The enduring physiological controversy: Alcohol as cardiac poison or social elixir?

“ The aim of liquor, ladies and gentlemen, is to stay and lift the spirit, not to degrade it. Drinking at proper intervals ceased to be respectable at a fixed date in human progress—to be exact, at the moment when it was no longer a mere incident of personal or social recreation but had become a sociological and political issue, staggering drunkenly under a weary burden of most painful statistics.”
“You are eminently right, Governor Dangerfield,” said the governor of South Carolina, helping himself to the salted almonds ”

“ Wherever civilisation penetrates, champagne sooner or later is sure to follow; and if Queen Victoria’s morning drum beats round the world, its beat is certain to be echoed before the day is over by the popping of champagne-corks. Now-a-days the exhilarating wine graces not merely princely but middle-class dinner-tables, and is the needful adjunct at every petit souper in all the gayer capitals of the world. ”

“ The lighter and drier the sparkling wine, the more wholesome it is, the saccharine element in conjunction with alcohol being not only difficult of digestion, but generally detrimental to health.
The faculty are agreed that fine dry Champagnes, consumed in moderation, are among the safest wines that can be partaken of. Any intoxicating effects are rapid but exceedingly transient, and arise from the alcohol suspended in the carbonic acid being applied rapidly and extensively to the surface of the stomach. ‘Champagne,’ said Curran, ‘simply gives a runaway rap at a man’s head.’ Dr. ”

“ Let the faculty dispute about the best remedy if they please; but a sensible man with a bottle of champagne will beat them all. Moreover, whenever there is pain, with exhaustion and lowness, then Dr. Champagne should be had up. There is something excitant in the wine; doubly so in the sparkling wine, which the moment it touches the lips sends an electric telegram of comfort to every remote nerve. Nothing comforts and rests the stomach better, or is a greater antidote to nausea. ”

“ A tired man in our heavy atmosphere feels often that champagne is the one wine that will give him life again; and as the ladies as a rule would think a dinner at a restaurant incomplete without champagne, ninety-nine out of a hundred Englishmen, in ordering a little dinner for two, turn instinctively to the champagne page of the wine-card. It is wrong, but until we get a new atmosphere and give up taking ladies out to dinner, champagne will be practically the only wine drunk at restaurants. ”

“ Martin, of Johns Hopkins University, from a series of carefully conducted experiments upon dogs, concluded that blood containing one fourth per cent of alcohol almost invariably diminishes within a minute the work done by the heart; blood containing one half per cent always diminishes it, and may reduce the amount pumped out by the left ventricle so that it is not sufficient to supply the coronary arteries. One hundred years ago, alcohol was always spoken of as a stimulant. Modern experiment and investigation challenged that definition, and it is now classified as a narcotic. ”

“ If that be so, we reduce alcohol not only from the position of food medicine, but we reduce it from the position of a goad; and we say that the supposititious stimulating or goading influence of alcohol is a mere delusion; that in fact alcohol always lessens the power of the patients, and always damages their chance of recovery, when it is a question of their getting through exhausting diseases. ”

“ Alcohol, when taken in small quantity, is in general said to act as a direct cardiac stimulant, and its stimulating effect is supposed to be due to its possessing the faculty of increasing the muscular power of the heart. ”

“ There is nothing in the ascertained physiological action of alcohol on the human system, as developed by a wide range of experimental investigation, to sustain this claim. I have used the sphygmograph and every other available means for testing experimentally the effects of alcohol upon the action of the heart and blood-vessels generally, but have failed in every instance to get proof of any increased force of cardiac action. ”

“ It will be said that alcohol cheers the weary, and that to take a little wine for the stomach's sake is one of the lessons that comes 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 ”

“ The common prescription of wine or some form of spirits for states of general exhaustion and anæmia, is a serious mistake. It assumes that the temporary increase in the action of the heart is renewed vigor, and that some power is added to the failing energies. ”

“ Diluted, as in fermented liquors, it dilates the blood vessels, quickens the circulation, hastens the heart throbs, and accelerates the respiration.
THE EFFECT OF ALCOHOL UPON THE HEART.—What means this rapid flow of the blood? It shows that the heart is overworking. The nerves that lead to the minute capillaries and regulate the passage of the vital current through the extreme parts of the body, are paralyzed by this active narcotic. The tiny blood vessels at once expand. ”

