Tobacco and Alcohol

Few persons who have not been specially educated in science have ever learned this great lesson of Materia Medica, "that everything depends on the size of the dose." It is not merely that a small dose will often produce effects differing in degree from those produced by a large dose; nor is it merely that the small dose will often produce an effect differing in kind from that of the large dose; but it is that the small dose will often produce effects diametrically opposite and antagonistic to those of the large dose. The small dose may even serve as a partial antidote to the large dose. The adage concerning the hair of the dog that has bitten us, embodies the empirical wisdom of our ancestors on this subject. Especially is this true of all the substances classed as narcotics. In doses of a certain size, they, one and all, produce effects exactly the reverse of narcotic. If anything is entitled to be called a deadly narcotic poison, it is strychnia, which, by paralyzing the spinal cord, induces tetanic convulsions: yet minute doses of strychnia have been used with signal success in the cure of hemiplegic paralysis. In teething children, the pressure upon the dental branches of the trigeminal nerve sometimes causes an irritation so great as partly to paralyze the medulla, inducing clonic convulsions, and perhaps death by interference with the heart's action.7 In these cases, alcohol has been frequently used with notable efficacy, averting as it does the paralysis of the medulla. Epileptic fits, choreic convulsions, and muscular spasms – such as colic, and spasmodic asthma – are also often relieved by the tonic or anti-paralytic action of alcohol. And how often has the temperate smoker, after some occasion of distressing excitement, his limbs and viscera trembling, his nerves "all unstrung," or incipiently paralyzed, – how often has the temperate smoker found his whole system soothed and quieted, and the steadiness of his nerves restored, by a single pipe of tobacco! That this is due to its action as a counteracter of paralysis is shown by the fact that tobacco has been successfully used in tetanus,8 in spasm of rima glottidis,9 in spasmodic asthma,10 and in epilepsy.11 For these phenomena physiology has but one explanation. They are due to the fact that narcotics, in small doses, either nourish, or facilitate the normal nutrition of the nervous system. They restore its equilibrium, enabling it, with diminished effort, to discharge its natural functions. And anything which performs this office is, in modern physiology, called a stimulant.

Here then we have obtained an important amendment of our notion of a narcotic. A narcotic is a substance which, taken in the requisite dose, causes paralysis. But we have seen that by diminishing the dose we at last reach a point where the narcotic entirely ceases to act as a narcotic and becomes a stimulant. What then is a stimulant? There is a prejudice afloat which interferes with the proper apprehension of this word. People call alcohol, indiscriminately, a stimulant; and when a man gets drunk, he is incorrectly said to be stimulating himself; stimulants are therefore looked at askance, as things which demoralize. The reader is already in a position to know better than this. He sees already that it is not stimulus but narcosis which is ruining the drunkard. Nevertheless, that he may understand thoroughly what a stimulant is, we must give further explanation and illustration.

Food and stimulus are the two great, equally essential factors or co-efficients in the process of nutrition. We mean by this, that in order to nourish your system and make good its daily waste, you need both food and stimulus. You must have both, or you cannot support life. Day by day, in every act of life, be it in the acts of working and thinking which go on consciously, or be it in the acts of digestion and respiration which go on unconsciously, in the mere keeping ourselves alive, we are continually using up and rendering worthless the materials of which our bodies are composed. We use up tissue as an engine uses up fuel; and we therefore need constant coaling. Tissue once used is no better than ashes; it must be excreted, and food must be taken to form new tissue. Now the wonderful process by which digested food is taken up from the blood by the tissues – each tissue taking just what will serve it and no more, muscle-making stuff to muscle, bone-making stuff to bone, nerve-making stuff to nerve – is called assimilation, nutrition, or repair. It is according as waste or repair predominates that we are feeble or strong, useless or efficient. When repair is greatly in excess, as it usually is in childhood and youth, we grow. When waste is greatly in excess, we die of consumption, gangrene, or starvation. When the daily repair slightly outweighs the daily waste, we are healthy and vigorous. When the daily repair is not quite enough to replace the daily waste, we are feeble, easily wearied, and liable to be assailed by some illness.

Now, in order to carry on this great process of nutrition, we have said that food and stimulus are equally indispensable. We must have food or we can have nothing to assimilate; but we must also have stimulus, or no assimilation will take place. The unstimulated tissue will not assimilate food. The nutritive material rushes by it, unsought for and unappropriated, and no repair takes place. There are some people whom no amount of eating will build up: what they need is not more food, but more nerve stimulus; they doubtless eat already more than their tissues are able to assimilate. In pulmonary consumption, the chief monster which we have to fight against is impaired nutrition, the tubercles being only a secondary and derivative symptom.12 The problem before us, in dealing with consumption, is to improve nutrition, to make the tissues assimilate food. And to this end we prescribe, for example, whisky and milk – a food which easily reaches the tissues, and a stimulant which urges them to take up the food sent to them. We define, therefore, a stimulant as any substance which, brought to bear in proper quantities upon the nervous system, facilitates nutrition.

