two things: 1) the analgesic or "narcotic" pain-alleviating effect
of alcohol which raises the threshold at which pain is felt, and
2) the ability of alcohol to allay worry and anxiety and induce
psychic as well as physical relaxation. This also tends to raise
the threshold of pain tolerance.
The analgesic quality of alcohol has an element of risk in-
volved. Some heart patients may overexert or strain their hearts
while under the influence of the alcohol, since it may have re-
moved Nature's warning signal—pain!
One of my patients, Mr. N., when he first consulted me regard-
152 HOW DOES ALCOHOL AFFECT YOUR HEALTH?
ing his anginal pains following his coronary attack, insisted
that a few highballs before his lunch and his supper diminished
the number and severity of his attacks of angina. His wife, who
accompanied him to my office, turned to me and said, "But
Doctor, I keep telling Jim that ever since he started taking these
highballs, he falls asleep after his meals, and is quite groggy
even when he awakens from his *naps\ And since he loves to
smoke his pipe right after meals, he has already set himself on
fire several times when falling asleep! I really think he gets
'drugged* after his highballs. Don't you?"
Mrs. N. puts her finger precisely on the diagnostic spot. Mr.
N., it was true, felt less pain after his drinks. But in Mrs. N.'s
words, it was an abnormal or 'drugged' kind of relief. It came
as a result of the narcotic action of alcohol in deadening his
pain, and stupefying his senses. It actually did nothing in any
way to improve or relieve the strain on his heart.
Alcohol can relax tension in heart cases. On the whole,
however, I find that alcohol, when used wisely, is helpful to most
heart cases and is an excellent way to relax the tension that
many heart patients consciously or unconsciously experience.
THE INJURIOUS EFFECTS OF ALCOHOL
Now, having considered the beneficial effects of alcohol, we
come to the injurious ones.
I shall mention here only in passing the well known blights
of the excessive use of alcohol on the home, the individual, and
society. Volumes have been written on the devastating effects
of alcoholic excess on crime, suicide, divorce, general misery
in the home and to the individual, venereal disease, juvenile
delinquency, traffic accidents, economic and industrial losses.
Here we are concerned only with alcohol as it affects your health.
The effects of alcohol have been so profound that it is startling
to consider that the United States of America exists today prob-
ably as a result of alcoholic excess! In the words of the "father
HOW DOES ALCOHOL AFFECT YOUR HEALTH?
153
of our country," the British were defeated on Xmas eve, after the
epochal crossing of the Delaware, because "Cornwallis* men had
drunk not wisely, but too well!" What would have happened to the
cause of world democracy and freedom if Washington's tattered,
frozen, and decimated men had faced a sober and efficient
fighting army instead of a band of drunken soldiers!
Let us now consider briefly some of the main systems of the
body and the effects of alcoholic damage upon them.
Alcohol can be harmful to the emotions and the mind.
Since we began this discussion with the beneficial effects of alcohol
on the psychic and mental processes, let us now see what the
pharmacologists like Sollman find in their texts on the subject.
The habitual, even moderate, use of alcohol (not even to
the point of intoxication) induces relaxation, the easing of
strain (tension), of maladjustments, of excessive inhibitions,
indeed euphoria, all of which may be beneficial. But it also
leads to diminished efficiency, especially in accuracy, im-
paired judgment, increased liability to auto accidents, loss
of self-reliance, perhaps diminished resistance to disease,
danger of excesses, higher incidence of venereal disease and
general disrespect for law and order.
In answer to the popular notion that alcohol is a "stimulant,"
the principle that alcohol is actually a depressant was first
advanced in 1883 by the noted German pharmacologist,
Schmeideberg. The following quotation is from the American
translation by Doctors R. N. Harger, H. R. Hulpieu and G. N.
Thompson:
The subjective and objective states and manifestations,
from which alcoholic drinks are considered stimulants, are
usually attributed to the stimulating effect of the alcohol.
One refers to the manifestations which we observe under
these conditions, namely to certain exaltations of the psychic
functions resulting in loud and profuse speech, and vivacious
acts, also to accelerated pulse rate, engorgement and flush-
ing of the body surface and the face, and a sensation of
154
HOW DOES ALCOHOL AFFECT YOUR HEALTH?
increased warmth. However, a closer consideration of these
manifestations shows that they are the results of a beginning
paralysis of certain parts of the brain, (italics mine)!
Since this finding was first expressed in 1883, the idea that
alcohol acts as a stimulant to the nervous system has been dis -
proved in a host of pharmacological laboratories by countless
scientists. To continue:
In the psychic sphere there is first lost the finer grades of
attention, judgment, reflection, and ability to comprehend.
