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of alcohol on the human organism and upon a people as scientifically proven facts. These opinions have almost without protest from anyone been pressed upon all ranks of the population and have unquestionably contributed strongly to confirm the belief that the total abstinence from all alcoholic beverages and even complete prohibition are firmly supported by the medical-scientific point of view. The reason why this quasi-scientific propaganda has not been halted is explained in large part by the laudable object it would serve. The unsubstantiated and exaggerated assertions hinted at are not of the kind which, when shown to be untenable, would justify a cessation of energetic and far-reaching efforts to stop the abuse of alcohol. But, on the other hand, one should not minimize the danger imminent when a movement, in order to gain certain socio-political aims, is permitted without hindrance to formulate a doctrine whose foundations can be undermined at the very time when it needs to develop its highest potential strength. The wellknown Committee of Fifty, organized in the United States for an impartial study of the liquor problem, utters the following noteworthy words on this point: "There is much to fear from excess of drink, but there is also much to fear from the excessive statements which experience soon discovers to be unsupported by facts."
There are still other reasons why physicians should feel themselves especially called upon to contribute to the solution of the temperance question. (The limited sense in which the word "solution" must be understood is noted). They have received and are more and more receiving a biologic-scientific training. Man in health and sickness is the object of their study not only during the years of their preparation, but is also the object of their observation and care in the practice of their profession. They come into contact with all classes of society from the lowest to the highest. They are the most interested spokesmen for matters of public hygiene. Therefore, physicians realize better than others the importance of dealing with a question of public hygiene of extraordinary weight like that of alcohol in an objective, impartial, and, in the best sense of the term, modern scientific manner.
But the physicians should not regard their duty as limited to a consideration of the temperance question from its medical aspects only. To split up a social question in such a manner distorts the perspective and leads to one-sided conceptions. As members of society, with that special insight which education and exercise of
calling afford them, the physicians should endeavor to gain a conception of the question in all its bearings and to get such conception accepted.
The Influence Upon the Organism of Small and Medium Large Doses of Alcohol. A Question of Subordinate Importance for a Determination of Desirable Measures in the Domain of Temperance Legislation.
As indicated in the previous chapter, the modern temperance movement aiming to introduce a general obligatory absolutism (prohibition) has for many years based its argumentation chiefly upon data said to be garnered from the medical science, and which unquestionably have greatly contributed to the formation of the system of doctrine which is a conspicuous part of the present day "alcohology." In Sweden, at least, the more far-seeing spokesmen of the temperance movement have in the most recent times begun to understand that they have ventured upon shaky ground without quite realizing it, and are now more inclined to emphasize the dominant position of the social aspects of the question as contrasted with the purely medical. Still the question of the influence of small and medium large doses of alcohol continues to occupy an extremely large and disproportionate place in the current temperance literature.
It is proven that in cases of persons who have died from acute alcohol poisoning, alcohol is found in the largest relative amount in the blood, where it may reach 0.5 per cent. The next largest relative amount occurs in the brain, with 0.4 per cent. Even in cases of the strongest alcohol poisoning the amount of alcohol in the organism hardly exceeds one-half of one per cent. When consumed in medium large or smaller doses the concentration is necessarily smaller. The alcohol absorbed by the organism oxidizes. Generally about one per cent. leaves the body in an unaltered condition. When alcohol cannot serve the organism as building material or is not conserved in other ways, it begins at once to burn up. In this process energy is produced corresponding to seven heat units for each gram of alcohol. The corresponding figures for the usual nutriments are: For albumen and carbohydrates, 4.4 and for fats, 9. The energy generated serves as a source of heat to the body. But it has not yet been possible to find compelling proof that this energy is transformed into muscular strength.
Alcohol is thus oxidized within the body, and since it has been demonstrated that by this process, the usual foods, carbo-hydrates, proteids and albumen are in corresponding proportions saved from destruction, there is no reason at hand for denying alcohol its place among the nutriments.
Nevertheless alcoholic beverages should not be designated as a food without reservation. Even after the consumption of such beverages in admittedly too large and injurious quantities, that feeling of safety does not occur which takes place after eating much and which prevents the usual foods from being used in too large quantities. For this reason and on account of the comparatively high cost of alcoholic beverages, they are not adapted as articles of food.
In regard to the influence of the alcohol doses under consideration upon the digestion, it has been proved that they stimulate the appetite and promote the generation of gastric juices. It does not follow, however, that this effect is generally desirable or necessary. The usual statement that while the burning up of alcohol generates heat, this effect is quickly nullified by an augmented radiation of heat from the body has not been demonstrated by the most careful investigations that have been made by Atwater and Benedict. Still it is possible that a dose of alcohol taken at once and producing intoxication causes a loss of heat which is certain cases may have injurious results.
