Summary of the Effects upon the Stomach and its Functions:

1. In so far as they stimulate the appetite, alcoholic beverages induce a psychic secretion of gastric juice.

2. While in the stomach, alcohol in 10 per cent. dilution has little if any effect upon the digestive chemistry, the motor activity, or the secretion; the wines and malt liquors tend to retard secretion and the digestive chemistry.

3. While it remains in the stomach, alcohol up to 20 per cent.

in strength promotes absorption of other substances.

4. After absorption from the stomach alcohol induces a copious flow of gastric juice rich in hydrochloric acid and poor in, or devoid of, pepsin; the same qualitative result being obtained, though less in quantity, when alcohol is given by rectum or injected directly into the blood.

5. Strong liquors are carminative, but in the empty stomach irritate and induce a secretion of thick, tenacious mucus.

6. Long-continued drinking of strong liquors tends to produce a chronic gastritis. Taken by mouth, in moderation and properly diluted, alcoholic drinks tend to improve the appetite, to give a feeling of warmth and comfort in the stomach, and to promote the secretory and absorptive functions. In conditions of hyperchlor-hydria, hypersecretion, or ulcer of the stomach, they tend to be harmful. Ordinary amounts of even strong liquors taken at meals are quickly brought down to proper dilution by admixture with the contents of the stomach, and this admixture with food retards their absorption and their systemic activity.

Intestines

After alcohol in moderate quantities any amount that may be carried through the pylorus is probably too dilute to have any local effect in the intestine. After excessive drinking some of it reaches the duodenum and acts there as an irritant. A factor of influence upon the intestine may be a delay in the passage of food from the stomach as a result of the induced hyperchlorhydria. (Brandy has a reputation as an intestinal astringent, and is used in small amounts for diarrhea.)

Pancreas

The amount of pancreatic secretion is increased even up to five times the normal, whether the alcohol is placed in the stomach, the small intestine, the colon, or the rectum. It may be that this also is due to increased formation of the secretin.

Of the ferments, experiments in vitro have demonstrated that alcohol of 5 per cent. strength is completely inhibitory to the action of trypsin and amylopsin, the proteolytic and starch-digesting ferments of the pancreatic juice; while in any strength up to 90 per cent. it distinctly favors the action of steapsin, the fat-splitting ferment. When added to pancreatic juice which is obtained from a fistula, alcohol markedly increases the lipolytic power of the secretion; so it would seem to have the property of changing the proferment into the active ferment, steapsin. After ordinary amounts this action upon the ferments does not take place, as little of the alcohol reaches the intestinal contents. After very large amounts such an action may influence the intestinal digestive process.

Liver

From the stomach and duodenum the absorbed alcohol passes by the portal circulation directly to the liver. Moderate amounts are sufficiently diluted by the portal blood. Large amounts, as in excessive drinking, surcharge the portal blood with alcohol. This attacks the hepatic parenchyma, as shown by the presence of albumin and epithelial cylinders in the bile, and swelling of the liver, with more or less fatty degeneration. In other words, it produces an acute hepatitis. This usually disappears in a few days if no more alcohol is drunk; but a single excessive dose does vastly more harm to the liver than the same amount of liquor taken a little at a time.

Good-sized doses of liquor, frequently repeated during many years, tend to establish permanent changes in the liver - either fatty degeneration or connective-tissue invasion (cirrhosis), or both.

It is a well-known fact that the drinking of large quantities of alcohol for years is a regular prelude to the appearance of cirrhosis of the liver. A number of children also who have been given beer or wine have developed cirrhosis of the liver. Therefore there is a close relation between cirrhosis and alcohol. Yet in animals, though the continued administration of alcohol readily produces a fatty liver, even in starved dogs (prevented by sugar - Von Noorden), almost all investigators, Strassmann, Afanassiew, von Kahlden, etc., have been unable to produce typical cirrhosis even by prolonged administration. I have reports of true cirrhosis being so produced in animals in only very few cases. It seems, then, that it takes years of excessive alcoholism before any extensive connective-tissue changes can be detected, and it is quite probable that the production of cirrhosis of the liver requires more than alcohol. (See "The Pathologic Effects on Organs," page 350.)

The Bile

Alcohol is excreted in the bile only after large doses, and the amount excreted is quickly reabsorbed from the intestine. The quantity of bile, both liquid and solid constituents, may be much increased. Salant's experiments showed that when alcohol was given by stomach the bile increased 50 to 365 per cent.; when alcohol was placed in the intestine the bile increased 80 to 140 per cent., and the solid constituents were increased. This would be the effect expected coincidentally with the increase of pancreatic secretion (Starling) if the alcohol, as we suggested before, results in increased production of secretin. It seems especially probable that this is the case, because alcohol itself, under ordinary circumstances, does not reach the intestines in strength sufficient to have any effect, either direct or reflex. Salant reported, however, that alcohol injected into the blood caused a reduction in the secretion of bile. In addition to these effects excessive amounts may hasten the disappearance of glycogen from the liver, with tendency to increase fat and lessen the oxidative processes of the liver, as shown by the appearance of more uric acid and less urea in the urine, and by an increase of the poisonous symptoms in indolic auto-intoxication. Several researches go to show that sugars tend to lessen these effects.

Absorption is rapid from stomach or intestines. It is retarded by fats, as milk, cream, or oil emulsions (Jacoby).