SECTION IV. Notes on Alcohol

NOTES ON ALCOHOL

The influence of alcohol on longevity can be most satisfactorily determined by the records of life insurance companies wherein the death-rates among those abstaining from alcohol have been computed as compared to those of the general class of insured lives. In considering such figures it is well to bear in mind that the general or non-abstaining class comprises only those who were accepted as standard healthy risks and so far as could be determined were moderate in their use of alcohol. Such experiences have been carefully compiled by the following companies:

United Kingdom Temperance and General Provident Institution of London; The Sceptre Life; The Scottish Temperance Life of Glasgow; The Abstainers and General Life of London; The Manufacturers' Life of Canada; Security Mutual Life of Binghamton, N. Y.

The notes ("" etc.) refer to the publications listed at the close of the section.

The comparative mortality among abstainers and non-abstainers in several of these companies is shown in the charts exhibited in this section.

It is probable that the heavier mortality among non-abstainers as compared to abstainers is not wholly due to the chemical effect of alcohol on the tissues, but in some degree to collateral excesses (especially those resulting in infection from the diseases of vice) and a more careless general manner of living engendered by alcoholic indulgence; that, furthermore, those who indulge in so-called moderation are open to greater temptation to increased indulgence and final excess than those who abstain altogether.

It has often been alleged, however, that the lower mortality among abstainers was due solely to a more conservative habit of living, and that this class is largely composed of people in favorable or preferred occupations, such as clergymen and teachers.

The experience of the Security Mutual of Binghamton, N. Y., does not support such a postulate. During a twelve years' experience the mortality among the abstainers was one-third that of the tabular expectation, and their occupations were classified as follows:

Clergymen 4 per cent. Farmers 19 " " Clerks 15 " " Miscellaneous (earning $15 to $25 per week) 62 " "

Mr. Roderick McKenzie Moore, Actuary of the United Kingdom Temperance and General Provident Institution, has this to say regarding the abstainers' class in that company:

The total abstainer class was not "nursed" or favored to produce a low mortality. So far as could be determined (and many of the risks came in personal contact with the officers) they were of the same general class as the non-abstainers. They were written by the same group of agents, for the same kind of policies, for the same average amounts, and were in the same general walks of life, and of the same general financial condition. They were almost equal in numbers to the general class and did not form a small high grade section of the policyholding body. On the contrary, greater care was exercised in the selection of the non-abstainers because of the less favorable experience anticipated on them, and many borderline risks were accepted in the abstaining class because of a feeling that their abstinence would neutralize some unfavorable factor.

UNITED KINGDOM TEMPERANCE AND GENERAL PROVIDENT INSTITUTION OF LONDON HEALTHY MALES--WHOLE LIFE POLICIES 1866-1910

EXPECTED MORTALITY________________________________________100%

NON-ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY........ 91%

ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY--.--.--. 66%

MORTALITY AMONG NON-ABSTAINERS--STANDARD RISKS--37.7% HIGHER THAN AMONG ABSTAINERS

THAT IS, WHERE--ACCORDING TO THE MORTALITY TABLES UPON WHICH PREMIUMS ARE BASED--100 WERE EXPECTED TO DIE, ONLY 66 ACTUALLY DIED.

* * * * *

SCEPTRE LIFE ASSOCIATION OF LONDON WHOLE LIFE POLICIES 1884-1911

EXPECTED MORTALITY________________________________________100%

NON ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY........ 80%

ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY--.--.--.--. 52%

MORTALITY AMONG NON-ABSTAINERS--STANDARD RISKS--51.8% HIGHER THAN AMONG ABSTAINERS

THE LIFE EXTENSION INSTITUTE, INC.

