Drink in Relation to Health & Disease.

By Dr. Chopple, of Wellington.

The Mortality from alcoholic diseases is hard to estimate from the mortality tables compiled officially. With the single exception of Delirium Tremens, all the diseases caused by alcohol are named according to their local pathology or according to the organ affected.

Alcoholism affecting the liver principally or primarily, is known as Cirrhosis of the Liver, and certified to as such in case of death from this disease. Alcoholism of the nerves is known as "Multiple Neuritis"; of the arteries as "Atheroma"; of the stomach as "Chronic Gastritis", and so on.

All these diseases have other causes besides alcoholic excess, and certificates of death rarely distinguish the cause. Especially is this the case when the fatal disease is clearly traceable to alcoholic indulgence, as the death certificate as a rule passes through the hands of the friends of the diseased, and doctors usually abstain from certifyng the cause of the disease, being only required to certify to the cause of death.

It has been suggested that, as a classification of the causes of disease is so essential in the interest of Public Health, a simple certificate to the friends that death was due to natural causes should be made to suffice, and that every medical practitioner should be required to forward to the Registrar a certificate specifying the disease and the cause of the disease, as far as can be ascertained. Such a reform in the matter of death certification would help materially in the classification of the causes of all diseases of known origin, and would be of special interest in sheeting home to alcohol its true responsibility in the causation of disease and death.

When however, we consider that no organ of the body is immune from the evil effects of alcoholic excess, that many organic diseases such as Apoplexy, Cirrhosis, &c. are largely caused by alcohol, that all diseases are more intractable and fatal in alcoholic subjects, that many acute diseases are predisposed to by alcoholic indulgence, that the chances of death after major operations are immeasurably greater in those addicted to alcohol, and that many accidents and suicides are directly due to this fatal indulgence, we realise the appalling mortality due directly or indirectly to this national vice, notwithstanding the fact that in mortality statistics the deaths ascribed to alcoholism are comparatively few.

Let me here explain the term "alcoholic excess," from a medical point of view. There are two forms of alcoholic excess, the acute and the chronic. Very different results may follow these two forms, socially as well as physically.

Acute alcoholic excess leads to a state of intoxication and the victim is said to be drunk, and a succession of such attacks would lead society and the law to deem such an unfortunate a drunkard. And it would be said of a community containing a large number of these so-called drunkards that it was intemperate and drunken. But a man may indulge in a succession of acute attacks for many years and not suffer very much in health, provided a sufficient period of total abstinence elapses between these, to allow of his complete recovery; or in other words, to allow of the complete restoration of all his organic functions after the alcohol has been eliminated from his system. It is not uncommon to find a man indulging in these periodical bouts for years and, (escaping accidents), to enjoy health for a long lifetime.

The fact is he starts his career of drunkenness with sound organs, and after a free libation which makes his excess conspicuous to all, he gives his eliminative organs a chance during a period of total abstinence, to free his system, and to recover to such an extent as not to require an increased dose of the drug, to produce a like affect on a subsequent occasion. Now a community where such a custom prevailed would be branded drunken and highly intemperate, and such were many of the communities in some parts of the Old Country, half a century ago.

During recent years a change has come over the views society holds with regard to these acute outbursts of intemperance, and it is now considered a disgrace to be discovered under the influence of liquor. In consequence of this, loss drunkenness is seen, especially amongst the upper and middle classes. But is there less indulgence? We shall see.

Chronic alcoholic excess however is very different. It does not necessarily unfit its votaries for social and business intercourse, and is therefore condoned by Society. But it is the excess which is responsible for the diseases and the evils I have already mentioned. It is characterised by a daily, and as a rule, ever increasing indulgence. It is this constant and gradually increasing saturation of all the tissues and organs of the body, that sooner or later produces, first a predisposition to all acute diseases by decreasing tissue and circulatory resistance, and finally, fatal disease of some vital organ.

