Alcohol, a Dangerous and Unnecessary Medicine/Chapter 16
CHAPTER XVI.
RECENT RESEARCHES UPON ALCOLOL.
In the year 1900 Prof. Taav Laitinen, of the University of Helsingfors, Finland, published an account of experiments made upon 342 animals—dogs, rabbits, guinea pigs, fowls and pigeons—to determine the effects of alcohol upon the resistance of the body to infectious diseases. He used as infecting agents, anthrax bacilli, tubercle bacilli, and diphtheria bacilli. The doses of alcohol given varied with the animal. For his "small dose" experiments he used the quantity of alcohol given as a food or as a medicine, or both, in a neighboring sanitorium. The alcohol employed was, as a rule, a 25 per cent, solution of ethyl alcohol in water. It was given either by esophageal catheter, or by dropping it into the mouth from a pipette. It was administered in several ways, and for varying times; sometimes in single large doses, at others in gradually increasing doses for months at a time, in order to produce here an acute, and there a chronic poisoning; in fact, he produced the conditions consequent upon steady, moderate drinking.
His first conclusion from these experiments, most carefully carried out, is that alcohol, however given, induces in the animal body a markedly increased susceptibility to infectious diseases; and he maintains that his experiments indicate that the use of alcohol, at least in the treatment of anthrax, tuberculosis, and diphtheria, is not only useless but probably injurious. From a number of other experiments carried out with scrupulous care he comes to the same conclusion as Abbott, Welch, and others that the predisposing to disease of alcohol must be explained by its action in producing abnormal conditions—pathological changes in the alimentary canal, liver, kidneys, heart, and nervous system. He found that the alkalinity of the blood was slightly diminished, and the number of leucocytes somewhat decreased. He also draws attention to the fact that his experiments prove that pregnant animals and their offspring are markedly affected by the continued use of small doses of alcohol. He shows, too, that the temporary lowering of the body temperature by alcohol produces the most favorable condition for the invasion of disease germs.
Since the publication of these experiments, and of others similar to them, the use of alcohol in diphtheria and tuberculosis has very largely ceased. Boards of health and charity organizations unite in warning against indulgence in alcoholic drinks as conducive to tuberculosis.
At the International Congress on Alcoholism, held in London in July, 1909, Professor Laitinen delivered two lectures. The first was upon "The Influence of Alcohol on Immunity." The following is taken from this lecture:—
"Modern researches have done much to explain the extent and nature of the protective powers by which the organisim endeavors to defend itself against the attacks of all kinds of injurious agencies, and especially against invasion by the germs of infective diseases. It is now a well-established fact that alcohol weakens the normal resisting power of the body against the above-named disease-producing influences. In the hope of contributing something to the explanation of the way in which alcohol weakens the organism, I have made a number of experiments bearing upon the question of the influence of alcohol on immunity.
"Early in this century careful experiments went to show that alcohol certainly had some influence upon immunity. Two Americans, Abbott and Bergey, were the first to discover that this agent produces a diminution of the hsemolytic complement in the blood-serum of certain animals which were tested. They showed also that the formation of specific hæmolytic receptors (immune bodies) may be retarded by the action of alcohol.
"The extent of the evil effects upon the human body resulting from the consumption of alcoholic liquors is as yet far from being fully known, and stands in need of scientific verification. Many other injurious influences such as unsanitary dwellings, bad feeding, excessive toil, and toxic agents like nicotine, etc., may produce somewhat similar morbid effects. It is therefore necessary, in the scientific study of the question, to take these possibilities into consideration. In my investigations, the results of which I am now to lay before you, I have endeavored to select as subjects for my experiments both abstainers from alcohol, and those who indulge more or less in its use, in such a way that their conditions of life and their habits in other respects should be as nearly as possible the same. All persons, for instance, suffering from any acute or chronic disease were rejected, and very few of the persons selected were smokers. The subject of this research has been human blood, and especially its two principal components, namely, red blood-corpuscles and blood-serum, both of which up to the present time have been very little studied in relation to the question under discussion. I have gone into these matters chiefly because the modern theoretical study of immunity during the last few years has, in general, attracted greater attention to the blood, and shown the important role which the different parts, properties, and capacities of the blood play in defending the organism against internal and external injurious agencies. Further, the subtle methods employed in the study of immunity (such as organic reactions, and reactions between greatly attenuated organic liquids) would also seem to be available for our purpose, as they allow of the detection of the minutest differences which alcohol may produce in any part of the organism in question.
