decided failure both of nervous and muscular power ; so that men Avho drink largely of such liquors in the intervals of their Avork, are obliged to abstain from them Avhilst their labor is in progress. This result appears fairly' attributable to vitiation of the circulating blood, consequent upon the retention of matters destined for ex- cretion ; the removal of which, by the oxygenating process, has been obstructed by the presence of alcohol. And the same in- ference appears legitimately deducible from the peculiar ten- dency (already referred to, §§ 54,55) Avhich the habitual use of alcoholic liquors in warm climates ha? to engender diseases of the Liver ; the duty of separating those hydro-carbonaceous products of the Avaste of the system, Avhich are poisonous if re- tained in the blood, being unduly throAvn upon the liver, when their elimination by the lungs is interfered with. 130. That the use of Alcohol is especially necessary to support the system undor its excessive loss by Perspiration at high temperatures, is an idea so commonly held, that it demands a serious refutation ; although the fallacy of the notion that, because water is drawn off from the blood through the pores of the skin, alcohol must be taken into the stomach to" replace it, would appear self-evident. The fundamental error seems to lie in the notion that copious perspiration in itself really Aveak- ens the system ; whilst it is, in fact, nothing else than the means by Avhich the external Avarmth is prevented from raising the heat of the body aboVe its- normal standard. The determination of the blood to the skin, which that heat excites, appears to cause an unusual transudation of the Avatery part of the blood through the thiu-walled capillaries of the sweat-glands ; just as certain e 5 106 SUPPOSED USES OF ALCOHOL diuretic medicines increase the quantity of water in the urine, by causing an increased determination of blood to the kidneys; but with this large amount of watery fluid, very little solid matter passes off—none, in fact, but what is purely excremen- titious. 131. That Perspiration, however abundant, has in itself no weakening effect—except by diminishing the quantity of water in the blood (which is readily supplied by absorption from the stomach)—appears from the fact that, if persons exposed to a very high temperature make no bodily exertion, they do not ex- perience any loss of vigor, if copiously supplied with cold Avater. In fact, such exposure may be made to conduce very decidedly to the invigoration of the system. All travellers who have tried the Russian baths, speak of the feelings of renovation which the copious perspiration, and the subsequent plunge into cold water, produce in the wearied frame. And those who have given a fair trial to the Hydropathic treatment, in appropriate cases, are unanimous in the same testimony. The Avriter has himself been in a stove-room, in which delicate females Avere accustomed to remain for half an hour or more, Avhen it Avas heated to a temperature of from 140 ~ to 170 ° Fahr.; their Avrappings be- coming saturated by copious perspiration, the material for which Avas supplied by the water administered to them internally from time to time ; and he has had ample assurance to the effect that this process, Avhen followed by the cold plunge, had usually an invigorating influence, Avhich quite sets aside the idea that the act of perspiration is in itself exhausting, or that it removes from the system anything Avhich it can be requisite for alcohol to supply. 132. The peculiar fatigue Avhich usually results from mus- cular exertion at a high temperature is generally set down as the consequence of the excessive perspiration ; although the fact is that the fatigue is chiefly to be attributed to the inter- ference with the vaporous or " insensible " transpiration, which is produced by .the accumulation of liquid or "sensible" perspira- tion on the surface of the skin, and "by the saturation of the garments in contact Avith it. For the same fatigue is experien- ced Avhen the atmosphere is loaded with dampness, even at a low temperature ; and it has been the uniform result of the at- tempt to use any muscular effort, when the body has been clothed in water-proof garments made after the fashion of ordin- ary clothes, so as not only to keep out the rain, but to keep in the insensible perspiration. In either case the effect is the same; IN SUSTAINING THE VITALPOWEBS. IftJ the due vaporization of fluid at tho surface of the skin Is checked; the cooling influence of the perspiration is not exerted; and the heat of the body itself is injuriously augmented.* And as an augumentation of from 11° to 13° in the temperature of a Avarm-blooded animal produces an invariably fatal result, so can it be readly understood that an increase of 2° or 3° must be attended with injurious consequences, so long as it lasts. 133. Among these consequences, we may probably rank a still further diminution in the quantity of carbonic acid exhaled from the lungs ; as well as an obstruction to the cutaneous respiration, Avhich, although its proportional amount has not yet been satisfactorily ascertained, is certainly of no mean im- portance in the depuration of the blood. Hence, an accumula- tion of excrementitious matters will take place in the circulating fluid, such as affords quite a sufficient explanation of the pecu- liar fatigue which is experienced when muscular exertion is called for in a heated atmosphere already charged with mois- ture, And Ave should expect that such exertion could be per- formed with much less feeling of exhaustion in an atmosphere of dry air, though of very high temperature—such as that of glass-houses, gas works, or foundries—than in the less heated atmosphere of tropical countries, which usually contains a con- siderable amount of watery vapor. This is undoubtedly the fact ; and, as a far larger amount of liquid Avill be carried off by insensible transpiration in the former case than in the latter' it proves the correctness of our position, that it is not the loss of liquid from the skin Avhich is the cause of the peculiar exhaus- tion that results from muscular exertion in a heated atmos- phere ;f and that we are to look for the source of that exhaus- tion in the elevation of the temperature of the body itself, which will be produced Avith peculiar facility in a damp and heated * Thus, it Avas found by -AIM. Delaroche and Berger that, whenani- mals were exposed to the temperature of 120°, their bodies being en- yeloped in close boxes, whilst their heads were free, a thermometer placed in the mouth showed an increase of 6° in the heat of the body, in the course of seventeen minutes; this elevation being obviously due to the obstruction to the transpiration from the surface of the body. When by continued exposure to a heated atmosphere saturated with mois- ture, the temperature of the body was raised from 11° to 13° above the natural standard, the animals uniformly died. \ We are of course supposing, throughout, that water is freely sup- plied in both cases. The exhaustion produced by the undue diminution of the fluids of the body, indicated by excessive thirst, is of quite- a dif- ferent character. 108 SUPPOSED USES OF ALCOHOL atmosphere ; and in the accumulation of excrementitious mat- ters in the blood, which will be especially likely to take place when their elimination through the lungs is being checked, at the same time that an increased amount is being generated by the waste of the muscular tissues. 134. If, then, our foundamental positions have been just, and our argument correct, we should infer that, putting aside their peculiar influence upon the nervous system, the use of Alcoholic liquors during the muscular exertion in a heated atmosphere, and especially when that atmosphere is charged with moisture, can be nothing else than injurious; as tending to interfere still more Avith that elimination of excrementitioua matters from the the blocd Avhich is peculiarly required Avhen a continual production of such matters is taking place through the disintegration of the nervous and muscular tissues conse- quent upon their functional activity, and which is already retarded by the diminution in the activity of respiration. We shall presently find that experience is here also in accordance with theory ; the result of many trials having shown that severe and long-continued exertion in tropical climates' can be better sustained without alcoholic liquors than with their habitual use. 135. The stimulative effects, from Avhich Alcoholic liquors derive their reputation as supporters of bodily vigor, during habitual exposure to a heated atmosphere, are exerted in two ways ; in the first place, by giving temporary assistance to the digestive process; and secondly, by increasing, for a time, the nervous and muscular power. It is commonly supposed that the diminution of appetite Avhich is experienced bv most per- sons Avho change their residence from a temperate country to a hot one is the result of the enervating influence of the climate ; whereas the fact is evident to those Avho take into account the proportionally smaller amount of carbonic acid exhaled as the external temperature rises, that the diminished appetite chiefly results from dimunitionin the demand for com- bustive material ; and that it ought, therefore, to be taken as an indication of the propriety of lessening' the amount of food ingested, rather than of forcing the stomach to auhes, Avho find the " cup of cold water" more refreshing and sustaining than the spirituous drinks which' hurry so many of their comrades to an early grave; and by numbers of men and Avomen, in every rank of life, in every variety of condition, and subjected to every kind of mental and' bodily exertion, who have given the principle of Total Absti- nence a fair trial, and have borne their willing testimony to its beneficia results. And where such is the case, there can scarcely be a question that this system is preferable to th* IN SUSTAINING THE VITAL POWERS. 119 habitual use, however moderate, of fermented liquors. For, if the appetite prompt to the use of an adequate amount of nourishment to repair the waste of the system ; if the stomach perform its action wdth due energy, and supply to the absorbent vessel^ the material for fresh blood in a state of due prepara- tion ; if the circulation be carried on with that equable regu- larity which is most favorable to the actions to-which it is sub- servient ; if the various tissues draw from the current of nutri- tious fluid the materials which they severally require, and apply these materials to their own maintenance and regeneration ; if the lungs freely exhale the carbonic acid Avhich is evolved by their exercise, and introduce the oxygen Avhich is needed for a renewal of the effort; and if the liver, kidneys, and skin,-by the constant discharge of their respective offices, eliminate from the blood the other products of the waste of the system, and thus; keep it in the state of purity most favorable to the discharge of its multitudinous functions ;—in a word, if all the actions con- cerned in the maintenance of the fabric be already discharged' with that vigor and uniformity which constitute health, why should Ave attempt to alter them by means of agents, which, if they produce any effect whatever on the system, can only ope- rate by producing a departure from that perfect balance of the several parts of the nutritive functions Avhich it is so desirable to maintain, and so difficult to restore when perverted ? Let us examine these questions in more detail. VI. CONSEQUENCES OF THE HAniTUAL " MODERATE " USE OF ALCOHOLIC LIQUORS. 152. Effect upon the General System and Excretory Organs. —If the natural appetite be already good enough to give a relish to the food Avhich the system requires, can the artificial production of an increased appetite be necessary or desirable ? And if the stomach be already capable of digesting and pre- paring as much nutriment as is required to keep up the solids of the blood to their proper amount, can any but prejudicial consequences result from forcing it to dispose of more ? Two classes of evils may be expected to proceed from such a system ; in the first place, the habitual introduction of more alimentary material into the circulating current than the nutritive functions can appropriate, must predispose to disorder of the system in general; and secondly, by constant reliance upon an artificial stimulus, the natural poAvers of the stomach itself must be in danger of becoming gradually impaired. 120 SUPPOSED USES OF ALCOHOL 153. The effect upon the system at large of an habitual in- troduction of more alimentary material than the nutritive func- tions can appropriate seems to vary Avith the temperament. In some individuals, they are converted into blood, so that the normal amount of that liquid undergoes an augmentation; thereby inducing a state of plethora, Avhich is favorable to local congestions and inflammatory diseases of various organs, and which especially predisposes to hemorrhage—this being an ef- fort of nature to relieve the undue turgescence. But in other constitutions, the superfluous aliment Avould seem to be never so far vitalized and assimilated, but is from the first destined to excretion; the lungs, the liver, the kidney, and the skin are thus called upon to remove, not merely the products of the normal waste or disintegration of the sysem, but also the superfluous non-assimilated matter ; and hence they are brought into a state of undue functional activity, which cannot but render them peculiarly susceptible of derange- ment. The excretory action of the lungs, liOAvever, is chiefly regulated (as already shoAvn § 127) by the temperature; so that, Avhen it is diminished by external warmth, more remains to be accomplished by the other depurating organs ; and hence any excess in diet is more likely to have a prejudicial effect upon the latter in warm climates, and during the summer, than in a colder atmosphere. 154. This is precisely Avhat experience teaehes. From habit- ual excess in diet, in temperate climates, in persons not of the sanguineous temperament, disorders both of the Liver and Kidney are very apt to arise ; those being most liable to the former who have not the poAver of generating fatty tissue at the expense of the surplus of non-azotized food ; and those being most liable to the latter, in Avhom the too free use of alcoholic hquors occasions an undue determination of blood to the Kid- neys. On the other hand, habitual excess of food in warm cli- mates usually manifests itself first in disorders of the Liver; since the diminished excretion of carbon by the lun^s causes the blood to proceed to the liver more highly charged with that element whilst at the same time the consumption of that part of the biliary secretion which should be norm ally oxy- genated and carried off through the lungs, is interfered with. On the other hand, the Skin, whose functions are oreatly in- creased m activity, comes to the as^tance of the Kidneys in disposing of the superfluity of azotized aliment; a considerable amount of urea being daily excreted through the former chan- IN SUSTAINING THE VITAL POAVLRS. 1*21 nel* This result of what is accounted the "moderate" use of alcoholic liquors in Avafm climates, for the purpose of increasing the appetite and stimulatin..- the digestive powers of the stomach, is much dwelt upon by Avriters on tropical- diseases; Avho represent it as, in the long run, not less hurtful than that excess Avhich produces effects more immediately and obviously pernicious. In this point of view, it ranks Avith high-seasoned dishes, and those other seducing provocatives to the diminished", appetite and lessened digestive powers of the residents in such climates, Avhich, by occasioning the habitual ingestion of more, food than the system requires, are among the most fertile sources of tropical disease. 155. Now, as already remarked, almost CA-ery cause of dis- . ease acts on the human system with greater potency in tropical than in temperate regions; and avc have opportunities, there' fore, in the study of tropical diseases, of perceiving the agency of causes Avhose tardiness of operation under other circumstan- ces interferes wdth our recognition of their real results. It- cannot, then, be imagined that even a small habitual excess in1 diet, induced by the stimulating action of fermented- liquors, can be without its remote consequences up6n tile general. system ; evren though it may be for a time sufficiently compen- sated by increased activity of the excreting organs. And the disorders of the Liver and Kidneys which are so frequent among those Avho have been accustomed to this mode of living for many years, Avithout (as they belieA'e) any injurious conse- quences, are as surely to be set down to it as are those conges-. tive and inflammatory diseases of the abdominal viscera which" so much more speedily follow upon habitual excess in warm climates. For the excreting organs cannot be always kept in a condition of excessive activity ; like other parts of the system, r they suffer sooner or later from too great an exaltation of their function ; and if this should not pass, as it often does, into an inflamniatofy, condition, it is almost certain to be remotely followed by a state of depressed activity, in which the nutrition' of the organ becomes impaired, so that it is left, during the remainder of life, in a state by no means ecpial to the perform- ance of its regular duties. 150. In asserting that to the, ordinary use of fermented liquors in "moderate" quantity, during early and middle life, * Sea the experiments of Dr. Landerer of Athens, in Brit. an;i For. Med. Chir. Review, vol. i. p. 541. r 1. 122 SUPPOSED USES OF ALCOHOL and to the habitual excess in diet (however slight) fo which they prompt, we are to attribute many of the chronic disorders of the excreting organs which are amongst the most common ailments of advancing years, we may seem to go beyond the positive teachings of experience. The consequences are so re- mote, that Ave may not appear to be justified in attributing them to the causes we haA'e assigned. But let it be remembered that Ave have multitudes of other cases, in Avhich the long-con- tinued agency of morbific causes of comparatively Ioav intensity has been proved to be in the end not less potent than the administration of a poison in a dose large enough to produce its obviously and immediately injurious effects. Thus, a man Avho would be rapidly suffocated by immersion in an atmosphere of carbonic acid may live for weeks, months, or years in an atmosphere slightly contaminated by it, Avithout experiencing any evil effects which he can distinctly connect with its influ- ence ; and yet Avho will now deny that the constant action of this minute dose of aerial poison is insidiously undermining his vital poAvers, and preparing him to become the easy prey of the destroying pestilence? So again, we see that a brief exposure to the pestilential atmosphere of the SAvamps of the Guinea coast is often sufficient to induce an attack of the most rapidly fatal forms of tropical fever; but the dweller among the marshy lands of temperate climates, inhaling the paludal poison in its less concentrated form, becomes after a time afflicted with intermittent fever ; and no one has any hesitation in here re- cognizing the connection of cause and effect. On the other hand, the resident in a toAvn, where the insufficiency of the drainage causes the surface-moisture to be imperfectly carried off, and to be not merely charged Avith the malaria of vegetable decomposition, but with the miasmatic emanations of animal putrescence, may long be free from serious disorder, if the cause do not operate in sufficient intensity ; yet he becomes liable in a greatly increased degree to the operation of almost every morbific agent, and especially of the various forms of fever- poison ; and no one who has paid even a slight degree of atten- tion to the results of the sanitary inquiries which have now been carried on for many years past, hesitates in admitting the relation of cause and effect between insufficiency of drainage and the higher rate of mortality in undrained localities, although not only days and weeks, but months and years, may be required for the operation of the cause upon the animal system. 