* * * * *

THE SCOTTISH TEMPERANCE LIFE ASSURANCE CO. OF GLASGOW HEALTHY MALES--WHOLE LIFE POLICIES 1883-1912

EXPECTED MORTALITY________________________________________100%

NON-ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY........ 66%

ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY--.--.--.--. 48%

MORTALITY AMONG NON-ABSTAINERS--STANDARD RISKS--43.5% HIGHER THAN AMONG ABSTAINERS

* * * * *

COMPARATIVE MORTALITY AMONG USES OF ALCOHOL 43 AMERICAN LIFE INSURANCE COMPANIES 1885-1908

DEATH RATE AMONG INSURED LIVES GENERALLY--MEDICO ACTUARIAL TABLE 100 |||||||||||||||||||||||||

DEATH RATE AMONG POLICYHOLDERS USING 2 GLASSES OF BEER OR 1 GLASS OF WHISKEY DAILY 118 ||||||||||||||||||||||||||||||

DEATH RATE AMONG POLICYHOLDERS GIVING HISTORY OF PAST INTEMPERANCE, BUT APPARENTLY CURED 150 ||||||||||||||||||||||||||||||||||||||

DEATH RATE AMONG POLICYHOLDERS USING MORE THAN 2 GLASSES OF BEER OR 1 GLASS OF WHISKEY DAILY, BUT, REGARDED AS TEMPERATE & STANDARD RISKS 186 |||||||||||||||||||||||||||||||||||||||||||||||

* * * * *

Now that accurate laboratory evidence is available regarding the physiological effect of alcohol in so-called moderate doses the insurance experience seems consistent, and the higher mortality among so-called moderate drinkers is only what we would naturally expect to find in the light of the most recent knowledge regarding its effects upon the human organism, not only in the direct causation of disease, but in lowering the defense to disease and increasing the liability to accident, and the tendency to careless living.

In the recent medico-actuarial investigation, including forty-three American life insurance companies, the combined experience on users of alcohol has been compiled, with very interesting results. It may be subdivided as follows:

First: Those who were accepted as standard risks but who gave a history of occasional alcoholic excess in the past. The mortality in this group was 50 per cent. in excess of the mortality of insured lives in general, equivalent to a reduction of over four years in the average lifetime of the group.

Second: Individuals who took two glasses of beer, or a glass of whisky, or their alcoholic equivalent, each day. In this group the mortality was 18 per cent. in excess of the average.

Third: Men who indulge more freely than the preceding group, but who were considered acceptable as standard insurance risks. In this group the mortality was 86 per cent. in excess of the average. In short, we find the following increase of mortality over the average death rate among insured risks generally:

Steady moderate drinkers but accepted as standard risks 86 per cent. Having past excesses 50 " " Very moderate drinkers 18 " "

This means that steady drinkers who exceed two glasses of beer or one glass of whisky daily are not, on the evidence, entitled to standard insurance, but should be charged a heavy extra premium.

In these groups, the death rates from Bright's disease, pneumonia and suicide were higher than the normal.

The per capita consumption of alcohol has greatly increased in the United States in recent years, while in the United Kingdom it has materially decreased, as shown in the following table. This factor must be considered in assigning a cause for the increasing mortality from degenerative diseases in this country as compared to a decreasing mortality from these maladies in Great Britain.

ANNUAL PER CAPITA CONSUMPTION (IMPERIAL GALS.) OF ALCOHOL IN VARIOUS COUNTRIES 1896-1912

--------+------------------------------+-------------------------------- | 1896-1900. | 1908-1912. +------+------+--------+-------+------+------+--------+--------- | Beer.| Wine.|Spirits.| Total.| Beer.| Wine.|Spirits.| Total. --------+------+------+--------+-------+------+------+--------+--------- Germany | 25.4 | 1.37| 1.66 | 28.43 | 22.4 | 1.09| 1.29 | 24.78 U. K. | 31.6 | .39| 1.05 | 33.04 | 26.65| .26| .71 | 27.62 France | 5.5 | 19.9 | 1.7 | 27.1 | 8.6 | 24.7 | 1.42 | 34.72 U. S. | 13.01| .30 | .81 | 14.12 | 16.62| .52| 1.02 | 18.16 --------+------+------+--------+-------+------+------+--------+---------

#Laboratory and Clinical Evidence Relating to the Physiological Effects of Alcohol#

To interpret correctly the mortality statistics relating to moderate drinkers and total abstainers, one must have some knowledge of the physiological effects of alcohol in so-called moderate doses, a knowledge which is often lacking in those who assume to interpret such statistics.

