CHAPTER V.. On Drinks.

ON DRINKS.

Thirst the best guide in taking simple drinks--Thirst increased by diminution of the circulating fluids--The desire for liquids generally an indication of their propriety--Much fluid hurtful at meals--Most useful three or four hours later--The temperature of drinks is of consequence--Curious fall of temperature in the stomach from cold water--Ices hurtful after dinner--Useful in warm weather, when digestion is completed and caution used--Cold water more dangerous than ice when the body is overheated--Tepid drinks safest and most refreshing after perspiration--Kinds of drink--Water safe for every constitution--Wine, spirits, and other fermented liquors, too stimulating for general use, but beneficial in certain circumstances--Test of their utility.

On the subject of drinks two questions naturally occur. When ought we to drink? and, What ought we to drink? On both I shall offer a few very brief remarks.

In the first part of this volume I endeavoured to shew that the sensation of thirst is given to us for the express purpose of impelling us to take liquids whenever the wants of the system require them, and that, in all ordinary circumstances, we cannot have a better or a safer guide. Such is the general case; but exposed as we are to numerous deviations from the intentions of Nature in our ways of living, a few precautionary observations may not be without use.

The quantity of fluid separated from the blood and thrown out of the system, in the course of twenty-four hours, by perspiration, exhalation from the lungs, the urinary discharge, and the various other secretions, is very great; and were not the loss as regularly supplied by the ingestion of liquid, either as food or as drink, the blood would speedily become so thick as to be unfit for circulation. This actually happens in spasmodic cholera, in which the serum or watery portion of the blood passes off through the bowels with such rapidity, as to cause the entire suppression of the urinary secretion, and in which consequently, the urgency of thirst is almost always excessive. In the healthy state, however, the loss of fluid is never too rapid unless under severe exertion or exposure to a very high temperature, both being circumstances in which it is well known that thirst becomes urgent in proportion to the necessities of the frame.

In proof of the sensation of thirst being greatly dependent upon the quantity of fluid circulating in the vessels, Professor Dunglison of Maryland refers to the fact, mentioned by Dupuytren, that he “succeeded in allaying the thirst of animals by injecting milk, whey, water, and other fluids into their veins;” and to Orfila’s statement, “that, in his toxicological experiments, he frequently allayed, in this way, the excessive thirst of animals to which he had administered poison, and which were incapable of drinking, owing to the œsophagus having been tied. He found, also, that the blood of animals was more and more deprived of its watery portions as the abstinence from liquids was more prolonged;” and hence the greater thirst naturally experienced under such circumstances.

As a general rule, then, the desire for liquids will in itself be an indication of their propriety; but in gratifying it, we should be careful not to drink so fast as either to distend the stomach beyond proper bounds, or to disturb the progress of digestion by undue dilution too soon after eating. Many persons, from habit rather than thirst, impair the tone of the stomach by drinking largely during or immediately after meals, and thus relaxing the mucous coat, and probably affecting the quality of its secretions. If the gastric juice be greatly diluted by extraneous fluids, it is natural to suppose that its solvent power must be diminished; but whether this explanation be sound or not, the practice of drinking frequently is certainly hurtful, and therefore we ought to avoid it.

Experience proves that a moderate quantity of liquid during a meal is beneficial; and if we drink little at a time, the risk of exceeding the proper limit will be very small. Dyspeptics, however, ought to be on their guard against taking too much, as they are apt to be misled by uneasy sensations in the region of the stomach, which are relieved for the moment, but afterwards aggravated, by the free dilution of the food. Those, also, who live well, and are in the habit of taking wine daily whether the system requires it or not, often fall into the error of excessive indulgence in liquids to mitigate the thirst and irritability which the unnecessary use of stimulus never fails to induce, especially at night. The continual dilution, however, adds to the mischief, by increasing the debility of the stomach, and, as pointed out in the chapter on Thirst, the only effectual remedy is to adapt the diet and regimen to the real wants of the constitution. Except in disease, a continually recurring thirst must proceed from mismanagement, and it is to be satisfied by an improved and rational regimen, and not by oceans of fluid, which only weaken the stomach still more, and aggravate the craving they are meant to cure.

