A remarkable change has occurred in the past twenty years in the attitude of the medical profession on the question of the value of alcohol in the treatment of disease. Whereas formerly wines and spirits were largely used in the treatment of many acute and chronic diseases, the present tendency is more and more to discard alcohol in the treatment of disease. This change in the custom of the profession is very well shown by a reference to the following figures. In the year 1890, the annual cost of wines and spirits per occupied bed in the Royal Infirmary of Edinburgh was 12s. 10 1/2d. - 10s. for spirits, and 2s. 10 1/2,d. for wines. In 1908, the annual cost was is. per head per annum for spirits, and nothing for wines.
Additional evidence of the general trend of medical opinion upon this matter is found in the steady fall in the amount of alcohol used in seven of the London hospitals in the past forty years. Quoting from a diagram in Horslcy and Sturge's book on Alcohol and the Human Body, we find that whereas in 1862 the cost of alcohol for the year in the seven main London hospitals was a little under £8000, in 1902 the cost is under £3000. The extent of this decrease is enhanced by the fact that in the later period a very much larger number of patients were treated than in the earlier years. This decrease of alcohol has been seen alike in surgical and medical cases. In surgery it is probable that the development of the antiseptic system has been to a great extent responsible for the diminished use of alcohol in recent years. The only surgical condition in which alcohol is still considered by some to be of use is " shock," and even here it is largely giving place to other forms of stimulant. The decrease of alcohol in medical cases is very well illustrated by a reference to its use in fevers, which are generally the main class of disease for which alcohol has in the past been extensively used. In the year 1894 the cost of stimulants in the hospitals under the Metropolitan Asylums Hoard, London (quoted by Horsley), was 1s. 46. per head; in 1904 this had fallen to 4d, a very pronounced reduction. This reaction against the prescribing of alcohol in the treatment of disease has been very general, both in this country and abroad. There is little doubt that this movement is in the right direction.
The reason for this change is found in the fuller knowledge we now possess of the unfavourable effects of alcohol, on the structure, function, and resisting power of the body generally, and also to some extent to the recent discovery of valuable medicinal substances which have taken the place of alcohol in the treatment of certain diseases. While the use of alcohol in the treatment of disease is now very restricted, there is no question as to its undoubted value in the treatment of certain diseases, more especially in their critical stages, and we have to consider shortly the physiological effects of alcohol, its therapeutic uses, and the composition and characteristics of the leading alcoholic beverages.
Alcohol is a general stimulant, small doses exciting, larger doses paralysing the nervous system, beginning with the higher centres; it also stimulates the cardio-vascular system, accelerating the circulation, but not notably increasing the force of the heart. In large doses the blood-vessels are paralysed, thus becoming dilated, resulting in a fall of the body temperature. It also stimulates primary digestion to a slight extent, due to its influence on the gastric vessels, and on the muscle wall of the stomach. It does not increase the amount of the gastric juice. Alcohol cannot be regarded as a food. It is beyond the province of this work to describe in full the toxic effects of alcohol, it will suffice to refer briefly to the facts regarding it which bear on its use in the treatment of disease.
When taken in moderate amount, alcohol is completely oxidised in the tissues; when taken in larger amounts, it escapes unoxidiscd with the breath and urine. It is therefore clear that alcohol can furnish energy to the organism, and in virtue of this, alcohol is by some writers regarded as a food. There is no doubt, however, that the fact of a substance being burnt up in the body with the liberation of a certain amount of energy does not entitle it to be regarded as a food. Alcohol does not produce energy for muscular work; on the contrary, the reverse is the case. It is not a physiological source of heat production, because the heat produced by its oxidation is at once lost by the marked dissipation and loss of heat which occurs through the skin. Alcohol possesses no power of repairing tissue. Liebig, the renowned chemist, stated that 9 quarts of the best ale contain as much nourishment as would lie on the end of a table knife. And lastly, there is little or no evidence that alcohol has any effect in the prevention of tissue waste. We must, therefore, conclude that when judged by the requisite standards alcohol cannot be regarded as a food. It may be true that in a very acute illness a patient may live for some days on nothing but large quantities of whisky, brandy, or champagne, and may apparently not emaciate in that time as much as he would have done if he had been living merely on his own tissues; but even if this be so, it does not justify us in regarding alcohol as in any real sense a food.
A further effect of alcohol has to be noted, viz., alcohol as a cause of deficient oxidation of tissue. In virtue of its affinity for oxygen it interferes with the process of oxidation in the tissues, and so leads to fatty degeneration and infiltration of the tissues. Hence the obesity observed in many subjects who take alcohol to excess.
Small doses increase the frequency of the heart-beat, partly indirectly through stimulating the gastric mucous membrane, and partly directly through acting on the nerves and muscles of the heart. There is no evidence, however, that alcohol strengthens the force of the heart-beat; on the contrary, the available experimental evidence rather points in the opposite direction. In disease, however, when the heart is beating quickly but feebly, alcohol may diminish the number of beats, and at the same time increase its force. Alcohol dilates the peripheral blood-vessels, with the result that more heat is given off by radiation than is produced by its own combustion, so that the body temperature is lowered. It is therefore a mistake to take alcohol in any form with the object of "keeping out the cold," as the initial feelings of warmth are soon followed by a lowered temperature from the increased radiation of heat from the skin that immediately ensues. If taken in excess, a state of chronic congestion of the peripheral vessels is induced, hence the purplish appearance of the face seen in subjects who take much alcohol. Degenerative changes in the vessels are also induced by the immoderate use of alcohol in any form.
Alcohol induces a temporary initial stimulation or excitation of the central nervous system. It is now known, however, that this is the result of a deadening of the higher centres, and is in no sense due to a real stimulant action, as was formerly supposed. The effects of small quantities of alcohol on the more highly specialised functions of idealism, reasoning, etc., have been very minutely investigated in a very ingenious manner in recent years by Kraepelin, whose researches have clearly proved that there is no real quickening of brain activity under alcohol, but the reverse.
The chief effect of alcohol when taken in small doses is to increase the motility of the stomach, and thus indirectly stimulate digestion. There is no evidence that it otherwise improves the powers of digestion.
As in the case of the nervous system, there is an initial apparent increase in the muscular activity. This is not a real increase, however. An interesting experiment on the sustaining power of alcohol was made upon three British regiments, and reported in 1899 (quoted by Thompson). The men were subjected to fatiguing exercises. To one regiment a ration of whisky was allowed, to a second a ration of malt liquor, and to the third no alcohol. The men taking whisky exhibited more energy for about four days than either of the other groups, but then became fatigued and weak; whereas those taking none steadily gained in endurance, and those taking malt liquor showed an intermediate condition. Alcohol is usually forbidden to athletes in training, for although it may temporarily lessen muscular fatigue, it soon reduces the power of endurance.
Alcohol is obtained from fermentation of grape sugar by means of yeast. The source of the grape sugar is grain, especially barley, grapes, and in some instances potatoes - the different kinds of alcoholic liquors obtained depending to some extent on the particular kind of sugar, and also the special yeast employed. The various by - products in the process of fermentation also materially influence the nature of the product. The strength of alcoholic liquors is usually expressed as the percentage of alcohol by volume, the percentage of alcohol by volume in some of the commoner alcoholic beverages being roughly as follows: -
. 43 per cent.
10 to 15 per cent.
• 35 "
• • 25 "
• • 21 "
We have to consider shortly the three different classes of alcoholic beverages: spirits, malt liquors, and wines.