"During the course of this research, which has lasted over a period of three years, I sought to investigate the action of alcohol on the resistive power of human red blood-corpuscles. I wished to ascertain whether the resistivity of the red blood-corpuscles in a healthy man could be lowered by the consumption of alcohol. * * *
"It may be well for me here to explain that in this lecture I mean by the term 'drinker' a person who has taken alcohol in any quantity whatever. Many of these 'drinkers,' therefore, were in fact most moderate consumers of alcohol. By the term 'abstainer' I mean a person who has never taken alcohol in any quantity worth mentioning. In the course of my investigations I have examined blood from two hundred and twenty-three persons. They were of different classes and ages. There were professors of medicine and other physicians, University fellows, students of both sexes, hospital nurses, school-teachers, waiters, and other men and women belonging to the working-classes."
The rest of the lecture as given here is an abstract made by Professor Laitinen:—
"My studies have been directed to an investigation of the following points :
"1. I sought to ascertain whether the resistance of human red blood-corpuscles against a heterogeneous normal serum, or an immune serum, can be diminished by the use of alcohol.
"2. I have studied the action of alcohol in drinking and abstaining persons on the hæmolytic power of blood-serum over heterogeneous red blood-corpuscles (rabbits). I have studied not only the haemolytic power of the human blood-serum, but also its power of precipitation in the presence of rabbit-serum, with a view to ascertain if the reaction between a known dilution of rabbit-serum and a certain dilution of serum of alcohol-users and non-drinking persons is different or not, and if the reaction is more apparent with the former or with the latter.
"3. The resisting power of serum obtained both from alcohol-drinking and from non-drinking persons was further tested by human blood, with the object of discovering whether any difference in reaction existed between the same immune serum and the two kinds of human sera above mentioned.
"4. I have studied the problem as to whether the hæmolytic complement in the blood-serum of alcohol-drinking and non-drinking persons is altered in any way by alcohol.
"5. The bactericidal power of blood-serum from both alcohol-drinking and non-drinking persons was determined by some experiments.
"The above experiments have given the following results:
"1. The normal resistance of human red blood-corpuscles appears to be somewhat diminished against a heterogeneous normal serum or an immune serum by the consumption of alcohol, provided that tolerably large equal, or nearly equal, numbers of drinkers and abstainers of both sexes be examined, and the average of resistance be taken on both sides: this last-named precaution being necessary because the resistance of red blood-corpuscles from different human beings varies largely. The difference is often greater when using weaker solutions than when using stronger dilutions of lysin.
"2. These experiments have shown the normal hæmolytic power of human blood-serum to be less in the case of alcohol-drinkers than in that of abstainers.
"3. The precipitating reaction between a solution of 1 per cent, human blood-serum and different dilutions of immune serum was greater in the case of drinkers than in that of abstainers.
"4. These experiments have also shown that the bactericidal power of blood-serum against typhoid bacteria was less in the case of drinkers than in that of abstainers.
"It seems clear, therefore, that alcohol, even in comparatively small doses, exercises a prejudicial effect on the protective mechanism of the human body."
The lecturer made his points clear by a carefully prepared series of charts. At its close Sir Victor Horsley, Professor Sims Woodhead, A. Pearce Gould, and several other distinguished physicians spoke in high terms of the painstaking care exhibited in the experiments.
Professor Laitinen's second lecture was upon "The Influence of Alcohol Upon Human Offspring." He sent out 15,000 circulars to his countrymen, asking many questions relative to themselves and their infant children, and received 5,845 replies relative to 20,008 children. He also studied personally a large number of drinking and abstaining families. From these studies he shows by careful tables that the drinking of alcohol by parents, even in small quantities, has an injurious influence upon human offspring. His studies in former years showed the same unfavorable influence upon the offspring of animals. One of his tables gives percentages of deaths of children in the homes of abstaining parents, moderate drinkers, and harder drinkers. Children of abstainers dying in the first year, 13.45 per cent; of moderates, 23.17 per cent.; of harder drinkers, 32.02 per cent. Other tables show that abstainers' children gain in weight more steadily in the first year than drinkers' children, and have their teeth earlier, as a rule.
