Experiments with Alcohol.

145

and it is interesting as being the first symptom probably (when it occurs at all) of narcosis." In speaking of the stimulant or food action of alcohol, he says that to produce this effect it must be taken" in doses just too small to produce flushing of the face and sweating of the brow." Professor John Fiske makes the same statement. 3 Anstie fixes the maximum amount of absolute alcohol which can be taken daily by the adult male without causing any narcotic effect at six hundred grains, or about an ounce and a half; and yet in giving the details of an experiment made on himself of taking an ounce and a half of whisky, equal to about three-fourths of an ounce of alcohol, he admits that "in this instance I used a quantity of alcohol so small as I should not beforehand have supposed capable of producing the poisonous results." But "the poisonous effects were fully developed, though not very lasting.... The face felt hot, and was visibly flushed; pulse eighty-two, full and bounding; slight perspiration on the brow."5

Now without dwelling on the fact at which Anstie hints above, and which is a matter of common observation, that some people are narcotised by alcohol without any flushing of the face at all, it naturally occurs to any one to inquire whether it is not possible that this paralysis of the vaso-motor nerves may take place in some slight degree at least long before it is manifest in the flushing of the face; and whether a sharper scrutiny may not detect some more subtile and earlier evidence of such paralysis than this "conspicuous" symptom, and a paralysis which may be the result of even smaller doses than those which" beforehand would not have been supposed capable of producing the poisonous results." A hint which may help to answer this question is given in the observations made by Drs. Nicol and Mossop of Edinburgh. These gentlemen, conducting a series of experiments upon each other, examined the base of the eye by means of the ophthalmoscope while the system was under the influence of various drugs. They found that the nerves controlling the delicate blood-vessels of the 2 Ibid. p. 113.

1 Stimulants and Narcotics, p. 204.

3 Tobacco and Alcohol (New York, 1869), p. 92. London Practitioner, vol. xiii. p. 28.

Disease, p. 7.

* Stimulants and Narcotics, pp. 187, 345.

VOL. XXXI.-NO. CXIX.

On the Use of Wine in Health and

K

retina were paralysed, and the vessels themselves congested by a dose of two drachms of rectified spirits-less than a quarter of an ounce of absolute alcohol-or about a table-spoonful of brandy. Here was a genuine paralysis, "a real physical damage to the nervous tissue," wrought by a dose of alcohol so small as to be regarded by Anstie as only very mildly "stimulant." The narcosis caused by this minute dose was, of course, less extended, but just as real as that which occurs when a man becomes dead-drunk.

As the nerves and blood-vessels of the eye have a peculiarly intimate connection with the brain, this experiment would seem to show us, through this little window, as it were, to the cerebrum, how it is that even half a glass of light wine "goes to the head" of many people, that is, causes for a moment a slight dizziness and blurring of sight; and also how it is that, as Dr. E. Smith has shown, all the senses, particularly the sight, are blunted by very small doses of alcohol.2 Is it impertinent to suggest that even smaller quantities than this quarter of an ounce may cause incipient narcosis, if only we had an instrument sharp enough to detect it? If so, the distinction in kind between the effects of large and of small doses vanishes.

Some further light is given on this point by experiments made by Dr. Mulvaney, staff-surgeon of the Royal Navy, upon the effect of alcohol upon the electrical currents of the body. He discovered that an ounce of brandy, equal to about half an ounce of alcohol, taken by a healthy man, raised the galvanometer in a few minutes in one case twenty-five degrees, and in another case forty-five degrees. He concluded that the thermo-electric currents of the system were strongly excited by small doses of alcohol, and that this excitement may be profitably employed when there is "clear evidence of derangement of function springing from enfeeblement of the organic system of nerves;" but that "in health, when function, nutrition, and blood and nerve influence are harmonised by structural integrity," such artificially excited currents, by tending to abstract an undue amount of water from the braincells, "must interfere with their normal working." This is

1 British and Foreign Medico-Chirurgical Review, vol. 1. p. 200 seq.

2 Transactions of the Royal Society, 1859, p. 732. International Scientific Series, "Food," by Dr. E. Smith, p. 430.

3 London Lancet, 1875, vol. ii. p. 166.

Effect of Alcohol on bodily temperature.

147

clear testimony to the bad effects of even small amounts of alcohol in health, a matter to be noticed further on; but the precise point to be observed here is that the galvanometer affords a delicate test of the action of comparatively small quantities of alcohol upon the nerves, and of their narcotic, and therefore injurious, effect long before the ordinary signs of narcosis are apparent.

Relevant to the same point is some of the evidence as to the effect of alcohol upon the temperature of the body. This question has been profoundly discussed, chiefly in relation to the supposed food-action of alcohol, but it also has a bearing upon the inquiry as to the signs of narcotism.