“ This is as just a description of good, healthy Bourdeaux, as was that given by Sheridan, I believe, of Champagne: “It does not enter,” he said, “and steal your reason; it simply makes a runaway knock at a man’s head, and there’s an end of it!”
But we are indulging in too much wine at dinner. Let us return to the solids. Of the self-important personages who daily cross our path, perhaps the most important circumstance of their life is, that they have dined every day of it. But it is a necessity. All men must, or should; and sorrow of the saddest sort is subdued before the anguish of appetite. ”

“ That alcohol when taken into the living body acts as a general stimulant, and especially so to the cardiac and vasomotor functions. 2. That in mild, uncomplicated cases of typhoid fever in young and previously healthy subjects, stimulants are not required and no alcohol should be given. 3. That in a 'majority of cases' the tendency toward dangerous 'nervous exhaustion' and 'heart failure' is so great that the giving of 'more or less alcohol is required.' 4. The amount required may vary from two to twelve or more ounces per day. ”

“ No doubt; the spirit, by stimulating the nerves, increases the action of the muscles; and the heart, which is one of the strongest muscular organs, beats with augmented vigour, and propels the blood with accelerated quickness. After such a 224 strong excitation the frame naturally suffers a proportional degree of depression, so that a state of debility and languor is the invariable consequence of intoxication. But though these circumstances are well ascertained, they are far from explaining why alcohol should produce such effects. ”

“ Many of them could perhaps have saved their lives if they had ever heard of the proper precautions to be taken against this danger. Some persons think that the drinking of strong liquor will enable them to resist the cold more readily; this, however, is very delusive. Even if we increase the activity of some organs by a stimulating drink, we must not forget that the taking of liquor causes the blood to rush to the brain, and that the cold, too, drives the blood from the skin to the inner organs, and particularly to the brain. ”

“ In the evidence given before the last Arctic Committee, of which I was a member, all the witnesses were unanimous in the opinion that spirits taken to keep out cold was a fallacy, and that nothing was more effectual than a good fatty diet, and hot tea or coffee as a drink. Seamen who journeyed with me up the shores of Wellington Channel, in the Arctic Regions, after one day's experience of rum-drinking, came to the conclusion that tea, which was the only beverage I used, was much preferable, and they quickly derived great advantage from its use while undergoing hard work and considerable cold. ”

“ General debility without obvious cause, may be treated by cold or tepid bathing. Salt added to the bath is helpful. Change of air is a good tonic. Port wine and other alcoholics while giving a false sensation of increased vigor, really reduce the tone of the pulse, and therefore tend to enfeeble the system. Alcohol is a relaxant, not a tonic.”
Depression of Spirits:—“Learn the Delsarte exercise for the ‘blues,’ and practice them daily. Hot air baths. Avoid rich food. Take out-door exercise.”
Diarrhœa:—“This is a symptom of the presence of an irritant of which the stomach is trying to be rid. ”

“ What is the difference between the alcohol present in beer and cider, and that in gin and whiskey? Name another dangerous effect of alcoholic drinks. What business consideration should deter young men from liquor drinking?
141-143. Illustrate the general effect of alcohol upon the circulation. Upon the heart. Is alcohol a stimulant or a narcotic? Describe how alcohol becomes the "Genius of Degeneration." ”

“ The other class of investigators who claim that alcohol diminishes the actual work done by the heart base their estimates on the amount of blood the heart passes through its cavities into the arteries in a given time. This is the physiological function of the heart; i. e. to aid in circulating the blood. Professor Martin's experiments were admirably contrived to determine, not how frequently the heart beat, but the amount of blood it delivered per minute under the influence of alcohol and without alcohol. ”

“ I have demonstrated by actual experience that no form of alcoholic drink is necessary, or desirable, for internal use, either in health, or any of the varied forms of disease; but that health can be better preserved, and disease more successfully treated, without the use of such drinks.* * * * * Simple truth compels me to say that I have never yet seen a case in which the use of alcoholic drinks either increased the force of the heart's action, or strengthened the patient. ”

“ The pupil should be careful to note here that alcohol does not act upon the heart directly, and cause it to contract with more force. The idea that alcohol gives energy and activity to the muscles is entirely false. ”