This serves to explain the typical behaviour of persons
under the influence of alcoholic drinks. The soldier becomes
more courageous since he observes the danger less, and
reflects upon it less. The speaker is not tormented and in-
fluenced by the proximity of the public; he, therefore, speaks
freer and with more animation. One's self-appraisal rises
greatly. Often one is astounded at the ease with which he
expresses his thoughts and with the keeness of his judgment
in matters which are beyond his mental sphere when sober,
and is later ashamed of this delusion. The drunken indi-
vidual attributes to himself great muscular strength and
wastes this through unaccustomed and useless exhibits of
strength without thinking of the harm which may ensue,
while the sober person willingly spares his strength.
This conclusion is now verified and accepted by all present-
day pharmaceutical experts in the field of medicine and drugs.
Even the public is thoroughly versed in the excessive effects of
alcohol in causing poor or double vision, the unsteady, clumsy
gait, the impairment of muscular coordination, the delayed
reaction time, and the loss of normal judgment and self-control.
The effects of alcoholic excess. It is remarkable that the
source of relief with which man most frequently seeks to relieve
his nervous tension, with which to relax, should be so free from
poisonous or toxic effects when used in moderation. The fatal
dose of alcohol is often very difficult to determine because of
the wide variability of its action and its tolerance. In those cases
where death has occurred from acute alcoholism, it usually
is impossible to get the exact information from the companions
HOW DOES ALCOHOL AFFECT YOUR HEALTH?
155
of the departed one, since they have been too befuddled to give
an intelligible account of the events preceding death, including
the amounts of liquors drunk.
As a rule, however, to those unaccustomed to alcohol,
approximately 2 to 3 ounces of alcohol will result in acute
symptoms of alcoholism and three times this quantity usually
produces stupor in the average 150 lb. man! A fatal dose of
alcohol ranges from 1 pint to 1 quart of whiskey, or 8 to 16
ounces of pure alcohol. Children seem to have a particular sus-
ceptibility to acute alcoholic poisoning due to their smaller
body weight and low tolerance. Most cases of fatal alcoholic
poisoning will show blood alcohol levels between 0.3 per cent
and 0.5 per cent; that is, only a fraction of 1 per cent! The
intoxicating blood level of alcohol, as generally used in drunk-
driving tests, is generally 0.1 per cent or only one-tenth of one
per cent!
Medical journals are filled with reports of silly wagers by
would-be heroes anxious to show their virility and drinking
prowess. Their post-mortem studies, after the coma, show that
death is usually due to paralysis of the respiratory center, even
though the heart may continue to beat for a while after breath-
ing ceases. In these cases the brain, when opened, usually has
the faint odor of alcohol, is swollen and often bulges over the
edges of the opened skull.
Chronic alcoholism. I shall not attempt to discuss the
social and economic evils of this disease; it is universally con-
demned, while being universally talked about. But unlike the
weather, something is being done about it.
A. The brain: The changes in this organ are often those re-
lated to vitamin B and C deficiencies. Hemorrhages frequently
are found throughout the cerebral tissue in chronic alcoholism.
The brain is particularly susceptible to injuries, such as a blow
on the head. Rupture of the blood vessels with subsequent death
is a frequent close to an alcoholic bout where the victim has
been lodged in the "drunk tank" overnight at the local jail, and
156
HOW DOES ALCOHOL AFFECT YOUR HEALTH?
has eit her fall en on his head or sust ained a knock on his
"noggin."
B. Wernicke's disease. Back in 1881, Dr. C. Wernicke in Ger
many first described three alcoholic patients with paralysis of
the eye muscles, uncoordinated walk, clouding of the conscious
ness and finally, coma. Such cases are caused by a destruction
of certain brain tissue and are common. I have had this kind of
patient during my ward service in Philadelphia and Los Angeles
County General Hospitals.
C. Marchiafava-Bignani's disease. This is a rather unusual
disorder, occurring only in those who drink the common Italian
red wine without proper food intake and is seen especially in
Italy. Destruction of the brain tissue here is also characteristic,
the patient usually being excited, confused, and finally psychotic.
D. Delirium Tremens. This interesting condition was first
described in 1813 by Sir Thomas Sutton and is associated with
a "wet brain." An alcoholic complication that is very frequent,
it is characterized by confusion, anxiety or terror, auditory and
visual hallucinations, and delusions.
