Popular Science Monthly/Volume 1/June 1872/The Physiological Position of Alcohol
By B. W. RICHARDSON, M. D., F. R. S.
IN whatever mode alcohol may be passed into the living body to produce modification of physical action, the changes it excites are remarkably uniform, and, other things being equal, the amount required to induce the changes is also uniform. Thus, I have found, by many researches, that the proportion of sixty grains of alcohol to the pound weight of the animal body is the quantity capable of producing an extreme effect.
The order of the changes induced is, in like manner, singularly uniform, and extends in a methodical way through all classes of animals that may be subjected to the influence; and, as the details of this part of my subject are the facts that concern us most, I shall expend some time in their narration.
The first symptom of moment that attracts attention, after alcohol has commenced to take effect on the animal body, is what may be called vascular excitement; in other words, over-action of the heart and arterial vessels. The heart beats more quickly, and thereupon the pulse rises. There may be some other symptoms of a subjective kind—symptoms felt by the person or animal under the alcohol—but this one symptom of vascular excitement is the first objective symptom, or that which is presented to the observer. I endeavored in one research to determine from observations on inferior animals what was the actual degree of vascular excitement induced by alcohol, and my results were full of interest. They have, however, been entirely superseded by the observations made on the human subject by Dr. Parkes and Count Wollowicz.
These observers conducted their inquiries on the young and healthy adult man. They counted the beats of the heart, first at regular intervals, during what were called water periods, that is to say, during periods when the subject under observation drank nothing but water; and next, taking still the same subject, they counted the beats of the heart during successive periods in which alcohol was taken in increasing quantities; thus step by step they measured the precise action of alcohol on the heart, and thereby the precise primary influence induced by alcohol. Their results were as follows:
The average number of beats of the heart in 24 hours (as calculated from eight observations made in 14 hours), during the first or water period, was 106,000; in the alcoholic period it was 127,000, or about 21,000 more; and in the brandy period it was 131,000, or 25,000 more.
The highest of the daily means of the pulse observed during the first or water period was 77.5; but on this day two observations are deficient. The next highest daily mean was 77 beats.
If, instead of the mean of the eight days, or 73.57, we compare the mean of this one day, viz., 77 beats per minute, with the alcoholic days, so as to be sure not to over-estimate the action of the alcohol, we find:
On the 9th day, with one fluid ounce of alcohol, the heart beat 430 times more.
On the 10th day, with two fluid ounces, 1,872 times more.
But as there was ephemeral fever on the 12th day, it is right to make a deduction, and to estimate the number of beats in that day as mid-way between the 11th and 13th days, or 18,432. Adopting this, the mean daily excess of beats during the alcoholic days was 14,492, or an increase of rather more than 13 per cent.
The first day of alcohol gave an excess of 4 per cent., and the last of 23 per cent.; and the mean of these two gives almost the same percentage of excess as the mean of the six days.
Admitting that each beat of the heart was as strong during the alcoholic period as in the water period (and it was really more powerful), the heart on the last two days of alcohol was doing one-fifth more work.
Adopting the lowest estimate which has been given of the daily work done by the heart, viz., as equal to 122 tons lifted one foot, the heart, during the alcoholic period, did daily work in excess equal to lifting 158 tons one foot, and in the last two days did extra work to the amount of 24 tons lifted as far.
The period of rest for the heart was shortened, though, perhaps, not to such an extent as would be inferred from the number of beats for each contraction was sooner over. The heart, on the fifth and sixth days after alcohol was left off, and apparently at the time when the last traces of alcohol were eliminated, showed in the sphygmographic tracings signs of unusual feebleness; and, perhaps, in consequence of this, when the brandy quickened the heart again, the tracings showed a more rapid contraction of the ventricles, but less power, than in the alcoholic period. The brandy acted, in fact, on a heart whose nutrition had not been perfectly restored.
It is difficult, at first glance, to realize the excessive amount of work performed by the heart under this extreme excitement. Little wonder is it that, after the labor imposed upon it by six ounces of alcohol, the heart should flag; still less wonder that the brain and muscles which depend upon the heart for their blood-supply should be languid for many hours, and should require the rest of long sleep for renovation. It is hard physical work, in short, to fight against alcohol; harder than rowing, walking, wrestling, carrying heavy weights, coal-heaving, or the tread-wheel itself.