And further it is this constant saturation, and this steady increase in the dosage, that protects from all appearance of drunkenness, and the subjects of this excess are generally classed among Moderate Drinkers.

In acute drunkenness a small dose comparatively produces a marked effect in the condition and appearance of the subject of it. But the organs being unused to the spirituous bath revolt. Violent page 8 sickness soon follows, and all the organs of the body set to and tidy up by a process of active elimination.

The poor unfortunate organs of the moderate but constant drinker get no such chance. And so it happens that a man or a community may be afflicted with the most fatal alcoholic indulgence, and yet get credit for being moderate and temperate. Such is the change that has come about in Britain. This explanation is necessary because of the persistent statements that alcoholic indulgence is gradually disappearing and the people of Britain are becoming more and more temperate. The fact is that the alcoholic indulgence in the Old Country is greater now than ever, and this notwithstanding the fact that total abstinence has spread of recent years, to a very large extent amongst every section of the community. Returns published in the Brewers' Almanac and quoted by Mr. James Whyte, show that the alcohol consumed in Britain in 1841, was equivalent to 3.461 gallons of proof spirit per head of population. In 1852 it was 3.36 gallons, and in 1890 it was 3.245 gallons per head. This means that a relatively fewer number of people in Britain are consuming more, alcohol while there is a gradual disappearance of conspicuous intemperance, especially amongst the well-to-do classes.

Mr. Whyte shows in a masterly article in the London Times that while improved sanitation, better water, purer air, shorter hours of labour, less women and child labour, increased park and garden space, and better housing for the poor, have together brought about a striking reduction in the death rates for all ages under thirty, the non-drinking period, there has been not only no reduction hut actually a steady increase in the death rates during the age periods above thirty, the drinking period, or rather the period during which drink claims its victims.

We have then these facts to consider, that the conditions of life for all classes have immeasurably improved during the past fifty years, but these improved conditions have led to a diminished death rate, page 9 only for age periods under twenty-live or thirty; that above this age, the death rate has slightly increased, while there is nothing apparent to account for the discrepancy. And that during the half century under review an increasing amount of alcohol has been consumed by a relatively decreasing number of people. Have we not a right to assume that all that sanitation and industrial legislation have given, has been snatched away by a growing intemperance amongst certain classes of the community?

With regard to the alcohol consumed in New Zealand the figures are; In 1883 the amount was equivalent to 2.126 gallons of proof spirit per head of population, excluding Maoris. Up till 1895 it has gradually diminished and at this date (1895) stands at an equivalent of 1.411 gallons of proof spirit per head.

This is a matter for congratulation on the part of all temperance reformers and well-wishers for our country's progress, but placed alongside the mortality table it proves nothing, as the mortality observations are not sufficiently numerous and the variations not sufficiently constant. I give the figures however as they worked out.

The statistical observations over many years in Britain and on some parts of the Continent where the liquor question is being studied and grappled with, give abundant evidence of the convincing fact that alcohol is a fruitful source of organic disease, shortens life and stunts physical development. Some interesting figures collected by Mr Whyte go far to prove this.

In Norway, where the alcohol consumed since the introduction of local option laws is only 1 -5th or 1-6th of what it was sixty years ago, the mortality has reached 16.86 per thousand. In Sweden in 1851-55 the mortality was 21.8 per thousand. Local option was introduced and the consumption of liquor has decreased 1-4th, while the mortality has decreased from 21.3 to 16.96 per thousand. Of course this might be a mere coincidence were it not for the fact that in Denmark, where no change had taken place in liquor legislation up till 1890 and little if any change in the amount of liquor consumed, the mortality has remained practically the same, being 19.25 in 1851-55, and in 1890 18.61 per thousand. Much the same social, climatic, and sanitary-conditions prevail over these three countries, but with a diminished consumption of alcohol in Sweden there is, pari passu, a diminished mortality, but with a persistently high consumption of alcohol in Denmark the mortality keeps up. There is here a suggestion of cause and effect.