Some patients I have seen and treated for this disorder are
obsessed with snakes, others with animals, and still others with
people following, watching, or persecuting them. Violent tremors
and shaking frequently join with delirious episodes in this
devastating form of alcoholic disease.
I shall never forget an experience during my internship days
with an alcoholic suffering from delirium tremens. He was in
terror of the usual "pink elephant," animals, and insects crawl -
ing all around him, the walls of his room, and on his own body.
This unfortunate man had lost his business and his wife and
children. They had to leave him because of his abnormal be-
haviour and his chronic alcoholism. He had become psychotic,
shook like a leaf, and now had severe hallucinations.
When my "chief (the attending physican) and I entered his
room at the hospital together with the floor nurse, the patient
was lying quietly in bed. He looked up at us and let out a blood -
HOW DOES ALCOHOL AFFECT YOUR HEALTH?
157
curdling scream. He leaped out of bed, seized the necktie around
his physician's neck and tried to yank it off, strangling the
doctor in the process and letting out a salvo of piercing shrieks
strong enough to awaken the dead. After we had wrestled him
free and sedated him, it came out that he had imagined the
doctor's necktie to be a snake. He had only attempted to yank
it free and had heroically tried to save the doctor's life! The
realism of these hallucinations to the patient with D.T.'s is
pathetic, and their terror and suffering tragic to see.
E. Polyneuritis. This most frequent complication of chronic
alcoholism is caused specifically by changes or destruction, in
the peripheral nerves of the body due to lack of vitamin B. The
feet are usually numb, tender, or painful and frequently para
lyzed so that walking may become impossible. This is called
"foot drop," and is often associated with other complications
of chronic alcoholism.
F. Korsakoffs Psychosis. This disease is also believed to
result from a vitamin deficiency and is a most curious one. The
patient is highly suggestible to any idea and is completely with
out any judgment regarding its credibility. He tells incredible
stories that outdo Baron Munchausen; he can imagine the tallest
of tall tales.
One case of this bizarre condition that stands out in my
memory is that of a waiter whom I took care of some 25 years
ago. He had been a chronic alcoholic for many years and was
installed in the psychiatric ward for observation and commitment.
One day, during my ward rounds, he informed me that he
had just learned I was leaving for London, on a fellowship in
medicine and wished me good luck. Then to my surprise he dis-
cussed and advised me in the greatest detail imaginable about
many of the hotels in London and their advantages and disadvan-
tages for an American. He knew with the knowledge of a con-
noisseur the virtues of certain restaurants and pubs, transporta-
tion facilities, entertainment spots. He reminisced fondly over
many enjoyable hours and delightful memories of his life in
158
HOW DOES ALCOHOL AFFECT YOUR HEALTH?
London. And yet his family assured me with utter finality that
he had never left the United States, and was never seen to read
a book!
In the case of this psychotic patient, it was his extraordinary
imagination that gave to his stories the ring of conviction and
truth. I finally discovered that this patient had worked for years
with a bartender at a restaurant. During slow periods many an
hour was passed drinking with this bartender, a "Cockney"
who regaled my patient with endless reminiscences of his life
and experiences in London. But the patient, who was exceedingly
suggestible (like many normal individuals under hypnosis),
believed completely that he himself had lived through these past
experiences of another person.
What does alcohol do to the liver? Cirrhosis of the liver is
a sequel to chronic alcoholism. It is basically a nutritional dis -
ease, brought on by inadequate and improper diet coupled
with excessive alcoholic intake. In this disease, the liver is
usually swollen and enlarged at first, but later it becomes small,
shrunken, and atrophied. It is accompanied by a series of signs
and symptoms that are characteristic. These range from nerv-
ousness, fatigue, dyspepsia, vomiting and passage of blood, chest
and abdominal pains and swelling, to jaundice, coma, an d
death.
Some years ago I introduced a program of treatment for this
condition based on a high protein diet, nutritional and vitamin
supplements, and certain injections of liver and vitamins. I
reported in various medical journals the results of this tempo -
rarily effective treatment for over 100 cases with this disease,
and it was used extensively by physicians in the country and
abroad.
Psychiatric care did not help in 95 per cent of the cases I
have described. However, Alcoholics Anonymous was a tremen-
dous help in at least half of them, a striking demonstration of
the value of group psychotherapy and a blessing to countless
unfortunate victims.
HOW DOES ALCOHOL AFFECT YOUR HEALTH?
159
Moderation in drinking alcohol is a term with very wide
latitude. Some people have only to take the proverbial whiff
from the cork of a whiskey bottle, and they already feel 'giddy.'
