As to the effects of alcohol as a shorten er of life quite a different method was followed by the already cited Medico-Actuarial Mortality Investigation by the forty-three leading life insurance companies than in the investigation already alluded to. The object was to determine the type of lives that are good and those that are bad risks. The companies wanted nothing but facts, carefully checked, regardless of the expense and labor involved.
As to the alcohol habit it was found that among saloon proprietors, whether they attended the bar or not, there was an extra mortality of 70 per cent. The hotel proprietors who attended the bar, either occasionally or regularly, had as high a mortality as the saloon keeperthat is, the life period was reduced about six years on the average. Among those connected with breweries the mortality was found to be about one-third above normal. The large class of proprietors of wholesale liquor houses had an extra mortality of about one-fifth. In the fourteen subdivisions of the trades connected with the manufacture or sale of alcohol there was but one class of normal mortality and that was the distillery proprietors.
Among the insuredand it should be noted that we are dealing with a preferred physical class accepted by the insurance companies, which was not the case with the students cited abovewho admitted they had taken alcohol occasionally to excess in the past, but whose habits were considered satisfactory when they were accepted, there were 289 deaths, while there would have been 190 had this group been made up of insured lives in general. The extra mortality was, therefore, over 50 per cent which was equivalent to a reduction of over four years on the average life of these men. This does not mean that but four years would be cut off the end of the average life of each man, but that in each year a number of men will die at an earlier age than they should. At 35 the expectation of life is 32 years. If in the first year after that age there should be 12 deaths where normal expectancy is 9, then three men would each lose 32 years of life. In the next year probably four men would each lose 31 years and so on. As a mat-ter of fact many immoderate drinkers would live longer than the 32 years, but not nearly so many as there would be had they been moderate drinkers and far fewer than if they had been total abstainers from alcohol.
With regard to light drinkers daily but not to excess the experiences of the companies were divided into two groups: (a) men who took two glasses of beer or a glass of whiskey or their equivalent a day; (b) men who took more than the foregoing amount, but were considered by the companies to be good risks and not excessive drinkers. The mortality of the second group was found to be fully 50 per cent greater than the first.’ An analysis of 42,000 insurance risks of “steady, free users” of alcohol was made, under the two interpretations of the meaning of the words “steady free users,”conservative and liberal. In the first class were placed the risks of those companies which considered that two or more glasses of beer or one glass of whiskey or their equivalents per day constituted a free use. In the liberal interpretation section were placed the risks from those companies which considered that it required the drinking of two ounces of alcohol a day to constitute a “steady, free user.”
In the liberal section the death rate from cirrhosis of the liver (hardening) was five times the normal and from diabetes, tuberculosis, pneumonia and suicide twice the normal.’
Among those whose habits were formerly intemperate but who had reformed for at least two years prior to their acceptance, the extra mortality was fully 30 per cent; that is their average length of life was reduced by about three years, partly due to the weakened power of resistance to disease and partly to relapses into old habits.’
Among proprietors, superintendents and managers who attended bar, either occasionally or regularly, there was found a much higher death rate than when members of the same class did not attend bar. For the bar-tenders the excess over normal ran to 178 per cent; in the second class to an excess of 135 per cent. The proportion of overweights in both these classes was unduly large. For the bartenders the death rate from certain diseases was as follows:
Cirrhosis of the liver, six times the standard (drunkard’s liver).
Diabetes three times the standard (sugar in the urine). Cerebral hemorrhage and apoplexy, nearly twice the standard.
Organic diseases of the heart nearly three times the standard.
Bright’s disease nearly three times the standard (kidney disease).
Pneumonia, nearly twice the standard.
While no report was made on total abstinence there are sufficient facts published by individual insurance companies to warrant the statement that total abstainers, who have always been so, have a lengthened expectancy of life during the working years of about one-half greater than those who indulge in as much as two glasses of whiskey a day (Meaning “two fingers” on a whiskey glass.)
While the accuracy of the foregoing figures has not been challenged the conclusions have been by several writers. Arne Fisher, a Dane, asserts that the West Jutlanders (of Denmark) living on the shores of the North Sea, tillers of a barren soil, in a damp raw climate, are the heaviest drinkers of spirits in the world and yet, with New Zealand, have the lowest death rate.
This argument is answered by Arthur Shadwell, M. D., an English authority and contributor to the Encyclopedia Britannica, that where there are so many differing factors as climate, habits of life, occupations, etc., such comparisons as the above are not trustworthy. For instance, France, the largest consumer of alcohol, takes it in form of light, diluted wines. Spirits can be consumed with less danger to health in a damp, northern climate than in a warmer southern one, because in the former case they are more completely oxidized (utilized). When Denmark is compared with her more temperate northern neighbors we get a different result, apparently sustaining the contention of Shadwell. After the age of 44, about the age when alcoholic diseases, like cirrhosis of the liver, may be expected to begin affecting the death rate of a country with a heavy consumption of spirits, both Norway and Sweden make a better showing than Denmark. At deaths for the different ages from 44 to 75, Norway has an average reserve population of 14.44, Sweden 12.91 and Denmark 11.88, (the larger the population the better the showing).