For example: If it could be shown that small doses of alcohol produce no ascertainable ill effects upon the human organism, the higher mortality among the moderate drinkers as compared to total abstainers might have to be explained as due to some as yet unrecognized cause or causes other than alcohol. But if laboratory and clinical evidence shows that alcohol in so-called moderate quantities (social moderation) produces definite ill effects, such as lowering the resistance to disease, increasing the liability to accident and interfering with the efficiency of mind and body and thus lessening the chances for success in life, to say nothing of any toxic degenerative effect upon liver, kidneys, brain and other organs, the excess mortality that unquestionably obtains among moderate drinkers as compared to total abstainers must be ascribed chiefly to alcohol.

It is not possible here to give all the evidence, but the following items will serve to clarify these questions.

Kraepelin and his pupils have contributed most extensively to our knowledge on this subject. According to such authorities, a half to a whole liter of beer is sufficient to lower intellectual power, to impair memory, and to retard simple mental processes, such as the addition of simple figures. Habitual association of ideas, and free association of ideas are interfered with.

As far back as 1895, Smith demonstrated the influence of small doses of alcohol in impairing memory, and these results have been confirmed by Kraepelin and quite recently by Vogt in experiments on his own person--15 cc. (about 4 teaspoonfuls) of whisky on an empty stomach, or 25 cc. with food, being sufficient to distinctly impair the power to memorize.

Careful and exact experiments have shown the influence of moderate doses of alcohol in lessening the amount of work performed by printing compositors. There has also been shown a disturbance in the sequence of ideas. The time that elapses between an irritation and the beginning of a responsive movement can be measured within one one-thousandth of a second. According to Aschaffenburg, under the influence of even very small doses of alcohol this reaction period is disturbed and shortened. It is below the normal, the acceleration being attained at the expense of precision and reliability. Indeed, the reaction is often premature, and constitutes a false reaction--"the judgment of the reason comes limping along after the hasty action."

It is now conceded that alcohol is not a real brain stimulant, but acts by narrowing the field of consciousness. By gradually overcoming the higher brain elements the activities of the lower ones are released, hence the so-called stimulation and the lack of judgment and common sense often shown by those even slightly under the influence of alcohol. The man who wakes up under alcohol is really going to sleep, as far as his judgment and reason are concerned. Complete abolition of consciousness is brought about by sufficient doses as when ether or chloroform is taken.

Under moderate doses, muscular efficiency is at first increased a little and then lowered, the total effect being a loss in working power, as shown by the experiments of Dubois, Schnyder, Hellsten, and others.

Muller, Wirgin and others have shown that alcohol restricts the formation of antibodies (the function of which is to resist infection in the blood) in rabbits, and Laitinen has shown that the prolonged administration of small doses in men (15 cc.) is sufficient to lower vital resistance, especially to typhoid fever.

Rubin has demonstrated that alcohol, ether and chloroform, injected under the skin, render rabbits more vulnerable to streptococcus (blood poison) and pneumnococcus infection (pneumonia); Stewart, that small amounts lower the resistance to tuberculosis and streptococcus infection; Craig and Nichols, that moderate doses of whisky were sufficient to cause a negative Wassermann reaction in syphilitic subjects; Fillinger found the resistance of red blood cells much reduced after the administration of champagne to healthy human subjects. Similar results were found in dogs and rabbits.

Weinburg confirmed these results by the same methods, showing that 20 per cent. of the red cells lose their resistance after the administration of 450 cc. of champagne.