The opinion is very prevalent, that mild drinks may be taken with most advantage about three or four hours after a solid meal; and, certainly, the almost universal use of tea or coffee about that time appears to sanction its soundness. Theoretically, too, we might expect this result; for digestion is then nearly over, and any food remaining in the stomach is already in a fluid state. Many objections, however, have been made to both tea and coffee as an evening beverage, but most of them seem to me to apply to their undue quantity and strength rather than to their temperate use. When made very strong, or taken in large quantity, especially late in the evening, they not only ruin the stomach, but very seriously derange the health of the brain and nervous system.

The question of drink is of little importance as regards breakfast. During the night, the chief expenditure of the system--by perspiration, urine, and exhalation from the lungs--is of a fluid nature, and hence there is a marked and general preference of fluids as part of our first meal. In this country, accordingly, tea, coffee, and chocolate, are in almost universal use for breakfast, and no other liquid is required merely as drink. If, from the mode of life or other causes, thirst be excited in the forenoon, no valid objection can be urged against its moderate and reasonable gratification.

The temperature at which liquids are taken is a matter of perhaps greater consequence than it is usually considered. As regards the teeth, we have already seen that either very cold or very hot substances coming into contact with them are apt to be injurious. As regards the stomach, the same principle holds true; and when we consider the multitude and intricacy of its nervous connexions with other vital organs, we can scarcely be surprised at even sudden death being frequently caused by drinking ice-cold water when the body is weakened by profuse perspiration. Of the various subjects connected with digestion on which Dr Beaumont has thrown light by his experiments on St Martin, this is one of the few which he has omitted to investigate with his usual diligence and accuracy; a circumstance which is the more remarkable, because an incidental observation of his own seems, from its singularity, to have been well calculated to direct his attention to its consideration. On the occasion alluded to, when a gill of water, at the temperature of 55° Fahr., was received into the empty stomach, in which the thermometer previously indicated a heat of 99°, Dr Beaumont remarked that it immediately diffused itself over the interior surface, and brought down the temperature to 70°, at which it stood for a few minutes, and then began again to rise very slowly. It was not till thirty minutes had elapsed, and all the water been for some time absorbed, that the mercury regained its former level of 99°. This is an important fact, and it is curious that Dr Beaumont did not think of following it up by a regular series of experiments, to ascertain the effects of cold and hot drinks on the progress of digestion and on the general system. It is well known, for example, that a copious draught of cold water, taken in a state of perspiration and fatigue, is often instantly fatal; but its operation has never been satisfactorily explained. The above experiment, however, throws some light on it; for if a single gill of water at 55° (which is not by any means a low temperature) is able to reduce the heat of the stomach in a moment by no less than twenty-nine degrees, when neither fatigue nor perspiration is present to add to its effect, the influence of a large quantity, such as is usually drunk by harvest-labourers and others who die of it, and at a still lower temperature, must undoubtedly be much more powerful and permanent, especially when the bodily energies and means of resisting the shock are impaired by previous labour and exhaustion under a burning sun. In these cases the shock necessarily arising from such a sudden and extensive fall of temperature is greatly increased by the position of the stomach in the very centre of the vital organs, to all of which it is most intimately linked by the numerous nervous connexions given for the express purpose of extending the range and direction of its sympathies.

Keeping in mind the great depression of temperature caused by swallowing so small a quantity of cold water, and also the ascertained fact that a heat of about 100° is requisite for healthy digestion, we shall have no difficulty in accounting for the frequent injurious consequences arising from considerable quantities of ice-cream being hastily eaten, as they often are, at the end of a substantial dinner. The immediate effects of the rapid abstraction of heat to which they give rise in the stomach, are the instantaneous contraction and diminished action of its bloodvessels, the consequent stoppage of the gastric secretion, diminished sensibility of its nerves and muscular fibres, and, lastly, disturbance of the heart and neighbouring vital organs, both by sympathy and by the direct abstraction of their heat. Such, at least, are the consequences which flow from the application of cold to parts exposed to observation, and partially verified by Dr Beaumont in the case of the stomach; and if the analogy holds throughout, as there is every reason to believe, we cannot wonder that the free use of ice-cream at the end of a good dinner or supper should retard and even arrest digestion in a person delicately constituted.

