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the physiological effects of alcohol which maintain the increased circulation and keep the external surface supplied with fresh, warm blood from the internal and engorged bodily organs. The obvious danger of prescribing alcohol in health is to induce intemperance; but it is only right to state that intemperance is also often the effect of brain weakness and brain disease; indeed, some writers have gone so far as to state that in practically all cases of mental disease associated with intemperance, the latter is a consequence of mental weakness and not the cause—a statement which is probably less than half the truth.
In regard to alcohol, physiology teaches us that alcohol is primarily a strong dehydrating agent. It takes away water from living matter, and as a fixed amount of water is a necessity for the life of a healthy protoplasm, this dehydrating action must prove to be highly injurious, hence its effect upon living tissues is to cause a degeneration and decay, which can be seen in the pyramidal or the essentially psychic cells of the brain, with consequent loss of their function and with marked intellectual degradation when they are affected. The higher will power is impaired, the will loses its grip, normal inhibition is removed, so that the person is easily tempted to other forms of indulgences, and we know that the great campaign of the National Council for combating Venereal Diseases cannot afford to disregard the connection between alcohol and the social evil. I have seen young officers, barely 20 years of age, whose army career has been ruined by drink and debauchery. The disposition in those who drink to excess changes into querulousness and impulsiveness; in fact, the most marked mental effect of excessive drinking is the tendency towards the development of a hostile attitude of mind, with the consequent liability to react furiously and intolerantly. Alcohol attacks the hierarchy of the tissues, for it has a special affinity for the nervous system; there is a shedding by degrees of the most highly evolved faculties; there is a loss of prevision, an impairment of the judgment and a failure in the power of discrimination; later on, the memory becomes affected and no amount of reasoning is able to persuade the person who has got into the habit of drinking to give it up, even if it be clearly pointed out to him that he and his family dependent upon him are being pauperized by it.
It is always very difficult to estimate the exact etiology even in the most common diseases, but it is impossible to arrive at accurate conclusions in regard to the causation of mental diseases; yet, in connection with alcohol, the Lunacy Commissioners in their Report for 1905 made the precise and definite statement that alcohol in their opinion was a “brain poison.” Whether it be justifiable to describe as a deleterious poison an organic substance useless to the individual under ordinary conditions of health, may be a matter for legitimate differences of opinion, but the Lunacy Commissioners made in addition the further statement that although some counties with a comparatively low rate of insanity had a high proportion of cases with a history of intemperance admitted into asylums, there were other counties with a high rate of insanity but with a low proportion of cases suffering from alcoholic intemperance; nevertheless, in those areas in which there was an association of intemperance and insanity, there was also the definite association of intemperance and crime, which appears to justify the inference that in those areas where there may be a high incidence of intemperance, there will also be a high proportion of insanity and crime-it is the considered conclusion from the definite observation of all social workers that where there is intemperance there also are crime and insanity. It is interesting to note that when statistics as to the causation of insanity are taken over a series of years, the number of cases appearing as caused by alcohol as well as by other causes show but little variation from year to year, and it is computed that alcoholic intemperance may correctly and without any doubt be attributed as the assigned cause of insanity in no less than 20 per cent of all males admitted into asylums and in no less than 10 per cent of all the females; and when the total number of admissions for the last year of which we have record, viz., 1915, was quoted as 8600 males and 10,000 females, we can readily see that alcohol was in one year responsible for over 2700 cases of mental disease in England and Wales, i. e., of persons who had to be compulsorily detained against their will and who in consequence of drink were deprived of their social, civil, domestic and financial rights, and of whom it may be observed a number will continue under detention for the remainder of their lives. It may be surmised that about 3000 persons every year become insane through drink in England and Wales.