15"7. Should Ave not then be running counter to all analogs IN SUSTAINING THE VITAL POAVERS. 123 if we do not hold ourselves ready to admit that such an habitual excess in diet as is favored by the moderate use of alcoholiG stimulants, and a consequent habitual over-exertion of the ex- cretory urgans, must be likely to have remotely injurious results \—and are avc not justified in assuming a relation of cause and effect to exist, Avhen we find such results occurring precisely as we should predict ? If the medical man has no hesitation in regarding those severer derangements of the ex- cretory organs Avhich are so common amongst those who com- mit habitual excesses in eating and drinking as the consequence of those excesses, Avhy should he refrain from attributing the milder but more protracted disorders of the same organs to the less violent but more enduring operation of the same cause ?— " The little I take does me no harm," is the common defence of tliose Avho are indisposed to abandon an agreeable habit, and Avho cannot plead a positive benefit derived from it; but, before such a statement can be justified, the individual who makes it ought to be endowed Avith tne gift of prophecy, and to be able- to have present to bis mind the Avhole future history of his bodily fabric, and to sIioav that, by reducing the amount of his excess to a measure which product's no immediately injurious- results, he has not merely postponed its evil consequences to a remote period, but has kept himself free from them altogether. The onus probandi lies Avith those who assume the absence of a connection Avhich is indicated by every fact Avith Avhich Ave are acquainted. 158. Although Ave have hitherto been considering the effects of the " moderate " use of alcoholic stimulants upon the excre- tory organs, as consisting simply in augmenting the amount of labor they are called upon to perform, by favoring the reception of too large an amount of alimentary matter into the system, yet there is another point of vieAv under Avhich it will be con- venient here to examine its results ; namely, the direct influence of the alcoholic stimulus upon the organs themselves. This influence may for a time be corrective of the other, and may thus aid in concealing and retarding its evil consequences. For we have seen (§ 57) that the introduction cf a small quantity of alcohol into the circulation has a direct action upon the Kidney, increasing the determination of blood to that organ, and tending to augment its secretion ; and it is highly probable that it has a similar effect upon the Liver, more especially as the blood Avhich has receiA'ed the alcohol by the absorbent ac- tion of the gastric veins passes through that organ before pro- 1124 SUPPOSED USES OF ALCOHOL ceedinff to any other part of the system. In this manner, the call for increased action of these two depurating organs being met by augmented functional activity on their part, a system of compensation is maintained, whereby the effects of excess are neutralized for a time—but only for a time ; for, as surely as any organ is habitually exerted in an excessive degree, so surely must its vital powers be prematurely exhausted, the remoteness of the period at Avhich the flagging of its power begins to manifest itself, being inversely to the degree of habitual over- excitement. Hence Ave have additional reason for imputing a considerable proportion of those chronic disorders of the ex- cretory organs, to which reference has been more especially made, to the habitual employment of alcoholic liquors in what i6 ofdmarily considered to be a " moderate " amount, and re- garded as perfectly consistent with health, if not required to maintain it. 159. It would be absurd, however, to affirm that such dis- eases always proceed from this cause; since those who practice Total Abstinence from alcoholic liquors are by no means proof against other errors in dietetics ; and in so far as they habitually take in more food than their system needs, the;' Avrll be liable to suffer from disorder of the organs whose duty it is to elimi- nate the Avaste. But they Avill be much sooner warned of tta excess they have committed, if the stomach refuses to digest the superfluity, instead of being forced by artificial, stimulation to an undue exertion of its poAver ; and an attack of indigestion, by early giving a salutary check to the practice, may ward off its remote consequeuces. It is the freedom from such checks, up to a certain time of life, Avhich encourages in those who habitually use fermented liquors in '• moderation*," and who at the same time practice habitual though slight excess in the amount of solid food Avhich they consume, the delusive belief that in neither case are they doing themselves-am" harm. 160. Effect upon the Stomach.—Such-, then, are the conse- quences to the. system at large, Avhich- Theory and Expe- rience join to indicate, as resulting from such an habitual use of Alcoholic liquors' as stimulates the appetite"to desire, and the stomach to digest, a larger amount of food than is necessary to supply the Avants of the body ; and Ave have next to enquire into the effects it produces upon the Stomach itself. We have already described the admitted results of what is commonly regarded as " excess ;" and we shall therefore at present limit ourselves to the enquiry, Avhether the " moderate" use of alco- IN 8UWTAINIXG THE VITAL TOAVERS. 126 holic liquors is likely to be productive of any injurious conse- quences, as regards this important organ. All our knoAvledge of the action of stimulants would lead to the conclusion, that, Avhen once the habit of employing them has been established, and the stomach is come to rely (as it Avere) upon the extra- neous aid Avhieh they afford, its power of performing its duty without such aid must be impaired. The case is very similar to that of sleep. A person in health, and not subject to any unfavorable influences, is naturally disposed to pass as much time in repose as his system needs for its renovation ; but, if he were long to accustom himself to the tise of a narcotic, he Avould find himself completely unable to sleep Avithoutit. And experience shows, in like manner, that those who have long hnm habituated to the moderate use of Alcoholic be\'erages Avith their meals, are >eldom able to discontinue them Avithout a temporary loss of appetite and of digestive power—unless, in- deed, their place he supplied by the more wholesome excite- ment of fresh air and exercise. • J 61. With many persons, the evil, so far as the Stomach is concerned, may seem to be confined to the induction of this state of reliance on artificial aid. Year after year passes aAvay, without any indication that its powers haAre been overtasked, or 4>hat any unhealthy change has taken place in its circulation or nutrition; and the usual dose of the alc'oholic stimulant ap- pears still to produce its Avonted effect. But this does not show that the. practice is really innocuous. We have seen that, whilst .1 potent dose of a poison speedily manifests its action by the violence of its edW-ts, the repeated introduction of minute doses is not' really inoperative, although the effects are not speedily apparent. If the stomach be not an exception to the general law of the action of stimulants upon the animal body, Ave should expect that, by the habitual over-excitement of its functions, in however trilling a degree, ii> vital energy will undergo a .premature depression; and that the result of the moderate use of alcoholic stimulants Avill manifest itself, sooner or later, in diminution of the digestive power. The earliest judication of this, in most instances, is the demaud for the aug- mentation of the stimulus to produce the same result; the amount which Avas at first sufficient to whet the appetite and increase the digestive power, being" no longer found adequate. If the demand be yielded to, and the quantity of the stimulus be augmented, the original benefit seems for a time to be de- rived from it; but, after the stomach has become tolerant of f 3 126 SUPPOSED USES OF ALCOHOL the liquor, that Avhich at first excited it to increased functional activity, does so no longer, and a further increase is called for; until what began in "moderation" ends in positive excess, Avith all its consequent evils. But, supposing this demand not to be felt, or not to be yielded to, the same "moderate" allowance being indulged in for a long course of years, we should antici- pate that injurious consequences, though perhaps long post- poned, must ultimately show themselves ; and that such is the case is unfortunately the experience of a vast number avIio suf- fer by that "loss of tone" of the stomach which is so common an attendant of advancing years, for the too great activity to Avhich the organ has been previously forced, during the long period of early and middle life. And although the common idea, that alcoholic liquors, Avhen, taken in small quantities, have a tonic property, may render it difficult for some to coincide in the conclusion that the real effect of the habitual use of even this small quantity must be of the opposite kind—exhaustive instead of tonic—yet as this idea has no other foundation than the temporary assistance derived from the stimulating powers of alcohol, it ought not to prevent our recognition of the con- sequences Avhich might be theoretically expected to proceed from its long-Gontinued action. 162. It is not here maintained, however, that the habitual employment of Alcoholic stimulants in small quantity, even when coupled with habitual excess in the amount of food in- gested, uniformly stands, to the loss of appetite and digestive power so frequent with the advance of years, in the relation of cause and effect; for there can be no doubt that the habit may be persevered in by some individuals throughout a long life, Avithout the manifestation of any injurious results; Avhilst on the other hand, it cannot but be admitted that the disorder in question may be induced in other Avays. But the existence of exceptional cases by no means invalidates the argument based upon general experience, any more than our occasionally meeting with individuals wdio have daily consumed a bottle of spirits, and have yet enjoyed a hearty old age, Avarrants us in rejecting the evidence Avhich indicates that such a consumption Avould have, in by far the larger proportion of mankind, a de- cided tendency to shorten life. Nor does it follow that, be- cause the loss of digestive power may be justly attributed to other causes when this one has been wanting, it has been in- operative when present. In fact, there can be little doubt that, amongst the class of men who are engaged in active mental IN SUSTAINING THE VITAL POWERS. 127 occupation, and who justify a moderate use of alcoholic liquors on the ground that it keeps them "up to their work," the ex- penditure of nervous power, consequent upon that undue exer- tion of the cerebral functions which has been aided by the con- tinual over-stimulation, has a large share in the result. 163. Effect upon the Nervous System.—Every medical man is familiar with cases in Avhich the "wear and tear" of an over- active life has been sustained with little apparent loss of power for perhaps a long series of years ; but in Avhich there is a sud- den failure both of mental and bodily vigor, as manifested in deficiency of power of continued mental exertion, depression of spirits, want of appetite, enfeebled digestion, and the Avhole train of disordered actions which is consequent upon this con- dition. It is not to be denied that such a state may arise quite independently of the agency, direct or indirect, of habitual sti- mulation ; one instance, in particular, is strongly present to the writer's recollection, in which it supervened on a long course of excessive mental exertion, in an individual Avho was most mo- derate in everything but the labor of.; his brain, and Avho rarely or never sought for artificial support from alcoholic stimulants. But the most common case is that in Avhich tAVo sets of causes are in action together. An habitual system of over-exertion of the nervous system may be maintained for a longer time by many persons, Avith the assistance of alcoholic stimulants, than without them; and thus the delusion is kept up, that the strength is not really overtasked ; when the fact is, on the con- trary, that the prolongation of the term of over-exertion, by the "repeated application of the stimulus, is really expending more and more of the poAvers of the nervous system, and pre- paring for a more complete prostration at a later period. 164. The temporary advantage, then, which is thus gained is very dearly purchased. The man who habitually abstains, not merely from alcoholic liquors, but from other artificial provoca- tives (misnamed supports) to the endurance of mental activity, is early Avarned by the failure of his intellectual energy and cheerful tone of spirits, that he is overtasking his brain ; Avhilst his stomach tells the same tale in another Avay—the failure of power to digest that which the fabric really needs for its re- generation being indicative of an exhaustion of nervous energy. A short period of rest and change, in such a condition, is usually sufficient for the renovation of the system, and for the recovery of the mental and bodily vigor. But the case is very different when the effort has been sustained, for a lengthened series of f 4 12S SUPPOSED USES OF ALCOHOL years, by means of the delusive support afforded by alcoholic li- quors; for, as the excessive-expenditure of nervous power has been greater, so is the exhaustion more complete; and as the stom- ach has been longer over-excited and overtasked, its tone is the more seriously injured, not merely by the depression conse- quent upon its own over-Avork, but by the impairment of the nervous poAver Avhich is required for its due activity. Thus, then, although the results ot" habitual over-exertion of the brain may h^e less speedily felt, when the stomach is kept upbyalcdr hulk- stimulants to a state of extraordinary activity of supply-^ and although, in like manner, the habitual u-e of alcoholic stimulants may cause the stomach to be less susceptible of the loss of the accustomed energy—yet, ay hen the crisis does come, 'each condition aggravates the other ; the effects of undue difr integration of the nervous matter being more difficult to repair ■Avhen the nutritive apparatus is depressed in functional power; and the restoration of the tone of the stomach being impeded by the deficiency of neiwous energy, Avhen this has been lower- ed by excessive action of the brain. The length of tinie then required for the cure is proportional to the duration of the causes Avhich have induced the malady ; and tedious apd diffi- cult is the process of restoration, as every medical man well knows. We shall hereafter have occasion (§§ 227,22§) to con- sider the best methods of medical and hygienic treatment for this condition ; and shall show that the measures Avhich experience noAv proves to be the most efficacious means of restoring the system, are precisely such as the physiologist Avould recom- mend, under the guidance of the preceding views of the causa- tion of the morbid state in question. 165. We haA-e'thus been led to consider the remote influ- ences of the prolonged ai.d habitual use of fermented liquors, in hoAvever "-moderate" a-quantity, upon the digestive appar* tus, the excretory organs, and the nervous system; and we have found that Ave may, with the highest probability, if not Avith absolute certainty, attribute many of the chronic disorders Avhich affect these organs in advancing life—especially that loss of functional poAver which is frequently the earliest stage of such disorders, and which, if appropriately treated in tluffirst instance, might not proceed further—to the excessive action to which they have been subjected, under the stimulating influ- ence of alcoholic beverages. In so far, therefore, as the*use of these beverages causes or favors such excessive action it must in tho end be hurtful, rather than beneficial, to the general IN SUSTAINING THE VITAL TOWERS. 120 health—notwithstanding that its temporary effect may appear to be Avholesome and exhilarating—or at any rate, if negative for good, to be also negative for evil. But we haA'e further to consider whether this inference is borne out by the effects of alcoholic liquors, taken habitually in small quantities, upon the functions of circulation and nutrition. 166. Effect upon the Circulation.—It may be difficult tq prove that the ingestion of a small quantity of Alcoholic liquor, taken in conjunction Avith food, has any decidedly stimulating influence upon the general circulation ; since a certain accelera- tion of the pulse, and an increase in its fulness, normally occur jiuring digestion; and the augmentation produced by the alcohol may be so trifling as to be scarcely detectible. Such augmentation, however, is certainly produced by the imbibition of a quantity usually accounted " moderate;" and we have pow to inquire whether it can recur habitually, through a long series of years, without producing injurious results. There cannot be a doubt that, in a healthy person, the rate of the circulation is proportioned to the amount of functional activity pf the principal organs of the body. We find that it depends, in great degree, upon muscular exertion, as put forth in the maintenance of the erect posture, and still more in active exer- cise ; but it may be accelerated also by exalted activity of the nervous system, Avhich sets up an unusual demand for blood in the brain ; and its increase of weight, during the digestive pro- cess, appears to be connected with the large supply of blood then transmitted to the chylopoietic viscera, and required for the due performance of their several offices. Noav, Avhenever the circulation undergoes any considerable acceleration, there is a tendency to a recurrence of local congestions, arising from £he want of power, on the part of the vessels of some particular organ, to allow their current to pass at the same rate with the rest. Of this Ave have a familiar example in that accumulation pf blood in the pulmonary arteries Avhich is liable to take place in most persons during violent muscular exertion, producing the feeling of being " out of breath ;" and Avhich is particularly marked in those in Avhom there exists some disordered condi- tion of the lungs that obstructs the passage of blood through their capillaries. 167. There are few persons, however, in whom there is not some tendency to an irregularity of the circulation, which manifests itself in a torpor in some parts, and an undue activity |n other*. One of the most common forms of this, especially 7 5. 130 SUPPOSED USES OF ALCOHOL among individuals who work their brains more than their mus- cles, is a torpor of the current in the extremities, and an undue activity in the cephalic circulation ; so that the head is habitu- ally heated, whilst the hands and feet are cold. Now where such is the case, we find that even the normal acceleration pro- duced by the ingestion of food aggravates this disordered con- dition ; so that the face becomes more flushed, and the head more hot, after meals, than at any other time.