In thus condemning the free use of ices at the end of a substantial meal, I do not, however, mean to say that a few tea-spoonfuls of them, eaten slowly, and allowed to acquire a higher temperature before reaching the stomach, will do permanent injury to a person in health and in the enjoyment of sound digestion. Many eat them in this way and are little the worse; partly from the subsequent reaction, as in bathing, being sufficient to counteract the depressing influence, and partly from a person in vigorous health being able to throw off causes of disease from which those who are less robustly constituted suffer severely. My belief however is, that the tendency of ices, taken in such circumstances, is to produce mischief. A healthy person, for example, may possess vigour enough to escape injury from immersion in cold water, caused by the ice giving way when skating; but as well might it be inferred, on that account, that a similar immersion would be generally innocuous, and even salubrious, as that all may safely eat ices freely because a given individual has done so with impunity. Dr Beaumont’s experiment with the cold water shews clearly that the effect is to lower the vital tone of the stomach; and, such being the case, those whose digestion is weak ought to be careful against impairing it still farther by the use of ices. In some instances, however, it is not improbable that they help to neutralize the bad effects of hot soup, and other dishes eaten at too high a temperature.

The use of cold or iced water in hot weather and in warm climates, when digestion is not going on and exhaustion is not present, is so far from being necessarily hurtful, that with proper caution it may prove both grateful and refreshing. In Italy, accordingly, ice is considered so much a necessary of life in summer, that in Naples and other places the confectioners are punished by a fine if they allow their supply to fall short. In Virginia, too, where, we are told by Professor Dunglison, it was very common some years ago for the labourers in the harvest-field to be killed by drinking copiously of spring-water while overheated, cases of death have become extremely unfrequent since the custom was introduced of supplying them with ice. When water was taken, it was always hastily and in large quantity, so that the immediate effect on the system was greater than could possibly arise from the small quantity of ice which is required for quenching thirst. The very slowness, indeed, with which ice melts, not only prevents much being taken, but causes the water procured from it to reach a higher and safer temperature before it arrives at the stomach. Hence, when ices are taken, the more slowly they are eaten the more refreshing and salubrious will they become, because the less violent will be their action upon the nerves, bloodvessels, and membranes of the stomach. From the close sympathy existing between the stomach, and the skin, a single tea-spoonful of ice-cream suddenly swallowed when the body is weak and perspiring, will produce as instantaneous a sense of chill as a pail of cold water dashed over the surface; and on account of this very power over the vital actions of the stomach, ice has of late been cautiously and beneficially prescribed to subdue inflammation of that organ.

Liquids, such as soup, tea, and coffee, taken at a very high temperature, are also injurious, but not in the same degree. They relax the mucous membrane and weaken the action of the muscular coat, and in so far tend to impair digestion. The fittest temperature for both solid and liquid food is perhaps about the natural heat of the body, or a little above 100°. Dr Dunglison, however, and some other physiologists, regard hot fluids as stimulating to the stomach, and therefore conducive to digestion; but he admits that debility is their ultimate effect.

When great thirst has been excited either by bodily labour or by external heat, it will generally be more effectually as well as safely quenched by drinking moderately of tepid than of cold fluids. A tepid draught--a cup of tea for example--produces no disturbing action in the stomach, and, being immediately absorbed, supplies the deficiency of liquid without changing the balance of the circulating fluids, thus relieving thirst very much in the same way as Dupuytren did by injecting tepid water into the veins; whereas cold drink, by the suddenness of its impression, disturbs the balance of the circulation, and excites a degree of reaction which increases the original discomfort. If the system is at the same time weakened by fatigue, cold drinks are always injurious.

Of late years a change in the treatment of horses in this respect has taken place. Formerly it used to be considered dangerous to give water to a horse in a state of perspiration. Now, however, it is a common practice to allow post and stage-coach horses a little water before their run is completed, however warm they may be: but, in the first place, the quantity allowed is small, and is always given before the strength is exhausted; and, in the second place, the excitement of the subsequent exercise prevents any considerable disturbance in the balance of circulation, and thus ensures the safety of the animal. If even the same moderate quantity were given at the end of the stage, and the horse were then allowed to rest, inflammation would almost inevitably result.