At the International Medical Congress of 1909, held in Budapest, Professor Laitinen lectured again upon his researches, and summarized his conclusions thus:
"1. The importance of alcohol as an article of food is rendered very questionable by recent researches. 2. These researches prove that alcohol diminishes the natural power of the tissues to resist injury, promotes degeneration, and has a disastrous effect on future generations. 3. The questions of relation of alcoholic liquor to crime and of the manufacture and sale of such beverages deserve the serious consideration of the legislature. 4. It is the duty of medical men to direct more attention than formerly to the alcohol question, and by careful study to decide whether recent researches are justified or not in regarding alcohol and alcoholic beverages as a poison and one of the principal causes of degeneration in the human family; they ought also to consider whether it would not be advisable in medical practice, and especially in hospitals, either to banish it altogether or at least to prescribe it with the same care as other poisonous drugs. In this matter the attitude taken by medical men as representatives of public hygiene was of quite exceptional importance."
Metchnikoff, the illustrious Russian scientist, who has for some years been connected with the Pasteur Institute in Paris, was the discoverer of the work assigned by nature to the white corpuscles of the blood. These blood-cells are the "guardian-cells" of the body, and their duty is to destroy disease germs which may gain an entrance. They actually devour disease germs. Metchnikoff has been studying the effect of alcohol upon these protective cells, and he asserts that alcohol, even in small doses, has a harmful action on these agents of defence against disease. Alcohol seems to paralyze them more or less so that they are unable to do their full duty in destroying the infective microbes. Thus disease germs can multiply more rapidly when alcohol is in the blood. In his book called "The New Hygiene," Metchnikoff suggests that the administration of alcoholic liquors in infectious disease appears to be attended with danger to the patient.
The researches of Kraepelin, Ach, Aschaffenberg and other German scientists have become so well known through the articles by Henry Smith Williams in McClure's Magazine that only brief reference need be made to them here. Kraepelin used very small doses of alcohol for some of his experiments. He found that after ¼ to ½ ounce of alcohol had been taken the time occupied in making response to a signal was slightly shortened, but in a few minutes, in most cases, this quickening action passed and a slowing process began, and continued until the body was free from the influence of the alcohol, which was sometimes four or five hours.
The ability to add figures was tested, and this decreased very rapidly under minute doses of alcohol. Memory tests showed that only 60 figures could be remembered from numbers written in columns after alcohol had been taken, while 100 figures could be remembered correctly when the mind was free from the alcoholic influence. Type-setters were tested, and the average number of errors they made and the amount of work they did in a given time was carefully recorded. After a small dose of alcohol none of the men could in the same time do as much work, or as accurate work. Yet every one of the men experimented upon thought he was doing better work after his drink. This proves the narcotic effect of alcohol.
The economic loss to a people from beer and wine drinking is worthy of serious consideration since a bottle of wine or its equivalent in beer could diminish by ten to fifteen per cent, the amount of work done by these type-setters experimented upon by Professor Aschaffenberg.
Professor Kraepelin says:—
"I must admit that my experiments, extending over more than ten years, have made me an opponent of alcohol."
He says again :—
"The laborer who wins his livelihood by the working power of his arm strikes at the very foundation of his power by the use of alcohol."
Professor Aschaffenberg says of moderate doses:—
"Any quantity of alcohol must be regarded as considerable which causes a disturbance, even if only transitory, of bodily and mental efficiency."