Parkinson, in a series of careful tests, failed to establish any influence on phagocytosis (capacity of the white blood cells to destroy bacteria), except when large doses or continuous moderate doses were taken.

On the heart and circulation, alcohol acts as a depressant, increasing the rate, but not the force, of the pulse. It causes depression of the nerve center controlling the blood vessels and thus lowers blood pressure. Large doses cause paralysis of these nerves and of the heart.

Miller and Brooks found from small doses (6 to 12 cc. absolute alcohol) an increase in blood pressure in conscious (unanesthetized) animals, contrary to the findings of Crile, Cabot, Dennig, Hindelang and Grünbaum, Alexandroff and others, in man; but the amounts were small and variable, according to individual susceptibility, thus showing the drug to be, even on such evidence, uncertain and unserviceable as a heart stimulant.

Atwater and Benedict, and Beebe and Mendel, have shown that alcohol is a "protein sparer," and can, to some extent, take the place of fats and carbohydrates. This is what is meant by calling alcohol a "food." Always, however, it fails to pass some test by which true foods are measured. Apart from its effect on the nervous system, among which must be figured its action on the blood vessels which causes a loss of body heat, Mendel has shown that in moderate doses (96 cc. daily) it increases the output of uric acid and allied (purin) bodies derived from the tissues, a fact which distinguishes it from all other foods. These poisonous or drug effects must always be considered, together with any alleged nourishing effects. Alcohol is still used by some as a rapidly available fuel-food in fevers, and when ordinary foods cannot be readily digested and made available. But this is done to a much less degree than formerly, now that its narcotic and poisonous effects are more fully understood. Sugar and water often serve quite as useful a purpose.

It seems reasonable, on the evidence herein presented, to class alcohol among the narcotic or "deadening" drugs, such as ether or chloroform. Indeed, Aschaffenburg has recently called attention to the growth of the ether habit in eastern Germany, where this drug is used as a so-called stimulant, while in reality the effects are well known to be narcotic, or deadening.

The laboratory and the life insurance records simply give exact expression to what has long been a matter of common knowledge to the employer of labor and to leaders and commanders of men; to wit, that the influence of alcohol on any large group of men, whether they be artisans or soldiers, is harmful and lowers the efficiency of the group. Individual susceptibility varies, but the man who thinks he is an exception and can indulge with safety may find that he is mistaken only after serious damage to the body has been done and perhaps a definite loss sustained in happiness and achievement.

Stockard, in his experiments on animals, has demonstrated conclusively that the germ cells of males can be so injured by allowing the subjects to inhale the fumes of alcohol that they give rise to defective offspring, although mated with vigorous untreated females. The offspring of those so treated when reaching maturity are usually nervous and slightly undersize. These effects are apparently conveyed through the descendants for at least three generations. Such evidence establishes at least the probability of the transmission of serious ill effects to human offspring through alcoholic indulgence of the male parent.

Much of the statistical evidence that has been produced on both sides of this question of the transmissibility of the effect of alcohol is misleading unless very critically analyzed, but the results of exact laboratory experiments can hardly be gainsaid.

Those who trifle with alcohol should at least take the precaution to be periodically examined in order to detect the earliest signs of ill-effect. One's own feelings are not safe guides, and may fail to warn of danger until serious damage has been done.

In 1914, at the annual meeting of the National Council of Safety, at which there were present representatives from several hundred large industries, the members unanimously voted to abolish liquor from their plants. It has been well stated by Quensel that "work and alcohol do not belong together, especially when the work demands wideawakeness, attention, exactness and endurance."

The restrictive and prohibitive measures of the French and Russian governments, the well known opposition of the Kaiser to alcohol and the warnings uttered by Lord Kitchener and leading British statesmen, are sufficient evidence that the condemnation of alcohol represents the deliberate judgment of the world's strong men.

REFERENCES

United Kingdom Temperance and General Provident Institution of London, Annual Report, 1910.