Alcohol in smaller doses has a stimulating effect upon the muscles, both on the tired and the not-tired, permitting them to perform a larger work than they under ordinary conditions are capable of. This effect soon passes away, whereupon a lessened ability of performance ensues. There is, however, some contradictory evidence on this point. Thus Atwater and Benedict could not observe that daily doses of 72 grams taken in periods of 4-9 days diminished the ability to do ordinary muscular work.
Especially Kraepelin has done great service in investigating the influence of alcohol in small or medium large doses on the nervous system and the brain. He believes to have shown that after using alcohol certain psychic functions, such as adding numbers, distinguishing signals, typesetting, etc., are weakened, if not immediately, since in certain instances an augmented functional ability may occur, then after a short while. In particular, does he believe to have shown that quite small doses of alcohol, 7 to 10 grams, disturb the "higher" functions such as distinguishing
obscure impressions, taking a decision, analyzing thoughts,`controlling the will, etc., while the "lower" functions, such as repeating speeches and verses learned by heart, may be performed even more easily under the influence of alcohol than otherwise.
On the other hand, several investigators-for instance, Rudin, Joss and others--have arrived at quite different results and less disadvantages, so far as the effect of small and medium large doses of alcohol upon the psychical functions are concerned. Therefore, as regards this question, one cannot in the present condition of science affirm much as being certain or of general application.
The stimulating and pleasurable influence of alcohol upon the subjective state of being, is of course what has made alcoholic beverages the most widespread and popular of all things consumed. Taken in moderate quantities, they diminish the feeling of tiredness, quiet unpleasant sensations in general, and make sociai intercourse more open-hearted and genial. Herein lies also their danger. From the physiological point of view no line of demarcation can be drawn between such slight effects of alcohol and a state of intoxication. Healthy persons, at least the young and middle-aged, have no physiological need of using alcohol even in small quantities. Nevertheless, it must be conceded that numerous soberly living persons who are competent to judge, even physicians, have declared both in speech and writing, that alcoholic beverages agree with them and are beneficial. To this the only reply which can at present be made from a scientific standpoint is that made by the 70 physiologists gathered at Cambridge (England) in 1898: "Briefly, none of the exact results hitherto gained can be appealed to as contradicting, from a purely physiological point of view, the conclusions which some persons have drawn from their daily common experience, that alcohol so used (taken in diluted form in small doses, as indicated by the popular phrase 'moderate use of alcohol') may be beneficial to their health." This statement was occasioned by an assertion to the contrary in certain approved text-books used in the United States, and was signed by especially prominent physiologists from all countries.
To define "small and medium large doses of alcohol," in the sense of determining the quantity of absolute alcohol which anyone may take daily with impunity, is impossible. It is largely conditioned by age, sex, constitutional peculiarities, etc. Efforts in this direction, as might be expected, have yielded quite dissimi
lar results, the amounts stated varying from 25 to 100 grams per day. There is no means of determining the individual resistance to alcohol; that is, the amount one may consume without injury to his health. There are instances of apparently well persons with whom the daily use of a very small quantity of alcohol does not agree, while, on the other hand, aged individuals may be found who enjoy the best of health, although they for the greater part of their life have taken more than 100 grams of alcohol daily.
But there are other considerations than those of the purely individual kind which determine the amount of alcohol which apparently may be used without injury; for instance, the concentrated form of the beverages, their purity, whether the quantity used is consumed at once or in several successive portions, and with or without food; whether it is drunk by one engaged in hard muscular labor or by one of sedentary habits; whether it is used during work hours or at their close, etc. It is not particularly remarkable that in respect to all this no more definite statement can be made. Similar difficulties are met in deciding what may be a non-injurious use of other things, such as tobacco, coffee, tea, chocolate, spices, etc.
The attempt to find support in the results of medical investigations for the claim that alcohol in the form of the usual alcoholic beverages is under all conditions to be regarded as a deleterious substance, a "poison," may with certainty be said to have miscarried. The chain of evidence in favor of voluntary or obligatory absolutism (prohibition) cannot be completed in this manner.
But although proof of the injury of small and medium large doses of alcohol in physiological and psychological respects cannot be produced, and even if it seems probable that the use of alcohol may be beneficial to many persons, this does not afford a decisive reason against the justification or desirability of banishing alcohol by law as an article of general consumption. The suggestion that modern society may not be able to forego the use of alcoholic beverages without dangers to its development and well-being, does not of itself warrant opposition to the modern prohibition movement. The fundamental question is whether what alcoholic beverages contribute to social happiness and well-being outweigh the social unhappiness and misery which they cause.
Yet, should it appear that the evils arising from drink are unquestionably greater than any good it may do, the question still remains whether the total prohibition of intoxicants is desirable