“ Dr. B. W. Richardson's experiments tend to prove that this apparently stimulating action of alcohol upon the heart is due to the paralysis of the nerves that control the capillaries (Note, p. 208) , which ordinarily check the flow of the blood (p. 117) . The heart, like other muscles under the influence of alcohol, really loses power, and contracts less vigorously (p. 183) . Dr. Palmer, of the University of Michigan, also claimed that alcohol, in fact, diminishes the strength of the heart. ”

“ Alcohol acts on the heart, I believe, in precisely the same manner as atropia does, although less strongly; that is to say, it quickens the heart's action, as well as apparently increases its power, by paralyzing its restraining or inhibitory nerve mechanism. ”

“ The first effect of alcohol, as we have already described on page 144, is to paralyze the nerves that lead to the extreme and minute blood vessels, and so regulate the passage of the blood through the capillary system. The vital force, thus drawn into the nervous centers, drives the machinery of life with tremendous energy. The heart jumps like the mainspring of a watch when the resistance of the wheels is removed. The blood surges through the body with increased force. Every capillary tube in the system is swollen and flushed, like the reddened nose and cheek. ”

“ 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 ”

“ The first and very transient effect is generally increased frequency of beat, followed immediately by dilatation of the peripheral vessels from impaired vasomotor sensibility, and the same unsteady or wavy sphygmographic tracing as is given in typhoid fever, and which is usually regarded as evidence of cardiac debility. Turning from the field of experimentation to the sick-room, my search for evidences of the power of alcohol to sustain the force of the heart, or in any way to strengthen the patient has been equally unsuccessful. ”

“ Indeed, it may be stated as a physiological law, that the more frequent the heart action above the normal standard, the less efficiently does it promote the circulation and strength of the living system. But the effect of a moderate dose of alcohol in increasing the frequency of the heart-beat and of blood pressure is so temporary that the doses must be repeated so often that the alcohol accumulates in the blood and tissues, and extends its paralyzing effects to all the vasomotor, cardiac and respiratory nerves. ”

“ My own original experiments, made fifty years ago, uniformly showed that alcohol quickly increased the number of heart beats per minute, but at the same time diminished the efficiency of the circulation generally. Every experienced practitioner knows that the weaker the heart becomes, the faster it beats. ”

“ So I am bound to believe, on the evidence, that if you take alcohol habitually, in any quantity whatever, it is to some extent a menace to you. I am bound to believe, in the light of what science has revealed: (1) that you are tangibly threatening the physical structures of your stomach, your liver, your kidneys, your heart, your blood-vessels, your nerves, your brain; (2) that you are unequivocally decreasing your capacity for work in any field, be it physical, intellectual, or artistic ”

“ Open any work on the practice of medicine [Pg 709] quite at random, and whether you chance to read of diseased stomach or heart or blood-vessels or liver or kidneys or muscles or connective tissues or nerves or brain—it is all one: in any case you will learn that alcohol may be an active factor in the causation, and a retarding factor in the cure, of some, at least, of the important diseases of the organ or set of organs about which you are reading. ”

“ Eliminating as far as possible these sources of error by careful selection of cases, I find that the alcoholic heart in middle and advanced life presents clinical characters, as a whole, very different from those of tobacco heart, which we have just studied. The most striking and important of these are the evidences of actual pathological change in the size of the heart and the condition of the myocardium. We found no evidence that tobacco causes serious cardiac enlargement, and neither may alcohol in quite young subjects, who present mainly excited action both in force and in frequency. ”

“ Alcohol, taken in small quantities, or largely diluted, as in the form of beer, causes the stomach gradually to lose its tone, and makes it dependent upon artificial stimulus. Atony, or want of tone of the stomach, gradually supervenes, and incurable disorder of health results. * * * Should a dose of alcoholic drink be taken daily, the heart will very often become hypertrophied, or enlarged throughout. Indeed, it is painful to witness how many persons are actually laboring under disease of the heart, owing chiefly to the use of alcoholic liquors. ”

“ Beer-drinker's heart is a term well-known to the physicians of our large hospitals, and indicates a special condition of unhealthy enlargement of the heart due to dilatation, accompanied by some increase of tissue and of fat. ”

“ Alcohol causes fatty degeneration of the heart and other muscular structures. Old age also causes these degenerations, hence alcohol is said to produce premature aging of the body.
"In fatty degeneration the cells and fibres of the body become more or less changed into fat. If a muscular fibre undergoes fatty degeneration, the particles of which it is made disappear one by one, and particles of oil or fatty matter take their place, so that the degree or amount of degeneration varies according to the extent to which this change has gone on. ”