While the heart is thus laboring under the action of alcoholic stimulation, a change is observable in the extreme circulation—that circulation of blood which by varying shades of color in exposed parts of the body, such as the cheek, is visible to the eye. The peripheral circulation is quickened, the vessels distended. We see this usually in persons under the influence of wine in the early stage, and we speak of it as the flush produced by wine. The authors I have already quoted report upon it in definite terms: "The peripheral circulation (during alcoholic excitement) was accelerated, and the vessels were enlarged, and the effect was so marked as to show that this is an important influence for good or for evil when alcohol is used."
By common observation the flush seen on the cheek during the first stage of alcoholic excitation is supposed to extend merely to the parts actually seen. It cannot, however, be too forcibly impressed on the mind of the reader that the condition is universal in the body. If the lungs could be seen, they, too, would be found with their vessels injected; if the brain and spinal cord could be laid open to view, they would be discovered in the same condition; if the stomach, the liver, the spleen, the kidneys, or any other vascular organs or parts could be laid open to the eye, the vascular enlargement would be equally manifest.
In course of time, in persons accustomed to alcohol, the vascular changes, temporary only in the novitiate, become confirmed and permanent. The bloom on the nose which characterizes the genial toper is the established sign of alcoholic action on vascular structure.
Recently some new physiological inquiries have served to explain the reason why, under alcohol, the heart at first beats so quickly and why the pulses rise. At one time it was imagined that the alcohol acted immediately upon the heart, stimulating it to increased action, and from this idea—false idea, I should say—of the primary action of alcohol, many erroneous conclusions have been drawn. We have now learned that there exist many chemical bodies which act directly by producing a paralysis of the organic nervous supply of the vessels which constitute the minute vascular circuit. These minute vessels when paralyzed offer inefficient resistance to the stroke of the heart, and the heart thus liberated, like the mainspring of a clock from which the resistance has been removed, quickens in action, dilating the minute and feebly-acting vessels, and giving evidence really not of increased but of wasted power.
The phenomena noticed above constitute the first stage of alcoholic action on the body; we may call it the stage of excitement; it corresponds with a similar stage or degree caused by chloroform.
If the action of alcohol be carried further, a new set of changes is induced in another part of the nervous system—the spinal system. Whether this change be due simply to the modification of the circulation in the spinal cord, or to the direct action of the alcohol upon the nervous matter, is not yet known, but the fact of change of function is well marked, and it consists of deficient power of coordination of muscular movement. The nervous control of certain of the muscles is lost, and the nervous stimulus is more or less enfeebled. The muscles of the lower lip in the human subject usually fail first of all, then the muscles of the lower limbs, and it is worthy of remark that the flexor muscles give way earlier than the extensors. The muscles themselves by this time are also failing in power; they respond more feebly than is natural to the galvanic stimulus; they, too, are coming under the depressing influence of the paralyzing agent, their structure temporarily changed, and their contractile power everywhere reduced. This modification of the animal functions under alcohol marks the second degree of its action. In this degree, in young subjects, there is usually vomiting, and in birds this symptom is invariable. Under chloroform there is produced a degree or stage of action holding the same place in the order of phenomena.
The influence of the alcohol continued still longer, the upper portions of the cerebral mass, or larger brain, become implicated. These are the centres of thought and volition, and as they become unbalanced and thrown into chaos, the mind loses equilibrium, and the rational part of the nature of the man gives way before the emotional, passional, or mere organic part. The reason now is off duty, or is fooling with duty, and all the mere animal instincts and sentiments are laid atrociously bare. The coward shows up more craven, the braggart more braggart, the bold more bold, the cruel more cruel, the ignorant more ignorant, the untruthful more untruthful, the carnal more carnal. "In vino veritas" expresses faithfully, indeed even to physiological accuracy, a true condition. The spirits of the emotions are all in revel, and are prepared to rattle over each other in wild disorder; foolish sentimentality, extending to tears, grotesque and meaningless laughter absurd promises and asseverations, inane threats or childish predictions impel the tongue, until at last there is failure of the senses, distortion of the objective realities of life, obscurity, sleep, insensibility, and utter muscular prostration. This constitutes the third stage of alcoholic intoxication. It is the stage of insensibility under chloroform when the surgeon performs his painless task.
