Alcohol and Human Efficiency

I

IN a preceding article, we sought to establish from reliable data the fact that upon the mind and body alike alcohol, even in small regular doses, must exercise a depressing and degenerative effect. Let us now inquire to what extent the experiments in the Nutrition Laboratory confirm these findings, and whether or not any new evidence, either for or against alcohol, has been elicited by the latest methods of research with all the formidable armamentarium of the modern psychological laboratory.

Twelve subjects were used in these tests, two of whom were psychopathic; but the results found in the psychopaths were separated from the totals of the other findings and grouped for special study. The psychological programme, carried out by the Nutrition Laboratory with the coöperation of Dr. Wells, covered the following investigations: —

First, an investigation of a very simple reflex mechanism at the lowest level of the spinal cord, the patellar reflex or knee-jerk, elicited by sharply striking the tendon of the knee just below the knee-pan. Even in this simple experiment minute and delicate precautions were taken to control the test. The blow was administered by a magnetically released pendulum-percussion hammer, the reaction being recorded in a Blix-Sandeström kymograph, run at a rate of 100 millimetres per second. The variations in the reactions are recorded to a thousandth of a second.

The normal subjects were selected with care as individuals of average habits, temperate users of alcohol, apparently free from any peculiar susceptibility or resistance to its effects.

The alcohol was administered in two separate doses, ‘A,’ or 30 cubic centimetres, and ‘B,’ or 45 cubic centimetres, well diluted and its flavor disguised in various ways to avoid the effect of suggestion.

Summing up the results of the test, it was found that alcohol in the doses given produced a marked depression of the patellar reflex as shown in a decreased response, or a slower response, or both. As in all such tests, there were wide individual departures from the average, but the data on the whole unequivocally support the conclusion. The latent time of response was increased 10 per cent, and the degree of thickening of the muscles decreased 46 per cent. In fact, so extreme was this effect that it made it impossible to measure the kneejerk of several subjects after the larger dose ‘B.’

The next test was that of the protective eyelid, or wink reflex. This is elicited by a sudden stimulus, such as light or noise. In the experiment the sound stimulus was employed as giving more satisfactory results, and the nicety with which the tests were controlled is evidenced by the fact that artificial eyelashes of uniform length were glued to the eyelids of the subjects, so that the photographic record of the wink, or lid reflex, might be free from error due to the varying length of the subjects’ eyelashes. This reflex shows the second largest effect of alcohol, the latent time of response being increased 7 per cent and the extent of the lid movement decreased 19 per cent. This depression, or decreased excitability of the lid reflex varied directly with the dose of alcohol.

Having disposed of these simple reflex mechanisms with very decisive evidence of the effect of moderate doses of alcohol in depressing them, the more complex mechanisms at higher levels of the nervous system were approached: namely (1) eye-reaction to suddenly appearing stimulus, (2) speech-reaction to visual word-stimuli.

Without going into the technical detail of the test, it is sufficient to say that the first test involved the movement of the eyeball in reading typewritten letters on small uniform strips of paper in an exposure apparatus that presented them suddenly to view in one of six possible positions. A photographic camera record of the eye-movement was made.

On this reaction the effect of dose ‘A,’ 30 cubic centimetres, was an acceleration of response, while dose ‘B’ frankly depressed the reaction and increased the latent time of response, agreeing with the simpler reaction experiments of Kraepelin to which I have already referred.

The next experiment was on the effect of alcohol on the reaction-time in reading isolated words, a specially devised tachistoscope, or exposure apparatus, being used. The stimulus words and a fixation mark are placed on a rapidly revolving strip, which renders the words illegible until the motion of the strip is suddenly checked, when the exposure of the word is simultaneous in all its parts. Twenty-four words of four letters each were used throughout the year, the entire set being used in each experiment. The subject was required to hold a voice-key to the mouth and speak t he words as soon as they appeared, the breaking of an electrical circuit marking exposure and reaction.

