The Pamphlet Collection of Sir Robert Stout: Volume 36
Mr. Chairman, Ladies, and Gentlemen,—In my last lecture I endeavoured to explain to you the generally-accepted signification of the terms "stimulant" and "narcotic," and also to show you the manner in which these agents produce their peculiar effects upon the nervous system. I laid before you what appear to me satisfactory reasons for the belief that a "stimulant" adds no power whatever to the animal bod}', but that it seems to do so by its ability to liberate the energy which is resident in the tissues. I also pointed out to you that a large dose of a stimulant produces a narcotic or paralysing effect, while a small dose of a narcotic exercises a stimulating influence. And this led me to the first proposition which I desire to lay before you this evening—viz., that every stimulant is a narcotic and every narcotic a stimulant. It is not difficult to understand how the same agent may act both as a stimulant and as a narcotic. Suppose, for example, that you are lying about your house on a Sunday afternoon, languid and listless. You set out for a walk in the park, but the sedative effects of a hearty meal deprive you of all inclination for exertion. You persevere, however, and ere long the fresh air and gentle exercise brace you up to such a degree that you prolong your walk perhaps for many miles into the country. On your return you experience more or less exhaustion, and you sleep much more soundly than you would have done had you not exposed yourself to the stimulating influence of the country breezes. Thus it is plain that exercise and fresh air may act both as a stimulant and as a narcotic. In the same manner the whip and spur when applied to the unwilling horse not only compel him to greater exertion, but are the means of obtaining for him a good night's rest; for he certainly sleeps better after a good gallop than he would have done had he been permitted to stand all day in his stall, or had he been allowed to jog along at his own lazy pace, without interference on the part of his rider.
A good example of a single agent, producing first a stimulant and afterwards a narcotic influence upon the nervous system, is found in the effect of cold upon the human body. What produces a more stimulating influence upon the nerves of the skin, and, through them, on the brain, spinal cord, and ganglionic nervous system, than a plunge into your cold bath, before entering upon the duties of the day? It braces you up for exertion to such an extent that you feel able for any amount of page 11 arduous labour, and, if you have not remained too long in the water, you are none the worse for your morning stimulus. If, however, you expose yourself for a considerable length of time to the influence of cold, either in your bath or otherwise, the effect is injurious instead of beneficial. The stimulating influence will have been so great that it will soon produce more or less of a narcotic effect. Just as certainly as exercise creates exhaustion, so surely will antecedent stimulation result in subsequent narcotism; so that if you have been much exposed to the stimulating influence of cold, you will find yourself dull and sleepful several hours earlier than you are wont. If the cold should be very intense, and your nervous energy easily exhausted, the time of stimulation will be short, and it may be painful, and will be rapidly succeeded by extreme narcotism. But there must always be a period, however short, of stimulation, previous to that complete exhaustion of nervous power which is termed narcotism. It is during the period of stimulation that nervous energy is being expended, and unless a certain amount of energy is exhausted narcotism cannot supervene. Ceteris paribus, then, the smaller the amount of energy possessed by the organism, and the greater the degree of cold applied to that organism, the shorter will be the period of stimulation, and the sooner will it terminate in a state of narcotism. We have striking examples afforded us of the narcotic power of cold in the experience of those who have visited the Arctic regions. When these travellers have been exposed to intense cold for a length of time they are frequently seized by an irresistible impulse to lie down and sleep in the snow, and sometimes it is almost impossible for their companions to compel them to continue their march. So long as muscular exertion is kept up there is sufficient heat generated by the increased oxidation of the food and tissues to prevent death; but as soon as the traveller ceases to move, the low temperature causes a rapid evolution of the entire nervous energy, and thus narcotism and death speedily follow.