* Precisely the same result is observable in such persons, after the use of even a small quantity of alcoholic stimulant; and the habitual pro- duction of it cannot but be injurious, as tending to establish that inequality which it should be our endeavor to counteract. 168. Similar inequalities exist in different individuals, in re- gard to other organs : thus, it very frequently happens that the Liver is the part in which a disposition to torpidity of circula- tion exists; and congestion of its portal system of vessels must stagnate the whole of the circulation through the chylopoietic viscera, from which the blood of that system is derived. Any such disposition to local congestion must operate with increased force in producing general irregularity of the circulation, when une rate o :moA-ement is unduly accelerated; just as the outlets to a theatre, Avhich suffice to discharge the entire audience in a few minutes, when the pressure towards them is uniform and regular, are speedily blocked up and produce a stagnation of the entire current, Avhilst, under the influence of an alarm of fire, every one is rushing tOAvards them with undue haste.— And, as Ave haA'e seen that hepatic and abdominal congestions are among the ordinary results of excess in the use of alcoholic liquors (§ 155), it cannot be doubted that even their moderate employment must aggravate any tendency to such derangement of the circulation, when it already exists. Xo such derange- ment can be habitual, and be thus continually liable to aggra- vation, Avithout laving a foundation for other more serious dis- orders. So, again, as avc have seen that habitual excess in alcoholic liquors has a tendency to produce determination of blood towards* the Kidneys, and thereby to favor the develop- ment of many serious diseases in those organs (§§ 54-58), Ave can scarcely refuse to admit that, Avherc the least tendency to disordered action already exists in them, it must be aggravated * The acceleration produced by muscular exercise will, of course, be unattended by this result; the cause of the acceleration being such as to divert the current from the brain to the limbs, and to make it pass through them with energy and rapidity. IN SUSTAINING TIIE VITAL P0AVBR9. 181 by the habitual recurrence of such a slight increase in the afflux of blood to them as would of itself attract no attention. 169. If it be said that, in thus reasoning upon probabilities, we are going further than experience warrants us in doing, Ave must again take leave to refer to the argument from analogy on Avhich Ave have already dAATelt (§ 150), as a justification of our someAvhat theoretical propositions. The whole tendency of modern pathological research has been to shoAv that the human frame, if endoAved with an ordinar}' amount of inherent vigor, is no otherwise incident to disease than as it is in various ways subjected to the agency of causes which produce a departure from the normal jday of its functions; and that, although old "age and decay are inevitable, diseases are not, being preventible in the precise proportion in which Ave are able to discoArer and eradicate their causes. And Avhen Ave can clearly trace a rela- tion of cause and effect betAveen obvious and flagrant violations of the rules of heilth and the occurrence of certain forms of acute disease, Ave seem justified in assuming that minor but habitual \riolations of the same kind must be alloAved to partici- pate, at any rate, in the production of chronic diseases of the same order. The very nature of chronic disease implies a pro- longed action of the causes in which it arises ; for no such deter- minate alteration of the normal functions as it involves can be at all accounted for by any temporary causes of perversion ;— these either inducing a transitory disorder, or, if acting Avith sufficient intensity, exciting an attack of acute disease. In chronic diseases, we find that the organ has, so to speak, grown to its perverted action ; so that no curative, measure is perma- nently beneficial which does not first act by AAnthdraAving the cause of the original departure from the healthy state, and by placing the organ in the best condition for its recovery.—We are fully justified, therefore, by all that we know of the causes of disease, in asserting that the habitual use of Alcoholic liquors by healthy indiAdduals, even in small quantities, is likely, when sufficiently protracted, to favor the development of such chronic disorders as originally depend upon an irregularity in the movement of the circulating current, or are liable to be aug- mented by it. 170. Effect upon Nutrition.—There appears, moreover, to be an adequate amount of evidence that the practice in queytion has an unfavorable influence upon the Nutritive operations by Avhich the alimentary materials first converted into blood are applied to the regeneration of the living tissues. This influ *32 SUPPOSED UPE3 OF ALCOHOL ence is not so clearly manifested in the ordinary course of these operations—which indeed is not demonstrably affected by it—as in the extraordinary demand which is made upon the regenerative poAvers for the repair of injuries occasioned by accident or disease. It is well known to Surgeons that the most desirable of all modes by Avhich the reparation of Avounda can be effected is the simple adhesive process known as " union by the first intention ;" and that where, in consequence of loss of substance, union by the first into n'ion cannot be effected, the most favorable method is that which is termed the " scabbing process ; " in Avhich a hard crust being formed upon the sur- face, so as to protect it from the irritating action of the atmos- phere, a continued growth or re-formation of tissue takes place beneath, Avithout any interrupt! m from inflammatory action, until complete filling-up has been effected, and a new cutaneous surface is formed beneath the scab. But it too frequently happens that the reparative processes cannot be induced to take place after either of these fashions, but that inflammatory action is set up in the Avound, and matter forms between its lips, or beneath the scab, rendering its detachment necessary, and thus re-converting the wound into an open sore. The healing of this sore must be accomplished by the much less healthy process of suppurating granulation; during the pro- gress of Avhich a large amount of nutritive material runs to waste as purulent discharge, whilst a great degree of constitu- tional irritation is often setup; and the best termination of which is the formation of a cicatrix, that subsequently under- goes an uusightly and often inconvenient contraction, from which the neAv tissue formed under a scab is free. 171. Now the occurence of the first of these modifications of the healing process is an obvious indication of such a healthful condition of the nutritive operations as can repair the effects of an injury in the most complete manner, with a least pqssible Avaste of nutritive material, and with the most entire absence of constitutional disturbance. Whilst, on the other hand, the impossibility of procuring it, even under the most favorable circumstances of rest, fresh air, and wholesome aliment, indicates that the nutritive functions are not in their normal condition. Amongst the loAver animals we seldom find injuries repaired in any less favorable mode, unless the part be placed in circumstances adverse to this healthy action. But arnong " civilized" communities of men, the case is very differ- ent ; for the occurrence of the scabbing process, in the case of IS SUSTAINING THE VITAL POWERS. 133 any but trivial wounds, is the exception, not the rule—being, in fact, so rare that many Surgeons never think of attempting to bring it about. Now that there is nothing essentially different in the constitution of Man, which places him in this respect at a disadvantage as compared with the lower animals, appears from the fact that all who have visited "savage" nations, in whom more constant exposure to air is practiced, and who enjoy immunity from many causes of disease which exist in civilized communities, have been struck with the facility with which wounds heal among them, and with their remarkable freedom from that constitutional disturbance which, amongst ourselves, almost invariably folloAvs severe injuries. Thus, Hawkesworth, in his voyage to New Zealand, makes particular mention of " the facility with which wounds healed that had left scars behind them, and that Ave saw in a recent state; when we saw the man who had been shot with the musket ball through the fleshy part of the arm, his Avound seemed to be so well digested, and in so fair a way of being perfectly healed, that, if I had not known no application had been made to it, I should certainly have inquired with a very interested curiosity a#er the vulnerary herbs and surgical art of the country." Of these people, he states that at that period water was their sole and universal liquor. 172. Noav, it would be absurd to maintain that the habitual moderate use of fermented liquors is the sqle reason of the rarity of this healthful operation of the reparative process, amongst ourselves; since a multitude of other departures from the laws of health are continually practiced by almost every member of a civilized community. But, if we look to the unquestionable fact that habitual excess in the use of fermented liquors produces a condition altogether opposed to the healthful performance of these processes, so that the slightest scratch or abrasion may give rise to a rapidly fatal attack of inflammation (§ 63), it can scarcely be denied that, where a minor departure from the normal condition shows itself, and the same cause has been in action in less intensity, that departure may be reasonably considered, in part at least, as its effect. And this conclusion is remarkably confirmed by the surgical experience of the late campaigns in India, on occasions on which there had been, from accidental causes, an interruption in the usual supply of spirits. Thus, Mr. Havelock, in his " Narrative," in reference to the wounded, after the victories in India, observes: " The Medical Officers of this army havq 134 SUPPOSED USES OF ALCOHOL, ETC. distinctly attributed to their previous abstinence frorn^ strong drink the rapid recovery of the wounded at Ghuznce." And Mr. Atkinson, in his work 'on Afghanistan, is more explicit, stating that " all the sword cuts, which were very numerous, and many of them very deep, united in the most satisfactory manner; which Ave decidedly attributed to the men having been Avithout rum for the previous six weeks. In consequence, there Avas no inflammatory action to produce fever and inter- rupt the adhesion of the parts." 173. From the foregoing considerations, then, we seem entitled to draw the general conclusion that, in the " average man," the habitual use of Alcoholic liquors, in moderate or even in small quantities, is not merely unnecessary for the maintenance of bodily and mental A-igor, but is even unfavorable to the permanent enjoyment of health, even though for a time it may appear to contribute to it. For, as it is justly remarked by Dr. Robertson, " that man only is in good health who re- covers rapidly from the simple accidents incidental to his occu- pation, and from the simple disorders incidental to his humanity and to the climate he lives in, and who can bear the treatment that those accidents or those disorders demand ;" and if such be not the case, Ave may feel confident that, however great the temporary power of exertion may be, such power is destined to give way at a period much earlier than that of its normal duration. And if it be true, as we have endeavored to show, that the effect of the habit is not merely to induce certain pre- dispositions to disease by it its OAvn agency, but also to favor almost any of those Avhich may already exist in a latent form, we have an additional right to affirm that even the most moderate habitual use of alcoholic liquors becomes to the " average man" positively injurious, if protracted for a sufficient length of time to allow of the development of its effects, USB OF ALCOHOL IN EXCEPTIONAL CASKS. 135 CHAPTER HI. ARE THERE ANY SPECIAL MODIFICATIONS OF THE BODILY OR MENTAL CONDITION OF MAN, SHORT OF ACTUAL DISEASE, IN WHICH THE OCCASIONAL OR HABITUAL USE OF ALCOHOLIC LIQUORS MAY BE NECESSARY OR BENEFICLVL? 174. There appear to be three classes of cases in Avhich re- course may be had with temporary advantage to the use of Al- coholic liquors : those, in the first place, in Avhich there is a demand for some extraordinary exertion of the animal powers, and in Avhich the occurrence of subsequent depression may not be an adequate objection to the employment of a stimulus that enables the system to meet it ; those, in the second place, in wdiich there is a deficiency of the proper sustenance, and in which alcohol serves as a heat-producing article of food ; and those, in the third place, in Avhich there is a Avant of sufficient vigor on the part of the system itself to digest and assimilate the aliment which it really needs for its support. I. DEMAND FOR EXTRAORDINARY EXERTION. 175. Of the first class, the folloAving appropriate example may be extracted from the letter of Dr. J. D. Hooker, already cited : " I knoAv of only one occasion," he says, " on which the use of spirits appeared indispensable; and that Avas when a little more exertion at the crowning of a mighty and long-continued effort Avas demanded. Thus, the ship, Avhen sailing in the pack- ice, is sometimes beset, or falls to leeward into the lee-ice. This takes two or three minutes—but, if there is much Avind, it takes many hours—to get her out. Not being in command, the sails are of no use ; and the ice prevents her from moving in any way but with it to leeward. Under these circumstance, the only way to get her out is by fastening ropes from the ship to the larger masses of ice, and warping her out by main force against the wind. Now I have seen every officer and man in the ship straining at the capstan for hours together, through snow and sleet, with the perspiration running down our faces find bodies like water. ToAvards the end of such a struggle, at 136 USE OF ALCOHOL the mighty crowning effort, I have seen a little grog Avork wonders. I could not have drunk hot coffee Avithout stopping to cool ; nor, if I had, do I think it would have supplied the temporary amount of strength Avhich Avas called for on the spot under circumstances like this. These, however, are extreme cases, which do not affect the sailor in his ordinary condition, and which any ship might be well prepared for." 176. It must be within the experience of most persons that a very small quantity of Alcoholic stimulus has been of similar efficacy in sustaining the nervo-muscular energy under some temporary effort, Avhich circumstances called for, and to which the system, exhausted by preAdous fatigue, would not otherAvise have been equal. And the Avriter can speak from his own knowledge of its corresponding effect, in quickening and fresh- ening the mental power, during a brief period through which )t could riot othenvise have been sustained. Of course, in every such case, a corresponding depression is subsequently felt; but this depression is rather traceable to the fatigue of over-exertion than to the reaction consequent upon over excitement. For, in \he cases alluded to, the effect of the alcoholic liquor is not to quicken the circulation, or to exalt any of the functions above their normal activity, but merely to keep them up to par : and its use for such a purpose is therefore free from many of the objections Avhich have been urged against its habitual employ- ment. 177. But it must not hence be supposed that recourse to Al- coholic liquors can habitually be had with impunity for pur- poses of this kind. Every kind of "forcing" must be in the end injurious to the vital poAvers, and more especially to those of the nervous system ; and the more frequently and violently it is practiced, the more speedily may Ave expect that functional de- rangement will manifest itself. Extreme overtasking of its powers is often so immediately followed by apoplexy, paralysis, epilepsy, mental derangement, or fatuity, that no one has any hesitation in regarding these as the natural results of the pre- vious immoderate exertion ; and Ave appear equally justified in attributing similar results to similar causes, however remote the results may be, where causes less potent have been in con- tinual or frequently repeated operation. For every such irre- gularity tends to derange the nutrition of the system • and if a renewal of the irregularity should take place before the effects pf the preceding derangement have been recovered from they Are of course aggravated ; and thus a cumulative result L pro- IX EXci-:rTIONAL CASES. 137 duccd, and a permanently disordered state of nutrition estab- lished, which manifests itself af last in some serious and settled form of cerebral disease. 178. The case resembles that of the racer, excited to put forth his utmost speed, or the jaded rondster goaded to a tem- porary improvement of his pace, by the application of the spur. The spur gives no strength; but, like the drain to the sailor toiling at the capstan, or the glass of wine to the public speaker Avearied Avith his preAnoQs exertions, it calls forth the most vigo- rous exercise of the remaining strength. The racer may fall dead on the spot; the roadster may sink from exh.tu-tion ; but the spur has Only been the indirect means of bringing about this'catastrophe, the real cause of it being the undue exertion which it has called forth. And in like manner, Avhen recourse has been had to alcoholic liquors for the maintenance of the power to meet some extraordinary demand upon the bodily or mental energy, and the amount Used has been .merely such as to meet that demand, Ave ought to attribute the subsequent exhaustion rather to the violence of the effort Avhich has been 'put forth than to the stimulus, trifling in itself, by Ayhjch the system was rendered capable of making it. The occasional drain or glass of Avine Avould of itself have produced but littls mischief in comparison ; and its consequences might haA'e been manifested in some other way. But the frequent over-exertion of the vital powers, especially those of the nervous system, must ultimately tell upon the fabric, under Avhatever kind of excite- ment it is called forth. '-'" 179. IIoAvever desirable, then, it may be to aA-oid the neces- sity for such immoderate exertion, it can scarcely be denied that occasions will arise in the experience of some persons, in which the temporary assistance derived from Alcoholic liquors Could scarcely be replaced by any other. When the choice lies betAveen the easy and satisfactory performance of the pre- scribed duty, and the discharge of it as a task which vmst be got through at all hazards by the most determined bracing up of the poAvers for its execution, there can scarce'y be a doubt, in the opinion of the Avriter, that, if the former can be procured by the use of such a small dose of alcohol as shall merely raise the vital poAvers for a time to their usual energy, it will be fol- lowed by less of subsequent exhaustion than tho latter. But again, he would repeat—and he crinrot do so too often, or too earnestly—that the habitual recourse to such a "practice is "fraundit'with the greatest prospective danger; since it encou- 13S USE OF ALCOHOL rages the delusive idea that the exertion Avhich is thus for a time sustained is really doing no injury to the systenr ; besides which, it is next to impossible that the frequent use of alcohohc liquors, however moderate, can be persevered in, for any length of time, without favoring the production of that disordered state of nutrition of the brain Avhich the irregular activity of the nervous system has of itself so marked a tendency to generate. It should rather be the aim of those who have accustomed themselves to such assistance to avoid the necessity (so far as may be possible) for such extra exertion ; and to prepare them- selves to meet it, Avhen it is indispensable, by careful and con- stant attention to all the rules of health. The most beneficial results from such a use of stimulants are to be experienced by those Avho are habitually abstinent; since the quantity of alco- holic liquor Avhich they require for the purpose is extremely small; and whatever injurious effects it may produce will be more likely to be dissipated, Avhen a considerable interval elapses before it is again resorted to. When alcoholic liquor is employed as an ordinary beverage, the quantity required to give the desired aid, on the occasions in question, is such as must of itself exert a prejudicial influence on the system. 