I have referred to the difficulty there is in arriving at the exact factor of causation in mental diseases, and as may well be appreciated in this illness, the patient himself is unable to assist the investigator, as, owing to the clouding of his reason, the statements he makes are unreliable, and further, the information vouchsafed by the friends does not help to elucidate the cause, for the reason that they only relate such antecedents in the history as appear to them to bear upon the illness, which are rarely either accurate or full. Moreover, in many instances the cause attributed by the friends only stands in some immediate relation to the illness and forms no true part of the cause; indeed, it often has little or no connection with it, the real factor being some inherited or acquired frailty or some weakness in the nervous co-ordination which the friends have either minimized or overlooked or have carefully attempted to suppress. So often is this the case, owing to the stigma attaching to mental disease, that a studious effort is made by all the relations to lessen the importance of a faulty family history and to give prominence to trivial and unrelated factors having no definite causative effect. From what I may claim to be an extensive personal experience, I am more than ever convinced that in mental disease there exists some locus, resistentie minoris in the brain tissue, which renders the individual more prone to be affected by circumstances which in the healthy person would have less influence; and although several antecedents may combine in the ultimate production of a mental breakdown, it is logical to assume that any one of several causes may be the immediate agent responsible for the final breakdown. In regard to this, much depends upon the so-called "immunity" or the individual resistance shown by the person affected, and as we know when several persons are exposed continuously to the same infectious fevers, some always escape and do not contract the infection, whilst others appear to take the disease repeatedly and to suffer in turns from almost all the other ills to which flesh is heir. No fact in biology is more striking than the difference in susceptibility to disease conditions exhibited by different persons and different races, or even by different animals. It accounts for the very different symptoms produced by the same dose of the same kind of alcohol upon different persons. We know from medical experience how, in regard to drink, some persons may break down from arteriosclerosis, hæmorrhage, and cerebral softening; whilst others may suffer from infiltration of the glandular structures, e. g., the liver or kidneys; whilst others again rarely suffer from nervous or mental lesions at all, but they break down from more gross tissue changes and become physical rather than mental cripples. Drink in small doses is literally death to some persons, whereas others tolerate it in large quantities, and the brain worker rather than the manual laborer shows the least resistance to it. As we know, one person may become morbidly irritable and quarrelsome, another may be ludicrously affectionate, a third stupid, a fourth vain and boastful, and a fifth silly; all these differences denoting differences
a of susceptibility to the same dose of the same kind of alcohol. The same susceptibility to alcohol and to disease that is seen in persons is also exhibited in the history of races, e. g., the native races in many parts of the world are comparatively insusceptible to yellow fever, to enteric and to malaria ; and we know the same condition to exist in animals, for dogs and goats are rarely tubercular, and rats which are not susceptible to anthrax are only so after fatigue or when fed upon an exclusively vegetable diet, which helps to render the blood alkaline, a reaction which favors the growth of the bacillus; we know again that tetanus, for instance, is never met with in fowls. These facts demonstrate that there is a natural immunity or a natural insusceptibility on the part of certain races, individuals and animals to certain diseases which may in the same persons even vary at different ages, e. g., as age advances, the immunity to diphtheria and to scarlet fever becomes more marked and definite, and this immunity may be either partial or complete. Precisely the same sort of immunity or insusceptibility which occurs in disease is met with in the use of alcohol, and we are therefore unable to foretell the particular group of neurons likely to suffer in any special case of alcoholic indulgence; nor can we foretell the progress of the symptoms when a group of neurons has been attacked. All we can assert is that for every individual there is a spot or place of weakest resistance which has been arranged for him through natural selection and heredity. For long periods of time, many of the different races have been exposed to alcohol, but the susceptible ones have been weeded out, whilst the survivors transmit their insusceptibility to their descendants, and although this is an observed fact, yet it gives us no physiological explanation of the greater immunity of the insusceptible ones. It is possible that more proteolytic enzymes are produced by the organs of one individual than by those of another in order to destroy or to modify such a toxin as alcohol, with the result that a greater immunity exists in one person than in another. Whether the explanation of this phenomenon be afforded by the humoral hypothesis, which ascribes immunity to the action of certain substances existing in or generated by the body fluids, or the explanation be afforded by the cellular theory of the more active phagocytic action of the polymorphonuclear leucocytes, or to the cellulo-humoral theory of the production of alexins or bacteriolysins in the blood cannot now be discussed; but it is a well ascertained and an incontrovertible fact that alcohol acts differently upon different persons, and this personal equation of the individual should be taken into consideration not only when discussing the symptoms of alcohol, but also when urging legislation for the control of its sale. I have mentioned the subject of immunity in order to show that whilst alcohol may be regarded as a poison—and clearly in this particular what is one man's meat is another man's poison-yet, like many other poisons, it can under certain circumstances be of distinct service to mankind. I may say that I believe the consensus of opinion among medical men in the present day is that in many instances the use of alcohol is to some extent beneficial; but there is a strong section of the thinking public which realizes that alcohol is a lethal weapon which can work the most fell and deadly effects, and that its general use therefore needs the most careful and earnest control. We know personally in too many instances brought to our notice that alcohol reduces energy, lowers vigor, diminishes initiative and paralyzes enterprise, and therefore many persons abstain from it altogether, and they use untiring efforts to prohibit its use by others and this through the highest motives; but it must not be forgotten that total prohibition breeds vices in regard to drugs, sedatives and anodynes. At the moment, the public feeling generally is, that under the control of the normal reasoning and moral faculties the moderate demands of working men and women should be satisfied, i. e., within strict limitations, which is interpreted to apply to its use at meals only and only by those who find it helpful in their daily work. It is often felt by those who watch events that the logic of facts has to be carefully weighed against the sentiment of an ideal, and if true progress in regard to temperance is to be