Dr. Reid Hunt, chief of the Division of Pharmacology, Hygienic Laboratory, United States Public Health and Marine Hospital Service, made some very interesting experiments to determine the physiological changes upon animals which would result from the strictly moderate use of alcohol. These are described in Bulletin No. 33 of the Hygienic Laboratory, published in 1907. Mice and guinea-pigs were used. The food, usually oats, was soaked in diluted alcohol, at first of five per cent, strength, then gradually increased to forty or fifty per cent. By carefully observing the weight of the mice, and not increasing the strength of the alcohol too rapidly, it was possible to keep the animals for months on this diet without any material loss of weight. After the lapse of weeks, in some cases, and months in other cases, these alcohol fed animals were given small doses of a poison known as acetonitrile. Other mice to whom no alcohol was fed were given similar doses of this poison. In the first series the mice which had received alcohol died from about one-half the quantity of acetonitrile required to kill those which had not received alcohol. In the second series with a somewhat stronger dilution the alcohol mice succumbed to one-half to one-third the dose necessary to kill the non-alcoholized animals. In no case was enough alcohol given for any symptoms of intoxication to appear, nor was there any outward indication of any injury being done by the alcohol. In another experiment a mouse was kept for four months on a diet of oats soaked in water, then 0.5 milligram of acetonitrile per gram body weight was injected. The mouse recovered. It was then fed on oats soaked in an alcoholic solution which was gradually increased to 45 per cent. After a little more than a month of this diet 0.2 milligram acetonitrile per gram body weight proved fatal. The weight of the mouse had remained about the same throughout. Alcohol increased the susceptibility of the guinea pigs also.
Dr. Hunt says on page 33 of the bulletin:—
"These experiments with alcohol and acetonitrile are of interest in another connection. The greatest advance in recent years in our knowledge of the physiological action of alcohol has been the clear demonstration that alcohol is oxidized in the body, and may replace fats and carbohydrates and to a certain extent, the proteids of an ordinary diet. So clear has been this demonstration that the view that alcohol, in moderate amounts, should be regarded as a food is almost universally accepted by physiologists, and the drift of opinion is certainly toward the view that it is in all respects strictly analagous to sugar and fats, provided always that the amount used does not exceed that easily oxidized by the body. I Under these premises it would be expected that alcohol in a diet would have the same effect upon an animal's susceptibility to acetonitrile as has dextrose, for example. This is by no means the case, however; on the contrary, the action of these substances in this regard is entirely different. Mice fed upon oats soaked in a solution of dextrose or upon cakes containing considerable dextrose, or upon rice, show a very distinct increase in their resistance to acetonitrile; such mice may recover from two or three times the dose fatal to controls. (Controls are the animals fed in the ordinary way without alcohol or in this case dextrose.—Ed.) While these facts are not sufficient to justify the conclusion that in many cases alcohol has not a true food value, yet they are sufficient to indicate caution in applying, without further consideration, the brilliant and very exact results on the protein sparing power of alcohol to practical dietaries."
Various other experiments were made, but there is not room here for a record of them.
In the summary Dr. Hunt says :—
"It is believed that these experiments afford clear experimental evidence for the view that extremely moderate amounts of alcohol may cause distinct changes in certain physiological functions, and that these changes may, under certain circumstances, be injurious to the body. The results also afford further evidence that in some respects the action of alcohol as a food is different from that of carbohydrates, and finally that in all probability certain physiological processes in 'moderate drinkers' are distinctly different from those in abstainers."
Professor Chittenden, of Yale University, has made extensive researches upon alcohol and digestion. A full report of these may be found in the "Physiological Aspects of the Liquor Problem." In the Medical News, vol. 86, page 721, Professor Chittenden says of the theory that alcohol is a food similar to sugar and fats:—
"It is, I think, quite plain that while alcohol in moderate amounts can be burned in the body, thus serving as food in the sense that it may be a source of energy, it is quite misleading to attempt a classification or even comparison of alcohol with carbohydrates and fats, since, unlike the latter, alcohol has a most disturbing effect upon the metabolism or oxidation of the purin compounds of our daily food. Alcohol, therefore, presents a dangerous side wholly wanting in carbohydrates and fats. 1 The latter are simply burned up to carbonic acid and water, or are transformed into glycogen and fat, but alcohol, though more easily oxidizable, is at all times liable to obstruct, in some measure at least, the oxidative processes of the liver, and probably of other tissues also, thereby throwing into the circulation bodies such as uric acid, which are inimical to health; a fact which at once tends to draw a distinct line of demarcation between alcohol and the two non-nitrogeneous foods—fat and carbohydrate."