“ Alcohol causes fatty infiltration and fibrous encroachments; it engenders tubercles; encourages suppuration, and retards healing; it produces untimely atheroma (a form of fatty degeneration of the inner coats of the arteries) , invites hemorrhage, [Pg 35] and anticipates old age. The most constant fatty changes, replacement by oil of the material of epithelial cells and muscular fibres, though probably nearly universal, is most noticeable in the liver, the heart and the kidneys. ”

“ Newell Martin says in The Human Body:—
“Although fatty degeneration of the heart may occur from other causes, alcoholic indulgence is the most frequent one. Fatty liver or fatty heart is rarely if ever curable; either will ultimately cause death.” ”

“ Chronic overuse of alcohol may cause chronic myocarditis and fatty degeneration of the heart, with later weakening of the heart muscle and dilatation.
In acute alcohol poisoning the pulse may become very rapid and weak, and the patient may die of heart failure. This is often seen in delirium tremens. The administration in this condition of enormous doses of digitalis by the stomach is inexcusable, and the reason that such patients survive such digitalis poisoning is that the stomach does not absorb during this cardiac prostration. ”

“ There are nerves which act on the heart as brakes do on the train. They keep it steadily at work and do not let it beat too fast. There is another way that alcohol hurts the heart.
Helen: Please tell us how.
Mother: It changes the strong muscle walls into fat. The heart grows larger than it should be, and becomes so weak that it can not send the blood over the body as it should. The man has hard work to breathe. He gets the dropsy and other ailments, and perhaps dies of “heart failure.”
Percy: Does tobacco affect the heart, mother? ”

“ Weak or feeble heart is a common complaint, and is as ordinary an excuse for resorting to alcoholic liquors as ‘Timothy’s stomach.’ If there is no organic disease; if the valves of the heart are healthy and act properly, all anxiety on this point may be entirely banished. The slow pulse, the feeble pulse, the cold feet, the want of energy, these are not to be got rid of by such a mere temporary agent as alcohol, even if relief can be thus obtained from day to day. The constant application of alcohol to the tissues of the body alters them gradually by its chemical action. ”

“ Heart failure, one of the most frequent causes of death in people of adult and advanced years, is often due to fatty degeneration, and a patient who suffers from alcoholic degeneration necessarily runs a much greater risk of heart failure during the course of acute fevers or from overwork, exhaustion, and an overloaded stomach, and the like, than does the man with a strong, healthy heart unaffected by alcohol or similar poisons. ”

“ It is most frequent among those whose addiction to alcohol for years has caused repeated paroxysms of delirium tremens. The cause of the sudden death is usually heart failure. This term means nothing in itself, but it expresses the fact that a degenerated heart finally refuses to act. Alcoholic poison in the circulation has led to fibroid degeneration of the muscular elements of the heart and made them incapable of proper function, or at least has greatly hampered their action, and the heart ceases to beat. ”

“ The habit is established, other organs besides the heart are involved, other diseases than alcoholism are present, and the patient has neither the inclination nor the power to follow our advice. Cirrhosis, neuritis, dementia complicate the cardiac degeneration, or, more correctly, it complicates one or all of these. Chronic Bright's disease is made to account for a number of deaths in the mortality returns that strictly belong to alcoholism. Occasionally the end comes suddenly from fatty degeneration, or in the course of some acute disease ”

“ The delicate linings of the stomach, heart, brain, liver, and lungs are reddened, and every tiny vein is inflamed, like the blushing nose itself. If the use of liquor is habitual, this "Vascular enlargement," that at first slowly passed away after each indulgence, becomes permanent, and now the discolored, blotched skin reveals the state of the entire mucous membrane.
We learned on page 55 what a peculiar office the membrane fills in nourishing the organs it enwraps. Anything that disturbs its delicate structure must mar its efficiency. Alcohol has a wonderful affinity for water. ”

“ What I wish to maintain is that in cardiac degeneration of any kind, in chronic cardiac dilatation, and in the enlarged heart of Bright's disease and of emphysema, just as in ordinary valvular disease, attacks of distress, alarming both to patient and doctor, often occur which call for nothing more in the way of treatment than attention to some intercurrent influence—an indigestible meal, loaded bowels, a nervous shock, a thoughtless effort, a passing hardship or nervous strain. Digitalis and its allies, strychnine, alcohol, nitrites, iodides and the rest are out of place in such an event. ”