Sceptre Life Association, Annual Report, 1912.

Scottish Temperance Life Assurance Company, Annual Report, 1912.

The Abstainers and General Insurance Company, Ltd., Annual Report, 1912.

McMahon, T. F.: The Use of Alcohol and the Life Insurance Risk. Proceedings of the Association of the Life Insurance Medical Directors of America, 1911, Twenty-second Annual Meeting, p. 473; Medical Record, LXXX, p. 1121.

Lounsberry, R. L.: Proceedings of the Life Assurance Medical Directors. October, 1913.

Moore, Roderick McKenzie: On the Comparative Mortality Among Assured Lives of Abstainers and Non-Abstainers from Alcoholic Beverages. Transactions of the Institute of Actuaries, 1913, XXXVIII, pp. 248-272.

Report of Medico-Actuarial Mortality Investigation, IV, pp. 11-13.

Statistical Abstract for the United Kingdom, Sixty-first Number, 1809-1913 (Wyman & Sons), London, 1914, p. 173; Statistical Abstract for the Principal and Other Foreign Countries, 1901-1912, Thirty-ninth Number, pp. 505, 506, 507; Statistical Abstract of the United States, Thirty-sixth Number, 1913, p. 516.

Kraepelin, Emil: Ueber die Beeinflussung einfacher psychischer Vorgänge durch einige Arzneimittel, Verlag von Gustav Fisher, Jena, 1892; Aschaffenburg, Gustav: Praktische Arbeit unter Alkoholwirkung, Psychologische Arbeiten, 1896, I, pp. 608-626; Kurz, Ernest, and Kraepelin, Emil: Ueber die Beeinflussung psychischer Vorgänge durch regelmässigen Alkoholgenuss, Psychologische Arbeiten, 1901, III, pp. 417-457; Mayer, Martin: Ueber die Beeinflussung der Schrift durch den Alkohol, Psychologische Arbeiten, 1901, III, pp. 535-586; Rudin, Ernst: Ueber die Dauer der psychischen Alkoholwirkung, Psychologische Arbeiten, IV, pp. 1-44.

Vogt, R.: Om virkningen af 15-50 cm3 koncentrert spiritus paa erindringsevnen, Norsk. Mag. f. Laegevidensh., 1910, LXXI, pp. 605-626; The Lancet (London), 1910, II, p. 1040.

Aschaffenburg, Gustav: Crime and Its Repression, Little, Brown & Company, Boston, 1913, p. 84.

Schnyder, L.: Alkohol und Muskelkraft, Archiv für Physiologie, 1902-3, XCIII, p. 451.

Hellsten, A. F.: Ueber den Einfluss von Alkohol, Zucker und Thee auf die Leistungsfähigkeit des Muskels, Munchen Med. Wchnschr., 1914, LI, pp. 18-94.

Bastedo, Walter A.: Materia Medica Pharmacology and Therapeutics, W. B. Saunders Company, Philadelphia and London, 1913, p. 333.

Laitinen, T.: The Norman Kerr Lecture on The Influence of Alcohol on Immunity, Med. Rec., LXXVI, 1909, pp. 445-446. Read before the Twelfth International Anti-Alcoholic Congress, held in London, July, 1909; Uber die Einwirkung der kleinsten Alkoholengen auf die Widerstandsfähigkeit des tierischen Organismus mit besonderer Berücksichtigung der Nachkommenschaft, Ztschr. f. Hyg. u. Infections-krankheiten, LVIII, 1907-8, p. 139.

Rubin, George: The Influence of Alcohol, Ether, and Chloroform on Natural Immunity in its Relation to Leucocytosis and Phagocytosis, Jour. Infct. Dis., 1904, I, pp. 425-444.

Stewart, Chas. E.: The Influence of Alcohol on the Opsonic Power of the Blood, Mod. Med., 1907, XVI, pp. 241-246. Read before the American Society for the Study of Alcohol and Drug Neuroses, Atlantic City, June 4, 1907, and published in the Jour. of Inebriety.