Dr. S. P. Beebe, now of the Cornell Medical College Laboratory, New York City, has made some very valuable experiments with alcohol. It is well known that impairment of the functions of certain organs results in the appearance in the urine of nitrogeneous compounds which do not normally occur there. In certain diseases of the liver the same quantity of nitrogen may be excreted as in health, but a portion of it is in the form of acids never found in the urine during health. Dr. Beebe, with this knowledge in mind, sought to discover the effects of alcohol upon the excretion of uric acid in man. Most of the experiments were made on the same person, a young man in good health, of regular habits, unaccustomed to the use of alcohol in any form. Absolute alcohol, diluted with water, whisky, ale, and port wine were used at different times. Dr. Beebe reported his experiments in the American Journal of Physiology, vol. 12, No. 1. His conclusions are given as follows:—
"After a consideration of these experiments, it hardly seems possible to doubt that alcohol, even in what is considered by the most conservative as a moderate amount, causes an increase in the excretion of uric acid, and this effect is seen almost immediately after taking the alcohol. The following points indicate that the effect is due to a toxic effect on the liver, thereby interfering with the oxidation of the uric acid derived from its precursors in the food: Alcohol taken without food causes no increase. The maximum increase occurs at the same time after a meal as it does when purin food but no alcohol is taken. Alcohol is rapidly absorbed and passes at once to the liver, the organ which has most to do with the metabolism of proteid cleavage products.
"There is no evidence that the alcohol has merely hastened the excretion of urates normally present in the blood; the increased excretion means that a larger quantity has been in circulation, and although it is classed by Van Noorden among the substances easily excreted, still most physiologists would consider the presence in the blood of this larger quantity as undesirable. Certainly in pathological conditions it might be harmful.
"If we accept the origin of the increased quantity of uric acid to be in the impaired oxidative powers of the liver, the results of these experiments will have greater significance than can be attributed to uric acid alone. For the impaired function would affect other processes which are normally accomplished by that organ, and the possibilities for entrance into the general circulation of toxic substances, of intestinal putrefaction, for instance, would be increased. The liver performs a large number of oxidations and syntheses designed to keep toxic substances from reaching the body tissues, and if alcohol, in the moderate quantity which caused the increase in uric acid excretion, impairs its power in this respect, the prevalent ideas regarding the harmlessness of moderate drinking need revision."
Dr. Winfield S. Hall, professor of physiology at the Northwestern University Medical School, Chicago, has interpreted these researches of Beebe and Hunt in a very striking way. He says that they prove that the oxidation of alcohol in the body is a protective oxidation, the same as the oxidation of any other poisonous substance by the liver. His views have such an important bearing upon the commonly accepted theory that alcohol is in some sense a food that they are given here, somewhat abbreviated, as a fitting finish to this chapter. Dr. Hall says:—
"The fact that alcohol is oxidized in the body has been generally misunderstood. The first impression naturally was; 'Foods are Oxidized; Alcohol is Oxidized; therefore alcohol is a food.' But many difficulties appeared. A real food promotes muscular, glandular and nerve activity, and its oxidation maintains body temperature. But alcohol disturbs muscular, glandular, and nervous activity, and its oxidation does not maintain body temperature. When one eats a real food it is assimilated largely by muscle tissue and is oxidized for the purpose of liberating the life energy. When one ingests alcohol it is carried by the blood to the tissues, mostly to the liver, where it is oxidized, as any toxins would be, for the purpose of making it harmless. Its oxidation liberates heat energy but this energy cannot be utilized by the body even for the maintenance of body temperature. If a food is deemed as a substance which, taken into the body, is assimilated and used either to build or repair body structure, or to be oxidized in the tissues to liberate the energy used by the tissue in its normal activity, then alcohol is not a real food.
"But, if alcohol is not a real food, what is the significance of its oxidation? It has been long known that the liver produces oxidases and that it is the site of active oxidation of mid-products of katabolism of toxins and of other toxic substances. Alcohol, usually formed as an excretion of the yeast plant, is also found as a mid-product of tissue katabolism. On a priori grounds we should expect alcohol to be oxidized in the liver along with leucin, tyrosin, uric acid, xanthin bodies, and various amido bodies. There have recently appeared two most important papers based upon extended researches upon man and lower animals. These researches practically clear up this knotty question."