Shadwell also points out the record for 25 years of two English life insurance companies which classify their risks into abstainers and non-abstainers, giving a better rate of 15 per cent to the abstainers, which fact brings the latter class under close observation to prevent fraud. Here is the record for 25 years of actual to expected deaths (the smaller the figures the lower the death rate).
Non-abstainers Abstainers Scottish Life Association 79.67 53.05
Scottish Temperance Life Assurance Co. 64 46
Another English company, the United Kingdom Temperance and General Provident Institution, has a mortality for 40 years reckoned at 24 per cent less for abstainers than for non-abstainers.
A very prevalent idea with regard to alcohol is that it is more useful to persons in advanced than in middle age; in fact, that “wine is the milk of old people,” that it does for them what milk does for children. This doctrine is not in harmony with careful observation, and alcohol, excepting in great moderation, is even more dangerous to the aged than to younger people. “It seems to me,” said Dr. Parkes, “that there must be danger in the use of alcohol when the arteries become rigid in advanced life.”
In the “Action of Alcohol on Man,” by Starling, the eminent English physiologist, published in October, 1923, the most authoritative book so far in any quarter, his findings are summed up in these words: “Although we have been unable to find any evidence for the view so often expressed that the moderate use of alcoholic beverages is in itself harmful and leads in the long run to deterioration of health and morality, there is no question that its excessive use is the cause of a large amount of disease, crime, misery and inefficiency.” He quotes a table by Dr. T. H. C. Stevenson which shows the relative number of deaths from alcoholism and the same combined with liver diseases in a classified list which rises for saloon keepers to the rate of 202 in total deaths of 1265 for all causespossibly nine times the normal rate. As to the effect of the elaborate studies he has made he says: “I cannot pretend to foretell what will be the effect of the unbiased evidence here presented. As regards myself, it has convinced me that in a civilized society the abolition of all alcoholic beverages, even if carried out by universal consent, would be contrary to the permanent interest of the race.”
In this same book Dr. Raymond Pearl, of Johns Hopkins, contributes original studies of facts gathered by him at the instance of the National Tuberculosis Assocation and the Russell Sage Foundation. Cases were selected from among persons registered with the Baltimore City Health Department, the Phipp’s Tuberculosis Clinic, and the Johns Hopkins Hospital and dispensary. Eugenic workers were detailed to not only record the facts of the life history of each individual as to tuberculosis but as to alcohol consumption and use of tobacco. These family histories were found to embrace an average of about 250 persons per history. From these records 2,047 persons were selected as fulfilling all the conditions. They were classified as Total Abstainers, Moderate and Occasional Drinkers and Heavy or Steady Drinkers for both sexes. In this third or highest class he puts moderate drinkers, if they were steady drinkers, a classification which the author says he expects will invite criticism (because it commingles heavy and moderate drinkers). He adds: “What we then have in this material is, in effect, a sample of over 2,000 persons, drawn at random from the working classes of Baltimore (but of selected races), each at the age of 20, divided into 3 classes as to drinking habits, and followed by observers through-out life until its termination.”
Our author’s conclusion printed in italic is that “heavy or steady drinking of alcoholic beverages significantly shortens the average duration of life, but gives no evidence whatever that the moderate and occasional use of such beverages leads to any different duration of life than that associated with complete abstention from alcohol.”
As Pearl states in his finding that it is only the “moderate and occasional” use of alcoholic beverages that appears to be harmless, while condemning the free use of such beverages, an opinion in which he is strongly supported by Starling, the latter finds it useful to define “moderate” as used in such connection. On this point he says (digested):
Experiments that have been cited show that 12 cubic centimeters of alcohol (not quite 3 1/4 teaspoonsful of 60 drops each), when given on an empty stomach, occasionally produce an effect in diminishing power of muscular coordination and other complex nerve processes, but that in nearly all cases the effect of such a dose is unappreciable when taken with a meal. Such a quantity corresponds to a glass of beer or a wine glass of claret, so that our conclusion must be that any alcohol taken on an empty stomach will tend, if only slightly, to depreciate an individual’s powers but that a wineglass of claret or a glass of beer taken with the lunch will not interfere with the carrying out of the afternoon’s work.
With proper quantitative adjustments this finding corresponds reasonably with those reached by the elaborate investigation of the insurance companies, already cited. On this subject Pearl makes the comment:
“It will be seen that throughout the abstainers enjoyed the greater expectation of life. This is also true of those holding endowment policies. The Medico-Mortality Investigation of 43 insurance companies presented several sorts of data of a somewhat fragmentary character. In general it was found that there was an excess mortality associated with alcohol consumption, but this experience was extremely small.”
As to the insurance companies that discriminate between drinkers and non-drinkers he deems their data of little value as not being based on observations through-out the entire adult life-span of each individual.
This conclusion seems to place little or no value on the observation of the directors of insurance companies who, if a mistake is made, must pay heavily for it from the company’s earnings. They can point out that in tables quoted with approval in this book, barkeepers, who seldom change their occupations, therefore coming within the Pearl formula, head the list among drinkers of those who die before their time.