Dose ‘A’ increased the latency of the reaction about 3 per cent in four out of six subjects; but according to Benedict’s method of averaging the percentile differences, he regarded the experiment with dose ‘A’ as showing negative results on the reaction. Dose ‘B,’however, showed consistent increase of the latent time of response, and there was a positive depressant effect for both doses of 3 per cent.

The next step was investigation of the highest complication of the reflex mechanism that was considered justified by laboratory methods, that of free association of ideas. In this experiment the stimulus to the reaction is a word spoken by the operator and a response word spoken by the subject — the first word that occurs to him after the stimulus word is spoken. Complicated apparatus is used in this test, which does not require description. The experimenter’s comments on these tests are that only very few and small consistent effects were found measurable by available technique.

Tests of the power to memorize were next on the programme. In Kraepelin’s and Vogt’s experiments on memory methods were employed comparable to the exercise of this function in daily life: for example, in Vogt’s, the memorizing of verse, and in Kraepelin’s work the continuous memorizing of a series of numbers. The methods employed by the Nutrition Laboratory were in the nature of ‘ short cuts ’ applicable to laboratory work and measurable by laboratory technique rather than by subjective impressions — a more mechanical method and one subject to some question as to its complete testimony regarding the probable effect of alcohol on memory processes exercised in daily life, where elements of autogenic reinforcement might be lacking.

The theory of the tests employed is that any saving of time between the reaction-time in responding to the first exposure of a series of words and the reaction-time in responding to a second exposure must be due to the influence of memory. The experimenter admits that words are not usually read during a gradual exposure, certainly not during the kind of exposure employed in the laboratory. While different subjects varied widely in these tests, the total effect of dose ‘A’ on the group showed no predominating tendency of alcohol. It should be noted that the effect of dose ‘ B ’ was not tested, which seems unfortunate.

Next on the program was the Sensory Faradic Threshold, an investigation of the subject’s sensitivity to electric stimulation. The so-called threshold to electrical stimulation was, according to the tests, raised 14 per cent by moderate doses; that is, there was decreased sensitivity, which is consistent with the other depressant effects noted.

Eye-movements were selected as the basis of the next test, because simple movements of the eye in fixating seen objects are relatively independent of voluntary control. Photographic recording apparatus similar to that employed for eye-reactions already described was employed, except that two constant fixation marks were used, so placed that in looking from one to another the eye traveled through twenty degrees on either side. On signal the subject is required to look from one point to another, back and forth as rapidly as possible, until the signal to stop is given at the end of five seconds. The velocity of these eye-movements was decreased eleven per cent.

Next in order was the investigation of the influence of alcohol on certain finger-movements. In this test the subject is harnessed to an exceedingly delicate and complicated set of apparatus, including a string galvanometer and an electro-cardiograph for recording the electrical reaction of the heart mechanism. Electro-cardiograms, or the pulse records, as well as the finger-movements, were recorded in this experiment. When the record started, the operator said, ’Go,’and the subject was required to move the middle finger back and forth as fast as possible until signaled to stop. With all subjects, the speed of this ’reciprocal innervation ’ of the finger was decreased 9 per cent.

The pulse records taken during these tests developed evidence of considerable importance. There has been much conflict of opinion among physiologists regarding the effect of alcohol on the pulse, but the evidence from these carefully checked experiments with the most delicate modern instruments seems conclusive, and is thus commented upon in the report: ‘In view of the large amount of our pulse data and the thoroughness with which it was read and elaborated, we believe that the accelerating tendency of alcohol on the pulse-rate of normal human subjects during moderate mental and physical activity may be regarded as certain. We also believe that the evidence is sufficient to show that such relative acceleration must be referred to a partial paralysis of the cardio-inhibitory centres.’ In other words, along with depression and retardation and decreased irritability of a number of related neuro-muscular processes is found an acceleration of the pulse, giving ‘a clear indication of decreased organic efficiency, as a result of moderate doses of alcohol.’ The ‘brake’ is taken off the heart, but there is no direct stimulation of the heart-muscle.

II

The question now arises as to what effect this evidence has on alcoholic tradition as established by previous investigations. Unquestionably, the modern view of alcohol as essentially a narcotic is fully supported; but this evidence goes further and fails to disclose any evidence of even partial stimulation of any muscular or organic function. Alcohol is found to be uniformly a depressant.