Dr. Hall then reviews the work of Dr. Reid Hunt and Dr. S. P. Beebe, and continues:—
"The value of this work can hardly be over-estimated. In the first place the rapid oxidation of the alcohol in the liver is explained. Alcohol itself being one of the toxic substances which reach the liver from the alimentary canal is at once attacked by the liver, and if the oncoming tide of alcohol is not too great it will practically all be oxidized.
"But the liver oxidation of other toxic substances is impaired in the meantime so that they get past the liver to the tissues, where they may do injury. Some of these toxins are excreted unoxidized by the kidneys. There are three ways of accounting for this condition: (i.) The oxidation capacity of the liver is limited. The physiological limit of alcohol ingestion is that amount which taxes the oxidation capacity of the liver to its limit. When thus taxed all other toxic substances including uric acid and the xanthin bodies pass through the liver unoxidized to appear in the urine. (2.) The presence of alcohol in the blood, through its toxic action upon the liver cells, impairs the hepatic oxidation capacity and thus permits toxic substances to pass unoxidized. (3.) A combination of these conditions may represent the real situation. It is hardly conceivable that the relation of alcohol to the liver activity is not covered in the hypotheses above formulated.
"We may therefore accept it as practically demonstrated by the researches of Beebe, Hunt, and others that the oxidation of alcohol in the liver is simply one of the defensive activities of that organ, i. e., it is a protective oxidation and belongs strictly in the same category with the oxidation of uric acid, xanthin bodies, leucin, tyrosins, and the amido acids.
"The next question which arises is, why does the liver select alcohol first and oxidize that substance to the exclusion of other toxic substances up to the oxidation capacity? The answer is probably to be found in the chemical composition of alcohol.
"It oxidizes very easily, much more so than any of the other toxic substances which gain access to the liver. Its early oxidation may be due to this fact alone, or in part to an actual selection on the part of the liver. Another question of importance: Is the energy liberated in the oxidation of alcohol in the liver available for the use of the muscles, nervous system, or glands?
"If this question is answered affirmatively, then alcohol is a food. If negatively then alcohol is not a food. Let us reason together. All body oxidations may be classified in two groups: (1.) Active oxidations which take place in the active tissues—muscles, nervous system, or glands and take place incident to action. It is under the perfect control of the nervous system and is proportional to normal activity. (2.) Protective oxidations which take place in the liver. This class of oxidation processes is wholly independent of the usual tissue activity and is proportional to the ingestion of toxic substances and quite independent of muscle action, brain action, or gland action, other than liver action.
"If the oxidation of alcohol in the liver belongs to class 1, the following consequences should be found: (1.) The ingestion of alcohol would lead to an increase in muscular power and in the working capacity of the brain or glands. (2.) The ingestion of alcohol would serve to maintain body temperature in the healthy individual subjected to low external temperature. (3.) The accession of muscle, brain, or gland activity would be proportional to the amount of alcohol ingested, but laboratory observations and general experience show that none of these things are true; i. e., the ingestion of alcohol decreases muscle, brain, and gland work, and depresses body temperature when external temperature is low.
"In the nature of the case there can be no proportional relation. The oxidation of alcohol does not therefore belong to class 1. If the oxidation of alcohol in the liver belongs to class 2, the following consequences would be found: (1.) The ingestion of alcohol would be followed by its early oxidation in the organs in question. (2.) If the oxidation capacity of the liver is limited this capacity may be overloaded by exceeding the physiological limit of alcohol. (3.) If the oxidation capacity of the liver is taxed nearly to its limit in the oxidation of uric acid, xanthins, and other toxic substances, the introduction of alcohol may seriously interfere with this protective oxidation by overtaxing the capacity. (4.) If the oxidation capacity is overtaxed, an excess of uric acid, xanthin bodies, and other toxic substances will get by this portal and reach the active tissues or the kidneys. Now all of these things take place, so we are forced to the conclusion that the oxidation of alcohol is a protective oxidation. In the light of this presentation the significance of Dr. Hunt's work becomes very clear. The alcohol given to the animals taxed the oxidation capacity of the liver to the limit and left the organism defenseless against bacterial or other toxic substances."