The experience of Friendly Societies is becoming more and more convincing as statistics are collected. The investigation of Mr. F. G. P. Nelson, a disinterested actuary, into the relative death-rates of the non-abstaining Foresters and Oddfellows and of the abstaining Rechabites, tells greatly in favour of abstinence. He says: "Regarding first, the mortality rates, the divergency is great, the death-rate among the Rechabites being so remarkably low that I was at once led to examine whether there was palpable any fault in the original returns submitted to me, which afforded a solution of this feature. No such explanation was apparent, and, though the years of life observed were not as numerous as I should have desired, they wore ample to preclude violent fluctuations in the experience due to the paucity of the observations. Whether this low death-rate might not be partially due to the large number of fresh entrants into the Society, most of whom would no doubt have passed through some test of examination as to health, next received my attention. Therefore, the records in respect of only members who had not been admitted into the Society during the period of observation, viz., the ten years 1878-1887, were separately examined, but with the result that their death-rate was found to be almost identical with that for the whole of the members." Later comparisons show a difference of five years in the expectancy of life at the age of 25 in favour of the abstaining body, while no real difference in the condition of life and sanitary surroundings exists to account for the remarkable difference in the mortality rates.

Here the "actual" deaths are only 58% of the "expected" deaths in the temperance section and 80% in the general section, to which it Lust be remembered only strictly moderate drinkers are admitted.

And every doctor's experience will bear out these remarkable and (convincing figures. What medical man of any experience is there the could not tell of constant disappointment in the treatment of disease of all kinds in those addicted to alcoholic excess, an excess too often so mild as to have been unobserved by both the patient and his friends. Tissues that have been saturated with alcohol refuse to heal after accident or operation—reaction and recovery from shock are slow Land the germs of acute disease gain unresisted access and flourish from the want of a vigorous vitality to throw them off.

Not only then does constant drinking produce true alcoholic diseases of all the tissues and organs of the body, but it predisposes to most acute diseases and diminishes the chances of recovery.

Now one word with regard to the specific action of alcohol in the body. Most drugs have a selective affinity for secretory tissue, strychnine for the spinal chord, digitalis for the heart, and so on. The specific action of alcohol is exerted on the brain centres, and these it affects in the inverse order of their development. The highest centres and those last developed are affected first and most. The highest brain centres, what we might term the upper tiers of the brain, have to do with self-control, and these are affected first and most in acute intoxication, and are first and most degenerated in chronic alcoholism.

On the motor side the highest and latest developed muscular movements may be the fingering of a piano in a difficult piece, or delicate adjustments at a game of billiards. These delicate movements are the first to become impossible of performance, alike in acute and chronic alcoholism.

As we come down the brain layers, both on the motor and mental sides, this progressive paralysis maintains this strict inverse order, till finally, in acute and fatal poisoning by alcohol, as has sometimes occurred, the respiration stops and lastly the heart, whose centre has been first developed in utero, ceases to beat.

It is this specific action of this drug on the brain centres that largely accounts for the power for degradation and ruin that it possesses. In one unaccustomed to drinking, a glass of liquor is speedily followed by a loss of that reserve, reticence, discretion, and self-control that characterised him. This uppermost brain layer is paralysed. Now if constant drinking supervene or the acute attacks are often repeated this highly sensitive layer becomes rapidly and permanently damaged, and to this extent self-control, with all that it implies, is so far lost. The special action of alcohol then is on the brain cells, paralysing them from above downwards, the most sensitive and unstable centres going first. Hence the moral degradation that attends its constant use, and hence to a large extent the power the drug possesses of creating an irresistible craving for itself.

It is this subtle influence of alcohol on the brain centres that makes it so dangerous a beverage. Its action is so insidious that no one who takes it can say that he is not putting an enemy in his mouth that will steal away his brains.