While these changes in the action of the nervous system are in progress there is a peculiar modification proceeding in respect to the temperature of the body. For a little time the external or surface temperature is increased, especially in those parts that are unduly charged and flushed with blood. But it is to be observed that in respect to the mass of the body the tendency is to a fall of temperature. In the progress toward complete intoxication under alcohol, however, there are, as we have already seen, three degrees or stages. The first is a stage of simple exhilaration, the second of excitement, the third of rambling insensibility, and the fourth of entire unconsciousness, with muscular prostration. The duration of these stages can be modified in the most remarkable manner by the mode of administration; but whether they are developed or recovered from in an hour or a day, they are always present except in cases where the quantity of alcohol administered is in such excess that life instantly is endangered or destroyed. In the first or exhilarative stage the temperature undergoes a slight increase; in birds a degree Fahrenheit, in mammals half a degree. In the second degree, during which there is vomiting in birds, or attempts at vomiting, the temperature comes back to its natural standard, but soon begins to fall; and during the third degree the decline continues. The third degree fully established, the temperature falls to its first minimum, and in birds comes down from five and a half to six degrees; in rabbits from two and a half to three degrees. In this condition the animal temperature often remains until there are signs of recovery, viz., conscious or semi-conscious movements, upon which there may be a second fall of temperature of two or even three degrees in birds. In this course of recovery I have seen, for instance, the temperature of a pigeon which had a natural standard of 110° Fahr. reduced to 102°. Usually with this depression of force there is a desire for sleep, and with perfect rest in a warm air there is a return of animal heat; but the return is very slow, the space of time required to bring back the natural heat being from three to four times longer than that which was required to reduce it to the minimum.
In these fluctuations of temperature the ordinary influences of the external air play an important part as regards duration of the fluctuation, and to some extent as regards extremes of fluctuation.
These facts respecting fall of temperature of the animal body under alcohol were derived from observations originally taken from the inferior animals; they have been confirmed since by other observers, from the human subject. Dr. De Marmon, of King's Bridge, New York, has specially proved this fact in some instances of poisoning by whiskey in young children. In one of these examples the temperature of the body fell from the natural standard of 98° Fahr. to 94°, in another to 93½°.
Through all the three stages noticed in the above, the decline of animal heat is a steadily-progressing phenomenon. It is true that in the first stage the heat of the flushed parts of the body is for a brief time raised, but this is due to greater distribution of blood and increased radiation, not to an actual increment of heat within the body. The mass of the body is cooling, in fact, while the surfaces are more briskly radiating, and soon, as the supply of heat-motion fails, there is fall of surface temperature also; a fall becoming more decided from hour to hour up to the occurrence of the fourth and final stage, of which I have now to treat.
The fourth degree of alcoholic intoxication is one of collapse of the volitional nervous centres, of the muscular organs under the control of those centres, and of some of the organic or mere animal centres. It is true that, while the body lies prostrate under alcohol, there are observed certain curious movements of the limbs, but these are not stimulated from the centres of volition, nor are they reflected motions derived from any external stimulus; they are strange automatic movements, as if still in the spinal cord there were some life, and they continue irregularly nearly to the end of the chapter, even when the end is death.
Through the whole of this last stage two centres remain longest true to their duty, the centre that calls into play the respiratory action, and the centre that stimulates the heart. There is then an interval during which there are no movements whatever, save these of the diaphragm and the heart, and, when these fail, the primary failure is in the breathing-muscle: to the last the heart continues in action.
The leading peculiarity of the action of alcohol is the slowness with which the two centres that supply the heart and the great respiratory muscle are affected. In this lies the comparative safety of alcohol: acting evenly and slowly, the different systems of organs die after each other, or together, gently, with the exception of those two on which the continuance of mere animal life depends. But for this provision, every deeply-intoxicated animal would inevitably die.
It happens usually, nevertheless, that under favorable circumstances the intoxicated live: the temperature of the body sinks two or three degrees lower, but the alcohol diffusing through all the tissues, and escaping by diffusion and elimination, the living centres are slowly relieved, and so there is slow return of power. If death actually occurs, the cause of it is condensation of fluid on the bronchial surfaces and arrest of respiration from this purely mechanical cause. The animal is literally drowned in his own secretion. Such are the stages or degrees of alcoholic narcotism, from the first to the last. Let me add two or three observations.
In the first place, we gather that this agent is a narcotic. I have compared it throughout to chloroform, and the comparison is good in all respects save one, viz., that alcohol is less fatal than chloroform as an immediate destroyer.