Others seem to have the 'hollow wooden leg,' and feel no effects
from alcohol unless they have had 5 or 10 times the amount re -
quired by the average person to feel their drink. Usually, an
average of one or two highballs or cocktails, or glasses of wine
or beer, once or twice a day is regarded as drinking in modera -
tion. The main thing to remember is that drinking is not to be
indulged in to the point of excess, where intoxication occurs, or
where the critical judgment, the physical or mental faculties are
in the least way impaired or interfered with.
What are the conclusions for you? What are the conclu-
sions to be gained from all the descriptions of these "medical
chambers of horrors"? Simply that drinking alcoholic beverages
in moderation is a great help to relax you, to put you at ease from
your cares and worries; and in general it is good for your cir -
culation. If you find that you cannot stop at "moderation," then
before it's too late don*t touch it again! And if it is too late for
that, then see your doctor for further help, and join Alcoholics
Anonymous!
NOT LONG AGO, DAVID S., NOW A PA-
tient of mine, was rushed to the hospital after he had collapsed
during a meeting of his newspaper's editorial board. He had
had a heart attack.
The people who work with Dave, and those who knew him
well, were astonished and a little frightened.
"He's younger than I am," said the publisher apprehensively.
"And a real dynamo. Best city editor I ever had. I didn't know
he had heart trouble."
Dave didn't know it either.
There were some premonitory signs of trouble, it is true. But
Dave ignored them or dismissed them lightly. That morning,
for instance, he had come to the office a little earlier than usual
to make sure his paper didn't miss any newsworthy angles in
the running story of a big forest fire that was raging not far
from his city. The telephones were ringing constantly; there
were instant decisions to be made in covering the day's fast-
breaking news; there were several appointments with important
people—a luncheon engagement with the chief of police, and
an afternoon editorial meeting.
Dave was only 41. He had climbed fast in his profession
160
CARING FOR YOURSELF AFTER A HEART ATTACK
161
because, as his publisher said, he was a dynamo. He felt that
he had to keep the flow of news moving like a Niagara of copy
into the presses.
During the past week he had not been feeling as well as usual.
He felt a little tired, and had to keep himself going by sheer
force of will. It was just that he needed a little vacation, he told
himself. He was a little too tense, that was all. That's why he
"bounced back" when he got a chance to relax a bit over the
weekend.
Dave was late getting back to the office after his luncheon with
the chief of police. The official had been detained, and that had
thrown Dave's schedule off completely. So he ate rapidly and
discussed his business with the chief as he forced down his
food. He was not very hungry, but he ate a hearty meal on
the theory that he needed the energy to keep going.
By the time he got back to the office, Dave was a little short
of breath and somewhat dizzy. Also, he was annoyed by a pain
in his chest that occasionally ran down into his left arm and
hand. He barely had time to see the fourth edition out before
hurrying into the editorial meeting.
In the meeting he relaxed a little in his chair and felt some -
what better until the national advertising manager made him
angry by charging that the paper was losing revenue because
the editorial department would not support advertisers with
local newstories.
At that point, Dave jumped up and began a heated oration
on the responsibilities of the press. And just as his remarks
had reached fever pitch, Dave suddenly felt a sharp, pressing
pain deep inside his chest, under his breastbone. Beads of
perspiration broke out on his forehead. He felt nauseated and
very weak. His voice faltered and he collapsed to the floor.
In his quiet room at the hospital, after the administration of
oxygen had made his breathing easier, and an injection of
medicine had relieved the pain in his chest, Dave began to
realize what had happened. As a reporter he had once been as -
162
CARING FOR YOURSELF AFTER A HEART ATTACK
signed to the city's receiving hospital, and he recognized his
own symptoms. He had suffered a heart attack.
But what was going to happen now? Patients who had not
died at the hospital or who had not been dead upon arrival,
were always sent to other hospitals and he never had had oc-
casion to follow up the story to see what happened afterward.
Was he going to die? Or would he be an invalid the rest of his
life, a burden to his family and an object of pity to his friends
and colleagues?
A generation ago Dave's doctor probably would have given
him only slight encouragement. For when coronary thrombosis
first began to be accurately diagnosed in the mid -twenties,
medical authorities regarded a three-year survival period as the
best of good fortune. Today the average survival span, which
includes the extremely bad cases as well as the good, may be
about 10 years.
So when I later discussed Dave's own case with him, I could
cite from my own medical experience cases of patients who are
in good health as much as 30 years after the attack.
HOW AND WHY THE HEART HEALS ITSELF
To understand the real basis for hope, following a heart at«
tack, let us l