Alcohol is so rapidly absorbed from the stomach and the upper intestine, that it does not as a rule produce much change in the small intestines. The absorption of the digested food from the intestinal tract by alcoholics when recovering from a debauch is greater than normal, provided they have ceased from their alcohol. The absorbing powers of the intestine remain a long time, and is the reason that so many alcoholics appear so well nourished. The acids of the gastric juice also stimulate the excretion of bile from the liver, and combining with the same ferment, the secretion, being taken up by the blood, stimulates the liver to an increased secretion of bile. If therefore one has so injured the stomach with the taking of alcohol that the mucous membrane is unable to secrete a proper gastric juice, it is readily seen that the proper stimulation to the liver and the pancreas are lacking, and the equilibrium of the entire digestive process of the body is upset. The blood from all the intestines goes directly to the liver, the circulation of this organ being so arranged that the blood must filter through and bathe the liver cells before it is gathered into a central vein and returns into the general circulation. In fact the liver is the great chemical laboratory of the body, and the complex processes that go on there are as yet but little understood. The processes which I have described as generally characteristic of alcohol are seen to a very marked extent in the liver. There is a chronic congestion, and there is very frequently various forms of degeneration in the hepatic cells, and in many cases an increase in the connective tissue to such an extent as to cause the disease known as cirrhosis of the liver.
Alcohol may also under certain circumstances produce such excessive fatty degeneration in the liver, as in itself to be a menace to existence, for if the liver ceases to do its proper work, the whole minute nutritive chemistry, the metabolism of the body, breaks to pieces. The liver stands an enormous amount of use and abuse, and it is one of the last organs to give way under great strain, but when its functional processes do break down, the existence of the individual is not much further prolonged. The liver can consume and break down a certain amount of alcohol, but when more is poured into it than it can assimilate, some of it must go through into the general circulation and over the body, flowing to the brain and poisoning this organ, and the other nervous tissues.
The action of alcohol on the nervous tissues constitutes, in the eyes of the majority, the main injury that alcohol does to a human being. Certain it is that the action of alcohol on the brain does more to distort and pervert a man’s relationship with his environment than any other action which alcohol has on the body. It is through the poison of this organ that the personality of the individual is so changed and so poisoned that a degeneration of the individual in character and morals is brought about. It is here, too, that the widest differences of tolerance and intolerance to alcohol are shown. Some men may consume enormous quantities and their mental balance apparently remain intact. Other individuals cannot take a single glass of wine without being distinctly affected by it, or rendered unmistakably drunken. The gross injuries found in the brain of those dying from the effects of alcohol are partly due to the effect of alcohol on the circulation and the injury to the blood vessels, thus diminishing the nutrition of the brain and injuring the brain tissue itself, and besides, as we have seen in other viscera, to the increase in connective tissue.
It is not necessary here to go into the details of the minute formation of the cells, how each cell is formed of a cell body and many branches, as one may conceive, growing like a tree or bush with the many branches stretching out and touching other branches of related and adjacent cells. When these dendrites or branches are in contact, there is an interrelationship between the processes of the two cells. Alcohol causes a retraction of the tiny branches one from another and the cells are dissociated, so that the mental processes become dissociated from each other, and the cells themselves degenerate and are unable to carry on their functions; thus we see the functions of memory and of the reproduction of images by memory prevented, the inability of the mind to reason, through the inability of the mind to call up former experiences, feelings and ideas, and a weakening of the power of each cell to take in impressions.