Craig, Chas. F., and Nichols, Henry J.: The Effect of the Ingestion of Alcohol on the Result of the Complement Fixation Test in Syphilis, Jour. A. M. A., 1911, LVII, pp. 474-76.

Fillinger, F. V.: Weitere Mitteilungen über Resistenzverminderung der Erythrozyten nach Alkoholgenuss, Deutsch. Med. Wchnschr., 1912, XXXVIII, p. 999.

Weinburg, W. W.: The Lowering of Stability of Erythrocytes in Alcoholic Intoxication, Russky Vratch, 1912, II, p. 1324; New York Med. Jour., 1912, XCVI, p. 1040.

Parkinson, P. R.: The Relation of Alcohol to Immunity, The Lancet (London), 1909, VII, pp. 1580-82.

Brooks, Clyde: The Action of Alcohol on the Normal Intact Unanesthetized Animal, Jour. A. M. A., 1910, LV, pp. 372-73. Read in the Section on Pathology and Physiology of the A. M. A. at the Sixty-first Session, St. Louis, June, 1910.

Crile, George W.: Blood Pressure in Surgery, J. B. Lippincott Company, Philadelphia, 1903. Cartwright Prize of the Alumni Ass'n of the College of Physicians and Surgeons, New York City.

Cabot, Richard C.: Studies of the Action of Alcohol in Disease, Especially upon the Circulation, Med. News, LXXXIII, 1903, pp. 145-153. Read before the Association of American Physicians, May 13, 1903.

Dennig, Hindelang und Grünbaum: Uber den Einfluss des Alkohols auf den Blutdruck und die Herzarbeit in pathologischen Zuständen, Namentlich beim Fieber, Deutsch. Arch. f. klin. Med., 1909, XCVI, pp. 153-162.

Alexandroff, Emilie: Ueber die analeptische Wirkung des Alkohols bei pathologischen Zuständen, Cor. Bl. f. schweiz. Aerzte., 1910, XL, pp. 465-475; Action of Alcohol During Febrile and other Pathologic Conditions, Jour. A. M. A., 1910, LV, p. 174.

Atwater, W. A., and Benedict, F. G.: An Experimental Inquiry Regarding the Nutritive Value of Alcohol, National Academy of Science, 1902, Sixth Memoir.

Beebe, L. B.: The Effect of Alcohol and Alcoholic Fluids Upon the Excretion of Uric Acid in Man, Amer. Jour. Physiol., 1904, XII, pp. 13-37.

Mendel, L. B., and Hilditch, Warren W.: The Influence of Alcohol Upon Nitrogenous Metabolism in Men and Animals, Amer. Jour. Physiol., 1910, XXVII, pp. 1-23.

Aschaffenburg, Ibid.

Stockard, C. R.: A Study of Further Generations of Mammals from Ancestors Treated with Alcohol, Proc. Soc. Exper. Biol. and Med., 1914, XI, p. 136.

Quensel, Ulrik: The Alcohol Question from a Medical Viewpoint--Studies in the Pathology of Alcoholism, Year Book, United States Brewers' Association, 1914, p. 168.

* * * * *

Bastedo, Walter A.: Materiel Medico, Pharmacology and Therapeutics, W. B. Saunders Company, Philadelphia and London, 1913, p. 318.

Bertillon, Jacques: On Mortality and the Causes of Death According to Occupations, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, I, p. 345.

Boos, William F.: The Relation of Alcohol to Industrial Accidents and to Occupational Diseases, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, I, p. 829.

Cabot, Richard C.: The Consumption of Alcohol and of Other Medicines at the Massachusetts General Hospital, Boston Med. Jour., CLX, 1909, pp. 480-81.

Dixon, W. E.: Alcohol in Relation to Life, The Nineteenth Century, 1910, LXVII, pp. 516, 523.