It is, of course, unthinkable that such positive and definitely depressant effects could seek out only the lower nervous mechanisms and not in any way reach the centres involving the more complex and controlling functions of the cerebro-spinal system. It is postulated by the investigators that the effect on these centres is resisted through their power of ‘autogenic reinforcement ’ — a necessary function of such centres for preservation of the organism through guidance and control of its more important activities. Evidence of such reinforcement was found in the experiments, one subject being able to rouse himself from temporary somnolence and quickly bring up his performance to normal. We frequently see instances of men ‘sobering up’ under the effect of some shock or sudden demand on their control.

Reasoning along these lines, the investigators say with regard to the effect of 30 cubic centimetres of alcohol in accelerating the eye-reaction, —

‘It is not without significance that under almost identical circumstances of a complex “choice” reaction in the process of training, Frankfurther found typewriting errors enormously increased by alcohol, while the speed was occasionally increased. His introspection is not irrelevant: “I had the feeling that the fingers ran faster than I could find the right spot for the stroke. I often struck keys against my will, so that I must voluntarily inhibit the movements in order not to make a mistake at every letter.”

‘There can be little doubt that, even in small experimental doses, along with and as a part of the general depression, we have clear indications of a paralysis of inhibitory or controlling factors. These may on occasion suffer greater relative depression than the direct process, as in the pulse. When this depression of controls is combined with a reinforcement caused by the experimental instructions, suitable conditions are provided for the slight reinforcement of reactions that rapidly pass over into depression with slightly larger doses. It seems probable, too, that we have herewith come upon the grounds for a wide variety of effects which arc commonly observed in the social use of alcohol, when circumstances give the reinforcement and alcohol reduces the inhibitions.

‘Whatever may be the effect in isolated tissue, our data give clear and consistent indications that the apparent alcoholic depression of neuro-muscular processes is a genuine phenomenon that cannot be reduced to the excitation of inhibitory processes; but that, conversely, whenever apparent excitation occurs as a result of alcohol, it is either demonstrably (pulse-rate, reflexes, memory and threshold), or probably (eye-reaction), due to a relatively overbalancing depression of the controlling and inhibitory processes.’

Another interesting and suggestive fact was that the maximum effect of alcohol and the beginning of recovery occurred within the three-hour interval of the experiments. In general it was found that the reflexes recovered first, suggesting the possibility that the partial recovery of the lower centres was due to increasing paralysis of the higher ones.

There is, as the investigations show, a strong discrepancy between their findings and those of the Kraepelin school with regard to the incidence of these depressant effects on the various levels of the nervous system. The simpler neural arcs in the lower levels of the spinal cord are first and most profoundly affected. There is no evidence of acceleration or facilitation of these separate neuro-muscular processes by primary paralysis of the higher inhibitory centres as predicated by Kraepelin, except in the instance of the eyereaction. Here the effect of 30 cubic centimetres was contrary to that of 45 cubic centimetres, and, as the investigators state, corresponded rather closely with Kraepelin’s simple reaction experiments. It is pointed out, however, that at the time of Kraepelin’s experiments the conception of all sensory and motor processes as a resultant of complex stimulating and inhibiting factors was not so well established in the psychophysiological tradition as now. So-called ‘discrimination’ and ‘choice’ reactions are viewed more as a complex of exciting and controlling tendencies, with great variability in the adequateness and completeness of controls.

We see confirmation of this in the social use of alcohol. Under circumstances of conviviality and relaxation the effect of alcohol on the higher mental processes is not resisted; there is no autogenic reinforcement of these functions and their control is relaxed and exhibits the full narcotic effects of alcohol. But the lower mental and nervous activities are reinforced by suggestion, and we have released tendencies to animal indulgence and foolish uncoördinated acts of mind and muscle, varying in degree according to the amount of indulgence, the susceptibility of the individual, and the character of the environment. These considerations must qualify and govern any implications derived from the laboratory experiments with regard to the slight apparent effect of alcohol on memory and free association.