180. Nearly allied to the preceding cases, are those in which the use of Alcoholic liquors may be found beneficial in assisting to fortify the system against a temporary exposure to cold or damp, separately, or in combination. We haA'e already ex- amined into the reputed efficacy of alcoholic liquors in favoring the resistance to cold; and have found reason to adopt the conclusion that this reputation is altogether fallacious as regards the poAver of continued endurance. There can scarcely be a question, however, that although, considered simply as a heat- producing material, alcohol is inferior in some important parti- culars to such oleaginous matters as can be readily introduced into the current of blood, it has for a time the power of keeping off the chilling influence of severe external cold, in virtue of the augmented rapidity of the circulation which it induces, and particularly of the determination of blood which it favors to- wards the vessels of the skin. And this effect seems to be ex- erted with still greater benefit Avhen cold and damp are acting together; their depressing influence being kept at bay for a time by the moderate use of alcoholic stimulants, so that no injurious result is subsequently felt from an exposure which might otherwise have been followed by a severe '• cold," an at- tack of rheumatism, or some other malady, as determined bv the ldiosnycrasy of the individual. IN EXCPTIONAL CASES. 139 181. It is not here argued, hoAvever, that Alcoholic liquors afford the best means of resisting such influences. On the con- trary, it is Avithin the experience of most persons that muscular exertion, where it can be employed, is a far better means of keeping up that vigor of the circulation Avhich shall resist the influence of the external chill, than the use of any stimulants Avhatever in a state of bodily inactivity. But Avhere circum- stances prevent a resort to the former, and the choice lies among the best internal means of protection—as in the case of a traveller exposed to cold and Avet on the top of a coach—Ave seem justified in believing that, if the chilling influence is poAverhil and likely to be of short duration, it may be better resisted by a stimulating dose of alcoholic liquor than in any other Avay. But, if the resisting poAver is to be prolonged, such a course is most undesirable; for the system is never so ob- noxious to the depressing influence of cold and damp as Avhen it is already in a state of depression resulting from previous over-stimulation; and the use of coffee, cocoa, and other hot beverages, Avith solid food, Avhich shall aid in permanently sus- taining the heat of the system, is then unquestionably to be preferred. Here, again, Ave would remark, that the habitual abstainer has decidedly the advantage, since a very small amount of the stimulus is sufficient, as in the former case, to produce the desired result; and that, if recourse be too fre- quently had to it, the remote consequences of alcoholic excite- ment may be expected to manifest themselves. II. DEFICIENCY OF OTHER ADEQUATE SUSTENANCE. 182. The second class of cases in Avhich the use of a small amount of alcoholic liquors seems beneficial, or at any rate justifiable, is that in which there is a deficiency of the proper sustenance, so that the alcohol supplies the means of maintain- ing the animal heat, for which the animal tissues Avould other- Avise be attacked. Under such circumstances, too, the tempo- rary elevation of the habitually depressed state of the animal power seems rather beneficial than injurious. Of this Ave have a remarkable example in the Avell-known case of the Mutiny of the Bounty, from Captain Bligh's Narrative, of Avhich the fol- lowing passages are extracted:—" At daybreak I served to every person a teaspoonful of rum, our limbs being so much cramped that Ave could scarcely moAre them." Further on— " Being unusually wet and cold, I served to the people a tea- spooonful of rum each, to enable them to bear Avith their dis- HO -CSB OF ALCOHOL U.s.mcr situation." And again—" Our situation was miserable; •ihv ivs°wet, and suffering extreme cold in the night, without the feast shelter from the weather. The little rum we had was of the greatest service ; when our nights were particularly dis- tressing I generally served a teaspoonful or two to each person, and it was always joyful tidings when they heard of my inten- tion." Now, however decidedly we may give the preference to hot tea, coffee, or cocoa-, with plenty of nourishing food, over alcoholic liquors, in facilitating the endurance of such an expo- sure, it can scarcely be questioned that, in circumstances such as those of Captain Bligh's crew, the administration of a-few drops of spirit was of the most important service, both as sup- plying combustible material, and as enabling the powers of their system, already seriously depressed, from being fatally re- duced by the privations to Avhich the party Avas subjected. 183. The beneficial influence of a small quantity of Alco- holic stimulus, in contributing to the endurance of bodily labor under circumstances peculiarly trying, and under the disadvantage of a deficient allowance of animal food, has been demonstrated on an extensive scale by the hygienic-experience of the large prison at Xismes, called the " Maison Cent rale," of Avhich an account has been recently published bv the chief physician, M. Boile.au Castlenau, Avho has been connected with the prison for the last tAventy-five years.* Of this account an abridgment will be here given, as the facts are consi- dered by the writer as of very great importance, in clU proving, by the experience of a large number of individuals, the position of those Avho assert that under no circumstances, can the habitual use of alcoholic liquors be otherwise than injurious. j nis prison ii-uarlly contains a population of 1200 convicts, most of them adults, the minimum age being eleven. lt> wards have been habitually over-croAvded and ill-ventilated, and insufficiently heated in Avinter; aid the food of the pri- soners has been coarse and innutritious, Avhil.-t more labor has been exa-ted and from others which might be cited to the same effect, we seem justified in conclud- ing that the use of Alcoholic liquors in small quantity may assist in sustaining the powers of the system, when these have undergone an extreme depression from the combined influence IN EXCEPTIONAL CASES. 143 of exposure or exertion, and of want of food; so that under such circumstances the alcohol does decidedly more good than harm, and should-therefore be employed Avhen accessible. And this we may freely admit, Avithout having in the least degree to qualify the doctrine previously advanced, that continual ex- posure and protracted exertion may be better sustained Avithout the use of alcoholic liquors than with it, when an adequate sup- ply of wholesome food is to be had, and the stomach is capable of digesting it. III. DEFICIENCY OF CONSTITUTIONAL Vp30R. 188. We have now to inquire into the third class of cases, in which a temporarily beneficial result appears to be derived from the occasional, or even (for a time at least) the habitual use of Alcoholic liquors;—those, namely, in which there is a want of sufficient vigor on the part of the system itself to digest and assimilate the aliment which it really needs. Such cases present themselves in all ranks of life. In the higher, they too frequently result from heated rooms and late hours, from the want of regular exercise of mind and body, and from habits of self-indulgence and "coddling," Avhich foster, especially in females, what may have been an hereditary Aveakness of diges- tive power. In the middle classes, it is usually traceable to the " wear and tear" of professional or commercial avocations; to undue cerebral labor, carried on, as this frequently is, in ill-ven- tilated apartments; and to the anxieties incident to the con- scientious discharge of the duties of a profession or to the fluc- tuations of business. Among the lower classes, on the other hand, it is traceable rather to the condition of their dwellings, workshops, and persons; to the Avant of ventilation of the buildings in AA-hich they dwell or labor, to the miasmatic atmos- phere of their ill-drained streets, and to the foulness of their skins and garments. 189. Noav in the first of these groups, it is obvious that the want of appetite is a natural result of the reduction of demand for aliment to its loAvest point; for where neither the muscular nor the nervous systems are adequately exercised, and Avhere the body is habitually kept in a temperature not far below its own, there can be very little " waste" to be repaired, and a very small amount of combustive action can be needed to keep tip the heat of the body to its proper standard. But the digestive powers.are very liable, when their natural use is too little called for, to mnk below the level at which the demands of the system 144" USE OF ALCOHOL should keep them ; and thus an.almost total want of ap- petite, and extreme debility of the stomach, are the result, which of course tends to augment the habits of self-indul- gence, and to foster the whole system of " coddling." In such case, an apparent benefit is derived from the habitual employment of a glass or two of Avine or a tumbler of bit- ter ale; but this merely facilitates the persistence in a wrong course ; and every judicious practitioner would now assent to the truthfulness of the advice given by Abernethy in a case of this kind, to " live on a shilling a clay and earn it." It is utterly impossible that alcoholic liquors can qounteract the influence vf heated rooms and late hours ; that they can stand in the place of healthful exercise of mind and body ; or that they can neutralize the evil results which are sure to proceed from the habitual direction of the attention to self. All that they can beneficially do is to create for a time that appetite which ought to be naturally felt, and to urge the unwilling stomach to digest that food which the body really requires. But thus they can only effect by their stimulating properties ; arm-as the usual dose, almost invariably ceases after a time to exert its origiual influence, it requires a gradual increase, until the evil effects of its habitual use in such a state of the system are unmistakably manifested. 190. The true cure for conditions of this kind lies in such an entire change of habits as shall place the system in the condition most favorable to the recovery of its vigor, or to the acquire- ment of that which it has never enjoyed ;—the substitution of fresh- air and bracing breezes for heated and ill-ventilated rooms; of early and regular hours for the system of turning night into day and day into night ; of plain but Avholesome fare for sea- soned dishes and refined cookery ; of the use of even a Aveakly pair of limbs for that of a carriage and horses ; and of labor in behalf of others for the weariness of ennui or continual thought of one's self. 191. Nevertheless, it may happen that, after all these means have had a fair trial, and considerable improvement may have been produced, the stomach may not be equal to its work; and this is liable to be the case more particularly with those to whom weak digestive powers have been transmitted from their parents (generally in consequence of their own unhealthful habits), or in who-m they have been tixed (so to speak) by an erroneous system of bodily and mental training and especially IN EXCEPTIONAL CASUS. 145 by the habitual use of stimulants during childhood and youth. In such cases, the writer believes that the habitual use of a small quantity of alcoholic stimulant, especially when combined with a bitter tonic, may be of more service than any other form of medicine; and if care be taken not to employ it to such an extent as to produce an artificial appetite, or to force the stomach to digest more than the system really needs, it does not appear likely to have the same permanently injurious effects as it exerts in most other cases. It will generally be found to be an indication of its beneficial use, that the dose does not require increase ; the small quantity originally taken continuing to exert its good effects; and this benefit will be more likely to be persistent, if the use of the alcoholic stimu- lant be intermitted whenever the digestive powers seem adequate to the support of the system without it. 192. The Avant of appetite and feebleness of digestive power, so common among individuals in the middle classes, Avho go through an undue amount of cerebral labor, frequently under circumstances which are of themselves prejudicial to health, has been already adverted to under another head (§§ 163,164); and it has been shown that the use of alcoholic liquors cannot, in general, be regarded as likely to be permanently beneficial in such a condition, although temporary benefit may doubtless be derived from it. It is impossible that Alcohol can supply the place of mental repose to the man whose intellect is over- tasked, and whose anxieties are unduly excited for himself or for others; or that it can be an efficient substitute for muscular exercise to the man of sedentary habits, or for fresh air to him who is habitually exercising his brain in a close, ill-ventilated apartment. All that it can do is, as in the former case, to re- store the appetite which ought to be felt, and to force the digestive poAvers to the discharge of the duty which they are indisposed to perform of their own accord. And here, too, Ave find that, Avhen stimulants are habitually employed for such a purpose, they gradually lose their poAver; and the wearied stomach, like the jaded roadster, at last breaks down, under the combined influence of the withdraAval of nervous agency conse- quent upon cerebral exhaustion, and of the depression of its own energies consequent upon the habitual over-excitement to which it has itself been subjected. 193. Here, then, it is obvious that the use of Alcoholic stimulants can only serve as a palliative, and that the true remedy can only be found in such a change of habits as shall G 1. 146 USE OF ALCOHOL bring back the system as nearly as possible to the natural state. The intellectual labour must be moderated ; the mind must be prevented from dwelling on its own sources of anxiety by the healthful influences of social and domestic intercourse, of A-a- riety of occupation, and of objects that shall interest Avithout exciting it; and the body must be placed, by regular exercise, fresh air, and adequate repose, in the most favorable condition for the endurance of mental labor. Such measures, steadily pursued, with an occasional complete intermission from the ordinary occupations, and an entire change of scene Avith the accompaniment of fresh objects of interest (for ennui is to be especially7 avoided), more especially' wdien a bracing air and augmented muscular exercise tend still further to the bodily invigoration, will usually' be foimd sufficient, Avhen employed in time, for sustaining the appetite and digestive poAvers under that amount of mental labor to Avhich the system is really equal; and recourse should be had to all such natural means of procuring and sustaining the vigor of health, before the artificial and delusive aid of alcoholic stimulants is imroked. It is, in- deed, among the most injurious results of their habitual use that it is found possible, through their means, to prolong the health-destroying system ; and thereby, like the trader Avho bolsters up his failing credit Avith accommodation bills, to carry omvards, from page to page of the book of life, a heavy balance which must be accounted for at some subsequent period. 194. Still, the Avriter is by no means disposed to deny that, after all other practicable means had been taken for the invigor- ation of the system, the habitual use of a small or moderate quantity of Alcoholic liquors may be found beneficial in some individuals of the class referred to ; enabling them to digest that food which the system really needs, and thus contributing to sustain their poAvers under an amount of exertion to which they would not otherwise be equal. And this Avill be especially the case (as with the class first treated of), Avhere, from hereditary pre- disposition, or the habits of early life, there is a fixed constitu- tional debility of the digestive powers. In such instances, the stimulating effects of the alcohol do not manifest themselves ; it is not found requisite to increase the dose ; and the practice is continued with apparent benefit through the whole of life A characteristic example of the results of experience in this respect is afforded by the case of the late Dr. Joseph Clarke, of Dublin, who lived to the age of 76 years, and who discharged IN EXCEPTIONAL CASES. 147 the duties of a laborious profession, with scarcely any intermis- sion, to the end of his life* 195. The craving which is felt for Alcoholic liquors among the classes Avhose labor is rather physical than mental, and the benefit Avhich in many cases appears to be derived from it, pro- ceeds from a different cause. Nothing can be conceived in it- self more likely to Avhet the appetite and invigorate the diges- tive powers than regular but not excessive muscular toil, with that moderate occupation of mind which the execution of the labor involves ; but in order that this may exert its proper effect, it must be carried on under circumstances othenvise favorable to health, and more especially in a pure atmosphere of moder- ate temperature. If, in place of this, the air be already loaded with carbonic acid, an obstruction is created to the unusually rapid exhalation of that gas Avhich muscular exertion involves ; and the labor cannot be borne Avithout the assistance of stimu- lants. And if the atmosphere of the dwelling be charged Avith the noxious emanations resulting from animal or vegetable putrefaction, the appetite and the digestive powers fail, the ali- ment Avhich the system really needs for the regeneration of its "wasted " material is no longer prepared and supplied to the circulating current, and the strength consequently flags. Under such circumstances, recourse is had, with :.pparent benefit, to the use of alcoholic liquors ; for they spur on the stomach to its work, and cause it, for a time at least, to furnish what is need- ed for the maintenance of the various functions of the body ; the whole train of which depends, more or less directly, upon the due performance of the digestive operation. 