The well-proven fact that alcohol, when it is taken into the body, reduces the animal temperature, is full of the most important suggestions. It shows that alcohol does not in any sense act as a supplier of vital heat, as is so commonly supposed, and that it does not prevent the loss of heat, as those imagine "who take just a drop to keep out the cold." It shows, on the contrary, that cold and alcohol in their effects on the body run closely together, an opinion most fully confirmed by the experience of those who live or travel in cold regions of the earth.
The conclusive evidence now in our possession that alcohol taken into the animal body sets free the heart, so as to cause the excess of motion of which the record has been given above, is proof that the heart, under the frequent influence of alcohol, must undergo deleterious change of structure. It may, indeed, be admitted in proper fairness, that when the heart is passing through this rapid movement it is working under less pressure than when its movements are slow and natural; and this allowance must needs be made, or the inference would be that the organ ought to stop at once in function by the excess of strain put upon it.
I cannot, by any argument yet presented to me, admit the alcohols by any sign that should distinguish them from other chemical substances of the exciting and depressing narcotic class. When it is physiologically understood that what is called stimulation or excitement is, in absolute fact, a relaxation, I had nearly said a paralysis, of one of the most important mechanisms in the animal body—the minute, resisting, compensating circulation—we grasp quickly the error, in respect to the action of stimulants, in which we have been educated, and obtain a clear solution of the well-known experience that all excitement, all passion, leaves, after its departure, lowness of heart, depression of mind, sadness of spirit. In the scientific education of the people no fact is more deserving of special comment than this fact, that excitement is wasted force, the running down of the animal mechanism before it has served out its time of motion.
It will be said that alcohol cheers the weary, and that to take a little wine for the stomach's sake is one of those lessons that come from the deep recesses of human nature. I am not so obstinate as to deny this argument. There are times in the life of man when the heart is oppressed, when the resistance to its motion is excessive, and when blood flows languidly to the centres of life, nervous and muscular. In these moments alcohol cheers. It lets loose the heart from its oppression, it lets flow a brisker current of blood into the failing organs; it aids nutritive changes, and altogether is of temporary service to man. So far alcohol is good, and if its use could be limited to this one action, this one purpose, it would be among the most excellent of the gifts of Nature to mankind.
It is assumed by most persons that alcohol gives strength, and we hear feeble persons saying daily that they are being kept up by stimulants. This means actually that they are being kept down, but the sensation they derive from the immediate action of the stimulant deceives them and leads them to attribute lasting good to what, in the large majority of cases, is persistent evil. The evidence is all-perfect that alcohol gives no potential power to brain or muscle. During the first stage of its action it may enable a wearied or feeble organism to do brisk work for a short time; it may make the mind briefly brilliant; it may excite muscle to quick action, but it does nothing at its own cost, fills up nothing it has destroyed as it leads to destruction.
On the muscular force the very slightest excess of alcoholic influence is injurious. I find, by measuring the power of muscle for contraction in the natural state and under alcohol, that, so soon as there is a distinct indication of muscular disturbance, there is also indication of muscular failure, and if I wished, by scientific experiment, to spoil for work the most perfect specimen of a working animal, say a horse, without inflicting mechanical injury, I could choose no better agent for the purpose of the experiment than alcohol. But alas! the readiness with which strong, well-built men slip into general paralysis under the continued influence of this false support, attests how unnecessary it were to put a lower animal to the proof of an experiment. The experiment is a custom, and man is the subject.
It may be urged that men take alcohol, nevertheless, take it freely and yet live; that the adult Swede drinks his average cup of twenty five gallons of alcohol per year, and yet remains on the face of the earth. I admit force even in this argument, for I know that under the persistent use of alcohol there is a secondary provision for the continuance of life. In the confirmed alcoholic, the alcohol is in a certain sense so disposed of that it fits, as it were, the body for a long season, nay, becomes part of it; and yet it is silently doing its fatal work; all the organs of the body are slowly being brought into a state of adaptation to receive it and to dispose of it; but in that very preparation they are themselves undergoing physical changes tending to the destruction of their function and to perversion of their structure. Thus, the origin of alcoholic phthisis, of cirrhosis of the liver, of degeneration of the kidney, of disease of the membranes of the brain, of disease of the substance of the brain and spinal cord, of degeneration of the heart, and of all those varied modifications of organic parts which the dissector of the human subject so soon learns to observe—almost without concern, and certainly without any thing more than commonplace curiosity—as the devastations incident to alcoholic indulgence.—Condensed from the Popular Science Review.