The stimulating effects of cold are experienced when we find ourselves in a damp bed or with an insufficient supply of blankets. Then, indeed, we have no excessive tendency to sleep; but, on the contrary, we roll over and over all night long in miserable wakefulness. And if by reason of excessive exhaustion we sink into slumber in spite of the cold, we are almost certain to awake next morning with the seeds of an internal inflammation sown within us. Put into the same bed a stronger man, whose heat-producing power is very considerable, and the cold will not cause him the slightest inconvenience. He will sleep soundly, and on awaking will be refreshed and benefited. In his "Ride to Khiva," Captain Burnaby supplies us with many examples both of the stimulant and narcotic power of low temperature. "On one occasion," he says, "we threw ourselves down upon the snow page 12 and tried to sleep. No fire could be made, as there were no brambles in the neighbourhood, and the cold, which was becoming very intense, penetrated through my sheepskin clothes. It was impossible to go to sleep, the frost not being of that violent nature which utterly prostrates a man, although it was quite sufficient to make me feel very uncomfortable. However, the guide seemed to be impervious to the weather, whilst some loud, snoring informed me that he was lost to consciousness. . . . Lighting a cigarette, I walked up and down, straining my eyes in the direction of our gradually-approaching caravan. I was looking forward to the moment when we could once more trot onwards, the rough motion of the horse, frostbites and all, not being so hard to bear as this wearisome onslaught of the elements, which utterly prevented slumber."
Now, if Captain Burnaby had indulged in some alcoholic stimulant to "keep out the cold" he would soon have been stretched alongside of his guide sound asleep; but it is highly probable that from that sleep he would never have awakened. The stimulus of the cold, assisted by the stimulus of the alcohol, would have exhausted his energy to such an extent as to produce in all likelihood a condition of fatal narcotism. On this point we have Captain Burnaby's own testimony. He informs us that the most suitable drink for those who are exposed to a very low temperature is "boiling tea." He says, "this beverage becomes an absolute necessity when riding across the (Russian) steppes in mid-winter, and is far superior in heat-giving properties to any wines or spirits. In fact, a traveller would succumb to the cold on the latter when the former will save his life." This evidence is quite in accordance with scientific fact in so far as alcohol is concerned, it having been conclusively proved that the effect of alcohol is not to increase, but rather to diminish the heat of the body. With regard to the heat-producing properties of tea no exact experiments have been made—the fact of its being less injurious than alcohol during exposure to cold proves nothing whatever, seeing that alcohol, instead of imparting heat, exercises its influence in the opposite direction. From careful scientific experiments, conducted by Dr. Alexander Bennett, it has been demonstrated that tea produces a condition of narcotism when its stimulating effects have passed off. Therefore I am persuaded that the principal heat-giving agent in Captain Burnaby's "boiling tea" is the boiling water in which it was infused. Practically I do not think that much harm will be produced by tea under such circumstances, because its stimulating power is very slight, but that it generates any increased heat in the organism must be scientifically denied. The Indian porters of South America, when about to undergo severe exertion, drink nothing but water as hot as the stomach will bear. They seem to have discovered empirically one of the most important of scientific truths—viz., page 13 that heat is one form of energy. And my belief is that Captain Burnaby and his train would have suffered slightly less from the cold had they drunk their hot water without any admixture of tea. As an example of the stimulant influence of cold we may instance the following. A courier informed the captain that "the wind was the main difficulty (in travelling in cold climes), for, cutting keenly against the horses' faces, it caused them so much pain that the poor beasts could not face it. This, he said, was the reason that travellers found themselves so constantly driving off the track."
The pain is produced by the stimulating effect of the cold upon the sensitive nerves of the skin. If the animals were driven forward in spite of this suffering, these sensitive nerves would become paralysed, and no pain whatever would be experienced; and if this condition were not interfered with, the portions of skin thus affected would lose their vitality—in other words, would become frost-bitten. The stimulus of the cold has compelled these nerves and portions of skin to give out all their inherent energy, and when any part of animal tissue has expended all its energy, its life is at an end. It must then be thrown off, and an ulcer will remain in its place until new tissue be supplied by the surrounding parts.
Here is another extract to impress upon you the narcotic power of cold. Captain Burnaby says:—" The evening wore on, and one by one our party lay down to sleep, or to find what rest they could obtain on the wooden planks of the floor (of a Russian station). In spite of the hardness of the boards, we were all speedily plunged in the arms of Morpheus, the cold winds and exposure having taken more out of me than any other clime which I had hitherto experienced. The burning rays of a tropical sun on an African Sahara dry up the sap of the human frame. A long camel journey fatigues the rider, but nothing like the pitiless cold and physical suffering which inevitably accompany a winter tour in Russia."