196. Noav, it is a remarkable characteristic of this condition, that the stimulus which was at first found sufiicient very speed- ily ceases to produce its usual effect; and that the feeling of necessity for it increases, the more it is used. Of this, Ave have an example—which, though an extreme case, teaches the lesson with the force that extreme cases alone can do—in the con- dition of the journeymen Tailors employed in the large London Avorkshops, as disclosed by the inquiries Avhose results are pub- lished in the fii>t "Sanitary Ileport" (1842). The heat and closeness of the workshops were stated by the Avitnesses to be such that, on the coldest nights of winter, large thick tallow candles melted and fell over with the heat; and fresh hands * See the Sketch of Dr. Clarke's Life and Writings, bv his Nenhew Dr. Collins, p. 81. J l 2 © 148 USB OF ALCOHOL from the country fainted aAvay. In order to get the strength up for the day's work, and to create an appetite for breakfast, it was customary to take a glass of gin at seven o'clock in the morning; and this was repeated three or four times in the sub- sequent ten hours. Now the utter inability of the alcoholic stimulus to afford more than a temporary power of endurance under such a state of things, and the cumulative effect of the nrxious atmosphere on the one hand, and of the habitual use of spirits on the other, are fearfully shown in the excessive mor- tality among this class of men, especially from consumption; their average age not being above thirty-two, and a man of fifty being considered as superannuated.* 197. Nothing can be more absurd, then, than to maintain that any real benefit is derived from Alcoholic liquors in such cases, or that it can in the least degree supply the place of pure air, or enable the body to resist the influence of excessive heat Nor can it be more potent in preventing the morbific influence of putrescent miasmata; nor, again, can it make up for the want of personal cleanliness. These agencies can only be re- medied by their proper antagonistic measures;—hot and foul air by proper ventilation ; noxious emanations from the soil by efficient sewrerage ; filthiness of the skin and garments by the use of baths and Avash-houses ;—and if they be allowed to con- tinue, they must exert their influence on the bodily system, all the alcohol in the Avorld notwithstanding. When, on the other hand, they are removed—the artizan's labor being prosecuted in pure air, and his home and garments being kept clean and fresh, so that his skin and lungs are allowed their due exercise —it will be seldom, if ever, that anything else Avill be required to sharpen his appetite, and invigorate his digestiA'e powers, for the consumption of as much food as his system may require. 198. On the Avhole, then, we may conclude that in by far the greater number of cases falling under one or other of the above categories, the influence of the habitual use of Alcoholic liquors, while it may seem temporarily beneficial, is in the end rather pernicious than otherwise ; and this not so much (in the cases now under consideration) by their own specific effects on the system, as by causing the individual to feel less need of the very change Avhich isjieeded for the restoration of the body to * The writer has been informed that these workshops have been gnC/}LTZ°l • JatG ?e.°r8> esPeda%in regard to ventilation; and that the craving for spmts, on the part of thole employed in them, has gradually ceased to manifest itself. IN KXCEPTIONAL CASES. 149 its wonted vigor. The insensibility to the effects of various morbific causes, Avhich the habitual use of these stimulants in- duces, and the toleration of them Avhich it thus permits, may be regarded, indeed, as one of its most injurious results. Those who are prevented from feeling the immediate consequences of their improper course flatter themselves that they are unin- fluenced by them, and give to their Avine, their spirits, or their beer, the credit of their escape. But this is far from being the case. The enemv is only baffled, not dispersed ; and although he lies concealed for a time, he only Avails until his onslaught may be more effectually made. Any systematic departuie from the laws of health—all experience teaches—must exert its influence on the system, sooner or later; the sooner it does so, the more readily .may the mischief usually be corrected ; Avhilst the postponement of its effects tends to render the process of cure as protracted as the operation of the causes has been. It is one of the greatest benefits of the abstinent system, then, that by making the evils of such a departure less endurable, it sooner prompts the sufferer to seek a remedy. 198. Pregnancy.—Among the modifications of the bodily condition, short of actual disease, in Avhich the occasional and even the habitual use of fermented liquors seems desirable in some instances, are the states of pregnancy and lactation. The state of pregnancy frequently occasions a peculiar irritability of the stomach (apparently of a purely nervous character), Avhich indisposes it to retain the nutriment really required by the sys- tem, or Avhich prevents it from properly digesting and preparing it when retained. This irritability is occasionally so aggravated as to become the subject of medical treatment; and the most powerful sedative medicines are sometimes required to subdue it sufficiently for the retention of even small quantities of food. Sometimes even these are ineffectual; and more relief is obtain- able from small quantities of Avine, frequently repeated, than from anything else. Dr. Meigs (of Philadelphia) mentions a case in which nothing could be borne but champagne. In milder cases of the same kind, it often happens that a small quantity of fermented liquor, taken with the principal meal, seems to establish a tolerance of it in the stomach, and to pro- mote its digestiou, in a Avay Avhich no ordinary sedative or tonic medicine can effect; and it certainly seems a less evil to employ this, even habitually, during the period of pregnancy, than to alloAV the system of both mother and foetus to be suf- fering- for Avant of the aliment which this condition so peculiarly b oS. 150 U9K OF ALCOHOL requires. And as the source of irritation is temporary, therd is less danger than in other circumstances, lest the demand should be rendered permanent by the habituation of the stomach to the stimulus. 199. But the evils attending its habitual use, even under such circumstances, can only be reduced to their minimum by very careful attention to all the other conditions favorable to health during the pregnant state—especially fresh air, moderate exercise, early hours, adequate repose, and the avoidance of all sources of excitement; and also by the strict limitation of the quantity of the alcoholic liquor to that Avhich is sufficient to produce the desired result. The Avriter has knoAvn cases in Avhich, lUKh-r such watchful regulation, great benefit appeared to be derived from the very moderate use of alcoholic liquors (especially of those in which the bitter and sedative properties of the hop are combined) Avithout any corresponding disadvan- tage ; the stomach being thereby enabled, so long as the preg- nant state lasted, to receive and digest the food which the sys- tem really needed; and the requirement not being felt after its termination. But it must not be forgotten that the habit of indulgence in fermented liquors, once established, is often felt by females, as well as by men, to be very difficult of relinquish- ment ; and Avhere there is reason to believe that the individual does not possess self-command sufficient to break through the habit at the proper time, it might be advisable to endeavor to substitute a medicine for a beverage, giving to the alcoholic compound such a form as may render it not peculiarly pala- table or inAdting. 200. Lactation.—The benefit derivable from the use of Alco- holic liquors to support the system during lactation, is more doubtful. Certainly it may be affirmed, that in every case in which the appetite is good,"and the general system healthy, the habitual use of these stimulants is no more called for than at any other time; and that they are likely to produce the same injurious effects as when unnecessarily given under ordinary circumstances. The regular administration of alcohol, with the professed object of supporting the system under the demand occasioned by the flow of milk, is « a mockery, a delusion, and a snare. For alcohol affords no single element of the secre- tion; and is much more likely to impair than to improve the quality of the milk. The only mode in which it can contri- bute, even indirectly, to increase the amount of solid aliment which the secretion may contain, is by affording a supply of IN EXCEPTIONAL CA9HS. 151 combustive material, the consumption of Avhich may leave more oleaginous and saccharine matter to pass into the milk. But Avhere the appetite already prompts to the mgestiou, and the stomach is equal to the efrgestion, of an adequate amount of solid food, no such benefit can be looked for ; and although it cannot be certainly affirmed that the character of the milk is always impaired by the habitual use of moderate quantities of alcoholic liquors, yet there can be little doubt that such is usually the case. For it is unquestionable that their excessive employment is highly prejudicial to the quality of the milk; and thereby to the health of the child; having a special ten- dency to occasion derangements of the digestive organs, and convulsive complaints.* This, indeed, might be fully expected ; since all that avc knoAV of the mode in Avhich substances taken into the blood affect the mammary secretion, would lead us to expect that alcohol, if introduced into the circulation more ra- pidly than it can be consumed, Avould pass into the milk, and would consequently produce the same effects upon the child as if directly given to it—besides deranging by its presence, the act of secretion itself, in virtue of its tendency to produce coagu- lation of albuminous matters. And the fact that multitudes of Avomen of good constitutions, Avhose general habits are condu- cive to health, go through the period of lactation without any feeling of debility, simply finding their appetite increased during its continuance, is a sufficient proof that this condition is not one Avhich in itself occasions a demand for alcoholic liquors. 201. But there are cases in Avhich, notwithstanding all that can be done to promote the general health, the stomach does not seem capable of retaining and digesting the requisite amount of nutriment, except under the artificial assistance af- forded by Alcoholic liquors; and in which it appears more de- sirable, for the Avelfare alike of mother and child, that such as- sistance should be afforded than that lactation should be carried on without it. In one case of this kind that fell particularly under the Avriter's notice, in which the mother Avas most an- xious to avoid the assistance of fermented liquors, and began to nurse Avithout their support, the milk Avas obviously too poor in quality, and not sufficient in quantity, for the"" nutrition of the infant; and the use of a single glass of Avine, or a tumbler * Dr. North says (Practical Observations on the Convulsions of In fants) that he has seen these almost instantly removed by the trans- ference of the child to a temperate woman. Q 4. 152 U?E OF ALCOUOL of porter per day, was followed by a speedy and marked im- provement in the condition of both mother and child ; and this small allowance did not require to be increased during the con- tinuance of the lactation, and was relinquished without difficulty soon after the weaning of the infant. In such cases, the alco- holic liquor seems to have no other operation than that of en- abling the stomach to digest the amount of solid aliment re- quired by the system ; whilst the smallness of the quantity of alcohol introduced at any one time, prevents it from either it- self passing into the milk, or exerting any injurious influence on the secreting process. But it may be questioned whether the practice is in the end desirable ; or whether it is not, like the same practice under other circumstances already adverted to, really detrimental, by causing lactation to be persevered in, without apparent injury at the time, by females whose bodily vigor is not adequate to sustain it. Sueh certainly appeared to be the case in the instance just referred to; for the system remained in a very depressed state for some time after the con- clusion of the first lactation ; and on subsequent occasions it has been found absolutely necessary to discontinue nursing at a very early period of the infant's life, owing to the inadequacy of the milk for its nutrition, and the obvious inability of the mother to bear the drain. Hence it may be affirmed, with tolerable certainty, that the first lactation, although not pro- longed beyond the usual period, and although apparently well sustained by the mother, Avas really injurious to her ; and the inability to furnish what was required, Avithout the stimulus of alcoholic liquors, Avas Nature's warning, Avhich ought not to have been disregarded. 202. Considering, then, that lactation (unlike pregnancy) may be put an end to at anyT period, should it prove injurious to the mother, the writer is disposed to give the full assent to the dictum of Dr. Macnish: that " if a woman cannot afford the necessary supply Avithout these indigencies, she should give over the infant to some one who can, and drop nursing altogether."—" The only cases," continues Dr. M., " in which a ■moderate portion of malt liquor is justifiable, are when the milk is deficient, and the nurse averse or unable to put another in her place. Here, of two evils, we choose the less, and rather give the infant milk of an inferior quality than endanger its health by weaning it prematurely, or stinting it of its accustomed nourishment."* Now upon this the writer would * Anatomy of Drunkenness, p. 301. IN EXCEPTIONAL CASES. 153 remark that a judicious system of feeding, gradually introduced from a very early period in the life of a child, will generally be preferable to an imperfect supply of poor milk from the mother ;* and that, if the mother be so foolish as to persevere iu nursing her infant, Avhen nature has warned her of her inca- pacity for doing so, it is the duty of the medical man to set before her, as strongly as possible, the risk—the almost absolute certainty—of future prejudice to herself. The evils Avhich pro- ceed from lactation, protracted beyond the ability of the system to sustain it, may be to a certain degree kept in check by the use of alcoholic stimulants ; but the writer is convinced, from observation of the above and similar cases, that its manifesta- tion is only postponed. Under no circumstances, therefore, can he consider that the habitual or even occasional use of alcoholic liquors, during lactation, is necessary or beneficial. 203. Childhood.—It has been maintained by some, that there' are certain states of the constitution in childhood in Avhich benefit is derived from the habitual use of small quantities of fermented liquors ; and this especially in those Avho inherit the scrofulous diathesis, and in Avhom the nutritive functions are altogether imperfectly performed. Experience, it is said, de- monstrates the benefit Avhich is derivable from the judicious employment of stimulants, in exciting the digestive and assimi- lative processes to augmented activity, and in thus improving the general tone of the system. It is not denied that temporary benefit may be derived from such a course; but this will be obtained at the risk of prospective evil, extending through the whole of life. For, if the habit be begun thus "early, it will seldom be found possible to discontinue it; the stomach is rendered dependent upon artificial support; and the improve- ment which this appears to produce Avill probably render the parent less anxious to avail himself of other means of invigo- rating the system, and of promoting a more active and complete performance of the nutritive actions, which are more permanent in their character, because they act more naturally on the system. Every measure of this kind, therefore—such as un- limited exposure to fresh air (avoiding damp and cold,) plenty of exercise, warm but not too impervious clothing, the copious * The author has found, in his own experience, that good Cow's milk, somewhat diluted with water, and sweelened with a small quantity of sugar (so as to be brought nearly to the composition of Human milk,) has answered extremely well even for very young infants. g 5 154 USE OF ALCOHOL use of cold Avater with the addition of salt, sea-bathing, and other adjumenta—ought to have a complete trial, before re- course be had to the completely artificial support yielded by alcoholic liquors. 204. There cannot be any reasonable doubt that the habitual use of Alcoholic liquors by children in average health is in every Avay injurious.* In no period of life are the nutritive functions more energetically carried on, if the child be only placed in circumstances favorable to health ; and at no period of life is there such a disposition to take just that amount of exercise of the nervo-muscular apparatus which is beneficial to the system, Avithout exceeding it. The motives Avhich stimulate the adult to over-exertion in his battle wdth the Avorld, do not operate upon the child : unless forced by the zeal of injudicious instructors, he will seldom be disposed to carry his mental ex- ertions beyond the stage at Avhich they may be best intermitted; and Avhilst naturally7 prone to muscular exercise, he readily complains of fatigue, and is indisposed to persevere after this warning of the failure of his poAvers. The chief thing to. be watched for and avoided, therefore, is the excess in diet to which children are sometimes prone, more especially if their palates be tempted by articles of which they are fond; and if this be duly restrained, and every natural means for the pre- servation and improvement of health be judiciously and perseveringly employed, it is believed by the writer that more good will in the end be done than will be accomplished by the assistance of alcoholic liquors. And in support of this belief, he can appeal to the large numbers of families noAv groAving up, in this country and America, in the enjoyment of vigorous health, among Avhom no alcoholic liquor is ever consumed; * In illustration of the injurious effects of the habitual use of fermented liquors upon healthy children, Dr. Macnish (Anatomy of Drunkenness,p. 302) relates the following experiment made bv Dr. Hun, ter upon two of his children,both of then/having been previously unused to wine. To one, a child of five years of agcjie save every day a full glass of sherry; to the other, a child of nearly the same as>;e, he gave an orange. In the course of a week, a very' marked difference was perceptible in the pulse, urine, and evacuations from the bowels of the two children. The pulse of the first child was raised, the urine high colored, and the evacuations destitute of their usual quantity of bile. In the other child, no change whatever was produced. He then reversed the experiment; giving to the first the orange, and to the second the wine and the results corresponded: the child who had the orange continued well and the system of the other got straightway mto disorder as in tha first experiment. B»"w»j IX EXCEPTIONAL CASKS. 