The ‘complex of exciting and controlling tendencies’ that may exist in the ordinary environment outside the laboratory, especially under the conditions where alcohol is usually taken, must be reckoned in the total possible effect of alcohol. It seems clear that the preponderating effect of alcohol is central, and that such local effect as has been shown on isolated muscle, as by Lee’s experiments, is overbalanced by its central nervous effects.

Answering the question, ‘Is alcoholic depression a conservative process?’ the experimenters say, ‘The fact of increased heart-rate from a given kind and amount of mental work absolutely prohibits us from regarding the neuromuscular depression incident to alcohol as a conservative process like sleep.’

If we wipe off the slate all previous evidence of the unfavorable effect of moderate doses of alcohol on the human organism, and consider solely this preliminary study of its effects on certain important bodily processes that have to do with safeguarding life, what inferences may we draw from these remarkable experiments, so carefully checked and controlled, as to the total effect of moderate indulgence in alcohol on large masses of men? Is there a scintilla of evidence to support the view that such effect is negative, let alone conservative or beneficial?

Surely not. On the contrary, if we knew nothing of life-insurance statistics and were asked to consider alcohol as a newly discovered drug, these experiments would amply justify the belief that the more or less steady use of the very moderate doses employed in the tests would place the human organism at a disadvantage in the struggle for existence, entirely apart from the well-recognized danger of increasing indulgence, and exposure to manifold destructive agencies.

If alcohol is the key that unlocks the door to the chamber of disease, degeneration and life-failure, we must hold it solely responsible for the results that follow its use. The only safe course is not to use the key. Some individuals may enter the chamber for a little while and escape without noticeable injury; but given two million supposedly sound, healthy men, and let them one after another enter that door, and there can be no reasonable doubt of the result. Many will come out smitten as from the war zone; many will not come out at all. Given two million men of the same type, who pass by the door and do not use the key, and, considering the exactly measured evidence from so many sources, as well as the evidence of common observation, who can question that at the end of twenty-five years, the first group will be decimated as compared to the second? If the life-insurance statistics showed any other result, they would be inconsistent. Whether the total effect is directly due to indulgence strictly maintained within the limit of so-called moderation is a purely academic question.

As practical men, what we wish to know is: What does it cost us in the long run to drink alcohol? The evidence that society is paying a heavy bill for the indulgence cannot be longer disregarded by conservative men, entirely outside of the propaganda for drastic methods of reform.

The contention that there is an inborn social craving for alcohol is pure dogma. Man craves enjoyment, relaxation, change. He seeks to anticipate good fortune and to quiet the activity of those conservative faculties which cause him to worry over trouble and life-struggle. He finds that alcohol apparently assists him in attaining these ends, and he drinks it for these effects, not because he is ‘thirsty’ or ‘craves’ alcohol qua alcohol, without any previous knowledge of its effects. Many individuals who are wrecked by alcohol would lead normal lives undisturbed by any ‘craving’ for it if they were protected from the repeated experience of its effects.

It is a mistake, of course, indiscriminately to ascribe all the ills to which flesh is heir to alcohol. Total abstainers die of degenerative affections, and I am honestly convinced that much of the degenerative disease charged against alcohol is due to mouth-infection and other focal infection. There is good evidence, however, that focal infection in the alcoholic is more lethal because of the lowered resistance and the collateral pressures on the organism. Alcohol has enough to answer for without making it the object of random and ill-considered charges.

V

We have measured the difference between so-called moderate drinkers and abstainers, which gives us a hint of the powerful effect of alcohol on mortality, but we have not measured the effect of the widespread grossly excessive use of alcohol among all classes of the population.

After twenty-five years of experience in the close personal observation and physical examination of all types of men, from laborers to statesmen and leaders of scientific thought, and in the sifting and weighing of evidence relating to the influences that affect longevity as revealed by the experience on large masses of men, my cumulative judgment is that alcohol is a destructive force, wholly evil in its total effects. I deprecate the too prevalent tendency to apologize for alcohol, to deal gently and tenderly with it, instead of bringing it to the bar of human judgment to answer for its misdemeanors and justify its right to be exposed for sale on the street corners as a beverage harmless for the average man.