"Ethyl Alcohol," The Dispensatory of the United States of America, J. B. Lippincott & Company, Philadelphia, 19th edition, p. 102.

Ewald: Alcohol in Relation to Infectious Diseases, Med. Rec., 1913, LXXXIV, p. 75. Read before the Fourth National Congress on Physiotherapy, Berlin, March 26, 1913.

Horsley, Sir Victor: Discussion on Alcohol in Therapeutics, Med. Rec., 1912, LXXI, p. 951. Read before the Hunterian Society.

Hunter, Arthur: Can Insurance Experience be Applied to Lengthen Life? Proceedings of the Association of Life Insurance Presidents, Eighth Annual Meeting, 1914, pp. 27-37.

Kelynak, T. M.: The Drink Problem, London, Methuen & Company, 1907.

Landau, Anastazy: Beitrage zur hehre vom Purinstoffwechsel und zur Frage über den Alkoholeinfluss auf die Harnsaureausscheidung, Deutsch. Arch. f. klin. Med., XCV, 1908-9, pp. 280-328.

Miller, Joseph L.: The Physiologic Action, Uses and Abuses of Alcohol in the Circulatory Disturbance of the Acute Infection, Jour. A. M. A., 1910, LV, pp. 2034-2037. Read in the joint session of the Sections of Practice of Medicine and Pharmacology and Therapeutics of the A. M. A., Sixty-first Annual Session, held at St. Louis, June, 1910.

Neff, Irwin H.: The Problem of Drunkenness, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, IV, p. 510.

Phelps, Edward Bunnell: The Mortality from Alcohol in the United States, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, Vol. I, p. 813.

Proceedings: Association of Life Insurance Medical Directors, October, 1911.

Report of the Committee of Fifty on: Physiological Aspects of the Liquor Problem, Houghton, Mifflin & Company, two volumes, 1903.

Togel, O., Brezina, E., and Durig, A.: Ueber die kohlenhydratsparende Wirkung des Alkohols, Biochem. Ztschr., 1913, I, 296; Editorial, Jour. A. M. A., 1913, LXI, p. 967.

Williams, Henry Smith: Alcohol, How it Affects the Individual, the Community and the Race, The Century Company, New York, 1909.

Woods, Robert A.: The Prevention of Inebriety: Community Action, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, IV, p. 517.

#Additional Notes on Alcohol#

There has lately been undertaken at the Nutrition Laboratory of the Carnegie Institution at Washington a very broad and comprehensive study of the effect of moderate doses of alcohol on the healthy and normal human body. The immense scope of the investigation planned may be judged by the fact that under the physiological division of the research, as laid out by Professors Raymond Dodge and E. C. Benedict, there are seven main sections and one hundred and sixty subdivisions. The program has been arranged after conferences, either in person or by letter, with the leading physiologists of the world, and may take ten years to complete.

The psychological program, carried out with the co-operation of Dr. F. Lyman Wells, has already been completed and the results recently published. These results must be accepted as the testimony of pure science, free from all bias or even remote suggestion of propaganda. They were based upon experiments with moderate doses of alcohol (30 cubic centimeters, or about 8 teaspoonfuls, and 45 cubic centimeters) upon ten normal subjects, very moderate users of alcohol, and may be summarized as follows:

A very simple reflex act, the "knee-jerk," a nervous mechanism controlled by a center at the lower level of the spinal cord, was markedly depressed, the time of response being increased 10 per cent. and the thickening of the muscles concerned in the act decreased 45 per cent. In some subjects the larger dose, 45 cubic centimeters, practically abolished the knee-jerk.

The eye-lid reflex, elicited by a sudden noise, showed the next largest effect, the time of response being increased 7 per cent. and the degree of movement decreased 19 per cent.