155 aud he can point to numerous cases Avithin his personal know- ledge, in Avhich the apparent debility of constitution having been such as in the opinion of some to call for the assistance of fermented liquors, the advice Avas resisted, and those other nietms adopted Avhich have been already adverted to, with the effect of rearing to vigor and endurance children that originally ap- peared very unlikely to possess either. 205. Old Age.—It has been maintained, again, by some of those who fully admit the undesirableness of the habitual use of Alcoholic liquors during the a igor of early and middle life, that they are requisite or useful for the support of old age. Noav, upon this point, also, the Avriter believes that much misconception is prevalent, arising out of a disregard to the dictates of Nature on the subject. During the most active period of life, the " Avaste " of the body is considerable, and the demand for food, and the poAver of digesting it, are both adequate (in the healthy state) to supply that waste. _ But with the advance of years, the power of activity diminishes; the body (so to speak) lives much more slowly, as is proved by the lessened exhalation of carbonic acid and the diminished excretion of urea; and the Avaste being thus lessened, the de mand for food, and the poAver of digesting it, are proportionable diminished. Now this abatement of the appetite and digestivy power (like that Avhich is felt by those who _ go from cold or temperate climates to reside in tropical regions) is a natural warning that a smaller amount of food should be taken in ; and if it be so received, and no more nutriment be habitually ingested than the appetite legitimately prompts, the digestive poAvers will be found as adequate as in a state of greater ac- tivity to provide for the wants of the system. But this abate- ment is very commonly regarded as an indication of the failure of the poAvers of the stomach ; and the recourse is had to alcoholic liquors, with, the vieAV of re-exciting these. Now, although from such a practice, when very moderately resorted to, less prospective evil may be anticipated, as regards merely the effects of the continual ingestion of alcohol upon the stomach, than it is liable to occasion when commenced earlier in life • yet it is very much to be deprecated on another account—namely, that it forces admission into the system (so to -peak) for a larger amount of alimentary matter than it can appropriate ; and as all the organs which are set apart for the elimination of the superfluity (the kidneys, the liver the skin, Tnd the glanduke of the intestinal canal), are les* eanly o 6 150 USE OF ALCOHOL stimulated to increased activity in the decline of life than at an earlier period, it folloAVS that habitual excess in diet, even though to no great amount, is yet more likely to be followed by the disorders which it tends to produce. And hence, it is, more especially, that we find the lithic acid diathesis so prone to manifest itself in advanced life, and requiring such careful dietetic management for its correction. 206. The author would not take upon him to deny that cases may present themselves in which the habitual use of a small quantity of Alcoholic liquors may be beneficial to persons advanc- ed in life and not suffering under any positive ailment, but expe- riencing absolute deficiency of digestive power beyond that which is in conformity with the general decline of activity; in such cases, the benefit to be expected from their employment is that the stomach should be assisted in the digestion of the food which the system really requires ; and in so far as their use is carried beyond that point, it is hurtful in every way. Such cases may be expected to be rare among those who have habitually ob- served the laAvs of health, and who have not prematurely exhausted the powers of their digestive apparatus by habitual excess in diet or in mental labor, or by the continual use of stimulants. Those, on the other hand, Avho have adopted the habit, early in life, of relying upon the aid of alcoholic liquors for the performance of the digestive operation ; or who have overtasked their nenrous systems, and thus deprived the sto- mach of the nervous power which it requires; or Avho have impaired their vigor by breathing a foul atmosphere, by irregu- larity and insufficiency in regard to the periods of repose, or by various other departures from the ordinances of Nature; are more likely to suffer in advanced life from a loss of diges- tive power, Avhich no treatment, medical or hygienic, can ever completely repair. 207. But here, as in all other instances, if the prolongation of life and the restoration of vigor be the paramount objects of consideration, recourse should at first be had to all those measures of general Hygiene, which prudential experience TU t /"ecommend 5 and the assistance of alcoholic liquors should be avoided, with a jealous apprehension of their pros- pective evils, until it shall appear that no other more natural means can bring about the desired result. Those who have been in the habit of employing them during the whole of life are certainly those who are least likely to feel able to dispense with them in old age: yet ^p.rience h a, demonstrated .even IN EXCEPTIONAL CASES. 1 57 here, that, Avhere the evil results of their continued use have begun to manifest themselves, decided and permanent benefit has followed their abandonment; and where it was believed by the individual that he could not possibly dispense with their use, the stomach has recovered its healthy tone (especially under the copious external and internal use of cold Avater, and the influence of an invigorating atmosphere,) so as to be able to discharge its duties for the remainder of life Avith greater ease than it ever previously had done.* 208. For the results of experience on this and other points, any statements of Avhich should be based rather on a wide and general survey than on induction from a comparatively limited number of instances, the author has thought it safest to rely on the assurances of medical practitioners in the New England States; since the entire disuse of fermented liquors has been now practiced as a habit, for some years, by a large proportion of the population of those States, including those who are most subject to those influences (the " wear and tear" of social life) which are usually regarded as most powerfully conspiring to render the assistance of stimulants desirable.—The folloAving statements on this subject have recently been put forth by the Massachusetts Temperance Society, under the sanction of their distinguished President, Dr. Warren :—f 209. " In regard to the habitual use of Avine, it is probable that the change of opinion is greater here than in Europe. A vast number of persons on this side of the Atlantic have wholly abandoned the use of Avine, cider, and malt liquors; and many of those who continue to employ7 them have greatly diminished the quantity. Wine is no longer thought necessary in the con- valescent stage of fever. Cider, formerly one of the household provisions of almost every family in the North, is rarely seen ; and the very trees Avhich produced it are either cut doAvn for fuel, or converted to the production of fruits for food. The stronger beers are quite disused, except among emigrants; and even the milder are employed only in some very light and un- stimulating form to allay thirst, principally in the hot season." " The apprehension that a sudden disuse of fermented liquors might be injurious has been dispelled by a vast number of cases, in which, after long-continued employment, a sudden and * For two remarkable cases of this kind, see Appendix C. t Preface to the Reprint of an Essay on the Physiological eff^ Alcoholic Drinks, from Dr. Forbea's Review, Boston, .v Tv, 1B4S 158 USE OF ALCOHOL total abandonment has taken place, not only without impairing health and comfort, but with positive improvement in strength, activitv, and agreeable sensations. IIoav common is it amongst us to see persons Avho in former times used wine freely, and who have noAV given it up, present an appearance of mental and bodily vigor they had not exhibited before. The influence of such a change of habit in the wealthier classes has been great beyond calculation, in leading the mass of society to abandon the use of spirits, and to repeat an experiment already made by those Avhom they are accustomed to respect and follow. Si;eh having been the consequences of the disuse of Avine, how desirable is it that all those Avho have not abandoned it, who * wish Avell to their fellow-men, and are Avilling to show that they are capable of making the sacrifice they advise, should submit to a privation Avhich they have sufficient reason to be- lieve Avill be most salutary to themselves and others." 210 The extent of change of habit, in this respect, among the middle and higher clas-es of society in Boston, and other great towns of Xcav England, may be judged of from the fact that many of those public festivities at Avhich the assistance of 4 alcoholic liquors is considered indispensable in this country, are there conducted Avithout anyT such artificial excitement. '• Of late years" (we quote the same authority), " we have had the gratification of witnessing so many exceptions to the former practice, that it appears very probable that the rule will be re- versed, and the exceptions change to the opposite side. The great festivals on the Anniversary of National Independence are in many places celebrated without other stimulus than that of patriotic feeling. The annual ceremonies of our literary ' institutions, too often stained by lavish draughts of the juice of the grape, are noAv purified by the effusions of chastened wit, and elevated by the flights of au unci aided imagination. Most of the Universities, and particularly the oldest, and we may perhaps venture to say the most distinguished, have unshackled themselves from the chains of ancient habit. Under the influ- ence of a master-spirit (President Everett) the great annual festival of Commencement at Cambridge University has been accomplished Avithout the aid of Avine; and the oldest of our literary fraternities, the Phi Beta Kappa Society, has enjoyed the excitement of a social meeting Avithout the consequent de- pression from artificial stimulus. "Wine is no longer admitted at the yearly convocation of the Clergy, or the assemblage of the Medical profession of this state, the great association of IX EXCEPTIONAL CASES. 159 mechanics of the metropolis hold a brilliant triennial feast, from which every kind of alcoholic, fermented, vinous, and other stimulating liquid is wholly excluded."* 211. On the whole, then, the writer thinks that Physiology and Experience alike sanction the conclusion that, although there are states of the stomach in Avhich the diminished appe- tite and digestive power prevent the reception of an adequate supply of aliment into the system, and in which the assistance of alcoholic liquors is temporarily beneficial, that assistance is rather a. palliative than a cure of" the condition which calls for it; and, if perseveringly had recourse to, is likely to induce a train of evils of its OAvn; whilst, at the same time, by the ap- parent support which it gives, and by rendering the system more tolerant of the unfavorable influences from which its de- pression of .power may have proceeded, it renders the individual less disposed to seek, in a change of habit, the remedies Avhich will be really effectual. " Thus," as an American physician has remarked to the Avriter, " where you (the English practitioner) recommend to a man losing his digestive poAver, from the fa- tigue and confinement of a city life, to take Avine, porter, or bitter ale, Avith his dinner, we order him out of toAvn, to get fresh air, and the refreshment of idleness in the country." No man of observation can doubt which of these two systems is likely to be most beneficial in the long run. 212. But, again, the writer believes that there are exceptional cases, arising chiefly from peculiarity of original constitution, in which the want of digestive poAver is more completely and per- manently supplied by the habitual use of a small quantity of Alcoholic liquors than it can be by any other means within the power of the individual. It may be impossible to predicate, in any individual instance, whether this shall be the case or not; but the results of observation appear sufficient to prove that it would be erroneous to assert dogmatically that it never can be. Still, the evils resulting from the unnecessary employment of stimulants are so great that recourse should never be had to * In order to give a more exact idea of the importance of the cele- brations alluded to above, we huve thoaght it well to state the number of persons that attended them, as nearly as can be ascertained. Fourth of July Celebration in Faneuil Hall - - 1000 Commencement at Cambridge University - - 300 Festival of Phi Beta Kappa.....150 Festival of the Clergy " ! ' . " ' ' ?22 Festival of the Massachusetts Medical bociety - 300 Festival of the Massachusetts Mechanics' Association. 600 160 TSE OF ALCOHOL IK EXCEPTIONAL CASKS. them until every other more natural method of sustaining the vital poAvers has been tried without success; they should never be employed to replace any hygienic requirement,such as fresh air, mental repose, muscular exercise, &c.; and they should be disused whenever it may appear that the necessity for them no longer exists. C8E OF ALCOHOL IN THE TREATMENT OF DISEASE. 161 CHAPTER IV. IS THE EMPLOYMENT OF ALCOHOLIC LIQUORS NECESSARY IN THE PRACTICE OF MEDICINE ? IF SO, IN "WHAT DIS- EASES, OR IN WHAT FORMS AND STAGES OF DISEASE, IS THE USE OF THEM NECESSARY OR BENEFICIAL t 213. Those who maintain that Alcoholic liquors are not requisite for the ordinary sustenance of Man, or even that they are likely to be rather prejudicial than otherwise when habit- ually taken in small quantities—that, in fact, Alcohol is to al- most every one a true poison, slower or more rapid in its opera- tion, accordii g to the rate at Avhich it is taken—may still main- tain, with perfect consistency, that (like many other poisons) it may be a most valuable remedy Avhen administered, with caution and discrimination, in various forms of disease. In re- plying to the aboA'e question, Ave shall first look at the inferen- ces which we may draw from the physiological action of Alcohol, in regard to the conditions of the system in which it is most likely to be useful. I. RECOVERY FROM SHOCK. 213. We have seen that Alcohol, when introduced into the circulation, acts as a stimulant in augmenting the force and rapidity of the hearts contractions, and that it abo increases the excitability of the nervous system ; Ave have found, moreover, that it supplies the means of keeping up the Animal Heat, which may be advantageously employed when other means are deficient. Hence we should say that alcoholic liquors may be advantageously employed to assist in rousing the system from the effects of agencies of various kinds, which threaten, for a time, to produce a fatal depression of the vital poAvers ; such, for example, as severe injuries that produce a violent shock, under the primary effect of which the system appears likely to sink. But great caution must be used in their administration, and they should not be given unless there appears to be a positive necessity for doing so (i. e. unless the patient appears likely to sink without them) ; for it is as certain that reactionary excitement will follow a primary depression as it is that 102 IN THE TREATMENT OF DISE1SS. depression will be consequent upon primary excitement; and if Btimulaiits have been unnecessarily employed, the difficulty of controlling the reaction Avill be increased. This caution is more especially necessary where the brain is the part to which the injury has occurred ; since the special determination of alcohol to this organ Avill increase the violence of the re-action in a most dangerous manner. 214. There is no class of cases, perhaps, in which the good effects of stimulants in maintaining the heart's action, and in keeping up the nervous excitability, are more manifest than in those severe and extensive burns of the trunk of the body to which the children of the loAver classes are peculiarly liable, from their clothes taking fire through carelessness or negli- gence. The shock given by this injury to the delicate and impressible system of the child is often rapidly fatal; the heart's action being extremely depressed, the nervous poAver reduced, and the body gradually cooling, until its temperature falls to a degree incompatible with the maintenance of life. The Avriter has witnessed many such cases, in Avhich life seemed to be kept in the body by the frequent administration of a spoonful of cordial, but in which death supervened upon a short intermis- sion of the stimulus—the nurses in Hospitals being generally possessed Avith the belief that the little patients must die, and being too freqently careless in the employment of the only means by Avhich life can be sustained. II. TREATMENT OF ACUTE DISEASES. 215. Resistance to the depressing influence of Morbific Agents' •—In the class of cases to.which reference has just been made the shock is temporary ; and if the patient can be kept alive until the system has recovered from its immediate consequences, a great point is gained. There is another class of cases in which the depression is produced by a morbific agency, and in which it is of equal importance to keep up the vital poAvers for a time ; since, if they can be sustained for a feAv hours or days, the patient has a fair chance of recovery. Of such Ave have examples in many forms of Fever; especially in those which run a tolerably determinate course, and which exert their noxious influence rather in producing a general depression of the vital powers than in occasioning any decided local lesion. No two epidemics of fever are precisely alike ; and the treat- ment which is of service in one may be found injurious in the other, notwithstanding that the general type maybe the same. USE OF ALCOHOL 16.1 A severe epidemic of typhoid fever, Avhich the Avriter witnessed in Edinburgh in the years 1836-7, afforded him an opportunity of seeing the decided efficacy of Alcoholic stimulants in one form at iea.;t of this fever ; the opposite methods of treatment, followed lv two physicians whose practice he watched, being attended with such different results that, as the cases were of the same ehiss, and other conditions identical, there Avas no other way of accounting for the difference. By neither phy* sicians were any active measures taken during the early stages of the fever, for none seemed called for ; but in one set of cases the same expectant practice Avas continued to the end ; whilst in the other, the administration of Avine and spirit was com- menced, as soon as the Aveakness of the pulse, and the coldness of the extremities, indicated the incipient failure of the circula- ting and caloritying powers. The quantity was increased as the necessities of the patient seemed to require ; and in one case (that of a woman whose habits had been previously in- temperate, and on whom a more potent stimulus Avas therefore needed to make an impression), a bottle of sherry with twelve ounces of Avhiskey Avas the daily alloAvance for a week or more —the patient ultimately recovering. Noav the result of this wine-treatment Avas that the mortality was not above a third of that of the simple expectant treatment : the patients dying under the latter from actual exhaustion and failure of calorifying poAver, and no local lesion being detectible on post- mortem examination. 