The same principle applies to the human frame, and affords an easy explanation of the occasional instances we see of persons heated by exertion drinking cold water without injury. If the exertion have been merely sufficient to produce excitement without fatigue, and heat without debilitating perspiration, and especially if it be resumed after the draught, little or no harm will ensue. But if exhaustion or fatigue have been induced, and the individual be allowed to drink freely of the cold water and then rest, the probability of mischief resulting from it will be greatly increased. Many accidents result from losing sight of this distinction, and from acting alike in circumstances so essentially different.

On the subject of the kind of drink which ought to be taken a great deal might be said, were it necessary to discuss here the qualities of all the liquors that are in use. But as my purpose is very different, a few general remarks will be enough.

Water is a safe drink for all constitutions, provided it be resorted to in obedience to the dictates of natural thirst only, and not of habit, and with the precautions already pointed out; but unless the desire for it is felt, there is no occasion for its use during a meal, for the mere purpose of obeying a general rule. Toast and water, whey, beer, barley-water, aërated and soda water, and other liquids of a similar kind, which are little stronger than pure water, may be used, according to the same general principle, by those who prefer them and find them agreeable to the stomach. But with regard to such fermented liquors as porter, ale, spirits, and wine, much greater restriction is necessary, because much good or evil may be done by them when properly or improperly administered.

The primary effect of all distilled and fermented liquors is to stimulate the nervous system and quicken the circulation. In all conditions, therefore, in which the action of these requires to be increased or supported, they are calculated to be useful; and, on the contrary, where it requires to be soothed and abated, they are sure to be prejudicial. To shew the utility of this principle as a standard, we shall notice a few of its applications.

Among the higher classes, it is common to give children an allowance of wine every day from a very early age. To determine the propriety of doing so, let us examine what is then their constitutional state.

In infancy and childhood the circulation is rapid and easily excited, and the nervous system is strongly acted upon even by the slightest external impressions. Hence slight causes of irritation readily excite febrile and convulsive disorders. The object of the parent, therefore, is not to stimulate, but rather to abate nervous and vascular action. Wine, accordingly, is not only unnecessary, but positively detrimental to children, and it is wrong to accustom them to it. There are individual children, no doubt, who are so imperfectly and sluggishly constituted as to require some stimulus to rouse the system to healthy action, and to whom wine is beneficial as a medicine. But these are the exceptions to the general rule, and to them it should be given only under medical sanction.

In youth the natural tendency of the constitution is still to excitement; and consequently, as a general rule, the stimulus of fermented liquors is injurious. During rapid growth, however, the animal functions are sometimes so enfeebled by the great demands made upon them, that not only a full supply of nourishing food, but also an allowance of wine and malt liquor, is required for a time to sustain their energy. In this case the beneficial influence of the fermented drinks is apparent, by their giving tone to the system without raising the pulse or increasing nervous sensibility; but whenever any of these effects is produced, their employment ought to be discontinued.

In mature age, when digestion is good and the system in full vigour, if the mode of life be not too exhausting, the nervous functions and general circulation are in their best condition, and require no stimulus for their support. The bodily energy is then easily sustained by nutritious food and a regular regimen, and consequently artificial excitement only increases the wasting of the natural strength. Where, however, the system has been long accustomed to the use of wine, it will, in general, be better to leave it off gradually than to make a sudden change. In old age, when the powers of life begin to fail, moderate stimulus may be used with evident advantage.

If it be said that this doctrine amounts to a virtual prohibition of wine and stimulant liquors, I admit at once that, where the whole animal functions go on healthfully and energetically without them, their use is, in my opinion, adverse to the continuance of health. But there are many constitutions so inherently defective in energy, as to derive benefit from a moderate daily allowance of wine; and there are many situations in which even the healthiest derive additional security from its occasional use. If, for example, a healthy person is exposed to unusual and continued exertion in the open air, or to the influence of anxious and depressing watchfulness, a moderate quantity of wine along with his food may become the means of warding off actual disease, and enabling him to bear up uninjured, where without it he would have given way. This preservative influence has been so often experienced, that it is impossible to deny its reality.

While, then, I consider stimulating liquors of every kind as both useless and hurtful, where without them the system is healthful and energetic, I can see no reason why their temperate use in circumstances of an opposite nature ought to be denied. Many weak constitutions and many invalids are benefited by wine, and all that can reasonably be demanded is, that it shall not be abused.