Every person who drinks alcohol to excess will not show every form of mental deterioration that may be produced by excessive indulgence, and the degree of deterioration in intelligence which goes to make up the sum total of mentality varies greatly in different individuals. All who drink alcohol to excess, however, show some diminution in their judgment. Judgment means the power of recalling various memories of perceptions through the senses, which have come in from the outside world, memories of ideas, memories of emotions, and all the complicated association of ideas that these bring up, and in the recalling of them weigh each one with the other and judge of the value between them. This also means reasoning and decision for action. This power of reasoning and judging is weakened in the alcoholic, and in any brain long poisoned by alcohol it is an impossibility to exercise it. Memory itself is also weakened. There is excessive forgetfulness of the recent past, and in some cases of advanced alcoholism there is absolute forgetfulness of wide gaps of years; a man may be unable to remember anything from the last five minutes back for twenty years, and then remember back to childhood. The memories of childhood are more easily stamped on the brain than are those of adult life, both because it takes less to impress a child, and because there is not the complexity of ideas crowding into the brain, nor the complexity of association of ideas to be recorded. Therefore memories of childhood make a deeper impress and last longer, and so the complex memories of the adult are the first to be forgotten in the alcoholic, and those of childhood remain.
EFFECT UPON MEMORY AND JUDGMENT
Besides the absolute forgetfulness, there is another form of forgetfulness in the alcoholic which often produces a ludicrous result. This is a perversion of memory. The person may be in a perfectly strange place and meet strangers, and yet be convinced that he has seen the place and met the strangers before, and greet them as old friends. This feeling of having been there before occurs in normal, healthy people, and may be simply the expression of momentary fatigue, or proceed from some unknown cause; but it is grossly exaggerated in the alcoholic, and cannot as easily be straightened out as in the normal mind.
The imaginative faculties of the mind are at first heightened by alcohol, and this often produces bright, witty remarks in those who have taken enough alcohol to have their imaginations stimulated and their judgment slightly inhibited, so that their ideas crowd readily to their minds and their tongues are loosened. Often, however, they say things which though bright and witty had better be left unsaid, and this is an indication of the beginning paralysis of their judgment. The imaginative faculties, however, are not constructively increased by alcohol, and it does not conduce to reproduction and creative ability, which requires memory and constructive thought. In this connection Kraeplin’s experiments have shown that alcohol makes easy the liberation of movements from the cortical areas of the brain, that is, the transformation of ideas and memories of movements into deeds, but no real mental power is given; for while a man may feel that he is doing things better with than without alcohol, as a matter of fact he is not doing them so well. This sense of self-approbation is very characteristic of the alcoholic. His judgment is gone, not only in regard to his mental processes, but very essentially regarding himself, and it may be truly said that while alcohol shrinks the judgment, it swells the self-conceit. This abnormally good opinion of his diminished abilities renders the alcoholic exceedingly complacent; he is persuaded that at any time he can give up drinking if he chooses, and he is unable to appreciate the rapid deterioration of his intellect. One cannot separate the will of an individual from his personality, and the weak-willed individuals, while they may possess many other agreeable characteristics, are lacking in the progressive force which strong characters possess. Alcohol weakens the will, causes the personality itself to deteriorate, and there is a lack of initiative; there is the ever ready specious explanation why nothing is ever done; there is a boastful conceited estimation of what can be done. With the judgment perverted the alcoholic cannot act at the proper time in the right way, no matter how much he may be willing to admit the necessity for correct action, and on the other hand he is equally powerless to prevent wrong action on his part, especially when such action has anything to do with a further indulgence in his alcohol.
The emotional side of the personality shows the same deterioration from the higher to the lower, as do the other intellectual processes. It is the same story that the last to come are the first to go, and the first to come are the last to go. All emotions of refinement, those of the esthetic development, disappear the earliest. The sense of affection and moral responsibility, duty to family and friends deteriorate and vanish. There is nothing left but the consideration of what affects the self, and an alcoholic is the most studied, selfish soul that exists. The remaining emotions of anger, fear and nutritional reaction for food and drink remain to the last, as these are the most primitive of the emotions. With the weak will preventing action, and with the loss of memory and inability for continuity of thought, we find the emotion of fear predominating to a very noticeable extent. This is true whether the alcoholic be delirious or not, for in all forms of alcoholic delirium, fear is a very predominant symptom. In some forms of delirium tremens, the intensity of the fear is a fair criterion of the degree of the poisoning. The various senses of sight, hearing and taste are dulled, because the cells producing the mental perceptions are equally poisoned with the rest of the mind.