There are two principal factors to be reckoned with in the lenient mental attitude toward alcohol. One of them arises from very human tendencies — from the aversion to being regarded as a ‘crank,’a ‘spoilsport’ or ‘killjoy.' Physicians are no exception to the rule that the average man likes to be thought a ‘good fellow’ in the best sense of the term. The second factor is the view commonly held, even by physicians and pathologists, as well as actuaries, that there is a certain law of mortality, that the span of life is fixed, that the observed habits of mankind are a part of his natural adjustment, and that there is no use of disturbing him; that, in common parlance, he cannot ’beat the game,’so far as greatly extending his life or checking the so-called ravages of time is concerned. That death is always a pathological finish to some form of poison, strain, starvation, injury, or bacterial infection, and not the effect of time, is a concept only just taking form as we gain knowledge. Time can no more kill a man than the Rule of Three can kill him. Time is a mere mathematical abstraction, a synthesis of space and motion.

In so far as we can discern and neutralize the influences which are incessantly at work destroying the cells of our bodies, to that degree we shall perform a service far more important than that of adding a few years to existence — the service of lifting mankind to higher planes of living, where sordid misery and needless physical sufferings and handicaps may be reduced to a minimum.

The unbiased mind must accept the implications flowing from the impartial business investigations of the life insurance companies, confirmed by the equally impartial labors of the laboratory. Can it be questioned that alcohol is one of the forms of poison which, among other factors, is responsible for the gradual bodily impairment and decay which we unthinkingly ascribe to time, and that it consistently imposes a burden of poverty, disease, insanity, and crime, which, regardless of debate as to its exact mathematical degree, not only warrants, but demands, energetic action for its control as a social evil?

As to its effect on progeny, the degree of this effect in man is debatable, but there is positive proof of an extremely adverse influence on the germ plasm of animals, as shown by Stockard. Until the degree of this influence in man is determined, which should properly receive the benefit of the doubt — alcohol or the baby?

Within the past few years, medical literature reveals a rapidly changing attitude with regard to alcohol. The leading medical journals are strongly anti-alcohol, and there is evident a growing sense of the tremendous responsibility resting on the scientific man who sanctions an indulgence which may lead to more misery and disease than he can cure or prevent through a life-time of surgical or therapeutic endeavors.

Furthermore, alcohol is alcohol, either in whiskey or beer. It is nonsense to claim that beer is a hygienic drink. It is drunk chiefly for its alcoholic effect, and if the alcoholic effect is produced, the danger of alcohol exists. Any one who doubts that beer can produce a certain form of intoxication need only visit the saloon and watch the beerdrinker in various stages of befuddlement or excitement. If beer does not intoxicate or produce any alcoholic effect, what becomes of the ‘racial craving for stimulants’ which it is said to satisfy? Furthermore, heavy beer-drinking, as in the case of brewery employees, adds the danger of excessive fluid intake, entirely apart from alcohol. The heavy mortality of brewery employees is sufficient evidence that beer, so far as its effect on masses of men is concerned, is not a hygienic drink.

There is abroad in this land a cynical feeling that a man must break some law of health in order to have a good time; that the hygienic life is a dull existence; that all the best things are forbidden. This is superficial, admittedly foolish, reasoning. The thoroughly healthy man has hormones circulating in his blood, derived from various organs and glands, that make him far more thoroughly alive to the best things in life than the narcotized and poisoned, self-indulgent high liver. Do you ever view with envy the wild hilarity of young people who have abounding health? This is due to hormones. Alcohol cannot really take the place of hormones, although it is used for this purpose. It is an imitation hormone.

Finally, whatever view one may take regarding the effect of alcohol on a sound, strong, resistant body, there is no question of its seriously harmful effect on an impaired or non-resistant body. All men who drink alcohol should be thoroughly examined at least once a year, and learn what is happening in their circulation, kidneys, and nervous system. This is a wise precaution for anybody, but the alcohol-user only accelerates the ‘slow suicide’ of unhygienic living by neglecting it.