Continued and severe exertion, whether of body or of mind, often exhausts the system so much as to render the temporary use of wine, and even of spirits, not only innocuous, but positively beneficial; but in these cases they should be considered as medicines, and care ought to be taken not to carry the stimulus too far. That, in some circumstances, stimulus is really required, is accordingly shewn by the ease with which the system bears its effects. I have known a delicate lady, during recovery from fever, take to the extent of a bottle of Madeira in twenty-four hours, without producing the least undue excitement of either the mind or the pulse, but rather the contrary--it soothed the mind and reduced the pulse; and this I take to be the true test of its propriety in all circumstances.

The same principle explains the well-known fact that many sportsmen, who, while living a sedentary life in town, are easily affected by even a small quantity of spirits, yet bear triple the quantity, with apparent impunity, under the influence of inspiriting exercise in a pure mountain-air: on resuming their former habits, the spirits again affect them as readily as before.

As a support to the system in cases which require it, wine is in general far preferable to spirits of any description. The former, when seasonably used, communicates a more healthful and permanent tone to the frame; while spirits impart a strong and unnatural stimulus, which is sooner or later followed by collapse and debility--and hence the incessant craving for more when the system has once been accustomed to them. Ardent spirits, therefore, ought to be used only as a medical remedy. At present, however, this is so far from being the case, that they are resorted to on all occasions, afflictive and convivial, as if they were a specific against every evil. Among the poor, especially, whisky or gin is considered a sovereign remedy for every disease. Even to infants it is administered with a recklessness which savours strongly of barbarism, and the consequences are as might be expected--deplorable. Among the higher classes, too, brandy and strong stimuli are in more frequent use than they ought to be; and medical men should be on their guard against directly or indirectly encouraging, in their patients, a practice so utterly destructive to both physical and moral happiness. For, in some instances, it is to be feared that the stimulant bitters and anti-spasmodics, so generally had recourse to in indigestion and nervous diseases, have had an unsuspected share in the formation of a habit of intemperance.

Of late years, great exertions have been made, both in this country and in America, to warn the public against indulging in the use of ardent spirits; and powerful medical, as well as moral facts and arguments, have been adduced to demonstrate the unspeakably greater advantages of temperance. These efforts have been followed with astonishing success, and the good which has been already effected is immense. It seems to me, however, that much more might be accomplished, if we did not confine ourselves so exclusively to the mere inculcation of abstinence from intoxicating liquors, but concerned ourselves more in improving the general character, as the surest road to reformation, and in providing resources by means of which the reformation, when once effected, might be fully confirmed. The temperance which is produced by elevation of mind, and an improved state of moral feeling, will be not only much more beneficial in its consequences, but infinitely more proof against temptations, than that which is observed merely in fulfilment of a vow; and unless something be made to come in the place of the enjoyment which is withdrawn, the danger of a relapse will continue to be great. The importance of this principle is perhaps not sufficiently recognised in the otherwise valuable labours of Temperance Societies.

Many persons imagine that spirits, taken in moderate quantity, cannot be injurious, because they feel no immediate bad effects from their use. If the fundamental principle which I have advanced is sound, and if all the functions of the system are already vigorously executed without the aid of spirits, their use can be followed by only one effect--morbid excitement; and it is in vain to contend against this obvious truth. The evil attending their unnecessary use may not be felt at the moment, but nevertheless it is there; and for demonstrative proof of the fact, we are again indebted to Dr Beaumont. On examining St Martin’s stomach after he had been indulging freely in ardent spirits for several days, Dr Beaumont found its mucous membrane covered with erythematic (inflammatory) and aphthous (ulcerous) patches, the secretions vitiated, and the gastric juice diminished in quantity, viscid, and unhealthy; although St Martin still complained of nothing, not even of impaired appetite. Two days later, when the state of matters was aggravated, “the inner membrane of the stomach was unusually morbid, the erythematic appearance more extensive, the spots more livid than usual; from the surface of some of them exuded small drops of grumous blood; the aphthous patches were larger and more numerous,--the mucous covering thicker than common, and the gastric secretions much more vitiated. The gastric fluids extracted were mixed with a large proportion of thick ropy mucus, and a considerable muco-purulent discharge slightly tinged with blood, resembling the discharge from the bowels in some cases of dysentery. Notwithstanding this diseased appearance of the stomach, no very essential aberration of its functions was manifested. St Martin complained 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; had a thin yellowish-brown coat on his tongue, and his countenance was rather sallow; pulse uniform and regular, appetite good; rests quietly, and sleeps as usual.”