At the head of all stimulants stands oxygen, concerning which, for further illustration, we shall quote the following passage from Dr. Anstie:

"It needs but a glance at the vital condition of different populations in any country to arrive at a tolerably correct idea of the virtues of oxygen as a promoter of health and a curer of disease. If we compare the physical condition of the inhabitants of a London alley, an agricultural village, and a breezy sea-side hamlet, we shall recognize the truth of the description which assigns to it the same therapeutic action as is exercised by drugs, to which the name of stimulant seems more naturally applicable than to such a familiar agent as one which we are constantly breathing in the common air. A child that has been bred in a London cellar may be taken to possess a constitution which is a type of all the evil tendencies which our stimulants are intended to obviate… It is highly suggestive to find that that very same quiet and perfect action of the vital functions, without undue waste, without pain, and without excessive material growth, is precisely what we produce, when we produce any useful effect, by the administration of stimulants, though, as might be expected, our artificial means are weak and uncertain in their operation, compared with the great natural stimulus of life."13

Stimulus implies no undue exaltation of the activity of any part of the organism. In complete health all parts of the body should work together in unhindered co-operation. Any undue exaltation of a particular function – excessive brain-action, excessive muscular-nutrition, excessive deposit of fat – is a symptom of lowered life, in which the co-ordinating control of the whole system over its several parts is diminished. Stimulus, on the other hand, implies an increase of the co-ordinating and controlling power. Dr. Anstie therefore recommends that the word "overstimulation" be disused, as unphilosophical and self-contradictory.

In yet one further particular, current notions need to be rectified before we can proceed. In no case is the action of a stimulant followed by a depressive reaction. This seems at first like a paradox. Physiologists have in times past maintained the contrary; and some have even ventured to apply to the phænomena of stimulation the dynamic law that "action and reaction are equal and opposite." But in physiology we shall not be helped much by the theorems of mechanics. In no case is the stimulus followed by any other "recoil" than that which is implied in the mere gradual cessation of its action, just as in the case of food which has been eaten, assimilated, and used up. We quote the following from Dr. Anstie: – "We often hear the effects of strong irritation of the skin, or the mucous surfaces, quoted as an example of the way in which action and reaction follow each other. The immediate effect of such treatment (it is said) is to quicken the circulation and improve the vital condition of the part, but its ultimate result is a complete stagnation of the vital activities in the irritated tissues. The real explanation of the matter is, however, very different. Mild stimulation of the skin (as by friction, warm liniments, &c.) has no tendency to produce subsequent depression; nor has mild stimulation of the mucous membranes (as by the mustard we eat with our roast beef). But the application of an irritant strong enough to produce a morbid depression at all, produces it from the first. Thus the cantharidine of a blister has no sooner become absorbed through the epidermis than it at once deprives a certain area of tissue of its vitality to a considerable extent, as is explained by the researches of Mr. Lister… Here is no stimulation first and depressive recoil afterward, but unmitigated depression from the first."14 "What has been commonly spoken of as the recoil from the stimulant action of a true narcotic is, in fact, simply the advent of narcosis owing to a large impregnation of the blood with the agent after the occurrence of stimulation, owing to a small one. Thus a man drinking four ounces or six ounces of brandy gradually, has not in reality taken a truly narcotic dose till perhaps half the evening has worn away; previously to that he has not been 'indulging in narcotism' at all; nor, had he stopped then, would any after depression have followed, for he might have taken no more than two ounces of brandy, equal perhaps to one ounce of alcohol. But he chose to swallow the extra two ounces or four ounces, thus impregnating his blood with a narcotic mixture capable of acting upon nervous tissue so as to render it incapable of performing its proper functions. The narcosis has no relation to the stimulation but one of accidental sequence. This is proved by the fact that in cases where a narcotic dose is absorbed with great rapidity, no signs of preliminary stimulation occur."15

This disposes of the popular objection to stimulants – based upon the long-exploded theories of vitalistic physiology16 – that every stimulus is followed by a reaction. It is seen that when a man feels ill and depressed after the use of alcohol or tobacco, it is because he has not stimulated but narcotized himself. We challenge any person, not hopelessly dyspeptic, to produce from his own experience any genuine instance of physical or mental depression as the result of a half-pint of pure wine taken with his dinner,17 or of one or two pipes of mild tobacco smoked after it.

Let us not, however, indulge in sweeping statements. We have expressed ourselves with caution, but a still further limitation needs to be made. There are a few persons who are never stimulated, but always poisonously depressed, by certain particular narcotics. There are a few persons – ourselves among the number – in whom a very temperate dose of coffee will often give rise to well-defined symptoms of narcosis. There are others in whom even the smallest quantity of alcoholic liquor will produce giddiness and flushing of the face. And there are still others upon whom tobacco, no matter how minute the dose, acts as a narcotic poison. But such cases are extremely rare; and it is needless to urge that such persons should conscientiously refrain, once and always, from the use of the narcotic which thus injuriously affects them. Our friendly challenge, above given, is addressed to the vast majority of people; and thus limited, it may be allowed to stand.