“ The alteration in the pulse due to alcohol is chiefly owing to its paralyzing action on the blood-vessels, and when they are too contracted, and thereby cause the weakened heart to labor too much, the alcohol will give relief for the time. But we have in nitrite of amyl, a fluid which will act more quickly and more powerfully ”

“ The apparent increase of strength which follows the administration of alcohol in cases of cardiac weakness is delusive. There is increased volume of the pulse for the reason that the small arteries and capillaries are dilated, but this apparent improvement in cardiac action is very evanescent. ”

“ If alcohol is pushed when a heart is in trouble, the secondary vasodilatation and more or less nerve prostration and muscle debility will cause greater circulatory weakness than before it was administered. ”

“ The cold compress applied over the cardiac area of the chest may well replace alcohol as a heart tonic. The thing necessary to encourage the heart's action is not merely relaxation of the peripheral vessels, but, as Winternitz has shown, increased activity of the peripheral circulation in the skin, muscles and elsewhere. Alcohol paralyzes the vasoconstrictors, and so dilates the small vessels and lessens the resistance of the heart action ”

“ We find that where stimulants are required, such remedies as caffeine, nitro-glycerine and kolafra take the place of alcohol, and are even more satisfactory. The main use of alcohol is to stimulate the action of the heart in various ailments. ”

“ ALCOHOL It is rarely, if ever, advisable to use alcohol. In certain instances, however, especially in older patients who are accustomed to alcohol, a little whisky administered several times a day may act only for good, both as a food and as a peripheral dilator. But it must be remembered that alcohol is not a cardiac stimulant, and that a large dose will be followed by more cardiac depression. Nitroglycerin may act as well as whisky in the kind of cases mentioned. Caffein stimulation in any form is generally inadvisable during inflammation of the heart. ”

“ Can nervous and cardiac exhaustion, induced by the presence of toxic agents in the blood, with deficiency of both hemoglobin and oxygen, be relieved by a simple stimulant, that neither neutralizes nor eliminates the toxic agents, nor increases either the hemoglobin or oxygen? That alcohol does not neutralize or destroy toxic ptomaines, or tox-albumins, is proved by abundant clinical experience, and also by the fact that chemists use it freely in the processes for separating these substances from other organic matters for experimental purposes. ”

“ Indeed, all the investigators agree that alcohol in any dose capable of producing an appreciable effect, diminishes the function of the lungs in direct proportion to the quantity taken; and as the lungs are the only channel through which free oxygen reaches the blood, and such oxygen is the natural exciter of all vital activities in the living body, it is not possible to explain how alcohol, or any other drug that diminishes the function of the lungs can, at the same time, act as a cardiac, or any other kind of tonic. ”

“ Intoxication they admit to be an evil, but defend the moderate use of a liquor as infallibly injurious in the smallest as in the largest dose; they underrate the progressive tendency of their vice and overrate their power of resistance; they cling to the tradition that alcohol, discreetly enjoyed, may prove a blessing instead of a curse. We must banish that fatal delusion. We must reveal the true significance of the poison habit before we can hope to suppress it as a life blighting vice. ”

“ The results of these researches were that I learned purely by experimental observation that, in its action on the living body, alcohol deranges the constitution of the blood; unduly excites the heart and respiration; paralyzes the minute blood-vessels; disturbs the regularity of nervous action; lowers the animal temperature, and lessens the muscular power. ”

“ It is that of adynamic disease. It has been conclusively proven that alcohol decreases the muscular power. It decreases (from the minimum dose to the maximum) the power of the heart as well as that of all other muscles. I say this has been absolutely demonstrated by Richardson and others. In death from adynamia it is through failure of muscle, that is, of the heart, of the scaleni and intercostals, of the diaphragm, and of the laryngeal muscles, et cetera. All of the muscles may gradually fail, become wearied unto death. ”

“ Alcohol is an agent, the sole, perpetual and inevitable effects of which are to avert blood development, to retain waste matter, to irritate mucous and other tissues, to thicken normal juices, to impede digestion, to deaden nervous sensibility, to lower animal heat, to kill molecular life, and to waste, through the excitement it creates in heart and head, the grand controlling forces of the nerves and brain. ”