216. It is by no means difficult to give a satisfactory ration- ale of this beneficial action. The immediate cause of death in such cases appears to be a failure of the power of the heart, the contractions of which, in the advanced stage of typhus and typhoid fevers, become progressively feebler and more rapid; and it has been noticed by Drs. Stokes and Graves, as the best indication for the use of wine, that the impulse is greatly diminished, and that the first sound becomes very feeble or is entirely extinguished. Noav the effect of Avine, where it acts beneficially, is to render the heart's action more vigorous and at the same time slower. Again, Avith this state of the circula- tion Ave generally have a Ioav muttering and restless delirium, with an approach to subsultus tendinum ; and if the wine acts beneficially, it renders the patient more tranquil and disposes him to sleep. Under the influence of wine, too, in suitable cases, the skin and tongue become moister, and the breathing more deep and slow ; but if the Avine be acting injuriously, the 164 CSE OF ALCOHOL skin and tongue become drier, and the respiratory movements more hurried. Concurrently with the failure of the heart's ac- tion, there seems often to be a deficiency of heat-producing material; all that was previously contained in the body having been burned off during the earlier period of the fever; and little or none having been taken in from without. Day by day the fatty matter of the body is used up by the respiratory pro- cess; and thus, as in cases of simple starvation, the patient must die of cold, unless some means be provided for the sus- tenance of the heat. In such a condition of the system, no farinaceous or oleaginous matters could be digested or absorbed in sufficient quantity ; Avhereas alcohol is taken into the current of the circulation by simple endosmose, Avithout any preparation Avhatever, and can be immediately applied to the production of heat. 217. N">av in the cases in which the Alcohol is thus useful, there is an entire absence of stimulating effects. This is pro- bably due in part to the fact that the Alcohol is burned off nearly as fast as it is introduced (the general rule in such cases being to give a small quantity at a time, but to repeat this frequently) ; but it would also appear to result in part from this—that the stimulating poAver of the Alcohol is expended in neutralizing (so to speak) the depressing influence of the fever-poison already in the system, and that it simply tends, therefore, to restore both the heart and the brain to their con- dition of normal activity. Where the habits of the patient have been previously intemperate, the ordinary doses of alco- holic stimulants have no perceptible effect; and it is necessary to go on increasing them, until some marked influence is ex- erted by them—as in the case just now cited. 218. It is not only in the idiopathic typhoid and typhus fevers that Alcohol thus becomes the most important remedy which the Physician has at his command ; for it is equally so in the typhoid states of other diseases, especially Erysipelas, and the Exanthemata; and it is in the typhoid form of erysipelas, Avhich so often presents itself in men of the bad habit of body resulting from habitual intemperance (§ 63), that the largest quantities of alcoholic stimulants may be given, without any other perceptible effect than that most beneficial one—the support of the system Avhilst the disease runs its course. 219. Recovery from States of Prostration.—-During the stage of convalescence from fevers and acute inflammatory dis- eases, in which the vital powers have been greatly depressed, \ IN THE TREATMENT OF DISEASE. 165 it Avill frequently happen that the use of alcoholic liquors will be decidedly beneficial; and this apparently in two ways—by raising the neivous system from that Ioav irritative state which is the consequence of depressed vit.d power, and by increasing the digestive power of the stomach and the general nutritive activity of the system, so that the reparative processes take place more rapidly, and the general vigor is more speedily re- stored. Every practical man must have perceived that the state of debility in which the patient is left after the termination of an acute disease is extremely different from the state of exhaustion consequent upon a long-continued course of over-excitement. The former partakes of the nature of shock; the vital poAvers are not so much exhausted as depressed; and recovery is best promoted by arousing the system, so far as possible, to the due performance of its functions. If alcoholic stimulants are really beneficial under such circumstances, they make their utility ap- parent in the same Avay as in the advanced stage of typhoid fever—that is, by reducing the rapidity of the heart's action at the same time that its strength increases, and by calming the mind instead of exciting it. Dr. A. Combe mentions the case of a delicate lady, who, during recovery from fever, took to the extent of a bottle of Madeira in twenty-four hours, Avith these obviously beneficial results. It is well knoAvn that much depends, in this condition, on procuring as speedy a reneAval as possible of the normal actions of nutrition, especially where either the disease, or the treatment it has required, has caused them to be greatly lowered, or almost entirely suspended ; for there is great danger lest the convalescent should pass into a cachectic condition, and a foundation be laid for tubercular or or other forms of disease dependent upon the imperfect perfor- mance of the nutritive processes. Hence, if, Avhen these opera- tions are just being reneAved, a little increased energy can be artificially imparted to them, Ave have a better hope of escape from these evil consequences. As a general rule, no alcoholic stimulants should be employed, until after the complete subsi- dence of the inflammatory processes : but this rule is not in- variable ; for a state of chronic inflammation is often kept up by the Ioav and imperfect state cf the general nutritive opera- tions, and hence (as Professor Alison Avas wont to teach and to practice with great success), however contradictory it may at first appear, we may frequently combine a general tonic or somewhat stimulant regimen -with local depletion or counter- irritation. THE TREATMENT OF DISEASH . Alcoholic stimulants are employed for these j greatest care and watchfulness should be used in dstration, both to avoid doing positive mischief by /se, and also to avoid bringing the system into a habit ndence upon them, and thereby predisposing it to the ,s remoter evils formerly described. There is no doubt a course of over-indulgence in alcoholic liquors has fre- jntly commenced with the therapeutic use of them ; and it , extremely desirable, therefore, that the medical practitioner should enforce the diminution of the dose, and the final discon- tinuance of the remedy, at the earliest possible period—substi- tuting, if he should think it necessary, a small quantity of alco- hol in some medicinal form—in order that the patient may have as little motive as possible for continuing its use, after the time for their really beneficial action has passed. 221. Support under Exhausting Drains.—There is another class of cases, in which the stimulating action of Alcoholic liquors may be occasionally had recourse to Avith advantage; those, namely7, in which there is great drain upon the nutritive material, OAving to some disordered action Avhich at the same time lowers the vital powers of the system—such, especially, as an extensive suppurating surface. Now here the general rub1, that the ap- petite and the digestive power are proportionate to the demand for nutriment in the body, does not hold good ; since the depressing influence of the disease lowers the functional activity of the digestiAre apparatus to such a degree that it cannot sup- ply what is needed ; and thus there is a progressive dimunition of the nutritive solids of the blood, Avhich still further depresses the vital poAvers of the system. We should therefore antici- pate a beneficial result from such an employment of alcoholic stimulants as would for a time augment the digestive poAver of the stomach, and Avould thus enable it to appropriate and pre- pare the amount of nutritive matter which the system really needs, Avhilst at the same time its general poAvers are sustained under the depressing influence of the disease. Experience shoAvs that such is the case; and that, under such circumstan- ces, alcoholic liquors may be beneficially employed^ not so much to stimulate the heart, or the nervous system, nor to take the place of solid food; but, by stimulating the stomach, to augment the quantity of solid material Avhich it can advauta- geously receive. 222. Allusion has already been made to the unfavorable course which febrile and inflammatory diseases are disposed to USE OF ALCOHOL 167 run in the habitually intemperate; this being chiefly depen- dent upon the imperfect elaboration of plastic material, which predisposes to suppurative action, or to gangrenous or phage- denic ulceration, and impedes the attempt at regeneration which constitutes a most important part of the asthenic form of inflam- mation. A similar disposition to the asthenic form of inffam- matory disease and its severe consequences is seen among the habitually ill-fed, ill-lodged, ill-clothed inhabitants of the den- sest and worst-drained parts of our great towns, manyof Avhom are also intemperate; and in many of these cases, it would seem requisite to support the system by Alcoholic liquors, even during the acute stage of an inflammatory attack, in order to enable it to resist the depressing influence of the disease, and to bear the requisite treatment. AVhatever arguments the plasti- city of the fibrine, up to a certain point, is likely to be benefi- cial ; and as the great object in such cases is to give the requi- site support Avithout stimulus, the use of malt liquors Avill be indicated. Here, too, we find that experience is in full ac- cordance with the teachings of theory ; and that ale and por- ter are frequently the physician's and surgeon's main stay under such circumstances. They must, however, be very guardedly employed ; and the test of their beneficial influence will be found in the absence of stimulating effects, and in the improvement of the character of the inflammatory process; which will be made known, Avhere there is prudent discharge, by the conversion of a thin, sanious, fetid pus into that which is expressively designated by the term " laudable," and by the stoppage of an extending gangrene or phagedaena. 223.- The foregoing are the principal forms of acute disease, in which recourse may be advantageously had to Alcoholic liquors; but the writer Avould remark that, whilst general principles may be thus laid down, their application to each individual case must be left to the discrimination and tact of the practitioner, since no two cases are alike in all their con- ditions ; and it will frequently happen that even the most ex- perienced physician and surgeon will find it necessary to be rather guided by the result of trials cautiously made, than by any rules Avhatsoever. In cases of fever, it may be especially noticed that the instinct of the patient, shoAvn by his desire for wine, or his disposition to reject it, will generally prove a most A'aluable guide, even when his intelligence is prostrated. 224. Forms of Alcoholic Liquors most desirable.—The dif- ferent forms of alcoholic liquors must not be used indiscrimi- USE OF ALCOHOL i varying conditions, for the operation upon the , considerably, and there are certain conditions to Avhich each is especially appropriate. Thus, .rit is the most rapid and powerful in its action upon and nervous system ; and hence it is the most potent alcoholic liquor in those states of alarming depression vhich Ave desire to arouse the patient as rapidly as possi- We find, too, that it is frequently requisite to administer .its to patients who have been in the habit of free or .cessive indulgence in alcoholic liquors, under circumstances in which wine would otherwise be preferable, e. g. in Fever; the milder stimulus, in such cases, not producing the effect we desire. Were, hoAvever, we desire to give more continued support, Avith less of stimulation, it is not usually desirable to administer distilled spirit, and wineAvill be found the preferable form ; this is especially the case in the advanced stage of fever, and in convalescence from acute diseases. On the other hand where we desire to give still greater support, with as little stimulation as possible, as in the class of cases last referred to, malt liquor may be more advantageously employed; as the alcohol, probably from its peculiar state of admixture, is less disposed to exert its remote effects, and the nutritive matter with which it is combined is in itself beneficial; whilst the bitter and somewhat calmative properties of the bop aid in producing the desired effect upon the stomach. III. TREATMENT OF CHRONIC DISEASES. 225. Of the use of Alcoholic liquors in the treatment of chronic diseases, however, it becomes us to speak with much greater caution ; the condition of the system under the deprei- sing influence of " shock " or of poisonous agents being very different from that Avhich results from the exhaustion of its powers through chronic diseases, although debility is a charac- teristic of both. The avliter's idea of the difference between the two states, and of the relations of each to alcoholic stimu- laiits, may perhaps be best explained by a simple illustration. When a vigorous man is prostrated by a violent blow, he speedily rallies from it, and is all the better for the aid of a helping hand in getting on his legs again. But if the same man expend his powers in a prolonged pugilistic encounter, although he may not have received any one severe injury, he becomes at last so exhausted that no helping hand can avail him anything, and he sinks beneath the slightest force put forth IN THE TREATMENT OF DISEASE. 169 by his opponent—nothing but time and rest being then effectual for his restoration. In general, then, it is believed by the writer that little permanent good can be expected from the use of alcoholic stimulants in chronic diseases, so far, at least, as regards their stimulant operation upon the heart and nervous system ; and what benefit they are capable of conferring will be obtained by their improvement of the digestive power, and of the processes of primary assimilation. But it is very doubt- f-. Avhether the temporary improA-ement which can sometimes b, ,uus obtained is not really fallacious—like that which we see in the burning of a lamp, just after the raising of the wick, when there is a deficiency of oil; since it is procured, not by the re-animation of power which exist in the body, but has previously lain dormant, but by the more rapid consumption of the small stock of power left. And the question of their benefit or injury will often depend upon whether, by this more rapid consumption, new vigor can be infused into the system, by the introduction of new material. 226. The use of Alcoholic stimulants in such cases has been hitherto so customary Avith medical men, that it may seem to be running in the face of the established results of experience, to deny or even to doubt their efficacy. But we have seen reason, within a recent period, to deny or doubt the efficacy of many systems of treatment of chronic diseases which long- continued experience appeared to have sanctioned, and to believe that the vis medicatrix of the system is often itself the great restorer, when time is given for its operation, and other circumstances concur to favor it. And it is especially important, in judging of the action of all remedies which must be per- severed in for some time in order to produce any decided result, to take their remcte consequences fully into account, and to consider hoAv far these are, or are not, favorable to our object. Now the writer has endeavored to show that the remote con- sequences of the continued use of alcoholic liquors, even in small quantity, are all of them so unfavorable to health that, if the immediate invigoration of the digestive power aud of the assimilative processes, which seems to be their only beneficial effect under such circumstances, can be obtained in some other way, it will be most desirable to avoid their use. 227. This will be more particularly the case, when the causes of the disordered state have been such as to exhaust the vital energy of the stomach itself—such as long-continued excess in diet, and habitual indulgence in a moderate alloAvance of fer h 1. 170 LSB OF ALCOHOL mented liquors, especially when accompanied by exhaustion of the nervous power by over-exertion or anxiety of mind. It is quite absurd to expect that any change or variety of direct stimulation can reinvigorate the digestiA'e apparatus under such circumstances. We may keep our patient in town at his usual occupations, practice all kinds of experiments upon his stomach, recommend fat bacon or lean chops, prescribe blue pill and senna-draught, or quinine and calumbo, and ring the changes upon all the wines, spirits, and malt liquors which the cellar can furnish, without effecting any permanent benefit. Whereas, if he can be induced to give himself a complete holiday ; to be- take himself to some agreeable spot, where there is sufficient to interest, but nothing to excite ; to inhale the fresh and in- vigorating breezes of a mountainous country, in place of the close and deteriorated atmosphere of a toAvn; to promote the copious action of his skin by exercise, sweating, and free ablu- tion ; to Avash out his inside and increase the tonic power of his stomach with occasional (but not excessive) draughts of cold water; and to trust to the natural call of appetite alone, in preference to artificial piwocatives ; we shall be giving him the best possible chance of permanent restoration to health. 228. There is perhaps no class of cases in which the benefits of the Hydropathic treatment are so strikingly displayed, especially when it is carried on in a spot where all other aids concur to make it most effectual; and reasoning from analogy, the writer is strongly inclined to believe that it would be of similar efficacy in re-invigorating the system exhausted by other forms of chronic disease, and would in most cases be preferable to anyr form of alcoholic stimalants for procuring an increase of digestiA'e and assimilative powrer. So far as the writer is ac- quainted with the results of comparative experience, they are decidedly in favor of the Hydropathic treatment, moderately and judiciously applied, especially in cases of chronic Gout and Rheumatism; but he would not be dogmatic enough to assert that there are not individual instances in which (as in the class formerly adverted to § 194,) the long-continued or even the habitual use of alcoholic liquors will promote recovery from chronic diseases by their influence on the digestive and assimi- lative apparatus. He does not see the possibility, however, of laying down any general rules by which such cases can be dis- tinguished ; and it will be only from the results of an extended experience of the comparative advantages and disadvantages of different modes of treatment, and of the immediate and remota IN THE TREATMENT OF DISEASE 171 consequences of the employment of alcoholic stimulants, as compared with those of the abstinent system, that any really valuable inferences can be draAvn. Until these shall have been obtained, he believes that abstinence will in most cases be the safer plan; except Avhere the prostration of the vital powers has proceeded to such an extent as to require temporary stimula- tion for the performar.ee of any of the nutritive and regenera- tive operations. 