From the above-quoted instances it may be plainly perceived that cold acts upon the human body both as a stimulant and as a narcotic, and I maintain that its narcotic effects are entirely dependent upon its stimulating power. A nerve is in a state of narcotism when its energy is more or less exhausted; and as every stimulant produces its peculiar effects by liberating nerve energy, it must of necessity produce more or less narcotism when its stimulating power is exhausted. The mode of action of a "narcotic" is exactly the same as that of a "stimulant;" but the power of the former to liberate nerve energy is so great that it very soon exhausts the irritability of the nervous system, and narcotism sets in much more rapidly than when a so-called stimulant is administered. A stimulant produces narcotism after a long period of stimulation, while a narcotic produces narcotism after a very short page 14 period of more energetic stimulation. Stimulants, then, are simply weak narcotics; and narcotics, on the other hand, are strong stimulants.
Tobacco is generally classed among the narcotics, nevertheless its first effect is decidedly that of a stimulant. In some men a few whiffs from the pipe will stimulate the nerves of the stomach so as to sharpen the appetite; but, as the indulgence is continued, these nerves become paralysed, and the craving for food passes away.
Some years ago I met with a very remarkable case, which proves the stimulating power of tobacco. A gentleman in good position had just returned home from a dinner party where he had indulged very moderately. He sat down in his smoking-room on his return to enjoy a few whiffs of tobacco before retiring to rest. He had been merry previously, but now he became furious and excited, and was with difficulty restrained from murdering his wife and children. When next morning he was informed of what he had attempted he was quite thunderstruck, and vowed that he would never again run the risk of being a murderer. He was one of the most abstemious men—not to be a total abstainer—that I have known, and yet this one mistake might have terminated in a fearful tragedy. Had he imbibed more alcohol, or had he continued his smoke some time longer, the narcotic effect would have been produced, and complete unconsciousness would have prevented such maniacal excitement.
Such a case as the above shows that tobacco first produces a stimulant and then a narcotic effect, or, in other words, that it produces its narcotic effect by means of its power to liberate nervous energy.
With chloroform, which is generally looked upon as a narcotic, we find the same stimulating influence preceding its narcotic effects. Those who are in the habit of administering chloroform have abundant examples of its stimulating power, as it frequently requires considerable exercise of force to restrain the patient during the stage of stimulation. And the feeling of exhaustion which is experienced by those to whom it has been administered is sufficient proof that it produces its narcotic effect by previously inducing a rapid expenditure of nerve-power.
It is the same with alcohol. When you take a small quantity you experience its stimulating power; but when you take a large quantity it puts you to sleep. A comparatively small dose of morphia acts as a narcotic; but if you take a still smaller amount, it acts as a stimulant and keeps you awake.
This is the reason that so-called stimulants produce such various effects upon different persons. The same quantity of the same alcoholic liquor makes one man uproarious, while in his neighbour it produces merely a feeling of comfort. Pitt could electrify the House of Commons after his second bottle of port; whereas Sheridan, after an equal potation, would have been utterly unable page 15 to hold up his head. Both the stimulant and narcotic effects are more easily produced upon one man's nerves than upon those of his more sensitive neighbour.
One of the most powerful narcotics at present known has been proved to be a stimulant when used in sufficiently small quantity. This poison—called curara,—produces a rapidly fatal narcotic effect upon man and other animals, even when administered in small doses. It was doubted whether curara could ever exercise the smallest stimulating effect, however minute the quantity given. But M. Brown-Sequard, a great French physiologist, has settled this point in the affirmative. He injected a very small amount of the poison into an animal, and watched the effects produced on its nerves.
At first the nerves became very easily excited, but, in a short time complete paralysis set in, so that the animal could not move. In fact, all the latest scientific experiments tend to confirm the truth of the proposition which I now lay before you—viz., that all stimulants are narcotics and all narcotics stimulants; or, in other words, that stimulant and narcotic effects are not independent phenomena produced by two different classes of agents, but that these phenomena are inseparably connected, both being the necessary effects of the same class of agents, and both being manifested in an invariable sequence, so that stimulus always precedes narcotism, and, more or less, narcotism invariably follows stimulus. And such being the case, it must be evident to all that the occasions must be exceedingly rare on which a stimulant will be really useful to any man whether in health or disease. Since I became convinced of the truth of this principle, I have had abundant opportunity of testing its correctness in the conducting of a large and varied private practice in Liverpool during the last six years. And my predecessor and former partner, Dr. Burrows, who conducted the same practice for nearly forty years previously, gives similar evidence—at least in so far as alcoholic stimulants are concerned.