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1

Smoking and Drinking. By James Parton. Boston, Ticknor & Fields, 1868. 12mo, pp. 151.

2

When we first read this remark, we took it for a mere burst of impassioned rhetoric; but on second thoughts, it appears to have a meaning. Another knight-errant in physiology charges tobacco with producing "giddiness, sickness, vomiting, vitiated taste of the mouth, loose bowels, diseased liver, congestion of the brain, apoplexy, palsy, mania, loss of memory, amaurosis, deafness, nervousness, emasculation, and cowardice." Lizars, On Tobacco, p. 29. A goodly array of bugbears, quite aptly illustrating the remark of one of our medical professors, that hygienic reformers, in the length of their lists of imaginary diseases, are excelled only by the itinerant charlatans who vend panaceas. There is, however, no scientific foundation for the statement that tobacco "takes off the edge of virility." The reader who is interested in this question may consult Orfila, Toxicologie, tom. II. p. 527; Annales d'Hygiène, tom. XXXVIII.; and a Memoir by Laycock in the London Medical Gazette, 1846, tom. III.

3

"I am not acquainted with any well-ascertained ill effects resulting from the habitual practice of smoking." – Pereira, Materia Medica, vol. ii., p. 1431. Tobacco "is used in immense quantities over the whole world as an article of luxury, without any bad effect having ever been clearly traced to it." – Christison on Poisons, p. 730. These two short sentences, from such consummate masters of their science as Christison and Pereira, should far more than outweigh all the volumes of ignorant denunciation which have been written by crammers, smatterers, and puritanical reformers, from King James down.

4

Only a basis, however. The argument as applied to tobacco, though a necessary corollary from Dr. Anstie's doctrines, is in no sense Dr. Anstie's argument. We are ourselves solely responsible for it.

5

Sleep is caused by a diminution of blood in the cerebrum; stupor and delirium, as well as insomnia, or nocturnal wakefulness, are probably caused by excess of blood in the cerebrum. We feel sleepy after a heavy meal, because the stomach, intestines and liver appropriate blood which would ordinarily be sent to the brain. But after a drunken debauch, a man sinks in stupor because the brain is partially congested. The blood rushes to the paralyzed part, just as it rushes to an inflamed part; and in the paralysis, as in the inflammation, nutrition and the products of nutrition are lowered. The habitual drunkard lowers the quality of his nervous system, and impairs its sensitiveness, – hence the necessity of increasing the dose. It will be seen, therefore, that it is not the function of a narcotic, as such, to induce sleep, though in a vast number of cases it may induce stupor. The headache felt on awaking from stupor, is the index of impaired nutrition, quite the reverse of the vigor felt on arising from sleep.

6

Mr. Lizars (On Tobacco, p. 54) has the impudence to cite Pereira (vol. ii. p. 1426) as an opponent of smoking, because he calls nicotine a deadly poison! And on p. 58 he similarly misrepresents Johnston. This is the way in which popular writers contrive to marshal an array of scientific authorities on their side. In the case of tobacco, however, it is difficult to find physiologists who will justify the popular clamour. They have a way of taking the opposite view; and when Mr. Lizars cannot get rid of them in any other way, he insinuates that all writings in favour of tobacco "have been got up from more than questionable motives." (p. 137.) This is in the richest vein of what, for want of a better word, we have called radicalism; and may be compared with Mr. Parton's belief that physicians recommend alcoholic drinks because they like to fatten on human suffering! (Smoking and Drinking, p. 56.)

7

Clendon, On the Causes of the Evils of Infant Dentition.

8

Curling, On Tetanus, p. 168; Earle, in Med. Chir. Trans., vol. vi., p. 92; and O'Beirne, in Dublin Hospital Reports, vols. i. and ii.

9

Wood, U. S. Dispensatory.

10

Sigmond, in Lancet, vol. ii., p. 253.

11

Currie, Med. Rep., vol. i., p. 163.

12

Indeed, there are many fatal cases in which tubercles never appear. See Niemeyer on Pulmonary Phthïsis.

13

Stimulants and Narcotics, p. 144.

14

Stimulants and Narcotics, p. 148.

15

Id. p. 224.

16

"The origin of the belief that stimulation is necessarily followed by a depressive recoil is obviously to be found in the old vitalistic ideas. It is our old acquaintance, the Archæus, whose exhaustion, after his violent efforts in resentment of the goadings which he has endured, is represented in modern phraseology by the term 'depressive reaction.' This idea once being firmly established in the medical mind, the change from professed vitalism to dynamical explanations of physiology has not materially shaken its hold." Id. p. 146. An interesting example of the way in which quite obsolete and forgotten theories will continue clandestinely to influence men's conclusions. The subject is well treated by Lemoine, Le Vitalisme et l'Animisme de Stahl. Paris, 1864.

17

"From good wine, in moderate quantities, there is no reaction whatever." – Brinton, Treatise on Food and Digestion.