229. It may not be amiss to remark, in conclusion, that it is through the medium of the Water contained in the Animal Body that all its vital functions are carried on. No other liquid than Water can act as the solvent for the various articles of food which are taken into the Stomach. It is Water alone which forms all the fluid portion of the blood, and thus serves to convey the nutritive material through the minutest capillary pores into the substance of the solid tissues. It is Water Avhich, when mingled in various proportions with the solid components of the various textures, gives to them the con- sistence Avhich they severally require. And it is Water which takes up the products of their decay, and conveys them, by a most complicated and wonderful system of seAverage, altogether out of the system. It Avould seem most improbable, then, that the habitual admixture of any other fluid—especially of one which, like Alcohol, possesses so marked a physical, chemical, and vital influence upon the other components of the Animal body—can be otherwise than injurious in the great majority of cases ; and where a benefit is derivable from it, this will depend upon the fact that the abnormal condition of the system renders some one or more of the special actions of alcoholic remedial instead of noxious, so that the balance becomes on the whole in favor of its use. h 2. APPENDIX A, P. 55. Some very remarkable details regarding the condition of the Ballasters and Coal-whippers employed on the Thames, have lately been ascertained by the inquiries of the " Commissioner" employed by the Morning Chronicle, and have been made public in the columns of that newspaper. The drinking habits of these men have been in part engendered by the system under which they have worked; which has involved, as the necessary condition of their employment, the expenditure of a large portion of their earnings at the public house. This system was done away Avith, a few years since, as regards the Coal-whippers ; but it still remains in force with respect to the Ballasters. Several of the former class are now Total Abstainers; while others who adopted the Abstinence system for a time have returned to their former habits. The in- quiries of Mr. Mayhew, the " Commissioner," were specially direc- ted to the experience of both these classes; and Ave shall first quote the statement of one of the latter, by way of showing the extreme severity of the labour undergone by these men, and the circumstan- ces under which the assistance of Alcoholic liquors is\mght by them : " I was a strict teetotaler for many years, and I wish I could be so hoav. All that time I was a coal-whipper, at the heaviest work, and I have made one of a gang that has done as much as one hundred and eighty tons in one day. I drank no fer- mented liquors the Avhole of the time. I had only ginger-beer and milk, and that cost me Is. Qd. It was in the summer time. I did'nt ' buff it' that day ; that is I did'nt take my shirt off- Did this work at Regent's Canal, and there was a little milk-shop close on shore, and I used to run there when I was dry. I had about two quarts of milk and five bottles of ginger-beer, or about three quarts of fluid altogether. I found that amount of drink necessary. I perspired very violently—my shirt Avas wet through, and my flannels wringing Avet Avith the perspiration over the work. The rule amono- us is that we do twenty-eight tons on deck, and twenty- eight tons filling in the ship's hold. We go on in that way through- out the day, spelling at every twenty-eight tons. The perspiration in th» summer streams doAvn our foreheads so rapidly, that it will oftenget into our eyes before we have time to Avipe it off. This makes the eyes very sore. At night when we get home Ave cannot H 3. 174 APPENDIX. bear to sit with a candle. The perspiration is of a very briny nature, for I often taste it as it runs down my lips. We are often so heated over our work that the perspiration runs into the shoes; and often, from the dust and heat, jumping up and down, and the feet being galled with the small dust, I have had my shoes full of blood. The thirst produced by our work is very excessive. It is completely as if you had a fever upon you. The dust gets into the throat and very nearly suffocates you. You can scrape the coal-dust off the tongue with the teeth; and, do what you will, it is impossible to get the least spittle hi to the mouth. I have knoAvn the coal-dust to be that thick in a ship's hold, that I have been unable to see my mate, though he was only tAvo feet from me. Your legs totter under you. Both before and after I Avas a tee- totaler, I Avas one of the strongest men in the business. I was able to carry seven hundred weight on my back for fifty yards, and 1 could lift nine half-hundreds Avith my right arm. After finishing my day's work, I was like a child with weakness." To the foregoing account, the folloAving may be added from another Avitness by way of finish to the picture :— " Then there's the coals on your back to be carried up a nasty ladder, or some such contrivance, perhaps tAArenty feet—and a sack full of coals weighs two cwts. and a stone at least; the sack itself's heavy and thick. Isn't that a strain on a man? No horse could stand it long. Then, Avhen you get fairly out of the ship, you go along planks to the Avagon, and must look sharp, 'specially in slip- pery or wet weather, or you'll topple over, and there's the hospital or Avork-house for you. Last week Ave carried along planks sixty feet, at least. There's nothing extra alloAvedfor distance, but there ought to be. I've sweat to that degree in summer that I've been tempted to jump into the Thames just to cool myself. The sweat's run into my boots, and I've felt it running down me for hours as I had to trudge along. It makes men bleed at the nose and mouth, this work does. Sometimes Ave put a bit of coal in our mouths to prevent us biting our tongues." Now it cannot be questioned that, such labor is greater than any man should be called on to perform ; and that, even if-it should be proved that assistance is derived in its execution from the use of Alcoholic liquors, the fact Avould not be in the least degree in their favor. For we might fairly anticipate -that under this artificial stimulation, more work being got out of the frame than it is natu- rally capable of discharging, its powers Avould be exhausted at an earlier period than that to which they would be preserved under a system of less excessive labor, performed without artificial support. And that such is_the case is abundantly proved by the fact that such of these men as "survive the attacks of acute disease, or are not the subjects of accident, become prematurely old; and that, among the Avhole class, there are few who have passed the age of fifty years. The amount of alcoholic liquor habitually consumed by APPENDIX. 175 them may be judged of from the following statements made to Mr. Mayhew by two men Avho have remained firm to the Total Absti- nence principle. " Before I Avas a teetotaler I principally drank ale. I judged that the more I gave for my drink the better it was. Upon an average I used to drink from three to four pints of ale per day. I used to drink a good drop of gin too. The coal- porters are very partial to dog's-nose—that is, half a pint of ale with a penny-Avorth of gin in it: and, when they haA'e got the money, they go up to Avhat they term the Mucky shop' for it. The coal-porters take this eA-ery morning through the week, Avhen they can afford it. After my Avork, I used to drink more than when I was at it. I used to.sit as long as the house Avould let me haATe any. Upon an average, I should say, I used to take three or four pints more of an evening; so that altogether I think I may fairly say I drank my four pots of ale regularly every day, and about half a-pint of dog's-nose. I reckon my drink used to cost me 13s. a week when I was in work. At times I was a noisy drunken gentleman then." Another coal-porter, who has been a teetotaler ten years on the 25th of last August, told Mr. M. that before he took the pledge he used to drink a great deal after he had done his Avork, but Avhile he was at his Avork he could not stand it. <: I don't think I used to drink more than three pints and a half and a peimyAvorth of gin in the day time," said this man. " Of an evening, I used to stop at the publrj house generally till I Avas drunk, and unfit for work in the morning. I will vouch for it I used to take about three pots a day after I had done Avork. My reckoning used to come to about Is. Sid. per day, or including Sundays, about 10s. Gd. per week. At that time I could average all the year round 30s. a week, and I ised to drink aAvay ten of it regularly I I did indeed, sir, more to rry shame." It seems a legitimate inference, from the early decay of the phy- sical poyers cf these men, that no real support is given them by Alcoholic liquors, in the performance of their arduous labor; and it is a remarkible point in the statements just quoted, that both agree in the asse-tion that the principal part of the liquor consumed is taken in^tht evening, after the day's toil is over, as they " could not stand it" whlgt at work. Thus it appears that the amount which can be effecUely employed as a stimulus to nervo-muscular ex- ertion is really mall; and it is further evident that there is an en- tire absence of -,r0of that anything is in the end gained by their use;—a conclusion -which is in perfeet harmony with the state- ments made in the ?,S3av (§§ 85-102). as to.the incapacity of Alco- holic liquors for maatainjng tjie physical" powers of the humam system. That some of those w 0 nave tr-ie^ tne rpotaj Abstinence system have gone back to their-i».mer habits, from a feeling of the neces- sity of support, is capable c-beiDg acC0unted for not merely by the 176 APPENDIX. excessive amount of labor they are called on to perform, but also by the want of adequate sustenance from solid food. A due allow- ance of this is unquestionably essential to the maintenance of the strength; and it appears from the testimony of other individuals similarly employed (given in the next Appendix), that where this course has been followed, the labor has been performed with more ease, and that the power of endurance has been increased. APPENDIX B. P. 78. The recent inquiries of the :< Commissioner" of the Morning Chronicle not only reveal the circumstances under which a vasi amount of excessive drinking takes place among men engaged fn laborious employments, but also confirm all that is stated in the text as to the possibility of performing the severest labor without such assistance, provided due support be obtained from solid food. The following is the statement made to Mr. Mayhew by a Coal- whipper, Avho had been a teetotaler of eight years' standing : " It's food only that can give real strength to the frame. I have done more work since I have been a teetotaler in my eight years, than I did in ten or twelve years before. I have felt stronger. I don't say that I do my work better; but this I will say, without fear of successful contradiction, that 1 do my work with more eise to my- self, and with more satisfaction to my employer, since I have given over intoxicating drinks. I scarcely know what thirst is. Before I took the pledge, I was always dry; and the mere stadow of the pot-boy was quite sufficient to convince me that I vanted some- thing. I certainly havn't felt weaker since I have left off malt liquor. I have eaten more and drank less. I live as well now as any of the publicans do—and who has a better right io do so than the man who works? I have backed as many as sixty tons in a day since I took the pledge, and have done £ without any intoxicating drink with perfect ease to myself, pid walked five miles to a temperance meeting afterwards. But Jefore I be- came a teetotaler, after the same amount of w>rk I should scarcely have been able to crawl home. I should ;av© been cer- tain to have lost the next day's work at least; burrow I can back that quantity of coals week after Aveek without l^ng a day. I've got a family of six children under twelve yearf^f age; My wife is a teetotaler and has suckled four children upc* tne principle of to- tal abstinence. Teetotalism has made my bme quite happy, and what I get goes twice as far. Where I av'"* now> four of us out of five are teetotalers. I am quite satisfic tnat the heaviest work APPENDIX. 177 that a man can possibly do may may be done without a drop of fer- mented liquor. I say so from my own experience. All kinds of intoxicating drinks is quite a delusion. We teetotalers can do the work better, that is, with more ease to ourselves, than the drink- ers can. Many teetotalers have backed coals out of the hold, and I have heard them say over and over again that they did their work Avith more comfort aud ease than they did when they drank intox- icating drink. Coal-backing from the ship's hold is the hardest work that it is possible for a man to do. Going up a ladder six- teen feet high, with -238 lbs. weight upon a man's back, is sufficient to kill any one; indeed, it does kill the men in a few years—they're soon old men at that work." It appears from the statement of this man—1st, That he could do more Avork in the time, on the total abstinence system, than on his previous system ;—2d, That he could do it with more ease and comfort to himself .—3d, That at the end of his day's labor he was not too much fatigued to prevent him from voluntarily walking five miles to a temperance meeting; whilst (like tne first w>.tneS3 cited in the preceding Appendix, who spoke of himself as " like a child with weakness" when his toil was over) he was previously scarce able to crawl home. APPENDIX C, P. 156. On the Effect of Water-Drinking in the Cure of Gout. By John Bostock, M. D., F. R. S.— Communicated to the Medico- Chirur- gical Society. " The case to which I propose to direct the attention of the So- ciety is that of a gentleman seventy years of age, who had been, from a very early period of his life, subject to very frequent attacks of gout, the predisposition to which complaint is inherited from his parents. Connected with this, he has been a constant sufferer from stomach-affections of various kinds ; acidity, flatulence, heart- burn, irregularity of the bowels, and, in short, from every one of the affections which are enumerated in Cullen's well-known defi- nition of dyspepsia. His mode of life was regular and moderately active, and his diet what might be styled temperate, although not abstemious. He had, indeed, been advised by his medical friends to take wine in moderate quantity ; he had occasionally employ- ed ale, porter, and brandy-and-water, but never in what could be considered an excessive quantity. In this way he had passed about forty years seldom actually confined by indisposition, but almost 178 APPENDIX. always subject to a succession of ailments, which rendered it ne- cessary to have recourse to medicines of various kinds, and, more especially, to alkalies, which were taken in large quantity, and, as the symptoms appeared to indicate, to purgatives, or to sedatives, and to a variety of tonics and stimulants. During this period, the renal secretion Avas seldom in what could be considered a perfectly healthy state; it was sometimes loaded with deposits, and of high specific gravity ; sometimes of Ioav specific gravity, limpid and ac- queous; sometimes very copious, at other times scanty; while its chemical constitution was most variable both as to the nature and the proportion of its saline contents. "About four years ago, in consequence of the accession of certain alarming symptoms of a neAv description, which were supposed to require the antiphlogistic treatment, the patient was ordered by his medical attendants to reduce his system of diet, and, more espe- cially, to abstain entirely from fermented liquor or distilled spirits of any description. By this restriction, and by other appropriate remedies, the threatened disease was aA-erted. And- besides this fortunate result, the patient found his general state of health and feelings so much improved by the change of diet, that the absti- nence from all kinds of liquors has been strictly adhered to up to the present period. The effect has been that he has lost all the dyspeptic symptoms to which he had been subject for upwards of forty years; and, what I am more particularly desirous of pointing out to the Society, the renal secretion has been now, for a long period, in a per- fectly natural state : it is nearly uniform in its specific gravity, and is totally free from all the morbid deposits which were before seldom absent from it And there is a circumstance connected with it which I conceive to be particularly deserving of attention; that, although of an average specific gravity, and containing the proper proportion of urea and saline ingredients, it is uniformly increased in quantity, so that there has been now, for several months, con- siderably more of these substances discharged from the system than was formerly the case. It would appear, therefore that the abstrac- tion of alcohol has produced a more healthy state of the digestive and secreting functions ; so that the functions of the kidney are more actively and effectively performed."—Medical Gazette, Feb. 23. 1844. ' To this interesting case, which is understood to be that of Dr. Bostock himself, may be added the following, from the Bristol Tem- perance Herald. "Rebecca Griffiths, the individual referred to, resided in this city (Bristol) the larger portion of her long life, and until her eighty-ninth year had daily taken as a beverage some kind of intoxicating drink. Beer, and occasionally gin and water, had been commonly used ; but, for a few years before practicing total abstinence, she took daily a small portion of the best Madeira Avine—having, perhaps both as regarded the quantity and quality of the liquor, every advantage APPENDIX. 179 that any one could possess in using a stimulating drink. This practice she relinquished all at once in the eighty-ninth year of her age. For a time, it was feared her health Avould suffer, but it was soon manifested that those fears were groundless ; her appetite improved with the change of diet, and occasional interruptions by a disordered stomach were much less frequent; she would at times observe that she could eat, drink, and sleep as well as at almost any period of her life ; nor did her spirits appear to suffer even tem- porarily. For nearly fifteen years, she had been tried with a sore in one of her legs, which was troublesome, and at times appeared to be dangerous ; after practising teetotalism for about a year and a half, this sore began to diminish, and was soon perfectly healed.— At the expiration of two years, she had a rather violent attack of influenza, which brought her so low that her medical attendant recommended wine, to Avhich she had recourse for about six months, when the wound in her leg again opened, and became troublesome ; the wine was consequently discontinued, and, after the lapse of a few months, the sore again healed up ! Her health also improved yet more decidedly than after her first trial of total abstinence, and she continued, until within a few days of her decease (which took place in the spring of 1843), in the enjoyment of excellent health and spirits, and the full possession of nearly all her faculties, although ninety-three years old." INDEX. CHAPTER 1 m-. 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