What, then, are the circumstances in which a stimulant (either alcoholic or otherwise) may prove useful? Suppose that a medical man satisfies himself that he has to do with a derangement of some organ, or of the system generally, which may be removed by the temporary excitement of the nervous system, then he will feel bound to administer a stimulant in one form or another. But if the diseased condition is not cured before the stimulation has produced symptoms of commencing narcotism, the patient will be in a much worse plight than had nature been allowed to manage the cure in her own way. For it must always be borne in mind that the usual termination of disease is not death or loss of function, but recovery, and unless the physician unites his efforts with those of nature he will do harm instead of good. But, even although his efforts be exerted in the proper direction, he will page 16 still do positive and irretrievable injury if he miscalculate the amount of stimulation which the nervous system will bear, through ignorance of the fact that every stimulant is a narcotic. The driver must have good grounds for believing that his horse will not become exhausted ere he reach the summit of the hill before he urges the animal with the lash to drag his load straight from the bottom to the top. If he doubts the horse's strength he gives the poor animal longer time, and leads him gently by a zigzag course. In the same way the careful physician will refrain from administering a stimulant to any patient whose nervous energy is very deficient, and he will by innumerable devices endeavour to smooth the way, so that nature may have as little difficulty as possible in effecting a cure. A stimulant, then, is only admissible when there is a good supply of latent nervous energy which nature is sluggish in bringing into operation, and it will rarely be useful except when a cure can be effected in a short time.
When stimulation is carried on for weeks, months, or years, its effect is in every respect pernicious, and cannot be too strongly reprehended; for then it produces a chronic condition of partial narcotism in those delicate portions of the nervous system which are intimately connected with the nutrition of the tissues.
These effects are produced not merely by alcohol (although its effects are most frequently observed on account of its extensive ' consumption) but by all other stimulants. Tea, coffee, tobacco, ammonia, quinine, opium, and excessive mental excitement (either from business or pleasure)—all these have a paralysing effect upon the more delicate portions of the nervous system. When nature is endeavouring to put new energy into the injured nerves, a feeling of discomfort and unrest is experienced by the patient, and to dispel such a depressing sensation a renewed application is made to the cause of the distress. The effect of the stimulant is to reproduce the paralysed condition, and thus repair of the nerve tissue is effectually prevented. This succession of paralysis and stimulation goes on month after month and year after year, in many cases, until the health is completely broken and the constitution ruined, without the patient ever exceeding the bounds of, to all appearance, the strictest moderation in the use of alcohol. Seeing that mental excitement acts in the same way upon the nervous system as alcoholic and other stimulants, it must be evident that any man who has much excitement or worry, either in business or otherwise, or whose work directly produces nervous exhaustion, ought to avoid as far as possible all extra stimulation.
Those who enjoy perfect health, who live much in the open air, and who have no business worries or family troubles, may drink alcohol in almost any form without apparent injury, at least for a considerable length of time; but whenever the nervous energy page 17 begins to fail, either from disease or otherwise, or when healthy country life is exchanged for the enervating atmosphere and excitement of the town, then the pernicious influence of the stimulant begins to make itself felt. If professional and business men, who have injured their health by using up an excessive amount of energy, could be got to understand that it is not tonics and stimulants which they require, but rest and fresh air, there would be saved to the community many useful lives which are now sacrificed through ignorance and prejudice.
The next proposition which I wish to lay before you is that a certain dose either of alcohol or other stimulant may produce a stimulating effect upon one portion of the nervous system and a narcotic effect upon another portion in the same person at the same moment. This depends upon the difference of delicacy between one set of nerves and another. Some nerves are much more easily stimulated and are therefore much more quickly paralysed than others. Why is it that the same quantity of brandy-and-water, which stays the appetite of a hungry man, makes him continue his work with greater ease than previously I The nerves of the stomach have been paralysed, so that they cannot express the wants of that organ; but certain portions of the brain and spinal cord have been stimulated to a greater exhibition of energy. If the brandy-and-water had produced the same effect upon the brain and spinal cord that it has produced upon the nerves of the stomach, the man would have been reduced to a state of complete intoxication. The brain and spinal cord will, to a certain extent, suffer a sedative influence when the stimulant effect has passed off, so that, unless the man gets his work accomplished before that time, he will be compelled either to renew the stimulus or cease from further exertion. If, instead of the brandy, the man had taken food and rest, he would probably have been able to do double the amount of work with less exhaustion. I may here remark that a very small amount of alcohol would have the effect of increasing the appetite by its stimulating effect upon the gastric nerves; but when the stimulating effect had died away, slight nerve paralysis would set in, and thus digestion would be seriously interfered with. Many an epicure is led to believe that alcohol materially aids his digestive organs, when in reality it merely exerts a narcotic influence upon the gastric nerves, and thus prevents him experiencing any dyspeptic inconvenience. The dyspepsia is not removed, it is merely disguised, and will at some future time break forth with uncontrollable severity.