That the temperature of the body is lowered by the administration of alcohol may now be regarded as a fact established by the investigations of nearly all observers. The substance of the fact is well stated by Professor Carl Binz: "The thermometer, the only reliable guide, indicates no important rise or fall after small doses of alcohol. Given in quantities a little larger, but still sufficiently moderate not to cause drunkenness, it causes a distinct fall, lasting half an hour or more; while after a dose powerful enough to inebriate, a still more decided lowering of the temperature, from 35° to 5° Fahr., is observable, which lasts several hours." 2 Now the precise action of alcohol in diminishing animal heat is still in debate, but it is agreed that one way in which it acts is by relaxing the muscular tone of the capillaries through paralysis of the vaso-motor nerves, thus increasing the action of the heart, and bringing the warm blood more rapidly to the surface, where (though a sensation of warmth is experienced) it is cooled at the expense of the internal heat. But we have the testimony of Professor Binz, above quoted, to the fact that though small doses do not produce any important rise or fall of the bodily temperature, yet "a distinct fall, lasting half an hour or more," is effected by a dose sufficiently moderate not

1 Ringer's Therapeutics (New York, 1876), p. 275; London Lancet, 1866, vol. ii. p. 208; Richardson's Cantor Lectures on Alcohol, Nat. Temp. Soc. (New York, 1881), p. 111; London Practitioner, vol. v. p. 101. For other authorities, see Treatise on Therapeutics, by H. C. Wood, Jr., M.D. (Philadelphia, 1876), p. 115 Ref.

London Practitioner, vol. xxvi. p. 286.

3 British and Foreign Medico-Chirurgical Review, vol. lviii. p. 2; and Dr. Lauder Brunton, London Practitioner, vol. xvi. p. 63.

to cause drunkenness. This extract from Binz, as well as others to the same effect which might be made from Ringer, Rickard, Wood, and others, certainly does not seem to indicate. any difference in kind, but only in degree, between the effects of large and of small doses. It points to a regular gradation in narcosis from the action of the smallest to the action of the largest dose. Certainly it shows that the thermometer reveals minute paralysis of nerve-filaments produced by quantities of alcohol so small that they are called by some only stimulant doses, because they do not effect obvious signs of narcotism.

The fact is, Anstie's theory and his experiments and arguments in support of it are unsatisfactory. The theory so implicitly relied on by the friends of moderate drinking is by no means proved. It is no doubt true that in increasing the dose of alcohol from minute quantities a point is finally reached (never a fixed one, as we shall see) when the ordinary signs of narcosis begin to appear, but it is not shown to be true that no narcosis whatever exists till that point is reached, still less that an effect entirely different in kind goes on up to that point. Analogy leads us to believe that, without evidence to the contrary, the same effect in kind is produced by a small as by a large dose. But such evidence is wanting. On the other hand, experience and many of the more refined and recent experiments, though certainly not conclusive, tend in the other direction, and indicate that the anaesthetic effect of a small dose, though not exhibited in the usual way, and not appreciably harmful, simply because there is no pronounced effect of any sort, is yet a real effect, and increases, as the dose increases, to distinct narcotism.

We are aware that it will be said in reply that other substances, such for example as salt and iron, have one action. when given in small, and an entirely different action when given in large, amounts; in the one case being necessary to life, in the other being deadly poisons. But the analogy does not hold when applied to the action of alcohol, for we have very clear evidence that the food-action of salt or iron consists in a series of chemical and vital processes, by which these substances are partly absorbed and partly decomposed to become normal constituents of the body; while the poisonous action of large quantities of these substances is simply irritant

Use and Abuse of Opium.

149

and inflammatory-an entirely different thing. But in the case of alcohol, though large and concentrated doses doubtless have a certain amount of irritant and corrosive effect in addition to their narcotic, yet the distinctive action of the drug, whether in large or small amounts, is practically one and the same in kind-anaesthetic, sedative, or narcotic. There may, indeed, often seem to be a stage of true food or stimulant action wrought by small doses of alcohol, but the evidence adduced would appear to show that this is not a direct, but a secondary effect, produced by a quickened circulation through a very slight deadening of the vaso-motor nerves,—the narcotic action being real, though practically imperceptible.

Before proceeding further it is worth while to notice that this theory of Dr. Anstie applies as much to opium as to alcohol, and abstractly gives the same countenance to the moderate use of the one as of the other. Dr. Anstie, speaking of the abuse of opium by Orientals, declares that with them "its use is an important and genuine one: it acts as a powerful food-stimulant, enabling the taker to undergo severe and continuous physical exertion without the assistance of ordinary food, or on short rations," and he believes that to a certain extent the same remarks apply to natives of England, though the doses are generally smaller. While he thinks there is seldom "any noticeable intermediate state between the stimulant and narcotic dose of opium," 2 yet he feels sure that its use in quantities of from one to three drachms of laudanum daily is very common among "persons who would never think of narcotising themselves any more than they would of getting drunk; but who simply desire a relief from the pains of fatigue endured by an ill-fed, ill-housed body and a harassed mind."3 That is, more exactly, like the moderate drinker of alcohol, they desire just enough paralysis of the nervous tract as shall suffice to dull sensibility, and blot out annoying impressions. But the man who therefore, wholly sustained by this theory, should advocate the moderate use of opium as a food-stimulant to be used generally, would be regarded as an enemy of his kind. Dr. Beard, a fair witness on this point, says: "I would rather risk my life by jumping off Niagara Falls than by forming the habit of opium 1 Stimulants and Narcotics, p. 139. 2 Ibid. p. 141. 3 Ibid. p. 141.