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Annual Report of the Medical Officer of Health—1895.
33
Environment and Drink.*
In the present year of grace there is happily no need to enlarge upon the evils of
alcoholic intemperance. It may be at once assumed that such indulgence entails
disaster upon the individual no less than upon the family and the nation. For all
that, the underlying causes of inebriety are but ill understood, although of late years
a flood of light has been thrown upon their inwardness by many earnest workers.
Among recent advances none is likely to be of more practical value than that which
recognizes alcoholism as pointing to some mental flaw in the individual.
To the medical man a "symptom" is merely the evidence of a more remote
disorder. Thus, a red and inflamed skin may be symptomatic of scarlet fever, of
parasites, of measles, of sunburn, and of a host of more or less sharply defined and
definable causes. In a similar way the craving for strong drink may be regarded as
a symptom of varied origin. That it may be the token of an inherited mental
instability is now generally acknowledged. When, however, it results from acquired
brain conditions little appears to be known as to its causation.
In the matter of drink, as in other ways, the individual responds to the influences
of his environment. Thus, bad surroundings may convert a man of seemingly sound
mental and bodily constitution into a drunkard. On the other hand, a good environment
may to a great extent neutralise the effects of even a large and long continued
consumption of alcohol. Take, for instance, the case of a country squire well off in
such things as food, clothes, housing, and open air exercise. He may consume a
large quantity of strong drink every day of his life, and yet live to a hale and hearty
old age. A poor man in a bad environment who drank to a similar extent would
probably never reach forty. In the first case, it should be noted, the special
circumstances imply good liquor, whereas in the second they mean drink of an inferior
and highly injurious nature.
Then a bad environment acts in many ways as a direct physiological incentive to
the use of alcohol. In most instances it sooner or later lessens the moral control
of the individual by damaging his brain, the nutrition of which is sensitive to changes
in the blood and circulation. By enfeebling the body generally, and the heart in
particular, it leads the individual, naturally enough, to seek relief from the stimulant
that lies nearest to his hand.
Environment is, of course, a wide term, and includes such circumstances as
occupation, habitat, worldly gear, in short, all the immediate externals of the
individual. The circumstances of town life are more harmful to mankind than those
of the country, as shown by a comparison of the death rates of the one and the other.
If we compare the mortality of the rustic labourer with that of the. corresponding class
in London we find that the countryman enjoys a life on an average three times as
long as that of his metropolitan brethren. Much of this disparity may be accounted
for by the fact that labour competition is keener in the towns, and hence there is a
greater amount of poverty and privation. Among other causes are the smoky
atmosphere and the general dissipation of town life, as against the simple habits and
pure air of the country. Town mortality is further influenced by such points of
special environment as bad drainage and unhealthy employments, but it may be
questioned if, after all, the great determining factor of its havoc among adults may
not be ascribed to alcohol.
It need hardly be pointed out that all comparative figures of class mortalities
bristle with fallacies. Thus, certain rich London districts, such as Hampstead,
with a death-rate of 14.6 per 1.000 of population, and Plumstead, with 164 per 1,000,
compare favourably with many rural districts, and dilute, as it were, the returns for
the whole metropolis. Then, again, the towns are recruited by a steady stream of
robust country folk. The urban child mortality, moreover, is about twice that of the
rural. Taking such things into consideration, it is likely that the brunt of the total
mortality of Great Britain falls upon the town poor.
* Reprint of Article in the October Number of the North American Review, by F. J. Waldo, M.D.,
and David Walsh, M.B.