The comfort experienced by the worn-out merchant after his evening potation is the result of the combined stimulant and narcotic effect of the alcohol imbibed. Those nerves which inform us that we have done enough of work, and make us feel uncomfortable so as to prevent us doing too much, are very quickly paralysed page 18 by a small amount of alcohol. But the quantity which paralyses such nerves is just sufficient to exert a stimulating influence upon certain portions of the brain; hence there follows both freedom from uneasiness and positive stimulation besides. When the merchant has been led to understand that his sherry and whisky-and-water deprive his nervous system of as much energy as a few hours' extra work, he will either give it up entirely, or, at all events, he will only drink it as a luxury and at such times as he can well spare the loss of nervous energy to which it gives rise. Those portions of the nervous system which convey to us the most delicate impressions are most easily paralysed. Take, for example, the nerves which inform us, from looks, tones, accents, and movements, what people are thinking about us. You notice a young man who goes out to an evening party among entire strangers. At first he feels very bashful and "conscious" of himself. He cannot get himself into an easy posture. He doesn't know what to with his hands; they seem such a burden, so awkward and so useless. He thinks everybody is looking at him, and he cannot think of anything to say to anybody. How differently he feels after his second glass of wine. The "conscious" feeling is banished; he is at ease with himself and all the world besides; and he gives forth his opinions with a boldness which is quite astonishing to those who have witnessed his embarrassment half-an-hour previously. He has no longer the notion that others are invidiously glancing at him. On the contrary, you may soon make a joke at his expense without his being able to detect that you are laughing at him. One portion of his nervous system has already become paralysed, while other portions are as yet undergoing stimulation.
When alcohol is indulged in to excess, even the least sensitive portions of the nervous system become more or less paralysed; but a very moderate quantity disables a man from distinguishing with accuracy the modulations of sound; it diminishes his sensibility to light, and renders his sense of touch less accurate. All this may take place while he is at the same time bright and cheerful, and showing no symptom whatever of having had "a drop more than is good for him." Every abstainer must have remarked the pointlessness of the jokes, and the inane character of the general conversation which delights many moderate drinkers after dinner, even although they are men of considerable intelligence and attainments. And most literary and scientific men have noticed that they are unable to perform work requiring severe exactitude of detail after they have indulged to a very small extent in alcoholic liquor. I am informed by an eminent architect that whenever he takes a "stimulant" to enable him to proceed with work which involves careful calculation, he is invariably compelled to lay it aside. Again, although a little brandy-and-water will urge with fresh impetus the worn-out skater over the page 19 glistening plain of ice, he will find himself less able than previously to perform those wonderful feats of precision in which accomplished skaters so much delight. Having thus endeavoured to explain the mode of action of stimulants, and to show that more or less narcotism of some portion of the nervous system is an invariable consequence of their use, let me now conclude by a few words of practical import.
From what I have said, it naturally follows that the daily use of alcoholic liquors, tobacco, or even strong tea or coffee, must be more or less injurious. At the best they are merely luxuries, and as such, ought only be used on special occasions, and in small quantities. It must be borne in mind that, although we cannot prove that a small quantity of alcohol taken occasionally will do positive injury to a healthy man, neither can this be proved of small doses of strychnine, morphia, nor arsenic. We have, however, fully demonstrated the truth of the following, viz., that whenever a man has much bodily or mental work to do, or whenever his energy becomes more or less exhausted, either by disease or otherwise, the worst possible course for him to pursue is to take a stimulant. What he then requires are rest, food, and fresh air. As a medicine, alcohol is no worse than other drugs, but the less medicine a man takes the better it will be for his health.