Other nervous mechanisms, or reflex arcs, at the higher levels of the cord, were next investigated: (1) eye-reaction to suddenly appearing stimulus, and (2) speech reaction to visual word stimuli. Dose A (30 cubic centimeters), accelerated the eye-reaction, while dose B (45 cubic centimeters) positively depressed it, agreeing with the simple reaction experiments of Kraepelin. This was the only instance of acceleration of movement of the voluntary muscles through alcohol, all the other tests showing it to be a consistent depressant. The speech reaction showed a positive depressant effect of 3 per cent.

Free association of ideas and memory tests were also made, and showed practically no effect from alcohol, but, unfortunately, the smaller dose only was used in these tests.

The sensitiveness to electrical stimulation was decreased 14 per cent.

Motor co-ordination, as evidenced by eye-movements in fixating seen objects, was next investigated. The velocity of these movements was decreased 11 per cent. Finger-movements, measured in an exceedingly delicate way, were reduced in speed 9 per cent.

The effect on the pulse while these tests were made was observed, and electrocardiograms taken. The pulse was found to be accelerated, but not increased in force, that is, the "brake" was taken off the heart, but no driving force supplied by alcohol. The condition of the circulation was impaired by the narcotic effect of alcohol on the cardio-inhibitory center which holds the heart action in check.

According to the investigators, the effect is to "decrease organic efficiency." This should shut off such little debate as still persists with respect to alcohol having any value as a heart stimulant.

While these investigations only confirm in part the contention of the Kraepelin school that alcohol first acts by depressing the higher centers, and tend to show that its first and most profound effect is on the lower levels of the spinal cord and the simpler nervous mechanisms, it confirms the view of these and other investigators, that the total effect of alcohol is that of a narcotic, depressing drug, even in the smallest doses usually taken as a beverage.

The possible reactions are more complex than those supposed by Kraepelin, and there is evident in the higher centers (the effect on highest brain functions, were not measured by Dodge and Benedict) a power of "autogenic reinforcement," which is well exemplified by the ability of a half-intoxicated person to sober up under some shock or strong incentive. When social conditions do not stimulate this reinforcement, but, on the contrary, dull and retard it, as in convivial company, there is reinforcement of the lower, more animal mechanisms of the nervous system, and we have exhibited revolting and foolish reactions to alcohol, which are consistent with these findings.

The slight effect on memory and free association is explained partly by the methods used in the laboratory (difference in time of recognizing words suddenly exposed a second time), which are more in the nature of "short cuts" and perhaps not so accurate a reproduction of normal memorizing as those employed by Kraepelin and Vogt (memorizing numbers and verse), and partly by the power of "autogenic reinforcement," which it is difficult to eliminate in a laboratory test.

This, the latest contribution of science to the study of alcohol, gives added proof that the higher mortality among so-called moderate users of alcohol is largely due to the unfavorable effect on the protective mechanism of the body.

This has been further emphasized by the studies of Reich at the University of Munich, who found that the resistance of blood cells to salt solution and to typhoid bacilli was less among alcohol users than among total abstainers.

Konrádi has found that comparatively few antibodies against cholera germs develop in persons who consume alcohol daily in fairly large quantities and who had been inoculated against cholera. Pampoukis has observed that alcoholics are not favorable subjects for inoculation against rabies. The Pasteur Institute in Budapest has made similar observations, based on twenty-five years' experience.

#Additional References#

Benedict, E. C.: The Psychological Effects of Alcohol, The Carnegie Institution, Washington, D. C., 1916.

Benedict, E. C.: The Psychologic Effect of Alcohol on Man, The Journal A. M. A., 1916, lxvi, p. 1424.

Reich, H. W.: Ueber den Einfluss des Alkoholgenusses auf Bakterizidie, Phagozytose und Resistenz der Erythrocyten, beim Menschen, Arch. f. Hyg., 1916, lxxxiv, 337.

Konradi: Ueber den Wert der Choleraschutzimpfungen, Centralbl. f. Bakteriol., I. O., 1916, lxxvii, 339.

Alcohol and Immunity, Jour. A. M. A., 1916, lxvi, p. 962, p. 1122.