I have marked part of this quotation in italics, because it cannot be too attentively considered by those who contend that the stimulus of spirits is not injurious to the stomach or general health, unless where the mischief shews itself by palpable external signs. Here we have incontestible proof, that disease of the stomach was induced, and going on from bad to worse, in consequence of indulgence in ardent spirits, although no prominent symptom made its appearance, and St Martin was in his general habits a healthy and sober man. And if such be the results of a few days of intemperance in a person of a sound constitution, it is impossible to deny that continued indulgence must be followed by more serious evils, whether these shew themselves from the first by marked external signs or not.

After a few days of low diet and the use of mild diluents, the coats of St Martin’s stomach were seen to resume their healthy appearance; the secretions became natural, the gastric juice clear and abundant, and the appetite voracious. Dr Beaumont adds, that, in the course of his experiments, diseased appearances of a similar kind were frequently observed--generally, but not always, after some appreciable cause. “Improper indulgence in eating and drinking has been the most common precursor of these diseased conditions of the coats of the stomach. The free use of ardent spirits, wine, beer, or any intoxicating liquor, when continued for some days, has invariably produced these morbid changes. Eating voraciously or to excess, swallowing food coarsely masticated or too fast,” “almost invariably produce similar effects, if repeated a number of times in close succession.” (P. 239.) These observations require no comment; their practical bearing must be obvious to all who are willing to perceive it.

Dr Beaumont had also frequent occasion to remark, that, when stomachic disorder attended with febrile symptoms were present, the mucous coat of the stomach presented distinct appearances of disease. He frequently saw it, for example, red, irritable, and dry; and on the food touching it no gastric juice exuded, and consequently any food taken lay long undigested. But after the diseased action was subdued by regimen and medicine, the gastric juice again flowed readily, and digestion went on as vigorously as before. Even anger and violent mental emotions sometimes produced these appearances, and gave rise to temporary indigestion. These observations shew the futility, not to say mischief, of administering food during fever and other diseases by way of supporting the strength, when, from the deficiency of the gastric juice, it cannot be digested, and can only add to the existing irritation. In this state, however, bland fluids are appropriate; because they allay irritation, and are almost entirely absorbed, without requiring to be digested.

The condition of the stomach above described, and the consequent failure and vitiation of the gastric secretion, induced by drinking ardent spirits, and by general intemperance, explain at once the miserable digestion and impaired appetite of the habitual drunkard; and it would be well for those who are in danger of becoming the victims of the habit, were they early impressed with some of these striking and important truths.

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If it be asked, whether I go the length of proscribing all fermented liquors, from table-beer upwards, I answer that I do not; I merely mean, that, where the general health is perfect without them, they ought not to be taken, because then their only effect is to produce unnatural excitement. But wherever the constitution or health is so deficient, or the exertions required by the mode of life are so great, that the system cannot be sustained in proper vigour without some additional stimulus, I would not only sanction but recommend the use of either wine or such other fermented liquor as should be found by experience to support the strength, without quickening the circulation, exciting the mind, or disordering the digestive functions. If, however, any of these effects be produced, I would consider its occurrence as a proof that the stimulus is inappropriate, and cannot be too soon discontinued, or at least diminished to such a quantity as shall be consistent with the ordinary action of the animal functions.

It may be alleged that a glass of brandy after a heavy dinner facilitates digestion, and therefore cannot do harm. I admit at once, that, when we eat too much, or fill the stomach with indigestible food, a dram of brandy, from its temporary stimulus, enables us to get rid of the load sooner than we could do without it. But it seems to me, that a far wiser plan would be, to abstain from eating what we know to be oppressive to the stomach; and that, by this means, we shall attain our end infinitely better, than by first eating a heavy meal and then, taking a stimulus, the efficacy of which is diminished by every repetition of its use. If we were compelled to exceed the bounds of moderation in eating, there would be some apology for our conduct.